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PubMedDate not supplied

[Percutaneous kidney biopsy, analysis of 26 years: complication rate and risk factors; comment].

UNLABELLED: Percutaneous renal biopsy is an invasive procedure that can result in major and minor complications. The objective of this study was to know the frequency and type of complications in relation with this procedure, as well as the efficacy to obtain enough material for diagnosis. METHODS: Retrospective study. We review the charts of patients to whom a percutaneous renal biopsy of native kidneys was done between January 1970 and March 1996. The following data were obtained: age, gender, clinical and histopathological diagnosis, complications associated with the procedure (minor: hematuria, local infections, hematoma; major: transfusions, severe infections, surgery, nephrectomy, arteriography, embolism and death). RESULTS: We analyzed 1,005 renal biopsies in 840 patients, mean age 37.7 +/- 13.1 years, 67% female. There were no complications in 88.8% (893 biopsies), minor complications in 8.65% (87 biopsies) and only in 2.4% of the procedures major complications. We divided the cases in two groups: percutaneous renal biopsy without complications (n = 893, 89%) and with complications (n = 112, 11%). The most frequent complications were hematuria (91 cases, 9.1%) and perirenal hematoma (29 cases, 2.7%). In these cases transfusion was required in 2.4% (26). Infectious complications were: urosepsis in 7 cases (0.7%), bacteremia, sepsis and perirenal abscesses (1 case each, 0.1%). One patient died because of multiple complications (0.1%). We observed greater risk of major complications on patients in those who biopsy was done because of acute renal failure (OR 4.03, p < 0.003). DISCUSSION: In our experience percutaneous renal biopsy is a low risk procedure. Most complications are minor and without clinical repercussion. There must be a strict selection criteria of the patients to whom percutaneous renal biopsy is going to be done because of the risk of severe complications.

Abscess↗

PubMed1997

Cumulative glycemic exposure and microvascular complications in insulin-dependent diabetes mellitus. The glycemic threshold revisited.

BACKGROUND: The development of microvascular insulin-dependent diabetes mellitus (IDDM) complications has been shown to be related to both duration of diabetes and the degree of glycemic exposure. However, controversy exists as to whether there is a threshold of glycemic exposure, below which there is minimal risk. Furthermore, there are few data describing the relationship of total glycemic exposure (duration x degree) to complications rates-a potentially useful research and clinical tool. OBJECTIVES: To determine a cumulative glycemic exposure variable that combines the effect of both degree and duration of hyperglycemia and to evaluate this variable in terms of its relation to microvascular complications. The association between cumulative glycemic exposure and complication risk was also examined to evaluate whether there was a threshold effect. METHODS: A total of 353 patients with IDDM who had completed the first 6 years of follow-up in the Pittsburgh Epidemiology of Diabetes Complications Study were included in this analysis. These subjects had a mean age of 27.9 years, and the mean duration of the disease was 19.4 years. Subjects were examined at baseline (cycle 1) and then biennially (cycle 2, cycle 3, and cycle 4) for diabetes complications. Total glycosylated hemoglobin (HbA1) was measured at each cycle. A cumulative glycemic exposure variable, named A1months, was calculated by multiplying the number of HbA1 units above normal at each cycle by the number of months between the midpoints of the preceding and succeeding cycle intervals. RESULTS: The mean number of A1months experienced at the time of diagnosis of proliferative retinopathy (914), microalbuminuria (952), overt nephropathy (1043), and distal symmetrical polyneuropathy (1043) did not vary by duration of diabetes. Thus, approximately 1000 A1months were needed (on average) for the advanced complications to develop. Although the risk for developing proliferative retinopathy rose gradually as A1months increased, a more abrupt increase in the risk was seen (again at approximately 1000 A1months) for microalbuminuria (odds ratio, 6.9; 95% confidence interval, 2.5-19.1), overt nephropathy (odds ratio, 6.5; 95% confidence interval, 2.0-21.7), and distal symmetrical polyneuropathy (odds ratio, 6.5; 95% confidence interval, 2.4-17.8). Nonetheless, complications developed in the majority of cases at glycemic exposures below 1000 A1months. The cumulative glycemic exposure variable A1months does not predict complications any better than its component variables (duration and HbA1). Furthermore, formal statistical testing failed to show a definitive threshold for any complication. CONCLUSIONS: Although A1months does not enhance prediction of complications, it may be a useful summary measure of glycemic exposure for both patients and physicians. However, although subjects with 1000 A1months or more appear to be at increased risk of developing most microvascular complications, because the majority of complications arise in subjects with less than this exposure, this threshold value should only be considered a minimal goal. For example, our data suggest that for most microvascular complications to develop, it would take, on average, 83 years with an HbA1 unit at 1% above normal, 42 years at 2% above normal, 28 years at 3% above normal. 21 years at 4% above normal, and 18 years at 5% above normal.

