OBJECTIVETo define the determinants of perioperative death and complications after cardiac valve replacement in 702 patients.

METHODSClinical data of the patients after cardiac valve replacement were analyzed retrospectively.

RESULTSPerioperative mortality and morbidity correlated significantly with some of the perioperative variables, such as higher NYHA functional class (III or IV), large left ventricular end-diastolic diameter (>/= 70 mm), C/T >/= 0.70, prolonged aortic cross-clamping time and cardiopulmonary bypass time, unsatisfactory myocardial protection.

CONCLUSIONSPerioperative mortality and morbidity correlate significantly with some of perioperative variables, such as higher NYHA functional class, unsatisfactory myocardial protection, inappropriate surgical procedure, improper therapy of some complications after cardiac valve replacement. To avoid the occurrence of these independent predictors or to correct them timely might effectively decrease the perioperative mortality and morbidity after cardiac valve replacement.

Adolescent ; Adult ; Aged ; Cause of Death ; Child ; Female ; Heart Valve Diseases ; mortality ; surgery ; Heart Valve Prosthesis ; adverse effects ; Humans ; Intraoperative Complications ; mortality ; Male ; Middle Aged ; Mortality ; Postoperative Complications ; mortality

PURPOSE: The objective of this study was to evaluate the advantages of a laparoscopic technique for the treatment of intussusception in children with repeated hydrostatic reduction failure. METHODS: Between April 2001 and March 2002, twenty one children with intussusception were treated. Eleven patients, with repeated barium reduction failure, underwent a laparoscopic reduction. The type of intussusception, operative time, postoperative hospital stay, and conversion rate, were prospectively examined. RESULTS: The laparoscopic reduction was successful in 8 patients (72.7%), with a conversion to an open procedure occurring in 3 (27.3%). In the 8 successful laparoscopic reduction cases, the average operative time and postoperative hospital stay were 66 minutes and 3 days, respectively. Seven cases were of the ileo-colic type of intussusception and remaining one was of the ileo-ileo-colic type. There were no mortalities or intraoperative complications. CONCLUSION: Intussusception in number of children with hydrostatic reduction failure could be reduced with the laparoscopic technique. The laparoscopic procedure for intussusception was safe and resulted in the avoidance of open surgery.
Barium ; Child* ; Conversion to Open Surgery ; Humans ; Intraoperative Complications ; Intussusception* ; Length of Stay ; Mortality ; Operative Time ; Prospective Studies

PURPOSE: To retrospectively analyze and compare the results of proximal femoral nail (PFN) and dynamic hip screw (DHS) in the treatment of A22, 23 AO/OTA intertrochanteric fractures. MATERIALS AND METHODS: Out of 100 patients who had an A22,23 unstable intertrochantericfractures, 50 patients were treated with DHS (Group I) and 50 patients were treated with PFN (Group II). The age, gender, preoperative morbidity, intraoperative data (type of anesthesia, duration of surgery, the amount of blood transfusion, the position of implant) and postoperative functional status and complications of both groups were compared. RESULTS: The mean surgical duration was shorter in the PFN group than in the DHS group (P=0.03) but the amount of transfusion was comparable. The intraoperative complications encountered were a femoral shaft fracture in the PFN group, cut-through of the lag screws in one patient from each group, and a loss of reduction in one hip in the DHS group. There were no significant differences in the union time, postoperative morbidity or mortality. The mobility score was higher in the PFN group than in the DHS group (P=0.02) even though the social function score was similar. CONCLUSION: The use of PFN has the advantage of a shorter operative time and a better mobility of patients without altering the overall course of patients' recovery.
Anesthesia ; Blood Transfusion ; Hip Fractures* ; Hip* ; Humans ; Intraoperative Complications ; Mortality ; Operative Time ; Retrospective Studies

