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At least 127 records · Page 7Linked to original sources
PubMed1996

Postoperative complications requiring relaparotomies after 700 gastretomies performed for gastric cancer.

BACKGROUND: Prevention of fatal postoperative complications and improved management of patients with complications are important means of increased survival in gastric cancer patients. PATIENTS AND METHODS: A study of 700 patients undergoing gastrectomy was performed to examine factors that contributed to a high rate of postoperative complications. RESULTS: Of 700 patients undergoing gastrectomy for adenocarcinoma, 40 (5.7%) underwent reexploration because of serious complications. The frequency of the relaparotomies varied from 2.1% and 4.4% after regular subtotal and total gastrectomies, respectively, to 20% and 30.4% after palliative and conventional total gastrectomies, respectively. The complications that required reexploration most frequently were anastomotic leakage and incompetence of sutures (11, 27.5%), intra-abdominal abscesses (8, 20%), and pancreatic necrosis (7, 17.5%). A combination of preventive measures allowed the attainment of low rates of esophagojejunal anastomotic leakage (0.8%). CONCLUSION: We believe that the decision to perform an urgent reexploration, based on clinical findings, should generally be made by a group of experienced surgeons (not only the primary surgeon). Timely relaparotomy prevented death in 37.5% of the patients with serious acute postoperative complications.

Adenocarcinoma↗
PubMed2003

[Postoperative complications in cataract surgery].

The paper is a statistical retrospective trial that evaluates the prevalence of postoperative complications of the cataract surgery in the IInd Department of Ophthalmology Timisoara. The parameters of interest were the type and the frequency of the postoperative complication encountered after the extracapsular cataract extraction (ECCE) followed by a PMMA intraocular lens (IOL) implantation. The most frequent early postoperative complications were endoepithelial comeal edema (20.8%), inflammatory complications (uveitis) (8.72%), hemorrhagic complications (4.02%), and postoperative rise of IOP (8.05%). Out of late complication, we encountered cystoid macular edema (1.34%), bullous keratopathy (1.34%), IOL malposition (0.67%) and secondary glaucoma (1%).

Aged↗
PubMed1993

The effects of age, gender, race and concomitant disease on postoperative complications.

The purpose of this study was to identify factors from simple past medical history which could alert surgeons to patients at increased risk of postoperative complications. Five hundred and fourteen patients undergoing elective surgery were studied prospectively. Factors evaluated included the patients' age, gender, race and the presence in the past medical history of coronary artery disease, congestive heart failure, cardiac dysrhythmias, respiratory disease, endocrine disease, peripheral atherosclerosis, renal disease, neuropsychiatric disease, hypertension, diabetes mellitus, prior major surgery and prior or active malignancy. All complications were recorded. The data were analysed by univariate and multivariate statistical methods. Gender, race and age were not associated with any complications. Coronary artery disease, respiratory disease, atherosclerotic peripheral vascular disease, neuropsychiatric disease, malignancy, the absence of prior major surgery, hypertension and diabetes mellitus were associated with specific postoperative complications by univariate analysis. Malignancy, diabetes mellitus, peripheral atherosclerosis, coronary artery disease, neuropsychiatric disease, renal disease and respiratory disease were independent predictors of complications as determined by multivariate analysis. Of interest is the phenomenon that the risk of postoperative complications when a combination of risk factors was present was greater than what would be predicted by the cumulative risk of these factors. This study helps identify those patients which by simple history may be at increased risk of postoperative complications and may require aggressive preoperative evaluation.

Age Factors↗
PubMed1995

Postoperative complications of intraocular lens implantation in patients with Fuchs' heterochromic cyclitis.

We studied 29 eyes of 24 patients with Fuchs' heterochromic cyclitis who had extracapsular cataract extraction and posterior chamber intraocular lens implantation. Follow-up ranged from one to four years (mean two years). Intraoperative complications included mild hyphema (n = 4). Early postoperative complications included uveitis (n = 9), glaucoma (n = 7), pigment deposits on the lens surface (n = 8), vitreous opacities (n = 8), and cystoid macular edema (n = 1). Late postoperative complications included posterior capsule opacification (n = 6), recurrent uveitis (n = 4), and persistent glaucoma (n = 3). Best corrected visual acuity of 20/40 or better was achieved in 24 eyes (82.8%).

