Types Of Postoperative Complications Research Articles

Predictors for complication in renal cancer surgery: a national register study.

Nationwide register data provide unique opportunities for real-world assessment of complications from different surgical methods. This study aimed to assess incidence of, and predictors for, post-operative complications and to evaluate 90-day mortality following different surgical procedures and thermal ablation for renal cell carcinoma (RCC). All patients undergoing surgical treatment and thermal ablation for RCC in Sweden during 2015-2019 were identified from the National Swedish Kidney Cancer Register. Frequencies and types of post-operative complications were analysed. Logistic regression models were used to identify predictors for 90-day major (Clavien-Dindo grades III-V) complications, including death. The overall complication rate was 24% (1295/5505), of which 495 (8.7%) were major complications. Most complications occurred following open surgery, of which bleeding and infection were the most common. Twice as many complications were observed in patients undergoing open surgery compared to minimally invasive surgery (20% vs. 10%, P < 0.001). Statistically significant predictors for major complications irrespective of surgical category and technique were American society of anesthiologists (ASA) score, tumour diameter and serum creatinine. Separating radical and partial nephrectomy, surgical technique remained a significant risk factor for major complications. Most complications occurred within the first 20 days. The overall 90-day readmission rate was 6.2%, and 30- and 90-day mortality rates were 0.47% and 1.5%, respectively. In conclusion, bleeding and infection were the most common major complications after RCC surgery. Twice as many patients undergoing open surgery suffer a major post-operative complication as compared to patients subjected to minimally invasive surgery. General predictors for major complications were ASA score, tumour size, kidney function and surgical technique.

Abdominal aortic aneurysm surgery with a modern method - is there anything to fear?

Background: Endovascular surgery for abdominal aortic aneurysms using a stent graft is the modern method of supplying these life-threatening lesions in large arterial vessels. In recent years, there have been significant improvements in the technique of performing these procedures, despite which complications are still common. In order to make progress in dealing with this problem, it is important to understand in which areas of the treatment strategy appropriate changes have not yet been implemented. Various clinical cases that describe post-operative complications of stent-graft surgery, types of post-operative complications and methods of dealing with the complication that has occurred should be analysed. And also other research papers relating to this topic. The first step is to deepen the knowledge of existing post-operative complications and the types of complications that can occur after stent-graft implantation into the abdominal aorta, as well as contemporary methods of treating complications that have already arisen.&#x0D; Aim of the study: The aim of this study is to present the incidence of complications after endovascular surgery for abdominal aortic aneurysms using a stent graft, the repair methods used when a complication occurs, the types of complications and their different kinds based on a review of the literature.&#x0D; Material and methods: A literature review was conducted in English-language databases, based on original articles and case reports, on post-operative complications of abdominal aortic stent-graft surgery, together with treatment methods and different types of complications arising from this procedure published between 2022 and 2023. Using the keywords: "abdominal aortic stent-graft" and "complications".

Predictive factors and diagnostic significance of CT findings for anastomotic leak after gastric cancer surgery: A retrospective analysis

AbstractBackgroundAnastomotic leak following radical gastrectomy poses a significant risk to patients. Despite previous studies, effective methods for diagnosing anastomotic leaks after gastric cancer surgery remain elusive. In this study, we aimed to assess the overall burden of anastomotic leaks and investigate diagnostic factors, particularly radiological signs on postoperative computed tomography (CT), that may facilitate early detection.MethodsWe included a total of 70 gastric cancer patients who underwent curative gastrectomy and underwent CT examination post‐surgery. Among them, 35 patients with anastomotic leak were matched with 35 patients without anastomotic leak. We compared the rates of various types of postoperative complications between the two groups and conducted univariate and multivariate analyses to identify predictive variables for postoperative diagnosis.ResultsPatients with anastomotic leaks experienced significantly longer postoperative hospital stays and higher overall expenditures (p &lt; 0.001). Logistic regression analysis revealed that extraluminal gas at the anastomosis site, fever (T ≥ 38.5°C), and neutrophilia (NE ≥ 78%) on postoperative days 4–7 were independent diagnostic factors for anastomotic leaks (p &lt; 0.05).ConclusionsThe diagnostic factors identified in this study offer valuable insights into early detection of anastomotic leaks. We recommend early CT examination for patients exhibiting consistent fever and neutrophilia between postoperative days 4 and 7 following gastric cancer surgery.

