Adequate Outcome Research Articles

Fixed Dose Versus Height and Weight Adjusted Dose of Bupivacaine for Spinal Anesthesia in Elective Caesarean Section

Background: Spinal anesthesia is gaining global popularity. Caesarian section with spinal anesthesia are considered one of the comment applied surgeries. Hypotension is one of most frequent side effect of spinal anesthesia, if uncorrected causes adverse effect on the mother and neonate . The aim of this study is to assess the hemodynamic measures and anesthetic outcome between fixed dose and adjusted for weight and height dose of bupivacaine. Patients and method: A comparative clinical trial double-blinded study was conducted in the operation theatre of the obstetric surgical department, Baghdad Teaching Hospital, Baghdad, Iraq during the period from the 1st of April 2022 to the 1st of July 2023. A total of 100 pregnant women were included in this study who underwent cesarean section under spinal anesthesia and met the inclusion criteria. These women were allocated randomly into two groups: Group A: Fixed dose group: 50 patients received an intrathecal dose of heavy bupivacaine (0.5%) 2.5 ml. Group B: adjusted dose group: 50 patients received intrathecal adjusted dose heavy bupivacaine (0.5% ) according to height and weight of patient from Hartens chart. Results: A higher mean SBP was reported among the adjusted dose group at 15 min., 20 min., 30 min., and 40 min. (P=0.002, 0.002, <0.001, and <0.001 respectively). A higher mean DBP was reported among the adjusted dose group at 10 min., and 20 min. (P=0.037, and 0.005 respectively). A higher mean MBP was reported among the adjusted dose group at 30 min., and 40 min. (P=0.001, and <0.001 respectively). A lower mean HR due to bradycardia among some cases was reported among the fixed-dose group at 10 min., 30 min., and 40 min. (P=0.024, 0.034, and <0.001 respectively) lowest 10 min., 30 min., and 40 min. (P=0.024, 0.034, and <0.001 respectively). There 40.0% (20) patients in the fixed-dose group received an ephedrine dose once and 24.0% (12) patients in the fixed-dose group received an ephedrine dose more than once, and this was significantly higher than the adjusted dose (P=0.027). Conclusion: Adjusting bupivacaine dose in spinal anesthesia for elective cesarean sections provides favorable hemodynamic stability with adequate anesthetic outcome in both groups

Caught Between Stewardship and Resistance: How to Treat Acute Complicated Diverticulitis in Areas of Low Antimicrobial Susceptibility?

Antimicrobial resistance is one of the main threats to public health, with multidrug-resistant (MDR) pathogens on the rise across continents. Although treatment guidelines generally recommend antimicrobial therapy for acute complicated diverticulitis, they do not specify treatment pathways according to local or national resistance profiles. There is sparse data regarding specific pathogens involved in Hinchey II–IV patients who undergo surgery. This study seeks to address these issues and determine how often and what types of MDR bacteria occur in patients undergoing emergency surgery. We prospectively enrolled patients admitted between 2020–2023 and who underwent emergency surgery for complicated acute diverticulitis. We analysed the inflammatory response parameters at admission, the type of surgery employed for source control, identified pathogens in the peritoneal samples, their antimicrobial susceptibility, the efficacy of antimicrobial empiric therapy, and mortality. Gram-negative bacteria were identified most often, with Escherichia coli being mostly MDR (43.9%) or extended-spectrum beta-lactamase producing (ESBL +ve) (24.4%), while most strains of Klebsiella pneumoniae were extended-spectrum beta-lactamase positive (ESBL +ve) (80%) and MDR (80%). Of the Enterococcus spp., 57.14% were vancomycin-resistant (VRE) strains. Patients with Hinchey III/IV were significantly more associated with MDR. Patients with multiple pathogens were significantly associated with ESBL+/VRE strains. Age, leucocytosis, and procalcitonin levels at admission were good indicators for mortality prediction, which occurred in four cases. In an age when antibiotic stewardship is advisable especially in emergency settings, the treatment should be tailored according to local profiles of MDR to ensure adequate outcomes for patients.

