Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

The adrenal glands are common dissemination sites for metastasis of various solid tumors. Surgical treatment is often recommended because targeted therapies and immunotherapy are frequently ineffective for adrenal metastasis. We report the experience with short-term and long-term surgical outcomes of patients undergoing surgery for adrenal metastasis in two hospitals. A retrospective, multicenter study was performed to analyze patient characteristics, tumor-related data, perioperative outcomes, and oncological outcomes. Postoperative complications that occurred within 30 days were scored according to the Clavien Dindo classification. Metastatic adrenalectomy was performed in 95 patients. We observed an increase from an average of 3 metastatic adrenalectomies per year between 2001–2005 to 10 between 2015–2019. The most frequent underlying malignancies were colorectal and lung cancer. In 55.8%, minimal invasive adrenalectomy was performed, including six conversions to open surgery. A total of 37.9% of patients had postoperative complications, of which ileus or gastroparesis, wound problems, pneumonia, and heart arrhythmias were the most occurring complications. Improved cancer care has led to an increased demand for metastatic adrenalectomy over the past years. Complication rates of 37.9% are significant and cannot be neglected. Therefore, multidisciplinary teams should weigh the decision to perform metastatic adrenalectomy for each patient individually, taking into account the drawbacks of the described morbidity versus the potential benefits.

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Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

The American Surgeon ◽

10.1177/0003134821995060 ◽

2021 ◽

pp. 000313482199506

Author(s):

Youngbae Jeon ◽

Kyoung-Won Han ◽

Won-Suk Lee ◽

Jeong-Heum Baek

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Surgical Treatment ◽

Postoperative Complications ◽

Postoperative Mortality ◽

Nonsurgical Treatment ◽

Perioperative Outcomes ◽

Rank Test ◽

Kaplan Meier ◽

Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

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A NSQIP Analysis of MELD and Perioperative Outcomes in General Surgery

The American Surgeon ◽

10.1177/000313481508100811 ◽

2015 ◽

Vol 81 (8) ◽

pp. 755-759 ◽

Cited By ~ 18

Author(s):

Shannon M. Zielsdorf ◽

John C. Kubasiak ◽

Imke Janssen ◽

Jonathan A. Myers ◽

Minh B. Luu

Keyword(s):

Liver Disease ◽

Postoperative Complications ◽

Hernia Repair ◽

Postoperative Complication ◽

General Surgery ◽

Meld Score ◽

Perioperative Outcomes ◽

Complication Rates ◽

Umbilical Hernia Repair ◽

The Mean

It is well known that liver disease has an adverse effect on postoperative outcomes. However, what is still unknown is how to appropriately risk stratify this patient population based on the degree of liver failure. Because data are limited, specifically in general surgery practice, we analyzed the model of end-stage liver disease (MELD) in terms of predicting postoperative complications after one of three general surgery operations: inguinal hernia repair (IHR), umbilical hernia repair (UHR), and colon resection (CRXN). National Surgical Quality Improvement Program data on 17,812 total patients undergoing one of three general surgery operations from 2008 to 2012 were analyzed retrospectively. There were 7402 patients undergoing IHR; 5014 patients undergoing UHR; 5396 patients undergoing CRXN. MELD score was calculated using international normalized ratio, total bilirubin, and creatinine. The primary end point was any postoperative complication. The statistical method used was logistic regression. For IHR, UHR, and CRXN, the overall complication rates were 3.4, 6.4, and 45.9 per cent, respectively. The mean MELD scores were 8.6, 8.5, and 8.5, respectively. For every 1-point increase greater than the mean MELD score, there was a 7.8, 13.8, and 11.6 per cent increase in any postoperative complication. The overall 30-day mortality rate was 0.9 per cent. In conclusion, the MELD score continuum adequately predicts patients’ increased risk of postoperative complications after IHR, UHR, and CRXN. Therefore, MELD could be used for preoperative risk stratification and guide clinical decision making for general surgery in the cirrhotic patient.

