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Sample records for early postoperative complications

  1. [Early postoperative complications after scoliosis surgery].

    Science.gov (United States)

    Pérez-Caballero Macarrón, C; Burgos Flores, J; Martos Sánchez, I; Pérez Palomino, A; Vázquez Martínez, J L; Alvarez Rojas, E; Fernández Pineda, L; Vellibre Vargas, D

    2006-03-01

    Several medical complications can occur after scoliosis surgery in children and adolescents. New surgical techniques have allowed greater degrees of scoliosis correction but have also increased the possibility of postsurgical deficit due to their greater aggressivity. We analyzed the early postsurgical complications of scoliosis surgery in a pediatric intensive care unit over a 10-year period. Seventy-six surgical procedures were performed. Of these, no complications occurred in 55 (73%). Chest X-ray revealed pulmonary atelectasia in 8 patients (10%) and pleural effusion in 7 patients (9%). Symptoms and signs of infection related to surgery were observed in only 6 children (8%). The absence of severe medical complications may be related to new surgical techniques and an experienced team.

  2. Does testosterone prevent early postoperative complications after gastrointestinal surgery?

    Institute of Scientific and Technical Information of China (English)

    Birendra Kumar Sah; Ming-Min Chen; Yi-Bing Peng; Xiao-Jing Feng; Min Yan; Bing-Ya Liu; Qi-Shi Fan; Zheng-Gang Zhu

    2009-01-01

    AIM: To investigate the role of sex hormones in the early postoperative complications of gastrointestinal diseases.METHODS: A total of 65 patients who underwent operations for gastric and colorectal diseases (mainly malignant diseases) were included in the study.Peripheral venous blood samples were collected at different times for analysis of estradiol, testosterone and progesterone. The only study endpoint was analysis of postoperative complications.RESULTS: Patients of both sexes were uniform but postoperative complication rate was significantly higher in female patients ( P = 0.027). There was no significant association of estradiol and progesterone with postoperative complications. Testosterone levels in complicated patients were significantly lower than in uncomplicated patients ( P < 0.05). Area under the receiver operating characteristic curve showed that a lower value of testosterone was a predictor for higher complication rate ( P < 0.05), and a lower value of testosterone at later times after surgery was a better predictor of complications.CONCLUSION: Patients with low testosterone level were prone to higher postoperative complications, which was evident in both sexes. However, further studies are necessary to support this result.

  3. SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION: EARLY POSTOPERATIVE COMPLICATIONS

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    M.Sh. Khubutia

    2014-01-01

    Full Text Available Aim: evaluation of the incidence of early postoperative complications after simultaneous pancreas-kidney transplantation.Materials and methods. The analysis of early postoperative complications after simultaneous pancreas-kidney transplantation is presented in the paper, the most rational diagnostic algorithms, non-surgical and surgical complications’ treatment; the outcomes of the SPKT are reported.Results. 15,6% of patients experienced surgical complications, 12,5% – immunological complications, 12,5% – infectious complications, 6,25% – complications of the immunosuppressive therapy. 1-year patient survival after SPKT was 91,4%; pancreas graft survival – 85,7%; kidney graft survival – 88,6%.Conclusion. The incidence of early postoperative complications after simultaneous pancreas-kidney transplantation remains signifi cant in spite of progressive improvement of simultaneous pancreas-kidney transplantation due to surgical technique improvement, introduction of new antibacterial and immunosuppressive agents. Data, we recovered, fully correspond to the data obtained from the global medical community.

  4. Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital

    Institute of Scientific and Technical Information of China (English)

    Birendra; Kumar; Sah

    2010-01-01

    AIM:To investigate the occurrence of postoperative complications of gastric cancer surgery,and analyze the potential causes of reoperation for early postoperative complications. METHODS:A total of 1639 patients who underwent radical or palliative gastrectomies for gastric cancer were included in the study.The study endpoint was the analysis of postoperative complications in inpatients. RESULTS:About 31%of patients had early postoperative complications,and complications of infection occurred most frequently....

  5. EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS

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    STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

  6. Computed tomography findings of early abdominal postoperative complications

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    Zissin, R.; Osadchy, A. [Sapir Medical Center, Dept. of Diagnostic Imaging, Kfar Saba (Israel)]. E-mail: zisinrivka@clalit.org.il; Gayer, G. [Assaf Harofe Medical Center, Dept. of Diagnostic Imaging, Zrifin (Israel)

    2007-06-15

    Various surgical approaches are used for different abdominal pathological conditions. Postoperative complications occur not infrequently and vary according to the type of the surgery and the clinical context. Nowadays, multidetector computed tomography (MDCT) provides superb anatomic detail and diagnostic accuracy for various intraabdominal pathological processes, even if clinically unsuspected, and it thus has become an essential diagnostic tool for evaluating postoperative insults. Other advantages of abdominal MDCT include its accessibility and its speed, which allow scanning of uncooperative, marginally stable patients. Computed tomography (CT)-guided percutaneous (PC) drainage of postoperative collections is another advantage of CT. Therefore, although CT requires transportation of a critically ill, postoperative patient, it is recommended in any suspicious clinical setting because several conditions require prompt management and a correct diagnosis is crucial. In assessing a patient for suspected postoperative complications, several points should be taken into consideration, including the relevant clinical and laboratory data, the surgical findings, the type of the surgery, the time elapsed since surgery, and the operative technique (either open laparotomy of laparoscopic procedure). (author)

  7. Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer

    DEFF Research Database (Denmark)

    Iversen, L.H.; Bulow, S.; Christensen, Ib Jarle

    2008-01-01

    . The strongest risk factor for early death was postoperative medical complications (cardiopulmonary, renal, thromboembolic and infectious), with an odds ratio of 11.7 (95 percent confidence interval 8.8 to 15.5). Such complications occurred in 24.4 per cent of patients, of whom 57.8 per cent died. Other...

  8. Randomized Clinical Trial for Early Postoperative Complications of Ex-PRESS Implantation versus Trabeculectomy: Complications Postoperatively of Ex-PRESS versus Trabeculectomy Study (CPETS).

    Science.gov (United States)

    Arimura, Shogo; Takihara, Yuji; Miyake, Seiji; Iwasaki, Kentaro; Gozawa, Makoto; Matsumura, Takehiro; Tomomatsu, Takeshi; Takamura, Yoshihiro; Inatani, Masaru

    2016-05-17

    We compared early postoperative complications between trabeculectomy and Ex-PRESS implantation. Enrolled patients with 39 primary open-angle or 25 exfoliative glaucoma were randomly assigned to receive trabeculectomy (trabeculectomy group) or Ex-PRESS implantation (Ex-PRESS group). Primary outcomes were early postoperative complications, including postoperative anterior chamber inflammation, frequencies of hyphema, flat anterior chamber, choroidal detachment, hypotonic maculopathy, and the change of visual acuity. The postoperative flare values in trabeculectomy group were higher than those in the Ex-PRESS group (overall, P = 0.004; and 10 days, P = 0.02). Hyphema occurred significantly more frequently in the trabeculectomy group (P = 0.0025). There were no significant differences of the other primary outcomes between the two groups. Additionally, duration of anterior chamber opening was significantly shorter in the Ex-PRESS group (P = 0.0002) and the eyes that had iris contact with Ex-PRESS tube had significantly shallower anterior chambers than did the eyes without the iris contact (P = 0.013). The Ex-PRESS implantation prevented early postoperative inflammation and hyphema in the anterior chamber and shortened the duration of anterior chamber opening. Iris contact with the Ex-PRESS tube occurred more frequently in eyes with open-angle glaucoma and shallow anterior chambers.

  9. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy

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    Aleksandr Kalabin

    2017-01-01

    Full Text Available Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threatening postoperative complication following laparoscopic sleeve gastrectomy. From our extensive review of literature, there is no existing report of acute pancreatitis with splenic infarction postsleeve gastrectomy to this date.

  10. Influence of early postoperative complication on the operative results in elderly intertrochanteric fractured patients

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:Early complications were analyzed in those with Evans Ⅲ type of intertrochanteric fracture treated with operation or nonoperative approaches. Methods:59 cases with Evans Ⅲ type of intertrochanteric fracture between June, 1999 to July, 2006 were admitted in our department. 38 patients were complicated with cardiovascular diseases, such as hypertension and arrhythmia. All the cases were operated. Results:58 cases were operated successfully. One died of pulmonary interstitial fibrosis. Grade data of different age brackets indicated that early infective complications had apparent differences between the operation and the control group. Compared with the control group, the operation group had benefits such as fewer complications, especially the infective complications, and incidence of lower extremities venous thrombosis, and the results showed notable differences. Conclusion:In elderly patients with Evans Ⅲ type of intertrochanteric fracture, the incidence of pulmonary infection was the highest. Venous thrombosis in lower extremities was the most serious complication. So it will be helpful to perform the quadriceps femories function exercise. The postoperative effect is also related with the operation approach.

  11. Intraoperative ICG plasma disappearance rate helps to predict absence of early postoperative complications after orthotopic liver transplantation

    NARCIS (Netherlands)

    Vos, J. J.; Scheeren, T. W. L.; Lukes, D. J.; de Boer, M. T.; Hendriks, H. G. D.; Wietasch, J. K. G.

    2013-01-01

    Early postoperative complications after orthotopic liver transplantation (OLT) are a common problem in intensive care medicine. Adequate assessment of initial graft function remains difficult, however, plasma disaperance rate of indocyanine green (PDRICG) may have an additional diagnostic and

  12. EARLY POST-OPERATIVE WOUND INFECTION IN ORTHOPAEDIC IMPLANT SURGERY AND ITS COMPLICATION

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    Rajesh

    2013-03-01

    Full Text Available ABSTRACT: INTRODUCTION: Bone infections after implant surgery leading to non union and implant failure is one of the most challenging Ortho paedic complications. This study is done to find out relation of type of pathogens causing postope rative infection with that of fracture nonunion, chronic osteomylities and implant failure. METHODOLOGY: This is a retrograde study of 20 cases, in which post operative wound infe ction occurred after implant surgery from 2009 to 2012. Results: Out of 20 postoperative infect ed cases, 12 were infected by S ’ \\aureus, 2 by pseudomonas and 1 from E-coli. 5 cases had their culture sterile. Out of 12 cases infected by S. aureus 7 developed infected non union in which 4 had serious infection also leading to chronic osteomylities.5 cases of S aureus infection got cured after implant removal following union. CONCLUSION: Most of the postoperative wound infections are cause d by S. aureus. 2-.S. aureus is the commonest organism isolated from infe cted non-union. Majority have early onset of infection. 3-Early culture positive infection (w ithin seven days after surgery have poor out come.4- In our setup S Aurous strain is sensitive t o linezolid, clindamycin and vancomycin. 5- The use of ceftriaxone for preoperative surgical pro phylaxis in orthopaedic implant surgery is questionable.6- The ideal strategy for S. aureus in fected implant is lacking. By surgical debridement, culture sensitivity specific antibiotic for 6 to 8 week and retention of implant, union were not achieved in majority of cases. 7-New approach is required for prevention and management of postoperative S. aureus infected implan t

  13. Intraoperative and early postoperative flap-related complications of laser in situ keratomileusis using two types of Moria microkeratomes.

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    Karabela, Yunus; Muftuoglu, Orkun; Gulkilik, Ibrahim Gokhan; Kocabora, Mehmet Selim; Ozsutcu, Mustafa

    2014-10-01

    The purpose of this study is to describe the incidence, management, and visual outcomes of intraoperative and early postoperative flap-related complications of laser in situ keratomileusis (LASIK) surgery using two types of Moria M2 microkeratomes. This retrospective analysis was performed on 806 primary LASIK cases. The intraoperative and early postoperative flap-related complications were identified and categorized according to type of Moria microkeratome. There were 52 intraoperative and early postoperative complications--one case of partial flap (0.124 %), one case of free flap (0.124 %), one case of small flap (0.124 %), 13 cases of epithelial defect (1.61 %), 12 cases of flap striae (1.49 %), 10 cases of diffuse lamellar keratitis (1.24 %), 10 cases of interface debris (1.24 %), three cases of epithelial ingrowth (0.37 %), and one case of microbial infection (0.124 %). The overall incidence of flap complications was 6.45 %. There were 27 right eye (6.73 %) and 25 left eye (6.17 %) complications. The incidence of complications with the Moria automated metallic head 130 microkeratome was 4.22 % and with the Moria single-use head 90 microkeratome was 2.23 %. We observed one culture-negative interface abscess which was cured with surgical cleaning and intensive medical treatment. The most common complication encountered was epithelial defects, followed by flap striae. Our study showed that LASIK with a microkeratome has a relatively low incidence of intraoperative and early postoperative flap complications. The authors have no financial interest in any of the issues contained in this article and have no proprietary interest in the development of marketing of or materials used in this study.

  14. Respiratory complications in the early post-operative period following elective craniotomies

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    Sachidanand J Bharati

    2015-01-01

    Full Text Available Background and Aims: Respiratory complications are of major concern after intracranial procedures. The objective of the study was to assess the incidence of respiratory complications in the initial 72 hours after elective craniotomies and to identify the associated risk factors. Materials and Methods: Patients undergoing elective craniotomies were studied prospectively. Information pertinent to history, physical examinations, investigation reports, perioperative events and outcome at discharge of the patients were recorded. Occurrence of any sign or symptom of respiratory system, need for reintubation/increased ventilatory support within 72 hours of surgery were considered as post-operative respiratory complication. Relationships of numerical variables and categorical variables with post-operative respiratory complications (PRCs were assessed via T test and Chi-square (or Fisher′s exact. Multivariate analysis using multiple logistic regression was performed for finding independent risk factors for respiratory complications. Results: Out of 961 patients, 137 (14.3% patients developed PRC within 72 hours of surgery. Ninety-nine (10.3% patients developed purulent tracheobronchitis. The patients who had PRC had longer hospital stays and poor Glasgow Outcome Scale at hospital discharge. The variables found as independent risk factors were tachycardia, blood transfusion in the intraoperative period and Glasgow Coma Scale (GCS deterioration, hypokalemia and fever in the post-operative period. Conclusions : Respiratory complications within first 72 hours of elective craniotomies were common and were associated with prolonged hospital stay and poor neurological outcome. The variables which were found as independent risk factors were tachycardia, blood transfusion in the intraoperative period and GCS deterioration, hypokalemia and fever in the post-operative period.

  15. Postoperative Complications of Beger Procedure

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    Nayana Samejima Peternelli

    2015-01-01

    Full Text Available Introduction. Chronic pancreatitis (CP is considered an inflammatory disease that may cause varying degrees of pancreatic dysfunction. Conservative and surgical treatment options are available depending on dysfunction severity. Presentation of Case. A 36-year-old male with history of heavy alcohol consumption and diagnosed CP underwent a duodenal-preserving pancreatic head resection (DPPHR or Beger procedure after conservative treatment failure. Refractory pain was reported on follow-up three months after surgery and postoperative imaging uncovered stones within the main pancreatic duct and intestinal dilation. The patient was subsequently subjected to another surgical procedure and intraoperative findings included protein plugs within the main pancreatic duct and pancreaticojejunal anastomosis stricture. A V-shaped enlargement and main pancreatic duct dilation in addition to the reconstruction of the previous pancreaticojejunal anastomosis were performed. The patient recovered with no further postoperative complications in the follow-up at an outpatient clinic. Discussion. Main duct and pancreaticojejunal strictures are an unusual complication of the Beger procedure but were identified intraoperatively as the cause of patient’s refractory pain and explained intraductal protein plugs accumulation. Conclusion. Patients that undergo Beger procedures should receive close outpatient clinical follow-up in order to guarantee postoperative conservative treatment success and therefore guarantee an early detection of postoperative complications.

  16. Which frailty measure is a good predictor of early post-operative complications in elderly hip fracture patients?

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    Kua, Joanne; Ramason, Rani; Rajamoney, Ganesan; Chong, Mei Sian

    2016-05-01

    Current pre-operative assessment using, e.g., American Society of Anaesthesiologists score does not accurately predict post-operative outcomes following hip fracture. The multidimensional aspect of frailty syndrome makes it a better predictor of post-operative outcomes in hip fracture patients. We aim to discover which frailty measure is more suitable for prediction of early post-operative outcomes in hip fracture patients. Hundred consecutive hip fracture patients seen by the orthogeriatric service were included. We collected baseline demographic, functional and comorbidity data. In addition to ASA, a single blinded rater measured frailty using two scales (i) modified fried criteria (MFC) and (ii) reported edmonton frail scale (REFS). The MFC adopted a surrogate gait speed measure with two questions: (i) Climbing one flight of stairs and (ii) Ability to walk 1 km in the last 2 weeks. Immediate post-operative complications during the inpatient stay were taken as the primary outcome measure. Subjects had mean age of 79.1 ± 9.6 years. Sixty six percent were female and 87 % of Chinese ethnicity. Eighty two percent had surgery, of which 37.8 % (n = 31) had post-operative complications. Frailty, measured by MFC (OR 4.46, p = 0.04) and REFS (OR 6.76, p = 0.01) were the only significant predictors of post-operative complications on univariate analyses. In the hierarchical logistic regression model, only REFS (OR 3.42, p = 0.04) predicted early post-operative complications. At 6 months follow-up, REFS significantly predicted [basic activities of daily living (BADL)] function on the multivariable logistic regression models. (BADL, OR 6.19, p = 0.01). Frailty, measured by the REFS is a good predictor of early post-operative outcomes in our pilot study of older adults undergoing hip surgery. It is also able to predict 6 months BADL function. We intend to review its role in longer-term post-operative outcomes and validate its potential role in pre

  17. Postoperative Interleukin-6 Level and Early Detection of Complications After Elective Major Abdominal Surgery.

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    Rettig, Thijs C D; Verwijmeren, Lisa; Dijkstra, Ineke M; Boerma, Djamila; van de Garde, Ewoudt M W; Noordzij, Peter G

    2016-06-01

    To assess the association of systemic inflammation and outcome after major abdominal surgery. Major abdominal surgery carries a high postoperative morbidity and mortality rate. Studies suggest that inflammation is associated with unfavorable outcome. Levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α and the systemic inflammatory response syndrome (SIRS) were assessed in 137 patients undergoing major abdominal surgery. Blood samples were drawn on days 0, 1, 3, and 7, and SIRS was scored during 48 hours after surgery. Primary outcome was a composite of mortality, pneumonia, sepsis, anastomotic dehiscence, wound infection, noncardiac respiratory failure, atrial fibrillation, congestive heart failure, myocardial infarction, and reoperation within 30 days of surgery. An IL-6 level more than 432 pg/mL on day 1 was associated with an increased risk of complications (adjusted odds ratio: 3.3; 95% confidence interval [CI]: 1.3-8.5) and a longer median length of hospital stay (7 vs 12 days, P < 0.001). As a single test, an IL-6 cut-off level of 432 pg/mL on day 1 yielded a specificity of 70% and a sensitivity of 64% for the prediction of complications (area under the curve: 0.67; 95% CI: 0.56-0.77). Levels of CRP started to discriminate from day 3 onward with a specificity of 87% and a sensitivity of 58% for a cut-off level of 203 mg/L (AUC: 0.73; 95% CI: 0.63-0.83). A high IL-6 level on day 1 is associated with postoperative complications. Levels of IL-6 help distinguish between patients at low and high risk for complications before changes in levels of CRP.

  18. Abdominal CT findings of delayed postoperative complications

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    Zissin, R.; Osadchy, A. [Sapir Medical Center, Dept. of Diagnostic Imaging, Kfar Saba (Israel)]. E-mail: zisinrivka@clalit.org.il; Gayer, G. [Assaf Harofe Medical Center, Dept. of Diagnostic Imaging, Zrifin (Israel)

    2007-10-15

    Despite progress in surgical techniques and modern medical treatment, postoperative complications occur not infrequently and vary according to type of surgery, clinical setting, and time elapsed since surgery. In general, they can be divided into early and delayed complications. Delayed postoperative complications can be classified as specific and nonspecific. The common nonspecific delayed complications are incisional hernia and postoperative bowel obstruction. Bowel obstruction can be further categorized as obstruction related to benign or neoplastic etiology, the latter occurring in oncology patients in whom the primary surgery was related to an underlying abdominal neoplasm. Gossypiboma is another, fortunately rare, postoperative complication. Specific complications appear after specific operations and include the following: Splenosis - following splenectomy. Retained gallstones and spilled gallstones - following cholecystectomy, mainly laparoscopic. Dropped appendicolith and stump appendicitis - following appendectomy, mainly laparoscopic. Obturation obstruction by a bezoar - following gastric surgery. Afferent loop syndrome (ALS) - following Bilroth II gastrectomy. (author)

  19. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy

    OpenAIRE

    Aleksandr Kalabin; Mani, Vishnu R.; Ankita Mishra; Hector Depaz; Leaque Ahmed

    2017-01-01

    Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threat...

  20. Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults

    Science.gov (United States)

    2014-01-01

    Introduction Altered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to develop postoperative complications. Methods Haemodynamic measurements and peripheral perfusion parameters were collected one day prior to surgery, directly after surgery (D0) and on the first (D1), second (D2) and third (D3) postoperative days. Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient (Tskin-diff). Generalized linear mixed models were used to predict severe complications within ten days after surgery based on Clavien-Dindo classification. Results We prospectively followed 137 consecutive patients, from among whom 111 were included in the analysis. Severe complications were observed in 19 patients (17.0%). Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at D0, and PPI and Tskin-diff were altered on D1 and D2, respectively. Among the different peripheral perfusion parameters, the diagnostic accuracy in predicting severe postoperative complications was highest for CRT on D2 (area under the receiver operating characteristic curve = 0.91 (95% confidence interval (CI) = 0.83 to 0.92)) with a sensitivity of 0.79 (95% CI = 0.54 to 0.94) and a specificity of 0.93 (95% CI = 0.86 to 0.97). Generalized mixed-model analysis demonstrated that abnormal peripheral perfusion on D2 and D3 was an independent predictor of severe postoperative complications (D2 odds ratio (OR) = 8.4, 95% CI = 2.7 to 25.9; D2 OR = 6.4, 95% CI = 2.1 to 19.6). Conclusions In a group of patients assessed following major abdominal surgery

  1. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery

    NARCIS (Netherlands)

    Rettig, Thijs C. D.; Verwijmeren, Lisa; Dijkstra, Ineke M.; Boerma, Djamila; Van De Garde, Ewoudt M. W.; Noordzij, Peter G.

    2016-01-01

    Objective: To assess the association of systemic inflammation and outcome after major abdominal surgery. Background: Major abdominal surgery carries a high postoperative morbidity and mortality rate. Studies suggest that inflammation is associated with unfavorable outcome. Methods: Levels of

  2. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery

    NARCIS (Netherlands)

    Rettig, Thijs C. D.; Verwijmeren, Lisa; Dijkstra, Ineke M.; Boerma, Djamila; Van De Garde, Ewoudt M. W.; Noordzij, Peter G.

    2016-01-01

    Objective: To assess the association of systemic inflammation and outcome after major abdominal surgery. Background: Major abdominal surgery carries a high postoperative morbidity and mortality rate. Studies suggest that inflammation is associated with unfavorable outcome. Methods: Levels of C-react

  3. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery

    NARCIS (Netherlands)

    Rettig, Thijs C. D.; Verwijmeren, Lisa; Dijkstra, Ineke M.; Boerma, Djamila; Van De Garde, Ewoudt M. W.|info:eu-repo/dai/nl/304841528; Noordzij, Peter G.

    2016-01-01

    Objective: To assess the association of systemic inflammation and outcome after major abdominal surgery. Background: Major abdominal surgery carries a high postoperative morbidity and mortality rate. Studies suggest that inflammation is associated with unfavorable outcome. Methods: Levels of C-react

  4. Respiratory complications in the early post-operative period following elective craniotomies

    OpenAIRE

    Bharati, Sachidanand J; Mihir P Pandia; Rath, Girija P.; Parmod K Bithal; Dash, Hari H

    2015-01-01

    Background and Aims: Respiratory complications are of major concern after intracranial procedures. The objective of the study was to assess the incidence of respiratory complications in the initial 72 hours after elective craniotomies and to identify the associated risk factors. Materials and Methods: Patients undergoing elective craniotomies were studied prospectively. Information pertinent to history, physical examinations, investigation reports, perioperative events and outcome at discharg...

  5. EARLY POSTOPERATIVE HOMEOSTATIC CHANGES AFTER TRANSURETHRAL RESECTION OF THE PROSTATE AND WAYS OF PREVENTING ITS COMPLICATIONS

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    D. Yu. Volkov

    2014-07-01

    Full Text Available During the study, the authors assessed changes in the blood coagulation system and made a spectral analysis of serum and prostate tissue. They revealed immunological changes suggesting occult disseminated intravascular coagulation, an evolving systemic inflammatory response and the latter caused by endothelial damage, microcirculatory disorders, lipid peroxidation, and release of inflammatory factors. The findings permit a tactic for medical prevention of complications to be elaborated.

  6. EARLY POSTOPERATIVE HOMEOSTATIC CHANGES AFTER TRANSURETHRAL RESECTION OF THE PROSTATE AND WAYS OF PREVENTING ITS COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    D. Yu. Volkov

    2011-01-01

    Full Text Available During the study, the authors assessed changes in the blood coagulation system and made a spectral analysis of serum and prostate tissue. They revealed immunological changes suggesting occult disseminated intravascular coagulation, an evolving systemic inflammatory response and the latter caused by endothelial damage, microcirculatory disorders, lipid peroxidation, and release of inflammatory factors. The findings permit a tactic for medical prevention of complications to be elaborated.

  7. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD

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    Kim ES

    2016-06-01

    Full Text Available Eun Sun Kim,1 Young Tae Kim,2 Chang Hyun Kang,2 In Kyu Park,2 Won Bae,1 Sun Mi Choi,1 Jinwoo Lee,1 Young Sik Park,1 Chang-Hoon Lee,1 Sang-Min Lee,1 Jae-Joon Yim,1 Young Whan Kim,1 Sung Koo Han,1 Chul-Gyu Yoo1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, 2Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea Purpose: This study aimed to investigate whether the prevalence of postoperative pulmonary complications (PPCs in patients with non-small-cell lung cancer (NSCLC is even higher in the early stages of COPD than in such patients with normal lung function and to verify the usefulness of symptom- or quality of life (QoL-based scores in predicting risk for PPCs.Patients and methods: Patients undergoing pulmonary resection for NSCLC between July 2012 and October 2014 were prospectively enrolled. Preoperative measurements of lung function, dyspnea, and QoL, operative characteristics, PPCs, duration of postoperative hospitalization, and in-hospital mortality were assessed.Results: Among 351 consecutive patients with NSCLC, 343 patients with forced expiratory volume in 1 second (FEV1 ≥70% of predicted value were enrolled. At least one PPC occurred in 57 (16.6% patients. Prevalence of PPC was higher in patients with COPD (30.1% than in those with normal spirometry (10.0%; P<0.001. However, in patients with COPD, the prevalence of PPC was not different in patients with FEV1 ≥70% compared to those with FEV1 <70% and between group A (low risk and less symptoms and group B (low risk and more symptoms patients with COPD, based on the new Global initiative for chronic Obstructive Lung Disease 2011 guidelines. In patients with COPD, body mass index (odds ratio [OR]: 0.80, P=0.007, carbon monoxide diffusing capacity of the lung (DLCO, % predicted value (OR: 0.97, P=0.024, and operation time (OR: 1.01, P=0.003, but not COPD assessment test or St

  8. Intraoperative and early postoperative complications using the buccal fat pad during cleft palate surgery in East Indonesia

    Directory of Open Access Journals (Sweden)

    Eveline Vere Konijnendijk

    2016-06-01

    Full Text Available Six baby’s with cleft are born in Indonesia every hour. There is no standardized treatment of cleft in East Indonesia. Closure is an important aspect during cleft lip and palate surgery. Various techniques have been advocated to gain tissue for closure of cleft area. Mostly these techniques may only provide a small amount of additional length. For lager defects they may be use the local flaps or the buccal fat pad flap. The aim of this study is gain more information about intraoperative and early postoperative complications using the buccal fat pat during cleft palate surgery in East Indonesia. The mouth can be divided in six parts therefor the LAHSAL index will be used. This LAHSAL system is a diagrammatic classification of cleft lip and palate. The LAHSAL system is being used for this study as this system classifies the cleft primarily on location and also on the cleft being complete or incomplete, which can be significant for the research. After diagnosis and classification, the following patient data was obtained: patient age, weight, gender, type of surgery (primary or following, i.e. when the surgery is a correction of a previous treatment, if a bone graft is needed for closure, history of maxillofacial surgery or orthodontics, operation technique, operation duration, type of an aesthesia (local or general, radiographical records and light photos. These data were collected during the pre-operative consultation, about 24 hours before surgery. It was the policy of the team to admit and see all patients one day prior to surgery for counselling, postoperative instructions and evaluating the patient's facial defect.

  9. May Renal Resistive Index Be an Early Predictive Tool of Postoperative Complications in Major Surgery? Preliminary Results

    Directory of Open Access Journals (Sweden)

    Enrico Giustiniano

    2014-01-01

    Full Text Available Background. Patients who undergo high-risk surgery represent a large amount of post-operative ICU-admissions. These patients are at high risk of experiencing postoperative complications. Renal Resistive Index was found to be related with renal dysfunction, hypertension, and posttraumatic hemorrhagic shock, probably due to vasoconstriction. We explored whether Renal Resistive Index (RRI, measured after awakening from general anesthesia, could have any relationship with postoperative complications. Methods. In our observational, stratified dual-center trial, we enrolled patients who underwent general anesthesia for high-risk major surgery. After awakening in recovery room (or during awakening period in subjects submitted to cardiac surgery we measured RRI by echo-color-Doppler method. Primary endpoint was the association of altered RRI (>0.70 and outcome during the first postoperative week. Results. 205 patients were enrolled: 60 (29.3% showed RRI > 0.70. The total rate of adverse event was 27 (18.6% in RRI ≤ 0.7 group and 19 (31.7% in RRI > 0.7 group (P=0.042. Significant correlation between RRI > 0.70 and complications resulted in pneumonia (P=0.016, septic shock (P=0.003, and acute renal failure (P=0.001 subgroups. Patients with RRI > 0.7 showed longer ICU stay (P=0.001 and lasting of mechanical ventilation (P=0.004. These results were confirmed in cardiothoracic surgery subgroup. RRI > 0.7 duplicates triplicates the risk of complications, both in general (OR 2.03 93 95% CI 1.02–4.02, P=0.044 and in cardiothoracic (OR 2.62 95% CI 1.11–6.16, P=0.027 population. Furthermore, we found RRI > 0.70 was associated with a triplicate risk of postoperative septic shock (OR 3.04, CI 95% 1.5–7.01; P=0.002.

  10. Preoperative Smoking Status and Postoperative Complications

    DEFF Research Database (Denmark)

    Grønkjær, Marie; Eliasen, Marie; Skov-Ettrup, Lise Skrubbeltrang;

    2014-01-01

    To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type.......To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type....

  11. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  12. Stairs climbing test with pulse oximetry as predictor of early postoperative complications in functionally impaired patients with lung cancer and elective lung surgery: prospective trial of consecutive series of patients.

    Science.gov (United States)

    Nikolić, Igor; Majerić-Kogler, Visnja; Plavec, Davor; Maloca, Ivana; Slobodnjak, Zoran

    2008-02-01

    To test the predictive value of stairs climbing test for the development of postoperative complications in lung cancer patients with forced expiratory volume in one second (FEV1)stairs climbing with pulse oximetry before the operation with the number of steps climbed and the time to complete the test recorded. Oxygen saturation and pulse rate were measured every 20 steps. Data on postoperative complications including oxygen use, prolonged mechanical ventilation, and early postoperative mortality were collected. Eighty-seven of 101 patients (86%) had at least one postoperative complication. The type of surgery was significantly associated with postoperative complications (25.5% patients with lobectomy had no early postoperative complications), while age, gender, smoking status, postoperative oxygenation, and artificial ventilation were not. There were more postoperative complications in more extensive and serious types of surgery (Pstairs climbing test produced a significant decrease in oxygen saturation (-1%) and increase in pulse rate (by 10/min) for every 20 steps climbed. The stairs climbing test was predictive for postoperative complications only in lobectomy group, with the best predictive parameter being the quotient of oxygen saturation after 40 steps and test duration (positive likelihood ratio [LR], 2.4; 95% confidence interval [CI], 1.71-3.38; negative LR, 0.53; 95% CI, 0.38-0.76). In patients with other types of surgery the only significant predictive parameter for incident severe postoperative complications was the number of days on artificial ventilation (P=0.006). Stairs climbing test should be done in routine clinical practice as a standard test for risk assessment and prediction of the development of postoperative complications in lung cancer patients selected for elective surgery (lobectomy). Comparative to spirometry, it detects serious disorders in oxygen transport that are a baseline for a later development of cardiopulmonary postoperative

  13. [Postoperative complications after larynx resection: assessment with video-cinematography].

    Science.gov (United States)

    Kreuzer, S; Schima, W; Schober, E; Strasser, G; Denk, D M; Swoboda, H

    1998-02-01

    In past decades, the surgical techniques for treating laryngeal carcinoma have been vastly improved. For circumscribed tumors, voice-conserving resections are possible and for extensive neoplasms, radical laryngectomy, sometimes combined with chemoradiation, has been developed. Postoperative complications regarding swallowing function are not uncommon. Radiologic examinations, especially pharyngography and videofluoroscopy, are most often used to evaluate patients with complications after laryngeal surgery. An optimized videofluoroscopic technique for evaluation of complications is described. The radiologic appearance of early and late complications, such as fistulas, hematomas, aspiration, strictures, dysfunction of the pharyngoesophageal sphincter, tumor recurrence, and metachronous tumors is demonstrated.

  14. 活体供者供肝术后早期并发症分析%The early postoperative complications in living liver transplantation donors

    Institute of Scientific and Technical Information of China (English)

    米凯; 李川; 文天夫; 严律南; 李波; 王文涛; 徐明清; 杨家印; 魏永刚

    2012-01-01

    Objective To investigate the incidence of early postoperative complications in living donor liver transplantation.Methods Postoperative data of 170 living liver donors were retrospectively collected from January 2002 to August 2009 and the collected data were divided into two groups according to the type of donors (right-lobe graft,R group and left lobe graft,L group). Early postoperative complications were analyzed using Clavien classification system.Results The difference between two groups was no statistically significant in donor's age,body mass index,operation time and other characters (P>0.05).R group had a bigger actual cut weight of donor liver (P<0.05),smaller residual liver weight (P<0.05) which also smaller than standard liver weight (P<0.05),and a longer hospital stay (P<0.05) than L group.During hospitalization,62 complications occurred in 55 cases with the total complication rate being 32.35% (55/170). In detail,the incidence of complications was 34.39% (54/157) in R group,and 7.69% (1/13) in L group (chi-square value =2.787,P>0.05).Among these 62 complications,there were 39 times of Ⅰ grade,5 times of Ⅱ grade,16 times of Ⅲ grade,2 times of Ⅳ a grade. All the complications were cured by active treatment and all donors survived well.Conclusion Although the security of living donor liver transplantation is better,the risk of serious complications must be faced.We must strictly select and assess the donor before the operation,very carefully carry out surgical operation,and pay more attention to postoperative management in order to avoid postoperative complications of donors.%目的 探讨活体肝移植供者术后早期并发症的发生情况.方法 对2002年1月至2009年8月间170例活体肝移植供者的临床资料进行回顾性分析,依据供肝类型分为右半供肝组和左半供肝组,采用Clavien分类系统对术后早期发生的并发症进行分析.结果 两组间供者年龄、身高体重指数、手

  15. Preoperative Alcohol Consumption and Postoperative Complications

    DEFF Research Database (Denmark)

    Eliasen, Marie; Grønkjær, Marie; Skov-Ettrup, Lise Skrubbeltrang

    2013-01-01

    .30-2.49), prolonged stay at the hospital (RR = 1.24; 95% CI: 1.18-1.31), and admission to intensive care unit (RR = 1.29; 95% CI: 1.03-1.61). Clearly defined high alcohol consumption was associated with increased risk of postoperative mortality (RR = 2.68; 95% CI: 1.50-4.78). Low to moderate preoperative alcohol...... complications, prolonged stay at the hospital, and admission to intensive care unit....

  16. Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: A prospective observational study in adults

    NARCIS (Netherlands)

    M.E. van Genderen (Michel); J. Paauwe (Jaap); J. de Jonge (Jeroen); R.J.P. van der Valk (Ralf); A.A.P. Lima (Alexandre ); J. Bakker (Jan); J. van Bommel (Jasper)

    2014-01-01

    textabstractIntroduction: Altered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to

  17. Postoperative care and complications after ventricular assist device implantation.

    Science.gov (United States)

    Allen, Sara Jane; Sidebotham, David

    2012-06-01

    In this article, the routine postoperative care and complications of patients with ventricular assist devices are reviewed. Routine postoperative care encompasses patients who have undergone emergency ventricular assist device (VAD) implantation for acute cardiogenic shock, as a bridge to decision making, and semi-elective patients who have undergone VAD implantation for end-stage heart failure, either as destination therapy or as a bridge to heart transplantation. Early postoperative management should focus on haemodynamic optimisation, including fluid and inotrope therapy, VAD settings and support of right ventricular function. Echocardiography is an essential tool in optimising haemodynamics and identifying complications. Early postoperative complications include bleeding, arrhythmias, right ventricular failure and infection. Late postoperative problems include bleeding, thrombosis and thrombo-embolism, device failure and psychological problems. In a small percentage of patients, weaning and explantation of the VAD are possible. For patients undergoing VAD implantation for destination therapy, end-of-life care planning should form part of the multidisciplinary care of the patient.

  18. Bariatric surgery: A review of normal postoperative anatomy and complications

    Energy Technology Data Exchange (ETDEWEB)

    Quigley, S., E-mail: shaun.quigley@bartsandthelondon.nhs.uk [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Colledge, J. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Mukherjee, S. [Bariatric Surgery Unit, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Patel, K. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom)

    2011-10-15

    The number of bariatric surgery procedures performed is increasing every year. Patients may be referred for radiological investigations to exclude complications not only in the early postoperative period but many months later. Radiologists who do not work in bariatric centres are therefore required to have an understanding of the complex normal anatomy and complications associated with bariatric surgery to interpret imaging studies correctly. The purpose of this article is to describe the surgical techniques and normal anatomy of the four bariatric operations performed today, review the most common problems encountered in this patient group, and to describe the imaging findings that allow the accurate diagnosis of complications. In particular, we focus on identification of the internal hernia, a grave complication of bariatric surgery often missed by radiologists.

  19. Orthotopic neobladder reconstrution: postoperative CT appearance, complications and potential pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Su Lim; Jung, Seung Eun; Im, Yeon Soo; Lee, Jae Mun; Lee, Ji Youl; Yoon, Moon Soo; Hahn, Seong Tai [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2003-08-01

    To evaluate the postoperative CT appearance, complications and potential pitfalls of radical cystectomy with orthotopic neobladder reconstruction. We examined 46 patients [43 men and 3 women aged 34-72 (mean, 56.7) years] who had undergone neobladder reconstruction (ileocolic neobladder in 25 patients and ileal-W neobladder in 21). The CT scans were assessed in terms of their depiction of normal anatomy, namely the shape, location and internal architecture of the neobladder, the location of bladder bases, and the ureteral course. Early and late complications were also assessed. The characteristics of ileocolic neobadder were a right-side location, a lobulated outer margin, interal projections due to haustra or plication, a base in the retropubis, and right-side insertion of both ureters. In contrast, the characteristics of an ileal-W neobladder were a central location, an ovoid shape, nodular thickening at the ureteral insertion site, internal projections due to plication, and a retropubic bladder base. Early complications included hematoma with abscess formation (n=2), and postoperative peritonitis (n=1), while late complications were hydronephrosis due to stricture ar the ureteral anastomotic site (n=16), tumor recurrence at this site (n=1), distal ureteral stone (n=1), mucus urinary retention (n=1), incisional hernia (n=2), tumor recurrence in the pelvic side wall (n=1), carcinomatosis peritonei (n=1), and liver metastasis (n=2). A knowledge of normal anatomic changes is essential for the accurate interpretation of CT scans. CT is a useful modality of the evaluation of postoperative change and the complications occurring in patients who have undergone radial cystectomy with othotopic neobladder reconstruction.

  20. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe.

  1. Postoperative complications and mortality after major gastrointestinal surgery

    Directory of Open Access Journals (Sweden)

    Triin Jakobson

    2014-01-01

    Conclusion: The complication rate after major gastro-intestinal surgery is high. ASA physical status and revised cardiac risk index adequately reflect increased risk for postoperative complications and worse short and long-term outcome.

  2. Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery.

    Science.gov (United States)

    Andrés-Cano, P; Godino, M; Vides, M; Guerado, E

    2015-01-01

    To study postoperative complications of arthroscopic anterior cruciate ligament (ACL) reconstruction performed as an outpatient compared with same surgery performed as a regular admission (inpatient). A study was conducted on a historical cohort of 342 patients (115 outpatients vs 227 inpatients) who underwent arthroscopic ACL primary ligamentoplasty (2004-2012). A review was performed on the demographic, surgical and hospital variables. A study was made of early complications (60 days postoperative) including visits to emergency department and readmissions. A descriptive and bivariate distribution analysis was performed between groups, with the grouping criterion: performing of the surgery with or without admission. The Chi-square test was used for qualitative variables and Mann-Whitney U test for quantitative. Limit significance p<0.05. Overall, there were 13.2% emergency department visits (mean of 1.24 visits) with an average delay of 8.22 days after discharge. pain not controlled with analgesia (6.7%), hemarthrosis that required arthrocentesis (4.4%), fever (3.2%), deep vein thrombosis (0.6%), cellulitis (0.6%), septic arthritis that required arthroscopic debridement (0.3%), and others (1.2%) including problems with immobilization. The hospital readmissions (2.3%) were for surveillance and monitoring of the surgical wound. In the bivariate analysis no statistically significant differences were found between groups as regards the sociodemographic characteristics of the patients or the complications recorded. The most frequent complications recorded were acute pain, hemarthrosis and fever. Serious complications (deep vein thrombosis, septic arthritis or need for hospital readmission) were rare. Outpatient arthroscopic ACL repair is a common technique that can be performed safely by surgery without admission, with an overall low complication rate with no differences between outpatients and inpatients. Copyright © 2014 SECOT. Published by Elsevier Espana. All

  3. Excessive visceral fat area as a risk factor for early postoperative complications of total gastrectomy for gastric cancer: a retrospective cohort study.

    Science.gov (United States)

    Takeuchi, Masashi; Ishii, Kenjiro; Seki, Hiroaki; Yasui, Nobutaka; Sakata, Michio; Shimada, Akihiko; Matsumoto, Hidetoshi

    2016-08-05

    Obesity is a known risk factor for complications after digestive surgery. Body mass index (BMI) is commonly used as an index of obesity but does not always reflect the degree of obesity. Although some studies have shown that high visceral fat area (VFA) is associated with poor outcomes in digestive surgery, few have examined the relationship between VFA and total gastrectomy. In this study, we demonstrated that VFA is more useful than BMI in predicting complications after total gastrectomy. Seventy-five patients who underwent total gastrectomy for gastric cancer were enrolled in this study; they were divided into two groups: a high-VFA group (n = 26, ≥100 cm(2)) and a low-VFA group (n = 49, <100 cm(2)). We retrospectively evaluated the preoperative characteristics and surgical outcomes of all patients and examined postoperative complications within 30 days of surgery (including cardiac complications, pneumonia, ileus, anastomotic leakage, pancreatic fistula, incisional surgical site infection [SSI], abdominal abscess, and hemorrhage). The incidence of anastomotic leakage (p = 0.03) and incisional SSI (p = 0.001) were higher in the high-VFA group than in the low-VFA group. No significant differences were observed in the other factors. We used univariate analysis to identify risk factors for anastomotic leakage and incisional SSI. Age and VFA were risk factors for anastomotic leakage, and BMI and VFA were risk factors for incisional SSI. A multivariate analysis including these factors found that only VFA was a predictor of anastomotic leakage (hazard ratio [HR] 4.62; 95 % confidence interval [CI] 1.02-21.02; p = 0.048) and incisional SSI (HR 4.32; 95 % CI 1.18-15.80; p = 0.027]. High VFA is more useful than BMI in predicting anastomotic leakage and SSI after total gastrectomy. Therefore, we should consider the VFA value during surgery.

  4. Surgical Apgar Score Predicts Postoperative Complications in ...

    African Journals Online (AJOL)

    neurotrauma patients by using an effective scoring system can reduce ... complications was 7.04 while for patients with complications was ... their SAS for purposes of risk stratification; high risk. (0-4), medium .... Deep Venous. Thrombosis. 0.

  5. Is glycosylated hemoglobin A1 c associated with increased risk for severe early postoperative complications in nondiabetics after laparoscopic gastric bypass?

    Science.gov (United States)

    Stenberg, Erik; Szabo, Eva; Näslund, Ingmar

    2014-01-01

    Glycosylated hemoglobin A1 c (HbA1 c) has been described as a risk factor for adverse outcome after cardiovascular and colorectal surgery, but not for obese patients undergoing bariatric surgery. The objective of this study was to see if there is an association between HbA1 c and adverse outcome in laparoscopic gastric bypass surgery. From the Scandinavian Obesity Surgery Registry we identified 12,850 patients, without treatment for diabetes and operated with laparoscopic gastric bypass between January 1, 2010 and September 30, 2012, and where a baseline HbA1 c value was registered. Preoperative data were compared with data from a 30-day follow-up. Severe complications were defined according to the Clavien-Dindo-Scale as Grade 3 b or higher. HbA1 c levels below 5.7 % were associated with a lower incidence of severe complications (2.7 %) than higher levels (HbA1 c 5.7-6.49% incidence 3.5%, P = .015; HbA1 c>6.5%, incidence 4.5%, P = .012). After multivariate analysis with patient-specific confounders the difference remained significant (HbA1 c 5.7-6.49% adjusted P = .046; HbA1 c>6.5% adjusted P = .023) CONCLUSION: Elevated HbA1 c levels in patients without pharmacologic treatment for diabetes undergoing laparoscopic gastric bypass surgery is associated with an increased risk for severe complications during the first 30 postoperative days. This is the case, even at levels not regarded as diagnostic for diabetes. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  6. The postoperative complication for adenocarcinoma of esophagogastric junction

    Directory of Open Access Journals (Sweden)

    Hui Zhang

    2015-01-01

    Full Text Available Objective: The purpose of this study was to evaluate the postoperative complications for patients with adenocarcinoma of esophagogastric junction. Methods: Two hundred and eighty subjects with adenocarcinoma of esophagogastric junction who received operation were retrospectively analyzed from June 2006 to December 2010 in the Department of Oncology of First Affiliated Hospital of Bengbu Medical College, Bengbu, China. The postoperative complication such as ventricular premature beat, atrial fibrillation, supraventricular tachycardia, heart failure, pulmonary infection, pulmonary atelectasis, respiratory failure, bronchospasm, anastomotic leakage, gastroplegia, pleural infection, and cerebral accident were reviewed and recorded by to doctors. Moreover, the correlation between clinical characteristics and postoperative complication was analyzed by statistical methods. Results: A total of 70 complications were found for the included 280 cases of adenocarcinoma of esophagogastric junction with general incidence of 25%. For the relationship between clinical characteristics and postoperative complication analysis, no significant association of gender, age, operation time, operative approach, tumor differentiation, and clinical states was found with the postoperative complications (P > 0.05; but the complication rate in patients with basic disease of heart and lung was significant than the patients without this kind of disease (P < 0.05. Conclusion: The positive operative complications for patients with adenocarcinoma of esophagogastric junction were relative high. Moreover, basic heart and lung diseases can increase the risk of developing positive operative complications.

  7. Prevention of postoperative and wound complications - a hopeful method of radiotherapy of nontumorous diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kishkovskij, A.N.; Dudarev, A.L. (Voenno-Meditsinskaya Akademiya, Leningrad (USSR))

    1983-01-01

    587 patients with different postoperative and wound complications revealed that radiotherapy applied early after trauma or surgical intervention with the first clinical signs of inflammation (so-called preventive irradiation) the development of a series of severe postoperative and wound complications such as pyesis of the wound, fistulation, secondary parotitis, phantom limb pain syndrome, contact osteomyelitis, keloids, casting off of skin transplants and other can be avoided.

  8. Postoperative complications and mortality after major gastrointestinal surgery

    DEFF Research Database (Denmark)

    Jakobson, Triin; Karjagin, Juri; Vipp, Liisa

    2014-01-01

    BACKGROUND AND OBJECTIVE: The incidence of postoperative complications and death is low in the general population, but a subgroup of high-risk patients can be identified amongst whom adverse postoperative outcomes occur more frequently. The present study was undertaken to describe the incidence o...

  9. Perioperative complications of cardiac surgery and postoperative care.

    Science.gov (United States)

    Nearman, Howard; Klick, John C; Eisenberg, Paul; Pesa, Nicholas

    2014-07-01

    The care of the cardiac surgical patient postoperatively is fraught with several complications because of the nature of the surgical procedure itself and the common comorbidities of this patient population. Most complications occurring in the immediate postoperative period are categorized by organ system, and their pathophysiology is presented. Current diagnostic approaches and treatment options are offered. Preventive measures, where appropriate, are also included in the discussion.

  10. [The surgery of laparoceles. The postoperative complications].

    Science.gov (United States)

    Garavello, A; Tuccimei, U; Sadighi, A; Belardi, A; Remedi, M; Antonellis, D

    1997-05-01

    The use of prosthetic meshes in incisional hernias repairs is now very attractive, particularly for wide fascial defects; nevertheless the presence of a foreign body and placement technique may be responsible for complications sometimes leading to failure. To evaluate technical problems and complications in incisional hernia surgery the authors reviewed their 5 year experience in 70 patients; 39 mesh repairs and 31 direct sutures of the abdominal wall were performed. Local complications (fistulas, wound hematoma or infections) were more frequent in the former group; PTFE meshes showed a lower resistance to infections, particularly in diabetics, and in three patients partial or total removal was mandatory. Prosthetic meshes showed a marked reduction of recurrences in incisional hernia surgery, but their use leads to more local complications than direct repair; the authors believe that mesh placement must be evaluated for every single patient and not used as a routine procedure.

  11. Postoperative pyoderma gangrenosum: A rare complication after appendectomy

    Directory of Open Access Journals (Sweden)

    G Faghihi

    2015-01-01

    Full Text Available Pyoderma gangrenosum (PG is an uncommon inflammatory ulcerative skin disease. It is characterized by painful progressive necrosis of the wound margins. Rarely, postoperative pyoderma gangrenosum (PPG manifests as a severe disturbance of wound healing following surgical interventions. Only rare cases of this complication have been reported after appendectomy. We report a case of PPG in a 29-year-old female after appendectomy. She was successfully treated with oral prednisolone. Postoperative pyoderma gangrenosum should be kept in mind in the differential diagnosis of any postoperative delayed wound healing, because this disease is simply distinguished from a postoperative wound.

  12. Prevention and Treatment of Postoperative Complications of the Penile Elongation

    Institute of Scientific and Technical Information of China (English)

    余墨声; 陕声国; 赵月强; 吴晓蔚; 周立纯; 龙道畴

    2003-01-01

    Summary: To explore the cauls of the postoperative complications of the penile elongation and themeasures to prevent them in order to raise the success rate of the penile elongation. 1 000 patientswho had received the penile elongation were reviewed and analyzed for the causes of postoperativecomplications, and the measures of prevention and treatment were discussed. Our results showedthat, of the 1 000 cases, 64 had the postoperative complications, including 20 cases of edema of pre-puce, 15 cases of flap necrosis, 12 hematoma, 9 infections, and 8 cases of fat and clumsy penis. It isconcluded that correct operative manipulation, strict aseptic measures and necessary postoperativecare and management could avoid or reduce the postoperative complications. When complications hap-pened, a satisfactory result can be achieved with timely and correct treatment in the majority of thepatients.

  13. Postoperative recovery from posterior communicating aneurysm complicated by oculomotor palsy

    Institute of Scientific and Technical Information of China (English)

    YANG Ming-qi; WANG Shuo; ZHAO Yuan-li; ZHANG Dong; ZHAO Ji-zong

    2008-01-01

    Background Oculomotor palsy is a common complication in patients with posterior communicating aneurysm.This study was conducted to investigate the postoperative recovery of patients with posterior communicating aneurysm complicated with oculomotor palsy and to analyze the factors influencing length of recovery.Methods From 2000 to 2006,148 patients with posterior communicating aneurysm were treated at our hospital,with 74 of them having concurrent unilateral oculomotor palsy.All of the patients underwent craniotomy after the diagnosis by means of whole-brain digital subtraction angiography (DSA).The patients were divided into two groups for observation of postoperative recovery during the follow-up period.Patients in group A were treated with simple pedicle clipping of the aneurysm while patients in group B were treated with pedicle clipping of the aneurysm and decompression of the oculomotor nerve.Results Of the 40 patients in group A.20 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days.Fourteen patients underwent surgery within 14-30 days.of whom 12 completely recovered within 30-90 days and 2 cases recovered incompletely.The remaining six patients underwent surgery after more than 30 days:of these.four patients recovered completely and two recovered incompletely.Of the 34 cases in group B,15 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10-40 days.Sixteen patients underwent surgery in 14-30 days.of whom 14 completely recovered in 30-90 days and 2 recovered incompletely.The remaining three patients underwent surgery after more than 30 days,of whom two patients recovered completely and one recovered incompletely.Conclusions Early diagnosis and surgical treatment of patients with unilateral oculomotor palsy induced by posterior communicating aneurysm are important to full postoperative recovery of the oculomotor nerve.No correlation was found,however,between decompression of the

  14. Early postoperative outcomes in lumpectomy versus simple mastectomy.

    Science.gov (United States)

    Chatterjee, Abhishek; Pyfer, Bryan; Czerniecki, Brian; Rosenkranz, Kari; Tchou, Julia; Fisher, Carla

    2015-09-01

    Relatively scarce outcomes research exists that compares early postoperative complications between breast conservation surgery (BCS) and simple mastectomy (SM). Such information would improve a surgeon's ability to provide informed consent when considering treatment options, especially for women with early stage breast cancer who have the option to receive either BCS or SM. The National Surgical Quality Improvement Program database from years 2009-2012 was analyzed. For each treatment group, we used Current Procedural Terminology codes specific to the treatment modality with sentinel lymph node biopsy as an inclusion criteria. We excluded patients who received axillary lymphadenectomies, bilateral disease or symmetry procedures, and additional breast reconstructive surgery. We compared each group with chi square and two-sample t-tests to look for preoperative comorbidity differences, then used unadjusted odds ratios to compare postoperative complication rates. Inclusion and exclusion criteria provided 6682 patients in the BCS group and 3339 patients in the SM group. Baseline comorbid condition characteristics showed no clinical differences between groups except for diabetes (8.5% in SM versus 6.5% in BCS). Statistical analysis between each treatment modality revealed that the SM group had significantly higher wound complications, bleeding, infections, and overall complications than the BCS group. Although both BCS and SM options have low early postoperative complication rates when treating early stage breast cancer, BCS has fewer complications with regard to bleeding, wound complications and infections. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Postoperative complications following colectomy for ulcerative colitis: A validation study

    Science.gov (United States)

    2012-01-01

    Background Ulcerative colitis (UC) patients failing medical management require colectomy. This study compares risk estimates for predictors of postoperative complication derived from administrative data against that of chart review and evaluates the accuracy of administrative coding for this population. Methods Hospital administrative databases were used to identify adults with UC undergoing colectomy from 1996–2007. Medical charts were reviewed and regression analyses comparing chart versus administrative data were performed to assess the effect of age, emergent operation, and Charlson comorbidities on the occurrence of postoperative complications. Sensitivity, specificity, and positive/negative predictive values of administrative coding for identifying the study population, Charlson comorbidities, and postoperative complications were assessed. Results Compared to chart review, administrative data estimated a higher magnitude of effect for emergent admission (OR 2.52 [95% CI: 1.80–3.52] versus 1.49 [1.06–2.09]) and Charlson comorbidities (OR 2.91 [1.86–4.56] versus 1.50 [1.05–2.15]) as predictors of postoperative complications. Administrative data correctly identified UC and colectomy in 85.9% of cases. The administrative database was 37% sensitive in identifying patients with ≥ 1Charlson comorbidity. Restricting analysis to active comorbidities increased the sensitivity to 63%. The sensitivity of identifying patients with at least one postoperative complication was 68%; restricting analysis to more severe complications improved the sensitivity to 84%. Conclusions Administrative data identified the same risk factors for postoperative complications as chart review, but overestimated the magnitude of risk. This discrepancy may be explained by coding inaccuracies that selectively identifying the most serious complications and comorbidities. PMID:22943760

  16. Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer

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    Wang, Jingya [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Myles, Bevan; Palmer, Matthew [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hofstetter, Wayne L.; Swisher, Stephen G. [Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H., E-mail: SHLin@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-08-01

    Purpose: While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials: From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ{sup 2} or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results: The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions: The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.

  17. 高龄食管癌患者术后早期肠内营养并发症的防治%Prevention and treatment of early postoperative enteral nutrition complications in elderly esophageal cancer patients

    Institute of Scientific and Technical Information of China (English)

    夏晓明; 施仁忠; 张亚锋

    2012-01-01

    Objective To study the prevention and treatment of the complications during early postoperative enteral nutrition in the elderly patients with esophageal cancer.Methods The early enteral nutrition were carried out in 67 cases of esophageal cancer over 70 years old.The prevention and treatment of the complications during the early enteral nutrition were analyzed.Results There were 39 cases with diarrhea(58.21%),7 cases with metabolic disorder( 10.45% ),15 cases with the nutritional tube obstruction ( 22.39% ).After receiving active treatment for the complications,48 cases complete enteral nutrition.14 cases (20.90%) changed to mixed nutrition,5 cases changed to parenteral nutrition (7.46% ).Conclusions The complications of the early enteral nutrition in the elderly patients have some relation with the injected method of nutrient solution,the status of intestine function,and other diseases accompanied,etc.After receiving positive treatment,most patients were able to tolerate enteral nutrition.The early postoperative enteral nutrition is still the preferred option in the elderly patients with esophageal cancer.%目的 探讨高龄食管癌患者术后早期肠内营养并发症的防治对策.方法 对67例70岁以上食管癌患者术后进行早期肠内营养,分析早期肠内营养期间并发症的预防与治疗.结果 67例患者中发生腹泻39例,占58.21%,代谢紊乱7例,占10.45%,营养管方面并发症15例,占22.39%.针对并发症原因进行积极处理,48例完成肠内营养,占71.64%,14例改为混合营养,占20.90%,5例改为肠外营养,占7.46%.结论 高龄患者肠内营养并发症主要与营养液输入方法、肠道功能、伴随疾病等因素有关,经过积极处理后大多数患者均能够耐受肠内营养,肠内营养仍然是高龄患者优先选择的营养方法.

  18. [Nutritional status and postoperative complications in patients with digestive cancer].

    Science.gov (United States)

    Pañella, Loreto; Jara, Marlene; Cornejo, Morelia; Lastra, Ximena; Contreras, María Gladys; Alfaro, Kattia; De La Maza, María Pía

    2014-11-01

    Risk of malnutrition is elevated among oncologic patients, and this increases postoperative morbidity and mortality. To study the association between nutritional status and postoperative outcomes in a group of patients with gastrointestinal cancers. We studied 129 patients with diagnosis of digestive cancer, previous to potentially curative surgery. Nutritional status was evaluated through anthropometric measures, Subjective Global Assessment (SGA), dietary intake recalls and routine biochemical parameters. Functional performance was assessed by the Karnofsky index (KI). Cancer stage was classified according to TNM4. During the postoperative period, complications, length of stay at the critical care ward and duration of hospitalization were registered. Thirty days after discharge, patients were contacted, and the appearance of new complications was listed. According to SGA 14.7% of patients were classified as well nourished (A), 57.3% as moderately undernourished or at risk of malnutrition (B) and 27.9% as severely malnourished (C). The incidence of total complications was 25.5%. Nutritional status was not associated with cancer stage. The frequency of complications among patients classified as A, B and C were 5.5, 25.3 and 37.1% respectively (p = 0.03). We detected a high frequency of malnutrition in this group of patients. Overall the frequency of postoperative complications was low, however malnourished patients exhibited a higher rate of surgical complications.

  19. Risk factors for postoperative complications in robotic general surgery.

    Science.gov (United States)

    Fantola, Giovanni; Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Germain, Adeline; Ayav, Ahmet; Bresler, Laurent

    2017-03-01

    The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

  20. Postoperative complications and mortality after major gastrointestinal surgery.

    Science.gov (United States)

    Jakobson, Triin; Karjagin, Juri; Vipp, Liisa; Padar, Martin; Parik, Ants-Hendrik; Starkopf, Liis; Kern, Hartmut; Tammik, Olavi; Starkopf, Joel

    2014-01-01

    The incidence of postoperative complications and death is low in the general population, but a subgroup of high-risk patients can be identified amongst whom adverse postoperative outcomes occur more frequently. The present study was undertaken to describe the incidence of postoperative complications, length of stay, and mortality after major abdominal surgery for gastrointestinal, hepatobiliary and pancreatic malignancies and to identify the risk factors for impaired outcome. Data of patients, operated on for gastro-intestinal malignancies during 2009-2010 were retrieved from the clinical database of Tartu University Hospital. Major outcome data included incidence of postoperative complications, hospital-, 30-day, 90-day and 1-year mortality, and length of ICU and hospital stay. High-risk patients were defined as patients with American Society of Anesthesiologists (ASA) physical status ≥3 and revised cardiac risk index (RCRI) ≥3. Multivariate analysis was used to determine the risk factors for postoperative mortality and morbidity. A total of 507 (259 men and 248 women, mean age 68.3±11.3 years) were operated on for gastrointestinal, hepatobiliary, or pancreatic malignancies during 2009 and 2010 in Tartu University Hospital, Department of Surgical Oncology. 25% of the patients were classified as high risk patients. The lengths of intensive care and hospital stay were 4.4±7 and 14.5±10 days, respectively. The rate of postoperative complications was 33.5% in the total cohort, and 44% in high-risk patients. The most common complication was delirium, which occurred in 12.8% of patients. For patients without high risk (ASA130min, and positive fluid balance >1300mL after the 1st postoperative day, were identified as independent risk factors for the development of complications. The complication rate after major gastro-intestinal surgery is high. ASA physical status and revised cardiac risk index adequately reflect increased risk for postoperative complications and

  1. Early Complications of Heart Transplantation

    Science.gov (United States)

    Schnee, Mark

    1987-01-01

    In cyclosporine-treated cardiac allograft recipients, rejection and infection are two principal early complications. The following report describes our approach to the diagnosis and management of rejection. Infectious complications are discussed elsewhere in this journal. Lymphoproliferative disorders have not been reported in our series of transplant recipients. Other early complications particularly related to cyclosporine immuno-suppressive therapy include systemic hypertension, renal insufficiency, hepatic toxicity, and pancreatitis. Each of these is illustrated by a representative group or patient profile. (Texas Heart Institute Journal 1987; 14:257-261) Images PMID:15227308

  2. Postoperative Complications after Thoracic Surgery in the Morbidly Obese Patient

    Directory of Open Access Journals (Sweden)

    Lebron Cooper

    2011-01-01

    Full Text Available Little has been recently published about specific postoperative complications following thoracic surgery in the morbidly obese patient. Greater numbers of patients who are obese, morbidly obese, or supermorbidly obese are undergoing surgical procedures. Postoperative complications after thoracic surgery in these patients that can lead to increased morbidity and mortality, prolonged hospital stay, and increased cost of care are considered. Complications include difficulties with mask ventilation and securing the airway, obstructive sleep apnea with risk of oversedation, pulmonary complications related to reduced total lung capacity, reduced functional residual capacity, and reduced vital capacity, risks of aspiration pneumonitis and ventilator-associated pneumonia, cardiomyopathies, and atrial fibrillation, inadequate diabetes management, positioning injuries, increased risk of venous thrombosis, and pulmonary embolism. The type of thoracic surgical procedure may also pose other problems to consider during the postoperative period. Obese patients undergoing thoracic surgery pose a challenge to those caring for them. Those working with these patients must understand how to recognize, prevent, and manage these postoperative complications.

