Browsing by Subject "Postoperative Complications"
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Item Analysis of Free Flap Breast Reconstruction Failures: Are Specific Patient Characteristics Associated with Free Flap Failure?(2013-01-22) Sciano, Natalie M.; Farkas, Jordan; Cortez, Robert; Miller, Travis; Davis, Kathryn; Kenkel, Jeffrey M.PURPOSE: This study was performed to gain insight on the patients who have undergone free flap breast reconstructive surgery. Recognizing certain patient variables, as risk factors for developing free flap failure, is invaluable. This knowledge can provide surgeons the benefit of foresight when assessing patients pre and postoperatively. The goal was to identify specific characteristics that predisposed patients to developing flap failure. METHODS: A retrospective chart review was completed on patients who had received free flap breast reconstructive surgery during January 2008 to January 2012. A cohort of 124 patients receiving free flap reconstruction was identified using the Current Procedural Technology (CPT) code 19364. A number of patient variables which include general characteristics, comorbidities, and surgical characteristics were analyzed to determine their contribution toward a patient's development of free flap failure. Patients were categorized into two groups- those without and those with flap failure. A comparison of the means and proportions was performed to determine statistical significance between the two groups. The level of statistical significance for this univariate analysis was set at a P < 0.05. RESULTS: All of the 124 patients identified were female. The overall flap success rate was 91.94 percent, with only ten patients experiencing flap failure. Of the factors analyzed in this study, there was not an identified patient characteristic that predisposed a patient to developing free flap failure. CONCLUSIONS: Flap failure is an unfortunate risk of reconstructive surgery that needs to be minimized at all costs. No specific patient variables were identified as predisposing risk factors that could contribute to free flap failure. Institutions should strive to educate all breast reconstruction candidates on their options and risks which can help increase the volume of patients acquiring reconstruction. In the future, other investigations with a larger sample size should be done to yield more beneficial information for the physician and patient.Item Assessing Complications of Epiphysiodesis for Leg Length Discrepancy(2014-02-04) Terrill, Tyler A.; Dunn, Samuel H.; Birch, John; Makarov, MarinaINTRODUCTION: Leg length discrepancy in children and adolescents is a serious orthopedic problem that can cause leg and back problems due to abnormal gait. This condition may be congenital or caused by disease or trauma. One method to correct leg length discrepancies in children is to perform an epiphysiodesis. This surgical procedure removes one or more growth plates from the femur, tibia, or fibula. This operation slows down the growth of the long leg to allow the shorter leg to catch up, or at least prevent the discrepancy from increasing. As there has been no large study of epiphysiodesis patients in the literature, the rates for surgical complications and errors associated with this surgery are not well known. These complications may include infections, nerve damage, and incomplete epiphysiodesis, which often results in an angular deformity. Because of the lack of understanding for rate of complications and characteristics associated with these, we studied a large patient population to gain insight into these aspects of the procedure. METHODS: The patient population at Texas Scottish Rite Hospital for Children undergoing epiphysiodesis for the treatment of leg length discrepancy from 1980 to 2008 was examined by a retrospective review of both charts and radiographs, with a total of 755 patients included in the study. The information recorded in the study included the extent of leg length discrepancy, angular measurements of the joints, method of epiphysiodesis, postoperative development of angular deformities, underlying etiology, length correction prediction, and other clinical features. RESULTS: Of the 755 patients examined, 38 had surgical complications, (5%). Of these patients, 27 had incomplete epiphysiodesis, 6 had neurological problems, 3 had overcorrection of the leg length discrepancy, and 2 had other complications not specific to this procedure. Patients incurring complications had statistically significant risk factors that include greater leg length discrepancies at the time of epiphysiodesis, congenital defects instead of acquired ones, and younger age. There were also trends towards open curettage method, epiphysiodesis involving the femoral growth plate, and male gender as risk factors, though these did not achieve statistical significance. DISCUSSION: It is important that surgeons understand which populations of patients are at greater risk for complications during this procedure, so that extra caution may be taken to prevent harm. Also, parents should be aware that there is a 