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Bisphosphonates and parathyroid hormone analogs for improving bone quality in spinal fusion: State of evidence

Orthopedic Reviews ◽

10.4081/or.2020.8590 ◽

2020 ◽

Vol 12 (2) ◽

Author(s):

Kivanc Atesok ◽

Martina Stippler ◽

Brendan Striano ◽

Grace Xiong ◽

Matthew Lindsey ◽

...

Keyword(s):

Parathyroid Hormone ◽

Spinal Fusion ◽

Bone Quality ◽

Treatment Strategies ◽

Patient Characteristics ◽

Complication Rates ◽

Disc Disease ◽

Potential Benefits ◽

Hormone Analogs ◽

Selection Of

Spinal fusion is among the most commonly performed surgical procedures for elderly patients with spinal disorders – including degenerative disc disease with spondylolisthesis, deformities, and trauma. With the large increase in the aging population and the prevalence of osteoporosis, the number of elderly osteoporotic patients needing spinal fusion has risen dramatically. Due to reduced bone quality, postoperative complications such as implant failures, fractures, post-junctional kyphosis, and pseudarthrosis are more commonly seen after spinal fusion in osteoporotic patients. Therefore, pharmacologic treatment strategies to improve bone quality are commonly pursued in osteoporotic cases before conducting spinal fusions. The two most commonly used pharmacotherapeutics are bisphosphonates and parathyroid hormone (PTH) analogs. Evidence indicates that using bisphosphonates and PTH analogs, alone or in combination, in osteoporotic patients undergoing spinal fusion, decreases complication rates and improves clinical outcomes. Further studies are needed to develop guidelines for the administration of bisphosphonates and PTH analogs in osteoporotic spinal fusion patients in terms of treatment duration, potential benefits of sequential use, and the selection of either therapeutic agents based on patient characteristics.

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Robotic Hysterectomy for Endometrial Cancer in Obese Patients With Comorbidities: Evaluating Postoperative Complications

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000480 ◽

2015 ◽

Vol 25 (7) ◽

pp. 1271-1276 ◽

Cited By ~ 13

Author(s):

Floor J. Backes ◽

Maggie Rosen ◽

Margaret Liang ◽

Georgia A. McCann ◽

Aine Clements ◽

...

Keyword(s):

Endometrial Cancer ◽

Postoperative Complications ◽

Postoperative Complication ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Additional Patient ◽

Complication Rates ◽

Obese Patients ◽

Robotic Hysterectomy ◽

Nonobese Patients

ObjectivesThe objective of this study is to determine (1) if there is a relationship between increasing body mass index (BMI) and postoperative complications in patients undergoing robotic hysterectomy for endometrial cancer and (2) if there are additional patient characteristics, specifically preoperative comorbidities, which increase the risk of postoperative complicationMethodsA retrospective chart review was conducted on women who underwent a robotic staging surgery for endometrial cancer from 2006 to 2012. Basic demographics and preoperative and postoperative complications were extracted from the medical records. Obesity was divided into 4 categories, and complication rates were compared across these subgroups. Patients were also divided by the number of comorbidities and compared.ResultsThe cohort included 543 patients. The BMI ranged from 17.3 to 69.5 kg/m2. Three hundred eighty patients (70%) were obese (BMI >30 kg.m2). One hundred ninety patients (35%) had no comorbidities other than obesity, and 180 patients (33%) had only 1 comorbidity other than obesity (Table 1).Postoperative complications occurred in 102 (18.7%) of the patients. Severe postoperative complications, including intensive care unit admission, reintubation, reoperation, and perioperative death, occurred in 14 patients (2.6%). Of the nonobese patients, 27 (16.5%) had postoperative complications; of the obese patients, 75 (19.7%) had a complication (P = 0.38). In patients with no comorbidities, 16.3% had a complication; 18% of patients with 1 to 2 comorbidities had a complication, and 28% of patients with 3 or more comorbidities had a complication (P = 0.08).ConclusionsThe postoperative complication rate based on BMI or number of comorbidities was not statistically significant, but patients with greater number of comorbidities had an increased rate of postoperative complications. Patients with certain comorbidities, cardiac and renal specifically, had the highest rates of postoperative complications.

