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PubMed1998

Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting.

BACKGROUND: Biliary complications occur frequently after liver transplantation, and many are historically related to T tubes. Stents placed through the donor cystic duct have been used to attempt to reduce tube-related complications yet maintain access to the biliary tree. METHODS: The outcomes of all liver transplant procedures performed at the University of Michigan between December 7, 1990 (when transcystic stenting was first used), and April 6, 1995, were analyzed retrospectively. Preoperative, perioperative, and postoperative variables were studied in relationship to biliary complications. The management of complications was also reviewed. RESULTS: A total of 291 transplants qualified for study. The overall biliary complication rate was 25%, with no difference between the 237 patients who received transcystic stents, the 28 who received T tubes, and the 26 who received no tube. Among the complications patients experienced, 65% had stricture(s), 44% had stone or sludge formation, and 40% had a leak. Complications attributable solely to transcystic stents occurred in 4% of cases. Advanced age was the only preoperative variable associated with complications. Primary sclerosing cholangitis was associated with intrahepatic strictures, and prolonged cold ischemia time and rejection were associated with stone or sludge formation. Nonoperative management had the highest success rate for anastomotic stricture (76%) and the lowest for intrahepatic strictures (65%). Only one death was directly attributable to a biliary complication. CONCLUSION: Transcystic stenting reduces the incidence of significant tube-related complications, but not the frequency of other biliary complications. Biliary complications can usually be managed percutaneously or endoscopically, although intrahepatic strictures and large, early leaks frequently require reoperation. Aggressive, early management of these complications can reduce excess mortality to less than 2%.

Adolescent↗

PubMed2001

Complications of central venous catheterization in critically ill children.

OBJECTIVE: Analysis of central venous catheterization complications in different access sites with the Seldinger technique. Patients and Methods: A prospective study (May 1992 through December 1996) of 308 central venous catheterizations in children of different ages in a pediatric intensive care unit. RESULTS: Access sites were the subclavian vein (76.3%), femoral vein (20.4%), and jugular vein (3.2%). The frequency of catheter placement-related complications was 22%, and the frequency of serious catheter placement-related complications was 2.9% (pneumothorax 1.9%, hemothorax 1%). Catheter placement-related complications were more common in the subclavian than in the femoral vein (chi-square, p =.02) for the larger bore catheters (chi-square, p =.01) and for the higher number of attempts (Student's t -test, p <.001). Catheter placement-related complications were not related to the age, weight, or whether the procedure was performed by the staff physician or resident. The overall complication rate for maintenance-related complications was 36%. Maintenance-related complications were more common in younger children (Student's t -test, p =.03). The most frequent maintenance-related complications were mechanical complications (catheter obstruction and central venous thrombosis), and these were higher for femoral access (chi-square, p <.01) and for catheters indwelling for a longer period of time. Infection was found in 5.8% of patients, mainly due to Staphylococcus epidermidis. Infection was not related to the site of venous access or to the length of time the catheter was left indwelling. CONCLUSIONS: Central venous catheterization can be performed readily in children of all ages with an acceptable degree of risk. The immediate complications were more frequent and severe for subclavian vein catheterization, and the highest risk factor was the number of attempts at catheter insertion. Although the most frequent late complications were mechanical, which were higher for the femoral access and long-indwelling catheters, femoral catheters can be left indwelling for longer periods if routine ultrasound follow-up is performed. Infectious complications were independent of the venous access site or the duration of catheterization.

Journal Article↗

PubMed2005

Why do complications of gastrointestinal disease and procedures come as serial rather than singular events?

BACKGROUND: It often appears as if complications arising from gastrointestinal disease and interventional procedures come in 'series' and 'cluster' in individual patients. AIM: The aim of this study was to analyse the clustering of complications in terms of stochastic modelling and Markov chains. METHODS: A patient with gastrointestinal disease is simulated to move along either a 'bad track' associated with multiple consecutive complications or a 'good track' free of complications, the transitions within each track and between the two tracks being governed by probability values. RESULTS: Because the occurrence of a single complication increases the risk of further complications, subjects who encounter their first complication are more likely to experience a second, third or even more complications, before they leave the 'bad track' and their personal chain of cascading complications becomes discontinued. The model of a Markov chain explains why the overall number of complications in the total population of patients with digestive disease remains low even if individual patients are expected to encounter more than a single complication. CONCLUSIONS: Published complication rates for gastrointestinal procedures underestimate the true risk to the patient, because they do not consider the added vulnerability to cascading complications after the first event.

