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PubMed1998

[Complications in the treatment of angle class II division 1 malocclusion].

OBJECTIVE: This article describes a retrospective inventory of various categories of complications which occurred in a sample consecutively treated patients with Class II division 1 malocclusion. DESIGN: Retrospective, descriptive study. METHODS: Treatment was performed with a headgear-activator and a edgewise appliance. All patients originate from one orthodontic specialist office and were between 10 and 14 years of age during treatment. From the group of 600 patients 100 (n = 100) were randomly selected for the study. A standard form was used for the inventory of the complications. The complications were divided into 5 categories: dental, skeletal, functional, psychosocial and multiple (two or more complications). RESULTS: In the group of 100 patients no complications were found in 48 patients (48%); 52 patients showed complications (52%). From these 52 patients 29 showed one complication, 19 had 2 complications, 4 showed 3 complications. In total 79 complications occurred divided as follows: dental complications 23 (29.1%); skeletal complications 19 (24.1%); functional complications 15 (19.0%); psychosocial complications 22 (27.8%). CONCLUSION: Complications occur very frequently in the treatment of Angle Class II division 1 malocclusions. These complications may occur in various combinations and may compromise the treatment result in a variable way.

Adolescent↗
PubMed2004

[Male urethral stenosis: review of complications].

OBJECTIVES: To evaluate a historical series of urethral stenosis retrospectively. To study the urinary, genital and systemic complications. To study risk factors for the development of such complications and, based on them, identify groups of patients more susceptible to complications with the aim to establish prophylactic, therapeutic or follow-up actions. METHODS: We studied 175 male patients with urethral stenosis, which constitute the historical series of male urethral stenosis treated in the Hospital General Universitario in Alicante from 1977 to 1987 (11 years). Statistical treatment: clinical protocol for data collection. Codification of variables. Descriptive statistics for all variables. Percentage description of qualitative variables. Data processing by the basic SPSS + statistical software and the Harvard Graphics graphical software ran in an IBM PS/2 computer. The level of statistical significance for comparisons between variables was established in p < 0.05. RESULTS: 155/175 patients presented complications (88.57%). The number of complications overall was 795. Complication sites in order of frequency were: 628 (78.99%) urinary tract, 111 (13.96%) genital system, 44 (5.53%) systemic and 12 (1.50%) abdominal wall hernias. The most frequent complications were: acute urinary retention 100 patients, bladder obstructive uropathy 84, urinary tract infection 63, ejaculation disorders 50, stenosis recurrence 47, and 30 with various degrees of renal failure. Most complications were reversible after resolution of the stenosis, although 3 patients had non reversible deterioration of their renal function and 4 unilateral postobstructive renal atrophy 3 patients died as a consequence of such complications (two cases of septicemia and one postoperative pulmonary embolism. Prophylaxis is the best treatment for these complications, eradicating urinary tract infection if present, and treating stenosis itself. Nevertheless, the treatment of complications required 132 medical treatments, 16 suprapubic bladder punctions, 94 surgical treatments, 5 extracorporeal shock wave lithotripsies, 2 mechanical lithotripsies, and 1 hemodialysis in a patient with end stage renal disease (single kidney with ureteritis secondary to tuberculosis). Risk factors for the development of complications are among others: age > 70 years (retired), history of sexually transmitted diseases, urinary tract infection, previous urethral surgery for recurrent stenosis, and post void residual urine. CONCLUSIONS: Complications of urethral stenosis are very frequent in this series. Currently, in comparison with past times, these complications can be prevented, since its diagnostic is very simple by ultrasound. Many of these complications are reversible if obstruction and infection are corrected. Based on these results we have identified several groups of patients with higher risk of complications. Global studies of this issue are necessary, both national and international.

Adolescent↗
PubMedDate not supplied

Prosthetic complications with dental implants: from an up-to-8-year experience in private practice.

