Risk Factors For Surgical Complications Research Articles

Complication and prognosis factor analysis of stent-assisted coil embolization for ruptured wide-necked saccular intracranial aneurysms

Objective To investigate the factors influencing the complications and prognosis of stent-assisted coil embolization (SACE) for ruptured wide-necked saccular intracranial aneurysms. Methods A retrospective analysis was conducted about the clinical data of 147 patients with ruptured wide-necked saccular intracranial aneurysms who underwent SACE from March 2008 to December 2015 at Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Command. The modified Rankin Scale (mRS) was used to assess the patients’ outcomes. Univariate and multivariate Logistic regression were utilized to identify the factors influencing the related complications and prognosis. Results Surgery-related complications occurred in 26 patients (17.7%) out of 147 cases. The location (P=0.002) and size (P=0.028) of intracranial aneurysms might be risk factors of the complications. Among all patients, 125(85.0%) achieved good clinical outcome. The univariate analysis revealed that the patient's age over 65 (P=0.041) and relatively high Hunt-Hess grade at admission (P<0.001) might be associated with high mRS at the time of discharge. The analysis using multivariate Logistic regression demonstrated that the Hunt-Hess grade (OR, 28.790, 95% CI 8.091-102.446, P<0.001) and aneurysm size (OR, 0.149, 95% CI 0.030-0.734, P=0.019) were independent factors influencing the patient's mRS at the time of discharge, while the short-term outcome was only associated with the Hunt-Hess grade(P<0.001). Conclusions The treatment of SACE seems to be a safe and effective procedure for ruptured wide-necked saccular intracranial aneurysms. Middle cerebral artery aneurysms and large aneurysms might be the risk factors of surgical complications. The patient's age over 65, high Hunt-Hess grade on admission and large size of aneurysm could be associated with poor outcome at the time of discharge assessed by mRS. High Hunt-Hess grade might be a significant factor influencing the patient's short-term prognosis. Key words: Intracranial aneurysm; Embolization, therapeutic; Stents; Postoperative complications; Prognosis

Role of CO-Oximeter in Reduction of Post-Operative Respiratory Complications in Chronic Heavy Smokers

The worldwide number of smokers exceeds one billion, and about 6 million people die per year, due to tobacco use. Smoking and its hazards exert a heavy toll on healthcare expenditure as well, in countries around the world. Patients with a history of smoking have a greater risk for pulmonary complications following surgical procedures. The Conventional technology relies on the use of arterial blood gas (ABG) analysis for monitoring gas saturation parameters in the blood but is invasive, expensive and cumbersome. Pulse CO-oximetry is a widely employed, operator-friendly, non-invasive monitoring method that yields comparable results to laboratory CO-oximetry and facilitates multi-parametric monitoring of the patients. It can accurately measure arterial oxygen saturation levels in heavy smokers who might have higher levels of circulating carboxyhemoglobin. The technology is cost-effective, can facilitate early detection of post-operative pulmonary complications and has the potential to reduce healthcare costs and improve clinical outcomes. Though clinical trials are yet to show benefit in patient monitoring from this technology, it is assumed to hold considerable promise in patients with risk factors for surgical complications.

Tumor Necrosis Factor Alpha Inhibitors Did Not Influence Postoperative Morbidity After Elective Surgical Resections in Crohn's Disease.

The real impact of anti-tumor necrosis alpha (TNF) therapy in postoperative complications after intestinal resections in Crohn's disease (CD) still needs to be determined. To compare the postoperative complication rates after elective intestinal resections in CD patients, with or without previous exposure to anti-TNF therapy. This was a retrospective and observational study, with elective intestinal resections for CD (emergency procedures were excluded). Patients were allocated in two groups according to preoperative anti-TNF status. Surgical and medical complications were analyzed and subsequently compared between the groups. A total of 123 patients were included (71 with and 52 without preoperative anti-TNF). The groups were considered homogeneous, except for perianal CD, previous azathioprine, and stomas. There was no significant difference between the groups regarding overall surgical complications (32.69% in anti-TNF- vs. 39.44% in anti-TNF+patients, p=0.457) or overall medical complications (21.15 vs. 21.13%, respectively, p=1.000). In univariate analysis, previous steroids, perianal CD, and stomas were considered risk factors for surgical complications, and previous steroids and hypoalbuminemia for medical complications. In multivariate analysis, previous steroids were associated with higher rates of surgical and medical complications, while hypoalbuminemia was associated with higher medical complication rates. There was no influence of the previous use of anti-TNF agents in postoperative surgical and medical complication rates in elective intestinal resections for CD. Previous steroids and hypoalbuminemia were associated with higher complication rates. This was the first case series of the literature describing outcomes in exclusively elective operations.