Cluster Analysis↗

PubMed2005

Complications of varicella in healthy children in Izmir, Turkey.

BACKGROUND: The purpose of the paper was to evaluate the indications of hospital admissions and complications of varicella infection in immunologically healthy children. METHODS: Between 1997 and 2001, patient records of children hospitalized due to varicella infection were reviewed. Incidence and clinical spectrum of complications and their distribution related to age and seasonal variations were analyzed. RESULTS: A total of 178 immunocompetent children were hospitalized for varicella complications during the study period. This resulted in a crude incidence of 6.3/100 000 population at risk. All hospital admissions were due to accompanying complications. The majority of complications occurred in preschool-age children with a median age of 3 years. No gender predominance was found. The most frequent complications were infectious complications, which were observed in 79 children (44%). Superinfections of the skin were present in 24 patients. Pneumonia was observed in 59 children: 49 had bacterial, 10 had viral pneumonia. Pyogenic arthritis was seen in two children and one had concomitant osteomyelitis. Group A beta-hemolytic streptococci were recovered from two patients with invasive bacterial infections. A total of 68 (38%) neurologic complications were observed. Cerebellar ataxia was present in 24, encephalitis was present in 17. Infectious complications occurred more frequently in younger children (median age: 2 years), whereas neurologic complications occurred at an older age (median age: 6 years). Hematologic complications were seen in nine children. There was a seasonal distribution of complications with a peak in January. CONCLUSION: Complications of varicella requiring hospitalization in immunocompetent children are more frequent than previously thought.

Arthritis, Infectious↗

PubMed1996

Alterations in lymphocyte phenotype and function in children with shigellosis who develop complications.

This study was designed to see whether alterations occur in peripheral blood mononuclear cell phenotype and function in children with Shigella dysenteriae 1 infection with complications (leukemoid reaction and/or hemolytic-uremic syndrome) and whether there are any alterations prior to the development of complications. The following groups of children (ages, 12 to 60 months) were compared: children without any infection (n = 51), children with uncomplicated shigellosis (n = 65), children admitted with complicated shigellosis (leukemoid reaction and/or hemolytic-uremic syndrome) (n = 29), and children with shigellosis who developed complications after enrollment (subsequently complicated shigellosis) (n = 12). Tests for the peripheral blood mononuclear cell phenotype (CD3, CD4, CD8, CD57 [corrected], CD20, and CD25), spontaneous proliferation, and the proliferative response to phytohemagglutinin, pokeweed mitogen, and the lipopolysaccharide of S. dysenteriae 1 were performed, as were skin tests for delayed-type hypersensitivity (DTH). Children who subsequently developed complications differed from other groups of children as follows: (i) the numbers of CD3+ and CD4+ cells were lower than in uninfected children (P < 0.05), (ii) the CD4/CD8 ratio was lower than in children with uncomplicated shigellosis (P < 0.05) and in uninfected children (P < 0.05), and (iii) the levels of spontaneous proliferation of peripheral blood mononuclear cells were higher and DTH responses were lower than those in children with uncomplicated shigellosis (P < 0.05 and P < 0.017, respectively). Children with complications differed by having (i) increased numbers of CD3- CD57- [corrected] CD20- cells (P < 0.05) compared with those in other groups of children and (ii) lower CD4/CD8 ratios (P < 0.05), higher levels of spontaneous proliferation (P < 0.05), and lower DTH responses (P = 0.005) than children with uncomplicated shigellosis. Three to five days after enrollment, the number of CD4+ cells increased in children who subsequently developed complications (P = 0.025), i.e., when they developed complications and at this time their CD4+ cell number was similar to that of other groups of children. Thus, lymphocyte phenotype and function are altered prior to the development of complications in children with shigellosis, and once complications develop, the pattern of alterations changes. Whether these alterations have a role in precipitating complications or whether they reflect early events underlying the development of complications remains to be elucidated.

