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PubMed1998

Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial.

BACKGROUND: Leukocytes in transfused blood are associated with several posttransfusion immunomodulatory effects. Although leukocytes play an important role in reperfusion injury, the contribution of leukocytes in transfused blood products has not been investigated. To estimate the role and the timing of leukocyte filtration of red cells in cardiac surgery, we performed a randomized study. METHODS AND RESULTS: Patients scheduled for cardiac surgery were randomly allocated to receive either packed cells without buffy coat (PC, n = 306), fresh-filtered units (FF, n = 305), or stored-filtered units (SF, n = 303) when transfusion was indicated. We evaluated the periods of hospitalization and stay at the intensive care unit, and the occurrences of postoperative complications up to 60 days after surgery. The average hospital stay was 10.7 days, of which 3.2 days were in the intensive care unit, without significant differences between the groups. In the PC trial arm, 23.0% of the patients had infections versus 16.9% and 17.9% of the patients in the leukocyte-depleted trial arms (P=.13). Within 60 days, 45 patients had died, 24 patients in the PC trial arm (7.8%), versus 11 (3.6%) and 10 (3.3%) patients in the FF and SF trial arms, respectively (P=.015). CONCLUSIONS: In cardiac surgery patients, especially when more than three blood transfusions are required, leukocyte depletion by filtration results in a significant reduction of the postoperative mortality that can only partially be explained by the higher incidence of postoperative infections in the PC group.

Aged↗
PubMed2005

Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: a case study using the National Surgical Quality Improvement Program (NSQIP) database.

OBJECTIVE: This single-center study tested the hypothesis that preoperative risk factors and surgical complexity predict more variation in hospital costs than complications. BACKGROUND: Complications after surgical operations have been shown to significantly increase hospital cost. The impact on complication-related costs of preoperative risk factors is less well known. METHODS: The National Surgical Quality Improvement Program (NSQIP) preoperative risk factors, surgical complexity, and outcomes, along with hospital costs, were analyzed for a random sample of 5875 patients on 6 surgical services. Operation complexity was assessed by work RVUs (Centers for Medicare and Medicaid Services Resource Based Relative Value Scale). The difference in mean hospital costs associated with all variables was analyzed. Multiple linear regression was used to determine the cost variation associated with all variables separately and combined. RESULTS: Fifty-one of 60 preoperative risk factors, work RVUs, and 22 of 29 postoperative complications were associated with higher variable direct costs (P < 0.05). Linear regressions showed that risk factors predicted 33% (P < 0.001) of cost variation, work RVUs predicted 23% (P < 0.001), and complications predicted 20% (P < 0.001). Risk factors and work RVUs together predicted 49% of cost variation (P < 0.001) or 16% more than risk factors alone. Adding complications to this combined model modestly increased prediction of costs by 4% for a total of 53% (P < 0.001). CONCLUSION: Preoperative risk factors and surgical complexity are more effective predictors of hospital costs than complications. Preoperative intervention to reduce risk could lead to significant cost savings. Payers and regulatory agencies should risk-adjust hospital cost assessments using clinical information that integrates costs, preoperative risk, complexity of operation, and outcomes.

Databases as Topic↗
PubMed1986

The predictive role of delayed cutaneous hypersensitivity testing in postoperative complications.

Ten parameters, including delayed cutaneous hypersensitivity testing (DCH), were evaluated with regard to their predictive value in instances of postoperative septic complications. In 302 patients undergoing surgical treatment, 45 complications, including wound infection, abscess, pneumonia and sepsis, were seen postoperatively in 42 patients. When these patients were compared with 260 patients without complications, hemoglobin, leukocyte count, serum albumin, total protein, blood sedimentation rate, age and sex were found not to contribute to the prediction of postoperative complications. In DCH testing, the complication rate increased from 7.5 per cent in normergic patients to 20.6 per cent in anergic patients. With increasing length and severity of operation, the complication rate increased from 6.5 to 26.4 per cent and from 6.5 to 31.8 per cent, respectively. Only in severe, long lasting operations could DCH testing differentiate the complication risk. Normergic patients had a 8.6 per cent complication rate; hypoergic patients, 36.6 per cent, and anergic patients, 37.5 per cent. The results of DCH testing did not correlate with the complication rate in any of the other operative groups. In conclusion, the predictive value of DCH testing is clearly greater in groups of patients highly affected by the operative trauma. The results of this study show that it is important to consider both host defense mechanisms and environmental factors in the assessment of operative risks.