PURPOSE: Evaluation of prosthetic complication was performed on 236 patients treated with 528 implants in an 8-year private practice experience. MATERIALS AND METHODS: The study sample included 55 overdentures (ODs) and 265 fixed partial dentures (FPDs). Among the latter, 231 FPDs were cemented and 34 were screw-retained. The type and frequency of prosthetic incidents were recorded, including adjustments and complications. Statistical analysis was performed using a chi-square test to identify risk factors associated with complications. RESULTS AND DISCUSSION: Over this period, 1 abut ment fractured and 2 became loose, leading to a cumulative implant component success rate of 99.2%. Patients with removable prostheses had more complications than those with fixed ones, 66.0% versus 11.5%; the difference was significant (P < .001). Posterior fixed prostheses had more complications than anterior ones, 11.0% versus 0%; however, the difference was not significant (P = .16). The complication rates for cemented and screw-retained prostheses did not differ significantly (10.4% versus 5.9%; P = .61). Prostheses with an extension cantilever had more complications, 29.4% versus 7.9%; the difference was significant (P = .01). In the OD group, the ball-retained prostheses had a significantly higher rate of complications than the bar-retained ones (77.5% versus 42.9%; P = .04). In the FPD group, complications were not recurrent; most occurred during the first 2 years, and the rate of complications did not increase with time. In the OD group, 1.3 incidents per prosthesis were recorded. Incidents were often recurrent, and the rate of complications did not decrease with time. CONCLUSIONS: Removable and fixed prostheses were associated with complications at different frequencies and of different types. In the removable group, adjustments and foreseeable complications were numerous, recurrent, and usually easy to manage. Bar-retained prostheses had fewer complications than ball-retained ones. In the fixed group, complications were limited in number and did not increase with time. Complications were restricted to the posterior region.

Adolescent↗
PubMed1998

[Peripheral arterial complications after heart catheterization].

After diagnostic and interventional cardiac catheterization, local vascular complications at the arterial entry site must be expected. With respect to the method applied for catheterization and the puncture site, the type of complications may vary. With transfemoral approach a large variety of vascular complications have to be feared, mostly in the form of bleeding complications and hematomas, arterial dissections or occlusions, pseudoaneurysms and AV-fistulas. Each of these complications may have the potential for serious morbidity. When cardiac catheterization is performed via the arteries of the arm (either in the classical Sones technique by arterial cutdown to the brachial artery or by direct puncture of the brachial or radial artery) vascular occlusions will mostly occur as local vascular complications. These occlusions can often be managed conservatively or by a surgical procedure. The incidence of a vascular complication is mainly dependent on patient-related (sex, age, height, weight, arterial hypertension, diabetes, presence of peripheral vascular disease and compliance of the patient after withdrawal of the sheath) and procedure-related (arterial access site, diagnostic or interventional study, sheath size, periprocedural anticoagulation, duration of intra-arterial sheath placement, faulty puncture technique, operator skill) factors. In addition, the definition of a complication, the publication year of a certain study and the technique used for identification of complications seem to play a role for the reported incidence of peripheral vascular complications after cardiac catheterization. Currently, incidences of 0.1 to 2% for significant local vascular complications after diagnostic transfemoral catheterization are reported, after interventional transfemoral treatment 0.5 to 5% and after complex procedures using large sheath sizes with periprocedural anticoagulation (directional atherectomy, IABP, left-heart assist, valvuloplasty) up to 14%. Following transbrachial and transradial catheterization, local vascular complications at the entry site amount to 1 to 3% after diagnostic and 1 to 5% after interventional procedures. Local vascular complications may be diminished by a cautious and sensitive puncture technique with additional care in patients at higher risk for vascular complications (females, prediagnosed peripheral vascular disease, mandatory anticoagulation, necessity for large sheaths). By using smaller sized catheters and an adequate, defensive anticoagulation regimen, the rate of arterial access site complications may be reduced. Proper methods for achievement of hemostasis as well as a close and careful observation after sheath withdrawal are required.

Angioplasty, Balloon, Coronary↗
PubMed2003

Complication rates and patency of radiologically guided mushroom gastrostomy, balloon gastrostomy, and gastrojejunostomy: a review of 250 procedures.

PURPOSE: To compare complication rates and tube performance of percutaneous mushroom gastrostomy, balloon gastrostomy, and gastrojejunostomy. METHODS: Between September 9, 1999 and April 23, 2001, 203 patients underwent 250 radiologically guided percutaneous gastrostomy and gastrojejunostomy procedures. Follow-up was conducted through chart reviews and review of our interventional radiology database. Procedural and catheter-related complications were recorded. Chi-square statistical analysis was performed. RESULTS: In patients receiving mushroom-retained gastrostomy catheters (n = 114), the major complication rate was 0.88% (n = 1), the minor complication rate was 5.3% (n = 6), and the tube complication rate was 4.4% (n = 5). In patients receiving balloon-retained gastrostomy tubes (n = 67), the major complication rate was 0, the minor complication rate was 4.5% (n = 3), and the tube complication rate was 34.3% (n = 23). In patients receiving gastrojejunostomy catheters (n = 69), the major complication rate was 1.4% (n = 1), the minor complication rate was 2.9% (n = 2), and the tube complication rate was 34.8% (n = 24). No statistically significant differences were found between procedural or peri-procedural complications among the different types of tubes. Mushroom-retained catheters had significantly fewer tube complications (p < 0.01). CONCLUSIONS: Percutaneous gastrostomy and gastrojejunostomy have similar procedural and peri-procedural complication rates. Mushroom gastrostomy catheters have fewer tube-related complications compared with balloon gastrostomy and gastrojejunostomy catheters. In addition, mushroom-retained catheters exhibit the best overall long-term tube patency and are therefore the gastrostomy catheter of choice.