Antigens, CD↗

PubMed1996

Cardiac catheter complications related to left main stem disease.

OBJECTIVE: To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database. SETTING: Coordinating centre for national database. DESIGN: Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. Complications involving the left main coronary artery were flagged at entry. Where necessary additional information was sought from participating centres. 112,921 procedures were registered, 12,849 of which were coronary angioplasties and the remainder diagnostic studies. RESULTS: The total number of cases for which complications were recorded was 993 (0.88%). In 61 (6.14%) of the 993 cases complications were associated with left main coronary disease or damage. In 57 (93%) of these 61 cases complications were major, necessitating resuscitation or immediate coronary bypass grafting. Ten patients (16%) died in the catheter laboratory, a further 9 (15%) within 24 hours, and a total of 23 patients (38%) died within one month of the procedure. Left main stem related complications account for 17% of total mortality in the CECCC database. Urgent coronary bypass grafting was attempted in 42 patients, of whom 31 were alive at one month. In all of the six reported PTCA-related complications the cause was traumatic damage to the left main coronary artery. Operators of all grades of seniority experienced complications in similar proportions. CONCLUSIONS: The risk of a complication relating to the left main stem is relatively low, but when such complications occur they tend to be life-threatening and contribute a fifth of total catheter-related mortality. In the absence of a widely available non-invasive investigation with good predictive value for left main stem disease, the best safeguard is careful technique. Patients who do develop complications should have emergency coronary bypass grafting.

Cardiac Catheterization↗

PubMed1998

Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. RANTTAS Investigators.

BACKGROUND AND PURPOSE: Medical and neurological complications after acute ischemic stroke may adversely impact outcome and in some cases may be preventable. Limited data exist regarding the frequency of such complications occurring in the first days after the ictus and the relationship of these complications to outcome. Our objective was to identify the types, severity, and frequency of medical and neurological complications following acute ischemic stroke and to determine their role in mortality and functional outcome. METHODS: Rates of serious (life-threatening) and nonserious medical and neurological complications and mortality were derived from the placebo limb of the Randomized Trial of Tirilazad Mesylate in Acute Stroke (RANTTAS) database (n=279). Complications were correlated with clinical outcome using logistic regression techniques. RESULTS: Of all patients, 95% had at least one complication. The most common serious medical complication was pneumonia (5%), and the most common serious neurological complication was new cerebral infarction or extension of the admission infarction (5%). The 3-month mortality was 14%; 51% of these deaths were attributed primarily to medical complications. Outcome was significantly worse in patients with serious medical complications, after adjustment for baseline imbalances, as measured by the Barthel Index (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.5 to 15.1) and by the Glasgow Outcome Scale (OR, 11.6; 95% CI, 4.3 to 30.9). After death was discounted, serious medical complications were associated with severe disability at 3 months as determined by the Glasgow Outcome Scale (OR, 4.4; 95% CI, 1.3 to 14.8). CONCLUSIONS: Medical complications that follow ischemic stroke not only influence mortality but may influence functional outcome.

Aged↗

PubMed1992

The complications of infective endocarditis. A reappraisal in the 1980s.

BACKGROUND: The frequency of complications of infective endocarditis and their influence on the outcome of the patients changed in the antibiotic era. Therefore, we evaluated the complications in a recent large series of patients with infective endocarditis. METHODS: We studied 300 episodes of endocarditis in 287 patients in a tertiary cardiology referral center. Predisposing cardiac conditions were valvular heart disease in 147 episodes, congenital heart disease in 37, other heart diseases in five, and prosthetic heart valves in 69. In 69 episodes, there was no previous heart disease. The infecting microorganisms were streptococci in 147 episodes, Staphylococcus aureus in 59, Staphylococcus epidermidis in 14, gram-negative bacteria in 16, other gram-positive bacteria in eight, and fungi in four. In 52 episodes, blood cultures were negative. Seventy-eight patients (26%) died. Complications were defined as any clinically unfavorable event occurring during treatment. RESULTS: A total of 386 complications occurred in 223 episodes (74%); one complication occurred in 128 episodes (57%), two in 57 (26%), three in 18 (8%), four in 13 (6%), five in three (1%), and six or more in three (1%). The complications were as follows: cardiac, 100 occurrences; neurological, 72; septic, 46; associated with medical treatment, 41; renal, 27; extracranial systemic arterial embolism, 16; septic pulmonary embolism, 26; complications related to surgical treatment, 11; acute prosthetic heart valve insufficiency, six; splenic infarction or abscess, three; cardiac rhythm disturbances, three; and other, 19. The distribution of the complications relative to outcome of the patients revealed that fatality exceeded survival rates for neurologic and septic complications. CONCLUSIONS: Complications may be common in patients with infective endocarditis. Cardiac complications were the most common ones, but fatality rates were higher for neurologic and septic complications. Hence, heart failure was replaced by neurologic and septic complications as the leading causes of death in patients with infective endocarditis.

