Incidence Of Common Complications Research Articles

Application of multidisciplinary collaborative nursing with family care for enhanced recovery after surgery in children with inguinal hernia.

Perioperative nursing can reduce the stress reaction and improve the prognosis of children. To elucidate the influence of multidisciplinary collaborative nursing for enhanced recovery after surgery (ERAS) with family care in perioperative nursing children with an inguinal hernia and its impact on the prognosis. The data of 100 children with inguinal hernia were retrospectively analyzed. The participants were divided into three groups according to different nursing methods: Groups A (n = 38), B (n = 32), and C (n = 30). Group A received multidisciplinary collaborative ERAS nursing combined with family care nursing; Group B received multidisciplinary collaborative nursing for ERAS; and Group C received routine nursing. The postoperative recovery results of the three groups were compared, including intraoperative blood loss and postoperative feeding time, time of getting out of bed, hospitalization time, and defecation time. Furthermore, the incidence of common complications was also compared between the three groups. There was less intraoperative blood loss in Groups A and B than in Group C (P < 0.05), and the time of getting out of bed and postoperative hospitalization and defecation times were also decreased in Group C (P < 0.05). There was no significant difference in postoperative feeding time among the three groups (P > 0.05). Each index had no statistical significance between Groups A and B (P > 0.05). The incidence of urinary retention, infection, hematoma, and hernia recurrence in Group A was less than that in Group C (P < 0.05). No significant difference was observed in the overall complication rate between Groups A and B and between Groups B and C (P > 0.05). The application of multidisciplinary collaborative nursing combined with family care in the perioperative care of children with an inguinal hernia for ERAS may promote postoperative rehabilitation for children and reduce the incidence of complications.

Secular increase in the prevalence of gestational diabetes and its associated adverse pregnancy outcomes from 2014 to 2021 in Hebei province, China.

We aimed to investigate the secular prevalence of gestational diabetes mellitus (GDM) and evaluate its adverse pregnancy outcomes among pregnant women in Hebei province, China. We analyzed the data from the monitoring information management system for pregnant women in 22 hospitals of Hebei province, China. In this study, 366,212 individuals with singleton live births from 2014 to 2021 were included, of whom 25,995 were diagnosed with gestational diabetes. We described the incidence of common complications and further analyzed the clinical characteristics in GDM patients and the relationship between GDM and adverse pregnancy outcomes. The top 3 pregnancy complications in Hebei province are anemia, gestational hypertension, and GDM. The average incidence of GDM was 7.10% (25,995/366,212). The incidence rate of GDM significantly increased from 2014 to 2021 (χ2 trend = 7,140.663, P < 0.001). The top 3 regions with GDM incidence were Baoding (16.60%), Shijiazhuang (8.00%), and Tangshan (3.80%). The incidence of GDM in urban pregnant women (10.6%) is higher than that in rural areas (3.7%).The difference between the GDM and Non-GDM groups was statistically significant in terms of maternal age, gravidity, parity, education level, and incidence of pregnancy complications (gestational hypertension, heart diseases, and anemia) (P < 0.05). GDM individuals were at significantly increased risk of most assessed adverse pregnancy outcomes, including premature delivery, Cesarean delivery, uterine inertia, neonatal intensive care unit (NICU) admission, Apgar (activity-pulse-grimace-appearance-respiration) score at 1min, and macrosomia (P < 0.05). The multivariate logistic regression analysis showed that GDM was an independent risk factor in terms of premature birth, Cesarean delivery, uterine inertia, placental abruption, NICU admission, and macrosomia. The risk of adverse pregnancy outcome in pregnant women with GDM is significantly increased. In order to reduce the occurrence of adverse pregnancy outcomes, effective interventions are needed.

The Dutch national paediatric heart transplantation programme: outcomes during a23-year period.

