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PubMed1999

[Analysis of outcome of free jejunal-autograft for head and neck reconstruction--postoperative complications and functional results of swallowing in 49 cases].

We evaluated postoperative results in 49 patients (39 men, 10 women) who underwent pharyngoesophageal reconstruction with free-jejunal autograft following total pharyngolaryngoesophagectomy in the Department of Otolaryngology, Hokkaido University School of Medicine from 1989 to 1997. Evaluation was performed regarding the following points: 1) postoperative complications, 2) factors that determine the functional results of swallowing, 3) relation between forms of jejunal anastomosis and swallowing. The primary malignancy site was hypopharynx (39), cervical esophagus (4), larynx (3), thyroid (2) and trachea (1), Reconstructions were made with free jejunal autograft alone in 45 cases and with free jejunum in combination with gastric pull-up in 4. In patients who underwent reconstruction with jejunum alone, the anastomosis of the jejunum to the pharynx was performed in side-to-end fashion in 22, end-to-end in 18 and rho-shaped in 4. In the 1 remaining case, we used jejunal-patch graft. Postoperative complications including minor or nongraft related, occurred in 24 of 49 (49.0%) patients. Among these, graft-related complications were graft failure in 1 (2.0%), fistula formation in 3 (6.1%) and graft stricture in 2 (4.0%). Re-operations were required in one case of graft failure and 2 of fistula formation. Consequently, the overall graft-survival rate was 98.0% (48/49). Therefore, we considered the method of reconstruction to be a reliable procedure with a high-success rate. The swallowing function after reconstructive surgery was studied in 35 patients who underwent side-to-end (18) and end-to-end (17) anastomosis of the jejunum to the pharynx. We indicated that appropriate tension in the jejunum was the most important factor for adequate swallowing function. The end-to-end group had a higher rate of taking normal diet compared with the side-to-end group. The rate of swallowing dysfunction was only 5.9% (1/17) in the end-to-end group. On the other hand, 4 of 18 (22.2%) cases in the side-to-end group were regarded as having poor swallowing function. As a result we considered the end-to-end proximal jejunal anastomosis to be the more desirable form.

Adult↗
PubMed2000

Preoperative spirometry to predict postoperative complications in thoracic surgery patients.

UNLABELLED: Spirometry is a simple and basic test that can provide more information about pulmonary function. Many thoracic surgeons do a spirometry test to assess the pulmonary status of their patients before surgery. OBJECTIVE: To determine if preoperative spirometry can predict postoperative complications following thoracic surgery. DESIGN: Retrospective case control study. SETTING: Srinagarind Hospital Medical School, Khon Kaen University, Khon Kaen Thailand. PARTICIPANTS: Adult patients who had spirometry before thoracic surgery. MEASUREMENT AND RESULTS: From 1995 to 1998, we reviewed thoracic surgery patients who had spirometry testing before thoracic surgery. Fifty-six patients were enrolled in our study. Postoperative complications of these patients were determined by a systemic extraction of medical record data. The postoperative complications were classified into two groups, respiratory and non-respiratory complications. Eighteen patients experienced at least one respiratory and other complications. There was a sixfold or greater increase in non-respiratory complications (cardiac arrhythmia, congestive heart failure, prolonged hospital stay, upper gastrointestinal bleeding and wound infection), which were associated with moderate and severe impairment of FEV1 and FVC (< 66% predicted) (P < 0.05). There was a thirty percent increase in non-respiratory complications, which were associated with FEV1 < 2 liters (p < 0.05), FEV1 or FVC less than 70 per cent of predicted value (p < 0.05). No spirometric values were a good predictor of respiratory complications. CONCLUSION: Preoperative spirometry levels in patients requiring thoracic surgery of FEV1 < 2 liters, FEV1 or FVC < 70 per cent of predicted value was associated with postoperative complications, especially non-respiratory complications.

Adolescent↗
PubMed2005

[Early postoperative complications in patients with Moyamoya disease--a comparison of inhaled anesthesia with total intravenous anesthesia (TIVA)].

