Surgery Center Research Articles

Family centered care in pediatric cardiac surgery departments: Nurses’ perceptions

Background: Family-centered care (FCC) in pediatric healthcare settings holds significant implications for hospitalized children and their family, as well as for healthcare providers, particularly nurses. This study aims to explore the perceptions of Pediatric Nurses (PN) working in Pediatric Cardiac Surgery departments regarding FCC. Materials and Methods: A cross-sectional study was conducted between November 2021 and July 2022 at two pediatric hospitals and a Cardiac Surgery Center in Athens, Greece. The Family Centered Care Questionnaire–Revised (FCCQ-R) was utilised to assess nurses' perceptions of FCC. This questionnaire consists of 45 items divided in 9 subcategories accessing the current nursing practice and the perceived necessity of FCC. Data analysis was performed using SPSS-28, with a significance level set at α=0.05. Results: 62 nurses were recruited. Most nurses were female (93.5%), with 41.9% aged between 31 and 40 years. Mean scores for the necessity scale and current scale were 25.93 (±5.26) and 17.85 (±4.25), respectively, with Cronbach's alpha coefficients of 0.942 and 0.937, respectively. Predictors of the current scale score included age group 51–60 years (β=4.62, p=0.010) and necessity scale score (β=0.26, p=0.016), whilst predictors of the necessity scale score included years of experience (β=-7.31, p<0.001) and daily scale score (β=0.35, p=0.019). Conclusions: Nurses acknowledge the importance of FCC dimensions but may encounter challenges in consistently applying them in their work. Further strategies may be required to bridge this gap and enhance the integration of FCC principles into pediatric nursing practice.

Impact of Dexamethasone on Blood Glucose After Total Knee Arthroplasty in Patients With Type 2 Diabetes.

With the global aging population, the incidence of OA is rising annually, and the number of TKA surgeries is rapidly increasing, placing a heavy economic and healthcare burden on society. As one of the key medications in the ERAS protocol, DXM can significantly reduce postoperative pain, suppress nausea and vomiting, and accelerate patient recovery. However, the safety of perioperative DXM use in patients with diabetes remains unclear. This study aims to clarify the safety of perioperative DXM application in diabetic patients. This retrospective analysis involved 285 patients with type 2 diabetes and late-stage knee osteoarthritis who underwent unilateral TKA at the Joint Surgery Center of Peking University Third Hospital from January 2019 to November 2022. After application of the inclusion and exclusion criteria, 161 patients were included in the study. The patients were divided into two groups according to whether they had received continuous intravenous administration of DXM for 3 days postoperatively: the DXM group (n = 66) and the non-DXM group (n = 95). All other treatments and medications were the same in both groups. The patients' PBG, incidence of PONV, length of hospital stay, pain scores, and clinical data were collected and compared between the two groups. There were no significant differences in the general preoperative data between the DXM and non-DXM groups. The average PBG and the proportion of patients with levels exceeding 200 mg/dL were not significantly different between the two groups (10.84 mg/dL vs. 11.05 mg/dL and 43.2% vs. 43.9%). The postoperative visual analog scale scores (3.67 vs. 2.48) and the incidence of PONV were significantly lower in the DXM than non-DXM group (40% vs. 16%). The preoperative level of glycated hemoglobin accurately predicted PBG. Furthermore, there were no statistically significant differences in the incidence of early postoperative complications between the groups. The administration of DXM after unilateral TKA can effectively reduce postoperative pain and suppress the occurrence of PONV without affecting PBG in patients with type 2 diabetes. In addition, the preoperative level of glycated hemoglobin can accurately predict PBG.

Introduction of Patient-reported Outcome Measures in a Cardiac Surgery Center.

