PREVALENCE OF ADDICTION IN MALE PATIENTS POSTED FOR ORTHOPAEDIC OPERATIONS AND ITS SURGICAL OUTCOME

Introduction: Addiction of tobacco and other substances is a signicant surgical risk factor for peri-operative surgical events. Orthopedic perioperative complications of smoking include impaired wound healing, augmented infection, delayed and/or impaired fracture union and arthrodesis and worst total knee and hip arthroplasty results. This study is designed to analyse such routinely recorded data and observe prevalence addiction in male patients posted for orthopaedic operation. Material and methods: This Observational Retrospective study was conducted in MRD, ESI-PGIMSR & MC. All elective post-surgical patients who underwent surgery in between the period of January 2017 to December 2017. Total 120 patients were present in this study. Result: The most signicant effects of intervention were seen for wound-related complications (5% vs 31%, p=0·001), cardiovascular complications (0% vs 10%, p=0·08), and secondary surgery (4% vs 15%, p=0·07). The median length of stay was 11 days (range 7–55) in the smoker and 13 days (8–65) in the nonsmoker. Conclusion: Smoking is a risk factor for wound infection and cardiopulmonary complications in almost any type of surgery; smokers make up a considerable proportion of the total number of postoperative complications. An effective smoking intervention programme applied 6–8 weeks before surgery more than halved the frequency of postoperative complications, with the greatest effect on wound-related and cardiovascular complications.

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Actualización en el manejo anestésico del paciente obeso. ¿Lo sabemos todo?

Revista Electrónica AnestesiaR ◽

10.30445/rear.v11i7.766 ◽

2019 ◽

Vol 11 (7) ◽

pp. 2

Author(s):

Belén Sánchez Quirós ◽

María Asunción Pérez Herrero

Keyword(s):

Metabolic Syndrome ◽

Risk Factor ◽

Difficult Intubation ◽

Perioperative Complications ◽

Anesthetic Management ◽

Preoperative Evaluation ◽

Cardiovascular Complications ◽

Prothrombotic State ◽

Respiratory Complications ◽

Intraoperative Management

La obesidad creciente en nuestro medio es un factor de riesgo para la aparición de complicaciones perioperatorias. Un manejo perioperatorio individualizado, teniendo en cuenta la idiosincrasia de estos pacientes es esencial para mejorar los resultados y la seguridad del procedimiento quirúrgico. Un manejo anestesico adecuado puede cambiar sustancialmente el desenlace vital de estos pacientes. ABSTRACT Anesthetic management of obese patient update. Do we know everything? Obesity is a growing risk factor that leads to perioperative complications increase. An appropriate preoperative evaluation, intraoperative management and monitoring during the postoperative period is essential to improve safety during the surgical procedure. These patients present criteria of difficult intubation and ventilation, respiratory complications, especially the Apnea / hypopnea sleep syndrome (OSA); metabolic syndrome; prothrombotic state and cardiovascular complications. The commented article described the physiopathological characteristics and current recommendations of the anesthetic management for these patients.

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FC02-02 - Prevention of violence among out-patients with schizophrenia (previos i): A feasibility study

European Psychiatry ◽

10.1016/s0924-9338(11)73520-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1816-1816

Author(s):

T. Steinert ◽

K. Hamann ◽

U. Frommberger ◽

M. Schwarz ◽

G. Weithmann

Keyword(s):

Psychotic Disorders ◽

Controlled Trial ◽

Psychiatric Hospitals ◽

Behavioural Therapy ◽

Considerable Proportion ◽

Intervention Programme ◽

Prevention Of Violence ◽

Psychiatric Units ◽

Male Patients ◽

Randomised Controlled

IntroductionThe number of beds in forensic psychiatry has increased more than two-fold since 1990 in many countries, mostly due to an increasing number of admitted male patients with psychotic disorders. Most of these patients had previous admissions to general psychiatric units.AimsTo develop a manual for interventions aiming on the prevention of violence based on cognitive behavioural therapy and to test its feasibility.MethodsA manual comprising of 11 different domains of possible interventions was developed. For each patient, the three most relevant domains should be identified. A pilot study was conducted in two psychiatric hospitals. Included patients should receive two sessions as in-patients and consecutively three more as out-patients.ResultsOut of 368 male patients with a diagnosis of a schizophrenic or schizoaffective disorder, 89 (24.2%) had a relevant history of violence. Only 15 (17%) could be recruited for the study, 13 (14.6% of eligible patients) completed the intervention. A considerable proportion refused to participate. The manual was considered to be applicable and relevant. Domains used most frequently were anger management, substance abuse, and medication adherence.ConclusionsThe intervention based on a flexible manual and five sessions was feasible and well accepted by participating patients. However, it turned out to be difficult to recruit this group of patients for an intervention programme and for a study. To conduct a randomised controlled trial, a screening of about 4.000 patients with schizophrenia will be necessary.