BACKGROUND: Moyamoya disease is a rare neurovascular disorder that requires special anesthetic managements during revascularization procedures. We have investigated the incidence of early postoperative complications under inhaled anesthesia in comparison with total intravenous anesthesia (TIVA) retrospectively. METHODS: Seventy-two patients undergoing revascularization procedures were divided into two groups, one with inhaled anesthesia (n = 23) and the other with TIVA (n = 49). Surgical procedures were performed under normocapnia, proper body temperature, and all patients were prevented from anemia by homologous transfusion. To avoid the variance in anesthetic managements, 39 patients under 15 years of age were picked up and divided in the same way as above. Early postoperative complications including transient ischemic attack and cerebral infarction during the first 2 weeks after operation were investigated. RESULTS: In all patients, early postoperative complications occurred in 48% of inhaled anesthesia group and in 49% of TIVA group. In patients under 15, these complications occurred in 44% and in 57%, respectively. There was no significant difference in the incidence of complications between the two anesthetic groups. CONCLUSIONS: Several previous studies reported the excellence of TIVA for revascularization procedure on the basis of regional blood flow because inhaled anesthesia may provoke intracerebral steal in moyamoya disease. Our investigation in this study revealed that both anesthetic methods have no significant difference in postoperative complications during the first 2 weeks after operation. Thus further study should be needed to verify the safety of inhalation anesthetics in patients with moyamoya disease.

Adolescent↗
PubMed1989

[Intra- and postoperative complications in infrarenal abdominal aortic aneurysms].

Patients scheduled for operation of an abdominal aortic aneurysm are a challenge to the anesthesiologist due to multiple coexisting diseases and serious intraoperative hemodynamic changes caused by cross-clamping. The aim of this study was to investigate the incidence of intra- and postoperative complications and to analyze the coexisting diseases in order to estimate complications and risks. PATIENTS AND METHOD: The charts of 72 patients scheduled for resection of an abdominal aortic aneurysm in 1984 and 1985 were retrospectively analysed. The patients are divided into 6 groups: E: elective operation; K: without pulmonary catheterization; N: emergency operation; R: ruptured aneurysm; D: acute dissection. The statistical analysis was performed by chi-square test. RESULTS: Patients monitored by Swan-Ganz catheter suffered more frequently from chronic obstructive or restrictive pulmonary diseases and coronary heart disease or cardiac failure. INTRAOPERATIVE COMPLICATIONS: Emergency patients showed more than twice as many intraoperative cardiovascular complications than scheduled patients; 3 fatal cases were observed in this group. Renal complications (anuria) occurred in 2% during elective operations and in 30% during emergency operations. POSTOPERATIVE COMPLICATIONS: Most of the postoperative complications - 75% - were associated with the cardiovascular system, followed by disturbances of gas exchange and hypoxemia. Two patients in group E had a short-lasting renal insufficiency; 1 patient died of myocardial infarction 3 weeks postoperatively. Emergency procedures were much more risky, with a 90% incidence of cardiovascular complications; 4 patients died within 5 days, 1 other after 1 week. Patients monitored by Swan-Ganz catheter showed more arrhythmias and hypotension than the others. Atelectasis was seen on X-rays in 46% of emergency patients, 35% of group P, and 2.6% of group K. CONCLUSIONS: Retrospective studies of special and high-risk patients are very useful in assessing the individual clinical standard, despite problems with data acquisition. This study permitted the assessment of perioperative complications and risks in these patients.

Aged↗
PubMed2005

Does EuroSCORE predict length of stay and specific postoperative complications after coronary artery bypass grafting?

