Risk Factors For Early Complications Research Articles

Predicting early complications in patients with spinal gunshot wounds: A multicenter study

IntroductionThere is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research questionwe aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methodsThis is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. ResultsResults: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68–7.30), dirty wound (3.32, 1.50–7.34), GCS ≤8 (3.56, 1.17–10.79), hemodynamic instability (2.29, 1.07–4.88), and multiple bullets (1.97, 1.05–3.67). Discussion and conclusionSpinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.

Gender differences in early complications after STEMI and their associations with anxiety and depression.

The female gender is known to be associated with a poor outcome in ST-Elevation Myocardial Infarction (STEMI). Anxiety and depression are more common in women and they may contribute to the increase in early complications after STEMI. We sought to determine the gender differences in early complications after STEMI and their relationship with patients' anxiety and depression. This is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) is used to screen depression (HADS-D) and anxiety (HADS-A). A total of 188 patients (age 56.8±10.5, 69.2% male) with STEMI were included in this study. The incidence of early complications was significantly higher in women than in men (50.0% vs. 14.6%, p<0.001). The prevalence of anxiety and depression was significantly higher in women than in men (60.3% vs. 40.0% and 50.0% vs. 14.6%, respectively). In multivariable analyses, left ventricular ejection fraction (LVEF) level (OR: 0.942; 0.891-0.996, p=0.036), HADS-A (OR: 1.593; 1.341-1.891, p<0.001) and HADS-D (OR: 1.254; 1.057-1.488, p=0.01) scores were found to be independent risk factors for early complications after STEMI. The incidence of early complications and the prevalence of anxiety and depression were significantly higher in women. LVEF level, HADS-A, and HADS-D scores were found to be independent risk factors for early complications.

Risk factors for early complications following arthroplasty in elderly patients with a femoral neck fracture.

Early complications after arthroplasty for geriatric femoral neck fractures are known to negatively affect postoperative recovery and increase postoperative mortality. Identifying risk factors associated with early complications after arthroplasty may offer an opportunity to address and prevent these complications in many patients. To evaluate preoperative risk factors for early complications after arthroplasty in elderly patients with a femoral neck fracture. 119elderly patients with femoral neck fractures who had been treated with arthroplasty (hemiarthroplasty or total hip arthroplasty) between December 2015 and December 2018 were retrospectively analysed. Early complications were defined as any complications that did not exist preoperatively, and occurred during hospital stay after arthroplasty Preoperative clinical, epidemiological and laboratory data were collected. Binary univariable and multivariable logistic regression analysis were applied to identify predictors of early complications after arthroplasty for geriatric femoral neck fractures. Median age of all patients was 80.0 (IQR 74.0-84.0) years. We identified 28 (23.5%) early complications after arthroplasty. Univariable logistic regression analysis found that preoperative body mass index (BMI p= 0.031), C-reactive protein (CRP p= 0.017) and serum Albumin (p= 0.006) were potential risk factors for early complications. Then preoperative BMI, CRP and serum Albumin were stratified and used for multivariable logistic regression analysis The multivariate logistic regression analysis showed that preoperative higher BMI (⩾ 28kg/m2; OR 10.440; 95% CI 2.674-41.170; p= 0.001) and lower serum Albumin (⩽ 35g/L; OR 3.933; 95% CI 1.509-10.800; p= 0.006) were independent risk factors for early complications after arthroplasty in geriatric femoral neck fractures. However, preoperative higher CRP levels (> 10mg/L; OR 1.139; 95% CI 1034-1428; p= 0.833) was found to be not an independent risk factor for early complications. Our results demonstrate that obesity and hypoalbuminemia are independent predictors for early complications during hospital stay after arthroplasty, which should be meticulously noted to minimize these risk factors in geriatric femoral neck fractures.

Risk factors of early complications after thoracic and lumbar spinal deformity surgery: a systematic review and meta-analysis.

