Association between Postoperative Complications and Reoperation for Patients Undergoing Geriatric Surgery and the Effect of Reoperation on Mortality

2012 ◽  
Vol 78 (10) ◽  
pp. 1137-1142 ◽  
Author(s):  
Warren B. Chow ◽  
Ryan P. Merkow ◽  
Mark E. Cohen ◽  
Karl Y. Bilimoria ◽  
Clifford Y. Ko
Keyword(s):  
Elderly Patients ◽  
Wound Dehiscence ◽  
Improvement Program ◽  
Surgical Quality ◽  
Risk Of Mortality ◽  
Pancreatic Resections ◽  
American College Of Surgeons ◽  
Reoperation Rates ◽  
Colorectal Resections ◽  
Preoperative Factors

Elderly patients have greater risk for postoperative adverse events (PAEs). The study examines the rates of reoperation, the association between PAEs and reoperation, and the effect of reoperation on mortality for patients 65 years of age or older undergoing colorectal resections (CRRs), pancreatic resections (PRs), and lower extremity bypass (LEB) in 2010 American College of Surgeons National Surgical Quality Improvement Program. The models evaluating associations between reoperation and preoperative factors, PAEs, and mortality were developed using multiple logistic regression. The reoperation rates were 6.41 per cent for CRR (n = 11,084), 6.79 per cent for PR (n = 1,606), and 15.04 per cent for LEB (n = 4,170). Preoperative factors predicting reoperation included indications for surgery, procedure category, emergency status, and systemic sepsis. The PAEs most strongly associated with reoperation were wound dehiscence for CRR (odds ratio [OR], 15.286; 95% confidence interval [CI], 11.035 to 21.175) and for PR (OR, 19.656; 8.677 to 44.531) and for LEB, graft failure (OR, 28.151; 18.030 to 43.954) and organ space surgical site infection (OR, 15.753; 6.938 to 35.711). Higher rates of mortality occurred with reoperation for patients undergoing CRR (16.88 vs 5.45%, P < 0.0001), PR (28.44 vs 2.14%, P < 0.0001), and LEB (6.22 vs 3.05%, P < 0.0001). For elderly patients undergoing general and vascular surgery, reoperation occurs frequently, is strongly associated with other PAEs, and may elevate risk of mortality for this vulnerable population.

scholarly journals Parathyroidectomy in Dialysis Patients: What is the Risk?

2016 ◽  
Vol 8 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Jamie E Anderson ◽  
Jennifer L Olson ◽  
Michael J Campbell
Keyword(s):  
Complication Rates ◽  
Dialysis Patients ◽  
Improvement Program ◽  
Surgical Quality ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
American College Of Surgeons ◽  
Surgical Evaluation ◽  
Cardiopulmonary Complications ◽  
Complications And Mortality

ABSTRACT Aims Patients with chronic kidney disease (CKD) on dialysis commonly develop hyperparathyroidism (HPT), but are often not referred for surgical evaluation because of the belief that the cardiopulmonary risks of a parathyroidectomy are prohibitively high. Previous studies have not adequately determined the surgical risks of parathyroidectomy in this population. Materials and methods We used the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 to evaluate risk of complications for dialysis vs nondialysis patients undergoing parathyroidectomy using univariate and multivariate logistic regressions. We also compared outcomes between dialysis patients undergoing parathyroidectomy and arteriovenous fistula (AVF) creation to understand the relative risk between these procedures. Results A total of 28,438 patients underwent parathyroidectomy; 1,833 (6.5%) were on dialysis. Among patients undergoing parathyroidectomy, unadjusted mortality and complication rates were higher for patients on dialysis compared to those not on dialysis (1.4% vs 0.1%, p < 0.001; 7.9% vs 1.4%, p < 0.001). Multivariate analysis found increased odds of mortality, all complications, and cardiopulmonary complications among patients on dialysis compared to those not on dialysis [odds ratio (OR) 5.28, p = 0.004; 2.10, p < 0.001; 5.14, p < 0.001]. When compared to patients undergoing parathyroidectomy, dialysis patients undergoing AVF had no difference in odds of death (p = 0.392) or cardiopulmonary complications (p = 0.138), but did have an increased risk of any complication (OR 1.66, p = 0.035). Conclusion Dialysis patients undergoing parathyroidectomy have an increased risk of cardiopulmonary complications and mortality compared to patients not on dialysis; however, these risks are similar to patients undergoing AVF creation. The risks of parathyroidectomy in dialysis patients are likely similar to other commonly performed procedures for dialysis patients. Clinical significance: The risk of mortality and complications should be discussed during informed consent with dialysis patients undergoing parathyroidectomy. These findings can also assist in preoperative risk assessments. How to cite this article Anderson JE, Olson JL, Campbell MJ. Parathyroidectomy in Dialysis Patients: What is the Risk? World J Endoc Surg 2016;8(3):193-198.

Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

2020 ◽  
Author(s):  
George A. Beyer ◽  
Karan Dua ◽  
Neil V. Shah ◽  
Joseph P. Scollan ◽  
Jared M. Newman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Extremity ◽  
Free Flap ◽  
Quality Improvement Program ◽  
Readmission Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Reoperation Rates

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

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