[Round-table discussion on the topic: postoperative complications].
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Humans↗
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[Postoperative complications of retinal detachment surgery. 1. Postoperative massive retraction of the vitreous. 2. Erosion of the sclera and retinal atrophy following circling operation].
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Adult↗
Predictive factors of immediate postoperative complications after uvulopalatopharyngoplasty.
OBJECTIVES/HYPOTHESIS: This study was performed to assess the relationships between polysomnographic data, including the level of obstruction inducing apnea, and immediate postoperative complications or oxygen saturation in patients who had undergone uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Retrospective study. METHODS: Using the data of 90 patients with a polysomnography-confirmed diagnosis of OSAS who had undergone UPPP surgery with/without tonsillectomy under general anesthesia, we determined apnea-hypopnea indices (AHI), preoperative lowest arterial saturation (LSAT-PREOP) levels, percentages of obstruction at the upper level of the uvula during apnea (AL-U), need for an airway in the postanesthesia care unit (PACU) or during the first postoperative night in a ward (POPN1), LSAT- PACU, LSAT-POPN1, and the incidence of postoperative bleeding or other complications. RESULTS: Postoperative complications developed in 19 (21.1%) of the 90 patients, airway-related complications in 5 (5.6%), oxygen desaturation in 8 (8.9%), excessive or recurrent bleeding in 7 (7.8%), and a postoperative electrocardiogram change in 1(1.1%). Patients with postoperative complications had higher AHI (68.1 vs. 49.3, P = .008), lower LSAT-PREOP (71.1 vs. 77.8, P = .012), and lower AL-U (24.2 vs. 57.4, P = .005) than those without. After UPPP surgery, LSAT-POPN1 improved more than LSAT-PREOP (94.4 vs. 76.2%, P = .03), and LSAT-POPN1 correlated with LSAT-PREOP (r = 0.274, P = .014) and AL-U (r = 0.286, P = .046). CONCLUSIONS: This study shows that immediate postoperative complications and oxygen saturation are associated with OSAS severity and the level of obstruction, inducing apnea in those who have undergone UPPP for OSAS.
Adult↗
Flap perfusion after free musculocutaneous tissue transfer: the impact of postoperative complications.
In a previous study, the authors found persistence of pedicle blood flow up to 10 years after uncomplicated free latissimus dorsi transfer. In this study, the impact of postoperative complications (hematoma, thrombosis, infection) and successful surgical revision was tested. Since 1982, more than 1200 free tissue transfers have been performed at the authors' institution (Hannover Medical School). Of these, the authors selected two groups of 30 patients each who had received a free latissimus dorsi transfer to the lower leg without microsurgical nerve coaptation for wound coverage. All patients included in this study were carefully selected for clinical homogeneity, with one difference: group I comprised patients who had no postoperative complications after free latissimus dorsi transfer. Group II included only patients with major postoperative complications after the procedure. All flaps in group II survived after successful surgical revision. The arteries, which nourished the lower leg, were visualized and documented by means of a duplex scanner in both groups. Three different time intervals were chosen for measurements of blood flow: 4 to 6 months (groups I.I and II.I), 4 to 6 years (groups I.II and II.II), and 8 to 10 years (groups I.III and II.III). Quantitative measurements of local flap perfusion in milliliters per minute per 100 g tissue were performed by means of the hydrogen clearance technique. In each patient, a total of nine measurements was performed in three phases: phase A, before closing the vascular pedicle by manual compression (n = 3); phase B, with a closed pedicle (n = 3); and phase C, after releasing the vascular pedicle from manual compression (n = 3). Each measurement took approximately 10 minutes. One hundred percent closure of each pedicle in phase B was confirmed by the duplex scanner. Furthermore, all patients were monitored both clinically and by means of the hydrogen clearance technique during phase B for adequate blood supply to the lower leg. Lower leg perfusion showed no statistical differences for phases A, B, and C in all groups of patients. In group I, no statistical differences in local flap perfusion were encountered for phases A and C. In phase B, however, a statistically significant (p < 0.01) complete extinction of local flap perfusion was registered in all patients of group I at the site of the flap's skin paddle. In group II, however, persistent flap perfusion was registered during phase B in up to 50 percent of cases in one subgroup (II.III). No statistically significant alterations of local blood flow were registered in the surrounding tissue of group II during phases A, B, and C. Patients with thrombosis of the venous anastomosis (n = 7) seemed to have the highest incidence of loss of autonomous blood supply through the vascular pedicle (5 out of 11 cases). No inconstant results were found during the repetitive measurements (n = 3) for each patient in each phase. After uncomplicated free tissue transfer, the flap's intact vascular pedicle seems to play an important role in permanent flap survival up to 10 years after the procedure. Postoperative complications after free tissue transfer with successful surgical revision, especially venous thrombosis of the vascular anastomosis, may lead to loss of vascular flap autonomy over time.
