Browsing by Subject "Complications"

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  • Niimura del Barrio, Maria C; David, Florent; Hughes, J. M L; Clifford, David; Wilderjans, Hans; Bennett, Rachel (BioMed Central, 2018)
    Abstract Background The mortality rate of horses undergoing general anaesthesia is high when compared to humans or small animal patients. One of the most critical periods during equine anaesthesia is recovery, as the horse attempts to regain a standing position. This study was performed in a private equine practice in Belgium that uses a purpose-designed one-man (head and tail) rope recovery system to assist the horse during the standing process. The main purpose of the retrospective study was to report and analyse complications and the mortality rate in horses during recovery from anaesthesia using the described recovery system. Information retrieved from the medical records included patient signalment, anaesthetic protocol, duration of anaesthesia, ASA grade, type of surgery, recovery time and complications during recovery. Sedation was administered to all horses prior to recovery with the rope system. Complications were divided into major complications in which the horse was euthanized and minor complications where the horse survived. Major complications were further subdivided into those where the rope system did not contribute to the recovery complication (Group 1) and those where it was not possible to determine if the rope system was of any benefit (Group 2). Results Five thousand eight hundred fifty two horses recovered from general anaesthesia with rope assistance. Complications were identified in 30 (0.51%). Major complications occurred in 12 horses (0.20%) of which three (0.05%) were assigned to Group 1 and nine (0.15%) to Group 2. Three horses in Group 2 suffered musculoskeletal injuries (0.05%). Eighteen horses (0.31%) suffered minor complications, of which five (0.08%) were categorised as failures of the recovery system. Conclusions This study reports the major and minor complication and mortality rate during recovery from anaesthesia using a specific type of rope recovery system. Mortality associated with the rope recovery system was low. During recovery from anaesthesia this rope system may reduce the risk of lethal complications, particularly major orthopaedic injuries.
  • Kostiainen, Iiro; Hakaste, Liisa; Kejo, Pekka; Parviainen, Helka; Laine, Tiina; Löyttyniemi, Eliisa; Pennanen, Mirkka; Arola, Johanna; Haglund, Caj; Heiskanen, Ilkka; Schalin-Jäntti, Camilla (2019)
    BackgroundAdrenocortical carcinoma (ACC) is a rare endocrine carcinoma with poor 5-year survival rates of20 Hounsfield Units (HU) for all tumours (median 34 (21-45)), median size 92mm (20-196), Ki67 17% (1-40%), Weiss score 7 (4-9) and Helsinki score 24 (4-48). ACC was more often found in the left than the right adrenal (p5 to>10 years was achieved after repeated surgery of metastases. Overall 5-year survival was 67%, and 96% vs. 26% for ENSAT stage I-II vs. III-IV (p20 on nonenhanced CT but variable tumour size (20-196mm). Malignancy cannot be ruled out by small tumour size only. The 5-year survival of 96% in ENSAT stage I-III compares favourably to previous studies.