To determine risk factors increasing susceptibility to early complications (intraoperative and postoperative within 6weeks) associated with surgery to correct thoracic and lumbar spinal deformity. We systematically searched the PubMed and EMBASE databases for studies published between January 1990 and September 2021. Observational studies evaluating predictors of early complications of thoracic and lumbar spinal deformity surgery were included. Pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated via the random effects model. Fifty-two studies representing 102,432 patients met the inclusion criteria. Statistically significant patient-related risk factors for early complications included neurological comorbidity (OR = 3.45, 95% CI 1.83-6.50), non-ambulatory status (OR = 3.37, 95% CI 1.96-5.77), kidney disease (OR = 2.80, 95% CI 1.80-4.36), American Society of Anesthesiologists score > 2 (OR = 2.23, 95% CI 1.76-2.84), previous spine surgery (OR = 1.98, 95% CI 1.41-2.77), pulmonary comorbidity (OR = 1.94, 95% CI 1.21-3.09), osteoporosis (OR = 1.60, 95% CI 1.17-2.20), cardiovascular diseases (OR = 1.46, 95% CI 1.20-1.78), hypertension (OR = 1.37, 95% CI 1.23-1.52), diabetes mellitus (OR = 1.84, 95% CI 1.30-2.60), preoperative Cobb angle (SMD = 0.43, 95% CI 0.29, 0.57), number of comorbidities (SMD = 0.41, 95% CI 0.12, 0.70), and preoperative lumbar lordotic angle (SMD = - 0.20, 95% CI - 0.35, - 0.06). Statistically significant procedure-related factors were fusion extending to the sacrum or pelvis (OR = 2.53, 95% CI 1.53-4.16), use of osteotomy (OR = 1.60, 95% CI 1.12-2.29), longer operation duration (SMD = 0.72, 95% CI 0.05, 1.40), estimated blood loss (SMD = 0.46, 95% CI 0.07, 0.85), and number of levels fused (SMD = 0.37, 95% CI 0.03, 0.70). These data may contribute to development of a systematic approach aimed at improving quality-of-life and reducing complications in high-risk patients.

The predictive value of prognostic nutritional index on early complications after robot-assisted radical cystectomy.

The purpose of the study was to evaluate the predictive value of prognostic nutritional index (PNI) on early complications (within 30-day) after robot-assisted radical cystectomy (RARC) and urinary diversion. Patients underwent RARC and urinary diversion between November 2018 and December 2021 in our centre were screened in this retrospective study. Baseline characteristics and perioperative data were recorded. Early complications after surgery were classified according to Clavien-Dindo system. Univariate and multivariate logistic analysis were performed to decide the potential factors associated with post-RARC complications. The receiver operating characteristic (ROC) curve was conducted to determine the predictive value of PNI on early overall and major complications after RARC. Overall 139 men and 13 women with a median age of 69 years and mean BMI of 24.4 kg/m2 were included in this study. As for urinary diversion, most patients (n = 111, 73%) received cutaneous ureterostomy, 36 patients (23.7%) underwent orthotopic neobladder and 5 patients (3.3%) received ileal conduit. The incidence of postoperative complication rate was 44.7%, which included 82.2% minor complications and 17.8% major complications. Further univariate and multivariate logistic analyses demonstrated that hypertension (OR = 2.96, 95% CI: 1.24-7.07, P = 0.015), PNI (OR = 0.73, 95% CI: 0.62-0.86, P < 0.001), and CCI (OR = 1.44, 95% CI: 1.01-2.06, P = 0.047) were independent risk factors of early complications after RARC. Moreover, PNI (OR = 0.72, 95% CI: 0.60-0.86, P < 0.001) was also the predictor of major complications after RARC. The ROC curve demonstrated that PNI (AUC = 0.829; AUC = 0.840) has a great predictive value in early overall and major complications after RARC. PNI can be an early alert for RARC patients thus aiding in closer monitoring and postoperative management.

Timing of Complications Following Carotid Endarterectomy for Symptomatic and Asymptomatic Carotid Artery Stenosis

The objective of our study was to examine the time to early postoperative complications and identify the risk factors for early complications to assess the safety of implementing same-day discharge after carotid endarterectomy.

