Cause Of Reoperation Research Articles

An oxidative stress-responsive electrospun polyester membrane capable of releasing anti-bacterial and anti-inflammatory agents for postoperative anti-adhesion

Peritendinous adhesion, secondary to the repair surgery of tendon rupture or injury, is one of the most common causes of reoperation, owing to the proliferation of fibrous tissue and excessive collagen synthesis caused by the residing inflammatory cells. In this study, a smart oxidative stress-responsive electrospun polyester membrane (EPM) was fabricated as both physical barrier and reservoir of curcumin/celecoxib (CUR/CEL) to prevent peritendinous adhesion. The multicomponent EPM was designed to release the encapsulated drugs in response to oxidative stress of the local microenvironment induced by inflammation. Specifically, sulfides in the EPM were able to react with reactive oxygen species (ROS) and become hydrophilic sulfoxide or sulfone to accelerate the release rate of drugs and regulate oxidative stress level in the inflammatory site intelligently. The oxidation-sensitive multicomponent EPM loaded with CUR and CEL was tested for anti-adhesion capacity in vitro and in vivo. An excellent ROS-sensitive degradation behavior and good cytocompatibility with cell viability of above 85% were presented with the fabricated EPM. The CUR- or CEL-loaded EPM possessed a better anti-adhesion ability compared with EPM without the drugs. Nevertheless, they were inferior to the EPM simultaneously loaded with both drugs, where the adhesion rate and fibrous adhesion number in the EPM+CUR/CEL group were close to extremely low values of about zero, demonstrating that CUR and CEL could synergistically prevent peritendinous adhesion. More interestingly, the multicomponent EPM was able to react with the local oxidative stress, leading to a smart and sustained behavior of releasing approximately 80% of the drug within 20days. Overall, the smart multicomponent EPM offers a promising barrier strategy to prevent peritendinous adhesion.

Do readmissions and reoperations adversely affect patient-reported outcomes following complex adult spinal deformity surgery at a minimum 2 years postoperative?

Unplanned readmissions and reoperations are known to be associated with undesirable costs and potentially inferior outcomes in complex adult spinal deformity (ASD) surgery. A paucity of literature exists on the impact of readmissions/reoperations on patient-reported outcomes (PRO) in this population. Consecutively treated adult patients who underwent complex ASD surgery at a single institution from 2015-2018 and minimum 2-year follow-up were studied. Demographics/comorbidities, operative factors, inpatient complications, and postoperative clinical and patient-reported outcomes (SRS-22r, ODI) were assessed for those with and without readmission/reoperation. 175 patients (72% female, mean age 52.6 ± 16.4) were included. Mean total instrumented/fused levels was 13.3 ± 4.1, range 6-25. The readmission and reoperation rates were 16.6% and 12%, respectively. The two most common causes of reoperation were pseudarthrosis (5.1%) and PJK (4.0%). Predictors for readmission within 2years following surgery included pulmonary, cardiac, depression and gastrointestinal comorbidities, along with performance of a VCR, and TLIF. At 2years postoperatively, those who required a readmission/reoperation had significant increases in SRS and reductions in ODI compared to 1-year and preoperative values. Inpatient complications did not negatively impact 2-year PRO's. The 2-year MCID in PROs was not significantly different between those with and without readmission/reoperation. Complex ASD surgery carries risk, but the vast majority can achieve MCID (SRS-86.4%, ODI-68.2%) in PROs by 2years. Importantly, even those with inpatient complications and those who required unplanned readmission/reoperation can improve PROs by 2-year follow-up compared to preoperative baseline and 1-year follow-up and achieve similar improvements compared to those who did not require a readmission. III.

Localization of recurrent lesions following ileocolic resection for Crohn\u2019s disease

BackgroundCrohn’s disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following an ileocolic resection (ICR) procedure. The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion.MethodsWe examined cases of surgery with ICR initially performed at our institution. Those with simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded.ResultsA total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4–27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n = 31), 29.0% (n = 9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n = 5) in the group with residual disease (n = 14).ConclusionsAnastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.

