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PubMed2003

Temporal patterns of postoperative complications.

HYPOTHESIS: A variety of major complications occur after intra-abdominal operations. Knowledge of when specific complications occur during the postoperative period would be useful in their diagnosis, prevention, and management. Our aim was to determine the incidence of major complications during specific postoperative intervals. DESIGN: One thousand twenty-one patients undergoing intra-abdominal operations were studied postoperatively as part of a randomized clinical trial. Thirteen defined major complications were sought at the following specific intervals: less than 1, 1 through 3, 4 through 7, and 8 through 30 days after the operation. SETTING: Cooperative trial from 15 Veterans Affairs medical centers. INTERVENTIONS: Intra-abdominal aortic, gastric, biliary, and colonic procedures. MAIN OUTCOME MEASUREMENTS: Major postoperative complications. RESULTS: Four hundred thirty-five major complications were diagnosed within 30 days of the patients' being operated on. Seventy-four (17%) occurred within 1 day, 185 (43%) between 1 and 3 days, 72 (17%) between 4 and 7 days, and 104 (24%) between 8 and 30 days. Three deaths (8%) occurred within 1 day, 3 (8%) in 1 through 3 days, 4 (11%) in 4 through 7 days, and 27 (73%) in 8 through 30 days. The greatest risk of hypotension (43%), myocardial infarction (47%), and respiratory depression (55%) was within 1 day. The highest incidence of congestive heart failure (46%), pulmonary embolus (50%), and respiratory failure (76%) occurred at 1 through 3 days. Pneumonia (38%) was most common at 4 through 7 days. Cerebrovascular accident (53%) and sepsis (71%) occurred preponderantly at 8 through 30 days. Renal failure had a bimodal distribution with maxima at 1 through 3 days (31%) and 8 through 30 days (56%). The risk of cardiac arrhythmia and gastrointestinal tract bleeding was similar throughout all intervals. CONCLUSIONS: While major complications occur throughout the postoperative period, the highest incidence is 1 through 3 days after the operation. However, specific complications occur in the following distinct temporal patterns: early postoperative, several days after the operation, throughout the postoperative period, and in the late postoperative period. Knowledge of these patterns should aid clinical management.

Aged↗
PubMed2002

Rates of postoperative complications among human immunodeficiency virus-infected women who have undergone obstetric and gynecologic surgical procedures.

Clinical observations indicate that human immunodeficiency virus (HIV)-positive women experience more postoperative problems than do HIV-negative women. To obtain a better estimate of the individual risk of postoperative morbidity among HIV-infected women, and to determine which procedures pose the greatest risk, we performed a retrospective case-control study in which we assessed the outcomes after 235 obstetric and gynecologic surgical procedures. For purposes of comparison, an HIV-negative control patient was matched for each of the 235 surgical procedures performed, on the basis of the type of procedure and patient age. We found a significantly greater number of postoperative complications among the HIV-positive women. Higher complication rates occurred after abdominal surgery (odds ratio [OR], 3.6; P=.001) and curettage (OR, 7.7; P=.06). Among HIV-infected women, the risk of complications was associated with immune status. Antiretroviral therapy and standard perioperative antibiotic prophylaxis did not decrease the risk of complications. Indications for performing abdominal surgery and curettage on HIV-infected women should be carefully weighed against the potential risk of postoperative complications.

Adult↗
PubMed1978

[Intra-and postoperative complications in pulmonary surgery (author's transl)].

The age of the patients, the causative diseases, and the extent of the surgical operation are decisive for the development of intraoperative and postoperative complications in pulmonary surgery. Restrictive and obstructive pulmonary changes of the older-age group involve the danger of postoperative complications. By our experience the critical age for pulmonary surgery is about 50 years.

Adolescent↗
PubMed1995

[Effect of postoperative complications on nutritional status: therapeutic consequences].

