Morbidity and Mortality Associated with the Operative Treatment of Disorders of the Pediatric Spine: A Report from the SRS M&M Committee

Background and Aims: Esophageal perforation is a life-threatening disease. Factors impacting morbidity and mortality include the cause and site of the perforation, the time to diagnosis, and the therapeutic procedure. This study aimed to identify risk factors for morbidity and mortality after esophageal perforation. Patients and Methods: This retrospective study analyzed data collected from all patients treated for esophageal perforation at the Department of Surgery, University of Schleswig–Holstein, Luebeck Campus, from January 1986 through December 2011. Results: Altogether, 80 patients (52 men, 28 women; mean age 65 years) were treated. The cause of perforation was intraluminal in 44 (55%) (group A) and extraluminal in 2 (3%) (group B). Spontaneous perforations were observed in 12 (15%) (group C). Perforations were due to a preexisting esophageal disease in 22 (28%) (group D). The survival rate was higher for group A (82%) than for groups B (50%), C (57%), and D (59%). The distal third of the esophagus had the highest prevalence of perforations (49, 61%) independent of the cause. Mortality, however, was independent of the perforation site. Perforations were diagnosed within 24 h in 57% (n = 46) of patients, associated with a statistically significant lower mortality rate (p = 0.035). Altogether, 40 patients underwent non-operative treatment, and among those 27 had endoscopic treatment. Emergency thoracic surgery was performed in 40 patients: direct suture of the defect (n = 26), partial esophageal resection (n = 11), other (n = 3). Significantly higher morbidity (p = 0.007) and prolonged hospitalization (p < 0.0001) was observed among patients who underwent emergency surgery. Mortality was higher in the surgical group (14/40) than in the non-operative treatment group (9/40) but without statistical significance. Conclusion: Intraluminal perforations, rapid initiation of therapy, and non-operative treatment were associated with favorable outcomes. The perforation site did not have an impact on outcomes. Esophageal resection was associated with high mortality.

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Cervical spine fractures in the elderly: morbidity and mortality after operative treatment

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-013-0311-5 ◽

2013 ◽

Vol 39 (5) ◽

pp. 469-476 ◽

Cited By ~ 4

Author(s):

A. L. Sander ◽

A. El Saman ◽

P. Delfosse ◽

S. Wutzler ◽

S. Meier ◽

...

Keyword(s):

Cervical Spine ◽

Operative Treatment ◽

The Elderly ◽

Morbidity And Mortality ◽

Spine Fractures ◽

Cervical Spine Fractures

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Aggressive Operative Treatment for Emetogenic Rupture Yields Superior Results

The American Surgeon ◽

10.1177/000313481007600832 ◽

2010 ◽

Vol 76 (8) ◽

pp. 865-868

Author(s):

Dustin Neel ◽

Eric G. Davis ◽

Russell Farmer ◽

J. David Richardson

Keyword(s):

Hospital Stay ◽

Operative Treatment ◽

Morbidity And Mortality ◽

Suture Repair ◽

Short Hospital Stay ◽

Primary Suture ◽

Esophageal Function ◽

Operative Repair ◽

Tissue Flap ◽

Patient Presentation

The treatment of emetogenic rupture remained controversial and was particularly so when the patient arrived for definitive care greater than 24 hours postrupture. We treated patients with continued extravasation of contrast from the esophagus by early operation regardless of the timing of their presentation. All primary repairs received a reinforced closure and many delayed repairs had an onlay flap for closure of the leak. We treated 31 patients with emetogenic rupture; 24 of 25 patients with extravasation had operative repair, whereas six with small, contained ruptures were treated medically. Twelve were operated on within 24 hours, whereas 24 presented from 36 to 796 hours postrupture. We were able to achieve closure of the defect by primary suture repair or with a tissue flap in all patients. There were no postoperative leaks. One patient each died in the operated group and observed group. There were minimal complications and a relatively short hospital stay. Our results support the use of aggressive operative treatment for emetogenic rupture regardless of the timing of patient presentation. Such treatment preserved esophageal function and was accomplished with relatively low morbidity and mortality.

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Should Elective Surgery for Chronic Pancreatitis be Performed in High-Risk Patients?

The American Surgeon ◽

10.1177/000313480607200705 ◽

2006 ◽

Vol 72 (7) ◽

pp. 592-598

Author(s):

Thomas Schnelldorfer ◽

David B. Adams

Keyword(s):

Chronic Pancreatitis ◽

Health Status ◽

High Risk ◽

Operative Treatment ◽

Adverse Outcome ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

High Risk Patients ◽

Lateral Pancreaticojejunostomy ◽

Risk Patients

As morbidity and mortality rates for pancreatic surgery have improved over the past decades, patients with major medical comorbidities have been considered for operative treatment. The influence of poor health status on operative morbidity in patients with chronic pancreatitis is evaluated in this study. The records of 313 consecutive patients who underwent pancreaticoduodenectomy (n = 78), distal pancreatectomy (n = 83), or lateral pancreaticojejunostomy (n = 152) for chronic pancreatitis were retrospectively reviewed and analyzed. Patients’ risk for adverse outcome resulting from overall health status was audited using age, comorbidities, and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) physiological score. Univariate analysis showed that patient's age did not contribute to change in morbidity (odds ratio [OR] = 1.01, P = 0.59). The presence of cardiac disease but not other comorbidities increased adverse outcome affected the need for intensive care unit stay and length of hospital stay (morbidity: 29% vs. 51%, OR = 2.6, P = 0.003). POSSUM physiological score was associated with an increase in morbidity and mortality (morbidity: OR = 1.16, P = 0.001; mortality: OR = 1.49, P = 0.001), in particular intraabdominal abscesses. Multivariate analysis showed that the only variable independently correlating with perioperative complications was POSSUM physiological score. Single comorbidities do not independently influence outcome after operations for chronic pancreatitis. A combination of several comorbidities is associated with an increase in postoperative infectious morbidity and mortality. High-risk patients should not be excluded from operative treatment, but need to be closely selected on a case-by-case basis.

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