1st Postoperative Day Research Articles

Change in Corneal Astigmatism After Phacoemulsification with Rigid Intraocular Lens Implantation

Phacoemulsification with lens implant is the preferred method of cataract extraction nowadays. In resource-deficient settings, rigid polymethyl methacrylate (PMMA) lenses are implanted which require enlargement of corneal incision to 5.5mm. Objectives: We conducted this study to evaluate the effect of corneal incisions secured with a single suture on corneal astigmatism after routine cataract surgery. Methods: It was a quasi-experimental study conducted at tertiary care hospitals. Sixty patients were studied and preoperative visual acuity and keratometry readings were noted. After standard phacoemulsification, a 5.5mm rigid PMMA lens was implanted in the bag, and the corneal incision was sutured using a single central 10/0 nylon suture. Visual acuity and keratometry readings were noted on 1st postoperative day, 1-week postoperatively, and 6-weeks postoperatively and compared with pre-operative values. Results: The mean age was 59.27 ± 10.72 (range: 46 – 78) years. There were 32 (53.3%) males and 28(46.7%) females in the study. The mean preoperative keratometry reading was 0.89 ± 0.70 D, and the mean first-day postoperative cylinder was 1.94 ± 0.98 D (p < 0.05). The mean astigmatism at the 6th week postoperatively was 0.96 ± 0.65 D, and its comparison with the pre-operative astigmatism was statistically not significant (p > 0.05). Surgically induced astigmatism was found to be 0.07 diopters. Almost 60% of the patients achieved uncorrected 6/7.5 or better visual acuity, and more than one-third of patients achieved 6/6 best corrected visual acuity six weeks after the cataract surgery using the described technique. Conclusions: Phacoemulsification with 5.5mm PMMA IOL with a central single suture is an effective procedure for postoperative astigmatism and visual outcome.

Impact of early postoperative haemodynamic and laboratory parameters on outcome after the Fontan procedure.

To identify early postoperative haemodynamic and laboratory parameters predicting outcomes following total cavopulmonary connection. Patients who underwent total cavopulmonary connection between 2012 and 2021 were evaluated. Serial values of mean pulmonary artery pressure, mean arterial pressure, peripheral oxygen saturation, and lactate levels were collected. The influence of these variables on morbidities was analyzed. Cut-off values were calculated using the receiver operating characteristic analysis. A total of 249 patients were included. All patients had previous bidirectional cavopulmonary shunt. Median age and weight at total cavopulmonary connection were 2.2 (1.8-2.7) years and 11.7 (10.7-13.4) kg, respectively. All patients were extubated in the ICU at a median of 3 (2-5) hours after ICU admission. Postoperative pulmonary artery pressure, around 12 hours after extubation, was significantly associated with chest tube drainage (p = 0.048), chylothorax (p = 0.021), ascites (p = 0.016), and adverse events (p = 0.028). Receiver operating characteristic analysis revealed a cut-off value of 13-15 mmHg for chest tube drainage and chylothorax and 17 mmHg for ascites and adverse events. Mean arterial pressure 1 hour after extubation was associated with prolonged chest tube drainage (p = 0.015) and adverse events (p = 0.008). Peripheral oxygen saturation 6 hours after extubation (p = 0.003) was associated with chest tube duration and peripheral oxygen saturation 1 hour after extubation (p < 0.001) was associated with ascites. Lactate levels on 2nd postoperative day (p = 0.022) were associated with ascites and lactate levels on 1st postoperative day (p = 0.009) were associated with adverse events. Higher pulmonary artery pressure, lower mean arterial pressure, lower peripheral oxygen saturation, and higher lactate in early postoperative period, around 12 hours after extubation, predicted in-hospital and post-discharge adverse events following total cavopulmonary connection.

