Low Incidence Of Morbidity Research Articles

1116 An Institutional Review of Holmium LASER Enucleation of the Prostate Morbidity

Abstract Aim To review morbidity rate of Holmium Laser Enucleation of Prostate (HoLEP) in at a single institution in the UK. Method A retrospective review of 148 patients who underwent HoLEP between 2017 and 2022 was performed. Demographic, intraoperative, immediate postoperative and postoperative follow up data were recorded to determine the incidence of complications. Mean data are presented. Results The mean age was 71.4 years (SD 7.5), prostate volume 109.7ml (SD 38.5), weight of enucleated tissue 61.4g (SD 41.4), and length of stay 1.5 days (SD 0.9). 76 patients (51.4%) had long term catheter and 18 patients (12.2%) had intermittent self-catheterization preoperatively. 114 patients (77%) had successful TWOC prior to discharge. 4 patients (2.7%) never had a successful TWOC. Clavien-Dindo II complications included urinary infection (2.8%, n = 4) and lavage for haematuria (2.7%, n = 4), and of those, clot retention in 1.4% (n = 2). Clavien-Dindo III complications included urethral stricture (1.4%, n = 2) and clot evacuation for hematuria (0.7%, n = 1). The 30-day readmission rate was 2.7 % (n = 4), all for clot retention. Among 5 patients (3.4%) with haematuria or clot retention, 4 patients were treated with lavage/irrigation, and 1 required bladder washout in theatre. There were 3 patients on anticoagulant medications and 1 patient on an antiplatelet within 30 days of HoLEP. Conclusions HoLEP is associated with low incidence of morbidity and low rate of readmission, however pre-operative anticoagulant use was associated with readmission due to haematuria.

Is robotic assistance an added value in minimally invasive mitral valve surgery? A meta-analysis from propensity score-matched series.

There is still ongoing debate about the benefits of robotic assistance (R-MVS) in comparison with video assistance (V-MVS) in minimally invasive mitral valve surgery. This study aims to update the current evidence. Three propensity score-matched studies published from 2011 to 2021 were included with a total of 1193 patients operated on from 2005 (R-MVS: 536, V-MVS: 657). Data regarding early mortality, postoperative event, and time-related outcomes were extracted and submitted to a meta-analysis using weighted random-effects modeling. The incidence of early mortality, stroke, renal failure, conversion, atrial fibrillation, and prolonged ventilation were similar, all in the absence of heterogeneity. Reoperation for bleeding (odds ratio [OR]: 0.36, 95% confidence interval [CI] 0.16-0.81, p = 0.01) and the need for blood transfusion (OR: 0.30, 95% CI, 0.20-0.56, p = 0.001) were significantly lower in V-MVS group. Regarding time-related outcomes, there was evidence for important heterogeneity of treatment effect among the studies. Operative times were longer in R-MVS: differences in means were 20.7 min for cross-clamp time (95% CI, 9.07-32.3, p = 0.001), 20.7 min for cardiopulmonary bypass time (95% CI, 2.5-38.9, p = 0.03) and 40.2 min for total operative time (95% CI, 24.5-55.8, p < 0.001). Intensive care unit stay and hospital stay were reported in one study, and longer after R-MVS compared to V-MVS; the differences in means were 0.17 days (p = 0.005) and 0.6 days (p = 0.017), respectively. Total cost of both procedures was reported in an additional dedicated propensity score-matched series including 448 patients; it was 21% higher for R-MVS than for V-MVS. This meta-analysis showed excellent outcomes of both video and robotic techniques with low incidence of morbidity and mortality. However, there is no evidence for an added value of robotic assistance in comparison with video assistance; the drawbacks of mini access are reported higher regardless the induced over cost.

