응급의학과 전공의가 시행한 흉관 삽입술의 합병증에 대한 고찰

조대윤 ( Dai Yun Cho ),손동섭 ( Dong Suep Sohn ),전영진 ( Young Jin Cheon ),홍기훈 ( Ki Hun Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.2

Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons. (J Korean Soc Traumatol 2012;25:37-43)

Complication Rates of the 720 Video-Assisted Minilaparotomy Living Donor Nephrectomies: Supplementing Clavien Classification

정하범,최경화,양승철,한웅규 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.1

Purpose: Laparoscopic living donor nephrectomy (LLDN) has been reported to be as safe and effective as open surgery. We systematically evaluated the safety of video-assisted minilaparotomy surgery-living donor nephrectomy (VAMS-LDN) with use of the modified Clavien classification. Materials and Methods: We retrospectively analyzed complications in 720 cases of VAMS-LDN conducted in our institute from 2003 to 2010 by use of the modified Clavien classification of surgical complications. Results: The mean age of the donors was 39.3 years (range, 16 to 66 years) and their mean body mass index was 23.3 kg/m2 (range, 15.8 to 36.4 kg/m2). A total of 67 complications occurred (9.3%). Based on the modified Clavien classification, grade 1, 2a, and 2b complications occurred in 49 (6.8%), 16 (2.2%), and 2 (0.3%) of the donors, respectively. Most grade 1 complications involved mild vascular injuries that were immediately repaired with polypropylene sutures during the surgery. These did not cause any postoperative problems. The other grade 1 complications were wound dehiscence, not requiring secondary closure, and wound site pain in 11 (1.5%) and 5 (0.7%) cases, respectively. Grade 2a complications occurred in 16 (2.2%) cases: 9 (1.3%) involved postoperative transfusions and 1 (0.1%) involved a renal fossa hematoma. One grade 2b complication occurred; it was a lymphocele that resolved with placement of a pigtail catheter. No complications classified as grade 2c or worse occurred. Conclusions: According to the present analysis of complications, VAMS-LDN is a safe procedure with complication rates comparable to those of LLDN as evaluated in previous studies. Purpose: Laparoscopic living donor nephrectomy (LLDN) has been reported to be as safe and effective as open surgery. We systematically evaluated the safety of video-assisted minilaparotomy surgery-living donor nephrectomy (VAMS-LDN) with use of the modified Clavien classification. Materials and Methods: We retrospectively analyzed complications in 720 cases of VAMS-LDN conducted in our institute from 2003 to 2010 by use of the modified Clavien classification of surgical complications. Results: The mean age of the donors was 39.3 years (range, 16 to 66 years) and their mean body mass index was 23.3 kg/m2 (range, 15.8 to 36.4 kg/m2). A total of 67 complications occurred (9.3%). Based on the modified Clavien classification, grade 1, 2a, and 2b complications occurred in 49 (6.8%), 16 (2.2%), and 2 (0.3%) of the donors, respectively. Most grade 1 complications involved mild vascular injuries that were immediately repaired with polypropylene sutures during the surgery. These did not cause any postoperative problems. The other grade 1 complications were wound dehiscence, not requiring secondary closure, and wound site pain in 11 (1.5%) and 5 (0.7%) cases, respectively. Grade 2a complications occurred in 16 (2.2%) cases: 9 (1.3%) involved postoperative transfusions and 1 (0.1%) involved a renal fossa hematoma. One grade 2b complication occurred; it was a lymphocele that resolved with placement of a pigtail catheter. No complications classified as grade 2c or worse occurred. Conclusions: According to the present analysis of complications, VAMS-LDN is a safe procedure with complication rates comparable to those of LLDN as evaluated in previous studies.

한국인 제2형 당뇨병환자에서 조기 대혈관 합병증 발생과 관련된 위험 인자

이해리 ( Hae Ri Lee ),유재명 ( Jae Myung Yu ),최문기 ( Moon Gi Choi ),유형준 ( Hyung Joon Yoo ),홍은경 ( Eun Gyoung Hong ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.2

