Elective Surgery Group Research Articles

Effects of Total Hip or Knee Arthroplasty on Median Survival in Patients Aged 80 Years and Older

During the 20th century, the life expectancy increased by 30 years. At the same time, the number of people living longer than that has grown significantly. The aim of this study was to investigate whether total hip or knee arthroplasty (THA or TKA) in patients over 80 years of age does not reduce their life expectancy. The study examined the data of patients who had undergone THA or TKA between 1994 and 2002 and were older than 80 years at the time of surgery. The study group was divided into a group of patients in whom elective total hip or knee arthroplasty was performed for arthritis and into a group of patients who underwent the same procedure for proximal femur fracture. The investigated parameter was the real survival, which was compared with the life expectancy predicted by the Institute of Health Information and Statistics of the Czech Republic. We also monitored postoperative mortality and postoperative interval after which the life expectancy was no longer reduced. The study included 547 patients. Of whom, 96 patients underwent elective surgery (36%) and 351 patients underwent surgery for intracapsular hip fracture (64%). In the elective surgery group, the survival was longer than the national average: In the 80-84-year group, the median survival was 6.0 years vs. median life expectancy of 5.6 years; in the 85-89-year group, the median survival was 6.3 years vs. median life expectancy of 3.9 years. The fracture surgery group showed a decrease in the life expectancy compared to the national average - in the 80-84-year group, the median survival was 3.5 years vs. median life expectancy of 5.6 years, and in the 85-89-year group, the median survival was 2.9 years vs. median life expectancy of 3.9 years. The likelihood of postoperative mortality was significantly higher in the fracture group than in the elective group (p = 0.05 vs. 0.01), with the difference being the highest in the first 8 weeks after surgery. Correctly indicated THA or TKA in patients over 80 years of age improves the quality of life of these patients and does not reduce the life expectancy. Intracapsular femoral neck fractures in patients of that age can still be considered as an indication for surgical treatment as a life-saving procedure. total hip arthroplasty, total knee arthroplasty, osteoarthritis, hip fracture, life expectancy.

Surgical Service Utilization and In-Patient Satisfaction in Surgical Service.

The patient satisfaction study is an important and commonly used valid indicator for service quality improvement in healthcare institutions. The aim of this study was to assess the service utilization and patient satisfaction in patients admitted under surgical service in Bir Hospital. A prospective cross sectional analytical study was conducted in Bir Hospital, National Academy of Medical Sciences from February 2021 till June 2023. The patient satisfaction data was collected using the SAPS scale after obtaining ethical clearance from the Institutional Review Board. Data were entered and analyzed in Statistical Package for the Social Sciences version 20.0. There were 152 patients included in the study categorized into conservative treatment group, elective surgery group and emergency surgery group. 32.9%(50) patients were "very satisfied", 62.5%(95) patients were "satisfied", 2.6%(4) were "neither satisfied nor dissatisfied" and 2%(3) were "dissatisfied" with the effect of their treatment/care. The mean satisfaction score in conservative treatment group was 22.13 ±2.53 as compared to the mean satisfaction in elective surgery group which was 21.11± 2.55 (P=0.036) and the mean satisfaction score in emergency surgery group which was 21.66 ±2.68 (P=0.64). The mean score and proportion of patient satisfaction regarding service utilization in patients admitted under surgical service were high with satisfaction score higher in emergency surgery group among the operative groups in Bir Hospital, National Academy of Medical Sciences.

