30-day Outcomes Research Articles

Hyponatremia is associated with malignant brain edema after mechanical thrombectomy in acute ischemic stroke

BackgroundHyponatremia (< 135 mmol/L) is the most common electrolyte disturbance in patients with stroke. However, few studies have reported the relationship between hyponatremia at admission and outcomes in patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). This study is aimed to explore the association between hyponatremia and clinical outcomes following MT.MethodsA retrospective study was conducted at our center. The primary outcome was postoperative malignant brain edema (MBE). The secondary outcomes included mortality and adverse function at the 90-day follow-up, which were defined as modified Rankin scale scores of 6 and > 2, respectively. Patients were classified into hyponatremia and nonhyponatremia groups based on their serum sodium concentration at admission before drug use. The occurrence of MBE was evaluated via computed tomography after MT, and 90-day outcomes were obtained through in-person interviews at the clinic or via telephone. Multivariate analysis was performed to investigate the associations among postoperative MBE, 90-day mortality, adverse function and hyponatremia.ResultsA total of 342 patients were enrolled into the study, of whom 52 (15.2%) had hyponatremia, 86 (25.1%) developed postoperative MBE, 93 (27.2%) died within 90 days after MT, and 201 (58.8%) had adverse functions at the 90-day follow-up. Multivariate analysis revealed that hyponatremia was significantly associated with postoperative MBE (odds ratio [OR] 3.91, 95% confidence interval [CI] 1.66 − 9.23, p = 0.002), 90-day mortality (OR 5.49, 95% CI 2.48 − 12.14, p < 0.001), and 90-day adverse function (OR 3.25, 95% CI 1.29 − 8.12, p = 0.012). In addition, mediation analysis revealed that postoperative MBE may partially account for the 90-day mortality/adverse function of patients with hyponatremia (regression coefficients changed by 18.6% and 23.9%, respectively).ConclusionHyponatremia is an independent predictor of postoperative MBE, 90-day mortality, and adverse function. Correction of hyponatremia may reduce the postoperative MBE to improve the prognosis of patients.

Black-vs-white racial disparities in 30-day outcomes following primary and revisional metabolic and bariatric surgery: a MBSAQIP database analysis.

Previous studies have demonstrated Black-vs-White disparities in postoperative outcomes following primary metabolic and bariatric surgery (MBS). With the rising prevalence of MBS, it is important to examine racial disparities using quality indicators in primary and revisional procedures. This study explores Black-vs-White disparities in postoperative outcomes following primary and revisional MBS. We performed an observational cohort study using the 2015-2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database of adults who underwent primary or revisional Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch, or one-anastomosis gastric bypass. Black and White patients were 1:1 matched using propensity scores across 19 covariates for primary and revisional MBS groups. McNemar's tests were used to compare 11 postoperative outcomes from the MBSAQIP semi-annual report and death, between matched cohorts. We identified 112,495 Black and 434,266 White primary MBS and 10,838 Black and 37,075 White revisional MBS patients. A total of 219,114 primary and 21,314 revisional patients were matched. Following primary MBS, Black patients had higher rates of death (0.1% vs. 0.06%, p < 0.001), all occurrences morbidity (5.6% vs. 4.7%, p < 0.001), serious events (2.2% vs. 1.9%, p < 0.001), and all cause and related reoperations (1.2% vs. 1.1%, p = 0.006; 0.2% vs. 0.1%, p = 0.01), readmissions (4.6% vs. 3.4%, p < 0.001; 2.8% vs. 1.9%, p < 0.001), and interventions (1.4% vs. 1.1%, p < 0.001; 0.8% vs. 0.6%, p < 0.001) compared to White patients. In contrast, there were no significant Black-vs-White disparities in death, morbidity, serious events, reoperations, interventions, and bleeding following revisional MBS. Interestingly, Black patients had higher rates of all cause and related readmissions (7.4% vs. 6.2%, p = 0.005; 4.4% vs. 3.6%, p = 0.01), but lower surgical site infection rates (1.6% vs. 2.1%, p = 0.04). Our findings demonstrate a measurable contrast between racial disparities in postoperative outcomes following primary and revisional MBS. Equity-focused measures in national MBS assessments are needed to elucidate and address these disparities.

Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery

BackgroundClinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient’s own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were not readily available for EHR-integration, our objective was to develop and validate a risk stratification tool, named the Assessment of Geriatric Emergency Surgery (AGES) score, predicting risk of 30-day major postoperative complications in geriatric patients under consideration for urgent and emergency surgery using pre-surgical existing electronic health record (EHR) data.MethodsPatients 65-years and older undergoing urgent or emergency non-cardiac surgery within 21 hospitals 2017–2021 were used to develop the model (randomly split: 80% training, 20% test). The primary outcome was a 30-day composite outcome including several postoperative major complications and mortality; secondary outcomes included common individual complications included in the primary composite outcome (sepsis, progressive renal insufficiency or renal failure, and mortality). Patients’ EHR-based clinical history, vital signs, labs, and demographics were included in logistic regression, LASSO, decision tree, Random Forest, and XGBoost models. Area under the receiver operating characteristics curve (AUCROC) was used to compare model performance.ResultsOverall, 66,262 patients (median [IQR] age 78 [(70.9–84.0], female 53.9%, White race 68.5%) received urgent or emergency non-cardiac surgery (25.7% orthopedic cases, 21.9% general surgery cases). AUCROC ranged from 0.655 (Decision Tree) – 0.804 (XGBoost) for the primary composite outcome. XGBoost AUCROC was 0.823, 0.781, and 0.839 in predicting outcomes of sepsis, progressive renal insufficiency or renal failure, and mortality, respectively.ConclusionsWe developed a model to accurately predict major postoperative complications in geriatric patients undergoing urgent or emergency surgery using the patient’s own existing EHR data. EHR implementation of this model could efficiently support clinicians’ surgical risk assessment and perioperative decision-making discussions in this vulnerable patient population.

Learning Curve for Robotic Inguinal Hernia Repair With da Vinci Single-Port Robotic System.

Transabdominal pre-peritoneal inguinal hernia repair using the da Vinci Single-Port robot (SP-TAPP) is currently performed in few centers. We aimed to define the learning curve for SP-TAPP by analyzing operative times. The operative times of 122 SP-TAPP performed between 2019 and 2024 were retrospectively analyzed. The following phases were analyzed: docking time (DT); pre-robot time (PRT, from skin incision to side cart placement); flap closure time (FCT); console time (CT), and overall time (OT). Cumulative sum analysis (CUSUM) was used to analyze learning curves. Surgical and 30-day outcome were analyzed. The DT has remained constant over time (P > 0.9). PRT was divided into 3 phases with n1 = 5, n2 = 95 and n3 = 4, in which there was a progressive decrease in time (14.8 vs 11.9 vs 6.8 min; P = 0.08). In FCT and CT, 3 phases were identified in which times remained stable (P > 0.9 and P = 0.7). CUSUM analysis of OT identified 3 phases consisting of n1 = 13, n2 = 100 and n3 = 9 in which there was a progressive decrease in times (82 vs 72 vs 62 min; P = 0.3). Analysis of complications and early surgical outcomes did not differ except for estimated blood loss, although this was a clinically insignificant finding. The learning curve for SP-TAPP is rapid and it shows how the technical skills are transferable between the multiport platform and the da Vinci Single Port robotic system for an experienced surgeon. An improvement is evident in PRT and OT, also compared to multiport systems, showing a potential for the platform to increase surgical activity.

Impact of Acute Myocardial Injury on Short- and Long-Term Outcomes in Patients With Primary Intracerebral Hemorrhage.

Myocardial injury is common after brain injury; however, few studies have reported serial cardiac troponin (cTn) measurements to distinguish whether the myocardial injury is acute or chronic. The fourth Universal Definition of Myocardial Infarction introduced for the first time the criteria for acute myocardial injury (AMI). We aimed to investigate the prevalence and prognostic implications of AMI in primary intracerebral hemorrhage. We retrospectively analyzed patients with primary intracerebral hemorrhage within 48 hours after symptom onset. All patients included had at least 2 cTn measurements: 1 obtained at the time of emergency admission and at least 1 more within the first 2 days of hospitalization. AMI was defined as an elevated cTn above the upper-reference limit (14 ng/L) along with a rise/fall >20%. Patients were followed for up to 5 years. Outcomes included major adverse cardiac events (MACEs; a composite of vascular death, nonfatal coronary events, and nonfatal stroke) and 90-day unfavorable outcomes (modified Rankin scale score ≥4). Cox proportional hazards models, multivariable logistic regression models, and Kaplan-Meier analyses were used to evaluate the association between AMI and outcomes. Of 600 patients included, 115 had AMI (19.2%). AMI independently conferred an increased risk for major adverse cardiac events (adjusted hazard ratio, 1.69 [95% CI, 1.12-2.53]) and 90-day unfavorable outcomes (adjusted odds ratio, 2.15 [95% CI, 1.26-3.67]) compared with patients without AMI. AMI is relatively common in patients with intracerebral hemorrhage and is associated with both long-term major adverse cardiac events and 90-day unfavorable outcomes.

