Common Minor Complication Research Articles

Periprocedural complications during transvenous lead extraction. Lessons learned from the GermAn Laser Lead Extraction RegistrY (GALLERY)

Abstract Background Transvenous lead extraction (TLE) has become an established therapy for patients with cardiac device-related complications such as infection or lead dysfunction. Although safe and effective, periprocedural complications such as vascular or cardiac lacerations with the need for major surgical intervention occur and lead to morbidity and mortality. Objective & Methods The aim of this study was to conduct a retrospective analysis of the incidence, management and outcome of all major complications suffered by patients undergoing TLE in the GALLERY and to compare patient characteristics, procedural data and outcome against patients who suffered minor or no periprocedural complications. We performed multivariate regression analysis to identify independent predictors for death in patients with major complications. Results We identified 52 patients with major (Group A), 57 patients with minor (Groups B) and 2415 patients with no periprocedural complications (Group C) undergoing TLE in the GALLERY (2.1%, 2.3% and 95.7% of total patients, respectively). There were no differences in age (67.4±14.0 vs. 66.6±13.5 vs. 68.1±13.8 years; p=0.612), body mass index (BMI – 26.5±5.4 vs. 26.1±4.2 vs. 27.1±4.7 kg/m2; p=0.140) or other comorbidities, such as arterial hypertension or chronic kidney disease (CKD), except for more patients with diabetes mellitus (15.4 vs. 42.1 vs. 31.3%; p=0.01) in Group B and a trend towards less patients with previous cardiac surgery (15.4 vs. 35.1 vs. 24.2%; p=0.053) in Group A. Mean number of leads per patient were 2.5±1.1, 2.4±1.0 and 2.4±1.0 (p=0.645). Most common minor complication was pocket hematoma in 82.6% of cases. Laceration of the superior vena cava (SVC – 40.4%) was the most common major complication, followed by perforation of the right atrium (RA – 23.1%). Emergent median sternotomy was necessary in 80.8% of cases in Group A, of which 67.4% required cardiopulmonary bypass. Clinical success for TLE could only be achieved in 63.5% of cases in Group A, whereas Groups B and C achieved 100.0 and 98.5% (p<0.001), respectively. The mortality rate in Group A was 28.9%, in contrast to 5.3% and 3.0% in Groups B and C (p<0.001), which translates into a procedure-related mortality of 0.6% for the entire GALLERY. Septic shock was the most common cause of death in all groups (7.7 vs. 3.5 vs. 1.9%, p=0.013). Multivariate regression analysis revealed CKD (OR:4.7, 95%CI: 1.06-20.7, p=0.04) and previous cardiac surgery (OR:6.3, 95%CI: 1.2-33.6, p=0.03) as independent predictors for death in patients who suffered a major complication during TLE. Conclusion Although rare, TLE remains a procedure with potential for major complications such as lacerations of the SVC or perforation of the RA. Immediate availability of emergent surgical intervention ensures a survival rate of 71,1%. Previous cardiac surgery and CKD seem to be independent predictors for death in such patients.

Real-World Safety of Prostate Cancer Focal Therapy: MAUDE Database Analysis.

Objective: The aim of this study was to assess the real-world safety profile of medical devices used in focal prostate cancer treatment utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. Methods: The MAUDE database was searched for reports on high-intensity focused ultrasound (HIFU), cryoablation, laser ablation, and irreversible electroporation (IRE) devices used in prostate cancer treatment from 1993 to 2023. Adverse events were identified and categorized. Results: We identified 175 reports for HIFU, 1362 for cryoablation, 615 for laser ablation, and 135 for IRE devices, with 28, 284, 126, and 2 respective reports, directly related to prostate cancer treatment. The aggregated data revealed the majority of complications were minor, with 82.5% (n = 363 out of 440 total complications) classified as Clavien-Dindo grade 1 or 2. Common minor complications included erectile dysfunction and urinary retention. Severe complications such as rectal fistulas were noted in HIFU and IRE treatments, along with singular mortality due to pulmonary embolism in cryoablation. Conclusions: Our analyses from MAUDE reveal that devices used in focal therapy for prostate cancer are predominantly associated with minor complications, underscoring their overall real-world safety profile. However, the occurrence of severe adverse events emphasizes the critical importance of rigorous patient selection and meticulous procedural planning. These findings provide valuable insights into the safety profile of focal therapy devices and contribute to the growing body of evidence on their use in prostate cancer treatment.

