Safety of surgical tracheostomy under continued antithrombotic therapy

Abstract Objective: Although various guidelines have been established for the management of antithrombotic therapy during surgical treatments, surgical tracheostomy (ST) under continued antithrombotic therapy (CAT) remains a challenge. We investigated the risk factors for complications after ST by focusing on CAT use during ST. Method: Patients’ medical records from 2009 to 2020 were reviewed in this retrospective study. We selected patients who underwent ST at the Department of Otolaryngology of the University of Tokyo Hospital. Patient demographics, complications, and blood test values were recorded and statistically analyzed to identify the risk factors for postoperative complications. Results: We identified 288 patients (median age: 64 years; 184 men [64%]), among whom 40 (median age: 67 years; 29 men [73%]) underwent CAT. Although the patients undergoing CAT had significantly higher values of activated partial thromboplastin time (p = 0.002) and prothrombin time-international normalized ratio (p = 0.006) than those of antithrombotic naïve patients, no statistically significant intergroup differences were observed in the risks of bleeding, infection, or subcutaneous emphysema. Instead, ST under local anesthesia (p = 0.01) and ST for airway emergency (p = 0.02) significantly increased the risk of early postoperative complications. Conclusion: The results of the present study suggest that ST under CAT can be safely performed without any increased risk of postoperative complications. Nevertheless, surgeons should be extra cautious about early complications after ST under local anesthesia without intubation or ST for airway emergency. Key points: 1. We aimed to investigate the risk factors for complications after ST by focusing on CAT use during ST. 2. Patients undergoing CAT had significantly higher values of APTT and PT-INR than those of antithrombotic naïve patients. 3. ST under CAT can be safely performed without any increased risk of postoperative complications. 4. ST under local anesthesia and airway emergency was a risk factor for complications after ST. 5. Among the complications, subcutaneous emphysema was significantly more frequent in ST under local anesthesia and under airway emergency.

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Risk factors and outcomes of postoperative emergency response team activation: a matched case-control study

Critical Care and Resuscitation ◽

10.51893/2020.1.oa1 ◽

2020 ◽

Vol 22 (1) ◽

pp. 6-14

Author(s):

Matthew I Hardman ◽

◽

S Chandralekha Kruthiventi ◽

Michelle R Schmugge ◽

Alexandre N Cavalcante ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Postoperative Complications ◽

Emergency Response ◽

Case Control Study ◽

Case Control ◽

Multiple Logistic Regression ◽

Increased Risk ◽

Response Team ◽

Control Study

OBJECTIVE: To determine patient and perioperative characteristics associated with unexpected postoperative clinical deterioration as determined for the need of a postoperative emergency response team (ERT) activation. DESIGN: Retrospective case–control study. SETTING: Tertiary academic hospital. PARTICIPANTS: Patients who underwent general anaesthesia discharged to regular wards between 1 January 2013 and 31 December 2015 and required ERT activation within 48 postoperative hours. Controls were matched based on age, sex and procedure. MAIN OUTCOME MEASURES: Baseline patient and perioperative characteristics were abstracted to develop a multiple logistic regression model to assess for potential associations for increased risk for postoperative ERT. RESULTS: Among 105 345 patients, 797 had ERT calls, with a rate of 7.6 (95% CI, 7.1–8.1) calls per 1000 anaesthetics (0.76%). Multiple logistic regression analysis showed the following risk factors for postoperative ERT: cardiovascular disease (odds ratio [OR], 1.61; 95% CI, 1.18–2.18), neurological disease (OR, 1.57; 95% CI, 1.11–2.22), preoperative gabapentin (OR, 1.60; 95% CI, 1.17–2.20), longer surgical duration (OR, 1.06; 95% CI, 1.02–1.11, per 30 min), emergency procedure (OR, 1.54; 95% CI, 1.09–2.18), and intraoperative use of colloids (OR, 1.50; 95% CI, 1.17–1.92). Compared with control participants, ERT patients had a longer hospital stay, a higher rate of admissions to critical care (55.5%), increased postoperative complications, and a higher 30-day mortality rate (OR, 3.36; 95% CI, 1.73–6.54). CONCLUSION: We identified several patient and procedural characteristics associated with increased likelihood of postoperative ERT activation. ERT intervention is a marker for increased rates of postoperative complications and death.

