Incidence Of Specific Complications Research Articles

The impact of preoperative skeletal muscle mass index-defined sarcopenia on postoperative complications and survival in gastric cancer: An updated meta-analysis.

The impact of preoperative sarcopenia on postoperative outcomes in gastric cancer remains debated. This study aims to perform an in-depth meta-analysis and comprehensive review of the relationship between preoperative sarcopenia, as assessed by the Skeletal Muscle Mass Index (SMI), and postoperative complications and survival metrics in gastric cancer patients, to offer new insights into this issue. We conducted a systematic search of primary studies in databases such as Embase, PubMed, and Web of Science, up to July 2024. Our analysis focused on comparing postoperative readmission and mortality rates, overall and severe complication rates, incidence of specific complications, as well as overall survival (OS) and disease-free survival (DFS) between groups with and without preoperative sarcopenia. Our review included 42 studies with a total of 11,981 patients. Findings revealed that patients with sarcopenia had significantly higher rates of overall postoperative complications, severe complications, mortality, and readmissions compared to those without sarcopenia (all P<0.001). A detailed examination showed that sarcopenic patients had notably higher incidences of pulmonary complications, bowel obstruction, and pancreatic fistulas. Additionally, the OS (P<0.001) and DFS (P=0.003) rates were considerably lower in the sarcopenia group. Preoperative sarcopenia is associated with an increased risk of postoperative complications and poorer survival outcomes in gastric cancer patients. Given these associations, it is recommended to incorporate routine screening for sarcopenia using SMI before surgery, where feasible, to enhance patient risk assessment and customize treatment approaches.

Poster 352: Adverse Events and Complications following Primary ACL Reconstruction with Quadriceps Tendon Autograft: A Systematic Review

Objectives: To systematically review the incidence of postoperative complications and adverse events following primary ACLR with quadriceps tendon autograft, while secondarily comparing the reported rates in an all-soft tissue quadriceps tendon (QT) graft relative to quadriceps tendon grafts with a patellar bone plug (QTPB). Methods: Two independent authors conducted a literature search using PubMed, Embase, and Scopus databases using the Preferred Reporting Items for Systematic Meta-Analyses (PRISMA) guidelines. The search strategy included the following keywords combined with Boolean operators: ‘Anterior Cruciate Ligament’, ‘ACL’ ‘Reconstruction’, and ‘Quadriceps Tendon’. Inclusion criteria consisted of level I to IV human clinical studies in English or English-language translation reporting complications and adverse events after primary ACLR using quadriceps tendon autograft. The overall incidence of complications throughout the included studies, as well as the incidence of specific complications were extracted. A 2- proportion z-test was performed to evaluate for potential differences in the incidence of postoperative complications between ACLR with quadriceps tendon with and without a patellar bone plug. Results: A total of twenty studies, consisting of 2,381 patients (2,389 knees) with a mean age of 27 (mean range, 12 - 58) years, consisting of 68.3% males (n=1626/2381), were identified. The mean follow-up was 28.5 (mean range, 6 – 47) months. The total incidence of complications was 10.3% (n = 246/2389 patients), with persistent post-operative knee pain being the most common, as seen in 10.8% (n = 91/843) of knees. Patients who underwent ACL reconstruction with QT graft had increased incidence of persistent knee pain (23.3%) and reoperations (5.9%) when compared to QTPB grafts (8.6% and 3.2%, respectively) (p &lt; .01). Nontraumatic graft ruptures were greater with the QTPB (2.1%) relative to QT (0.5%) (p = 0.01). There was no appreciable difference in total complications, total graft failures, traumatic rupture, ACLR revisions, cyclops lesions, or arthrofibrosis (all, p &gt; 0.05). Patellar fractures occurred exclusively with the QTPB (2.2%). Conclusions: Complications following primary ACLR using quadriceps tendon autograft were recorded in 10.5% of knees, the most common of which is persistent knee pain. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts, however persistent knee pain was 2.7x greater with QT. [Table: see text][Table: see text]

A Systematic Review of Adverse Events and Complications After Isolated Posterior Medial Meniscus Root Repairs