Adult↗
Multivariate analysis of postoperative complications after esophageal resection.
To determine the contributing factors for eight postoperative complications after esophagectomy through a right thoracoabdominal approach, a multivariate analysis was carried out on preoperative and intraoperative variables in 141 patients with thoracic esophageal cancer. Although postoperative complications occurred in 125 patients, only 7 died of such complications. The multivariate analysis indicated that the retrosternal route was a significant factor predisposing to postoperative atelectasis. Age, preoperative arterial oxygen tension, and volume transfused were significant factors predisposing to postoperative hypoxemia, whereas age, routes other than the intrathoracic route, and volume transfused were significant factors predisposing to prolonged respiratory support. In addition, preoperative total serum bilirubin level and volume transfused were significant factors predisposing to postoperative hyperbilirubinemia; preoperative serum creatinine level was a significant contributing factor for postoperative renal insufficiency; and sex, antesternal route, and substituted colon were significant contributing factors for anastomotic leakage. There were no significant factors predisposing to postoperative pneumonia and liver dysfunction. These significant factors should be taken into consideration not only during perioperative management but also when choosing the operative procedures and extending the surgical indication for esophagectomy through a right thoracoabdominal approach.
Age Factors↗
Sickle cell disease and tonsillectomy. Preoperative management and postoperative complications.
BACKGROUND: Patients with sickle cell disease are recognized as having a relatively higher risk for postoperative complications, including fever, atelectasis, pneumonia, or sickle cell vas-occlusion. OBJECTIVE: To present a protocol for preoperative management of patients with sickle cell disease undergoing tonsillectomy, including the use of transfusions and intravenous hydration. DESIGN: Retrospective chart review. SETTING: Academic, tertiary care referral medical center. PATIENTS: Seventy-five patients with sickle cell disease who underwent tonsillectomy with or without adenoidectomy were included for review. Preoperative management was documented, and risk factors were assessed. Intraoperative management was reviewed, and postoperative complications were identified and compared with preoperative data and management. RESULTS: Preoperative management consisted of transfusions to a hemoglobin S ratio (hemoglobin S-total hemoglobin) less than 40% or a hemoglobin level greater than 100 g/L. Aggressive intravenous hydration of 1.5 times the maintenance fluid was given 24 hours before surgery. Increased complications were associated with a preoperative hemoglobin S ratio greater than 40% (P < .05) and an age younger than 4 years (P < .05). Operative time, technique, and blood loss were not statistically significant risk factors. The average length of hospitalization was 4.8 days. CONCLUSIONS: Children with sickle cell disease presenting for elective tonsillectomy should be given a transfusion to a hemoglobin S ratio less than 40% in an attempt to reduce postoperative complications. Additional factors, such as age and presence of obstructive sleep apnea, only increase the potential risks.
Adenoidectomy↗
Perioperative nutrition and postoperative complications in patients undergoing spinal surgery.