Adolescent↗

PubMed2005

[Influence of complications on independence of patients with spinal cord injury in early rehabilitation].

OBJECTIVE: To evaluate the influence of complications on independence of patients after spinal cord injury during rehabilitation. MATERIAL AND METHODS: Data were collected on 130 patients with spinal cord injury admitted to the Clinic of Rehabilitation, Kaunas University of Medicine Hospital in 1999-2004. The study population consisted of 94 (72.3%) males and 36 (27.7%) females. Their age ranged from 16 to 80 years. The functional improvement was determined in terms of progress in independence in twelve daily living skills using Functional Independence Measure scale. Neurological status was evaluated by Standard Neurological Classification of traumatic spinal cord injury. Also, during early rehabilitation period complications were evaluated. Patients were divided into two groups: patients with complications and patients without complications during rehabilitation. More passive occupational therapy procedures were applied to patients with complications in comparison with patients without complications. RESULTS AND CONCLUSIONS: The results of the study showed that 44 (33.8%) cases were without complications during rehabilitation and 86 (66.2%) patients had complications. The most frequent complications were chronic pain (55.8%), urinary infection (43%), spasticity (30.2%) and pressure ulcers (20.9%). No statistically significant dependence was found between the rate of complications and age, gender and level of injury (p>0.05). Statistically significant dependence has been observed only between the rate of complication and completeness of injury (p<0.05). The change of the increased independence of patients without complications during rehabilitation was statistically significantly greater in comparison with patients who had complications (p<0.05).

Activities of Daily Living↗

PubMedDate not supplied

Thromboembolic and/or bleeding complications in patients under oral anticoagulation followed at a tertiary hospital.

UNLABELLED: A better understanding of the characteristics of patients that come to the anticoagulation (AC) clinic of a tertiary hospital could lead to better healthcare provision and reduce the number of thromboembolic and bleeding complications. OBJECTIVES: To evaluate the characteristics of patients followed at our AC clinic and to determine which factors could predict an increased risk of complications. METHODS: Data obtained by doctors through a questionnaire from patients attending the AC clinic of our hospital were analyzed. Demographic characteristics (gender, age, literacy, educational level), classical coronary artery disease (CAD) risk factors, the diagnosis that led to oral anticoagulation therapy (OAT) and its duration, the number of INR determinations, the minimum, maximum and current INR value and complications of OAT were studied. Complications were defined as bleeding and/or thromboembolic events occurring during the course of OAT. RESULTS: Of the 101 patients enrolled, 74 were female (73.3%), with a mean age of 6410 years (21-85). This population had had 4.53.5 years of schooling and there was a 15% incidence of illiteracy. The main reason for OAT was mechanical valve prosthesis implantation (56.4%). Each patient had an average of one CAD risk factor. The mean number of months of OAT was 99.489 (1-360). Sixty-six patients (65.3%) knew the reason for the therapy. Each patient had 1.20.6 INR determinations per month. Forty-five patients had bleeding and/or thromboembolic complications during OAT. There were 50 bleeding complications in 41 patients, seven leading to hospital admission. There were 7 thromboembolic events (central or peripheral), in 7 patients. The patients were divided into two groups: group I--with complications (GI) and group II--without complications (GII). There were 45 patients in GI, mean age 63.59.1 years (39-80), and 56 patients in GII, mean age 64.711.3 years (21-85). A greater number of complications were found in patients with mitral valve mechanical prostheses (GI--60.6%; GII--9.4%; p = 0.024). More complications were also found in patients with recommended maximum INR >3 (GI--55.2; GII--44.8; p = 0.013) and in those who had undergone dental procedures (GI--68.3%; GII--31.7; p < 0.001). The duration of OAT had the greatest predictive value for the development of complications (GI--138.196.5 months; GII--67.868.2 months; p < 0.00005). Multivariate analysis identified OAT duration as the only independent predictive factor. CONCLUSIONS: The high percentage of illiteracy found in this observational study could have hindered understanding of this sometim&e complex therapy. However, in our study this was not a significant predictor of complications. The predictive factors for bleeding and/or thromboembolic complications during OAT were the duration of therapy, the recommended maximum INR value and dental procedures. After multivariate analysis only the first variable was shown to be significant in this context.