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Multidisciplinary Tracheotomy Teams: An Analysis of Patient Outcomes and Resource Allocation

Ear Nose & Throat Journal ◽

10.1177/0145561319840103 ◽

2019 ◽

Vol 98 (4) ◽

pp. 232-237 ◽

Cited By ~ 2

Author(s):

Timothy R. Holmes ◽

Benjamin D. Cumming ◽

Anders W. Sideris ◽

Jennifer W. Lee ◽

Nancy E. Briggs ◽

...

Keyword(s):

Chart Review ◽

Neck Surgery ◽

Multidisciplinary Teams ◽

Complication Rates ◽

Insufficient Evidence ◽

Icu Stay ◽

System A ◽

Medicine Service ◽

Before And After ◽

Potential Benefits

We sought to establish the effect of introducing a multidisciplinary tracheotomy management team (MDT). Tracheotomies are high-cost interventions with potentially devastating complications. Multidisciplinary teams have been introduced in many hospitals with the aim of reducing complications, however, data supporting them are lacking. There is currently insufficient evidence to conclude MDTs reduce length of hospital or intensive care unit (ICU) stay, and there is little information on cost analysis. A chart review identified patients who had a tracheotomy inserted at a major metropolitan teaching hospital with an acute spinal medicine service 2 years before and after the MDT was implemented. The primary outcome was time to decannulation. Other outcomes included tracheotomy complications, the proportion of patients decannulated, length of ICU and hospital stay, and admission cost. Our search identified 174 (78 prior and 96 post-MDT) patients. Baseline demographics were similar between groups. There was no difference in time to decannulation, the decannulation rate, or the length of hospital or ICU stay. Complication rates were low in both groups. There was an increase in the proportion of patients who received speaking valves and a reduction in cost of admission in a subgroup of patients who did not undergo head and neck surgery. There is insufficient evidence to support the widespread introduction of tracheotomy MDTs. Institutions considering introducing a tracheotomy team should carefully consider their case-mix, volume, and available resources as well as the structure and responsibilities of the team, and the timing of its activities within the working week. The potential benefits of MDTs including teaching of staff, and collaboration of teams should be acknowledged. Given the potentially significant implications for cost to the health system, a randomized trial is needed to guide policy in this area.

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Comparison of Perioperative Outcomes and Complication Rates Between Conventional Versus Robotic-Assisted Laparoscopy in the Evaluation and Management of Early, Advanced, and Recurrent Stage Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000096 ◽

2014 ◽

Vol 24 (3) ◽

pp. 600-607 ◽

Cited By ~ 26

Author(s):

Farr Reza Nezhat ◽

Tamara Natasha Finger ◽

Patrick Vetere ◽

Amir Reza Radjabi ◽

Mario Vega ◽

...

Keyword(s):

