General Complications Research Articles

Current Trends in Total Ankle Replacement.

Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an alternative to total ankle arthrodesis to treat end-stage ankle arthritis. There are several generations of TAR techniques based on component design, implant material, and surgical technique. With more recent TAR implants, an attempt is made to minimize bone resection and mirror the native anatomy. There are more than 20 implant devices currently available. Implant survivorship varies among prosthesis types and generations, with improved outcomes reported with use of the more recent third- and fourth-generation ankle implants. Pre- and postoperative assessments of TAR are primarily performed by using weight-bearing radiography, with weight-bearing CT emerging as an additional imaging tool. Preoperative assessments include those of the tibiotalar angle, offset, and adjacent areas of arthritis requiring additional surgical procedures. US, nuclear medicine studies, and MRI can be used to troubleshoot complications. Effective radiologic assessment requires an understanding of the component design and corresponding normal perioperative imaging features of ankle implants, as well as recognition of common and device-specific complications. General complications seen at radiography include aseptic loosening, osteolysis, hardware subsidence, periprosthetic fracture, infection, gutter impingement, heterotopic ossification, and syndesmotic nonunion. The authors review several recent generations of TAR implants commonly used in the United States, normal pre- and postoperative imaging assessment, and imaging complications of TAR. Indications for advanced imaging of TAR are also reviewed. ©RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.

Robotic surgery versus conventional laparoscopy in colon cancer patients: a systematic review and meta-analysis.

To compare robotic versus laparoscopic colectomies in colon cancer patients in general complications. Nine databases were searched for randomized controlled trials (RCT) investigating patients with colon cancer, submitted to robotic surgery (RS) compared to a laparoscopic (LC) approach. The risk of bias was assessed using RoB 2.0 tool, and certainty of the evidence was evaluated by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Data synthesis was performed using the software R. The meta-analysis of the included studies was carried out using the fixed-effects model (DerSimonian and Laird). Heterogeneity was measured using I2 analysis. A total of four studies were used with 293 patients. Three studies were used in this comparative LC vs. RS when evaluating infection rates on surgical wound sites. The odds ratio (OR) appeared to be slightly favorable to LC (OR = 3.05; 95% confidence interval-95%CI 0.78-11.96). In the hospitalization rates analysis, two randomized controlled trials were used, and the mean differences slightly favored the RS (MD = -0.54; 95%CI -2.28-1.19). GRADE evaluation detected a serious risk of bias due to RCT format and RoB-2 concurred. Both types of procedures seem to have their own benefits, risks, and limitations. They seem close to equal in terms of postsurgical infection and hospitalization.

RESULTS OF LAPAROSCOPIC AND LAPAROTOMIC INTERVENTIONS FOR POSTOPERATIVE VENTRAL HERNIA

The study is based on a clinical examination of 105 patients with postoperative ventral hernias who were operated on in the surgical department of the multidisciplinary clinic of Samarkand State Medical University for the period from 2019 to 2023. Depending on the choice of operation, patients were divided into two groups:The first group (main group) consisted of 50 patients operated on laparoscopically, the second group, the comparison group included 55 patients who underwent open (traditional) prosthetic hernioplasty. The use of the laparoscopic "ipom" technique can significantly reduce the number of early postoperative and general complications (by 3.6 times), the duration of hospitalization (from10.2 ± 1.8days before6.2 ± 0.8days), periods of temporary disability (from40.9 ± 5.6days before15.1 ± 1.8days), and also reduce the number of relapses (from 10.9% to 2.0%).

A Validation of the Swedish Colorectal Cancer Register - With Focus on Histopathology, Complications and Recurrences.

