Common Operations Research Articles

Investigation of Abdominoplasty Without General Anesthesia: A Scoping Review

Introduction: Abdominoplasty is a common aesthetic surgical procedure primarily performed under general anesthesia (GA). However, GA is aerosol-generating and involves extended immobilization associated with systemic complications like venous thromboembolisms (VTEs). There is increasing interest in performing abdominoplasties without GA because of potential lower complication rates and shorter postoperative recovery time. This review sought to summarize all available literature on the safety and outcomes of abdominoplasty performed without GA. Methods: A scoping review was conducted with no date limits in October 2023 encompassing Medline, Embase, Web of Science, and CINAHL. The type of anesthesia was separated into 3 categories: conscious or intravenous (IV) sedation, regional anesthetic blocks (RAB: spinal and epidural), and local anesthesia (direct local infiltration and field blocks). Results: A total of 28 studies were included. Safety data was reported for abdominoplasty alone ( n = 6), with liposuction ( n = 14), or both ( n = 1). The employed anesthesia methods were IV and local ( n = 13), RAB and local ( n = 3), IV and RAB ( n = 2), IV and RAB and local ( n = 2), and IV only ( n = 1). A total of 48 379 patients were identified, with 30 cases of VTEs reported. Two studies reported GA conversion rates between 4.8% and 6.0%. A total of 11 studies assessed abdominoplasty outcomes, highlighting high patient satisfaction and low postoperative pain. The majority of analyzed studies had a “high” or “critical” risk of bias. Conclusion: Our review provides preliminary evidence that performing abdominoplasty without GA is safe and feasible. Additional high-quality studies are necessary to further validate our findings and to develop a standardized approach.

Risk factors for benign uretero-enteric anastomotic strictures after open radical cystectomy and ileal conduit.

Radical Cystectomy (RC) is one of the most common and complex surgical procedures in urologic surgery, and benign ureteroenteric anastomosis strictures (UAS) are complications described in about 15% of patients undergoing RC with different urinary diversion (UD). The aim of this study is to evaluate and analyze risk factors related to the development of ureteral stenosis after RC. All consecutive patients who underwent RC with ileal conduit from December 2019 to December 2022 were included. According to the guidelines patients with hydronephrosis were investigates with CT-scan or Ultrasound and blood tests at 3-6-12 months and then early. UAS was confirmed with CT-scan and eventually treated with nephrostomies with (with or without descendent pyelography). Several potential risk factor releated to UAS were analyzed by univariate analysis including preoperative, intraoperative and postoperative variables. In total 116 patients were included. At 30 months mean follow up, 21 patients (19%) were diagnosed with UAS. Median time from RC to diagnosis of benign UAS was 6 months (IQR: 4-9). At the univariable analysis previous abdominal surgery (OR 13.5 CI 3.4-63.4, p < 0.001) had the strongest association with shorter time to stricture development and six-fold highest risk of UAS development (OR 6.41, IC 95%; 2.16-21.1, p < 0.001). Also, gender, age, body mass index, lower albumin serum level, higher fibrinogen serum level showed statistically significant association (p < 0.05). Patients with preoperative lower albumin serum level, lower albumin/fibrinogen ratio and higher fibrinogen level are more likely to develop UAS. Moreover, having a history of PAS significantly increases the risk of strictures formation.

3D-printed patient-specific implants made of polylactide (PLDLLA) and β-tricalcium phosphate (β-TCP) for corrective osteotomies of the distal radius

