scholarly journals A retrospective study of perioperative outcomes following surgery for brain tumors: objective assessment and risk factor evaluation in rural centre

2018 ◽  
Vol 32 (2) ◽  
pp. 366-376
Author(s):  
Sachidanand Gautam ◽  
Ojha Piyush ◽  
Sharma Anubhav
Keyword(s):  
Risk Factors ◽  
Brain Tumors ◽  
Objective Assessment ◽  
Surgical Techniques ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Neurosurgical Department ◽  
Related Factors ◽  
Important Indicator ◽  
Systemic Complications

Abstract Background: Extensive surgical resection remains nowadays the best treatment available for most brain tumours. Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. The goal of this study was to review the results of surgical treatment in our Department, run by a single neurosurgeon, in order to quantify morbidity and mortality and determine predictive risk factors for each patient. Materials and Methods: A total of Three hundred patients undergoing various surgeries for brain tumors were analyzed. Routine surgical techniques and uniform antibiotic policy were used. Navigation advanced operating microscope/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinicoepidemiological factors, tumor-related factors, and surgery-related factors. Results: Median age was 36.37 years. 74.3% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 14.3, 14.3, and 11.3%, respectively. Overall, major morbidity occurred in 14.3% and perioperative mortality rate was 3.3%. Conclusions: Our patients were younger and had larger tumors than were generally reported. Despite the unavailability of advanced intraoperative aids, we could achieve acceptable levels of morbidity and mortality rates. The knowledge of the complications rate in each particular neurosurgical department turns out essentially to provide the patient with tailored information about risks before surgery.

scholarly journals Perioperative outcomes following surgery for brain tumors: Objective assessment and risk factor evaluation

2012 ◽  
Vol 03 (01) ◽  
pp. 28-35 ◽  
Author(s):  
Aliasgar V Moiyadi ◽  
Prakash M Shetty
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Brain Tumors ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Related Factors ◽  
Important Indicator ◽  
Systemic Complications

ABSTRACT Background: Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. Perioperative morbidity not only has implications on direct patient care, but also serves as an indicator of the quality of care provided, and enables objective documentation, for comparision in various clinical trials. We document our experience at a tertiary care referral, a dedicated neuro-oncology center in India. Materials and Methods: One hundred and ninety-six patients undergoing various surgeries for intra-axial brain tumors were analyzed. Routine microsurgical techniques and uniform antibiotic policy were used. Navigation/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinico-epidemiological factors, tumor-related factors, and surgery-related factors. Univariate and multivariate analysis were performed. Results: Median age was 38 years. 72% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 16.8, 17.3, and 10.7%, respectively. Overall, major morbidity occurred in 18% and perioperative mortality rate was 3.6%. Although a few of the known risk factors were found to be significant on univariate analysis, none achieved significance on multivariate analysis. Conclusions: Our patients were younger and had larger tumors than are generally reported. Despite the unavailability of advanced intraoperative aids we could achieve acceptable levels of morbidity and mortality. Objective recording of perioperative events is crucial to document outcomes after surgery for brain tumors.

Feasibility of repeat surgery for pediatric brain tumors: an objective assessment of perioperative outcomes

2012 ◽  
Vol 10 (5) ◽  
pp. 411-417 ◽  
Author(s):  
Aliasgar V. Moiyadi ◽  
Prakash Shetty
Keyword(s):  
Brain Tumors ◽  
Tertiary Care ◽  
Pediatric Brain Tumors ◽  
Prior Treatment ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Repeat Surgery ◽  
Systemic Complications ◽  
Presenting Symptoms ◽  
Pediatric Brain

