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At least 451 records · Page 25Linked to original sources
PubMed2002

Anesthetic techniques for pharyngeal flap surgery: effects on postoperative complications.

OBJECTIVE: To assess the effects of 2 different anesthetic techniques on early complications after superior pharyngeal flap surgery. DESIGN: Randomized, prospective, single-blind study. SETTING: Large referral hospital. PATIENTS: One hundred patients undergoing superior pharyngeal flap surgery for the correction of velopharyngeal insufficiency were randomly divided into 2 equal groups to receive either isoflurane or propofol-based anesthesia. INTERVENTIONS: Following induction of anesthesia with fentanyl citrate and propofol, patients were randomized to receive either isoflurane or propofol for the maintenance of general anesthesia. The inspired isoflurane concentration and propofol infusion rate were adjusted to maintain a stable depth of anesthesia as judged by clinical signs and hemodynamic responses to surgical stimuli. MAIN OUTCOME MEASURES: Recovery from anesthesia, recovery from surgery, and early postoperative complications. RESULTS: The groups were similar in age, weight, height, induction time, surgery time, extubation time, and anesthetic time. The time (mean +/- SD) required to achieve a maximal Steward Recovery Score was 7 +/- 14 minutes in the propofol group compared with 32 +/- 28 minutes in the isoflurane group (P<.04). No significant differences in postoperative patient satisfaction scores, time to first swallow, drinking time, and time to "home readiness" were noted. Overall, 17 patients (17%) developed airway-related complications and 2 of the patients (2%) were accounted as severe. Two patients (2%) bled from the operation site. However, there was no difference in the incidence of postoperative complications between the groups. CONCLUSIONS: When compared with isoflurane administration for maintenance of general anesthesia, propofol-based anesthesia was associated with more rapid mental and psychomotor recovery. However, airway-related complications and "home readiness" were similar between the groups.

Adolescent↗
PubMed1979

[Postoperative complications in the Billroth I gastrectomy].

A series of 234 patients who underwent Billroth I gastric resection for gastric and duodenal ulcerous lesions is reported. Special attention is paid to the immediate postoperative complications whose incidence was 5.5%. Particularly serious is the dehiscence of gastroduodenal anastomosis which requires emergency reconversion intervention, namely gastrojejunostomy with sinking of the duodenal stump.

Aged↗
PubMed1991

Preoperative insurance status influences postoperative complication rates for gastric bypass.

One hundred morbidly obese patients who had gastric bypass surgery were studied to determine how various demographic and medical variables affected complication rates, weight loss, and reduction in comorbidities associated with obesity. During the follow-up period (range: 12 to 59 months), 42 patients developed at least 1 complication. Twenty-three patients developed postoperative medical complications, 9 developed psychiatric complications, and 24 developed complications related to food ingestion. No significant relationships were observed between outcome and age, sex, age of obesity onset, or associated medical disorders. Striking differences in outcome were noted, however, when patients were contrasted according to their preoperative insurance status. Patients dependent on medical assistance, social security disability, or workman's compensation (publicly funded group) (n = 40) developed significantly more medical and psychiatric complications than did those (n = 60) who had private medical insurance (p less than 0.02). Despite the higher complication rate, both groups had the same average weight loss (44.9 +/- 15.3 kg for the publicly funded group versus 43.1 +/- 12.9 kg for those with private insurance) and similar reductions in percent excess weight (66.0 +/- 18.4% versus 75.7 +/- 23.0%) during the first postoperative year. All patients also had similar reductions in medication requirements for hypertension, diabetes, and degenerative joint disease. Additionally, 45% of the publicly funded insurance group who either received public welfare (n = 26) or disability benefits (n = 14) preoperatively were able to attain either full-time or part-time employment postoperatively which allowed them to decrease their level of support (58% and 21%, respectively). Forty-six percent of women in the private insurance group who were not working outside the home also began part-time or full-time employment postoperatively. All patients who were working preoperatively continued to work. These data suggest that although the risks associated with gastric bypass surgery are greater in patients dependent on public funding, these patients benefit significantly from the surgery.

Adolescent↗
PubMed1993

The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement. Comorbidity and outcomes after hip replacement.

