Contemporary Surgical Practice Research Articles

Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States: report from the 18-centre TRACK-TBI cohort study

Contemporary surgical practices for traumatic brain injury (TBI) remain unclear. We describe the clinical profile of an 18-centre US TBI cohort with cranial surgery. The prospective, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (2014-2018; ClinicalTrials.gov #NCT02119182) enrolled subjects who presented to trauma centre and received head computed tomography within 24-h (h) post-TBI. We performed a secondary data analysis in subjects aged ≥17-years with hospitalisation. Clinical characteristics, surgery type/timing, hospital and six-month outcomes were reported. Of 2032 subjects (age: mean=41.4-years, range=17-89-years; male=71% female=29%), 260 underwent cranial surgery, comprising 65% decompressive craniectomy, 23% craniotomy, 12% other surgery. Subjects with surgery (vs. without surgery) presented with worse neurological injury (median Glasgow Coma Scale=6 vs. 15; midline shift ≥5mm: 48% vs. 2%; cisternal effacement: 61% vs. 4%; p<0.0001). Median time-to-craniectomy/craniotomy was 1.8h (interquartile range=1.1-5.0h), and 67% underwent intracranial pressure monitoring. Seventy-three percent of subjects with decompressive craniectomy and 58% of subjects with craniotomy had ≥3 intracranial lesion types. Decompressive craniectomy (vs. craniotomy) was associated with intracranial injury severity (median Rotterdam Score=4 vs. 3, p<0.0001), intensive care length of stay (median=13 vs. 4-days, p=0.0002), and six-month unfavourable outcome (62% vs. 30%; p=0.0001). Earlier time-to-craniectomy was associated with intracranial injury severity. In a large representative cohort of patients hospitalised with TBI, surgical decision-making and time-to-surgery aligned with intracranial injury severity. Multifocal TBIs predominated in patients with cranial surgery. These findings summarise current TBI surgical practice across US trauma centres and provide the foundation for analyses in targeted subpopulations. National Institute of Neurological Disorders and Stroke; US Department of Defense; Neurosurgery Research and Education Foundation.

CLosure of Abdominal MidlineS Survey (CLAMSS): A national survey investigating current practice in the closure of abdominal midline incisions in UK surgical practice.

Incisional herniation (IH) is a frequent complication following midline abdominal closure with significant associated morbidity. Randomized controlled trials have demonstrated that the small bites technique (SBT) and prophylactic mesh augmentation (PMA) may reduce IH compared to mass closure techniques, but data are lacking on their implementation in contemporary surgical practice. This survey aimed to evaluate the use of the SBT and PMA and to identify factors associated with their adoption. Between 22 January 2023 and 16 March 2023, consultant surgeons across the UK were asked to complete a 25-question survey on closure of an elective primary midline incision. Responses were received from 267 of 675 eligible surgeons (39.6%) in 38 NHS Trusts. Respondents were evenly split between tertiary centres (47.6%) and district general hospitals (49.4%). SBT and PMA were used by 19.9% and 3.0% of respondents, respectively. Compared to other techniques, surgeons using the SBT were more likely to close the anterior aponeurotic layer only, use single suture filaments, 2-0 gauge sutures and sharp needle points and routinely dissect abdominal layers to aid closure (all p < 0.001). Attendance at lectures/conferences on SBT (p = 0.043) and basing practice on available evidence (p < 0.001) were independently associated with use of the SBT. The commonest barriers to adopting SBT were a perceived lack of evidence (23.8%) and belief that personal IH rates were low (16.8%). A minority of UK consultant surgeons have adopted the SBT or PMA. Practice change should be driven by more widespread dissemination of current evidence and procedural information.

Computational image analysis of distortion, sharpness, and depth of field in a next-generation hybrid exoscopic and microsurgical operative platform.

