Postoperative Day Research Articles

Safety and efficacy of low-dose esketamine weakly opioidized anesthesia in elderly patients with lumbar spinal stenosis undergoing surgery: a prospective, double-blind randomized controlled trial

BackgroundThe perioperative use of esketamine may reduce opioid use and their adverse effects. We aimed to evaluate the intraoperative safety and efficacy of weak opioidized anesthesia with low-dose esketamine in the treatment of elderly patients with lumbar spinal stenosis undergoing total laminectomy with complete decompression and interbody implant fusion.MethodsIn total, 90 elderly patients were randomized into three groups: the esketamine HS group (0.2 mg/kg induction, 0.25 mg/(kg·h) infusion), the esketamine LS group (0.2 mg/kg induction, 0.125 mg/(kg·h) infusion), and the control group (group C receiving an equal volume of saline). The primary outcome was the cumulative dose of sufentanil administered during the perioperative period. Pain (VAS rest and movement scores) on preoperative day 1 (POD-1), postoperative day 1 (POD1), postoperative day 3 (POD3), and postoperative day 7 (POD7), and serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) on POD-1, POD1, POD3, and POD7 were the secondary outcomes. We also measured mean arterial pressure and the heart rate of the three groups at each time point before anesthesia (T0), immediately after intubation (T1), 5 min after intubation (T2), at the time of surgical skin incision (T3), at the time of extubation (T4), and 30 min after surgery (T5), intraoperative propofol and remifentanil dosage, and the incidence of adverse reactions within 5 days postoperatively, etc.ResultsThe cumulative perioperative sufentanil dosage and the number of patients undergoing postoperative PACU remedial analgesia were significantly lower in the HS and LS groups compared to the C group (P < 0.05). Cumulative perioperative sufentanil use was lower in the HS group compared with the LS group (P < 0.01). The VAS dynamic and static pain scores were significantly lower in the HS group at POD1 compared to the C and LS groups. There was no significant difference in VAS dynamic and static pain scores among the three groups at POD3 and POD7 (P > 0.05). At POD1, the VAS dynamic and static pain scores were significantly lower in the HS group compared to the C and LS groups. VAS static pain scores were lower in the LS group at POD1 compared to group C (P < 0.05), whereas VAS dynamic pain scores did not differ compared to group C (P > 0.05). Compared with group C, the serum levels of TNF-α, IL-1β, and IL-6 were significantly lower in the HS and LS groups at POD1, POD3, and POD7. At POD1 and POD3, the serum levels of TNF-α, IL-1β, and IL-6 were lower in the HS group than in the LS group (P < 0.05). Serum IL-10 levels were significantly increased at POD1, POD3, and POD7 in the HS and LS groups compared with group C (P < 0.05). The incidence of intraoperative hypotension was significantly lower in the HS and LS groups compared with group C (P < 0.05). At T2 and T4, the HS and LS groups had significantly lower levels of MAP and HR decline than the C group. At T5, the MAP and HR of the C group were significantly higher than those of the HS and LS groups (P < 0.05). The HR at T3 was reduced in the LS group compared with the C and HS groups (P < 0.05). The incidence of postoperative respiratory depression was reduced in the HS and LS groups compared to the C group (P < 0.05). There was no significant difference between the three groups in terms of postoperative psychiatric adverse reactions, such as hallucinations, nightmares, diplopia, somnolence, and dizziness (P > 0.05).ConclusionLow-dose esketamine is used for its anti-inflammatory and analgesic effects in lumbar spine surgery of elderly patients. It is beneficial to hemodynamic stabilization and can reduce the incidence of postoperative respiratory depression in elderly patients. Among them, 0.2 mg/kg induction and 0.25 mg/(kg-h) infusion were more effective.Graphical

From colostomy creation to full enteral feeding in neonates with an anorectal malformation: evaluating the role of central venous access