Variation in Complications and Mortality According to Infant Diagnosis.

Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of postoperative complications and mortality in infants. The majority of mortality events in pediatric surgery occur among infants (ie, children <1y old). However, there is limited data characterizing patterns of infant perioperative mortality and diagnoses that account for the highest proportion of mortality. Infants who received inpatient surgery were identified in the National Surgical Quality Improvement Program-Pediatric database (2012-2019). Perioperative mortality was stratified into mortality associated with a complication or mortality without a complication. Complications were categorized as wound infection, systemic infection, pulmonary, central nervous system, renal, or cardiovascular. Multivariable logistic regression was used to evaluate the association between different complications and complicated mortality. Among 111,946 infants, the rate of complications and perioperative mortality was 10.4% and 1.6%, respectively. Mortality associated with a complication accounted for 38.8% of all perioperative mortality. Seven diagnoses accounted for the highest proportion of mortality events (40.3%): necrotizing enterocolitis (22.3%); congenital diaphragmatic hernia (7.3%); meconium peritonitis (3.8%); premature intestinal perforation (2.5%); tracheoesophageal fistula (1.8%); gastroschisis (1.4%); and volvulus (1.1%). Relative to wound complications, cardiovascular [odds ratio (OR): 19.4, 95% confidence interval (95% CI): 13.9-27.0], renal (OR: 6.88; 4.65-10.2), and central nervous system complications (OR: 6.50; 4.50-9.40) had the highest odds of mortality for all infants. A small subset of diagnoses account for 40% of all infant mortality and specific types of complications are associated with mortality. These data suggest targeted quality improvement initiatives could be implemented to reduce adverse surgical outcomes in infants.

Postoperative Complications After Total Thyroidectomy for Patients With Graves' Disease.

To identify the rates and types of postoperative complications in patients with and without Graves' disease undergoing total thyroidectomy using the National Surgical Quality Improvement Program (NSQIP) database. Retrospective cohort study. All hospitals participating in NSQIP from 2007 to 2017. Thyroidectomy data were abstracted from the NSQIP database from 2007 to 2017 using related Current Procedural Terminology codes. Exclusion criteria included diagnosis of malignancy and partial thyroidectomy. Patients with a diagnosis of Graves' disease were compared against the control group, which consisted of other nononcologic diagnoses. Statistical analysis including matched pair analysis was performed. Unmatched data demonstrated that patients with Graves' disease who underwent total thyroidectomy (n = 5495) had a higher rate of readmission (odds ratio [OR], 1.41; 95% CI, 1.16-1.73) and rate of reoperation (OR, 2.29; 95% CI, 1.88-2.79) in comparison to control patients (n = 24,213). They also had a higher rate of postoperative complication (OR, 1.54; 95% CI, 1.23-1.93) especially for wound-related outcomes (OR, 1.88; 95% CI, 1.32-2.69), readmission for postoperative hypocalcemia (OR, 2.12; 95% CI, 1.54-2.92), and reoperation for hematoma or hemorrhage (OR, 1.88; 95% CI, 1.32-2.69). A matched-pair analysis of the data also demonstrated similar significant results. Patients with Graves' disease undergoing total thyroidectomy are at higher risk of complications in comparison to those who do not have Graves' disease, likely due to sequelae of the disease. However, overall rates were low, suggesting that the procedure remains relatively low risk and should continue to be offered to select patients who meet criteria for surgery.

