Cardiovascular and respiratory complications after major head and neck surgery

BACKGROUND: Our aim was to gain insight into the incidence rates for, distribution of, and risk factors of postoperative cardiovascular and respiratory complications in major head and neck surgery. METHODS: We performed a retrospective review of 469 patients who had undergone primary major head and neck surgery. Outcome measures were incidence rates, risk factors, and distribution over time for postoperative cardiovascular and respiratory complications. A multivariate analysis was performed. RESULTS: The incidence rates for cardiovascular and respiratory complications were 57 of 469 (12%) and 50 of 469 (11%), respectively. The incidence rate for heart failure exceeded that for pneumonia. The peak incidence for cardiovascular complications was on the first postoperative day; for respiratory complications, on the second postoperative day. Risk factors for cardiovascular complications were age, pulmonary disease, alcohol abuse, and tumor location; risk factors for respiratory complications were pulmonary disease, previous myocardial infarction, and American Society of Anesthesiologists (ASA) grade. CONCLUSION: In this study, the incidence rates for cardiovascular and respiratory complications were very similar. The first postoperative day was crucial with regard to cardiovascular complications. Age and chronic pulmonary diseases were the common risk factors for cardiovascular and respiratory complications.     

腹膜透析非感染相关并发症的防治

随着腹膜透析的广泛应用及长龄腹膜透析患者的增加,腹膜透析非感染相关并发症的发生日渐增多。腹膜透析非感染相关并发症主要包括导管相关并发症、腹膜透析液留腹引起的腹内压增加相关并发症和代谢并发症等。积极预防和治疗非感染相关并发症是改善腹膜透析患者预后的重要措施之一。     

原位肝移植术后并发症的影像学评价

目的：对评价原位肝移植(orthotopic liver transplantation，OLT)术后并发症的影像学检查方法进行评价。方法：对OLT术后并发症的影像学检查结果进行分析，并对各类并发症的相关影像学表现加以总结。结果：B超可用作OLT术后并发症的早期筛查；彩色多谱勒超声能早期发现血管性并发症；螺旋CT和MRI对术后血管性和(或)胆管性并发症、肝实质本身异常以及肝外转移性并发症有很高的诊断价值；对排斥反应．目前影像学检查还无特征性表现。结论：影像学检查(特别是超声、螺旋CT和MRD在OLT术后各类并发症的诊断中具有重要的作用。     

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目的 探讨肝移植术后血管并发症的诊断与治疗。方法 回顾性分析1993年4月至2002年8月施行的180例次原位肝移植的临床资料。结果 发生血管并发症19例(10．6％)，18例经选择性血管道影证实，1例经尸体检查证实。彩色多普勒超声(CDI)的诊断敏感度和特异度分别为94．7％和92.5％。术中超声检查(I0US)对动脉并发症诊断的敏感度和特异度分别为100％和96.0％。11例、3例、3例和1例受者分别接受介入、再血管化、保守治疗和再次肝移植。与血管并发症有关的病死率为3.9％(7／180)。结论 CDI是监测血管并发症的首选方法，选择性血管造影是早期诊断血管并发症必不可少的手段。应根据血管并发症类型、诊断时间、全身情况、有无其他并发症、肝功能损害程度等来决定血管并发症的治疗方案。非肝动脉的血管并发症首选介入方法治疗，肝动脉血栓形成或狭窄则应选择再血管化或再次肝移植，部分病人可尝试保守治疗。     

Surgical complications of microendoscopic procedures for lumbar spinal stenosis.

Microendoscopic discectomy (MED) is one of the minimally invasive endoscopic procedures for treating lumbar disc herniation. We have applied MED techniques to posterior decompression procedures for treating lumbar spinal stenosis (LSS). In the present study, we examined the surgical complications in 114 consecutive patients surgically treated with MED procedures for LSS. Intraoperative complications occurred in 9 patients. Six patients (5.3%) experienced a dural tear, and three (2.6%) had a fracture of an inferior facet. Early postoperative complications occurred in 13 patients. Twelve patients (10.5%) experienced transient neurological complications. The clinical outcomes at the mean 28-month follow-up were not affected by these surgical complications. Other major complications such as nerve injury and surgical site infection were not observed. Most of the complications occurred in the initial series of patients, and the incidence of complications decreased with an increase in the surgeon's experience and the application of several preventive measures against the complications. The surgeon should undergo training when MED techniques are applied in surgical treatment in order to recognize the specific complications associated with such procedures and apply preventive measures against these complications.     