Co-existent or comorbid diseases are appreciated as prognostic factors in studies of quality and effectiveness of care when mortality is the end point. The need to measure and adjust for comorbidity in studies of postoperative hospital complications or long-term recovery from surgery has not been documented. In this study, we determined the impact of co-existent disease on post-operative complications and 1-year health-related quality of life in patients hospitalized for a total hip replacement. The study population consisted of a cohort of 356 patients who were hospitalized in four teaching hospitals in California and Massachusetts for a total hip replacement. Patients' medical records were reviewed to collect information regarding severity of illness, co-existent disease, and postoperative complications. The kind and amount of baseline preoperative co-existent disease was measured from medical record information at admission using a four level Index of co-existent Disease (ICED). Approximately 12 months after hospital discharge, 283 (80%) of the patients were surveyed by questionnaire. The presence and amount of co-existent disease were significant predictors of postoperative complications. The complication rates ranged from 3% to 41% between the lowest and highest levels of the ICED. Patients treated at the four study hospitals differed in functional outcomes 1 year after surgery. Functional outcomes were strongly related to ICED scores: patients in Level 4 ICED scored 26.8 points lower in instrumental activities of daily living than patients in Level 1. After controlling for gender, age, education, and marital status, ICED remained a significant predictor of functional status at 1 year. Furthermore, differences among hospitals in functional outcomes disappeared when the ICED was included in the model to adjust for patient characteristics at the time of surgery. A measure of co-existent disease was crucial in explaining differences among hospitals in recovery from total hip replacement patients.

Activities of Daily Living↗
PubMed1993

Prevention of postoperative complications following pancreatic surgery.

Major pancreatic resection is still accompanied by considerable morbidity and even mortality. Complications which occur after pancreatic surgery are chiefly associated with exocrine pancreatic secretion, hence, the inhibition of exocrine pancreatic secretion perioperatively is a promising concept in the prevention of complications. The hormone somatostatin and its synthetic analogue octreotide have been shown to profoundly inhibit exocrine pancreatic secretion, particularly the secretion of proteases. In a randomized, placebo-controlled, multicenter double-blind trial we analyzed the potential role of octreotide in the prevention of postoperative complications after major pancreatic surgery. A significant reduction in complications such as fistula, abscess, fluid collection, sepsis, pulmonary insufficiency, and postoperative acute pancreatitis could be demonstrated in patients who received octreotide at 3 x 100 micrograms/day subcutaneously. Octreotide was particularly effective in patients undergoing Whipple resection for cancer.

Double-Blind Method↗
PubMed1983

The value of instant nutritional assessment in predicting postoperative complications and death in gastrointestinal surgical patients.

A retrospective statistical analysis of admission serum albumin and total lymphocyte counts (TLC) of 126 gastrointestinal surgical patients was accomplished to determine the value of these two parameters in predicting postoperative morbidity and mortality. Patients were classified into four groups according to their laboratory values in the two parameters studied with Group I having the normal values (albumin greater than 3.5 and TLC greater than 1500) and Groups II through IV having one or both abnormal parameters. Groups were subjected to the chi-square test to determine the relationship of abnormal values to the incidence of postoperative complications and deaths. Levels of statistical significance were revealed when comparing the normal group to each of the abnormal groups. The data demonstrates the usefulness of admission serum albumin levels and total lymphocyte counts in predicting surgical complications and deaths. It also identifies that group of patients that might benefit from preoperative nutritional support.

Florida↗
PubMedDate not supplied

Incidence of postoperative complications among coronary artery bypass patients with and without hypertension.

Patients (n = 3301) undergoing first-time elective coronary artery bypass surgery, between 1994 and 2000, with or without hypertension were compared for the incidence of postoperative complications. Fifty-five leg infections were documented (overall incidence 1.7%). Hypertension patients had a significantly increased risk of leg infections (2.45% versus 0.46%). A 10-year increase in age was associated with a 44% increased risk of leg infections (odds ratio = 1.44; 95% confidence interval = 1.09, 1.91). Hypertension patients also had a greater risk of stroke and prolonged ventilation time but not of postoperative mortality.

