Higher Complication Rate Research Articles

Feasibility and Safety of bedside placement of tunneled dialysis catheters: A systematic review and meta-analysis of prevalence.

Tunneled dialysis catheters (TDCs) are typically the vascular access of choice for critically ill patients in need of urgent dialysis for prolonged periods of time. The standard of practice is to insert these catheters under fluoroscopic guidance to ensure proper catheter placement in the cavo-atrial junction or right atrium. However, there is increasing interest in bedside placement of TDCs without fluoroscopic guidance in patients deemed too critically ill to be transported to the fluoroscopy suite or operating room. Our aim was to systematically review the literature on bedside placement of TDCs and to calculate the pooled prevalence rates of technical success, favorable clinical outcomes, and overall complications. We searched PubMed and Google Scholar for articles on bedside insertion of TDCs without setting a specific timeframe. We stratified the articles based on the risk of publication bias. Data on technical success, favorable clinical outcomes and complications were collected. A total of 22 articles were included, comprising 1546 TDCs inserted at bedside. The technical success rate was found to be 97.2% [95% CI: 94.6 - 98.9%; I2 = 77.5%]; LFK index = -0.72 and favorable clinical outcome was reported in 97.6% [95% CI: 94.5-99.5%; I2 = 84.8%]; LFK index = -1.62. The pooled prevalence of complications was found to be 6.98% [95% CI: 3.12 - 12.1%; I2 = 87.8%]; LFK index = 0.95, most of which were mechanical in nature. Our findings suggest that bedside placement of TDCs is a technically feasible procedure with high favorable clinical outcomes and comparable complication rates to the conventional method of TDC insertion under fluoroscopic guidance. Several non-fluoroscopic techniques have also been suggested to confirm the proper positioning of the catheter in the right atrium. These findings may challenge the gold standard of utilizing fluoroscopic guidance for TDCs.

Comparative analysis of malnutrition screening tools in predicting mortality in critically ill patients: SGA, GLIM, and mNutric Score.

Introduction: Malnutrition is prevalent among critically ill patients and is associated with increased mortality, prolonged hospital stays, and higher rates of complications. Several malnutrition screening tools are available, including the Subjective Global Assessment (SGA), the Global Leadership Initiative on Malnutrition (GLIM), and the modified Nutrition Risk in Critically Ill (mNutric) Score. This study aims to compare the predictive ability of these three tools in determining mortality among critically ill patients. Methods: A retrospective cohort study was conducted in the Intensive Care Unit (ICU) of RSUP Dr. Wahidin Sudirohusodo from April 2022 to March 2023. Patients aged 18 years and older were included. Nutritional status was assessed using SGA, GLIM, and mNutric Score. The primary outcome was mortality. Result: A total of 1,106 patients were included in the analysis. The overall ICU mortality rate was 23.1%. The mNutric Score was a significant independent predictor of mortality (OR = 6.601, 95% CI: 4.183–10.416, p < 0.001), while neither SGA nor GLIM were significant after adjustment for confounders. Conclusion: The mNutric Score is a superior tool for predicting mortality in critically ill patients compared to SGA and GLIM. Its use should be considered in ICU settings to identify patients at nutritional risk and guide timely interventions.

Clinical outcomes of circumcisions and prevalence of complications of male circumcisions: A five-year retrospective analysis at a teaching hospital in Ghana.