배경: 대혈관 합병증은 당뇨병환자의 주요 사망 원인으로 미세혈관 합병증과는 달리 유병기간과 비례하지 않는다. 그러나 한국인에서 당뇨병성 대혈관 합병증 발생까지의 당뇨병의 평균 유병기간이나 합병증 발생과 관련된 예측 인자들에 대한 연구는 아직 많이 부족한 실정이다. 따라서 저자들은 제2형 당뇨병에서 대혈관 합병증 발생까지의 평균 유병기간과 대혈관 합병증 발생에 영향을 미치는 요인들, 특히 조기합병증 발생에 관여하는 위험요소들을 조사하고자 하였다. 방법: 대혈관 합병증이 처음 발생하여 입원한 121명의 환자와 대혈관 합병증의 과거력이 없는 115명의 제2형 당뇨병 입원환자를 대상으로 하여 임상적 특성을 후향적으로 조사, 분석하였다. 대혈관 합병증 발생까지의 당뇨병 이환 기간을 5년을 기준으로 조기발생군(54명)과 후기발생군(67명)으로 나누어 비교 분석하였다. 또한 대혈관 합병증 발생군을 성별에 따라 나누어 추가 분석을 시행하였다. 결과: 대혈관 합병증 발생까지의 평균 당뇨병 유병기간은 8.7±7.8년, 평균 연령은 61세, 남녀 각 63명, 58명이었다. 대혈관 합병증 발생군과 대조군과의 비교에서 평균 나이(61.0±11.8 vs. 56.0±14.6세, P=0.004), 수축기와 이완기 혈압 모두 대혈관 합병증 발생군에서 높았고(133.6±20.7/79.8±12.3 vs. 121.8±17.7/76.3±9.6 mm Hg, P<0.05), 흡연력이 있는 환자의 비율이 높았다(42.1 vs. 20.0%, P<0.001). 그러나 당화혈색소는 대조군에서 대혈관 합병증 발생군에 비해 더 높았고(9.5±2.4 vs. 8.2±1.8%, P<0.001), 미세혈관 합병증 동반율도 유의하게 더 높았다. 대혈관 합병증 조기발생군의 평균 연령이 후기발생군보다 더 적었으며(58.2±12.8 vs. 63.4±10.4세, P=0.015), 흡연력은 더 많았다(53.7 vs. 32.8%, P=0.021). 대혈관 합병증 발생군에서 성별에 따른 분석 결과, 남성에서 여성보다 합병증 발생 연령이 보다 적었고(57.5±10.3 vs. 64.9±12.2세, P<0.001), 당뇨병의 가족력이 남성에서 더 많았으며 흡연력은 남성에서 77.8%로 여성의 3.4%에 비해 매우 높았다. 결론: 본 연구를 통하여 제2형 당뇨병에서 대혈관 합병증발생에 고령, 고혈압, 그리고 흡연력이 중요한 위험 인자임을 알 수 있었고 대혈관 합병증 위험도는 미세혈관 합병증 발생 이전부터 높아져 있었다. 특히 흡연력은 한국인 남성 제2형 당뇨병환자에서 대혈관 합병증 조기 발생에 관여하는 중요한 예측 인자로 생각된다. 또한 추가 분석 결과를 미루어볼 때, 같은 당뇨병의 유병기간을 가졌다 하더라도 60세 미만의 상대적으로 젊은 나이의 당뇨병환자들이 고령의 환자들보다 대혈관 합병증 조기 발생 위험도가 상대적으로 높은 것으로 여겨지며, 대혈관 합병증 발생과 관련하여 성별에 따라 연령, 당뇨병의 가족력, 고혈압, 흡연력과 같은 몇 가지 위험 요소들의 차이점이 발견되었다. 이러한 결과들은 제2형 당뇨병환자에서 대혈관 합병증 발생 예방에 효과적으로 이용될 수 있을 것으로 생각된다. Background: The average duration of diabetes and predictive factors of macrovascular complications in Korean diabetic patients remain to be elucidated. This study examines the average duration of diabetes up to the onset of macrovascular complications and clinically important factors of early development of these complications in Korean type 2 diabetic patients. Methods: Clinical characteristics in type 2 diabetics with (n=121) and without macrovascular complications (n=115) were analyzed. In addition, early onset (≤5 years, n=54) and late onset groups (>5 years, n= 67) were compared, as were the clinical characteristics between male and female patients in the macrovascular complications group. Results: The average duration of diabetes was 8.7±7.8 years in the macrovascular complications group. Average age, systolic and diastolic blood pressures and smoking history were all higher in the macrovascular complications group than the control group. However, HbA1c levels and prevalence of microvascular complications were higher in the controls. Average age was lower in the early onset group and many more patients of that group had a smoking history. In the analysis based on sex, marcrovascular complications developed earlier in male patients. In addition, the prevalence of family history of diabetes was higher in males and 77.8% of male patients had a smoking history (female: 3.4%). Conclusion: Our study confirms that older age, high blood pressure and smoking history are major risk factors for the development of macrovascular complications. Moreover, a smoking history in males can be both risk and predictive factors for earlier development of macrovascular complications in Korean type 2 diabetic patients. We also found that several clinical characteristics including age, family history of diabetes, hypertension and smoking history, vary between the sexes, and these findings can provide useful indices for the prevention of macrovascular complications. (Korean Diabetes J 33:134-142, 2009)