There is an urgent need to evaluate the quality of healthcare systems to improve and deliver high-quality care. Clinical registries have become important platforms for performance measurements, improvements, and clinical research. Hence, the quality of data in registries is crucial. This study aimed to assess the validity of data in the Swedish Colorectal Cancer Register (SCRCR). Seven hundred patients from 12 hospitals were randomly selected and proportionally distributed among three different hospital categories in Sweden using two-stage cluster sampling. Validity was assessed by re-abstracting data from the medical files of patients reported to the SCRCR in 2015. Data on histopathology, postoperative complications, and a 3-year follow-up were selected for validation. Re-abstracted data were defined as source data, and validity was defined as the proportion of cases in the SRCRC dataset that agreed with the source data. Validity was expressed as the percentage of exact agreement of non-missing data in both data sets, and Cohen´s kappa coefficient (κ) was used to measure the strength of the agreement. The median agreement of the categorical histopathology variables was 93.4% (κ = 0.83). The general postoperative complication variable showed substantial agreement (84.3%, κ = 0.61). Likewise, the variable for overall cancer recurrence showed an almost perfect agreement (95.7%, κ = 0.86), whereas specific variables for local recurrence and distant recurrence displayed only moderate and fair agreement (85.9% and 89.1%, κ = 0.58 and 0.34, respectively). Validation of the SCRCR data showed high validity of pathology data and recurrence rates, whereas detailed data on recurrence were not as good. Data on postoperative complications were less reliable, although the incidence and Clavien-Dindo grading of severe complications (grade 3b or higher) were reliable.

Linking the impact of aspiration to host variables using the BOLUS framework: support from a rapid review.

The purpose of this rapid review was to identify the level of evidence for a previously proposed theoretical framework to assess risks associated with prandial aspiration using the host as a central theme. Covidence software was used to search two databases (PubMed and Web of Science). PEDro scale was utilized to determine the quality of individual studies. Data points were evaluated for level of support and determined to be either conclusive, suggestive, unclear, or not supportive. Within each component of the framework, data points were clustered to determine the level of evidence as strong, moderate, insufficient, or negative. The rapid review process resulted in a limited number of publications investigating host variables impact on outcomes for patients with swallowing disorders. Overall, it yielded 937 articles, of which, upon review, 16 articles were selected for data extraction. There was a strong level of evidence to support that (a) as viscosity and density of aspirate increased, so did the likelihood of general medical complications, (b) poor oral care and oral health increase the risk of a pulmonary or general medical complication, and (c) the presence of oropharyngeal or laryngeal tubes increases the risk of a pulmonary consequence. There was moderate evidence to support the impact of amount and frequency of aspiration on outcomes. There was insufficient evidence to determine relationships for all other aspects of the BOLUS framework. Additional evidence to support the BOLUS framework was obtained; however, the number of studies was limited. A more thorough review such as a systematic review should be employed.

Prognostic Nutritional Index as a Prognostic Indicator for the Occurrence of Postoperative Complications in Patients with Esophageal Squamous Cell Carcinoma Following Neoadjuvant Immunochemotherapy.

The objective of this study was to evaluate the prognostic nutritional index (PNI) as a predictor of short-term postoperative complications in esophageal squamous cell carcinoma patients undergoing neoadjuvant immunochemotherapy. Clinical data were collected from 77 patients undergoing radical esophageal cancer surgery after neoadjuvant immunochemotherapy at Tongji Hospital from January 2022 to January 2023. The receiver operating characteristic curve (ROC) was utilized to establish the optimal cut-off point for the PNI. Subsequently, patients were stratified into low and high PNI groups according to this cut-off point, and comparisons were made between the two groups in terms of clinical data and postoperative complications. Out of the 77 patients included in the study, 31 were categorized in the low PNI group and 46 in the high PNI group, with a defined cutoff point of 47.38. Significant statistical variances were noted in the occurrence rates of general complications (P < 0.001), pulmonary infections (P < 0.001), and anastomotic fistula (P = 0.034) between the two groups. The low PNI group displayed elevated rates of these complications in comparison to the high PNI group. The research findings indicate that preoperative nutritional assessment using the PNI can effectively predict short-term postoperative complications in esophageal squamous cell carcinoma patients who have undergone neoadjuvant therapy. Furthermore, the results suggest that implementing nutritional interventions for patients with moderate-to-severe malnutrition, as indicated by preoperative PNI evaluation, may help reduce the incidence of postoperative complications.