  • Kurkela, Olli; Forma, Leena; Ilanne-Parikka, Pirjo; Nevalainen, Jaakko; Rissanen, Pekka (2021)
    Aims/hypothesis Diabetes and diabetes complications are a cause of substantial morbidity, resulting in early exits from the labour force and lost productivity. The aim of this study was to examine differences in early exits between people with type 1 and 2 diabetes and to assess the role of chronic diabetes complications on early exit. We also estimated the economic burden of lost productivity due to early exits. Methods People of working age (age 17-64) with diabetes in 1998-2011 in Finland were detected using national registers (N-type 1 = 45,756, N-type 2 = 299,931). For the open cohort, data on pensions and deaths, healthcare usage, medications and basic demographics were collected from the registers. The outcome of the study was early exit from the labour force defined as pension other than old age pension beginning before age 65, or death before age 65. We analysed the early exit outcome and its risk factors using the Kaplan-Meier method and extended Cox regression models. We fitted linear regression models to investigate the risk factors of lost working years and productivity costs among people with early exit. Results The difference in median age at early exit from the labour force between type 1 (54.0) and type 2 (58.3) diabetes groups was 4.3 years. The risk of early exit among people with type 1 diabetes increased faster after age 40 compared with people with type 2 diabetes. Each of the diabetes complications was associated with an increase in the hazard of early exit regardless of diabetes type compared with people without the complication, with eye-related complications as an exception. Diabetes complications partly but not completely explained the difference between diabetes types. The mean lost working years was 6.0 years greater in the type 1 diabetes group than in the type 2 diabetes group among people with early exit. Mean productivity costs of people with type 1 diabetes and early exit were found to be 1.4-fold greater compared with people with type 2 diabetes. The total productivity costs of incidences of early exits in the type 2 diabetes group were notably higher compared with the type 1 group during the time period (euro14,400 million, euro2800 million). Conclusions/interpretation We found a marked difference in the patterns of risk of early exit between people with type 1 and type 2 diabetes. The difference was largest close to statutory retirement age. On average, exits in the type 1 diabetes group occurred at an earlier age and resulted in higher mean lost working years and mean productivity costs. The potential of prevention, timely diagnosis and management of diabetes is substantial in terms of avoiding reductions in individual well-being and productivity.
  • Jacob, Louis; Weber, Katherina; Sechet, Ingeborg; Macharey, Georg; Kostev, Karel; Ziller, Volker (2016)
    To analyze the impact of caesarean section (CS) on fertility and time to pregnancy in German gynecological practices. Women initially diagnosed for the first time with a vaginal delivery (VD) or CS between 2000 and 2013 were identified by 227 gynecologists in the IMS Disease Analyzer database. They were included if they were aged between 16 and 40 years, and were not previously diagnosed with female sterility. The two main outcomes were the first-time diagnosis of female sterility and the time between the first delivery and the next pregnancy within 10 years. A multivariate Cox regression model was used to predict these outcomes on the basis of patient characteristics. 6483 patients were included in the CS group and 6483 in the VD group. Mean age was 30.6 years and the proportion of individuals with private health insurance amounted to 9.0 %. Within 10 years of the index date, 19.5 % of women who delivered by CS and 18.3 % of women who delivered vaginally were diagnosed with sterility (p value = 0.0148). CS and polycystic ovary syndrome significantly increased the risk of sterility. Within 10 years of the index date, 57.9 % of women who underwent a CS and 64.0 % of women who delivered vaginally were pregnant for the second time (p value <0.001). CS, polycystic ovary syndrome, and the deterioration of menstrual cycle significantly decreased the chance of becoming pregnant a second time. CS is associated with an increased risk of sterility and a decreased number of subsequent pregnancies in Germany.
  • Carpelan, A.; Kauhanen, S. (2016)
