Complications In General Surgery Research Articles

Anesthesia-related Complications in General Surgery: Strategies for Prevention and Management

Background: Anesthesia-related complications in general surgery remain a significant concern despite advances in anesthetic techniques. These complications can lead to increased morbidity and mortality if not effectively managed. This study aimed to evaluate the incidence, prevention, and management of anesthesia-related complications in a tertiary care hospital in Bangladesh. Methods: A prospective observational study was conducted on 60 patients who underwent general surgery at the Department of Anesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, from 2022 to 2023. Demographic data, anesthesia-related complications, preventive measures, and management strategies were recorded and analyzed. Results: Cardiovascular complications were the most common, with hypotension in 11.7% and arrhythmias in 6.7% of patients. Respiratory complications, including hypoxemia and bronchospasm, occurred in 13.3% and 5% of cases, respectively. Neurological complications, such as postoperative delirium, were observed in 10% of patients. Preventive strategies, including fluid preloading, bronchodilators, and antiemetic prophylaxis, were effective in reducing the incidence of complications. All cases of hypotension, hypoxemia, postoperative nausea and vomiting (PONV), and arrhythmias were successfully managed with standard interventions, achieving a 100% success rate. Conclusion: This study demonstrates that anesthesia-related complications can be effectively managed through vigilant perioperative care and established management protocols. Cardiovascular and respiratory complications were the most common, and prompt interventions such as fluid resuscitation, oxygen therapy, and pharmacological treatment ensured favorable outcomes. Future studies with larger sample sizes and multicenter settings are recommended to further validate these findings and optimize anesthesia practices in diverse healthcare environments.

Efficacy of machine learning algorithms versus conventional assessment techniques in predicting postoperative complications in general surgery: a comprehensive literature review

We examine machine learning algorithms' efficacy and core abilities versus conventional methods in predicting postoperative complications in general surgery. Our findings revealed that machine learning algorithms generally supervised and non-supervised assessment techniques in predicting postoperative complications, offering greater accuracy and reliability, thus suggesting a shift towards integrating these advanced tools in clinical practice. This paper discusses the potential of machine learning to revolutionize postoperative care, enhancing prediction accuracy and improving patient outcomes significantly.

Perioperative Care Innovations: Optimizing Recovery and Reducing Complications in General Surgery

Significant progress has been made in perioperative care for general surgery with the goal of minimising postoperative complications and improving patient outcomes. This thorough analysis examines developments in the preoperative, intraoperative, and postoperative domains of the perioperative continuum. This article explores the most recent innovations influencing the profession, with a focus on patient-centered tactics, technology improvements, and interdisciplinary approaches.
 Within the context of preoperative optimisation, therapies aimed at correcting dietary deficiencies, individualised exercise programmes, and psychological preparedness are critical to improving surgical patient readiness. Improved surgical methods, such as robotics and minimally invasive surgery, revolutionise surgical accuracy while reducing trauma and facilitating a quicker recovery.
 Innovations in postoperative care, such improved recovery procedures and remote monitoring devices, speed up recovery and lower complications. Pain treatment and infection control advances in pharmacology have a major positive impact on patient comfort and lower morbidity.
 This study emphasises the value of customised treatment plans, collaborative decision-making, and specialised communication while embracing patient-centered methods. It highlights how important it is for patients to be involved in their treatment, how to promote their own autonomy, and how to improve compliance with postoperative instructions.
 This study seeks to highlight the combined influence of these breakthroughs on changing general surgery perioperative care paradigms through an examination of these advances. The perioperative setting is driven by the combination of innovative tactics, cooperation across varied healthcare specialties, and technology breakthroughs with the ultimate goal of optimising recovery and minimising problems.

Manejo profiláctico de herida quirúrgica con terapia por presión negativa en cirugía abdominal de emergencia: ¿realmente es útil?

Mr Editor Infection at the operating site (ISO) is the most common postoperative surgical complication in general surgery. This is more frequent in cases of emergency interventions, compromises the patient's prognosis, causes high health costs, and significantly increases the risk of reintervention. Negative pressure therapy (NPT) is an innovative strategy that was proposed about two decades ago, and has been gradually replicated around the world. This means that there are still many gaps in the evidence when it is used in many diseases and under different contexts. Nevertheless, it allows obtaining conclusive results in the time of healing, reduction of complications (mainly dehiscence and ISO), decrease in hospital stay, among other factors.