Treatment Stability and Intermolar Width Changes in Patients Undergoing Surgically Aided Rapid Palatal Expansion: A Systematic Review

Introduction: The primary objectives of this systematic review were to critically evaluate clinical research assessing the stability of treatment outcomes following surgically aided rapid palatal expansion (SARPE) and to review published studies on intermolar width measurements taken before and after the treatment.Materials and Methods: A complete search across the electronic databases of the Cochrane Library, Google Scholar, PUBMED, Europe PMC and Science Direct, and a complimentary manual search of all orthodontic journals until 2024 were carried out. Selection criteria were used in the evaluation of the articles.Selection Criteria: Based on the PICOS (population, intervention, comparison, outcome, study design), the inclusion criteria were established. Adult patients with constricted maxillary arches and resulting transverse discrepancies were included in the study, and SARPE was carried out to address this clinical problem. Although many studies have been conducted on this topic, only randomized clinical trials were covered in this review. Excluded from this review were case reports, conference papers, animal experiments, in vitro research, case series, and FEM studies.Data Collection and Analysis: The primary outcome of the systematic review was the assessment of treatment stability and intermolar width changes in patients who underwent surgically aided rapid palatal expansion (SARPE). The selection of studies and data collection were conducted using standard methodological techniques. The assessment of the risk of bias was conducted, and the results were synthesized. Cochrane Risk of Bias was used for evaluating the outcomes obtained in the various studies. They were assessed by the GRADE protocol for Outcome Assessment for listing the parameters studied.Results: No significant difference in stability was noted between the two groups.Conclusion: With adequate literature review and outcome assessment, it can be concluded from this review that weak evidence exists to conclusively prove the stability of SARPE in the inter-molar and inter-first premolar regions. Immediate post-surgical stability is dependent on a variety of factors that have not been standardized in the various RCTs. Further well-designed trials that establish the extent of transverse discrepancies along with defining the obtained results with clarity are required before we obtain sufficiently conclusive outcomes.

Thoracic spinal cord trauma: an adequate functional outcome with timely surgical management

Thoracic spinal cord trauma: an adequate functional outcome with timely surgical management

Kidney-Sparing Management of UTUC in Solitary Kidney Patients: A Retrospective Analysis and Narrative Review.

Background/Objectives: The aim of this study is the presentation of an endoscopic therapeutic approach for three patients with a solitary kidney who were diagnosed with urothelial cancer of the upper tract. Methods: This retrospective analysis included patients with solitary kidneys who suffered from high-grade UTUC (urothelial cancer of the upper urinary tract) and underwent conservative treatment. Results: The first patient was a 67-year-old male who had a prior history of a nephroureterectomy due to UTUC six years ago. The patient was diagnosed with high-grade UTUC in the contralateral kidney. The tumor has been managed with endoscopic ablation. The second patient was a 74-year-old male with a non-functional kidney and high-grade UTUC diagnosed in the contralateral side. The patient underwent endoscopic ablation for the tumor. The third case was a 68-year-old female patient who had a history of a nephroureterectomy due to UTUC. Afterward, she was diagnosed with high-grade UTUC in the contralateral kidney. The patient was treated with percutaneous tumor resection and the placement of a nephrostomy tube. The first patient was included in an immunotherapy program based on an oncologist consultation after laser ablation treatment for Ta high-grade UTUC, followed by the endoscopic management of two recurrences. Afterward, no recurrence was detected. The remaining two patients followed up without the detection of a new recurrence. Conclusions: The kidney-sparing approach (tumor laser ablation or resection) for high-risk UTUC treatment in selected patients with solitary kidneys seems to provide adequate early outcomes in relation to preserving renal function and effective disease management. It is important to personalize the way of treatment in every case after a thorough examination of the patient's data.

