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PubMed1988

Complications from large field intermediate dose infradiaphragmatic radiation: an analysis of the patterns of care outcome studies for Hodgkin's disease and seminoma.

There are only infrequent complications from intermediate dose infradiaphragmatic radiation to the para-aortics or para-aortic and iliac nodal regions as given in Hodgkin's disease or seminoma. Nonetheless, such complications can cause significant debility and may be lifelong. Treatment related factors associated with such complications should be identified and where possible, avoided. We have analyzed the records of 1,026 patients treated nationwide in the Patterns of Care Outcome. Studies including the Hodgkin's national practice survey (387 patients), Hodgkin's large facility survey (253 patients), and Seminoma national practice survey (386 patients). There were 883 patients who received infradiaphragmatic radiation to the para-aortics or para-aortic and iliac regions. Complications which occurred in these patients included gastrointestinal injury, hepatitis, nephritis, gonadal injury, hematopoietic injury, second malignancy, and miscellaneous others. There were 139 complications of any severity and 35 major complications requiring hospitalization for management. The 3-year actuarial complication rates were 14% and 4% for any and major complications, respectively. There was a statistically significant increase in both any complications and major complications with dose (p less than .01). The most frequent complications were those related to gastrointestinal injury such as peptic ulceration, hemorrhage, chronic diarrhea, and intestinal obstruction. Major bowel complications comprised 60% (21/35) of major complications and increased with dose from 1% for doses less than 3,500 cGy to 3% for doses greater than or equal to 3,500 cGy (p = .03). This study indicates that total dose is an important factor in determining complications, particularly gastrointestinal injury, in patients receiving infradiaphragmatic radiation in Hodgkin's disease and seminoma and that prior G.I. disease is associated with an increased risk of radiation related bowel complication. The radiotherapist should seek to optimize the therapeutic ratio in these diseases where gross disease can be controlled with 3500 cGy or less with few exceptions.

Diaphragm↗

PubMed1999

Late retinal complications of radiation therapy for nasal and paranasal malignancies: relationship between irradiated-dose area and severity.

PURPOSE: Radiation-induced cataract, once a notorious ocular complication of radiation therapy, is no longer considered a severe complication, because visual acuity can be restored by surgical treatment without significant complications. Late retinal complications of retinopathy and glaucoma, for which there is no effective method of treatment, have become serious complications of radiotherapy of the head and neck. We retrospectively investigated the risk of late retinal complications of radiotherapy for nasal and paranasal malignancies according to the radiation dose and area of the retina irradiated. METHODS AND MATERIALS: Between October 1982 and May 1996, 43 eyes of 25 patients were exposed to fractionated external-beam irradiation for treatment of advanced nasal and paranasal cancer. None of the patients had tumor invasion into the eyes. The patients were followed ophthalmologically for a minimum of 2 years (range 2.0-11, mean 4.5, median 3.3). The radiation dose and area of the retina irradiated were estimated from the dose distribution figures calculated using the portal films and CT scan. RESULTS: Major late adverse effects of radiotherapy were observed in the retina in 9 of 43 eyes (in 8/25 patients). Radiation retinopathy was observed in 7 eyes, and the cumulative incidence was 25%. The median interval before the onset of symptoms attributable to retinopathy was 32 months (range 16-60). Neovascular glaucoma developed in 3 of the 43 eyes, with a cumulative incidence of 7%. The median period to the onset of symptoms attributable to glaucoma was 22 months (range 16-26). Obstruction of the central retinal artery was observed in 1 eye. The irradiation doses to the retinas that developed late complications ranged between 54-75 Gy (mean 61, median 61). No patients who received less than 50 Gy developed retinal complications. The retina in 21 eyes was exposed to a dose of 50 Gy or more. In 13 of the 21 eyes, 60% or more of the retina was irradiated, and 8 of the eyes (62%) in this group (> or = 50 Gy, > or = 60%) developed severe retinal complications, whereas such complications only developed in 1 of the 8 eyes (13%) in the other group (> or = 50 Gy, > or = 60%). The results suggest that the radiation dose and area irradiated are the most important factors in the development of severe complications. CONCLUSION: Radiation-induced retinopathy and glaucoma are more serious late complications than cataracts, which are easily treated with surgery. We investigated the risk of late retinal complications of radiotherapy, and our findings suggested that the radiation dose and area irradiated are the most important factors in the development of severe complications. We recommend that the radiation dose and area of the retina irradiated be minimized in patients at risk of eye complications, and the patients should be closely followed by periodic ophthalmologic testing after treatment.

