Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

2014 ◽  
Vol 13 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Erik J. van Lindert ◽  
Hans Delye ◽  
Jody Leonardo
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Surgical Procedure ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Tumor Surgery ◽  
Infection Rates ◽  
Targeted Interventions

Object The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care. Methods The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded. Results Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders. Conclusions The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).

scholarly journals Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis

2021 ◽  
Author(s):  
M. D. Filipe ◽  
E. de Bock ◽  
E. L. Postma ◽  
O. W. Bastian ◽  
P. P. A. Schellekens ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Complication Rate ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Complication Rates ◽  
Flap Necrosis ◽  
Postoperative Complication Rate ◽  
Common Cancer ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

AbstractBreast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.

Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position

2017 ◽  
Vol 127 (1) ◽  
pp. 182-188 ◽  
Author(s):  
Benjamin T. Himes ◽  
Grant W. Mallory ◽  
Arnoley S. Abcejo ◽  
Jeffrey Pasternak ◽  
John L. D. Atkinson ◽  
...  
Keyword(s):  
Complication Rate ◽  
Perceived Risk ◽  
Perioperative Complications ◽  
Subdural Hemorrhage ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Sitting Position ◽  
Tension Pneumocephalus ◽  
Suboccipital Craniotomy ◽  
Clinically Significant

OBJECTIVEHistorically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series.METHODSThe authors reviewed the anesthesia records for instances of clinically significant VAE and other complications for all neurosurgical procedures performed in the sitting position between January 1, 2000, and October 8, 2013. In addition, a prospectively maintained morbidity and mortality log of these procedures was reviewed for instances of subdural or intracerebral hemorrhage, tension pneumocephalus, and quadriplegia. Both overall and specific complication rates were calculated in relation to the specific type of procedure.RESULTSIn a series of 1792 procedures, the overall complication rate related to the sitting position was 1.45%, which included clinically significant VAE, tension pneumocephalus, and subdural hemorrhage. The rate of any detected VAE was 4.7%, but the rate of VAE requiring clinical intervention was 1.06%. The risk of clinically significant VAE was highest in patients undergoing suboccipital craniotomy/craniectomy with a rate of 2.7% and an odds ratio (OR) of 2.8 relative to deep brain stimulator cases (95% confidence interval [CI] 1.2–70, p = 0.04). Sitting cervical spine cases had a comparatively lower complication rate of 0.7% and an OR of 0.28 as compared with all cranial procedures (95% CI 0.12–0.67, p < 0.01). Sitting cervical cases were further subdivided into extradural and intradural procedures. The rate of complications in intradural cases was significantly higher (OR 7.3, 95% CI 1.4–39, p = 0.02) than for extradural cases. The risk of VAE in intradural spine procedures did not differ significantly from sitting suboccipital craniotomy/craniectomy cases (OR 0.69, 95% CI 0.09–5.4, p = 0.7). Two cases (0.1%) had to be aborted intraoperatively due to complications. There were no instances of intraoperative deaths, although there was a single death within 30 days of surgery.CONCLUSIONSIn this large, modern series of cases performed in the sitting position, the complication rate was low. Suboccipital craniotomy/craniectomy was associated with the highest risk of complications. When appropriately used with modern anesthesia techniques, the sitting position provides a safe means of surgical access.

scholarly journals Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

2017 ◽  
Vol 42 (6) ◽  
pp. E17 ◽  
Author(s):  
Geng Zhou ◽  
Ming Su ◽  
Yan-Ling Yin ◽  
Ming-Hua Li
Keyword(s):  
Mortality Rate ◽  
Complication Rate ◽  
Meta Analysis ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Morbidity Rate ◽  
Complication Rates ◽  
Significant Difference ◽  
Neurological Morbidity ◽  
Electronic Database Search

OBJECTIVEThe objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies.METHODSA systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies.RESULTSSixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%–20.5%) and a low mortality rate of 2.8% (95% CI 1.2%–4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%–5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2–4.3).CONCLUSIONSThe use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required.

