Higher Rate Of Postoperative Complications Research Articles

Early Postoperative Complications and Associated Variables After Tibial Tubercle Osteotomy: A 15-Year Experience From a Single Academic Institution.

Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patients with patellofemoral disorders. To determine the rate of early (≤90 day) postoperative complications after TTO and variables related to postoperative complications. Case series; Level of evidence, 4. Patients who underwent TTO at a single academic institution within a 15-year period (2008-2022) were identified. All patients with a minimum 90-day follow-up were considered for study inclusion. Exclusion criteria were age younger than 14 years and revision surgery. Patient characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications. A total of 344 knees in 313 patients met eligibility criteria and were included in the final analysis. One intraoperative complication (0.3%), a premature closure of the incision before repair of the vastus medialis, was identified. There were 141 postoperative complications (138 surgical, 3 medical) in 118 patients for a complication rate of 34.3%. The most common complications were stiffness requiring a nonstandard-of-care intervention (16.3%), superficial wound infection/wound dehiscence (8.1%), and hemarthrosis/effusion requiring aspiration (5.8%). Patients experiencing postoperative complications were older (mean difference, 3.49 years; 95% CI, 1.26-5.73 years; P = .002), had a higher mean Charlson Comorbidity Index (mean difference, 0.26; 95% CI, 0.08-0.45; P = .006), and were more likely to be current smokers (P = .015) compared with patients with no complications. Inpatient surgery (defined as surgery in a hospital setting with at least 1 overnight stay) was associated with postoperative complications (odds ratio [OR], 2.29; 95% CI, 1.39-3.77; P = .001); this association remained significant generation of a multivariate model (OR, 2.07; 95% CI, 1.19-3.58; P = .010). Previous surgery on the ipsilateral knee (P < .001) and concomitant autologous chondrocyte implantation (P = .046) were also associated with postoperative complications. The study findings indicated a low intraoperative complication rate (0.3%) and a relatively high early postoperative (≤90 day) complication rate (34.3%) after TTO. Variables associated with postoperative complications included greater age, higher Charlson Comorbidity Index, surgery in an inpatient setting, previous surgery on the ipsilateral knee, and concomitant autologous chondrocyte implantation.

A narrative review of anastomotic leak in the Ivor Lewis esophagectomy: expected, accepted, but preventable.

Anastomotic leak (AL) remains a common and highly morbid complication after Ivor Lewis Esophagectomy. Leak is associated with increased morbidity, mortality, strictures and even cancer recurrence. Unfortunately, despite advances in surgical technique and perioperative care, the reported frequency of AL has remained largely unchanged. A PubMed search for all English-language articles that discuss Ivor Lewis esophagectomy, AL, risk factors, and outcomes was conducted from 1901 to 2023 prioritizing research from randomized trials that evaluated outcomes from patients undergoing esophagectomy. This narrative review will discuss the prevailing literature on AL, risk factors and outcomes with a focus on its relationship to the Ivor Lewis esophagectomy (ILE). In particular, we emphasize that the gastric conduit, as commonly created for most esophagectomy procedures, is inherently vulnerable to ischemia. We will show trends in the literature that have contributed to the high rate of postoperative complications, with a focus on the AL. In addition, we propose that the traditional Ivor Lewis procedure itself is a risk factor for AL. We review a surgical alternative that increases blood supply of the conduit, and is associated with reduced leak, no strictures, and improved surgical outcomes. Multiple factors contribute to AL after esophagectomy; including several current surgical practices. We believe that some of them, especially the commonly accepted approach to the gastric conduit, can be modified to optimize tissue perfusion. With further investigation, we may reduce the incidence of short and long-term anastomotic complications and improve surgical outcomes.

Prevalence of Herpes Simplex and Varicella-Zoster Virus DNA in Corneal Grafts Is Higher than Expected.

