Early Postoperative Complications Research Articles

The influence of age at total hip replacement on perioperative complications associated with a press-fit cementless stem with lateral bolt in dogs.

To assess the influence of age on perioperative stem-associated complications when total hip replacement (THR) was performed with a BFX lateral bolt stem. Retrospective (2017-2022). A total of 197 client-owned dogs. Medical records of dogs that underwent THR with a lateral bolt stem were reviewed. Perioperative complications were recorded. Stem and femoral features were measured on postoperative and follow-up radiographs. The population was divided into juveniles (6-10 months), adults (>10 months to <7 years), and older dogs (≥7 years old). Association between groups and perioperative complications was assessed. Two-hundred and fifty five THRs were recorded: 139 unilateral and 58 bilateral. Intraoperative and early postoperative stem complication rates were 8.6% and 2%, respectively. Juveniles were at increased risk of developing intraoperative fissures. Age was not associated with early postoperative stem complications. German shepherd dogs were associated with postoperative fractures. Subsidence was weakly, but positively, associated with weight and canal flare index. Juveniles were at increased risk of developing fissures. There was no difference in postoperative stem complications among age groups. German shepherds were at increased risk of postoperative fracture despite the use of a lateral bolt stem. More studies are required to assess the effect of giant breeds on the risk of subsidence, as well as the effect of young age on fissure development. Age influenced the development of intraoperative, but not postoperative, stem complications with a lateral bolt stem. Prophylactic cerclage application could be considered in juvenile and German shepherd dogs.

Factors Associated with Early Postoperative Complications in Gastrointestinal Surgeries

Gastrointestinal surgeries´ postoperative complications are significant contributors to patient morbidity and healthcare economic burden. The outcomes could be influenced by some of the factors, such as the patient's demographic characteristics, surgical elements, and perioperative management. Early problems, which usually appear 30 days after surgery, can have a detrimental effect on patient outcomes, lengthen hospital stays, escalate medical expenses, and, in serious cases, cause death. This study aims to identify factors associated with early postoperative complications in gastrointestinal surgeries within the Iraqi population. This is a cross-sectional study that took place in hospitals of the Wasit province during the period from August to the end of December 2024. Two hundred patients of each group who had undergone GI surgeries participated. The questionnaire was pretested before it was sent for data collection. Included the patient's demographics, surgery details, and postoperative outcomes. The data were recorded by direct patient interviews. Statistical analysis was performed using SPSS to identify associations between risk factors and complications. Half of the total (100/200) patients were aged between 30 and 50 years old. More than half of those were males (65%) and nonsmokers (60%). The most frequently performed surgeries were cholecystectomy (30%), bowel resection (25%), and appendectomy (20%). Most of these surgeries (70%) were elective and (55%) by laparoscopy. Around a third (30%) of samples reported early postoperative complications; surgical site infection was the most frequent (33.3%). Half (50%) of patients who had complications were aged more than 50 years old with a significant association (P &lt; 0.001). High body mass index (above 30), emergency surgeries, open surgeries, and no prophylactic antibiotics were also associated with early postoperative complications.

Robot-assisted Kidney Transplantation: The 8-year European Experience.

Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30d) and late (from 31 to 90d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. A total of 624 patients with a median age of 35yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group. With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.

TREATMENT OF EARLY POSTOPERATIVE COMPLICATIONS IN CHILDREN WITH PRIMARY CONGENITAL GLAUCOMA

Purpose – to study the nature of early postoperative complications in children with primary congenital glaucoma and methods of their correction after antiglaucoma surgery using a combined method with a simultaneous effect on three outflow tracts. Material and methods The total number of children who underwent antiglaucoma surgery using the combined method (simultaneous impact on the outflow tracts in three directions: sinus trabeculectomy according to Burian in the scleral sinus, cyclodialysis-cycloretraction with autoscleral pedicle into the suprachoroidal space, basal iridectomy with sclerectomy beneath the scleral flap into the episcleral venous system) was 151 (270 eyes). Results On the first postoperative day following antiglaucoma surgery, the incidence of early postoperative complications was 62.6%, which increased to 67.4% by the third day. Among these, the highest proportion of patients presented with severe hypotony – 33.3%, hyphema – 10.0%, and ocular hypertension – 6.7%. After conservative treatment, the incidence of complications in children decreased to 10% by the seventh postoperative day. Conclusion Thus, following conservative treatment, the incidence of complications in the early postoperative period decreased by 52.6%. There was no need for repeated surgical intervention in these patients. Patients were discharged home under the supervision of an ophthalmologist at their place of residence. Key words: primary congenital glaucoma, glaucoma surgery, early postoperative complications

Modified posterior pelvic exenteration combined with ileocecal resection for locally advanced endometrial cancer.