Causes of same-route reoperations in degenerative cervical spine disease after a primary anterior approach

Introduction : An anterior approach is most commonly used in procedures performed in cases of degenerative cervical spine disease (DCSD). Although generally considered safe, they are not free of complications that may result in the need for reoperation. The aim of the study is to analyse causes of reoperation via the same approach for DCSD in patients who have previously undergone one of the anterior cervical approaches. Materials and methods : Of the 2,794 patients managed with a surgical procedure performed from an anterior approach, a total of 38 were reoperated on via the same anterior route between year 2004–2019 at a single tertiary centre. Retrospective assessment was conducted based on medical records and radiological imaging. Subjects were grouped into 2 categories: early revision surgeries (within 90 days of the 1st procedure) and late revision surgeries (after 90 days). Results : The incidence of same-route reoperation was 1.36%. Late reoperations were over twice as frequent as early ones (n = 26 vs n = 12). The main cause for reoperation in the late group was adjacent segment disease (ASD; n = 25, 96.15%) whereas in the early group, persistent stenosis and implant dislocation were equally prevalent (each n = 3, 27.3%). The reoperations which were conducted earliest were due to emergent post-operative prevertebral hematomas (n = 2, 16.67%). Conclusion : The risk of needing a same-route reoperation after anterior approaches in DCSD is relatively low with late revisions being more prevalent. Adjacent segment disease is the most common cause. Implant dislocation as well as persistent spinal canal stenosis are the main causes behind early revisions.

A systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role

BackgroundInfection is the most feared complication of a penile prosthesis. Diabetes mellitus (DM) is widely known to increase the risk of several infections, but its role in the penile prosthesis is still controversial. This systematic review aims to show the contemporary scenario of penile prosthesis infection and present a meta-analysis about DM contribution to penile prosthesis infection.MethodsThe review was performed with no language or time limitation, including ten databases. The included articles were about the male population who received a penile prosthesis with no model restriction, with a minimum follow up of 1 year, and outcomes adequately reported.ResultsThe mean infection incidence of penile prosthesis ranged from 0.33 to 11.4%. In early 2000, the general incidence of infection was 3 to 5%, then, the introduction of coated materials decreased it to 0.3 to 2.7%. The meta-analysis showed that diabetes mellitus is related to an increased risk of penile prosthesis infection with an odds ratio of 1.53 (95% CI 1.15–2.04).ConclusionsPenile prosthesis infection decreased in the last decades but remains a significant cause of reoperation, and it is related to lower prosthesis survival. Meta-analysis concludes that diabetes mellitus is related to a higher risk of penile prosthesis infection.

Causes of unsatisfactory results after laparoscopic hiatal hernia repair

Purpose of the study. To analyze the causes of unsatisfactory results after laparoscopic repair of hiatal hernia, complicated by gastroesophageal reflux disease. Materials and methods. A retrospective analysis of the treatment of 171 patients, who underwent laparoscopic hiatal hernia repair for the period 2009–2018 was carried out. In case of hiatal hernia defect 5 or more cm 29 (29.6%) of 98 patients performed the mesh hiatal hernia repair. Nissen fundoplication was used in 109 (63.7%) patients, Toupet fundoplication – in 62 (36.3%) patients. Intra‑abdominal esophagus segment length was measured intraoperatively after mediastinal mobilization, and after desuflation before the creation of the fundoplication wrap. In the long‑term postoperative period in patients, who did not have complaints the length of fundoplication wrap was measured. The causes of reoperations were analyzed. Results. In the long‑term period, recurrence was noted in 34 (19.9%) patients, persistent dysphagia was noted in 10 (5.8%) patients, the overall unsatisfactory result was 22.8% (39 patients). 26 (15.2%) patients were unsatisfied their present condition (according to the GERD‑HRQL questionnaire). The use of mesh repair in comparison with simple suture repair not affected on frequency of recurrence in case of hernia 5 cm or more – 4 (13.8%) versus 14 (20.3%), CI: 0.19–2.1, p=0.44. The choice of fundoplication method (Nissen or Toupet) not affected on recurrence rate – 17.4% (19/109) versus 24.2% (15/62), CI: 0.71–3.24, p=0.39. The length of the fundoplication wrap at uppercontrastradiographswas 3.2 cm (2.3–3.7 cm). Intraoperativly after desuflation, the shortening of the esophagus was 1.3 cm (0.5–2 cm). 12 (7%) patients were reoperated. The shortening of the esophagus was revealed in all cases of reoperations. Conclusion. Unreduced during the first operation short esophagus, which was diagnosed during all reoperations, was one of the possible factors, affecting the frequency of recurrence in the long term. Further studies are needed to evaluate the use of lengthening esophagus procedure on the long-term outcomes.

