scholarly journals The impact of delayed surgical intervention following high velocity maxillofacial injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daniel Oren ◽  
Amiel A. Dror ◽  
Adeeb Zoabi ◽  
Adi Kasem ◽  
Lior Tzadok ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
High Velocity ◽  
Medical Center ◽  
Complication Rates ◽  
Maxillofacial Injuries ◽  
Delayed Treatment ◽  
Syrian Civil War ◽  
The Mean ◽  
The Impact

AbstractOur study compares the number of postoperative complications of Syrian patients admitted to the Galilee Medical Center (GMC) over a 5-year period (May 2013–May 2018) for treatment after initial high-velocity maxillofacial injuries sustained during the Syrian civil war. Specifically, we evaluated complication rates of patients arriving “early,” within 24 h, to the GMC versus those who arrived “late,” or 14–28 days following high-velocity maxillofacial injuries. Both groups of patients received definitive surgical treatment within 48 h of admission to our hospital with a total of 60 patients included in this study. The mean age was 26 ± 8 years (range: 9–50) and all except one were male. Postoperative complications in the early group were found to be significantly higher compared to the delayed arrival group (p = 0.006). We found that unintentionally delayed treatment may have contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications. We discuss potential mechanisms for complication rate variations, including critical vascularization periods. Our study may add to a growing body of work demonstrating the potential benefit of delayed surgical treatment for high-velocity maxillofacial injuries.

scholarly journals The Benefit of Inevitably Delayed Surgical Intervention Following High-Velocity Maxillofacial War Injuries

2020 ◽  
Author(s):  
Daniel Oren ◽  
Amiel A Dror ◽  
Adeeb Zoabi ◽  
Adi Kasem ◽  
Lior Tzadok ◽  
...  
Keyword(s):  
Civil War ◽  
High Velocity ◽  
Medical Center ◽  
Fistula Formation ◽  
Complication Rates ◽  
Retrospective Case ◽  
War Injuries ◽  
Oroantral Fistula ◽  
Syrian Civil War ◽  
Delayed Group

Abstract Background: Over 3200 Syrian patients were admitted and treated at Galilee Medical Center (GMC) over a five-year period (May 2013 - May 2018) since the beginning of the Syrian civil war in 2011. This study compares the number of postoperative complications of patients admitted to the GMC immediately after injury or two to three weeks after initial high-velocity maxillofacial injuries and the potential mechanisms for the variation in complication rates. We describe our experiences, strategies, and resultant treatment approach.Methods: Retrospective case studies in which the incidence of complications including infection, rejection of hardware, bone or soft tissue grafts, tissue dehiscence, oroantral fistula formation, excessive scarring, and unplanned return to the operating theater were investigated. Patients arriving at the GMC within 24 hours following maxillofacial injury were considered “early” while patients arriving to the GMC within 14-28 days following initial trauma without treatment prior to arrival were considered “late” or “delayed.” Both groups of patients received definitive surgical treatment within 48 hours of admission to our hospital. Results: Sixty patients suffering from "high-velocity" maxillofacial Syrian civil war-related battlefield injuries were included in this study. The mean age was 26±8 years (range: 9-50) and all except one were male. Post-operative complications in the early group were found to be significantly higher compared to the delayed group (p = 0.006).Conclusions: We discovered that the delayed group of patients, characterized by progressive neovascularization of injured tissue, had better surgical success from rich blood supply that enhances tissue survival. Sustained tissue perfusion to the tissue supports efficient systemic antibiotic delivery, a favorable condition in lowering infection rate and complication. We found that the unintendedly delayed treatment contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications.

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

scholarly journals The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

2021 ◽  
Author(s):  
M. Runkel ◽  
T. D. Diallo ◽  
S. A. Lang ◽  
F. Bamberg ◽  
M. Benndorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Visceral Obesity ◽  
The Body ◽  
Postoperative Outcomes ◽  
Sarcopenic Obesity ◽  
Colorectal Metastases ◽  
Complication Rates ◽  
The Impact ◽  
Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

scholarly journals The effects of surgical treatment and sclerotherapy for intramuscular venous malformations: a comparative clinical study