Adult↗

PubMed1994

Complications of Advanced Operative Laparoscopy: A Review of 452 Cases

To evaluate complications of advanced operative laparoscopy, operative and postoperative complications in 452 consecutive cases from January 1, 1991 to August 31, 1993 were evaluated. The series was divided into three time-segments of 8, 12, and 12 months. Common and serious complications were classified and reviewed. Complications developed during and after advanced operative laparoscopy in 47 (10.4%) patients in the series, of which 24 (5.3% of all cases, or 51% of total complications) were serious complications, such as hemorrhage, ureteral injuries and fistulas, and intestinal obstruction. Seventeen (3.8%) patients required further unplanned surgery for management of complications. During the initial learning period of 8 months, the rate of complications averaged 17.3%, decreasing to 7.7% and 10.1%, respectively, in the second and third periods of the series. There were no cases of death, postoperative ileus, thrombophlebitis, or pulmonary complication. We concluded that the overall incidence of complications in advanced operative laparoscopy is low. Serious complications may account for half of all complications. Surgical experience reduces the incidence of complications. Ovarian cystectomy produced the lowest rate of common complications and no serious ones. Laparoscopically assisted vaginal hysterectomy (LAVH) produced the highest rates of both common and serious complications.

Journal Article↗

PubMed2000

Venous complications after orthotopic liver transplantation.

Complications involving the portal vein or the vena cava, are rare after orthotopic liver transplantation. We report on the incidence and treatment of venous complications following 1000 orthotopic liver transplantations in 911 patients. Twenty-six of the adult patients (2.7%) suffered from portal complications after transplantation, whereas complications of the vena cava were observed in only 17 patients (1.8%). Technical problems or recurrence of the underlying disease (e.g. Budd-Chiari syndrome) accounted for the majority of complications of the vena cava, whereas alteration of the vessel wall or splenectomy during transplantation could be identified as important risk factors for portal vein complications. In patients undergoing modification of the standard end-to-end veno-venous anastomosis of the portal vein due to pathological changes of the vessel wall, complications occurred in 8.3%, whereas only 2.4% of patients who received a standard anastomosis of the portal vein experienced complications of the portal vein. Furthermore, splenectomy during transplantation was also associated with an increased incidence of portal vein complications (10.5 vs. 2.2% in patients without splenectomy). Treatment was dependent on the signs and symptoms of the patients, and varied considerably between patients with portal vein complications and patients suffering from complications of the vena cava. Complications of the vena cava led to retransplantation in about one-third of the patients, whereas in patients with occlusion of the portal vein, retransplantation was necessary in only 15%, and more than half of the patients suffering from portal vein complications did not require any treatment at all. Usually, treatment of patients with portal vein complications only became necessary when additional complications such as arterial occlusion or bile duct injuries occurred.

Adult↗

PubMed2002

Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae.

OBJECTIVE: The frequency of children who are hospitalized with pneumococcal pneumonia complicated by necrosis, empyema/complicated parapneumonic effusion, and lung abscess seems to be increasing. The factors that contribute to this increase are unclear; therefore, the objective of this study was to describe and compare the relative frequency, clinical characteristics, and outcome of hospitalized children with complicated pneumonia with those of children with uncomplicated pneumonia caused by Streptococcus pneumoniae in the era of antibiotic resistance. METHODS: A multicenter, retrospective study of 8 children's hospitals in the United States was undertaken. A total of 368 children who were hospitalized with pneumococcal pneumonia identified from patients enrolled in the US Pediatric Multicenter Pneumococcal Surveillance Study over the period from September 1, 1993, to January 31, 2000 were studied. Demographic and clinical variables, antibiotic susceptibility, pneumococcal serotypes, antimicrobial therapy, and clinical outcome in hospitalized children with complicated versus uncomplicated pneumococcal pneumonia were measured. RESULTS: A total of 368 patients with pneumococcal pneumonia were identified. Of the 368 isolates, 47 (12.8%) were intermediate and 37 (10.1%) were resistant to penicillin; 18 (5%) were intermediate to ceftriaxone, and 9 (2.5%) were resistant to ceftriaxone. A total of 133 patients met the criteria for complicated pneumonia and had a chest tube placed; 56 of these patients subsequently underwent decortication. The proportion of hospitalized patients with complicated pneumococcal pneumonia increased progressively over the study period from 22.6% in 1994 to 53% in 1999. Patients with complicated disease were older (median age: 45 vs 27 months) and significantly more likely to be of white race and have chest pain on presentation compared with patients with uncomplicated disease. Patients who had complicated disease and underwent decortication were more likely to have pleural fluid lactate dehydrogenase levels of >7500 IU/L compared with those patients who had chest tube placement alone. Fifty-three percent of children who were > or =61 months of age and were hospitalized had complicated pneumonia. This group of children accounted overall for 42% of the patients with complicated pneumonia, 48.2% of the patients who subsequently underwent decortication, and 44% of the patients who had received a course of antibiotics before diagnosis. Pneumococcal serotypes 1, 6, 14, and 19 were the most prevalent serotypes causing disease, with serotype 1 causing 24.4% of the complicated cases versus 3.6% of the uncomplicated cases. Ninety-eight percent of the patients in both groups recovered from their pneumonia. Antibiotic resistance was not found to be more prevalent in those patients with complicated disease. CONCLUSIONS: The relative frequency of complicated disease in hospitalized children with pneumococcal pneumonia is increasing. Patients with complicated pneumococcal disease were older and significantly more likely to be of white race compared with those patients with uncomplicated disease. Pneumococcal serotype 1 caused significantly more disease in patients with complicated versus uncomplicated pneumonia. Patients with complicated disease were not more likely to be infected with an antibiotic-resistant isolate.