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The Association of International Normalized Ratio with Postoperative Complications in Revision Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1700841 ◽

2019 ◽

Author(s):

Jessica L. Churchill ◽

Linsen T. Samuel ◽

J. M. Karnuta ◽

Alexander J. Acuña ◽

Atul F. Kamath

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

International Normalized Ratio ◽

Revision Total Knee Arthroplasty ◽

Hospital Length Of Stay ◽

Operating Characteristics ◽

Improvement Program ◽

Increased Risk ◽

Total Knee

AbstractThe purpose of this study was to examine the relationship between elevated preoperative international normalized ratio (INR) and (1) mortality, (2) postoperative bleeding, and (3) other postoperative complications in a national cohort of patients who underwent revision total knee arthroplasty (rTKA). The American College of Surgeons National Surgical Quality Improvement Program was queried for rTKA procedures conducted between 2006 and 2017. Cohorts were based on INR ranges: <1, 1 < INR ≤ 1.25, 1.25 < INR ≤ 1.5, and >1.5. Univariate/multivariate statistics were calculated to analyze associations between INR value and designated covariates. These statistics were additionally applied to optimal cutoff values of INR calculated using a receiver operating characteristics curve. The final cohort consisted of 1,676 patients. Progressively higher INR values were associated with an increased risk of mortality within 30 days (p < 0.006), bleeding requiring transfusion (p < 0.001), sepsis (p < 0.001), return to the operating room (Odds Ratio [OR], p = 0.011), reintubation (p < 0.001), pneumonia (p < 0.001), failure to wean from mechanical ventilation ≤48 hours (p < 0.001), acute renal failure (p = 0.001), and hospital length of stay (LOS). Statistically significant associations were similarly seen when calculated optimal INR values were used. Optimal INR turn point was found to be associated with a significant increased risk of long LOS (optimal INR = 1.03, OR: 1.7, 95% confidence interval [CI]: 1.33–2.18; p < 0.001) and a significant decreased risk of bleeding requiring transfusion (INR = 1.005, OR: 0.732, 95% CI: 0.681–0.786; p < 0.001). High preoperative INR values were independently and significantly associated with an increased risk of multiple postoperative complications. Current guidelines for INR <1.5 should be reassessed for patients undergoing rTKA.

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Influence of Hypertension and Diabetes on Postoperative Outcomes In Cancer Patients Undergoing Moderate/High Risk Surgical Procedures

10.21203/rs.3.rs-184334/v1 ◽

2021 ◽

Author(s):

Lafayete William Ferreira Ramos ◽

Beatriz Nery Nascimento ◽

Gabriel Rossi Silva ◽

Marcos Vinícius Ferreira Ramos ◽

Barbara Cristina Ferreira Ramos ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Cancer Patients ◽

Multiple Logistic Regression Analysis ◽

Diabetic Group ◽

Postoperative Outcomes ◽

Morbidity And Mortality ◽

Systemic Hypertension ◽

Surgical Time ◽

Increased Risk

Abstract Background: Systemic hypertension (HTN) and diabetes mellitus (DM) are believed to be risk factors for adverse postoperative outcomes in patients undergoing surgical interventions, but evidence is lacking. This retrospective study evaluated the effects of HTN and DM, alone or in combination, on postoperative outcomes of elective noncardiac surgery in cancer patients. Methods: Patients (n = 844) with malignancies, who underwent elective surgery at a tertiary hospital, were categorised into healthy (group A, n = 339), hypertensive (group B, n = 357), diabetic (group C, n = 21), and hypertensive and diabetic (group D, n = 127) groups. Preoperatively, all patients had systolic blood pressure ≤ 160 mmHg and plasma glucose level ≤ 140 mg/dl. Postoperative in-hospital morbidity and mortality were compared among groups. Results: Postoperative complications occurred in 22 (6.5%), 21 (5.9%), 2 (9.5%), and 11 (8.7%) patients in groups A, B, C, and D, respectively (p = 0.712). HTN (p = 0.538), DM (p = 0.990), and HTN+DM (p = 0.135) did not impact the occurrence of adverse events. Patients with higher surgical risk (ASA III or IV) and those with longer surgical time had higher morbidity and mortality (p = 0.001, p < 0.001, respectively). In multiple logistic regression analysis, ASA status and surgical time were independent risk factors for postoperative complications (both p < 0.001). Conclusion: Cancer patients with preoperative comorbidities, such as HTN and DM, alone or in combination, regardless of other characteristics, do not have an increased risk of adverse postoperative outcomes.Trial registration: Retrospectively registered.