Specifics of Epidural Compression Syndrome Surgery in Patients with Spinal Malignancy

Background. Epidural spinal cord compression (ESCC) is the most common neurological complication in metastatic spinal tumours.Materials and methods. The study included 87 spinal malignancy patients operated within 01.01.2014–30.09.2021. All patients had a type of palliative decompressive and stabilising surgery: standard posterior access (SPA, 55 patients), minimally invasive posterior access (MPA, 22 patients) or anterior access (AA, 10 patients).Results. The patient cohorts did not differ significantly by the duration of surgery, length of hospital stay, rates and types of postoperative complications. The AA cohort revealed a statistical difference by intraoperative blood loss. A Karnofsky performance status was statistically improved post- vs. pre-surgery (p &lt; 0.05) at no significant change of Frankel neurological function status (p &gt; 0.05). A Kaplan — Meier curve analysis showed no significant survival rate variation among the surgical techniques. Discussion. Our results suggest that posterior access interventions should be considered optimal. We report no statistical difference in the postoperative neurological and performance status dynamics between both cohorts, which encourages the MPA use in all patients with minimal epidural compression.Conclusion. Posterior access with cytoreductive tumour removal in anterior spinal cord compression is advantageous over anterior surgery. A posterior access surgery with minimal spinal canal decompression is recommended in all patients with grade 1 tumoural epidural compression.

Pituitary Adenoma: Role of the Nurse to Minimize Postoperative Complication Following Transsphenoid Surgery

Abstract: Background: The postoperative management of patients undergoing transsphenoidal pituitary surgery requires a multidisciplinary approach involving neurosurgeons, endocrinologists, and often intensive care teams. Aim of the work: was to evaluate the effect of nursing role on minimizing bleeding from nose after transsphenoidal surgery for patients with pituitary adenoma. Patients and Methods:convenice sample of 30 adult male and female patients diagnosed with pituitary adenoma and undergoing transsptenoidal surgery in the neurosurgery department. Age ranged from 18 to 65 years. Tools: Patients assessment sheet and risk factors for postoperative nasal bleeding transsphenoidal surgery. Results: There were (33.3%) of study patients had nasal bleeding with mean of frequency 2.77times/day. Conclusion: Patients had different types of postoperative complications in which cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea , vomiting and hematoma at operation site. Tumor size or pathology may be the contributory factor for these findings. Nursing play an important role in reducing postoperative nasal bleeding after transsphenoid surgery for pituitary adenoma.

Safety of early postoperative hydrotherapy in dogs undergoing thoracolumbar hemilaminectomy.

Hydrotherapy is a common part of the postoperative care after surgical treatment of thoracolumbar intervertebral disc extrusion in dogs. There are currently no guidelines on when to commence hydrotherapy after surgery. Early hydrotherapy may be associated with an increased risk of postoperative complications including surgical site infection and neurological deterioration. The goal of this study was to report the prevalence and types of postoperative complications in dogs receiving early hydrotherapy. Eighty-three dogs commencing hydrotherapy within 5 days after surgical treatment for thoracolumbar intervertebral disc extrusion were included in a retrospective descriptive study. All postoperative complications were recorded. Ten minor and 16 major complications were recorded in a total of 26 dogs. The majority of recorded complications were unlikely, but not excluded to be, caused by the initiation time of hydrotherapy. One dog developed a surgical site infection and one dog had a confirmed further extrusion of the originally operated intervertebral disc, which may have been influenced by early initiation of hydrotherapy. Early hydrotherapy is possibly associated with occurrence of postoperative complications. Associations between the reported complications and early hydrotherapy, and possible benefits of early hydrotherapy, need to be further investigated before early initiation of hydrotherapy can be recommended.

An Analysis of the Risk Factors for Postoperative Complications and Their Effects on Hospital Stay in Taiwanese Geriatric Surgical Patients.