Tying Arthroscopic Knot for Glenoid Suture Anchor

As arthroscopic and minimally invasive procedures have become increasingly more common over the past decade, a versatile understanding of several arthroscopic knot tying techniques is essential for reproducible and reliable repairs. While there are numerous descriptions of unique arthroscopic knots, selection and correct implementation is critical for adequate soft tissue fixation and successful patient outcomes. Specifically, the Roeder knot, a type of locking sliding knot, with 3 alternating half hitches, has been described to provide the loop and knot security among other sliding knot techniques. Therefore, the Roeder knot has emerged as a preferred knot tying technique amongst orthopedic surgeons, especially in the setting of arthroscopic shoulder stabilization procedures. In this case, we describe the basic fundamentals of performing a Roeder knot with 3 alternating half hitches to anchor the labrum to the glenoid in the setting of an arthroscopic Bankart repair.

Effects of Neoadjuvant Radiation and Recipient Vessel Characteristics on Microvascular Complication Rates in Reconstruction of Lower Extremity Soft-Tissue Sarcoma Defects.

The treatment approach for soft-tissue sarcomas (STS) of the lower extremity has shifted toward the use of neoadjuvant radiation combined with limb-sparing surgery (LSS). The resulting defects often require reconstruction with free tissue transfer for adequate outcomes. Data has demonstrated a potential increased risk of microvascular complications for free flaps performed using irradiated recipient vessels. Similarly, certain anatomic areas of the lower extremity have a high proportion of unnamed perforators that are available as recipient vessels, increasing the technical difficulty. We aimed to determine if the characteristics of recipient vessels that were used for reconstruction of STS defects influenced rates of microvascular complications in our patients. A retrospective chart review of all patients who underwent reconstruction of lower extremity STS defects with free tissue transfer from 2009-2020 was conducted. Data regarding recipient vessel type (axial vessel vs. unnamed perforator), radiation status of the recipient vessels (irradiated vs. non-irradiated), and microvascular complications was compared across groups. A total of 204 free flaps were included. The overall microvascular complication rate was 13.7% (28 cases). Most microvascular complications were detected postoperatively (82.1%) rather than intraoperatively, with the majority involving venous congestion/thrombosis (20 cases, 71.4%). While there was a trend toward increased microvascular complications with the use of irradiated recipient vessels (27 cases, 96.4%), this did not reach statistical significance (OR = 1.98, p = 0.52). The use of perforating branches as recipient vessels did not confer increased risk of microvascular complications (OR = 0.87, p = 0.75). Reconstruction of irradiated lower extremity STS defects represents a particularly challenging issue. This analysis demonstrates that free tissue transfer can be safely performed using irradiated vessels without significant increased risk of microvascular complications. Furthermore, unnamed perforating branches can also be successfully used for reconstruction in anatomically challenging areas of the lower extremity.

Social network interventions for dietary adherence among adults with type 2 diabetes: a systematic review and meta-analysis protocol

IntroductionOptimal adherence to recommended diets is crucial to achieving long-term glycaemic control among individuals with type 2 diabetes (T2D) individuals. However, there is limited evidence on the effectiveness of interventions...

Efficacy and safety of laparoscopic urethral anastomosis in the repair of congenital urethral stricture in children: a systematic review