Anti-Bacterial Agents↗

PubMed2003

Pulmonary complications of aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Pulmonary complications challenge the medical management of patients who have sustained aneurysmal subarachnoid hemorrhage (SAH). We assessed the frequency and types of pulmonary complications after aneurysmal SAH and analyzed the impact of pulmonary complications on patient outcome. METHODS: We reviewed the records of all patients with acute SAH treated at our institution between 1990 and 1997. Three hundred five consecutive patients with an aneurysmal hemorrhage source documented by angiography and treated within 7 days of ictus were analyzed. Outcomes at longest follow-up (mean, 16 mo) were measured by use of the Glasgow Outcome Scale. RESULTS: Pulmonary complications were documented in 66 patients (22%). The pulmonary complications were nosocomial pneumonia in 26 patients (9%), congestive heart failure in 23 (8%), aspiration pneumonia in 17 (6%), neurogenic pulmonary edema in 5 (2%), pulmonary embolus in 2 (<1%), and other pulmonary disorders in 4 (1%); 11 patients had two pulmonary complications. The incidence of symptomatic vasospasm was greater in patients with pulmonary complications (63%) than in patients without pulmonary complications (31%) (P = 0.001), and this association was independent of age and clinical grade at admission (odds ratio, 3.68; P < 0.001). Overall clinical outcomes were worse in patients with pulmonary complications (mean Glasgow Outcome Scale score, 3.3) than in patients without pulmonary complications (mean Glasgow Outcome Scale score, 4.0; P = 0.0001), but pulmonary complications were not an independent predictor of worse outcome when adjusted for age and clinical grade at admission (odds ratio, 1.38; P = 0.315). CONCLUSION: Patients who experience pulmonary complications after aneurysmal SAH have a higher incidence of symptomatic vasospasm than do patients without pulmonary complications. This most likely reflects both the failure to maintain aggressive hypervolemic and hyperdynamic therapy in patients with pulmonary compromise and the possible precipitation of congestive heart failure by hypervolemic therapy in patients with preexisting delayed ischemic neurological deficit. Although patients with pulmonary complications have worse overall clinical outcomes than do patients without pulmonary complications, this is attributable to older age and worse clinical grades at admission.

Adolescent↗

PubMed1999

Flap complications associated with lamellar refractive surgery.

PURPOSE: Corneal lamellar refractive surgery for myopia reduces the risk of corneal haze but adds to the risk of flap complications. We retrospectively determined the incidence of flap complications in the initial series of eyes undergoing lamellar refractive surgery by one surgeon. We assessed the incidence of flap complications overall, the trend in these complications during the surgeon's learning curve, and the impact of the complications on best spectacle-corrected visual acuity. METHODS: Charts of the first 1,019 eyes that underwent myopic keratomileusis in situ or laser in situ keratomileusis were reviewed for flap complications and visual outcome. RESULTS: Of the 1,019 eyes, 490 eyes underwent myopic keratomileusis in situ, and 529 eyes underwent laser in situ keratomileusis. Eighty-eight (8.6%) of 1,019 eyes had flap-related complications. Six eyes had two complications. Intraoperative complications included irregular keratectomy in nine eyes (0.9%), incomplete keratectomy in three eyes (0.3%), and a free cap in 10 eyes (1.0%). The incidence of intraoperative complications was six (6.0%) in the first 100 consecutive eyes, 14 (2.3%) in the next 600 consecutive eyes (P = .04, chi-square test), and one (0.3%) in the last 300 eyes (P = .03, chi-square test). Postoperative complications included displaced flaps that required repositioning in 20 eyes (2.0%), folds in the flap that required repositioning in 11 eyes (1.1%), diffuse lamellar keratitis in 18 eyes (1.8%), infectious keratitis in one eye (0.1%), and epithelial ingrowth that required removal in 22 eyes (2.2%). The incidence of flap displacement and folds in 200 eyes in which we irrigated under the flap and allowed it to settle without further manipulation averaged 8.5%, whereas the incidence in other groups of 100 consecutive eyes averaged 0.8% (P < .00001, chi-square test). The incidence of diffuse lamellar keratitis was 0.2% in eyes that had undergone myopic keratomileusis in situ and 3.2% in eyes treated by laser in situ keratomileusis (P = .0003, chi-square test). No eye lost 2 or more lines of best spectacle-corrected visual acuity because of flap complications. CONCLUSION: Flap complications after lamellar refractive surgery are relatively common but rarely lead to a permanent decrease in visual acuity. Physician experience with the microkeratome and with the handling of the corneal flap decreases the incidence of flap complications.

