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Chemical peel, dermabrasion, and laser skin resurfacing are alternative methods to achieve skin resurfacing for reconstructive or cosmetic applications. The potential postoperative complications are similar with all of these techniques. These postoperative complications and their therapy are reviewed.
The stimulation of reflexogenic zones and interoreceptors in experiments and in patients during operations on the heart, lungs and organs of the gastrointestinal tract induces hyperactivation of the sympatho-adrenal system and associated with it neurogenic dystrophic alterations of the internal organs (markedly decreased level of noradrenaline, destruction of the cell ultrastructure, mitochondria in particular) and energy metabolism. The use of high epidural anesthesia as the main component of narcosis in operations on the heart (mitral commissurotomy) and on the lung prevents the development of intra- and postoperative complications, the above mentioned dystrophic alterations in particular. Similar protecting effects in the abdominal operations are obtained when using associated combined spinal-epidural anesthesia.
OBJECTIVE: Our goal was to characterize variation in complication rates across hospitals with differing volumes for select high-risk operations in the United States. METHODS: Data from the Nationwide Inpatient Sample for 1996 and 1997 were analyzed for 3 high-risk operations: esophagectomy (n=1,226), pancreatectomy (n=4,789), and intact abdominal aortic aneurysm repair (n=11,863). Complications evaluated included aspiration, cardiac complications, infection, pneumonia, pulmonary failure, renal failure, septicemia, and others. The risk of complications was calculated by hospital volume deciles, as well as for high-volume hospitals (HVH) and low-volume hospitals (LVH) defined by median hospital volume. RESULTS: Rates of any postoperative complication varied nearly 2-fold across hospital volume groups. The proportion of patients across hospital deciles having at least one complication ranged from 30% to 51% for esophageal resection, 6% to 12% for pancreatic resection, and 9% to 18% for abdominal aortic aneurysm repair. HVH had lower rates of one or more complications after pancreatic resection (OR, 0.71; 95% CI, 0.57 to 0.83; P=.002), esophageal resection (OR, 0.68; 95% CI, 0.52 to 0.90; P=.008), and intact abdominal aortic aneurysm (AAA) repair (OR, 0.67; 95% CI, 0.59 to 0.76; P<.001). Patients with one or more complications after pancreatic resection had a mortality of 18.8% versus only 5.2% for those without complications (P<.001). Esophageal resection mortality was 16.9% for patients with at least one complication and 2.5% for those without complications (P<.001) and AAA repair mortality was 10.4% for patients with at least one complication and 2.9% for those without complications (P<.001). CONCLUSIONS: High-risk operations have a decreased rate of postoperative complications when performed at HVH. Variation in complication rates may contribute to the volume-outcome relationship and provide a focus for quality improvement at LVH.
The purpose of this study was to determine whether prior radiotherapy had any effect on the development of postoperative complications in patients undergoing microvascular tissue transfers for reconstruction of head and neck cancer. A prospective database was used to review 354 consecutive patients who had a total of 368 free tissue transfers limited to the head and neck during the 4-year period from July 1988 to June 1992. Postoperative complications in 167 patients who received preoperative radiotherapy (XRT) were compared with those of 187 patients who did not undergo radiotherapy preoperatively (NR). No statistical differences in complications or flap loss between the two groups were noted using the chi 2 test or Fisher's exact test (p > 0.2). Total flap loss occurred in 5.3% of the XRT group (9 of 169) and 5.0% of the NR patient group (10 of 199), and partial flap loss occurred in 4.1% of the irradiated patients and 2.5% of the nonirradiated patients. Major wound complications requiring additional surgery occurred in 16% of the XRT group and 11% of the NR group. Minor wound complications that did not require further surgery occurred in 21% of the irradiated patients and 18% of the nonirradiated patients. No significant difference in the timing or dose of preoperative radiation, previous neck dissection, or anastomotic type could be documented in failed versus successful flaps (two-tailed t-test, p > 0.80, and chi 2, p > 0.2). Our results show that, in a large group of cancer patients undergoing free tissue transfers to the head and neck, prior radiotherapy or surgery did not predispose them to a higher rate of acute flap loss or wound complications than their nonirradiated cohorts.
