Common Elective Procedures Research Articles

Patient’s Quality of Life After 3-and 6-Months Cataract Surgery

Cataract surgery is the most common elective procedure and has been shown to increase patients' visual acuity. However, visual acuity alone cannot adequately represent their quality of life. Quality of life can be measured with a standardized questionnaire, such as the National Eye Institute Refractive Error Quality of Life Instrument. Patients with better quality of life pre-operatively will benefit less from cataract surgery. This study aimed to describe patients' quality of life after long-term cataract surgery in the National Eye Center Cicendo Eye Hospital. This cross-sectional descriptive study used primary data collected using a questionnaire from March to May 2022. The subjects were 33 people with cataracts who underwent uncomplicated cataract surgery at Cicendo National Eye Hospital over the past three and six months of the study. Patients who met the inclusion criteria were given the NEI-RQL 42 questionnaire. In visual clarity, patient expectations, near vision, far vision, daily fluctuations, activity limitations, suboptimal correction, and satisfaction with correction variables, an increase in value at three months was observed, yet slightly decreased at 6 months. There was decreased glare complaints, symptoms, and dependence on correction at preoperative, 3 months, and 6 months. An increase in the level of concern and appearance from preoperative, 3 months, and 6 months post-operative was observed. Thus, an improvement in the patient's quality of life is observed three months after surgery, yet decreases slightly in six months after surgery.

COPD Patient's Outcomes following Total Knee Arthroplasty-An Analysis of the National Inpatients Sampling (2016-2020).

Total knee arthroplasty (TKA) is a common elective procedure aimed at improving patients' quality of life. Patients undergoing this procedure can have a wide variety of comorbidities, including chronic obstructive pulmonary disease (COPD). Several studies demonstrated a higher risk of postoperative complications for this patient population. In this study, we examined the mortality risk of this group of patients, as well as the length of stay (LOS) and general costs. This study is a retrospective, case-control study. Using the National Inpatients Sampling (NIS) database, we defined a cohort of adults who received their inpatient primary TKA between 1 January 2016 and 31 December 2020. Preoperative variables include age, sex, race, primary payer, hospital location, and hospital type. Outcomes examined in this study include overall patient mortality as a primary outcome. Secondary outcomes include total LOS (in days) and inpatient costs in the United States (in USD). A total of 2,835,499 patients who underwent TKA procedure in the United States were included. A total of 173,230 (6.1%) COPD patients were included in the COPD group. The mortality rate in the COPD group (0.1%) was more than three times higher than the control group (0.03%, p-value < 0.001). Patients in the COPD group had a longer in-hospital length of stay (2.76) compared to the control group (2.31, p-value < 0.001) and a higher treatment cost (average value of treatment per patient) (USD 69,386) compared to the control group (USD 64,446, p-value < 0.001). We also found higher mortality risk for patients older than 60 and patients of white ethnicity. COPD patients undergoing TKA have a higher mortality rate and this issue should be addressed in order to improve patient care and outcomes.

Classifying frailty in the ventral hernia population.

Frailty is increasingly recognized as a preoperative predictor of adverse outcomes following various surgical procedures. Our study aims to compare validated frailty measures in the ventral hernia population, as this is a common elective procedure with a paucity of data regarding frailty prevalence. Patients aged 18years or older with planned ventral hernia repairs were prospectively enrolled in our single-institution study from January 2023 through June 2023. After obtaining informed consent, patients completed the Fried Frailty Index (FFI), the FRAIL Scale, and the Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaires, as well as the standard completion of the Patient-Reported Outcomes Measurement Information System (PROMIS) measures at their preoperative clinic appointment. Chart review was performed for baseline demographics and comorbidities. The Modified Frailty Index (mFI-11) and the Charleston Comorbidity Index (CCI) were calculated. A total of 63 patients were enrolled in our study. On average, the population was 60years old, with a BMI of 32.4kg/m2, a CCI of 3, and on 10.5 medications preoperatively. Overall, 12 patients (19%) screened positive for frailty by the mFI-11, 17 patients (27%) by the FFI, 15 patients (23.8%) by the FRAIL Scale, and 15 patients (23.8%) screened positive for sarcopenia by SARC-F. The FFI and the FRAIL Scale were strongly correlated with the other measures by Spearman's rank-order correlation (p < 0.05). On multivariate regression analysis, a longer Timed Up and Go test was associated with screening positive for frailty or sarcopenia (OR 1.896, p = 0.016). In this study, we find that frailty is more prevalent than previously reported in the literature by any measure used. Both the FRAIL Scale and FFI strongly correlate with the other tools investigated. Surgeons should consider using these assessments preoperatively to estimate frailty and guide operative planning as well as shared decision-making.