The occurrence of a postoperative complication represents an additional stress factor for patients and leads in many cases rapidly to a malnutrition status. Thus a nutritional support is required as soon as the foreseeable duration of starvation has a longer duration than one week. Considering its lower risk of septic complications and lower cost, enteral feeding should be initiated as soon as possible. Appraisal of caloric needs with standard formulas often leads to inappropriate nutritional management. Therefore the requirements should be assessed by indirect calorimetry if available. Nutritional support is a part of the management of a postoperative septic patient. It must be initiated when initial phase of haemodynamic instability is amended. Branched chain amino acids, medium chain triglycerides and other specific nutrients have failed to demonstrate a real clinical beneficial effect. In case of acute respiratory failure, nutritional support must be cautious with regard to caloric load, as carbohydrates may increase CO2 production and lipids may worsen hypoxaemia. In case of postoperative acute renal failure, nutritional management is facilitated by continuous haemofiltration techniques allowing an unlimited nutrient intake. Solutions containing only essential amino acids are not recommended. During severe acute pancreatitis, enteral feeding is indicated when ileus does not permit the use of the intestinal tract. Jejunal access must be preferred to stomach or duodenum. Lipid emulsions can be used safely if serum triglyceride concentrations remain below 4 g.L-1 during infusion and below 2 g.L-1 between infusions.

Calorimetry, Indirect↗
PubMed2005

Cataract surgery and postoperative complications in diabetic patients.

Diabetes mellitus influences the function and morphology of the eye lens. The cataract is the second most common complication of diabetes mellitus on the eye. A hundred patients with cataract were examined in the prospective study. The patients were divided into two groups. The first group consisted of 50 patients with cataract who had not suffered from a system or local disease. The second group consisted of 50 patients with cataract and diabetes mellitus that had lasted for at least five years. In both groups the patients underwent identical cataract extra capsular extraction with intraocular PMMA (polymethylmethacrylate) lens implantation in camera posterior. The objective of this study was to compare the two groups of patients in order to find out the most common intraoperative or postoperative complications in diabetics. The most common postoperative complications in patients suffering from diabetes were inflammatory reactions and bleeding: postoperative keratopathy, uveitis anterior serous and uveitis anterior fibrinous with posterior sinechia and opacity of the posterior lens capsule as results. Postoperative visual acuity was worse in the patients in group II on the seventh day and six months after operation. It was diabetic retinopathy and its progression that caused deterioration of visual acuity. Diabetic retinopathy and its progression, as well as maculopathy were found only in patients who were not treated with photocoagulation before the operation.

Aged↗
PubMed1995

Total pelvic exenteration for locally advanced colorectal carcinoma--postoperative complications.

This study was designed to clarify the postoperative major complications of total pelvic exenteration for locally advanced colorectal cancer. Twenty-six patients (primary disease: 17, recurrent disease: 9) were retrospectively studied. Major complications developed in 30.8% (8 of 26); in 23.5% (4 of 17) for a primary disease and in 44.4% (4 of 9) for a recurrent disease. Only 2 patients (7.7%) died within 30 days after the operation; one patient died of hepatic failure and another of pelvic sepsis. Postoperative ileus developed at a high rate of 11.5% (3 of 26). Ileo-ileal anastomotic leakage developed at a rate of 7.7% (2 of 26) and it commonly occurred following irradiation. The remaining one patient had gastrointestinal bleeding. These 6 patients surviving the operation were successfully managed conservatively. Conclusion was as follows: Total pelvic exenteration should be performed carefully and aggressively regardless of the development of postoperative complications.

Adult↗
PubMed2001

Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases.

PURPOSE: We critically examined the intraoperative and postoperative complications associated with radical retropubic prostatectomy in the modern era. MATERIALS AND METHODS: Between April 18, 1994 and July 13, 2000, 1,000 men underwent radical retropubic prostatectomy performed by a single surgeon. The whole inpatient hospital medical record of 909 patients, the outpatient charts of 955 and a self-administered patient survey completed by 679 were reviewed by 2 data managers not involved in surgical management or followup care. In all 1,000 cases at least 1 of the 3 data sources was reviewed. RESULTS: Mean patient age was 60.3 years. In 73%, 99.8% and 95.7% of cases serum prostate specific antigen was 10 ng./ml. or less, disease was clinical stage T1 or T2 and Gleason score was 7 or less, respectively, while 19.9% of pathological specimens showed positive margins. There were 8 intraoperative complications (0.8%). All 5 rectal injuries and the single ureteral injury were detected during the initial surgical procedure and repaired without sequelae. Only 14 men (1.4%) had any other complications during hospitalization. Until postoperative day 30, 4 pulmonary emboli (0.4%) with or without deep vein thrombosis and 5 myocardial infarctions (0.5%) developed. There were no intraoperative or in-hospital postoperative deaths and only 1 postoperative death secondary to myocardial infarction during the initial 30 days. Reexploration was done for hemorrhage and a disrupted anastomosis in 3 and 2 cases, respectively. Mean hospitalization was 2.3 days, 9.7% of patients required allogenic blood transfusion and 15 (1.5%) were rehospitalized. CONCLUSIONS: Our series represents a rigorous assessment of the complications associated with radical retropubic prostatectomy. It shows that in the hands of an experienced urological surgeon, this procedure is associated with minimal intraoperative and postoperative morbidity. Of the patients 98% had no intraoperative or postoperative complications. Our series enables appropriate contemporary comparisons to be made with laparoscopic prostatectomy and radiation therapy. This outcomes analysis implies that radical retropubic prostatectomy cannot be assumed to have greater morbidity than radiation therapy and it sets a high standard for those advocating laparoscopic radical prostatectomy.