PURPOSE: Since its introduction by Knight and Griffen in 1980, the double stapling technique has gained widespread popularity in performing the low anterior resection for the rectal cancer. But their effectiveness is not clear. The purpose of this study is to evaluate the usefulness of the low anterior resection using the double stapling technique for rectal cancer in an oncological, technical standpoints. METHODS: Perioperative and follow up data were retrospectively reviewed in all patients undergoing the low anterior resection using the double stapling technique by same surgeons for rectal cancer over a 2.5 year period. RESULTS: Thirty two rectal cancer patients had double stapling technique anastomoses. There was no postoperative mortality. Intraoperative complications including rectal wall tearing, incomplete doughnuts, misfiring and extraction related problems occurred in 9 of 32 patients (28.2%). Early and late postoperative complications occurred in 9 (28.8%) and 8 (24.9%) of 32 patients. Early anastomotic leak developed in 1 patient (3.1%) and anastomotic site bleeding developed in 2 patient (6.3%). Lately, the local recurrence occurred in 3 patients (9.3%) and anastomotic site stricture occurred in 3 patients (9.3%). CONCLUSIONS: The low anterior resection using the double stapling technique has relatively low rate of leakage, stricture, local recurrence. The double stapling technique can be performed for mid or low rectal cancer with greater safety and facility.
Anastomotic Leak ; Constriction, Pathologic ; Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Mortality ; Postoperative Complications ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Improvements in the fields of neonatology and surgical subspecialities make tracheotomy possible to the younger population. But complication rates for pediatric tracheotomy are significantly higher than that for adult tracheotomy. This study was designed to present our 14-year experiences of pediatric tracheotomy and to evaluate the effect of several factors of complications. MATERIALS AND METHODS: From 1986 through 1999, 188 tracheotomies were performed on 162 children. The charts were reviewed retrospectively and the results were analyzed. RESULTS: There was no tracheotomy-related mortality. Intraoperative complications were not developed either. Early and late postoperative complication rates were 7.4% and 44.6% respectively. Wound infection and granulation tissue formation were common complications. Granulation tissue formation was related to the duration of the tracheotomised state, dysfunction of vocal fold and pulmonary infection during tracheotomised state. CONCLUSIONS: Pediatric tracheotomy had significant morbidities, especially late complications. Granulation tissue formation was related to the duration of the tracheotomised state, dysfunction of vocal fold and pulmonary infection during the tracheotomised state. Our experience of 14 years will be helpful in the management of tracheostoma and the airways in pediatric patients.
Adult ; Child ; Granulation Tissue ; Humans ; Intraoperative Complications ; Mortality ; Neonatology ; Pediatrics ; Postoperative Complications ; Retrospective Studies ; Tracheotomy* ; Vocal Cords ; Wound Infection

BACKGROUNDPatient safety has been gained much more attention in recent years. The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center, USA. The main objectives of the study were to determine the incidence of intraoperative cardiac arrest, to identify possible causes of cardiac arrest and to explore amenable modifications.

METHODSWith approval by the University of Pittsburgh Institutional Review Board, patients experienced cardiac arrest during surgery were retrieved from medical records, surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS), a hospital electronic searching system. Cases of cardiac arrest were collected over a period of thirteen years from the Presbyterian University Hospital (PUH), USA.

RESULTSWe found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000). Fourteen patients (60.8%) died in the operating room, leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics. Immediate overall survival rate after arrest was 39% (9/23). Half of the patients (12/23) were emergency cases with 41% survival rate (5/12). One fourth of the arrests were trauma patients (6/23). Most arrest patients (87%, 20/23) were American Society of Anesthesiologists Physical Status (ASA PS) IV and V, while only three patients were ASA PS-I, II and III, respectively. One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.

CONCLUSIONSMost intraoperative cardiac arrests were not due to anesthesia-related causes. Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

Adult ; Aged ; Aged, 80 and over ; Anesthesia ; adverse effects ; mortality ; Female ; Heart Arrest ; etiology ; mortality ; Humans ; Intraoperative Complications ; mortality ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

PURPOSE: The aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates. METHODS: The subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed. RESULTS: A total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance. CONCLUSION: Age alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.
Aged* ; Body Mass Index ; Colorectal Neoplasms ; Colorectal Surgery* ; Comorbidity ; Female ; Humans ; Intraoperative Complications ; Male ; Mortality ; Retrospective Studies