There are several retrospective studies which have suggested that optimal cytoreductive surgery for stage IV endometrial cancer improves survival [1-3]. In addition, some investigators have reported that achieving maximal cytoreduction to a visibly disease-free outcome in the abdominal cavity for endometrial cancer with distant metastases can extend patients' survival [4]. Due to the anatomic proximity of the rectosigmoid colon to the female pelvic organs and its involvement in locally advanced endometrial cancer, an en bloc resection of the uterus, adnexa, and rectosigmoid, also known as a modified posterior pelvic exenteration (MPPE), is performed to achieve optimal cytoreduction [5,6]. Additionally, if the tumor has infiltrated the ileal end and/or cecum, ileocecal resection can be added. I report the details of the technique for this surgery requiring intestinal reconstruction. We routinely placed a transanal drainage tube after a MPPE to decrease the rate of anastomotic leakage and the need for a diverting stoma [7]. No visible tumors were observed after surgery. No intraoperative or early postoperative complications occurred. The patient did not have an impediment in her postoperative bladder and bowel function. Concerning the extent of hysterectomy during surgery, the procedure was performed as described in that of a class II hysterectomy [8]. This might partly explain the preservation of these function. Subsequently, she was treated with 6 cycles of doxorubicin and cisplatin chemotherapy. Two years after surgery, she is alive with no evidence of recurrence. The patient provided informed consent for use of this video.

The Limited Utility of Hemoglobin A1c as a Predictor for Periprosthetic Joint Infection Following Total Joint Arthroplasty: A Continuous Variable Analysis.

Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip (THA) and total knee arthroplasty (TKA) patients. A healthcare database was used to identify primary THAs or TKAs performed from 2016 to 2021 with a preoperative HbA1c value within 28 days of surgery. The primary outcome was PJI within 90 days postoperatively. Secondary outcomes included aggregate medical and surgical complications. Restricted cubic splines (RCSs) were generated using logistic regression to quantify the impact of HbA1c as a continuous variable on the risk of PJI. Between HbA1c values of 5% and 12%, relevant sensitivity and specificity measurements were calculated at intervals of 0.5%. A Youden's J statistic identified clinically relevant preoperative HbA1c thresholds. In total, 17,481 elective arthroplasty patients who had a preoperative HbA1c were identified. The mean preoperative HbA1c was 6.5%. For TKA, a PJI threshold of 9.7% was identified (sensitivity: 19.4%, specificity: 99.1%), while for THA, a PJI threshold of 7.8% was identified (sensitivity: 22.7%, specificity: 89.9%). The threshold for aggregate medical complications was 6.8% for TKA (sensitivity: 53.7%, specificity: 59.1%) and 6.5% for THA (sensitivity: 45.5%, specificity: 66.5%). No association was observed between HbA1c and aggregate surgical complications for either THA or TKA. This study identified PJI and medical complication HbA1c thresholds above which patients were at a significantly increased risk of early postoperative complications. While our findings suggest that HbA1c has limited predictive utility for postoperative complications, it remains an accessible biomarker that can aid in preoperative risk stratification. Future studies should explore other promising or complementary biomarkers that may be more effective for preoperative risk stratification.

