In-hospital Complications In Patients Research Articles

Prognostic factors associated with mortality and major in-hospital complications in patients with bacteremic pneumococcal pneumonia: Population-based study.

Bacteremic pneumococcal pneumonia (BPP) causes considerable mortality and morbidity. We aimed to identify prognostic factors associated with mortality and major in-hospital complications in BPP.A prospective, population-based clinical registry of 1636 hospitalized adult patients (≥18 years) with BPP was established between 2000 and 2010 in Northern Alberta, Canada. Prognostic factors for mortality and major in-hospital complications (e.g., cardiac events, mechanical ventilation, aspiration) were evaluated using multivariable logistic regression.Average age was 54 (standard deviation 18) years, 57% males, and 59% had high case-fatality rate (CFR) serotypes. Overall, 14% (226/1636) of patients died and 22% (315/1410) of survivors developed at least 1 complication. Independent prognostic factors for mortality were age (adjusted odds ratio [aOR], 1.5 per decade; 95% confidence interval [CI], 1.3-1.7), nursing home residence (aOR, 3.7; 95% CI 1.8-7.4), community-dwelling dementia (aOR 3.7; 95% CI, 1.6-8.6), alcohol abuse (aOR, 2.2; 95% CI, 1.4-3.4), acid-suppressing drugs (aOR, 1.5; 95% CI, 1.0-2.3), guideline-discordant antibiotics (aOR, 3.4; 95% CI, 2.4-4.8), multilobe pneumonia (aOR, 2.6; 95% CI, 1.8-3.6), and high CFR serotypes (aOR, 1.8; 95% CI, 1.2-2.8). Similar prognostic factors were observed for major in-hospital complications. Pneumococcal vaccination was associated with reduced in-hospital mortality (aOR, 0.2; 95% CI, 0.05-0.9) but not major complications (P = 0.2).Older and frailer patients, and those who abuse alcohol or take acid-suppressing drugs, are at increased risk of BPP-related mortality and complications, as are those with high CFR serotypes. Beyond identifying those at highest risk, our findings demonstrate the importance of guideline-concordant antibiotics and pneumococcal vaccination in those with BPP.

Radiofrequency thermocoagulation for V2/V3 idiopathic trigeminal neuralgia

Radiofrequency thermocoagulation (RFT) is widely used to treat trigeminal neuralgia (TN); however, the optimal temperature at which RFT is most efficacious remains under much debate. Thus, the aim of the present study was to determine the lowest temperature at which morbidity could be minimized and patient outcomes maximized.A multivariate analysis was used to study 1354 patients who underwent computed tomography (CT)-guided RFT for V2/V3 idiopathic trigeminal neuralgia (ITN) during from June 2006 to May 2015. RFT was carried out at 62, 65, and 68°C, while keeping all other RF parameters the same. This was a prospective cohort study, in which we assessed intra- and postoperative complications, pain relief, and long-term health-related quality of life (HRQoL).The intraoperative and in-hospital complications of patients were mainly facial hematoma, mouth and external auditory meatus penetration, nausea, vomiting, dizziness, and headache, which were all treated symptomatically. In long-term follow-up, patients with pain relief (defined as no pain and no required drug intervention) at 62, 65, and 68°C accounted for 94.2%, 98.3%, and 98.8% (at discharge); 83.8%, 90.1%, and 91.4% (at 1 year); 66.7%, 80.5%, and 88.2% (at 3 years); 59.0%, 64.3%, and 77.2% (at 5 years); 48.7%, 57.8%, and 72.3% (at 7 years); 40.6%, 53.7%, and 60.3% (at 9 years), respectively. The number of patients with facial numbness, masticatory atonia, or corneal hypoesthesia was increased with the elevation of temperature, but these complications were all mild. No blindness, deafness, intracranial hemorrhage, or death as a result of the surgical intervention occurred in any patients. SF-36 scores showed highest HRQoL in the group treated at 68°C, followed by the 65 and 62°C groups, respectively.Our results demonstrate that 68°C is a good choice for RFT of V2/V3 ITN. The alternative option is 65 or 62°C for RFT to minimize the occurrence of complications including facial numbness, yet which often yields a higher recurrence rate.

Takotsubo cardiomyopathy: which role for serial electrocardiogram changes?