Adolescent↗

PubMedDate not supplied

The related outcome and complication rate in primary lumbar microscopic disc surgery depending on the surgeon's experience: comparative studies.

BACKGROUND CONTEXT: Studies concerning intraoperative complications and their influence on the clinical outcome of microscopic disc surgery are quite rare. Complication rates vary between 1.5% and 15.8%. A correlation between the surgeon's experience and the complication rate may be expected. PURPOSE: To determine the influence of the surgeon's experience on the intraoperative complication rate in lumbar microscopic disc surgery. STUDY DESIGN: Three studies are included: 1) retrospective analysis of intraoperative complications in microscopic disc surgery (N=1,872); 2) prospective follow-up study of microscopic disc surgery (N=583); 3) prospective evaluation of complication rates in microscopic disc surgery (N=90). PATIENT SAMPLE: Patient data sets from 1,872 lumbar microscopic disc surgeries performed between January 7, 1981, and June 31, 2000, were examined in a retrospective study. A total of 463 patients, operated on between 1991 and 1996, were followed up by a questionnaire. Finally, a prospective controlled trial (N=90) was performed. OUTCOME MEASURES: Such complications as incidental durotomy, wrong level exposure, or bleeding were analyzed based on the patient data sets by a blinded external evaluator. The rates of lower back pain and ischiatic pain were measured on a visual analogue scale at follow-up in Study 2 and Study 3. To measure the outcome of surgery in daily life activities and functional capacity, the Tegner activity level was calculated. In addition, a questionnaire with the Hannover score was used. The patient's social and economic status was also recorded. METHODS: A total of 1,872 lumbar microscopic disc surgeries, performed between January 7, 1981 and June 31, 2000, were examined in a retrospective study. Intra- and perioperative complications were evaluated and related to the surgeons' level of experience. Patients in the first group (XL) were operated on by the most experienced surgeon (more than 500 microscopic discectomies before the beginning of the study). The L-group surgeons performed between 50 and 100 microscopic disc surgeries before the study. This group included a total number of seven surgeons during the 1981-2000 time frame. None of this group reached the experience level of 500 surgeries during the course of the study. A total of 463 patients, operated on between 1991 and 1996, were followed up. Finally, a prospective controlled trial (N=90) was performed. Injuries of the dura, nerve root, ventral structures and wrong level exposure, which had been detected and corrected during surgery, were analyzed. In the second and third study, the outcome was correlated to surgery and complications during surgery. RESULTS: The rate of intraoperative complications showed a statistically significant difference between the groups. The comparison of both groups (n=1,872) with regard to the rate of intraoperative complications showed a statistically significant difference between 2.2% in the XL group and 10.7% in the L group (p< or =.001). Regarding work-related and socioeconomic factors, no significant difference in the outcome was seen. CONCLUSIONS: Microscopic disc surgery requires a course of instruction and a considerable number of surgeries under supervision by experienced surgeons. To shorten the learning curve, a number of standardized surgery steps to clearly identify anatomical landmarks are helpful. During training, these landmarks can be checked by an experienced surgeon to minimize the rate of intraoperative complications. Initial postoperative ischiatic pain was correlated to an incidental durotomy with p<.001. For long-term results after disc surgery, however, socioeconomic and work-related factors are of greater importance in spinal disc surgery than the incidence of intraoperative complications.

Follow-Up Studies↗

PubMed2025

Integrative oral and gut microbiome profiling highlights microbial correlates of complications in type 1 diabetes: a cross-sectional analysis.