5% risk of surgical complication, so that they may be fully informed before committing to the procedure.Item Association of Vitamin D Serum Concentration with Infection Outcomes for Children after Surgery(2016-01-19) Aboul-Fettouh, Nader; Williams, Timothy; Ploski, Roxana; Griffin, Allison; Szmuk, PeterVitamin D insufficiency and deficiency has been associated with various disease states and lower health outcomes. In the adult population, higher vitamin D levels correlated with decreased odds of in-hospital morbidity and mortality. However, no study examined the role of Vit D on the perioperative and post-operative outcomes in the pediatric patient population. We hypothesized that vitamin D deficient pediatric patients will have a higher incidence of composite infectious complications. As a secondary outcome we will analyze whether there is a relationship between the patient's vitamin D levels and hospital length of stay. With IRB approval we performed an EPIC search for all Children's Health patients from 2011 to 2015 where at least one 25-hydroxyvitamin D level was determined within the perioperative period (1 month pre- and post-surgery). Patients were included if they were less than 18 years of age and had underwent non-cardiac surgery. Patients were excluded if they did not receive general anesthesia, stayed less than one night in the hospital, had an American Society of Anesthesiologists Physical Status greater than 4, or underwent emergent surgery. Pertinent information including details of the surgery and relevant past medical history were collected for each patient to help analyze the data set and account for confounding factors. In order to have access to a larger number of patients, this project was performed in collaboration with Cleveland Clinic (Cleveland, OH). The EPIC search provided us with 1600 patient charts from CMC or Children's Health-Plano, and 850 were included into the study after being screened using the criteria noted previously. After analyzing the data, The incidence of infection were 5.5%, 5.8%, 4.9%, 5.8%, and 11.7% for patients with vitamin D level ≤13, 14-19, 20-25, 26-34, and ≥35 ng/ml, respectively. The odds of having infection did not differ significantly among the five vitamin D groups. Secondly, no difference was found in the length of hospital stay among the five vitamin D groups (P = 0.55). Vitamin D levels do not seem to be associated with infection or length of hospital stay in pediatric surgical patients. Other baseline and surgical factors have probably a stronger influence on in-hospital infection and length of hospital stay than vitamin D levels.Item Barbed Sutures and Wound Complications in Plastic Surgery(2013-01-22) Cortez, Roberto; Kenkel, Jeffrey M.; Farkas, Jordan; Lazcano, Eric; Hein, Rachel; Miller, Travis; Sciano, Natalie; Constantine, Ryan; Anigian, Kendall; Jewell, JamesGOALS: Technological advancements, along with their refinements, have substantially increased the amount of wound closure tools at the disposal of the surgeon. Barbed sutures, with a unique design containing circumferentially located barbs, could potentially decrease operation time and facilitate wound healing by eliminating the need to tie knots and providing even tension distribution across the wound. This study was conducted: 1) to determine whether using a barbed suture device in wound closure showed an increase, decrease, or no difference in wound complication development when compared to conventional non-barbed sutures 2) to analyze complication rates observed within the barbed suture population (Angiotech QuillTM SRS vs. Covidien V-LocTM) to test for any significant difference between the two competing brands. METHODS: An IRB-approved retrospective chart review identified 1709 patients undergoing plastic surgery procedures from January of 2008 to January of 2012. In our database, a barbed suture device was used in a total of 372 cases and the type used (Angiotech QuillTM SRS vs. Covidien V-LocTM) was recorded in each case. The QuillTM SRS device was used in 106 cases, while the V-LocTM device was used in 266 total cases. Outcomes following these procedures were compared to outcomes of the same CPT codes where a barbed suture device was not used. Wound complications were defined as one or more of the following: infection, dehiscence, erythema, necrosis, seroma, hematoma, and delayed wound healing. RESULTS: Using multivariate analysis, barbed sutures appear to be associated with an increased incidence of wound complications (p=0.012), to include dehiscence (p=0.007), erythema (p=0.008), and necrosis (p=0.03) when compared to their non-barbed counterparts. Further exploration within the barbed suture population found the Covidien brand associated with an increased incidence of wound complications (p=0.03), particularly dehiscence (p=0.009), while the Quill brand was found to have a higher association with erythema (p=0.001) along the incision site. CONCLUSIONS: Barbed sutures appear to be associated with an increased incidence of wound complications in plastic and reconstructive surgery procedures, with the Covidien V-LocTM