Neuroendoscopic Surgery for Pediatric Intraventricular Tumors

Various tumors are found in ventricles and tissues surrounding the ventricles in children, adolescents, and young-adult patients. They cause cerebrospinal fluid pathway obstruction, resulting in hydrocephalus and isolated ventricles. In this paper we describe a neoplasm arising from the lateral and third ventricle. Intraventricular tumors are good candidates for neuroendoscopic surgery. Firstly, minimally invasive and established procedures, neuroendoscopic biopsy with flexible endoscopy or rigid endoscopy, are performed. These endoscopic biopsies can be performed concurrently with other procedures, such as third ventriculostomy or septostomy, to improve cerebrospinal fluid circulation. Neuroendoscopic biopsy for intraventricular tumor is associated with high diagnostic yield and relatively low incidence of morbidity and mortality, compared with open surgery. Endoscopic diagnostic procedure also can be applied in patients without ventricular dilatation, assisted by neuronavigation or echo-guided equipment. Secondly, neuroendoscopic cylinder surgery also makes it possible to remove intraventricular tumors with less damage. The two hands technique with rigid endoscopy helps debulking and hemostasis during tumor removal. Further developments in endoscopic equipment and training systems aimed at enhancing cooperation between the operator and assistant should be expected in the future. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors.

Combined endoscopic and radiologic intervention for management of acute perforated peptic ulcer: a randomized controlled trial

BackgroundPeptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.MethodsThis is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management.ResultsOne hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1–2) days in EG, while in SG was 7 (range 6–8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively).ConclusionCombined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.

Is percutaneous cholecystostomy safe and effective in acute cholecystitis? Analysis of adverse effects associated with the technique

IntroductionThe main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure. Material and methodObservational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy. ResultsOf 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%). ConclusionWe consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.

Surgical outcomes of minimally invasive aortic valve replacement via right mini-thoracotomy for hemodialysis patients.

Minimally invasive valve surgery has become increasingly accepted as an alternative to conventional median sternotomy in low-risk patients. However, there have been no reports regarding the outcomes of this procedure on high-risk hemodialysis patients. The purpose of this investigation was to assess the surgical outcomes of minimally invasive aortic valve replacement (AVR) via right mini-thoracotomy (MIAVR) in hemodialysis patients compared with those of conventional AVR (CAVR) via full sternotomy. Two hundred and seventy-four patients underwent isolated AVR for severe AS, and 42 hemodialysis patients were included in this study. MIAVR was performed in 17 cases and CAVR in 25 cases. We compared the short-term surgical outcome among the two groups. There was no difference in the aortic cross-clamp or cardiopulmonary bypass time. However, the procedure time was significantly shorter in the MIAVR group. Patients in the MIAVR group had less bleeding and a smaller amount of transfused red blood cells. There were four hospital deaths (18.2%) in the CAVR group. For postoperative complications, there were 2 (9.1%) cerebrovascular incidents, 2 (9.1%) cases of respiratory failure, 1 (4.5%) re-exploration for bleeding in CAVR group. The postoperative ventilation time was significantly shorter in the MIAVR group. There was no difference in the length of postoperative intensive care unit stay or of postoperative hospital stay. The surgical outcomes of MIAVR in hemodialysis patients were acceptable, with a low incidence of morbidity, reasonable lengths of hospital stay, and no mortality among the patients studied.

¿Es segura y eficaz la colecistostomía percutánea en la colecistitis aguda? Análisis de los efectos adversos asociados a la técnica

IntroductionThe main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure. Material and methodObservational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy. ResultsOf 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%). ConclusionWe consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.

Vision improvement after trans-sphenoidal resection of pituitary macroadenoma

Introduction: Pituitary adenomas are tumours that occur in the Pituitary gland. Depending on the size it can be divided into Microadenoma (10mm). It can present with endocrine manifestations secondary to hypo or hyper function of pituitary gland and ophthalmological manifestations due to mass effect. Case Report: A 36-year-old female was admitted to our institution with complaints of loss of vision of right eye, headache and amenorrhea for 3 months, which were progressive in nature. Her MRI Scan revealed a well-defined sellar mass, measuring 27 x 23.18 mm, with suprasellar extension, causing expansion of pituitary fossa and superiorly extending into Hypothalamus with mild compression over optic chiasma. Prolactin level was 72.16 ng/ml. Surgery was done under general anesthesias, by Endoscopic assisted transsphenoidal approach. The adenoma was completely removed. Sella opening was closed by synthetic graft. On awakening from anesthesias visual acuity in right eye was immediately and completely restored. Conclusion: Pituitary adenoma is a complex set of benign tumours that present with hypersecretory syndrome and mass effect. An appropriate imaging of pituitary region using MRI and endocrinological consultation is the standard for detection of pituitary adenoma. Although, medical management and radiotherapy offer effective treatment for these tumours in specific situations, Endoscopic Trans-sphenoidal approach continues to provide optimal outcomes with low incidence of morbidity. Keywords: Pituitary macroadenoma, Vision loss, TransSphenoidal resection.

