General Postoperative Complications Research Articles

Comparative analysis of surgical techniques in the management of chronic subdural hematomas and risk factors for poor outcomes.

Chronic subdural hematomas (CSDH) are increasingly prevalent, especially among the elderly. Surgical intervention is essential in most cases. However, the choice of surgical technique, either craniotomy or burr-hole opening, remains a subject of debate. Additionally, the risk factors for poor long-term outcomes following surgical treatment remain poorly described. This article presents a 10-year retrospective cohort study conducted at a single center that aimed to compare the outcomes of two common surgical techniques for CSDH evacuation: burr hole opening and minicraniotomy. The study also identified risk factors associated with poor long-term outcome, which was defined as an mRS score ≥ 3 at 6 months. This study included 582 adult patients who were surgically treated for unilateral CSDH. Burr-hole opening was performed in 43% of the patients, while minicraniotomy was performed in 57%. Recurrence was observed in 10% of the cases and postoperative complications in 13%. The rates of recurrence, postoperative complications, death and poor long-term outcome did not differ significantly between the two surgical approaches. Multivariate analysis identified postoperative general complications, recurrence, and preoperative mRS score ≥ 3 as independent risk factors for poor outcomes at 6 months. Recurrence contribute to a poorer prognosis in CSDH. Nevertheless, use burr hole or minicraniotomy for the management of CSDH showed a similar recurrence rate and no significant differences in post-operative outcomes. This underlines the need for a thorough assessment of patients with CSHD and the importance of avoiding their occurrence, by promoting early mobilization of patients. Future research is necessary to mitigate the risk of recurrence, regardless of the surgical technique employed.

Chimeric versus Multiple Flaps for Composite Oral Cavity Defects: A Systematic Review and Meta-Analysis.

Complex head and neck defects involving composite defects can be reconstructed using chimeric flaps or multiple flaps with separate anastomoses. Limited comparisons exist between chimeric and multiple flap reconstructions. We compare outcomes between chimeric and multiple flap reconstructions in oral cavity reconstruction. PubMed (NLM), Embase (Elsevier), Web of Science (Clarivate Analytics), and Cochrane CENTRAL (Wiley). A systematic review was conducted, including English articles reporting outcomes of oral cavity reconstruction with either chimeric flaps or multiple flaps. Data extraction included patient characteristics, flap type, and outcomes such as flap survival, partial flap loss, operating room time, hospital length of stay, and postoperative complications. Forty-seven articles comprising 1435 patients were included. Notably, 552 patients underwent multiple flaps, while 883 received chimeric flaps. Meta-analysis revealed no statistically significant difference in flap survival between chimeric and multiple flap patients (98% vs. 99%, p = 0.198). Multiple flap patients had higher rates of operating room take-backs for anastomotic issues and longer hospital stays compared with chimeric flap patients. There were no significant differences in partial flap failure, resumption of diet and speech, need for subsequent flaps, fistula formation, or general complications. This large-scale meta-analysis demonstrates equivalent flap survival between chimeric and multiple flaps in the reconstruction of composite oral cavity defects. Both approaches appear to be safe and acceptable, with comparable outcomes in terms of diet and speech resumption, rates of fistulization, and general postoperative complications. Multiple flap patients had higher rates of operating room take-backs and longer hospital stays. NA Laryngoscope, 2024.

Clinical predictors of postoperative complications in the context of enhanced recovery (ERAS) in patients with esophageal and gastric cancer.

The overall frequency of postoperative complications in patients with esophageal and gastric cancer diverges between studies. We evaluated the frequency and assessed the relationship between complications and demographic and clinical features. For this observational study, data were extracted from the ERAS Registry managed by the University of Verona, Italy. Patients were evaluated and compared for postoperative complications according to the consensus-based classification and the Clavien-Dindo scale. The study population was 877 patients: 346 (39.5%) with esophageal and 531 (60.5%) with gastric cancer; 492 (56.2%) reported one or more postoperative complications, 213 (61.6%) of those with esophageal and 279 (52.5%) of those with gastric cancer. When stratified by consensus-based classification, patients with esophageal cancer reported general postoperative complications more frequently (p < 0.001) than those with gastric cancer, but there was no difference in postoperative surgical complications between the two groups. Multiple logistic regression models revealed an association between postoperative complications and the Charlson Comorbidity Index (adjusted odds ratio [OR] 1.22; 95% confidence interval [CI] 1.08-1.36), operation time (adjusted OR, 1.08; 95% CI 1.00-1.15), and days to solid diet intake (adjusted OR, 1.39; 95% CI 1.20-1.59). Complications in patients with esophageal and gastric cancer are frequent, even in those treated according to ERAS principles, and are often associated with comorbidities, longer operative time, and longer time to solid diet intake.

No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospective analysis.

Adult Acquired Buried Penis (AABP) is a pathological condition necessitating surgical correction, ranging from simple to complex procedures involving the utilization of full-thickness (FTSG) or split-thickness (STSG) skin grafts especially in cases of substantial viable penile skin loss. In this retrospective study, we aimed to compare the surgical, functional, and patient-reported outcomes (PROs) of graft types that were utilized to treat AABP among 39 patients at a single center between November 2017 and May 2023. Among these patients, 22 needed skin grafts, with 9 undergoing FTSG and the remainder receiving STSG. Lichen Sclerosus (LS) was the primary cause (54.6%) of AABP requiring skin grafts. Patients primarily presented with voiding (63.6%) and sexual (27.3%) dysfunction. The STSG group had a lower mean age (64.7 ± 11.6) than the FTSG group (66.7 ± 11.6; P = 0.015), with no significant differences in BMI (p = 0.643). Complex repairs (Santucci grade ≥3) were performed in 81.0% of cases, with 88.9% in the FTSG group and 75.0% in the STSG group. Operative times were similar (160.2 ± 31.7 vs 161.5 ± 50.3, p = 0.945). No significant differences in preoperative penis length were found between the FTSG and STSG groups (P = 0.918). Postoperative complications occurred in 36.4% of patients, with severe complications (Clavien grade ≥3) in 9.1%. General postoperative complications and recurrence rates did not significantly differ between groups (P = 0.397 and 0.375; respectively). Functional outcomes, evaluated using the International Index of Erectile Function and the International Prostate Symptom Score, improved significantly in both groups after surgical procedures (P < 0.001 for all). Patient-reported satisfaction for the operation was 81.3% calculated by ad-hoc questionnaire. In conclusion, no discernible differences in outcomes were observed between STSG and FTSG. Larger comparative studies with extended follow-up periods and validated questionnaires are warranted for confirmation. Physicians should consider specialized centers for AABP surgical repair due to its intricacies.

The Effect of Preoperative Oil Chemoembolization Techniques on the Results &#x0D; of Combined Treatment of Operable Pancreatic Cancer

