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Postoperative complications associated with blood transfusions are frequently reported to be a result of the transfused leukocytes. This paper examines the effects of leukocyte depletion. Leukocyte depletion by filtration which can reduce leukocyte presence by more than 99.9%. The implications of this are postulated in terms of the results that may be obtained.
Postoperative complications can be localised and identified via sonography. This is of special interest in haematomas and abscesses situated subfascially or in the true pelvis, where they often produce misleading clinical signs and symptoms. Of equal importance is the detection of an intraperitoneal or subperitoneal haemorrhage and an estimation of its amount, even if it is only a rough estimate. Effective therapy can be instituted as soon as an exact diagnosis has been established.
Surgical complications were evaluated in 162 vulvar cancer patients. Assessed were: the frequency and type of postoperative complications, the incidence of perioperative blood transfusions, the course of postoperative wound healing, the length of postoperative hospital stay and reasons for perioperative mortality. An analysis of factors influence the risk of complications was conducted.
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Results of the patients treatment, in whom biliodigestive anastomosis was performed for hepatopancreatobiliary zone cancer, were adduced. Among early complications hepatorenal insufficiency, septic-purulent and thrombohemorrhagic complications, postoperative pancreatitis, an acute purulent cholangitis had prevailed. The late complications were mainly presented by the biliary ducts cicatricial stricture, the jaundice and cholangitis recurrency. To improve the results of treatment of early and late postoperative complications the complex of surgical and therapeutic prophylactic measures was proposed as well as the monitoring system, based on the active diagnostico-therapeutic tactics algorhythm elaborated, which was directed on revealing and removal of complications. The timely performance of relaparotomy and "second look" operation constitutes the principal surgical method used.
In recent years nutritional status gained greater attention as a surgical risk factor. In 100 patients with solid and operable tumours nutritional assessment with different types of measurements (dietary habits, ideal weight/height, triceps skinfold, arm muscle circumference, creatinine-height index, serum protein, albumin, prealbumin, cholinesterase, transferrin, total peripheral lymphocytes, and skin tests) was performed. Individual abnormal nutritional measurements were compared with the incidence of complications postoperatively, which were found in 32 out of 95 patients. These complications appeared more often in correlation with the decline of nutritional status. However, we could not prove a statistically significant correlation between the examined parameters themselves and the incidence or lack, respectively, of postoperative complications. Possible reasons are discussed.
Medical documentation is getting more extensive, it is not standardised and can hardly be used to provide the exact and proper feedback. The crisis of data storage, processing and uninterrupted flow of information is becoming concial in the medical institutions as well. An example of informatic model of observation of postoperative complications following cataract surgery is presented in this work. The model has a very flexible pattern, and can, therefore, with minor changes, be used in observation of all postoperative complications in ophthalmology. It is based on the use of personal computer with professional software support (data base III programme was used for creation of data base, while statistical graphic analysis was carried out by following programmes: MICROSTAT, ABSTAT, STATGRAPHIC and FRAMEWORK). It has to be pointed out that any doctor, after only a short (optional) education, could prepare such models for his own purposes, and could thus assist in overcoming the information in medicine. In conclusion, the authors state computer is simple to work with, fast, economical and precise. Computerisation of health service shall include it in one of the aspects of practical realisation of the third technological revolution.
53 renal transplant recipients aged 13 to 58 years were followed up regularly clinically, microbiologically and serologically over observation periods ranging from 6 to 82 months following transplantation with a view to diagnosing mycetic complications. The only (facultative) pathogenic species found was Candida albicans. This species was isolated in every single patient, but far-reaching differences were observed with regard to the degree of form of infection in the individual person. Mainly, cases showed only a transient growth of Candida to a greater or lesser extent on the mucous membranes of the orointestinal tract, but in few cases serious systemic forms like fungaemia and urinary tract infections were manifest. Comparing the mycological and clinical findings it was apparent that the degree of mycetic infection and attendant complications was closely correlated to the incidence and severity of several--at least primarily--non-mycetic complications postoperatively, such as disorders of transplant function, rejection reactions, diabetes and bacterial infections. A causal connexion, thus, probably exists between postoperative mycetic and non-mycetic complications and the presumable underlying pathological mechanism is discussed.
A retrospective study was conducted of two groups of patients over (group 1, n = 57) and under (group 2, n = 655) the age of 70 years who underwent laparoscopic cholecystectomy (LC). The pre-operative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the two groups were compared. The incidence of pre-operative complications in group 1 was significantly higher than that in group 2 (P < 0.05). Postoperatively no severe complication was found in any patient. Group 1 showed significantly prolonged operation time and postoperative hospital stay compared with group 2 (P < 0.05). The difference between the groups in the intra-operative treatment time and postoperative treatment is attributed to the greater prevalence of common bile duct stone in group 1 as there was little difference between the groups in the postoperative recovery after exclusion of these patients. No pulmonary complications, which are associated with LC, were observed; the postprocedure pain was slight and the period of bedrest was short. If complications associated with pneumoperitoneum can be prevented, this surgery is an excellent measure to improve the quality of life of even elderly patients with cholecystolithiasis.
We examined postoperative serial changes in the levels of serum interleukin 6 (IL-6), serum acute phase reactants (APRs) and plasma neutrophil elastase (NE) in patients with various cancers and reviewed these changes in patients who did, and did not, show postoperative complications. Serum IL-6 level was elevated after surgery, peaking on the first postoperative day. Elevation of serum APRs and plasma NE levels also followed. There was a significant correlation between the serum peak level of IL-6 and those of APRs and NE (P less than 0.01). Moreover, there was a significant difference in the serum IL-6 level in patients with and without complications. The relationship between the serum IL-6 greater than 400 pg/ml and the incidence of postoperative complications was also marked. These results suggest that circulating IL-6 is a clinically useful marker for the earliest detection and prediction of postoperative complications.