BACKGROUND: To evaluate the performance of EuroSCORE in the prediction of in-hospital postoperative length of stay and specific major postoperative complications after coronary artery bypass grafting (CABG). METHODS: Data on 3760 consecutive patients with CABG were prospectively collected. The EuroSCORE model (standard and logistic) was used to predict in-hospital mortality, prolonged length of stay (>12 days) and major postoperative complications (stroke, myocardial infarction, sternal infection, bleeding, sepsis and/or endocarditis, gastrointestinal complications, renal and respiratory failure). A C statistic (receiver operating characteristic curve) was used to test the discrimination of the EuroSCORE. The calibration of the model was assessed by the Hosmer-Lemeshow goodness-of-fit statistic. RESULTS: In-hospital mortality was 2.7%, and 13.7% of patients had one or more major complications. EuroSCORE showed very good discriminatory ability in predicting renal failure (C statistic: 0.80) and good discriminatory ability in predicting in-hospital mortality (C statistic: 0.75), sepsis and/or endocarditis (C statistic: 0.72) and prolonged length of stay (C statistic: 0.71). There were no differences in terms of the discriminatory ability between standard and logistic EuroSCORE. Standard EuroSCORE showed good calibration (Hosmer-Lemeshow: P>0.05) in predicting these outcomes except for postoperative length of stay, while logistic EuroSCORE showed good calibration only in predicting renal failure. CONCLUSIONS: EuroSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also prolonged length of stay and specific postoperative complications such as renal failure and sepsis and/or endocarditis after CABG. These outcomes can be predicted accurately using the standard EuroSCORE which is very simple and easy in its calculation.

Aged↗
PubMed2005

Reconstruction after resection of hypopharyngeal carcinoma: comparison of the postoperative complications and oncologic results of different methods.

BACKGROUND: Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. METHODS: We retrospectively reviewed the records of 91 patients who underwent radical surgery and reconstruction. Postoperative complications and oncologic results of the different reconstructive methods were compared. RESULTS: Reconstruction with gastric pull-up had the lowest pharyngocutaneous (PC) fistula (0%) and pharyngoesophageal (PE) stenosis rates (0%). However, the overall postoperative complication rate was high (64%). Laryngotracheal flap (LTF) reconstruction had relatively lower rates of PC fistula (3%), PE stenosis (10%), and overall complications (22%). The introduction of the LTF technique significantly decreased postoperative complications from 71% to 30% (p = .0001), with similar tumor control and survival. CONCLUSIONS: Hypopharyngeal reconstruction with an LTF is a simple and effective method. The chance of using a complex flap is decreased. The postoperative complications are reduced, and the oncologic results are satisfactory.

Adult↗
PubMed2003

[Postoperative complications and unanticipated admission in ambulatory surgery].

BACKGROUND: Day-case surgery is becoming more popular in Japan. The incidence of postoperative complications and unanticipated hospital admission was evaluated between June 1, 1998 and May 31, 2001. METHODS: Two hundred fifty seven cases of ambulatory surgery were retrospectively evaluated in terms of methods of anesthesia, anesthesia time, recovery time, postoperative complications and unanticipated hospital admission. RESULTS: General anesthesia was used in 44% of 257 ambulatory surgical cases. Mean anesthesia time was 81 minutes and mean recovery time was 227 minutes. The most frequent complication was postoperative pain, incidence of which was 53%. The incidence of unanticipated hospital admission was 7.8%. Among this admission, anesthesia-related reasons were cited in 44%. CONCLUSIONS: Effective pain management and well-chosen anesthetic technique are important for the success of ambulatory surgery.

Adolescent↗
PubMed2000

[Hysterectomy for benign lesions: peroperative and early postoperative complications].

OBJECTIVE: Although hysterectomy for benign disorders is a routine and usually well-tolerated procedure, complications do occur, and the resulting morbidity rates are not negligible. The aim of this prospective study was to report perioperative and early postoperative complications observed after hysterectomy, regardless of the route or the operator. PATIENTS AND METHODS: Between March 31, 1991 and December 14, 1998, 1,604 patients (mean age: 46.5 +/- 8.1 years) underwent an hysterectomy for benign disorders. Perioperative and early postoperative complications, in the 1,248 vaginal hysterectomies (77.9%), 190 laparoscopically-assisted vaginal hysterectomies (11.9%) and 166 abdominal hysterectomies (10.2%) were noticed in each group and compared. RESULTS: None of the patients died in this series. Lesions on the urinary tract included 15 bladder injuries (0.9%) and 1 ureter injury (0.06%) without significant difference between routes. There were 9 (0.6%) intestinal injuries, with a significant increase when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 mL: and vaginal hysterectomy caused significantly fewer cases of heavy bleeding (2%, p < 0.001) than either laparotomy (6.7%) or laparoscopy (5.3%). The overall reoperating rate was 0.8% and this does not differ with the type of the procedure. CONCLUSION: Peri- and early postoperative complications after hysterectomy for benign disorders are not a rare event. In order to control complications and decrease the morbidity, a high-risk population should be defined based on the patients' history of pelvic surgery and endometriosis, on their parity and the size of their uterus. For these patients, the most appropriate route should be preferred and complications should be assessed using different tests and subsequently treated during the same procedure.