PurposeAfter creating a colostomy in newborns with anorectal malformations (ARMs), reaching full enteral feeding may take longer than expected, resulting in an unanticipated period of starvation. This retrospective cohort study aimed to evaluate the postoperative course regarding enteral feeding tolerance and the necessity for a central venous access device (CVAD) after colostomy formation in newborns with ARMs.MethodsThe files of neonates with ARMs who underwent colostomy formation between January 2014 and August 2023 were reviewed. The primary outcome was the postoperative tolerance of enteral feeding. Secondary outcomes were the need for a CVAD and CVAD-related complications.ResultsThirty-four neonates with an ARM underwent colostomy formation. Enteral feeding was initiated on median postoperative day two (IQR 1–2). Full enteral feeding was reached on median postoperative day six (IQR 4–8). In nine neonates (26.5%), it took more than seven postoperative days to reach full enteral feeding, of whom seven (77.8%) had one or more comorbidities that could affect neonatal feeding tolerance. A CVAD was placed in 17 neonates (50%), of whom four (23.5%) needed additional general anesthesia for its placement. There were one or more CVAD-related complications in seven of 17 (41.2%) neonates, mainly involving suspicion of mild catheter-related infections.ConclusionsThe majority of neonates undergoing colostomy formation for an ARM require more than five days to achieve full enteral feeding. It is recommended to bridge this period of inadequate feeding with either fluids or parenteral nutrition by inserting a CVAD during colostomy formation, particularly for those with comorbidities affecting neonatal feeding tolerance.

Evaluation of a Perioperative Fungal Prophylaxis Protocol Change in Orthotopic Liver Transplant.

Orthotopic liver transplant (OLT) carries a risk for invasive fungal infections (IFI). A targeted antifungal prophylaxis protocol can identify OLT patients who warrant antifungal prophylaxis. The optimal protocol and appropriate risk factors have yet to be confirmed. This study aimed to describe the impact of a targeted antifungal prophylaxis protocol post OLT on rates of IFI and protocol adherence. This was a retrospective observational cohort study of patients ≥18 years old with an OLT at Cleveland Clinic. Pre-protocol was defined as June 1, 2019 to May 31, 2020 and post-protocol was June 1, 2021 to May 31, 2022. The primary objective was to determine adherence to the prophylaxis protocol on postoperative day (POD) 0. Secondary objectives included comparing the 90-day incidence of proven or probable IFI post-OLT between groups. The pre-protocol group included 134 patients, whereas the post-protocol group included 166. Prior to protocol implementation, 73% received clotrimazole, 13% fluconazole, 13% micafungin, and 1% nystatin. After protocol implementation, 63% received clotrimazole, 16% fluconazole, and 21% micafungin. Adherence to the protocol was 66% on POD0 and increased to 84% over the duration of prophylaxis. Rates of IFI development decreased to 3.6% after implementation from 6.7% prior to the protocol (P = 0.22). Median time to IFI was 8 days (interquartile range [IQR] = 2-19) pre-protocol and 15 days (IQR = 6-17) post-protocol. The implementation of a post-OLT-targeted antifungal prophylaxis protocol can promote consistency in antifungal prophylaxis. This study showed an 84% adherence rate to the implemented protocol, with numerically lower rates of IFIs post-protocol compared with pre-protocol.

Early Escalation to CentriMag for Acute Myocardial Infarction-Induced Out-of-Hospital Cardiac Arrest With Refractory to Extracorporeal Membrane Oxygen Support.

The mortality rate of acute myocardial infarction (AMI)-related refractory cardiogenic shock (rCS) remains high, particularly in patients experiencing cardiac arrest with extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to evaluate the outcomes of early escalation to CentriMag for AMI-induced out-of-hospital cardiac arrest (OHCA) with ECPR. Patients with AMI-induced OHCA with refractory to ECMO support after ECPR were enrolled. Clinical data were analyzed to identify predictive factors for mortality and survival benefits. Eighty-nine patients were enrolled, of whom 26 underwent CentriMag implantation. The 1-year survival rate for those with the implantation was 34.6%. In contrast, those without implantation showed a survival rate of 7.9%. The average time from the initiation of ECPR to CentriMag implantation was 22.5 ± 14.6 h. The surgical mortality group exhibited a larger body surface area, longer intervals from CPR to ECPR, shorter duration of CentriMag support, and higher preoperative serum creatinine and postoperative day 1 serum aspartate aminotransferase levels. A prolonged interval from CPR to ECPR was identified as an independent risk factor for mortality. Extended duration of CentriMag support was associated with improved survival outcomes. Early CentriMag implantation rescues patients experiencing AMI-related OHCA with rCS and refractory to ECMO support after ECPR. This intervention provides a critical time window, serving as a safe bridge to decision.