scholarly journals C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures—a comparative retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Eva Steinhausen ◽  
Wolfgang Martin ◽  
Rolf Lefering ◽  
Sven Lundin ◽  
Martin Glombitza ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Complication Rate ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Complication Rates ◽  
Matched Pairs ◽  
Calcaneal Fractures ◽  
Postoperative Complication Rate ◽  
Wound Edge

Abstract Background Locking plate osteosynthesis via an L-shaped lateral approach is the gold standard in treating displaced intra-articular calcaneal fractures. High complication rates are known for this approach. The most frequent complications are wound edge necrosis and superficial wound infections. To reduce complication rates, a locking intramedullary nail (C-Nail) was developed that can be implanted minimally invasively via a sinus tarsi approach. We compared the postoperative complication rate and the outcome of plate osteosynthesis versus C-Nail in displaced intra-articular calcaneal fractures. Methods All patients with calcaneal fractures who received osteosynthesis with either plate or C-Nail between January 2016 and October 2019 in our institution were retrospectively analyzed. A subgroup analysis was performed with matched pairs (matching Sanders type, age, Böhler’s angle postoperative in normal range, 33 pairs). Endpoints were postoperative complication rate, bone healing, full weight-bearing and functional outcome. Treatment groups were compared using Fisher’s exact test for binary data, and Mann-Whitney U-test for continuous data. A p-value < 0.05 was considered statistically significant. Results One hundred and one calcaneal fractures were included (C-Nail n = 52, plate n = 49). Patients with C-Nail developed significantly less postoperative complications (p = 0.008), especially wound edge necrosis (p < 0.001). Screw malposition was found more often in the C-Nail group. The rates of achieving full weight-bearing as well as bone healing were comparable in both groups, but in each case significant faster in the C-nail subgroup. The results of the matched-pairs analysis were comparable. Conclusions The postoperative complication rate was significantly lower in the C-Nail group. The C-Nail appears to be a successful alternative in the treatment of calcaneal fractures, even in Sanders IV fractures because of the minimal-invasive implantation as well as the high primary stability. Long-term analysis of this new implant including elaboration on functional outcome is planned. Trial registration Deutsches Register Klinischer Studien (DRKS) DRKS00020395. Date of registration 3 January 2020.

scholarly journals Does a prior hysterectomy complicate transvaginal/transumbilical hybrid NOTES cholecystectomy?—a comparative analysis of prospectively collected data

2021 ◽  
Author(s):  
Dirk R. Bulian ◽  
Axel Sauerwald ◽  
Panagiotis Thomaidis ◽  
Claudia S. Seefeldt ◽  
Dana C. Richards ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Length Of Stay ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Comprehensive Complication Index ◽  
Asa Classification ◽  
Bladder Catheterization ◽  
Hybrid Notes

Abstract Purpose Hysterectomy alters the anatomy of the posterior vaginal vault used as access for transvaginal/transumbilical hybrid NOTES cholecystectomy (NC), creating potential consequences for the feasibility and complication rate of the procedure. Therefore, the aim of our retrospective analysis of prospectively collected data was to analyze the postoperative course after NC in previously hysterectomized (PH) patients compared with patients who had not undergone hysterectomy (NH). Methods A total of 126 NH patients and 50 PH patients aged over 42 who had an NC from 12/2008 to 04/2021 were compared regarding age, body mass index (BMI), ASA classification, number of percutaneous trocars, need for intraoperative urinary bladder catheterization, length of procedure, conversion rate, and intraoperative and postoperative complication rate according to the Clavien/Dindo classification, Comprehensive Complication Index (CCI), mortality, and hospital length of stay. Results PH patients were older than NH patients (63.0 vs 51.5 years; P < 0.001) but did not differ significantly in ASA classification (P = 0.595) and BMI (26.8 vs 27.9 kg/m2; P = 0.480). They required more percutaneous trocars (P = 0.047) and longer procedure time (66.0 vs. 58.5 min; P = 0.039). Out of all 287 scheduled NC only one had to be “converted” to traditional laparoscopic cholecystectomy. Intraoperative and postoperative complication rates, Clavien/Dindo classification, CCI, need for intraoperative urinary bladder catheterization, and length of stay did not differ significantly. Conclusion Our results indicate an increased degree of difficulty of NC in PH patients, although there is no major impact on intraoperative and postoperative complication rates. Urinary bladder perforation is a specific access-related complication in PH patients.