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Frailty as a risk factor for postoperative complications in adult patients with degenerative scoliosis administered posterior single approach, long-segment corrective surgery: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04186-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Bin Li ◽

Xianglong Meng ◽

Xinuo Zhang ◽

Yong Hai

Keyword(s):

Risk Factor ◽

Postoperative Complications ◽

Posterior Approach ◽

Frailty Index ◽

Cardiac Complications ◽

Corrective Surgery ◽

Degenerative Scoliosis ◽

Acute Renal Dysfunction ◽

Radiographic Measurements ◽

Single Approach

Abstract Background With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined. Methods ADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years. Results A total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences. Conclusions Frailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.

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Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211016252 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110162

Author(s):

Matthew S. Broggi ◽

Philip O. Oladeji ◽

Syed Tahmid ◽

Roberto Hernandez-Irizarry ◽

Jerad Allen

Keyword(s):

Risk Factor ◽

Hip Fracture ◽

Postoperative Complications ◽

Hip Fractures ◽

Depressive Disorders ◽

Surgical Site Infections ◽

Wound Complications ◽

Non Union ◽

Hip Fracture Surgery ◽

Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

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Is sarcopenia really a risk factor in the development of postoperative complications?

Surgical Oncology ◽

10.1016/j.suronc.2021.101527 ◽

2021 ◽

Vol 37 ◽

pp. 101527

Author(s):

Gül Bora Makal ◽

Aydın Aslan

Keyword(s):

Risk Factor ◽

Postoperative Complications

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Relationship between Oral Bacterial Count and Postoperative Complications among Patients with Cardiovascular Disease Treated by Surgery: A Retrospective Cohort Study

Healthcare ◽

10.3390/healthcare9070850 ◽

2021 ◽

Vol 9 (7) ◽

pp. 850

Author(s):

Rie Osako ◽

Yuhei Matsuda ◽

Chieko Itohara ◽

Yuka Sukegawa-Takahashi ◽

Shintaro Sukegawa ◽

...

Keyword(s):

Cardiovascular Disease ◽

Postoperative Complications ◽

Operation Time ◽

Bacterial Count ◽

Cardiovascular Complications ◽

Pericardial Fluid ◽

Bacterial Counts ◽

Lung Torsion ◽

Propensity Score Adjustment ◽

The Relationship

In this retrospective observational study, we evaluated the relationship between perioperative oral bacterial counts and postoperative complications in cardiovascular disease (CVD) patients. From April 2012 to December 2018, all patients scheduled for surgery received perioperative oral management (POM) by oral specialists at a single center. Tongue dorsum bacterial counts were measured on the pre-hospitalization day, preoperatively, and postoperatively. Background data were collected retrospectively. Among the 470 consecutive patients, the postoperative complication incidence rate was 10.4% (pericardial fluid storage, n = 21; postoperative pneumonia, n = 13; surgical site infection, n = 9; mediastinitis, n = 2; and seroma, postoperative infective endocarditis, lung torsion, and pericardial effusion, n = 1 each). Oral bacterial counts were significantly higher in the pre-hospitalization than in the pre- and postoperative samples (p < 0.05). Sex, cerebrovascular disease, and operation time differed significantly between complications and no-complications groups (p < 0.05). Multivariate analysis with propensity score adjustment showed a significant association between postoperative oral bacterial count and postoperative complications (odds ratio 1.26; 95% confidence interval, 1.00–1.60; p = 0.05). Since the development of cardiovascular complications is a multifactorial process, the present study cannot show that POM reduces complications but indicates POM may prevent complications in CVD patients.

