scholarly journals The Analysis of the Intraoperative Complications During the Transitional Period from In-patient Cataract Surgery to Ambulatory Day Surgery

2021 ◽  
Author(s):  
Bu Shaochong ◽  
Li Xiao-Rong ◽  
Zhao Shaozhen ◽  
Li Mengran ◽  
Feng Qing ◽  
...  
Keyword(s):  
Clinical Audit ◽  
Intraoperative Complications ◽  
Day Surgery ◽  
Transitional Period ◽  
Contributing Factors ◽  
Intraoperative Complication ◽  
Model Method ◽  
Patient Model ◽  
Capsular Rupture ◽  
Safety Recommendation

Abstract Purpose: To report the incidence of posterior capsular rupture (PCR) of phacoemulsification and the contributing factors during the transitional period from in-patient model to ambulatory day surgery model. Method: The medical records and intraoperative complication reports were systemically reviewed during the period of August 2015 to October 2020. The PCR rate was analyzed according to the following factors: type of surgery (day surgery vs. in-patient surgery), gender, age, surgery performed in the month containing long holiday (Chinese New Year and National day), surgery performed in the first month of the residents’ rotation, increase of surgical volume comparing to the previous month, stage of the day surgery transition and whether it was before or after the implementation of safety recommendation based on clinical audit results in January 2018. The univariable logistic regression model was initially performed.Results: Within the study period, 29 493 cases of phacoemulsification surgery were enrolled in the study, 14 451 of them were performed as day surgery while 15 042 of them were inpatient surgery. The overall incidence of PCR was 1.17% (346 cases) among the 29 493 planned phacoemulsification surgery. The increase incidence of PCR was associated with older age and male gender. The incidence of PCR decreased significantly after the implementation of safety recommendations. Conclusion: The ambulatory day surgery for cataract patients could provide safe, efficient, and quality services. During the transitional period from in-patient to day surgery, careful planning and organization with dynamic clinical audit surveillance can further reduce the incidence of intraoperative complications, especially intraoperative PCR.

scholarly journals A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

2021 ◽  
pp. 014556132110257
Author(s):  
Dongho Shin ◽  
Andrew Ma ◽  
Yvonne Chan
Keyword(s):  
Retrospective Study ◽  
Teaching Hospital ◽  
Intraoperative Complications ◽  
Percutaneous Tracheostomy ◽  
Hospital Setting ◽  
Complication Rates ◽  
Safe Alternative ◽  
Neck Extension ◽  
Intraoperative Complication ◽  
Community Teaching

Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Conclusion: Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

scholarly journals Usefulness of Surgical Media Center as a Cataract Surgery Educational Tool

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Tomoichiro Ogawa ◽  
Takuya Shiba ◽  
Hiroshi Tsuneoka
Keyword(s):  
Cataract Surgery ◽  
Surgical Procedures ◽  
Intraoperative Complications ◽  
Recording Device ◽  
Educational Tool ◽  
Intraoperative Complication ◽  
Vacuum Level ◽  
Media Center ◽  
Medical Optics ◽  
Education Tool

Purpose.This study retrospectively analyzed cataract surgeries to examine the usefulness of Surgical Media Center (SMC) (Abbott Medical Optics Inc.), a new cataract surgery recording device, for training of cataract surgery.Methods.We studied five hundred cataract surgeries conducted with a phacoemulsification system connected to the SMC. After surgery, the surgical procedures were reviewed, with changes in aspiration rate, vacuum level, and phaco power displayed as graphs superimposed on the surgical video. We examined whether use of SMC is able to demonstrate the differences in technique between experienced and trainee operators, to identify inappropriate phacoemulsification techniques from analyzing the graphs, and to elucidate the cause of intraoperative complications.Results. Significant differences in the time taken to reach maximum vacuum and the speed of increase in vacuum during irrigation and aspiration were observed between experienced and trainee operators. Analysis of the graphs displayed by SMC detected inappropriate phacoemulsification techniques mostly in cases operated by trainee operators.Conclusions. Using SMC, it was possible to capture details of cataract surgery objectively. This recording device allows surgeons to review cataract surgery techniques and identify the cause of intraoperative complication and is a useful education tool for cataract surgery.

