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PubMed2006

Association of postoperative complications with hospital costs and length of stay in a tertiary care center.

BACKGROUND: Postoperative complications are a significant source of morbidity and mortality. There are limited studies, however, assessing the impact of common postoperative complications on health care resource utilization. OBJECTIVE: To assess the association of clinically important postoperative complications with total hospital costs and length of stay (LOS) in patients undergoing noncardiac surgery. METHODS: We determined total hospital costs and LOS in all patients admitted to a single tertiary care center between July 1, 1996 and March 31, 1998 using a detailed administrative hospital discharge database. Total hospital costs and LOS were adjusted for preoperative and surgical characteristics. RESULTS: Of 7,457 patients who underwent noncardiac surgery, 6.9% developed at least 1 of the postoperative complications. These complications increased hospital costs by 78% (95% confidence interval [CI]: 68% to 90%) and LOS by 114% (95% CI: 100% to 130%) after adjustment for patient preoperative and surgical characteristics. Postoperative pneumonia was the most common complication (3%) and was associated with a 55% increase in hospital costs (95% CI: 42% to 69%) and an 89% increase in LOS (95% CI: 70% to 109%). CONCLUSIONS: Postoperative complications consume considerable health care resources. Initiatives targeting prevention of these events could significantly reduce overall costs of care and improve patient quality of care.

Adult↗

PubMed2003

Prevention and treatment of postoperative complications of the penile elongation.

To explore the causes of the postoperative complications of the penile elongation and the measures to prevent them in order to raise the success rate of the penile elongation. 1,000 patients who had received the penile elongation were reviewed and analyzed for the causes of postoperative complications, and the measures of prevention and treatment were discussed. Our results showed that, of the 1,000 cases, 64 had the postoperative complications, including 20 cases of edema of prepuce, 15 cases of flap necrosis, 12 hematoma, 9 infections, and 8 cases of fat and clumsy penis. It is concluded that correct operative manipulation, strict aseptic measures and necessary postoperative care and management could avoid or reduce the postoperative complications. When complications happened, a satisfactory result can be achieved with timely and correct treatment in the majority of the patients.

Adolescent↗

PubMed2003

[Diagnosis and treatment of postoperative intraabdominal complications].

Postoperative complications after 8168 reoperations were seen in 143 (1.8%) patients. Clinical symptoms, laboratory tests, results of x-ray and ultrasound examinations were taken into account in diagnosis of the complications. Differential diagnosis of postoperative peritonitis, stable paralytic intestinal obstruction, early adhesive obstruction and intraabdominal bleeding based only on clinical data is difficult in many cases. Ultrasonic examination and laparoscopy permitted to reduce number of unjustified relaparotomies. In the majority of cases relaparotomy was considered as a method of choice in treatment of these complications. Mini-invasive surgeries may be performed only in mild complications. Lethality in the treatment of postoperative complications after relaparotomy was 39.4%, after laparoscopic surgeries--8.8%, after US-assisted drainage--0. General lethality was 29.4%.

Abdomen↗

PubMed1996

[Registration of postoperative complications to improve the results of surgery].

OBJECTIVE: To analyse the consequences of postoperative complications in 1418 surgical patients. DESIGN: Prospective descriptive study. SETTING: St. Elisabeth Hospital in Tilburg, The Netherlands. METHOD: In the period 1986-1992 all postoperative complications and their consequences occurring during or after the clinical treatment of surgical patients were registered. RESULTS: In 5% of the 28,485 surgical procedures (= 1418 patients) postoperative complications were found. To treat these complications, 577 patients had to be reoperated on, 233 patients several times, and generally because of postoperative infections. Readmission after discharge was necessary in 310 patients for treatment of their complications. Mean hospital stay for all patients was 10 days, as against 21 days in patients with postoperative complications. On the basis of the figures recorded, quality enhancing measures were taken, e.g. regarding antibiotic prophylaxis and wound treatment. CONCLUSION: The consequences of postoperative complications are considerable. With respect to quality control in health care it is important to develop national registration and documentation of surgical complications.