scholarly journals Post-operative Complication Rate Comparison Between Airway Surgery and Upper Airway Stimulation Using NSQIP and ADHERE

OTO Open ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 2473974X2110513
Author(s):  
Douglas J. Van Daele ◽  
John W. Cromwell ◽  
Jennifer K. Hsia ◽  
Ryan S. Nord
Keyword(s):  
Heart Disease ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Upper Airway ◽  
Surgical Site Infections ◽  
Complication Rates ◽  
Improvement Program ◽  
Chi Square ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep

Objective Postoperative complication rates were compared between obstructive sleep apnea surgery (OSAS) and hypoglossal nerve upper airway stimulation (UAS). Study Design Cohort. Setting Multi-institutional international databases. Methods OSAS data were collected from the NSQIP database (2014; American College of Surgeons National Surgery Quality Improvement Program). UAS data were obtained from the ADHERE registry (Adherence and Outcome of Upper Airway Stimulation for OSA International Registry; 2016–December 2019). ADHERE comorbidities and complications were categorized to match NSQIP definitions. A chi-square test was used for proportion P values. Results There were 1623 UAS procedures in ADHERE and 310 in NSQIP. The UAS group was older than the OSAS group (mean ± SD, 60 ± 11 vs 42 ± 13 years) but similarly male (75% vs 77%) and overweight (body mass index, 29 ± 4 vs 29 ± 3 kg/m2). There was a higher proportion of hypertension, diabetes, and heart disease in the UAS cohort. Palatopharyngoplasty was the most common surgical procedure (71%), followed by tonsillectomy (25%). UAS operative time was longer (132 ± 47 vs 54 ± 33 minutes). Postoperative length of stay was not normally distributed, as 71% of UAS stays were <1 day as opposed to 40% of OSA stays ( P < .0001). Thirty-day return to the operating room related to the procedure was 0.1% for UAS and 4.8% for OSAS ( P < .0001). Surgical site infections were 0.13% for UAS and 0.9% for OSAS ( P = .046). Conclusion The UAS cohort was older and more likely to have comorbid hypertension, diabetes, and heart disease. Despite baseline differences, the postoperative complication rate was lower with UAS than with OSAS.

WP1-12 Reducing infection rates in an intrathecal baclofen service; closing the audit cycle

2019 ◽  
Vol 90 (3) ◽  
pp. e4.3-e3
Author(s):  
A Donnelly ◽  
M Balaratnam ◽  
M Murphy ◽  
S Bahadur ◽  
H Padilla ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Complication Rate ◽  
Intrathecal Baclofen ◽  
Infection Risk ◽  
Pressure Sores ◽  
Complication Rates ◽  
Annual Incidence Rate ◽  
Infection Rates ◽  
Occlusive Dressing ◽  
Audit Cycle

ObjectivesIntrathecal baclofen (ITB) is a recognised treatment strategy for the management of spasticity. We have 30 years of experience, and 160 patients currently receiving treatment.DesignAn audit (Jan 13 – Jul 15) demonstrated complication rates of 4.4% (infection) and 4.92% (catheter). After this we recommended 1 vancomycin wash of the pump pocket, 2 occlusive dressing of pressure sores, 3 timely MRSA pre-screening, and this was introduced June-August 2016. We present a re-audit of the service.SubjectsAll patients admitted for ITB pump surgery between June 2016 and June 2018.MethodsThe database of patients was used, from which the patient notes were reviewed with information relating to each surgical procedure recorded.ResultsThere were 92 surgical procedures and 78 patients (M 30, F 48). 12 patients had complications, requiring 18 surgical procedures. Out of 18 surgical procedures, 10 were catheter- and 7 pump-related). Our infection rate was lower at 1% of all surgeries (compared with 4.4%), or 0.6% of all ITB pump patients per year (compared with 3.4%), and our catheter complication rate was 6.25% of all patients per year. Our annual incidence rate of all complications was 5.6% in both groups.ConclusionsThe infection risk is lower and complication rate remains stable. We will discuss factors which may influence the risk of complication, and consider recommendations for the future.

scholarly journals The influence of smoking in minimally invasive spinal fusion surgery

