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PubMed1979

Postoperative complications in 1,000 cases of intracranial aneurysms.

Clinical analysis of postoperative complications was made in 1,000 cases of intracranial saccular aneurysm. Psychological symptoms, motor disturbances, and aphasia were observed in 107 cases (11.5%), 74 cases (7.1%) and 20 cases (2.1%), respectively, in 939 discharged cases. Water and electrolyte disturbances and gastro-intestinal bleeding were found in 60 cases (6.0%) and 19 cases (1.9%), respectively, in 1,000 surgically treated patients including those that died during hospitalization. Psychological symptoms were most apt to develop in cases of vertebrobasilar artery aneurysm, multiple aneurysms and anterior communicating aneurysm. It appeared that the poorer the preoperative grade, the higher the incidence of psychological symptoms. These developed most frequently in patients operated on the third to seventh days after the subarachnoid hemorrhage. The postoperative psychological symptoms improved in 63% of 107 cases. The occurrence rates of other complications were also studied.

Alcohol Amnestic Disorder↗
PubMed1986

[Effect of previous and concomitant lung pathology on the postoperative complications in patients with lung cancer].

The Institute's data on postoperative complication development in 247 lung cancer patients with previous or concomitant lung pathology and 206 patients suffering from lung cancer alone were compared for the period of 1975-1984. It was found that after radical surgery pulmonary complications and lethality were much more frequent in lung cancer patients with concomitant lung disease and/or pulmonary pathology in case history (17 and 9.3%) than in patients free from such pathology (8.7 and 3.7%). To illustrate, postoperative pneumonia, bronchial fistula and pleural empyema and acute pulmonary failure were observed in 11.3, 4.9 and 2.4% of cases of concurrent lung pathology, respectively, to match respective 5.3, 2.4 and 0% in the other study group, with pneumonia being the most frequent complication, particularly, after partial resection (13.6%).

Bronchial Fistula↗
PubMed1989

Spinal traumas: some postoperative complications in experimental animals.

Animals with severe spinal traumas show paraplegic syndrome and various somatic and autonomic dysfunctions. Of the various dysfunctions those related to hypothermia, bladder problems, and autophagia are of serious nature. The condition of animals with these complications deteriorates rapidly, and the animals are sacrificed for histological and pathological analyses. The findings show that the postoperative complications are related to the degree of severity of the trauma, and that 50-80% animals are lost due to these complications. Most of these animals are lost during the first two weeks after surgery, and the remaining at later stages. Transplantation of neural tissue at the site of lesion does not ameliorate these postoperative complications and improve the survival rate of the animals.

Animals↗
PubMed1987

Diagnosis and management of early postoperative complications in open heart surgery.

Open heart surgery involving the use of artificial prosthetic materials, and extracorporeal circulation for varying periods, is often performed on patients seriously or acutely ill. Despite excellent surgical procedures, various postoperative complications may detract from perfect primary results. Postoperative myocardial failure and cardiac arrhythmias can be expected while vascular accidents and disorders of various organ systems are less common, but serious, complications. The treatment of these complications requires correct diagnosis without delay, their recognition being particularly difficult during the immediate postoperative period. This review deals with the incidence, diagnosis and therapy of the most important early postoperative complications specific to open heart surgery.

Arrhythmias, Cardiac↗
PubMed2002

[Early postoperative complications and prevention of them in ischemic heart disease patients after direct myocardial revascularization].

AIM: To specify risk factors affecting development and frequency of complications early after the bypass operation in direct myocardial revascularization. MATERIAL AND METHODS: 455 patients with ischemic heart disease (IHD) of whom 392 (86.2%) had stable angina pectoris class III-IV, 25 (5.5%) had unstable angina pectoris (UAP) and 38 (8.5%) had survived myocardial infarction (MI) underwent autovenous coronary artery bypass operation. IHD combined with arterial hypertension in 103 (22.6%), diabetes mellitus type II in 67 (14.7%), cardiac failure (CF) stage IIa in 97 (21.3%) patients. The ejection fraction (EF) was 37.8 +/- 3.3% in 113 (24.8) patients, in the others it was 46.7 +/- 2.7%. RESULTS: Early postoperative complications arose more frequently in patients with UAP, MI, CF and low EF. Postoperative acute cardiovascular failure was registered in 132 (29.5%) patients, arrhythmia--in 60 (13.4%), perioperative MI--in 13 (2.9%) patients. CONCLUSION: The most significant risk factors of postoperative complications in the above patients are the following: UAP, MI, CF, low EF. These risk factors should be allowed for in preparation of patients for coronary bypass surgery.