    Background and aims: Reduction mammaplasties are increasingly performed as outpatient procedures. Cost savings are assumed, but published data on the subject are scarce. The aim of this study was to retrospectively determine the possible cost savings achieved by performing reduction mammaplasties as outpatient procedures. Material and methods: Reduction mammaplasty was performed for 90 outpatients and 44 inpatients, with comparable health status. Demographic, surgical, and complication data were collected retrospectively. Data on the costs of the entire treatment process were acquired and statistical analyses performed. Results: The average total cost of the process was 5039(sic)for inpatients and 4114(sic)for outpatients. Thus, the total costs were 925(sic) (18%) lower for the outpatient procedures. On average, cost saving per patient was 294(sic) (43%) onward expenditures. Higher ward expenditure was a statistically significant cause of the increased cost of the inpatient group on uni- and multivariable analyses; however, for total costs, the effects of complications and reoperations were significant. Conclusions: Reduction mammaplasty performed as an outpatient procedure results in up to 18% cost savings compared with inpatient treatment. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
  • Kainulainen, S.; Tornwall, J.; Koivusalo, A. M.; Suominen, A. L.; Lassus, Patrik (2017)
    Objectives: Glucocorticoids are widely used in association with major surgery of the head and neck to improve postoperative rehabilitation, shorten intensive care unit and hospital stay, and reduce neck swelling. This study aimed to clarify whether peri-and postoperative use of dexamethasone in reconstructive head and neck cancer surgery is associated with any advantages or disadvantages. Materials and methods: This prospective double-blind randomized controlled trial comprised 93 patients. A total dose of 60 mg of dexamethasone was administered to 51 patients over three days peri-and post-operatively. The remaining 42 patients served as controls. The main primary outcome variables were neck swelling, length of intensive care unit and hospital stay, duration of intubation or tracheostomy, and delay to start of possible radiotherapy. Complications were also recorded. Results: No statistical differences emerged between the two groups in any of the main primary outcome variables. However, there were more major complications, especially infections, needing secondary surgery within three weeks of the operation in patients receiving dexamethasone than in control patients (27% vs. 7%, p = 0.012). Conclusions: The use of dexamethasone in oral cancer patients with microvascular reconstruction did not provide a benefit. More major complications, especially infections, occurred in patients receiving dexamethasone. Our data thus do not support the use of peri-and postoperative dexamethasone in oropharyngeal cancer patients undergoing microvascular reconstruction. (C) 2016 Elsevier Ltd. All rights reserved.
  • GBD 2019 Diabet Mortality Collabor; Cousin, Ewerton; Duncan, Bruce B.; Stein, Caroline; Kivimäki, Mika; Shiri, Rahman (2022)
    Background Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990-2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73.7% (68.3 to 77.4) were classified as due to type 1 diabetes. The age-standardised death rate was 0.50 (0.44 to 0.58) per 100 000 population, and 15 900 (97.5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0.13 (0.12 to 0.14) per 100 000 population in the high SDI quintile, 0.60 (0.51 to 0.70) per 100 000 population in the low-middle SDI quintile, and 0.71 (0.60 to 0.86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r(2)=0.62). From 1990 to 2019, age-standardised death rates decreased globally by 17.0% (-28.4 to -2.9) for all diabetes, and by 21.0% (-33.0 to -5.9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (-13.6% [-28.4 to 3.4]) and for type 1 diabetes (-13.6% [-29.3 to 8.9]). Interpretation Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
  • Ahola, Aila J.; Freese, Riitta; Mäkimattila, Sari; Forsblom, Carol; Groop, Per-Henrik; FinnDiane Study Grp (2016)
    Aims: Diet plays an important role in the management of type 1 diabetes. However, the association between dietary intake and health has not been extensively studied in this population. We studied the cross-sectional association between dietary factors, and selected vascular health markers and complications in type 1 diabetes. Methods: Data from 874 individuals with type 1 diabetes participating in the FinnDiane Study were included. Dietary intake was assessed using a self-reported questionnaire and a diet score, expressing the extent to which individuals adhered to the dietary recommendations, was calculated. Diet questionnaire was also used to reveal dietary patterns using factor analysis. Results: Seven factors with high degree of inter-correlation were formed; healthy, traditional, vegetable, sweets, modern, low-fat cheese, and fish and eggs. In multivariate models, higher diet score and healthy factor score were associated with better glycaemic control. Higher diet score was associated with higher, while sweets, and fish and eggs patterns were associated with lower systolic blood pressure. Healthy, sweets, and fish and eggs factors were additionally associated with lower diastolic blood pressure. Conclusions: Closer adherence to the dietary recommendations, and a diet high in fresh vegetables, fruits and berries, cooked vegetables, fish dishes, and yoghurt may be beneficial for the glycaemic control in type 1 diabetes. Moreover, a diet pattern with fish and eggs may have beneficial effects for blood pressure. (C) 2016 Published by Elsevier Inc.