Administration, Oral↗

PubMed1994

Complications of limb lengthening. A learning curve.

Major complication rates during limb lengthening were plotted in a consecutive series to produce a learning curve. All unwanted events during and after treatment were considered complications, and graded as minor, serious, and severe. All serious and severe complications were considered major. A novel system was used to classify the preoperative severity of each deformity. One-hundred ten patients had 140 bone segments lengthened between 2.2 cm and 10.5 cm, with a mean of 4.4 cm. Three methods were used in lengthening: the Wagner method in 22 patients, the DeBastiani method in 34 patients, and the Ilizarov method in 84 patients. Ninety-eight complications categorized as serious or severe occurred, for a total major complication rate of 72%. The percentage of major complications began to drop after 30 lengthenings to a current rate of 25%. Major complications were frequent in patients with more severe deformities, particularly in those whose cases occurred early in the series. Bone healing complications were high (72%) in the Wagner segments but were also high (80%) in the first ten patients treated with the DeBastiani technique. The first ten Ilizarov patients, who were treated later in the series, had a 40% rate of bone-healing complications. The current rate of major complications is 13% for those patients treated with DeBastiani's method and 33% for those patients treated with Ilizarov's method. This difference in complication rates appears to relate to the severity of the deformity, rather than the device used. There was a significant decrease in complications as experience was gained. Directed formal study and surgical instruction should help diminish these complications.

Adolescent↗

PubMed2004

Complications of abdominal urologic laparoscopy: longitudinal five-year analysis.

OBJECTIVES: To analyze complications of abdominal laparoscopic surgery of the urinary tract at a single institution during a 5-year period. METHODS: From 1996 to 2000, we identified 894 abdominal laparoscopic procedures performed at a single institution: 600 nephrectomies (live donor, simple, radical, nephroureterectomy, and partial), 112 pyeloplasties, 61 renal biopsies, 35 retroperitoneal lymph node dissections, 31 renal cyst ablations, 18 adrenalectomies, and 37 other abdominal procedures. The charts were retrospectively reviewed for complications, which were classified as operative, postoperative, or medical. Complications were correlated with patient age and American Society of Anesthesiologists score. Statistical analysis was performed with Fisher's exact test and chi-square tests. RESULTS: A total of 118 complications (13.2%) occurred. Two patients (0.2%) died. As a result of operative complications, the procedure of 13 patients (1.5%) was converted to an open one. As a result of postoperative complications, 13 (1.5%) underwent operative and 6 (0.7%) nonoperative intervention. The most common intraoperative complications were vascular (n = 23), adjacent organ (n = 10), and bowel (n = 9) injuries. The most common postoperative complications were neuromuscular pain (n = 12), hematoma (n = 11), urine leak (n = 7), and wound infection (n = 7). The differences in the annual complication rates for all procedures did not attain statistical significance (P = 0.5). Among all procedures, excluding live donor nephrectomy, complications of any kind correlated with a greater patient American Society of Anesthesiologists score (P = 0.01). CONCLUSIONS: Rather than decreasing, the overall incidence of laparoscopic complications did not change significantly during a 5-year period at our institution. The factors contributing to this observation likely included the progression of inexperienced individual surgeons through the learning curve, the introduction of new, more sophisticated laparoscopic procedures, and stable rates of patient comorbidity. This experience may represent the average complication rate for urologic laparoscopy at a large-volume, academic training center.

Adrenalectomy↗

PubMed2001

Surgical complications after primary nephrectomy for Wilms' tumor: report from the National Wilms' Tumor Study Group.