A comparison of visual acuities obtained following biometry measurements by contact and immersion A-scan techniques

Objectives: This study aimed to obtain and compare ocular biometry measurements in terms of axial length, anterior chamber depth, and lens thickness by contact and immersion ultrasound techniques of A-scan and compare postoperative results in terms of visual acuity and spherical refractive error obtained by each of these techniques. Materials and Methods: This study was a prospective cohort and a comparative study that was done on 188 eyes under evaluation for cataract surgery. Out of these, 94 eyes were evaluated for biometry measurements using the immersion technique, and the rest were evaluated using the contact technique. Intraocular lens (IOL) powers were calculated using each of the above biometry parameters, and postoperative visual outcomes were obtained in terms of visual acuity and spherical refractive error. Results of demographic, clinical, and biochemical characteristics were expressed as range, mean, and median. For qualitative data, the Chi-square test and for comparison, Students’ unpaired t-tests were used. TAQhe statistical software SPSS Statistics was used to analyze the data. Microsoft Office Word and Excel 2019 were used to generate graphs and tables. P&lt;0.05 was considered as significant. Results: Visual acuity was significantly better in the patients who underwent IOL implantation whose power was calculated by the immersion method on the 1st postoperative day. However, there was no significant difference in the final corrected visual acuity. Spherical refractive error at the end of 1 month was significantly greater in patients who underwent IOL power calculation by the contact method as compared to the immersion method. Conclusion: The immersion method of A-scan gives a lesser refractive error postoperatively and is a more precise method of biometry, though there is no difference in the final visual acuity obtained by either of these methods.

Mortality and major postoperative complications within 1 year after vascular surgery: a prospective cohort study.

Patients undergoing vascular procedures are prone to developing postoperative complications affecting their short‑term mortality. Prospective reports describing the incidence of long‑term complications after vascular surgery are lacking. We aimed to describe the incidence of complications 1 year after vascular surgery and to evaluate an association between myocardial injury after noncardiac surgery (MINS) and 1‑year mortality. This is a substudy of a large prospective cohort study Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION). Recruitment took place in 28 centers across 14 countries from August 2007 to November 2013. We enrolled patients aged 45 years or older undergoing vascular surgery, receiving general or regional anesthesia, and hospitalized for at least 1 night postoperatively. Plasma cardiac troponin T concentration was measured before the surgery and on the first, second, and third postoperative day. The patients or their relatives were contacted 1 year after the procedure to assess the incidence of major postoperative complications. We enrolled 2641 patients who underwent vascular surgery, 2534 (95.9%) of whom completed 1‑year follow‑up. Their mean (SD) age was 68.2 (9.8) years, and the cohort was predominantly male (77.5%). The most frequent 1‑year complications were myocardial infarction (224/2534, 8.8%), amputation (187/2534, 7.4%), and congestive heart failure (67/2534, 2.6%). The 1‑year mortality rate was 8.8% (223/2534). MINS occurred in 633 patients (24%) and was associated with an increased 1‑year mortality (hazard ratio, 2.82; 95% CI, 2.14-3.72; P <0.001). The incidence of major postoperative complications after vascular surgery is high. The occurrence of MINS is associated with a nearly 3‑fold increase in 1‑year mortality.

Short-Term Outcomes of a Modified Safer Surgery Trabeculectomy Technique.

To determine the short-term outcomes of a modified Moorfields Safer Surgery System technique of trabeculectomy. This is a prospective interventional study. Trabeculectomy was performed according to the author's modification of Moorfields Safer Surgery System. This method allows titrating the opening pressure of trabeculectomy by varying the side cuts, varying the ostium size, and adjusting the tightness of the sutures. Forty-four eyes of 43 patients were included. Main outcome measures include postoperative intraocular pressure (IOP), incidence of intra and postoperative complications, and success up to 6 months after surgery. The mean preoperative and postoperative IOP at 6 months were 20.97 ± 7.93 mmHg and 12.69 ± 4.76 mmHg, respectively (n = 44). 70.5% of the patients had absolute success at 6 months, and the overall success was 88.6%. None of the patients had hypotony and there were no intraoperative complications noted. Forty-two out of 44 eyes (95.5%) had diffuse formed blebs without leak on the 1st postoperative day. The most common postoperative complication (13.6%) was a conjunctival leak that was detected on fluorescein staining. In all these patients, the anterior chamber was deep, and the bleb well formed. These leaks were resolved with conservative measures. Many of these leaks would have been missed if not intentionally looked for. Excluding this complication, we had a complication rate of 9.1%. The authors' modification of the Moorfields Safer Surgery System technique may allow the surgeon to optimize aqueous flow through trabeculectomy while mitigating complications.

