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PubMed1996

[Surgical procedures and intra-operative management to prevent postoperative complications following resection of esophageal cancer].

To prevent postoperative complications following resection of an esophageal cancer, the nerves and vessels related to the cardiopulmonary function should be preserved as far as possible. Preservation of the right bronchial artery, the pulmonary branches of the right vagus nerve, the thoracic duct, the azygos vein, the inferior thyroidal artery, and the paratracheal sheath decreases the incidence of pulmonary distress syndrome and of tracheobronchial ischemic lesions. In patients whose vessels and nerves are resected together with a locally advanced tumor, reinforcement of the tracheal membrane using a gastric pedicle or lattisimus dorsi muscle flap, or a two-staged operation is recommended. So as not to injure the recurrent nerves, use of a tracheal retractor and taping of the left recurrent nerve are recommended. Also, the phrenic nerves should be found in the deep cervical fascia before dissection of the supraclavicular nodes and should be preserved.

Esophageal Neoplasms↗
PubMed1994

Postoperative complications of subconjunctival THC-YAG (Holmium) laser sclerostomy.

BACKGROUND: The THC-YAG (Holmium) laser is currently being used to create thermal sclerostomies, an alternate method of intraocular pressure control with poorly regulated glaucoma. A significant advantage of this procedure is the ab externo approach, which utilizes a small fiberoptic laser probe that is advanced subconjunctivally to the limbus. Surgical intraocular trauma is minimized, decreasing the amount of scarring and ultimate bleb failure. Complications may be seen with the THC-YAG sclerostomy and include: conjunctival burn, filtration bleb leak, posterior corneal striae, peaked pupil, iris incarceration, infection, hyphema, cataracts and ocular hypotony. METHODS: This paper presents four glaucoma patients, co-managed at the Illinois Eye Institute, who developed complications following THC-YAG laser sclerostomy. A discussion of other possible postoperative complications and their management is included. RESULTS: While the holmium laser has shown positive results in lowering intraocular pressure in patients with uncontrolled refractory glaucoma, complications are inherent in this procedure. The most common are posterior corneal striae, iris incarceration with secondary peaked pupil, and ocular hypotony. Conjunctival burn with secondary filtration bleb leak, limbal pigment deposition and hyphema may also be seen. CONCLUSION: Early diagnosis and treatment of postoperative complications may help in maintaining the long term filtration ability of the sclerostomy.

Aged↗
PubMed2005

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

OBJECTIVES: 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. DESIGN: Prospective observational cohort study. SETTING: University teaching hospital. PARTICIPANTS: 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged < 60; those with periprosthetic fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery. INTERVENTIONS: Routine care for hip fractures. MAIN OUTCOME MEASURES: Postoperative complications and mortality at 30 days and one year. RESULTS: 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). CONCLUSIONS: 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.

Age Distribution↗
PubMed1988

Risk factors in relation to postoperative complications in patients undergoing esophagectomy or gastrectomy for cancer.

To clarify the risk factors contributing to postoperative complications in the elderly patients (over 70 years) undergoing esophagectomy and/or gastrectomy, 364 patients with primary cancer seen were evaluated. As a result, some characteristic patterns of stress response in the elderly could be detected as follows: the disorders of the vital organs were more important indices for the development of postoperative complications rather than age, and a reduction in the maximum response of the stress hormones to surgical procedures in aged patients was noted; moreover, the functional variability of target organ in the aged group was confirmed. Studies on the hormonal response to surgery suggest that the restriction of fluid replacement is advisable until the third postoperative day, maintaining the host on the dry side, to prevent cardiopulmonary complications. As the nutritional status in the patients with esophageal and gastric cancer goes from bad to worse with the advancing clinical stages, adequate perioperative nutrition is imperative to prevent complications such as anastomotic leakage, wound dehiscence, and/or infections. For the treatment of anastomotic leaks after esophagectomy and esophagogastrectomy, more than 45 kcal/kg/d must be provided, and the serum albumin level must be restored to 3.5 g/dL in order to achieve spontaneous healing of small anastomotic leakages.

Adult↗
PubMed1989

Intra- and postoperative complications in lumbar disc surgery.