Limitation of the model for end-stage liver disease for outcome prediction in patients with cirrhosis-related complications

The model for end-stage liver disease (MELD) has been used to prioritize cirrhotic patients awaiting liver transplantation. Bleeding esophageal varices, spontaneous bacterial peritonitis and hepatic encephalopathy are major complications of cirrhosis and traditional indications for liver transplantation evaluation. However, these complications are not included in the MELD and it is not clear if these complications correlate with MELD score in terms of outcome prediction. This study aimed to investigate the feasibility of cirrhosis-related complication as a prognostic predictor in 290 cirrhotic patients. The MELD score and outcome were compared between patients with and without cirrhosis-related complications. There was no significant difference of the MELD score between patients with (n = 67) and without (n = 223) complications (11.6 +/- 2.9 vs. 12.2 +/- 3.2, p = 0.184). The area under the receiver operating characteristic curve was 0.687 for MELD vs. 0.604 for complications (p = 0.174) at six months, and the area was 0.641 for MELD vs. 0.611 for complications (p = 0.522) at 12 months. A high MELD score and presence of complications had a similar profile of predictive accuracy and both were significant predictors of mortality at six and 12 months in multivariate logistic regression analysis. Patients with cirrhosis-related complications at presentation had a decreased survival compared with those without complications (p < 0.0001). In conclusion, the occurrence of cirrhosis-related complications is a predictor of poor prognosis. While early transplantation referral is recommended, these patients do not necessarily have a higher MELD score and could be down-staged in the MELD era.     

主动脉支架植入术后少见并发症及其治疗

目的探讨主动脉腔内支架治疗后少见井发症及其治疗方法。方法 回顾性分析5例主动脉疾病患者的特点和行主动脉支架治疗后所出现的并发症。结果4例患者在支架植入后出现的并发症经手术或再次支架治疗均获缓解,1例患者死亡。结论主动脉腔内支架植入的并发症与传统手术并发症截然不同．术者应具备良好的手术技巧和介入治疗水平,以及时治疗可能出现的并发症。     

Intraoperative complications of laparoscopic adrenalectomy

A laparoscopic or retroperitoneoscopic access to the adrenal gland is the standard of care for adrenalectomy in most cases. Although in laparoscopic adrenalectomy the approach is minimally invasive, the procedure is challenging. This is reflected in the scope of possible complications. The surgeon must consider complications related to the anatomical topography of the adrenal gland, which typically encompasses the complications known from open surgery and complications related to the minimal invasive access. In this topic paper we will address the most frequently encountered complications of adrenalectomy: vascular injuries, injuries of the bowel, pleural tears, and injuries to the liver, spleen and pancreas. Fortunately, these complications occur rarely. However, many of these complications can have devastating consequences. Therefore, it’s the surgeon’s obligation to be aware of the possible complications he might encounter during laparoscopic adrenalectomy. This awareness is essential for their prevention and it helps the laparoscopic surgeon to identify complications intraoperatively.     

肝胆管结石术后并发症的防治(附180例分析)

目的探讨肝胆管结石手术后并发症及其影响因素，合理选择肝胆管结石的术式，预防或减少肝胆管结石的术后并发症。方法对180例肝胆管结石手术术后并发症进行回顾性分析。结果本组肝胆管结石术后1～30d内79例(43．9％)发生术后并发症，发生率较高的术后并发症有残余结石(21．7％)、切口感染(11．1％)、胸水(10．0％)；在不同的术式中，单纯T管外引流术后并发症率为50．0％，胆肠内引流术为46．9％，肝叶段切除 T管外引流术为31．0％，肝叶段切除 胆肠内引流术为60．0％，肝叶段切除术后并发症率较低且易于处理；全组手术死亡率1．7％。结论肝胆管结石手术并发症多，发生率高，结石部位和手术术式是影响术后并发症的主要因素，肝区段切除术既能达到治愈肝胆管结石及由其引起的肝胆病理改变的目的，又能获得较低的术后并发症率；对常见的术后并发症提出预防措施，探讨手术技巧的改进。     

Vascular complications after orthotopic liver transplantation after neoadjuvant therapy for hilar cholangiocarcinoma.

Liver transplantation after neoadjuvant chemoradiotherapy has emerged as an effective treatment for patients with localized, node-negative, unresectable hilar cholangiocarcinoma (CCA) or CCA arising in the setting of primary sclerosing cholangitis (PSC). However, concern has arisen regarding the potential for vascular complications due to high-dose neoadjuvant therapy before transplantation. We reviewed our experience with specific aims to determine the incidences of arterial, portal, and hepatic venous complications in patients transplanted for CCA compared with patients who undergo transplantation for other indications, and to describe patient outcome as a result of these vascular complications. We reviewed data for all patients who underwent liver transplantation for CCA between January 1993 and April 2006 and compared the incidences of vascular complications to whole organ and living donor recipient control groups. Sixty-eight patients underwent neoadjuvant therapy and subsequent liver transplantation. Arterial complications arose in 21%; portal venous complications arose in 22%; and overall, 40% developed vascular complications. Late hepatic artery complications occurred more often in living donor recipients transplanted for CCA compared with the living donor control group (P=0.047). Late portal vein complications occurred more often in both whole organ and living donor recipients transplanted for CCA compared with the control groups (P=0.01 and P=0.009). Hepatic venous complications were rare. Patient and graft survival were not different between CCA and control patients. Liver transplantation with neoadjuvant therapy is associated with far higher rates of late arterial and portal venous complications, but these complications do not adversely affect patient and graft survival.     