scholarly journals Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Yu Jeong Kim ◽  
Su Jin Park ◽  
Jong Yeon Lee ◽  
Dae Yeong Lee ◽  
Dong Heun Nam
Keyword(s):  
Cataract Surgery ◽  
Intraoperative Complications ◽  
Case Series ◽  
The Elderly ◽  
Posterior Capsule ◽  
Anterior Capsule ◽  
Intraoperative Complication ◽  
Surgery Group ◽  
Posterior Capsule Rupture ◽  
Capsule Rupture

Purpose. To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design. A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods. A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures. Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results. The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions. In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

scholarly journals A new three-step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retrospective cohort

Hernia ◽  
2020 ◽  
Author(s):  
L. Matthijs van den Dop ◽  
Gijs H. J. de Smet ◽  
Michaël P. A. Bus ◽  
Johan F. Lange ◽  
Sascha M. P. Koch ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Intraoperative Complication ◽  
Hybrid Repair

Abstract Purpose In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives To evaluate first perioperative outcomes with this technique. Methods From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.

scholarly journals Factors Associated with Cataract Surgical Outcomes in a Tertiary Health Facility in Oyo State, Nigeria: A Retrospective Study

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Abiola T. Owolabi ◽  
Susannah T. Adepoju ◽  
Olawale Oladejo ◽  
Kunle I. Oreagba
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Goodness Of Fit ◽  
Intraoperative Complications ◽  
Visual Outcome ◽  
Sub Saharan Africa ◽  
P Value ◽  
Goodness Of Fit Test ◽  
Intraoperative Complication ◽  
Factors Associated

Background: Cataract surgery is the most common operation performed in ophthalmology. It is the commonest cause of reversible blindness globally, in Sub-Saharan Africa and Nigeria. The study examined some factors affecting the outcome of cataracts surgery measured by Visual acuity after 6 weeks. Methods: Data was collected from the records of ophthalmic patients who had cataract surgery at LAUTECH Teaching Hospital Ogbomoso, from the period of January 2013 to December 2018. Two hundred and twenty-seven patients’ records were retrieved for the study. Logistic Regression was used to investigate factors associated with the outcome of Cataracts Surgery. The goodness of fit test was used to determine the fit of the model to the data. Results: Two variables; intraoperative complication, and unaided visual acuity on the fir st postoperative day were statistically significant (p-value < 0.05). The outcome of surgery using unaided visual acuity after six weeks of surgery showed that 47.1% of the patients had a good visual outcome (6/18) or better and 52.9% had a poor outcome (worse than 6/60). Factors such as complications within six weeks, presence of ocular and systemic comorbidity, and presence of intraoperative complications were found to increase the likelihood of poor outcomes in cataract surgery. Conclusion: This study has shown that Intraoperative complications and unaided visual acuity on the first postoperative day are important to the outcome of cataract surgery. Therefore, the two factors should be given attention during cataract surgery

scholarly journals Surgical Outcome of Posterior Polar Cataract in Adults

2019 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Visual Acuity ◽  
Intraoperative Complications ◽  
Anterior Segment ◽  
Descriptive Study ◽  
Slit Lamp ◽  
Special Challenge ◽  
Male Patients ◽  
Capsular Rupture ◽  
Surgery Incidence ◽  
Posterior Polar Cataract