The development of surgical microscope-associated cameras has given rise to a new operating style embodied by hybrid microsurgical and exoscopic operative systems. These platforms utilize specialized camera systems to visualize cranial neuroanatomy at various depths. Our study aims to understand how different camera settings in a novel hybrid exoscope system influence image quality in the context of neurosurgical procedures. We built an image database using captured cadaveric dissection images obtained with a prototype version of a hybrid (microsurgical/exoscopic) operative platform. We performed comprehensive 4K-resolution image capture using 76 camera settings across three magnification levels and two working distances. Computer algorithms such as structural similarity (SSIM) and mean squared error (MSE) were used to measure image distortion across different camera settings. We utilized a Laplacian filter to compute the overall sharpness of the acquired images. Additionally, a monocular depth estimation deep learning model was used to examine the image's capability to visualize the depth of deeper structures accurately. A total of 1,368 high-resolution pictures were captured. The SSIM index ranged from 0.63 to 0.85. The MSE was nearly zero for all image batches. It was determined that the exoscope could accurately detect both the sharpness and depth based on the Laplacian filter and depth maps, respectively. Our findings demonstrate that users can utilize the full range of camera settings available on the exoscope, including adjustments to aperture, color saturation, contrast, sharpness, and brilliance, without introducing significant image distortions relative to the standard mode. The evolution of the camera incorporated into a surgical microscope enables exoscopic visualization during cranial base surgery. Our result should encourage surgeons to take full advantage of the exoscope's extensive range of camera settings to match their personal preferences or specific clinical requirements of the surgical scenario. This places the exoscope as an invaluable asset in contemporary surgical practice, merging high-definition imaging with ergonomic design and adaptable operability.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland

BackgroundHandovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. MethodsAfter ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. Main findingsA total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. ConclusionsSurgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.

What is the most appropriate comparator group to use in assessing the performance of primary total hip prostheses within the community?

There are variations in the performance of individual prostheses used in hip replacements. Some of which have unexpectedly higher revision rates - outliers. The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has established a standardised multi-stage approach for identifying these devices. This is done by comparing the revision rates of individual prostheses to all other prostheses in class, with the exception of large head metal-on-metal (LHMoM) prostheses. However, improvements in device design and performance over time have required a need to reconsider the comparator group. This study aimed to identify a more specific comparator to better reflect contemporary surgical practice. The time to first revision was estimated on the data of 413,417 primary total conventional hip replacements undertaken for osteoarthritis (OA) from 01 January 2003 to 31 December 2019. Survivorship analyses with stepwise exclusions were undertaken. The first exclusion was LHMoM, followed by other non-modern bearing surfaces (defined as all the bearing couples except metal or ceramic heads on cross-linked polyethylene and mixed ceramic-on-ceramic), and then devices with modular neck-stem design or used for specific purposes (incl. constrained, dual-mobility, and head size <28 mm). Lastly, all remaining prostheses previously identified as having a higher than anticipated rate of revision (HTARR) were also excluded. These exclusions progressively reduced the cumulative percent revision (CPR) rate. The final comparator, which only includes satisfactory-performed prostheses of contemporary design and use, has a 10-year CPR of 4.30% (95% CI, 4.2-4.41) which is lower than 4.93% (95% CI, 4.84-5.02) for the current comparator used by the AOANJRR (all prostheses excluding LHMOM). Over the study period, 13 additional components were identified utilising the modified comparator. The calculation of the comparator revision rate should be re-evaluated to include only modern prosthesis constructs to ensure that poorly performing prostheses are identified early.

Changes in treatment patterns of thoracoabdominal aortic aneurysms in the United States

BackgroundThe introduction of endovascular repair provides an alternative to traditional open repair of thoracoabdominal aortic aneurysms (TAAA). Its utility is not well defined, however. Using a national database, we studied the treatment patterns and outcomes of TAAA to gain insight into its contemporary surgical practice in the United States. MethodsRecords of TAAA patients who received endovascular and open repair were retrieved from the 2002 to 2018 National Inpatient Sample database. Each cohort was stratified into 4 age groups: ≤50, 51 to 60, 61 to 70, and >70 years. Patient characteristics and in-hospital outcomes were compared between the 2 repair modalities. Temporal trends were investigated. ResultsEndovascular repair use increased steadily, whereas open repair volume remained stable until 2012, before declining by 50% by 2018. This appears to be associated with a declining number of open repairs in patients age >60 years. Patients who underwent endovascular repair were older and had a higher Charlson Comorbidity Index (mean, 2.8 ± 1.7 vs 2.5 ± 1.5; P < .001) but lower in-hospital mortality (mean, 8.9% vs 17.1%; P < .001), shorter length of stay (mean, 10.1 ± 12.2 days vs 17.1 ± 17.4 days; P < .001), and fewer postoperative complications. A difference in mortality between open and endovascular repair was observed for patients age >60 years but not for patients age ≤60 years. ConclusionsThere has been a shift in the treatment of TAAA in the United States from open repair–dominant to endovascular repair–dominant. It has increased surgical access for older and more comorbid patients and has led to a decline in the use of open repair while lowering in-hospital mortality.

Canalis cruropopliteus - the overlooked canal of Wenzel Gruber

It is widely known that the popliteal fossa and the lower leg are connected by a canal, containing the neuro-vascular bundle to the posterior leg region, containing the tibial nerve and the posterior tibial artery and veins. The existence of this canal has not been duly recognized in literature, even though it has been named by Wenzel Gruber in 1871, and its contents, walls, entrance, and exits have been extensively described by him in 1878. In the present paper, we would like to pay a homage to the work of this prominent anatomist, which retains its significance for contemporary surgical practice. The cruropopliteal canal, canalis cruropopliteus, as named by him, and having been assigned a multitude of terms in practice, deserves to regain its eponymous name – Gruber’s canal. The history, and the anatomy with its clinical implications are discussed herein. We hereby recommend that the original name of this canal be included in anatomical textbooks and specialized literature.

Current use of the National Surgical Quality Improvement Program surgical risk calculator in academic surgery: a mixed-methods study.

This study aims to quantitatively assess use of the NSQIP surgical risk calculator (NSRC) in contemporary surgical practice and to identify barriers to use and potential interventions that might increase use. We performed a cross-sectional study of surgeons at seven institutions. The primary outcomes were self-reported application of the calculator in general clinical practice and specific clinical scenarios as well as reported barriers to use. In our sample of 99 surgeons (49.7% response rate), 73.7% reported use of the NSRC in the past month. Approximately half (51.9%) of respondents reported infrequent NSRC use (<20% of preoperative discussions), while 14.3% used it in ≥40% of preoperative assessments. Reported use was higher in nonelective cases (30.2% vs 11.1%) and in patients who were ≥65 years old (37.1% vs 13.0%), functionally dependent (41.2% vs 6.6%), or with surrogate consent (39.9% vs 20.4%). NSRC use was not associated with training status or years in practice. Respondents identified a lack of influence on the decision to pursue surgery as well as concerns regarding the calculator's accuracy as barriers to use. Surgeons suggested improving integration to workflow and better education as strategies to increase NSRC use. Many surgeons reported use of the NSRC, but few used it frequently. Surgeons reported more frequent use in nonelective cases and frail patients, suggesting the calculator is of greater utility for high-risk patients. Surgeons raised concerns about perceived accuracy and suggested additional education as well as integration of the calculator into the electronic health record.

Peripheral parenteral nutrition in surgery – a systematic review and meta-analysis

Peripheral parenteral nutrition (PPN) refers to the delivery of artificial nutrition via a peripheral intravenous cannula. As a nutritional intervention it remains under-utilised in peri-operative care. This is despite purported advantages which includes avoiding the risks associated with central venous lines and preventing potential delays to the initiation of nutrition support. This systematic review and meta-analysis will detail the available evidence for PPN use in surgery. A comprehensive search of the EMBASE and Medline databases was undertaken to identify randomised control trials (RCTs) involving PPN use in surgical patients published until July 30th 2022. Three domains of PPN use were reviewed including: PPN compared to crystalloid intravenous fluids on nutritional and clinical outcomes; PPN compared to Central PN (CPN) on nutritional outcomes and complications; and strategies to prevent thrombophlebitis associated with PPN. The meta-analysis included 8 studies which included 698 patients. Use of PPN led to reduced post-operative weight loss (% body weight change) with a mean difference of-1.45% (95% CI -2.9 to-0.01, p=0.05). There was no statistically significant difference in terms of length of stay, infectious/non-infectious complications, surgical site infections or phlebitis. 42 RCTs were included in the systematic review. 14 RCTs compared PPN to crystalloid infusion. There was significant heterogeneity in the trial populations, interventions and measured outcomes. Most trials found that PPN may improve nitrogen balance and positively impact nutritional markers. Quality of life and post-operative complications were either improved or no difference found in trials assessing these outcomes. Four RCTs showed that PPN is a safe and feasible alternative to CPN. 22 RCTs reported on measures that may impact on thrombophlebitis rates associated with PPN. These included lower osmolality of PPN solution, cyclical PPN delivery, use of a small gauge polyurethane cannula in an upper limb vein, addition of heparin/hydrocortisone to PPN solutions and placement of a GTN patch over infusion sites. PPN is a safe and effective mode of delivery of peri-operative nutrition. It is a feasible short-term alternative to central-line delivered PN. There are a number of strategies to reduce thrombophlebitis associated with PPN use. Further high-quality RCTs are required to assess the use of PPN in contemporary surgical practice.

