Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery

2017 ◽  
Vol 104 (4) ◽  
pp. 337-346 ◽  
Author(s):  
D. B. Wright ◽  
C. E. Koh ◽  
M. J. Solomon
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Early Postoperative Complications ◽  
Laparoscopic Reoperation

Does obesity increase early postoperative complications after laparoscopic colorectal surgery? Results from a single center

2014 ◽  
Vol 28 (7) ◽  
pp. 2090-2096 ◽  
Author(s):  
Camila Estay ◽  
Alejandro J. Zarate ◽  
Magdalena Castro ◽  
Udo Kronberg ◽  
Francisco López-Köstner ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Single Center ◽  
Early Postoperative Complications

scholarly journals The Assessment of Early Complications and Risk Factors Affecting Their Occurrence in Breast Reconstructive Procedures

2021 ◽  
Author(s):  
Justyna Jończyk ◽  
Jerzy Jankau
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Complication Rate ◽  
Clinical Factors ◽  
Early Complications ◽  
Reconstructive Procedures ◽  
Factors Affecting ◽  
Rehospitalization Rate ◽  
Early Postoperative Complications

AbstractThe presence of postoperative complications may have a significant impact on the outcome of the breast reconstruction. The aim of this study was to investigate early postoperative complications and the risk factors for their occurrence. A prospective analysis was carried out to evaluate surgical outcomes after breast reconstructive surgeries performed over a 2-year period. Procedures included expander/implant (TE/IMP), pedicle transverse rectus abdominis musculocutaneous (pTRAM), and latissimus dorsi (LD) techniques. All adverse events which occurred within 6 weeks of surgery were ranked according to severity based on the contracted Accordion grading system. Outcomes were assessed for their association with surgical, demographic, and clinical variables. Sixty-one consecutive breast reconstruction procedures were analyzed. The overall complication rate was 60.7% (n = 37), and 8 patients (13.1%) required reoperation. The lowest complication rate was observed in implant-based reconstructions (TE/IMP, 18.8%; pTRAM, 72.7%; LD, 78.3%; p = 0.008). Mild complications occurred significantly more often after LD reconstructions (LD, 60.9%; pTRAM, 22.7%; TE/IMP, 12.5%; p = 0.031), while severe complications were significantly more frequent after the pTRAM procedures (pTRAM, 27.3%; TE/IMP, 6.2%; LD, 8.7%; p = 0.047). Severe complications were associated with higher rehospitalization rate (p = 0.010) and longer hospital stay. Study revealed a significant impact of the operative method on the incidence and severity of early complications after breast reconstruction procedures with little effect from other demographic and clinical factors.

scholarly journals Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Antonio Messina ◽  
Chiara Robba ◽  
Lorenzo Calabrò ◽  
Daniel Zambelli ◽  
Francesca Iannuzzi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Randomised Controlled Trials ◽  
Elective Surgery ◽  
Fluid Management ◽  
Risk Difference ◽  
Controlled Trials ◽  
Perioperative Fluid Management ◽  
Liberal Approach ◽  
Randomised Controlled

Abstract Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value  = 0.001]. We found no difference in either early (p value  = 0.33) or late (p value  = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059.

Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies

2020 ◽  
pp. 000313482095484
Author(s):  
Andrés Zorrilla-Vaca ◽  
Gabriel E. Mena ◽  
Juan Cata ◽  
Ryan Healy ◽  
Michael C. Grant
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Observational Studies ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Conventional Care ◽  
Recovery Programs ◽  
Enhanced Recovery Programs ◽  
Postoperative Aki

Background Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value = .95). Conclusions Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.

scholarly journals Impact of combined use of intraoperative MRI and awake microsurgical resection on patients with gliomas: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Constantin Tuleasca ◽  
Henri-Arthur Leroy ◽  
Iulia Peciu-Florianu ◽  
Ondine Strachowski ◽  
Benoit Derre ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Brain Tumors ◽  
Standard Error ◽  
Complete Resection ◽  
Awake Craniotomy ◽  
Intraoperative Mri ◽  
Primary Brain Tumors ◽  
Combined Use ◽  
Microsurgical Resection

