Strategies for the
Prevention of Complications in Brain Glioma Surgery

Introduction: Brain glioma is the most common and lethal primary malignant intracranial tumor. Nonetheless, gross tumor resection remains the most successful treatment modality, which may prolong progression free survival of these patients. However, excessive surgery brings a danger of neurological, regional and systemic complications, which may be diminished/ avoided by better pre- and intra-operative care and by modern neurosurgical techniques. Aim: To analyze the incidence and type of peri- and post-operative complications in surgical brain glioma patients. Computing the results, advice on complication prevention was made. Methods: A single institution series of brain glioma patients operated on during a two-year period was analyzed. The incidence, type and time of complications were observed, as well as the patients’ gender and age, and the extent of tumor resection complications, dichotomized as peri- and post-operative variables, were correlated with investigated parameters to find out their possible association. Results: Transitory neurological deficit was the most common peri-operative complication. Seizures, meningitis, and permanent neurological deficit were commonly recorded among post operative complications. Conclusion: Patients’ gender and age, and the extent of tumor resection were not influential to the development of brain glioma complications. Aggressive surgery requires the avoidance of complications by cautious patient selection, multidisciplinary preoperative planning, and scrupulous neurosurgical technique augmented by up-to-date armamentarium.

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The impact of pre-operative biologic therapy on post-operative surgical outcomes in ulcerative colitis: a systematic review and meta-analysis

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820937089 ◽

2020 ◽

Vol 13 ◽

pp. 175628482093708

Author(s):

Jasmine Zanelli ◽

Subashini Chandrapalan ◽

Abhilasha Patel ◽

Ramesh P. Arasaradnam

Keyword(s):

Ulcerative Colitis ◽

Biologic Therapy ◽

Meta Analysis ◽

Complication Rates ◽

Surgical Morbidity ◽

Biologic Treatment ◽

Operative Care ◽

Operative Complications ◽

The Impact ◽

Post Operative Complications

Background and aims: Biologic therapy has emerged as an effective modality amongst the medical treatment options available for ulcerative colitis (UC). However, its impact on post-operative care in patients with UC is still debatable. This review evaluates the risk of post-operative complications following biologic treatment in patients with UC. Methods: A systematic search of the relevant databases was conducted with the aim of identifying studies that compared the post-operative complication rates of UC patients who were either exposed or not exposed to a biologic therapy prior to their surgery. Outcomes of interest included both infection-related complications and overall surgical morbidity. Pooled odds-ratio (OR) and 95% confidence intervals (CI) were calculated using Review Manager 5.3. Results: In all, 20 studies, reviewing a total of 12,494 patients with UC, were included in the meta-analysis. Of these, 2254 patients were exposed to a biologic therapy prior to surgery. The pooled ORs for infection-related complications ( n = 8067) and overall complications ( n = 11,869) were 0.98 (95% CI 0.66–1.45) and 1.14 (95% CI 1.04–1.28), respectively, which suggested that there was no significant association between the use of pre-operative biologic therapy and post-operative complications. Interestingly, the interval between the last dose of biologic therapy and surgery did not influence the risk of having a post-operative infection. Conclusions: This meta-analysis suggests that pre-operative biologic therapy does not increase the overall risk of having post-operative infection-related or other complications. PROSPERO registration id-CRD42019141827.

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Clinical Outcomes Following Re-Operations for Intracranial Meningioma

Cancers ◽

10.3390/cancers13194792 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4792

Author(s):

George E. Richardson ◽

Conor S. Gillespie ◽

Mohammad A. Mustafa ◽

Basel A. Taweel ◽

Ali Bakhsh ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Performance Status ◽