A protocol for a prospective, multicentre observational study to determine if nonanaemic iron deficiency worsens postoperative outcome in patients undergoing elective surgery for resection of colorectal cancer: The NATO study.

Preoperative absolute and functional iron deficiency anaemia is associated with poor postoperative outcomes in patients undergoing surgery for colorectal cancer. It is biologically plausible that "early", or "nonanaemic" iron deficiency may also be associated with worse postoperative outcomes in similar cohorts, albeit at lesser severity than that seen for anaemia. The evidence supporting this assertion is of low quality. We have designed a prospective, observational study to delineate associations between preoperative non-anaemic iron deficiency and postoperative outcomes after surgery for colorectal cancer. Patients without anaemia, undergoing elective surgery for colorectal cancer will be allocated to an iron replete or an iron deficient group based on preoperative transferrin saturation. The primary outcome is days alive and at home on postoperative day 90. Secondary outcomes include days alive and at home on postoperative day 30, length of hospital stay, readmission to acute care, postoperative complications, health-related quality of life scores, quality of postoperative recovery, and requirement for allogeneic blood transfusion. The planned sample size is 422 patients, which has 80% power to detect a two-day difference in the primary outcome. The study commenced in May 2019. The results of this study will provide patients and clinicians with high-quality evidence concerning associations between nonanaemic iron deficiency and patient-centred outcomes after surgery for colorectal cancer. The study will be conducted in multiple urban and rural centres across Australia and New Zealand. The results will be highly generalisable to contemporary surgical practice and should be rapidly translated.

Management of Malignant Obstructive Jaundice: Defining the Relevance of Various Palliative Surgical Options in Resource-Challenged Settings: A Review Article.

Malignant obstructive jaundice (MOJ) constitutes an important surgical problem with high morbidity and mortality worldwide. Presentation is usually delayed with a majority of patients benefitting only from palliative treatment. Surgeons practicing in developing countries face herculean task in managing MOJ due to lack of minimally invasive endoscopic procedures. Palliative surgical procedures are associated with high morbidity and sometimes mortality. Abdominal pain, generalized pruritus, and gastric outlet obstruction are some of the symptoms of MOJ requiring palliation. Successful surgical palliation may improve the overall quality of life in patients with MOJ considered fit for surgery. Bypass procedures and regional nerve blocks constitute the most effective surgical palliation available to surgeons practicing in resource-limited settings. This review article discusses the indications, the role, and types of surgical bypass procedures in the management of MOJ in contemporary surgical practice. This is important for surgeons in countries where expertise and resources for the less morbid endoscopic and radiologic approaches are not available. Relevant articles up to January 2021 published in PubMed, Google Scholar, and Hinari on the surgical management of obstructive jaundice were reviewed for inclusion. We also reviewed some modern surgical textbook topics on obstructive jaundice.

Influence of systemic comorbidities on the complications of orthognathic surgery: A scoping review

The potential impact of systemic comorbidities has not yet been thoroughly explored in orthognathic surgery. Therefore, the following scoping review was conducted to accumulate evidence on the possible impact of systemic comorbidities on the orthognathic surgery complications. PubMed, Embase, Cochrane, and Web of Science databases were searched up to April 2022 to identify studies about patients with systemic comorbidities who underwent orthognathic surgery. A total of 12,938 articles were screened, and seven articles met the inclusion criteria. Only one study had control group, other six articles had a non-comparative study design. The current evidence suggests a high impact of rheumatic diseases and neuromuscular disorders on the surgery- and patient-related postoperative complications following orthognathic surgery. At the same instance, the findings of the review should be interpreted with caution due to a lack of substantial evidence for extrapolating the findings to a contemporary surgical practice.

The feasibility of endourological surgery in low-resource settings.

One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa (SSA) has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients that established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically or restricted by the abilities of the surgeons in SSA. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them, and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. However, they are largely dependent upon the supply of equipment from non-governmental organisations in high-income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.

