Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.938
Filtrar
1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 51-55, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958931

RESUMO

Objective: To investigate the Clavien-Dindo (CD) classification of complications after complete mesocolic excision (CME) in laparoscopic radical resection of right-sided hemicolon cancer and its influencing factors. Methods: A retrospective case-control study was performed. Inclusion criteria: (1) the adenocarcinoma located at colon from cecum to hepatic flexure; (2) laparoscopic right hemicolectomy with CME was completed. Exclusion criteria: (1) patients had severe organ dysfunction before operation; (2) tumor invaded adjacent organs or developed distant organ metastasis; (3) emergency surgery; (4) failure of laparoscopic surgery, and conversion to laparotomy; (5) without complete clinical data. Finally, clinical data of 141 patients in our hospital form March 2015 to February 2019 were retrospectively analyzed. CD grading standard was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyse were used to analyze the factors that might affect the complications. Survival analysis was conducted by grouping the indicators with statistically significant difference in multivariate analysis. Kaplan-Meier method was used to draw the survival curve and log-rank test was used to analyze the difference. Results: Of the 141 patients, 89 were male and 52 were female with mean age of (61.8±11.0) years. All the operations completed successfully. A total of 37 postoperative complications were developed in 26 (18.4%) patients had postoperative 37 cases of complications, mainly including 7 delayed incision healing, 6 diarrhea, and 5 respiratory dysfunction. According to CD classification standard, grade I, II, and IV a complication rates were 40.5% (15/37), 56.8% (21/37), and 2.7% (1/37) respectively. Univariate analysis showed that age ≥ 65 years (χ(2)=4.338, P=0.037), BMI ≥ 28 kg/m(2) (χ(2)=5.971, P=0.015), and preoperative hemoglobin < 100 g/L (χ(2)=3.985, P=0.046) were risk factors of postoperative complications. Multivariate analysis testified that age ≥ 65 years (OR=7.991, 95%CI: 2.203 to 28.983, P=0.002) and body mass index (BMI) ≥ 28 kg/m(2) (OR=4.231, 95%CI: 1.034 to 17.322, P=0.045) were independent risk factors for complications after laparoscopic CME surgery for right-sided hemicolon cancer. All the patients were followed up for median time of 24 (1-48) months. The log-rank test showed that there were no significant differences in the cumulative survival rate between patients of age < 65 years and age ≥ 65 years (χ(2)=0.986, P=0.321), and between those with BMI < 28 kg/m(2) and BMI ≥ 28 kg/m(2) (χ(2)=0.370, P=0.543). Conclusions: The main complications after CME in laparoscopic radical resection of right hemicolon cancer are CD grade I and II. Elderly and obesity are independent risk factor for postoperative complications. Before the operation, reasonable preventive measures should be taken for the elderly and the obese in order to reduce postoperative complications.


Assuntos
Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Mesocolo/cirurgia , Fatores Etários , Idoso , Colectomia/métodos , Neoplasias do Colo/complicações , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Resultado do Tratamento
2.
Pan Afr Med J ; 33: 254, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692805

RESUMO

Introduction: Postoperative complications are common; some are transient, others may be serious, but they are all important to patients. One of the most important gaps in surgical research is the lack of consensus over the preferred result, the type of measurement or of evaluation. Methods: We conducted a retrospective study of postoperative complications at the Surgery Department of the National Hospital Center of Nouakchott. Eight hundred thirty-four patients underwent surgery over a seven-month period (1 January 2017-31 July 2017). The demographic and clinical parameters were studied and analyzed statistically using SPSS software 20. Results: The study involved 834 patients, of whom 426 (51.1%) were men. The average age of patients was 34.81 years (1-90 years). Four hundred thirty-two (51.2%) patients underwent emergency surgery. The sex ratio (M/F) was 1.04. Arab-Berbers race accounted for 77.8%. Appendicular disease accounted for 41.12%, hepatobiliary disease accounted for 17.76%, and abdominal wall disease accounted for 16.1%). Thyroid disease accounted for 5.6%. One hundred eighty-three (21.94%) patients developed postoperative complications, including 4 (2.1%) deaths. Clavien-Dindo grade II was the most represented with 82.5% of complications and accounted for 17.91% of all operated patients. Surgical site infection accounted for 62.8% of all complications. Conclusion: This study shows that the Clavien-Dindo classification can be applied to patients who have undergone elective surgery and emergency surgery. We think that the lack of follow-up and the lack of means to fight the infection and the non-rigorous respect of asepsis and antisepsis procedures would play an important role.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Adulto Jovem
3.
Medicine (Baltimore) ; 98(45): e17915, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702671