<p>Takotsubo cardiomyopathy (TTC) is a cardiac syndrome characterized by acute regional-reversible systolic dysfunction of the left ventricle (LV) and related to psycho-physical acute stress. Recently, physicians and researchers have posed their attention on the time course of ECG changes in TTC. Knowledge of ECG changes in TTC could be useful for the clinical management of this disease. Among all TTC deaths, 38% of cases are directly related to in-hospital complications. Serial ECG assessment could be a first line defence in reducing mortality and in-hospital complications in patients with TTC. </p>

ONSET OF IN-HOSPITAL COMPLICATIONS IN ACUTE TYPE B AORTIC DISSECTIONS INITIALLY UNCOMPLICATED

It is unknown what the incidence is of in-hospital complications in patients presenting with initially uncomplicated acute type B aortic dissection (ABAD) and what predicts such clinical evolution. Our aim was to identify the incidence and predictors of development of in-hospital complications in

To evaluate the role of plasma vitamin D level as a prognostic marker and its relation to in-hospital complications in patients with acute coronary syndrome

Background: Deficiency in 25-hydroxyvitamin D (25[OH] D), the main circulating form of vitamin D in blood, could be involved in the pathogenesis of acute coronary syndromes (ACS). To date, however, the possible prognostic relevance of 25 (OH) D deficiency in ACS patients remains poorly defined. The purpose of this study was to assess the association between 25 (OH) D levels, at hospital admission, with in-hospital complications in an unselected cohort of ACS patients. Methods: We measured 25 (OH) D in 200 ACS patients at hospital presentation. Vitamin D serum levels >30 ng/mL were considered as normal; levels between 29 and 21 ng/mL were classified as insufficiency, and levels < 20 ng/mL as deficiency. In-hospital complications were evaluated according to 25 (OH) D levels. Results: In the study population 85(42.5%) patients had normal 25 (OH) D levels, whereas 36 (18%) and 79 (39.5%) had vitamin D insufficiency and deficiency, respectively. The patients with vitamin D deficiency were associated with a higher risk for several in-hospital MACEs (major adverse clinical events) including mortality and it was statistically significant (P value < 0.05). The left ventricular function was more severely compromised in patients with vitamin D deficiency and it was statistically significant (P value < 0.05). Conclusions: In ACS patients, severe vitamin D deficiency is independently associated with poor in-hospital outcomes. Whether low vitamin D levels represent a risk marker or a risk factor in ACS remains to be elucidated.

Early use of beta blockers in patients with cocaine associated chest pain

BackgroundThe most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key event is the increase of activity of the adrenergic system. Beta blockers (BBs), a cornerstone in the treatment of ACS, are felt to be contraindicated in the patient with CICP due to a potential of an “unopposed alpha adrenergic effect (UAE)”. ObjectivesIdentify signs of UAE and in-hospital complications in patients who received BB while having cocaine induced chest pain. MethodsWe performed a retrospective review of 378 patients admitted to a medical unit because of CICP. Twenty six of these were given a BB at the time of admission while having CICP. We compared these patients to a control group paired by age, sex, race and history of hypertension who did not received a BB while having CICP. Blood pressure, heart rate, length of stay and in-hospital cardiovascular complications were compared. ResultsNo statistically significant differences were found between the two groups except for a longer length of stay in the case group. This was felt to be due to unrelated causes. ConclusionsThis study does not support the presence of an UAE in patients with continuing CICP and treated early with BB. There were no in-hospital cardiovascular complications in the group of patients who had an early dose of BB while having CICP. ImplicationsBB appeared safe when given early on admission to patients with CICP.

Impact of body mass index on in-hospital complications in patients undergoing percutaneous coronary intervention in a Japanese real-world multicenter registry.

