Application of Nursing Cooperation Path in Operating Room and Analysis of Complication Rate During Laparoscopic Hysterectomy

Objective:To explore the clinical benefits achieved by implementing the operating room nursing cooperation path for patients undergoing laparoscopic hysterectomy.Methods:64 laparoscopic hysterectomy cases were divided into groups according to the order of admission.The control group received routine perioperative care.The observation group implemented the nursing cooperation path in the operating room on the same basis as the control group.The two groups’physiological responses,stimulus indicators,anxiety,and complication rates were compared.Results:The heart rate,blood pressure 0.5 hours after surgery,anxiety scores 1 day before and 3 days after surgery,and the total number of complications in the observation group were all lower than those in the control group(P<0.05).Conclusion:The development of a nursing cooperation path in the operating room can help patients undergoing laparoscopic hysterectomy reduce heart rate,blood pressure,stress responses,and the risk of complications,and is worthy of promotion.

Prevention and Management of Related Complication due to Laparoscopic Operation: Pneumothorax, Pneumomediastinum and Subcutaneous Emphysema

Essential prerequisite of laparoscopic operation is establishing and maintaining pneumoperitoneum with a certain pressure. But under certain circumstances CO2-gas insuffiating could induce pneumothorax , pneumomediastinum and subcutaneous emphysema during the operation. to probe the mechanism of the above complications. 2 typical cases were reported with attempt to probe the mechanism of the development of such applications. We believe that high intraabdominal pressure during operation is the primary cause of the complications. The essentials of prevention and management of such complications were proposed.

Defining the association between the prolonged operative time and 90-day complications in patients undergoing radical cystectomy

Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.Methods:The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution.The OT of 369 min was set as a cutoff value between short and long OT groups.The primary outcome was 90-day postoperative complication rates.Secondary outcomes were gastrointestinal recovery time,length of hospital stay,and 90-day readmission rates.Results:The overall incidence of 90-day postoperative complications was 79.7%where 43.2%representing low-grade complications according to the ClavieneDindo classification(Grade 1 and Grade 2),and 36.5%representing high-grade complications(Grade3).Gastrointestinal tract and infectious complications are the most common complications in our data set(45.9%and 45.6%,respectively).On multivariable analysis,prolonged OT was significantly associated with odds of high-grade complications(odds ratio 2.340,95%confidence interval 1.288e4.250,p=0.005).After propensity score-matched analysis,a higher incidence of major complications was identified in the long OT group 55(51.4%)compared to 35(32.7%)in the short OT group(p=0.006).A shorter gastrointestinal tract recovery time was noticed in the short OT group(p=0.009).Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses(p<0.001,p=0.001,respectively).

Effect of self-made exhaust plaster on patients with gastrointestinal dysfunction after gynecological operation

Objective:To explore the effect of self-made exhaust patch(SMEP)on gastrointestinal dysfunction after gynecological operation.Methods:A total of 200 patients with gynecological operation in the gynecological ward of Shandong Changle People's Hospital were randomly divided into the control group(n=100)and the treatment group(n=100).The recovery time of bowel sounds,the time of first anal exhaust,the duration of abdominal distention,the duration of abdominal pain,the incidence of abdominal distention and abdominal pain and linical efficacy of SMEP were observed.Results:Compared with the control group,the recovery time of gastrointestinal function and the first anal exhaust time in the treatment group were shorter;the duration of abdominal distention and abdominal pain in the treatment group were shorter than those in the control group(P<0.05);Cure rate of abdominal distention in the treatment is 62.5%and cure rate of abdominal pain in the treatment is 60%within 72 hours after operation,which is higher than that in the control group(44.%,45.9%).Conclusion:The results showed that the self-made exhaust patch can improve the clinical symptoms of patients after gynecological abdominal surgery,and the self-made exhaust patch had a significant effect on gastrointestinal dysfunction after gynecological surgery,which was worthy of clinical promotion.