BACKGROUND/OBJECTIVE: Chronic vascular complications are the primary threat in long-standing type 1 diabetes (T1D) patients. We examined the associations between oral-gut microbiome dysbiosis and these complications, offering novel insights into therapeutic strategies and underlying mechanisms. METHODS: This cross-sectional study enrolled 75 T1D participants (disease duration ≥ 10 years) and 43 healthy controls who underwent comprehensive clinical assessment, including blood glucose, lipid profile, and complication-related examinations. Fecal and oral rinse samples were collected for shotgun metagenomic sequencing. T1D participants were stratified by the presence of microvascular (retinopathy, nephropathy, or neuropathy) or macrovascular complications separately. Microbial differences across groups were assessed. RESULTS: Significant differences in oral and gut microbiota compositions were observed between T1D participants with and without complications (both microvascular and macrovascular). A core set of 26 gut and 8 oral microbial species was specifically associated with vascular complications. Butyrate-producing gut bacteria (Blautia wexlerae, Anaerobutyricum hallii, Roseburia inulinivorans, A. soehngenii) and specific oral Neisseria species were enriched in T1D without complications individuals, suggesting protective effects against complications. Mediation analysis indicated associations consistent with partial mediation between certain microbial species and the relationships of glycemic control or insulin resistance (HbA1c, glucose risk index, estimated glucose disposal rate) with complication risk. Moreover, potential oral-gut microbiome interconnections were implicated in complication development. Finally, classification models integrating both oral and gut microbial features significantly outperformed models based on either site alone in distinguishing T1D patients with complications. CONCLUSIONS: Distinct oral and gut microbiome features are associated with chronic vascular complications in T1D. These findings highlight the potential of microbiome-targeted strategies for understanding and preventing T1D-related complications.

Humans↗

PubMed1993

Complications of laparoscopic hysterectomy.

OBJECTIVE: To evaluate complications of laparoscopic hysterectomy. METHODS: A retrospective analysis of complications was tabulated from hospital and office records. Forty-five consecutive patients had laparoscopic hysterectomies from November 1991 to November 1992. Complications were divided into operative, anesthetic, postoperative, nursing, and equipment. Each complication was subjectively graded from mild to severe. RESULTS: Complication rates by group were: operative 11%, anesthetic 7%, postoperative 16%, nursing 4%, and equipment 56%. Operative complications included one bladder perforation, two superficial epigastric artery perforations, and two subcutaneous emphysema cases. There were three anesthetic complications from fluid overload. Postoperative complications included four patients with periumbilical cellulitis. Three patients, who had laparoscopic supracervical hysterectomies, continued to menstruate. Nursing complications included two transient nerve injuries, one femoral and one peroneal. Equipment complications had the highest incidence; the most common type was bipolar cautery dysfunction (22 of 45). There were two video difficulties and one lost laser tip. There were no cases of death, postoperative ileus, fever, thrombophlebitis, transfusions, urinary tract infections, urinary atony, pneumonia, bowel injuries, ureteral injuries, or atelectasis. All patients were treated as outpatients, and no one was admitted or readmitted. Ninety-eight percent of the complications were mild to moderate, with only 2% (one of 45) severe. CONCLUSION: Overall complication rates are high after laparoscopic hysterectomy, even though the complications are predominantly mild to moderate in severity.

Anesthesia↗

PubMed2006

Predicting medical and surgical complications of carotid endarterectomy: comparing the risk indexes.

BACKGROUND: Several generic cardiac risk assessment tools predict perioperative cardiac complications, but their ability to predict a broader range of medical, neurologic, and surgical complications is unknown. METHODS: A multicenter retrospective observational cohort study of 1998 patients undergoing carotid endarterectomy (CEA). Complications within 30 days of surgery were assessed by medical record review, including death or nonfatal stroke and cardiac, noncardiac medical, minor neurologic, and wound complications. Logistic regression and receiver operating characteristic curve analyses assessed the predictive abilities of the Goldman, Detsky, Revised Cardiac Risk, and American Society of Anesthesiologists indexes and of 2 CEA-specific risk models (the Halm and Tu scores). RESULTS: Death or stroke occurred in 3.2% of patients, cardiac complications in 4.0%, noncardiac medical complications in 3.2%, minor neurologic complications in 6.9%, and wound complications in 6.0%. All risk models (except the Tu score) significantly predicted cardiac complications equally well (P<.05). All 6 risk models were equivalent in predicting noncardiac medical complications. Only the Revised Cardiac Risk Index and the 2 CEA-specific risk models (Halm and Tu scores) predicted death or stroke and minor neurologic and wound complications. The Halm score was superior in predicting death or stroke compared with the Tu score and the Revised Cardiac Risk Index (area under the receiver operating characteristic curve, 0.72 vs 0.62 and 0.61, respectively; P<.05). Patients with cardiac, noncardiac medical, minor neurologic, or wound complications had 3- to 16-fold increased odds of death or stroke. CONCLUSION: The Halm score CEA-specific risk model and the generic Revised Cardiac Risk Index predicted a broad range of medical, neurologic, and surgical complications following CEA.

Aged↗

PubMed2005

Postoperative complications of salvage total laryngectomy.