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Complications of spinal osteotomy for thoracolumbar kyphosis secondary to ankylosing spondylitis in 342 patients: incidence and risk factors

Journal of Neurosurgery Spine ◽

10.3171/2018.6.spine171277 ◽

2019 ◽

Vol 30 (1) ◽

pp. 91-98 ◽

Cited By ~ 1

Author(s):

Bang-ping Qian ◽

Ji-chen Huang ◽

Yong Qiu ◽

Bin Wang ◽

Yang Yu ◽

...

Keyword(s):

Risk Factors ◽

Ankylosing Spondylitis ◽

Postoperative Complications ◽

Intraoperative Complications ◽

Thoracolumbar Kyphosis ◽

Sagittal Vertical Axis ◽

Spinal Osteotomy ◽

Increased Risk ◽

Significant Difference ◽

Surgical Data

OBJECTIVETo describe the incidence of complications in spinal osteotomy for thoracolumbar kyphosis caused by ankylosing spondylitis (AS) and to investigate the risk factors for these complications.METHODSFrom April 2000 to July 2017, 342 consecutive AS patients with a mean age (± SD) of 35.4 ± 9.8 years (range 17–71 years) undergoing spinal osteotomy were enrolled. Patients with complications within the 1st postoperative year were identified. Demographic, radiological, and surgical data were compared between patients with and without complications. The complications were classified into intraoperative and postoperative complications.RESULTSA total of 310 consecutive pedicle subtraction osteotomy (PSO) and 37 multiple Smith-Petersen osteotomy (SPO) procedures were performed in 342 patients. Overall, 47 complications were identified in 47 patients (13.7%), including 31 intraoperative complications and 16 postoperative complications. Patients with complications were older than those without (p = 0.006). A significant difference was observed in preoperative global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), and the correction of these radiographic parameters between patients with and without complications (p < 0.05). Two-level PSO (p = 0.022) and an increased number of instrumented vertebrae (p = 0.019) were significantly associated with an increased risk of complications.CONCLUSIONSThe overall incidence of complications was 13.7%. Age; preoperative GK, LL, and SVA; the correction of GK, LL, and SVA; 2-level PSO; and number of instrumented vertebrae were risk factors. Therefore, the potential risk of extensive surgeries with large correction and long fusion in older AS patients with severe GK should be seriously considered in surgical decision-making.

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Evaluation of post-operative complications after mastectomy performed without perioperative antimicrobial prophylaxis in dogs

Acta Veterinaria Scandinavica ◽

10.1186/s13028-021-00600-3 ◽

2021 ◽

Vol 63 (1) ◽

Author(s):