A simplified sclerocorneal tunnel approach in performing pediatric cataract surgery.

Performing pediatric lensectomy, anterior vitrectomy with intraocular lens implantation in one session, using a long sclerocorneal tunnel and covering the incision site with 8/0 Vicryl sutures. This study includes 52 eyes of 30 patients with pediatric cataracts. At the temporal side, the conjunctival peritomy was performed, followed by two long sclerocorneal side ports and the main incision for intraocular lens (IOLs) implantation. At the end of the operation, the side port and the conjunctiva incisions were sutured with 8/0 Vicryl sutures. The IOLs were implanted in children older than 24 months, not in smaller ones. The operations and intraoperative complications were recorded. After the operation, the patients were examined on the 1st postoperative day, then six times for the first 6 months. During follow-ups, the impact of the suture on the anterior segment complications and astigmatism was evaluated. The age of the patients ranged between 2 months and 8 years. The average operation time was 28 ± 6 min. Due to the suture-related complication, neither re-suturing nor stitch removal was carried out; therefore, general anesthesia was not repeated. The average astigmatism value of the children in the postoperative 1st week was 1.5 ± 1.2 D (0.5-4.0). The mean astigmatism value was 0.8 ± 0.5 D (0.5-1.5) in the 3rd postoperative month. The long corneoscleral tunnel method has been found safe in pediatric cataract surgery.

Tailored sacroplasty for sacral fracture secondary to an epileptic seizure.

Sacral fractures causing neurological deficits secondary to epileptic seizures are very rare. They are traditionally treated by laminectomy and sacral fixation. However, minimally invasive techniques such as sacroplasty offer more limited surgery with decreased morbidity. Here, a 23-year-old male with a seizure-induced sacral fracture was successfully treated with a decompressive laminectomy and transcorporal sacroplasty. After a grand-mal seizure, a 23-year-old male presented with severe paraparesis accompanied by bilateral S1/S2 radiculopathy and urinary/fecal incontinence (Gibbons grade 4). When studies documented a Roy-Camille type 2 sacral fracture with severe central compression of the S1/S2 spinal canal, he underwent an S1-S2 laminectomy with transcorporal sacroplasty. On the 1st postoperative day, he ambulated without assistance and demonstrated only mild residual sensory deficits (Gibbons grade 2); 1-month later, he walked without assistance. A 23-year-old male with a seizure-induced sacral fracture was successfully treated with a decompressive S1/S2 laminectomy/transcorporal sacroplasty.

Postoperative Outcome of Transseptal Suturing and Merocele Nasal Packing During Septoplasty among Cases with Symptomatic Deviated Nasal Septum

Introduction: Nasal obstruction is one of the most common complaints in cases attending otorhinolaryngology surgeon’s practice. One of the causes for nasal obstruction is deviated nasal septum. Deviation of the nasal septum is a common structural cause of nasal obstruction and can arise from dislocation of the quadrangular cartilage from its bony boundaries. Septoplasty is a surgical procedure that corrects a deformity of the nasal septum. Aim: To assess and compare the postoperative outcome of transseptal suturing versus merocele nasal packing during septoplasty regarding the postoperative pain, bleeding and synechiae. Material and methods: This is a prospective, comparative study done in the Department of ORL-HNS, Bir Hospital, Kathmandu with the patients undergoing septoplasty. A total of 70 patients with an age range of 15-65 years were included irrespective of gender diagnosed as symptomatic DNS (Deviated Nasal Septum) who underwent septoplasty. The patients were divided into two groups Group A and Group B during registration in outpatients department. Group A patients underwent septoplasty with transseptal suturing without merocele nasal packing whereas Group B patients underwent septoplasty with merocele nasal packing without transseptal suturing. Postoperative pain and bleeding were assessed on 6th hour, 12th hour, 1st ,2nd, 3rd, 7th and after 42nd POD (postoperative day). Presence of synechiae was assessed on 7th POD and 42nd POD. Results: The mean age was 28.31 +/- 9.149 years. Patients who underwent septoplasty with transeptal suturing reported lower pain scores compared to their counterparts and the differences were statistically significant at 6th hour, 12th hour, 1st POD, 3rd POD and 7th POD with p-value 0.0001, 0.0001, 0.0001, 0.29 and 0.0001 respectively. Synechiae was observed in patients who underwent septoplasty with merocele nasal packing on 7th POD. The p-value for synechiae on 7th POD was 0.028. No synechiae was observed on 42nd POD. Bleeding was only the complication that was commonly associated with septoplasty with transseptal suturing as compared to septoplasty with merocele nasal packing which was statistically significant (p=0.42). Conclusion: There were increased potential morbidity (pain and synechiae) in cases of septoplasty with merocele nasal packing without transseptal suturing in comparison to septoplasty with transseptal suturing without merocele nasal packing. So, septoplasty with transseptal suturing can be good alternative to septoplasty with packing.