  3. Obesity - a risk factor for postoperative complications in general surgery?

    NARCIS (Netherlands)

    E.K.M. Tjeertes (Elke); S.S.E. Hoeks (Sanne S.E.); S.S.B.J.C. Beks (Sabine S.B.J.C.); T.M. Valentijn (Tabita); A.A.G.M. Hoofwijk (Anton A.G.M.); R.J. Stolker (Robert J.)

    2015-01-01

    textabstractBackground: Obesity is generally believed to be a risk factor for the development of postoperative complications. Although being obese is associated with medical hazards, recent literature shows no convincing data to support this assumption. Moreover a paradox between body mass index and

  4. Systemic Inflammatory Response Syndrome and postoperative complications after orthognathic surgery.

    Science.gov (United States)

    Kasahara, Kiyohiro; Yajima, Yasutomo; Ikeda, Chihaya; Kamiyama, Isao; Takaki, Takashi; Kakizawa, Takashi; Shibahara, Takahiko

    2009-02-01

    Symptoms of Systemic Inflammatory Response Syndrome (SIRS) presenting immediately after surgery have lately been regarded as potential warnings of impending postoperative complications and multiple organ failure. Reports discussing the relationship between operative stress and SIRS are found in the field of digestive surgery, but not in that of oral surgery. Sixty-five patients with jaw deformity who had undergone maxillary and mandibular orthognathic surgery (Le Fort I osteotomy and sagittal splitting ramus osteotomy) between September 2003 and October 2006 were involved in this study. A search based on the SIRS diagnostic criteria resulted in assignment of 33 cases to the SIRS group and 32 cases to the non-SIRS group. Postoperative complications occurred in 27.3% of the SIRS group and 0.0% of the non-SIRS group (pSIRS patients in preventing complications.

  5. Management of late postoperative complications of bariatric surgery.

    Science.gov (United States)

    Hamdan, K; Somers, S; Chand, M

    2011-10-01

    The prevalence of obesity is increasing worldwide and the past decade has witnessed an exponential rise in the number of bariatric operations performed. As a consequence, an increasing number of patients are presenting to non-specialist units with complications following bariatric procedures. This article outlines the management of the most common late postoperative complications that are likely to present to the general surgeon. A search was conducted for late postoperative complications after bariatric surgery using PubMed, Embase, OVID and Google search engines, and combinations of the terms bariatric surgery, gastric bypass, gastric banding or sleeve gastrectomy, and late or delayed complications. Only studies with follow-up longer than 6 months were included. The most common long-term complications after gastric banding include band slippage and erosion. Deflation or removal of the band is often required. Internal hernia, adhesions and anastomotic stenosis are common causes of intestinal obstruction after gastric bypass surgery. Hepatobiliary complications pose a particular challenge because of the altered anatomy. Functional disorders such as reflux and dumping, and nutritional deficiencies are common and should be differentiated from conditions that require urgent investigations and timely surgical intervention. The immediate management of bariatric patients presenting with complications outside the immediate postoperative period requires adherence to basic surgical principles. Accurate diagnosis often relies on high-quality contrast and cross-sectional imaging, and effective surgical intervention necessitates a broad understanding of the altered anatomy, advanced surgical skills and liaison with specialists in the field when necessary. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  6. Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction

    Directory of Open Access Journals (Sweden)

    Hashem M. Al-Shamiri

    2017-01-01

    Full Text Available Aim. To evaluate the effect of preoperative versus postoperative administration of oral Dexamethasone on postoperative complications including pain, edema, and trismus following lower third molar surgery. Methods. 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one hour preoperatively and the other group immediately after surgery. Pain was measured using VAS, edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening was measured using a graduated sliding caliper. Results. In this study pain and trismus records were similar and statistically nonsignificant in both groups. The results had proven that preoperative administration was superior when compared to postoperative administration regarding edema (0.002. Conclusions. Preoperative oral administration of 8 mg Dexamethasone was superior to the postoperative administration of the same dose concerning edema after lower third molar surgery.

  7. [Hip fracture, antiplatelet drugs treatment and postoperative complications].

    Science.gov (United States)

    Reguant, F; Martínez, E; Gil, B; Prieto, J C; del Milagro Jiménez, L; Arnau, A; Bosch, J

    2013-11-01

    To assess the incidence of postoperative complications, blood transfusions and survival at one month, in the old patients operated for hip fracture undergoing chronic treatment with antiplatelet drugs. Two hundred twenty three patients operated for hip fracture were studied retrospectively, separated into 3 groups: patients who received acetylsalicylic acid (group I), patients who were given 100mg/day of acetylsalicylic acid or 300mg/day of triflusal (group II) and patients receiving>100mg/day of acetylsalicylic acid, or>300mg/day of triflusal or thienopyridines (group III). Surgery was delayed for 4 days in patients in group III. Demographic, biological, clinical and treatment characteristics, postoperative complications and survival at one month were recorded. Patients in group III were older and sustain worse general health status. Patients with a higher transfusion requirement were those of group II (73.8%) (P=0.192), who also showed a higher percentage of anaemia on admission. Severe cardiovascular complications were experienced by 5.4% of group III patients, 4.8% of group II patients and 2.1% of group I patients. Patients from group III presented a significant amount of respiratory complications (P=0.007). Our results suggest that delaying surgery for 4 days in patients treated with clopidogrel can be associated to an increase in postoperative respiratory complications and severe adverse cardiovascular events, without increasing the tranfusional index, hospital stay, mortality, and without complications related to neuraxial anaesthesia. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  8. Small Bowel Perforation as a Postoperative Complication from a Laminectomy

    Directory of Open Access Journals (Sweden)

    Robert H. Krieger

    2015-01-01

    Full Text Available Chronic low back pain is one of the leading chief complaints affecting adults in the United States. As a result, this increases the percentage of patients that will eventually undergo surgical intervention to alleviate debilitating, chronic symptoms. A 37-year-old woman presented ten hours postoperatively after a lumbar laminectomy with an acute abdomen due to the extraordinarily rare complication of small bowel injury secondary to deep surgical penetration.

  9. Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

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    Nertila Kodra

    2016-05-01

    Full Text Available BACKGROUND: Incidence of postoperative pulmonary complications (PPC in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system. AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures. MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors. RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01. CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit.

  10. Hyperprolactinaemia: a cause of severe postoperative complication after reduction mammaplasty.

    Science.gov (United States)

    Mestak, Ondrej; Mestak, Jan; Borsky, Jiri

    2014-12-01

    Galactorrhoea is a rare complication of wound healing after breast reduction and its association with necrosis of the areolar skin in women with no recent history of breast feeding has to our knowledge never been described. Galactorrhoea is common and there are many differential diagnoses. We report a case of a 46-year-old woman who had bilateral reductions of the breast and developed hyperprolactinaemia and galactorrhoea six weeks postoperatively. Subsequently she developed dry necrosis of both areolas. All radiographic and laboratory findings were within the reference ranges except for of prolactin.

  11. Cutaneous zygomycosis: A possible postoperative complication in immunocompetent individuals

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    Tilak Ragini

    2009-01-01

    Full Text Available Fungi in the class of zygomycetes usually produce serious infections in diabetics and immunocompromised hosts. Cutaneous zygomycosis is a less common form, with an unpredictable extent of anatomical involvement and clinical course. Here, we report two cases of primary cutaneous zygomycosis as postoperative complications in otherwise healthy females. Zygomycosis was suspected and specimens from the surgical debridement were examined by microbiological and histopathological studies for confirming the clinical diagnosis. Rapid diagnosis, liposomal amphotericin B, and proper debridement of affected tissue are necessary to avoid a fatal outcome.

  12. 腹腔镜下全膀胱切除术疗效及早期并发症的临床分析%Early stage postoperative complications of laparoscopic radical cystectomy

    Institute of Scientific and Technical Information of China (English)

    许传亮; 杨波; 高旭; 侯建国; 王林辉; 孙颖浩; 曾蜀雄; 张振声; 于晓雯; 宋瑞祥; 韦荣超; 鲁欣; 李惠珍; 周铁

    2014-01-01

    ,术后并发症发生率较低,但术后患者白蛋白明显降低,需注意维持术后营养平衡。%Objective To investigate feasibility and early stage postoperative complications of lapa-roscopic radical cystectomy ( LRC) . Methods We retrospectively analyzed the data of 63 consecutive pa-tents (58 males and 5 females) who underwent LRC from Oct .2011 to Oct.2013 in our institute.Of these patients, 46 patients underwent ileal conduit , 9 patients underwent ureterocutaneostomy , and 8 patients un-derwent orthotopic ileal neobladder urinary diversion .The average age and body mass index of patients were 67.7±11.1 (33-84) years and 23.3±2.1 (18.8-28.7) kg/m2, respectively.The mean hemoglobin and al-bumin of patients were (130.7±20.3) g/L and (38.9±4.1) g/L, respectively.Comorbidities of hyperten-sion, diabetes, coronary heart disease and decompensated liver cirrhosis were found in 10, 6, 2 and 1 pa-tient, respectively.10 of 61 patients had a history of abdominal surgery .The indications for cystectomy were classified as muscle invasive bladder cancer for 30 patients, unresectable superficial bladder cancer for 19 patients and recurrent bladder cancer for 14 patients.Postoperative data and early stage postoperative compli-cations within 3 months after surgery were collected . Results The median operative time for LRC and uri-nary diversion was 390 (260-480) min, with a median estimated blood loss of 400 (100-1 500) ml.This was one patient converted to open surgery .The mean postoperative hemoglobin and albumin of patients was 108.5±14.7 g/L and 29.5±3.7 g/L, respectively, both of which significantly reduced compared with pre-operative data (P<0.01).The median duration of hospital stay was 15 days.The median time for liquid in-take, abdominal drainage removal and ureteral stent removal was 4 days, 9 days and 2 months after surgery , respectively.Catheter was removed 2 weeks after laparoscopic orthotopic cystectomy .21 (33.3%) of 63 pa-tients suffered

  13. Pylorus-preserving whipple pancreaticoduodenectomy : CT findings of immediate postoperative complications

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keon Woo; Kim, Tae Hun [Kyungpook National Univ., Taegu (Korea, Republic of). School of Medicine

    1998-03-01

    The purpose of this paper is to determine the CT findings of immediately postoperative complications including anastomotic leakage, and to evaluate the usefulness of CT scan in the assessment of early postoperative complications of pylorus preserving whipple pancreaticoduodenectomy (PPPD). During the early postoperative period, fluid accumulated in the abdominal cavity of ten of 23 patients who had undergone PPPD. In all cases, the time interval between the first follow up CT scan and surgery was no more than two weeks. At each leakage site, we compared CT findings with those of conventional fluoroscopic studies: upper gastrointestinal studies with oral water-soluble contrast materials, a contrast injection study via drainage catheters in place in the stomach, the site of choledochojejunostomy during surgery and pancreaticojejunostomy, and nine cases of sinogram via percutaneous drainage catheters. We also evaluated CT findings of the locations, amounts, and margin of the fluid collections. If conventional fluoroscopic studies showed no evidence of anastomotic leakage, as was the case with six patients, the leakage site was determined on the basis of clinical and laboratory data. In four of the six, this was found to be the site of pancreaticojejunostomy, and in the other two, an abscess without anastomotic leakage. In some cases of suspected complications arising after PPPD, and including anastomotic leakage and abdominal abscess, leakage is not revealed by conventional fluoroscopic studies; in such cases, CT scanning may help detect the complications and determine the site of anastomotic leakage. (author). 10 refs., 2 figs.

  14. 胃癌术后早期肠内营养对改善营养状况及降低并发症的价值%Effect of Early Postoperative Enteral Nutrition on Gastric Cancer Patients’ Nutritional Status and Complications

    Institute of Scientific and Technical Information of China (English)

    叶培军

    2014-01-01

    目的:分析胃癌术后早期肠内营养对改善营养状况及降低并发症的价值。方法选择在本院接受手术治疗的胃癌患者作为研究对象,随机分为术后常规营养的对照组及术后早期肠内营养的观察组,比较其术后营养指标及并发症发生率等差异。结果观察组患者术后早期营养指标值明显优于对照组患者(P<0.05);各项并发症发生率明显低于对照组患者(P<0.05)。结论胃癌术后患者早期行肠内营养可提高患者的术后营养指标,且降低各项并发症的发生率,具有积极的临床意义。%Objective To analyze the Effect of early postoperative enteral nutrition on gastric cancer patients’ nutritional status and complications. Methods Choosed patients with gastric cancer underwent surgery in our hospital as study object, randomly divided into control group with routine postoperative nutritional and observation group with early postoperative enteral nutrition, compared postoperative nutritional indicators and complications incidence. Results Observation group patients postoperative nutritional value index was higher than control group patients (P<0.05); complication rate was significantly lower than control group patients(P<0.05). Conclusions Early postoperative enteral nutrition in patients can improve nutrition indicators, reduce incidence of various complications, had positive clinical significance.

  15. Postoperative Complications Following Gingival Grafts: A Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Alexandra ROMAN

    2011-12-01

    Full Text Available Aim: Treating gingival recessions (GRs is a challenge for the practitioner who must take into consideration objective clinical factors, subjective symptoms and also factors related to the patient’s expectations. The aim of this study was to evaluate the postoperative complications associated with connective tissue graft (CTG plus coronally advanced flap (CAF and free gingival graft (FGG used to cover GRs and to compare post-operative morbidities for the two groups of procedures. Material and Methods: A total of 17 patients diagnosed with Miller class 1 to 3 GRs ≥2mm were surgically treated using CTG plus CAF or FGG. When minimum 2 mm of keratinized gingiva was present apically to GR, CTG plus CAF was used. FGG was chosen to cover GRs when keratinized gingiva was absent. Post-operative complications were evaluated with a questionnaire with six questions given to the patients at 14 days follow-up visit. The study used a 1 to 10 visual analogic scale (VAS and the levels of outcomes were classified as “none to minimum” “moderate” and “very important/severe”. Results: A total of 21 procedures, 10 CTG plus CAG and 11 FGG were included in the analysis. No palatal bleeding and no severe pain or swelling were recorded. The patients experienced more pain in the grafted area than in the donor area, for both surgical techniques, with a mean value of 3.09 (1.3 standard deviation sd versus 2.27 (1.4 sd for CTG plus CAF group and of 3.7 (2.21 sd versus 2.9 (1.7 sd for FGG group, respectively. CTG plus CAF generated significantly higher scores of tumefaction than FGG, the mean values being 2.45 (0.93 sd and 4 (2.21 sd (t-value=2.12, p<0.05 respectively. Conclusion: The complications associated with the two periodontal surgical approaches seem manageable and clinically acceptable.

  16. Identification of patients with postoperative complications who are at risk for failure to rescue.

    Science.gov (United States)

    Ferraris, Victor A; Bolanos, Michael; Martin, Jeremiah T; Mahan, Angela; Saha, Sibu P

    2014-11-01

    A minority of patients who experience postoperative complications die (failure to rescue). Understanding the preoperative factors that lead to failure to rescue helps surgeons predict and avoid operative mortality. To provide a mechanism for identifying a high-risk group of patients with postoperative complications who are at a substantially increased risk for failure to rescue. Observational study evaluating failure to rescue in patients entered into the American College of Surgeons National Surgical Quality Improvement Program database. The large sample of surgical patients included in this study underwent a wide range of operations during a 5-year period in more than 200 acute care hospitals. We examined and identified patients at high risk for failure to rescue using propensity stratification. We also developed a risk-scoring system that allowed preoperative identification of patients at the highest risk for failure to rescue. Risk-scoring system that predicts failure to rescue. Of the 1,956,002 database patients, there were 207,236 patients who developed serious postoperative complications. Deaths occurred in 21,731 patients with serious complications (10.5% failure to rescue). Stratification of patients into quintiles, according to their propensity for developing serious complications, found that 90% of operative deaths occurred in the highest-risk quintile, usually within a week of developing the initial complication. A risk-scoring system for failure to rescue, based on regression-derived variable odds ratios, predicted patients in the highest-risk quintile with good predictive accuracy. Only 31.8% of failure-to-rescue patients had a single postoperative complication. Perioperative deaths increased exponentially as the number of complications per patient increased. Patients with complications who had surgical residents involved in their care had reduced rates of failure to rescue compared with patients without resident involvement. Twenty percent of high

  17. Postoperative Elevation of the Neutrophil: Lymphocyte Ratio Predicts Complications Following Esophageal Resection.

    Science.gov (United States)

    Vulliamy, Paul; McCluney, Simon; Mukherjee, Samrat; Ashby, Luke; Amalesh, Thangadorai

    2016-06-01

    Complications following esophagectomy are a significant source of morbidity. The aim of this study was to investigate the utility of the neutrophil:lymphocyte ratio (NLR) in the early identification of complications following esophagectomy, as compared to other routinely available parameters. We performed a retrospective cohort study of patients undergoing Ivor-Lewis esophagectomy at a single centre. Baseline characteristics and complications occurring within the first 30 days of surgery were recorded. White blood cell counts and C-reactive protein (CRP) levels immediately following surgery (day 0) and over the subsequent three postoperative days were analysed. Sixty-five patients were included, of whom 29 (45 %) developed complications. The median NLR was similar among patients with and without a complicated recovery on day 0 (12.7 vs 13.6, p = 0.70) and day 1 (10.0 vs 9.3, p = 0.29). Patients who subsequently developed complications had a higher NLR on day 2 (11.8 vs 7.5, p 8.3 on day 2 had a sensitivity of 93 % and a specificity of 72 % for predicting complications. The NLR is a simple and routinely available parameter which has a high sensitivity in the early detection of complications following esophagectomy.

  18. [Pleural hernia of an esophageal graft--late postoperative complication].

    Science.gov (United States)

    Grabowski, K; Lewandowski, A; Moroń, K; Strutyńska-Karpińska, M; Błaszczuk, J; Machała, R

    1997-01-01

    Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

  19. [Postoperative necrotizing fasciitis: a rare and fatal complication].

    Science.gov (United States)

    Ghezala, Hassen Ben; Feriani, Najla

    2016-01-01

    Postoperative parietal complications can be exceptionally severe and serious threatening vital prognosis. Necrotizing fasciitis is a rare infection of the skin and deep subcutaneous tissues, spreading along fascia and adipose tissue. It is mainly caused by group A streptococcus (streptococcus pyogenes) but also by other bacteria such as Vibrio vulnificus, Clostridium perfringens or Bacteroides fragilis. Necrotizing fasciitis is a real surgical and medical emergency. We report, in this study, a very rare case of abdominal parietal gangrene occurring in a 75-year-old woman on the fifth day after surgery for an ovarian cyst. Evolution was marked by occurrence of a refractory septic shock with a rapidly fatal course on the third day of management.

  20. Delirium is associated with early postoperative cognitive dysfunction

    DEFF Research Database (Denmark)

    Rudolph, J.L.; Marcantonio, E.R.; Culley, D.J.

    2008-01-01

    The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects......). Postoperative cognitive dysfunction was defined as a composite Z-score > 2 across tests or at least two individual test Z-scores > 2. Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative...... cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1-2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6-2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive...

  1. Early postoperative acetabular discontinuity after total hip arthroplasty.

    Science.gov (United States)

    Desai, Gaurav; Ries, Michael D

    2011-12-01

    Periprosthetic acetabular fracture is a rare complication after total hip arthroplasty (THA). However, we have treated 2 patients with acute postoperative acetabular discontinuity that occurred 2 and 3 weeks after primary THA. Both fractures were in elderly osteoporotic female patients with minimal trauma and may have developed from unrecognized intraoperative fractures. Pelvic stability was restored with acetabular revision using medial morselized bone grafting and a cemented reconstruction cage. This report demonstrates that early postoperative periprosthetic acetabular discontinuity after THA is a risk in elderly patients with severe osteoporosis and that salvage of acetabular fixation can be achieved with cemented cage reconstruction and medial morselized bone grafting. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. [Analysis of postoperative complications in 256 non-small cell lung cancer patients and the value of cardiopulmonary risk index (CPRI)].

    Science.gov (United States)

    Su, Yanjun; Wang, Changli

    2005-10-20

    Pulmonectomy is the first priority in treatment of non-small cell lung cancer (NSCLC). The postoperative complication is the main factor which affects the efficacy of operation. The aim of this study is to analyze the incidences of postoperative complications in NSCLC patients and the value of modified cardiopulmonary risk index (CPRI) in predicting the short-term complication. Postoperative complications were analyzed in patients who underwent pulmonectomy in Tianjin Cancer Institute and Hospital from January 2004 to November 2004, and the value of modified Epstein CPRI in predicting the risk of pulmonectomy was estimated. A total of 256 consecutive patients were studied. Postoperative cardiopulmonary complications occurred in 86 patients (33.6%), hemathorax in 6 patients (2.3%) and other complications in 11 patients (4.3%). Postoperative cardiopulmonary complications occurred in 61 of the 67 patients with CPRI≥4, which was significantly more frequent than that in those with CPRI CPRI≥4 as a threshold for predicting postoperative complication, the sensitivity, specificity and accu- racy were 70.9%, 96.5% and 87.9% respectively. The main early postoperative complications are cardiopulmonary complications. CPRI shows significant importance in predicting the early postoperative prognosis for patients with NSCLC.

  3. Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation

    DEFF Research Database (Denmark)

    Wulff, N B; Kristensen, C.A.; Andersen, E

    2015-01-01

    total laryngectomy for squamous cell carcinoma of the larynx or hypopharynx. MAIN OUTCOME MEASURES: Overall postoperative complications and fistula formation. RESULTS: Overall postoperative complications, fistula formation, wound infection, bleeding and wound necrosis within one year after total....... Tumour localisation in the hypopharynx was associated with overall postoperative complications (P = 0.036). Residual tumour or cancer recurrence was associated with late-onset fistulas (P

  4. Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cheong Ah Oh; Dae Hoon Kim; Seung Jong Oh; Min Gew Choi; Jae Hyung Noh; Tae Sung Sohn; Jae Moon Bae; Sung Kim

    2012-01-01

    AIM:To investigate the correlation between the nutritional risk index (NRI) and postoperative wound complications.METHODS:From January 2008 through June 2008,669 patients who underwent curative gastrectomy for gastric cancer were included in a retrospective study.Medical records of consecutive patients were collected and analyzed to determine postoperative wound complication rates.The NRI was assessed on the fifth postoperative day and other possible risk factors for the incidence of wound complications were analyzed to identify the factors affecting postoperative wound complications.Patients with other postoperative complications were excluded from the study.RESULTS:On the 5th postoperative day,the NRI showed a malnutrition rate of 84.6% among postoperative patients.However,postoperative wound complications occurred in only 66/669 (9.86%) patients.Of the patients with wound complications,62/66 (94%)belonged to the malnourished group (NRI < 97.5),and 4/66 (6%) patients to the non-malnourished group (NRI ≥ 97.5).The only factor correlated with wound complications was the NRI on the 5th postoperative day (odds ratio of NRI ≥ 97.5 vs NRI < 97.5:0.653; 95%confidence interval:0.326-0.974; P =0.014) according to univariate analysis as well as multivariate analysis.CONCLUSION:This study suggests that malnutrition immediately after surgery may play a significant role in the development of wound complications.

  5. Postoperative Anticholinergic Poisoning: Concealed Complications of a Commonly Used Medication.

    Science.gov (United States)

    Zhang, Xiao Chi; Farrell, Natalija; Haronian, Thomas; Hack, Jason

    2017-07-27

    Scopolamine is a potent anticholinergic compound used commonly for the prevention of postoperative nausea and vomiting. Scopolamine can cause atypical anticholinergic syndromes due to its prominent central antimuscarinic effects. A 47-year-old female presented to the emergency department (ED) 20 h after hospital discharge for a right-knee meniscectomy, with altered mental status (AMS) and dystonic extremity movements that began 12 h after her procedure. Her vital signs were normal and physical examination revealed mydriasis, visual hallucinations, hyperreflexia, and dystonic movements. Laboratory data, lumbar puncture, and computed tomography were unrevealing. The sustained AMS prompted a re-evaluation that revealed urinary overflow with 500 mL of retained urine discovered on ultrasound and a scopolamine patch hidden behind her ear. Her mental status improved shortly after patch removal and physostigmine, with complete resolution after 24 h with discharge diagnosis of scopolamine-induced anticholinergic toxicity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although therapeutically dosed scopolamine transdermal patches rarely cause complications, incomplete toxidromes can be insidiously common in polypharmacy settings. Providers should thoroughly evaluate the skin of intoxicated patients for additional adherent medications that may result in a delay in ED diagnosis and curative therapies. Our case, as well as rare case reports of therapeutic scopolamine-induced anticholinergic toxicity, demonstrates that peripheral anticholinergic effects, such as tachycardia, dry mucous membranes, and hyperpyrexia are often not present, and incremental doses of physostigmine may be required to reverse scopolamine's long duration of action. This further complicates identification of the anticholinergic toxidrome and diagnosis. Published by Elsevier Inc.

  6. Inspiratory oxygen fraction and postoperative complications in obese patients: a subgroup analysis of the PROXI trial

    DEFF Research Database (Denmark)

    Staehr, Anne K; Meyhoff, Christian Sylvest; Rasmussen, Lars S;

    2011-01-01

    Obese patients are at a high risk of postoperative complication, including surgical site infection (SSI). Our aim was to evaluate the effect of a high inspiratory oxygen fraction (80%) on SSI and pulmonary complications in obese patients undergoing laparotomy....

  7. Inspiratory oxygen fraction and postoperative complications in obese patients: a subgroup analysis of the PROXI trial

    DEFF Research Database (Denmark)

    Staehr, Anne K; Meyhoff, Christian Sylvest; Rasmussen, Lars S

    2011-01-01

    Obese patients are at a high risk of postoperative complication, including surgical site infection (SSI). Our aim was to evaluate the effect of a high inspiratory oxygen fraction (80%) on SSI and pulmonary complications in obese patients undergoing laparotomy....

  8. Comparative analyses of postoperative complications and prognosis of different surgical procedures in stage II endometrial carcinoma treatment

    Directory of Open Access Journals (Sweden)

    Yin H

    2016-02-01

    Full Text Available Hongmei Yin,1 Ting Gui2 1Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, Shandong, 2Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Objective: To investigate the impact of surgical resection extent on the postoperative complications and the prognosis in patients with stage II endometrial cancer. Methods: A total of 54 patients were retrospectively reviewed, 35 patients underwent subradical hysterectomy and 19 patients received radical hysterectomy, both with simultaneous bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. Results: Comparing the surgical outcomes in subradical hysterectomy group vs radical hysterectomy group, there were no significant differences in operative time, estimated blood loss, and hospital stay. After surgery, 37.1% vs 36.8% patients received postoperative radiotherapy in the subradical hyster­ectomy group vs radical hysterectomy group, without statistically significant difference. As for postoperative complications, the early postoperative complication rate in patients who underwent subradical hysterectomy was 14.3%, significantly lower than that in patients submitted to radical hysterectomy (14.3% vs 42.1%, with P=0.043. However, there was no significant difference in late postoperative complication rate between the two surgical procedures. Regarding the clinical prognosis, patients receiving the subradical hysterectomy showed similar survival to their counterparts undergoing the radical procedures. The relapse rate was 5.71% vs 5.26%, respectively, without significant difference. There were no deaths in both surgical groups. Conclusion: For stage II endometrial carcinoma, subradical hysterectomy presented with less early postoperative complications and similar survival duration and recurrence

  9. Total mechanical stapled oesophagogastric anastomosis on the neck in oesophageal cancer - prevention of postoperative mediastinal complications.

    Science.gov (United States)

    Zieliński, Jacek; Jaworski, Radosław; Irga-Jaworska, Ninela; Haponiuk, Ireneusz; Jaśkiewicz, Janusz

    2015-12-01

    Oesophagogastric anastomosis after oesophagus resection is commonly performed on the neck. Even though a few different techniques of oesophagogastric anastomosis have been previously detailed, both manual and mechanical procedures have been burdened with leakages and strictures. Our simple technique of oesophagogastric anastomosis is a modification of mechanical anastomosis with the use of a circular stapler in order to prevent postoperative leak and concomitant mediastinal complications. Since 2008, we have performed nine oesophagogastric anastomoses following oesophagus resection. The mean age of the operated patients was 54 years. There was no mortality among the operated patients in the early post-operative period. The mean follow-up period for the patients operated on in our department was 17 months until the time of the analysis. None of the patients showed any leakage or stricture, and no mediastinal complications were reported in the group. Following our own experience, mechanical anastomosis with the use of a circular stapler seems to decrease the time of the operation as well as significantly reducing the incidence of leakages from the anastomosis. This type of anastomosis may decrease the number of postoperative strictures and the most dangerous mediastinal infections.

  10. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial

    DEFF Research Database (Denmark)

    Lindström, David; Sadr Azodi, Omid; Wladis, Andreas;

    2008-01-01

    To determine whether an intervention with smoking cessation starting 4 weeks before general and orthopedic surgery would reduce the frequency of postoperative complications.......To determine whether an intervention with smoking cessation starting 4 weeks before general and orthopedic surgery would reduce the frequency of postoperative complications....

  11. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial

    DEFF Research Database (Denmark)

    Møller, Ann; Villebro, Nete Munk; Pedersen, Tom;

    2002-01-01

    Smokers are at higher risk of cardiopulmonary and wound-related postoperative complications than non-smokers. Our aim was to investigate the effect of preoperative smoking intervention on the frequency of postoperative complications in patients undergoing hip and knee replacement....

  12. CEUS: A new imaging approach for postoperative vascular complications after right-lobe LDLT

    Institute of Scientific and Technical Information of China (English)

    Yan Luo; Yu-Ting Fan; Qiang Lu; Bo Li; Tian-Fu Wen; Zhong-Wei Zhang

    2009-01-01

    AIM: To investigate contrast-enhanced ultrasound (CEUS) for early diagnosis of postoperative vascular complications after right-lobe living donor liver transplantation (RLDLT). METHODS: The ultrasonography results of 172 patients who underwent RLDLT in West China Hospital, Sichuan University from January 2005 to June 2008 were analyzed retrospectively. Among these 172 patients, 16 patients' hepatic artery flow and two patients' portal vein flow was not observed by Doppler ultrasound, and 10 patients' bridging vein flow was not shown by Doppler ultrasound and there was a regional inhomogeneous echo in the liver parenchyma upon 2D ultrasound. Thus, CEUS examination was performed in these 28 patients. RESULTS: Among the 16 patients without hepatic artery flow at Doppler ultrasound, CEUS showed nine cases of slender hepatic artery, six of hepatic arterial thrombosis that was confirmed by digital subtraction angiography and/or surgery, and one of hepatic arterial occlusion with formation of lateral branches. Among the two patients without portal vein flow at Doppler ultrasound, CEUS showed one case of hematoma compression and one of portal vein thrombosis, and both were confirmed by surgery. Among the 10 patients without bridging vein flow and with liver parenchyma inhomogeneous echo, CEUS showed regionally poor perfusion in the inhomogeneous area, two of which were confirmed by enhanced computed tomography (CT), but no more additional information about bridging vein flow was provided by enhanced CT. CONCLUSION: CEUS may be a new approach for early diagnosis of postoperative vascular complications after RLDLT, and it can be performed at the bedside.

  13. Diagnostic radiology of early complications after renal transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Looser, C.M.; Terrier, F.; Scheidegger, J.R.; Frey, F.J.; Gertsch, P.; Lerut, J.; Revel, D.

    1988-12-01

    Postoperative complications after renal transplantation, such as hematomas, abscesses, urinomas and lymphoceles and obstruction of the ureter, can be diagnosed by means of ultra sonography. Early vascular complications, such as venous thrombosis and arterial occlusion or stenosis, can be recognized by duplex ultrasonography and accurately depicted by angiography to allow planning of surgical intervention. Stenosis of the renal artery is amenable to treatment by percutaneous angioplasty. Parenchymatous complications (acute tubular necrosis, acute rejection, cyclosporin-Atoxicity) can cause changes in the intrarenal flow patterns at duplex ultra sonography, but this examination does not allow accurate diagnosis and differentiation of these changes. Magnetic resonance imaging is a very promising method for the differential diagnosis of parenchymatous complications. (orig.) .

  14. Catheter-related Complications in Postoperative Intraperitoneal Chemotherapy for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To analyze catheter-related complications during postoperative Intraperitoneal chemotherapy (IPCT) for gastric cancer. Methods: From December 2003 to April 2007, 80 patients with gastric cancer were treated with postoperative IPCT using central venous catheters (CVCs), during which the complications that occurred in association with CVCs were documented and analyzed. Results: Catheter-related complications were seen in 10 out of the 80 patients, yielding a total complication rate of 12.5%. Main complications included abdominal pain (3.8%), local infection (1.3%), catheter obstruction (2.5%), leakage (2.5%) and dislocation (2.5%). All patients successfully finished their IPCT, the success rate was 100%. There occurred no severe complications or treatment-related deaths. Conclusion: It is convenient and safe to carry out postoperative IPCT for gastric cancer using CVCs, which, with a low catheter-related complication rate, should be recommended for more clinic use.

  15. Relationship between surgical time and postoperative complications in senile patients with hip fractures

    Institute of Scientific and Technical Information of China (English)

    MA Ren-shi; GU Gui-shan; WANG Cheng-xue; ZHU Dong; ZHANG Xi-zheng

    2010-01-01

    Objective:To elucidate the relationship between surgical time and postoperative complications in senile patients with hip fractures, and try to find out other factors which are related to these complications.Methods: Sixty-two patients, 28 males aged from 65 to 72 years with a mean age of 76.3 years and 34 females aged from 65 to 95 years with a mean age of 78.1 years, who had undergone orthopedic surgery because of hip fractures,were enrolled in a retrospective cohort study. The surgical time and pattern, the type of fracture, preoperative comorbidities, American Society of Anesthesiologists (ASA) score and the volume of blood transfusion during operation were obtained from these patients who were followed up by telephone calls for postoperative complications.All the patients were followed up at least for 1 year and were divided into subgroups according to their clinical characteristics and the results were analyzed by the Statistical Analysis System software.Results:There was no significant difference in the morbidity of postoperative eomplications with the gender,age,surgical time and pattern,or ASA score. There was significant difference in the morbidity of postoperative complications related to preoperative comorbidities and the volume of blood transfusion. There was a significant causality between preoperative comorbidities and postoperative complications. The morbidity of postoperative complications was 1.651 times higher in patients with preoperative comorbidities than those without.Conclusions:There is no relationship between the surgical time and postoperative complications in senile patients who received surgery for hip fracture within 1 year.No correlation is found between the postoperative complications and gender,age,type of fracture, surgical pattern,ASA score and the volume of blood transfusion. Preoperative comorbidities are an independent predictor for postoperative complications.

  16. Relationship between inflammatory response and postoperative cognitive complications: Advance in research

    Directory of Open Access Journals (Sweden)

    Ya-wei LI

    2014-10-01

    Full Text Available Postoperative cognitive complications (including delirium and cognitive dysfunction are common in elderly patients after an operation, and they are usually accompanied by a poor prognosis. Although the mechanism of postoperative cognitive complications remains unclear, previous studies suggest that inflammatory reaction of central neural system (CNS may play an important role in its development. Peripheral inflammatory reaction could be spread to CNS in several ways, and inflammatory reaction of CNS may interfere its function, inhibit the regeneration of neurons, and induce apoptosis of neurons, finally resulting in cognitive impairment and complications. Intraoperative administration of single, high-dose glucocorticoid (dexamethasone and perioperative non-stero idal anti-inflammatory drugs (NSAIDs may be helpful to decrease the incidence of postoperative cognitive complications. The influence of perioperative prophylactic usage of ulinastatin and anesthetic technique in prevention of postoperative cognitive complications calls for further investigation. DOI: 10.11855/j.issn.0577-7402.2014.08.17

  17. [A simple point score for definition of the risk of postoperative complications].

    Science.gov (United States)

    Grundmann, R; Papoulis, C

    1989-01-01

    During a 5-year-period we recorded prospectively 5,823 patients who had undergone general surgery and documented the postoperative complications as wound infection, pneumonia, reoperations and death. A score including all these complications was developed to evaluate the risk of an operation more exactly than using the wound infection rate alone. This method seems to provide a continuous monitoring and the comparison of the complication risks of certain operations within a quality assurance program. For gastric and colon surgery we found a correlation between postoperative antibiotic use and score, but not between score and postoperative hospitalization time.

  18. Computed tomography findings of postoperative complications in lung transplantation; Achados tomograficos nas complicacoes pos-operatorias do transplante pulmonar

    Energy Technology Data Exchange (ETDEWEB)

    Hochhegger, Bruno; Irion, Klaus Loureiro; Marchiori, Edson; Bello, Rodrigo; Moreira, Jose; Camargo, Jose Jesus [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil). Postgraduate Program in Respiratory Sciences; Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Postgraduate Program in Radiological Sciences], e-mail: brunorgs@mail.ufsm.br

    2009-03-15

    Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis. (author)

  19. Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications.

    Science.gov (United States)

    Patel, Nishant; Shi, William; Liss, Michael; Raheem, Omer; Wenzler, David; Schallhorn, Craig; Kiyama, Linsday; Lakin, Charles; Ritter, Michele; Sur, Roger L

    2015-05-01

    Multidrug resistant (MDR) uropathogens are increasing in prevalence and may contribute to significant morbidity after percutaneous nephrolithotomy (PCNL). We investigate the presence of MDR bacteriuria and occurrence of postoperative infectious complications in patients who underwent PCNL at our institution. Retrospective review was performed of 81 patients undergoing PCNL by a single surgeon (RLS) between 2009 and 2013. Patient demographics, comorbidities, stone parameters on imaging, and microbial data were compiled. MDR organisms were defined as resistant to three or more of the American Urological Association Best Practice Statement antimicrobial classes for PCNL. Postoperative complications were graded by Clavien score and European Association of Urology infection grade. Univariate comparisons were analyzed between patients with and without a postoperative infectious complication. Multivariate logistic regression was performed to determine significant predictor variables for postoperative infectious complications. Of the 81 patients undergoing PCNL, 41/81 (51%) had positive preoperative urine culture, 24/81 (30%) had positive MDR urine culture, and 16/81 (19%) had a postoperative infectious complication. Multivariate analysis revealed a positive preoperative MDR urine culture significantly increased the risk of postoperative infectious complication (odds ratio [OR]=4.89, 95% confidence interval [CI] 1.134-17.8, P=0.016). The presence of more than one access tract during PCNL also predicted for infectious complications (OR=7.5, 95% CI 2.13-26.4, P=0.003) Of the 16 patients with a postoperative infection 3 (18%) had postoperative urine cultures discordant with the preoperative urine cultures. Our institution demonstrated a relatively high prevalence of MDR bacteriuria in patients undergoing PCNL and that MDR is a significant risk factor for postoperative infectious complications despite appropriate preoperative antibiotics. Further investigations regarding

  20. Postoperative intussusception in pediatric abdominal malignancies: early diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Maged M. Elshafiey; Gehad T. Meselhy; Amal Refaat; Alaa A. Younes

    2012-01-01

    Objective: The aim of this study was to review the incidence of postoperative intussusception (POI) in our patients with pediatric abdominal malignancies and the end result of management of these cases. Methods: From November2007 till the end of December 2011, a total of 538 patients with different abdominal malignancies were operated upon by laparotomies in our hospital. Reoperations were required in 12 patients for post operative intestinal obstruction developed in the 1st postoperative month. Review of the identified cases focused on patient's characteristics, the primary tumor type, the primary surgical procedure, clinical and imaging features of the intussusceptions, timing and findings at the 2nd laparotomy and the end result of subsequent interventions. Results: Early post operative intestinal obstruction (within 1 month) developed in 12 patients of whom 8 patients had POI. Five patients had adhesive intestinal obstruction (one patient developed POI then adhesive obstruction). The median duration between the primary surgery and the onset of intestinal obstruction symptoms was 5 days (range 4-12 days) in the POI group and 24 days (range 10-30 days) in the adhesion group. Abdominal CT was done in all cases and it could properly diagnose POI and detect its site in the POI group while in the adhesion group it showed evidence of complete obstruction. Plain radiograph failed to detect signs of intestinal obstruction in 3 cases (two in the POI group and one in the adhesion group). In POI group simple reduction was done in 7 cases while resection anastmosis was done in 1 case due to gangrene of the ileocecal region. Adhesiolysis was done in the 5 cases of intestinal adhesion group.Conclusion: Early POI in pediatric abdominal cancer is a rare complication; however it should be kept in mind with high index of suspicion. Early diagnosis and intervention is essential for successful management. Abdominal CT is very helpful as it can detect the level and possible cause of

  1. Interest in Rhinoplasty and Awareness about its Postoperative Complications Among Female high School Students

    Directory of Open Access Journals (Sweden)

    Aliasghar Arabi Mianroodi

    2012-03-01

     Conclusion: Many teenagers are interested in having rhinoplasty in Iran. As the number of teenagers and young adults who choose to have cosmetic surgery increases, surgeons should consider their expectations, motivations and awareness of postoperative complications before surgery.

  2. Postoperative complications associated with external skeletal fixators in cats.

    Science.gov (United States)

    Beever, Lee; Giles, Kirsty; Meeson, Richard

    2017-07-01

    The objective of this study was to quantify complications associated with external skeletal fixators (ESFs) in cats and to identify potential risk factors. A retrospective review of medical records and radiographs following ESF placement was performed. Case records of 140 cats were reviewed; fixator-associated complications (FACs) occurred in 19% of cats. The region of ESF placement was significantly associated with complication development. Complications developed most frequently in the femur (50%), tarsus (35%) and radius/ulna (33%). Superficial pin tract infection (SPTI) and implant failure accounted for 45% and 41% of all FACs, respectively. SPTI occurred more frequently in the femur, humerus and tibia, with implant failure more frequent in the tarsus. No association between breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, degree of fracture load sharing, and the incidence or type of FAC was identified. No association between region of placement, breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, fracture load sharing and the time to complication development was identified. Complication development is not uncommon in cats following ESF placement. The higher complication rate in the femur, tarsus and radius/ulna should be considered when reviewing options for fracture management. However, cats appear to have a lower rate of pin tract infections than dogs.

  3. The risk for immediate postoperative complications after pancreaticoduodenectomy is increased by high frequency of acinar cells and decreased by prevalent fibrosis of the cut edge of pancreas.

    Science.gov (United States)

    Laaninen, Matias; Bläuer, Merja; Vasama, Kaija; Jin, Haitao; Räty, Sari; Sand, Juhani; Nordback, Isto; Laukkarinen, Johanna

    2012-08-01

    Soft pancreas is considered as a factor for pancreatitis after pancreaticoduodenectomy, which in turn constitutes a high risk for local complications. The aim was to analyze the proportion of different cell types in the cut edge of pancreas (CEP) in relation to postoperative pancreatitis and other complications after pancreaticoduodenectomy. Data from postoperative follow-up was collected on 40 patients who had undergone pancreaticoduodenectomy. Positive urine trypsinogen-2, an early detector of pancreatitis, was checked on days 1 to 6 after operation. Drain amylase was measured on postoperative day 3. Anastomotic leakages, delayed gastric emptying, and other complications were registered. The areas of different cell types were calculated from the entire hematoxylin-eosin-stained section of CEP. High frequency of acinar cells in the CEP significantly increased positive urine trypsinogen-2 days, drain amylase values, and delayed gastric emptying. In a subgroup of patients with more than 40% acini in the CEP, there were significantly more postoperative complications. Increased fibrosis correlated with a small number of positive urine trypsinogen-2 days and postoperative complications. A large number of acinar cells in the CEP increases, whereas extensive fibrosis in the CEP decreases, the risk for postoperative complications after pancreaticoduodenectomy. These results emphasize the importance of acini in the development of postoperative complications.

  4. Effect of unrestricted bottle-feeding on early postoperative course after cleft palate repair.

    Science.gov (United States)

    Kim, Eun Key; Lee, Taik Jong; Chae, Soo Wook

    2009-09-01

    Although bottle-feeding after cheiloplasty is widely accepted, postoperative feeding regimen after palatoplasty is still controversial. The aim of this prospective randomized study was to evaluate the effect of bottle-feeding on early postoperative course after palatoplasty in a relatively homogeneous group of patients. Eighty-two consecutive patients with nonsyndromic cleft palate undergoing 2-flap palatoplasty by a single surgeon were randomized to feeding from a bottle with the usual nipple (G1, N = 42) or to feeding with a spoon, cup, or syringe (G2, N = 40). Complication rates, postoperative sedative use, oral intake for the first 6 days, and relative weight gain at 1 and 2 months were compared. There were no significant complications such as bleeding or respiratory problem. The overall complication rate including wound dehiscence and oronasal fistula was similar in G1 and G2 (11.9% versus 12.5%, P = 1.000) as was postoperative sedative use and mean daily oral intake for the first 5 days. Mean intake on the sixth day was significantly higher in G1. There were no significant between-group differences in relative weight gain after 1 and 2 months. In conclusion, bottle-feeding had no adverse effect on the early postoperative course after palatoplasty including complication rate, oral intake, and weight gain. These findings suggest that an unrestricted feeding regimen is appropriate immediately after palatoplasty.

  5. [Diagnosis and risk assessment of postoperative complications of gastric cancer in Japan and Korea].

    Science.gov (United States)

    Hu, Xiang; Zhang, Chi

    2017-02-25

    Radical surgery of gastric cancer (D2 lymph node dissection) as the standard operation is widely used in clinical practice and satisfactory prognosis can be obtained in patients who receive radical gastrectomy. But surgical invasion can cause high morbidity of complications and mortality. The data of large-scale evidence-based medical clinical trials and large databases in Japan and Korea showed that anastomotic leakage, pancreatic leakage and abdominal abscess were the most common complications after gastrectomy, and the morbidity of complication was about 20% and mortality was about 1%. The risk factors such as elderly, obesity, and comorbidities may increase the morbidity of complications and mortality, and these factors were regarded as poor predictors after operation. Postoperative complications criteria of gastric cancer surgery is mainly used with Clavien-Dindo classification of surgical complications as international standard, and this criteria is also used in Korea. The postoperative complications are evaluated with the Common Terminology Criteria for Adverse Events (CTCAE v4.0) and Japanese Clinical Oncology Group(JCOG) postoperative complications criteria for grading definitions of postoperative complications after gastric surgery in Japan. These classifications of postoperative complications criteria were adopted widely in Japan with large-scale evidence-based medical clinical trials of gastric cancer. PS, ASA, POSSUM, E-PASS, APACHE-II(, Charison weighted index of comorbidities (WIC), Frailty Score was used in predicting postoperative mortality and morbidity in gastric cancer patients. These risk factors were assigned points in scoring systems to objectively evaluate risk of surgery, and surgical operation method was one of the risk factors on the basis of these scoring systems. We can use these scoring systems for choosing reasonable surgical methods and proper perioperative management.

  6. Effect of Pre-Designed Instructions for Mothers of Children with Hypospadias on Reducing Postoperative Complications

    Science.gov (United States)

    Mohamed, Sanaa A.

    2015-01-01

    Hypospadias is a common congenital anomaly with a prevalence estimated to be as high as 1 in 125 live male births. Complications after surgical procedures are possible. The incidence of complications can be reduced by meticulous preoperative planning, and judicious postoperative care. So the aim of the study was to investigate the effect of…

  7. Post-operative bariatric surgery complications: Deficiency of nutrients

    Directory of Open Access Journals (Sweden)

    Syed Abdul Majid Mufaqam1, Soni Dhwani Satishkumar2, Patel Palak Arvindkumar2

    2013-08-01

    Full Text Available Since more than half of the population in America falls under the category of obesity, scientists have discovered a surgical technique to reduce the weight of the obese patients. Bariatric surgery or gastric bypass surgery is a procedure that has been successful in reducing the weight for obese people. This technique requires a permanent gastric bypass (Roux-en-Y where part of the stomach and duodenum is removed. Since the size of the stomach is reduced to 20% of its original size along with the removal of duodenum – this may lead to improper absorption of several vitamins and minerals. This review showed that several vitamins and mineral deficiencies are observed in patients, post-operative bariatric surgery. Thiamin, folate, and B12 deficiencies were most commonly observed, and Vitamin A, D, C and B6 deficiencies were also seen in some cases. Iron and calcium deficiencies were also reported by some of the studies.

  8. Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms?

    Science.gov (United States)

    Cañizares Carretero, Miguel-Ángel; García Fontán, Eva-María; Blanco Ramos, Montserrat; Soro García, José; Carrasco Rodríguez, Rommel; Peña González, Emilio; Cueto Ladrón de Guevara, Antonio

    2017-03-01

    Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer

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    Sharma Mamta S

    2006-06-01

    Full Text Available Abstract Background With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer. Methods In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy, we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods – logistic regression, Cox proportional hazards regression and Poisson regression, respectively – to examine the association of the predictors with these three domains. Results We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR = 8.9, p = 0.001], abdominal distension (3.8, 0.048 and a need of blood transfusion (OR = 8.2, p = 0.027. Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR = 2.6, p = 0.015; RR = 4.6, p - blood group (RH = 4.7, p = 0.04. Conclusion Abdominal distension, presence of a concomitant medical illness and a history suggestive of shock at the time of admission warrant a closer and alacritous postoperative management in patients of perforated peptic ulcer.

  10. Postoperative Decrease in Platelet Counts Is Associated with Delayed Liver Function Recovery and Complications after Partial Hepatectomy.

    Science.gov (United States)

    Takahashi, Kazuhiro; Kurokawa, Tomohiro; Oshiro, Yukio; Fukunaga, Kiyoshi; Sakashita, Shingo; Ohkohchi, Nobuhiro

    2016-05-01

    Peripheral platelet counts decrease after partial hepatectomy; however, the implications of this phenomenon are unclear. We assessed if the observed decrease in platelet counts was associated with postoperative liver function and morbidity (complications grade ≤ II according to the Clavien-Dindo classification). We enrolled 216 consecutive patients who underwent partial hepatectomy for primary liver cancers, metastatic liver cancers, benign tumors, and donor hepatectomy. We classified patients as either low or high platelet percentage (postoperative platelet count/preoperative platelet count) using the optimal cutoff value calculated by a receiver operating characteristic (ROC) curve analysis, and analyzed risk factors for delayed liver functional recovery and morbidity after hepatectomy. Delayed liver function recovery and morbidity were significantly correlated with the lowest value of platelet percentage based on ROC analysis. Using a cutoff value of 60% acquired by ROC analysis, univariate and multivariate analysis determined that postoperative lowest platelet percentage ≤ 60% was identified as an independent risk factor of delayed liver function recovery (odds ratio (OR) 6.85; P decreased postoperative prothrombin time ratio and serum albumin level and increased serum bilirubin level when compared with patients with platelet percentage ≥ 61%. A greater than 40% decrease in platelet count after partial hepatectomy was an independent risk factor for delayed liver function recovery and postoperative morbidity. In conclusion, the decrease in platelet counts is an early marker to predict the liver function recovery and complications after hepatectomy.

  11. [ANALYSIS OF COMPLICATIONS POSTOPERATIVE CAUSES AND MORTALITY AFTER RADICAL TREATMENT FOR TUMORS OF THE LEFT ANATOMICAL SEGMENT OF THE PANCREAS].

    Science.gov (United States)

    Kopchak, V M; Kopchak, K V; Khomyak, I V; Duvalko, O V; Tkachuk, O S; Andronik, S V; Shevkolenko, H H; Khanenko, V V; Kvasivka, O O; Zubkov, O O

    2015-07-01

    Radical surgery for tumors of the left anatomical and surgical segment of the pancreas proved for distal resection in various versions, central resection and enucleation of tumors. The causes of early postoperative complications and mortality in 129 patients aged from 14 to 81 years, operated on for neoplastic lesions of the left anatomical segment of the pancreas in the period from 2009 to 2014 were analysed. The influence of various factors of risk of complications and mortality were studied in particular, extended resection, for tumor invasion of adjacent organs, and adjacent vessels.

  12. Risk of post-operative complications associated with anti-TNF therapy in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Tauseef Ali; Laura Yun; David T Rubin

    2012-01-01

    There have been increasing concerns regarding the safety of perioperative antitumour necrosis factor (antiTNF) α agents. We performed a literature review to evaluate the postoperative complications associated with perioperative antiTNF use in patients with inflammatory bowel disease. A comprehensive review was performed with a literature search utilizing Pub Med, Cochrane, OVID and EMBASE databases according to published guidelines. To date, there are only data for infliximab. There are three published studies which have assessed postoperative complications with perioperative infliximab use in patients with Crohn's disease (CD), four studies in ulcerative colitis (UC) patients, and one study on both CD and UC patients. Two out of the three studies in CD patients showed no increased postoperative complications associated with perioperative infliximab. Two out of four studies in UC patients also did not show an increase in postoperative complications, and the combined study with CD and UC patients did not show an increased risk as well. Study differences in study designs, patient population and definition of their endpoints. There appears to be a risk of postoperative complications associated with TNF therapy in some patients. Based on these data, careful patient selection and prospective data collection should be performed.

  13. Time in the stair-climbing test as a predictor of thoracotomy postoperative complications.

    Science.gov (United States)

    Ambrozin, Alexandre Ricardo Pepe; Cataneo, Daniele Cristina; Arruda, Karine Aparecida; Cataneo, Antônio José Maria

    2013-04-01

    The stair-climbing test as measured in meters or number of steps has been proposed to predict the risk of postoperative complications. The study objective was to determine whether the stair-climbing time can predict the risk of postoperative complications. Patients aged more than 18 years with a recommendation of thoracotomy for lung resection were included in the study. Spirometry was performed according to the criteria by the American Thoracic Society. The stair-climbing test was performed on shaded stairs with a total of 12.16 m in height, and the stair-climbing time in seconds elapsed during the climb of the total height was measured. The accuracy test was applied to obtain stair-climbing time predictive values, and the receiver operating characteristic curve was calculated. Variables were tested for association with postoperative cardiopulmonary complications using the Student t test for independent populations, the Mann-Whitney test, and the chi-square or Fisher exact test. Logistic regression analysis was performed. Ninety-eight patients were evaluated. Of these, 27 showed postoperative complications. Differences were found between the groups for age and attributes obtained from the stair-climbing test. The cutoff point for stair-climbing time obtained from the receiver operating characteristic curve was 37.5 seconds. No differences were found between the groups for forced expiratory volume in 1 second. In the logistic regression, stair-climbing time was the only variable associated with postoperative complications, suggesting that the risk of postoperative complications increases with increased stair-climbing time. The only variable showing association with complications, according to multivariate analysis, was stair-climbing time. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  14. [Significance and prevention of post-operative wound complications].

    Science.gov (United States)

    Napp, M; Gümbel, D; Lange, J; Hinz, P; Daeschlein, G; Ekkernkamp, A

    2014-01-01

    Although surgical site infections (SSI) in dermatologic operative procedures are extremely rare, it is important to understand risks and etiological factors to initiate risk assessment and specific preventive measures. SSI commonly are associated with a complicated, long-term and expensive outcome. Typical wound pathogens of these infections include a variety of multiresistant organisms along with Staphylococcus aureus, Staphylococcus epidermidis, hemolytic streptococci and the gram-negative bacilli Escherichia coli and Pseudomonas aeruginosa. Effective hygienic measures as part of an adequate quality management system should consider the critical points in the development of SSI, particularly in the setting of an outpatient dermatologic unit, such as preparation of the operative area, preoperative skin antisepsis, hand hygiene, safe and skilled technique by surgeons, and barrier nursing to prevent spread of pathogens. The baseline infection incidence in dermatologic surgery inherently is low; nevertheless significant improvements can be achieved by implementation of risk-adapted infection control measures.

  15. Complications of rotator cuff surgery—the role of post-operative imaging in patient care

    Science.gov (United States)

    Thakkar, R S; Thakkar, S C; Srikumaran, U; Fayad, L M

    2014-01-01

    When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low “metal presence” and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms. PMID:24734935

  16. Nutritional risk index is predictor of postoperative complications in operations of digestive system or abdominal wall?

    Science.gov (United States)

    Thieme, Rubia Daniela; Cutchma, Gislaine; Chieferdecker, Maria Eliana Madalozzo; Campos, Antônio Carlos Ligocki

    2013-01-01

    Malnutrition can be considered the most common disease in hospitals due to its high prevalence. To investigate the methods of evaluation of the nutritional status that better correlate with postoperative complications and the length of hospital stay in patients submitted to gastrointestinal or abdominal wall surgeries. This is a retrospective evaluation of 215 nutritional assessment records. All were submitted to traditional anthropometry (weight, height, BMI, arm circumference, triceps skinfold thickness and mid-arm muscle circumference), subjective global assessment, serum albumin and lymphocyte count. Nutritional risk index was also calculated. A total of 125 patients were included. Malnutrition was diagnosed by mid-arm muscle circumference, nutritional risk index and subjective global assessment in 46%, 88% and 66%, respectively. Severe malnutrition was found in 17,6% if considered subjective global assessment and in 42% by the nutritional risk index. Oncologic patients had a worst nutritional status according to this index (5,42 less units). There was a negative correlation between occurrence the noninfectious postoperative complications with the nutritional risk index (p=0,0016). Similarly, lower serum albumin levels were associated with higher non infectious complications (p=0,0015). The length of hospital stay was, in average, 14,24 days less in patients without complications as compared with non infectious postoperative complications (p<0,05). Nutritional risk index and serum albumin are the parameters with the best capacity to predict the occurrence of non infectious postoperative complications and the length of hospital stay was higher to this patients.

  17. Carotid thromboses in the early postoperative period after carotid endarterectomy.

    Science.gov (United States)

    Pokrovskiĭ, A V; Kuntsevich, G I; Beloiartsev, D F; Timina, I E; Kolosov, R V

    2005-01-01

    demonstrated postoperative progression of neurological symptomatology and coma with fatal outcome. The last patient, for whom a reoperation was contraindicated, died due to aggravation of cerebral coma. Dynamic follow-up in early postoperative period after CEA, especially in the first 6 hours, as well as an urgent duplex scanning of the reconstructed area in case of neurological symptoms development, provides timely diagnosis of postoperative thrombosis and the success of reoperations. Adjustments to patient's cardiac status and appropriate intraoperative heparinization can decrease the risk of this complication. An urgent reoperation aimed at the restoration of carotid blood flow, immediately after the diagnosis of thrombosis (provided the absence of deep coma), promotes a complete or partial regression of neurological symptoms and helps to prevent a progression of cerebrovascular disturbances.

  18. Value of a step-up diagnosis plan: CRP and CT-scan to diagnose and manage postoperative complications after major abdominal surgery

    Directory of Open Access Journals (Sweden)

    Jennifer Straatman

    2014-12-01

    Full Text Available Postoperative complications frequently follow major abdominal surgery and are associated with increased morbidity and mortality. Early diagnosis and treatment of complications is associated with improved patient outcome. In this study we assessed the value of a step-up diagnosis plan by C-reactive protein and CT-scan (computed tomography-scan imaging for detection of postoperative complications following major abdominal surgery. An observational cohort study was conducted of 399 consecutive patients undergoing major abdominal surgery between January 2009 and January 2011. Indication for operation, type of surgery, postoperative morbidity, complications according to the Clavien-Dindo classification and mortality were recorded. Clinical parameters were recorded until 14 days postoperatively or until discharge. Regular C-reactive protein (CPR measurements in peripheral blood and on indication -enhanced CT-scans were performed. Eighty-three out of 399 (20.6 % patients developed a major complication in the postoperative course after a median of seven days (IQR 4-9 days. One hundred and thirty two patients received additional examination consisting of enhanced CT-scan imaging, and treatment by surgical reintervention or intensive care observation. CRP levels were significantly higher in patients with postoperative complications. On the second postoperative day CRP levels were on average 197.4 mg/L in the uncomplicated group, 220.9 mg/L in patients with a minor complication and 280.1 mg/L in patients with major complications (p < 0,001. CT-scan imaging showed a sensitivity of 91.7 % and specificity of 100 % in diagnosis of major complications. Based on clinical deterioration and the increase of CRP, an additional enhanced CT-scan offered clear discrimination between patients with major abdominal complications and uncomplicated patients. Adequate treatment could then be accomplished.

  19. Early enteral nutrition therapy in congenital cardiac repair postoperatively: A randomized, controlled pilot study

    Science.gov (United States)

    Sahu, Manoj Kumar; Singal, Anuradha; Menon, Ramesh; Singh, Sarvesh Pal; Mohan, Alka; Manral, Mala; Singh, Divya; Devagouru, V.; Talwar, Sachin; Choudhary, Shiv Kumar

    2016-01-01

    Background and Objectives: Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery. Methodology: Fifty infants surgery is feasible and recommended. In addition, enriching the EBM is helpful in achieving the maximum possible calorie intake in the postoperative period. EN therapy might help in providing adequate nutrition, and it decreases ventilation duration, infection rate, LOIS, LOHS, and mortality. PMID:27716696

  20. Impact of specific postoperative complications on the outcomes of emergency general surgery patients.

    Science.gov (United States)

    McCoy, Christopher Cameron; Englum, Brian R; Keenan, Jeffrey E; Vaslef, Steven N; Shapiro, Mark L; Scarborough, John E

    2015-05-01

    The relative contribution of specific postoperative complications on mortality after emergency operations has not been previously described. Identifying specific contributors to postoperative mortality following acute care surgery will allow for significant improvement in the care of these patients. Patients from the 2005 to 2011 American College of Surgeons' National Surgical Quality Improvement Program database who underwent emergency operation by a general surgeon for one of seven diagnoses (gallbladder disease, gastroduodenal ulcer disease, intestinal ischemia, intestinal obstruction, intestinal perforation, diverticulitis, and abdominal wall hernia) were analyzed. Postoperative complications (pneumonia, myocardial infarction, incisional surgical site infection, organ/space surgical site infection, thromboembolic process, urinary tract infection, stroke, or major bleeding) were chosen based on surgical outcome measures monitored by national quality improvement initiatives and regulatory bodies. Regression techniques were used to determine the independent association between these complications and 30-day mortality, after adjustment for an array of patient- and procedure-related variables. Emergency operations accounted for 14.6% of the approximately 1.2 million general surgery procedures that are included in American College of Surgeons' National Surgical Quality Improvement Program but for 53.5% of the 19,094 postoperative deaths. A total of 43,429 emergency general surgery patients were analyzed. Incisional surgical site infection had the highest incidence (6.7%). The second most common complication was pneumonia (5.7%). Stroke, major bleeding, myocardial infarction, and pneumonia exhibited the strongest associations with postoperative death. Given its disproportionate contribution to surgical mortality, emergency surgery represents an ideal focus for quality improvement. Of the potential postoperative targets for quality improvement, pneumonia, myocardial

  1. Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Anirban Hom Choudhuri

    2014-01-01

    Full Text Available Background: Postoperative pulmonary complication (PPC is a serious complication after liver surgery and is a major cause of mortality and morbidity in the intensive care unit (ICU. Therefore, the early identification of risk factors of PPCs may help to reduce the adverse outcomes. Objective: The aim of this retrospective study was to determine the predictors of PPCs in patients undergoing hepatic resection. Design: Retrospective, observational. Methods: The patients admitted after hepatic resection in the gastrosurgical ICU of our institute between October 2009 and June 2013 was identified. The ICU charts were retrieved from the database to identify patients who developed PPCs. A comparison of risk factors was made between the patients who developed PPC (PPC group against the patients who did not (no-PPC group. Results: Of 117 patients with hepatic resection, 28 patients developed PPCs. Among these, pneumonia accounted for 12 (42.8% followed by atelectasis in 8 (28.5% and pleural effusion in 3 (10.7%. Among the patients developing PPCs, 16 patients were over a 70-year-old (57.1%, 21 patients were smokers (75% and 8 patients (28.5% had chronic obstructive pulmonary disease (COPD. The requirement for blood transfusion and duration of mechanical ventilation were greater in the patients developing PPC (2000 ± 340 vs. 1000 ± 210 ml; 10 ± 4.5 vs. 3 ± 1.3 days. Conclusion: Old age, chronic smoking, COPD, increased blood product transfusion, increased duration of mechanical ventilation and increased length of ICU stay increased the relative risk of PPC, presence of diabetes and occurrence of surgical complications (leak, dehiscence, etc. were independent predictive variables for the development of PPC.

  2. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    Science.gov (United States)

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  3. Early postoperative bone scintigraphy in the evaluation of microvascular bone grafts in head and neck reconstruction

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    Poissonnet Gilles

    2007-04-01

    Full Text Available Abstract Background Bone scintigraphy was performed to monitor anastomotic patency and bone viability. Methods In this retrospective study, bone scans were carried out during the first three postoperative days in a series of 60 patients who underwent microvascular bone grafting for reconstruction of the mandible or maxilla. Results In our series, early bone scans detected a compromised vascular supply to the bone with high accuracy (p Conclusion When performing bone scintigraphy during the first three postoperative days, it not only helps to detect complications with high accuracy, as described in earlier studies, but it is also an additional reliable monitoring tool to decide whether or not microvascular revision surgery should be performed. Bone scans were especially useful in buried free flaps where early postoperative monitoring depended exclusively on scans. According to our experience, we recommend bone scans as soon as possible after surgery and immediately in cases suspicious of vascularized bone graft failure.

