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PubMed2006

Identifying risk factors for postoperative pulmonary complications.

Postoperative pulmonary complications are potentially preventable adverse events that are a major source of postoperative morbidity and mortality. Although these events occur more frequently than cardiac complications, less is known about how to predict their occurrence. This review of the literature identifies significant risk factors for postoperative pulmonary complications. Nurses can be instrumental in preventing postoperative pulmonary complications by identifying patients at risk for their development.

Comorbidity↗
PubMedDate not supplied

[Transrectal magnetotherapy of the prostate from Intramag device in prophylaxis of postoperative complications of transurethral resection of prostatic adenoma].

The authors analyse preoperative preparation of 91 patients with benign prostatic hyperplasia (BPH). Two groups of patients received conventional preparation (group 1) and magnetotherapy (group 2) before TUR of the prostate. The examination covered immune system, bacteriological indices of urine and prostatic tissue. Infection of the urinary tract is a main risk factor of complications after TUR. Conventional preoperative preparation fails to correct immunity, to change bacterial urine flora, to improve hemodynamics in the prostate. Transrectal magnetotherapy with running magnetic field eliminates deficiency of T- and B-cell immunity, raises functional activity of B-lymphocytes and phagocytic ability of neutrophils, reduces endogenic intoxication, tissue edema, bacterial contamination, number of thrombohemorrhagic complications. This leads to a decrease in the number of postoperative complications.

B-Lymphocytes↗
PubMed1997

[Parkinsonism and postoperative complications in the elderly].

The risk factors for postoperative morbidity and mortality in elderly patients with Parkinsonism after gastrointestinal surgery were evaluated by univariate and multivariate analyses in comparison to those of patients with cerebrovascular disease and to those of patients with no comorbid condition. Data were obtained on 36 patients with Parkinsonism (PK), 77 with cerebrovascular disease (CVD) and 120 with no comorbid condition (ND). All data were adjusted for age, sex and operative procedure. The postoperative morbidity rate was highest in the PK group (77.8%), followed by the CVD group (70.1%), and both differed significantly from the rate of the ND group (32.5%). Gastrointestinal and pulmonary complications and delirium were the major postoperative complications, and were significantly more common in the PK group than in the ND group. Patients in the PK group had the longest postoperative hospital stay, followed by those in the CVD and ND groups; the differences were significant between the PK and ND groups and between CVD and ND groups. The PK group had the highest operative and hospital mortality rates, and they differed significantly from the ND group. Hayashi's second method of quantification was used to assess the risk factors for postoperative death. The highest partial correlation coefficient was that found for postoperative pulmonary complication. We conclude that we should pay close attention to postoperative respiratory management, particularly in elderly patients with Parkinsonism, to prevent pulmonary complications and reduce postoperative mortality.

Aged↗
PubMed2005

Transurethral bladder tumor resection: intraoperative and postoperative complications in a residency setting.

PURPOSE: We established a database on the incidence of intraoperative and postoperative complications associated with transurethral bladder tumor resection (TURBT) in an academic teaching setting, and we prospectively recorded all TURBTs performed by residents and fellows in our urology department. MATERIALS AND METHODS: : We prospectively evaluated all TURBTs performed between November 2003 and October 2004. All cases were performed at least in part by residents and fellows under direct attending supervision at a single academic medical center with 3 different teaching hospitals. Intraoperative complications were recorded by the resident and attending surgeon at the completion of the operative procedure. At patient discharge from the hospital the data sheet was reviewed, and length of stay, postoperative transfusions and any other complications were recorded. RESULTS: A total of 173 consecutive TURBTs were performed by residents and fellows at 3 different teaching hospitals. There were 10 (5.8%) complications, including 4 (2.3%) cases of hematuria that required blood transfusion and 6 (3.5%) cases of bladder perforation. Of these 6 perforations 4 were small extraperitoneal perforations requiring only prolonged catheter drainage. These perforations were caused by residents in their first or third year of urology training. Two perforations were intraperitoneal, caused by a senior resident or a fellow, 1 of which required abdominal exploration to control bleeding. CONCLUSIONS: TURBT is a reasonably safe procedure when performed by urologists in training under direct attending supervision. The complication rate was 5.8%, however only 1 case required surgical intervention. Contrary to expected findings, more senior residents were involved in the complications, likely secondary to their disproportionate roles in more difficult resections.

Academic Medical Centers↗
PubMed1977

[Hemobilia, a rare and dangerous postoperative complication].