In a prospective study, 412 primary and 69 reoperations for herniated lumbar disc were observed and intra- and postoperative complications compiled. Only surgeons with the experience of more than 100 surgical procedures on lumbar discs entered this study. The complication rates of the micro- and macrosurgical techniques are compared. Intraoperative complications range from 7.8% in the microdiskectomies and 13.7% in the macrodiskectomies to 27.5% in the reoperations. Postoperative complications range from 1.4% in reoperation, 3.9% in the microdiskectomies up to 4.2% in the macrodiskectomies. The risk of complications correlates with the age of the patient and the operating time.

Adult↗
PubMed2003

[The effect of pelvic and paraaortic lymphadenectomy on intensity of pain and intraoperative and postoperative complications].

OBJECTIVES: The aim of the study was the estimation of effect of pelvic and paraaortic lymphadenectomy on intensity of pain complains, and comparison of quantity of intraoperative and postoperative complications in groups of patients subjected and not subjected the lymphadenectomy. MATERIAL AND METHODS: We studied to 80 patients divided into two groups: 40 people with endometrial cancer, who were treated with total abdominal hysterectomy, salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy; and 40 people with uterine myomas or benign neoplasms of uterine adnexa, who were treated with abdominal hysterectomy and salpingo-oophorectomy, but without lymphadenectomy. The measure of intensity of pain complaints was twenty-four hour analgetic requirement of patients in postoperative period, counted by PCA (Patient Controlled Analgesia) pump (Perfusor fm Braun). RESULTS: Twenty-four hour consumption of morphine counted by PCA pump did not statistically differ in both groups of patients. Twenty-four hour consumption of morphine on kilogram of body mass was similarly too. We find 3 (3.8%) intraoperative and 15 (18.8%) postoperative complications. The number of complications did not statistical to differ in groups of patients subjected and not subjected lymphadenectomy. CONCLUSIONS: The inclusion of lymphadenectomy into the operation procedures did not increase of pain in the postoperative course. The percentage of intraoperative and postoperative complications in both groups was similar. The lymphadenectomy executed in specialised centres of oncological gynaecology is a safe intervention, with a low number of complications.

Analgesics, Opioid↗
PubMed2003

The value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and postoperative complications.

OBJECTIVE: To assess the value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and postoperative complications. METHODS: Forty-one patients after orthotopic liver transplantation were examined by using color Doppler flow imaging to observe the hepatic blood flow and change of ultrasonography of the hepatic parenchyma and bile duct. The measured indexes included maximum blood flow velocity, time-average blood flow velocity (TAV), resistance index (RI) and diameter of the bile duct. RESULTS: Among 41 patients, 17 (41.5%) suffered from liver transplant rejection. Of the 17 patients, 13 (76.4%) showed decrease of TAV of the portal vein, 15 (88.25%) low-amplitude single-phase serrated wave or negative biphasic wave of the hepatic vein, 9 (52.9%) increased hepatic arterial RI, and 5 (29.4%) slightly dilated bile duct. Sonography showed disappearance of the hepatic artery blood flow around the portal vein in 5 (12.2%) of the 41 patients with hepatic artery thrombosis in the postoperative period. Slight dilatation of the intrahepatic bile duct was found in 3 (7.3%) of the 41 patients in the early postoperational period and it normalized within 2 weeks. Ultrasonography of 20 patients (48.8%) revealed a visible dilatation of the intrahepatic bile duct, which was worsening gradually. The causes of bile duct dilatation included biliary stricture in 2 patients (10%), stone in 15 patients (75%) and others in 3 patients (15%). CONCLUSIONS: Color Doppler ultrasonography is valuable for monitoring normal liver transplantation and postoperative complications.

Bile Duct Diseases↗
PubMedDate not supplied

Preoperative albumin and surgical site identify surgical risk for major postoperative complications.