Although patient-reported outcome measures (PROMs) as an integral part of value-based healthcare have important potential for clinical issues, e.g., for shared decision-making, data are limited. Thus, the aim of this study was to report initial results when introducing PROMs in the setting of cardiac surgery. Patients undergoing elective coronary artery bypass grafting (CABG) were included. Three questionnaires (Seattle Angina Questionnaire 7 [SAQ-7], Rose Dyspnea Scale [RDS], and Patient Health Questionnaire 2 [PHQ-2]) were either administered via iPad (in-hospital) or via a web-based tool (at home). Baseline PROMs were completed at admission. Follow-ups were conducted at 30 days, 1 year, and 2 years postoperatively. We investigated the probability of improvement using multilevel, mixed-effects, ordered logistic regression. Overall, 99 patients answered the questionnaires preoperatively, 84 of whom answered at least one questionnaire postoperatively. No patient died within the hospitalization. Median (IQR) length of stay in the intensive care unit (ICU) was 1.0 (1.0 to 2.0) days. In all dimensions of any PROMs questionnaire, OR was above 1, indicating that most patients reported improvement 1 to 2 years after surgery by at least 1 grade. In the exploratory analysis we found age ≥75 years positively associated with a significantly greater improvement of the SAQ-7 angina frequency and SAQ-7 quality of life score. Length of stay in the ICU showed no significant association with any PROMs at midterm follow-up. In patients undergoing CABG, after a decline within 30 days postoperatively, quality of life-related outcomes improved markedly in a midterm follow-up compared with the preoperative state.

Office-Based Endoscopic Urological Procedures Under Local Anesthesia: Prospective Evaluation of Feasibility, Pain, and Patient Preference.

Introduction: Several diagnostic and therapeutic endoscopic urological procedures, such as stent placement, ureteroscopy, and bladder stone lithotripsy, can be performed in a hospital, an ambulatory surgery center, in the office with IV sedation, or in the office using only topical anesthesia. The potential benefits of performing procedures in the office setting using topical anesthesia include efficiency and cost reduction. The potential harms are failure to achieve the desired outcome and patient pain. The purpose of our study was to assess the feasibility, safety, pain tolerance, and cost-effectiveness of advanced office endourological procedures. Methods: All patients from September 2022 to July 2023 undergoing certain office-based endoscopic procedures under topical anesthesia, including ureteral stent placement for obstruction, ureteral stent exchange, ureteroscopy with laser lithotripsy, ureteroscopy with tumor ablation, laser ablation of multifocal bladder tumors, laser lithotripsy of bladder stones, nephrostomy tube exchange, and ureteral catheterization for chemotherapy instillation or retrograde ureteropyelography, were prospectively enrolled and evaluated. At the end of every procedure, visual analog scale (VAS) score and procedure location preference were assessed. Complications and facility costs were also assessed. Results: A total of 80 endoscopic procedures were performed, including 11 bladder procedures, 9 ureteroscopies, and 60 stent and nephrostomy procedures. The mean VAS pain score for bladder procedures was 2.4, ureteroscopy procedures 3.9, and stent and nephrostomy procedures 3.3. Patients undergoing bladder and stent/nephrostomy procedures unanimously expressed a preference for the in-office setting. The office setting was also largely preferred in the ureteroscopy procedure cohort (77.8%). There were eight postprocedure calls and two ED visits. One complication and one failed stent placement occurred. Procedure cost savings ranged from $5,309 to $6,009. Conclusions: Performing certain endoscopic urological procedures in an office setting with only the use of topical anesthesia is feasible, safe, well tolerated, and cost-effective when compared with performing these procedures in the operating room or with general anesthesia.

Posterior Hepatectomy and Inferior Vena Cava Graft Reconstruction for En Bloc Resection of a Hepatocellular Carcinoma: A Tribute to Couinaud's Liver Anatomy Description.

Hepatocellular carcinoma (HCC) associated with major vasculature tumor extension is considered an advanced stage of disease to which palliative radiotherapy or chemotherapy is proposed.1,2 Surgical resection associated with chemotherapy or chemoembolization could be an opportunity to improve overall survival and recurrence-free survival in selected cases in a high-volume hepatobiliary center.3,4 Moreover, it has been 25 years since Couinaud described the entity of a posterior liver located behind an axial plane crossing the portal bifurcation.5 The aim of this video was to show how to reproduce such a resection technique. We report the case of a 72-year-old male presenting with a 6cm HCC developed in a well-compensated Child-Pugh A alcohol-related cirrhosis and localized in the dorsal liver sector. The tumor invaded the retrohepatic inferior vena cava (IVC) as well as segment 2 and the right posterior section glissonean pedicles. The initial management of the patient was performed outside of a reference center for hepatobiliary surgery and the tumor was initially considered unresectable. Transarterial chemoembolization was judged ineffective due to the size and location of the tumor. Initial treatment included 6 months of atezolizumab-bevacizumab, permitting tumor volume stability and enabling surgical resection. The procedure included an enbloc posterior hepatectomy (H1267)6 with IVC resection and polytetrafluoroethylene (PTFE) graft replacement. A well-tolerated intermittent pedicle and IVC clamping of 30min in total was used. The duration of surgery was 240min, with 30min of total vascular liver exclusion, and total blood loss was 650mL. The patient was discharged on postoperative day 8. R0 resection was achieved and the patient was free of disease at 1year post-surgery. To our knowledge, this video reports the first posterior hepatectomy performed in clinical practice and demonstrates liver anatomy as described by Couinaud in 1999.5 Moreover, complex vascular resections for HCC should be considered a valid therapeutic option in selected cases and high-volume hepatobiliary centers.