Introduction: Posterior polar cataract (PPC) is a relatively uncommon form of congenital cataract accounting for around 0.5% to 2% of the total cataract. A posterior polar cataract presents a special challenge to the phaco surgeon because of its predisposition to posterior capsular dehiscence during surgery. Incidence of posterior polar cataract ranges from 3 to 5 in 1000. Methodology: Prospective descriptive study done at Biratnagar Eye Hospital from December 2016 to March 2017. A detailed slit-lamp biomicroscopy of the anterior segment, intraocular pressure and dilated fundus examination was performed in all patients after checking for visual acuity and refraction. Result: Total of 60 eyes of 59 patients was included in the study, out of which only 5% had posterior capsular rupture during surgery. Mean age of patients in our study was 49.35 +_ 9.5yrs (range 35-73yrs). There were 34 male patients and 26 female patients. Mean axial length was 23.40mm. Out of 60 eyes, 12 eyes had bilateral posterior polar cataract. Mean preoperative visual acuity was 0.949 while first post-operative day visual acuity was 0.5137, which was statistically significant (P < 0.0001) (paired t test). Conclusion: Intraoperative complications during posterior polar cataract surgery can be minimized by careful and appropriate surgical procedure.

scholarly journals Iris manipulation during phacoemulsification: intraoperative and postoperative complications

2021 ◽  
Vol 14 (5) ◽  
pp. 676-683
Author(s):  
Eric R. Williams ◽  
◽  
D. Claire Miller ◽  
Anne M. Lynch ◽  
Richard S. Davidson ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Cataract Extraction ◽  
Exclusion Criteria ◽  
Intraoperative Complication ◽  
Postoperative Inflammation ◽  
University Of Colorado ◽  
Additional Surgery ◽  
The University ◽  
Complex Cases

AIM: To quantify intraoperative and postoperative complications in complex phacoemulsification cataract extraction (phacoemulsification) with iris manipulation compared to non-complex and complex phacoemulsification without iris manipulation. METHODS: All phacoemulsification cases at the University of Colorado between January 1, 2014, and June 30, 2017 were included. Exclusion criteria for the primary outcome of intraoperative complications were planned combination surgery and eyes with less than 28d follow-up. Exclusion criteria for the secondary outcomes of postoperative complications were unplanned additional surgery, and chronic steroid eye drop use prior to surgery. Data including sex, race/ethnicity, surgery length, visual acuity, intraoperative and postoperative complications, and intraocular pressures (IOP) were collected and analyzed utilizing general linear and Logistic regression modeling. RESULTS: The medical records of 5772 eyes were reviewed (500 complex without iris manipulation, 367 with iris manipulation). The number of any intraoperative complication in the complex with iris manipulation and complex without iris manipulation groups was 15 (4.1%) and 26 (5.2%), respectively, compared to 41 (0.8%) in the non-complex group. Postoperative inflammation was found in 135 (2.8%) non-complex cases, 20 (4.1%) complex cases without iris manipulation, and 20 (5.6%) complex cases with iris manipulation. The adjusted odds ratio of postoperative inflammation in phacoemulsification with iris manipulation compared to non-complex was 2.3 (95%CI: 1.3-4.0, P=0.005). The rate of IOP spikes &#x003E;10 mm Hg was significantly greater in cases with iris manipulation (P=0.001). CONCLUSION: Complex cases have more intraoperative complications. However, only complex cases with iris manipulation led to increase rates of postoperative inflammation and IOP spikes &#x003E;10 mm Hg.

scholarly journals Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thanasit Prakobpon ◽  
Apirak Santi-ngamkun ◽  
Manint Usawachintachit ◽  
Supoj Ratchanon ◽  
Dutsadee Sowanthip ◽  
...  
Keyword(s):  
Tumor Size ◽  
Adrenal Tumor ◽  
Intraoperative Complications ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Transfusion Rate ◽  
Intraoperative Complication ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Laparoscopic Transperitoneal

Abstract Background The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors. Methods We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. Results Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22–22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48–12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. Conclusions Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor. Trial registration: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.

scholarly journals USE OF THREE-DIMENSIONAL ENDOSCOPY IN ENDONASAL AND ANTERIOR SKULL BASE SURGERY

2021 ◽  
Author(s):  
Amr Kholief ◽  
Ahmed Youseef ◽  
Ahmed Ibrahim ◽  
Samy Elwany ◽  
Shahz Ahmed
Keyword(s):  
Clinical Study ◽  
Skull Base ◽  
Surgical Procedures ◽  
Skull Base Surgery ◽  
Intraoperative Complications ◽  
Three Dimensional ◽  
Anterior Skull Base ◽  
Anatomical Landmarks ◽  
Intraoperative Complication ◽  
3D Endoscope