Aged↗
PubMed2003

Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group.

The reported complication rates after various surgical techniques used to create a lumbar fusion vary within wide ranges. In a previous paper, the Swedish Lumbar Spine Study Group have reported on the clinical outcome of lumbar spine fusion for chronic low back pain in a comparably homogeneous patient population where there were no significant differences between baseline sociodemographic, clinical and paraclinical characteristics. In this report we compared the complication rates of the surgical procedures used in that study and analyzed the association between complications and baseline variables, and between outcome results and complications. A multicenter randomized study was conducted where 211 patients aged 25-65 were treated with lumbar fusion according to three different surgical techniques: noninstrumented posterolateral fusion (PLF, n=71), instrumented posterolateral fusion (VSP, n=68), and in the third procedure we added an interbody fusion with solid autogenous bone grafts ("360", n=72). We categorized complications as: early/late, major/minor. The association between complications and sociodemographic characteristics (age, gender, comorbidity, previous surgery, smoking), and technical variables (surgical technique, levels fused, hospital category) was analyzed. The association between outcome variables (patient global assessment, pain, disability, depressive symptoms) and complications was analyzed. A literature review was conducted. There was no mortality. There was no significant difference in clinical outcome between the surgical groups after 2 years, although the power to detect such a difference was low. The total complication rate after 2 years in the PLF group was 12%, compared with 22% in the VSP group, and 40% in the "360" group (P=0.0003). After exclusion of complications, there was still no difference in outcome between the groups. The odds ratio (confidence intervals) of having a complication was 5.3 (2.2-12.7) when "360" was used compared with PLF, and 2.4 (1.1-5.3) for "360" compared with VSP. There was no association between clinical outcome and complications on a group level. The reintervention rate was 6% in the PLF group, 22% in the VSP, and 17% in the "360" group (P=0.020). The odds ratio (confidence intervals) of having a reintervention was 4.0 (1.3-11.9) when instrumentation was used compared with non-instrumented fusion. In this prospective randomized study comparing three lumbar fusion techniques in a comparably homogeneous patient population, complications increased significantly with increasing technicality of the surgical procedure. Even though we did not find a significant association between clinical outcome and complications after 2 years, the increased morbidity inflicted on an individual patient was not negligible. In this light, and as no fusion technique produced superior clinical outcome irrespective of whether complications were included or excluded in the analyses, the patient and the treating physician should carefully discuss the possible advantages and drawbacks of the different surgical options before making a decision. In order to make valid comparisons of both complication and reintervention rates after lumbar fusion, there is a need for a consensus in the spinal society regarding the definition of these entities.

Adult↗
PubMed2004

[Intraoperative and early postoperative complications of lumbar and lumbosacral fusion: prospective analysis of 872 patients].

PURPOSE OF THE STUDY: Incidence of complications following lumbar or lumbosacral fusion is still an imprecise notion. The aim of this prospective observational study was to determine the frequency of intraoperative and early postoperative complications after this procedure and to analyze favoring factors. MATERIAL AND METHODS: Twenty-one orthopedic units participated in this study which included 872 patients who underwent lumbar or lumbosacral fusion procedures involving the sector limited by L1 and S1. A minimum of 6 months follow-up was required for inclusion. Four types of complications were studied: general complications, infection, neurological and meningeal complications, mechanical problems. The following preoperative and intraoperative parameters were recorded: epidemiological and morphological data, history of lumbar spine surgery, comorbid conditions, indication for surgery, and technical aspects of the fusion. Two types of analysis were performed. The first was a descriptive analysis designed to determined the overall incidence of complications and the incidence of each type of complication. A multivariate analysis was then performed in order to determine factors influencing occurrence of complications. RESULTS: Mean follow-up was 13 months, mean age of the cohort was 51 +/- 15.5 years. Prior lumbar surgery was noted in 12% of the patients. A decompression procedure was associated in 40% of the patients due to lumbar stenosis. Posterolateral arthrodesis was used in 71% of the patients and 91% were instrumented. Most of the fusions were short, involving one or two levels. One or more intraoperative or early postoperative complications were observed in 200 patients (23%). The incidences of the four types of complications expressed in percent of the total cohort were 9.7%, 5.6%, 8.6%, and 3.6% for general, infectious, neurological and meningeal, and mechanical complications respectively. Three factors exhibited a significant correlation with occurrence of complications, irrespective of the type: excess weight, presence of several comorbid conditions, and extent of the zone of fusion. CONCLUSION: This study enabled a precise assessment of the incidence of complications subsequent to lumbar or lumbosacral fusion: 23%. The incidence of serious complications requiring a reoperation was 14.7%. This finding, together with the factors found to influence occurrence of these complications should be kept in mind when determining indications for lumbar or lumbosacral fusion.