Male circumcision is increasing in popularity due to its medical benefits, including reducing HIV prevalence. It is commonly performed by both health and non-health professionals, with most circumcisions occurring during the neonatal period. Studies suggest the benefits outweigh the risks, though complications can occur. This study aimed to determine the clinical outcomes of circumcisions and the prevalence of adverse events of circumcision in the Volta region of Ghana. A five-year retrospective descriptive and analytic study was conducted at Ho Teaching Hospital, using a structured data extraction sheet to collect demographic, clinical, and circumcision-related data from 186 cases. Among 186 circumcision cases, 23 (12.37%) experienced complications, with the most common being partial circumcision (43.48%), post-circumcision bleeding (21.74%), and urethrocutaneous fistula and/or wrongfully circumcised congenital hypospadias (13.04%). Low heamoglobin levels and infections were also noted. A significant relationship was found between the circumcision provider and complication rates (Chi-square = 16.975, p = 0.00). Doctors conducting circumcision had the lowest complication rates (4.3%), while nurses and traditional circumcisers had higher complication rates (39.1% and 34.8%, respectively). Circumcision-Revision surgery was the most common salvage surgery for circumcision mishaps (31.82%), with urethroplasty and hypospadias repair (for wrongful circumcised neonates born with hypospadias) accounting for 15.91%. Meatoplasties, glansplasties, fistulectomy plus primary repair and chordae-release surgeries were also performed. The success rate for salvage surgeries (first attempt) was 70%. Prompt initial management strategies were significantly associated with good outcomes. Under less-trained hands, circumcision could be catastrophic. Salvage surgeries for circumcision mishaps are associated with less favourable outcomes in about one-third of the cases, suggesting that circumcision mishaps are better prevented than salvaged. Training, guidance, and policy interventions are needed to reduce the incidence of circumcision-related mishaps. Public health campaigns to dissuade non-surgeon circumcisers to refrain from circumcising children with hypospadias but refer them, are urgently needed.

Endovascular treatment versus bypass in long SFA atherosclerotic lesions: a non-randomized comparative study

Background: The TransAtlantic Inter-Society Consensus (TASC II) classification categorizes superficial femoral artery (SFA) lesions. This study compares endovascular therapy and bypass surgery for treating challenging TASC II C and D SFA lesions, which are typically complex and involve severe disease. Purpose: the aim is to compare the outcome of endovascular interventions versus surgical bypass in treatment of superficial femoral artery atherosclerotic TASC II C&D lesions in patients with critical limb ischemia in terms of patency and limb salvage within one year follow up. Patients and methods: our study included 41 patients in bypass group (groub A) and 74 patients in endovascular group (groub B) with atherosclerotic TASC II C&D SFA lesion. Patients with non-salvageable limbs, acute ischemia, trauma, aneurysms, connective tissue disorders and arteritis were excluded. All patients had Rutherford 4 to 6. Saphenous vein and synthetic grafts were used in bypass group. POBA, DCB and stents were used in endovascular group. The patients were followed up for 1 year.Results: mean Patients’ age was 63.15 years in endo group and 58.76 years in bypass group, male 78.4% in endo group and 85.4% in bypass group. Patients’ presentation was incapacitating claudications, rest pain, minor tissue loss, and major tissue loss. Technical success achieved in 100% in bypass cases and 95.9%in endo group. 1ry patency rate was 71.4% in the bypass group versus 57.6% in the endo group, still not significant statistically (p-value 0.171). The assisted 1ry patency was 77.1% in bypass group and 83.3% in the endo group,.(p.value 0.449) 2ry patency rates was 82.9% and 89.4% in bypass and endo groups respectively. Our 1-year limb salvage rates were 85% in the bypass group versus 91.7%, the rate was better in the endo group but with statistically insignificant p.value between them (p: 0.343). The rate of reintervention was higher in endo group (31.8%) than bypass group (11.4%) which was statistically significant, (p.value 0.024). Overall mortality during follow up was only 1 patient in the bypass group (2.4%). the bypass group had higher complication rate (41.5%) than the endovascular group (12.2%) with statistically significant (p.value <0.001). Conclusion: Bypass surgery and endovascular management have comparable short terms outcomes in terms of patency and limb salvage in treating long SFA atherosclerotic lesion TASC II C&D. Rate of reintervention is higher with endovascular strategy. However, with lower morbidity and mortality compared with surgery.

Healing of Comminuted Fractures of Long Bones in Dogs

Fracture healing in dogs is a complex process influenced by factors such as age, weight, fracture type, and underlying conditions. Among fractures, complex diaphyseal comminuted fractures stand out due to their susceptibility to complications like delayed union or nonunion. Despite the recognized complexities, veterinary-specific data on their incidence, complications, and effective treatment strategies remain surprisingly scarce. This retrospective study analyzed 99 comminuted fractures among 542 long bone fractures treated at the Small Animal Clinic of the Freie Universität Berlin (2007–2014). The femur (n = 42) was most affected, followed by the tibia/fibula (n = 29), radius/ulna (n = 24), and humerus (n = 4). Plates (n = 81) and intramedullary pins or external fixators (n = 16) were used for osteosynthesis. Healing occurred without complications in 72%, while 28% experienced issues such as implant failure or delayed union. Open fractures, high-energy trauma, and >3 fragments were associated with higher complication rates (p < 0.05). Fractures treated with plates healed slower (p = 0.016), and implants were removed later compared to other methods (p = 0.049). This study highlights the challenges of managing complex fractures and emphasizes the need for tailored surgical approaches. It provides new insights into their treatment and outcomes, paving the way for future research to establish standardized veterinary protocols.