Surgical causes of neck masses in pediatrics: management and outcome

Background: Neck masses are common pathologies in pediatrics, surgery is considered the only line of treatment in most of neck lesions, and usually early intervention is recommended to avoid complications, The aim of our study is to evaluate the clinical and radiological presentations, the pathological findings, and the surgical outcome of neck lesions operated in our institution in pediatric age group.Methods: All pediatric patients presented at our pediatric surgery unit in the period from January 2017 to January 2018 by neck masses were included in this study, Patients with fistulae without underlying swellings and those with inflammatory lesions who responded to medical treatment and surgery wasn't indicated were excluded from this study. History taking, clinical evaluation, routine laboratory investigations and neck ultrasound were done in all cases, and Imaging studies (CT, MRI) were done in selected cases, all resected specimens were sent for histopathological examination, demographic data, duration of surgery, using of haemostatic devices, need of blood transfusion, duration of hospital stay, morbidity and mortality all were recorded and statistically analyzed.Results: In the majority of cases swelling was cystic in nature (69.4%), with lateral position in most of the lesions (61.2%), thyroglossal cyst proved to be the commonest (30.6%), followed by branchial cyst (22.4%). Clinical diagnosis with neck ultrasound was sufficient for diagnosis in most of the cases (55.1 %). Follow up of patients for 3 months in all cases with no mortality recorded and very low incidence of morbidity (6.1%).Conclusions: Neck swellings in pediatric population is common with wide range of differential diagnosis, with respecting anatomical and pathological backgrounds surgery has excellent outcome with very low incidence of morbidity.

Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

Introduction: Hepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experience of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes. Method: This is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017. Result: Elective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5 – 31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical significant differences between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications. Conclusion: Giant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobeHH,HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time.

Ultrasound-Guided Robotic Enucleation of Pancreatic Neuroendocrine Tumors.

Pancreatic neuroendocrine tumors (PanNETs) are relatively rare neoplasms with a low to mild malignant potential. They can be further divided into functioning and nonfunctioning, according to their secretive activity. Surgery is an optimal approach, but the classic open approach is challenging, with some patients having long hospitalization and potentially life-threatening complications. The robotic approach for PanNETs may represent an option to optimize their management. We retrospectively reviewed our prospectively maintained databases from 2 high-volume Italian centers for pancreatic surgery. Demographics, pathological characteristics, perioperative outcome, and medium-term follow-up of patients who underwent robotic pancreatic enucleations were collected. Twelve patients with final diagnosis of PanNET were included. The mean age of the patients was 53.8 years (25-77). The median body mass index was 26 (24-29). Three lesions were functioning insulinomas, while the others were nonfunctioning tumors. No deaths occurred. Mild postoperative complications occurred, except for 1 grade B pancreatic fistula. The mean postoperative stay was 3.9 days (2-5). Our results confirm that robotic enucleation is a feasible and safe approach for the treatment of PanNETs, with short hospital stay and low incidence of morbidity.

Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

BackgroundHepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experiences of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes. Patients and MethodsThis is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017. ResultsElective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5–31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical difference between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications. ConclusionGiant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobe HH, HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time

Role of radiosurgery in the management of glomus tumors.

