Risk Of Complications Research Articles

A large single-center propensity score-matched cohort study on outcomes and complications based on the number of corrective bars used in the Nuss procedure.

The Nuss procedure is the most common corrective surgery for pectus excavatum. We analyzed treatment outcomes and complication rates in 1238 patients treated with the Nuss procedure from 2002 to 2021, focusing on the number of corrective bars used. Using Propensity Score Matching based on age, sex, BMI, pre-operative FEV1, and the Haller index, we created two groups: 546 patients with a single bar and 546 with two bars. Both groups achieved similar correction effects (Haller index: single bar = 2.58 vs. two bars = 2.56; p = 0.65). In the univariate analysis, in the two-bar group, the postoperative complications were observed more often (28.6% vs. 15.4%, p < 0.001), including pneumothorax (11.2% vs. 6.2%, p < 0.001), hemothorax (3.7% vs. 0.7%, p < 0.001), additional drainage (13.7% vs. 5.3%, p < 0.001), the need for thoracentesis (8.6% vs. 2.9%, p < 0.001), bar displacement (3.8% vs. 0.7%, p < 0.001), pleural effusion (10.6% vs. 3.1%, p < 0.001), and fever (6.6% vs. 3.8%, p < 0.041). In the logistic regression, two bars significantly increased the risk of postoperative complications (p = 0.019), including hematoma (p = 0.036), pleural effusion (p = 0.002), and the need for thoracentesis (p = 0.013). Using two corrective bars during the Nuss procedure is associated with a higher rate of postoperative complications but similar corrective results.

Role of albumin and prealbumin in assessing nutritional status and predicting increased risk of infectious complications during childhood cancer treatment

IntroductionProper nutrition in patients with cancer is important for preventing treatment complications and achieving remission. Malnutrition in these patients leads to reduced production of essential structural proteins.PurposeThe aim of the study was to assess the role of albumin and prealbumin in assessing the nutritional status of cancer patients and in predicting an increased risk of infectious complications during treatment.Patients and MethodsThe study included 40 pediatric patients with newly diagnosed cancer and 30 healthy children serving as controls. Prealbumin, albumin, and C-reactive protein (CRP) levels and the upper arm muscle area (UAMA) were measured before and after treatment in children with cancer and compared with the control group to evaluate nutritional status. Additionally, we assessed associations between these parameters and the incidence of infectious complications during cancer treatment in patients with anthropometric malnutrition, as well as associations with an increased risk of malnutrition related to inflammation before treatment.ResultsAt baseline, patients with cancer had lower prealbumin and albumin levels (p&amp;lt; 0.001), higher CRP levels (p &amp;lt; 0.001), and lower UAMA percentiles (p = 0.0245) compared with controls. Cancer treatment resulted in an increase in prealbumin and albumin levels (p &amp;lt; 0.001) and a reduction in CRP levels (p &amp;lt; 0.001), with no change in UAMA (p = 1.000). Prealbumin deficiency was more common than albumin deficiency before and after cancer treatment. Median prealbumin and albumin levels tended to increase with an increasing UAMA percentile range, but these differences were not significant (p&amp;gt; 0.05). The incidence of infectious complications during treatment in patients with risk factors for inflammation-related malnutrition was similar to that in patients with pre-existing anthropometric malnutrition without inflammation (p = 1.000). In a univariable logistic regression model including prealbumin and albumin deficiency, as well as low UAMA percentile, albumin deficiency before treatment was shown to be a significant predictor of 3 or more infectious episodes during treatment (p = 0.02).ConclusionAlbumin and prealbumin deficiency may predict the risk of malnutrition associated with inflammation in patients with cancer. Hypoalbuminemia may predict an unfavorable course of treatment complicated by frequent infections in these patients.

Pre-admission opioid use disorder as a new predictor of in-hospital mortality and six-month outcomes in traumatic brain injury patients: a retrospective longitudinal cohort study.