Results of surgical treatment of 277 patients with hepatic echinococcosis and bile duct affection demonstrated that the rate of specific postoperative complications depends on duration of the disease, location and size of the parasitic cyst, changes in the cyst (suppuration, calcification), and also on the level of the lesion in the bile ducts. They were seen in the lesion of the segmental ducts 1.5 times less (18%) often than in the lesion of the hepatic ducts (25.7%). Early diagnosis, adequate surgical treatment, characteristics of pathological alterations in the cyst and bile ducts influence treatment outcomes. Postoperative complications arose in 25.9% cases with lethality 1.4%. These complications were diagnosed 6 times less often after elimination of the residual cavity, suturing of bile fistulas or other methods (resection, pericyctectomy) application than after drainage of the residual cavity.
The paper deals with the problems of treatment for local postoperative complications in patients suffering cancer of the larynx and throat. Early diagnosis of complications as well as therapy employing modern glass fibre equipment are discussed. The first attempt to study the microflora of the newly formed throat in the early postoperative period is described. A wide spectrum of dormant bacteria was identified. Healing was found to depend upon microorganism level and profile of bacterial species in the newly formed throat. Complex application of endoscopic and laser procedures proved to be an effective means of sanative care.
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.
The study including 414 patients aged over 60 years suffering lung esophageal, gastric and colorectal cancer was carried out to assess the possibility of preventing postoperative complications. Preoperative preparation, anesthesiologic medication and drug treatment in the early postoperative period included vitamins, eleutherococcus, sodium oxybutyrate, retabolil, splenin, curantyl, heparin, panangin, sulfalen and trichopol. In that group, the overall postoperative complication rate was 1.5 times lower and that of purulent complications, cardiovascular disorders, pneumonia and pancreatitis--2 times lower than those in 642 controls. The duration of postoperative stay in the hospital was shorter and the postoperative lethality tended to decrease. Topical treatment with methylsiloxane-immobilized gentamycin and 5-fluorouracil was shown to prevent development of purulent complications and pancreatitis.
OBJECTIVE: The aim was to examine to what extent lifestyle, education, social support, and comorbidity predict the ability of perioperative smoking cessation, and are associated with the development of important postoperative complications. DESIGN: The design was a randomized clinical trial. SETTING: University hospitals in Copenhagen, Denmark, were the settings. PARTICIPANTS AND METHODS: One hundred twenty patients scheduled for primary elective hip or knee arthroplasty were randomized to either smoking intervention or standard care. Tobacco and alcohol consumption, exercise and eating habits, level of education, matrimonial status, and the presence of social support were registered. The data gathered concerned smoking cessation/reduction and severe postoperative morbidity. RESULTS: Men and patients with a good social network were more likely to successfully quit smoking. Smoking intervention successfully reduced the incidence of postoperative complications, as did weekly exercise exceeding 4 h, and having a high education level. CONCLUSIONS: This study emphasizes that smoking intervention programs in health care settings are highly effective in reducing postoperative risks in hip and knee arthroplasty.
A prospective, controlled and randomized study of 275 patients undergoing major surgery was performed to investigate if postoperative complications were influenced by restrictive use of plasma to replace operative blood loss. All patients were given 6% dextran (Macrodex) for thromboprophylaxis and haemodilution. The "Dextran Group" received equal amounts of 6% dextran and electrolyte solution as substitution for plasma loss. The need for red-cell transfusion (60% suspension in saline-adenine-glucose-mannitol storage medium) averaged 5.8 units in this group and 5.2 in the "Plasma Group". The respective mean totals of infused plasma and dextran were 400 ml and 1,383 ml in the Dextran Group, compared with 1,099 and 619 ml in the Plasma Group. The mean total electrolyte infusion in the first postoperative week was c. 7,500 ml in both groups. Serum albumin decreased considerably in both groups, but significantly more in the Dextran Group. The incidence and pattern of postoperative complications were similar in both groups. When blood loss is up to 50-60% of the total volume, Macrodex can be used in preference to plasma, unless administration of plasma protein is specifically indicated.
