Complications In Primary Surgery Research Articles

Prognostic factors for complications after loop ileostomy reversal.

Defunctioning ileostomy creation and closure are both associated with morbidity. There is little data available about complications after ileostomy closure. The aim of this study was to evaluate morbidity related to loop ileostomy closure (LIC) and to determine if patients with postoperative complications in primary surgery suffer from more postoperative complications during stoma closure. This was a retrospective study on prospectively registered consecutive patients undergoing elective LIC in a single centre in Spain between April 2010 and December 2017. Baseline characteristics, postoperative complications after primary surgery and after stoma closure were recorded. Primary surgery included any colorectal resection, elective or urgent associated with a diverting loop ileostomy either as a protective stoma or rescue procedure. A logistic regression model was used to assess the effects of baseline variables and postoperative complications after primary surgery on the existence of postoperative complications related to LIC. Four hundred and twenty-eight patients (288 men, median age 64.5years [IQR 55.1-72.3years]) were included in the study, and 37.4%, developed complications after LIC. The most common was paralytic ileus. Only chronic kidney disease (OR 2.31; 95% CI 1.03-5.33, p = 0.043), existence of postoperative complications after primary surgery (OR 2.25; 95% CI 1.41-3.66, p = < 0.001) and ileostomy closure later than 10months after primary surgery (OR 1.52; 95% CI 1.00-2.33, p = 0.049) were statistically significant in the multivariate analysis. Patients with chronic kidney disease, those who had any complication after primary surgery and those who had LIC > 10months after primary surgery have a significantly higher risk of developing postoperative complications.

Predictive value of the surgical Apgar score on postoperative complications in advanced gastric cancer patients treated with neoadjuvant chemotherapy followed by radical gastrectomy: a single-center retrospective study

BackgroundThe surgical Apgar score (SAS) or modified SAS (mSAS) has been reported as a simple and easy risk assessment system for predicting postoperative complications in primary surgery for gastric cancer. However, few studies have described the SAS’s utility in gastric surgery after neoadjuvant chemotherapy (NAC).MethodsOne hundred and fifteen patients who received NAC and radical gastrectomy from 2008 and 2015 were included in this study. The SAS was determined by the estimated blood loss (EBL), lowest intraoperative mean arterial pressure, and lowest heart rate. The mSAS was determined by the EBL reassessed using the interquartile values. The predictive values of the SAS/mSAS for postoperative complications were assessed with univariate and multiple logistic regression analyses.ResultsAmong the 115 patients, 41 (35.7%) developed postoperative complications. According to analyses with receiver operating characteristic curves of the SAS and mSAS for predicting postoperative complications, the cut-off value of the mSAS was set at 8. The rates of anastomotic leakage, pancreatic fistula, and arrhythmia in patients with high mSAS (> 8) values were higher than in those with low (0–3) and moderate [1–4] mSAS values. A multiple logistic regression analysis showed that the operation time, body mass index, and diabetes mellitus were independent risk factors for postoperative complications. The mSAS was not a significant predictor.ConclusionThe predictive value of SAS or mSAS for morbidity may be limited in patients who undergo gastric cancer surgery after NAC. Future prospective studies with a large sample size will be needed to confirm the present results.

Failed Thumb Carpometacarpal Arthroplasty: Common Etiologies and Surgical Options for Revision.

Carpometacarpal (CMC) arthroplasty surgery, although modifications have occurred over time, continues to be commonly performed and has provided patients with their desired pain relief and return of function. The complications of primary surgery, although relatively rare, can present in various clinical ways. An understanding of the underlying anatomy, pathology of coexisting conditions, and specific techniques used in the primary surgery is required to make the best recommendation for a patient with residual pain following primary CMC arthroplasty. The purpose of this review is to provide insights into the history of CMCarthroplasty and reasons for failure and to offer an algorithmic treatment approach forthe clinical problem of persistent postoperative symptoms.

The First Year After Colorectal Surgery in the Elderly.

PurposeSurgery for colorectal malignancy is increasingly being performed in the elderly. Little is known about the impact of complications on late mortality. This study aimed to analyze whether a complicated postoperative course affects the 1-year survival in elderly patients.MethodsAll consecutive patients older than 75 years of age who underwent colorectal cancer surgery between January 2009 and April 2013 were included in this study. The main outcome was mortality at 1 year after surgery. Logistic regression analyses were performed to determine risk factors for a poor outcome (mortality) after survival of the early postoperative course of surgery at 1-year follow-up. Patients who died within 30 days postoperatively were excluded from analysis.ResultsThe early mortality rate was 6.3% (n = 15), and 2 patients died during follow-up as a result of complications after a second surgery. A total of 223 patients survived the perioperative period and were included in this study. Twenty-two patients (9.9%) died during the first year of follow-up. Stage IV disease (P = 0.002), complications of primary surgery (P = 0.016), and comorbidity (P = 0.050) were risk factors for 1-year mortality. Intensive care unit stay, reoperation and readmission were not associated with a worse 1-year outcome.ConclusionElderly patients with stage IV disease at the time of surgery, comorbidity, and postoperative complications are at risk for mortality during the first year after surgery. A patient-tailored approach with special attention to perioperative care should be considered in the elderly.