E-43 | Comparison of Transcatheter Mitral Valve Repair Versus Surgical Mitral Valve Repair in Patients with Obesity: Propensity Matched Comparison

Obesity is associated with difficult management of vascular access and airway and postoperative complications in general surgery. Transcatheter mitral valve repair(TMVr) can be a good substitute for surgical mitral valve repair(SMVr) especially in these patients. We sought to evaluate the national in-hospital outcomes of patients with obesity undergoing TMVr or SMVr.

Causes and Nursing Countermeasures of Complications in General Surgery

Causes and Nursing Countermeasures of Complications in General Surgery

Evaluation of Surgical Complications in a University Hospital: A Novel Root Cause Analysis Classification

Objective: To analyze general surgery morbidity and mortality in King Chulalongkorn Memorial Hospital to identify the preventability and root causes of the complications using a novel root cause analysis (RCA) classification according to the period that the corrective action could have been introduced to prevent the complications. Materials and Methods: The authors retrospectively reviewed the morbidity and mortality between October 2012 and October 2016. The data collection included diagnostic groups, organ systems, severity, preventability, and RCA of the complications. Functional outcomes of the patients were also obtained such as full recovery, residual functional impairment, and death. Results: Six hundred seventy-six surgical complications occurred out of 19,440 surgeries performed (3.47%) during the study period. The most common organ system involved was gastrointestinal system (42.8%), followed by wound complications (18.9%). According to the Clavien-Dindo classification, the severity of the complications was 20.7% as grade 1, 18.9% as grade 2, 41.6% as grade 3, 3.7% as grade 4, and 15.1% as grade 5. The authors classified 27 complications as preventable (4.0%), 573 as potentially preventable (84.8%), and 76 as unpreventable (11.2%). RCA of the preventable and potentially preventable complications using the present RCA classification revealed that root causes were defect in the diagnoses (0.5%), defect in management decision making (5.0%), defect in preoperative management (6.1%), defect in intraoperative management (61.3%), and defect in postoperative management (27.0%). The most common defect in intraoperative management was inappropriate surgical approach or technique (58.7%). Most patients (80.2%) fully recovered from the complications, while 4.7% had residual functional impairment, and 15.1% died. Conclusion: The present study demonstrated that most complications in general surgery were preventable or potentially preventable. RCA showed that the most common root cause was the defect is intraoperative management, especially inappropriate surgical approach or technique. Keywords: Surgical complications; Root cause analysis; Morbidity and mortality conference

New score for prediction of morbidity in patients undergoing open pancreaticoduodenectomy.

ObjectiveThe Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is commonly used to predict the risk of postoperative complications in general surgery. However, use of the POSSUM is not absolutely suitable for open pancreaticoduodenectomy (OPD), which has unique complications such as pancreatic fistula formation. This study was performed to establish a new risk score for assessing the incidence of postoperative complications of OPD.MethodsThis retrospective case-control study involved 159 patients who underwent standard OPD from 2 January 2017 to 1 February 2019. The risk factors for post-OPD complications were statistically investigated, and a risk score model was established by multivariate logistic regression.ResultsAmong all 159 patients, 72 (42.28%) developed complications. A scoring system was developed based on the following five independent variables: sodium concentration of <141.20 mmol/L, white blood cell count of >6.35 × 109/L, pancreatic texture grade, body mass index of >25.06 kg/m2, and basic respiratory diseases. Our risk score model demonstrated better discriminating power, prediction power, and prediction probability than the POSSUM model in the receiver operating characteristic curve analysis.ConclusionThis novel risk score may help to predict postoperative complications after OPD with higher accuracy than the POSSUM system.

Fistula after a Left Colectomy- a Simple Suture and Drainage Can Be an Option?

Anastomotic leak is a frequent complication in general surgery which is related to significant morbidity and mortality. Nowadays, several approaches are utilized, frequently invasive for the patient. Nevertheless, a common strategy for anastomotic leak management has not been identified. We report here an alternative surgical procedure, associated to reduced interventional time and less invasively for the patient.

Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients.