The present study aimed to investigate the effect of pre-admission Opioid Use Disorder (OUD) on in-hospital mortality and 6-month follow-up TBI outcomes. This study included 2804 patients with TBI admitted to the Intensive Care Unit of Emtiaz (Rajaee) Hospital, a referral trauma center in Shiraz, Iran. Finally, 1087 eligible participants were selected from included patients. Then, 872 discharged patients were followed for six months. Subsequently, unfavorable neurological outcomes (Glasgow Outcome Scale-Extended ≤ 4) and the mortality rate were compared among the patients with and without OUD. The mean age of the patients was 38.0 ± 18.9 years old (84.7% men). About 9.2% of patients had OUD. Opioid users had a slightly lower risk of in-hospital mortality (OR = 0.62, 95% CI = [0.328, 1.183], P-value = 0.148). In contrast, 6-month follow-up mortality significantly increased in the survived patients with a history of pre-admission OUD (OR = 2.49, 95%CI= [1.29, 2.80], P-value = 0.007). Moreover, 6-month unfavorable outcomes were raised in OUD, though it was not significant (OR = 1.59, 95%CI= [0.89, 2.84], P-value = 0.121). Our results revealed that patients with OUD are at increased risk of 6-month follow-up complications and also death following moderate to severe TBI. Although OUD decreased in-hospital mortality, 6-month follow-up indicated that mortality and unfavorable outcomes were increased in the OUD group. Based on the existing evidence, this effect is probably not only due to the destructive impact of pre-admission OUD on brain physiology. However, it may also be due to an increase in opioid consumption to alleviate pain and withdrawal symptoms after hospital discharge.

Using Time in Tight Glucose Range as a Health-Promoting Strategy in Preschoolers With Type 1 Diabetes.

Children who develop diabetes in their first years of life risk being exposed to many decades of hyperglycemia, hence having a high risk of early complications and premature death. An additional age-dependent risk is that dysglycemia, especially hyperglycemia, negatively affects the developing brain. In evaluating the outcome of insulin treatment at an individual and group level, cutoff thresholds for glucose values are needed. Time in tight range (TITR) was defined as a measurement of time spent in a state of normoglycemia. The International Society of Pediatric and Adolescent Diabetes recommended that for preschoolers with type 1 diabetes (T1D), either >70% of time with glucose in range 70-180 mg/dL (3.9-10 mmol/L) or >50% of time in a tighter range 70-140 mg/dL (TITR) can be used as continuous glucose monitoring targets. In Sweden, over the past two decades, pediatric diabetes teams set glycemic targets to 70-140 mg/dL (3.9-7.8 mmol/L). Swedish registry data show that >50% of children <7 years old have >50% TITR. The purpose of this review is to share and discuss international knowledge and experiences of working with TITR as a health-promoting strategy in preschoolers with T1D on a structural and individual level. We conclude that as insulin treatment improves, a reasonable goal is to strive for as much time in a state of normoglycemia as possible, and this can easily be explained to families of children with diabetes. For children with access to an experienced health care team and diabetes technologies a currently realistic target can be at least half of the time in normoglycemic range, i.e., TITR >50%.

Comparative study on maternal and fetal outcomes in emergency versus elective caesarean section

: The progressive increase in the incidence of caesarean section during the last few decades has been constant worldwide, increasing; at the same time, the indications, many of them unnecessary, resulting in indiscriminate practice, becoming the most frequent surgical intervention performed in health institutions, both private and public. Caesarean section is preferred as an emergency or elective procedure depending on the maternal and fetal conditions. It has been seen that risk of surgical complications is greater with emergency as compared with elective caesarean section. : Present study is a retrospective study, designed to evaluate maternal and fetal outcomes in elective versus emergency caesarean sections performed at our hospital from January 2023 to December 2023.: Out of total 2573 deliveries conducted, 1496 were normal deliveries, 116 were instrumental and 961 were caesarean deliveries, 446 were emergency and 515 were elective caesarean section. In our study overall operative complications were 114(11.8%) which was mainly contributed to emergency group.: The elective caesarean section shows less maternal and perinatal complications as compared to emergency caesarean sections.

Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery

The application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program. The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized. According to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, etc., which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function. Reasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.

Skin as a mirror of metabolic syndrome: Do some dermatoses alarm internal metabolic sinister?

Metabolic syndrome is a group of abnormalities in metabolism including hypertension, central obesity, insulin resistance and dyslipidaemia. Etiopathogenesis is multifactorial including genetic and environmental factors. It is more prevalent in recent decade due to sedentary lifestyle with unhygienic food habits and cause increased prevalence in younger age group. This abnormal metabolism leads to oxidative stress in body involving multiple inflammatory pathways. There are so many dermatoses which are associated with metabolic syndrome due to common factors are involved in etiopathogenesis. These includes psoriasis, acne vulgaris, acanthosis nigricans, hidradenitis suppurativa, atopic dermatitis, androgenetic alopecia, lichen planus. There is increased risk of developing diabetes mellitus and damage to cardiovascular system. Early diagnosis and management are required to reduce risk of complications. These includes active lifestyle, dietary changes and medications.

