Home About us Contact
|
Home About us Contact | ||
|
|
||
Postoperative Complication Rate (postoperative + complication_rate)
Selected AbstractsThe Surgical Learning Curve in Aural Atresia SurgeryTHE LARYNGOSCOPE, Issue 1 2007FRACS, Nirmal Patel MBBS (Hons) Abstract Objective: The objective of this retrospective case review is to examine the effect of surgical learning on hearing outcomes and complications in congenital aural atresia surgery. Patients: Sixty-four consecutive ears (in 60 patients) operated on during the period of 1994 to 2004 at a tertiary referral center were studied. Intervention)s): Intervention consisted of aural atresiaplasty through an anterior approach by the same surgeon (C.S.). Main Outcome Measure)s): Hearing outcomes and complication rates were compared between four temporally sequential groups of 16 ears. Acceptable hearing and complication rate outcomes were defined as results comparable to larger series in the literature. Results: Hearing results, in the short term, comparable to larger series were achieved during the first group of ears (nos. 1,16). A plateau in the learning curve for short-term hearing outcomes was achieved after the first two groups, that is, after 32 ears. Hearing outcomes, in the long term (>1 year) comparable to larger series, were achieved in the second group of ears (nos. 16,32). The learning curve for long-term hearing demonstrated a significant improvement in outcomes in the final group of 16 ears compared with the first 48 ears. Long-term hearing results for the final group show closure of the postoperative air-bone gap to less than 30 dB in 94% of cases. Postoperative complication rates were equivalent to larger series in the first group of 16 ears and showed no statistically significant difference between the four groups. There was one patient with sensorineural hearing loss after surgery; there were no anacoustic ears and no facial palsies in the study group. Conclusions: A learning curve of at least 32 ears was required to achieve stable short-term hearing results. To achieve stable long-term hearing results required a learning curve of at least 48 patients in our series. Complication rates remained stable throughout the study period. [source] Reconstruction after resection of hypopharyngeal carcinoma: Comparison of the postoperative complications and oncologic results of different methods,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2005Pen-Yuan Chu MD Abstract Background. Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. Methods. We retrospectively reviewed the records of 91 patients who underwent radical surgery and reconstruction. Postoperative complications and oncologic results of the different reconstructive methods were compared. Results. Reconstruction with gastric pull-up had the lowest pharyngocutaneous (PC) fistula (0%) and pharyngoesophageal (PE) stenosis rates (0%). However, the overall postoperative complication rate was high (64%). Laryngotracheal flap (LTF) reconstruction had relatively lower rates of PC fistula (3%), PE stenosis (10%), and overall complications (22%). The introduction of the LTF technique significantly decreased postoperative complications from 71% to 30% (p = .0001), with similar tumor control and survival. Conclusions. Hypopharyngeal reconstruction with an LTF is a simple and effective method. The chance of using a complex flap is decreased. The postoperative complications are reduced, and the oncologic results are satisfactory. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Long-term results of laparoscopic treatment of Spigelian hernias with meshASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 2 2010G Portillo Abstract Introduction: Spigelian hernias are exceptional. They often present with vague signs and symptoms, and the diagnosis can be problematic. Most Spigelian hernias are treated with open surgery and without mesh; little is known of the laparoscopic treatment and the long-term follow-up with mesh. The aim of this study was to prospectively evaluate the safety and effectiveness of the laparoscopic treatment of Spigelian hernias with mesh at the Texas Endosurgery Institute. Methods: From February 1991 through April 2008, all Spigelian hernias treated laparoscopically with mesh were prospectively followed. The technique was essentially the same for each procedure and involved (1) lysis of adhesions, (2) reduction of hernia contents, (3) closure of the defect, (4) 3,5 cm circumferential mesh coverage beyond the original edges, and (5) transfascial fixation of the mesh. Results: Eighteen patients were analyzed, all of them having Spigelian hernia. The subjects included eight women (44%) and 10 men (56%), with a mean age of 65 years (range, 39,89 years). The mean height of patients was 1.69 cm (range, 1.44,1.98 cm), with a mean weight of 84.6 kg (range, 63,103.5 kg). The mean operative time was 91 min with a range of 75,120 min. The estimated blood loss was 30 ml (range 10,50 ml). The mean postoperative hospital stay was 2 d (range from same-day discharge to 5 d). The overall postoperative complication rate was 16.6%. No conversions to open approach were required. The mean follow up was 84.6 months (range, 13,176 months); no recurrence has been observed. Conclusion: The laparoscopic treatment of Spigelian hernias is safe and