Risk Factors for Early Complications of Acute Coronary Syndromes Seen in the Cardiology Department of Befelatanana

Risk Factors for Early Complications of Acute Coronary Syndromes Seen in the Cardiology Department of Befelatanana

Management of early complications of hepatic artery post living donor liver transplantations in adults

Background: Liver transplantation has rightly gained recognition as an established therapy for end stage liver disease and acute liver failure. Liver transplantation in humans has come a very long way in a short period of time. The aim were to identify the causes and the risk factors of early complications of hepatic artery post LDLT in adults. Methods: This is a retrospective &amp; prospective analysis study, which was carried out in Orthopedic Surgery This study was conducted on a retrospective review of 20 recipient patients who underwent LDLT and suffering from an early hepatic artery complications at Cairo University Hospitals and Dar Al Foad Hospital from starting the program till 2016. Results. Risk factors were examined as predictors of success including age, sex, history of HCV +/- HCC and any co-morbidity (DM, HTN), the Child-Pugh score, MELD score, identification of potential risk factors (trans-arterial chemo embolization (TACE) &amp; Hyper-coaglable states), careful preoperative evaluations (Donor &amp; Recipient). Conclusion: Early HA complications remain a major cause of morbidity and mortality after LDLT. Urgent revascularization is necessary to avoid graft loss.

Influence of visceral lipids obesity on the early postoperative complications after radical gastrectomy

Objective: To investigate the effect of visceral fat area (VFA) on the surgical efficacy and early postoperative complications of radical gastrectomy for gastric cancer. Methods: A retrospective cohort study method was used. Clinicopathological data and preoperative imaging data of 195 patients who underwent D2 radical gastric cancer surgery at the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2017 were analyzed retrospectively. Inclusion criteria: (1) complete clinicopathological and imaging data; (2) malignant gastric tumor diagnosed by preoperative pathology, and gastric cancer confirmed by postoperative pathology; (3) no preoperative complications such as bleeding, obstruction or perforation, and no distant metastasis. Those who had a history of abdominal surgery, concurrent malignant tumors, poor basic conditions, emergency surgery, palliative resection, and preoperative neoadjuvant therapy were excluded. The VFA was calculated by software and VFA ≥ 100 cm2 was defined as visceral obesity according to the Japan Obesity Association criteria . The patients were divided into high VFA (VFA-H, VFA≥100 cm2, n=96) group and low VFA (VFA-L, VFA<100 cm2, n=99) group . The clinicopathological characteristics, surgical outcomes and early postoperative complications were compared between the two groups. Univariate and multivariate Logistic regression models were used to analyze the risk factors of early complications. Receiver operating characteristic (ROC) curve was used to analyze predictive values of VFA for early complications. Pearson's χ2 test was used to analyze the correlation between BMI and VFA. Results: There were no significant differences in terms of gender, age, American Society of Anesthesiologists physical status classification, preoperative comorbidities, preoperative anemia, tumor TNM staging, N staging, T staging and tumor differentiation, surgical method, extent of resection, and tumor location between the VFA-L group and the VFA-H group (all P>0.05). However, patients in the VFA-H group had higher BMI, larger tumor, lower rate of hypoalbuminemia and greater subcutaneous fat area (SFA) (all P<0.05). The VFA-H group presented significantly longer operation time and significantly less number of harvested lymph nodes as compared to the VFA-L group (both P<0.05). However, there were no significant differences in intraoperative blood loss, conversion to laparotomy and postoperative hospital stay (all P>0.05). Complications of Clavien-Dindo grade II and above within 30 days after operation were mainly anastomosis-related complications (leakage, bleeding, infection and stricture), intestinal obstruction and incision infection. The VFA-H group had a higher morbidity of early complications compared to the VFA-L group [24.0% (23/96) vs 10.1% (10/99), χ2=6.657, P=0.010], and the rates of anastomotic complications and incision infection were also higher in the VFA group [10.4% (10/96) vs. 3.0% (3/99), χ2=4.274, P=0.039; 7.3% (7/96) vs. 1.0% (1/99), P=0.033]. Multivariate logistic analysis showed that high BMI (OR=3.688, 95%CI: 1.685-8.072, P=0.001) and high VFA (OR=2.526, 95%CI: 1.148-5.559,P=0.021) were independent risk factors for early complications. The area under the ROC curve (AUC) of VFA for predicting early complications was 0.645, which was higher than that of body weight (0.591), BMI (0.624) and SFA (0.626). Correlation analysis indicated that there was a significantly positive correlation between BMI and VFA (r=0.640, P<0.001). Conclusion: VFA ≥ 100 cm2 is an independent risk factor for early complications after radical gastrectomy for gastric cancer.It can better predict the occurrence of above early postoperative complications.