Adolescent↗
PubMed2005

Usefulness of an estimation of physiologic ability and surgical stress (E-PASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery.

Surgical intervention induces various host responses to maintain homeostasis. When postoperative inflammation is intense and persists for a long time, postoperative complications may occur, sometimes developing into multiple organ failure. Therefore, it is very important to assess surgical stress and predict the risk of morbidity and mortality. Using a new scoring system, an estimation of physiologic ability and surgical stress (E-PASS) scoring system, surgical stress following gastrointestinal surgery was evaluated to assess the feasibility of this scoring system. This system comprises a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) that is calculated from both the PRS and the SSS. The relationship of the E-PASS score to the incidence of morbidity and mortality was examined. The relationship between the E-PASS score and a sequential organ failure (SOFA) score was also evaluated. The CRS had a significant positive correlation between not only the incidence but also the grade of postoperative complications. Total maximum SOFA score in patients with a CRS of more than 1 was significantly higher than that in patients with a CRS of less than 1. In conclusion, the E-PASS scoring system will be useful for predicting and recognizing the risk of postoperative complications. This scoring system is brief, simple, and reproducible and can be useful in all types of hospitals.

Aged↗
PubMed2001

Risk factors for postoperative complications in oral cancer and their prognostic implications.

BACKGROUND: The surgical treatment of head and neck cancer can be limited by the risk of postoperative complications. Early identification of risk factors based on clinical characteristics may assist therapeutic planning. OBJECTIVES: To identify risk factors for these complications and to evaluate their prognostic significance. METHODS: The medical records of 110 patients with oral squamous cell carcinoma admitted from January 1, 1990, to December 31, 1994, who underwent radical surgery were reviewed. Data collected included demographic information, comorbidities, extended clinical severity stage, treatment, complications, and survival. The chi(2) test was used to verify the association between the variables. Survival analysis was performed with the Kaplan-Meier method. Logistic and Cox proportional hazards regression were used to build models with independent predictive factors for the risk of complications and death, respectively. RESULTS: The overall complication rate was 50%. Dehiscence and infection rates were 20.9% and 22.7%, respectively. The death rate was 3.6%. Forty-seven patients (42.7%) were electively referred to the intensive care unit (ICU). The occurrence of postoperative complications was associated with extended clinical severity stage (P =.02), type of surgery (P =.03), ICU (P =.03), type of reconstruction (P =.02), Functional Severity Index (P =.03), neck dissection (P =.002), and APACHE II (Acute Physiology and Chronic Health Evaluation II) (P =.008). The number of complications was significantly correlated with the length of hospital stay (r = 0.24, P =.01) and with the Functional Severity Index (r = 0.19, P =.04). Five-year overall survival was affected by the type of complications (none, 41.7%; local, 34.1%; and local plus systemic, 0% [P<.001]), ICU (no, 46.3%; yes, 20.7% [P =.001]), and extended clinical severity stage (stage 1, 75.6%; stage 2, 50%; stage 3, 28.6%; and stage 4, 10.2% [P<.001]). In a multivariate analysis bilateral neck dissection (relative risk = 3.57, P =.01) and an APACHE II score greater than 10 (relative risk = 3.86, P =.02) were independent risk factors for complications. The predictive prognostic model consisted of the following: staying in the ICU (hazard ratio = 1.83), local plus systemic complications (hazard ratio = 6.27), and extended clinical severity stage (stage 3, hazard ratio = 3.57; stage 4, hazard ratio = 6.34). CONCLUSIONS: Bilateral neck dissection and the APACHE II score were identified as risk factors for postoperative complications in oral cancer, which also increase the length of hospital stay. The occurrence of systemic complications, advanced extended clinical severity stage, and staying in an ICU adversely affect the prognosis. Therefore, the prompt recognition of the adverse risk factors for postoperative complications may guide proactive interventions that may improve survival and achieve cost-effectiveness.