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Timing of resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.77 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S11-S11 ◽

Cited By ~ 2

Author(s):

D Guha ◽

S Coyne ◽

RL Macdonald

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Postoperative Complications ◽

Retrospective Cohort ◽

Significant Risk ◽

Significant Risk Factor ◽

Antithrombotic Agents ◽

Major Hemorrhage ◽

Subdural Hematomas ◽

Surgical Evacuation

Background: Antithrombosis (AT), with antiplatelets or anticoagulants, is a significant risk factor for the development of chronic subdural hematomas (cSDH). Resumption of AT following hematoma evacuation is variable, with scant evidence for guidance. Methods: We retrospectively analyzed 479 patients with surgically-evacuated cSDH at St. Michael’s Hospital from 2007-2012. Collected variables included type of AT, indication for AT, timing and type of postoperative complications, and restart intervals for AT agents. Postoperative complications were classified as major or minor hemorrhages, or thromboembolism. Results: Among all patients, 14.8% experienced major hemorrhage, 23.0% minor hemorrhage, and 1.67% thromboembolism. Patients on any preoperative AT were at higher risk of major hemorrhage (OR=1.93, p=0.014), experienced earlier major hemorrhage (mean 16.2 versus 26.5d, p=0.052) and earlier thromboembolism (mean 2.7 versus 51.5d, p=0.036). The type of agent did not affect complication frequency or timing. Patients restarted on any AT postoperatively were at decreased risk of major rebleed following resumption, than those not restarted (OR=0.06, p<0.01). Conclusions: Patients on preoperative AT experienced thromboembolism significantly earlier, at 3d postoperatively, with no increase in rebleed risk following AT resumption. We provide cursory evidence that resuming AT early, at 3d postoperatively, may be safe. Larger prospective studies are required for definitive recommendations.

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Pneumonectomy for Treatment of Destroyed Lung: A Retrospective Study of 137 Patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1583524 ◽

2016 ◽

Vol 65 (07) ◽

pp. 528-534 ◽

Cited By ~ 2

Author(s):

Yuping Li ◽

Gening Jiang ◽

Chang Chen ◽

Xuefei Hu

Keyword(s):

Risk Factor ◽

Postoperative Complications ◽

Operative Technique ◽

Independent Risk Factor ◽

Multivariate Analyses ◽

Bronchopleural Fistula ◽

Long Term Outcomes ◽

Term Survival ◽

Destroyed Lung

Objectives Whether pneumonectomy is needed for the treatment of destroyed lungs is still controversial and unresolved in the clinic. Pneumonectomy is destructive and is associated with a significant incidence of postoperative complications. The purpose of this study is to analyze the operative techniques, postoperative morbidity, mortality, and long-term outcomes of patients with destroyed lungs who underwent pneumonectomy. Patients and Methods We retrospectively analyzed 137 patients with destroyed lungs who underwent pneumonectomy. The data were queried for the details of operative technique, development of perioperative complications, mortality, and long-term survival. Univariate and multivariate analyses were performed to investigate the risk factors of pneumonectomy among the patients. Results A total of 77 male and 60 female patients were reviewed. The youngest patient was 18 years, and the oldest was 75 years, with a mean age of 40.1 years. Postoperative complications were observed in 25 patients (18.2%). The rate of bronchopleural fistula (BPF) was 5.1% (7/137). Two perioperative deaths (1.5%) were noted. Univariate and multivariate analyses indicated the blood loss (hazard ratio [HR], 5.32; 95% confidence interval [CI], 1.27–18.50; p = 0.021) was the independent risk factor of postoperative complications, and the type of the disease (HR, 4.50; 95% CI, 1.19–9.69; p = 0.034) was the independent risk factor of the BPF, for the patients with destroyed lung after pneumonectomy. Conclusion Pneumonectomy for destroyed lung is a high risk for postoperative complications. Our findings suggested that pneumonectomy in destroyed lung was satisfactory with strict surgical indications, adequate preoperative preparation, and careful operative technique, and the long-term outcomes can be especially satisfactory. Pneumonectomy for destroyed lung is still a treatment option.

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Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

10.31083/jomh.2021.107 ◽

2021 ◽

pp. 1

Keyword(s):

Postoperative Complications ◽

Ileal Conduit ◽

Perioperative Complications ◽

Movement Time ◽

Oral Intake ◽

Total Cost ◽

Handsewn Anastomosis ◽

Significant Difference ◽

The Mean ◽

Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

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