The most common surgical procedure to manage the malunion of the bones is corrective osteotomy. The current gold standard for securing the bone segments after osteotomy is the use of titanium plates and allografts which have disadvantages such as possible allergic reaction, additional operations such as extraction of the graft from other sites and removal operation. The utilization of resorbable materials presents an opportunity to mitigate these drawbacks but has not yet been thoroughly researched in the literature. This study assesses the viability of using biodegradable, 3D-printed patient-specific implants made of Poly(-L-lactide-co-D, L-lactide) (PLDLLA) and β-Tricalcium Phosphate (β-TCP) as an alternative material in an in-vitro biomechanical study involving ex vivo biomechanical compression testing, biodegradation testing, and calorimetric measurements. These implants possess a unique shape, resembling a wedge and are fixated as a connection between the osteotomised bone using resorbable screws. Following point-of-care virtual planning, bio-mechanical compressive tests with (n = 5) ex vivo radii equipped with PLDLLA/ β-TCP implants were performed to prove sufficient stability of the connection. All PLDLLA/ β-TCP implants withstood a compressive force of at least 1ʼ211 N which exceeds the maximum force reported in literature in case of a fall from the height of one meter. Furthermore, the results showed a consistent surface chemistry and slow degradation rate. The outcomes are encouraging, establishing the groundwork for an innovative distal radius corrective osteotomy surgical method. However, further research is necessary to thoroughly evaluate the long-term biodegradability and mechanical efficacy of the implants.

Progress in the treatment of giant cell tumors of extremities with pathological fracture

Giant cell tumor of bone (GCTB) is a common locally aggressive junctional primary bone tumor, whose clinical treatment becomes more difficult once combined with pathological fracture. Extended curettage and en-bloc resection are common surgical procedures for treating GCTB, and drugs such as receptor activator of nuclear factor-κB ligand(RANKL) inhibitors and bisphosphonates have been successfully used. Curettage is recommended for patients with Campanaccigrade Ⅱor Campanaccigrade Ⅲ with localized soft tissue invasion only and simple fractures with intact bone structure. Resection may be considered for Campanaccigrade Ⅲ with extensive soft tissue invasion or complex fractures with incomplete bone structure. RANKL inhibitors such as denosumab may be recommended if surgery is not possible or before performing resection. This article summarizes the common treatment modalities of pathological fractures combined with giant cell tumors of extremities, including the current status of surgical and pharmacological treatments, analyzing the choice of surgical modalities in different clinical situations, in order to provide clinical inspirations for diagnosis and treatment.

Long-Term Evaluation of Ocular Surface and Meibomian Gland Function after Laser Assisted in Situ Keratomileusis surgery.

Laser-assisted in Situ Keratomileusis (LASIK) is a common refractive surgery. But it may lead to temporary dry eye due to reversible damage to the corneal sub-basal nerve plexus. However, chronic ocular surface changes are unclear. This study reports the ocular surface changes, partial blinking rate, and meibomian gland status in eyes that underwent LASIK for at least 48 months. Cross-sectional, matched case-control comparison study, including 48 post-LASIK patients and 48 sex-, age-, smoking-, and axial length-matched healthy controls, recruited from a community eye screening program. Outcome measures include anterior segment clinical findings, keratographic and meibographic imagings. Totally 48 right eyes of 48 post-LASIK Chinese patients (39 females, 2 smokers) were analyzed with 48 right eyes of 48 matched healthy controls. The age on ocular surface examination was 50±11 years, and the axial length 26±1mm. Post-LASIK eyes had a lower quality of meibum (P=0.008) compared to healthy controls. Post-LASIK eyes were associated with a shorter Schimer test (P=0.03). The ocular surface disease index (OSDI) score was higher in post-LASIK patients (P=0.00001). Other anterior segment examination parameters, partial blinking rate, meibomian gland dropout, lipid layer thickness, non-invasive tear break-up time, and tear meniscus height were comparable between the 2 groups. Up to 75% of post-LASIK patients complained of chronic dry eye symptoms. Post-LASIK eyes were associated with a reduced aqueous tear production. Post-LASIK patients with chronic dry eye symptoms should have comprehensive ocular surface evaluation. Treatment should be commenced in patients with poor tear film stability.

