Common Postoperative Complication Research Articles

Anesthetic Management Recommendations Using a Machine Learning Algorithm to Reduce the Risk of Acute Kidney Injury After Cardiac Surgeries

Background: Open heart surgeries are a common surgical approach among patients with heart disease. Acute kidney injury (AKI) is one of the most common postoperative complications following cardiac surgeries, with an average incidence of 6 - 10%. Additionally, AKI has a mortality rate of 5 - 10%. One of the challenges of cardiac surgeries is selecting the appropriate anesthetic approaches to reduce the risk of AKI. Objectives: This study presents a machine learning-based method that consists of two regression models. These models can inform the anesthesiologist about the risk of AKI resulting from the improper selection of anesthetic parameters. Methods: In this cohort study, the medical records of 998 patients who underwent cardiac surgery were collected. The proposed method includes two regression models. The first regression model recommends optimal anesthesia parameters to minimize the risk of AKI. The second model provides the anesthesiologist with the safest margin for deciding on anesthetic parameters during surgery, including cardiopulmonary bypass (CPB) time, anesthesia time, crystalloid dose, diuretic dose, and transfusion of packed red cells (PC) and fresh frozen plasma (FFP). Using this method, the specialist can evaluate the anesthetic parameters and assess the potential AKI risk. Additionally, the proposed method can also provide the treatment team with anesthetic parameters that carry the lowest risk of AKI. Results: This method was evaluated using data from 526 patients who suffered from postoperative AKI (AKI+) and 472 who did not suffer any injury (AKI-). The accuracy of the proposed method is 80.6%. Additionally, the evaluation of the proposed method by three experienced cardiac anesthesiologists shows a high correlation between the results of the proposed method and the opinions of the anesthesiologists. Conclusions: The results indicated that the outputs of the proposed models and the designed software could help reduce the risk of postoperative AKI.

Surgical Outcomes of Revision Orbital Reconstruction in Patients With Inadequate Primary Orbital Fracture Repair.

This study aimed to investigate the clinical characteristics of patients with complications following inadequate primary orbital fracture repair and to evaluate surgical outcomes of secondary revision orbital reconstruction. The authors retrospectively reviewed data from 41 patients who underwent revision orbital reconstruction by a single surgeon following complications from primary orbital fracture repair performed elsewhere. Clinical characteristics, including enophthalmos, exophthalmos, diplopia, ocular motility limitation, epiphora, infraorbital hypoesthesia, infection, eyelid malposition, lagophthalmos, hypoglobus, and compressive optic neuropathy, were assessed. Surgical outcomes of revision surgery were evaluated to determine improvements in clinical deficits and postoperative patient satisfaction. The most common postoperative complications of primary orbital fracture repair were enophthalmos (n=20/41) and diplopia (n=20/41). The mean time between primary and revision surgeries was 67.2 months (range: 1-276mo). Revision surgery significantly improved enophthalmos, diplopia (Hess area ratio), epiphora (Munk score), periorbital pain, and exophthalmos (P=0.003, P=0.001, P<0.001, P<0.001, and P=0.007, respectively) compared to the pre-revision state. In addition, 6 patients experienced improved infraorbital hypoesthesia. Among the 41 patients, 23 were very satisfied, 17 were satisfied, and 1 was neutral after revision orbital reconstruction. Our study highlights the positive impact of revision orbital reconstruction in addressing complications from inadequate primary orbital fracture repair. Surgeons should consider revision surgery to address clinical deficits following prior surgery, especially when anatomic abnormalities are evident in imaging studies, regardless of the time lapse since the initial surgery or concerns about tissue fibrosis and fat atrophy.

Relationship between preoperative high triglyceride-glucose index and myocardial injury following non-cardiac surgery in advanced-age patients: a retrospective cohort study

