The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.

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Complications of Robotic Spine Surgery

Neurosurgery ◽

10.1093/neuros/nyz310_118 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Daniel Myers ◽

Gordon Mao ◽

Alexander Kwong-Tak Yu ◽

Donald M Whiting

Keyword(s):

Pedicle Screw ◽

Spine Surgery ◽

Complication Rate ◽

Surgical Complications ◽

Surgical Complication ◽

Spinal Instrumentation ◽

Pedicle Screws ◽

Medical Complication ◽

Complication Rates ◽

Robotic Assisted

Abstract INTRODUCTION Robotic assisted spine surgery is becoming increasingly widespread during spinal instrumentation cases. We report our early experience utilizing robotic assisted spinal instrumentation. The aim of the study is to review complications experienced during robotic assisted spinal instrumentation including analysis of pedicle screw accuracy, medical, and surgical complications. METHODS This study was performed as a descriptive, retrospective study. We reviewed cases over the course of 12 mo and examined all operative and postoperative data including pedicle screw accuracy, medical, and surgical complications related to the surgery and hospital stay. Pedicle screw accuracy was assessed utilizing the Gertzbein–Robbins scale. RESULTS The study included 67 consecutive patients undergoing 68 robotic-assisted procedures. Patient ages ranged from 20 to 90 yr. There were 37 males and 30 females. Indications for surgery included degenerative disease 33, trauma 24, tumor 5, and infection 1. There were a total of 592 pedicle screws placed. A total of 26 (4.3%) screws were revised intraoperatively using the robot. An additional 32 (5.4%) screws were aborted from robotic assistance. Pedicle screw accuracy was noted to be excellent with 97% of screws rated as clinically acceptable. There were 4 deaths (5.8%), 18 patients (26%) experienced a medical complication, 26 patients (38%) experienced a surgical complication and 6 patients (9%) experienced both a medical and surgical complication. A total of 38 patients (55%) experienced any morbidity or mortality related to surgery. Mean operative time was 277 min. CONCLUSION We report our initial experience with robotic-assisted spine surgery. Pedicle screw accuracy was noted to be high. We experienced a broad array of medical and surgical complications. The high complication rate may be due to long operative times and presence of a learning curve utilizing the robot. Further study is warranted to note if more experience decreases complication rates. It is unclear if the complication rate is significantly different compared to traditional methods of spinal instrumentation.

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Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine191330 ◽

2020 ◽

Vol 33 (3) ◽

pp. 297-306

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Rushikesh S. Joshi ◽

Christopher P. Ames

Keyword(s):

Risk Factor ◽

Complication Rate ◽

Surgical Complications ◽

Deformity Correction ◽

Neurological Deficits ◽

Wedge Osteotomy ◽

Medical Complication ◽

Complication Rates ◽

Cervical Deformity ◽

Significant Difference

OBJECTIVEThe correction of severe cervicothoracic sagittal deformities can be very challenging and can be associated with significant morbidity. Often, soft-tissue releases and osteotomies are warranted to achieve the desired correction. There is a paucity of studies that examine the difference in morbidity and complication profiles for Smith-Petersen osteotomy (SPO) versus 3-column osteotomy (3CO) for cervical deformity correction.METHODSA retrospective comparison of complication profiles between posterior-based SPO (Ames grade 2 SPO) and 3CO (Ames grade 5 opening wedge osteotomy and Ames grade 6 closing wedge osteotomy) was performed by examining a single-surgeon experience from 2011 to 2018. Patients of interest were individuals who had a cervical sagittal vertical axis (cSVA) > 4 cm and/or cervical kyphosis > 20° and who underwent corrective surgery for cervical deformity. Multivariate analysis was utilized.RESULTSA total of 95 patients were included: 49 who underwent 3CO and 46 who underwent SPO. Twelve of the SPO patients underwent an anterior release procedure. The patients’ mean age was 63.2 years, and 60.0% of the patients were female. All preoperative radiographic parameters showed significant correction postoperatively: cSVA (6.2 cm vs 4.5 cm [preoperative vs postoperative values], p < 0.001), cervical lordosis (6.8° [kyphosis] vs −7.5°, p < 0.001), and T1 slope (40.9° and 35.2°, p = 0.026). The overall complication rate was 37.9%, and postoperative neurological deficits were seen in 16.8% of patients. The surgical and medical complication rates were 17.9% and 23.2%, respectively. Overall, complication rates were higher in patients who underwent 3CO compared to those who underwent SPO, but this was not statistically significant (total complication rate 42.9% vs 32.6%, p = 0.304; surgical complication rate 18.4% vs 10.9%, p = 0.303; and new neurological deficit rate 20.4% vs 13.0%, p = 0.338). Medical complication rates were similar between the two groups (22.4% [3CO] vs 23.9% [SPO], p = 0.866). Independent risk factors for surgical complications included male sex (OR 10.88, p = 0.014), cSVA > 8 cm (OR 10.36, p = 0.037), and kyphosis > 20° (OR 9.48, p = 0.005). Combined anterior-posterior surgery was independently associated with higher odds of medical complications (OR 10.30, p = 0.011), and preoperative kyphosis > 20° was an independent risk factor for neurological deficits (OR 2.08, p = 0.011).CONCLUSIONSThere was no significant difference in complication rates between 3CO and SPO for cervicothoracic deformity correction, but absolute surgical and neurological complication rates for 3CO were higher. A preoperative cSVA > 8 cm was a risk factor for surgical complications, and kyphosis > 20° was a risk factor for both surgical and neurological complications. Additional studies are warranted on this topic.