Complications of Hip Endoscopy in the Treatment of Subgluteal Space Pathologies

To assess complications of hip endoscopy in patients with subgluteal space pathologies. This was a retrospective study of patients diagnosed with sciatic nerve entrapment (SNE), ischiofemoral impingement (IFI), and rupture of the proximal origin of the hamstring muscles (RHM) who underwent a hip endoscopy from January 2012 to December 2018, after a minimum of 3 months of conservative management without satisfactory results. Complications were documented and graded using the adapted system of Clavien-Dindo. Revision surgeries were classified as treatment failures. Function was evaluated by the Western Ontario McMaster Universities Osteoarthritis Index before and 12 months after the surgical procedure. A total of 97 hips with subgluteal space pathologies were treated with hip endoscopy. This total consisted of 77 hips with SNE, 5 with IFI, 12 with SNE+ IFI, and 3 hips with RHM. Minor (Clavien-Dindo I-II) and major (Clavien-Dindo III-V) complications occurred in 7.22% (7) (95% confidence interval 3.54%-14.15%) and 12.37% (12) (95% confidence interval 7.22%-20.39%). Grade II, III, and IV complications were reported in 7.22% (7), 7.22%, and 5.15% (5) hips, respectively. Temporary nerve injury of the sciatic nerve, hematoma, and permanent nerve injury of the posterior femoral cutaneous nerve were the most common grade II, grade III, and grade IV complications, respectively. The revision rate was 6.19% (6) and entrapment of the sciatic nerve was the main cause of reoperation. No statistically significant differences were found between cases with and without complications in the Western Ontario McMaster Universities Osteoarthritis Index scores evaluated before and after surgery (P > .05). A high rate of complications associated with hip endoscopy were observed in patients with SNE, IFI, and RHM. Sciatic nerve and posterior femoral cutaneous nerve injury were the most frequent events. IV, case series type.

Second Look After Retromuscular Repair With the Combination of Absorbable and Permanent Meshes

Objective: The aim of this study is to describe the macroscopic features and histologic details observed after retromuscular abdominal wall reconstruction with the combination of an absorbable mesh and a permanent mesh.Methods: We have considered all patients that underwent abdominal wall reconstruction (AWR) with the combination of two meshes that required to be reoperated for any reason. Data was extracted from a prospective multicenter study from 2012 to 2019. Macroscopic evaluation of parietal adhesions and histological analysis were carried out in this group of patients.Results: Among 466 patients with AWR, we identified 26 patients that underwent a reoperation after abdominal wall reconstruction using absorbable and permanent mesh. In eight patients, the reoperation was related to abdominal wall issues: four patients were reoperated due to recurrence, three patients required an operation for chronic mesh infection and one patient for symptomatic bulging. A miscellanea of pathologies was the cause for reoperation in 18 patients. During the second surgical procedures made after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt dissection between the permanent material and the peritoneum. Samples of this tissue were obtained for histological examination. No case of severe adhesions to the abdominal wall was seen. In four cases, the reoperation could be carried out laparoscopically with minimal adhesions from the previous procedure.Conclusions: The reoperations performed after the combination of absorbable and permanent meshes have shown that the absorbable mesh acts as a protective barrier and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia repair, the layer between peritoneum and permanent mesh could be dissected without special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed, mainly filmy, easy to detach, facilitating reoperations.

Analysis of Risk Factors For Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction

Cyclops syndrome is an important cause of re-operation after anterior cruciate ligament (ACL) reconstruction. The objectives of this study were to evaluate the incidence and risk factors for the development of cyclops syndrome in a large series of patients undergoing ACL reconstruction. Retrospective analysis of prospectively collected data was performed including all patients who underwent primary ACL reconstruction between January 2011 to December 2017. All patients who underwent re-operation for arthroscopic debridement of a symptomatic cyclops lesion were identified and potential risk factors were analyzed in a multivariate logistic regression. 3633 patients were included in the study. 65 (1.8%) underwent re-operation for cyclops syndrome. Table 1 reports the differences between those who did, and did not develop cyclops syndrome, with respect to patient demographics, intra-operative variables, and the percentage of patients regaining full extension by 3 and 6 weeks post-operatively. Multivariate analysis demonstrated that the only significant risk factor for cyclops syndrome was early knee extension deficit after ACL reconstruction. Patients who had a knee extension deficit at 3 weeks postoperatively had a >2-fold increase in the risk of developing a cyclops syndrome (OR = 2.302, IC 95% 1.268 – 4.239; p < .01) and the risk was 8–fold greater when the extension deficit was still present 6 weeks after ACL reconstruction (OR = 7.959, IC 95% 4.442 – 14.405; p<.001). None of the other variables studied (those listed in Table 1), including preservation of large ACL remnants was proven to be an important risk factor. The preservation of large ACL remnants does not predispose to cyclops syndrome after ACLR. The most important risk factor for development of cyclops syndrome is extension deficit in the early post-operative period.