COMPLICATIONS IN LAPAROSCOPIC GYNECOLOGIC SURGERY

Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies. Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (176%). Results. Complications occured in 34 cases, the overall complication rate was 192%. Unintended laparotomies occured in 6 cases(034%). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 353% of all complications of this series. Five intraoperative complications (147%) occured during the laparoscopic surgery (3 severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was required in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities. Conlusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.

Orthopedic surgery and its complication in systemic lupus erythematosus

Systemic lupus erythematosus(SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedicrelated conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to andmanaged prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.

OBSERVATION ON THERAPEUTIC EFFECTS OF ACUPUNCTURE IN 206 CASES WITH POSTOPERATIVE COMPLICATION OF ANUS AND INTESTINE

The authors have treated postoperative complication of anus and intestine by usingacupuncture at main point Chengshan(BL 57) with cool-producing needling manipulation. Therapeuticeffects of the treatment on postoperative severe pain, retention of urine, constipation, and bleedingwere observed clinically. Results indicated that the cure rate was 97. 6 % and the total effective ratewas 100%. Strong stimulation of Chengshan(BL 57) point improved mainly postoperative edema,spasm, local edema. The improvement of hyperemia and spasm is a ma jor factor of curing various postoperative complication of the anus and intestine. The therapeutic method has advantages of using lesspoints, rapidly producing effects, shorter therapeutic course, suffering little for patients, and no sideeffect.

Early Post-Operative Complications in Surgeries Pertaining Oral and Maxillofacial Region in MNH, Tanzania

The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.

Surgical apgar score predicts early complication in transfemoral amputees:Retrospective study of 170 major amputations

AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.

Post-operative abdominal complications in Crohn's disease in the biological era: Systematic review and meta-analysis

AIM: To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn's disease(CD) comparing biological with no therapy.METHODS: Pub Med, Medline and Embase databases were searched to identify studies comparing postoperative outcomes in CD patients receiving biological therapy and those who did not. A meta-analysis with a random-effects model was used to calculate pooled odds ratios(OR) and confidence intervals(CI) for each outcome measure of interest. RESULTS: A total of 14 studies were included for metaanalysis, comprising a total of 5425 patients with CD 1024(biological treatment, 4401 control group). After biological therapy there was an increased risk of total infectious complications(OR = 1.52; 95%CI: 1.14-2.03, 8 studies) and wound infection(OR = 1.73; 95%CI: 1.12-2.67; P = 0.01, 7 studies). There was no increased risk for other complications including anastomotic leak(OR = 1.19; 95%CI: 0.82-1.71; P = 0.26), abdominal sepsis(OR = 1.22; 95%CI: 0.87-1.72; P = 0.25) and re-operation(OR = 1.12; 95%CI: 0.81-1.54; P = 0.46) in patients receiving biological therapy. CONCLUSION: Pre-operative use of anti-TNF-α therapy may increase risk of post-operative infectious complications after surgery for CD and in particular wound related infections.

Surgical Complications of Kidney Transplantation in a Resource Limited Country: Retrospective Study of the First Five Years

Background: Kidney transplantation is the most efficient treatment for renal failure but may be ruined by complications. Objective: To report the surgical complications of renal transplantation and the therapeutic means applied. Method: It was a retrospective study including 42 files of kidney transplantation in Côte d’Ivoire. We report 11 cases of surgical complications of the recipient’s intervention during the first five years. Results: The mean age was 42.64 years (±15.04). In 90.9% of the cases, there was a comorbidity factor. Lymphocele and stenosis of the uretero vesical anastomosis were the most frequent complications. One death was observed. Conclusion: Kidney transplantation is an effective way of managing chronic renal failure. Postoperative complications are polymorphic and unpredictable.

