scholarly journals INTRAOPERATIVE NEUROMONITORING DURING SURGICAL CORRECTION OF SPRENGEL’S DEFORMITY

2020 ◽  
Vol 33 (33) ◽  
pp. 53-57
Author(s):  
Agata Maria Kaczmarek ◽  
Juliusz Huber ◽  
Przemysław Daroszewski ◽  
Maciej Zbigniew Głowacki ◽  
Agnieszka Szymankiewicz-Szukała ◽  
...  
Keyword(s):  
Motor Evoked Potentials ◽  
Perioperative Complications ◽  
Nerve Impulse ◽  
Normal Activity ◽  
Surgical Correction ◽  
Efferent Nerve ◽  
Strong Point ◽  
Sprengel’S Deformity ◽  
Increased Risk ◽  
Iatrogenic Damage

Introduction Neuromonitoring (IOM) is a procedure for verification of the nerve impulse transmission along structures of central and peripheral nervous system during surgical procedures. Motor evoked potentials (MEPs) recordings from muscles induced with electrical pulses transcranially to motor cortex centers are especially useful during the surgery with an increased risk of iatrogenic damage to efferent nerve structures. Aim of the study The aim of this report is to present the scenario of the reversible inhibition in pathways transmitting nerve impulses during surgical correction of Sprengel’s deformity with the assessment of IOM. Material and methods Nine-year old girl was admitted to the hospital due to congenital high scapula. Corrective surgery was performed using the Woodward technique with an assessment of IOM. Results The amplitudes and latencies of the MEPs from muscles of upper right extremity were recorded as decreased and increased, respectively at about 20% during the final fixation of scapula. Thanks to these recordings surgeons could prevent the permanent damage of the brachial plexus fibers, by partial releasing of applied sutures. After surgery and subsequent rehabilitation the patient returned to the normal activity in right upper extremity. Association of electromyography and MEPs results helped with ordering and controlling the course of treatment. Conclusions The benefit of IOM relay on the safety of orthopedic surgery and decreasing the number of iatrogenic perioperative complications. This diagnostic procedure is also a strong point for argumentation in hospital administration during negotiations with lawyer representing the patient when iatrogenic complication appear.

Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome

2021 ◽  
pp. 155633162110148
Author(s):  
Philipp Gerner ◽  
Stavros G. Memtsoudis ◽  
Crispiana Cozowicz ◽  
Ottokar Stundner ◽  
Mark Figgie ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Selection Criteria ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Rate Ratios

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

Breast Reconstruction Completion in the Obese: Does Reconstruction Technique Make a Difference in Its Achievement?

2021 ◽  
Author(s):  
Christine Velazquez ◽  
Robert C. Siska ◽  
Ivo A. Pestana
Keyword(s):  
Breast Reconstruction ◽  
Perioperative Complications ◽  
Major Complication ◽  
Normal Body Mass Index ◽  
Reconstruction Technique ◽  
Autologous Reconstruction ◽  
Obese Women ◽  
Areolar Complex ◽  
Obese Female ◽  
Increased Risk

Abstract Background Breast mound and nipple creation are the goals of the reconstructive process. Unlike in normal body mass index (BMI) women, breast reconstruction in the obese is associated with increased risk of perioperative complications. Our aim was to determine if reconstruction technique and the incidence of perioperative complications affect the achievement of reconstruction completion in the obese female. Methods Consecutive obese women (BMI ≥30) who underwent mastectomy and implant or autologous reconstruction were evaluated for the completion of breast reconstruction. Results Two hundred twenty-five women with 352 reconstructions were included. Seventy-four women underwent 111 autologous reconstructions and 151 women underwent 241 implant-based reconstructions. Chemotherapy, radiation, and delayed reconstruction timing was more common in the autologous patients. Major perioperative complications (requiring hospital readmission or unplanned surgery) occurred more frequently in the implant group (p ≤ 0.0001). Breast mounds were completed in >98% of autologous cases compared with 76% of implant cases (p ≤ 0.001). Nipple areolar complex (NAC) creation was completed in 57% of autologous patients and 33% of implant patients (p = 0.0009). The rate of successfully completing the breast mound and the NAC was higher in the autologous patient group (Mound odds ratio or OR 3.32, 95% confidence interval or CI 1.36–5.28 and NAC OR 2.7, 95% CI 1.50–4.69). Conclusion Occurrence of a major complication in the implant group decreased the rate of reconstruction completion. Obese women who undergo autologous breast reconstruction are more likely to achieve breast reconstruction completion when compared with obese women who undergo implant-based breast reconstruction.

scholarly journals Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

2021 ◽  
Author(s):  
Alexander Younsi ◽  
Lennart Riemann ◽  
Cleo Habel ◽  
Jessica Fischer ◽  
Christopher Beynon ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Perioperative Complications ◽  
Chronic Subdural Hematoma ◽  
Western Society ◽  
Increased Risk ◽  
Surgical Evacuation ◽  
Antithrombotic Medication ◽  
Univariate Analyses