BackgroundMyocardial injury after non-cardiac surgery (MINS) is a common and insidious postoperative complication. This study aimed to evaluate the relationship between the triglyceride-glucose index (TyG) and MINS in advanced-age patients.MethodsWe performed a single-center retrospective study including patients ≥ 65 years of age who underwent non-cardiac surgery. The relationship between TyG and MINS was investigated using univariate and multivariate logistic regression analyses. Multivariate logistic regression analysis involved three models: Model I adjusted for preoperative factors, Model II adjusted for surgery-related factors, and Model III adjusted for both preoperative and surgery-related factors. Propensity score matching (PSM) was used to reduce the confounding effects of covariates. Subgroup analyses were then performed to evaluate the relationship between TyG and MINS in various subsamples.ResultsA total of 7789 patients were studied, among whom 481 (6.2%) developed MINS. A cut-off value of TyG of 8.57 was determined using a receiver operating characteristic (ROC) curve to be associated with the best predictive performance. Participants with TyG ≥ 8.57 were at a higher risk of developing MINS than those with TyG < 8.57 [n = 273 (7.6%) vs. n = 208 (4.9%), respectively; p < 0.001]. The univariate analysis showed that TyG ≥ 8.57 was significantly associated with MINS in elderly patients [odds ratio (OR): 1.58; 95% confidence interval (95%CI): 1.32–1.91; p < 0.001)]. In multivariate logistic regression, adjustments were made for risk factors including age, sex, body mass index (BMI), hypertension, coronary heart disease, and duration of surgery, etc. The adjusted ORs for TyG ≥ 8.57 were 1.46 (95%CI: 1.17–1.82), p = 0.001; 1.46 (95%CI: 1.19–1.77), p < 0.001; and 1.43 (95%CI: 1.13–1.81), p = 0.003, in the three multivariate models, respectively. The relationship remained after PSM (adjusted OR: 1.35, 95% CI: 1.03–1.78, p = 0.029). Furthermore, the relationship between TyG and MINS remained in a number of subgroups in the sensitivity analyses, but not in participants with peripheral vascular stenosis.ConclusionsA preoperative high TyG (≥ 8.57) is associated with a higher risk of MINS in advanced-age patients undergoing non-cardiac surgery.

Midterm Outcomes and Predictors of Failure of Lower Extremity Bypass to Para-Malleolar and Pedal Targets

ObjectivesThe frequency of distal lower extremity bypass (LEB) for infra-popliteal critical limb threatening ischemia (IP-CLTI) has significantly decreased. Our goal was to analyze the contemporary outcomes and factors associated with failure of LEB to para-malleolar and pedal targets. MethodsWe queried the VQI infra-inguinal database from 2003-2021 to identify LEB to para-malleolar or pedal/plantar targets. Primary outcomes were graft patency, major adverse limb events [vascular re-intervention, above ankle amputation] (MALE), and amputation-free survival at 2 years. Standard statistical methods were utilized. ResultsWe identified 2331 LEB procedures (1265 anterior tibial at ankle/dorsalis pedis, 783 posterior tibial at ankle, 283 tarsal/plantar). The prevalence of LEB bypasses to distal targets has significantly decreased from 13.37% of all LEB procedures in 2003 to 3.51% in 2021 (p<0.001). The majority of cases presented with tissue loss (81.25. Common post-operative complications included major adverse cardiac events (8.9%) and surgical site infections (3.6%). Major amputations occurred in 16.8% of patients at 1 year. Post-operative mortality at 1 year was 10%.On unadjusted Kaplan-Meier survival analysis at 2 years, primary patency was 50.56%±3.6%, MALE was 63.49%±3.27%, and amputation-free survival was 71.71%±0.98%. In adjusted analyses [adjusted for comorbidities, indication, conduit type, urgency, prior vascular interventions, graft inflow vessel (femoral/popliteal), concomitant inflow procedures, surgeon and center volume] conduits other than GSV (p<0.001) were associated with loss of primary patency and increased MALE. High center volume (>5 procedures/year) was associated with improved primary patency (p=0.015), and lower MALE (p=0.021) at 2 years. ConclusionsDespite decreased utilization, open surgical bypass to distal targets at the ankle remains a viable option for treatment of IP-CLTI with acceptable patency and amputation-free survival rates at 2 years. Bypasses to distal targets should be performed at high volume centers to optimize graft patency and limb salvage and minimize re-interventions.