Progression Free Survival ◽

World Health ◽

Intracranial Meningioma ◽

Complication Rates ◽

Patient Goals ◽

Operative Complications ◽

Post Operative Complications

The outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted. The primary outcome measure was World Health Organization performance. Secondary outcomes were complications, and overall and progression free survival (OS and PFS respectively). Baseline clinical characteristics, tumor details, and operation details were collected. Multivariable binary logistic regression was used to identify risk factors for performance status outcome following a second operation. Between 1988 and 2018, 712 patients had surgery for intracranial meningiomas, 56 (7.9%) of which underwent a second operation for recurrence. Fifteen patients (26.8%) had worsened performance status after the second operation compared to three (5.4%) after the primary procedure (p = 0.002). An increased number of post-operative complications following the second operation was associated with a poorer performance status following that procedure (odds ratio 2.2 [95% CI 1.1–4.6]). The second operation complication rates were higher than after the first surgery (46.4%, n = 26 versus 32.1%, n = 18, p = 0.069). The median OS was 312.0 months (95% CI 257.8–366.2). The median PFS following the first operation was 35.0 months (95% CI 28.9–41.1). Following the second operation, the median PFS was 68.0 months (95% CI 49.1–86.9). The patients undergoing a second operation for meningioma had higher rates of post-operative complications, which is associated with poorer clinical outcomes. The decisions surrounding second operations must be balanced against the surgical risks and should take patient goals into consideration.

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Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

Vascular and Endovascular Surgery ◽

10.1177/15385744211026455 ◽

2021 ◽

pp. 153857442110264

Author(s):

Krystina Choinski ◽

Omar Sanon ◽

Rami Tadros ◽

Issam Koleilat ◽

John Phair

Keyword(s):

Delayed Diagnosis ◽

Aortic Aneurysms ◽

Medical Specialties ◽

Efficient Treatment ◽

Operative Care ◽

Malpractice Claims ◽

Operative Complications ◽

Aortic Dissections ◽

Aortic Pathologies ◽

Post Operative Complications

Objective: Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes. Methods: Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included “aortic aneurysm” and “aortic dissection.” Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases. Results: A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included “failure to diagnose and treat” (61%), “delayed diagnosis and treatment” (21%), “post-operative complications after open repair” (10%) and “negligent post-operative care” (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462). Conclusion: For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.

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Management of neck dissection complications in head and neck cancers

International Surgery Journal ◽

10.18203/2349-2902.isj20190811 ◽

2019 ◽

Vol 6 (3) ◽

pp. 664

Author(s):

Suhas N. Bhushan ◽

Arun H. N.

Keyword(s):

Head And Neck ◽

Neck Dissection ◽

Nerve Injury ◽

Regional Lymph Node ◽

Head And Neck Cancers ◽

Operative Complication ◽

Marginal Mandibular Nerve ◽

Operative Care ◽

Operative Complications ◽

Post Operative Complications

Background: Neck dissection is a vital step in eradicating the regional lymph node metastasis. The aim of study is to establish the incidence of post-operative complications in patients undergoing neck dissection and its management.Methods: A cross-sectional retrospective study of 82 patients admitted in the department of general surgery, BMCRI from June 2016 till January 2018 who underwent neck dissections for various head and neck cancers. These patients were studied for post-operative complications and their management.Results: Intra-operative complication being vascular injury (IJV repaired-2 cases), nerve injury and lymphatic injury (thoracic duct identified and serial ligation in 3 cases and right-side lymphatic duct injury in l case). Immediate post-operative complication being hemorrhage among 2 cases, re-opened in 1 case and managed by compression dressing in 1 case. Delayed complications being nerve injury among which marginal mandibular nerve injured in 5 cases, phrenic nerve in 1 case, vagus nerve in 1 case, spinal accessory nerve in 13 cases (palsy in 3 cases and praxia in 10 cases). Another delayed complication being chylorrhoea in 2 cases which was managed conservatively. Wound dehiscence noted among 4 cases, 2 of them were major (1 required redo flap, 1 managed conservatively) and 2 of them were minor complications.Conclusions: In our study, there were no peri-operative deaths. Nerves were most common structures injured. A careful pre-operative assessment, meticulous surgical technique, high quality post-operative care and appropriate rehabilitation help in preventing and managing complications.