device showing a higher incidence of wound complication development compared to Angiotech QuillTM SRS device.Item Bariatric surgery and effects on calcium and bone metabolism(2015-06-26) Sakhaee, KhashayarItem Challenges Associated with Internal Mammary Vessels in Multiple Free Flap Breast Reconstruction(2017-01-17) Kayfan, Samar; Zhou, Michael; Wang, Jenny; Teotia, Sumeet S.; Haddock, Nicholas T.INTRODUCTION: As breast reconstructive microsurgeons increase their armamentarium of flaps with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. Bi-pedicled and stacked flaps have been performed by microsurgeons using the cranial and caudal internal mammary system. We present our experience utilizing this system for flap reliability. METHOD: 736 flaps for breast reconstruction were performed from 2010-2016 (DIEP/SIEA and PAP flaps) by 2 senior surgeons at a university hospital. 220 (30%) of those flaps were either: Stacked PAP flaps, 4-flap (Bilateral PAP+DIEP flap), or Double-pedicle DIEP/SIEA flaps. Specific data regarding number, type, and locality of anastomosis was analyzed. RESULTS: 454 anastomosis were performed in 87 patients who underwent 220 flaps. Out of 454 anastomosis, 167 were to Caudal IMA/V (37%), 171 were to Cranial IMA/V (38%), and 116 were intra-flap (25%). There were 0 flap losses in Double-pedicle DIEP group (58-patients, 116-flaps), 3 flap losses in 4-Flap group (23-patients, 92-flaps), and 0 in Stacked-PAP group (6-patients, 12-flaps). In the 3 flap losses of 4-Flap group, 2 flaps were to Caudal IMA/V (1 arterial thrombosis, 1 venous thrombosis), and 1 cranial IMA/V (venous thrombosis). Also, in the 4-Flap group, 3 flaps were salvaged by converting to intra-flap anastomosis due to intraoperative caudal arterial thrombosis. In the Stacked-PAP group, there were 2 flaps salvaged, 1 by converting to intra-flap artery from caudal IMA, and other was venous congestion from caudal IMV pedicle kink seen POD#1. In the Double-pedicle DIEP group, 1 flap was salvaged by converting 1 arterial anastomosis from caudal IMA to intra-flap. Total flap loss rate in entire group was 1.4%. Flap loss avoidance by either conversion to intra-flap anastomosis or early suspicion of caudal system compromise was 2.7%. CONCLUSION: Caudal IMA/V system remains a viable and safe option for anastomosis in multiple flap procedures. However, based on our large experience with stacked and multiple flaps, we add caution utilizing the caudal system, particularly in patients with radiation, anastomosis mismatch and intraoperative spasm. The enthusiasm towards usage of caudal IMA/V system should be appropriately attenuated in certain circumstances with preference towards intra-flap anastomosis.Item Does Delay to Surgery in Type III Supracondylar Humerus Fractures Lead to Longer Surgical Times and More Difficult Reductions?(2017-01-17) Prabhakar, Pooja; Elliott, Marilyn; Ho, ChristineBACKGROUND: As numerous studies have shown that delay in reduction of pediatric supracondylar humerus fractures (SCHFx) does not affect clinical outcomes, and as many hospitals adopt dedicated daytime trauma operative time, more type III SCHFx are being pinned non-emergently after hospital admission. We sought to determine if delay in surgical treatment of type III SCHFx would affect the length of operative time. METHODS: This is an IRB-approved, retrospective review of a series of 317 modified Gartland type III supracondylar fractures treated operatively at a tertiary referral center from 2011 to 2013. Mean patient age was 5.4 years (range, 2-10y). To balance the study design, 15 hours was selected as the cut-off between early and delayed treatment. A total of 53.6% (170/317) fractures were treated early, and 46.4% (147/317) were delayed. Surgical time was defined as "incision start" to "incision close". Fluoroscopy time was use as a surrogate for difficulty of reduction. RESULTS: Time from injury to OR was shorter for high-energy fractures (fractures with soft tissue or neurovascular injury) versus low energy fractures (12.9 vs. 15.2 hours, p < 0.0001); however, surgical time (37.3 vs. 31.9 minutes, p = 0.005) and fluoroscopy time (54.4 vs. 48.4 sec, p = 0.032) were longer in high-energy fractures vs. low-energy fractures. Among low energy fractures, no significant difference was detected in surgical time between the early and delayed treatment groups (32.0 vs. 31.9 minutes, p = 0.284) or in the fluoroscopy time (50.6 vs. 46.5 seconds, p = 0.778). Additionally, there was no statistically significant difference found in surgical or fluoroscopy time with the presence of a surgical assistant. Mean surgical time when the attending surgeon was alone was 29.3 minutes, compared to 38.6 min with a fellow, 33.5 min with a resident, 34.8 min with a mid-level practitioner, and 40.9 min with both a fellow and resident (p=0.065). Mean fluoroscopy time when the surgeon was alone was 42 seconds, compared to 58.3 sec with a fellow, 51 sec with a resident, 47.6 sec with a mid-level practitioner, and 53.4 sec with multiple trainees (p=0.102). CONCLUSIONS: Delay in surgery did not result in a longer surgical