Predictive value of dynamic changes in inflammatory markers within 24 hours after mecha nical thrombectomy for outcome in patients with acute ischemic stroke.

This study analyzes the factors influencing the 90-day prognosis of acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT) and established a multidimensional risk model to predict postoperative 90-day outcomes. A retrospective analysis of clinical data was conducted for AIS patients who underwent MT at our hospital. A total of 111 patients who met the inclusion criteria were included in the study. Based on the modified Rankin Scale (mRS) scores from follow-up records at 3 months post-surgery, the patients were divided into a good prognosis group (88 cases, 79.28%), a poor prognosis group (23 cases, 20.72%). Receiver operating characteristic (ROC) curves were plotted using MedCalc software, and area under the curve (AUC) values were calculated to establish a risk prediction model, presented in the form of a nomogram. Logistic regression analysis showed that C-reactive protein (T3) (p < 0.001), NIHSS score at admission (p = 0.001), and a history of atrial fibrillation (p = 0.004) were independent predictors of poor prognosis, while albumin (T2) (p = 0.008) was a protective factor for the 90-day outcome. The AUC values for these factors were 0.812, 0.760, 0.655, and 0.757, respectively. The AUC values of Normotu was 0.945. Calibration slope = 0.856, Calibration-in-the-Large ≈ 0, and Observed/Expected (O/E) ratio ≈ 1. Post-MT CRP levels, NIHSS score at admission, and a history of atrial fibrillation are significantly associated with poor prognosis in these patients. Moreover, higher levels of endogenous albumin are a protective factor for the 3-month prognosis of AIS patients after MT.

Mechanical thrombectomy in elderly stroke patients with low ASPECTS: insights from STAR

BackgroundThe elderly population (≥80 years) were underrepresented in recent trials of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion acute ischemic stroke (LVO-AIS) with low Alberta Stroke Program Early...

Systematic Review and Meta-Analysis to Assess Safety and Early Mortality in Octogenarians undergoing Fenestrated and Branched Endovascular Aortic Repair for Complex Aortic Aneurysms.

The population in the U.S., and across the world is aging rapidly which warrants an assessment of the safety of surgical approaches in elderly individuals to better risk stratify and inform surgeons' decision making for optimal patient care. This review is designed to assess the risk of 30-day mortality and other outcomes of interest among the octogenarians undergoing fenestrated or branched endovascular aortic aneurysm repair (F/BEVAR) for thoracoabdominal aortic aneurysms (TAAAs). The review protocol was registered in the PROSPERO database (CRD42023435673). A systematic review of the English literature was performed using literature databases PubMed and Scopus from inception till May 2024. The review was designed on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included only studies reporting 30-day mortality following F/BEVAR. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. A pooled odds ratio (OR) for the overall mortality was computed, and a p-value of <0.05 was designated as statistically significant. Interstudy heterogeneity was evaluated by Q-metric and quantified using Higgins I2 statistics. Nine studies were found fit for the meta-analysis per inclusion and exclusion criteria. Of these seven studies, three exclusively reported F/BEVAR for Type IV TAAA. Based on a random effects model, a 30-day mortality for octogenarians undergoing F/BEVAR for any type of TAAA was found to be higher (OR, 1.73; 95% CI, 1.13-2.63, p=0.250), however was not statistically difference as compared to non-octogenarians. This insignificance was pertinent, when a meta-analysis with similar model was computed for Type IV TAAA (OR, 1.89; 95% CI, 0.75-4.77, p= 0.163). Other outcomes including spinal cord ischemia, kidney injury, transient ischemic attack or stroke, non-home discharge, and all-cause reintervention were all found not to be statistically significant in the older population. No statistical difference was observed for the risk of 30-day mortality in octogenarians versus non-octogenarians undergoing F/BEVAR for TAAA. This finding was consistent in sub-group meta-analysis of F/BEVAR for Type IV TAAAs, and all other outcomes. Factors pertaining to patient's health, and the system factors like surgeon's skills and postoperative care should be weighed when performing F/BEVAR in older patients. Further research is imperative to assess and better understand the impact of comorbidities on surgical outcomes.