Timing of Complications Following Carotid Endarterectomy for Symptomatic and Asymptomatic Carotid Artery Stenosis

Current decision-making for safe discharge following carotid endarterectomy is based on clinical judgment after routine overnight observation. The aim of this study is to examine the time to early postoperative complications and identify risk factors of early complications to assess the safety of implementing same-day discharge following carotid endarterectomy.

Risk Factors for Early and Late Complications after Laparoscopic Sleeve Gastrectomy in One-Year Observation.

Background: Although laparoscopic sleeve gastrectomy (LSG) is considered a safe bariatric procedure in the treatment of obesity, it still involves a risk of developing postoperative complications. Knowledge of risk factors for possible complications would allow appropriate preoperative planning, optimization of postoperative care, as well as early diagnosis and treatment. The aim of this study was to evaluate risk factors for complications after laparoscopic sleeve gastrectomy. Methods: A retrospective study of 610 patients who underwent LSG at a tertiary institution were included in the study through retrospective analysis of the medical data. Complications were categorized as early (<30 days) and late (≥30 days) and evaluated according to the Clavien–Dindo Classification. Results: Early complications were observed in 35 patients (5.74%) and late complications occurred in 10 patients (1.64%). Independent risk factors of early complications after laparoscopic sleeve gastrectomy included hypercholesterolemia (OR 3.73; p-value = 0.023) and smoking (OR = 274.66, p-value < 0.001). Other factors that may influence the postoperative course are length of hospital stay and operation time. Smoking, peptic ulcer diseases and co-existence of hiatal hernia were found to be an independent predictors of late complications. Conclusions: Smoking is associated with the higher risk of both, early and late complications, while hypercholesterolemia with only <30 days complications after laparoscopic sleeve gastrectomy.

Short- and Long-Term Safety and Efficacy of Self-Expandable Leo Stents Used Alone or with Coiling for Ruptured and Unruptured Intracranial Aneurysms: A Retrospective Observational Study.

To assess the efficacy and safety of the Leo stent used alone or with coiling to treat complex intracranial aneurysms (IAs) not eligible for simple or balloon-assisted coiling, this single-center retrospective study included consecutive adults with ruptured or unruptured IAs treated in 2011–2018 by stenting with or without coiling. The indication for stenting was IA complexity precluding simple or balloon-assisted coiling. Extensive data on the patients, IAs, antiplatelet treatments, procedures, and outcomes over the first 36 months were collected. Risk factors for early complications (univariate analysis) and delayed ischemia (multivariate analysis) were sought. We include 64 patients with 66 IAs. The procedural success rate was 65/66 (98.5%). Obliteration was Raymond Roy class I or II for 85% of IAs. Six patients died including four of the 12 patients presenting with subarachnoid hemorrhage, which was the only significant risk factor for early major complications. At 1 month, 45/64 (69%) had no disabilities. No rebleeding was reported. Ischemia was detected by routine MRI in 20 (35%) of the 57 patients with long-term data and was asymptomatic in 14. The stent-within-a-stent configuration was the only independent risk factor for ischemia. The Leo stent used alone or with coils to manage challenging IAs was associated with a high procedural success rate and complete or nearly complete IA obliteration of 85% of IAs. The high frequency of ischemia is ascribable to our use of routine serial MRI. In patients with bleeding, the Leo stent was associated with an excess risk of early, major, intracranial complications, as compared to patients without bleeding. Long-term follow-up was marked by the occurrence of ischemic events in the vascular territory of the stent, mostly silent.