BACKGROUND: Although malnutrition contributes to morbidity, studies of pre- and postoperative nutrition often include well-nourished patients unlikely to benefit from therapy and usually do not stratify by the site of surgical pathology. This study evaluates whether perceived preoperative markers of nutritional status recorded in charts correlates with postoperative complications and resource use in patients who receive no preoperative nutrition support and reinterprets the results of several conflicting randomized, prospective studies in this context. METHODS: This is a retrospective cohort study of 526 surgical patients who had preoperative serum albumin levels measured and were undergoing elective esophageal, gastric, pancreaticoduodenal, or colon surgery between 1992 and 1996 who could have received preoperative nutrition but did not. RESULTS: Most medical records contained inadequate analysis of preoperative nutritional status, but preoperative albumin correlated inversely with complications, length of stay, postoperative stay, intensive care unit (ICU) stay, mortality, and resumption of oral intake. Patients undergoing esophageal or pancreatic procedures sustained a significantly higher complication rate at most albumin levels, whereas colonic surgery resulted in lower complication rates at the same albumin levels. Resource use (eg, length of stay and ICU stay) related to these complication rates; esophageal and pancreatic procedures used the most resources and colon procedures used the fewest at most albumin levels. This lack of appreciation for nutritional risk and operative site can explain discrepancies in outcome noted in several randomized, prospective nutritional studies and must be applied to the design and implementation of new studies. CONCLUSIONS: Elective, non-emergent esophageal and pancreatic procedures performed in patients who could have had surgery delayed for preoperative nutrition, but did not, result in higher risk than colon surgery at any given level of serum albumin below 3.25 g/dL. Patient populations in trials should be stratified by operative site and by markers of nutritional status. Degree of hypoalbuminemia and other potential markers of nutritional status may explain many of the discrepancies between trials of nutrition support. Preexisting hypoalbuminemia in patients undergoing elective surgery remains underappreciated, unrecognized, and untreated in many hospitalized patients.

Cohort Studies↗
PubMed2000

Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results.

A retrospective study was done on a population of 258 women who had undergone surgery for abdominal dermolipectomy between January of 1991 and May of 1996. The postoperative complications and flaws seen at long-term follow-up are discussed. The surgical techniques used, with or without lipoaspiration, were the infraumbilical plasty and full plasties with horizontal or inverted T scars. Six types of postoperative complications were noted: hemorrhage in 1.2 percent, lymphorrhea in 10.9 percent, infection in 7 percent, skin necrosis in 6.6 percent, secondary dehiscence of the scar in 2.3 percent, and thromboembolic accidents in 1.2 percent. No significant difference was found in the rate of necrosis development between patients who did and did not undergo lipoaspiration. However, a statistically significant difference was seen in the rate of skin necrosis between the T-type plasty (35.5 percent) and the other two procedures (1.43 percent for infraumbilical plasties and 4.60 percent for full plasties with horizontal scar). With regard to the flaws found at long-term follow-up, the rate of above-scar fat folds and/or dog-ears was 27.9 percent, and the rate of defective scars was 26 percent. No significant difference was found with regard to the rate of flaws. The rate of all secondary surgical procedures was 29.1 percent, but performance of secondary procedures depended on the willingness of the patient and on the surgeon's judgment. Abdominoplasty procedures involve a high risk of early complications. The rate of skin necrosis is clearly augmented in cases of T-type plasty. The need for secondary surgical correction is frequent, and the patient should be reminded of this possibility during preoperative consultation.

Abdomen↗
PubMed2005

Does EuroSCORE predict length of stay and specific postoperative complications after heart valve surgery?

BACKGROUND AND AIM OF THE STUDY: EuroSCORE is the most rigorously evaluated scoring system in cardiac surgery. The study aim was to evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative length of stay and specific major postoperative complications after heart valve surgery. METHODS: Data obtained from 1,105 consecutive patients who underwent isolated or combined heart valve surgery were collected prospectively. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, prolonged length of stay (> 20 days) and major postoperative complications. A C statistic (receiver operating characteristic curve) was used to test discrimination of the EuroSCORE. Calibration of the model was assessed by the Hosmer-Lemeshow goodness-of-fit statistic. RESULTS: In-hospital mortality was 6.3%, and 21.7% of patients had one or more major complication. EuroSCORE showed very good discriminatory ability in predicting postoperative renal failure (C statistic: 0.78) and good discriminatory ability in predicting in-hospital mortality (C statistic: 0.72), prolonged length of stay (C statistic: 0.71), stroke over 24 h (C statistic: 0.73), gastrointestinal complications (C statistic: 0.73) and respiratory failure (C statistic: 0.71). There were no differences in terms of the discriminatory ability between standard and logistic EuroSCORE. The standard EuroSCORE model showed good calibration in predicting these outcomes (Hosmer-Lemeshow: p > 0.05). The logistic EuroSCORE model showed good calibration, except for prolonged length of stay and respiratory failure. CONCLUSION: EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also prolonged length of stay and specific postoperative complications such as renal failure, stroke over 24 h, gastrointestinal complications and respiratory failure within the whole context of heart valve surgery. These outcomes can be predicted accurately using the standard EuroSCORE, which is very easily calculated.