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Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

The American Surgeon ◽

10.1177/000313480507100309 ◽

2005 ◽

Vol 71 (3) ◽

pp. 219-224 ◽

Cited By ~ 12

Author(s):

JosÉ A. Montalvo ◽

JosÉ A. Acosta ◽

Pablo RodrÍguez ◽

Kathia Alejandro ◽

AndrÉs SÁrraga

Keyword(s):

Surgical Complications ◽

Causes Of Death ◽

Surgical Complication ◽

Damage Control ◽

Multiple Logistic Regression Analysis ◽

Hypovolemic Shock ◽

Damage Control Surgery ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

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Neoadjuvant bevacizumab: Surgical complications of mastectomy with and without reconstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1100 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1100-1100

Author(s):

Kari Joanne Kansal ◽

Laura Stewart Dominici ◽

Sara M. Tolaney ◽

Steven J. Isakoff ◽

Ian E. Krop ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Therapy ◽

Surgical Complications ◽

Small Sample Size ◽

Small Sample ◽

P Value ◽

Data Sets ◽

Complication Rates ◽

Similar Time ◽

Time Period

1100 Background: Neoadjuvant therapy is commonly used in operable breast cancer. We prospectively evaluated the surgical complications in a cohort of patients who underwent mastectomy following neoadjuvant doxorubucin hydrochloride/cyclophosphamide/paclitaxel (AC/T) plus bevacizumab and compared the rate of complications to a matched cohort of neoadjuvant AC/T without bevacizumab. Methods: One hundred patients with HER2-negative breast cancer enrolled in a single-arm trial of neoadjuvant AC/T plus bevacizumab (cohort 1), 60 of these patients underwent mastectomy and were matched with 59 patients who received standard neoadjuvant AC/T (cohort 2) over a similar time period in the same healthcare system. All patients underwent mastectomy with or without reconstruction. Fisher’s exact tests were used to compare complication rates, with a p<0.05 was considered significant. Results: Patients were matched well in terms of demographics. The overall complication rate was 33% in cohort 1 and 31% in cohort 2 (P-value=0.84; Table). In cohort 1, 7 of 23 (30%) patients who underwent immediate expander/implant reconstruction had complications, including 2 patients who had explantation of their reconstructions. In cohort 2, 0 of 8 (0%) had complications (p value=0.15). Conclusions: Nearly a third of patients undergoing neoadjuvant therapy with AC/T with or without bevacizumab developed a postoperative complication after mastectomy. The use of bevacizumab was not associated with a significant increase in surgical complications, although this is a non-randomized data with a small sample size. As larger data sets become available with the use of neoadjuvant bevacizumab with mastectomy, further refinement may be necessary. [Table: see text]

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Estimating the Risk of Deep Brain Stimulation in the Modern Era: 2008 to 2020

Operative Neurosurgery ◽

10.1093/ons/opab261 ◽

2021 ◽

Author(s):

Eun Jeong Koh ◽

Joshua L Golubovsky ◽

Richard Rammo ◽

Arbaz Momin ◽

Benjamin Walter ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Complication Rate ◽