Assessing impact of postoperative outcomes and quality of life on decisional regret after resection of pancreatic ductal adenocarcinoma.

699 Background: Surgery is potentially curative for patients with localized pancreatic ductal adenocarcinoma (PDAC). Given the high rate of complications, decline in quality of life (QoL) postoperatively, and high rates of recurrence, clear preoperative communication and expectation setting is critical. This study investigates clinical outcomes that affect postoperative decisional regret (DR) in patients with PDAC. Methods: This mixed-methods study investigates the impact of clinical outcomes and QoL on the degree of DR in patients with PDAC who have undergone curative-intent resection at least 6 months prior to study recruitment. Patients completed validated surveys assessing DR and QoL by the European Organization for Research and Treatment of Cancer (EORTC). Groups are stratified by presence or absence of DR, assessed by the Decisional Regret Scale (DRS). Characteristics and survey scores were compared by chi-square, independent t-test, and median test. Narrative responses were thematically analyzed. Given significant findings, results of this interim analysis are reported below. Results: 45 patients met inclusion criteria and completed all questionnaires. 19 (42.2%) patients expressed regret about their decision to pursue curative-intent surgery, with 5 patients expressing moderate to severe regret (DRS ≥ 25). There was no significant difference in median postoperative timing of survey completion between groups (56 months in DR group vs 34 months, P=0.465). Baseline characteristics, medical treatments, and operative approaches were similar. Both groups had similar recurrence rates at time of survey completion. While 30 and 90 day readmission rates were similar, a greater proportion of the DR group had 30 day complications (42.1% vs 15.4%, P=0.045). Those expressing regret reported poorer physical functional status (mean score 79.30 ± 18.84 vs 92.31 ± 10.27, P=0.011) and greater impact on social activities (mean score 67.54 ± 33.55 vs 84.67 ± 19.19, P=0.038). Thematic analysis of narrative responses revealed that a majority of patients expressed a strong desire to have a greater focus on potential QoL changes during preoperative discussions. Conclusions: Patients expressing postoperative DR experienced more 30 day complications, and still report lasting effects on their current physical status and social activities. This emphasizes the importance of thorough preoperative counseling on surgical risks and potential changes in postoperative QoL so that patients may make the best informed decision.

Chest pain and coronary artery disease in cardiac amyloidosis: Prevalence, mechanisms, and clinical implications.

Amyloidosis is a systemic disease affecting multiple organs, and often presents with cardiac involvement, with 2 primary underlying pathologies: amyloid light chain- and transthyretin cardiac amyloidosis. Chest pain can occur in both types with variable clinical presentations. This narrative review describes the relationship between cardiac amyloidosis (CA) and chest pain. A PubMed search (June 03. 2024) identified 393 articles related to chest pain in CA. Twenty-eight studies, in English and with full text, were selected. Articles included were case reports, reviews, perfusion- and autopsy studies. In CA patients 10%-20% report chest pain as the initial symptom preceding the diagnosis, and the overall prevalence of chest pain is 38% of patients with CA and it is related to an increased risk of heart failure hospitalization. The mechanisms leading to chest pain in CA patients include increased left ventricular diastolic pressure, infiltration of amyloid fibrils inside and around coronary arteries, and amyloid compression of the microvasculature. The mechanisms commonly lead to elevations of plasma troponin levels, which are higher in amyloid patients with chest pain compared to amyloid patients without chest pain. Symptomatic treatment of chest pain can be challenging due to the low tolerability of medical therapy and poor outcomes of coronary interventions in alleviating the pain and with a higher rate of complications. Our review underscores the importance of recognizing chest pain as a CA symptom, particularly in the elderly. Persistent troponin elevation without coronary artery disease could indicate CA. Screening-based and longitudinal studies are crucial for understanding the relationship between chest pain and CA. Acknowledging the significance of chest pain in CA may facilitate early intervention and improve patient outcomes.

