Comparison Of Mid-term Outcomes Research Articles

Robot-assisted thoracoscopic versus conventional thoracoscopic plication for diaphragmatic eventration in children: Comparison of mid-term outcomes

ObjectiveMinimally invasive surgery has been widely used for diaphragmatic eventration (DE). We aimed to compare the mid-term outcomes of robot-assisted thoracoscopic (RTP) and conventional thoracoscopic plication (CTP) for DE and to discuss the technical advantages of RTP. MethodsFrom January 2015 to July 2022, the clinical outcomes of 30 RTP patients and 35 CTP patients were retrospectively analyzed. The baseline data, surgical outcomes and surgical technique will be compared in detail. ResultsThe baseline data of two groups were comparable. No intraoperative conversion or complications occurred. The total operation time and intraoperative blood loss were similar between two groups, but RTP group had a significantly shorter diaphragmatic plication time compared to CTP group (25.77±3.55 min vs 44.49±4.43 min, p < 0.001). The total surgical cost of RTP group was higher than that of CTP group (48,593.06±2752.33 RMB vs 25,181.23±5681.51 RMB, p < 0.001). No significant differences were found in postoperative hospital stay, diclofenac suppository dosage, unplanned readmission rate within 30 days postoperatively, recurrence rate, or postoperative complications within 1 year postoperatively between RTP and CTP groups. Sixty patients had preoperative symptoms resolved or significantly improved with normal diaphragmatic position. However, two patients in CTP group encountered recurrence, and one patient in CTP group and two patients in RTP group had a diaphragm descent in only one intercostal space. ConclusionRTP is a feasible and effective minimally invasive option for the treatment of DE, with mid-term outcomes comparable to CTP, which has a great advantage in terms of easier suturing and free knotting. DE can serve as an ideal disease type to train robots for thoracoscopic surgery by young doctors. Level of evidenceLevel III.

Comparison of Midterm Outcomes between All-Inside Arthroscopic and Open Modified Broström Procedures as Treatment for Chronic Ankle Instability.

Although the all-inside arthroscopic modified Broström operation (AMBO) and open modified Broström operation (OMBO) for chronic lateral ankle instability (CLAI) showed favorable outcomes up to 1-year short-term follow-up, concerns about the long-term stability of AMBO are still present. Therefore, we aimed to compare midterm outcomes between the 2 methods by extending the observation period. Fifty-four patients undergoing ankle surgery between August 2013 and July 2017 were included in the AMBO (n = 37) and OMBO (n = 17) groups. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS) were used to evaluate the clinical outcomes. Anterior drawer test and talar tilt angle were used to evaluate the radiological outcomes. The mean follow-up duration was 59.69 months. The 2 groups both showed improved clinical and radiological results statistically. In addition, they did not differ in age, sex, or preoperative AOFAS ankle-hindfoot scale score, VAS score, anterior drawer test, or talar tilt angle. No significant difference in the final follow-up postoperative clinical scores or radiological outcomes was observed. AMBO and OMBO as treatments for CLAI did not yield differing clinical or radiological outcomes at a mean follow-up time point of 59.69 months.

Clinical relevance of roll-back replacement of ultra congruent total knee arthroplasty: comparison of mid-term outcomes with posterior stabilizing design.