BackgroundSince 1998, there has been a national programme for paediatric heart transplantations (HT) in the Netherlands. In this study, we investigated waiting list mortality, survival post-HT, the incidence of common complications, and the patients’ functional status during follow-up.MethodsAll children listed for HT from 1998 until October 2020 were included. Follow-up lasted until 1 January 2021. Data were collected from the patient charts. Survival, post-operative complications as well as the functional status (Karnofsky/Lansky scale) at the end of follow-up were measured.ResultsIn total, 87 patients were listed for HT, of whom 19 (22%) died while on the waiting list. Four patients were removed from the waiting list and 64 (74%) underwent transplantation. Median recipient age at HT was 12.0 (IQR 7.2–14.4) years old; 55% were female. One-, 5‑, and 10-year survival post-HT was 97%, 95%, and 88%, respectively. Common transplant-related complications were rejections (50%), Epstein-Barr virus infections (31%), cytomegalovirus infections (25%), post-transplant lymphoproliferative disease (13%), and cardiac allograft vasculopathy (13%). The median functional score (Karnofsky/Lansky scale) was 100 (IQR 90–100).ConclusionChildren who undergo HT have an excellent survival rate up to 10 years post-HT. Even though complications post-HT are common, the functional status of most patients is excellent. Waiting list mortality is high, demonstrating that donor availability for this vulnerable patient group remains a major limitation for further improvement of outcome.

Routine Postoperative Antibiotics After Tissue Expander Placement Postmastectomy Does Not Improve Outcome.

In an attempt to reduce the incidence of infectious complications after tissue expander-based breast reconstruction, the routine administration of postoperative antibiotics regimen is common in many practices. In recent years, there has been a plethora of reports scrutinizing the prophylactic use of postoperative antibiotics in this setting. The aim of this study was to determine the efficacy of prolonged administration of postoperative antibiotics compared with perioperative-only antibiotic administration for prophylaxis after tissue expander placement for immediate mastectomy reconstruction. A retrospective chart review of all patients who underwent immediate tissue expander placement after mastectomy at our institution from June 2005 to September 2018 was performed. All patients in the study received perioperative intravenous antibiotics 30 to 60 min preoperatively and for 24 hours postoperatively. Patients were divided into 2 groups. Patients in group A did not receive antibiotics beyond the perioperative period. Patients in group B received oral antibiotics for at least 7 days postoperatively in addition to the perioperative intravenous antibiotics. The 2 groups were compared for demographics and prevalence of risk factors such as radiation, chemotherapy, smoking, and diabetes. The incidence of complications such as infection, wound complications, hematoma, seroma, capsular contracture, loss of tissue expander, and reoperations was assessed. A total of 529 patients were included in the study, of which 241 were in group A and 288 were in group B. The total number of breasts reconstructed in group A was 398, whereas in group B, it was 466 breasts. Patients were followed up to 5 months postoperatively in each group. There were no statistically significant differences in the demographic and patient characteristics among the 2 groups. The incidence of infection in group A was 23.24% and in group B was 21.53% (P = 0.412). The incidence of other complications follows the same trend when comparing group A versus B. This retrospective study shows that the routine use of postoperative antibiotics after tissue expander placement for immediate mastectomy reconstruction does not result in reduction in the incidence of common complications or improvement of clinical outcomes.

The Incidence of Common Complications, Including Ectropion and Entropion, in Transconjunctival and Subciliary Approaches for Treatment of ZMC Fractures.

Statement of the Problem: Treating zygomaticomaxillary complex fractures (ZMC Fx) can result in postoperative complications that should be minimized by choosing the best surgical approach.Purpose: This study compared incidence rates of some common postoperative complications with emphasis on ectropion (an outward curling of the lower eyelid) and entropion (an inward curling of the lower eyelid) occurring with transconjunctival or subciliary approaches for the treatment of ZMC fractures.Materials and Method: This prospective study enrolled 80 patients with ZMC Fx who had been surgically treated. Patients were visited within one month and five months postoperatively by the same surgeon. An information checklist was completed for each patient for clinical assessment of postoperative complications.Results: There was no significant difference between the two groups in the type of trauma (simple or comminuted) (p= 0.1) or the frequency of ectropion and entropion one month and five months postoperatively (p> 0.05). The same results were observed for history of massage under the eye or around the field of surgery (p= 0.151), scleral show (p= 0.414), history of post-surgical epiphora (overflow of tears and accumulation of tear) (p= 0.059), duration of the use of suspension/frost sutures (used to prevent eyelid distortion secondary to wound injury applied at the skin inferior to the incision to help elevate the lid) (p= 0.057), and the use of porex (an alloplastic material over the defect in the orbital floor) (p= 0.91).Conclusion: There was no significant difference between the transconjunctival approach and the subciliary approach in terms of common postoperative complications such as ectropion and entropion.