BackgroundObesity is associated with advanced cardiovascular disease. However, some studies have reported the “obesity paradox” after percutaneous coronary intervention (PCI). The relationship between body mass index (BMI) and clinical outcomes after PCI has not been thoroughly investigated, especially in Asian populations.MethodsWe studied 10,142 patients who underwent PCI at 15 Japanese hospitals participating in the JCD-KICS registry from September 2008 to April 2013. Patients were divided into four groups according to BMI: underweight, BMI <18.5 (n=462); normal, BMI ≥18.5 and <25.0 (n=5,945); overweight, BMI ≥25.0 and <30.0 (n=3,100); and obese, BMI ≥30.0 (n=635).ResultsPatients with a high BMI were significantly younger (p<0.001) and had a higher incidence of coronary risk factors such as hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes mellitus (p<0.001), and current smoking (p<0.001), than those with a low BMI. Importantly, patients in the underweight group had the worst in-hospital outcomes, including overall complications (underweight, normal, overweight, and obese groups: 20.4%, 11.5%, 8.4%, and 10.2%, p<0.001), in-hospital mortality (5.8%, 2.1%, 1.2%, and 2.7%, p<0.001), cardiogenic shock (3.5%, 2.0%, 1.5%, and 1.6%, p=0.018), bleeding complications (10.0%, 4.5%, 2.6%, and 2.8%, p<0.001), and receiving blood transfusion (7.6%, 2.7%, 1.6%, and 1.7%, p<0.001). BMI was inversely associated with bleeding complications after adjustment by multivariate logistic regression analysis (odds ratio, 0.95; 95% confidence interval, 0.92–0.98; p=0.002). In subgroup multivariate analysis of patients without cardiogenic shock, BMI was inversely associated with overall complications (OR, 0.98; 95% CI, 0.95–0.99; p=0.033) and bleeding complications (OR, 0.95; 95% CI, 0.91–0.98; p=0.006). Furthermore, there was a trend that BMI was moderately associated with in-hospital mortality (OR, 0.94; 95% CI, 0.88–1.01; p=0.091).ConclusionsLean patients, rather than obese patients are at greater risk for in-hospital complications during and after PCI, particularly for bleeding complications.

In-Hospital Morbidity and Mortality Following Total Joint Arthroplasty in Patients with Hemoglobinopathies

Given the growing patient population with hemoglobinopathies needing total joint arthroplasty (TJA) and paucity of literature addressing this cohort, we examined the in-hospital complications in patients with hemoglobinopathies undergoing TJA. International Classification of Diseases, Ninth Revision codes were used to search the Nationwide Inpatient Sample database for hemoglobinopathy patients undergoing primary or revision TJA. Hemoglobinopathy patients had a significant increase in cardiac, respiratory, and wound complications; blood product transfusion; pulmonary embolism; surgical site infection; and systemic infection events, while there was no significant effect on deaths, deep vein thrombosis, and renal complications. It may be prudent to implement blood conservation strategies as well as diligent postoperative protocols to minimize the need for transfusion and related complications in this patient population.

CRT-708 Initial US Experience with Commercial Transfemoral Edwards SAPIEN Transcatheter Heart Valve Compared to Partner Cohort B for Inoperable Symptomatic Severe Aortic Stenosis

TAVR using the Edwards SAPIEN valve is approved for commercial use in the United States. This study aims to assess the clinical profile, procedural characteristics and in-hospital complications in patients treated with a commercial SAPIEN valve outside the clinical trial context. We retrospectively

Risk factor profile and in-hospital complications in patients admitted with acute coronary syndrome in Menoufia Governorate

Objective The aim of this work was to study the pattern of risk factors in patients admitted with acute coronary syndrome (ACS) to the coronary care unit in Menoufia Governorate and their relationship with the in-hospital complications. Background Coronary artery disease is a progressive disease process that generally begins in childhood and manifests clinically in mid-to-late adulthood. Patients and methods The study included 120 patients admitted to Coronary Care Unit with ACS during the period from October 2009 to April 2010. Patients were divided into three groups according to their age (≤40, 40-60, and ≥60 years) and followed up during the period of their admission, and the in-hospital complications were recorded. Statistical presentation and analysis of the present study was conducted using the mean, SD, and the c 2 -test by SPSS v. 16. Results Our study included 95 men (79.1%) and 25 women (20.9%). ACS was higher in the older women group III than in the other groups ( P Conclusion Group I (<40 years) had fewer risk factors as they represented the lowest incidence of diabetes mellitus, hypertension, obesity, and metabolic syndrome. In addition, they had better pattern of lipid profile than the other groups. In contrast, they had increased incidence of other risk factors such as positive family history of premature coronary artery disease, higher incidence of current smoking, low HDL value, and being male sex.