SummaryBackgroundThe standardized Clavien-Dindo classification of surgical complications is applied as a simple and widely used tool to assess and report postoperative complications in general surgery. However, most documentation uses this classification to report surgery-related morbidity and mortality in a single field of surgery or even particular intervention. The aim of the present study was to present experiences with the Clavien-Dindo classification when applied to all patients on the general surgery ward of a tertiary referral care center.MethodsWe analyzed a period of 6 months of care on a ward with a broad range of general and visceral surgery. Discharge reports and patient charts were analyzed retrospectively and reported complications rated according to the most recent Clavien-Dindo classification version. The complexity of operations was assessed with the Austrian Chamber of Physicians accounting system.ResultsThe study included 517 patients with 817 admissions, of whom 463 had been operated upon. Complications emerged in 12.5%, of which 19% were rated as Clavien I, 20.7% as Clavien II, 13.8% as Clavien IIIa, 27.6% as Clavien IIIb, 8.6% as Clavien IVa, and 10.3% as Clavien V. No Clavien grade IVb complication occurred within the investigation. Patients having undergone more complex surgery or with higher scores experienced significantly longer lengths of hospital stay.ConclusionThe Clavien-Dindo classification can easily be used to document complication rates in general surgery, even though this collective was not included in the original validation studies of Clavien et al. and consisted of more heavily impaired patients.

A systematic review of portomesenteric vein thrombosis after sleeve gastrectomy

BackgroundPortomesenteric vein thrombosis (PMVT) is considered an uncommon complication in general surgery; nevertheless, with the growing popularity of sleeve gastrectomy (SG) as a bariatric procedure we have seen an increase in the occurrence of this complication. ObjectivesTo elucidate the question if it is a procedure-related complication and explore the modalities of prevention and treatment of this complication, a systematic review of available literature regarding PMVT events after SG was conducted. MethodsOur systematic review yielded 28 studies enclosing 89 patients. Perioperative data was collected from each study and analyzed. ResultsThe incidence of PMVT after SG ranged from .37% to 1%, 65% of the patients were female, and the mean body mass index was 41.63 kg/m2. Perioperative co-morbidities including hypertension, diabetes, and dyslipidemia were recorded in 39.7%, 41.63%, and 38.23% of cases respectively. Tachycardia and fever were reported only in 23.9% and 20.89%, respectively, and hereditary thrombophilia studies were positive in 30.43% of cases. The rate of acute major complications after PMVT was 14.6% (13 cases), and mortality was reported in 3 cases (average 3.37%). ConclusionPMVT seems to be an uncommon multifactorial disease, with unpredictable symptoms and varieties of the treatments options, but additional studies are required to further define optimal management and prevention algorithms.

Erratum to: Obesity – a risk factor for postoperative complications in general surgery?

Unfortunately the original version of this article contained a mistake. The author list contained superfluous initials for each author.

Obesity--a risk factor for postoperative complications in general surgery?

BackgroundObesity is generally believed to be a risk factor for the development of postoperative complications. Although being obese is associated with medical hazards, recent literature shows no convincing data to support this assumption. Moreover a paradox between body mass index and survival is described. This study was designed to determine influence of body mass index on postoperative complications and long-term survival after surgery.MethodsA single-centre prospective analysis of postoperative complications in 4293 patients undergoing general surgery was conducted, with a median follow-up time of 6.3 years. We analyzed the impact of bodyweight on postoperative morbidity and mortality, using univariate and multivariate regression models.ResultsThe obese had more concomitant diseases, increased risk of wound infection, greater intraoperative blood loss and a longer operation time. Being underweight was associated with a higher risk of complications, although not significant in adjusted analysis. Multivariate regression analysis demonstrated that underweight patients had worse outcome (HR 2.1; 95 % CI 1.4-3.0), whereas being overweight (HR 0.6; 95 % CI 0.5–0.8) or obese (HR 0.7; 95 % CI 0.6–0.9) was associated with improved survival.ConclusionObesity alone is a significant risk factor for wound infection, more surgical blood loss and a longer operation time. Being obese is associated with improved long-term survival, validating the obesity paradox. We also found that complication and mortality rates are significantly worse for underweight patients. Our findings suggest that a tendency to regard obesity as a major risk factor in general surgery is not justified. It is the underweight patient who is most at risk of major postoperative complications, including long-term mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0096-7) contains supplementary material, which is available to authorized users.

