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There remains debate surrounding partial (PN) versus radical nephrectomy (RN) for T1b-T2 renal cell carcinoma (RCC). PN offers nephron-sparing benefits but involves increased perioperative complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed newly available nephrectomy-specific NSQIP data to elucidate predictors of perioperative outcomes in localized T1b-T2 RCC. We identified 2094 patients undergoing nephrectomy between 2019-2020. Captured variables include surgical procedure and approach, staging, comorbidities, prophylaxis, peri-operative complications, reoperations, and readmissions. 816 patients received PN while 1278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p = 0.026), bleeds (9.19% vs. 5.56%, p = 0.001), renal failure requiring dialysis (1.23% vs. 0.31%, p = 0.013) and urine leak or fistulae (1.10% vs. 0.31%, p = 0.025). Infectious, pulmonary, cardiac, and venothromboembolic event rates were comparable. Robotic surgery reduced occurrence of various complications, readmissions, and reoperations. PN remained predictive of all four complications upon multivariable adjustment. Several comorbidities were predictive of complications including bleeds and readmissions. This population-based cohort explicates perioperative outcomes following nephrectomy for pT1b-T2 RCC. Significant associations between PN, patient-specific factors, and complications were identified. Risk stratification may inform management to improve post-operative quality of life (QOL) and RCC outcomes.

BACKGROUND: Meningioma is the most common primary CNS tumour. Most meningiomas are benign, and most patients are 65 years or older. Surgery is usually the primary treatment option. Most prior studies on early surgical outcomes in older patients with meningioma are small, and there is a lack of larger population-based studies to guide clinical decision-making. We aimed to explore the risks for perioperative mortality and morbidity in older patients with meningioma and to investigate changes in surgical incidence over time. METHODS: In this retrospective population-based study on patients in Sweden, 65 years or older with surgery 1999-2017 for meningioma, we used data from the Swedish Brain Tumour Registry. We analysed factors contributing to perioperative mortality and morbidity and used official demographic data to calculate yearly incidence of surgical procedures for meningioma. RESULTS: The final study cohort included 1676 patients with a 3.1% perioperative mortality and a 37.6% perioperative morbidity. In multivariate analysis, higher age showed a statistically significant association with higher perioperative mortality, whereas larger tumour size and having preoperative symptoms were associated with higher perioperative morbidity. A numerical increased rate of surgical interventions after 2012 was observed, without evidence of worsening short-term surgical outcomes. CONCLUSIONS: Higher mortality with increased age and higher morbidity risk in larger and/or symptomatic tumours imply a possible benefit from considering surgery in selected older patients with a growing meningioma before the development of tumour-related symptoms. This study further underlines the need for a standardized method of reporting and classifying complications from neurosurgery.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Anesthetic complications in the perioperative period in plastic surgery are extremely rare, although they can be catastrophic and sometimes fatal. Proper selection and correct preoperative assessment of patients are the key to staying away from unwanted events. Pre-anesthetic evaluation is mandatory in each patient and should include a medical history, complete physical examination, and routine and special laboratory tests in patients with associated pathologies. Anesthetic management is based on these results, the type of surgery, the anesthesiologist's experience, and the operating environment. The anesthetic technique can be local, regional, or general with standard noninvasive monitoring. It is recommended that an anesthesiologist be present in all plastic surgery procedures. Complications are usually the result of straying from already established guidelines for excellent practice or the result of events in the place of human error. Pulmonary embolism is probably the most feared complication, with soft tissue infections being the most common complication in plastic surgery. Less common complications include arrhythmias, overhydration, allergies, bleeding, skin necrosis, wound dehiscence, brain damage, and death. Anesthesiologists, surgeons, nurses and all personnel involved in the care of these patients must work as a team of highly qualified and up-to-date professionals., Las complicaciones anestésicas en el periodo perioperatorio en cirugía plástica son extremadamente raras, aunque pueden ser catastróficas y en ocasiones fatales. La selección adecuada y la correcta valoración preoperatoria de los pacientes son la clave para mantenerse alejado de eventos no deseados. La evaluación preanestésica es obligatoria en cada paciente y debe incluir la historia clínica, el examen físico completo y las pruebas de laboratorio de rutina y especiales en pacientes con patologías asociadas. El manejo anestésico se basa en estos resultados, el tipo de cirugía, la experiencia del anestesiólogo y el entorno operativo. La técnica anestésica puede ser local, regional o general con monitorización no invasiva estándar. Se recomienda que un anestesiólogo esté presente en todos los procedimientos de cirugía plástica. Las complicaciones suelen ser el resultado de alejarse de las pautas ya establecidas para una práctica excelente o el resultado de eventos en lugar de errores humanos. La embolia pulmonar es probablemente la complicación más temida, siendo las infecciones de tejidos blandos la complicación más frecuente en la cirugía plástica. Las complicaciones menos comunes incluyen arritmias, sobrehidratación, alergias, sangrado, necrosis cutánea, dehiscencia de heridas, daño cerebral y muerte. Los anestesiólogos, cirujanos, enfermeras y todo el personal involucrado en el cuidado de estos pacientes deben trabajar como un equipo de profesionales altamente calificados y actualizados.

