Postoperative complication rates and invasiveness of laparoscopy-assisted distal gastrectomy and open distal gastrectomy based on the American Society of Anesthesiologists classification system

2013 ◽  
Vol 6 (3) ◽  
pp. 170-176 ◽  
Author(s):  
Hideki Kawamura ◽  
Toshiro Tanioka ◽  
Munenori Tahara ◽  
Masahiro Takahashi
Keyword(s):  
Postoperative Complication ◽  
Classification System ◽  
Distal Gastrectomy ◽  
Complication Rates ◽  
Open Distal Gastrectomy ◽  
American Society ◽  
American Society Of Anesthesiologists

American Society of Anesthesiologists Class as Predictor for Perioperative Morbidity in Head and Neck Free Flaps

2019 ◽  
Vol 161 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Luke T. Small ◽  
Madison Lampkin ◽  
Emre Vural ◽  
Mauricio A. Moreno
Keyword(s):  
Intensive Care Unit ◽  
High Risk ◽  
Risk Group ◽  
Free Flaps ◽  
High Risk Group ◽  
Medical Complication ◽  
Complication Rates ◽  
Asa Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

ObjectiveTo evaluate outcomes of free flaps in low- versus high-risk American Society of Anesthesiologists (ASA) classes utilizing a standardized perioperative clinical pathway.Study DesignCase series with chart review.SettingSingle tertiary care academic institution.Subjects and MethodsData were collected from 301 patients who underwent 305 free flap reconstructions for head and neck defects from January 2012 to March 2016 by a single surgeon (M.M.). A standardized perioperative clinical pathway was utilized for all patients, aimed at abbreviating hospital stay and minimizing intensive care unit stay. Data included ASA classification, comorbidities, length of hospitalization, intensive care unit stay, 30-day mortality/readmission, discharge disposition, flap survival, and postoperative complications. Low-risk ASA classes were defined as 1 and 2 (n = 53) and high risk as 3 and 4 (n = 248).ResultsTotal medical complication rates ( P = .012) were mildly increased in the high-risk group, as a result of increased minor—not major—medical complication rates ( P = .007). Discharge to a nursing or rehabilitation facility was found to be more common in the high-risk group ( P = .024). All other outcomes were not statistically different between the cohorts.ConclusionThe ASA classification system is a validated tool in determining perioperative risk. We found that minor medical complications and discharge to a rehabilitation/nursing facility were increased in the high-risk ASA classes; otherwise, there were no statistical differences between the groups. These findings suggest that the ASA classification may be helpful for preoperative discharge planning and counseling but should not be used for patient selection or to assess candidacy for the procedure.

Utilization of the American Society of Anesthesiologists (ASA) classification system in evaluating outcomes and costs following deformity spine procedures

2020 ◽  
Vol 9 (1) ◽  
pp. 185-190
Author(s):  
Alexander J. Schupper ◽  
William H. Shuman ◽  
Rebecca B. Baron ◽  
Sean N. Neifert ◽  
Emily K. Chapman ◽  
...  
Keyword(s):  
Classification System ◽  
Asa Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

2007 ◽  
Vol 73 (8) ◽  
pp. 737-742 ◽  
Author(s):  
Naveen Pokala ◽  
S. Sadhasivam ◽  
R.P. Kiran ◽  
V. Parithivel
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Complicated Appendicitis ◽  
Complication Rates ◽  
Intraabdominal Abscess ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 ± 16.5 versus 31.3 ± 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 ± 36.2 versus 81.5 ± 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5–9] versus 6 [interquartile range 4–8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.