Clinical patterns and outcomes of patients affected by primary malignant melanoma of the oral mucosa: A European multicenter retrospective chart review.

The purpose of this European multicenter study was to describe and assess the characteristics, diagnosis, management, and recurrence of oral malignant melanoma at different European oral and maxillofacial surgery centers. This study was based on a systematic computer-assisted database that allowed the recording of data for all primary oral mucosal melanomas treated in the involved surgical units across Europe between January 1, 2003 and December 31, 2022. The following data were recorded for each patient: gender, age, site, TNM staging, metastases, symptoms, imaging features, histopathological features, treatment, complications, recurrence, follow up, and survival. A total of 29 patients (15 females, 14 males) with a primary oral mucosal malignant melanoma fulfilled the inclusion criteria. The mean age was 64.4 years. The most frequent primary site was the vestibular and crestal maxillary gum. Nineteen patients had been diagnosed with a T3 oral melanoma, nine patients with a T4a oral melanoma, and one patient with a T4b neoplasm. Three patients had distant metastases at diagnosis. Clinically, the most frequently observed clinical features were hyperpigmentation, nodular appearance, ulceration, and hemorrhage. Among the 27 surgical cases, radical/clear margins were obtained in 24 cases, non-radical/invaded margins were obtained in two cases, while in one case a non-specific result of margin positivity was found. The overall 2-year survival was 62%. The 2-year disease-free survival was 52%. Oral mucosal melanoma is an aggressive and often asymptomatic malignancy. The overall long-term survival for patients with oral mucosal melanoma is poor, with a high rate of distant metastasis, independently from the performed treatment. Prevention and early diagnosis could be crucial to improving the disease-free survival of patients with oral mucosal melanomas.

Feasibility of YOLOX computer model-based assessment of knee function compared with manual assessment for people with severe knee osteoarthritis

ObjectiveThis study aimed to assess the feasibility of computer model-based evaluation of knee joint functional capacity in comparison with manual assessment.MethodsThis study consisted of two phases: (1) developing an automatic knee joint action recognition and classification system on the basis of improved YOLOX and (2) analyzing the feasibility of assessment by the software system and doctors, identifying the knee joint function of patients, and determining the accuracy of the software system. We collected 40–50 samples for use in clinical experiments. The datasets used in this study were collected from patients admitted to the Joint Surgery Center. In this study, the knee joint assessment items included stair climbing, walking on uneven surfaces, and knee joint function. To assess the computer model’s automatic evaluation of knee joint function, MedCalc 20 statistical software was used to analyze the consistency of the Lequesne functional index between the computer model’s automated determinations and manual independent assessments.ResultsThe weighted kappa coefficients between the doctors’ assessments and the software system’s assessments were 0.76 (95% confidence intervals:0.59 ~ 0.92) for climbing up and down stairs, 0.64 (95% confidence intervals:0.45 ~ 0.82) for walking on uneven floors, and 0.68 (95% confidence intervals:0.53 ~ 0.84) for the Lequesne functional index, indicating good consistency between the assessments of the software system and doctors.ConclusionThis paper introduces an automatic knee joint action recognition and classification method based on improved YOLOX. By comparing the results obtained by orthopedic doctors and the software system, the feasibility of this software system was validated in the clinic.