  • Boom, V.; Anton, J.; Lahdenne, P.; Quartier, P.; Ravelli, A.; Wulffraat, N. M.; Vastert, S. J. (2015)
    Background: Macrophage activation syndrome (MAS) is a severe and potentially lethal complication of several inflammatory diseases but seems particularly linked to systemic juvenile idiopathic arthritis (sJIA). Standardized diagnostic and treatment guidelines for MAS in sJIA are currently lacking. The aim of this systematic literature review was to evaluate currently available literature on diagnostic criteria for MAS in sJIA and provide an overview of possible biomarkers for diagnosis, disease activity and treatment response and recent advances in treatment. Methods: A systematic literature search was performed in MEDLINE, EMBASE and Cochrane. 495 papers were identified. Potentially relevant papers were selected by 3 authors after which full text screening was performed. All selected papers were evaluated by at least two independent experts for validity and level of evidence according to EULAR guidelines. Results: 27 papers were included: 7 on diagnosis, 9 on biomarkers and 11 on treatment. Systematic review of the literature confirmed that there are no validated diagnostic criteria for MAS in sJIA. The preliminary Ravelli criteria, with the addition of ferritin, performed well in a large retrospective case-control study. Recently, an international consortium lead by PRINTO proposed a new set of diagnostic criteria able to distinguish MAS from active sJIA and/or infection with superior performance. Other promising diagnostic biomarkers potentially distinguish MAS complicating sJIA from primary and virusassociated hemophagocytic lymphohistiocytosis. The highest level of evidence for treatment comes from case-series. High dose corticosteroids with or without cyclosporine A were frequently reported as first-line therapy. From the newer treatment modalities, promising responses have been reported with anakinra. Conclusion: MAS in sJIA seems to be diagnosed best by the recently proposed PRINTO criteria, although prospective validation is needed. Novel promising biomarkers for sJIA related MAS are in need of prospective validation as well, and are not widely available yet. Currently, treatment of MAS in sJIA relies more on experience than evidence based medicine. Taking into account the severity of MAS and the scarcity of evidence, early expert consultation is recommended as soon as MAS is suspected.
  • Barlovic, Drazenka Pongrac; Harjutsalo, Valma; Groop, Per-Henrik (2022)
    Type 1 diabetes is a challenging disease, characterized by dynamic changes in the insulin need during life periods, seasons of the year, but also by everyday situations. In particular, changes in insulin need are evident before, during and after exercise and having meals. In the midst of different life demands, it can be very burdensome to achieve tight glycemic control to prevent late diabetes complications, and at the same time, to avoid hypoglycemia. Consequently, many individuals with type 1 diabetes are faced with diabetes distress, decreasing profoundly their quality of life. Today, the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study, launched in 1997, has gathered data from more than 8,000 well-characterized individuals with type 1 diabetes, recruited from 93 centers all over Finland and has established its position as the world's leading project on studying complications in individuals with type 1 diabetes. Studying risk factors and mechanisms of diabetes complications is inconceivable without trying to understand the effects of exercise and nutrition on glycemic control and the development of diabetes complications. Therefore, in this paper we provide findings regarding food and exercise, accumulated during the 25 years of studying lives of Finnish people with type 1 diabetes.
  • Haeren, Roel; Hafez, Ahmad; Korja, Miikka; Raj, Rahul; Niemelä, Mika (2022)
    OBJECTIVE: Anterior communicating artery aneurysms (ACoAAs) are challenging to treat both surgically and endovascularly. In this study, we evaluate the treatment-related morbidity and clinical outcome of microsurgical clipping and endovascular treatment for a consecutive series of unruptured ACoAAs while the treatment paradigm was in transition from surgical to endovascular first.METHODS: We retrospectively reviewed clinical and radiologic data of adult patients who underwent microsurgical clipping or endovascular treatment of an unruptured ACoAA at a high-volume academic neurovascular center (Helsinki University Hospital) during 2012-2019. During this period, a transition from microsurgical clipping to endovascular treatment took place. Regarding outcome, we focused on treatment-related complications, dischargeto-home rates, functional performance (modified Rankin Scale score), and obliteration rates.RESULTS: Of 128 treated ACoAAs, 81 (64%) were treated surgically and 47 (36%) endovascularly. There was no difference in major complications, intracranial hemorrhagic complications or ischemic complications, discharge-to-home rates, or functional performance between the surgically and endovascularly treated patients. With time, a decrease in major complications was observed in the surgical cases (from 29% to 17%), whereas the major complication rate increased in the endovascularly patients (from 0% to 25%). Cerebral ischemia was the most frequent complication in both groups. The risk for permanent neurologic deficit remained low in both groups (9% for endovascular and 5% for surgery).CONCLUSIONS: We did not find any major differences regarding complications and outcomes after the treatment paradigm shift from clipping to endovascular of unruptured ACoAAs. Prospective studies evaluating durability of treatments are needed to compare overall effectiveness.
