Occurrence Of Perioperative Adverse Events Research Articles

The Effects of Peri-Operative Adverse Events on Clinical and Patient-Reported Outcomes After Surgery for Degenerative Cervical Myelopathy: An Observational Cohort Study from the Canadian Spine Outcomes and Research Network.

There is a lack of data examining the effects of perioperative adverse events (AEs) on long-term outcomes for patients undergoing surgery for degenerative cervical myelopathy. We aimed to investigate associations between the occurrence of perioperative AEs and coprimary outcomes: (1) modified Japanese Orthopaedic Association (mJOA) score and (2) Neck Disability Index (NDI) score. We analyzed data from 800 patients prospectively enrolled in the Canadian Spine Outcomes and Research Network multicenter observational study. The Spine AEs Severity system was used to collect intraoperative and postoperative AEs. Patients were assessed at up to 2 years after surgery using the NDI and the mJOA scale. We used a linear mixed-effect regression to assess the influence of AEs on longitudinal outcome measures as well as multivariable logistic regression to assess factors associated with meeting minimal clinically important difference (MCID) thresholds at 1 year. There were 167 (20.9%) patients with minor AEs and 36 (4.5%) patients with major AEs. The occurrence of major AEs was associated with an average increase in NDI of 6.8 points (95% CI: 1.1-12.4, P = .019) and reduction of 1.5 points for mJOA scores (95% CI: -2.3 to -0.8, P < .001) up to 2 years after surgery. Occurrence of major AEs reduced the odds of patients achieving MCID targets at 1 year after surgery for mJOA (odds ratio 0.23, 95% CI: 0.086-0.53, P = .001) and for NDI (odds ratio 0.34, 95% CI: 0.11-0.84, P = .032). Major AEs were associated with reduced functional gains and worse recovery trajectories for patients undergoing surgery for degenerative cervical myelopathy. Occurrence of major AEs reduced the probability of achieving mJOA and NDI MCID thresholds at 1 year. Both minor and major AEs significantly increased health resource utilization by reducing the proportion of discharges home and increasing length of stay.

Predictors of postoperative mortality among neonates after major-risk surgery: A one-year experience from a Tunisian hospital

Background: Neonatal surgery in developing countries remains a high-risk modality p and its outcomes depend on various patient-related, system-related, and management-related factors. This study aims to describe our experience in managing newborns requiring surgical interventions and to investigate the primary predictors of postoperative mortality. Methods: In this observational study, we included all newborns aged less than 28 days who underwent surgery in the pediatric surgery department under general anesthesia with tracheal intubation for major-risk surgery. Patients were categorized into two groups based on the outcome (survival or death) during the two months following surgery. Following a comparison of the two groups, univariable and multivariable logistic regression analyses were conducted to explore predictors of perioperative mortality among neonates. Results: Sixty-seven newborns were included in this study, with an early mortality incidence of 28.3%. Anesthesia management did not impact neonatal mortality. The main predictors of neonatal mortality were revision surgery [aOR=35.5; 95% CI: 1.33- 94.1], surgery duration ≥ 120 minutes [aOR=36.5; 95% CI: 1.48- 312], preoperative mechanical ventilation [aOR=3.88; 95% CI: 1.12- 30.8], and the occurrence of perioperative adverse events [aOR=5.7; 95% CI: 1–29.5] or postoperative surgical complications [aOR=32.5; 95% CI: 1.05–101]. Conclusion: The early mortality rate after major neonatal surgery remains high in our department. It appears that preoperative poor conditions can elevate the risk. Additionally, major-risk surgeries requiring prolonged procedures and revision surgery, along with the incidence of postoperative infections, significantly increase the risk of neonatal mortality.

Association of perioperative adverse events with subsequent therapy and overall survival in patients with WHO grade III and IV gliomas.