Neuromuscular Scoliosis: Comorbidities and Complications

Weissmann Karen Andrea,Lafage Virginie,Pitaque Carlos Barrios,Lafage Renaud,Huaiquilaf Carlos M.,Ang Bryan,Schulz Ronald G. 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

Study Design: Single-center, retrospective cohort study conducted from 2013 to 2017.Purpose: To determine the risk factors for surgical complications in neuromuscular scoliosis based on known patient comorbidities. Overview of Literature: The concept of neuromuscular scoliosis includes a wide variety of pathologies affecting the neuromuscular system. Complications are numerous and are often difficult to predict.Methods: A retrospective analysis of a single-center database was conducted from 2013 to 2017. Inclusion criteria were patients aged <25 years, diagnosis of neuromuscular scoliosis, and history of posterior fusion deformity surgery. A total of 64 patients (mean age, 15 years; 63% females) were included in this study. Clinical, radiological, and laboratory parameters in the preoperative, intraoperative, and postoperative settings were analyzed. Univariate analysis was performed using Student t -test for continuous variables, and a chi-square test was used for noncontinuous variables. Multivariate analysis was performed to identify predictors of major, mechanical, and total complications.Results: Complications were found in 44% of patients, with 46.9% consisting of major complications, and 84.4% being early complications. Univariate analysis revealed that the presence of perinatal comorbidities, independent of other comorbidities, increased the risk for complications (p =0.029). Preoperative hypoglycemia, high number of instrumented levels, longer surgical time, use of an all-screw construct, lower preoperative pelvic obliquity, postoperative lower kyphosis, high thoracic spinopelvic angle (as measured by T9 spino-pelvic inclination), absence of deep drain, and use of superficial drain were associated with postoperative complications (all p <0.05). Logistic regression demonstrated that comorbidities, longer surgical time, hypoglycemia, and absence of deep drains are predictors of complications. Independent variables that predicted major complications were the number of levels fused, postoperative kyphosis (p =0.025; odds ratio [OR], 1.074), and high screw density (p =0.014; OR, 4.380).Conclusions: Complications in neuromuscular scoliosis are increased by comorbidities, long surgical time, and inadequate correction. Preventative measures to decrease these complications include appropriate preoperative patient preparation and surgical planning.