Surgical Complication ◽

Neurological Complication ◽

The United States ◽

Complication Rates ◽

Systemic Complication ◽

United States Food ◽

Deep Brain

Abstract BACKGROUND Deep brain stimulation (DBS) was first approved by the United States Food and Drug Administration in 1997. Although the fundamentals of DBS remain the same, hardware, software, and imaging have evolved significantly. OBJECTIVE To test our hypothesis that the aggregate complication rate in the medical literature in the past 12 years would be lower than what is often cited based on early experience with DBS surgery. METHODS PubMed, PsycINFO, and EMBASE were queried for studies from 2008 to 2020 that included patients treated with DBS from 2007 to 2019. This yielded 34 articles that evaluated all complications of DBS surgery, totaling 2249 patients. RESULTS The overall complication rate in this study was 16.7% per patient. There was found to be a systemic complication rate of 0.89%, intracranial complication rate of 2.7%, neurological complication rate of 4.6%, hardware complication rate of 2.2%, and surgical site complication rate of 3.4%. The infection and erosion rate was 3.0%. CONCLUSION This review suggests that surgical complication rates have decreased since the first decade after DBS was first FDA approved. Understanding how to minimize complications from the inception of a technique should receive more attention.

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Risk Factors for Medical and Surgical Complications Following Single-Level ALIF

Global Spine Journal ◽

10.1177/2192568217694009 ◽

2017 ◽

Vol 7 (2) ◽

pp. 141-147 ◽

Cited By ~ 11

Author(s):

Winward Choy ◽

Nikki Barrington ◽

Roxanna M. Garcia ◽

Robert B. Kim ◽

Heron Rodriguez ◽

...

Keyword(s):

Risk Factors ◽

Weight Loss ◽

Complication Rate ◽

Surgical Complications ◽

Surgical Complication ◽

Medical Complication ◽

Clinical Practices ◽

Preoperative Anemia ◽

Single Level ◽

Associated Risk Factors

Study Design: Retrospective cohort study. Objective: The objective of the study was to determine rates of medical and surgical postoperative complications following anterior lumbar interbody fusion (ALIF) along with their associated predictors. Methods: Using the American College of Surgeons National Surgical Quality Improvement database, patients who underwent single-level ALIF surgery from 2006 to 2013 were identified. The 30-day rate of postoperative medical and surgical complications along with associated risk factors were evaluated by multivariable logistic regression. Results: In total, 1474 patients were included in the analysis. The overall rate of complications was 14.5%. The medical complication rate was 12.7%, while the surgical complication rate was 2.8%. Predictors of surgical complications were diabetes (odds ratio [OR] = 2.79, 95% CI = 1.20-6.01, P = .009), corticosteroid dependence (OR = 4.94, 95% CI = 1.73-14.08, P = .003), and preoperative transfusion of >4 units (OR = 7.12, 95% CI = 1.43-35.37, P = .016). Predictors of medical complications were longer operative times (OR = 4.25, 95% CI = 2.90-6.24, P < .001), preoperative anemia (OR = 2.29, 95% CI = 1.50-3.50, P < .001), >10% weight loss prior to surgery (OR = 6.79, 95% CI = 1.01-45.93, P = .049), and more severe American Society of Anesthesiologists classification (OR = 2.18, 95% CI = 1.54-3.11, P < .001). Conclusions: The present study determines postoperative medical and surgical complications among patients undergoing ALIF. The risk factors elucidated in this study indicate that clinical practices to curtail complications should be targeted toward patients with preoperative anemia, weight loss, corticosteroid dependence, and toward those at risk for perioperative transfusions.

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When is the Critical Time for Soft Tissue Reconstruction of Open Tibia Fracture Patients?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1717151 ◽

2020 ◽

Author(s):

