Early Postoperative Complications Research Articles

Congenital Diaphragmatic Eventration: Should we Maintain Surgical Treatment? A Retrospective Multicentric Cohort Study

BackgroundThe aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France. MethodsRetrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared. Results139 patients were included, with a median age of 8 [1–16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients. ConclusionsDiaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence. ClinicalTrialsNCT04862494, April 28, 2021. Level of evidencelevel III treatment study.

Early Hemorrhagic Complications after Holmium Laser Enucleation of the Prostate in Patients Undergoing Antithrombotic Therapy: A Retrospective Analysis from a High-Volume Centre.

Objectives: This study intends to evaluate early hemorrhagic complications after holmium laser enucleation of the prostate (HoLEP) in patients undergoing antithrombotic therapy. Methods: The data of patients undergoing HoLEP between January 2020 and February 2023 were retrospectively analysed. Patients were clustered into three groups: (1) no antithrombotic therapy; (2) antiplatelet (AP) therapy; and (3) anticoagulant (AC) therapy. Pre-, intra-, and post-operative variables were compared. A logistic regression model was built to identify predictors of post-operative hemorrhagic complications. Results: A total of 338 patients underwent HoLEP, including 212 who received no antithrombotic therapy (62.7%), 76 who received AP (22.5%), and 50 who received AC (14.8%). Intra-operative outcomes did not show any significant difference. A significant difference was observed in terms of catheterisation time (p = 0.001) and length of hospital stay (p < 0.001), favouring patients who did not receive antithrombotic therapy. Early post-operative hemorrhagic complications (<30 days) included re-admissions for macrohematuria (3.5%), transfusions (2.4%), and endoscopic re-interventions for bleeding (1.2%). A comparison between the groups showed significant differences for both re-admission (p < 0.001) and transfusion rates (p = 0.01), favouring patients who did not receive antithrombotic therapy. The re-intervention rate did not show any significant difference between the groups (p = 0.1). In multivariate analysis, AC therapy was identified as an independent predictor of those complications (OR 4.9, p = 0.005). Conclusions: HoLEP is a safe and effective procedure for patients undergoing antithrombotic therapy. Both AP and AC therapies are associated with longer catheterisation and hospitalisation times. AC therapy is shown to be a predictor of minor post-operative hemorrhagic complications.

TECHNOLOGY OF MINIMALLY INVASIVE SURGICAL CORRECTION FUNNEL-SHAPED DEFORMATION OF THE CHEST IN CHILDREN

The most common method surgical treatment of pectus excavatum (PE) is thoracoplasty according by D.Nuss at the moment. But serious complications associated with trauma to the pericardium, blood vessels, and bleeding are known. Objective. Development of a modified technology surgical correction of pectus excavatum, which involves exclusively extrapleural passage of the plate, according to the individual size and shape of the deformation of the patient’s chest, in order to prevent intraoperative complications. Methods. 81 patients aged 10 to 17 years were involved in the study. A modified technology of extrapleural surgical correction of PE was performed. The plate was carried level of the VI–VII sternocostal joints through the formed through submuscular-extrapleural retrosternal tunnel from right to left under control of right-sided thoracoscopy. The plate was modeled according by individual deformation parameters chest. The analysis was carried out according to the following criteria: age, gender, type of deformity, Haller index, duration of surgery, intraoperative and early postoperative complications according by Clavien–Dindo classification. Results. The median age of patients was (13.8 ± 1.9) years, of which there were 65 (85.25 %) boys, 16 (19.75 %) girls. 48 (59.3 %) children were diagnosed with type I (symmetric) deformity, and 33 (40.7 %) with type II (asymmetric) according to the classification. The median Haller was (4.07 ± 0.62), which corresponds to 2–3 degrees. Differences in the degree of deformation in children of different sexes were not determined (р = 0.828). Impaired lung function was d iagnosed i n 55.55 % (n = 45), i mpaired h eart f unction — 40.74 % (n = 33). T he d uration of the o peration was on a verage (70.6 ± 15.4) minutes, from 50 to 110 minutes. Early postoperative complications were found in 5 (6.17 %) patients classified as grade I (mild) according to the Clavien–Dindo classification, which did not require additional medical or surgical correction. After the operation, the correction of chest deformation was on average (2.35 ± 0.22) according by Haller index, which was statistically significantly (р = 0.001) different from the initial level. Conclusions. The use of modified technology surgical correction of PE meets safety requirements and minimizes postoperative complications.