Refractive Outcome of Femtosecond Assisted Laser in situ Keratomileusis in 1564 cases of Myopia and Compound Myopic Astigmatism.

To determine the outcomes of Femtosecond Assisted Laser in situ Keratomileusis (Femto LASIK) on eyes with myopia and compound myopic astigmatism in terms of efficacy, safety, accuracy, predictability, and stability of the procedure. Quasi-experimental study. Place and Duration of the Study: Refractive Surgical Department, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan, from January 2014 to August 2019. Participants aged 18 years and above with upto -12D (dioptre of myopia, underwent preoperative detailed work-up with history, ocular examination, subjective refraction and assessment on topography, tomography, and aberrometry. Suitable candidates underwent Femto LASIK and were re-evaluated at 1stpostoperative day, end of 1stweek, 1month, 3 months, 6months and 1year. Results were analysed and represented in form of standard graphs for refractive surgery. Results: Postoperative UDVA (uncorrected distance visual acuity) of 20/40 was achieved in 99% of patients. Efficacy index was 1.02 + 0.15. Safety index was 1.04 + 0.199. None of the patients lost more than one line in postoperative CDVA (corrected distance visual acuity) when compared to preoperative CDVA. All the eyes (100%) were accurately treated within +1.0 DS of intended spherical equivalent (SEQ) range. Mean SEQ showed stability with 1% eyes recorded to have more than 0.5D change or more over 12 months. Femto LASIK is an effective, safe, accurate, predictable, and stable procedure for correction of myopia and compound myopic astigmatism. Femtosecond, Laser in situ Keratomileusis, Refractive surgery, Myopia, Compound myopic astigmatism, Uncorrected distance visual acuity.

Prospective Study of the Incidence of Asymptomatic Deep-vein Thrombosis in Postoperative Patients: A Single-center Study

Abstract Introduction: Postoperative DVT remains one of the formidable challenges for the surgeon. It is associated with a significant risk of associated morbidity and mortality. Diagnosis of DVT is usually established by the combination of symptoms and imaging, which is most commonly performed noninvasively by color Doppler. However, in multiple instances, the patient may remain asymptomatic, and hence, the diagnosis may be missed. Aim and Methodology: This study was performed at tertiary care to study the incidence of asymptomatic DVT in postoperative patients across various specialties. All postoperative patients were subjected to color Doppler on the 1st, 7th, and 30th postoperative days. Results: Out of 300 patients who were part of the study over 1 year, 31 patients developed DVT, of which eight were symptomatic. They all were managed as per any other patient of DVT by anticoagulants, class II stockings, and limb elevation. We had no mortality. Conclusion: DVT may develop in postoperative cases. It may be fatal if not recognized and treated in time. Timely diagnosis and adequate management remain key in avoiding morbidity and mortality. Data related to postoperative patients developing asymptomatic DVT are limited. There seems to be ambiguity in its etiology, prognosis, management protocol, and follow-up.