Introduction: Congenital urethral strictures are rare but significant defects in pediatric urology, causing urinary system abnormalities. These defects are difficult to manage in children due to differences in anatomy and physiology. Laparoscopic urethral anastomosis, a minimally invasive surgery, has become a popular option in pediatric urology.Objective: The research paper was aimed to assess the outcomes of laparoscopic urethral anastomosis in the pediatric patients with congenital urethral strictureMethods: This review article focuses on the effectiveness and safety of laparoscopic urethral anastomosis in pediatric patients. It includes studies focusing on pediatric patients, surgical outcomes, and published in peer-reviewed journals. Exclusions include adult populations, non-academic studies, non-academic methods, lack of adequate outcome data, and non-academic studies. Data integration and statistical evaluation are performed using a systematic review approach.Result: The studies were selected for the analysis, and the results showed that laparoscopic urethral repair is a secure method with positive postoperative results. The subcuticular uninterrupted suturing method exhibited a reduced complication rate compared to full-thickness interrupted stitches in distal hypospadias treatment. Various suturing methods such as close and open reported various complications. Interrupted suturing in the urological surgical procedure showed a tendency for reduced incidence of urethrocutaneous fistula development. The review indicated that urethral surgical intervention showed significant positive consequences.Conclusion: It was concluded that both interrupted and continuous suturing techniques were effective in treating pediatric patients with congenital urethral strictures. However interrupted suturing showed a potential benefit. The study highlighted the need for more large-scale, randomized controlled trials to validate these findings and improve surgical methodologies and postoperative outcomes

Long-term Outcomes of Complete Tears of the Distal Biceps Tendon: An Analysis of Surgical Management at a Median Follow-up of 14.7 Years.

Surgical repair of full thickness biceps tears has demonstrated adequate outcomes in short and mid-term studies. However, data on the long-term outcomes of full thickness distal biceps injuries and their treatment are currently lacking. The purpose of this study was to report on patient demographics, injury characteristics, and long-term outcomes for patients with full-thickness distal biceps tears. It was hypothesized that complete distal biceps tears managed operatively would demonstrate robust clinical success at long-term follow-up. Case series; Level of evidence, 4. Patients with magnetic resonance imaging-confirmed, complete distal biceps tendon rupture sustained between 1996 and 2016 were identified. Patients were cross-referenced with a regional geographic database. A total of 66 patients (3 female, 63 male) with a median age of 50.8 years (IQR, 41.5-60.4) and a median clinical follow-up of 14.7 years (IQR, 9.6-17.9 years) were included. Patients who sustained a full-thickness distal biceps tendon tear were likely to be in their early 50s, male, right-hand dominant, current/former smokers, and laborers with a history of traumatic injury during an intentional movement. Most of these patients had pain and supination weakness but no loss of range of motion. All included tears were treated operatively. At final follow-up, patients maintained a majority of near-normal range of motion (median total arc of flexion/extension 140° and supination/pronation 80°), excellent elbow flexion strength (91% of patients had full strength), and adequate elbow supination strength (76% of patients had full strength). The overall complication rate was 24%, with 16 out of 66 patients experiencing some type of complication between infection, rerupture, heterotopic ossification, reoperation, and nerve complications. Overall return to work was 98%, and 85% of those who returned to work did so without restrictions. Complete tears of the distal biceps were most common in patients 50 years of age, male sex, right-hand dominant, and current/former smokers. The most common profession was laborer, and injuries were primarily traumatic in nature during intentional activity. Patients managed operatively demonstrated high rates of success at long-term follow-up with respect to elbow function and clinical outcomes.

Awareness, treatment, and control among adults living with arterial hypertension or diabetes mellitus in two rural districts in Lesotho.

In Lesotho, the hypertension and diabetes care cascades are unknown. We measured awareness, treatment, and control of hypertension and diabetes among adults ≥18 years and identified factors associated with each step of the cascade, based on data from a population-based, cross-sectional survey in 120 randomly sampled clusters in the districts of Butha-Buthe and Mokhotlong from 1st November 2021 to 31st August 2022. We used multivariable logistic regression to assess associations. Among participants with hypertension, 69.7% (95%CI, 67.2-72.2%, 909/1305) were aware of their condition, 67.3% (95%CI 64.8-69.9%, 878/1305) took treatment, and 49.0% (95%CI 46.3-51.7%, 640/1305) were controlled. Among participants with diabetes, 48.4% (95%CI 42.0-55.0%, 111/229) were aware of their condition, 55.8% (95%CI 49.5-62.3%, 128/229) took treatment, and 41.5% (95%CI 35.1-47.9%, 95/229) were controlled. For hypertension, women had higher odds of being on treatment (adjusted odds ratio (aOR) 2.54, 95% CI 1.78-3.61) and controlled (aOR 2.44, 95%CI 1.76-3.37) than men. Participants from urban areas had lower odds of being on treatment (aOR 0.63, 95% CI 0.44-0.90) or being controlled (aOR 0.63, 95% CI 0.46-0.85). Considerable gaps along the hypertension and diabetes care cascades in Lesotho indicate that access and quality of care for these conditions are insufficient to ensure adequate long-term health outcomes.