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389 Impact of Surgical Drain Output Monitoring on Patient Outcomes in Gastrointestinal Surgery: A Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab259.928 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Kowal ◽

W Bolton ◽

B Van Duren ◽

J Burke ◽

D Jayne

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Gastrointestinal Surgery ◽

Cochrane Library ◽

Emergency General Surgery ◽

Operative Care ◽

Operative Complications ◽

Output Monitoring ◽

Surgical Drain ◽

Post Operative Complications

Abstract Aim Surgical drains are widely utilised in Gastrointestinal Surgery to prevent intra-abdominal collections and identify post-operative complications. Surgical drain monitoring ranges from simple output measurements through to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect post-operative complications and impact on patient outcomes. Method A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing gastrointestinal surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. Results The search returned 396 articles. Following abstract review, 383 were excluded and 13 articles were included for full review. The studies were classified according to speciality: Oesophagogastric (1), Pancreatic (6), Hepatobiliary (2), Colorectal (3) and Emergency General Surgery (1). Post-operative monitoring of amylase and bilirubin decreased the incidence of post-operative complications (pancreatic fistulas, intra-abdominal infections, surgical site infections), length of stay and mortality rate in Pancreatic and Hepatobiliary Surgery. Testing of drain contents following Colorectal Surgery can aid anastomotic leak and the detection of peritonitis, however this did not confer any improvement in patient outcome. Surgical drain monitoring did not improve patient outcomes in Oesophagogastric Surgery. Conclusions Surgical drain monitoring has established advantages in the post-operative care for patients undergoing Gastrointestinal Surgery. Enhanced surgical drain monitoring involving the testing of drain amylase, bilirubin, lactate, and cytokines may improve detection of complications in the immediate post-operative period.

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DDIS-02. DEVELOPMENT OF NOVEL SPRAY-TYPE FLUORESCENT PROBES FOR GLIOBLASTOMA DETECTION

Neuro-Oncology ◽

10.1093/neuonc/noz175.262 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi65-vi65

Author(s):

Yosuke Kitagawa ◽

Shota Tanaka ◽

Yugo Kuriki ◽

Kyoko Yamamoto ◽

Takahide Nejo ◽

...

Keyword(s):

Fluorescent Probes ◽

Tumor Resection ◽

Proteome Analysis ◽

Progression Free Survival ◽

Fluorescent Labeling ◽

Detection Methods ◽

Clinical Samples ◽

Low Grade ◽

Glioma Surgery ◽

Labeling System

Abstract PURPOSE: ALA is commonly used as an intraoperative tool in malignant glioma surgery, which has been proven effective for radical tumor resection and extended progression-free survival. However, there are some limitations in its use, such as false positivity, false negativity, and inability of re-administration. We aim to develop a novel fluorescent labeling system which can be repeatedly administered by spray during surgery, using hydroxymethyl rhodamine green (HMRG) as fluorescent scaffold originally designed at our university for cancer detection. [Methods]Primary probe screening was performed using the homogenized glioblastoma (GBM) samples with the fluorescent probe library comprised of more than 320 kinds of HMRG fluorescent scaffold combined with various types of dipeptides. Second probe screening was performed using fresh GBM specimens and the selected probes in primary screening. To identify the responsible enzymes, diced electrophoresis gel (DEG) assay was performed. This method utilizes the combination of two dimensional electrophoresis (isoelectric point and molecular weight) and a multiwell-plate-based fluorometric assay to find protein spots with the specified activities. [Results] The prominent probes were selected based upon the above two-step screenings. We identified two enzymes by proteome analysis and experiments using inhibitors, which was further confirmed with real-time PCR and western blotting. [Discussion] This screening methodology is innovative in that it is based on selecting probes from the probe library that respond to clinical samples rather than creating probes from the responsible enzymes. Practical fluorescent probes can be established even for low-grade gliomas, which would be a breakthrough for rapid intraoperative diagnosis in glioma surgery. [Conclusion] HMRG-based aminopeptidase fluorescent probes may be effective for GBM detection.

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BOT-03 INVESTIGATION OF NOVEL SPRAY TYPE FLUORESCENT PROBE FOR GLIOBLASTOMA DETECTION

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz039.055 ◽

2019 ◽

Vol 1 (Supplement_2) ◽

pp. ii12-ii12

Author(s):

Yosuke Kitagawa ◽

Shota Tanaka ◽

Yugo Kuriki ◽

Kyoko Yamamoto ◽

Taijun Hana ◽

...

