Analysis of risk factors of the postoperative complications of surgical treatment of ankle fractures in the elderly: A series of 477 patients

Abstract OBJECTIVES There is no clear consensus on the surgical indications for spontaneous pneumothorax in elderly patients. In this study, we aimed to assess the efficacy and safety of surgical treatment of spontaneous pneumothorax in patients aged ≥70 years. We also sought to identify the risk factors for postoperative prolonged air leaks and complications in such patients. METHODS Data pertaining to 104 elderly patients who underwent surgery out of 206 patients (aged ≥70 years) who were diagnosed with spontaneous pneumothorax at our institution between 1994 and 2018 were retrospectively reviewed. The incidences of postoperative persistent air leaks (≥2 days) and postoperative complications (≥grade 3; Clavien–Dindo classification) were analysed for efficacy and safety assessment, respectively. RESULTS Median postoperative air leaks continued for 0 days (range 0–25); 14.4% patients developed ≥grade 3 postoperative complications. On the basis of results of multivariable analysis, it was observed that a higher PaCO2 level was significantly associated with prolonged postoperative air leaks [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.00–1.17; P = 0.047]. Poorer performance status was associated with a significantly increased risk of postoperative complications, as assessed by multivariable analysis (OR 6.13, 95% CI 1.38–27.3; P = 0.017). The recurrence rate was 4.8%; mortality rate of patients was 2.9%. Three-year survival rate after surgery was 73.8%. CONCLUSIONS Surgical treatment of spontaneous pneumothorax may be effective and safe in selected elderly patients. Moreover, higher PaCO2 and poorer performance status were independent risk factors for postoperative persistent air leaks and complications, respectively.

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Surgical Treatment of Cervical Spondylosis in the Elderly: Surgical Outcomes, Risk Factors, and Complications

Neurologia medico-chirurgica ◽

10.2176/nmc.48.377 ◽

2008 ◽

Vol 48 (9) ◽

pp. 377-382 ◽

Cited By ~ 4

Author(s):

Kazutoshi HIDA ◽

Shunsuke YANO ◽

Izumi KOYANAGI ◽

Minoru AKINO ◽

Toshitaka SEKI ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Surgical Outcomes ◽

Cervical Spondylosis ◽

The Elderly

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Risk Factors for Postoperative Complications among the Elderly after Plastic Surgery Procedures Performed under General Anesthesia

Plastic Surgery International ◽

10.1155/2018/7053839 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Kiyoko Fukui ◽

Masaki Fujioka ◽

Kazumi Yamasaki ◽

Sho Yamakawa ◽

Haruka Matsuo ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

General Anesthesia ◽

Plastic Surgery ◽

Medical Center ◽

Performance Status ◽

Multiple Logistic Regression Analysis ◽

The Elderly ◽

Albumin Level ◽

Hospital Organization

Background. The frequency of surgery involving elderly patients has been increasing. The use of free tissue transfers in the elderly has been examined previously (Howard et al., 2005, Hwang et al., 2016, Grammatica et al., 2015, Serletti et al., 2000, and Sierakowski et al., 2017), whereas there have not been any such studies of plastic surgery procedures. We evaluated the risk factors for complications after plastic surgery procedures performed under general anesthesia in patients aged ≥75 years. Methods. The cases of patients aged ≥75 years who underwent plastic surgery procedures under general anesthesia at the Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, between 2009 and 2016 were reviewed retrospectively. Multiple logistic regression analysis was used to identify the risk factors for postoperative complications. Results. Two hundred and sixty-three cases were reviewed. Complications were seen in 137 patients. Age was not predictive of complications. The risk factors included a serum albumin level of <2.8 g/dl (odds ratio (OR): 2.96), an operative time of ≥120 min (OR: 6.22), and an American Society of Anesthesiologists performance status of ≥3 (OR: 2.39). Conclusions. Age is not contraindication for surgery in the elderly. It is important to assess comorbidities and perform surgical procedures as soon as possible to shorten the surgical period.

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Independent Risk Factors for Impaired Early Outcome after Isolated Ankle Fracture – A Multivariate Analysis and Prognostic Models

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1200-2504 ◽

2020 ◽

Author(s):

Alexander Kaltenborn ◽

Michael Bullok ◽

Christoph Schulze ◽

Sebastian Hoffmann ◽

Peter Springer ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Operative Therapy ◽