Early case series with placement of NeuroOne Evo stereoelectroencephalography depth electrodes and review of other Food and Drug Administration-approved products

Background: Stereoelectroencephalography (SEEG) is a common diagnostic surgical procedure for patients with medically refractory epilepsy. We aimed to describe our initial experience with the recently released NeuroOne Evo SEEG electrode product (Zimmer Biomet, Warsaw, IN) and review technical specifications for other currently approved depth SEEG electrodes. Methods: We performed a record review on the first five patients implanted with NeuroOne Evo SEEG electrode product using the robotic stereotactic assistance robot platform and described our surgical technique in detail. We recorded technical specifications of all currently Food and Drug Administration-approved SEEG electrodes for comparison. Results: Our initial 5 surgical patients were reviewed. The average total time of operation was 92 min, with an average of 16.8 electrodes. The estimated time per electrode insertion was &lt;2 min. There were no intracranial hemorrhages or hardware complications noted during monitoring. Monitoring provided diagnostic information in all patients, and removal and incision healing proceeded without issues. Conclusion: NeuroOne SEEG electrodes can be implanted with efficiency and provide a valuable additional tool for the epilepsy surgeon. A tapered drill bit prevents the bolt from being placed beyond the inner cortex and may reduce the risk of brain contusion or inadvertent advancement of anchor bolts, and the electrode internal stylet also affords the potential to reduce the number of trajectory passes. MeSH Terms: Epilepsy, EEG, Drug-resistant Epilepsy, Intracranial EEG

Application of augmented reality navigation in oral surgery

BACKGROUND: Augmented reality is a potential alternative for surgical navigation, as it can provide visualization of various anatomical structures of the maxillofacial region. We have developed a specific platform for three-dimensional model management and intraoperative augmented reality navigation for surgical procedures. AIM: To evaluate surgeons’ perceptions and the usability of augmented reality navigation for the most common surgical procedures in oral surgery. MATERIALS AND METHODS: We performed a phantom study to determine the accuracy of the augmented reality system in the maxillofacial region. Registration errors typical in image-guided surgery were measured: fiducial registration error, target registration error, and fiducial localization error. Thereafter, a clinical trial with several surgeons performing surgical procedures on jaws using augmented reality technology was conducted. Surgeons filled out a dedicated questionnaire after their experience with augmented reality navigation. RESULTS: The mean fiducial registration error was 0.9 mm (standard deviation 0.7 mm; 95% confidence interval 0.4–1.3 mm). The mean target registration error was 1.3 mm (standard deviation 0.5 mm; 95% confidence interval 1.1–1.5 mm). The fiducial localization error was the most significant with 2.2 mm (standard deviation 0.9; 95% confidence interval 1.9–2.5 mm). The higher rankings in the user experience questionnaire were related to the novelty and excitement of using augmented reality navigation in maxillofacial surgery. The pragmatic quality aspect explains the technical focus of perception to achieve goals in a product, system, or service design. Efficiency was expected to be slightly higher; however, in our opinion, this is due to the technical difficulties of the system for novel augmented reality technology. CONCLUSION: The results revealed the satisfactory accuracy of the augmented reality system in the maxillofacial region and the user experience of the augmented reality navigation system for oral surgery.

Intraperitoneal Bupivacaine 0.25% versus intravenous Diclofenac on post-operative analgesia in the cesarean section under spinal anesthesia: A prospective randomized comparative study in a tertiary care hospital of India

Background: Cesarean section (CS) is a common surgical procedure, often accompanied by significant post-operative pain, which can hinder recovery, bonding with the baby, and breastfeeding. Effective pain management is crucial to prevent complications such as chronic pain and depression. Intraperitoneal (IP) instillation of local anesthetics, such as Bupivacaine has shown promise in providing analgesia, while intravenous (IV) Diclofenac is a common alternative. Aims and Objectives: This study aimed to compare the post-operative analgesic efficacy of IP Bupivacaine with IV Diclofenac in parturients undergoing lower segment CS (LSCS). Materials and Methods: A randomized, double-blind, prospective study was conducted in Deen Dayal Upadhyay Hospital, New Delhi, with 60 patients divided into two groups: Group B received IP Bupivacaine (30 mL, 0.25%) and Group D received IV Diclofenac (1 mg/kg). Post-operative pain was assessed using the Visual Analog Scale (VAS) at various time points up to 24 h. The time to first rescue analgesia and total analgesic requirement were also measured. Results: Group B had significantly lower VAS scores at 6, 8, 10, 12, and 24 h post-operatively (P&lt;0.05). Time to first rescue analgesia was longer in Group B (7.26±1.04 h) compared to Group D (5.01±0.49 h) (P=0.001), and the total analgesic requirement was lower in Group B (P=0.01). Early breastfeeding was more feasible in Group B. Conclusion: IP Bupivacaine provided superior analgesia compared to IV Diclofenac, promoting earlier mobilization, bonding, and breastfeeding. It is a simpler and more effective method for post-operative pain management in LSCS.