2021 ◽  
Vol 48 (6) ◽  
pp. 622-629
Author(s):  
Yun Hyun Kim ◽  
Jeong Yeop Ryu ◽  
Joon Seok Lee ◽  
Seok Jong Lee ◽  
Jong Min Lee ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Clinical Outcomes ◽  
Vascular Malformations ◽  
Medical Center ◽  
Surgical Excision ◽  
Complication Rates ◽  
Venous Malformations ◽  
Treatment Groups ◽  
Comparative Clinical Study

Background Venous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision.Methods Of 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement.Results Although there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group.Conclusions Although several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs.

scholarly journals BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

2021 ◽  
Vol 10 (23) ◽  
pp. 5665
Author(s):  
Helena Sophie Leitner ◽  
Reinhard Pauzenberger ◽  
Ines Ana Ederer ◽  
Christine Radtke ◽  
Stefan Hacker
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Positive Impact ◽  
Surgical Techniques ◽  
Study Cohort ◽  
Complication Rates ◽  
Impaired Wound Healing ◽  
Reconstruction Methods ◽  
Study Results ◽  
The Impact

Background: Breast reconstruction has a positive impact on body image and quality of life for women after experiencing the physically and psychologically demanding process of mastectomy. Previous studies have presented body mass index (BMI) as a predictor for postoperative complications after breast reconstruction, however, study results vary. This retrospective study aimed to investigate the impact of patients’ BMI on postoperative complications following implant-based breast reconstruction. Methods: All implant-based breast reconstructions performed at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna from January 2001 to March 2018 were evaluated. A total of 196 reconstructed breasts among 134 patients met eligibility criteria. Demographic data, surgical techniques, as well as major and minor complications within a one-year follow-up period were analyzed. Results: Patients’ BMI did not show a significant impact on complication rates. The overall incidence of postoperative complications was 30.5% (40/131) of which 17.6% required reoperation. Impaired wound healing (18.3%), seroma (6.1%), hematoma (4.6%), capsular contraction (4.6%) and infection (3.8%) were the most common complications. Conclusion: In our study cohort, BMI was not associated with a significantly higher risk of complications. However, postoperative complications significantly increased with a longer operative time and resulted in an extended length of hospital stay.

scholarly journals Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease

2019 ◽  
Vol 130 (2) ◽  
pp. 531-542 ◽  
Author(s):  
Meng Zhao ◽  
Xiaofeng Deng ◽  
Dong Zhang ◽  
Shuo Wang ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Moyamoya Disease ◽  
Functional Disability ◽  
Neurological Status ◽  
Complication Rates ◽  
Modified Rankin Scale ◽  
Cerebral Hyperperfusion ◽  
The Impact

OBJECTIVEThe risk factors and clinical significance of postoperative complications in moyamoya disease are still unclear. The aim of this study was to investigate the predictors of postoperative complications in moyamoya disease and examine the impact of complications on outcomes.METHODSThe authors reviewed consecutive cases involving adult moyamoya disease patients who underwent indirect, direct, or combined bypass surgery in their hospital between 2009 and 2015. Preoperative clinical characteristics and radiographic features were recorded. Postoperative complications within 14 days after surgery were examined. Multivariate logistic regression analyses were performed to identify the risk factors for either postoperative ischemia or postoperative cerebral hyperperfusion. Outcome data, including recurrent strokes and neurological status (modified Rankin Scale [mRS]) during follow-up, were collected. Outcomes were compared between patients who had complications with those without complications, using propensity-score analysis to account for between-group differences in baseline characteristics.RESULTSA total of 500 patients (610 hemispheres) were included in this study. Postoperative complications were observed in 74 operations (12.1%), including new postoperative ischemia in 30 cases (4.9%), hyperperfusion in 27 (4.4%), impaired wound healing in 12 (2.0%), and subdural effusion in 6 (1.0%). The complication rates for different surgery types were as follows: 12.6% (n = 25) for indirect bypass, 12.7% (n = 37) for direct bypass, and 10.0% (n = 12) for combined bypass (p = 0.726). Postoperative ischemic complications occurred in 30 hemispheres (4.9%) in 30 different patients, and postoperative symptomatic hyperperfusion occurred after 27 procedures (4.4%). Advanced Suzuki stage (OR 1.669, 95% CI 1.059–2.632, p = 0.027) and preoperative ischemic presentation (OR 5.845, 95% CI 1.654–20.653, p = 0.006) were significantly associated with postoperative ischemia. Preoperative ischemic presentation (OR 5.73, 95% CI 1.27–25.88, p = 0.023) and admission modified Rankin Scale (mRS) score (OR 1.81, 95% CI 1.06–3.10, p = 0.031) were significantly associated with symptomatic postoperative cerebral hyperperfusion syndrome (CHS). Compared with patients without postoperative complications, patients who experienced any postoperative complications had longer hospital stays and worse mRS scores at discharge (both p < 0.0001). At the final follow-up, no significant differences in functional disability (mRS score 3–6, 11.9% vs 4.5%, p = 0.116) and future stroke events (p = 0.513) between the 2 groups were detected.CONCLUSIONSAdvanced Suzuki stage and preoperative ischemic presentation were independent risk factors for postoperative ischemia; the mRS score on admission and preoperative ischemic presentation were independently associated with postoperative CHS. Although patients with postoperative complications had worse neurological status at discharge, postoperative complications had no associations with future stroke events or functional disability during follow-up.