3 cases of severe postoperative hemobilia are reported, one patient with an echinococcus cysticus of the liver, two others after surgical procedures on biliary tract. Diagnostic means as cholangiography, coeliacography, scanning of the liver and endoscopic retrograde cholangiography were not possible because of the massive bleeding. In those cases, if no other sources of bleeding are found, only esophago-gastro-duodenoscopy can leed to the correct diagnosis. In gastrointestinal bleeding after surgical manipulation on the biliary tract, the duodenum and the pancreas, hemobilia is a possible cause.

Adult↗
PubMed2002

Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications.

OBJECTIVE: Type and frequency of postoperative abnormalities were registered after cardiovascular surgery to evaluate the aetiology and diagnostic value of increased concentrations of procalcitonin (PCT) and C-reactive protein (CRP) during the early postoperative period. DESIGN: Prospective, observational study. PATIENTS: Two hundred and eight patients undergoing coronary artery bypass grafting or valve replacement requiring cardiopulmonary bypass were monitored for 7 days postoperatively for various types of infectious or non-infectious complications. Plasma PCT and CRP levels were measured on day 1 and day 2 after surgery and, when increased, until day 7. RESULTS: More patients with PCT above 2 ng/ml on day 1 or 2 (n=55) had postoperative abnormalities (95%) than patients with lower PCT (59%). Specifically, the incidence of three or more criteria of the "systemic inflammatory response syndrome" was 45% versus 4% (area under the curve of the receiver operating characteristic 0.866); positive inotropic support was needed in 65% versus 9% (0.870); respiratory insufficiency (PaO(2)/FIO(2)<200) 38% versus 12% (0.704); proven and suspected bacterial infection 9% versus 1% (0.900) and 24% versus 1% (0.897), respectively. For CRP, the respective areas under the curve were all below 0.63, while all patients had elevated CRP levels, whether they had a complication or not. CONCLUSIONS: Elevated PCT, but not CRP, correlates with evidence of systemic inflammation and other complications early postoperatively after cardiac surgery. Although the PCT levels do not rise as quickly as the criteria of the systemic inflammatory response syndrome appear, they do reflect systemic inflammation. Early identification and quantification of a systemic inflammatory response may help reduce postoperative complications.

APACHE↗
PubMed1992

Postoperative complications and survival after pancreatoduodenectomy in patients aged over 70 years.

An analysis of postoperative complications and survival was conducted in 31 patients undergoing pancreatoduodenectomy (PD) for carcinoma of the pancreas or periampullary carcinoma. Of them, 11 were over 70 years of age and 20 were under 70. Anastomotic leakage was the most common complication after PD. Definite pancreatic leakage was found in one patient in the over 70 group, and one case each of pancreatic, biliary, and gastric leakage were found in the under 70 group. All complications were treated conservatively without any further operative intervention. The overall morbidity rate was 41.9% (13/31), being 45.5% (5/11) in the over 70 group and 40.0% (8/20) in the under 70 group, and no operative deaths occurred within 30 days after surgery. The cumulative survival rate of the patients aged over 70 years with carcinoma of the pancreas or periampullary carcinoma did not differ significantly from the rate of those under 70. It was thus concluded that PD achieves an adequate prognosis and survival in patients over 70 years of age.

Adult↗
PubMed2006

Lack of increase in postoperative complications with low-dose methotrexate therapy in patients with rheumatoid arthritis undergoing elective orthopedic surgery.

To determine the potential contribution of intermittent low-dose methotrexate (MTX) treatment (2-8 mg/week) to postoperative complications, we studied 122 patients with rheumatoid arthritis (RA) who had 201 surgical procedures. The patients with treatment with MTX were allocated to two groups: those who continued MTX (group A, 77 procedures) and those who discontinued MTX more than 1 week (group B, 21 procedures). The patients who had no treatment with MTX were allocated to group C (103 procedures). The incidence of postoperative infection, poor wound healing, and flare-up of RA was compared between the three groups. Postoperative infection occurred in 3.9%, 4.8%, and 3.9% in groups A, B, and C, respectively. Poor wound healing was experienced in 1.3%, 9.5%, and 7.8% in groups A, B, and C, respectively. At 4 weeks postoperatively, 3.9%, 14.3%, and 6.8% of flares were seen in groups A, B, and C, respectively. No significant difference was found in the patients with or without perioperative use of MTX. From these results, it is unlikely that continuation of intermittent low-dose MTX treatment increases the risk of postoperative complications in patients with RA. Continued treatment with MTX during perioperative period could suppress disease flares, especially in severe RA patients.