AbstractIn an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.

scholarly journals For the 30th anniversary of laparoscopic cholecystectomy: problems remain

2019 ◽  
Vol 100 (3) ◽  
pp. 537-541
Author(s):  
I V Fedorov ◽  
A N Chugunov ◽  
L E Slavin ◽  
D A Slavin ◽  
V I Fedorov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Ducts ◽  
Perioperative Complications ◽  
Open Cholecystectomy ◽  
Intrahepatic Bile Ducts ◽  
Negative Effect ◽  
Iatrogenic Damage ◽  
Extrahepatic Bile Ducts ◽  
Legal Costs

The review describes perioperative complications of laparoscopic cholecystectomy. Over the past 30 years, laparoscopy has become the «gold standard» for cholecystectomy and one of the most frequently performed procedures in abdominal surgery. Nevertheless, despite the advantages of the method, it has an «Achilles heel» - the frequency of iatrogenic damage to the extrahepatic bile ducts is 3-5 times higher than with an open cholecystectomy. This complication has a negative effect on the survival of patients after surgery, leads to deterioration in the quality of life and is a major source of legal costs in many countries. In general, the total range for any damage to the biliary tract during laparoscopic cholecystectomy is 0.32-0.52%, while the complication rate and mortality rate are 1.6-5.3% and 0.08-0.14%, respectively. Patients who have undergone a complete intersection of the hepaticoholedochus, become «bile cripples» for life. Recurrent cholangitis, strictures of anastomoses with a possible outcome in liver cirrhosis are quite likely in later periods after damage to the intrahepatic bile ducts. Technological efforts to improve the results of laparoscopic cholecystectomy reside. These include the routine use of intraoperative cholangiography, infrared fluorescent cholangiography, etc. Nevertheless, despite the growing number of methods designed to reduce these complications, evidence of their effectiveness remains limited. The most important factors ensuring the safety of laparoscopic cholecystectomy are recognized: understanding of anatomy, adequate exposure when using electrosurgery, psychological readiness to invite a senior colleague in time for help, the ability to recognize a situation that requires conversion and rejection of laparoscopy.

Outcomes After Noncardiac Surgery For Patients With Pulmonary Hypertension: A Historical Cohort Study

2019 ◽  
Author(s):  
Juraj Sprung ◽  
Atousa Deljou ◽  
Moldovan Sabov ◽  
Garvan C Kane ◽  
Robert P. Frantz ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cohort Study ◽  
Functional Status ◽  
Perioperative Complications ◽  
Elevated Serum ◽  
Noncardiac Surgery ◽  
Historical Cohort ◽  
Surgical Risk ◽  
Perioperative Morbidity ◽  
Increased Risk

Abstract Abstract Background: Pulmonary hypertension (PH) is a significant preoperative risk factor. We aimed to determine predictors of perioperative morbidity and mortality after noncardiac surgery for patients with precapillary PH. Methods: We conducted a retrospective cohort study of adults with pulmonary hypertension having surgery at a single large medical referral center. The PH and surgical databases were reviewed from 2010 to 2017. Patients were excluded if PH was attributable to left-sided heart disease or they had undergone cardiac or transplant operations. To assess whether PH-specific diagnostic or cardiopulmonary testing parameters were predictive of perioperative complications, analyses were performed using generalized estimating equations. Results: Of 196 patients with PH undergoing noncardiac operations, 53 (27%) experienced 1 or more complications, including 5 deaths (3%) within 30 days. After adjustment for age and PH type, there were more complications in those undergoing moderate-to-high vs low-risk procedures (odds ratio [OR], 4.17 [95% CI, 2.07 to 8.40]; P<0.001). After adjustment for age, surgical risk, and PH type, the risk for complications was higher for patients with worse functional status (OR, 2.39 [95% CI, 1.19 to 4.78]; P=0.01 for class 3/4 vs class 1/2) and elevated serum N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) (OR, 2.28 [95% CI, 1.05 to 4.96]; P=0.04 for ≥300 vs. <300 pg/mL). From an analysis that included covariates for age, surgical risk, and functional status, elevated serum NT-proBNP levels remained associated with increased risk (OR, 2.23 [95% CI, 1.05 to 4.76]; P=0.04). Conclusions: Patients with PH undergoing noncardiac surgery with general anesthesia have a high frequency of perioperative complications. Specific clinical (functional status), diagnostic (serum NT-proBNP), and intraoperative factors (higher-risk surgery) are predictive of worse outcomes.