Background: Medial meniscus posterior root (MMPR) tears are recognized as a substantial cause of disability and morbidity. However, meniscus root repair, regardless of technique, is not without potential complications. Purpose: To evaluate the reported incidence of complications and adverse events after isolated MMPR repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed, and Scopus databases with the following search terms combined with Boolean operators: “meniscus,”“root,” and “repair.” Inclusion criteria consisted of level 1 to 4 human clinical studies in English or English-language translation reporting complications and adverse events after isolated posterior medial meniscus root repairs. The overall incidence of specific complications was estimated from the pooled sample of the included studies. Results: Eleven studies with a total pooled sample of 442 patients were identified. The mean patient age was 58.1 years, while the mean final follow-up time was 37.2 months (range, 12-84.8 months). The overall incidence of complications was 9.7% (n = 43/442), with the most commonly reported complication being progressive degenerative changes within the knee (10.4%; n = 25/240; n = 5 studies). A total of 1.25% (n = 3/240) of patients who experienced degenerative changes required conversion to total knee arthroplasty. Repair failures were reported in 3.1% (n = 10/327; n = 8 studies) of patients. Conclusion: Repairing MMPR tears is critical in preventing accelerated progression of knee osteoarthritis in patients without significant knee osteoarthritis preoperatively. While this repair is still recommended and necessary in appropriate patients, this review found that the incidence of complications after isolated posterior medial meniscus root repair was 9.7%, primarily involving the presence of progressive degeneration, while repair failure was reported in 3% of patients.

Perioperative outcomes following pelvic floor reconstruction in women with hereditary disorders of connective tissue: a retrospective cohort study.

Women with hereditary disorders of connective tissue (HDCT) are at increased risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesized that patients would have increased incidence and severity of perioperative complications up to 6weeks after surgeries for POP/SUI. Secondary objectives were to compare pre- and post-operative pelvic floor symptoms and anatomical support as well as pelvic floor disorder recurrence. In this multi-center retrospective cohort study, we identified patients with HDCTs by patient history and ICD-9 codes over an 11-year period. Controls without HDCTs were matched 2:1 to the primary POP or SUI procedure and surgeon. Demographic characteristics, perioperative pelvic floor information and complications were collected. A sample size of 65 HDCT patients and 130 controls was calculated to detect a 20% difference in complications with 80% power and alpha of 0.05. We identified 59 HDCT patients and 118 controls. Of the women with HDCTs, 49% had Ehlers-Danlos, 22% joint hypermobility syndrome, 15% Marfan syndrome, and 14% had others. Compared with controls, HDCT patients had more total perioperative complications (46% vs 22%, p =0.002); an age-adjusted relative risk of complications was 1.4 (CI 0.7-2.6). HDCT patients had more Clavien-Dindo grades I and II complications (p =0.02, 0.03) and more hospital readmissions (14% vs 3%, p =0.01) than controls. There was no difference in the incidence of specific complications nor was there a difference in recurrence of POP (10%) or SUI (11%) between groups. Patients with HDCTs had more Clavien-Dindo grade I and II complications following pelvic floor reconstructive surgery and more readmissions.

Realistic Advantages of Early Surgical Drain Removal after Pancreatoduodenectomy: A Single-Institution Retrospective Study.

The latest guidelines from the Enhanced Recovery After Surgery (ERAS®) Society stated that early drain removal after pancreatoduodenectomy (PD) is beneficial in decreasing complications including postoperative pancreatic fistulas (POPFs). This study aimed to ascertain the actual benefits of early drain removal after PD. The data of 450 patients who underwent PD between 2018 and 2020 were retrospectively reviewed. The surgical outcomes were compared between patients whose drains were removed within 3 postoperative days (early removal group) and after 5 days (late removal group). Logistic regression analysis was performed to identify the risk factors for clinically relevant POPFs (CR-POPFs). Among the patients with drain fluid amylase < 5000 IU on the first postoperative day, the early removal group had fewer complications and shorter hospital stays than the late removal group (30.9% vs. 54.5%, p < 0.001; 9.8 vs. 12.5 days, p = 0.030, respectively). The incidences of specific complications including CR-POPFs were comparable between the two groups. Risk factor analysis showed that early drain removal did not increase CR-POPFs (p = 0.163). Although early drain removal has not been identified as apparently beneficial, this study showed that it may contribute to an early return to normal life without increasing complications.