Objectives: Fire in the operating theater is a potential source of important morbidity for the patient. Laser surgery of the head and neck district presents a particularly high risk of fire due to the presence of all three elements of the ‘fire triad,’ necessary to cause combustive or explosive events: an oxidiser, a fuel, and a heat source. The aim of the present study is to emphasise the need of new prevention tools and greater adher-ence to the recommendations available in the literature. Methods: The sudden occurrence of combustion within the airway of an infant undergoing laryngeal laser surgery was presented along with his management. Results: An infant underwent CO2 laser surgery for the treatment of the laryngeal stenosis. Unfortunately, the endoscopic procedure was com-plicated by a fire of the tracheal tube. The tube was immediately removed, the saline was flushed down the trachea and the ventilation was main-tained through a face mask. Subsequently, a fiberoscopy was performed and showed a vocal cord burn. Conclusions: Since operating room fires are still an underreported occurrence, we believe that this present work might raise awareness about this potential complication and give useful suggestions for the management of airway fires in paediatric anaesthesia.

An increasing number of patients require precise intraoperative hemodynamic monitoring due to aging and comorbidities. To prevent undesirable outcomes from intraoperative hypotension or hypoperfusion, appropriate threshold settings are required. These setting can vary widely from patient to patient. Goal-directed therapy techniques allow for flow monitoring as the standard for perioperative fluid management. Based on the concept of personalized medicine, individual assessment and treatment are more advantageous than conventional or uniform interventions. The recent development of minimally and noninvasive monitoring devices make it possible to apply detailed control, tracking, and observation of broad patient populations, all while reducing adverse complications. In this manuscript, we review the monitoring features of each device, together with possible advantages and disadvantages of their use in optimizing patient hemodynamic management.

Obstructive sleep apnea (OSA) results from a combination of several factors leading to the obstruction of the upper respiratory tract (URT). OSA represents a systemic pathophysiological entity and leads to many comorbidities such as hypertension, coronary ischemia, and stroke. Patients with this pathophysiological entity experience also an increased risk of postoperative complications. Obesity is certainly the main cause of developing OSA. However, many other predisposing factors influence the genesis of obstructive apnea. It is important to understand the complexity of the interactions between predisposing factors to understand the relationship between weight loss following obesity surgery and the improvement in the severity of OSA. In this narrative review, we expose the seven major categories of predisposing factors that interact to generate obstructive apneas in patients, namely the anatomic abnormalities of the URT, the mechanical and the metabolic responses of the upper airway musculature, the loop gain, the arousal threshold, and the hormonal abnormalities. The genesis of apnea is the result of a complex dynamic interaction between the anatomical risk factors and the compensatory neuromuscular reflexes. All of these points are integrally part of the perioperative care of the obese patients. Finally, we will discuss different options for weight reduction.