Postoperative Complications ◽

Recurrent Disease ◽

Early Stage ◽

Perioperative Outcomes ◽

Complication Rates ◽

Intraoperative Complication ◽

Robotic Assisted ◽

Peritoneal Cancer ◽

Significant Difference ◽

Robotic Assisted Laparoscopy

ObjectiveThe objective of this study was to examine perioperative outcomes, including complication rates, of conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RALS) in the evaluation and management of early, advanced, and recurrent ovarian, fallopian tube, and peritoneal cancer.MethodsThis is a retrospective analysis of a prospectively maintained database of surgery performed from July 2008 to December 2012. Sixty-three women had 83 surgeries performed; 22 surgeries for early-stage disease (International Federation of Gynecology and Obstetrics stage I) and 61 for advanced and/or recurrent disease.ResultsOf the 22 for early stage, 10 were CL, 9 were RALS, and 3 were laparoscopy converted to laparotomy (LP). There was no significant difference between CL and RALS in estimated blood loss (EBL,P= 0.27) or length of stay (LOS,P= 0.43); however, both had significantly less EBL (P= 0.03 and 0.03, respectively) and LOS (P= 0.03 and 0.03) than LP. There was no difference in OR time among the groups (P= 0.79). One patient (33%) had an intraoperative complication in LP. One patient (10%) had a postoperative complication in CL, 2 (22%) in RALS, and 1 (33%) in LP, with no significant difference (P= 0.61).Among the 42 patients with advanced/recurrent disease, 61 surgeries were performed: 14 diagnostic procedures and 47 cytoreductive surgeries. Of the 47, there was no difference in operating room time (P= 0.10). There was no difference in EBL or LOS between CL and RALS (P= 0.82,P= 0.87); however, both were less in CL (P< 0.001 andP= 0.02) and RALS (P= 0.01 andP= 0.02) compared with LP. There were 5 (63%) intraoperative transfusions in LP and none in CL or RALS. When including all surgeries for advanced/recurrent disease, there was 1 intraoperative complication (12%) in LP. There was no difference in postoperative complications between groups (P= 0.89); 8 patients (19%) had postoperative complications in CL, 2 (18%) in RALS, and 2 (25%) in LP. Overall, there were no grade 4 or 5 complications and no perioperative or intraoperative deaths.ConclusionsIn our experience, perioperative outcomes are comparable between CL and RALS in both early and advanced/recurrent disease and not inferior to laparotomy, making CL and RALS an acceptable approach in selected patients.

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Surgical treatment of degenerative lumbar stenosis: comorbidities and complications

Coluna/Columna ◽

10.1590/s1808-1851201413040r109 ◽

2014 ◽

Vol 13 (4) ◽

pp. 291-293

Author(s):

Carlos Fernando Pereira da Silva Herrero ◽

Daniel José Mazzo Bedran de Castro ◽

Helton Luiz Aparecido Defino

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Medical Records ◽

Descriptive Analysis ◽

Complication Rates ◽

Lumbar Stenosis ◽

Common Complication ◽

Comorbid Conditions ◽

Study Population ◽

De Medicina

Objectives: To study the characteristics of patients who underwent surgical treatment of degenerative spinal stenosis in the last 10 years (2000â€"2010) at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (USP-HCFMR) and correlate the postoperative complications and preoperative comorbidities found in the study population. Methods: Retrospective review of medical records and radiographs of patients with degenerative lumbar stenosis treated surgically. Descriptive analysis of data was done with SAS 9.0. Results: 92 patients were included, 47 (51.08%) males and 45 (48.91%) females, with ages ranging from 32 to 86 years (mean age of 64.27 years). The most prevalent comorbidities were hypertension (47.82%) and diabetes mellitus (25%). Twenty-three patients (25%) had two or more comorbidities. Postoperative infection was the most common complication found in 12 cases (13%). Patients with only one preoperative comorbidity showed similar complication rates compared to the population without comorbidities. However, patients with two or more comorbid conditions had a higher incidence of postoperative complications (p<0.001). Conclusions: Comorbidities negatively influenced the outcome of surgical treatment of degenerative lumbar stenosis with higher rates of postoperative complications.

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The impact of delayed surgical intervention following high velocity maxillofacial injuries

Scientific Reports ◽

10.1038/s41598-021-80973-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daniel Oren ◽

Amiel A. Dror ◽

Adeeb Zoabi ◽

Adi Kasem ◽

Lior Tzadok ◽

...