Risk Factors for Proximal Junctional Kyphosis Following Surgical Deformity Correction in Pediatric Neuromuscular Scoliosis.

Single-center retrospective cohort analysis. The aim of this study was to evaluate risk factors associated with the development of proximal junctional kyphosis (PJK) in pediatric neuromuscular scoliosis (NMS). PJK is a common cause of reoperation in adult deformity but has been less well reported in pediatric NMS. Sixty consecutive pediatric patients underwent spinal fusion for NMS with a minimum 2-year follow-up. PJK was defined as >10° increase between the inferior end plate of the upper instrumented vertebra (UIV) and the superior end plate of the vertebra two segments above. Regression analyses as well as binary correlational models and Student t tests were employed for further statistical analysis assessing variables of primary and compensatory curve magnitudes, thoracic kyphosis, proximal kyphosis, lumbar lordosis, pelvic obliquity, shoulder imbalance, Risser classification, and sagittal profile. The present cohort consisted of 29 boys and 31 girls with a mean age at surgery of 14 ± 2.7 years. The most prevalent diagnoses were spinal cord injury (23%) and cerebral palsy (20%). Analysis reflected an overall radiographic PJK rate of 27% (n = 16) and a proximal junctional failure rate of 7% (n = 4). No significant association was identified with previously suggested risk factors such as extent of rostral fixation (P = 0.750), rod metal type (P = 0.776), laminar hooks (P = 0.654), implant density (P = 0.386), nonambulatory functional status (P = 0.254), or pelvic fixation (P = 0.746). Significant risk factors for development of PJK included perioperative use of halo gravity traction (38%, P = 0.029), greater postoperative C2 sagittal translation (P = 0.030), decreased proximal kyphosis preoperatively (P = 0.002), and loss of correction of primary curve magnitude at follow-up (P = 0.047). Increase in lumbar lordosis from post-op to last follow-up trended toward significance (P = 0.055). Twenty-seven percent of patients with NMS developed PJK, and 7% had revision surgery. Those treated with halo gravity traction or with greater postoperative C2 sagittal translation, loss of primary curve correction, and smaller preoperative proximal kyphosis had the greatest risk of developing PJK.Level of Evidence: 4.

Comparative analysis of treatment results in patients with disс herniation of different age groups

Objective. To perform comparative analysis of the results of surgical treatment of patients with intervertebral disc herniation of different age groups. Material and Methods. The results of treatment of 2,448 patients (1,307 men and 1,141 women) with lumbar intervertebral disc herniation were analyzed. Out of them, 393 (16 %) people were elderly and senile patients with a mean age of 66 years. Evaluation of the treatment results in patients with herniated intervertebral discs was carried out in two groups: Group I – young and middle-aged patients; and Group II – elderly and senile patients. Mandatory preoperative evaluation included clinical and neurological examination, radiation diagnostic methods (X-ray, CT, CT-myelography, MRI), and survey using scales and questionnaires (VAS, ODI, CCI). Results. Body mass index (BMI), blood loss, duration of surgery, and length of hospital stay were statistically significantly greater in patients of Group II. In terms of pain, quality of life before and within 5 years after surgical treatment, patients of groups I and II have no statistically significant differences. The total complication rate was 4.9 %, while in patients of Group II complications developed statistically significantly more often (1.7 times) than in patients of Group I (p = 0.02). The most common complication was unintentional durotomy, which occurred in 3.6 % of cases, without statistically significant differences between groups. Epidural hematomas requiring revision intervention were observed in 13 patients, statistically significantly more often in patients of Group II (p = 0.04). The volume of blood loss in patients of Group II is significantly greater (p < 0.001). The cumulative index of reoperations over the 5-year follow-up period in Group I was 11.5 %, in Group II – 13.6 %. During the first year, reoperations in Group I amounted to 6.0 %, in Group II – 8.7 % (p = 0.05), which indicates the possible effect of age on the frequency of repeated operations. Convincing data on the effect of BMI and the comorbidity index on this indicator have not been obtained. The most common cause of reoperation in patients with herniated discs in both groups was hernia recurrence at the operated level, while the relapse rate in Group II was slightly higher – 46 % (n = 37) compared with 36 % (n = 168) in Group I. Conclusion. No difference was found between the clinical outcomes of surgical treatment of herniated intervertebral discs in patients of different age groups during a 5-year follow-up period. Elderly and senile age is a predictor of a higher frequency of early and intraoperative complications, an increase in the surgery duration and in the volume of intraoperative blood loss. Obesity and concomitant somatic pathology do not affect the clinical outcomes of surgical treatment and the cumulative index of repeated operations in patients with herniated discs of the lumbar spine.