The outcomes of total knee arthroplasty (TKA) remain controversial, and we do not know which factors are important for successful outcomes. This study aimed to compare the mid-term outcomes of different conceptual designs by evaluating the radiological and clinical outcomes. A total of 478 total knee arthroplasties (TKAs) were enrolled and allocated into groups I [posterior stabilizing (PS) with anterior referencing (AR)], II [PS with posterior referencing (PR), and III [ultra-congruent (UC) TKA)]. Preoperative findings, last follow-up clinical outcomes, and final follow-up radiological and indirect assessments of the femoral rollback were compared between the groups. The mean follow-up period was 72.6 ± 12.9months. The tourniquet was used samely applied to every group. Flexion contracture was significantly larger in group III than in groups I and II (3.3 ± 2.7, p < 0.001), and further flexion was significantly smaller in group III (130.0° ± 2.7°, p < 0.001). Among the radiological parameters, posterior osteophyte formation was the most common in group III (67.8%). The rollback distance was significantly smaller in group III than in groups I and II (p < 0.001). The active deep flexion angle was affected by the posterior condylar offset (PCO) ratio, and the contact point changed the distance (p < 0.05). PS TKAs showed better ROMs than UC TKAs; however, no differences were noted in the clinical outcome scales. The flexion angle was affected by the PCOR and rollback at both PS and UC TKAs. However, rollback negatively affected the flexion angle during UC TKAs. An inappropriate femoral rollback was identified, and femoral osteophyte formation was determined to be the most prominent in UC TKAs. Level of evidence Level III comparative study.

Comparison of Mid-Term Outcomes between Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade.

This study retrospectively examined the mid-term surgical outcomes between microhook ab interno trabeculotomy (μLOT) and goniotomy when one was using the Kahook Dual Blade (KDB) in combination with phacoemulsification in primary open-angle glaucoma and exfoliation glaucoma patients. Between December 2016 and December 2020, the current study examined 47 μLOT and 52 KDB eyes that underwent surgery. When there was a &lt; 20% reduction in the preoperative intraocular pressure (IOP) or when the IOP was &gt; 18 mmHg (criterion A), the IOP was &gt; 14 mmHg (criterion B) at two consecutive follow-up visits, or when there was a requirement for reoperation, these were all considered to indicate that the surgery failed. A genetic algorithm that used the preoperative IOP was used to determine the score matching. After score matching, a total of 27 eyes were evaluated. In the μLOT and KDB groups, the mean postoperative follow-up periods were 31.2 ± 13.3 and 37.2 ± 16.3 months, respectively. The results for both of the groups show there were significant postoperative reductions in the IOP (p &lt; 0.05) and medication scores (p &lt; 0.05) at 6, 12, 24 and 36 months. At 12, 24, and 36 months, the probabilities of success in the μLOT and KDB groups for criterion A were 70.4% and 48.2%, 61.9% and 48.2%, and 55.0% and 48.2% (p = 0.32; log-rank test), respectively. For criterion B, the results for the two groups were 55.6% and 33.3%, 44.4% and 33.3%, and 44.4% and 33.3% (p = 0.15; log-rank test), respectively. Similar postoperative complications were found between the groups. Comparable mid-term surgical outcomes were found for the uses of μLOT and KDB.

Comparison of Midterm Outcomes Between the Intramedullary Fibular Nail and the Locking Plate for the Treatment of Unstable Ankle Fractures in Active Young Patients

Category:Trauma; AnkleIntroduction/Purpose:We aimed to compare the midterm radiological and clinical outcomes between closed reduction and internal fixation (CRIF) using the fibular intramedullary nail (IMN) and open reduction and internal fixation (ORIF) using plates for the treatment of unstable ankle fractures in active young patients.Methods:In this retrospective cohort study, 204 patients treated with CRIF using the fibular IMN (94 patients) or ORIF using the locking plate (110 patients) were included after at least 3 years of follow-up. The mean patient age was 41.4 years. Radiographic evaluation included the quality of reduction assessed by plain radiography and the three-dimensional (3D) reconstruction model using the CT scan images as well as the development of posttraumatic ankle osteoarthritis (PTOA) assessed by weightbearing plain radiography. Clinical evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud and Molander score (OMAS), the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) pain score as well as complications.Results:In an assessment by both plain radiography and the 3D reconstruction model, the fair or poor reduction was more observed in the IMN group than in the ORIF group at final follow-up (P <.001). Poor reduction in the IMN group was significantly related to Weber type C, pronation type injury, and comminuted fibular and trimalleolar fractures (P <.001). PTOA was observed in 21.3% in the IMN group compared to 9.1% in the ORIF group (P =.024). There were no significant differences in clinical outcomes between the 2 groups. There were significantly fewer postoperative complications in the IMN group than in the ORIF group (9.5% vs 39%, P <.001).Conclusion:Surgeons should consider ORIF for unstable ankle fractures in active young patients with Weber type C, pronation type injury, and comminuted fibular and trimalleolar fractures.