THE VERY FIRST EXPERIENCE WITH eTEP IN OUR DEPARTMENT

Abstract Background Nowadays the main method everybody is talking about in ventral hernia repair is eTEP. The retromuscular hernia repair seems to be the gold standard for ventral hernias. The occurrence of ventral hernias is around 20% for primary and 30% for incisional hernias following the midline incisions. There is a surge of surgeons who are diving into this relatively new mini-invasive method. Until 2022 we performed only open ventral hernia repairs. Therefore, we have decided that we cannot be stuck "in the past" and started our long way of learning and improving in the eTEP field. Method We have run a retrospective trial looking at our small cohort of patients with ventral hernias that have undergone eTEP procedure at our department in the University hospital. We have specifically focused on the conversion rate to open surgery, possible complications, operating times, and postoperative complications. Results 14 patients have successfully undergone the eTEP hernia repair. We had to convert 5 of those cases. The main surgical accident resulting in conversion was the perforation of peritoneum and entering the abdominal cavity. There were no sever complications and the most common postoperative complication was hematoma with no need of surgical revision. Conclusion Our first experience with the eTEP has been challenging and as the results show that we need to improve in many surgical categories. Especially in developing the retromuscular space. Also, lately we have managed to schedule easier cases with primary hernias and the results became better immediately.

Mechanism and clinical role of TIMP-2 and IGFBP-7 in cardiac surgery-associated acute kidney injury: A review.

Acute kidney injury (AKI) is a common postoperative complication, but there is still a lack of accurate biomarkers. Cardiac surgery-associated AKI is the most common cause of major-surgery-related AKI, and patients requiring renal replacement therapy have high mortality rates. Early diagnosis, intervention, and management are crucial for improving patient prognosis. However, diagnosing AKI based solely on changes in serum creatinine level and urine output is insufficient, as these changes often lag behind actual kidney damage, making early detection challenging. Biomarkers such as tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein-7 (IGFBP-7) have been found to be significant predictors of moderate-to-severe AKI when combined with urine content analysis. This article reviews the mechanism of biomarkers TIMP-2 and IGFBP-7 in AKI and provides a comprehensive overview of the clinical effects of TIMP-2 and IGFBP-7 in cardiac surgery-associated AKI, including prediction, diagnosis, and progression.

#1807 Use of teriparatide to prevent severe hypocalcemia after parathyroidectomy in dialysis-dependent patients: a feasibility study

Abstract Background and Aims Hungry bone syndrome is a common postoperative complication after parathyroidectomy (PTx) for severe secondary hyperparathyroidism (SHPT). We aimed to conduct a feasibility study to assess the potential impact of teriparatide on the course of postoperative hypocalcemia after PTx in dialysis-dependent patients. Method We performed a randomized controlled pilot study in 20 dialysis-dependent patients with severe SHPT undergoing total parathyroidectomy with autotransplantation of parathyroid tissue. Patients were randomized to receive either 20 mcg teriparatide (Forsteo) subcutaneously on day 1 after surgery in addition to standard postoperative care (n=11) or standard postoperative care alone (n=9). Severe postoperative hypocalcemia was defined as an ionized serum calcium level of less than 0.8 mmol/l during the first 3 days after surgery. Results Patients in the two groups did not differ in terms of pre- and postoperative laboratory data, including PTH, corrected total calcium, ionized calcium and alkaline phosphatase levels – Table 1. Severe hypocalcemia was observed in 6 patients in the teriparatide group (55%) and in 4 patients (44%) in the control group (p=0.99). The proportion of patients with symptoms of hypocalcemia was higher in patients not receiving teriparatide (67% vs 27%, p=0.17), although these differences did not reach statistical significance. All post-PTx patients received standard supplementation according to local protocol, including calcium carbonate 20 gr/day, active vitamin D 2 mcg/day per os, and intravenous calcium gluconate supplementation on demand for symptoms of hypocalcemia (e.g. numbness, tingling, or cramps). Total elemental calcium requirement after surgery (which may serve as a surrogate for the severity of hungry bone syndrome) was higher in patients receiving standard treatment alone (41 [Q1-Q3: 33; 49] grams per hospitalization vs 33 [Q1-Q3: 25; 40] grams in the teriparatide group, p=0.0375) – Fig. 1. The total length of hospital stay was 4 ± 1 days in teriparatide group and 5 ± 2 in control group, p=0.36. Conclusion In dialysis-dependent patients after PTx, we observed a trend towards an alleviation of postoperative hypocalcemia after single injection of teriparatide in addition to routine care. Further studies with larger sample sizes are needed to confirm these preliminary results.