(1) To determine the prevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), varicella-zoster virus (VZV), and cytomegalovirus (CMV) DNA in donor corneas; (2) To evaluate the clinical outcome of the grafts with viral DNA and to compare donors with and without viral DNA. We analyzed data from all donors and recipients who underwent penetrating keratoplasty (PK) or Descemet membrane endothelial keratoplasty (DMEK) between September 2022 and March 2023. Donor corneoscleral rims and excised recipients' corneal buttons were tested for the presence of HSV-1, HSV-2, VZV, and CMV DNA by polymerase chain reaction (PCR). The results were known 2-3 days after the surgery. We closely followed up on patients whose grafts tested positive for viral DNA. We compared the medical histories of donors with and without viral DNA. We included 85 corneas from 67 donors. Seven (8.2%) donor corneas tested positive for HSV-1 (n = 3) or VZV (n = 4) DNA. We did not detect any HSV-2 or CMV DNA. In the postoperative follow-up of patients with positive PCR, a graft failure was observed in one and infections in two eyes. Re-operation was necessary in three of these cases (42.9%). Patients without herpes DNA in the donor cornea needed reoperation in 7.7% of the cases. Cultural duration, the cause of the donor's death, and the death-to-explantation interval did not differ significantly between donors with and without viral DNA. Additionally, 3 of the 7 (42.9%) donors with positive PCR were in a septic status at the time of death, compared to 21 of the 78 (26.9%) donors with negative PCR (p = 0.52). The prevalence of herpes DNA in the donor corneas was 8.2% and thus higher than previously reported. We did not notice any evidence for a donor-to-host transmission, but a higher rate of postoperative complications in recipients of the grafts with viral DNA. The donors with and without herpetic DNA did not differ significantly regarding systemic diagnoses or cultural conditions, but sepsis was more frequent in the group with viral DNA.

Lung Volume Reduction Surgery (Clinical Cases)

Emphysema is a chronic lung disease in which the walls of the alveoli in the lungs weaken and collapse; leaving abnormally large residual spaces filled with air even when the patient exhales. The most common symptoms of emphysema are shortness of breath (dyspnea); cough; fatigue; and weight loss. Emphysema often coexists with chronic obstructive pulmonary disease. The treatment of emphysema requires a multidisciplinary approach; including education; exercise; tobacco cessation; oral and inhaled medications; oxygen therapy; and lung transplantation. Lung volume reduction surgery (LVRS) may be an option for patients who experience shortness of breath and whose pulmonary function tests show severe obstruction and enlarged lungs. The surgery aims to remove the least functional part of the lung to improve airflow; diaphragm; and chest wall mechanics; as well as alveolar gas exchange in the remaining lung. Objective — to familiarize doctors with the clinic’s experience in reducing lung volume in patients with bullous emphysema. Materials and methods. Our clinic performed the following surgical interventions to reduce lung volume: VATS resection of large (giant) lung bullae — 14 (77.7 %) cases; VATS lo­­bec­tomy — 2 (11.1 %); lobectomy through thoracotomy — 1 (5.6 %); VATS sublobar resection — 1 (5.6 %). Results and discussion. There were no fatalities. The following postoperative complications were recorded: prolonged under-expansion of the operated lung in 5 (27.7 %) cases; empyema of the residual pleural cavity with bronchial fistula in 1 (5.6 %). The overall incidence of postoperative complications was 33.3 %. Two patients with prolonged underdistension of the operated lung required reoperation (VATS revision of the pleural cavity and redilation). The patient who developed pleural empyema with a bronchial fistula underwent bronchial blockage with a satisfactory result. In all cases of LVRS; a positive clinical effect was recorded in the first 3 months after surgery. During the follow-up period of up to 2 years; only 2 (11.1 %) patients showed no clinical effect and signs of progression of chronic obstructive pulmonary disease and respiratory failure were observed. Conclusions. Lung volume reduction surgery is a method of treating bullous lung disease that allows achieving overall treatment effectiveness in the follow-up period of up to 3 months in 100 % of cases; and in the follow-up period of up to 2 years — in 89.9 %. The high rate of postoperative complications in LVRS requires a physician to carefully select patients for surgery and monitor their condition daily in the postoperative period.