A prospective 3 year study of clinical spectrum and outcome of dengue fever in ICU from a tertiary care hospital in North India.

Background and Aims:The incidence of specific complications and adverse outcomes in dengue patients needing admission to intensive care units (ICU) may be quite variable in different regions of India presumably because of different strains of dengue virus or due to re infection.Methods:Patients admitted with acute febrile illness (AFI) with either positive IgM antibody or NS1 antigen for dengue were enrolled. Data were collected for 3 years (2015-2017). A total of 313 patients with acute febrile illness were admitted in the study period (2252 total ICU admissions). A total of 137 (43.76%) cases were serologically proven as dengue fever.Results: Median age (IQR) of study population was 36.0 (26.0–52.0) years. Liver (65.7%) was the main organ involved followed by acute kidney Injury (AKI) (18.6%). Dengue Shock Syndrome (DSS) was found in 18.6% of cases. Fifty-two patients died and the crude mortality was 38.0%. On multivariate analysis APACHE Score <10, thrombocytopenia, hepatic dysfunction, AKI and dengue shock syndrome (DSS) were associated with the risk of mortality.Conclusion: This study in ICU patients showed high mortality in relatively younger patients. Liver (in the form of raised Bilirubin) was the most common organ dysfunction. The need to recognise early warning signs for ICU admission is highlighted.

Measuring the effect of adjuvant chemotherapy on function-related adverse outcomes among older breast cancer patients.

10052Background: The incidence of specific complications of adjuvant chemotherapy in breast cancer is well documented in clinical trials. However, the effect of chemotherapy on functional outcomes ...

A prospective study of different complications following laparoscopic cholecystectomy in a tertiary care hospital in Eastern India

Background: Laparoscopic approach for cholecystectomy has already become the standard of care for the management of symptomatic and (in selected cases) asymptomatic cholelithiasis. Despite proven advantages laparoscopic cholecystectomy (LC) is known to be associated with certain complications. Methods: This prospective study was undertaken to document the incidences of such complications and to compare them to those in already published data. A total of 750 cases of LC performed in the department of general surgery at IPGME and R and SSKM hospital, Kolkata were observed for a minimum period of 8 weeks following surgery. The complications were noted and their incidences calculated using simple statistical tools. These were then compared with those in already published data. Results: A total of 493 complications occurred in 483 patients (64.4%). The most common complication was port-site infection (PSI) occurring in 476 patients (63.5%). The other complications included bleeding (1.2%), bowel injury (0.7%) and bile duct injury (0.4%). Mortality occurred in 3 cases (0.4%). Conversions to open cholecystectomy (OC) due to inability to proceed in a timely manner because of difficult exposure or unclear anatomy were not considered as complications rather as an inevitable extension of the primary approach in some difficult scenarios. Conclusions: At the end of our study period we could conclude that the incidences of specific complications in our study are less than those reported from different centres across the globe except for PSI. The alarmingly high incidence of PSI noted is a matter for introspection. A detailed study needs to be undertaken so that appropriate measures may be taken to prevent this scourge.

Predictors of Postoperative Morbidity after Minor and Major Liver Resections in a Single German Centre

1.1 Background: Hepatic resections are classically subdivided into major and minor resections. These definitions are important for the perioperative management as major resections are associated with a higher incidence of complications like liver failure or bile leakage. However, other perioperative factors might also influence patient outcome. The present study aims to evaluate the significance of major and minor hepatic resection as well as other factors on the postoperative course. For this purpose we analysed data retrospectively from our centre. 1.2 Patients and methods: The study was based on a prospective database of all liver resections performed at the University Hospital Mannheim between January 1998 and December 2010 (a total of 627 consecutive liver resections). In these patients 135 major hepatectomies, and 192 minor resections were performed. Wedge resections were excluded from analysis. Variables independently associated with the occurrence of complications were identified using a binary regression analysis model. 1.3 Results: 186 (56.9%) of the patients were male, the mean age of all patients was 61.9 years (SD 11.5). The rate of patients with postoperative liver failure was 3.4% and 30-day mortality was 5.5%. Mean length of stay was 15.6 days. Surgical and non-specific complications were significantly more frequent in major hepatectomies. However, we found that the performed procedure was no independent risk factor for the incidence of specific complications, liver failure and mortality. Multivariate analysis could reveal different other independent risk factors for the incidence of complications and mortality. Among these were ASA classification, low preoperative serum albumin and elevated preoperative levels of ALAT. 1.4 Conclusion: Our data suggests that quality and quantity of complications does not only depend on the extent of the performed procedure. Our analysis identified additional independent risk factors. These risk factors, as well as the performed procedure, should be considered in the perioperative management.