Blood Loss, Surgical↗
PubMed2006

Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators.

BACKGROUND: This systematic review examined the use of immunomodulators and the risk of postoperative complications after abdominal surgery in patients with inflammatory bowel disease. METHODS: Electronic databases (PubMed, Embase, Ingenta, Zetoc and Ovid) were searched and the reference lists in all articles identified were hand-searched for further relevant papers. Studies were included if they evaluated postoperative complications and defined exposure to individual immunomodulators. RESULTS: All 11 studies that met the inclusion criteria were observational studies; two were reported only in abstract form. Five studies reported risks associated with azathioprine, five reported risks associated with cyclosporin and three reported risks associated with infliximab. None showed an increased risk of either total or infectious complications associated with immunomodulator use. However, subgroup analysis in one study, published as an abstract, suggested increased rates of anastomotic complications and reoperation associated with azathioprine. CONCLUSION: Available evidence does not suggest an increased rate of postoperative complications associated with immunomodulator use.

Aged↗
PubMed1997

Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications.

BACKGROUND: Malnutrition is reported frequently in head and neck cancer patients. The impact of malnutrition on surgical outcome is not clearly understood. The purpose of this study was to define the usefulness of six different parameters in scoring malnutrition and to determine the nutritional parameter primarily related to postoperative complications. METHODS: Sixty-four patients undergoing major surgery for advanced head and neck cancer were studied prospectively, and six different parameters were used to define malnutrition. Logistic regression was used to relate nutritional parameters to postoperative complications. RESULTS: The parameters applied all identified different aspects of the nutritional status, as malnutrition varied between 20% and 67%. Logistic regression analysis identified a weight loss of more than 10% to be the most prominent predictive parameter for the occurrence of major postoperative complications. CONCLUSIONS: Patients with weight loss more than 10% during the six months before surgery are at a great risk for the occurrence of major postoperative complications.

Carcinoma, Squamous Cell↗
PubMed1999

Early postoperative complications following neurosurgical procedures.

PURPOSE: To assess the incidence and characteristics of early postoperative complications in patients following neurosurgical procedures. METHODS: All patients undergoing neurosurgery during a four month period were followed postoperatively for up to four hours in the post anesthetic care unit or intensive care unit. Patient information and all complications were documented by the investigators on a standardized form. Complications were classified as respiratory, cardiovascular, nausea and vomiting, shivering and other. Risk factors analyzed for the occurrence of complications included age, sex, ASA status, type of surgery, elective or emergency surgery and postoperative placement. RESULTS: Four hundred eighty six adult patients were followed, but in 55 patients the trachea remained intubated during the four hour study period and they were eliminated from the analysis of postoperative complications. At least one complication occurred in 54.5% of the remaining 431 patients. Respiratory problems occurred in 2.8%, trauma to the airway in 4.4%, cardiovascular complications in 6.7%, neurological in 5.7% and nausea and/or vomiting in 38%. The highest incidence of patients with complications was during spine (65%) and vascular (66%) surgery, compared with tumour (47%) and other (43%) surgery, P < 0.05. Other risk factors included age < 70 yr for nausea and vomiting (P < 0.02), and elective surgery for spine and vascular surgery (P < 0.001). CONCLUSION: There was a high incidence of early postoperative complications in neurosurgical patients. The most common problem was nausea and vomiting especially in the younger patient undergoing elective spine surgery.

Adult↗
PubMed2006

Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer.

