Incidence Rate Of Major Complications Research Articles

Complications following salvage transoral robotic surgery with and without reconstruction: A systematic review of the literature

BackgroundTransoral robotic surgery (TORS) has been used in the salvage setting for head and neck cancers both with and without reconstruction. The complications of salvage TORS and the effect of reconstruction on complications has not been studied. ObjectiveTo study the complications of salvage TORS and examine the effect of reconstruction on complication rates.Method:An electronic search of the English- language literature using PubMed, Medline, and the Cochrane database was conducted and a systematic review performed in accordance with PRISMA guidelines (CRD42020181057). ResultsA total of 23 studies including 533 patients have been published on salvage TORS.The average patient age was 61.2 years.Prior treatment was described for 420 patients.205 (48.8%) underwent prior definitive radiotherapy (RT).160 (38.1%) underwent definitive chemoradiotherapy (CRT).Only 55 (13.1%) had prior surgery.Overall, there were 158 complications with a pooled rate of 33.6% (95%CI: 25.4–42.3%).77 were major complications requiring surgical intervention with a pooled rate of 18.9% (95% CI: 14.8–23.3%).The number of patients undergoing reconstruction among salvage cases in the literature is 59 (9.19%), with 24 local flaps and 25 microvascular free flaps.Reconstruction was associated with lower overall hemorrhage rates but had no impact on major hemorrhage rates. ConclusionsThe pooled incidence rates of major complications, major POH and emergency tracheostomy following salvage TORS are 18.9%, 10.5%, and 4.4%.The rate of death following salvage TORS is 3.6%. Reconstruction was associated with lower overall hemorrhage rate after salvage TORS but had no impact on major postoperative hemorrhage rates.

Incidence of Complications of Colostomy in Children with Hirschsprung Disease and Anorectal Malformation

Colostomy formation, A surgery used in the management of Hirschsprung's disease, and anorectal malformations. colostomy complications were represented both in children with Hirschsprung's disease and in those with anorectal malformation Objective: To estimate the incidence rate of major complications after colostomy formation surgery. Methods: A prospective longitudinal descriptive study was performed to calculate the incidence rates of complications following the surgical intervention of colostomy formation. All 200 cases of consecutive young children (age 2 days to 60 days) who received a colostomy between (date January 2017 to January 2020) were included. The incidence of major colostomy-related complications was calculated. This was analyzed for colostomy formation. Non-colostomy-related complications were not included in study. Results: 200 young children were included. And a follow-up of 6 months of this study to review the complications of colostomy formation in infants and children with Hirschsprung's disease or an anorectal malformation. 80% experienced colostomy-related complications, colostomy prolapse (35% in HD more with a transverse colostomy, 20% in Anorectal malformation), colostomy stenosis (15% in HD, 35% in Anorectal malformation), Skin excoriation (40% in HD, 25% in Anorectal malformation), Revision of colostomy (15% in HD, 12% in Anorectal malformation), colostomy bleeding almost same in both conditions 30%, Parastomal herniation, 5% in both conditions, colostomy wound infection were also recorded, Same in both conditions 5%. Conclusions: Consider the risks associated with a colostomy formation before undergoing surgery in both Hirschsprung's disease and anorectal malformation. complications can be excluded with careful surgery and proper nursing care.

Clinical effect of an additional maintenance dose of caffeine before ventilator weaning in preterm infants with respiratory distress syndrome: a prospective randomized controlled trial

Objective To study the clinical effect of an additional maintenance dose (5 mg/kg) of caffeine citrate injection at 1 hour before ventilator weaning in improving the success rate of ventilator weaning in preterm infants (gestational age ≤32 weeks) with respiratory distress syndrome (RDS) on mechanical ventilation. Methods A total of 338 preterm infants with RDS (gestational age of ≤32 weeks) who were admitted to the Neonatal Intensive Care Unit of Xiamen Maternal and Child Health Hospital from January 2017 to December 2019 and treated with mechanical ventilation were enrolled. They were randomly divided into an observation group and a routine group, with 169 infants in each group. Both groups received early routine treatment with caffeine. The infants in the observation group received an additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning. The two groups were compared in terms of reintubation rate and number of apnea episodes within 48 hours after ventilator weaning, changes in blood gas parameters, blood glucose, heart rate, and mean blood pressure at 2 hours after ventilator weaning, and incidence rates of major complications during hospitalization. Results Compared with the routine group, the observation group had significantly lower reintubation rate (P=0.034) and number of apnea episodes (≥2 times/day) (P=0.015) within 48 hours after ventilator weaning. Compared with the routine group at 2 hours after ventilator weaning, the observation group had a significantly higher pH value and a significantly lower arterial partial pressure of carbon dioxide (P 0.05). During hospitalization, the observation group had a significantly lower incidence rate of intraventricular hemorrhage than the routine group (P=0.048), but there were no significant differences between the two groups in the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, and periventricular leukomalacia and mortality rate (P > 0.05). Conclusions An additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning is safe and effective in improving the success rate of ventilator weaning in preterm infants with RDS and thus holds promise for clinical application.