Randomized controlled trial comparing the effectiveness of tamsulosin, tamsulosin with tolterodine and double J stent position in controlling stent related symptoms after ureteroscopic lithotripsy

Background: Objective of the study was to determine the effect of stent position and medications in preventing stent-related symptoms. Methods: This was a prospective study conducted at Meenakshi Mission Hospital and Research Centre Madurai, Tamil Nadu, India. 150 patients who underwent ureteroscopic lithotripsy with indwelling stent were distributed into three groups. On demand analgesics were given to group 1 (n=50), Tamsulosin 0.4 mg daily for group 2 (n=50) and tamsulosin 0.4 mg and tolterodine 4 mg daily for group 3 (n=50). The patients were also subclassified into appropriate or inappropriate group according to stent position. All patients completed various domains of Ureteral stent symptom questionnaire (USSQ) on 1st and 7th postoperative days. Appropriate tests statistics were performed using EPI-Info statistical software package. Results: In control group, patients with appropriate stent position had significantly lower symptom scores than those with inappropriate stent position (p value~0.0001) in all domains of USSQ except global quality of life score (p value=0.08). Addition of tamsulosin 0.4 mg (group 2) had superadded beneficial effect in appropriate position group, but not in patients with inappropriately positioned stents. Patients taking both tamsulosin 0.4 mg and tolterodine 4 mg (group 3) had no significant improvement in symptom scores in appropriate position group (all domains of USSQ) and inappropriate position group (most domains). Conclusions: Appropriate stent position is the most important independent factor than medications in preventing stent related symptoms; tamsulosin has superadded benefit in patients with correctly positioned stents.

Outcome of laparoscopic vs open appendectomy in the management of acute appendicitis

The worldwide trend of appendectomy is shifting from conventional open to the laparoscopic technique. The study’s objective was to compare laparoscopic and open appendectomy in terms of various operative and postoperative parameters to find the best operative technique. A prospective comparative study was conducted on 142 patients undergoing laparoscopic (n=43) or open appendectomy (n=99) from 1st February 2022 to 30th January 2023 under the Department of Surgery of Kathmandu Medical College Teaching Hospital (KMCTH). In five patients, laparoscopic appendectomy was later converted to open and excluded from the study. The mean operating time for the open appendectomy group was 44.1±13.1 minutes while for the laparoscopic appendectomy group, it was 48.4±14.0 minutes (p=0.047). Visual analogue score taken on 1st, 7th and 30th post-operative day for open and laparoscopic appendectomy were 4.0±2.2 vs 3.6±1.9 (p=0.160); 1.4±1.3 vs 0.6±0.9 (p&lt;0.001) and 0.2±0.5 vs 0.02±0.15 (p=0.107) respectively. The total days of postoperative hospital stay were 1.57±0.96 for open appendectomy and 1.58±1.07 for laparoscopic appendectomy (p=0.843). However, laparoscopic appendectomy group had an earlier return to normal activity (7.30±1.15 days) when compared to the open appendectomy group (8.05±2.42 days) (p=0.023). The laparoscopic appendectomy group also had fewer postoperative complications than the open appendectomy group (18.6% vs 24.2%) (p=0.411). Thus, laparoscopy is a safe and effective method of removal of appendix for acute appendicitis.

Timing of Chest Tube Removal Following Adult Cardiac Surgery: A Cluster Randomized Controlled Trial

Objectives Early chest tube removal following cardiac surgery may be associated with an increased risk of pleural or pericardial effusions following cardiac surgery. This study compares the effects of two fast-track chest tube removal protocols regarding the risk of pleural or pericardial effusions, requirement of opioids, respiratory function, and postoperative complications. Design Prospective non-blinded cluster-randomized study with alternating chest tube removal protocol in adult patients undergoing elective cardiac surgery. Monthly changing allocation to scheduled chest tube removal on the day of surgery (Day 0) versus removal on the 1st postoperative day (Day 1) provided no air leakage and output < 200 mL within the last four hours. Results A total of 527 patients were included in the study from September 1st 2020 until October 29th 2021 and randomly allocated to chest tube removal at day 0 (n = 255), and day 1 (n = 272). More than every fourth patient required drainage for pleural effusion with no significant difference between the groups. Earlier removal of chest tubes did not reduce requirement of analgesics, improve early respiratory function, or reduce postoperative complications. The study was halted for futility after halfway interim analysis showed insufficient promise of any treatment benefit. Conclusion Fast-track protocols with chest tube removal within the first 24 h after cardiac surgery may be associated a high rate of pleural effusions.