Trends and Outcomes of General Surgery in the Pakistani Population: A Retrospective Analysis

Background: General surgery in Pakistan addresses a broad spectrum of medical conditions. However, surgical outcomes in low- and middle-income countries (LMICs) are affected by resource limitations, disparities in healthcare access, and delayed presentations. Objectives: This study aims to evaluate trends, outcomes, and predictors of complications in general surgery over a two-year period in a tertiary care center in Pakistan. Methodology: A retrospective analysis was conducted on n=400 adult patients who underwent elective or emergency general surgical procedures from January 2022 to December 2024. Data on patient demographics, surgical approaches (open vs. laparoscopic), and postoperative outcomes were collected. Predictors of complications were analyzed using Chi-square tests, t-tests, and logistic regression. Results: The mean age of patients was 44.5 (±12.8) years, with 58% being male. Laparoscopic techniques were used in 52% of surgeries, with a 6% conversion rate. Overall, 14% of patients experienced complications, including surgical site infections (5%) and hemorrhage (4%). Emergency procedures were associated with higher complication rates (p<0.01). Significant predictors of complications included BMI >30 kg/m² (OR: 2.3, 95% CI: 1.5–3.2, p<0.001), operative time >90 minutes (OR: 2.7, 95% CI: 1.8–4.1, p<0.001), and emergency surgery (OR: 3.2, 95% CI: 2.1–4.8, p<0.001). The 30-day mortality rate was 2%, predominantly due to emergency cases. Conclusion: While laparoscopic techniques have improved surgical outcomes in Pakistan, disparities in emergency care and resource allocation persist. Addressing key predictors of complications through systemic reforms, enhanced training, and infrastructure improvements is crucial for aligning surgical outcomes with global standards.

Optimal duration of neoadjuvant chemotherapy prior to CRS±HIPEC for colorectal cancer: An assessment of survival and postoperative outcomes.

188 Background: Cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC) represents a viable treatment option for select patients with colorectal cancer peritoneal metastases. Given high recurrence rates after surgery, it is common practice to administer neoadjuvant chemotherapy (NAC). The optimal duration, however, when considering oncologic value and postoperative outcomes, is not known. Methods: A single institution database (2009-2024) of colorectal cancer patients that underwent CRS±HIPEC was reviewed. Patients with colorectal cancer undergoing CRS±HIPEC for curative intent (completeness of cytoreduction 0 or 1) with known NAC duration were included. Analysis was stratified by NAC duration of 0-3 months or greater than 3 months. Co-primary outcomes were recurrence free survival (RFS) and overall survival (OS). Secondary outcomes included clinically significant complications, defined as Grade 3 or greater adverse events based on Common Terminology Criteria for Adverse Events Version 5.0. Results: From 2009-2024, 108 patients underwent CRS±HIPEC for colorectal cancer. Final analysis included 84 patients that underwent curative intent surgery and had a known duration of NAC ( > 3 months NAC: 55 patients, 0-3 months NAC: 29 patients). Median peritoneal cancer index (PCI) score was similar between the two cohorts ( > 3 months: median PCI 11 versus (vs) 0-3 months: median PCI 12; p = 0.42). Recurrence-free survival was 9 months for the entire cohort and not significantly different based on duration of NAC ( > 3 months: 8 months vs 0-3 months: 15 months, p = 0.14). Overall survival was also similar between both cohorts ( > 3 months: 26 months vs 0-3 months: 37 months; p = 0.11). On univariate analysis, > 3 months of NAC was associated with an increased rate of complications of any severity ( > 3 months: 83.6% vs 0-3 months: 55.2%; p = 0.01), clinically significant complications ( > 3 months: 54.5% vs 0-3 months: 31.0%; p = 0.07), and increased median length of stay ( > 3 months: 10 days vs 0-3 months: 8 days; p = 0.01). When controlling for other perioperative variables on multivariable analysis, > 3 months of NAC trended towards an increased risk of clinically significant complications (HR 1.76, 95% CI 0.59-5.30; p = 0.32). Conclusions: Even with a similar disease burden, as measured by PCI, an extended duration of neoadjuvant chemotherapy prior to CRS±HIPEC does not appear to be associated with any improved recurrence-free or overall survival. Conversely, postoperative outcomes are worse with higher complication rates and increased length of stay. Thus, despite high recurrence rates after CRS±HIPEC for this disease, it still appears that in well selected patients, an extended duration of neoadjuvant chemotherapy may not be the best treatment strategy.