Surgical outcomes and complications in geriatric patients may be affected due to their increased number of underlying diseases. This study was conducted to evaluate the risk factors for postoperative complications and their effects on hospital stay in geriatric surgical patients (aged ≥ 80 years). A total of 404 geriatric patients (aged ≥ 80 years) who underwent noncardiac surgery were enrolled in this study. Their preoperative, perioperative, and postoperative data were collected and subjected to univariate and multivariate analyses to calculate the odds ratio of risk factors. The risk of discharge was analyzed by calculating the hazard ratio to evaluate their relationship with postoperative complications. Approximately three-fourths (76.0%) of the patients had hypertension preoperatively, and 5.9% of them developed at least one postoperative complication. Respiratory disorders were the most frequent postoperative complications. Multivariate analysis revealed emergency surgery, preoperative renal diseases, preoperative anemia, and nonextubation as risk factors for postoperative respiratory complications. Intraoperative estimated blood loss of ＞ 500 mL and intraoperative low blood pressure were identified as risk factors for postoperative neurological complications. Intraoperative hypothermia was found to be a risk factor for postoperative renal complications. Postoperative respiratory complications, postoperative neurological complications, and infection statistically significantly prolonged the length of hospital stay. The in-hospital mortality rate was 1.0%. Patients aged ≥ 80 years under certain conditions need more attention to prevent the development of different types of postoperative complications. Those who did develop postoperative respiratory complications, postoperative neurological complications, and infection might require prolonged hospitalization. Physicians must pay more attention preoperatively to the risk factors that increase postoperative complications.

Evaluation of the Nighttime Operation Impact on Liver Transplantation: A Meta-Analysis

Background: Liver transplant is frequently performed at night due to the unpredictability of organ procurement and reduction of Cold Ischemia Time (CIT). Previous study reported a doubled mortality Hazard Ratio (HR) of early death and increased postoperative complications in nighttime liver transplant. This study aims to evaluate the impact of nighttime operation on patients’ survival and postoperative complications by using meta-analysis. Methods: We performed a systematic review of the PubMed database and identified five eligible studies. Three time points (30 days, 90 days and 1 year) were explored in patients’ survival by using pooled HR. Four types of postoperative complications (vascular, biliary tract, wound and primary graft non-function) were investigated by using pooled Odds Ratio (OR). Publication bias was also performed. Results: Our study results were contradicting with the previous report and yielded no significant difference with a HR=0.98 (95% CI=0.89-1.06) on 30 days, HR=1.12 (95% CI=0.89-1.35) on 90 days and HR=1.07 (95% CI=0.95-1.18) on 1 year in nighttime procedure. Consistent with the result of patients’ survival, no significant result was found in postoperative complications evaluation as well. None of the four complications demonstrated significant result. And we failed to detect any significant publication bias. Conclusions: Based on current evidence, nighttime liver transplantations do not degrade patients’ survival or increase postoperative complications risk compared with daytime operations.

Abnormal Coagulation as a Risk Factor for Postoperative Complications After Primary and Revision Total Hip and Total Knee Arthroplasty

BackgroundPatients undergoing total joint arthroplasty (TJA) have an increased likelihood of having an abnormal coagulation profile compared with the general population. Coagulation abnormalities are often screened for before surgery and considered during perioperative planning. This study assesses a preoperative abnormal coagulation profile as a risk factor for postoperative complications after total hip arthroplasty (THA), revision THA (rTHA), total knee arthroplasty (TKA), and revision TKA (rTKA) and then examines specific coagulopathies to determine their influence on complication rates. MethodsPatients who underwent THA, rTHA, TKA, or rTKA from 2011 to 2017 were identified in the American College of Surgeons National Surgical Quality Improvement Program database and then assessed for preoperative abnormal coagulation profiles. Various postoperative complications were analyzed for each cohort, and two separate multivariate regression analyses were used to assess the relationship between abnormal coagulation and postoperative complications. Results403,566 THA, rTHA, TKA, or rTKA cases were identified, and 40,466 (10.0%) of patients were found to have an abnormal coagulation profile. Patients with preoperative coagulation abnormalities had higher likelihoods of postoperative complications after primary TJA than in revision TJA. An international normalized ratio>1.2 was associated with the most types of postoperative complications, followed by a bleeding disorder diagnosis. A partial thromboplastin time>35 seconds was associated with only one type of postoperative complication, while a platelet count <150,000 per μL was associated with postoperative complications only after TKA. ConclusionTJA in patients with abnormal coagulation profiles may result in adverse outcomes. These patients may benefit from preoperative intervention. Prophylactic care needs to be personalized to the specific coagulation abnormalities present.