Cornea↗

PubMed1997

Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience.

OBJECTIVE: The primary objectives of this report were, first, to determine the number and incidence of complications of transsphenoidal surgery performed by a cross-section of neurosurgeons in the United States and, second, to ascertain the influence of the surgeon's experience with the procedure on the occurrence of these complications. The secondary objective was to review complications of transsphenoidal surgery from the standpoint of their causation, treatment, and prevention. METHODS: Questionnaires regarding 14 specific complications of transsphenoidal surgery were mailed to 3172 neurosurgeons. The data reported were analyzed from the 958 respondents (82%) who reported performing the operation. The neurosurgeons surveyed were asked to estimate the number of transsphenoidal operations performed, to identify any complications observed, and to estimate the percentage of operations that had resulted in any of the 14 specific complications. The 958 respondents were placed into three experience groups, based on the number of transsphenoidal operations performed. The data were analyzed by using chi 2 tests and Spearman correlation coefficients. The secondary objectives were met through a detailed review of the literature, in light of our experience. RESULTS: Of the respondents, 87.3% reported having performed < 200 operations and 9.7% reported 200 to 500 previous operations. The remaining 3% reported more than 500 previous operations. More extensive previous experience with transsphenoidal surgery was associated with a greater likelihood of having witnessed each specific complication. The mean operative mortality rate for all three groups was 0.9%. Anterior pituitary insufficiency (19.4%) and diabetes insipidus (17.8%) were complications with the highest incidence of occurrence. The overall incidence of cerebrospinal fluid fistulas was 3.9%. Other significant complications, such as carotid artery injuries, hypothalamic injuries, loss of vision, and meningitis, occurred with incidence rates between 1 and 2%. An inverse relationship was found between the experience group and the likelihood of complications, as indicated by significant negative Spearman correlation coefficients for all but 2 of the 14 complications listed in the survey (P < 0.05). Thus, increased experience with transsphenoidal surgery seems to be associated with a decreased percentage of operations resulting in complications. Some caution should be exercised in interpreting these data, because they are based on the respondents' estimates. CONCLUSION: Transsphenoidal surgery seems to be a reasonably safe procedure, with a mortality rate of less than 1%. However, a significant number of complications do occur. The incidence of these complications seems to be higher, with statistical significance, in the hands of less experienced surgeons. The learning curve seems to be relatively shallow, because a statistically significantly decreased incidence of morbidity and death could be documented after 200 and even 500 transsphenoidal operations. Better understanding of the indications for transsphenoidal surgery and improved familiarity with the regional anatomy should further lower the incidence of death and morbidity resulting from this procedure in the hands of all neurosurgeons.

Adenoma↗

PubMed2007

Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients.

STUDY DESIGN: Retrospective review. OBJECTIVE: To quantify and describe perioperative complication rates in a large series of well-matched elderly patients who underwent lumbar decompression and arthrodesis. SUMMARY OF BACKGROUND DATA: Posterior lumbar decompression and fusion is frequently performed to treat lumbar stenosis with instability. An increasing number of elderly patients are undergoing operative treatment for degenerative lumbar disease. The reported morbidity of performing decompression and arthrodesis in this population varies widely in the literature, with recent reports showing a high rate of major complications. METHODS: A total of 166 patients age 65 or older that underwent primary posterior lumbar decompression and fusion with (group 1; n = 75) or without (group 2; n = 91) instrumentation were included. Hospital records were reviewed for the occurrence of any complications (major and minor), the need for transfusion, estimated length of stay, and disposition at discharge. Logistic regression (with the presence/absence of major complications as the dependent variable) was used to identify risk factors for the occurrence of a complication. RESULTS: Five major complications (3%) occurred (group 1, 1; group 2, 4). Minor complications developed in 30.7% of group 1 and 31.9% of group 2. There were no deaths, and only one perioperative complication was attributable to the use of instrumentation. Decompression/fusion of 4 or more segments was significantly associated with the occurrence of a major complication. Advanced age, the presence of medical comorbidities, or the use of instrumentation did not increase the rate of major or minor complications. The occurrence of either a major or minor complication prolonged hospital stay. CONCLUSIONS: Posterior lumbar decompression and fusion can be safely performed in elderly patients, with a low rate of major complications. The addition of instrumentation does not increase the complication rate. These results differ from those previously reported in the literature, which describe a significantly higher rate of complications in this age group, with a prolonged rate of hospitalization.