Functional outcome and complications of open reduction and internal fixation with plate for displaced midshaft clavicle fractures

Introduction: The purpose of the present study is to evaluate functional outcomes and complications associated with open reduction and internal fixation (ORIF) with plates for displaced midshaft clavicle fractures. Materials and Methods: A retrospective review was performed utilising hospital database for patients treated with ORIF with plate for displaced mid-shaft clavicle fracture from January 2016 to August 2018. The primary outcome measure was union. The secondary outcome measures were functional outcome (DASH), patient satisfaction with treatment and cosmetic appearance, pain, complications and reoperations. All selected patients were requested to attend out-patient department (OPD) for assessment of patient oriented functional outcome measures. Results: Thirty patients were included in the study. Eighty percent were male patients with male female ratio of 4:1, with an average age of 35years. Forty percent fractures were Robinson type 2B1 and 60% were type 2B2. All patients treated with ORIF had fracture union (ie union rate of 100%) at an average time of 7.9 weeks. Patient satisfaction rate was 83%. Mean DASH Score was 14.63 6.27. The complication rate was 33.33%. The common complications were reoperation rate (30%), symptomatic hardware (23.33%), implant failure (6.66%) and superficial infection (3.33%). Conclusion: Open reduction and internal fixation for displaced, midshaft clavicle fracture results in high rates of union and patient satisfaction, and improved functional outcome. Symptomatic hardware removal remains the most common cause of reoperation. Patients with complications reported significantly worst functional outcome scores than patients without complication. Keywords: Clavicle fracture, Mid-shaft, Plate fixation, Functional outcome, Union, Reoperations, Complications.

Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary-Referencing Implant.

Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant. A retrospective review was performed of 18 consecutive revision TAA cases between 2008-2015 using an intramedullary-referencing, fixed-bearing, 2-component total ankle system. Demographic and radiographic data were collected preoperatively, immediately postoperatively, and at the most recent follow-up. Functional outcome data were collected immediately postoperatively and at mean follow-up 47.5 months. Eighteen patients underwent revision TAA, with 77.8% (14/18) implant survival. Index revision was performed most commonly for aseptic talar subsidence (55.6%) or implant loosening (tibia, 29.4%; talus, 58.9%). Following revision, 22.2% (4/18) patients required reoperation at a mean 57.3 (39-86) months. Osteolysis of the tibia, talus, and fibula was present preoperatively in 66.7% (12/18), 38.9% (7/18), and 38.9% (7/18) of patients, respectively, with progression of osteolysis in 27.8% (5/18), 11.1% (2/18) and 11.1% (2/18) of patients, respectively. Subsidence of the tibial and talar revision components was observed in 38.9% (7/18) and 55.6% (10/18) of patients, respectively. The median American Orthopaedic Foot & Ankle Society (AOFAS) score was 74.5 (26-100) and Foot Function Index (FFI) score 10.2 (0-50.4). Early results of intramedullary-referencing revision TAA demonstrated good patient-reported outcomes with maintenance of radiographic parameters at mean follow-up of 47.5 months. Aseptic talar subsidence or loosening were the main postoperative causes of reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant was a viable option for the failed TAA. Level IV, case series.

