[Clinical experiences in vagotomized persons with postoperative complications].
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Postoperative Complications↗
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[Pulmonary atelectasis as a postoperative complication].
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Humans↗
[Postoperative complications of abdominal aortic aneurysm--with special reference to postoperative renal hypofunction].
Effects of various factors before and during operation on postoperative renal hypofunction were studied in 34 preoperatively evaluated surgical cases of non-ruptured abdominal aneurysm. The cases were divided into two groups, with and without postoperative renal hypofunction. The two groups showed no differences with respect to age, sex, preoperative serum Crn or Ccr level, presence or absence of treatment with antihypertensives or diabetes mellitus, duration of intraoperative aortic clamping, or the volume of blood loss or transfusion. However, the group with postoperative renal hypofunction included many cases of preoperative hypertension. The incidence of postoperative renal hypofunction was high among cases which exhibited preoperative hypertension, but was low among those with preoperative normal blood pressure. Further, renal hypofunction occurred in few of the patients whose blood pressure had been controlled by the use of antihypertensives. The possibility was suggested that in palliative operations, preoperative blood pressure control, was useful for the prevention of postoperative renal hypofunction.
Aged↗
Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications.
BACKGROUND: The role of early postoperative enteral nutrition after gastrointestinal surgery is controversial. Traditional management consist of 'nil by mouth', where patients receive fluids followed by solids when tolerated. Although several trials have implicated lower incidence of septic complications and faster wound healing upon early enteral feeding, other trials have shown opposite results. The immediate advantage of caloric intake could be a faster recovery with fewer complications, to be evaluated systematically. OBJECTIVES: To evaluate whether early commencement of postoperative enteral nutrition compared to traditional management (no nutritional supply) is associated with fewer complications in patients undergoing gastrointestinal surgery SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, PUBMED, EMBASE, and LILACS from 1979 (first RCT published) to March 2006. We manually scanned the references from the relevant articles, and consulted primary authors for additional information. SELECTION CRITERIA: We looked for randomised controlled trials (RCT's) comparing early commencement of feeding (within 24 hours) with no feeding in patients undergoing gastrointestinal surgery. Early enteral nutrition is defined as all oral intakes (i.e. registered oral intake, supplemented oral feeding) and any kind of tube feeding (gastric, duodenal or jejunal) containing caloric content. No feeding is traditional management, defined as none caloric oral intake or any kind of tube feeding before bowel function. The definition 'no nutrition' includes non caloric placebo and water. DATA COLLECTION AND ANALYSIS: The three authors independently assessed the identified trials, and extracted the relevant data using a specifically developed data extraction sheet. Primary end points of interest were: Wound infections and intraabdominal abscesses, postoperative complications such as acute myocardial infarction, postoperative thrombosis or pneumonia, anastomotic leakages, mortality, length of hospital stay, and significant adverse effects. We combined data to estimate the common relative risk of postoperative complications, and calculated the associated 95% confidence intervals. For analysis, we used fixed effects model (risk ratios to summarise the treatment effect) whenever feasible. The treatment effect on length of stay was estimated using effect size (presented as mean +/- SD). Some outcomes were not analysed but presented in a descriptive way. We used a random effects model to estimate overall risk ratio and effect size. MAIN RESULTS: We identified thirteen randomised controlled trials, with a total of 1173 patients, all undergoing gastrointestinal surgery. Individual clinical complications failed to reach statistical significance, but the direction of effect indicates that earlier feeding may reduce the risk of post surgical complications. Mortality was the only outcome showing a significant benefit, but not necessarily associated with early commencement of feeding, as the reported cause of death was anastomotic leakage, reoperation, and acute myocardial infarction. AUTHORS' CONCLUSIONS: Although non-significant results, there is no obvious advantage in keeping patients 'nil by mouth' following gastrointestinal surgery, and this review support the notion on early commencement of enteral feeding.
Colon↗
Oxygen delivery as a factor in the development of fatal postoperative complications after oesophagectomy.