STUDY DESIGN: The authors undertook a three-part study to better understand the impact of perioperative nutritional status on postoperative complications in patients undergoing spinal surgery. In preliminary Parts I and II, the authors targeted two groups of patients who are particularly nutritionally challenged. In Part III, they studied a large group of consecutive patients undergoing routine lumbar spinal fusion. OBJECTIVES: To determine whether preoperative nutritional status was a significant predictor of postoperative complications in patients undergoing elective lumbar spinal fusion. SUMMARY OF BACKGROUND DATA: In Part I, 27 patients treated surgically for vertebral osteomyelitis were divided into two groups based on their preoperative nutritional status. Twenty-four of the 26 postoperative complications were in the malnourished group (P < 0.001). In Part II, 15 (75%) of 20 patients treated surgically for spinal cord injury were found to become malnourished in the postoperative period. Seventeen complications were noted, all in the malnourished group (P = 0.001). METHODS: One hundred fourteen consecutive patients undergoing selective lumbar decompression and fusion were identified and their records reviewed. In addition to preoperative nutritional status, data gathered included age, sex, height, weight, past medical history, steroid use, alcohol use, tobacco use, type of bone graft (allograft vs. autograft), history of previous lumbar surgery, number of levels fused, and use of spinal instrumentation. RESULTS: Eleven of 13 postoperative infectious complications (10 deep wound infections) were noted in the malnourished group (P < 0.001). By stepwise logistic regression analysis, preoperative nutritional status was an extremely significant independent predictor of postoperative complications in patients undergoing elective lumbar spinal fusion (P = 0.0018). CONCLUSIONS: The prevalence data in our study population suggest that a large number (25%) of patients undergoing elective lumbar spine surgery are nourished inadequately at surgery. This number is higher (42%) in older patients. The authors recommend that close attention be paid to the perioperative nutritional status of patients undergoing lumbar spinal surgery. Patients with suboptimal nutritional parameters should be supplemented and replenished before elective surgery.
Adult↗
Cognitive dysfunction after total knee arthroplasty: effects of intraoperative cerebral embolization and postoperative complications.
Cerebral emboli identified as high-intensity transient signals (HITS) occur during total knee arthroplasty (TKA). Their effects on cognitive outcome remain speculative. Intraoperative HITS and postoperative complications were correlated with the cognitive function of TKA patients. Cognitive function was assessed both before and after surgery (1 week and 3 months). High-intensity transient signals occurred in 22 of 37 patients. Counts of HITSs were higher in patients with sonographically detected intracardiac shunts. Cognitive dysfunction was found in 41% of patients at 1 week, but in only 18% at 3 months. High-intensity transient signal counts were not associated with the prevalence of cognitive deficits. At 1 week, 58% of patients with cognitive deficits had at least 1 postoperative complication (6% in nondeficit patients). All cognitively impaired patients at 3 months had complications (17% in the nondeficit group). This raises the possibility that postoperative complications might be associated with cognitive dysfunction in TKA patients.
Aged↗
Are postoperative complications genetically determined by TNF-beta NcoI gene polymorphism?
BACKGROUND: Postoperative infectious complications are the leading causes for postoperative sepsis. In severe sepsis, tumor necrosis factor-beta (TNF-beta) NcoI polymorphism was associated with increased mortality. Therefore, the aim of this study was to determine whether the biallelic NcoI polymorphism within the TNF locus is associated with the development of postoperative complications. METHODS: One hundred sixty patients were included in this prospective observation study. Patients undergoing major gastrointestinal surgery, such as esophagectomy, gastrectomy, Whipple operation, major liver resection, or colon resection were included. Patients were monitored during the clinical course, and postoperative complications, divided into severe and minor complications, were documented. The NcoI restriction fragment length polymorphism of the TNF-beta gene was determined by polymerase chain reaction; gene expression as well as complications were correlated. RESULTS: The patients' genotype distribution and demographic characteristics were comparable within the different groups of operations. Patients with the heterozygous genotype TNF-beta1/beta2 had a 1.6-fold higher relative risk for developing complications. If patients with the homozygous genotype TNF-beta2 developed a complication, they had a 1.5-fold higher relative risk for severe complications. Furthermore, the mortality of patients with postoperative sepsis who were homozygous for the genotype TNF-beta2 was significantly elevated. CONCLUSIONS: The TNF-beta NcoI polymorphism influences the development of postoperative complications. While the genotype TNF-beta1/beta2 has a higher risk for developing complications in general, the TNF-beta2/beta2 genotype is associated with more severe complications and mortality from sepsis.