BACKGROUND: Surgical complications are a recognized morbidity of the treatment of patients with Wilms tumor. This study examines the incidence of surgical complications in the most recently completed study from the National Wilms' Tumor Study Group (NWTSG). STUDY DESIGN: The fourth National Wilms' Tumor Study (NWTS-4) enrolled 3,335 patients from August 1986 to August 1994. A random sample of 534 patients was selected from 2,290 eligible patients randomized to treatment regimens or enrolled in the followed category and treated according to NWXTSG protocol. The patient records received at the NWTSG Data and Statistical Center were analyzed for surgical complications (intraoperative and postoperative). RESULTS: Sixty-eight patients (12.7%) experienced 76 complications. Intestinal obstruction was the most common complication (5.1% of patients), followed by extensive hemorrhage (1.9%), wound infection (1.9%), and vascular injury (1.5%). The incidence of surgical complications in NWTS-4 was significantly lower than NWTS-3 (12.7% versus 19.8%, p < 0.001). There has been a marked decrease in the risk of extensive intraoperative bleeding and major intraoperative complications. Factors previously shown to be associated with an increased risk for surgical complications, together with indicators of type of hospital and surgeon specialty, were analyzed by multiple logistic regression analysis. Intravascular extension into the inferior vena cava (IVC), the atrium, or both (p = 0.02; odds ratio [OR] 3.8, 95% confidence interval [CI] 1.2, 11.8), and nephrectomy performed through a flank or paramedian incision (p = 0.02; OR 5.3, 95% CI 1.3, 22) were both associated with increased risk of complications. Tumor diameter greater than or equal to 10cm was also associated with an increased risk of surgical complications (p = 0.05; OR 2.0, 95% CI 1.0, 3.9). The risk of complications was higher if the nephrectomy was performed by a general surgeon (OR 9.0, 95% CI 1.3, 65; p = 0.03) rather than a pediatric surgeon (reference group, OR 1.0) or pediatric urologist (OR 0.7, 95% CI 0.3, 1.8). CONCLUSIONS: The incidence of surgical complications in NWTSG patients undergoing primary nephrectomy has significantly decreased over the past decade. But surgical morbidity should not be overlooked. It is important that surgeons treating young children with solid tumors are aware of their role and the potential risks encountered in removal of the primary tumor. This study found that surgical specialists who primarily treat children can perform these operations with lower surgical morbidity.

Chemotherapy, Adjuvant↗

PubMed1997

Endoscopic sinus surgery complications in residency.

Otolaryngology has seen a rapid proliferation of functional endoscopic sinus surgery, and there is variability in the teaching of the procedure, in part because of the seriousness of the complications. A retrospective review of 106 consecutive cases was conducted at a teaching program to evaluate complications. Complication rates were combined and compared with the reported complication rates of other teaching programs and practicing otolaryngologists. The complication rate in our program was 13.9%; all were minor complications. This compared favorably with the rates of other programs (6% to 29%). The combined complication rate for residency training programs (16.6%) was significantly greater than the nonresident complication rate (10.5%). When divided into major and minor complications, the resident minor complication rate (15.9%) was significantly greater than the nonresident rate (8%), yet the major complication rates were significantly less for the resident group (0.7%) than for the nonresident group (2.5%). In addition, complications were significantly greater when procedures were performed under general anesthesia as compared with local anesthesia, and estimated blood loss was significantly greater under general anesthesia.

Adolescent↗

PubMed2002

[Complications after radical cystectomy in patients with bladder carcinoma].