RESUMO

Trans-catheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement (SAVR) in high and intermediate risk patients with aortic stenosis. TAVR programs are spreading from large referral centers and being established in community based institutions. The purpose of this study was to compare the outcomes of TAVR to those of SAVR in a community hospital.A historical cohort study of patients with aortic stenosis and pre-post procedure echocardiography data who underwent SAVR or TAVR in Cape Cod Hospital between January 2014 and December 2016. Patient characteristics and procedure outcomes were compared between the two procedures.The study included 230 patients, of them 111 underwent SAVR and 119 underwent TAVR. None of the patients died during the 30 days after the procedure. TAVR patients had higher rates of postoperative mild+ aortic regurgitation (AR) (29.4% vs 12.6%, P = .002), postoperative atrial ventricular blocks (11.8% vs 0.9%, P = .001), and more often need an implantation of pacemaker (16.8% vs 0.9%, P < .001). Postoperative mean gradient of SAVR patients was higher (median 14 vs 11 mm Hg, P = .001) and atrial fibrillation postoperatively was more frequent (18.9% vs 2.5%, P < .001). Length of stay after procedure was shorter in TAVR patients (median 2 vs 4 days, P < .001).After controlling for confounders, the use of TAVR was associated with an increased risk for postoperative pacemaker implantation (OR = 16.3, 95%CI 1.91-138.7, P = .011), lower mean gradient (-4.327, 95%CI -7.68 to -0.98, P = .011), and lower risk for atrial fibrillation (OR = 0.11, 95%CI 0.03-0.38, P = .001), but not with postoperative AR (OR = 0.84, 95%CI 0.22-3.13, P = .789).In conclusion, short-term mortality was not reported in SAVR or TAVR patients. However, TAVR was associated with an increased risk for postoperative pacemaker implantation but with a lower risk for atrial fibrillation. Aortic valves implanted through a trans-catheter approach are also associated with a better hemodynamic performance.


Assuntos
Estenose da Valva Aórtica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Ecocardiografia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/classificação , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
4.
Am Surg ; 85(10): 1150-1154, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657313

RESUMO

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/lesões , California , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Hospitais Comunitários , Humanos , Jejunostomia/métodos , Jejunostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Stents/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento , Ferimentos e Lesões/classificação , Adulto Jovem
5.
Zhonghua Wai Ke Za Zhi ; 57(10): 31-37, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510730

RESUMO

Objective: To examine the association of hyperglycemia and postoperative complications in non-diabetic patients underwent pancreaticoduodenectomy(PD). Methods: The clinical data of 209 non-diabetic patients who underwent PD from January 2012 to June 2018 at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University and met the inclusion criteria were retrospectively analyzed. According to the diagnostic criteria of postoperative hyperglycemia, the patients were divided into postoperative hyperglycemia group (167 cases, 79.9%) and control group(42 cases, 20.1%). The propensity score matching(PSM) method was used to eliminate the difference between groups(caliper value=0.02; 38 cases in control group including 30 males and 8 females with age of 59.0 years;38 cases in postoperative hyperglycemia group including 32 males and 6 females with age of 61.0 years;37 cases of pancreatic head carcinoma,30 cases of periampullary carcinoma and 9 cases of benign diseases). A comparative analysis was applied for preoperative data, surgical related indicators and postoperative complication rates.The receiver operating characteristic(ROC) curve was used to calculate the area under the curve(AUC) of blood glucose values on postoperative day 1,3 and 5(POD1, POD3, POD5), to determine the high-risk blood glucose cutoff value of complications and to evaluate its sensitivity and specificity for the prediction of postoperative complications. Results: Univariate analysis showed that the differences in gender, body mass index, preoperative blood glucose, and serum urea nitrogen levels were statistically significant before PSM.There was no significant difference in the preoperative data between the two groups after PSM. Compared with the control group, the incidence of postoperative pancreatic fistula (31.6% vs. 5.3%), abdominal infection(29.0% vs. 7.9%) and Clavien-Dindo Ⅲ-Ⅴ complications(31.6% vs.7.9%) were statistically different(χ(2)=7.092,P=0.008; χ(2)=4.290,P=0.038; χ(2)=5.316,P=0.021), respectively. According to the AUC on POD3,the blood glucose value ≥8.860 mmol/L was an independent risk factor for pancreatic fistula with sensitivity of 58.3% and specificity of 76.9%,the blood glucose value ≥9.130 mmol/L was an independent risk factor for abdominal infection with sensitivity of 54.5% and specificity of 81.5% and the blood glucose value ≥7.685 mmol/L was independent risk factor of Clavien-Dindo Ⅲ-Ⅴ complications with sensitivity of 75.0% and specificity of 57.7%. Conclusions: Postoperative hyperglycemia in non-diabetic patients is associated with postoperative pancreatic fistula, abdominal infection, and Clavien-Dindo Ⅲ-Ⅴ complications.According to the early postoperative blood glucose value,the occurrence of postoperative pancreatic fistula, abdominal infection and Clavien-Dindo Ⅲ- Ⅴ complications can be effectively predicted.