Aged↗

PubMed1997

Complications of laparoscopy: a prospective multicentre observational study.

OBJECTIVE: To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands. DESIGN: A nationwide prospective multicentre observational study. METHODS: Data on complications were registered from 1 January to 31 December 1994 by 72 hospitals. Any unexpected or unplanned event requiring intra-operative or post-operative intervention was defined as a complication. Complications were classified in two groups: approach and technique related complications. Complication rates were compared with these already published. RESULTS: Of 25,764 laparoscopic procedures, 145 complications occurred (rate 5.7 per 1000 [/1000]); two deaths occurred. In 84 women laparotomy was necessary (rate 3.3/1000). In 83 cases (57%; 95% CI for approach = 49-65%) the complication was caused by the surgical approach; in 62 cases (43%) the technique was at fault. Haemorrhage of the epigastric vein and intestinal injury, often requiring laparotomy (90% of cases) were the most frequently observed complications. The complication rate was 2.7/1000 for diagnostic laparoscopic procedures, 4.5/1000 for sterilisation and 17.9/1000 (chi 2 = 127; dF = 2; P < 0.001) for operative laparoscopy. The highest incidence was registered for complications occurring during laparoscopic (assisted) hysterectomy. Stepwise logistic regression analysis showed that previous laparotomy and surgical experience were associated with complications requiring laparotomy. CONCLUSIONS: Most complications occurred during operative laparoscopic procedures (rate 17.9/1000). Residents in training are required to learn diagnostic laparoscopy and sterilisation and this training programme results in a fall in the risk of the complications. However, operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy. Women with a previous laparotomy are particularly at risk.

Female↗

PubMed2002

[Per- and postoperative complications of surgical treatment of lumbar spinal stenosis. Prospective study of 306 patients].

PURPOSE OF THE STUDY: The main objective of this prospective observational study of a consecutive series of patients was to determine the rate of per- and postoperative complications of surgical treatment of lumbar spinal stenosis. A second objective was to describe these complications and search for factors favoring their occurrence. MATERIAL AND METHODS: All patients who underwent surgical treatment of spinal stenosis without significant spinal deviation in our unit between January 1998 and January 2000 were enrolled in this study. The series thus included 306 patients with at least six months follow-up. Three types of data were recorded before surgery: demographic data including comorbidity, data related to the type of stenosis operated, and data related to the type of procedure (simple release, release with fusion, etc.). A special observation chart was designed to record all complications during the hospital stay and follow-up visits at three, six and twelve months. Four categories of complications were recorded: general complications, early or late infections, early or late mechanical disorders, and neurological complications including meningeal involvement and surgery-related neurological disorders. Univariate analysis was performed to determine the overall rate of complications and the incidence within each category of complications. Multivariate analysis using logistic regression was performed to examine factors favoring occurrence of complications. RESULTS: The overall rate of complications was 26.5%. The incidence of general, infectious, neurological, and mechanical complications was 13, 4.5, 2.6 and 2% respectively. The incidence of serious complications and/or events requiring reoperation was 12%. Comorbidity, body mass index, operative time, and reoperation were found to favor the occurrence of complications. DISCUSSION AND CONCLUSION: The rates of complications reported in the literature have varied greatly. Most have been calculated from retrospective series, making it difficult to compare them with our results. Our work emphasizes the importance of certain favoring factors which should be re-examined in a larger series.

Adult↗

PubMed1996

Complications of major operative laparoscopy. A review of 452 cases.

OBJECTIVE: To evaluate complications of operative laparoscopy. STUDY DESIGN: Operative and postoperative complications in 452 consecutive cases from January 1, 1991, to August 31, 1993, were evaluated. The series was divided into three time segments--8, 12 and 12 months. Common and serious complications were classified and reviewed. RESULTS: Complications developed during and after major operative laparoscopy in 47 (10.4%) patients in the series; 24 (5.3% of cases, or 51% of total complications) were serious, such as hemorrhage, ureteral injuries and fistulas, and intestinal obstruction. Seventeen (3.8%) patients required unplanned surgery for management of complications. During the initial learning period of eight months, the rate of complications averaged 17.3%, decreasing to 7.7% and 10.1%, respectively, in the second and third periods in the series. There were no cases of death, postoperative ileus, thrombophlebitis or pulmonary complications. CONCLUSION: The overall incidence of complications in major operative laparoscopy was 10.4%. Serious complications accounted for half the complications. Surgical experience reduced the incidence of complications. Ovarian cystectomy produced the lowest rate of common complications and no serious ones. Laparoscopically assisted vaginal hysterectomy had the highest rate of serious complications.