Comparison of Midterm Outcomes Between Open and Robotic Emergent Ventral Hernia Repair.

Background. There are no studies on the role of robotics in emergency ventral hernia repair (EVHR). We aimed to compare outcomes of robotic EVHR (REVHR) and open (OEVHR). Methods. We performed a retrospective study of EVHRs performed between 2013 and 2019. Patients who underwent ventral hernia repair in an elective setting and patients who had concomitant non-abdominal wall procedures were excluded. Pre-, intra-, and postoperative variables were compared. Univariate and multivariate analyses were performed. Results. In all, 43 patients underwent OEVHR as compared to 35 patients who underwent REVHR. The patients in both groups were similar in terms of hernia etiology as well as Acute Physiology and Chronic Health Evaluation (APACHE-II) and the Sequential Organ Failure Assessment (SOFA) scores. Mean operative times for the robotic group were almost 2-fold compared with those of the open group (139minutes vs 70minutes, respectively; P < .001). Median length of stay (LOS) did not differ between the groups (3days for both groups; P = .488). Major complications (P = .001), morbidity scores (P = .006), surgical site events (SSEs) (P = .045), and procedural interventions (P = .020) were found higher in the open group. No differences in freedom of recurrence were found (P = .662). Multivariate logistic regression analysis showed that open repair was associated with a 4-fold risk for the development of complications as compared to robotic repair (P = .025; odds ratio (OR) = 4, 95% confidence interval (CI) = 1.193-13.444). Conclusion. Compared to OEVHR, REVHR resulted in longer operative times and lower morbidity, including SSEs and related interventions. However, neither LOS nor recurrence differed between the groups.

The Combination of Inlay Patellofemoral Arthroplasty and Medial Unicompartmental Knee Arthroplasty Versus Total Knee Arthroplasty for Mediopatellofemoral Osteoarthritis: A Comparison of Mid-Term Outcomes

BackgroundTo the best of our knowledge, there have been no studies in the literature related to the use of second-generation inlay patellofemoral arthroplasty and unicompartmental knee arthroplasty combination (inlay PFA/UKA) in the treatment of mediopatellofemoral osteoarthritis (MPFOA). The aim of this study is to evaluate the efficacy of inlay PFA/UKA in MPFOA. MethodsThe study included 49 patients applied with inlay PFA/UKA because of MPFOA and 49 patients applied with TKA, matched one-to-one according to age, gender, body mass index, follow-up period, preoperative Knee Society Score, and range of motion. All the patients were evaluated clinically using the Knee Society Score, Knee Injury Osteoarthritis Outcome Score, and range of motion, and were also evaluated radiologically. Complication rates and length of hospital stay were compared. ResultsThe mean follow-up period was 54 ± 4 and 54.4 ± 3.9 months in inlay PFA/UKA and TKA groups, respectively. (P = .841). No statistically significant difference was determined between the 2 groups in respect of the mean clinical scores at the final follow-up examination (P ≥ .129). Total complications were fewer and length of hospital stay was shorter in the inlay PFA/UKA group than in the TKA group (P = .037 and P = .002). There was no radiographic evidence of progression of lateral compartment osteoarthritis according to Kellgren-Lawrence in any patient in the inlay PFA/UKA group. ConclusionIn selected patient groups, inlay PFA/UKA is an alternative to TKA, with lower complication rates, shorter length of hospital stay, and clinical and functional results similar to those of TKA without osteoarthritis progression in the unresurfaced lateral compartment in the mid-term. Level of EvidenceIII.