Postoperative outcomes among patients evaluated via telemedicine-based preoperative consultations for inguinal hernia care.

In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments. We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders. 265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003). Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices.

Bio-Inspired Motion Emulation for Social Robots: A Real-Time Trajectory Generation and Control Approach.

Assistive robotic platforms have recently gained popularity in various healthcare applications, and their use has expanded to social settings such as education, tourism, and manufacturing. These social robots, often in the form of bio-inspired humanoid systems, provide significant psychological and physiological benefits through one-on-one interactions. To optimize the interaction between social robotic platforms and humans, it is crucial for these robots to identify and mimic human motions in real time. This research presents a motion prediction model developed using convolutional neural networks (CNNs) to efficiently determine the type of motions at the initial state. Once identified, the corresponding reactions of the robots are executed by moving their joints along specific trajectories derived through temporal alignment and stored in a pre-selected motion library. In this study, we developed a multi-axial robotic arm integrated with a motion identification model to interact with humans by emulating their movements. The robotic arm follows pre-selected trajectories for corresponding interactions, which are generated based on identified human motions. To address the nonlinearities and cross-coupled dynamics of the robotic system, we applied a control strategy for precise motion tracking. This integrated system ensures that the robotic arm can achieve adequate controlled outcomes, thus validating the feasibility of such an interactive robotic system in providing effective bio-inspired motion emulation.

Clinical effectiveness of customized versus noncustomized orthodontic appliances: A systematic review.

To evaluate the clinical effectiveness of treatment with customized compared to noncustomized fixed orthodontic appliances. A comprehensive search was performed using 13 databases until February 20, 2024. Study eligibility criteria were based on studies that compared orthodontic treatment with customized fixed appliances (labial or lingual) with noncustomized appliances. All ages and types of malocclusions were included. The search identified 95 studies, of which only four fulfilled the inclusion criteria. Three studies compared labial customized brackets with self-ligating brackets, while one study compared lingual customized brackets with labial conventional brackets. There were no significant differences between these systems for treatment duration, outcome, number of appointments, analgesic consumption, patient satisfaction, and the archwire bends requirement. On the other hand, treatment planning was longer and the finishing and detailing phase was shorter in the customized appliances. There was a greater tendency for mandibular incisor proclination and bracket repositioning in the noncustomized appliances group and a greater number of bracket failures, complaints, and requirements for archwire changes in the customized appliances. Qualitative synthesis was applied due to heterogeneity in investigating the difference between the two appliance systems. Based on the current limited evidence, the clinical effectiveness of customized and noncustomized orthodontic appliances was similar for the majority of clinical outcomes. Further high-quality clinical studies are required to confirm this finding. Proper treatment planning and clinical management are the key factors for adequate outcomes apart from the type of appliance used.

Deep learning-based digitization of Kurdish text handwritten in the e-government system

Many government institutions in developing countries such as the Kurdistan Region of Iraq (KRI) keep a variety of paper-based records that are available in printed or handwritten format. The need for technology that turns handwritten writing into digital text is therefore highly demanded. E-government in developed and developing countries is a crucial facilitator for the provision of such services. This paper aims to develop a deep learning model based on the mask region convolutional neural network (mask-RCNN) to effectively digitize kurdish handwritten text recognition (KHTR). In this research, typical datasets, which includes the isolated handwritten Central Kurdish character images, an extensive database of 40,410 images, and 390 native writers have been produced to determine the developed approach’s performance in terms of identification rates. This approach achieves adequate outcomes in terms of training time and accuracy. The proposed model gives higher performance for detection, localization, and recognition when using a dataset containing many challenges, the results were 80%, 96%, and 87.6 for precision, recall, and F-score respectively. The findings revealed that the proposed model obtained better results compared to other similar works. The accuracy of optical character recognition (OCR) is more than 99%.