Dysmenorrhea↗

PubMed2006

Risk factors for serious complication after uvulopalatopharyngoplasty.

OBJECTIVE: To test the hypothesis that comorbidity, performance of concurrent sleep apnea procedures in addition to uvulopalatopharyngoplasty, body mass index, apnea-hypopnea index, and lowest oxygen saturation are risk factors for serious perioperative complications after uvulopalatopharyngoplasty. DESIGN: Prospective cohort and nested case-control studies. SETTING: United States Veterans Affairs medical centers. PATIENTS: A prospective cohort of 3130 consecutive adult inpatients who underwent uvulopalatopharyngoplasty from 1991 to 2001 was retrospectively analyzed from the Veterans Affairs National Surgical Quality Improvement Program database to determine the relationship between perioperative complications and both concurrent procedures and medical comorbidity. A nested case-control analysis was conducted on 43 cases with complications and 212 controls without complications from the cohort. Controls were matched on age, sex, year of operation, and concurrent surgery; this case-control analysis enabled the study of body mass index, apnea-hypopnea index, and lowest oxygen saturation, which were not available in the cohort database. Multivariate logistic regression measured associations between risk factors and complications, adjusting or controlling for age, sex, race, smoking status, year of uvulopalatopharyngoplasty, and presence of any concurrent procedure. MAIN OUTCOME MEASURE: Sixteen specific serious perioperative complications, including 30-day mortality. RESULTS: The cohort included 3130 veterans (97% were men aged 50+/-11 [mean+/-SD] years). In the cohort study, comorbidity was associated with serious complication: the adjusted risk ratio was 1.96 (95% confidence interval, 1.16-3.18) for each increase in American Society of Anesthesiologists class. Concurrent nonnasal procedures increased the risk of complication compared with no concurrent procedures (adjusted risk ratio, 4.94; 95% confidence interval, 2.34-10.4). In the case-control analyses, the apnea-hypopnea index, body mass index, and medical comorbidity were each associated with serious complication after adjustment for confounding variables, but this study had insufficient power to determine if these risk factors were independent of each other. Concurrent retrolingual procedures demonstrated an independent association with complication after adjustment for confounders. The lowest oxygen saturation was not associated with serious complication. CONCLUSIONS: Apnea-hypopnea index, body mass index, and medical comorbidity were each associated with serious complication; however, the low complication rate precluded demonstration of associations independent of each other. Concurrent retrolingual procedures were also associated with serious complication, but the cumulative risk of separate retrolingual procedures is unknown.

Adult↗

PubMed2004

[Wisdom teeth-complications requiring in-patient treatment. A 1-year prospective study].

BACKGROUND: In view of the conflicting guidelines issued by national and international scientific societies, debate about the indications for prophylactic extraction of wisdom teeth is ongoing. This prospective study was therefore set up to explore the complications associated with wisdom teeth and requiring in-patient treatment. PATIENTS AND METHODS: From January /2003 to December 2003, 21 subjects were admitted for treatment of complications associated with wisdom teeth. The medical history was recorded for each of these patients, as were the cause and type of the complications. The parameter used to quantify the severity of any infections was the CRP, and the overall clinical complexity level of each case was assessed by the length of stay in hospital (and the duration of intensive care if this had been necessary). The characteristics of patients in the group with postoperative complications were compared to those of patients with complications attributable to pericoronitis. Moreover, complications in patients who had undergone prophylactic extraction of wisdom teeth that had not been causing any symptoms were compared with those in patients whose wisdom teeth had been extracted because of morbidity. RESULTS: Overall, 18 deep-space infections (15 abscesses, 2 inflammatory infiltrations, 1 case of phlegmonous cellulitis), 2 mandibular fractures and 1 lingual nerve injury were noted within 1 year. The complications resulted from surgical procedures in 15 of the 21 cases, while in 6 they had their origin in pericoronitis. Extensive surgery or intensive care was required only for patients with postoperative complications. The length of stay in hospital was significantly greater for patients with postoperative complications ( p= 0.007, U-test). However, 9 of these 15 patients reported preoperative episodes of infection. Thus, more than two thirds of the complications could be traced back to wisdom teeth that were causing symptoms. CONCLUSION: In our clinic's catchment area, infectious complications were more frequent and more severe and required more intensive and longer treatment in hospital than complications arising from pericoronitis. However, complications of prophylactic extraction of wisdom teeth were decidedly less frequent than direct or indirect complications of extraction of symptomatic teeth. Thus, our data tend to support the concept of elective extraction of wisdom teeth with the aim of preventing serious infections.

Adolescent↗

PubMed1988

Complications in arthroscopic surgery performed by experienced arthroscopists.