Value of the Rapid Immunochromatographic Test for Diagnostic Guidance in the Diagnosis of Pharyngo-Tonsillitis Caused by Group A Hemolytic Beta Streptococcus (Abhs) In Southern Benin

Background: Group A beta-hemolytic streptococcus (ABHS) tonsillitis is an acute disease that is often benign but sometimes serious due to its locoregional and general complications. It is a frequent cause of consultation among general practitioners, ENT and paediatrics. The choice and interest of our work was motivated by the fact that one of the most important acute upper respiratory infections is tonsillitis with the risk of serious complications. This study aims to determine the sensitivity and specificity of RDOT in the diagnosis of ABHA tonsillitis in southern Benin. Methods: This was a prospective analytical and descriptive study carried out at the Vallée de Grâce Medical Clinic (CM VG) and at the Padre Pio Humanitarian Health Center (CSVH), at the Laboratory of Biology and Molecular Typing in Microbiology / UAC, in Benin over 12 months (July 2, 2022 and June 31, 2023). It included patients diagnosed with tonsillitis. All the patients included underwent a RDOT and a cytobacteriological examination of the throat swab (Gold Standard). We studied the following variables: age, sex, months, clinical signs, cytobacteriological examination of the throat swab and TROD results. Results: We recorded 272 tonsillitis cases. 60 cases of group A beta-hemolytic streptococcal (ABHS) tonsillitis are confirmed by bacterial culture. Group A beta-hemolytic streptococcal tonsillitis accounted for 22.06% of tonsillitis. 133 men (49%) and 139 women (51%) were registered. 32 men (53.33%) and 28 women (46.67%) had SBHA tonsillitis. The highest frequency of isolation of group A streptococcus was observed in the age group [0 to 5[years with 27 cases out of 60, i.e. a proportion of 45%. SBHA tonsillitis are more frequent in the months of December and August with the respective proportions of 16.67% and 10%. The SBHA TROD performed showed a Sensitivity of 95%, a Specificity of 94%, a positive predictive value of 92% and a negative predictive value of 98%. Conclusion: Streptococcal etiology represents 22.06% of tonsillitis in Benin. Our results reinforce the interest of RDOT and especially cytobacteriological examination in the etiological diagnosis of tonsillitis.

Mean-Variance Serum Sodium Associations with Diabetes Patients

Serum sodium (SNa) is a critically significant component of hyponatremia and bones, has firmly been established as a risk factor correlated with many diseases such as diabetes, heart, anaemia, etc and the incidence of fragility fractures. Note that the fragility fractures are a general complication in type 2 diabetes (T2D) patients, contributing to high rates of mortality and morbidity together with mounting public health costs. SNa is a fundamental component for normal physiological processes, and T2D patients may experience osmotic diuresis as a consequence of disease-related hyperglycemia, contributing to the excess excretion of sodium in the urine and resulting in hyponatremia. Dysnatremias [hyponatremia (&lt;136 mmol/L) and hypernatremia (&gt;145mmol/L)] can severely affect several physiologic organ systems and functions. Diabetes is correlated with many important electrolyte disorders, predominantly affecting magnesium, SNa, and potassium. However, the correlation/ association of SNa with diabetes patients is not clear. This can be confirmed based on the proper probabilistic model of SNa with diabetes status along with the other explanatory factors of the disease. On the other hand, this type of association can be obtained based on the models of fasting glucose/post glucose/random glucose/HbA1c level with SNa and other explanatory factors of the diabetes disease.