Umbilical port versus epigastric port for gallbladder retrieval in laparoscopic cholecystectomy: An intervention study

Background: Open cholecystectomy as a routine operation once for cholecystitis and cholelithiasis is no more a routine practice. Laparoscopic cholecystectomy (LC) is one of the most common surgeries done these days and has become the gold standard for the treatment of symptomatic cholelithiasis. Aims and Objectives: The aim of the study was to compare the retrieval of gallbladder (GB) between epigastric port and umbilical port as two approaches of LC in terms of the time taken to remove GB, pain, and other complications postoperatively. Materials and Methods: An intervention study was conducted in the general surgery department between June 2022 and May 2023 among 73 patients who were admitted for cholecystectomy recruited by a total consecutive sampling method. Patients were put into two modalities of retrieval of GB by performing the two methods alternately. Templates were generated in MS Excel sheet and analysis was done. Appropriate statistical tests were used and the P&lt;0.05 was taken as significant. Results: There was no significant difference in the mean age (P=0.21) of patients as well as the mean duration of surgery (P=0.07) through epigastric port as compared to umbilical port. Patients who had undergone retrieval of GB through epigastric port (P=0.04) had significantly lesser pain at 6 h post-operation as compared to epigastric port. The overall pain scores were lesser when extraction of GB was done through epigastric port in comparison with umbilical port. The post-operative complications in terms of infection, hernia was lesser in patients undergoing extraction of GB through epigastric port. Conclusion: Epigastric port could be better as compared to umbilical port for retrieval of GB with respect to mean duration, post-operative pain and herniation from port site, and also surgical site infection.

Impact of deep and tail trap states on the electrical performance of double-gate ZnO thin film transistors

Abstract Traps in ZnO thin film transistors (TFTs) affect the electrical characteristics of the device. Traps originate primarily due to the disordered nature of the deposited semiconductor channel or are present at the ZnO and gate-dielectric interface. This work studies the effect of traps in double-gate ZnO TFTs using technology computer-aided design. The grain boundary and interface traps are assumed to be localized at the ZnO/SiO2 interface and are defined within the energy bandgap of ZnO using a double-exponential function. The traps are assumed to be of the acceptor type. The concentration of tail states is assumed to be 103 times more than in the deep state, while the characteristic temperature of deep state traps is assumed to be higher than the tail states. In common mode operation (i.e. both top and bottom gates are shorted), the tail states dominate the device characteristic compared with the deep state, while in independent mode (i.e. both gates are biased independently) the deep state traps affect the device characteristics more than the tail states.

Incisionless Otoplasty: Current State of the Art.

Prominent ears, also known as prominauris, inflict psychological distress and suffering on both children and adults. Otoplasty has become one of the most common aesthetic operations due to its high prevalence and significant impact on patients. Various surgical techniques for otoplasty have been documented and developed over time. While complications are rare, open and cartilage-resection techniques may result in hemorrhage, hematomas, contour deformities, hypertrophic scarring, and keloid formation. Incisionless otoplasty has been demonstrated in the literature to be an effective method, when correctly indicated, to correct prominauris with a shorter recovery time and reduced morbidity. A thorough preoperative evaluation, awareness of the different techniques, and assessment of their appropriate application minimize potential risks and unpleasant results.