  4. Clinical nursing path after endoscopic submucosal dissection reduces the risk of postoperative complications

    Institute of Scientific and Technical Information of China (English)

    Xia Bai; Jun-Ping Wang; Lan Ming; Ya-Jie Xu; Xia Sun

    2016-01-01

    Objective: To investigate the effect of the nursing path on postoperative complications after endoscopic submucosal dissection (ESD). Method: Patients' nursing paths for ESD were established based on a systematic analysis of relevant literature, previous clinical procedures and consultation with chief physicians from a gastroenterology department. Forty patients were divided into the observation or control group and were assigned to follow the nursing path or the conventional path after an ESD, respectively. Next, the incidence of postoperative complications of these two groups was measured, primarily assessing the occurrences of bleeding, perforation, infection, and anxiety. Results: The incidence of complications after ESD in the observation group was remarkably lower than that of the control group (P Conclusion: The nursing path for ESD has a positive role in reducing certain frequent complications that occur after ESD, particularly infection and anxiety;in addition, the nursing path optimizes nursing care in patients with gastrointestinal stromal tumor.

  5. Post-Operative Complications of Ventriculoperitoneal Shunt in Hydrocephalic Pediatric Patients-Nursing Care

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    Efstratios Athanasakis

    2011-01-01

    Full Text Available Introduction: Hydrocephalus is the most common congenital abnormality of the central nervous system ininfants. Many cases of hydrocephalic children are described since ancient times. It is characterized by excessiveaccumulation of cerebrospinal fluid in the ventricles of the brain. Its symptomatology during infanthood or earlychildhood is characterized by swelling of the head, protrusion of the forehead and brain atrophy. All thesesymptoms appear due to increased cerebrospinal fluid volume, increased intracranial pressure and dilatation ofthe ventricular walls.Aim: The aim of this paper is to describe the ventriculoperitoneal shunt complications in pediatrics patients andto point out the role of nursing stuff in the prevention of them.Methods: This include literature search on the database Medline and relevant with that issue internationalhydrocephalus organizations to identify studies regarding the complications of ventriculoperitoneal shunt and thenursing care for each complication.Results: Ventriculoperitoneal shunt is the treatment of hydrocephalic infants, rather than endoscopic thirdventriculostomy. Although the success of the ventriculoperitoneal shunt’s placement, the patients usually sufferfrom its afterwards complications. The complications involves postoperative shunt infection, shunt placementfailure, shunt obstruction – malfunction, abdominal complications – peritonitis, valve complications, slitventriclesyndrome and seizures. The role of the nursing stuff is vital, particularly in the postoperative weeks.Conclusion: A proper nursing assessment includes valid identification of complications and their prompttreatment. Also, nurses had to implement accurate nursing care, in order to prevent any complication. Finally,parental teaching from the nurses is crucial in the process of health outcomes for pediatric patient.

  6. Temporary ileostomy for the preservation of colon fistula in patients with postoperative complications: case report

    OpenAIRE

    Solaine Chiminácio De Oliveira Patrício; Alcides José Branco Filho; Ana Carla Broetto Biazon

    2011-01-01

    Among the postoperative complications in the digestive system, the fistulae are the most common ones. The changes resulting from these fistulae are very important, once they can determine the patient's situation and the development of multiple organic failures. This paper reports the case of a patient who had relevant complications after having undergone temporary ileostomy to maintain the colon fistulized. About 90 to 95% of the digestive tract fistulae have spontaneous resolution. In so...

  7. Acute Pancreatitis in the Postoperative Course after Esophagectomy: A Major Complication Described in 4 Patients

    Directory of Open Access Journals (Sweden)

    R.L.G.M. Blom

    2009-11-01

    Full Text Available Background: Postoperative pancreatitis is a rare but devastating complication after esophageal surgery. It has been described in connection with abdominal surgery but the etiology in connection with esophageal surgery has never been evaluated. The present study describes 4 cases of postoperative pancreatitis, and a hypothesis about the etiology is formed. Methods: We performed a search for patients with postoperative pancreatitis after esophagectomy using our prospective database including all patients that underwent esophageal resection at our institution between 1993 and 2008. Pancreatitis was described as abdominal pain, hyperamylasemia, signs of pancreatitis on CT scan or findings during laparotomy or autopsy. Results: A total of 950 patients underwent esophagectomy at our institution, 4 patients developed postoperative pancreatitis (incidence 0.4%. Two out of four patients died. Discussion: Pancreatitis following esophageal surgery is a serious, potentially lethal complication. Diagnosis can be difficult as clear clinical or laboratory findings might be lacking. Peroperative manipulation of the pancreas, mobilization of the duodenum or compromized vascularization have been suggested as etiological factors; although in the described patients, none of these factors were identified as the cause of pancreatitis. In conclusion, pancreatitis following esophageal surgery is a serious but rare complication that should always be considered in patients who deteriorate postoperatively.

  8. Biopsies in the Community Lead to Postoperative Complications in Soft Tissue Sarcomas.

    Science.gov (United States)

    Bedi, Meena; King, David M; Hackbarth, Donald A; Charlson, John A; Baynes, Keith; Neilson, John C

    2015-09-01

    Percutaneous biopsies allow for precise diagnosis in soft tissue sarcomas and have a low rate of complications. However, it is unknown whether biopsies performed in a community setting lead to higher rates of wound complications at the time of resection. The goal of this study was to determine whether percutaneous biopsies performed at a sarcoma center have lower rates of wound complications compared with those performed in the community setting. A total of 125 patients with soft tissue sarcomas were treated with neoadjuvant radiation followed by limb-sparing resection. Of these, 92 underwent percutaneous biopsy. Patient, demographic, and treatment variables and postoperative wound complications were reviewed. Predictors of wound complications were evaluated with Fisher's exact test for univariate analysis and with logistic regression for multivariate analysis. The wound complication rate was 27% for open or percutaneous biopsies. When only percutaneous biopsies were assessed, the wound complication rate was 25%. The wound complication rate for percutaneous biopsies was 18% when the biopsy was performed at the authors' sarcoma center and 46% when the biopsy was performed in the community setting (P=.01). The Common Terminology Criteria for Adverse Events grade 4 wound complication rate was 73% in patients who underwent percutaneous biopsy at a community hospital vs 14% in those who underwent percutaneous biopsy at the authors' sarcoma center (P=.005). Multivariate analysis showed that lower-extremity soft tissue sarcomas (P=.03) and biopsies performed in the community setting (P=.01) had an increased rate of postoperative wound complications. Percutaneous biopsies performed at community hospitals had an increased incidence of grade 4 postoperative wound toxicity compared with biopsies done at tertiary centers. These wound results confirmed previous recommendations that biopsy of soft tissue sarcomas should be performed at an experienced sarcoma center.

  9. Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea

    Science.gov (United States)

    Stefan, Mihaela S.; Hill, Nicholas S.; Raghunathan, Karthik; Liu, Xiaoxia; Pekow, Penelope S.; Memtsoudis, Stavros G.; Ramachandran, Satya Krishna; Lindenauer, Peter K.

    2016-01-01

    Study Objectives: To examine the relationship of early initiation of noninvasive ventilation (NIV) with postoperative outcomes in patients with obstructive sleep apnea (OSA) undergoing bariatric surgery. Methods: We included 5,266 patients with OSA undergoing bariatric surgeries at 161 hospitals in the United States. We defined early postoperative NIV as NIV used on the day of or the day after surgery; this could include prophylactic NIV or NIV used for early signs of respiratory deterioration. We developed a hierarchical model to identify factors associated with early use of NIV. Then, in a propensity matched cohort, we assessed the association between NIV use and outcomes. Results: Overall, 996 patients (18.9%) were treated with early postoperative NIV. Predictors of NIV initiation were: male sex (odds ratio: 1.34, 95% confidence interval 1.14–1.59), older age, chronic obstructive pulmonary disease (COPD; odds ratio 1.39, confidence interval: 1.17–1.64), gastric bypass surgery, short-acting narcotics intravenous on the day of surgery and admission to a hospital with high rate of OSA diagnosis. In a propensity matched analysis, we found no significant association between early initiation of NIV and receipt of invasive mechanical ventilation (IMV) (early NIV 4.5% vs. no NIV 3.8% p = 0.46), cardiovascular complications or mortality. Results were consistent in several sensitivity analyses. Conclusions: In this large observational study of patients with OSA undergoing bariatric surgery, early postoperative NIV use was not associated with better outcomes including less intubation and mortality. Properly designed controlled trials will be necessary to provide more definitive answers to this important clinical question. Citation: Stefan MS, Hill NS, Raghunathan K, Liu X, Pekow PS, Memtsoudis SG, Ramachandran SK, Lindenauer PK. Outcomes associated with early postoperative noninvasive ventilation in bariatric surgical patients with sleep apnea. J Clin Sleep Med 2016

  10. Surgical Treatment of Orbital Blowout Fractures: Complications and Postoperative Care Patterns.

    Science.gov (United States)

    Shew, Matthew; Carlisle, Michael P; Lu, Guanning Nina; Humphrey, Clinton; Kriet, J David

    2016-11-01

    Orbital fractures are a common result of facial trauma. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. Average length of stay was 17 hours for those observed overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on

  11. Postoperative complications after reconstructive surgery for cloacal malformations: a systematic review

    NARCIS (Netherlands)

    Versteegh, H.P.; Sutcliffe, J.R.; Sloots, C.E.; Wijnen, R.M.; Blaauw, I. de

    2015-01-01

    The repair of cloacal malformations is most often performed using a posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) or total urogenital mobilization (TUM) with or without laparotomy. The aim of this study was to systematically review the frequency and type of postoperative complication se

  12. Impact of Nursing Educational Program on Reducing or Preventing Postoperative Complications for Patients after Intracranial Surgery

    Science.gov (United States)

    Elmowla, Rasha Ali Ahmed Abd; El-Lateef, Zienab Abd; El-khayat, Roshdy

    2015-01-01

    Intracranial surgery means any surgery performed inside the skull to treat problems in the brain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr…

  13. Modification of early postoperative X-ray research after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Sapounov, S.

    1982-10-01

    A modification of the early postoperative X-ray research after gastrectomy is described. The application of gastrografin happens through a nasogastric tube. By changing the position of its tip during the screening control, and excellent and precise represention of the anastomotic region will be achieved. We present a research of 35 patients.

  14. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M; Jørgensen, Christoffer Calov; Jørgensen, T B

    2009-01-01

    BACKGROUND: A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand because of symptoms of cerebral hypoperfusion as intolerable dizziness, nausea and vomiting, feeling of heat...

  15. The effect of routine availability of sugammadex on postoperative respiratory complications: a historical cohort study.

    Science.gov (United States)

    Olesnicky, Benjamin L; Traill, Catherine; Marroquin-Harris, Frank B

    2017-03-01

    Postoperative residual curarisationf is a preventable cause of postoperative morbidity. Although sugammadex has been shown to reduce the risk of residual curarisation, it has not yet been shown if this directly translates to a reduction in morbidity. We aimed to demonstrate whether the introduction of unrestricted sugammadex for routine reversal changed the incidence of post-operative respiratory diagnoses and the rate of airway and respiratory complications in the post-operative care unit. A historical cohort study of 1257 patients who underwent general surgical or ear, nose and throat (ENT) procedures before and after the introduction of unrestricted availability of sugammadex. Patient records were used to identify the incidence of postoperative in-hospital respiratory diagnoses and of airway complications in PACU, the pattern of muscle relaxant use and the relative costs associated with the routine availability of sugammadex. Unrestricted sugammadex availability was associated with a significant reduction in the rate of a postoperative in-hospital respiratory diagnosis; Odds Ratio (OR) = 0.20 (95%CI 0.05-0.72, p=0.01). Furthermore, the use of sugammadex itself was also associated with a reduction in inhospital respiratory diagnoses; OR = 0.26 (95%CI 0.08-0.94, p=0.04). Unrestricted sugammadex was also associated with a decrease in the need for manual airway support in the recovery room (3.2% vs 1.1%, p=0.02) and a decrease in patients being transferred intubated to ICU (5.5% vs 1.3%, psugammadex availability is associated with a reduction in post-operative respiratory complications. A well-designed, prospective randomised trial is needed to provide further validation of the data.

  16. [Stair climbing test in prediction of postoperative complications after lung cancer surgery].

    Science.gov (United States)

    Zurauskas, Aleksas; Tikuisis, Renatas; Miliauskas, Povilas

    2002-01-01

    Preoperative physical state of a patient is very important for adaptation of the patient after lung resections. Purpose of this work is to evaluate an information factor of a stair-climbing test while predicting of postoperative complications after lung cancer surgery. Fifty two patients were examined, who passed lung surgery of different volume. The patients are distributed to two groups: I(st) group included the patients able to climb 1-44 footsteps (n=22/42.3%) and the II(nd) group included the patients able to climb more than 44 footsteps at a moderate speed without stopping for rest (n=30/57.7%). One flight of stairs made up to 22 footsteps with 15 cm of height each. Postoperative myocardial ischemia, disorders of heart rhythm, pneumonias, atelectasis, prolonged artificial ventilation of lungs, sanative bronchoscopy, duration of treatment, and cases of death were registered. It was established that postoperative cardiac and lung complications occurred in 17 patients (32.7%), two patients died (3.8%). Rate of complications between the patients of the I(st) and II(nd) group was 82.4 ir 17.6 percent. Postoperative course was normal for those patients (n=11) who were able to climb five or more flights of stairs. It was noticed that duration of postoperative period has an inverse proportion to a number of the climbed up footsteps. The stair-climbing test is a simple, safe, cheap and informative enough for prediction of postoperative cardiopulmonary complications after lung cancer surgery.

  17. 肾细胞癌合并下腔静脉癌栓患者发生术后早期并发症的临床分析%Early postoperative complications of renal cell cancer surgery with inferior vena cava tumor thrombus invasion

    Institute of Scientific and Technical Information of China (English)

    刘茁; 马潞林; 王国良; 侯小飞; 赵磊; 张树栋; 田晓军; 肖春雷; 卢剑

    2016-01-01

    Objective To analyze the early postoperative complications in renal cell cancer (RCC) surgery with inferior vena cava tumor thrombus (IVCTT) invasion.Methods The clinical data of 27 patients with RCC and IVCTT from February 2015 to April 2016 were analyzed retrospectively.Of the 27 patients,21 were male and 6 were female.The average age was (61.7 ± 9.8) years old (47 to 84 years).The average body mass index (BMI) was (22.2 ± 2.9) kg/m2 (17.6 to 30.8 kg/m2).Imaging suggested the right renal tumor in 18 cases and left renal tumor in 9 cases.The tumor size ranged from 3.6 to 21.1 cm.The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients,including type 0 thrombus in 6 cases,type Ⅰ thrombus in 6 cases,type Ⅱ thrombus in 8 cases,type Ⅲ thrombus in 5 cases and type Ⅳ thrombus in 2 cases (Mayo Medical Center classification).We completed laparoscopic surgery for RCC with IVCTT in 14 cases and open surgery in 13 cases.Postoperative complications were graded according to the modified Clavien classifications,respectively.Serious complications were defined as grade Ⅲ or higher.Results Among 27 patients,early postoperative complications occurred in 14 cases (51.9%).Chyle leak occurred in 2 cases,they were cured after treated with dietcontrol and subcutaneous injection of somatostatin.Lower extremity venous thrombosis occurred in 3 cases,they were cured after treatment with low molecular weight heparin.Three cases had postoperative pulmonary infection and were cured after antibiotics treatment.Bilateral thigh rash occurred in 1 case.Considering related with antibiotic induced allergy,we stopped the drug and treated with intravenous drip of vitamin C and glucose acid calcium.Serious postoperative complication rate was 18.5% (5 cases).One case had postoperative abdominal distension and peritoneal effusion.He underwent ultrasound guided puncture and drainage.Renal insufficiency and hyperkalemia occurred in 2 cases,they were cured

  18. EFFECT OF CHECKLIST ON THE OCCURRENCE OF POSTOPERATIVE COMPLICATION ON SURGICAL PATIENT

    Directory of Open Access Journals (Sweden)

    Birhanemeskel Tegene Adankie

    2017-01-01

    Full Text Available Background: Surgical safety checklists (SSCs are designed to improve inter professional communications and ultimately avoiding catastrophic errors that often characterizes the culture of surgical teams. However, data on effect of surgical checklists implementation are scarce in the study area. The purpose of this research project was to directly examine the effect of utilization surgical safety checklist on patient outcomes at University of Gondar Hospital, in Northwest Ethiopia. Material and methods: Institution based cross sectional study was done at Gondar university teaching hospitals from January to May 2013. We reviewed medical records of all consecutive patients admitted to the surgery department (N=403. For those who have clinical symptoms of surgical site infection a laboratory diagnosis were performed to compare occurrences of all postoperative complication among patients with and without utilization of surgical safety checklist. Results: During the study period from 403 patients operated, SSCs were attached for only 158 (39.2% of the surgical patients. Post-operative complication were observed in 238 (59 % of the patients and postoperative fever was the major complication accounting for 70 (17.3% of all the complication. Surgical wound infection and pneumonia accounted for 47(16.6% and 33(11.7% respectively. S. aurous was the predominant isolated bacteria accounted for 7(30%, In addition, a statistically non-significant 11.2% decline the rate of surgical wound infection in the checklist group. In a logistic regression model of postoperative fever, the SSCs emerged as a significant independent predictor of this outcome: (OR = 0.49, 95% CI 0.31–0.75, and P value = 0.001. Conclusions and recommendation: patients with checklist have observed significant reductions of post operative complication particularly bacterial infection. It is possible to some extent that the improved usage of check list and preoperative prophylactic antibiotics

  19. Effect of smoking on early complications after elective orthopaedic surgery

    DEFF Research Database (Denmark)

    Møller, Ann; Pedersen, Tom Søndergård; Villebro, Nete

    2003-01-01

    Smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. We studied 811 consecutive patients who had undergone hip or knee arthroplasty, recording current smoking and drinking habits, any history of chronic disease and such ......Smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. We studied 811 consecutive patients who had undergone hip or knee arthroplasty, recording current smoking and drinking habits, any history of chronic disease...

  20. Sarcopenia Adversely Impacts Postoperative Complications Following Resection or Transplantation in Patients with Primary Liver Tumors

    Science.gov (United States)

    Valero, Vicente; Amini, Neda; Spolverato, Gaya; Weiss, Matthew J.; Hirose, Kenzo; Dagher, Nabil N.; Wolfgang, Christopher L.; Cameron, Andrew A.; Philosophe, Benjamin; Kamel, Ihab R.

    2015-01-01

    Background Sarcopenia is a surrogate marker of patient frailty that estimates the physiologic reserve of an individual patient. We sought to investigate the impact of sarcopenia on short- and long-term outcomes in patients having undergone surgical intervention for primary hepatic malignancies. Methods Ninety-six patients who underwent hepatic resection or liver transplantation for HCC or ICC at the John Hopkins Hospital between 2000 and 2013 met inclusion criteria. Sarcopenia was assessed by the measurement of total psoas major volume (TPV) and total psoas area (TPA). The impact of sarcopenia on perioperative complications and survival was assessed. Results Mean age was 61.9 years and most patients were men (61.4 %). Mean adjusted TPV was lower in women (23.3 cm3/m) versus men (34.9 cm3/m) (Psarcopenia. The incidence of a postoperative complication was 40.4 % among patients with sarcopenia versus 18.4 % among patients who did not have sarcopenia (P=0.01). Of note, all Clavien grade ≥3 complications (n=11, 23.4 %) occurred in the sarcopenic group. On multivariable analysis, the presence of sarcopenia was an independent predictive factor of postoperative complications (OR=3.06). Sarcopenia was not associated with long-term survival (HR=1.23; P=0.51). Conclusions Sarcopenia, as assessed by TPV, was an independent factor predictive of postoperative complications following surgical intervention for primary hepatic malignancies. PMID:25389056

  1. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, T; Tønnesen, H; Møller, A M

    2009-01-01

    BACKGROUND: The aim of this study was to examine the effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation itself. METHODS: Relevant databases were searched for randomized controlled trials (RCTs) of preoperative smoking cessation interventions....... Trial inclusion, risk of bias assessment and data extraction were performed by two authors. Risk ratios for the above outcomes were calculated and pooled effects estimated using the fixed-effect method. RESULTS: Eleven RCTs were included containing 1194 patients. Smoking interventions were intensive......, medium intensity and less intensive. Follow-up for postoperative complications was 30 days. For smoking cessation it was from the day of surgery to 12 months thereafter. Overall, the interventions significantly reduced the occurrence of complications (pooled risk ratio 0.56 (95 per cent confidence...

  2. Interest in Rhinoplasty and Awareness about its Postoperative Complications Among Female high School Students.

    Science.gov (United States)

    Arabi Mianroodi, Aliasghar; Eslami, Mobina; Khanjani, Narges

    2012-01-01

    Rhinoplasty is a popular cosmetic surgical procedure. Informal statistics show that Iran has one of the highest rates of rhinoplasty in the world. However, rhinoplasty like any other surgery can have complications. In this cross-sectional study, 320 female students were selected by multistage cluster-stratified sampling from high schools in Kerman, Iran and each completed a questionnaire. More than half of the students said they would like to undergo rhinoplasty. The main reasons for wanting rhinoplasty were beauty and because it is fashionable. However, more than half of the interested students did not know about the possible postoperative complications of rhinoplasty. There was no relation between interest in having rhinoplasty and parents' education, city of birth or economic status. Many teenagers are interested in having rhinoplasty in Iran. As the number of teenagers and young adults who choose to have cosmetic surgery increases, surgeons should consider their expectations, motivations and awareness of postoperative complications before surgery.

  3. Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications.

    Science.gov (United States)

    Werner, Brian C; Kurkis, Gregory M; Gwathmey, F Winston; Browne, James A

    2015-09-01

    This study used a national database to compare 90-day postoperative complication rates between three groups of patients who underwent total knee arthroplasty (TKA): (1) non-obese patients (n=66,523), (2) morbidly obese patients who did not have bariatric surgery (n=11,294) and (3) morbidly obese patients who underwent bariatric surgery prior to TKA (n=219). Morbidly obese patients who underwent bariatric surgery prior to TKA had reduced rates of major (OR 0.45, P=0.001) and minor (OR 0.61, P=0.01) complications compared to morbidly obese patients who did not have bariatric surgery. Bariatric surgery prior to TKA appears to be associated with less risk of postoperative complications, although not to the same level as non-obese patients.

  4. Classification and valuation of postoperative complications in a randomized trial of open versus laparoscopic ventral herniorrhaphy.

    Science.gov (United States)

    Kaafarani, H M A; Hur, K; Campasano, M; Reda, D J; Itani, K M F

    2010-06-01

    Generic instruments used for the valuation of health states (e.g., EuroQol) often lack sensitivity to notable differences that are relevant to particular diseases or interventions. We developed a valuation methodology specifically for complications following ventral incisional herniorrhaphy (VIH). Between 2004 and 2006, 146 patients were prospectively randomized to undergo laparoscopic (n = 73) or open (n = 73) VIH. The primary outcome of the trial was complications at 8 weeks. A three-step methodology was used to assign severity weights to complications. First, each complication was graded using the Clavien classification. Second, five reviewers were asked to independently and directly rate their perception of the severity of each class using a non-categorized visual analog scale. Zero represented an uncomplicated postoperative course, while 100 represented postoperative death. Third, the median, lowest, and highest values assigned to each class of complications were used to derive weighted complication scores for open and laparoscopic VIH. Open VIH had more complications than laparoscopic VIH (47.9 vs. 31.5%, respectively; P = 0.026). However, complications of laparoscopic VIH were more severe than those of open VIH. Non-parametric analysis revealed a statistically higher weighted complication score for open VIH (interquartile range: 0-20 for open vs. 0-10 for laparoscopic; P = 0.049). In the sensitivity analysis, similar results were obtained using the median, highest, and lowest weights. We describe a new methodology for the valuation of complications following VIH that allows a direct outcome comparison of procedures with different complication profiles. Further testing of the validity, reliability, and generalizability of this method is warranted.

  5. Post-operative complications after caesarean section in HIV-infected women.

    Science.gov (United States)

    Ferrero, Simone; Bentivoglio, Giorgio

    2003-10-01

    This retrospective study evaluated complications associated with caesarean section in HIV-infected women. For each HIV-positive patient ( n=45) a control group of ten seronegative women ( n=450) was matched for age, number of foetuses, gestational age, indication for caesarean section, status of the membranes and kind of anaesthesia. All women delivered in the same hospital using a uniform protocol. We evaluated the duration of stay in hospital after operation, the need for antibiotics after caesarean section, the incidence of minor postoperative complications (mild anaemia, mild temperature or fever 24 h after surgery, wound haematoma or infection, urinary tract infection, endometritis) and major postoperative complications (severe anaemia, pneumonia, pleural effusion, peritonitis, sepsis, disseminated intravascular coagulation, thromboembolism). Most HIV-positive women (64.5%) had a complicated recovery after surgery. A higher incidence of major and minor postoperative complications were observed in the HIV-positive group than in the control group. There was a statistically significant greater incidence of mild anaemia, mild temperature or fever, urinary tract infection and pneumonia in the HIV-positive group. HIV-positive women with less than 500x10(6) CD4(+) lymphocytest/l had higher post-caesarean section morbidity than HIV-positive women with more than 500x10(6) CD4(+) lymphocytest/l. The median duration of hospital stay was significantly higher in the HIV-positive group (median 7 days) than in the HIV-negative group (median 4 days). The rate of HIV vertical transmission was 8.8%. Higher post-caesarean section morbidity was found in HIV-positive women than in controls. Unfortunately, the HIV-positive women (with low CD4 lymphocytes counts), whose infants theoretically will benefit most from caesarean delivery, are also the women who are most likely to experience post-operative complications.

  6. [Usefulness of upper gastrointestinal series to detect leaks in the early postoperative period of bariatric surgery].

    Science.gov (United States)

    Medina, Francisco J; Miranda-Merchak, Andrés; Martínez, Alonso; Sánchez, Felipe; Bravo, Sebastián; Contreras, Juan Eduardo; Alliende, Isabel; Canals, Andrea

    2016-04-01

    Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique.

  7. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer.

    Science.gov (United States)

    Garth, A K; Newsome, C M; Simmance, N; Crowe, T C

    2010-08-01

    Malnutrition and its associated complications are a considerable issue for surgical patients with upper gastrointestinal and colorectal cancer. The present study aimed to determine whether specific perioperative nutritional practices and protocols are associated with improved patient outcomes in this group. Patients admitted for elective upper gastrointestinal or colorectal cancer surgery (n = 95) over a 19-month period underwent a medical history audit assessing weight changes, nutritional intake, biochemistry, post-operative complications and length of stay. A subset of patients (n = 25) underwent nutritional assessment by subjective global assessment prior to surgery in addition to assessment of post-operative medical outcomes, nutritional intake and timing of dietetic intervention. Mean (SD) length of stay for patients was 14.0 (12.2) days, with complication rates at 35%. Length of stay was significantly longer in patients who experienced significant preoperative weight loss compared to those who did not [17.0 (15.8) days versus 10.0 (6.8) days, respectively; P nutritional assessment, 32% were classified as mild-moderately malnourished and 16% severely malnourished. Malnourished patients were hospitalised twice as long as well-nourished patients [15.8 (12.8) days versus 7.6 (3.5) days; P nutrition post surgery was a factor in post-operative outcomes, with a positive correlation with length of stay (r = 0.493; P cancer. Poor nutritional status coupled with delayed and inadequate post-operative nutrition practices are associated with worse clinical outcomes.

  8. Multivariate analysis of risk factors for postoperative complications after laparoscopic liver resection.

    Science.gov (United States)

    Tranchart, Hadrien; Gaillard, Martin; Chirica, Mircea; Ferretti, Stefano; Perlemuter, Gabriel; Naveau, Sylvie; Dagher, Ibrahim

    2015-09-01

    The identification of modifiable perioperative risk factors in patients undergoing laparoscopic liver resection (LLR) should aid the selection of appropriate surgical procedures and thus improve further the outcomes associated with LLR. The aim of this retrospective study was to determine the risk factors for postoperative morbidity associated with laparoscopic liver surgery. All patients who underwent elective LLR between January 1999 and December 2012 were included. Demographic data, preoperative risk factors, operative variables, histological analysis, and postoperative course were recorded. Multivariate analysis was carried out using an unconditional logistic regression model. Between January 1999 and December 2012, 140 patients underwent LLR. There were 56 male patients (40%) and mean age was 57.8 ± 17 years. Postoperative complications were recorded in 30 patients (21.4%). Postoperative morbidity was significantly higher after LLR of malignant tumors [n = 26 (41.3%)] when compared to LLR of benign lesions [n = 4 (5.2%) (P multivariate analysis, operative time [OR = 1.008 (1.003-1.01), P = 0.001] and LLR performed for malignancy [OR = 9.8 (2.5-37.6); P = 0.01] were independent predictors of postoperative morbidity. In the subgroup of patients that underwent LLR for malignancy using the same multivariate model, operative time was the sole independent predictor of postoperative morbidity [OR = 1.008 (1.002-1.013); P = 0.004]. Postoperative complication rate increases by 60% with each additional operative hour during LLR. Therefore, expected operative time should be assessed before and during LLR, especially when dealing with malignant tumor.

  9. Clostridium perfringens infection complicating periprosthetic fracture fixation about the hip: successful treatment with early aggressive debridement.

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2012-07-13

    Periprosthetic fracture and infection are both challenges following hip arthroplasty. We report the case of an 87 year old female who underwent open reduction and internal fixation of a periprosthetic femoral fracture. Her post-operative course was complicated by infection with Clostridium perfringens. Early aggressive antibiotic treatment and surgical debridement were successful, and allowed retention of the original components.

  10. Evaluation of postoperative complications according to treatment of third molars in mandibular angle fracture

    Science.gov (United States)

    2017-01-01

    Objectives The aim of this study was to evaluate the implication of third molars in postoperative complications of mandibular angle fracture with open reduction and internal fixation (ORIF). Materials and Methods Data were collected on patients who presented with mandibular angle fracture at our Department of Oral and Maxillofacial Surgery between January 2011 and December 2015. Of the 63 total patients who underwent ORIF and perioperative intermaxillary fixation (IMF) with an arch bar, 49 patients were identified as having third molars in the fracture line and were followed up with until plate removal. The complications of postoperative infection, postoperative nerve injury, bone healing, and changes in occlusion and temporomandibular joint were evaluated and analyzed using statistical methods. Results In total, 49 patients had third molars in the fracture line and underwent ORIF surgery and perioperative IMF with an arch bar. The third molar in the fracture line was retained during ORIF in 39 patients. Several patients complained of nerve injury, temporomandibular disorder (TMD), change of occlusion, and postoperative infection around the retained third molar. The third molars were removed during ORIF surgery in 10 patients. Some of these patients complained of nerve injury, but no other complications, such as TMD, change in occlusion, or postoperative infection, were observed. There was no delayed union or nonunion in either of the groups. No statistically significant difference was found between the non-extraction group and the retained teeth group regarding complications after ORIF. Conclusion If the third molar is partially impacted or completely nonfunctional, likely to be involved in pathologic conditions later in life, or possible to remove with the plate simultaneously, extraction of the third molar in the fracture line should be considered during ORIF surgery of the mandible angle fracture. PMID:28280708

  11. Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

    Directory of Open Access Journals (Sweden)

    Ezri Tiberiu

    2015-04-01

    Full Text Available Background: Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy.

  12. ROLE OF PRE-OPERATIVE INVESTIGATIONS IN PREVENTING THE POST-OPERATIVE COMPLICATIONS OF THYROID SURGERY

    Directory of Open Access Journals (Sweden)

    Kamreddy Ashok

    2015-11-01

    Full Text Available Thyroid surgeries are performed worldwide for various indications. In the past complications of thyroid surgeries were reported more than 24%. With an increase in accuracy in Cytological reporting, non-invasive radiological investigations to know the extent of the tumor and infiltration of malignant tumors, the complications are reduced to less than 4%. AIM: To evaluate the predictability of pre-operative investigations in preventing the post-operative complications of thyroid surgery. MATERIALS AND METHODS: A prospective study conducted on 86 patients by investigating before thyroid surgeries with FNAC, ultrasonography, CT scan, X-ray Neck lateral view, MRI, 2D ECHO of Cardia, isotope scanning, video laryngoscopy and thyroid function tests. Demographic characteristics of the patients and indications for thyroid surgeries were used to predict the post-operative complications. Post-operative investigations included serum calcium levels, Thyroid function tests and serum Electrolyte levels to diagnose the complications. RESULTS: sensitivity of FNAC was 93.33%, ultra sound Neck was 92.83%, serum calcium was 89.16%, in thyroid function tests it was 77.66%. With X-Ray Neck the specificity was 57.66%, CT scan was 44.50%, MRI was 15%, and isotope study was 30.6%, Doppler study was 33.83% and 2DEcho was 27.83%. Pre-operative assessment was Airway obstruction 3.48%, hematoma formation 4.65%, RLN palsy 3.48%, Hypocalcaemia 33.72%, wound infection 4.65% were the complications encountered. CONCLUSIONS: Thorough investigations prior to surgery of thyroid, proper selection of the surgical procedure, tumor location knowledge, understanding the pathophysiology of the thyroid disease and type of anesthesia gives confidence to the surgeon and avoids complications. The methods applied in the present study had a definitive role in preventing hypocalcaemia with an incidence of 33.72% and RLN palsy 3.48%. These were added upon by the experience of the operating

  13. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

    Science.gov (United States)

    Fukuda, Yasunari; Yamamoto, Kazuyoshi; Hirao, Motohiro; Nishikawa, Kazuhiro; Nagatsuma, Yukiko; Nakayama, Tamaki; Tanikawa, Sugano; Maeda, Sakae; Uemura, Mamoru; Miyake, Masakazu; Hama, Naoki; Miyamoto, Atsushi; Ikeda, Masataka; Nakamori, Shoji; Sekimoto, Mitsugu; Fujitani, Kazumasa; Tsujinaka, Toshimasa

    2016-07-01

    Malignancy is a secondary cause of sarcopenia, which is associated with impaired cancer treatment outcomes. The aim of this study was to investigate the prevalence of preoperative sarcopenia among elderly gastric cancer patients undergoing gastrectomy and the differences in preoperative dietary intake and postoperative complications between sarcopenic and non-sarcopenic patients. Ninety-nine patients over 65 years of age who underwent gastrectomy for gastric cancer were analyzed. All patients underwent gait and handgrip strength testing, and whole-body skeletal muscle mass was measured using a bioimpedance analysis technique based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm for the evaluation of sarcopenia before surgery. Preoperative dietary intake was assessed using a food frequency questionnaire. Of these patients, 21 (21.2 %) were diagnosed with sarcopenia. Sarcopenic patients consumed fewer calories and less protein preoperatively (23.9 vs. 27.8 kcal/kg ideal weight/day and 0.86 vs. 1.04 g/kg ideal weight/day; P = 0.001 and 0.0005, respectively). Although the overall incidence of postoperative complications was similar in the two groups (57.1 % vs. 35.9 %; P = 0.08), the incidence of severe (Clavien-Dindo grade ≥ IIIa) complications was significantly higher in the sarcopenic group than in the non-sarcopenic group (28.6 % vs. 9.0 %; P = 0.029). In the multivariate analysis, sarcopenia alone was identified as a risk factor for severe postoperative complications (odds ratio, 4.76; 95 % confidence interval, 1.03-24.30; P = 0.046). Preoperative sarcopenia as defined by the EWGSOP algorithm is a risk factor for severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

  14. Impact of neoadjuvant therapy on postoperative complications in patients undergoing resection for rectal adenocarcinoma.

    Science.gov (United States)

    Turner, Immanuel I; Russell, Gregory B; Blackstock, A William; Levine, Edward A

    2004-12-01

    Surgical resection continues to be the mainstay of treatment for rectal cancer. Neoadjuvant therapy (chemotherapy and radiation) has also been shown to be efficacious. The impact of preoperative chemotherapy and radiation on postoperative complications is unclear. The purpose of this study is to evaluate the relationship of neoadjuvant therapy on postoperative complications in patients undergoing a resection of rectal cancer. A total of 325 patients who underwent curative resection for rectal cancer from 1984 to 2001 were retrospectively reviewed. Only cases with complete data sets who had undergone surgery at this institution were evaluable (257). The patients were divided into groups based on the operative procedure performed; abdominoperineal resection (APR) versus sphincter-sparing (SS) procedures (LAR/Transanal) and whether or not preoperative chemotherapy or radiation was administered. There was no significant difference between complication rates for APR and SS with 19 per cent and 14 per cent, respectively. The preoperative therapy had no effect on complications after APR. However, the SS group showed 21 per cent of the patients who received radiation had complications compared to 11 per cent in those who did not (P = 0.087). Complications in the SS group included leaks, wound infections, abscess, embolism, cardiac dysrhythmias, and myocardial infarctions. The 30-day mortality was 1.9 per cent for the entire cohort with no clear difference between groups. There was no significant difference in complication rate between APR and SS. In the APR group, neoadjuvant therapy had no impact on the incidence of complications. However, the SS group did show a trend between preoperative chemotherapy and radiation and complication rate. However, this may not outweigh the advantages of preoperative therapy in this setting.

  15. Increased postoperative complications after protective ileostomy closure delay: An institutional study

    Institute of Scientific and Technical Information of China (English)

    Ines; Rubio-Perez; Miguel; Leon; Daniel; Pastor; Joaquin; Diaz; Dominguez; Ramon; Cantero

    2014-01-01

    AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy cre-ation was rectal cancer(56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the pa-tients, with 1% mortality. The most frequent were ileus(13%) and wound infection(13%). Pseudomembra-nous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomyclosure(P = 0.041). Male patients had more complica-tions(P = 0.042), mainly wound infections(P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure(P = 0.003). End-to-end in-testinal anastomosis without resection was significantly associated with postoperative ileus(P = 0.037). CONCLUSION: Although closure of a protective il-eostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.

  16. Accelerating Chart Review Using Automated Methods on Electronic Health Record Data for Postoperative Complications

    Science.gov (United States)

    Hu, Zhen; Melton, Genevieve B.; Moeller, Nathan D.; Arsoniadis, Elliot G.; Wang, Yan; Kwaan, Mary R.; Jensen, Eric H.; Simon, Gyorgy J.

    2016-01-01

    Manual Chart Review (MCR) is an important but labor-intensive task for clinical research and quality improvement. In this study, aiming to accelerate the process of extracting postoperative outcomes from medical charts, we developed an automated postoperative complications detection application by using structured electronic health record (EHR) data. We applied several machine learning methods to the detection of commonly occurring complications, including three subtypes of surgical site infection, pneumonia, urinary tract infection, sepsis, and septic shock. Particularly, we applied one single-task and five multi-task learning methods and compared their detection performance. The models demonstrated high detection performance, which ensures the feasibility of accelerating MCR. Specifically, one of the multi-task learning methods, propensity weighted observations (PWO) demonstrated the highest detection performance, with single-task learning being a close second.

  17. The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy

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    Tian Yang

    2017-01-01

    Full Text Available This study was to evaluate the risk factors of infectious complications after percutaneous nephrolithotomy (PCNL and build a prediction tool for postoperative complications based on the risk factors. A total of 110 male (67.1% and 54 female (32.9% patients who underwent PCNL for renal stones between 2010 and 2014 in our institute were included. A detailed clinical information and laboratory results were obtained from patients. Systemic inflammatory response syndrome (SIRS and postoperative fever were recorded after PCNL surgery. In all, 45 cases (27.4% developed SIRS and fever was observed in 20 cases (12.2%. In multivariate analysis, stone size (odds ratio, OR = 1.471, p=0.009 and urine white blood cell (WBC (OR = 1.001, p=0.007 were related to the development of SIRS. Stone size (OR = 1.644, p=0.024, urine WBC (OR = 1.001, p=0.002 and serum albumin (OR = 0.807, p=0.021 were associated with postoperative fever. We concluded that patients with larger stone size and preoperative urinary tract infection might have a higher risk of developing SIRS and fever after operation, while a high-normal level of serum albumin might be the protective factor for postoperative fever.

  18. Postoperative Complications After Prophylactic Thyroidectomy for Very Young Patients With Multiple Endocrine Neoplasia Type 2

    OpenAIRE

    Kluijfhout, Wouter P; van Beek, Dirk-Jan; Verrijn Stuart, Annemarie A.; Lodewijk, Lutske; Gerlof D. Valk; Van der Zee, David C.; Vriens, Menno R.; Inne H. M. Borel Rinkes

    2015-01-01

    Abstract The aim of this study was to investigate whether younger age at surgery is associated with the increased incidence of postoperative complications after prophylactic thyroidectomy in pediatric patients with multiple endocrine neoplasia (MEN) 2. The shift toward earlier thyroidectomy has resulted in significantly less medullary thyroid carcinoma (MTC)-related morbidity and mortality. However, very young pediatric patients might have a higher morbidity rate compared with older patients....

  19. Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy

    Science.gov (United States)

    Karakaş, Hüseyin Buğra; Çiçekbilek, İzzet; Tok, Adem; Alışkan, Tamer; Akduman, Bülent

    2016-01-01

    Objective In this study we aimed to evaluate intraoperative and postoperative complications which developed according to pre-operative American Society of Anesthesiologists (ASA) risk criteria in patients who had undergone percutaneous nephrolithotomy (PNL). Material and methods Five hundred and sixty patients who had undergone PNL between 2002 and 2014 were included in the study. Patients operated on the ipsilateral kidney, those with solitary kidney or the cases who had previously undergone more than one access were excluded from this study. Preoperative anesthesia risks were determined according to preoperative classification developed by ASA. Postoperative complications were evaluated using Clavien Complication Grading Scale. Results The mean age of the cases was 47±14 years. The 57% (n=319) of the cases were male, 241 (43%) of them were female. The average indwell time of nephrostomy catheter was 2.88±1.00 (1–8), and length of hospital stay was 4.91±1.54 (2–17) days. When the cases were assessed according to ASA risk groups, intraoperative complications were observed in 9 (5.5%) ASA I, 27 (8.6%) ASA II, and 18 (22%) ASA III patients and and distribution of the patients was statistically significant (pPNL operations in terms of intraoperative complications. PMID:27635291

  20. Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery.

    Science.gov (United States)

    Goodenough, Christopher J; Liang, Mike K; Nguyen, Mylan T; Nguyen, Duyen H; Holihan, Julie L; Alawadi, Zeinab M; Roth, John S; Wray, Curtis J; Ko, Tien C; Kao, Lillian S

    2015-10-01

    Glycosylated hemoglobin (HbA1c) is diagnostic of and a measure of the quality of control of diabetes mellitus. Both HbA1c and perioperative hyperglycemia have been targeted as modifiable risk factors for postoperative complications. The HbA1c percent cutoff that best predicts major complications has not been defined. A prospective study of all abdominal operations from a single institution from 2007 to 2010 was performed. All patients with HbA1c within 3 months before surgery were included. The primary end point was major complication, using the Clavien-Dindo complication system, within 30 days of surgery. Stepwise, multivariate analysis was performed including clinically relevant variables chosen a priori. Among 438 patients who had a measured HbA1c, 96 (21.9%) experienced a major complication. On multivariate analysis, HbA1c ≥ 6.5% (odds ratio = 1.95; 95% CI, 1.17-3.24; p = 0.01) was found to be the most significant predictor of major complications. Glyosylated hemoglobin and glucose were strongly correlated (correlation coefficient 0.414, p 30 kg/m(2), history of coronary artery disease, and nonwhite race were more likely to have a HbA1c ≥ 6.5%. Elevated HbA1c ≥ 6.5% and perioperative hyperglycemia were associated with an increased rate of major complications after abdominal surgery. Elevated peak postoperative glucose levels were correlated with elevated HbA1c and were independently associated with major complications. More liberal HbA1c testing should be considered in high-risk patients before elective surgery. Safe, feasible, and effective strategies to reduce both HbA1c and perioperative hyperglycemia need to be developed to optimize patient outcomes. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry.

    Science.gov (United States)

    Stenberg, Erik; Szabo, Eva; Agren, Göran; Näslund, Erik; Boman, Lars; Bylund, Ami; Hedenbro, Jan; Laurenius, Anna; Lundegårdh, Göran; Lönroth, Hans; Möller, Peter; Sundbom, Magnus; Ottosson, Johan; Näslund, Ingmar

    2014-12-01

    To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients. Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications. From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications. The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%. Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.

  2. Predicting postoperative cardio-pulmonary complications by a test of stair climbing.

    Science.gov (United States)

    Salahuddin, Nawal; Fatimi, Saulat; Salahuddin, Nawal; Huda, Shehzad; Islam, Mohammad; Shafquat, Azam

    2005-12-01

    To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia. Cohort study. The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications or mortality. Period of follow-up was until hospital discharge. Seventy-eight patients were enrolled, 59 (75.6%) climbed 1 flight of stairs, 19 (24.3%) climbed climb 1 flight and 40% in those patients who climbed climbed climb at least 1 flight of stairs, was calculated to be 1.8 (95% CI 0.7 - 4.6). Stair climbing can be a useful pre-operative tool to predict the risk of postoperative cardiopulmonary complications.

  3. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Postoperative complications of pediatric dental general anesthesia procedure provided in Jeddah hospitals, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Almushayt Abdullah

    2009-02-01

    Full Text Available Abstract Background Review of post-operative morbidity reports for pediatric dental care under general anesthesia (GA show great variations. Until now, no morbidity data has been available to estimate the safety of pediatric patients under GA for dental rehabilitation in Saudi Arabia. The purposes of this study were to (1 investigate post-operative complications associated with dental care under GA and (2 correlate morbidity reports with patient's characteristics, dental procedures, and hospital protocol. Methods Study sample included 90 children attending GA for dental treatment at major governmental hospitals in Jeddah. Data were collected from every patient on three occasions, intra-operatively at the operating room, and post-operatively via phone calls in the first and third days after operation. Results Results showed that 99% of the children had one or more complaints in the first day in contrast to only 33% in the third day. Inability to eat (86%, sleepiness (71%, and pain (48% were the most common complaints in the first day, followed by bleeding (40%, drowsiness (39%, sore throat (34%, vomiting (26%, psychological changes (24%, fever (21%, cough (12%, and nausea (8%. A great significant complaints reduction was reported by the third post-operative day. Age, gender, admission type of the patients and GA duration were the factors that showed a significant relationship with post-operative complaints. Conclusion Post-operative morbidity was common, but mostly of mild severity and limited to the first day. Hospital staff efforts should be directed to control commonly reported postoperative complaints.

  5. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery.

    Science.gov (United States)

    Mokart, D; Merlin, M; Sannini, A; Brun, J P; Delpero, J R; Houvenaeghel, G; Moutardier, V; Blache, J L

    2005-06-01

    Patients who undergo major surgery for cancer are at high risk of postoperative sepsis. Early markers of septic complications would be useful for diagnosis and therapeutic management in patients with postoperative sepsis. The aim of this study was to investigate the association between early (first postoperative day) changes in interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) serum concentrations and the occurrence of subsequent septic complications after major surgery. Serial blood samples were collected from 50 consecutive patients for determination of IL-6, PCT and CRP serum levels. Blood samples were obtained on the morning of surgery and on the morning of the first postoperative day. Sixteen patients developed septic complications during the first five postoperative days (group 1), and 34 patients developed no septic complications (group 2). On day 1, PCT and IL-6 levels were significantly higher in group 1 (P-values of 0.003 and 0.006, respectively) but CRP levels were similar. An IL-6 cut-off point set at 310 pg ml(-1) yielded a sensitivity of 90% and a specificity of 58% to differentiate group 1 patients from group 2 patients. When associated with the occurrence of SIRS on day 1 these values reached 100% and 79%, respectively. A PCT cut-off point set at 1.1 ng ml(-1) yielded a sensitivity of 81% and a specificity of 72%. When associated with the occurrence of SIRS on day 1, these values reached 100% and 86%, respectively. PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

  6. High incidence and spontaneous resolution of mastoid effusion after craniotomy on early postoperative magnetic resonance images

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, T.; Saito, N.; Takahashi, A.; Fujimaki, H.; Tosaka, M.; Sasaki, T. [Department of Neurosurgery, Gunma University School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma (Japan); Sato, N. [Department of Diagnostic Radiology, Gunma University School of Medicine, Maebashi, Gunma (Japan)

    2003-07-01

    Mastoid effusion is a poorly understood complication after craniotomy. The incidence and severity of postoperative mastoid effusion were retrospectively examined on postoperative magnetic resonance (MR) images to assess any association with craniotomy procedures, time course, and neuro-otological complications. We evaluated the early postoperative MR images (within 4 days of craniotomy) and medical records of 74 patients who underwent 77 operations for the treatment of various intracranial diseases from January 2000 to December 2001. Mastoid effusion was classified into four grades: none, partial, moderate, and severe diffuse effusion in the mastoid air cells. Thirty-three follow-up MR images from 26 patients were also reviewed. Postoperative mastoid effusion occurred ipsilateral to the craniotomy site in 62 cases and contralateral in 56 cases. Mastoid effusion was significantly more severe ipsilateral than contralateral to craniotomy with exposure of the mastoid air cells (P<0.0001). There was no significant difference in severity between the contralateral and ipsilateral sides after craniotomy without mastoid air cell opening (P=0.437). Mastoid effusion following craniotomy without exposure of mastoid air cells resolved within 3 months. However, otitis media with effusion developed in six patients with severe mastoid effusion ipsilateral to craniotomy with exposure of the mastoid air cells. Mastoid effusion frequently developed on both sides. Any grade of mastoid effusion on the ipsilateral side to craniotomy without exposure of mastoid air cells, or on the contralateral side, was asymptomatic or had a benign course, and disappeared within 3 months. (orig.)

  7. Technique of ICP monitored stepwise intracranial decompression effectively reduces postoperative complications of severe bifrontal contusion

    Directory of Open Access Journals (Sweden)

    Guan eSun

    2016-04-01

    Full Text Available Background Bifrontal contusion is a common clinical brain injury. In the early stage, it is often mild, but it progresses rapidly and frequently worsens suddenly. This condition can become life threatening and therefore requires surgery. Conventional decompression craniectomy is the commonly used treatment method. In this study, the effect of ICP monitored stepwise intracranial decompression surgery on the prognosis of patients with acute severe bifrontal contusion was investigated. Method A total of 136 patients with severe bifrontal contusion combined with deteriorated intracranial hypertension admitted from March 2001 to March 2014 in our hospital were selected and randomly divided into two groups, i.e., a conventional decompression group and an intracranial pressure (ICP monitored stepwise intracranial decompression group (68 patients each, to conduct a retrospective study. The incidence rates of acute intraoperative encephalocele, delayed hematomas, and postoperative cerebral infarctions and the Glasgow outcome scores (GOSs 6 months after the surgery were compared between the two groups.Results (1 The incidence rates of acute encephalocele and contralateral delayed epidural hematoma in the stepwise decompression surgery group were significantly lower than those in the conventional decompression group; the differences were statistically significant (P < 0.05; (2 6 months after the surgery, the incidence of vegetative state and mortality in the stepwise decompression group were significantly lower than those in the conventional decompression group (P < 0.05; the rate of favorable prognosis in the stepwise decompression group was also significantly higher than that in the conventional decompression group (P < 0.05.Conclusions The ICP monitored stepwise intracranial decompression technique reduced the perioperative complications of traumatic brain injury through the gradual release of intracranial pressure and was beneficial to the prognosis of

  8. The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology.

    Science.gov (United States)

    Albisinni, Simone; Oderda, Marco; Fossion, Laurent; Varca, Virginia; Rassweiler, Jens; Cathelineau, Xavier; Chlosta, Piotr; De la Taille, Alexandre; Gaboardi, Franco; Piechaud, Thierry; Rimington, Peter; Salomon, Laurent; Sanchez-Salas, Rafael; Stolzenburg, Jens-Uwe; Teber, Dogu; Van Velthoven, Roland

    2016-02-01

    To analyze postoperative complications after laparoscopic radical cystectomy (LRC) and evaluate its risk factors in a large prospective cohort built by the ESUT across European centers involved in minimally invasive urology in the last decade. Patients were prospectively enrolled, and data were retrospectively analyzed. Only oncologic cases were included. There were no formal contraindications for LRC: Also patients with locally advanced tumors (pT4a), serious comorbidities, and previous major abdominal surgery were enrolled. All procedures were performed via a standard laparoscopic approach, with no robotic assistance. Early and late postoperative complications were graded according to the modified Clavien-Dindo classification. Multivariate logistic regression was performed to explore possible risk factors for developing complications. A total of 548 patients were available for final analysis, of which 258 (47%) experienced early complications during the first 90 days after LRC. Infectious, gastrointestinal, and genitourinary were, respectively, the most frequent systems involved. Postoperative ileus occurred in 51/548 (9.3%) patients. A total of 65/548 (12%) patients underwent surgical re-operation, and 10/548 (2%) patients died in the early postoperative period. Increased BMI (p = 0.024), blood loss (p = 0.021), and neoadjuvant treatment (p = 0.016) were significantly associated with a greater overall risk of experiencing complications on multivariate logistic regression. Long-term complications were documented in 64/548 (12%), and involved mainly stenosis of the uretero-ileal anastomosis or incisional hernias. In this multicenter, prospective, large database, LRC appears to be a safe but morbid procedure. Standardized complication reporting should be encouraged to evaluate objectively a surgical procedure and permit comparison across studies.

  9. Exploring the Frontier of Electronic Health Record Surveillance: The Case of Post-Operative Complications

    Science.gov (United States)

    FitzHenry, Fern; Murff, Harvey J.; Matheny, Michael E.; Gentry, Nancy; Fielstein, Elliot M.; Brown, Steven H; Reeves, Ruth M; Aronsky, Dominik; Elkin, Peter L.; Messina, Vincent P.; Speroff, Theodore

    2013-01-01

    Background The aim of this study was to build electronic algorithms using a combination of structured data and natural language processing (NLP) of text notes for potential safety surveillance of nine post-operative complications. Methods Post-operative complications from six medical centers in the Southeastern United States were obtained from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) registry. Development and test datasets were constructed using stratification by facility and date of procedure for patients with and without complication. Algorithms were developed from VASQIP outcome definitions using NLP coded concepts, regular expressions, and structured data. The VASQIP nurse reviewer served as the reference standard for evaluating sensitivity and specificity. The algorithms were designed in the development and evaluated in the test dataset. Results Sensitivity and specificity in the test set were 85% and 92% for acute renal failure, 80% and 93% for sepsis, 56% and 94% for deep vein thrombosis, 80% and 97% for pulmonary embolism, 88% and 89% for acute myocardial infarction, 88% and 92% for cardiac arrest, 80% and 90% for pneumonia, 95% and 80% for urinary tract infection, and 80% and 93% for wound infection, respectively. A third of the complications occurred outside of the hospital setting. Conclusions Computer algorithms on data extracted from the electronic health record produced respectable sensitivity and specificity across a large sample of patients seen in six different medical centers. This study demonstrates the utility of combining natural language processing with structured data for mining the information contained within the electronic health record. PMID:23673394

  10. Exploring the frontier of electronic health record surveillance: the case of postoperative complications.

    Science.gov (United States)

    FitzHenry, Fern; Murff, Harvey J; Matheny, Michael E; Gentry, Nancy; Fielstein, Elliot M; Brown, Steven H; Reeves, Ruth M; Aronsky, Dominik; Elkin, Peter L; Messina, Vincent P; Speroff, Theodore

    2013-06-01

    The aim of this study was to build electronic algorithms using a combination of structured data and natural language processing (NLP) of text notes for potential safety surveillance of 9 postoperative complications. Postoperative complications from 6 medical centers in the Southeastern United States were obtained from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) registry. Development and test datasets were constructed using stratification by facility and date of procedure for patients with and without complications. Algorithms were developed from VASQIP outcome definitions using NLP-coded concepts, regular expressions, and structured data. The VASQIP nurse reviewer served as the reference standard for evaluating sensitivity and specificity. The algorithms were designed in the development and evaluated in the test dataset. Sensitivity and specificity in the test set were 85% and 92% for acute renal failure, 80% and 93% for sepsis, 56% and 94% for deep vein thrombosis, 80% and 97% for pulmonary embolism, 88% and 89% for acute myocardial infarction, 88% and 92% for cardiac arrest, 80% and 90% for pneumonia, 95% and 80% for urinary tract infection, and 77% and 63% for wound infection, respectively. A third of the complications occurred outside of the hospital setting. Computer algorithms on data extracted from the electronic health record produced respectable sensitivity and specificity across a large sample of patients seen in 6 different medical centers. This study demonstrates the utility of combining NLP with structured data for mining the information contained within the electronic health record.

  11. Risk Factors of Early Complications of Tracheostomy at Kenyatta ...

    African Journals Online (AJOL)

    Risk Factors of Early Complications of Tracheostomy at Kenyatta National Hospital. ... Journal Home > Vol 17, No 1 (2012) >. Log in or ... The aim of this study was to identify risk factors that contribute to complications following tracheostomies.

  12. Complications after radiotherapy and radical hysterectomy in early-stage cervical carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Gerdin, E. [Univ. Hospital, Dept. of Obstetrics and Gynecology, and Gynecologic Oncology, Uppsala (Sweden); Cnattingius, S. [Univ. Hospital, Dept. of Social Medicine, Uppsala (Sweden); Johnson, P. [Univ. Hospital, Dept. of Obstetrics and Gynecology, Uppsala (Sweden)

    1995-08-01

    Objective: To evaluate the overall complications, major as well as minor, in patients treated for early-stage cervical carcinoma as related to treatment parameters. Methods: In this retrospective study, 167 consecutive patients with early-stage cervical carcinoma treated with preoperative radiotherapy and radical hysterectomy were investigated. Clinical data were collected from the medical files. Results: Transient or permanent complications appeared in up to half of all patients. Seven percent exhibited intraoperative complications and 35% suffered from early postoperative urinary tract problems; most frequently urinary tract infection. After one year, the urinary tract complications dominated; voidance difficulties and incontinence being most common. Gastrointestinal complications occurred in 15% of patients. Lymphedema appeared during the first year in 21% of the patients but several of the mild or moderate cases improved after the first year. The relative risk of lymphedema was increased with shorter duration of surgery, extensive preoperative irradiation to the bladder and after external postoperative irradiation. Some form of late sequelae remained in every fifth patient, and every fourth patient, aged 23-44 years, periodically suffered from vasomotor symptoms despite estrogen replacement therapy. Conclusion: The complications after radiotherapy and radical hysterectomy in early stage cervical carcinoma suggest that attempts should be made to evaluate effective treatments designed to minimize risk to the patients. (au) 29 refs.

  13. Video-assisted thoracoscopic surgery for esophageal cancer attenuates postoperative systemic responses and pulmonary complications.

    Science.gov (United States)

    Tsujimoto, Hironori; Takahata, Risa; Nomura, Shinsuke; Yaguchi, Yoshihisa; Kumano, Isao; Matsumoto, Yusuke; Yoshida, Kazumichi; Horiguchi, Hiroyuki; Hiraki, Shuichi; Ono, Satoshi; Yamamoto, Junji; Hase, Kazuo

    2012-05-01

    Less invasive operations such as laparoscopic surgery have been developed for treating gastrointestinal malignancies. However, the advantages of video-assisted thoracoscopic surgery for esophageal cancer (VATS-e) with regard to postoperative morbidity and mortality remains controversial. We investigated the postoperative clinical course of patients who underwent esophagectomy for esophageal cancer in terms of systemic inflammatory response syndrome (SIRS) induced by VATS-e (VATS-e group) or conventional open surgery (OS group) combined with laparoscopic gastric tube reconstruction. Compared with the OS group (n = 27), the VATS-e group (n = 22) had a greater thoracic operation time (VATS-e versus OS, 181 ± 56 vs 143 ± 45 minutes, respectively), and lesser duration of stay in the intensive care unit (17 ± 2 vs 32 ± 21 hours, respectively). The VATS-e group also had a lesser SIRS duration (1.5 vs 4.3 days), a lesser incidence of SIRS, a lesser number of positive SIRS criteria, and lesser serum interleukin-6 levels immediately after operation and on postoperative day (POD) 1. The heart rate in the VATS-e group was less than that in the OS group on POD 3. The respiratory rate in the VATS-e group was significantly less than that in the OS group on PODs 3, 5, and 7. Although no difference was observed in the frequencies of postoperative complications between the 2 groups, the VATS-e group had less postoperative pneumonia. VATS-e attenuates postoperative SIRS, and is therefore a potentially less invasive operative procedure. Copyright © 2012 Mosby, Inc. All rights reserved.

  14. A Comparison of Postoperative Early Enteral Nutrition with Delayed Enteral Nutrition in Patients with Esophageal Cancer

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    Gongchao Wang

    2015-06-01

    Full Text Available We examined esophageal cancer patients who received enteral nutrition (EN to evaluate the validity of early EN compared to delayed EN, and to determine the appropriate time to start EN. A total of 208 esophagectomy patients who received EN postoperatively were divided into three groups (Group 1, 2 and 3 based on whether they received EN within 48 h, 48 h–72 h or more than 72 h, respectively. The postoperative complications, length of hospital stay (LOH, days for first fecal passage, cost of hospitalization, and the difference in serum albumin values between pre-operation and post-operation were all recorded. The statistical analyses were performed using the t-test, the Mann-Whitney U test and the chi square test. Statistical significance was defined as p < 0.05. Group 1 had the lowest thoracic drainage volume, the earliest first fecal passage, and the lowest LOH and hospitalization expenses of the three groups. The incidence of pneumonia was by far the highest in Group 3 (p = 0.019. Finally, all the postoperative outcomes of nutritional conditions were the worst by a significant margin in Group 3. It is therefore safe and valid to start early enteral nutrition within 48 h for postoperative esophageal cancer patients.

  15. Degree of Vascular Encasement in Sphenoid Wing Meningiomas Predicts Postoperative Ischemic Complications.

    Science.gov (United States)

    McCracken, D Jay; Higginbotham, Raymond A; Boulter, Jason H; Liu, Yuan; Wells, John A; Halani, Sameer H; Saindane, Amit M; Oyesiku, Nelson M; Barrow, Daniel L; Olson, Jeffrey J

    2017-06-01

    Sphenoid wing meningiomas (SWMs) can encase arteries of the circle of Willis, increasing their susceptibility to intraoperative vascular injury and severe ischemic complications. To demonstrate the effect of circumferential vascular encasement in SWM on postoperative ischemia. A retrospective review of 75 patients surgically treated for SWM from 2009 to 2015 was undertaken to determine the degree of circumferential vascular encasement (0°-360°) as assessed by preoperative magnetic resonance imaging (MRI). A novel grading system describing "maximum" and "total" arterial encasement scores was created. Postoperative MRIs were reviewed for total ischemia volume measured on sequential diffusion-weighted images. Of the 75 patients, 89.3% had some degree of vascular involvement with a median maximum encasement score of 3.0 (2.0-3.0) in the internal carotid artery (ICA), M1, M2, and A1 segments; 76% of patients had some degree of ischemia with median infarct volume of 3.75 cm 3 (0.81-9.3 cm 3 ). Univariate analysis determined risk factors associated with larger infarction volume, which were encasement of the supraclinoid ICA ( P 62 cm 3 was found when the ICA, M1, and A1 vessels all had ≥360° involvement ( P = .001). Residual tumor was associated with smaller infarct volumes ( P = .022). As infarction volume increased, so did modified Rankin Score at discharge ( P = .025). Subtotal resection should be considered in SWM with significant vascular encasement of proximal arteries to limit postoperative ischemic complications.