Do lowered hemoglobin and hematocrit levels have a favorable effect on early septic complications in colorectal surgery?

A group of 114 colorectal resections was investigated for preoperative haemoglobin and haematocrit in relation to postoperative septic complications. The group subdivided in men and women with and without complications were comparable in respect of their age and their diseases. There were significant differences in the preoperative levels of Hb and Ht in the groups with and without postoperative septic complications (p less than 0.05). The mean values were 14.7 g/dl for men with postoperative complications and 13.7 g/dl for those without any complications. The corresponding Ht-values were 45% vs. 42%. The mean values of Hb for women were 13.9 g/dl in the groups with postoperative complications and 12.9 g/dl in those without any complications (Ht-values 43% resp. 39%).     

Prognostic significance of a preoperative risk check list

The perioperative risk of lethal complications amounts to 0.02 to 0.4% dependent on different investigators. A further decrease of this perioperative risk has failed to occur in spite of most sophisticated methods of anesthesiology. We desire a safe classification of risk scores in order to calculate the prognosis of the individual patient who is scheduled for operation and anaesthesia. 15 anamnestical, clinical and blood chemistry data of 700 patients planned for general surgery were registered, intra- and postoperative complications were documented, and by means of statistical methods (discriminant analysis) evaluated. The patients' data were registered from the date of premedication to discharge or to four weeks after operation. To define the complications they were classified as mild, moderate and severe complications. The 15 variables used show a calculated risk prognosis of 40% for mild, 57% for moderate and 79% for severe complications. We find a very good correlation of the calculated versus observed risk of complications. The risk of mild complications are underestimated and severe complications overestimated.     

肝移植术后门静脉并发症的诊断和治疗(附6例分析)

目的 探讨肝移植术后门静脉并发症的诊断和治疗。方法 回顾性分析160例原位肝移植临床资料。结果 肝移植术后门静脉并发症发生率为3．75％，与门静脉并发症相关死亡率为0。门静脉狭窄发生率为1．25％，门静脉栓塞发生率为2．5％，需治疗的门静脉并发症占33．3％。结论 术前有门脉高压症手术治疗史、移植术前门静脉血栓、门静脉手术史以及严重感染病史等是门静脉并发症的高危因素；彩色多普勒超声检查是监测门静脉并发症的有效方法，确诊门静脉并发症依赖门静脉造影；有症状的门静脉并发症需及时行再血管化手术。     

聚丙烯酰胺水凝胶注射隆鼻术后并发症的处理及临床分析

目的探讨聚丙烯酰胺水凝胶注射隆鼻术后并发症产生的原因及相关的处理。方法通过总结处理52例聚丙烯酰胺水凝胶注射隆鼻术后并发症的经验体会，分析并发症产生的原凶及处理补救措施。结果52例中产生的并发症有感染、肉芽肿、皮肤破溃、外形不良、疼痛和严重的心理压力等。每例有1～4种并发症。根据不同情况采取不同处理方法，并选取适当病例在取出聚丙烯酰胺水凝胶的同期或二期置入硅胶或膨体聚四氟乙烯假体，多数病例能取得较满意的效果，少数病例遗留后遗症和长久的心理压力或鼻部隐痛。结论聚丙烯酰胺水凝胶注射隆鼻术后并发症种类多样，与聚丙烯酰胺水凝胶的同有性质、鼻部软组织解剖特点有关。出现并发症后反复抽吸，会导致聚丙烯酰胺水凝胶分布更加紊乱，损伤加重。只有采取综合的手术方法才能较彻底地清除聚丙烯酰胺水凝皎。     

Renal transplant complications. Minimally invasive management

Advancements in endourology, laparoscopic urology, and interventional radiology continue to influence the contemporary management of renal transplant complications. The successful implementation of these minimally invasive therapies significantly relies on careful patient selection; not all renal transplantation complications are suitable or amenable for this form of management--true for transplant ureteral complications and less so for other potential complications. With such a strategy, renal transplant complications can be managed efficiently and effectively with these minimally invasive modalities to minimize further recipient morbidity while also minimizing potential risk to the recipient and for the renal allograft.     

Chronic complications of spinal cord injury

Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients’ functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.     