Assuntos
Hiperglicemia/complicações , Pancreaticoduodenectomia/efeitos adversos , Feminino , Humanos , Hiperglicemia/sangue , Infecções Intra-Abdominais/etiologia , Masculino , Pessoa de Meia-Idade , Pancreatopatias/cirurgia , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/classificação , Valor Preditivo dos Testes , Estudos Retrospectivos
6.
Transplant Proc ; 51(8): 2587-2592, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31474452

RESUMO

BACKGROUND: Slow graft function (SGF) is considered to be an intermediate state between immediate graft function (IGF) and delayed graft function (DGF). However, the criteria of SGF is still arbitrary, and the clinical outcomes of SGF are not fully understood. METHODS: A total of 212 deceased donor kidney transplantation recipients were enrolled. Three schemas were adopted, which classified SGF according to the serum creatinine (Cr) level by a given postoperative day (POD). SGF was defined as Cr ≥ 3.0 mg/dL on POD5, Cr ≥ 2.5 mg/dL on POD7, and Cr ≥ 1.5 mg/dL on POD14 without dialysis in schema I, II, and III, respectively. Estimated glomerular filtration rate (eGFR) after transplantation, acute rejection, and graft survival were compared in each schema. Decreased renal function, defined as eGFR less than 30.0 mL/min/1.73m2, was also compared. RESULTS: In schema I and III, SGF had significantly lower eGFR at 3 months after transplantation compared with IGF (P < .017), and only schema III maintained the difference until 36 months after transplantation. The incidence of decreased renal function showed significant difference among groups in schema I and III (P < .05). Graft survival did not show significant difference among groups in all schemas. However, SGF and DGF groups showed a higher probability of decreased renal function than the IGF group (P < .017) in schema I and III. CONCLUSIONS: In deceased donor kidney transplantation, certain definitions of SGF identified significantly worse clinical outcomes compared with IGF, suggesting similar impact with DGF. It is necessary to reach a consensus on a clearer definition of SGF with further studies.


Assuntos
Transplante de Rim/efeitos adversos , Rim/fisiopatologia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/etiologia , Adulto , Função Retardada do Enxerto/etiologia , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
7.
Pediatr Surg Int ; 35(11): 1239-1243, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31414172

RESUMO

PURPOSE: Hirschsprung's disease (HSCR) is a developmental defect of the enteric nervous system. Transanal endorectal pullthrough (TERPT) is one of the surgical procedures for HSCR. Clavien-Dindo is an objective classification system, used worldwide, to describe postoperative complications. The aim of this study was to use Clavien-Dindo grading for short-term complication after TERPT. METHODS: This was a cohort study including all 69 individuals, with biopsy-verified HSCR, managed with TERPT at our institution between 2006 and 2018. Data on the surgical procedure, as well as short-term complications, were retrieved from the medical records. The main outcome was postoperative complications graded according to Clavien-Dindo. RESULTS: Fifteen (22%) of the 69 patients (51 males) had a short-term postoperative complication graded according to Clavien-Dindo. The complications were Grade I in ten patients, Grade II in four patients, and Grade IIIb in one patient. Individuals with a Clavien-Dindo complication had a significantly longer post-operative hospital stay [median 6 days (4-30) compared to 4 days (1-22), p = 0.035]. CONCLUSIONS: It is important to describe postoperative complications in a structured way to make it possible to compare studies. Post-operative complications, according to Clavien-Dindo, occurred in 22% of the patients after TERPT.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doença de Hirschsprung/cirurgia , Complicações Pós-Operatórias/classificação , Adolescente , Canal Anal/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Reto/cirurgia
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 736-741, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422611