Trends and predictors of changes in renal function after radical nephrectomy for renal tumours

BackgroundChronic kidney disease (CKD) is a common postoperative complication in patients who undergo radical nephrectomy for renal tumours. However, the factors influencing long-term renal function require further investigation.ObjectiveThis study was designed to investigate the trends in renal function changes and risk factors for renal function deterioration in renal tumour patients after radical nephrectomy.MethodsWe monitored changes in renal function before and after surgery for 3 years. The progression of renal function was determined by the progression and degradation of CKD stages. Univariate and multivariate logistic regression analyses were used to analyse the causes of renal function progression.ResultsWe analysed the data of 329 patients with renal tumours who underwent radical nephrectomies between January 2013 and December 2018. In this study, 43.7% of patients had postoperative acute kidney injury (AKI), and 48.3% had CKD at advanced stages. Further research revealed that patients’ renal function stabilized 3 months after surgery. Additionally, renal function changes during these 3 months have a substantial impact on the progression of long-term renal function changes in patients.ConclusionAKI may be an indicator of short-term postoperative changes in renal function. Renal function tests should be performed in patients with AKI after radical nephrectomy to monitor the progression of functional impairment, particularly within the first 3 months after radical nephrectomy.

Tracheostomy care of non-ventilated patients and COVID considerations: A scoping review of clinical practice guidelines and consensus statements.

The purpose of this study is to examine and evaluate the existing clinical practice guidelines and consensus statements regarding tracheostomy care for non-mechanically ventilated patients. A systematic search of databases, and professional organisations was conducted from inception to 19 March 2023. Two appraisers evaluated each guideline using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers. No specific clinical guidelines exist on airway management in non-mechanically ventilated patients. Of 6318 articles identified, we included 12 clinical practice guidelines, and 9 consensus statements, which were from China, the US, the UK, South Korea, Australia, France and Belgium. The AGREE II scores in six domains are (1) the scope and purpose, 70.30%; (2) stakeholder involvement, 37.61%; (3) rigor of development, 33.97%; (4) clarity of presentation, 68.16%; (5) applicability, 44.23% and (6) editorial independence, 40.06%. The overall quality of evidence was level B. The summarised recommendations for clinical practice encompass the following six areas: airway humidification, management of the trach cuff, management of inner cannula, tracheostoma care, tracheostomy suctioning and management and prevention of common post-operative complications. The overall quality of the clinical guidelines on non-ventilated tracheostomy care was moderate, and further improvements are needed in domains of stakeholder involvement, applicability, clarity of presentation and editorial independence. Recommendations on non-ventilated tracheostomy care are often embedded in the guidelines on ventilated tracheostomy. Specific clinical guidelines are needed to provide a standardised approach to tracheostomy care for non-ventilated patients. Patients with non-ventilated tracheostomy need specialised airway management. Improving patient outcomes requires standardised protocols, patient involvement, quality evaluation, and interdisciplinary approaches. The study reviewed clinical practice guidelines and consensus statements, therefore patient or public input was not needed.

THE ROLE OF MULTIPARAMETRIC EVALUATION PRIOR TO L–VAD IMPLANT IN RIGHT VENTRICLE DISFUNCTION: A CASE REPORT

Abstract Background Right ventricular failure is the most common post–operative complication after L–VAD implant and it represents an important cause of mortality in these patients. Pre–existing right ventricular disfunction is considered an absolute contraindication to L–VAD implant, though in some cases right ventricular hypokinesia could be the expression of elevated pressure in the pulmonary circulation secondary to high left heart filling pressures. Numerous clinical, echocardiographic and hemodynamic parameters have been proposed for the evaluation of L–VAD eligibility. Among these Michigan right ventricle failure score, rest and dobutamine stress echocardiography (TAPSE, S wave peak, right wall longitudinal strain) and right heart catheterization parameters showed an adequate correlation with L–VAD implant outcome. Case Report A 67 yo patient affected by advanced heart failure secondary to ischemic dilatative cardiomyopathy was referred to our unit for frequent exacerbations of heart failure despite optimal medical therapy. Echocardiography detected severe left ventricle disfunction, severe mitral regurgitation and a hypokinetic right ventricle that was not present at a previous evaluation showing only a mild disfunction. We therefore performed a dobutamine stress echocardiography to assess right ventricular contractile reserve, which demonstrated an adequate systolic response at hight dose of dobutamine (20 y/Kg/min). These data were confirmed by right heart catheterization, which allowed the evaluation of hemodynamic predictors of post L–VAD RV failure. After Heart Team discussion the L–VAD was successfully implanted. The patient was extubated at day 1 PO and weaned from inotropes at day 4, he did not present any clinical and hemodynamic signs of RV failure and is currently undergoing post–surgical rehabilitative care. Conclusions Our experience strengthen the importance of a standardized multiparametric assessment in patients affected by advanced heart failure proposed for L–VAD and showing right ventricle contractile impairment.

