Risk Of Complications Research Articles

Severe Maternal Morbidity and Other Perinatal Complications Among Black, Hispanic, and White Birthing Persons With and Without Physical Disabilities.

Background: People with physical disabilities are at increased risk of adverse perinatal outcomes, including severe maternal morbidity (SMM). Risks may be even greater for disabled people in minoritized racial or ethnic groups, but little is known about this intersection. Methods: We analyzed linked hospital discharge and vital records data from California, 2008-2020. We identified physical disabilities using diagnosis codes for maternal congenital anomalies, major injuries, musculoskeletal disorders, or nervous system disorders. We compared birthing persons in five groups (Black and Hispanic with and without physical disabilities, White with physical disabilities) to a reference group of non-Hispanic Whites without disabilities. We used Poisson regression to assess associations with SMM and other outcomes, with and without adjusting for sociodemographic and clinical covariates. Results: Disabled Black and Hispanic birthing persons had particularly high relative risks (RRs) of SMM (Black disabled RR = 6.13, 95% confidence interval [CI]: 4.94, 7.61; Hispanic disabled RR = 3.67, 95% CI: 3.29, 4.10) as compared with nondisabled White persons. These risks were greater than those for nondisabled Black (RR = 2.05, 95% CI: 1.99, 2.11), nondisabled Hispanic (RR = 1.36, 95% CI: 1.34, 1.39), and disabled White birthing persons (RR = 2.44, 95% CI: 2.16, 2.77). For most other outcomes, risks were also largest for disabled Black birthing persons, followed by disabled Hispanic birthing persons. Conclusions: Black and Hispanic people with physical disabilities are highly likely to experience SMM and are at increased risk for other complications and adverse outcomes. Efforts are needed to understand underlying causes of these disparities and develop policies and practices to eliminate them.

The influence of the structure of the masticatory system on the presence and severity of the gag reflex in children with cerebral palsy.

Dysphagia, prevalent in 90% of children with neurological disorders, poses risks of medical complications and is associated with cognitive and psychosocial challenges. The absence of the sucking-swallowing reflex and variations in the gag reflex contribute to feeding difficulties. This study focuses on examining the impact of the gag reflex on the masticatory system structure in children with cerebral palsy, aiming to assess its significance. This observational study investigated the gag reflex and soft palate shape in 25 children with cerebral palsy (average age: 14 years). Inclusion criteria considered specific levels of the Eating and Drinking Ability Classification System (EDACS) and the Gross Motor Function Classification System (GMFCS). Exclusion criteria comprised hypotension, inflammation and tumors. The Castillo-Morales questionnaire assessed variables and statistical analysis (Spearman's rank correlation and non-parametric tests) utilizing PQStat v. 1.8.6.120 software. Findings did not reveal an association between the absence of the gag reflex and abnormal palate structure in children. Our results showed a correlation between higher tension of the buccinator muscles and mobility of the tongue on the structure of the palate. Children with neurological disorders, such as cerebral palsy, are a diverse group requiring specialized orthodontic treatment and close interdisciplinary collaboration.

Frontalis sling surgery - pediatric versus adult population: characteristics and outcomes

PurposeFrontalis sling surgery is a common method for ptosis correction for both pediatric and adult populations. This study aims to compare the characteristics and outcomes of this surgery in these two populations.MethodsA retrospective cohort study. Patients who underwent frontalis sling surgery between the years 2009 and 2024, with complete medical chart data, and had at least a one-month follow-up period were included. Age, gender, ptosis type, type of sling, complications, and re-surgery were analyzed.ResultsA total of 62 patients were included, with 41 patients in the pediatric group and 21 patients in the adult group. The mean age was 4.7 ± 5.0 and 46.04 ± 18.33 years old in the pediatric and adult groups, respectively. The most common etiology of ptosis in the pediatric group was simple congenital (70%), while the most common etiology in the adult group was myogenic ptosis due to a systemic condition (47%) (p < 0.001). Baseline pre-operative MRD1 (marginal reflex distance 1) was lower in the adult group compared to the pediatric ( -0.37 ± 1.21 mm vs. 0.36 ± 0.65 mm respectively (t-test, p = 0.04)). However, the mean change in MRD1 (pre-operative to postoperative) was not significantly different for both groups (t-test, p = 0.5). A higher rate of sling extrusion was observed among the adult group (0% of pediatrics vs. 14% of adults, chi-square, p = 0.013). A higher number of previous sling surgeries were found to be positively correlated (r = 0.672) with overall postoperative complications (Pearson correlation. p = 0.006).ConclusionFrontalis sling surgery varies between adult and pediatric patients regarding etiology, preoperative findings, surgical approach, and complications. Adults experienced higher rates of complications such as sling extrusion and dry eye. Moreover, an increased number of previous sling surgeries was associated with a rise in postoperative complications such as suture dehiscence, extrusion, and granuloma formation. Consequently, frontalis sling procedures should be regarded as a last resort for ptosis correction in adults due to the elevated risk of complications.