Selective dorsal rhizotomy in children with hereditary spastic paraplegia

To analyze the results of selective dorsal rhizotomy (SDR) in children with hereditary spastic paraplegia (Strumpell disease, HSP). SDR was performed in 8 patients with genealogical or genetic verification of HSP between 2022 and 2024. Mean age of patients was 10.3±4.9 years. We analyzed the results via testing spasticity and goniometry before surgery, on the third postoperative day and in delayed postoperative period. Mean follow-up period was 11±7.5 months. All children improved lower limb movements. There was regression of spasticity in most cases. Three children had significant impairment of movements in some joints due to orthopedic deformities. No regression of the post-surgery movements level and even increase later in some cases was observed. There were no complications. SDR is effective and safe in patients with HSP. Long-term follow-up of larger samples is required.

Comparative analysis of glycemic outcomes following implementation of a pharmacist‐led insulin management service in postoperative cardiothoracic surgery patients

AbstractIntroductionPerioperative hyperglycemia is a predictor of mortality in cardiothoracic surgery (CTS) patients. Cardiothoracic surgery patients with diabetes have improved clinical outcomes with maintained glycemic management, including improved hospital length of stay (LOS), surgical site infection risk, and rates of morbidity and mortality. A pharmacist‐led insulin management service was implemented, granting pharmacists autonomy to adjust basal, bolus, and infusion insulin regimens to optimize glycemic management following CTS. Literature evaluating the impact on glycemic management in CTS patients following a pharmacist‐led insulin management service is limited.ObjectiveThe study objective was to compare postoperative glycemic management in CTS patients before and after implementation of a pharmacist‐led insulin management service.MethodsThis retrospective study included adult CTS patients with diabetes with a hemoglobin A1c (HbA1c) of 6.5% or greater who received at least 2 basal insulin doses following postoperative intravenous (IV) insulin infusion. The primary outcome was the percentage of blood glucose concentrations within the target range (70–180 mg/dL) until postoperative Day 7 or discharge, if sooner. Secondary outcomes were average daily blood glucose, time to discontinuation of postoperative IV insulin infusion, incidence of hypoglycemia and hyperglycemia requiring re‐initiation of an insulin infusion, hospital LOS, and postoperative surgical site infections within 3 months.ResultsA total of 200 patients were included, 100 in each group. Mean percent of glucose checks within target range was higher in the post‐implementation group compared with the pre‐implementation group (60.8 vs. 48.9, p = 0.0004). The post‐implementation group achieved a lower mean daily blood glucose (170 vs. 191, p &lt; 0.0001) and spent fewer days on postoperative insulin infusion (1.24 vs. 1.85, p &lt; 0.0001). There were no differences in the incidence of hypoglycemia, re‐initiation of insulin infusion, LOS, or surgical site infections.ConclusionImplementation of a pharmacist‐led insulin management service was a safe and effective strategy to improve glycemic management in postoperative CTS patients.

Effect of parecoxib on postoperative delirium in patients with hyperlipidemia: a randomized, double-blind, single-center, superiority trial.

Hyperlipidemia has been implicated in the higher risk of developing postoperative delirium. Prostaglandin endoperoxide synthase-2 mediates neuroinflammatory processes in postoperative delirium. This study aims to investigate whether preoperative administration of parecoxib is more efficient than a placebo in averting postoperative delirium in patients with hyperlipidemia. In this randomized, double-blind, superiority trial, participants with hyperlipidemia were randomized in a 1:1 ratio to receive parecoxib (40 mg parecoxib administered intravenously before anesthesia induction) or placebo (normal saline). The primary outcome was postoperative delirium incidence within three days, with a 5.4% difference set as the superiority threshold. Secondary outcomes were cumulative incidences of emergence delirium and prostaglandin endoperoxide synthase-2 levels, inflammatory cell counts, and pain score on postoperative day 1 and postoperative adverse events. This trial conducted between August 2023 and August 2024 at a tertiary hospital in China included 452 adults with hyperlipidemia, with 226 in the parecoxib group and 226 in the placebo group. The incidence of postoperative delirium in the parecoxib group was 13.72%, a reduction of 12.39% compared to the placebo group (hazard ratio, 0.491; 95% confidence interval: 0.318 to 0.759; P < 0.001). The parecoxib group also had a lower incidence of emergence delirium, prostaglandin endoperoxide synthase-2 levels, white blood cell counts and neutrophil, and pain scores on postoperative day 1. The occurrence of adverse events was comparable between the two groups. Prostaglandin endoperoxide synthase-2 expression levels, white blood cell counts, and pain scores mediated the reduction of postoperative delirium incidence by parecoxib. Parecoxib may help in reducing the hyperlipidemia-related postoperative delirium incidence. The effective anti-inflammatory activity of prostaglandin endoperoxide synthase-2 inhibition by parecoxib and postoperative pain control may be important mechanisms for preventing postoperative delirium.

Robot-Assisted Thoracoscopic Surgery Can Be Safely Performed in Patients With Obesity from the Early Stages of Implementation.

This study aimed to compare the perioperative outcomes of robot-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer in patients with obesity. Anatomical pulmonary lobectomy or segmentectomy performed at a single institution from April 2018 to September 2023 in patients with obesity (body mass index ≥25 kg/m2) were statistically compared in terms of perioperative clinical factors including operative time, blood loss, chest tube duration, pain score, intraoperative events, and early postoperative complications between RATS and VATS. In all, 89 patients were evaluated; 43 underwent RATS and 46 underwent VATS. All RATS procedures were performed using the da Vinci Xi system. Patient characteristics were comparable between the 2 groups. The operative time, blood loss, number of dissected lymph nodes, intraoperative events, and conversion rate to open thoracotomy were similar between the 2 groups. The frequencies of postoperative complications and chest tube placement duration between the groups were also similar. The median pain scores were slightly higher in the RATS group on postoperative day 1 but were equivalent between the 2 groups on postoperative day 7. The RATS group had a shorter postoperative hospital stay than the VATS group (P < 0.01). A surgical team proficient in conventional VATS can safely introduce RATS in patients with obesity and lung cancer with equivalent perioperative outcomes.

Exploring the Role of Intraoperative Prolactin Levels in Surgical Management of Prolactinomas: Predicting Operative Success and Enhancing Surgical Decision-Making

Objective: Prolactinomas comprise half of all pituitary adenomas. This study explores the significance of measuring intraoperative (IO) prolactin (PRL) levels in guiding surgical decision making and predicting operative success. Methods: Retrospective cohort study design of consecutive patients with prolactinomas who underwent TSS resection from June 2021 to May 2023. Intraoperative prolactin was measured after tumor resection was completed. Remission was defined as normalization of prolactin levels during follow-up without medication. Outcomes included factors associated with remission, utilizing significance thresholds at p&lt;0.05. Results: Thirteen patients were included with a 5.3-month median follow-up (range, 3-15 months). Most of the tumors were microadenomas (61%), with a median preoperative PRL level of 116 ng/mL (range, 25-471 ng/mL). Gross total resection (GTR) was achieved in 69% of patients, all of whom attained remission. The median IO PRL was 19.8 ng/mL (range, 1-329), the postoperative day 1 (POD1) PRL of 3.6 ng/mL (range, 1-203 ng/mL) and the latest PRL at 9.3 ng/mL (range, 1-137 ng/mL). A ≥40% decline in IO PRL from baseline was identified as the optimal cut-off for predicting biochemical remission, with 89% sensitivity, 75% specificity, and 85% accuracy. Conclusions: Monitoring prolactin levels intraoperatively may be a useful biomarker aiding surgeon’s assessment of the extent of tumor resection and guiding surgical decision-making. Further refinement of the immunoassay assay and clinical testing with more extensive prospective studies are needed.

ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study

Background: Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored. Methods: In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires. Results: Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P&lt;.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels. Conclusions: ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.

Intraoperative Endoluminal Pyloromyotomy Versus Stretching of the Pylorus for the Reduction of Delayed Gastric Emptying After Pylorus-Preserving Partial Pancreatoduodenectomy: A Blinded Randomized Controlled Trial (PORRIDGE Study; DRKS00013503).

Pylorus-preserving partial pancreatoduodenectomy (ppPD) is a treatment for tumors of the pancreatic head. Delayed gastric emptying (DGE) is one of the most common complications following ppPD. In a retrospective analysis, intraoperative endoluminal pyloromyotomy (PM) was shown to be associated with a reduction in DGE rates. The aim of this randomized controlled trial was to investigate the effect of intraoperative endoluminal PM on DGE after ppPD. Patients undergoing ppPD were randomized intraoperatively to receive either PM or atraumatic stretching of the pylorus prior to creation of the duodenojejunostomy. The primary endpoint was the rate of DGE within 30 days after surgery. Sixty-four patients were randomly assigned to the PM group and 64 patients were assigned to the control group. There were no differences between the two groups regarding baseline characteristics. The DGE rate was 59.4% (76/126). In two patients (1.6%) DGE was not assessable. The most common DGE grade was A (51/126, 40.5%), followed by B (20/126, 15.9%) and C (5/126, 4.0%). The rate of DGE was 62.5% in the PM group versus 56.3% in the control group (odds ratio 1.41, 95% confidence interval 0.69-2.90; p=0.34). The complication rate did not differ between both groups (p=0.79) and there were no differences in quality of life on postoperative day 30. Intraoperative endoluminal PM did not reduce the rate or severity of DGE after ppPD compared with atraumatic stretching of the pylorus.

Postoperative acute pain trajectory and chronic postsurgical pain after abdominal surgery: a prospective cohort study and mediation analysis.

This study aimed to investigate the trajectories of acute postoperative pain intensity during the initial 5days after abdominal surgery, and to analyze their association with the risk of developing chronic postsurgical pain (CPSP). We enrolled patients with elective abdominal surgery with pain measurements taken across postoperative days 1 through 5. Since postoperative pain is often unavoidable and its initial intensity is closely related to the invasiveness of the surgery, focusing on the overall pain trajectory may be more meaningful than evaluating pain at a single time point. Therefore, the primary outcome of this study was to identify distinct pain trajectories. Secondary outcome was the incidence of CPSP between differences pain trajectories. Lastly, mediation analyses were performed to explore the mediating role of the quality of recovery and subacute pain on the studied associations. The final analysis encompassed 1170 patients (36.75% female) with a median age of 55years. Two distinct clusters were identified: with movement (high: 533 [45.56%]; low: 637 [54.44%]) and at rest (high: 363 [31.03%]; low: 807 [68.97%]). Patients in the high pain trajectory group (during movement [odds ratio [OR] 2.04, 95% CI 1.56-2.68] or at rest [OR 1.90, 95% CI 1.44-2.53]) exhibited nearly doubled risk of CPSP. Moreover, these patients exhibited a significantly poorer recovery quality. Mediation analyses revealed that the poor recovery quality at postoperative 5days (17.62%-18.57%) and higher subacute pain at postoperative 1month (29.46%-32.75%) were significant mediators in the association between adverse postoperative acute pain trajectory patterns and CPSP. This study highlights the clinical significance of postoperative pain trajectory profiles in predicting the risk of CPSP, emphasizing postoperative acute pain trajectory as a critical indicator and subacute pain as a significant mediator. The findings underscore the potential for tailored pain management strategies targeting acute pain trajectories to reduce such risk.

Efficacy and safety of repetitive peripheral magnetic stimulation in patients with lumbosacral radiculopathy during early postoperative rehabilitation period following microdiscectomy

Background. The considerable number of surgical interventions for the treatment of discogenic lumbosacral radiculopathy(LSR) highlights the importance of optimizing complex post-surgical rehabilitation programs, particularly those incorporating innovative physiotherapeutic techniques. One of the modern and safe methods in physiotherapeutic rehabilitation is repetitive peripheral magnetic stimulation (rPMS).Objective: to evaluate the efficacy of a rehabilitation therapy that includes rPMS for patients with LSR during the early postoperative rehabilitation period following microdiscectomy.Material and methods. A prospective randomized comparative study involved 71 patients with LSR following microdiscectomy. On postoperative Day 7, the patients were randomly assigned to one of two groups. Group 1 (n=35) received a course of rPMS in addition to the standard rehabilitation therapy, while Group 2 (n=36) received only the standard treatment. Pain intensity was assessed using the visual analog scale, anxiety was evaluated using the state-trait anxiety inventory, and health-related quality of life was measured with the EuroQol-5D questionnaire.Results. On Day 21 of rehabilitation, a statistically significant difference (p=0.036) in pain intensity in the lower limb was observed between the two groups. In addition, a statistically significant difference (p=0.042) was revealed in the frequency distribution of trait anxiety severity. A statistically significant improvement in the frequency distribution of self-care level was observed in Group 1 between Days 7 and 21 (p&lt;0.05).Conclusion. The clinical effects observed in terms of the regression of pain, improved sensory function, and psychological wellbeing were more pronounced in the group receiving rPMS. These findings suggest that rPMS incorporated into postoperative rehabilitation programs may serve as a valuable tool for enhancing patient recovery.

Visual, clinical and quality of life outcomes of a new multifocal IOL with optimized diffractive grating: a non-randomized clinical trial

BackgroundMultifocal intraocular lenses (IOLs) are designed to reduce dependence on spectacles by providing multiple focal points. However, they are associated with photic phenomena such as halos and glare, and may reduce contrast sensitivity. The BIOS Trifocal is a single-piece acrylic diffractive IOL with a closed-loop haptic design, optimized for centration and stability. It features an aspheric, aberration-neutral surface and a precisely engineered diffraction grating for effective energy distribution across multiple distances. This study aims to evaluate the visual, clinical, and quality of life outcomes of the BIOS Trifocal IOL for treatment of cataract and presbyopia.MethodsParticipants who met the inclusion criteria underwent implantation of the BIOS Trifocal IOL and were assessed at 30 and 90 days post-surgery. The evaluations included measurements of patient-reported outcomes using the NEI-VFQ 25 at postoperative day 30 and uncorrected and corrected distance visual acuity and defocus curves at postoperative day 90. Additionally, intraoperative and postoperative complications were documented. Visual acuity assessments were performed under photopic conditions, with a range of defocus from + 1.5 D to -3.0 D.ResultsSignificant improvements were observed in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and near visual acuity (UNVA) at both 30 and 90 days post-surgery (p < 0.001). The defocus curve demonstrated functional vision from + 1.5 D to -3.0 D, supporting the lens’s efficacy for near, intermediate, and far distances. Quality of life, as assessed by the NEI-VFQ 25, showed marked improvement across all domains (p < 0.05), with no significant complications directly attributable to the IOL.ConclusionsThe BIOS Trifocal IOL presented satisfactory effectivity in the treatment of cataract and presbyopia, providing functional vision across near, intermediate and far distances and maintaining good patient satisfaction. Trial RegistrationThis trial was registered at the ReBEC (Registro Brasileiro de Ensaios Clínicos – Brazilian Registry of Clinical Trials)database under the registration code RBR-772s6y at April 6th, 2020.

Successful management of drug-resistant rhizobium radiobacter endophthalmitis: A case report.

To report a unique case of post-cataract surgery endophthalmitis caused by Ceftazidime-resistant Rhizobium radiobacter, successfully managed with timely vitrectomy and intravitreal Levofloxacin. A healthy 73-year-old man underwent phacoemulsification and posterior chamber intraocular lens implantation in his left eye. Postoperative ocular examination (OE) one day after the surgery revealed no specific findings. However, on postoperative day 6, he presented with a painful and red left eye. Diagnosed with postoperative endophthalmitis on day 8 at another hospital, he received IVI of Ceftazidime and Vancomycin before being urgently referred to our hospital on the same day. Early vitrectomy and anterior chamber irrigation were performed timely when he arrived on day 8, with cultures identifying Ceftazidime-resistant Rhizobium radiobacter, sensitive to Levofloxacin. Repeated IVI of Levofloxacin (500 mcg/0.1 ml) ensued on post-cataract operative days 13 and 18. Six months post-cataract surgery, the corrected distance visual acuity of the left eye stabilized at 20/33, and OE remained stable. Early vitrectomy and vitreous culture prove effective in managing postoperative endophthalmitis in drug-resistant Rhizobium radiobacter. IVI of Levofloxacin, though rare, proved to be effective in treating Ceftazidime-resistant and Levofloxacin-sensitive pathogens in our case.

Comparing Open and Robotic Unilateral Transversus Abdominis Release in Incisional Hernias With a Lateral Component: A Single Center Retrospective Study

IntroductionLateral hernias are often more challenging to correct when compared to midline defects, due to the anatomic boundaries of the bony pelvis, retroperitoneum, and costal margin. With the insurgence of robot assisted abdominal wall surgery, these defects have been found more manageable through a minimal invasive repair. In this study, we aim to present our short-term results of incisional hernia repair with a lateral component requiring a unilateral transversus abdominis release, through open surgery versus robot assisted.MethodsA retrospective analysis was performed of our robotic and open abdominal wall repairs of lateral hernias, where a unilateral transversus abdominis release was performed, between January 2017 and December 2023. Patient, hernia and perioperative details are reported.Results54 patients in the open group versus 10 patients in the robotic group were included. Hernia width and hernia surface area were higher in the open group, but not significant. Operation time was similar between open and robotic procedures. In-hospital complications, surgical site infection and clinical seroma rate during the first 30 postoperative days were similar in both groups. There was a clear difference in length of stay, in favor of the robotic group.DiscussionIn our limited series, a robotic approach seems safe and feasible when faced with large lateral hernias. Short-term results show a shorter length of stay using the robotic approach, with no significant difference in short term complications, specifically SSI-rate. However, conclusions are limited due to the low number of patients and additional studies should be performed to account for long term recurrence and increase included patient number.

Monitoring Hip Joint Muscle Function in Osteoarthritis Patients Following Arthroplasty: A Prospective Cohort Study

Background/Objectives: Osteoarthritis (OA) is a chronic and progressive joint disease, leading to functional limitations and significantly impairing the quality of life. Muscle weakness, reduced mobility, and compensatory biomechanical changes are common consequences, further exacerbating functional decline. The aim of this study was to assess the impact of hip osteoarthritis on muscle functionality and to evaluate the effectiveness of hip arthroplasty using the MyotonPro device to measure key biomechanical parameters, i.e., tension, stiffness, and flexibility. Methods: This cohort study included 40 patients (17 women and 23 men; mean age 64.55 ± 10.49 years) with advanced hip OA (Kellgren–Lawrence grade III–IV) undergoing hip arthroplasty. Measurements of muscle tension (F), stiffness (S), and flexibility (D) in the gluteus maximus, rectus femoris, and biceps femoris were performed at three time points: before surgery, on postoperative days 8–10, and one month after hospital discharge. Pain (VAS), balance (Tinetti scale), and functional ability (WOMAC index) were also assessed. Results: Hip arthroplasty significantly reduced pain levels (VAS: 6.38 ± 0.28 preoperatively to 1.88 ± 0.22 postoperatively, p &lt; 0.001) and improved functional ability (WOMAC: p &lt; 0.001). Muscle tension and stiffness of the gluteus maximus initially increased after surgery (tension: 11.57 ± 0.32 to 12.15 ± 0.38, p = 0.009), reflecting compensatory stabilization but decreased by the final evaluation. Flexibility improved significantly over time (p = 0.014). The biceps femoris muscle exhibited a significant reduction in tension one month postoperatively (p = 0.015), alongside decreased stiffness (p = 0.015) and enhanced flexibility. The rectus femoris muscle showed minor changes in biomechanical properties, with no statistically significant differences detected. Conclusions: Osteoarthritis significantly impacts muscle function, reducing the gluteus muscle tension and stiffness, which compromises joint stability and triggers compensatory activity in the rectus femoris and biceps femoris muscles. Postoperative rehabilitation is essential for improving flexibility and addressing compensatory muscle tension.

Wearable, noninvasive, pulsed shortwave (radiofrequency) therapy for postoperative analgesia: A randomized, double-masked, sham-controlled pilot study.

Nonthermal, pulsed shortwave (radiofrequency) therapy (PSWT) is a nonpharmacologic, noninvasive modality that limited evidence suggests provides analgesia. Its potential favorable risk-benefit ratio stems from its lack of side effects and significant medical risks, applicability to any anatomic location, long treatment duration, and ease of application by simply affixing it with tape. Even with a relatively small treatment effect, PSWT might contribute to a multimodal analgesic regimen, similar to acetaminophen. However, widespread clinical use is hindered by a lack of systematic evidence. The current randomized, controlled pilot study was undertaken to determine the feasibility and optimize the protocol for a subsequent definitive investigation and estimate the treatment effect of PSWT on postoperative pain and opioid consumption. Within the recovery room following primary knee and hip arthroplasty, cholecystectomy, hernia repair, and non-mastectomy breast surgery, we applied 1-3 PSWT devices (Model 088, BioElectronics Corporation, Frederick, Maryland) over the surgical bandages. Participants were randomized to 28 days of either active or sham treatment in a double-masked fashion. The outcomes of primary interest were the cumulative opioid consumption and the mean of the "average" and "worst" daily pain measured with the Numeric Rating Scale over the first 7 postoperative days. During the first 7 postoperative days, oxycodone consumption in participants given active treatment (n = 55) was a mean (SD) of 21 mg (24) versus 17 mg (26) in patients given sham (n = 57): difference 4 (95% CI, -5 to 13), p = 0.376. During this same period, the "average" daily pain intensity in patients given active treatment was 2.4 (1.6) versus 2.6 (1.7) in sham: difference -0.2 (95% CI -0.8 to 0.5), p = 0.597. Concurrently, the worst/maximum pain for the active group was 4.6 (2.0) versus 4.7 (2.1) in sham: difference -0.1 (95% CI -0.8 to 0.7), p = 0.888. No device-related systemic side effects or serious adverse events were identified. Pulsed shortwave (radiofrequency) therapy did not reduce pain scores and opioid requirements to a statistically significant or clinically relevant degree during the initial postoperative week in this pilot study. These results must be replicated with a subsequent study before being considered definitive. Data from this preliminary study may be used to help plan future trials.

Abstract TMP52: Corticospinal Tractography and Motor Function in Patients Undergoing Intracerebral Hemorrhage Evacuation

Introduction: A recent randomized-controlled trial confirmed the value of minimally-invasive intracerebral hemorrhage (ICH) evacuation to improve outcomes in properly-selected patients. Yet, there remains a need to optimize patient selection and prognosis following ICH evacuation. Magnetic resonance diffusion tensor imaging (DTI) allows visualization and quantification of critical white matter tracts. Corticospinal tract DTI (CST-DTI) in particular can be associated with motor function, which may improve prognosis and patient selection for ICH evacuation. Methods: Patients who underwent minimally-invasive ICH evacuation and had perioperative DTI performed were retrospectively reviewed. CST metrics including fractional anisotropy, radial diffusivity, axial diffusivity, geodesic anisotropy, fiber count, and tract volume were associated with motor function pre- and postoperatively. Motor function was scored on each hemibody via the weakest muscle group in each extremity according to the Medical Research Council grading scale (maximum score of 10 on each hemibody). Results: Eighteen patients with available peri-operative DTI data were included, 12 each with preoperative and postoperative DTI, seven with matched pre- and postoperative DTI. Preoperative geodesic anisotropy was significantly associated with both preoperative motor function on the contralateral hemibody (R=0.616, p=0.032, Pearson correlation) and at postoperative day one (R=0.606, p=0.038). Restoration of a deformed CST could be seen in several patients from preoperative to the immediate postoperative period ( Figure 1) . However, no preoperative or postoperative CST-DTI metrics were associated with motor scores at a median follow-up of 6.3 months post-ICH (p&gt;0.05 for all comparisons). There was a significant increase in motor scores on the affected hemibody from postoperative day one to last follow-up (3.8±3.5 vs 6.3±6.8; p = 0.038, Wilcox signed-rank test). Conclusions: Preoperative CST-DTI metrics are associated with both preoperative and immediate postoperative motor function after minimally invasive ICH evacuation. A restored CST after ICH evacuation could be seen in a subset of patients. However, neither preoperative nor immediate postoperative CST-DTI metrics were associated with longer-term motor function. Tractography from the perioperative period should be used with caution in providing motor prognosis.

Inhibition of STAT3 phosphorylation attenuates perioperative neurocognitive disorders in mice with D-galactose-induced aging by regulating pro-inflammatory reactive astrocytes.

Perioperative Neurocognitive Disorders (PND) are associated withanesthesia and surgery, especially in the elderly. Astrocyte activation in old mice correlates with PND development. These cells can switch to a pro-inflammatory or an anti-inflammatory phenotype, regulated by the STAT3 pathway. It remains unclear whether STAT3 can alleviate PND symptoms in elderly mice by modulating the transitions between these astrocyte phenotypes. Senescence was induced in eight-week-old male C57BL/6J mice with D-galactose, followed by tibial fracture surgery under anesthesia to model PND. On the third postoperative day, cognitive function was assessed using fear conditioning, synaptic plasticity using Golgi/ electrophysiology, and astrocyte phenotype /STAT3/pSTAT3(phosphorylated STAT3) using Western blot/immunofluorescence. The content of neurotrophic factors, including brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF), was also measured. Primary astrocytes were stimulated with the conditioned medium referred to as ACM to induce pro-inflammatory reactive astrocytes. Stattic, an inhibitor of STAT3 phosphorylation, was used to investigate its effects on astrocyte phenotypic transformation and hippocampus-dependent learning and memory in aging mice, both in vitro and in vivo. On the third postoperative day, pSTAT3 levels and pro-inflammatory astrocytes increased in the hippocampal CA1 region, with no change in total STAT3 or anti-inflammatory astrocytes, accompanied by a decrease in GDNF and BDNF.ACM treatment of primary astrocytes promoted pro-inflammatory phenotype conversion, which was inhibited by stattic without affecting anti-inflammatory phenotype. Intraperitoneal injection of stattic in mice reduced the accumulation of pro-inflammatory astrocytes, increased the levels of BDNF and GDNF, enhanced synaptic plasticity, and improved hippocampus-dependent learning and memory functions in anesthesia-induced senescent mice, without altering anti-inflammatory astrocytes. Inhibiting STAT3 phosphorylation may improve synaptic plasticity in the CA1 region of the hippocampus by modulating pro-inflammatory astrocytes, thereby alleviating perioperative neurocognitive dysfunction in D-galactose-induced aging mice.