Visual outcome of cataract surgery in paediatric uveitis

1. To analyse the visual outcome in patients of paediatric uveitis who underwent cataract surgery; 2. To analyse the post-operative complications of cataract surgery in paediatric uveitis.Retrospective observational study was done on patients of uveitis who underwent cataract surgery. Patients who were under 18 years and co-operative for examination were included.They underwent Phacoaspiration with posterior chamber IOL implantation by a single surgeon after 3 months of activity free interval, BCVA(in Log MAR) in every follow up, anterior segment examination using slit lamp and posterior segment examination using IDO, post-operative complications and Intra ocular pressure was recorded using Noncontact tonometer.Uveitis was classified using the SUN classification of uveitis. Use of corticosteroids, biologics and immunosuppressive drug were collected at each visit. Total of 18 subjects diagnosed with cataract as a complication of uveitis &amp; undergone cataract surgery were studied (6 were females, 12 were males) 9 had anterior uveitis, 1had intermediate uveitis and 5 had pan uveitis. JRA (66.7%) was the most common cause identified. Improvement in vision from baseline was observed post-surgery at the end of first, third and 6th month which was statistically significant (P- Value &amp;#60;0.05). Average duration of disease before they underwent surgery was 18 months. Most common post op complication was posterior capsular opacification (50 %), others include secondary glaucoma (38.9), exudative retinal detachment (5.6%) and Vitritis (22.2%)Unlike adult uveitic patients, the surgical management of paediatric uveitic cataract is both challenging and controversial, and the surgery itself has been associated with poor visual outcomes. However, our study had shown that with implantation of IOL, good immunosuppressants and control of the disease can give these children a good visual outcome.

Factors affecting anatomical and visual outcomes in Terson syndrome managed by surgery or observation.

To investigate visual outcomes and prognostic factors of patients with Terson syndrome (TS) managed with observation or pars plana vitrectomy (PPV). retrospective review of medical records of 117 eyes from 81 patients (43 females) with TS. Main outcome measures were final best corrected visual acuity (BCVA), intraoperative findings and long-term sequelae. 46 (39.3%) eyes were managed conservatively and 71 (60.7%) eyes underwent PPV. Median follow-up was 8.4 months. The PPV group had significantly worse (p < 0.001) baseline BCVA (median 2.3 versus 0.7 logMAR, Snellen equivalent 20/4000 versus 20/100). Final BCVA did not differ between the two groups (p = 0.38). Final BCVA ≥ 0.3 logMAR (20/40) in the surgery group was associated with post-operative retinal detachment (p = 0.013) and macular abnormalities (p = 0.014), and in the observation group with ocular comorbidity (p = 0.008). Retinal breaks were detected intraoperatively in 25 (35.2%) eyes and were associated with an interval longer than 3 months between ocular diagnosis and surgery (p = 0.04), but not with larger gauge instrumentation and posterior vitreous detachment. Incidence of ERM did not differ among patients managed conservatively and after PPV (p = 0.9) and between eyes undergoing early or delayed surgery (p = 0.09). The most common post-operative complications were cataract in 16 (22.5%) eyes and ERM in 8 (11.3%) eyes. visual outcomes in TS are similar with both management strategies. Surgery allows faster and greater visual recovery but carries high risk of intraoperative retinal tears if delayed for longer than 3 months from initial presentation. ERM and retinal detachment are not correlated with timing of surgery or management strategy.