Aged↗
PubMedDate not supplied

[The causes of early postoperative complications in the surgical treatment of hemorrhaging gastroduodenal ulcers].

Based on the material of 1201 patients who had been operated on for complicated gastroduodenal ulcers, the causes are analyzed of the early postoperative complications (EPC) development. The EPCs were encountered in 15.5%. The most important risk factors identified in the study included peptic ulcer complications, the degree of severity of ulcer bleeding, time for the surgical intervention to be done, the technique employed, with the effects thereof having been studied on the EPC occurrence. Stenosis presenting with penetration and gigantic ulcers was found out to have the most apparent impact on the origination of EPC.

Duodenal Ulcer↗
PubMed1997

[The use of cefotetan for the prevention of infectious postoperative complications in gynecology].

The study presents the results from the use of cefotetan for perioperative prophylaxis in 43 gynaecology patients compared with 29 controls without perioperative antibiotic prophylaxis with similar diseases and operations. Both groups show equal percentage of the cases with smooth postoperative period (70 and 72% respectively). 13 of the patients on cefotetan prophylaxis received additional antibiotic treatment (9 because of temperature up to 37.5 degrees and 4 because of temperature from 37.6 to 38.5 degrees). Mo major infections postoperative complications occurred among the patients on cefotetan prophylaxis. 8 of the non-prophylacted patients needed antibiotic treatment postoperatively including 4 with temperature above 38.5 degrees. Two infections of the operative wounds also occurred in the same group. The conclusion is that cefotetan effectively prevents the major infection postoperative complications in gynaecology. The administration of additional antibiotic treatment is most often not warranted.

Adolescent↗
PubMed2006

[Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis].

INTRODUCTION: Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. OBJECTIVE: We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. MATERIAL AND METHODS: The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). RESULTS: In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. CONCLUSIONS: Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used.

Adolescent↗
PubMedDate not supplied

[Late paraparesis as a postoperative complication in a patient undergoing the repair of a double aortic aneurysm].

We report a case of a fifty-seven (57)-years old man undergoing elective surgery of a thoracoabdominal and aortoiliac aneurysm in a single surgical time. The patients is operated undergoing general anesthetic combined with thoracic epidural blockade, and it was done two aortic cross-clamping: one to five cm of the aortic arch and the other to the infrarenal level. The most important intraoperative complications were during the thoracic aortic cross-clamping and the most important postoperative complication was related 48 hours later, to paraparesis after a hypotension episode what improved with rehabilitation treatment.

Anastomosis, Surgical↗
PubMed1994

[Prevention of postoperative complications in diffuse purulent peritonitis in children].

A complex pathogenetic approach to the prevention of postoperative complications in generalized fibrinopyogenic peritonitis is suggested. It includes a wide operative access, one-stage cleansing with antiseptics and detoxification solutions, ultrasonic cavitation of the abdominal cavity, creation of laparostomy, local infiltration of the wound edges with 0.01% thymalin solution, correction of hemostasis disorders, and increase of the organism's general reactivity. With the use of this complex the results of treatment were significantly improved in 21 children and the number of complications was much less than in the control group of patients subjected to operation.

Adjuvants, Immunologic↗
PubMed1975

[The penetrating duodenal ulcer. Operative technique and postoperative complications (author's transl)].

The results of 133 gastric resections for penetrating duodenal ulcer are reported. Because of the postoperative complications (acute hemorrhagic pancreatitis, duodenal stump insufficiency, icterus and intraluminal postoperative bleeding) in future only the atypical closure of the duodenal stump according to the method of Nissen-Bsteh should be carried out. A bleeding ulcer should be operated within 48 hrs. If the bleeding needs more than 2500 ml blood substitute, this means a indication for a immediate operation.

Acute Disease↗
PubMed2004

Postoperative complications after chemoradiation for advanced head and neck cancer.

BACKGROUND: To compare the rate of postoperative complications of patients with advanced head and neck cancer treated with the chemoradiation protocol "RADPLAT" with that of a similar cohort of patients treated with primary surgery. METHODS: We retrospectively analyzed 50 patients treated with RADPLAT and 50 patients treated with primary surgery. RESULTS: The rates of complications for local wound problems were 54% and 42%, respectively, for the RADPLAT cohort and the primary surgery cohort. However, the rate of local complications for the subset of RADPLAT patients undergoing clean-contaminated surgery was 69% (p =.305). The rates of complications for medical (systemic) problems were 10% and 12%, respectively, for RADPLAT versus primary surgery patients. There was no significant difference in hospitalization time between the groups. CONCLUSIONS: Among patients with advanced head and neck cancer, surgical complications are high but not significantly different between patients undergoing the chemoradiation protocol "RADPLAT" and those undergoing primary surgery.