time or more difficult reduction for type III SCHFx. Patients with low energy fractures still underwent a shorter operative time even with delay from injury to surgery. When excluding high-energy injuries, surgical treatment of Gartland type III SCHFxs may be delayed without increasing surgical time or difficulty of reduction.Item Donor issues in organ transplantation(2014-07-11) Wada, SuzanneItem Factors That Alter the Relationship Between Peak Postoperative CKMB and Troponin T after CABG(2017-01-17) Mehta, Kinjal M.; Pruszynski, Jessica; Peltz, Matthias; Huffman, Lynn C.; Bajona, Pietro; Wait, Michael A.; Correa, Ronald; Ring, W. Steves; Jessen, Michael E.INTRODUCTION: Peak postoperative creatine kinase MB fraction (CKMB) and Troponin T (TnT) levels have been measured after cardiac surgery to assess perioperative myocardial damage, evaluate myocardial protective strategies and predict adverse events. However, the relationship between peak levels of both enzymes has not been fully established in this setting. We compared peak levels of CKMB and TnT in patients after CABG to test the hypothesis that patient and operative characteristics influence the correlation between the values of these biomarkers. METHODS: Data were prospectively collected from 171 consecutive patients undergoing on-pump CABG at a single institution between July 1, 2014 and Dec 31, 2015. Peak values were selected from all serum levels of CKMB and TnT collected during the hospital stay following surgery. Clinical variables were collected based on definitions in the STS Adult Cardiac Surgery Database version 2.181. Linear regression models were used to statistically compare the slope of the linear relationship between peak postoperative CKMB and TnT for the patient cohort. Models were created to compare the slopes by pre-defined clinical variables including (1) gender, (2) age (< or >70), (3) race, (4) tobacco use, presence or absence of (3) hypertension, (4) dyslipidemia, (5) diabetes, (6) renal dysfunction (GFR<60), (7) MI within 21 days, (8) EF (< or > 40%), preoperative use of (9) ACE-inhibitors, (10) beta-blockers, and (11) anticoagulants; and operative variables including (1) cross clamp time (< or > 70 min), (2) CPB time (< or > 100 min), and (3) whether or not intra-operative blood products were received. A lower slope implies less change in CKMB compared to the change in TnT. RESULTS: Overall, the correlation between peak postoperative CKMB and TnT was robust in patients undergoing CABG (m = 19.6, r= 0.783). However, the slope of the relationship was significantly lower in males, patients > 70 years, diabetics, non-smokers, patients with renal dysfunction, patients with lower EF, patients receiving anticoagulants, and patients undergoing CABG following a recent MI. The slope was significantly greater in patients with longer clamp times and who were receiving beta blockers and ACE-inhibitors (Table I). In all other models, the slope of the relationship was similar. CONCLUSION: The relationship between CKMB and TnT following CABG appears to be influenced by patient and operative characteristics. These data do not assess which enzyme more accurately reflects myocardial injury, but does suggest conclusions about myocardial damage may be affected by the biomarker selected in the presence of certain variables. Further study to assess the association between these biomarkers and patient outcomes is warranted.Item Factors That Alter the Relationship Between Peak Postoperative CKMB and Troponin T After CABG(2019-04-02) Mehta, Kinjal Mukesh; Jessen, Michael; Pruszynski, Jessica; Huffman, LynnBACKGROUND: Peak postoperative creatine kinase MB fraction (CKMB) and Troponin T (TnT) levels have been measured after cardiac surgery to assess perioperative myocardial damage, evaluate myocardial protective strategies and predict adverse events. However, the relationship between peak levels of both enzymes has not been fully established in this setting. We compared peak levels of CKMB and TnT in patients after CABG to test the hypothesis that patient and operative characteristics influence the correlation between the values of these biomarkers. OBJECTIVE: To examine the relationship between peak levels of cTnT and CKMB following CABG in defined subsets of patients with pre-defined comorbidities to test the hypothesis that patient and operative characteristics influence the correlation between the values of these biomarkers. METHODS: Data were prospectively collected from 885 consecutive patients undergoing on-pump CABG at a single institution between July 2011 and June 2017. Peak values were selected from all serum levels of CKMB and TnT collected during the hospital stay following surgery. Clinical variables were collected based on definitions in the STS Adult Cardiac Surgery Database version 2.181. Analysis of covariance (ANCOVA) and linear regression models were used to statistically compare the slope of the linear relationship between peak postoperative CKMB and TnT for the patient cohort. Models were created to compare the slopes by pre-defined clinical variables including (1) age, (2) sex, (3) race, (4) current smoking status (5) hypertension, (6) dyslipidemia, (7) ejection fraction (EF), (8) diabetes, (9) renal dysfunction (GFR<60), (10) recent MI, preoperative use of (11) ACE-inhibitors, (12) beta-blockers, and (13) anticoagulants; and operative variables including (1) cross clamp time (< or > 70 min), (2) CPB time (< or > 100 min), and (3) intra-operative blood products transfusion. RESULTS: Overall, the correlation between peak postoperative CKMB and TnT was robust in patients undergoing CABG. However, the slope of the relationship was significantly lower in males, diabetics, patients with dyslipidemia, patients with hypertension, patients with lower EF, patients who received red blood cell transfusions, and patients receiving beta-blockers. The slope was significantly greater in patients with renal dysfunction, current smokers, patients with a recent MI, patients with longer cross clamp times, patients with longer CPB time, and patients receiving ACE inhibitors. CONCLUSION: The relationship between CKMB and TnT following CABG appears to be influenced by patient and operative characteristics. These data do not assess which enzyme more accurately reflects myocardial injury, but does suggest conclusions about myocardial damage may be affected by the biomarker selected in the presence of certain variables. Further study to assess the association between these biomarkers and patient outcomes is warranted.Item Factors that Predict Poor Outcome after Treatment of Un-Ruptured Anterior Communicating Artery Aneurysms(2014-02-04) Krishnan, Govind; White, JonathanINTRODUCTION: Management of un-ruptured anterior communicating artery (ACOM) aneurysm is variable. The objective of this study was to identify demographic information, presentation indices, and clinical information that could help predict pattern outcomes after undergoing treatment for an un-ruptured ACOM aneurysm. METHODS: The study was a retrospective review of 139 patients with un-ruptured ACOM aneurysms from 2007 to 2012, who underwent either microsurgical clipping or endovascular coiling to treat the aneurysm. Demographics, medical history, presenting condition and patient outcomes were analyzed. The outcome of the treatment was quantified using the Glasgow Outcomes Score. A score of 3 or greater at discharge was considered favorable. Multivariate regression analysis was used to identify significant predictors of poor outcomes. RESULTS: A favorable outcome at discharge was achieved in 116 of the 139 total patients (83.45%). Multivariate analysis identified patient age grated than 70 (p<0.005), history of prior brain injury or surgery (p<0.005), current but not precious smoking (p<0.05), aneurysms of size greater than 20 mm (p<0.05), duration of temporary occlusions greater than 20 minutes (p<0.001), and the use of microsurgical clipping (p<0.005) as significant predictors of poor outcome. CONCLUSION: Age over 70, prior history of brain injury, current smoking, and an aneurysm size greater than 20 mm, along with the use of clipping and a duration of temporary occlusion greater than 20 minutes are the strongest predictors of poor outcome from treatment of un-ruptured ACOM aneurysms. This would indicate that treatment should be reconsidered in patients with any of the above risk factors and coiling should be attempted whenever possible.Item Impact of Sex on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from a Multicenter US Registry(2017-01-17) Alame, Aya J.; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Wyman, R. Michael; Patel, Mitul; Bahadorani, John; Lombardi, William; Grantham, J. Aaron; Kandzari, David; Lembo, Nicholas; Moses, Jeffrey W.; Kirtane, Ajay; Toma, Catalin; Doing, Anthony; Choi, James; Uretsky, Barry; Karacsonyi, Judit; Resendes, Erica; Karatasakis, Aris; Danek, Barbara A.; Rangan, Bavana V.; Thompson, Craig A.; Banerjee, Subhash; Brilakis, Emmanouil S.INTRODUCTION: The effect of sex on in-hospital outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS: Using data collected from 14 experienced U.S. centers between 2012 and 2016, we compared the clinical, angiographic, and procedural characteristics of 1,753 CTO PCIs performed in 1,718 patients by sex. RESULTS: Most patients were men (84.7%) with a mean age of 65.3±10 years. As compared with women, men presented for CTO PCI at a younger age (65.0±10 vs. 66.8±11 years, p=0.022), had higher J-CTO (2.54±1.23 vs. 2.35±1.28, p=0.045) and Progress-CTO (1.05±1.0 vs. 0.875±0.94, p=0.005) scores, longer lesions [30.0 (20.0, 50.0) mm vs. 28.0 (15.0, 40.0) mm, p=0.034] and more moderate to severe tortuosity (36.9% vs. 28.8%, p=0.016). They were also more likely to have had prior coronary artery bypass graft surgery (36.4% vs. 30.0%, p=0.046) and to undergo CTO PCI using the retrograde approach (41.0% vs. 32.6%, p=0.010). The final successful crossing strategy was more likely to be antegrade wire escalation in women (40.8% vs. 54.4%, p<0.001). Technical success was lower in men (88.0% vs. 92.6%, p=0.034), whereas procedural success (86.6% vs. 89.4%, p=0.232) and major adverse cardiovascular events (2.42% vs. 3.41%, p=0.348) were similar (Figure 1). CTO PCI in men was associated with longer procedural time, fluoroscopy time, increased use of contrast, and higher air kerma radiation dose. CONCLUSIONS: As compared with women, CTO PCI in men is associated with higher lesion complexity and lower technical success, but similar procedural success and similar incidence of major adverse cardiovascular events.Item Incidence, Risk Factors, and Outcomes among Patients with Venous Thromboembolic Events in the Early Post-Transplant Period(2018-01-23) Kanade, Rohan; Smith, Lauren; Mahan, Luke; Bollineni, Srinivas; Mullins, Jessica; Kaza, Vaidehi; Mohanka, Manish; Wait, Michael; Torres, Fernando; Banga, AmitINTRODUCTION: With the introduction of lung allocation score (LAS), progressively sicker patients are undergoing lung transplantation (LT) which has the potential to increase the risk of venous thromboembolic (VTE) events during the post-transplant period. This study was conducted to determine the incidence and risk factors for early VTE and its association with 2 year survival. METHODS: All adult patients with single, double or heart LT at the UT Southwestern Medical Center between 2012-14 (n=193) were included in the study. Various demographic, clinical and laboratory variables before and after LT were recorded. Development of any VTE events during the first 30 days after LT was the primary outcome variable. Variables were compared among patients with and without VTE to identify risk factors for VTE. Survival at two years was compared among patients with and without VTE. RESULTS: Overall incidence of VTE during the first 30 days after LT was 28.5% (n=55) among which, majority were upper extremity thrombosis (48/55). Pulmonary embolism was uncommon (n=3). Majority events (78%) were diagnosed with in the first 15 days after LT. Pre-transplant history of hyperlipidemia (adjusted OR, 95%CI: 2.8, 1.1-7.2; p=0.03) and use of anticoagulants (AC) for at least 72 hours (4.1, 1.8-9.5; p=0.001) were independently associated with a reduced risk of VTE. On the other hand, development of primary graft dysfunction at 72 hours (1.6, 1.1-2.4; p=0.009) and use of >3 central catheters during the post-transplant period (25.9, 2-342.1; p=0.013) were independently associated with increased risk of VTE. Development of VTE was associated with increased risk of 2 year mortality (log rank p=0.036, see figure). CONCLUSION: A significant proportion of patients develop VTE early after LT and it is associated with worse survival at 2 yr post-LT. Despite majority being catheter related VTE, the use of AC appears to be protective. Protective effect of hyperlipidemia may be linked to statin use among these patients which needs to be investigated further in future studies.Item Is It Safe to Combine Excisional Procedures with Liposuction in Body Contouring Surgery?(2014-02-04) Chen, Mo; Hardy, Krista; Davis, Kathryn; Yan, Jingsheng; Matthew, Anoop; Lysikowski, Jerzy; Reed, Gary; Kenkel, Jeffrey M.BACKGROUND: Excisional procedures, including abdominoplasty, brachioplasty, thighplasty, and body lift are often combined with liposuction with the goals of minimizing cost and hospital stays while maximizing aesthetic results. The aim of this study is to evaluate postoperative complications in patients undergoing excisional surgery with or without liposuction. Risk factors for this type of combined body contouring surgery are also evaluated. Methods: The electronic medical records of 413 patients undergoing body contouring surgery at UT Southwestern Medical Center were retrospectively reviewed. Three groups of patients were compared: liposuction only, excision only, and combined liposuction and excision surgeries. Some patients also received additional intra-abdominal, gynecologic, and breast procedures. Patient variables analyzed included age; body mass index (BMI); American Society of Anesthesiologists risk score (ASA score); Caprini score; operative time; co-morbidities (diabetes, hypertension, cardiovascular diseases, pulmonary diseases, and renal diseases); smoking status; prophylactic antibody use, and recent major surgery. RESULTS: No statistically significant differences in complication rates were found when comparing combined excision and liposuction surgeries to excision alone. Operative time was a significant risk factor for developing wound problems and overall complications. There was a trend for males and patients with higher BMI, older age (>45), and co-morbidities toward developing postoperative complications. CONCLUSIONS: Combining excisional body contouring procedures with liposuction does not increase overall complication rates in this cohort of patients. Plastic surgeons should balance the number of combined procedures with estimated operative time in order to maximize patient safety.Item Late Presentation of Complications of Mid-Urethral Slings and Outcomes After Sub-Urethral Sling Removal(2024-01-30) Suzman, Evan; Shah, Anjana; Alhalabi, Feras; Christie, Alana; Zimmern, Philippe E.INTRODUCTION: Mid-urethral slings (MUS) are common procedures for surgical management of stress