Clinical study on the efficacy and safety of glaucoma drainage implants in the treatment of different types of glaucoma

Objective: To evaluate the efficacy and safety of glaucoma drainage implants(XEN-45 Gel Stent) for glaucoma treatment. Methods: A prospective study was conducted to continuously collect the clinical data of patients who were diagnosed with glaucoma and underwent XEN-45 Gel Stent implantation in the Ophthalmology Department of Peking University People's Hospital from January 2022 to August 2023. The visual acuity, intraocular pressure, number of glaucoma medications, and success rate of the patients were analyzed before and after surgery at 1 day, 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months. The differences in intraocular pressure and number of glaucoma medications among primary open-angle glaucoma, primary angle closure glaucoma, secondary glaucoma, and different implantation methods of XEN-45 Gel Stent among patients with primary open-angle glaucoma were compared. The intraoperative and postoperative complications were observed, and the risk factors for needling and surgical complete success were analyzed. Results: A total of 48 eyes from 48 patients were included in this study, comprising 27 males and 21 females, with a mean age of (54.4±18.0) years and the disease duration was 36.0(7.3, 81.0) months.There were 28 cases of primary open-angle glaucoma, 4 cases of primary angle closure glaucoma, and 16 cases of secondary glaucoma.The follow-up period was 8.0 (3.0, 12.0) months. At 12 months after surgery, the intraocular pressure decreased from 20.5 (17.0, 26.0) mmHg to (13.5±3.3) mmHg (P<0.05), and the number of glaucoma medications decreased from 3.0 (3.0, 4.0) to 0.0 (0.0, 0.0) (P<0.05). The complete success rate and qualified success rate were 73.9% (17/23) and 91.3% (21/23), respectively. The most common postoperative complications were shallow anterior chamber in 6 cases (12.5%), hypotony in 3 cases (6.3%), and blocked stent in 3 cases (6.3%). The most common postoperative treatment was needling in 27 cases (56.3%). There was no significant difference in intraocular pressure among different types of glaucoma. In the comparison of postoperative effects of different surgical implantation methods for primary open-angle glaucoma, there were no statistically significant differences in intraocular pressure and the number of glaucoma medications at other follow-up time points except 1 month after surgery (P<0.05). Univariate logistic regression analysis did not find any risk factors associated with needling and surgical complete success. Conclusions: XEN-45 Gel Stent implantation is an effective and safe surgical option for different types of glaucoma patients in China, which can significantly reduce intraocular pressure and the use of glaucoma medications and has a high success rate. However, some patients may need needling or other treatments after surgery.

Twenty four-month follow-up after bullectomy, unilateral and bilateral lung volume reduction surgery: a single-center retrospective analysis of consecutive cases

PurposeWhile pharmacologic therapy remains the cornerstone of lung emphysema treatment, surgery is an additional therapeutic option in selected patient groups with advanced emphysema. The aim of lung volume reduction surgery (LVRS) is to improve lung function, exercise capacity, quality of life and survival. We sought to determine the therapeutic value of surgical resection in specific patients with lung emphysema.Patients and methodsA retrospective study was performed consisting of 58 patients with lung emphysema who underwent surgical intervention over a 10-year period and were followed for 2 years postoperatively. The clinical characteristics recorded were FEV1 (forced expiratory volume in 1 s), the 6-min walk test (6-MWT), the Modified Medical Research Council (mMRC), body mass index (BMI) and quality of life prior to and 6, 12 and 24 months after surgical intervention. Moreover, all peri- and post-operative complications were noted.ResultsOut of 58 emphysema patients (72% male, FEV1 (L) 2.21 ± 0.17, RV (L) 3.39 ± 0.55), 19 underwent surgical bullectomy, 31 unilateral LVRS and 8 sequential bilateral LVRS. Six months after surgery, there was a statistically significant improvement in FEV1, RV, TLC, 6-MWT and mMRC. Over a period of 12 to 24 months postoperatively, clinical benefit gradually declines most likely due to COPD progression but patients still experienced a significant improvement in FEV1. The most common postoperative complications were persistent air leakage (> 7 days), arrhythmia and subcutaneous emphysema in 60%, 51.6% and 22.4%, respectively. No deaths were observed after surgical intervention.ConclusionIn a selected patient population, surgery led to significant improvement of lung function parameters, exercise capacity and quality of life. Over a period of 12 to 24 months postoperatively, clinical benefit gradually decreased most likely due to COPD progression.

Descemet Stripping Endothelial Keratoplasty in Patients With a Custom Foldable Silicone Artificial Iris: Safety and Efficacy Outcomes.