P0917 Corticosteroid sparing effects of treatment with guselkumab in patients with moderate to severely active Crohn’s disease: Phase 3 GALAXI 2/3 results through week 48

Abstract Background GALAXI 2 &amp; GALAXI 3 (G2 &amp; G3) are identical 48-week (Wk), randomized, double-blind, head-to-head, placebo- and active-comparator (ustekinumab; UST) treat-through trials assessing the efficacy and safety of guselkumab (GUS), a dual-acting IL-23p19 subunit inhibitor, in participants (pts) with Crohn’s disease (CD). Here we report the corticosteroid (CS)-sparing effects of treatment with GUS vs UST from the pooled G2 &amp; G3 studies through Wk48. Methods Pts with moderately to severely active CD (based on CDAI and SES-CD scoring) and inadequate response or intolerance to conventional or biologic (BIO-IR) therapy were eligible. Pts were randomized 2:2:2:1 to GUS 200mg IV q4w(x3)→200mg SC q4w, GUS 200mg IV q4w(x3)→100mg SC q8w, UST ~6mg/kg IV(x1)→90mg SC q8w, or placebo. Pts receiving oral CS upon entry (up to 40mg/day of prednisone-equivalent dose) were required to begin tapering their daily CS dose at Wk12, unless not medically feasible. CS use and 90-day CS-free clinical outcomes at Wk48 were assessed vs UST. Results The primary analysis (all pts) included 508 (G2) and 513 (G3) pts. Baseline (BL) characteristics were similar across trials: mean [SD] CDAI (G2: 295.0 [52.0], G3: 294.7 [53.8]), mean [SD] SES-CD (13.1 [7.3], 12.8 [7.3]), BIO-IR history (52.8%, 51.9%), BIO-naïve (41.9%, 41.5%), and oral CS use (37.4%, 36.1%). In analyses of pooled data (G2+G3), the proportion of pts receiving oral CS at BL was similar across treatment groups (GUS 100mg q8w: 38.1%; GUS 200mg q4w: 35.8%; UST: 37.5%). Greater proportions of pts receiving both GUS doses achieved 90-day CS-free Wk-48 outcomes of endoscopic response vs UST (100 mg q8w vs UST: ∆11.2%; 200 mg q4w vs UST: ∆14.5%), endoscopic remission (∆9.5%, ∆11.9%), the composite endpoint of clinical remission + endoscopic response (∆8.1%, ∆12.4%), the composite endpoint of clinical remission + endoscopic remission (∆8.0%, ∆10.9%), and clinical remission (∆4.1%, ∆5.3%) (Table 1). The 90-day CS-free outcomes vs UST in BIO-IR and BIO-naïve pts in the primary analysis were also assessed at Wk48 (Table 1). Among all pts receiving oral CS at BL, greater proportions of GUS-treated pts (100mg q8w: 71.6%; 200mg q4w: 75.5%) were not receiving CS at Wk 48 vs UST (67.0%). Also, among all pts receiving oral CS at BL, greater proportions of GUS-treated pts achieved 90-day CS-free outcomes at Wk48 vs UST, including endoscopic response (41.3%, 42.5% vs 31.2%) and endoscopic remission (30.3%, 28.3% vs 20.2%), and similar proportions for clinical remission (52.3%, 54.7% vs 53.2%). Conclusion In CD, greater proportions of GUS-treated pts achieved CS-free endoscopic-based efficacy outcomes through Wk48 vs UST, regardless of prior biologic exposure status.

Cardiogenic shock in patients with active onco-hematological malignancies: A multicenter retrospective study.

Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs). This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010-2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients. The 30-day survival rate was 44.8%. Multivariate analysis identified previous cardiomyopathy (OR=1.61), acute kidney injury (OR=1.62), lactate levels (OR=1.08 per 1mmol/L), pulmonary embolism (OR=3.04), invasive mechanical ventilation (OR=3.48), and epinephrine use (OR=2.09) as factors associated with 30-day mortality. Among ICU survivors, 54% were alive at 1year with a median left ventricular ejection fraction of 52%. OH malignancy was significantly associated with 30-day mortality (HR 2.54). The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.