Adult↗
PubMed2006

What is the value of available risk-scores in predicting postoperative complications after aorto-iliac surgery? A prospective non randomized study.

AIM: With an aging population, atherosclerotic manifestations are steadily increasing. Beside the anatomical and pathophysiological preoperative risk-factors accompanying perioperative risk-factors like patient's age, length of operation, blood loss and skill of the surgeon, all need to be accounted for when assessing the risk of morbidity and mortality after vascular surgery. The demand for cost effectiveness may make a risk-score system useful. The aim of the present study was, therefore, to prospectively apply various scoring systems in order to estimate outcome in patients undergoing aortobifemoral surgery due to arterial occlusive disease at the aorto-iliac level. METHODS: A prospective non randomized study was carried out. The SPSS 9.0 statistical package for Windows and, for nominal data, chi-squared-tests were used to compare rates between groups. For continuous data analysis of variance (ANOVA) was performed. When appropriate, a multivariate analysis with binary-regression by Wald was used. Sensitivity and specificity was done using ROC-curves. P < 0.05 was considered significant. From May 1996 to June 2000, 107 patients were included in the study. Besides basic data, all postoperative complications were noted according to a specific definition. Four different risk-scoring systems were used: ASA-classification; the acute physiology and chronic health evaluation (APACHE-II) system; the physiological and operative severity score for enumeration of mortality and morbidity (POSSUM) classification and, finally, the simplified acute physiology score (SAPS) classification. RESULTS: We found no significant correlation between risk-scores and outcome. None of the scoring systems used was able to predict mortality. The independent factors that influenced the postoperative complication rate were operating time, blood loss, intraoperative assisted ventilation time and age. The endpoint using the relative operating characteristic (ROC) curves analysis was either mortality or morbidity. CONCLUSIONS: It can be concluded that none of the systems analyzed separately was useful for determining morbidity and mortality. We still lack a system, that can be used preoperatively in an individual case and the vascular surgeon still has to build up his own clinical judgement or to transfer a clinical judgement.

Adult↗
PubMed1990

The predictive role of bioelectrical impedance analysis (BIA) in postoperative complications of cancer patients.

The correlation between body composition measured by bioelectrical impedance (BIA) and postoperative complications in 115 patients with gastrointestinal cancer was analysed. A significant increase in severe complications was found independent of lean body mass (LBM). In patients with LBM below the normal range the complication rate proved to be 31% (17/55), whereas patients with normal LBM had a complication rate of 10% (6/60). Other decisive factors, such as sex, age, tumor stage, operative procedure and body height were equally distributed in both groups. The practicability and efficiency of BIA became obvious in this study.

Adult↗
PubMed1995

Exercise capacity as a predictor of postoperative complications in lung resection candidates.

Exercise testing with measurement of maximal oxygen uptake (VO2max) is increasingly used in the assessment of lung resection candidates, but its predictive value for postoperative complications remains controversial. We therefore sought to determine the prognostic value of VO2max compared with other pulmonary function tests. A consecutive group of 80 patients (mean age 61 yr; 57 males and 23 females) scheduled for lung resection (62 malignancies, 12 benign disorders, and 6 carcinoids) underwent pulmonary function tests and symptom-limited cycle ergometry. All patients underwent lung resections: 21 pneumonectomies, 45 lobectomies, and 14 segmental or wedge resections. Group A (64 patients, 80%) had an uneventful postoperative course, whereas Group B (16 patients, 20%) had complications; 3 of them died (4% overall mortality rate). In a stepwise logistic regression analysis used to determine independent risk factors for postoperative complications (within 30 d), VO2max expressed as a percentage of predicted (84 +/- 19 for Group A versus 61 +/- 11 for Group B) proved to be the best predictor (predictive value 85.5%). Although VO2max expressed in absolute values (ml/kg/min) was also highly predictive (79.5%), a ROC curve analysis proved the percentage predicted values to be significantly more sensitive. Of 9 patients with a VO2max < 60% of predicted, 8 had complications, including all 3 patients who died after resections of more than one lobe (sensitivity 50%, specificity 98%). The estimated probability (probit model SAS software package) of suffering no complication was 0.9 for VO2max > 75% of predicted and 0.1 for a VO2max < 43%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