  • Santos, Juan Serna; Laukontaus, Sani; Laine, Matti; Pellicer, Pablo Valledor; Sonetto, Alessia; Venermo, Maarit; Aho, Pekka (2023)
    Background: Total occlusion of the iliac-femoral tract can cause a variety of life-limiting symp-toms ranging from mild claudication to chronic limb-threatening ischemia. Efforts should be made to revascularize the symptomatic ischemic limb. Currently there are different options in the vascular surgeon's armamentarium to achieve this. The aim of the study was to verify the feasibility and outcomes of inflow hybrid revascularizations combining femoral endarterectomy and recanalization of iliac atherosclerotic occlusion. Methods: A retrospective review was conducted of all hybrid revascularizations involving femoral endarterectomy and endovascular treatment of iliac occlusion. The operations were per-formed in Helsinki University Hospital between January 2013 and December 2018. First, infor-mation about patients' baseline characteristics, indications and details of surgery and technical/ hemodynamic success, and complications and mortality were obtained from the vascular regis-try and patients records. Secondarily, a prospective assessment of mid-term patency was per-formed through follow-up in November 2019. Immediate technical success, 30-day mortality, complications, and patency were considered major outcomes. Hemodynamic improvement, amputation rate, and overall mortality were also assessed.Results: One hundred sixty three iliofemoral occlusions were performed on 147 patients during the period studied. Six patients (3.6%) had infrarenal aortic occlusion, 86 (52.7%) had common iliac, and 128 (78.5%) had external iliac artery occlusion. Technical success rate was 88.3% (n = 144 occlusions recanalized). Primary technical success was somewhat lower in lesions > 90 mm (87.1%) compared to lesions shorter than 90 mm (95.7%; c2 P = 0.06). Iliac stent was deployed in 141 (94.6%) cases, 51 (34.3%) of which were covered stents. Significant resid-ual stenosis remained in 1.2% of cases. Median operative time was 4 hr 34 min (interquartile range 2 hr 43 min) and median estimated blood loss was 743 mL (interquartile range 500 mL). Five patients (3.0%) developed a deep groin infection and 12 (8.1%) suffered any ma-jor cardiovascular event or stroke perioperatively. Primary patency at 30 day, 6 months, 1 year, and 2 years was 98.7%, 98.1%, 96.6%, and 93.7%, respectively. Hemodynamic success was documented in 107 patients (73%). By the end of the follow-up, 7 iliofemoral tracts (11.1%) reoc-cluded, 2 limbs (1.2%) required amputation, and 50 patients (3.0%) died. Conclusions: Good immediate success rate and mid-term patency can be achieved by hybrid revascularization of iliofemoral occlusions. Careful patient selection is mandatory because this pop-ulation often suffers from universal atherosclerosis. The involvement of the aorta represents a sig-nificant determinant of worse long-term patency, although it did not preclude technical success.