AbstractMicrosurgical resection of primary brain tumors located within or near eloquent areas is challenging. Primary aim is to preserve neurological function, while maximizing the extent of resection (EOR), to optimize long-term neurooncological outcomes and quality of life. Here, we review the combined integration of awake craniotomy and intraoperative MRI (IoMRI) for primary brain tumors, due to their multiple challenges. A systematic review of the literature was performed, in accordance with the Prisma guidelines. Were included 13 series and a total number of 527 patients, who underwent 541 surgeries. We paid particular attention to operative time, rate of intraoperative seizures, rate of initial complete resection at the time of first IoMRI, the final complete gross total resection (GTR, complete radiological resection rates), and the immediate and definitive postoperative neurological complications. The mean duration of surgery was 6.3 h (median 7.05, range 3.8–7.9). The intraoperative seizure rate was 3.7% (range 1.4–6; I^2 = 0%, P heterogeneity = 0.569, standard error = 0.012, p = 0.002). The intraoperative complete resection rate at the time of first IoMRI was 35.2% (range 25.7–44.7; I^2 = 66.73%, P heterogeneity = 0.004, standard error = 0.048, p < 0.001). The rate of patients who underwent supplementary resection after one or several IoMRI was 46% (range 39.8–52.2; I^2 = 8.49%, P heterogeneity = 0.364, standard error = 0.032, p < 0.001). The GTR rate at discharge was 56.3% (range 47.5–65.1; I^2 = 60.19%, P heterogeneity = 0.01, standard error = 0.045, p < 0.001). The rate of immediate postoperative complications was 27.4% (range 15.2–39.6; I^2 = 92.62%, P heterogeneity < 0.001, standard error = 0.062, p < 0.001). The rate of permanent postoperative complications was 4.1% (range 1.3–6.9; I^2 = 38.52%, P heterogeneity = 0.123, standard error = 0.014, p = 0.004). Combined use of awake craniotomy and IoMRI can help in maximizing brain tumor resection in selected patients. The technical obstacles to doing so are not severe and can be managed by experienced neurosurgery and anesthesiology teams. The benefits of bringing these technologies to bear on patients with brain tumors in or near language areas are obvious. The lack of equipoise on this topic by experienced practitioners will make it difficult to do a prospective, randomized, clinical trial. In the opinion of the authors, such a trial would be unnecessary and would deprive some patients of the benefits of the best available methods for their tumor resections.

scholarly journals Defining standards in colorectal optimisation: a Delphi study protocol to achieve international consensus on key standards for colorectal surgery prehabilitation

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e047235
Author(s):  
Iona Pearson ◽  
Sue Blackwell ◽  
Rebecca Fish ◽  
Sarah Daniels ◽  
Malcolm West ◽  
...  
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Outcome Measures ◽  
Delphi Study ◽  
Public Involvement ◽  
Healthcare Professionals ◽  
Patient And Public Involvement ◽  
International Consensus ◽  
Elective Colorectal Surgery ◽  
Patient Related Outcome

IntroductionPrehabilitation in colorectal surgery is evolving and may minimise postoperative morbidity and mortality. With many different healthcare professionals contributing to the prehabilitation literature, there is significant variation in reported primary endpoints that restricts comparison. In addition, there has been limited work on patient-related outcome measures suggesting that patients with colorectal cancer needs and issues are being overlooked. The Defining Standards in Colorectal Optimisation Study aims to achieve international consensus from all stakeholders on key standards to provide a framework for reporting future prehabilitation research.Methods and analysisA systematic review will identify key standards reported in trials of prehabilitation in colorectal surgery. Standards that are important to patients will be identified by a patient and public involvement (PPI) event. The longlist of standards generated from the systematic review and PPI event will be used to develop a three-round online Delphi process. This will engage all stakeholders (healthcare professionals and patients) both nationally and internationally. The results of the Delphi will be followed by a face-to-face interactive consensus meeting that will define the final standards for prehabilitation for elective colorectal surgery.Ethics and disseminationThe University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee has approved this protocol, which is registered as a study (200190120) with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of the standards developed by all stakeholders will increase the potential for comparative research that advances understanding of the clinical application of prehabilitation.PROSPERO registration numberCRD42019120381.

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