Collagen fleece grafting for surgical treatment of patients with mild to severe peyronie's curvatures.

Collagen fleece grafting (CFG) is the recommended treatment for severe Peyronie's disease (PD) curvature (> 60°), but its efficacy in mild/moderate curvatures remains uncertain. This study evaluated CFG in patients with mild/moderate curvatures (< 60°) at risk of penile shortening or symptomatic plaque. A retrospective review was conducted on patients who underwent surgical treatment for PD using plaque incision or partial plaque excision and CFG. Clinical parameters and complications were reviewed. Subgroup analysis was performed on patients with curvatures of > 60° and curvatures ≤ 60°. 89 patients with a median age of 59years and a median curvature of 70 (20-90)° were identified. Dorsal curvature was predominant in 66% of cases, followed by lateral (16%), ventral (8%), and complex curvatures (10%). Partial plaque excision was performed in 98% of patients, with an average grafting area of 2.1cm2; 71% had a singular penile plaque, while 29% presented two or more plaques. The comparison between patients with curvatures ≤ 60° and > 60° revealed no significant differences in mean operation time (86.3 vs. 94.4min, p = 0.13) or in the incidence of postoperative complications, including glans necrosis, hypoesthesia, ecchymosis, bleeding, hematoma, infection, residual curvature, revision surgery, or pain. Early postoperative outcomes and complication rates following plaque incision or partial plaque excision and grafting with CFG were comparable in patients with mild/moderate and severe PD deformities. The technique may be a viable option with a similar risk profile for achieving penile straightening in selected PD cases, particularly when plication is not feasible.

Early and Unplanned Readmission of Patients After Thoracic Surgery Operations.

Background Thoracic surgery patients face unique postoperative challenges, particularly those undergoing lung resections. This study aimed to identify common complications and their management within the 30-day postoperative period, as well as investigate the relationship between early postoperative complications and unplanned outpatient follow-ups. Methods A retrospective analysis was conducted on 947 patients who underwent thoracic surgery between January 2020 and December 2023. Of these, 168 patients who had unscheduled follow-ups were included in the final analysis. Results The most common surgical procedure was pulmonary resection (68.5%), with prolonged air leaks (19.6%) being the most frequent postoperative complication. Unplanned outpatient visits were primarily due to dyspnea (38.1%) and surgical site complications (33.9%). While the rate of readmission did not significantly differ between complication-free and complicated patients (p=0.070), patients with complications were 2.117 times more likely to be readmitted (p=0.044). Surgical technique impacted postoperative outcomes, with minimally invasive surgery associated with fewer complications and shorter hospital stays compared to open thoracotomy. Conclusion Our findings emphasize the need for tailored postoperative care and diligent follow-up, especially for patients at higher risk of readmission due to complications such as pneumothorax, empyema, and prolonged air leaks.

Features of Kidney Transplant in Pediatric Recipients: Experience of a Single Center.

Congenital abnormalities of the kidneys and the urinary tract are common reasons for endstage renal disease in children. We studied the features of postoperative management and possible complications after pediatric kidney transplant. We retrospectively analyzed 29 children aged from 9 to 18 years who underwent kidney transplants from April 2018 to December 2013 (17 boys and 12 girls). All recipients were on hemodialysis for 3 to 18 months (mean of 10.17 ± 4.52 mo). Etiology of end-stage kidney disease included chronic glomerulonephritis (n = 12 [41.4%]), urolithiasis (n = 3 [10.3%]), and congenital abnormalities of the kidneys and the urinary tract (n =14 [48.3%]), including urinary reflux (n = 5 [17.2%]). Donors were parents in 16 cases, siblings in 5, uncles in 5, and aunts in 3 cases. HLA mismatching ranged from 2 to 5 (mean of 2.93 ± 1.39). Three patients had intraoperative nephrectomy, and 2 patients had hydronephrosis and urethroplasty with megaureter to prevent urinary tract infection. Six patients (20.6%) had early postoperative complications: 2 with delayed graft function, 1 with venous anastomosis thrombosis, 2 with hematoma around the graft, and 1 with lymphocele. Venous anastomosis thrombosis was eliminated by open thrombectomy, with graft function restored on postoperative day 17. The lymphocele was eliminated by puncture and drainage. Hematomas did not require surgical correction and blood transfusion. Ten patients (34.4%) had late postoperative complications: 1 with stricture of vesicoureteral anastomosis, 3 with vesicoureteral reflux, and 5 with urinary tract infection (3 with bacterial culture). Stricture of vesicoureteral anastomosis was successfully resolved by open surgery. Vesicoureteral reflux was eliminated with hydrogel. One patient developed chronic kidney rejection within 6 months because of noncompliance with posttransplant regimen and required transplantectomy. A major factor in reducing frequency of infections after surgery is the recipient's nephrectomy.

