Statistical Analysis Of Complications Research Articles

Third-generation posterior-stabilised cemented system for total knee arthroplasty: Survivorship and outcomes after 20-year follow-up.

Total knee arthroplasty is a common procedure due to increased life expectancy and ageing populations, necessitating implants with long-term efficacy. After some initial designs, the third-generation modular posterior-stabilised NexGen® prosthesis aimed to enhance kinematics and reduce complications. This study evaluates the long-term outcomes, survivorship, revision rates and complications of this implant. With promising results observed up to 15 years in previous studies, this investigation aims to assess the implant's performance over extended follow-up periods, aiding in optimal implant selection for improved patient outcomes. We carried out a retrospective study on 263 total knee arthroplasties performed in our centre between 1998 and 2002. Statistical analysis of complications was performed and study of survival using the Kaplan-Meier method and competing risk analysis were calculated. Description of reinterventions and complications were also included. Results show a 20-year prosthesis survival rate of 90.8% for revision due to any reason, with an estimated survival of 92.3% considering competitive events. Estimated survivorship at 20 years is 98% for aseptic loosening as the end point, and an estimation of 98.80% considering competitive events. Twenty revisions were performed, with 10 cases due to infection and 10 for noninfectious reasons and three of them due to aseptic loosening. Radiographic analysis revealed radiolucent lines, but no clinical evidence of loosening was observed in these cases. This study offers survivorship data from longer follow-up periods, what is difficult to find in the reported literature and showed excellent results of this implant in terms of survivorship and low rates of revision in our cohort. Level IV.

Retrosternal Goitre: Anatomical Aspects and Technical Notes.

Background and Objectives: surgery for substernal goitre is still debated in the literature, due to the wide range of surgical options. This article outlines the findings of our extensive experiences, which include 264 cases of patients with “goitre plongeant“, and compares postoperative complications, despite surgical approaches. Material and Methods: preoperative planning and anatomical landmarks are described to determine the potential need of a combined approach. The surgical procedure is described, along with some stratagems, to ensure that the operation is completed safely. A statistical analysis of complications and the length of stay, with a comparison of cervicotomy and combined access, was performed using the Pearson chi-square significance test. Results: 264 patients underwent thyroid surgery for substernal goitre. The Kocher incision was the surgical approach chosen in 256 patients (96.6%), while an accessory incision was performed in 8 patients (3.4%). The necessity to use a two-fold surgical access was linked to a higher rate of postoperative complications (p-value < 0.01). The average length of stay (LOS) for cervicotomy was 2 days (1–3 days), while the average LOS was 5 days (4–7 days) (p-value = n.s.) for combined access. Conclusions: cervicotomy should be the gold standard technique for exploring intrathoracic goitre with a digital dissection, which, in almost all cases, enables the externalization of the mediastinal portion associated. Sternotomy is related to a higher rate of complications, so it should be performed only in selected cases. Management in large-volume centres may be more appropriate.

Clinical application of segmental prosthesis in reconstruction of diaphyseal tumors