Effects of Preoperative Chronic Steroid Use on Postoperative Outcomes in Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Higher rates of postoperative complications have been found in preoperative chronic steroid users. However, the effects of preoperative chronic steroid use on outcomes in orthopedic surgery were unclear. We performed a systematic review of cohort studies examining the effects of chronic steroid use on postoperative outcomes following orthopedic surgery and searched PubMed, Embase, and CENTRAL through 29 April 2023. We included 17 studies with 1,546,562 patients. No increase in 30-day mortality (adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 0.64-3.09) and composite thromboembolic events (aOR 1.61, 95% CI 0.99-2.63) but increases in 30-day overall complications (aOR 1.42, 95% CI 1.16-1.75), wound dehiscence (aOR 2.91, 95% CI 1.49-5.66), infectious complications (any infection (aOR 1.61, 95% CI 1.44-1.80), sepsis (aOR 2.07, 95% CI 1.34-3.21), superficial surgical site infection (SSI) (aOR 1.73, 95% CI 1.03-2.89) and deep SSI (aOR 1.96, 95% CI 1.26-3.05)), re-admission (aOR 1.62, 95% CI 1.48-1.77), both 30-day (aOR 1.28, 95% CI 1.03-1.59) and 1-year re-operation (aOR 1.78, 95% CI 1.09-2.92), pulmonary embolism (aOR 5.94, 95% CI 1.52-23.29), and deep vein thrombosis (aOR 2.07, 95% CI 1.24-3.46) were detected in preoperative steroid users. An increased risk of adverse outcomes following orthopedic surgery in chronic steroid users was found.

Unrecognized Pulmonary Hypertension in Non-Cardiac Surgical Patients: At-Risk Populations, Preoperative Evaluation, Intraoperative Management and Postoperative Complications.

Pulmonary hypertension is a well-established independent risk factor for perioperative complications after elective non-cardiac surgery. Patients undergoing cardiac surgery are routinely evaluated for the presence of pulmonary hypertension in the preoperative period. Better monitoring in the postoperative critical care setting leads to more efficient management of potential complications. Data among patients with pulmonary hypertension undergoing elective non-cardiac surgery are scant. Moreover, the condition may be unidentified at the time of surgery. Also, monitoring after non-cardiac surgery can be very limited in the PACU setting, as opposed to the critical care setting. All these factors can result in a higher postoperative complication rate and poor outcomes.

Hyperthermic Intraperitoneal Chemotherapy After Interval Cytoreductive Surgery for Patients With Advanced-Stage Ovarian Cancer Who Had Received Neoadjuvant Chemotherapy

Hyperthermic intraperitoneal chemotherapy (HIPEC) followed by interval cytoreductive surgery (ICS) has shown survival benefits for patients with advanced-stage ovarian cancer. However, there is still a lack of consensus regarding the integration of HIPEC into clinical practice. To evaluate the safety and effectiveness of ICS with HIPEC compared with ICS alone in clinical practice for patients with advanced-stage ovarian cancer. This prospective, multicenter, comparative effectiveness cohort study enrolled 205 patients with stage III or IV ovarian cancer who had received at least 3 cycles of neoadjuvant chemotherapy followed by ICS with HIPEC or ICS without HIPEC at 7 Korean Gynecologic Oncology Group institutions between September 1, 2017, and April 22, 2022. Nine patients were excluded because they did not meet the inclusion criteria. Neoadjuvant chemotherapy followed by ICS with HIPEC or ICS without HIPEC. The primary end point was progression-free survival (PFS). Overall survival (OS) and the safety profile were the key secondary end points. This study included 196 patients (median age, 58.0 years [range, 38-82 years]), of whom 109 underwent ICS with HIPEC and 87 underwent ICS without HIPEC. The median duration of follow-up was 28.2 months (range, 3.5-58.6 months). Disease recurrence occurred in 128 patients (65.3%), and 30 patients (15.3%) died. Interval cytoreductive surgery with HIPEC was associated with a significant improvement in median PFS compared with ICS without HIPEC (22.9 months [95% CI, 3.5-58.6 months] vs 14.2 months [95% CI, 4.0-56.2 months]; P = .005) and median OS (not reached [95% CI, 3.5 months to not reached] vs 53.0 [95% CI, 4.6-56.2 months]; P = .002). The frequency of grade 3 or 4 postoperative complications was similar in both groups (ICS with HIPEC, 3 of 109 [2.8%] vs ICS without HIPEC, 3 of 87 [3.4%]; P > .99). Among patients with recurrence, the frequency of peritoneal recurrence was lower in the ICS with HIPEC group than in the ICS without HIPEC group (21 of 64 [32.8%] vs 41 of 64 [64.1%]; P = .001). This study suggests that ICS in conjunction with HIPEC was associated with longer PFS and OS than ICS without HIPEC for patients with advanced-stage ovarian cancer and was not associated with higher rates of postoperative complications. The lower rate of peritoneal recurrence after HIPEC may be associated with improved OS.