OBJECTIVE: To describe the frequency and type of complications after radical cystectomy for cancer of the urinary bladder and their relationship with the different types of urinary diversion techniques utilized. METHODS: We conducted a retrospective study of 166 patients who underwent radical cystectomy in the same department of urology over a period of 12 years. The intraoperative, early, late complications and the need for postoperative treatments are analyzed according to percentages, main trends, scatter and confidence interval. RESULTS: 87.3% of the patients were male. The most common tumor stage was pT3 (37.9%). Transintestinal urinary diversion was performed in 81.1%; the most common being cutaneous ureteroileostomy (44%) and external diversion (64.1%). 16.7% presented hyperchloremic metabolic acidosis. Intraoperative, early and late complications were observed in 53.6%, 47.5% and 71.1% of the survivors for each time period, respectively. 28.3% of the patients required some type of medical treatment in the course of their disease and 30.7% required some type of surgical or percutaneous procedure. The most frequent complications were intraoperative bleeding (50%), respiratory complications early postoperatively (12.6%) and chronic urinary infection as late complication (30.7%). CONCLUSIONS: The high percentage of complications in our series is basically due to the fact that all types of complications, whether directly related or not to the disease and surgical procedure, were included. There was a higher incidence of late complications, the survival time being an important factor that influences the presentation of these complications. Complications are directly related to the type of urinary diversion performed, patient age, tumor stage and previous morbidity. The appearance of complications carries a high percentage of long-term complementary medical treatments or surgical and percutaneous procedures.

Aged↗

PubMed2003

[Surgery for morbid obesity: 2. Complications. Results of a Technologic Evaluation by the ANAES].

The frequency of bariatric surgery has increased markedly in France in recent years, partly due to a better appreciation of the problem of morbid obesity but also due to the commercial introduction of adjustable gastric banding devices which can be placed by laparoscopic approach. Numerous complications of this surgery are known and require recognition to be appropriately treated. Studies of complications suffer from selection bias, methodologic flaws, and lack of follow-up. The incidence and type of complication are affected by the learning curve and surgical techniques. Postoperative mortality varies from 0.14% for laparoscopic gastric banding (LGB), to 0.31% for vertical banded gastroplasty (VBGP) and 0.35% for Roux-en-Y gastric bypass (GBP); pulmonary embolus accounts for 60-70% of deaths in all groups combined. Early post-operative complications vary with specific procedures. Abdominal wall complications, already frequent in an obese population, are decreased from 10% for open procedures to 6% for laparoscopic gastric banding. Both VBGP and GBP are now being done laparoscopically with increasing frequency. Complications specific to LGB include gastric perforation (0.3%), or port problems (5%). Complications with VBGP and GBP include fistula (1-3%), deep abscess, and pulmonary embolus (2%). Global early morbidity is 4.2% for LGB, and varies from 6.4%-22% for VBGP and 6.2%-11.3% for GBP depending on laparoscopic versus open approach. Late mechanical complications are also specific to type of surgery. Pouch dilatation is the most common late complication of LGB (6.3%) and seems related both to operative experience and to site of placement of the band; it has decreased with higher positioning of the band to leave a minimal gastric pouch and with dissection through the pars flaccida of the lesser omentum instead of directly along the muscular wall of the stomach. It usually requires reintervention. Erosion of the gastric band into the stomach (1.6%) is often asymptomatic and is suggested by late weight gain. With VBGP, disruption of a gastric staple line occurs in 12.1% and stenosis of the outlet with proximal dilatation in 6.5%; erosion of the calibrating band of Marlex or silastic occurs in 2.7%. With GBP, the disruption of a staple line across an intact stomach (23%) has become less of a problem with division of the gastric pouch from the distal stomach (2%). Stenosis of the gastrojejunostomy (3.7%) and marginal ulcer (3.5%) are not uncommon. The incidence of wound hernia, obstructive adhesions, and late cholecystectomy vary with the length and thoroughness of follow-up. Late functional complications such as vomiting, dysphagia, heartburn and esophagitis vary with the quality and length of follow-up study. GBP may cause diarrhea and dumping syndrome. Nutritional complications are more common with GPB than with purely restrictive procedures; iron, folate, and Vitamin B12 deficiency are the rule with GBP and require routine replacement therapy; iron deficiency has been noted even with LGB. ate death seems more related to co-morbidities than to the intervention itself. Thorough long-term follow-up study of complications is indispensable for assessment of outcomes and improvement of laparoscopic techniques. Even the less traumatic surgical approach of laparoscopic band placement should not be considered free of risk; strict adherence to pre-operative surgical indications should be maintained.

Adult↗

PubMed2006

Anesthesia-related complications in children.