Objective To investigate the clinical value of segmental prosthesis in the repair of diaphyseal defect. Methods The clinical data and follow-up information of 40 patients who accepted segmental prosthesis reconstruction of long bone defects in limbs were collected from June 2010 to June 2017 in General Hospital of Jinan Military Commanding and Tianjin Hospital. The parameters for outcome evaluation including general information, surgical complications, Musculoskeletal Tumor Society (MSTS) functional score, survival and prostheses status were analyzed. Results Forty patients were underwent segmental prosthesis surgery, including 18 males and 22 females, with a median age of 64 years and the age range of 13-83 years. The surgery was performed on 28 cases of femur, 8 cases of humerus, 3 cases of tibia, and 1 cases of ulna. There were 5 cases of primary tumor, 3 cases of multiple myeloma and 32 cases of metastatic tumor of bone, in which lung cancer, breast cancer, kidney cancer, liver cancer and colorectal cancer are common. Pathological fracture of surgical site occurred in 32 cases. The average osteotomy length was 93.5 mm. The shortest osteotomy was 60 mm and the longest osteotomy was 190 mm. The average operation time was 104.6 minutes. The median bleeding volume was 600 ml. The least bleeding was 200 ml and the most bleeding was 2 800 ml. The patients median survival time was 8.5 months from 3 to 79 months. The prosthesis median survival time was 8 months from 3 to 79 months. According to the Henderson tumor prosthesis complications classification, there were 3 cases of type I including 2 cases of incision delayed healing and 1 case of radial nerve paralysis. There was 1 case of type II with humeral prosthesis aseptic loosening. There was 1 case of type III with angulation deformity between femoral prosthesis force line and biological force line. There were 2 cases of type V with tumor recurrence followed by amputation. The limb function score of MSTS was 20.4±4.1 points. Except for two patients with tumor recurrence and amputation, 38 patients got stable prosthesis function until the death or follow-up cut-off. The similar tendency of patients survival curve and prosthesis survival curve indicated that survival was the main factor affecting postoperative prosthesis survivorship. Although the use rate of humeral plate (4/8, 50.0%) was higher than that of femoral plate (5/28, 17.9%), the difference was not statistically significant (F=3.426, P=0.064). The results of statistical analysis of complications showed that the type of tumor was an independent risk factor for complications (χ2=7.446, P=0.024). The postoperative complications rate of primary tumor was significantly higher than that of multiple myeloma and bone metastasis. Patients with no complications have better limb function after surgery (F=9.709, P=0.003). Multivariate linear regression analysis showed that age, tumor type, preoperative pathologic fracture, surgery, osteotomy length did not affect limb functions after operation. The longer survival time mean better limb function (t=4.228, P=0.000). Conclusion Segmental prosthesis is a reliable method for the repair of bone metastases with defects. Combined with bone plate fixation, it can effectively reduce the occurrence of prosthetic complications. Key words: Prosthesis implantation; Diaphyses; Bone neoplasms; Reconstructive surgical procedures

Statistical analysis of complications in laser treatment under general anesthesia performed for pediatric inpatients.

We report relationship between complications and predictive factors of occurrence with multivariate analysis for cases of laser treatment under general anesthesia.Study Design: Pediatric patients (330 cases, aged 1 to 15 years old) who underwent laser treatment under inpatient general anesthesia against body surface hemangiomas or melanocytosis were examined for the complications. Retrospective study from medical and anesthesia records, statistical assessment was carried out using multivariate analysis by univariate and logistic regression analysis, and p value less than 0.05 was considered to be significant difference. Complications were confirmed in 25%, mostly due to emergence agitation from anesthesia, and no severe complications were recognized. Multivariate analysis of factors causing complications revealed a significant difference in the limbs, the Q-switched Nd: YAG laser, and the anesthesia time of 60 minutes or longer. While the length of anesthesia time was reported as a factor of complication occurrence in the past, there has been no report on the extremity and the Q-switched Nd: YAG laser as significant complication factors.

Arthroscopy—“No problem surgery”—A statistical analysis of complications in 2002 cases

Arthroscopy—“No problem surgery”—A statistical analysis of complications in 2002 cases

Risk factors in percutaneous transthoracic needle biopsy.

In percutaneous transthoracic needle biopsies, statistical analysis of complications in men and women of different age groups is believed to be helpful in borderline cases for a better evaluation of risk factors versus the value of the information gained by the procedure. The 95 percent confidence interval and the X2 test showed a significantly lower rate of pneumothorax in mediastinal and pleural based lesions as compared to intralobar changes. Age and sex were found to be the most important parameters for the rate and degree of pneumothorax. The incidence of pneumothorax (mean value 27,2%) steadily increased with age from 2 of 10 in the age group of 9 to 29 years, to 3 to 10 in age group up to 69 years in both sexes, and after 70 years it was as high as 4 of 10. In women the relative frequency of pneumothorax was lower for the respective age groups than in men. Other factors influencing the complications include: experience of the operator, size and depth of the lesion to be punctured and to a certain degree the outer diameter of the needle being used.