BACKGROUND: The objectives of the current study were to report the incidence of postoperative complications for salvage total laryngectomy (STL) compared with primary total laryngectomy (PTL) and to identify patient and tumor-related factors predictive of postoperative complications. METHODS: A sample of 183 patients who had received a total laryngectomy were identified from an existing database of 662 patients treated for squamous cell carcinoma of the larynx. PTL and STL were performed in 113 and 70 patients, respectively. Initial therapy in the patients who required salvage surgery included radiotherapy (RT) in 32 (46%) and chemoradiotherapy (CTRT) in 38 (54%). Postoperative complications were recorded for each group and categorized into local, swallowing, airway, and systemic complications. Postoperative complication rates for STL after RT and CTRT were compared with those after PTL by univariate analysis. Patient and tumor-related predictors of complications were identified by univariate and multivariate analyses. RESULTS: The overall mortality rate was 0.5%. Forty percent of all patients developed a postoperative complication after total laryngectomy. Local complications, which were the most frequent, occurred in 52 (28%) patients. Pharyngocutaneous fistula occurred in 31 (17%) patients. Statistical analysis showed that there was a greater number of patients with local wound (45% vs. 25%, P = 0.02) and fistula complications (32% vs. 12%, P = 0.012) in the STL-CTRT group compared with the primary laryngectomy group. Multivariate analysis showed that primary CTRT was an independent predictor of local complications and pharyngocutaneous fistula. CONCLUSIONS: Salvage laryngectomy was more frequently associated with postoperative complications after CTRT compared with PTL. Problems related to local wound healing, especially the development of pharyngocutaneous fistula, constituted the most common postoperative complication in these patients. Multivariate analysis showed that primary CTRT was an independent predictor of local wound complications and pharyngocutaneous fistula.

Adult↗

PubMed1996

Shunt complications in the first postoperative year in children with meningomyelocele.

The authors analyze the incidence of early mechanical and infective CSF shunt complications and various factors that might be correlated with the incidence in a series of 170 children affected by hydrocephalus and meningomyelocele (MM), with the aim of the finding to this specific risk factors related to this particular type of hydrocephalus. Factors investigated for correlation with CSF shunt malfunction are the following: level of spinal malformation, age of the patient at MM repair, age at diagnosis of hydrocephalus, degree of ventricular dilatation, age at shunt implantation, modality of the surgical procedure, characteristics of CSF at operation. In the first postoperative year following CSF shunting, 45.9% of the patients presented one shunt malfunction, three-quarters of which were due to mechanical causes, and one quarter to infection. Age of the patient at diagnosis of hydrocephalus and at CSF shunt operation did not significantly influence shunt patency, nor did the surgical modality (programmed vs emergency procedure). On the other hand, MM level did influence the outcome of CSF shunting: a higher percentage of malfunctions (and in particular of infective complications) was observed among the patients with "high level" MMs than in the group with more caudal location of the spinal defect. Similarly, the degree of ventricular dilatation correlated with the incidence of complications (more severe ventricular dilatation was associated with the highest incidence of complications). The order in which MM repair and CSF shunting were carried out and the age of the patients at MM repair did not affect the occurrence of mechanical complications, whereas they had a significant effect on the incidence of infective complications. In fact, the rate of overall complications, and of infective complications in particular, was proportional the age at MM repair. Furthermore, the group of children who underwent to MM repair and CSF shunting simultaneously scored the lowest percentage of complications, although these were mainly infections; the highest incidence of complications (and in particular of infective ones) was observed in the children who underwent CSF shunting first. The most striking correlation, however, was found with the characteristics of CSF. While normal CSF values correlated with an overall incidence of complications of 39.2%, abnormal CSF values were correlated with a rate of complications of 90.9%; in particular, the rates of infective complications were 2.7% and 77.3%, respectively. On the grounds of these observations a protocol is proposed of temporary CSF external drainage in children requiring prompt relief of increased intracranial pressure but at risk for the presence of a leaking spinal defect or of a MM left unrepaired for more than 48 h.

Cerebrospinal Fluid Shunts↗

PubMed1995

Colorectal complications following cardiac surgery. Six-year experience.