Adult↗
Postoperative complications of cholecystectomy in Victorian public hospitals.
Cholecystectomies in Victorian public hospitals were evaluated by analysis of hospital morbidity data. The Victorian Inpatient Minimum Dataset (VIMD) contains data on postoperative complications from all cholecystectomies in Victorian public hospitals. Hospital separations associated with cholecystectomy were identified according to Australian national diagnosis-related groups and the procedures were grouped as open, laparoscopic or conversion from laparoscopic to open cholecystectomy (conversion). Postoperative complications were identified by ICD9-CM external-cause codes (E-codes) in the VIMD. The 35593 cholecystectomies performed between 1987-88 and 1993-94 were analysed. A further detailed analysis of all cholecystectomies performed in 1993 was based on logistic regression. This identified the adjusted odds (AOR) of occurrence of complications and included covariates of age, sex, admission type, diagnosis-related group and hospital identification code. The annual frequency of cholecystectomy increased after introduction of laparoscopic cholecystectomy in 1990, and was associated with an increase in rates of separations having adverse events, but laparoscopic cholecystectomy had the lowest rate (66.7 per 1000 separations). Adverse-event rates for open procedures increased to 157.5 per 1000 in 1993-94, and for conversions to 290.0 per 1000. Of 5627 cholecystectomies in 1993, 74.4 per cent were laparoscopic, 21.5 per cent open and 4.1 per cent conversions. Postoperative complications were more likely in males (AOR 1.67, 95 per cent confidence interval (CI) 1.38 to 2.04), in patients admitted as an emergency (1.27, CI 1.01 to 1.60), and in those having open cholecystectomies (2.25, 1.78 to 2.85) or conversions (4.29, 3.05 to 6.03). Analysis of the VIMD has provided information for the evaluation of cholecystectomy. The VIMD is a useful tool for monitoring postoperative complications and the quality of care in Victorian hospitals.
Cholecystectomy↗
Relationship between provider volume and postoperative complications for bariatric procedures in New York State.
BACKGROUND: Although the number of bariatric procedures has grown recently, few studies have focused on the relationship between provider volume and outcomes among patients undergoing a bariatric procedure. STUDY DESIGN: Using New York State's inpatient discharge database, we identified adults undergoing a bariatric procedure in New York State between January 1, 2003 and December 31, 2003 (n=7,868). Separate multivariable statistical models were constructed to examine the relationship between surgeon volume and hospital volume and postoperative complications (using surgeon volume cutpoints of 25, 50, 100, 150 and hospital volume cutpoints of 100, 125, 150, 200) while controlling for demographic characteristics and comorbidity. RESULTS: There was a considerably higher likelihood of postoperative complications among surgeons performing 100 or fewer bariatric procedures compared with those performing more than 100 procedures (odds ratio [OR]: 2.39, 95% CI: 1.59 to 3.59) and for those performing 150 or fewer procedures compared with those performing more than 150 procedures (odds ratio: 2.05, 95% CI: 1.29 to 3.25) after risk adjustment. Likewise, for each of the four hospital volume cutpoints, there was a notably higher likelihood of postoperative complications in the lower volume hospitals. Analyses of the interaction between surgeon and hospital volume indicated a markedly higher likelihood of postoperative complications among patients operated on by a low-volume surgeon (100 procedures or fewer) in a low-volume hospital (150 procedures or fewer) or a low-volume surgeon in a high-volume hospital than among patients operated on by a high-volume surgeon in a high-volume hospital. CONCLUSIONS: The likelihood of postoperative complications from bariatric procedures is greater for patients with low-volume surgeons or in low-volume hospitals.