노인의 퇴행성 요추 질환에서 후방 요추 수술후 수술주의기간의 합병증

석세일,김진혁,김원중,이상민,정의룡,황훈,김우일,김태윤 대한척추외과학회 2000 대한척추외과학회지 Vol.7 No.2

연구계획 : 퇴행성 요추 질환으로 후방감압 및 후외방 유합술을 시행받은 노인에서의 수술 주위기간 합병증을 후향적 방법으로 분석하였다. 목적 : 후방감압 및 후외방 유합술의 수술 주위기간 합병증과 유합 범위가 이환율에 미치는 영향을 알아보고자 하였다. 대상 및 방법 : 1997년 6월부터 1998년 7월까지 본원에서 퇴행성 요추 질환으로 후방감압 및 후외방 유합술을 시행 받은 65세 이상의 환자 51례로 3개월 이상 추시 가능했던 경우를 대상으로 하였다. 동반된 내과적 질환, 수술중 감압 및 유합 범위 따른 합병증을 분석하였다. 결과 : 51명중 17명(33.3%)에서 수술주위기간 합병증이 발생하였으며 7명(13.6%)은 적어도 1개 이상의 고도의 합병증을, 5명(9.8%)은 적어도 1개 이상의 중등도의 합병증을, 8명(15.7%)은 적어도 1개이상의 경도의 합병증을 가지고 있었다. 혈종 및 감염이 흔한 수술적 합병증이었다. 가장 흔한 내과적 합벙증으로 마비성 장폐색이었다. 분류한 유합군 사이의 수술 주위기간 합병증의 비는 통계적으로 의미있는 차이는 없었다. 75세 이상의 환자들은 수술 주위기간 합병증의 높은 발생율을 보였다. 환자의 성별, 진단, 수술시간, 골이식 방법, 혹은 수혈량과 수술 주위기간 합병증 발생사이의 통계학적으로 의미있는 관계는 없었다. 결론 : 수술 주위기간의 합병증이 전체 33.3%로 비교적 높은 편이었으며, 75세 이상의 고령은 수술주위기간의 합병증 발생의 위험요소였다. 유합범위와 동반 질환은 합병증 발생과 연관성이 없었다. Study Design : A retrospective study of perioperative complications was performed in elderly patients undergoing posterior decompression and fusion for lumbar degenerative conditions. Objective : To identify the perioperative complications and to analyze the influence of posterior decompression and fusion on the occurrence of the morbidity. Summary of Background Data : Because of the better long-term results, the decompression and fusion with instrumentation have been recently recommended for treatment of degenerative lumbar disease in the elderly. However, the perioperative complication rate and their correlating factors have not been adequately defined. Materials and Methods : A retrospective review of the medical charts of fifty-one patients aged 6.5 years or older operated during June 1997 to July 1998 was undertaken. The minimum follow-up required for inclusion was three months. All medical and surgical perioperative complications directly related to the surgical procedure were noted. The association of fusion levels and other factors with the occurrence of perioperative complications were analyzed. Results : Perioperative complications occurred in 17(33.3%) of the 51 patients. Seven satients(13.7%) had at least one major complication, 5(9.8%) had at least one minor complication and 9(17.6%) had insignificant complications. Hematoma and wound infection were the most common surgical complications Paralytic ileus was the most common medical complication. There was no difference in the rate of perioperative complications between the long and short fusion groups. An age of more than eventyfive years at the time of surgery was associated with a higher risk of complications. There was no statistically significant relationship between the perioperative complications and sex diagnosis, operative time, type of bone grafting, amount of blood transfusion, or preoperative comorbidity of the patients. Conclusion : Perioperative complications were quite common in the present series, occurring in 33.3% of the patients. An age over seventy-five hyears was a risk factor for associated with morbidity. The number of levels fused and the comorbidity did not associated the development of the complications.

A Review of Complications and Outcomes following Vertebral Column Resection in Adults

Sravisht Iyer,Venu M. Nemani,Han Jo Kim 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3

The correction of rigid spinal deformities in adult patients can require a three-column osteotomy (pedicle subtraction osteotomy [PSO] or vertebral column resection [VCR]) to obtain spinal balance. Unfortunately, the existing adult deformity literature frequently reports the outcomes and complications of these procedures together even though VCR is a more extensive procedure with potentially higher rates of complications. We sought to address this shortcoming and provide clinicians with an overview of the existing literature regarding VCR in adult patients. The goals of this review are: to determine the rate of overall and neurologic complications following VCR, the rate of complications with VCR compared to PSO, and the impact of VCR on clinical and radiographic outcomes. An electronic literature search was used to identify studies reporting outcomes or complications following VCR in adult patients. Raw data on patient demographics, case information, radiographic outcomes, complications and clinical outcomes were extracted. Data were pooled to report a rate of overall complications and neurologic complications. A pooled relative risk of complications following PSO vs. VCR was also calculated. Eleven retrospective studies (Level IV) met our inclusion criteria. The overall rate of complications was 69.2%. The reoperation rate was 9.6%. The rate of neurologic complications was 13.3% (range, 6.3% to 15.8%) with most cases being transient. The rate of permanent neurologic deficits was 2.0%. We found a significantly higher rate of all complications with VCR compared to PSO (relative risk, 1.36; 95% confidence interval, 1.24–1.49; p <0.001). All studies reporting clinical outcomes showed significant improvements in functional outcome postoperatively.

Risk Factors for the Severity of Complications in Minimally Invasive Total Gastrectomy for Gastric Cancer: a Retrospective Cohort Study