Timing of surgery in patients with synchronous colorectal cancer liver metastases undergoing neoadjuvant chemotherapy: a propensity score analysis

BackgroundThe optimal timing of surgery after neoadjuvant chemotherapy (NAC) in patients with synchronous colorectal cancer liver metastases (SLM) remains controversial. We plan to analyze whether the choice of different surgical timings will have different effects on the perioperative and oncologic outcomes of patients.MethodWe retrospectively collected all patients who met the inclusion and exclusion criteria from 2010 to 2020 in West China Hospital. Patients were grouped according to time interval (TI) after NAC to surgery. The perioperative and oncologic outcomes of the two groups were compared after propensity score matching. Univariate and multivariate analyzes were used to screen factors associated with prognosis.ResultAmong 255 enrolled patients, 188 were matched with comparable baseline (94 each group). Patients in the 6≦TI≦8 group had longer operation time, less intraoperative blood loss, and less postoperative complications than those in the 4≦TI < 6 group. However, the overall survival (OS) (p = 0.012) and disease-free survival (DFS) (p = 0.013) of the patients in the 4≦TI < 6 group were better than those in the 6≦TI≦8 group. Subgroup analysis found that the above conclusions still apply in age ≥ 60, non-anemic patients, and patients who underwent R0 resection. OS was inversely correlated with TI in patients without preoperative jaundice. DFS was negatively correlated with TI in patients with preoperative jaundice. Multivariate analysis showed that the prolongation of TI after NAC to surgery was an independent prognostic risk factor for OS and DFS.ConclusionsPatients with SLM may be a better choice for surgery within 4–6 weeks after receiving NAC. Although patients with SLM undergoing surgery 4–6 weeks after NAC has a higher rate of postoperative complications, radical surgery is still recommended for a better survival benefit.

151. INFLUENCE OF PERIOPERATIVE ANEMIA ON MORBIDITY AND MORTALITY OUTCOMES AFTER RADICAL ESOPHAGECTOMY

Abstract Objectives Methods Retrospective and analytical study of patients who underwent radical esophagectomy for esophageal cancer performed in our institution from 2015 to 2021. Several parameters related to anemia were measured: hemoglobin, ferritin, transferrin saturation and iron blood levels, as well as the need for perioperative blood transfusion. We analyzed, on the one hand, the incidence of complications in the immediate postoperative period. On the other hand, we assessed the results of overall survival and disease-free survival in relation to tumor disease. Results A total of 137 patients treated for esophageal neoplasia were included. The interventions performed were McKeown/Ivor-Lewis esophagectomy. Up to 106 (77,4%) patients received neoadjuvant therapy. Patients who required transfusion in the perioperative period (35 patients; 26%) had a significantly lower mean survival (33 vs. 53 months). In addition, they presented higher rates of postoperative complications as well as a lower 5-year overall survival (Log Rank; p = 0.004). Patients with preoperative hemoglobin levels below 12 g/dL had a significantly higher recurrence rate (21% vs. 7%; p &amp;lt; 0.05). The anemic status was improved after the implementation of a multimodal prehabilitation protocol (12.1 g/dL versus 13 g/dL). Conclusions Radical esophagectomy is associated with high morbidity and mortality. Minimally invasive surgery has improved intra and postoperative outcomes. Despite this, the risk of intraoperative bleeding is not negligible. Therefore, it is essential for the patient to be in an optimal clinical and analytical status. Multimodal prehabilitation could improve this status and the postoperative recovery. Studies with a larger number of patients and a longer follow-up will be necessary to evaluate the impact of this strategy.

