Patients In Early Postoperative Period Research Articles

Acute Symptomatic Epileptic Seizures After Microsurgical Removal of Supratentorial Meningiomas

RELEVANCE. One of the problems complicating the early postoperative period in patients with supratentorial meningiomas is epileptic seizures, which in 9-16% of cases first develop within the first 7 days after tumor removal (acute symptomatic epileptic seizures).AIM OF THE STUDY. To identify risk factors for the occurrence of acute symptomatic epileptic seizures in the early postoperative period in patients with supratentorial meningiomas and to evaluate the effectiveness of prophylactic antiepileptic therapy.MATERIAL AND METHODS. A prospective, single-blind, randomized, placebo-controlled study was conducted using the sequential, alternate-arm randomization method. The treatment of 102 patients with supratentorial meningiomas was analyzed, in whom the tumor was removed between 01.01.2021 and 30.09.2023 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. To identify risk factors for the development of acute symptomatic epileptic seizures in patients, we assessed the data of the anamnesis, examination of the patient, electroencephalography before surgery, neuroimaging before and after tumor resection, as well as the characteristics of the intraoperative period, duration and outcomes of hospitalization. To evaluate the effectiveness of the prophylactic use of antiepileptic drugs, patients were divided into two groups. The first group consisted of 49 patients who took an antiepileptic drug as a prophylaxis of early epileptic seizures. The second group consisted of 53 patients who took a placebo drug. Both groups were divided into two subgroups each depending on the development of an epileptic seizure or its absence after surgery. In the first group, patients with epileptic seizures were considered the main subgroup, the patients without seizures were considered the control. We assessed the placebo group similarly.RESULTS. In the placebo group, a risk factor for the development of acute symptomatic epileptic seizures was the transection of one or more veins, which was necessary to achieve sufficient surgical access, leading to a change in cerebral venous blood flow (p=0.013, odds ratio (OR)=11.43; 95% CI [1.75–74.73]). In both the antiepileptic drug group and the placebo group, risk factors included an increase in the volume of cerebral edema according to postoperative CT scan data compared with preoperative (p=0.05, OR=18.8; 95% CI [2.0–182.7] and p=0.01, OR=12.6; 95% CI [2.36–68.0], respectively), as well as hemorrhagic transformation of the perifocal edema zone (p=0.03, OR=8.75; 95% CI [1.36–56.4] and p=0.02, OR=9.7; 95% CI [2.1–44.6], respectively). The efficacy of prophylactic use of antiepileptic drugs in reducing the incidence of acute symptomatic epileptic seizures in the first 7 days after surgery was not established (p=0.295, OR=0.533; 95% CI [0.181–1.572]).CONCLUSION. We have identified the following risk factors for the development of acute symptomatic epileptic seizures: an increase in the volume of cerebral edema compared to the preoperative level according to postoperative computed tomography, the development of hemorrhagic transformation of cerebral edema in both groups, and the intersection of one or more veins during surgery (in the placebo group). Confirmation of the efficacy of routine use of antiepileptic drugs for the prevention of acute symptomatic epileptic seizures not received.

Improvement of Single-port Laparoscopic Cholecystectomy

The desire of both surgeons and patients to reduce the trauma of the operation and shorten the length of hospital stay, on the one hand, and on the other hand, the development of new technologies and the emergence of special devices led to the development and implementation of video endoscopic minimally invasive methods of surgical intervention. The results of single-port laparoscopic cholecystectomy and the possibility of choosing instrumental support when performing these operations should be analyzed. Our study included 116 patients hospitalized for planned surgical treatment with chronic calculous cholecystitis from 2019 to 2023. The patients were divided into two groups: the first main group consisted of 52 (44.8%) patients with chronic calculous cholecystitis who underwent single-port laparoscopic cholecystectomy (SLP) using the single access technique (SAL). The second group (TLCE) consisted of 64 (55.2%) patients with CCC who underwent laparoscopic four-port cholecystectomy. A comparative analysis of the results of the intraoperative and early postoperative periods in patients after TLCE using the single access method, the number of complications was minimal than with TLCE using a four-port approach. Long-term results of surgical treatment of patients with cholelithiasis after OLCE using the single access method are characterized by the least complications, high cosmetic effect, and low morbidity.