Versatility of the Axillary Intra-Aortic Balloon Pump in Adult Cardiac Surgery

The axillary intra-aortic balloon pump (ax-IABP) has been proposed as an alternative to the femoral IABP, particularly for patients with comorbidities rendering them unsuitable for fem-IABP insertion. Patient mobilisation with the ax-IABP in situ is deemed an additional potential benefit. We reviewed our experience with the ax-IABP. A single-centre retrospective review of all adult patients undergoing cardiac surgery (including heart transplantation) in a UK quaternary cardiac surgery centre between 2017 and 2021 was undertaken. During the study period a total of 232 IABPs were inserted, of which 2.2% (n = 5) were ax-IABPs. Overall in-hospital mortality for this cohort was 19.9% (n = 46). Amongst the five patients who received an ax-IABP, the mean age was 57.4 years, and three patients were female. All patients received an ax-IABP through the right axillary artery via a Dacron side graft. Appropriate positioning was confirmed with real-time fluoroscopy and transoesophageal echocardiography. Operations included heart transplantation (n = 1), coronary artery bypass grafting (CABG) (n = 1), CABG & mitral valve surgery (n = 2) and CABG & mitral & aortic valve surgery (n = 1). No patient experienced IABP-related morbidity and three patients survived to discharge. In this limited series, ax-IABP has emerged as a reasonable alternative to fem-IABP. Several patients in this series who received an ax-IABP were not suitable for fem-IABP. The absence of IABP-related morbidity in this series supports the usage of ax-IABP as an appropriate alternative treatment for patients requiring IABP support.

Evaluating ASC-4 Transfer Rates in Cataract Surgery: Insights into Timing and Causes of Hospital Transfers.

To describe the causes, timing, and contributing factors of direct hospital transfer cases from an ophthalmology-specific ambulatory surgery center and to identify potential strategies for decreasing future transfers. A large ophthalmology surgery center in Des Moines, Iowa. Retrospective review. A retrospective chart review was performed on patients requiring hospital transfer from a Midwest ophthalmology-specific surgery center from March 2022 through July 2024. Variables reviewed included patient demographics, comorbidities, prior surgeries/surgical complications, results of pre-operative physical exams, type of surgery and anesthesia performed, the type and timing of each complication, and the reasons for transfer. Each transfer was assessed for its necessity, preventability, and outcome. A total of 22 patients required hospital transfer out of 24,960 admissions for a rate of 0.88 per 1,000 admissions (95% CI: 0.58-1.33). Only 5 (23%) transfer cases were temporally related to anesthesia or surgery. The other 17 (77%) had concerns first noted prior to the induction of anesthesia. Nine (41%) of the surgeries were completed, 1 (5%) partially completed, and the remaining 12 (55%) surgeries were cancelled. The reasons for transfer were largely cardiac and/or blood pressure related (18/22, 82%). Nearly a third of the transfers (7/22, 32%) were considered preventable. Hospital transfers from ASCs are rare and all-cause hospital transfer rates may overestimate the true risk of ocular surgery. Most patients requiring hospital transfer were identified in the pre-operative area. Greater attention to preoperative physical exam reports could potentially prevent some hospital transfers.

High Cirrhosis Surgical Volume Centers have Reduced Postoperative Mortality in Patients with Cirrhosis Undergoing Major Surgery.

Patients with cirrhosis have increased surgical risk and require care team expertise. We explored the association between center cirrhosis surgical volume and post-operative mortality in a large VA dataset. In this retrospective cohort study of 14,500 major surgeries in patients with cirrhosis, we found in adjusted analysis that high-volume centers (>16 surgeries in past year) had a 36% reduced hazard of post-operative mortality through 90 days versus low-volume centers (<9 surgeries in past year; hazard ratio 0.64, 95% confidence interval 0.43-0.94, p=0.02). These findings demonstrate the importance of triaging patients with cirrhosis to high-volume centers for major surgery when feasible.

High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis.