Impact of anxiety symptoms on dialysis adherence and complication rates: A longitudinal observational study

BACKGROUND Anxiety is a common psychological comorbidity in patients undergoing dialysis, yet its impact on treatment adherence and complication rates remains understudied. We designed a longitudinal observational study to investigate these relationships, based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen. AIM To investigate the relationship between anxiety symptoms, dialysis adherence, and complication rates in patients undergoing dialysis over a 24-month period. METHODS This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months. Dialysis adherence was evaluated through attendance records, interdialytic weight gain, and patient-reported medication adherence. We recorded complications (infections, cardiovascular events, and hospitalizations) and used mixed-effects models and survival analyses to infer associations between anxiety symptoms, adherence measures, and complication rates. RESULTS Higher anxiety symptoms were significantly associated with poorer dialysis adherence, including increased missed sessions [incidence rate ratio = 1.32, 95% confidence interval (CI): 1.18-1.47, P &lt; 0.001], greater interdialytic weight gain (β = 0.24, 95%CI: 0.15-0.33, P &lt; 0.001), and lower medication adherence (odds ratio = 0.85, 95%CI: 0.78-0.93, P &lt; 0.001). Patients with clinically significant anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale ≥ 8) had a higher risk of complications [hazard ratio (HR) = 1.68, 95%CI: 1.32-2.14, P &lt; 0.001], particularly infections (HR = 1.89, 95%CI: 1.41-2.53, P &lt; 0.001) and cardiovascular events (HR = 1.57, 95%CI: 1.18-2.09, P = 0.002). The relationship between anxiety and complications was partially mediated by adherence measures. CONCLUSION Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates. Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

Retrospective Evaluation of Central Venous Catheters Applications in Pediatric Patients in Tertiary Hospital

Introduction: Central venous catheters are mainly used for safe fluid infusion, total parenteral nutrition, and evaluation of hemodynamic parameters. Complications related to central venous access can occur during insertion, after insertion or during catheter maintenance. The aim of this study was to investigate the demographic data and the presence of catheter-related complications in pediatric patients with central venous catheters in our hospital. Materials and methods: This study retrospectively reviewed demographic data and the presence of catheter-related complications in pediatric patients with central venous catheters in our hospital from June 1, 2019, to February 28, 2023. Results: Patients who underwent central venous catheterisation in our hospital between June 2020 and February 2023 were included in the study. When the demographic data of the patients were evaluated, 141 (57.8%) of our patients were male and 103 (42.2%) were female, and there was no statistically significant difference between the groups. In the femoral group, catheterisation of the right femoral vein was preferred more than the left vein (72.2%-27.7%), whereas in the jugular-subclavian group, the right internal jugular vein was preferred more than other sites. The risk of infection was statistically higher in the femoral group compared to the subclavian group. Conclusion: In clinical practice, we think that the risk of complications can be reduced in central venous catheter applications in pediatric patients by experienced personnel by complying with asepsis/antisepsis conditions and using appropriate imaging devices. Keywords: Central venous catheter, pediatric, complication

Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries.

The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes. We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications. There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd's ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77-2.02), gestational hypertension (aOR = 1.84, CI = 1.65-2.05), preeclampsia (aOR = 1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44-2.87), and placenta previa (aOR = 0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06-1.34), chorioamnionitis (aOR = 1.24, CI = 1.03-1.51), caesarean deliveries (aOR = 1.28, CI = 1.18-1.38), wound complications (aOR = 1.65, CI = 1.31-2.08), and transfusions (aOR = 0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16-2.10). Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications.