Mechanical properties of regionally (India) manufactured versus internationally manufactured intramedullary tibial nails - A pilot study

Mechanical properties of regionally (India) manufactured versus internationally manufactured intramedullary tibial nails - A pilot study - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.015, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

What Factors Are Associated with Reoperation After Operative Treatment of Terrible Triad Injuries?

Terrible triad injuries of the elbow, consisting of posterior ulnohumeral joint dislocation with associated fractures of the radial head and coronoid process, are challenging injuries due to the difficulty in restoring stability to the joint surgically while also attempting to allow early ROM to prevent stiffness. Furthermore, complications are both debilitating and relatively common, frequently requiring reoperation. (1) What patient-, injury-, or surgery-related factors are associated with reoperation after surgical treatment of terrible triad injuries of the elbow? (2) What are the most common causes of reoperation after these injuries? Between January 2000 and June 2017, we identified 114 patients who had surgery for terrible triad injuries at two tertiary-care referral centers. Of those, 40% (46 of 114) were lost to follow-up before 1 year, and an additional 5% (6 of 114) were excluded because they underwent the index surgery at an outside institution (n = 4) or underwent closed reduction with or without percutaneous pinning (n = 2). That left 62 patients for analysis in this retrospective study with a minimum of 1-year follow-up (median 22 months; range 12 to 65) or who met the endpoint of reoperation before 1 year. During the study period, indications for surgical treatment of terrible triad injuries of the elbow included joint incongruity or instability precluding early ROM. In our study cohort, 45% (28 of 62) underwent reoperation. Indications for reoperation after surgical treatment included stiffness that interfered with activities of daily life, symptomatic prominent hardware, ulnar neuropathy, instability of the elbow joint at rest or with range of motion, and infection. Patient-related (such as age, sex, race), injury-related (for example, ipsilateral extremity fracture, open fracture), and surgery-related factors (for instance, time to surgery, radial head treatment) as well as outcomes were collected by the treating surgeon at the time of follow-up and ascertained using chart review. The primary outcome measure was reoperation after surgical treatment of a terrible triad injury of the elbow. Bivariate analysis was used to assess whether explanatory variables were associated with reoperation after surgical treatment of terrible triad injuries of the elbow. Of the patient-, injury-, and surgery-related factors that were analyzed, only radial head treatment was associated with an increased reoperation risk (p = 0.03). No other variable met criteria for inclusion in our multivariable logistic regression model (p < 0.10), and therefore, a multivariable logistic regression model was not performed. The most common indication for reoperation was stiffness (21% [13 of 62 patients]), followed by symptomatic hardware (18% [11 of 62 patients]), nerve symptoms (ulnar neuropathy 16% [10 of 62 patients] and incisional neuroma 2% [1 of 62 patients]), instability (6% [4 of 62 patients]), and wound problems (infection 2% [1 of 62 patients]). The reoperation risk after surgical treatment of terrible triad injuries of the elbow is high. No patient- or injury-related factors were associated with the reoperation risk. Based on our finding, we recommend fixation of radial head fractures in these injuries when feasible and compatible with early postoperative motion, and we suggest the use of radial head excision or arthroplasty as a secondary options. Level III, therapeutic study.

Bicuspid Aortic Valve Repair: Causes of Valve Failure and Long-Term Outcomes

Repair of bicuspid aortic valves (BAVs) for aortic regurgitation (AR) has favorable outcomes, but the impact of natural disease progression on durability of repair is uncertain. We evaluated causes of reoperation and compared outcomes of BAV repair to those of patients undergoing aortic valve replacement (AVR). Between January 1993 and December 2016, 113 patients had BAV repair at our institution for significant AR. Operative notes and pathology reports were studied to identify late causes of repair failure. For comparison with AVR, we utilized propensity score weighting with the score derived from preoperative and operative characteristics using gradient boosting machine model. A total of 26 patients had late AVR after initial repair. Causes of late valve dysfunction included calcification or fibrosis of the cusps (68%), concomitant replacement addressing moderate degree of aortic valve disease to avoid future operation (20%), and cusp prolapse (12%). Pathological evaluation of these excised valves reported calcification and fibrosis in 88% of the valves. Ten-year survival of patients undergoing BAV repair was 91% compared with 90% for patients undergoing AVR with a mechanical valve and 79% for AVR with a bioprosthesis (P= .6). Incidence of reoperation after AVR with a bioprosthesis was similar to risk after repair whereas AVR with mechanical valve showed significant advantage. Disease progression with calcification or fibrosis is the most common cause of valve failure after initial repair of BAV. Clinical outcomes of BAV repair for severe AR appear superior to AVR with bioprosthesis.