PURPOSE: This study was undertaken to assess colorectal complications following cardiopulmonary bypass surgery. METHOD: This is a retrospective review of 5,801 patients who underwent 5,801 cardiopulmonary bypass procedures from 1985 to 1991. Patients were evaluated for type of bypass procedure, postoperative colorectal complications, age, sex, bypass time, aortic cross-clamp time, elective vs. emergency cases, uses of intra-aortic balloon pump, perioperative hypotension, and use of vasopressors. Statistical analysis was performed using chi-squared analysis and Student's t-test. RESULTS: Nineteen of the 5,801 patients developed 19 colorectal complications, a prevalence of 0.3 percent for the initial hospital stay following bypass surgery. Mortality in those with complications was 37 percent (7/19). Of the 19 complications, 9 (47 percent) followed coronary artery bypass grafting, whereas 10 (53 percent) followed valve replacement or combined coronary artery bypass grafting with other cardiac procedures. Five (26 percent) of the complications followed emergency cases, whereas 14 (74 percent) followed elective cases. Average age of those with complications was 69.8 years, compared with 63.2 years for those without complications. Average aortic cross-clamp time for those with complications was 71 +/- 25 minutes; pump time was 106 +/- 34 minutes. That was significantly higher than in those without complications. Nine (47 percent) patients with complications required vasopressors during the perioperative period, whereas eight (42 percent) suffered prolonged hypotension (systolic blood pressure, < 90 mmHg). CONCLUSIONS: It appears that increased age, valve replacement, or combined cardiac procedures, emergency procedures, and prolonged aortic cross-clamp and bypass pump times are risk factors for development of colorectal complications. Hypoperfusion, as suggested by prolonged pump times, clamp times, and emergency procedures may be a possible cause for development of colorectal complications.

Aged↗

PubMed1995

Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery.

OBJECTIVE: Internists frequently evaluate preoperative cardiopulmonary risk and co-manage cardiac and pulmonary complications, but the comparative incidence and clinical importance of these complications are not clearly delineated. This study evaluated incidence and length of stay for both cardiac and pulmonary complications after elective laparotomy. DESIGN: Nested case-control. SETTING: University-affiliated Department of Veterans Affairs Hospital. PATIENTS: Computerized registry of all 2,291 patients undergoing elective abdominal operations from 1982 to 1991. MEASUREMENT AND MAIN RESULTS: Strategy for ascertainment and verification of complications was systematic and explicit. The charts of all 116 patients identified by the registry as having complications and 412 (19%) randomly selected from 2,175 remaining patients were reviewed to verify presence or absence of cardiac or pulmonary complications, using explicit criteria and independent abstraction of pre- and postoperative components of charts. From these 528 validated cases and controls (23% of the cohort), 96 cases and 96 controls were matched by operation type and age within ten years. Hospital and intensive care unit stays were significantly longer (p < 0.0001) for the cases than for the controls (24.1 vs 10.3 and 5.6 vs 1.5 days, respectively). All 19 deaths occurred among the cases. Among the cases, pulmonary complications occurred significantly more often than cardiac complications (p < 0.00001) and were associated with significantly longer hospital stays (22.7 vs 10.4 days, p = 0.001). Combined cardiopulmonary complications occurred among 28% of the cases. Misclassification-corrected incidence rates for the entire cohort were 9.6% (95% CI 7.2-12.0) for pulmonary and 5.7% (95% CI 3.6-7.7) for cardiac complications. CONCLUSIONS: For noncardiac surgery, previous research has focused on cardiac risk. In this study, pulmonary complications were more frequent, were associated with longer hospital stay, and occurred in combination with cardiac complications in a substantial proportion of cases. These results suggest that further research is needed to fully characterize the clinical epidemiology of postoperative cardiac and pulmonary complications and better guide preoperative risk assessment.

Abdomen↗

PubMed2004

The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma.

BACKGROUND: Efforts to improve surgical outcomes have traditionally focused on improving preoperative patient selection and reducing the risk of postoperative medical complications. Strategies to optimize surgical technique have been less well studied. We sought to assess the relation between complications related to surgical technique and outcomes after esophagogastrectomy for cancer. STUDY DESIGN: Medical records of 510 consecutive patients undergoing esophagogastrectomy for invasive squamous cell carcinoma or adenocarcinoma at Memorial Sloan-Kettering Cancer Center from 1996 to 2001 were reviewed. Data on diagnosis, stage of disease, therapies received, surgical approach, patient comorbidities, technical complications, and postoperative medical complications and outcomes including length of stay and overall survival were determined by one reviewer of the medical records. The primary predictor was surgical complications and the primary outcome was survival. RESULTS: Of the 150 patients studied 138 (27%) had complications directly attributable to surgical technique, such as an anastomotic leak, a paralyzed vocal cord, or chylothorax. At 3 years 43 of 138 patients (31%) with technical complications were alive, whereas 179 of 372 patients (48%) without technical complications were alive. Technical complications were associated with increased length of stay (median 23 days versus 11 days, p < 0.001), increased in-hospital mortality (12.3% versus 3.8%, p < 0.001), and a higher rate of medical complications (77.5% versus 47.3%, p < 0.001). After controlling for age, medical comorbidities, use of induction therapy, tumor stage, histology, and location, and completeness of resection the presence of a technical complication was highly predictive of poorer overall survival; the multivariable hazard ratio was 1.41 (1.22 to 1.63, p = 0.008). CONCLUSIONS: Technical complications have a large negative impact on survival after esophagogastrectomy for cancer. Strategies to optimize surgical technique and minimize complications should improve outcomes in this cancer operation.

