[Analysis of the incidence and causes of repeated surgical interventions in patients with early complications electrotherapy - 1 center experience from the period 2012-2015].

Baclground: Due to increasing number of patients treated by cardiac implantable electronic devices we observe increasing number of complications after these procedures Material and methods: We analysed causes of early surgical revision of implantable devices connected with 1673 procedures of implantation (871 procedures) or exchange (802 procedures) of pacing systems (PM), cardioverter-difibrillators (ICD) and resynchronisation systems (CRT) in one local centre of electrotherapy in years 2012 to 2015. We characterised risk factors and its influence on encountered complications. Results: In analysed period 72 reinterventions after implantations or exchanges of PM/ICD/CRT were performed. Main causes of early complications were: lead malfunction (2.5%), including the dislodgement of the leads in 1.9%, pocket hematoma (1.4%) and other abnormalities of the pocket (0.4 %), including pocket infections in 0.2%. The most important risk factors of early complications were often implantations of the leads with passive fixation and anticoagulation therapy in perioperative period. Conclusions: The knowledge of the early complications after implantations and exchanges of PM/ICD/CRT should improve the safety of procedures through more often used of the leads with active fixation and properly preparation of the patients requering the antithrombic therapy.

The risk of surgical treatment in patients aged 85+, with special consideration of colorectal cancer.

UNLABELLED: The increase in prevalence of chronic diseases in old age is concomitant with increasing risk of neoplasms requiring surgical treatment. The aim of the study was to assess the indications, treatment outcomes, complications and mortality associated with surgical treatment of patients aged 85 or more, with special consideration of colorectal cancer. MATERIAL AND METHODS: The retrospective analysis involved a group of 94 patents (x = 88.9) aged 85 or more and treated surgically in the years 2006-2011. The results were compared with a randomly selected control group of 91 patients aged 45-75 (x = 56,4) and treated surgically in the same period. RESULTS: Neoplastic diseases in the study group (85 ≥), compared with the control group (< 75), were a significantly more frequent indication for surgical treatment (p < 0.01). In the group of patients aged 85 or more, the most frequent indications for elective surgery were neoplasms of the skin and subcutaneous tissue (26.4%) and gastrointestinal neoplasms, mainly colorectal cancer (23.5%). Postoperative complications were significantly more frequent (p < 0.01) among patients aged 85 or more (n = 27; 34.8%) than in the younger group (n = 17; 18.7%). Postoperative mortality among patients undergoing emergency surgery was significantly higher (p < 0.05) in the senior group than in the group of younger patients. CONCLUSIONS: Surgical procedures in patients aged 85 or more are most frequently performed in the emergency setting, and their most common cause are neoplastic diseases. Emergency surgical treatment in patients aged 85 or more is associated with a significantly higher risk, compared with younger age groups, of developing multi-organ postoperative complications, usually leading to death. Elective surgical treatment in patients aged 85+ after appropriate preoperative preparation and in the group of younger patients shows similar early outcomes.