Objectives: Cytologically indeterminate thyroid nodules (Bethesda class III or IV) carry a 10-40% risk of malignancy. Diagnostic lobectomies are frequently performed but negative surgeries incur unnecessary costs on the healthcare system, potential complications, and negative impacts on quality of life. Molecular tests (MTs) have been developed to reduce unnecessary surgeries. However, well-validated, high-performance MTs are often expensive, and their cost-effectiveness has not been studied in the Asian population. This study evaluates the rate of unnecessary surgery in the setting without MT (our current practice) and the cost-effectiveness of introducing a commercially available MT for the management of cytologically indeterminate thyroid nodules in a modernized city in Asia. Methods: Management decisions and outcomes of consecutive Bethesda III or IV thyroid nodules in a tertiary endocrine surgery center in Hong Kong were evaluated. Costs of health service provided by the public health system, which covers >90% of healthcare service in the city, were retrieved. A decision tree model was developed to compare the cost-effectiveness in avoiding unnecessary surgeries of current practice versus routine MT from a public healthcare provider's perspective. In our current practice, MT was not available, and patients with indeterminate nodules received either upfront lobectomy, repeat fine needle aspiration cytology (FNAC), or active surveillance. Results: Over a 4-year period, 2157 FNACs were performed. After exclusion, 1957 FNACs were analyzed, and 18.6% were Bethesda III or IV. Thirty-six percent of these cytologically indeterminate nodules received upfront surgery, with 28% having malignancy in final pathology, that is, 72% of surgeries were unnecessary. Routine MT could reduce 82 unnecessary surgeries/year, 26% more than current practice. Routine MT resulted in an incremental cost-effectiveness ratio of Hong Kong dollar (HKD) 49,102 (US dollar [USD] 6314) per unnecessary surgery. Sensitivity analysis showed test cost of MT contributed significantly to incremental cost-effectiveness ratio. Lowering the commercial price of MT to below HKD 8044 (USD 1031) would render routine MT cost-saving. Conclusion: Currently, a high rate of unnecessary surgeries is being performed for cytologically indeterminate thyroid nodules. MT was more effective in reducing unnecessary surgeries than current practice, but at a higher cost. MT will become cost-saving if the test cost could be lowered.

Clinical and economic effects of the transformation from an open to a laparoscopic center for colorectal surgery

PurposeThe purpose of this study was to assess the feasibility of transitioning from open to laparoscopic surgery for colorectal carcinoma in a primary care hospital setting. Despite the recognized benefits of laparoscopic surgery in postoperative recovery and its demonstrated oncological equivalence, only a minority of patients (30–40%) in Germany undergo laparoscopic procedures, primarily due to concerns which, in addition to the perioperative quality data and economic aspects, focus on patient safety.MethodsOver a three-year period (2012–2014), the transformation process was observed in a colorectal cancer center. Data from 237 patients (115 laparoscopic; 122 open) were collected prospectively and analyzed retrospectively. Short-term outcomes, including demographic data, perioperative complications, and quality metrics, as well as long-term survival data, were included.ResultsLaparoscopic surgery demonstrated several advantages. Postoperative intensive care needs decreased significantly (average length of stay: laparoscopic 1.2 days vs. open 2.5 days; p = 0.032). Hospital stays were also shorter following laparoscopic surgery (median laparoscopic 10 days vs. median open 14 days; p = 0.011). Quality of specimens, particularly lymph node retrieval, remained comparable (median laparoscopic = 18 vs. median open = 19). Survival data showed non- inferiority of the laparoscopic approach. Despite higher initial costs, laparoscopic surgery yielded cost savings of approximately 3150 € per case due to reduced intensive care and shorter hospital stays.ConclusionIn conclusion, this study demonstrates the feasibility of transitioning from open to laparoscopic oncologic colorectal surgery in a primary care hospital setting. The findings suggest that such a transition can be accomplished without compromising the quality of specimens, while also realizing cost savings and maintaining patient safety.

Comparison the Cosmetic Outcome of the Triangular Flap Insertion Versus Direct Linear Resection in Correction of Dog Ear Deformities on the Face-A Prospective and Randomized Controlled Trial.

Compared with direct linear resection, the triangular flap insertion method is a correction method that purportedly reduces the incision tension of dog ears deformity. Randomized clinical trials comparing these 2 methods seem to be limited or absent. A randomized study was planned to compare the cosmetic effect and scar in the defect area between the triangular flap insertion method and direct linear resection in the repair of dog ear deformities after the suture of the facial circular defect. The authors' study was prospective, 2-arm, randomized, evaluator-blinded clinical trial in a single-center outpatient academic plastic surgery center. Patients were eligible if they or their parents were able to provide informed consent and had dog ear deformity higher than 8mm at both ends of the incision after suture of a circular or oval facial defect. Each dog ear deformity at the ends of the incision, half accept direct linear random resection, the other half to accept triangular flap insert. At 3-month and 6-month follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale (POSAS). In all, 52 subjects completed the study. At the 3-month follow-up, there was a statistically significant difference in the mean total POSAS scores for both the blinded observer and patients, indicating a preference for the side with the triangular flap insertion method. However, at the 6-month follow-up, this difference was lost. Three months after surgery, the triangular flap insertion method resulted in a better scar outcome than direct linear resection in correction of dog ear deformities on the face. At 6 months' follow-up, this difference diminished, with scars for both sides appearing similar. Level II.