Advancements in Temporomandibular Joint Arthroscopy: Refinements in Surgical Techniques for Treating the Superior Joint Spaces.

This study introduces a novel technique for arthroscopic surgery of the temporomandibular joint (TMJ), developed by the first author. Traditional TMJ arthroscopy techniques typically utilize a reference plane extending from the lateral canthus to the tragus, which may misalign with the zygomatic arch and create technical challenges during percutaneous joint access. The proposed method addresses these limitations by leveraging coronal and sagittal tomographic measurements alongside 3-dimensional reconstructions to determine precise and anatomically appropriate entry points. The inclusion of a 3-port video arthroscopy system enhances intraoperative visualization and access to the superior joint spaces. Compared with conventional techniques, this refined method demonstrates increased procedural efficiency, improved safety, simplified technical execution, and enhanced reproducibility. Detailed procedural steps are presented, supplemented with illustrative diagrams to ensure clarity and replicability. This innovative approach significantly advances surgical maneuverability, allowing for a comprehensive assessment and treatment of the glenoid fossa, condyle, and articular disc while minimizing the risk of iatrogenic complications often associated with traditional techniques.

The impact of white matter hyperintensities on short-term outcomes of reperfusion therapy in patients with acute ischemic stroke.

This study aimed to explore the impact of white matter hyperintensities (WMH) on the short-term outcomes of reperfusion therapy in acute ischemic stroke (AIS) patients. We prospectively collected data on AIS patients undergoing reperfusion therapies at Chengdu Second People's Hospital from January 2020 and January 2024. WMH severity was graded as 0-3 (none to moderate) or 4-6 (severe) by the Fazekas scale. We analyzed National Institutes of Health Stroke Scale (NIHSS) scores, good functional outcomes (modified Rankin Scale, mRS 0-2) at 7days and discharge, and safety outcomes like in-hospital mortality and intracranial hemorrhage. During the study period, 669 patients were included, with 345 having none to moderate WMH and 324 with severe WMH. Patients with severe WMH exhibited significantly higher NIHSS and mRS at 7days and discharge, with a decrease in good outcomes (mRS 0-2: 40.43% vs. 75.65%), and an increase in intracranial hemorrhage (16.4% vs. 5.8%) and in-hospital mortality (11.7% vs. 2.0%) compared with none to moderate WMH patients. After matching the baseline data, none to moderate WMH was associated with higher likelihood of good outcomes at discharge [adjusted odds ratio (aOR), 2.142; 95% confidence interval (CI), 1.380-3.304; P < 0.001] and a lower rate of any intracranial hemorrhage (aOR, 0.348; 95% CI 0.180-0.673; P < 0.001), with no significant difference in in-hospital mortality between the groups. Severe WMH could reduce the benefits of reperfusion therapy in AIS, with increased risk of hemorrhagic complications, warranting further research into treatment strategies for these patients.

Influence of heart rate variability on platelet hemostasis by average aggregate size in patients with chronic coronary heart disease in combination with COVID-19

BACKGROUND. In order to prevent complications of coronavirus infection (platelet hemostasis disorders, heart rate variability and QT interval dispersion, which increase the risk of thromboembolic complications and fatal arrhythmias), it is promising to study the relationship between heart rate variability and platelet hemostasis in patients with coronary artery disease (CAD) in combination with coronavirus disease (COVID-19). OBJECTIVE. The aim of the study was to investigate the impact of COVID-19 on the interdependence of changes in platelet hemostasis and heart rate variability in patients with CAD. MATERIALS AND METHODS. We examined 102 patients divided into three groups: group 1 – CAD without COVID-19 (n=32); group 2 – CAD in combination with COVID-19 (n=35); group 3 – COVID-19 without CAD (n=35). The control group included 30 conditionally healthy individuals. Changes in platelet hemostasis were studied according to laser aggregometry by the Born method and analysis of the average size of aggregates with an assessment of spontaneous aggregation and aggregation induced by adenosine diphosphate (ADP), arachidonic acid, epinephrine, collagen, ristomycin. Heart rate variability parameters and QT interval variability characteristics were determined by the results of 24-hour Holter electrocardiogram monitoring. RESULTS AND DISCUSSION. The time for spontaneous aggregation was longer in all patients compared to the control group, with the highest values observed in groups 2 and 3 (with COVID-19). In ADP aggregation, the control group showed higher results. The rate of aggregation in ADP was lowest in group 2. Collagen-induced aggregation was higher in COVID-19 cases. All groups exhibited lower values of adrenaline-induced aggregation, with the lowest values in group 3. The time of aggregation under adrenaline was shortest in group 2. Ristocetin induced greater aggregation in the control group, but the lowest rate in group 2, and the shortest time in group 1 (СAD without COVID-19). In СAD with COVID-19, an inverse relationship was observed between the parasympathetic nervous system and adrenaline-induced aggregation, as well as between sympathetic activity and ristocetin-induced aggregation. The degree of platelet aggregation induced by ADP had a direct correlation with the corrected QT interval. The rate of aggregation with ADP had an inverse correlation with the mean QT. The time of platelet aggregation activated by ristocetin had an inverse correlation with the standard deviation of QT(NN). The mode of QT had an inverse correlation with the degree of aggregation with ristocetin. CONCLUSIONS. In СAD and COVID-19, platelet hemostatic function is impaired, as confirmed by laser aggregometry data. Autonomous dysregulation and prolonged QT interval have been identified. A complex interaction between platelet hemostasis and heart rate variability is observed. Considering platelet hemostatic function, heart rate variability, and QT dispersion is crucial for treating this cohort of patients.

