scholarly journals Perioperative morbidity and mortality after transmyocardial laser revascularization: incidence and risk factors for adverse events

1999 ◽  
Vol 33 (4) ◽  
pp. 1021-1026 ◽  
Author(s):  
G.Chad Hughes ◽  
Kevin P Landolfo ◽  
James E Lowe ◽  
Robin B Coleman ◽  
Carolyn L Donovan
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Morbidity And Mortality ◽  
Perioperative Morbidity ◽  
Transmyocardial Laser Revascularization

Specific diseases: chronic heart failure/hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 2663-2665
Author(s):  
Rodrigo Modolo ◽  
Ana Paula de Faria
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Adverse Events ◽  
Heart Function ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
Cardiac Markers ◽  
Perioperative Morbidity ◽  
Clinical Conditions

Hypertension and chronic heart failure are clinical conditions that greatly impact perioperative adverse outcomes of patients undergoing non-cardiac surgery. Although the first does not have a major impact on morbidity and mortality, it is the most frequent condition present in these patients. The second—chronic heart failure—is increasing in prevalence, with the ageing of the population and with the identification of incipient structural cardiac abnormalities, and has a major impact on the perioperative morbidity and mortality. For those reasons, the proper identification of these conditions in the perioperative setting is imperative in order to diminish perioperative adverse events. This chapter summarizes the current indications for identification, assessment of heart function and of cardiac markers, and the therapeutic management of these patients.

scholarly journals Surgical prehabilitation using mobile health coaching in patients with obesity: A pilot study

2020 ◽  
Vol 48 (5) ◽  
pp. 373-380
Author(s):  
Kasia Kulinski ◽  
Natalie A Smith
Keyword(s):  
Risk Factors ◽  
Mobile Health ◽  
Elective Surgery ◽  
Text Message ◽  
Cost Effective ◽  
Text Messages ◽  
Morbidity And Mortality ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Patient Health

Many patients spend months waiting for elective procedures, and many have significant modifiable risk factors that could contribute to an increased risk of perioperative morbidity and mortality. The minimal direct contact that usually occurs with healthcare professionals during this period represents a missed opportunity to improve patient health and surgical outcomes. Patients with obesity comprise a large proportion of the surgical workload but are under-represented in prehabilitation studies. Our study piloted a mobile phone based, multidisciplinary, prehabilitation programme for patients with obesity awaiting elective surgery. A total of 22 participants were recruited via the Wollongong Hospital pre-admissions clinic in New South Wales, Australia, and 18 completed the study. All received the study intervention of four text messages per week for six months. Questionnaires addressing the self-reported outcome measures were performed at the start and completion of the study. Forty percent of participants lost weight and 40% of smokers decreased their cigarette intake over the study. Sixty percent reported an overall improved health score. Over 80% of patients found the programme effective for themselves, and all recommended that it be made available to other patients. The cost was A$1.20 per patient per month. Our study showed improvement in some of the risk factors for perioperative morbidity and mortality. With improved methods to increase enrolment, our overall impression is that text message–based mobile health prehabilitation may be a feasible, cost-effective and worthwhile intervention for patients with obesity.

scholarly journals Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

2013 ◽  
Vol 472 (1) ◽  
pp. 111-120 ◽  
Author(s):  
Lazaros Poultsides ◽  
Stavros Memtsoudis ◽  
Alejandro Gonzalez Della Valle ◽  
Ivan De Martino ◽  
Huong T. Do ◽  
...  
Keyword(s):  
Risk Factors ◽  
Morbidity And Mortality ◽  
Perioperative Morbidity ◽  
Bilateral Tkas

scholarly journals Perioperative Risk Factors Associated With Morbidity and Mortality Following Pediatric Inpatient Sinus Surgery

2018 ◽  
Vol 128 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Brittany N. Burton ◽  
Sapideh Gilani ◽  
Milli Desai ◽  
Robert Saddawi-Konefka ◽  
Lindia Willies-Jacobo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Acute Sinusitis ◽  
Morbidity And Mortality ◽  
Sinus Surgery ◽  
Factors Associated ◽  
Wide Range ◽  
Comorbidity Burden