Adult↗
[Prophylaxis and treatment of postoperative complications in peritonitis of appendicular genesis].
The results of treatment of postoperative complications in 227 children with destructive forms of appendicitis and appendicular peritonitis were analyzed. The expediency of the low-intensive laser radiation application in the treatment of various forms of peritonitis was noted. The frequency of the postoperative complications occurrence was 17.3% at average, constituting one half in comparison with the control groups.
Adolescent↗
Analysis of postoperative complications after esophagectomy for esophageal cancer in patients receiving neoadjuvant therapy.
Postoperative complications were investigated in 72 patients who received neoadjuvant therapy with esophagectomy. Preoperative chemotherapy consisted of 5-fluorouracil (700 mg/m2/day, on days 1 to 5), cisplatinum (70 mg/m2/day, on day 1) and leucovorin (20 mg/m2/day, on days 1 to 5). Preoperative chemoradiotherapy consisted of cisplatinum combined chemotherapy and radiotherapy (total dosage of 30-70 Gy). The incidence of postoperative pneumonia (16%) and anastomotic leakage (24%) in the preoperative chemotherapy group was slightly higher than that in the control group (n = 506), and mortality (6.0%) after esophagectomy in the preoperative chemotherapy group was higher than that (2.4%) of the control group. Postoperative morbidity and mortality were observed more frequently in patients who received two cycles of the chemotherapy than those receiving only one cycle. Postoperative complications occurred more frequently in patients suffering high grade toxicities due to the preoperative chemotherapy. The highest preoperative serum creatinine value correlated to that of postoperative period (r = 0.6494). The use of the preoperative chemoradiotherapy with a total exposure dosage of 60 Gy or more significantly increased the postoperative pneumonia rate (67%; p < 0.05) compared to the group receiving 40 Gy or less. The mortality rate (33%) also increased. The second cycle of the preoperative chemotherapy should be cancelled if patients suffer high grade toxicities during or after the first cycle, and the total exposure dosage of the preoperative chemoradiotherapy should be limited to 40 Gy or less.
Antineoplastic Combined Chemotherapy Protocols↗
A systematic review of intraoperative warming to prevent postoperative complications.
This systematic review examines whether preventing hypothermia during surgery prevents postoperative complications and thereby improves outcomes for patients. Twenty-six randomized controlled trials were identified, and data extraction and assessment of study quality were carried out by two researchers independently. The results of studies with similar patients, surgical procedures, and outcomes were pooled. Outcomes measured included postoperative pain levels, thermal comfort, and treatment costs. Postoperative complications identified were shivering, cardiac events, need for blood transfusion, wound infections, and pressure ulcers. The majority of studies favored treatment.
Hot Temperature↗
Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery.
OBJECTIVES: The purpose of the present study was to assess whether preoperative and postoperative B-type natriuretic peptide (BNP) levels could be used as predictors of postoperative complications and outcomes in patients after open-heart surgery. BACKGROUND: A variety of multifactor indexes have been proposed for preoperative risk assessment of patients undergoing cardiac surgery, but they have shown limited ability and utility in accurately predicting postoperative complications, hospital stay, and mortality. METHODS: Subjects consisted of 98 male patients (63 +/- 9.1 years) undergoing open-heart surgery at the San Diego Veterans Administration Health System during a 19-month period. B-type natriuretic peptide levels were analyzed, and postoperative data recorded. RESULTS: There was a higher preoperative BNP level in patients requiring the use of intra-aortic balloon pumps (IABPs) (mean BNP = 387 +/- 112 pg/ml vs. 181 +/- 25 pg/ml), in patients who died within one year (357 +/- 93 pg/ml vs. 184 +/- 26 pg/ml), and in patients with postoperative hospital stays of 10 days or more (307 +/- 68 pg/ml vs. 179 +/- 27 pg/ml). Receiver operating characteristic curves demonstrated preoperative BNP levels as predictors of postoperative IABP use, hospital stay 385 pg/ml predict the postoperative complications and one-year mortality after heart surgery. Postoperatively, elevated peak BNP levels and elevated change to peak BNP levels were associated with prolonged hospital stay and mortality within one year.