Adenocarcinoma↗

PubMed2005

Incidence of and risk factors for neurologic complications after heart transplantation.

INTRODUCTION: Following heart transplantation (HT), neurologic complications occur in 50% to 70% of patients, mostly in the perioperative period. The objective of our study was to analyze the frequency and impact of factors related to the development of neurological complications after HT. MATERIALS AND METHODS: HT patients with survival greater than 1 month (November 1987 to May 2003) were included. Heart-lung transplants, retransplants, and pediatric patients were excluded. Neurologic complications were defined as a neurologic event requiring hospitalization or detected in the hospital. Groups included ischemic or hemorrhagic stroke, seizures, neurotoxicity or other complications (e.g., infections, headaches, Alzheimer's). RESULTS: We assessed 322 HT patients (87.6% men, 12.4% women) and grouped them according to the presence of neurologic complications during follow-up. There were no differences in the baseline characteristics between the two groups. Of patients the patients studied, 13.7% suffered a neurologic complication: ischemic stroke (3.5%), neurotoxicity (2.9%), seizures (1.9%), and other complications (1.6%). Only two cases of hemorrhagic stroke (0.6%) were observed. Associations with pretransplant risk factors included seizures with diabetes mellitus (OR, 6.54; 95% CI, 1.28 to 33.6, P = .024), seizures with renal failure (OR, 5.95; 95% CI, 1.03 to 34.3; P = .046), and ischemic stroke with prior valvular disease (OR, 4.96, 95% CI, 1.22 to 20.1; P = .045). Associations with pretransplant risk factors were neurologic complications with the number of infections (OR, 1.35, 95% CI, 1.05 to 1.73; P = .02). No differences were found in survival of patients with neurologic complications. CONCLUSIONS: The incidence of neurologic complications in our series was 13.7%. The most frequent neurologic complication was ischemic stroke. Valvular disease as the underlying disease was associated with ischemic stroke. Diabetes mellitus and renal failure were associated with seizures. The number of posttransplant infections was associated with neurologic complications. There were no differences in survival of patients with neurologic complications.

Adult↗

PubMed1999

Risk adjustment for complications of hysterectomy: limitations of routinely collected administrative data.

OBJECTIVE: We sought to determine the utility of routinely collected administrative data for risk adjustment for complications of hysterectomy. STUDY DESIGN: Using abstracted discharge data on 107, 648 women undergoing hysterectomy in North Carolina from 1988 through 1994, we constructed logistic regression models for the prediction of medical and surgical complications incorporating coded demographic, diagnostic, and procedural data. RESULTS: The overall complication rate was 16%, with surgical complications (11.8%) more common than medical complications (6.7%). Hysterectomy type, teaching hospital status, patient age >/=65 years, and insurance status of Medicaid or no insurance were significantly associated with both medical and surgical complication risk, as were procedures performed for cancer or pregnancy complications. Models that incorporated coded comorbidity were better predictors of medical complications (C = 0.714) than surgical complications (C = 0.630). CONCLUSION: Although surgical complications of hysterectomy are more common than medical complications, risk adjustment methods that use routinely collected administrative data are better at predicting medical complications. Ambiguities in coding, misclassification, and uncoded factors such as disease severity limit the utility of administrative data for risk adjustment for hysterectomy complications.

Adult↗

PubMed2001

The early complications of cataract surgery: is routine review of patients 1 week after cataract extraction necessary?