Adult↗
PubMed2005

[Complications of surgical treatment of spinal deformities: a prospective multicentric study of 3311 patients].

PURPOSE OF THE STUDY: The incidence of complications secondary to surgical treatment of spinal deformations remains imprecise. The purpose of this prospective multicentric observational study was to assess the incidence of intra- and postoperative complications secondary to this type of surgery to detail the observed complications and to identify favoring factors. MATERIAL AND METHODS: For this study, we included 3311 patients who underwent surgery during a 12-month period for spinal deformation, defined as idiopathic or secondary scoliosis or kyphosis, irrespective of the localization, severity, or type of surgery performed. Four main categories of complications were studied: general, infectious, neurological, and mechanical. Pre- and intraoperative variables recorded were: epidemiological and morphological data, history of surgery for the same spinal deformation, comorbid conditions, type of deformation treated (nature, anatomic localization, severity, reducibility), type of surgery performed (approach, duration of the operation), operative blood loss, extent and localization of the fusion, associated neurological release, vertebral osteotomy or not, type of graft used. Two types of analysis were performed. The first was a descriptive analysis to detail the overall incidence of complications and the incidence of each of the four main categories. The second was a multivariate analysis designed to determine factors significantly associated with complication occurrence. RESULTS: Mean age of the cohort was 27 +/- 18 years; 6.8% of the patients had had a prior operation for the spinal deformation. The deformation was scoliosis in 90% (mean angle 56 +/- 20 degrees) and kyphosis in 10% (mean angle 47 +/- 23 degrees). An isolated posterior approach was used for 72.5% of patients, an isolated anterior approach for 6.4%, and a combined anteroposterior approach for 21.1%. Seven hundred four patients (21.3%) had one or more complications (850 complications) during or shortly after their operation. The incidences of general, infectious, mechanical and neurological complications were: 5.7%, 4.7%, 11.5%, and 1.8% respectively. Globally, considering all types of complications, the following factors were found to be significantly associated with complication occurrence: patient age, ASA score, extent of the fusion, presence of vertebral osteotomy, inclusion of the sacrum in the arthrodesis, and initial angle of the treated deformation. For patients with scoliosis, the following factors were significantly associated with a secondary central neurological disorder: initial angle of the deformation, use of vertebral osteotomy, type of curvature with greater risk for thoracic curvatures and double thoracic and lumbar curvatures. CONCLUSION: This work enabled us to determine the overall rate of complications after surgical treatment of spinal deformations. Certain risk factors related with complication occurrence were identified, but the heterogeneous nature of the population and the methodology used to identify these factors only allowed detection of trends. A future study by etiological group or focusing on specific complications should allow a more precise analysis of these risk factors. This overall rate of complications should be used to better inform patients and their family about the risks of this type of surgery.

Adolescent↗
PubMed2003

Variation in postoperative complication rates after high-risk surgery in the United States.