Chul Kyu Roh,이수민,손상용,허훈,한상욱 대한위암학회 2021 Journal of gastric cancer Vol.21 No.4

Purpose: Minimally invasive gastrectomy is a promising surgical method with well-known benefits, including reduced postoperative complications. However, for total gastrectomy of gastric cancers, this approach does not significantly reduce the risk of complications. Therefore, we aimed to evaluate the incidence and risk factors for the severity of complications associated with minimally invasive total gastrectomy for gastric cancer. Materials and Methods: The study included 392 consecutive patients with gastric cancer who underwent either laparoscopic or robotic total gastrectomy between 2011 and 2019. Clinicopathological and operative characteristics were assessed to determine the features related to postoperative complications after minimally invasive total gastrectomy. Binomial and multinomial logistic regression models were used to identify the risk factors for overall complications and mild and severe complications, respectively. Results: Of 103 (26.3%) patients experiencing complications, 66 (16.8%) and 37 (9.4%) developed mild and severe complications, respectively. On multivariate multinomial regression analysis, independent predictors of severe complications included obesity (OR, 2.56; 95% CI, 1.02−6.43; P=0.046), advanced stage (OR, 2.90; 95% CI, 1.13−7.43; P=0.026), and more intraoperative bleeding (OR, 1.04; 95% CI, 1.02−1.06; P=0.001). Operation time was the only independent risk factor for mild complications (OR, 1.06; 95% CI, 1.001−1.13; P=0.047). Conclusions: The risk factors for mild and severe complications were associated with surgery, indicating surgical difficulty. Surgeons should be aware of these potential risks that are related to the severity of complications so as to reduce surgery-related complications after minimally invasive total gastrectomy for gastric cancer.

Direct Medical Costs for Patients with Type 2 Diabetes and Related Complications: A Prospective Cohort Study Based on the Korean National Diabetes Program

Kim, Tae Ho,Chun, Ki Hong,Kim, Hae Jin,Han, Seung Jin,Kim, Dae Jung,Kwak, Jiyeong,Kim, Young Seol,Woo, Jeong Taek,Park, Yongsoo,Nam, Moonsuk,Baik, Sei Hyun,Ahn, Kyu Jeung,Lee, Kwan Woo The Korean Academy of Medical Sciences 2012 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.27 No.8

<P>We analyzed the direct medical costs for Korean patients with type 2 diabetes according to the type of complications and the number of microvascular complications. We analyzed costs for type 2 diabetes and associated complications in 3,125 patients. These data were obtained from the Korean National Diabetes Program (KNDP), a large, ongoing, prospective cohort study that began in 2005. The cost data were prospectively collected, using an electronic database, for the KNDP cohort at six hospitals. The costs were analyzed according to complications for 1 yr from enrollment in the study. Among 3,125 patients, 918 patients had no vascular complications; 1,883 had microvascular complications only; 51 had macrovascular complications only; and 273 had both complications. The annual direct medical costs for a patient with only macrovascular, only microvascular, or both macrovascular and microvascular complications were 2.7, 1.5, and 2.0 times higher than the medical costs of patients without complications. Annual direct medical costs per patient increased with the number of microvascular complications in patients without macrovascular complications. The economic costs for type 2 diabetes are attributable largely to the management of microvascular and macrovascular complications. Proper management of diabetes and prevention of related complications are important for reducing medical costs.</P>

Direct Medical Costs for Patients with Type 2 Diabetes and Related Complications: A Prospective Cohort Study Based on the Korean National Diabetes Program

김태호,전기홍,Hae Jin Kim,Seung Jin Han,김대중,Jiyeong Kwak,김영설,우정택,박용수,남문석,백세현,안규정,이관우 대한의학회 2012 Journal of Korean medical science Vol.27 No.8

We analyzed the direct medical costs for Korean patients with type 2 diabetes according to the type of complications and the number of microvascular complications. We analyzed costs for type 2 diabetes and associated complications in 3,125 patients. These data were obtained from the Korean National Diabetes Program (KNDP), a large, ongoing,prospective cohort study that began in 2005. The cost data were prospectively collected,using an electronic database, for the KNDP cohort at six hospitals. The costs were analyzed according to complications for 1 yr from enrollment in the study. Among 3,125 patients,918 patients had no vascular complications; 1,883 had microvascular complications only;51 had macrovascular complications only; and 273 had both complications. The annual direct medical costs for a patient with only macrovascular, only microvascular, or both macrovascular and microvascular complications were 2.7, 1.5, and 2.0 times higher than the medical costs of patients without complications. Annual direct medical costs per patient increased with the number of microvascular complications in patients without macrovascular complications. The economic costs for type 2 diabetes are attributable largely to the management of microvascular and macrovascular complications. Proper management of diabetes and prevention of related complications are important for reducing medical costs.

Complications of Medial Unicompartmental Knee Arthroplasty

지종훈,박상은,송인수,Hanvit Kang,하지윤,정재중 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.4

Background: We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA). Methods: This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed. Results: Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed. Conclusions: The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required.