Early Postoperative Complications of One-Stage Substitution Urethroplasty with Oral Mucosa Graft: A Monocentric Retrospective Study

Introduction: We report early postoperative complications (PCs) (≤90 days) of one-stage oral mucosa graft (OMG) urethroplasty in treatment of acquired anterior urethral strictures. Material and Methods: In this study, we evaluated 530 males who underwent one-stage substitution urethroplasty (SU) between September 1996 and October 2020. Medical records were reviewed to identify and classify early PCs based on the Clavien-Dindo classification (CDC). We subdivided the PCs into three groups with different kinds of complications which allowed us a more detailed analysis concerning general surgical complications (GSCs), donor site morbidity (DSM) and complications specific for free graft urethroplasty (CSUs). The influence of patient demographics, stricture characteristics and operative procedure on the occurrence of PCs was analysed. Results: Early (90-day) PCs occurred in 90 (16.98%) patients, whereas only 19 patients (3.58%) experienced serious events (CDC grades III and IV). Early complications include 4.5% GSCs, 1.7% DSM and 10.8% CSUs. Only stricture length turned out to be an independent statistically significant risk factor for the occurrence of early PCs. There was a trend towards a higher rate of complications in patients with ASA III compared to ASA I. Conclusion: The incidence of severe early complications in patients undergoing one-stage SU with OMG is low.

The Impact of Standardized Emergency Care on Acute Stroke Treatment and Recovery Time

Objective: To investigate the clinical benefits derived from the implementation of standardized emergency care for patients experiencing acute strokes. Methods: One hundred cases of acute stroke were categorized based on the admission order, with 50 cases per group. The control group received routine emergency care, while the observation group received standardized emergency care. A comparison of the general observation indicators and complication rates of emergency care was conducted. Results: The observation group exhibited shorter pre-examination and assessment time, quicker physician reception time, faster emergency green channel treatment time, and reduced door-to-needle time compared to the control group (P &lt; 0.05). Moreover, the emergency treatment success rate was higher, and the total number of complications was lower in the observation group than in the control group (P &lt; 0.05). Conclusion: The implementation of standardized emergency care proves effective in reducing treatment and recovery times for acute stroke patients. It enhances the success rate of emergency treatment and diminishes the risk of associated complications. These findings underscore the significance of promoting standardized emergency care for acute stroke patients.

Engineering a highly selective leucine aminopeptidase near-infrared fluorescence probe for early diagnosis of diabetic nephropathy

Diabetic nephropathy (DN) is one of the most serious and general complications of diabetes, while schedules for prevention and treatment are unsatisfactory. Leucine aminopeptidase (LAP) as one of the biomarkers of DN is associated with glomerular and/or tubular injury. Imaging of LAP activity in DN disease model in vivo is thus beneficial for early diagnosis and prevention of DN, but such a strategy is still lacking. Herein, an enzyme-activated probe HD-LAP with a NIR fluorescence emission for specific detection of LAP activity in the DN model is designed and synthesized. HD-LAP has a significant fluorescence enhancement after reacted with LAP and shows a NIR fluorescence emission at 704 nm based on intramolecular charge transfer mechanism. Moreover, HD-LAP can be employed to image LAP activity in HK-2 and HepG2 cells. More importantly, HD-LAP is the first example to real-time image LAP in DN mice and clinical serum samples. These results demonstrated that HD-LAP is promising as a powerful tool for the research on LAP associated diabetic diseases in future.

Enhanced recovery and same-day discharge after brain tumor surgery under general anesthesia: initial experience with Hospital-at-Home-based postoperative follow-up.