BackgroundMaximum safe resection followed by chemoradiotherapy as current standard of care for WHO grade III and IV gliomas can be influenced by the occurrence of perioperative adverse events (AE). The aim of this study was to determine the association of AE with the timing and choice of subsequent treatments as well as with overall survival (OS).MethodsProspectively collected data of 283 adult patients undergoing surgery for WHO grade III and IV gliomas at the University Hospital Zurich between January 2013 and June 2017 were analyzed. We assessed basic patient characteristics, KPS, extent of resection, and WHO grade, and we classified AE as well as modality, timing of subsequent treatment (delay, interruption, or non-initiation), and OS.ResultsIn 117 patients (41%), an AE was documented between surgery and the 3-month follow-up. There was a significant association of AE with an increased time to initiation of subsequent therapy (p = 0.005) and a higher rate of interruption (p < 0.001) or non-initiation (p < 0.001). AE grades correlated with time to initiation of subsequent therapy (p = 0.038). AEs were associated with shorter OS in univariate analysis (p < 0.001).ConclusionAEs are associated with delayed and/or altered subsequent therapy and can therefore limit OS. These data emphasize the importance of safety within the maximum-safe-resection concept.

Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation.

BACKGROUNDAlthough transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for aortic stenosis, it still carries some risks, such as valve leaks, stroke, and even death. The left ventricular global longitudinal strain (LVGLS) measurement may be useful for the prediction of adverse events during this operation.AIMTo explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODSIn this study, 61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography. Before surgery, data on left ventricular ejection fraction (LVEF) and LVGLS were collected separately following balloon expansion and stent implantation. Difference in values of LVGLS and LVEF during preoperative balloon expansion (pre-ex), preoperative stent implantation (pre-im) and balloon expansion-stent implantation (ex-im) were also examined. Adverse events were defined as perioperative death, cardiac rupture, heart arrest, moderate or severe perivalvular leakage, significant mitral regurgitation during TAVI, perioperative moderate or severe mitral regurgitation, perioperative left ventricular outflow tract obstruction, reoperation, and acute heart failure. RESULTSThe occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS, but not with difference in pre-ex LVEF. There were significant differences between pre-LVGLS and ex-LVGLS, and between pre-LVGLS and im-LVGLS (P = 0.037 and P = 0.020, respectively). However, differences in LVEF were not significant (P = 0.358, P = 0.254); however differences in pre-ex LVGLS were associated with pre-LVGLS (P = 0.045). Compared to LVEF, LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period. Moreover, the differences in LVGLS were associated with the occurrence of perioperative adverse events, and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery. Furthermore, LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSIONGreater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

Adverse Events in Anesthesia: An Integrative Review

This study conducted an integrative review of the literature in a search for scientific evidence related to the occurrence of perioperative adverse events resulting from anesthesia. Integrative review. The search was performed in the PubMed/MEDLINE, Virtual Health Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases and portals, including studies published in Portuguese, English, or Spanish, from 1997 to 2017. The studies were supposed to assess adverse events associated exclusively with anesthesia care. We selected 21 studies. The main adverse events in anesthesia were respiratory, drug error, cardiology, and neurology. Most of the events were related to human errors, slips, and lapses that resulted in damage to the patient, such as permanent injuries or death. Care planning, efficient communication, and teamwork are critical to prevent adverse events in anesthesia.

Evolution of the Application of Techniques Derived from Abdominal Transplant Surgery in Urologic Oncology.

The techniques derived from abdominal transplant surgery have become a major actor in recent surgical evolution by providing a more optimal solution for urologic malignancies hosted in the upper abdomen. To describe in detail the objectives, rationale, relevant milestones, and surgical maneuvers of the so-called transplant techniques as applied to complex urologic oncology cases. The transplant-based surgical approach aims to decrease perioperative complications by improving tumor accessibility and field visibility through an enhanced exposure (via the use of a transverse incision, a specific retractor, and specific surgical maneuvers). A sequence of milestones inspired these advances, which finally brought the technique into maturation. The transplant-based approach has demonstrated its safety and usefulness even in the low-volume practice of more complicated urologic oncology, offering protection against the occurrence of perioperative adverse events and placing us at the gates of a new stage of surgical innovation.