Acil inguinal hernilerde cerrahi yaklaşıma etki eden faktörler: Tek merkez deneyimi

Objective
 The aim is to establish the principles of surgery for patients who have undergone emergency groin hernia surgery by examining risk factors, diagnostic modalities, time to operation, and surgical techniques.
 Methods
 A retrospective analysis was conducted on patients who underwent groin hernia repair surgery between the years 2017 and 2022. The study evaluated various parameters such as demographic characteristics, physical examination findings, co-morbidities, radiologic assessments, operation notes, time of arrival to the hospital, and the duration of the operation. Data was collected from the hospital's electronic medical records system. Based on the mode of pre-operative assessment, patients were classified into two groups: group 1, comprising patients whose decision for surgery was based on physical examination alone, and group 2, comprising patients who underwent radiologic assessment prior to the operation.
 Result
 The risk evaluation of patients who underwent emergent hernia surgery revealed a higher incidence of women gender (25%) and femoral hernia type (16.6%) as compared to the elective surgery group, where the incidence was 6.7% and 1.6%, respectively. The diagnosis of patients was primarily based on physical examination findings, although radiologic methods were used preoperatively in 75% of the cases. It was observed that radiologic assessments increased the duration of the operation and resulted in higher morbidity and intestinal resection rates.
 Conclusion
 Radiologic methods, apart from in cases of suspected conditions such as obesity and recurrent hernias, may lead to delayed treatment and increased morbidity and mortality rates in patients undergoing emergent hernia surgery. Prompt surgical intervention based on physical examination findings is crucial in cases of strangulation or incarceration. In instances of spontaneous reduction, incisional exploration, hernioscopy, laparoscopy, or laparotomy should be considered if there is any suspicion of intestinal viability.

Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study.

Background: Limited information is currently available on the barriers to implementing mobilization at the bedside for critically ill patients. Therefore, we investigated the current practice of and barriers to the implementation of mobilization in intensive care units (ICU). Methods: A multicenter prospective observational study was conducted at nine hospitals between June 2019 and December 2019. Consecutive patients admitted to the ICU for more than 48 h were enrolled. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Results: The 203 patients enrolled in the present study were divided into 69 elective surgical patients and 134 unplanned admission patients. The mean periods of time until the initiation of rehabilitation programs after ICU admission were 2.9 ± 7.7 and 1.7 ± 2.0 days, respectively. Median ICU mobility scales were five (Interquartile range: three and eight) and six (Interquartile range: three and nine), respectively. The most common barriers to mobilization in the ICU were circulatory instability (29.9%) and a physician's order for postoperative bed rest (23.4%) in the unplanned admission and elective surgery groups, respectively. Conclusions: Rehabilitation programs were initiated later for unplanned admission patients and were less intense than those for elective surgical patients, irrespective of the time after ICU admission.

Pandemi Döneminde COVID Dışı Yoğun Bakımlardaki Postoperatif Hastaların Retrospektif Değerlendirilmesi

Objective: During the pandemic period, hospital admissions for reasons other than COVID-19 infection decreased compared to the pre-pandemic period. In our study, it was aimed to examine the surgical (emergency and elective) and anesthesia (general and regional) type, clinical and demographic characteristics, COVID-19 (Polymerase Chain Reaction (PCR) status, length of stay and mortality rates of postoperative patients hospitalized in the non-COVID-19 intensive care unit during the pandemic, retrospectively. Methods: The files of the patients hospitalized in the postoperative intensive care unit between March, 2021 and March, 2022 were reviewed retrospectively. The patients were divided into two groups as emergency (Group A) and elective surgery (Group E). Age, gender, reason and duration of hospitalization, accompanying comorbidities, COVID-19 PCR results, Acute Physiology and Chronic Health Evaluation II (APACHE) score, Glasgow coma scale and mortality rates of the patients were recorded. Results: Gender, APACHE II score and Glasgow coma scale were similar in both groups. However, there was a difference between the two groups in terms of age, length of stay, accompanying comorbidities, COVID-19 PCR results and mortality rates. Conclusion: The positive effect of the PCR test taken from elective surgeries in the preoperative period was observed. We think that the risk of COVID-19 infection is higher in patients undergoing emergency surgery and because of the high risk of transmission, isolation intensive care units are needed for these patients. Keywords: COVID-19, surgery, critical care

Outcomes following cholecystectomy in human immunodeficiency virus-positive patients treated with antiretroviral therapy: A retrospective cohort study.