Congenitally Corrected Transposition Cardiac Surgery: Society of Thoracic Surgeons Database Analysis

BackgroundCongenitally corrected transposition of the great arteries (ccTGA) has many management strategies, with the emergence of anatomic repair increasing the available surgical options. Contemporary surgical practices have not been described in multicenter analyses. This study describes the distribution of heart surgery in patients with ccTGA and defines contemporary outcomes in a large multicenter cohort. MethodsIndex cardiovascular operations in patients with primary or fundamental diagnosis of ccTGA were identified in The Society of Thoracic Surgeons Congenital Heart Surgery Database from 2010 to 2019. Operations of interest were combined into mutually exclusive groups designating overall ccTGA management strategies. Outcomes were defined with standard Society of Thoracic Surgeons Congenital Heart Surgery Database definitions. Pearson χ2 and Kruskal-Wallis tests were used for statistical comparisons. ResultsOne hundred one centers performed 985 index operations, with anatomic repair the most common approach. Twenty-six centers performed more than 10 operations. Atrial switch plus Rastelli operations had the highest rate of operative mortality (8.4%) and major complications (38.2%). Heart transplant operations had the longest postoperative length of stay among survivors (18 days [interquartile range, 13.5-26]). ConclusionsPatients with ccTGA remain a challenging cohort, with significant diversity in the operations used and a substantial burden of operative mortality and morbidity.

Retained surgical drain fragments: A systematic review and case report

AbstractAimRetained surgical drains are an avoidable and serious cause of postoperative morbidity. This study aims to first report on our unit's experience in identifying and managing retained surgical drains and then consolidate current knowledge regarding retained surgical drains, causes and associated complications.Patients and MethodsA systematic review of the literature was performed through searches in electronic databases to identify studies that described incidents involving retained surgical drains. Data were extracted regarding patient and operative characteristics, drain complications and management.ResultsA total of 36 case reports and/or series were identified in the literature, with 39 individual cases of retained surgical drains in patients undergoing abdominal, thoracic or orthopaedic procedures. The most common cause for retained drain was fracture of drain tubing. Patients presented with complications ranging from chronic pain, abscess or fistula formation, to migration of the drain fragment into a hollow viscus. In all cases an invasive intervention was required to remove the retained drain.ConclusionSurgeons should be aware of retained surgical drains as an iatrogenic cause of postoperative morbidity. Contemporary surgical practice should include methods to prevent, identify and manage retained drains and associated complications.

English

Contemporary surgical practice relating to Tetralogy of Fallot is shifting towards earlier correction; however, a recent large study proposes later correction to increase event free survival. Surgery aims to improve the quantity and quality of life at minimal risk to the patient. Surgical outcome and risk assessment requires a comparison of externally valid studies of natural history and surgical outcome. The authors reviewed the literature to identify the most externally valid natural history and surgical outcome data and used it to develop a composite survival graph to help clinicians determine when surgery would offer the greatest survival advantage. The composite graph suggests that, for symptomatic patients, the greatest survival advantage occurs when corrective surgery is performed within the 1st week of life. Key words: Pediatric, tetralogy of Fallot, operative, outcomes.

Traditional Chinese medicine and contemporary surgical practice: the Hong Kong experience

Traditional Chinese medicine (TCM) is an ancient practice that dates back more than 2,000 years and has evolved into a unique system of diagnosis and disease management that, in particular, employs herbal medicines and dietary therapies but in addition utilises acupuncture, massage and qigong (meditation, breathing and movement) exercises.1,2 It is especially popular in Hong Kong and, following legislation to establish the Chinese Medicine Ordinance in 1999 and subsequent registration of TCM practitioners via the Chinese Medicine Council of Hong Kong, has seen widened patient participation.

Usual Interstitial Pneumonia in Contemporary Surgical Pathology Practice: Impact of International Consensus Guidelines for Idiopathic Pulmonary Fibrosis on Pathologists.

Idiopathic pulmonary fibrosis is a clinical syndrome characterized by the presence of usual interstitial pneumonia (UIP) radiologically and pathologically. Per consensus criteria adopted in 2011, diagnosis of idiopathic pulmonary fibrosis no longer requires a biopsy in an appropriate context if UIP is seen on imaging. As a result, lung biopsies are now typically reserved for patients having indeterminate clinical or imaging findings or suspicion for alternative diagnoses, but the impact of updated guidelines on pathology practice remains unclear. To determine the frequency of histologic UIP before and after 2011. Surgical lung biopsies from adults were studied within two 4-year periods: July 1, 2006 through June 30, 2010 and January 1, 2012 through December 31, 2015. Pathology slides were reviewed in a fashion blinded to clinical information and were classified using current guidelines. Biopsies from 177 and 86 patients (mean [SD] age, 62 [12] and 59 [14] years; 50.3% [89 of 177] and 48.8% [42 of 86] men) before and after 2011, respectively, were reviewed. Probable UIP or UIP was less-frequently encountered after 2011 in all patients with fibrosis (9 of 54 [16.7%] versus 41 of 119 [34.5%] before 2011, P = .02) and also in patients 50 years old and older (8 of 46 [17.4%] versus 39 of 109 [35.8%] before 2011, P = .02), with a concomitant rise in cases indeterminate for UIP or showing alternative diagnoses. Histology for UIP is less frequently encountered in our contemporary practice compared with the historic era. The pretest probability of a non-UIP diagnosis is now high, even in elderly patients, underscoring the need for pathologists to be familiar with the histologic features of alternative diagnoses.