Efficacy and Safety of Paragastric Neural Blockade in Controlling Pain, Nausea, and Vomiting After Sleeve Gastrectomy: A Randomized Controlled Trial

BackgroundThere are difficulties in controlling the symptoms of pain, nausea, and vomiting after laparoscopic sleeve gastrectomy (LSG). This study aimed to evaluate the efficacy and safety of PGNB on pain and nausea and vomiting in the early postoperative period in patients who underwent LSG.MethodsIn this prospective, randomized, controlled, double-blind study, the patients were divided into two equally formed groups: patients who underwent PGNB after LSG and the control group. Postoperative pain symptoms were evaluated using the visual analog scale (VAS) scores, and nausea and vomiting symptoms were evaluated using the postoperative nausea and vomiting (PONV) scores.ResultsThe study was completed with 90 patients, 45 patients in each group. The VAS scores measured at postoperative hours 1, 6, and 12 were statistically significantly lower in the PGNB group. There was no significant difference between the two groups in terms of the 24th hour VAS scores. The mean PONV scores of the PGNB and control groups were 0.47 ± 0.89 and 1.67 ± 1.95, respectively, revealing a significantly higher value for the controls. The mean time to first mobilization in the postoperative period was significantly shorter in the PGNB group. Upon the evaluation of patient satisfaction, it was determined that the satisfaction score of the PGNB group was significantly higher.ConclusionsPGNB is an effective and safe method for managing pain, nausea, and vomiting that occur in the early period after LSG.Graphical

Abstract PO4-12-03: PATIENT REPORTED OUTCOMES IN TERMS OF ARM AND SHOULDER FUNCTIONS AND QUALITY OF LIFE AND LYMPHEDEMA ARE AFFECTED BY THE STAGE, AND EXTENT OF AXILLARY SURGERY IN THE EARLY POSTOPERATIVE PERIOD OF PATIENTS WITH BREAST CANCER

Abstract This study evaluated whether lymphedema, patient-reported arm and shoulder morbidity and quality of life one year after axillary surgery are affected by stage or axillary surgery type between early stage patients and patients with locally advanced breast cancer who underwent surgery following neoadjuvant therapy. By determining the risk factors associated with severe lymphedema and deterioration of patient-reported outcomes, lymphedema could be prevented by early intervention to improve the prognosis of lymphedema and quality of life. Material and Methods: Between January 2021 and May 2022, a total of 253 breast cancer patients, 128 early stage and 125 locally advanced stage who underwent surgery including sentinel lymph node biopsy (SLNB) with/without axillary lymph node dissection (ALND) following neoadjuvant therapy were included in this study. The patients who underwent upfront surgery were defined as early-stage, and those who underwent surgery following neoadjuvant chemotherapy were considered as having locally advanced breast cancer (LABC) who have also participated in the prospective MF18-03 registry trial. Patients were prospectively evaluated by the SF-12 quality of life and QUICK-DASH hand, arm, and shoulder range of motion questionnaires and circumferential tape measurements of the arm width to evaluate the lymphedema before surgery, and 6 month- and 12-month assessments. The volume difference of 10% or more in the operated arm compared to the healthy arm was considered as lymphedema. Results: In the assessment of SF-12 quality of life questionnaire, there was a decrease in physical function scores at the 6th month despite recovery at the 12th month in both groups compared to the initial preoperative scores (p< 0,001). Moreover, patients with locally advanced breast cancer were found to have decreased SF-12 general health (p=0.024), vitality (p=0.034), and mental health scores in one year after surgery (p=0.004). Patients with mastectomy and locally advanced breast cancer were more likely to have a diminished arm and shoulder function as assessed with the QUICK-DASH questionnaire at the 6th and 12th months compared to those with breast conservation (6. month, p=0,009, 12. month, p=0.004), and early breast cancer, respectively (6. month, p=0.014, 12. month, p< 0.001) In the present cohort, lymphedema was detected in 19 (7.5%) patients including 16 cases with mild (11-20%), 2 cases with moderate (21-40%), and one case with severe (41-80%) lymphedema one year after surgery. Axillary dissection was found to be associated with an increased risk of lymphedema (SLNB, 5.0% vs ALND, 17.6%; p=0.005). Similarly, removal of >6 lymph nodes was also associated with an increased risk of lymphedema that was not statistically significant (<6 LNs, 6.4% vs >6LNs, 10.8%; p=0.277). Among those with LABC, however, patients with removal >6 LNs were more likely to have lymphedema (>6 LNs, 15.4% vs <6 LNs, 5.8%; p=0.096). Conclusion: These findings suggest that only an extensive axillary surgery was associated with an increased risk of breast cancer-related lymphedema. Patients with a mastectomy were more likely to have diminished arm and shoulder function compared to those with breast conservation. Furthermore, patients with locally advanced breast cancer were more likely to have a dispaired quality of life score and a limited arm and shoulder function regardless of the presence of lymphedema. Early prompt diagnosis and therapy of lymphedema can therefore potentially improve quality of life. Citation Format: Halime Gul Kilic, Selman Emiroglu, Ekin Ozgorgu, Mustafa Tukenmez, Atilla Bozdogan, Mahmut Muslumanoglu, Vahit Ozmen, Dilsad Sindel, Abdullah Igci, Aydan Oral, Neslihan Cabıoğlu. PATIENT REPORTED OUTCOMES IN TERMS OF ARM AND SHOULDER FUNCTIONS AND QUALITY OF LIFE AND LYMPHEDEMA ARE AFFECTED BY THE STAGE, AND EXTENT OF AXILLARY SURGERY IN THE EARLY POSTOPERATIVE PERIOD OF PATIENTS WITH BREAST CANCER [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-12-03.

