Multiple Surgical Complications Research Articles

Inferior surgical outcomes following reverse total shoulder arthroplasty for nonunion and malunion compared to acute arthroplasty: a nationwide matched cohort analysis

BackgroundReverse total shoulder arthroplasty (rTSA) has become popularized in the management of acute proximal humerus fractures (PHFs). Limited evidence exists to compare the outcomes of acute rTSA to management following failed open reduction and internal fixation. We aimed to analyze the differences between acute rTSA for PHF compared to subsequent rTSA for nonunion/malunion. MethodsPatients who underwent primary rTSA from 2016 to 2020 were identified in the Premier Healthcare Database. Nonunion, malunion, and hardware complication patients were identified using International Classification of Diseases Tenth Revision diagnosis codes and compared to acute PHF controls. Patients were matched in a 1:1 fashion to acute fracture based on age (±3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, patient comorbidities, and 90-day complications were assessed and compared between the two cohorts. Descriptive statistics and regression analysis were employed with significance set at P < .05. ResultsPrior to matching, 8561 nonunion/malunion cases and 11,134 acute rTSA controls were identified. Patients undergoing acute rTSA for PHF were older, had longer length of stay, and higher total costs (P < .0001). When compared to acute rTSA for fracture, nonunion/malunion patients were at increased risk of multiple surgical complications including periprosthetic joint infection (odds ratio [OR]: 4.56; 95% confidence interval [CI]: 2.95-7.04; P < .0001), periprosthetic fracture (OR: 2.86; 95% CI: 2.09-3.93), stiffness (OR: 2.01; 95% CI: 1.17-3.44; P = .01), and dislocation (OR: 2.37; 95% CI: 1.80-3.12; P < .0001). However, patients undergoing acute rTSA had higher rates of all medical complications investigated, including deep vein thrombosis, pulmonary embolism, pneumonia, myocardial infarction, acute kidney infection, and sepsis (P < .001). ConclusionrTSA after nonunion/malunion of PHFs is associated with increased risk of surgical complications compared to acute rTSA. Initial rTSA for PHFs may mitigate subsequent increased risk of surgical complication and should be considered as the initial treatment option in patients with PHFs. However, the increased risk of medical complications seen in acute PHF warrants attention and diligent medical optimization from providers.

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report

Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.

Anatomy of the Gallbladder Venous System - a Corrosion Compounds Study

Although it has long been considered that the gallbladder lacks a constant venous vascularization the existence of multiple surgical complications has required various studies to elucidate this hypothesis. Keywords: gallbladder, veins, corrosion

Pancreatectomy and body mass index: an international evaluation of cumulative postoperative complications using the comprehensive complications index

BackgroundOverweight and obese patients undergoing pancreatectomy are at increased risk for postoperative complications and readmission. We examined the association between body mass index (BMI) and postoperative complications following major pancreatectomy using the novel Comprehensive Complications Index (CCI), which analyzes the impact of multiple surgical complications rather than just the most severe. MethodsWe performed a retrospective dual institutional international review of 500 consecutive patients who underwent pancreatic resection and assessed the association of BMI with postoperative complications using the CCI and Clavien-Dindo Classification (CDC) with uni- and multivariable analyses. ResultsOverweight and obese patients undergoing pancreatic resection demonstrated a higher incidence and severity of CCI-measured complications (29.3 vs. 21.1, P < 0.001), more pancreatic fistulae (15.4 vs. 8.8%, 95% CI 1.005 -1.902), and an increased 30-day readmission rate (21.1 vs. 12.1%, 95% CI 1.067 -1.852) (all p < 0.05) than normal-BMI patients. The CCI was a more sensitive marker of post-pancreatectomy complications relative to the CDC, with a higher multicomplication rate in overweight/obese patients (54.8% vs. 44.5%). ConclusionPatients with overweight and obese body mass index undergoing major pancreatectomy demonstrated higher rates of postoperative complications, pancreatic fistulae, and readmissions. The CCI is a more robust and sensitive tool to assess post-pancreatectomy complications than the CDC.

The rs-fMRI study of effects of fornix and hippocampus-related brain function after the transcallosal interforniceal approach