Incidence, Risk-Factors and Associated Mortality of Complications in Orthogeriatric Co-Managed Inpatients.

Introduction:Pneumonia, thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures. In a 2 years-follow-up we determined the according incidence and risk factors of these and other complications in orthogeriatric inward patients, as well as the respective associated mortality.Methods:All patients treated on an orthogeriatric co-managed ward over the course of a year were included. Besides injury, therapy and geriatric assessment parameters, we evaluated the inward incidence of common complications. In a 2 years-follow-up the associated death rates were aquired. SPSS (IBM) was used to determine the importance of risk factors predisposing to the respective occurrence of a complication and accordingly determine it’s impact on the patients’ 1- and 2-years-mortality.Results:830 orthogeriatric patients were initially assessed with a remaining follow-up cohort of 661 (79.6%). We observed very few cases of thrombosis (0.6%), pulmonary embolism (0.5%), apoplex (0.5%) and myocardial infarction (0.8%). Pneumonia was seen in 42 (5.1%), UTI in 85 (10.2%), delirium in 186 (22.4%) and AKI in 91 (11.0%) patients. Consistently ADL on admission was found to be a relevant risk factor in the development of each complication. After adjustment only AKI showed a significant increased mortality risk of 1.60 (95%CI:1.086-2.350).Discussion:In our fracture-independent assessment of complications in the orthogeriatric treatment of inward patients we’ve seen very rare cases of cardiac and thrombotic complications. Typical fragility-fracture associated common events like pneumonia, UTI, delirium and AKI were still more incidental. No complication except AKI was associated to significant increased mortality risk.Conclusions:The relevance of orthogeriatric care in prevention and outcome of inward complications seems promising, needing still more controlled studies, evaluating not just hip fracture patients but more diverse groups. Consensus is needed in the scholar evaluation of orthogeriatric complications.

Pathological staging of chorioamnionitis contributes to complications in preterm infants

ObjectiveTo investigate the effect of pathological staging of chorioamnionitis (CA) on complications in preterm infants;MethodsA single-center, retrospective study was conducted to choose singleton preterm infants (gestational age < 37 weeks) from the Department of Obstetrics and Gynecology in our hospital from December 2016 to December 2017. The basic data and placental pathological results were retrospectively collected. According to the placental pathological results of whether inflammation infiltrating amnion, CA 0/I phase was classified into non-amnionitis group, CA II/III phase was classified into amnionitis group, the incidence of common complications in preterm infants was compared. Further, logistic regression was used to analyze the effects of amnionitis on complications after being adjusted to gestational age, birth weight and thrombocytopenia.ResultsA total of 221 preterm infants were enrolled, including 186 cases in non-amnionitis group and 35 cases in amnionitis group. The gestational age of amnionitis group (32.00 ± 2.71 weeks) was significantly lower than non-amnionitis group (34.14 ± 2.06 weeks), birth weight (1.93 ± 0.64 kg) was significantly lower than that of non-amnionitis group (2.26 ± 0.58 kg), and the hospital stay in amnionitis group was significantly longer (25.71 ± 19.23 days), all of the difference above was statistically significant(P < 0.05). The incidence of intraventricular hemorrhage (IVH) in amnionitis group (37.14%) was significantly higher than that in non-amnionitis group (13.98%) (P = 0.002), and the risk of IVH was significantly increased by amnionitis (OR = 3.636, 95%CI: 1.632–8.102); after correction of gestational age, birth weight and thrombocytopenia, the risk of IVH was still significantly increased (OR = 2.471, P = 0.046, 95% CI: 1.015–6.015). And the late-onset IVH was more common (P = 0.009).ConclusionAmnionitis leads to a significant reduction in gestational age and birth weight in preterm infants, and it is an independent risk factor for IVH.