Object Repeat surgery for pediatric brain tumors is gaining acceptance, with extent of resection an important predictor of outcome. However, repeat surgeries may be associated with increased morbidity. Few studies in the literature provide such outcomes objectively. The authors report on their experience with repeat surgery at a tertiary care neurooncology referral center in India. Methods A prospectively maintained database documented epidemiological, clinical, radiological, operative, and perioperative events. The authors analyzed 117 children (younger than 18 years of age) who had undergone various resective surgeries for brain tumors over a period of 5 years. Assessed end points included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Results The majority of children (48%) were between 3 and 10 years of age. Elevated intracranial pressure (70% of patients) and neurological deficits (60% of patients) were the commonest presenting symptoms. A significant proportion of patients (35%) had a poor Karnofsky Performance Scale score (≤ 70). Supratentorial procedures were performed in 58% of the patients. Most patients (72%) had large (> 4 cm) tumors. Fifty-eight patients (50%) had received prior treatment, surgery in 55. Neurological morbidity (worsening), regional complications, and systemic complications occurred in 27%, 32%, and 25% of patients overall, respectively. Overall morbidity was 44.4% (26.5% major), and perioperative mortality was 7.7%. Neurological worsening occurred more frequently in patients undergoing a first surgery (p = 0.038), whereas wound-related complications were more common in those undergoing reoperations (p = 0.00). Conclusions Pediatric patients had larger tumors and were more likely to present with a poor performance status, often after prior treatment, than their adult counterparts. Wound-related complications were higher in the previously treated subgroup; however, neurological complications were fewer, probably because of a favorable selection of patients. Despite the unavailability of advanced intraoperative aids, acceptable levels of overall morbidity and mortality could be achieved in repeat surgeries for pediatric brain tumors.

Risk factors for postoperative systemic complications in elderly patients with brain tumors

2009 ◽  
Vol 111 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Kenichiro Asano ◽  
Takahiro Nakano ◽  
Tetsuji Takeda ◽  
Hiroki Ohkuma
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Brain Tumors ◽  
Blood Loss ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Intraoperative Blood Loss ◽  
Systemic Complications ◽  
Level Difference ◽  
Cutoff Values

Object In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors. Methods The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre- and postoperative values), and change in TP level (difference between pre- and postoperative values). The cutoff values for significant independent factors were also determined. Results Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl. Conclusions In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre- and postoperative Hb levels are significant risk factors for postoperative systemic complications.

scholarly journals Risk Factors for Posterior Cage Migration after Lumbar Interbody Fusion Surgery

2018 ◽  
Vol 12 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Dong-Yeong Lee ◽  
Young-Jin Park ◽  
Sang-Youn Song ◽  
Soon-Taek Jeong ◽  
Dong-Hee Kim
Keyword(s):  
Risk Factors ◽  
Interbody Fusion ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Related Factors ◽  
Low Bmi

<sec><title>Study Design</title><p>A retrospective clinical case series.</p></sec><sec><title>Purpose</title><p>To determine the strength of association between cage retropulsion and its related factors.</p></sec><sec><title>Overview of Literature</title><p>Lumbar interbody fusion with cage can obtain a firm union and can restore the disc height with normal sagittal and coronal alignment. Although lumbar interbody fusion procedures have satisfactory clinical outcomes, peri- and postoperative complications regarding the cage remain challenging.</p></sec><sec><title>Methods</title><p>From January 2006 to June 2016, 1,047 patients with lumbar degenerative disc disease who underwent posterior lumbar interbody fusion or transforaminal interbody fusion at Gyeongsang National University Hospital were enrolled. Medical records and pre- and postoperative radiographs were reviewed to identify significant cage retropulsion-related factors. The associations between cage retropulsion with various risk factors were evaluated by calculating odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis.</p></sec><sec><title>Results</title><p>Of 1,229 disc levels, 16 cases (1.3%, 10 men and 6 women) had cage retropulsion. Univariate analysis revealed no significant differences between the cage retropulsion group and the no cage retropulsion group with regard to demographic data such as age, sex, weight, height, body mass index (BMI), smoking habits, presence of osteoporosis, and duration of follow-up. Multivariate analysis revealed that low BMI (OR, 0.875; 95% CI, 0.771–0.994; <italic>p</italic>=0.040), presence of screw loosening (OR, 27.400; 95% CI, 7.818–96.033; <italic>p</italic>&lt;0.001), and pear-shaped disc (OR, 9.158; 95% CI, 2.455–34.160; <italic>p</italic>=0.001) were significantly associated with cage retropulsion.</p></sec><sec><title>Conclusions</title><p>This study demonstrated that low BMI, loosening of posterior instrumentation, and pear-shaped disc were associated with cage retropulsion after lumbar interbody fusion. Therefore, when performing lumbar interbody fusion with a cage, surgeons should have skillful surgical techniques for firm fixation to prevent cage retropulsion, particularly in non-obese patients.</p></sec>