RESUMO

Objective: To identify the risk factors of perioperative complications after radical gastrectomy for gastric cancer. Methods: A retrospective case-control study was performed. Case inclusion criteria: (1) patients undergoing radical gastrectomy (D2); (2) primary gastric cancer without distant organ metastasis confirmed by postoperative pathology; (3) no neoadjuvant chemotherapy before surgery. Patients with peritoneal tumor dissemination found during operation, undergoing palliative operation due to distant metastasis, and undergoing combined organ resection and those without complete clinicopathological data were excluded. According to the above criteria, 426 patients with gastric cancer at our department from January 2015 to June 2017 were included in this study. Of 426 patients, 285 were male and 141 were female with a mean age of (55.4±9.7) years. According to the "Japan Clinical Cancer Research Group (JCOG) classification criteria for postoperative complications of gastric cancer", patients with grade II and higher complications were classified as complication group, and patients with no complication or grade I complication were classified as non-complication group. Baseline data were compared between two groups. Associations of perioperative complication with gender, age, body mass index, preoperative routine laboratory test, American Society of Anesthesiologists (ASA) classification, activities of daily living (ADL) assessment, past medical history as well as preoperative conditions (hypertension and/or diabetes), surgical resection procedure, incision type, operation time, intraoperative blood loss/body mass ratio were examined. Univariate analysis was performed using χ(2) test and the Wilcoxon rank sum test to screen the statistically significant variables associated with perioperative complications. The significant variables were included in multivariate logistic regression analysis to identify risk factors of perioperative complication. Results: Grade II or higher complications after surgery were developed in 97 patients (22.8%), which included anastomotic leakage in 18 cases (4.2%), postoperative bleeding in 9 cases (2.1%), abdominal abscess in 5 cases (1.2%), intestinal obstruction in 5 cases (1.2%), pancreatic leakage in 1 case (0.2%), and other adverse events in 59 cases (13.8%). Univariate analysis suggested that the gender, age, ADL, incision type, intraoperative blood loss/body mass ratio, and operation time were associated with perioperative complication (all P<0.05). Multivariate analysis revealed that elder age (OR=1.033, 95% CI:1.013-1.053, P=0.013), incision type of laparotomy (OR=2.091, 95% CI:1.247-3.508, P=0.004), longer operation time (OR=1.004, 95% CI:1.001-1.007, P=0.001) and higher ratio of intraoperative blood loss/body mass (OR=1.100, 95% CI: 1.039-1.163, P=0.031) were risk factors for postoperative complications. Conclusion: Attention should be paid to those cases with elder age, laparotomy incision, longer operation time and higher ratio of intraoperative blood loss/body mass, and perioperative management after gastrectomy should be improved.


Assuntos
Gastrectomia/efeitos adversos , Neoplasias Gástricas/cirurgia , Idoso , Análise Fatorial , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
9.
J Pediatr Orthop ; 39(8): 406-410, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393299

RESUMO

BACKGROUND: Congenital scoliosis (CS) is associated with more rigid, complex deformities relative to adolescent idiopathic scoliosis (AIS) which theoretically increases surgical complications. Despite extensive literature studying AIS patients, few studies have been performed on CS patients. The purpose of this study was to evaluate complications associated with spinal fusions for CS and AIS. METHODS: A retrospective review of the Kid's Inpatient Database (KID) years 2000 to 2009 was performed. Inclusion: patients under 20 years with ICD-9 diagnosis codes for idiopathic scoliosis (IS-without concomitant congenital anomalies) and CS, undergoing spinal fusion from the KID years 2000 to 2009. Two analyses were performed according to age below 10 years and 10 years and above. Univariate analysis described differences in demographics, comorbidities, intraoperative complications, and clinical values between groups. Binary logistic regression controlling for age, sex, race, and invasiveness predicted complications risk in CS (odds ratios; 95% confidence interval). RESULTS: In total, 25,131 patients included (IS, n=22443; CS, n=2688). For patients under age 10, CS patients underwent 1 level shorter fusions (P<0.001), had fewer comorbidities (P<0.001), and sustained similar complication incidence. In the 10 and over age analysis, CS patients similarly had shorter fusions, but greater comorbidities, and significantly more complications (odds ratio, 1.6; confidence interval, 1.4-1.8). CONCLUSIONS: CS patients have higher in-hospital complication rates. With more comorbidities, these patients have increased risk of sustaining procedure-related complications such as shock, infection, and Adult Respiratory Distress Syndrome. These data help to counsel patients and their families before spinal fusion. LEVEL OF EVIDENCE: Level III-retrospective review of a prospectively collected database.