A Retrospective analysis of peri-implant fractures: insights from a large volume clinical Study.

Peri-implant fractures (PIFs) are a concept in evolution for which different diagnostic criteria have been proposed and modified over time. They have not been extensively reported. PIFs are usually located in the distal part of previous osteosynthesis, where fragile bone is in contact with the rigid implant and are a significant complication after orthopaedic surgery, which requires careful management and treatment. This clinical study presents findings from a retrospective analysis of PIF's, providing description of characteristics and outcomes. They provide information about the associated risk factors and description of the effectiveness of various treatments. A retrospective analysis was performed in a clinical study involving patients with PIFs. Data from medical records, radiographic images, and surgical reports were collected and analyzed. The study included patients with refracture of pre-existing osteosynthesis admitted to the hospital between 2015 and 2022. Demographic information, fracture characteristics, surgical interventions, and post-operative outcomes were assessed. Each case was followed for a minimum of one year after surgery, and a critical analysis was performed by senior surgeons. Furthermore, the PIFs were classified according to the type of initial implant and the position of the new fracture in relation to the original implant. Between 2015 and 2022, out of 18,813 fractures treated at a Level 1 traumatology hospital, a total of 85 patients with PIF's were identified. Fracture characteristics varied, including location, fracture pattern, and implant type. Most of the PIFs, 71 cases (83.53%), occurred in the femur. Additionally, there were seven cases (8.24%) involving the humerus, four cases (4.71%) affecting the tibia/fibula, two cases (2.35%) in the radius, and one case (1.18%) involving the clavicle. Surgical management was the primary attitude in treatment. Various techniques were used, including the use of longer and stronger implants to achieve high-quality fixation, facilitating early rehabilitation and return to previous activities. Postoperative complications after surgery for PIFs were observed in 16 cases (18.8%). Peri-implant fractures (PIF) are a distinct topic and a challenging condition with a high rate of postoperative complications. Complications after the second surgery may be severe and life threatening in older patients. A classification can be useful to make decisions about the optimal treatment in different anatomic areas and type of implant used for primary osteosynthesis. Currently there are no standardized protocols for management, therefore each case should be carefully discussed and planned before surgery.

Nephrectomy for xanthogranulomatous pyelonephritis—a not-so-simple solution

BackgroundXanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory condition of the kidney, associated with high patient morbidity, often requiring targeted antibiotic therapy and surgical removal of the affected kidney.AimWe report the outcomes of patients undergoing nephrectomy for XGP in our institution over a 12-year period.MethodsFollowing ethical approval, a retrospective review of histological samples of renal tissue demonstrating features of XGP from June 2010 to 2022 was conducted. Laboratory, imaging, and clinical data of included participants were collected.ResultsEleven patients were included (8 women, 3 men), mean age of 58.1 (35–81). Recurrent urinary tract infection was the most common clinical presentation (55%, n = 6). Other presentations included flank pain (36%, n = 4), collection/ abscess (45%, n = 5), and nephro-cutaneous fistulae (9%, n = 1). The majority of patients had bacteriuria (91%, n = 10), and Escherichia coli was the most common bacteria isolated (55%, n = 6). Antibiotic resistance was seen in 60% of positive urine samples (n = 6). An open nephrectomy was performed in all but one case (91%, n = 10). A postoperative complication occurred in 73% (n = 8), with 50% (n = 4) of complications Clavien Dindo grade 3 or higher, including one patient mortality.ConclusionsXGP is a difficult and complex condition to treat. All patients in this series presented with infection or associated sequelae thereof. Complex XGP cases therefore often require open nephrectomy and have high rates of postoperative complications. Careful consideration of antibiotic and operative intervention is therefore essential to ensure the best outcome for these patients.

WTP7.14 The ‘Right’ Strategy? Can we change the risk profile of emergency presentations of right sided colorectal cancers?