The Impact of Diabetes Mellitus on Wound Healing in Breast Reconstruction.

Although diabetes mellitus (DM) is a known risk factor for surgical complications in general, there is little published evidence to establish such an effect among patients undergoing breast reconstruction (BR). The purpose of this study was to assess the impact of DM on complications in patients undergoing postmastectomy BR. Patients who underwent BR at our institution from November 2002 to November 2012 were identified. Clinical and demographic data of patients with type 1 or type 2 DM were reviewed. Complications occurring within 60 days of surgery were compared between diabetic and nondiabetic patients for both autologous and nonautologous reconstruction types. A total of 1371 BR were performed in 1035 patients. There were 877 (64.0%) autologous reconstructions and 494 (36.0%) implant-based reconstructions. Patients with DM (n = 64) had significantly higher preoperative blood glucose levels (137.5 vs 100.1, P < 0.05). Postoperatively, DM patients reconstructed with implants had a significantly higher incidence of delayed wound healing (22.2% vs 9.7%; P = 0.04). This was not observed in patients with DM reconstructed with autologous tissue (7.4% vs 6.6%; P = 0.70). Diabetic patients had a significantly higher incidence of hypertension and were older than nondiabetic patients. To control for these variables and other potential confounders, multiple logistic regression analysis was performed. Again, diabetic patients had a significantly higher incidence of delayed wound healing following implant-based reconstruction (odds ratio, 2.52, 95% confidence interval = 1.2-6.2) but not autologous reconstruction (odds ratio, 0.97; 95% confidence interval = 0.2-4.6). Diabetes heightens the risk of wound healing complications among patients undergoing implant-based reconstruction.

Mucosal perforation during laparoscopic surgery for achalasia: impact of preoperative pneumatic balloon dilation.

Controversy remains whether preoperative pneumatic balloon dilation (PBD) influences the surgical outcome of laparoscopic esophagocardiomyotomy in patients with esophageal achalasia. The aim of this study was to evaluate whether preoperative PBD represents a risk factor for surgical complications and affects the symptomatic and/or functional outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD). A retrospective chart review was conducted on a prospectively compiled surgical database of 103 consecutive patients with esophageal achalasia who underwent LHD from November 1994 to September 2014. The following data were compared between the patients with preoperative PBD (PBD group; n=26) and without PBD (non-PBD group; n=77): (1) patients' demographics: age, gender, body mass index, duration of symptoms, maximum transverse diameter of esophagus; (2) operative findings: operating time, blood loss, intraoperative complications; (3) postoperative course: complications, clinical symptoms, postoperative treatment; and (4) esophageal functional tests: preoperative and postoperative manometric data and postoperative profile of 24-h esophageal pH monitoring. (1) No significant differences were observed in the patients' demographics. (2) Operative findings were similar between the two groups; however, the incidence of mucosal perforation was significantly higher in the PBD group (n=8; 30.7%) compared to the non-PBD group (n=6; 7.7%) (p=0.005). (3) Postoperative complications were not encountered in either group. The differences were not significant for postoperative clinical symptoms, the incidence of gastroesophageal reflux disease, or necessity of postoperative treatments. (4) Lower esophageal sphincter pressure was effectively reduced in both groups, and no differences were observed in manometric data or 24-h pH monitoring profiles between the two groups. Multivariate logistic regression analysis showed that preoperative PBD and the maximum transverse diameter of esophagus were significantly associated with intraoperative mucosal perforation. Although postoperative outcomes were not affected, additional caution is recommended in identifying intraoperative mucosal perforation in patients with preoperative PBD when performing LHD.