Background: Pancreatogastroduodenal resection is widely used for the treatment of pancreatic cancer but the 5-year survival rate does not exceed 10%. The treatment should be combined, but the question of the expediency of neoadjuvant therapy (NAT) with initially operable cancer has not been resolved.&#x0D; Aims: Substantiation of the expediency of the use of preoperative intra-arterial interventions in the combined treatment of patients with operable pancreatic cancer and the study of the impact of the technical features of the intervention on the treatment results.&#x0D; Materials and methods: The study included 92 patients (45 men and 47 women; mean age 63.910.1 years, T2N0M0 n=13; T3N0M0 n=32; T2N1M0 n=1; T4N0and1M0 n=46) who received combined treatment for the period 2014-2017.In I group, n=45 patients, the NAT was not performed.In II group, n=47 patients underwent intra-arterial oil chemoembolization of the pancreas with an emulsion of oil contrast and gemcitabine concentrate 400 mg/m2.The technique of distributive embolization of the artery gastroepiploica (GEA) differed: in IIA group, n= 22 patients with a spiral; in IIB group, n=25 patients with a temporarily inflated balloon.All 92 patients underwent radical surgery and received adjuvant chemotherapy based on gemcitabine 1000 mg/m2 in 1,8.15 days, 6 cycles. The frequency of specific and general postoperative complications was analyzed. For control, ultrasound, CT with contrast, CA 19-9 antigen level, general and biochemical blood tests were used. For 5 years, the results of each patient were tracked. The primary endpoints were overall (OS) and relapse-free (RFS) survival.&#x0D; Results: Postembolization syndrome did not affect the timing of the operation. The edematous form of acute pancreatitis was noted in 11 (50%) patients of group IIA and in 5 (20%) patients of group IIB, (p=0.043). Destructive pancreatitis was not marked. The overall 1-year survival rate (OS) in I group (n=31) was 68.9%, in II group (n=40) 85.1%, (p=0.062). The 2-years OS was: in I group (n=19) 42.2%, in II group (n=30) 63.8%, (p=0.042). The 3-year OS was: in I group (n=9) 20%, in II group (n=19) 40.4%, (p=0.021). The 4-years OS was: in I group (n=4) 8.9%, in II group (n=7) 14.8%, (p=0.387). The 5-year OS was: in I group 0, in II group (n=2) 4.3%, (p=0.168). The 1-year RFS was: in I group (n=23) 57.1%, in II group (n=29) 61.7%, (p=0.316). The 2-years RFS was: in I group (n=10) 22.2%, in II group (n=23) 48.9%, (p=0.012). The 3-years RFS was: in I group (n=7) 15.6%, in II group (n=16) 34%, (p=0.047). The 4-years RFS was: in I group (n=3) 6.7%, in II group (n=5) 10.6%, (p=0.568). The 5-years RFS was: in I group 0, in II group (n=1) 4%, (p=0.333).&#x0D; Conclusions: The results of the study confirm the feasibility of using preoperative intra-arterial interventions in the combined treatment of pancreatic cancer. There was a significant difference in the rates of 2-year and 3-year OS and RFS in patients receiving such therapy. The technique of occlusion of the artery gastroepiploica with a balloon probably provides more preferable results.

Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Fractures With Anterior or Posterior Tension Band Failure (OF 5): Short-Term Results From the Prospective EOFTT Multicenter Study

Subgroup analysis of a multicenter prospective cohort study. To analyse surgical strategies applied to osteoporotic thoracolumbar osteoporotic fracture (OF) 5 injuries with anterior or posterior tension band failure and to assess related complications and clinical outcome. A multicenter prospective cohort study (EOFTT) was conducted at 17 spine centers including 518 consecutive patients who were treated for an osteoporotic vertebral fracture (OVF). For the present study, only patients with OF 5 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale (VAS), Oswestry Disability Questionnaire (ODI), Timed Up & Go test (TUG), EQ-5D 5L, and Barthel Index. In total, 19 patients (78 ± 7 years, 13 female) were analysed. Operative treatment consisted of long-segment posterior instrumentation in 9 cases and short-segment posterior instrumentation in 10 cases. Pedicle screws were augmented in 68 %, augmentation of the fractured vertebra was performed in 42%, and additional anterior reconstruction was done in 21 %. Two patients (11 %) received short-segment posterior instrumentation without either anterior reconstruction or cement-augmentation of the fractured vertebra. No surgical or major complications occurred, but general postoperative complications were observed in 45%. At a follow-up of mean 20 ± 10 weeks (range, 12 to 48 weeks), patients showed significant improvements in all functional outcome parameters. In this analysis of patients with type OF 5 fractures, surgical stabilization was the treatment of choice and lead to significant short-term improvement in terms of functional outcome and quality of life despite a high general complication rate.