Elective hand surgery and concomitant corticosteroid injection: Confirming increased infection risk using A national dataset

BackgroundRecent studies demonstrate a link between corticosteroid injection and surgical complications when procedures occur shortly after steroid administration. These publications focus on single procedures like carpal tunnel release. This study seeks to demonstrate how surgical site infection risk changes across thirteen common elective hand procedures when steroid injection is performed contemporaneously. MethodsThe Truven MarketScan® database identified patients who had undergone elective hand surgery between 2015 and 2016. Two cohorts were created based on the administration, or absence thereof, of contemporaneous corticosteroid injection. The primary outcome measure was infection within 30 days of surgery as measured by antibiotic prescription or repeat surgical intervention. Multivariate logistic regression was performed to assess the association between concomitant corticosteroid injections and post-operative infections while controlling for demographics and comorbidities. Results149,689 patients underwent elective hand surgery. 6104 (4.1 %) received concomitant corticosteroid injection and 14,070 (9.4 %) received post-operative antibiotics or underwent secondary surgical intervention for infection. Treatment for post-operative infection was significantly higher in the corticosteroid group (10.2 % versus 9.3 %; p = 0.02) driven by difference in severe infection requiring surgical intervention (3.7 % versus 3.1 %; p = 0.03). This finding persisted when controlling for demographics and comorbidities with adjusted OR of 1.10 (CI 1.01–1.20) for all infections and 1.16 (CI 1.01–1.33) for severe infections. DiscussionThese results support prior findings that patients undergoing concurrent steroid injections and surgery have increased rates of infectious complications though the absolute risk remains small. Limitations of the database preclude further investigation into the details of each procedure (e.g. ipsilateral vs contralateral injection, peri-operative antibiotics) which may impact infection rates. ConclusionsConcomitant steroid injection with elective hand surgery may increase the risk of postoperative infection, particularly severe infection. However, that relative increase lies between 1 and 33 percent and should be weighed against the benefit from intraoperative corticosteroid administration.

Practices of Informed Written Consent for Elective Urological Procedures at a Tertiary Care Hospital in Sudan.

Objective This study aimed to assess informed consent practices in elective urological surgeries at a tertiary care facility. Materials and methods A retrospective cross-sectional survey was carried out between March 1, 2023and April 1, 2023, at the Department of Urology, Omdurman Military Hospital, Sudan. We included all patients who had undergone elective urological procedures under local, spinal, or general anesthesia. The medical records were accessed to analyze the consent forms' standards. A total of 42 consent forms were included and analyzed. We use the General Medical Council's (GMC) Guidance on Professional Standards and Ethics for Doctors: Decision Making and Consent, and the Royal College of Surgeons (RCS) of England's Consent: Supported Decision-Makingas the standard for our study. The GMC and the RCS of England have provided comprehensive and standardized guidelines for obtaining informed written consent, including indications, benefits, risks involved, and alternatives in addition to demographics, patient details, responsible consultant, diagnosis, and title of the surgery, intended benefits, probable risks, type of anesthesia, consenting doctor's name, designation, and signature, and the patient's signature and name. Results A total of 42 consent forms were included. The diagnosis and the intended surgical procedure were mentioned in all consents. The potential benefits and risks were discussed in 36 (85.7%) and 18 (42.9%) cases, respectively. The type of anesthesia was discussed in 39 (92.9%) of cases. The likely result of not having the procedure and the alternative treatment: Recorded completion rates of 10 (23.8%) and 12 (28.6%), respectively. Patient demographics were completely documented in 41 (97.6%) forms. Senior doctors were only involved in 14 (33.3%) of the consents. Details of the consenting doctor, including name, title, and signature, were present in 30 cases (71.4%), and the date of signing the consent was documented in 38 cases (90.5%). The completeness of the consent form correlated with the level of the doctor obtaining it, with consultants achieving the highest completion rates (100%), followed by registrars (66.7%) and medical officers (35.7%). Conclusion The current practices of informed consent were found to be substandard. Handwritten consent forms do not adhere to the recommended guidelines for informed consent in elective urological procedures. It is preferable to utilize a pre-designed consent form, allowing for personalized additions based on the patient's specifics. Our recommendation is to organize an educational session for junior doctors to emphasize proper consent procedures, and deepen their knowledge of common urological elective procedures, and associated risks. This approach promotes adherence to best clinical practices and minimizes the risk of legal challenges.