  • ESPN Dialysis Working Grp (2019)
    BackgroundChildren with congenital nephrotic syndrome (CNS) commonly develop end stage renal failure in infancy and require dialysis, but little is known about the complications and outcomes of dialysis in these children.MethodsWe conducted a retrospective case note review across members of the European Society for Pediatric Nephrology Dialysis Working Group to evaluate dialysis management, complications of dialysis, and outcomes in children with CNS.ResultsEighty children (50% male) with CNS were identified form 17 centers over a 6-year period. Chronic dialysis was started in 44 (55%) children at a median age of 8 (interquartile range 4-14) months. Of these, 17 (39%) were on dialysis by the age of 6months, 30 (68%) by 1year, and 40 (91%) by 2years. Peritoneal dialysis (PD) was the modality of choice in 93%, but 34% switched to hemodialysis (HD), largely due to catheter malfunction (n=5) or peritonitis (n=4). The peritonitis rate was 0.77 per patient-year. Weight and height SDS remained static after 6months on dialysis. In the overall cohort, at final follow-up, 29 children were transplanted, 18 were still on dialysis (15 PD, 3 HD), 19 were in pre-dialysis chronic kidney disease (CKD), and there were 14 deaths (8 on dialysis). Median time on chronic dialysis until transplantation was 9 (6-18) months, and the median age at transplantation was 22 (14-28) months.ConclusionsInfants with CNS on dialysis have a comparable mortality, peritonitis rate, growth, and time to transplantation as infants with other primary renal diseases reported in international registry data.
  • de Bree, Remco; Meerkerk, Christiaan D. A.; Halmos, György B.; Mäkitie, Antti A.; Homma, Akihiro; Rodrigo, Juan P.; Lopez, Fernando; Takes, Robert P.; Vermorken, Jan B.; Ferlito, Alfio (2022)
    In head and neck cancer (HNC) there is a need for more personalized treatment based on risk assessment for treatment related adverse events (i.e. toxicities and complications), expected survival and quality of life. Sarcopenia, defined as a condition characterized by loss of skeletal muscle mass and function, can predict adverse outcomes in HNC patients. A review of the literature on the measurement of sarcopenia in head and neck cancer patients and its association with frailty was performed. Skeletal muscle mass (SMM) measurement only is often used to determine if sarcopenia is present or not. SMM is most often assessed by measuring skeletal muscle cross-sectional area on CT or MRI at the level of the third lumbar vertebra. As abdominal scans are not always available in HNC patients, measurement of SMM at the third cervical vertebra has been developed and is frequently used. Frailty is often defined as an age-related cumulative decline across multiple physiologic systems, with impaired homeostatic reserve and a reduced capacity of the organism to withstand stress, leading to increased risk of adverse health outcomes. There is no international standard measure of frailty and there are multiple measures of frailty. Both sarcopenia and frailty can predict adverse outcomes and can be used to identify vulnerable patients, select treatment options, adjust treatments, improve patient counselling, improve preoperative nutritional status and anticipate early on complications, length of hospital stay and discharge. Depending on the definitions used for sarcopenia and frailty, there is more or less overlap between both conditions. However, it has yet to be determined if sarcopenia and frailty can be used interchangeably or that they have additional value and should be used in combination to optimize individualized treatment in HNC patients.
  • 2015 European Soc Coloproctology; Kössi, Jyrki (2019)
    BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC). AIM To investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD. METHODS This is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission. RESULTS Three hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P <0.01), had lower American Society of Anesthesiology score (ASA) grade (P <0.01) and less comorbidity (P <0.01), but were more likely to be current smokers (P <0.01). Patients with CD were more frequently operated on by colorectal surgeons (P <0.01) and frequently underwent ileocecal resection (P <0.01) with higher rate of de-functioning/primary stoma construction (P <0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P <0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers. CONCLUSION Patients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups.
