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PubMed1988

Ruptured aortic aneurysms: postoperative complications and their management.

Postoperative complications in 92 patients undergoing repair of ruptured abdominal aortic aneurysms are reviewed. Renal failure and cardiac complications were fatal in 74% and 85% of the patients, respectively. Preoperative renal function at the time of presentation had no correlation with the development of renal failure. All but one patient in whom the left renal vein was divided developed renal failure postoperatively. There also was a preponderance of this complication in the patients needing suprarenal aortic control. Respiratory complications were seen in 29% of patients with 22% mortality. Peripheral emboli and ischemic colitis developed in 8% and 9% of the patients, respectively.

Aged↗
PubMed2005

Risk factors for postoperative complications after liver resection.

BACKGROUND: Liver resection is still a complicated operation with a high risk of postoperative morbidity. This study was undertaken to analyze the risk factors for postoperative complications after liver resection. METHODS: From 2001 to 2004, a total of 146 patients underwent liver resection for malignant or benign lesions. Postoperative complications after the resection were classified as surgical and medical, their incidences were analyzed retrospectively. The risk factors for both surgical and medical complications were analyzed. To increase the safety of liver resection, surgical techniques were modified after April 2003, including control of inflow or outflow and intra-operative test with methylene blue. RESULTS: Before April 2003, a series of 58 patients received liver resection. Modified surgical techniques were used in liver resections for 88 patients after April 2003. A total of 36 patients (24.7%) had postoperative complications. Surgical and medical complications occurred in 24 and 13 patients respectively (One patient had both surgical and medical complications). Perioperative blood transfusion was related to a higher risk of surgical complications (P < 0.05). Patients with diabetes mellitus were associated with a higher risk of medical complications (P < 0.05). Surgical complications and postoperative hospitalization were decreased after the use of modified surgical techniques (P < 0.05). CONCLUSION: Postoperative surgical complications can be decreased by modified surgical techniques, and careful selection of patients for liver resection may help to decrease postoperative medical complications also.

Adult↗
PubMed2001

[Early postoperative complications of choledochal cyst excision and reconstruction of biliary tract].

OBJECTIVE: To study the early postoperative complications of choledochal cyst excision with reconstruction of the biliary tract. METHODS: In last 10 years, 173 patients aged from 27 days to 14 years (mean = 2.4 years) were operated on with procedures of choledochal cyst excision and biliary tract reconstruction by jejunointerposition between the liver hilum and duodenum or Roux-en-Y hepaticojejunostomy in our hospital. Amongst these 173 patients, 16 were found to suffer from postoperative complications. Therefore, their clinical data were retrospectively analyzed, and the prevention and treatment of the early postoperative complications discussed. RESULTS: The morbidity of early postoperative complications was 9.3% (16/173). The early complications included biliary leakage in 10 patients, wound dehiscence of abdominal wall in 3, hepatic failure in 1, pancreatic fistula in 1, and postoperative enteric intussusception in 1. The morbidity of early postoperative complications in infants younger than 1-year old was significantly higher than that in children(chi 2 = 15.78, P < 0.01). However, there was no significant difference in the morbidity of early postoperative complications between patients undergoing biliary tract reconstruction by jejunal segment interposition and those undergoing that by Roux-en-Y hepaticojejunostomy (chi 2 = 0.07, P > 0.05). The total mortality in all the operated patients was 2.3% (4/173). Three patients died from biliary leakage and 1 from postoperative hepatic failure. CONCLUSIONS: Biliary leakage, wound dehiscence of abdominal wall and hepatic failure are major early postoperative complications. The morbidity in infants younger than 1-year old is higher than in children. The preoperative treatment of biliary tract infection, hypohepatia, and surgical skills during operation should be emphasized. Reoperation for biliary leakage should not be delayed and mycotic cholangitis after biliary leakage needs more attention. Tension suture in the fascial space of the abdominal wall is useful for the prevention and treatment of abdominal wall dehiscence.

Adolescent↗
PubMed2005

[Radical cystectomy early postoperative complications and mortality rate].