Arterial prophylactic occlusion technique in the application of surgery for locally advanced pancreatic cancer with arterial involvement after conversion therapy

Objective: To investigate and compare the clinical outcomes of the arterial pre-occlusion technique(APOT) and the traditional technique in the surgery of locally advanced pancreatic cancer with arterial involvement after conversion therapy. Methods: This is a retrospective cohort study. The clinical data of 145 patients with locally advanced pancreatic cancer with arterial involvement admitted to the Department of Hepato-Biliary-Pancreatic Surgery of the First Hospital Affiliated to Naval Medical University,from January 2020 to December 2022 were retrospectively analyzed. All patients completed neoadjuvant therapy for tumors, and the feasibility of radical surgical treatment was determined by a multidisciplinary collaborative team evaluation before surgery. According to whether the intraoperative artery was pre-occluded, 145 patients were divided into two groups, including 28 cases in the APOT group(16 males, 12 females, aged (59.0±9.4) years), and 117 cases in the routine surgery group(76 males, 41 females, aged (55.1±8.2) years). To ensure comparability of baseline data between the APOT group and the routine surgery group, a 1∶2 match was performed using the propensity score matching method, and the caliper value was 0.006 45. The t-test,the Mann-Whitney U test, χ2 test or Fisher's exact test were used to compare the data between the two groups,respectively. Results: After matching the propensity score,there were 28 cases in the APOT group and 56 cases in the routine surgery group. There were no significant differences in gender,age,preoperative comorbidities,preoperative body mass index,surgical approaches,chemotherapy regimen,stereotactic body radiation therapy ratio,tumor markers,and type of invaded artery between the two groups (all P>0.05).The arterial occlusion time M(IQR) in the APOT group was 7.0(3.8)minutes(range:3 to 15 minutes),and no ischemic manifestations were observed in the distal target organs that blocked blood vessels after surgery. The operation time was (170.3±57.7)minutes in the APOT group and (235.0±80.2)minutes in the routine surgery group,and the difference was statistically significant (t=-3.800,P<0.01). The APOT group also experienced less intraoperative blood loss(650(588)ml vs. 800(600)ml;U=1 026.500,P=0.021). No significant differences were found between the groups in combined vein resection and reconstruction,celiac trunk resection,early postoperative complications, readmission rates at 30 days,and postoperative length of stay(all P>0.05). Extra-arterial dissection was performed in all patients,with arterial resection and reconstruction in 3 cases: 2 cases in the APOT group(1 case involving the superior mesenteric artery and 1 case involving the common hepatic artery) and 1 case in the routine group(involving the common hepatic artery). Postoperative abdominal bleeding occurred in 4 cases,with 3 cases in the routine group,1 case in the routine group. The R0 resection rate was 85.7%(24/28) in the APOT group and 80.4%(45/56) in the routine group,without significant differences between the groups(P=0.763). The median overall survival time was 27.6 months for the APOT group and 22.5 months for the routine group,while the median disease-free survival was 11.7 months and 16.8 months,respectively,with no significant differences between the two groups(P=0.532,P=0.927). Conclusion: The arterial pre-occlusion technique can be used for extra-arterial dissection in patients with locally advanced pancreatic cancer involving the arteries,reducing surgery time and intraoperative blood loss.

Extraperitoneal Single Port vs Transperitoneal Multiport Robot Assisted Radical Prostatectomy in Frail Patients: A Propensity Score Matched Comparative Analysis