OBJECTIVE: This study sought to define the nature and frequency of complications present 1 week after cataract surgery, to determine whether these complications are predictable, and to ascertain if patients undergoing cataract surgery require routine review at this time. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One thousand consecutive patients undergoing cataract removal by either phacoemulsification or extracapsular extraction at a large teaching hospital between January 1996 and May 1998. Patients with both complicated and uncomplicated histories and surgeries were included. MAIN OUTCOME MEASURES: Nature and frequency of complications present 1 week after cataract surgery. RESULTS: At the routine 1-week visit, postoperative complications were observed in 41 of 1000 patients (4.1%). Twenty-one (51%) of these patients had a completely unremarkable history to that point, and whereas only four (19%) were symptomatic, 20 (95%) required a change to their postoperative management. The most significant unexpected complications were uveitis (seven cases), cystoid macular edema (four cases), and vitreous to the wound, exposed knots, and loose suture (one case of each). Complications were present in 20 of 257 (7.8%) patients with a preoperative or surgical risk factor, and there was a significant relationship between preoperative (P = 0.02), and combined preoperative and intraoperative risk factors (P = 0.001), and complications present at the 1-week review. The relationship between surgical risk factors and 1-week complications was not significant (P = 0.07). There were coexistent pathologic features in 19% of all eyes. Registrars performed 38% of surgeries, and 96% of cataracts were removed by phacoemulsification. Operative complications occurred in 6.7% of patients, most commonly a posterior capsule tear (4.4% of all cases). Complications were observed in 10% of eyes on the first postoperative day. Raised intraocular pressure was the complication in 88% of these patients. CONCLUSIONS: This study provides an overview of modern cataract surgery in a large teaching hospital and indicates that abandonment of routine 1-week review may result in the failure to detect significant postoperative complications.

Eye Diseases↗

PubMed2001

Superficial and deep sternal wound complications: incidence, risk factors and mortality.

OBJECTIVES: Sternal wound complications often have a late onset and are detected after patients are discharged from the hospital. In an effort to catch all sternal wound complications, different postdischarge surveillance methods have to be used. Together with this long-term follow-up an analysis of risk factors may help to identify patients at risk and can lead to more effective preventive and control measures. METHODS: This retrospective study of 3008 adult patients who underwent consecutive cardiac surgery from January 1996 through September 1999 at Linköping University Hospital, Sweden, evaluated 42 potential risk factors by univariate analysis followed by backward stepwise multivariate logistic regression analysis. RESULTS: Two-thirds of the 291 (9.7%) sternal wound complications that occurred were identified after discharge. Of the 291 patients, 47 (1.6%) had deep sternal infections, 50 (1.7%) had postoperative mediastinitis, and 194 (6.4%) had superficial sternal wound complications. Twenty-three variables were selected by univariate analysis (P<0.15) and included in a multivariate analysis where eight variables emerged as significant (P<0.05). Preoperative risk factors for deep sternal infections/mediastinitis were obesity, insulin-dependent diabetes, smoking, peripheral vascular disease, and high New York Heart Association score. An intraoperative risk factor was bilateral use of internal mammary arteries, and a postoperative risk factor was prolonged ventilator support. Risk factors for superficial sternal wound complications were obesity, and an age of <75 years. The 30 day mortality was 2.7% for patients without sternal wound complications and 2/291 (0.7%) for all patients with sternal wound complications, 0.5% for superficial sternal wound complications, and 1.0% for deep sternal infections/mediastinitis. The 1 year mortality rate was 4.8% for patients without sternal wound complications and 11/291 (3.8%) for patients with sternal wound complications, 2.1% for superficial sternal wound complications, and 7.2% for deep sternal infections/mediastinitis. CONCLUSIONS: The risk factors found in this study have been detected and reported in previous studies. The predictive ability was stronger though for deep sternal infections/mediastinitis (those needing surgical revisions) than for superficial sternal wound complications. Earlier recognition of sternal wound complications and aggressive treatment have probably contributed to the relatively low mortality rate seen in this study.

Age Factors↗

PubMed2003

A comparison of three scoring systems for predicting complications after major lung resection.

OBJECTIVES: Although complications occur frequently after major lung resection, current predictive models are not entirely satisfactory. We devised a new predictive scoring system and compared it to two existing systems. METHODS: We performed an initial retrospective review of 400 patients who underwent major resection for lung cancer from 1980 to 1995. Predictive covariates (age, spirometry, diffusing capacity) associated with three or more complication groups were used to develop a scoring system. This system (EVAD) was then evaluated against the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and Cardiopulmonary Risk Index (CPRI) systems for patients operated between 1996 and 2001. RESULTS: Major resection for lung cancer included lobectomy (188) and pneumonectomy (30). Complication categories were: pulmonary (23; 10.5%); cardiovascular (24; 11.0%); infectious (8; 3.6%); other (29; 13.2%); nonfatal (45; 20.6%); and any (53; 24.2%). Death occurred in ten patients (4.6%). Mean EVAD scores were significantly different between groups with and without complications in all categories except infectious complications and death, whereas mean CPRI scores differed only for pulmonary complications, nonfatal complications, and death, and mean POSSUM scores did not appropriately differ for any complications. EVAD predicted incremental risk in all complication categories except cardiovascular, infectious, and death, whereas CPRI predicted incremental risk only for nonfatal and possibly any complications, and POSSUM did not predict incremental risk for any complication category. Receiver operating characteristic analysis demonstrated the EVAD system to be equivalent to or better than CPRI and POSSUM for all complication categories. CONCLUSIONS: A simple scoring system (EVAD) that utilizes pulmonary function test data and patient age predicts the likelihood of complications after major lung resection. It is easier to use and at least as accurate as other scoring systems currently in use.