Commercial Versus PARTNER Study Experience With the Transfemoral Edwards SAPIEN Valve for Inoperable Patients With Severe Aortic Stenosis

In patients with aortic stenosis who cannot have surgery, transcatheter aortic valve replacement using the Edwards SAPIEN valve has been shown to improve survival rate and is approved for commercial use in the United States. This study aims to assess the clinical profile, procedural characteristics, and in-hospital complications in patients treated with a commercial SAPIEN valve outside the clinical trial context. We retrospectively analyzed 69 consecutive patients who underwent transcatheter aortic valve replacement with a commercial SAPIEN valve compared with 55 Placement of AoRTic traNscathetER valves (PARTNER) trial patients from cohort B enrolled in the same institution by the same Heart Team. Compared with the commercial group, patients in the PARTNER cohort B had higher mean Society of Thoracic Surgeons score (10 ± 5 vs 9 ± 4, p= 0.04) and a lower rate of peripheral arterial disease (19% vs 44%, p= 0.004). Most patients in the commercial group had the procedure under conscious sedation (83% vs 66%, p= 0.03). Planned surgical cut down for vascular access was rare in the commercial group (1.4% vs 46%, p <0.001). The overall rates of major vascular complications, life-threatening or major bleeding, and blood transfusions were lower in commercial group (7.2% vs 27%, p= 0.003; 2.9% vs 16%, p= 0.01; and 28% vs 60%, p <0.001, respectively). In-hospital all-cause mortality (5.8% vs 9.1%, p= 0.51) and stroke rates (7.2% vs 14.5%, p= 0.19) were not statistically different between groups. The median length of hospitalization (p <0.001) and postprocedural length of stay (p= 0.01) was shorter in the commercial group. In conclusion, transfemoral commercial use of the Edwards SAPIEN valve for inoperable patients shows similar in-hospital mortality and stroke rates compared with PARTNER cohort B. The refinements in the procedure such as more conscious sedation, experience of the operators, and careful vascular planning in the commercial group led to lesser vascular and bleeding complications and shorter length of stay.

CONTRAST INDUCED NEPHROPATHY AND BLEEDING: A BIDIRECTIONAL LINK WITH PROGNOSTIC VALUE IN ACS

The 2 most common non-thrombotic in-hospital complications in patients with Acute Coronary Syndorme (ACS) were contrast-induced nephropathy (CIN) and bleeding. The aim was to analyse the relationship between CIN and bleeding in a contemporaneous cohort of ACS patients, together with the predictive

CRT-138 Initial US Experience with Commercial Transfemoral Sapien Transcatheter Heart valve compared to PARTNER Cohort B

Edwards Sapien transcatheter valve is FDA approved for commercial use in non-operable patients with severe symptomatic aortic stenosis (AS) via the transfemoral approach. To assess the clinical profile and in-hospital complications in patients treated with commercial valve compared to PARTNER

Anxiolytic medication use is not associated with anxiety level and does not reduce complications after acute myocardial infarction

To examine the association of anxiety level and anxiolytic medication use with in-hospital complications in patients following acute myocardial infarction (AMI). There are conflicting data about the protective effect of anxiolytic medication used in patients after acute myocardial infarction. Examination of the interaction of anxiolytic medication and anxiety level may explain these disparate results. This was a secondary analysis of existing data from a multisite, prospective study of the impact of anxiety on in-hospital complications in patients with AMI. Patients were primarily men, Caucasians, with Killip class 1 or 2, from the USA and Australia (n = 156). Anxiety level in the emergency department and intensive care unit and in-hospital complications were collected using self-report measures and medical record review. Logistic regression analyses examined whether the use of anxiolytic medication influenced the relationship between anxiety and in-hospital complications after controlling for demographic and clinical covariates. In the ED, 31% of participants were very or extremely anxious; anxiolytic medication was given to only 5%. In the intensive care unit, nearly half of participants received anxiolytic medication. There was no association between anxiety level and use of anxiolytic medication. Anxiety was an independent predictor of the probability of in-hospital complications. The administration of anxiolytic medication did not alter the relationship between anxiety and in-hospital complications. Use of anxiolytics in patients with AMI was not associated with anxiety level and did not reduce the probability of in-hospital complications. Clinicians need to regularly assess anxiety and treat it appropriately. Regular anxiety assessment may promote appropriate use of anxiolytic medication. Clinical guidelines for the management of patients with an AMI should address anxiety assessment and appropriate use of anxiolytic medication to improve patients' outcomes.