Female↗

PubMed1993

[Exercise test to predict postoperative complications in patients with impairment of pulmonary function].

We studied the prediction of postoperative complications in patients whose predicted postoperative FEV1.0% and/or %VC were below fifty. Preoperative exercise tests were performed in 88 cases mainly old patients of age or with impaired pulmonary function; 57 were lobectomies, 10 were bilobectomies and 21 were pneumonectomies. Predicted postoperative FEV1.0% and/or %VC were below fifty in 29 cases consisting of 12 lobectomies, one bilobectomy and 16 pneumonectomies. Among these 29 patients, thirteen suffered postoperative complications (A group) and sixteen did not (B group). All five cases of operative death (death within 30 days after operation) were included in the A group. The prediction of postoperative complications in cases of which pred. postope, FEV1.0% and %VC were fifty or over (C group) was also studied. The results were as follows; (1) The percentage of complications among A and B groups was higher than that among C group but no statistical difference could be found. (2) In the A group, the number of pred. postope. FEV1.0% and/or %VC had little correlation to complications. (3) Statistical differences between A and B group were found in submax VO2 (p < 0.05), VO2/VE at AT (p < 0.001) and VCO2/VE at submaximal exercise (p < 0.001). (4) Cardiac output ratio of maximal exercise to rest had marked correlation to complications (p < 0.001) in C group but had no correlation in the A and B groups. (5) The three items of A and B groups, submax VO2 < 500 ml/min/m2, VO2/VE at AT < 40 ml/l and submax VCO2/VE < 25 ml/l, showed high correlation to operative death (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Preoperative nutritional assessment to predict postoperative complication in gastric cancer patients.

The correlation between preoperative nutritional parameters and postoperative complications in 440 patients with gastric cancer were analyzed. All the nutritional parameters reflected a significant deterioration as the stages of cancer progressed, and the frequency of postoperative complications was highest in patients with stage IV gastric cancer. The incidence of anastomotic leaks was increased in patients undergoing total gastrectomy with no relation to the clinical stage or nutritional status. However, there was a close relationship between nutritional status and immunocompetence, lung complications, and infection. The nutritional indices which reliably predicted preoperatively the nutritional status of cancer patients were the serum protein concentrations including the serum albumin (Alb) and prealbumin (PA). The indices predicting postoperative complications were the Alb, PA, and total lymphocyte count. These results suggest that preoperative nutritional assessment can be beneficial for the prediction of postoperative complications.

Humans↗

PubMed2004

Postoperative complications in the first 24 hours: a general surgery audit.

BACKGROUND: Traditionally, the purpose of routine postoperative surveillance has been to detect postoperative complications. The literature reports well-documented, procedure-specific postoperative complication rates. However, there are no reports detailing the prevalence of postoperative complications in general surgical ward settings, where nurses care for patients following a variety of surgical procedures. AIMS: This paper reports an audit of the frequency and type of postoperative complications in a general surgical population occurring in the first 24 hours postoperatively. METHOD: A patient record audit was undertaken for all postoperative patients who returned to two general surgical wards. This was conducted sequentially, involving a 4 week data collection phase in each participating ward during 2001. RESULTS: The audit sample comprised 144 patient records with an average patient age of 54 years. Statistically significant results included the rate of postoperative nausea and vomiting of 37.5% (n = 54), and 17% (n = 25) of patients experiencing another 'clinical event'. LIMITATIONS: The findings reflect only those complications recorded/documented in postoperative patients' records, and cannot be generalized beyond the sample and setting. CONCLUSIONS: Postoperative patients cared for on general surgical wards experienced a high level of nausea and vomiting, while the occurrence of life-threatening complications was small.

Adolescent↗

PubMed1994

[Postoperative complications and criteria of their identification].

A postoperative complication is considered as a secondary process conditioned by the peculiarities of pathogenesis of the primary disease, or as a new disease which develops resulting from diagnostic and therapeutic measures. Timely diagnosis and adequate treatment, and advanced training of physicians as well contribute to reduction in the number of postoperative complications.