Comparison of clinical outcomes, complications and patient satisfaction following deep anterior lamellar keratoplasty and penetrating keratoplasty.

Keratoplasty is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor tissue, thereby restoring vision. Recent advancements have led to the replacement of penetrating keratoplasty (PKP) with the more selective deep anterior lamellar keratoplasty (DALK) procedure, especially for treating keratoconus. Although DALK typically has a shorter recovery time, less pain and a lower risk of rejection, PKP is still being performed for more severe corneal diseases. A comparative study of clinical profiles, treatment outcomes and patient-reported satisfaction will provide valuable insights into the cost-effectiveness, impact on quality of life and ability of each procedure to treat different pathologies of the cornea. Here, we aimed to compare the clinical and subjective outcomes of DALK with those of the PKP at a single center in the Kingdom of Saudi Arabia. This retrospective cohort study included eyes that underwent either PKP or DALK from January 2017 to January 2021. The demographic features, indications, best corrected visual acuity (BCVA) and complications of the patients were recorded for both groups, analyzed and compared. A subgroup of eyes with keratoconus was analyzed separately and compared to the larger group. A 6-item survey was conducted via telephone to assess patient satisfaction and expectation, and the results were compared between the two procedures. The chi-square test or Fisher's exact test for categorical variables or the t test or Kruskal‒Wallis test for continuous variables were used as appropriate for all comparisons, and the level of significance was set at α = 0.05. A total of 97 patients were included. PKP and DALK were performed on 63 and 39 eyes, respectively. Patients who underwent DALK were younger (mean ± standard deviation 31 ± 10.82 years versus 43 ± 26.89 years for patients who underwent PKP). The most frequent indication for PKP was keratoconus (35.5%); however, in 97.4% of the eyes undergoing DALK, the indication was keratoconus. In both groups, visual acuity and refractive error improved, but the postoperative corrected distance visual acuity in the DALK group (0.3 log MAR) was noticeably greater than that in the PKP group (0.6 log MAR). Compared with PKP, DALK may carry a lower risk of early graft edema and rejection. Overall, the reported postoperative patient satisfaction was similar for both procedures. The findings highlight the effectiveness of PKP and DALK in improving visual acuity and emphasize the importance of considering patient-reported outcomes in evaluating success. DALK has been demonstrated to be beneficial for protecting the corneal endothelium and lowering the risk of complications and graft rejection.

Underutilization of Influenza Antiviral Treatment Among Children and Adolescents at Higher Risk for Influenza-Associated Complications - United States, 2023-2024.

Annually, tens of thousands of U.S. children and adolescents are hospitalized with seasonal influenza virus infection. Both influenza vaccination and early initiation of antiviral treatment can reduce complications of influenza. Using data from two U.S. influenza surveillance networks for children and adolescents aged <18 years with medically attended, laboratory-confirmed influenza for whom antiviral treatment is recommended, the percentage who received treatment was calculated. Trends in antiviral treatment of children and adolescents hospitalized with influenza from the 2017-18 to the 2023-2024 influenza seasons were also examined. Since 2017-18, when 70%-86% of hospitalized children and adolescents with influenza received antiviral treatment, the proportion receiving treatment notably declined. Among children and adolescents with influenza during the 2023-24 season, 52%-59% of those hospitalized received antiviral treatment. During the 2023-24 season, 31% of those at higher risk for influenza complications seen in the outpatient setting in one network were prescribed antiviral treatment. These findings demonstrate that influenza antiviral treatment is underutilized among children and adolescents who could benefit from treatment. All hospitalized children and adolescents, and those at higher risk for influenza complications in the outpatient setting, should receive antiviral treatment as soon as possible for suspected or confirmed influenza.

How does chronic endometritis influence pregnancy outcomes in endometriosis associated infertility? A retrospective cohort study.