Non-Pharmacological Sleep Interventions after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

To synthesise up-to-date research evidence for non-pharmacological interventions to improve various sleep outcomes (e.g., sleep quality, duration) in postsurgical cardiac patients. Sleep disturbances are common amongst postsurgical cardiac patients, yet the effectiveness of non-pharmacological interventions in improving various sleep outcomes has not been comprehensively reviewed. A systematic review and meta-analysis guided by the PRISMA protocol. CINAHL, PubMed, PsycINFO, Embase, Web of Science, and Cochrane Library were searched for relevant research in May 2023. Included studies used a randomised controlled trial design that applied a non-pharmacological intervention for postsurgical cardiac patients and reported sleep as an outcome. For the meta-analysis, mean effect sizes were separately calculated for studies with regular and reverse-scored scales. Of 37 studies included, the most common cardiac surgery was coronary artery bypass graft. Most interventions were performed within the first postoperative week and assessed sleep quality outcomes using the Pittsburgh Sleep Quality Index. The interventions are categorised into five types. Human resource-based strategies emerged as the most effective. The meta-analysis of 27 eligible studies showed a mean effect size of 0.76 for studies with regular scoring scales and - 1.04 for those with reverse-scored scales, indicating medium to large effect sizes. Our findings provide strong evidence that non-pharmacological interventions, particularly human resource-based strategies, significantly improve sleep quality in postsurgical cardiac patients. The medium to large effect sizes underscore the clinical significance of these findings. Healthcare professionals should consider incorporating non-pharmacological interventions, especially human resource-based strategies, in care plans for postsurgical cardiac patients to improve sleep outcomes and promote recovery. These interventions should be tailored to individual physical and cultural differences for maximum effectiveness. Future research should evaluate the long-term effects of these interventions on various sleep outcomes, using both objective and subjective measures to provide a comprehensive assessment of their efficacy. This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Patient and public contributions were not required for this review.

Supine versus prone percutaneous nephrolithotomy: Surgeon and anesthesiologist perspective. Can agile supersede traditional?

Background: Percutaneous nephrolithotomy (PCNL) is the most common surgical procedure for the removal of renal stone of size &gt;2 cm. It has evolved over the years both in terms of surgical technique and plan of anesthesia. The procedure is performed most commonly in the prone position. This position provides edge in offering greater anatomical feasibility due to the posterior retroperitoneal position of kidneys. Supine position bestows several perks over prone in terms of better access to patient’s airway, lower cardiopulmonary complications, better patient comfort, repositioning issues addressal along with convenient access to the patient by anesthesiologist in case of untoward medical emergency. Aims and Objectives: The primary aim to compare the safety and efficacy of prone versus supine PCNL. The objective Visual Analog Scale Score, patient satisfaction rate, stone-free rate, procedure time (calculated from placement of ureteric catheter to skin closure), overall complication rate. Materials and Methods: This prospective randomized study of 80 patients was conducted at our institute from December 2022 to June 2023. Institutional Ethical Committee clearance was sought and the inclusion criteria were all adult patients aged between 16 and 65 years with single renal, upper ureteric calculus of size 10–25 mm with ASA physical status 1 and 2 having normal renal function and a sterile urine culture. Results: All the patients completed the study and there were no dropouts. Male/female ratio, age, and stone size were comparable in both the groups. The mean time taken in supine PCNL was 48.3 min and in prone PCNL was 68.7 min, which was significant. Conclusion: Supine PCNL is a safe and efficacious procedure for renal stone disease in the selected group of patients with results comparable to prone PCNL, having additional advantages like less time-consuming, better upper calyceal access through lower calyx, less radiation exposure to surgeon’s hand, overcoming positional difficulties of prone position, simultaneous accessibility for performing flexible ureteroscopy and more convenient airway access to anesthesiologist and better pain scores.

Ensuring quality information for patients tool to assess patient information on CABG websites: Systemic search and evaluation.