A NSQIP Analysis of MELD and Perioperative Outcomes in General Surgery

2015 ◽  
Vol 81 (8) ◽  
pp. 755-759 ◽  
Author(s):  
Shannon M. Zielsdorf ◽  
John C. Kubasiak ◽  
Imke Janssen ◽  
Jonathan A. Myers ◽  
Minh B. Luu
Keyword(s):  
Liver Disease ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Postoperative Complication ◽  
General Surgery ◽  
Meld Score ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Umbilical Hernia Repair ◽  
The Mean

It is well known that liver disease has an adverse effect on postoperative outcomes. However, what is still unknown is how to appropriately risk stratify this patient population based on the degree of liver failure. Because data are limited, specifically in general surgery practice, we analyzed the model of end-stage liver disease (MELD) in terms of predicting postoperative complications after one of three general surgery operations: inguinal hernia repair (IHR), umbilical hernia repair (UHR), and colon resection (CRXN). National Surgical Quality Improvement Program data on 17,812 total patients undergoing one of three general surgery operations from 2008 to 2012 were analyzed retrospectively. There were 7402 patients undergoing IHR; 5014 patients undergoing UHR; 5396 patients undergoing CRXN. MELD score was calculated using international normalized ratio, total bilirubin, and creatinine. The primary end point was any postoperative complication. The statistical method used was logistic regression. For IHR, UHR, and CRXN, the overall complication rates were 3.4, 6.4, and 45.9 per cent, respectively. The mean MELD scores were 8.6, 8.5, and 8.5, respectively. For every 1-point increase greater than the mean MELD score, there was a 7.8, 13.8, and 11.6 per cent increase in any postoperative complication. The overall 30-day mortality rate was 0.9 per cent. In conclusion, the MELD score continuum adequately predicts patients’ increased risk of postoperative complications after IHR, UHR, and CRXN. Therefore, MELD could be used for preoperative risk stratification and guide clinical decision making for general surgery in the cirrhotic patient.

scholarly journals The Impact of Upper Airway Stimulation on Swallowing Function

2019 ◽  
Vol 98 (8) ◽  
pp. 496-499 ◽  
Author(s):  
Colin Huntley ◽  
Adam Vasconcellos ◽  
Michael Mullen ◽  
David W. Chou ◽  
Haley Geosits ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Swallowing Function ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep ◽  
The Mean ◽  
The Impact

Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

scholarly journals The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhihui Gao ◽  
Jie Wang ◽  
Sheng Shen ◽  
Xiaobo Bo ◽  
Tao Suo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Medical Center ◽  
Radical Resection ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Link Type ◽  
Study Population ◽  
The Impact

Abstract Background The efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and yet indications for PBD remain controversial. The aim of this study was to compare the postoperative morbidity and mortality in patients with malignant obstructive jaundice undergoing direct surgery versus surgery with PBD. Methods All consecutive patients with malignant obstructive jaundice who underwent radical resection between June 2017 and December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: PBD group (PG) and direct surgery group (DG). The subgroups were chosen based on the site of obstruction. Perioperative indicators and postoperative complications were compared and analyzed. Results A total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (46.4%). Patients in the PG group had a lower overall rate of postoperative complications compared with the DG group, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001–1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level > 162 μmol/L predicted postoperative complications. Conclusions PBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice. Trial registration ClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.

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