The number of the human immunodeficiency virus (HIV)-positive patients are increasing worldwide, and more HIV-positive patients are undergoing urgent or elective cholecystectomy. There is still insufficient evidence on the relationship between surgical complications of cholecystectomy and antiviral status in HIV-positive patients. The purpose of the present study is to evaluate surgical outcomes after cholecystectomy in HIV-positive patients. Records of consecutive HIV-positive patients who underwent cholecystectomy between January 2010 and December 2020 were reviewed retrospectively. Patients were divided into urgent and elective surgery groups. Urgent surgery was defined as surgery within 48 hours of admission. Postoperative complications were evaluated according to the Clavien-Dindo classification. A total of 30 HIV-positive patients underwent urgent (n = 7) or elective (n = 23) cholecystectomy. Four complications (13.3%) occurred, and the rate was significantly higher in the urgent group than in the elective group (p = 0.008). However, all complications were minor (3 cases of grade I and one case of grade II), and there were no severe postoperative complications. There was no significant difference in CD4+ lymphocyte status in all patients and between the 2 groups before and after surgery (p = 0.133). No cases of postoperative deterioration in the control of HIV infection were observed. In conclusion, cholecystectomy in HIV-positive patients with controlled HIV under recent antiretroviral therapy may be performed safely even in an emergency situation.

Survival Outcomes after Elective or Emergency Surgery for Synchronous Stage IV Colorectal Cancer.

Patients with stage IV colorectal cancer (CRC) who have not undergone primary tumor resection (PTR) are at risk of sudden medical emergencies. Despite the ongoing controversy over the necessity and timing of PTR in patients with stage IV CRC, studies comparing the survival outcomes of elective and emergency surgery in this population are scarce. This is a retrospective study conducted at a single institute. The patients were divided into two groups: the elective surgery (ELS) group (n = 46) and the emergency surgery (EMS) group (n = 26). The primary outcome was 2-year overall survival (OS). During a median follow-up period of 27.0 months, the 2-year OS was significantly better in the ELS group (80% vs. 42.9%, p = 0.002). No significant differences were observed in the 2-year relapse-free survival and 30-day postoperative complication rates. Planning and performing elective surgery could help increase the survival rate of patients with synchronous stage IV CRC, especially those that undergo simultaneous or staged metastasectomy.

Perioperative outcomes of emergency and elective colorectal surgery: a bi-institutional study.

Emergency colorectal surgery tends to be associated with poorer outcomes compared to elective colorectal surgery. This study assessed the morbidity and mortality in patients undergoing emergency and elective colorectal resection in two metropolitan hospitals. Patients were identified retrospectively from two institutions between April 2018 and July 2020. Baseline, operative and postoperative parameters were collected for comparative analysis between emergency and elective surgery groups. A binary logistic regression was performed to identify independent predictors of postoperative complications. During the study period, 454 patients underwent colorectal resection, 135 were emergency cases (29.74%) and 319 were elective cases (70.26%). Compared with elective resections, patients undergoing emergency resections were observed to have a higher American Society of Anesthesiologists (ASA) score of III to IV (53.33% vs. 38.56%) (P= 0.004). The mortality rate was similar between the emergency and elective group (1.48% vs. 0.63%, P= 0.369). The overall complication rate was higher in patients undergoing emergency resections (64.44% vs. 36.68%, P< 0.001), but the major complication rate was similar between groups (12.59% vs. 10.34%, P= 0.484). Independent predictors for postoperative complications included emergency surgery (Odds Ratio (OR) 2.77, 95% Confidence Interval (CI): 1.66 to 4.61) and an ASA Score of III to IV (OR 2.87, 95% CI: 1.84 to 4.47). The overall complication rate was higher in patients undergoing emergency colorectal resection, however, rates of major complications and mortality were similar between groups. Higher complication rates reflect advanced disease pathology in patients who are more comorbid.

A comparative study of thumb reconstruction through the transplant of the first toe compound free flap between emergency surgery and elective surgery.