Cervical Corpectomy: Complications and Outcomes

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS295-ONS302 ◽  
Author(s):  
Maxwell Boakye ◽  
Chirag G. Patil ◽  
Chris Ho ◽  
Shivanand P. Lad
Keyword(s):  
Type 1 Diabetes ◽  
Multivariate Analysis ◽  
Mortality Rates ◽  
Complication Rates ◽  
Improvement Program ◽  
Cervical Corpectomy ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Objective: Previously, information on cervical corpectomy complication rates has been obtained from retrospective analysis of single-institution data. The aim of this study was to report 30-day mortality and complication rates after cervical corpectomy using multicenter prospective data from the Veterans Affairs National Surgical Quality Improvement Program database. Methods: The National Surgical Quality Improvement Program database was used to identify 1560 patients who underwent cervical corpectomy in United States Veterans Affairs hospitals from 1997 to 2006. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on morbidity and mortality rates. Results: A total of 1560 patients underwent corpectomy, with an overall in-hospital mortality rate of 1.6%, a complication rate of 18.4%, and a mean length of stay of 6 days. Multivariate analysis identified age older than 80 years (odds ratio [OR], 21.24), history of Type 1 diabetes (OR, 2.36), American Society of Anesthesiologists class greater than 3 (OR, 6.93), and dependent functional status (OR, 3.17) as the most significant preoperative predictors of complications. Three or more corpectomy levels (OR, 2.46) and operative duration longer than 6 hours (OR, 3.45) were also found to be significant predictors of postoperative complications. Patients who underwent 3 or more levels of corpectomy had a return-to-operating room rate of 17.9% and a graft/instrumentation failure rate of 5.4% compared with those who underwent single-level corpectomy, who had rates of 6.2 and 1.87%, respectively. Patients who were returned to the operating room had significantly higher mortality rates (7.0 versus 1.2%) and accounted for 39.9% of the total number of complications. Multivariate analysis identified age, American Society of Anesthesiologists class, history of disseminated cancer, and diabetes as the most significant predictors of mortality. Patients with Type 1 diabetes had 4-fold higher mortality rates compared with patients with no history of diabetes or diet-controlled diabetes. Conclusion: We have analyzed the morbidity and mortality data on the largest series of corpectomy reported to date. We have demonstrated the impact of age, American Society of Anesthesiologists class, and number of operated levels on complication rates. Type 1 diabetes was established as a strong risk factor for 30-day mortality after cervical corpectomy.

Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): results from the prospective multicentre electronic registry of sedation-associated complications

Gut ◽  
2018 ◽  
Vol 68 (3) ◽  
pp. 445-452 ◽  
Author(s):  
Angelika Behrens ◽  
Anton Kreuzmayr ◽  
Hendrik Manner ◽  
Herbert Koop ◽  
Albrecht Lorenz ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Major Complication ◽  
Complication Rates ◽  
Gi Endoscopy ◽  
Study Results ◽  
Study Centre ◽  
Registration Number ◽  
Independent Risk Factors ◽  
American Society ◽  
American Society Of Anesthesiologists

ObjectivesSedation has been established for GI endoscopic procedures in most countries, but it is also associated with an added risk of complications. Reported complication rates are variable due to different study methodologies and often limited sample size.DesignsAcute sedation-associated complications were prospectively recorded in an electronic endoscopy documentation in 39 study centres between December 2011 and August 2014 (median inclusion period 24 months). The sedation regimen was decided by each study centre.ResultsA total of 368 206 endoscopies was recorded; 11% without sedation. Propofol was the dominant drug used (62% only, 22.5% in combination with midazolam). Of the sedated patients, 38 (0.01%) suffered a major complication, and overall mortality was 0.005% (n=15); minor complications occurred in 0.3%. Multivariate analysis showed the following independent risk factors for all complications: American Society of Anesthesiologists class >2 (OR 2.29) and type and duration of endoscopy. Of the sedation regimens, propofol monosedation had the lowest rate (OR 0.75) compared with midazolam (reference) and combinations (OR 1.0–1.5). Compared with primary care hospitals, tertiary referral centres had higher complication rates (OR 1.61). Notably, compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5% of all procedures), adding another person for sedation (nurse, physician) was associated with higher complication rates (ORs 1.40–4.46), probably due to higher complexity of procedures not evident in the multivariate analysis.ConclusionsThis large multicentre registry study confirmed that severe acute sedation-related complications are rare during GI endoscopy with a very low mortality. The data are useful for planning risk factor-adapted sedation management to further prevent sedation-associated complications in selected patients.Trial registration numberDRKS00007768; Pre-results.

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