Robotic surgery for endometrial cancer (EC): Identifying risk factors for surgical complications using the Clavien-Dindo classification system

Robotic surgery for endometrial cancer (EC): Identifying risk factors for surgical complications using the Clavien-Dindo classification system

Assessment of pediatric Malone antegrade continence enema (MACE) complications: Effects of variations in technique

The Malone antegrade continence enema (MACE) procedure is performed for patients with fecal incontinence and constipation who do not respond to medical therapy. The MACE procedure provides antegrade catheter access to the right colon and allows administration of enemas to help evacuate the bowel regularly. The objective of this study was to identify risk factors for surgical complications in children who undergo the MACE procedure. Records from 97 pediatric patients who underwent MACE procedure were reviewed retrospectively. Data collected included age, sex, weight (obese/not obese), stomal location, presence of a permanent button/catheter in the stoma, open vs. laparoscopic surgery, and etiology of fecal incontinence/constipation. The complications reviewed included stomal stenosis, leakage, and stomal site infection. The relationships between the independent variables and complications were assessed using chi-square tests and Fisher's exact test. Statistical significance was set at p<0.05. Overall, 66 (68%) patients had at least one complication. Twenty-three (23.7%) patients developed stomal stenosis, and 27 (27.8%) patients had significant stomal leakage. Insertion of a stomal button/catheter device was associated with an increased risk of developing stomal leakage and stomal infection. The presence of a stomal button/catheter was also associated with a decreased risk of stomal stenosis (Figure). The non-intubated, imbricated sub-population, preteen patients (<12 years old) experienced more stomal leakage than teenage patients. In this subgroup, patients with umbilical stomas also experienced more leakage than patients with right lower quadrant (RLQ) stomas. The prevalence rates of stomal complications in our study were consistent with previously reported series. In our study, however, stomal leakage had a higher prevalence in comparison with stomal stenosis. This seems to be related to the heterogeneity of the study group, which contained two variants of the MACE procedure; non-imbricated, intubated MACE and imbricated, non-intubated MACE. The use of stomal buttons in conjunction with MACE has previously been reported without changes in complication rates. We found the use of stomal buttons/catheters to be associated with changes in the prevalence of stomal complications. Stomal complications are common in the MACE procedure. The use of a permanent stomal button/catheter is associated with changes in the rates of stomal complications. While many find an umbilical stomal site is more cosmetically appealing, there is an increased risk of leakage with imbricated, non-intubated stomas. In the non-intubated, imbricated sub-population, the MACE procedure results in a higher risk of stomal leakage in preteen patients in comparison with teenage patients.

Risk Assessment of Pancreatic Surgery by Surgical Apgar Score and Body Mass Index

Postoperative morbidity is high after pancreatic surgery. Recently, a simple and easy-to-use surgical complication prediction system, the surgical Apgar score (SAS), calculated using 3 intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate) has been proposed for general surgery. In this study, we evaluated the predictability of the SAS for severe complications after pancreatic surgery for pancreatic cancer. We investigated 189 patients who underwent pancreatic surgery at Kanagawa Cancer Center between 2005 and 2014. Clinicopathologic data, including the intraoperative parameters, were collected retrospectively. In this study, the patients with postoperative morbidities classified as Clavien-Dindo grade 2 or higher were classified as having severe complications. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for morbidity. Postoperative complications were identified in 73 patients, and the overall morbidity rate was 38.6%. The results of both univariate and multivariate analyses of various factors for overall operative morbidity showed that an SAS of 0 to 4 points and a body mass index ≥25 kg/m2 were significant independent risk factors for overall morbidity (P = 0.046 and P = 0.013). The SAS and body mass index were significant risk factors for surgical complications after pancreatic surgery for pancreatic cancer.

Prolonged Medical Therapy Increases the Risk of Surgical Complications in Patients with Severe Ulcerative Colitis

Aims: To determine the risk factors of surgical complications and the optimal timing of surgery for patients with severe ulcerative colitis (UC). Methods: One hundred one UC patients who had undergone surgery for a severe indication were retrospectively reviewed. Indications included severe disease unresponsive to medical therapy, massive bleeding, toxic megacolon, and colon perforation. Outcomes were compared based on the occurrence or absence of surgical complications. Patients with severe disease unresponsive to medical therapy were investigated separately to determine the optimal timing of surgery. Results: There was no significant difference regarding the use of rescue therapy. The duration of all medical therapy for a severe attack was the only significant factor associated with a surgical complication (p = 0.032). In patients with severe disease unresponsive to medical therapy, the receiver operating characteristic curve analysis showed that 30.5 days was the length of medical therapy after which the risk of surgical complications significantly increased. Conclusions: In patients with severe UC, rescue therapy itself was not related to an increased risk of surgical complications. However, prolonged medical therapy increased the risk of surgical complications. Patients should undergo surgery within 30 days from the institution of medical therapy for a severe attack.

Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York

OBJECTIVE Chiari malformation Type I (CM-I) is a common and often debilitating pediatric neurological disease. However, efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, single-center studies. Consequently, the objective of this study was to investigate CM-I surgical outcomes using population-level administrative billing data. METHODS The authors used Healthcare Cost and Utilization Project State Inpatient Databases (SID) to study pediatric patients undergoing surgical decompression for CM-I from 2004 to 2010 in California, Florida, and New York. They assessed the prevalence and influence of preoperative complex chronic conditions (CCC) among included patients. Outcomes included medical and surgical complications within 90 days of treatment. Multivariate logistic regression was used to identify risk factors for surgical complications. RESULTS A total of 936 pediatric CM-I surgeries were identified for the study period. Overall, 29.2% of patients were diagnosed with syringomyelia and 13.7% were diagnosed with scoliosis. Aside from syringomyelia and scoliosis, 30.3% of patients had at least 1 CCC, most commonly neuromuscular (15.2%) or congenital or genetic (8.4%) disease. Medical complications were uncommon, occurring in 2.6% of patients. By comparison, surgical complications were diagnosed in 12.7% of patients and typically included shunt-related complications (4.0%), meningitis (3.7%), and other neurosurgery-specific complications (7.4%). Major complications (e.g., stroke or myocardial infarction) occurred in 1.4% of patients. Among children with CCCs, only comorbid hydrocephalus was associated with a significantly increased risk of surgical complications (OR 4.5, 95% CI 2.5-8.1). CONCLUSIONS Approximately 1 in 8 pediatric CM-I patients experienced a surgical complication, whereas medical complications were rare. Although CCCs were common in pediatric CM-I patients, only hydrocephalus was independently associated with increased risk of surgical events. These results may inform patient counseling and guide future research efforts.

Surgical complications associated with spinal decompression surgery in a Japanese cohort

The aim of the present study was to identify risk factors for perioperative complications associated with spinal surgery for cervical, thoracic, and lumber spinal stenosis in a Japanese cohort. Patients with spinal stenosis who underwent spinal surgery between 2008 and 2012 were included. Neurological and/or surgical site complications within 30days of index surgery were retrospectively collected, and the rates of complications were calculated. Using univariate and multivariate logistic regression analyses, risk factors for complications were identified. A total of 364 patients underwent 407 spinal surgeries. Of the 407 surgeries performed, 236 were cervical, 28 were thoracic, and 143 were lumbar surgeries. Ossification of the ligamentum flavum was the most common diagnosis in patients with thoracic stenosis (85%), whereas spinal degenerative stenosis and disc herniation were the two most common diagnoses in patients with cervical and lumbar stenosis. Laminoplasty and laminectomy alone were the two most frequently performed procedures. The rate of complications was greater in patients with thoracic stenosis (36%) than in those with cervical (16%) or lumbar stenosis (13%, p=0.013). After a multivariate analysis, only thoracic stenosis (odds ratio 2.87) remained an independent risk factor for surgical complications. The novel result of the present study was that the level of stenosis in the spine had a significant impact on complications after spinal surgery in a Japanese cohort. The result can be explained by the fact that challenging ossified lesions are a common cause of thoracic stenosis in eastern Asia.

Influence of body habitus on the surgical outcomes of bilateral axillo-breast approach robotic thyroidectomy in papillary thyroid carcinoma patients.