Safety Analysis of Fiberoptic Bronchoscopy in Children

Fiberoptic bronchoscopy (FOB) is a crucial procedure in pediatric pulmonology, providing significant diagnostic and therapeutic benefits. This study evaluates the safety of FOB in children at The People's Hospital of Keyouqianqi, Inner Mongolia. A retrospective analysis was conducted on the medical records of 10 pediatric patients who underwent FOB between 2018 and 2023. The study assessed the incidence, types, and severity of complications, as well as factors contributing to these complications. The findings indicated a complication rate of 20%, with transient hypoxia and mild bleeding as the most common minor complications. No severe complications, such as severe bleeding, bronchospasm, or pneumothorax, were observed. Statistical analysis revealed that procedural factors significantly influenced the occurrence of complications. The study concludes that FOB is generally safe for pediatric patients, with a low incidence of severe complications. Recommendations include enhancing training and protocols, continuous monitoring, preventive measures, further research, and policy development to ensure the highest standards of patient care.

Risk factors for major complications following pelvic exenteration: A NSQIP study

ObjectivesDue to the rarity of pelvic exenteration surgery, it is challenging to predict which patients are at an increased risk for postoperative complications. We aimed to study the predictors for postoperative complications among women undergoing pelvic exenteration for gynecologic malignancy. MethodWe used the National Surgical Quality Improvement Program registry to evaluate postoperative course and complications of those patients undergoing pelvic exenteration in the period 2012–2022. The primary objective of the analysis was to estimate the major postoperative complications following pelvic exenteration. ResultsOverall, 794 pelvic exenterations were included. Of those, 56.5 % were anterior exenteration, 43.5 % were posterior exenteration, and 13.9 % were a combined exenteration. The rate of minor complications was 72.5 % (n = 576), and the rate of major complications was 31.5 % (n = 250). The most common minor complications were blood transfusion (n = 538, 67.8 %), followed by superficial surgical site infections (SSI) and urinary tract infections (9.8 % and 9.4 %, respectively). Among the major complications, the most common was organ/space SSI (11.2 %), followed by sepsis (9.2 %), reoperation (8.6 %), and wound dehiscence (5.2 %). Death within 30 days occurred in 1.5 % of patients. In multivariable regression analysis, the following factors were independently associated with major complications: higher BMI [adjusted odds ratio (aOR) 1.03 95 % confidence interval (CI) (1.01–1.05)], diabetes [aOR 1.82 95 % CI (1.13–3.22)], low serum albumin [aOR 0.73 95 % CI (0.54–0.98)], and high serum creatinine [aOR 1.70 95 % CI (1.05–2.77)]. ConclusionsMajor postoperative complications occur in approximately one third of pelvic exenterations for gynecologic malignancies. Our study highlights independent factors associated with major postoperative complications, of which some are potentially modifiable.

Complications and factors associated with mortality in patients undergoing percutaneous endoscopic gastrostomy

Objective: The aim of our study was to examine the factors associated with mortality in patients who underwent percutaneous endoscopic gastrostomy (PEG) and identify biomarkers that may guide clinical practice. Methods: This retrospective observational study included adults who underwent PEG placement in our center. Demographic data, date of PEG placement, inpatient ward, PEG indication, time from admission to PEG placement, post-PEG complications, and outcome (discharge/mortality) were recorded. Logistic regression analysis was performed to identify factors associated with 90-day and 6-month mortality. Results: Of 100 patients included in the study, 52% were men and the median age was 73 years. The most common indication for PEG was malignancy (n=25, 25%). The most common minor complication was minor peristomal bleeding and peristomal infection requiring tube removal The most common major complication was aspiration pneumonia. Thirty-eight patients (38.0%) died within 90 days and 52 patients (52.0%) died within 6 months of PEG placement. The odds of 90-day mortality were 57.5% lower per 1-unit increase in total serum protein level (odds ratio [OR]: 0.425, 95% CI: 0.230–0.888; p=0.021), 1.6% higher per 1-unit increase in serum CRP (OR: 1.016, 95% CI: 1.006–1.027; p=0.003), and 13.6 times higher in patients with aspiration pneumonia (OR: 13.631, 95% CI: 2.997–61.988; p=0.001). For 6-month mortality, a 1-unit increase in serum albumin level was associated with 81.4% lower odds (OR: 0.186, 95% CI; 0.081–0.430; p<0.001) and aspiration pneumonia with 22 times higher odds (OR: 21.984, 95% CI: 2.412–200.342; p=0.006). Conclusion: Aspiration pneumonia, low total serum protein and albumin levels, and high CRP level were associated with higher mortality.

Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads-A Single-Center Experience.

Background and Objectives: The number of cardiac pacemakers being used has increased in recent decades, and this increase has led to a rise in device-related complications, requiring percutaneous device extraction. Our aim was to present our single-center clinical experience in percutaneous lead extractions. Materials and Methods: We analyzed an observational retrospective cohort study of 93 patients for the transvenous removal of a total of 163 endocardial leads. We evaluated the device details, indications, lead characteristics, extraction methods, complications, reimplantation procedure, follow-up data, effectiveness, and safety. Results: Patients' mean age was 68.6 ± 11.6 years. Lead extraction indications were pocket infection in 33 (35.5%), lead dysfunction in 33 (35.5%), and system upgrade in 21 (23%) cases, and lead endocarditis in 6 (6%) cases. The duration from implantation to extraction time was a detected median of 43 (24-87) months. The most common retracted lead type was the RV defibrillator lead (62%), and the lead fixation type was active for one hundred (61%) patients. A new device was inserted in 74 (80%) patients, and the device type was most commonly a CRT-D (61%). Patients were followed up at a median of 17 (8-36) months, and 18 patients (19%) died at follow-up. Complete procedural success was obtained in 78 (84%) patients, and clinical procedural success was obtained in 83 (89%) patients. Procedural failure was detected in 15 (16%) patients. Major and minor complications were detected in 10 (11%) and 6 (6.5%) patients, respectively. The most common minor complication was pocket hematoma. Conclusions: Our experience suggests that transvenous lead extraction has a high success rate with an acceptable risk of procedural complications. The simple manual traction method has a high rate of procedural success, despite a high dwell time of the lead.

Complications of cochlear implantation: a decade's experience.

Surgery for cochlear implantation is becoming increasingly common. It is a precise surgery and carries with it a number of very specific complications. Although uncommon, they can profoundly affect the recipients' quality of life. We report on our patients' population and compare with different series. This is a retrospective analysis of patients who underwent cochlear implant surgery in our center or who were referred for management of complications between November 2012 and November 2022. There were 2126 patients aged 9 months-68 years [mean 3.2 yrs] with 147 adults > 18 yrs. The male: female ratio was nearly 1. We are reporting on late complications excluding device failures. There were 186 complications [8.7%], 124 minor complications [66% of the complications, 5.8% of the total population; and 62 major complications [ 33% of the complications and 2.9% of the total]. The commonest minor complication was surgical site infection [16%] and the commonest major complication was flap necrosis and device extrusion [26%]. Complications in our series were comparable to other series from different locations. But there seems to be a difference in the frequency of each complication depending on many factors which must be addressed. Standardization of reporting should be also more homogenized.

Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment: A prospective study.

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus. It is the most common gynecological disorder, affecting up to 80% of women of reproductive age. Uterine fibroids can cause various symptoms such as abnormal uterine bleeding, pelvic pain, infertility, and pregnancy complications. The treatment options for uterine fibroids include medical therapy, surgical intervention, and minimally invasive techniques. To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE). This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE, and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments. The two groups were matched for age, body mass index, parity, and baseline characteristics of uterine fibroids. The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), as well as ovarian reserve tests, such as antral follicle count (AFC) and ovarian volume (OV). The secondary outcome was fertility that was evaluated based on the menstrual cycle, ovulation, conception, pregnancy, and delivery. The participants were followed-up for 36 months and assessed at 1, 3, 6, 12, 24, and 36 months after treatment. The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women, resolving within a week. No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones (FSH, LH, E2, AMH) and ovarian reserve indicators (AFC, OV) at any point up to 36 months post-treatment. Additionally, there were no significant differences in conception, pregnancy, or delivery rates, with the average time to conception and gestational age at delivery being similar between the two groups. Birth weights were also comparable. Finally, there was no significant correlation between ovarian function, fertility indicators, and the type or amount of embolic agent used or the change in fibroids post-treatment. UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