  16. EFFECTIVENESS OF SCHEDULED AMBULATION ON EARLY POSTOPERATIVE OUTCOME AMONG PATIENTS WHO HAVE UNDERGONE ABDOMINAL HYSTERECTOMY

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    Rinku Girija

    2017-01-01

    Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis

  17. A body shape index has a good correlation with postoperative complications in gastric cancer surgery.

    Science.gov (United States)

    Eom, Bang Wool; Joo, Jungnam; Yoon, Hong Man; Ryu, Keun Won; Kim, Young-Woo; Lee, Jun Ho

    2014-04-01

    The relationship between obesity and surgical complications has been controversial. A Body Shape Index (ABSI) is a newly developed anthropometric index based on waist circumference adjusted for height and weight. The aim of this study was to investigate the relationship between ABSI and surgical complications. From November 2001 to September 2012, 4,813 patients underwent curative resection for gastric cancer. ABSI was defined as waist circumference divided by (BMI(2/3)height(1/2)). Data of clinicopathologic characteristics and morbidity were collected by retrospective review. Binary logistic regression was used for multivariable analyses to determine whether ABSI was independently associated with postoperative complications. The incidence of overall surgical complications was 13.4 %, and the most common complication was ileus (2.8 %). In the multivariable analysis, ABSI was an independent factor for overall complications [odds ratio (OR), 1.22; 95 % confidence interval (CI) 1.01-1.48; P = 0.041). However, BMI showed no statistical significance (OR, 1.03; 95 % CI 1.00-1.06; P = 0.063). In the subgroup analyses, ABSI was significantly associated with overall complications regarding open gastrectomy (OR, 1.26; 95 % CI 1.01-1.57; P = 0.039). Regarding laparoscopy-assisted gastrectomy, ABSI had no significant effect on overall complications (P = 0.844). ABSI shows good correlation with surgical complications in patients with gastric cancer. Further studies are needed for the various clinical roles of ABSI, and the results could be helpful to determine the effect of abdominal obesity on gastric cancer surgery and the clinical usefulness of ABSI.

  18. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Valkenet, Karin; Trappenburg, Jaap Ca; Gosselink, Rik; Sosef, Meindert N; Willms, Jerome; Rosman, Camiel; Pieters, Heleen; Scheepers, Joris Jg; de Heus, Saskia C; Reynolds, John V; Guinan, Emer; Ruurda, Jelle P; Rodrigo, Els He; Nafteux, Philippe; Fontaine, Marianne; Kouwenhoven, Ewout A; Kerkemeyer, Margot; van der Peet, Donald L; Hania, Sylvia W; van Hillegersberg, Richard; Backx, Frank JG

    2014-01-01

    BACKGROUND: Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare cos

  19. Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer

    Science.gov (United States)

    Awad, Mahmoud I.; Palmer, Frank L.; Kou, Lei; Yu, Changhong; Montero, Pablo H.; Shuman, Andrew G.; Ganly, Ian; Shah, Jatin P.; Kattan, Michael W.; Patel, Snehal G.

    2016-01-01

    IMPORTANCE Postoperative complications after head and neck surgery carry the potential for significant morbidity. Estimating the risk of complications in an individual patient is challenging. OBJECTIVE To develop a statistical tool capable of predicting an individual patient’s risk of developing a major complication after surgery for oral cavity squamous cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series derived from an institutional clinical oncologic database, augmented by medical record abstraction, at an academic tertiary care cancer center. Participants were 506 previously untreated adult patients with biopsy-proven oral cavity squamous cell carcinoma who underwent surgery between January 1, 2007, and December 31, 2012. MAIN OUTCOMES AND MEASURES The primary end point was a major postoperative complication requiring invasive intervention (Clavien-Dindo classification grades III–V). Patients treated between January 1, 2007, and December 31, 2008 (354 of 506 [70.0%]) comprised the modeling cohort and were used to develop a nomogram to predict the risk of developing the primary end point. Univariable analysis and correlation analysis were used to prescreen 36 potential predictors for incorporation in the subsequent multivariable logistic regression analysis. The variables with the highest predictive value were identified with the step-down model reduction method and included in the nomogram. Patients treated between January 1, 2007, and December 31, 2008 (152 of 506 [30.0%]) were used to validate the nomogram. RESULTS Clinical characteristics were similar between the 2 cohorts for most comparisons. Thirty-six patients in the modeling cohort (10.2%) and 16 patients in the validation cohort (10.5%) developed a major postoperative complication. The 6 preoperative variables with the highest individual predictive value were incorporated within the nomogram, including body mass index, comorbidity status, preoperative white blood cell count

  20. The Effect of Releasing Incision on the Postoperative Complications of Mandibular Third Molar Surgery

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    Aliasghari Abandansari, S.

    2016-06-01

    Full Text Available Surgical extraction of impacted mandibular third molars often result in a wide range of complications such as trismus, pain, swelling and occasionally ecchymosis. The purpose of this study was to assess the effect of two flap designs (triangular and envelope flaps on such consequences.Twenty healthy patients with similarly positioned bilateral impacted mandibular third molars participated in this randomized clinical trial. Two flap designs were compared in terms of duration of the surgical procedure, postoperative pain, trismus, edema and also ecchymosis. No statistical differences were observed in duration of surgery and postoperative outcomes comparing two flap designs.Regarding to lack of significant differences between the two techniques, the selection of flap design seems to be based on the surgeon's experience and the amount of surgical access that he or she needs.

  1. Serial MRI in the early postoperative period after lumbar discectomy

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    Annertz, M. [Dept. of Radiology, University Hospital, Lund (Sweden); Joensson, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Stroemqvist, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Holtaas, S. [Dept. of Radiology, University Hospital, Lund (Sweden)

    1995-04-01

    The aim of this study was to determine MRI findings in patients successfully operated upon for lumbar disc herniation. We investigated 20 patients with a successful outcome after L4-5 or L5-S1 disc operations clinically and with MRI preoperatively, and at 5 days, 6 weeks, and 4 months after surgery. Postoperatively, T1- and T2-weighted images were obtained. At 4 months gadolinium-enhanced images were added. Pronounced intraspinal MRI changes were seen during follow-up. Deformation of the dural sac was seen in 13 patients preoperatively, in 19 at 5 days after operation, in 15 at 6 weeks, and in 12 at 4 months. Nerve root involvement was seen in all cases both preoperatively and at 5 days after operation, in 17 at 6 weeks, and in 15 at 4 months. No correlation between symptoms or the straight leg raising test and the size or nature of the abnormal tissue in the spinal canal postoperatively could be demonstrated. It was concluded that early postoperative MRI after lumbar discectomy must be interpreted carefully, and that oedema and scar formation are probable reasons for difficulties in interpretation. (orig.)

  2. Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications.

    Science.gov (United States)

    Cooper, William O; Guillamondegui, Oscar; Hines, O Joe; Hultman, C Scott; Kelz, Rachel R; Shen, Perry; Spain, David A; Sweeney, John F; Moore, Ilene N; Hopkins, Joseph; Horowitz, Ira R; Howerton, Russell M; Meredith, J Wayne; Spell, Nathan O; Sullivan, Patricia; Domenico, Henry J; Pichert, James W; Catron, Thomas F; Webb, Lynn E; Dmochowski, Roger R; Karrass, Jan; Hickson, Gerald B

    2017-06-01

    Unsolicited patient observations are associated with risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, a question remains as to whether behaviors that generate patient dissatisfaction might also contribute to the genesis of adverse outcomes themselves. To examine whether patients of surgeons with a history of higher numbers of unsolicited patient observations are at greater risk for postoperative complications than patients whose surgeons generate fewer such unsolicited patient observations. This retrospective cohort study used data from 7 academic medical centers participating in the National Surgical Quality Improvement Program and the Vanderbilt Patient Advocacy Reporting System from January 1, 2011, to December 31, 2013. Patients older than 18 years included in the National Surgical Quality Improvement Program who underwent inpatient or outpatient operations at 1 of the participating sites during the study period were included. Patients were excluded if the attending surgeon had less than 24 months of data in the Vanderbilt Patient Advocacy Reporting System preceding the date of the operation. Data analysis was conducted from June 1, 2015, to October 20, 2016. Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation. Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest. Among the 32 125 patients in the cohort (13 230 men, 18 895 women; mean [SD] age, 55.8 [15.8] years), 3501 (10.9%) experienced a complication, including 1754 (5.5%) surgical and 2422 (7.5%) medical complications. Prior unsolicited patient observations for a surgeon were significantly associated with the risk of a patient having any complication (odds ratio, 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical

  3. Interest in Rhinoplasty and Awareness about its Postoperative Complications Among Female high School Students

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    Aliasghar Arabi Mianroodi

    2012-03-01

    Full Text Available Introduction: Rhinoplasty is a popular cosmetic surgical procedure. Informal statistics show that Iran has one of the highest rates of rhinoplasty in the world. However, rhinoplasty like any other surgery can have complications.  Materials and Methods: In this cross-sectional study, 320 female students were selected by multistage cluster-stratified sampling from high schools in Kerman, Iran and each completed a questionnaire.  Results: More than half of the students said they would like to undergo rhinoplasty. The main reasons for wanting rhinoplasty were beauty and because it is fashionable. However, more than half of the interested students did not know about the possible postoperative complications of rhinoplasty. There was no relation between interest in having rhinoplasty and parents’ education, city of birth or economic status.  Conclusion: Many teenagers are interested in having rhinoplasty in Iran. As the number of teenagers and young adults who choose to have cosmetic surgery increases, surgeons should consider their expectations, motivations and awareness of postoperative complications before surgery.

  4. Automated identification of postoperative complications within an electronic medical record using natural language processing.

    Science.gov (United States)

    Murff, Harvey J; FitzHenry, Fern; Matheny, Michael E; Gentry, Nancy; Kotter, Kristen L; Crimin, Kimberly; Dittus, Robert S; Rosen, Amy K; Elkin, Peter L; Brown, Steven H; Speroff, Theodore

    2011-08-24

    Currently most automated methods to identify patient safety occurrences rely on administrative data codes; however, free-text searches of electronic medical records could represent an additional surveillance approach. To evaluate a natural language processing search-approach to identify postoperative surgical complications within a comprehensive electronic medical record. Cross-sectional study involving 2974 patients undergoing inpatient surgical procedures at 6 Veterans Health Administration (VHA) medical centers from 1999 to 2006. Postoperative occurrences of acute renal failure requiring dialysis, deep vein thrombosis, pulmonary embolism, sepsis, pneumonia, or myocardial infarction identified through medical record review as part of the VA Surgical Quality Improvement Program. We determined the sensitivity and specificity of the natural language processing approach to identify these complications and compared its performance with patient safety indicators that use discharge coding information. The proportion of postoperative events for each sample was 2% (39 of 1924) for acute renal failure requiring dialysis, 0.7% (18 of 2327) for pulmonary embolism, 1% (29 of 2327) for deep vein thrombosis, 7% (61 of 866) for sepsis, 16% (222 of 1405) for pneumonia, and 2% (35 of 1822) for myocardial infarction. Natural language processing correctly identified 82% (95% confidence interval [CI], 67%-91%) of acute renal failure cases compared with 38% (95% CI, 25%-54%) for patient safety indicators. Similar results were obtained for venous thromboembolism (59%, 95% CI, 44%-72% vs 46%, 95% CI, 32%-60%), pneumonia (64%, 95% CI, 58%-70% vs 5%, 95% CI, 3%-9%), sepsis (89%, 95% CI, 78%-94% vs 34%, 95% CI, 24%-47%), and postoperative myocardial infarction (91%, 95% CI, 78%-97%) vs 89%, 95% CI, 74%-96%). Both natural language processing and patient safety indicators were highly specific for these diagnoses. Among patients undergoing inpatient surgical procedures at VA medical centers

  5. Use of indocyanine green videoangiography during intracranial aneurysm surgery reduces the incidence of postoperative ischaemic complications.

    Science.gov (United States)

    Lai, Leon Tat; Morgan, Michael Kerin

    2014-01-01

    Microscope-integrated near-infrared indocyanine green videoangiography (ICGVA) has been shown to be a useful adjunct for intracranial aneurysm surgery. That the routine application of this technique reduces the risk of postoperative ischaemic complication, however, has not been reported. We present a retrospective matched-pair comparison of ICGVA guided aneurysm surgery versus historic control surgical cohort treated by the same author. Index patients and controls were matched for aneurysm size, location, patient demographics, risk factors, comorbidities, and surgical treatments. Ninety-one eligible patients with 100 intracranial aneurysms were treated using ICGVA assistance. There were no statistically significant differences between the two groups in terms of patient age, sex, risk factors, comorbidities and aneurysm characteristics. Of the 100 aneurysms in the ICGVA group, 107 investigations of ICGVA were performed. In 79 aneurysms (79.0%), ICGVA was considered useful but did not affect surgical management. In six patients (6.0%), ICGVA led to a crucial change of intraoperative strategies. In nine patients (9.0%), it was considered critical in assuring patency of small perforators. ICGVA was of no benefit in four patients (4.0%) and was misleading in two (2.0%). Postoperative ischaemic complications occurred in three patients (3.3%) in the ICGVA group compared with seven patients (7.7%) in the control group (paneurysm surgery as a safe and effective modality of intraoperative blood flow assessment. With all limitations of a retrospective matched-pair comparison, the use of ICGVA during routine aneurysm surgery reduces the incidence of postoperative ischaemic complications.

  6. Relationship of short-course preoperative radiotherapy and serum albumin level with postoperative complications in rectal cancer surgery

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    Trifunović Bratislav

    2015-01-01

    Full Text Available Background/Aim. The identification of risk factors could play a role in improving early postoperative outcome for rectal cancer surgery patients. The aim of this study was to determine the relationship between short-course preoperative radiotherapy (RT, serum albumin level and the development of postoperative complications in patients after anterior rectal resection due to rectal cancer without creation of diverting stoma. Methods. This retrospective study included patients with histopathologically confirmed adenocarcinoma of the rectum by and the clinical stage of T2-T4 operated on between 2007 and 2012. All the patients underwent open anterior rectal resection with no diverting stoma creation. Preoperative serum albumin was measured in each patient. Tumor location was noted intraoperatively as the distance from the inferior tumor margin to the anal verge. Tumor size was measured and noted by the pathologist who assessed specimens. Some of the patients received short-course preoperative RT, and some did not. The patients were divided into two groups (group 1 with short-course preoperative RT, group 2 with no short-course preoperative RT. Postoperative complications included clinically apparent anastomotic leakage, wound infection, diffuse peritonitis and pneumonia. They were compared between the groups, in relation to preoperative serum albumin level, patients age, tumor size and location. Results. The study included 107 patients (51 in the group 1 and 56 in the group 2. There were no significant difference in age (p = 0.95, and gender (p = 0.12 and tumor distance from anal verge (p = 0.53. The size of rectal carcinoma was significantly higher in the group 1 than in the group 2 (51.37 ± 12.04 mm vs 45.57 ± 9.81 mm, respectively; p = 0.007. The preoperative serum albumin level was significantly lower in the group 1 than in the group 2 (34.80 ± 2.85 g/L vs 37.55 ± 2.74 g/L, respectively; p < 0.001. A significant correlation between the tumor

  7. A RARE CASE OF DESMOID TUMOUR AND NEUROFIBROMA WITH POSTOPERATIVE COMPLICATION AND MANAGEMENT: CASE REPORT

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    Rahul Raj C. L

    2016-09-01

    Full Text Available BACKGROUND Desmoid tumour is included under group of aggressive fibromatosis. It is an uncommon neoplasm that occurs sporadically or as a part of syndrome (Familial Adenomatous Polyposis. It has a high propensity for recurrence even after surgical removal. Occur with a frequency of 2.4 to 4.3 cases per million population. Occur in young women during gestation or more from one year of childbirth. We are here by reporting a 36-year-old female who diagnosed with desmoid tumour and underwent surgical excision and her postoperative complications.

  8. Cerebral salt wasting syndrome: postoperative complication in tumours of the cerebellopontine angle.

    Science.gov (United States)

    Ruiz-Juretschke, Fernando; Arístegui, Miguel; García-Leal, Roberto; Fernández-Carballal, Carlos; Lowy, Alejandro; Martin-Oviedo, Carlos; Panadero, Teresa

    2012-02-01

    Cerebral salt wasting (CSW) is a rare complication in posterior fossa tumour surgery. We present two patients with cerebellopontine angle (CPA) tumours who developed cerebral salt wasting postoperatively. Both patients deteriorated in spite of intensive fluid and salt replacement. On CT scan the patients presented mild to moderate ventricular dilation, which was treated with an external ventricular drainage. After the resolution of hydrocephalus, fluid balance rapidly returned to normal in both patients and the clinical status improved. Identification and treatment of secondary obstructive hydrocephalus may contribute to the management of CSW associated to posterior fossa tumour surgery.

  9. Effect of smoking on early complications after elective orthopaedic surgery

    DEFF Research Database (Denmark)

    Møller, Ann; Pedersen, Tom Søndergård; Villebro, Nete

    2003-01-01

    Smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. We studied 811 consecutive patients who had undergone hip or knee arthroplasty, recording current smoking and drinking habits, any history of chronic disease and such ...

  10. Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study

    Science.gov (United States)

    Martos-Benítez, Frank Daniel; Gutiérrez-Noyola, Anarelys; Echevarría-Víctores, Adisbel

    2016-01-01

    Objective This study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery. Methods A prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed. Results Postoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002). Conclusions Postoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality. PMID:27096675

  11. Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery

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    Rao Raghavendra

    2008-01-01

    Full Text Available Context : Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. Objective : The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Methods : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL-2 receptor (IL-2R, tumor necrosis factor (TNF-alpha and interferon (IFN-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Results : Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36. The results suggest a significant decrease in the duration of hospital stay ( P = 0.003, days of drain retention ( P = 0.001 and days for suture removal ( P = 0.03 in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group ( P < 0.001, as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. Conclusion : The results suggest

  12. The effect of kidney morcellation on operative time, incision complications, and postoperative analgesia after laparoscopic nephrectomy

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    Affonso H. Camargo

    2006-06-01

    Full Text Available INTRODUCTION: Compare the outcomes between kidney morcellation and two types of open specimen extraction incisions, several covariates need to be taken into consideration that have not yet been studied. MATERIALS AND METHODS: We retrospectively reviewed 153 consecutive patients who underwent laparoscopic nephrectomy at our institution, 107 who underwent specimen morcellation and 46 with intact specimen removal, either those with connected port sites with a muscle-cutting incision and those with a remote, muscle-splitting incision. Operative time, postoperative analgesia requirements, and incisional complications were evaluated using univariate and multivariate analysis, comparing variables such as patient age, gender, body mass index (BMI, laterality, benign versus cancerous renal conditions, estimated blood loss, specimen weight, overall complications, and length of stay. RESULTS: There was no significant difference for operative time between the 2 treatment groups (p = 0.65. Incision related complications occurred in 2 patients (4.4% from the intact specimen group but none in the morcellation group (p = 0.03. Overall narcotic requirement was lower in patients with morcellated (41 mg compared to intact specimen retrieval (66 mg on univariate (p = 0.03 and multivariate analysis (p = 0.049. Upon further stratification, however, there was no significant difference in mean narcotic requirement between the morcellation and muscle-splitting incision subgroup (p = 0.14. CONCLUSION: Morcellation does not extend operative time, and is associated with significantly less postoperative pain compared to intact specimen retrieval overall, although this is not statistically significant if a remote, muscle-splitting incision is made. Morcellation markedly reduces the risk of incisional-related complications.

  13. Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy.

    Science.gov (United States)

    Rodriguez-Larrad, Ana; Vellosillo-Ortega, Juan Manuel; Ruiz-Muneta, Carlos; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

    2016-07-01

    To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Quasi-experimental study. Tertiary referral academic hospital. 208 patients undergoing lobectomy by open thoracotomy. Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy. Copyright © 2016 SEPAR. Published by Elsevier Espana. All rights reserved.

  14. C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection.

    Science.gov (United States)

    Shishido, Yuji; Fujitani, Kazumasa; Yamamoto, Kazuyoshi; Hirao, Motohiro; Tsujinaka, Toshimasa; Sekimoto, Mitsugu

    2016-01-01

    Postoperative infectious complications (PICs) after gastric cancer resection remain a clinically relevant problem. Early detection of PICs, before critical illness develops, may be of considerable clinical benefit. The aims of this study were to investigate the predictive factors for PICs and to define the clinical parameters for detecting them early in patients with gastric cancer resection. Clinical data for 417 consecutive patients undergoing elective gastrectomy for primary gastric cancer between 2009 and 2012 were retrospectively analyzed. Diagnostic accuracy was determined by the area under the receiver operating characteristic curve (AUC). Univariate and multivariate logistic regression analyses identified clinical factors predicting PICs of grade III or more according to the Clavien-Dindo classification. Forty-four patients developed PICs of grade ≥ III [10.6%, 95% confidence interval (CI) 7.6-13.5%]. As a systemic inflammatory marker, C-reactive protein (CRP) on postoperative day (POD) 3 had superior diagnostic accuracy for PICs (AUC 0.802, 95% CI 0.735-0.870) with a calculated cutoff value of 17.7 mg/dl, yielding a sensitivity of 0.66 (95% CI 0.524-0.774) and a specificity of 0.84 (95% CI 0.821-0.850). Multivariate analysis identified CRP on POD 3 of 17.7 mg/dl or greater [odds ratio (OR) 8.094, 95% CI 3.568-19.342) as well as clinical stage ≥ II (OR 4.445, 95% CI 1.478-15.881) and operation time ≥ 250 min (OR 3.638, 95% CI 1.449-10.137) as significant predictive factors for PICs after gastrectomy. Elevated CRP levels on POD 3 will help physicians predict the postoperative course and facilitate decision-making regarding prompt, comprehensive clinical searches and therapeutic approaches for PICs.

  15. Cardiac catheterization in the early post-operative period after congenital cardiac surgery.

    Science.gov (United States)

    Nicholson, George T; Kim, Dennis W; Vincent, Robert N; Kogon, Brian E; Miller, Bruce E; Petit, Christopher J

    2014-12-01

    This study sought to demonstrate that early cardiac catheterization, whether used solely as a diagnostic modality or for the use of transcatheter interventional techniques, can be used effectively and with an acceptable risk in the post-operative period. Cardiac catheterization offers important treatment for patients with congenital heart disease. Early post-operative cardiac catheterization is often necessary to diagnose and treat residual anatomic defects. Experience with interventional catheterization to address post-operative concerns is limited. This was a retrospective cohort study. The medical and catheterization data of pediatric patients who underwent a cardiac catheterization ≤30 days after congenital heart surgery between November 2004 and July 2013 were reviewed. Patients who underwent right heart catheterization and endomyocardial biopsy after heart transplantation were excluded. A total of 219 catheterizations (91 interventional procedures, 128 noninterventional catheterizations) were performed on 193 patients. Sixty-five interventions (71.43%) were dilations, either balloon angioplasty or stent implantation. There was no difference in survival to hospital discharge between those who underwent an interventional versus noninterventional catheterization (p = 0.93). One-year post-operative survival was comparable between those who underwent an intervention (66%) versus diagnostic (71%) catheterization (p = 0.58). There was no difference in the incidence of major or minor complications between the interventional and diagnostic catheterization cohorts (p = 0.21). Cardiac catheterization, including transcatheter interventions, can be performed safely in the immediate post-operative period after congenital heart surgery. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Impact of neoadjuvant chemoradiation therapy on the postoperative complication rate in rectal cancer

    Directory of Open Access Journals (Sweden)

    Kruschewski M

    2014-10-01

    Full Text Available Purpose: The impact of neoadjuvant chemoradiation therapy (CRT on the postoperative complication rate is discussed controversially. Thus the aim of this study was to evaluate the postoperative complication rate in our patient population. Methods: A retrospective analysis was performed to examine all patients documented online who had undergone conventionally fractionated adjuvant or neoadjuvant CRT from 2001 to 2009 in conjunction with curative resection (R0 for sporadic primary colorectal cancer in the middle or lower third. A total of 246 patients were included and analyzed. Two groups were formed: Group I, 2001-2004, adjuvant CRT, n=108, and Group II, 2005-2009, neoadjuvant CRT, n=138. Results: The two groups had comparable patient-, tumor- and therapy-related characteristics. No difference was found in the anastomotic leak rate (Group I vs. II: 10% vs. 11%. The rate of perineal wound healing problems differed significantly (Group I vs. II: 5% vs. 36%, p=0.016. While no patient died in Group I, lethality amounted to 1.5% (2/138 in Group II. Conclusions: Neoadjuvant CRT does not lead to a higher anastomotic leak rate or lethality in comparison to patients who were primarily operated and received adjuvant CRT in the further course. The rate of perineal wound healing problems is significantly increased.

  17. Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery.

    Science.gov (United States)

    McTier, Lauren; Botti, Mari; Duke, Maxine

    2016-02-01

    Clinical interventions aimed at reducing the incidence of postoperative pulmonary complications necessitate patient engagement and participation in care. Patients' ability and willingness to participate in care to reduce postoperative complications is unclear. Further, nurses' facilitation of patient participation in pulmonary interventions has not been explored. To explore patients' ability and willingness to participate in pulmonary interventions and nurses' facilitation of pulmonary interventions. Single institution, case study design. Multiple methods of data collection were used including preadmission (n=130) and pre-discharge (n=98) patient interviews, naturalistic observations (n=48) and nursing focus group interviews (n=2). A cardiac surgical ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. One hundred and thirty patients admitted for cardiac surgery via the preadmission clinic during a 1-year period and 40 registered nurses who were part of the permanent workforce on the cardiac surgical ward. Patients' understanding of their role in pulmonary interventions and patients' preference for and reported involvement in pulmonary management. Nurses' facilitation of patients to participate in pulmonary interventions. Patients displayed a greater understanding of their role in pulmonary interventions after their surgical admission than they did at preadmission. While 55% of patients preferred to make decisions about deep breathing and coughing exercises, three-quarters of patients (75%) reported they made decisions about deep breathing and coughing during their surgical admission. Nurses missed opportunities to engage patients in this aspect of pulmonary management. Patients appear willing to take responsibility for pulmonary management in the postoperative period. Nurses could enhance patient participation in pulmonary interventions by ensuring adequate information and education is provided. Facilitation of patients' participation

  18. Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer

    Science.gov (United States)

    McSorley, Stephen T.; Khor, Bo Y.; MacKay, Graham J.; Horgan, Paul G.; McMillan, Donald C.

    2017-01-01

    Abstract The aim of the present study was to examine whether a C-reactive protein (CRP) first approach would improve the detection rate of postoperative complications by CT. CRP is a useful biomarker to identify major complications following surgery for colorectal cancer. Patients with histologically confirmed colorectal cancer, who underwent elective surgery between 2008 and 2015 at a single centre were included. Exceeding the established CRP threshold of 150 mg/L on postoperative day (POD) 4 was recorded. Results of CT performed between postoperative days 4 and 14 were recorded. Four hundred ninety-five patients were included. The majority were male (58%), over 65 (68%), with node-negative disease (66%) and underwent open surgery (70%). Those patients who underwent a CT scan (n = 93), versus those who did not (n = 402), were more likely to have a postoperative complication (84% vs 35%, P cancer. PMID:28207541

  19. Effectiveness criteria of early rehabilitative treatment of patients with postoperative upper plexopathy

    Directory of Open Access Journals (Sweden)

    Tosheva M.l.

    2017-03-01

    Full Text Available The damage of the peripheral nervous system often acts as a complication of extensive surgical interventions on the removal of malignant breast tumors. The research goal is to evaluate the criteria for the effectiveness of early rehabilitation treatment of postoperative upper plexopathies. Material and Methods. The analyzed results of complex diagnosis and treatment of 162 women undergoing radical mastectomy for breast cancer, aged 33 to 79 years were presented. The examination included neurological examination, analysis of the psychological state using the HADS scales, Janet Taylor and HDRS, holding electroneuromyography Results. 98.76% of cases of patients after radical mastectomy for malignant breast tumors were diagnosed with unilateral shoulder complex. At 1.24% it established a bilateral lesion of the brachial plexus. The presence of pain is not a leading complaint in all cases. Among patients with classical mastectomy performed significantly prevailed damage of the intercostal nerves III and IV. In post-operative patients with the retrofit radical mastectomy neuro- and plexopathy were often diagnosed. Consent to one-stage reconstructive surgery is directly correlated with the level of education and marital status. Indicators of depression and anxiety were lower after reconstructive plastic surgery. Conclusion. The criteria for the effectiveness of early rehabilitation treatment of postoperative upper plexopathies were obtained. The decisions on the nature and scope of reconstructive and plastic surgery were established to be in conjunction with the social components of life of patients.

  20. Early vascular complications after pediatric liver transplantation

    NARCIS (Netherlands)

    Sieders, E; Peeters, PMJG; Ten Vergert, EM; de Jong, KP; Porte, RJ; Zwaveling, JH; Bijleveld, CMA; Slooff, MJH

    Vascular complications have a detrimental effect on the outcome after liver transplantation. Most studies focus exclusively on hepatic artery thrombosis (HAT), The current study analyzed the incidence, consequences, and risk factors for HAT, portal vein thrombosis (PVT), and venous outflow tract

  1. EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    2013-03-01

    Full Text Available Context Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years. Contexto A cirurgia bariátrica tem mostrado ser o método mais eficaz de tratamento da obesidade grave. No entanto, sua aceitação como terapia padrão-ouro ainda é questionada. As complicações cirúrgicas observadas no início do período p

  2. Difference between early versus delayed postoperative physical rehabilitation protocol following arthroscopic rotator cuff repair

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    Samar M Fawzy

    2016-01-01

    Conclusion Significant improvement in pain, ROM, and function after arthroscopic rotator cuff repair was seen at 1 year postoperatively, regardless of early or delayed postoperative rehabilitation protocols. However, early motion increases pain scores and may increase the possibility of rotator cuff retear but with early regain of ROM. A delayed rehabilitation protocol with immobilization for 6 weeks would be better for tendon healing without risk for retear or joint stiffness and easily convalescence with less postoperative pain.

  3. The Effect of Neoadjuvant Therapy on Early Complications of Esophageal Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Mohammadtaghi Rajabi Mashhadi

    2015-07-01

    Full Text Available Introduction: Early diagnosis and appropriate treatment is required in esophageal cancer due to its invasive nature. The aim of this study was to evaluate early post-esophagectomy complications in patients with esophageal cancer who received neoadjuvant chemoradiotherapy (NACR.   Materials and Methods: This randomized clinical trial was carried out between 2009 and 2011. Patients with lower-third esophageal cancer were randomly assigned to one of two groups. The first group consisted of 50 patients receiving standard chemoradiotherapy (Group A and then undergoing surgery, and the second group consisted of 50 patients undergoing surgery only (Group B. Patients were evaluated with respect to age, gender, clinical symptoms, type of pathology, time of surgery, perioperative blood loss, and number of lymph nodes resected as well as early post-operative complicate including leakage at the anastomosis site, chylothorax and pulmonary complications, hospitalization period, and mortality rate within the first 30 days after surgery.   Results: The mean age of patients was 55 years. Seventy-two patients had squamous cell carcinoma (SCC and 28 patients had adenocarcinoma (ACC. There was no significant difference between the two groups with respect to age, gender, time of surgery, complications including anastomotic leakage, chylothorax, pulmonary complications, cardiac complications, deep venous thrombosis (DVT, or mortality. However, there was a significant difference between the two groups regarding hospital stay, time of surgery, perioperative blood loss, and number of lymph nodes resected.   Conclusion:  The use of NACR did not increase early post-operative complications or mortality among patients with esophageal cancer.

  4. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.

    Science.gov (United States)

    Roche, J J W; Wenn, R T; Sahota, O; Moran, C G

    2005-12-10

    To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality. Prospective observational cohort study. University teaching hospital. 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery. Routine care for hip fractures. Postoperative complications and mortality at 30 days and one year. Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3). In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.

  5. Association Between Nutritional Status, Inflammatory Condition, and Prognostic Indexes with Postoperative Complications and Clinical Outcome of Patients with Gastrointestinal Neoplasia.

    Science.gov (United States)

    Costa, Milena Damasceno de Souza; Vieira de Melo, Camila Yandara Sousa; Amorim, Ana Carolina Ribeiro de; Cipriano Torres, Dilênia de Oliveira; Dos Santos, Ana Célia Oliveira

    2016-10-01

    The aim of this study is to describe and relate nutritional and inflammatory status and prognostic indexes with postoperative complications and clinical outcome of patients with gastrointestinal malignancies. Twenty-nine patients were evaluated; nutritional assessment was carried out by subjective and objective parameters; albumin, pre-albumin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) were determined. To assess prognosis, the Glasgow scale, the Prognostic Inflammatory Nutritional Index (PINI), and CRP/albumin ratio were used; the clinical outcomes considered were hospital discharge and death. A high Subjective Global Assessment (SGA) score was associated with the occurrence of postoperative complications: 73% of the patients with postoperative complications had the highest SGA score, but only 6% of those without postoperative complications had the highest SGA score (P 1, and Glasgow score 2. There was a positive correlation between weight loss percentage with serum CRP levels (P = 0.002), CRP/albumin (P = 0.002), PINI (P = 0.002), and Glasgow score (P = 0.000). This study provides evidence that the assessment of the nutritional status and the use of prognostic indexes are good tools for predicting postoperative complications and clinical outcome in patients with gastrointestinal neoplasia.

  6. Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: A prospective study.

    Science.gov (United States)

    Lou, N; Chi, C-H; Chen, X-D; Zhou, C-J; Wang, S-L; Zhuang, C-L; Shen, X

    2017-01-01

    Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. This study aims to explore the prevalence of sarcopenia in overweight and obese gastric cancer (GC) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients. According to the recommended body-mass index (BMI) for Asian populations by WHO, we conducted a prospective study of overweight and obese gastric cancer patients (BMI ≥ 23 kg/m(2)) under curative gastrectomy from August 2014 to December 2015. Including lumbar skeletal muscle index, handgrip strength and gait speed as the sarcopenic components were measured before surgery. Patients were followed up after gastrectomy to gain the actual clinical outcomes. Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis. Total of 206 overweight or obese patients were enrolled in this study, 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications, higher hospital costs, and higher rate of 30-days readmission compared with the non-sarcopenic ones. On the basis of univariate and multivariate analysis, sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer (P = 0.002). Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  7. Correlation of antibiotic prophylaxis and difficulty of extraction with postoperative inflammatory complications in the lower third molar surgery.

    Science.gov (United States)

    Lee, J Y; Do, H S; Lim, J H; Jang, H S; Rim, J S; Kwon, J J; Lee, E S

    2014-01-01

    Our aim was to investigate the correlation among antibiotic prophylaxis, difficulty of extraction, and postoperative complications in the removal of lower 3rd molars. A total of 1222 such extractions in 890 patients between January 2010 and January 2012 were analysed retrospectively. The difficulty of extraction measured by Pederson's index, antibiotic prophylaxis with cefditoren, and postoperative complications were recorded. The difficulty of extraction was significantly associated with postoperative complications (p=0.03). There were no significant associations between antibiotic prophylaxis and postoperative complications in groups of equal difficulty ("easy" group (class I) p=1.00; "moderate" group (class II) p=1.00; and "difficult" group (class III) p=0.65). There was a small but insignificant increase in the number of dry sockets and infections in class III cases. In conclusion, this study provides further evidence that antibiotic prophylaxis for the prevention of postoperative inflammatory complications is unnecessary for extraction of 3rd molars. Copyright © 2013. Published by Elsevier Ltd.

  8. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery?

    Science.gov (United States)

    Kalogianni, Antonia; Almpani, Panagiota; Vastardis, Leonidas; Baltopoulos, George; Charitos, Christos; Brokalaki, Hero

    2016-10-01

    The effect of preoperative education on anxiety and postoperative outcomes of cardiac surgery patients remains unclear. The aim of the study was to estimate the effectiveness of a nurse-led preoperative education on anxiety and postoperative outcomes. A randomised controlled study was designed. All the patients who were admitted for elective cardiac surgery in a general hospital in Athens with knowledge of the Greek language were eligible to take part in the study. Patients in the intervention group received preoperative education by specially trained nurses. The control group received the standard information by the ward personnel. Measurements of anxiety were conducted on admission-A, before surgery-B and before discharge-C by the state-trait anxiety inventory. The sample consisted of 395 patients (intervention group: 205, control group: 190). The state anxiety on the day before surgery decreased only in the intervention group (34.0 (8.4) versus 36.9 (10.7); P=0.001). The mean decrease in state score during the follow-up period was greater in the intervention group (P=0.001). No significant difference was found in the length of stay or readmission. Lower proportions of chest infection were found in the intervention group (10 (5.3) versus 1 (0.5); P=0.004). Multivariate linear regression revealed that education and score in trait anxiety scale on admission are independent predictors of a reduction in state anxiety. Preoperative education delivered by nurses reduced anxiety and postoperative complications of patients undergoing cardiac surgery, but it was not effective in reducing readmissions or length of stay. © The European Society of Cardiology 2015.

  9. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    Directory of Open Access Journals (Sweden)

    David Snowdon

    2014-06-01

    Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

  10. Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice.

    Science.gov (United States)

    Qian, Xiao-Lan; Zhang, Wei; Liu, Ming-Zheng; Zhou, Yu-Bing; Zhang, Jing-Min; Han, Li; Peng, You-Mei; Jiang, Jin-hua; Wang, Qing-Duan

    2015-01-05

    Postoperative cognitive dysfunction (POCD) is a frequent complication following major surgery in the elderly. However, the exact pathogenic mechanisms are still unknown. Dexmedetomidine, a selective alpha 2 adrenal receptor agonist, was revealed anesthesia and brain protective role. The present study aimed to examine whether dexmedetomdine protects against POCD induced by major surgical trauma under general anesthesia in aged mice. In the present study, cognitive function was assessed by Y-maze. Proinflammatory cytokines interleukin-1β (IL-1β) and tumor necrosis factor (TNF-α), apoptosis-related factor caspase-3 and Bax were detected by real-time PCR, Western blot or immunohistochemistry. The results showed that anesthesia alone caused weak cognitive dysfunction on the first day after general anesthesia. Cognitive function in mice with splenectomy under general anesthesia was significantly exacerbated at the first and third days after surgery, and was significantly improved by dexmedetomidine administration. Splenectomy increased the expression of IL-1β, TNF-α, Bax and caspase-3 in hippocampus. These changes were significantly inversed by dexmedetomidine. These results suggest that hippocampal inflammatory response and neuronal apoptosis may contribute to POCD, and selective alpha 2 adrenal receptor excitation play a protective role.

  11. Early postpartum eclampsia complicated by subarachnoid ...

    African Journals Online (AJOL)

    Adele

    Southern African Journal of Anaesthesia & Analgesia - November 2003. 19. Early postpartum .... baseline CPP compared with normotensive women. The CPP changes ... critical determinant of intracranial injury in preeclampsia A new hypothesis. ... A long and dangerous journey maternal mortality in Af- rica. Anaesthesia ...

  12. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery

    DEFF Research Database (Denmark)

    Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili;

    2011-01-01

    Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed....

  13. Anesthetic complications including two cases of postoperative respiratory depression in living liver donor surgery

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    David Beebe

    2011-01-01

    Full Text Available Background: Living liver donation is becoming a more common means to treat patients with liver failure because of a shortage of cadaveric organs and tissues. There is a potential for morbidity and mortality, however, in patients who donate a portion of their liver. The purpose of this study is to identify anesthetic complications and morbidity resulting from living liver donor surgery. Patients and Methods: The anesthetic records of all patients who donated a segment of their liver between January 1997 and January 2006 at University of Minnesota Medical Center-Fairview were retrospectively reviewed. The surgical and anesthesia time, blood loss, hospitalization length, complications, morbidity, and mortality were recorded. Data were reported as absolute values, mean ± SD, or percentage. Significance (P < 0.05 was determined using Student′s paired t tests. Results: Seventy-four patients (34 male, 40 female, mean age = 35.5 ± 9.8 years donated a portion of their liver and were reviewed in the study. Fifty-seven patients (77% donated the right hepatic lobe, while 17 (23% donated a left hepatic segment. The average surgical time for all patients was 7.8 ± 1.5 hours, the anesthesia time was 9.0 ± 1.3 hours, and the blood loss was 423 ± 253 ml. Forty-six patients (62.2% received autologous blood either from a cell saver or at the end of surgery following acute, normovolemic hemodilution, but none required an allogenic transfusion. Two patients were admitted to the intensive care unit due to respiratory depression. Both patients donated their right hepatic lobe. One required reintubation in the recovery room and remained intubated overnight. The other was extubated but required observation in the intensive care unit for a low respiratory rate. Twelve patients (16.2% had complaints of nausea, and two reported nausea with vomiting during their hospital stay. There were four patients who developed complications related to positioning during the

  14. Postoperative infection in laparoscopic cholecystectomy in treatment of acute cholecystitis complicated by choleperitonitis

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    YANG Yalin

    2017-01-01

    Full Text Available ObjectiveTo investigate the influence of laparoscopic cholecystectomy (LC versus open cholecystectomy (OC on postoperative systemic infection and immune response in patients with acute cholecystitis complicated by choleperitonitis. MethodsA prospective randomized controlled trial was performed for 45 patients who had a definite diagnosis of acute calculous cholecystitis complicated by choleperitonitis in Shanghai Liqun Hospital from January 2014 to June 2016. According to surgical procedures, the patients were randomized into LC group (23 patients and OC group (22 patients. The length of hospital stay, postoperative complications, and deaths were evaluated in both groups. Blood samples were collected from all patients before surgery and at 1, 3, and 6 days after surgery to compare the changes in neutrophil count, serum levels of C-reactive protein (CRP and interleukin-6 (IL-6, and erythrocyte sedimentation rate (ESR, as well as the incidence of endotoxemia.  The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe LC group had a significantly shorter length of hospital stay than the OC group (5.4±2.7 d vs 10.2±3.5 d, t= -5.46, P<0.001. One patient (4.3% in the LC group and 6 (27.3% in the OC group experienced peritoneal abscess after surgery, and there was a significant difference in the incidence rate of complications between the two groups (χ2=4.77, P=0.03. In all patients, the mortality rate was 17.8% (8/45, with 1 (4.3% in the LC group and 7 (31.8% in the OC group, and there was a significant difference between the two groups (χ2= 5.16, P=0.02. Of all patients in the OC group, 4 died of peritoneal abscess, 1 died of pulmonary embolism, and 1 died of myocardial infarction; of all patients in the LC group, 1 died of myocardial infarction. There were no significant differences in inflammatory markers before surgery between the two

  15. Classification and Risk-factor Analysis of Postoperative Cardio-pulmonary 
Complications after Lobectomy in Patients with Stage I Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yutian LAI

    2016-05-01

    Full Text Available Background and objective There are incresing lung cancer patients detected and diagnosed at the intermediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health consciousness. The aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary complications in stage I non-small cell lung cancer (NSCLC patients, based on routine laboratory tests, basic characteristics, and intraoperative variables in hospital. Methods The 421 patients after lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratified into complication group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications after lobectomy in 30 days. Results Of them, 64 (15.2% patients were finally identified and selected into the complication group, compared with 357 (84.8% in non-complication group: pneumonia (8.8%, 37/421 was the primary complication, and other main complications included atelectasis (5.9%, 25/421, pleural effusion (≥middle (5.0%, 21/421, persistent air leak (3.6%, 15/421; The operation time (P=0.007, amount of blood loss (P=0.034, preoperative chronic obstructive pulmonary disease (COPD (P=0.027, white blood cell (WBC count (P<0.001, neutrophil-lymphocyte ratio (NLR (P<0.001 were significantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD (OR=0.031, 95%CI: 0.012-0.078, P<0.001 and WBC count (OR=1.451, 95%CI: 1.212-1.736, P<0.001 were independent risk factors for postoperative cardio-pulmonary complications. Conclusion Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD

  16. Can C-reactive protein predict the severity of a post-operative complication after elective resection of colorectal cancer?

    Science.gov (United States)

    Selby, James; Prabhudesai, Ash

    2014-10-01

    To explore if post-operative day 3 C-reactive protein (CRP), the ratio of pre-operative to day 3 white cell count (WCC) and platelet count can be used to predict the risk of post-operative complication and stratify the severity of complications as defined by the Clavien-Dindo classification. Data was obtained retrospectively on 127 patients who had elective bowel resection for malignancy between 2011 and 2013. Baseline demographics and clinical details were obtained including pre-operative and day 3 WCC and platelets and day 3 CRP. Ratio of pre-operative to day 3 WCC and platelets was calculated. Outcome measures were if a complication occurred (death included) and complication as defined by the Clavien-Dindo clasification. Mann-Whitney U test and Kruskal-Wallis were used to test for significance. Of 127 patients, 57 % (n = 73) were male with a total median age of 72 and the commonest histology result T3N0 (40.6 %, n = 52). CRP was found to predict a complication (p < 0.0005) and the severity of complication as per the Clavien-Dindo classification (p < 0.0005). Day 3 CRP over 285 suggested a life-threatening complication (Clavien-Dindo score 4). There was no statistical significance between the ratio of WCC and platelets to any of the outcome measures. WCC, platelets and CRP are routinely performed in the post-operative period. Previous research has shown CRP to be a good predictor of a complication. This paper has shown that day 3 CRP can not only predict but can also stratify the severity of post-operative complications.

  17. Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis: report of 2 cases.

    Science.gov (United States)

    Gragnaniello, Cristian; Seex, Kevin A; Eisermann, Lukas G; Claydon, Matthew H; Malham, Gregory M

    2013-08-01

    The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported. The anterior Maverick device has a ball-and-socket design made of cobalt-chromium-molybdenum metal plates covered with hydroxyapatite. The superior and inferior endplates have keels to resist translation forces. The patient in Case 1 was a 52-year-old man with severe L4-5 discogenic pain; and in Case 2, a 42-year-old woman with disabling L4-5 and L5-S1 discogenic back pain. Both patients were without medical comorbidities and were nonsmokers with no risk factors for osteoporosis. Both had undergone uneventful retroperitoneal approaches performed by a vascular access surgeon. Computed tomography studies on postoperative Day 2 confirmed excellent prosthesis placement. Initial recoveries were uneventful. Two weeks postoperatively, after stretching (extension or hyperextension) in bed at home, each patient suffered the sudden onset of severe abdominal pain with anterior dislocation of the Maverick prosthesis. The patients were returned to the operating room and underwent surgery performed by the same spinal and vascular surgeons. Removal of the Maverick prosthesis and anterior interbody fusion with a separate cage and plate were performed. Both patients had recovered well with good clinical and radiological recovery at the 6- and 12-month follow-ups. Possible causes of the anterior dislocation of the Maverick prosthesis include the following: 1) surgeon error: In both cases the keel cuts were neat, and early postoperative CT confirmed good placement of the prosthesis; 2) equipment problem: The keel cuts may have been too large because the cutters were worn, which led to an inadequate press fit of the implants; 3) prosthesis

  18. The Effects of Early Post-Operative Soluble Dietary Fiber Enteral Nutrition for Colon Cancer

    Directory of Open Access Journals (Sweden)

    Rui Xu

    2016-09-01

    Full Text Available We examined colon cancer patients who received soluble dietary fiber enteral nutrition (SDFEN to evaluate the feasibility and potential benefit of early SDFEN compared to EN. Sixty patients who were confirmed as having colon cancer with histologically and accepted radical resection of colon cancer were randomized into an SDFEN group and an EN group. The postoperative complications, length of hospital stay (LOH, days for first fecal passage, and the difference in nutritional status, immune function and inflammatory reaction between pre-operation and post-operation were all recorded. The statistical analyses were performed using the t-test and the chi square test. Statistical significance was defined as p < 0.05. After the nutrition support, differences in the levels of albumin, prealbumin and transferrin in each group were not statistically significant (p > 0.05; the levels of CD4+, IgA and IgM in the SDFEN group were higher than that of the EN group at seven days (p < 0.05; the levels of TNF-α and IL-6 in the SDFEN group were lower than that of the EN group at seven days (p < 0.05; and patients in the SDFEN group had a significantly shorter first flatus time than the EN group (p < 0.05. Early post-operative SDFEN used in colon cancer patients was feasible and beneficial in immune function and reducing inflammatory reaction, gastrointestinal function and speeding up the recovery.

  19. Postoperative complications necessitating right lower lobectomy in a heart-lung transplant recipient with previous sternotomy.

    Science.gov (United States)

    Diethrich, E B; Bahadir, I; Gordon, M; Maki, P; Warner, M G; Clark, R; Siever, J; Silverthorn, A

    1987-09-01

    Heart-lung transplantation for treatment of end-stage cardiopulmonary disease continues to be plagued by many problems. Three primary ones are the technical difficulties that can be encountered, particularly in those patients who have undergone previous cardiac operations, the additional restriction on donor availability imposed by the lack of satisfactory preservation techniques, and the need for lung size compatibility. Two of these difficulties and others surfaced postoperatively in a heart-lung transplant recipient who presented a series of unique operative and therapeutic challenges. A 42-year-old woman with chronic pulmonary hypertension and previous atrial septal defect repair underwent a heart-lung transplantation in August 1985. The operative procedure was expectedly complicated by bleeding from extensive mediastinal adhesions from the previous sternotomy and bronchial collateralization. Excessive chest tube drainage postoperatively necessitated reoperation to control bleeding from a right bronchial artery tributary. Phrenic nerve paresis, hepatomegaly, and marked abdominal distention caused persistent atelectasis and eventual right lower lobe collapse. Arteriovenous shunting and low oxygen saturation necessitated right lower lobectomy 15 days after transplantation, believed to be the first use of this procedure in a heart-lung graft recipient. Although oxygenation improved dramatically, continued ventilatory support led to tracheostomy. An intensive, psychologically oriented physical therapy program was initiated to access and retrain intercostal and accessory muscles. The tracheostomy cannula was removed after 43 days and gradual weaning from supplemental oxygen was accomplished. During this protracted recovery period, an episode of rejection was also encountered and successfully managed with steroid therapy. The patient continued to progress satisfactorily and was discharged 83 days after transplantation. She is well and active 20 months after discharge.

  20. Decreased heart rate variability responses during early postoperative mobilization

    DEFF Research Database (Denmark)

    Jans, Øivind; Brinth, Louise; Kehlet, Henrik

    2015-01-01

    to postoperative autonomic dysfunction. Thus, based on a previous study on haemodynamic responses during mobilization before and after elective total hip arthroplasty (THA), we performed secondary analyses of heart rate variability (HRV) and aimed to identify possible abnormal postoperative autonomic responses...

  1. Radiological intervention in postoperative complications following liver transplantation; Interventionelle radiologische Verfahren bei postoperativen Komplikationen nach Lebertransplantation

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    Berger, H. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern, Univ. Muenchen (Germany); Staebler, A. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern, Univ. Muenchen (Germany); Kunzfeld, A. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern, Univ. Muenchen (Germany); Zuelke, C. [Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Univ. Muenchen (Germany); Anthuber, M. [Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Univ. Muenchen (Germany); Kraemling, H.J. [Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Univ. Muenchen (Germany)

    1997-03-01

    Purpose: Postoperative complications contribute significantly to the morbidity and mortality of liver transplant patients. The management of these complications requires a multidisciplinary approach in which interventional radiology plays an integral role. Indications, techniques, and results of radiological interventions in the management of the liver transplant patient are presented. Material and methods: During a 10-year period, 52 out of 420 liver transplant recipients underwent radiological interventions, including angioplasty (n=20), embolization (n=2), percutaneous drainage (n=11), and biliary interventions (n=19). Results: Nine out of ten arterial stenoses located at the anastomoses (n=8), within the liver (n=1) and in the coeliac trunk (n=1) were successfully treated by balloon dilatation. Angioplasty of supra- or infrahepatic anastomotic stenoses of the IVC (n=5) provided long-term success only in combination with stent implantation. Portal vein stenoses and chronic thrombosis were treated by balloon dilatation and stent insertion via transhepatic catheterization of the portal vein. Late strictures of bile-duct anastomoses can be managed by ante- or retrograde interventions. If biliary complications are related to inflammatory or septic problems, the prognosis of graft survival is poor. Conclusion: Interventional radiological procedures are very useful in the management of vascular and biliary complications after liver transplantation. These techniques provide a cure in many situations, and thus, surgical interventions may be avoided in selected cases. (orig.) [Deutsch] Die komplexe chirurgisch-technische Operation sowie immunologische und ischaemieverursachte Probleme tragen zur relativ hohen Komplikationsrate nach Lebertransplantation bei, die grundsaetzlich organ- bzw. lebensbedrohlich fuer den Patienten sind. Interventionelle radiologische Techniken sind aufgrund ihres minimal-invasiven Charakters in der klinischen Versorgung dieser Komplikationen

  2. A retrospective, unicentric evaluation of complicated diverticulosis jejuni: Symptoms, treatment and postoperative course

    Directory of Open Access Journals (Sweden)

    Patrick eTeoule

    2015-11-01

    Full Text Available BackgroundIn contrast to the diverticulosis of the colon jejunal diverticulosis is a rare condition. The incidence is 0.06% up to 5% in large autopsy series. Complicated diverticulosis jejuni (CDJ often presents with unspecific symptoms. Therefore diagnosis is often a challenging diagnosis and due to the clinical rarity no generally valid recommendation of perioperative management exists. Patients and MethodsWe considered only patients that were operated in our centre between April 2007 and August 2014. Patients were identified by data bank search via International Statistical Classification of Diseases and Related Health Problems (ICD diagnosis code K57.10. Data was manually screened and patients with Meckel’s and duodenal diverticula were excluded from this study. Eleven consecutive patients with CDJ were finally included in this study. We analysed symptoms, diagnostic procedures, surgical treatment and postoperative morbidity and mortality. ResultsThe median age of our patients was 76 years (range 34 87. CDJ presented most frequently as intestinal bleeding or as diverticulitis. Clinical symptoms were unspecific abdominal pain, hematemesis or melena, ileus, nausea and emesis as well as patients with acute abdomen. Esophagogastroduodenoscopies confirmed CDJ in two of three patients. An abdominal CT-scan only helped to diagnose CDJ in two of ten patients. Eight (72.7% patients received an open segmental resection with primary anastomosis. In three (27.3% cases a reoperation was necessary. Overall morbidity rate was 45.5% and perioperative mortality was 9.1%. Conclusions Due to the acute character of the disease patients with CDJ are seriously ill. To diagnose patients with CDJ remains challenging as diagnostic investigations are usually not helpful in confirming diagnosis. Still, diagnosis of CDJ is most frequently confirmed intraoperatively.Keywords: complicated jejunal diverticulitis, perioperative management, acute abdomen, visceral surgery

  3. Postoperative Complications After Prophylactic Thyroidectomy for Very Young Patients With Multiple Endocrine Neoplasia Type 2 : Retrospective Cohort Analysis

    NARCIS (Netherlands)

    Kluijfhout, Wouter P; van Beek, Dirk-Jan; Verrijn Stuart, Annemarie A; Lodewijk, Lutske; Valk, Gerlof D.; van der Zee, David C; Vriens, Menno R; Borel Rinkes, Inne H M

    The aim of this study was to investigate whether younger age at surgery is associated with the increased incidence of postoperative complications after prophylactic thyroidectomy in pediatric patients with multiple endocrine neoplasia (MEN) 2. The shift toward earlier thyroidectomy has resulted in

  4. Preoperative protein and energy intake and postoperative complications in well-nourished, non-hospitalized elderly cardiac surgery patients

    NARCIS (Netherlands)

    L.M.W. van Venrooij; P.A.M. van Leeuwen; R. de Vos; M.M.M.J. Borgmeijer-Hoelen; B.A.J.M. de Mol

    2009-01-01

    Background & aims: Little is known about the impact of preoperative protein or energy intake in relation to the occurrence of postoperative complications in patients who are not undernourished but cannot keep up their daily protein or energy requirements prior to cardiac surgery. Therefore, a prospe

  5. Application of Minimum Effective Cuff Inflating Volume for Laryngeal Mask Airway and its Impact on Postoperative Pharyngeal Complications

    Directory of Open Access Journals (Sweden)

    Bing-Bing Li

    2015-01-01

    Conclusions: The relationship between the cuff inflating volume and the intracuff pressure for size 4 or 5 LMA Well LeadTM is in a linear correlation manner at the range of 5–30 ml. The minimal cuff inflating volume is adequate for satisfactory airway sealing and consequently associated with lower incidence of postoperative pharyngeal complications for LMA Well Lead.™

  6. Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: beyond oxygen consumption.

    Science.gov (United States)

    Shafiek, Hanaa; Valera, Jose Luis; Togores, Bernat; Torrecilla, Juan Antonio; Sauleda, Jaume; Cosío, Borja G

    2016-10-01

    Patients with poor lung function usually undergo cardiopulmonary exercise testing (CPET) and those with a predicted postoperative maximal oxygen consumption (VO2 max) of >10 ml/kg/min undergo lung resection surgery and still some complications are observed. We aimed to determine other parameters beyond VO2 able to predict postoperative complications in patients undergoing lung resection surgery. This is an observational study with longitudinal follow-up. Patients with forced expiratory volume in 1 second (FEV1) or diffusing capacity for carbon monoxide of VO2 max of >10 ml/kg/min were considered fit for surgery. Patients were followed up prospectively for 12 months and postoperative complications and survival were recorded. Physiological parameters obtained during CPET and pulmonary function tests were analysed. Eighty-three chronic obstructive pulmonary disease (COPD) patients were evaluated for surgery between 2010 and 2015. Twenty-four patients were considered unfit for surgery and received an alternative therapy. Fifty-five patients had a VO2 max of >10 ml/kg/min and underwent lung surgery. Among them, 4% died and 41% developed complications postoperatively. Baseline minute ventilation to carbon dioxide output (VE/VCO2) slope was significantly higher among those who developed postoperative complications or died (P = 0.047). Furthermore, VE/VCO2 slope of >35 (at maximal exercise) was the single parameter most strongly associated with the probability of mortality and postoperative complications (hazard ratio 5.14) with a survival probability of 40% after 1 year of follow-up. In a multivariable model, VO2, VE/VCO2 slope of >35 and work load were independently associated with the probability of having an event. VO2 is not the unique parameter to consider when CPET is performed to evaluate the postoperative risk of lung cancer surgery in COPD patients. The signs of ventilatory inefficiency such as VE/VCO2 slope predict complications better than VO2 does. © The

  7. Sarcopenia, but not visceral fat amount, is a risk factor of postoperative complications after major hepatectomy.

    Science.gov (United States)

    Higashi, Takaaki; Hayashi, Hiromitsu; Taki, Katsunobu; Sakamoto, Keita; Kuroki, Hideyuki; Nitta, Hidetoshi; Hashimoto, Daisuke; Chikamoto, Akira; Beppu, Toru; Baba, Hideo

    2016-04-01

    Major hepatectomy is associated with significant morbidity and mortality rates, particularly in patients aged more than 70 years. This study assessed whether physical indicators, such as sarcopenia and visceral fat amount, could predict morbidity and mortality after major hepatectomy. The study enrolled 144 patients who underwent curative major hepatectomy. Skeletal muscle and visceral fat amount at the third lumbar vertebra (L3) in the inferior direction were quantified using enhanced computed tomography scans. The patients were divided into two subgroups, with and without sarcopenia, based on median skeletal muscle mass in men and women (43.2 cm(2)/m(2) in men; 35.3 cm(2)/m(2) in women). The study included 108 men and 36 women, with median skeletal muscle tissue of 43.2 and 35.3 cm(2)/m(2), respectively. The mortality rate was significantly higher in patients with than without sarcopenia [seven cases (9.7 %), one case (1.4 %), respectively; P = 0.021], whereas liver-related morbidity and mortality rates were similar. In patients aged >70 years, the morbidity, liver dysfunction-related morbidity, and mortality rates were significantly higher in patients with than without sarcopenia (P Sarcopenia was a risk factor for postoperative complications after major hepatectomy, particularly in elderly patients.

  8. Early clinical outcome and complications related to balloon kyphoplasty

    Directory of Open Access Journals (Sweden)

    Martin Bergmann

    2012-06-01

    Full Text Available The treatment of painful osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly over the last two decades. The benefits of balloon kyphoplasty compared to conservative treatment remain controversial and are discussed in the literature. The complication rates of vertebroplasty and kyphoplasty are considered to be low. The focus of this study was the analysis of acute and clinically relevant complications related to this procedure. In our department, all patients treated between February 2002 and February 2011 with percutaneous cement augmentation (372 patients, 522 augmented vertebral bodies were prospectively recorded. Demographic data, comorbidities, fracture types, intraoperative data and all complications were documented. The pre- and postoperative pain-level and neurological status (Frankel-Score were evaluated. All patients underwent a standardized surgical procedure. Two hundred and ninety-seven patients were treated solely by balloon kyphoplasty; 216 females (72.7% and 81 males (27.3%. Average patient age was 76.21 years (±10.71, range 35-98 years. Average American Society Anestesiologists score was 3.02. According to the Orthopedic Trauma Association classification, there were 69 A 1.1 fractures, 177 A 1.2 fractures, 178 A 3.1.1 fractures and 3 A 3.1.3 fractures. Complications were divided into preoperative, intraoperative and postoperative events. There were 4 pre-operative complications: 3 patients experienced persistent pain after the procedure. In one case, the pedicles could not be visualized during the procedure and the surgery was terminated. One hundred and twenty-nine (40.06% of the patients showed intraoperative cement leaking outside the vertebras, one severe hypotension and tachycardia as reaction to the inflation of the balloons, and there was one cardiac arrest during surgery. Postoperative subcutaneous hematomas were observed in 3 cases, 13 patients developed a

  9. Impact of early or delayed elective resection in complicated diverticulitis

    Institute of Scientific and Technical Information of China (English)

    Kai Bachmann; Geeske Krause; Tamina Rawnaq; Lena Tomkotter; Yogesh Vashist; Shanly Shahmiri; Jakob R Izbicki; Maximilian Bockhorn

    2011-01-01

    AIM: To investigate the outcomes of early and delayed elective resection after initial antibiotic treatment in patients with complicated diverticulitis.METHODS: The study, a non-randomized comparison of the two approaches, included 421 consecutive patients who underwent surgical resection for complicated sigmoid diverticulitis (Hinchey classification Ⅰ-Ⅱ) at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2004 and 2009. The operating procedure, duration of hospital and intensive care unit stay, outcome, complications and socioeconomic costs were analyzed, with comparison made between the early and delayed elective resection strategies. RESULTS: The severity of the diverticulitis and American Society of Anesthesiologists score were comparable for the two groups. Patients who underwent delayed elective resection had a shorter hospital stay and operating time, and the rate of successfully completed laparoscopic resections was higher (80% vs 75%). Eight patients who were scheduled for delayed elective resection required urgent surgery because of complications of the diverticulitis, which resulted in a high rate of morbidity. Analysis of the socioeconomic effects showed that hospitalization costs were significantly higher for delayed elective resection compared with early elective resection (9296 € ± 694 € vs 8423 € ± 968 €; P = 0.001). Delayed elective resection showed a trend toward lower complications, and the operation appeared simpler to perform than early elective resection. Nevertheless, delayed elective resection carries a risk of complications occurring during the period of 6-8 wk that could necessitate an urgent resection with its consequent high morbidity, which counterbalanced many of the advantages. CONCLUSION: Overall, early elective resection for complicated, non-perforated diverticulitis is shown to be a suitable alternative to delayed elective resection after 6-8 wk, with additional beneficial socioeconomic

  10. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer

    Science.gov (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-01-01

    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. PMID:27043677

  11. Total knee arthroplasty in patients with dialysis: Early complications and mortality

    Directory of Open Access Journals (Sweden)

    Jen-Hung Chen

    2014-04-01

    Full Text Available Background: Total hip arthroplasty (THA in patients on long-term hemodialysis may result in a high prevalence of complications which related to nature of the disease, and associated cardiovascular conditions. However, the result of total knee artrhopalsty (TKA in those patients is not clear. The purpose of this study was to retrospectively evaluate the early mortality and complications of TKA performed in patients with dialysis. Methods: We retrospectively evaluated 15 dialysis patients (18 knees who underwent TKA using antibiotic-loaded cement fixation. Fourteen patients had maintained hemodialysis and one patient had continuous ambulatory peritoneal dialysis. The function of the knee was evaluated before operation and postoperatively using Knee Society evaluating system. Postoperative complications and mortality were recorded for all patients. The average follow up period was 25 months (6 to 59 months. Results: There were no mortalities including short-term (≤90 days or long-term (>90 days follow up. The mean knee and function scores improved from preoperative 36 points (27~46 and 19.4 points (10~35 to 79 points (68~87 and 81 points (70~95 respectively at the latest follow up. One (6.7% patient had early postoperative pneumonia (≤90 days. The late (>90 days complica-tion rate was 20% including 1 sepsis with toe gangrene, 1 recurrent stroke and 1 acute myocardiac infarction. There was no deep prosthetic joint infection or loosening of the components. Conclusion: TKA with antibiotic-loaded cement resulted in a substantial low short-term mortality and deep infections in 15 patients with dialysis. However, a longer term follow up is necessary.