Objectives: Pediatric sinus surgery is indicated for a wide range of sinonasal and skull base pathologies, but it is most commonly performed for recalcitrant chronic rhinosinusitis or complicated acute sinusitis. The authors aim to report medical risk factors of morbidity and mortality following inpatient sinus surgery in the pediatric population. Methods: Using data from the Kids’ Inpatient Database from 2003 to 2012, patients with International Classification of Diseases, Ninth Revision, procedure codes for primary sinus surgery were identified. Mixed-effect multivariable logistic regression was used to identify risk factors of inpatient postoperative morbidity and mortality. Results: The final sample included a weighted estimate of 4965 pediatric patients. The rates of inpatient morbidity and mortality were 6% and 1%, respectively. Respiratory complications (2.5%) were the most prevalent postoperative adverse events. The most prevalent comorbidities were chronic sinusitis (59.8%), acute sinusitis (27.8%), and cystic fibrosis (26.4%). Compared with patients who did not experience any morbidity, patients with inpatient morbidity had higher rates of pneumonia, mycoses, and nasal or paranasal benign neoplasm ( P < .05). The odds of inpatient morbidity and mortality were highest for patients with leukemia (odds ratio, 2.74; 95% confidence interval, 1.59-4.72; P < .001) and mycoses (odds ratio, 15.84; 95% confidence interval, 6.45-38.89; P < .001), respectively. Conclusions: This study is the first to report the national comorbidity burden and risk factors for postoperative adverse events following inpatient sinus surgery. Knowledge of the comorbidities and independent factors associated with morbidity and mortality will help in directing preoperative optimization and counseling. Level of Evidence: 2c

Complications Associated with Mohs Micrographic Surgery: Data from the Nationwide Prospective Cohort REGESMOHS

Dermatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Verónica Ruiz-Salas ◽  
Onofre Sanmartin-Jiménez ◽  
Joan R. Garcés ◽  
Eva Vilarrasa ◽  
Román Miñano-Medrano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Prospective Cohort ◽  
Tumour Size ◽  
Outpatient Setting ◽  
Single Type ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Surgical Treatments

<b><i>Background:</i></b> Large prospective studies on the safety of Mohs micrographic (MMS) surgery are scarce, and most focus on a single type of surgical adverse event. Mid-term scar alterations and functional loss have not been described. <b><i>Objectives:</i></b> To describe the risk of MMS complications and the risk factors for them. <b><i>Methods:</i></b> A nationwide prospective cohort collected all adverse events on consecutive patients in 22 specialised centres. We used multilevel mixed-effects logistic regression to find out factors associated with adverse events. <b><i>Results:</i></b> 5,017 patients were included, with 14,421 patient-years of follow-up. 7.0% had some perioperative morbidity and 6.5% had mid-term and scar-related complications. The overall risk of complications was mainly associated with use of antiaggregant/anticoagulant and larger tumours, affecting deeper structures, not reaching a tumour-free border, and requiring complex repair. Age and outpatient setting were not linked to the incidence of adverse events. Risk factors for haemorrhage (0.9%) were therapy with antiaggregant/anticoagulants, tumour size, duration of surgery, and unfinished surgery. Wound necrosis (1.9%) and dehiscence (1.0%) were associated with larger defects and complex closures. Immunosuppression was only associated with an increased risk of necrosis. Surgeries reaching deeper structures, larger tumours and previous surgical treatments were associated with wound infection (0.9%). Aesthetic scar alterations (5.4%) were more common in younger patients, with larger tumours, in H-area, and in flap and complex closures. Risk factors for functional scar alterations (1.7%) were the need for general anaesthesia, larger tumours that had received previous surgery, and flaps or complex closures. <b><i>Conclusions:</i></b> MMS shows a low risk of complications. Most of the risk factors for complications were related to tumour size and depth, and the resulting need for complex surgery. Antiaggregant/anticoagulant intake was associated with a small increase in the risk of haemorrhage, that probably does not justify withdrawal. Age and outpatient setting were not linked to the risk of adverse events.