PurposeObesity is associated with a number of medical comorbidities and is considered a risk factor for surgical complications. The purpose of this study was to analyze the influence of body habitus including obesity on the surgical outcomes of the Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) in papillary thyroid carcinoma (PTC) patients.MethodsThe medical records of 456 PTC patients who underwent BABA RoT between January 2011 and December 2012 were reviewed, and 310 women PTC patients who had undergone BABA robotic total thyroidectomy with central lymph node dissection were examined. Body habitus were evaluated by measuring body mass index (BMI), body surface area, and neck circumference. We divided the patients into BMI < 25 kg/m2 and BMI ≥ 25 kg/m2 groups. Clinicopathological data, surgical outcomes, and postoperative complications were evaluated.ResultsClinicopathological characteristics did not differ between the 2 BMI groups. The creation of working space time (P = 0.210) and other surgical outcomes showed no significant differences between the groups. There were no statistically significant differences between body habitus indexes and postoperative length of hospital stay, number of retrieved central lymph nodes, postoperative thyroglobulin levels, occurrence of hypoparathyoidism, recurrent laryngeal nerve injury and wound complication.ConclusionPatient with large body habitus undergoing BABA RoT were not at an increased risk of surgical complications and showed good surgical outcomes. BABA RoT may be a good alternative operative method for PTC patients for whom cosmetic outcome is an important consideration.

Symptomatic small schwannoma is a risk factor for surgical complications and correlates with difficulty of enucleation

Postoperative neurological deficits of schwannomas are the complications that we want to avoid most. Predicting postoperative neurological deficits is crucial; however, the correlation between preoperative symptoms and neurological findings with postoperative neurological complications has not yet been completely clarified. Here we analyzed the risk factors for postoperative neurological complications. The study included 131 tumors from 107 patients histologically confirmed as schwannomas, which developed in the extremities and trunk without spinal cord involvement. The correlation between clinical findings and postoperative complications were statistically analyzed. One-hundred three tumors (78.6 %) had the preoperative neurological symptoms; these symptoms were detected in 93.3 % of small tumors (<4 cm3). We defined it as follows about the anatomical location of schwannomas. One is “central type” that normal nerve bundles widely splayed over the tumor’s capsule (tumor located in the central region of the nerve). Another is “peripheral type” that easy to enucleate without neurolysis (tumor located in the peripheral region of the nerve). Static analysis showed a significant difference in the Tinel sign, numbness, and postoperative neurological deficits (p = 0.04, 0.006, p < 0.001, respectively). Twenty-one cases (16.0 %) showed new postoperative neurological symptoms, including numbness in 12 cases, dysesthesia in three cases, pain in three cases, and slight motor palsy in two cases. In statistical analysis, small tumors (<4 cm3) significantly correlated with Tinel sign (p < 0.001), and was marginally significant with postoperative neurological deficits (p = 0.05). Moreover, small tumors (<4 cm3) accompanying numbness preoperatively significantly correlated with postoperative neurological deficits (p = 0.04). Small (<4 cm3) tumors significantly correlated with the preoperative neurological symptoms. Those tumors accompanying numbness also significantly correlated with the difficulty of the enucleation and postoperative neurological deficits. These findings will help to predict the neurological complication.

Assessing the Risks Associated with Antidepressant Use in Plastic Surgery: A Systematic Review.

Antidepressant use has increased dramatically over the past decade. Although there is no question about the benefits of these medications, uncertainty exists with regard to the implications of antidepressant treatment surrounding plastic surgery. This systematic review collates all of the available literature that evaluates the risks of patient antidepressant treatment, in relation to plastic surgery. A comprehensive literature review of the PubMed and Cochrane databases was conducted. Articles were assessed by two independent reviewers using predefined data fields and selected using specific inclusion criteria. The two authors independently reviewed the literature and extracted data from included reviews, and discrepancies were resolved by consensus. Twenty-six articles were included in the analysis and were categorized into five groups for comparison: risk of bleeding, risk of breast cancer, risk of breast cancer recurrence, breast enlargement, and miscellaneous (unique complications). Extracted information included study type, statistical analyses, conclusion, and limitations. This review does not support the cessation of antidepressants in patients before plastic surgery, as the numbers needed to harm are low and the implications of withdrawal may prove to be detrimental to postoperative management. However, the use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications, and sufficient exploration into the patient's indications for the prescription is crucial. Evidence so far does not suggest that antidepressants increase the risk of breast cancer or recurrence in general, but caution should be exercised for those specifically on concurrent tamoxifen and paroxetine treatment.