  12. Intra- and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures

    DEFF Research Database (Denmark)

    Zwingmann, Jörn; Südkamp, Norbert P; König, Benjamin;

    2013-01-01

    and the small target corridor for the iliosacral screw may be difficult to visualise using an image intensifier. 2D and 3D navigation techniques may therefore be helpful tools. The aim of this multicentre study was to evaluate the intra- and postoperative complications after percutaneous screw implantation...... by classifying the fractures using data from a prospective pelvic trauma registry. The a priori hypothesis was that the navigation techniques have lower rates of intraoperative and postoperative complications. METHODS: This study is based on data from the prospective pelvic trauma registry introduced...... were identified. Out of these a further analysis was performed in 597 patients suffering injuries of the SI joint (187×with surgical interventions) and 597 patients with sacral fractures (334×with surgical interventions). The rate of intraoperative complications was not significantly different, with 10...

  13. Can we predict postoperative complications in elderly Chinese patients with hip fractures using the surgical risk calculator?

    Directory of Open Access Journals (Sweden)

    Wang X

    2017-09-01

    Full Text Available Xiao Wang, Bin Jiang Zhao, Yue Su Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China Purpose: Hip fractures are associated with poor prognosis in elderly patients partly due to the high rate of postoperative complications. This study was aimed to investigate whether the surgical risk calculator is suitable for predicting postoperative complications in elderly Chinese patients with hip fractures.Methods: The incidence of postoperative complications among 410 elderly patients with hip fractures was predicted by the surgical risk calculator and then compared with the actual value. The risk calculator model was evaluated using the following three metrics: Hosmer–Lemeshow test for the goodness-of-fit of the model, receiver operating characteristic curve (ROC (also referred as C-statistic for the predictive specificity and sensitivity, and the Brier’s score test for predictive accuracy.Results: Preoperative risk factors including gender, age, preoperative functional status, American Society of Anesthesiologists grade, hypertension, dyspnea, dialysis, previous cardiovascular history, and cerebrovascular disease were positively correlated with the incidence of postoperative complications in elderly patients with hip fractures. The predicted complication incidence rate was well matched with the actual complication rate by Hosmer–Lemeshow test. The model had high sensitivity and specificity for predicting the mortality rate of these patients with a C-statistic index of 0.931 (95% CI [0.883, 0.980]. The surgical calculator model had an accuracy of 90% for predicting the reoperation rate (Brier’s score <0.01.Conclusions: The surgical risk calculator could be useful for predicting mortality and reoperation in elderly patients with hip fracture. Patients and surgeons may use this simple calculator to better manage the preoperative risks. Keywords: hip fracture, femoral head fracture, elder age, surgical

  14. The Effect of Postoperative Single-Dose Intravenous Dexamethasone on Common Complications After Tonsillectomy in Children: A Randomized Controlled Trial

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    Kaboodkhani

    2016-01-01

    Full Text Available Background Tonsillectomy is associated with early and late postoperative complications in the children. Previous studies have shown some effects of dexamethasone; however, there has been a lack of studies that evaluate its effects on other complications, including odynophagia and otalgia. Objectives We aimed to investigate the effects of dexamethasone on odynophagia and otalgia after surgery. Patients and Methods In this randomized clinical trial, 100 patients who underwent adenotonsillectomy were divided into two groups: one group received 0.1 mg/kg of dexamethasone (case and the other received Ringer serum as a placebo (control. Intravenous (IV dexamethasone was prescribed to be administered by a nurse on the ward. The incidence of bleeding, nausea and vomiting, odynophagia, voice change, acetaminophen intake, halitosis and otalgia, and activity were evaluated at 24 h and during the first 7 days after surgery. Results The mean ages of patients were 7.1 ± 2.8 and 6.5 ± 2.4 years in the control and case groups, respectively. The overall proportions of females and males were 41% and 59%, respectively. No significant difference in demographic data was seen between the two groups (P > 0.05. There was a significant difference in terms of odynophagia and nausea and vomiting between the case and control groups after 24 h (P = 0.001. There was no significant difference between the case and control groups in terms of bleeding, voice change, halitosis, or nausea and vomiting after 7 days (P > 0.05. Meanwhile, there were a significant difference in the incidence of acetaminophen intake (60% vs. 30%, P = 0.002, odynophagia (24% vs. 6%, P = 0.011, otalgia (20% vs. 4%, P = 0.014, and activity (80% vs. 98%, P = 0.004 of patients after 7 days between the groups. Conclusions In children undergoing adenotonsillectomy, dexamethasone has a significant antiemetic effect and decreases odynophagia, otalgia, and the need for analgesia.

  15. Impact of Airflow Limitation on Comorbidities and Postoperative Complications in Patients Undergoing Thoracic Surgery: A Retrospective Observational Study

    Science.gov (United States)

    Yoshimi, Kaku; Oh, Shiaki; Suzuki, Kenji; Kodama, Yuzo; Sekiya, Mitsuaki; MD, Yoshinosuke Fukuchi

    2016-01-01

    Purpose: To assess the frequency of airflow limitation (AFL), and the relationship between AFL and preoperative comorbidities or postoperative complications in patients who had undergone thoracic surgery. Methods: The medical records of patients who underwent non-cardiac thoracic surgery at our institution between August 1996 and January 2013 were retrospectively reviewed. On the basis of preoperative pulmonary function tests, patients were classified with those with FEV1/FVC <70% [AFL(+) group] or with FEV1/FVC ≥70% [AFL(−) group]. Patient characteristics, preoperative comorbidities and postoperative complications were compared between the groups. Results: Of the 3667 patients assessed, 738 (20.1%) were allocated to the AFL(+) group. AFL was an independent risk factor for three preoperative comorbidities: chronic obstructive pulmonary disease (odds ratio [OR]: 4.65), bronchial asthma (OR 4.30) and cardiac diseases (OR 1.41). Airflow limitation was also an independent risk factor for postoperative respiratory failure including long-term oxygen therapy (OR 2.14) and atelectasis (OR 1.90) in the patients who underwent lobectomy or partial resection of the lung. Conclusions: Our retrospective study revealed that careful attention needs to be paid to airflow limitation in patients who undergo non-cardiac thoracic surgery since it appears to be an important feature of preoperative comorbidities and to increase postoperative complications. PMID:26935262

  16. De Garengeot's hernia: the importance of early diagnosis and its complications.

    Science.gov (United States)

    Kagan Coskun, A; Kilbas, Z; Yigit, T; Simsek, A; Harlak, A

    2012-12-01

    De Garengeot's hernia is a rare condition of acute appendicitis in an incarcerated femoral hernia. A 65-year-old woman was admitted to the emergency room with a 3-day history of a painful and non-reducible mass in her right groin. The patient underwent emergency surgery. At exploration, an acute appendicitis in an incarcerated femoral hernia was identified, likely prediagnosed by computed tomography. The postoperative period was uneventful. In De Garengeot's hernia, early diagnosis is important to reduce the morbidity rate. The surgical approach should be designed according to the condition of the patient, the anatomical position of the appendix vermiformis, and the likelihood of complications.

  17. Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients

    DEFF Research Database (Denmark)

    Toft Tengberg, Line; Cihoric, M; Foss, N B;

    2016-01-01

    %) deaths occurred between 72 h and 30 days after surgery; all of these patients had complications, indicating that there is a prolonged period with a high frequency of complications and mortality after emergency laparotomy. We conclude that peri-operative, enhanced recovery care bundles for preventing......Mortality and morbidity occur commonly following emergency laparotomy, and incur a considerable clinical and financial healthcare burden. Limited data have been published describing the postoperative course and temporal pattern of complications after emergency laparotomy. We undertook...... a retrospective, observational, multicentre study of complications in 1139 patients after emergency laparotomy. A major complication occurred in 537/1139 (47%) of all patients within 30 days of surgery. Unadjusted 30-day mortality was 20.2% and 1-year mortality was 34%. One hundred and thirty-seven of 230 (60...

  18. Temporary ileostomy for the preservation of colon fistula in patients with postoperative complications: case report

    Directory of Open Access Journals (Sweden)

    Solaine Chiminácio De Oliveira Patrício

    2011-09-01

    Full Text Available Among the postoperative complications in the digestive system, the fistulae are the most common ones. The changes resulting from these fistulae are very important, once they can determine the patient's situation and the development of multiple organic failures. This paper reports the case of a patient who had relevant complications after having undergone temporary ileostomy to maintain the colon fistulized. About 90 to 95% of the digestive tract fistulae have spontaneous resolution. In some cases, the general state of the patient compromises the spontaneous closure. In this study, after one month of nutritional support and medicine treatment, the spontaneous closure of the colon fistula did not occur, thus, a surgical intervention was necessary to solve the case.Dentre as complicações pós-operatórias do aparelho digestório, as fístulas apresentam alta incidência. As alterações decorrentes dessas fístulas são muito importantes, pois podem determinar o agravamento do estado geral do paciente e o desenvolvimento de insuficiências orgânicas múltiplas. O presente trabalho relata o caso de um paciente com complicações relevantes após a realização de uma ileostomia temporária para preservação do cólon fistulizado. A maioria (90-95% das fístulas do trato digestório tem resolução espontânea; entretanto, em alguns casos, o estado geral do paciente compromete o fechamento espontâneo. No caso em estudo, após um mês de suporte nutricional e tratamento medicamentoso, o fechamento espontâneo da fístula de cólon não ocorreu, sendo necessária a intervenção cirúrgica para resolução do caso.

  19. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis - a nationwide cohort study

    DEFF Research Database (Denmark)

    Nørgård, B M; Nielsen, J; Qvist, N;

    2012-01-01

    It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC).......It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC)....

  20. [The value of postoperative C-reactive protein in predictive diagnosis of postoperative intra-abdominal septic complications for patients with Crohn disease].

    Science.gov (United States)

    Li, Y; Zhu, W M; Gong, J F; Guo, Z; Cao, L

    2016-08-01

    To analyze the value of postoperative C-reactive protein (CRP) in predictive diagnosis of postoperative intra-abdominal septic complications (IASC) for patients with Crohn disease (CD). Clinical data of patients with CD received intestinal resection and anastomosis surgery at Research Institute of General Surgery, Jinling Hospital from January 2011 to January 2015 were analyzed. Patients were divided into two groups by whether suffer from IASC 1 month after surgery, including IASC group and no-IASC group. Propensity score matching method was used to match the general clinical data. A total of 54 patients were analyzed, including IASC 17 cases, no-IASC 37 cases. Postoperative CRP at 1-day and 3-day were compared between the two groups using t test. Receiver operator characteristic (ROC) cure was used to analyze the value of postoperative CRP in predictive diagnosis of IASC. IASC group had higher levels of CRP at 1-day ((78±13) mg/L vs. (54±19) mg/L, t=4.633, P=0.000) and 3-day ((103±19) mg/L vs. (69±21) mg/L, t=5.859, P=0.000) after surgery than no-IASC group. ROC analysis showed that the CRP 3-day after surgery cut-off point value of 81.45 mg/L, as used for the predictive diagnosis of IASC, provided a sensitivity of 94.1%, a specificity of 82.9%, an area under the curve of 0.90, better than CRP 1-day after surgery. Postoperative CRP can be used as a predictive diagnosis of IASC for CD patients received intestinal resection and anastomosis surgery.

  1. Complications of otitis media - The importance of early recognition

    NARCIS (Netherlands)

    Albers, FWJ

    Objective: The purpose of this study was to determine the factors that are important for the early diagnosis of intracranial and intratemporal complications of otitis media. Study design: The study design was a retrospective follow-up study. Setting: The study took place at a tertiary referral

  2. Pancreatic surgical biopsy in 24 dogs and 19 cats: postoperative complications and clinical relevance of histological findings.

    Science.gov (United States)

    Pratschke, K M; Ryan, J; McAlinden, A; McLauchlan, G

    2015-01-01

    To assess the immediate postoperative complications associated with pancreatic biopsy in dogs and cats and review the clinical relevance of biopsy findings. Retrospective review of clinical records from two referral institutions for cases undergoing pancreatic biopsy between 2000 and 2013. Twenty-four dogs and 19 cats that had surgical pancreatic biopsy had sufficient detail in their clinical records and fulfilled the inclusion criteria. Postoperative complications were seen in 10 cases of which 5 were suggestive of post-surgical pancreatitis. Two patients were euthanased within 10 days of surgery because of the underlying disease; neither suffered postoperative complications. Pancreatic pathology was found in 19 cases, 7 cases showed no change other than benign pancreatic nodular hyperplasia, and no abnormalities were seen in 18 cases. Complications may be encountered following surgical pancreatic biopsy, although the risk should be minimal with good surgical technique. Pancreatic biopsy may provide a useful contribution to case management but it is not clear whether a negative pancreatic biopsy should be used to rule out pancreatic disease. Dogs were more likely to have no significant pathology found on pancreatic biopsy than cats, where chronic pancreatitis was the most common finding. © 2014 British Small Animal Veterinary Association.

  3. Post-operative abdominal complications in Crohn’s disease in the biological era: Systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Peter Waterland; Thanos Athanasiou; Heena Patel

    2016-01-01

    AIM: To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn’s disease(CD) comparing biological with no therapy.METHODS: Pub Med, Medline and Embase databases were searched to identify studies comparing postoperative outcomes in CD patients receiving biological therapy and those who did not. A meta-analysis with a random-effects model was used to calculate pooled odds ratios(OR) and confidence intervals(CI) for each outcome measure of interest. RESULTS: A total of 14 studies were included for metaanalysis, comprising a total of 5425 patients with CD 1024(biological treatment, 4401 control group). After biological therapy there was an increased risk of total infectious complications(OR = 1.52; 95%CI: 1.14-2.03, 8 studies) and wound infection(OR = 1.73; 95%CI: 1.12-2.67; P = 0.01, 7 studies). There was no increased risk for other complications including anastomotic leak(OR = 1.19; 95%CI: 0.82-1.71; P = 0.26), abdominal sepsis(OR = 1.22; 95%CI: 0.87-1.72; P = 0.25) and re-operation(OR = 1.12; 95%CI: 0.81-1.54; P = 0.46) in patients receiving biological therapy. CONCLUSION: Pre-operative use of anti-TNF-α therapy may increase risk of post-operative infectious complications after surgery for CD and in particular wound related infections.

  4. Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians

    Directory of Open Access Journals (Sweden)

    Kim YW

    2016-05-01

    Full Text Available Young Wan Kim, Ik Yong Kim Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea Purpose: To identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Methods: Between 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included. Results: One hundred patients were male (49% and 52 patients had American Society of Anesthesiologists (ASA score ≥3 (25%. Combined surgery was performed in 32 patients (16%. Postoperative complications within 30 days after surgery occurred in 54 patients (26% and 30-day mortality occurred in five patients (2%. Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69-14.47], P=0.004, an ASA score ≥3 (HR with 95% CI =4.19 [1.8-9.74], P=0.001, performance of combined surgery (HR with 95% CI =3.1 [1.13-8.46], P=0.028, lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07-18.63], P<0.001, and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43-9.69], P=0.007. An ASA score ≥3 (HR with 95% CI =2.72 [1.15-6.46], P=0.023, tumor-node-metastasis (TNM stage IV (HR with 95% CI =3.47 [1.44-8.39], P=0.006, and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39-14.09], P=0.012 were significant prognostic factors for 1-year mortality. Conclusion: Patient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin and procedure-related factors (performance of combined surgical procedure increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality. Keywords: colonic neoplasms, rectal neoplasms, laparoscopy, laparotomy, aged 80 years and above

  5. Impact of preoperative patient education on prevention of postoperative complications after major visceral surgery: study protocol for a randomized controlled trial (PEDUCAT trial)

    OpenAIRE

    Fink, Christine; Diener, Markus K; Bruckner, Thomas; Müller,Gisela; Paulsen, Lisa; Keller, Monika; Büchler, Markus W; Knebel, Phillip

    2013-01-01

    Background In line with the growing number of surgical procedures being performed worldwide, postoperative complications are also increasing proportionately. Prevention of these postoperative complications is a high medical priority. Preoperative education of patients, including provision of preparatory information about the correct behavior after surgery, could improve the postoperative outcome, but the evidence for this is inconclusive. The aim of the PEDUCAT trial is to evaluate the feasib...

  6. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation

    Science.gov (United States)

    Ulutaş, Murat; Çınar, Kadir; Seçer, Mehmet

    2017-01-01

    Abstract Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH. Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy. The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period. The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to

  7. Relationship between postoperative erythromycin breath test and early morbidity in liver transplant recipients

    DEFF Research Database (Denmark)

    Schmidt, Lars E; Rasmussen, Allan; Kirkegaard, Preben;

    2003-01-01

    BACKGROUND: Interindividual variability in dosage requirements of the calcineurin inhibitor immunosuppressive agents cyclosporine and tacrolimus after liver transplantation may result from differences in the CYP3A activity of the liver graft. Early postoperative erythromycin breath test (ERMBT......) is an in vivo measure of graft CYP3A activity. This study evaluates the usefulness of an early postoperative ERMBT in predicting early morbidity in liver transplant recipients. METHODS: In 26 liver transplant recipients, ERMBT was performed within 2 hr after transplantation. Main end points were the occurrence...... with low postoperative ERMBT values (0.21%+/-0.15% 14C/hr vs. 1.09%+/-0.72% 14C/hr, P=0.002). CONCLUSION: An early postoperative ERMBT may be useful in predicting the development of cyclosporine and tacrolimus nephrotoxicity, severe graft dysfunction, or even graft loss in liver transplant recipients when...

  8. Heart rhythm and conduction disturbances in early postoperative period after surgical correction for congenital heart defects in infants

    Directory of Open Access Journals (Sweden)

    Bockeria L. A.

    2012-03-01

    Full Text Available Objective. The study aimed to determine the range of rhythm and conduction disturbances in early postoperative period in infants and prove the prognostic value of some pre- and intraoperative factors for development of such complications. Material and methods. The study included 235 children aged from 1 to 3 years who underwent surgeries for congenital heart diseases (CHD under cardiopulmonary bypass (CPB. Exclusion criteria were: age less than 1 year or more than 3 years, presence of confirmed heart rhythm disturbances before surgery except incomplete or complete right bundle branch block in presence of right ventricular myocardial hypertrophy, left anterior bundle branch block in presence of partial or complete atrioventricular canal defect and sinus tachycardia equal to circulatory failure (CF. Results. Ventricular arrhythmias such as premature ventricular contraction (PVC of different character were frequently seen in early postoperative period after surgical correction of CHD. They were noted in 36% of overall number postoperative arrhythmias. Supraventricular extrasystole occurred in 29% cases, different types of supraventricular tachycardias – in 17%, AV-blocks of different grades – in 10%. We noted the following predictors for postoperative rhythm disturbance development: age more than 25 months at the moment of surgery, prolonged CPB and aortic cross-clamping during ventricular septal defect (VSD (70 and 39 minutes, respectively and Fallot’s tetralogy correction (100 and 60 minutes, respectively and exceeding the critical end-point of aortic cross-clamping during atrial septal defect correction (ASD (24 minutes, presence of IIA and IIb grade for CF before surgery, surgical correction of ASD under hypothermia of less than 32 °C. Exceeding the critical end-points of CPB and aortic clamping in patients with Fallot’s tetralogy and exceeding the critical end-points of aortic clamping in children with VSD and ASD were shown to be the

  9. Early post-operative results of percutaneous needle fasciotomy in 451 patients with Dupuytren disease.

    Science.gov (United States)

    Molenkamp, Sanne; Schouten, Tanneke A M; Broekstra, Dieuwke C; Werker, Paul M N; Moolenburgh, J Daniel

    2017-02-13

    Percutaneous needle fasciotomy (PNF) is a minimally invasive treatment modality for Dupuytren disease (DD). In this study we analyzed the efficacy and complication-rate of PNF using a statistical method that takes the multi-level structure of data, regarding multiple measurements from the same patients, into account. The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy (PNF) were analyzed retrospectively. We described the early postoperative results of PNF and we applied linear mixed models to compare mean correction of PED between joints and efficacy of primary versus secondary PNF. Mean preoperative PED's at the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints were 37˚, 40˚ and 31˚ respectively. Mean preoperative TPED was 54˚. Results were excellent, with a mean TPED correction of 85%. PNF was most effective for MCP-joints and less effective for PIP and DIP-joints. Secondary PNF was as effective as primary PNF. Complications were rare and mostly minor. The results of this study confirm that PNF is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure.

  10. Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease.

    Science.gov (United States)

    Molenkamp, Sanne; Schouten, Tanneke A M; Broekstra, Dieuwke C; Werker, Paul M N; Moolenburgh, J Daniel

    2017-06-01

    Percutaneous needle fasciotomy is a minimally invasive treatment modality for Dupuytren disease. In this study, the authors analyzed the efficacy and complication rate of percutaneous needle fasciotomy using a statistical method that takes the multilevel structure of data, regarding multiple measurements from the same patient, into account. The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy were analyzed retrospectively. The authors described the early postoperative results of percutaneous needle fasciotomy and applied linear mixed models to compare mean correction of passive extension deficit between joints and efficacy of primary versus secondary percutaneous needle fasciotomy. Mean preoperative passive extension deficits at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 37, 40, and 31 degrees, respectively. Mean preoperative total passive extension deficit was 54 degrees. Results were excellent, with a mean total passive extension deficit correction of 85 percent. Percutaneous needle fasciotomy was most effective for metacarpophalangeal joints and less effective for proximal interphalangeal and distal interphalangeal joints. Secondary percutaneous needle fasciotomy was as effective as primary percutaneous needle fasciotomy. Complications were rare and mostly minor. The results of this study confirm that percutaneous needle fasciotomy is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure. Therapeutic, IV.

  11. The value of early CT in complicated childhood pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Tan Kendrick, A.P. [Department of Diagnostic Imaging, Kandang Kerbau Women' s and Children' s Hospital (Singapore); Ling, Ho [Department of Paediatric Medicine, Kandang Kerbau Women' s and Children' s Hospital (Singapore); Subramaniam, Ramnath; Joseph, Vijeyakaran T. [Department of Paediatric Surgery, Kandang Kerbau Women' s and Children' s Hospital (Singapore)

    2002-01-01

    Objective. To investigate the value of CT in complicated childhood pneumonia and its role in early intervention when chest radiography (CXR) is non-contributory. Materials and methods. Forty-two immunocompetent children, aged 1-11 years, admitted for community-acquired pneumonia from October 1997 to September 1999, had 42 contrast-enhanced CT scans and frontal chest radiographs on the same day, which were assessed independently. CT was performed when the patient remained unwell and the CXR images showed failure of resolution despite 7-10 days of antibiotics and/or drainage with urokinase therapy. Results. Compared to CT, CXR revealed suboptimal accuracy rates of lobar involvement (84%), chest tube placement (73%), fluid loculation (42%), abscess formation (40%) and bronchopleural fistulae (33%). It could not assess parenchymal or pleural complications such as cavitary necrosis, early abscess formation, empyemas or pericardial effusions. On the basis of the CT findings and poor clinical progress, 16 patients underwent surgical intervention with the aid of video-assisted thorascopic surgery (VATS). The CT features correlated well with surgical findings. Ten cases required pleural decortication while six with destructive or necrotic lung lesions had surgical resection. Debridement was difficult when the pleura had become thick and fibrotic. Streptococcus pneumoniae was the offending organism in 81% of cases. The right side was affected in 67% of cases. Conclusions. In complicated childhood pneumonia, CT is far superior to CXR in revealing pleural and parenchymal complications, which may require early surgical intervention. (orig.)

  12. [Late paraparesis as a postoperative complication in a patient undergoing the repair of a double aortic aneurysm].

    Science.gov (United States)

    Bonome González, C; Alvarez Refojo, F; Fernández Carballal, F; Rodríguez Alvarez, R

    1993-01-01

    We report a case of a fifty-seven (57)-years old man undergoing elective surgery of a thoracoabdominal and aortoiliac aneurysm in a single surgical time. The patients is operated undergoing general anesthetic combined with thoracic epidural blockade, and it was done two aortic cross-clamping: one to five cm of the aortic arch and the other to the infrarenal level. The most important intraoperative complications were during the thoracic aortic cross-clamping and the most important postoperative complication was related 48 hours later, to paraparesis after a hypotension episode what improved with rehabilitation treatment.

  13. Postoperative Complications After Prophylactic Thyroidectomy for Very Young Patients With Multiple Endocrine Neoplasia Type 2 : Retrospective Cohort Analysis

    OpenAIRE

    Kluijfhout, Wouter P; van Beek, Dirk-Jan; Verrijn Stuart, Annemarie A.; Lodewijk, Lutske; Gerlof D. Valk; Van der Zee, David C.; Vriens, Menno R.; Inne H. M. Borel Rinkes

    2015-01-01

    The aim of this study was to investigate whether younger age at surgery is associated with the increased incidence of postoperative complications after prophylactic thyroidectomy in pediatric patients with multiple endocrine neoplasia (MEN) 2. The shift toward earlier thyroidectomy has resulted in significantly less medullary thyroid carcinoma (MTC)-related morbidity and mortality. However, very young pediatric patients might have a higher morbidity rate compared with older patients. Hardly a...

  14. Risk Stratification for Major Postoperative Complications in Patients Undergoing Intra-abdominal General Surgery Using Latent Class Analysis.

    Science.gov (United States)

    Kim, Minjae; Wall, Melanie M; Li, Guohua

    2017-08-10

    Preoperative risk stratification is a critical element in assessing the risks and benefits of surgery. Prior work has demonstrated that intra-abdominal general surgery patients can be classified based on their comorbidities and risk factors using latent class analysis (LCA), a model-based clustering technique designed to find groups of patients that are similar with respect to characteristics entered into the model. Moreover, the latent risk classes were predictive of 30-day mortality. We evaluated the use of latent risk classes to predict the risk of major postoperative complications. An observational, retrospective cohort of patients undergoing intra-abdominal general surgery in the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program was obtained. Known preoperative comorbidity and risk factor data were entered into LCA models to identify the latent risk classes. Complications were defined as: acute kidney injury, acute respiratory failure, cardiac arrest, deep vein thrombosis, myocardial infarction, organ space infection, pneumonia, postoperative bleeding, pulmonary embolism, sepsis/septic shock, stroke, unplanned reintubation, and/or wound dehiscence. Relative risk regression determined the associations between the latent classes and the 30-day complication risks, with adjustments for the surgical procedure. The area under the curve (AUC) of the receiver operator characteristic curve assessed model performance. LCA fit a 9-class model on 466,177 observations. The composite complication risk was 18.4% but varied from 7.7% in the lowest risk class to 56.7% in the highest risk class. After adjusting for procedure, the latent risk classes were significantly associated with complications, with risk ratios (95% confidence intervals) (compared to the class with the average risk) varying from 0.56 (0.54-0.58) in the lowest risk class to 2.15 (2.11-2.20) in the highest risk class, a 4-fold difference. In models incorporating surgical

  15. Postoperative Cervical Haematoma Complicated by Ipsilateral Carotid Thrombosis and Aphasia after Anterior Cervical Fusion: A Case Report

    Directory of Open Access Journals (Sweden)

    Kingsley R. Chin

    2013-01-01

    Full Text Available Hematoma alone is the most common vascular complication reported after anterior cervical decompression and fusion (ACDF. We present this case to report the occurrence of postoperative cervical hematoma complicated by ipsilateral carotid thrombosis and aphasia after an uncomplicated C4–6 ACDF. This is a case of a 65-year-old woman who underwent revision fusions of the C4-5 and C6-7 levels complicated by postoperative cervical hematoma and carotid thrombosis. The patient's history, clinical examination, imaging findings, and treatment are reported. The revision fusions were performed and deemed routine. Approximately eight hours later 200 mL of blood was evacuated from a postoperative cervical hematoma. The patient became unresponsive and disoriented a few hours after evacuating the hematoma. Computed tomography and magnetic resonance imaging of the brain were normal, but magnetic resonance angiography demonstrated total occlusion of the left carotid artery. Thrombectomy was performed and the patient was discharged without residual deficits. At the latest followup she is fully functional and asymptomatic in her neck. We suggest, after evacuating a cervical hematoma, an evaluation of the carotids be made with MRA or cerebral angiography, as this may demonstrate a clot before the patient develops symptoms.

  16. Preoperative body size and composition, habitual diet, and post-operative complications in elective colorectal cancer patients in Norway.

    Science.gov (United States)

    Berstad, P; Haugum, B; Helgeland, M; Bukholm, I; Almendingen, K

    2013-08-01

    Both malnutrition and obesity are related to worsened post-operative outcomes after colorectal surgery. Obese cancer patients may be malnourished as a result of short-term weight loss. The present study aimed to evaluate preoperative nutritional status, body composition and dietary intake related to post-operative complications (POC) and post-operative hospital days (POHD) in elective colorectal cancer (CRC) patients. Anthropometry, body composition measured by bioelectric spectroscopy and dietary habits assessed by a validated food-frequency questionnaire were examined in 100 newly-diagnosed CRC patients. Data from 30-day POC and POHD were collected from medical records. Nonparametric and chi-squared tests and logistic regression were used to analyse associations between body and dietary variables and post-operative outcome. Twenty-nine patients had at least one POC. The median POHD was six. Body size and composition measures and short-term weight loss were no different between patients with and without POC, or between patients with POHD composition and short-term weight loss were not related to 30-day post-operative outcomes in CRC patients. A high content of marine n-3 PUFA in preoperative habitual diets may protect against POC after CRC surgery. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

  17. Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer.

    Science.gov (United States)

    Li, B; Liu, H Y; Guo, S H; Sun, P; Gong, F M; Jia, B Q

    2015-06-29

    The impact of early enteral nutrition (EEN) on clinical outcomes of gastric cancer patients was investigated. Three hundred pa-tients undergoing gastric cancer surgery from July 2010 to May 2014 were randomly divided into experimental and control groups (n = 150/group). Experimental group patients received enteral nutrition in water during the early postoperative period. Control group patients received conventional perioperative treatment. Patients' clinical outcomes, post-operative immune function, and nutritional statuses were compared, which revealed that the postoperative fever duration (80.2 ± 6.0 vs 88.1 ± 8.1 h, P 0.05]. At postoperative days 3 and 7, the CD3(+), CD4(+), natural killer cell, albumin, and prealbumin levels and CD4(+)/CD8(+) ra-tio were significantly higher in the experimental group than the control group (all P nutritional status and immune function and promote early recovery of intestinal function in patients with gastric cancer.

  18. Postoperative early hemolytic anemia due to inverted teflon felt strip after emergency repair for type A dissection.

    Science.gov (United States)

    Hata, M; Yoshitake, I; Wakui, S; Unosawa, S; Hata, H; Shiono, M

    2012-10-01

    A 39-year-old man underwent emergency surgery for type A acute aortic dissection complicated by paraplegia. However, hemolytic anemia increased significantly due to severe stenosis of the proximal anastomosis one month after surgery. He finally underwent a redo procedure 4 months after the initial operation whereupon it was verified that half of the inner felt strip used for proximal stump fixation had turned up and was protruding into the inner lumen. We report here on a rare case of survival of postoperative early hemolytic anemia due to severe graft stenosis caused by an inverted inner Teflon felt strip without any extra vascular compression.

  19. Early detection of diabetes after pregnancy complicated by gestational diabetes

    DEFF Research Database (Denmark)

    Nielsen, Jane Hyldgård; Overgaard, Charlotte; Olesen, Christinna Rebecca

    2016-01-01

    ) develops type 2 diabetes within a ten-year period. Early detection can prevent or delay the onset of late complications, for which follow-up screening is important. The women are recommended follow-up screening every 1-2 years after birth do to the potentials in early detection of diabetes and prevention...... of health consequences for women. Aims: Examine the extent of participation in follow-up screening in the Danish Region of North Jutland, and the possible consequences of nonattendance. Methods: A register based study. In Danish national registers 2171 birthing women whose pregnancy was complicated by GDM...... and their participating in follow-up screening were identified. Diagnosis of diabetes or treatment with glucose-lowering agents after giving birth were also identified. Results: Attendance in follow-up screening significantly decreased with time after giving birth. Women attending follow-up screening had a significantly...

  20. RHEOLOGICAL PROPERTIES OF BLOOD AT PATIENTS WITH BOWEL OBSTRUCTION OF TUMORAL GENESIS IN THE EARLY POSTOPERATIVE PERIOD

    Directory of Open Access Journals (Sweden)

    V. V. Maslyakov

    2014-01-01

    Full Text Available Introduction. Microcirculation plays an important role in early postoperative period in colorectal cancer patients. At the same time the question connected with studying of rheological properties of blood as one of microcirculation indicators in literature it studied insufficiently.Materials and methods. We studied rheological properties of blood in 30 patients operated for bowel obstruction caused by right colon cancer. 17 (56,7 % patients were male, 13 (43,3 % – female. Average age was 57 ± 3 years. Time from the moment of manifestation of the first clinical signs before admission to a hospital and the beginnings of carrying out medical and diagnostic actions was 12 ± 0,5 h. The stage of a disease was T3N0–1M0. The group of comparison consisted of 20 healthy volunteers of the same age. Changes of a rheology of blood were measured by means of the accounting of viscosity of blood, change of an index of deformation and aggregation of erythrocytes. Studying of viscosity of blood was carried out by means of the rotational viscometer at shift speeds: 200; 100; 150; 50 and 20 MPas. Measures were conducted at the time of receipt, on the first, third, fifth, seventh and tenth postoperative day.Results. In patients with bowel impassability at the time of receipt the increase in indicators of viscosity of blood is noted at all speeds of the shift, analyzed indicators increase by the third postoperative day, decrease on the seventh and are partially restored for the tenth postoperative days. Complications developed in 16,6 % of cases, in all cases – pneumonia. By comparison of the obtained laboratory data to a clinical picture it is established that complications developed on 3–5th postoperative days.

  1. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study

    Science.gov (United States)

    Grosse-Sundrup, Martina; Henneman, Justin P; Sandberg, Warren S; Bateman, Brian T; Uribe, Jose Villa; Nguyen, Nicole Thuy; Ehrenfeld, Jesse M; Martinez, Elizabeth A; Kurth, Tobias

    2012-01-01

    Objective To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications. Design Prospective, propensity score matched cohort study. Setting General teaching hospital in Boston, Massachusetts, United States, 2006-10. Participants 18 579 surgical patients who received intermediate acting neuromuscular blocking agents during surgery were matched by propensity score to 18 579 reference patients who did not receive such agents. Main outcome measures The main outcome measures were oxygen desaturation after extubation (hemoglobin oxygen saturation 3%) and reintubations requiring unplanned admission to an intensive care unit within seven days of surgery. We also evaluated effects on these outcome variables of qualitative monitoring of neuromuscular transmission (train-of-four ratio) and reversal of neuromuscular blockade with neostigmine to prevent residual postoperative neuromuscular blockade. Results The use of intermediate acting neuromuscular blocking agents was associated with an increased risk of postoperative desaturation less than 90% after extubation (odds ratio 1.36, 95% confidence interval 1.23 to 1.51) and reintubation requiring unplanned admission to an intensive care unit (1.40, 1.09 to 1.80). Qualitative monitoring of neuromuscular transmission did not decrease this risk and neostigmine reversal increased the risk of postoperative desaturation to values less than 90% (1.32, 1.20 to 1.46) and reintubation (1.76, 1.38 to 2.26). Conclusion The use of intermediate acting neuromuscular blocking agents during anesthesia was associated with an increased risk of clinically meaningful respiratory complications. Our data suggest that the strategies used in our trial to prevent residual postoperative neuromuscular blockade should be revisited. PMID:23077290

  2. ANAESTHESIA, POSTOPERATIVE ANALGESIA AND EARLY REHABILITATION FOR UPPER EXTREMITY BONE AND MAJOR JOINTS SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Kurnosov

    2011-01-01

    Full Text Available A new method was developed to perform prolonged brachial plexus block with almost 100% effectiveness. It was also shown in 44 patients to be 33 % safer for local complications and 11,3 % safer for general complications than common used supraclavicular Winnie block (42 patients in control group, received opiates and NSAID for post-operative analgesia. This new method of analgesia allows effective rehabilitation after elbow arthroplasty to be started on the first day after the surgery.

  3. Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery

    DEFF Research Database (Denmark)

    Friis, Esbern; Hørby, John; Sørensen, Lars Tue

    2004-01-01

    Hematoma and bruising (sugillation) are frequent problems after operations for primary breast cancer. In the present study we evaluated the influence of various methods of perioperative thromboembolic prophylaxis on the postoperative incidence of hematoma and suggilation. From June 1994 through A...

  4. Postoperative complications after reconstructive surgery for cloacal malformations: a systematic review

    NARCIS (Netherlands)

    H.P. Versteegh (Hendt); J.R. Sutcliffe; C.E.J. Sloots (Pim); R.M.H. Wijnen (René); I. de Blaauw (Ivo)

    2015-01-01

    textabstractThe repair of cloacal malformations is most often performed using a posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) or total urogenital mobilization (TUM) with or without laparotomy. The aim of this study was to systematically review the frequency and type of postoperative com

  5. Effect of Tributyrin on Electrical Activity in the Small Intestine during Early Postoperative Period.

    Science.gov (United States)

    Tropskaya, N S; Kislyakova, E A; Popova, T S

    2015-12-01

    The effect of enteral administration of tributyrin on electrical activity in the upper segments of the small intestine was examined in rats on the model of postoperative ileus. This postoperative state is characterized with pronounced and long-term disturbances in generation of migrating myoelectric complex of the small intestine. The enteral administration of tributyrin in the early postoperative period aimed to suppress the non-adrenergic non-cholinergic influences and activation of the cholinergic anti-inflammatory pathways is an effective procedure to normalize the migrating myoelectric complex and therefore the coordinated propulsive peristalsis in the small intestine.

  6. Cervical sympathetic chain schwannoma masquerading as a carotid body tumour with a postoperative complication of first-bite syndrome.

    LENUS (Irish Health Repository)

    Casserly, Paula

    2012-01-31

    Carotid body tumours (CBT) are the most common tumours at the carotid bifurcation. Widening of the bifurcation is usually demonstrated on conventional angiography. This sign may also be produced by a schwannoma of the cervical sympathetic plexus. A 45-year-old patient presented with a neck mass. Investigations included contrast-enhanced CT, MRI and magnetic resonance arteriography with contrast enhancement. Radiologically, the mass was considered to be a CBT due to vascular enhancement and splaying of the internal and external carotid arteries. Intraoperatively, it was determined to be a cervical sympathetic chain schwannoma (CSCS). The patient had a postoperative complication of first-bite syndrome (FBS).Although rare, CSCS should be considered in the differential diagnosis for tumours at the carotid bifurcation. Damage to the sympathetic innervation to the parotid gland can result in severe postoperative pain characterised by FBS and should be considered in all patients undergoing surgery involving the parapharyngeal space.

  7. Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report

    Directory of Open Access Journals (Sweden)

    Masukume Gwinyai

    2013-01-01

    Full Text Available Abstract Introduction Advanced abdominal (extrauterine pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. Case presentation We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. Conclusion Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn.

  8. Efficacy and postoperative complication of tension-free vaginal tape-Secur for female stress urinary incontinence

    Institute of Scientific and Technical Information of China (English)

    CHEN Ying-he; WANG Yi-jun; LI Fei-ping; WANG Qian

    2011-01-01

    Background As the third-generation tension-free tape for female stress urinary incontinence (SUI), tension-free vaginal tape (TVT)-Secur has decreased the common complications associated with TVT and tension-free vaginal tape-transobturator (TVT-O), such as bladder perforation and obstruction of the bladder outlet; but its efficacy and persistence were still controversial. The aim of this study was to prospectively evaluate and compare the postoperative efficacy and complication at different follow-up time.Methods Patients with SUI, who underwent lVT-Secur treatment in two hospitals from October 2008 to October 2009,were selected. By analyzing preoperative and intraoperative data and postoperative complications, the therapeutic effect and satisfaction at different follow-up stages were evaluated.Results A total of 30 female patients participated in this study. Patients were scheduled for follow-up at the 1st month,3rd month, 6th month and 12th month, while the cure rate was 83.3% (25 patients), 66.7% (20 patients), 63.3% (19patients) and 60.0% (18 patients) respectively and the overactive bladder (OAB) symptoms appeared in 11 patients (36.7%), 10 patients (33.3%), 6 patients (20%) and 7 patients (23.3%) respectively.Conclusion With the follow-up time becoming longer, TVT-Secur has a high recurrence rate of SUI, the therapeutic effect from the 3rd month to the 12th month is relatively persistent.

  9. Postoperative Complications After Prophylactic Thyroidectomy for Very Young Patients With Multiple Endocrine Neoplasia Type 2: Retrospective Cohort Analysis.

    Science.gov (United States)

    Kluijfhout, Wouter P; van Beek, Dirk-Jan; Verrijn Stuart, Annemarie A; Lodewijk, Lutske; Valk, Gerlof D; van der Zee, David C; Vriens, Menno R; Borel Rinkes, Inne H M

    2015-07-01

    The aim of this study was to investigate whether younger age at surgery is associated with the increased incidence of postoperative complications after prophylactic thyroidectomy in pediatric patients with multiple endocrine neoplasia (MEN) 2. The shift toward earlier thyroidectomy has resulted in significantly less medullary thyroid carcinoma (MTC)-related morbidity and mortality. However, very young pediatric patients might have a higher morbidity rate compared with older patients. Hardly any literature exists on complications in the very young. A retrospective single-center analysis was performed on the outcomes of MEN2 patients undergoing a prophylactic total thyroidectomy at the age of 17 or younger. Forty-one MEN2A and 3 MEN2B patients with thyroidectomy after January 1993 and at least 6 months of follow-up were included, subdivided in 9 patients younger than 3 years, 15 patients 3 to 6 years, and 20 patients older than 6 years. Postoperative hypocalcemia and other complications were registered. Twelve (27%) patients developed transient hypocalcemia and 9 (20%) patients suffered from permanent hypocalcemia, with a nonsignificant trend toward higher incidence with decreasing age. Three (7%) patients had other complications, of whom 2 were younger than 3 years. For patients younger than 3 years, the average length of stay (LOS) was 6.7 days, versus 1.7 and 3.5 days, respectively, for the older patient groups (P surgery, MTC did not recur in any patient. In planning optimal timing of surgery, clinicians should take the risk of complications into account. We advise not to perform total thyroidectomy before the age of 3 for patients defined high risk by the American Thyroid Association guideline.

  10. A propensity score matched analysis of obesity as an independent risk factor for postoperative complications in reduction mammaplasty

    Institute of Scientific and Technical Information of China (English)

    James D Goggin; Stacy Wong; Jessica E Pruszynski; Jon P Ver Halen

    2016-01-01

    Aim: Reduction mammaplasty is a commonly performed procedure for the treatment of symptomatic macromastia and is increasingly desired by the obese population. With the increasing prevalence obesity in the population, it is imperative to understand its effect on postoperative outcomes. The purpose of this study is to evaluate obesity as an independent risk factor for postoperative complications in breast reduction surgery using 1:1 patient matching through propensity scores between obese patients and non-obese controls.Methods: Between 2005 and 2013, the National Surgical Quality Improvement Program dataset identified a total of 6,016 patients as having undergone primary reduction mammaplasty with 30-day postoperative follow-up. Patients were divided into obese [body mass index (BMI) of 30 or more] vs. not obese (BMI below 30). Patients were initially analyzed using standard multivariable analysis. Using propensity scores obtained from a logistic regression model, patients were subsequently matched 1:1 according to preoperative and operative variables to truly isolate the effect of obesity on surgical outcomes. Outcomes were compared between the matched cohorts using McNemar’s test and the Wilcoxon signed rank test.Results: In unmatched multivariable analysis, rates of overall complications (7.2%vs. 5.3%,P = 0.0024), wound complications (5.5%vs. 3.6%,P = 0.0004), superficial surgical site infection (4.1%vs. 2.8%,P = 0.0050), and wound dehiscence (0.3%vs. 1.1%,P = 0.0005) were found to be statistically different between obesevs. non-obese, respectively. However, when comparing 1:1 matched obese and non-obese patients, only wound complications (4.6%vs. 3.1%,P = 0.0334) were significantly increased in the obese cohort.Conclusion: Using the most robust statistical tools available, obesity was determined to affect wound complications after breast reduction without increased detriment on other major complications when compared to the non-obese. Obesity should be a

  11. Postoperative handover

    DEFF Research Database (Denmark)

    Møller, Thea P; Madsen, Marlene D; Fuhrmann, Lone

    2013-01-01

    Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject to a down......Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject...

  12. Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications

    OpenAIRE

    Mavrodi, Alexandra; Ohanyan, Ani; Kechagias, Nikos; Antonis TSEKOS; Konstantinos VAHTSEVANOS

    2015-01-01

    Background Post-operative complications of various degrees of severity are commonly observed in third molar impaction surgery. For this reason, a surgical procedure that decreases the trauma of bone and soft tissues should be a priority for surgeons. In the present study, we compare the efficacy and the post-operative complications of patients to whom two different surgical techniques were applied for impacted lower third molar extraction. Material and Methods Patients of the first group unde...

  13. Staphylococcal Scalded-Skin Syndrome Complicating Wound Infection in a Preterm Infant with Postoperative Chylothorax

    Science.gov (United States)

    Peters, Bjoern; Hentschel, Juliane; Mau, Harald; Halle, Elke; Witte, Wolfgang; Obladen, Michael

    1998-01-01

    The course of infection in a 3-week-old premature newborn suffering from extensive dermatitis with flaccid blisters is described. Staphylococcus aureus was recovered from a local wound infection around a chest tube inserted to drain a postoperative chylothorax. The strain isolated tested positive for the eta gene for exfoliative toxin A, the causative agent of staphylococcal scalded-skin syndrome (SSSS). In this case, prematurity and loss of chylus with consecutive lymphopenia may have contributed to development of SSSS. PMID:9738069

  14. Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery.

    LENUS (Irish Health Repository)

    O'Riordan, J M

    2013-08-01

    Laparoscopic colorectal surgery has increasingly become the standard of care in the management of both benign and malignant colorectal disease. We herein describe our experience with laparoscopy in the management of complications following laparoscopic colorectal surgery.

  15. Investigating Early and Late Complications in Conventional and LigaSure Hemorroidectomy

    Directory of Open Access Journals (Sweden)

    M Zare

    2014-06-01

    Full Text Available Introduction: The traditional Milligan-Morgan and the Ferguson operations are still the most used for patients with symptomatic haemorrhoids of III and IV degrees. Nowadays LigaSure is used as a new technique to decrease the complications resulting from conventional hemorroidectomy. In this study, patients were investigated on the basis of the following main outcomes: mean operative time, postoperative pain (score and duration, bleeding loss in operation, early (within the first month after surgery and late (after the first month complications in conventional as well as LigaSure hemorroidectomy. Methods: it is an analytical study conducted on 101 patients aged 19–80 years old of both males and females with III and IV-degree hemorrhoids who had been gone to Shahid Sadoughi hospital between 2011 and 2012. Forty-three patients were treated by conventional diathermy and fifty -eight by LigaSure. Patients received analgesic administration for about 24 hours after operations and, after hospital discharge. In fact, analgesia was administered until 5 days (three times a day. All patients were required to record pain from the first postoperative day until the 28th postoperative day on a self-administered NAS scale (0–10. Results: Patients completed a questionnaire face to face one week, one month, six, and twelve months after the operation. The mean operative time, bleeding loss in operation and return to work were significantly shorter in LS group, whereas there were no difference in hospital stay period, anal stenosis, healing time of wound and retention of urinary. A statistically significant difference in pain score was observed three and four days after the operation. Finally, patients with LigaSure haemorrhoidectomy recovered from pain earlier than those with conventional diathermy. Conclusions: although LigaSure proposes additional costs, it is an effective instrument in order to treat hemorrhoids of III and IV degrees.

  16. Immediate and early complications of the open Latarjet procedure: a retrospective review of a large consecutive case series.

    Science.gov (United States)

    Gartsman, Gary M; Waggenspack, Wame N; O'Connor, Daniel P; Elkousy, Hussein A; Edwards, T Bradley

    2017-01-01

    Immediate and early postoperative complications of the Latarjet procedure are not well documented in the literature. The purpose of this study was to report the procedure-related complications of our large consecutive case series of 3 surgeons at a single high-volume center. We conducted a retrospective chart review of 416 Latarjet procedures performed on 400 patients (16 patients had bilateral procedures) who underwent surgery by the 3 senior authors from October 2002 to July 2015. Immediate and early complications included hardware problems, infection, and neurologic injury. In addition, the patient's age and history of prior instability surgery were noted and evaluated as risk factors for complication. The overall complication rate was 5.0% (21 complications in 19 procedures). Thirteen neurologic injuries (3.1%) occurred to the axillary (7), musculocutaneous (4), and suprascapular (2) nerves, including 2 patients with multiple nerves affected. All but 2 patients had complete resolution of symptoms at time of last follow-up. Six infections (1.4%) developed, including 3 superficial infections treated with oral antibiotics and 3 deep infections requiring irrigation and débridement with intravenous antibiotics. Two early hardware-related complications (0.05%) were also noted. Increased age was associated with a higher complication rate. History of prior surgery was not associated with increased complications in our series. This study highlights the procedural complications of the Latarjet procedure. Neurologic injury was the most common complication in our series, with complete or near-complete recovery in 11 of 13 patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  17. Intra- and Postoperative Complications of Lateral Maxillary Sinus Augmentation in Smokers vs Nonsmokers: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Ghasemi, Samaneh; Fotouhi, Akbar; Moslemi, Neda; Chinipardaz, Zahra; Kolahi, Jafar; Paknejad, Mojgan

    This meta-analysis and systematic review focused on the following question: Does tobacco smoking increase the risk of intra- or postoperative complications of lateral maxillary sinus floor elevation? The following electronic databases were searched up to and including November 2015 without language restriction: CENTRAL, MEDLINE, Google Scholar, Scopus, Sirous, and Doaj. Studies were included if rates of intra-or postoperative complications of sinus floor elevation in smokers and nonsmokers were recorded separately. The following complications were assessed: sinus membrane perforation, bleeding, wound dehiscence, wound infection, sinusitis, hematoma, and oroantral fistula. The Critical Appraisal Skills Programme was used to assess the risk of bias in included studies. Random-effects meta-analyses were used to assess the number of each complication in smokers and nonsmokers. Out of 929 eligible publications, 11 articles were included. Meta-analysis of the studies revealed a significantly increased risk of developing wound dehiscence after sinus floor elevation among smokers compared with nonsmokers (Risk Ratio [RR]: 7.82; 95% confidence interval [CI]: 2.38, 25.74; P = .0007). Moreover, risk of developing wound infection was greater in smokers when prospective studies were included in the meta-analysis (RR: 5.33; 95% CI: 1.34, 21.25; P = .02). However, the meta-analysis of included studies did not show significant differences between smokers and nonsmokers concerning risk of sinus membrane perforation and bleeding during sinus floor elevation (P = .46 and P = .33, respectively). Considering the lack of randomized controlled trials and the small number of included studies, the results indicate that smoking seems to be associated with increased risk of wound dehiscence and infection after the sinus augmentation procedure.

  18. Postoperative Survival for Patients with Thymoma Complicating Myasthenia Gravis
- Preliminary Retrospective Results of the ChART Database

    Directory of Open Access Journals (Sweden)

    Fangrui WANG

    2016-07-01

    Full Text Available Background and objective It is so far not clear that how myasthenia gravis (MG affected the prognosis of thymoma patients. The aim of this assay is to compare the postoperative survival between patients with thymoma only and those with both thymoma and MG. Methods The Chinese Alliance for Research in Thymomas (ChART registry recruited patients with thymoma from 18 centers over the country on an intention to treat basis from 1992 to 2012. Two groups were formed according to whether the patient complicated MG. Demographic and clinical data were reviewed, Patients were followed and their survival status were analyzed. Results There were 1,850 patients included in this study, including 421 with and 1,429 without MG. Complete thymectomy were done in 91.2% patients in MG group and 71.0% in non-MG group (P<0.05. There were more percentage of patients with the histology of thymoma AB, B1, or B2 (P<0.05 in MG group, and more percentage of patients with MG were in Masaoka stage I and II. The 5 year and 10 year OS rates were both higher in MG group (93% vs 88%; 83% vs 81%, P=0.034 respectively. The survival rate was significantly higher in patients with MG when the Masaoka staging was III/IV (P=0.003. Among patients with advanced stage thymoma (stage III, IVa, IVb, the constituent ratios of III, IVa, IVb were similar between MG and Non-MG group. Histologically, however, there were significantly more proportion of AB/B1/B2/B3 in the MG group while there were more C in the non-MG group (P=0.000. Univariate analyses for all patients showed that MG, WHO classification, Masaoka stage, surgical approach, chemotherapy and radiotherapy and resectability were significant factors, and multivariate analysis showed WHO Classification, Masaoka stage, and resectability were strong independent prognostic indicators. Conclusion Although MG is not an independent prognostic factor, the survival of patients with thymoma was superior when MG was present, especially in late

  19. Risk factors for early post-operative neurological deterioration in dogs undergoing a cervical dorsal laminectomy or hemilaminectomy: 100 cases (2002-2014).

    Science.gov (United States)

    Taylor-Brown, F E; Cardy, T J A; Liebel, F X; Garosi, L; Kenny, P J; Volk, H A; De Decker, S

    2015-12-01

    Early post-operative neurological deterioration is a well-known complication following dorsal cervical laminectomies and hemilaminectomies in dogs. This study aimed to evaluate potential risk factors for early post-operative neurological deterioration following these surgical procedures. Medical records of 100 dogs that had undergone a cervical dorsal laminectomy or hemilaminectomy between 2002 and 2014 were assessed retrospectively. Assessed variables included signalment, bodyweight, duration of clinical signs, neurological status before surgery, diagnosis, surgical site, type and extent of surgery and duration of procedure. Outcome measures were neurological status immediately following surgery and duration of hospitalisation. Univariate statistical analysis was performed to identify variables to be included in a multivariate model. Diagnoses included osseous associated cervical spondylomyelopathy (OACSM; n = 41), acute intervertebral disk extrusion (IVDE; 31), meningioma (11), spinal arachnoid diverticulum (10) and vertebral arch anomalies (7). Overall 54% (95% CI 45.25-64.75) of dogs were neurologically worse 48 h post-operatively. Multivariate statistical analysis identified four factors significantly related to early post-operative neurological outcome. Diagnoses of OACSM or meningioma were considered the strongest variables to predict early post-operative neurological deterioration, followed by higher (more severely affected) neurological grade before surgery and longer surgery time. This information can aid in the management of expectations of clinical staff and owners with dogs undergoing these surgical procedures.

  20. Performance in the 6-minute walk test and postoperative pulmonary complications in pulmonary surgery: an observational study

    Science.gov (United States)

    Santos, Bruna F. A.; Souza, Hugo C. D.; Miranda, Aline P. B.; Cipriano, Federico G.; Gastaldi, Ada C.

    2016-01-01

    OBJECTIVES: To assess functional capacity in the preoperative phase of pulmonary surgery by comparing predicted and obtained values for the six-minute walk test (6MWT) in patients with and without postoperative pulmonary complication (PPC) METHOD: Twenty-one patients in the preoperative phase of open thoracotomy were evaluated using the 6MWT, followed by monitoring of the postoperative evolution of each participant who underwent the routine treatment. Participants were then divided into two groups: the group with PPC and the group without PPC. The results were also compared with the predicted values using reference equations for the 6MWT RESULTS: Over half (57.14%) of patients developed PPC. The 6MWT was associated with the odds for PPC (odds ratio=22, p=0.01); the group without PPC in the postoperative period walked 422.38 (SD=72.18) meters during the 6MWT, while the group with PPC walked an average of 340.89 (SD=100.93) meters (p=0.02). The distance traveled by the group without PPC was 80% of the predicted value, whereas the group with PPC averaged less than 70% (p=0.03), with more appropriate predicted values for the reference equations CONCLUSIONS: The 6MWT is an easy, safe, and feasible test for routine preoperative evaluation in pulmonary surgery and may indicate patients with a higher chance of developing PPC. PMID:26786074

  1. Application of Machine Learning Techniques to High-Dimensional Clinical Data to Forecast Postoperative Complications.

    Directory of Open Access Journals (Sweden)

    Paul Thottakkara

    Full Text Available To compare performance of risk prediction models for forecasting postoperative sepsis and acute kidney injury.Retrospective single center cohort study of adult surgical patients admitted between 2000 and 2010.50,318 adult patients undergoing major surgery.We evaluated the performance of logistic regression, generalized additive models, naïve Bayes and support vector machines for forecasting postoperative sepsis and acute kidney injury. We assessed the impact of feature reduction techniques on predictive performance. Model performance was determined using the area under the receiver operating characteristic curve, accuracy, and positive predicted value. The results were reported based on a 70/30 cross validation procedure where the data were randomly split into 70% used for training the model and the 30% for validation.The areas under the receiver operating characteristic curve for different models ranged between 0.797 and 0.858 for acute kidney injury and between 0.757 and 0.909 for severe sepsis. Logistic regression, generalized additive model, and support vector machines had better performance compared to Naïve Bayes model. Generalized additive models additionally accounted for non-linearity of continuous clinical variables as depicted in their risk patterns plots. Reducing the input feature space with LASSO had minimal effect on prediction performance, while feature extraction using principal component analysis improved performance of the models.Generalized additive models and support vector machines had good performance as risk prediction model for postoperative sepsis and AKI. Feature extraction using principal component analysis improved the predictive performance of all models.

  2. Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Postoperative Complication

    OpenAIRE

    Zalesin, Kerstyn C.; Wendy M. Miller; Barry Franklin; Dharani Mudugal; Avdesh Rao Buragadda; Judith Boura; Katherine Nori-Janosz; David L. Chengelis; Krause, Kevin R.; McCullough, Peter A

    2010-01-01

    Introduction. Few data are available on vitamin A deficiency in the gastric bypass population. Methods. We performed a retrospective chart review of gastric bypass patients (n = 69, 74% female). The relationship between serum vitamin A concentration and markers of protein metabolism at 6-weeks and 1-year post-operative were assessed. Results. The average weight loss at 6-weeks and 1-year following surgery was 20.1 ± 9.1 kg and 44.1 ± 17.1 kg, respectively. At 6 weeks and 1 year after surgery,...

  3. Early and late postoperative seizure outcome in 97 patients with supratentorial meningioma and preoperative seizures: a retrospective study.

    Science.gov (United States)

    Zheng, Zhe; Chen, Peng; Fu, Weiming; Zhu, Junming; Zhang, Hong; Shi, Jian; Zhang, Jianmin

    2013-08-01

    We identified factors associated with early and late postoperative seizure control in patients with supratentorial meningioma plus preoperative seizures. In this retrospective study, univariate analysis and multivariate logistic regression analysis compared 24 clinical variables according to the occurrence of early (≤1 week) or late (>1 week) postoperative seizures. Sixty-two of 97 patients (63.9 %) were seizure free for the entire postoperative follow-up period (29.5 ± 11.8 months), while 13 patients (13.4 %) still had frequent seizures at the end of follow-up. Fourteen of 97 patients (14.4 %) experienced early postoperative seizures, and emergence of new postoperative neurological deficits was the only significant risk factor (odds ratio = 7.377). Thirty-three patients (34.0 %) experienced late postoperative seizures at some time during follow-up, including 12 of 14 patients with early postoperative seizures. Associated risk factors for late postoperative seizures included tumor progression (odds ratio = 7.012) and new permanent postoperative neurological deficits (odds ratio = 4.327). Occurrence of postoperative seizures in patients with supratentorial meningioma and preoperative seizure was associated with new postoperative neurological deficits. Reduced cerebral or vascular injury during surgery may lead to fewer postoperative neurological deficits and better seizure outcome.

  4. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals.

    Science.gov (United States)

    Ludwig, A K; Glawatz, M; Griesinger, G; Diedrich, K; Ludwig, M

    2006-12-01

    Although transvaginal ultrasound-guided oocyte retrievals (OR) are performed routinely worldwide, there is very little systematic data about its complications. We performed a prospective cohort study following the perioperative and post-operative complications of over 1058 ORs. Additionally, we assessed the pain experienced during the OR. A total of 1166 OR were performed during the study period, of which 1058 (90.7%) ORs were included prospectively. Incomplete data meant that the remaining 9.3% were excluded. No complications were caused by sedation or general anaesthesia. Vaginal bleeding was observed in 2.8% of procedures, without any cases of intra-abdominal bleeding. An injury of pelvic structures (a ureteral lesion) occurred in one case. No case of pelvic infection, but one case of unexplained fever, was observed. A severe ovarian hyperstimulation syndrome (OHSS) occurred in 2.7% of cases. Although most patients tolerated the OR well, 3% of patients experienced severe to very severe pain after the OR and 2% of patients were still suffering from severe pain 2 days after the procedure. The pain level increased with the number of oocytes retrieved. About 0.7% of patients required hospitalization for pain treatment. Patients can be reassured that overall OR is a safe procedure. However, patients have to be counselled about the minor risks of the OR. The literature on complications is reviewed in the article.

  5. Vitamin a deficiency after gastric bypass surgery: an underreported postoperative complication.

    Science.gov (United States)

    Zalesin, Kerstyn C; Miller, Wendy M; Franklin, Barry; Mudugal, Dharani; Rao Buragadda, Avdesh; Boura, Judith; Nori-Janosz, Katherine; Chengelis, David L; Krause, Kevin R; McCullough, Peter A

    2011-01-01

    Introduction. Few data are available on vitamin A deficiency in the gastric bypass population. Methods. We performed a retrospective chart review of gastric bypass patients (n = 69, 74% female). The relationship between serum vitamin A concentration and markers of protein metabolism at 6-weeks and 1-year post-operative were assessed. Results. The average weight loss at 6-weeks and 1-year following surgery was 20.1 ± 9.1 kg and 44.1 ± 17.1 kg, respectively. At 6 weeks and 1 year after surgery, 35% and 18% of patients were vitamin A deficient, (Vitamin A directly correlated with pre-albumin levels at 6 weeks (r = 0.67, P vitamin A serum concentrations at these post-operative follow-ups. Vitamin A levels and markers of liver function testing were also unrelated. Conclusion. Vitamin A deficiency is common after bariatric surgery and is associated with a low serum concentration of pre-albumin. This fat-soluble vitamin should be measured in patients who have undergone gastric bypass surgery and deficiency should be suspected in those with evidence of protein-calorie malnutrition.

  6. An analysis of postoperative complications and efficacy of 3-D miniplates in fixation of mandibular fractures

    Directory of Open Access Journals (Sweden)

    Sadhasivam Gokkulakrishnan

    2012-01-01

    Conclusions: It was seen that 3-D titanium miniplates were effective in the treatment of mandibular fractures and overall complication rates were lesser. In symphysis and parasymphysis regions, 3-D plating system uses lesser foreign material than the conventional miniplates using Champy′s principle.

  7. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study.

    Science.gov (United States)

    Jielile, Jiasharete; Badalihan, Ayinazi; Qianman, Bayixiati; Satewalede, Tuerde; Wuerliebieke, Jianati; Kelamu, Mailamuguli; Jialihasi, Ayidaer

    2016-07-01

    Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI). Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed. Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group. Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture. II.

  8. Insurance status affects postoperative morbidity and complication rate after shoulder arthroplasty.

    Science.gov (United States)

    Li, Xinning; Veltre, David R; Cusano, Antonio; Yi, Paul; Sing, David; Gagnier, Joel J; Eichinger, Josef K; Jawa, Andrew; Bedi, Asheesh

    2017-08-01

    Shoulder arthroplasty is an effective procedure for managing patients with shoulder pain secondary to end-stage arthritis. Insurance status has been shown to be a predictor of patient morbidity and mortality. The current study evaluated the effect of patient insurance status on perioperative outcomes after shoulder replacement surgery. Data between 2004 and 2011 were obtained from the Nationwide Inpatient Sample. Analysis included patients undergoing shoulder arthroplasty (partial, total, and reverse) procedures determined by International Classification of Disease, 9th Revision procedure codes. The primary outcome was medical and surgical complications occurring during the same hospitalization, with secondary analyses of mortality and hospital charges. Additional analyses using the coarsened exact matching algorithm were performed to assess the influence of insurance type in predicting outcomes. A data inquiry identified 103,290 shoulder replacement patients (68,578 Medicare, 27,159 private insurance, 3544 Medicaid/uninsured, 4009 other). The overall complication rate was 17.2% (n = 17,810) and the mortality rate was 0.20% (n = 208). Medicare and Medicaid/uninsured patients had a significantly higher rate of medical, surgical, and overall complications compared with private insurance using the controlled match data. Multivariate regression analysis found that having private insurance was associated with fewer overall medical complications. Private insurance payer status is associated with a lower risk of perioperative medical and surgical complications compared with an age- and sex-matched Medicare and Medicaid/uninsured payer status. Mortality was not statistically associated with payer status. Primary insurance payer status should be considered as an independent risk factor during preoperative risk stratification for shoulder arthroplasty procedures. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All

  9. Split liver transplantation using extended right grafts: the natural history of segment 4 and its impact on early postoperative outcomes.

