Patient- and procedure-specific risk factors for postoperative complications in peripheral vascular surgery.

BACKGROUND: Interest in measuring the quality of surgical care has grown over the past decades. As complications after vascular surgery may be used as a quality indicator of care, analysis of these adverse events remains essential. OBJECTIVE: The goal of this study was to identify patient and procedure specific risk factors of postoperative complications following infrainguinal vascular surgery and to describe the incidence, cause and consequence of all complications in this group. PATIENTS AND METHODS: This study included all 296 patients undergoing infrainguinal arterial bypass surgery at our institution over a 5-year period. All complications occurring during these patients' admission were registered in a prospective standardised complication registration and analysed. RESULTS: Seventy-three of 296 (25%) procedures in 247 patients were followed by 129 complications. The mean patient age was 70 years. Factors associated with a significantly higher complication risk were diabetes, critical ischaemia with rest pain or gangrene, a cardiac medical history, acute surgery and a former cerebrovascular accident (CVA). Independent risk factors in multivariate analysis were a former CVA and acute surgery. Postoperative haemorrhage (n = 19), early occlusion of the graft (n = 15) and surgical site infection (n = 10) were the most frequently registered surgery-related complications. The most common consequence of a complication was blood transfusion or treatment with additional medication (33%). In 16% of all complications, a reoperation was necessary. Twelve patients died during admission (mortality 5%). CONCLUSION: A former CVA and acute surgery were independent risk factors of postoperative complications. Identifying the cause and consequence of each complication is essential in a complication registration. When using complications as an indicator of quality of care in this population, an adjustment should be made for patient comorbidity and surgical indication.

Adenocarcinoma Arising within a Colonic Diverticulum in a Patient with Recurrent Diverticulitis.

In 2006, while admitted in our hospital for surgical treatment of recurrent diverticulitis, a 54-year-old man was found to have an adenocarcinoma arising within a colonic diverticulum. Computed tomography, during this episode of diverticulitis, showed a thickened wall of the sigmoid and inflammatory induration of the pericolonic fat. Colonoscopy could be performed up to no more then 25 cm from the anus due to mucosal edema. A sigmoid resection was performed. Histopathological examination of the resected specimen showed an inflamed diverticulum with a submucosal adenocarcinoma of the intestinal type within its wall. The surrounding flat colonic mucosa was not involved by the cancerous process. Due to lymph node involvement the patient received adjuvant chemotherapy and remained disease free during follow up.

Leptomeningeal disease in chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the western hemisphere, with an annual incidence of 3:100000. Commonly patients are asymptomatic but not rarely disease progression occurs in the setting of lymphadenopathy and extensive leukemic burden. Leptomeningeal involvement in patients with CLL is infrequent, with presenting symptoms of headache (23%), acute or chronic changes in mental status (28%), cranial nerve abnormalities (54%) including optic neuropathy (28%), weakness of lower extremities (23%) and cerebellar signs (18%). In this report, we discuss a CLL patient with leptomeningeal involvement, who presented with neurological symptoms as the first clinical sign, and a diagnosis of leptomeningeal was made based on CSF cytology and flow cytometry. Treatment consisted of radiation therapy and intrathecal chemotherapy with arabinoside-cytosine and systemic chemotherapy. On the basis of this patient-report together with 37 other previously reported cases, the clinical characteristics together with treatment options and outcome of leptomeningeal involvement in CLL are reviewed. Our case together with data from the literature indicate that a timely diagnosis and intensive treatment of leptomeningeal disease of CLL may lead to longstanding and complete resolution of neurological symptoms.