Use of the modified Clavien‑Dindo classification to determine the risk factors for early complications following radical gastrectomy and the effect of such complications on long‑term prognosis

Surgical resection remains the gold standard treatment for gastric cancer; however, the rate of post‑operative complications remains unsatisfactory. Although the majority of complications are treatable, it remains unknown whether the long‑term survival of patients is affected and what type of complications affect prognosis. In the present study, the modified Clavien‑Dindo classification system was used to examine the incidence of early complications along with the related risk factors following radical gastrectomy (RG) and to determine the effects of such complications on long‑term prognosis. For this purpose, 525 gastric cancer patients with RG were analyzed retrospectively. The results revealed that age [odds ratio (OR), 1.781; P=0.013], pre‑operative comorbidity (OR, 1.765; P=0.020), blood loss (OR, 2.153; P=0.001) and the type of surgery (OR, 3.137; P&lt;0.001) were identified as independent risk factors associated with post‑surgery complications. Blood loss (OR, 13.053; P=0.013) and the resection type (OR, 7.936; P=0.047) were identified as independent risk factors for severe complications. The 5‑year overall survival (OS) rate of patients in the severe complication group was 35%, which was significantly worse than that of patients in the non‑severe complication group (61.8%). Severe complications (hazard ratio, 1.595; P=0.107) were not found to be independent risk factors associated with the 5‑year OS. On the whole, the present study demonstrates that complications following RG were significantly related to age, pre‑operative comorbidity, blood loss and the type of surgery. Severe complications were distinctly affected by blood loss and the resection type. The 5‑year OS of patients in the severe complication group was significantly worse than that of patients in the non‑severe complication group; however, severe complications were not found to be independent risk factors associated with long‑term survival.

Fifteen-Year Experience with the Ghent Technique of Penile Inversion Vaginoplasty.

Demand for male-to-female gender-affirmation surgery is rising. Creation of a vaginal vault and a feminine vulva remains challenging, especially in circumcised patients. The authors present the 15-year results of the technique developed by the senior author (S.M.). A retrospective case review was performed of all penile inversion vaginoplasties carried out by the senior author between 2003 and 2017. Age, hormonal therapy time, body mass index, smoking, diabetes, circumcision, and the need for full-thickness skin grafts to lengthen the vaginal vault were investigated as potential risk factors for postoperative complications. A total of 384 penile inversion vaginoplasties were retained, with 85.7 percent of patients requiring a full-thickness skin graft to lengthen the vaginal vault. Rectum perforation occurred in six patients (1.6 percent). Early revisions were necessary in 8.4 percent of patients and late revision surgery was performed in 37.1 percent of cases. There was no independent risk factor for early complications. Diabetes was an independent risk factor for late revision surgery. After vaginoplasty, 97.2 percent of patients reported being able to engage in penetrative intercourse, and 83.4 percent of patients reported having orgasms. Vaginoplasty is possible in all trans women, with most patients being able to engage in penetrative intercourse and reach an orgasm. To reach the desired depth of 14 cm, the neovaginal vault is usually lined with full-thickness skin grafts from the scrotum and/or abdomen. Diabetes was the only independent risk factor for revision surgery. Rectal tears are a rare complication and can usually be managed conservatively. Therapeutic, IV.

Risk factors for early morbidity and mortality following pancreatoduodenectomy with concomitant vascular reconstruction

BackgroundLocally advanced pancreatic tumors may require vascular reconstruction for complete resection. However, pancreatoduodenectomy with vascular resection (PDVR) remains a subject of debate due to increased complications. MethodsPatients were identified using the ACS NSQIP Participant User Data Files from 2014 to 2019. ResultsThe 30-day mortality rate was 2.7%; major complications occurred in 32.2%. There is an increasing trend of PDVR in patients requiring pancreatectomy. There were no significant differences in mortality between PDVR with vein, artery, or venous and arterial resections. High BMI and postoperative biliary stent were risk factors for early complications. High BMI and COPD increased risk of early mortality. Chemotherapy and chemoradiotherapy were negative predictors for early morbidities and mortality, respectively. ConclusionThis study identifies the predictors of early morbidity and mortality in PDVR. The results of this study may assist decision making in perioperative management to optimize overall survival and guide additional research.