  • Altman, Daniel; Mikkola, Tomi S.; Bek, Karl Moller; Rahkola-Soisalo, Paivi; Gunnarsson, Jonas; Engh, Marie Ellstrom; Falconer, Christian; Nordic TVM Grp (2016)
    The objective was to assess safety and clinical outcomes in women operated on using the Uphold (TM) Lite Vaginal Support System. We carried out a 1-year, multicenter, prospective, single cohort study of 207 women with symptomatic Pelvic Organ Prolapse Quantification (POP-Q) stage aeyen2 apical pelvic organ prolapse, with or without concomitant anterior vaginal wall prolapse. Safety data were collected using a standardized questionnaire. Anatomical outcome was assessed by the POP-Q and subjective outcomes by the Pelvic Floor Distress Inventory after 2 months and 1 year using a one-way repeated measures analysis of variance. Pain was evaluated using a visual analog scale. The overall rate of serious complications was 4.3 % (9 out of 207 patients), including 3 patients with bladder perforations, 1 with bleeding > 1,000 ml, 2 who had undergone re-operations with complete mesh removal because of pain, and 3 surgical interventions during follow-up because of mesh exposure. POP-Q stage aecurrency sign1 after 1 year was 94 % and subjective symptom relief was reported by 91 % of patients (p <0.001). Pain after 2 months and 1 year was 60 % lower compared with the preoperative mean (p <0.001). Minor complications occurred in 20 women (9.7 %) and were dominated by lower urinary tract dysfunction. No predisposing risk factors for complications were found. The Uphold (TM) Lite procedure in women with apical pelvic organ prolapse provided satisfactory restoration of vaginal topography and symptom relief. However, serious complication rates were largely comparable with those of other transvaginal mesh kits.
  • Kotaniemi, Karoliina V. M.; Suojanen, Juho; Palotie, Tuula (2021)
    This retrospective study was performed to report the peri- and postoperative complications encountered by patients who underwent Le Fort I osteotomy, as well as predictor variables affecting the risk of complications. Patients who underwent only Le Fort I osteotomy were included in the study. Information on peri- and postoperative complications were collected from the patient data records. The effects of certain predictor variables on complication rates were also studied. Twenty-four per cent of the patients suffered from complications, six (6.1%) of whom were reoperated. Most of the complications were minor and transient. Compared with one-piece osteotomy, segmental osteotomy was a significant risk factor predisposing patients to postoperative complications (p = 0.04619). Additionally, the use of patient-specific implants seemed to increase the risk of both perioperative and postoperative complications (p = 0.0248). Currently, the conventional plate fixation method is the primary method in Le Fort I osteotomies. Careful patient selection, surgical planning, and selection of surgical technique seem to be the most important factors in reducing the complication risk. Special attention should be paid with segmental osteotomy surgery. (C) 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
  • Ruohoalho, Johanna; Aro, Katri; Makitie, Antti A.; Atula, Timo; Haapaniemi, Aaro; Keski-Santti, Harri; Kylanpaa, Leena; Takala, Annika; Back, Leif J. (2017)
    Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist-head and neck (ORL-HN) surgeons-have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology-head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P <0.005). The proportion of early PEG placements within 0-3 days increased from 3.6 to 14.6% (P <0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.
