PURPOSE: Despite significant improvements in surgery, anesthesia, and postoperative critical care, the postoperative mortality rate of ruptured abdominal aortic aneurysm (RAAA) has remained at 40% to 50% for several decades. Therefore, we evaluated factors associated with the postoperative mortality of RAAA. MATERIALS AND METHODS: From January 1999 to December 2008, a retrospective study was performed with 34 patients who underwent open repair of RAAA. The preoperative factors included age, sex, smoking, comorbidities, serum creatinine, hemoglobin, shock, pulse rate, and time from emergency room to operation room. The intraoperative factors included blood loss, transfusion, aortic clamping site and time, aneurysmal characteristics, rupture type, graft type, hourly urine output (HUO), and operative time. The postoperative factors included inotropic support, renal replacement therapy (RRT), reoperation, bowel ischemia, multiple organ failure (MOF), and intensive care unit stay. The 2-day and the 30-day mortality rates were analyzed separately. RESULTS: The 2-day and the 30-day mortality rates were 14.7% and 41.2%, respectively. On univariate analysis, shock, transfusion, HUO, inotropic support and MOF for the 2-day mortality and serum creatinine, transfusion, aortic clamping site, HUO, inotropic support, RRT and MOF for the 30-day mortality were statistically significant. On multivariate analysis, shock, inotropic support and MOF for the 2-day mortality and aortic clamping site, RRT and MOF for the 30-day mortality were statistically significant. CONCLUSION: To decrease the postoperative mortality rate of RAAA, prevention of massive hemorrhage and acute renal failure with infrarenal aortic clamping, as well as prompt operative control of bleeding and maintenance of systemic perfusion are important.
Aged ; Aortic Rupture/*mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/*mortality ; Postoperative Period ; Retrospective Studies

BACKGROUNDThere are increasing numbers of patients who survive more than one year after liver transplantation. Many studies have focused on the early mortality of these patients. However, the factors affecting long-term survival are not fully understood. This study aims to evaluate prognostic factors predicting long-term survival and to explore measures for improving the survival outcomes of patients who underwent liver transplantation for benign end-stage liver diseases.

METHODSThe causes of late death after liver transplantation and potential prognostic factors were retrospectively analyzed for 221 consecutive patients who underwent liver transplantation from October 2003 to June 2008. Twenty-seven variables were assessed using the Kaplan-Meier method, and those variables found to be univariately significant at P < 0.10 were entered into a backward step-down Cox proportional hazard regression analysis to identify the independent prognostic factors influencing the recipients' long-term survival.

RESULTSTwenty-eight recipients died one year after liver transplantation. The major causes of late mortality were infectious complications, biliary complications, and Hepatitis B virus recurrence/reinfection. After Cox analysis, the five remaining co-variables were: age, ABO blood group, cold ischemia time, post-infection region, and biliary complications.

CONCLUSIONSThe major causes of late mortality were infection, biliary complications and Hepatitis B virus recurrence/reinfection. Five variables (Age, ABO blood group, cold ischemia time, infection, and biliary complications) had significant impacts on patient survival.

End Stage Liver Disease ; mortality ; surgery ; Hepatitis B ; mortality ; Humans ; Liver Transplantation ; Postoperative Complications ; mortality ; Retrospective Studies

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

BACKGROUNDRectal carcinoma patients are often accompanied by hepatic metastasis. The aim of this study was to evaluate the therapeutic efficacy of simultaneous laparoscopic excision for rectal carcinoma with synchronous hepatic metastasis.

METHODSA total of 41 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients underwent laparoscopic surgery and 18 patients underwent traditional open surgery to simultaneously remove the rectal tumor and hepatic metastasis lesions. All patients received postoperative adjuvant chemotherapy. All the patients were followed up from 36 to 72 months (mean 45.3 months).

RESULTSAll the operations were performed successfully and no patient was turned to open surgery in laparoscopic group. The mean blood loss, the mean postoperative hospital stay, the mean blood transfusion and the mean intestinal functional recovery time showed a significant difference between the two groups (P < 0.05). The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the laparoscopic group, without significant difference compared with the open group (77.8%, 38.9% and 0) (P > 0.05).

CONCLUSIONSSimultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis is safe and effective with similar survival achieved by the traditional open abdominal surgery.