Prognostic factors for recurrence and complications in the surgical management of primary chordoid gliomas: A systematic review of literature

ObjectiveChordoid gliomas (CG) are rare neoplasms which frequently arise within the third ventricle. Surgery remains the mainstay treatment for CG. The present study comprehensively reviews all reported cases of CG within the literature in order to identify risk factors for surgical complications and tumor recurrence. MethodsA comprehensive search on MEDLINE (OVID and PubMed), Scopus, Embase, and Web of Science was conducted following PRISMA guidelines to identify all reported cases of CG. ResultsA total of 81 patients met the study criteria which comprised of 33 males and 48 females. Median age at diagnosis was 48 years with a range from 5 to 72 years, and mean tumor size was 3.1cm. Biopsy, subtotal resection (STR), and gross total resection (GTR) were achieved in 8, 34, and 33 patients, respectively, with six cases not reporting extent of resection (EOR). Thirteen patients underwent adjuvant radiotherapy. Postoperative complications were noted in 30 cases (37%), with new onset diabetes insipidus being the most common. Postoperative morbidity was not associated with age, tumor size, or extent of resection. A trans-lamina terminalis approach demonstrated a strong trend towards decreased overall rates of postoperative morbidity compared to other approaches (p=0.051). GTR was associated with improved progression-free survival (PFS; p=0.028), while adjuvant radiotherapy, age, tumor size and proliferative index were not predictive of patient outcomes. ConclusionGTR should be the primary goal for the management of CG, as it is associated with improved rates of tumor control without an increased rate of postoperative complications. Surgical approach was a stronger predictor of complication rates than extent of resection. Morbidity remains high, and future studies to further elaborate on factors predictive of postoperative complications are critical.

Risk factors for surgical complications in rotator cuff repair in a veteran population

Technical advances have allowed arthroscopic rotator cuff repair to supplant open repairs with similar outcomes. However, few data exist to support the theoretical decrease in complications with the arthroscopic technique. We used the Veterans Administration Surgical Quality Improvement Program database from the entire U.S. Veterans Administration system. We obtained perioperative data of all patients undergoing rotator cuff repair between 2003 and 2008. Single and multivariate analyses were performed to evaluate risk factors for perioperative complications associated with rotator cuff surgery. There were 6975 open rotator cuff repairs and 2918 arthroscopic rotator cuff repairs performed with similar patient age, gender breakdown, body mass index, and comorbidities. Complications occurred in the early postoperative period in 2.1% of the open repair group and 0.9% of the arthroscopic repair group (P < .0001). The prevalence of both superficial and deep wound infection was higher in the open group compared with the arthroscopic group (1% vs. 0.1% superficial, P < .0001; 0.3% vs. 0.1% deep, P = .11). Return to the operating room within the 30-day surveillance period occurred in 1.1% of the open repair patients compared with 0.5% of patients undergoing arthroscopic repairs (P < .0001). -Multivariate logistic regression analysis revealed that the arthroscopic group had a significantly lower risk of complications (P = .0001), a lower rate of superficial infection (P = .0002), a lower incidence of return to the operating room within 30 days (P = .007), and a lower risk of hospital readmission (P < .0001). Arthroscopic rotator cuff repair in the veteran population resulted in a lower incidence of perioperative complications compared with open repair.

Association Between Diabetes, Obesity, and Short-Term Outcomes Among Patients Surgically Treated for Ankle Fracture.

Although obesity is widely accepted as a risk factor for surgical complications following orthopaedic surgery, the literature is unclear with regard to the effect of obesity on outcomes of ankle fracture surgery, particularly in the setting of competing risks from diabetes. We hypothesized that obesity would be independently associated with more frequent complications, longer hospital length of stay, and higher costs of care among patients with and without diabetes. With use of data from 2001 to 2010 from the Nationwide Inpatient Sample, we identified all adult patients who underwent surgical treatment for a primary diagnosis of an isolated ankle fracture or dislocation. We then divided patients into four groups according to the presence or absence of diabetes or obesity: Group A included patients with neither diagnosis; Group B, obesity alone; Group C, diabetes alone; and Group D, both diagnoses. Multivariable regression models were constructed to determine the association between diagnostic group and in-hospital complications, hospital length of stay, and imputed costs of care, while controlling for other conditions. The final sample included 148,483 patients (78.4% in Group A, 5.0% in Group B, 13.6% in Group C, and 3.0% in Group D). The median age was 53.0 years, and most patients (62.2%) were female and had a closed bimalleolar or trimalleolar fracture (62.2%). In the unadjusted analysis, the frequency of in-hospital complications (2.6%, 4.2%, 5.3%, and 6.5% in Groups A, B, C, and D, respectively; p < 0.001), length of stay (3.0, 3.6, 4.4, and 4.8 days, respectively; p < 0.001), and costs of care ($9686, $10,555, $11,616, and $12,804, respectively, in 2010 U.S. dollars; p < 0.001) increased across groups. Patients with obesity alone (Group B) (adjusted odds ratio [OR] = 1.4; 95% confidence interval [CI] = 1.3 to 1.6), diabetes alone (Group C) (OR = 1.1; 95% CI = 1.0 to 1.2), and both diagnoses (Group D) (OR = 1.4; 95% CI = 1.2 to 1.5) had more frequent in-hospital complications than those with neither diagnosis. We found that patients with concurrent diagnoses of diabetes and obesity had higher health-care utilization and costs than those with neither diagnosis or with obesity alone or diabetes alone. The delay in the diagnosis of diabetes may somewhat obscure the true effect.