Endometriosis (EMS) and chronic endometritis (CE) frequently coexist. This study aimed to examine the impact of CE on reproductive outcomes in patients with EMS. We enrolled 685 patients with endometriosis-associated infertility from January 2018 to December 2020. The patients were divided into CE (318) and non-CE (367) groups. A subset of 123 clinically pregnant women from the CE group and 369 from the non-CE group was selected for detailed comparison. Pregnancy and delivery data were meticulously collected from hospital records and through telephone interviews. CE was diagnosed in 46.42% of EMS patients. Higher pregnancy rates were observed in patients with Endometriosis Fertility Index (EFI) scores of 7-10. EMS patients with CE had increased risks of placenta previa (13.01%), gestational hypertension (5.69%), and cesarean sections (59.34%). CE, which is prevalent among EMS patients, is linked to increased risks of pregnancy complications, including placenta previa, gestational hypertension, and cesarean delivery. Although combined hysteroscopy and laparoscopy improve pregnancy rates, they demand careful management of these complications.

Imaging Photoplethysmography (iPPG) in Head and Neck Reconstructive Surgery: A Novel Technique for Noninvasive Flap Perfusion Monitoring.

Evaluate imaging photoplethysmography (iPPG) as a novel noninvasive technique to assess flap perfusion in head and neck free flap reconstructive (FFR) surgeries. Intraoperative iPPG was performed in 17 patients undergoing FFR surgery. Imaging consisted of a 30-s video from which perfusion maps were extracted, providing detailed information about blood flow and pulsatility in the flap microvasculature. During each procedure, iPPG acquisitions were acquired representing distinct perfusion conditions of the flap (fully perfused/ischemic/reperfused). When possible, postoperative measurements were performed to assess flap recovery during the critical time period (3 days) and long-term follow-up (30 days). Perfusion maps, displaying iPPG amplitude and delay times, correlated strongly (p < 0.001) with the perfusion status of the tissue. One case of postoperative thrombosis, leading to flap failure, was identified with iPPG. After surgical revision in this case, flap perfusion was restored and confirmed by iPPG. Postoperative follow-up imaging allowed for objective visualization of flap recovery short term (3 days) and up to 30 days after the surgical procedure. This study shows that iPPG is suitable for objective and noninvasive assessment of flap perfusion in head and neck FFR surgery. In addition, postoperative monitoring shows potential for assessing flap perfusion in patients with increased risk of postoperative complications.

Artificial Intelligence Applied in Early Prediction of Lower Limb Fracture Complications

Background: Artificial intelligence has become a valuable tool for diagnosing and detecting postoperative complications early. Through imaging and biochemical markers, clinicians can anticipate the clinical progression of patients and the risk of long-term complications that could impact the quality of life or even be life-threatening. In this context, artificial intelligence is crucial for identifying early signs of complications and enabling clinicians to take preventive measures before problems worsen. Materials and methods: This observational study analyzed medical charts from the electronic archive of the Clinical Emergency Hospital in Galați, Romania, covering a four-year period from 2018 to 2022. A neural network model was developed to analyze various socio-demographic and paraclinical data. Key features included patient demographics, laboratory investigations, and clinical outcomes. Statistical analyses were performed to identify significant risk factors associated with deep venous thrombosis (DVT). Results: The analysis revealed a higher prevalence of female patients (60.78%) compared to male patients, indicating a potential gender-related risk factor for DVT. The incidence of DVT was highest among patients aged 71 to 90 years, affecting 56.86% of individuals in this age group, suggesting that advanced age significantly contributes to the risk of developing DVT. Additionally, among the DVT patients, 15.69% had a body mass index (BMI) greater than 30, categorizing them as obese, which is known to increase the risk of thrombotic events. Furthermore, this study highlighted that the highest frequency of DVT was associated with femur fractures, occurring in 52% of patients with this type of injury. The neural network analysis indicated that elevated levels of direct bilirubin (≥1.5 mg/dL) and prothrombin activity (≤60%) were strong predictors of fracture-related complications, with sensitivity and specificity rates of 78% and 82%, respectively. These findings underscore the importance of monitoring these laboratory markers in at-risk populations for early intervention. Conclusions: This study identified critical risk factors for developing DVT, including advanced age, high BMI, and femur fractures, which necessitate longer recovery periods. Additionally, the findings indicate that elevated direct bilirubin and prothrombin activity play a significant role in predicting DVT development. These results suggest that AI can effectively enhance the anticipation of clinical evolution in patients, aiding in early intervention and management strategies.