Chronic Kidney Disease and Infection Risk: A Lower Incidence of Peritonsillar Abscesses in Specific CKD Subgroups in a 16-Year Korean Nationwide Cohort Study

Peritonsillar abscesses and deep neck infection are potentially serious infections among patients with chronic kidney disease (CKD), posing risks for severe complications and drawing significant public health concern. This nationwide, population-based longitudinal study (2002–2019) assessed the extended relationship between chronic kidney disease (CKD) and the likelihood of peritonsillar abscess and deep neck infection in a Korean cohort. Using a 1:4 propensity score overlap-weighted matching, we included 16,879 individuals with CKD and 67,516 comparable controls, accounting for demographic variables and comorbidities to ensure balanced group comparisons. Hazard ratios (HRs) and 95% confidence intervals (CIs) for deep neck infection and peritonsillar abscesses in relation to CKD history were calculated with a propensity score overlap-weighted Cox proportional hazards model. Our results revealed no significant increase in the overall incidence of deep neck infections or peritonsillar abscesses in CKD patients compared to controls. Interestingly, CKD patients demonstrated a 50% reduced likelihood of developing peritonsillar abscesses (HR 0.50; 95% CI = 0.30–0.83; p = 0.007), particularly among subgroups aged 70 years or older, females, non-smokers, rural residents, overweight individuals, and those with lower comorbidity burdens (e.g., absence of hypertension, hyperlipidemia, or hyperglycemia). In summary, the results suggest that lifestyle modifications and the effective management of comorbidities could reduce the risk of peritonsillar abscess in certain CKD subgroups. Our findings may help to alleviate public health concerns regarding peritonsillar abscesses and deep neck infections as CKD-related comorbidities.

Postoperative factors predicting outcomes in patients with Perihilar cholangiocarcinoma undergoing curative resection—a 10-year single-center experience

Background Perihilar cholangiocarcinoma (pCCA) has a 5-year overall survival (OS) ranging from 10–40%, following resection. However, prognostic models for postoperative outcomes are limited by long study timespan and variations in work-up. We investigated postoperative outcomes in patients resected for pCCA in a high-volume center with standardized work-up. Method Patients resected with confirmed pCCA, between 2013 and 2023, were included. Cox-regression investigated association between postoperative factors and OS as well as disease-free survival (DFS). Results Totally, 65 patients were resected for pCCA. The 1-, 3- and 5-year OS rates were 86.1%, 56.5% and 32.6% respectively. The 1-, 3- and 5-year DFS rates were 67.7%, 40.0% and 26.8%, respectively. Portal vein embolization (PVE) (HR 4.52 [CI 1.66–12.27], p = 0.003), lymph node metastasis (LNM) (HR 6.37 [CI 2.06–19.67], p = 0.001) and Clavien-Dindo (CD) ≥3a (HR 2.83 [CI 1.43–5.56], p = 0.002) were associated with inferior OS. Clavien-Dindo (CD) ≥3a (HR 2.10 [CI 1.05–4.22], p = 0.03) and T-stage >2 (HR 2.36 [CI 1.01, 5.05], p = 0.04) were associated with inferior and superior DFS, respectively. Conclusion PVE, T-stage >2, LNM and CD ≥ III were associated with worse prognosis in resected pCCA. Research is needed to improve pre-operative detection of oncological features and patients with risk of major surgical complications.

Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine

Background: Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine. Methods: Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.’s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates. Results: A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%, p = 0.024), 2Y (29.5 vs. 49.6% (p = 0.003), and 5Y (48.7 vs. 62.8%, p = 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (p = 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both p &gt; 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (p = 0.007) and last follow-up (p &lt; 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model p &lt; 0.001), no such relationship was identified in LT patients. Conclusions: Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required.

Distinct effects of obesity and diabetes on the action potential waveform and inward currents in rat ventricular myocytes.

Obesity is a significant global health challenge, increasing the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular disease. Research indicates that obese individuals, regardless of their diabetic status, have an increased risk of cardiovascular complications. Studies suggest that these patients experience impaired electrical conduction in the heart, although the underlying cause-whether due to obesity-induced fat toxicity or diabetes-related factors-remains uncertain. This study investigated ventricular action potential parameters, as well as sodium (INa) and calcium (ICa, L) currents, in Zucker fatty (ZF) rats and Zucker diabetic fatty (ZDF) rats, which serve as models for obesity and T2DM, respectively. &#160;Ventricular myocytes were isolated from 25-30-week-old Zucker rats. Resting and action potentials were recorded using a β-Escin perforated patch clamp, while INa and ICa, L were assessed with whole-cell patch clamp methods. ZF rats exhibited higher excitability and faster upstroke velocity with greater INa density, whereas ZDF rats showed decreased INa and slower action potential upstroke. No differences in ICa, L density or voltage sensitivity were found among the groups.</p> In summary, obesity, with or without accompanying T2DM, distinctly impacts the action potential waveform, INa density, and excitability of ventricular myocytes in this rat model of T2DM.

Increased risk of adverse events following the treatment of associated versus elementary acetabular fractures: a matched analysis of short-term complications

PurposeThis retrospective cohort study aims to compare short-term complication rates between patients receiving open reduction and internal fixation (ORIF) for associated versus elementary acetabular fractures, with a secondary objective of identifying independent risk factors for adverse outcomes.MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent ORIF for associated acetabular (CPT 27228) or elementary acetabular fractures (CPT 27226, 27227) from 2010 to 2021. Propensity score matching was employed to account for baseline differences and the short-term complication rates were compared between the cohorts.ResultsWe identified 1,330 patients who underwent ORIF for an acetabular fracture between 2010 and 2021, including 868 patients with elementary fractures and 462 with associated fractures. After matching, there were 462 patients in each cohort. The matched associated acetabular fracture group experienced higher rates of any adverse event (AAE, p = 0.029), transfusion (p = 0.010), and reoperation (p = 0.049). Increased age, increased operative time, higher body mass index (BMI), and prolonged hospital length of stay (LOS) augmented the risk of any complication.ConclusionThe findings of this study identify areas of greater risk of postoperative complications after ORIF in individuals with associated versus elementary acetabular fractures. Discussion of these heightened risks is critical to appropriate patient care. Understanding these risks plays an important role in the clinical decision-making process and may identify areas to monitor patients postoperatively.

Transophthalmic Artery Embolization of Anterior Skull Base Meningiomas: Technical Case Series.

Preoperative embolization of anterior skull base meningiomas can facilitate surgical resection by reducing tumor vascularity. However, transophthalmic artery embolization carries risks of visual complications. This study aimed to evaluate the safety and efficacy of this technique using modern endovascular tools. This retrospective study included patients with anterior skull base meningiomas who underwent preoperative transophthalmic artery embolization followed by surgical resection between January 2022 and April 2024. Patient demographics, tumor characteristics, embolization details, surgical outcomes, and complications were analyzed. Seven patients (median age 57 years; 6 male) underwent embolization for tumors located primarily at the planum sphenoidale (58%). Unilateral embolization was performed in most cases, with one bilateral transophthalmic approach. Commonly embolized branches included the anterior and posterior ethmoidal arteries. Polyvinyl alcohol particles were the primary embolic agent (71%). Angiographic devascularization was achieved in all cases without complications. Gross total resection was achieved in 71%, with a median blood loss of 427 cc. At a 9-month follow-up, the median modified Rankin Scale score was 1. With careful patient selection, advanced microcatheter technology, and meticulous technique, preoperative transophthalmic artery embolization can be safely performed to facilitate resection of anterior skull base meningiomas. These results suggest it is a viable option for well-selected patients at experienced centers, though larger prospective studies are needed. Fr = French (unit of measurement for catheter diameter); IQR = Interquartile range; IRB = Institutional Review Board; PVA = Polyvinyl alcohol; TOAE = Transophthalmic artery embolization; WHO = World Health Organization.