Radiofrequency ablation for hepatic oligometastatic pancreatic cancer: An analysis of safety and efficacy

ObjectivesThis study was to evaluate the value of radiofrequency ablation (RFA) in the treatment of pancreatic cancer with synchronous liver oligometastasis. Methods102 patients diagnosed with pancreatic cancer with synchronous liver oligometastasis undergoing RFA were recruited in this retrospective study between January 2012 and December 2015. Clinical efficacy was evaluated by computed tomography or magnetic resonance imaging 1 month later. All patients were treated with RFA and systemic chemotherapy based on NCCN guideline. ResultsThe median follow-up was 21 months (range, 4.0–43.8 months). Of all patients, the 1-year survival rate was 47.1% and the median overall survival time was 11.40 months. Complete tumor ablation was achieved in 137 of 145 RFA sessions (94.5%), and in 244 of 254 tumors (96.1%). The incidence of common complications was 9.8%, and no severe complications were reported in any patient. Multivariate Cox regression analysis revealed that primary tumor in the head of the pancreas (HR = 1.868, 95% CI: 1.023–3.409; P = 0.042), maximum diameter of liver metastasis 3–5 cm (HR = 1.801, 95% CI: 1.081–3.001, P = 0.024) and neutrophil/lymphocyte ratio (NLR) ≥2.5 (HR = 1.716, 95% CI: 1.047–2.811; P = 0.032) were independent predictors of poorer survival. ConclusionRFA provides a minimally invasive and safe treatment for patients with pancreatic cancer with liver oligometastases. The clinical efficiency of RFA for hepatic oligometastatic pancreatic cancer was easily affected by the following factors: primary tumor location, maximum diameter of liver metastasis and NLR. These factors could be helpful for treatment decision and clinical trial design.

Effect of long-term mild hypothermia therapy on immune function in patients with acute severe brain injury

Objective To investigate the effect of long-term mild hypothermia therapy on immune function and its prognostic significance in patients with acute severe brain injury. Methods From January 2014 to August 2015, 58 patients with severe brain injury admitted to the Intensive Care Unit, the Second Affiliated Hospital of Wenzhou Medical University were collected. They were randomly divided into either a mild hypothermia group(n=32)or a normal temperature group(n=26). Serum immunoglobulin IgA, IgM, IgG content and T cell subsets CD3+ , CD4+ , CD8+ , and CD4+ /CD8+ levels of both groups were detected on admission at day 1, 3, 5, and 14 after procedure. At the same time, its complications and mortality rate at day 14 were observed. Results Compared with before procedure, the postoperative IgA, IgM, and IgG levels were decreased in both groups of patients after procedure. The IgG level of the normal temperature group was decreased significantly at day 14 after procedure(P=0.032); the IgM and IgG levels of the mild hypothermia group were significantly higher than those of the normal temperature group over the same period(P=0.049, P=0.046). Compared with before procedure, CD3+ and CD4+ were decreased after procedure in both groups, CD3+ was decreased significantly at day 3 after procedure in the normal temperature group(P=0.010), and CD4+ was decreased significantly at day 5(P=0.037). Compared with before procedure, CD3+ and CD4+ of the mild hypothermia group were decreased at all time points, but there were no significant differences(all P>0.05). The level of CD8+ was increased slightly in both groups after procedure, but compared with before procedure, there was no significant difference(all P>0.05). At day 14 after procedure, the levels of CD4+ /CD8+ were decreased significantly in the normal temperature group(P=0.002). There was no significant difference in the incidence of common complications between the 2 groups(P>0.05), and the mortality of the normal temperature group at day 14 was significantly higher than that of the mild hypothermia group(P=0.045). Conclusions Long-term mild hypothermia therapy stabilized and improved the humoral and cellular immunity in patients with severe craniocerebral injury, reduced the mortality at day 14, and did not have any serious complications. Key words: Craniocerebral trauma; Mild hypothermia; Immunomodulation; CD4-positive T-lymphocytes; CD4-CD8 ratio

Evaluation of the clinical value of carbon nanoparticles as lymph node tracer in differentiated thyroid carcinoma requiring reoperation.