Is constant negative pressure for external drainage of the main pancreatic duct useful in preventing pancreatic fistula following pancreatoduodenectomy?

BackgroundThis study sought to investigate the utility of constant negative pressure for external drainage of the main pancreatic duct in preventing postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. MethodsOnly patients with soft pancreas were included. In the former period (July 2013 to May 2015), gravity dependent drainage was applied (gravity dependent drainage group), and in the latter period (June 2015 to November 2016), constant negative pressure drainage (negative pressure drainage group) was applied to the main pancreatic duct stent. ResultsThere were 37 patients in the gravity dependent drainage group and 39 patients in the negative pressure drainage group. Clinically relevant POPF occurred in 21 patients (56.8%) in the gravity dependent drainage group and 13 patients (33.3%) in the negative pressure drainage group (p = 0.040). The incidence rate of major complications (Clavien-Dindo grade > III) was significantly lower in the negative pressure drainage group (13.2%) compared to the gravity dependent drainage group (48.7%) (p = 0.001). In-hospital stay was also significantly shorter in the negative pressure drainage group compared to the gravity dependent drainage group (median 25 vs. 33 days, p = 0.024). Multivariate analysis demonstrated that the gravity dependent drainage was one of the independent risk factors for the incidence of POPF (odds ratio, 3.33; p = 0.032). ConclusionsIn patients with soft pancreas, the incidence rate of clinically relevant POPF may be reduced by applying constant negative pressure to the pancreatic duct stent. It also has a potential to reduce overall incidence of major complications and shorten in-hospital stay after pancreatoduodenectomy.

Efficacy of microwave ablation in treatment of hepatocellular carcinoma within the Milan criteria: a report of 696 cases

Objective: To investigate the efficacy of microwave ablation in the treatment of hepatocellular carcinoma (HCC) within the Milan criteria and to investigate the differences in clinical efficacy of microwave ablation in tumors with different sizes. Methods: A retrospective analysis was performed on the clinical data of the patients with HCC within the Milan criteria who received microwave ablation in our hospital from January 2011 to January 2013. The complete ablation rate, incidence rate of major complications, recurrence rate, and overall survival rate were analyzed and the treatment outcomes were compared between two groups with different tumors sizes. The patients were followed up for 3.4-61.8 months. The Kaplan-Meier method was used to calculate overall survival rate, local recurrence rate, and distant recurrence rate. Comparison of rates between groups was made by the chi-square test and comparison of survival rates between groups was made by the log-rank test. Results: A total of 696 patients with HCC within the Milan criteria involving 801 tumors were included in this study. The complete ablation rate was 93.8% (653/696) and the incidence rate of major complications was 1.7% (12/696). The median survival time was 59.6 months and the 1-, 2-, and 3-year overall survival rates were 94.8%, 82.2%, and 71.7%, respectively. The local recurrence rate was 13.4% (93/696) and the rate of intrahepatic distant metastasis was 40.1% (279/696). The overall intrahepatic recurrence rate was 48.1% (335/696), and the 1-, 2-, and 3-year recurrence rates were 22.9%, 38.4%, and 46.8%, respectively. There were no significant differences in complete ablation rate, incidence rate of major complications, and overall survival rate between the two groups with different tumor sizes (diameters≤3 cm and 3-5 cm) (P = 0.12; P = 0.61; P = 0.61). Conclusion: Microwave ablation is a safe and effective treatment modality for HCC within the Milan criteria. And there are no significant differences in safety, effectiveness, and long-term efficacy of microwave ablation between the two groups with different tumor sizes (diameters ≤3 cm and 3-5 cm). However, if the operator's experience is not rich and cannot accurately use conformal ablation and make an individualized treatment, the tumors with a diameter of 3-5 cm should be carefully treated using microwave ablation to avoid residual tumor after treatment.

Surgery-Related Muscle Loss and Its Association with Postoperative Complications After Major Hepatectomy with Extrahepatic Bile Duct Resection.