Outcome of Dual Mobility Constructs for Adverse Local Tissue Reaction Associated Abductor Deficiency in Revision Total Hip Arthroplasty

BackgroundTreatment of adverse local tissue reaction (ALTR) is challenging owing to high complications and poor outcomes after a revision surgery. As dislocation is the most common cause of reoperation, it is often necessary to use advanced articulations such as dual mobility. This study aims to evaluate the outcome and complication rates after revision surgery with dual mobility constructs, compared to constrained and conventional articulations in the setting of significant abductor deficiency due to ALTR. MethodsOut of a total of 338 revision total hip arthroplasties for ALTR, 234 patients with a significant tissue necrosis and abductor muscle insufficiency (grade 3) were evaluated. The complication rates after revisions were compared between 42 hips with dual mobility implants, 24 hips with constrained liners, 104 hips with large diameter heads (36-40 mm), and 64 hips with small diameter heads (≤32 mm). ResultsAfter an average of 4 years of follow-up (2.8-8.6), the dual mobility articulation had no dislocation, compared to 4.1% and 15.5% for constrained liner and conventional articulations, respectively (P < .001). Utilization of dual mobility and constrained liner cup also did not increase the risk of nondislocation complications, including periprosthetic joint infection and periprosthetic fracture (P = .18 and .52). ConclusionsThis study demonstrates significantly lower dislocation rates for dual mobility when compared to conventional articulations and comparable to constrained liners in cases of severe abductor deficiency due to ALTR, suggesting that dual mobility implants are viable surgical treatment alternatives to constrained liners to minimize dislocation during revision total hip arthroplasty in the setting of significant abductor deficiency due to ALTR.

Radiographic findings for surgery-related complications after pedicle subtraction osteotomy for thoracolumbar kyphosis in 230 patients with ankylosing spondylitis.

The purpose of this study was to investigate the rate of and the risk factors for surgery-related complications demonstrated on radiography after pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis in patients with ankylosing spondylitis (AS). The authors retrospectively reviewed the medical records of 230 consecutive patients with thoracolumbar kyphosis due to AS who had undergone 1-level PSO at a single institution in the period from 2010 to 2017. The causes of surgery-related complications were divided into two types: surgical/technical failure and mechanical failure. The patients consisted of 20 women and 210 men, with an average age of 43.4 years. The average follow-up period was 39.0 months. The preoperative sagittal vertical axis was 18.5 ± 69.3 cm, which improved to 4.9 ± 4.6 cm after PSO. Of the 77 patients (33.5%) who experienced minor or major surgery-related complications, 56 had complications related to surgical/technical failure (overall incidence 24.3%) and 21 had complications related to mechanical failure (overall incidence 9.1%). Fourteen patients (6.1%) underwent reoperation. However, among the 77 patients with complications, the rate of revision surgery was 18.2%. The most common radiological complications were as follows: sagittal translation in 24 patients, coronal imbalance in 20, under-correction in 8, delayed union in 8, and distal junctional failure and kyphosis in 8. The most common causes of reoperation were coronal imbalance in 4 patients, symptomatic malposition of pedicle screws in 3, and distal junctional failure in 3. Delayed union was statistically correlated with posterior sagittal translation (p = 0.007). PSO can provide acceptable radiographic outcomes for the correction of thoracolumbar kyphosis in patients with AS. However, a high incidence of surgery-related complications related to mechanical failure and surgical technique can develop. Thorough radiographic investigation before and during surgery is needed to determine whether complete ossification occurs along the anterior and posterior longitudinal ligaments of the spine.

Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta-analysis.