Prognostic Value of Neutrophil Gelatinase-associated Lipocalin in Predicting In-hospital Complications in Patients with ST-segment Elevation Myocardial Infarction

Prognostic Value of Neutrophil Gelatinase-associated Lipocalin in Predicting In-hospital Complications in Patients with ST-segment Elevation Myocardial Infarction

Use of routine hospital morbidity data together with weight and height of patients to predict in-hospital complications following total joint replacement

BackgroundRoutinely collected data such as hospital morbidity data (HMD) are increasingly used in studying clinical outcomes among patients undergoing total joint replacement (TJR). These data are readily available and cover large populations. However, since these data were not originally collected for the purpose of health research, a rigorous assessment of their quality is required. We assessed the accuracy of the diagnosis of obesity in HMD and evaluated whether the augmentation of HMD with actual weight and height of patients could improve their ability to predict major in-hospital complications following total joint replacement in men.MethodsThe electronic records of 857 participants in the Health In Men Study (HIMS) who had had TJR were linked with Western Australia HMD. HMD-recorded diagnosis of obesity was validated using the actual weight and height obtained from HIMS. In-hospital major complications were modelled using multivariable logistic regressions that either included the actual weight and height or HMD-recorded obesity. Model discrimination was calculated using area under ROC curve.ResultsThe HMD failed to detect 70% of the obese patients. Only 64 patients (7.5%) were recorded in HMD as obese although 216 (25%) were obese [BMI: ≥30kg/m2] (sensitivity: 0.2, positive predictive value: 0.7). Overall, 174 patients (20%) developed an in-hospital major complication which was significantly higher in the overweight and obese comparing with patients with normal weight. HMD-recorded obesity was not independently associated with major complications, whereas a dose–response relationship between weight and these complications was observed (P=0.004). Using the actual weight and height of the participants instead of HMD-recorded diagnosis of obesity improved model discrimination by 9%, with areas under ROC curve of: 0.69, 95% CI: 0.64-0.73 for the model with HMD-recorded obesity compared with 0.75, 95% CI: 0.70-0.79 for the model with actual weight and height, P<0.001.ConclusionBody weight is an important risk factor for in-hospital complications in patients undergoing TJR. HMD systems do not include weight and height as variables whose recording is mandatory. Augmenting HMD with patients’ weight and height may improve prediction of major complications following TJR. Our study suggests making these variables mandatory in any hospital morbidity data system.

Usefulness of Sum of ST-Segment Elevation on Electrocardiograms (Limb Leads) for Predicting In-Hospital Complications in Patients With Stress (Takotsubo) Cardiomyopathy

Although the prognosis of patients with stress (takotsubo) cardiomyopathy is relatively favorable, serious complications occur in some patients. It is generally accepted that electrocardiography is an essential tool for the diagnosis of stress cardiomyopathy, with findings highly suggestive of the characteristics of myocardial damage. We tested the hypothesis that the quantitative analysis of electrocardiograhic changes can predict complications in stress cardiomyopathy. The study subjects were 85 patients with stress cardiomyopathy. A total of 34 patients developed ≥1 in-hospital complications (heart failure, intraventricular pressure gradient [>30 mm Hg], cardiogenic shock, ventricular tachycardia/fibrillation, and embolism). Patients with complications were likely to have a higher heart rate (96 ± 25 vs 76 ± 17 beats/min, p <0.001), larger sum of ST-segment elevation in 12 leads (median 10.5 mm; interquartile range 5.0 to 17.5 vs 3.0 mm, interquartile range 0 to 7.0; p <0.001) and extension of ST-segment elevation to limb leads (50% vs 12%, p <0.001) than those without complications. Multivariate logistic regression analysis identified heart rate (odds ratio 1.05, 95% confidence interval 1.02 to 1.07, p = 0.001) and sum of ST-segment elevation in 12 leads (odds ratio 1.24, 95% confidence interval 1.11 to 1.39, p <0.001) as significant and independent predictors of complications. Receiver operating characteristic analysis selected 5.5 mm as the best cutoff value of sum of ST-segment elevation in 12 leads for the prediction of complications, with a sensitivity and specificity of 74% and 73%, respectively, and area under the curve of 0.81 (95% confidence interval 0.72 to 0.90, p <0.001). The results suggest that the extent and magnitude of ST-segment elevation on the electrocardiogram are potentially useful predictors of in-hospital complications in patients with stress cardiomyopathy.

