Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina

Abstract

Introduction: Registration of adverse events following orthopedic surgery has a critical role in patient safety and has received increasing attention. The purpose of this study was to determine the prevalence and severity of postoperative complications in the department of orthopedic unit in a tertiary hospital.Methods: A retrospective review from the postoperative complication registry of a cohort of consecutive patients operated in the department of orthopedic surgery from May 2015 to June 2016 was performed. Short-term complications (3 months after surgery), age gender, types of surgery (elective, scheduled urgency, non-scheduled urgency, and emergency), operative time, surgical start time (morning, afternoon or evening), American Society of Anesthesiologists score and surgeon's experience were assessed. Complications were classified based on their severity according to Dindo-Clavien system: Grade I complications do not require alterations in the postoperative course or additional treatment; Grade II complications require pharmacological treatment; Grade III require surgical, endoscopic, or radiological interventions without (IIIa) or with (IIIb) general anesthesia; Grade IV are life-threatening with single (IVa) or multi-organ (IVb) dysfunction(s), and require ICU management; and Grade V result in death of the patient. Complications were further classified in minor (Dindo I, II, IIIa) and major (Dindo IIIb, IVa, IVb and V), according to clinical severity.Results: 1960 surgeries were performed. The overall 90-day complication rate was 12.7% (249/1960). Twenty-three complications (9.2 %) were type I, 159 (63.8%) type II, 9 (3.6%) type IIIa, 42 (16.8%) type IIIb, 7 (2.8%) type IVa and 9 (3.6%) were grade V according to Dindo-Clavien classification (DCC). The most frequent complication was anemia that required blood transfusion (27%) followed by wound infection (15.6%) and urinary tract infection (6%).Discussion: The overall complication rate after orthopedic surgery in our department was 12.7%. The implementation of the DCC following orthopedic surgery was an important tool to measure the standard of care.

Validation of a modified Clavien-Dindo Classification for postoperative complications in orthopedic surgery

“…The original classification of Clavien-Dindo was previously used at our institution by some of the authors of this manuscript [19][20] , resulting useful in terms for showing the prevalence of complications; however, several limitations were found, mainly because the majority of scenarios were developed for abdominal surgery being difficult to extrapolate to certain orthopedic settings. Bellut et al 21 applied the Clavien-Dindo classification scheme to lumbar spine surgery observing a direct correlation between outcome scales, hospital length of stay and complication grades.…”

Safe Clavicle Fracture Surgery

“…The legendary Dr Neer himself had reported his vascular complications while operating on clavicle. [1][2][3]18,[21][22][23][24][25][26][27] Registration of adverse events following orthopedic surgery has a crucial role in patient safety and has received increasing attention today. The overall complication rate after orthopedic surgery is 12.7% in a well-established orthopedic center and implementation standard protocol will improve the safety and standard of care.…”

“…2,5,11,[18][19][20] In spite of the potential advantages in the clavicle fracture surgery, a quantity of major complications had been extensively reported by the surgeons in the recent decades. [1][2][3]18,[21][22][23][24][25][26][27] Poor knowledge of anatomy and inability to recognize key structures will lead to grave complications in surgery. 28 The purpose of this review piece of writing is to rejuvenate the applied anatomical knowledge and required key operative skills for the surgeons who intend to surgically fix the clavicle fractures in a safe manner (Figs 1 and 2).…”

High prevalence and seasonal variation of hypovitaminosis D in patients scheduled for lower extremity total joint arthroplasty

“…Furthermore, although the definitive prevalence of hypovitaminosis D and the potential detrimental effect it could have on patient outcomes following TJA is still to be determined, there is a need to determine cost-benefit analysis of universal screening versus vitamin D supplementation in TJA preoperative guidelines. Since the most-effective method of improving patient care and reducing readmissions is to avoid complications (28)(29)(30)(31)(32)(33)(34), special consideration towards vitamin D assessment should be taken in the winter months, or immediate months after this season.…”