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PubMed1989

[Systematic assessment of postoperative complications. A form of personal quality control].

A quality control program for the surveillance of surgical complications is described which includes all persons working at a surgical unit. The house surgeon when writing his letter for the general practitioner after the patient is demissed uses a special form for postoperative complications. Ten well defined types of complications, e.g. haematoma, fistula, abscess, pneumonia are recorded. Another surgeon responsible for the control program gathers weekly all forms presenting the results monthly at an audit to all surgeons of the unit. Here results are discussed in detail. Each surgeon gets his own complication profile monthly. Every three months the results of surveillance program are presented to all staff members including nurses, so that cooperative actions to reduce the complication rate can be taken. From January 1, 1985 to June 30, 1987, 2597 operations were performed, 213 patients (8.2%) suffered postoperative complications especially after surgery of the colon and rectum (28%), cholecystectomy (26%) and hernia repair (18%). Comparing three time periods (1985, 86, 87) no significant amelioration of complication rates were found. But factors influencing complications like very high age of patients, seriousness of the disease, and diabetes were not evenly distributed in all three samples. Therefore it might be impossible to lower the complication rate since those factors can't be influenced by better preparation for and better performing of surgery.

Germany, West↗
PubMed2005

Early postoperative complications after coronary artery bypass grafting at the San Juan Veterans Affairs Medical Center.

OBJECTIVES: Describe the perioperative characteristics of the patients undergoing coronary artery bypass grafting (CABG) in San Juan, Veterans Affairs Medical Center (SJ-VAMC). Determine the in-hospital and 30-day morbidity and mortality following CABG and identify adverse predictors for postoperative complications. BACKGROUND: Preoperative risk factors for complications post-CABG have been identified; however limited data is available regarding the value of these predictors in the Puerto Rican Population. METHODS: Perioperative characteristics and 30-day complications were gathered from all patients undergoing CABG (n = 252) at the SJ-VAMC (2001-2003). Logistic regression analysis was performed to determine factors associated with the occurrence of complications. RESULTS: The population's mean age was 66.9 +/- 8.1 years. Associated illnesses included: hypertension (95.6%), diabetes (57%), past smoking (61%), COPD (26%), chronic renal insufficiency (CRI-11.5%), cerebrovascular disease (CVD-20.6%), disabling angina (78%), 3-vessel coronary disease (75.8%), significant left main stenosis (20%), and non-elective surgical intervention (54%). The most frequent primary complications were postoperative myocardial infarction (MI-4.8%) and congestive heart failure (4.8%). The 30-day mortality was 1.2%. Upon multivariate analysis PRBC transfusions > 3 units was associated to increased risks of primary complications, in patients with prior history of CVD. CRI and LVEF < or = 40% were independently associated to development of primary complications, in patients with prior MI and CVD. CONCLUSION: The preoperative characteristics are suggestive of an older and sicker patient that is undergoing CABG at the SJ-VAMC. Despite this, the death rate was low and the frequency of other complications comparable to the Society of Thoracic Surgeons (STS) National Adult Cardiac Database.

Adult↗
PubMed2005

Perisurgical smoking cessation and reduction of postoperative complications.

OBJECTIVE: The purpose of this study was to determine if a perisurgical smoking cessation program reduces smoking-related postoperative complications in urogynecologic surgery. STUDY DESIGN: A review of patients that underwent pelvic reconstructive surgery from 1998 to 2003 was performed. All smokers underwent a perisurgical smoking cessation program of their choice for at least 1 month before surgery, and continued for 1 month after surgery. Complications unrelated to smoking (cystotomy, enterotomy, urethral obstruction, etc) were excluded in the smoking-potentiated complications. Problems considered to be potentiated by smoking were: wound, pulmonary, cardiac, and febrile morbidity. RESULTS: Eight hundred eighty-seven patients were included. There were 233 smoker cessation patients (SC) and 654 nonsmokers (NS). The total number of complications in the SC group was 61 (61/233, 26%) compared with 172 (172/654, 29%) in the NS group: (chi-square, P = .97). When looking at smoking-potentiated complications only, there were 34 (34/61, 56%) patients in the SC group and 90 (90/172, 52%) in the NS group (chi-square, P = .75). CONCLUSION: There are no differences in smoking-potentiated complications between nonsmoking patients and patients who undergo a perisurgical smoking cessation program.

Aged↗
PubMed2006

[The relationship between postoperative complication and pathological features of 324 patients with neuronal intestinal malformations].

OBJECTIVE: To investigate the relationship between the morphological features of different types of neuronal intestinal malformations (NIM) and their postoperative complications. METHODS: The data of morphological and clinical features of 324 cases with NIM were analyzed retrospectively. RESULTS: In all 324 patients, 210 cases were Hirschsprung's disease (HD), 38 intestinal neuronal dysplasia (IND), 45 mixed HD/IND, 8 hypoganglionosis, 22 combined HD/hypoganglionosis and 1 immaturity of ganglion cells. The percentages of normal neuron in bowel of different NIM were 88.1%, 24.4%, 18.4%, 4/8, 27.7% and 0/1 in HD, HD/IND, IND, hypoganglionosis, HD/hypoganglionosis and immaturity of ganglion cells respectively. There were totally 46 cases complicated with recurrent postoperative enterocolitis (EC). Incidence of recurrent postoperative EC in HD patients was 6.7% while in IND/HD and IND patients was 35.6% and 28.9%, respectively. Incidences of EC in cases with the residual IND margins and with the normal margins were 38.2% and 8.7%, respectively. Incidence of EC in cases with transanal endorectal pull-through procedure and with transabdominal procedure was 18.0% and 8.3%, respectively. Nine cases underwent another procedure because of severe persistent constipation or EC after operation, including 4 cases HD/IND, 1 case IND, 3 cases HD and 1 case HD/hypoganglionosis. CONCLUSIONS: Neuron distribution is inconsistent with pathology of NIM. Postoperative EC are rare in the patients only with isolated HD. Furthermore, margins with residual IND and transanal endorectal pull-through procedure are risk factors to recurrent EC. However, the extension of excision about IND is uncertain and need further study.

Adolescent↗
PubMed1990

[Intra- and postoperative complications of arthroscopic surgery of the knee joint].

In a review of the literature, intra- and postoperative complications in arthroscopic surgery of the knee joint are analyzed on the basis of 167,210 reported cases. Depending on the variable criteria and definitions, the respective studies are based upon the individual complication rates differ greatly between 0.8 and 17.7%. The incidence of serious complications was less than 1%. Factor analysis proved the following variables to be correlated with the incidence of complications: age and sex, kind and etiology of joint lesion, kind of operative procedure performed, duration of operation, and experience of the surgeon. Compared to arthrotomy, arthroscopic surgery is associated with reduced morbidity and a low complication rate.

Arthroscopes↗
PubMed1987

Significance of the extent of transurethral prostatic resection for postoperative complications.

The significance of the extent of transurethral prostatic resection for benign prostatic hypertrophy was evaluated as regards early and late postoperative complications in a prospective, randomized study. The two treatment groups were preoperatively comparable in age, incidence of urinary retention and estimated prostatic weight. In 83 cases the median weight of resected tissue was 18 (range 4-118) g, while in 84 cases the resection was less extensive--median weight 7 (1-40) g. No significant intergroup difference was found in incidence of bladder tamponade, bladder perforation, urinary tract infection or pneumonia. The blood transfusion need was greatest among the patients with complete transurethral adenomectomy of the prostate. Concerning late postoperative complications, the groups did not differ in incidence of urethral stricture, bladder neck contracture or reoperation for benign prostatic hypertrophy. Patients with preoperative urethral instrumentation had heightened risk of developing postoperative urethral stricture.

Aged↗
PubMed1995

Factors related to the occurrence of postoperative complications following penetrating gastric injuries.

The aim of this study was to determine the relationship between diaphragmatic injury and gross contamination of the peritoneal cavity caused by gastric injuries and the occurrence of postoperative complications, especially those related to the pleural cavity. Charts of 73 patients sustaining gastric injuries due to penetrating trauma were retrospectively reviewed. There were 66 males and mean age was 28 years. Stab wounds were the most frequent mechanism of injury, occurring in 46 cases. Most of the injuries were treated using simple suture and minor debridement. Postoperative morbidity rate was 30 per cent and thoracic complications occurred in 11 patients. Twenty-six patients had diaphragmatic injuries; 54 per cent of them developed postoperative complications. Of the remaining 47 patients without diaphragmatic injuries, only eight developed complications. Of the 26 patients with diaphragmatic injuries, seven developed pleuropulmonary complications compared with 4 of 47 without diaphragmatic injury. Of sixteen patients who had gross contamination secondary to gastric injury, characterized by the presence of food or great amounts of gastric contents in the peritoneal cavity, 10 developed postoperative complications compared with 12 of 57 without gross contamination. Overall mortality rate was 11 per cent mostly due to sepsis. In conclusion, the presence of a diaphragmatic injury as well as gross contamination of the abdominal cavity are important factors related to the development of postoperative infections particularly in the pleural space.

Adolescent↗
PubMedDate not supplied

Hand grip dynamometry as a predictor of postoperative complications reappraisal using age standardized grip strengths.

A mechanical hand grip dynamometer was used to derive age- and sex-related standard grip strengths from 247 healthy volunteers between 16 and 95 yr old. Preoperative grip strength was measured in 90 patients and related to postoperative complication rates. A grip strength of 85% standard for age and sex was found to be the most effective cut-off for prediction of postoperative complications in terms of sensitivity and specificity, predicting 74% of the complications (p less than 0.05). Specificity is improved over previously published standards related to sex alone especially when assessing the elderly patient (50% vs 21%). A grip strength below the recommended cut-off for age and sex suggests that the patient is in a high-risk group and demands further investigation of nutritional status. Studies of pre-operative nutritional support for the at risk group need to be undertaken.

Adolescent↗
PubMed2004

[Intraoperative and early postoperative complications of lumbar and lumbosacral fusion: prospective analysis of 872 patients].

PURPOSE OF THE STUDY: Incidence of complications following lumbar or lumbosacral fusion is still an imprecise notion. The aim of this prospective observational study was to determine the frequency of intraoperative and early postoperative complications after this procedure and to analyze favoring factors. MATERIAL AND METHODS: Twenty-one orthopedic units participated in this study which included 872 patients who underwent lumbar or lumbosacral fusion procedures involving the sector limited by L1 and S1. A minimum of 6 months follow-up was required for inclusion. Four types of complications were studied: general complications, infection, neurological and meningeal complications, mechanical problems. The following preoperative and intraoperative parameters were recorded: epidemiological and morphological data, history of lumbar spine surgery, comorbid conditions, indication for surgery, and technical aspects of the fusion. Two types of analysis were performed. The first was a descriptive analysis designed to determined the overall incidence of complications and the incidence of each type of complication. A multivariate analysis was then performed in order to determine factors influencing occurrence of complications. RESULTS: Mean follow-up was 13 months, mean age of the cohort was 51 +/- 15.5 years. Prior lumbar surgery was noted in 12% of the patients. A decompression procedure was associated in 40% of the patients due to lumbar stenosis. Posterolateral arthrodesis was used in 71% of the patients and 91% were instrumented. Most of the fusions were short, involving one or two levels. One or more intraoperative or early postoperative complications were observed in 200 patients (23%). The incidences of the four types of complications expressed in percent of the total cohort were 9.7%, 5.6%, 8.6%, and 3.6% for general, infectious, neurological and meningeal, and mechanical complications respectively. Three factors exhibited a significant correlation with occurrence of complications, irrespective of the type: excess weight, presence of several comorbid conditions, and extent of the zone of fusion. CONCLUSION: This study enabled a precise assessment of the incidence of complications subsequent to lumbar or lumbosacral fusion: 23%. The incidence of serious complications requiring a reoperation was 14.7%. This finding, together with the factors found to influence occurrence of these complications should be kept in mind when determining indications for lumbar or lumbosacral fusion.