APACHE↗
PubMed2003

[Laparoscopy and re-laparoscopy in the diagnosis and treatment of postoperative complications].

Experience of repeated laparoscopic surgeries in early and late postoperative period in 112 patients is analyzed. In early postoperative period repeated laparoscopy was performed in 75 patients for prevention, diagnosis and treatment of postoperative complications. In 54 patients repeated laparoscopy was carried out for programmed control for pathologic process. Laparoscopic surgery for diagnosis and treatment of postoperative complications was performed in 27 patients. In this group complications were seen in 2 patients. Technical features of repeated laparoscopy are demonstrated. Laparoscopic surgeries after laparotomic and laparoscopic operations are a good component of complex treatment and prophylaxis of severe complications in abdominal surgery. Prior performed abdominal operation is not contraindication for laparoscopy.

Digestive System Surgical Procedures↗
PubMedDate not supplied

Risk factors for intraoperative and early postoperative complications in extracapsular cataract surgery.

The risk factors for intraoperative and early postoperative complications were evaluated in 351 consecutive cataract operations at the Oulu University Hospital in 1990. Bleeding into the anterior chamber during the operation was recorded in 8.6%, zonular rupture in 6.6%, posterior capsular rupture in 5.4% and vitreous loss in 3.2%, On account of the loss of capsular support an anterior chamber intraocular lens was implanted in 3.1%. Of the early postoperative complications, signs of fibrinous reaction were observed in 24.5%, corneal edema in 53.6% and rise of intraocular pressure to 30 mmHg or more in 27.6%. There was no difference in the complication rate between men and women or in relation to age. The use of anticoagulant (although discontinued before surgery) or antiplatelet medication increased the risk of intraoperative bleeding but no sight-threatening bleeding occurred. The use of acetylsalicylic acid was also associated with an increased risk of postoperative fibrinous reaction. Other systemic diseases like systemic hypertension, diabetes, asthma, or cardiac or mental disorders, or medications, did not increase the complication rate. Of the various ocular parameters, small pupil and exfoliation syndrome were the most important risk factors for both intra- and early postoperative complications, and the presence of glaucoma increased the risk of vitreous loss, postoperative pressure rise and corneal edema. General anesthesia did not seem to reduce the complications rate.

Adult↗
PubMed1990

Intraoperative blood pressure. What patterns identify patients at risk for postoperative complications?

While monitoring blood pressure is a routine part of intraoperative management, several methods have been proposed to characterize intraoperative hemodynamic patterns as predictors of postoperative complications. In this prospective study of a high-risk population of hypertensive and diabetic patients undergoing elective noncardiac surgery, one objective was to compare different approaches to the assessment of intraoperative hemodynamic patterns to identify those patterns most likely to be associated with postoperative complications. Twenty-one per cent of the 254 patients sustained cardiac or renal complications after operation. Patients with more than 1 hour of greater than or equal to 20-mmHg decreases in mean arterial pressure (MAP) or patients with less than 1 hour of greater than or equal to 20-mmHg decreases and more than 15 minutes of greater than or equal to 20-mmHg increases were at highest risk for postoperative complications. Together these two patterns had a 46% sensitivity rate and a 70% specificity rate in predicting postoperative complications. Using 20% change in intraoperative MAP produced results nearly identical to 20-mmHg changes. When the duration of 20-mmHg changes was accounted for, changes of a greater magnitude (e.g., 40 mmHg) were not significant independent predictors of complications. The use of the mean difference from preoperative MAP was misleading because patients who experienced both high and low MAPs tended to have nearly normal mean MAPs, but high complication rates. The absolute magnitude of intraoperative MAPs, regardless of the preoperative levels, also was evaluated. The overall mean intraoperative MAP was not a significant predictor of complications. Specific intraoperative MAPs (e.g., less than 70 mmHg and more than 120 mmHg) also were evaluated. While neither was a significant predictor, there was a trend for increased complications among patients whose MAPs decreased to less than 70 mmHg. Intraoperative blood pressure should be analyzed in relation to the patient's preoperative blood pressure. Prolonged changes of more than 20 mmHg or 20% in relation to preoperative levels were significantly related to complications.