Fluorescence angiography with indocyanine green for low anterior resection in patients with rectal cancer: a prospective before and after study.

Inadequate bowel perfusion is among risk factors for colorectal anastomotic leaks. Perfusion can be assessed with indocyanine green fluorescence angiography (ICG) during colon resections. Possible benefits from its systematic use in high-risk patients with rectal cancer remain inconsistent. This study aimed to evaluate the surgical modifications induced by ICG assessment during rectal cancer surgery and associated anastomotic leaks. This prospective before and after cohort study was conducted in a single Canadian high-volume colorectal surgery center. Eligible patients were undergoing alow anterior resection for rectal cancer below 15cm from the anal margin. Stapled and handsewn coloanal anastomoses were included. The experimental group was recruited prospectively, undergoing surgery using fluorescence angiography with ICG. The control group was built retrospectively from consecutive patients who had been operated on without ICG, prior to its implementation. Each cohort included 113 patients. The use of ICG led to modifications from initial surgical plan in 10.6% of patients, with no occurrence of anastomotic leaks in this specific group. When comparing leak rates, using ICG seemed to be protective, but this could not be statistically proven, overall (13.3% vs. 6.2%, p = 0.07), nor for handsewn coloanal anastomoses (11.8% vs. 5.9%, p = 0.67). A lack of power could explain such non-significant results, especially with low overall anastomotic leak rates recorded. ICG influenced ultimate proximal resection margin in a clinically relevant proportion of cases. It might be associated with reduced leak rates although not formally proven with this data. This technology is safe and easy to apply in high-volume colorectal centers.

Functional outcome of limb sparing surgery of shoulder girdle tumors after free vascularized fibular flap.

Objective: To share the functional outcome of free vascularized fibular flap for shoulder reconstruction using Toronto Extremity Salvage Score (TESS). Study Design: Descriptive Cross-sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2023. Methods: All the patients presented with biopsy proven sarcoma involving proximal humerus were included in this study. Informed consent for data collection was obtained. Patient data regarding demographics, tumor location, extent of lesion, reconstruction and complications was collected from patient records. Six month follow up was done to assess functional recovery of the patient. Toronto Extremity Salvage Score (TESS) was used 6 months post-operatively to assess recovery of the patient using TESS questionnaire. Patient data was analyzed in using an open source software, GNU PSPP version 2.0.0. Results: A total of 11 patients were included in this study. Mean age of the patients was 15±3.5 years. Eight patients (72.7%) were male while 3 (27.3%) were female. Two patients has post-operative bleeding and 1 patient had fracture of fibula. Average TESS score was 61±7.71 years. Eight patients (72.7%) reported a good TESS score while 4 (27.3%) patients scored poor on TESSS Questionnire. Conclusion: Reconstruction of shoulder in sarcoma patients is a complex problem. Both prosthetic and biological reconstructive options present their own set of issues. In our experience, the use of free vascularized fibular flap (FVFF) presents a much better option with lower rate of infection and on average good Toronto Extremity Salvage Score (TESS) Scores.

Role of Absorbable Polysaccharide Hemostatic Powder in the Prevention of Complications After Axillary Lymph Node Dissection in Breast Cancer Patients: A Multicenter Retrospective Analysis.

Background and Objectives: Although breast surgery has undergone a drastic de-escalation in recent decades, axillary dissection is still indicated in some selected cases. Unfortunately, in 3-85% of cases, complications such as seroma formation occur, highlighting the need for more accurate hemostasis systems. The aim of this study is to evaluate the effectiveness of absorbable polysaccharide hemostatic such as HaemocerTM in preventing postoperative seroma. Materials and Methods: Patients referred to two surgery centers for a diagnosed breast cancer and candidates for axillary lymph node dissection were retrospectively evaluated and included in Group A (treated with HaemocerTM) and B (control group). The primary endpoints were the drain output after 48 h, the daily amount just before the removal, and the duration of axillary drainage placement. Secondary endpoints included the presence of seroma at the ultrasound (US) follow-up, significant blood loss, hematoma, the duration of surgery, and postsurgical complications. Results: The drain output within 48 h was 196 ± 93 vs. 286 ± 38 mL in Groups A and B, respectively (p = 0.013). The daily output before the removal was 40 ± 7 mL in Group A and 47 ± 2 mL in Group B (p = 0.049). The duration of axillary drainage placement was shorter in the experimental group (7 ± 3 days) compared to the control group (10 ± 1 days) with a statistically significant difference (0.037). During the US follow-up, on days 7, 15, and 30, the number of patients affected by seroma and the volumes were lower in the experimental group. Conclusions: The adsorbable hemostatic powder proved to be effective both in reducing the volume of drained fluid postoperatively and in decreasing the number and volume of reported seromas during the US follow-up.

