• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.103-110
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• 2016

Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.10
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• pp.5225-5228
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• 2012

Introduction : The objective of this study was to analyze the complication rates after completion thyroidectomy and compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. Patients and Methods: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiated thyroiud cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 given total thyroidectomy for benign diseases (Group 3). Results: When groups were compared for complications, there were no significant difference except temporary hypocalcemia between completion thyroidectomy and total thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were no significant difference observed except unilateral temporary RLN palsy. Conclusion: With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies which need special attention. To evaluate the patients more carefully in preoperative period and performing adequate thyroidectomy appears more logical.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1126-1135
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• 2000

Objectives : The goal of surgical management of cerebral arteriovenous malformation(AVM) is elimination of the lesion without development of new neurological deficits. To improve the management results of cerebral AVMs in the future, this article discusses about surgical complications of the AVM and their management. Material and Methods : During the past 18 years, 116 patients with cerebral AVMs were managed by surgery. Among these cases, 7 cases died, 7 cases developed new neurological deficits, 11 cases residual AVM and 5 cases intracerebral hematoma(ICH) after surgery. The author analyzes the causes of those complications and investigates the methods to minimized those complications based on the review of the literatures. Results : One stage removal of AVM and ICH in the poor neurological state were performed in 5 of 7 death cases. Subtotal removal of ICH followed by delayed AVM surgery after recovery is regard as one method to improve the outcome of patient with large ICH. Postoperative new neurological deficits developed owing to normal perfusion pressure breakthrough(NPPB) in 3, judgement error in 2, preoperative embolization in 1 and cortical injury in 1 case(s). Proper management of NPPB, accurate anatomical knowledge and physiological monitoring during operation, and well trained skill for embolization are regard as methods to minimize those complications. Residual AVMs after surgery were noticed in 11 cases, in which unintended 6 cases due to inaccurate dissection of peripheral margin of AVM, and intended 3 cases due to massive brain swelling during operation, 1 cases due to diffuse type and 1 case due to multiple type of AVM. Accurate dissection of peripheral margin of AVM and mild hypotension during operation may help to avoid this complication. Postoperative hemorrhage occurred in 3 cases due to rupture of the residual AVM and in 2 cases due to oozing from the AVM bed. Complete resection of AVM, complete control of bleeding points at AVM bed and mild hypotension during early postoperative period are the methods to avoid this complication. Conclusion : A precise but flexible therapeutic strategy and refined skill for endovascular, radiosurgical and microsurgical techniques are required to successful treatment of cerebral AVM. Adequate timing of AVM resection, accurate anatomical knowledge, proper management of NPPB and accurate dissection of peripheral margin of AVM are the key points for avoiding complications of the AVM surgery.

• Archives of Plastic Surgery
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• v.46 no.4
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• pp.336-343
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• 2019

Background Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. Methods Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. Results There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). Conclusions Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.36-53
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• 2024

As the number of spinal surgeries being performed expands, the number of medical imaging procedures such as radiography, CT, and MRI is also increasing, and the importance of their interpretation is becoming more significant. Herein, we present the radiological findings of a variety of complications that can occur after spinal surgery and discuss how effectively and accurately they can be diagnosed through imaging. In particular, this study details the characteristic imaging findings specific to the early and long-term postoperative periods. Early complications of spinal surgery include improper placement of surgical instruments (instrument malpositioning), seromas, hematomas, pseudomeningoceles, and infections in the region surrounding the surgical site. Conversely, long-term complications may include osteolysis around surgical instruments, failure of fusion, adjacent segment disease, and the formation of epidural fibrosis or scar tissue. A precise understanding of the imaging assessments related to complications arising after spinal surgery is crucial to ensure timely and accurate diagnosis, which is necessary to achieve effective treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.1
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• pp.27-33
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• 2017

Purpose: Gastrostomy is commonly used procedures to provide enteral nutrition support for severely handicapped patients. This study aimed to identify and compare outcomes and complications associated with percutaneous endoscopic gastrostomy (PEG) and surgical gastrostomy (SG). Methods: A retrospective chart review of 51 patients who received gastrostomy in a single tertiary hospital from January 2000 to May 2016 was performed. We analyzed the patients and the complications caused by the procedures. Results: Among the 51 patients, 26 had PEG and 25 had SG. Four cases in the SG group had fundoplication for gastroesophageal reflux disease. PEG and SG groups were followed up for an average of 29 months and 44 months. Major complications occurred in 19.2% of patients in the PEG group and 20.0% in the SG group, but significant differences between the groups were not observed. Minor complications occurred in 15.4% of patients in the PEG group and 52.0% in the SG group. Minor complications were significantly lower in the PEG group than in the SG group (p=0.006). The average use of antibiotics in the PEG and SG groups was 6.2 days and 15.7 days (p=0.002). Thirteen patients died of underlying disease but not related to gastrostomy, and only one patient died due to complications associated with general anesthesia. Conclusion: The duration of antibiotics use and incidence of minor complications were significantly lower in the PEG group than those in the SG group. Early PEG could be recommended for nutritional supports.