A comparison is presented of the complications found in two series each consisting of 331 consecutive patients undergoing thyroidectomy in the same Unit ten years apart. The overall incidence of postoperative complications has been reduced, particularly in the group of patients having thyroidectomy for thyrotoxicosis following which it is now no greater than after thyroidectomy for benign non-toxic goitre. The techniques used to try to reduce the postoperative complication rate are discussed. The incidence of permenent recurrent laryngeal nerve palsy has been reduced to 0-3% and of permanent hypoparathyroidism to 1-2%. The overall incidence of complications causing permanent disability is now 3-9%.
This study was conducted to determine the effects of spinal (n = 113) vs epidural (n = 31) anesthetic techniques on 3 common postoperative complications: pain, urinary retention, and mobility for patients undergoing inguinal herniorrhaphy. The study design was a retrospective chart review. Data were collected on 144 subjects who underwent herniorrhaphy between January 1 and December 31, 1999, had an ASA classification of I to III, and were older than 18 years. The local anesthetics used to provide spinal anesthesia were 5% lidocaine, 0.75% bupivacaine, and 1% tetracaine solutions. The anesthetics used to provide epidural anesthesia were a solution of 2% lidocaine with epinephrine or 3% chloroprocaine with epinephrine. Results revealed that pain was not significantly different between the 2 anesthetic groups (P = .65); however, subjects in the epidural anesthesia group were able to ambulate (P = .008) and void (P = .02) sooner than subjects in the spinal anesthesia group. This study demonstrates that epidural anesthesia results in less urinary retention and earlier mobility than spinal anesthesia in men undergoing inguinal herniorrhaphy. Minimizing postoperative complications is essential in order for the nurse anesthetist to provide a satisfactory anesthetic experience. This study's findings suggest that epidural anesthesia optimizes recovery for the patient undergoing inguinal herniorrhaphy.
BACKGROUND: Prediction of risk of postoperative complication is necessary for optimal use of available resources and makes possible to compare patient population and postoperative outcomes in different institutions. The goal of the study was to identify preoperative risk factors for morbidity following coronary artery bypass grafting. MATERIAL AND METHODS: Data of 1829 consecutive patients undergoing surgery for coronary artery disease in Clinics of Santariskes of Vilnius University Hospital. Morbidity was defined as the presence of one or more of the following categories of complications: cardiac, pulmonary, neurologic, renal and infectious. RESULTS: The observed crude hospital mortality was 2.57%. Major morbidity events occurred in 14.1% of the patients. The most frequently occurring complications were cardiac (myocardial infarction or low cardiac output syndrome), followed with the need of prolonged mechanical ventilation and stroke. CONCLUSIONS: Older age, diabetic patients, patients with renal dysfunction and reduced contractility of the left ventricle, especially operated on as emergency with uncontrolled heart failure, cardiogenic shock or ongoing infarction are at risk of development one or more complications following coronary artery bypass grafting. Major perioperative complications following coronary artery bypass grafting occur relatively frequently and could be used for quality assessment and quality improvement activities in our institution.
To date, gabexate mesilate, a synthetic protease inhibitor, has been used in the prophylaxis and treatment of acute pancreatitis, but has yet to be tested in preventing the postoperative complications of pancreatic surgery. For this purpose we planned a pilot study based on two treatment groups, each numbering 25 patients, submitted to high-risk pancreatic resection. In the first group, all patients received a continuous infusion of gabexate mesilate 1 g/day up to postoperative day 4; the second group of patients received the same treatment plus octreotide 0.1 mg every 8 hours for 5 days after surgery. All patients were followed until discharge with clinical and instrumental investigations to detect the onset of postoperative complications. The overall incidences of an uneventful course were 40% (10/25) and 32% (8/25), respectively. We found 12 complications closely related to pancreatic surgery in the former and 8 in the latter group. In the combined treatment group therefore we observe a 33% reduction in the incidence of related abdominal complications (12 vs 8). This favourable trend, however, needs to be confirmed in a larger multicentre trial.