Long-Term Oncological Outcomes Related to Lymphadenectomy in Clinical Stage I NSCLC: A Multicenter Retrospective Experience.

Lymphadenectomy is considered a key part of the radical treatment of resectable lung cancer, although its appropriate extension in early stages is a debated topic due to the great heterogeneity of studies in the literature. This study aims to evaluate the impact of lymphadenectomy extent on survival and recurrence in the treatment of early-stage NSCLC patients undergoing lobectomy and lymph node dissection. Data from clinical stage I NSCLC patients undergoing lobectomy and hilar-mediastinal lymphadenectomy at two thoracic surgery centers from 2016 to 2019 were retrospectively evaluated. Information regarding perioperative outcomes and lymphadenectomy details was collected and analyzed, and their impact on OS, CSS, and DFS was assessed. During the period under review, 323 patients with stage cI lung cancer underwent lobectomy with lymphadenectomy. Statistical analysis showed that the evaluated lymph nodal factors (mean number of lymph nodes removed and number and type of lymph node station explored) did not statistically significantly impact OS, CSS, and DFS at a median follow-up of 59 months (IQR 45-71). The results of this study suggest that a less invasive procedure than systematic lymphadenectomy could be performed in early-stage cases with adequate preoperative staging.

An Iterative Algorithm for Workflow Analysis in a Day Surgery Center

An Iterative Algorithm for Workflow Analysis in a Day Surgery Center

Construction of a Multi-View Deep Learning Model for the Severity Classification of Acute Pancreatitis.

Acute pancreatitis (AP) is a prevalent pathological condition of abdomen characterized by sudden onset, high incidence and complex progression. Timely assessment of AP severity is crucial for informing intervention decisions so as to delay deterioration and reduce mortality rates. Existing AP-related scoring systems can only assess current condition of patients and utilize only a single type of clinical data, which is of great limitation. Therefore, it is imperative to establish more accurate and data-compatible methods for predicting the severity of AP. The artificial intelligence (AI) algorithm based on artificial neural network (ANN) allow for the adaptive feature extraction for objective task through its internal complex network, instead of the hand-crafted methods commonly used in traditional machine learning (ML) algorithms. In this study, we delve into the final severity classification prediction of newly admitted AP patients, using deep learning (DL) algorithm to develop multi-view models, incorporated with patients' demographic information, vital signs, AP-related laboratory indexes and admission computed tomography (CT) images. The pancreatitis database in the platform of Clinical Data Research Center of Acute Abdominal Surgery at the First Affiliated Hospital of Dalian Medical University was used to gather AP cases. Deep neural network (DNN) and convolutional neural network (CNN) were utilized to construct models. The DNN prediction models with clinical data as input, the CNN prediction models with admission CT as input, and the multi-view models combining the two inputs were respectively established to predict the severity of AP. DL models for AP severity classification based on clinical indexes, imaging data and merged data were constructed. The multi-view model based on merged data offered more accurate prediction of the final severity classification of AP, with an overall accuracy rate of 80.26% (95% confidence interval (CI): 79.58%-80.94%). The constituent accuracy rates for mild acute pancreatitis, moderately severe acute pancreatitis, and severe acute pancreatitis were 91.69% (95% CI: 87.80%-95.57%), 64.90% (95% CI: 58.85%-70.95%), and 75.56% (95% CI: 68.58%-82.53%), respectively. The multi-view models using clinical indexes and imaging data as input outperform single-view models in AP severity prediction.

Long-term outcome of oesophageal atresia in adolescence (TransEAsome): a national French cohort study protocol

IntroductionThe TransEAsome project, funded by the Agence Nationale de la Recherche, aims to evaluate the long-term outcomes of patients with oesophageal atresia (OA) between 13 and 14 years old and...