To assess outcomes of Descemet stripping endothelial keratoplasty (DSEK) in eyes with custom artificial iris (CAI) implantation. This is a retrospective, interventional, consecutive, surgical case series of patients who underwent DSEK after CAI implantation between 2010 and 2021 at 2 referral centers. Primary safety measures were loss of corrected distance visual acuity (CDVA), increase in intraocular pressure (IOP), development or progression of glaucoma, and intraoperative and postoperative complications. Efficacy measures were graft survival at year 1 and improvement in cosmesis at postoperative month 3. In general, measures were compared between baseline and postoperative year 1 while any complication was reported for the full follow-up period. Thirty-nine eyes of 39 patients were identified. 64.1% of eyes had acquired aniridia from trauma. The mean follow-up interval was 27.7 months (range 12.2-117.4). Median CDVA improved from logMAR 1.0 to 0.7 at year 1 (P = 0.0047). At the final follow-up, permanent loss of CDVA occurred in 25.6% of eyes, of which 90% was due to glaucoma. The most common postoperative complication was IOP elevation (66.7% of eyes). Graft survival at postoperative year 1 was 82.0% (95% confidence interval, 66.3-91.4). Secondary graft failure occurred in 28.2% of eyes at a mean duration of 39.7 months (SD 27.9 months) after DSEK. Cosmesis improved among 87.2% of eyes at postoperative month 3. DSEK is an effective procedure for addressing corneal edema in eyes with a CAI, but a majority develop elevated IOP and graft survival is shorter than in eyes without a CAI.

Clinicopathological profile and management challenges of congenital encephaloceles in a tertiary hospital in southwest Nigeria.

A congenital encephalocele is the herniation of intracranial contents through skull defects of various sizes. Depending on the site, content, and size, it is associated with significant morbidity and mortality in children. There is a paucity of recent and comprehensive local clinical data regarding this anomaly. Understanding the peculiarities, clinical-pathologic profiles, and management challenges will help prevent and effectively manage congenital encephalocele to improve outcomes. This was a retrospective study of all cases of congenital encephalocele managed between July 2000 and December 2023 at a tertiary hospital in the southwest region of Nigeria. Relevant demographic, clinicopathological, and management data were retrieved and analysed. There were 31 females and 11 males. Their ages ranged from 3hours to 24years. Sixteen (35.3%) were delivered in a non-health facility. Birth asphyxia was reported in 5 babies. Few mothers (4.8%) used preconception folic acid. Anaemia (n = 5) and sepsis (n = 4) were the common preoperative morbidities. All patients had definitive surgery, with 18 operated on within the first month of life. Cerebrospinal fluid (CSF) leak was the most common postoperative complication and was significantly observed in the sincipital group (p = 0.018). Thirty-one patients (73.8%) presented for follow-up after surgery, and the mean follow-up duration was 26.6weeks. Mortality was recorded in a patient (2.4%) due to Klebsiella meningitis. Congenital encephaloceles are relatively common in our setting. Therefore, there is a need to address the associated poor maternal and neonatal health conditions. Early surgery can be performed with a favourable outcome.

Outcome of video-assisted thoracoscopic treatment of idiopathic chylothorax in 15 cats.

To evaluate the outcomes and complications of video-assisted thoracoscopic (VATS) treatment of chylothorax in cats. Multi-institutional retrospective study. Fifteen client-owned cats. The medical records of cats undergoing thoracoscopic thoracic duct ligation (TDL) for treatment of idiopathic chylothorax were reviewed. Cats undergoing additional procedures including thoracoscopic pericardectomy and/or laparoscopic cisterna chyli ablation (CCA)_were included. Follow up was obtained through communication with the referring veterinarian or owner. All cats underwent thoracoscopic TDL. Thirteen cats underwent simultaneous pericardectomy and two cats underwent laparoscopic CCA without pericardectomy. Conversion from a thoracoscopic to open approach was necessary in 2/15 (13%) of thoracic duct ligations and 1/11 (9%) of pericardectomies. The most common postoperative complication was persistent pleural effusion in five cats (33%). Four of 15 cats (27%) died or were euthanized prior to hospital discharge following surgery. Recurrence of effusion occurred in 1/7 (14%) of cats that sustained resolution of the effusion at the time of surgery with a median follow up of 8 months. The overall mortality attributed to chylothorax was 47%. Thoracoscopic treatment of idiopathic chylothorax resulted in a low incidence of intraoperative complications or conversion in the study population; however, mortality related to feline idiopathic chylothorax remained high. While VATS treatment of idiopathic chylothorax is technically feasible, further consideration of the underlying pathology and current treatment algorithm is needed to improve outcomes as this remains a frustrating disease to treat in the feline population.