Objectives: The three dimensional (3D) endoscope is considered as a new surgical tool which used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of the 3D endoscopy over the two dimensional (2D) one that have been demonstrated along clinical applications, surgical training and different experimental studies. Our study aimed to show the difference between using the 3D & 2D endoscopes during endonasal and anterior skull base surgery and its importance specially when used by novice users. Design: Our study is divided into two phases (clinical & cadaveric phases).In the clinical study we have done 52 endonasal & anterior skull base surgical procedures (26 study cases and 26 control cases).We recorded accuracy, duration and intraoperative complication for each case. The cadaveric study was performed on three cadavers, difference in accuracy and dissection time were recorded using 3D & 2D endoscopy for each side chosen by randomization. Results: In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared to cases done using 2D endoscope. In cadaveric dissection while using 3D endoscope there was better depth of perception regarding the anatomical landmarks compared to 2D endoscope. Conclusion: 3D endoscopy is an advanced instrument that allows better training for the coming generation of ENT surgeons. Both clinical and cadaveric studies offer a promising outcomes in both endonasal and anterior skull base surgery.

scholarly journals Complications of robot-assisted and laparoscopic partial nephrectomy

2021 ◽  
Vol 17 (2) ◽  
pp. 34-45
Author(s):  
S. A. Rakul ◽  
K. V. Pozdnyakov ◽  
R. A. Eloev
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Laparoscopic Approach ◽  
High Complexity ◽  
Robot Assisted ◽  
Kidney Tumors ◽  
Intraoperative Complication ◽  
Grade Ii

Objective: to analyze complications after laparoscopic and robotic-assisted partial nephrectomy.Materials and methods. In our study was included 246 cases. Intra- and postoperative complications were studied after nephron-sparring surgery. The laparoscopic approach was used in 68 (27.3 %) cases, the robot-assisted - in 178 (71.5 %) cases. Intraoperative complications were assessed according to the Rosenthal classification, postoperative complications - according to the Clavien-Dindo classification.Results. The overall incidence of intraoperative complications was 12.6 %. The most frequent intraoperative complication was bleeding that did not require blood transfusion (grade I) - 5.69 % (laparoscopic approach - in 3 (4.41 %) cases, robot-assisted approach - in 11 (6,18 %) cases). Bleeding requiring blood transfusion and injuries of internal organs, which were restored intraoperatively (grade II), were recorded in laparoscopic and robot-assisted approaches in 4.41 % and 2.25 % of cases, respectively. Complications leading to the loss of organ (nephrectomy, splenectomy) were observed in 2.94 % and 4.49 % of cases, respectively. Intraoperative deaths (grade IV) were not registered.The incidence of postoperative complications was 18.29 %. Minor complications (Clavien-Dindo ≤II) were detected in 16 (6.5 %) patients (laparoscopic approach - 7.35 %, robot-assisted approach - 6.18 %). Serious complications (Clavien-Dindo ≥III) were detected in 29 (11.79 %) cases (with laparoscopic approach - 14.71 %, robot-assisted - 10.67 %). In the group of tumors with the RENAL index 4-6, the incidence of postoperative complications was 14.7 % with the laparoscopic approach, and 7.1 % with the robot-assisted approach; in the RENAL 7-9 group - 21.9 % and 13.0 %, respectively. In the group of tumors of high complexity (RENAL 10-12), only the robot-assisted approach was used, the incidence of postoperative complications was 22.0 %.Conclusion. Partial nephrectomy for kidney tumors is an effective and safe surgical technique. The incidence of complications when using the laparoscopic approach is higher than when using the robot-assisted technique in groups of tumors of simple and medium complexity. For tumors of high complexity, robot-assisted approach is a priority. The largest number of serious complications is observed with partial nephrectomy with complex tumors.

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