Impact of Metabolic Syndrome in Surgical Patients

Abstract Clinicians inevitably encounter patients who meet the diagnostic criteria for the metabolic syndrome (MetS); these criteria include central obesity, hypertension, atherogenic dyslipidaemia, and hyperglycaemia. Regardless of the variations in its definition, MetS may be associated with adverse outcomes in patients undergoing both cardiac and non-cardiac surgery. There is a paucity of data concerning the anaesthetic management of patients with MetS, and only a few observational (mainly retrospective) studies have investigated the association of MetS with perioperative outcomes. In this narrative review, we consider the impact of MetS on the occurrence of perioperative adverse events after cardiac and non-cardiac surgery. Metabolic syndrome has been associated with higher rates of cardiovascular, pulmonary, and renal perioperative events and wound infections compared with patients with a non-MetS profile. Metabolic syndrome has also been related to increased health service costs, prolonged hospital stay, and a greater need for posthospitalization care. Therefore, physicians should be able to recognize the MetS in the perioperative period in order to formulate management strategies that may modify any perianaesthetic and surgical risk. However, further research is needed in this field.

Clinical Outcomes of Carotid Endarterectomy in Symptomatic and Asymptomatic Patients with Ipsilateral Intracranial Stenosis.

The risk of perioperative stroke and the benefits of carotid endarterectomy (CEA) remain uncertain in the case of an ipsilateral intracranial stenosis. The aim of this observational study was to analyze the early and late outcomes of CEA in patients with a carotid tandem lesion (CTL), defined as a severe stenosis at the bifurcation with any concomitant lesion ≥50 % involving the intracranial portion of the ipsilateral internal carotid artery or the main trunk of the anterior or middle cerebral artery. From 2000 to 2009, 1143 patients underwent CEA for symptomatic or asymptomatic extracranial carotid stenosis according to the NASCET and ACAS recommendations, respectively. CTLs were diagnosed in 219 patients (19.2 %) by extracranial and transcranial color-coded Doppler sonography combined with noninvasive brain imaging studies. The primary endpoints of the study were perioperative (30-day) stroke and death, and any ipsilateral ischemic adverse events during the follow-up, which ranged from 0.1 to 10 years (mean 4.9 ± 3.3 years). The rates of the primary endpoints were compared between patients with (group I) and without CTL (group II). Overall, 219 CEAs were performed in group I and 924 in group II. Nearly two in three of the carotid lesions (777 of 1143, 68 %) were symptomatic at presentation (62.1 % in group I vs 69.4 % in group II; p = 0.03), with a 23.8 % rate of stroke (21.9 % in group I vs 24.2 % in group II; p = 0.85). There were 2 (0.9 %) perioperative ipsilateral strokes in group I and 5 (0.5 %) in group II (p = 0.62), and no deaths. The 5-year ipsilateral stroke-free, any stroke-free, and overall survival rates did not differ significantly between patients with and without CTL. This study has shown that patients with and without CTL who underwent CEA had a similar occurrence of perioperative adverse events (probably due to the extremely low incidence of perioperative complications) and comparable late outcomes, suggesting that the presence of CTL does not justify refusing CEA for patients who could benefit from it.

Association of Abdominal Obesity in Children With Perioperative Respiratory Adverse Events

Waist circumference (WC), a measure of abdominal obesity, is associated with several chronic disorders. Less is known about the association between WC and acute perioperative adverse events. The purpose of the present investigation was to test the hypothesis that abdominal obesity increases the occurrence of perioperative adverse events in children undergoing elective, noncardiac surgeries. Prospective observational study. We studied the association between WC and perioperative adverse events in children aged 6 to 18 years who underwent elective noncardiac surgeries at our institution. Patients were considered to have abdominal obesity if WC was 90th percentile or greater for age and gender. Subsequently, univariate factors associated with abdominal obesity were explored and then odds ratios for the occurrence of perioperative respiratory adverse events were calculated from logistic regression after controlling for clinically pertinent covariates. Among 1,102 patients, the prevalence of abdominal obesity was 23.1%. WC was positively correlated with age and measured anthropometric parameters. Composite perioperative adverse events were more frequent in children with abdominal obesity. After adjusting for several clinically relevant risk factors, abdominal obesity independently predicted increased relative odds of respiratory adverse events (OR = 2.35, 95% CI = 1.6 to 3.5, P < .001). Abdominal obesity was also associated with prolonged postanesthesia care unit (PACU) length of stay. WC, a measure of abdominal obesity, is an independent predictor of perioperative respiratory adverse events in children undergoing elective noncardiac surgery. Furthermore, abdominal obesity was associated with prolonged PACU length of stay.