P0677 Population-Based Analysis of 30-Day Postoperative Course in Crohn’s Disease Patients Undergoing Primary Bowel Resection

Abstract Background Despite a growing array of medical treatment options, resection rates for Crohn’s disease (CD) have decreased over time, while re-resection rates have remained stable at approximately one-third in historical cohorts. This study aimed to assess 30-day postoperative outcomes and complication rates following primary bowel resection in CD patients. Methods This study encompassed all CD patients undergoing primary resection in Eastern Denmark from 2010 to 2020 (46% of the Danish population, n=2,730,000). Clinical characteristics, surgical procedures, and complications (Clavien-Dindo classification and Rahbari score) were collected 30 days postoperatively (Figure 1). We used nonparametric statistics (median, interquartile range (IQR), percentages) and assessed complication risk with chi-square tests and multivariate logistic regression. Results Primary resection was performed on 631 CD patients due to disease activity. The median age at resection was 35 years (IQR: 25-49) with disease duration of 2 years (IQR: 0-7), and 227 (36%) were smokers. A total of 76 patients (12%) underwent acute resection (&amp;lt;24 hours), while 380 (60%) underwent elective procedures, 349 (55%) had laparoscopic surgery, 479 (76%) received a primary anastomosis (PA), and 94 (15%) were re-admitted. In total, 164 patients (26%) experienced complications within 30 days. Twenty-two (3%) had a Rahbari score of grade C, and two (0.3%) had grade B, and none had grade A. The Clavien-Dindo classification showed grade I: 22 (3%), grade II: 42 (7%), grade III: 95 (15%), grade IV: 4 (0.6%), and only one death (0.2%). Active steroid use (OR 2.26, 95% CI: 1.47–3.45, p&amp;lt;0.001), open surgery (OR 1.60, 95% CI: 1.10–2.34, p=0.015), and resection length &amp;gt;10 cm (OR 2.82, 95% CI: 0.532–51.9, p=0.325) were associated with higher odds, while primary anastomosis reduced risk (OR 0.42, 95% CI: 0.281–0.633, p&amp;lt;0.001). Never received IBD medication (OR 0.76, 95% CI: 0.42–1.30, p=0.336) or being on therapeutic doses of biologics (OR 1.31, 95% CI: 0.87–1.96, p=0.191) was not significantly associated with the risk of 30-day complications, nor were symptom burden (HBI) or smoking status (p=0.670 and 0.250). Conclusion CD patients are often diagnosed and primary resected young, facing significant risks within 30 days postoperatively: 15% were readmitted, and one-fourth experienced complications requiring treatment. the Risk of complications was increased by open surgery, resection length &amp;gt;10 cm, and preoperative corticosteroid use, while primary anastomosis reduced the risk. Receiving biologic therapy did not increase the risk of complications.

Comparing General Anesthesia-Based Regimens for Endovascular Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis.

Total intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy. We conducted a systematic literature search across MEDLINE, Embase, Cochrane, CINAHL, Web of Science, and Scopus. We identified English language studies including adult acute ischemic stroke patients managed with endovascular therapy under general anesthesia delineable into TIVA only and/or volatile only, and obtained categorical data for favorable functional outcomes using the modified Rankin scale (mRS ≤2), at 90 days after endovascular therapy. Odds ratios (OR) and standardized mean differences were calculated to inform a network meta-analysis approach, which permitted the inclusion of studies comparing a form of general anesthesia (ie, TIVA only or volatile only) to conscious sedation. The search rendered 6235 articles, of which 15 met inclusion criteria. Three studies directly investigated TIVA versus volatile, whereas 12 studies compared general anesthesia to conscious sedation. The total number of subjects was 3015 (conscious sedation: n = 1067; general anesthesia: n = 1948 [TIVA: n = 1212, volatile: n = 736]). No significant differences were identified between TIVA and volatile groups in 90-day neurological outcome (OR = 1.25, 95% confidence interval [CI], 0.81-1.91; P = .31), 90-day mortality (OR = 0.72, 95% CI, 0.42-1.24; P = .24), successful recanalization (OR = 1.33, 95% CI, 0.70-2.52; P = .39), or recanalization time (standardized mean difference = 0.03, 95% CI, -0.35 to 0.41; P = .88). Additionally, no significant differences were identified between the conscious sedation group and the TIVA group in 90-day neurological outcome (OR = 1.14, 95% CI, 0.84-1.53; P = .40), 90-day mortality (OR = 0.87, 95% CI, 0.62-1.23; P = .43), successful recanalization (OR = 0.76, 95% CI, 0.52-1.10; P = .15), or recanalization time (standardized mean difference = -0.18, 95% CI, -0.47 to 0.11; P = .23), and between the conscious sedation group and the volatile group in 90-day neurological outcome (OR = 1.42, 95% CI, 0.92-2.17; P = .11), 90-day mortality (OR = 0.63, 95% CI, 0.36-1.12; P = .11), successful recanalization (OR = 1.01, 95% CI, 0.52-1.94; P = .98), or recanalization time (standardized mean difference = -0.15, 95% CI, -0.52 to 0.23; P = .44). This network meta-analysis showed that the perioperative use of either general anesthesia-based regimen, or sedation, did not significantly impact various endovascular therapy-related outcomes. However, the current work was underpowered to detect differences in anesthetic agents, clinico-demographic characteristics, or procedural factors.