Survival Analysis up to 8 Years of 304 Anatomic-Contour Implant Zirconia Crowns Fabricated with a Fully Digital Cast-Free Workflow and Directly Screwed on External Hexagonal Implant Connections without the Interposition of a Ti-Base: A Multicentric Retrospective Study.

Data on the clinical performance of monolithic Zirconia screw-retained crowns on external hexagon implants fabricated from digital scans through a cast-free, fully digital workflow is lacking and needs to be included. This retrospective multicentric study aimed to evaluate the real-life clinical results of monolithic Zirconia screw-retained crowns without the interposition of a Ti-base on external hexagon implants fabricated from intraoral scans and a cast-free approach in private practices. Single external hex implant fixtures were restored with monolithic zirconia crowns without the interposition of a Tibase. The crowns were directly screwed on external hexagonal implant connections with a castfree, fully digital workflow. Data were analyzed using descriptive statistics and the Kaplan- Meier test. Between September 2022 and March 2023, the California Dental Association modified criteria were adopted for clinical evaluation after recalling all patients. A total of 304 single tooth restorations in the maxillary and mandibular posterior regions fabricated between July 2014 and July 2022 in 252 patients (120 males and 132 females, mean age 53.6 years, SD 23.3). Seven crowns were excluded because of patient dropout. The most common minor technical complications were screw loosening (3 crowns) and loss of the screw-access hole filling (3 crowns). Four failures included two implant failures with mobility and two fractured crowns. No screw or implant fractures were recorded. The overall cumulative survival rate was 98.6% and the average success rate (crowns experiencing no failures or complications) was 96.0%. The mean overall survival time was 101.3 months (standard error, 0.847; 95% confidence interval for the mean, 99.67-102.99). The overall survival probability was 87.9% up to 97 months. With careful case selection and comprehensive periodontal maintenance program, single crowns directly screwed onto an external hexagon platform have shown to have excellent survival and success (complication-free) rates, comparable to available data regarding single crowns with a metal implant- prosthetic interface.

Validity of Pleuroscopy in Evaluating Pleural Effusions of Uncertain Etiology at the Cardiothoracic Unit of Minia University Hospital, Egypt.

Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in the body. Doctors use medical thoracoscopy for both diagnostic and therapeutic purposes. This technique allows them to view the internal pleural surfaces and take biopsies of any abnormal lesions within the pleural cavity. This work aimed to evaluate the diagnostic value of pleuroscopy in patients with undiagnosed exudative pleural effusion. A study was conducted on 61 patients who had undiagnosed exudative pleural effusion and were admitted to the chest department at the cardiothoracic unit of the Minia University Hospital. All patients provided written consent and underwent a complete history and clinical examination. Standard laboratory tests, including routine liver and kidney function tests, a complete blood count, and a coagulation profile, were conducted on all patients, along with chest X-rays. If necessary, a chest CT scan was also performed. Diagnostic thoracentesis was done, and the pleural fluid was analyzed for sugar, protein, and lactate dehydrogenase and sent for bacteriological analysis (Gram stain, culture, and acid-fast bacilli smear) and cytopathological examination. Medical thoracoscopy was performed in cases where an etiological diagnosis was not established. A total of 61 patients with undiagnosed exudative pleural effusions were included. A definitive etiological diagnosis was reached in 58 (95%) patients. In 47 (77%) of the studied group, malignant etiology was confirmed; nine (14.8%) had tuberculous pleurisy, one (1.6%) had empyema, and one (1.6%) had inflammatory/autoimmune pleurisy. A definite diagnosis was not reached in three (5%) patients. The malignant pathology was caused by bronchogenic carcinoma in 20 (42.5%) cases, malignant mesothelioma in 10 (21.3%) cases, metastatic malignant deposits from other organs in six (12.7%) cases, and lymphoma in three (6.5%) cases. No serious adverse events related to the procedure were recorded. The most common minor complications were transient chest pain in 34 (55.7%) patients, followed by surgical emphysema in 10 (16.4%) patients. Pleuroscopy is an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear. It is a minimally invasive and straightforward procedure associated with high diagnostic accuracy and low complication rates.