Outcome of Noncardiac and Nonvascular Surgery in Patients With Mechanical Heart Valves

There is a tendency to avoid noncardiac surgery in patients with mechanical heart valves (MHVs) owing to the increased risk of perioperative thromboembolism, infective endocarditis, and bleeding. We aimed to determine the risk of cardiac and noncardiac complications in patients with MHVs who underwent noncardiothoracic, nonvascular surgery. A total of 140 patients with MHVs (77 aortic, 46 mitral, and 17 double valve) and 1,200 patients with native valves (control group) were prospectively followed up for a minimum of 3 months after noncardiothoracic and nonvascular surgery. Patients with bioprostheses were excluded. Those patients aged >18 years who underwent an elective, non-outpatient, open surgical procedure were enrolled. Subcutaneous enoxaparin 1 mg/kg, twice daily, was used as bridging anticoagulation. The demographics, co-morbidities, and preoperative (medications, echocardiographic findings, laboratory results) and postoperative data were evaluated for their association with the occurrence of perioperative adverse events. The incidence of perioperative adverse cardiovascular (10.8% vs 10.7%, p = 0.985) and noncardiovascular (11.9% vs 11.4%, p = 0.989) events was similar in those patients with and without MHVs. Bleeding (18.6% vs 14.2%, p = 0.989), thromboembolism (3.6% vs 2%, p = 0.989), and mortality at 3 months (1.4% vs 1.3%, p = 0.825) were also similar for the 2 groups. In conclusion, with close follow-up and strict adherence to the guidelines, patients with MHVs and patients with native heart valves undergoing noncardiac and nonvascular surgery have a similar risk of mortality and morbidity.

Intra‐ and postoperative adverse events in children with nephrotic syndrome requiring surgery under general anesthesia

There are few data regarding perioperative adverse events in children with nephrotic syndrome. The aim of this study was to describe the nature and frequency of perioperative adverse events in children with nephrotic syndrome. This is a retrospective study from a large university pediatric hospital. All procedures under general anesthesia in children with nephrotic syndrome between January 1995 and May 2007 were included, with the exception of renal transplantation. Data were collected on demographics, etiology of nephrotic syndrome and related treatments, surgical procedures and anesthetic techniques, and pre- and postoperative treatments. Adverse events occurring during the intraoperative period and up to the fifth postoperative day were recorded. Data on eight patients who underwent 24 surgical or interventional procedures under general anesthesia over the study period were reviewed. Three patients had steroid-resistant nephrotic syndrome and five patients had congenital or infantile nephrotic syndrome. Five patients had progressed to end-stage renal failure requiring dialysis. General anesthesia was performed for: nephrectomy (n = 9), central venous catheter insertion (n = 8), peritoneal dialysis catheter insertion (n = 5), and emergency surgery in two cases (acute intestinal intussusception and hemodialysis catheter insertion). Three patients were receiving aspirin and one anticoagulant therapy. No postoperative thrombosis or infections, bleeding, peripheral edema or ascites, and increase in kalemia were noted. There was no significant postoperative increase in median serum creatinine level. Surgical procedures were seldom associated with the occurrence of perioperative adverse events. However, larger studies are needed to confirm these results.

Association of Neck Circumference With Perioperative Adverse Respiratory Events in Children