Biliary complications after adult living donor liver transplantation

We evaluated the causes and outcomes of biliary complications occurring after adult living donor liver transplantation (ALDLT) in a large patient cohort. Among 46 patients who underwent ALDLT at two different centers early bile duct complications occurred in 11 recipients (23.9%), consisting of leakage from the anastomotic site or from the cut surface of the liver. T-tube-associated biliary complications occurred in four patients. Late complications, primarily anastomotic strictures, occurred in 15 patients (32.6%) at 6.7+/-3.5 months after transplantation. Surgical intervention was generally required for early biliary complications but rarely necessary for late complications. No graft loss was caused by biliary complications. Thus, ALDLT is accompanied by a high rate of biliary complications, which in our series have been of low severity. However, long-term effects on graft function are not yet known.     

第三脑室底造瘘治疗脑积水的手术并发症

目的 探讨第三脑室底造瘘治疗脑积水产生手术并发症的原因及预防措施。方法 对13例（15例次）行第三脑室底造瘘术治疗脑积水出现并发症的情况进行回顾性分析。结果 本组患者出现脑室内感染2例、膜膜下积液1例、造瘘口再堵塞1例、术中出血后的血凝块堵塞第三脑室形成脑疝1例。并发症的主要原因为手术设备的不良和先期经验的不足。结论 采用良好的手术设备,提高对各种并发症发生原因的不足,可减少手术并发症的发生。     

Comprehensive Standardized Report of Complications of Retropubic and Laparoscopic Radical Prostatectomy

Background

The lack of standardized reporting of the complications of radical prostatectomy in the literature has made it difficult to compare incidences across institutions and across different surgical approaches.

Objective

To define comprehensively the incidence, severity, and timing of onset of medical and surgical complications of open retropubic prostatectomy (RP) and laparoscopic radical prostatectomy (LP) using a standardized reporting methodology to facilitate comparison.

Design, setting, and participants

Between January 1999 and June 2007, 4592 consecutive patients underwent RP or LP without prior radiation or hormonal therapy. Median follow-up was 36.9 mo (interquartile range: 20.3–60.6).

Intervention

Open or laparoscopic radical prostatectomy.

Measurements

All medical and surgical complications of radical prostatectomy were captured and graded according to the modified Clavien classification and classified by timing of onset.

Results and limitations

There were 612 medical complications in 467 patients (10.2%) and 1426 surgical complications in 925 patients (20.1%). The overall incidences of early minor and major medical and surgical complications for RP were 8.5% and 1.5% for medical and 11.4% and 4.9% for surgical complications, respectively. The overall incidences of early minor and major medical and surgical complications for LP were 14.2% and 2.3% for medical and 23.1% and 6.6% for surgical complications, respectively. On multivariate analysis, LP approach was associated with a higher incidence of any grade medical and surgical complications but a lower incidence of major surgical complications than RP. Six hundred fifty-two men (14.2%) visited the emergency department, and 240 men (5.2%) required readmission. The main limitation is the retrospective nature.

Conclusions

With standardized reporting, the incidence of some complications is higher than recognized in the literature. Although most complications are minor in severity, medical and surgical complications are observed in approximately 10% and 20% of patients, respectively. Accurate reporting of complications through a standardized methodology is essential for counseling patients regarding risk of complications, for identifying modifiable risk factors, and for facilitating comparison across institutions and approaches.     

Complications of radical and partial nephrectomy in a large contemporary cohort

PURPOSE: Standardized criteria for reporting the early complications of urological procedures are lacking. We reviewed the early complications of radical nephrectomy (RN) and partial nephrectomy (PN) in a large contemporary cohort using a standardized complication grading scale. MATERIALS AND METHODS: Between 1995 and 2002, 1,049 patients underwent RN (66%) or PN (34%) for renal cortical neoplasm. Records were reviewed for perioperative complications. Complications were graded using a 5-tiered scale based on the severity of impact or intensity of therapy required. RESULTS: A total of 235 complications occurred in 180 patients (17%). Overall 55% and 31% of complications were grade I and grade II, respectively. There were 3 perioperative deaths (0.2%). PN was not associated with more complications compared to RN when accounting for other variables. PN cases had more procedure related complications compared to RN (9% versus 3%, respectively, p = 0.0001) due to complications of urinary leak and the reintervention rate was subsequently higher (2.5% versus 0.6%, p = 0.02). All but 1 of the reinterventions for PN involved either endoscopy or radiology. By multivariate analysis operative time (p <0.0001) and solitary kidney (p = 0.06) were associated with procedure related complications of PN. CONCLUSIONS: RN and PN are associated with low rates of serious morbidity and mortality. Compared to RN, PN is associated with higher rates of procedure related complications, the majority of which are minor. Overall, however, PN is not associated with more complications than RN.