Challenges in the evaluation of suicide prevention measures and quality of suicide data in Germany, Austria, and Switzerland: findings from qualitative expert interviews

BackgroundSuicide prevention requires diverse, integrated, and evidence-based measures. Comprehensive evaluation of interventions and reliable suicide data are crucial for guiding policy-making and advancing suicide prevention efforts. This study aimed to analyze current issues and gaps in the evaluation of suicide prevention measures and the quality of suicide data in Germany, Austria, and Switzerland to derive specific recommendations for improvement.MethodsOnline, semi-structured interviews were conducted with 36 experts in suicide prevention from Germany, Austria, and Switzerland, covering insights from policy, science, and practice. The interviews took place between September 2022 and February 2023, were audio-recorded, transcribed verbatim, and analyzed using the Framework method.ResultsWhile solid evidence supports the effectiveness of some suicide prevention interventions, experts indicated that the evaluation of many other measures is weak. Conducting effectiveness studies in suicide prevention presents a range of methodological and practical challenges, including recruitment difficulties, choosing adequate outcome criteria, ethical considerations, and trade-offs in allocating resources to evaluation efforts. Many interviewees rated the quality of national suicide statistics in Germany, Austria, and Switzerland as comparatively high. However, they noted limitations in the scope, timeliness, and reliability of these data, prompting some regions to implement their own suicide monitoring systems. None of the three countries has national routine data on suicide attempts.ConclusionWhile some challenges in evaluating suicide prevention measures are inevitable, others can potentially be mitigated. Evaluations could be enhanced by combining traditional and innovative research designs, including intermediate outcomes and factors concerning the implementation process, and employing participatory and transdisciplinary research to engage different stakeholders. Reliable suicide data are essential for identifying trends, supporting research, and designing targeted prevention measures. To improve the quality of suicide data, a standardized monitoring approach, including uniform definitions, trained professionals, and cross-sector agreement on leadership and financing, should be pursued. This study provides actionable recommendations and highlights existing good practice approaches, thereby supporting decision-makers and providing guidance for advancing suicide prevention on a broader scale.

1000 Robotic-assisted lobectomies for primary lung cancer: 16 years single center experience

ObjectiveThis study aimed at describing our high-volume single center experience in robotic-assisted thoracic surgery (RATS) to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve. MethodsWe retrospectively analyzed data from 1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach between May 2007 and May 2023. ResultsNine-hundred ninety-seven patients (99.7 %) underwent lobectomy, whereas 3 (0.03 %) patients bilobectomy. Conversion rate to open surgery was 3.7 %. Minor complications occurred in 213 (21.3 %) patients, major complications in 29 patients (2.9 %). The 30-day and 90-day operative mortality was 0 % and 0.1 %, respectively. The median number of N1 + N2 stations resected was 5 (range 0–9), with a median number of 17 of N1 + N2 lymph nodes resected (range 0–55). The oncological outcome was evaluated only on the subgroup of patients (n = 895) with non-small cell lung cancer. Pathological lymph node upstaging from cN0 to pN1/pN2 was evident in 147 patients (17.3 %): 9 % from cN0 to pN1 and 7.1 % from cN0 to pN2. With a median follow-up of 3.9, 5-year OS and DFS were respectively 89.3 % and 83.6 % for stage I, 74 % and 66.5 % for stage II, and 61 % and 36.4 % for stage IIIA. ConclusionsBetter vision and excellent instrument maneuverability of the robotic surgical system allowed excellent results in terms of early, adequate oncological outcome comparable to open surgery literature data, and acceptable learning curve. Ultramini abstract1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach have been analyzed with the aim to describe our high-volume single center experience, and to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve.