Association of thrombus enhancement with mortality following endovascular therapy in patients with acute anterior circulation stroke

BackgroundThrombus enhancement sign (TES) has emerged as a potential imaging biomarker in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT).ObjectiveTo evaluate the prognostic value of TES on 90-day...

Risk Factors for 30-Day Postoperative Infection in Pediatric Ventricular Shunts for Hydrocephalus.

Ventricular shunt infections lead to significant morbidity and mortality. This study aimed to identify risk factors for 30-day postoperative infection outcomes of ventricular shunts for pediatric hydrocephalus. This was a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) Pediatric database for years 2016-2021. Patients were included in this study if they were under 18 years of age and underwent ventricular shunt surgery. The primary outcome was 30-day postoperative shunt infection. A multivariable logistic regression analysis was performed using fourteen prognostic variables to determine factors associated with infection risk. A total of 10,878 patients were included in the study, with a mean age of 3.1 years (SD 4.83), and 44.2% were female. The overall 30-day postoperative shunt infection rate was 3.7%. We found that infection risk increased in patients on nutritional support, with longer operating room duration, and congenital hydrocephalus. Conversely, infection risk decreased with increasing patient age, delivery of intraoperative intraventricular antibiotics, and placement of first-time shunts. Variables that did not significantly affect the risk of 30-day postoperative shunt infection included sex, BMI, ostomy, tracheostomy, neuromuscular disease, structural pulmonary/airway abnormality, steroid use within 30 days, antibiotic-impregnated shunt use, and endoscopy for catheter placement. Various modifiable and non-modifiable factors are associated with postoperative shunt infections. Recognizing and modifying risk factors can reduce pediatric shunt infections, thereby preventing revisions and improving therapeutic outcomes and quality of life.

Comparison of Partial Endoscopic vs Surgical Fundoplication after Hiatal Hernia Repair.

The concomitant hiatal hernia repair with endoscopic fundoplication (c-TIF) is a novel anti-reflux procedure that addresses the hiatus and the gastro-esophageal flap valve for surgical candidates with GERD. We aim to compare the outcomes of a hiatal hernia repair with endoscopic fundoplication (TIF) vs surgical partial fundoplication (anterior and posterior) with regards to quality-of-life scores at 12 months after surgery. Following IRB approval, a prospectively maintained anti-reflux database was retrospectively reviewed to identify patients who underwent a c-TIF procedure or a surgical hiatal hernia repair with partial fundoplication. The primary endpoint was QoL scores at 2, 6, and 12 months from surgery with attention to bloating and dysphagia scores. Secondary endpoints were PPI use, 30-day outcomes, OR time and costs, re-operation within 1 year. The three groups were compared using analysis of variance for continuous variables and Pearson's Chi-square test for categorical variables. P-values < 0.05 were considered indicative of statistical significance. Demographics between groups were similar except for age, PPI use, and presenting symptoms. There was no difference between the three groups with regards to post-operative QoL scores, PPI use, dysphagia, or bloating. All three types of fundoplication are associated with significant improvement of all symptom types and 65-80% of patients are no longer using a PPI at 12 months. There are no differences in outcomes between the c-TIF and a surgical partial fundoplication. QoL scores significantly decrease with all partial fundoplications and there are no differences in dysphagia or bloating between the three types of fundoplication. Long term data is necessary to see if either technique provides superior control of symptoms while minimizing dysphagia and bloating.

Impact of Disease Etiology and Indication for Colectomy on Postoperative Outcomes: A NSQIP Colectomy-Targeted Database Study.