Analysis of the course of the early postoperative period in patients with diastasis of the rectus abdominis after different methods of its surgical correction

Objective. To compare the indicators of the early postoperative period in patients with diastasis of the rectus abdominis after suture plication and after mesh implantation. Materials and methods. The study included 120 patients with diastasis of the rectus abdominis muscles. In 60 patients (group 1), a suture was used to correct the diastasis, and in another 60 patients (group 2), a prolene mesh was used. Results. The regression of pain in patients of group 1 on the 1st and 3rd postoperative days was more dynamic than in patients of group 2: pain decreased by 3.0 and 2.5 times, respectively. Mesh placement increased the risk of hyperthermia by 61%. The number of patients with complications in the groups was not statistically significant (p=0.265), but the difference between the number of patients with several complications was statistically significant (p=0.018). The use of mesh increased the risk of seroma by 64% (p=0.046), haematoma by 19% (p=0.819), wound infection by 36% (p=0.741), and paresthesia by 64% (p=0.025). Conclusions. The correction of diastasis of the rectus abdominis muscles with a suture is more acceptable than the correction with the help of mesh placement.

State of the microbial spectrum (microbiome) of the ocular surface of patients with cataracts and glaucoma in the early postoperative period

Background. The occurrence of infectious complications in the early postoperative period in patients undergoing ophthalmic surgery remains a persistent challenge in contemporary clinical practice. Typically the treatment regimen involves the administration of a combination of antibiotics and corticosteroids, often utilized in a fixed-dose combination for simplicity. Despite the prevalent use of these regimens, there’s a notable disregard for comprehensive microbiological diagnostics of the conjunctiva in surgical patients, attributed to various socio-economic factors. However, the significance of such diagnostics in forecasting postoperative outcomes is indisputable. Purpose of the study: to determine the medical and economic feasibility of prescribing individual antibacterial and anti-inflammatory medications in fixed combinations (FC) in postoperative treatment regimens for patients scheduled ophthalmic surgeries. Materials and methods. The study included data from 99 patients (65 males and 34 females, mean age 74 (70–77) years) admitted for elective surgery to address cataracts or glaucoma from May to September 2023. Patients were randomly divided to 2 observation groups. The division into groups was carried out according to the drugs (medicines) used in the postoperative treatment regimens, each of which was further divided into 2 subgroups in accordance with ophthalmopathology. The first group of patients received postoperative therapy with the levofloxacin/dexamethasone FC (L-dexopt, RK.O. Rompharm Company S.R.L., RU LP-007490), the second group was treated with a tobramycin/dexamethasone FC (Tobrazon, Kadila Pharmaceuticals, RU P№015176/01). All subjects underwent a comprehensive ophthalmological examination, as well as a microbiological examination of the conjunctival cavity before surgery and 8 days after surgical treatment. Additionally, all patients completed the Ocular Surface Disease Index (OSDI) questionnaire. Results. Analysis of microbial flora changes during therapy revealed an increase in cultures exhibiting a “zero” degree of growth by 29 and 11,1 % in the “cataract” and “glaucoma” subgroups of the fi rst observation group, respectively. The second group showed a similar increase. “zero” degree of growth (11,7 and 28,6 %, respectively). The treatment costs for patients undergoing cataract surgery and receiving the FC levofloxacin/ dexamethasone were 105.9 rubles per treatment course, compared to 40.5 rubles for those undergoing surgery for glaucoma or complicated cataracts. The cost-effectiveness for those treated with the FC tobramycin/dexamethasone in the early postoperative period was 21,6 and 51,9 rubles. respectively. The OSDI scores across in all subgroups ranged from 16,6 to 25,0 points indicating normal values. The administration of FC levofloxacin/dexamethasone and tobramycin/dexamethasone in the early postoperative period for patients with cataracts and glaucoma was clinically effectively in managing the inflammatory process by influencing the microbial spectrum (microbiome) of the ocular surface. No significant differences were observed in the degrees of microflora growth during the preoperative period between the “cataract” and “glaucoma” subgroups, which does not support the hypothesis regarding the antiseptic action of topical antiglaucoma medications in patients with glaucoma at this stage. Conclusions. The conducted medical and economic analysis proved the feasibility of using both drug combination with a slight preference FC levofloxacin/dexamethasone in patients undergoing surgery for glaucoma and FC tobramycin/dexamethasone for those with uncomplicated cataracts in the early postoperative period.