Adult↗
PubMed2004

Inflammatory changes secondary to postoperative complications of Hirschsprung's disease as a cause of histopathologic changes typical of intestinal neuronal dysplasia.

PURPOSE: The aim of this study was to clarify the pathogenesis of intestinal neuronal dysplasia (IND). METHODS: The bowel habits of 36 postoperative HD patients were assessed retrospectively. Twenty-five had no complaints. Seven had persistent enterocolitis and were the focus of our study. They were divided into group A (n = 2) if they were severe and had associated postoperative surgical complications, and group B (n = 5) if they were mild. The histological changes were assessed. RESULTS: The 7 patients who had persistent enterocolitis postoperatively had no AchE activity in the mucosa, and there was normal distribution of submucosal and myenteric ganglia in the proximal resection margin. Rectal biopsies performed postoperatively for investigation of persistent enterocolitis in group A showed inflammatory changes and typical histopathologic features of IND such as abundant acetylcholinesterase (AchE)-positive nerve fibers in the lamina propria associated with giant submucosal ganglia and hyperganglionosis, and in group B there was increased AchE activity without hyperganglionosis or giant ganglia. CONCLUSIONS: This is the first report of histopathologic changes typical of IND occurring in response to persistent enterocolitis related to postoperative complications of surgery for HD.

Acetylcholinesterase↗
PubMed1995

A comparative study of postoperative complications associated with the modified Indiana pouch in elderly versus younger patients.

PURPOSE: We defined the nature and risk of complications associated with the modified Indiana pouch in patients older than 75 years. MATERIALS AND METHODS: We analyzed the clinical course of 25 elderly patients and a control group of 25 selected randomly from the cohort of those younger than 75 years. All patients underwent the modified Indiana pouch procedure. Charts were reviewed for type of operation, mean patient age, length of hospital stay, medical conditions, and early and late morbidity and mortality. Comparisons were made between the 2 groups. RESULTS: Simultaneous cystectomy or anterior exenteration was performed in 84% and 95% of patients in the elderly and younger groups, respectively. Mean age was 78.5 years in the elderly and 59.3 years in the younger group. Medical illnesses and early postoperative complication rates did not differ significantly between the 2 groups. Mean hospital stay was increased but not significantly in the elderly group (12.4 versus 11.1 days). There were 2 perioperative deaths in the elderly group (8%) and 1 in the control group (4%). Mean followup was 24.5 months (range 4 to 64) in the elderly versus 29.5 months (range 6 to 69) in the younger group. Late complications with the pouch were also similar (16% in the elderly and 12% in the control group). Of the elderly patients 9 died (intercurrent medical disease in 1 and cancer progression in 8) compared to 4 in the younger group (intercurrent medical disease in 1 and cancer progression in 3). Of the elderly patients 13 are alive (mean age 81 years) with a well functioning continent diversion. CONCLUSIONS: The modified Indiana pouch can be created with acceptable postoperative morbidity and mortality in elderly patients, and it provides an excellent functional result.

Age Distribution↗
PubMed1995

[Postoperative complications of self-catheterizable continent urinary diversions (Kock, Indiana, and appendiceal Mainz pouch) and patient care].