OBJECTIVE: Our goal was to characterize variation in complication rates across hospitals with differing volumes for select high-risk operations in the United States. METHODS: Data from the Nationwide Inpatient Sample for 1996 and 1997 were analyzed for 3 high-risk operations: esophagectomy (n=1,226), pancreatectomy (n=4,789), and intact abdominal aortic aneurysm repair (n=11,863). Complications evaluated included aspiration, cardiac complications, infection, pneumonia, pulmonary failure, renal failure, septicemia, and others. The risk of complications was calculated by hospital volume deciles, as well as for high-volume hospitals (HVH) and low-volume hospitals (LVH) defined by median hospital volume. RESULTS: Rates of any postoperative complication varied nearly 2-fold across hospital volume groups. The proportion of patients across hospital deciles having at least one complication ranged from 30% to 51% for esophageal resection, 6% to 12% for pancreatic resection, and 9% to 18% for abdominal aortic aneurysm repair. HVH had lower rates of one or more complications after pancreatic resection (OR, 0.71; 95% CI, 0.57 to 0.83; P=.002), esophageal resection (OR, 0.68; 95% CI, 0.52 to 0.90; P=.008), and intact abdominal aortic aneurysm (AAA) repair (OR, 0.67; 95% CI, 0.59 to 0.76; P<.001). Patients with one or more complications after pancreatic resection had a mortality of 18.8% versus only 5.2% for those without complications (P<.001). Esophageal resection mortality was 16.9% for patients with at least one complication and 2.5% for those without complications (P<.001) and AAA repair mortality was 10.4% for patients with at least one complication and 2.9% for those without complications (P<.001). CONCLUSIONS: High-risk operations have a decreased rate of postoperative complications when performed at HVH. Variation in complication rates may contribute to the volume-outcome relationship and provide a focus for quality improvement at LVH.

Aged↗
PubMed2002

Complications associated with arthroscopic shoulder surgery.

We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two decades. As with all interventions complications can occur which require recognition and management by the orthopedic surgeon. While the literature is helpful with identifying types of complications, establishing the rate of these complications remains elusive. These complications can be divided into general complications, complications generic to all shoulder procedures, and complications specific to the type of procedure performed. General complications such as infection and anesthesia problems continue to show low incidences. Shoulder arthroscopy presents increased risk of complications over knee arthroscopy in regard to vascular and neurologic injury, fluid extravasation, stiffness, iatrogenic tendon injury, and equipment failure. New techniques of increased complexity for subacromial surgery, rotator cuff repair, and arthroscopic instability present new problems related to implant failure, nerve injury, iatrogenic fracture, and capsular necrosis. While the rate of complications especially with newer procedures remain elusive, most studies suggest that the rate is low, 5.8-9.5% in all recent review studies published. Underreporting complications makes assessment of incidence rates of complication difficult. Proper patient selection, attention to operative detail, and careful post-operative monitoring can minimize the morbidity associated with these complications.

Arthroscopy↗
PubMed2002

Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation.

Hepatic artery thrombosis (HAT) and other vascular complications are significant causes of morbidity after liver transplantation. Although cigarette smoking increases the risk of vascular complications after renal transplantation, its impact after liver transplantation remains unknown. Between May 1995 and April 2001, 288 liver transplantations were performed in 263 patients. Vascular complications developed in 39 patients (13.5%) (arterial complications, 28 patients [9.7%]; venous complications, 11 patients [3.8%]). Patient demographics, comorbid illnesses, and risk factors were analyzed using the Mann-Whitney U test, Chi-squared test, and Fisher's exact test. In patients with a history of cigarette smoking, incidence of vascular complications was higher than in those without history of cigarette smoking (17.8% v 8%, P =.02). Having quit cigarette smoking 2 years before liver transplantation reduced the incidence of vascular complications by 58.6% (24.4% v 11.8%, P =.04). The incidence of arterial complications was also higher in patients with a history of cigarette smoking compared with those without such history (13.5% v 4.8%, P =.015). Cigarette smoking cessation for 2 years also reduced the risk of arterial complications by 77.6% (21.8% v 5.9%, P =.005). However, the incidence of venous complications was not associated with cigarette smoking. Furthermore, there was no significant association between development of vascular complications and all other characteristics studied. Cigarette smoking is associated with a higher risk for developing vascular complications, especially arterial complications after liver transplantation. Cigarette smoking cessation at least 2 years before liver transplantation can significantly reduce the risk for vascular complications. Cigarette smoking cessation should be an essential requirement for liver transplantation candidates to decrease the morbidity arising from vascular complication after liver transplantation.

Comorbidity↗
PubMed2005

Changes in prognosis after the first postoperative complication.