Results of Primary Arteriovenous Fistulas Formation with Different Types of Anastomoses in the Early Postoperative Period in Patients on Programmed Hemodialysis

The study includes the analysis of the results of using the different types of arteriovenous anastomoses in the formation of arteriovenous fistulas and their impact on fistula maturation in the early postoperative period. One of the main aspects of the work is to determine the optimal type of anastomosis to ensure the proper functioning of arteriovenous fistula that is an important element of vascular access in patients on renal replacement therapy. It is important to consider such factors as the diameter of formed arteriovenous fistula, the blood flow velocity through it, the incidence of complications and the duration of its functioning. The study also takes into account the impact of patients’ characteristics, such as age, condition of arteries and veins, as well as general health indicators on the results of surgery. Taking these factors into account allows to identify the groups of patients who can benefit most from a particular type of anastomosis.
 During the sample period, 384 patients with terminal stage of renal failure aged 20 to 84 years undergoing programmed hemodialysis, the native arteriovenous fistula was formed. It was found that 94.01 % of arteriovenous fistulas were successful in the early postoperative period. The average age of these patients was 44.2 years, while unsuccessful cases developed in people with an average age of 66.8 years. It was also found that within an hour after surgery for the formation of an arteriovenous fistula with the type end-to-side anastomosis, its diameter increases from 2.08±0.42 mm to 2.96±1.68 mm, and the blood flow velocity increases from 21.4±7.6 ml/min to 212.4±74.6 ml/min. The risk factor for effective fistula formation, in addition to age, is the diameter of vessels, anatomical features of the venous system, the presence of concomitant pathology (primarily diabetes mellitus).
 The obtained results can serve as a basis for the developing of recommendations for the optimal choice of anastomosis type for certain categories of patients who will undergo renal replacement therapy. The study is aimed at improving the results of surgical treatment and increasing the quality of life of patients with chronic renal failure.

Ultrasound-guided versus conventional lung recruitment manoeuvres in thoracic surgery: a randomised controlled study.

Lung recruitment manoeuvres (RMs) during mechanical ventilation may reduce atelectasis, however, the optimal recruitment strategy for patients undergoing thoracic surgery remains unknown. Our study was designed to investigate whether ultrasound-guided lung RMs is superior to conventional RMs in reducing perioperative atelectasis during thoracic surgery with one-lung ventilation. We conducted a randomised controlled clinical trial from August 2022 to September 2022. Sixty patients scheduled for video-assisted thoracoscopic surgery (VATS) under general anaesthesia were enrolled. Subjects were randomly divided into the ultrasound-guided RMs group (manual inflation guided by lung ultrasound) or conventional RMs group (manual inflation with 30 cmH2O pressure). Lung ultrasound were performed at three predefined time points (1min after anaesthetic induction; after RMs at the end of surgery; before discharge from postanesthesia care unit [PACU]). The primary outcome was lung ultrasound score before discharge from the PACU after extubation. In the early postoperative period, lung aeration deteriorated in both groups even after lung RMs. However, ultrasound-guided lung RMs had significantly lower lung ultrasound scores when compared with conventional RMs in bilateral lungs (2.0 [0.8-4.0] vs. 8.0 [3.8-10.3], P < 0.01) at the end of surgery, which remained before patients discharged from the PACU. Accordingly, the lower incidence of atelectasis was found in ultrasound-guided RMs group than in conventional RMs group (7% vs. 53%; P < 0.01) at the end of surgery. Ultrasound-guided RMs is superior to conventional RMs in improving lung aeration and reducing the incidence of lung atelectasis at early postoperative period in patients undergoing VATS. The study protocol was approved by the Institutional Review Board of the Fudan University Shanghai Cancer Center (No. 220,825,810; date of approval: August 5, 2022) and registered on Chinese Clinical Trial Registry (registration number: ChiCTR2200062761).

Comparison of patient Satisfaction of Return to Work in Early Post-operative Periods in patients with High Radial Nerve Injury undergoing Primary Nerve Repair Plus Tendon Transfer Versus Primary Nerve Repair Alone