BackgroundThe tumors in third ventricle are common intracranial tumors in children, characterized by various pathological types and difficult to be removed. The transcallosal interforniceal approach is often used for these tumors. The separation of bilateral fornix causes multiple surgical complications. In the past, complications could only be assessed by clinical feature and traditional imaging, lack of quantitative data to support. Resting-state functional magnetic resonance imaging (rs-fMRI) can assess brain functional connectivity between local regions and different regions in quiet state. The changes of ReHo, ALFF, fALFF and brain function connections (DMN and Hippocampus as ROI) can be used to evaluate the effects caused by operation. ObjectiveTo evaluate the effects of brain function caused by operation. Methods9 children patients with tumors in third ventricle were randomly selected in Yuquan hospital, and scanned by rs-fMRI before and after operation. ReHo, ALFF, fALFF and function connections (DMN and Hippocampus as ROI) were chosen to analyze rs-fMRI data. ResultsThe results of ReHo, ALFF, fALFF and brain function connections (DMN and Hippocampus as ROI) showed that: (1) Compared with preoperative state, ReHo decreased in left superior frontal gyrus in 1 month after operation, while increased in right middle occipital gyrus, right middle temporal gyrus, and left posterior central gyrus. In 2 months after operation, ReHo decreased in left superior temporal gyrus and right precentral gyrus compared with that in 1 month after operation. (2) Compared with preoperative state, ALFF decreased in left middle frontal gyrus and increased in left superior temporal gyrus in 1 month after operation; ALFF decreased in right fusiform gyrus and right supramarginal gyrus, while increased in left parahippocampal gyrus and left caudate nucleus in 2 months after operation. When compared with these in 1 month after operation, ALFF decreased in right fusiform gyrus and left precentral gyrus in 2 months after operation. (3) Compared with preoperative state, fALFF decreased in left superior frontal gyrus in 1 month after operation, and decreased in left middle frontal gyrus in 2 months after surgery. (4) The connections of DMN showed that enhanced connections of bilateral middle frontal gyrus and other regions in 1 month after operation, which restored to preoperative state in 3 months after operation. (5) There were changes of connections between bilateral hippocampus and related brain regions without any interruption occurred. The effects of approach can disappear in 3 months after operation. ConclusionsThe short-term effects of ReHo, ALFF and fALFF in brain regions of children patients can recover to preoperative state with time. The operation did not interrupt the connections between DMN and hippocampus related brain areas. The effects of surgery can restore to the preoperative state in 3 months after operation.

Increased rates of cesarean sections and large families: a potentially dangerous combination.

Rates of cesarean sections have been on the rise over the past three decades all over the world, despite the ideal rate of 10-15% that had been set by the World Health Organization (WHO) in 1985, in Fortaleza, Brazil. This epidemic increase in the rate of cesarean delivery is due to many factors which include, cesarean delivery on request, advanced maternal age at first pregnancy, decrease in number of patients who are willing to try vaginal birth after cesarean delivery, virtual disappearance of vaginal breech delivery, perceived increase in the weight of the fetus and increase in the number of women with chronic medical conditions such as Diabetes Mellitus and congenital heart disease in the reproductive age. There is no doubt that cesarean delivery is a safe procedure and it is getting safer and safer for many reasons. However, like all other surgical procedures it is not without risks both to the mother and the new born. There is a substantial increase in the incidence of morbidly adherent placenta and the risk of scar pregnancy. In the Middle East and many African and Asian countries women tend to have large families. The number of previous cesarean section deliveries is directly proportional to the risk of developing morbidly adherent placenta. Morbidly adherent placenta is the most common cause of emergency postpartum hysterectomy, which is often associated with multiple surgical complications, severe maternal morbidity and mortality. The increased rates of cesarean sections lead to increased rates of scar pregnancies, which can have lethal consequences. Cesarean delivery has a negative impact on the infant immune system. This effect on the infant led to the introduction of a new concept called "Vaginal seeding". This refers to the practice of transferring some maternal vaginal fluid to the infant born via cesarean section in an effort to enhance its immune system.

Endoscopic Management of Esophageal Anastomotic Leaks Following Surgery for Malignant Disease

Introduction: Esophageal anastomotic leaks following gastric or esophageal cancer surgery remain a major cause of morbidity and mortality. To limit the risks associated with operative repair, endoscopic interventions, including stenting, clipping, and percutaneous endoscopic jejunostomy (PEJ), have been increasingly used to manage these patients. The study aimed to determine the efficacy of endoscopic management of esophageal anastomotic leaks following cancer surgery. Methods: We performed a retrospective review of prospectively maintained databases of all gastric and esophageal operations at our hospital. Included patients had esophageal or gastric cancer and were operated on between January 2003 and December 2012. Patients with radiographic or endoscopic evidence of an anastomotic leak and who underwent an attempt at endoscopic management were included. Results: Of the 107 patients with esophageal anastomotic leaks, 51 underwent an attempt at endoscopic management. Forty were men, and the mean age was 61. Forty-two patients underwent esophagectomies, 6 had partial or total gastrectomies, and 3 had esophagogastrectomies. Fully covered esophageal stents were placed in 32 patients. On average, stents were in place for 59 days (range 12-170 days). Stent migration was seen in 34% of patients and managed with endoscopic revision. There were no other documented complications from stent placement. Overall, 26 patients (81%) treated with stents healed. Direct PEJs were placed in 41 patients for a mean duration of 106 days (range 18-358 days). Four patients failed PEJ placement and required a second attempt for successful insertion. There were no documented complications from PEJ placement. Overall, 39 patients (95%) treated with PEJs healed. Endoscopic clips were placed in 3 patients, all of whom also received stents. There were no documented complications related to clipping, and all 3 patients healed. Among these groups, 22 patients were treated with stent and PEJ. Healing was seen in 21 out of 22 (95%) of these patients in a mean of 105 days (range 31-337 days). Of the 51 total patients, 44 (86%) achieved documented anastomotic healing. Mean healing time was 92 days (range 3-337 days). Of the remaining 7 patients, 3 required anastomotic revision, 1 required esophageal exclusion, 2 died of multiple surgical complications, and 1 died at another facility with stent in place. Conclusion: Our results suggest that anastomotic leaks can be managed safely and successfully with endoscopic therapy in select patients. A combination of esophageal stenting to control the leak and PEJ placement for nutrition was highly effective in achieving anastomotic healing, without the need for highrisk operative repair.