BACKGROUND: Postoperative complications are common in the Medicare population, yet no study has formally quantified the change in prognosis that occurs after a broad range of first complications. OBJECTIVE: We sought to estimate the relative severity of 24 first postoperative complications. RESEARCH DESIGN: We undertook a multivariate matched, population-based, case-control study of death after surgery in a sample of 1362 Pennsylvania Medicare patients. SUBJECTS: Cases (681 deaths) were selected randomly using claims from 1995-1996. Models were developed to scan all Pennsylvania claims, looking for similar controls that did not die. MEASURES: Charts were abstracted, complications identified, and models were constructed to estimate the odds of dying after any 1 of 24 first postoperative complications. RESULTS: The odds of dying within 60 days increased 3.4-fold (95% confidence interval [CI] 2.5-4.7) in patients with complications as compared with those without complications. A first complication of respiratory compromise was associated with a 7.2-fold increase in the odds of dying (95% CI 4.5-11.6). The first complications of pneumonia or congestive heart failure were associated with, respectively, 5-fold (95% CI 2.1-12.1) and 5.1-fold (2.3-11.1) increases in odds of dying as compared with no complication. CONCLUSIONS: First complications after surgery, even seemingly mild ones, may radically alter the patient's risk of death. First complications often begin the cascade of complications that end in death. Caregivers should consider the first complication as a timely signal of a changed clinical situation demanding a reevaluation of the patient's care. Researchers may use these estimates to determine the relative severity of a broad range of first or early complications.

Aged↗
PubMed2002

Cerebrospinal fluid shunt complications after urological procedures in children with myelodysplasia.

OBJECTIVE: Invasive urological procedures, commonly performed on patients with myelodysplasia, may contribute to the occurrence of cerebrospinal fluid shunt complications. Shunt complications that occurred after urological procedures in children with myelodysplasia were studied. METHODS: Shunt complications occurring after urological procedures were examined in 29 patients. Differences between patients with or without complications were studied. Complications were analyzed according to the location of abnormality, the treatment, and the timing after shunt and urological surgery. RESULTS: The 1-year incidence of shunt complications after a urological procedure had been performed was 31% (overall incidence, 41.4%). Shunt complications were observed only after intraperitoneal urological procedures. Most complications were distal, occurring more than 1 year after the preceding shunt surgery. The patients in the shunt complications group had significantly more intraperitoneal urological procedures (3.2 versus 0.8, P = 0.004) and previous shunt revisions (2.0 versus 0.9, P = 0.015) than had the group without complications. As compared with the group of patients with extraperitoneal complications, the intraperitoneal group experienced significantly more infections (4 of 9 versus 0 of 10, P = 0.014) requiring more complex treatment, and their complications occurred significantly earlier in the follow-up period after the urological procedure had been performed (7.2 versus 27.3 mo, P = 0.006). The patients in the group with extraperitoneal complications experienced significantly more mechanical shunt malfunctions than did the intraperitoneal group (9 of 10 versus 4 of 9, P = 0.016), which required simple shunt revisions. CONCLUSION: Patients with spina bifida and shunted hydrocephalus may have an increased risk of developing intraperitoneal shunt complications after intraperitoneal urological procedures have been performed. These intraperitoneal shunt complications usually occur a few months after urological surgery and require complex treatment.

Adolescent↗
PubMed2006

Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee.

STUDY DESIGN: The Morbidity and Mortality database of the Scoliosis Research Society (SRS) was queried as to the incidence and type of complications as reported by its members for the treatment of adolescent idiopathic scoliosis (AIS) with spinal fusion and instrumentation procedures regarding surgical approach (anterior, posterior, or combined anterior-posterior) during a recent 3-year period. OBJECTIVE: To evaluate the incidence of surgeon-reported complications in a large series of spinal fusions with instrumentation for a single spinal deformity diagnosis and age group regarding surgical approach. SUMMARY OF BACKGROUND DATA: The SRS has been collecting morbidity and mortality data from its members since its formation in 1965 with the intent of using these data to assess the complications and adverse outcomes (death and/or spinal cord injury) of surgical treatment for spinal deformity. Surgical approaches to the management of treatment of AIS have a measurable impact on efficacy of correction, levels fused, and operative morbidity. However, there is a lack of consensus on the choice of surgical approach for the treatment of spinal deformity. METHODS: Of the 58,197 surgical cases submitted by members of the SRS in the years 2001, 2002, and 2003, 10.9% were identified as having had anterior, posterior, or combined spinal fusion with instrumentation for the diagnosis of AIS, and comprised the study cohort. All reported complications were tabulated and totaled for each of the 3 types of procedures, and statistical analysis was conducted. RESULTS: Complications were reported in 5.7% of the 6334 patients in this series. Of the 1164 patients who underwent anterior fusion and instrumentation, 5.2% had complications, of the 4369 who underwent posterior instrumentation and fusion, 5.1% had complications, and of the 801 who underwent combined instrumentation and fusion, 10.2% had complications. There were 2 patients (0.03%) who died of their complications. There was no statistical difference in overall complication rates between anterior and posterior procedures. However, the difference in complication rates between anterior or posterior procedures compared to combined procedures was highly significant (P < 0.0001). The differences in neurologic complication rates between combined and anterior procedures, as well as combined and posterior procedures were also highly statistically significant (P < 0.0001), but not between anterior and posterior procedures. CONCLUSIONS: This study shows that complication rates are similar for anterior versus posterior approaches to AIS deformity correction. Combined anterior and posterior instrumentation and fusion has double the complication rate of either anterior or posterior instrumentation and fusion alone. Combined anterior and posterior instrumentation and fusion also has a significantly higher rate of neurologic complications than anterior or posterior instrumentation and fusion alone.