Endovascular Recanalization in Patients With Vertebral Artery Stump Syndrome: A Single-Center Experience.

To evaluate the feasibility, success rate, and safety of endovascular revascularization of patients with vertebral artery stump syndrome (VASS). This single-center retrospective study analyzed clinical and imaging data from consecutive patients with VASS who underwent endovascular recanalization from January 2020 until June 2023. Our study enrolled 30 patients [mean age 69 (range 51-84) years; 26 men]. The rate of successful technical revascularization was 96.7% (n = 29), and the rate of complications was 3.3% (n = 1). At the 6-month follow-up, the patients with successful endovascular revascularization of VASS did not have any neurological symptoms, and computed tomography angiography showed 3/29 (10.3%) re-occlusions and 4/29 (13.8%) restenosis of the stent, which was confirmed by digital subtraction angiography. Endovascular recanalization in patients with VASS is feasible in selected patients and has a high procedural success rate and low rate of complications. A large, multicenter, randomized study is warranted to confirm these findings.

The use of a percutaneous cystostomy tube as an adjunctive treatment option for dogs with idiopathic functional outflow tract obstruction.

Functional outflow tract obstruction (FOO) remains a challenging disease to manage in male dogs. Cystostomy tubes have been used to relieve urethral obstruction while allowing time to achieve effective medical management, avoiding the need for emergency visits and repeat urinary catheterizations. To describe a series of dogs with FOO and categorize the most successful management strategies including medical management alone or with the support of cystostomy tubes for urinary diversion. Twelve client-owned dogs with FOO were included. Medical records of dogs presented from August 2012 to September 2021 with a presumptive diagnosis of FOO were retrospectively reviewed and findings recorded. Seven dogs were managed with a cystostomy tube and 5/7 (71%) had a good-excellent outcome. Five dogs were managed without a tube and 1/5 (20%) had a good outcome. Eight dogs were refractory to medical management; 5 managed with a cystostomy tube and 3/5 (60%) had a good-excellent outcome; 3 managed without a cystostomy tube and 0/3 had a good or excellent outcome. Overall, dogs with cystostomy tubes had better outcomes but also had mild, moderate, and severe complications (100%, 71%, and 71%, respectively) reported. Most dogs that received a percutaneous cystostomy tube as part of their management plan had a good to excellent outcome, particularly when compared to those that did not, despite the high rate of tube-related complications. Percutaneous cystostomy tubes could be considered early during management for FOO to improve overall outcomes.

Maternal and Infant Outcomes in a Subset of Patients with Sickle Cell Disease in South Carolina.

Sickle cell disease (SCD), which disproportionately affects minorities, increases complications during pregnancy. Severe maternal mortality is increased in women with SCD, including morbidity related to the disease and other nondisease-related complications. It also can have devastating complications for fetuses, with increases in premature birth and low birth weight. This study aimed to describe the characteristics of women with SCD in South Carolina, with a specific focus on fetal and maternal outcomes and complications. The secondary aim of this study was to identify the effect of maternal characteristics on birth outcomes, including social determinants of health. A secondary analysis of women from a single institution, the Medical University of South Carolina, which was part of the registry from the multi-institutional Sickle Cell Disease Implementation Consortium, was conducted. Patient demographics, self-reported pregnancy history, hydroxyurea use, and maternal and fetal outcomes were collected from patient-reported survey data. In addition, the number of vaso-occlusive episodes surrounding their pregnancies was collected for analysis. Fifty-nine percent (116/195) of the female participants reported ever being pregnant. Seventy-two percent had live births, 15.8% had miscarriages, 1.8% had stillbirths, and 6.1% had an abortion. The mean age was 22.3 ± 4 years, with no difference in markers of severity between the groups. Most women were HbSS genotype with high rates of pain in the last year. No difference was found in age, education, employment, or income between these groups of women. Women in the nonlive birth cohort had higher body weights (78.7 versus 72.1 kg, P = 0.045). The Distressed Community Index was used as a marker for social determinants of health and was similar between the two groups, with a majority of both cohorts (61.7% and 52%) living in "at risk" and "distressed" communities. Complications related to SCD were high, including 43% of women experiencing pain during pregnancy, 5.2% developing acute chest syndrome, and 22.4% requiring transfusion. An additional 11% experienced preeclampsia. Unfavorable infant outcomes included 49% of the infants being premature and 40% having babies weighing less than 5.5 lb at birth. High rates of complications to both mother and infant were found in the women with SCD. Although few statistically significant predictors were found, by identifying and addressing specific needs of pregnant women with SCD, we can work toward reducing fetal and maternal mortality in an already vulnerable population.