Risk factors for surgical complications after distal pancreatectomy for pancreatic diseases

Risk factors for surgical complications after distal pancreatectomy for pancreatic diseases

Minimally Invasive Surgical Management of Early-Stage Cervical Cancer: An Analysis of the Risk Factors of Surgical Complications and of Oncologic Outcomes

The objective of this study was to evaluate the morbidity and the oncologic outcomes of laparoscopic radical hysterectomy in treating early-stage cervical cancer. We included all patients with early-stage cervical cancer (IA, IB1, IIA1, and IIB), as assessed by the Federation International of Gynecology and Obstetrics staging criteria, undergoing laparoscopic radical hysterectomy from January 1999 to December 2013 in our center. Morbidity was classified according to the Clavien and Dindo classification. A total of 170 patients were included in which 7 patients were in stage IA2, 150 in IB1, 2 in IIA, and 7 in IIB. The mean operation time was 256 minutes (67-495 minutes). Fourteen severe perioperative complications (8.2%) occurred, in which 5 patients (2.9%) required conversion to an open procedure: 3 bowel injuries, 3 hemorrhages, 2 ureteral injuries, 3 bladder injuries, 2 severe adhesions, and 1 intolerance to the Trendelenburg position. Fourteen patients (8.2%) presented with 1 severe postoperative complication (grade III or more). Two factors appeared as independent risk factors for perioperative and/or postoperative complications: the tumor size (odds ratio, 1.128; 95% confidence interval, 1.054-1.207) and operative time (odds ratio, 1.0116; 95% confidence interval, 1.003-1.020). In a median follow-up of 47.7 months, the 5-year overall survival was 94.1% (range, 88.1%-97.3%), and the 5-year disease-free survival was 88.8% (range, 81.0%-92.6%). The laparoscopic approach was favorable for both perioperative and postoperative morbidity. With the advantage of minimal invasiveness, laparoscopic treatment by experienced surgeons is an alternative for early-stage cervical cancer with correct long-term survival outcomes. Mini-invasive surgery could be the standard in early-stage cervical cancer.

Oropharyngeal Contamination Predisposes to Complications after Neck Dissection: An Analysis of 9462 Patients.

While neck dissection is important in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. We sought to compare preoperative variables and outcomes between clean and contaminated neck dissections, using the 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data sets. Retrospective review of prospectively maintained database. Multicenter (university hospitals; tertiary referral centers). A retrospective review was performed of the NSQIP database to identify patients undergoing neck dissection in clean vs oropharyngeal contaminated cases. Clinical factors, comorbidities, epidemiologic factors, and procedural characteristics were analyzed to identify factors associated with 30-day postoperative adverse events, including medical and surgical complications, unplanned reoperation, and mortality. Bivariate and multivariable analyses were performed for the outcome of one or more adverse events. In total, 8890 patients had clean neck dissections, while 572 patients had neck wound contamination with oropharyngeal flora. On multivariable regression analysis, oropharyngeal contamination was a significant risk factor for surgical complications (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.96-5.96; P < .001). However, medical complications and mortality were not significantly different between the 2 cohorts. This finding persisted after subgroup analysis, with removal of all thyroidectomy patients from analysis (OR, 2.33; 95% CI, 1.25-4.36; P = .008). Using the ACS-NSQIP data set, this study found an increased risk of surgical complications in the setting of contaminated neck dissections. These data should be used for patient risk stratification, informed consent, and to guide further research.