Twenty-one experienced arthroscopists participated in a prospective, 19-month study to analyze complications in arthroscopic surgery of the knee and other joints. Participants responded to a monthly questionnaire that provided information on a case-by-case basis for the duration of the study. A total of 63 specific procedures were studied. A total of 10,262 procedures were recorded. Procedures performed on the knee joint were most prevalent in the study (8,741 or 86%). Complications were placed in one of 11 descriptive categories for analysis; 173 complications occurred and the overall complication rate was 1.68%. The types of complications recorded in order of frequency were hemarthrosis, 60.1%; infection, 12.1%; thromboembolic disease, 6.9%; anesthetic complications, 6.4%; instrument failure, 2.9%; reflex sympathetic dystrophy, 2.3%; ligament injury, 1.2%; and fracture and neurologic injuries, 0.6% each. The remainder were miscellaneous complications, 6.9%. No vascular injuries were reported. The two most frequent procedures reported were medial meniscectomy (2,468) with a complication rate of 1.78%, and lateral meniscectomy (1,149) with a complication rate of 1.48%. Overall, there was a lower incidence of complications in meniscal repair (1.29%), including both inside-out and outside-in techniques, than in meniscectomy (1.69%). In-depth information was gathered on each complication. In addition, profiles on surgical techniques and surgical equipment were obtained from each of the contributing surgeons. The complication rate in arthroscopic surgery was found to be higher than had been previously found in retrospective surveys. With further analysis oft he complication data and profiles of the surgeons, protective techniques can be further identified to help reduce the incidence of complications in arthroscopic surgery.

Arthroscopy↗

PubMed2026

Risk of mortality and complications in people with depressive disorder and co-occurring diabetes mellitus: a systematic review and meta-analysis.

AIMS: People with depressive disorder have increased premature mortality and higher rates of diabetes mellitus than general population. Evidence shows that diabetes may further increase their risk of premature death from diabetes-related complications, especially cardiovascular diseases (CVDs). Earlier studies examining depression-associated outcomes in diabetes patients have shown mixed results and were hindered by important limitations, especially the use of self-reported questionnaires to ascertain depression, causing misclassification bias by identifying subclinical symptoms or diabetes distress. Associations of depression with specific diabetes complications have not been systematically evaluated. This meta-analysis aimed to investigate the risk of mortality and complications among patients with depression and co-occurring diabetes (depression-diabetes group) relative to patients with diabetes-only (diabetes-only group), on their all-cause mortality rates, and if applicable cause-specific mortality rates, and occurrence of specific diabetes complications. METHODS: We systematically reviewed and quantitatively synthesized diabetes-related outcomes in patients with depression by searching Embase, MEDLINE, PsycInfo and Web-of-Science from inception to 20 December 2024, and included studies that examined mortality and complication outcomes in depression-diabetes group relative to diabetes-only group. Results were synthesized by random-effects meta-analytic models, with stratified-analyses (subgroup analyses and meta-regression) by study-level characteristics, including age, gender, study period, geographic region, follow-up duration and nature of diabetes sample. The study was registered with PROSPERO (CRD42024595145). RESULTS: Twenty-six studies were identified from nine geographic regions. Regarding mortality risk, depression-diabetes group exhibited increased risks of all-cause mortality (RR = 1.30 [95% CI: 1.21-1.39]) and CVD-specific mortality (1.15 [1.02-1.29]) relative to diabetes-only group. Regarding complication risk, depression-diabetes group showed increased risk of complications (1.28 [1.18-1.40]) relative to diabetes-only group, especially in incident-diabetes sample signifying advanced disease stage upon presentation, with stratified-analyses showing higher risk of metabolic complications (1.63 [1.33-1.99]) and cardiovascular complications (1.20 [1.11-1.29]), and lower likelihood of retinopathy (0.84 [0.76-0.94]), albeit comparable rates of cerebrovascular complications (1.36 [0.99-1.87]), nephropathy (1.09 [0.93-1.27]) and peripheral-vascular complications (0.97 [0.79-1.18]). Both overall mortality and complication risks were present in various regions and persisted over time. Heterogeneities were noted and could not be entirely explained by stratified analyses. CONCLUSIONS: Our study demonstrated that patients with depression and co-occurring diabetes were associated with elevated overall mortality risk and complication risk (particularly metabolic and cardiovascular-complications) than non-depressed counterparts, suggesting an overall poorer glycemic control that might eventually drive their earlier death. Comprehensive and multipronged interventions are needed for individualized risk estimation of diabetes-related outcomes, with consequent early interventions to minimize the avoidable physical morbidity and premature mortality in this vulnerable population.

Humans↗

PubMed2004

[Complications after endonasal surgery of the paranasal sinuses for inflammatory diseases].