Early post-operative complications in abdominal surgery at the university clinics of Lubumbashi: Frequency, diagnosis and prognosis

Introduction: Postoperative complications in abdominal surgery have a high incidence in developing countries’ hospitals, thus increasing the rate of their morbimortality. The aim of this work was to determine the frequency of early postoperative complications in abdominal surgery, their indications for operation, the types of postoperative complications, and their prognosis at University Clinics of Lubumbashi. Patients and Methods: This is a descriptive cross-sectional observational study with retrospective data collection from January 1, 2018 to December 31, 2019 including all patients operated on in the abdominal surgery department of the University Clinics of Lubumbashi and having presented complications within 30 postoperative days.Results: The frequency of early postoperative complicationsin abdominal surgery was 32.2%. The sex ratio M / F was 2.5 and the mean age was 31.5 ± 0.6. Emergency was the mode of admission in 80% of cases with a mean admission time of 17.2 ± 0.5. In this study, 71.42% of patients were classified ASA III. The mean time to surgical management was 36.5 ± 1.7 hours.Asthenia (62.9%) and abdominal pain (80%) were the most dominant functional signs. Suppuration of the wound (30.5%), abdominal distension (26.6%) and flow of stercoral fluid through the wall (23.8%) were the most dominant physical signs. The antibiogram on wound secretion (19%), imaging combining the chest x-ray (20%), the abdomen without preparation (27.6%) and the abdominal ultrasound (65.7%) are additional examinations which were more practiced. The post-operative complications were grade III in 95.24% of cases (n = 100) according to the Clavien-Dindo classification. The initial indications for surgery were more dominated by acute peritonitis (60%), followed by mechanical intestinal obstruction (16%). The duration of surgery was> 2 hours in 81% of cases and in 58.09% of cases the initial intervention was performed by a specialist. The mean time to resumption of oral feeding was 3.4 ± 0.6 days (Extreme: 12 hours and 192 hours). POC occurred within 5 days of surgery (59.04%).Surgical complications were more dominant (80%), made up of postoperative peritonitis (33.33%), digestive fistulas (19.5%), surgical site infection (16.7%), post-operative intestinal obstruction (13.1%) and evisceration in 6%% of cases. The majority of post-operative complications (52.4%) had undergone relaparotomy, and the outcome was good in 69.5% of cases (n = 73/105), with a mortality rate of 30.4% of cases (n = 32/105). The mean length of hospital stay was 27.4 ± 0.5 days.Conclusion: Postoperative complications are frequent at University Clinics of Lubumbashi and dominated by infection, postoperative peritonitis and digestive fistulas. The implementation of well-coded management algorithms could reduce this incidence.

O19 Adecuado manejo de la hiperglucemia en el postoperatorio inmediato se asocia con menos complicaciones en pacientes sometidos a cirugía de revascularización miocárdica

Introducción: la hiperglucemia en hospitalización (glucemia &gt;=140 mg/dl) es un evento frecuente en el peri-operatorio de cirugía cardiovascular (CCV), reportándose hasta en un 80% de pacientes con diabetes mellitus (DM), y en un 12 a 30% en pacientes sin DM previa (hiperglucemia de estrés, HGE), asociada a mayor tasa de mortalidad.Objetivos: describir la frecuencia de complicaciones postoperatorias (POP) y su asociación con el grado de control glucémico en pacientes adultos, mayores de 40 años, sometidos a cirugía de revascularización miocárdica (CRM), quienes siguieron un protocolo estandarizado para control de glucemia durante la internación.Materiales y métodos: estudio observacional de cohorte prospectiva. Se incluyeron 80 pacientes, de edad media 71,08±5,66 años, sometidos a CRM entre junio de 2019 y marzo de 2020. Se excluyeron los que presentaron cetoacidosis o síndrome hiperosmolar. La glucemia se controló por monitoreo capilar. Se clasificaron en DM conocida 42,5%, DM no conocida 7,5% e HGE 50%, considerándose a los dos primeros como DM. A su vez se dividieron, según el grado de control glucémico en las primeras 24 horas post operatorias, en: 1) óptimo: pacientes con glucemia promedio &lt;=180 mg/dl y sin hipoglucemia (glucemia &lt;=70 mg/dl); 2) no óptimo: pacientes con glucemia promedio &gt;180 mg/dl. Se evaluó severidad y tipo de complicaciones POP. Se construyó un modelo de regresión logística entre las variables edad, sexo, tipo de hiperglucemia, duración de la cirugía, control glucémico, puntuaciones en las escalas CardiacAnesthesiaRiskEvaluation Score (CARE), EuroSCOREII, comorbilidades de Charlson, y la presencia o ausencia de complicaciones POP; para formar parte del modelo multivariado, se consideraron variables con p&lt;0,05 como estadísticamente significativas. El estudio lo aprobó el Comité de Ética y Revisión institucional.