Preoperative Optimization Strategies in Elective Spine Surgery.

» Although spine surgery is effective in reducing pain and improving functional status, it is associated with unacceptably high rates of complications, thus necessitating comprehensive preoperative patient optimization.» Numerous risk factors that can impact long-term surgical outcomes have been identified, including malnutrition, cardiovascular disease, osteoporosis, substance use, and more.» Preoperative screening and personalized, evidence-based interventions to manage medical comorbidities and optimize medications can enhance clinical outcomes and improve patient satisfaction following spine surgery.» Multidisciplinary team-based approaches, such as enhanced recovery after surgery protocols and multidisciplinary conferences, can further facilitate coordinated care from across specialties and reduce overall hospital length of stay.

Ballistic femoral neck fractures: Associated injuries and outcomes.

Ballistic fractures of the femoral neck, rare injuries that overwhelmingly affect younger adults, pose significant challenges to the treating surgeon. However, there is limited literature that the treating surgeon can leverage to guide their treatment decisions. The goal of this study is to describe the demographics, associated injuries, outcomes, and complications associated with ballistic femoral neck fractures. This retrospective case series, performed at a single, academic, urban, level-one trauma center, evaluated patients with a ballistic fracture of the femoral neck (AO/OTA 31B) between 2003 and 2022. International Classification of Disease codes were utilized to identify patients in the electronic medical record. Chart review was performed to assess patient demographics, associated injuries, success rate of operative and nonoperative intervention, and post-operative complication rate and types. Seventeen patients were included (94 % male; median age 22.5 years). Median follow up was 12.2 months (range 1-84 months). Five patients (29 %) sustained a concomitant vascular injury. Eight patients (47 %) sustained an additional osseous injury. The median injury severity score was 9 (interquartile range 4-17). Thirteen patients were treated with operative reduction and fixation, 3 patients with incomplete fractures were treated nonoperatively, and one was treated with acute total hip arthroplasty (THA). Overall, 12 of 17 patients (71 %) healed their fracture or had an uncomplicated recovery after acute THA. Of the 13 patients treated with operative reduction and fixation, 8 (62 %) healed their fracture and 5 (38 %) developed one or more post-operative complications. Nearly 1 in 3 patients with ballistic femoral neck fractures sustain concomitant vascular injury and almost half sustain another osseous injury. In this series, only 62 % of patients who underwent operative reduction and fixation healed their fractures, and nearly 40 % of patients treated with operative reduction and fixation developed a post-operative complication. Given the poor outcomes and high complication rates associated with these injuries, surgeons should counsel patients with ballistic femoral neck fractures accordingly. Further research into the optimal treatment of ballistic femoral neck fractures is needed.

Catheter Ablation in Older Patients with Atrial Fibrillation

The prevalence of atrial fibrillation (AF) increases with age and treatment with catheter ablation is performed frequently. Catheter ablation may have a lower rate of success and a higher rate of complications in older patients.We compared the characteristics, success rates, and complications of catheter ablation in patients with AF categorized into late old-aged (≥ 75 years, n = 148), early old-aged (65-74 years), n = 129), and middle-aged (< 65 years, n = 91) groups. Effects of catheter ablation on cardiac function in the left ventricle (LV) and left atrium (LA), and plasma B-type natriuretic peptide levels were evaluated at baseline and 1 year.AF ablation was successfully performed in older patients and the recurrence rate did not differ between groups (late old-aged: 29.7%, early old-aged: 15.5%, middle-aged: 23.1%). Procedural complications did not statistically differ among the groups (late old-aged: 9.5%, early old-aged: 6.2%, middle-aged: 3.3%). The LA volume index was greater in the late old-aged patients than in the other 2 groups. As comorbidities, hypertension and history of heart failure and stroke were more common in late old-aged patients. At 1 year after ablation, the LV ejection fraction, the LA volume index, and LA emptying fraction were improved, even in late old-aged patients. Plasma B-type natriuretic peptide levels were reduced in both the late old-aged and early-old-aged groups.Our findings indicate that AF ablation in late old-aged patients is effective, particularly with regard to LA structure and function, and the complication rate is similar to that in middle-aged patients.