17% of postoperative ICU patients develop postoperative complications. In 84% of cases, complications are related to surgery, in 16% they are not. The main postoperative surgical complications are abdominal sepsis (65%), postoperative bleeding (25%), and bowel obstruction (7%). Therefore, the primary objective of postoperative investigations must be to check the sites of operation. Bedside procedures are examination of drainage fluid, sonography, endoscopy, and X-ray (gastrografin swallow). The diagnostic value of these procedures is 80%. Other diagnostic procedures include CT, angiography, and diagnostic laparatomy.
PURPOSE: To compare the intraoperative complications and postoperative blood-aqueous barrier (BAB) disturbance after high-frequency capsulotomy and continuous curvilinear capsulorhexis (CCC). SETTING: Vienna General Hospital, Vienna, Austria. METHODS: This prospective, randomized clinical study evaluated 53 eyes with senile cataract. Patients were divided into two groups: high-frequency capsulotomy (n = 27) or CCC (n = 26). The surgical procedure and postoperative therapy were standardized for both groups. The intraoperative course was documented, and postoperative complications were examined by biomicroscopy 3 months postoperatively. Without the pupil dilated, BAB disturbance was evaluated with a laser flare-cell meter at 1, 3, 7, and 14 days postoperatively. The findings were analyzed statistically. RESULTS: Intraoperatively, the high-frequency capsulotomy group had a significantly higher rate of radial tears in the anterior lens capsule. Postoperatively, this resulted in a higher incidence of postoperative false positioning of the intraocular lens. At no time were the flare-cell meter results between groups statistically significant. CONCLUSION: High-frequency capsulotomy resulted in no more trauma than CCC. It can be a good alternative to conventional techniques, particularly in eyes with no red reflex. However, the technique is associated with less mechanical stability.
Intra-abdominal abscess, which carries significant rates of death and complications, may complicate the postoperative course. Treatment options include percutaneous needle aspiration, placement of an external drain under ultrasonic guidance, or surgical drainage, depending on the size, site, and nature (simple or complicated) of the abscess. Laparoscopic drainage may be a treatment option. A retrospective review of patients who underwent laparoscopic drainage of postoperative complicated intra-abdominal abscesses at the authors' institution from January 1997 to July 1999 was performed. Seven patients had complicated intra-abdominal abscesses 7 to 17 (mean 11) days after their initial operation. All abscesses were successfully drained by laparoscopy. The mean operative time was 64 minutes. There were no intraoperative or postoperative complications. The postoperative analgesic requirement was minimal. The suction drain was removed on average 5 days after laparoscopy, and the mean hospital stay was 6 days. There was no recurrence of symptoms at a mean follow-up of 23 months. Laparoscopic drainage, in combination with systemic antibiotics, is a safe and effective treatment option in patients with postoperative complicated intra-abdominal abscesses.
Postoperative complications following laparotomy for patients with abdominal trauma may be difficult to detect, particularly in those patients with multiple injuries. Such complications may lead to multiple organ system failure and death. Consequently, techniques for prevention of these postoperative complications, from resuscitation through operation, are emphasized. These techniques include means for detecting all abdominal injuries, management of the complicated wound, and evaluation and treatment of abdominal abscesses.
Selected postoperative complications following a craniotomy are discussed in relation to assessment and nursing care. Clinical differentiation between structural and metabolic postoperative complications is emphasized. The signs, symptoms, diagnostic aids and nursing implications related to each of these two major classifications of complications are presented. The specific postoperative complications discussed include: cerebral edema, intracranial bleeding, hydrocephalus, cerebral infarction, tension pneumocephalus, hypoxia, water and electrolyte imbalances, hypoglycemia, endocrine disturbances, hyperthermia, and seizures.
The influence of postoperative complications on employment and health status following orthotopic liver transplantation (OLT) remains elusive. Postoperative complications were scored prospectively using a standardized medical outcome classification in each patient transplanted at Duke University from October 1992 to January 1995. Functional status was evaluated by using the Karnofsky score. Between 12 and 18 months following transplantation, patients were asked to complete mailed questionnaires to assess employment and health status (SF-36). The response rate was 86% (42 of 49 eligible patients). The mean patient age was 48 yr. Sixteen of 42 patients (38%) exhibited minimal or no postoperative complications, and 62% exhibited moderate to severe postoperative complications. Age, gender, education, UNOS status for severity of disease, insurance status, and Karnofsky score did not correlate with postoperative complications. Postoperative complications did not predict employment post-transplantation. Paradoxically, patients with minimal or no postoperative complications perceived that their health status was significantly impaired post-transplantation, as evidenced by a median score of 0 in the role-physical subscale of the SF-36, in contrast to those patients with moderate or severe postoperative complications who exhibited a median score of 25 (p < 0.01). Similarly, patients with minimal or no postoperative complications had significantly lower scores on the mental health subscale than those with moderate or severe complications, with median score of 60 vs. 78 (p < 0.03). The physical functioning subscale was not affected by postoperative complications. Thirteen of 42 (31%) respondents returned to full employment post-transplantation. Health perceptions differed with respect to employment status post-transplantation. Patients unemployed post-transplantation exhibited a median score of 55 in the physical functioning subscale, a value much lower than the median score of 80 in the patients who were employed post-transplantation (p < 0.02). No differences in the role physical or mental health subscales were noted with respect to employment status post-transplantation. Employment status was unaffected by Karnofsky status, indicating that functional status does not predict employment. In conclusion, patients exhibited very poor health perceptions post-transplantation, irrespective of postoperative complications. Prospective evaluation of patients undergoing liver transplantation revealed that medical complications did not affect employment post-transplantation.