Adult↗

PubMed1999

Surgical complications after pancreas transplantation with portal-enteric drainage.

BACKGROUND: Despite recent advances, surgical complications remain an important source of morbidity after pancreas transplantation (PTX). Several previous studies have delineated the surgical complications after PTX with systemic-bladder (S-B) drainage, but data are limited regarding the incidence and outcomes of surgical complications after PTX with portal-enteric (P-E) drainage. STUDY DESIGN: We retrospectively studied surgical complications after 83 vascularized PTXs with P-E drainage in 79 patients (65 simultaneous kidney-PTXs [SKPT] and 18 solitary PTXs [SPT], 8 pancreas alone and 10 pancreas after kidney transplantation). Twelve (15%) were retransplants. A surgical complication was defined as the need for repeat laparotomy within the first 3 months after PTX. RESULTS: A total of 53 surgical complications requiring repeat laparotomy occurred in 31 patients (37%). The incidence of surgical complications in SKPT and SPT was 38% and 33%, respectively. The most common indications for repeat laparotomy were: vascular thrombosis in 13% (SKPT 14% and SPT 11%), intraabdominal infection in 10% (SKPT 12% and SPT 0%), intraabdominal bleeding in 8% (SKPT 8% and SPT 11%), and duodenal allograft leak in 4% (SKPT 3% and SPT 6%). Patient survival rates at 1 and 3 years with versus without surgical complications were 84% and 80% versus 94% and 86%, respectively (p = NS). Pancreas graft survival rates at 1 and 3 years with versus without surgical complications were 48% and 44% versus 89% and 76%, respectively (p < 0.0001). The incidence of surgical complications was 45% in the first 42 P-E transplantations performed between 1990 and 1995, compared with 29% in the next 41 transplantations performed during 1996 and 1997 (p = NS). The mean number of repeat laparotomies per patient decreased from 1.2 in the former group to 0.5 in the latter group (p = NS). The incidence rates of vascular thrombosis, intraabdominal infection, and duodenal leak in the former and latter groups were 17% versus 10%, 12% versus 7%, and 2% versus 5%, respectively. CONCLUSIONS: Surgical complications after PTX are common, and their incidence and outcomes with P-E drainage are similar to those with S-B drainage. The complication rate does not vary according to the type of transplant (SKPT versus SPT). Increasing experience with P-E drainage results in a decreased incidence of surgical complications.

Adult↗

PubMed1997

Complications of pediatric craniofacial surgery in the Orient: analysis of a 10-year experience.

Numerous reports on the complications of craniofacial surgery have been published in the western world. However, relatively little such information concerning Oriental populations has been documented. We therefore set out to provide a retrospective analysis of all the complications of craniofacial surgery encountered during the 10-year period of 1986 to 1995 at Seoul National University Children's Hospital, the only children's hospital in Korea. Forty-nine children underwent 57 consecutive craniofacial procedures at our institution during 1986 to 1995. A retrospective chart analysis of the frequency and types of complications was performed. Mantel-Haenszel chi-square tests were then calculated for several factors, including age at surgery, duration of surgery, intraoperative losses of hemoglobin and hematocrit, total amount of blood transfusion, and the number of complications according to year, diagnosis, and operative procedure to find any significant correlation with the incidence of complications. Mortality was 1.8%. The major complication rate was 7.0% and included cases of visual loss and persistent cerebrospinal fluid leak. Analysis revealed the presence of several trends, including an increased incidence of complications with increased patient age at surgery, duration of surgery, and intraoperative loss of hematocrit. The number of complications was also noted to increase in cases with complex craniofacial synostosis syndromes (Crouzon's, Apert's Antley-Bixler, etc.) and tumors of the orbit and cranium. Finally, complications were noted to decrease in recent years, most likely due to the increased experience of our craniofacial team. Nevertheless, statistical analysis revealed that the incidence of complications correlated significantly only with increased duration of surgery (p < 0.05). The results of our study indicate that although craniofacial surgery in the Orient carries an inherent risk for significant complications, the risk can be minimized and the rate of mortality and major complications kept to an acceptable level by a careful and experienced craniofacial team. Groups at most risk for complications are those with a long duration of surgery.

Adolescent↗