Complications Per and Post Operatory (CPPO) at the Gabriel Toure University Hospital in Bamako

Introduction: Despite the use of less invasive and increasingly effective techniques in order to reduce the morbi-mortality per and post-operative, the CPPO remain an important problem in surgery. Objectives: To determine the rate of per and post-operative complications, to describe the types of complications and to identify their risk factors. Methodology: This was a prospective study carried out from 04 April to 03 June 2016 in the surgical department of CHU-Gabriel TOURE. All patients aged 18 and over operated in the Surgical Department (General Surgery, Gynaecology and Obstetrics, Urology, Traumatology, Otolaryngology, Neurosurgery and Emergency Department), having been hospitalized at least for 24 hours after surgery, were retained. The method of sampling N=P(1-P)Za2/I2 was used;the minimum size necessary was 209 patients. We conducted invitations and the phone call to determine the occurrence of complications and survival of patients up to 30 days after surgery. Results: We counted 262 patients, of whom 142 (54.2%) were women and 120 (45.8%) were men with a sex ratio = 0.85. The average age was 41.48 years, with extremes of 18 and 86 years. We found 71 complications in 61 patients, an early CPPO rate of 23.28%. The various complications encountered were: urinary tract infections (26.76%), surgical site infections (28.17%), pulmonary infections (12.68%) and Deaths (21.13%). The occurrence of complications prolonged the hospital stay by 6 days and increased the average cost of care of 102,700 FCFA. According to Clavien Dindo’s classification, the severe postoperative complication in our series was 9.16% (grade III + IV + V). Factors favoring the occurrence of CPPO were age > 41 years old, ASA > II, the classes of Altemeier 3 and 4, NNISS score 1 and 2, diabetes and hemoglobin rate 8 g/dl. Conclusion: Complications per and post-operative (CPPO) are common in the department of Surgery of CHU-Gabriel TOURE and are dominated by post-operative infection. These complications seem to be favored by multiple factors more related to the patients than to the hospital structure.

Obstructive Sleep Apnea and Post-Operative Complications: Single Center Data, Review of Literature and Guidelines for Practicing Internists and Surgeons

Obstructive sleep apnea has been linked to higher rates of post-operative complications in some studies. We examined the prevalence of obstructive sleep apnea and its impact on post-operative complications in 125 patients (21 prospective, 104 retrospective) undergoing various elective outpatient surgeries at our institution. Ten percent of these patients had OSA, and half of them were on continuous positive airway pressure therapy (CPAP). Patients who were on CPAP as outpatients received CPAP post-operatively as well. No patients died, and the prevalence of post-operative complications was low. There was no difference in complication rates between patients with and without OSA. We also review the existing literature on this subject and make practical recommendations regarding pre-operative evaluation and post-operative management of these patients for practicing internists and surgeons based on the current literature.

Hypospadias Repair and Its Complications at the Plastic Surgery Department, Khoula Hospital

This study reviewed the complications associated with hypospadias repair surgery done at Khoula hospital, Oman during the period of January, 2010 to October, 2015. During this period, 178 cases were operated. Snodgrass and Bracka’s techniques were the most used techniques. Complications were noted in 16 out of 82 patients operated using Snodgrass technique and 2 out 10 patients operated via Bracka’s technique. This study helped in shifting the practice towards the technique associated with the lowest complications. As a result we adopted for our practice MAGPI for glandular hypospadias, Snodgrass for any type of hypospadias without chordee and Bracka’s two stages repair for hypospadias with chordee.

Unusual complications of spinal surgery: A report of lifethreatening vascular injury

Kyphoplasty and lumbar spine fusion are rarely associated with significant vascular damage and internal bleeding. However, anaesthesiologists must maintain vigilance in order to detect rare, but potentially lifethreatening haemorrhagic complications of these procedures which may present intra-operatively or in the immediate post-operative period. We present two cases of life-threatening haemorrhagic complications of spine surgery, one from T12 kyphoplasty and the other from a redo lumbar laminectomy and fusion. In both cases, prompt recognition of vascular injuries with internal or covert bleeding which presented shortly after surgery allowed timely and life-saving treatment.