Assuntos
Complicações Pós-Operatórias , Escoliose , Fusão Vertebral , Adolescente , Criança , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Escoliose/congênito , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
Medicine (Baltimore) ; 98(27): e16054, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277099

RESUMO

The aim of the study was to determine the financial burden of complications and examine the cost differentials between complicated and uncomplicated hospital stays, including the differences in cost due to extent of resection and operative technique.Liver resection carries a high financial cost. Despite improvements in perioperative care, postoperative morbidity remains high. The contribution of postoperative complications to the cost of liver resection is poorly quantified, and there is little data to help guide cost containment strategies.Complications for 317 consecutive adult patients undergoing liver resection were recorded using the Clavien-Dindo classification. Patients were stratified based on the grade of their worst complication to assess the contribution of morbidity to resource use of specific cost centers. Costs were calculated using an activity-based costing methodology.Complications dramatically increased median hospital cost ($22,954 vs $15,593, P < .001). Major resection cost over $10,000 more than minor resection and carried greater morbidity (82% vs 59%, P < .001). Similarly, open resection cost more than laparoscopic resection ($21,548 vs $15,235, P < .001) and carried higher rates of complications (72% vs 41.5%, P < .001). Hospital cost increased with increasing incidence and severity of complications. Complications increased costs across all cost centers. Minor complications (Clavien-Dindo Grade I and II) were shown to significantly increase costs compared with uncomplicated patients.Liver resection continues to carry a high incidence of complications, and these result in a substantial financial burden. Hospital cost and length of stay increase with greater severity and number of complications. Our findings provide an in-depth analysis by stratifying total costs by cost centers, therefore guiding future economic studies and strategies aimed at cost containment for liver resection.


Assuntos
Hepatectomia/economia , Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/economia , Complicações Pós-Operatórias/economia , Análise Custo-Benefício , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Período Pós-Operatório , Estudos Retrospectivos , Estatísticas não Paramétricas
11.
J Plast Surg Hand Surg ; 53(6): 321-327, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31187676

RESUMO

Comparing complication rates between centres is difficult due to the lack of unanimous criteria regarding what adverse events should be defined as complications and how these events should be compiled. This study analysed all adverse events in a cohort of craniofacial (CF) operations over a 10-year period and applied three different scales (Clavien-Dindo, Leeds and Oxford) for systematic comparison. A total of 1023 consecutive CF procedures in 641 patients was identified. The Clavien-Dindo scale captured 74 complications in 74 procedures (7.2%), whereas the Leeds and Oxford scales captured 163 complications in 134 procedures (13.1%) and 85 complications in 83 procedures (8.1%), respectively. The Clavien-Dindo scale appeared less suitable for CF surgery, because it is predominantly adapted to severe complications and also regards blood transfusion as a complication. The Leeds scale provided a detailed picture of all complications, as well as minor events, whereas the Oxford scale captured all major complications well but applied less accurate definitions for the minor events. Our findings contribute to the benchmarking of complications between CF centres and suggest that both the Leeds and the Oxford scale appear relevant, depending on the emphasis required for major and minor complications and inter-centre audits, respectively.


Assuntos
Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Procedimentos Cirúrgicos Bucais/efeitos adversos , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Complicações Pós-Operatórias/classificação , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos de Coortes , Humanos
12.
Expert Rev Med Devices ; 16(7): 569-580, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31177862

RESUMO

INTRODUCTION: Stress urinary incontinence and pelvic organ prolapse are major quality of life conditions affecting millions of individuals. Transvaginal mesh materials have been proposed to supplant native tissue repairs. However, these materials have opened a new field, meshology, devoted to the management of mesh complications. AREAS COVERED: This review highlights some of the recent developments in this subspecialty which often requires a multidisciplinary approach. With better imaging, the preoperative assessment of mesh complications has been enhanced. Specialized centers with high volumes are best suited to handle these challenging patients who fear the many risks of mesh removal and the uncertainties of their clinical status after the removal procedure(s). However, despite a better classification system recommended by specialized societies, the multidimensional outcome of these repair procedures will require the adoption of outcome tools which can cover several domains such as urinary incontinence, pelvic pain, dyspareunia, bladder infections, to name a few. EXPERT OPINION: The surgical approach to mesh removal is also evolving with some experts recommending complete removal while others prefer more selective excision. Finally, the long-term outcome of these mesh removal procedures is not yet fully known.


Assuntos
Pesquisa Biomédica , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas/efeitos adversos , Vagina/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Slings Suburetrais , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(25): e16185, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232977