Comparison of Mid-term Outcomes Between an Arthroscopic and an Open Modified Broström Procedure for Ankle Instability

Category: Arthroscopy Introduction/Purpose: Although the short-term results of an all-inside arthroscopic Modified Broström operation (MBO) have been as satisfactory as open MBO, there is always a concern about the long-term stability of an arthroscopic MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs at mid-term follow up. Methods: From August 2012 to July 2014, totally 87 patients underwent an arthroscopic MBO and an open MBO. Of these, we retrospectively reviewed 48 patients who had a more than 3 years follow-up period. They were divided into two groups: all-inside arthroscopic MBO goup (26 patients), open MBO group (22 patients). The American Orthopaedic Foot &amp; Ankle Society (AOFAS) ankle–hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. Clinical and radiologic outcome evaluations were performed preoperatively, at 12 months postoperatively, and at a final follow-up at a minimum of 36 months postoperatively. Results: Evaluations were performed for 26 ankles in the all-inside arthroscopic MBO group and 22 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P &gt; .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P &lt; .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P &gt; .05). Conclusion: There was no difference in the clinical and radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 3 years after surgery. An all-inside arthroscopic MBO should be a good treatment option in patients who have lateral ankle instability.

Abstract 12446: Comparison of Midterm Outcomes After Surgical Correction in Patients With Biventricular Obstruction Hypertrophic Cardiomyopathy

Introduction: Data on the incidence, natural history and treatments of biventricular obstruction hypertrophic cardiomyopathy are limited. Objective: We aimed to the compare midterm outcomes of surgery and medication in biventricular outflow tract obstruction(BVOTO) HCM with left ventricular outflow tract obstruction (LVOTO) HCM and non-obstructive hypertrophic cardiomyopathy (NOHCM). Methods: Among 4945 HCM patients, we identified 43 with BVOTO and recruited age and sex matched 54 with LVOTO and 52 with NOHCM. The primary endpoint was all cause death and second endpoints were cardiovascular events. Results: Age and male were paired among BVOTO, LVOTO and NOHCM (26±17 ys, 30±18 ys, 31±16 ys P=0.3; 57%, 66%, 69%, p=0.5). More patients with BVOTO (69%) had NYHA III/IV than with LVOTO (51%)and NOHCM (15%) (p=0.000). And patients with BVOTO (5.6%±4 %) had higher risk of SCD than with LVOTO (3.9%±1.8%) and NOHCM (2.9%±2.1%)(p=0.000). In BVOTO, 20 patients had left-and-right sided correction (LRVC-B) (1 died and 5 had III AVB), 12 patients accepted left-sided correction (LVC-B) (1 died and 1 occurred III AVB) while 11 patients received medication. At the last follow-up, patients in LRVC-B and LVC-B had a reduction in left and right ventricular intracavity pressure gradient and NYHA class (vs before myectomy, p &lt; 0.001). And no death occurred in the remained 147 patients. The second endpoint-free survival rates of BVOTO were less than LVOTO and NOHCM while the rates were similar among LRVC-B, LVC-B, LVC-L and NOHCM groups. (Fig1ab) Independent predictors of the second endpoint were age (HR 1.05,95%CI 1.0-1.1), RVOTO (HR 1.06,95%CI 1.03-1.10), myectomy (HR 0.16,95%CI 0.03-0.61) and pre-NYHA (HR 4.1,95%CI 2.1-8.33). Conclusions: Patients with BVOTO had more severe symptoms. Both LRVC-B and LVC-B could improve symptom but LRVC-B had a higher risk of III AVB. Mid-term outcomes after surgical correction in BVOTO were similar to that in NOHCM.