    Science.gov (United States)

    Sepulveda, Ailton; Scatton, Olivier; Tranchart, Hadrien; Gouya, Hervé; Perdigao, Fabiano; Stenard, Fabien; Bernard, Denis; Conti, Filomena; Calmus, Yvon; Soubrane, Olivier

    2012-04-01

    Split liver transplantation (SLT) using extended right grafts is associated with complications related to ischemia of hepatic segment 4 (S4), and these complications are associated with poor outcomes. We retrospectively analyzed 36 SLT recipients so that we could assess the association of radiological, biological, and clinical features with S4 ischemia. The overall survival rates were 84.2%, 84.2%, and 77.7% at 1, 3, and 5 years, respectively. The recipients were mostly male (24/36 or 67%) and had a median age of 52 years (range = 13-63 years), a median body mass index of 22.9 kg/m(2) (range = 17.3-29.8 kg/m(2) ), and a median graft-to-recipient weight ratio of 1.3% (range = 0.9%-1.9%). S4-related complications were diagnosed in 22% of the patients (8/36) with a median delay of 22 days (range = 10-30 days). Secondary arterial complications were seen in 3 of these patients and led to significantly decreased graft survival in comparison with the graft survival of patients without complications (50.0% versus 85.6%, P = 0.017). Patients developing S4-related complications had significantly elevated aspartate aminotransferase (AST) levels (>1000 IU/L) on postoperative day (POD) 1 and elevated gamma-glutamyl transpeptidase (GGT) levels (>300 IU/L) on PODs 7 and 10 (P graft survival, and the development of these complications can be anticipated by the early identification of a specific biological profile and a routine radiological examination.

  10. Patients with ovarian cancer have elevated (51)Cr-EDTA plasma clearance early post-operatively

    DEFF Research Database (Denmark)

    Nielsen, S S; Havsteen, H; Petersen, L K;

    2002-01-01

    Plasma clearance of (51)Cr-EDTA (Clp(EDTA)) is widely used to determine glomerular filtration rate prior to carboplatin based chemotherapy. We have observed that many patients with ovarian cancer have elevated Clp in the early post-operative phase compared to later phases. The purpose of this stu...

  11. Impact of mild renal impairment on early postoperative mortality after open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Ghani A

    2010-01-01

    Full Text Available Preoperative severe renal impairment is included in the risk scores to predict out-come after open cardiac surgery. The purpose of this study was to assess the impact of pre-operative mild renal impairment on the early postoperative mortality after open heart surgery. Data of all cases of open cardiac surgery performed from January 2005 to June 2006 were collec-ted. Cases with preoperative creatinine clearance below 60 mL/min were excluded from the study. Data were retrospectively analyzed to find the impact of renal impairment on short-term outcome. Of the 500 cases studied, 47 had preoperative creatinine clearance between 89-60 mL/min. The overall mortality in the study cases was 6.8%. The mortality was 28.7% in those who developed postoperative ARF, 33.3% in those who required dialysis and 40.8% in those with preoperative mild renal impairment. Binary logistic regression analysis showed that female gender (P = 0.01, preoperative mild renal impairment (P = 0.007 as well as occurrence of multi organ failure (P < 0.001 were the only independent variables determining the early postoperative mortality after cardiac surgeries. Among them, preoperative mild renal impairment was the most significant and the best predictor for early postoperative mortality after cardiac surgery. Our study suggests that renal impairment remains a strong predictor of early mortality even after adjustment for several confounders.

  12. Early rise in C-reactive protein is a marker for infective complications in laparoscopic colorectal surgery.

    LENUS (Irish Health Repository)

    Nason, Gregory J

    2014-02-01

    Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications.

  13. Anterograde amnesia as a possible postoperative complication of Midazolam as an agent for intravenous conscious sedation.

    Science.gov (United States)

    Malamed, S F; Nikchevich, D; Block, J

    1988-01-01

    Anterograde amnesia is often considered to be a beneficial effect of intravenous conscious sedation. The recently introduced benzodiazepine, midazolam, has associated with its administration a significant anterograde amnesic period. In the case presented here, a healthy young female presented for third molar extraction under midazolam conscious sedation and local anesthesia. After uncomplicated removal of the teeth and clinically adequate recovery from sedation, it was noted that the patient had swallowed the postsurgical gauze packs. Efforts at recovery of the gauze packs were futile. Follow-up discussion with the patient revealed a complete lack of recall of all events occurring for up to an hour or more after the administration of intravenous midazolam. The need for written and oral postoperative instructions to both the patient and his/her escort is emphasized.

  14. Anterograde Amnesia as a Possible Postoperative Complication of Midazolam as an Agent for Intravenous Conscious Sedation

    Science.gov (United States)

    Malamed, Stanley F.; Nikchevich, Donald; Block, James

    1988-01-01

    Anterograde amnesia is often considered to be a beneficial effect of intravenous conscious sedation. The recently introduced benzodiazepine, midazolam, has associated with its administration a significant anterograde amnesic period. In the case presented here, a healthy young female presented for third molar extraction under midazolam conscious sedation and local anesthesia. After uncomplicated removal of the teeth and clinically adequate recovery from sedation, it was noted that the patient had swallowed the postsurgical gauze packs. Efforts at recovery of the gauze packs were futile. Follow-up discussion with the patient revealed a complete lack of recall of all events occurring for up to an hour or more after the administration of intravenous midazolam. The need for written and oral postoperative instructions to both the patient and his/her escort is emphasized. PMID:3166354

  15. The postoperative stomach

    Energy Technology Data Exchange (ETDEWEB)

    Woodfield, Courtney A. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Levine, Marc S. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States)]. E-mail: marc.levine@uphs.upenn.edu

    2005-03-01

    Gastric surgery may be performed for the treatment of a variety of benign and malignant diseases of the upper gastrointestinal tract, including peptic ulcers and gastric carcinoma. Radiographic studies with water-soluble contrast agents often are obtained to rule out leaks, obstruction, or other acute complications during the early postoperative period. Barium studies may also be obtained to evaluate for anastomotic strictures or ulcers, bile reflux gastritis, recurrent tumor, or other chronic complications during the late postoperative period. Cross-sectional imaging studies such as CT are also helpful for detecting abscesses or other postoperative collections, recurrent or metastatic tumor, or less common complications such as afferent loop syndrome or gastrojejunal intussusception. It is important for radiologists to be familiar not only with the radiographic findings associated with these various abnormalities but also with the normal appearances of the postoperative stomach on radiographic examinations, so that such appearances are not mistaken for pseudoleaks or other postoperative complications. The purpose of this article is to describe the normal postsurgical anatomy after the most commonly performed operations (including partial gastrectomy, esophagogastrectomy and gastric pull-through, and total gastrectomy and esophagojejunostomy) and to review the acute and chronic complications, normal postoperative findings, and major abnormalities detected on radiographic examinations in these patients.

  16. Normothermic Versus Hypothermic Heart Surgery: Evaluation of Post-Operative Complications

    Directory of Open Access Journals (Sweden)

    H Akhlagh

    2012-04-01

    Full Text Available Introduction: The recently introduced technique of warm heart surgery may be a very effective method of myocardial protection. Although the systemic effects of hypothermic cardiopulmonary bypass are well known, the effects of warm heart surgery are not. Methods: In a prospective trial, 60 patients undergoing an elective coronary artery bypass grafting were randomly allocated to normothermic(30 patients and hypothermic(30 patients group and assessments regarding renal, respiratory and neurologic complications and bleeding volume was done. Resulst: Eighty percent of hypothermic group and 86% of normothermic group were males (p=0/36. Mean age was 56.4 and 56.1 years in hypothermic and normothermic groups, respectively. Groups had similar central temperature, shivering, nipride usage, intake and output, bleeding volume, neurologic complications and ICU staying(p>0/05 but inotrop usage and incidence of phrenic nerve palsy were higher in hypothermic group(p<0/05. Conclusion: Hypothermic procedure leads to a lower rate of respiratory complications, therefore we recommend replacing hypothermic procedure by normothermic one.

  17. Post-operative Streptococcus pneumoniae meningoencephalitis complicating surgery for acromegaly in an identical twin.

    Science.gov (United States)

    Cote, David J; Iuliano, Sherry L; Smith, Timothy R; Laws, Edward R

    2015-06-01

    This case report provides provocative and useful data regarding two aspects of acromegaly and its management. The patient, who is one of a pair of identical twins, has no known hereditary, genetic or otherwise potentially etiologic factors as compared to her unaffected sister. Secondly, transsphenoidal surgery, which was ultimately successful, was complicated by pneumococcal meningitis, an unusual event with only four previously reported patients, three of whom ended in death or major neurologic deficits. In this case, a 57-year-old woman gradually developed classical signs and symptoms of acromegaly while her identical twin sister remained normal with no evidence of endocrine disease. Endoscopic transsphenoidal surgery was complicated by the development of meningitis 25 days after surgery. This was controlled following a difficult hospital course. Streptococcus pneumoniae meningoencephalitis is a rare but life-threatening complication of transsphenoidal surgery. A high index of suspicion for incipient meningitis should be maintained when patients present with severe headache and increased intracranial pressure, even if they initially lack the typical symptoms and signs. Immediate and aggressive treatment is necessary to avoid significant neurologic deficit.

  18. Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cuaron, John J. [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chon, Brian; Tsai, Henry; Goenka, Anuj; DeBlois, David [Procure Proton Therapy Center, Somerset, New Jersey (United States); Ho, Alice; Powell, Simon [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Hug, Eugen [Procure Proton Therapy Center, Somerset, New Jersey (United States); Cahlon, Oren, E-mail: cahlono@mskcc.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Procure Proton Therapy Center, Somerset, New Jersey (United States)

    2015-06-01

    Purpose: To report dosimetry and early toxicity data in breast cancer patients treated with postoperative proton radiation therapy. Methods and Materials: From March 2013 to April 2014, 30 patients with nonmetastatic breast cancer and no history of prior radiation were treated with proton therapy at a single proton center. Patient characteristics and dosimetry were obtained through chart review. Patients were seen weekly while on treatment, at 1 month after radiation therapy completion, and at 3- to 6-month intervals thereafter. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Frequencies of toxicities were tabulated. Results: Median dose delivered was 50.4 Gy (relative biological equivalent [RBE]) in 5 weeks. Target volumes included the breast/chest wall and regional lymph nodes including the internal mammary lymph nodes (in 93%). No patients required a treatment break. Among patients with >3 months of follow-up (n=28), grade 2 dermatitis occurred in 20 patients (71.4%), with 8 (28.6%) experiencing moist desquamation. Grade 2 esophagitis occurred in 8 patients (28.6%). Grade 3 reconstructive complications occurred in 1 patient. The median planning target volume V95 was 96.43% (range, 79.39%-99.60%). The median mean heart dose was 0.88 Gy (RBE) [range, 0.01-3.20 Gy (RBE)] for all patients, and 1.00 Gy (RBE) among patients with left-sided tumors. The median V20 of the ipsilateral lung was 16.50% (range, 6.1%-30.3%). The median contralateral lung V5 was 0.34% (range, 0%-5.30%). The median maximal point dose to the esophagus was 45.65 Gy (RBE) [range, 0-65.4 Gy (RBE)]. The median contralateral breast mean dose was 0.29 Gy (RBE) [range, 0.03-3.50 Gy (RBE)]. Conclusions: Postoperative proton therapy is well tolerated, with acceptable rates of skin toxicity. Proton therapy favorably spares normal tissue without compromising target coverage. Further follow-up is necessary to assess for clinical outcomes and cardiopulmonary

  19. 尿道下裂包皮血管分布及其与术后近期并发症的相关性研究%Blood vessel distribution of foreskin in children with hypospadias and its correlation with postoperative early complications

    Institute of Scientific and Technical Information of China (English)

    赵彰; 孙宁; 张潍平; 白继武; 田军; 李明磊; 宋宏程; 李宁

    2012-01-01

    目的 通过对尿道下裂患儿包皮及皮瓣血管蒂的血管分布进行研究,评估并重新认识成形尿道材料的血运情况.术后对患儿随访,了解近期并发症的发生情况,探讨包皮血管分布与近期并发症的相关性,评估手术效果.方法 利用冷光源透照包皮法记录血管的分布及数量并进行归纳、分析、总结.术后对行Duckett或Duckett+ Duplay手术治疗的患儿进行随访.结果 包皮浅筋膜深层血管分布类型:①1支主导血管,占42.4%;②2支主导血管,占34.7%;③3支主导血管,占13.6%;④多支主导血管(主导血管>3支),占2.5%;⑤无明确主导血管,占6.8%.在有主导血管的病例中,主导血管的数目与尿道瘘及尿道狭窄的发生率无明确关系.结论 尿道下裂患儿包皮浅筋膜深层血管分布可分为五个类型.浅筋膜深层血管分布类型与尿道下裂的严重程度无明确对应关系.包皮血管分布对Duckett整体手术效果影响很小.%Objective To study the blood vessels distribution of foreskin in children with hypospadias and vesselpedicle, aiming to evaluate and recognize blood supply after application of urethra reconstruction materials. Follow up study was conducted after surgery and early complications were investigated to evaluate the correlation between blood vessel distribution of foreskin and early complications, as well as the therapeutic efficacy. Methods Duckett and Duckett + Duplay procedures were performed for the children with hypospadias. The cold lighting transmission techniques was utilized to record and evaluate the distribution of blood vessels in foreskins, and followed by summarization and analysis. The follow up was conducted for patients. Results Various blood vessels distribution could be found in superficial fascia in foreskin, in which simple main branch blood vessel type was 42.4 percent, double main branches type was 34.7 percent, three main branches types in them was 13

  20. Validation in colorectal procedures of a useful novel approach for the use of C-reactive protein in postoperative infectious complications.

    Science.gov (United States)

    Medina-Fernández, F J; Garcilazo-Arismendi, D J; García-Martín, R; Rodríguez-Ortiz, L; Gómez-Barbadillo, J; Gallardo-Valverde, J M; Martínez-Dueñas, J L; Navarro-Rodríguez, E; Torres-Tordera, E; Díaz-López, C A; Briceño, J

    2016-03-01

    Our aim was to validate a novel use of C-reactive protein (CRP) measurement to identify postoperative infectious complications in patients undergoing colorectal surgery, and to compare the predictive value in this setting against white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR). This was a retrospective study of CRP, NLR and WBC measurements in patients undergoing colorectal surgery. CRP, NLR and WBC were recorded on the second postoperative day and on the day of infectious complication (patients who developed infectious complications) or within 3 days prior to discharge (subjects with no complications). The test for detecting infectious complications consisted of comparing the value of the inflammatory marker on the day on which a complication was suspected against the value recorded on the second postoperative day. The test was considered positive if a given value was higher than the registered peak at postoperative day 2. Factors influencing the postoperative peak CRP were also studied. A total of 254 patients were retrospectively studied. Patients whose CRP value was higher than on the second postoperative day had a diagnostic accuracy for infectious complications of up to 94.4% and sensitivity, specificity, positive predictive value and negative predictive value of up to 97.4%, 93.4%, 85.7% and 99.1%, respectively. Poorer results were observed when WBC count and NLR were used rather than CRP measurement. Multiple linear regression analysis showed that surgical procedure and approach, as well as additional resections, were independent factors for 48 h peak CRP. C-reactive protein is a better parameter than WBC count and NLR for detecting infectious complications. Our proposed methodology presents good diagnostic accuracy and performance and could potentially be used for any surgical procedure. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  1. Reliable? The Value of Early Postoperative Magnetic Resonance Imaging after Cerebral Cavernous Malformation Surgery.

    Science.gov (United States)

    Chen, Bixia; Göricke, Sophia; Wrede, Karsten; Jabbarli, Ramazan; Wälchli, Thomas; Jägersberg, Max; Sure, Ulrich; Dammann, Philipp

    2017-07-01

    Cerebral cavernous malformations (CCM) can cause intracerebral hemorrhage. The lesions themselves are frequently associated with perifocal hemosiderin deposits caused by repetitive microhemorrhages. Main indications for a surgical treatment are recurrent symptomatic hemorrhages or cavernoma-related epilepsy. After surgical resection, follow-up magnetic resonance imaging (MRI) is usually performed to confirm 1) the complete resection of the CCM and, especially in cases of cavernoma-related epilepsy, 2) the complete resection of the hemosiderin deposits. This prospective study evaluates the value of early postoperative MRI (within 72 hours) regarding the detection of CCM or hemosiderin remnants compared with a standard 3-6 months postoperative MRI control in 61 CCM cases. Sensitivity of early postoperative MRI for CCM remnant detection was 66.67% (95% confidence interval [CI], 9.43%-99.16%), specificity was 76.74% (95% CI, 61.37%-88.24%), positive predictive value was 16.67% (95% CI, 2.09%-48.41%), and negative predictive value was 97.06% (95% CI, 84.67%-99.93%). Because of the high number of patients who could not be evaluated because of imaging artifacts, sensitivity and specificity analysis was not performed for early postoperative MRI using T2*/susceptibility-weighted imaging to assess hemosiderin remnants. Sensitivity of early postoperative MRI for hemosiderin remnant detection using T2-weighted sequences was 85.71% (95% CI, 63.66%-96.95%), specificity was 66.67% (95% CI, 44.68%-84.37%), positive predictive value was 69.23% (95% CI, 55.45%-80.27%), and negative predictive value was 84.21% (95% CI, 64.31%-94.04%). Our data suggest that early postoperative MRI after CCM surgery is often hampered by imaging artifacts creating false-positive results and therefore ineligible for a resection control. However, reliability of a negative result on early postoperative T2-weighted MRI is relatively high regarding both CCM and hemosiderin remnants. Copyright © 2017

  2. Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial - The PINOCCHIO trial

    Directory of Open Access Journals (Sweden)

    Spinelli Allison

    2011-07-01

    Full Text Available Abstract Background Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient. We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. Methods/Design After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl. The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation. Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight and to the

  3. Post-operative stress fractures complicating surgery for painful forefoot conditions.

    Science.gov (United States)

    Edwards, Max R; Jack, Christopher; Jones, Gareth G; Singh, Samrendu K

    2010-01-01

    A stress fracture is caused by repetitive or unusual loading of a bone leading to mechanical failure. Fatigue type stress fractures occur in normal bone exposed to abnormally high repetitive loads, whereas insufficiency type stress fractures occur in abnormal bone exposed to normal loads. We describe three cases of insufficiency stress fractures that have complicated surgery for painful forefoot conditions. The diagnosis and management of these cases are discussed. Stress fractures should be included in the differential diagnosis of any patient who continues or develops pain after surgery to the forefoot.

  4. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    Directory of Open Access Journals (Sweden)

    Jimmy Thomas

    2014-01-01

    Full Text Available This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

  5. Impact of preoperative patient education on prevention of postoperative complications after major visceral surgery: study protocol for a randomized controlled trial (PEDUCAT trial).

    Science.gov (United States)

    Fink, Christine; Diener, Markus K; Bruckner, Thomas; Müller, Gisela; Paulsen, Lisa; Keller, Monika; Büchler, Markus W; Knebel, Phillip

    2013-08-26

    In line with the growing number of surgical procedures being performed worldwide, postoperative complications are also increasing proportionately. Prevention of these postoperative complications is a high medical priority. Preoperative education of patients, including provision of preparatory information about the correct behavior after surgery, could improve the postoperative outcome, but the evidence for this is inconclusive. The aim of the PEDUCAT trial is to evaluate the feasibility and the impact of preoperative patient education on postoperative morbidity, mortality and quality of life in patients scheduled for elective major visceral surgery. PEDUCAT is designed as a cluster-randomized controlled pilot study. The experimental group will visit a standardized preoperative seminar to learn how best to behave after surgery in addition to being given a standard information brochure, whereas the control group will only receive the information brochure. Outcome measures such as postoperative morbidity, postoperative pain, postoperative anxiety and depression, patient satisfaction, quality of life, length of hospital stay and postoperative mortality will be evaluated. Statistical analysis will be based on the intention-to-treat population. Analysis of covariance will be applied for the intervention group comparison, adjusting for age, center and quality of life before surgery. This is a pilot study to show the feasibility of the concept. Nevertheless, the planned sample size of n = 204 is large enough to show an effect with power of 90% and a significance level of 5%. German Clinical Trial Register number: DRKS00004226.

  6. Biliopancreatic diversion with duodenal switch modifies plasma chemerin in early and late post-operative periods.

    Science.gov (United States)

    Parlee, Sebastian D; Wang, Yan; Poirier, Paul; Lapointe, Marc; Martin, Julie; Bastien, Marjorie; Cianflone, Katherine; Goralski, Kerry B

    2015-06-01

    Bariatric surgery remains the most effective treatment for obesity and metabolic syndrome. Surgical benefit arises from early-phase resolution of hyperglycemia and late-phase weight loss. The adipokine chemerin is of interest given its roles in immunity, adipogenesis, and metabolism. The study objective was to examine the effects of biliopancreatic diversion with duodenal switch (BPD-DS) on plasma chemerin in the early and late post-operative stages. 83 adults with obesity undergoing BPD-DS, 45 obese non-surgical controls, and 9 lean surgical controls were enrolled. Plasma parameters and anthropometric measures were obtained at baseline and at, early (24 h, 5 D) and late (6 months and 12 months) post-operative stages. Plasma chemerin dropped from 176±49 ng/mL at baseline to 132±52 ng/mL 24 h after BPD-DS, rebounded to 200±66 ng/mL after 5 D, and declined to 124±51 and 110±34 ng/mL after 6 and 12 months. Plasma chemerin correlated negatively with measures of inflammation and hepatic injury and positively with measures of obesity, metabolic syndrome, and inflammation in the early and late post-operative periods, respectively. Chemerin has a novel role in surgical injury but not hyperglycemia resolution early after BPD-DS. Over the long term, plasma chemerin declines to a new set point that is partially determined by body fat reductions. © 2015 The Obesity Society.

  7. A Meta-analysis of Postoperative Complications of Tissue Expander/Implant Breast Reconstruction Using Acellular Dermal Matrix.

    Science.gov (United States)

    Zhao, Xiangyi; Wu, Xiaowei; Dong, Jie; Liu, Yingying; Zheng, Liang; Zhang, Liming

    2015-12-01

    Acellular dermal matrix (ADM) is commonly used for tissue expander/implant breast (TE/I-based) reconstruction. But the relation between ADM and postoperative complications remains controversial. A few meta-analyses were conducted in 2011-2012 and the result revealed that ADM can increase the risk of complications. The purpose of our study is to offer updated evidence for ADM clinical application by analyzing the effect of ADM on complications of TE/I-based breast reconstruction. The literature published from January 2010 to February 2015 was searched in EMbase, Medline, Science Direct, the Cochrane Central Register of Controlled Trials (CENTRAL), CBMdisc, CNKI, VIP, and the references of those included studies were also searched by hand. According to inclusive criteria, 11 studies were selected and the values were extracted from the included literature. Complications with four different categories assigned for overall complications, infection, hematoma/seroma, and explantation were collected. RevMan 5.1 was used for meta-analysis. The evidence level was assessed by using the GRADE system. Eleven published studies were included. The results showed that compared to the control group, the ADM group increased the rate of overall complications (OR = 1.33, 95% CI 1.03-1.70, p = 0.03), infection (OR = 1.47, 95% CI 1.04-2.06, p = 0.03), hematoma/seroma (OR = 1.66, 95% CI 1.13-2.44, p = 0.01), but there was no significant difference in explantation (OR = 1.37, 95% CI 0.89-2.11, p = 0.15). Based on the GRADE system, all the evidence was at level C and weak recommendation. In TE/I-based breast reconstruction, ADM increased the incidence of overall complications, infection, and hematoma/seroma; the incidence of explantation remains unknown. For the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are needed. This journal requires that authors assign a level of evidence to each submission to which Evidence

  8. Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery.

    Science.gov (United States)

    Girish, M; Trayner, E; Dammann, O; Pinto-Plata, V; Celli, B

    2001-10-01

    Thoracotomy, sternotomy, and upper abdominal laparotomy are associated with high rate of postoperative cardiopulmonary complications (POCs). We hypothesized that symptom-limited stair climbing predicts POCs after high-risk surgery. A prospective evaluation of 83 patients undergoing thoracotomy, sternotomy, and upper abdominal laparotomy surgery. The 52 men and 31 women completed symptom-limited stair climbing. A separate investigator, blinded to the number of flights of stairs climbed, assessed 30-day actual outcomes for POCs, including pneumonia, atelectasis, mechanical ventilation for > 48 h, reintubation, myocardial infarction, congestive heart failure, arrhythmia, pulmonary embolus, and death within 30 days of surgery. The operations performed included 31 lobectomies, 6 wedge resections, 3 pneumonectomies, 3 substernal thymectomies, 1 substernal thyroidectomy, 23 colectomies, 3 laparotomies, 7 abdominal aortic aneurysm repairs, 5 esophagogastrectomies, and 1 nephrectomy. POCs occurred in 21 of 83 patients (25%) overall, in 9 of 44 patients undergoing thoracotomy/sternotomy (20%), and in 12 of 39 patients undergoing upper abdominal laparotomy (31%). Of those unable to climb one flight of stairs, 89% developed a POC. No patient able to climb the maximum of seven flights of stairs had a POC. The inability to climb two flights of stairs was associated with a positive predictive value of 82% for the development of a POC. The number of days in the hospital postoperatively decreased with a patient's increased ability to climb stairs. Symptom-limited stair climbing offers a simple, inexpensive means to predict POCs after high-risk surgery.

  9. A simple scoring system for predicting early major complications in spine surgery: the cumulative effect of age and size of surgery.

    Science.gov (United States)

    Brasil, Albert Vincent Berthier; Teles, Alisson R; Roxo, Marcelo Ricardo; Schuster, Marcelo Neutzling; Zauk, Eduardo Ballverdu; Barcellos, Gabriel da Costa; Costa, Pablo Ramon Fruett da; Ferreira, Nelson Pires; Kraemer, Jorge Luiz; Ferreira, Marcelo Paglioli; Gobbato, Pedro Luis; Worm, Paulo Valdeci

    2016-10-01

    To analyze the cumulative effect of risk factors associated with early major complications in postoperative spine surgery. Retrospective analysis of 583 surgically-treated patients. Early "major" complications were defined as those that may lead to permanent detrimental effects or require further significant intervention. A balanced risk score was built using multiple logistic regression. Ninety-two early major complications occurred in 76 patients (13%). Age > 60 years and surgery of three or more levels proved to be significant independent risk factors in the multivariate analysis. The balanced scoring system was defined as: 0 points (no risk factor), 2 points (1 factor) or 4 points (2 factors). The incidence of early major complications in each category was 7% (0 points), 15% (2 points) and 29% (4 points) respectively. This balanced scoring system, based on two risk factors, represents an important tool for both surgical indication and for patient counseling before surgery.

  10. Postoperative anemia and early functional outcomes after fast-track hip arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Bandholm, Thomas Quaade; Kurbegovic, Sorel

    2016-01-01

    BACKGROUND: Postoperative anemia is prevalent in fast-track hip arthroplasty (THA) where patients are mobilized and discharged early, but whether anemia impairs functional recovery after discharge has not been adequately evaluated previously. This study aimed to evaluate whether postoperative...... anemia influenced recovery of mobility and quality of life (Qol) during the first 2 weeks after discharge from THA. STUDY DESIGN AND METHODS: This was a prospective observational study in 122 THA patients more than 65 years of age. Mobility and Qol were assessed pre- and postoperatively by the 6-minute...... walk test (6MWT; primary outcome), the timed up-and-go test, and the FACT-anemia subscale. Twenty-four-hour mobility at home was assessed by activity monitoring on Days 1 to 6 after discharge. Hemoglobin (Hb) at discharge (HbD) and the Hb decrease from preoperatively (ΔHb) were compared to mobility...

  11. Multivariate analysis of perioperative risk factors associated with postoperative pulmonary complications in elder patients undergoing upper abdominal surgery

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    Wen-bing LI

    2011-06-01

    Full Text Available Objective To explore the correlation between the perioperative risk factors and postoperative pulmonary complications(POPC in elder patients undergoing upper abdominal surgery.Methods A retrospective survey of 169 elder patients(age over 60 years,received elective upper abdominal surgery under general anesthesia from Jan.1,2006 to Jan.1,2010 was conducted.The perioperative factors influencing respiratory function were evaluated,including clinical manifestations,chest X-ray,pulmonary function,arterial blood gas analysis,duration of anesthesia,incision type,duration of nasogastric tube and ambulation time.Meanwhile,the relationship between POPC and the factors mentioned above was analyzed.Results POPC were seen to occur in 77 of the 169 patients(45.6%,and the most common complication was pneumonia(20 cases,followed by atelectasis(18 cases,tracheobronchitis or acute exacerbations of chronic bronchitis(17 cases,bronchospasm(15 cases,acute respiratory failure(5 cases and pulmonary embolism(2 cases.Multivariate logistic analysis showed that the postoperative nasogastric intubation,preoperative respiratory symptoms,decreased forced expiratory volume in 1st second/forced vital capacity(FEV1/FVC and longer duration of anesthesia were the valuable risk factors for prediction of POPC.Conclusions It is recommend that a detailed preoperative pulmonary examination and pulmonary function test in elder patients who are going to have upper abdominal surgery should be done to identify the risk for POPC.Preoperative intervention therapy may be helpful to improve pulmonary function,decrease the incidence of POPC and lower mortality of the patients.

  12. [Characteristics of postoperative peritonitis].

    Science.gov (United States)

    Lock, J F; Eckmann, C; Germer, C-T

    2016-01-01

    Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.

  13. ROLE OF MULTISLICE COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF POSTOPERATIVE COMPLICATIONS OF AUGMENTATION MAMMOPLASTY

    Directory of Open Access Journals (Sweden)

    A. B. Abduraimov

    2008-01-01

    Full Text Available Analysis of the findings has shown that the complex use of radiation studies allows the valid diagnosis of the complications due to aug- mentation mammoplasty to be established.Due to its high informative value, multislice computed tomographic (MSCT mammography should be used as an adjuvant in high- risk patients and when there are contraindications to magnetic resonance imaging.Bolus intravenous contrast-enhanced MSCT mammography has proved to be highly effective in differentiating scar tissue from cancer recurrences.The inclusion of this technique into the examination program for patients with the nodules of irregular shape being around the implant, detected at ultrasonography and magnetic resonance mammography, may increase the specificity of noninvasive diagnosis of cancer, thus reducing the number of excision biopsies.

  14. Factores pronósticos de complicaciones postoperatorias en el trasplante hepático Prognostic factors associated with postoperative complications in liver transplantation

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    A. Rodríguez-Ariza

    2008-03-01

    Full Text Available Objetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo. Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias. Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas. Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO.Objectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity

  15. Resective surgery for liver tumor:a multivariate analysis of causes and risk factors linked to postoperative complications

    Institute of Scientific and Technical Information of China (English)

    Enrico Benzoni; Dario Lorenzin; Umberto Baccarani; Gian Luigi Adani; Alessandro Favero; Alessandro Cojutti; Fabrizio Bresadola; Alessandro Uzzau

    2006-01-01

    BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative deaths, stress must be placed on reducing the postoperative complication rates reported to be still as high as 50%. This study was designed to analyze the causes and foreseeable risk factors linked to postoperative morbidity on the grounds of data derived from a single-center surgical population. METHODS: From September 1989 to March 2005, 287 consecutive patients, affected either with HCC or liver metastasis, had liver resection at our department. Among the HCC series we recorded 98 patients (73.2%) in Child-Pugh class A, 32 (23.8%) in class B and 4 in class C (3%). In 104 colorectal metastases, 71% were due to colon cancer, 25% rectal, 3% sigmoid, and 1% anorectal. In 49 non-colorectal metastases, 22.4% were derived from breast cancer, 63.2% gastrointestinal tumors (excluding colon) and 14.4%other cancers. We performed 80 wedge resections, 77 bisegmentectomies and/or left lobectomies, 74 segmentectomies, 22 major hepatectomies, 20 left hepatectomies, and 14 trisegmentectomies. RESULTS: The in-hospital mortality rate in this series was 4.5%, and the morbidity rate was 47.7%, because of pleural effusion (30%), hepatic abscess (25%), hepatic insufifciency (19%), ascites (10%), hemoperitoneum (10%), or biliary ifstula (6%). The variables associated with the technical aspects of the surgical procedure that were responsible for the complications were: a Pringle maneuver length more than 20 minutes (P=0.001);the type of liver resection procedure, including major hepatectomy (P=0.02), left hepatectomy (P=0.04), trisegmentectomy (P=0.04), bisegmentectomy and/or left lobectomy (P=0,04);and a blood transfusion of more than 600 ml (P=0.04). CONCLUSION: The evaluation of causes and foreseeable risk factors linked to postoperative morbidity during the planning of

  16. A STUDY OF POSTOPERATIVE COMPLICATIONS FOLLOWING OPEN MESH INGUINAL HERNIA REPAIR

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    Abdul Kalam

    2016-09-01

    Full Text Available BACKGROUND Inguinal hernia is the most common type of hernia. Inguinal region consists of deep inguinal ring, inguinal canal and superficial inguinal ring, which make the region weak and susceptible to hernia. 65% of inguinal hernias are indirect hernias and 35% direct hernias. Hernioplasty is the strengthening of posterior wall of inguinal canal. It can be done either with the help of mesh repair or darning. Hernioplasty is indicated in recurrent hernia cases, inguinal hernia with weak abdominal muscle tone where mesh plasty is preferred and inguinal hernia with good muscle tone where darning can be done. In mesh repair, posterior wall (Lichtenstein repair of inguinal canal is strengthened by a Prolene or Marlex mesh. Over time, fibroblasts and capillaries grow over the mesh converting it into a thick sheath strengthening the posterior wall. Complications which can be encountered postsurgery are pain, bleeding, urinary retention, scrotal swelling, abdominal distension, seroma and wound infections, chronic pain, keloid and testicular atrophy. MATERIALS AND METHODS  The study was conducted in the Department of General Surgery, Travancore Medical College, Kollam.  The study was done from January 2015 to January 2016.  One hundred cases were identified and were chosen for the study. INCLUSION CRITERIA 1. Inguinal hernia cases treated by open mesh repair. EXCLUSION CRITERIA 1. Other types of inguinal hernia repair. RESULTS All the cases studied belonged to male sex. In our study, age group twenty to forty years amounted to sixty one cases followed by age group forty to sixty years, which amounted to twenty eight cases. Age group zero to twenty years amounted to six cases and age group more than sixty years amounted to five cases. In the study group, seventy two cases were indirect inguinal hernias and twenty eight cases were direct inguinal hernias. Based on the complications encountered, pain at the site was the commonest complaint, which

  17. Continuous irrigation and drainage for early postoperative deep wound infection after posterior instrumented spinal fusion.

    Science.gov (United States)

    Lian, Xiao-Feng; Xu, Jian-Guang; Zeng, Bing-Fang; Liu, Xiao-Kang; Li, Hao; Qiu, Man-le; Yang, Er-Zhu

    2014-12-01

    A retrospective study of clinical cases. To evaluate the efficacy of continuous irrigation and drainage for early postoperative deep wound infection after posterior instrumented spinal fusion. Aggressive debridement and irrigation has been recommended to treat postoperative wound infections after instrumented spinal fusion. However, this method of management, indicating repeating visits to the operating room until the wound is clean enough for closure, often results in prolonged hospitalization, increased cost, and sometimes compromise of the desired outcome. We hypothesize that repeat visits to the operating room for debridements can be avoided by aggressive debridements and primary closure with continuous irrigation and drainage for postoperative wound infections. From 2004 to 2009, 23 patients with early postoperative deep wound infections after spinal fusion with instrumentation were surgically treated with thorough debridement and primary closure with continuous irrigation and drainage. All patients were followed up for 30.6 months (range, 24-54 mo). The mean duration of irrigation was 12.0 days (range, 7-16 d). In 21 patients (91.3%), the wound healed after continuous irrigation. The removal of the instrumentation or cages was not required in any case. Spinal fusion was achieved in all cases, except 1, where the patient developed a pseudoarthrosis at the L4-L5 level after L4-S1 fusion. The mean ODI for these 23 patients improved significantly from 53.4±18.7 preoperatively to 18.3±11.2 at the final follow-up visit (Pirrigation and drainage is an effective and safe method for the treatment of early postoperative deep wound infection after posterior instrumented spinal fusion.

  18. Repaired supraspinatus tendons in clinically improving patients: Early postoperative findings and interval changes on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, So Hee; Park, So Young; Jin Wook [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2015-04-15

    To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs. Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated. The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050). Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

  19. Early hospital discharge and early puerperal complications Egreso temprano postparto y complicaciones en el puerperio mediato

    Directory of Open Access Journals (Sweden)

    Dolores Ramírez-Villalobos

    2009-06-01

    Full Text Available OBJECTIVE:To evaluate the association between time of postpartum discharge and symptoms indicative of complications during the first postpartum week. MATERIALS AND METHODS: Women with vaginal delivery at a Mexico City public hospital, without complications before the hospital discharge, were interviewed seven days after delivery. Time of postpartum discharge was classified as early (25 hours. The dependent variable was defined as the occurrence and severity of puerperal complication symptoms. RESULTS:Out of 303 women, 208 (68% were discharged early. However, women with early discharge and satisfactory prenatal care had lower odds of presenting symptoms in early puerperium than women without early discharge and inadequate prenatal care (OR 0.36; 95% confidence intervals = 0.17-0.76. CONCLUSIONS:There was no association between early discharge and symptoms of complications during the first postpartum week; the odds of complications were lower for mothers with early discharge and satisfactory prenatal care.OBJETIVO:Evaluar la asociación entre el tiempo de egreso posparto y las posibles complicaciones en el puerperio mediato. MATERIAL Y MÉTODOS:Mujeres con parto vaginal atendidas en un hospital público de la Ciudad de México, sin complicaciones antes del egreso hospitalario, fueron entrevistadas a los siete días de egreso. La variable dependiente fue la ocurrencia y severidad de complicaciones. Se calcularon media y desviación estándar para las variables continuas, y proporciones para las categóricas. Las variables relacionadas con egreso temprano en el análisis bivariado (con p<0.15 fueron incluidas en un modelo de regresión logística. RESULTADOS:Se analizó información de 303 partos, de los cuales 208 (68% tuvieron egreso temprano posparto. Las mujeres que fueron egresadas en forma temprana con un control prenatal adecuado reportaron menos síntomas de complicaciones en el puerperio mediato (RM= 0.36; IC 95% = 0.17-0.76. CONCLUSIONES

  20. Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

    Science.gov (United States)

    Bonini, G.; Pezzotta, G.; Morzenti, C.; Agazzi, R.; Nani, R.

    2007-01-01

    Purpose To evaluate the utility of contrast-enhanced sonography in the study of pediatric liver transplant recipients and its potential impact in reducing the need for invasive diagnostic procedures. Materials and methods From October 2002 to December 2003 we performed routine color Doppler ultrasound and contrast-enhanced ultrasound studies on 30 pediatric patients who had undergone liver transplantation. Findings indicative of complications were confirmed with invasive studies (angiography, computed tomography, and PTC). Results Contrast-enhanced sonography correctly identified four of the five cases of hepatic artery thrombosis and all those involving the portal (n = 6) and hepatic vein (n = 3) thrombosis. It failed to identify one case of hepatic artery thrombosis characterized by collateral circulation arising from the phrenic artery and the single case of hepatic artery stenosis. The latter was more evident on color Doppler, which revealed a typical tardus parvus waveform. The use of contrast offered no significant advantages in the study of biliary complications although it did provide better visualization of bile leaks. Conclusions Contrast-enhanced sonography improves diagnostic confidence and reduces the need for more invasive imaging studies in the postoperative follow-up of pediatric liver transplant recipients. PMID:23396596

  1. Dietician-delivered intensive nutritional support is associated with a decrease in severe postoperative complications after surgery in patients with esophageal cancer.

    Science.gov (United States)

    Ligthart-Melis, G C; Weijs, P J M; te Boveldt, N D; Buskermolen, S; Earthman, C P; Verheul, H M W; de Lange-de Klerk, E S M; van Weyenberg, S J B; van der Peet, D L

    2013-08-01

    The aim of this study was to evaluate the effect of dietician-delivered intensive nutritional support (INS) on postoperative outcome in patients with esophageal cancer. Approximately 50-80% of patients with esophageal cancer are malnourished at the time of diagnosis. Malnutrition enhances the risk of postoperative complications, resulting in delay of postoperative recovery and impairment of quality of life. Sixty-five patients with esophageal cancer were included. All patients who received surgery (n = 28) in the time frame between March 2009 and April 2010, the first year after the start of INS, were included in the INS intervention group. The control group (n = 37) consisted of patients who received surgery during the 3 years before the start of INS. Logistic regression analysis was used to compare differences in severity of postoperative complications using the Dindo classification. Linear regression was applied to evaluate differences in preoperative weight change. The adjusted odds ratio for developing serious complications after surgery of INS compared with the control group was 0.23 (95% confidence interval: 0.053-0.97; P = 0.045). Benefit was mainly observed in patients who received neoadjuvant therapy before esophagectomy (n = 35). The INS program furthermore resulted in a relative preoperative weight gain in comparison with the control group of +4.8% (P = 0.009, adjusted) in these neoadjuvant-treated patients. This study shows that dietician-delivered INS preserves preoperative weight and decreases severe postoperative complications in patients with esophageal cancer.

  2. MODERN PHYSICAL THERAPY IN THE EARLY POSTOPERATIVE REHABILITATION OF PATIENTS WITH CHOLELITHIASIS

    Directory of Open Access Journals (Sweden)

    O. A. Poddubnaya

    2013-01-01

    Full Text Available Early postoperative rehabilitation of patients with cholelithiasis is aimed at improving the function of bile secretion, adaptability and normalization of psycho-vegetative state body, which in the aggregate prevents progression of the disease and reduces the risk of postcholecystectomy violations. Use in rehabilitation activities fresh mineral water, magnetic-laser and EHF-therapy allows to receive significant improvement of the studied parameters in a significant improvement and normalization of clinical and laboratory indicators, increase adaptive capacity and normalization of psychoemotional and vegetative status of the organism. It is provides immediate high efficiency of the activities (94.7% of early postoperative rehabilitation of patients with cholelithiasis, which reduces the risk of the development of postcholecystectomy violations and prevents progression of the disease.

  3. Application of Minimum Effective Cuff Inflating Volume for Laryngeal Mask Airway and its Impact on Postoperative Pharyngeal Complications

    Institute of Scientific and Technical Information of China (English)

    Bing-Bing Li; Jie Yan; Hong-Gang Zhou; Jing Hao; Ai-Jia Liu; Zheng-Liang Ma

    2015-01-01

    Background:High intracuffpressure can cause severe pharyngeal complications including sore throat or hoarseness after laryngeal mask airway (LMA) removal postoperatively.Though the application of minimum effective cuffinflating volume is suggested to maintain airway sealing and adequacy of ventilation for patients receiving general anesthesia with LMA at lower level of the intracuffpressure,it is currently not a standard care in most of the anesthetic departments.In this study,the minimum effective cuff inflating volume was determined for classic LMA Well LeadTM (Well Lead Medical Co.,Ltd.,China) and its impact on postoperative pharyngeal complications was also explored.Methods:Patients with American Society of Anesthesiologists physical status (Ⅰ-Ⅲ) undergoing the short-duration urological surgery were recruited in this trial.First,the minimum effective cuff inflating volume was determined for size 4 or 5 LMA Well LeadTM in the study 1.Immediately following placement and confirmation of ideal LMA position,the cuff was inflated with 5,7,10 ml of air and up to 30 ml at 5 ml increment.The intracuff pressure,oropharyngeal leak pressure (OLP),and inspiratory peak airway pressure under positive pressure ventilation at the corresponding cuff volume as indicated above were recorded.Second,the enrolled patients were randomly allocated into minimum effective cuff inflating volume group (MC) and routine care (RC) group in the study 2.The minimum effective cuff inflating volume was applied and maintained in MC group,whereas the cuff volume was inflated with half of the maximum cuff inflating volume recommended by manufacturer in RC group throughout the surgical procedure and stay in postanesthesia care unit prior to LMA removal.The incidence of pharyngeal complications at 0,2,24,and 48 h after removal of LMA and other intra-operative adverse events were also documented.Results:The intracuffpressure varied with the cuff inflating volume in a positive linear correlation

  4. Early complications of stenting in patients with congenital heart disease : a multicentre study

    NARCIS (Netherlands)

    van Gameren, Menno; Witsenburg, Maarten; Takkenberg, Johanna J. M.; Boshoff, Derize; Mertens, Luc; van Oort, Anton M.; de Wolf, DanieL; Freund, Matthias; Sreeram, Narayanswani; Bokenkamp, Regina; Talsma, Melle D.; Gewillig, Marc

    2006-01-01

    Aims Stenting has become an established interventional cardiology procedure for congenital heart disease. Although most stent procedures are completed successfully, complications may occur. This multicentre study evaluated early complications after stenting in patients with congenital heart disease,

  5. A comparison of preliminary oncologic outcome and postoperative complications between patients undergoing either open or robotic radical cystectomy

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    Antonio Cusano

    Full Text Available ABSTRACT Purpose: To compare complications and outcomes in patients undergoing either open radical cystectomy (ORC or robotic-assisted radical cystectomy (RRC. Materials and Methods: We retrospectively identified patients that underwent ORC or RRC between 2003- 2013. We statistically compared preliminary oncologic outcomes of patients for each surgical modality. Results: 92 (43.2% and 121 (56.8% patients underwent ORC and RRC, respectively. While operative time was shorter for ORC patients (403 vs. 508 min; p<0.001, surgical blood loss and transfusion rates were significantly lower in RRC patients (p<0.001 and 0.006. Length of stay was not different between groups (p=0.221. There was no difference in the proportion of lymph node-positive patients between groups. However, RRC patients had a greater number of lymph nodes removed during surgery (18 vs. 11.5; p<0.001. There was no significant difference in the incidence of pre-existing comorbidities or in the Clavien distribution of complications between groups. ORC and RRC patients were followed for a median of 1.38 (0.55-2.7 and 1.40 (0.582.59 years, respectively (p=0.850. During this period, a lower proportion (22.3% of RRC patients experienced disease recurrence vs. ORC patients (34.8%. However, there was no significant difference in time to recurrence between groups. While ORC was associated with a higher all-cause mortality rate (p=0.049, there was no significant difference in disease-free survival time between groups. Conclusions: ORC and RRC patients experience postoperative complications of similar rates and severity. However, RRC may offer indirect benefits via reduced surgical blood loss and need for transfusion.

  6. Postoperative complications and short-term oncological outcomes of patients aged ≥80 years undergoing robot-assisted radical cystectomy.

    Science.gov (United States)

    Nguyen, Daniel P; Al Hussein Al Awamlh, Bashir; Charles Osterberg, E; Chrystal, James; Flynn, Thomas; Lee, Daniel J; Scherr, Douglas S

    2015-09-01

    To assess complication rates and early oncological outcomes of patients aged ≥80 years who underwent robot-assisted radical cystectomy (RARC). A total of 368 consecutive patients underwent radical cystectomy from April 2001 to September 2013 in a tertiary referral center. Sixty-one patients aged ≥80 years underwent RARC and constitute the cohort of interest. Complications arising within 30 and 90 days of surgery were graded using the modified Clavien classification and were additionally categorized by organ system using a standardized complication reporting system. Recurrence-free survival, disease-specific survival and overall survival were calculated using Kaplan-Meier curves. Median age was 83 years (range 80-94). Twenty-nine (48 %) of all tumor specimens were stage ≥pT3. The median number of nodes removed was 19 (range 6-67). The soft tissue positive margin rate was 10 %. A total of 27 (44 %) patients had complications within 90 days, of which 9 had major complications. Two patients (3 %) died from surgical complications within 90 days. At a median follow-up of 13 months, 12 (20 %) patients had developed recurrent cancer and subsequently died from disease. An additional 13 (21 %) patients died from non-cancer-related causes. The median overall survival time was 36.0 months. At 2 years, recurrence-free, cancer-specific and overall survival rates were 73, 74 and 61 %, respectively. In patients aged ≥80 years, RARC is feasible with acceptable perioperative morbidity and favorable short-term oncological outcomes. Therefore, RARC should be considered a valid option for carefully selected patients aged ≥80 years with bladder cancer.

  7. Impact of general versus epidural anesthesia on early post-operative cognitive dysfunction following hip and knee surgery

    Directory of Open Access Journals (Sweden)

    Mandal Sripurna

    2011-01-01

    Full Text Available Background : Post-operative cognitive dysfunction is the subtle cerebral complication temporally seen following surgery. The aim of this study was to compare the influence of either general anesthesia (GA or epidural anesthesia (EA on the early post-operative neurocognitive outcome in elderly (>59 years subjects undergoing hip and knee surgery. Methods : A total of 60 patients were recruited in a prospective, randomized, parallel-group study, comparable by age and sex. They were enrolled and randomized to receive either EA (n = 30 or GA (n = 30. All of them were screened using the Mini Mental State Examination (MMSE, with components of the Kolkata Cognitive Screening Battery. The operated patients were re-evaluated 1 week after surgery using the same scale. The data collected were analyzed to assess statistical significance. Results : We observed no statistical difference in cognitive behavior in either group pre-operatively, which were comparable with respect to age, sex and type of surgery. Grossly, a significant difference was seen between the two groups with respect to the perioperative changes in verbal fluency for categories and MMSE scores. However, these differences were not significant after the application of the Bonferroni correction for multiple analyses, except the significant differences observed only in the MMSE scores. Conclusions : We observed a difference in cognitive outcome with GA compared with EA. Certain aspects of the cognition were affected to a greater extent in this group of patients undergoing hip and knee surgery.

  8. Prevention and treatment of postoperative complications after surgery for craniopharyngioma%颅咽管瘤术后并发症的防治

    Institute of Scientific and Technical Information of China (English)

    高树梓; 韩光魁; 周忠清; 石祥恩

    2013-01-01

    目的 探讨颅咽管瘤切除术后并发症的特点和处理原则.方法 回顾性分析82例颅咽管瘤病人的临床资料,均经手术治疗,术后监测水、电解质和血糖变化,并记录24 h尿量.结果 肿瘤全切除75例,次全切除7例.颅咽管瘤术后并发症较多,其中尿崩症78例,钠代谢紊乱74例,垂体功能低下67例,高热17例,精神障碍11例,意识障碍4例,深静脉血栓4例,癫(癎)3例.随访17~36个月,平均28个月,恢复正常生活和学习68例,仅能生活自理8例,不能生活自理4例,死亡2例.结论 颅咽管瘤术后并发症较多,早期监测和及时处理可进一步提高该病的治愈率.%Objective To explore the characteristics and treatment principles for surgical complications of craniopharyngiomas. Methods Clinical data of 82 patients with craniopharyngiomas undergoing surgery were analyzed retrospectively. The changes of water, electrolyte and blood glucose were detected, and the urinary volume in 24 h was recorded. Results Total tumor resection was achieved in 75 patients and subtotal resection in 7. There were many postoperative complications of craniopharyngioma, including diabetes insipidus in 78 patients, metabolic disturbance of sodium in 74, hypopituitarism in 67, hyperpyrexia in 17, mental disorder in 11, consciousness disturbance in 4, deep vein thrombosis in 4 and epilepsy in 3. All the patients were followed up for mean period of 28 month, ranged from 17 to 36 months. Normal life and learning was found in 68 patients, self-care ability in 8, no self-care ability in 4 and death in 2. Conclusion Postoperative complications of craniopharyngioma are common, and early monitoring and timely treatment can increase the cure rate.

  9. Effect of early nutrition support on postoperative rehabilitation in patients with oral cancer

    Institute of Scientific and Technical Information of China (English)

    Xing-An Zhang; Xiao-Yao Tan; Lan-Fang Zhang; Hua-Dong Wang; Xin-Sheng Han; Hua-Wei Ming

    2016-01-01

    Objective:To explore the effect of early nutrition support on the postoperative nutrition metabolism and rehabilitation in patients with oral cancer.Methods:A total of 80 patients with oral cancer who were admitted in our hospital from January, 2013 to January, 2015 were included in the study, and divided into the observation group (early nutrition support) and control group (routine treatments) with 40 cases in each group. The postoperative basic nutrition requirement amount in the observation group was calculated according to Harris-Nenedict formula. The appropriate pharmaceutics and nutritional pathway were selected. The patients in the control group were given routine diets after operation. The levels of ALB, PAB, TRF, TCL, IgM, IgG, and IgA before and after operation in the two groups were compared. The body mass and wound healing in the two groups were recorded and compared.Results:The body mass and serum TRF level after operation in the observation group were slightly reduced, but were not significantly different from those before operation (P>0.05). The serum ALB, PAB, and TLC levels after operation in the observation group were significantly reduced when compared with before operation (P0.05), but the above indicators were significantly elevated after operation (P<0.05). The peripheral blood IgM, IgG, and IgA levels 1 week after operation in the observation group were significantly higher than those in the control group (P<0.05). The stage I healing rate of the surgical wound in the observation group was significantly higher than that in the control group (P<0.05). Conclusions: The early nutrition support can effectively enhance the postoperative nutrition status and immunological function in patients with oral cancer, and is beneficial for the postoperative rehabilitation.

  10. Affect of surgical approaches on functional results of total hip arthroplasty in early postoperative period

    Directory of Open Access Journals (Sweden)

    D. V. Andreyev

    2013-01-01

    Full Text Available Minimally invasive approaches implies a less soft tissue damage and, therefore, more rapid recovery of the patient in the early postoperative period. The present study is a comparison of minimally invasive and standard approaches using biomechanical analysis of standing and walking patients before and after total hip arthroplasty, as well as an analysis of clinical outcomes in the early postoperative period. Fifty patients undergoing primary total hip arthroplasty using a minimally invasive and conventional techniques were divided into three groups. The first group consisted of patients operated on using the MIS AL (modified minimally invasive approach Watson-Jones (n = 17, the second - MDM (minimally invasive approach to the modified Mueller (n = 16 and in the third - with the use of transgluteal conventional approach by Harding (n = 17. The estimation of biomechanical parameters in static and dynamic patients before surgery and at 8-10 days after surgery. Also assessed clinical outcome postoperative visual analogue scale (VAS and Harris scale on day 10, 6 and 12 weeks and 1 year. When comparing the three groups of patients stabilometry best results were observed in groups of minimally invasive approaches MIS AL and MDM. When comparing the three groups significantly better (a moderate increase in the duration of the step, rolling the contralateral limb and a slight increase in the duration of the step the operated limb by increasing the duration of the roll-over were identified in the minimally invasive group MIS AL and MDM. In assessing the scale of Harris in the early postoperative period, higher rates were observed in groups of minimally invasive approaches. A year after the operation functional results become similar in all groups.

  11. Preoperative factors and early complications associated with hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures.

    Science.gov (United States)

    Miller, Christopher P; Buerba, Rafael A; Leslie, Michael P

    2014-06-01

    Displaced femoral neck fractures are common injuries in the elderly individuals. There is controversy about the best treatment with regard to total hip arthroplasty (THA) versus hemiarthroplasty. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to evaluate the preoperative risk factors associated with the decision to perform THA over hemiarthroplasty. We also evaluate the risk factors associated with postoperative complications after each procedure. Patients older than 50 years undergoing hemiarthroplasty or THA after fracture in the NSQIP database from 2007 to 2010 were compared to each other in terms of preoperative medical conditions, postoperative complications, and length of stay. Multivariate logistic regression models were used to adjust for preoperative risk factors for undergoing a THA versus a hemiarthroplasty and for complications after each procedure. In all, 783 patients underwent hemiarthroplasty and 419 underwent THA for fracture. Hemiarthroplasty patients had longer hospital stays. On multivariate logistic regression, the only significant predictor for having a THA after fracture over hemiarthroplasty was being aged 50 to 64 years. The patient characteristics/comorbidities that favored having a hemiarthroplasty were age >80 years, hemiplegia, being underweight, having a dependent functional status, being on dialysis, and having an early surgery. High body mass index, American Society of Anesthesiologists (ASA) class, gender, and other comorbidities were not predictors of having one procedure over another. Disseminated cancer and diabetes were predictive of complications after THA while being overweight, obese I, or a smoker were protective. High ASA class and do-not-resuscitate status were significant predictors of complications after a hemiarthroplasty. This study identified clinical factors influencing surgeons toward performing either THA or hemiarthroplasty for elderly patients

  12. Laparoscopic sleeve gastrectomy without over-sewing the staple line: A case series demonstrating efficacy and minimization of both intra- and post-operative complications

    Directory of Open Access Journals (Sweden)

    Dr. S. Moradian, DO

    2017-01-01

    Conclusion: Our technique, to our knowledge, is the first to describe laparoscopic sleeve gastrectomy without over-sewing the staple line, no post-operative anticoagulation, no UGI series on POD#1, and discharge home on POD#1 with no major complications.

  13. Postoperative spine; Postoperative Wirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Schlaeger, R. [Universitaetsspital Basel, Neurologische Klinik und Poliklinik, Basel (Switzerland); Lieb, J.M. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Shariat, K. [Neurochirurgie Koeln-Merheim, Koeln (Germany); Ahlhelm, F.J. [Kantonsspital Baden AG, Abteilung Neuroradiologie, Institut fuer Radiologie, Baden (Switzerland)

    2014-11-15

    Approximately 15-30 % of surgical procedures involving the lumbar spine are associated with complications that require further diagnostic work-up. The choice of imaging modality for postoperative complications depends on the extent, pattern and temporal evolution of the postoperative neurological signs and symptoms as well as on the preoperative clinical status, the surgical procedure itself and the underlying pathology. The interpretation of imaging findings, in particular the distinction between postoperative complications and normally expected nonspecific postoperative imaging alterations can be challenging and requires the integration of clinical neurological information and the results of laboratory tests. The combination of different imaging techniques might help in cases of equivocal imaging results. (orig.) [German] Etwa 15-30 % der operativen Eingriffe im Bereich der lumbalen Wirbelsaeule verlaufen nicht komplikationsfrei und erfordern weiterfuehrende Abklaerungen. Die Auswahl des bildgebenden Verfahrens im Rahmen postoperativer Komplikationen haengt dabei wesentlich von der zeitlichen Entwicklung, dem Ausmass und Verteilungsmuster der neuaufgetretenen klinisch-neurologischen bzw. orthopaedischen Symptome sowie von den Ausfaellen vor dem Eingriff, der zugrundeliegenden Pathologie und der Lokalisation und Art des Eingriffs ab. Die Interpretation der bildgebenden Befunde, insbesondere die Abgrenzung postoperativer Komplikationen von natuerlicherweise zu erwartenden postoperativen Veraenderungen kann dabei eine Herausforderung darstellen. Bei unklaren Befunden kann ergaenzend zur eingehend klinisch-neurologischen und laborchemischen Bestandsaufnahme auch der kombinierte Einsatz mehrerer bildgebender Modalitaeten diagnostisch weiterhelfen. (orig.)

  14. Glucose balance and muscle glycogen during TPN in the early post-operative phase

    DEFF Research Database (Denmark)

    Henneberg, S; Stjernström, H; Essén-Gustavsson, B

    1985-01-01

    In order to study how muscle glycogen is influenced by different nutritional regimens in the early post-operative period we took muscle biopsies from 20 patients preoperatively and on the fourth post-operative day after abdominal aortic surgery. Ten patients received 93% of non-protein energy......-production) were performed and from these data glucose balance was calculated as the difference between glucose intake and glucose expenditure. Muscle biopsies were analysed for glycogen, adenosine triphosphate, glucose-6-phosphate, lactate and citrate. We found that it was possible to maintain muscle...... glycogen stores at pre-operative levels with a glucose-insulin regimen. With the fat regimen there was a 31% decrease in muscle glycogen and two patients had a negative glucose balance despite the fact that 150 g of glucose were given. Average glucose balance throughout the study correlated positively...

  15. Endothelial dysfunction in the early postoperative period after major colon cancer surgery

    DEFF Research Database (Denmark)

    Ekeløf, Sara; Larsen, Mikkel Hjordt; Schou-Pedersen, Anne Marie Voigt

    2017-01-01

    Background. Evidence suggests that endothelial dysfunction in the early postoperative period promotes myocardial injury after non-cardiac surgery. The aim of this study was to investigate the impact of colon cancer surgery on endothelial function and the association with the l-arginine-nitric oxide...... pathway postoperatively. Methods. Patients undergoing elective colon cancer surgery (n = 31) were included in this prospective observational cohort study. Endothelial function, as measured using the reactive hyperaemia index (RHI), was assessed non-invasively using digital pulse tonometry. RHI and plasma...... was attenuated in the first days after colon cancer surgery indicating acute endothelial dysfunction. Endothelial dysfunction correlated with disturbances in the L-arginine – nitric oxide pathway. Our findings provide a rationale for investigating the hypothesized association between acute endothelial...

  16. Glucose balance and muscle glycogen during TPN in the early post-operative phase

    DEFF Research Database (Denmark)

    Henneberg, S; Stjernström, H; Essén-Gustavsson, B;

    1985-01-01

    In order to study how muscle glycogen is influenced by different nutritional regimens in the early post-operative period we took muscle biopsies from 20 patients preoperatively and on the fourth post-operative day after abdominal aortic surgery. Ten patients received 93% of non-protein energy...... as glucose, 7% as fat (Intralipid) and insulin was given to keep the blood glucose below 10 mmol/l. The remaining patients had 80% of non-protein energy as fat (Intralipid). Amino acids constituting 12 g of nitrogen daily were given to both groups. Daily measurements of gas exchange (oxygen uptake, CO2...... glycogen stores at pre-operative levels with a glucose-insulin regimen. With the fat regimen there was a 31% decrease in muscle glycogen and two patients had a negative glucose balance despite the fact that 150 g of glucose were given. Average glucose balance throughout the study correlated positively...

  17. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort.

    Science.gov (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-03-01

    Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm²/m² for women and 40.8 cm²/m² for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I.

  18. Neurostimulation for Parkinson's disease with early motor complications

    NARCIS (Netherlands)

    Schuepbach, W.M.; Rau, J.; Knudsen, K.; Volkmann, J.; Krack, P.; Timmermann, L.; Halbig, T.D.; Hesekamp, H.; Navarro, S.M.; Meier, N.; Falk, D.; Mehdorn, M.; Paschen, S.; Maarouf, M.; Barbe, M.T.; Fink, G.R.; Kupsch, A.; Gruber, D.; Schneider, G.H.; Seigneuret, E.; Kistner, A.; Chaynes, P.; Ory-Magne, F.; Brefel Courbon, C.; Vesper, J.; Schnitzler, A.; Wojtecki, L.; Houeto, J.L.; Bataille, B.; Maltete, D.; Damier, P.; Raoul, S.; Sixel-Doering, F.; Hellwig, D.; Gharabaghi, A.; Kruger, R.; Pinsker, M.O.; Amtage, F.; Regis, J.M.; Witjas, T.; Thobois, S.; Mertens, P.; Kloss, M.; Hartmann, A.; Oertel, W.H.; Post, B.; Speelman, H.; Agid, Y.; Schade-Brittinger, C.; Deuschl, G.

    2013-01-01

    BACKGROUND: Subthalamic stimulation reduces motor disability and improves quality of life in patients with advanced Parkinson's disease who have severe levodopa-induced motor complications. We hypothesized that neurostimulation would be beneficial at an earlier stage of Parkinson's disease. METHODS:

  19. Postoperative Delirium

    Science.gov (United States)

    Marcantonio, Edward R.