Bioactive Polylactide Fibrous Materials Prepared by Crazing Mechanism

AbstractBioactive suture materials made of biodegradable polymers containing biologically active substances are increasingly demanded in contemporary surgical practice. Herein, the functional fibrous materials are produced by structural modification of polylactide (PLA) fibers according to the crazing mechanism in water–ethanol solutions. The threshold of ethanol concentration, at which the breaking elongation of the polymer substantially increases (up to 600–700%), is found to be 30 wt%. The crazing mechanism is employed to fill the porous structure of PLA fibers by different antiseptic substances (brilliant green, iodine, and fuchsin). PLA loaded by 0.8 wt% of brilliant green exhibits antimicrobial activity on Escherichia coli and Candida guilliermondii. The additive is released stepwise for a prolongated time period (2.5 months). The addition of 1–6 wt% iodine dramatically accelerates the polymer degradation in sodium‐phosphate buffer solution at 37 °C. The obtained filled fibers may possess great interest for producing suture materials with prolonged action of functional components and variable degradation times.

P015 ILEOCOLIC RESECTION FOR CROHN’S DISEASE: CURRENT TRENDS FROM ANALYSIS OF 2 YEARS OF NSQIP IBD COLLABORATIVE DATA

Abstract Background Ileocolic resection (ICR) is performed for Crohn’s disease (CD) patients with terminal ileitis requiring surgery. Current National Surgical Quality Improvement Program (NSQIP) data is lacking specificity around IBD surgery, including stoma formation and biologic therapies. The NSQIP IBD Collaborative (NSQIP-IBD) is a multicenter working group formed to better collect and analyze perioperative data unique to IBD patients under the auspices of NSQIP. We present retrospective analysis of a multicenter cohort of ICR for CD to describe the current practice of ICR for CD across our collaborative and explore factors associated with rates of postoperative complications on behalf of NSQIP-IBD. Methods Review of NSQIP data from 10 participating sites was performed to select ICR cases for CD from March 2017 to March 2019. In addition to standard data from NSQIP, IBD-specific data regarding stoma formation, immunosuppressant use (biologics, steroids, and immune modulators), and dysplasia is included. Primary outcome was anastomotic leak measured in a 30-day postoperative window in undiverted patients. Secondary outcomes were total non-leak complications and total postoperative infections. Multivariable analysis was performed to adjust for confounding pre- and intraoperative confounders. Backward selection of covariates and factors was performed using a cutoff of p&amp;lt;0.2 for main effects. Results 506 ICR cases for CD were identified. 78 patients had stomas per our unique ileostomy NSQIP-IBD variable, compared to 38 found by querying generally available NSQIP data (48.7% of total stomas). ICR patients receiving stoma were more likely to have more severe ASA class and weight loss and had significantly lower albumin and hematocrit. Age, BMI, and sex were similar in either group. Intraoperatively, stoma patients were more likely have worse wound class, be emergent, and longer operative time. 421 cases had complete baseline and intraoperative data for multivariable analysis of leak rates. 422 were available for secondary outcomes analysis. Multivariable analysis of leak rates showed significant association with infections prior to operation (PATOS; OR=6.6, 95% CI 1.1–40, p=0.041). Significant predictors of total postoperative complication rate and infection rate are shown in Tables 1 and 2, respectively. Conclusions NSQIP-IBD data provides clearer, more detailed data than the NSQIP colectomy module alone in IBD patients. We show that CD ICR patients receiving stomas were more emergent, had intraoperative infection, or had more severe disease. This is consistent with most contemporary surgical practices. Total infections PATOS are associated with increased risk of postoperative anastomotic leak, non-leak complications, and infections. NSQIP-IBD data improves on existing NSQIP data to allow a more robust analysis of factors and outcomes unique to IBD cases. We anticipate with more time and greater numbers we will be able to obtain even more granular data.