The incidence of parathyroid injury in patients with differentiated thyroid carcinoma (DTC) who underwent reoperation is significantly higher than that incurred from the initial surgery. The aim of this study was to investigate the clinical value of carbon nanoparticles (CN) as tracers for lymph nodes to guide cervical lymph node dissection and protect the parathyroid during reoperation for DTC. Our study recruited 116 patients with DTC who previously underwent thyroidectomy and later received remedial surgical treatment at the Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital, China, between February 2011 and February 2014. Those patients were randomly divided into the experimental group (the CN group) with 64 cases and the control group with 52 cases. Carbon nanoparticle suspension (CNS, 0.1-0.3 ml) was intraoperatively injected into the residual thyroid or enlarged lymph nodes in the CN group; in the control group, CNS was not applied intraoperatively. The differences in identification of the parathyroid glands, the number of lymph nodes resected intraoperatively, and the incidence of common complications after thyroidectomy in both groups were recorded and analyzed. The accuracy of identification of the parathyroid in the CN group and control group was 92.2 % and 28.8 %, respectively, and the identification rate of three glands or more in both groups was 75 % and 36.5 %, respectively; those differences were statistically significant between the two groups (P < 0.05). There was also a significant difference between the two groups in the number of lymph nodes removed in the central and lateral cervical compartments (P < 0.05). There was no increase in common complications after the second surgery compared with the previous surgery; in addition, there was a decline in the incidence of transient hypoparathyroidism (HPT) (P < 0.05). By tracing the thyroid and cervical regional lymph nodes with carbon nanoparticles, the parathyroid glands can be easily identified and protected to reduce the complications of transient hypoparathyroidism resulting from reoperation for residual or missed DTC. Carbon nanoparticle tracers also facilitate radical resection of lymph nodes at the central and lateral compartments of the neck.

Risk factors of complications after CT-guided percutaneous needle biopsy of lumps near pulmonary hilum.

The factors influencing the incidence of common complications (pneumothorax and pulmonary hemorrhage) of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax (13 cases, 27.1%) and pulmonary hemorrhage (14 cases, 20.24%). χ(2) test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases (17.5%) out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases (60%) out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases (41.4%) out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases (70%) out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation.

Intestinal Stomas

Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel and the colon. The most common intestinal stomas are the ileostomies (end and loop) and the colostomies (end and loop). Preoperative counseling, choice of procedure, and selection of stoma site are described. The general principles of the operative technique are listed, as is the creation of the stoma aperture. Types of colostomies are described and include end, loop, and double-barrel. For ileostomy, end, loop, loop-end, split, and continent are described. Details are provided on the stoma closure for loop ileostomy and loop colostomy. The chapter has sections on troubleshooting and complications, including ischemia, stenosis, prolapse, retraction, parastomal hernia, obstruction, and fistula. Figures show an end colostomy, loop colostomy, preparation of terminal ileum and placement of sutures for an end ileostomy, stoma closure for loop ileostomy, stabilization of retracted ileostomy, preperitoneal mesh repair of parastomal hernia, and laparoscopic intra-abdominal placement of polytetrafluoroethylene-coated mesh. Tables show indications for different types of intestinal stomas, incidence of common complications of the intestinal stomas, incidence of parastomal hernia formation, and additional complications arising after stoma formation. This review contains 12 figures, 5 tables, and 106 references.

Nutrient Adequacy and Incidence of Common Complications in Women on ART in Manipur State, India.

A cross sectional study to study the food intake, nutrient adequacy and incidence of common complications & adverse events in Manipur state, India, was carried out on 442 women on ART in 2 hospitals, RIMS & JNIMS from April, 2009-October 2012. Anthropometric assessments, diet survey by 24 hours recall method, & hemoglobin estimation was done. Average mean age of the women was 37.62 years. 55.7% consisted of widows, 68.8% had monthly income less than Rs. 5000 per month, 86.2% of the women got the virus from their husbands who were ex-IDUs. Mean intake of cereals, roots & tubers were significantly higher when compared against the recommended levels while intake of all other remaining items was significantly lower. Mean daily intake of protein, fat, calcium and vitamin-C were more than RDA whereas the intake of energy, iron, carotene, thiamin, riboflavin & niacin were less. Average BMI was 21.04, average W: H was 0.84. Mean hemoglobin was 10.36 g/dl, 55.9% had mild anemia. There were 12 cases of HCV, 4 cases of HBV, 15 cases of TB. Most recorded discomfort was anorexia (43 cases) and heartburn/ bloating (33 cases). Study suggested compulsory diet counseling with nutritional supplementation & monetary assistance, to have important