The purpose of this study was to quantitate the operative risk and costs encountered in the surgical treatment of institutionalized patients. Operative complications and duration of hospitalization for 200 institutionalized patients were compared with those in a control group of patients matched for age, sex, and type of operation drawn from the general hospital population. Postoperative complications occurred in 53 (26.5%) of the patients in the study group compared with 15 (7.5%) of the patients in the control group. Elective laparotomy was followed by a complication in 48% of institutionalized patients compared with 11.6% of matched controls. Emergency celiotomy carried a 75% complication rate in the study group. Atelectasis and pneumonia accounted for 50% of the postoperative complications and occurred with greatest frequency following intra-abdominal procedures. The median hospital stay for all institutionalized patients was 3 days more than for matched controls. A strategy for postoperative treatment is presented, with particular emphasis on prevention of pulmonary complications.
BACKGROUND: The decision which patient should undergo laparoscopic rather than open colorectal surgery depends on weighing its benefits against its complications. We explored which criteria prognosticate complications in a laparoscopic intervention by assembling experienced visceral surgeons' beliefs. METHODS: A two-round postal survey was conducted: 21 experts in laparoscopic surgery were contacted and asked to list (first round) and weigh (second round) indicators (scale 1-10) they believed predicted intra- or postoperative complications in patients undergoing laparoscopic colorectal surgery. Median ratings and interquartile ranges (IQRs) were calculated. Rates >or=6 and IQRs <or=3 depicted an important prognostic indicator for complications. RESULTS: Thirty-nine intraoperative and 43 postoperative listings and ratings of 19 experts (90%) were available for analysis. The experts depicted three domains of indicators (tumor, comorbidity and related institution). The strongest indicators for intraoperative complications were surgeon's experience (median 9, IQR 8-10) and portal hypertension (median 9, IQR 7-10), and those for postoperative complications were liver cirrhosis Child B/C (median 8, IQR 7.75-10) and experience of the surgeon (median 8, IQR 7-10). CONCLUSION: This survey provides additional evidence of risk indicators for intra- and postoperative complications in patients undergoing laparoscopic colorectal surgery. Whether the identified indicators can be compiled into a prognostic instrument requires confirmation in a properly designed and sized study.
A retrospective review of 107 patients with cerebral palsy who had undergone a posterior spinal fusion with unit rod instrumentation by the same two surgeons was done to determine what factors cause complications that lead to delayed recovery time and a longer than average hospital stay. The operative risk score was developed with scores for the child's ability to walk and talk, oral feeding ability, cognitive ability, and medical problems within the year prior to surgery. Operative risk score is primarily a measure of degree of neurologic involvement. The postoperative complication score (POCS) is a combined measure of all postoperative complications including factors for prolonged intubation, intensive care unit stay, hospital stay, and delayed feeding. The mean age at surgery was 14.3 years. The mean weight was 29.5 kg, with 89 of 107 patients below the fifth percentile for weight compared with age. The mean degree of spinal deformity was 75.2 degrees (range 43-120 degrees ). The mean weight for age was -1.96 SD below the normal. The mean operative time was 4.3 h, with estimated blood loss of 1.2 blood volumes. The mean length of hospitalization was 23 days 2 h, with 5 days 2 h in the intensive care unit. The operative risk score and weight for chronological age below the fifth percentile showed statistical significance (p = 0.05) in regard to increased POCS. The weight for height-age and deficient total lymphocyte count, both factors that measure nutritional status, showed no statistical significance (p > 0.05) compared with POCS. Curves with deformity of >70 degrees had statistically significant high POCS (p = 0.03). Complications for patients having a posterior and an anterior surgery versus those who had a posterior fusion alone were not statistically different (p > 0.05). The factors that led to a greater rate of complications were the severity of neurologic involvement, severity of recent history of significant medical problems, and severity of scoliosis.
The inflammation of Morgagni crypts in the anal canal plays a great part in pathogenesis of acute paraproctitis and anal fistula. Such inflammation is often of diffuse character and in 18--19% of cases results in postoperative complications--acute and chronic cryptitis and subcutaneous microabscesses. Sanitation of Morgagni crypts (cryptotomy and cryptectomy) during radical operations for paraproctitis decreases the number of local postoperative complications and may be considered as one of the prophylactic measures against recurrent abscesses or anal fistulas.