Utility of Thermal Imaging in Predicting Superficial Infections in Transfemoral Osseointegrated Implants.

Superficial infection is a common minor complication of transcutaneous implants that can be challenging to predict or diagnose. Although it remains unclear whether superficial infections progress to deep infections (which may require implant removal), predicting and treating any infection in these patients is important. Given that flap thinning during stage II surgery requires compromising vascularity for stability of the skin penetration aperture, we hypothesized that early skin temperature changes predict long-term superficial infection risk. We obtained standardized thermal imaging and recorded surface temperatures of the aperture and overlying flaps 2 weeks postoperatively for the first 34 patients (46 limbs) treated with the Osseointegrated Prosthesis for the Rehabilitation of Amputees transfemoral implant system. We used two-sided t tests to compare temperatures surrounding the aperture and adjacent soft tissues in patients with and without subsequent infection. During median follow-up of 3 years, 14 limbs (30.4%) developed 23 superficial infections. At patients' initial 2-week visit, mean skin temperature surrounding the aperture was 36.3ºC in limbs that later developed superficial infections and 36.7ºC in uninfected limbs (P = 0.35). In four patients with bilateral implants who later developed superficial infection in one limb, average temperature was 1.5ºC colder in the infected limb (P = 0.12). Superficial infections remain a frequent complication of transfemoral osseointegration surgery. We did not find differences in early heat signatures between limbs subsequently complicated and those not complicated by superficial infection. Further research should explore more objective measures to predict, diagnose, and prevent infections after osseointegration surgery.

A Study to Evaluate the Complications of Laparoscopic Renal and Adrenal Surgeries Using Modified Clavien-Dindo Classification

Background: Laparoscopic surgery has become a widely accepted approach for the treatment of renal and adrenal diseases. However, there is a need to assess the post-operative complications associated with these procedures using standardized classification systems. The modified Clavien-Dindo classification system offers a comprehensive framework for evaluating surgical outcomes and determining the severity of complications. Methods: This prospective study involved 106 patients who underwent laparoscopic renal and adrenal resective surgeries. Post-operative complications were recorded and graded according to the modified Clavien-Dindo classification system. The data collected were analysed to assess the incidence and severity of complications in relation to patient demographics, comorbidities, and surgical procedures. Results: Among the 106 patients, 16.03% experienced post-operative complications, with 13.20% classified as minor complications and 2.83% as major complications. The most common minor complications included delayed bowel movements and wound infection, while major complications included conversion to open surgery and the need for ventilator support or haemodialysis. No deaths were reported in the study. The association between complication rates and age, gender, ASA grade, side of pathology, comorbidities, and pathology/diagnosis was not statistically significant. However, higher grade complications tended to occur more frequently in elderly patients, males, and those with comorbidities. Conclusions: This study supports the effectiveness of laparoscopic surgery for renal and adrenal diseases, as evidenced by low complication rates. The modified Clavien-Dindo classification system proved valuable in assessing and categorizing post-operative complications, enabling a comprehensive evaluation of surgical outcomes. Implementation of this standardized classification system can contribute to improving patient safety and the overall quality of surgical care. Further research with larger sample sizes and longer follow-up periods is recommended to obtain more precise and comprehensive data on long-term morbidity and mortality associated with laparoscopic renal and adrenal resective surgeries.