The ACS-NSQIP Colectomy-Targeted database provides valuable metrics on surgical outcomes by utilizing clinical data to enhance quality improvement efforts. However, the quality measures offered in the ACS-NSQIP semiannual report do not stratify for the indication for colectomy. We aim to compare postoperative outcomes in patients undergoing colectomy for colon cancer, infectious causes, and inflammatory bowel disease (IBD). A retrospective review of patients undergoing colectomy was performed using the ACS-NSQIP Colectomy-Targeted database from 2012-2022. Logistic regression models were used to compare the 30-day postoperative outcomes of patients who underwent colectomy for colon cancer, infectious causes, and IBD while adjusting for pre-operative risk factors. There were 158,560 patients who underwent colectomy for colon cancer, 90,827 patients for infectious causes, and 30,548 patients for IBD. In unadjusted analysis, patients undergoing colectomy for infectious causes had the highest rates of mortality (2.6%) and morbidity (27.6%). After adjusting for covariates, IBD patients undergoing colectomy had significantly higher odds of morbidity compared to those undergoing colectomy for colon cancer (OR 1.3, 95% CI [1.1, 1.4]) and infectious causes (OR 1.3, [1.2, 1.4]). Furthermore, IBD patients had significantly higher odds of experiencing venous thromboembolism, surgical site infections, prolonged ileus, and readmission within 30 days compared to both colon cancer and infectious causes patients. This study demonstrates that the indication for colectomy impacts postoperative outcomes. Reporting risk-adjusted outcomes based on the underlying disease etiology could lead to identifying high-risk patients, improving benchmarking outcomes, and developing targeted quality initiatives.

Preoperative Glucagon-Like Peptide-1 Receptor Agonist Utilization and Association with Bariatric Surgery Outcomes.

The efficacy of Glucagon-Like Peptide-1 Receptor Agonists (GLP1RA) for the treatment of obesity has led to considerably increased demand for these medications. GLP1RA use prior to bariatric surgery may represent a novel approach to treating obesity. The objectives of this study were to (1) describe trends in pre-bariatric GLP1RA use, (2) investigate social and clinical factors associated with their use, and (3) evaluate differences in clinical outcomesbased on preoperative GLP1RA use. Patients who underwent bariatric surgery at three Indiana hospitals from 2018 to 2023were identified. Patients who utilized GLP1RA in the year preceding surgery werecompared to those who did not. Social factors included insurance, income, andunemployment. Outcomes included rates of GLP1RA use, 30-day postoperativereadmissions, ED visits, and percent total weight lost (%TWL) at 1 year. Associationsbetween preoperative GLP1RA use and outcomes of interest were evaluated usingmultivariable logistic and linear regressions. Of 2169 patients who underwent surgery, 293 (13.5%) utilized GLP1RA preoperatively.The rate of GLP1RA utilization increased threefold from 2018 to 2023. Males were morelikely to receive preoperative GLP1RA (20.1% vs, 12.2%, p<0.001). There were nosignificant differences in social determinants of health or 30-day postoperative outcomesbetween patients who did and did not use GLP1RA preoperatively. Similarly, there wereno significant differences in %TWL at 1 year postoperatively between groups (median25.5% vs. 27.3%, coefficient, -0.78, 95%CI, -2.26 to 0.70). Utilization of GLP1RA in the year prior to bariatric surgery has increased threefold.Preoperative GLP1RA use is not associated with worse 30-day outcomes or differencesin %TWL at 1 year postoperatively. Further work is needed to evaluate whether GLP1RAdosing and duration of treatment impact postoperative outcomes.

The impact of resident involvement and postgraduate year on head and neck surgery for obstructive sleep apnea.

To assess the impact of resident involvement and resident postgraduate year (PGY) on head and neck obstructive sleep apnea (OSA) surgical outcomes. We analyzed head and neck OSA surgeries from 2005-2012 via the National Surgical Quality Improvement Program database. Demographic, preoperative, and postoperative variables were analyzed via multivariate regression to determine the impact of resident involvement and resident PGY on 30-day outcomes. Of 975 surgeries, 234 (24.0%) involved a resident: 120 (51.3%) involved a junior (PGY 1-3) resident and 114 (48.7%) involved a senior (PGY 4-5) resident. Multivariate analysis showed no significant impact on surgical, medical, or overall complication rates with resident involvement (all p > 0.05). Likewise, after separation of involved residents into junior or senior cohorts based on PGY, neither junior nor senior resident involvement significantly increased the odds of medical, surgical, or overall complications compared to operations performed by the attending alone (all p > 0.05). Resident involvement significantly increased readmission rates (6.1% versus 1.4%, p = 0.041) and operation time (92.1 ± 59.9 minutes versus 53.6 ± 42.0 minutes, p < 0.001) when compared to cases without resident involvement. Resident involvement in OSA surgery does not significantly impact rates of surgical medical, or overall complications. However, resident involvement increases 30-day readmission rates and almost doubles operation time, suggesting that resident involvement in head and neck OSA surgery remains relatively safe but further efforts to improve efficiency are likely needed.