Diagnosis, Differential↗

PubMed1990

Ponderal index as a predictor of postoperative complications.

Four hundred sixty-eight patients undergoing elective surgery were prospectively followed for the development of postoperative complications. There was a trend toward increasing complication rate with a lower ponderal index. However, lower ponderal indices were associated with increasing rates of diabetes mellitus and hypertension. Of these patients, forty cases with postoperative complications were matched to 40 control cases for sex, age, concomitant illness and operation performed. The cases of postoperative complications had a statistically significantly lower ponderal index than the controls (11.98 versus 12.43). The increased risk of postoperative complications in those patients with a ponderal index of less than 11 was 3.36, and less than 13 was 3.44. Surgeons who treated patients with lower ponderal indices need to have a high index of suspicion for the development of postoperative complications in these patients.

Body Mass Index↗

PubMedDate not supplied

Can administrative data be used to ascertain clinically significant postoperative complications?

The purpose of this study is to assess whether postoperative complications can be ascertained using administrative data. We randomly sampled 991 adults who underwent elective open diskectomies at 30 nonfederal acute care hospitals in California. Postoperative complications were specified by reviewing medical literature and by consulting clinical experts. We compared hospital-reported ICD-9-CM data and independently recoded ICD-9-CM data with complications abstracted by clinicians using detailed criteria. Recoded ICD-9-CM data were more likely than hospital-reported ICD-9-CM data to capture true complications, when they occurred, but they also mislabeled more patients who never experienced clinically significant complications. This finding was most evident for mild or ambiguous complications, such as atelectasis, posthemorrhagic anemia, and hypotension. Overall, recoded ICD-9-CM data captured 47% and 56% of all mild and severe complications, respectively, whereas hospital-reported ICD-9-CM data captured only 37% and 44%, respectively, of all mild and severe complications. These findings raise questions about the validity of using administrative data to ascertain postoperative complications, even if coders are carefully hired, trained, and supervised. ICD-9-CM complication codes are more promising as a tool to help providers identify their own adverse outcomes than as a tool for comparing performance.

Abstracting and Indexing↗

PubMed2002

Can administrative data be used to compare postoperative complication rates across hospitals?

BACKGROUND: Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES: To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious complications are more consistently reported. DESIGN: Retrospective cohort. SUBJECTS: Nine hundred ninety-one randomly sampled adults who underwent elective lumbar diskectomies at 30 nonfederal acute care hospitals in California in 1990 to 1991. Hospitals with especially low or high risk-adjusted complication rates, and patients who experienced complications, were over sampled. MEASURES: Postoperative complications were specified by reviewing medical literature and consulting clinical experts; each complication was mapped to ICD-9-CM. Hospital-reported complications were compared with our independent recoding of the same records. RESULTS: The weighted sensitivity, specificity, and positive and negative predictive values for reported complications were 35%, 98%, 82%, and 84%, respectively. The weighted sensitivity was 30% for serious, 40% for minor, and 10% for questionable complications. It varied from 21% among hospitals with fewer complications than expected to 45% among hospitals with more complications than expected. Only reoperation, bacteremia/sepsis, postoperative infection, and deep vein thrombosis were reported with at least 60% sensitivity. Half of the difference in risk-adjusted complication rates between low and high outlier hospitals was attributable to reporting variation. CONCLUSIONS: ICD-9-CM complications were underreported among diskectomy patients, especially at hospitals with low risk-adjusted complication rates. The validity of using coded complications to compare provider performance is questionable, even with careful efforts to identify serious events, although these results must be confirmed using more recent data.

California↗

PubMed2003

Current management of postoperative complications and benign biliary strictures.

Postoperative complications after surgery of the biliary tract are usually amenable to endoscopic treatment. Such complications are most frequent after laparoscopic cholecystectomy. Bile leaks and bile duct strictures are the two main biliary injuries. Bile leaks are usually detected during the early postoperative period and can be treated by endoscopic drainage of the biliary tree (endoscopic sphincterotomy with or without nasobiliary drain). Postoperative biliary strictures are usually identified months or years after surgery. Endoscopic placement of an increasing number of plastic stents can achieve morphologic disappearance of the stricture and persistent dilation on long-term follow-up in most cases.