Staged versus Simultaneous Surgery for Adult Spinal Deformity - A Systematic Review and Meta-analysis.

Systematic review and meta analysis. To assess the safety and efficacy of staged versus same-day spinal fusion surgeries in Adult spinal deformity (ASD). ASD surgeries are associated with high complication rates, ranging from 10% to 40%. Among the strategies to enhance safety, staging the procedure into two smaller procedures has been evaluated as an effective alternative. A systematic literature review following PRISMA guidelines was conducted using PubMed, Cochrane, Scopus, and Embase. Studies comparing staged and same-day spinal fusion for ASD were included. Perioperative data, patient-reported outcomes (ODI, SRS), radiological outcomes, and complication rates were analysed. The extracted data was analyzed and forest plots were generated to draw comparisons between the staged and the same day groups. Eleven studies, including 1323 patients (541 staged, 782 same-day) were analyzed. Staged surgeries were associated with longer operative time and length of hospital stay. There was no significant difference in estimated blood loss, clinical and radiological outcomes, or overall complication rates between groups. However, venous thrombo-embolism (VTE) rates were significantly higher in staged surgeries (odds ratio=4.33). In the staged group, surgical site infections was the most common complication with a rate of 10.5%, whereas neurological complications were the most frequent group of complications in same-day group. Staged surgeries for ASD result in longer operative time, length of hospital stay and increased VTE risk but show similar efficacy in clinical and radiological outcomes compared to same-day surgeries. Careful patient selection is crucial to balance risks and optimize outcomes in ASD surgical planning.

Standardization of Subcutaneous Injection of Prefilled Anticoagulants Through Lean Six Sigma Management: A Before-After Study.

The aim of this study was to investigate the impact of the Lean Six Sigma management approach on the standardization of nurses' prefilled anticoagulant subcutaneous injection practices, with a focus on improving anticoagulation outcomes, reducing patient complications, and enhancing overall patient satisfaction. The lack of standards for prefilled anticoagulant injection has resulted in a high complication rate, decreased patient satisfaction, and diminished service quality. This study investigated the impact of the Lean Six Sigma management approach on the standardization of nurses' prefilled anticoagulant subcutaneous injection practices. This study compared pre-implementation and post-implementation data from Lean Six Sigma. A baseline investigation was conducted to determine the type and incidence of complications caused by anticoagulant injection. The nurses' injection process was observed and analyzed to determine problems with the injection technology and the reasons for the reduction in injection quality. Solutions were developed to address these root causes, including formulating a standard process for the subcutaneous injection of preperfusion anticoagulant; recording teaching videos; formulating the standard operating procedure (SOP) while refining, quantifying, and optimizing the operation steps as much as possible; and making an injection site rotation card. Comparative assessments were conducted pre-training and post-training, focusing on nurses' knowledge, standardization of operations, duration of procedures, patient complication rates, and satisfaction with nursing care. Post-training, there was a significant increase in nurses' knowledge and standardization of injection procedures. In addition, there was a notable reduction in the duration of the procedure and patient complications and an increase in patient satisfaction (P<0.01 or P<0.05). Implementing the Lean Six Sigma management approach effectively standardized nursing procedures for prefilled anticoagulant subcutaneous injections, improved anticoagulation outcomes, minimized patient complications, reduced injection time, and elevated the overall quality of clinical nursing and patient satisfaction.

Indications for and limitations of laparoscopic anatomical liver resection: assessment of postoperative complications stratified by complexity of liver resection.