Transradial Approach for Neurovascular Interventions : A Literature Review.

The femoral artery is the preferred access route for neurointerventions. The transfemoral approach (TFA) offers advantages such as a large diameter and easy access. However, it also entails disadvantages such as patient discomfort and high risk of complications. Following the initial report of coronary angiography using the transradial approach (TRA) in 1989, cardiologists discovered the advantages of TRA over the TFA and gradually replaced it with the TRA. In 1997, Matsumoto et al. used the TRA for cerebral angiography and neurointervention. Thereafter, the adoption of TRA for neurointervention gradually increased and good outcomes were reported. However, despite these developments, the adoption rate of TRA is relatively low. We reviewed the relevant studies to increase the accessibility of TRA for neurointerventionists.

Cushing's syndrome and COVID-19.

This review aims to present current data on the course of COVID-19 in patients with Cushing syndrome (CS) and discuss treatment for CS during to the pandemic. Literature review using PubMed (pubmed.ncbi.nlm.nih.gov). The search included the following terms: "COVID19" in combination with "Cushing syndrome", "Hypercortisolism" and "Glucocorticoid". Chronic hypercortisolism has been reported to increase infectious risk and worsens prognostic of patients with COVID-19 potentially due to its direct impact on the immune system: lymphopenia, impairment of monocytes and neutrophils activity, diminution of complement activation. Main metabolic complications of CS - i.e. diabetes, hypertension and obesity - have been recognized as COVID-19 complications risk factors. Patients with CS treated with steroidogenesis inhibitors might experience adrenal insufficiency during COVID-19. Special attention should be paid to patients with CS and COVID-19. The pandemic has impacted - and delayed - care of chronic illnesses including CS. Specific recommendations had been provided during the pandemic: favor telemedicine consultations, limit in-hospital explorations and postpone surgery when feasible. There are enough evidence for an increased prevalence and severity of COVID-19 to recommend a specific attention and caution in patients with CS.

Reference intervals of adjacent disc height in fresh osteoporotic vertebral compression fractures and the association with postoperative adjacent segment complications: a quantitative study in Chinese postmenopausal women.

Preoperative adjacent disc height (DH) was found as an independent risk factor for adjacent segment degeneration (ASD) after percutaneous kyphoplasty (PKP), indicating the preoperative status of the adjacent intervertebral discs may be closely related to adjacent segment complications. To establish the reference intervals (RIs) for adjacent DH of fresh osteoporotic vertebral compression fracture (OVCF) in Chinese postmenopausal women, and investigate the association with adjacent segment complications after PKP. Consecutive inpatients diagnosed with fresh OVCF between November 2015 and August 2023 were reviewed. The enrolled patients were divided into subgroups based on injured vertebral level; then, the cranial and caudal DH were measured. The characteristics of DH among subgroups were identified, and specific RIs were established using the indirect Hoffmann method. The associations between DH and adjacent segment complications were assessed using multivariate analysis. The DH of the cranial disc was significantly lower than the corresponding caudal disc in all vertebral levels, which showed an increasing trend from T11 to L4. The RIs of DH were as follows: T11 (cranial), 2.14-5.14mm; T11 (caudal), 2.64-5.89mm; T12 (cranial), 2.69-5.77mm; T12 (caudal), 3.18-6.57mm; L1 (cranial), 3.05-6.59mm; L1 (caudal), 3.40-8.29mm; L2 (cranial), 3.68-8.36mm; L2 (caudal), 4.57-9.78mm; L3 (cranial), 4.53-8.92mm; L3 (caudal), 5.26-10.07mm; L4 (cranial), 4.70-11.42mm; and L4 (caudal), 5.52-12.12mm. Increased risks of adjacent segment complications after PKP were observed in patients with decreased adjacent DH. The estimated vertebral level and disc level-specific RIs for adjacent DH of fresh OVCF were established in the Chinese postmenopausal women population. A decrease in adjacent DH posed high risks of adjacent segment complications after PKP for treating OVCF.