Adult ; Aged ; Carcinoma ; mortality ; surgery ; Female ; Humans ; Laparoscopy ; Liver Neoplasms ; mortality ; secondary ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Rectal Neoplasms ; mortality ; surgery

This is a 30-year review of 4,059 patients who underwent cardiac operations at Yonsei University Medical Center between September 1, 1956 and August 31, 1986. Of these, there were 1,191 patients with acquired and 2,868 with congenital cardiac lesions, constituting 29% and 71% of the group, respectively. Of 1,191 patients with acquired lesions, the number in each major category and the operative mortality were as follows: closed mitral commissurotomy, 210 and 0.95%; open mitral commissurotomy, 164 and 43%, mitral valve replacement, 370 and 3.5%, aortic valve replacement, 154 and 9.7%; double valve replacement 123 and 2.4%, and coronary artery bypass grafting 94 and 85%. Of 2,868 patients with congenital cardiac lesions, the number and operative major categories were as follows: repair of tetralogy of Fallot, 593 and 93% repair of ventricular septal defect 817 and 7.1%, closure of atrial septal defect 403 and 1.5%, and closure of patent ductus arteriosus, 550 and 1.3%.
Academic Medical Centers ; Cross-Sectional Studies ; Heart Diseases/*surgery ; Human ; Korea ; Postoperative Complications/*mortality

BACKGROUNDThe effectiveness of chemoradiotherapy followed by surgery (CRTS) in patients with resectable esophageal carcinoma remains controversial. We performed a systematic review of the literature with meta-analysis.

METHODSElectronic databases were used to identify published studies between January 1992 and April 2012. Pooled relative risk (RR) with 95% confidence interval (95% CI) was utilized to estimate the strength of the association between CRTS and surgery alone (SA) survival of the resectable esophageal carcinoma patients. Heterogeneity and publication bias were also assessed in the present study.

RESULTSThe final analysis of 2755 resectable esophageal carcinoma cases from 21 randomized controlled trials (RCTs) are presented. Compared to the SA group, the 1, 3- and 5-year survival rates were significantly higher in the CRTS group (all P < 0.05); the 3- and 5-year survival rates for the Eastern patients, Western patients, patients undergoing concurrent chemoradiotherapy, patients with squamous cell carcinoma, patients undergoing High-dose radiotherapy (≥ 40 Gy), and patients given either "cisplatin + Fluorouracil" or "cisplatin + paclitaxel" chemotherapy were significantly higher in the CRTS group (all P < 0.05). There were no statistical significances in the 3- and 5-year survival rates for patients undergoing sequential chemoradiotherapy or patients with adenocarcinoma between the two groups (all P > 0.05). Compared to the RCTS group, the surgery rate in the SA group was higher (P < 0.05), while the CRTS group had significantly higher radical resection rate, R0 resection rate and lower postoperative local recurrence rate (all P < 0.05). The differences in postoperative complication incidence, post-operative distant metastasis and postoperative mortality rate were not statistically significant between the two groups (all P > 0.05).

CONCLUSIONCRTS can significantly improve the survival and surgical conditions of patients with resectable esophageal carcinoma.

Chemoradiotherapy ; Esophageal Neoplasms ; mortality ; surgery ; therapy ; Humans ; Postoperative Complications ; epidemiology ; Randomized Controlled Trials as Topic ; Survival Rate

BACKGROUND: Minimally invasive techniques for open heart surgery are widely accepted in these days. There are minimally invasive approaches by the right or left parasternal incision and another approaches by mini-sternotomy of upper or lower half or sternum. We report the safety and efficacy of minimally invasive technique with right parasternal incision compared with the routine full sternotomy. MATERIAL AND METHOD: From April 1997 through February 1999, 20 patients (Group A) underwent minimally invasive cardiac operations. We chose 41 patients (Group B) whose preoperative diagnosis were the same and general conditions were similar and who underwent routine full sternotomy before April 1997. We compared A group and B group in many aspects. We performed routine full median sternotomy in B group but we did a minimally invasive technique through a small right parasternal incision in A group. RESULT: mean age was 36.1 years in both groups. In disease entities, there were 11 cases of ASD, 9 cases of mitral valve disease in group A, and 16 cases of ASD, 25 cases of mitral valve diseases in group B. In ASD, operation time, cardiopulmonary bypass time of aortic occulusion time were 263 min, 82 min, and 41 min in group A and 180 min, 53 min, and 32 min in group B. In mitral valve disease, operation time, cardiopulmonary bypass time and aortic occlusion time were 267min, 106 min, and 70min in A group and were 207 min, 82 min, and 69 min in group B. There were significant differences in operation time, CPB time, and ACC time between group A and group B. There was a significant difference in the amount of bleeding in postoperative day 1 between group A and group B of mitral diasease. However, there was no significant difference in the amount of bleeding in other comparisons. Mean length of incision was 8.7 cm in group A. There was no significant difference in postoperative complications between A group and B group. There was no mortality in either group. CONCLUSION: We conclude that this minimally invasive technique with right parasternal incision is cosmetically excellent but it is not effective in reducing operative time and there was no significant difference in recovery time and postoperative complications compared with routine full sternotomy.
Cardiopulmonary Bypass ; Diagnosis ; Hemorrhage ; Humans ; Mitral Valve ; Mortality ; Operative Time ; Postoperative Complications ; Sternotomy ; Sternum ; Thoracic Surgery*

OBJECTIVETo summarize the clinical experiences in treating primary tracheal tumors by surgery.