Seung Yeol Lee ◽

Ik Hyun Seong ◽

Bo Young Park

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Roc Curve ◽

Complication Rate ◽

Surgical Outcomes ◽

Revision Rate ◽

Single Type ◽

Soft Tissue Reconstruction ◽

Complication Rates ◽

Tissue Reconstruction

Abstract Background The timing of soft tissue reconstruction for soft-tissue defect in patients with open fractures in the lower extremity is known to be critical for successful outcomes. However, medical advances, including development of dressing materials and refinement in the microsurgical techniques, might have undergone modifications in this “critical period.” There have been no studies on the role of timing on reconstructive outcomes. Thus, we have analyzed the effect of reconstruction timing on optimal surgical outcomes and complication rates in a single type of lower extremity injury. Methods Data of patients who underwent microvascular free tissue transfer with an open fracture in the lower extremity from 2014 through 2016 were retrospectively reviewed (n = 103). Surgical outcomes, including flap complication rate, flap revision rate, and long-term bony complications, were analyzed serially in accordance with time interval until coverage using the receiver operating characteristic (ROC) curve analysis. Significant factors with a p < 0.05 in the univariate analysis were included in the multivariate logistic regression model to identify independent risk factors. Results A total of 46 patients (33 males and 13 females) were finally included in the study. Based on the association between surgical timing and flap-related complication rate, the best cutoff period for surgery was 33 days, with an area under the curve of 0.658 (p = 0.040). Further, in the revision rate, the cutoff period was identified as 10 days (p = 0.016). Regarding the incidence of bony complications, ROC curve showed that the maximal period until operation was 91 days with no influence on the occurrence of bony complications (p = 0.029). Conclusion Although the best method is an early reconstruction, many modalities such as negative pressure wound therapy play a role as a temporary measure. Our study suggests that the acute or early period for successful reconstruction might be extended compared with previous studies.

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Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization

Journal of Neurosurgery Spine ◽

10.3171/2018.8.spine18198 ◽

2019 ◽

Vol 30 (3) ◽

pp. 308-313 ◽

Cited By ~ 2

Author(s):

Julia Onken ◽

Kathrin Obermüller ◽

Franziska Staub-Bartelt ◽

Bernhard Meyer ◽

Peter Vajkoczy ◽

...

Keyword(s):

Surgical Approach ◽

Complication Rate ◽

Posterior Approach ◽

Surgical Complication ◽

Extent Of Resection ◽

Surgical Approaches ◽

Special Focus ◽

Complication Rates ◽

Duration Of Surgery ◽

Spinal Meningiomas

OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).METHODSBetween 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.RESULTSThe authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.CONCLUSIONSThe duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.

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

OTO Open ◽

10.1177/2473974x211051313 ◽

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.

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SAFETY IN OUTPATIENT SURGICAL PROCEDURES – A REVIEW OF EARLY COMPLICATION RATES OF AMBULATORY SPORTS MEDICINE CASES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00059 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0005

Author(s):

Angelina Iyinbor ◽

Johnathan A. Bernard ◽

David C. Johnson ◽

Zahra Ismaeli ◽

Nathan Coleman ◽

...

Keyword(s):

Surgical Procedures ◽

Complication Rate ◽

Sports Medicine ◽

Surgical Site Infections ◽

Ambulatory Setting ◽

Complication Rates ◽

Inclusion Criteria ◽

Orthopaedic Surgeons ◽

Vein Thrombosis ◽

Operative Complications

Background: Due to rising health care costs, attention has been dedicated to understanding both outcomes and expenditure as it relates to improving value. There is an increasing trend to perform inpatient hospital procedures in the ambulatory setting to lower costs. Complications to surgical procedures are costly. However, there is a paucity of data reporting early complications. This study aims to determine the 30-day postoperative complication rate of ambulatory surgical procedures in a sports medicine practice. Methods: A retrospective review of four Sports Fellowship trained orthopaedic surgeons at a single institution was conducted for all procedures performed over a 29-month period. The inclusion criteria consisted of all ambulatory surgical cases. Surgeon completed infection control surveys were reviewed from the included patients which contained information on intra-operative complications, post-operative infections, emergency room (ER) visit or hospitalization related to the procedure. Demographics on the patients were collected via the institutional electronic medical record (EMR). Descriptive statistics were performed on case type and frequency (Microsoft Excel). Results: From January 1, 2015 through May 31, 2018, 571 surgical procedures performed in the ambulatory setting met inclusion criteria. There was a total of six surgical complications reported (three dermatologic, two deep vein thrombosis, one hemarthrosis). There were no intra-operative complications reported and no surgical site infections reported. Conclusions/Significance: During the two year and five months study period, the sports medicine, orthopaedic surgery institution had an overall complication rate of 0.51%. This rate is within the historical norm for the majority of the procedures performed. There were no intra-operative complications and no surgical site infections. Only one patient required an ER visit in over 2 years. Ambulatory surgery performed by Sports Fellowship trained, Board Certified Orthopaedic Surgeons in select patients can be performed safely with minimal complications thus lowering costs and improving value.

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