Aged↗
PubMed1993

Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease.

STUDY OBJECTIVE: To determine the risk of thoracic and major abdominal surgery in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Retrospective cohort study with controls. SETTING: A 692-bed teaching hospital. PATIENTS: A cohort of 26 patients with severe COPD (FEV1 < 50 percent predicted) undergoing thoracic and major abdominal surgery was matched by age and type of operation to 52 patients with mild-moderate COPD and 52 patients with no COPD. MEASUREMENTS AND RESULTS: The 26 patients with severe COPD had rates of cardiac, vascular, and minor pulmonary complications similar to patients with mild-moderate COPD and without COPD, but experienced higher rates of serious pulmonary complications (23 percent vs 10 percent vs 4 percent, p = 0.03) and death (19 percent vs 4 percent vs 2 percent, p = 0.02). All deaths and instances of ventilatory failure in the patients with severe COPD occurred in the subset undergoing coronary artery bypass surgery. Logistic regression revealed that increased age, higher American Society of Anesthesiologists class, an abnormal chest radiograph, and perioperative bronchodilator administration were associated with higher cardiac or serious pulmonary complication rates. Spirometry was not an independent predictor of postoperative complications. CONCLUSIONS: Clinical variables appear better than preoperative spirometry in predicting postoperative cardiopulmonary complications. The utility of preoperative spirometry as well as the benefits of perioperative bronchodilators in patients in stable condition remain to be determined.

Abdomen↗
PubMed2003

Postoperative complications of pulmonary resection after platinum-based induction chemotherapy for primary lung cancer.

PURPOSE: We investigated the postoperative complications that developed in patients who underwent surgery after induction chemotherapy (IC) for primary lung cancer. METHODS: Twenty-seven patients underwent surgery after receiving IC; for advanced non-small cell lung cancer in 16, and for small cell lung cancer in 11. All patients were given the platinum-based chemotherapy regimen. RESULTS: Lobectomies were performed for 18 patients, bilobectomies for 4, pneumonectomies for 2, and partial resections or segmentectomies for 3. There were two postoperative deaths; one caused by adult respiratory distress syndrome (ARDS) and one caused by respiratory failure, resulting in a mortality rate of 7.4%. The postoperative complications included sputum retention in six patients, ARDS in two, anastomotic dehiscence after bronchoplasty in one, and pneumonia in one, resulting in 44.4% morbidity. The morbidity of patients who had received IC (IC group) was higher than that of a comparative group of 560 who underwent lung resection without IC during the same period (non-IC group), but the difference was not significant (44.4% vs 22.6%; P = 0.16). Both ARDS and bronchial insufficiency occurred more frequently in the IC group than in the non-IC group, but the differences were not significant ( P = 0.25). CONCLUSIONS: These findings indicate the feasibility of treating primary lung cancer with IC followed by surgery as long as a cautious operative procedure is used and careful postoperative management is given, paying particular attention to the risk of ARDS and bronchial complications.

Adult↗
PubMed2001

Vaginal, laparoscopic, or abdominal hysterectomies for benign disorders: immediate and early postoperative complications.

OBJECTIVE: hysterectomy for benign disorders is usually well tolerated, but complications do occur. The aim of this retrospective study is to document such complications. PATIENTS AND METHODS: between March 1991 and December 1998, 1604 patients (mean age: 46 years) underwent hysterectomy for benign disorders. Peroperative and early postoperative complications were recorded for the 1248 vaginal hysterectomies (8%), 190 laparoscopically assisted vaginal hysterectomies (12%), and 166 abdominal hysterectomies (10%). RESULTS: none of the patients died. There were 15 bladder (0.9%) and one ureter injury (0.06%) with no significant difference between routes. Intestinal injuries (0.6%) overall were more common when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 ml. The rates were vaginal hysterectomy (2%, P<0.001), laparotomy (6.7%), and laparoscopy (5.3%). The overall reoperation rate of 0.8% does not differ with the type of the procedure. CONCLUSION: Per and early postoperative complications after hysterectomy remain important and patients should be aware of them. In order to control complications and decrease the morbidity, a high-risk population should be defined based on the patients' history of pelvic surgery and endometriosis, on their parity and the size of their uterus. For these patients, the most appropriate route should be preferred and complications should be assessed using different tests and subsequently treated during the same procedure.