Complications in Robotic-Assisted Gynecologic Surgery According to Case Type: A 6-Year Retrospective Cohort Study Using Clavien-Dindo Classification

Study ObjectiveTo estimate the risk of postoperative complications in robotic-assisted gynecologic surgery according to case type. Study DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingMayo Clinic Arizona. PatientsAll 1155 patients who underwent robotic-assisted gynecologic surgery between March 2004 and December 2009 were included. Patients were primarily white (94.3%), with a mean (SD) age of 51.5 (15.4) years, and were overweight, with body mass index (BMI) of 27.2 (6.8). InterventionsRisk of complications, overall and according to Clavien-Dindo grade, and incidence of specific complications were analyzed. Robotic-assisted gynecologic surgical procedures were categorized postoperatively according to case type as benign simple (e.g., oophorectomy, simple hysterectomy) in 552 (47.8%) patients, benign complex (e.g., excision of invasive endometriosis) in 262 (22.7%), urogynecologic in 121 (10.5%), and oncologic in 220 (19.1%). Measurements and Main ResultsIntraoperative complications occurred in 3.2% of patients. Postoperative complications of any type occurred in 18.4% of patients. Conversion to laparotomy was necessary in 2.7%. Urologic complications were more common in urogynecologic cases (5.8%) as compared with benign simple (0.5%), benign complex (2.7%), and oncologic (3.2%). Bleeding complications were most common in oncologic cases (5%). Clavien-Dindo grade ≥3 complications occurred in 5.2% of patients overall, and were >3-fold likely to occur in benign complex, urogynecologic, and oncologic cases than in benign simple cases. When adjusted for age, BMI, estimated blood loss, operative time, length of stay, and previous pelvic surgery, complications were nearly twice as common for benign complex (odds ratio [OR] 1.7; 95% confidence interval [CI], 1.1–2.7), urogynecologic (OR 1.9; 95% CI, 1.0–3.4), and oncologic (OR 1.9; 95% CI, 1.1–3.1) cases as for benign simple cases, although weakly significant. Case type, BMI, estimated blood loss, and length of stay remained important factors in predicting postoperative complications. ConclusionThe incidence of complications in robotic-assisted gynecologic surgery varies according to case type. Defining the role of patient and surgical variables such as case type in the occurrence of complications may help in identification of cases with increased risk, to improve patient counseling and surgical outcome.

A Prospective Audit of Early Pain and Patient Satisfaction Following Out-Patient Band Ligation of Haemorrhoids

Information regarding early morbidity, pain and patient satisfaction following band ligation of haemorrhoids is limited. This is the first report to address these issues specifically. A total of 183 patients underwent the procedure over a 10-month period. Prospective data were collected using a detailed structured questionnaire regarding symptoms, analgesia requirements and patient satisfaction in the following week. The response rate was 74% (135/183). Pain scores were highest 4 h following the procedure. At 1 week, 75% of patients were pain-free, with 9 (7%) still experiencing moderate-to-severe pain. About 65% required oral analgesia, most frequently on the day of procedure. Rectal bleeding occurred in 86 patients (65%) on the day after banding, persisting in 32 (24%) at 1 week. Vaso-vagal symptoms occurred in 41 patients (30%) and were commonest at the time of banding. Eighty patients (59%) were satisfied with their experience and would undergo the procedure again. Patients requiring oral analgesia and those experiencing bleeding or vaso-vagal symptoms were significantly less likely to be satisfied with the procedure. Only 57% of the patients surveyed would recommend the procedure to a friend. Data from this large cohort of patients suggest that discomfort and bleeding may persist for a week or more following banding of haemorrhoids. Patients should be aware of this in order to make an informed decision as to whether to undergo the procedure, and surgeons should investigate ways of reducing it. Patient satisfaction may be further improved by more accurate counselling regarding the incidence of specific complications.