Adolescent↗
PubMed2003

[Early complications in surgical treatment of thyroid diseases: analysis of 2100 patients].

Thyroid gland surgery today is not saddled with high incidence of main complications. Miscellaneous surgical institutions with different surgical approach, operative technique and radicality have published reports with great discrepancy in incidence of complications, analyzing them with different methods of diagnosis and result evaluation. In the same way it is well known that higher latitude of operative procedure gave better control of thyroid diseases, but it can be accompanied with more complications. All of that motivate us to analyze complications of operative treatment in our patients under well known criteria, with hypothesis that higher radicality of operative procedure do not increase incidence of complications, and that this incidence is in correlations with results published in world literature. Aim of this nonrandomized study was to analyze results of operative treatment for huge number of consecutively operated patients in our teaching hospital, to analyze and compare results according to group of diseases and operative procedures, and to compare final results with results published in the world literature. Complications of operative treatment were analyzed retrospectively for period 1988-1997 (Group I) and prospectively in period 1998-2002 (Group II). Operations were performed by 20 surgeons and 20 young surgeons during their education. We have analyzed only complications during first 30 days after operation. In Group I there was 1425 patients with 1451 operations (192 thyroid malignancies, 247 hyperthyreosis, 98 reoperations, 13% thyroidectomies and 14.8% lobectomies), with complication rate of 14.3%. Most common complication was recurrent laryngeal nerve injury in 9.3% patients or 6.3% according to number of exposed nerves (nerve at risk), then postoperative hypocalcemia with rate of 4.7% (persistent in 1.3%). In Group II in 675 patients there was 687 operations (96 thyroid malignancies, 111 hyperthyreosis, 35 reoperations, 36.6% thyreoidectomies and 25% lobectomies), with complication rate of 10.7%. Most common postoperative complication was hypocalcemia with 5% rate (persistent in 0.7%), then recurrent laryngeal nerve injury in 4.4% patients or 2.9% according to number of exposed nerves. Incidence of recurrent laryngeal nerve injury in Group II is less frequent than in Group I, highly statistically significant (p < 0.01), while for other complications there is no statistically significant difference. Totally for both groups there was 0.7% tracheotomies, postoperative bleeding in 1.1% of patients, wound hemathoma in 0.5%. wound infections in 0.9%, pneumonia in 0.5%, mortality 0.5% and most common cause of death (8/11) was problem with respiration, Airway obstruction. In Group II complications were less frequent in total thyroidectomies in relation to lobectomy with contra lateral subtotal lobectomy. In both groups and totally incidence of complications was higher in reoperations, in patients with more extensive operative procedure, in malignant diseases and hyperthyreosis. In thyroid gland surgery more extensive operative treatment with improved operative technique (micro dissection, recurrent laryngeal nerve visualization and parathyroid gland preservation), in our teaching hospital, do not have influence on incidence of postoperative complications, even recurrent laryngeal nerve injury was significantly less frequent. This results are in correlation with published results of similar hospitals around the world.

Adolescent↗
PubMedDate not supplied

Smoking and complications of onlay bone grafts and sinus lift operations.