Perioperative morbidity and mortality in patients treated by radical cystectomy: A multi-institutional retrospective study.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 270-270
Author(s):  
N. Takada ◽  
T. Abe ◽  
S. Maruyama ◽  
A. Sazawa ◽  
N. Shinohara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Death Rate ◽  
Operative Time ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Perioperative Morbidity ◽  
Asa Score

270 Background: It is well known that radical cystectomy is associated with comparatively high perioperative morbidity and mortality. In the present study, we collected data of perioperative outcomes from Hokkaido University Graduate School of Medicine and our teaching hospitals and assessed the complications and death rate within 90 days after radical cystectomy. Methods: We collected clinical data of 970 patients undergoing radical cystectomy for nonmetastatic bladder cancer in 21 institutions between 1999 and 2009. We then assessed 90-day complications and death after radical cystectomy. The complications were classified according to the modified Clavien classification. Over 40 variables were included in the analysis, including age, ASA score, BMI, comorbidity, neoadjuvant chemotherapy, clinical stage, type of urinary diversion, operative time, estimated blood loss, transfusion, and hospital stay. Statistical analysis was performed utilizing Student's t-tests, chi-square tests, and logistic regression analysis. Results: The median patient age was 70 (range, 25-91) years old. 62.5% of patients had an ASA score≥2. Regarding the urinary diversion, ileal conduit was performed in 523 (53.6%) patients, neobladder in 178 (18.4%), ureterocutaneostomy in 255 (26.3%). Median operative time was 399 (range, 100-927) minutes. Median hospital stay was 39 (0-364) days. Regarding the complications, 660 (68%) patients experienced at least one complication and death rate within 90 days after surgery was 1.34% (n=13), respectively. Of the complications, 34.1% was classified as grade 1, 41.5% as grade 2, 20.1% as grade 3, 1.1% as grade 4, 1.2% as grade 5. Multivariate analysis identified age≥70 (odds ratio 1.41), urinary diversion utilizing intestine (OR 1.58) and operative time ≥ 400 (OR 1.54) were independent risk factors. Conclusions: Death rate was 1.34%, which was compatible to reports form western high- volume centers. About two-thirds of the patients experienced at least one complication, although they were mostly classified as grade 2 or less. Age, urinary diversion, and operative time were significant risk factors for perioperative complications after radical cystectomy. No significant financial relationships to disclose.

scholarly journals Patient Selection for Day Case-eligible Surgery

2013 ◽  
Vol 119 (6) ◽  
pp. 1310-1321 ◽  
Author(s):  
Michael R. Mathis ◽  
Norah N. Naughton ◽  
Amy M. Shanks ◽  
Robert E. Freundlich ◽  
Christopher J. Pannucci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Surgical Procedures ◽  
Patient Selection ◽  
Outpatient Surgery ◽  
Morbidity And Mortality ◽  
Day Case ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Selection For

Abstract Background: Due to economic pressures and improvements in perioperative care, outpatient surgical procedures have become commonplace. However, risk factors for outpatient surgical morbidity and mortality remain unclear. There are no multicenter clinical data guiding patient selection for outpatient surgery. The authors hypothesize that specific risk factors increase the likelihood of day case-eligible surgical morbidity or mortality. Methods: The authors analyzed adults undergoing common day case-eligible surgical procedures by using the American College of Surgeons’ National Surgical Quality Improvement Program database from 2005 to 2010. Common day case-eligible surgical procedures were identified as the most common outpatient surgical Current Procedural Terminology codes provided by Blue Cross Blue Shield of Michigan and Medicare publications. Study variables included anthropometric data and relevant medical comorbidities. The primary outcome was morbidity or mortality within 72 h. Intraoperative complications included adverse cardiovascular events; postoperative complications included surgical, anesthetic, and medical adverse events. Results: Of 244,397 surgeries studied, 232 (0.1%) experienced early perioperative morbidity or mortality. Seven independent risk factors were identified while controlling for surgical complexity: overweight body mass index, obese body mass index, chronic obstructive pulmonary disease, history of transient ischemic attack/stroke, hypertension, previous cardiac surgical intervention, and prolonged operative time. Conclusions: The demonstrated low rate of perioperative morbidity and mortality confirms the safety of current day case-eligible surgeries. The authors obtained the first prospectively collected data identifying risk factors for morbidity and mortality with day case-eligible surgery. The results of the study provide new data to advance patient-selection processes for outpatient surgery.

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