ALLOPLASTY IN STRANGULATED COMPLICATED VENTRAL HERNIAS

There is no consensus on applying alloplasty in the care of strangulated complicated ventral hernias. Aim: to enhance the effectiveness of alloplasty in the management of strangulated complicated ventral hernias. Materials and methods. The results were obtained from a retrospective clinical analysis of the surgical treatment of 146 patients with diagnosis of strangulated complicated ventral hernias, who underwent urgent surgical operations by an open method with the use of alloplasty at the surgical department of the 1st Municipal Clinical Hospital in Poltava for the period from 2010 to 2020. There were 114 women (78.1%) and 32 men (21.9%). The age of patients ranged from 21 to 85 years (average age was 62±3.2 years). Postoperative hernias prevailed were more prevalent (n=117, 80.1%), recurrent hernias were found in 31 (21.2%) patients. Median localization of the defect (M) was found in 134 patients (91.8%), lateral defects (L) was diagnosed in 12 patients (8.2%). The following alloplasty techniques were applied: "onlay" for in 2 patients (1.4%), "sublay" for 116 (79.5%), "sublay-inlay" for 18 (12.3%), "inlay" for 3 (2.1%), separation of anatomical components was performed in 7 (4.7%) cases.&#x0D; Results. In the early postoperative period, local complications were observed in 14 (9.6%) cases. General postoperative complications were noted in 11 (7.5%) cases; 2 (1.4%) patients died. In the remote period, local complications were recorded in 8 patients (5.5%).&#x0D; Conclusion. Performing alloplasty in patients with strangulated complicated ventral hernias enables to reduce the number of complications and improve the results of surgical outcomes.

One-stage versus two-stage Roux-Y gastric bypass as redo surgery of failed adjustable gastric banding.

The study focussed on whether a one-stage Roux-Y gastric bypass (OS-RYGB) or a two-stage RYGB (TS-RYGB) has a significant advantage in terms of perioperative risk in patients after failed adjustable gastric banding (AGB). Data collection included patients who underwent OS-RYGB or TS-RYGB after AGB between 2005 and 2019 and whose outcomes were compared with those after primary RYGB (P-RYGB). Outcome criteria were perioperative complications, comorbidities, 30-day mortality and operating time. The study analysed data from patients who underwent OS-RYGB (N = 525), TS-RYGB (N = 382) and P-RYGB (N = 26,445). Intraoperative and postoperative complication rates were significantly lower for P-RYGB (p < 0.001). Total intraoperative and specific postoperative complication rates were significantly lower in TS-RYGB than in OS-RYGB (p = 0.048 and p < 0.001, respectively). In contrast, the total general postoperative complication rate was lower in OS-RYGB than in TS-RYGB (p < 0.001). The mean operating time differed significantly among the three groups (P-RYGB 96.5min, OS-RYGB 141.2min and TS-RYGB 190.9min; p < 0.001). The mortality rate was not significantly different between the three groups. Based on the significant difference between the two groups in revision surgery and the slight difference with the results of primary RYGB, this study concludes that removal of a failed AGB is safe and feasible with either the OS- or TS-RYGB procedure. However, we cannot directly recommend either procedure in our study. Proper patient selection and surgeon experience are critical to avoid potential adverse effects.

COVID-19 free pathways decrease postoperative complications in patients undergoing elective colorectal surgery.

BackgroundTo reduce the exposition risk to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in surgical patients more prone to develop serious forms of Coronavirus disease 2019, a reorganization that previewed the creation "COVID-19-free" hospitals or units was pursued. The aim of this study was to quantify the effect of clear pathways to reduce the risk of SARS-Cov-2 transmission, on postoperative complications.MethodsData of all consecutive patients undergoing surgical procedure for colorectal diseases, between November 2019 and July 2020 in two Italian referral centers, were retrospectively analyzed. Patients were divided into two groups: the ones underwent surgical procedures during the period before the pandemic from November 2019 to March 2020 (Group 1) (before-COVID), and those who underwent surgical procedure from April to July 2020 during the pandemic (Group 2) (during-COVID pandemic).ResultsOverall, 264 patients were collected, 168 (63.4%) in Group 1 and 96 (36.4%) Group 2. Preoperative characteristics were similar between groups; during the pandemic there was a higher proportion of patients who underwent surgical procedures for malignancy compared with the period before the pandemic (92.7% vs 72%; p = 0.001). Patients in Group 2 had a lower rate of postoperative general complications (21.9% vs 34.5%; p = 0.03) and a lower rate of surgical complications (14.6% vs 25%; p = 0.05). No difference in term of medical complications, infections, and intraoperative complications were found. Minimally invasive approach (OR 0.46; 95% CI 0.04–0.83; p = 0.01) and isolation of patients (OR, 0.18; 95% CI, 0.04–0.83; p = 0.03) were independently associated with lower risk of postoperative complications.ConclusionIn this cohort study COVID-19-free pathways were significantly associated with low rate of postoperative morbidity in patients undergoing colorectal elective surgery.