HPB SO10 - Evaluation of the impact of an Enhanced Recovery Pathway on clinical outcomes after Pancreaticoduodenectomy

Abstract Background Southampton General Hospital (SGH) is a high-volume HPB centre with a well-established Enhanced Recovery After Surgery pathway (ERAS). Despite the morbidity associated with pancreatic surgery, there is a large body of evidence supporting the use of a multi-modal approach to accelerate patient recovery. Within SGH, ERAS is utilised for all patients undergoing Pancreaticoduodenectomy (PD). Initial assessment of the pathway in SGH demonstrated a reduction in length of stay. Since its implementation, ERAS has been modified to optimise the pathway. The aim of this study was to assess whether the impact of ERAS had progressed over time. Method Single centre retrospective analysis of patients undergoing open PD from 2007-2023. Pancreatic reconstruction was with pancreaticojejunostomy. Pre and Post ERAS data were analysed. Post ERAS data was subdivided into Early, Middle and Late implementation time phases. Length of Stay, Complications (Clavien-Dindo Grade 3 and above), Readmissions and Mortality were all examined. Non-parametric data analysis was undertaken with Kruskal-Wallis, Spearman rank correlation and Wilcoxon rank-sum tests. Significance further assessed with Multi-variate regression (MVR). All Data were analysed using STATA. Results Overall, 861 patients underwent an open PD, the yearly volume increasing with time. Mean age was 66 years, which did not change with time. With ERAS implementation, Median Length of Stay (LOS) fell 13 to 9 days (p&amp;lt;0.01) and there was no statistically significant increase in Grade 3 complications or Readmissions (p=0.931, p=0.163). Grade 3 complications increased LOS (p&amp;lt;0.01). Increased age led to a small increase in LOS (p&amp;lt;0.01). Median LOS across Early, Middle and Late ERAS periods was 10, 9 and 9 respectively. LOS did not consistently demonstrate a statistically significant improvement across ERAS phases (MVR p=0.387, K-Wallis p&amp;lt;0.05). Conclusion The implementation of ERAS significantly reduced the median LOS for patients undergoing PD, without increasing their risk of complications or readmissions. This benefit has also been safely maintained across the period of its implementation.

Characteristics and In-Hospital Outcomes of Single-Vessel Coronary Disease Intervention: A Propensity-Matched Analysis of the National Inpatient Sample Database 2016–2020

Background/Objectives: Few studies have analyzed in-hospital complications and events following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures for patients who underwent these interventions for single-vessel coronary artery disease (CAD). This study aims to compare the outcomes of PCI and CABG in such patients using a large propensity-matched real-world database based on procedural codes. Methods: Adult patients receiving PCI or CABG for single-vessel CAD were identified from the 2016–2020 National Inpatient Sample (NIS) database. Any cases targeting multi-vessel disease or employing a multi-treatment approach were excluded using appropriate procedural codes. Differences in events and complications from admission to discharge were studied between the two procedures (PCI vs. CABG) via logistic regression analysis. Results: After propensity matching with 273,380 patients in both groups, complication risks such as cardiac tamponade (aOR: 3.6 [3.27–3.96]), acute kidney injury (aOR: 1.53 [1.51–1.56]), cardiogenic shock (aOR: 1.38 [1.34–1.40]), procedural bleeding (aOR: 1.75 [1.67–1.83]), acute ischemic stroke (aOR: 1.89 [1.80–1.97]), and all-cause mortality (aOR: 1.05 [1.02–1.08]) were higher among CABG patients. No differences were observed for events of cardiac perforation (aOR: 0.92, [0.84–1.01]). Conclusions: In this large real-world propensity-matched analysis, CABG was associated with higher risks of multiple in-hospital complications and all-cause mortality compared to PCI following a single-vessel coronary intervention.

HPB SO28 - Pre-operative Biliary Drainage in Pancreatic Adenocarcinoma and its Effect on Surgical Oncological Outcomes

Abstract Background Pre-operative biliary drainage (PBD) in patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been associated with a significantly increased risk of serious complications. This retrospective study investigated if PBD has a significant effect on lymphovascular (LVI) or perineural (PNI) invasion compared to direct surgery (DS). Method Data was collected retrospectively from patients undergoing PD for PDAC from 01/01/2014 to 30/12/2022. Patients were grouped according to whether they received any form of PBD or not. Patients’ T and N stage, as well as lymph node ratio (LNR), R status, Mortality, disease free (DFS) and overall survival (OS) were recorded. The primary outcome measure was lymph node ratio. Results A total of 87 patients were identified (48 PBD group vs 39 DS group), with a mean age of 68. The median LNR was 0.2 in PBD vs 0.21 in DS Group (p=0.87). There was no significant difference in median DFS (310 days PBD vs 285 DS p=0.94) or median OS (513 days PBD vs 515 DS p=0.39). PBD was not associated with a greater incidence of LVI (67% PBD vs 69% DS p=0.8), or PNI (94% PBD vs 97% p=0.41). PBD did not have a significant effect on resection margin status (p=0.75). Conclusion Despite evidence in the literature on its effects on the rate of complications, PBD has not been shown to have an effect on LVI or PNI, disease progression, nor overall survival in our patient group.