The effects of adding platelet rich plasma to fat grafting to rejuvenate the face

Background and objective: Despite refinement in surgical techniques, fat grafting survival is unpredictable, and the resorption rate varies. The objectives of this study were to assess the effects of adding Platelet Rich Plasma (PRP) to fat grafting for facial rejuvenationin terms of longevity of the results, complications, and satisfaction rates. Methods: The thigh or lower abdomen was chosen as a donor site for fat graft harvesting using a 10-cc syringe, then washed with saline, processed by low-speed centrifugation, and then inserted into the face with a 1 mm blunt-ended cannula at several points. on several tissue planes. A total of 369 cases treated with autologous fat graft with or without PRP for facial rejuvenation were included in this comparative study. The results were assessed clinically and followed for up to 5 years. Data analysis was done using the statistical package for social science SPSS V. 23. Results: The commonest minor complication was fat absorption (27% in group 1 and 11.9% in group 2), no major complications were reported. Adding PRP to the fat graft decreased the need for second session fat grafting from 31.2% to 15.3%. By adding PRP to fat graft, there was a significant increase in the number of highly satisfied patients (from 63.5% to 80.1%). Conclusion: We believe that adding PRP to autologous fat grafting has several advantages for facial rejuvenation with better long-term results, fewer complications, and better patient and surgeon satisfaction.

Lower body weight and increasing age are significant risk factors for complications following bi-oblique proximal ulnar osteotomy in dogs.

To report and evaluate the risk factors for complications following bi-oblique proximal ulnar osteotomy (PUO) in dogs. 82 client-owned dogs (93 limbs). Clinical records of dogs treated with bi-oblique PUO over a 5-year period were reviewed. Postoperative radiographs were analyzed, and osteotomy location and angles were recorded; follow-up radiographs were reviewed to assess the degree of osteotomy healing. Complications were classified as minor, major, and catastrophic. Logistic regression analysis was performed to investigate possible associations between the predictor variables and occurrence of complications. 82 dogs (93 limbs) were included. Postoperative complications were documented in 39 limbs (13 major and 26 minor). The most common major complication was osteotomy nonunion (8 limbs), while the most common minor complication was delayed union (21 limbs). Statistical analysis revealed that lower body weight (P = .01) and older age (P = .04) were significantly associated with the development of postoperative complications. In this study, lighter and older dogs were more likely to develop complications following bi-oblique proximal ulnar osteotomy. We did not identify an association between osteotomy angle and location on complication rate. Careful patient selection is therefore required to reduce the incidence of postoperative complications after bi-oblique PUO.

Modified Frailty Index and Albumin-Fibrinogen Ratio Predicts Postoperative Seroma After Laparoscopic TAPP.

Postoperative seroma is the most common minor complication after inguinal hernia repair surgery and can have negative consequences. The objective of this study was to identify potential risk factors for postoperative seroma. This study consecutively included 354 elderly patients with inguinal hernia who underwent laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP). Seroma diagnosis was conducted by the same experienced surgeon based on the physical examinations combined with ultrasound. Risk factors for seroma were identified through univariate analysis and subsequently included in the binary multivariate logistic regression model. A total of 40 patients experienced postoperative complications of seroma, with an incidence rate of 11.3% (40/354). The binary logistic regression analysis revealed that obesity (OR: 2.98, 95% CI: 1.20-7.41, P = 0.018), disease duration ≥ 4.5 years (OR: 4.88, 95% CI: 2.14-11.18, P < 0.001), albumin-fibrinogen ratio (AFR) level < 9.25 (OR: 6.13, 95% CI: 2.00-18.76, P = 0.001), and modified frailty index (mFI) score ≥ 0.225 (OR: 6.38, 95% CI: 2.69-15.10, P < 0.001) were four independent risk factors for postoperative seroma. Obesity, prolonged disease duration, decreased AFR level, and increased mFI score independently predict postoperative seroma after laparoscopic TAPP.

Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia

To aimed to determine the incidence of complications of endoscopic sinus surgery (ESS) and to investigate the factors associated with the occurrence of complications.In this retrospective study, we reviewed the medical records of all patients who had undergone ESS at King Saud University Medical City (KSUMC) between January 2015 and March 2022. Patients who underwent ESS for complicated acute sinusitis, sinonasal malignancy, and cerebrospinal fluid leak repair, and those who underwent extended ESS for indications other than chronic rhinosinusitis were excluded. This study was approved by the KSUMC Institutional Review Board.We included 1395 patients, 3 of whom had major complications and 28 had minor complications, resulting in an overall major complication rate of 0.2% and a minor complication rate of 2%. The most common major complication was orbital hematoma, and the most common minor complication was synechia. Moreover, the duration of surgery and laterality increased the risk of complications, whereas the use of image guidance had no effect.The ESS is a safe procedure. The operative start time and laterality were associated with an increased risk of complications and warrant further investigation.