METHODSThe clinical data concerning 70 surgically treated patients between 1968 and 2001 were retrospectively analyzed.

RESULTSThere were 39 sleeve tracheal resections, 13 carinal resections, 10 lateral tracheal wall resections, 5 local enucleations, and 1 pneumonectomy. The tumors in 2 patients were unresectable. The morbidity rate was 31% (22/70) and operative 30-day mortality for resection with primary reconstruction was 8% (4/52). The tumors were benign in 14 and malignant in 56 cases. The most common malignant tumors were adenoidcystic carcinoma (45%) and squamous cell carcinoma (23%). The cases of benign tracheal tumors were followed up for an average of 5.7 years. After resection for malignant tumors, the overall 5- and 10-year survival rates were 64% (21/33) and 54% (14/26), respectively.

CONCLUSIONSSurgical resection is the most effective treatment of tracheal tumors. Tracheal resection and reconstruction is the treatment of choice for primary tracheal tumors. Benign tumors should be resected conservatively with preservation of tracheal parenchyma. The reduction of operative complications are key points of good surgical results.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Prognosis ; Tracheal Neoplasms ; mortality ; surgery

OBJECTIVETo evaluate the applicability of the modified physiological and operative severity score for enumeration of mortality and morbidity (POSSUM) scoring system in predicting mortality in the patients undergoing hip joint arthroplasty.

METHODSA total of 295 patients with hip fractures were analyzed using the modified POSSUM surgical scoring system. The mean ages of the patients were 66.59 years in the complicative group, 62.28 years in noncomplicative group, 77.89 years in the death group and 63.25 years in the living group, respectively. The comparisons between the observed and predicted morbidity, between the observed and predicted mortality were made within 30 days after operation.

RESULTSThe average physiological scores and operative severity scores was 18.96+/-4.83 and 13.47+/-2.01 in complicative group, while 15.65+/-3.66 and 11.74+/-2.26 in noncomplicative group (P less than 0.05). The average physiological scores and operative severity scores was 25.56+/-3.78 and 14.22+/-0.67 in death group, while 16.46+/-4.09 and 12.25+/-2.33 in living group (P less than 0.05). Though POSSUM scoring system over-predicted the overall risk of death, its estimate was very close in the high risk groups (larger than 10% ). There was perfect consistence between the observed and the predicted morbidity as calculated by published predictor equation for morbidity, and consistence for mortality in the high risk band.

CONCLUSIONSModified POSSUM scoring system may be used to predict the morbidity in patients with hip fracture. Furthermore, POSSUM scoring system overpredicts the overall risk of death, but its estimate is close to the actual data in the high risk band (larger than 10%).

Aged ; Hip Fractures ; mortality ; surgery ; Humans ; Middle Aged ; Osteoporosis ; complications ; Postoperative Complications ; Severity of Illness Index ; Treatment Outcome

Enhanced recovery after surgery (ERAS) is a multimodal and multidisciplinary approach to maintaining physiologic function and improving recovery for surgical patients. The ERAS protocol is based on a range of empirical evidence, and consensus ERAS guidelines for various surgical procedures have been published. The elements of the ERAS protocol include minimal preoperative fasting and carbohydrate treatment instead of overnight fasting; no routine use of preoperative bowel preparation; minimally invasive surgical techniques; standard anesthetic protocol; optimal fluid management rather than generous intravenous fluid administration; prevention and treatment of postoperative nausea and vomiting; active prevention of perioperative hypothermia; multimodal approaches to controlling postoperative pain; and early oral intake and mobilization. Implementation of ERAS shortened hospital stays by 30% to 50% and reduced postoperative complications by 50%. A recent study reported that, when patient compliance with the colorectal ERAS protocol was over 70%, 5-year mortality fell by 42% compared with when compliance was below 70%. Auditing process compliance and patient outcomes are key measures for assisting clinicians implementing the ERAS program. As a perioperativist, an anesthesiologist can play a crucial role in implementing the ERAS program and contribute to protocol establishment, auditing, team education and team leadership. While the ERAS protocol was first implemented for colorectal surgery, as a result of its efficacy, it is now being used in nearly all major surgical specialties.
Colorectal Surgery ; Compliance ; Consensus ; Education ; Fasting ; Humans ; Hypothermia ; Leadership ; Length of Stay ; Mortality ; Pain, Postoperative ; Patient Compliance ; Postoperative Complications ; Postoperative Nausea and Vomiting ; Specialties, Surgical