Philip Spåre ◽

Ingrid Ljungvall ◽

Karl Ljungvall ◽

Annika Bergström

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Antimicrobial Prophylaxis ◽

Common Procedure ◽

Mammary Tumours ◽

Increased Risk ◽

Perioperative Antibiotics ◽

Healthy Dogs ◽

Excisional Surgery ◽

Perioperative Antimicrobial Prophylaxis

Abstract Background Mastectomy is the most common procedure for treatment of mammary tumours. Dogs undergoing mastectomy have a risk of developing surgical site infections (SSI) and other postoperative complications. However, potential risk factors associated with such complications have been sparsely investigated. Thus, the objective of this retrospective study was to determine the incidence of, and identify risk factors for, SSI and non-SSI postoperative complications after mastectomy performed without perioperative antimicrobial prophylaxis in privately owned otherwise clinically healthy dogs. Results Medical records were reviewed retrospectively for 135 client-owned female dogs, 10–35 kg in weight and three to 10 years of age, which had undergone mastectomy due to mammary tumours at three referral animal hospitals in Sweden over a 3-year period. Twelve (8.9%) dogs developed SSI, and 21 dogs (17.1%) dogs suffered a non-SSI postoperative complication. The incidence of SSI and all complications (SSI and non-SSI) were higher in dogs that had two to three (SSI: P = 0.036 and all complications: P = 0.0039) and four to five (SSI and all complications: P = 0.038) mammary glands excised, compared to dogs that had one mammary gland excised. The incidence of SSI was 1.7% (n = 1/60) in dogs that had one gland removed. The incidence of non-SSI postoperative complications was higher in dogs with a higher body weight (P = 0.02). Conclusions The incidence of SSI was lower than or similar to previously reported incidences of SSI in dog populations that have undergone tumour excisional surgery, despite the fact that dogs in the present study had not received perioperative antibiotics. Dogs that had two or more glands excised had an increased risk of developing SSI and non-SSI complications compared to dogs that had one gland excised. Furthermore, higher BW was associated with an increased risk of non-SSI complications. Results from the study indicate that routine use of perioperative antibiotics in tumour excisional surgery can be questioned, at least in single gland mastectomy in otherwise clinically healthy dogs.

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Risk factors for postoperative stroke in adults patients with moyamoya disease: a systematic review with meta-analysis

10.21203/rs.2.304/v2 ◽

2019 ◽

Author(s):

Wei Wei ◽

Xin Chen ◽

Yu Jun ◽

Xuqin Li

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Postoperative Complications ◽

Moyamoya Disease ◽

Meta Analysis ◽

Age At Onset ◽

Adult Patients ◽

Cochrane Library ◽

Postoperative Stroke ◽

Increased Risk

Abstract Background This systematic review and meta-analysis aimed to clarify the risk factors for postoperative stroke in adult patients with moyamoya disease (MMD). Methods We comprehensively searched MEDLINE/PubMed, Web of Science, and Cochrane Library for eligible published literature with regard to the risk factors and postoperative complications in adult patients with MMD. Statistical analysis was conducted using Stata version 12.0. Pooled odds ratio (OR) with 95% confidence interval (CI) were assessed for each risk factor. Results There were 8 studies encompassing 1649 patients who underwent surgery with MMD were selected for analysis. Preoperative ischemic event significantly increase the risk of postoperative stroke events (OR=1.40; 95%CI=1.02–1.92; P=0.039). PCA involvement correlate with an increased risk of post-infarction (OR=4.60; 95%CI=2.61–8.11; P=0.000). Compared to direct bypass, patients who underwent indirect bypass or combined bypass could significantly increase the risk of postoperative stroke events. (OR=1.17; 95%CI=1.03–1.33; p=0.017). MMD patients with diabetes were associated with an increased risk of postoperative stroke events (OR=4.02, 95% CI=1.59-10.16; p=0.003). MMD patients with hypertension, age at onset and male sex were not associated with an increased risk of postoperative stroke events (P>0.05). Conclusions This systematic review and meta-analysis indicated that preoperative ischemic events, PCA involvement and diabetes were independent risk factors for postoperative stroke in MMD patients. Therefore, in order to ensure the curative effect of patients with MMD, it is very necessary to detect these risk factors and prevent postoperative complications in time.

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Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

10.2310/vasc.2202 ◽

2020 ◽

Author(s):

Herbert Chen ◽

Irene Lou

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Antiplatelet Therapy ◽

Antithrombotic Therapy ◽

Bleeding Complications ◽

Thromboembolism Prophylaxis ◽

Therapy Management ◽

Vte Prophylaxis ◽

Increased Risk ◽

Perioperative Anticoagulation

The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis. This review contains 2 figures, 7 tables, and 61 references. Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis

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Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

Foot & Ankle International ◽

10.1177/10711007211058163 ◽

2021 ◽

pp. 107110072110581

Author(s):