The aim of this study is to determine mortality rate, intraoperative, early postoperative complications and length of postoperative hospitalization in patients treated with cystectomy carried out for radical or palliative purposes. TESTS AND METHODS: This retrospective study included 57 patients that were treated in the Urological Clinic Clinical Centre University of Sarajevo in period from January 2000 until July 2004, for bladder cancer. RESULTS: Early mortality rate was 3.5%, early postoperative complication rate was 33.2% and it normally included prolonged ileus, wound dehiscence and urinary infection. CONCLUSION: Early mortality and the intraoperative one did not rise when compared to the results indicated in professional literature; early postoperative complications and length of postoperative hospitalization increased. Postoperative mortality and early postoperative complication rates are not statistically in patients over the age of 70 but they depended on concomitant diseases (comorbidity) and general health status of patients.

Adult↗
PubMed1983

Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications.

One hundred seventy-nine eyes were analyzed to determine the incidence of postoperative complications after vitrectomy for proliferative diabetic retinopathy. One hundred twenty-nine (72%) of the 179 eyes achieved improved vision, and 117 (65%) were considered visual successes with final vision in the functional range of 5/200 or better. Corneal epithelial defects occurred in 51 eyes (28%), but severe corneal complications were rare, and no eye developed corneal clouding as the sole cause of later visual loss. The lens was retained in 128 eyes (75%), and visually significant lens opacities occurred later in 17% of the phakic eyes. Postoperative iris neovascularization was reduced by not removing the lens, and rubeosis iridis occurred in 15 (13%) of 114 phakic eyes and in 21 (32%) of 65 aphakic eyes (P = 0.012). Vitreous hemorrhage was present in 75% of eyes immediately after surgery and cleared in an average of 6.2 weeks in phakic eyes and 5.4 weeks in aphakic eyes. Fifty-two eyes (29%) had recurrent vitreous hemorrhage after the initial postoperative period. New retinal detachment occurred after surgery in 16% of eyes and was treated successfully in 38%. Reoperations were done in 45 eyes (25%), and 32 (71%) of these were for repair of retinal detachment or removal of nonclearing vitreous hemorrhage. Six eyes (3%) developed phthisis bulbi, and one other eye was enucleated.

Adult↗
PubMed2001

Postoperative altered plasma growth hormone levels--a predictor for postoperative complications? A case report.

We compared the onset of predictors for postoperative complications (lactate, total T2 (tT2), total T4 (tT4) and cortisone) retrospectively with the onset of altered growth hormone (GH) concentration in a patient who had had a lethal postoperative outcome and in 13 patients who were without postoperative complications for a period of 24 hours postoperatively. Compared with the values of the patients without postoperative complications, GH values were elevated (68-fold) 1 h after surgery to 103 ng/ml and lactate was increased (12-fold) to 12.7 mmol/l at 6 h postoperatively in the patient with the lethal outcome. The other parameters measured (tT3, tT4 and cortisone) showed no rapid alteration during the first hours postoperatively. This case report suggests that the rapid postoperative onset of raised GH concentration in plasma may be an earlier marker for postoperative complications than the 'established' predictors.

Aged↗
PubMed2005

The relationship between postoperative complications and outcomes after hip fracture surgery.

INTRODUCTION: We studied the prevalence of postoperative complications in a series of consecutive patients who received surgery for hip fractures in a major public hospital in Singapore. We also studied the predictors for the occurrence of complications and the impact of these complications on patient outcomes. MATERIALS AND METHODS: A retrospective chart review of patients admitted with hip fracture, from March to November 2001, was carried out. Patients were classified as having postoperative complications if they developed any of the following conditions after surgery: dislocation of prosthesis, deep vein thrombosis, postoperative confusion, foot drop, stroke, cardiac arrhythmias or acute myocardial infarctions, urinary retention, urinary tract infection, pneumonia, wound infection and incident pressure sores. RESULTS: Of the 180 patients studied, 60 developed postoperative complications. Significant predictors of complications after logistic regression included being of female gender [odds ratio (OR), 2.79; 95% confidence interval (CI), 1.13 to 6.89] and pre-fracture mobility status (OR for independent ambulators 0.45; 95% CI, 0.23 to 0.87), but not the age of the patients. Postoperative complications significantly affected the length of stay within the acute hospital (beta coefficient, 6.42; 95% CI, 2.55 to 10.29), but were not associated with a decline in mobility status at 3 months post-fracture, eventual discharge destination or readmission within 1 year. CONCLUSION: Postoperative complications are common after surgery for hip fractures and result in significantly longer hospitalisation periods. Significant predictors for such complications include being of female gender and pre-fracture mobility. Age, in itself, does not result in a higher risk of complications and should not preclude older hip fracture patients from surgical management.