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

High Velocity ◽

Medical Center ◽

Complication Rates ◽

Maxillofacial Injuries ◽

Delayed Treatment ◽

Syrian Civil War ◽

The Mean ◽

The Impact

AbstractOur study compares the number of postoperative complications of Syrian patients admitted to the Galilee Medical Center (GMC) over a 5-year period (May 2013–May 2018) for treatment after initial high-velocity maxillofacial injuries sustained during the Syrian civil war. Specifically, we evaluated complication rates of patients arriving “early,” within 24 h, to the GMC versus those who arrived “late,” or 14–28 days following high-velocity maxillofacial injuries. Both groups of patients received definitive surgical treatment within 48 h of admission to our hospital with a total of 60 patients included in this study. The mean age was 26 ± 8 years (range: 9–50) and all except one were male. Postoperative complications in the early group were found to be significantly higher compared to the delayed arrival group (p = 0.006). We found that unintentionally delayed treatment may have contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications. We discuss potential mechanisms for complication rate variations, including critical vascularization periods. Our study may add to a growing body of work demonstrating the potential benefit of delayed surgical treatment for high-velocity maxillofacial injuries.

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Temporary “liquid” Implant for Congenital Glaucoma (long-term results)

International scientific-practical journal Ophthalmology ◽

10.30702/ophthalmology30092020-11.1.2049-65 ◽

2020 ◽

pp. 49-65

Author(s):

N Bobrova ◽

N Trofimova

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Hypotensive Effect ◽

Congenital Glaucoma ◽

Long Term Results ◽

General Will ◽

Visual Functions ◽

Advanced Stages ◽

Intraocular Fluid

The aim of the work was to analyze the long-term results of using a temporary “liquid” implant in the surgery of congenital glaucoma in children. The basis of the developed method of filtrative antiglaucomatous surgery (Patent of Ukraine No. 45099 of 2009) – viscosinusotrabeculotomy – has been set the task of reducing the risk of developing intra- and postoperative complications, reducing the scarring rate and maintaining the newly created ways of the intraocular ﬂuid outﬂow, which in general will increase the effectiveness of surgical treatment of congenital glaucoma in children. 54 children (91 eyes) with simple congenital glaucoma at the age of 1 to 36 months were operated on average (8.7 ± 8.2) months. The persistent and long-lasting hypotensive effect achieved due to viscosinusotrabeculotomy in children with developed and far-advanced stages of congenital glaucoma stops the processes of stretching of the membranes of the eye and stabilizes their size, which in general allows preserving and visual functions improving, in infancy – creating conditions for their formation.

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FEATURES OF OPHTHALMIC CARE FOR PATIENTS WITH COMPLICATED CATARACTS

International Medical Journal ◽

10.37436/2308-5274-2019-4-18 ◽

2020 ◽

pp. 84-89

Author(s):

Inna Ivanovna Lapkina

Keyword(s):

Health Care ◽

Surgical Treatment ◽

Postoperative Complications ◽

Key Words ◽

Outpatient Treatment ◽

Practical Application ◽

Unified Approach ◽

Case Histories ◽

High Prevalence

Today, around 50 million people worldwide suffer from cataracts, more than a half of them need surgical treatment. High prevalence of this pathology in Ukraine, the need to improve the provision of ophthalmic care to patients, and the reform of the health care system have made the research relevant. Concomitant diseases and special conditions of the eye increase the risk of intra− and postoperative complications, worsen the functional parameters of patients after surgery. In order to develop a unified approach to the treatment of complicated cataracts based on diagnostically related groups of patients, a retrospective analysis of case histories of patients with different variants of complications related to the condition of the lens itself, its ligament apparatus and other structures of the eye was conducted. In each case, the surgeon has to choose the appropriate modification of cataract phacoemulsification surgery. The study proposed the classification of cataract phacoemulsification modifications on the basis of the techniques and the sequence of operation stages, taking into account the classification of the degrees of turbidity of the lens, proposed by L. Buratto. It has been noted that in complicated cases, according to the indications of the patient, surgery may be performed on several modifications of cataract phacoemulsification. The developed classification made it possible to generalize the various variants of pathology and greatly facilitate the choice of tactics of surgical treatment in complicated cataracts. It can be used not only for practical application, but also for improving the qualification of trained professionals. The prospect of further research is to identify contraindications for outpatient treatment of the patients with complicated cataracts. Key words: cataract complication, classification of phacoemulsification modifications, diagnostically related groups.

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