A self-catheterizable continent urinary reservoir has become one of the major options for urinary diversion in patients with invasive bladder cancer or other pelvic malignancies. We performed the Kock pouch, the Indiana pouch and the appendiceal Mainz pouch in 124, 51 and 4 patients with the mean followup periods of 50, 33, and 10 months, respectively. In the Kock pouch, the efferent and afferent nipple valve malfunction was seen in 16.7 and 21.3 percent each, requiring repair surgery, such as fixation of the efferent nipple to the pouch wall, reconstruction of an isoperistaltic nipple valve in the former, and removal of the Dacron fabric collar or re-anastomosis of the ureter to the pouch using LeDuc technique in the latter. In the Indiana pouch, stomal stenosis, an hourglass-like pouch deformity, difficult catheterization occurred in 3, 2 and 2 patients, respectively. Among the 4 patients with the appendiceal Mainz pouch, there were no major late postoperative complications except for mild stenosis of the conduit, handled with bougienage. As a whole, surgical revisions, related to urinary diversion, was done in 20.3, 10.6, 0 percent in the Kock, Indiana, Mainz pouch patients, respectively. Stone formation, mostly multiple and recurrent, occurred in 27.8, 6.4, 0 percent in the Kock, Indiana, Mainz pouch, respectively. Most of the stones were removed endoscopically via a stoma or by percutaneous approach. Acidosis was seen in 3 patients in both the Kock and Indiana pouch, and 3 patients with the Kock pouch suffered from symptomatic choleithiasis. At the time of the latest observation, continence was achieved in 90.2, 93.0, and 100 percent, whereas excretory urograms showed normal collecting systems in 64.5, 90.4, and 100 percent in the Kock, Indiana, and Mainz pouch, respectively. In conclusion, the Kock pouch, performed by an original method using unabsorbable polyester fabric collars and metallic staples, has an intolerably high rate of late complications, and either the modified Indiana pouch with ileal patch or the appendiceal Mainz pouch using the umbilicus as a stoma is recommended for a self-catheterization continent urinary diversion.

Adult↗
PubMed1999

[Chylothorax as a postoperative complication of aortocoronary bypass operation].

HISTORY AND CLINICAL FINDINGS: One month after a coronary bypass grafting operation, pericardial- und pleural effusions were found in a 75-year-old woman. Dressler-syndrome was assumed and an antiphlogistic and cortisone were prescribed. Under this therapy, the pericardial effusion disappeared, but the pleural effusion increased in size. After thoracocentesis, the diagnosis of a chylothorax could be confirmed. Three days later, the thoracic radiography was inconspicuous and the patient was discharged without changes in medication. As dyspnea occurred two weeks later, the patient was admitted to our hospital. INVESTIGATIONS: The thoracic radiography showed a reappearance of the pleural effusion. DIAGNOSIS, THERAPY AND COURSE: The laboratory test confirmed a relapse of the chylothorax. After a pleurodesis by drainage and a prescription of a high-caloric, fat-reduced diet the patient could be discharged two weeks later. The diet could be terminated two months later after a recurrence of the chylothorax had been excluded in the thoracic radiography. In the follow-up examinations, there was no evidence for a relapse of the chylothorax. CONCLUSIONS: The chylothorax is an uncommon postoperative complication of the aortocoronary bypass surgery. A relapse is likely and it can result in life-threatening cachexia. Therefore, a early and adequate therapy is important.

Aged↗
PubMed1993

[Pre-operative, operative and postoperative complications in 2266 cases of transurethral resection of the prostate].

Pre-operative and operative complications in 2266 patients having undergone transurethral resection of prostate (TURP) for the past 20 years at Kitasato University Hospital were analyzed. They consisted of 2008 benign prostatic hyperplasia and 258 prostate cancer patients. Seven hundred and fifty four patients showed some of physical disorders prior to TUR:hypertension in 147 cases, diabetes mallitus in 87, ischemic heart disease in 46, chronic obstructive lung disease in 41 and others. Operative and postoperative complications of TURP were seen in 308 cases (13.6%). Perforation of the prostatic capsule was seen in 100 cases (4.4%) and bladder perforation into intraperitoneal cavity in 6 cases (0.3%). Transurethral fulgulation for postoperative hemorrhage was conducted on 79 cases (3.5%). Hyponatremia lower than 130 mEq/L was noted in 14 cases (0.6%). Severe urinary tract infection leading to bacteremia was observed in 9 cases (0.4%). Postoperative epididymitis was evident in 20 cases (0.8%). There was postoperative urinary incontinence in 19 cases, 3 of which was treated with Teflon-paste injection successfully. One patient had to undergo AMS-800 artificial sphincter implantation. The number of postoperative urethral stricture patients requiring urethral dilatation or internal urethrotomy was 12 (0.5%) and postoperative bladder neck contracture was seen in 20 cases (0.9%). One patient (0.04%) who developed DIC after profuse postoperative hemorrhage died on the 37th postoperative day. The efficiency of TURP depends not so much on the skill of cutting as on the speed and accuracy of orientation and haemostasis. The quick recognition of anatomical landmarks will assure effective and safe resection.

Adult↗
PubMed1999

[The postoperative complications and management of excimer laser in situ keratomilleusis].

OBJECTIVE: To evaluate the safety of excimer laser in situ keratomilleusis (LASLK) METHODS: The postoperative complications in 699 eyes of LASIK were observed and statistically analyzed. RESULTS: The haze, halo, growth of corneal epithelium under valve, the foreign body under valve, the fold of corneal valve, infection, decentralization, irregular astigmatism, valvular damage, low contrast sensibility, undercorrection and over correction, the psychological dysopia, glaucoma, fluctuating visual acuity and the loss of the best corrected visual acuity were found. CONCLUSION: LASIK has it's advantages of accurate manipulation, extensive range of correction and rapid recovery, but some of the complications resulting from this operation are so difficult to treat that careful consideration should be given before using this technique.

Adolescent↗
PubMed1988

Early postoperative complications after (sub)total pancreatoduodenectomy: the AMC experience.

The postoperative course is described in 70 patients who underwent pancreatic resection for a tumor of the head of the pancreas and peri-ampullary region: 64 patients had malignant disease. Subtotal pancreatoduodenectomy was carried out in 52 patients and total pancreatoduodenectomy in 18 patients. The overall 30-day mortality was 4.3% (3 patients died: one after subtotal, 2 after total pancreatoduodenectomy). Major complications required surgical reintervention in 15 patients. Another 24 patients developed minor complications, and responded well to conservative treatment. Infective complications were the main cause of post-operative morbidity, occurring in 29 patients. Dehiscence of the pancreatico-jejunostomy required surgical reintervention in one patient. This patient died. Leakage of the pancreatico-jejunostomy was radiologically demonstrated in 10 other patients. Four of these 10 patients presented with clinical symptoms: one needed surgical intervention and 3 responded to conservative management. The results of this study confirm the present trend of decreasing mortality after pancreatoduodenectomy. Postoperative morbidity remains high. Usually, leakage of the pancreatic anastomosis was not associated with serious postoperative complications and subsided without the need of treatment in the majority of cases.

Aged↗
PubMed2003

[Intraoperative conversion and postoperative complication of video-assisted thoracoscopic surgery lobectomy for primary lung cancer].

By 2002, we had attempted video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy for 140 primary lung cancer cases. Four cases (2.9%) were converted to standard posterolateral thoracotomy for oncologic reasons and aortic injury, and 7 cases (5%) were converted to minithoracotomy with a 10 cm incision due to almost injuring the vascular system. Average blood loss in these cases was 379 ml, and there was no blood transfusion required. Seven of these 11 cases had true pleural symphysis in the thoracic cavity. The remaining 129 cases, consisted of 93 lobectomies and 34 segmentectomies, performed with a minithoracotomy of 5 cm using 2 ports. Average surgical duration was 227 minutes, and blood loss was 100 ml. Postoperative complication occurred in 15 patients (11.6%). Major complications included 1 broncho-pleural fistula, 1 pulmonary infarction, 1 cerebral infarction and 1 respiratory failure needed for mechanical ventilation. However, there were no hospital deaths. The mean postoperative hospital stay was 12 days. We recommend that surgeons should pay attention to hilar dissection, particularly in the presences of adhesion and carefully judge whether to convert to thoracotomy at the time of hemorrhage. The VATS procedure has a low mortality and morbidity for lung cancer, but particulaly in high risk patients, requires care and management the same as an open thoracotomy.

