Intraoperative complications of phacoemulsification: risk factors, incidence, prediction

Abstract Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative neurological status of the patient. However, there is paucity of information regarding factors responsible for continuation of MV in these patients. This study was carried out to identify the indications and risk factors for elective ventilation after intracranial tumour surgery. Materials and Methods: A prospective observational study was carried out on consecutive adult patients who underwent elective craniotomy for tumour excision, and postoperatively required MV. Data on anaesthesia technique, duration of anaesthesia and surgery, blood loss and transfusion and volume of fluids infused were noted. Intraoperative complications like tight brain, massive blood loss, brainstem handling, cranial nerve handling, haemodynamic instability, cardiac arrhythmias, venous air embolism, electrolyte abnormality and hypothermia were also recorded. Statistical analysis was done using Strata 9.0 software. Categorical data was analysed using Chi-square test or Fisher's exact test and continuous data by Student's t-test. Results: A total of 709 patients enrolled for the study over a period of one year out of which 347 patients (48.9%) required continuation of MV during the postoperative period. The mean duration of MV was 29.7 ± 39.7 hrs. The most common causes for postoperative MV were ‘not responding to commands’ (43.2%), and neurosurgeon's advice (41.8%). The mean ICU and hospital stays were 92.2 ± 134.0 hrs and 13.8 ± 16.5 days, respectively. 47.6% of patients who required postoperative MV on neurosurgeon's advice developed complications whereas it was 33.2% for those ventilated other reasons (P < 0.05). Glasgow outcome scale (GOS) at discharge was poor in 12.4%. On multivariate analysis, intraoperative blood transfusion, tracheostomy and duration of ventilation more than 48 hrs were the independent risk factors associated with poor outcome. Conclusions: Although the neurosurgeon's advice for elective ventilation should not be ignored, but prolonged and avoidable MV may exacerbate the postoperative morbidities apart from increasing the cost of treatment. Hence, a complete understanding of intraoperative events, cerebral physiology and various factors influencing it during the perioperative period may not be overemphasised.

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Risk Factors for Intraoperative Complications in Resident-Performed Phacoemulsification Surgery

Ophthalmology ◽

10.1016/j.ophtha.2008.10.028 ◽

2009 ◽

Vol 116 (3) ◽

pp. 431-436 ◽

Cited By ~ 71

Author(s):

Tina Rutar ◽

Travis C. Porco ◽

Ayman Naseri

Keyword(s):

Risk Factors ◽

Intraoperative Complications

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Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein—a retrospective risk stratification of 500 consecutive patients

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02097-w ◽

2021 ◽

Author(s):

Felix Becker ◽

Lennart A. Wurche ◽

Martina Darscht ◽

Andreas Pascher ◽

Benjamin Struecker

Keyword(s):

Risk Factors ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Intraoperative Complications ◽

Venous Access ◽

Access Port ◽

Oncological Treatment ◽

Number Of Patients ◽

Venous Access Port

Abstract Purpose Modern oncological treatment algorithms require a central venous device in form of a totally implantable venous access port (TIVAP). While most commonly used techniques are surgical cutdown of the cephalic vein or percutaneous puncture of the subclavian vein, there are a relevant number of patients in which an additional strategy is needed. The aim of the current study is to present a surgical technique for TIVAP implantation via an open Seldinger approach of the internal jugular vein and to characterize risk factors, associated with primary failure as well as short- (< 30 days) and long-term (> 30 days) complications. Methods A total of 500 patients were included and followed up for 12 months. Demographic and intraoperative data and short- as well as long-term complications were extracted. Primary endpoint was TIVAP removal due to complication. Logistic regression analysis was used to analyze associated risk factors. Results Surgery was primarily successful in all cases, while success was defined as functional (positive aspiration and infusion test) TIVAP which was implanted via open Seldinger approach of the jugular vein at the intended site. TIVAP removal due to complications during the 1st year occurred in 28 cases (5.6%) while a total of 4 (0.8%) intraoperative complications were noted. Rates for short- and long-term complications were 0.8% and 6.6%, respectively. Conclusion While the presented technique requires relatively long procedure times, it is a safe and reliable method for TIVAP implantation. Our results might help to further introduce the presented technique as a secondary approach in modern TIVAP surgery.

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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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Assessment of risk factors for hospital readmission after kidney transplantation

Iranian Journal Of Health Sciences ◽

10.18502/jhs.v9i2.6565 ◽

2021 ◽

Author(s):

Mahmoud Tavakkoli ◽

Amir Yarahmadi ◽

Mahin Ghorban Sabbagh ◽

Mona Najaf Najafi ◽

Milad Tavakoli ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Hospital Readmission ◽