Prognostic factors of flap techniques for pilonidal disease based on magnetic resonance imaging and clinical parameters

Postoperative complications and recurrence are major diffficulties in the flap techniques for the treatment of pilonidal sinus (PS), however, the risk factors remain unclear. While magnetic resonance imaging (MRI) offers the highest soft tissue resolution, few studies have applied MRI to investigate the basic parameters of PS. A total of 100 patients receiving Limberg flap (LF) or Karydakis flap (KF) surgery at the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed, and the median follow-up period was 42 (range, 20-90) months. We performed a multivariate logistic analysis on the clinicopathological parameters and MRI data to identify risk factors for complications and recurrence. The basic parameters of PS were obtained by MRI analysis. The multivariate analysis revealed a large longitudinal sinus diameter (OR=1.020, 95%CI=1.000-1.041) and sacrococcygeal dermal thickness (OR=1.680, 95%CI=1.142-2.472) to be independent risk factors for early complications. Meanwhile, a small sacrococcygeal fat thickness (OR=0.923, 95%CI=0.864-0.987) and a high BMI (OR=1.291, 95%CI=1.067-1.563) are independent risk factors for late complications and recurrence, respectively. We used MRI to measure the basic parameters of PS accurately, including size, volume, location and some key points of the surrounding tissues, and identified, besides the selection of surgical approach, some specific basic parameters of PS might be the risk factors for complications and recurrence after flap techniques.

Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: A comparative study

BACKGROUNDAlthough several methods of totally laparoscopic total gastrectomy (TLTG) have been reported. The best anastomosis technique for LTG has not been established.AIMTo investigate the effectiveness and surgical outcomes of TLTG using the modified overlap method compared with open total gastrectomy (OTG) using the circular stapled method.METHODSWe performed 151 and 131 surgeries using TLTG with the modified overlap method and OTG for gastric cancer between March 2012 and December 2018. Surgical and oncological outcomes were compared between groups using propensity score matching. In addition, we analyzed the risk factors associated with postoperative complications.RESULTSPatients who underwent TLTG were discharged earlier than those who underwent OTG [TLTG (9.62 ± 5.32) vs OTG (13.51 ± 10.67), P < 0.05]. Time to first flatus and soft diet were significantly shorter in TLTG group. The pain scores at all postoperative periods and administration of opioids were significantly lower in the TLTG group than in the OTG group. No significant difference in early, late and esophagojejunostomy (EJ)-related complications or 5-year recurrence free and overall survival between groups. Multivariate analysis demonstrated that body mass index [odds ratio (OR), 1.824; 95% confidence interval (CI): 1.029-3.234, P = 0.040] and American Society of Anaesthesiologists (ASA) score (OR, 3.154; 95%CI: 1.084-9.174, P = 0.035) were independent risk factors of early complications. Additionally, age was associated with ≥ 3 Clavien-Dindo classification and EJ-related complications.CONCLUSIONAlthough TLTG with the modified overlap method showed similar complication rate and oncological outcome with OTG, it yields lower pain score, earlier bowel recovery, and discharge. Surgeons should perform total gastrectomy cautiously and delicately in patients with obesity, high ASA scores, and older ages.

Complications After Adult Spinal Deformity Surgeries: All Are Not Created Equal.