  • Mäki-Lohiluoma, Lauri; Kilpeläinen, Tuomas P.; Järvinen, Petrus; Söderström, Henna K.; Tikkinen, Kari A.O.; Sairanen, Jukka (2022)
    Background: Despite being one of the most frequent urological procedures, the risk estimates for complications after hydrocele surgery (hydrocelectomy) are uncertain. Decision-making about hydrocelectomy involves balancing the risk of complications with efficacy of surgery—a tradeoff that critically depends on the complication risks of hydrocele surgery. Objective: To examine the 90-d risks of complications of hydrocele surgery in a large, contemporary sample. Design, setting, and participants: We retrospectively reviewed all surgeries performed for nonrecurrent hydroceles conducted in all five Helsinki metropolitan area public hospitals from the beginning of 2010 till the end of 2018, and evaluated the complication outcomes. Outcome measurements and statistical analysis: The following outcomes were evaluated: (1) risk of moderate or severe (Clavien-Dindo II–V) hydrocele surgery complications, (2) risk of reoperation due to a surgical complication, and (3) risk of an unplanned postoperative visit to the emergency room or outpatient clinic, all within 90 d after surgery. Results and limitations: We identified 866 hydrocele operations (38 [4.3%] bilateral operations). A total of 139 (16.1%) patients had moderate or severe hydrocele surgery complications within 90 d after surgery. Of the 139 complications, 94 were (10.9% of all or 67.6% of patients with moderate or severe complications) Clavien-Dindo grade II, 43 (5.0% and 30.9%, respectively) grade III, two (0.2% and 1.4%, respectively) grade IV, and none grade V. A total of 45 patients (5.2% of all and 32.4% of those who had moderate or severe complications) required immediate reoperation due to complications. All together 219 operated patients (25.3% of all operated patients) had an unplanned visit to the emergency room. The retrospective study design limits the reliability of the results. Conclusions: Complications after hydrocele surgery are common and warrant further research. These estimates can be useful in shared decision-making between clinicians and patients. Patient summary: We investigated the complication rates after hydrocele surgery and found that complications are common after a procedure often considered minor: every ninth patient had a moderate and every 20th a severe complication. Every fourth patient had an unplanned postoperative visit to the emergency room.
  • Vasara, Henri; Halonen, Lauri; Stenroos, Antti; Kosola, Jussi (Helsingin yliopisto, 2020)
    Suomessa operoidaan noin 2000 pertrokanteerista lonkkamurtumaa vuosittain. Nämä murtumat kuormittavat huomattavasti terveydenhuoltojärjestelmää ja murtuman saaneita yksilöitä. Nykyisten suositusten mukaan lonkkamurtuman luutumista tulisi seurata kuuden viikon välein otetuilla röntgenkuvilla, kunnes luutuminen on tapahtunut. Murtumien rutiininomaista seurantaa on kuitenkin kyseenalaistettu useammassa eri murtumatyypissä. Tämän tutkimuksen tarkoitus on selvittää, onko intramedullaarisesti korjattujen pertrokanteeristen murtumien rutiininomaisesta seurannasta hyötyä. Analysoimme retrospektiivisesti kaikki 995 Töölön sairaalassa vuosina 2011-2016 intramedullaarisesti operoidut pertrokanteeriset murtumat. Potilaita seurattiin potilastietojärjestelmistä minimissään kaksi vuotta tai kuolemaan asti. Kaikki operaation jälkeiset lonkkamurtumaan liittyvät suunnitellut ja suunnittelemattomat käynnit analysoitiin. Aineiston potilaiden keski-ikä oli 81 vuotta ja heistä 67 % oli naisia. Potilaiden kolmen kuukauden kuolleisuus oli 14 % ja kahden vuoden 35 %. Kaikkiaan 9 potilaalla (0,9 %) suunniteltu seurantakäynti johti muutokseen potilaan hoitolinjassa. Näistä 6 johtui mekaanisista komplikaatioista, 2 murtuman luutumattomuudesta ja 1 periproteettisesta murtumasta. 64 potilaalla (6,4 %) tehtiin hoitolinjan muutos suunnittelemattoman käynnin takia. Näiden potilaiden käynneistä 28 johtui infektiosta, 15 mekaanisesta komplikaatiosta, 14 periproteettista murtumasta, 6 painehaavasta ja 1 avaskulaarisesta nekroosista. Rutiininomaiset seurantakäynnit ovat rasite sekä terveydenhuoltojärjestelmälle että potilaille. Lonkkamurtumapotilaat ovat keskimäärin huonokuntoisia ja seurantakäynneille saapuminen vaatii usein erityisjärjestelyjä. Silti alle 1 % suunnitelluista seurantakäynneistä johtaa muutoksiin hoitolinjassa. Ehdotuksemme on antaa potilaille ja kuntoutuslaitoksille kattavat ohjeet hoitoon hakeutumisesta rutiininomaisen seurannan sijaan.