PURPOSE: Postoperative biliary stricture is rare, but can result in a dreadful condition unless it is properly treated. This study was undertaken to assess the clinical features of a postoperative biliary stricture and to evaluate the outcome of reconstructive methods according to the stricture locations and types. METHODS: From 1984 to 2001, 28 cases (M=16, F=12) of postoperative biliary stricture, which resulted from surgical injury and had subsequent reconstructive procedures performed in department of surgery of Seoul National University Hospital, during the period of 1984 to 2001, were retrospectively reviewed. Clinical features such as the symptom, type of surgery causing the stricture, laboratory finding, diagnostic modality, interval between the operation and symptoms and the type of stricture were reviewed and clinical outcomes of the reconstructive procedures were also analyzed. The mean follow-up period was 45.9 months (2~157). RESULTS: The most common symptoms of stricture was jaundice. 57.1% of patients showed symptoms within postoperative 6 months and 64.3% showed symptoms within 1 year. A cholecystectomy was most common surgical procedure that caused a postoperative biliary stricture. Bismuth type I was most common type of stricture (52.2%). Bilioenteric anastomosis (Roux-en Y hepaticojejunostomy) showed most excellent result among the many reconstructive methods. One case of an interventional balloon dilatation has maintained a good condition for 3 years after the procedure. The postoperative complications comprises bile leakage, a subphrenic abscess, an incisional hernia, am intrahepatic duct stone, recurrent pyogenic cholangitis. There were 2 cases of postoperative mortality. CONCLUSION: Roux-en Y hepaticojejunostomy is considered to the procedure of choice for a postoperative biliary stricture. An interventional balloon dilatation is expected to show good result with more cases and adequate indications.
Bile Ducts* ; Bile* ; Bismuth ; Cholangitis ; Cholecystectomy ; Constriction, Pathologic* ; Dilatation ; Follow-Up Studies ; Hernia ; Humans ; Intraoperative Complications ; Jaundice ; Mortality ; Postoperative Complications ; Retrospective Studies ; Seoul ; Subphrenic Abscess

BACKGROUND: The number of elderly patients undergoing surgery is steadily growing. Therefore, this study was designed to determine the prevalence and predictors of postoperative complications in patients older than 80 years. METHODS: The medical records of 532 patients above 80 years in age who underwent elective or emergent noncardiac surgery between June 2011 and May 2013 were reviewed retrospectively. Preoperative concomitant disease, operation site, anesthetic technique, and postoperative complications were analyzed. RESULTS: A total of 81.4% of the patients had pre-existing concomitant diseases, while 22.9% had severe systemic diseases. The incidence of severe complications within the first month after operation was 4.1%, and the in-hospital mortality rate was 1.3%. Among the severe postoperative complications, respiratory and cardiovascular complications were commonly observed. In multivariate logistic regression analysis, the predictors of postoperative severe complications included American Society of Anesthesiologists physical status classification of 3 or greater (odds ratio [OR], 5.271; 95% confidence interval [CI], 2.019-13.758; p=0.001), neurosurgery (OR, 23.132; 95% CI, 2.528-211.707; p=0.005) and duration of operation (OR, 1.006; 95% CI, 1.001-1.012; p=0.027). CONCLUSION: Proper preoperative evaluation and appropriate treatment for age-related concomitant diseases are suggested for patients older than 80 years in order to reduce postoperative complications. After operation, the respiratory and cardiovascular systems should be carefully monitored.
Aged ; Anesthesia ; Cardiovascular System ; Classification ; Hospital Mortality ; Humans ; Incidence ; Intraoperative Complications ; Logistic Models ; Medical Records ; Neurosurgery ; Postoperative Complications* ; Prevalence* ; Retrospective Studies

OBJECTIVETo study the effect of standard large trauma craniotomy (SLTC) on outcomes of patients with severe traumatic brain injury (TBI) (GCS<=8).

METHODS230 patients with severe TBI were randomly divided into two groups. 115 patients underwent SLTC (10 cm x 12 cm) as an SLTC group, and other 115 patients underwent temporo-parietal or fronto-temporal craniotomy (6 cm x 8 cm) according to the position of hematomas as a routine craniotomy (RC) group. Other treatments were identical in two groups. According to Glasgow outcome scale (GOS), the prognosis of the patients was evaluated and the complications were compared between two groups.

RESULTS27 patients got good outcome and moderate disability (23.5%), 40 severe disability and vegetative survival (34.8%), and 48 died (41.7%) in SLTC group. 21 patients got good outcome and moderate disability (18.3%), 28 severe disability and vegetative survival (24.3%), and 66 died (57.4%) in RC group. The incidence of incision hernia was lower in SLTC group than in RC group. However, the incidence of operative encephalocele, traumatic epilepsy and intracranial infection were not different in two groups.

CONCLUSIONSStandard large trauma craniotomy significantly reduces the mortality of patients with severe TBI without serious complications, but does not improve the life quality of the patients.

Adult ; Brain Injuries ; mortality ; surgery ; Chi-Square Distribution ; Craniotomy ; standards ; Female ; Glasgow Coma Scale ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Postoperative Complications ; Treatment Outcome