BACKGROUND: There are sufficient reports on the incidence of complications after endonasal surgery of the paranasal sinuses. It is the aim of this study to calculate the incidence of typical complications after primary and revision surgery, after "functional" and "extended" operations, together with the influence of expertise and of different optical devices on the complications rate. Preoperative computer tomography of the paranasal sinuses are the golden standard. There exists a historical interest to compare the complication rate in patients operated without and those with a CT, especially in those countries where the availability of CTs is low or not existent. METHODS: 266 consecutive patients who underwent an endonasal surgery of the paranasal sinuses from January 1989 to December 1990 were revised to study the incidence and relative risk rate of typical complications after primary and revision surgery, after "functional" or "extended" surgery, the rate for more experienced or less experienced surgeons, as well as the differences between endoscopic or microscopic surgery. The study also compares the complication rate of patients operated on with and without a preoperative computed tomography. RESULTS: 207 out of 263 patients (78.7 %) had no complication. 58 minor and three severe complication were registered for 56 patients. 6 patients had two or more minor complications. No surgeon showed a higher complication rate compared to others (p = 0.33), and there was no statistically significant difference (p = 0.279) in the complication rate between experienced and less experienced surgeons. Endoscopic or microscopic surgery showed no statistically significant differences (p = 0.117) and extended sinus surgery displayed more complications compared to minor surgery (p = 0.041), as well as primary surgery compared to revision surgery (p = 0.003). No statistically significant differences could be found for surgeries performed with or without computed tomography (p = 0.097). CONCLUSIONS: A higher complication rate is to be expected for primary surgery and after extended sinus surgery, especially when an infundibulotomy was performed. In our series no learning curve was observed, especially as the variable "experience" showed no statistically significant difference. Endonasal surgery without CAT scan is not recommended, however, no higher complication rate was found in surgery without CAT scan.

Adolescent↗

PubMed1994

[Abdominal complications following heart surgery].

OBJECTIVE: Intra-abdominal complications occurring after cardiopulmonary bypass operations are rare but often fatal. There are only speculative approaches concerning the pathogenesis and the risk factors of these complications. The aim of our study was therefore to determine the causative factors and to evaluate the diagnostic and therapeutic measures, because early diagnosis and immediate treatment is essential for the outcome of the patients. DESIGN: 500 consecutive patients who underwent cardiopulmonary bypass procedures over a period of 14 months were examined for intra-abdominal complications. The records of these patients were reviewed in relation to possible risk factors and the group with intra-abdominal complications was compared with a random sample of 50 patients in respect of possible risk factors. The diagnostic procedures (serum lactate concentrations, sigmoidoscopy, coloscopy) and the therapeutic interventions were also evaluated. MAIN RESULTS: 9 (1.8%) of the 500 patients developed intra-abdominal complications. The mortality rate was 44% (4 of 9). 5 patients had bowel necrosis or ischaemic colitis. Pseudo-obstruction appeared in 5 cases. One patient developed cholecystitis and one acute haemorrhagic pancreatitis. Gastroduodenal complications were not observed. There was no difference between the group with intra-abdominal complications and the random sample with regard to sex, type of operation and preoperative intra-abdominal diseases. Clinical risk factors identified were: age, occlusive vascular disease, atrial fibrillation, prolonged aortic cross-clamping times and mean bypass times, intraoperative and postoperative need for supply of epinephrine and norepinephrine, implantation of an intraaortic balloon counterpulsation pump, low cardiac output, postoperative multiple organ failure. 8 out of the 9 patients had severe intraoperative surgical complications or general complications in the postoperative course. All patients with bowel necrosis or ischaemic colitis had abnormal serum lactate concentrations. With the aid of sigmoidoscopy in one patient, only bowel necrosis or ischaemic colitis could be detected. In one patient with pseudoobstruction, an operation was probably obviated by decompression of the colon by coloscopy. 6 of the 500 patients after cardiopulmonary bypass required emergency laparotomy. Two patients with bowel necrosis were saved by early hemicolectomy. CONCLUSION: In reviewing both our results and data cited in earlier studies, intra-abdominal complications can generally be attributed to the following: Intraoperative surgical complications with the consequence of prolonged aortic cross clamping and total bypass times can cause low cardiac output and mesenteric hypoperfusion. Predominantly as a result of the low cardiac output, the use of vasopressors increases splanchnic ischaemia, in particular in patients with pre-existing occlusive vascular disease of the mesenteric arteries. Mucosal ischaemia might be aggravated by a concurrent pseudo-obstruction. On the other hand, intraoperative complications and low cardiac output can cause further complications and finally multiple organ failure. Multiple organ failure and ischaemia of the gut can initiate the vicious circle which is responsible for the high mortality from these complications. Early detection by careful physical examination and the combination of the diagnostic procedures and prompt treatment should lead to a reduction of mortality.

Abdomen↗