Aged↗
PubMed1996

[Lung scintigraphy and ergospirometry in prediction of postoperative course in lung resection candidates with increased risk of postoperative complications].

Patients with impaired pulmonary function are at increased risk for the development of postoperative complications. We therefore analyzed the value of preoperative lung scanning and exercise testing for the prediction of postoperative complications and of the short- as well as long-term performance in lung resection candidates at increased risk for complications. Twenty-five (mean age 63 y; 17 m) out of 84 consecutive lung resection candidates were considered at increased risk for postoperative complications due to impaired pulmonary function (FEV1 < 2L or diffusion for carbon monoxide (DLCO) < 50% predicted, or FEV1 and DLCO < or = 80% predicted combined with New York Heart Association dyspnea index > or = 2). Candidates underwent radionuclide perfusion scans and exercise testing to predict postoperative ( = ppo) values for FEV1, DLCO and maximal O2-uptake (VO2max). They all underwent thoracotomy for neoplastic lesions; 7 had pneumonectomies, 18 lobectomies. Six had postoperative complications (within 30 days), of whom three died. Three and 6 months postoperatively, pulmonary function tests and VO2max were repeated. In the 22 survivors, the observed values were then compared with the predicted values. At 3 months, there were excellent correlations (absolute/predicted values): for FEV1r = 0.78 and 0.81; for DLCOr = 0.77 and 0.74; and for VO2max r = 0.71 and 0.83. The means of FEV1 and VO2max did not differ from the predicted values, whereas the predicted DLCO was lower than the observed value (ml/min/mmHg: 15.1 vs 17.9; percent predicted: 59.6 vs 70.9) (p < 0.05). At 6 months, correlations remained very good for FEV1 (r = 0.81 and 0.84) and for DLCO (r = 0.76 and 0.74), but had decreased for VO2max to 0.56 and 0.65, respectively. All means were higher than predicted (p < 0.05) owing to recovery in the lobectomy group. Patients with postoperative complications (group B) had a lower preoperative VO2max in percent predicted (62.8 +/- 7.5% vs 84.6 +/- 19.7%) (p < 0.01) and also a lower VO2max-ppo (10.6 +/- 3.6 vs 14.8 +/- 3.5 ml/kg/min and 44.3 +/- 13.5 vs 68.0 +/- 20.7 percent predicted) (p < 0.05) than patients without complication (group A). AVO2max-ppo < 10/ml/kg/min was associated with a 100% mortality. Although FEV1-ppo and DLco-ppo were lower in group B the difference did not reach significance. We conclude that radionuclide-based calculations of postoperative VO2max are predictive of perioperative morbidity and mortality: a VO2max-ppo of < 10 ml/kg/min may indicate inoperability. Further, short-term postoperative performance is accurately predicted by FEV1-ppo and VO2max-ppo, but long-term function is underestimated after lobectomy.

Adult↗
PubMed2001

[Orthopaedic one day surgery: anaesthesiologic techniques used and intra- and postoperative complications].

OBJECTIVE: Optimize patient management in one day surgery (ODS) by an observative study regarding one day orthopaedic surgery, assessing kind and quantity of intra- and postoperative complications, need for prolonged postoperative assistance postponing discharge, recovery in other hospitals, patients satisfaction index. METHODS: From september 1999 until december 2000 we distributed a questionnaire 1286 consecutive patients. The patients were ASA I (80,7%), ASA II (17%) and ASA III (2,3%). We evaluated intra- and postoperative complications considering type of surgery and anaesthesiologic technique; need and reason for medical consulting; if consulting took place in other institutes. Patients judgement regarding medical and nursing assistance during in hospital stay was assessed. RESULTS: Main surgical procedures: arthroscopy (44,6%), internal fixation removal (21,3%), neurolysis (9,5%), cysts/tumours/nodules removal (7,5%), foot surgery (8,0%). Used anaesthesiologic techniques: neural block (65,6%), plexus block (15,1%), general (12,5%), spinal (4,8%) and local anaesthesia (1,9%). An intraoperative complication (convulsion) was reported twice. Postoperative complications: pain (3,6%) most frequent in foot surgery (5,2%), nausea (0,2%), fever (0,7%), haematoma (0,5%). 5 delayed discharges (beyond 24h) were reported, for surgical reasons. In 5 cases another institute was visited. There were no deads. CONCLUSIONS: The percentage of not planned recoveries (0,1%) is an indication of frequency of major complications. Satisfaction index of patients was high (96%). Kind of surgical procedure and anaesthesiologic technique, considering the minimal intra- and postoperative complications, are adjusted to the ODS regime. Reinforcing analgesic protocols in foot surgery though are necessary. According to our opinion the peripheral block is preferable in orthopaedic ODS.

