scholarly journals Complications of Spine Surgery in “Super Obese” Patients

2020 ◽  
pp. 219256822095339
Author(s):  
Gennadiy A. Katsevman ◽  
Scott D. Daffner ◽  
Nicholas J. Brandmeir ◽  
Sanford E. Emery ◽  
John C. France ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Complication Rate ◽  
Elective Surgery ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Control Group ◽  
Complication Rates ◽  
Obese Patients ◽  
Super Obese ◽  
Indications And Complications

Study Design: Retrospective chart review with matched control. Objective: To evaluate the indications and complications of spine surgery on super obese patients. Methods: A retrospective review assessed super obese patients undergoing spine surgery at a level-1 trauma and spine referral center from 2012 to 2016. Outcomes were compared to age-matched controls with body mass index (BMI) <50 kg/m2. The control group was further subdivided into patients with BMI <30 kg/m2 (normal) and BMI between 30 and 50 kg/m2 (obese). Results: Sixty-three super obese patients undergoing 86 surgeries were identified. Sixty patients (78 surgeries) were in the control group. Age and number of elective versus nonelective cases were not significantly different. Mean BMI of the super obese group was 55 kg/m2 (range 50-77 kg/m2) versus 29 kg/m2 in the controls (range 20-49 kg/m2). Fifty-two percent of surgeries were elective, and the most common indication was degenerative disease (39%). Compared with controls, super obese patients had a higher complication rate (30% [n = 19] vs 10% [N = 6], P = .0055) but similar 30-day mortality rate (5% vs 5%), a finding that was upheld when comparing super obese with each of the control group stratifications (BMI 30-50 and BMI <30 kg/m2). The most common complication among super obese patients was wound dehiscence/infection (n = 8, 13%); 2 patients’ surgeries were aborted. Complication rates for elective surgery were 21% (n = 7) for super obese patients and 4% (n = 1) for controls ( P = .121); complication rates for nonelective procedures were 40% (n = 12) and 14% (n = 5), respectively ( P = .023). Conclusion: The complication rate of spine surgery in super obese patients (BMI ≥ 50 kg/m2) is significantly higher than other patients, particularly for nonelective cases.

scholarly journals Intestinal Ostomies Created During Emergency Surgery Possess Unique Challenges

2020 ◽  
Author(s):  
Wibke Schulte ◽  
Ilhamiyya Aliyeva ◽  
Michael Knoop ◽  
Johann Pratschke
Keyword(s):  
Emergency Surgery ◽  
Online Survey ◽  
Elective Surgery ◽  
Surgical Care ◽  
Wound Dehiscence ◽  
University Hospital ◽  
Complication Rates ◽  
Emergency Patients ◽  
Artificial Opening

Abstract Background: The surgical creation of an artificial opening of the bowel, called ostomy, can become necessary for very different causative diseases. A special subgroup are ostomies created during emergency surgery, which pose particular challenges to affected patients. This work is dedicated to their detailed characterization.Methods: A retrospective analysis of surgical ostomy creations at an acute care university hospital and an online survey for patients with an ostomy were performed and evaluated.Results: In our study, about one third of all ostomies were created during emergency surgery (37.4%). Compared to patients who received an ostomy during elective surgery, emergency patients had a higher ASA score and diagnoses requiring acute surgical care. Patients undergoing emergency surgery were more likely to have inadequate preoperative medical education (60% vs. 33.3%, p=0.029), and rarely received preoperative ostomy marking (4% vs. 79.2%, p<0.001). Emergency patients underwent minimally invasive surgery less frequently (26.8% vs. 51.3%, p=0.001), and showed a higher rate of peristomal wound dehiscence (9.9% vs. 2.5%, p=0.028). Accordingly, emergency ostomies often resulted in an overall reduction in postoperative quality of life.Conclusion: Ostomies are often created during emergency surgery under suboptimal perioperative conditions. This results in higher complication rates and negative physical and psychological effects. Therefore, intensive interdisciplinary care is essential to provide the best possible care for patients affected by these artificially created intestinal outlets.