effective. [source] Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2010I. Schwegler Background: This study investigated whether nutritional risk scores applied at hospital admission predict mortality and complications after colorectal cancer surgery. Methods: Some 186 patients were studied prospectively. Clinical details, Reilly's Nutrition Risk Score (NRS) and Nutritional Risk Screening 2002 (NRS-2002) score, tumour stage and surgical procedure were recorded. Results: The prevalence of patients at nutritional risk was 31·7 per cent according to Reilly's NRS and 39·3 per cent based on the NRS-2002. Such patients had a higher mortality rate than those not at risk according to Reilly's NRS (8 versus 1·6 per cent; P = 0·033), but not the NRS-2002 (7 versus 1·8 per cent; P = 0·085). Based on the NRS-2002, there was a significant difference in postoperative complication rate between patients at nutritional risk and those not at risk (62 versus 39·8 per cent; P = 0·004) but not if Reilly's NRS was used (58 versus 44·1 per cent; P = 0·086). Nutritional risk was identified as an independent predictor of postoperative complications (odds ratio 2·79; P = 0·002). Conclusion: Nutritional risk screening may be able to predict mortality and morbidity after surgery for colorectal cancer. However, the diverse results reflect either the imprecision of the tests or the small sample size. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unitBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2001Dr K. Smedh Background: Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques. Methods: All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993,1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144). Results: The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0·002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0·001). Surgical complications dropped from 37 to 11 per cent (P < 0·001). The relaparotomy rate fell from 11 to 4 per cent (P < 0·05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0·001). Conclusion: The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half. © 2001 British Journal of Surgery Society Ltd [source] The effect of learning curve on the outcome of caesarean sectionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2006WY Fok Objective, To evaluate the operative outcomes when trainees first perform caesarean sections independently. Design, A retrospective study in a tertiary obstetric unit. Population, Five hundred caesarean sections, which represented the first 50 caesarean sections performed independently by each of ten trainees, were studied. Methods, The effect of learning curve on outcome was analysed. Main outcome measures, Total operative time, incision-to-delivery interval, operative blood loss, Apgar score, cord arterial pH, incidence of neonatal intensive care unit admission, postoperative complication rates and duration of hospitalisation. Results, The mean operative time for the first five cases by trainees was 52.2 ± 11.4 minutes. It progressively decreased and reached 39.6 ± 8.4 minutes for the 46th to 50th cases. The operative time was significantly longer in the first 15 caesarean sections (P < 0.05). Moreover, the incision-to-delivery interval was also longer during the first five cases (P= 0.02). Besides the time of the operation, the trend for operative blood loss stabilised after the first ten caesarean sections (P < 0.05). Otherwise, there were no significant differences among other outcome variables. Conclusion, This study shows that trainees need to perform 10,15 caesarean sections before their skills become more proficient. Senior obstetricians may need to provide guidance to the trainees during their first independent 15 caesarean sections. [source] Australasian Laparoscopic Colon Cancer Study shows that elderly patients may benefit from lower postoperative complication rates following laparoscopic versus open resection,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2010R. A. Allardyce Background: A retrospective analysis of age-related postoperative morbidity in the Australia and New Zealand prospective randomized controlled trial comparing laparoscopic and open resection for right- and left-sided colonic cancer is presented. Methods: A total of 592 eligible patients were entered and studied from 1998 to 2005. Results: Data from 294 patients who underwent laparoscopic and 298 who had open colonic resection were analysed; 266 patients were aged less than 70 years and 326 were 70 years or older (mean(s.d.) 70·3(11·0) years). Forty-three laparoscopic operations (14·6 per cent) were converted to an open procedure. Fewer complications were reported for intention-to-treat laparoscopic resections compared with open procedures (P = 0·002), owing primarily to a lower rate in patients aged 70 years or more (P = 0·002). Fewer patients in the laparoscopic group experienced any complication (P = 0·035), especially patients aged 70 years or above (P = 0·019). Conclusion: Treatment choices for colonic cancer depend principally upon disease-free survival; however, patients aged 70 years or over should have rigorous preoperative investigation to avoid conversion and should be considered for laparoscopic colonic resection. Registration number: NCT00202111 (http://www.clinicaltrials.gov). Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | ||||||||||