Bile↗

PubMed1998

[Endoscopic interventions of the biliary tract in postoperative complications after cholecystectomy for preventing relaparotomy].

The postoperative complication rate of laparoscopic cholecystectomy (LC) is about 5-6%. The most frequent complications are residual gallstones in the common bile duct, biliary leckage, biliary fistula and duct stenosis. In the period between 01.11.94 and 01.04.96 we performed 1620 endoscopic retrograde cholangio pancreatographies including 410 papillotomies at the second Department of Medicine in the Clinic of Suhl. Thereby in 2.1% (34 cases) of patients a complication after laparosopic cholecystectomy was seen and endoscopically controlled. Residual bile duct stones were removed without any problems by papillotomy and stone extraction. Biliary leckage were brigded by stent implantation. In case of aberrant cystic duct it was also possible to implant a stent depending on anatomical situation. All patients were followed up over a period of 6 to 8 month after endoscopic procedure. All except two patients showed an occlusion of biliary leckage and the bile duct stent could be revved. In one case, a younger patient, with a failed endoscopic occlusion of biliary fistula had to undergo a further operation because of residual gallbladder tissue. In the other case, a 84-years old patient, we use a new method, developed at our department, for selective embolization of the cystic duct to prevent a relaparotomy. The leckage was sufficiently closed. Endoscopic intervention is indicated in case of postoperative complication after LC and successful in the majority of cases. This should primarily discussed between surgeon and physician. Only secondarily a relaparotomy should be performed, if endoscopic procedures have failed.

Adult↗

PubMed1983

Postoperative complications in oral surgery. A study of cases treated during 1980.

Postoperative complications associated with 1.457 surgical operations performed during 1980 at the Department of Oral Surgery, Faculty of Odontology, Karolinska Institute, Stockholm, are reported. The frequency was found to be 7.4%. With the exception of alveolitis which mostly occurred in older patients, no sex or age differences could be found. The majority of operations were performed in the region of the mandibular third molar and most of the postoperative complications were found to occur here. Of the 102 postoperative complications those most frequently found were alveolitis (41), postoperative infections (31), bleedings (11) and postoperative prolonged anaesthesia (10).

Adolescent↗

PubMed1983

[Postoperative complications and followup in cystectomy].

Clinical studies on postoperative complications and prognosis were done on 27 patients who had undergone cystectomy at our hospital. Thirty one postoperative complications were seen in 16 patients. Early complications which developed within 3 months of operation were more frequent (25 cases). They included pyelonephritis (5 cases), wound infection (4 cases), pulmonary complications (2 cases), cardiovascular complications (2 cases), ileus (2 cases) and delayed ambulance (2 cases) in decreasing order of frequency. Complications related to urinary diversion were observed in 4 out of 6 late complications. Reoperation secondary to surgical complications were done in 6 cases. Four of the 6 reoperations were related to gastrointestinal complications, all of which would be fatal if left untreated. Postoperative followup period ranged from 3 weeks to 49 months with a mean period of 12.8 months. The present status of the patients is as follows: 16 patients alive, 10 patients dead and 1 patient lost to followup. So far we cannot draw a definite conclusion regarding the relationship between surgery and the prognosis of the patients because the followup period is too short in many patients. In our experience: 1) The fewest cancer deaths occurred in patients who had undergone radical surgery; 2) the largest percentage of living patients was seen in the group of patients who had undergone radical cystectomy; and, 3) almost all patients with low stage tumors are living more than 6 months after operation.

Adult↗

PubMedDate not supplied

Mild elevation of fasting plasma glucose is a strong risk factor for postoperative complications in gastric bypass patients.