Prior bariatric surgery lowers complication rates following spine surgery in obese patients

2018 ◽  
Vol 160 (12) ◽  
pp. 2459-2465 ◽  
Author(s):  
Peter G. Passias ◽  
Samantha R. Horn ◽  
Dennis Vasquez-Montes ◽  
Nicholas Shepard ◽  
Frank A. Segreto ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Spine Surgery ◽  
Complication Rates ◽  
Obese Patients

scholarly journals Gynaecomastia correction: A review of our experience

2014 ◽  
Vol 47 (01) ◽  
pp. 56-60 ◽  
Author(s):  
Arvind Mohan ◽  
Muhammad Adil Abbas Khan ◽  
Karthik Srinivasan ◽  
Jeremy Roberts
Keyword(s):  
Complication Rate ◽  
Case Series ◽  
Wound Dehiscence ◽  
University Hospital ◽  
Minor Bleeding ◽  
Complication Rates ◽  
Male Population ◽  
Treatment Techniques ◽  
High Satisfaction ◽  
Superficial Wound

ABSTRACT Introduction: Gynaecomastia is a common problem in the male population with a reported prevalence of up to 36%. Various treatment techniques have been described but none have gained universal acceptance. We reviewed all gynaecomastia patients operated on by one consultant over a 7-year period to assess the morbidity and complication rates associated with the procedure. Materials and Methods: Clinical notes and outpatient records of all patients who underwent gynaecomastia correction at University Hospital North Staffordshire between 01/10/2001 to 01/10/2009 were retrospectively reviewed. A modified version of the Breast Evaluation Questionnaire was used to assess patients satisfaction with the procedure. Results: Twenty-nine patients and a total of 53 breasts were operated on during the study period. Patients underwent either liposuction alone (6 breasts - 11.3%), excision alone (37 breasts - 69.8%) or both excision and liposuction (10 breasts - 18.9%). Twelve operated breasts (22.6%) experienced some form of complication. Minor complications included seroma (2 patients), superficial wound dehiscence (2 patients) and minor bleeding not requiring theatre (3 patients). Two patients developed haematomas requiring evacuation in theatre. No cases of wound infection, major wound dehiscence or revision surgery were encountered. Twenty-six patients (89.7%) returned the patient satisfaction questionnaire. Patients scored an average 4.12 with regards comfort of their chest in different settings, 3.98 with regards chest appearance in different settings, and 4.22 with regards satisfaction levels for themselves and their partner/family. Overall complication rate was 22.6%. Grade III patients experienced the highest complication rate (35.7%), followed by grade II (22.7%) and grade I (17.6%). Overall complication rates among the excision only group was the highest (29.8%) followed by the liposuction only group (16.7%) and the liposuction and excision group (10.0%). There were high satisfaction rates amongst both patients and surgeon. Eleven patients (37.9%) had their outcome classified as ‘excellent’ by the operating surgeon, 16 patients (55.2%) as ‘good’, 1 (3.4%) as ‘satisfactory’ and 1(3.4%) as ‘poor’. Conclusion: Gynaecomastia is a complex condition which poses a significant challenge to the plastic surgeon. Despite the possible complications our case series demonstrates that outcomes of operative correction can be favourable and yield high levels of satisfaction from both patient and surgeon.

Evaluation of Cardiopulmonary Complication Rates after Port Insertion: Is a Postoperative X-Ray Needed?