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 198-206
Author(s):  
Wolfgang Senker ◽  
Harald Stefanits ◽  
Matthias Gmeiner ◽  
Wolfgang Trutschnig ◽  
Christian Radl ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Clinical Effectiveness ◽  
Complication Rates ◽  
Spinal Fusion Surgery ◽  
The Difference ◽  
A Prospective Study ◽  
The Impact

Abstract Background The impact of smoking on spinal surgery has been studied extensively, but few investigations have focused on minimally invasive surgery (MIS) of the spine and the difference between complication rates in smokers and non-smokers. We evaluated whether a history of at least one pack-year preoperatively could be used to predict adverse peri- and postoperative outcomes in patients undergoing minimally invasive fusion procedures of the lumbar spine. In a prospective study, we assessed the clinical effectiveness of MIS in an unselected population of 187 patients. Methods We evaluated perioperative and postoperative complication rates in MIS fusion techniques of the lumbar spine in smoking and non-smoking patients. MIS fusion was performed using interbody fusion procedures and/or posterolateral fusion alone. Results Smokers were significantly younger than non-smokers. We did not encounter infection at the site of surgery or severe wound healing disorder in smokers. We registered no difference between the smoking and non-smoking groups with regard to peri- or postoperative complication rate, blood loss, or length of stay in hospital. We found a significant influence of smoking (p = 0.049) on the overall perioperative complication rate. Conclusion MIS fusion techniques seem to be a suitable tool for treating degenerative spinal disorders in smokers.

scholarly journals Intraoperative complications in pediatric neurosurgery: review of 1807 cases

2016 ◽  
Vol 18 (3) ◽  
pp. 363-371 ◽  
Author(s):  
Erik J. van Lindert ◽  
Sebastian Arts ◽  
Laura M. Blok ◽  
Mark P. Hendriks ◽  
Luc Tielens ◽  
...  
Keyword(s):  
Informed Consent ◽  
Intraoperative Complications ◽  
Pediatric Neurosurgery ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Tumor Surgery ◽  
Neurosurgical Department ◽  
Intraoperative Complication ◽  
Cerebrovascular Complications ◽  
Cerebrovascular Surgery

OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.

scholarly journals Does gender influence morbidity or mortality in the surgical treatment of renal masses?

2014 ◽  
Vol 8 (5-6) ◽  
pp. 311
Author(s):  
Brian J. Minnillo ◽  
Andrew Horowitz ◽  
Antonio Finelli ◽  
Shabbir Alibhai ◽  
Lee E. Ponsky ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Complication Rate ◽  
Population Based ◽  
Multivariable Logistic Regression Analysis ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Renal Masses ◽  
Multivariable Logistic Regression

Introduction: We determine the relationship between gender and surgical morbidity after radical nephrectomy (RN) and partial nephrectomy (PN) for renal masses on a population level.Methods: We conducted a population-based, retrospective study using the Canadian Institute for Health Information Discharge Abstract Database. This included 20 286 RNs (82.5%) and 4292 PNs (17.5%) from April 1, 1998 to March 31, 2008. Complications were identified by ICD-9 and 10 codes, and comorbidity was assessed with the Charlson Index. The association between gender and in-hospital complication rates and mortality were examined using the Chi-square test, as well as with multivariable logistic regression, adjusting for explanatory variables including type of surgery, age, and comorbidity.Results: Overall, men experienced a higher unadjusted complication rate than women (35.1% vs. 32.7%), as well as a higher unadjusted in-hospital mortality rate (1.46% vs. 0.84%), respectively. Men also demonstrated significantly higher rates of cardiac, wound, nephrectomy-specific, and medical complications. Women experienced fewer complications than men after RN (p = 0.0002), but not after PN (p = 0.33). On multivariable logistic regression analysis, women had a lower overall complication rate (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.88-0.99), and a lower in-hospital mortality rate (OR 0.64, 95% CI 0.49-0.83) after kidney surgery.Conclusions: In our population-based analysis, in-hospital morbidity after renal surgery was significantly lower for women. Further study is needed to determine if the observed effect is related to differences in surgical difficulty, perioperative care, or unmeasured confounders.

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