Determining Surgical Complications in the Overweight (DISCOVER): a multicentre observational cohort study to evaluate the role of obesity as a risk factor for postoperative complications in general surgery

IntroductionObesity is increasingly prevalent among patients undergoing surgery. Conflicting evidence exists regarding the impact of obesity on postoperative complications. This multicentre study aims to determine whether obesity is associated with...

Utility of Electrofusion for the Femoral Approach in Vascular Surgery: A Randomized Prospective Study

The local complications are frequent after a femoral approach in vascular surgery and are often the cause of a delay in healing. Electrofusion showed its effectiveness to decrease the complications in general surgery but was not tested in vascular surgery. The aim of our study was to evaluate if the use of electrofusion in the approach to femoral vessels improved healing at 1month by decreasing the local complications. This prospective randomized study was conducted in 2 centers from May 1, 2012 to April 30, 2013. All the patients requiring a surgical access of the femoral trigone were included in 2 French teaching hospitals. Femoral artery surgical exposure was carried out using electrofusion or according to the conventional technique (diathermy or cold scalpel) according to a protocol of randomization. The principle criterion of the study was a complete healing at 1month. The secondary criteria were the appearance of cutaneous, infectious, or lymphatic local complications. Two hundred ninety-two femoral approaches were carried out in 221 consecutive patients. One hundred forty-eight approaches were carried out with electrofusion and 144 according to the conventional technique. The demographic and operative characteristics were similar between the 2 groups. At 1month, 86.3% of the approaches were healed without statistically significant difference between the 2 groups (88.5% vs. 84%, P=0.241). There were less local complications (P=0.012) and seromas (P=0.012) in the electrofusion group. This difference could be linked with the least quantities (P=0.036) and durations (P=0.014) of drainage observed after approaches carried out with electrofusion. On the other hand, the incidence of cutaneous or infectious complications was not different between the 2 groups. In our series, the use of electrofusion decreased the lymphatic complications after a femoral approach. However, the correction of this single parameter was not sufficient to improve the rate of healing at 1month.

Épidémiologie des accidents vasculaires cérébraux périopératoires

ObjectivesStroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature. Article typeSystematic review. Data sourcesFirstly, Medline and Ovid databases using combination of stroke, cardiac surgery, carotid surgery, general non-cardiac non-carotid surgery as keywords; secondly, national and European epidemiologic databases; thirdly, expert and French health agency recommendations; lastly, reference book chapters. ResultsIn cardiac surgery, with an incidence varying from 1.2 to 10% according to procedure complexity, stroke occurs peroperatively in 50% of cases and during the first 48 postoperative hours for the others. The incidence of stroke after carotid surgery is 1 to 20% according to the technique used as well as operator skills. Postoperative stroke is a rare (0.15% as mean, extremes around 0.02 to 1%) complication in general surgery, it occurs generally after the 24–48th postoperative hours, exceptional peroperatively, and 40% of them occurring in the first postoperative week. It concerned mainly aged patient in high-risk surgeries (hip fracture, vascular surgery). Postoperative stroke was associated to an increase in perioperative mortality in comparison to non-postoperative stroke operated patients. ConclusionPostoperative stroke is a quality marker of the surgical teams’ skill and has specific onset time and induces an increase of postoperative mortality.

Electrofusion for Femoral Approach in Vascular Surgery: A Randomized Prospective Study

Local complications are frequent after femoral approach in vascular surgery and are often at the cause of a healing delay. Electrofusion showed its effectiveness to decrease the incidence of complications in general surgery but was never tested in vascular surgery. The aim of our study was to evaluate if the use of the electrofusion for the approach to the femoral vessels improved the one month healing by decreasing the local complications, in particular lymphatic.