The purpose of this investigation was to examine the association of neck circumference (NC) with perioperative respiratory adverse events in children undergoing elective noncardiac surgery, a relationship that has not been previously characterized. Using a prospective, observational design, we studied children aged 6 to 18 years undergoing elective noncardiac surgeries at our institution. Trained research assistants collected clinical (including perioperative adverse events) and anthropometric data from all subjects. Patients were stratified into 2 classes: high NC versus low NC on the basis of age- and gender-specific receiver operating characteristic curve analysis. Subsequently, univariate factors associated with high NC were explored, and odds ratios for the occurrence of perioperative adverse events were then calculated from logistic regression after controlling for clinically relevant cofactors. Among the 1102 patients, the prevalence of high NC was 24.3%. NC was positively correlated with age and other anthropometric parameters. Children with high NC were more likely to be loud snorers and have a history of bronchial asthma, hypertension, and type 2 diabetes. Composite adverse airway events were more frequent in children with a large NC. There was no significant association between high NC and difficult laryngoscopy in our study population. NC was positively correlated with other indices of obesity in children, and large NC (indicative of central obesity) was associated with some adverse respiratory events in these children undergoing noncardiac surgery. NC could be a useful clinical screening tool for the occurrence of perioperative adverse respiratory events in children.

Prevalence of habitual snoring in children and occurrence of peri-operative adverse events

To describe the prevalence of habitual snoring and examine its association with peri-operative adverse events in children undergoing elective non-cardiac surgery--a relationship that has not been previously characterised. Using a prospective observational design, we studied children aged 6-18 years undergoing elective non-cardiac surgeries at our institution. Trained research assistants collected clinical (including peri-operative adverse events) and anthropometric data on all individuals. Patients were stratified into two classes, habitual snorers and non-snorers. Subsequently, univariate factors associated with snoring were explored and then odds ratios for the occurrence of peri-operative adverse events were calculated from logistic regression after controlling for clinically relevant cofactors. Among 1102 patients, the prevalence of habitual snoring was 27.3% (28.2% for boys vs. 26.3% for girls). All the measured anthropometric parameters (BMI, waist circumference and neck circumference) were significantly higher in habitual snorers compared with non-snorers. The overall respiratory complication rate was 11.1%. Respiratory adverse events were more frequent in habitual snorers compared with non-snorers (16.9 vs. 8.9%; P < 0.001). Additionally, habitual snoring was associated with longer post-anaesthesia care unit (PACU) stay (114.0 ± 49.6 vs. 103.6 ± 48.9 min; P = 0.002) even after controlling for the occurrence of adverse respiratory events. The prevalence of habitual snoring was high in this cohort of paediatric surgical patients. Habitual snoring was associated with some peri-operative adverse events and prolonged PACU stay and should be considered an important symptom in the pre-operative review of children.

Implications of Anesthesia in Children with Long QT Syndrome

Patients with congenital long QT syndrome (LQTS) are susceptible to an episodic malignant ventricular tachyarrhythmia known as torsade de pointes, which can result in a cardiac arrest and death. Patients can suffer severe cardiac events resulting in syncope, seizures, and sudden cardiac death during times of physical and emotional stress and when exposed to certain drugs including anesthetics. We describe the occurrence of perioperative adverse events (AEs) related to arrhythmias in children with congenital LQTS exposed to volatile general anesthesia and describe associated risk factors. We performed a retrospective cohort study of children with LQTS undergoing general anesthesia for noncardiac surgery or device implant, or revision for cardiac rhythm management. This study was a retrospective chart review with data collection from computerized and electronic patient medical records. Seventy-six patients with congenital LQTS were identified who had a total of 114 anesthetic encounters. Of the 114 anesthetic encounters, there were 3 AEs, 2 definite and 1 probable AE, for an incidence of 2.6%. The events occurred in boys (aged 11, 13, and 15 years) while undergoing noncardiac surgery under volatile general anesthesia. All were receiving β-blocker therapy preoperatively. The AEs occurred in close proximity to the administration of reversal drugs (anticholinesterase/anticholinergic combinations) and the antiemetic ondansetron. The events occurred during emergence from anesthesia, and exclusively in the group of patients who received both reversal drugs and ondansetron. All were treated successfully with short-term antiarrhythmic drug therapy and discharged the next morning. There is an increased risk of AEs during periods of enhanced sympathetic activity, especially emergence. This risk seems to be further enhanced if drugs are administered at this time that are known either to prolong the corrected QT interval or the transmural dispersion of repolarization or increase the incidence of tachycardia. Restriction of medications that adversely affect ion channels and intense vigilance and monitoring during this time and in the postoperative phase could help prevent occurrence or progression of AEs.