Evaluation of antimicrobial stewardship implementation in elective surgery in dr Cipto Mangunkusumo General Hospital using Gyssens Method

Introduction. Nowadays, surgical site infections (SSI) remain the most common complication of surgical procedures. In prevention, prophylactic antibiotics are the first option, which leads to the high use of antibiotics. However, antibiotic administration should be based on strategies such as stewardship. Thus, the study aimed to assess the situation using Gyssens' method. Method. A retrospective cohort study analyzed the antibiotic administration of most major elective surgeries, including thyroidectomy, mastectomy, and cholecystectomy, proceeded in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from January to July 2023. Indication, type, dosage, timing, interval, duration, and route of administration were the variables of interest. Results. Of 191 subjects who underwent the most common elective surgery procedures, 30 used combination antibiotics. Gyssens category 0 consists of 165 subjects (86.5%), and 11 subjects (5.8%) were classified as category IIA, indicating inappropriate dose (inadequate, insufficient). Inaccuracies were identified as mistimed administration (5.8%), less effective antibiotic selection (3.1%), incorrect dosage (2.6%), and inappropriate timing (2.1%). The association of Gyssens categories with SSIs showed a p-value of &gt; 0.05 with an odds ratio of 1, indicating that both appropriate and inappropriate antibiotics of the Gyssens category showed no impact on SSIs or non–SSIs. Conclusion. The adherence to antimicrobial stewardship in the most common elective surgery in the Department of Surgery, dr. Cipto Mangunkusumo General Hospital was 86.4 and subjected to improvement.

Quality of life among older patients after elective ventral hernia repair: A retrospective review

BackgroundVentral hernia repair is a common elective general surgery procedure among older patients, a population at greater risk of complications. Prior research has demonstrated improved quality of life in this population despite increased risk of complications. This study sought to assess the relationship between post–ventral hernia repair quality of life and patient frailty. We hypothesized that frail patients would report smaller gains in quality of life compared to the non-frail group. MethodsThe Abdominal Core Health Quality Collaborative was used to identify a cohort of patients 65 years of age or older undergoing elective ventral hernia repair from 2018 to 2022. Patients were categorized based on their modified frailty index scores as not frail/prefrail, frail, and severely frail. Quality of life was assessed using a patient-reported 12-item scale preoperatively, 30 days, 6 months, and 1 year postoperatively. ResultsA total of 3,479 patients were included: 30.93% non-frail, 47.17% frail, and 21.90% severely frail. Severely frail patients had lower quality of life scores at baseline (P = .001) but reported higher quality of life at both 30 days (1.24 points higher, 95% confidence interval (–1.51, 2.52), P = .010) and 6 months (0.92 points higher, 95% confidence interval (–2.29, 4.13), P = .005). Severely frail patients had higher rates of surgical site complications (P < .001) but no difference in 30-day readmissions. ConclusionOur results found that frail patients reported the greatest increase in quality of life 1 year from baseline, showing that they, when selected appropriately, can gain equal benefits and have similar surgical outcomes as their non-frail counterparts.

New CMS Policy on the Mandatory Collection of Patient-Reported Outcome Measures for Total Hip and Knee Arthroplasty by 2027: What Orthopaedic Surgeons Should Know.