BACKGROUND: Careful preoperative assessment and adequate planning of an appropriate anesthetic are the cornerstones safe pediatric anesthetic practice. A prospective study was carried out in pediatric surgical patients to identify and quantitate both intra-operative and post anesthesia recovery room complications, management and outcome. METHODS: Two hundred and seventy children, aged day 1-16 years who had surgery over twelve months period were recruited in the study. There were 151 males (56%) and 119 females (44%). There were 15 neonates (5.5%), 69 infants below 1 year (25%), 99 (36.7%) toddlers and younger children (1-5 years); older children >5 years were 87 (32.2%). Anesthetists managing the patients were free to use drugs and technique they considered appropriate for each patient. A standardized form was used to collect patient's details, type of surgery, technique of anesthesia, duration of anesthesia and surgery. The incidence of intra-operative and post-anesthesia recovery room complications was determined. RESULTS: Twenty five intraoperative complications were recorded in 14 (5.1%) patients while forty postoperative complications were recorded in 25 (9.25%) patients. The incidence of intraoperative complications was 9.3% while that of postoperative complications was 14.8%. There were no statistically significant differences. P = 0.0635, Odds ratio = 0.5867, 95% CI: 0.3449 - 0.9981. Intraoperative adverse events were mainly cardiovascular and respiratory. After cardiovascular complication, pain was the second commonest postoperative complication observed in the recovery room. Occurrence of complication was not related to ASA physical status but the outcome of management of complications was directly related to ASA status. Three preterm infants weighing 1.6 kg, 1.9 kg and 2 kg respectively were transferred to Intensive Care Unit for ventilatory support. Neonates and infants < below 12 months old had the highest rate of adverse events both intraoperatively and in the postanesthesia recovery room. There were two cases of cardiac arrest. Mortality rate was 0.34%. CONCLUSION: Preterm infants are more prone to developing respiratory complications. Anesthesia-related morbidity and mortality can either be minimized or avoided with early identification and prompt management of any complication.

Adolescent↗

PubMed2003

Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients.

HYPOTHESIS: Infectious complications are the main causes of postoperative morbidity in abdominal surgery. Identification of risk factors, which could be avoided in the perioperative period, may reduce the rate of postoperative infectious complications. DESIGN: A database was established from 3 prospective, randomized, multicenter studies. Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio (OR). SETTING: Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals). PATIENTS: From June 1982 to September 1996, a database was established containing the information of 4718 patients who underwent noncolorectal abdominal surgery. MAIN OUTCOME MEASURES: The dependent variables studied included surgical site infection (SSI) (divided into parietal and deep infectious complications with or without fistulas) and global infectious complications (SSI and extraparietal and abdominal infectious complications). RESULTS: The rate of global infectious complications was 13.3%; SSI, 4.05%; parietal infectious complications, 2.2%; deep infectious complications with fistulas, 2.18%; and deep infectious complications without fistulas, 1.38%. In multivariate analysis, the following 7 independent risk factors for global infectious complications have been identified: age (60-74 years, OR, 1.64; >or=75 years, OR, 1.45); being underweight (OR, 1.51); having cirrhosis (OR, 2.45), having a vertical abdominal incision (OR, 1.66); having a suture placed or an anastomis of the bowel (OR, 1.48) in the digestive tract; having a prolonged operative time (61-120 minutes, OR, 1.66; 121 minutes, OR, 2.72); and being categorized as having a class 4 surgical site (ie, obese patients or having a risk factor of a healing defect) (OR, 1.66). Ceftriaxone sodium therapy was identified as a protective factor (OR, 0.43). In multivariate analysis, the following 5 independent risk factors for SSI have been identified: the existence of a preoperative cutaneous abscess or cutaneous necrosis (OR, 4.75), having a suture placed or an anastomosis of the bowel (OR, 1.82) in the digestive tract, having postoperative abdominal drainage (OR, 2.15), undergoing a surgical procedure for the treatment of cancer (OR, 1.74), and receiving curative anticoagulant therapy (OR, 3.33) postoperatively. CONCLUSIONS: Our data show that risk factors for SSI and for global infectious complications are disparate. Indeed, only the placement of a suture or having an anastomosis of the bowel in the digestive tract is a risk factor for both SSI and global infections. Some of these factors may be modifiable before or during the surgical procedure to reduce the infection rate or to prevent postoperative complications.

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