Keyword(s):

Fluorescent Probe ◽

Fluorescent Probes ◽

Tumor Resection ◽

Proteome Analysis ◽

Progression Free Survival ◽

Fluorescent Labeling ◽

Clinical Samples ◽

Low Grade ◽

Glioma Surgery ◽

Labeling System

Abstract PURPOSE 5-ALA is commonly used as an intraoperative tool in malignant glioma surgery, which has been proven effective for radical tumor resection and extended progression-free survival. However, there are some limitations in its use, such as false positivity, false negativity, and inability of re-administration. We aim to develop a novel fluorescent labeling system which can be repeatedly administered by spray during surgery, using hydroxymethyl rhodamine green (HMRG) as fluorescent scaffold originally designed at our university for cancer detection. METHODS Primary probe screening was performed using the homogenized glioblastoma (GBM) samples with the fluorescent probe library comprised of more than 320 kinds of HMRG fluorescent scaffold combined with various types of dipeptides. Second probe screening was performed using fresh GBM specimens and the selected probes in primary screening. To identify the responsible enzymes, diced electrophoresis gel (DEG) assay was performed. This method utilizes the combination of two dimensional electrophoresis (isoelectric point and molecular weight) and a multiwell-plate-based fluorometric assay to find protein spots with the specified activities. RESULTS The prominent probes were selected based upon the above two-step screenings. We identified two enzymes by proteome analysis and experiments using inhibitors, which was further confirmed with real-time PCR and western blotting. DISCUSSION This screening methodology is innovative in that it is based on selecting probes from the probe library that respond to clinical samples rather than creating probes from the responsible enzymes. Practical fluorescent probes can be established even for low-grade gliomas, which would be a breakthrough for rapid intraoperative diagnosis in glioma surgery. CONCLUSION HMRG-based aminopeptidase fluorescent probes may be effective for GBM detection.

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Overnight oximetry in children undergoing adenotonsillectomy: a single center experience

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-019-0391-2 ◽

2019 ◽

Vol 48 (1) ◽

Cited By ~ 1

Author(s):

C. Carrie Liu ◽

Kathleen H. Chaput ◽

Valerie Kirk ◽

Warren Yunker

Keyword(s):

Hospital Admissions ◽

Poor Correlation ◽

Single Center Experience ◽

Operative Care ◽

Home Based ◽

Obstructive Sleep ◽

Operative Complications ◽

Overnight Oximetry ◽

Abnormal Sleep ◽

Post Operative Complications

Abstract Background Obstructive sleep apnea (OSA) is the most common indication for adenotonsillectomy in children. Home-based sleep oximetry continues to be used in the diagnosis of pediatric OSA despite a lack of correlation with lab-based polysomnography. This study investigates whether factors influence surgeons in selecting patients for home-based sleep oximetry, how the study findings are used in patient management, and whether abnormal oximetry findings are associated with post-operative complications. Methods A retrospective review was performed on children with suspected OSA who had undergone a tonsillectomy and/or an adenoidectomy over a three-year period. Demographic features, comorbidities, pre-operative oximetry results, and post-operative complications were recorded. Data analysis consisting primarily of logistic regression was performed using Stata 12.0 (College Station, Texas). Results Data was collected from 389 children. Two hundred and seventy-one children underwent pre-operative oximetry (69.7%). There was no significant association between age or the presence of comorbidities and the likelihood of undergoing pre-operative sleep oximetry. The post-operative complication rate was 0.8%. There was no significant association between abnormal sleep oximetry parameters and post-operative complications. Children with one or more abnormal sleep oximetry parameters were more likely to be observed in hospital for at least one night (OR 2.4, p < 0.0001). Conclusions Our study suggests that surgeons are using home-based sleep oximetry findings to inform the post-operative care of children with suspected OSA, as those with abnormal home-based sleep oximetry findings were more likely to be observed in hospital. These hospital admissions may be unnecessary given the poor correlation of home-based oximetry and PSG as well as the low rate of serious post-operative complications.