PurposeThe rise of frail patients in the worldwide population poses a challenge in the prostate cancer surgical care. In this light, we aimed to compare perioperative and early surgical outcomes of Extraperitoneal Single Port (SP)- vs Transperitoneal Multiport (MP) - Robot Assisted Radical Prostatectomy (RALP) in different frailty settings. Materials and methodsClinical and surgical data of all consecutive patients treated with RALP between March 2014 and October 2023 were gathered. Propensity score matching was performed to adjust for potential baseline pre-operative confounders. The 5-miFI score was calculated for each patient and then three risk categories were identified (5-mFI score = 0, 1 and >2). ResultsA total of 549 patients were assessed in the unmatched analysis. After the propensity score, 126 patients for each treatment group were matched. When stratified in different frailty-groups, 30-days postoperative complications occurred significantly more frequently in case of 5-mFI score >2 (p=0.001). Moreover, higher rate of both overall (52 vs 23%, p=0.01) and major (19.6 vs 8.2%, p=0.02) postoperative complications was found in these patients in case of transperitoneal MP RARP as compared to the extraperitoneal SP procedures. Exploring predictors of postoperative early complications in patients with 5-mFI score >2, extraperitoneal SP robotic approach showed a significant protective role on both overall (OR 0.21, p=0.001) and major (OR 0.33, p=0.001) complications occurrence. ConclusionsIn a matched cohort of patients treated with Robot Assisted Radical Prostatectomy, extraperitoneal Single Port approach significantly reduced the overall and major early complications rate in frail patients.

Undergoing Meniscectomy Within One Year Before Primary Total Knee Arthroplasty Is Associated With Worse Postoperative Outcomes

BackgroundPatients undergoing primary total knee arthroplasty (TKA) who have a history of meniscectomy have worse postoperative functional outcomes, increased rates of early postoperative complications, and higher revision rates. Despite knowing this, to the best of our knowledge, it has not been previously studied whether the timing of meniscectomy before TKA impacts functional outcomes after undergoing TKA. Compared to patients who underwent meniscectomy more than one year before TKA, do patients who have meniscectomy less than one year before TKA have significantly different postoperative outcomes? MethodsA retrospective cohort study was conducted at an academic medical center. Patients who did not have a history of meniscectomy (controls) were matched in a 1:3 ratio with patients who underwent meniscectomy before primary TKA (cases) based on age, sex, race, body mass index, and non-age-adjusted Charlson Comorbidity Index. Inclusion criteria consisted of patients undergoing TKA from 2013 to 2020, with a minimum of one-year follow-up for Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS-JR). Exclusion criteria comprised patients undergoing revision or conversion TKA. There were 1,767 patients in the control cohort and 589 patients in the cases cohort who were included. ResultsPreoperative KOOS-JR scores did not significantly differ between the five cohorts, while postoperative KOOS-JR scores were significantly lower for patients who underwent meniscectomy less than six months before TKA, and between six months and one year before TKA. Patients undergoing meniscectomy within six months of TKA had a significantly higher rate of aseptic revision, while patients who had a history of meniscectomy at other timeframes did not have a significantly increased rate of aseptic revision. ConclusionsPatients undergoing TKA who had a history of meniscectomy within one year of the TKA may experience worse postoperative functional outcomes, and patients undergoing meniscectomy within six months of TKA may have an increased risk of revision TKA.

Ранние и отдаленные результаты профилактики абдоминального компартмент-синдрома у пациентов с W3 вентральными грыжами

Abdominal compartment syndrome is a severe pathology requiring special preventive and treatment measures. The development of methods for the prevention of abdominal compartment syndrome is important in patients with W3 ventral hernias and loss of the domain. The study analyzed the results of treatment of 71 patients with W3 hernias of the anterior abdominal wall. Before surgery, all patients were calculated the size of the hernia implant necessary for the prevention of compartment syndrome. To calculate the size of the required hernia implant, radiography, ultrasonography and anthropometric data of the patient were used. The patients underwent hernioplasty with sublay, inlay and, developed by the authors, in a combined method. In the groups with inlay and combined method hernioplasty, the development of compartment syndrome was not observed. The combination of the developed methods of preoperative calculation of the hernia implant and the combined method of hernioplasty showed a low number of early and late postoperative complications, the same as in other study groups. The results obtained indicate the effectiveness of the developed methods for the prevention of abdominal compartment syndrome.

Мультидисциплинарный подход в лечении рецидива рака прямой кишки с вовлечением мочевых путей

Aim. To evaluate immediate and long-term oncological results ofsurgical treatment of recurrent rectal cancer involving the urinary tractsystem to show the need for a multidisciplinary treatment approach for locally advanced recurrent rectal cancer. Material and methods. Retrospective cohort analysis with prospective supported database. Analyzed 14 cases: all patients with locally advanced rectal cancer recurrence involving urinary tract system were operated at the Clinic of Coloproctology and Minimally Invasive Surgery in 2013-2022. Results. The age of the patients was 51.6 ± 13.0 years, 6 men, 8 women. The greatest recurrence number was (88%) finded in group of primary colorectal cancer of the lower and middle parts of the rectum. In 57.2% observations patients received preoperative chemotherapy or combination with radiotherapy. Approximately 64% of primary operations were performed using an open approach. Recurrence of CRC with pT3-T4 invasion was diagnosed in 72% of cases. Metastatic damage of lymphatic nodes after primary surgery were identified in 57.2% of cases. In 2 observations primary surgery was performed with R2 resection margin, relapse in that cases was detected after 11 and 13 months. One histopathological report indicated R1 resection, relapse noted after 6 months. Adjuvant chemotherapy was performed in 10 cases (71.4%), in two cases (14.3%) – postoperative radiation therapy. Average time for recurrence detecting after primary operation was 16.5 [12-28] months. Advanced combined interventions including recurrence removal with colon resection, gynecological and urological stages (RR+CR+GR+UR) amounted to 36%, recurrence removal with resection colon and urological stage (RR+CR+UR) was performed in 43% of cases, recurrence removal without the colonic stage (RR+GR+UR and RR+UR) - 3 (21%) patients. Reconstructive surgery to restore urine derivation were performed in 12 (85.7%) cases. The average duration of the procedures was 412.5[205-490] minutes, intraoperative blood loss - 275 [150-400] ml. Early postoperative complications are classified as Clavien-Dindo III. One patient with SIRS was classified as a complication Clavien-Dindo IV. The duration of the postoperative period was 25.5 [14-30] days. Postoperative mortality was 0%. According pathohistological examination R1 resection was detected in 3 (21.4%) cases. Adjuvant chemotherapy was performed 8 (57.1%) patients, in 1 case (7.1%) combination with a course of radiotherapy. During the period 24 months after surgery the mortality rate was 14.3%, repeated relapses diagnosed in 3 (21.4%) patients, one was reoperated. Distant metastases was noted in 4 (28.6%) patients, of which in 1 case with repeated recurrence. Discussion. Our urogenital bacterial diversity analysisshowed that human testicular tissue is not a microbiologically sterile environment and also presented new data associated with testicular tissue and its possible relations with male infertility. Conclusion. The main treatment method for locally advanced rectal cancer recurrence involving the urinary tract system is surgical. Multidisciplinary approach with the involvement in the surgical team urologist oncologist made it possible to perform a one-stage radical intervention for locally advanced recurrence of rectal cancer with restoration of derivation urine without the need for subsequent reconstructive procedures on the urinary system. Keywords: rectal cancer, urinary tract, multidisciplinary approach, surgical treatment, recurrence.

Precose Post-Operative Complications of Abdominal Surgery at the Communal Medical Center of Ratoma (CMC Ratoma)

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;Postoperative complications are incidents or accidents that may occur after any surgical intervention. They lead to the aggravation of the previous situation by their morbidity and even their mortality. The objective of this work was to study the early postoperative evolution in the digestive surgery and Maternity departments at the CMC of Ratoma. &amp;lt;i&amp;gt;Methodology&amp;lt;/i&amp;gt;: This was a descriptive prospective study over a period of (6) months from July 01, 2021 to December 31, 2021 carried out in the surgery and maternity departments of the Ratoma municipal center. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: we operated on 403 patients in the surgery and maternity departments of the CMC in Ratoma, of which 50 cases, or 12%, developed early postoperative complications. The age group of 20-30 years was the most affected 22 cases or 44% with an average age of 29.5 years, extremes of 3 years and 85. The female sex was dominant 36 cases or 78% of cases with a sex ratio of 3.5. The majority of patients 26 or 56% were operated on in the maternity ward, where caesarean section was the most performed surgical procedure. Emergencies were represented in 26 cases or 56% of surgical interventions, infection of the surgical site was the most common postoperative complication in 40 cases or 80%. All our suppurated patients benefited from a pus sample for cytobacteriological examination and were treated according to the result of the antibiogram plus local care. 72% of our patients were followed on an outpatient basis. The evolution was favorable in 44 of our patients, i e. 88%, and unfavorable in 6 of our patients, i e. 12%, including ISO, evisceration and death each in 2 cases, i e. a common rate of 4%. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Early postoperative complications were frequent at CMC Ratoma. Surgical site infections were the main early OCC presented by the patients. The management was medical and surgical. The evolution was favorable in most cases, however we recorded a few cases of death.

Primary Anterior Sagittal Anorectoplasty Shift from Staged to Single-stage Procedure for Low Anorectal Malformations in Female Children: Our Initial Experience in Single Centre.

Anorectal malformation (ARM) is a common congenital anomaly found in the paediatric age group. Previously, the repair of the vestibular fistula (VF) was performed as three-stage procedure with initial colostomy followed by a definite procedure and, lastly, colostomy closure. At present, a single-stage procedure is preferred, especially in lower anomalies owing to the convenient and time-saving approach. The clinical profile and outcome of ASARP for treatment of ARM in females (vestibular anus and perineal fistula). A retrospective analytical study was conducted at Government Medical College, Jammu. A total of 60 patients were included in the study. Most of the patients were in the age group of 1-5 years (30%), followed by 6 months-1 year age group (25%). Forty-five (75%) females had VF while 15 (25%) had perineal fistula. Intraoperative complication was vaginal tear seen in 6 (10%) patients followed by rectal tear seen in 3 (5%) patients. Early post-operative complications were seen in 9 (15%) patients. Wound infection was the most common complication seen in 5 (8.3%) patients, wound dehiscence in 3 (5%) patients and retraction of rectum in 1 (1.6%) patient. Late post-operative complications were seen in 24 (40%) patients. Perineal excoriation was the most common complication seen in 6 (10%) patients, constipation seen in 5 (8.3%) patients, anal stenosis in 4 (6.6%) patients and mucosal prolapse in 4 (6.6%) patients. The single-staged ASARP procedure resulted in satisfactory outcomes. It is an excellent procedure for females with VF and perineal fistula. Appropriate selection, preparation of patient, optimal correction with minimal sphincter damage and needful post-operative care of wound give excellent cosmetic and functional outcomes in terms of continence. It also decreases the burden on treating the surgeon, family and psychological stress on the patients and parents.

Prolonged operative time significantly impacts on the incidence of complications in spinal surgery

BackgroundIn spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient’s outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery.MethodsWe retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications.ResultsA total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events.ConclusionsThis study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient’s safety, without compromising the technical achievement of the procedure.

Development and Validation of a Mobile Phone Application for Measuring Knee Range of Motion.

Knee range of motion (ROM) is an important indicator of knee function. Outside the clinical setting, patients may not be able to accurately assess knee ROM, which may impair recovery following trauma or surgery. This study aims to validate a smartphone mobile application developed to measure knee ROM compared to visual and goniometer ROM measurements. A knee ROM Android mobile application was developed to measure knee ROM. Patients ≥ 18 years old presenting to an orthopaedic clinic with native knee complaints were approached to participate. Knee ROM was measured bilaterally by an arthroplasty-trained surgeon using (1) vision, (2) goniometer, and (3) the mobile application. Measurements were compared in flexion and extension using a one-way analysis of variance with post hoc Tukey test (alpha = 0.05). Eighty-four knee ROM measurements (40 left, 44 right) were obtained in 47 patients. Median Kellgren-Lawrence grade from available radiographs was grade 3. In flexion, mobile application (117.6 ± 14.7 degrees) measurements were not significantly different from visual (116.1 ± 13.6 degrees) or goniometer (116.2 ± 13.6 degrees) measurements. In extension, mobile application (4.8 ± 7.3 degrees) measurements were significantly different from visual (1.9 ± 4.1 degrees) measurements on post hoc analysis (p < 0.01), while no differences were present compared to goniometer (3.1 ± 5.8 degrees) measurements. Our study found that a mobile application for evaluating knee ROM was noninferior to goniometer-based measurements performed by an arthroplasty-trained surgeon. Future studies will investigate this application's utility in (1) remote patient care, (2) accelerating recovery during rehabilitation, (3) detecting early postoperative complications including arthrofibrosis, and (4) adding additional functionalities to the application to provide more detail-oriented descriptive analyses of patient knee function.

The Value of Systemic Inflammatory Indices for Predicting Early Postoperative Complications in Colorectal Cancer.

Background and Objectives: Systemic inflammatory indices have been largely investigated for their potential predictive value in multiple inflammatory, infectious, and oncological diseases; however, their value in colorectal cancer is still a subject of research. This study investigates the dynamics of pre- and postoperative values of NLR, PLR, SII, and MLR in patients with colorectal cancer and their predictive value for early postoperative outcomes. Materials and Methods: A 2-year retrospective cohort study was performed on 200 patients operated for colorectal adenocarcinoma. Systemic inflammatory indices were calculated based on complete blood count preoperatively and on the first and sixth postoperative days. The patients were divided into two groups based on their emergency or elective presentation. The pre- and postoperative values of serum inflammatory biomarkers and their correlations with postoperative outcomes were separately analyzed for the two study subgroups. Results: There were no significant differences in sex distribution, addressability, associated comorbidities, or types of surgery between the two groups. Patients in the emergency group presented higher preoperative and postoperative values of WBC, neutrophils, NLR, and SII compared to elective patients. The postsurgery hospital stays correlated well with pre- and postoperative day one and day six values of NLR (p = 0.001; 0.02; and <0.001), PLR (p < 0.001), SII (p = 0.037; <0.001; <0.001), and MLR (p = 0.002; p = 0.002; <0.001). In a multivariate analysis, reintervention risk was higher for emergency presentation and anemia, and lower in right colon cancer. In the emergency group, a multivariate model including age, MLR PO1, and pTNM stage was predictive for severe postoperative complications (AUC ROC 0.818). First-day postoperative inflammatory indices correlated well with sepsis, with the best predictive value being observed for the first postoperative day NLR (AUC 0.836; sensibility 88.8%; specificity 66.7%) and SII (AUC 0.796; sensitivity 66.6%; specificity 90%). For elective patients, the first postoperative day PLR and anemia were included in a multivariate model to predict Clavien-Dindo complications graded 3 or more (AUC ROC 0.818) and reintervention (AUC ROC 0.796). Conclusions: Easy-to-calculate and inexpensive systemic inflammatory biomarkers could be useful in predicting early postoperative outcomes in colorectal cancer for both elective and emergency surgery.

Perioperative Complications of Oblique Lumbar Interbody Fusion (OLIF): 5 Years of Experience with OLIF

Abstract Objective The objective of this study was to share our early experience with oblique lumbar interbody fusion (OLIF), with emphasis on the perioperative complications and determine clinical outcomes following OLIF. Materials and Methods It was a retrospective prospective study performed at a single institute from March 2019 to August 2023. A total of 56 consecutive patients who had undergone OLIF for degenerative spine disorders were enrolled in the study. Pre-, intra-, and postoperative data on these patients were collected. All the patients were followed up at regular intervals with an evaluation of Visual Analog Scale (VAS), Oswestry Disability Index (ODI), neurological parameters, and X-rays to look for fusion, screw loosening, pseudoarthrosis, and cage slippage. Statistical analysis was done with the odds ratio, chi-square test, and Student's t-test. A p-value of &lt; 0.05 was considered significant. Results The overall incidence of complications was 25%, with no mortality. Intraoperative complications were noted in 10.7% of cases. This included endplate fractures (n = 3), peritoneal lacerations (n = 2), and ureteric injury (n = 1). The most common early postoperative complications were postoperative ileus (n = 6), followed by anterior thigh or groin numbness (n = 3), ipsilateral psoas weakness (n = 2), and superficial surgical site infection (n = 2). Of the late postoperative complications, cage subsidence was the most common, which occurred in 4 patients, followed by adjacent segment degeneration (n = 2) and loss of indirect decompression (n = 1). The mean ODI and VAS scores showed significant improvement (p &lt; 0.05) at the final follow-up. Conclusion OLIF is a promising surgical technique with the potential to treat a variety of degenerative conditions of the lumbar spine with a good clinical outcome. Despite its various benefits, OLIF can lead to complications in rare instances, which every spine surgeon should be aware of.

Complications of Percutaneous Nephrolithotomy: Experience From a Tertiary Care Center.