• Neurospine
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• v.15 no.4
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• pp.329-337
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• 2018

Objective: Machine learning algorithms excel at leveraging big data to identify complex patterns that can be used to aid in clinical decision-making. The objective of this study is to demonstrate the performance of machine learning models in predicting postoperative complications following anterior cervical discectomy and fusion (ACDF). Methods: Artificial neural network (ANN), logistic regression (LR), support vector machine (SVM), and random forest decision tree (RF) models were trained on a multicenter data set of patients undergoing ACDF to predict surgical complications based on readily available patient data. Following training, these models were compared to the predictive capability of American Society of Anesthesiologists (ASA) physical status classification. Results: A total of 20,879 patients were identified as having undergone ACDF. Following exclusion criteria, patients were divided into 14,615 patients for training and 6,264 for testing data sets. ANN and LR consistently outperformed ASA physical status classification in predicting every complication (p < 0.05). The ANN outperformed LR in predicting venous thromboembolism, wound complication, and mortality (p < 0.05). The SVM and RF models were no better than random chance at predicting any of the postoperative complications (p < 0.05). Conclusion: ANN and LR algorithms outperform ASA physical status classification for predicting individual postoperative complications. Additionally, neural networks have greater sensitivity than LR when predicting mortality and wound complications. With the growing size of medical data, the training of machine learning on these large datasets promises to improve risk prognostication, with the ability of continuously learning making them excellent tools in complex clinical scenarios.

• Journal of Veterinary Science
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• v.23 no.5
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• pp.66.1-66.8
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• 2022

Background: Prospective clinical study of blood lactate concentration in horses undergoing colic surgery is needed to determine utility in outcome prediction. Objectives: To evaluate venous lactate measurements in horses following colic surgery, including immediately after anesthetic recovery and daily throughout hospitalization, as well as to determine if lactate concentrations were significantly higher in horses that developed postoperative complications or did not survive to hospital discharge. Methods: Horses > 1 year of age undergoing surgery for colic and recovered from general anesthesia were sampled. A portable lactate meter was used to measure venous samples collected immediately following anesthetic recovery and daily throughout hospitalization. Complications arising during hospitalization and survival to hospital discharge were recorded. Results: Fifty one horses were enrolled, ranging in age from 2 to 29 years. Lactate concentration immediately following anesthetic recovery was higher in horses that developed complications during hospitalization (p = 0.046). The odds of developing complications postoperatively were doubled for horses with a venous lactate concentration > 5 mmol/L. Lactate measurements in non-survivors were significantly higher compared to survivors by 96 h postoperatively (p < 0.006). Conclusions: Higher venous lactate concentrations in the postoperative colic period were associated with an increased risk of complications and death. Results suggest horses with higher venous lactate measurements in recovery are more likely to have postoperative complications, with the odds of developing complications doubled for horses with a venous lactate > 5 mmol/L. Evaluation of venous lactate could provide information on prognosis in the postoperative period for horses with surgical colic.

• Journal of Korean Neurosurgical Society
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• v.40 no.4
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• pp.239-244
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• 2006

Objective : The present study evaluated overall surgical results for 3,000 patients with intracranial aneurysms, operated on in Busan Paik Hospital institution. Methods : Three thousand aneurysm cases, operated on in Busan Paik Hospital between January 1980 to June, 15th, 2005, were evaluated based on the following criteria; aneurysm form, aneurysm location, surgical results, postoperative complications, and seasonsonality of occuence. 957 cases were anterior communicating artery aneurysms, 776 were internal carotid artery[ICA] aneurysms, 755 were middle cerebral artery[MCA] aneurysms, 96 were anterior cerebral artery[ACA] aneurysms, 128 were vertebro-basilar artery[VBA] aneurysms and 288 were multiple aneurysms. The male to female ratio was 0.7 to 1 Surgical methods included 2.738 clippings, 219 coating and wrappings, 23 aneurysmoraphies, 20 proximal ligations. Results : Rebleeding occured in 5.1% of the early operation group and 16% of the late operation group respectively. Incidence of clinical vasospasm was 166% and angiographic vasospasm was 24.1%. The percentage of the multiple aneurysms was 9.5%, the percentage of the dissecting aneurysm was 6 cases [0.2%], 6 of the total [0.2%];De Novo" aneurysm, the percentage of lobectomies with clipping cases was 9 cases [03%] the percentage were incidental aneurysms; 164 [5.5%]. 88.1% had overall favorable surgical results with a 5.5 % mortality rate. Calcium-channel blocker and "Triple H" therapy did not improve mortality but did significantly improve morbidity. In the old age group, early operation reduced vasospasm, rebleeding and medical complications. The early surgery group exhibited a 86.2% favorable outcome with a 8.1% mortality rate. Intraoperative angiography reduced residual or remained aneurysms in large, giant aneurysm, especially in A.com artery aneurysm. Conclusion : The surgical results for the early surgery group according to surgical timming was better, but there were not statistically significant. ntraoperative angiography was especially useful on large aneurysms of the anterior communicating artery.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7627-7632
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• 2015

Background: The present study was conducted to evaluate the technical feasibility, safety and adequacy of surgical margins with salvage transoral robotic surgery (TORS) for recurrent or residual head and neck squamous cell carcinoma patients. Materials and Methods: Thirty patients who underwent salvage TORS using the 'DaVinci' robot were enrolled in the study and data related to their surgical time, complications and functional outcome were recorded. Results: The feasibility of salvage TORS in our study was observed to be 100%. Positive margins were encountered in only 6.7% of patients. Mean blood loss was 23.3 ml with no patient requiring blood transfusion. Postoperative complications in the form of primary haemorrhage requiring active surgical intervention occurred in 13.3%. Oral feeding could be started as early as the 3rd postoperative day in a few patients, with nasogastric tubes being removed on the 12th postoperative day. Long term gastrostomy tube dependency was seen in 10% cases. Median survival of patients was 19 months. Conclusions: Salvage TORS is a safe, effective and feasible option in the management of treatment failure cases. It offers an alternative surgical approach with unexpected benefits in terms of tracheostomy tube use, Ryle's tube and gastrostomy dependence.