Endoscopic pituitary surgery: National database review.

Pituitary tumors surgery is increasingly performed via endoscopic transsphenoidal approach (TSP). This study describes outcomes of TSP surgery in the United States. A retrospective cross-sectional analysis of adult patients with pituitary adenoma was performed using the Nationwide Readmissions Database, 2010-2015. A total of 5891 patients were identified. The average age was 51.29 ± 0.29 years. The risk of postoperative epistaxis, diabetes insipidus, cerebrospinal fluid (CSF) leak, and other general postoperative complications was 0.71%, 10.20%, 8.35%, and 2.37%, respectively. Independent risk factors of CSF leak included: age <65-year, male, body mass index ≥25, and multiple comorbidities (p< 0.001 each). The prevalence of CSF leak was not associated with hospital TSP volume and teaching status. This study provides a national epidemiological perspective on TSP in the United States. The risk of postoperative CSF leak appears to be associated with intrinsic patient factors rather than resource and expertise availability.

Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer - a single-center experience.

BackgroundAlthough the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields and robot-assisted esophagectomy may be a possible alternative to the standard minimally invasive esophagectomy. The goal of this study was to investigate whether robot assistance in esophagectomy can improve patient outcome while maintaining good oncological control.Material and methodsData of all patients who underwent minimally invasive esophagectomy between January 2018 and November 2021 at University Hospital Mannheim was collected retrospectively. Patients were divided into two cohorts according to operative technique (standard minimally invasive (MIE) vs. robot-assisted esophagectomy (RAMIE), and their outcomes compared. In a separate analysis, patients were propensity score matched according to age, gender and histological diagnosis, leading to 20 matching pairs.Results95 patients were included in this study. Of those, 71 patients underwent robot-assisted esophagectomy and 24 patients underwent standard minimally invasive esophagectomy. Robot-assisted esophagectomy showed a lower incidence of general postoperative complications (52.1% vs. 79.2%, p=0.0198), surgical complications (42.3% vs. 75.0%, p=0.0055), a lower rate of anastomotic leakage (21.1% vs. 50.0%, p=0.0067), a lower Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0065) as well as a shorter duration of hospital stay (median of 15 vs. 26 days, p=0.0012) and stay in the intensive care unit (median of 4 vs. 7 days, p=0.028) than standard minimally invasive surgery. After additionally matching RAMIE and MIE patients according to age, gender and diagnosis, we found significant improvement in the RAMIE group compared to the MIE group regarding the Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0276), anastomotic leakage (20% vs. 55%, p=0.0484) and severe toxicity during neoadjuvant treatment (0 patients vs. 9 patients, p=0.005).ConclusionRobot-assisted surgery can significantly improve outcomes for patients with esophageal cancer. It may lead to a shorter hospital stay as well as lower rates of complications, including anastomotic leakage.

Influencia del ingreso hospitalario ectópico en pacientes con fractura del cuello femoral

ObjectivesThe objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. Material and methodA historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. ResultsOutlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). ConclusionsOutlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.

An Ounce of Prediction is Worth a Pound of Cure: Risk Calculators in Breast Reconstruction.