Abstract Background Up to 30% of patients with colorectal cancer present acutely and have worse outcomes than elective patients. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer. Methods This single-centre, retrospective study included all patients who underwent operative management (emergency and elective) for a right-sided colon cancer, from 1st April 2017 to 31st March 2022. Data were collected from electronic patient records and analysed to compare host and tumour factors as well as outcomes between emergency and elective cohorts. Results Overall 303 patients (median age 72) were included. 65 patients (22%) presented as an emergency: 36 presented in obstruction and 11 with tumour perforation, compared to 1 patient with tumour perforation in the elective group (p=&amp;lt;0.0001). Emergency presentation was associated with more advanced tumour stage (p=0.001). The emergency group had lower rates of laparoscopic surgery (32% vs 86% p=&amp;lt;0.0001); higher rates of post-operative complications (47% vs 27% p=0.05); increased 90-day mortality (20% vs 3% p=0.001); and a longer hospital stay (9 vs 4 days p=0.048). 50% of emergency patients received adjuvant chemotherapy compared to 56% of elective patients (p=0.71). No differences were found between the two groups regarding demographics, comorbidities, or time to MDT discussion. Discussion Outcomes of acute right-hemicolectomy are poor, with inadequate access to subsequent chemotherapy. Strategies addressing acute presentations of left-sided tumours have moved towards temporisation and elective surgery; this strategy is rarely adopted for acute presentations of right-sided tumours. Delaying major resectional surgery for optimisation may improve short-term outcomes, and access to adjuvant therapies.

Outcomes of Adolescent T-condylar Fractures: Kids Do Not Always Make You Look Good.

Optimal treatment for pediatric and adolescent T-condylar fractures remains poorly understood. We sought to assess how functional outcomes and range of motion (ROM) after surgical fixation of T-condylar fractures are affected by patient and surgical factors. This is a retrospective cohort study of 52 patients with operatively treated T-condylar fractures at a single tertiary pediatric referral center between 2003 and 2021. All patients younger than 18 at the time of injury with a radiographically confirmed diagnosis were included. Fifty-two T-condylar fractures were included, with a mean patient age of 12.9 years (SD, 2.8). The cohort was 65% male. Nine (19%) fractures were open, 46% (24/52) were AO type C2, and 33% (17/52) occurred in skeletally mature individuals. The surgical approach was through olecranon osteotomy in 29% (15/52) of patients, and fixation included anatomically specific plates and screws in 42% (22/52) of patients. In our cohort, 46% (24/52) achieved good outcomes based on Jarvis ROM criteria and 42% (22/52) achieved good to excellent results based on Roberts functional criteria. The median loss of ROM was 58 degrees at 6 weeks, 20 degrees at 3 and 6 months, and 8 degrees at 1 year postoperatively. We observed a complication rate of 54% (28/52). Patients undergoing adult-type plate fixation had better postoperative range of motion at 6 weeks (ROM loss 52 vs. 80 degrees, P =0.03) and 3 months (10 vs. 35 degrees P =0.004) compared with pediatric-type fixation and trended towards better functional outcomes. We did not identify significant differences in functional outcome scores or complication rates with respect to surgical approach or skeletal maturity. Surgical fixation of pediatric and adolescent T-condylar fractures achieved a good to excellent functional outcome in only a minority of patients (46% Jarvis / 42% Roberts) with a high rate of postoperative complications (54%). Future work is needed to elucidate optimal treatment to minimize complications and achieve the best functional outcomes in these challenging fractures. Level-IV.

Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty.

Frailty is characterized by reduced physiological reserves across multiple systems. In patients with frailty, oncological surgery has been associated with a high rate of postoperative complications and worse overall survival. Further, given that cancer and frailty can co-exist in the same patient, cancer and cancer-related symptoms can rapidly accelerate the progression of baseline frailty, which we have termed "cancer frailty". This distinction is clinically meaningful because the prioritization of interventions and the treatment outcomes may differ based on health conditions. Specifically, in patients with cancer frailty, improvements in frailty may be achieved via surgical removal of tumors, while prehabilitation may be less effective, which may in turn result in delayed treatment and cancer progression. In this review, we focused on challenges in the surgical treatment of non-metastatic colorectal cancers in patients with frailty, including those related to decision making, prehabilitation, and surgery. Potential recommendations for treating patients with cancer frailty are also discussed.