    2013-01-01

    Delirium (acute confusion) complicates 15% to 50% of major operations in older adults and is associated with other major postoperative complications, prolonged length of stay, poor functional recovery, institutionalization, dementia, and death. Importantly, delirium may be predictable and preventable through proactive intervention. Yet clinicians fail to recognize and address postoperative delirium in up to 80% of cases. Using the case of Ms R, a 76-year-old woman who developed delirium first after colectomy with complications and again after routine surgery, the diagnosis, prevention, and treatment of delirium in the postoperative setting is reviewed. The risk of postoperative delirium can be quantified by the sum of predisposing and precipitating factors. Successful strategies for prevention and treatment of delirium include proactive multifactorial intervention targeted to reversible risk factors, limiting use of sedating medications (especially benzodiazepines), effective management of postoperative pain, and, perhaps, judicious use of antipsychotics. PMID:22669559

  20. Multivariate logistic regression analysis of postoperative complications and risk model establishment of gastrectomy for gastric cancer: A single-center cohort report.

    Science.gov (United States)

    Zhou, Jinzhe; Zhou, Yanbing; Cao, Shougen; Li, Shikuan; Wang, Hao; Niu, Zhaojian; Chen, Dong; Wang, Dongsheng; Lv, Liang; Zhang, Jian; Li, Yu; Jiao, Xuelong; Tan, Xiaojie; Zhang, Jianli; Wang, Haibo; Zhang, Bingyuan; Lu, Yun; Sun, Zhenqing

    2016-01-01

    Reporting of surgical complications is common, but few provide information about the severity and estimate risk factors of complications. If have, but lack of specificity. We retrospectively analyzed data on 2795 gastric cancer patients underwent surgical procedure at the Affiliated Hospital of Qingdao University between June 2007 and June 2012, established multivariate logistic regression model to predictive risk factors related to the postoperative complications according to the Clavien-Dindo classification system. Twenty-four out of 86 variables were identified statistically significant in univariate logistic regression analysis, 11 significant variables entered multivariate analysis were employed to produce the risk model. Liver cirrhosis, diabetes mellitus, Child classification, invasion of neighboring organs, combined resection, introperative transfusion, Billroth II anastomosis of reconstruction, malnutrition, surgical volume of surgeons, operating time and age were independent risk factors for postoperative complications after gastrectomy. Based on logistic regression equation, p=Exp∑BiXi / (1+Exp∑BiXi), multivariate logistic regression predictive model that calculated the risk of postoperative morbidity was developed, p = 1/(1 + e((4.810-1.287X1-0.504X2-0.500X3-0.474X4-0.405X5-0.318X6-0.316X7-0.305X8-0.278X9-0.255X10-0.138X11))). The accuracy, sensitivity and specificity of the model to predict the postoperative complications were 86.7%, 76.2% and 88.6%, respectively. This risk model based on Clavien-Dindo grading severity of complications system and logistic regression analysis can predict severe morbidity specific to an individual patient's risk factors, estimate patients' risks and benefits of gastric surgery as an accurate decision-making tool and may serve as a template for the development of risk models for other surgical groups.

  1. [Postoperative hypothyroidism].

    Science.gov (United States)

    Olifirova, O S; Trynov, N N

    2015-01-01

    There is a number of factors such as the thyroidectomy and limiting subtotal thyroid resection against the background of euthyroidism and initial hypothyroidism (in any extent of operation) which leads to the prediction of early postoperative hypothyroidism origin during 10 days of the postoperative peri- od. The early postoperative hypothyroidism is accompanied by activation processes of lipid peroxide oxidation and at the same time by reduction of antioxidant protection.

  2. CLINICAL EFFECTIVENESS OF OSMOTIC LAXATIVE DRUGS IN EARLY POSTOPERATIVE PERIOD IN CHILDREN WITH CHRONIC COLON STASIS

    Directory of Open Access Journals (Sweden)

    P.V. Ivanov

    2010-01-01

    Full Text Available The clinical effectiveness of osmotic laxative drugs based on lactulose in restoration of gastrointestinal tract function in early postoperative period after transanal interventions and laparoscopic operations in 53 children 2–17 years old was studied. All patients had non-functional (cologenic and proctogenic constipation. Patients underwent full-thickness laparoscopic or transanal biopsy due to suspicion of gastrointestinal malformation presence. Children from base group (n = 28 used lactulose (Duphalac from the second day of postoperative period (dose complied with the age once daily, in the morning. The control group (n = 25 received subcutaneous or intramuscular proserinum for the stimulation of peristalsis. Blood tests with serum potassium control were performed on 2nd and 4th day. The study showed clinical effectiveness of lactulose in treatment of postoperational hypotonic constipation in children with colon malformations. Key words: children, gastrointestinal malformations, postoperative period, chronic constipation, lactulose.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(1:122-125

  3. Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort

    Directory of Open Access Journals (Sweden)

    Daniel Chiung-Jui Su

    2015-01-01

    Full Text Available Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan’s National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab and delayed rehabilitation (Delayed Rehab. Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p<0.001 higher medical and rehabilitation expenses and more outpatient department (OPD visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR: 3.152; 95% confidence interval (CI: 1.211–8.203; p<0.05 than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA.

  4. Postural control in patients with lumbar disc herniation in the early postoperative period.

    Science.gov (United States)

    Sipko, Tomasz; Chantsoulis, Marzena; Kuczyński, Michał

    2010-03-01

    Chronic spinal disc disease leads to disorders in postural movement coordination. An incorrect asymmetrical movement pattern for the lower limbs loading impairs proprioception and deteriorates postural stability, particularly when the vision is occluded. The standard surgical treatment improves biomechanical conditions in the lumbar spine, reduces pain, yet does it reduce the stability deficit in the upright position? An answer to the latter question would help work out targeted therapy to improve postural stability. We hypothesized that the standard surgical treatment would improve postural stability reflected by decreased sway variability accounting for better use of proprioceptive inputs postoperatively. Thirty-nine patients with lumbar disc herniation participated in the study. Their postural sway was recorded in anterior/posterior and medial/lateral planes with their eyes open or closed (EC) before and after surgery. The variability, range, mean velocity of the recorded time series and the area of the ellipse enclosed by the statokinesiogram were used as measures of postural stability. Preoperatively, EC condition resulted in an increased variability and mean velocity of postural sway, while postoperatively it caused an increase in sway mean velocity and sway area only with no effect on sway variability and range. The comparison of the balance before and after the surgery in the EC condition showed significant decrease in all parameters. In the early postoperative period, the patients recover the ability to control their postural sway in EC within normal limits, however, at the expense of significantly increased frequency of corrective torques. It is probably a transient short-term strategy needed to compensate for the recovery phase when the normal weighting factors for all afferents are being reestablished. We propose that this transient postoperative period may be the best timing of therapeutic intervention targeted at facilitating and reinforcing the

  5. Profile of preoperative fecal organic acids closely predicts the incidence of postoperative infectious complications after major hepatectomy with extrahepatic bile duct resection: Importance of fecal acetic acid plus butyric acid minus lactic acid gap.

    Science.gov (United States)

    Yokoyama, Yukihiro; Mizuno, Takashi; Sugawara, Gen; Asahara, Takashi; Nomoto, Koji; Igami, Tsuyoshi; Ebata, Tomoki; Nagino, Masato

    2017-10-01

    To investigate the association between preoperative fecal organic acid concentrations and the incidence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection for biliary malignancies. The fecal samples of 44 patients were collected before undergoing hepatectomy with bile duct resection for biliary malignancies. The concentrations of fecal organic acids, including acetic acid, butyric acid, and lactic acid, and representative fecal bacteria were measured. The perioperative clinical characteristics and the concentrations of fecal organic acids were compared between patients with and without postoperative infectious complications. Among 44 patients, 13 (30%) developed postoperative infectious complications. Patient age and intraoperative bleeding were significantly greater in patients with postoperative infectious complications compared with those without postoperative infectious complications. The concentrations of fecal acetic acid and butyric acid were significantly less, whereas the concentration of fecal lactic acid tended to be greater in the patients with postoperative infectious complications. The calculated gap between the concentrations of fecal acetic acid plus butyric acid minus lactic acid gap was less in the patients with postoperative infectious complications (median 43.5 vs 76.1 μmol/g of feces, P = .011). Multivariate analysis revealed that an acetic acid plus butyric acid minus lactic acid gap acid profile (especially low acetic acid, low butyric acid, and high lactic acid) had a clinically important impact on the incidence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection. Copyright © 2017. Published by Elsevier Inc.

  6. Effects of three-dimensional navigation on intraoperative management and early postoperative outcome after open reduction and internal fixation of displaced acetabular fractures

    DEFF Research Database (Denmark)

    Oberst, Michael; Hauschild, Oliver; Konstantinidis, Lukas;

    2012-01-01

    BACKGROUND: This study was conducted to evaluate whether intraoperative procedure and/or early postoperative results after open reduction and internal fixation (ORIF) of displaced acetabulum fractures are influenced by the use of a three-dimensional (3D) image intensifier in combination with a na....... In addition, the complication rate in the navigated group was significantly lower. CONCLUSION: We support the use of navigation systems and a 3D image intensifier as helpful tools during ORIF of displaced acetabular fractures. LEVEL OF EVIDENCE: Therapeutic study, level III....... acetabular fractures led to a significant increase in skin-to-skin time. Postoperative radiolographic analysis revealed an improvement in the quality of fracture reduction in the 3D navigation group. Navigation in combination with the 3D images of the ISO-C 3D limited the need for extended approaches...

  7. [The early postoperative rehabilitation of the patients presenting with cholelithiasis and experiencing psychoemotional stress].

    Science.gov (United States)

    Poddubnaia, O A; Marsheva, S I

    2013-01-01

    Early postoperative rehabilitation of the patients presenting with cholelithiasis and experiencing psychoemotional stress is designed to restore the function of bile secretion, enhance their adaptive capabilities, and normalize the psychovegetative status for the purpose of preventing further progress of the disease and reducing the risk of the development of post-cholecystectomy syndrome. The inclusion of drinking mineral water, magnetic laser therapy, and UHF therapy in the combined rehabilitative treatment of such patients results in the appreciable enhancement of all functional abilities of the body manifest as the significant improvement and normalization of clinical and laboratory characteristics (elimination of clinical symptoms of the disease, improvement of general and biochemycal parameters of peripheral blood). Simultaneously, the adaptive capabilities and the psychovegetative status of the patients improved as apparent from the increased lymphocyte count, normalization of the Kerdo and Hildebrandt indices and indices of stress level, decreased psychoemotional stress, enhancement of physical functioning characteristics. Taken together, these changes account for the high effectiveness of the above procedures of early postoperative rehabilitation of the patients presenting with cholelithiasisand experiencing psychoemotional stress (94.7%).

  8. Evaluation of Coronary Artery Bypass Grafts in the Early Postoperative Period Using 64-Slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Yu Mi; Kim, Jeong Ho; Park, Chul Hyun; Park, Kook Yang; Byun, Sung Su; Hwang, Hee Young; Park, Chul Hi; Kim, Hyung Sik [Gachon University Hospital, Incheon (Korea, Republic of)

    2009-05-15

    The aim of this study was to evaluate the accuracy of 64-slice multidetector row CT (MDCT), as compared with conventional coronary angiography (CCA), for assessing coronary artery bypass grafts (CABG) in the early (< 1 month) postoperative period. Twenty-four patients underwent both 64-slice MDCT (0.6 mm collimation, 0.37s gantry rotation) and CCA within 15 days after CABG. Sixty-five bypass grafts (20 venous grafts and 45 arterial grafts) and 67 distal runoff arteries in 24 patients were included in the analysis. The bypass grafts and distal runoffs were evaluated for the presence of significant stenosis, including obstruction. The CT findings were compared with the CCA findings. CCA confirmed that 62 of the 65 grafts were patent and that 3 had significant stenosis or obstruction. Sixty of the 62 patent grafts were correctly identified by MDCT. One of the three grafts that had significant stenosis was misinterpreted on the MDCT images. The sensitivity, specificity and positive and negative predictive values for detecting stenosis were 67%, 97%, 50% and 98%, respectively, with an overall diagnostic accuracy of 95%. MDCT also correctly detected all the stenotic distal runoff arteries (4 of 67). 64-slice MDCT is a promising alternative diagnostic modality for evaluating a CABG in the early postoperative period.

  9. Maternal complications in pregnancy and wheezing in early childhood

    DEFF Research Database (Denmark)

    Zugna, Daniela; Galassi, Claudia; Annesi-Maesano, Isabella

    2015-01-01

    complications and wheezing symptoms in the offspring. Exposures of interest included hypertension and preeclampsia, diabetes, as well as pre-pregnancy overweight (body mass index between 25 and 29.9) and obesity (body mass index ≥ 30) compared with normal weight (body mass index between 18.5 and 24.9). Outcomes...... wheezing (P=0.027). CONCLUSIONS: Preeclampsia, maternal pre-pregnancy overweight and obesity are associated with an increase risk of wheezing in the offspring.......BACKGROUND: Evidence on the effect of maternal complications in pregnancy on wheezing in offspring is still insufficient. METHODS: A pooled analysis was performed on individual participant data from fourteen European birth cohorts to assess the relationship between several maternal pregnancy...

  10. Early and Late Neurological Complications after Cardiac Transplantation

    Directory of Open Access Journals (Sweden)

    Mehmet Balkanay

    2011-08-01

    Full Text Available The clinical use of cyclosporine as an immunosuppressant improved the recipient’s life span and revolutionized the field of cardiac transplantation. But most of the immunesuppressant drugs including cyclosporine may cause neurological and many other side effects. In this article we present three cases, from 58 patients, undergoing cardiac transplantation at our hospital from 1989 to 2008 in whom developed transient neurological complications.

  11. Early post-operative relief of pain and shivering using diclofenac suppository versus intravenous pethidine in spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Ali Janpour Ebrahim

    2014-01-01

    Full Text Available Background: Pain and shivering are two challenging components in the post operative period. Many drugs were used for prevention and treatment of them. The aim of this study was to compare the effects of prophylactic prescription of diclofenac suppository versus intravenous (IV pethidine in spinal anesthesia. Materials and Methods: We conducted a multi central, prospective, double-blind, randomized clinical trial on a total of 180 patients who were scheduled for surgery under spinal anesthesia including 60 patients in three groups. Patients were randomly allocated to receive 100 mg sodium diclofenac suppository or 30 mg IV pethidine or placebo. Categorical and continuous variables were analyzed by Chi-square test, t-test, Mann-Whitney and ANOVA or Kruskal-Wallis tests. Results: There was no statistical difference with regard to patient characteristics and hemodynamic indices among the three groups. Nine (15%, 10 (16.65% and 24 (40% of patients in diclofenac, pethidine and control groups reported pain and 2, 2, 7 patients received treatment due to it, respectively (P = 0.01. Prevalence of shivering in pethidine group and diclofenac group was the same and both of them were different from the control group (P < 0.001. Pruritus was repetitive in the pethidine group and was statistically significant (P = 0.036 but, post-operative nausea and vomiting was not significantly different among groups. Conclusion: A single dose of sodium diclofenac suppository can provide satisfactory analgesia immediately after surgery and decrease shivering without remarkable complications. This investigation highlights the role of pre-operative administration of a single dose of rectal diclofenac as a sole analgesic for early post-operative period.

  12. Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review.

    Science.gov (United States)

    Jilesen, Anneke P J; van Eijck, Casper H J; in't Hof, K H; van Dieren, S; Gouma, Dirk J; van Dijkum, Els J M Nieveen

    2016-03-01

    Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75%. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45%; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58%. Delayed gastric emptying rates were, respectively, 5-5-18-16%. Postoperative hemorrhage rates were, respectively, 6-1-7-4%. In-hospital mortality rates were, respectively, 3-4-6-4%. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93%. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80%. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival.

  13. Does Fibrin Glue Sealant Used During Pancreaticoduodenectomy Reduce Post-Operative Complication? Audit of 100 Consecutive Patients Undergoing Whipple's Procedure by a Single Surgeon

    Directory of Open Access Journals (Sweden)

    Shafiq Rehman

    2016-03-01

    Full Text Available Introduction This study evaluated the effect of fibrin glue applied as a sandwich film between a two layer pancreatico-jejunostomy anastomosis following pancreaticoduodenectomy. Primary end-points were post-operative pancreatic fistulae, overall complication rates and post-operative length of stay. Methods Pancreaticoduodenectomy was performed by fashioning a two layer pancreatico-jejunostomy with or without a glue sealant which when applied, formed a thin film external to the ductal anastomosis but internal to the seromuscularpancreatic parenchymal layer. Results Following audit of 100 consecutive patients undergoing pancreaticoduodenectomy, patients were separated into two groups; those with glue augmented anastomosis [Glue (G N=50] or those without [No Glue (NG, N=50]. Each group was matched with regard to age [median, G=68 years vs. NG=66 years, (P=0.19] and sex (P=0.84. There were no statistically significant differences between the two groups with respect to overall POPF [G N=7(14% vs. NG N=11(22%, (P=0.42], significant complications (Clavien Grade 3 or more, [G N=4(8% vs. NG N=2(4% (P=0.40], or post-operative length of stay [G 13 days vs. NG 14 days, (P=0.90]. In those patients with the highest fistulae risk score, there were significantly more post-operative pancreatic fistulae in the no glue cohort. There was no mortality in either group. Conclusion This study shows that application of sealant glue significantly reduces post-operative pancreatic fistulae in high-risk patients, but does not reduce overall complications or hospital stay following pancreaticoduodenectomy.

  14. The effect of preoperative renal dysfunction with or without dialysis on early postoperative outcome following cardiac surgery.

    LENUS (Irish Health Repository)

    Al-Sarraf, Nael

    2011-01-01

    Although previous studies have shown increased mortality in renal dysfunction patients undergoing cardiac surgery, there is lack of data on the pattern of postoperative complications that occur in such patients and their distribution among dialysis and non-dialysis dependent renal dysfunction.

  15. Early post-operative pulmonary function tests after mitral valve replacement: Minimally invasive versus conventional approach. Which is better?

    Directory of Open Access Journals (Sweden)

    Magdy Gomaa

    2016-12-01

    Conclusion: Minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. There was a highly significant difference denoting better post operative pulmonary function of the minimally invasive approach.

  16. Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies

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    Mikito Inokuchi

    2016-01-01

    Full Text Available Background. Some meta-analyses of case-controlled studies (CCSs have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG had some short-term advantages over open total gastrectomy (OTG. However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. Methods. CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients’ status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. Result. This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG (n = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29–0.85, P=0.01, I2 = 0%, and OR 0.46, 95% CI 0.17–0.52, P<0.0001, I2 = 0%. However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG (n = 2,560; OR 1.44, 95% CI 0.96–2.16, P=0.08, I2 = 0%. Conclusion. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.

  17. Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery

    DEFF Research Database (Denmark)

    Hasselager, Rune; Gögenur, Ismail

    2014-01-01

    to systematically review the literature where core muscle size measurements have been used for risk assessment of patients undergoing major abdominal surgery. METHODS: PubMed and EMBASE databases were searched for studies that investigated core muscle size measured with abdominal CT scans and outcomes after major...... abdominal surgery. RESULTS: Eight studies were found. Four studies investigated postoperative complications related to core muscle area. Three of these studies found significantly increased risk of complications related to low core muscle area. Three studies investigated length of hospitalization, and two......PURPOSE: Risk stratification of patients prior to surgery is important for reduction of postoperative morbidity and mortality. The frailty concept has been put forward as a good predictor of surgical outcomes. Sarcopenia (depletion of muscle mass) can be used to measure frailty. We aimed...

  18. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group

    DEFF Research Database (Denmark)

    Mynster, T; Christensen, Ib Jarle; Moesgaard, F

    2000-01-01

    BACKGROUND: The frequency of postoperative infectious complications is significantly increased in patients with colorectal cancer receiving perioperative blood transfusion. It is still debated, however, whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise...... affects the prognosis. METHODS: Patient risk variables, variables related to operation technique, blood transfusion and the development of infectious complications were recorded prospectively in 740 patients undergoing elective resection for primary colorectal cancer. Endpoints were overall survival (n.......13-2.82)), localization of cancer in the rectum and Dukes classification were independent risk factors. CONCLUSION: Blood transfusion per se may not be a risk factor for poor prognosis after colorectal cancer surgery. However, the combination of perioperative blood transfusion and subsequent development of postoperative...

  19. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group

    DEFF Research Database (Denmark)

    Mynster, T; Christensen, Ib Jarle; Moesgaard, F;

    2000-01-01

    = 740) and time to diagnosis of recurrent disease in the subgroup of patients operated on with curative intention (n = 532). The patients were analysed in four groups divided with respect to administration or not of perioperative blood transfusion and development or non-development of postoperative......BACKGROUND: The frequency of postoperative infectious complications is significantly increased in patients with colorectal cancer receiving perioperative blood transfusion. It is still debated, however, whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise...... affects the prognosis. METHODS: Patient risk variables, variables related to operation technique, blood transfusion and the development of infectious complications were recorded prospectively in 740 patients undergoing elective resection for primary colorectal cancer. Endpoints were overall survival (n...

  20. The effect of ranitidine on postoperative infectious complications following emergency colorectal surgery: a randomized, placebo-controlled, double-blind trial

    DEFF Research Database (Denmark)

    Moesgaard, F; Jensen, L S; Christiansen, P M

    1998-01-01

    OBJECTIVE AND DESIGN: To study the potential effect of ranitidine on postoperative infectious complications following emergency colorectal surgery. A randomized, placebo-controlled, double-blind trial was carried out in three university clinics and two county hospitals in Denmark. PATIENTS...... patients were withdrawn from the study (for reasons such as other diagnosis, refused to continue, medication not given as prescribed). MAIN OUTCOME MEASURES: Patients were observed for signs of infectious complications; such as wound infection, intra-abdominal abscess, septicemia, and pneumonia. RESULTS...... pneumonia were 12.9%, 5.2%, 3.8% and 14%, respectively in group I. In group II, the infectious complications were 16.1%, 6.8%, 6.9% and 22%, respectively. Twelve patients (13.8%) in the placebo group developed more than one complication...

  1. Involvement of Residents Does Not Increase Postoperative Complications After Open Reduction Internal Fixation of Ankle Fractures: An Analysis of 3251 Cases.

    Science.gov (United States)

    Louie, Philip K; Schairer, William W; Haughom, Bryan D; Bell, Joshua A; Campbell, Kevin J; Levine, Brett R

    Ankle fractures are common injuries frequently treated by foot and ankle surgeons. Therefore, it has become a core competency for orthopedic residency training. Surgical educators must balance the task of training residents with optimizing patient outcomes and minimizing morbidity and mortality. The present study aimed to determine the effect of resident involvement on the 30-day postoperative complication rates after open reduction and internal fixation of ankle fractures. A second objective of the present study was to determine the independent risk factors for complications after this procedure. We identified patients in the American College of Surgeons National Surgical Quality Improvement Program database who had undergone open reduction internal fixation for ankle fractures from 2005 to 2012. Propensity score matching was used to help account for a potential selection bias. We performed univariate and multivariate analyses to identify the independent risk factors associated with short-term postoperative complications. A total of 3251 open reduction internal fixation procedures for ankle fractures were identified, of which 959 (29.4%) had resident involvement. Univariate (2.82% versus 4.54%; p = .024) and multivariate (odds ratio 0.71; p = .75) analyses demonstrated that resident involvement did not increase short-term complication rates. The independent risk factors for complications after open reduction internal fixation of ankle fractures included insulin-dependent diabetes, increasing age, higher American Society of Anesthesiologists score, and longer operative times. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. The role of the neurophysiological intraoperative monitoring to prevention of postoperative neurological complication in the surgical treatment of scoliosis

    Directory of Open Access Journals (Sweden)

    M. A. Khit

    2014-01-01

    Full Text Available Bearing in mind that the technique of surgical treatment of scoliosis and skills are high enough, iatrogenic spinal cord injury is still one of the most feared complication of scoliosis surgery. It is well known that the function of the spinal cord may be estimated by combining somatosensory evoked potentials (SSEP and motor evoked potentials (MEP. We have retrospectively evaluated the results of intraoperative neurophysiological monitoring (IOM in a large population of patients underwent surgical treatment of spinal deformity. Intraoperative neuromonitoring SSEP and transcranial electrostimulation (TES – MEP in conjunction with the assessment of the correct position of the screws was performed in 142 consecutive cases, i. e. all patients who had undergone surgical treatment of idiopathic (127 pts, congenital (10 pts or neurogenic (5 pts scoliosis. A neurophysiological “alarm” was defined as a decrease in amplitude (uni- or bilateral of at least 50 % for SEPs and of 70 % for TES-MEP compared with baseline. Total intravenous anesthesia (TIVA in 138 cases was achieved by infusion of propofol (8–16 mg / kg / h and in 4 cases by halogenate anesthesia – sevoflurane (0.4–1.8 MAC. Seven patients (4.9 % were reported intraoperative neurophysiological parameters significant changes that require action by the surgeons and anesthetists, with deterioration of ostoperative neurologic status in one case. Of these three cases, the amplitude drop SSEPs and TESMEPs-was due, to the pharmacological aspects of anesthetic management, in the other four cases – with surgical procedures (response halo-traction – 1 case, mechanical damage of sheath of the spinal cord by pliers Kerrison – 1case, overcorrection – 2 cases. In five cases (3.5 % required reposting of pedicle screws (1–2 levels. Only one patient (0.7 % had a persistent postoperative neurological disorder (neuropathic pain, respectively from a level of re-reposition of

  3. Influence of the femoral head size on early postoperative gait restoration after total hip arthroplasty

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yi-xin; GUO Sheng-jie; LIU Qing; TANG Jing; LI Yu-jun

    2009-01-01

    Background We investigated the effects of using large-diameter femoral heads in total hip prostheses on eady postoperative gait restoration in patients undergoing total hip arthroplasty (THA). Methods We collected data for 19 primary THAs using 28-mm metal-on-polyethylene heads (conventional group) and for 12 THAs (BHR group) using metal-on-metal femoral heads with an average size of 45 mm (range, 40-49 mm). All patients had unilateral femoral head avascular necrosis. All patients underwent Harris Hip Scores evaluation and gait analysis with the IDEEA device at the same 3 time points which were before surgery and then at 1 month and again at 3 months after surgery, and the parameters measured were walking speed, stride length (SL), single limb support (SLS), cycle duration (CD), and swing power (SP). Harris Hip Scores and gait analysis parameters for both groups were compared.Results Intraclass comparison indicated that Harris Hip Scores, speed scores, and gait parameter measures in both groups improved significantly with the passage of time; Interclass comparison showed no significance between Harris1m postop - Harrispreop and Harris3m postop- Harrispreop in both groups. The speed in the BHR group at 1 month and at 3 months after surgery was significantly higher than that of conventional group. At 1 month after surgery, each mean for SLnormal-SLaffected, (SLSnormal - SLSaffected)/CD, and SPnormal - SPaffocted in the BHR group was significantly lower than that for the conventional group. At 3 months after surgery, the differences between means for both groups for SLnormal - SLaffected.(SLSnormal- SLSaffected)/CD, and SPnormal - SPaffected were not significant, but the mean of SPnormal - SPaffected in the BHR group was significantly lower than that in the conventional group.Conclusions Our data suggest that large-diameter femoral heads in THA provide better early gait restoration than conventional-size femoral heads.

  4. Early postoperative fluoroquinolone use is associated with an increased revision rate after arthroscopic rotator cuff repair.

    Science.gov (United States)

    Cancienne, Jourdan M; Brockmeier, Stephen F; Rodeo, Scott A; Young, Chris; Werner, Brian C

    2017-07-01

    To evaluate the association of postoperative fluoroquinolone use following arthroscopic primary rotator cuff repair with failure requiring revision rotator cuff repair. An insurance database was queried for patients undergoing rotator cuff repair from 2007 to 2015. These patients were divided into three groups: (1) patients prescribed fluoroquinolones within 6 months postoperatively (divided into 0-2, 2-4, and 4-6 months), (2) a matched negative control cohort of patients not prescribed fluoroquinolones, and (3) a matched positive control cohort of patients prescribed fluoroquinolones between 6 and 18 months following rotator cuff repair. Rates of failure requiring revision rotator cuff repair were compared within 2 years. A total of 1292 patients were prescribed fluoroquinolones within 6 months after rotator cuff repair, including 442 within 2 months, 433 within 2 to 4 months, and 417 within 4 to 6 months, and were compared to 5225 matched negative controls and 1597 matched positive controls. The rate of revision rotator cuff repair was significantly higher in patients prescribed fluoroquinolones within 2 months (6.1 %) compared to matched negative (2.2 %, P = 0.0009) and positive controls (2.4 %, P = 0.0026). There were no significant differences in the rate of revision rotator cuff repair when fluoroquinolones were prescribed >2 months after rotator cuff repair. Early use of fluoroquinolones following rotator cuff repair was independently associated with significantly increased rates of failure requiring revision rotator cuff repair. This is the first clinical study examining the association of postoperative fluoroquinolone use with failure following arthroscopic rotator cuff repair. III.

  5. Early outcome after emergency gastrectomy for complicated peptic ulcer disease.

    Science.gov (United States)

    Cheng, Mina; Li, W H; Cheung, M T

    2012-08-01

    OBJECTIVE. To analyse outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease. DESIGN. Prognostic study on a historical cohort. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients who underwent emergency gastrectomy from 2000 to 2009 in our hospital. MAIN OUTCOME MEASURES. Primary outcome measures were in-hospital mortality and the predictors of such deaths. Secondary outcome measures were 7-day mortality, 30-day mortality, and morbidities. RESULTS. In all, 112 patients had emergency gastrectomies performed for complicated peptic ulcer disease during the study period. In-hospital mortality was 30%. In the univariate analysis, old age, duodenal ulcer, failed primary surgery, gastrojejunostomy anastomosis for reconstruction, hand-sewn technique for duodenal stump closure, use of a sump drain, low haemoglobin level, preoperative blood transfusion, prolonged prothrombin time, and high creatinine or bilirubin levels were associated with an increased risk of in-hospital mortality. In the multivariate analysis, failed primary surgery, old age, and high creatinine level turned out to be independent risk factors. CONCLUSIONS. Emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication.

  6. Complicaciones posoperatorias y mortalidad en pacientes operados por endocarditis infecciosa Postoperative complications and mortality observed in patients operated on from infective endocarditis

    Directory of Open Access Journals (Sweden)

    Joaquín Gómez Armando Gonga

    2013-03-01

    Full Text Available Objetivo: describir las causas de morbilidad y mortalidad perioperatorias en los pacientes afectos de endocarditis infecciosa activa y significar cómo pueden ser disminuidas. Métodos: se realizó un estudio retrospectivo de las complicaciones posoperatorias y mortalidad en 139 pacientes operados por presentar endocarditis infecciosa en un período de 16 años. Se efectuaron 147 operaciones a los 139 pacientes de las cuales 83 (57,1 % fueron electivas y 64 (42,9 % fueron de urgencia. El 24 % de los pacientes fueron remitidos de otros centros en los que habían sido sometidos a tratamiento médico no exitoso por más de 4 semanas. Resultados: las operaciones efectuadas fueron: Sustituciones valvulares aórticas,mitrales y tricuspídeas 75 (41,1 %, extracción de electrodos de marcapasos o desfibriladores automáticos implantables del ventrículo derecho 57 (41 % , otras operaciones en número de 7 (4,9 %y 8 reintervenciones. La complicación más frecuente fue la sepsis generalizada (10,07 % pObjective: To describe the causes of perioperative morbidity and mortality of patients suffering active infectious endocarditis and to explain how both aspects can be reduced. Methods: A retrospective study of postoperative complications and mortality observed in 139 patients operated on from infectious endocarditis in 16 years. One hundred forty seven surgeries were performed, of which 83 (57.1 % were elective and 64 (42.9 % were emergency surgeries. In this group, 24 % had been referred from other medical centers where they had been unsuccessfully treated for 4 weeks. Results: The performed surgeries comprised 15 aortic, mitral and tricuspid valve replacements, 57 (41 % removals of pacemaker electrodes or of implanted automatic defibrillators in the right ventricle, seven other types of surgeries and 8 reoperations. The most frequent complication was generalized sepsis ((10.07 % p< 0.01, followed by the low heart output and postoperative bleeding. The

  7. Early follow-up after endovascular aneurysm repair: is the first postoperative computed tomographic angiography scan necessary?

    Science.gov (United States)

    Oikonomou, Kyriakos; Ventin, Felipe C; Paraskevas, Kosmas I; Geisselsöder, Peter; Ritter, Wolfgang; Verhoeven, Eric L

    2012-04-01

    To examine whether initial postoperative computed tomographic angiography (CTA) is needed in all patients undergoing endovascular aneurysm repair (EVAR). A total of 105 consecutive patients underwent EVAR with standard infrarenal devices in our department between November 2009 and May 2011. Five patients were excluded due to severe renal insufficiency, leaving 100 (85 men; median age 73 years, range 46-91) eligible for prospective enrollment in a triple-modality early postoperative follow-up protocol [intraoperative completion angiography, postoperative duplex ultrasonography (DUS), and plain abdominal radiography). Findings were compared for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) against the first postoperative CTA results for the detection of endoleaks or other signs of EVAR failure. There were 10 inconclusive DUS examinations. In the remaining 90 patients, DUS had 75.0% sensitivity, 95.4% specificity, 85.7% PPV, and 91.5% NPV for the detection of endoleaks. The intraoperative angiogram, DUS, and abdominal radiograph combined resulted in 87.5% sensitivity and 95.4% specificity, with a 65.6% PPV and 94.8% NPV for the detection of endoleaks. In 2 patients who required a reintervention for endoleak in the early postoperative period, both endoleaks were correctly detected by the triple-modality early postoperative follow-up protocol. An early follow-up protocol consisting of an intraoperative completion angiogram, DUS, and abdominal radiograph shows a high sensitivity and NPV for the detection of endoleaks and should detect early migration or kinking of the stent-graft. An initial postoperative CTA is not necessary for most patients undergoing EVAR and should be reserved for those individuals in whom the aforementioned modalities are inconclusive or show signs of endoleak or other EVAR failure.

  8. Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Sinan Kahraman

    2013-01-01

    Full Text Available Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period.

  9. Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer.

    Science.gov (United States)

    Yu, Guiping; Chen, Guoqiang; Huang, Bin; Shao, Wenlong; Zeng, Guangqiao

    2013-06-01

    To explore the effect of early enteral nutrition (EN) on postoperative nutritional status, intestinal permeability, and immune function in elderly patients with esophageal cancer or cardiac cancer. A total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study. They were divided into EN group (n=50) and parenteral nutrition (PN) group (n=46) based on the nutrition support modes. The body weight, time to first flatus/defecation, average hospital stay, complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed. Peripheral blood samples were collected on the days 1, 4 and 7 after surgery. The plasma diamine oxidase (DAO) activity and D-lactate level were determined to assess the intestinal permeability. The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier. The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme-linked immunosorbent assay (ELISA). After the surgery, the time to first flatus/defecation, average hospital stay, and complications were significantly less in the EN group than those in the PN group (Pcancer or cardiac cancer, early EN after surgery can effectively improve the nutritional status, protect intestinal mucosal barrier (by reducing plasma endoxins), and enhance the immune function.

  10. Surgical apgar score predicts early complication in transfemoral amputees

    DEFF Research Database (Denmark)

    Wied, Christian; Foss, Nicolai Bang; Kristensen, Morten T

    2016-01-01

    AIM: To assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery. METHODS: This was a single-center, retrospective observational cohort study conducted between January 2013...... and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation......) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed...

  11. Intercostal Artery Laceration: Rare Complication of Thoracentesis and Role of Ultrasound in Early Detection

    Directory of Open Access Journals (Sweden)

    Wissam Mansour

    2017-01-01

    Full Text Available Hemothorax is a rare but potentially fatal postthoracentesis complication. Early clinical signs may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further bleeding. Following procedure, early bedside ultrasound findings can be vital for early detection. We report a case of massive hemothorax in a 63-year-old male following therapeutic thoracentesis. Diagnosis was made following highly suggestive sonographic findings prompting thoracotomy and lacerated intercostal artery cauterization.

  12. Early individualised manipulative rehabilitation following lumbar open laser microdiscectomy improves early post-operative functional disability: A randomized, controlled pilot study.

    Science.gov (United States)

    Kim, Byungho J; Ahn, Junghoon; Cho, Heecheol; Kim, Dongyun; Kim, Taeyeong; Yoon, Bumchul

    2016-01-01

    Lumbar open laser microdiscectomy has been shown to be an effective intervention and safe approach for lumbar disc prolapse. However early post-operative physical disability affecting daily activities have been sporadically reported. To evaluate the feasibility of using early individualised manipulative rehabilitation to improve early post-operative functional disability following lumbar discectomy. Randomised controlled pilot trial. Setting at a major metropolitan spine surgery hospital. Twenty-one patients aged 25-69 years who underwent lumbar microdiscectomy were randomised to either the manipulative rehabilitation treatment group or the active control group. Rehabilitation was initiated 2-3 weeks after surgery, twice a week for 4 weeks. Each session was for 30 minutes. Primary outcomes were the Roland-Morris disability questionnaire and the visual analogue pain scale. Outcome measures were assessed at baseline and post-intervention. Early post-operative physical disability was improved with a 55% reduction by early individualised manipulative rehabilitation, compared to that of control care with a 5% increase. Early post-operative residual leg pain decreased with rehabilitation (55%) and control care (9%). This pilot study supports the feasibility of a future definitive randomised control trial and indicates this type of rehabilitation may be an important option for post-operative management after spinal surgery.

  13. Early ambulation and prevention of post-operative thrombo-embolic risk.

    Science.gov (United States)

    Talec, P; Gaujoux, S; Samama, C M

    2016-12-01

    The prevention of post-operative risk of venous thrombo-embolism (VTE) is of fundamental importance, but preventive methods have progressed with the introduction of direct oral anticoagulants (DOAC), the development of ambulatory surgery and enhanced recovery programs (ERP) after surgery. Surgery is, inherently a trigger for venous thrombo-embolic disease, as is prolonged immobilization. However, the risk of VTE is very low following ambulatory surgery, especially in this selected population. ERP, consists of a set of measures to optimize the patient's peri-operative management while reducing length of stay, costs and morbidity and mortality; one measure is the encouragement of early ambulation. This will undoubtedly have an impact on the incidence of VTE and lessen the need for prolonged thrombo-prophylaxis.

  14. The Results and Prognostic Factors of Postoperative Radiation Therapy in the Early Stages of Endometrial Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Ja [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2008-09-15

    To evaluate the results and prognostic factors for postoperative adjuvant radiation therapy in patients at stages I and II of endometrial cancer. Materials and Methods: Between January 1991 and December 2006, 35 patients with FIGO stages I and II disease, who received adjuvant radiation therapy following surgery for endometrial cancer at Ewha Womans University Hospital, were enrolled in this study. A total of 17 patients received postoperative pelvic external beam radiation therapy; whereas, 12 patients received vaginal brachytherapy alone, and 6 patients received both pelvic radiation therapy and vaginal brachytherapy. Results: The median follow-up period for all patients was 54 months. The 5-yr overall survival and disease-free survival rates for all patients were 91.4% and 81.7%, respectively. The 5-yr overall survival rates for low-risk, intermediate-risk, and high-risk groups were 100%, 100% and 55.6%, respectively. In addition, the 5-yr disease-free survival rates were 100%, 70.0%, and 45.7%, respectively. Although no locoregional relapses were identified, distant metastases were observed in 5 patients (14%). The most common site of distant metastases was the lung, followed by bone, liver, adrenal gland, and peritoneum. A univariate analysis revealed a significant correlation between distant metastases and risk-group (p=0.018), pathology type (p=0.001), and grade (p=0.019). A multivariate analysis also revealed that distant metastases were correlated with pathology type (p=0.009). Papillary, serous and clear cell carcinoma cases demonstrated a poor patient survival rate compared to cases of endometrioid adenocarcinoma or adenosquamous carcinoma. The most common complication of pelvic external beam radiation therapy was enteritis (30%), followed by proctitis, leucopenia, and lymphedema. All these complications were of RTOG grades 1 and 2; no grades 3 and 4 were observed. Conclusion: For the low-risk and intermediate-risk groups (stages 1 and 2) endometrial

  15. Dynamics of parameters of ultrasonic, microbiological and cytological investigations in the treatment of postoperative wound complications using magnesium containing minerals in the elderly patients

    Directory of Open Access Journals (Sweden)

    Muntyan S.O.

    2017-04-01

    Full Text Available 57 patients aged over 60 years with various types of wound complications after surgery for abdominal and anterior abdominal wall were treated. Treatment of wound complications included both traditional methods and the use of packs of bishofit. Оn the third day after the start of treatment there was a significant decrease in almost all computing performance indices as compared with treatment using bishofit. On the day 7 a noticeable difference of wound cavity width by 62.88%, the volume of the wound cavity by 85.76% in patients of the second group as compared with patients of the first was noted. So, bishofit use in the form of compresses in the treatment of postoperative wound complications such as hematoma, seroma and infiltration leads to a significant reduction in wound exudation, rapid decline in the concentration of microorganisms in the wound; this reduces time of wounds healing and patients’ recovery.

  16. Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Waleed A Almarakbi

    2014-01-01

    Full Text Available Background: The main function of an endotracheal tube (ETT cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L with those by just to seal technique (JS and assess the postoperative incidence of sore throat, cough and hoarseness. Materials and Methods: In a prospective, randomized clinical trial, 100 patients′ tracheas were intubated. In the first group (n = 50, ETT cuff inflation was guided by PV-L, while in the second group (n. = 50 the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Results: Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5 vs 5 (4.8-5.5, P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19 vs 33 (32-35, P ≤ 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ≤ 0.009, except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ≤ 0.065. Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001. Conclusions : The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications.

  17. Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial

    Science.gov (United States)

    Almarakbi, Waleed A.; Kaki, Abdullah M.

    2014-01-01

    Background: The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness. Materials and Methods: In a prospective, randomized clinical trial, 100 patients’ tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Results: Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ≤ 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ≤ 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ≤ 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P pressure and lower incidence of cuff-related complications. PMID:25191181

  18. Early gastric cancer and its complications: bleeding, perforation and pyloric stenosis.

    Directory of Open Access Journals (Sweden)

    Itano,Satoshi

    1983-10-01

    Full Text Available Some cases of early gastric cancer are accompanied with complications of the upper gastro-intestinal tract. The characteristics of these complications were investigated, and the problems of diagnosis and treatment were discussed. Out of 297 cases of early gastric cancer, 18 cases were accompanied with complications of the upper gastro-intestinal tract, including 11 cases of bleeding, a case of perforation and 6 cases of pyloric stenosis. All 18 cases were of the macroscopically depressed type, and about 85 percent of the 297 early gastric cancer cases were of the depressed type. The depressed lesions were often accompanied by ulceration which was an important factor causing the complications, and the mechanism of which appeared to be the same as that of a benign ulcer. There are some cases of early gastric cancer which are discovered by their complications, and it would be more difficult to find an early gastric cancer lesion if there were a benign lesion at the same time. Therefore, it is necessary to take much care when diagnosing and treating cases which have such complications. An endoscopic examination before the operation is especially important, and a biopsy is indispensable.

  19. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C.; Solgaard, Søren

    2017-01-01

    fractures ≤ 90 days postoperatively was 2.1% (n = 150). 70 fractures were detected intraoperatively (46 required osteosynthesis). 51 postoperatively detected fractures occurred without trauma (42 of which were reoperated) and 29 were postoperative fall-related fractures (27 of which were reoperated). 134...

  20. The impact of storage time of transfused blood on postoperative infectious complications in rectal cancer surgery. Danish RANX05 Colorectal Cancer Study Group

    DEFF Research Database (Denmark)

    Mynster, T; Nielsen, Hans Jørgen

    2000-01-01

    BACKGROUND: We have studied the impact of storage time of transfused allogeneic blood together with other known risk factors on postoperative infectious complications after operation for rectal cancer. METHODS: Intra-abdominal abscess, anastomotic leakage, septicaemia, wound infection, and pneumo......BACKGROUND: We have studied the impact of storage time of transfused allogeneic blood together with other known risk factors on postoperative infectious complications after operation for rectal cancer. METHODS: Intra-abdominal abscess, anastomotic leakage, septicaemia, wound infection...... and storage time of saline-adenine-glucose-mannitol (SAGM) blood, administered to each patient, were recorded retrospectively. RESULTS: The overall infection rate was 24% in 78 non-transfused and 40% in 225 transfused patients (P = 0.011). The proportion of SAGM blood stored for > or = 21 days administered...... to each transfused patient was a median of 60% in patients developing postoperative infections versus 25% (P = 0.037) in patients without infections. A multivariate analysis of significant risk variables showed weight > 75 kg (odds ratio, 2.0 versus blood stored > or = 21...

  1. The OPERA trial - comparison of early nasal high flow oxygen therapy with standard care for prevention of postoperative hypoxemia after abdominal surgery: study protocol for a multicenter randomized controlled trial.

    Science.gov (United States)

    Futier, Emmanuel; Paugam-Burtz, Catherine; Constantin, Jean-Michel; Pereira, Bruno; Jaber, Samir

    2013-10-18

    Respiratory support following postoperative extubation is of major importance to prevent hypoxemia and subsequent respiratory failure and reintubation. High-flow nasal cannula oxygen (HFNC) delivers a flow-dependent positive airway pressure and improves oxygenation by increasing end-expiratory lung volume. Whether application of HFNC may have therapeutic advantages over conventional oxygen therapy for respiratory support in the early postextubation surgical period remains to be established. The Optiflow for prevention of post-extubation hypoxemia after abdominal surgery (OPERA) trial is an investigator-initiated multicenter randomized controlled two-arm trial with assessor-blinded outcome assessment, randomizing 220 patients with intermediate to high risk of pulmonary complications after abdominal surgery to receive HFNC or conventional oxygen therapy following extubation, stratified by the presence of epidural analgesia and center. The primary outcome measure is the percentage of patients with postoperative hypoxemia one hour after tracheal extubation. Secondary outcome measures are postoperative pulmonary complications, need for noninvasive ventilation and intubation for respiratory failure. The OPERA trial is the first randomized controlled study powered to investigate whether early application of HFNC following extubation after abdominal surgery prevents against postoperative hypoxemia and pulmonary complications. ClinicalTrials.gov Identifier: NCT01887015.

  2. Malnutrition Increases With Obesity and Is a Stronger Independent Risk Factor for Postoperative Complications: A Propensity-Adjusted Analysis of Total Hip Arthroplasty Patients.

    Science.gov (United States)

    Fu, Michael C; D'Ambrosia, Christopher; McLawhorn, Alexander S; Schairer, William W; Padgett, Douglas E; Cross, Michael B

    2016-11-01

    Obesity is frequently associated with complications after total hip arthroplasty (THA) and is often concomitant with malnutrition. The purpose of this study was to investigate the independent morbidity risk of malnutrition relative to obesity. The National Surgical Quality Improvement Program from 2005 to 2013 was queried for elective primary THA cases. Malnutrition was defined as albumin malnutrition with 30-day outcomes. A total of 40,653 THA cases were identified, of which 20,210 (49.7%) had preoperative albumin measurements. Propensity score adjustment successfully reduced potential selection bias, with P > .05 for differences between those with and without albumin data. Malnutrition incidence increased from 2.8% in obese I to 5.7% in obese III patients. With multivariable propensity-adjusted logistic regression, malnutrition was a more robust predictor than any obesity class for any postoperative complication(s) (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.25-2.08), major complications (OR 1.63, 95% CI 1.21-2.19), respiratory complications (OR 2.35, 95% CI 1.27-4.37), blood transfusions (OR 1.71, 95% CI 1.44-2.03), and extended length of stay (OR 1.35, 95% CI 1.14-1.59). Malnutrition incidence increased significantly from obese I to obese III patients and was a stronger and more consistent predictor than obesity of complications after THA. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Early Non-Immunological Post Transplant complications: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Jabur Wael

    2008-01-01

    Full Text Available To assess non-immunological complications affecting renal transplant patients in the first six months after transplantation in Al-Karama hospital, Baghdad, Iraq, we studied 68 patients (49 males, 19 females attending the clinic during the year 2006. Forty six (67% patients received kidneys from related and 22 (33% from unrelated donors. The patients revealed the following complications: post transplant hypertension in 28 (41% patient, infection (mostly bacterial in 27 (37%, new onset diabetes in 11 (16%, calcineurin inhibitor toxicity in 10 (14%, anemia in 8 (12%, surgical complications in 7 (10%, slow graft recovery in 4 (6%, cardiovascular complications in 3 (4%, and Kaposi sarcoma in 2 (2.9%.Transient hyperglycemia, hypertension, infection and diabetes mel-litus were the commonest early complications of renal transplantation. The incidence of complications is comparable to the average reported in the literature, especially in this region of the world.

  4. STUDY ON EARLY PHYSICAL THERAPY IN POSTOPERATIVE INTERVENTION ON CHILDREN WITH MYELOMENINGOCELE

    Directory of Open Access Journals (Sweden)

    Necula Dana

    2015-10-01

    Full Text Available Objectives targeted in early intervention thru physical therapy postoperative, to recover the functional for the neuro-musculo-arthropod kinetic system and prevent bone deformities and dysfunctions of micturition and defecation sequlae. Materials and methods The study included 12 children aged 0-5 years, 7 boys and 5 girls that followed at least 12 months of recovery. The group included children with hydrocephalus associated with myelomeningocele and equinus foot lime, lime myelomeningocele and equinus foot (with varying degrees of paraplegia mono or bilateral and children with myelomeningocele and only urinary dysfunction and lower limb hypotonia. Results and discussion: Initial tests showed the presence of lumbar neurological paraplegia disorders with symptoms as urination and defecation dysfunction, impaired neuromotor development as a result of hydrocephalus, mono or bilateral foot equine deviated lime and dysplasia of the hip joint. Conclusions: Early physiotherapy intervention after complex neurosurgical intervention has an important role in regaining muscle tone, joint mobility and muscle strength in the lower body, improving and regaining alignment vault planting. Also we mention prophylaxis of the urinating device and prevention of deficiencies in postural alignment of the spine and pelvis.

  5. Early complications of the Nuss procedure for pectus excavatum: a prospective study.

    Science.gov (United States)

    Castellani, Christoph; Schalamon, Johannes; Saxena, Amulya K; Höellwarth, Michael E

    2008-06-01

    The Nuss procedure is a minimally invasive method for the correction of pectus excavatum, with several centers reporting its successful application. Complications related to the Nuss procedure are not uncommon and life-threatening complications have been reported. This study focuses on the incidence and management of complications in a series of 167 children and adults with funnel chest corrected by Nuss procedure. Guidelines and strategies to avoid the most common and typical complications are proposed. All patients with funnel chest, operated between April 2000 and 2006 were evaluated prospectively. Our surgical approach involved the submuscular insertion of the pectus bar under right-sided thoracoscopic control. The bar was secured in most cases with one stabilizer on the right side on the underlying rib to prevent bar displacement. Postoperative pain was primarily managed by epidural catheters. All data in the patient report forms was prospectively entered in a database. All complications were documented and classified into major or minor complication. A major complication was noted, if an organ injury occurred or if a significant surgical intervention became necessary. A minor complication was documented, if either an endoscopy or an evacuation of fluid or gas from the thorax by puncture were necessary. One hundred and sixty seven patients (136 males and 31 females) with a mean age of 16.3 (range 5-40 years) were included in this study. Major complications occurred in seven patients (4.2%) and consisted of one intraoperative heart perforation, one piercing of the liver with the trocar, bar infections (n = 2) and significant bar displacement (n = 3). Minor complications were seen in 122 patients (73.1%) and consisted of breakage of wires used to secure the lateral stabilizer plate (n = 48), pleural effusions (n = 28), intraoperative rupture of the intercostal muscle (n = 15), pericardial tears without clinical significance (n = 7) and lung atelectasia (n = 4

  6. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.

    Science.gov (United States)

    Smith, Justin S; Klineberg, Eric; Lafage, Virginie; Shaffrey, Christopher I; Schwab, Frank; Lafage, Renaud; Hostin, Richard; Mundis, Gregory M; Errico, Thomas J; Kim, Han Jo; Protopsaltis, Themistocles S; Hamilton, D Kojo; Scheer, Justin K; Soroceanu, Alex; Kelly, Michael P; Line, Breton; Gupta, Munish; Deviren, Vedat; Hart, Robert; Burton, Douglas C; Bess, Shay; Ames, Christopher P

    2016-07-01

    OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82

  7. The effect of anti-tumor necrosis factor alpha agents on postoperative anastomotic complications in Crohn's disease

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa Abdul-Hussein H; Krag, Aleksander; Olaison, Gunnar

    2013-01-01

    Patients with Crohn's disease treated with anti-tumor necrosis factor alpha agents may have an increased risk of surgical complications.......Patients with Crohn's disease treated with anti-tumor necrosis factor alpha agents may have an increased risk of surgical complications....

  8. The postanesthetic period. Complications.

    Science.gov (United States)

    Malamed, S F

    1987-01-01

    Postanesthetic complications can occur even in the best of circumstances. Proper preparation of the staff, aggressive monitoring of the recovering patient, and early recognition and management of the complications are essential if the outcome is to be successful. In reviewing postanesthetic complications, two factors are present in the overwhelming majority of situations--hypoxia and hypercarbia--often the direct result of inadequate monitoring during the postanesthetic period. The anesthetic procedure is not over once the anesthetic agents are discontinued. The skillful anesthetist is aware of the possibilities of postoperative complications and prevents problems by employing enhanced monitoring techniques during the recovery phase.

  9. Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study

    Science.gov (United States)

    Gopie, Jessica P.; Brinkman, J. Nick; Kleijne, Annelies; Seynaeve, Caroline; Menke-Pluymers, Marian B. E.; ter Kuile, Moniek M.; Tibben, Aad; Mureau, Marc A. M.

    2017-01-01

    Background Substantial complication rates after postmastectomy breast reconstruction (BR) in breast cancer patients have been reported. Few studies have reported on the resulting psychological distress (PD) and satisfaction with the aesthetic result in relation to postoperative complications after completion of implant or DIEP flap BR. The present study investigated whether women were able to recover from complication related distress in the long term. Methods PD was prospectively measured using questionnaires regarding anxiety, depression and cancer distress. Eligible patients completed questionnaires before BR (T0, n = 144), after one month (T1, n = 139) and after completion of BR, approximately 21 months after initial reconstructive surgery (T2, n = 119). Satisfaction with the aesthetic result was assessed 21 months after BR. Data concerning complications, subsequent additional surgery and total reconstruction failure up to T2 were collected from the medical records. Analyses were performed using multi-level regression analyses correcting for age. Results One or more complications occurred in 61 patients (42%) and 50 women required subsequent surgery (35%). In time, mean PD significantly declined towards baseline scores independent of complications. However, a total reconstruction failure (n = 10) was significantly associated with a large temporary increase in depression scores. After additional surgery due to complications patients were less satisfied with aesthetic outcome, although patient satisfaction was independent of PD. Conclusions PD outcomes generally declined to normal levels after completion of the entire BR course. Patients experiencing a total reconstruction failure reported more depression after this loss, but in the long term recovered to the same level as women without complications. These findings indicate that women generally can cope efficiently with these serious adverse events, even if they were less satisfied with the aesthetic result

  10. Computed tomography findings of postoperative complications in lung transplantation Achados tomográficos nas complicações pós-operatórias do transplante pulmonar

    Directory of Open Access Journals (Sweden)

    Bruno Hochhegger

    2009-03-01

    Full Text Available Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post-transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.Com o número cada vez maior e uma melhor sobrevida dos pacientes submetidos ao transplante pulmonar, os radiologistas devem estar cientes das diversas possibilidades de complicações associadas ao transplante de pulmão. O tratamento precoce das complicações é importante para a sobrevida a longo prazo dos receptores de transplante pulmonar. Com frequência, a TCAR desempenha um papel central na investigação de tais complicações. O reconhecimento precoce dos sinais de complicações proporciona um tratamento rápido e melhora a sobrevida. O objetivo desta revisão pictórica foi proporcionar uma visão sobre as complicações mais prevalentes na TC, tais como edema de reperfusão, rejeição aguda, infecção, tromboembolismo pulmonar, rejeição crônica, síndrome da bronquiolite obliterante, pneumonia em organização criptogênica, doença linfoproliferativa pós-transplante, deiscência brônquica e estenose brônquica.

  11. Eyelid hygiene as a tool for prevention and treatment of complications due to ocular surface diseases in early post-LASIK period

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov

    2014-07-01

    Full Text Available Purpose: to analyze the effect of eyelid hygiene and therapy on early post-op period following excimer laser refractive surgery.Methods: 144 patients (288 eyes aged 18-57 yrs who underwent excimer laser vision correction (LASIK were followed. All patients were divided into two groups depending on therapy. In treatment group (70 patients/140 eyes, eyelid hygiene was prescribed 7 days before and 7 days again following refractive surgery for 1 or 2 months. In control group (74 patients/148 eyes, no eyelid hygiene was prescribed.Results: Complex method of eyelid hygiene and therapy was developed that consisted in eyelid margins self-massage using Blepharogel 1 or Blepharogel 2 and warm compresses using Blepharopads impregnated with Blepharolotion. When using in combina- tion with antibacterial and tear replacement therapy, this method provides significant decrease in infectious complications rate and effective recovery of tear production in early post-op period following excimer laser surgery. these observations are confirmed by the dynamics of clinical, functional and subjective parameters.Conclusion: 7-days eyelid hygiene and therapy course that is prescribed immediately before and following laser vision correctionprovides multi-factorial effect, i.e., reduces post-op inflammatory complications rate and increases tear film stability.

  12. Eyelid hygiene as a tool for prevention and treatment of complications due to ocular surface diseases in early post-LASIK period

    Directory of Open Access Journals (Sweden)

    V. V. Kurenkov

    2012-01-01

    Full Text Available Purpose: to analyze the effect of eyelid hygiene and therapy on early post-op period following excimer laser refractive surgery.Methods: 144 patients (288 eyes aged 18-57 yrs who underwent excimer laser vision correction (LASIK were followed. All patients were divided into two groups depending on therapy. In treatment group (70 patients/140 eyes, eyelid hygiene was prescribed 7 days before and 7 days again following refractive surgery for 1 or 2 months. In control group (74 patients/148 eyes, no eyelid hygiene was prescribed.Results: Complex method of eyelid hygiene and therapy was developed that consisted in eyelid margins self-massage using Blepharogel 1 or Blepharogel 2 and warm compresses using Blepharopads impregnated with Blepharolotion. When using in combina- tion with antibacterial and tear replacement therapy, this method provides significant decrease in infectious complications rate and effective recovery of tear production in early post-op period following excimer laser surgery. these observations are confirmed by the dynamics of clinical, functional and subjective parameters.Conclusion: 7-days eyelid hygiene and therapy course that is prescribed immediately before and following laser vision correctionprovides multi-factorial effect, i.e., reduces post-op inflammatory complications rate and increases tear film stability.

  13. Postoperative Ileus in the Elderly

    Directory of Open Access Journals (Sweden)

    Chih-Peng Tu

    2014-03-01

    Full Text Available Postoperative ileus is among the most common complications after surgery. Aging is associated with an increased colonic transit time, and anesthetic disturbance to colonic motility is often aggravated in the elderly. Postoperative ileus increases morbidity, prolongs the length of hospital stay, and constitutes a significant economic burden on the healthcare system. Multimodal enhanced recovery protocols, or fast-track surgeries, have been developed to improve postoperative recovery. Patient education, avoidance of perioperative fluid overload, selective use of nasogastric decompression, early ambulation, adopting a minimally invasive approach, early initiation of clear fluids, and gum chewing are all possible measures to reduce postoperative ileus. Thoracic epidural anesthesia is a well-established technique to hasten recovery, whereas insufficient data are available to ascertain the safety and efficacy of opioid-sparing analgesia in the elderly. The evidence is clear that traditional prokinetic medications are not helpful in the treatment or prevention of postoperative ileus. Early results suggest that alvimopan is a promising agent to reverse opioid-induced ileus. Since postoperative ileus is a multifactorial condition, a concerted effort is therefore necessary to prevent or decrease the duration of postoperative ileus using multimodal strategies.

  14. Post-operative complications associated with the Arthrex Canine Cranial Cruciate Ligament Repair Anchor System in small- to medium-sized dogs: A retrospective analysis (2009-2012).

    Science.gov (United States)

    Rappa, Nick S; Radasch, Robert M

    2016-08-01

    This study classified and determined the post-operative complication rate associated with stabilization of cranial (CCL) ligament deficient stifles in small- to medium-sized dogs with the Arthrex Canine Cranial Cruciate Ligament Repair Anchor System (CCLRAS). Eighty-five medical records from 2009 to 2012 from 1 institution were evaluated. Complications were classified according to previously proposed definitions for orthopedic studies in veterinary medicine. Fifty-two owners were contacted by telephone at least 6 months after surgery and given a questionnaire to classify complications related to the implant. A visual analog scale was used to assess functionality and degree of pain. The overall complication rate was 30.3% with an inflammation-infection rate of 5.4% and a documented infection rate requiring implant removal of 1.8%. Owners reported full or acceptable function in 96% of cases with an average functional score of 86.5. Stabilization of CCL-deficient stifles in small- to medium-sized dogs with the Arthrex Canine CCLRAS is reliable with acceptable complication rates.

  15. The effect of ranitidine on postoperative infectious complications following emergency colorectal surgery: a randomized, placebo-controlled, double-blind trial

    DEFF Research Database (Denmark)

    Moesgaard, F; Jensen, L S; Christiansen, P M

    1998-01-01

    OBJECTIVE AND DESIGN: To study the potential effect of ranitidine on postoperative infectious complications following emergency colorectal surgery. A randomized, placebo-controlled, double-blind trial was carried out in three university clinics and two county hospitals in Denmark. PATIENTS......) or i.v. placebo (group II). All patients were given 1.5 g metronidazole plus 3.0 g cefuroxime at the time of surgery. Patients with perforation of the colon or rectum were given metronidazole and cefuroxime for further 3 days. All patients were assessed daily until discharge from the hospital. Thirty...

  16. The Nursing Experience of 3 Cases of Patients With Postoperative Gastric Fistula Complicated With Intestinal Fistula%3例胃癌术后并发胃肠瘘患者的护理

    Institute of Scientific and Technical Information of China (English)

    陈小艳

    2016-01-01

    Objective To explore the nursing experience of postoperative gastric cancer complicated by gastric fistula.Methods Retrospective analysis of the nursing measures for 3 cases of patients with postoperative gastric fistula was summarized.Results 3 cases of patients with gastrointestinal fistula were cured after active conservative treatment. Conclusion Patients with gastric cancer should be actively strengthen the nursing observation, in order to achieve early detection and early treatment,improve gastrointestinal ifstula cure rate, to attach importance to abdominal drainage tube, nutritional support, ifstula skin care and psychological care, which has signiifcances for rehabilitation of patients.%目的:探讨胃癌术后并发胃肠瘘的护理。方法回顾分析3例胃癌术后并发胃肠瘘患者的护理措施。结果3例胃肠瘘患者经积极保守治疗后均痊愈。结论对于胃癌术后患者应积极加强护理观察,以达到早发现、早治疗,提高胃肠瘘治愈率,重视腹腔引流管、营养支持、瘘口皮肤的护理及心理护理等,对患者的康复有重要意义。

  17. Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa Abdul-Hussein H; Andersen, Jens; Bisgaard, Thue

    2012-01-01

    Objectives: There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease. Patients and methods. Retrospective study...... complications were more frequent after a colo-colic anastomosis than after an entero-enteric or entero-colic (33% vs. 12% (p=0.013)). Patients with anastomotic complications were older (40 years vs. 35 years (p=0.014)), had longer disease duration (7.5 years vs. 4 years (p=0.04)), longer operation time (155 min...... vs. 115 min (p=0.018)) and more operative bleeding (200 ml vs. 130 ml (p=0.029)). Multivariate analysis revealed preoperative treatment with prednisolone 20 mg or more, operation time and a colo-colic anastomosis as negative predictors of anastomotic complications. Conclusions: Preoperative biologic...

  18. Preoperative factors as a predictor for early postoperative outcomes after repair of congenital transposition of the great arteries.