The objective of this study was to describe the outcomes of outpatient oncological neurosurgery (OON) in a European clinical setting and to compare them with the conventional inpatient protocol. Patients who had undergone OON (either tumor removal or biopsy) at the authors' center since 2019 were analyzed. A matched cohort of patients was selected from patients undergoing tumor surgery in the same period. Collected data included patient demographics, postoperative progress, specific location of the target lesion, and the procedure performed. There were 18 patients in the case group and 59 patients in the control group. The outpatient surgeries had a same-day discharge rate of 89%, and all ambulatory patients successfully completed the Enhanced Recovery After Surgery program within 6.24 hours of the procedure. All ambulatory patients underwent Hospital-at-Home postoperative follow-up for an average of 4.12 days. Radiological complications were present in 11% of the case group and 8% of the control group. Postoperative neurological deficit occurred in 6% of the same-day discharge group and 3% of the control group. Among the patients in the control group, 3% suffered from postoperative seizures, whereas no seizures were observed in the case group. These differences were not statistically significant. General anesthesia-related complications were not observed in any of the patients. The authors' findings demonstrate that Enhanced Recovery After Surgery protocols and same-day discharge craniotomy for tumor resection and image-guided biopsy under general anesthesia, when patients are carefully selected, can be safely performed with excellent outcomes in a European clinical setting. The OON program proved to be a viable alternative to conventional hospitalization, showing comparable safety records and offering advantages in terms of patient recovery.

Single- and Multilevel Corpectomy and Vertebral body replacement for treatment of spinal infections. A retrospective single-center study of 100 cases

BackgroundThe optimal operative approach for treating spinal infections remains a subject of debate. Corpectomy and Vertebral Body Replacement (VBR) have emerged as common modalities, yet data on their feasibility and complication profiles are limited. MethodsThis retrospective single-center study examined 100 consecutive cases (2015–2022) that underwent VBR for spinal infection treatment. A comparison between Single-level-VBR and Multi-level-VBR was performed, evaluating patient profiles, revision rates, and outcomes. ResultsAmong 360 cases treated for spinal infections, 100 underwent VBR, located in all spinal regions. Average clinical and radiologic follow-up spanned 1.5 years. Single-level-VBR was performed in 60 cases, Two-level-VBR in 37, Three-level-VBR in 2, and Four-level-VBR in one case.Mean overall sagittal correction reached 10° (range 0–54°), varying by region. Revision surgery was required in 31 cases. Aseptic mechanical complications (8% pedicle screw loosening, 3% cage subsidence, 6% aseptic adjacent disc disease) were prominent reasons for revision. Longer posterior constructs (>4 levels) had significantly higher revision rates (p < 0.01). General complications (wound healing, hematoma) followed, along with infection relapse and adjacent disc infection (9%) and neurologic impairment (1%).Multilevel-VBR (≥2 levels) displayed no elevated cage subsidence rate compared to Single-level-VBR. Three deaths occurred (43–86 days post-op), all in the Multi-level-VBR group. ConclusionThis study, reporting the largest number of VBR cases for spinal infection treatment, affirmed VBR's effectiveness in sagittal imbalance correction. The overall survival was high, while reinfection rates matched other surgical studies. Anterior procedures have minimal implant related risks, but extended dorsal instrumentation elevates revision surgery likelihood.

Long-term prognosis of fatty-acid oxidation disorders in adults: Optimism despite the limited effective therapies available.

Fatty-acid oxidation disorders (FAODs) are recessive genetic diseases. We report here clinical and paraclinical data from a retrospective study of 44 adults with muscular FAODs from six French reference centers for neuromuscular or metabolic diseases. The study cohort consisted of 44 adult patients: 14 with carnitine palmitoyl transferase 2 deficiency (32%), nine with multiple acyl-CoA deficiency (20%), 13 with very long-chain acyl-CoA dehydrogenase deficiency (30%), three with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (7%), and five with short-chain acyl-CoA dehydrogenase deficiency (11%). Disease onset occurred during childhood in the majority of patients (59%), with a mean age at onset of 15 years (range = 0.5-35) and a mean of 12.6 years (range = 0-58) from disease onset to diagnosis. The principal symptoms were acute muscle manifestations (rhabdomyolysis, exercise intolerance, myalgia), sometimes associated with permanent muscle weakness. Episodes of rhabdomyolysis were frequent (84%), with a mean creatinine kinase level of 68,958 U/L (range = 660-300,000). General metabolic complications were observed in 58% of patients, respiratory manifestations in 18% of cases, and cardiological manifestations in 9% of cases. Fasting acylcarnitine profile was used to orient genetic explorations in 65% of cases. After a mean follow-up of 10 years, 33% of patients were asymptomatic and 56% continued to display symptoms after exercise. The frequency of rhabdomyolysis decreased after diagnosis in 64% of cases. A standardized register would complete this cohort description of muscular forms of FAODs with exhaustive data, making it possible to assess the efficacy of therapeutic protocols in real-life conditions and during the long-term follow-up of patients.

Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications.

A maxillary sinus lift procedure is indicated if a dental implant needs to be placed in the posterior maxilla with limited bone available to accommodate a dental implant. Both open and closed sinus lifting procedures are reliable approaches for increasing the bone volume needed to support proper implant positioning. However, these methods can lead to several complications. In addition to the general complications commonly linked to oral surgery, such as swelling or hematoma, the primary complication in open sinus lifting is typically the perforation of the Schneiderian membrane during osteotomy. Detailed and extensive presurgical evaluation is crucial to minimize such complications. The objective of this study was to delineate contemporary trends in sinus lift surgery, with a specific emphasis on different techniques of sinus lift procedure, anatomical and surgical factors, presurgical evaluation, bone grafting, and the practical implications of these factors in implant dentistry cases involving a deficient posterior maxilla. In conclusion, while both osteotome and lateral window techniques can assist clinicians in addressing the complexities of implant placement in a deficient posterior maxilla, bone height before implantation remains a critical factor in determining the success and longevity of implants.

What determines complications and prognosis among patients subject to multivisceral resections for locally advanced gastric cancer?

BackgroundLocally advanced gastric cancer (GC) extending to the surrounding tissues may require a multivisceral resection (MVR) to provide the best chance of cure. However, little is known about how the extent of organ resection affects the risks and benefits of surgery.MethodsAn electronic database of patients treated between 1996 and 2020 in an academic surgical centre was reviewed. MVRs were defined as partial or total gastrectomy combined with splenectomy, distal pancreatectomy, or partial colectomy.ResultsSuspected intraoperative tumour invasion of perigastric organs (cT4b) was found in 298 of 1476 patients with non-metastatic GC, and 218 were subject to MVRs, including the spleen (n = 126), pancreas (n = 51), and colon (n = 41). MVRs were associated with higher proportions of surgical and general complications, but not mortality. A nomogram was developed to predict the risk of major postoperative morbidity (Clavien–Dindo’s grade ≥ 3a), and the highest odds ratio for major morbidity identified by logistic regression modelling was found for distal pancreatectomy (2.53, 95% CI 1.23–5.19, P = 0.012) and colectomy (2.29, 95% CI 1.04–5.09, P = 0.035). Margin-positive resections were identified by the Cox proportional hazards model as the most important risk factor for patients’ survival (hazard ratio 1.47, 95% CI 1.10–1.97). The extent of organ resection did not affect prognosis, but a MVR was the only factor reducing the risk of margin positivity (OR 0.44, 95% CI 0.21–0.87).ConclusionsThe risk of multivisceral resections is associated with the organ being removed, but only MVRs increase the odds of complete tumour clearance for locally advanced gastric cancer.

Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis.

Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90days mortality. We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18years old) with postoperative primary or recurrent median abdominal wall defects larger than 6cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index-BMI, American Society of Anesthesiologists Classification-ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell's equation. Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370-2.125, p = 0.788; OR 1.50, 95% CI 0.677-3.33, p = 0.318 and OR 0.386, 95% CI 0.117-1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004). Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn't find any specific factor related to complications.

Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study

IntroductionShort stems are a valuable option in young patients undergoing total hip arthroplasty (THA) because of their bone stock preserving properties facilitating revision hip arthroplasty. Although the effect of obesity on conventional THA is well studied, data about short stem THA in obese patients are lacking. Therefore, this study aimed to investigate the influence of obesity on complications, revisions, and outcome after short stem THA.Materials and methodsThis multicenter, observational cohort study included patients undergoing short stem THA with the optimys prosthesis. Follow-up examinations were performed at specific intervals up to 7 years postoperatively. Operation characteristics, general and specific complications, revisions, VAS rest pain, VAS load pain, VAS patient satisfaction, and Harris Hip Score (HHS) were recorded and statistically compared between obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) patients.ResultsOf the 224 patients included with a mean follow-up of 87.2 months (range 81.9–104.0), 69 were assigned to the OB group and 155 to the non-OB group. A minimally invasive approach was significantly less often selected in obese patients (p = 0.049), whereas operating time and length of hospital stay were not significantly different. The rate of general and specific complications did not significantly differ between both groups. Survival of the optimys prosthesis was 99.1% at 7-year follow-up and one patient per group had to undergo revision surgery. VAS rest pain, load pain, and satisfaction improved from preoperatively to postoperatively in both groups without a significant difference between both groups. While the HHS was improved from preoperatively to postoperatively, obese patients showed a significantly lower HHS at the 7-year follow-up (p = 0.01) but still exhibited an excellent scoring above the PASS threshold.ConclusionShort stem THA with the optimys prosthesis is a safe and effective option also in obese patients with an excellent clinical outcome and a low complication rate.

Does intestinal anastomosis in resection of colon cancer have a significant impact onto early postoperative outcome and long-term survival?

To investigate the influence of anastomosis on the early postoperative and long-term oncological outcomes of patients with primary colon carcinoma (CA). All consecutive patients with the histologically diagnosed primary colon CA (design, prospective multicenter observational study) were registered with regard to patient-, diagnostic-, tumor (Tu) finding-, and treatment-related aspects using a computer-based registry with 60 items to characterize early postoperative and long-term oncological outcome. Basic data: From 2010 to 2016, data from a total of 14,466 patients were documented (mean age, 72.8 [range, 22-96] years; sex ratio, m:f=7,696:6,770).- 717/14,466 patients (4.96 %) were included in a matched-pair analysis. The majority of these patients underwent elective surgery (n=12,620 patients; 87.2 %) regardless of whether a bowel anastomosis or an ostomy was created. In emergency surgery, a bowel anastomosis was possible in a large proportion (n=1,332 patients [72.1 %]). In contrast, in 514 patients (27.9 %) who underwent emergency surgery, an ostomy was created. Interestingly, ostomy had to be created even less frequently in patients who had undergone planned surgery (n=366 [2.5 %]).- Early postoperative outcome: Cases of postoperative mortality were mainly due to general complications. Especially among the patients treated in an emergency situation without intestinal anastomosis, a high proportion died of their pre-existing condition (17.0 %). Patients who underwent ostomy creation or emergency surgery had a worse risk profile (incl. arterial hypertension, diabetes mellitus, and secondary cardiac or renal diseases) which led to the decision to operate without anastomosis. Furthermore, data show no matter which technique had been used, patients that had undergone surgical intervention without anastomosis were more likely to develop complications.- Long-term oncosurgical outcome: The most important factors influencing long-term survival were age, resection status, and tumor stage (according to TNM and UICC). The more advanced the tumor growth, the lower the long-term survival. Patients categorized with the same tumor stage, age,and risk factors had a better chance of survival, if they underwent elective surgical intervention and with intestinal anastomosis. Interestingly, the multivariable analysis showed that older patients and such with distant metastasis benefit from a discontinuity resection. The association of intraoperative and postoperative complications with increased postoperative mortality, as well as preexisting risk factors and perioperative complications is in line with findings of current studies. Furthermore, current studies also agree that older patients and such with reduced general condition benefit from discontinuity resection.

Hospital variations in failure to rescue after abdominal surgery: a nationwide, retrospective observational study

ObjectivesThis study aims to determine hospital variation and intensive care unit characteristics associated with failure to rescue after abdominal surgery in Norway.DesignA nationwide retrospective observational study.SettingAll 52 hospitals in Norway...