The Centers for Medicare & Medicaid Services (CMS) has finalized a landmark national policy to standardize and expand the collection and reporting of patient-reported outcome measures (PROMs) following total hip arthroplasty (THA) and total knee arthroplasty (TKA). This policy will be rolled out through phased implementation, beginning with voluntary reporting starting in 2023 and transitioning to mandatory reporting starting in 2025, which will be tied to hospital payment determinations in fiscal year 2028. The overarching goal of this policy is to gather meaningful pre- and postoperative PROM data directly from patients to enhance clinical care, shared decision-making, and quality measurement for these common elective procedures. This national initiative underscores the value of incorporating patient perspectives and priorities into assessments of surgical care quality. For orthopaedic surgeons and hospitals, participating in the initial voluntary reporting period provides an opportunity to integrate PROM collection into clinical workflows and to leverage these data to improve patient care. The achievement of robust PROM response rates and a strong performance on the underlying THA/TKA Patient-Reported Outcome-Based Performance Measure may have increasing relevance as payment models shift toward value-based care. The aim of the present forum was to provide an in-depth review of this new CMS policy and key details regarding required PROM instruments, data-collection time frames, and other specifications that surgical teams should understand as they prepare for implementation. The goal was to equip orthopaedic surgeons with actionable information as they embark on this new era of national PROM collection and reporting.

Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States.

Retrospective study with epidemiologic analysis of public Medicare data. The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10). Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. Level III-retrospective.

BENEFICIAL EFFECTS OF A NOVEL INTRAOPERATIVE SURGICAL IRRIGANT ON POST-OPERATIVE KNEE SWELLING AND LIMB FUNCTION IN PRIMARY TOTAL KNEE ARTHROPLASTY

Total knee arthroplasty (TKA) is one of the most common elective orthopedic procedures performed in inpatient and outpatient settings. Swelling, stiffness and pain are common complications that occur after TKA resulting in functional impairment of the joint. Reducing post-operative (PO) inflammation, which consequently helps mitigate edema, swelling and pain, is critical to functional recovery after surgery. This pilot study was designed to evaluate the effects of the intraoperative application of a novel surgical irrigant called XPERIENCE® Advanced Surgical Irrigation (XP), on post TKA lower extremity swelling, joint function, and pain, as part of an all-encompassing swelling reduction regimen. Intraoperative povidone-iodine (PI) application was used as the control. Swelling; an indicator of inflammation, was measured by single frequency-bioimpedance assessment (SF-BIA). Range of motion (ROM) and reliance on ambulatory assistive devices (AAD) were evaluated as indicators of functional recovery. Narcotic consumption for pain management and numerical pain scoring were evaluated as surrogate, limited indicators of quality of life. These parameters were assessed over a period of 6 weeks post index TKA and compared between the control cohort treated intraoperatively with PI and the intervention cohort treated intraoperatively with XP. Intraoperative irrigation with XP resulted in statistically significant improvements in PO swelling at days 7 (p&lt;0.05) and 14 (p&lt;0.01) post index surgery compared to the PI treated control cohort. Statistically significant improvements in ROM at day 7 (p=0.043) and AAD usage at day 21 (p=0.049) were noted in the XP cohort compared to the PI cohort. The XP cohort exhibited a quicker “weaning off opioids” timeline evidenced by the PI cohort reaching half of the maximum percentage of subjects using opioids 8 days later than the XP cohort. There was no statistically significant difference noted in numerical pain scores between the two cohorts. This pilot study signifies the utility of XP as a multifunctional, intraoperative surgical irrigation solution which has demonstrable benefits of reducing PO swelling with the potential to impact functional recovery after TKA.

OGBN P03 Surgeons’ perceptions of elective laparoscopic cholecystectomy in the post-COVID era

Abstract Background The COVID-19 pandemic has significantly impacted healthcare systems worldwide, leading to modifications in surgical practices. Laparoscopic cholecystectomy (LC), a common elective procedure, has faced challenges in the post-COVID era, with increased waiting times and episodes of acute gallstone disease in patients awaiting their procedure. This poses the question as to whether modifications to routine practice should be made. This study aims to explore surgeons' perceptions on performing laparoscopic cholecystectomy in the current post-pandemic landscape. Methods An anonymous survey was conducted among general surgeons with expertise in LC across multiple healthcare institutions nationally. The survey included questions relating to surgeons’ speciality, and their experience with elective LCs, intraoperative cholangiograms (IOC) and laparoscopic common bile duct exploration (LCBDE) in post-COVID era. Further opinions were sought on complicated intraoperative findings, rate of aborting procedure, rate of conversion to open and number of elective LCs completed by trainees. The data obtained was analysed using descriptive statistics and Fisher’s exact test for statistical significance calculations. Results 40 surgeons with varying levels of experience with LC completed the survey: 8 (20%) &amp;lt;50, 16 (40%) 100-500 LCs,10 (25%) 500-&amp;gt;1000. Overall, 21 (53%) perceived LC to be more challenging. Analysis between the different groups found no significant difference (p = 0.68) between those who performed &amp;lt;50 LCs (6/8) and 500- &amp;gt;1000 LCs (6/10). 8 (20%) respondents found no increase in complicated intraoperative findings. Of those not working in specialist centres, 11/36 perceived an increase in referral to a hepatobiliary unit. 14 (35%) perceived an increase in unplanned admission. 21 (53%) perceived a reduction in completion of LC by trainees. Conclusions This study demonstrates that a significant proportion of respondents believe that LC has become more technically challenging. In patients with increased time till surgery or episodes of acute gallstone disease, MRCP should be considered at pre-assessment. Furthermore, during challenging LCs, options to ‘bail-out’ or convert to open should be considered. This study also raises awareness on the reduction in training opportunities and the need to ensure trainees progress appropriately. Limitations include small sample size and subjective nature of responses. Further research on patient outcomes is required to provide strong recommendations to optimise surgical practice of LC in the post-pandemic era.

Differences in joint line level and posterior condylar offset during total knee replacement with use of gap-balancing and measured resection techniques—matched cohort study

BackgroundTotal knee replacement (TKR) is considered one of the most common elective orthopaedic procedures. The main focus of TKR is to offer patient's symptomatic relief from persistent knee pain. To achieve this it is crucial to restore joint biomechanics by performing proper bone cuts. Some surgeons favor the measured resection technique, others prefer gap balancing technique. The researchers of the presented study performed TKR using these two techniques. The aim of this study was to compare the postoperative change in joint line and posterior condylar offset after TKR with use of anatomic knee design implants between gap balancing and measured resection techniques.MethodsTwo hundred twenty-five X-rays of patients who underwent TKR performed by a single surgeon between 2020 and 2021 were analyzed. The first group of patients (101) was operated with the use of gap balancing technique and the second group (124) was operated with the use of measured resection technique. Patients included in the study were > 50 years of age, had confirmed primary knee osteoarthritis, underwent primary TKR with a PS (posterior stabilized) knee implants without patella resurfacing and had at least 15 degree flexion contracture. T-student test and U Mann–Whitney test were used in statistical analysis of results, according to the normality of distribution examined with the Shapiro–Wilk test. Post-hoc analysis was performed using the Dwass-Steel-Crichtlow-Fligner test (DSCF).ResultsThe postoperative analysis showed a significantly elevated joint line level in the gap balancing group (-2.6 ± 4.1 vs -0.7 ± 4.8, p < 0.0005). In the gap balancing group significantly more patients had joint lines elevated > 2 mm comparing to measured resection technique. The difference between pre- and postoperative PCO (posterior condylar offset) and PCOR (posterior condylar offset ratio) results had no significant differences (100.8 ± 11.8 vs 101 ± 12.5, p > 0.05) between the groups.ConclusionsThe results of the study suggest that when it comes to restoring joint line level measured resection technique seems to be superior in comparison to the gap balancing technique. What is more, results indicate measured resection is equal in terms of restoring posterior condylar offset to the gap balancing technique.Trial registrationNCT04164147, date of registration: November 14, 2019.

Intraoperative Diagnosis and Management of Duplicated Gallbladder: A Case Report

Laparoscopic cholecystectomy (LC) is the most common elective laparoscopic procedure performed globally and is the gold standard treatment for gallstone disease. A double gallbladder (GB), with or without duplication of cystic duct is a very rare surgical encounter, with an incidence of approximately 1 in 4000–5000 population.Symptomatic conditions of duplicated gallbladder are usually associated with cholecystitis, cholangitis, gallstone disease, and pancreatitis but are rarely diagnosed with carcinoma. Surgery is the ideal treatment choice of symptomatic duplicated gallbladder.Duplication of the GB is rarely detected preoperatively, can lead to difficulties during surgery with increased likelihood of conversion to open surgery and complications. Our patients is a 45-year-old woman admittedas case of symptomatic cholelithiasis. Patient was admitted to the hospital for laparoscopic Cholecystectomy. Preoperative investigations showed that the patient had only Gallstones. Intraoperatively, patient was found to have double gallbladder with double cystic duct.Subsequently,we successfully performed laparoscopic Cholecystectomy after carful identification and dissection of all these critical structures. The patient's recovery was uneventful, and she was discharged on day one post op.All surgeons should be aware of this rare congenital abnormality of the gallbladder, in addition, thorough knowledge of the anatomical variations of the gallbladder and cystic duct greatly aids the surgeon in anticipating duplications, managing it accordingly and avoiding any complications.

Total Joint Arthroplasty Time-of-Day Start Time Has Minimal Effect on Intraoperative Efficiency

Introduction Total hip (THA) and knee arthroplasties (TKA) are common elective procedures, and dedicated arthroplasty teams perform multiple procedures per day. Little is documented about how time-of-day scheduling affects the intraoperative efficiency of total joint arthroplasties (TJA). In this study, we analyzed the effects of surgical start time on TJA operative lengths. Methods A retrospective study was performed for primary TJA patients done within a four-year period at a single academic medical center. Surgical start time, operative duration, and patient demographics were collected. Based on a 12-hour operative day, surgical start times were categorized as early (7AM to 11AM), mid-day (11AM to 3PM), or late (after 3PM). A chi-squared test was performed to examine for associations between patient demographics and surgical start time. A multivariate linear regression (MLR) was performed to determine the effect of surgical start time on operative duration. P-values less than 0.05 were considered significant. Results This study identified 1663 TJAs – 869 total knee (TKA) and 791 total hip arthroplasties (THA) who met inclusion criteria. Among TKAs, we identified 319 (36.7%) early, 437 (50.3%) mid-day, and 113 (13.0%) late operations. Among THAs, we identified 407 (51.4%) early, 297 (37.5%) mid-day, and 87 (11.0%) late operations. MLR demonstrated that for TKA there was a 4.9 (p =0.018) and 7.3 (p=0.013) minute increase for mid-day and late cases, respectively. For THAs, a non-early start time was associated with an increased operative duration of 9.1 to 12 minutes (p&lt;0.001). Discussion Surgical start time has a statistically significant, but minimal, effect on operative length for TJAs, with later cases being slightly longer than first-start cases.

P-095 EXPERIENCE IN COOPERATION PROJECT IN TANZANIA

Abstract Objectives In rural África, hernia and caesarean section are the most common elective procedures with a very high burden of morbidity and mortality in inguinal hernias. We present the interventions carried out during 2022 by European aid workers in a referral and third level hospital in Tanzania and the techniques performed from the scarce material available. Material and Methods A retrospective observational study of the number of inguinal hernias operated in a Hospital in Tanzania by European aid workers. Results Throughout 2022 the hospital performed 2818 surgical interventions (1445 men and 1373 women) of which 155 were inguinal hernias (5.5% of total interventions). Of this total, only 5 were repaired with mesh using the Lietchenstein technique (3% of operations). The remaining cases were repaired by herniorrhaphy using the Shouldice technique. The postoperative period was between 24 and 48 hours. Follow-up is carried out in less than 5% due to the fact that this is a rural hospital, with 17 reoperations. Conclusions Treatment of inguinal hernia in cooperative projects are challenging to the surgeon's skills and require a thorough understanding of the anatomy of the inguinal region and nonprosthetic repair options.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

Postacute Care Utilization and Episode of Care Payments Following Common Elective Operations.