Anti-TNF and Postoperative Complications in Abdominal Crohn's Disease Surgery.

Biological therapy with anti-Tumour Necrosis Factor (TNF)-α agents revolutionised the treatment of inflammatory bowel disease over the last decades. However, there may be an increased risk of postoperative complications in Crohn's disease (CD) patients treated with anti-TNF-α agents prior to abdominal surgery. To evaluate the effects of preoperative anti-TNF-α therapy on the incidence of complications after surgery. A critical assessment of the results of clinical trial outcomes and meta-analyses on the available data was conducted. Based on the outcomes of previous reports including meta-analyses, preoperative use of anti- TNF-α agents modestly increased the risk of overall complications and particularly infectious complications after abdominal surgery for CD. Nevertheless, previous studies have several limitations. The majority of them were retrospective research with heterogeneous outcome measures and single centre trials with relatively small sample size. In retrospective studies, the standard protocol for assessing various types of postoperative complications was not used. The most serious limitation of the previous studies was that multiple confounding factors such as malnutrition, use of corticosteroids, and preoperative sepsis were not taken into consideration. Among patients treated with preoperative anti-TNF-α therapy, the risk of overall complications and infectious complications may slightly increase after abdominal surgery for CD. Nevertheless, the previous reports reviewed in this study suffered from limitations. To rigorously evaluate the risk of anti-TNF-α therapy prior to surgery, large prospective studies with standardised criteria for assessing surgical complications and with proper adjustment for confounding variables are warranted.

PECULIARITIES OF THE MORPHOLOGICAL STRUCTURE OF THE ORAL MUCOSA FLAPS DURING REST AND STRETCHING

In modern dental practice, there is a tendency towards correction of secondary adentia by using bone augmentation and dental implant placement. One of the main types of postoperative complications is the bone augmentation exposure and its infection as a result of ischemic processes in the mucous flap, which covers the augmentation, resulting from its overstretching. This study was aimed at improving the efficiency of flap operations and bone augmentation in patients with secondary adentia and reducing the risk of postoperative complications caused by ischemic changes in mucous flaps due to their overstretching, identifying features of the morphological structure of mucous flaps at rest and stretching. We conducted an investigation of mucosa flap microslides of 40 laboratory rabbits taken from the lower alveolar bone. The preparations were stained according to Van Gieson's technique with haematoxylin and eosin at low magnifications of the light microscope. The structural features of the mucous membrane of the upper and lower alveolar processes after stretching within 5% revealed minimal, slightly differed from the intact mucosa of the corresponding anatomical region. Thus, in the epithelium, the basal, intermediate, and superficial layers were located one above the other; their structural organization was mainly the same as in the intact animals. Our studies have shown that the morphological structure of the mucous membrane of the gums of laboratory rabbits is similar to the structure of human gums. The data obtained suggests that stretching of the gingival mucosa flaps when performing flap operations in the oral cavity within 5% of the initial length is morphologically substantiated and can cause no complications.