P2507Role of “Walk with a doc” program practice in total risk approach to prevention of cardiovascular disease in RF

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Bockeria ◽  
Z Kudzoeva ◽  
S G Khugaev
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
General Population ◽  
Life Style ◽  
Morbidity And Mortality ◽  
Individual Risk ◽  
High Tech ◽  
Preventive Action ◽  
Total Risk ◽  
Related Factors

Abstract Background It is known that life-style related factors are the main risk factors for CVD morbidity and mortality. In countries with economies in transition (such as Russia) many efforts were aimed at CVD diagnostic and treatment procedures improvement, but lack of primary prevention strategies is observed in general population. CVD morbidity and mortality could be prevented through population based strategies. Purpose To evaluate the feasibility and potency of implementing “Walk with a doc” program practice using newly-developed “Cardiac numbers Diary” for estimation of the individual risk on making decision about whether to initiate specific preventive action to reduce CVD morbidity. Methods The program has successfully started in Moscow, RF in July 2012 as a Russian branch of the global “Walk with a doc” activity. As of January 2019 there are 1576 participants in the database. Special “Cardiac numbers Diary” was developed and includes special charts to allow the introduction of the total risk stratification approach for management of CVD. The charts use a modelling approach with age, sex, physical activity, smoking, blood pressure, body weight, blood glucose and cholesterol. With support of center specialists the weekly events are carried out in different open space grounds and include the assessment of the above risk factors, life style modifying counseling including lectures and 35–40 minutes' walk at the moderate pace. 150 participants participated in more than 20 walks mean age 58,2 years old (±17,1) were assessed in this prospective study. They were assessed for risk factors modifying in 6 months follow-up period. At the moment of inclusion 37.5% participants had arterial hypertension, 12.1% were smokers, 20.2% were overweight. The official Walk-with-a-doc movement is registered in RF. Special Web site provides information on future events, physician team, life-style, diet, physical activity recommendations, photo materials and etc. Results After 6 month of regular walking the number of hypertensive participants decreased to 20.2%. 9.4% of all participants were able to lose weight by 1–6 kg, and 33.3% quit smoking. 75% of people who walked noticed an increase in the level of physical activity. 17.3% of them underwent inpatient treatment using high-tech medical care. Ther were no major events in the above cohort of patients. Conclusions “Walk with a doc” program practice using newly-developed individual “Cardiac numbers Diary” for a predicted individual risk with regular professional counseling can be a useful guide for making clinical decisions on the intensity of preventive interventions to reduce cardiovascular risk factors in general population. Acknowledgement/Funding None

Perioperative morbidity and mortality in patients treated by radical cystectomy: A multi-institutional retrospective study.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 270-270
Author(s):  
N. Takada ◽  
T. Abe ◽  
S. Maruyama ◽  
A. Sazawa ◽  
N. Shinohara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Death Rate ◽  
Operative Time ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Perioperative Morbidity ◽  
Asa Score

270 Background: It is well known that radical cystectomy is associated with comparatively high perioperative morbidity and mortality. In the present study, we collected data of perioperative outcomes from Hokkaido University Graduate School of Medicine and our teaching hospitals and assessed the complications and death rate within 90 days after radical cystectomy. Methods: We collected clinical data of 970 patients undergoing radical cystectomy for nonmetastatic bladder cancer in 21 institutions between 1999 and 2009. We then assessed 90-day complications and death after radical cystectomy. The complications were classified according to the modified Clavien classification. Over 40 variables were included in the analysis, including age, ASA score, BMI, comorbidity, neoadjuvant chemotherapy, clinical stage, type of urinary diversion, operative time, estimated blood loss, transfusion, and hospital stay. Statistical analysis was performed utilizing Student's t-tests, chi-square tests, and logistic regression analysis. Results: The median patient age was 70 (range, 25-91) years old. 62.5% of patients had an ASA score≥2. Regarding the urinary diversion, ileal conduit was performed in 523 (53.6%) patients, neobladder in 178 (18.4%), ureterocutaneostomy in 255 (26.3%). Median operative time was 399 (range, 100-927) minutes. Median hospital stay was 39 (0-364) days. Regarding the complications, 660 (68%) patients experienced at least one complication and death rate within 90 days after surgery was 1.34% (n=13), respectively. Of the complications, 34.1% was classified as grade 1, 41.5% as grade 2, 20.1% as grade 3, 1.1% as grade 4, 1.2% as grade 5. Multivariate analysis identified age≥70 (odds ratio 1.41), urinary diversion utilizing intestine (OR 1.58) and operative time ≥ 400 (OR 1.54) were independent risk factors. Conclusions: Death rate was 1.34%, which was compatible to reports form western high- volume centers. About two-thirds of the patients experienced at least one complication, although they were mostly classified as grade 2 or less. Age, urinary diversion, and operative time were significant risk factors for perioperative complications after radical cystectomy. No significant financial relationships to disclose.