Coronary artery bypass surgery (CABG) is the most common cardiac surgical procedure worldwide. The Internet is often the first place for patients to obtain medical information and may influence their health-seeking behaviour. This study aimed to assess the quality of online CABG information for patients. A review was conducted on the available CABG information online using four search terms in Google: "coronary artery bypass grafting", "CABG", "bypass surgery", and "coronary surgery". Websites on the first three pages of each search term were assessed by two independent assessors using the Ensuring Quality Information for Patients (EQIP) tool (score 0-36). 71 websites in total were eligible for the evaluation. Most websites originated from the USA and the UK (35% for both). The median EQIP score was 16.5. Most websites used everyday language (94%) in short sentences (83%). More than half (60%) of the websites addressed qualitative complications and risks of surgery. Only 1/3 of the websites described treatment alternatives, precautions before surgery, and warning signs after surgery. Only about 1/10 of websites could address quality-of-life issues and resolution of complications. Most online sites concerning CABG scores were low in EQIP tool assessment in terms of quality and readability with insufficient sources. Minimal information is provided regarding the quantitative risks and complications. Enhancement of the credibility and informativeness of websites is needed to reduce patients' anxiety about surgical procedures and help with treatment options for coronary artery disease. Education and investigation on the consistency of high-quality websites may help patient identify high quality medical information.

Stepwise multi-stage resection technique for surgical extraction of a partially erupted mandibular third molar with inferior alveolar nerve entrapment: a case report

The removal of lower third molars is one of the most common surgical procedures in routine dental practice. However, perforation of the mandibular third molars by the inferior alveolar nerve (IAN) is a rare occurrence. These cases are considered to carry a heightened risk of IAN injury due to the nerve being entrapped within the tooth. This case report details the experience of a 43-year-old female who visited the clinic for surgical removal of her lower third molar. She reported a six-month history of pain in area of tooth number 38, along with persistent hypersensitivity radiating through the lower lip and chin on the left side of her face, accompanied by abnormal sensations and numbness occurring alongside the pain. The case includes entrapment of IAN within the root of the partially erupted tooth, causing neurosensory disturbances. The associated lower third molar was extracted using a stepwise multi-stage resection technique in order to preserve the entrapped nerve. The patient's pain improved after surgery. This report contributes to current clinical knowledge and practices for extracting teeth with IAN entrapment. It addresses a gap in the limited and outdated literature on such cases.

Cerebral hypoperfusion reduces tau accumulation

AbstractObjectiveAlzheimer's disease (AD) often coexists with cerebrovascular diseases. However, the impact of cerebrovascular diseases such as stroke on AD pathology remains poorly understood.MethodsThis study examines the correlation between cerebrovascular diseases and AD pathology. The research was carried out using clinical and neuropathological data collected from the National Alzheimer's Coordinating Center (NACC) database and an animal model in which bilateral common carotid artery stenosis surgery was performed, following the injection of tau seeds into the brains of wild‐type mice.ResultsAnalysis of the NACC database suggests that clinical stroke history and lacunar infarcts are associated with lower neurofibrillary tangle pathology. An animal model demonstrates that chronic cerebral hypoperfusion reduces tau pathology, which was observed in not only neurons but also astrocytes, microglia, and oligodendrocytes. Furthermore, we found that astrocytes and microglia were activated in response to tau pathology and chronic cerebral hypoperfusion. Additionally, cerebral hypoperfusion increased a lysosomal enzyme, cathepsin D.InterpretationThese data together indicate that cerebral hypoperfusion reduces tau accumulation likely through an increase in microglial phagocytic activity towards tau and an elevation in degradation through cathepsin D. This study contributes to understanding the relationship between tau pathology and cerebrovascular diseases in older people with multimorbidity.

Stoma-Related Complications: Frequency of Postoperative Morbid Events and Factors Related to Adverse Outcomes

Abstract Introduction Stoma placement is a common surgical procedure that can be performed in the context of urgent and elective surgery for benign and malignant conditions, with an estimated morbidity ranging from 21% to 70%. Methods A retrospective cohort analysis to determine the incidence of stoma placement postoperative-related complications and potential associated factors. This study was conducted at a single tertiary care center in Mexico City including all patients who underwent a stoma construction between January 2016 and October 2023. Results A total of 276 patients underwent stoma construction. Eighty-one (29.3%) patients presented morbidity exclusively related to the ostomy.The multivariate analysis showed the following risk factors: advanced age for developing stoma-related complications; obesity for developing parastomal hernia; strangulated hernia and complicated diverticular disease for developing mucocutaneous dehiscence; bowel obstruction and parastomal hernia for developing stomal prolapse; anastomotic leak and preoperative corticosteroid therapy for developing parastomal abscess; and end-colostomy and advanced age for reoperation. Discussion Ostomy creation carries a high morbidity rate. Preoperative features such as advanced age, obesity, corticosteroid therapy, the indication of the surgery, as well as the type of the stoma created must be considered as they could significantly impact the development of adverse outcomes.