Vascular reconstruction and outcomes of 220 adult-to-adult right lobe living donor liver transplantations

Rationale: Adult-to-adult right lobe living donor liver transplantation is a viable alternative to whole liver transplantation from a deceased donor. The key aspect of the surgical procedure is the restoration of adequate graft blood flow and maintenance of sufficient volume of well vascularized parenchyma in the donor. Specific features of vascular anatomy in the donor and the recipient can be eventual cause for significant technical difficulties during transplantation. They can also increase the risk of complications and deteriorate graft functioning.Aim: To identify the incidence of various types of afferent and efferent vascularization of right lobe of the liver, potential techniques of vascular reconstructive procedures, rates and types of postoperative complications, as well as immediate surgical results.Materials and methods: We retrospectively analyzed the data on 220 right lobe liver transplantations adult patients, consecutively performed from 2010 to 2017 in one center. Specific characteristics of liver vascularization in donors and recipients were determined by pre-operative computed tomography and intra-operatively. The information on the types of vascular reconstruction, complications and results of surgical procedures was obtained from patients' medical files.Results: The following variants of blood supply to the right liver lobe were seen most frequently: portal vein trifurcation 22%, shortened trunk of the right portal vein branch 13%, supplementary v. hepatica from SgVIII with a diameter of &gt; 5 mm 22%, supplementary lower right v. hepatica 17%, isolated venous outflow from all right lobe segments 2%, two arteries 2%. In addition, 17% of the recipients had portal vein thrombosis and 1% portal vein fibrosis. During the follow-up all donors remained alive. The rate of surgical complications was 12.5%, among them bile pocket or biloma 8.5%, intra-abdominal bleeding 2.5%, wound complications 1.5%. The rate of early post-operative complications in the recipients was 31.5%, with 4.5% of them being vascular and 15.5% biliary. The 6-months and 4-years survival of the recipients (Kaplan-Meier) was 98% and 95%, respectively.Conclusion: Immediate and longterm survival of the recipients of living donor right lobe live grafts, as well as absence of fatalities among their donors, confirm high effectiveness and expedience of this type of intervention. The observed anatomic variety of blood supply to the right liver lobe stipulates stringent requirements to the quality of preoperative diagnostics, deliberate donor selection, thorough planning of the procedure and high qualification of the surgical team. A relatively high rate of postoperative complications warrants the necessity of an intensive diagnostic monitoring in the early post-operative period and active strategies of their correction.

Does Intermittent Pringle Maneuver Increase Postoperative Complications After Hepatectomy for Hepatocellular Carcinoma? A Randomized Controlled Trial.

In a previous study, we have shown that intermittent Pringle maneuver (IPM) might increase postoperative complications after hepatectomy for various indications. Complications which thought to be related to IPM were ascites, pleural effusion, wound infection and intra-abdominal collection. The aim of this study was to test the hypothesis that applying IPM during hepatectomy for hepatocellular carcinoma (HCC) could increase postoperative complications. Between January 2013 and October 2016, eligible patients who received elective open hepatectomy for HCC were randomized to have IPM or no Pringle maneuver (NPM). Occurrence of various types of postoperative complications was specifically looked for. A routine postoperative day 5 abdominal ultrasound examination and chest X-ray were done to detect and grade any radiological ascites, pleural effusion and intra-abdominal collection. Fifty IPM and 50 NPM patients with histological proven HCC were recruited for final analysis. Demographics and operative parameters were comparable between the two groups. The postoperative complication rates were similar (IPM 36.0 vs. NPM 28.0%, P = 0.391). However, in the IPM group, more patients developed radiological posthepatectomy ascites (42.0 vs. 22.0%, P = 0.032) and pleural effusion (66.0 vs. 38.0%, P = 0.005). In patients with histologically proven cirrhosis, there were 28 IPM and 25 NPM patients. Again, there was no difference in postoperative complication rate but more radiological posthepatectomy ascites and pleural effusion in the IPM group. This trial was not able to detect a difference in postoperative complications whether IPM was applied or not, but use of IPM was associated with more subclinical ascites and pleural effusion. (ClinicalTrials.gov NCT01759901). ClinicalTrials.gov NCT01759901.