Adult↗
PubMed1998

[Laparoscopic versus conventional appendectomy--a comparison with reference to early postoperative complications].

OBJECTIVE AND METHODS: To compare the complications of laparoscopic appendectomy (LA) and conventional appendectomy (CA) 930 consecutive patients from 1989 until 1997 were analysed retrospectively. RESULTS: Conventional appendectomy was performed in 330 patients, laparoscopic in 554 patients and another 46 patients required conversion after laparoscopy. The groups were similar in sex ratio, age and degree of inflammation. Postoperative complications occurred in 8.78%. There were less complications in the LA-group (4.69%) than in the CA-group (13.33%) (p < 0.01), especially wound infections were found less in the LA-group (1.8% vs. 11.21%, p < 0.01). The incidence of intraabdominal abscesses was similar in the LA and CA group (1.44% vs. 1.52%). The differences between the groups are not influenced by complicating appendicitis (perforation or abscess). Systemic complications were similar for LA and CA (0.72% and 0.61%), but were seen more often after conversion (6.52%, p < 0.01). CONCLUSIONS: This retrospective analysis shows that laparoscopic appendectomy significantly reduces postoperative complications, especially wound infections. The authors consider laparoscopic appendectomy to be the procedure of choice in patients with acute appendicitis.

Adolescent↗
PubMed1992

General anaesthesia and the hypereosinophilic syndrome: severe postoperative complications in two patients.

Two patients with markedly increased eosinophil counts developed severe postoperative complications after general anaesthesia. One patient suffered life-threatening Adult Respiratory Distress Syndrome (ARDS), while the other presented with a coagulopathy and less severe respiratory problems. The hypereosinophilic syndrome is described and the possibility of a role of eosinophils in the pathogenesis of tissue injury is discussed. These cases suggest that, in patients with marked eosinophilia requiring general anaesthesia, perioperative steroid cover is advisable. This may reduce or prevent serious lung damage and other complications.

Adolescent↗
PubMed1989

[Tc-99m DTPA scintigraphic findings in patients with postoperative complications of renal transplantation].

Tc-99m DTPA scintigraphic findings in patients with postoperative complications of renal transplantation were presented. In acute tubular necrosis, excretion of the tracer was not observed though its perfusion was preserved. In acute rejection, perfusion was reversibly disturbed. In chronic rejection, perfusion was irreversibly disturbed. In renal infarction, multiple defects were observed. In renal vein thrombosis, similar pattern to acute tubular necrosis was found but RI venography was helpful. In lymphocele, perirenal photon deficiency was observed. In renal artery thrombosis, absence of the perfusion and total photon deficient were noted. Tc-99m DTPA renal scintigraphy is useful for diagnosis and follow up of the complications of transplanted kidneys.

Adolescent↗
PubMed1986

The influence of trauma to the spleen on postoperative complications and mortality.

Although splenectomy has been associated with an increased risk of late sepsis, it is not clear whether splenectomy for trauma increases the incidence of acute infectious complications or deaths during the initial hospital stay. We reviewed the charts of 175 trauma patients who had exploratory laparotomy between July 1977 and June 1983. Eighty patients underwent total splenectomy and 15 patients had splenic salvage operations performed. A group of 80 patients with no splenic trauma (N.S.T.) who had laparotomy for trauma, served as a control group. These N.S.T. patients had injury severity scores (ISS) similar to the patients who had splenectomy. The incidence and types of postoperative complications, mortality rates, and length of hospitalization were similar for both groups, indicating that splenectomy was not associated with an increased risk of postoperative complications or mortality.