urinary incontinence (SUI) in women and have recognized complications, which are often underdiagnosed if they occur late and may result in complex care even after sub-urethral sling removal (SSR). This study focused on the evaluation of MUS complications occurring 10+ years after placement, and outcomes after sling release. METHODS: Demographics, past medical history, original MUS operative note, presenting symptoms, pre-SSR evaluation, peri-operative complications, post-SSR symptoms at last visit, were collected from EMR (EPIC) for patients who underwent SSR at least 10 years after MUS placement. For those not seen in the past 2 years, a standardized phone interview using validated questionnaires was performed by a neutral investigator not involved in the care of these patients. RESULTS: From 2006 to 2023, 58 patients met study criteria with mean age of 65 ± 10.5 years and predominantly Caucasian (91%). Nine were reached by phone and 4 were lost to follow-up. Time from initial MUS procedure to SSR removal was 16.7 ± 3.9 years. Most MUS were TVT (76%), followed by TOT (18%). At presentation, 90% of patients reported pain, 86% dyspareunia, 69% recurrent UTI, 52% SUI, and 53% urge urinary incontinence. Multiple presenting symptoms were observed in 83% of patients. At a mean follow-up of 2.2 years, SSR resulted in resolution of pain in 50% of patients, dyspareunia in 50%, recurrent UTI in 60%, SUI in 29%, and urge urinary incontinence in 37%, for each respective initial symptom. Some patients reported de novo pain (3%), UTIs (2%), SUI (9%) or urge urinary incontinence (7%). 7% required subsequent surgery for UI or persistent pain-related issues. CONCLUSIONS: It is important that pelvic reconstructive surgeons monitor patients who receive MUS over time and counsel patients considering MUS on these potential risks.Item Long Term Central Venous Access in a Pediatric Leukemia Population(2015-01-26) Fu, Aurelia; Hodgman, Erica; Renkes, Rachel; Slone, Tamra; Alder, AdamBACKGROUND: Central venous access devices (CVADs) are used during the treatment of malignancies to facilitate chemotherapy administration and to reduce the pain and trauma of frequent blood sampling. Despite the importance of venous access, there is little recent data on complication rates associated with CVADs among pediatric patients. Our aim was to retrospectively analyze the complication rates among patients with acute leukemia at a single pediatric tertiary referral center. METHODS: After IRB approval, we reviewed the medical records of all patients with a diagnosis of acute lymphoblastic leukemia or acute myeloid leukemia admitted to our institution from May 2009-July 2014. Patient data, including demographics, CVAD type (subcutaneous port or tunneled catheter), peri-operative complications (<24 hours of surgery), long-term complications (>24 hours after surgery), and overall patient outcomes were collected. Chi square, t-tests and backward stepwise multivariate-regressions were used (significance p<0.05). RESULTS: There were 292 CVADs placed in 198 patients. The peri-operative complication rate was 4.8% (14 out of 292). Out of 292 CVADs, 23 did not have any long-term complications. Long-term complications included 93 line-associated infections (blood stream and/or port site infections), 6 episodes of deep vein thrombosis (DVT), and 136 instances of line malfunction without an identifiable cause. Seventy-five CVAD's were prematurely removed: 31 due to infection and 44 to malfunction. Univariate analysis identified age as a risk factor for a hematoma (p=0.02), and weight status as a risk factor for blood stream infection (p=0.02), DVT (p=0.009), line malfunction (p=0.02), and premature removal (p=0.02). The number of days from diagnosis to CVAD placement (p=0.008) and location of the subcutaneous port reservoir (p=0.01) were identified as predictors of early CVAD removal by multivariate analysis. There were no significant differences in long term complications between ports or tunneled catheters. CONCLUSION: Our rate of peri-operative complications compares to the 1.3-14% range reported in previous studies. Long term complications are high and require additional treatment, catheter replacement, or premature removal. This is costly in health, time, and money for both the patient and our institution, and should be addressed to improve patient care. Our retrospective study is the largest recent evaluation of CVAD complications within a single institution and also represents the largest Hispanic pediatric leukemia population reported upon to date.Item Neurosurgery in Resource-Poor Settings: Improving Access to Surgical Education and Outcomes Analysis of Spine Surgery in a Training Hospital in Cambodia(2019-03-26) Still, Megan Elizabeth Hermann; Bagley, Carlos; Patel, Toral; Lega, Bradley C.BACKGROUND: Access to basic surgical care, and neurosurgery in particular, has historically been a neglected topic in the global health sphere. However, up to 30% of the global burden of disease is surgical in nature and great strides have been made in the past few years to spotlight and begin to rectify