PURPOSE: To compare the incidence of complications related to onlay bone grafts (OBGs) and sinus lift operations (SLOs) among smokers and nonsmokers. MATERIALS AND METHODS: Data from 143 operations performed during the years 1995 to 2003 were analyzed. There were 64 OBGs and 79 SLOs. Patients were divided into 3 groups: nonsmokers, mild smokers (up to 10 cigarettes per day), and heavy smokers (more than 10 cigarettes per day). Duration of smoking (less or more than 10 years) was recorded. OBG complications were classified as minor (hematoma, swelling, inflammation, or temporary paresthesia) or major (graft exposure or mobility). For the SLO, perforations of the schneiderian membrane were the main intraoperative complication; postoperative complications mostly consisted of swelling, acute or chronic sinus infection, or bleeding. RESULTS: Of smokers having OBG, 50% experienced complications, compared to 23.1% of nonsmokers. Major complications were observed in one third of the smokers, compared to only 7.7% in nonsmokers. There was also a tendency toward complications in former smokers, although this relationship was not statistically significant. There was no relationship between SLO complications and smoking or a past smoking habit. DISCUSSION: In the present study, smokers demonstrated significantly higher postoperative complications following OBG operations. Smoking did not influence the results in the SLO group. There was no statistically significant difference between complications and past smoking. This finding indicates that the risk of complications can be reduced up to the normal nonsmoker complication rate when smoking ceases. CONCLUSIONS: This study established a relationship between OBG complications and smoking in this patient population. A higher incidence of complications was found in the smoking group. There was no significant influence of smoking on SLO complications.

Analysis of Variance↗
PubMedDate not supplied

Fatal and non-fatal complications after surgical resection for gastric cancer.

BACKGROUND/AIMS: We divided overall complications after surgical resection for gastric cancer into fatal and non-fatal, and examined them in view of risk factors. Next we examined the meaning of dividing complications into two groups. METHODOLOGY: Records of 331 patients who underwent gastrectomies for cancer between 1992 and 2003 were used. Any postoperative overall complications were divided into fatal and non-fatal according to the association with mortality. RESULTS: Leakage and respiratory complication were defined as fatal complications. Tumor size (cm) (OR=1.14, 95% CI 1.05-1.25, p=0.003) and patient age (OR=1.06, 95% CI 1.06-1.10, p=0.007) were shown to be risk factors for fatal complications. Total gastrectomy (vs. distal gastrectomy) was a risk factor for non-fatal complications (OR= 1.63, 95% CI 0.99-2.7, p=0.05). Extended lymphadenectomy was a further possible risk factor for non-fatal complications (OR=1.71, 95% CI 0.98-3.0, p=0.06). On the other hand, intra-operative blood loss (mL) was only a risk factor for overall complications (OR=1.001, 95% CI 1.0-1.001, p=0.009). CONCLUSIONS: Independent risk factors for fatal complications and those for non-fatal complications did not include that for overall complications. To divide overall complications into fatal or non-fatal was useful for finding the real reason for complications. We could not prepare preventive measures for complications until analyzing the divided groups.

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PubMed1996

Complications of care in a pediatric intensive care unit: a prospective study.

OBJECTIVES: (a) To examine the frequency, type, and severity of complications occurring in a pediatric intensive care unit; (b) to identify populations at risk; and (c) to study the impact of complications on morbidity and mortality. DESIGN: Prospective survey. SETTING: Pediatric intensive care unit (PICU) of a university-affiliated hospital. PATIENTS: 1035 consecutive admissions over an 18-month period. RESULTS: 115 complications occurred during 83 (8.0%) admissions, for 2.7 complications per 100 PICU-days; 48 (42%) complications were major, 45 (39%) moderate, and 22 (19%) minor. Sixty complications (52%) were ventilator-related, 14 were drug-related, 13 procedure-related, 24 infectious, and 22 involved invasive devices (18 vascular catheters). Human error was involved in 41 (36%) cases, 21 of which were major (18%). Treatments included reintubation < 24 h (28), intravenous antimicrobials (24), and invasive bedside procedures (14). Cardiopulmonary resuscitation was required in 6 patients. Thirteen patients with complications died (15.7%); 2 deaths were directly due to complications. Patients with complications were younger, had longer lengths of stay, and had a higher mortality. Length of stay was a positive risk factor for complication risk (odds ratio = 1.09, 95% confidence interval: 1.05 to 1.13; p = 0.0001); other patient characteristics had no predictive effect. Kaplan-Meier estimates showed that the most severe complications occurred early in the PICU stay. The best indicators of patient mortality were number of complications (odds ratio = 2.96, 95% confidence interval 1.72 to 5.08; p = 0.0001), and mortality risk derived from the Pediatric Risk of Mortality Score (odds ratio = 1.08, 95% confidence interval 1.06 to 1.10; p = 0.0001). Mortality was correlated with increasing severity of complications. CONCLUSION: Complications have a significant impact on patient care. Patients may be at increased risk earlier in their PICU course, when the number of interventions may be greatest. Complications may increase patient mortality and predict patient death better than other patient variables.

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