This study compared emergency surgery with elective surgery for thumb reconstruction to explore the advantages, safety, and clinical value of emergency reconstruction. By comparing the advantages and disadvantages of thumb reconstruction in emergency surgery and elective surgery, it provides data support for optimizing the treatment process and methods. In this study, 22 patients who underwent thumb reconstruction in Rizhao people’s Hospital from January 2018 to December 2020 were randomly divided into emergency operation group and elective operation group. The differences in operation period, hospitalization time, postoperative complications, hand function score, and satisfaction score between the 2 groups were analyzed. The operation period and hospitalization time of patients in the emergency surgery group were significantly lower than those in the elective surgery group, with statistical significance (P < .05). There was no significant difference in postoperative complications between the 2 groups (P > .05). After 3 months of rehabilitation training, the 2-point discrimination, functional score, and satisfaction score of the reconstructed thumb in the emergency surgery group were higher than those in the elective surgery group, and the difference was statistically significant (P < .05). Emergency reconstruction of the thumb can reduce operation time and hospitalization time, reduce operation costs, and obtain a more ideal appearance and function.

Analysis of risk factors related to severe postpartum hemorrhage of twin pregnancies delivered by cesarean section

ObjectiveTo investigate the risk factors of severe postpartum hemorrhage (PPH) in cesarean section of twin pregnancy, and to provide clinical basis for pregnancy management and perioperative obstetric management of twin pregnancy. MethodsThe clinical data of 631 twin pregnancies with gestational age ≥28 weeks delivered by cesarean section at Peking University People's Hospital (PKUPH) from January 2004 to January 2017 were retrospectively analyzed. Methods of conception, the combined weight of twins, serum albumin level before cesarean section, operation time and other factors on the amount of blood loss during cesarean section were analyzed. ResultsThe proportion of severe PPH was significantly higher in in vitro fertilization-embryo transfer (IVF-ET) group, the combined weight of twins > 6000g group, serum albumin before cesarean section < 30 ​g/dl group than in the natural pregnancy group, 4000–6000g group, < 4000g group and serum albumin ≥30 ​g/dl group respectively (P ​< ​0.05). The proportion of severe PPH in the elective surgery group of twin pregnancy was higher than that in the emergency surgery group, but the difference was not statistically significant (P ​> ​0.05). Moreover, according to the surgical indications, the emergency surgery group was divided into premature rupture of membranes (PROM), labor, fetal distress and others groups, no significant difference were detected among these groups (P>0.05). ConclusionIVF-ET, the combined weight of twins, serum albumin before operation were significantly correlated with severe PPH of twin pregnancies delivered by cesarean section, revealing that it is necessary to strengthen pregnancy management of twin pregnancy.

Causes of Suboptimal Preoxygenation Before Tracheal Intubation in Elective and Emergency Abdominal Surgery

Abstract Optimal preoxygenation (PO) prior to tracheal intubation reduces the risk of arterial desaturation and prolongs the period of safe apnoea. The common methods of PO are mask ventilation with 100% O2 for 3–5 minutes or, alternatively, asking the patient to take eight deep breaths in a minute. Our study group conducted a prospective study to assess the impact of the most common risk factors on PO and to compare the efficiency of PO in patients undergoing elective and emergency abdominal surgery without premedication. PO was performed using mask ventilation with 6 l/min of 100% oxygen for 5 minutes. End-tidal oxygen (EtO2) was documented in 30-second increments. We found that optimal PO (EtO2 &gt; 90%) was not achieved by almost half of the patients (46%) and that this was more common in the elective surgery group. Effective PO was not impacted by any of the evaluated risk factors for suboptimal oxygenation. Despite these findings, we believe that the identification of potential risk factors is crucial in the pre-anaesthesia stage, given the benefits of optimal PO.

Comparative evaluation of the advantages of single-layer closure to en-masse closure in the surgeries of the abdomen

Background: Closure of the abdomen is a vital step in abdominal surgeries, with advent of newer techniques for suturing and suture material, repair technique, and incision, which has evoked great interest among surgeons.Aim: To comparatively evaluate the advantages of single-layer closure to en-masse closure in the surgeries of the abdomen.Subjects and Methods: 64 subjects randomly divided into two groups of 32 subjects each where Group I was closed with single-layer closure, and, Group II with layered closure. The subjects were assessed postoperatively on days 1, 3, 7, and 10, and were compared for burst abdomen, infection, and operative time. The follow-up was done every month for first 3 months and then after 6 months.Results: Wound infection incidence was higher in Group II (layer closure) compared to Group I (mass closure). In the Group I, elective surgery group, wound infection was seen in 1 subject with an abdomen burst. In emergency surgery group, wound infection was seen in no subject with abdomen burst and subjects without abdomen burst. In Group II (layered closure), in elective surgery group, wound infection was seen in 5 study subjects.

The clinical outcomes of the radiologic method for self-expandable metal-stent placement in patients with colorectal obstruction: A prospective study

ObjectivesTo assess the clinical outcomes of self-expandable metal stent (SEMS) placement for patients with colorectal obstruction. MethodsA total of 61 patients underwent SEMS placement using computerized tomography (CT) to confirm malignancy of intrinsic origin and evaluate the exact location, notch, and extent of the disruptive laceration. ResultsThe overall technical success rate and clinical success rate of SEMS placement using the radiological method were 59 (96.7%) and 57 (93.4%), respectively. The technical success rate and clinical success rate of SEMS placement in the palliative and bridge to elective surgery (BTS) groups were 35 (97.2%), 24 (96.0%), 33 (91.7%), and 24 (96.0%). The median cumulative primary stent patency duration and patients’ survival of SEMS placement was 123 days (95% CI, 65–123 days), and 133 days (95% CI, 72–133 days). The median cumulative primary stent patency duration and patient survival did not differ significantly between the palliative group 119 days; (95% CI, 59–119 days), 128 days; (95% CI, 71–128 days), and the BTS group 120 days; (95% CI, 68–120 days; p = 0.362), 130 days; (95% CI, 78–130 days); p = 0.412). ConclusionsThe colorectal obstruction had convoluted with curved angulation and located mainly at the rectum, sigmoid, descending colon, and the radiologic method of SEMS placement has more efficacious with a high technical and clinical success rate. However, SEMS placement was highly technical, and clinical success with median stent patency and patient survival did not differ significantly between the palliative group and the BTS group.

Elective surgical versus conservative management of complicated diverticulitis: A systematic review and meta-analysis.

There is no consensus on the optimal treatment for patients with complicated diverticulitis. In this systematic review and meta-analysis we aimed to determine the indications for elective surgery in complicated diverticulitis by comparing conservative treatment with elective surgery. A meta-analysis of recurrence, morbidity and stoma rates was performed using a random effects model. Patient-reported quality of life (QoL) and cost-effectiveness outcomes were synthesized qualitatively. Eleven randomized controlled trials and non-randomized studies with a total of 7415 patients were included. In statistical terms, the recurrence of diverticulitis was significantly higher in the conservatively treated group than in the elective surgery group (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.12-0.51). The stoma rate (OR 2.34, 95% CI 1.88-2.92) and the morbidity rate (OR 4.29, 95% CI 2.24-8.23) were significantly higher in the elective surgery group than in the conservatively treated group. There was some evidence for a significant increase in QoL and long-term cost-effectiveness in the elective surgery group than in the conservatively treated group. Indications for elective surgery should not include the prevention of emergency colostomy or complications. Elective surgical resection may be considered in patients with complicated diverticulitis with the goal of improving their QoL and long-term cost-effectiveness.