SMAS-rhytidectomy and fractional laser therapy in patients with age-related facial changes

Annotation. Aim – to evaluate the outcomes of the combination of SMAS facelift and fractional laser resurfacing in patients with involutional facial changes. The study included 58 female patients aged 30 to 55 who underwent SMAS facelift combined with fractional CO2 laser resurfacing. SMAS rhytidectomy was performed using the standard technique for lifting soft tissues of the face and neck. The power settings and the number of CO2 laser passes were adjusted individually based on the patient's skin type. Ninety days after surgery, 95% of patients reported high satisfaction with the procedure, 3.5% rated the result as satisfactory, and one patient (1.5%) was dissatisfied. Early postoperative complications were observed in 5 patients (8.6%): hematomas occurred in 5.1%, partial skin flap necrosis in 1.7%, infection in 1.7%, and hyperpigmentation in the laser-treated areas in 1.7%. So, the combination of SMAS facelift and fractional CO2 laser resurfacing is an effective method for correcting facial aging in women aged 30–55 years, providing high patient satisfaction with a low complication rate. The combination of rhytidectomy and laser skin treatment achieves more stable rejuvenation results, making it a reliable choice for patients with mixed signs of skin involution and tissue ptosis. Further research should focus on evaluating the long-term outcomes of this method in a larger cohort, considering different skin types and individual characteristics.

Prevalence, outcome and complications of Intertrochanteric Femur Fracture In Patients Admitted to AL Sammad General Hospital-from MAY 2020 to MAY 2022 Amran-Yemen

Background: Intertrochanteric fractures are common injuries, especially in elderly, and require effective management to minimize complications. This study aimed to evaluate the demographic characteristics, treatment modalities, and early postoperative complications of patients with intertrochanteric fractures admitted to the Al Sammad General Hospital, Amran, Yemen, from May 2020 to May 2022. Methods: A retrospective analysis was conducted on 90 patients diagnosed with intertrochanteric fractures during the study period. Data on age, sex, mechanism of injury, fracture type, treatment methods, and postoperative complications were collected and analyzed. Results: Among the 90 patients, 51% were male and 49% female, with the highest incidence in those aged &gt; 60 years (46.7%). The primary mechanism of injury was falling from a standing height (73.4%). Fracture classifications included 46.7% stable , 44.4% unstable , and 8.8% reverse oblique. Surgical treatment was performed in 96.7% of the cases, predominantly using dynamic hip screws (53.3%). Early postoperative complications were noted in 9.9% of the patients, with deep vein thrombosis (DVT) being the most common (3.3%). Conclusion: Intertrochanteric fractures are more common in males aged &gt; 60 years, with falls from standing height being the leading cause. Surgical treatment is preferred, and the complication rate is relatively low. Continued efforts to improve surgical outcomes and manage complications are vital to enhance patient recovery.

Perioperative morbidity after primary hiatal hernia repair increases as hernia size increases.

Minimally invasive hiatal hernia (HH) repair is the gold standard for correcting mechanical defects of the crural diaphragm due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms). However, several operative factors, including HH size, may negatively affect the postoperative course. We sought to determine if an increase in HH size was associated with an increased risk of perioperative complications, ICU admission, or hospital readmissions after minimally invasive HH repair. We conducted a retrospective observational cohort study of patients who underwent primary HH repair by an experienced foregut surgeon between September 2016 and July 2023. Four groups were defined based on the percentage of stomach at the thorax determined during surgery (small-HH: <25%, moderate-HH: 25-49%, large-HH: 50-74%, and intrathoracic stomach [ITS]: ≥75%). Covariates were compared between the groups, and logistic regressions were performed to identify factors associated with postoperative morbidity. A total of 391 patients (73.7% female; mean age, 64.4 ± 12.5years) comprised the groups: small-HH (n = 160), moderate-HH (n = 63), large-HH (n = 64), and ITS (n = 104). Patients with ITS were older (p < 0.001), had longer operations (p < 0.001), greater blood loss (p < 0.001), longer hospital stays (p < 0.001), and an increased risk of early postoperative complications (aOR 2.59 [CI95: 1.28-5.25], p = 0.009) and ICU admission (aOR 13.3 [CI95: 3.10-57.06], p < 0.001). An increase in HH size was associated with an increased risk of early postoperative complications, ICU admission, and a trend toward higher 30- and 90-day hospital readmissions, likely due to the progressive nature of the disease.

Trauma Causing Complications After Cleft Lip Repair.

A case series of early postoperative complications due to trauma following primary cleft lip repair has been presented. Out of 193 primary cleft lip repair performed over the past 4 years, 5 patients had trauma related complications, 2 had complete wound dehiscence, 2 had partial dehiscence, and 1 presented with bleeding. This is the first report on complications following trauma after cleft lip repair. Such complications can be prevented with due vigilance during the early postoperative period. All children presented with wound dehiscence were managed with immediate suturing with good outcome. A protocol for the management of complications following trauma after cleft lip repair is being presented.

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer.

Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-day postoperative complications between these two techniques. We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications. A cohort of 8,403 breast cancer patients was analyzed. A total of 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years (p < 0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, p < 0.001), exhibited a higher body mass index (31.73 vs. 26.93, p < 0.001), had a greater prevalence of diabetes mellitus (11.0 vs. 5.0%, p < 0.001). They also had a higher ASA classification (2.33 vs. 2.15, p < 0.001), shorter operative time (173.39 vs. 216.20 minutes, p < 0.001), and a higher proportion of outpatient procedures (83.7 vs. 39.5%, p < 0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients (4.2 vs. 10.9%, p < 0.001), including lower rates of surgical complications (2.2 vs. 8.0%, p < 0.001) and wound complications (1.9 vs. 4.8%, p = 0.005) compared with MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications. OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared with MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.

Severe malnutrition predicts early postoperative complications in aseptic revision total shoulder arthroplasty.

This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a simple readily available measure of malnutrition risk, and 30-day postoperative complications following revision total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2022. The study population was divided into three groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Logistic regression analysis was conducted to investigate the connection between preoperative GNRI and postoperative complications. Compared to normal nutrition, moderate malnutrition was not independently associated with postoperative complications. Compared to normal nutrition, severe malnutrition was independently associated with a greater likelihood of experiencing any complication (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.80-5.27; P < 0.001), blood transfusions (OR 3.68, 95% CI 1.40-9.66; P = 0.008), non-home discharge (OR 2.99, 95% CI 1.50-5.98; P = 0.002), and length of stay >2 days (OR 3.10, 95% CI 1.77-5.42; P < 0.001). Severe malnutrition based on GNRI is a predictor of early complications following revision TSA, however moderate malnutrition is not.

The Incidence of Early Postoperative Complications Following Modified Radical Mastectomy in Breast Cancer Patients.

Introduction Breast cancer is considered the most common malignant tumor in women, and incidence rates have risen progressively over the last decades. Modified radical mastectomy (MRM) is an effective treatment option. This research sought to establish the frequency, causes, and distribution of postoperative complications that are associated with MRM in the Pakistani population suffering from breast cancer. Materials and methods A descriptive cross-sectional study was conducted over one year (May 2023 to April 2024) at the Surgical Department of Holy Family Hospital, Rawalpindi. Sixty-one female patients (aged 15 and above) with histopathologically confirmed stage I or II infiltrative ductal carcinoma, undergoing neoadjuvant radiotherapy and radical modified mastectomy, were included. Exclusion criteria involved patients with breast cancer complicated by inflammation, immune deficiencies, or preoperative chemotherapy. Patients were discharged on the second day post-surgery and followed for six weeks to assess seroma formation and wound infection. Data was analyzed using SPSS v23 (IBM Inc., Armonk, New York), with descriptive statistics and mean/standard deviation for variables. Results Patients' mean age in the study was 48.50 ± 12.30 years. Wound infections were observed in seven patients (11.4%) at around postoperative day 5.20 ± 2.10. Seroma formation was observed in 14 patients (23%), and it usually formed by postoperative day 8.70 ± 4.20. Complications led to longer hospital stays, delayed adjuvant therapies, and increased patient suffering. Complication predictors included the patient's age, cancer stage, and surgical parameters. These complications are clearly demonstrated in this study, and it shows that better management approaches are required to reduce their prevalence and improve the patients' experience. Conclusion This study highlights the common postoperative complications following modified radical mastectomy (MRM) in breast cancer patients, including wound infections and seroma formation. These complications led to longer hospital stays and delays in adjuvant therapies. Improved management strategies are essential to reduce complication rates and enhance patient outcomes in MRM surgeries.

Skin Graftless Dorsal Metacarpal Island VY Advancement Flap vs. Dorsal Rectangular Flap with Skin Grafting in 213 Simple Syndactyly Releases.

Simple syndactyly is a common congenital upper extremity difference. Traditional reconstructive approaches utilize skin grafts; however, recent studies suggest skin graftless techniques may improve outcomes. We hypothesized that patients who underwent reconstruction with a skin graftless dorsal metacarpal island VY advancement flap would have fewer postoperative complications compared to those released with a dorsal rectangular flap with skin grafts. Patients 0-17 years of age presenting for primary reconstruction of simple syndactyly were retrospectively analyzed at a large pediatric hospital. Medical records were identified using ICD-9/10 codes, CPT codes, and case logs from six hand surgeons. Outcomes of interest included early postoperative complications (within 30 days) such as infection, hematoma, seroma, wound healing issues, unplanned returns to the operating room, and digit loss. Late complications (greater than 30 days) included web creep and development of pathologic scar formation. In total, 213 syndactyly repairs from 153 patients were analyzed (rectangular=94 webspaces, 58 patients; VY=119 webspaces, 95 patients). The rectangular group had significantly more early complications (p=0.04). The rectangular group had significantly higher incidences of web creep and hypertrophic scarring (19.3% vs 1.8%, p<0.001; 19.1% vs 5.9%, p=0.003, respectively). The rectangular flap with skin grafts was the only variable predictive of web creep and hypertrophic scar formation on regression analysis (p<0.001 and p=0.004, respectively). Subgroup analyses of syndromic and nonsyndromic cases and incomplete and complete cases mirrored overall cohort results. Simple syndactyly releases with the skin graftless technique produces fewer complications compared to the traditional approach with skin grafts.

Growth Differentiation Factor 15 as a Biomarker for Risk Stratification in the Cardiothoracic Surgery Intensive Care Unit.

Growth Differentiation Factor 15 (GDF15) is an emerging biomarker that significantly increases during acute stress responses, such as infections, and is moderately elevated in chronic and inflammation-driven conditions. While evidence suggests that high levels of GDF15 in cardiac surgery are associated with worse outcomes, its utility as an evaluator of early postoperative complications remains unclear. This study aims to characterize the postoperative profile of GDF15 in patients undergoing isolated surgical aortic valve replacement, evaluating its association with short-term outcomes. Serum samples from patients undergoing cardiac surgery were collected preoperatively and at defined postoperative time points (1 h, 6 h, 12 h, 24 h, and 48 h) to measure GDF15 levels. GDF15 levels significantly increased after surgery, peaking at 6 h. A positive correlation was observed between GDF15 levels and both cardiopulmonary bypass and aortic cross-clamp times. Notably, patients who developed postoperative acute kidney injury (AKI) or required prolonged hemodynamic support had significantly higher GDF15 levels, with increased mechanical ventilation time and extended intensive care unit length of stay. Furthermore, GDF15 levels correlated with postoperative SOFA scores at 24 h after surgery. GDF15 may be a valuable biomarker for risk stratification and guiding therapeutic decisions in cardiac surgery patients. Higher GDF15 levels were significantly associated with prolonged hemodynamic support, postoperative AKI, and measures of illness severity.

Does Approach Matter? Comparison of Early Postoperative Life-threatening Complications in Elderly Patients With Multilevel Cervical Stenosis.

Retrospective cohort study. The optimal surgical approach for multilevel cervical stenosis in elderly patients is controversial because of the risk of life-threatening complication. To compare life-threatening early complication rates between ≥3 levels anterior and posterior cervical surgery in elderly patients. Data from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) were queried for patients 65 years or older who underwent ACDF or PS between 2016 and 2021. Patients with subaxial cervical degenerative disorders were identified using ICD10 codes. Surgical procedures were defined with CPT code indicating ACDF (3-5 levels; ACDF3+), laminoplasty or laminectomy (3-5 levels), and posterior decompression and fusion (3-5 levels). Outcomes of interest including reoperation, airway complications, venous thromboembolism (VTE), surgical site infections (SSIs), and urinary tract infections (UTI) were compared by utilizing 1:1 propensity score matching between the 2 approaches. We identified 568 patients who underwent ACDF3+ and 1590 patients who underwent PS. After propensity score matching, the cohorts with 568 patients each were well-balanced with a mean age of 70.9 years. All 17 patients with dialysis and 24 of 28 patients with congestive heart failure in the PS group before the matching were excluded through the matching process. Complications rates between ACDF3+ and PS group were similar in reoperation (2.1% vs. 3.3%; P=0.275), airway complications (0.9% vs. 0.9%; P=1.000), and VTE (1.1% vs. 0.7%; P=0.751), whereas the PS group had a higher rate of SSI (0.2% vs. 1.4%; P=0.045), UTI (1.1% vs. 3.0%; P=0.035), and LOS (2.5±6.1 vs, 4.3±3.9d; P<0.001). Among elderly patients undergoing 3 or more levels of cervical spine surgery, there were comparable rates of 30-day life-threatening complications between the 2 approaches. However, potential selection bias exists, with surgeons possibly favoring posterior surgery for patients with higher-risk comorbidities.

Сравнение робот-ассистированной и лапароскопической пиелопластики в лечении обструкции пиелоуретерального сегмента у детей

Purpose of this research was to evaluate the perioperative and functional outcomes of robot-assisted and laparoscopic pyeloplasty performed in a specialized pediatric surgical center with the use of the Versius modular &amp; portable surgical robot by “CMR Surgical,” Ltd. (Cambridge, Cambridgeshire, United Kingdom). Material and methods used: Authors present retrospective data on all patients (34) with pyeloureteral junction obstruction who had undergone the Anderson-Hynes pyeloplasty using either robot-assisted or laparoscopic techniques at the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia) in Jan. 2020-May 2023. Robotic surgical interventions were performed using the Versius modular &amp; portable surgical robot. All surgical procedures were performed in the manner of the Anderson-Hynes procedure. The study recorded patients' perioperative parameters related to demographics, surgical details and both early and long-term outcomes. Results: all surgical interventions were considered successful based on the fact that the desired result was achieved: a decrease in the size of the pelvis after the surgery. Robot-assisted procedures were performed in 10 and a laparoscopic method was used in 24. The mean age of patients was significantly lower in the laparoscopy group (4.0 [1,9;6,8] y/o v. 11,0 [7,0;15,0] y/o; p=0.001) as was the mean patients’ weight (17. 0 [11.5; 26.8] kg v. 54.6 [29.1; 63.0] kg; p=0.003). The gender composition in both groups was comparable (p=0.252) and demonstrated the dominance of male patients. The indicator of the total duration of surgical interventions was higher in the robot-assisted surgery group (157,5 [128,8; 196,3] minutes v. 117,5 [95.0; 161.3] minutes in the laparoscopy group; p=0,037). The average duration of the installation of the robotic system (i.e. the “docking time”) was 15,0 [10,0; 20,0] minutes. During the study, no statistical difference was found between the length of stay of patients in the intensive care unit (19,0 [16,9; 19,6] minutes v. 19,0 [17.0; 19.0] minutes). There was a significant difference in hospital stay in favor of a reduction in the robot-assisted surgery group (p&lt;0,001), with a median hospital stay after robot-assisted surgery of 7,0 [6.0; 7.0] days, while patients who underwent laparoscopy were discharged only after 14 [13.0; 14.0] days. Authors did register neither early nor late postoperative complications of any kind in both groups. Conclusion: the robotic pyeloplasty is a safe and effective technique for the treatment of pyeloureteral junction obstruction. The robotic approach in the treatment of hydronephrosis in children is accompanied by the benefits of earlier recovery of patients after the surgery which in its turn is confirmed by a shorter time spent both in the intensive care unit and in the hospital.

Assessment of the American College of Surgeons Surgical Risk Calculator (ACS-SRC) for Prediction of Early Postoperative Complications in Patients Undergoing Cytoreductive Surgery for Ovarian Peritoneal Carcinomatosis.

Ovarian cancer (OC) is diagnosed at a locally advanced stage in two-thirds of cases. The first line of treatment consists of cytoreductive surgery (CRS) combined with neoadjuvant and/or adjuvant chemotherapy. However, CRS can be associated with high rates of postoperative complications (POCs), and detection of fragile patients at high risk of POCs is important. The American College of Surgeons Surgical Risk Calculator (ACS-SRC) provides a predictive model for early POCs (30 days) for any given surgical procedure. This study aimed to evaluate the performance of the ACS-SRC in predicting the occurrence of early POCs for patients undergoing CRS for OC. This was a retrospective study that included patients undergoing CRS for advanced OC between January 2010 and December 2022. Early POCs were reviewed, and the rate of POCs was compared with those predicted by the ACS-SRC to evaluate its accuracy (i.e., discrimination and calibration). A total of 218 patients were included, 112 of whom underwent extensive surgery/resection. A total of 94 complications were recorded. This cohort demonstrated correct calibration of the ACS-SRC for the prediction of surgical site infection, readmission, and the need for nursing care post-discharge (NCPD; transfer to revalidation center or need for nursing care at home). Using both the discrimination and calibration methods, the score only predicted NCPD. In this study, the ACS-SRC was shown to be of little value for patients undergoing cytoreductive surgery for ovarian peritoneal carcinomatosis, as it only accurately predicted NCPD.

Premature wear of the hip prosthesis as an early mechanical complication qualified for revision surgery – a rare case report and clinical implications

Background: Mechanical complications of total hip arthroplasty (THA) are potential issues that may arise following the primary THA. Improper placement of THA can lead to misalignment of the joint axis, resulting in instability, pain, and walking difficulties. Among the relatively rare postoperative mechanical complications, premature wear of prosthesis components is included. This wear can lead to catastrophic prosthesis dislocation, necessitating surgical revision of the THA. Aim of the study: The aim of this paper is to present an intriguing case description of a patient with premature THA wear classified as an early postoperative mechanical complication, warranting revision THA surgery. The likely cause of premature wear of the implanted acetabular cup was excessive prosthesis use associated with intense physical activity and a high level of patient fitness. Care report: The paper presents the medical history and treatment course of a 33-year-old active patient who underwent uncemented left hip THA surgery due to diagnosed coxarthrosis caused by congenital dysplasia. After 5 years, premature wear of the implanted acetabular cup occurred. The likely cause was excessive prosthesis exploitation related to intensive physical activity and a high level of patient fitness. A year after the first revision surgery, THA dislocation occurred, resulting in the necessity of a second revision with replacement of the acetabular cup, polyethylene inserts and femoral head of the endoprosthesis. Summary: Premature wear of THA poses a significant clinical challenge. Functional limitations, associated with the loss of hip joint stability, lead to difficulties in performing basic activities, further decreasing the patient's quality of life. It is also worth emphasizing that the treatment process for premature THA wear is associated with the possibility of surgical complications and a prolonged recovery period.

A novel technique for the construction of an end ileostomy to prevent stoma outlet obstruction after rectal resection and total colectomy: a single-center retrospective study.

Stoma outlet obstruction (SOO) is an early postoperative complication of rectal cancer. We devised a novel surgical technique: end-ileostomy, to reduce SOO. Here, we describe the surgical technique used for constructing an end ileostomy and assess its impact on SOO. The subjects of this retrospective study were 78 patients who underwent low anterior resection or total colectomy with a defunctioning ileostomy (DI) between 2018 and 2022. The surgical procedure for end ileostomy can be summarized as follows: First, the ileum was separated using a linear stapler, approximately 30cm from the Bauhin valve; then the opposite sides of the mesentery of the oral and anal ilea were sutured; and finally, end ileostomy was performed using standard techniques. End and loop ileostomies were performed in 34 and 44 patients, respectively. We assessed the independent risk factors for SOO. SOO occurred in 12 patients (15.3%): 1 (2.9%) with an end ileostomy and 11 (25%) with a loop ileostomy. Multivariate analysis identified loop ileostomy as an independent risk factor for SOO (p = 0.037). End ileostomy construction is a useful and safe technique for reducing the incidence of SOO in defunctioning ileostomies following rectal resection.