BACKGROUND: This study was designed to assess the impact of oxygen transport variables on outcome in 115 patients undergoing elective surgery for oesophageal carcinoma. METHODS: Haemodynamic parameters were determined using a Swan-Ganz catheter in all patients on the day before operation, 6 h after operation, and daily for the first 4 days after operation. RESULTS: Oxygen delivery and consumption at 6 h were significantly higher in survivors than in non-survivors. However, oxygen delivery and consumption in both groups did not differ significantly after postoperative day 1. Of 17 patients with oxygen delivery levels lower than 445 ml min-1 m-2 at 6 h, eight died in hospital. Oxygen delivery in patients who developed either an anastomotic leak or severe pneumonia was significantly lower 6 h after surgery. Lower levels of oxygen delivery preceded postoperative complications. CONCLUSION: Oxygen delivery 6 h after oesophagectomy correlates with postoperative complications and may be a determinant of hospital mortality.
Aged↗
[Acute acalculous cholecystitis as a postoperative complication-- the stress gallbladder].
Acute acalculous cholecystitis (AACH) is a relatively rare disease in relation to postoperative complications. The majority of AACH are cured by conservative treatment along with the basic disease but if there are further complications relaparotomy and an adequate operation is necessary, as in the presented case.
Acute Disease↗
[Application of meloxicam in scheme of prophylaxis of postoperative complications in patients with an acute ileus of tumoral etiology].
Meloxicam application in complex of prophylactic treatment of patients with colonic cancer, complicated by an acute obturation ileus, had promoted the lowering of postoperative complications rate, caused by inhibition of the inflammation mediators synthesis and connected with him pathologic reactions of the systemic inflammatory response syndrome (SIRS).
Acute Disease↗
Cerebrospinal fluid pseudocyst: a postoperative complication of augmentation ileocystoplasty in myelodysplastic children.
Peritoneal cerebrospinal fluid pseudocyst (CSFoma) formation is a rare postoperative complication of augmentation cystoplasty in children, with only three other cases being reported in the world literature. We describe two patients with CSFoma formation following augmentation ileocystoplasty. The management of these cases and a brief review of the pathogenesis and management of this condition are presented.
Cerebrospinal Fluid↗
[The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas].
The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI.HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma,bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination.
Brain Abscess↗
[No reduction in postoperative complications by the use of catheterized epidural analgesia following major abdominal surgery].
This study was designed to assess whether intra- and postoperative epidural analgesia would diminish the overall rate of postoperative complications after major abdominal operations when compared to a standard anesthetic and postoperative analgesic regimen. A total of 214 patients undergoing infrarenal aortic bypass operations, gastric resection, gastrectomy, Whipple's operation, or duodenum-preserving pancreatic resection were randomly divided into two groups. Patients in the epidural group (n = 98) were operated on under light general anesthesia (midazolam, low-dose fentanyl, N2O/O2, pancuronium bromide). In addition, a mixture of bupivacaine (0.25%) and fentanyl (2 micrograms/ml) was infused (6-10 ml/h) via a thoracic epidural catheter intra- and postoperatively for 76:1.45 h (logarithmic normal distribution). Patients in the control group (n = 116) were operated on under a standard general anesthesia (midazolam, fentanyl, N2O/O2, isoflurane, pancuronium-bromide). Piritramid was injected for postoperative pain relief, either i.v. (recovery room, intensive care unit) or i.m. (surgical ward). In the epidural group the quality of analgesia and ability to cough were significantly better (2 P less than 0.0071) than in the control group (four observations each on the 1st and 2nd postoperative days). Heart rate and mean arterial pressure were lower in the epidural group at the same points of observation (2 P less than 0.01), as was the plasma glucose on the 1st postoperative day. The time up to the first postoperative defecation was shorter in the epidural group (79:1.51 h) as compared to the control group (93:1.38 h; 2 P less than 0.0167). The time to hospital discharge was equal in both groups (epidural group 19:1.6 days, control group 18:1.6 days).(ABSTRACT TRUNCATED AT 250 WORDS)
Abdomen↗
Pars plana lensectomy by ultrasonic fragmentation: 1984--Part II: Operative and postoperative complications--avoidance or management.
Operative complications of pars plana lensectomy included mechanical failure, blocked fragmenting needle, air bubbles in the irrigating tubing, miosis, inadvertent iridectomy, hemorrhage, lens remnants in the posterior pole, metal fragments from the fragmenting needle, retinal hole, and retinal detachment. Postoperative complications included hypotony, hypertension, hemorrhage, lens remnants, cystoid maculopathy, retinal hole, retinal detachment, and sterile endophthalmitis.
Cataract↗
[Prophylaxis of the postop complications in combined treatment of patients with laryngeal cancer].
The method of prevention of local and systemic postoperative complications in partial resections of the larynx and laryngectomy is proposed: preoperative radiotherapy is planned in medium-fraction regimen; on the day of the last radiation exposure the operation is performed; the operative wound is throughly sutured and drained; local intermittent hypothermia is used before and after surgery. The healing of the postoperative wound is described in 115 patients and 22 controls.
Humans↗
[General biological characteristics of the etiology of postoperative complications in patients with surgical diseases of the lungs].
The causes of lethal outcomes (n = 60) and postoperative complications which occurred in 26.1% of 610 patients operated on for lung cancer were investigated with due consideration for the regularities of thermodynamics of nonequilibrium processes and theory of disasters. A total systems pathological inflammatory reaction, which augments the injury by many times and develops as a result of inadequate anesthesiological protection, underlies the development of the most unfavorable variant of response to surgery leading to life-threatening complications, such as pneumonia, thromboembolism, or ulcerative hemorrhages.
Blood Loss, Surgical↗
[Postoperative complications and mortality in abdominal aortic aneurysm surgery].
OBJECTIVE: To analyze morbidity and mortality in patients undergoing surgery for aneurysm of the abdominal aorta, in order to identify risk factors. PATIENTS AND METHODS: We conducted a retrospective study of 143 patients with aortic aneurysm undergoing surgery between January 1986 and April 1993. One hundred twenty-seven aneurysms were infrarenal and 16 were adjacent to the kidney. RESULTS: Surgery was scheduled in 67.1% of the cases, emergency in 27.2% and deferred in 5.59%. The mortality for each of these groups was 8.3%, 33.3% and 62.5%, respectively. Exitus took place within the first 24 hours after admission. Secondary diseases, usually ischemic cardiopathy, were present in 68.5%. The most frequently observed postoperative complications were cardiovascular, followed by renal, respiratory and digestive problems. The most frequent cause of death was acute myocardial infarction, followed by hypovolemic shock in emergency patients. Factors representing significant risk of mortality were age over 80 years (p < 0.001), aneurysmatic rupture (p < 0.001) and blood loss requiring transfusion of more than 4 units of packed red cells during surgery (p < 0.001). CONCLUSIONS: The increase in the number of elective procedures (including scheduled resection of small aneurysms), early diagnosis and treatment of ruptures and aggressive hemodynamic management in the perioperative period--with special attention to cardiovascular status in the first 24 hours after surgery--are all factors that can contribute to better outcome.
Aged↗
The immediate complications of gastrectomy. A twelve-year review of early postoperative complications in ulcer surgery.
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Gastrectomy↗
Laparoscopic cholecystectomy. Intraoperative findings and postoperative complications.
From November 1990 to April 1994 we attempted laparoscopic cholecystectomy (LC) in 1,788 consecutive patients. The intraoperative findings related to gallbladder's pathology were as following: chronic cholecystitis in 792 patients (44.3%), simple cholecystolithiasis in 760 (42.5%), acute cholecystitis in 98 (5.5%), hydrops in 44 (2.5%), empyema in 38 (2.1%), gangrenous cholecystitis in 12 patients, acalculous cholecystitis in 20 patients, polyps in 11 patients, adenomyomatosis in 9 patients, and gallbladder's carcinoma in 4 patients. Although we had a considerable number of cases with severe inflammation and/or dense adhesions the conversion rate to open surgery was relatively low (2.5%). There was no procedure-related mortality and no common bile duct injury. Postoperative complications occurred in 58 patients (3.2%). Bile leak was present in 19 patients, retained bile duct stones in 8, severe bleeding in 6, mild pancreatitis in 4, pulmonary embolism in 1, cerebral bleeding in 1, wound infection in 6, abdominal wall hematoma in 4, and umbilical incisional hernia in 2; 7 patients presented other minor complications. The mean postoperative hospital stay of our patients was 1.8 days (range 1-12 days). Adequate measures to prevent intraoperative accidents, meticulous technique, and full maintenance of the equipment are among the most important factors in keeping a low conversion and complication rate in the patients undergoing LC.