Abdomen↗
PubMed2003

[Functional studies in the prediction of postoperative complications in the presence of lung diseases].

Data on the functional status of the cardiorespiratory system are required to identify patients at risk for postoperative complication in the presence of lung diseases. Very many factors influence the course of an operation and the postoperative period so there is no golden standard or the only parameter for predicting how the postoperative period runs. Patients with normal spirographic values (FEV1, more than 80%??) and without cardiovascular comorbidity are at a slight risk for postoperative complications. These patients do not need to be additionally examined. A less than one-month history of myocardial infarction, instable angina pectoris, decompensated heart failure, severe valvular disease are contraindications to planned surgery. The risk of cardiovascular events is high when the signs of myocardial ischemia occur with low exercise (less than 4 MET). Stress echocardiography, loading tests, and radioisotopic study are used as auxiliary techniques, FEV1, under 60%; ppo-FEV1, and ppo-DC, under 40%; VO2max, under 15 ml/kg/min are the values of a high risk for respiratory complications.

Contraindications↗
PubMed1983

Vaginal administration of 15-methyl-PGF2 alpha-methyl ester prior to vacuum aspiration. Peri- and postoperative complications.

In order to simplify the operative technique and lower the postoperative complication rate, 354 healthy primigravidae were treated with a vaginal suppository containing 1 mg of 15-methyl-prostaglandin F2 alpha 12 hours prior to vacuum aspiration abortion in the first trimester. The mean cervical diameter found at the operation was 8.5 mm and in 38% of the women no further mechanical dilatation of the cervix was needed. The amount of bleeding during the operation was low (mean 30 ml, max. 300 ml). No perforations of the uterus or cervical lacerations occurred at operation. Side effects of the prostaglandin such as vomiting, diarrhea and lower abdominal pain occurred in 80% of the women and must be regarded as disturbing to the patient and seem to require that the women be hospitalized. The incidence of genital infection following the abortion was found to be 6.2%. In 8.2% of the women, the postoperative bleeding persisted for more than 14 days. It is concluded that if the frequency of side effects can be lowered by using new analogues of prostaglandins, pretreatment with vaginal suppositories may be recommended before vacuum-aspiration at legal abortion in the first trimester.

Abortion, Induced↗
PubMed1998

A continuing postoperative complication: nausea and vomiting--who is affected, why, and what are the contributing factors? A review.

Outpatient surgery has become increasingly popular. Technical advances in both surgery and anesthesia have made the practice of ambulatory surgery safe and attractive. However, vomiting remains one of the most common postoperative complications. The valid patient complaint of postoperative nausea and vomiting has been shown to significantly delay discharge from the recovery area after ambulatory surgery. This article reviews the numerous factors that have been identified as fostering the postoperative complication of nausea and vomiting.

Ambulatory Surgical Procedures↗
PubMed1981

A comparison of the effect of phenoxymethylpenicillin and azidocillin on postoperative complications after surgical removal of impacted mandibular third molars.

Postoperative complications after surgical removal of mandibular third molars are still a clinical problem. Sixty patients undergoing operations for removal of an impacted third mandibular molar, were included in a double blind study. Phenoxymethylpenicillin 800 mg, azidocillin 750 mg, or placebo were given to the patients pre-operatively and then twice per day for the following seven days. The concentrations of phenoxymethylpenicillin and azidocillin in serum and alveolar serum were measured and the postoperative courses - pain, trismus, swelling and wound-healing - were recorded. The 40 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 20 patients in the placebo group, and there were no differences between phenoxymethylpenicillin and azidocillin. Antibiotics significantly reduced pain on day 7 postoperatively. There were no differences between antibiotic groups and placebo with respect to trismus and swelling. When the dental alveolar serum concentrations of phenoxymethylpenicillin 3.0 microgram/ml and azidocillin 7.9 microgram/ml were related to their range of inhibitory concentrations for microorganisms isolated from orofacial infections, it was noticed that the two drugs achieved levels sufficient to inhibit most strains. The effect of phenoxymethylpenicillin and azidocillin on postoperative infections can be of value after traumatic oral surgery or after operations on patients especially susceptible to infections.

Adolescent↗