Glomus tumors are benign slow-growing hypervascular neoplasms. The role of radiosurgery for the treatment of these tumors has increased. The purpose of this study was to show our experience with glomus tumors and to analyze different prognostic factors. Data from 39 adult patients were retrospectively analyzed. All of them underwent head frame stereotactic radiosurgery with linear accelerator (LINAC). Tumor and symptomatic control were calculated using the Kaplan-Meier method. Bivariate statistical analyses were performed to examine different prognostic factors. The median follow-up was 71 months. The radiological local and symptomatic control was achieved in 37 patients (94.8%) and 29 patients (74.3%), respectively. Toxicity was detected in 4 patients (10%). In the bivariate analysis, dose coverage and maximum dose were associated with tumor control with an odds ratio (OR) of 5.29 (p = .041) and 2.67 (p = .056), respectively. Stereotactic radiosurgery is a safe and efficient treatment for glomus tumors that is associated with high probability of radiological and symptomatic control and low incidence of morbidity. © 2015 Wiley Periodicals, Inc. Head Neck 38: E798-E804, 2016.

Surgical Repair of Ileovesical Fistulas: Long-term Complications, Quality of Life, and Patient Satisfaction

Ileovesical fistulas (IVFs) are an uncommon complication of Crohn's disease. The aim of this study is to compare long-term surgical outcomes, assess quality of life, and quantify patient satisfaction after IVF repair. A retrospective chart review followed by a prospective survey was carried out. Survey questions focused on patient satisfaction and quality of life after repair of IVF. Fifty-one patients were identified from an administrative database. Mean follow-up was 4.3 years with a response rate of 51 per cent. At the time of the study, 0 per cent mortality and 16 per cent morbidity were recorded. No recurrence was noted. There was no statistical significance in incidence of complications between laparoscopic and open surgery. Statistically significant differences in single-stage versus multistage operations were found in postoperative day of discharge (P < 0.001) and patient satisfaction (P = 0.049). Ninety-eight per cent of patients reported extreme satisfaction with their surgery and an improvement in quality of life. A low incidence of morbidity and recurrence supports early surgical intervention in IVFs.

Retraction to 'The complications of repeat median sternotomy in paediatrics: six-months follow-up of consecutive cases'.

Repeat median sternotomy in paediatrics though associated with increased perioperative risks, yet the incidence of injury to the underlying structures during sternal re-entry is poorly quantified. We reviewed 108 patients undergoing repeat sternotomies (group-I) and a control group of 516 patients undergoing first time sternotomy (group-II) over six years with six-months follow-up. Overall mean age was 17 months (range 1 day-16 years). Uncontrollable bleeding was encountered in 4 patients (3.7%), non-fatal cardiac laceration in 10 (9.2%), minor injuries to aorta in 7 (6.4%) and right atrium in 8 (7.4%) in Group-I. Forty-one times (38%) pericardial sac was closed and 55 times (51%) artificial materials (Dacron/Gortex) were used in initial procedures. The incidence of injuries during sternal re-entry was significantly lower in those patients where pericardial sac was closed initially (P<0.001). Hospital mortality was 3.7% in Group-I and 2.7% in Group-II, however, overall survival was 95% (group-I) and 97% (group-II) at 6 months' follow-up. Complete heart block, neurological problems and persistence of shunts being the most common reported morbidities in both groups. In conclusion, low incidence of morbidity and mortality in repeat median sternotomy is possible with careful surgical approach. The closure of pericardial sac in initial procedure provides many potential and practical advantages with regard to lesser trauma to underlying structures.

Pre- and post-operative management of dental implant placement. Part 1: management of post-operative pain.

Although dental implant placements have high success rates and a low incidence of morbidity, post-operative pain and complications with the healing process have been reported. There is little guidance available regarding optimal pre- and post-operative management of dental implant placement. This first paper discusses the mechanisms of pain associated with dental implant placement and offers guidance to clinicians on optimal pre- and post-operative pain management regimes. The second paper aims to discuss pre- and post-operative means of reducing the risk of early healing complications.