Safety and efficacy of remote ischemic conditioning in adult moyamoya disease patients undergoing revascularization surgery: a pilot study.

Revascularization surgery for patients with moyamoya disease (MMD) is very complicated and has a high rate of postoperative complications. This pilot study aimed to prove the safety and efficacy of remote ischemic conditioning (RIC) in adult MMD patients undergoing revascularization surgery. A total of 44 patients with MMD were enrolled in this single-center, open-label, prospective, parallel randomized study, including 22 patients assigned to the sham group and 22 patients assigned to the RIC group. The primary outcome was the incidence of major neurologic complications during the perioperative period. Secondary outcomes were the modified Rankin Scale (mRS) score at discharge, at 90 days post-operation, and at 1 year after the operation. The outcome of safety was the incidence of adverse events associated with RIC. Blood samples were obtained to monitor the serum concentrations of cytokines (VEGF, IL-6). No subjects experienced adverse events during RIC intervention, and all patients could tolerate the RIC intervention in the perioperative period. The incidence of major neurologic complications was significantly lower in the RIC group compared with the control group (18.2% vs. 54.5%, P = 0.027). The mRS score at discharge in the RIC group was also lower than the control group (0.86 ± 0.99 vs. 1.18 ± 1.22, P = 0.035). In addition, the serum IL-6 level increased significantly at 7 days after bypass surgery in the control group and the serum level of VEGF at 7 days post-operation in the RIC group. In conclusion, our study demonstrated the neuroprotective effect of RIC by reducing perioperative complications and improving cerebral blood flow in adult MMD patients undergoing revascularization surgery. Thus, RIC seems to be a potential treatment method for MMD. ClinicalTrials.gov, identifier: NCT05860946.

Safety and Outcomes of Bariatric Surgery in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Background: The need for surgical management of severe obesity in the context of inflammatory bowel disease (IBD) is becoming an increasingly common clinical scenario, yet has been met with significant reservation due to the paucity of current data from which to inform evidence-based clinical decision making. The aim of our study was to perform a systematic review to characterize and evaluate the safety and efficacy of bariatric surgery in IBD patients. Methods: A medical librarian developed and executed comprehensive searches on November 2, 2021. The population of interest was adult subjects (&gt;18 years) diagnosed with inflammatory bowel disease (IBD) undergoing any type of bariatric surgery. Meta-analysis was used to evaluate outcomes using RevMan 5.4.1. Results: A total of 330 687 patients were identified within the 11 studies included. Within all included studies there were 1595 patients with IBD. Patients had a mean weighted age of 46.0, with a female predominance (n = 1287, 80.7%). The mean duration of follow up was 39.7 months. Metabolic and anthropometric outcomes were only reported in noncomparative studies evaluating only patients with IBD, limiting the ability to complete meta-analysis. Meta-analysis revealed that IBD was associated with increased rates of postoperative complications (RR 2.14; 95% CI 1.87-2.44; P &lt; .00001) in comparison to controls without IBD. Conclusion: While bariatric surgery presents an effective weight loss option for patients with IBD, these patients are associated with higher rates of postoperative complications. This work highlights the need to better delineate the effect of bariatric procedures for patients with IBD with respect to both metabolic and IBD-related outcomes.

Pharyngeal Flap Versus Sphincter Pharyngoplasty for the Treatment of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome: Preliminary Findings From a Systematic Review.

The purpose of this study was to examine and compare surgical and speech outcomes of the posterior pharyngeal flap and sphincter pharyngoplasty following surgical management of velopharyngeal insufficiency in patients with 22q11.2 deletion syndrome (22q11.2DS). This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist and guidelines. Selected studies were chosen using a 3-step screening process. The 2 primary outcomes of interest were speech improvement and surgical complications. Preliminary findings based on included studies suggest a slightly higher rate of postoperative complications with the posterior pharyngeal flap in patients with 22q11.2DS but a lower percentage of patients needing additional surgery compared with the sphincter pharyngoplasty group. The most reported postoperative complication was obstructive sleep apnea. Results from this study provide some insight into speech and surgical outcomes following pharyngeal flap and sphincter pharyngoplasty in patients with 22q11.2DS. However, these results should be interpreted with caution due to inconsistencies in speech methodology and lack of detail regarding surgical technique in the current literature. There is a significant need for standardization of speech assessments and outcomes to help optimize surgical management of velopharyngeal insufficiency in individuals with 22q11.2DS.