Adult↗
PubMed2003

Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications.

BACKGROUND AND AIMS: Neoadjuvant radiation and chemotherapy in rectal cancer reduces local recurrences and increases the rate of conservative sphincter surgery. However, an increase in postoperative morbidity and mortality has also been observed. This study analyzed the operative difficulty and postoperative complications in patients with this treatment. PATIENTS AND METHODS: Retrospective review of 103 patients with rectal cancer, divided into two groups: group A, 53 patients undergoing preoperative radiotherapy with 45 Gy combined with chemotherapy, and group B, 50 patients with rectal cancer who received surgery after diagnosis. Both groups were homogeneous. The two groups were compared for both technical difficulty, using intraoperative data and rate of complications. RESULTS: There were no statistically significant differences between the two groups with regard to intraoperative or postoperative data. In group A there were 20 complications in 17 patients (32%) and in group B 22 complications in 19 patients (38%). The rates of perineal wound infection were similar. The percentage of anastomotic leaks was higher in group A. A greater number of anterior resections was performed in group A. CONCLUSION: Preoperative radiation and chemotherapy in rectal cancer does not increase postoperative complications and increases the rate of sphincter-preserving surgery.

Adult↗
PubMed2002

Recording of postoperative complications: quantity and quality.

OBJECTIVE: To evaluate a simple working procedure for recording postoperative complications. DESIGN: Prospective cohort study. SETTING: Teaching hospital, Denmark. SUBJECTS: 218 of 312 patients who were operated on from March to July 1996. INTERVENTIONS: Follow up 30 days after operation by looking up the local register of complications, review of medical records and by structured telephone interview with the patient. MAIN OUTCOME MEASURES: Morbidity. RESULTS: All the patients were recorded in the local register, showing a complication rate of 21% (n = 49). However the medical record and the telephone interview showed complication rates of 68 (31%) and 76 (33%), respectively. CONCLUSION: It is possible to improve the quantity of the recording by a simplified working procedure, while the quality is still a challenge.

Adolescent↗
PubMed2007

Use of fibrin sealant in hypospadias surgical repair reduces the frequency of postoperative complications.

INTRODUCTION: Urethrocutaneous fistulas (UCF) and flap dehiscence (FD) are the most common postoperative complications after hypospadias (HS) surgical repair. The aim of this study was to evaluate whether the application of fibrin sealant over the site of surgery and suture lines reduces these complications. MATERIALS AND METHODS: A prospective cohort of consecutive patients was treated over a 3-year period. 30 patients were submitted to HS surgical repair plus application of fibrin glue over the suture line and surgical site; for comparison, another 56 subjects made up the control group which was submitted to surgical repair only. Variables assessed included: age, type of HS, fibrin sealant used, complications and number of surgical procedures required to treat recurrences. RESULTS: In general, the frequency of complications was 10 vs. 41% for UCF (p = 0.002), 13 vs. 50% for FD (p = 0.001), and for flap necrosis (FN) 6.7 vs. 28.6% (p = 0.01) for the treatment and control groups respectively. The number of surgical reinterventions to treat recurrences was higher in the control group than in the study group (p = 0.04). CONCLUSION: The incidence of UCF after HS surgical repair can be reduced by applying fibrin sealant over the site of surgery and the suture lines.

Child, Preschool↗
PubMed2000

Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany.