Several studies have reported that preoperative sarcopenia negatively impacts postoperative outcomes. Meanwhile, changes in skeletal muscle mass during the acute phase after surgery and their association with postoperative complications are unknown. The objective of this study was to investigate the relation between changes in skeletal muscle mass and postoperative complications after major hepatectomy with extrahepatic bile duct resection. This study included 254 patients who underwent major hepatectomies with extrahepatic bile duct resections. Total psoas muscle area (TPA) was measured using abdominal computed tomography images obtained before and 1week after surgery. The percent change in TPA after surgery was calculated. Patients were stratified by sex-specific tertiles according to the extent of muscle mass change by percentage. Surgery-related muscle loss (SML) was defined as the lowest tertile of percent change in TPA. Male patients with a percent change of TPA lower than -5.0% (n=54) and female patients with that lower than -2.6% (n=31) were included in the lowest tertile and were categorized into a group with SML. The incidence rates of major complications, pancreatic fistula, infectious complications, and mortality were all significantly higher in the group with SML than in the group without SML. By multivariate analyses, SML was identified as an independent factor associated with major complications (odds ratio 3.21; 95% confidential interval 1.82-5.76, p<0.001). SML is significantly associated with postoperative morbidity and mortality in patients who underwent major hepatectomies with extrahepatic bile duct resections.

Stress Related Cardiomyopathy during Flexible Bronchoscopy

Flexible bronchoscopy is a safe medical procedure, but the incidence rate of major complications is 0.08-0.3%. Here, we report 2 cases of stress induced cardiomyopathy, which developed immediately after flexible bronchoscopy. Stress related cardiomyopathy was confirmed by EKG, echocardiography, and coronary angiogram. The cardiac functions of these patients were fully recovered with conservative treatment. Although, the pathogenesis of stress related cardiomyopathy is not well understood, post-bronchoscopy tachycardia or arrhythmia is thought to be associated with hypoxemia or catecholamine excess. Because the clinical presentation is quite similar to acute myocardial infarction, discrete evaluations are required for appropriate treatment.

Evaluation of adult pott's puffy tumor: Our five cases and 27 literature cases

Pott's puffy tumor (PPT) is defined as one or more subperiosteal abscesses of the frontal bone based on osteomyelitis. PPT is observed predominantly in the adolescent age group and rarely in adults. Some parameters affecting prognosis and an appropriate surgical approach for antecedent frontal sinusitis have not been elucidated due to the rarity of patients with adult PPT. Retrospective patient record and literature study. Five patients from our cohort and 27 patients identified in a literature search formed the study group. The incidence rate of intracranial complications was lower than in previous reports at 29.0%. There was no correlation between the incidence rate of intracranial complications and each patient's parameters. It was indicated that the department first consulted by the patients was possibly related to the initial diagnosis and the incidence rate of intracranial complications. Although the incidence rate of major complications is lower than in children and later than in earlier published adult cases, patients are still at high risk of serious intracranial complications. Early diagnosis and adequate treatment may contribute to reducing the incidence rate.

Abstract 3027: The Pocket Protector Study: Use of D-Stat ® Flowable Hemostat in Pulse Generator Pectoral Pockets Reduces the Rate of Clinically Relevant Hematomas

Background : Patients who are anti-coagulated following pulse generator implantation have a 20% risk of hematoma development in the pre-pectoral pocket. In general, hematomas are correlated with patient discomfort &amp; pain, lead to increased risk of infections, &amp; may require surgical drainage leading to longer hospitalization. Objectives : This investigation was conducted to evaluate safety &amp; effectiveness associated with use of D-Stat ® Flowable Hemostat following implantation of a pulse generator compared to standard of care. Safety endpoint evaluated the incidence of major study-related adverse events &amp; effectiveness endpoint evaluated the incidence rate of clinically significant hematomas. Clinically relevant hematoma was defined as alteration in the standard of care. Methods : Two hundred sixty nine anticoagulated patients were enrolled at ten sites &amp; followed through 8 weeks post-procedure. Patients undergoing implantation were randomized to either D-Stat Flowable Hemostat or standard of care. Results : No statistical differences were observed in the baseline demographics between treatment groups. The D-Stat Flowable group presented with 65.4% males compared to 71.4% in the control group. Mean age was 73.3 years in the D-Stat Flowable group vs 72.2 years in the control group. Pulse generator distribution between the study groups was 54.4% pacemakers &amp; 45.5% ICDs in the D-Stat Flowable group vs 54.9% pacemakers &amp; 45.1% ICDs in the control group. The safety of the D-Stat Flowable was successfully demonstrated as the incidence rate of major complications experienced in both groups (D-Stat Flowable: 21.3%; Control: 27.8%) was equivalent (p value 0.0008). The effectiveness of D-Stat Flowable was successfully demonstrated as the overall rate of clinically relevant hematomas experienced in the D-Stat Flowable group (11.8%) was significantly less than that of the control group (22.6%) (p-value 0.0231). Conclusions : The findings from this investigation demonstrate the use of D-Stat Flowable within the pre-pectoral pocket in anti-coagulated patient population undergoing placement of a pulse generator is safe and effective. Use of D-Stat Flowable resulted in a 48% reduction in the rate of clinically relevant hematomas in the target population.