OBJECTIVE: This study evaluates the risks of postoperative complications in 124 patients with non-small-cell lung cancer who received pre-operative induction chemoradiotherapy and surgery. METHODS: All patients with non-small-cell lung cancer who underwent surgery after induction therapy between January 1990 and December 2003 were reviewed. We adopted univariate and multiple logistic regression models to identify predictors that increased the incidence of postoperative complications. RESULTS: Of 124 patients, 59 received carboplatin and docetaxel, 53 received cisplatin and etoposide, and 12 received other platinum-based combinations. Pre-operative thoracic radiotherapy was performed concurrently with chemotherapy. The median dose to the primary tumor was 40 Gy, and 29 patients (23.4%) received radiotherapy of more than 45 Gy before surgery. There were 25 pneumonectomies (20.2%). The overall postoperative mortality was 9 of 124 patients (7.3%), and complications developed in 54 patients (43.5%). Multivariate analysis demonstrated that only thoracic radiotherapy of more than 45 Gy predicted postoperative complications (P = 0.021; odds ratio, 3.620; 95% confidence interval, 1.214-10.797). CONCLUSIONS: Thoracic radiotherapy of more than 45 Gy, in combination with chemotherapy, was a significant risk factor for postoperative complications.

Adult↗
PubMed1977

[Postoperative complications following pulmonary surgery (author's transl)].

Postoperative complications occurring in a series of 177 patients undergoing lung surgery are discussed in detail according to their pathogenesis. In all, 68 serious complications were observed in 54 patients (30.5 per cent). 9 patients died as a result of these complications (letality rate of 5.1 per cent).

Adult↗
PubMed2003

Intraoperative and postoperative complications of Cionni endocapsular ring implantation.

PURPOSE: To analyze the intraoperative and postoperative complications of Cionni ring implantation in eyes with a subluxated lens or zonular weakness. SETTING: Departamento de Oftalmología, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain. METHODS: This case series comprised 7 eyes of 5 patients with a subluxated lens or zonular weakness secondary to Marfan's syndrome (n = 2), traumatic cataract (n = 2), or megalocornea (n = 1) or of unknown etiology (n = 2). An AcrySof (Alcon) foldable intraocular lens (IOL) was implanted in all eyes. A 2-eyelet Cionni ring was implanted in 1 eye and a 1-eyelet Cionni ring, in 6 eyes. The Cionni ring was secured in position with a transscleral suture knotted to the ring's hook, avoiding peripheral perforation of the capsular bag. RESULTS: In 1 eye, corectopia was inadvertently produced by passing the suture needle through the iris root; lens subluxation temporarily increased during ring rotation and implantation. However, after the transscleral suture was tightened, capsular bag centration was excellent. In the eye with megalocornea, traction from the 2 hooks tore the edge of the anterior capsule rim. The most frequent postoperative complication was posterior capsule opacification, which occurred in 5 eyes, 2 of which required a neodymium:YAG posterior capsulotomy. After 1 year, the Cionni ring continued to provide excellent stability and capsular bag and IOL positioning in all cases. CONCLUSIONS: Results indicate that Cionni ring implantation is an acceptable procedure to correct limited lens subluxation, preserves the capsular bag, and has few significant complications.

Acrylic Resins↗
PubMed2001

[Postoperative complications--what is often? What is rare?].

The postoperative course after major (elective) digestive surgical procedures was prospectively analysed in 5693 patients. Postoperative complications were documented in 553 patients (9.7%). There were general complications (not related to surgery) in 97 patients (17.5%) and surgical complications (related to surgery) in 456 patients (82.5%). The most frequent surgical complication was abdominal sepsis in 72.1% followed by postoperative bleeding (17.1%) and others (10.7%). The leading cause for abdominal sepsis was anastomotic leakage in 207 patients (70.2%). Bedside diagnostic procedures like sonography, analysis of fluid drainage and endoscopy could identify the underlying problem of abdominal sepsis in 60.9% of cases. The mortality rate of all studied patients was (113/5693 patients) 1.9%.

Critical Care↗
PubMed2001

Outcome of and postoperative complications in dogs undergoing surgical treatment of laryngeal paralysis: 140 cases (1985-1998).