RESUMO

BACKGROUND: Most of the previous studies combined all types of intramedullary ependymomas without providing accurate pathological subtypes. In addition, it was very difficult to evaluate the factors associated with postoperative outcomes of patients with different pathological subtypes of intramedullary Grade II ependymomas by traditional meta-analysis. This study evaluated the factors related with postoperative outcomes of patients with intramedullary Grade II ependymomas. METHODS: Individual patient data analysis was performed using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The search included articles published up to April 2018 with no lower date limit on the search results. The topics were intramedullary Grade II ependymomas. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier survival analysis (log-rank test). The level of significance was set at P < .05. RESULTS: A total of 21 studies with 70 patients were included in this article. PFS of patients who underwent total resection was much longer than the PFS of those who received subtotal resection (P < .001). Patients who received adjuvant therapy (P = .005) or radiotherapy and chemotherapy (P < .001) seemed to have shorter PFS than others; PFS of patients who had cerebrospinal fluid disease dissemination (P = .022) or scoliosis (P = .001) were significantly shorter than others. OS of cellular ependymoma patients was less than giant cell ependymoma patients (P < .001). CONCLUSIONS: PFS of patients who received total resection was much longer than those who received subtotal resection. Patients treated with adjuvant therapy or radiotherapy and chemotherapy appeared to have shorter PFS than others; PFS of patients with cerebrospinal fluid disease dissemination or scoliosis were significantly shorter than others. Cellular ependymomas would have better OS than giant cell ependymoma. However, giant cell ependymoma patients might have the worst OS.


Assuntos
Ependimoma/cirurgia , Complicações Pós-Operatórias/classificação , Resultado do Tratamento , Adulto , Ependimoma/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Neoplasias da Medula Espinal/cirurgia , Análise de Sobrevida
14.
N Z Med J ; 132(1497): 32-36, 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31220063

RESUMO

AIM: New Zealand has a high incidence of colorectal cancer. Most patients are treated with resectional surgery. There is a significant rate of complication associated with treatment. Costs of surgical treatment and effect of complications have not been previously investigated in New Zealand. The aim of this study was to define treatment costs of complications in patients undergoing resectional surgery for colorectal cancer. METHODS: Adult patients who underwent a resectional operation for colorectal adenocarcinoma at Northland DHB between January 2011 and December 2016 were identified. Actual costs and diagnoses-related group (DRG) costs were obtained. Demographic data and information on outcomes were identified using the hospital's results reporting system CONCERTO. RESULTS: Three hundred and ninety patients were included. One hundred and seven patients suffered a complication. Median cost per patient was $17,090. In those with complications, median cost was $28,485 compared to $14,697 in those without. Cost of complications increased as complication grade increased. Additional cost in patients with complications was on average $20,683 per patient, equating to a total of $2.2 million in this cohort. CONCLUSION: This study has defined the costs associated with colorectal cancer resection. Complications following colorectal surgery add significant costs. Significant investment in initiatives to reduce complications is justified.


Assuntos
Neoplasias Colorretais/economia , Neoplasias Colorretais/cirurgia , Complicações Pós-Operatórias/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
15.
Clin Interv Aging ; 14: 681-688, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31043774

RESUMO

Objective: The population of Japan is aging rapidly, and, since the aging of patients who undergo total knee arthroplasty (TKA) is also expected, it is necessary to determine the efficacy and safety of TKA among old adult patients. Methods: This study retrospectively analyzed the cases of patients who underwent a primary TKA for osteoarthritis at Bange Kosei General Hospital between January 2009 and June 2014 and were postoperatively followed-up for ≥1 year. Among the 2,945 knees of the 1,968 patients, 1,003 knees of 679 patients aged ≥80 years at the time of surgery were designated as the older group, and we compared their cases with those of the younger group of 1,044 knees of 673 patients aged <75 years. Results: The rates of improvement of the Japanese Orthopaedic Association (JOA) score were not significantly different between the older and younger groups. Postoperative ranges of motion were significantly improved in both groups. The number of postoperative days of hospital stay in the older group was 2 days longer than that of the younger group. Concerning postoperative complications, confusion, delayed wound healing, and acute heart failure were significantly more frequent in the older group. The frequencies of pneumonia, cerebral infarction, peroneal nerve palsy, and bedsore did not differ significantly. Loosening of implants was observed: older group, n=0 joints; younger group, n=5 joints. The number of prosthetic joint infections: older group, n=5; younger group, n=2 (non-significant). Conclusion: The rate of improvement in the JOA score did not differ significantly between the groups. TKA is an effective and safe treatment for osteoarthritis, even in old adult patients, when the surgical indication is based on careful preoperative screening and attention to specific postoperative complications.