Non-absorbable surgical sutures versus autologous tendons in the reconstruction of medial patellofemoral ligaments: a randomised controlled trial protocol

IntroductionArthroscopic-assisted medial patellofemoral ligament reconstruction (MPFLR) is a common surgical procedure for patellar dislocation. We present the protocol of a randomised controlled clinical trial to compare postoperative pain, knee function...

Timing and risk factors of complications following total knee arthroplasty.

Total knee arthroplasty (TKA) is a common surgical procedure for end-stage arthritis; however, the precise timing of postoperative complications remains uncertain. This study aimed to estimate complication rates, timing, and risk factors associated with TKA. Data from 846 patients with TKA treated at a single tertiary center, were scrutinized. Complications were categorized based on timing, whereas risk factors were assessed through logistic regression. Most patients were aged >60 years (76.2%) and obese (78.4%). Urinary tract infection (UTI) was the most common complication (2.7%). Fever and hypernatremia each affected 1.8% of patients, whereas acute kidney injury (AKI) occurred in 1.4% of cases. Major complications typically arose within the first 4 days after surgery, with delirium, fever, and hyponatremia appearing earliest (median 2.0 days). Late complications included deep vein thrombosis (median 13.5 days) and surgical site infections (median 11.5 days). Risk factors included age ≥60 for UTI (odds ratio [OR]=9.09) and longer surgery duration for AKI (OR=1.01). This study offers crucial insights into the risk factors and timing of complications after TKA. By identifying the risk factors and timing of post-TKA complications, clinicians can better tailor interventions, and improve patient care. Further research is needed to refine risk prediction models and optimize therapeutic strategies.

Association of Complication Rates and Severe Obesity in Patients Undergoing Ankle Arthrodesis.

Tibiotalar arthrodesis (TTA) is a common operation for end-stage ankle arthritis. Elevated body mass index (BMI) is believed to contribute to complications following TTA. Previous studies involved national registries or small, underpowered cohorts. This study aimed to determine the effects of elevated BMI on nonunion and complication rates following TTA with a large cohort from a single academic institution. A retrospective study identified 514 patients (527 ankles) who underwent primary TTA from 2005-2017. Mean age was 60 years. Patients were stratified by BMI according to the World Health Organization classification. A reference group of 203 patients (208 ankles) included normal weight or mildly overweight patients (BMI 18.5 to <30). Ankle radiographs were evaluated to determine union or nonunion. Other outcomes included revision TTA, reoperations, subsequent adjacent joint arthrodesis, infection, and readmission. Data were analyzed using Pearson χ2 and odds ratios for categorical variables. Analysis of variance and Kaplan-Meier estimation assessed continuous variables and time-to-event outcomes, respectively. Mean follow-up was 34.3 months. Obesity class III patients had elevated risk of complications compared with normal weight patients including nonunion (odds ratio [OR] 3.96, P = .002), revision (OR 3.69, P = .03), superficial infection (OR 9.36, P = .002), and readmission (OR 10.90, P = .01). Superficial infection rates were elevated in class I (OR 6.36, P = .007) and readmissions in class II (OR 9.98, P = .01). No differences were found in reoperation (P = .448), symptomatic implant removal (P = .805), adjacent joint arthrodesis (P = .353), or deep infection (P = .507) rates. In this retrospective review after TTA, increased rates of nonunion, revision, superficial infection, and readmission were found in obesity class III patients, compared with the reference group of normal weight or mildly overweight patients. Superficial infection rates were likewise relatively elevated in class I and readmission rates in class II patients.