Background: Major perioperative cardiac complications affect over 10 million patients annually worldwide. Cancer is associated with multiple shared cardiovascular risk factors, but the incidence of cardiovascular complications after cancer surgery is unknown. Furthermore, cardiovascular risk prediction remains challenging. Cardiopulmonary exercise testing (CPET) objectively assesses exercise capacity and can predict overall perioperative morbidity and mortality and guide prehabilitation strategies, but cardiac imaging is required to determine the location and severity of coronary artery disease preoperatively. Currently available stress tests rely on surrogate markers for ischaemia and the evidence supporting these investigations perioperatively is weak. Cardiac positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) can image myocardial metabolism directly. Myocardial ischaemia appears as a ‘hot spot’ due to uptake of radiolabelled glucose in ischaemic myocytes undergoing anaerobic metabolism. Performing cardiac PET imaging after CPET may improve cardiac-specific perioperative risk prediction. However, accurate imaging requires preparation with a high-fat low-carbohydrate (HF-LC) diet, and the feasibility of incorporating cardiac PET imaging into existing preoperative CPET clinics is unknown. This thesis explores the incidence of cardiovascular complications in a cancer surgery population, and the feasibility of post-exercise cardiac PET imaging for preoperative risk assessment prior to major cancer surgery, within the setting of a CPET clinic. Methods: Cardiovascular complications within 30 days of cancer surgery were retrospectively investigated during a 12-month period at a single cancer institution (Peter MacCallum Cancer Centre, Melbourne, Australia). Screening identified patients via positive troponin results, ICD-10 diagnosis, and a manual search of intensive care unit discharge summaries. Standardized diagnostic criteria then identified the pri

An increasing number of patients require precise intraoperative hemodynamic monitoring due to aging and comorbidities. To prevent undesirable outcomes from intraoperative hypotension or hypoperfusion, appropriate threshold settings are required. These setting can vary widely from patient to patient. Goal-directed therapy techniques allow for flow monitoring as the standard for perioperative fluid management. Based on the concept of personalized medicine, individual assessment and treatment are more advantageous than conventional or uniform interventions. The recent development of minimally and noninvasive monitoring devices make it possible to apply detailed control, tracking, and observation of broad patient populations, all while reducing adverse complications. In this manuscript, we review the monitoring features of each device, together with possible advantages and disadvantages of their use in optimizing patient hemodynamic management.

Background: Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group. Methods: We performed a prospective observational study including all patients (age>18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events. Results: Of a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01-1.06], p=0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33-5.17], p=0.003), a preoperative haemoglobin level lower than 12g/dL (OR 2.13 [95% CI 1.21-4.07], p=0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03-4.07], p=0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98-1.59], p=0.106 per litre), intraoperative blood losses greater than 500mL (2.07 [95% CI 1.00-4.31], p=0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55-27.72], p=0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75-0.84, p<0.001). Conclusions: Our findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overlo, SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Hyperglycemia (HG) is widely known to be associated with increased postoperative complications after colorectal surgery. Very few data on the effects of HG on patients after gastric surgery for cancer are reported in literature. The aim of this study was to evaluate the effects of postoperative HG in non-diabetic patients undergoing gastrectomy for cancer. Methods: One hundred and ninety-three consecutive gastrectomies for cancer performed between January 2010 and December 2015 were considered. Diabetic patients, and those undergoing pancreatic resections were excluded. Postoperative blood glucose levels were monitored in the first 72 h after surgery. Postoperative complications, mortality, and postoperative course were analyzed in patients who experienced postoperative HG (blood glucose level; BGL > 125 mg/dl) compared with euglycemic patients (BGL ≤ 125 mg/dl). Differences between mild HG (BGL between 125 and 200 mg/dl) and severe HG (BGL ≥ 200 mg/dl) were also analyzed. Results: Ninety-six patients (55.5 %) experienced postoperative HG. In 11 patients (6.4 %), a severe postoperative HG was found. Postoperative BGL > 200 mg/dl was related to worse outcomes than those experienced by euglycemic patients (and even than patients who experienced mild postoperative HG). The postoperative complications rate was 24.8 % (43 patients out of 173), but significantly higher in patients with postoperative severe HG compared to mild HG and normoglycemic patients (63.6, 30.6, and 13 %, respectively, p < 0.001). Conclusion: Poor postoperative glycemic control seems to be related to worse postoperative outcomes even in patients undergoing elective gastric surgery for cancer.