Aged↗
PubMed1989

[Early postoperative complications in elective splenectomy in hematologic diseases].

This study analyses frequency of complications and mortality after elective splenectomy done for various hematological diseases, dependent on the spleen weight. From 1979 to 1988 year, 236 patients were treated by splenectomy for various haematological disorders, including: autoimmune disorders (90), Hodgkin's disease (34), lymphoproliferative diseases (96) and myeloproliferative diseases (16 patients). In the early postoperative period, complications occurred in 51 (21.61%) patients, 10 of which (4.24%) died. Considering the size of the spleen (more or less than 1500 gr) there was no difference in the early postoperative mortality (p greater than 0.05; 3.30%:5.38%), while postoperative complications occurred significantly more often in patients with massive splenomegaly (p greater than 0.05; 1259%:3548%). The most frequent complications were septical (8.90%), prolonged fever (5.51 x), and postoperative bleeding (2.97%), while cardial, pulmonary and urinary complications occurred seldom, but more often caused patient's death. Defining the appropriate indications for splenectomy, performing suitable preoperative preparations and postoperative care, mortality was diminished from 7.14% in the period, 1979-1983 year, to 2.17% in the period 1984-1988.

Adolescent↗
PubMed1990

[Correction of chronic disorders of duodenal patency in the prevention of postoperative complications of peptic ulcer].

Experiments on dogs demonstrated the role of chronic disorders of duodenal patency (ChDDP) in the development of immediate and late-term postoperative complications of gastric and duodenal ulcer, like incompetence of the duodenal stump, reflux gastritis, progression of duodenostasis existing before the operation, the afferent loop syndrome, postresection cholecystitis and pancreatitis, the dumping syndrome. The formation of valvar anastomoses and early recognition and correction fo ChDDP in resection of the stomach (554 patients) made it possible to reduce significantly both the mortality rates (0.18%) and the percentage of other complications.

Afferent Loop Syndrome↗
PubMed1989

[Blood concentration of granulocytic elastase, surgical invasion and postoperative complications--with special reference to surgical resection of liver cirrhosis].

The blood concentrations of granulocytic elastase (PMN-E), alpha 1-antitrypsin and alpha 2-macroglobulin were examined to evaluate their clinical significance in patients who underwent hepatectomy due to liver cancer with liver cirrhosis (n = 31, Group A), due to liver cancer with chronic hepatitis (n = 5, Group B) and without hepatic complications (n = 6, Group C) and other major surgeries (n = 10, Group D). In all groups, on the first postoperative day, blood PMN-E increased rapidly more than three times of the preoperative levels. Despite a decreasing tendency from postoperative Day 3, the value in Group A reincreased on Day 5. The peak PMN-E values within 24 postoperative hours showed significant positive correlations (p less than 0.01) with the amounts of hemorrhage and blood transfusion during operation in all groups. Even in 18 cases without blood transfusion, peak PMN-E was positively correlated (p less than 0.05) with the operative time and the amount of blood loss during operation. In Group A, patients in whom blood PMN-E increased after postoperative Day 3 developed infection and adult respiratory distress syndrome. After temporary reduction after operation except for Group C, blood alpha 1-antitrypsin increased from postoperative Day 3. However, alpha 1-antitrypsin in Group A was significantly low (p less than 0.01), compared to the increased levels in Group C and D. Blood alpha 2-macroglobulin showed no tendency of postoperative increase in all groups.

Granulocytes↗
PubMed1994

Late-onset Bochdalek hernia with a rare postoperative complication: case report.

We report a case of a 7-year-old-girl with a late-presenting Bochdalek hernia. The postoperative course was complicated by splenic torsion and subsequent total splenic infarction. Total splenic infarction due to splenic torsion has been reported in children with "wandering spleen" and in incarcerated Bochdalek hernias, but to our knowledge, not as a postoperative complication of Bochdalek hernia repair.

Child↗