Introduction Renal stones are mineral concretions in the pelvicalyceal system. Their prevalence and recurrence are increasing globally. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the removal of kidney stones. It is a safer technique offering the highest stone-free rates. However, a few complications may still occur. We aimed to evaluate our experiences of PCNL and classify the complications as intraoperative, early postoperative, and late postoperative events. We also aimed to find the predictors of complications in PCNL. Methods A single-center prospective observational study was conducted from June 2021 to October 2022 where all patients who were >18 years old with radiopaque calculus in the kidney and underwent PCNL were included. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). A p-value of <0.05 was considered significant. Results Two hundred one patients including 137 males and 64 females participated in the study. The overall rate of complications was 21.9%. Most of the patients (16.4%) experienced minor complications of Clavien grades 1 and 2. A Clavien grade of >3 included major complications and was noted in 5.5% of patients. No mortality was seen in the postoperative period. Female patients (p = 0.028), a stone burden of >3 cm (p = 0.003), stones in multiple calyces (p = 0.001), hydronephrosis (p = 0.001), history of recently treated urinary tract infection (UTI) (p < 0.001), longer operative time (>91 minutes) (p < 0.001), Guy's stone scores (GSS) III and IV (p < 0.001), complex renal calculi (staghorn) (p = 0.002), and multiple punctures (p = 0.001) were associated with higher complication rates after PCNL. Conclusion Most PCNL-related complications are minor and resolve with conservative or minimally invasive management. However, there are certain complications that can limit the surgical outcome. The overall complication rate in the current study is similar to that reported in the literature. Bleeding was the most common intraoperative complication, whereas hematuria was the most common early postoperative complication. A stone burden of >3 cm, hydronephrosis, longer operative time, higher GSS, and multiple punctures can all affect the rate of complications.

Clinical Outcomes of Mid-Urethral Sling Procedures for the Treatment of Female Urinary Incontinence: A Retrospective Cohort Study

Background: Urinary incontinence (UI) significantly affects women’s quality of life globally. Mid-urethral sling (MUS) procedures are common minimally invasive surgeries for treating stress urinary incontinence (SUI) and mixed urinary incontinence (MUI), but comparative outcome studies, especially regarding complication rates, are lacking. The purpose of this study was to assess and compare the efficacy and safety of the retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT) approaches in treating SUI and MUI. The study also aimed to investigate predictive factors for intraoperative and postoperative complications. Methods: A retrospective cohort study was conducted at King Saud University Medical City from February 2016 to October 2022, involving 166 women who underwent either TVT or TOT surgeries. Data were collected on intraoperative and postoperative complications, with statistical analyses performed using chi-square tests and multivariate regression to identify significant predictors of morbidity. Results: The study included 166 patients who underwent MUS procedures, with 61% (n = 102) undergoing retropubic TVT and 39% (n = 64) undergoing TOT surgeries. The demographic characteristics were similar between the groups, with no significant differences in age (p = 0.559), body mass index (BMI) (p = 0.600), or presence of cystocele (p = 0.912). The TVT group experienced a significantly higher rate of intraoperative bladder/urethral perforation compared to the TOT group (9.8% vs. 0%, p = 0.008). Early postoperative complications, including urinary retention, were comparable between the groups (TVT: 10.8%, TOT: 12.5%, p = 0.600). Patients in the TOT group had shorter hospital stays, with 71.9% discharged within one day compared to 41.2% in the TVT group (p &lt; 0.001). At long-term follow-up (&gt;6 months), both groups reported high satisfaction, with 93.7% of TVT and 87.3% of TOT patients reporting good or very good comfort (p = 0.252). However, pain-free status was significantly higher in the TVT group (91.1% vs. 67.2%, p &lt; 0.001). Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. Conclusions: Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. We recommend the formation of a national registry to track long-term outcomes and enhance procedural evidence.

Efficacy of Foldable Capsular Vitreous Body Implants Filled With Light or Heavy Silicone Oil in the Treatment of Silicone Oil-dependent Eyes.

The purpose of this study was to compare the clinical efficacy of foldable capsular vitreous body (FCVB) filled with either light or heavy silicone oil and the incidence of complications after their implantation for the treatment of severe ocular trauma and silicone oil-dependent eyes. FCVB filled with either light (n = 16) or heavy (n = 8) silicone oil was implanted in 24 patients. During the 12-month follow-up period, the intraocular pressure, final best-corrected visual acuity, retinal reattachment condition, position of the FCVB, and complications were assessed. All surgeries were performed without issue. There was no significant difference in preoperative and postoperative best-corrected visual acuity between the two groups. A significant improvement in the intraocular pressure was observed after surgery in both the light silicone oil (P = 0.029) and heavy silicone oil (P = 0.035) groups. None of the patients developed displacement or prolapse of the FCVB. The most common early and late postoperative complications were postoperative hemorrhage (33.3%) and corneal opacification (50%), respectively. FCVB filled with heavy silicone oil can be used as a supplemental therapy for patients who have lost the anterior segment of their eye, have lesions of the inferior retina, or cannot maintain the prone position for various reasons. Implantation of FCVB combined with heavy silicone oil compensates for the shortcomings of this with light silicone oil, providing patients with more personalized treatment.