Ambulatory Surgical Procedures↗
PubMed1987

Silicone oil removal. II. Operative and postoperative complications.

A retrospective study of the effects of silicone oil removal was carried out on 85 patients who had undergone pars plana vitrectomy and silicone oil exchange for giant retinal tears or proliferative vitreoretinopathy. Silicone oil was removed either as part of the treatment of anterior segment complications such as glaucoma and keratopathy (25 patients) or in order to prevent these complications (60 patients). The major complications of the removal of silicone oil were retinal redetachment (25%), hypotony (16%), and expulsive haemorrhage (1%). The length of time that the oil remained in the eye and the presence of anterior segment complications did not appear to have an effect on the rate of retinal redetachment or hypotony.

Corneal Diseases↗
PubMedDate not supplied

Age related risk and prevention of postoperative complications.

Perioperative morbidity in elderly patients has decreased in last years, with the advent of newer surgical, anaesthetic and monitoring techniques, but is still important when compared with that of younger patients. Complications in the post-operative show different frequencies and mainly depend: a) on age-related conditions of pulmonary, cardiovascular and renal functions, of C.N.S. and of nutritional status; b) on surgery and medication-related risk factors, inclusive of emergency, bedrest, analgesia and infusions, drugs and intensive care; c) on neoplastic or non-neoplastic disease, type of surgery and surgeon's experience. Appropriate surgical intervention, therefore, should not be deferred because the patient is elderly, but surgeon must look beyond measured indices to the qualities of vitality and motivation.

Age Factors↗
PubMed1982

[Interruption of pregnancy by vacuum aspiration or uterotomy. Intra- and postoperative complications].

From 1971-1977, 1097 pregnancy-interruptions were performed by vacuum-aspiration and 152 by uterotomy. In 93,3% of the patients a psychiatric indication was registered and in 6,7% the interruption was medicosomatically indicated. Surgery was done under stationary conditions in anaesthesia with halothane/N2O. 39,5% of the women operated were unmarried, 34,1% primigravides and 39,7% without children. Before the undesired pregnancy approximately half of the patients did not practice contraception. The average interval between first visit to the doctor and interruption was 18,9 days. 77% of the vacuum-aspirations were performed in pregnancies of 10 to 12 weeks, 42,7% of the uterotomies after the 12th week. Simultaneous sterilization was undertaken in 35,9% of the cases after vacuum-aspiration. The rate of complications of vacuum-aspiration was 25,8%, after uterotomy 16,5%.

Abortion, Induced↗
PubMed1998

[Postoperative complications in proximal stomach resection].

During 20 years (1972-1994) the authors carried out proximal resections of the stomach in 106 patients for cancer of proximal part of the stomach extended to the esophagus. Morphological verification data are presented. Total lethality rate made up 20.8%. It decreased with gaining of experience and improvement in selection of patients (1972-1982--29.6%, 1983-1994--17.7%). The most common complication in postoperative period was exudative pleuritis: in 16% of operated patients insufficiency of sutures of the esophagogastric anastomosis was observed. For prophylaxis of suture insufficiency pyloroplasty by Heineke-Mikulich and continuous (to 4-5 days) naso-gastral drainage were of principal significance. Great importance was attached to establishment of the anastomosis by the method developed by the authors. The results of the operations depend also on the operative approach: two-stage combined approach (laparotomy, thoracotomy) brings the least lethality.

Adenocarcinoma↗
PubMed2003

[Postoperative complications of refractive surgery, Lasik technique].

PURPOSE: To determine the postoperative complications of laser Excimer surgery, LASIK technique. MATERIAL AND METHOD: We studied 142 eyes with different refractive defects operated with laser Excimer. RESULTS: The early postoperative complications were: DLK stage 11/III--6 eyes, Hase--24 eyes, Epitelial Ingrowth în 2 eyes and Central Islands în 2 cases. Late postoperative complications were: secondary glaucoma after steroids administration în 1 case and subcorrection în 19 eyes. CONCLUSION: A quickly treatment of postoperative complications after LASIK technique assure the estimated functional results.

Adolescent↗