Traumatic Pneumothorax Secondary to Acupuncture Procedure: A Case Report

Acupuncture is an alternative medicine, actually it has had a greater acceptance in our continent being use for multiple therapeutic purposes. Although it is a minimally invasive procedure it is not exempt from complications, most common minor complications such as infections or local pain have been described, as well as less frequently but potentially fatal complications such as subarachnoid hemorrhage and tension pneumothorax. We report a case of pneumothorax secondary to acupuncture in a patient who was treated for carpal tunnel syndrome.

Complications and Outcomes of Endovascular Embolization for Intractable Epistaxis: A Systematic Review and Meta-analysis.

Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.

Complications and their management in the surgical treatment of Lipohyperplasia dolorosa. English version.

There are both conservative and surgical treatment options for Lipohyperplasia dolorosa (LiDo). Aprocedure that has been established since 1997 is the surgical treatment through Lymphological Liposculpture according to Cornely™. After extensive suctioning of the extremities, an extensive subcutaneous wound cavity with atrabecular connective tissue scaffold remains. Nevertheless, surgery-related complications are rare. Postoperative management and administration of antibiotics and antithrombotics are reviewed. The therapies for complications are presented in detail. Retrospectively, the frequencies of adverse events in 1400 LiDo surgeries in 2020 were evaluated. The mean age of the patients was 47.81years (range 16-78years). Symmetrically, 504 outer legs (outer half of the limb [BO]), 504 inner legs (inner half of the limb [BI]), and 392 arms[A] were surgically treated. Relevant adverse events rarely occurred: infections (1.79%), seromas (0.79%), erysipelas (0.28%), necrosis (0.14%) and deep vein thrombosis (0.07). We were able to reduce the rate of postoperative complications to 3.07% in the Lymphological Liposculpture™ regime for the surgical treatment of LiDo. In their meta-analysis on liposuction, Kanapathy etal. reported an overall incidence of major surgical complications of 3.35%. The overall incidence of minor surgical complications was 11.62%, with seroma (5.51%) being the most common minor complication [26]. Kruppa etal. report that the liposuction procedure including fat removal for esthetic reasons has acomplication rate of 9.5%. Wound infections with 4.5% and the formation of erysipelas with 4% are clearly in the foreground [20].

574: SAFE AND EFFECTIVE VOCALIZATION IN MECHANICALLY VENTILATED PATIENTS WITH TRACHEOSTOMY

Introduction: As many as 10-15% of patients admitted to the intensive care unit (ICU) will require a temporary tracheostomy. Verbal communication, however is still difficult and often ineffective. Certain tracheostomy tubes have added a subglottic port similar to endotracheal tubes for suctioning above the cuff. This above the cuff (ACV) port can also be used for vocalization by instilling air through this port which passes through the larynx and vocal cords to allow for phonation. Studies have been limited with very small sample sizes and ACV remains an underutilized modality for communication in patients with tracheostomy. Methods: An IRB approved retrospective review was performed in all adult patients admitted to any ICU requiring tracheostomy from November 2019 to October 2021. All patients receiving tracheostomy were identified. Patients with a tracheostomy tube with an above the cuff suction port were then evaluated 48 hours after surgery and underwent ACV. Major and minor complications and level of phonation achieved were recorded. Speech effectiveness was stratified by no voice, whisper, word level and sentence level performance with ACV. Major and minor complications were recorded. Results: 48 patients underwent 139 interventions. 100% of patients identified were able to attempt ACV. 20 patients (42%) achieved word-level speech and 10 (21%) reached sentence-level speech. Word-level speech was achieved in 52% of all interventions and sentence-level in 17.5%. 95.7% reported no complications and there were no major complications. Comparison to a hypothetical 1% major complication rate using a one-sample binominal test was significant. (P < 0.000) The most common minor complications was excessive oral secretions occurring in 2 patients (1.4%). Conclusions: ACV is a valuable procedure that can result in effective communication for patients with tracheostomy still requiring mechanical ventilation. The procedure is simple and safe to perform and tolerated very well by patients even early after tracheostomy.