Adult↗
PubMed2005

Risk factors for early and late postoperative complications of patients with endometrial cancer.

OBJECTIVE: We have routinely performed staging with pelvic and/or paraaortic lymphadenectomy in patients with endometrial cancer having moderate to high risk for lymph node metastasis. The aim of this study was to investigate the risk factors for the occurrence of early and late postoperative complications in patients managed primarily by surgery in our institution. STUDY DESIGN: Two-hundred and fifty-nine consecutive cases of endometrial cancer were enrolled in the study. Past history, body mass index, type of surgery, intraoperative findings, and follow-up information were collected from patient charts. Of these, 200, 127, and 30 patients underwent systematic pelvic lymphadenectomy, systematic paraaortic lymphadenectomy, and radical hysterectomy, respectively. The median numbers of dissected pelvic and paraaortic lymph nodes were 32 and 14, respectively. RESULTS: None of the complications resulted in death. Of the study population, 36 early complications and 34 late complications occurred. Overall 65 patients (25.1%) had at least one complication. Multivariate analysis revealed that a longer operative time and paraaortic lymphadenectomy were independent predictors for the occurrence of early and late postoperative complications, respectively. CONCLUSIONS: Since the therapeutic value of lymphadenectomy is still under evaluation, the indications for systematic pelvic and paraaortic lymphadenectomy should be carefully considered.

Adult↗
PubMed1982

The relation between the status of adaptive system and the number of postoperative complications in patients with gastrointestinal cancer: the effect of phenazepam.

The decrease in 11-hydroxycorticosteroids concentration caused by 0.5 mg of dexamethasone administered at 11 pm was studied in 91 primary patients suffering from gastrointestinal cancer. In dexamethasone-resistant patients postoperative complications developed in 65% of colon cancer patients and in 42% of stomach cancer patients. In dexamethasone-sensitive patients the complications were observed in 24% and 12% of patients, correspondingly. The elevation of hypothalamic threshold of sensitivity to the inhibiting effect of glucocorticoids, revealed by the dexamethasone suppression test, was considered to be as result of a combined action of age, the tumor itself, and pronounced emotional stress during the preparation for operation. The derivative of benzodiazepin--phenazepam--when administered before the operation in colon cancer patients improved the results of the dexamethasone suppression test and decreased the number of postoperative complications.

11-Hydroxycorticosteroids↗
PubMedDate not supplied

[Incidence of postoperative complications in geriatric gynecology].

The results of a retrospective-study concerning postoperative complications after gynecologic geriatric surgery (506 patients, aged 60 years and over) at the Departement of Gynecology and Obstetrics of the District Hospital Stralsund/GDR are presented. In 106 patients (10,94 per cent) we have registered post-operative complications, in particular anaemia, fever and wound-period (1967 to 1971 = 8,22%, 1977 to 1981 = 13,29%). Gynecologic surgery in the aged requires a carefully clinical management in preoperative diagnostic and an intensive postoperative care.

Aged↗
PubMed1997

[Postoperative complications of anterior and middle skull base surgery].

The authors present the postoperative complications of skull base surgery based on a 10-year experience with 26 patients operated on via the supraorbital trans-basal or orbitozygomatic approach. The lesions included 19 malignant tumors and seven benign tumors. Postoperative cerebrospinal (CSF) leak occurred in one of the two patients in whom the dural defects were repaired with a fascia lata graft. None of the remaining 24 patients who were repaired with a musculopericranial flap suffered postoperative CSF leak. Three patients developed epidural abscess, but no infection was seen in the patients who had been reconstructed with a vascularized musculo-cutaneous flap to occlude the dead space. Preoperative radiation therapy correlated with a high incidence of postoperative infection. Cranial nerve deterioration or palsy occurred in four patients. Intraoperative injury of the internal carotid artery occurred in one patient who developed severe neurological deterioration. After an average follow-up period of 40 months (range 12 to 109 months), 68% of patients with malignant tumors and 100% of patients with benign tumors were alive with no evidence of recurrence.

