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

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

OBJECTIVETo investigate the outcome and relative problems of patients over 60 years old underwent orthotopic liver transplantation (OLT).

METHODSData of patients over 60 years old (>or= 60 years old group, n = 59) patients recipients who were 18 to 59 years old (< 60 years old group, n = 500) were reviewed retrospectively.

RESULTSOverall patients survival at 1 year was not significantly different among >or= 60 years old group (66%) and < 60 years group (76%). There were no differences in the operation time, the quantity of blood lost during operation, the days of hospitalization and the incidence of hepatic artery thrombosis between the two groups. The incidence rate of acute rejection reaction in >or= 60 years old group was lower. Both the duration of staying in intensive care unit and the time of using ventilator in >or= 60 years old group were longer than the other group. Moreover, the incidence rates of infection and intracerebral hemorrhage were higher in >or= 60 years old group, which were the primary causes of death in this group.

CONCLUSIONEven though the complications were higher, recipients over 60 years old underwent OLT have more excellent 1 year survival.

Aged ; Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Length of Stay ; Liver Transplantation ; adverse effects ; methods ; mortality ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo analyze the incidence and cause of complications during and after interventional therapy for congenital heart disease (CHD).

METHODSFrom April 1986 to April 2009, 388 out of 6029 patients with CHD developed complications during and post interventional therapy, another 5 patients died post procedure, clinical data from these 393 patients were retrospectively analyzed. The patients with severe functional insufficiency requiring intervention or surgery during and after interventional therapy were classified as severe complications.

RESULTSThe overall complication rate was 6.44% [7.69% post atrial septal defect occlusion, 4.20% post patent ductus arteriosus (PDA) occlusion, 1.31% post percutaneous balloon pulmonary valvuloplasty, 14.94% post ventricular septal defect occlusion, 3.13% post percutaneous closure of aortopulmonary collaterals, 30.95% post catheter embolotherapy of pulmonary arteriovenous malformations, 12.50% post transcatheter closure of coronary artery fistulae, 20.00% post transcatheter closure of ruptured sinus of Valsava aneurysm, 66.67% post percutaneous balloon aortic valvuloplasty]. The severe complication rate was 0.65%(39/6029). The procedure-related mortality rate was 0.08% (5/6029), 0.26% (2/761) post percutaneous balloon pulmonary valvuloplasty, 0.05% (1/2070) post PDA occlusion, 9.10% (1/11) post balloon atrial septostomy, 33.33% (1/3) post percutaneous balloon aortic valvuloplasty. Emergency Cardiovascular surgery rate was 0.22% (13/6029). Selective surgery was required in 0.13% (8/6029) of patients post procedure. Two patients (0.03%) received permanent pacemaker implantation.

CONCLUSIONSThe severe complications and mortality rate of interventional therapy for CHD are relative low. Post procedure follow-up is needed fro monitoring possible procedure-related complications.

Cardiac Catheterization ; adverse effects ; Cardiovascular Surgical Procedures ; Heart Defects, Congenital ; surgery ; therapy ; Humans ; Incidence ; Intraoperative Complications ; epidemiology ; Postoperative Complications ; epidemiology ; mortality ; Retrospective Studies ; Treatment Outcome