the huge gap in access to safe, timely, and affordable surgical care around the globe. Spine pathology is a common reason for admission to neurosurgical units in low- and middle- income countries (LMICs) and can have high morbidity rates from lack of specialized institutes. However, good surgical outcomes and quality of life scores have been reported in LMICs. OBJECTIVE: This study details the complication rates and predictive factors from spine surgery at a large hospital in Cambodia, aiming to identify high-risk patients to improve surgeon understanding of these complications for improved pre-operative planning and patient counseling. METHODS: This is a retrospective review of patients admitted for spine conditions to Preah Kossamak Hospital, in Phnom Penh (2013-2017). Univariate analysis was conducted on potential predictive factors; variables with p<0.1 were entered into multivariate logistic regression models. RESULTS: 773 patients were included. 46 patients had complications including wrong level surgery, hardware failure, and infection. On multivariate analysis, patients from the provinces of Kratie (p=0.009) or Sihanoukville (p=0.036), and delay to evaluation of over one year (p=0.027) were significant predictive factors of postoperative complications and ASIA A injury (p=0.020) was a predictive factor of poor outcome. CONCLUSION: Many factors play a role in spine surgery complications in LMICs, including limited access to intra-operative technology, low follow-up rates, and minimal physiotherapy and rehabilitation capabilities. Patients with long delays in presentation, ASIA A injuries, and lumbar-level surgery may be especially susceptible to complications and post-operative morbidity. Despite this, institutions have reported encouraging spine trauma outcomes, and spine surgeries are becoming more accepted and safe operations in many LMICs. Additionally, various groups are working towards equality and training in neurosurgery around the globe using different approaches towards education.Item Preoperative pulmonary evaluation(1993-12-02) Wait, JulietteItem Pulmonary complications of general surgery(1975-02-06) Pierce, Alan K.Item Resident Complicaitons of Intravitreal Injections at a Large County Hospital(2018-01-23) Balachandar, Neeraja; Bolisetty, Keerthana; Robertson, ZacharyINTRODUCTION: Intravitreal injections (IVIs) have now surpassed cataract surgery as the most frequently performed procedure in ophthalmology. Their incidence has increased from less than 3,000 in 1999 to more than 2.3 million in 2012. The most common pharmacologic agents administered intravitreally inhibit angiogenesis by blocking vascular endothelial growth factor. Diabetic macular edema, exudative age-related macular degeneration, and venous-occlusion associated macular edema are the most common indications. As such, IVI usage will only increase in the future as the population ages, new medications become available, and indications broaden. With IVIs being performed at increasing rates at the Parkland county hospitalメs resident ophthalmology clinic, identification of an accurate risk profile must be delineated, including possible complications during cataract surgery. METHODS: A retrospective chart review of patients who received one or more IVIs by an ophthalmology resident at Parkland between 01/2010 and 07/2016 was conducted. Charts were reviewed for a variety of IVI-related complications as well as the incidence of posterior capsule rupture (PCR) during cataract surgery, after one or more IVIs. RESULTS: 1893 eyes (from 1300 subjects) that had undergone at least one IVI were included. Of a total of 8642 IVIs that were reviewed, 76 complications (0.88%) were noted. Their nature ranged from relatively non-vision threatening (corneal abrasion, ptosis, and posterior vitreous detachment) to severely vision threatening (endophthalmitis, intraocular pressure (IOP) elevation, retinal detachment (RD), and other patient movement-related complications). The majority of complications did not occur at a significantly higher or lower rate than those reported in the literature. However, a significantly lower rate of RD (p=0.039) and a significantly higher rate of acute and chronic IOP elevation (p=0.001) was found. Further, of 354 cataract surgeries included and reviewed on eyes with prior IVIs, PCR occurred 12 eyes. Of these 13 eyes, 7 eyes were excluded for a prior history of pars plana vitrectomy, a known independent risk factor for PCR. This resulted in a PCR rate of 1.41% compared to average rates in literature of 1.9-2.1% (p=0.677). DISCUSSION: Resident administered IVIs at Parkland pose an overall low risk of complication, minimally different from IVIs administered at other institutions. The PCR rate in eyes with a history of IVIs at Parkland, excluding previously vitrectomized eyes, is not significantly different than the standard rate in literature. This data will prove useful in analyzing the unique risks of IVIs and subsequent cataract surgeries in individual patients. The etiology of the increased rates of IOP elevations at Parkland requires further investigation.