The impact of perioperative fluid therapy on the short-term outcomes after laparoscopic colorectal cancer surgery with ERAS protocol: a prospective observational study

The main goals of the Enhanced recovery after surgery (ERAS) protocol are focused on shortening the length of hospital stay (LOS), expediting convalescence, and reducing morbidity. A balanced perioperative fluid therapy is among the significant interventions incorporated by the ERAS protocol. The article contains extensive discussion surrounding the impact of this individual intervention on short-term outcomes. The aim of this study was to assess the impact of perioperative fluid therapy on short-term outcomes in patients after laparoscopic colorectal cancer surgery. The analysis included consecutive patients, who had undergone laparoscopic colorectal cancer operations between 2013 and 2020. Patients were divided into two groups: restricted (≤ 2500 ml) or excessive (> 2500 ml) perioperative fluid therapy. A standardized ERAS protocol was implemented in all patients. The study outcomes included recovery parameters and the morbidity rate, LOS and 30 days readmission rate. There were 361 and 80 patients in groups 1 and 2, respectively. There were no statistically significant differences between the groups in terms of demographic parameters and factors related to the surgical procedure. Logistic regression showed that restricted fluid therapy as a single intervention was associated with improvement in tolerance of diet on 1st postoperative day (OR 2.18, 95% CI 1.31–3.62, p = 0.003), accelerated mobilization on 1st postoperative day (OR 2.43, 95% CI 1.29–4.61, p = 0.006), lower risk of postoperative morbidity (OR 0.58, 95%CI 0.36–0.98, p = 0.046), shorter LOS (OR 0.49, 95% CI 0.29–0.81, p = 0.005) and reduced readmission rate (OR 0.48, 95% CI 0.23–0.98, p = 0.045). A balanced perioperative fluid therapy on the day of surgery may be associated with faster convalescence, lower morbidity rate, shorter LOS and lower 30 days readmission rate.

Brain Abscess: A Comparison of Surgical Outcomes between Conventional Burr Hole Aspiration and Endoscope-assisted Evacuation.

Brain abscess is a major health problem with a significant morbidity and mortality rate. The objective of this study was to compare the surgical efficacy between endoscope-assisted evacuations of brain abscess with a single burr hole aspiration procedure in a tertiary health care center. This single center non-randomized clinical study was conducted in our Department of Neurosurgery during the period of July 2020 to December 2021. Patients under 30 years of age of both genders presented with brain abscess were enrolled in this study. Patients were treated with two different techniques and divided into 2 groups: conventional burr hole aspiration group and endoscope-assisted evacuation group. Thirty patients were enrolled for this study. The mean age was 13.0 ± 6.3 years in burr hole group and is 13.1 ± 6.4 years in endoscope-assisted group. This study showed ≥75.0% evacuation of brain abscess at 1st post-operative day in 13 (92.9%) patients in endoscope-assisted group and 5 (33.3%) patients in burr hole group. This study showed mortality rate of 6.7% in both the groups. Mean residual volume at 30th post-operative day was 0.75 ml in endoscope-assisted group and 1.75 ml in burr hole aspiration group. No patients treated with required endoscope-assisted evacuation required a repeated surgery, whereas 5 patients (33.3%) of patients treated with conventional burr hole required it. This study showed that endoscope-assisted procedure has better rate of abscess evacuation, less chance of residual and repeated surgeries than conventional burr hole.

Theory-based implementation of an enhanced recovery protocol for cranial surgery.