Outcomes for unplanned reinterventions following paediatric cardiac surgery for tetralogy of Fallot

2021 ◽  
pp. 1-6
Author(s):  
Asaad G. Beshish ◽  
Elizabeth B. Aronoff ◽  
Nikita Rao ◽  
Mohua Basu ◽  
Tawanda Zinyandu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Native American ◽  
Tetralogy Of Fallot ◽  
Surgical Techniques ◽  
Morbidity And Mortality ◽  
Secondary Outcome ◽  
Genetic Syndromes ◽  
Retrospective Case ◽  
Entire Cohort

Abstract Background: Advances in surgical techniques and post-operative management of children with CHD have significantly lowered mortality rates. Unplanned cardiac interventions are a significant complication with implications on morbidity and mortality. Methods: We conducted a single-centre retrospective case–control study for patients (<18 years) undergoing cardiac surgery for repair of Tetralogy of Fallot between January 2009 and December 2019. Data included patient characteristics, operative variables and outcomes. This study aimed to assess the incidence and risk factors for reintervention of Tetralogy of Fallot after cardiac surgery. The secondary outcome was to examine the incidence of long-term morbidity and mortality in those who underwent unplanned reinterventions. Results: During the study period 29 patients (6.8%) underwent unplanned reintervention, and were matched to 58 patients by age, weight and sex. Median age was 146 days, and median weight was 5.8 kg. Operative mortality was 7%, and 1-year survival was 86% for the entire cohort (cases and controls). Hispanic patients were more likely to have reinterventions (p = 0.04) in the unadjusted analysis, while Asian, Pacific Islander and Native American (p = 0.01) in the multi-variate analysis. Patients that underwent reintervention were more likely to have post-op arrhythmia, genetic syndromes and higher operative and 1-year mortality (p < 0.05). Conclusion: Unplanned cardiac interventions following Tetralogy of Fallot repair are common, and associated with increased operative, and 1-year mortality. Race, genetic syndromes and post-operative arrhythmia are associated with increased odds of unplanned reinterventions. Future studies are needed to identify modifiable risk factors to minimise unplanned reinterventions.

Critical Review on Suicide Among Nurses

Crisis ◽  
2015 ◽  
Vol 36 (2) ◽  
pp. 91-101 ◽  
Author(s):  
Marie Alderson ◽  
Xavier Parent-Rocheleau ◽  
Brian Mishara
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
High Stress ◽  
Related Factors ◽  
Work Settings ◽  
Work Related ◽  
High Prevalence ◽  
Full Text Review ◽  
The Subject ◽  
Psychiatric Problems

Background: Research shows that there is a high prevalence of suicide among nurses. Despite this, it has been 15 years since the last literature review on the subject was published. Aim: The aim of this article is to review the knowledge currently available on the risk of suicide among nurses and on contributory risk factors. Method: A search was conducted in electronic databases using keywords related to prevalence and risk factors of suicide among nurses. The abstracts were analyzed by reviewers according to selection criteria. Selected articles were submitted to a full-text review and their key elements were summarized. Results: Only nine articles were eligible for inclusion in this review. The results of this literature review highlight both the troubling high prevalence of suicide among nurses as well as the persistent lack of studies that examine this issue. Conclusion: Considering that the effects of several factors related to nurses' work and work settings are associated with high stress, distress, or psychiatric problems, we highlight the relevance of investigating work-related factors associated with nurses' risk of suicide. Several avenues for future studies are discussed as well as possible research methods.

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