OBJECTIVE: To compare outcomes of various surgical techniques for treatment of laryngeal paralysis in dogs and determine incidence and risk factors for development of postoperative complications. DESIGN: Retrospective study. ANIMALS: 140 dogs undergoing surgical treatment for laryngeal paralysis at a veterinary teaching hospital between 1985 and 1998. PROCEDURE: Data were analyzed to determine outcome and factors influencing outcome and development of complications. Kaplan-Meier curves were constructed for survival analysis. RESULTS: Postoperative complications were documented in 48 (34.3%) dogs; 20 (14.3%) dogs died of related causes. Aspiration pneumonia was the most common complication (33; 23.6%). Seven dogs died of aspiration pneumonia > 1 year after surgery. Dogs that underwent bilateral arytenoid lateralization were significantly more likely to develop complications and significantly less likely to survive than were dogs that underwent unilateral arytenoid lateralization or partial laryngectomy. Factors that were significantly associated with a higher risk of dying or of developing complications included age, temporary tracheostomy placement, concurrent respiratory tract abnormalities, concurrent esophageal disease, postoperative megaesophagus, concurrent neoplastic disease, and concurrent neurologic disease. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that surgical repair of laryngeal paralysis may be associated with high postoperative complication and mortality rates. Surgical technique and concurrent problems or diseases increased the risk of complications. Dogs appeared to have a life-long risk of developing respiratory tract complications following surgical correction.

Age Factors↗
PubMed2006

Total intravenous anaesthesia with propofol and remifentanil for elective neurosurgical procedures: an audit of early postoperative complications.

BACKGROUND AND OBJECTIVES: This was a prospective audit to assess the incidence and characteristics of early postoperative complications in the recovery room in extubated patients after elective neurosurgical procedures using propofol and remifentanil-based total intravenous anaesthesia. METHODS: Vital signs (temperature, conscious level, respiratory rate, oxygen saturation, pulse and blood pressure) and postoperative complications (shivering, nausea, vomiting and cardiorespiratory) were analysed in 145 adult patients over a 1-yr period. RESULTS: The overall shivering, postoperative nausea and vomiting and postoperative hypertension (systolic blood pressure more than 25% of the preoperative value) incidences were 30.3%, 16.6% and 35.2%, respectively. Fifty-one percent of the patients had at least one of the above complications. The complication rates were found to be widely different among various types of neurosurgery. The surgical procedures were divided into five groups: supratentorial craniotomy, posterior fossa craniotomy, intracranial vascular procedures, transphenoidal hypophysectomy and extracranial procedures. Median extubation time was similar in all groups and patients were fully conscious with no hypoxia in the recovery room. The intracranial vascular group had the highest shivering and postoperative nausea and vomiting rates (58.8% and 29.4%, respectively). In the supratentorial craniotomy group, 46% of the patients had hypertension. The overall complication rate (presence of any complications) was highest in the supratentfial craniotomy (55.4%), posterior fossa craniotomy (75%) and intracranial vascular (76.5%) groups. Shivering and overall complication rate was significantly related to the anaesthetic time (P<or=0.001 and 0.02, respectively). CONCLUSIONS: Despite the potential advantages of total intravenous anaesthesia in titratability, rapid return of consciousness and reduced respiratory complications, making it suitable for planned extubation at the end of neurosurgery, the postoperative complications of shivering, postoperative nausea and vomiting and hypertension were still high.

Anesthesia, Intravenous↗
PubMed1985

[Possibility of predicting and preventing postoperative complications leading to relaparotomy].

The occurrence of relaparotomies is known to be 1,2% of operations on the abdomen organs. Pyo-inflammatory complications are responsible for more than half cases resulting in relaparotomies. Relaparotomies are divided into emergent and urgent, radical and palliative. A system for prognosis of complications and differential diagnosis of postoperative paresis of the gastro-intestinal tract and postoperative peritonitis is presented. Prophylactics of postoperative complications reduced lethality after relaparotomies from 79% to 56%.

Electrodiagnosis↗