Blood Pressure↗
PubMedDate not supplied

Postoperative complications after simultaneous vitrectomy and cataract surgery.

OBJECTIVE: We reviewed postoperative complications after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion. PATIENTS AND METHODS: Combined surgery was performed in 316 eyes of 279 patients between 1995 and 1997. Postoperative observation was continued in all of them for more than 6 months. The diagnoses that led to vitrectomy included diabetic retinopathy in 155 eyes, rhegmatogenous retinal detachment in 64 eyes, macular hole in 43 eyes, and other diseases in 93 eyes. The rate of postoperative complications that needed any reoperation was investigated. RESULTS: Reoperations were needed for intravitreal hemorrhage in 23 eyes (7.3%), retinal detachment in 15 eyes (4.7%), rubeotic glaucoma in 6 eyes (1.9%), and other conditions in 4 eyes (1.3%). Among them, reoperations were performed on 13 eyes (4.1%) twice and more. A removal of an intraocular lens was needed in 16 eyes (5.1%) for treatment of vitreoretinal disease. In patients with diabetic retinopathy, reoperations were needed for intravitreal hemorrhage in 21 eyes (13.5%), rubeotic glaucoma in 6 eyes (3.9%), other diseases in 4 eyes (2.6%), and a removal of an intraocular lens was needed in 10 eyes (6.5%) at a higher rate than the other disease. CONCLUSION: This combined surgery is considered advantageous for removing peripheral vitreous, while preventing these complications is important for preserving visual function.

Acrylic Resins↗
PubMed2002

Predictors of postoperative complications in high-risk octogenarians undergoing cardiac operations.

BACKGROUND: Cardiac operations in octogenarians are currently reserved for selected patients with severe symptoms and low extracardiac comorbidity; early and midterm results are satisfactory. We evaluated the outcome of high-risk octogenarians undergoing cardiac operations and investigated the predictors of postoperative complications. METHODS: Between June 1998 and March 2001, 73 consecutive octogenarians (mean age = 83.1 +/- 3.0 years) hospitalized and awaiting operation in our Department were analyzed for postoperative complications. We recorded the main risk factors for cardiovascular disease, symptoms of heart failure, previous myocardial infarction, reoperation, left ventricular ejection fraction, use of intraaortic balloon pump, surgical priority, and operative risk. Cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and renal failure were the preoperative extracardiac comorbidities considered. We adopted a multidisciplinary approach to perioperative management. RESULTS: Surgical procedures included coronary artery bypass grafting in 36 patients (49.3%), valve procedures in 20 (27.4%), and combined coronary artery bypass grafting and valve procedures in 17 patients (23.3%). In-hospital death occurred in 6 patients (8.2%). Twenty-one patients (28.8%) had major postoperative complications including renal failure (15.1%), respiratory failure (8.2%), and myocardial infarction (8.2%). The main predictors of postoperative complications were New York Heart Association functional class IV, Canadian Cardiovascular Society angina class 4, and prolonged aortic cross-clamping time. CONCLUSIONS: Cardiac operations can achieve satisfactory results even in high-risk octogenarians. Early surgical intervention before severe symptoms appear, and a multidisciplinary approach to perioperative management, may reduce postoperative complications.

Aged↗
PubMed1997

[Esophageal resection for cancer--analysis of postoperative complications from personal materials].

The aim of the present study was to analyse the rate of postoperative complications in patients after esophageal resection for cancer, as well as the dependence of its frequency from surgical tactics employed during the operation. Postoperative complications occurring in 38 patients who underwent esophagectomy and intrathoracic esophagogastric anastomosis (treated from 1978 to 1987) were compared with the same data of 74 patients (1988-1996) in whom the operation consisted of the total intrathoracic esophagectomy, cardia, lesser curvature of the stomach and large regional lymph nodes dissection. In these latter cases the esophagogastric anastomosis was performed in the neck. The most frequent postoperative complications in both groups were of cardiopulmonary origin. The anastomotic leak occurred less frequently in patients with cervical esophagogastric anastomosis. However, when occurred, healing was more likely by local drainage and conservative treatment. Anastomotic leaks after intrathoracic esophagogatric anastomoses were usually fatal. In these cases the only chance of patient's survival was an aggressive surgical treatment consisting of disconnection of alimentary tract: esophageal fistula in the neck and feeding jejunostomy.

