Assessment Of Perioperative Complications Research Articles

Management of the incidental adrenal mass, continued surveillance versus surgical excision: analysis of US claims data on contemporary socio-demographic predictors and perioperative outcomes.

Incidentally diagnosed adrenal masses represent an entity that can result in either long term follow-up, surgical excision, or both. Understanding when and which adrenal masses are ultimately excised surgically is not well understood. We sought to understand the ultimate fate of these incidentalomas using a large population-based dataset. The primary outcome of the study was determining the trend in adoption of surveillance vs. surgical excision according to socio-demographic, economic, and pathologic indices, and also provider specialty. Secondary outcomes were the assessment of perioperative complications, operative time, surgical approach, hospital stay, and provider specialty (general surgery vs. urology) among the cohort that underwent excision. Out of a total of N.=91,560 adrenal masses, ultimately N.=3375 (3.83%) of these underwent surgical excision. In the surgical excision cohort, the incidence of aldosteronoma, functional adenoma/Cushing's disease, and adrenocortical carcinoma was higher than in the surveillance cohort. Those patients who were older, female, and with higher Charlson Comorbidity indexes (CCI) were less likely to undergo surgical resection. Factors that predicted for an increased probability of resection included obtaining more CT/MRI scans as well as general surgeons as primary physician providers. Over the study period, the vast majority of surgeries were performed by surgeons other than urologists (12.9%) and open and laparoscopic approaches dominated, with the robotic-assisted approach accounting for a minority of the surgical cases (23.9%). The minimally invasive surgery (MIS) approach independently predicted for both lower rates of complications and shorter hospital stay. In the US, adrenal incidentalomas are more likely to undergo surveillance rather than surgical resection. In our study, surgery is mainly offered for functional or malignant disease and the receipt of surgery can vary by physician specialty. A MIS approach independently predicted for both lower rates of complications and shorter hospital stay.

The Comprehensive Complication Index. Proposed modification to improve estimates of perioperative morbidity after radical cystectomy. A pilot study.

IntroductionThe aim of this article was to compare the 30-day morbidity after radical cystectomy comparing the prevalent Clavien-Dindo Classification (CDC) and the novel Comprehensive Complication Index (CCI). Additionally, we evaluated the correlation between particular clinical features and the severity of perioperative morbidity.Material and methodsA total of 42 patients were included into the study (33 men and 9 women) who underwent open radical cystectomy (RC) with bilateral lymphadenectomy for bladder cancer. The selection of complications was based on groundbreaking research on morbidity after RC. The assessment of perioperative complications was performed using the CDC and then the CCI.ResultsThe CCI was found to be a significant upgrade in capturing cumulative morbidity in comparison to the CDC when used as the only evaluational tool.ConclusionsUsing only the CDC may underestimate the severity of perioperative complications. Unfavorable clinical features e.g. older age, chronic kidney disease (CKD), persistent nodal (pN+) disease, prior abdominal and pelvic surgeries as well as smoking are of significant importance for the increase of the severity of perioperative complications.

Surgeon's experience and clinical outcome after retropubic tension-free vaginal tape-A case series.

The retropubic tension-free vaginal tape procedure has been the preferred method for primary surgical treatment of stress and stress-dominant mixed urinary incontinence in women for more than 20years. In this study, we assessed associations between surgeon's experience with the primary tension-free vaginal tape procedure and both perioperative complications and recurrence rates. Using a consecutive case-series design, we assessed 596 patients treated with primary retropubic tension-free vaginal tape surgery performed by 18 surgeons from 1998 through 2012, with follow up through 2015 (maximum follow-up time: 10years per patient). Data on perioperative complications and recurrence of stress urinary incontinence from medical records was transferred to a case report form. Surgeon's experience with the tension-free vaginal tape procedure was defined as number of such procedures performed as lead surgeon (1-19 ["beginners"], 20-49 and ≥50 procedures). All analyses were done with a 5% level of statistical significance. We applied the Chi-square test in the assessment of perioperative complications. The regression analyses of recurrence rate by number of tension-free vaginal tape procedures performed were restricted to the three surgeons who performed ≥50 procedures. We found a significantly higher rate of bladder perforations (P=.03) and a higher rate of urinary retentions among patients whose tension-free vaginal tape procedures were performed by "beginners" (P=.06). We observed a significant reduction in recurrence rates with increasing number of tension-free vaginal tape procedures for one surgeon (P=.03). Surgeon's experience with the tension-free vaginal tape procedure is associated with the risk of bladder perforation and urinary retention, and may be associated with the long-term effectiveness of the procedure.