Colon and rectal surgery for inflammatory bowel disease patients on vedolizumab: Preliminary surgical outcomes

Background and Objectives: Vedolizumab is an antagonist of leukocyte trafficking that targets gut α4β7 integrins and is efficacious in inflammatory bowel disease (IBD). Studies investigating postoperative complications in patients on this medication have not been performed. The objective of this study is to identify rates and types of postoperative complications experienced in patients with IBD who have undergone surgery following treatment with vedolizumab. Patients and Methods: This was a retrospective review of the electronic medical record of patients with IBD who underwent perianal or abdominal surgery, June 2014–March 2016, at the University of California San Diego Medical Center. Main outcome measures were rates and types of postoperative complications. Results: Patients were divided into three treatment groups: vedolizumab, other biologics, and no biologics. Twenty-nine patients on vedolizumab underwent forty operations that fit study criteria. Fifteen of 26 abdominal operations experienced a postoperative complication, for a complication rate of 57.7%. The most common complication was infectious (34.6%). Anastomotic leak rate was 16.7% and mortality rate was 7.7%. Complication rates in patients on vedolizumab were higher than rates in other patients with IBD. One of 14 perianal operations experienced an infectious complication (7%). Readmission rate in abdominal patients on vedolizumab was higher than the other categories (31% vs. 7% and 10%, P = 0.01). Conclusions: We observed high rates of postoperative complications in patients on vedolizumab who underwent abdominal surgery. Rates were higher than published outcomes as well as outcomes for other IBD patients at our institution. Studies including larger numbers of patients must be performed to further investigate this issue.

Complications and Risk after Mandibular Reconstruction with Fibular Free Flaps in Patients with Oral Squamous Cell Carcinoma: A Retrospective Cohort Study.

Background We retrospectively analyzed the incidence and types of postoperative complications after mandibular continuity reconstructions with fibular free flaps (FFF) in patients with oral squamous cell carcinoma (OSCC) and identified potential risk factors for postoperative complications. Methods Data were retrieved from the medical records in the Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands from April 1995 to September 2013, and were statistically analyzed. Results In this study, 85 patients were included in whom 86 FFFs were used for mandibular reconstruction. Thirty-seven patients (43%) developed ≥ 1 surgical complication and 9 patients (10.5%) developed ≥ 1 systemic complication. Three patients (3.5%) developed total flap failure and six patients (7.0%) developed partial flap failure. Surgical complications were correlated with tobacco use, partial glossectomy, type of mandibular defect, and anatomic staging. Systemic complications were associated with age > 60 years and Charlson comorbidity index > 2. Hospitalization > 30 days was associated with type of mandibular defect. Conclusions The use of the FFF for reconstructing mandibular continuity defects in OSCC patients may be associated with postoperative complications. Patients with coexisting medical conditions and anterior mandibular defects have an increased risk for developing complications. Patients who undergo segmental mandibular resection including a partial glossectomy could have a reduced risk for complications.

Postoperative Complications in Elderly Patients Undergoing Head and Neck Surgery: Opportunities for Quality Improvement.

To assess the frequency and nature of postoperative complications that occur in elderly patients, as compared with younger patients, following head and neck surgery. Cohort study of national database. American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013. We identified 29,891 patients who had head and neck surgery during the study period and classified them as having upper aerodigestive tract surgery (n = 8383) or endocrine/salivary gland (n = 21,508) surgery. We analyzed patients stratified by age categories: young (<65 years), intermediate age (65-75 years), and elderly (≥75 years). Risk-adjusted 30-day morbidity and mortality outcomes were compared across age categories with multivariable logistic regression models to adjust for patient characteristics, comorbidities, and surgical procedure. Elderly patients had increased odds for morbidity (adjusted odds ratio [OR] = 1.47, 95% CI: 1.22-1.78; OR = 1.89, 95% CI: 1.46-2.44) for upper aerodigestive tract and endocrine/salivary gland groups, respectively, versus young patients and for mortality (OR = 2.52, 95% CI: 1.26-5.06; OR = 3.73, 95% CI: 1.32-10.52). Elderly patients were more likely to develop pulmonary, urologic, and blood clotting-related complications. Elderly patients undergoing endocrine/salivary gland surgery were significantly more likely to have cardiac complications; however, this was not the case for aerodigestive tract operations. Head and neck surgery in the elderly carries an increased risk of certain types of postoperative complications as compared with younger patients treated similarly. Quality improvement efforts should focus on minimizing the risk of cardiac, pulmonary, and urologic complications in elderly patients.