Current Data ◽

Ankle Fractures ◽

Prognostic Models ◽

Binary Logistic Regression Analysis ◽

Roc Curve Analysis ◽

Prolonged Length ◽

Independent Risk Factors

Abstract Background Ankle fractures are common operative indications in orthopedic surgery. Their incidence is increasing. Objectives To identify independent risk factors and to develop prognostic models for the prediction of prolonged length of hospital stay (LOS) and the onset of postoperative complications. Materials and Methods This is a single-center, retrospective, observational study analyzing data of 154 consecutive, isolated, surgically treated ankle fractures. Multivariate binary logistic regression analysis was applied to identify significant independent risk factors. The validity and clinical applicability of the developed prognostic models was assessed with ROC-curve analysis (ROC: Receiver Operating Characteristic). Internal validation of prognostic models was performed with randomized backwards bootstrapping. Results The median LOS was 7 days. 50 patients (33%) had a longer LOS. 13% of operated patients had a postoperative complication (n = 20). Independent preoperative risk factors for prolonged length of stay were leukocytosis (p = 0.020; OR: 1.211), an increased CRP-level (p = 0.005; OR: 1.901), as well as a bi- (p = 0.002; OR: 15.197) or trimalleolar (p = 0.001; OR: 10.678) fracture type. Immediate operative therapy was an independent beneficial factor (p < 0.001; OR: 0.070). The onset of complications was associated significantly with diabetes mellitus (p = 0.004; OR: 9.903) and an elevated ASA score (p = 0,004; OR: 3.574). The developed prognostic models for the prediction of prolonged LOS (AUROC: 0.736) and postoperative complications (AUROC: 0.724) had a good clinical validity and were internally validated. Conclusion The current data pronounce the importance of preoperative laboratory works. Furthermore, co-morbidities play a major role in the prognosis of outcome. The developed prognostic models are able to reliably predict the outcome and enable the preoperative identification of high-risk patients.

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The Efficacy and Safety of Surgical Treatment for Patients With Tuberculosis Destroyed Lung With or Without Chronic Pulmonary Aspergillosis

World Journal of Surgery ◽

10.1007/s00268-021-05969-w ◽

2021 ◽

Author(s):

Hongyun Ruan ◽

Changfan Gong ◽

Jinxiang Wang

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Postoperative Complications ◽

Postoperative Mortality ◽

Efficacy And Safety ◽

Pulmonary Aspergillosis ◽

Preoperative Serum ◽

Chronic Pulmonary Aspergillosis ◽

Independent Risk Factors ◽

Destroyed Lung

Abstract Background To evaluate the efficacy and safety of surgical treatment of tuberculosis destroyed lung (TDL), and the influence of chronic pulmonary aspergillosis (CPA) on the outcomes of surgical treatment of TDL. Methods We performed a retrospective analysis of 113 patients with TDL who underwent surgical treatment from January 2005 to December 2019. Among them, 30 of these cases were complicated with CPA. The patients were divided into two groups: TDL group and TDL + CPA group. We analyzed the effectiveness and safety of surgical treatment of TDL, and further compared the effectiveness and safety of surgical treatment of TDL with or withoutthe presence of CPA. Results The TDL + CPA group had a significantly higher age (P=0.003), symptoms of hemoptysis (P=0.000), and a higher proportion of patients with preoperative serum albumin <30 g/L (P=0.014) as compared with TDL group. For all enrolled patients, the incidence of severe postoperative complications was 12.4% (14/113) and the postoperative mortality within 30 days after discharge was 4.4% (5/113). 86.7% (98/113) of the patients recovered and discharged, the incidence of severe postoperative complications in the TDA + CPA group was higher than that of TDL group (23.3% vs 8.4%, P = 0.034), although there was no difference in mortality between the two groups (P = 1.000). A binary logistic regression analysis showed that the independent risk factors for severe postoperative complications were male (OR 25.24, 95% CI 2.31–275.64; P = 0.008) and age ≥ 40 years (OR 10.34, 95% CI 1.56–68.65; P = 0.016). Conclusion Surgical treatment for patients with TDL is effective with an acceptable mortality rate whether or not the disease is complicated with CPA. The independent risk factors identified for severe postoperative complications in patients with TDL were male and ≥ 40 years old. It implies that when treating patients with TDA + CPA, particular attention should be paid to these patients who have these independent risk factors to avoid a poor outcome.

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The epidemic of ankle fractures in the elderly - is surgical treatment warranted?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s004020000172 ◽

2000 ◽

Vol 120 (9) ◽

pp. 511-513 ◽

Cited By ~ 69

Author(s):

M. Salai ◽

I. Dudkiewicz ◽

I. Novikov ◽

Y. Amit ◽

A. Chechick

Keyword(s):

Surgical Treatment ◽

The Elderly ◽

Ankle Fractures

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Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

Foot & Ankle International ◽

10.1177/10711007211058163 ◽

2021 ◽

pp. 107110072110581

Author(s):

Alisa Malyavko ◽

Theodore Quan ◽

William T. Stoll ◽

Joseph E. Manzi ◽

Alex Gu ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Internal Fixation ◽

Operative Treatment ◽

Ankle Fracture ◽

Open Reduction ◽

Bleeding Disorder ◽

Ankle Fractures ◽

Bleeding Disorders ◽

Increased Risk

Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

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