Background: High radial nerve injuries present complex challenges in upper extremity reconstruction, impacting both motor and sensory functions. The decision-making process for choosing the appropriate surgical intervention involves careful consideration of various factors, including the type of nerve repair and the potential need for adjunct procedures like tendon transfer. Aim: To compare patient satisfaction outcomes between these two surgical approaches, assessing grip strength, pinch strength, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and Quality of Life (QOL) scores. Methodology: This prospective, comparative, and observational study included 62 participants, equally divided into two groups: Group 1 undergoing Primary Nerve Repair plus Tendon Transfer (n=31) and Group 2 undergoing Primary Nerve Repair Alone (n=31). Data collection involved patient interviews, medical records review, and standardized questionnaires, covering variables such as age, gender, occupation, type of surgery, duration of injury, post-operative pain levels, and patient-reported satisfaction scores. Statistical analysis using SPSS vr 23.0 included descriptive statistics, independent samples t-tests, and chi-square tests. Results: Results indicated significant improvements in grip strength (Mean ± SD: 35.2 ± 4.2 pounds, p &lt; 0.001), pinch strength (Mean ± SD: 7.9 ± 1.4 pounds, p = 1.081), DASH scores (Mean ± SD: 11.5 ± 2.9, p = 2.59), and QOL scores (Mean ± SD: 93.8 ± 7.3, p = 0.73) in both groups, emphasizing the positive impact of surgical interventions on functional outcomes and patient satisfaction. These findings contribute valuable insights into refining surgical strategies for high radial nerve injuries, emphasizing the enhancement of patient outcomes and satisfaction. Practical implication:The study's findings offer crucial guidance for surgeons in selecting optimal surgical strategies, ultimately leading to improved functional outcomes and higher patient satisfaction in individuals with high radial nerve injuries. Conclusion: Both surgical approaches demonstrated significant improvements in grip strength, pinch strength, disabilities of the arm, shoulder, and hand (DASH) scores, and Quality of Life (QOL) scores. Notably, grip strength showed a substantial increase (Mean ± SD: 35.2 ± 4.2 pounds, p &lt; 0.001) in both groups, emphasizing the positive impact of surgical interventions on upper limb function. While pinch strength and QOL scores showed non-significant changes, the overall findings underscore the effectiveness of both surgical strategies in enhancing functional outcomes and patient satisfaction in the early post-operative periods for high radial nerve injuries. Keywords: High radial nerve injury, nerve repair, tendon transfer, patient satisfaction, early return to work, observational study.

Patient selection criteria for transcatheter implantation of aortic valve

The aim – to conduct a literature review, analyze and, based on our own results, present an algorithm for choosing the tactics of surgical treatment of patients with severe aortic stenosis.Materials and methods. In this prospective study, the medical records of adult patients (from 18 years of age) who underwent surgical or transcatheter aortic valve replacement at the Heart Institute of the Ministry of Health of Ukraine, between 2018 and 2023 were analyzed.Results. The algorithm for the selection of surgical treatment of patients included in the study was built based on a thorough analysis of the anamnesis, clinical, laboratory and instrumental examination data. An important stage in choosing the optimal surgical tactics is the assessment of the development of intraoperative and postoperative complications according to the EuroSCORE and STS SCORE scales, which are most widely used in cardiac surgery practice and allow predicting the complicated course of the early postoperative period in patients with acquired valvular heart defects. Although there is an increasing trend towards TAVI in younger, lower-risk patients, the more frequent possibility of residual paravalvular insufficiency and the need for permanent pacemaker implantation should be considered. As the experience of interventional cardiologists increases and new valve designs and delivery systems are developed, better clinical outcomes and lower complication rates can be expected, which will contribute to the expansion of indications for TAVI.Conclusions. Today, TAVI remains the only way to correct aortic valve defects for inoperable patients with severe symptomatic aortic stenosis. Based on the results of several randomized controlled trials, TAVI is associated with a much lower rate of postoperative complications and a faster recovery, and should be the method of choice in all high surgical risk patients and a competitive alternative to aortic valve replacement in intermediate risk patients.

Clinical and functional status and postoperative complications in patients with chronic thromboembolic pulmonary hypertension in the age aspect

Aim. To study the clinical and functional status and the early postoperative follow-up in elderly patients with chronic thromboembolic pulmonary hypertension (CTEPH).Material and methods. Patients with CTEPH were divided into two groups: group 1 (35 people) – patients ≥65 years old, group 2 (98 people) – &lt;65 years old. The baseline clinical and functional data of both groups and the in-hospital period after pulmonary endarterectomy, were analysed.Results. Patients with CTEPH ≥65 years old compared with patients &lt;65 years old were characterized by a higher comorbidity, a higher incidence of adverse cardiovascular events and the presence of chronic heart failure IV class (p&lt;0.05). Echo-CG data in patients with CTEPH ≥65 years old were characterized by a large size of the left atrium, more pronounced hypertrophy of the right ventricle free wall, interventricular septum and the left ventricular posterior wall compared with younger patients (p&lt;0.05). Also, in patients ≥65 years old, lower values of the left ventricular ejection fraction were found with preservation of global myocardial contractility (p&lt;0.05). The early postoperative period in patients with CTEPH ≥65 years is characterized by a more severe course compared to the group of patients &lt;65 years due to a larger proportion of patients with the development of newly diagnosed atrial fibrillation, multiple organ failure and postoperative bleeding (p&lt;0.05). Despite this, there were no intergroup differences in the length of the hospital period and in-hospital mortality (p&gt;0.05).Conclusion. The early postoperative results of pulmonary endarterectomy in elderly patients with CTEPH showed no differences in the length of hospital stay and in-hospital mortality compared with younger patients, which indicates the feasibility of surgical treatment of this category of patients in the specialized cardiac surgical centers.