National Registry of Catheter Ablation 2010

Background Catheter ablation of arrhythmogenic substrates and circuitsis a common procedure in current medical practice. The NationalRegistry of Catheter Ablation 2010 was carried out incardiac electrophysiology centers from the Autonomous Cityof Buenos Aires and from Argentine provinces; it was coordinatedby members of the Committees of Arrhythmias of the Argentine Society of Cardiology and the Argentine Federationof Cardiology. Its participation was free and anonymous. Objective Getting to know the number of catheter ablation procedures,treated arrhythmogenic substrates, results and complications,using the information provided by participants duringthe study period. Methods A retrospective registry of the procedures was carried out from January 1 to December 31st, 2010. A database was developed, and once completed by participants, was then unified into a single central database. Patients and centers were assigned number codes to ensure anonymity of data. Results The 24 centers reported 1,500 ablation procedures in 1,460patients. All patients were treated with radiofrequency. The most common substrates approached were tachycardia by AVnodal reentry (25%) and accessory bundles (25%), followed byatrial flutter (18%) and atrial fibrillation (16%). Overall successrate at the end of the procedures was 93.8%, and complications were present in 2.2% of the procedures. The most common complications were those related to vascular access (0.7%). Asingle death was recorded, due to pulmonary thromboembolism. Conclusions This third Argentine registry on catheter ablation providesimportant and useful information, and shows an adequate immediate success rate (93.4%), similar to those reported by previous national registries, with low incidence of morbidity and mortality rates. Therefore, in Argentina, this medical practice maintains similar efficacy and safety levels compared to other publications.

Mediterranean Diet and Cardiovascular Prevention

This epidemic could be contained oreven decreased if there were a social change in favor of a healthierlifestyle and diet, such as the Mediterranean diet (MedD). Severalyears ago, the low incidence of morbidity and mortality fromcoronary heart disease in Mediterranean countries created greatinterest. In fact, the number of PubMed publications on this topicincreased fromfewerthan10in1985toabout300in2012.Manyofthese wereobservationalstudies(ecological,cohort,orcase-control)in which increased adherence to the MedD was accompanied byreduced cardiovascular risk. In addition, numerous small clinicaltrials haveobservedtheeffectsofthisdietoritsmaincomponentsonintermediate variablesofcardiovascularrisksuchasbloodpressure,blood lipids, insulin resistance, or endothelial function,

Free jejunum reconstruction of upper esophageal defects

The free jejunum has become an important method for reconstructing extensive oncologic defects of the upper esophagus and pharynx. The advantages of a single-staged reconstruction with a low incidence of morbidity have generally outweighed criticisms such as the requirement for a laparotomy and poor voice quality. The aim of the study was to present the technique and outcomes of free jejunal reconstruction of the upper esophagus in 31 consecutive cases. We reviewed our experience of free jejunal flaps undertaken over a 6-year period. Our surgical approach, complications, and results of swallow and speech restoration are described. A functional swallow was achieved by 27/31 patients. However, satisfactory voice restoration was seen in only a small proportion of patients. Complications at the donor site occurred in just one patient. The current review confirms the jejunal flap as a reliable reconstructive option with minimal donor site morbidity.

A five‐year assessment of clinical incidents requiring transfer in a dental hospital day surgery unit

Previous studies regarding general anaesthesia related morbidity and mortality rates for dental surgery have taken the form of a retrospective survey. The Australian and New Zealand College of Anaesthetists also do not record morbidity and mortality for dental/oral and maxillofacial procedures. The aim of this study was to document the clinical incidents requiring transfer to another hospital and mortality. Records from patients transferred to another hospital after having treatment under general anaesthesia performed at the Royal Dental Hospital of Melbourne between 1 January 2005 and 31 December 2009 were prospectively reviewed. There were 17,557 general anaesthesia procedures performed during the review period, including paediatric, special needs and minor oral and maxillofacial surgery procedures. The incidence of morbidity requiring transfer to a hospital with overnight stay facilities was 0.13%. There were no cases of mortality recorded. The most common complication was low oxygen saturation. The low incidence of morbidity seen is most likely attributed to the safety of modern anaesthesia and appropriate patient selection. Dentists and dental specialists performing general anaesthesia procedures should be aware of the complications that arise so that informed consent can be obtained. This study also provides a benchmark for general anaesthesia morbidity/mortality for dental procedures.