Although complex anatomical liver resections are more often being performed laparoscopically, the short-term outcomes following laparoscopic anatomical liver resection (LALR), its optimal indications, and limitations remain unclear. This study aimed to clarify the indications for and limitations of LALR by assessing the short-term outcomes. This retrospective study included 233 patients who underwent LALR. The complexity of LALR was categorized into three levels: Grade I (low), grade II (moderate), and grade III (high). Short-term outcomes were compared among these groups, and the risk factors for severe morbidity were identified. The patients' backgrounds were similar across the three groups. Intraoperative blood loss, Pringle maneuver time, and postoperative hospital stay were comparable between grade I (n = 59) and grade II (n = 65) LALR but were greater for grade III (n = 109). The transfusion and conversion rates were similar among the three groups. The operative time increased with the rise in difficulty grade. The rate of severe morbidity was 3.4% in grade I, 6.2% in grade II, and 16.5% in grade III LALR (P = 0.012). Multivariable analysis identified three perioperative risk factors for severe morbidity: Operative time of ≥ 540min (odds ratio [OR] = 4.762, P = 0.009), intraoperative blood loss of ≥ 350mL (OR = 3.982, P = 0.024), and preoperative serum albumin of ≤ 3.8g/dL (OR = 3.518, P = 0.035). Grade II LALR can be performed with the same level of safety as grade I LALR. However, grade III LALR has a higher complication rate than grades I and II LALR, and the risk increases further due to longer operative time and greater blood loss.

Comparison of percutaneous liver aspiration biopsy and tru-cut biopsy results

Aims: The aim of this study was to compare the diagnostic rates, complications and histopathologic diagnoses of aspiration biopsy and tru-cut biopsy procedures in liver parenchyma and to reveal the differences between the technical methods. Methods: Patients who underwent liver parenchymal biopsy in our hospital were identified. While tru-cut biopsy needle was used in the radiology department, aspiration biopsy needle was used in the gastroenterology department. Patients who underwent parenchymal biopsy were included in the study, while lesion biopsies were excluded. Indications for biopsy, presence of hepatitis, type of biopsy needle, number of times, size of biopsy material, pathologic diagnosis and complications after biopsy were evaluated. Results: Of the 113 patients who underwent liver biopsy, 74 were male (mean age 40.38.±17.37 years) and 39 were female (mean age 45.49±15.85 years). Among the patients who underwent liver biopsy, tru-cut biopsy needle was used in 46 patients, while aspiration biopsy needle was used in 67 patients. The biopsy size and number of pieces were statistically significantly higher in aspiration biopsy compared to tru-cut biopsy. There was no difference between the two biopsies in terms of diagnosis rate, complication development, fibrosis staging and score. Conclusion: Percutaneous aspiration and tru-cut biopsies are reliable diagnostic methods with high diagnostic rates and low complication rates. The fact that biopsy is performed by experienced hands, under US guidance, and the number of biopsies is limited reduces the development of complications.

Assessment of safety and effectiveness after percutaneous closure for decannulation of Veno-Arterial Extracorporeal Membrane Oxygenation: A systematic review and meta-analysis.

Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) has emerged as a crucial component of critical care medicine, mainly as a lifesaving intervention for patients experiencing refractory cardiac arrest and respiratory failure. In the past, VA-ECMO decannulation was surgical and often associated with a high rate of periprocedural complications, such as surgical site infection, bleeding, and patient mobilization costs. To reduce the rate of these adverse events, many percutaneous techniques utilizing suture-mediated closing devices have been adopted. One of those devices is the Perclose Proglide® (PP). This study's goal was to perform a systematic review to evaluate PP devices' success and complication rates for VA-ECMO decannulation. To analyze the outcomes of PP in VA-ECMO decannulation, a systematic review of the most recent literature was conducted. The Medline, Web of Science, and Cochrane databases were systematically searched up to September 2023. The National Health, Blood, and Lung Institute Study quality assessment tools were used. The final analysis included 10 observational studies comprising 418 patients. The efficacy of PP in VA-ECMO decannulation was 93.0% (95% CI 90.1%-96.0%). In 381 patients, the incidence of acute limb ischemia after VA-ECMO decannulation was 2.5% (95% CI 0.9%-4.%), the infection of the puncture site after decannulation was 1% (95% CI 0%-2%) in 385 patients. The incidence of patients with pseudoaneurysm after decannulation was 1.1% (95% CI 0.1%-2.1%). This systematic review and meta-analysis demonstrate the safety and efficacy of the PP for achieving hemostasis after VA-ECMO decannulation, with a high success rate and low rate of major complications.