Prevalence of Diabetes Melitus, Glicemic Status in Periopeative Period and the Incidence of Complications in the Early Postoperative Period in Patients Operated for Heart Disease

Prevalence of Diabetes Melitus, Glicemic Status in Periopeative Period and the Incidence of Complications in the Early Postoperative Period in Patients Operated for Heart Disease

Effect of potential risk factors on renal functions in simultaneous bilateral total knee arthroplasty.

This retrospective study investigated the risk factors leading to a decrease in Renal glomerular filtration rate (eGFR) and the development of acute kidney injury (AKI) during the early postoperative period in patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA). SBTKA was performed on 862 patients between 2014 and 2021 in a single center, by a single surgeon. The risk factors affecting the development of AKI were analyzed by monitoring the changes in pre-and postoperative serum creatinine (Scr) levels and eGFR values. RIFLE criteria were used to evaluate the kidney functions of the patients, who were followed up for an average of 6 months. While there was no decrease in eGFR or AKI in 818 patients postoperatively, eGFR decreased and AKI of different stages developed in 44 patients, according to the RIFLE criteria. Of the 44 patients with AKI, 31 had Risk, 9 had Injury, 3 had Failure, and one had Loss of kidney function. Two patients with American Society of Anaesthesiologists (ASA) class IV died due to deepening of postoperative renal dysfunction. We found that the direct risk factors in SBTKA in terms of eGFR decrease and AKI development include long operation time, increased need for blood transfusion, and diabetic nephropathy, while increased body mass index (BMI) is an indirect risk factor. When planning for a SBTKA, we presume that a thorough analysis of these factors will decrease AKI risk.

Comparative analysis of early postoperative results of transcatheter aortic valve implantation and surgical aortic valve replacement with a biological prosthesis.

. Aim: The choice of aortic valve stenosis correction method is determined by a number of clinical and technical parameters. The task was to compare early postoperative outcomes in patients after correction of aortic valve stenosis using TAVI and surgical aortic valve replacement with a biological prosthesis. Materials and Methods: This retrospective study analyzed the medical records of adult patients (18 years of age and older) who had transcatheter aortic valve implantation or surgical aortic valve replacement with a biological prosthesis at the State Institution "Heart Institute of the Ministry of Health" in the period from 2018 to 2022. Results: In 47 (47.5%) cases, TAVI was performed and in 52 (52.5%) cases, SAVR with a biological prosthesis was performed. Patients who underwent TAVI were significantly older (p=0.002) and had a higher EuroSCORE II operative risk score (p<0.001). In patients with TAVI, larger diameter aortic valve prostheses were significantly more often used compared with the SAVR group with biological prosthesis (27.5±2.74 vs. 22.5±1.84, p<0.001). The early postoperative period in patients with TAVI was characterized by an 11.4% (p=0.046) and 15.4% (p=0.006). The length of stay in the ICU (p=0.024), as well as the duration of hospitalization in general (p=0.005), was also significantly lower in patients with TAVI compared with patients with biological prosthesis SAVR. Conclusions: Despite the higher surgical risk of surgery according to EuroSCORE II, TAVI was characterized by a lower incidence of postoperative complications, with shorter duration of stay in ICU and hospitalization in general in comparison with patients undergoing SAVR with a biological prosthesis.

Effect of bilateral low serratus anterior plane block on quality of recovery after trans-subxiphoid robotic thymectomy: Results of a randomized placebo-controlled trial.

Purpose: This study aimed to investigate the impact of ultrasound-guided, bilateral, low level (T8-T9) deep serratus anterior plane (DSAP) blocks on postoperative recovery quality and postoperative analgesia in patients undergoing trans-subxiphoid robotic thymectomy (TRT). Methods: 39 patients undergoing TRT were randomized to receive either low DSAP block under general anesthesia (Group S) or the sham block (Group C) on each side. The primary outcome was the QoR-40 score at postoperative day (POD) 1. Secondary outcomes included numeric rating scale (NRS) scores over time, postoperative 48 hours opioid consumption, QoR-40 scores at POD 2, 30, and 90. Results: The QoR-40 scores on POD1-2 were higher in Group S than in Group C [179.1 (4.9) vs 167.7 (2.8), P < 0.01; 187.7 (4.6) vs 178.1 (3), P < 0.01, respectively]. Pain scores were significantly lower in Group S, both during resting and motion at postoperative 6h, 12h, and 24h (P < 0.05 for each). The total amount of sufentanil consumed in the first 48 h was lower in Group S than in Group C [61.4 (4.9) vs 78.9 (4.6), P < 0.001]. Conclusion: The bilateral low DSAP blocks enhanced the QoR-40 for 2 days postoperatively, relieved postsurgical pain, and reduced opioid consumption during the early postoperative period in patients undergoing TRT.