Application and exploration of Clavien-Dindo Classification System for complications of minimally-invasive percutaneous nephrolithotomy

Objective To analyse the Clavien-Dindo Classification System (CDCS) in assessment of perioperative complications in minimally-invasive percutaneous nephrolithotomy (MPCNL), and to provide the reference data for the assessment and management of perioperative complications of MPCNL. Methods Clinical data of 310 patients with renal stones who underwent MPCNL from December 2014 to December 2016 were retrospectively analyzed. Complications were recorded and assessed by using CDCS. According to the occurrence of complications within grade Ⅲ (including grade Ⅲ), the patients were divided into observation group (61 cases) and control group (249 cases). Multiple logistic regression analysis were used to analyze the factors influencing the occurrence of MPCNL. Results Totally 68 cases (21.94%) of the 310 patients had perioperative complications, the rate of gradeⅠ, Ⅱ, Ⅲ, Ⅳ and Ⅴ complications with CDCS was in 7.42% (23 cases), 9.03% (28 cases), 3.23% (10 cases), 1.94% (6 cases)and 0.32% (1 case) respectively. The patients'age (>60 years), complicated calculi, diabetic history, urinary tract infection, application of hormone drus, operation time (>180 minutes), the amount of bleeding (>150 mL), hospitalization time (>14 d) of the observation group were significantly higher than that of control group (P<0.05). Multiple logistic regression analysis showed that the age, complicated calculi, diabetic history, application of hormone drus, operation time, intraoperative bleeding volume were closely related to complications within Ⅲ grade of CDCS (P=0.043, 0.000, 0.005, 0.000, 0.005, 0.003). Conclusions CDCS can effectively indicate the related factors of MPCNL, and provide reference data for reducing the frequent complications, which have certain application value in clinic. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Postoperative Complications; Surgical Procedures, Minimally Invasive

Analysis of complications of laparoscopic adrenalectomy

Objectives To draw lessons from standardized assessment of perioperative complications of laparoscopic adrenalectomy in our hospital. Methods Clinical data of 456 patients who underwent laparoscopic adrenalectomy were analyzed retrospectively from January 2008 to January 2014 .In order to evaluate perioperative complications, data of complications were analyzed with Satava and Clavien classification system. Results Rate of perioperative complications was 6.8%, and rate of intraoperative complicatioans was 3.1%, and rate of postoperative complications was 3.7%. Seven patients required surgery(Clavien IIIa/IIIb) and/or Intensive Care Unit (Clavien IV). Conversion to open surgery was necessary in two cases (0.4%). No mortality in perioperative period was seen in the group. Conclusions Standardized assessment can give us better hierarchical description for the complication level of laparoscopic adrenal gland surgery, guide clinical treatment, and evaluate the prognosis of complications, it also can be used to serve the clinic better. Key words: Adrenal Glands; Laparoscopes; Postoperative Complications

Splenectomy as a part of debulking surgery in patients with advanced ovarian cancer

The aim of the study was the assessment of perioperative complications in patients with advanced ovarian cancer who underwent splenectomy to achieve optimal debulking. We analyzed eight debulking procedures with splenectomy and the postoperative period in ovarian cancer patients, FIGO stage III/B-IV. Preoperative diagnostics included multidetector computed tomography (MDCT) or diffusion-weighted echo-planar magnetic resonance (MR-DWI). The following factors were analyzed: size of the removed tumor, size of remains left, blood loss, packed red blood cell transfusion, quantity and reason for reoperations, pancreatic amylase concentrations in the drainage fluid, wound infection, fever over 38 degrees C, and length of hospitalization. Complete debulking was achieved in 8 patients, including 5 cases with no macroscopic residual lesions and 3 patients with lesion diameter of < 10 mm. Median operative time was 175 min. There was one case of reoperation caused by perforation of the stomach wall (histologically confirmed stress ulcer). Median blood loss was 1050 ml and the rate of packed red blood cells transfusion was 75%. Elevated amylase levels in the drainage fluid was noted in 6 patients. Amylase concentration was greater than 5 times the normal serum value during the first postoperative day. After postoperative day 3 it was lower than normal serum range. There were no cases of postoperative fever wound infections, or deaths. The length of hospitalization was 6 days. Splenectomy as a part of cytoreductive surgery for advanced ovarian cancer may contribute to achieving complete debulking and bring benefits, especially in cases with no macroscopic residual disease. The risk of intra- and postoperative complications related to splenectomy seems to be acceptable.

A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results.

To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions. From February 1992 to December 2000, 40 patients (mean age 55.8 years, range 21-74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed. The median (range) follow-up was 47.6 (10-124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re-operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively (P = 0.13). Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved.