Early Complications Research Articles

Intra- and early postoperative complications of laparoscopic and robot-assisted radical prostatectomy

Radical prostatectomy is the gold standard for the treatment of localized prostate cancer. In the last decade, new surgical technologies have been actively implemented that certainly increases the efficiency of oncourological treatment. The rate of intra- and postoperative complications of radical prostatectomy yet remains quite high. In this regard, crucial tasks of modern urology are minimizing of their number and effective treatment. In the review article, intra- and early postoperative complications of laparoscopic and robot-assisted radical prostatectomy have been considered.

Surgical treatment of locally advanced kidney cancer in the T3a–с stage

BACKGROUND: Kidney cancer is a common pathologic condition, which ranks the 3rd place among urologic cancers. In 4–10% of patients, while growing it metastasizes upward the venous vessels up to the thoracic vena cava and right atrium. Selection of the optimal tactics for surgical treatment of such patients still remains a complex and unsolved task. AIM: To assess the surgical treatment findings for the patients suffered from kidney cancer with tumor invasion in the renal and inferior vena cava. MATERIALS AND METHODS: 115 patients with renal cell carcinoma complicated by tumor invasion into renal and inferior vena cava have been operated in North-Western State Medical University named after I.I. Mechnikov from 2003 to 2023. They were 76 (66.1%) men and 39 (33.9%) women, their mean age was 67.0 ± 4.1. Stage T3a covered 53 (46.1%), T3b — 33 (28.7%) and T3c 29 (25.2%) patients. Metastatic lesion of one lymph node was observed in 21 (18.3%) and of multiple nodes in 6 (5.2%) patients. Distant metastases were found in 26 (22.6%) patients: in the lungs in 9.6% and in the adrenal glands in 5.2%. All patients were treated with radical nephrectomy, removing blood trombi from the inferior vena cava system. Eight (7.0%) of them, received the treatment by the method developed in the clinic, which consists in preliminary endovascular extraction of the cranial trombus part. Another 3 (2.6%) patients were treated using cardiopulmonary bypass machine. RESULTS: Early postoperative complications developed in 36 (31.4%) patients. The most common and severe of them were pulmonary embolism (4.4%) and acute cardiovascular insufficiency (10.4%). These complications appeared the causes of death of 4 patients. The mortality rate was 3.5%. The three year survival rate in the T3a group was 70.6%, T3b group — 66.0% and T3c group — 50.6% (p 0.05). CONCLUSIONS: Nephrectomy with vena cava thrombectomy is a radical surgical treatment. Its complexity increases as the tumor thrombus spreads further through the venous system and in some cases requires an interdisciplinary approach.

Analysis of early results of edoxaban and warfarin in the treatment of deep vein thrombosis

Aim: Deep Vein Thrombosis (DVT) is an acute onset disease. Warfarin and new oral anticoagulants (NOAC) can be used for treatment. Edoxaban is one of the NOACs that acts directly as a ‘Factor Xa inhibitor’. The aim of our study was to investigate early treatment complications and efficacy in patients treated with warfarin and edoxaban. Material and Methods: The results of a total of 100 patients who started drug treatment for DVT between September 2018 and March 2020 were retrospectively analysed. The patients included in the study were divided into two groups according to the type of anticoagulant used [Warfarin (n=50), Edoxaban (n=50)]. Patients' routine examinations and colour Doppler ultrasound (CDUSG) results at baseline and 1-month follow-up were compared with their bleeding status. Results: Clinical status and CDUSG revealed acute DVT in 57 patients, subacute DVT in 32 patients, and chronic DVT in 11 patients. The recanalisation rate at 1 month was higher with edoxaban (80%) and lower with warfarin (62%) and this difference was statistically significant (p=0.008). The most common complication during follow-up was minor bleeding, which occurred in 24% and 18% of patients using Warfarin and Edoxaban, respectively. There was no mortality due to minor, major or cerebrovascular events in any of the patients. Conclusion: In our study, we evaluated the early results of anticoagulant therapy in patients with DVT and found faster recanalization and fewer complications in the NOAC group in agreement with the literature. Further randomised, advanced and large-scale studies are needed to evaluate the efficacy of the drugs.

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

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

OGC SO26 - Double tract reconstruction post total gastrectomy enables duodenal surveillance in familial polyposis: Case report

Abstract Background Familial polyposis syndromes such as Juvenille polyposis syndrome (JPS) and Familial adenomatous polyposis (FAP) are associated with ∼21% and ∼11% lifetime risk of foregut carcinoma respectively. In patients effected, routine oesophago-gastro-duodenoscopy (OGD) is recommended every 1-3 years, in JPS from 15 years old and in FAP from 25 years old. In patients with malignant transformation traditional resection with Roux-en-Y reconstruction inhibits future duodenoscopy. Method Between April and July 2024 two patients presented requiring total gastrostomy with familial polyposis syndromes. In both cases laparoscopic total gastrectomy with double tract reconstruction was decided upon to enable future duodenal surveillance. Results Case 1: 45 year old female with JPS (germline SMAD 4 mutation). Surveillance detected a massive circumferential proximal gastric polyp comprising ∼30% of total gastric mucosa, too large for endoscopic therapy. Biopsies showed JPS polyps. Patient had no early complications following laparoscopic total gastrectomy and a post operative barium swallow showed clear passage of contrast down the double tract. Case 2: 61 year old male with FAP (germline APC mutation). Surveillance detected innumerable fundic gland polyps with histology demonstrating multifocal high grade dysplasia. Previous subtotal colectomy Planned for laparoscopic total gastrectomy with double tract reconstruction in July 2024 Conclusion Roux-en-Y reconstruction is the most common reconstruction following total gastrectomy. However, in patients with familial polyposis syndromes ongoing lifelong duodenal surveillance is critical. In such patients double-tract reconstruction instead of Roux-en-Y may be preferable allowing future duodenoscopy and acceptable remnant foregut function.

Changes in Physical Function After Long Corrective Fusion to the Ilium for Adult Spinal Deformity

Study Design. Prospective cohort study. Objective. To investigate longitudinal changes in physical functional status after long corrective fusion in patients with adult spinal deformity (ASD) during 2 years of follow-up. Summary of Background Data. In ASD surgery, reports assessing physical functional status in long-term observations for more than a year are lacking. Assessing whether patients maintain significant improvements in their physical status with a longer follow-up duration is crucial. Methods. A total of 70 female patients with ASD who underwent long corrective fusion of ≥ 7 segments between June 2016 and June 2022 were included in this study. Preoperative and postoperative assessments (at 6 months, 1 year, and 2 years) included radiographic spinopelvic parameters, health-related quality of life (HRQOL) using the Scoliosis Research Society Outcome Instrument-22 (SRS-22) questionnaire, and physical function tests conducted by a physical therapist. Results. All domains of the SRS-22 improved the most in the first 6 months after surgery (P &lt;0.0001); however, the Pain and Function domains continued to improve gradually until 2 years postoperatively. Regarding trunk dynamic balance, the timed up-and-go test score improved gradually until 2 years postoperatively (P &lt;0.0001). Regarding gait performance, gait speed and the 6-minute walking test improved the most in the first 6 months after surgery (P &lt;0.01) and almost reached a plateau 1 year postoperatively. Conclusions. Long corrective fusion for ASD significantly enhanced physical function and HRQOL within 2 years, with the greatest improvement in the first 6 months after surgery. These findings underscore the importance of increasing activities of daily living through early exercise instruction, as well as preventive measures to avoid early surgery-related complications. Level of Evidence. 3

A Retrospective Study of Cricotracheostomy: Indications, Techniques, and Clinical Outcomes.

Cricotracheostomy (CT) is a surgical procedure for airway access that can be performed using 2 techniques: excising the cricoid cartilage (CTrach), or by creating an inverted U-shaped flap from the first tracheal ring (CTrachT). The aims of this study are to clinically evaluate factors such as patient background, complications, and stoma closure status in patients who underwent CT, and to compare the clinical outcomes between CTrach and CTrachT. Retrospective, cross-sectional study. Single-institution academic center. Records of patients who underwent CT at the University of Tokyo Hospital between 2014 and March 2024 were reviewed, detailing their demographics and clinical characteristics. We investigated differences in clinical backgrounds, complication risks for each surgical procedure, and factors contributing to stoma closure and complications after CT. The median age for patients undergoing CT was 70 years, predominantly male (76%), and most were malnourished. Common indications included low-lying larynx and obesity. Stoma closure was achieved in 16% of patients. Early complications were surgical site infection (9%) and subcutaneous emphysema (2%), with granuloma formation in 20%. The CTrach group had a significantly higher median age (P = .03), but other factors showed no significant differences. CTrachT was more often performed by board-certified specialists (P = .04). Stoma closure rates and complications were not significantly influenced by any single factor. CT presents a viable option with minimal postoperative complications for patients wherein conventional tracheotomy may be more challenging, such as in low-lying larynx, obesity, advanced age, and poor nutritional status.

Comparative analysis of 333 proGAV® and proGAV 2.0® adjustable valves in pediatric hydrocephalus treatment: survival and complication rate assessment

ObjectiveProGAV and ProGAV2.0 adjustable valves are extensively used for treating hydrocephalus in pediatric patients. This study aims to conduct a comprehensive comparison between these two valves concerning their survival and complication rates.MethodsThis retrospective study included all pediatric patients who underwent ProGAV or ProGAV2.0 valve implantation at our neurosurgical clinic from August 2008 to August 2020. A comparative analysis was performed considering age, gender, follow-up duration, complication and survival rates, adjustments, spontaneous adjustments, and adjustment difficulty rates. All valves were followed up for a maximum of 3 years.ResultsInclusion involved 333 cases (mean age of 5.4 ± 5.1 years; 54.1% males), comprising 173 cases (52.0%) with ProGAV valve implantation and 160 cases (48.0%) with ProGAV 2.0. Early complications within the first month post-implantation were observed in 51 cases (15.3%). No significant differences were noted in valve implantation indications, age distribution, or survival duration (27.1 vs. 27.8 months, p = 0.629) between the two groups. Predominant indications for implantation were post-hemorrhagic hydrocephalus and aqueduct stenosis for both valve types. Notably, both valves showed non-significantly different explantation rates during the first three years after implantation (34.7% vs. 29.7%, p < 0.289). However, there was a significantly higher early post-implantation complication rate (22% vs. 9.4%, p = 0.002), and a significantly increased association with difficulties in valve adjustments and spontaneous adjustments (p = 0.041 and 0.011, respectively). ProGAV2.0 cases displayed notably enhanced clinical and radiological improvement within the initial 6 months after implantation (p = 0.001 and p = 0.038). Younger children (< 2 years of age) also experienced significantly more valve adjustment difficulties (p = 0.049) and had higher rates of valve explantation (p < 0.001).ConclusionThe findings of this study highlight the superior performance of the ProGAV2.0 valve in terms of complication rate and maladjustment rate when employed in the treatment of pediatric hydrocephalus. Both valves demonstrated an acceptable survival rate with 65.3% for ProGAV and 71.3% for ProGAV2.0 within three years of implantation.

Exploring Early Complications in Paraumbilical Hernia Mesh Repair: A Rigorous Six-Month Prospective Study and In-Depth Analysis

Exploring Early Complications in Paraumbilical Hernia Mesh Repair: A Rigorous Six-Month Prospective Study and In-Depth Analysis

Clinical Outcomes and Early Postoperative Complications in Boston Type I Keratoprosthesis Implantation: A Retrospective Study

Background/Objectives: The purpose of this study is to evaluate clinical outcomes and early postoperative complications in patients undergoing Boston type I keratoprosthesis (BKPro) implantation, with a specific focus on the onset and nature of ocular surface disorders during the early postoperative period. Methods: This retrospective study included 77 eyes that underwent BKPro implantation between 2019 and March 2022. Patients were treated at the Saint Barbara Hospital, Trauma Centre, Sosnowiec, Poland, and District Railway Hospital, Katowice, Poland. Data were collected from medical records, including patient demographics, medical history, surgical outcomes, postoperative visual acuity, and complications. The analysis incorporated both detailed medical history and direct clinical examination results. Results: The most common early postoperative complication was glaucoma, affecting 32 eyes (42%). Retroprosthetic membrane formation occurred in 20 eyes (26%), while partial extrusion of the BKPro was observed in 10 eyes (13%). Severe corneal surface damage was noted in patients with underlying autoimmune diseases (36%) and after chemical burns (24%). Five patients suffered from transient hypotony resulting from keratoprosthesis extrusion. The results highlight the complex nature of managing ocular surface conditions and the frequent challenges associated with early postoperative complications. Conclusions: BKPro implantation is an effective solution for severe corneal diseases that are resistant to conventional treatments. However, it is associated with a significant risk of early complications, particularly glaucoma and retroprosthetic membrane formation. Early identification and management of these complications are crucial for improving outcomes and maintaining visual function. Further research into optimizing postoperative care is needed to minimize these risks and enhance patient outcomes.

Penile inversion vulvo-vaginoplasty with scrotal graft for trans women: surgical technique and results of initial experience.

A significant proportion of trans women is demanding for a genital gender-affirming surgery, with vulvo-vaginoplasty being the most frequently requested procedure. The gold standard for primary vaginoplasty in trans women is the penile skin inversion technique with scrotal skin graft, which allows for increased depth of the vaginal cavity. The assessment of vulvo-vaginoplasty outcomes utilizing penile skin inversion and scrotal skin graft in individuals assigned male at birth in the surgeon's learning curve involves evaluating aesthetics, functionality, and sexual aspects. A total of 76 individuals assigned male at birth were included in 2 French university hospitals from 2020 to 2022. They underwent vulvo-vaginoplasty following 8 key steps: scrotal skin excision; bilateral orchiectomy; dissection between the rectum, bladder, and prostate; penile dissection; clitoroplasty; urethroplasty; penile skin inversion with scrotal skin graft; labioplasty. The average follow-up period was 12.4months, with participants averaging 35.7years of age. Each patient was invited to complete a questionnaire during follow-up. The study's outcomes encompassed the assessment of both early and late surgical complications, postoperative sexuality, aesthetic results, and voiding satisfaction. Of the total patients, 15.8% experienced major early postoperative complications, while 3% encountered major late postoperative complications. No complication was classified 4 or 5 in Clavien-Dindo scale. Most early complications were related to issues in vulvar healing, which did not compromise long-term aesthetic results. Patients-reported satisfaction was 82% after the procedure. Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a reproductive surgery procedure that can be successfully performed by experienced urologist. It achieves high patient-reported satisfaction even during the learning curve. The surgical procedures were consistent, and the sizable cohort of patients accurately reflects the learning curve of both surgeons. However, extrapolating long-term complications is challenging due to the relatively brief follow-up period. Additionally, there is a lack of self-reported sexual function data, and the scales used to assess patient-reported quality of life and urinary satisfaction are not specifically validated for transgender patients. Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a complex surgical procedure. It appears to be achievable by experienced urologists during their learning curve, resulting in similar functional and surgical outcomes, along with high patient satisfaction.

Postoperative Complications of Intramedullary Nailing for Impending and Pathologic Fractures of the Humerus Due to Bone Metastases-A Systematic Review of the Literature.

Intramedullary nailing (IMN) is a common option for managing impending or pathologic fractures of the humerus secondary to metastatic disease. We sought to assess the (1) early complications, (2) failure rates and mechanisms, and (3) functional outcomes. A systematic review using the PubMed, Embase, and Cochrane databases was performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The study was registered on PROSERO (CRD42023406905). The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Studies describing postoperative outcomes of patients with impending or pathologic fractures of the humerus treated with IMN were included. Implant failure was classified into mechanical and nonmechanical causes. Functional outcomes were assessed via the Musculoskeletal Tumor Society (MSTS) score. Overall, 41 studies comprising 1431 patients were included. Early complications occurred in 5.5% of patients, with 2.8% of patients having systemic complications. The overall implant failure rate was 4.9%, and the mean MSTS score at the last follow-up was 79.9%. IMN was associated with good postoperative functional outcomes and low implant failure rates. Systemic complications were the most common type of early complication, and tumor progression was the main cause of implant failure. LEVEL OF EVIDENCE: III.

Radiofrequency ablation guided by real-time cardiovascular magnetic resonance.

Cardiovascular magnetic resonance (CMR) is gaining ground in guiding electrophysiology (EP)-based ablation procedures of typical atrial flutter and atrial fibrillation, allowing for the avoidance of radiation exposure for patients and operators and reducing the risk of occupational illnesses. CMR allows comprehensive assessment of cardiac anatomy and provides tissue characterization by identifying pathological substrates, such as myocardial scars and edema, identified with the implementation of late gadolinium enhancement and T2-weighted short-tau inversion recovery sequences. Intraprocedural imaging is useful for real-time catheter tracking during the ablation procedure while simultaneously providing visualization of cardiac anatomy. Additionally, CMR facilitates the evaluation of the ablation procedure accuracy by acquiring edema-sensitive sequences, thereby aiding in preventing early complications. This report serves as a primer for radiologists and illustrates the value of CMR in planning and performing the ablation procedure, as well as its role in post-procedural imaging.

Early Endocrine and Metabolic Complications in Childhood Cancer Survivors—Experience from a Tertiary Care Pediatric Oncology Center in South India

Background Endocrine abnormalities and metabolic complications remain one of the common late effects after cancer therapy in children. Data on the incidence and pattern of complications would help to guide appropriate monitoring and treatment of childhood cancer survivors. Methods, Aims, and Objectives Purpose of study is to determine endocrine and metabolic effects in childhood cancer survivors including both hematological malignancies and solid tumors due to cancer per se and treatment-related, including different chemotherapeutic agents and radiotherapy. Results Among 97 participants, 84 children (84.5%) had at least one endocrine or metabolic complication; 41 children (42.3%) had more than two endocrine/metabolic complications. Common endocrine complications included precocious puberty (6.2%), short stature (6.2%), and hypothyroidism (5.1%). Among metabolic complications, dyslipidemia was the highest with an incidence of 68%, followed by fasting hyperinsulinism (32%), diastolic hypertension (18.6%), systolic hypertension (11.3%), obesity (8.8%), and metabolic syndrome (8.2%) and impaired fasting glucose (4.1%).Among endocrine complications, there was a significant increase in incidence of hypothyroidism among children receiving radiotherapy (odds ratio [OR]: 7.13, 95% confidence interval [CI]: 1.1–46.2), and among metabolic complications, a significant increase in incidence of metabolic syndrome in children treated with L-asparaginase compared with those not treated with L-asparaginase was observed (OR: 5.61, 95% CI: 1.07–29.5). There was no significant difference between incidence of observed endocrine and metabolic complications based on type of tumor, gender, and puberty status of study participants. Conclusion This study suggests that there is significant incidence of endocrine and metabolic complications in childhood cancer survivors, hence timely and appropriate recognition of these complications by appropriate screening recommendations and pursuing further endocrine evaluation rationally is needed.

The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study

BackgroundThe current study aims to analyze the effect of pre-operative non-bisphosphonate anti-osteoporotic drugs on complication and revision rates following total joint arthroplasty (TJA). MethodsA retrospective cohort analysis of the PearlDiver (PearlDiver Technologies, Colorado Springs, CO) database was performed. The database was queried to identify all patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) with history of hip or knee osteoarthritis and either osteopenia or osteoporosis. The treatment groups consisted of patients prescribed non-bisphosphonate and bisphosphonate osteomodulatory agents for 1 year prior to and following surgery. The treatment groups were matched to control cohorts by age, gender, and comorbidities. Chi-square analyses were used to compare outcomes between paired cohorts. ResultsThere were no statistically significant differences (p ≤ 0.05) in risk of aseptic loosening, broken prosthesis, dislocation of prosthetic joint, periprosthetic fracture, periprosthetic osteolysis, postoperative infection, full or partial revision, or stress fracture between both the non-bisphosphonate and bisphosphonate groups following THA or TKA. Comparisons between both groups and control cohort also yielded no significant differences. ConclusionThe current study detected no significant differences in early post-operative complications following TJA between patients treated with different classes of anti-osteoporotic medications versus untreated osteopenic/osteoporotic patients. Further research is required to fully understand the impact of osteomodulatory medications on TJA outcomes. Analysis should continue to ensure a high-quality standard of care and aim to better understand outcomes for such patients requiring TJA.

Neurodevelopmental Outcome in Infants of Gestational Diabetic Mother in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Diabetes Mellitus (DM) is one of the most common metabolic complications of pregnancy, with negative influences on maternal and fetal health. Infants of Diabetic Mothers (IDMs) are prone to develop both early and late complications. Evidences shows that diabetes in pregnancy have strong association with long-term adverse effects on brain development in babies born to mothers with gestational diabetes mellitus. Very few studies were done in this subcontinent regarding association of gestational diabetes mellitus and infant’s neurodevelopmental outcome. This study will help to find out this associations and thus to reduce poor neurodevelopmental outcome in infants of diabetic mothers by early detection and providing proper early childhood stimulation. Objective: To assess the neurodevelopmental outcome of infants born to mother with gestational diabetes mellitus. Methodology: This prospective observational study was conducted in the department of Neonatology and Institute of Pediatric Neurodisorder and Autism (IPNA), BSMMU, from March 2022 to September 2023. Neonates (N= 52) born at or after 34 weeks of gestation and born to gestational diabetic mother were enrolled in this study. Consent was taken from guardians. The newborns fulfilling the inclusion criteria were followed up for neurodevelopmental assessment at their 9 months of age by clinical psychologists assigned from Institute of Pediatric Neurodisorder and Autism (IPNA), BSMMU, who were blinded about infant’s diagnosis. Bayley scales of infant and toddler development (BSID III) was used for developmental assessment. In the Bayley III, cognitive development, expressive and receptive language and fine and gross motor development all were evaluated at 9 months of age. All data were recorded in a preformed questionnaire and analyzed by Statistical Package for Social Sciences (SPSS), version 25. Results: According to inclusion and exclusion criteria 58 newborn were enrolled and their blood samples were sent at 24 to 48 hours of age to see the laboratory parameters of metabolic and hematological profile. Among them 6 patients lost to follow up, so 52 infants were followed up for neurodevelopmental outcome at 9 months of age. Among the baseline characteristics of mother and neonate 48% mother needed drugs for glycemic control, while others were on dietary modification and 75% of the mothers had good glycemic control. Most of the neonate were born at term and were age appropriate, 18 patients needed NICU admission. Among the neonatal laboratory parameters hyperbilirubinemia was most common (30.8%) and hypoglycemia was second most common found in 15.4% of newborns. The most common morbidity was sepsis (17.3%). Overall adverse neurodevelopmental outcome was found among 14 (26.9%) neonate and 38 (73.1%) neonates had favorable outcome. Use of drugs and poor maternal glycemic control were found statistically significant in between adverse and favorable groups. (p-value- 0.041 and 0.000). Among the neonatal clinical parameters only hypoglycemia was found statistically significant in between these two groups. (p-value- 0.014) Multivariate logistic regression among these predictive factors showed only maternal poor glycemic control was significantly associated with adverse neurodevelopmental outcome (p-value=0.001). Conclusion: Maternal gestational diabetes can adversely affect on their infants neurodevelopment. Among the adverse outcome of three domains language delay was most common. Neonatal hypoglycemia, maternal poor glycemic control and use of drugs for GDM are significant predictors of adverse neurodevelopmental outcome in infants of gestational diabetic mother. Among them maternal poor glycemic control was significantly associated with adverse neurodevelopmental outcome.

Incident dementia in ischaemic stroke patients with early cardiac complications: A propensity-score matched cohort study.

The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored. Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days post-stroke) and those without SHS. The primary outcome was the 1-year risk of dementia (vascular dementia, dementia in other disease, unspecified dementia, or Alzheimer's disease). The secondary outcome was the 1-year risk of all-cause death. Cox regression analysis after 1:1 propensity score matching (PSM) was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes. We included 52,971 patients with SHS (66.6 ± 14.6 years, 42.2% females) and 854,232 patients without SHS (64.7 ± 15.4 years, 48.2% females). Following PSM, 52,970 well-balanced patients were considered in each group. Patients with SHS had a higher risk of incident dementia compared to those without SHS (HR 1.28, 95%CI 1.20-1.36). The risk was the highest during the first 31 days of follow-up (HR 1.51, 95%CI 1.31-1.74) and was mainly driven by vascular and mixed forms. The increased risk of dementia in patients with SHS, was independent of oral anticoagulant use, sex and age but it was the highest in those aged <75 years compared to ⩾75 years. SHS is associated with increased risk of dementia. Future studies are needed to develop innovative strategies for preventing complications associated with stroke-heart syndrome and improving the long-term prognosis of these patients.

Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women

PurposeTo investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.MethodsFrom a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.ResultsThe study involved 146 patients with the median age 60 years (IQR, 51–66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.ConclusionsRobot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.

Early Complications in Kidney Donors and Course of Health-related Quality of Life 12 mo After Donation: An Analysis of the Swiss Organ Living-Donor Health Registry.

Since 1998, the Swiss Organ Living-Donor Health Registry (SOL-DHR) has recorded peri- and postoperative complications of living kidney (LK) donors, as reported by all Swiss transplant centers and has collected follow-up data prospectively. We analyzed the early complications of 2379 consecutive individuals who donated a kidney between January 1998 and June 2022 and assessed their health-related quality of life (HRQoL) 1 y after donation. In total, 447 early complications in 404/2379 LK donors (17.0%) were reported to the SOL-DHR. The frequency of donors with major complications (ie, Dindo-Clavien classification 3/4) was 2.4%. In total, 31 donors needed reoperation, and in 13/31 (42%), donors reoperation was necessary because of bleeding complications. Independent risk factors for major early complications were older donor age (P = 0.005) and type of surgical approach (ie, the laparoscopic retroperitoneal compared with laparoscopic transabdominal surgery; P = 0.01), but not sex. We observed a U-shaped association of body mass index, where very low/high body mass indexes had higher odds of major early complications, without reaching statistical significance. Although HRQoL was affected by kidney donation, 96.5% of donors indicated that they would donate their kidney again. The only independent risk factor for low HRQoL based on mental health scores was worsening EB after living kidney donation (P < 0.0001). Overall, living kidney donation is a safe procedure, however, donor age and type of surgical approach affect the risk of complications. A decline in emotional bonding with the recipient after donation may worsen the quality of life of the donor.

The Impact of Complication Timing on the Outcomes of Implant-based Breast Reconstruction.

The National Surgical Quality Improvement Program (NSQIP) database provides an important resource for determining complication rates and risk factors for surgical procedures. However, NSQIP is limited to 30-day follow-up, and it is unclear whether this is reliable for evaluating prosthetic breast reconstruction outcomes. A single-institution, cross-sectional, retrospective review was performed for patients undergoing mastectomy with immediate, prepectoral tissue expander reconstruction. Timing of complications was stratified as early (within 30 days of operation) versus late (after 30 days). Categorical variables were compared using χ2 (or Fisher exact) tests, and continuous variables were analyzed using Kruskal-Wallis or Wilcoxon rank-sum tests. There were 301 patients (509 reconstructed breasts) included with a median follow-up time of 11 months. Of them, 176 patients (58%) experienced a postoperative complication-140 patients (47%) experienced an early complication and 36 patients (12%) experienced a late complication. Patients with late complications had a significantly higher rate of reconstructive failure compared with the early complication group (17% versus 10%; P = 0.001) and were more likely to require a flap (28% versus 7%; P = 0.001) for final reconstruction. Revision surgery rates after final implant placement were higher in the late complication group (36% versus 64%; P = 0.285). Late complications after prepectoral breast reconstruction have a more prominent impact on reconstructive failure and revisions than early complications. This finding may inform strategies to revise national databases such as NSQIP to include more detailed information and longer capture periods.