Abscess↗
PubMed2000

Intraoperative and early postoperative complications of operative hysteroscopy.

With preoperative evaluation, meticulous technique, and vigilance for impending problems, intraoperative and early postoperative complications of operative hysteroscopy are largely preventable. Fluid overload is the most common serious complication. The hysteroscopist must understand the significant differences between hypotonic, electrolyte-free distention media and isotonic, electrolyte-containing media and their respective sequelae. As new operative tools become available, hypotonic and electrolyte-free distention media may become obsolete. The physiology and management of air embolism, the most grave intraoperative complication, are essential to the knowledge base of any active hysteroscopist. Mechanical accidents, anesthetic complications, laser and electrical injury, and infections can be reduced by knowledge and preparation. Technologic advances, ongoing research, and postgraduate training in hysteroscopic technique continue to expand the safe and beneficial applications of hysteroscopy into the next century.

Blood Loss, Surgical↗
PubMed1988

[Postoperative complications of surgical and combined treatment of cancer of the lungs].

An analysis of postoperative complication in 1800 patients with lung carcinoma has shown their incidence to depend on the volume and character of surgery, preoperative radiotherapy and to fluctuate from 6.1 to 33.7%, making on the whole 21.2%. Broncho-pulmonary complications are most frequent (64.2%). Preoperative radiotherapy makes the amount of complications higher (from 19.2 to 28.9%) but does not influence the postoperative lethality which is 6.6% on the whole.

Bronchial Fistula↗
PubMed1995

[The postoperative complications and risk factors in heart operations with extracorporeal circulation].

The analysis covers 150 patients subjected to open-heart surgery in the "St. Catherine" Hospital during the period January through April 1994. The postoperative complications are evaluated with a special emphasis on the risk factors involved. The timing of operation, cardiopulmonary bypass duration, and other predisposing factors are considered. In 105 patients (70 per cent) no complications are recorded in the early postoperative period (12-day postoperative hospitalization, and 30 days after discharge). In the remainder 45 patients (30 per cent), bacterial and abacterial complications develop in 23 cases (15.3 per cent) and 26 cases (17.3 per cent), respectively. Combined bacterial and abacterial complications are observed in 4 cases (2.7 per cent). The outcome of operation is significantly influenced by the timing of surgical intervention, duration of operation and cardiopulmonary bypass, intubation an chest re-exploration. The rest of the factors considered have no essential practical bearing on postoperative complications. In 17.7 per cent it is a matter of noninfectious complications where antibiotic treatment is unnecessary. Subfebrility as a single symptom after the sixth postoperative day is noted in many patients free of complications, and should be by no means considered as an indication for antibiotic therapy.

Adolescent↗
PubMed2006

[A study of 4,031 patients of transurethral resection of the prostate performed by one surgeon: learning curve, surgical results and postoperative complications].

A total of 4,031 patients who underwent transurethral resection of the prostate (TURP) performed by one surgeon between May 1979 and December 2003 were retrospectively examined to determine the improvement of the surgeon's skill in performing TURP assessed by using a learning curve, surgical results and postoperative complications. Analysis using the learning curve, which displayed the relationship between the number of TURP procedures and the speed of resection (i.e., the weight of tissue resected divided by the operation time), revealed that 81 operations were needed before the surgeon's skill reached a plateau in performing TURP. The means +/- standard deviations of the weight of tissue resected, operation time and speed of resection were 17.0 +/- 14.6 g, 21.0 +/- 13.5 minutes, 0.80 +/- 0.32 g/minutes, respectively. As the number of TURP procedures increased and the level of skill improved, the operation time was significantly reduced and the speed of resection was significantly increased. The incidences of postoperative complications were 2.4% for blood transfusion, 0.3% for the TURP syndrome, 1.5% for hemostatic procedures, 2.8% for bladder neck contracture, and 1.0% for urethral stricture. The incidences of transfusion and the TURP syndrome decreased as the surgeon's skill improved. The mortality rate was 0.1%.

Aged↗