Blood Loss, Surgical↗
PubMed1991

Scintigraphic evaluation of postoperative complications of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is gaining popularity as an alternative to standard open cholecystectomy. At our institution, approximately 400 laparoscopic cholecystectomies have been performed since May 1989. The frequency of major postoperative complications has been approximately 1.5% (6 out of 400 cases). The most common complications have been biliary tree injury, bile leak, and retained stone. We present three patients who developed postoperative complications that were properly diagnosed on 99mTc-DISIDA cholescintigraphy. Our report indicates that 99mTc-DISIDA scintigraphy facilitates the rapid and precise diagnosis of bile leaks in patients with abdominal pain and/or hyperbilirubinemia following laparoscopic cholecystectomy.

Adult↗
PubMed2002

The influence of histological diagnosis on the postoperative complication rate following trans-urethral resection of prostate (TURP).

BACKGROUND: A number of studies have shown that the early mortality following TURP is higher for patients with prostate cancer than those with benign disease. This study examines the effect of the histological diagnosis on the predischarge complication rate following TURP. METHODS: Information on the postoperative, predischarge complications of 3036 patients, who underwent TURP over the last decade at our institution, was collated from the urology department database (AuditBase for Windows). The information on this database is collected prospectively, at the point of care and validated at monthly audit meetings. Statistical analyses were performed using chi2 and difference of proportion where n > 60. Statistical significance was taken as P < 0.05. RESULTS: The postoperative, predischarge major complication rate for patients with benign disease was 2.1%. This was not statistically different from the 2.3% complication rate seen in patients with malignant disease. Patients suffering a postoperative complication stayed in hospital significantly longer than those who had a straightforward postoperative course (P < 0.001); however, patients with malignant histology suffering a postoperative complication did not stay statistically significantly longer than those with benign histology suffering a postoperative complication (P < 0.1). CONCLUSIONS: Patients undergoing TURP for prostate cancer do not suffer more postoperative, predischarge complications or stay in hospital longer than patients undergoing TURP for benign disease.

Aged↗
PubMed1987

Postoperative complications following tonsillectomy and adenoidectomy--who is at risk?

Postoperative complications following a large series of adenotonsillectomies (784 patients) at the Children's Hospital of Philadelphia fell into two major categories: hemorrhage and airway problems. Bleeding requiring operative intervention occurred in one child in the immediate postoperative period and in 16 children (2.0%) within 7-10 days. Eight patients (1.0%) had minor bleeding requiring only observation, and 9 others (1.2%) reported mild bleeding at home. Airway obstruction requiring the reinsertion of an airway or intensive care observation occurred in 10 children (1.3%). In general, these children were younger and most had significant underlying medical problems. We conclude that many complications encountered after adenotonsillar surgery are intrinsic to the patient's disease and overall medical condition. Improved surgical and anesthetic techniques have minimized the complications noted in earlier studies.

Adenoidectomy↗
PubMed1990

[Connection of immune status, nutritional status and postoperative complications in patients after surgery for organic esophageal stricture].

The postoperative complications were analysed in 64 patients after operation for stricture of the esophagus. The underfeeding in consequence of the esophagus stricture reduced the cellular immune functions and increased the operative risk. The comparison of the feeding and immune parameters of patients with benign and malign strictures of the esophagus showed that the poor immune reactivity is caused by the underfeeding first of all and not by the immune depression due the tumor.

Esophageal Neoplasms↗
PubMed1993

[Late postoperative complications after primary treatment of aortic coarctation].