Complications after acute coronary syndrome are reduced by perceived control of cardiac illness

To investigate the relationship between anxiety, perceived control and rate of in-hospital complications after acute coronary syndrome. Anxiety may be associated with higher risk of complications following acute myocardial infarction; perceived control may moderate this relationship. Prospective observational study. Patients enrolled in a trial investigating delay in seeking treatment for acute coronary syndrome had anxiety measured at enrolment and 3 months using the Brief Symptom Inventory anxiety subscale. The acute coronary syndrome hospital presentations investigated occurred between 2001-2006. Patients with anxiety scores greater than the population norm at both time points were categorized as persistently anxious. Perceived control was measured at enrolment using the control attitudes scale-revised. Data were collected from the medical record on in-hospital complications in patients presenting with acute coronary syndrome within 2 years of enrolment. Chi-square and t-tests were used for univariate analyses and multiple logistic regression to identify independent predictors of complications. Patients (n = 171) were 64% men with mean age 69 years. Ischaemic or arrhythmic complications occurred in 26 patients (15%) with no difference in complication rates between those persistently anxious and others. Important univariate predictors of in-hospital complications were lower perceived control, diagnosis of acute myocardial infarction, heart failure and higher pulse rate on admission. Low perceived control and diagnosis of acute myocardial infarction were independent predictors of in-hospital complications in the multiple logistic regression. Perceived control, but not persistent anxiety, prior to acute coronary syndrome was an important predictor of in-hospital complications after acute coronary syndrome. Interventions to increase cardiac patients' perceived control of their cardiac illness may reduce in-hospital complications after acute coronary syndrome.

Faecal impaction: in‐hospital complications and their predictors in a retrospective study on 130 patients

Faecal impaction may be a medical emergency. The frequency of complications of this condition and their predictors are not known. We determined the clinical presentation, the in-hospital complications and their predictors in 130 patients diagnosed with faecal impaction. This was a retrospective study of the medical records of 130 patients who presented with faecal impaction to a tertiary care center in Beirut, Lebanon, between 1992 and 2009. The clinical outcome and complications were reviewed. The association between in-hospital complications and other variables was determined. The mean age of the patients was 67.1 years. Ninety-eight (75.3%) patients had at least one of the following: heart disease (36.3%), neurological disease (28.8%) or diabetes (22.6%), and 26.7% were bedridden. The site of impaction was the rectum in 66.4%. The patients were treated by manual disimpaction (34.5%), enema (89.1%) or oral laxatives (84.0%). A delay in treatment of more than 6 h occurred in 70 (53.8%) patients. In-hospital complications occurred in 34 (24.6%) patients, the most common of which were infectious (16 cases), systemic inflammatory response syndrome (16 cases), cardiopulmonary (14 cases) and death (one patient). Time to the start of treatment was longer in patients who developed complications compared with those who did not (10.1 h vs 7.1 h; P = 0.02). Patients > 80 years of age, or patients with heart or neurological disease were at a higher risk of developing complications (P = 0.03, P = 0.03 and P = 0.02, respectively). Treatment delay, increasing age and the presence of heart or neurological disease seem to be predictors of in-hospital complications in patients with faecal impaction.

Intravenous Fluid Infusion Rate in Microsurgical Breast Reconstruction

The purpose of this study was to determine the role of intravenous fluid infusion rate in the development of in-hospital complications in patients undergoing microsurgical breast reconstruction for breast cancer. A retrospective review was performed between 2002 and 2009 at a single institution for all consecutive patients undergoing free flap reconstruction of the breast. The authors examined patient variables (age; body mass index; preoperative hemoglobin, hematocrit, and creatinine levels; American Society of Anesthesiologists classification; and cardiac risk factors), surgical variables (type of reconstruction, timing, laterality, need for blood transfusion, and duration of general anesthesia), and fluid variables (rate of crystalloid and colloid infusion in the first 24 hours standardized by weight). The primary outcome was in-hospital complications. The impact of each factor was first determined using univariate tests. The final multivariate logistic regression model was compiled based on variables found to be significant from the univariate analysis and variables felt a priori to affect complication rates. Of the 260 patients who had a total of 354 free flaps for breast reconstruction, 54 (20.8 percent) had postoperative complications. There were 40 surgical complications (15.4 percent) and 11 medical complications (4.2 percent), and three patients (1.2 percent) had both types. Most complications were flap related (7.3 percent), including two total flap losses (0.8 percent). Multivariate analysis suggested that the extremes of crystalloid infusion rate significantly predicted postoperative complications (p = 0.03) after adjusting for the effect of other covariates. : This is the first study to report that crystalloid infusion rate, a modifiable variable, is an important predictor of postoperative complications following microsurgical breast reconstruction. Risk, III.