Association between the age-adjusted Charlson Comorbidity Index and complications after kidney transplantation: a retrospective observational cohort study

BackgroundComplications following kidney transplantation elevate the risks of readmission and mortality. The aim of this study was to assess the association between the age-adjusted Charlson Comorbidity Index (ACCI) and postoperative complications among kidney transplant (KT) recipients.MethodsBetween January 2015 and March 2021, a study involving 886 kidney transplant recipients at the Third Affiliated Hospital of Sun Yat-sen University was conducted. Postoperative complications were defined by the Clavien-Dindo Classification of Surgical Complications. Target Maximum Likelihood Estimation (TMLE) was employed to assess the association between ACCI and postoperative complications. The odds ratio (OR) was computed to determine the relationship between ACCI and postoperative complications. Subsequent interaction and stratified analyses were performed to assess the robustness of the findings.ResultsOut of 859 KT participants ultimately included in the study, 30.7% were documented to have encountered postoperative complications. Participants with an ACCI value exceeding 3 exhibited a notably increased risk of postoperative complications following multivariable adjustment [aOR = 1.64, 95% CI [1.21,2.21], p = 0.001]. Congestive heart failure (OR = 16.18, 95% CI [1.98–132.17], p < 0.001), peripheral vascular disease (OR = 2.32, 95% CI [1.48–3.78], p < 0.001), and chronic obstructive pulmonary disease (OR = 6.05, 95% CI [2.95–12.39], p < 0.001) emerged as the top three preoperative comorbidities significantly linked to postoperative complications in ACCI.ConclusionAn ACCI value exceeding 3 preoperatively constituted a risk factor for postoperative complications among KT patients.

Development and internal validation of El-Shazly-Buchholz's nomogram to predict postoperative complications after PCNL: A multicenter study.

A model to predict the risk of surgical complications following percutaneous nephrolithotomy (PCNL) could be a useful tool to guide clinical decision-making. The aim of this study was to develop a simple and widely applicable stratification tool to be used for patient counseling, surgical planning, evaluation of outcomes, and academic reporting. Data of patients who underwent PCNL were retrieved from the database of the collaborating centers including demographics of patients, characteristics of their stones and urinary tracts, and perioperative data. The primary outcome was the development of postoperative complications. Data were randomly split into a training dataset (85%) and a validation dataset (15%). A univariate and multivariate logistic regression analysis of the training dataset was performed to identify independent predictors of postoperative complications. Model variables were used to construct a nomogram that was internally validated on the testing dataset by measuring calibration, discrimination, and plotting the decision curve. Six hundred thirty one patients (245 Males) with a median (IQR) age of 49 (37-56) years were included. Post-operative complications occurred in 147 (23.3%) patients. Significant predictors of complications included preoperative urine culture (p < 0.001), largest stone diameter (p = 0.02), and intraoperative blood loss (p = 0.002). A nomogram was developed from the predictors and applied to the validation dataset showing an area under the curve (95%CI) of 66.4% (52.2;80.6). This new scoring system emphasized patient characteristics and operative details rather than stone characters to predict the morbidity of PCNL. Furthermore, it should facilitate risk adjustment, enabling physicians to better define the nephrolithiasis disease continuum and identify patients who should be referred to tertiary care centers.

Anterior choroidal artery aneurysm case series: a clinical decision algorithm for endovascular and surgical treatment using a novel classification system.