Cost Implications of Primary Versus Revision Surgery in Adult Spinal Deformity

Adult spinal deformity (ASD) is an important problem to consider in the elderly. Although studies have examined the complications of ASD surgery and have compared functional and radiographic results of primary surgery versus revision, no studies have compared the costs of primary procedures with revisions. We assessed the in-hospital costs of these 2 surgery types in patients with ASD. The PearlDiver Database, a database of Medicare records, was used in this study. Mutually exclusive groups of patients undergoing primary or revision surgery were identified. Patients in each group were queried for age, sex, and comorbidities. Thirty-day readmission rates, 30-day and 90-day complication rates, and postoperative costs of care were assessed with multivariate analysis. For analyses, significance was set at P < 0.001. The average reimbursement of the primary surgery cohort was $57,078 ± $30,767. Reimbursement of revision surgery cohort was $52,999 ± $27,658. The adjusted difference in average costs between the 2 groups is $4773 ± $1069 (P < 0.001). The 30-day and 90-day adjusted difference in cost of care when sustaining any of the major medical complications in primary surgery versus revision surgery was insignificant. Patients undergoing primary and revision corrective procedures for ASD have similar readmission rates, lengths of stays, and complication rates. Our data showed a higher cost of primary surgery compared with revision surgery, although costs of sustaining postoperative complications were similar. This finding supports the decision to perform revision procedures in patients with ASD when indicated because neither outcomes nor costs are a hindrance to correction.

Malignancy and Complication Rate in Reoperation of Recurrent Goiter

Objective: The aim of this study was to evaluate the fine needle aspiration biopsy findings of recurrent goiter patients who were operated subtotally or lobectomised for benign causes, and to determine the malignancy and complication rates for those who were reoperated. Methods: Between 2008 and 2009, 114 patients diagnosed with recurrent goiter were involved in this study. The cytological findings of 158 nodules and histological findings of 18 patients with reoperation were examined. The complications of primary surgery and reoperation of recurrent goiter were determined. Results: The operation indications were euthyroid multinodular goiter in 106 of the patients and toxic multinodular goiter in 8 of them. The average time elapsed from the time of the first operation was 16.5±7.5 years. The patients with a fine needle aspiration biopsy resulted in 6 with suspicion of malignancy, 3 with malignancy, 5 with hurtle cell cytology, 7 with cellular microfollicular lesion, 1 patient with toxic multinodular goiter and 2 with inadequate cellular cytology; a total of 24 patients (21%) were asked for reoperation. Among the 18 patients who accepted reoperation, pathology results discovered 2 papillary microcarcinomas and 2 papillary thyroid carcinomas. A total of 7 of the 18 patients with reoperation had surgical complications: 3 had vocal cord paralysis and 4 had hypoparathyroidism. Conclusion: In our study, we found that a high rate of recurrent goiter patients required reoperation and there was a considerable amount of complication rate of reoperative thyroid surgery. To eliminate the potential risk of reoperation, we recommend a total thyroidectomy instead of subtotal thyroidectomy or lobectomy as the surgery of choice for the primary surgery with benign indications.

Salvage surgery of recurrence after laryngectomy – when should the alt free flap be modified?

SummaryBackgroundReconstruction of the pharynx and cervical esophagus has significantly progressed in the last 2 decades. A revolution in microvascular surgery has provided numerous choices for primary restoration, or in secondary reconstructions necessary for recurrences or complications of primary surgery. The goals of reconstruction after laryngopharyngoesophagectomy are to provide continuity of the alimentary tract, to protect major blood vessels, to heal the primary wound, and to restore the swallowing and breathing functions with minimal donor site and neck morbidity and deformation.Case ReportWe present 3 cases with complex defects of the laryngopharynx, cervical esophagus and trachea and anterior neck skin following central neck exenteration safely reconstructed with a single anterolateral thigh flap. No postoperative complications occurred in any of the 3 cases of reconstructions, each using a single anterolateral thigh flap.ConclusionsThis approach significantly simplified the reconstruction, with quick recovery, short hospital stay and excellent functional and aesthetic results.

Primary surgery for sapheno-femoral incompetence: A randomised controlled trial to compare two techniques to reduce lymphatic complications

We prospectively compared lymphatic complications after two types of surgery for primary sapheno-femoral incompetence: sharp dissection with meticulous ligation of lymphatic tissue and electrocoagulation technique respectively. 154 consecutive patients undergoing surgery for bilateral primary sapheno-femoral incompetence were randomised. Each side was the control for the other side. 154 groins underwent sharp dissection with ligation of lymphatic tissue using absorbable suture material and 154 controls had a dissection performed with electrocoagulation. There was no lymphocoele, no relevant lymphorrhea and no extremity oedema in either group. Three patients had a minor lymphatic discharge in both groins, self-limiting within 24 hours (1.9%). There were no significant differences between the two groups. Lymphatic complications in primary surgery for sapheno-femoral incompetence are very rare. There is no detectable advantage of sharp dissection with ligation of lymphatic tissue over dissection with electrocoagulation without ligatures.