Accuracy of wrist-worn activity trackers for measuring steps in patients after major abdominal surgery: A validation study.

Wearable activity trackers provide a simple and objective measurement of postoperative mobilization. However, few have validated the accuracy of trackers in patients after major abdominal surgery. To examine the accuracy of wrist-worn activity trackers to measure steps of patients in early mobilization after major abdominal surgery, and to explore the influence of clinical variables and gait parameters on the accuracy of trackers. Forty-five patients after major abdominal surgery were recruited to participate in modified six-minute walk tests wearing three trackers simultaneously, the Fitbit Inspire HR, Xiaomi MI 4, and HONOR 5. The differences in displayed steps before and after the walking test were considered as the step counts measured by the trackers; the actual steps taken were determined as the average of the values manually counted by two researchers. The intraclass correlation coefficient, Bland-Altman method, mean percentage error, and mean absolute percentage error were used to assess the accuracy of trackers with reference to manual step counts. The three trackers undercounted postoperative steps by -65.5% to -23.5%. Analysis showed low-to-good agreement between step counts recorded by trackers and actual steps (ICC = 0.35-0.75); the mean absolute percentage errors ranged from 24.5% to 65.7%. For all trackers, mean absolute percentage errors correlated negatively with postoperative days (r = -0.626 to -0.744), walking speed (r = -0.714 to -0.854), step length (r = -0.466 to -0.615), and cadence (r = -0.681 to -0.790), while there were positive correlations between mean absolute percentage errors and the number of abdominal drains (r = 0.450-0.514). The specific activity trackers used in this study might not be reliable tools for measuring steps counts during the walking test in the early postoperative period for patients undergoing major abdominal surgery.

COMPARATIVE ANALYSIS OF CONSERVATIVE AND SURGICAL TREATMENT OUTCOMES IN PATIENTS WITH DIAPHYSEAL HUMERUS FRACTURES

The frequency of diaphyseal humerus fractures varies from 1% to 5% of the total number of skeletal fractures in humans. A clear bimodal gender and age distribution of patients with fractures in the studied area has been established. The main methods of treatment for closed intra-articular humerus fractures are conservative functional and surgical treatment. Treatment of diaphyseal humerus trauma involves not only restoring the axis and length of the bone but also ensuring sufficient mobility of adjacent joints. The aim of the study was to conduct a comparative analysis of the outcomes of conservative and surgical treatment in patients with diaphyseal humerus fractures. The study involved 57 patients with diaphyseal humerus fractures aged from 19 to 83 years. The first clinical group comprised of 24 patients aged from 24 to 80 years who were treated using functional fixation devices. The second clinical group consisted of 33 patients aged from 19 to 83 years who were treated using surgical techniques, namely antegrade locked intramedullary nailing and cortical plate and screw osteosynthesis. Rehabilitation measures were initiated within the first two days for patients in the first group and in the early postoperative period for patients in the second group. The range of motion of adjacent joints was assessed using the CMS and MEPS scales. The use of surgical treatment techniques in combination with early rehabilitation measures, compared to conservative functional treatment, allows achieving significantly higher and statistically significant (p&lt;=0.01) functional outcomes of elbow joint mobility.

Usefulness of the N-Terminal of the Prohormone Brain Natriuretic Peptide in Predicting Acute Kidney Injury Requiring Renal Replacement Therapy in Patients Undergoing Heart Valve Surgery.

Background and Objectives: By definition, acute kidney injury (AKI) is a clinical syndrome diagnosed when the increase in serum creatinine concentration is >0.3 mg/dL in 48 h or >1.5-fold in the last seven days or when diuresis < 0.5 mL/kg/h for a consecutive 6 h. AKI is one of the severe complications that may occur in the early postoperative period in patients undergoing heart valve surgery, significantly increasing the risk of death. Early implementation of renal replacement therapy increases the chances of improving treatment results in patients with postoperative AKI. The study assessed the predictive ability of selected preoperative and perioperative parameters for the occurrence of postoperative AKI requiring renal replacement therapy in the early postoperative period in a group of patients with severe valvular heart disease. Materials and Methods: A prospective study was conducted on a group of patients undergoing consecutive heart valve surgeries. The primary endpoint was postoperative AKI requiring renal replacement therapy. AKI was diagnosed with an increase in serum creatinine > 0.3 mg/dL in 48 h or >1.5-fold in the previous 7 days and/or a decrease in diuresis < 0.5 mL/kg/h for 6 h. The observation period was until the patient was discharged home or death occurred. Logistic regression analysis was used to assess which variables were predictive of primary endpoint, and odds ratios (OR) were calculated with a 95% confidence interval (CI). Multivariate analysis was based on the result of single factor logistic regression, i.e., to further steps, all statistically significant variables were taken into consideration. Results: A total of 607 patients were included in the study. The primary endpoint occurred in 50 patients. At multivariate analysis: NT-proBNP (OR 1.406; 95% CI 1.015-1.949; p = 0.04), CRP (OR 1.523; 95% CI 1.171-1.980; p = 0.001), EuroSCORE II (OR 1.090; 95% CI 1.014-1.172; p = 0.01), age (OR 1.037; 95% CI 1.001-1.075; p = 0.04) and if they stayed in the intensive care unit longer than 2 days (OR 9.077; 95% CI 2.026-40.663; p = 0.004) remained the independent predictors of the primary endpoint. The mean preoperative NT-proBNP level was 2063 pg/mL (±1751). Thirty-eight patients with AKI requiring renal replacement therapy died in intrahospital follow-up. Conclusions: The results of the presented study indicate that a high preoperative level of NT-proBNP and postoperative hemodynamic instability may be associated with a significant risk of a postoperative AKI requiring renal replacement therapy. The results of the study may also suggest that qualifying for heart valve surgery earlier may be associated with improved prognosis in this group of patients.