Surgical Treatment of Strabismus Secondary to Glaucoma Drainage Device

To describe surgical strategies in a series of patients with diplopia following implantation of a glaucoma drainage device. Retrospective review of 9 consecutive patients who underwent strabismus surgery because of strabismus and diplopia after implantation of a glaucoma drainage device. Seven patients with marked limitation to ocular rotations and incomitant strabismus underwent surgery on the eye with the implant. Two patients with mild limitation to ocular rotations of the involved eye underwent surgery on the contralateral eye. All patients had a large fibrous capsule surrounding the implant plate, adjacent muscles, and sclera. Intraocular pressure was not elevated postoperatively. Postoperative diplopia in the primary position was eliminated in 5 patients and markedly improved in 3 patients. Strabismus following implantation of a glaucoma drainage device is an uncommon but serious complication. Restoration of ocular alignment is a complex undertaking requiring strabismus and glaucoma surgical expertise. Multiple surgical complications may occur. Surgical intervention may require complete removal of the fibrous capsule surrounding the implant and involved adjacent structures. Size reduction of the implant plate is helpful and did not interfere with postoperative intraocular pressure control in this study. Surgery on the contralateral eye is an option in patients with mild restriction.

Retrospective analysis of surgical complications following cadaveric kidney transplantation in the modern transplant era

Risk factors for surgical complications (SCs) following kidney transplantation in the modern transplant era need to be identified to perform appropriate prophylactic interventions. Records from 870 consecutive adult cadaveric kidney transplants done at a single centre were reviewed. SCs were classified into four groups: (i) vascular (12%, thrombosis or stenosis); (ii) haemorrhagic (12%); (iii) ureteral (7.5%, leaks and stenosis) and (iv) wound (16%, lymphocoeles or dehiscences). One or more SCs occurred in 299 (34%) patients, with multiple SCs in 65 (7.4%). By logistic regression analysis, recipient vessel atherosclerosis and delayed graft function (DGF) were significantly associated with both thrombotic complications [odds ratio (OR) 4, 95% confidence interval (CI), 1.4-11, P = 0.010 and OR 3.8, 1.3-12, P < 0.00001, respectively] and graft artery stenosis (OR 2.9, 1.2-6.8, P = 0.015 and OR 5.6, 2.3-13.4, P < 0.0001, respectively). Acute rejection increased the risk of graft artery or ureteral stenosis by 2.5 (CI 1.02-6.4, P = 0.045) and 3.3 (CI 1.1-10, P = 0.034), respectively. Older recipients were related to urinary leak (OR 1.04, CI 1.01-1.07, P = 0.011). Difficult bench surgery, DGF and the use of antiplatelet drugs increased the risk of bleeding by 3.6 (CI 1.9-6.4, P < 0.0001), 2.7 (CI 1.5-4.7, P < 0.0001) and 1.8 (CI 1.03-3.29, P = 0.038), respectively. Each month on dialysis increased the risk by 1.02 (CI 1.01-1.03, P = 0.002). Sirolimus increased the risk for wound SCs by 4.1 (CI 2.1-8.3, P < 0.0001) and obesity, retransplant and acute rejection were additional risk factors. Adult renal transplant recipients at risk for SCs can be identified by age, DGF, graft vessel and recipient atheromatosis, difficult bench surgery, obesity, rejection and the use of antiplatelet drugs and rapamycin.

Reconstruction by Pancreaticojejunostomy Versus Pancreaticogastrostomy Following Pancreatectomy

To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting. While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out. A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ). The 2 treatment groups showed no differences in vital statistics or underlying disease, mean duration of surgery, and need for intraoperative blood transfusion. Overall, the incidence of surgical complications was 34% (29% in PG, 39% in PJ, P = not significant). Patients receiving PG showed a significantly lower rate of multiple surgical complications (P = 0.002). Pancreatic fistula was the most frequent complication, occurring in 14.5% of patients (13% in PG and 16% in PJ, P = not significant). Five patients in each treatment arm required a second surgical intervention; the postoperative mortality rate was 0.6%. PG was favored over PJ due to significant differences in postoperative collections (P = 0.01), delayed gastric emptying (P = 0.03), and biliary fistula (P = 0.01). The mean postoperative hospitalization period stay was comparable in both groups. When compared with PJ, PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula. However, biliary fistula, postoperative collections and delayed gastric emptying are significantly reduced in patients treated by PG. In addition, pancreaticogastrostomy is associated with a significantly lower frequency of multiple surgical complications.