Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery.

ObjectiveThis retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery.MethodsAdults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery.ResultsA total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p=0.02) and estimated blood loss over 500 mL (OR, 3.67; p=0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p=0.02) and operative time (OR, 1.005; p=0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p=0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p=0.04) and higher intraoperative blood loss (OR, 1.0007; p=0.03).ConclusionPreoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery

Cervical plate fracture: a rare complication

In traumatic and degenerative diseases cervical fusion with anterior cervical plate are commonly used. The increase in the use of cervical plate segment level is also increased risk of developing complications. This case report shows that the increase in the use of cervical plate segment level and also the complications in cervical spinal instrumentation, short-segment cervical plate rare case reported to be broken

A Rare Presentation of Crohn's Disease

Free peritoneal perforation is a rare complication of Crohn's disease with a report of only 100 cases in the literature. It needs an emergency exploration and an unaware general surgeon is confounded in intraoperative decision-making. We present our experience when this rarity struck us in a district hospital and briefly review the guidelines of optimal management of this complication of Crohn's disease

A systematic review of ICD complications in randomised controlled trials versus registries: is our 'real-world' data an underestimation?

Implantable cardioverter defibrillator (ICD) implantation carries a significant risk of complications, however published estimates appear inconsistent. We aimed to present a contemporary systematic review using meta-analysis methods of ICD complications in randomised controlled trials (RCTs) and compare it to recent data from the largest international ICD registry, the US National Cardiovascular Data Registry (NCDR). PubMed was searched for any RCTs involving ICD implantation published 1999-2013; 18 were identified for analysis including 6433 patients, mean follow-up 3 months-5.6 years. Exclusion criteria were studies of children, hypertrophic cardiomyopathy, congenital heart disease, resynchronisation therapy and generator changes. Total pooled complication rate from the RCTs (excluding inappropriate shocks) was 9.1%, including displacement 3.1%, pneumothorax 1.1% and haematoma 1.2%. Infection rate was 1.5%.There were no predictors of complications but longer follow-up showed a trend to higher complication rates (p=0.07). In contrast, data from the NCDR ICD, reporting on 356 515 implants (2006-2010) showed a statistically significant threefold lower total major complication rate of 3.08% with lead displacement 1.02%, haematoma 0.86% and pneumothorax 0.44%. The overall ICD complication rate in our meta-analysis is 9.1% over 16 months. The ICD complication reported in the NCDR ICD registry is significantly lower despite a similar population. This may reflect under-reporting of complications in registries. Reporting of ICD complications in RCTs and registries is very variable and there is a need to standardise classification of complications internationally

A Hidden Complication of Pigtail Catheter Insertion

Pigtail catheters have emerged as an effective and less morbid alternative to traditional chest tubes for evacuation of pleural air. Rare complications in the literature have been reported. We report a case of a 92-year-old male who presented with dyspnea and shock, noted to have a pneumothorax requiring tube thoracostomy. Computed tomography demonstrated pigtail within the lung parenchyma. We discuss the implications of this occurrence

Malignant lymphomas in transplantation patients: a review of the world experience.

Malignant lymphomas developed in 9 renal homograft recipients treated at widely separated transplantation centers. The development of these tumors appears to be an indirect complication of organ transplantation and/or the measures taken to prevent rejection. A further complication may be an increased incidence of epithelial tumors. It also seems likely that immune paralysis may accelerate the growth of metastases

Appendicocecal Fistula – A Rare Complication of Appendicitis

Fistulisation of appendix to other organs or to the exterior through abdominal wall is a rare complication of appendicitis. We present one such rare case of appendicocecal fistula due to appendicitis in a patient initially managed conservatively for appendicular lum

The Relationship Between Smoking as a Modifiable Risk Factor and Chronic Complications on Elderly with Type 2 Diabetes Mellitus

Smoking is known as a variable that can be changed through a specific intervention activity. Recently in Indonesia, research related to chronic complication among elderly with type 2 Diabetes Mellitus (DM) was not available. This research has objective in exploring the risk of smoking towards chronic complication among elderly with type 2 DM. This research was using Riset Kesehatan Dasar (Riskesdas) in 2007. Riskesdas is a representative Indonesia Health Survey. 1,565 elderly (aged 60++ years) with type 2 DM have selected by random. 70-80% of the elderly have Chronic Complications and 32.11% of the sample is smokers. The elderly who smoke more than 24 cigarettes per day have risk 2.5 (95% CI, 1.54-3.97), smoker 1-12 cigarettes per day, and smoker 13-24 cigarettes per day have risk 1.3 and 1.6 respectively to get chronic complication compared with those who do not smoke, controlled by age, obesity, and physical activity. The proportion of smokers among elderly with type 2 DM is high, most of them are low education, low socioeconomic status, lack of access to the health services, low of physical activity, and low consume vegetables and fruit. Smoking increases the risk of chronic complication of type 2 DM

Delayed Manifestation of Transurethral Syndrome as a Complication of Transurethral Prostatic Resection

Metabolic encephalopathy as a part of ‘transurethral syndrome’ is an immediate complication following transurethral resection of prostate. It occurs during or few hours after the surgery. However, delayed manifestation of this complication is rare. It is also possible that pretreatment with diuretics can exaggerate this problem by predisposing the patient to electrolyte abnormalities. Here we present a report of such a patient who manifested with neurological complications six days after the prostate surger

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures. The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods. Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating. Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal. Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates