Elective Cases Research Articles

Potential of D-Dimer as a Tool to Rule Out Sac Expansion in Patients With Persistent Type 2 Endoleaks After Endovascular Aneurysm Repair.

In managing type 2 endoleak (T2EL) following endovascular aortic aneurysm repair (EVAR), an indication for reintervention is aneurysm enlargement (AnE). A previous study found that low D-dimer levels (DDLs) at 1 year were associated with reduced AnE risk in patients with persistent T2ELs (pT2ELs). This study analyzed patients with pT2ELs to determine the correlation between DDLs at annual follow-ups and AnE and proposed a follow-up protocol incorporating DDL monitoring. A retrospective review of elective EVAR cases between June 2007 and January 2021 identified "persistent" T2EL as confirmed at both 6- and 12-month contrast-enhanced CT studies. "Isolated" T2EL referred to cases without other endoleak types within 12 months. Inclusion criteria comprised >2 years of follow-up, isolated pT2ELs at 1 year, and DDL data at any annual follow-up over 5 years. The association between DDL and AnE, defined as ≥5 mm expansion within 5 years, was analyzed. A total of 109 patients with DDL data at 288 time points were enrolled. During a median follow-up of 49 months [31-60, IQR], 43 AnE were observed. In patients without AnE and with DDL data at 1 and 2 years (N=77 and 56), lower DDLs were associated with a reduced AnE risk (p=0.03 and 0.01). Optimal cutoff points were 5.4 and 5.3 µg/mL (AUC=0.651 and 0.702) with high negative predictive values (86.9% and 93.8%). Cox regression analyses confirmed that DDLs surpassing the cutoff values correlated significantly with AnE (p=0.042 and p=0.038). Our simulated protocol for omitting imaging studies in patients with stable aneurysms and low DDL might have overlooked one AnE but could have saved 28 imaging studies over 3 years if implemented on our patients. Low DDLs at the 1- and 2-year follow-ups can potentially exclude AnE in pT2EL patients, suggesting DDL monitoring as a resource-saving approach. The management of type 2 endoleaks in post-EVAR patients has been a topic of debate. This retrospective single-center study, featuring strict inclusion criteria, included 109 patients with persistent type 2 endoleaks. The findings indicate that patients with lower D-dimer levels at 1- and 2-year follow-ups are unlikely to experience sac enlargement ≥5 mm within 5 years, even in the presence of type 2 endoleaks. This study suggests that D-dimer monitoring has the potential to reduce reliance on imaging studies for the follow-up of patients with type 2 endoleaks, leading to significant savings in medical resources.

Association of Same-day Antiplatelet Loading and Outcomes after TransCarotid Artery Revascularization.

Prior studies have emphasized the importance of compliance with preoperative dual antiplatelet therapy (DAPT) in patients undergoing TransCarotid artery revascularization (TCAR). This investigation examines differences in perioperative outcomes following TCAR in those receiving loading dose of antiplatelet medications on the day of the procedure versus those already maintained on DAPT. Consecutive TCAR procedures from the Vascular Quality Initiative (2016-2022) were identified. Patients were divided into: 1) those on preoperative DAPT (Aspirin and P2YI2 antagonist) taken at least within 36 hours of the procedure (61.9%); 2) those on at least 1 antiplatelet medication who received a supplemental dose of another antiplatelet within 4 hours before the procedure (AP + Loading, 37.1%); 3) Patient receiving only a loading dose (of aspirin or P2Y12 antagonist) without prior use of antiplatelet therapy (1%). In-hospital and 30-day outcomes were compared between the 3 groups using univariable and multivariable analysis. A total of 22,310 patients were on DAPT, 13,392 were on at least one antiplatelet and received a supplemental dose (AP+Loading) and 361 patients received a loading dose on the day of the intervention. On univariable analysis, there was no significant difference in in-hospital or 30-day outcomes between the 3 groups, except for an increased rate of in-hospital stent thrombosis/occlusion in patients loaded with antiplatelet medications on the day of TCAR (n=2, 0.6%), compared to those maintained on DAPT (n=23, 0.1%) and patients in the AP+loading group (n=26, 0.2%) (P=0.01). After adjusting for baseline differences between the 3 groups, no significant association was observed between the groups and in-hospital stroke/death or bleeding complications. However, compared to patients maintained on DAPT, patients receiving antiplatelet loading had higher odds of stent thrombosis/occlusion [1.92 (1.08-3.4), P=0.03]. Among patients in the AP+loading group, those maintained on aspirin preoperatively and receiving another antiplatelet loading on the day of the intervention were more likely to have stent thrombosis. This study demonstrates that administering loading or supplemental doses of antiplatelet medication (s) to rapidly achieve therapeutic levels on the day of TCAR is not associated with higher rates of in-hospital stroke or bleeding complications. However, an increase in stent thrombosis/occlusion was noted in patients receiving loading/supplementation of antiplatelet medications and warrants further investigation. In elective cases, it might be safer to delay intervention until patients receive adequate DAPT regimen, especially if patients are not maintained on P2Y12 inhibitors preoperatively.

A Retrospective Review of Ambulatory Oral and Maxillofacial Surgery in a Suburban Tertiary Hospital in Nigeria

Background Ambulatory surgical procedures are integral aspects of oral and maxillofacial surgical (OMS) practice. Objective The aim of this study is to report the scope of ambulatory OMS procedures in a Nigerian suburban teaching hospital. Method A retrospective review of ambulatory OMS procedures performed at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between March 2021 and February 2022 was conducted. Sociodemographic data, diagnoses, procedures, type of anesthesia, and immediate postoperative complications were retrieved from patients' records. Data were analyzed using the Statistical Package of Social Sciences (SPSS) version 22. Results Two hundred and fifty-two ambulatory OMS procedures were performed during the 12-month study period. This accounted for 80.3% (252/314) of elective surgeries. The patients' mean (standard deviation [SD]) age was 32.2 (10.4) years, while a slight male preponderance (51.6%) was recorded. Third molar surgery was the commonest (48.0%) procedure undertaken in ambulatory setting. Most (90.9%) of them were performed under local anesthesia. Satisfactory postoperative pain control was achieved with the use of oral nonsteroidal anti-inflammatory analgesics in most patients (81.7%). However, owing to a failed ambulatory session, there was an eventual admission rate of 0.4% (1/252). Conclusion Ambulatory surgical procedures constitute the majority of the OMS elective cases, with third molar surgery being the commonest procedure. Judicious prescription and administration of oral analgesics were effective in managing postoperative pain in our day case OMS patients. We recommend a prospective study to determine an intermediate/long-term outcome of care in ambulatory settings.

Factors associated with elective surgical case cancellation at a tertiary hospital in Malawi.

Same-day cancellation of surgery affects up to 44% of cases at a public tertiary hospital in Lilongwe, Malawi. To characterize these cancellations, this study examines surgical volume, cancellation causes, and surgery completion rate after initial cancellation, which are not otherwise monitored for analysis in this setting. We conducted a serial cross-sectional study at the Kamuzu Central Hospital (KCH) during a 6month period. Variables included patient demographics, procedure information, and hospital capacity factors. Bivariate and multivariable regression models were constructed to assess factors associated with cancellation. Of the 3121 total surgeries, 2626 (84.1%) were elective procedures, of which 747 (28.4%) were canceled. Orthopedic surgery observed the highest cancellation rate (36.5%). Process-related factors, such as starting cases late, were the primary reason for cancellation (64.3%). Only 40% of patients with a canceled surgery underwent their procedure after index admission, with a median wait time of 3days. Emergency cases (aOR: 0.50 and CI: 0.39 and 0.64) and first cases of the day (aOR: 0.02 and CI: 0.01 and 0.04) were associated with lower odds of cancellation. Facility factors associated with lower odds of cancellation included number of open operating rooms (OR: 0.86 and CI: 0.77 and 0.96) and anesthetists assigned on duty (OR: 0.94 and CI: 0.88 and 0.99). Cancellation of elective surgery was primarily driven by process-related factors. We identify facility-related factors associated with lower odds of cancellation and thus provide targets for future interventions at KCH. Studies examining patient outcomes following elective case cancellation are warranted as most patients never return for surgery following cancellation.

Early outcomes of treatment selections for infrarenal abdominal aortic aneurysms: The first five year experience of a single center

Aim: We examined the criteria governing patient selection in contemporary practice in cases of infrarenal abdominal aortic aneurysm (AAA) treated electively or urgently in our Cardiovascular Surgery Clinic (CVSC). Material and Methods: From January 2019 to January 2024, we retrospectively evaluated infrarenal AAA patients treated either electively or urgently with Open Surgical Repair (OSR) or standard Endovascular Aortic Repair (EVAR) at our CVSC. The primary endpoints are distribution of AAA patients by treatment modality, early morbidity and mortality. The secondary endpoints were intensive care unit (ICU) duration and length of hospital stay (LOS). Results: A total of 332 patients received EVAR (Group 1), including 296 elective cases, while 90 patients underwent OSR (Group 2), with 66 being elective. Early mortality rates were significantly lower in the EVAR group (1.3% for elective and 27.8% for emergent) compared to the OSR group (6.1% for elective and 54.2% for ruptured cases, p=0.001). Major postoperative complications occurred in 12.5% of elective EVAR patients and 39.4% of elective OSR patients (p=0.001), while in ruptured cases, the rates were 11.1% and 58.3%, respectively (p=0.001). Comparisons of ICU duration and LOS also favored EVAR (p=0.001). Conclusion: EVAR offers a survival benefit in the early period compared to OSR. The choice of treatment should be tailored to the patient's comorbidities, preferences, and the vascular surgeon's expertise. Advanced aortic centers with hybrid operating rooms (HOR) and specialized CVSCs should aim for optimized patient outcomes and cost-effectiveness in our country.

BN SO11 - Optimising Day Case Laparoscopic Cholecystectomy: A GIRFT-Based Audit and Efficiency Analysis

Abstract Background Laparoscopic cholecystectomy (LC) is the gold standard for managing symptomatic gallstone disease and is commonly performed as a day surgery procedure due to its safety and efficiency. Despite its established benefits, recent analyses at our local hospital revealed a decline in the day case rate for elective LC, falling below the national median as highlighted by the Get It Right First Time (GIRFT) data. Method We analysed patient data for elective LC performed between 1st October 2023 and 29th February 2024. The data included patient demographics, length of stay, and reasons for unplanned admissions. Procedures from the hot and emergency lists were excluded from the analysis. To enhance the day case rate, a business case was developed to extend recovery staffing levels and coverage hours in the DSU from 6pm to 9pm. Additionally, we requested the coding team to distinguish elective cases from hot list cases for more accurate future analyses. The impact of these changes will be evaluated in a subsequent audit cycle. Results During the observed period, 86 elective LC cases were performed, with a day case rate of 64% (55/86), exceeding the national median of 60%. The discrepancy with the GIRFT analysis was due to the inclusion of hot list cases in their data. The primary reasons for unplanned admissions included monitoring observations (46%), late afternoon extubations (29%), and intra-operative concerns (18%). The median length of stay for unsuccessful day cases was 1 day. Cost analysis estimated the unplanned admission costs at over £12,000 for LC alone during the observed period, based on the NHS National Tariff 2024/25. Conclusion This audit demonstrated that our day case rate for elective LC surpasses the national median. By identifying key factors leading to unplanned admissions, we implemented targeted interventions, such as extending recovery area hours. These measures aim to further improve the day case rate, enhance patient care, and achieve significant cost savings.

BN SO14 - Evaluation of local cholecystectomy service and outcomes (Local Data for GECKO study)

Abstract Background Cholecystectomy is a common procedure performed for different biliary pathologies. Patients have their procedure as elective, emergency, or prioritised bases (Hot Gall bladder service). Method GECKO is a prospective, international, observational collaborative cohort study Consecutive patients undergoing cholecystectomy, between 23rd Oct – 19th Nov 2023 with follow-up at 30-day and one-year postoperatively Results Over a 4-week period , 38 cholecystectomies were performed, with 47.5% of patients having prior cholecystitis or cholangitis and multiple admissions. Half of the surgeries occurred within 6 months, and the longest wait was 13 months. Procedures were split equally between elective and emergency cases. Indications included acute cholecystitis (13), biliary colic (11), and others. All surgeries were laparoscopic, with 2 subtotal cholecystectomies. Complications included bile or stone spillage (12) and bleeding (7). Postoperative follow-up showed 16 patients discharged within 24 hours, 3 readmissions, and a 37% complication rate. No bile leaks or CBD injuries were reported. Conclusion Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions and treatments, with no significant associated complications. Selective gall bladder histological examination may help cost reduction with no significant recognised risks in the literature.

BN O02 - Introducing the Cholecystectomy Urgency Index (CUI) – A novel way to visualise and optimise the waiting list for laparoscopic cholecystectomy at a large district general hospital

Abstract Background Gallstone disease effects approximately 10-15% of the adult population, and laparoscopic cholecystectomy is one of the most common surgical procedures in the UK, with over 60,000 performed each year. Delays to surgery from diagnosis has been found to increase patient morbidity and readmission rate. Waiting lists in the UK have been struck with a significant backlog from the COVID-19 pandemic, and navigating this ever-expanding patient population to determine priority for booking cases is complex. We propose a new system to prioritise and visualise this cohort of patients in real time – the Cholecystectomy Urgency Index. Method At one large district general hospital, we had a waiting list of 148 patients for laparoscopic cholecystectomy. We identified the individual underlying pathology and established the waiting time since diagnosis to allocation of operative date. We used excel to formulate a pairwise scatter plot of the waiting list patients based upon the time waiting. We were able then to colour code them based on pathology (biliary colic/cholecystitis/cholangitis/pancreatitis/obstructive jaundice). We were then able to link this directly to our scheduling to create a live, visual representation of our waiting list, by both days waited and causative pathology. Results We found our median wait times for patients varied based on pathology: Biliary Colic = 185 days, Cholecystitis = 57 days, Pancreatitis, Cholangitis and Obstructive Jaundice (OJ) = 65 days. We found that the pairwise scatter plot provided a rapidly accessible, easily identifiable visual representation of our patient cohort by both days waited and diagnosis. This allows relevant staff, surgeons and schedulers to plan elective cases according to both urgency and time waited. Long waiters are easily identified as outliers on the graph and can therefore be flagged for last minute cancellation slots. Conclusion By using this system, we can optimise our waiting lists, improve productivity and patient outcomes. We propose a system to enable this further when booking patients: to give them a colour coded CUI number of 1-3. 1 being biliary colic, 2 – cholecystitis, 3 – pancreatitis/cholangitis/OJ. This will be directly linked to our scatter graph and in doing so, provides us with a readily available, live snapshot in time of the current wait list. This system allows for both clinical urgency prioritisation and easy visualisation of patient cohorts, thus catalysing the elimination of long waiters by means of clear identification.

HPB SO68 - Evaluating the Outcome of Laparoscopic Cholecystectomy Against Key Performance Indicator (KPI) of the British Benign Upper GI Surgical Society (BBUGSS)

Abstract Background Laparoscopic cholecystectomy (LC) presents inherent challenges and potential for significant complications, influenced by both patient factors and surgical expertise. Recognizing this variability, the British Benign Upper GI Surgical Society (BBUGSS) has established Key Performance Indicators (KPIs) aimed at enhancing LC outcomes. This study conducts an audit of LC outcomes in a single centre district general hospital (DGH) in accordance with BBUGSS KPIs and thus aims to determine if quality LC by modern standards is achievable in a DGH. Method The present retrospective observational study examined all adult LC conducted between August 2022 and June 2024 by two specialized biliary surgeons at a single surgical unit within a DGH, which also serves as a referral center of biliary cases from affiliated hospitals. The analysis encompassed preoperative assessments, intraoperative observations, and postoperative outcomes, with a focus on aligning these findings against the benchmarks established by the BBUGSS KPIs. Results 141 patients were included; median age was 54 years (IQR 41-64) and 59.6% were female. 37.6% were emergency cases, 44.2% were for acute cholecystitis, 22.7% for gallstone pancreatitis and 63.1% underwent intra-operative cholangiogram. KPIsBBUGSS StandardOur resultDay case for elective cases50%42%Readmission (within 30 days)<10%4.3%Laparoscopic cholecystectomy for acute cholecystitis (within 7 days)>35%97%Laparoscopic cholecystectomy for gallstone pancreatitis (within 2 weeks)>95%100%Conversion to open<5%0.7%Morbidity<10%1.4%Bile leak after elective surgery<1.5%0%Retained bile duct stones<2.5%0%Bile duct injury<0.3%0%Mortality<0.1%0% Conclusion This study shows that with the exception of day-case rate in elective LC, all KPIs were satisfactorily achieved, indicating that high quality LC is achievable within a DGH. The majority of readmissions within 30 days were related to inadequate postoperative analgesia. We have since enhanced pain management pathways. It is hoped that this will also improve same day discharge for elective cases to achieve BBGUGS standard. We are committed to conducting annual audits to monitor and optimize surgical outcomes and would encourage other centers to consider adopting the same approach.

Multicentre retrospective analysis of physician-modified fenestrated/inner-branched endovascular repair for complex aortic aneurysms.

In this multicentre retrospective observational study, we present the early outcomes of physician-modified fenestrated/inner-branched endovascular repair for pararenal and thoraco-abdominal aortic aneurysms in patients at high risk for open surgical repair. We comprehensively reviewed the clinical data and outcomes of consecutive patients treated with physician-modified fenestrated/inner-branched endovascular repair for pararenal or thoraco-abdominal aortic aneurysms at six centres between December 2020 and December 2021. Primary end-points included technical success, in-hospital mortality rates, major adverse events. Seven and 31 patients (median age, 80.5 years) had pararenal and thoraco-abdominal aortic aneurysms, respectively, involving 93 renal-mesenteric arteries incorporated through 10 fenestrations or 83 inner branches. Seven patients (18.4%) were treated non-elective conditions. The technical success rate was 89.5%. The median operative time was 334.5 min. Ten patients (26.3%) experienced major adverse events, including in-hospital mortality in six patients (15.8%), acute kidney injury in three patients (7.9%), respiratory failure in three patients (7.9%), bowel ischaemia in one patient (2.6%), stroke in one patient (2.6%), and paraplegia in one patient (2.6%). Among elective cases, in-hospital deaths occurred in three patients (9.7%), while in non-elective cases, the mortality rate was higher, with three patients (42.9%) succumbing. The median follow-up duration was 14 months. physician-modified fenestrated/inner-branched endovascular repair is a viable treatment for pararenal or thoraco-abdominal aortic aneurysms in patients at high risk for open surgical repair. It provides customization without location constraints or production delays, but further validation is needed to ensure long-term reliability.

Abstract 4115399: Comparative Outcomes of Local-Regional Versus General Anesthesia in Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Background: Endovascular Aortic Aneurysm Repair (EVAR) has emerged as a less invasive approach to aneurysm repair. However, the optimal anesthesia modality for elective cases—general or local-regional—remains uncertain. This meta-analysis compares the outcomes of local-regional versus general anesthesia (GA) for abdominal EVAR. Methods: We searched MEDLINE, Embase, and Cochrane databases for studies comparing local-regional and general anesthesia for EVAR up to May 2024. Following the PRISMA protocol, 1,796 articles were screened. Endpoints included 30-day mortality, type I endoleaks, length of hospital stay (LHS), and Intensive Care Unit (ICU) admissions. A random-effects model with odds ratios (OR) and 95% confidence intervals (CI) was used for binary endpoints and mean difference (MD) for continuous endpoints. Heterogeneity was assessed using Q and I2 statistics. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence. Results: Sixteen cohort studies, encompassing 70,654 patients treated with EVAR after excluding overlapping populations, were included. All groups had similar demographics, American Society of Anesthesiologists physical status, and aneurysm type. The mean age was 73.6 years, and 88.1% were male. Local-regional anesthesia was associated with significantly lower 30-day all-cause mortality (OR 0.74; 95% CI 0.55 to 0.99; p=0.049; I2=0, Figure A), shorter LHS (MD -0.72 days; 95% CI -1.29 to -0.15; p=0.01; I2=87%), and less ICU admissions (OR 0.53; 95% CI 0.31 to 0.93; p=0.027; I2=98%). There was no increase in endoleaks in the local-regional group (OR 0.78; 95% CI 0.55 to 1.09; p=0.143; I2=29%, Figure B). The GRADE rated this evidence as moderate certainty and high importance. Conclusion: Local-regional anesthesia may be preferable to general anesthesia for EVAR, as it reduces 30-day mortality, ICU admissions, and hospital stay length without increasing the risk of type I endoleaks.

Predictors of In-hospital and Short-term Outcomes of Thoracic Endovascular Aortic Repair for Aortic Aneurysm and Aortic Syndrome: A Single-Center Experience

BACKGROUND: Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data. METHODS: This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent. Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention. RESULTS: The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively). CONCLUSIONS: In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

NCOG-15. CONNECTOME-BASED APPROACHES FOR PRESERVING COGNITIVE FUNCTION AND MINIMIZING DELIRIUM DURING GLIOMA RESECTION: A PILOT STUDY

Abstract AIM The surgical treatment of gliomas poses significant challenges due to the involvement of complex neural networks critical for cognitive functions. This study reviews the application of connectome-based approaches to minimize cognitive impairments and delirium during glioma resection, focusing on networks related to cognitive functions: the Default Mode Network (DMN), Dorsal Attention Network (DAN), Salience Network (SN), and Central Executive Network (CEN). METHODS Ten patients underwent surgery utilizing cloud-based connectomics software (Quicktome®), which maps the brain’s structural and functional connectivity. Preoperative MRIs with structural and functional connectome were performed for preoperative planning and intraoperative navigation. Preoperative neuropsychological assessments were conducted for elective cases. Only one patient was able to undergo awake craniotomy due to various medical, neurological and psychological limitations. Intraoperatively, with connectome-navigation guidance, a connectomics-based approach was conducted to preserve the networks. A semiquantitative analysis was performed as described (https://pubmed.ncbi.nlm.nih.gov/36719613). Pre- and postoperative (inpatient and 2 week follow up) RASS and NuDESC delirium screenings were performed, with long-term cognitive evaluations and repeat connectomics imaging planned. RESULTS Three out of ten patients presented with rapid functional deterioration and needed urgent surgical decompression had postoperative delirium. Connectome analysis showed involvement of cognition-related networks in these patients. Two out of 3 patients showed improvement in delirium scores at a two-week follow-up after tumor resection. CONCLUSION This pilot study suggests that factors such as acute presentation, emergency surgery, and tumor location involving and disrupting the DMN, SN, DAN, and CEN networks may contribute to early postoperative delirium. The study may pave the way for the efficacy of connectomics in preserving cognitive functions post-operatively, particularly when awake craniotomy is not possible. This approach holds promise for improving surgical outcomes, survival, and the quality of life for patients with gliomas by mitigating the cognitive impacts of tumor resection and postoperative complications.

A Comparative Study of the Incidence and Severity of Surgical Site Infection Following Emergency and Elective Abdominal Surgeries in a Tertiary Care Hospital

Background: Surgical site infection is a medical condition that develops up to 30 days after the surgery if no implants have been placed, and as long as 12 months if the patient has an implant device. SSIs pose a substantial barrier to healing and resumption of normal activities. SSIs and its side-effects have been noted as one of their primary contributors to the morbidity following surgery. This study will look at the incidence and severity of infections at the surgical site after both emergency and elective abdominal surgery. Methods: This is prospective observational research in patients who underwent Surgeries in either elective or emergency settings. Southampton wound assessment scale and the ASEPSIS wound scoring system were used in grouping the patients with SSI followed by each patient's SSI type was further recorded. The study also documented other factors, such as hospital stay and interventions. Results: There were one fifty participants in this study. 23 patients experienced SSI (6 elective cases and 17 emergency cases), while 127 people did not. The pathogens most commonly cultured were coagulase negative staphylococcus (CoNS, 8 cases), after which came Escheria coli. (4 cases). Conclusion: A higher prevalence of SSI is linked to factors including the patient's advancing age, a dirty wound, prolonged surgery, usage of drains, nutritional deficiency, anemia, and diabetes. The hospital personnel need to be more careful about following aseptic procedures and have more awareness of infection management.

Minimally Invasive Video-Assisted Surgery for Concomitant Ascending Aorta and Aortic Valve Replacement via Right Infra-Axillary Thoracotomy.

This study aims to assess the safety, efficacy, and esthetic outcomes of an innovative 4 cm right infra-axillary incision approach for concomitant ascending aorta and aortic valve replacement (AAR and AVR), with a specific focus on achieving optimal surgical outcomes while ensuring minimal visible scarring. We retrospectively examined all elective cases of concomitant AAR and AVR surgery performed at our institution from July 2021 to June 2023. Exclusions encompassed emergency surgery, acute type A aortic dissection, active aortic valve endocarditis, redo cardiac surgery, the necessity for concurrent mitral valve replacement, or left ventricular assist device implantation. We collected and analyzed perioperative data for the patients. The study comprised 24 consecutive patients. Cardiopulmonary bypass time and aortic cross-clamp time averaged 215.0 (interquartile range [IQR], 38.0) and 158.0 (IQR, 37.0) min, respectively. No instances of reoperation due to postoperative bleeding or need for permanent pacemaker implantation were recorded. Initial 24-h postoperative drainage volume averaged 186.9 ± 76.9 mL. Average follow-up duration was 21.7 ± 6.2 months (range, 5 to 30 months). Throughout short-term follow-up, no occurrences of valve dysfunction, paravalvular leak, cardiovascular events necessitating readmission, or mortality were observed. The right infra-axillary incision approach effectively yields secure, successful, and cosmetically pleasing outcomes for concomitant AAR and AVR. Further research and comparisons are warranted to validate these findings.

The effect of COVID-19 lockdown on admission rates in Maternity Hospital.

The COVID-19 pandemic had adverse health outcomes on individuals and communities. In this cross-sectional study we evaluated the admission rates in a tertiary-level hospital during the first wave of the pandemic (March 22, 2020 to August 31, 2020). We compared the indications for admission during the first wave of the pandemic to a control period prior to the lockdown (November 9, 2019 to March 22, 2020). Most hospital admissions during the curfew period were obstetric emergencies (46.88%), which were significantly higher than the control group (38.19%) p ≤ 0.0001. Among the obstetric emergencies, cases in active labor (65.63%) were dominant. Significant rises in car deliveries (2.46%, p ≤ 0.0001) and admissions during the second stage of labor (6.43%, p ≤ 0.001) were noted. There was also an increased rate of admissions for early pregnancy complications, induction of labor, elective obstetric cases, and medical obstetric cases. This study demonstrates that lockdown precautions implemented had a significant impact on the rate of admissions to Maternity Hospital. The data obtained may be a used to aid in designing robust policies for future pandemics to avoid adverse health outcomes.

Analysis Of Political Communication Ahead Of The 2024 Presidential Election Case Studies On Political Campaigns, Political Propaganda, Public Opinion, Marketing, Political Advertising, And Political Negotiation

The 2024 presidential election is an important moment in the political life of a country. This study aims to analyze the role of various aspects of political communsication in the presidential election, including political campaigns, political propaganda, public opinion, political marketing and advertising, and political negotiations. The research methodology uses a holistic approach with quantitative and qualitative data collection through online surveys, interviews, and media content analysis. Key findings highlight the significance of social media in shaping public opinion and the political communication strategies used by candidates. Practical implications of these findings include recommendations for more effective political campaign strategies and the development of more transparent communication policies.

Analisis Rekrutmen Calon Anggota Legislatif dalam Pemilu 2024

This research aims to conduct a study in the 2024 Legislative Member Candidate Recruitment Analysis (Case Study of the Bogor Regency Golkar Party DPD). This research is an effort to find out how to analyze the recruitment of prospective legislative members in the 2024 elections (Case Study of the Golkar Party, Bogor Regency). Therefore, the method considered appropriate to use in this study is qualitative, descriptive analysis. The data collection technique through interviews is by asking a list of questions directly to the informant with the aim of obtaining data and information related to the Recruitment Analysis of Candidates for Legislative Members in the 2024 Election (Case Study of the Bogor Regency Golkar Party). The data collection instrument used to collect data is an interview guide containing a list of questions using a direct question and answer method with informants who are authorities on the object under study. Observation (observation) is a data collection technique, where the researcher makes direct observations of the research object to look closely at the activities carried out. This research found that from the three characteristics of the recruitment process above, the recruitment process carried out by the Bogor Regency Golkar party DPD was mixed in nature, combining top-dwon and bottom-up. We can see from the selection procedures listed in the DPP Decree Number: JUKLAK - 11/DPP/GOLKAR/V/2018 that the selection procedures begin with the selection team submitting a form of willingness to be nominated as a Candidate Member of the Regency DPRD to all members of the functionary cadre who have attended functionary orientation either organized by the Golkar Party DPP or the Regency Golkar Party DPD.

A Comparative Study of Hand-Sewn and Stapled Anastomosis in Gastrointestinal Surgeries.

Background Bowel anastomosis is a key part of gastrointestinal surgery where two sections of the intestines are connected. It is a critical step as it restores the digestive tract's continuity after removing damaged or diseased bowel. Stapler devices are a new method that helps connect bowel loops faster and with less tissue damage. This study aimed to evaluate and compare the safety and effectiveness of stapled anastomosis versus hand-sewn anastomosis in surgeries involving the bowel. Methods In this prospective non-randomized study, the study population included 60 patients with various gastrointestinal surgeries admitted to our institution from August 2022 to June 2024 within a single unit. The inclusion criteria included all patients aged over 18 years who underwent surgeries such as gastrojejunostomy, hemicolectomy, and small bowel resection with anastomosis. The exclusion criteria were age under 18, pregnancy, and immunocompromised states. Patients were divided into two groups based on how their digestive tract was reconstructed: 28 had stapled anastomoses and 32 had hand-sewn anastomoses, either as elective or emergency surgery. We examined multiple outcomes such as surgery duration in hours, time until bowel function returned post surgery, length of hospital stay in days, anastomotic leak rate, albumin levels to leak rate, post-surgery pain, and surgical site infection (SSI) rate for the two groups. Southampton wound grading system and the visual analog scale (VAS) were used to assess the SSI and pain score, respectively. Results When comparing the operation time for the suture and staple groups among the elective cases, the p-value was significant (0.02), with 15 patients having prolonged surgery in the suture group compared to only five in the staple group. Regarding the time until the return of bowel sounds post surgery, the p-value was significant (0.02) for elective cases in the two groups, with nine patients having their bowel sounds returning after the third postoperative day (POD) in the suture group. When comparing the duration of stay in the hospital for elective cases for the staple and suture groups, the p-value was significant (0.04), with eight patients staying after the seventh POD in the suture group. When comparing the leak rates for the two groups for elective cases, the p-value was significant (0.04), with four leaks in the suture group and no leaks in the staple group. On comparing the association between the albumin level and anastomotic leak, the p-value was significant at 0.001 and 0.0006 for the suture and staple groups, respectively, with more leaks associated with an albumin level of <3 mg/dl. When comparing pain scores of the suture and staple groups separately in elective and emergency settings, the p-values were both 0.4, which is not significant. Among the elective cases comparing SSIs for the suture and staple groups, the p-value was significant (0.04), with six patients having SSIs in the suture group compared to one patient in the staple group. Among the emergency cases, when comparing SSIs for the suture and staple groups, the p-value was not significant (0.1). Conclusion In elective surgeries, stapled anastomosis reduces surgery time, accelerates bowel function recovery, enables earlier discharge, and lowers anastomotic leak rates compared to sutures. The staples group showed no difference from sutures in the leak rate to albumin levels and pain while offering superior SSI prevention.

Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case–control study

ABSTRACT Objectives Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs. Methods Retrospective cohort study (2014 to 2018) of patients (&amp;lt;18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case–control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction. Results In follow-up, &amp;lt;5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service. Conclusions Using eConsult is associated with &amp;lt;5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.