Factors affecting length and complexity of hospital stay in pediatric dog bite patients

BackgroundDog bite injuries are a source of significant morbidity and expense in the USA, and rates of hospitalization have been rising. Children are at increased risk of dog bites compared...

Endometrial ablation and resection versus hysterectomy for heavy menstrual bleeding: an updated systematic review and meta-analysis of effectiveness and complications.

To evaluate the clinical efficacy, safety, and cost-effectiveness of endometrial ablation or resection (E:A/R) compared to hysterectomy for the treatment of heavy menstrual bleeding (HMB). Literature-search was performed for all the randomized control trials (RCTs) comparing (E:A/R) versus hysterectomy for the treatment of HMB. The literature-search was last updated in November 2022. The primary outcomes were objective and subjective reduction in HMB and patient-satisfaction rates in improving the bleeding symptoms at 1-14 years. The data were analyzed using Review Manager software. Twelve RCTs with 2,028 women (hysterectomy: n=977 vs. E:A/R: n=1,051) were included. Hysterectomy was compared with endometrial ablation in 5 studies, endometrial resection in 5 studies, and both ablation and resection in 2 studies. The meta-analysis revealed that the hysterectomy group showed improved patient-reported and objective bleeding-symptoms more than those of the EA/R group with risk ratios (RR) of (MD, 0.75; 95% CI, 0.71 to 0.79) and (MD, 44.00; 95% CI, 36.09 to 51.91), respectively. The patient-satisfaction was higher post-hysterectomy up to a follow-up period of 2 years (RR, 0.90; 95% CI, 0.86 to 0.94) but this effect was absent with long term follow-up. This meta-analysis shows that E:A/R offers alternatives to hysterectomy. Although both procedures are highly effective, safe, and improve the quality of life, hysterectomy is significantly superior at improving the bleeding symptoms and patient satisfaction up to two-years. However, hysterectomy is associated with longer operating times and recovery periods and has a higher rate of postoperative complications. The initial cost of E:A/R is less than that of hysterectomy but further surgical requirements are common, therefore there is no difference in the cost for the long term follow-up.

Influence of Race on Utilization and Outcomes in Shoulder Arthroplasty

Background: Studies have shown that utilization and outcomes after shoulder arthroplasty vary by sociodemographic factors, highlighting disparities in care. This systematic review synthesized all available literature regarding the relationship between utilization and outcomes of shoulder arthroplasty and race/ethnicity. Methods: Studies were identified using PubMed, MEDLINE (through Ovid), and CINAHL databases. All English language studies of Level I through IV evidence that specifically evaluated utilization and/or outcomes of hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty by race and/or ethnicity were included. Outcomes of interest included rates of utilization, readmission, reoperation, revision, and complications. Results: Twenty-eight studies met inclusion criteria. Since the 1990s, Black and Hispanic patients have demonstrated a lower utilization rate of shoulder arthroplasty compared with White patients. Although utilization has increased among all racial groups throughout the present decade, the rate of increase is greater for White patients. These differences persist in both low-volume and high-volume centers and are independent of insurance status. Compared with White patients, Black patients have a longer postoperative length of stay after shoulder arthroplasty, worse preoperative and postoperative range of motion, a higher likelihood of 90-day emergency department visits, and a higher rate of postoperative complications including venous thromboembolism, pulmonary embolism, myocardial infarction, acute renal failure, and sepsis. Patient-reported outcomes, including the American Shoulder and Elbow Surgeon's score, did not differ between Black and White patients. Hispanics had a significantly lower revision risk compared with White patients. One-year mortality did not differ significantly between Asians, Black patients, White patients, and Hispanics. Conclusion: Shoulder arthroplasty utilization and outcomes vary by race and ethnicity. These differences may be partly due to patient factors such as cultural beliefs, preoperative pathology, and access to care, as well as provider factors such as cultural competence and knowledge of health care disparities. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.