Suture-Free and Mesh Reinforced Small Intestinal Anstomoses: A Feasibility Study in Rabbits

ABSTRACTIntroduction: Anastomotic leakage still remains a major complication in general surgery. Beside general risk factors, the ideal method of anastomotic technique has not been found until now. The aim of the present study was to analyze wound healing in suture-free small intestine anastomoses using fibrin glue with and without mesh-reinforcement. Methods: Laparotomy and four different types of small bowel anastomoses were performed in 32 chinchilla rabbits. Standard hand-sewn anastomoses (CG), suture-free glued anastomoses (FG) with and without mesh reinforcement using two different types of meshes [Vicryl-mesh (VM) and Surgisis (SM)]. Animals were sacrificed after 5 and 21 days. Bursting pressure, collagen type I/III ratio, and matrix-metalloproteinase 2, 9, and 13 were analyzed. Results: None of the animals died due to an anastomotic leakage. All animals in the long term group with Surgisis mesh died due to a mechanical bowel obstruction based on a distinctive stenosis of the anastomosis. The bursting pressures did significantly differed in animals with fibrin glue alone compared to animals with Vicryl-mesh reinforcement (p < 0.05). Histological examination revealed statistically significant differences (p < 0.05) in the values for MMP-2 (VM < SM), MMP-9 (VM < CG), and MMP-13 (CG < SM, VM < FG, and VM < SM). However, collagen type I/III ratios were not significantly different between groups. Conclusions: Our results suggest that a mesh reinforced glued anastomosis is technically feasible. Furthermore, mesh-reinforcement using VM increased the integrity and simplified the technique of suture-free anastomoses.

Variable impact of complications in general surgery: a prospective cohort study

Registering complications is important in surgery, since complications serve as outcome measures and indicators of quality of care. Few studies have addressed the variation in severity and consequences of complications. We hypothesized that complications show much variation in consequences and severity. We conducted a prospective observational cohort study to evaluate consequences and severity of complications in surgical practice. All recorded complications of patients admitted to our hospital between June 1, 2005, and Dec. 31, 2007, were prospectively recorded in an electronic database. Complications were classified according to the system of the Trauma Registry of the American College of Surgeons. We graded the severity of complications according to the system proposed by Clavien and colleagues, and the consequences of each complication were registered. During the study period, 3418 complications were recorded; consequences and severity were recorded in 89% of them. Of 3026 complications, 987 (33%) were grade I, 781 (26%) were grade IIa, 1020 (34%) were grade IIb, 150 (5%) were grade III and 88 (3%) were grade IV. The consequences and severity of identically registered complications showed a large degree of variation, best illustrated by wound infections, which were grade I in 50%, grade IIa in 22%, grade IIb in 28% and grade III and IV in 0.3% of patients. Severity should be routinely presented when reporting complications in clinical practice and surgical research papers to adequately compare quality of care and results of clinical trials.

Costs of Postoperative Sepsis

To estimate the incremental costs associated with sepsis as a complication of general surgery, controlling for patient risk factors that may affect costs (eg, surgical complexity and comorbidity) and hospital-level variation in costs. Database analysis. One hundred eighteen Veterans Health Affairs hospitals. A total of 13878 patients undergoing general surgery during fiscal year 2006 (October 1, 2005, through September 30, 2006). Incremental costs associated with sepsis as a complication of general surgery (controlling for patient risk factors and hospital-level variation of costs), as well as the increase in costs associated with complications that co-occur with sepsis. Costs were estimated using the Veterans Health Affairs Decision Support System, and patient risk factors and postoperative complications were identified in the Veterans Affairs Surgical Quality Improvement Program database. Overall, 564 of 13878 patients undergoing general surgery developed postoperative sepsis, for a rate of 4.1%. The average unadjusted cost for patients with no sepsis was $24923, whereas the average cost for patients with sepsis was 3.6 times higher at $88747. In risk-adjusted analyses, the relative costs were 2.28 times greater for patients with sepsis relative to patients without sepsis (95% confidence interval, 2.19-2.38), with the difference in risk-adjusted costs estimated at $26972 (ie, $21045 vs $48017). Sepsis often co-occurred with other types of complications, most frequently with failure to wean the patient from mechanical ventilation after 48 hours (36%), postoperative pneumonia (31%), and reintubation for respiratory or cardiac failure (29%). Costs were highest when sepsis occurred with pneumonia or failure to wean the patient from mechanical ventilation after 48 hours. Given the high cost of treating sepsis, a business case can be made for quality improvement initiatives that reduce the likelihood of postoperative sepsis.