Anastomosis, Surgical↗
PubMed2004

[Early postoperative complications in patients with aneurysm of the abdominal aorta treated with vascular prosthesis].

Type and frequency of early postoperative complications were analyzed in a group of 226 patients (190 men and 36 women) at the age of 45 to 83 (mean age 65.3 +/- 8.2) who were operated as planned due to aneurysm of abdominal part of aorta. Patients were divided into two groups (I and II) depending on method of analgesia. Group I which constituted 173 patients operated at associated general and extrameningeal analgesia and group II constituted 53 patients operated at general analgesia. The division into groups was unintentional and was due to the fact that general analgesia was carried out in patients with contraindication of extrameningeal catheter use or technical troubles with its appliance. Patients of both groups were divided into groups (A and B) depending on type of complication or cause of death (A--cardiogenic, B--extracardiac). The followed up group is characterized by increased incidence in men than in women (5:1), the age of both sexes is not significantly different respectively men and women 65.5 and 65.2 years. In most cases, patients suffered from arterial hypertension (20.4%), ischaemic heart disease and myocardial infarction (21.2%) and chronic obstructive lung disease (12%). Early postoperative complications without lethal outcome occurred in 76 patients (33.6%), in 7.5% they included cardiogenic complications, while in 26% extracardiac complications, among which acute ischaemia of lower extremities (8.8%) and postoperative pulmonary complications (5.7%) were the most dominating. The observed group is characterized by relatively high postoperative mortality (9.3%). 4% of patients died due to cardiogenic reasons, while 5.3% of patients died due to extracardiac reasons. The most common cause of death in the last group was infection and embolism of mesentery (3.6%). Strong relation between preoperative loading, operation time, time of aorta occlusion, type of grafted prosthesis and frequency as well as type of postoperative complications was confirmed. The relationship was not confirmed with respect to the type of analgesia.

Aged↗
PubMed2006

Predictors of postoperative complications after radical resection for pulmonary aspergillosis.

OBJECTIVE: Although surgery has proven to be the best treatment for pulmonary aspergillosis, with the highest chance of achieving complete remission, it is difficult to determine the surgical indications for this disease because of the high incidence of postoperative complications. We conducted this study to identify some predictors of postoperative complications, in an attempt to reduce the morbidity rate. METHODS: We retrospectively analyzed the medical records of 31 patients (18 men, 13 women; median age 53 years) who underwent radical resection for pulmonary aspergillosis between 1976 and 2004. The clinical manifestations, surgical procedures, and postoperative complications were reviewed to clarify the predictors of postoperative complications. RESULTS: The morbidity rate associated with major complications such as intrapleural bleeding, bronchopleural fistula, and empyema, resulting in further surgery, was 19%. Univariate analysis revealed the predictors of major complications to be sex, severe preoperative symptoms, and extensive pulmonary resection. Multivariate analyses also indicated that preoperative symptom severity was an independent predictor of major complications. CONCLUSIONS: Pulmonary aspergillosis should be resected before the symptoms become too severe if the patient is a surgical candidate.

Adult↗
PubMed1996

[Inhibition of secretion in pancreas surgery reduces postoperative complication rate: a meta analysis of 4 multicenter studies].

We report on a meta-analysis of four randomized, placebo-controlled, double-blind multicenter trials evaluating the role of perioperative octreotide treatment in the prevention of postoperative complications following elective pancreatic surgery. From a total of 963 patients (483 placebo, 480 octreotide), the postoperative complication rate (329 placebo, 206 octreotide) and the number of patients with postoperative complications (placebo 38%, octreotide 22%) were significantly higher in the placebo groups compared with the octreotide groups. Postoperative morality was comparable between the placebo (3.9%) and the octreotide (3.5%) groups. These data indicate that perioperative application of octreotide can prevent postoperative complications following pancreatic surgery.