Anterior choroidal artery (AChA) aneurysms represent 2-5% of intracranial aneurysms. The proximity of the origin of the AChA to the aneurysm neck poses a risk of thromboembolic complications following treatment. AChA occlusion can result in significant neurological deficits. We present a case-series of patients with AChA aneurysms and their treatment outcomes. We describe how treatment was chosen based on aneurysm and patient-specific factors to minimize risks, enhance efficacy of treatment, and improve patient outcomes. We retrospectively reviewed 27 patients who underwent treatment for AChA aneurysms at a single institution from 2015-2024. Clinical presentation, aneurysm characteristics, procedural details, and follow-up data were collected. Twenty-seven AChA aneurysms (median diameter 2.94mm), were treated in 29 procedures. Treatments included clipping (11 aneurysms), flow diversion (13), or coiling (5). The five coiled aneurysms were ruptured at presentation. Three patients experienced permanent infarction (10.3%), two in the setting of vasospasm after coiling and one after flow diversion in a patient who proved to have resistance to clopidogrel. At a median follow-up of 4.73months (IQR = 1.23-14.03), 25 patients (93%) had favorable functional recovery (mRS 0-2). Patients treated for AChA aneurysms experienced favorable functional outcomes by utilizing surgical and endovascular techniques carefully chosen based on aneurysm and patient-specific factors. Two patients did not achieve independence post-coiling due to disability from their initial subarachnoid hemorrhage. There were no treatment related causes of unfavorable functional outcomes.

Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty

Introduction Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls. Methods The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients with a diagnosis of cirrhosis ( n = 627) were matched in a 1:1 proportion to patients who did not have cirrhosis. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative outcomes, and hospital utilization metrics between the two groups. Following Bonferroni correction, an alpha value of 0.003 defined significance. Results Patients with cirrhosis exhibited higher rates of postoperative medical and implant-related complications following primary TSA, including acute renal failure (6.3% vs 1.1%: p &lt; 0.001), urinary tract infection (3.5% vs 0.6%; p &lt; 0.001), transfusions (3.0% vs 0.2%; p &lt; 0.001), acute respiratory distress syndrome (2.9% vs 0.2%: p = 0.002), surgical site infection (2.0% vs 0.2%: p = 0.001), dislocation (2.1% vs 0.0%: p &lt; 0.001), and prosthetic loosening (1.5% vs 0.0%; p = 0.002). These patients also exhibited higher rates of all-cause complications (32% vs 9.2%: p &lt; 0.001) and mortality (1.5% vs 0.0%; p = 0.002) within 180 days of surgery and had an increased cost of admission ($24,633 vs $18,500; p &lt; 0.001) and LOS (2.6 vs 1.5 days; p &lt; 0.001). Conclusion Patients with cirrhosis were found to have increased risk of medical and surgical complications, higher costs, and longer LOS following TSA. These findings can assist orthopedic surgeons in developing strategies in the preoperative period to mitigate complications in this at-risk patient group. Level of evidence Level III – Retrospective cohort study.

Lower Gastrointestinal Bleeding (Nonvariceal): Concepts and Technique

AbstractLower gastrointestinal bleeding (LGIB) is defined as bleeding from the GI tract anywhere distal to the ligament of Treitz. It has multiple causes, including colonic diverticula, hemorrhoids, inflammatory bowel disease, and neoplasms. LGIB presents a wide spectrum of clinical manifestations, ranging from acute presentations with massive bleeding to insidious presentations with chronic, low-grade, intermittent bleeding. Although LGIB is less common and generally less severe compared with upper GI bleeding (UGIB), approximately 10 to 15% of cases eventually require endovascular intervention. Because of the unique vascular anatomy and potential complications, it often necessitates more specialized endovascular skills compared with UGIB. Embolization of LGIB carries a higher risk of ischemic complications compared with UGIB, as the superior mesenteric artery and the inferior mesenteric artery have a less rich collateral supply compared with the celiac trunk. The management of LGIB depends on its etiology, location, and severity. A multidisciplinary team approach, including gastroenterologists, surgeons, and interventional radiologists, is vital for achieving the best possible outcomes for these patients. With advances in microcatheter technology and newer embolic agents, interventional radiologist plays an increasingly important role in LGIB. Interventional radiologists managing these patients should have good knowledge of mesenteric arterial anatomy, the properties of different embolic agents, and basic principles of superselective embolization. In this comprehensive review, we discuss how to approach a patient with LGIB and the role of the interventional radiologist in these patients. Furthermore, we delve into endovascular techniques and concepts for superselective embolization and various embolic agents used in LGIB.