Another Brick in the Wall of an Ongoing Discussion– Reduction of Anastomotic Leaks after Colorectal Resection by Preoperative Mechanical Bowel Preparation in Combination with Oral and Parenteral Antibiotics?–A Clinical Retrospective Single Center Study

Background: In colorectal surgery, postoperative Anastomotic Leak (AL) is a serious complication. Besides the surgeon`s experience, bowel preparation may have an impact on AL, but the published data are still inconclusive. The purpose of this retrospective single center study was to investigate the role of preoperative Mechanical Bowel Preparation (MBP) in combination with Oral Antibiotic Bowel Preparation (OBP) and parenteral antibiotics in a certified highvolume colorectal center. Methods: In the period of January 2017 to December 2019, all colon and rectal surgeries were recorded and separated into emergency and elective surgeries. Patients in the elective surgery group were further divided into two groups: patients with Bowel Preparation (BP) and patients without BP and were evaluated concerning to AL, postoperative hospital length of stay and mortality. Results: Between 2017 to 2019, 625 patients underwent colorectal surgery. 262 patients had emergency operations and were therefore excluded from the study. 363 patients underwent colorectal elective surgery (197men, 166 women). 44.0% received Combined Bowel Preparation (CBP), 46.8% received no BP, 3.3% received OBP only, 4.1% received MBP only, and for 1.1% nothing was documented. CBP was not only associated with a reduction in the rate of AL (P=0.038) (14.1% vs. 4.4%), but also with reduction in mortality (P=0.032) (7.6% vs. 1.2%) and length of stay (P=0.016) (14 vs. 11 days). Conclusion: Our retrospective data showed a significant impact of preoperative intestinal preparation with MBP in combination with OBP and parenteral antibiotics on AL, length of stay and mortality. Therefore we strongly recommend the use of this regimen of preoperative BP in elective colorectal surgery.

Urea–Creatinine Ratio (UCR) After Aneurysmal Subarachnoid Hemorrhage: Association of Protein Catabolism with Complication Rate and Outcome

The urea-creatinine ratio (UCR) has been proposed as potential biomarker for critical illness-associated catabolism. Its role in the context of aneurysmal subarachnoid hemorrhage (aSAH) remains to be elucidated, which was the aim of the present study. We enrolled 66 patients with aSAH with normal renal function and 36 patients undergoing elective cardiac surgery as a control group for the effects of surgery. In patients with aSAH, the predictive or diagnostic value of early (day 0-2) and critical (day 5-7) UCRs was assessed with regard to delayed cerebral ischemia (DCI), DCI-related infarction, and clinical outcome after 12 months. Preoperatively, UCR was similar both groups. Within 2 days postoperatively, UCRs increased significantly in patients in the elective cardiac surgery group (P < 0.001) but decreased back to baseline on day 5-7 (P= 0.245), whereas UCRs in patients with aSAH increased to significantly greater levels on day 5-7 (P= 0.028). Greater early or critical UCRs were associated with poor clinical outcomes (P= 0.015) or DCI (P= 0.011), DCI-related infarction (P= 0.006), and poor clinical outcomes (P<0.001) respectively. In multivariate analysis, there was an independent association between greater early UCRs and poor clinical outcomes (P= 0.026). In this exploratory study of UCR in the context of aSAH, greater early values were predictive for a poor clinical outcome after 12 months, whereas greater critical values were associated with DCI, DCI-related infarctions, and poor clinical outcomes. The clinical implications as well as the pathophysiologic relevance of protein catabolism should be explored further in the context of aSAH.

Comparison Of Emergency And Elective Colorectal Cancer Surgery- A Single Center Experience.

About one-third of colorectal cancer surgery are performed as urgent surgery. This retrospective study aims to compare urgent surgery with patients those performed elective colorectal cancer surgery. Matherials and Methods: One hundred and sixty patients data those performed colorectal cancer surgery were analysed retrospectively. Patients were divided into two group; urgent surgery group (n=29) and elective surgery group (n=131). Demographics and clinicopathological features of the groups were compared. There were no significant difference between groups in terms of age,blood transfusion requirement, additional surgical intervetion. Urgent surgery was performed more frequently in male patients .Urgent surgery has higher complication rates but no significant difference were observed in length of hospital stay. Total harvested lymph node number were similar between groups but in urgent surgery group metastatic lymph node number was significantly higher. Urgent colorectal resections for colorectal cancers can be performed with regarding the oncological principles.