During the period between 1963 and 1988, 343 patients were operated due to aortic coarctation. 14 patients (4%) were necessarily reoperated for late postoperative complications. In 3 cases (0.8%) reoperation was indicated due to the development of aneurysm in the region of primary operation of aortic coarctation. The development of aneurysm is prevalently predisposed by Vosschulte's indirect aortoplastic operation by the use of a synthetic patch. In the remaining 11 patients (3.2%) the reoperation was indicated owing to the development of recoarctation. Today recoarctation concerns children which were operated under the age of two. The most important moment favourable for the recoarctation development is the secondary constriction of the repaired region in consequence of the coarctation listel fibroid tissue and owing to the incapability of the anastomosis to grow. The perspective rests on using new suture material and combined techniques. Late postoperative complications which follow operations performed due to aorta coarctation remarkably augment the peri and postoperative mortality. Three cases out of the given group of 14 patients terminated by exitus (21%). Hence, it is necessary to remove all moments of predisposition creating a condition favourable for the development of recoarctation and aneurysm. (Tab 2, Fig. 1, Ref. 14.).

Adolescent↗
PubMed2001

Gastric banding: intraoperative and early postoperative complications and their prevention.

BACKGROUND: Intraoperative and early postoperative complications in patients operated for morbid obesity were assessed. METHODS: 114 morbidly obese patients underwnent gastric banding (non-adjustable or adjustable). The influence of body mass index (BMI), age and preoperative morbidity on the occurrence of postoperative ventilatory disturbances was evaluated. RESULTS: Risk of postoperative ventilatory disorders increased with preoperative cardiovascular disease (p < 0.01), diabetes (p < 0.05), and increasing BMI (p < 0.01). Age, hypertension and pulmonary disease did not influence significantly the risk of complication in this series. There have been no deaths. CONCLUSION: In patients undergoing banding for morbid obesity, the potential for ventilatory complications increases with higher BMI, diabetes and cardiovascular disease in the preoperative comorbidities. Principles for postoperative care were developed.

Adolescent↗
PubMed2001

[The impact of hemodilution and low-molecular-weight fraxiparin on volumetric indexes and frequency of postoperative complications in surgical treatment of patients with oncological diseases].

The influence of moderate hemodilution (HD) and of low-molecular-weight heparin (LMWH) fraxiparine on volumetric indexes (VI) and postoperative complications frequency in 38 patients with cancer recti, to whom intraoperative blood transfusion was not performed, was estimated. Control group consisted of 45 patients, in whom the preserved blood was used for restoration of the blood loss. While application of moderate HD and LMWH the VI had lowered in less extent than while performance of the erythrocytes mass transfusion, the postoperative complications frequency was also lower.

Anticoagulants↗
PubMed1994

A review of 103 cases with elective repair for abdominal aortic aneurysm: an analysis of the risk factors based on postoperative complications and long-term follow-up.

From 1982 through 1992, 103 patients (mean age: 69 years) underwent an elective repair of an abdominal aortic aneurysm (AAA) at our institution. One or more postoperative complications occurred in 30 patients (29%), with a mortality rate of 1.9%. Factors which were found to be significantly associated with postoperative complications based on an univariate analysis included male sex (P = 0.0082), operation time (P = 0.0006), the size of the aneurysm (P = 0.0045), the amount of blood loss during operation (P = 0.0037), poor lung function (P = 0.0155), and the platelet count (P = 0.0468). A simple linear regression analysis showed that there were significant correlations among the AAA size, the duration of operation and the amount of blood loss. The age at operation, however, did not influence morbidity or mortality. Complete survival information was obtained in 96 (95%) patients, while the influence of preoperative risk factors on late survival was also examined by the Kaplan-Meier method. The factors influencing long-term survival were determined to be renal dysfunction and age at the time of operation.

Adult↗
PubMed1985

[Postoperative complications following gynecologic operations in elderly females with benign and malignant changes of the genitals].

The retrospective study reported here, which covered 2116 patients operated on, indicates that postoperative complications are more likely to occur in women aged over 60 than in younger patients. There is also a connection between the patient's age and previous internal disease, the surgical approach, and the severity of the change requiring surgery. The connection between age and postoperative complications is principally explained by previous internal disease. Patients with malignant tumors are at greater risk than women with benign genital changes. Carcinoma cases apart, these patients are older and have suffered more from previous internal disease. While postoperative morbidity and mortality rates are higher among older patients, the percentage of complications occurring is so low that age does not represent a contraindication to gynecological surgery.

Adolescent↗