Intraoperative Complications ◽

Demographic Data ◽

Graft Function ◽

Delayed Graft Function ◽

Post Discharge ◽

Ischemic Time ◽

Cold Ischemic Time

Background and Purpose: Hospital readmission after kidney transplantation is a real challenge for both patients and healthcare systems. Assessment of the risk factors of readmission after kidney transplantation is vital and can reduce morbidity and cost in transplant recipients and donors. The aim of the current study was to determine the risk factors of hospital readmission in patients undergoing kidney transplantation in Montaserieh Hospital of Mashhad, northeast of Iran. Materials and Methods: This retrospective study included 523 first kidney transplant patients between January 2013 and March 2019 from the Montaserieh Hospital Information System (HIS) of Mashhad, Iran. Every-time readmission was the study primary outcome. Donors and recipient's demographic data, recipient's comorbidities, reasons for end-stage renal disease (ESRD), panel reactive antibody (PRA) status, dialysis parameters, cold ischemic time, and delayed graft function (DGF) were the potential risk factors. Statistical analysis was done using Chi-square and Student's t-test. Results: Data from 523 patients were assessed for potential eligibility. Based on the exclusion criteria, data from 479 patients were included in the final analysis. 174 (36.3%) patients were never readmitted, and 305 (63.7%) were readmitted at least once post-discharge. 39 (12.8%) were readmitted within the first-month post-discharge. Older age, sex, higher prevalence of comorbidities, diabetes and hypertension, duration of primary disease before transplantation, hemodialysis and duration of pre-transplant dialysis, mean pre-transplant platelet count, intraoperative complications, increased cold ischemic time, and delayed graft function were associated with a higher prevalence of readmission (p<0.05). Conclusion Our results showed that different independent variables and patients' comorbidities were important risk factors for readmission after kidney transplantation. Early prediction of these risk factors could result in prevention from readmission in patients undergoing kidney transplantation.

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Risk factors for intraoperative complications in pheochromocytomas

Endocrine Related Cancer ◽

10.1530/erc-21-0230 ◽

2021 ◽

Author(s):

Marta Araujo-Castro ◽

Rogelio Garcia Centeno ◽

María-Carmen López-García ◽

Cristina Lamas ◽

Cristina Alvarez-Escola ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Antihypertensive Drugs ◽

Intraoperative Complications ◽

Tumour Size ◽

Hypertensive Crisis ◽

Pressure Control ◽

Hemodynamic Instability ◽

Beta Blockade ◽

Pre Treatment

We aimed to identify presurgical and surgical risk factors for intraoperative complications in patients with pheochromocytomas. A retrospective study of patients with pheochromocytomas who underwent surgery in ten Spanish hospitals between 2011 and 2021 was performed. One hundred and sixty-two surgeries performed in 159 patients were included. The mean age was 51.6±16.4 years-old and 52.8% were women. Median tumour size was 40 mm (range 10-110). Laparoscopic adrenalectomy was performed in 148 patients and open adrenalectomy in 14 patients. Presurgical alpha- and beta- blockade was performed in 95.1% and 51.9% of the surgeries, respectively. 33.3% of the patients (n=54) had one or more intraoperative complications. The most common complication was hypertensive crisis in 21.0%, followed by prolonged hypotension in 20.0% and hemodynamic instability in 10.5%. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more commonly than patients pre-treated with other antihypertensive drugs (51.1% vs 26.5%, P=0.002). Intraoperative complications were more common in patients with higher levels of urine metanephrine (OR=1.01 for each 100 mcg/24h, P=0.026) and normetanephrine (OR=1.00 for each 100 mcg/24h, P=0.025), larger tumours (OR=1.4 for each 10mm, P<0.001), presurgical blood pressure >130/80mmHg (OR=2.25, P=0.027), pre-treated with doxazosin (OR= 2.20, P=0.023) and who had not received perioperative hydrocortisone (OR=3.95, P=0.008). In conclusion, intraoperative complications in pheochromocytoma surgery are common and can be potentially life-threatening. Higher metanephrine and normetanephrine levels, larger tumour size, insufficient blood pressure control before surgery, pre-treatment with doxazosin, and the lack of treatment with perioperative hydrocortisone are associated with higher risk of intraoperative complications.

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Assessment of the frequency and possible risk factors for paroxysmal atrial fibrillation in the early postoperative period after transapical implantation of the MedLab-CT valve

Jounal of arrhythmology ◽

10.35336/va-2020-4-5-11 ◽

2021 ◽

Vol 27 (4) ◽

pp. 5-11

Author(s):

O. V. Popylkova ◽

S. S. Durmanov ◽

A. B. Voevodin ◽

V. V. Bazylev

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Aortic Valve ◽

Postoperative Period ◽

Intraoperative Complications ◽

Significant Risk ◽

Significant Risk Factor ◽

Early Postoperative Period ◽

Echocardiographic Parameters ◽

History Of

Aim. To study the incidence and possible risk factors for atrial fibrillation (AF) in the early postoperative period after transapical implantation of the first domestic aortic valve (TAVI) “MedLab-CT”.Material and methods. The study included 118 patients after successful TAVI. The study did not include patients with open aortic valve replacement due to dislocation of the prosthesis, with severe intraoperative complications leading to the death of the patient, and patients with permanent AF. The mean age of the patients was 71.1 ± 4.9 years, body mass index was 31.1 ± 5.9 kg/m2, men were 39.8%, hypertension was in 93.2%, diabetes mellitus (DM) was in 27.9%, paroxysmal AF was in 12.7%, coronary heart disease (CHD) was in 56.7%, smoking was noted in 8.4% cases. The median follow-up time corresponded to the hospital stay - 9.5 days. To identify cardiac arrhythmias, daily regular ECG recordings in 12 leads were assessed from the first day after TAVI. In the presence of palpitations, 24-hour ECG monitoring was performed. Indicators such as age, male gender, DM, history of AF, interatrial block before surgery, CHD, and echocardiographic parameters were studied as possible predictors of AF development in the early postoperative period after TAVI. There were no significant differences in the studied parameters in patients with AF paroxysms and sinus rhythm.Results. In the early postoperative period, AF episodess occurred in 46 (39%) patients. New-onset AF occurred in 38 (32.2%) patients. The only statistically significant risk factor for AF in the postoperative period in our series of observations was CHD (OR 5.756; 95% CI 1.009-8.132; p = 0.048).Conclusion. Patients with paroxysmal AF in the early postoperative period were not detected cerebrovascular events. In the early postoperative period, the only significant predictor of AF was the presence of proven CHD in patients.

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