Rett syndrome is a rare genetic neurodevelopmental disorder usually affecting females. Scoliosis occurs commonly and spinal fusion may be recommended if severe. We investigated short term complications of spinal fusion and the influence of pre-operative Cobb angle on aspects of the inpatient stay. Respiratory complications and severe bleeding occurred commonly following spinal fusion, but the extent of respiratory complications was greater in those with a larger pre-operative spinal deformity. Earlier spinal fusion has potential to reduce the short term complications of spinal fusion surgery and as a consequence, reduce hospital costs.

ObjectiveDetermine rates and reasons for revisits after ambulatory adult thyroidectomy.Study designCross-sectional analysis of multistate ambulatory surgery and hospital databases.SettingAmbulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011.Subjects and methodsAmbulatory thyroidectomy cases were linked to state ambulatory, emergency, and inpatient databases for revisit encounters occurring within 30 days. The numbers of revisits, mortality, and associated diagnoses were analyzed.ResultsA total of 25,634 cases of ambulatory thyroid surgery were identified: 44.2% total thyroidectomy (TT) and 55.8% partial thyroidectomy (PT). Common indications for surgery included goiter/cyst (39.5%), benign/uncertain neoplasm (24.2%), and malignant neoplasm (24.0%). The 30-day revisit rate was 7.2% (n = 1858; 61.8% emergency department, 22.4% inpatient admission, and 15.8% ambulatory surgery center). The most common diagnosis at revisit was hypocalcemia (20.8% of revisits), followed by wound hematoma/seroma/bleeding (7.1%). Higher rates of revisit, hypocalcemia, and hematoma/seroma/bleeding were seen in patients undergoing TT (P < .016 for all). Sixteen patients had bleeding less than 24 hours after the index procedure (0.1% overall, 0.9% of revisits). Most hypocalcemia and hematoma/bleeding occurred over the first postoperative week. Three deaths occurred within 30 days of the index procedure.ConclusionIn carefully selected patients, ambulatory thyroidectomy demonstrates a good postoperative morbidity and mortality profile. Common reasons for revisits included hypocalcemia and bleeding/seroma/hematoma, which occurred with relatively high frequencies as late as a week after surgery. Quality improvement measures should be targeted at lowering revisit rates and safely managing complications.

peer-reviewed, Background: Patients undergoing vascular surgery procedures constitute a 'high-risk' group. Fatal and disabling perioperative complications are common. Complications arise via multiple aetiological pathways. This mechanistic redundancy limits techniques to reduce complications that target individual mechanisms, for example, anti-platelet agents. Remote ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk tissue, conferring protection against ischaemia-reperfusion injury regardless of the trigger. RIPC is induced by repeated periods of upper limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC confers some protection against cardiac and renal injury during major vascular surgery in proof-of-concept trials. Similar trials suggest benefit during cardiac surgery. Several uncertainties remain in advance of a full-scale trial to evaluate clinical efficacy. We propose a feasibility trial to fully evaluate arm-induced RIPC's ability to confer protection in major vascular surgery, assess the incidence of a proposed composite primary efficacy endpoint and evaluate the intervention's acceptability to patients and staff.Methods/Design: Four hundred major vascular surgery patients in five Irish vascular centres will be randomised (stratified for centre and procedure) to undergo RIPC or not immediately before surgery. RIPC will be induced using a blood pressure cuff with four cycles of 5 minutes of ischaemia followed by 5 minutes of reperfusion immediately before the start of operations. There is no sham intervention. Participants will undergo serum troponin measurements preoperatively and 1, 2, and 3 days post-operatively. Participants will undergo 12-lead electrocardiograms pre-operatively and on the second post-operative day. Predefined complications within one year of surgery will be recorded. Patient and staff experiences will be explored using qualitative techniques. The primary outcome measure is the proportion of patients who develop, PUBLISHED, peer-reviewed