Adolescent↗
Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications.
PURPOSE: To determine the role of radiographic assessment in patients who underwent an adjustable laparoscopic gastric banding (ALGB) for the treatment of morbid obesity, and to evaluate the frequency and type of postoperative complications. MATERIALS AND METHODS: From September 1995 to March 1998, 98 consecutive patients (18 men, 80 women; mean age, 39 years; age range, 22-62 years) with morbid obesity (mean body weight, 132 kg; mean body mass index, 47.1 kg/m(2)) underwent ALGB. In all patients, fluoroscopy was performed postoperatively to confirm band position and to exclude perforation and at 6-8 weeks later to measure and adjust the stoma between the pouch and stomach for optimal weight loss. All patients underwent another examination 12 months postoperatively, whereas patients with unsatisfactory weight loss or patients suspected of having complications were examined earlier and on several occasions. RESULTS: Port puncture was feasible in all cases, and stomal adjustments could easily be repeated. Absolute (ie, total) weight loss after 1 year ranged from 8.8% to 39.2% (mean, 18.3%). Twenty patients showed unsatisfactory weight loss. No early complications occurred. Late complications occurred in 34 patients and included pouch dilatation (concentric or eccentric with posterior slippage), eccentric band herniation, band penetration, disconnection, axial pouch herniation, and port-site infection. CONCLUSION: ALGB is an effective method in the treatment of morbid obesity. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications.
Adult↗
Postoperative complications in Parkinson's disease.
BACKGROUND: Although Parkinson's disease is relatively common in America, with an average annual incidence of 20 cases per 100,000 population, little information exists about postoperative morbidity and mortality in those Parkinson's patients who undergo elective surgery. METHODS: We performed a retrospective cohort study using the Veterans Affairs (VA) Austin database system (a cumulative index of admissions and discharges from all US VA Medical Centers) to identify 41,213 patients who underwent elective bowel resection, cholecystectomy, or radical prostatectomy between January 1, 1990, and December 31, 1995. We examined the study population using univariate analysis, acute length of stay with multivariate analysis, and postoperative complications with logistic regression. RESULTS: The selected surgeries were performed on 234 patients with a diagnosis of Parkinson's disease and 40,979 with no such diagnosis. In univariate analysis, patients with Parkinson's disease had significantly longer acute hospital stays than non-Parkinson's patients (11.4 +/- 15.9 days vs 8.8 +/- 9.0 days, P < .001). In addition, Parkinson's patients had a higher in-hospital mortality than non-Parkinson's patients (7.3% vs 3.8%, P = .006). After we adjusted for coexisting morbidity, age, admitting location, and gender, patients with Parkinson's disease had an average acute hospital stay 2.34 days longer than that of non-Parkinson's patients (P < .001). However, the mortality difference did not reach statistical significance in multivariate analysis (P = .098). Finally, Parkinson's patients had significantly increased incidences of urinary-tract infection (odds ratio 2.045, P < .001), aspiration pneumonia (odds ratio 3.825, P < .001), and bacterial infections (odds ratio 1.682, P < .001). CONCLUSIONS: Patients with Parkinson's disease are at greater risk for specific complications and longer hospital stay after elective bowel resection, cholecystectomy, or radical prostatectomy. Awareness of these complications may help caregivers to reduce postoperative mortality and morbidity and to decrease the length of hospitalization.
Age Factors↗