Risk factors for postoperative complications of benign goiter surgery have not been investigated systematically. To this end, a prospective multicenter study (January 1 through December 31, 1998) was conducted involving 7266 patients with surgery for benign goiter from 45 East German hospitals. High-volume providers (>150 operations per year) performed 69% (5042/7266), intermediate-volume providers 27% (50-150), and low-volume providers 4% (258/7266) of operations. Among the hospital groups, the pattern of thyroid disease did not vary significantly, but there was a trend that small-volume providers tended to perform more operations for uninodular goiter and high-volume providers treated more patients with Graves' disease and recurrent goiter. Extent of resection (p < 0.0001) and remnant size (multinodular goiter and recurrent goiter, p < 0.001), differed significantly, with total thyroidectomy being performed more often in hospitals with more than 150 operations compared to hospitals with an operative volume of less than 150 procedures per year. Despite the larger extent of resection and smaller remnant size, rates of recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism were not increased. When the logistic regression analyses were fitted to evaluate the impact of risk factors on transient and permanent RLN palsy and hypoparathyroidism, larger extent of resection [relative risk (RR) 1.5-2.1] and recurrent goiter (RR 1.8-3.4) consistently evolved as independent risk factors. With hypoparathyroidism, additional significant factors included patient gender (RR 2.1-2.4), hospital operative volume (RR 0.8-1.5), and Graves' disease (RR 2.8). Unlike parathyroid gland identification during hypoparathyroidism, RLN identification (RR 1.6) significantly (p = 0.01) reduced permanent RLN palsy rates. The multivariate analyses clearly confirmed the pivotal role of routine RLN identification, independent of the extent of the thyroid resection. These findings might help hospitals with lower operative volumes to identify patients at increased risk whom they might consider for specialist care.

Adult↗
PubMed2006

Effect of jejunal and biliary decompression on postoperative complications and pancreatic leakage arising from pancreatojejunostomy after pancreatoduodenectomy.

BACKGROUND: Since its introduction, reconstruction after pancreatoduodenectomy has undergone numerous modifications, leading to a dramatic decline in the mortality rate. However, the reported morbidity rate, due mainly to pancreatic leakage, still remains high. METHODS: Between January 1999 and April 2005, 102 consecutive patients underwent pancreatojejunostomy after pancreatoduodenectomy. Patients treated by biliary decompression alone (n = 58) were compared with patients treated by jejunal decompression alone (n = 40). Four patients who underwent both biliary and jejunal decompression were excluded from the study. RESULTS: Patients who underwent jejunal decompression had a significantly lower incidence of overall postoperative complications (P = 0.028), pancreatic leakage (P = 0.009), and infection (P = 0.011) than patients who underwent biliary decompression. Only one patient who underwent biliary decompression died as a direct result of pancreatic leakage. CONCLUSIONS: Discontinuation of biliary decompression with postoperative jejunal decompression using tube jejunostomy may be a good option in patients undergoing pancreatoduodenectomy, because it appears to reduce the incidence of overall postoperative complications, pancreatic leakage, and infection.

Aged↗
PubMed1999

Postoperative complications in patients of esophageal cancer after neoadjuvant chemotherapy.

We examined the effects of neoadjuvant chemotherapy on surgery by evaluating postoperative complications in 50 patients who had undergone neoadjuvant chemotherapy (Group A) and in 108 patients who had undergone surgery without neoadjuvant chemotherapy (Group B). Toxicity of grade 3 by chemotherapy were WBC in 3 patients (6%), alopecia in 3 patients (6%), and anorexia in 22 patients (44%). There were 4 patients with anastomotic leakage (8%) (all in minor), 5 patients with infection of wound (10%), 6 patients with arrhythmia (12%), no patients with postoperative bleeding, 2 patients with respiratory complications (4%), and no patients who died due to complications in Group A. In Group B, there were 13 patients with anastomotic leakage (13%) (all in minor), 12 patients with infection of the wound (11%), 11 patients with arrhythmia (10%), 2 patients with postoperative bleeding (2%), 8 patients with respiratory complications (7%), and 2 patients who died due to complications (2%). There was no significant difference in the incidence of postoperative complications between the patients who had undergone surgery after neoadjuvant chemotherapy, such as CDDP + 5FU therapy and FAP therapy, and the patients who had undergone surgery without neoadjuvant chemotherapy, in patients who had been diagnosed as being able to undergo relative non-curative resection or better, who had Ccr 60 ml/min or more and no severe complication, and whose stomach could be used for reconstruction of the esophagus, on the condition that surgery would be performed on NC patients at the end of first-course treatment.