2017 ◽  
Vol 83 (7) ◽  
pp. 778-779 ◽  
Author(s):  
Justin G. Vaughan ◽  
Allison B. Cauthen ◽  
Ahkeel Allen ◽  
Paul Dale
Keyword(s):  
Complication Rate ◽  
Cost Benefit Analysis ◽  
Financial Burden ◽  
Cost Benefit ◽  
Retrospective Chart Review ◽  
Chest Radiographs ◽  
Complication Rates ◽  
Port Placement ◽  
X Ray ◽  
Asymptomatic Patients

It is customary for a postoperative chest radiograph to be obtained after fluoroscopic guided port insertion to exclude acute complications. In this review, we provide a cost-benefit analysis by examination of acute postoperative complications detected by postoperative port insertion chest films at our institution. We conducted a retrospective chart review of complications associated with port insertion procedures performed over a 5-year period. Our study included only ultrasound-assisted internal jugular venous or landmark guided subclavian ports placed with the assistance of fluoroscopy. A total of 519 port insertions were reviewed and there was noted to be a postoperative complication rate of 0.58 per cent. The operative note for each complication described a procedural abnormality that suggested a chest film would be of medical benefit. The total price of postoperative chest radiographs was $179,400. Performing chest X-ray films on asymptomatic patients after fluoroscopic guided placement of ports proved to be of no medical advantage to 516 out of 519 patients. Given the extremely low complication rate and financial burden placed on the patient population, we propose discontinuing routine use of postoperative port placement chest radiographs as a way to alleviate unwarranted medical cost.

scholarly journals Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

2017 ◽  
Vol 26 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Ikemefuna Onyekwelu ◽  
Steven D. Glassman ◽  
Anthony L. Asher ◽  
Christopher I. Shaffrey ◽  
Praveen V. Mummaneni ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Lumbar Fusion ◽  
Lumbar Spine Surgery ◽  
Complication Rates ◽  
Obese Patients ◽  
Nonobese Patients

OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

Robotic Hysterectomy for Endometrial Cancer in Obese Patients With Comorbidities: Evaluating Postoperative Complications

2015 ◽  
Vol 25 (7) ◽  
pp. 1271-1276 ◽  
Author(s):  
Floor J. Backes ◽  
Maggie Rosen ◽  
Margaret Liang ◽  
Georgia A. McCann ◽  
Aine Clements ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Additional Patient ◽  
Complication Rates ◽  
Obese Patients ◽  
Robotic Hysterectomy ◽  
Nonobese Patients

ObjectivesThe objective of this study is to determine (1) if there is a relationship between increasing body mass index (BMI) and postoperative complications in patients undergoing robotic hysterectomy for endometrial cancer and (2) if there are additional patient characteristics, specifically preoperative comorbidities, which increase the risk of postoperative complicationMethodsA retrospective chart review was conducted on women who underwent a robotic staging surgery for endometrial cancer from 2006 to 2012. Basic demographics and preoperative and postoperative complications were extracted from the medical records. Obesity was divided into 4 categories, and complication rates were compared across these subgroups. Patients were also divided by the number of comorbidities and compared.ResultsThe cohort included 543 patients. The BMI ranged from 17.3 to 69.5 kg/m2. Three hundred eighty patients (70%) were obese (BMI >30 kg.m2). One hundred ninety patients (35%) had no comorbidities other than obesity, and 180 patients (33%) had only 1 comorbidity other than obesity (Table 1).Postoperative complications occurred in 102 (18.7%) of the patients. Severe postoperative complications, including intensive care unit admission, reintubation, reoperation, and perioperative death, occurred in 14 patients (2.6%). Of the nonobese patients, 27 (16.5%) had postoperative complications; of the obese patients, 75 (19.7%) had a complication (P = 0.38). In patients with no comorbidities, 16.3% had a complication; 18% of patients with 1 to 2 comorbidities had a complication, and 28% of patients with 3 or more comorbidities had a complication (P = 0.08).ConclusionsThe postoperative complication rate based on BMI or number of comorbidities was not statistically significant, but patients with greater number of comorbidities had an increased rate of postoperative complications. Patients with certain comorbidities, cardiac and renal specifically, had the highest rates of postoperative complications.

scholarly journals Ventriculoperitoneal shunt complications in an adult population: A comparison of various shunt designs to prevent overdrainage