Data on timing of complications are important for accurate quality assessments. We sought to better define pre- and postdischarge complications occurring within 90 days of adult spinal deformity (ASD) surgery and quantify the effect of multiple complications on recovery. We performed a review of 1040 patients who underwent ASD surgery (age: 46 ± 23; body mass index: 25 ± 7, American Society of Anesthesiologists [ASA] score: 2.5 ± 0.6, levels: 10 ± 4, revision: 9%, 3-column osteotomy: 13%). We assessed pre- and postdischarge complications and risk factors for isolated versus multiple complications, as well as the impact of multiple complications. The 90-day complication rate was 17.7%. 85 patients (8.2%) developed a predischarge complication, most commonly ileus (12%), and pulmonary embolism (PE; 7.1%). The most common causes of predischarge unplanned reoperation were neurologic injury (12.9%) and surgical site drainage (8.2%). Predictors of a predischarge complication included smoking (odds ratio [OR]: 2.2, P = .02), higher ASA (OR: 1.8, P = .008), hypertension (HTN; OR: 2.0, P = .004), and iliac fixation (OR: 4.3, P < .001). Ninety-nine patients (9.5%) developed a postdischarge complication, most commonly infection (34%), instrumentation failure (13.4%), and proximal junctional failure (10.4%). Predictors of postdischarge complications included chronic obstructive pulmonary disease (OR: 3.6, P < .0001), congestive heart failure (OR: 4.4, P = .016), HTN (OR: 2.3, P < .0001), and multiple rod construct (OR: 1.8, P = .02). Patients who developed multiple complications (9.3%) had a longer length of stay, and increased risk for readmission and unplanned reoperation. Knowledge regarding timing of postoperative complications in relation to discharge may better inform quality improvement measures. PE and implant-related complications play a prominent role in perioperative complications and need for readmission, with several modifiable risk factors identified. Level 3. Advances in surgical techniques and instrumentation have improved postoperative radiographic and clinical outcomes after ASD surgery. The rate of complications after complex ASD surgery remains high, both at early postoperative and long term follow-up. This study reviews complications within 90 days of surgery, with an assessment of patient and surgical risk factors. We found that modifiable risk factors for early complications after ASD surgery include COPD, and current smoking. The data presented in this study also provide surgeons with knowledge of the most common complications encountered after ASD surgery, to aid in preoperative patient discussion.

Risk factors relating to the early complications of acute myocardial infarction after cardios-intervention treatment

Purpose of the study. Identify the main risk factors for early complications of acute myocardial infarction after cardiac intervention and assess the prognostic risk.&#x0D; Materials and methods. To collect the statistical material to determine risk factors, the method of copying medical history data was used, and then the odds ratio was calculated. In doing so, we calculated odds ratios (OR) and 95% confidence interval (CI). Subsequently, the risk of early complications of acute myocardial infarction (AMI) in cardiointerventional intervention by Cox regression was predicted, which took into account the time of patient transportation by EMD team. The object of observation was to identify a patient with AMI who was delivered to a tertiary level of care.&#x0D; Results. In determining the consequences of cardiovascular intervention, such complications as aneurysm, arrhythmia, decreased ejection fraction, cardiogenic shock, and pulmonary oedema were considered. Most patients experienced improvement in health status – 60,7%, single complication was 18,9%, combined complications – 15,2%, patient death – 4,1%.&#x0D; Conclusions. By Cox regression analysis, it was proved that the cumulative risk of early GIM complications with cardiovascular intervention increased with 10 minutes of arrival of EMS with established ECG diagnosis (STEMI), which increased the risk of complications 1,9 times p (0,00) p (0,00) p (0,00); the presence of diabetes – 4,259 times, exp (β) 4,259 (p = 0,001); smoking – 2,988 times, exp (β) 2,988 (p = 0,001); increased BMI in the patient – 2 times, exp (β) 2,066 (p = 0,002).

Low volumetric bone density is a risk factor for early complications after spine fusion surgery

Lumbar spine (LS) fusion surgery is increasingly performed worldwide. Complications after fusion result in significant morbidity and healthcare costs. Multiple factors, including osteoporosis, have been suggested to contribute to risk of complications and re-operation. However, most studies have used DXA, which is subject to artifact in patients with spine pathology, and none have investigated the relationship between BMD and timing of post-operative complications. This study aims to investigate LS volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. We evaluated a cohort of 359 patients who had initial LS fusion surgery at our institution, had pre-operative LS CTs and post-operative imaging available for review. Demographic factors, smoking status, vBMD, and details of surgical procedure were related to likelihood and timing of post-operative complications. Mean age was 60 ± 14years, vBMD 122 ± 37g/cm3. Median follow-up was 11months. Skeletal complications occurred in 47 patients (13%); 34 patients (10%) required re-operation. Low vBMD (directly measured and estimated using HU) and smoking were associated with increased risk of skeletal complications. Each increase in baseline vBMD of 10g/cm3 decreased the complication hazard and increased the complication-free duration in time-to-event analysis (hazard ratio 0.91, 95% CI 0.83-0.98, p < 0.02). Low vBMD was a significant risk factor for early post-operative complications in patients undergoing LS fusion. Prospective studies are needed to confirm these findings and to elucidate the optimal timing for follow-up and strategies for prevention of post-operative complications in this population.