Day Of Surgery Research Articles

AN EXPLORATIVE STUDY ON PROBLEMS OF PATIENTS WITH LOWER LIMB FRACTURE UNDERGONE SURGERY WITH A VIEW TO IDENTIFY THE NURSING CARE NEEDS IN SELECTED HOSPITAL OF DEHRADUN, UTTARAKHAND

Aims: To identify the problems and nursing care needs of patients with lower limb fracture undergone surgery and to find out the association between problems and selected socio-demographic profile. Materials and Methods: A quantitative research approach with explorative research design was used for the study. Total 53 participants were selected by purposive sampling technique in the orthopaedic ward of Himalayan hospital, Jollygrant, Dehradun, Uttarakhand. Data was collected by using self reporting checklist and observational checklist. Results: The statistical finding shows that in the post- operative day 1-2, (73.5%) of the patients had moderate problems and (26.41%) of the participants had severe problem followed by in day 3-6, (88.67%) of the participants had moderate problem and (11.32%) of the participants had severe problems and in day 7-8, (75.4%) of the participants had moderate problem and (24.52%) of the participants had mild problem and Nursing care need were management of pain, monitoring of sleeping pattern, helping in changing position, assistance in range of motion exercise, monitoring of surgical site. There is not significant association between problems and selected demographic profile. Conclusion: The study concluded that patient with lower limb fracture undergone surgery had problem related to pain, immobility, lack of hygiene, sleep disturbance and lack of information which was increased in day 1-2 but reduced as the post operative day increased.

Joint scheduling optimization of a microgrid with integration of renewable energy sources and electric vehicles considering energy and reserve minimization

AbstractTo lower operational costs as well as emissions when wind and solar resources are available in a microgrid (MG), this study discusses the scheduling of electric vehicles (EVs) and responsive demands simultaneously. To mitigate the effects associated with undispatchable energy sources such as wind and solar, the proposed system makes use of EVs for peak shaving and load curve changes, while responsive demands provide the reserves required to do so. In addition, a two‐stage model is provided to evaluate MG's planned running costs (energy and reserve). Costs related to generating and reserving electricity are minimized in Stage 1, while costs related to adjusting unit scheduling to account for fluctuations in wind and photovoltaic output are minimized in Stage 2. Converged barnacles mating optimizer (CBMO) is a highly effective and powerful optimization tool that is used to handle the resultant objective optimization issue. An MG consisting of multiple dispersed generations is used to implement the proposed model. It is worth mentioning that three scenarios have been defined to analyze the impact of joint scheduling of EVs and controllable loads on the MG's day‐ahead operation. The three cost terms, that is, the generation cost, the reserve cost, and the startup cost of units in this scenario, are derived as $745.6913, $10.5278, and $6.35, respectively, remarkably less than the values reported in Scenarios 1 and 2. In Scenario 1, the CBMO algorithm yielded a lower MG operational cost than methods by a margin of 843.2 $/day. Costs per day of operation in Scenario 2 are derived to be $819.3 using the CBMO technique, whereas in Scenario 3, they are determined to be $743.1.

Cross-Border Capacity Planning in Air Traffic Management Under Uncertainty

In European air traffic management (ATM), it is an important decision how much capacity to provide for each airspace, and it has to be made weeks or even months in advance of the day of operation. Given the uncertainty in demand that may materialize until then along with variability in capacity provision (e.g., due to weather), Airspace Users could face high costs of displacements (i.e., delays and reroutings) if capacity is not provided where and when needed. We propose a new capacity sharing scheme in which some proportion of overall capacities can be flexibly deployed in any of the airspaces of the same alliance (at an increased unit cost). This allows us to hedge against the risk of capacity underprovision. Given this scheme, we seek to determine the optimum budget for capacities provided both locally and in cross-border sharing that results in the lowest expected network costs (i.e., capacity and displacement costs). To determine optimum capacity levels, we need to solve a two-stage newsvendor problem: We first decide on capacities to be provided for each airspace, and after uncertain demand and capacity provision disruptions have materialized, we need to decide on the routings of flights (including delays) as well as the sector opening scheme of each airspace to minimize costs. We propose a simulation optimization approach for searching the most cost-efficient capacity levels (in the first stage), and a heuristic to solve the routing and sector opening problem (in the second stage), which is [Formula: see text]-hard. We test our approach in a large-sized simulation study based on real data covering around 3,000 flights across Western European airspace. We find that our stochastic approach significantly reduces network costs against a deterministic benchmark while using less computational resources. Experiments on different setups for capacity sharing show that total variable costs can be reduced by more than 8% if capacity is shared across borders: even though we require that no airspace can operate lower capacities under capacity sharing than without (this is to avoid substitution of expensive air traffic controllers with those in countries with a lower wage level). We also find that the use of different technology providers is a major obstacle to reap the benefits from capacity sharing and that sharing capacities across airspaces of the same country may instead be preferred. History: This paper has been accepted for the Transportation Science Special Issue on Emerging Topics in Transportation Science and Logistics. Funding: This work was supported by the Horizon 2020 Framework Programme [893380]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/trsc.2023.1210 .

To Evaluate the Frequencies of Post- Traumatic Cerebrospinal Fluid Leak in Patients Presenting with Traumatic Brain Injury

Introduction: Traumatic brain injury is the fourth largest cause of fatal trauma worldwide. The social and economic implications of traumatic brain injuries are immense whilst the physical and mental bearing upon the patient is devastating. Objective: Objective of this study is to evaluate the frequencies of post- traumatic cerebrospinal fluid leak in patients presenting with traumatic brain injury. Methodology of the study: This study was conducted at Neuro Surgery Department of Lady Reading Hospital, Peshawar during 20/7/2020 to 20/1/2021.In the current study a total of 303 patients presenting with initial head trauma presenting within 24 hours with Glasgow coma score ≤15, patients in age between 18 to 65 years and both gender (male/female) were included in the study. All the patients were subjected for detailed history, clinical examination and radiological examination i.e. CT and MRI was done for the confirmation of brain injury. All the patients were followed till 7th post operative day for the diagnosis of Cerebrospinal fluid leak. It is clear water cerebrospinal fluid discharge diagnosed on clinical examination till 7th post-trauma day and was determined in terms of rhinorrhea or otorrhea. Results: Our study shows that among 303 patients was analyzed as 215(71%) patients were in age range 18-40 years, 88(29%) patients were in age range 41-65 years. 239(79%) patients were male and 64(21%) patients were female. More over 18(6%) patients had CSF leak while 285(94%) patients didn’t had CSF leak. Practical Implication: This study will be useful for finding the post-traumatic cerebrospinal fluid leak. Conclusion: Our study concludes that the frequencies of post-traumatic cerebrospinal fluid leak was 6% in patients presenting with traumatic brain injury. Keywords: Post-traumatic cerebrospinal fluid leak, traumatic brain injury.

Botulinum Injection and Sphincterotomy for Management of Anal Fissure in Terms of Healing of Anal Fissure: A Randomized Controlled Trial

Aim: To compare the efficacy of botulinum injection with lateral internal sphincterotomydone for management of anal fissure in terms of healing of anal fissure Study design: Randomized controlled trail Setting and duration: Department of General Surgery, K.E. Medical University, Lahore from April, 2019 to Oct, 2019 Methodology: All 350(175 cases in each group) cases meeting inclusion criteria were enrolled through department of Surgery KEMU. Patients were randomly allocated in two groups, group A and B by Lottery method. Patients in group ‘A’ received treatment with 0.5 ml (20 units) Botulinum toxin injection on each side of anal fissure in the internal anal sphincters under direct vision and digital examination at 3 or 9 o’clock position in lithotomy position under strict aseptic measures by single expert surgeon having at least five years’ post fellowship experience. Patients in group ‘B’ underwent lateral internal anal sphincterotomy under general anesthesia by single expert surgeon also having at least five years’ post fellowship experience. Patients were discharged on 1st post operation day on oral antibiotics, analgesics, stool softeners and were advised sitz bath. In both groups, patients were followed up for 2 months. Results: The mean age of all patients was 43.09 ± 10.68 years while the mean age in Group-A was 43.17±10.32 years and in Group-B was 43.02±11.06 years. The efficacy in Group-A was seen in 158(90.3%) while the efficacy was seen in 114(65.1%) of Group-B, the efficacy of treatment was higher in group-A when compared with Group-B, p-value < 0.001. Conclusion: Botulinum toxin injection for the treatment of anal fissure has yielded higher rates of healing than lateral internal sphincterotomy. This suggests that botulinum injection could provide temporary relief from sphincter spasm, allowing for faster fissure healing and improved quality of life, with fewer risks of complications. Keywords: Sphincterotomy, anal fissure, healing of anal fissure, rectal pain, anal pain, anal surgery

Self-Reported Height and Weight for BMI Calculation Compared With Measured Height, Weight, and BMI in Patients Undergoing Liposuction of the Upper and Lower Abdomen: A Single-Center Retrospective Review

Self-reported height and weight is commonly used in medical practice for the determination of body mass index (BMI). Self-reported height and weight can be underestimated or overestimated resulting in inaccurate BMI calculations. In our practice the self-reported height and weight are obtained at the time of cosmetic surgery consultation. The purpose of this study is to determine the accuracy of preoperative height, weight, and BMI calculations in patients undergoing liposuction of the abdomen in comparison to measurements obtained by nursing staff the day of surgery. Clinically, these data may affect perioperative risk stratification and preoperative planning with respect to deep venous thrombosis prophylaxis. Using Nextech electronic medical records (EMR) system, charts were reviewed from July 2019 to July 2022. Patients identified as having underwent liposuction of the upper and lower abdomen were reviewed. All patients had been consented for the prescribed procedure. Data extracted included the self-reported height/weight and calculated BMIs obtained at the time of consultation as well as measured height/weight and BMIs from the day of surgery. The study sample included 50 patients (31 women and 19 men), with an average age of 44 ± 11 years (range, 20-71 years). Time from consult to surgery ranged from 2 to 270 days with an average of 58 days. Time of consult (TOC) height average was 169.1 cm (range, 152.4-190.5 cm) versus day of surgery (DOS) height average of 169.5 cm (range, 149-190 cm). Time of consult weight average was 82.4 kg/181.66 lbs (range, 54.5-115.9 kg/120.15-264.89 lbs) versus DOS average of 84 kg/185.19 lbs (range, 53.8-116 kg/118.61-255.74 lbs). Time of consult BMI average was 28.5 kg/m2 (range, 21.1-43.9 kg/m2) with a DOS average of 29 kg/m2 (range, 20.9-47 kg/m2). Height was on average underestimated by 0.03 cm. Weight was on average underestimated by 1.6 kg at the TOC compared with DOS. BMI difference between TOC and DOS had an average underestimate of 0.5 kg/m2. A total of 8 patients upstaged to a higher obesity classification based on DOS BMI calculation. Subgroup analysis of male and female height and weight estimations versus measured data are also reviewed. When averaged the time of consultation height, weight, and BMI correlated with height, weight, and BMIs measured and calculated the day of surgery in patients undergoing liposuction of the abdomen. Sixteen percent of our study population were reclassified to a higher obesity class based on DOS height and weight. For the purposes of accurate perioperative risk management and deep venous thrombosis prophylaxis planning, height and weight should be obtained accurately at the time of consultation or at a preoperative visit within 1 month of surgery.

(035) Risk of Post-Operative Venous Thromboembolism in Patients Undergoing Gender Affirming Surgery: An Assessment of 1,731 Patients

Abstract Introduction Venous thromboembolism (VTE) is a source of significant morbidity and mortality in the post-operative setting. However, poor follow up and the ability for patients to present to other hospital systems for post-operative care, have made assessment of the incidence of post-operative VTE difficult. As a result, previous attempts to assess VTE risk following gender affirming surgery have been limited to small volume, single institution studies. It has been hypothesized that patients undergoing gender affirming surgery may be at increased risk of post-operative VTE given the concomitant use of hormone therapy. Objective To assess the risk of venous thromboembolism and associated risk factors following feminizing and masculinizing gender affirming surgery. Methods Using IBM MarketScan, a commercial claims database, patients undergoing feminizing and masculinizing surgery were identified using Current Procedural Terminology (CPT), ICD-9, and ICD-10 procedure codes between 2011 and 2020. ICD-9 and ICD-10 codes were used to identify healthcare visits associated with lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90-days of surgery. Covariates including diabetes, peripheral vascular disease, cardiovascular disease, hypertension, varicose veins, hypercoagulable state, smoking history, and prior VTE were assessed. Given the small cohort size of men undergoing masculinizing surgery, descriptive statistics, including the 90-day incidence, were performed. In patients undergoing feminizing surgery, descriptive and univariate statistics were performed including Kruskal-Wallis tests (continuous variables) or Chi-squared/Fischer’s exact tests (categorical variables). Results 1,731 patients underwent feminizing surgery (1,588) or masculinizing (143) surgery between 2011 and 2020 with a median age (interquartile range) of 34 years (22, 53) and 35 years (26, 46), respectively. A history of DVT or PE events prior to gender affirming surgery was identified in 1.07% (feminizing) and 0.7% (masculinizing). DVT or PE events within 90-days following feminizing surgery and masculinizing surgery occurred in 1.07% and 0.7%, respectively. On univariable analysis, increasing age (p<0.001), bladder cancer (p<0.001), prior cystoprostatectomy (p=0.001), diabetes (p=0.007), cardiovascular disease (p<0.001), hypertension (p=0.04), prior DVT (p<0.001), and prior PE (p<0.001) were associated with increased likelihood of post-operative VTE in patients undergoing feminizing gender affirming surgery. Conclusions In a cohort of patients undergoing gender affirming surgery, the risk of post-operative VTE was low with 1.07% (feminizing) and 0.7% (masculinizing) of patients developing a VTE event within 90 days of surgery. In patients undergoing feminizing gender affirming surgery, increasing age, bladder cancer, cystoprostatectomy, diabetes, cardiovascular disease, hypertension, prior DVT, and prior PE were associated with an increased likelihood of developing a postoperative DVT or PE. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Cooper Medical, Boston Scientific, Acerus, Coloplast, Turtle Health, Maximus, FirmTech, StreamDx, Inherent Bioscience.

Total Joint Arthroplasty Time-of-Day Start Time Has Minimal Effect on Intraoperative Efficiency

Introduction Total hip (THA) and knee arthroplasties (TKA) are common elective procedures, and dedicated arthroplasty teams perform multiple procedures per day. Little is documented about how time-of-day scheduling affects the intraoperative efficiency of total joint arthroplasties (TJA). In this study, we analyzed the effects of surgical start time on TJA operative lengths. Methods A retrospective study was performed for primary TJA patients done within a four-year period at a single academic medical center. Surgical start time, operative duration, and patient demographics were collected. Based on a 12-hour operative day, surgical start times were categorized as early (7AM to 11AM), mid-day (11AM to 3PM), or late (after 3PM). A chi-squared test was performed to examine for associations between patient demographics and surgical start time. A multivariate linear regression (MLR) was performed to determine the effect of surgical start time on operative duration. P-values less than 0.05 were considered significant. Results This study identified 1663 TJAs – 869 total knee (TKA) and 791 total hip arthroplasties (THA) who met inclusion criteria. Among TKAs, we identified 319 (36.7%) early, 437 (50.3%) mid-day, and 113 (13.0%) late operations. Among THAs, we identified 407 (51.4%) early, 297 (37.5%) mid-day, and 87 (11.0%) late operations. MLR demonstrated that for TKA there was a 4.9 (p =0.018) and 7.3 (p=0.013) minute increase for mid-day and late cases, respectively. For THAs, a non-early start time was associated with an increased operative duration of 9.1 to 12 minutes (p<0.001). Discussion Surgical start time has a statistically significant, but minimal, effect on operative length for TJAs, with later cases being slightly longer than first-start cases.

Optimal resource rescheduling in classification yards considering flexible skill patterns

Classification yards represent network nodes in the single-wagonload transport system. The processes are complex due to a high number of involved resources and restrictive dependencies. Decisions on job sequencing and resource allocation have a major impact on outbound delays and thus on the quality of service in the network. Due to permanent updates of arrival times and resource availabilities, a constant revision of decisions is necessary. In many cases, considering multiple qualifications of the personnel is crucial for efficient operations. This paper presents an approach for the rescheduling of processes and the assignment of resources in classification yards, which allows to determine best working schedules based on current data such that the cumulative outbound delay of all trains is minimized. Therefore, the paper presents a mixed integer program that includes all essential components (tracks, locomotives and personnel with individual skill patterns). For the real-time capable solution of the optimization problem, four different heuristic approaches based on priority rules are presented. The performance of these approaches is evaluated by a gap analysis with respect to the solutions found by CPLEX. For this purpose, real example data of an operation day of a large classification yard in Germany are used.

54 Prophylactic Antibiotics are Unnecessary for Routine CO2 Laser Burn Scar Treatment

Abstract Introduction Many providers utilize prophylactic cephalexin prior to Co2 ablation laser for hypertrophic scarring. Many providers use this as standard of treatment despite a paucity of high-quality literature supporting the practice. The purpose of this study is to report a single-center experience in performing laser-assisted delivery of triamcinolone and destruction of burn scars without the use of antibiotics. Methods This was a retrospective descriptive study from a single center with a new laser scar program. The first 14 patients received cephalexin 500mg by mouth every 6 hours starting the day of the procedure for 5 days and valaciclovir 1000mg by mouth daily for 5 days for their first two procedures- as per manufacturer recommendations. After that, cephalexin was no longer utilized nor were any antibiotics given at the start time of procedure. Valacyclovir is given on a case-by-case basis for patients with a history of cold sores, known herpes simplex, or extensive facial procedures. Burn team staff members followed up with the patients within 48 -72 hours by phone call. Burn staff called patients after each laser treatment to assess for any adverse reactions. Adverse reactions include open areas, rashes, or blisters to laser site. The two groups were compared with a Fisher’s exact test for number of infections. Results Patients who received cephalexin accounted for the first 28 cases and none developed an infection. In 201 cases without antibiotics, only one patient developed cellulitis (0.5%), p=1. This patient was noncompliant with restrictions on hand hygiene and used a cheap lotion with parabens, dyes, and perfumes on post operative day 2. Another patient experienced a self-limiting dermatitis on their back of uncertain etiology. In 36 cases, valacyclovir was given. None of the patients in either group developed vesicular lesions consistent with HSV. Conclusions There were no significant differences in number of infections whether patients treated with or without prophylactic antibiotics before laser treatment of hypertrophic burn scars. The authors continue to treat patients without administering prophylactic antibiotics. Applicability of Research to Practice laser programs are common in burn centers

Efficient Aircraft Arrival Sequencing Given Airport Gate Assignment

The aircraft sequencing problem has been well discussed in many variants over the years; and during this time, the problem has changed from a standalone optimization problem to an embedded problem. At hub airports, aircraft sequencing influences passengers’ available connecting times. Short connections could benefit from a modification of the arrival or departure sequence. In our work, we have developed a bilevel optimization problem that combines the aircraft sequencing problem and the airport gate assignment problem at hub airports to make connections more efficient. The decision on the gate assignments is made at the upper level, whereas the efficient aircraft arrival sequencing is addressed at the lower level. Methods for solving this kind of large-scale bilevel optimization problem by considering a full day of operation and dynamically changing traffic situations have yet to be researched. In this paper, we focus on efficient aircraft sequencing by taking into consideration gate assignments, and we propose a multiobjective mixed integer linear program that is solved by an interactive method and considers the (contradicting) objectives of competing airlines and the air traffic control. The capabilities of our approach are demonstrated by modeling and solving a real-case scenario for Munich Airport.

The Role of Liposomal Bupivacaine in Multimodal Pain Management following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Faster and Farther with Less Opioids.

Retrospective controlled cohort. To evaluate the effect of intraoperative liposomal bupivacaine (LB) infiltration on post-surgical pain management in adolescent idiopathic scoliosis (AIS) patients by analyzing postoperative opioid consumption, ambulation, and length of stay (LOS). Optimal postoperative pain control for AIS patients undergoing posterior spinal fusion (PSF) is challenging. Multimodal pain management protocols provide adequate analgesia while decreasing opioid consumption. LB was recently approved for pediatric patients; however, use in AIS patients is understudied. 119 consecutive patients with AIS who underwent PSF were included. Patients were divided into 2 groups: patients who received LB as erector spinae block in addition to the standard postoperative pain management protocol (Group A), and patients who received only the standard postoperative pain protocol (Group B). Oral morphine equivalents, intravenous opioid and valium consumption, pain scores (VAS), nausea/vomiting, ambulation distance and LOS were assessed. Group A experienced significantly lower total opioid consumption compared to Group B (44.5mg vs. 70.2mg). Morphine use was lower in Group A on post operative day (POD) 0, and oxycodone use was lower in Group A on PODs 1 and 2. There was a higher proportion of patients who used only oral opioids in Group A (81% vs. 41%). Of patients requiring any intravenous opioids, 79% did not receive LB. A significantly higher proportion of LB patients were discharged on POD 2 (55% vs. 27%); therefore, LOS was shorter for Group A. Group A ambulated further postoperatively. There were no differences in pain scores, valium requirements or nausea/vomiting. LB was associated with decreased total opioid use, shorter LOS, and improved ambulation in AIS patients undergoing PSF. Including LB in multimodal pain management protocols proved effective in reducing opioid use while increasing mobilization in the immediate postoperative period. III Retrospective controlled cohort.

PO-02-056 REAL-TIME VIDEO ASSISTED THORACOSCOPIC SURGERY IN HIGH-RISK TRANSVENOUS LEAD EXTRACTION

Laceration injury to the superior vena cava (SVC) remains the most feared complication of transvenous lead extraction (TLE). Early recognition is crucial to prevent catastrophic complications. Use of real time video assisted thoracoscopic surgery (VATS) during high risk TLE can potentially be useful for prompt recognition of SVC injury. We describe the use of video assisted thorascopic surgery (VATS) guidance for complex transvenous lead extractions (TLE). We conducted a retrospective analysis of all patients that underwent TLE at our institution from September 2018 to November 2022. Our TLE protocol uses a risk stratification scheme of level 1, 2 and 3 based on perceived risk. Defibrillation leads with a dwell time of >10 years or presence of 3 leads with oldest lead >10 years qualify as level 3 TLE cases. All procedures are performed with surgical back up with the use of VAT via a right thoracoscopic approach in level 3 cases. During single lung ventilation, the surgeon places a camera port to provide visualization of the SVC and right atrium for direct visualization during the laser/mechanical sheath manipulation in the great vessels. Out of 41 patients that underwent TLE during the study period, 10 patients underwent concomitant right VATS. Mean age of cohort was 61.5 + 15.2 years and 70% were males. Mean BMI and LVEF was 28.8 + 7.9 & 28.5 + 5.9 % respectively. Indications for TLE included lead malfunction (50%), infection (40%) and removal of abandoned leads in 1 patient. Mean lead dwell time was 10.4 + 5.6 years. Laser sheath was used in all cases with 2 patients requiring use of additional mechanical sheaths. One case demonstrated externalized ICD coil and extraction was abandoned. A femoral approach with snaring was done in 1 patient. All patients had adequate visualization of the SVC via VATS during TLE. Average procedure duration was 134 + 79.1 minutes. There were no immediate procedural complications. VATS port was removed and a chest drain was placed which was removed on post operative day 1 in all patients. VATS allows for direct visualization of the venous structures, provides real time information regarding impending venous injury, and is feasible with minimal impact on procedural risk and length of stay.

PROSPECTIVE OBSERVATIONAL STUDY COMPARING OUTCOMES AND COMPLICATIONS OF OPEN VS LAPAROSCOPIC NEPHRECTOMY

Introduction: Nephrectomy refers to surgical removal of the kidney and is further divided into simple, radical, partial and donor nephrectomy. Simple nephrectomy is conducted in irreversible kidney damage; radical nephrectomy in malignant or benign renal tumours while partial nephrectomy involves removal of part of kidney. Nephrectomy may be performed via open or laparoscopic approaches; although there is evidence favouring laparoscopy, supplementary evidence is necessary to establish it.2 This study aims to compare outcomes, complications and other parameters for laparoscopic and open surgical nephrectomy at a tertiary care centre in western India. To compare outcomes and Aim: complications for laparoscopic and open nephrectomy. Objectives: To compare: 1. Immediate and late complications. 2. A] Requirement of analgesia. B] Return of bowel functions. 3. Mean length of hospitalization and return to regular normal activity. Materials And Methods: A prospective observational single centre study was conducted at a tertiary care centre in western India. Total sample size was 49 of which 25 patients underwent laparoscopic nephrectomy while 24 patients underwent open nephrectomy. Intraoperative anaesthesia, trocar access, duration of surgery, blood loss, repeat haemoglobin and haematocrit value at post operative day 1, requirement of blood transfusion, duration of analgesics requirement, post-operative stay; histopathology report and time to resume normal activity at immediate follow up, follow up at 3 months and further follow up after surgery were noted down. Current study found statist Results: ically signicant relationship of higher intra-operative blood transfusion requirement and higher post-op requirement of Analgesia in case of open surgery. Moreover, among laparoscopy group there was signicantly lower blood loss during surgery, early time to oral diet, low pain VAS score, lower doses of Tramadol and early return to normal activity was found as compared to Open surgery group (p<0.05). Laparoscopic nephrectom Conclusion: y results in less blood loss, less requirement of post operative analgesia and more rapid post operative recovery in comparison to open surgery

COMPARATIVE STUDY BETWEEN OPEN AND LAPAROSCOPIC VENTRAL HERNIA REPAIR

Introduction: In today's era laparoscopy has gained quite popularity still there is debate on its use for ventral hernia. The main challenges in hernia management lie in deciding the surgical approach and type of repair procedure to perform, that is, laparoscopic or open surgery. A prospective observational comparative study was Material and methods: carried which included 90 patients out of which 45 patients underwent open mesh repair for ventral hernia and 45 patients underwent Laparoscopic mesh repair for ventral hernia were included in the study. Patients were follow up on post operative day 1, day 2, day 10, day 30 and day 60. The average duration of Results: surgery was slightly higher for the patients who underwent laparoscopic repair (95.11 vs 78.26 mins) with a P value of <0.0001 suggestive of statistically signicant difference. The intraoperative blood loss was slightly lower lap repair group but the difference was not signicant statistically (P=0.1347). The mean VAS post operative pain scores were higher for the patients who underwent open hernia repair. Conclusion: The study concluded that laparoscopic repair took more time than compared to the open group of patients. However, the laparoscopic group of patients had a much better post operative outcome in terms of reduced intra operative blood loss and post operative pain

Abstract 648: Divergent Roles For Endothelial Cell Marcks In Endothelial Cell Regeneration And Signaling After Arterial Injury And Ischemia

Cardiovascular interventions cause endothelial injury and trigger re-establishment of intact endothelium. After ischemia, endothelial signaling is essential for capillary angiogenesis as well as flow-mediated collateral artery enlargement to restore perfusion. We studied the role of the signaling protein MARCKS (myristoylated alanine-rich C kinase substrate) in the endothelial response to injury and ischemia-induced angiogenesis. Methods: Targeted deletion of MARCKS in endothelial cells was done with Cadherin 5-driven Cre/Lox recombination and confirmed with immunohistochemistry. All controls were Cre(-) littermates. Re-endothelialization after femoral artery wire injury was measured by arterial area quantitation after Evan’s Blue exclusion. After femoral artery ligation, limb blood flow was determined by serial laser Doppler scanning, and angiogenesis by counting CD31-positive cells in the gastrocnemius muscle on day 28. Results: Endothelial cell-specific deletion of MARCKS was confirmed in Cre (+) animals. Deletion of MARCKS did not affect endothelial regeneration on post operative day 6 after denuding femoral wire injury (68.2% versus 68.7% recovery, n=5-6, p>.05). Ischemia-induced capillary angiogenesis was not affected by deletion of MARCKS (Capillary Count, Cre(+): 602 versus Cre(-): 511, n=6, p>.05), however animals lacking endothelial MARCKS had worsened limb perfusion on days 1, 3, 7 and 21 after ischemia (ABI Range Cre(+) versus Cre(-): 0.04-0.22 versus 0.07-0.41, respectively, n=6-9, p<.05). Conclusions: These studies demonstrate distinct and divergent roles for MARCKS in the endothelial cell response to injury and ischemia. MARCKS is not essential for endothelial regeneration after denuding large vessel injury, or for capillary angiogenesis induced by ischemia. Surprisingly, endothelial MARCKS appears to be a novel endogenous promotor of ischemia-induced limb revascularization. This suggests that endothelial cell MARCKS promotes flow-mediated endothelial cell signaling essential for ischemia-induced arterial enlargement. MARCKS activity could be a possible therapeutic target to enhance collateral artery formation in limb ischemia.

B-61 | Incidence of Patient Prosthesis Mismatch (PPM) After ViV-TAVI and ViV-TAVI With Bioprosthetic Valve Fracture (BVF)

Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an effective treatment for degenerated bioprosthetic valves in high-risk patients. Unfortunately, patient prosthesis mismatch (PPM) remains an issue. PPM is known to impact functional status, valve longevity, morbidity and mortality. Bioprosthetic valve fracturing (BVF) is a method by which operators fracture the bioprosthetic valve allowing for greater expansion of the new valve or implantation of a larger valve. We sought to determine the incidence of PPM in patients undergoing ViV-TAVI and the safety of BVF. Patients who underwent ViV-TAVI at our institution from 2015-2022 were selected and divided into two groups (with BVF and without BVF). BVF was performed at the discretion of the operator. PPM severity was assessed as insignificant, moderate or severe. Moderate PPM was defined as an indexed effective orifice area (iEOA) <0.85 cm2/m2 (if BMI<30 kg/m2) or <0.70 cm2/m2 (if BMI>30 kg/m2). Severe PPM was defined as an iEOA <0.65 cm2/m2 (if BMI<30 kg/m2) or <0.55 cm2/m2 (if BMI>30 kg/m2). Measurements were taken by TTE on post operative day 1. All-cause mortality was assessed at 30-days and at 1-year. A total of 78 patients underwent ViV-TAVI, of which 25 patients had suboptimal gradients and were successfully treated with BVF. The mean age was 76.71 years old. The overall mean iEOA post ViV-TAVI was 0.69 ± 0.20 cm2/m2. Severe PPM was present in 43.4% that underwent ViV-TAVI, while only in 16% of patients that underwent ViV-TAVI with BVF. 1 patient required a permanent pacemaker in the BVF group. Amongst patients who underwent ViV-TAVI, 96.2% of patients were living at 30-days and 90.6% of patients were living at 1-year. Amongst patients who underwent ViV-TAVI with BVF, 100% of patients were living at 30-days and 96% of patients were living at 1-year. PPM was present more often in ViV-TAVI patients compared to ViV-TAVI with BVF. Short term mortality appears to be similar between groups and complications rates are low.

Modular Multiport Electric-Vehicle DC Fast-Charge Station Assisted by a Dynamically Reconfigurable Stationary Battery

Multi-port Battery-Assisted dc Fast Charger (BA-DCFC) stations enable high charge rates of Electric Vehicles (EVs) at sites that have insufficient grid capacity. However, BA-DCFCs are expensive and inefficient due to the Battery Energy Storage System (BESS) and high-power isolated dc-dc converters that interface the BESS and EV charging ports. This paper presents a modular multi-port dc Linear Fast Charger (LFC) for EVs, which uses a stationary, reconfigurable Battery Energy Storage System (rBESS), a current-mode, digitally controlled bi-directional Linear Regulator (LR), and a contactor matrix. The LFC LR increases the overall station efficiency and eliminates the volume and cooling complexity associated with the high-power magnetics, high-voltage capacitors and high-frequency switches of state-of-the-art (SotA) isolated dc-dc converters. Compared to a SotA isolated dc-dc converter, the LR experiences 83.6% less loss for the same rated EV charge power. Over a day of typical operation, a three-port LFC station is shown to have 28% less loss than a state-of-the-art BA-DCFC, with an average efficiency of 93.4%. The LFC achieves redundancy at the station, BESS and LR levels while also integrating active balancing of state-of-charge/health without auxiliary switched-mode converters. The proposed system is verified using full-scale transient simulations and experimental results from a scaled, hardware-in-loop implementation with a custom LR and series-connected battery modules.

Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity Score-Matched Analysis.

Free tissue transfer (FTT) provides a versatile method to achieve successful lower limb salvage. Thrombocytosis in patients undergoing lower extremity (LE) FTT is associated with increased risk of complications. The aims of this study were to assess the feasibility of performing LE FTT in patients with preoperative thrombocytosis, and whether antiplatelet (AP) therapy on the day of surgery (DOS) affects outcomes. A retrospective review of thrombocytotic patients who underwent LE FTT between 2011 and 2022 was performed. Patients were stratified into groups based on the receipt of AP therapy on the DOS. Patients were propensity score matched for comorbidity burden and postoperative risk stratification. Outcomes of interest included perioperative transfusion requirements, postoperative flap-related complications, rates of flap success, limb salvage, and ambulatory status. Of the 279 patients who underwent LE FTT, 65 (23.3%) were found to have preoperative thrombocytosis. Fifty-three patients remained following propensity score matching; of which, 32 (60.4%) received AP therapy on the DOS and 21 (39.6%) did not. Overall flap success rate was 96.2% (n = 51). The likelihoods of thrombosis and hematoma development were similar between cohorts (p = 0.949 and 0.574, respectively). Receipt of DOS AP therapy was associated an additional 2.77 units and 990.10 mL of transfused blood (p = 0.020 and 0.018, respectively). At a mean follow-up of 20.7 months, overall limb salvage and ambulatory rates were 81.1% (n = 43) and 79.2% (n = 42), respectively, with no differences between cohorts. Preoperative thrombocytosis is not an absolute contraindication to LE FTT. DOS AP therapy may be protective in comorbid patients with elevated platelet counts but must be weighed against possible short-term bleeding as suggested by significant increases in postoperative transfusion requirements.

D39. Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Anti-platelet Therapy: A Retrospective Review

PURPOSE: In patients undergoing lower extremity (LE) free tissue transfer (FTT), preoperative thrombocytosis (PT) is associated with an increased risk of complications in select patient populations. We sought to assess the feasibility of performing LE FTT in atraumatic patients with PT, and whether antiplatelet (AP) therapy on the day of surgery (DOS) affects outcomes. METHODS: A retrospective review of patients with PT who underwent LE FTT between 2011-2022 was performed. Patients were categorized based on AP therapy on the DOS. Outcomes included transfusion requirements, postoperative flap-related complications (thrombosis, hematoma, return to the operating room), rates of flap success, limb salvage and ambulatory status. RESULTS: Of the 279 patients who underwent LE FTT, 65 (23.3%) had PT; of which, 32 (49.2%) received DOS AP therapy (“AP group”). Patients in the AP group were older (58.9 vs. 51.6 years, p=0.014), and had a greater representation of diabetes mellitus (87.5% vs. 57.6%, p=0.007) and calcified vessels (62.5% vs. 12.1%, p&lt0.0001). Average intraoperative and postoperative transfusion volumes were significantly higher in the AP group (p&lt0.05). Flap success rate was 96.9% (n=63). Rates of postoperative thrombosis were similar (9.4% vs. 6.1%, p=0.672), as was hematoma incidence (9.4% vs. 3.0%, p=0.287). At mean follow-up of 21.6 + 21.5 months, limb salvage and ambulatory rates were 75.4% (n=49) and 78.5% (n=51), respectively, and mortality rate was 7.7% (n=5). CONCLUSION: PT is not an absolute contraindication to LE FTT. DOS AP therapy may be protective in comorbid patients, but must be weighed against possible short-term bleeding, suggested by increased transfusion requirements.