Incidence of neurologic complications related to thoracic epidural catheterization.

Due to potential neurologic sequelae, the risk:benefit ratio of thoracic epidural analgesia is controversial. Surprisingly, however, few available data address neurologic complications. The incidence of neurologic complications occurring after thoracic epidural catheterization was studied in patients scheduled for abdominal or abdominothoracic surgery. A total of 4,185 patients were studied, including 2,059 during the prospective phase of the study and 2,126 during the retrospective phase. After thoracic epidural catheterization, all patients received general anesthesia. Patients' neurologic status was assessed by an anesthesiologist using clinical criteria after operation and after epidural catheter removal. If neurologic complications were suspected, a neurologist was consulted. The incidence of specific complications was compared for different thoracic puncture sites: upper (T3/4-6/7), mid (T7/8-8/9), and lower (T9/10-11/12) catheter insertion levels. The overall incidence of complications after thoracic epidural catheterization was 3.1% (n = 128). This included dural perforation (0.7%; n = 30); unsuccessful catheter placement (1.1%; n = 45); postoperative radicular type pain (0.2%; n = 9), responsive to catheter withdrawal in all cases; and peripheral nerve lesions (0.6%; n = 24), 0.3% (n = 14) of which were peroneal nerve palsies probably related to surgical positioning or other transient peripheral nerve lesions (0.2%; n = 10). No signs suggesting epidural hematoma were recognized, and there were no permanent sensory or motor defects attributable to epidural catheterization. Unintentional dural perforation was observed significantly more often in the lower (3.4%) than in the mid (0.9%), or upper (0.4%) thoracic region. A single patient experienced severe respiratory depression after receiving epidural buprenorphine but recovered without sequelae. Thoracic epidural catheterization for abdominal and thoracoabdominal surgery is not associated with a high incidence of serious neurologic complications. In fact, the incidence of puncture- and catheter-related complications is less in the mid and upper than in lower thoracic region, and the predicted maximum risk for permanent neurologic complications (upper bound of the 95% confidence interval) is 0.07%.

Reduction mammaplasty with the inferior pedicle technique: early and late complications in 371 patients

A review of reduction mammaplasties with the inferior pedicle technique in 371 patients over 10 years is presented and the complications associated with this particular technique are discussed. The mean age was 33.1 years (range 15–67), the average preoperative sternal notch to nipple distance was 30.4 cm (range 21–43), the mean breast tissue resected was 870 g per breast (range 250–1960) and the mean operating time was 3.1 hours (range 2.5–4). The overall complication rate was 11.4%. The incidence of specific complications in our series was: haematoma 0.3%, nipple and/or pedicle necrosis 0.8%, wound dehiscence 4.6%, fat necrosis 0.8%, carcinoma 0.5%, loss of sensitivity of the nipple 1.3%, hypertrophic scars 3.3%, dermoid cysts 0.3% and marked lower fullness 0.3%. 72% of the patients that became pregnant were able to lactate.

Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals.