Background:Preoperative risk calculators provide individualized risk assessment and stratification for surgical patients. Recently, several general surgery–derived models have been applied to the plastic surgery patient population, and several plastic surgery–specific calculators have been developed. In this scoping review, the authors aimed to identify and critically appraise risk calculators implemented in postmastectomy breast reconstruction.Methods:A systematic review of the literature was conducted. Included studies described the development of a novel risk calculator, or validation of an existing calculator, in postmastectomy breast reconstruction.Results:In total, 4641 studies met criteria for title and abstract screening. Forty-seven were eligible for full-text review, and 28 met final inclusion criteria. The most common risk calculators included the Breast Reconstruction Risk Assessment score (n = 6 studies), modified frailty index (n = 3), Caprini score (n = 3), and ACS NSQIP calculator (n = 2). Calculators were applied to institutional data (n = 17), NSQIP (n = 6), and Tracking Outcomes in Plastic Surgery (n = 1) databases. Predicted outcomes included general postoperative complications (n = 17), venous thromboembolism/pulmonary embolism (n = 4), infection (n = 2), and patient reported outcomes (n = 2). Model accuracy was reported in 18 studies, and it varied significantly (accurate risk calculator 0.49–0.85).Conclusions:This is the first study to provide a systematic review of available risk calculators for breast reconstruction. Models vary significantly in their statistical basis, predicted outcomes, and overall accuracy. Risk calculators are valuable tools that may aid in individualized risk assessments, preoperative counseling, and expectation management in breast reconstruction.

Surgical management of a dog bite in a patient with comorbidities. Case study

Millions of people worldwide require urgent medical care annually due to bites and injuries inflicted by wild or domestic animals. Injured patients most frequently suffer from extensive and deep wounds resulting in traumatic shock of different degrees. The extensive wounds are characterized by severe damage to fascial muscles, tendons, bones, major vessels and nerve trunks. Therefore, the management of patients attacked by wild or domestic animals includes the elimination of life‑threatening conditions and the application of various techniques and methods of reconstructive plastic surgery and their combinations to preserve the injured areas of the body (most commonly limbs). In each particular case, the prognosis and the choice of the most effective reconstructive surgery technique for the treatment of a wound defect depend on the state of the deep structures of the injured limb. The «reconstructive ladder principle» ensures the selection of the most appropriate treatment strategy, as it focuses on the nature of the injury and the patient’s overall health status, thus providing an adequate assessment of all possible surgical risks, general postoperative complications and challenges in wound healing. This algorithm allows prioritizing the most beneficial techniques from simple to difficult, as well as considering the «second line» methods. The «second line» methods are defined as simpler techniques that may be applied in case of some complications occurring after the administration of the primary method. Some additional difficulties may be experienced throughout the period of wound management in children and the elderly, in patients with complicated comorbidities and exacerbation of chronic diseases.This article presents a case study of a patient undergoing the treatment for an extensive and deep bite wound that is complicated by acute coronary syndrome and severe cardiogenic shock in the early postoperative period.

The impact of sleeve gastrectomy and gastric binding on weight loss and remission on comorbidities: a national registry-based study.

In recent decades, an extensive collection of research has shown various benefits of bariatric surgery in the remission of obesity-related diseases and in weight loss in patients with obesity. This study investigated whether sleeve gastrectomy (SG) or adjustable gastric banding (AGB) has the best benefit in terms of perioperative risk, weight loss, and remission of comorbidities. The German Bariatric Surgery Registry included 32,051 patients after SG and AGB. Outcome criteria were perioperative morbidity, perioperative complications, and remission of comorbidities after a one-year follow-up. Out of them 16,441 patients had completed one-year follow-up (2042 patients after AGB and 14,399 after SG). The %EWL was 40.8±23.4 for AGB and 62.4±22.6 for SG (P<0.001). BMI reduction was a significant difference in favor of SG (8.0±4.7 after AGB vs. 15.5±5.9 after SG; P<0.001). Significant differences in favor of SG were also found for remission of IDDM (P<0.001), NIDDM (P<0.001), hypertension (P<0.001), sleep apnea (P<0.001), and reflux disease (P<0.001). However, no significant difference was found between the two groups in terms of general intraoperative and general postoperative complications (P=0.809 and P=0.883, respectively). Specific postoperative complications were documented significantly more often after SG (3.4% in SG vs. 1% in AGB; P<0.001). Based on the results of our study, we can conclude that both SG and AGB can be safe surgical procedures. However, SG achieved more significant results in terms of remission of comorbidities. AGB is effective in patients without severe comorbidities and high BMI.