Aged↗
Peritoneal cytokine release after elective gastrointestinal surgery and postoperative complications.
BACKGROUND: Laparotomy is known to give rise to systemic and local cytokine release. In the present study we investigated the course of the peritoneal response of tumor necrosis factor alpha (TNFalpha), interleukin (IL)-6, and IL-10 after elective gastrointestinal surgery and studied the differences in local cytokine response in patients developing postoperative complications. METHODS: Twelve consecutive patients underwent pancreatoduodenectomy (n = 9) or biliary and gastric bypass (n = 3) for pancreatic carcinoma. Sampling (TNFalpha, IL-6, IL-10) of fluid from abdominal drains was performed at return to the recovery unit (T=0), and at 3, 6, 18, 30, 42, 54, 66, 78 hours. Systemic sampling was performed at T=0, 3, 6, 18, 42, 66 hours. Postoperative cytokine response in patients with and without postoperative complications was compared. RESULTS: In patients without postoperative complications, peritoneal TNFalpha and IL-10 levels decreased in time (P = 0.07 and P = 0.01, respectively), whereas IL-6 did not change significantly during sampling (P = 0.28). Systemic IL-6 and IL-10 levels decreased 10-fold within 66 hours (IL-6, P = 0.04; IL-10, P = 0.06). Four patients experienced postoperative complications. All 4 patients with complications showed a second rise in peritoneal TNFalpha levels preceding the complication. All 4 patients had positive bacterial drain cultures from the abdominal drain, following the TNFalpha rise. CONCLUSIONS: After elective abdominal surgery, cytokines are released into the abdominal cavity. Intra-abdominal complications are accompanied or preceded by a peritoneal TNFalpha rise. In patients after elective gastrointestinal surgery, monitoring of peritoneal TNFalpha might be helpful in the early detection of severe intra-abdominal complications.
Aged↗
ASA score as prognostic criterion for incidence of postoperative complications after transhiatal esophagectomy.
The aim of this study is to point out the importance of the American Society of Anesthesiologists risk score (ASA score) as a very cheap and simple prognostic criterion for the incidence and severity of postoperative complications of transhiatal esophagectomy (THE). During the past ten years, twenty-nine patients were operated for cancer of the esophagus using the THE method at the University Hospital Center "Rijeka". Patients' preoperative physical status was estimated using the 19 parameters of ASA score and they were classified into ASA risk groups. The incidence and severity of the two most common and potentially fatal postoperative complications of THE--aspiration pneumonia and anastomotic leak--were compared with the patients ASA score as well as with the duration of postoperative hospital stay and operative mortality. Postoperative complications after THE, even with lethal outcome occurred only in patients with high ASA score (ASA risk group IV and V). Our conclusion is that ASA score has proven to be a reliable and useful prognostic criterion for the development of postoperative complications after THE and for the incidence of operative mortality.
Adult↗
Respiratory risk factors in development of postoperative complications after the lung resection.
The objectives of the study were to identify possible associated respiratory risk factors and to assess incidence of overall postoperative complications after the lung resection. We reviewed 110 patients who underwent lung resections due to malignant neoplasms or benign lung diseases. The risk of postoperative complications was evaluated using the univariate analysis. Results confirmed that low FEV1, postoperative high PaCO2, ASA-status and advanced age were factors associated with development of postoperative complications.
Adult↗