Assuntos
Osteoartrite do Joelho , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/estatística & dados numéricos , Feminino , Humanos , Japão/epidemiologia , Masculino , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Amplitude de Movimento Articular , Estudos Retrospectivos
16.
Ann Surg ; 269(6): 1146-1153, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31082914

RESUMO

OBJECTIVE: The aim of this study was to describe characteristics and management approaches for grade B pancreatic fistula (B-POPF) and investigate whether it segregates into distinct subclasses. BACKGROUND: The 2016 ISGPS refined definition of B-POPF is predicated on various postoperative management approaches, ranging from prolonged drainage to interventional procedures, but the spectrum of clinical severity within this entity is yet undefined. METHODS: Pancreatectomies performed at 2 institutions from 2007 to 2016 were reviewed to identify B-POPFs and their treatment strategies. Subclassification of B-POPFs into 3 classes was modeled after the Fistula Accordion Severity Grading System (B1: prolonged drainage only; B2: pharmacologic management; B3: interventional procedures). Clinical and economic outcomes, unique from the ISGPS definition qualifiers, were analyzed across subclasses. RESULTS: B-POPF developed in 320 of 1949 patients (16.4%), and commonly required antibiotics (70.3%), prolonged drainage (67.8%), and enteral/parenteral nutrition (54.7%). Percutaneous drainage occurred in 79 patients (24.7%), always in combination with other strategies. Management of B-POPFs was widely heterogeneous with a median of 2 approaches/patient (range 1 to 6) and 38 various strategy combinations used. Subclasses B1-3 comprised 19.1%, 52.2%, and 28.8% of B-POPFs, respectively, and were associated with progressively worse clinical and economic outcomes. These results were confirmed by multivariable analysis adjusted for clinical and operative factors. Notably, distribution of the B-POPF subclasses was influenced by institution and type of resection (P < 0.001), while clinical/demographic predictors proved elusive. CONCLUSION: B-POPF is a heterogeneous entity, where 3 distinct subclasses with increasing clinical and economic burden can be identified. This classification framework has potential implications for accurate reporting, comparative research, and performance evaluation.


Assuntos
Custos de Cuidados de Saúde , Pancreatectomia/efeitos adversos , Fístula Pancreática/classificação , Fístula Pancreática/terapia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença
17.
Dis Colon Rectum ; 62(4): 438-446, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30844971

RESUMO

BACKGROUND: High-quality surgical resection of colonic cancer, including dissection along the embryologic mesocolic plane, translates into improved long-term oncological outcomes. OBJECTIVE: This study aimed to identify risk factors for compromised specimen quality and to evaluate the specimen quality of patients undergoing laparoscopic and open resection for colonic cancer. DESIGN: This is a retrospective observational study. SETTINGS: This database study is based on the prospective national Danish Colorectal Cancer Database including patients undergoing intended curative elective colonic cancer surgery from January 1, 2010 through December 2013. PATIENTS: A total of 5143 patients (1602 open resections; 3541 laparoscopic resections) with colonic cancer were included. MAIN OUTCOME MEASURES: Risk factors for poor resection quality were identified through uni- and multivariate logistic regression analysis. The surgical approach was assessed by propensity score-matched regression analysis. Poor resection quality was defined as resections in the muscularis plane accompanied by R0 resection, or resections in any resection plane accompanied by R1 resection. RESULTS: Overall, 4415 (85.8%) of the resections were considered good and 728 (14.2%) were considered poor. After multivariate analysis, neoadjuvant oncological treatment, advanced tumor stage (T3-4), advancing N stage (N1-2), open tumor perforation, and open surgery significantly increased the risk of poor resection quality. In a propensity score-matched sample (n = 1508 matched pairs), matched for age, sex, ASA score, BMI, neoadjuvant treatment, tumor stage, and tumor location, open resection was still associated with a higher risk of poor resection quality compared with laparoscopic resection (OR, 1.4; 95% CI, 1.1-1.8; p = 0.002). LIMITATIONS: Retrospective design was a limitation of this study. CONCLUSIONS: In this nationwide propensity score-matched database study, laparoscopic resection was associated with a higher probability of good resection quality compared with open resection for colonic cancer. Risk factors for compromised specimen quality were neoadjuvant oncological treatment, locally advanced tumor stage (T3-4), advanced N stage (N1-2), open tumor perforation, and open surgery. See Video Abstract at http://links.lww.com/DCR/A830.


Assuntos
Colectomia , Neoplasias do Colo , Laparoscopia , Terapia Neoadjuvante , Complicações Pós-Operatórias , Idoso , Colectomia/efeitos adversos , Colectomia/métodos , Colectomia/normas , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Bases de Dados Factuais/estatística & dados numéricos , Dinamarca/epidemiologia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/estatística & dados numéricos , Estadiamento de Neoplasias , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Risco
18.
Eur J Vasc Endovasc Surg ; 57(4): 477-486, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902606