Robotic versus laparoscopic right colectomy for nonmetastatic pT4 colon cancer: A European multicentre propensity score-matched analysis.

Minimally invasive surgery has been increasingly adopted for locally advanced colon cancer. However, evidence comparing robotic (RRC) versus laparoscopic right colectomy (LRC) for nonmetastatic pT4 cancers is lacking. This was a multicentre propensity score-matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra- and postoperative complication rates, overall (OS), and disease-free survival (DFS). Among a total of 200 patients, 39 RRC were compared with 78 PS-matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1-, 3- and 5-year OS (p = 0.757) and DFS (p = 0.321) did not significantly differ between RRC and LRC. Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short-term postoperative outcomes.

258 Ultrasonography-Guided Drainage Versus Surgical Drainage for Deep Neck Space Abscesses: A Systematic Review and Meta-Analysis

Abstract Aim Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies. We conducted the first and robust systematic review and meta-analysis to evaluate outcomes for ultrasonography-guided drainage (USD) versus conventional surgical incision and drainage (I&amp;D). Method The protocol was published a priori (PROSPERO: CRD42023466809) and the study adhered to PRISMA guidelines. MEDLINE, EMBASE, Cochrane CENTRAL and key ENT journals were searched. Primary outcomes were length of hospital stay and recurrence. The secondary outcomes included scar formation/cosmetic, reported complications and cost savings. The quality of included studies was assessed using the Cochrane ROBINS-I and RoB2.0 tools. Fixed effects model was applied. Results Of 646 screened articles, seven studies enrolling 384 participants were included. USD was associated with a significantly shorter length of hospital stay (Mean Difference [MD] = -2.31, P &amp;lt; 0.00001), but no statistically significant difference was noted in the recurrence rate compared to I&amp;D (odds ratio [OR] = 2.02, P = 0.21). USD appears to be associated with more cost-savings, better cosmetic outcomes, and fewer post-operative bleeding events. Conclusions USD appears to be associated with a shorter length of hospital stay, making it a viable and more cost-effective alternative. More randomized trials with adequate outcomes reporting are required to optimise the current evidence.

Issues in Distinguishing Sex and Gender in Surgical Registries: A NSQIP and VASQIP Analysis.

Surgical registries do not have separate sex (the biological construct) and gender identity variables. We examined procedures specific to sexually dimorphic anatomy, such as ovaries, testes, and other reproductive organs, to identify "discrepancies" between recorded sex and the anatomy of a procedure. These "discrepancies" would represent a structural limitation of surgical registries, one that may unintentionally perpetuate health inequities. Retrospective cohort study using 2015-2019 NSQIP and 2016-2019 VASQIP. Surgeries were limited to procedures pertaining to anatomy that is either specifically male (CPT codes 54000-55899) or female (56405-59899). The sex recorded in the surgical registries, often automatically retrieved from electronic health record data, was compared to the specified anatomy of each procedure to quantify discrepancies. 575,956 procedures were identified specific to sexually dimorphic anatomy (549,411 NSQIP; 26,545 VASQIP). Of those, 2,137 recorded a sex discordant with the anatomy specified by the surgical procedure (rates 0.4% in NSQIP; 0.2% in VASQIP). Procedures specific to female anatomy with recorded male sex were more frequent (82.6% in NSQIP; 98.4% in VASQIP) than procedures specific to male anatomy with recorded female sex. Discrepancies between recorded sex and the anatomy of a surgical procedure were limited. However, because sex in surgical registries is often directly acquired from electronic health record data, these cases likely represent transgender, gender diverse, or living with a difference of sex development (intersex) patients. As these populations increase and continue to seek healthcare, precise measurement of sex, gender identity, and legal sex is necessary for adequate risk adjustment, risk prediction, and surgical outcome benchmarking for optimal care.