We determined the incidence of acute, major complications in a population of 28,395 patients who underwent lumbar laminectomy for discogenic radiculopathy in the United States in 1980. This population was drawn from a broad cross-section of community hospitals and represented 31% of all patients who underwent laminectomy that year for this condition. Our cohort excluded patients with a) operations exceeding two disc levels, b) fusion, c) previous lumbar laminectomy, or d) coexistent discitis, spondylosis, spinal stenosis, myelopathy, or arachnoiditis. The incidence of death was 5.9 per 10,000. The causes of death were septicemia, myocardial infarction, and pulmonary emobolus. The incidence of at least one major complication was 157 per 10,000. The incidences of specific complications were as follows: infection requiring intravenously administered antibiotics, 30.7; major neurological deficit, 29.8; pulmonary embolus, 10.7; and myocardial infarction, 5.6. We studied four additional categories of complication. Patients were counted only when a second operation was required to treat the complication. The categories and incidence per 10,000 were as follows: incisional hematoma, 8.7; cerebrospinal fluid fistula, 10.5; ventral perforation, 1.6; and retention of a foreign body, 0.7. Among the patients whose hospitalizations were otherwise normal, 6.7% received a blood transfusion; of the patients whose hospitalizations were complicated, 24% required transfusion. The demographic characteristics of transfusion. The demographic characteristics of patients with a normal hospitalization were tabulated separately from those whose hospitalizations were complicated. Neurosurgeons performed 60% of the operations, and orthopedic surgeons performed 40%. The speciality of the surgeon was not a factor in determining the risk involved in surgery. Spinal anesthesia was used in 7% of the cases, and no pattern of complications emerged that was uniquely related to that technique.

Complications and Demographic Characteristics of Patients Undergoing Lumbar Discectomy in Community Hospitals

Abstract We determined the incidence of acute, major complications in a population of 28,395 patients who underwent lumbar laminectomy for discogenic radiculopathy in the United States in 1980. This population was drawn from a broad cross-section of community hospitals and represented 31% of all patients who underwent laminectomy that year for this condition. Our cohort excluded patients with a) operations exceeding two disc levels, b) fusion, c) previous lumbar laminectomy, or d) coexistent discitis, spondylosis, spinal stenosis, myelopathy, or arachnoiditis. The incidence of death was 5.9 per 10,000. The causes of death were septicemia, myocardial infarction, and pulmonary emobolus. The incidence of at least one major complication was 157 per 10,000. The incidences of specific complications were as follows: infection requiring intravenously administered antibiotics, 30.7; major neurological deficit, 29.8; pulmonary embolus, 10.7; and myocardial infarction, 5.6. We studied four additional categories of complication. Patients were counted only when a second operation was required to treat the complication. The categories and incidence per 10,000 were as follows: incisional hematoma, 8.7; cerebrospinal fluid fistula, 10.5; ventral perforation, 1.6; and retention of a foreign body, 0.7. Among the patients whose hospitalizations were otherwise normal, 6.7% received a blood transfusion; of the patients whose hospitalizations were complicated, 24% required transfusion. The demographic characteristics of patients with a normal hospitalization were tabulated separately from those whose hospitalizations were complicated. Neurosurgeons performed 60% of the operations, and orthopedic surgeons performed 40%. The speciality of the surgeon was not a factor in determing the risk involved in surgery. Spinal anesthesia was used in 7% of the cases, and no pattern of complications emerged that was uniquely related to that technique.

Surgical, infectious and thromboembolic complications of central venous catheterization.

The authors have analysed the incidence of specific complications in a series of 420 intracaval catheters placed in 388 patients, using six transcutaneous puncture techniques: supraclavicular and infraclavicular subclavian, external and internal jugular, antecubital and brachiocephalic approaches. Strict and moderate criteria were used to evaluate the frequency of complications. Using strict criteria, the lowest rate of surgical complications (5%) was found with the antecubital and external jugular approach, followed by infraclavicular (6.7%) and supraclavicular (9.3%) subclavian techniques; the highest rate was seen with internal jugular (10%) and brachiocephalic (15%) routes. As to inflammatory and infectious complications, the sequence was as follows: brachiocephalic (2.5%), infraclavicular (4.4%) and supraclavicular (5.3%) subclavian, and internal jugular (7%) veins; a 10% incidence was associated with external jugular and antecubital techniques. Manifest thromboembolic complications were observed only in the brachiocephalic and antecubital groups (2.5% and 10%, respectively), the overall incidence of pulmonary embolism being 0.2%. None of the approaches used can be recommended as an exclusive method of choice. The risks of central venous catheterization should be minimalized by adherence to strict principles of placing as well as care of the indwelling intravenous catheters.

Vasectomy: benefits versus risks.

The benefits and risks of modern vasectomy are presented, including a discussion of precautions and contraindications, the incidence of specific complications and suggestions for minimizing them, and the incidence of and reasons for procedure failures. Long-term side effects, including psychological sequelae, are also discussed.