2020 ◽  
Vol 11 ◽  
pp. 269
Author(s):  
Virendra Rajendrakumar Desai ◽  
Saeed Sam Sadrameli ◽  
Amanda V. Jenson ◽  
Samuel K. Asante ◽  
Bradley Daniels ◽  
...  
Keyword(s):  
Complication Rate ◽  
Adult Population ◽  
Retrospective Chart Review ◽  
Normal Pressure ◽  
Complication Rates ◽  
Related Complication ◽  
Hospital System ◽  
Proper Patient Selection ◽  
Ventriculoperitoneal Shunt Complications ◽  
Subgroup Analyses

Background: Overdrainage after cerebrospinal fluid diversion remains a significant morbidity. The hydrostatic, gravitational force in the upright position can aggravate this. Siphon control (SC) mechanisms, as well as programmable and flow regulating devices, were developed to counteract this. However, limited studies have evaluated their safety and efficacy. In this study, direct comparisons of the complication rates between siphon control (SC) and non-SC (NSC), fixed versus programmable, and flow- versus pressure regulating valves are undertaken. Methods: A retrospective chart review was performed over all shunt implantations from January 2011 to December 2016 within the Houston Methodist Hospital system. Complication rates within 6 months of the operative date, including infection, subdural hematoma, malfunction, and any other shunt-related complication, were analyzed via Fisher’s exact test, with P < 0.05 regarded as significant. Subgroup analyses based on diagnoses – normal pressure hydrocephalus (HCP), pseudotumor cerebri, or other HCP – were also performed. Results: The overall shunt-related complication rate in this study was 19%. Overall rates of infection, shunt failure, and readmission within 180 days were 3%, 11%, and 34%, respectively. No difference was seen between SC and NSC groups in any complication rate overall or on subgroup analyses. When comparing fixed versus programmable and flow- versus pressure-regulating valves, the latter in each analysis had significantly lower malfunction and total complication rates. Conclusions: Programmable and pressure regulating devices may lead to lower shunt malfunction and total complication rates. Proper patient selection should guide valve choice. Future prospective studies may further elucidate the difference in complication rates between these various shunt designs.

scholarly journals Improved capture of adverse events after spinal surgery procedures with a longitudinal administrative database

2015 ◽  
Vol 23 (3) ◽  
pp. 374-382 ◽  
Author(s):  
Anand Veeravagu ◽  
Tyler S. Cole ◽  
Tej D. Azad ◽  
John K. Ratliff
Keyword(s):  
Administrative Data ◽  
Spine Surgery ◽  
Wound Dehiscence ◽  
Administrative Databases ◽  
Administrative Database ◽  
Wound Complications ◽  
Complication Rates ◽  
Thomson Reuters ◽  
Specific Complication ◽  
Individual Complication

OBJECT The significant medical and economic tolls of spinal disorders, increasing volume of spine surgeries, and focus on quality metrics have made it imperative to understand postoperative complications. This study demonstrates the utility of a longitudinal administrative database for capturing overall and procedure-specific complication rates after various spine surgery procedures. METHODS The Thomson Reuters MarketScan Commercial Claims and Encounters and the Medicare Supplemental and Coordination of Benefits database was used to conduct a retrospective analysis of longitudinal administrative data from a sample of approximately 189,000 patients. Overall and procedure-specific complication rates at 5 time points ranging from immediately postoperatively (index) to 30 days postoperatively were computed. RESULTS The results indicated that the frequency of individual complication types increased at different rates. The overall complication rate including all spine surgeries was 13.6% at the index time point and increased to 22.8% at 30 days postoperatively. The frequencies of wound dehiscence, infection, and other wound complications exhibited large increases between 10 and 20 days postoperatively, while complication rates for new chronic pain, delirium, and dysrhythmia increased more gradually over the 30-day period studied. When specific surgical procedures were considered, 30-day complication rates ranged from 8.6% in single-level anterior cervical fusions to 27.3% in multilevel combined anterior and posterior lumbar spine fusions. CONCLUSIONS This study demonstrates the usefulness of a longitudinal administrative database in assessing postoperative complication rates after spine surgery. Use of this database gave results that were comparable to those in prospective studies and superior to those obtained with nonlongitudinal administrative databases. Longitudinal administrative data may improve the understanding of overall and procedure-specific complication rates after spine surgery.