Alopecia↗
PubMed2003

Peri-operative levels of s-100 protein in serum: marker for surgical manipulation and postoperative complications.

Although minimally invasive neurosurgical techniques are highly sophisticated nowadays, almost any operative procedure causes an inevitable surgical trauma to the brain. As a consequence unfavorable functional outcomes are not rare. Intraoperative biochemical monitoring can be helpful first to detect but also to prevent brain damage. We investigated if serum S-100 protein (S-100) levels are a reliable marker for the extent of acute cerebral damage caused by surgical trauma or postoperative complication. S-100 is present in the cytosol of glial cells. This protein leaks into the extracellular space after cell damage and can be detected both in the cerebrospinal fluid (CSF) and serum. To determine S-100 protein levels, serum samples from 20 patients with various intracranial tumors were collected before surgery, and at one day, as well as at seven days after surgery. It was hypothesised that the size of the tumor-brain contact surface (TBCS) was closely related to the dimension of the surgical trauma. TBCS was measured from radiological imaging. The pre- and postoperative (day 1 and day 7) clinical condition of each patient was assessed. The S-100 levels were correlated with the TBCS and the clinical condition. Levels of S-100 on day 1 and day 7 were significantly higher as compared with levels on day 0 ( p = 0.02, respectively p = 0.01). There was a significant relationship between rise of S-100 level and worsening of clinical condition between day 0 and day 1 ( p = 0.001). Also a significant positive relationship between TBCS and the level of S-100 could be found on day 1 and on day 7 ( R = 0.71, p = 0.0009, respectively R = 0.73, p = 0.004). Furthermore, a significant relationship between the rise of S-100 level between day 0 and day 1, as well as between day 0 and day 7, and TBCS could be documented ( R = 0.61, p = 0.01, respectively R = 0.64, p = 0.005). In conclusion, serum S-100 levels are a reliable marker for acute or recent CNS damage caused by neurosurgical manipulation or as a result of secondary postoperative complications. Therefore, intraoperative monitoring of serum S-100 levels seems very promising. In such a setting the negative effects of surgical manipulation can be measured instantaneously, which should bring the neurosurgeon to change his strategy. As a consequence the surgical trauma can be minimized and functional outcome can be optimized.

Adult↗
PubMed2000

Audit of single-stage proctocolectomy for Crohn's disease: postoperative complications and recurrence.

PURPOSE: This study was undertaken to review our overall experience of single-stage proctocolectomy for Crohn's disease. METHODS: One hundred three patients who underwent single-stage proctocolectomy for Crohn's disease between 1958 and 1997 were reviewed. Factors affecting the incidence of recurrence were examined using a multivariate analysis. RESULTS: Principal indications for proctocolectomy were chronic colitis (49 percent), acute colitis (37 percent), and anorectal disease (14 percent). The commonest postoperative complication was delayed perineal wound healing (n = 36; 35 percent), followed by intra-abdominal sepsis (17 percent) and stomal complications (15 percent). In 23 patients the perineal wound healed between three and six months after proctocolectomy, whereas in 13 patients the wound remained unhealed for more than six months. There were two hospital deaths (2 percent) caused by sepsis. The 5-year, 10-year, and 15-year cumulative reoperation rates for small-bowel recurrence were 13, 17, and 25 percent, respectively, after a median follow-up of 18.6 years. From a multivariate analysis, factors affecting reoperation rate for recurrence were gender (male; hazard ratio 2.4 vs. female; P = 0.03) and age at operation (< or =30 years; hazard ratio 2.6 vs. >30 years; P = 0.04). The following factors did not affect the reoperation rate: duration of symptoms, smoking habits, associated perforating disease, coexisting small-bowel disease, postoperative complications, and medical treatment. CONCLUSIONS: Proctocolectomy for Crohn's disease is associated with a high incidence of complications, particularly delayed perineal wound healing. Proctocolectomy carries a low recurrence rate in the long term. However, young male patients are at high risk of recurrence.

Adolescent↗