High incidence of complications following intraoral extractions and treatment of periapical infections in the management of domestic rabbit (Oryctolagus cuniculus) dental disease (51 cases).

To describe the outcome of common medical therapies, intraoral dental procedures, extraoral surgical interventions, and resulting complications of treatment in client-owned rabbits diagnosed with dental disease. The medical records of 51 client-owned domestic rabbits presenting for veterinary care and management of dental disease from 2013 to 2023 at 2 veterinary teaching hospitals were reviewed. Of the patients managed with coronal reduction and occlusal adjustment, none developed significant complications. Of the patients that required intraoral dental extractions, 41% developed postprocedural complications, including incomplete tooth extraction. Following periapical infection and the formation of an odontogenic abscess for which surgical intervention was implemented, 25% of patients developed complications, including abscess recurrence and sepsis. Meloxicam was the most frequently prescribed analgesic medication for all procedures reviewed. Trimethoprim-sulfamethoxazole combination oral suspension was the most frequently prescribed antibiotic following coronal reduction, occlusal adjustment, and dental extractions, and parenteral penicillin G procaine was the most frequently prescribed antibiotic following periapical infection-related interventions. Seven patients had documentation of natural death or humane euthanasia secondary to progressive dental disease. The risk of postprocedural complications during the management of dental disease must be considered and discussed given the high rate of potential complications. With the increasing popularity of rabbits as companion animals, dental disease is considered one of the most common reasons for veterinary care in this species. Rabbits undergoing intraoral dental procedures and extraoral surgical interventions for the treatment of acquired and progressive dental disease are at risk of developing adverse postprocedural sequelae that must be considered before attempting intervention. This report adds to the growing body of scientific literature related to the management of this challenging disease process.

BN SO17 - When cholecystectomies go wrong: A single-centre review of post-operative complications over a two year period

Abstract Background Laparoscopic cholecystectomy (LC) is the main treatment for symptomatic gallstone disease with around 70,000 performed in the UK each year. The majority of these are day case procedures and patients recover well, however, there will always be a risk of more serious complication which can have serious negative effects on patients. The Clavien-Dindo classification of surgical complications is the most recognised method of grading post-operative complications by severity. The aim of our study was to identify our rates and severity of post-operative complication and their management. Method All patients who had LC between 1st July 2020 and 30th June 2022 were identified. Patient and operative details were retrieved from their electronic record. A complication was defined as any deviation from the standard post-operative course and was graded according to the Clavien-Dindo classification. 30-day readmission data was collected via hospital episode statistics and outcomes were reviewed on the patient record. Results 974 patients underwent LC. 30-day morbidity = 8.9%, 30-day readmission = 4.8% and 30-day mortality = 0.31%. Clavien-Dindo grade of complication: Grade 1= 44.7%, Grade 2 = 22.4%, Grade 3A = 12.9%, Grade 3B = 11.8%, Grade 4A = 1.2%, Grade 4B = 1.2%; and Grade 5 = 3.5%. 11 patients (1.1%) returned to theatre; bile leak was the most common indication (73%). Two intra-operative bile duct injuries were observed (0.21%) with one managed locally and the other transferred to the regional HPB centre. 7 patients required post-operative ERCP (0.72%), 57% for CBD stones and 43% for persistent bile leak. Conclusion Our study showed that the majority of post-operative morbidity following LC is related to post-operative pain (2.9%) or simple wound infection (1.8%). 2.6% of patients who underwent LC during had a significant complication requiring surgical, endoscopic or radiological intervention or admission to intensive care (Clavien-Dindo &amp;gt; 2). We report a 0.21% risk of bile duct injury and a 0.92% risk of post-operative bile leak. Overall our findings are in keeping with other studies but provide an insight into our local practice and that an area of potential improvement would be better management of post-operative pain.