scholarly journals Complications of Robotic Spine Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Daniel Myers ◽  
Gordon Mao ◽  
Alexander Kwong-Tak Yu ◽  
Donald M Whiting
Keyword(s):  
Pedicle Screw ◽  
Spine Surgery ◽  
Complication Rate ◽  
Surgical Complications ◽  
Surgical Complication ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Medical Complication ◽  
Complication Rates ◽  
Robotic Assisted

Abstract INTRODUCTION Robotic assisted spine surgery is becoming increasingly widespread during spinal instrumentation cases. We report our early experience utilizing robotic assisted spinal instrumentation. The aim of the study is to review complications experienced during robotic assisted spinal instrumentation including analysis of pedicle screw accuracy, medical, and surgical complications. METHODS This study was performed as a descriptive, retrospective study. We reviewed cases over the course of 12 mo and examined all operative and postoperative data including pedicle screw accuracy, medical, and surgical complications related to the surgery and hospital stay. Pedicle screw accuracy was assessed utilizing the Gertzbein–Robbins scale. RESULTS The study included 67 consecutive patients undergoing 68 robotic-assisted procedures. Patient ages ranged from 20 to 90 yr. There were 37 males and 30 females. Indications for surgery included degenerative disease 33, trauma 24, tumor 5, and infection 1. There were a total of 592 pedicle screws placed. A total of 26 (4.3%) screws were revised intraoperatively using the robot. An additional 32 (5.4%) screws were aborted from robotic assistance. Pedicle screw accuracy was noted to be excellent with 97% of screws rated as clinically acceptable. There were 4 deaths (5.8%), 18 patients (26%) experienced a medical complication, 26 patients (38%) experienced a surgical complication and 6 patients (9%) experienced both a medical and surgical complication. A total of 38 patients (55%) experienced any morbidity or mortality related to surgery. Mean operative time was 277 min. CONCLUSION We report our initial experience with robotic-assisted spine surgery. Pedicle screw accuracy was noted to be high. We experienced a broad array of medical and surgical complications. The high complication rate may be due to long operative times and presence of a learning curve utilizing the robot. Further study is warranted to note if more experience decreases complication rates. It is unclear if the complication rate is significantly different compared to traditional methods of spinal instrumentation.

scholarly journals Hand Corticosteroid Injections in Patients on “Blood Thinners”

Hand ◽  
2019 ◽  
Vol 15 (6) ◽  
pp. 837-841
Author(s):  
Ajith Malige ◽  
Kristofer S. Matullo
Keyword(s):  
Complication Rate ◽  
Treatment Modality ◽  
Chart Review ◽  
Adverse Reactions ◽  
Surgical Intervention ◽  
Corticosteroid Injection ◽  
Retrospective Chart Review ◽  
Complication Rates ◽  
Corticosteroid Injections

Background: Our study aims to identify any influence that anticoagulation and antiplatelet (“blood thinner”) medications have on hand and wrist corticosteroid injection complication rates. Methods: This retrospective chart review looked at patients between the ages of 18 and 89 years who received corticosteroid injections in the hand or wrist between 2013 and 2017, noting anticoagulation and antiplatelet use, demographics, injection placement, and surgical intervention. Results: Only 152 (20.9%) of the 726 diagnoses that were treated needed eventual surgical intervention. There were 12 overall reported complications after 1473 injections (0.8%). There were 6 complications after 433 injections (1.6%) placed in patients on blood thinners and 6 complications after 1040 injections (0.6%) placed in patients not on blood thinners. Conclusions: With the complication rate of corticosteroid injections being so low, even in patients taking “blood thinners,” the fear of adverse reactions should not preclude a physician from using this treatment modality to prevent surgical intervention.

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