Nomogram for Predicting 90-day Outcomes in Patients with Acute Vertebrobasilar Artery Occlusion Undergoing Endovascular Treatment: A Multicenter Cohort Study.

In this study, we aimed to develop and validate a novel nomogram model for predicting 90-day non-favorable clinical outcomes in patients with acute vertebrobasilar artery occlusion after endovascular treatment by integrating clinical and MRI features. This multicenter retrospective study analyzed data from 181 patients with vertebrobasilar artery occlusion eligible for endovascular treatment from two Chinese stroke centers. We developed a predictive model for non-favorable clinical outcomes (modified Rankin Scale score >3) using the data of 125 patients from Stroke Center A (2019-2023). The model was constructed using univariate and multivariate logistic regression analyses of clinical and MRI characteristics, with continuous variables dichotomized based on receiver operating characteristic curve analysis. Internal validation employed smooth bootstrapping, while external validation utilized 56 cases from Stroke Center B (2019-2023), ensuring model reliability and generalizability across diverse clinical settings. Age, NIHSS baseline score, recanalization, novel posterior circulation scores, and MRA-based posterior circulation collateral scores were independent predictors of 90-day prognosis, which were used to create a nomogram model. Internal validation demonstrated excellent discriminative performance of the model (mean area under the curve, 0.92 [95% CI: 0.91-0.93]), while external validation further confirmed its robust generalizability (area under the curve, 0.88). The patients were effectively stratified into the low-risk and high-risk groups using the nomogram model. The posterior circulation collateral score was an independent predictor of prognosis. Our novel nomogram model, based on clinical and MRI characteristics, effectively predicts 90-day non-favorable clinical outcomes in patients with vertebrobasilar artery occlusion following endovascular treatment. AUC = area under the curve; ETO = estimated time of onset; EVT = endovascular treatment; FCO = favorable clinical outcome; mTICI = modified TICI; Novel-PCS = novel posterior circulation score; pc-ASPECTS = posterior circulation Acute Stroke Prognosis Early CT score; PC-CS = posterior circulation collateral score; ROC = receiver operating characteristic; VBAO = vertebrobasilar artery occlusion.

PROMISE: Prognostic Radiomic Outcome Measurement in Acute Subdural Hematoma Evacuation Post-Craniotomy.

Background/Objectives: Traumatic acute subdural hematoma (aSDH) often requires surgical intervention, such as craniotomy, to relieve mass lesions and pressure. The extent of hematoma evacuation significantly impacts patient outcomes. This study utilizes 3D Slicer software to analyse post-craniotomy hematoma volume changes and evaluate their prognostic significance in aSDH patients. Methods: Among 178 adult patients diagnosed with aSDH from January 2015 to December 2022, 64 underwent hematoma evacuation via craniotomy. Initial scans were performed within 24 h of trauma, followed by routine postoperative scans to assess residual hematoma. We conducted radiomic analysis of preoperative and postoperative volumes, surface area, Feret diameter, sphericity, flatness, and elongation. Clinical parameters, including SOFA score, APACHE score, pupillary response, comorbidities, age, anticoagulation status, and preoperative haematocrit and haemoglobin levels, were also evaluated. Results: Changes in Δ surface area significantly correlated with 30-day outcomes (p = 0.03) and showed moderate predictive accuracy (AUC = 0.65). Patients with a Δ surface area > 30,090 mm2 experienced poorer outcomes (OR = 6.66, p = 0.02). Significant features included preoperative surface area (p = 0.009), Feret diameter (p = 0.0012). In multivariate analysis, only the Feret diameter remained significant (p = 0.01). Conclusions: Postoperative Δ surface area is, among other variables, a strong predictor of 30-day outcomes, while in multivariate analysis, preoperative Feret diameter remains the only independent predictor. Radiomic analysis with 3D Slicer may enhance prognostic accuracy and inform tailored therapeutic strategies.