COOPERATING,WITH COMPLICATIONS——The Shanghai Cooperation Organization still has a long way to go before it can operate effectively

On June 15,2001, the Declaration on the Establishment of the Shanghai Cooperation Organization was signed, marking the formal launch of the regional organization. Its history can be traced back to 19% when Russia, China, Kazakhstan, Kyrgyzstan and Tajikistan formed the Shanghai Five, later renamed the Shanghai Forum. After Uzbekistan joined, the forum changed

Analysis of operation-related complications of totally laparoscopic aortoiliac surgery

Background Totally laparoscopic aortoiliac surgery has been newly developed in China.It is known as the most complex laparoscopic technique to learn because of its high-risk procedures.Analysis of the operation-related complications of this surgery is supposed to be helpful for the early success of this technique.Methods Twelve male patients （56-70 years old） with aortoiliac occlusive disease underwent totally laparoscopic aortoiliac bypass surgery （TLABS） in our institute.Clinical data and operation-related complications were retrospectively analyzed.Results Of the 12 patients,TLABS succeeded in nine and conversion to open surgery occurred in three.One of the converted patients finally died of pulmonary infection.Operation-related complications included bleeding from arterial injury,perforation from colonic injury,graft embolism,residual aortic stenosis,and hydronephrosis.Bleeding in two patients and colonic perforation in one patient resulted in three conversions to open surgery.Intraoperative graft embolectomy and postoperative aortic stenting were performed to resolve the thrombus/embolus-referring complications.Left hydronephrosis,which was thought to result from intraoperative injury and treated with ureteric intubation drainage,recovered 6 months after TLABS.Conclusions Good understanding and avoidance of operation-related complications are important to guarantee the technical success of TLABS.Immediate conversion to open surgery is necessary for saving the patient＇s life in case of lifethreatening complications.

Large bowel injuries during gynecological laparoscopy

Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the wellknown risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods,pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.

Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture： a meta-analysis

Background There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture- operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures. Methods We searched multiple databases in English （including EMBASE, PubMed, and OVID） and in Chinese （including CNKI, WANFANG, and VIP）, as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software. Results Eight randomized controlled trials （RCTs） involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher （Z=3.33, P 〈0.01）. However, the moderate （Z--4.27, P 〈0.01） and minor （Z--5.59, P 〈0.01） complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter （Z=2.65, P 〈0.01）. The inability to return to previous level sporting rate and ankle joint decreased range of motion （ROM） rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups. Conclusions Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alternative especially for the older and patients with lower sporting requirements.

The influence of obesity on operating room time and perioperative complications in cochlear implantation

Objective:The rising incidence of obesity in the United States is associated with increased healthcare expenditures and resource allocation.Obesity has been associated with prolonged operating times during surgical procedures.The primary objective of this study is to compare body mass index (BMI) to length of surgery during cochlear implantation.Methods:A retrospective case control study from a tertiary academic referral center was performed.Patients included were adults who underwent primary,single-sided cochlear implantation with documented BMI and operating room (OR) times from January 2009 to July 2015.The following data were collected:BMI,total operating room time (TORT),surgical operating room time (SORT),ASA status,perioperative and postoperative complications,age,and gender.Results:Two hundreds and thirty-four patients were included and stratified into obese (BMI ＞30)and non-obese (BMI ＜ 30) categories.Statistical analysis was performed comparing TORT against the obesity category along with other variables.Independent sample t-test demonstrated that obesity increases TORT and SORT by 16.8 min (P ＝ 0.0002) and 9.3 min (P ＝ 0.03),respectively,compared to the non-obese group.Multivariate linear regression analysis demonstrated no statistically significant impact of gender,or ASA status on total operating or surgical time.Obesity was associated with increased perioperative complications (odds ratio [OR],6.21;95％ CI,1.18-32.80;P ＝ 0.03) and postoperative complications (OR,3.97;95％ CI,1.29-12.26;P ＝ 0.02).Conclusions:Obesity leads to longer TORT and SORT during primary cochlear implant surgery.Obesity is also associated with increased perioperative and postoperative complications compared to non-obese patients.These data have implications with utilization of operating room resources.