There is growing evidence for the use of enhanced recovery protocols (ERPs) in cranial surgery. As they become widespread, successful implementation of these complex interventions will become a challenge for neurosurgical teams owing to the need for multidisciplinary engagement. Here, the authors describe the novel use of an implementation framework (normalization process theory [NPT]) to promote the incorporation of a cranial surgery ERP into routine neuro-oncology practice. A baseline audit was conducted to determine the degree of implementation of the ERP into practice. The Normalization MeAsure Development (NoMAD) questionnaire was circulated among 6 groups of stakeholders (neurosurgeons, anesthetists, intensivists, recovery nurses, preoperative assessment nurses, and neurosurgery ward staff) to examine barriers to implementation. Based on these findings, a theory-guided implementation intervention was delivered. A repeat audit and NoMAD questionnaire were conducted to assess the impact of the intervention on the uptake of the ERP. The baseline audit (n = 24) demonstrated limited delivery of the ERP elements. The NoMAD questionnaire (n = 32) identified 4 subconstructs of the NPT as barriers to implementation: communal specification, contextual integration, skill set workability, and relational integration. These guided an implementation intervention that included the following: 1) teamwork-focused training; 2) ERP promotion; and 3) procedure simplification. The reaudit (n = 21) demonstrated significant increases in the delivery of 5 protocol elements: scalp block (12.5% of patients before intervention vs 76.2% of patients after intervention, p < 0.00001), recommended analgesia (25.0% vs 100.0%, p < 0.00001) and antiemetics (12.5% vs 100.0%, p < 0.00001), trial without catheter (13.6% vs 88.9%, p < 0.00001), and mobilization on the 1st postoperative day (45.5% vs 94.4%, p < 0.00001). There was a significant reduction in the mean hospital length of stay from 6.3 ± 3.4 to 4.2 ± 1.7 days (p = 0.022). Two months after implementation, a repeat NoMAD survey demonstrated significant improvement in communal specification. Here, the authors have demonstrated the successful implementation of a cranial surgery ERP by using a systematic theory-based approach.

Intraventricular hemorrhage volume and younger age at surgery may be risk factors for postoperative hydrocephalus after hemispherotomy in children.

Hemispherotomy is an effective treatment for intractable hemispheric epilepsy; however, hydrocephalus remains a common complication of the procedure. The causes of hydrocephalus following hemispherotomy have not been fully elucidated; therefore, the purpose of this study was to identify the risk factors associated with the condition. The authors investigated the records of all patients aged < 18 years who underwent hemispherotomy at their institution between 2003 and 2020 and were monitored for hydrocephalus for at least 1 year after the procedure. To identify the risk factors for hydrocephalus, the following information about each patient was collected: sex, corrected age at surgery, body weight at surgery, previous intracranial surgery, etiology of epilepsy, results of PET for hypermetabolism, side of surgery, type of operation (vertical or horizontal approach), operation time, blood loss during surgery, use of intraventricular drainage, occurrence of intraventricular hemorrhage (IVH) on the 1st postoperative day, duration of postoperative fever of > 38°C, and maximum C-reactive protein level after the operation. Multivariate logistic regression analyses were performed. This study included 51 children who underwent hemispherotomies for drug-resistant epilepsy at our hospital. Seven patients (13.7%) experienced hydrocephalus and were treated with ventricular or subdural peritoneal shunts or fenestration. Multivariate logistic analysis using the Bayesian information criterion revealed that 3 factors were associated with the occurrence of hydrocephalus: age at surgery, postoperative IVH volume, and duration of postoperative fever of > 38°C. This study showed that younger age at surgery, postoperative IVH volume, and duration of postoperative fever of > 38°C might be risk factors for hydrocephalus after hemispherotomy. The risk of hydrocephalus should be considered in cases of early surgical indication in children. Intraoperative hemostasis and postoperative use of anti-inflammatory measures may reduce the risk of hydrocephalus.