Aged↗
PubMed1987

[Effect of controlled normovolemic hemodilution on the microcirculatory bed and the incidence of postoperative complications in abdominal surgery].

Directed normovolemic hemodilution with the preoperative reservation of part of the patients' blood considerably reduced the pathologic effect of the operative aggression on the microcirculation system, allowed reduction of the frequency of postoperative complications and increased the efficiency of treatment of 93 patients with diseases of organs of the abdominal cavity.

Anthropometry↗
PubMedDate not supplied

[Postoperative complications of penetrating subtotal keratoplasty in children].

Accordingly to experience of corneal transplantations during 1981-2001 in the children's clinic of the Helmholz Moscow Research Institute of Ocular Diseases the authors present the clinical picture, rate, prognostic value and modes of correction of postoperative complications after keratoplasty. A retrospective study analyzed the incidence of complications after 94 penetrating keratoplasties performed in 82 children aged from 10 months to 14 years in 89 eyes for congenital corneal opacity (n = 22) or corneal opacity caused by trauma (n = 40) or inflammation (n = 20). 60 (73%) within 1 year after operation developed different reactions and complications due to transplant failure in 41 (44%) cases. Among them there were graft rejection episodes (34%), anterior synechiae and retrocorneal membrane formation (17%), donor corneal neovascularization (11%), elevated intraocular pressure (11%). There were a few cases with shallow anterior chamber, hyphema/hemophthalmos, retinal detachment, primary graft failure, corneal ulcer, suture infiltrates and abscesses. Subatrophy of the eye was an outcome in 3 cases. The development of complications after penetrating keratoplasty is determined mainly by the physiology of children, age, severity of underlying and concomitant pathology of the eye. Nevertheless, the odds of donor tissue for transparent graft survival increase if such complications are detected and removed.

Child↗
PubMed1981

[Resistance to the inhibiting action of dexamethasone and the risk of postoperative complications in colonic and rectal cancer].

Dexamethasone-induced decrease in 11-hydroxycorticosteroid level was studied in 55 patients with primary tumors of the colon and rectum several days before operation. All lethal outcomes and most postoperative complications were registered in cases resistant to dexamethasone. The elevated threshold of hypothalamic sensitivity to inhibition by glucocorticoids is considered to be due to the influence of age, tumor process and long-term emotional stress during preoperative period, all these factors affecting the adaptive potential.

Adaptation, Physiological↗
PubMed2006

[Postoperative complications in a teaching surgical ward].

UNLABELLED: Definitive cure of the disease is the essential aim of surgical proceeding. However in some patients who are operated on, unwanted events happen, which make complete recovery delayed or even impossible. These events are known as surgical complications. THE AIM: Presentation of quantitive and qualitative analysis of surgical complications registered in one year of surgical practice of Department of General Surgery, Orlowski Hospital, Warsaw. MATERIAL AND METHODS: In the period between 1.01 and 31.12.2004 we operated on 1384 patients. Complications were registered prospectively, during monthly analysis of patients' medical records. RESULTS: From the number of 1384 patients operated on, 132 patients developed 141 complications (10.2% complication rate in 9.5% patients). CONCLUSIONS: The number of surgical complications reported by other authors differs. This can be explained by differences in methodology of collecting data of complications between the studies. Registering of postoperative morbidity is an important issue in surgical practice. Analysis of complications can lead to improvement in quality of surgical care and health-care management. Introduction of unified system of registration of postoperative complications in all surgical wards would allow making an objective ranking of surgical wards on a given area.

Hospitals, Teaching↗
PubMed1981

Phycomycosis as postoperative complication of urologic surgery.

A case of phycomycosis (Mucor) complicating urologic surgery is presented. It is a rare disease that is rapidly fatal, though caused by a usually benign saphophytic fungus. No previous urologic surgical cases have been found in the literature where Mucor has been a postoperative complication.

Aged↗
PubMed2004

Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery.