    Science.gov (United States)

    Kim, Jung-Won; Gwak, Mijeung; Shin, Won-Jung; Kim, Hyun-Jung; Yu, Jeong Jin; Park, Pyung-Hwan

    2015-03-01

    Transposition of the great arteries (TGA) requires early surgical repair during the neonatal period. Several preoperative factors have been identified for the postoperative poor outcome after arterial switch operation (ASO). However, the data remain uncertain an association. Therefore, we investigated the preoperative factors which affect the early postoperative outcomes. Between March 2005 and May 2012, a retrospective study was performed which included 126 infants with an ASO for TGA. Preoperative data included the vasoactive inotropic score (VIS) and baseline hemodynamics. Early postoperative outcomes included the duration of mechanical ventilation, the length of stay in the intensive care unit and hospital, and early mortality. Multivariate linear regression and receiver operating characteristics analysis were performed. The duration of mechanical ventilation was significantly correlated with the preoperative mechanical ventilator support and VIS, and CPB time. On multivariate linear regression analysis, a higher preoperative VIS, preoperative B-type natriuretic peptide (BNP) level, and the CPB time were identified as independent risk factors for delayed mechanical ventilation. Preoperative VIS (OR 1.154, 95 % CI 1.024-1.300) and the CPB time (OR 1.034, 95 % CI 1.009-1.060) were independent parameters predicting early mortality. A preoperative VIS of 12.5 had the best combined sensitivity (83.3 %) and specificity (85.3 %) and an AUC of 0.852 (95 % CI 0.642-1.061) predicted early mortality. Our results suggest that preoperative VIS and BNP can predict the need for prolonged postoperative mechanical ventilation. Moreover, preoperative VIS may be used as a simple and feasible indicator for predicting early mortality.

  19. The impact of storage time of transfused blood on postoperative infectious complications in rectal cancer surgery. Danish RANX05 Colorectal Cancer Study Group

    DEFF Research Database (Denmark)

    Mynster, T; Nielsen, Hans Jørgen

    2000-01-01

    BACKGROUND: We have studied the impact of storage time of transfused allogeneic blood together with other known risk factors on postoperative infectious complications after operation for rectal cancer. METHODS: Intra-abdominal abscess, anastomotic leakage, septicaemia, wound infection......, and pneumonia were prospectively recorded in 303 patients undergoing elective resection for primary rectal cancer in 18 Danish hospitals. Patient risk variables and variables related to operation technique and transfusion were recorded prospectively, whereas amount given before infectious complication...... and storage time of saline-adenine-glucose-mannitol (SAGM) blood, administered to each patient, were recorded retrospectively. RESULTS: The overall infection rate was 24% in 78 non-transfused and 40% in 225 transfused patients (P = 0.011). The proportion of SAGM blood stored for > or = 21 days administered...

  20. Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia.

    Science.gov (United States)

    AlQahtani, Awad; Parsyan, Armen; Payne, Richard; Tabah, Roger

    2014-08-01

    Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. A simple, reliable indicator to identify patients at risk would permit earlier pharmacologic prophylaxis to avoid these adverse outcomes. We examined the role of intact parathormone (PTH) levels 1 hour after surgery as a predictor of post-thyroidectomy hypocalcemia. We prospectively reviewed the cases of consecutive patients undergoing total or completion thyroidectomy. Ionized calcium (Ca(2+)) and intact PTH levels were measured preoperatively and at 1-, 6- and 24-hour intervals postoperatively. The specificity, sensitivity, negative and positive predictive values of the 1-hour PTH serum levels (PTH-1) in predicting 24-hour post-thyroidectomy hypocalcemia and eucalcemia were determined. We reviewed the cases of 149 patients. Biochemical hypocalcaemia (Ca(2+) sensitivity, specificity, positive and negative predictive values of a low PTH-1 were 89%, 100%, 97% and 100%, respectively. We found that PTH-1 levels were predictive of symptomatic hypocalcemia 24 hours after thyroidectomy. Routine use of this assay should be considered, as it could prompt the early administration of calcitriol in patients at risk of hypocalcemia and allow for the safe and timely discharge of patients expected to remain eucalcemic.

  1. Does Kinesiology Taping Improve the Early Postoperative Outcomes in Anterior Cruciate Ligament Reconstruction? A Randomized Controlled Study.

    Science.gov (United States)

    Chan, Mark Ci-En; Wee, Justin Wen-Jie; Lim, Mui-Hong

    2017-05-01

    The efficacy of kinesiology taping in arthroscopic knee surgery has not been reported. The objective of this study is to investigate the efficacy of kinesiology taping in the early postoperative phase after anterior cruciate ligament reconstruction (ACLR). We hypothesized that kinesiology taping reduces knee pain and swelling and improves knee range of movement and functional outcome. Randomized controlled study. Primary Institutional Hospital. Sixty subjects who underwent an elective ACLR with or without concurrent meniscectomy were randomized into intervention (with kinesiology taping postsurgery) and control groups. Subjects from both groups received standardized postoperative physiotherapy. Subjects from the intervention group received additional kinesiology taping on the first and second weeks postsurgery, each application lasting 5 days. Pain visual analogue score (VAS), total range of motion (ROM) of the knee, Lysholm-Tegner scale, and mid patella circumferential girth were measured before the surgery and at the first, second, and sixth week postsurgery. Within each group, statistically significant differences were found in all study parameters in both groups. Comparison of the study parameters between both groups revealed no statistical significance at various time points except the reduction of pain in the taping group in the early postoperative phase (between the first and second week) (P kinesiology taping in arthroscopic knee surgery. Our study showed that kinesiology taping reduced pain in the early postoperative period after ACLR. There was no statistical significance in the reduction of swelling or improvement of knee score and total range of motion with kinesiology taping.

  2. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients.

    Science.gov (United States)

    Mebust, W K; Holtgrewe, H L; Cockett, A T; Peters, P C

    1989-02-01

    The mortality rate for transurethral prostatectomy was 0.2 per cent in 3,885 patients reviewed retrospectively. The immediate postoperative morbidity rate was 18 per cent. Increased morbidity was found in patients with a resection time of more than 90 minutes, gland size of more than 45 gm., acute urinary retention and patient age greater than 80 years, and in the black population. Of the patients 77 per cent had significant pre-existing medical problems. Operative mortality, significant morbidity and hospital stay were reduced in comparison to studies done 15 and 30 years ago.

  3. Early postoperative 18F-FDG PET/CT in high-risk stage III colorectal cancer.

    Science.gov (United States)

    Wasserberg, Nir; Purim, Ofer; Bard, Vyacheslav; Kundel, Yulia; Gordon, Noa; Groshar, David; Goldberg, Natalia; Kashtan, Hanoch; Sulkes, Aaron; Brenner, Baruch

    2015-04-01

    PET/CT may contribute to staging modification in different phases of colorectal cancer (CRC) management. However, it is not routinely indicated for stage III CRC. This study sought to determine the role of early postoperative PET/CT in patients with high-risk stage III CRC. The tumor registry of a tertiary medical center was searched (2004-2011) for all patients with stage III CRC who underwent early postoperative PET/CT because of the presence of high-risk factors for systemic disease. Demographic and clinicopathological characteristics were compared between patients found/not found to have metastatic disease. The cohort included 91 patients with a median age of 67 years (range, 29-90 years). Pathological FDG uptake was observed in 38 (41%). Of these, 14 (15% of the whole cohort) were upstaged with alteration of their treatment protocol, 10 (11%) had local postoperative changes, and 14 (15%) had false-positive findings. The sensitivity and specificity of PET/CT for detecting metastatic disease were 100% and 69%, respectively. Elevated postoperative carcinoembryonic antigen and CA-19.9 levels correlated with a positive PET/CT (P = 0.05 and P = 0.03, respectively). The median follow-up time was 34 months (range, 4-85 months). The estimated 5-year survival rate was significantly higher in patients with a negative than a positive scan (70% vs 42%, P postoperative PET/CT may influence staging and treatment in 15% of selected patients with high-risk stage III CRC. Postoperative levels of carcinoembryonic antigen and CA-19.9 may serve as indications for PET/CT scanning in this setting. Prospective validation is warranted.

  4. Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in pancreaticoduodectomy patients: a prosepective, randomized study.

    Science.gov (United States)

    Park, Joon Seong; Chung, Hye-Kyung; Hwang, Ho Kyoung; Kim, Jae Keun; Yoon, Dong Sup

    2012-03-01

    The benefits of early enteral feeding (EEN) have been demonstrated in gastrointestinal surgery. But, the impact of EEN has not been elucidated yet. We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy (PD) according to the postoperative nutritional method and compared the clinical outcomes of two methods. A prospective randomized trial was undertaken following PD. Patients were randomly divided into two groups; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition (TPN) management. Thirty-eight patients were included in our analyses. The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group. Prealbumin and transferrin were significantly reduced on post-operative day (POD) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group. EEN group rapidly recovered weight after POD 21 whereas it was gradually decreased in TPN group until POD 90. EEN after PD is associated with preservation of weight compared with TPN and impact on recovery of digestive function after PD.

  5. The effect of patient-selected music on early postoperative pain, anxiety, and hemodynamic profile in cesarean section surgery.

    Science.gov (United States)

    Ebneshahidi, Amin; Mohseni, Masood

    2008-09-01

    After cesarean section surgery, routine pharmacologic methods of analgesia--opioids and benzodiazepines--may impair the immediate close contact of mother and neonate for their sedative and emetic effects. The aim of this study was to explore the effect of patient-selected music on postoperative pain, anxiety, opioid requirement, and hemodynamic profile. A total of 80 patients, American Society of Anesthesiologists (ASA) physical status I-II, scheduled to undergo general anesthesia and elective cesarean section surgery were enrolled. Patients were randomly allocated to receive 30 minutes of music or silence via headphones postoperatively. Pain and anxiety were measured with a visual analogue scale. Total postoperative morphine requirement as well as blood pressure and heart rate were recorded after the intervention period. Pain score and postoperative cumulative opioid consumption were significantly lower among patients in the music group (p 0.05). Postoperative use of patient-selected music in cesarean section surgery would alleviate the pain and reduce the need for other analgesics, thus improving the recovery and early contact of mothers with their children.

  6. Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention.

    Science.gov (United States)

    Kirklin, J K; Holm, A; Aldrete, J S; White, C; Bourge, R C

    1990-01-01

    Acute gastrointestinal (GI) illnesses are unusual but potentially fatal complications following cardiac transplantation. A retrospective study was performed to analyze the frequency, etiology, and severity of GI complications and the potential impact of early diagnosis and prompt surgical intervention when appropriate. Between 1981 and July 1, 1988, 31 GI complications (pancreatic, 6; colonic, 6; gastroduodenal, 6; biliary, 5; esophageal, 3; appendiceal, 2; hernia, 2; and splenic, 1) occurred in 26 patients undergoing 32 cardiac transplants. Complications were most common (14 of 31 patients, 45%) within the first 30 days after transplantation. Seventeen GI complications were treated medically (2 deaths), 2 with elective surgery and 12 with emergent operations (3 deaths). The overall mortality rate was 16%. All patients who underwent emergent operations within 3 days of onset of symptoms survived; the mean interval of onset between symptoms and operation in the nonsurvivors was 10 +/- 3.8 days. We infer that among patients requiring urgent surgical intervention, successful outcome is enhanced by intense surveillance for early symptoms, prompt diagnostic evaluation, and early surgical intervention. PMID:2339915

  7. Early central nervous system complications after reduced-intensity stem cell transplantation.

    Science.gov (United States)

    Kishi, Yukiko; Miyakoshi, Shigesaburo; Kami, Masahiro; Ikeda, Masayuki; Katayama, Yuta; Murashige, Naoko; Kusumi, Eiji; Yuji, Koichiro; Kobayashi, Kazuhiko; Kato, Daisuke; Hamaki, Tamae; Matsumura, Tomoko; Kim, Sung-Won; Morinaga, Shinichi; Mori, Shinichiro; Kanemaru, Mineo; Hayashi, Tatsuyuki; Takaue, Yoichi; Taniguchi, Shuichi

    2004-08-01

    To investigate clinical characteristics of early central nervous system (CNS) complications after reduced-intensity stem cell transplantation (RIST), we reviewed the medical records of 232 patients who had undergone RIST for hematologic diseases at our institutions between September 1999 and June 2003. All patients had received purine analog-based preparative regimens. Stem cell sources comprised granulocyte colony-stimulating factor-mobilized blood from HLA-identical or 1 locus-mismatched related donors (n = 151), unrelated bone marrow (n = 44), or unrelated cord blood (n = 37). Graft-versus-host disease prophylaxis incorporated cyclosporine with or without methotrexate. Diagnosis of CNS complications was based on clinical, radiologic, and microbiological findings. CNS complications occurred in 18 patients (7.8%), with a median onset of 22 days, and were infectious (n = 1), metabolic (n = 15), or cerebrovascular (n = 2). Symptoms included seizures (n = 7), visual disturbance (n = 2), headache (n = 8), nausea (n = 8), vomiting (n = 6), impaired consciousness (n = 16), and hemiparesis (n = 3). Complications improved promptly in 10 patients, and 8 patients died without improvement within 30 days. Multivariate analysis with logistic regression identified umbilical cord blood transplantation as a significant risk factor for early CNS complications (odds ratio, 14.5; 95% confidence interval, 3.7-56.9; P <.0001). CNS complications are a significant problem after RIST, particularly with umbilical cord blood. Limbic encephalopathy is an unrecognized subtype of neurotoxicity after umbilical cord blood transplantation.

  8. 骶骨肿瘤术后并发症分析及处理%Analysis and treatment of postoperative complications of sacral tumor after surgery

    Institute of Scientific and Technical Information of China (English)

    董军; 孙成良; 李栋

    2012-01-01

    Objective To analyze the postoperative complications of sacral tumor and treatment strategy. Methods This retrospective study included 38 cases of sacral tumors surgically treated from December 2003 to December 2010. The age of patients ranged from 18 to 65 years (mean 34.5 years) , including of 22 male and 16 female. Record the most common postoperative complication of these patients, causes and relative treatments were analyzed. Results After surgery, 26 cases were followed up for an average period of 3.1 years ( longest 5 years, shortest 10 months). None of the patients died in surgery. The early complications after surgery included gastrointestinal dysfunction in 31 cases. Nonunion of the incision occurred in 2 cases caused by radiation, one case with S4 tumor died of chronic infection after 8 monthes in spite of half year dressing, and the other was delayed union of the incision and the wound healed by dressing with granulation promoting plaster after 3 monthes. Incisal effuscin with hyperpyrexia happened in 3 cases. Enterococcal infection was confirmed by germiculture. Body temperature restored normally after 5-10 d with a method of puncture drainage and the application of vancomycin. Urine retention occurred in 2 cased after surgery and catheter removed after 3 monthes. Internal fixation( iliac screw) loosened in 3 cases during follow-up phase. Conclusion Because of stimulating bowel with effuscin and operation,gastrointestinal dysfunction in patients with sacral tumor rate is higher, but alleviated commonly. Sacral tumor patients with a higher incidence of enterococcal infection caused by differential tissue coverage and near perineum. The treatment of enterococcal infection is difficult. Be cautious about operating on patients after radiation. Selective nerve root should be preserved to avoid urine retention.%目的 探讨骶骨肿瘤术后常见并发症及其处理方法.方法 2003年12月~2010年12月间手术治疗的38

  9. Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients.

    Science.gov (United States)

    Smith, Justin S; Ramchandran, Subaraman; Lafage, Virginie; Shaffrey, Christopher I; Ailon, Tamir; Klineberg, Eric; Protopsaltis, Themistocles; Schwab, Frank J; OʼBrien, Michael; Hostin, Richard; Gupta, Munish; Mundis, Gregory; Hart, Robert; Kim, Han Jo; Passias, Peter G; Scheer, Justin K; Deviren, Vedat; Burton, Douglas C; Eastlack, Robert; Bess, Shay; Albert, Todd J; Riew, K Daniel; Ames, Christopher P

    2016-09-01

    Few reports have focused on treatment of adult cervical deformity (ACD). To present early complication rates associated with ACD surgery. A prospective multicenter database of consecutive operative ACD patients was reviewed for early (≤30 days from surgery) complications. Enrollment required at least 1 of the following: cervical kyphosis >10 degrees, cervical scoliosis >10 degrees, C2-7 sagittal vertical axis >4 cm, or chin-brow vertical angle >25 degrees. Seventy-eight patients underwent surgical treatment for ACD (mean age, 60.8 years). Surgical approaches included anterior-only (14%), posterior-only (49%), anterior-posterior (35%), and posterior-anterior-posterior (3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major. Twenty-two (28.2%) patients had at least 1 minor complication, and 19 (24.4%) had at least 1 major complication. Overall, 34 (43.6%) patients had at least 1 complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), and respiratory failure (5.1%). One (1.3%) mortality occurred. Early complication rates differed significantly by surgical approach: anterior-only (27.3%), posterior-only (68.4%), and anterior-posterior/posterior-anterior-posterior (79.3%) (P = .007). This report provides benchmark rates for overall and specific ACD surgery complications. Although the surgical approach(es) used were likely driven by the type and complexity of deformity, there were significantly higher complication rates associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning, patient counseling, and ongoing efforts to improve safety of care. 3CO, 3-column osteotomiesACD, adult cervical deformityEBL, estimated blood lossISSG, International Spine Study groupSVA, sagittal vertical axis.

  10. New photoacoustic platform for early detection of circulating clots to prevent stroke and other fatal thromboembolic complications (Conference Presentation)

    Science.gov (United States)

    Carey, Kai A.

    2017-03-01

    Nearly 800,000 people in the U.S. experience an incident of stroke each year; 80% of these are first time occurrences and 87% are ischemic in nature. Someone dies of a stroke every few minutes in the U.S. but despite its prevalence there have been minimal advances in the early detection and screening of thromboembolic events, especially during patient post-operative periods or in genetically predisposed individuals. Environmental or genetic factors may disrupt the balance between coagulation and lysis of micro-thrombi in circulation and increase the risk of stroke. We introduced here a novel in vivo multicolor negative-contrast photoacoustic (PA) flow cytometry (PAFC ) platform with many innovations including customized high pulse repetition rate 1064 laser from IPG Photonics Corporation, powerful laser diode array, multichannel optical schematic, and time-resolved recording system. Using animal models, we verified the potential of this technology to detect small clots in relatively large vessels in vivo. If future clinical trials using a cost-effective, easy-to-use, safe, watch-like, wearable PA probe are successful, PAFC could provide breakthroughs in early monitoring of the growth in size and number of small clots that may predict and potentially prevent fatal thromboembolic complications. We also believe that this technology could be utilized to assess therapeutic benefits of anticoagulants and develop more efficient dosage in treatments by analyzing changes in the composition and frequency of micro-thrombi

  11. Intensity Modulated Radiotherapy (IMRT in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

    Directory of Open Access Journals (Sweden)

    Novaes Paulo ERS

    2006-11-01

    Full Text Available Abstract Background Pelvic Radiotherapy (RT as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. Conclusion IMRT is a valid technique to prevent the kidney from radiation damage.

  12. Filtering bleb activation in the early post-operative period after fistulizing surgery

    Directory of Open Access Journals (Sweden)

    S. Yu. Petrov

    2014-10-01

    Full Text Available The article presents a case report of a patient with a cystic bleb in the early postoperative period after trabeculectomy. Patient complained of discomfort in a recently (4 weeks operated eye. Medical regimen administered previously had been taken irregularly. Biomicroscopy revealed a high, encapsulated cystic bleb with thin walls and hyperemia. Intraocular pressure at the moment of examination was 27 mmHg. Local hypotensive therapy had been neglected by the patient. A local anti-inflammatory (tobramycin / dexamethasone fixed combination and hypotensive (brimonidine / timolol fixed combination therapy was administered. 24 hours later, when intraocular pressure decreased to 20 mmHg, a needle revision procedure was conducted for partial bleb wall destruction and subconjunctival injection of dexamethasone, fluorouracil and ranibizumab. During the next day examination the bleb was diffuse, with less hyperemia and an abundance of conjunctival microcysts in the central bleb’s zone. Intraocular pressure was 10.2 mmHg. No choroidal detachment was noted during ophthalmoscopy and OCT examination. The patient continued anti-inflammatory therapy. Another needling procedure with the same drug combination was repeated two weeks after due to an increased hyperemia. At the end of the four-week follow-up period the filtering bleb remained diffuse and the intraocular pressure was 13.2 mmHg. Dexamethasone drops were prescribed to be instilled 1‑2 times a day for a month. This case report demonstrates the method of restoring a functioning filtering bleb by the needle revision with antiinflammatory, cytostatic and anti-VEGF therapy for prolonging the hypotensive effect of a trabeculectomy in the presence of wound healing.

  13. Filtering bleb activation in the early post-operative period after fistulizing surgery

    Directory of Open Access Journals (Sweden)

    S. Yu. Petrov

    2014-01-01

    Full Text Available The article presents a case report of a patient with a cystic bleb in the early postoperative period after trabeculectomy. Patient complained of discomfort in a recently (4 weeks operated eye. Medical regimen administered previously had been taken irregularly. Biomicroscopy revealed a high, encapsulated cystic bleb with thin walls and hyperemia. Intraocular pressure at the moment of examination was 27 mmHg. Local hypotensive therapy had been neglected by the patient. A local anti-inflammatory (tobramycin / dexamethasone fixed combination and hypotensive (brimonidine / timolol fixed combination therapy was administered. 24 hours later, when intraocular pressure decreased to 20 mmHg, a needle revision procedure was conducted for partial bleb wall destruction and subconjunctival injection of dexamethasone, fluorouracil and ranibizumab. During the next day examination the bleb was diffuse, with less hyperemia and an abundance of conjunctival microcysts in the central bleb’s zone. Intraocular pressure was 10.2 mmHg. No choroidal detachment was noted during ophthalmoscopy and OCT examination. The patient continued anti-inflammatory therapy. Another needling procedure with the same drug combination was repeated two weeks after due to an increased hyperemia. At the end of the four-week follow-up period the filtering bleb remained diffuse and the intraocular pressure was 13.2 mmHg. Dexamethasone drops were prescribed to be instilled 1‑2 times a day for a month. This case report demonstrates the method of restoring a functioning filtering bleb by the needle revision with antiinflammatory, cytostatic and anti-VEGF therapy for prolonging the hypotensive effect of a trabeculectomy in the presence of wound healing.

  14. Surgical-site infections and postoperative complications: agreement between the Danish Gynecological Cancer Database and a randomized clinical trial

    DEFF Research Database (Denmark)

    Antonsen, Sofie L; Meyhoff, Christian Sylvest; Lundvall, Lene

    2011-01-01

    OBJECTIVE: Surgical-site infections are serious complications and thorough follow-up is important for accurate surveillance. We aimed to compare the frequency of complications recorded in a clinical quality database with those noted in a randomized clinical trial with follow-up visits. DESIGN......-operation, urinary tract infection, pneumonia and sepsis. RESULTS: Surgical-site infection was found in 21 of 222 patients (9.5%) in the PROXI trial versus 6 of 222 patients (2.7%) in the DGCD (p ... registered in the PROXI trial, but not in the DGCD. Agreements between secondary outcomes were very varying (kappa-value 0.77 for re-operation, 0.37 for urinary tract infections, 0.19 for sepsis and 0.18 for pneumonia). CONCLUSIONS: The randomized trial reported significantly more surgical-site infections...

  15. Comparative Investigation of Postoperative Complications in Patients With Gastroesophageal Junction Cancer Treated With Preoperative Chemotherapy or Surgery Alone

    DEFF Research Database (Denmark)

    Achiam, M P; Jensen, L.B.; Larsson, H.

    2016-01-01

    complications of patients with cancer at the gastroesophageal junction treated with either neoadjuvant chemotherapy or surgery alone in patients from "The Danish Clinical Registry of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach." MATERIALS AND METHODS: A historical follow-up study......BACKGROUND AND AIM: Gastroesophageal junction cancer is one of the leading causes to cancer-related death and the prognosis is poor. However, progress has been made over the last couple of decades with the introduction of multimodality treatment and optimized surgery. Three-year survival rates have...... of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach. No difference was found in demographics between the two groups, except for alcohol consumption and a lower T and N stage in the surgery-only group, and no difference in complication rates was found. Furthermore, no variable...

  16. Can postoperative process of care utilization or complication rates explain the volume-cost relationship for cancer surgery?

    Science.gov (United States)

    Ho, Vivian; Short, Marah N; Aloia, Thomas A

    2017-08-01

    Past studies identify an association between provider volume and outcomes, but less is known about the volume-cost relationship for cancer surgery. We analyze the volume-cost relationship for 6 cancer operations and explore whether it is influenced by the occurrence of complications and/or utilization of processes of care. Medicare hospital and inpatient claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Regressions were first estimated to quantify the association of provider volume with costs, excluding measures of complications and processes of care as explanatory variables. Next, these variables were added to the regressions to test whether they weakened any previously observed volume-cost relationship. Higher hospital volume is associated with lower patient costs for esophagectomy but not for other operations. Higher surgeon volume reduces costs for most procedures, but this result weakens when processes of care are added to the regressions. Processes of care that are frequently implemented in response to adverse events are associated with 14% to 34% higher costs. Utilization of these processes is more prevalent among low-volume versus high-volume surgeons. Processes of care implemented when complications occur explain much of the surgeon volume-cost relationship. Given that surgeon volume is readily observed, better outcomes and lower costs may be achieved by referring patients to high-volume surgeons. Increasing patient access to surgeons with lower rates of complications may be the most effective strategy for avoiding costly processes of care, controlling expenditure growth. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. [The relationship between the effectiveness and specific features of the early postoperative rehabilitation of the patients presenting with cholelithiasis].

    Science.gov (United States)

    Poddubnaya, O A; Marsheva, S I

    2015-01-01

    The objective of the early postoperative rehabilitation of the patients presenting with cholelithiasis is to prevent the further progression of the disease and reduce the risk of development of post-cholecystectomy disorders. The combined treatment including the use of low-mineralized mineral waters, magnetic, laser, and EHF-therapy makes it possible to significantly improve the parameters of interest due to the marked improve mentor normalization of the clinical and laboratory characteristics, the increase of adaptive capabilities, and the correction of the psycho-emotional and vegetative status of the patients. Taken together, the peculiarities of the combined rehabilitative treatment of the patients with cholelithiasis during the early postoperative period account for its high clinical effectiveness amounting to 94.7%. The results of the study give reason to recommend the application of the proposed technology for the rehabilitative treatment of the patients presenting with cholelithiasis.

  18. Dental complications of rickets in early childhood: case report on 2 young girls.

    Science.gov (United States)

    Davit-Béal, Tiphaine; Gabay, Julie; Antoniolli, Pauline; Masle-Farquhar, Jeanne; Wolikow, Maryse

    2014-04-01

    Vitamin D is an essential hormone for calcium gut absorption. It is also involved in child growth, cancer prevention, immune system responses, and tooth formation. Due to inadequate vitamin D intake and/or decreased sunlight exposure, vitamin D deficiency has resurfaced in developed countries despite known inexpensive and effective preventive methods. Vitamin D deficiency is a common cause of rickets, a condition that affects bone development in children and that can have serious dental complications. Deficiency during pregnancy can cause enamel hypoplasia of primary teeth. Enamel regeneration is currently impossible; hypoplasia is therefore irreversible, and once affected, teeth are prone to fast caries development. Deficiency during early childhood can affect permanent teeth and ensuing caries can sometimes lead to tooth loss at a young age. Oral manifestations of rickets should be diagnosed early by both physicians and dentists to prevent severe dental complications. This case study presents 2 young girls with rickets in early childhood who suffered from subsequent serious tooth decay.

  19. Postoperative pyrexia after arthroplasty - when to panic ?

    OpenAIRE

    Agarwala Sanjay; Jain Deepak; Bhagwat Abhijit

    2005-01-01

    Background: Success of arthroplasty is contingent on a clear understanding of the potential complications. Today with improved methods of sepsis control, incidence of joint sepsis has dropped to less than 2%. Despite this fever is still common in the early post-operative period. Methods: We reviewed 184 consecutive hip and knee replacement surgeries for incidence and clinical significance of post-operative fever. The cases were followed up for a period of over 3 to 5 years. Temperat...

  20. Musculoskeletal complications of acromegaly: what radiologists should know about early manifestations.

    Science.gov (United States)

    Tagliafico, A; Resmini, E; Ferone, D; Martinoli, C

    2011-08-01

    The purpose of this article is to summarise the early musculoskeletal complications of acromegaly. Some of the early signs of acromegaly may be evaluated by the musculoskeletal radiologist. In the early stage of disease, peripheral nerve enlargement associated with carpal tunnel syndrome or cubital tunnel syndrome and thickening of retinacula, such as A1 pulley in trigger finger, represent the features that may be seen by radiologists and are worthy of an endocrinological evaluation. Due to the insidious nature of the disease, the diagnosis of acromegaly is significantly delayed. Few and nonspecific symptoms characterise the initial phases of the disease, and therefore, most patients will have generally consulted many specialists (most frequently musculoskeletal radiologists) before an adequate endocrinological assessment is performed. For this reason, initial clinical signs are much more important than symptoms for an early diagnosis of acromegaly. The first and most important therapeutic approach to acromegaly is early diagnosis, whereas the therapeutic goals are to eliminate morbidity and reduce mortality to the expected age- and sex-adjusted rates and prevent the development of systemic complications. Musculoskeletal radiologists should be aware that these features may be early manifestations of acromegaly. When both radiological and clinical abnormalities are present, an endocrinological workup is useful to diagnose the disease in an early phase.

  1. Effect of early mobilization and rehabilitation on complications in aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Karic, Tanja; Røe, Cecilie; Nordenmark, Tonje Haug; Becker, Frank; Sorteberg, Wilhelm; Sorteberg, Angelika

    2017-02-01

    OBJECTIVE Early rehabilitation is effective in an array of acute neurological disorders but it is not established as part of treatment guidelines after aneurysmal subarachnoid hemorrhage (aSAH). This may in part be due to the fear of aggravating the development of cerebral vasospasm, which is the most feared complication of aSAH. The aim of this study was to evaluate the effect of early rehabilitation and mobilization on complications during the acute phase and within 90 days after aSAH. METHODS This was a prospective, interventional study that included patients with aSAH at the neuro-intermediate ward after aneurysm repair. The control group received standard treatment, whereas the early rehab group underwent early rehabilitation and mobilization in addition to standard treatment. Clinical and radiological characteristics of patients with aSAH, progression in mobilization, and treatment variables were registered. The frequency and severity of cerebral vasospasm, cerebral infarction acquired in conjunction with the aSAH, and acute and chronic hydrocephalus, as well as pulmonary and thromboembolic complications, were compared between the 2 groups. RESULTS Clinical and radiological characteristics of patients with aSAH were similar between the groups. The early rehab group was mobilized beginning on the first day after aneurysm repair. The significantly quicker and higher degree of mobilization in the early rehab group did not increase complications. Clinical cerebral vasospasm was not as frequent in the early rehab group and it also tended to be less severe. Each step of mobilization achieved during the first 4 days after aneurysm repair reduced the risk of severe vasospasm by 30%. Acute and chronic hydrocephalus were similar in both groups, but there was a tendency toward earlier shunt implantation among patients in the control group. Pulmonary infections, thromboembolic events, and death before discharge or within 90 days after the ictus were similar between the 2

  2. Epidemiological profile and postoperative complications of women undergoing gynecological surgery in a reference center in the northern brazilian legal amazon

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    Sônia Maria Coelho

    Full Text Available Objective: To evaluate the epidemiological profile and the operative complications of patients undergoing gynecological operations for benign diseases in a tertiary public hospital in the state of Roraima, Brazil. Methods: We conducted a retrospective survey through the analysis of 518 records of patients submitted to gynecological operations between January and June 2012. We included the three major operations during this period (n = 175: hysterectomy, colpoperineoplasty and suburethral sling placement. We excluded 236 cases of tubal ligation and 25 cases where it was not possible to access to medical records. Results: The mean age was 47.6 years; the education level of most patients was completed junior high (36.6%; 77% were from the State capital, 47.4% were in stable relationships and 26.3% were housewives. The majority of patients had given birth three or more times (86.6%, with previous vaginal delivery in 50.2%, and cesarean delivery, 21%. The main diagnostic indications for surgical treatment were uterine myoma (46.3%, urinary incontinence (27.4% and genital dystopias (17.7%. We found three cases (1.7% of high-grade intraepithelial lesions on Pap smear. The most common procedure was total hysterectomy (19.8%, 15.5% vaginally. The most common complication was wound infection (2.2%. Conclusion: Women undergoing gynecological operations due to benign disease had a mean age of 47 years, most had levels of basic education, came from the capital, were in stable relationships, predominantly housewives, multiparous and showed low operative complication rates.

  3. Early complications following oesophagectomy for cancer in relation to long-term healthcare utilisation: a prospective population-based cohort study.

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    Eva Doorakkers

    Full Text Available Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period.This was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390. Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR and 95% confidence intervals (CI.There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4. The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6, and 1.2 (95% CI 0.9-1.6 for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0 for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5 for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0 or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7 after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9 and (IRR 1.1, 95% CI 0.8-1.5 respectively.This study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.

  4. Neurovascular complications following carotid body paraganglioma resection.

    Science.gov (United States)

    Lamblin, E; Atallah, I; Reyt, E; Schmerber, S; Magne, J-L; Righini, C A

    2016-11-01

    The present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications. A retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (3.2cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months' follow-up; no predictive factors could be identified for this. Surgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Does effective postoperative pain management influence surgical morbidity?

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1999-01-01

    after major procedures. In lower body procedures, however, intra- and early postoperative pain relief with epidural or spinal anaesthesia reduces blood loss and thromboembolic complications. It is hypothesized that effective postoperative pain relief may significantly improve outcome only if integrated......It has been assumed that adequate postoperative pain relief will improve outcome from surgery, but several controlled trials have demonstrated that pain treatment with nonsteroidal anti-inflammatory drugs, patient-controlled analgesia or epidural techniques will not significantly improve outcome...

  6. Left atrial volume index as a predictor for persistent left ventricular dysfunction after aortic valve surgery in patients with chronic aortic regurgitation: the role of early postoperative echocardiography.

    Science.gov (United States)

    Cho, In-Jeong; Chang, Hyuk-Jae; Hong, Geu-Ru; Heo, Ran; Sung, Ji Min; Lee, Sang-Eun; Chang, Byung-Chul; Shim, Chi Young; Ha, Jong-Won; Chung, Namsik

    2015-06-01

    This study aimed to explore whether echocardiographic measurements during the early postoperative period can predict persistent left ventricular systolic dysfunction (LVSD) after aortic valve surgery in patients with chronic aortic regurgitation (AR). We prospectively recruited 54 patients (59 ± 12 years) with isolated chronic severe AR who subsequently underwent aortic valve surgery. Standard transthoracic echocardiography was performed before the operation, during the early postoperative period (≤2 weeks), and then 1 year after the surgery. Twelve patients with preoperative LVSD demonstrated LVSD at early after the surgery. Of the 42 patients without LVSD at preoperative echocardiography, 15 patients (36%) developed early postoperative LVSD after surgical correction. All 27 patients without LVSD at early postoperative echocardiography maintained LV function at 1 year after surgery. In the other 27 patients with postoperative LVSD, 17 patients recovered from LVSD and 10 patients did not at 1 year after surgery. Multiple logistic analysis demonstrated that postoperative left atrial volume index (LAVI) was the only independent predictor for persistent LVSD at 1 year after surgery in patients with postoperative LVSD (OR 1.180, 95% CI, 1.003-1.390, P = 0.046). The optimal LAVI cutoff value (>34.9 mL/m(2) ) had a sensitivity of 80% and a specificity of 88% for the prediction of persistent LVSD. Prevalence of early postoperative LVSD was relatively high, even in the patients without LVSD at preoperative echocardiography. Postoperative LAVI could be useful to predict persistent LVSD after aortic valve surgery in patients with early postoperative LVSD. © 2014, Wiley Periodicals, Inc.

  7. Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies

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    Babak Amra

    2014-01-01

    Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.

  8. Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery.

    Science.gov (United States)

    Lonky, Neal M; Mohan, Yasmina; Chiu, Vicki Y; Park, Jeanna; Kivnick, Seth; Hong, Christina; Hudson, Sharon M

    2017-08-01

    To examine variables associated with hysterectomy-related complications, relative to surgical approach and other variables, that lead to readmission within 90 days of surgery. We conducted an observational cohort study for which data were extracted from electronic health records. Data were extracted of all patients (n = 3106) who underwent hysterectomies at 10 Kaiser Permanente Southern California medical centers between June 2010 and September 2011. Patients who were pregnant or had a cancer diagnosis were excluded from the study. To identify univariate associations between examined variables and procedure type, chi-square tests for categorical variables and t-tests or analysis of variance for continuous variables were used. Generalized estimating equations methods were used to test associations between independent variables and primary outcomes of interest. Statistical significance was determined using a p-value variables associated with an increased risk for readmission included high estimated blood loss (201-300 mL and 301+ mL, relative to 0-50 mL; odds ratio = 2.28, confidence interval = 1.24-4.18 and odds ratio = 2.63, confidence interval = 1.67-4.14) and long length of stay of 3 days or more (relative to 0 days; odds ratio = 2.93, confidence interval = 1.28-6.69). Pelvic specimen weight in the 151-300 g and 501+ g ranges appeared protective (odds ratio = 0.40, confidence interval = 0.25-0.64 and odds ratio = 0.54, confidence interval = 0.33-0.90). In a sub-analysis of 1294 patients, 74 hospital operative complications directly related to hysterectomy were identified among 59 patients. The most common hospital operative complications were excessive bleeding associated with surgery or injury to nearby structures. Among the sub-sample of 1294 patients, those with hospital operative complications were more likely to experience post-operative complications that lead to readmission (odds ratio = 3

  9. Familial liability, obstetric complications and childhood development abnormalities in early onset schizophrenia: a case control study

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    Lucarelli Elisabetta

    2011-04-01

    Full Text Available Abstract Background Genetic and environmental risk factors and gene-environment interactions are linked to higher likelihood of developing schizophrenia in accordance with the neurodevelopmental model of disease; little is known about risk factors and early development in early-onset schizophrenia (EOS and very early-onset schizophrenia (VEOS. Methods We present a case-control study of a sample of 21 patients with EOS/VEOS and a control group of 21 patients with migraine, recruited from the Child Neuropsychiatry Unit, Department of Neurologic and Psychiatric Science, University of Bari, Italy. The aim was to assess the statistical association between VEOS/EOS and family history for psychiatric disorders, obstetric complications and childhood developmental abnormalities using 2 × 2 tables and a Chi Squared or Fisher test. Results The results show a statistical association between EOS/VEOS and schizophrenia and related disorders (P = 0.02 and personality disorders (P = 0.003 in relatives, and between EOS/VEOS and developmental abnormalities of early relational skills (P = 0.008 and learning (P = 0.04; there is not a statistically relevant difference between cases and controls (P > 0.05 for any obstetric complications (pre, peri and postpartum. Conclusions This study confirms the significant role of familial liability but not of obstetric complications in the pathogenesis of VEOS/EOS; the association between childhood developmental abnormalities and EOS/VEOS supports the neurodevelopmental model of disease.

  10. Prevention Strategies of Pituitary Tumor Surgery and Postoperative Complications%垂体瘤手术与术后并发症的防治策略

    Institute of Scientific and Technical Information of China (English)

    陈爱明

    2016-01-01

    Objective Explore pituitary tumor surgery, treatment and prevention methods of postoperative complications.Methods 20 patients diagnosed as pituitary tumor surgery patients in parallel, take transsphenoidal surgery under a microscope to analyze the effect of surgery and postoperative complications.Results The group of 20 patients with total resection of 13 cases, accounting for 65.0%, partially cut two cases, accounting for 10.0%, subtotal ifve cases, accounting for 25.0%, diabetes insipidus, electrolyte imbalance, decreased vision in 1 case, 1 case of hypopituitarism, cerebrospinal fluid rhinorrhea one case, two cases of other complications.Conclusion Microscope Transsphenoidal treatment of pituitary tumor effect is remarkable, relieve symptoms signiifcantly higher total resection rate, fewer complications, can be used as the ifrst choice of treatment.%目的:探究垂体瘤手术的治疗效果及术后并发症的防治方法。方法选择20例诊断为垂体瘤并行手术的患者,采取显微镜下经蝶入路手术治疗,分析手术效果及术后并发症情况。结果本组20例患者全切13例,占65.0%,部分切2例,占10.0%,次全切5例,占25.0%;尿崩症、电解质紊乱、视力下降各1例,垂体功能低下1例,脑脊液鼻漏1例,其他并发症2例。结论显微镜经蝶入路手术治疗垂体瘤效果显著,患者的症状缓解显著,全切率较高,并发症少,可作为治疗的首选方案。

  11. Postoperative pulmonary complications in elderly patients with lung cancer:Possible reasons And preventive nursing Interventions%老年肺癌患者术后肺部并发症原因分析及围手术期的护理干预

    Institute of Scientific and Technical Information of China (English)

    靳海荣

    2011-01-01

    目的 探讨老年肺癌患者围手术期肺部并发症预防的原因及护理干预方法.方法 通过肺部并发症原因分析对88例肺癌手术治疗患者,进行术前戒烟教育、肺功能锻炼、有效咳嗽指导、控制原发病、上呼吸道清洁、心理护理,及术后早期活动、协助排痰、湿化气道、镇痛、病室空气消毒等.结果 88例患者均痊愈出院,无术后肺部并发症的发生.结论 通过对老年肺癌患者手术肺部并发症原因分析有针对性地进行围手术期并发症的护理干预,减少了肺部并发症的发生,促进了患者康复.%Objective To explore possible reasons and preventive nursing interventions for postoperative pulmonary complications in elderly patients with lung cancer. Methods Eighty-eight elderly patients with lung cancer, who had received surgery treatment, were analyzed. Nursing interventions were conducted including preoperative smoking giving-up, pulmonary rehabilitation, medicine treatment for primary disease, upper pulmonary tract cleaning, mental nursing, as well as postoperative early physical activities, sputum cleaning, steam inhalation, pain control and ward sterilization, etc. Results All patients recovered without any postoperative pulmonary complications. Conclusions Many reasons are related to postoperative pulmonary complications in elderly patients. Perioperative nursing interventions will be effective to prevent postoperative pulmonary complications.

  12. Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer

    Institute of Scientific and Technical Information of China (English)

    Guiping Yu; Guoqiang Chen; Bin Huang; Wenlong Shao; Guangqiao Zeng

    2013-01-01

    Objective:To explore the effect of early enteral nutrition (EN) on postoperative nutritional status,intestinal permeability,and immune function in elderly patients with esophageal cancer or cardiac cancer.Methods:A total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study.They were divided into EN group (n=50) and parenteral nutrition (PN) group (n=46) based on the nutrition support modes.The body weight,time to first flatus/defecation,average hospital stay,complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed.Peripheral blood samples were collected on the days 1,4 and 7 after surgery.The plasma diamine oxidase (DAO) activity and D-lactate level were determined to assess the intestinal permeability.The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier.The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzymelinked immunosorbent assay (ELISA).Results:After the surgery,the time to first flatus/defecation,average hospital stay,and complications were significandy less in the EN group than those in the PN group (P<0.05),whereas the EN group had significantly higher albumin levels than the PN group (P<0.05).On the 7th postoperative day,the DAO activity,D-lactate level and endotoxin contents were significantly lower in the EN group than those in the PN group (all P<0.05).In addition,the EN group had significantly higher IgA,IgG,IgM,and CD4 levels than the PN group (P<0.05) but significantly lower IL-2,IL-6,and TNF-α levels (P<0.05).Conclusions:In elderly patients with esophageal cancer or cardiac cancer,early EN after surgery can effectively improve the nutritional status,protect intestinal mucosal barrier (by reducing plasma endoxins),and enhance the

  13. The importance of early diagnosis and treatment of kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon

    Science.gov (United States)

    Vivas-Colmenares, Grecia V.; Ramirez-Villar, Gema L.; Bernabeu-Wittel, Jose; Matute de Cardenas, Jose A.; Fernandez-Pineda, Israel

    2015-01-01

    Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor that may be complicated by Kasabach-Merritt phenomenon (KMP), a profound thrombocytopenia resulting from platelet trapping within a vascular tumor, either KHE or tufted angioma (TA). Typical features also include low fibrinogen and elevated D-dimers. It is well known that KMP is not caused by infantile hemangiomas. Management of vascular tumors complicated by KMP is challenging, and it is common for referral centers to receive patients in critical medical condition after multimodality treatment failure of vascular anomalies. Our aim is to communicate the importance of early diagnosis and treatment of KHE associated with KMP. A full-term male newborn with KHE complicated by KMP is reported. Treatment with vincristine, aspirin and ticlopidine normalized the coagulation parameters within one week, requiring a total of six doses of vincristine, seven months of ticlopidine and 17 months of aspirin. Early diagnosis and treatment of KHE complicated by KMP may allow the administration of fewer doses of vincristine and avoid the use of corticosteroids. PMID:25692091

  14. Comparison of Treatment Outcomes of Surgical Repair in Inguinal Hernia with Classic versus Preperitoneal Methods on Reduction of Postoperative Complications

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    Hormoz Mahmoudvand

    2017-01-01

    Full Text Available Background. This study aims to evaluate and compare the results of inguinal herniorrhaphy with mesh in classic and preperitoneal method. Methods. Our study community includes 150 candidate patients for inguinal herniorrhaphy with mesh. Totally, 150 candidate patients for inguinal herniorrhaphy were randomly divided into two groups: (1 classic group in which the floor of the canal was repaired and the mesh was located on the floor of the canal and (2 preperitoneal group in which the mesh was installed under the canal and then the floor was repaired. Results. The frequency of recurrence was 10 (13.3% and 2 (2.66% in the classic and preperitoneal group, respectively. The frequency of postsurgical pain was 21 (28% in the classic group and 9 (12% in the preperitoneal group. The postsurgical hematoma was observed in 7 (9.3% and 9 (12% in the classic and preperitoneal group, respectively. Also, the frequency of postsurgical seroma was 8 (10.7% and 1 (1.3% in the patients treated with the classic and preperitoneal method, respectively. Conclusion. The findings of the present study demonstrated that the preperitoneal method is a more suitable method for inguinal herniorrhaphy than the classic one because of fewer complications, according to the findings of this study.

  15. Rhinogenic intracranial complication with postoperative frontal sinus pyocele and inverted papilloma in the nasal cavity: A case report and literature review

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    Michitsugu Kawada

    2016-02-01

    Full Text Available We report a patient who had rhinogenic intracranial complication with postoperative frontal sinus pyocele and inverted papilloma in the nasal cavity. A 72-year-old woman had undergone surgery for frontal sinusitis via external incision at another hospital 13 years previously. Left-sided hemiparesis appeared in the patient and gradually worsened. Five days later, she exhibited disorientation, abnormal behavior, poor articulation, and difficulty in standing. Therefore, she was taken to the neurosurgery department by ambulance. An extensive frontal sinus pyocele was suspected, and a cerebral abscess and edema of the frontal lobe were observed on magnetic resonance imaging. After antibiotics, steroid and glycerol were administered for a few weeks; disorientation and left hemiparesis improved. Next, craniotomy for complete removal of the brain abscess by neurosurgeons and endoscopic endonasal surgery by otolaryngologists were carried out at the same surgery. From the analysis of the pathological mucosa sample taken from the right ethomoidal sinus during surgery, an inverted papilloma was diagnosed. The patient completely recovered and is currently receiving follow-up examination. Regarding rhinogenic intracranial complications, ascertaining clinical condition in order to determine the need for either immediate radical surgery, or for curative surgery after waiting for improvement of the overall body condition by conservative management, is still needed.

  16. Rhinogenic intracranial complication with postoperative frontal sinus pyocele and inverted papilloma in the nasal cavity: A case report and literature review

    Science.gov (United States)

    Kawada, Michitsugu; Yokoi, Hidenori; Maruyama, Keisuke; Matsumoto, Yuma; Yamanaka, Hidetaka; Ikeda, Tetsuya; Shiokawa, Yoshiaki; Saito, Koichiro

    2016-01-01

    We report a patient who had rhinogenic intracranial complication with postoperative frontal sinus pyocele and inverted papilloma in the nasal cavity. A 72-year-old woman had undergone surgery for frontal sinusitis via external incision at another hospital 13 years previously. Left-sided hemiparesis appeared in the patient and gradually worsened. Five days later, she exhibited disorientation, abnormal behavior, poor articulation, and difficulty in standing. Therefore, she was taken to the neurosurgery department by ambulance. An extensive frontal sinus pyocele was suspected, and a cerebral abscess and edema of the frontal lobe were observed on magnetic resonance imaging. After antibiotics, steroid and glycerol were administered for a few weeks; disorientation and left hemiparesis improved. Next, craniotomy for complete removal of the brain abscess by neurosurgeons and endoscopic endonasal surgery by otolaryngologists were carried out at the same surgery. From the analysis of the pathological mucosa sample taken from the right ethomoidal sinus during surgery, an inverted papilloma was diagnosed. The patient completely recovered and is currently receiving follow-up examination. Regarding rhinogenic intracranial complications, ascertaining clinical condition in order to determine the need for either immediate radical surgery, or for curative surgery after waiting for improvement of the overall body condition by conservative management, is still needed. PMID:27489711

  17. Role of obesity and abdominal shape morphometric features to predict postoperative complications and quality of lymph node dissection of gastrectomy for gastric cancer.

    Science.gov (United States)

    HasbahcecI, M; MehdI, E; Malya, F U; Kunduz, E; MemmI, N; YIgman, S; Akcakaya, A

    2017-09-12

    Obesity and abdominal shape morphometric features have been thought to be independent risk factors for surgical outcomes after gastrectomy.A total of 113 patients undergoing surgery for primary gastric adenocarcinoma from June 2011 to January 2015 were retrospectively included. Body mass index, visceral fatty area, anterior-posterior abdominal and transverse diameters and depth ratio at levels of the umbilicus, the gastroesophageal junction and the root of the celiac artery were measured or calculated. Patients were grouped according to body mass index (<25.0 kg/m2or ≥25.0 kg/m2) or median value of these parameters. Surgical outcomes including postoperative complications, total and metastatic lymph node numbers and their ratio were compared.There was a significant association between body mass index and abdominal shape indexes. Body mass index and abdominal shape indexes showed no statistical significance on development of complications. But, lymph node numbers and their ratio were negatively affected by depth ratio at the root of the celiac artery.Our findings showed that gastrectomy with curative intent can be performed safely in patients with higher body mass index and abdominal shape indexes. Therefore, there is no need to perform any change in surgical strategy according to these measurements and calculations.

  18. A Meta-Analysis for Postoperative Complications in Tibial Plafond Fracture: Open Reduction and Internal Fixation Versus Limited Internal Fixation Combined With External Fixator.

    Science.gov (United States)

    Wang, Dong; Xiang, Jian-Ping; Chen, Xiao-Hu; Zhu, Qing-Tang

    2015-01-01

    The treatment of tibial plafond fractures is challenging to foot and ankle surgeons. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. However, conclusions regarding the superior choice remain controversial. The present meta-analysis aimed to quantitatively compare the postoperative complications between open reduction and internal fixation and limited internal fixation combined with an external fixator for tibial plafond fractures. Nine studies with 498 fractures in 494 patients were included in the present study. The meta-analysis found no significant differences in bone healing complications (risk ratio [RR] 1.17, 95% confidence interval [CI] 0.68 to 2.01, p = .58], nonunion (RR 1.09, 95% CI 0.51 to 2.36, p = .82), malunion or delayed union (RR 1.24, 95% CI 0.57 to 2.69, p = .59), superficial (RR 1.56, 95% CI 0.43 to 5.61, p = .50) and deep (RR 1.89, 95% CI 0.62 to 5.80) infections, arthritis symptoms (RR 1.20, 95% CI 0.92 to 1.58, p = .18), or chronic osteomyelitis (RR 0.31, 95% CI 0.05 to 1.84, p = .20) between the 2 groups. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. 部分脾动脉栓塞术后并发症的原因及护理%Nursing for postoperative complications from partly splenic artery embolization

    Institute of Scientific and Technical Information of China (English)

    顾萍

    2008-01-01

    目的 探讨部分脾动脉栓塞术(PSE)后并发症的发生原因及其护理.方法 18例肝炎后肝硬化、门脉高压继发脾功能亢进患者,在DSA引导下,将5FRH型或Cobra型导管经股动脉穿刺选择性地插入脾动脉内,用1 mm×1 mm×1 mm明胶海绵块60~120枚与抗菌素和造影剂混合后,在透视监视下分次注入脾动脉.术后1、2、3、4周和半年复查血常规、肝功能、血尿淀粉酶、脾脏B超或CT.结果 术后并发症包括发热、腹痛、胸水、腹水、顽固性呃逆、脾脓肿、肝肾功能损害、门静脉血栓、左下肺炎等.结论 掌握脾栓塞术后并发症发生的原因,给予及时准确的护理,可以减少或避免并发症的发生,提高手术成功率.%Objective To investigate the causes of the postoperative complications from partial splenic cmbolization (PSE) and make the nursing measures.Methods 18 patients with secondary hypersplenism due to posthepatitic cirrhosis and portal hypertension,5F RH type or Cobra catheter was placed selectively into splenic artery through femoral artery by DSA fluoroscopy.60~120 masses of 1 mm×1 mm×1 mm gelfoam mixed with antibiotic and conmist medium were injected fractionally.The routine blood test,hepatic function,serum amylase,urinary amylase,Bmode ultrasonic or CT scan on spleen were tested regularly in week 1,week 2,week 3,week 4 and half-year after PSE.Results The Postoperative Complicatiorm iuchded fever,abdom inal pain,pleural effusion,ascites pertinacions hiccup,splenic abscess impairment of liver and renal function,portal thrombosis left-lower pneumonia and so on.Conclusion Mastering the causes of the complications related to PSE and giving accurate nursing in time may decrease or avoid the incidence of complications and increase the succeas ratio of operation.

  20. A comparative study of postoperative complications of lightweight mesh and conventional prolene mesh in Lichtenstein hernia repair

    Directory of Open Access Journals (Sweden)

    Gugri Mukthinath

    2016-06-01

    Full Text Available Background: Inguinal hernia repair is the most frequently performed operation in any general surgical unit. The complications of using the mesh has been the rationale to examine the role of mesh in hernia repair in detail and to begin investigating the biocompatibility of different mesh modifications and to challenge old mesh concepts. Therefore the present study is undertaken to compare the lightweight mesh (Ultrapro with conventional prolene mesh in lichtenstein hernia repair. Methods: Thirty one patients with primary unilateral inguinal hernia was subjected either to lightweight mesh Lichtenstein's hernioplasty or standard prolene mesh Lichtenstein's hernioplasty. The patients were followed in the surgical OPD at 1 month, 6 months and 1 year for time taken to return to normal activities, chronic groin pain, foreign body sensation, seroma formation and recurrence. Results: Chronic pain among patients in standard prolene mesh group at 1 month, 6 month, and 1 year follow up was seen in 45.2%, 16% and 3.2% of the patients respectively, in light weight mesh group patients at 1 month, 6 month and 1 year follow up was 32.2%, 6.4% and none at one year respectively. Foreign body sensation in the light weight mesh group is significantly less compared to patients in standard prolene mesh group. Time taken to return to work was relatively shorter among patients in Light weight mesh group. There was no recurrence in both groups. Conclusion: Light weight mesh is an ideal choice in Lichenstein's hernioplasty whenever feasible. [Int J Res Med Sci 2016; 4(6.000: 2130-2134

  1. Modified radical mastectomy sparing one or both pectoral muscles in the treatment of breast cancer: intra and postoperative complications

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    Ruffo Freitas-Júnior

    Full Text Available CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle and the Patey technique (resection of this muscle. The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden. The chi-squared and Student t tests were used for analysis. RESULTS: The patients’ demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (± 29.9 and 102 minutes (± 33, for the Patey and Madden groups, respectively (p = 0.6. Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (± 7.6 for Patey and 19.8 (± 8.1 for Madden (p = 0.5. There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon’s discretion.

  2. Evidence-based nursing on prevention of postoperative complications of cesarean section%剖宫产术后并发症预防的循证护理

    Institute of Scientific and Technical Information of China (English)

    王丹

    2013-01-01

    目的 将循证护理应用于剖宫产术后并发症预防,促进患者康复.方法 通过对453例剖宫产患者的实际情况进行分析,应用计算机网络检索有关文献,查阅相关资料,寻找证据,对资料的可靠性,实用性进行分析、评价,并将所获得的证据和护理专业技能、临床经验、患者的愿望和需求相结合,制定并实施护理方案.结果 本研究453例剖宫产患者,经过循证后实施有针对性的护理措施,392例患者术后未出现并发症,59例患者经循证护理恢复正常,1例发生术后子痫,l例发生脂肪液化,2例心脏病(患者术前本身疾病),经积极对症处理病情基本平稳.结论 通过对剖宫产患者术后的循证护理实践,促进护士自觉寻找具有科学依据的护理实证来指导工作,对产后可能出现的不良反应及并发症采取措施进行干预,预防和减少不良反应及并发症的发生,保证了患者的安全和治疗效果.%Objective To explore the evidence-based nursing on prevention of surgical complications for cesarean section women,and promote the patient rehabilitation.Methods Based on the actual situation analysis of 453 cases with cesarean section,retrieved relevant literature,referred to the relevant material,looking for the evidence of reliability of the data and practical analysis,reviews,and nursing professional skills,clinical experience,patients' desire and demand for the integration of the formulation and implementation of care plan.Results Among 453 cases,after the implementation of evidence-based nursing measures targeted,392 patients with no postoperative complications,59 cases of patients with postoperative complications,1 case of postoperative eclampsia,1 cases of fat liquefaction,2 cases of heart disease (preoperative patients with the disease itself).Conclusions Evidence-based nursing is valuable,reliable scientific research results,which can reduce the adverse reaction and the complications

  3. [Combined cataract-glaucoma surgery with deep sclerectomy. An alternative to gonio-trephination in the intra- and early postoperative phases].

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    Mohr, A; Rais, M; Eckardt, C

    2001-03-01

    We examined the value of deep sclerectomy combined with phacoemulsification as a surgical technique in the peri- and postoperative phases. Deep sclerectomy with phacoemulsification was carried out in 18 patients. Mean postoperative follow-up was 7.5 weeks. Deep sclerectomy was more difficult to perform than goniotrephination. We observed neither fibrin reaction nor hypotonic dysregulation (intraocular pressure, IOP, < 8 mmHg). Five patients required additional pressure-lowering drugs during postoperative IOP regulation. We consider the low inflammatory response in the early postoperative phase to outweigh the greater surgical difficulty and prolonged surgery time. Further studies must verify whether higher IOP during the early postoperative phase is sufficient for good long-term IOP regulation.

  4. The Effect of Early Complications on Flap Selection on Sacral Pressure Sores

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    Musa Kemal Keleş

    2017-06-01

    Full Text Available Objective: Pressure sores occur in bedridden patients in intensive care units, clinics, and even at their own places. Care for sick relatives and working with doctors to address treatment options and ensure proper follow-up are some of the problems associated with these types of wounds. Surgical therapy in the treatment of pressure ulcers is associated with significant complications. In comparison to non-surgical treatment, surgical treatment has a low complication rate and is more cost-effective. The surgical treatment enables the patients to return to their social life sooner than non-surgical treatment. Patient's ability to early return to their social life is advantageous in terms of reducing morbidity and the need for additional operations. This study is aimed to review the flap choices used to treat sacral pressure sores and the resulting acute complications rates retrospectively. Material and Methods: Patients treated for stage 3 and stage 4 sacral pressure sores in our clinic in the past 5 years were included in the study. Patient records were analyzed retrospectively. Patients' demographic data and surgical treatment they received were documented. Surgical method and surgical outcomes were evaluated and early complication rates were determined. Result: Fifty patients were included in the study; 10 of them were female, 40 of were male cases. The most common causative agent was paraplegia after traffic accident. Conclusion: A significant difference was not observed between the type of flap used in the surgical treatment and the rate of complications. Consequently, the surgical treatment of pressure ulcers in the sacral region depends on the patient's individual situation, the cooperation of the family, and previously applied treatments

  5. Severe dengue in the early postoperative period after kidney transplantation: two case reports from Hospital Geral de Fortaleza

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    Samuelson Hugo Félix Maia

    2015-12-01

    Full Text Available Abstract: Dengue is an arbovirosis that ranges from an asymptomatic presentation to a more severe disease, which is characterized by a vascular leakage syndrome where abdominal pain is a major symptom. Transplant recipients are immunosuppressed and are less likely to develop a severe form of the disease because of a reduction in immune-mediated responses that trigger plasma extravasation events. Herein, we report two cases of severe dengue in the early postoperative period of two kidney transplant recipients. Considering the severity of the cases, we emphasize the importance of dengue screening immediately before transplantation in areas endemic for the disease.

  6. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study

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    Asteriou, Christos; Lazopoulos, Achilleas; Rallis, Thomas; Gogakos, Apostolos S; Paliouras, Dimitrios; Tsakiridis, Kosmas; Zissimopoulos, Athanasios; Tsavlis, Drosos; Porpodis, Konstantinos; Hohenforst-Schmidt, Wolfgang; Kioumis, Ioannis; Organtzis, John; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Barbetakis, Nikolaos

    2016-01-01

    Background Video-assisted thoracic surgery (VATS) has been shown to effectively reduce postoperative pain, enhance mobilization of the patients, shorten in-hospital length of stay, and minimize postoperative morbidity rates. The aim of this prospective study is to evaluate neuroendocrine and respiratory parameters as stress markers in cancer patients who underwent lung wedge resections, using both mini muscle-sparing thoracotomy and VATS approach. Methods The patients were randomly allocated into two groups: Group A (n=30) involved patients who were operated on using the VATS approach, while in group B (n=30), the mini muscle-sparing thoracotomy approach was used. Neuroendocrine and biological variables assessed included blood glucose levels, C-reactive protein (CRP) levels, cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) levels. Arterial oxygen (PaO2) and carbon dioxide (PaCO2) partial pressure were also evaluated. All parameters were measured at the following time points: 24 hours preoperatively (T1), 4 hours (T2), 24 hours (T3), 48 hours (T4), and 72 hours (T5), after the procedure. Results PaO2 levels were significantly higher 4 and 24 hours postoperatively in group A vs group B, respectively (T2: 94.3 vs 77.9 mmHg, P=0.015, T3: 96.4 vs 88.7 mmHg, P=0.034). Blood glucose (T2: 148 vs 163 mg/dL, P=0.045, T3: 133 vs 159 mg/dL, P=0.009) and CRP values (T2: 1.6 vs 2.5 mg/dL, P=0.024, T3: 1.5 vs 2.1 mg/dL, P=0.044) were found increased in both groups 4 and 24 hours after the procedure. However, their levels were significantly lower in the VATS group of patients. ACTH and cortisol values were elevated immediately after the operation and became normal after 48 hours in both groups, without significant difference. Postoperative epinephrine levels measured in group A vs group B, respectively, (T2: 78.9 vs 115.6 ng/L, P=0.007, T3: 83.4 vs 122.5 ng/L, P=0.012, T4: 67.4 vs 102.6 ng/L, P=0.021). The levels were significantly higher in group B. Conclusion This

  7. Postoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy†.

    Science.gov (United States)

    Agostini, Paula; Lugg, Sebastian T; Adams, Kerry; Vartsaba, Nelia; Kalkat, Maninder S; Rajesh, Pala B; Steyn, Richard S; Naidu, Babu; Rushton, Alison; Bishay, Ehab

    2017-06-01

    : Video-assisted thoracoscopic surgical (VATS) lobectomy is increasingly used for curative intent lung cancer surgery compared to open thoracotomy due to its minimally invasive approach and associated benefits. However, the effects of the VATS approach on postoperative pulmonary complications (PPC), rehabilitation and physiotherapy requirements are unclear; our study aimed to use propensity score matching to investigate this. Between January 2012 and January 2016 all consecutive patients undergoing lobectomy via thoracotomy or VATS were prospectively observed. Exclusion criteria included VATS converted to thoracotomy, re-do thoracotomy, sleeve/bilobectomy and tumour size >7 cm diameter (T3/T4). All patients received physiotherapy assessment on postoperative day 1 (POD1), and subsequent treatment as deemed appropriate. PPC frequency was measured daily using the Melbourne Group Scale. Postoperative length of stay (LOS), high dependency unit (HDU) LOS, intensive therapy unit (ITU) admission and in-hospital mortality were observed. Propensity score matching (PSM) was performed using previous PPC risk factors (age, ASA score, body mass index, chronic obstructive pulmonary disease, current smoking) and lung cancer staging. Over 4 years 736 patients underwent lobectomy with 524 remaining after exclusions; 252 (48%) thoracotomy and 272 (52%) VATS cases. PSM produced 215 matched pairs. VATS approach was associated with less PPC (7.4% vs 18.6%; P  < 0.001), shorter median LOS (4 days vs 6; P  < 0.001), and a shorter median HDU LOS (1 day vs 2; P  = 0.002). Patients undergoing VATS required less physiotherapy contacts (3 vs