Nonunion is the most frequent cause of reoperation and is associated with high morbidity after distal femur fracture (DFF). We examined the rates of nonunion requiring reoperation after fixation for DFF using a locking compression plate (LCP) or retrograde intramedullary nail (RIMN). We included four studies comparing LCP and RIMN and 38 single-cohort studies reporting LCP or RIMN. In total, 2156 femurs were included and 166 non-unions were detected. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the four comparative studies and a proportional meta-analysis on the 38 articles to estimate the nonunion rate. We performed sensitivity analysis by comparing studies using LCP with less invasive surgical systems (LISS) with those that used RIMN. The pairwise meta-analysis showed a similar nonunion rate between the groups [odds ratio: 1.02; 95% confidence interval (CI) 0.94-1.11, p = 0.633]. According to proportional meta-analysis, the pooled prevalence of nonunion was 5% (95% CI 4-7) totally, 6% (95% CI 4-8) in the LCP group, and 4% (95% CI 2-6) in the RIMN group (heterogeneity: p = 0.105). According to the sensitivity analysis, there was no difference in the union rate. The pooled prevalence of nonunion from sensitivity analysis was 4 % (95% CI, 3-5); it was 4% (95% CI, 3-6) in LCP with LISS and was 4% (95% CI, 2-6) in RIMN group (heterogeneity: p = 0.941). Approximately 5% of patients who underwent LCP or RIMN fixation developed nonunion. Therefore, LCP and RIMN are effective DFF techniques and mastering one of them is essential.

MP40-08 PREDICTORS AND PERIOPERATIVE MORBIDITY ASSOCIATED WITH EARLY VERSUS LATE DISCHARGE FOLLOWING ARTIFICIAL URINARY SPHINCTER PLACEMENT

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (MP40)1 Apr 2020MP40-08 PREDICTORS AND PERIOPERATIVE MORBIDITY ASSOCIATED WITH EARLY VERSUS LATE DISCHARGE FOLLOWING ARTIFICIAL URINARY SPHINCTER PLACEMENT Benjamin Schurhamer*, Mahmoud I. Khalil, Naleen Raj Bhandari, Bruno Machado, Sherif Mourad, Rodney Davis, and Omer Raheem Benjamin Schurhamer*Benjamin Schurhamer* More articles by this author , Mahmoud I. KhalilMahmoud I. Khalil More articles by this author , Naleen Raj BhandariNaleen Raj Bhandari More articles by this author , Bruno MachadoBruno Machado More articles by this author , Sherif MouradSherif Mourad More articles by this author , Rodney DavisRodney Davis More articles by this author , and Omer RaheemOmer Raheem More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000889.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS) is currently the gold standard management option for men with post-prostatectomy incontinence. However, nationwide data on discharge patterns after surgery and complication rates is sparse. We investigated factors that were associated with a likelihood of early discharge (≤1 day) versus late (>1 day) following AUS placement. We also compared 30-day complications between the two groups. METHODS: The National Surgical Quality Improvement Program database (NSQIP) was queried from 2005-2016 to identify male patients who underwent AUS placement with same day discharge and those who stayed >1 day. Patient demographics and complications within 30 days of receiving AUS were recorded and compared between the two groups using student t or Chi-square tests. Multivariable logistic regressions were used to determine factors associated with “early discharge” (vs. late) and the likelihood of having each 30-day complication among those who were discharged early. RESULTS: Of 1,176 males who underwent AUS placement, 232 (19.7%) were discharged early and 944 (80.3%) were discharged late. The majority of patient in both groups were ≥65 years old (76.5%) and with ASA Class III (52.5%). Unadjusted analysis suggested that patients in both groups differed significantly on race (p<0.001), year of surgery (p<0.001), and operating time (p<0.001). A trend towards early discharge was observed across the studied period (Figure 1). Patients who received AUS after the year 2012 were more likely to be discharged early (OR=3.66 [2.24, 5.81]). However, increased operating time (10-minute increment) were associated with a lower likelihood of early discharge (OR=0.92 [0.86, 0.95]). On comparing 30-day complications (4.3% vs. 3.4%, p=0.498), readmission (4% vs. 3.8%, p=0.888) and reoperation rates (3% vs. 2.5%, p=0.65) between early vs. late discharged patients, we did not find statistically significant difference. Overall, removal of the AUS (40%) and superficial wound infection (13.8%) were the most prevalent causes of reoperation and readmission respectively. CONCLUSIONS: Early discharge following AUS placement does not seem to increase the perioperative morbidity. Shorter operating time and year of surgery after 2011 were significantly associated with “early discharge”. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e588-e588 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Schurhamer* More articles by this author Mahmoud I. Khalil More articles by this author Naleen Raj Bhandari More articles by this author Bruno Machado More articles by this author Sherif Mourad More articles by this author Rodney Davis More articles by this author Omer Raheem More articles by this author Expand All Advertisement PDF downloadLoading ...