Hematoma and bruising (sugillation) are frequent problems after operations for primary breast cancer. In the present study we evaluated the influence of various methods of perioperative thromboembolic prophylaxis on the postoperative incidence of hematoma and suggilation. From June 1994 through August 1996, a series of 425 patients consecutively operated on for primary breast cancer were included. Thromboembolic prophylaxis was low-molecular-weight heparin (LMWH) in 310 patients and thigh-long graded compression (TED) stockings in 102 patients. Postoperative complications including deep vein thrombosis, pulmonary embolism, wound hematoma, and sugillation were recorded, and 17 variables with a potential influence on complications were analyzed by logistic regression analysis. Heparin prophylaxis compared to prophylaxis with TED stockings was significantly and independently associated with postoperative hematoma [odds ratio (OR) 3, 13; 95% confidence interval (CI) 1.38-7.13] or sugillation (OR 3.34; 95% CI 1.93-5.78). No clinically overt thromboembolic complications were diagnosed. After operations for breast cancer we found that LMWH was significantly associated with postoperative hematoma and sugillation compared to TED stockings for perioperative thromboembolic prophylaxis.

Anticoagulants↗
PubMed1978

The relationship between biliary tract infections and postoperative complications.

The hospital records of 870 consecutive patients undergoing elective biliary tract operations during an eight year period were reviewed. Bacteriologic cultures of the biliary tract obtained on 451 patients were correlated with specific biliary tract abnormalities and with postoperative complications. The incidence of positive biliary tract cultures was higher in patients with common duct disease than in those with chronic gallbladder disease without common duct disease. Choledocholithiasis and partial obstruction of the common duct are viewed as important factors in causing a high incidence of postive biliary tract cultures. Eighty-eight per cent of patients who had undergone previous biliary tract decompression procedures had positive cultures. There was no difference in the yield of postive cultures taken from the gallbladder wall and the gallbladder bile. Forty-nine per cent of patients with common bile duct disease and positive biliary tract cultures had no history of clinical cholangitis. Postoperative wound infections were more common in patients with common duct disease. The microorganism responsible for postoperative cholangitis and septicemia can usually be cultured from the biliary tract at operation. Antibiotics significantly decreased the incidence of postoperative cholangitis and septicemia.

Adult↗
PubMed1980

Nutritional status and postoperative complications in an Australian hospital.

A simple nutritional assessment was performed in 92 consecutive patients undergoing abdominal surgery, excluding appendicitis. The patients were given a nutritional score, and on the basis of that score were described as malnourished or normal. There was a statistically significant increase in postoperative complications in the malnourished group. This increase was observed in both the major and the minor complication groups, and also when septic and non-septic, and wound and non-wound, complications were considered.

Abdomen↗
PubMed1985

A method for predicting postoperative lung function and its relation to postoperative complications in patients with lung cancer.

We predicted the postoperative forced expiratory volume in 1 second (FEV1) with a formula based on the premise that the total number of subsegments was 42: postop FEV1 = [1 - (b - n)/(42 - n)] (preop FEV1), where n and b are the number of obstructed subsegments and total subsegments, respectively, in the resected lobe. It was assumed that b was 6, 4, and 12 in the right upper, middle, and lower lobes, respectively, and 10 each in the left upper and the left lower lobes. The obstructed subsegments, n, were obtained from the findings on bronchography or bronchofiberscopy or both before operation. The linear regression line derived from the correlation between predicted (x) and measured (y) FEV1 was y = 0.850x + 0.286 +/- 0.296 (standard error) (N = 52; r = 0.821; p less than 0.001). We calculated the predicted postoperative FEV1 in 188 patients with primary lung cancer. The predicted values were corrected with the regression equation just mentioned and then normalized by the patient's height and sex (%FEV1(p,c). The correlation between %FEV1(p,c) and the surgical risk was studied. Postoperative respiratory complications were inversely related to %FEV1(p,c), and a significantly high incidence of complications (p less than 0.05) was observed in those whose %FEV1(p,c) was less than 60% of predicted normal. In aged patients (65 years old or more) without complications, %FEV1(p,c) was 67.3 +/- 18.0%; it was 52.2 +/- 12.8% in those with respiratory trouble and 53.3% +/- 9.6% in those with circulatory complications. The difference between groups with and without complications was significant (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