Double-Blind Method↗
PubMed1996

Postoperative complications after splenectomy for hematologic malignancies.

OBJECTIVE: The authors analyzed the frequency and character of postoperative complications after splenectomy in patients with hematologic malignancies, and correlated these findings with preoperative conditions that could have predicted their outcome. SUMMARY BACKGROUND DATA: Splenectomy is performed for hematologic malignancies for diagnostic and therapeutic indications. The role of splenectomy for lymphoproliferative and myeloproliferative malignancies is complex and sometimes controversial. METHODS: The medical records of 135 patients undergoing splenectomies for hematologic malignancies at Roswell Park Cancer Institute from January 1, 1984 to December 31, 1993 were reviewed retrospectively. These included Hodgkin's disease (HD), hairy cell leukemia (HCL), non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), and a miscellaneous group. RESULTS: The overall postoperative complication and mortality rates for all patients were 52% and 9%, respectively. The complication rate was 63% for patients whose spleens weighed greater than 2000 g, and 29% for patients whose spleens weighed less than 2000 g (p = 0.001). Seventy-three percent of the postoperative deaths were due to septic complications, only one of which was caused by an encapsulated organism. Complications occurred in less than 20% of patients with the diagnosis of HD and HCL; more than 50% of patients with NHL, CLL, and CML suffered postoperative complications. CONCLUSIONS: Splenectomy performed in patients with hematologic malignancies is a potentially morbid procedure. Splenic size was the only preoperative factor found to be predictive of postoperative complications. The complication rate differed significantly between the different diagnostic subgroups.

Adolescent↗
PubMed1991

The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis.

The purpose of this study was to evaluate the ability of preoperative laboratory testing to predict postoperative complications. Five hundred twenty patients undergoing elective surgery had their American Society of Anesthesiologists' classification, ponderal index, electrolyte values, glucose levels, blood urea nitrogen/creatinine values, complete blood counts, coagulation studies, total protein/albumin/lymphocyte count, electrocardiogram, chest radiograph, urinalysis, pulmonary function tests, type of anesthesia, and type of operation recorded preoperatively. Patients were followed prospectively after surgery for the development of complications. The data were analyzed by univariate and multivariate methods. Postoperative complications were strongly associated with American Society of Anesthesiologists' classification, type of anesthesia, and type of operation. However, only a few laboratory tests, such as electrocardiogram, chest radiograph, and nutritional status, were associated with postoperative complications. Therefore, in general, preoperative laboratory testing should only be undertaken for specific indications. Recommendations for routine tests are made depending on the age of the patient.

Adult↗
PubMed2004

Perioperative prostaglandin E1 treatment for the prevention of postoperative complications after esophagectomy: a randomized clinical trial.

PURPOSE: We conducted a prospective randomized clinical study to examine whether perioperative prostaglandin E1 (PGE1) could help in the prevention of postoperative complications after esophagectomy for esophageal cancer. METHODS: Forty patients with esophageal cancer eligible for radical esophagectomy were randomly assigned to an experimental group ( n = 20), given perioperative PGE1, or to a control group ( n = 20), given standard postoperative treatment. The main clinical endpoints examined were the incidence of postoperative complications, hospitalization, duration of systemic inflammatory response syndrome (SIRS), portal vein blood flow, and serum bilirubin levels. RESULTS: Severe postoperative complications developed in five patients in the control group and two in the PGE1 group. There was one surgery-related death in the control group. The duration of SIRS was significantly shorter in the PGE1 group than in the control group (5.74 days vs 7.50 days; P = 0.047). Portal vein flow was also significantly lower on postoperative day (POD) 1 in the control group than in the PGE1 group ( P = 0.042). Maximum postoperative serum bilirubin levels were significantly lower in patients treated with PGE1, at 2.91 vs 4.38 mg/dl in the control group ( P = 0.040). CONCLUSIONS: The perioperative administration of PGE1 helps maintain adequate portal blood flow, improves hyperbilirubinemia, and attenuates the duration of SIRS, thereby reducing the risk of postoperative complications after esophagectomy and lymphadenectomy for esophageal cancer.

Adult↗