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Application of the surgical Apgar score (SAS) to predict postoperative complication(s) in the patients with traumatic brain injury: Study of single center in Indonesia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5843 ◽

2021 ◽

Vol 9 (B) ◽

pp. 225-229

Author(s):

Muhammad Z. Arifin ◽

Andi N. Sendjaja ◽

Ahmad Faried

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Apgar Score ◽

Inverse Correlation ◽

Major Health Problem ◽

Operative Care ◽

Estimated Blood Loss ◽

Operative Complications ◽

Surgical Apgar Score ◽

Post Operative Complications

BACKGROUND: Traumatic brain injury (TBI) is a major health problem. Surgery in patients with TBI is associated with a high rate of complications and mortality. The surgical Apgar score (SAS) is a simple quantitative and objective intraoperative tool for predicting major post-operative complications including mortality. AIM: Our study aimed to analyze the use of SAS as a predictor of post-operative complications in patients with TBI. METHODS: This was a prospective cohort study at our center in RSHS, Bandung, Indonesia, throughout 2017 by assessing SAS based on calculating intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate for each patient with TBI, as well as the incident complications within 30 days post-operative were recorded. RESULTS: One hundred fifty-six patients with TBI underwent surgery in 2017 with 123 patients met the inclusion criteria. Among those, 63 patients (51.2%) developed major complications with 8 patients (12.7%) experienced death. The mean SAS for patients without complication was 8.20, whereas for patients with complication was 6.11. SAS has an inverse correlation (r = –0.754) and an association (p < 0.005) with post-operative complication (s) within 30 days. CONCLUSIONS: The SAS has an inverse correlation and an association with incidence of complications thus potentially useful as an intraoperative predictor for incident complications within 30 days post-operative care in patients with TBI.

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Effectiveness of Standard post-operative Care on Post-operative Outcome Evaluation among Women Undergone Lower Segment Cesarean Section in Selected Hospital: A Narrative Review

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i33a31775 ◽

2021 ◽

pp. 81-90

Author(s):

Prabha Kumari ◽

Maharaj Singh ◽

. Sunita

Keyword(s):

Cesarean Section ◽

Outcome Evaluation ◽

Lower Segment ◽

Operative Outcomes ◽

Lower Segment Cesarean Section ◽

Operative Care ◽

Operative Outcome ◽

Operative Complications ◽

Hand Massage ◽

Post Operative Complications

Background: Present study focuses on effectiveness of standard post-operative care on post-operative evaluation among women undergone lower segment cesarean section in selected hospitals. Standard post operative care basically stands for list of non-pharmacological or pharmacological measures, procedures and methods adopted by the investigator/care giver during post-operative period of women undergone lower segment cesarean section for the reduction of negative post-operative outcomes or complications and to fasten recovery. Present study encompasses articles on post-operative care in terms of one, two or more than two or three measures or interventions as post-operative care measures adapted to reduce post-operative complications like use of music therapy, foot-hand massage therapy, planned early ambulation, planned ambulation techniques etc. for post-operative complications and pain relief. Objective: To identify various post-operative measures or care which can be included in standard post-operative care list and its effectiveness on post-operative outcome evaluation among women undergone Lower segment cesarean section in selected hospitals. Methods: Articles were searched in Google scholar, Pub-med, Medline and research gate by using keywords post-operative care of cesarean section, post-operative outcomes of cesarean section and Cesarean mother. Result: Review includes seven articles showing different non-pharmacological or pharmacological measures or techniques to overcome post-operative complications for early recovery and better outcomes. These measures can be included in standard post-operative care list for positive post-operative maternal and fetal outcomes. These measures include early planned ambulation, planned ambulation techniques, music therapy, Foot and hand massage therapy and use of certain analgesia for pain management in post cesarean women if needed, as per the patient’s condition. Conclusion: Conclusion of the review revealed that there are various measures which can be standardized in post-operative outcome evaluation among women undergone lower segment cesarean section.

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