Application of computerized virtual preoperative planning procedures in comminuted posterior wall acetabular fractures surgery

BackgroundThe treatment of comminuted posterior wall acetabular fractures remains challenging due to the difficulty in understanding of fracture patterns and lack of appropriate preoperative planning process. Virtual preoperative planning procedures are now being commonly used in orthopedic surgery to aid in management of such complex problems. Our aim was to evaluate the feasibility and clinical value of a new method by applying computerized virtual preoperative planning procedures in the treatment of comminuted posterior wall acetabular fractures.MethodsA total of 45 patients with comminuted posterior wall acetabular fractures from June 2014 to December 2018 were retrospectively analyzed. Based on the usage of computerized virtual preoperative planning procedures, they were assigned to group A and group B. In group A (24 patients), the new method was applied before surgery. In group B (21 patients), the conventional surgery was performed without assistance of computerized virtual preoperative planning procedures. The two groups were assessed in terms of blood loss, surgical time, reduction quality, fracture healing time, postoperative complications, and hip function.ResultsThere were no significant differences in demographic data between the two groups. Patients in group A had significantly less intraoperative blood loss (429.58 vs 570.24 ml, P < 0.001) and shorter operation time (154.79 vs 181.90 min, P < 0.01) compared to group B. Using the Matta scoring system, the reduction was graded as anatomic in 20 cases, imperfect in three cases and poor in one case in group A, versus 16 cases was graded as anatomic, three as imperfect and two as poor for group B. According to the modified Merle d’Aubigné score, hip function was graded as excellent in 15 cases, good in seven cases, fair in one and poor in one for group A in comparison to 11 cases, seven cases, two cases, and one case for group B, respectively. The reduction quality and hip function did not differ within the two groups (P > 0.05). The general postoperative complication rate in group A and group B was 12.5% and 28.6%, respectively, but the difference between the two groups was not statistically significant.ConclusionThe application of computerized virtual preoperative planning procedures is feasible in comminuted posterior wall acetabular fractures. It helps orthopedic surgeons better understand the fracture characteristics, enables simulation of the reduction process and preoperative planning of internal fixation methods. This new preoperative planning method using a 3D virtual model is a more effective method than conventional method in surgical treatment of comminuted posterior wall acetabular fractures.Trial registration retrospectively registered.

Treatment for transverse patella fractures with minimally invasive techniques (Review).

The transverse fracture pattern is the most common pattern among patellar fractures. Although open reduction with internal fixation using tension band wiring is the common method for treating the majority of transverse patellar fractures with displacement, this approach has distinct disadvantages, including damage to the blood supply and general post-operative complications. Therefore, minimally invasive techniques have been introduced to overcome these problems. In the present review, the advanced surgical procedures using Kirschner wires with cerclage, cannulated screw optioning of supplementary cerclage tension banding, external fixation and combined tension-band braided polyester with a suture button, as well as post-operative rehabilitation, were described in detail. To improve any malreduction due to poor control of the patellar articular surfaces, the utility of arthroscopically assisted techniques was also presented. The advantages and disadvantages of the above-mentioned techniques were also discussed. Minimally invasive techniques were demonstrated to achieve improved knee joint mobility, shorter hospitalization and more favorable outcomes. Such techniques decrease the risk of complications compared to conventional open reduction and fixation. Although specific problems associated with each technique still require to be resolved to reduce late complications, such as the onset of patella-femoral arthritis, minimally invasive techniques remain an alternative option for treating transverse patellar fractures.