Surgical correction of Sprengel’s deformity by modified Woodward procedure: outcomes in twenty eight patients

2020 ◽  
Vol 44 (6) ◽  
pp. 1143-1151
Author(s):  
Sandeep Patwardhan ◽  
Vivek Sodhai ◽  
Sunny Gugale ◽  
Parag Sancheti ◽  
Ashok Shyam
Keyword(s):  
Surgical Correction ◽  
Sprengel’S Deformity ◽  
Woodward Procedure

scholarly journals Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion

2019 ◽  
Vol 10 (7) ◽  
pp. 851-855
Author(s):  
Young Lu ◽  
Charles C. Lin ◽  
Hayk Stepanyan ◽  
Andrew P. Alvarez ◽  
Nitin N. Bhatia ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Resource Utilization ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Nationwide Inpatient Sample Database ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
The Impact

Study Design: Retrospective large database study. Objective: To determine the impact of cirrhosis on perioperative outcomes and resource utilization in elective spinal fusion surgery. Methods: Elective spinal fusion hospitalizations in patients with and without cirrhosis were identified using ICD-9-CM codes between the years of 2009 and 2011 using the Nationwide Inpatient Sample database. Main outcome measures were in-hospital neurologic, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, wound-related complications, and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients with and without cirrhosis undergoing spinal fusion. Results: A total of 1 214 694 patients underwent elective spinal fusions from 2009 to 2011. Oh these, 6739 were cirrhotic. Cirrhosis was a significant independent predictor for respiratory (odds ratio [OR] = 1.43, confidence interval [CI] 1.29-1.58; P < .001), gastrointestinal (OR = 1.72, CI 1.48-2.00; P < .001), urinary and renal (OR = 1.90, CI 1.70-2.12; P < 0.001), wound (OR = 1.36, CI 1.17-1.58; P < 0.001), and overall inpatient postoperative complications (OR = 1.43, CI 1.33-1.53; P < .001). Cirrhosis was also independently associated with significantly greater inpatient mortality (OR = 2.32, CI 1.72-3.14; P < .001). Cirrhotic patients also had significantly longer lengths of stay (5.35 vs 3.35 days; P < .001) and inpatient costs ($36 738 vs $29 068; P < .001). Conclusions: Cirrhosis is associated with increased risk of perioperative complications, mortality and greater resource utilization. Cirrhotic patients undergoing spinal fusion surgeries should be counseled on these increased risks. Current strategies for perioperative management of cirrhotic patients undergoing spinal fusion surgery need improvement.

scholarly journals SPRENGEL'S DEFORMITY: SURGICAL CORRECTION BY A MODIFIED GREEN PROCEDURE

2009 ◽  
Vol 44 (3) ◽  
pp. 208-213 ◽  
Author(s):  
Sandro da Silva Reginaldo ◽  
Ruy Rocha de Macedo ◽  
Rogério de Andrade Amaral ◽  
André Luiz Passos Cardoso ◽  
Helder Rocha Silva Araújo ◽  
...  
Keyword(s):  
Surgical Correction ◽  
Sprengel’S Deformity ◽  
Green Procedure

Outcomes of Pulmonary Endarterectomy Operation Concomitant with Cardiac Procedures

2020 ◽  
Author(s):  
Hasan Erdem ◽  
Oktay Korun ◽  
Mehmed Yanartaş ◽  
Serpil Taş ◽  
Benay Erden ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Artery Bypass ◽  
Characteristic Curve ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Endarterectomy ◽  
Cardiac Procedures ◽  
Increased Risk ◽  
Complex Procedure ◽  
Thromboembolic Pulmonary Hypertension ◽  
Hospital Stays

Abstract Background The aim of this study was to analyze the results of pulmonary endarterectomy (PEA) performed simultaneously with additional cardiac procedures in a single tertiary-level center. Methods Data of patients who underwent PEA with additional cardiac procedures for chronic thromboembolic pulmonary hypertension (CTEPH) in our clinic were retrospectively reviewed using patient records. Results Between March 2011 and April 2019, 56 patients underwent PEA with additional cardiac surgery. The most common additional procedure was coronary artery bypass grafting (21 patients; 38%). The median intensive care unit and hospital stays were 4 (3–6) days and 10 (8–14) days. Mortality was recorded in six patients (11%). In multivariate analysis, only preoperative pulmonary vascular resistance (PVR) (p = 0.02; odds ratio [OR]: 1.003) and cardiopulmonary bypass duration (p = 0.02; OR: 1.028) were associated with mortality. When the cutoff value of 1000 dyn.s.cm−5 was taken in the receiver operating characteristic curve analysis, preoperative PVR predicted mortality with 83% sensitivity and 94% specificity (area under curve = 0.89; p < 0.01). Conclusion PEA for CTEPH may be performed safely with other cardiac operations. This type of surgery is a complex procedure that should be performed only in expert centers. Patients with high preoperative PVR are at increased risk of perioperative complications.

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