Acute kidney injury and its predictors in surgery of malignant kidney tumors

Aim. To analyze our own results of the course of early postoperative period in patients who underwent surgical treatment of kidney tumors: partial nephrectomy (PN) and radical nephrectomy (RN) and to identify risk factors for the development of acute kidney injury (AKI).Materials and methods. The study included 399 patients, of which 276 patients (69.17 %) underwent PN, 123 (30.83 %) underwent RN. According to the clinical stage of the disease, patients in the PN and RN groups were distributed as follows: cT1a – 160 (91.95 %) and 14 (8.05 %), cT1b – 99 (61.11 %) and 63 (38.89 %) and cT2a – 17 (26.98 %) and 46 (73.02 %), respectively. Operations were performed with open (1.0 %), laparoscopic (39.35 %) and robot-assisted (59.65 %) accesses. AKI was evaluated by the changes in serum creatinine and glomerular filtration rate before surgery and 1–3 days after in accordance with KDIGO criteria.Results. The overall incidence of AKI after surgical treatment for kidney cancer at stages cT1a–cT2a was 27.57 %. The incidence of AKI after RN was 65.04 %, after PN – 11.23 %. At stages cT1a, cT1b, cT2a, after nephron-sparing surgery and radical treatment, this indicator was 9.37; 11.11; 29.41 % and 71.43; 63.49; 65.22 %, respectively. For warm ischemia time below 15 and 20 minutes, AKI incidence did not exceed 8.3 and 13.2 %, respectively. For warm ischemia time &gt;30 min, a dramatic increase in AKI incidence was observed.Conclusion. To preserve kidney function, PN is the operation of choice in surgical treatment of kidney tumors at stages cT1–cT2a. After RN, AKI development was observed 6 times more often than after PN. The following statistically significant predictors of AKI after PN were identified: presence of initial chronic kidney disease in patients, tumor size, operative time above 190 minutes, type of kidney ischemia used, and warm ischemia time above 25 minutes.

Postoperative Myocardial Injury and Inflammatory Biomarkers in Patients Undergoing Vascular Surgery: A Subanalysis of the Platelet Reactivity and Postoperative Myocardial Injury after Major Vascular Surgery (PROMISE) Study

BackgroundPostoperative myocardial injury (PMI) is associated with morbidity and mortality, but the aetiology remains unclear. We studied whether PMI is associated with perioperative systemic inflammation. ObjectiveTo examine the relationship between inflammatory biomarkers (Interleukin 6[IL-6], C-reactive protein [CRP]) and PMI, detected by elevated cardiac troponin (cTn), in patients undergoing elective open abdominal aortic surgery. MethodsThis prospective, single-centre, observational, cohort study included 54 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. IL-6 and CRP were measured pre-operatively, directly after surgery, 24h and 48h post-operative. The primary outcome was cTn release assessed by a fifth generation high-sensitive cTn assay. Multivariable generalized linear regression models were used to evaluate the association between inflammatory biomarkers and cTn concentrations. ResultsFifteen patients (27.8%) developed PMI. IL-6 directly and 24h post-operatively was associated with elevated cTn concentrations (1.28 [1.07-1.54], p=0.009)) and 1.75 [1.18-2.59], p=0.006, respectively). Also, CRP directly and 24h post-operatively was associated with elevated cTn concentrations (1.25 [1.06-1.47], p=0.009)) and 1.61 [1.1-2.33], p=0.013, respectively). No association was found between IL-6 or CRP and cTn concentrations when measured at 48h post-surgery. ConclusionBiomarkers of inflammation are associated with elevated post-operative cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.