Leveraging artificial intelligence to identify high-risk patients for postoperative sore throat: An observational study.

Postoperative sore throat (POST) is a prevalent complication after general anesthesia and targeting high-risk patients helps in its prevention. This study developed and validated a machine learning model to predict POST. A total number of 834 patients who underwent general anesthesia with endotracheal intubation were included in this study. Data from a cohort of 685 patients was used for model development and validation, while a cohort of 149 patients served for external validation. The prediction performance of random forest (RF), neural network (NN), and extreme gradient boosting (XGBoost) models was compared using comprehensive performance metrics. The Local Interpretable Model-Agnostic Explanations (LIME) methods elucidated the best-performing model. POST incidences across training, validation, and testing cohorts were 41.7%, 38.4%, and 36.2%, respectively. Five predictors were age, sex, endotracheal tube cuff pressure, endotracheal tube insertion depth, and the time interval between extubation and the first drinking of water after extubation. After incorporating these variables, the NN model demonstrated superior generalization capabilities in predicting POST when compared to the XGBoost and RF models in external validation, achieving an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI 0.74-0.89) and a precision-recall curve (AUPRC) of 0.77 (95% CI 0.66-0.86). The model also showed good calibration and clinical usage values. The NN model outperforms the XGBoost and RF models in predicting POST, with potential applications in the healthcare industry for reducing the incidence of this common postoperative complication.

Use of a novel three-dimensional anatomical plating system for treatment of caudal mandibular fractures in cats: 13 cases (2019-2023).

A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed. Preoperative, immediate postoperative and a minimum of 8 weeks postoperative CT images were required as inclusion criteria. The outcome and complications were determined from clinical data and radiographic follow-up examinations. All cases achieved adequate anatomical reduction, resulting in a functional and atraumatic occlusion postoperatively. No intraoperative complications were reported. Time to voluntary food intake was in the range of 1-25 days. No evidence of disruptions to the implants or screw loosening was observed in the 8-week postoperative CT imaging, with radiographic evidence of complete osseous union in all fractures. The most common postoperative complication was swelling at the surgical site. Two cats had postoperative exophthalmos due to retrobulbar haemorrhage, and one cat exhibited partial wound dehiscence 5 days postoperatively, which resolved with medical management. Longer-term complications included intraoral plate exposure in one cat, which required plate removal 10 months postoperatively. In this case series, rigid internal fixation of caudal mandibular fractures using the Ramus Anatomical Plate osteosynthesis system was associated with a minimal complication rate, and satisfactory radiographic and clinical outcomes. The reported outcomes of this novel technique are favourable when compared with previous techniques described for the management of these fracture types.

Analysis of Risk Factors for Urinary Tract Infection after Lumbar Interbody Fusion.

Urinary tract infection (UTI) is a common postoperative complication, so exploring its risk factors is helpful to provide a basis for clinical prevention. This study aims to analyse the risk factors for UTI after lumbar interbody fusion (LIF). A single-centre retrospective study was conducted on the clinical data of 358 patients treated with LIF from April 2020 to April 2023. In accordance with the results of postoperative urine culture, the patients were divided into UTI group (n = 19, those with UTI after LIF) and control group (n = 332, those without UTI after LIF). Binary logistic regression analysis was carried out through collecting the medical records of the two groups to probe into the risk factors for UTI after LIF. After seven patients were excluded, the remaining 351 patients were included in the analysis. In this study, 19 patients (5.41%) developed postoperative UTI, whereas 332 patients (94.59%) had no UTI. Regression analysis results showed drinking (odds ratio (OR) = 16.193, 95% confidence interval (CI): 1.017-257.860) and high preoperative C-reactive protein (CRP) level (OR = 3.237, 95% CI: 1.213-8.636) as risk factors for UTI after LIF. A high professional title of main surgeon (OR = 0.095, 95% CI: 0.010-0.932) and preoperative red blood cell (RBC) count (OR = 0.001, 95% CI: 0.000-0.198) were protective factors for UTI after LIF (p < 0.05). This study advocated strengthening the prevention and treatment of UTI in patients who had drinking history, high preoperative CRP level and low preoperative RBC count, and received LIF based on the study results. Attention should be paid to the training of physicians with low professional title.