The application of subcapsular saline injection to preserve the parathyroid gland during thyroidectomy

Objective: To evaluate the clinical effect of subcapsular saline injection (SCASI) after total thyroidectomy. Methods: A total of 77 patients who underwent total thyroidectomy in our hospital from January 2020 to December 2021 were selected and divided into the SCASI group (n = 43) and the non-SCASI group (n = 34). The general clinical data of the patients were collected, and serum parathyroid hormone (PTH) and serum calcium levels were determined preoperatively, on the 1st postoperative day, and at 1 and 6 months after the operation. These data were compared between groups. Results: There was no significant difference in postoperative complications between the two groups. The PTH and serum calcium levels in the SCASI group were significantly higher than those in the non-SCASI group on the 1st postoperative day (t = 2.340, 5.208, both P < 0.05), and the PTH levels in the SCASI group at 1 month after the operation were higher than those in the non-SCASI group (t = 2.141, P < 0.05). In addition, the proportion of transient and permanent hypoparathyroidism in the SCASI group was significantly decreased (χ2 = 3.920, 3.948, P < 0.05). Conclusion: Total thyroidectomy requires high surgical precision, and SCASI can reduce the incidence of temporary and permanent hypoparathyroidism.

Systemic inflammation response index (SIRI) on the 3rd postoperative day are associated with severe pneumonia in cerebral hemorrhage patients: A single-center retrospective study.

Inflammatory response was involved in the progression of cerebral hemorrhage. We sought to explore the associations of easily obtained inflammatory indicators including blood cell counts and the ratios of different blood cells counts with pneumonia and severe pneumonia in cerebral hemorrhage patients. We carried 1 retrospective study including 200 patients with cerebral hemorrhage and surgeries. The associations of neutrophils, lymphocytes, monocytes, platelets, systemic immune inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) with pneumonia and severe pneumonia in cerebral hemorrhage patients were estimated by univariate analysis and multivariate logistic regression model. Among the 200 patients included, there were a total of 163 (81.5%) had pneumonia after surgeries. Among 163 cerebral hemorrhage patients with pneumonia, 60 (36.8%) cases were evaluated as severe pneumonia. The level of SIRI on the 1st postoperative day in patients with severe pneumonia was higher than non-severe pneumonia (10.89 ± 12.10 × 109/L vs 7.14 ± 9.76 × 109/L, P = .003). The level of SIRI on the 3rd postoperative day in patients with severe pneumonia was more significantly higher (7.98 ± 7.46 × 109/L vs 4.10 ± 3.74 × 109/L, P < .001). The results of multivariate analysis showed that SIRI level on the 3rd postoperative day (>6.5 × 109/L) was associated with severe pneumonia in cerebral hemorrhage patients (OR: 4.409, 95% CI: 1.799-10.806, P = .001). SIRI was possibly a superior predictor for severe pneumonia in cerebral hemorrhage patients compared with other inflammatory indicators. On the one hand, we intend to validate the cutoff value of SIRI for predicting severe pneumonia in larger samples and multicenter studies. On the other hand, we also intend to use this index to guide the choice of antibacterial drugs in order to better benefit patients.

Comparative Evaluation of Efficacy of Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) in Bone Regeneration after Surgical Removal of Impacted Bilateral Mandibular Third Molars - A Comparative Study.

Aims and Objectives: To compare the efficacy of platelet rich plasma (PRP) and platelet rich fibrin (PRF) in bone regeneration after removal of impacted bilateral third molars. Materials and Methods: The study was carried out as an open clinical trial on 20 patients chosen from the ones referred to the department of Oral & Maxillofacial Surgery for surgical removal of bilateral mandibular third molar. Patients were prepared for surgical procedure, Inferior alveolar nerve block given using 2% lignocaine hydrochloride with 1:2,00,000 adrenaline. Third molar were removed by flap reflection and bone drilling. Finally, PRF in lower left mandibular third molar region and PRP in lower right mandibular third molar region was inserted and wound closure was done. Cone bean computer tomography (CBCT) was made on 1st postoperative day and 4 months after surgery to evaluate alveolar bone height and density. Result: Alveolar bone height and bone density at post-operative 1st day and 4 months were compared between PRP and PRF group. The bone density and bone volume were analyzed, and there was no significant difference between bone density in PRP and PRF at day 1 and 4th month. Conclusion: As per our study and evaluation, in our postoperative follow up there was no statistically significant differences in bone regeneration by placement of PRP and PRF in extracted socket of third molar. Thus, with this study we can conclude that PRF, would be a good option to Oral and Maxillofacial Surgeons in the near future due to ease of extraction.