Comparison of Midterm Outcomes between Surgical Treatment and Endovascular Reconstruction for Chronic Infrarenal Aortoiliac Occlusion

PurposeTo compare the midterm results of aortoiliac stent (AIS) placement with those of surgical treatment in patients with chronic infrarenal aortoiliac occlusion. Materials and MethodsMidterm outcomes in patients treated at a single center from 2005 to 2010 were retrospectively reviewed. Correlations between baseline clinical factors and midterm outcomes were assessed. ResultsThe technical success rate was significantly lower in the AIS group than in the surgery group (83.3% vs 100%; P = .016). Of 68 technically successfully treated patients, 33 underwent surgical revascularization and 35 received AIS placement. There were no significant differences in patient demographics, Rutherford classification, cardiovascular risk factors, and 30-day mortality rates. Surgically treated patients had a longer average postoperative hospital stay (P = .001) and higher rates of postoperative complications, including respiratory failure (P = .010), transient renal dysfunction (P = .002), and multiple organ dysfunction (P = .023). Mean ankle-brachial index increased significantly in both groups (P < .001), but to the same extent. The primary 1-, 3-, and 5-year patency rates were 93.6%, 90.2%, and 90.2%, respectively, in the surgery group, and 91.4%, 81.8%, and 64.2%, respectively, in the AIS group (P = .054). No differences were observed in survival rate (P = .945), limb salvage (P = .860), or secondary patency (P = .916). ConclusionsAIS for chronic infrarenal aortoiliac occlusion is associated with a shorter hospital stay and lower postoperative morbidity rates. Although midterm primary patency rate was lower than for traditional open surgery, AIS appears to be a safe, minimally invasive, and reliable procedure for patients with chronic infrarenal aortoiliac occlusion.

Repair of Anterior Mitral Leaflet Prolapse: Comparison of Midterm Outcomes With Chordal Transposition and Chordal Replacement Techniques

Mitral valve surgery for anterior leaflet prolapse is considered more difficult than repair of the posterior leaflet. Most used techniques consist in chordal transposition from the posterior to the anterior leaflet, and chordal replacement using expanded polytetrafluoroethylene sutures. The aim of this study was to compare the midterm outcomes of anterior leaflet repair using chordal transposition and chordal replacement techniques.

The improvement of hypoxia correlates with neuroanatomic and developmental outcomes: Comparison of midterm outcomes in infants with transposition of the great arteries or single-ventricle physiology

We performed a prospective longitudinal study of the neuroanatomic and developmental changes in infants with transposition of the great arteries (TGA) or single-ventricle (SV) physiology to identify variables in anatomic development of the brain associated with functional impairment. Thirty-three infants with congenital heart defects, 23 with SV and 10 with TGA, were studied at around 1 year old (time 1) and 3 years old (time 2) by magnetic resonance imaging of the brain. Neurodevelomental assessment was performed at the same time. The whole and frontal lobe volumes were significantly reduced in both groups at time 1 compared with normal control subjects (P < .01). However, by time 2 whole and frontal brain volumes were normal in the TGA group but remained significantly smaller (P < .01) in the SV group. In agreement with these findings, the mental development index (MDI) was lower (P < .05) at time 1 in both groups but improved to normal levels at time 2 in the TGA group. In the SV group, both MDI and the psychomotor development index (PDI) were significantly decreased at both time 1 and time 2 (P < .01). These patients continued to experience hypoxia, and multivariate analysis revealed that functional oxygen saturation was significantly associated with PDI. Further, the PDI score correlated with whole and regional brain volumes (P < .05). Neuroanatomic and developmental outcomes improve progressively in infants with TGA, unlike those with SV physiology. Impaired cerebral circulation and hypoxia may have significant effects on brain growth and development in infants with critical congenital heart disease.

Simultaneous mobile- and fixed-bearing total knee replacement in the same patients: A prospective comparison of mid-term outcomes using a similar design of prosthesis

Simultaneous mobile- and fixed-bearing total knee replacement in the same patients: A prospective comparison of mid-term outcomes using a similar design of prosthesis