To describe PAC utilization and associated payments for patients undergoing common elective procedures. Utilization and costs of PAC are well described for benchmarked conditions and operations but remain understudied for common elective procedures. Cross-sectional study of adult patients in a statewide administrative claims database undergoing elective cholecystectomy, ventral or incisional hernia repair (VIHR), and groin hernia repair from 2012 to 2019. We used multivariable logistic regression to estimate the odds of PAC utilization, and multivariable linear regression to determine the association of 90-day episode of care payments and PAC utilization. Among 34,717 patients undergoing elective cholecystectomy, 0.7% utilized PAC resulting in significantly higher payments ($19,047 vs $7830, P < 0.001). Among 29,826 patients undergoing VIHR, 1.7% utilized PAC resulting in significantly higher payments ($19,766 vs $9439, P < 0.001). Among 37,006 patients undergoing groin hernia repair, 0.3% utilized PAC services resulting in significantly higher payments ($14,886 vs $8062, P < 0.001). We found both modifiable and non-modifiable risk factors associated with PAC utilization. Morbid obesity was associated with PAC utilization following VIHR [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.29-2.02, P < 0.001]. Male sex was associated with lower odds of PAC utilization for VIHR (OR 0.43, 95% CI 0.35-0.51, P < 0.001) and groin hernia repair (OR 0.62, 95% CI 0.39-0.98, P = 0.039). We found both modifiable (eg, obesity) and nonmodifiable (eg, female sex) patient factors that were associated with PAC. Optimizing patients to reduce PAC utilization requires an understanding of patient risk factors and systems and processes to address these factors.

Retrospective Analysis of Otorhinolaryngology Related Elective Surgeries Performed in a Tertiary Care Centre, North Kerala, India

Introduction: Due to a better understanding of the disease process, surgical workshops, conferences, and better patient awareness, the trend of Ear Nose Throat (ENT) related surgeries has changed significantly over the years. Aim: To analyse the profile of various ENT-related elective surgeries performed over three years in a tertiary care centre. Materials and Methods: This retrospective observational study was conducted in the Department of ENT, in a tertiary care centre, North Kerala, India. Patients of both sexes and of all age groups who underwent elective ENT surgeries in the Department from January 2017- December 2019 were included in the study. Data analysis was done from 1/12/2020 to 1/6/2021 period. Emergency surgeries were excluded from the study. Data was collected from hospital records and analysed using appropriate statistical methods. Results: A total of 2895 patients underwent various major and minor procedures in the period of January 2017 to December 2019 in the study institute. The majority of procedures were tympanomastoid surgeries (n=896, 30.94%), which were followed by sinonasal surgeries including advanced endoscopic surgeries (n=670, 23.14%), tonsilloadenoid surgeries (n=550, 18.98%) and excision of various solid and cystic lesions from head and neck region (n=310, 10.70%). The remaining number contributed by various other procedures like laryngeal surgeries (n=99, 3.4%) and other miscellaneous procedures (n=370, 12.78%) which include preauricular sinus excision, punch biopsies, tongue tie release, styloidectomy, excision of rhinosporidiosis from nose and nasopharynx, nasal bone fracture reduction and young’s operation. Conclusion: The most common elective procedures performed in the study period were tympanomastoid surgeries. In the present study, there was an increasing trend of all major and minor surgeries in the department in subsequent years.

Examining the Potential for Koebnerization and Disease Precipitation in Cicatricial Alopecias.

The treatment of primary scarring alopecias is challenging and patients may be susceptible to koebnerization. This predisposes cicatricial alopecia patients to worsening of their disease following procedural treatments or interventions. Research and recommendations surrounding the risk for koebnerization within scarring alopecias is extremely limited. Using a comprehensive literature review, we summarized the risks of procedures in potentially koebnerizing alopecias. We evaluated the risk not only with procedural treatments, but also with common elective cosmetic procedures and potentially trauma-inducing hairstyling techniques. Although additional studies are needed to better elucidate the risks of procedural treatments within primary scarring alopecia, we believe this review of the current evidence and expert insight will benefit healthcare providers and patients alike to help guide treatments in this challenging patient population. J Drugs Dermatol. 2023;22(1):29-34. doi:10.36849/JDD.6849.

The true cost of hidden waiting times for cataract surgery in Australia.

Cataract surgery is a safe, effective and common elective procedure in Australia but access is inequitable. True waiting times for cataract care are undisclosed or inconsistently reported by governments. Estimates of true waiting times range from 4 to 30 months and have been extended during the coronavirus disease 2019 (COVID-19) pandemic. Comparative analysis revealed that reducing waiting periods from 12 to 3 months would result in estimated public health system cost savings of $6.6 million by preventing 50 679 falls. Investment in public cataract services to address current unmet needs would prevent avoidable vision impairment and associated negative consequences.