Development of A Risk Stratification Scoring System to Predict General Surgical Complications in Foot and Ankle Surgery Patients

Category:Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; TraumaIntroduction/Purpose:Preventing postoperative complications is crucial for patients, surgeons, and healthcare facilities. A risk stratification scoring system was created to help optimize risk factors for general surgical complications in foot and ankle surgery patients.Methods:A total of 85,363 patients that underwent foot and ankle procedures from 2005 to 2017 were identified as part of the American College of Surgeons National Surgical Quality Improvement Program. Independent risk factors associated with postoperative complications within 30 days of surgery were identified and used to develop a point-scoring system to estimate the relative risk for experiencing complications. For validation, the system was tested on a subset of patients from the database who had foot and ankle surgery.Results:The 30-day postoperative complication incidence after foot and ankle surgery was 19.1%. Risk factors associated with postoperative complications were tobacco abuse, age (>64), diabetes mellitus, hypertension, elevated creatinine (>1.3 mg/dL), hypoalbuminemia (<3.5 g/dL), and anemia (male hematocrit <42; female <38). Point scores from each factor were: anemia, +7; hypoalbuminemia, +4; hypertension, +4; elevated creatinine, +3; diabetes mellitus, +3; age over 64, +2; and tobacco abuse, +1. In the validation cohort, patients categorized as low risk (0-5), using the point scoring system had a 2.5% rate of 30-day complications; patients categorized as medium risk (6-10) had a 7.5% complication rate (relative risk = 2.0; 95% CI, 1.7-2.3 compared with low risk) and high risk (>=11), 33.1% (relative risk = 3.7; 95% CI, 3.2-4.3).Conclusion:This point scoring system predicts risk for general postoperative complications after foot and ankle surgery. These data may help foot and ankle surgeons identify areas of clinical concern with patients to reduce the risk of experiencing postoperative complications.

Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes.

Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients.

Rotator cuff repair in HIV-positive patients ages 65 and older: only slight increase in risk of general postoperative surgical complications.

To examine postoperative complications associated with rotator cuff repair (RCR) in HIV-positive patients ages 65 and older. Data were collected from the Medicare Standardized Analytic Files between 2005 and 2015 using the PearlDiver Patient Records Database. Subjects were selected using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Demographics including age, sex, medical comorbidities, and smoking status were collected. Complications were examined at 7-day, 30-day, and 90-day postoperative time points. Data were examined with univariate and multivariate analyses. The study included 152,114 patients who underwent RCR, with 24,486 (16.1%) patients who were HIV-positive. Following univariate analysis, patients with HIV were observed to be more likely to develop 7-day, 30-day, and 90-day postoperative complications. However, the absolute risk of each complication was quite low for HIV-positive patients. Univariate and multivariate analysis showed that within 7days following surgery, patients with HIV were more likely to develop myocardial infarction (OR 2.5, AR 0.1%) and sepsis (OR 2.5, AR 0.04%). Within 30days, HIV-positive patients were at increased risk for postoperative anemia (OR 2.8, AR 0.1%), blood transfusion (OR 3.3, AR 0.1%), heart failure (OR 2.3, AR 0.8%), and sepsis (OR 2.7, AR 0.1%). Within 90days, mechanical complications (OR 2.1, AR 0.1%) were increased in the HIV-positive group. Postoperative complications of RCR occurred at increased rates in the HIV-positive group compared to the HIV-negative group in patients ages 65 and older. In particular, increased risk for myocardial infarction, sepsis, heart failure, anemia, and mechanical complications was noted in HIV-positive patients. However, the actual percentage of patients who experienced each complication was low, indicating RCR is likely safe to perform even in older HIV-positive patients. As more older adults living with HIV present for elective orthopedic procedures, the results of the present study may reassure physicians who are considering RCR as an option for patients in this particular population, while also informing providers about potential complications. III.