Alisa Malyavko ◽

Theodore Quan ◽

William T. Stoll ◽

Joseph E. Manzi ◽

Alex Gu ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Internal Fixation ◽

Operative Treatment ◽

Ankle Fracture ◽

Open Reduction ◽

Bleeding Disorder ◽

Ankle Fractures ◽

Bleeding Disorders ◽

Increased Risk

Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

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Incidence and risk factors of postoperative complications in patients with tuberculosis-destroyed lung

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01641-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongyun Ruan ◽

Fangchao Liu ◽

Ming Han ◽

Changfan Gong

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Blood Transfusion ◽

Nontuberculous Mycobacteria ◽

Smoking History ◽

Independent Factor ◽

Increased Risk ◽

Low Bmi ◽

Patients Experience ◽

Destroyed Lung

Abstract Background The purpose of this study was to determine risk factors of postoperative complications in tuberculosis-destroyed lung (TDL) patients. Methods We retrospectively analyzed the data from all consecutive TDL patients undergoing surgical treatment at the Beijing Chest Hospital from January 2001 to September 2019. Results Of 113 TDL cases experiencing surgery, 33 (29.2%) experienced postoperative complications. The patients with low BMI were more likely to have postoperative complications compared to those with normal BMI, whereas a significant lower rate of postoperative complications was noted in patients with BMI ≥ 25 kg/m2. In addition, significant increased risk was observed in patients with smoking history. We found that the patients with underlying infection, including aspergillus and nontuberculous mycobacteria (NTM), had significantly higher odds of having postoperative complications compared with those without underlying infection. The anaemia was another important independent factor associated with postoperative complication. Patients with blood transfusion above 1000 mL had a strongly increased frequency of postoperative complications than patients with blood transfusion below 1000 mL. Conclusion In conclusion, our data demonstrate that approximate one third of TDL patients experience postoperative complications in our cohort. Patients with low BMI, anaemia, tobacco smoking, and coinfected aspergillus or NTM are at markedly higher risk to experience postoperative complications after pneumonectomy.

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Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

Otolaryngology ◽

10.1177/0194599820947001 ◽

2020 ◽

pp. 019459982094700

Author(s):

Ana D. Jotic ◽

Jovica P. Milovanovic ◽

Aleksandar S. Trivic ◽

Miljan M. Folic ◽

Sanja B. Krejovic-Trivic ◽

...

Keyword(s):

Postoperative Complications ◽

Operating Room ◽

Multivariable Analysis ◽

Upper Airway ◽

Direct Result ◽

Mortality Data ◽

Lethal Outcome ◽

Surgical Tracheostomy ◽

Increased Risk ◽

Surgical Tracheotomy

Objective In emergency airway management, the occurrence of surgical tracheotomy complications is increased and may be fatal for the patient. However, the factors that play a role in complication occurrence and lead to lethal outcome are not known. The objective of this study was to determine predictors associated with the occurrence of complications and mortality after emergency surgical tracheostomy. Study Design Retrospective study with a systematic review of the literature. Setting Tertiary medical academic center. Subjects and Methods We included 402 adult patients who underwent emergency surgical tracheostomy under local anesthesia due to upper airway obstruction. Demographic, clinical, complication occurrence, and mortality data were collected. For statistical analysis, univariable and multivariable logistic regression methods were used. Results In multivariable analysis, significant positive predictors of complication occurrence were previously performed tracheotomy (odds ratio [OR] 3.67, 95% confidence interval [CI], 0.75–17.88), neck pathology (OR 2.05, 95% CI 1.1–1.77), and tracheotomy performed outside the operating room (OR 5.88, 95% CI, 1.58–20). General in-hospital mortality was 4%, but lethal outcome as a direct result of tracheotomy complications occurred in only 4 patients (1%) because of intraoperative and postoperative complications. Conclusion The existence of neck pathology and situations in which tracheotomy was performed outside the operating room in uncontrolled conditions were significant prognostic factors for complication occurrence. Tracheotomy-related mortality was greater in patients with intraoperative and early postoperative complications. Clinicians should be aware of the increased risk in specific cases, to prepare, prevent, or manage unwanted outcomes in further treatment and care.

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