BACKGROUND: Bariatric surgery may be associated with surgical complications. The aim of the study was to identify significant risk factors for postoperative complications in patients undergoing Roux-en-Y gastric bypass (RYGBP). METHODS: The study consisted of 75 consecutive patients undergoing RYGBP. Full medical examination was performed, and the following parameters were assessed in the fasting state: plasma glucose, insulin, leptin, serum lipids, liver function tests, and lipoprotein Lp(a). All subjects had oral 75 g glucose tolerance test before the surgery. All complications occurring within 6 months after the RYGBP were recorded. The patients were divided into Group 1 - patients in whom complications occurred, and Group 2 - patients with no complications in the 6-month period. RESULTS: Postoperative complications occurred in 16 patients (wound infection, hernia, splenic injury, gastro-jejunal obstruction, duodenal ulcer, lower limb deep vein thrombosis). 3 significant risk factors for postoperative complications within 6 months after gastric bypass were found: 1) fasting plasma glucose >/= 6.0 mmol/l (OR 11.0; 95% confidence interval (CI) 2.1-77.3), 2) age >/=40 years (OR 5.89, 95% CI 1.35-29.4), and 3) BMI >/=45 kg/m(2) (OR 4.1, 95% CI 1.04-17.2). CONCLUSION: RYGBP is associated with increased risk of developing early postoperative complications in subjects with even slightly elevated fasting plasma glucose, age >/=40 and BMI >/=45 kg/m(2).

Adult↗

PubMedDate not supplied

Postoperative complications of hepatectomy for hepatocellular carcinoma in relation to liver fibrosis.

BACKGROUND/AIMS: Hepatectomy for hepatocellular carcinoma remains associated with significant morbidity and mortality, despite improved surgical techniques and perioperative management. The relationship between the extent of liver fibrosis and postoperative complications is controversial. METHODOLOGY: We studied 50 patients in whom hepatectomy for Child-Pugh grade A or B had been indicated. Surgical procedures were determined by the indocyanine green retention rate after 15 minutes (ICGR15). The extent of liver fibrosis was graded according to the Desmet classification. The frequency and grade of severity of postoperative complications were evaluated. RESULTS: Postoperative complications occurred in 24 patients (48%), the frequency being significantly higher among those with liver cirrhosis. However, no significant difference in the incidence of major complications was observed between cirrhotic and non-cirrhotic patients (p=0.311). There was no association between grade of severity of postoperative complications and extent of fibrosis. CONCLUSIONS: When the surgical indication and procedure were selected based on the Child-Pugh classification and ICGR15 value, respectively, the extent of liver fibrosis did not influence the incidence of major postoperative complications. In particular, there was no significant difference in the incidence of life-threatening postoperative complications between cirrhotic and non-cirrhotic patients.

Aged↗

PubMed1997

[Interventional radiologic procedures in postoperative complications after liver transplantation].

PURPOSE: Postoperative complications contribute significantly to the morbidity and mortality of liver transplant patients. The management of these complications requires a multidisciplinary approach in which interventional radiology plays an integral role. Indications, techniques, and results of radiological interventions in the management of the liver transplant patient are presented. MATERIAL AND METHODS: During a 10-year period, 52 out of 420 liver transplant recipients underwent radiological interventions, including angioplasty (n = 20), embolization (n = 2), percutaneous drainage (n = 11), and biliary interventions (n = 19). RESULTS: Nine out of ten arterial stenoses located at the anastomoses (n = 8), within the liver (n = 1) and in the coeliac trunk (n = 1) were successfully treated by balloon dilatation. Angioplasty of supra- or infrahepatic anastomotic stenoses of the i.c.v. (n = 5) provided long-term success only in combination with stent implantation. Portal vein stenoses and chronic thrombosis were treated by balloon dilatation and stent insertion via transhepatic catheterization of the portal vein. Late strictures of bile-duct anastomoses can be managed by ante- or retrograde interventions. If biliary complications are related to inflammatory or septic problems, the prognosis of graft survival is poor. CONCLUSION: Interventional radiological procedures are very useful in the management of vascular and biliary complications after liver transplantation. These techniques provide a cure in many situations, and thus, surgical interventions may be avoided in selected cases.

Anastomosis, Surgical↗