ObjectiveDetermine rates and reasons for revisits after ambulatory adult thyroidectomy.Study designCross-sectional analysis of multistate ambulatory surgery and hospital databases.SettingAmbulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011.Subjects and methodsAmbulatory thyroidectomy cases were linked to state ambulatory, emergency, and inpatient databases for revisit encounters occurring within 30 days. The numbers of revisits, mortality, and associated diagnoses were analyzed.ResultsA total of 25,634 cases of ambulatory thyroid surgery were identified: 44.2% total thyroidectomy (TT) and 55.8% partial thyroidectomy (PT). Common indications for surgery included goiter/cyst (39.5%), benign/uncertain neoplasm (24.2%), and malignant neoplasm (24.0%). The 30-day revisit rate was 7.2% (n = 1858; 61.8% emergency department, 22.4% inpatient admission, and 15.8% ambulatory surgery center). The most common diagnosis at revisit was hypocalcemia (20.8% of revisits), followed by wound hematoma/seroma/bleeding (7.1%). Higher rates of revisit, hypocalcemia, and hematoma/seroma/bleeding were seen in patients undergoing TT (P < .016 for all). Sixteen patients had bleeding less than 24 hours after the index procedure (0.1% overall, 0.9% of revisits). Most hypocalcemia and hematoma/bleeding occurred over the first postoperative week. Three deaths occurred within 30 days of the index procedure.ConclusionIn carefully selected patients, ambulatory thyroidectomy demonstrates a good postoperative morbidity and mortality profile. Common reasons for revisits included hypocalcemia and bleeding/seroma/hematoma, which occurred with relatively high frequencies as late as a week after surgery. Quality improvement measures should be targeted at lowering revisit rates and safely managing complications.

Background: The incidence of unplanned perioperative hypothermia among patients is high, it varies from 50 to 90 percent. This leads to several complications such as coagulation disorders, surgical site infections and also affects patient comfort negatively. Aim: The aim of this study was to investigate the complications of unplanned hypothermia on adult patients during perioperative care. Method: The study was carried out as a systematic literature review. Articles were searched in PubMed and Cinahl databases. Studies that were based on a quantitative method were used to investigate perioperative complications due to unplanned hypothermia. Hypothermia was defined as body temperature lower than 36°C. Nine studies were identified as relevant using SBU´s assessment criteria for study relevance. These nine articles were graded based on the CASP’s checklist for cohort studies. Results: The studies included in this literature review were carried out in Australia, New Zealand, Japan, the United States of America and Germany. Surgical site infections, loss of blood and need of blood transfusion, prolonged stay in hospital and need of intensive care, morbidity and mortality were identified as complications. Incidences of hypothermia during the perioperative care differed from 2,4 percent till 72 percent, which was also similar to the results from other studies. Association between hypothermia and those complications were confounded with several factors: low body mass index, old age, female gender and comorbidity. According to this study, unplanned hypothermia was not significantly related with an increased risk for complications during the perioperative care. However, it was evident that severe hypothermia, temperature below 35°C, increased the risk for complications. Conclusion: It was evident that there was a high incidence of hypothermia, although preventive measures to keep normal body temperature were used during perioperative care. Therefore, taking measures

Overall Goals and Objectives: 1. To understand that obstructive sleep apnea is a very common sleep related breathing disorder in surgical patients and is frequently not identified. 2. These surgical patients are at a higher risk of having perioperative complications and to understand why are these patients at a higher risk and how to identify these patients preoperatively. 3. To learn the perioperative measures that can be taken to reduce these complications. Presentation: 45 minutes