Diagnosis and treatment of obturator hernia: retrospective analysis of 86 clinical cases at a single institution

BackgroundTo explore the clinical characteristics, diagnosis and treatment of obturator hernia.MethodsEighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed.ResultsThirty days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients (24/59, 40.7%). There were 4 deaths (4/59, 6.8%) in this group, all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3-year recurrence rates of 5.1% (3/59) and 7.1% (1/14) were observed in the emergency surgery and the elective surgery group, respectively.ConclusionsCT examination plays an important role in improving the diagnostic rate of obturator hernia. Timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, intestinal resection and postoperative complications may be the important factors leading to postoperative death.

The weekday effect on postoperative mortality in elective abdominal surgery: An observational study using propensity score methods

BackgroundAlthough the “weekday effect” may influence postoperative outcomes, controversies regarding its existence remain. The aim of this study was to investigate the association between the day of the week the surgery was performed and postoperative outcomes. MethodsData from 58,646 patients who underwent elective abdominal surgery at Seoul National University Bundang Hospital from May 2003 to February 2018 were retrospectively analyzed. Two elective surgery groups comprising of 33,513 (57.1%) and 25,113 (42.9%) patients who underwent surgery in the early and late days of the week, respectively, were analyzed. Late days of the week was defined as days where surgery was performed within 2 days before weekends or holidays and early days of the week as all other weekdays. These groups were balanced using inverse probability of treatment weighting. The adjusted 30-day mortality and length of hospital stay were compared. ResultsIn the weighted sample, all 52 clinical covariates were comparable between the 2 groups. The weighted sample analysis did not reveal a significant difference in the 30-day mortality between early days of the week and late days of the week (0.19% early days of week vs 0.18% late days of the week; relative risk, 0.97; 95% confidence interval, 0.66–1.50; P = .82). Similarly, the median length of hospital stay showed no significant difference between the 2 groups (median value for both groups, 5.0 days; interquartile range 3.0–8.0; relative risk, 1.00; 95% confidence interval, 0.97–1.03; P = .16). ConclusionA weekday effect associated with the day of elective surgery performed was not found in this study for either the 30-day postoperative mortality or length of hospital stay.

A comparison of clinicopathologic features of the patients with colorectal cancer cfter emergency and elective surgery

The importance of oncologic principles in colorectal cancer has been particularly emphasized in recent years. There are several studies on the quality of the conditions of emergency surgery and comparison of stage, mortality and morbidity rates between patient who underwent emergency and elective surgery. This study aimed to investigate and compare the clinicopathologic characteristics of patients with colorectal cancer according to their surgical conditions whether urgent or elective. Medical records of 564 patients, who underwent colorectal resection between January 2011 and March 2017 anddiagnosed with colon/rectum adenocarcinoma after pathological examination, were investigated ret-rospectively. There were 104 (18.4%) patients in the emergency surgery group and 460 (81.6%) patients in the electi-ve surgery group. Majority of the patients were male61.2%, and the mean age was 64.27. The patients who had rectal tumor were 19.7% of all cases, and the tumor was located in colonic segments in the remaining 80.3%. Low anterior resection was determined as the most common procedure with the percentage of 23.2%. Anterior resection was the most common procedure in emergency surgery group (27.9%). There was no significant difference between the mean lymph node count in terms of the type of the operation, on the basis of surgical condition. When the factors such as age, gender, tumor location, type of the operation and stage of cancer that have effects on adequate lymph node dissection, were analyzed; the only statistically significant difference was found between emergency and elective cases of the transverse colon tu-mors (p&lt;0.05). While postoperative complications had no effect on the length of hospital stay, having an os-tomy and an advanced cancer found to be prolonging this duration (p&lt;0.05). Surgical conditions have been shown to not affect the lymph node dissection which is an important factor determining the oncological process of the patient.