RESUMO

OBJECTIVES: The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. METHODS: This is a systematic review and meta-analysis of 104 observational studies. RESULTS: Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79-2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91-4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5-31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42-14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92-3.82), increasing to 2.71% (95% CI 1.43-5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34-6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62-5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94-16.68) for Shamblin II, and 17.10% (95% CI 14.82-19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45-7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56-13.08) vs. no embolisation (5.82%; 95% CI 2.76-11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). CONCLUSIONS: This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Traumatismos dos Nervos Cranianos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Tumor do Corpo Carotídeo/mortalidade , Tumor do Corpo Carotídeo/terapia , Traumatismos dos Nervos Cranianos/etiologia , Embolização Terapêutica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/classificação , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/mortalidade
19.
Medicine (Baltimore) ; 98(8): e14669, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813214

RESUMO

BACKGROUND: Several studies have shown that patients with type 2 diabetes mellitus (T2DM) have worse clinical outcomes in comparison to patients without diabetes mellitus (DM) following Percutaneous Coronary Intervention (PCI). However, the adverse clinical outcomes were not similarly reported in all the studies. Therefore, in order to standardize this issue, a meta-analysis including 139,774 patients was carried out to compare the in-hospital, short-term (<1 year) and long-term (≥1 year) adverse clinical outcomes in patients with and without T2DM following PCI. METHODS: Electronic databases including MEDLINE, EMBASE, and the Cochrane Library were searched for Randomized Controlled Trials (RCTs) and observational studies. The adverse clinical outcomes which were analyzed included mortality, myocardial infarction (MI), major adverse cardiac events (MACEs), stroke, bleeding, target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis. Risk Ratios (RR) with 95% confidence intervals (CI) were used to express the pooled effect on discontinuous variables and the analysis was carried out by RevMan 5.3 software. RESULTS: A total number of 139,774 participants were assessed. Results of this analysis showed that in-hospital mortality and MACEs were significantly higher in patients with T2DM (RR 2.57; 95% CI: 1.95-3.38; P = .00001) and (RR: 1.38; 95% CI: 1.10-1.73; P = .005) respectively. In addition, majority of the short and long-term adverse clinical outcomes were also significantly higher in the DM group as compared to the non-DM group. Stent thrombosis was significantly higher in the DM compared to the non-DM group during the short term follow-up period (RR 1.59; 95% CI: 1.16-2.18;P = .004). However, long-term stent thrombosis was similarly manifested. CONCLUSION: According to this meta-analysis including a total number of 139,774 patients, following PCI, those patients with T2DM suffered more in-hospital, short as well as long-term adverse outcomes as reported by most of the Randomized Controlled Trials and Observational studies, compared to those patients without diabetes mellitus.


Assuntos
Síndrome Coronariana Aguda , Diabetes Mellitus Tipo 2/complicações , Efeitos Adversos de Longa Duração , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/cirurgia , Mortalidade Hospitalar , Humanos , Efeitos Adversos de Longa Duração/classificação , Efeitos Adversos de Longa Duração/mortalidade , Razão de Chances , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/mortalidade , Stents/efeitos adversos
20.
J Craniofac Surg ; 30(4): 1027-1032, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30908447

RESUMO

Postoperative cerebrospinal fluid (CSF) leak still represents the main limitation of endonasal endoscopic surgery. The aim of the study is to classify the risk of postoperative leak and to propose a decision-making protocol to be applied in the preoperative phase based on radiological data and on intraoperative findings to obtain the best closure.One hundred fifty-two patients were treated in our institution; these patients were divided into 2 groups because from January 2013 the closure technique was standardized adopting a preoperative decision-making protocol. The Postoperative CSF leak Risk Classification (PCRC) was estimated taking into account the size of the lesion, the extent of the osteodural defect, and the presence of intraoperative CSF leak (iCSF-L). The closure techniques were classified into 3 types according to PCRC estimation (A, B, and C).The incidence of the use of a nasoseptal flap is significantly increased in the second group 80.3% versus 19.8% of the first group and the difference was statistically significant P < 0.0001. The incidence of postoperative CSF leak (pCSF-L) in the first group was 9.3%. The incidence of postoperative pCSF-L in the second group was 1.5%. An analysis of the pCSF-L rate in the 2 groups showed a statistically significant difference P = 0.04.The type of closure programmed was effective in almost all patients, allowing to avoid the possibility of a CSF leak. Our protocol showed a significant total reduction in the incidence of CSF leak, but especially in that subgroup of patients where a leak is usually unexpected.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Endoscopia/normas , Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/classificação , Base do Crânio/cirurgia , Técnicas de Fechamento de Ferimentos/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/etiologia , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Doenças da Hipófise/cirurgia , Medição de Risco , Retalhos Cirúrgicos , Técnicas de Fechamento de Ferimentos/efeitos adversos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA