Higher Rate Of Surgical Complications Research Articles

Early surgical outcomes of children with mechanical intestinal obstruction at Moi teaching and referral hospital, Kenya

Background: Intestinal obstruction constitutes the largest proportion of abdominal surgical emergencies in the paediatric and adult patients in Sub-Saharan Africa, including Kenya. It is associated with high postoperative surgical complication and mortality rate in low resource healthcare systems. Methods: A prospective mixed methods study with consecutive sampling procedure was carried out from September 2021 to June 2023. Pediatric patients from birth to 14 years, with mechanical intestinal obstruction were included in the study. Categorical data was analyzed in frequencies and percentages and continuous data was analyzed using measures of central tendency and measures of dispersion. Bivariate and multivariate associations between the dependent and independent variables were assessed with a p value of less than 0.05 being statistically significant. Results: The final study population was 318 participants. Majority of participants were male with neonates comprising almost one third of participants. Classical symptoms were present in a majority of patients at initial presentation. Intussusception (34.6%) was the leading acquired aetiology of paediatric mechanical intestinal obstruction. Operative surgical management was in 94.6% of participants. Surgical complications were present in 61.1% of participants. The commonest surgical complication was surgical site infection in 16.9%. Overall mortality rate was 10.2% with 23.3% among neonates and 4.9% in older children. Referral status was statistically associated with mortality (p<0.001). Intestinal atresia had the highest case-specific mortality rate. Age, presence of comorbidity were factors associated to postoperative complications and mortality (p<0.05). Conclusions: The overall mortality rate was 10.2%. A higher mortality was seen among neonates compared to older children.

Early clinical outcomes and medical complications following long segment fusion for adult spinal deformity with and without three column osteotomy

BackgroundSurgical treatment of adult spinal deformity (ASD) commonly involves long-segment fusion with or without three column osteotomies (3CO) to provide satisfactory correction of sagittal and coronal balance. While some clinical studies have implicated 3CO as a driver of high surgical complication rates, these prior investigations are limited by small sample size. Herein, we compare early outcomes and adverse events in patients undergoing long segment posterior spinal fusion for ASD with and without 3CO. MethodsA multicenter administrative database was queried for patients undergoing elective posterior spinal fusion for ASD. Patients were stratified based upon long segment fusion with and without 3CO. Preoperative patient demographics, procedural characteristics, hospitalization events, and postoperative complication rates were evaluated. Student's t-test and Fisher's exact test were utilized where appropriate to compare differences between the two groups for continuous and categorical variables. Results340 cases met the inclusion criteria, of which 156 involved 3CO. Patients who required 3CO had a lower rate of preoperative diabetes (22.3 % vs 10.3 %, p = 0.003), higher rates of non-home discharge (26.2 % vs 57.1 %, p < 0.001), longer operation time (245.62 ± 9.45 vs. 434.40 ± 11.65, p < 0.001), and longer length of stay (4.17 ± 0.66 vs. 7.76 ± 0.83, p < 0.001). In terms of complications, 3CO patients had higher rates of deep surgical site infection (0 % vs 3.2 %, p = 0.02), reintubation (0 % vs 4.5 %, p = 0.004), inability to wean off ventilator (0 % vs 2.6 %, p = 0.04), and perioperative blood transfusion (20.1 % vs 76.3 %, p < 0.001). ConclusionsIn this retrospective analysis, posterior 3CO was frequently undertaken but associated with higher risk for postoperative adverse events following spinal deformity correction.

Impact of Dementia on Outcomes Following Hemiarthroplasty for Femoral Neck Fracture: A National Database Study

BackgroundDementia poses an elevated risk of femoral neck fracture (FNF) in the elderly, often leading to the need for hemiarthroplasty. Yet, the outcomes of hemiarthroplasty in patients who have dementia remain uncertain. The purpose of this study was to assess whether dementia serves as a potential risk factor for outcomes following hemiarthroplasty. MethodsDementia patients who underwent hemiarthroplasty for FNF with at least 1 year of follow-up were identified using a national insurance database. A 1:1 matched control cohort of patients who do not have dementia was created for comparison. Logistic regression analyses were used to evaluate the rates of complications between the two cohorts. A total of 89,072 patients, of whom half have dementia and half do not, undergoing hemiarthroplasty for FNF were identified. ResultsAside from increased risks of medical complications (P < 0.01), including pneumonia, cerebrovascular accident, acute kidney injury, urinary tract infection, and sepsis, within 90 days, dementia patients also demonstrated higher rates of surgical complications within 1 year, such as dislocation (Odds Ratio (OR) 1.87, 95% Confidence Interval (CI) 1.71 to 2.04), periprosthetic fractures (PPF) (OR 1.29, 95% CI 1.16 to 1.45), and revision (OR 1.23, 95% CI 1.10 to 1.36). On the other hand, dementia patients displayed slightly reduced rates of 90-day deep vein thrombosis and pulmonary embolism. However, no significant increase was found in transfusion, myocardial infarction, wound complications, periprosthetic joint infection (PJI), or aseptic loosening between the two cohorts. Additionally, patients who have dementia demonstrated a higher likelihood of 90-day emergency department visits, whereas rates of 90-day hospital readmission remained similar. ConclusionAlthough dementia patients do not exhibit an elevated risk of PJI, or aseptic loosening, they are more prone to experiencing higher risks of prosthetic dislocation, PPF, and revision. Furthermore, specific medical complications tend to be more prevalent among individuals who have dementia.

The effect of early surgery on clinical outcomes in proximal femoral fracture patients receiving chronic anticoagulation: A japanese nationwide database study

Introduction: Surgery is often delayed in patients with proximal femoral fractures who receive oral anticoagulants, to avoid complications related to perioperative bleeding. However, surgery delay may increase the risk of postoperative mortality. Our primary goal was to understand whether anticoagulated patients benefit from early surgery in terms of survival and perioperative complications.Methods: This is a multicenter retrospective cohort study of 581,189 patients with proximal femoral fractures. About 2.0 % (n = 11,385) received direct oral anticoagulants (DOAC) and 1.5 % (n = 8,726) received warfarin. Surgery was performed within 48 h in 37.6 % of DOAC patients, 27.6 % of warfarin patients and in 41.9 % of nonanticoagulated patients. Survival analysis was applied to compare mortality rate, blood transfusions, systemic complications and surgical complications during hospitalization between the study groups.Results: Patients receiving anticoagulation were older and had more comorbidities than patients without anticoagulation. There were overall similar rates of mortality (0.8 %, 1.1 % and 1.2 %) and surgical complications (2.1 %, 2.1 % and 2.2 %) in non-anticoagulated, DOAC and warfarin patients. Blood transfusions and systemic complications were higher in all anticoagulated patients regardless of surgery timing. There were comparable rates of early surgery (41.9 %, 37.6 % and 27.6 %, respectively). When operated early, DOAC patients had more surgical complications (OR=1.24, p = 0.04). Warfarin patients operated early had higher mortality (OR=1.48, p = 0.08) and higher risk of blood transfusions (OR=1.24, p < 0.001).Discussion: Age and comorbidities could explain higher rates of postoperative systemic complications in anticoagulated patients. Nevertheless, overall short-term mortality was similar between the groups. Early surgery was associated with higher rates of surgical complications in DOAC patients. When operated early, patients receiving warfarin were at an increased risk of mortality (p = 0.08) and perioperative blood transfusions.

Complications after Primary and Revision Shoulder Arthroplasty: A Matched Cohort Study

BackgroundPatients who undergo total shoulder arthroplasty (TSA) typically have excellent clinical outcomes, though some patients require revision shoulder arthroplasty to address complications such as infection, instability, and persistent pain. The purpose of this study was to compare the rates and types of complications, as well as patient-reported outcomes, following primary and revision shoulder arthroplasty. MethodsRetrospective chart review was conducted for patients who underwent revision anatomic or reverse shoulder arthroplasty between January 2015 and May 2021 (N = 152). A cohort of patients who underwent primary shoulder arthroplasty in the same period was generated by matching 1:1 for implant type (anatomic/reverse), age, and surgery date. Demographic data, patient reported-outcomes, surgical details, surgical complications, and reoperations were collected for both cohorts (N = 304). Chi-square, t-test, Fisher’s exact test, and Mann-Whitney test were used as appropriate. ResultsThe revision cohort had a significantly higher rate of surgical complications than the primary cohort (N = 58, 38.2% vs. N = 22, 14.5%; P < .0001). The distribution of complication types differed significantly between the primary and revision cohorts (P = .018). Revision patients reported less improvement in Single Assessment Numeric Evaluation (SANE) score from baseline to two-years follow-up compared to primary patients (post-pre scores 33.9 ± 35.9 vs. 52.3 ± 32.5; P = .036). Patients in the primary cohort who underwent a previous shoulder surgery prior to their shoulder arthroplasty were more likely to experience complications than those who did not (P < .001). The most common surgical complications in the revision cohort were persistent pain (N = 20) and periprosthetic joint infection (N = 10), while the most common complications in the primary cohort were persistent pain (N = 6) and instability (N = 4). 63.6% of complications in primary patients and 55.2% of complications in revision patients necessitated reoperation. Total procedure time was higher on average in revision patients (120 ± 68 min) than primary patients (94 ± 31 min; P < .0001). Revision patients were more likely than primary patients to have had cemented humeral stems in their primary arthroplasty (P = .043). ConclusionPatients undergoing revision shoulder arthroplasty are at an increased risk for subsequent surgical complications and worse clinical improvement compared to primary shoulder arthroplasty patients. The differing profiles of postoperative complication types following primary and revision shoulder arthroplasty should be considered when advising patients on the risks of surgery and creating preoperative surgical plans to minimize these risks.

Negative and Positive Predictors of Anastomotic Leakage in Colorectal Cancer Patients-The Case of Neutrophil-to-Lymphocyte Ratio.

Colorectal surgery for cancer is associated with a high rate of surgical complications, including anastomotic leakage. The ability to predict the risk of leakage early enough seems to be of high value, since it would facilitate the design of personalized treatment and duration of hospitalization. Although different studies present the neutrophil-to-lymphocyte ratio [NLR] as having a strong predictive value, there is a discrepancy with respect to which postoperative day is the most reliable. We evaluated a series of NLR values, from the day before surgery up to the POD7, in a cohort of 245 colorectal surgery patients in order to clarify the best predictable score for the identification of the risk of anastomotic leakage. There were 28 patients with leaks. ROC curve analysis of NLR on POD1 indicates that a cut-off point ≥ 7.4 exerts a negative prediction for leakage (AUC 0.881, sensitivity 68.7%, specificity 96.4%, PPV 28.4%, and NPV of 99.3%), thus excluding 150 patients from the risk of leakage. Furthermore, the ROC curve analysis of NLR on POD4 indicates that a cut-off point ≥ 6.5 gives a positive prediction of leakage (AUC 0.698, sensitivity 82.1%, specificity 51.6%, PPV 17.6%, and NPV of 95.6%), thus indicating 52 patients as being at high risk of leakage. Finally, NLR failed to identify five leaks out of twenty-eight. These results strongly indicate the ability of NLR on POD1 to predict patients at low risk of developing a leak and then on POD4 to predict the high-risk patients. This makes our study particularly innovative, in that it enables doctors to concentrate on potential high-risk patients from POD1.

Tethered cord syndrome from pediatric and adult perspectives: a comprehensive systematic review of 6135 cases.

This study aimed to investigate the differences in clinical features, diagnostic examination, treatment, and pathological results between adult-onset and pediatric-onset tethered cord syndrome (TCS). The authors searched the PubMed, Embase, and Cochrane Library databases through January 2023 for reports on TCS, extracting information on clinical features, imaging data, treatment modalities, prognosis, and pathological research results. A total of 6135 cases from 246 articles were included in the analysis. This review was conducted in accordance with the 2020 PRISMA guidelines and registered on PROSPERO. The most common adult clinical manifestations were pain, urinary symptoms, and numbness; in children, they were urinary symptoms, skin lesions, bowel symptoms, and unspecific motor deficits. Surgical treatment was the primary approach for both adults and children, with a higher clinical improvement rate observed in adults. However, adults also had a higher rate of surgical complications than children. TCS pathological studies have not yet identified the differences between adults and children, and the pathogenesis of adult-onset TCS requires further investigation. Adult-onset and pediatric-onset TCS exhibit certain differences in clinical characteristics, diagnostic examinations, and treatments. However, significant differences have not been found in current pathological studies between adults and children. Systematic review registration no.: CRD42023479450 (www.crd.york.ac.uk/prospero).

Abstract PO2-22-10: Surgical outcomes after neoadjuvant chemotherapy with and without immunotherapy in patients with triple negative breast cancer

Abstract Background: The KEYNOTE-522 trial demonstrated that the addition of neoadjuvant pembrolizumab to neoadjuvant chemotherapy (NAC) for the treatment of early-stage triple negative breast cancer (TNBC) significantly improves rates of both pathologic complete response (pCR) and event-free survival. The impact of adding immunotherapy to NAC on surgical outcomes, however, is unknown. The purpose of this study is to compare 90-day surgical complication rates and timing to subsequent adjuvant therapy of patients undergoing neoadjuvant chemotherapy for stage I-III TNBC with and without immunotherapy. Methods: Patients treated at University of California, Los Angeles with neoadjuvant therapy for TNBC between 2018-2022 were identified retrospectively. Patient comorbidities, tumor characteristics, type of surgery, 90-day postoperative minor and major complications, timing to adjuvant therapy, and oncologic outcomes were reviewed and analyzed. Major complications were defined as those requiring reoperation or hospitalization. Results: A total of 44 patients were included, 15 patients received neoadjuvant chemotherapy with immunotherapy (NAC-I) and 29 patients received neoadjuvant chemotherapy alone (NAC). There was no difference in patient comorbidities between the groups. Compared to the NAC group, significantly more patients in the NAC-I group had stage II or III tumors (58.6% vs. 86.7%, respectively, p=0.028). 73% of patients in the NAC-I group underwent mastectomy compared to only 44% of patients in the NAC group (p=0.111). In total, 23 patients underwent reconstruction with mastectomy, 6 patients underwent immediate DIEP flap (4 in NAC-I group and 2 in NAC group) and 17 underwent immediate tissue expander (7 in NAC-I and 10 in NAC group). 80% of patients in the NAC-I experienced a pCR compared to only 44% in the NAC group (p=0.026). A total of 15 patients (34.1%) experienced surgical complications and there was no significant difference in the complication rate between the groups (p= 0.552). Five patients (33%) in the NAC-I group experienced minor complications of seroma requiring aspiration (n=4), cellulitis requiring antibiotics (n=1), or wound dehiscence requiring local wound care (n=2). No patients in the NAC-I group had major complications. Ten patients (33%) in the NAC group experienced complications, including 6 minor complications and 4 major complications including postoperative bleeding or flap necrosis requiring unplanned return to surgery or hyperbaric oxygen treatment. On multivariable regression analysis, controlling for patient characteristics, tumor stage, and preoperative immunotherapy, only younger age was a statistically significant variable associated with increased risk of surgical complications (p=0.012). Median time to adjuvant therapy, including radiation and/or systemic therapy, was similar between NAC-I and NAC groups, at 32 and 36 days, respectively (p=0.37). In the NAC-I group, 14 patients (93.3%) had adjuvant systemic therapy including pembrolizumab alone (n=12), pembrolizumab with olaparib (n=1) or capecitabine alone (n=1). In the NAC group, 11 patients (37.9%) underwent adjuvant systemic treatment including chemotherapy with either capecitabine (n=1), pembrolizumab (n=1), or olaparib (n=2); or single agent capecitabine (n=6) or olaparib (n=1). Conclusions: Despite patients in the NAC-I group having more advanced stage tumors and undergoing more extensive surgery and reconstruction compared to those in the NAC alone group, a significantly higher rate of surgical complications was not observed in the NAC-I group and there was no significant difference in time to adjuvant therapy between the two groups. Similar to results from the KEYNOTE-522 trial, more patients in the NAC-I group experienced a pCR compared to NAC alone. Larger studies are needed to continue to assess and optimize the surgical safety of neoadjuvant immunotherapy with chemotherapy in patients with TNBC. Citation Format: Anouchka Coste Holt, Maurice Berkowitz, Nicholas McAndrew, Courtney Smith, Jennifer Baker, Nimmi Kapoor. Surgical outcomes after neoadjuvant chemotherapy with and without immunotherapy in patients with triple negative breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-10.

Nutritional care for cancer patients: are we doing enough?

Malnutrition is associated with higher rates of surgical complications, increased anticancer treatment toxicities, longer hospital stays, higher healthcare costs, poorer patient quality of life, and lower survival rates. Nutritional support has been shown to improve all of these outcomes. However, the nutritional care of cancer patients is still suboptimal and several issues remain unresolved. Although the effectiveness of nutritional support depends on the timeliness of intervention, assessment of nutritional status is often delayed and perceived as unimportant. When diagnoses of malnutrition are made, they are rarely recorded in medical records. Hospitals lack medical staff dedicated to clinical nutrition, making it difficult to integrate nutritional care into the multidisciplinary management of cancer patients. Outside the hospital, nutritional support is hampered by heterogeneous reimbursement policies and a lack of adequate community nutrition services. In addition, an increasing number of patients are turning to potentially harmful "anti-cancer" diets as trust in medicine declines. Adopting mandatory nutrition screening, monitoring quality of care metrics, providing nutrition education to care providers, and implementing telehealth systems are some of the most urgent interventions that need to be established in the future.

Comparative analysis of surgical treatment modalities for a popliteal pterygium: a meta-analysis.

Popliteal pterygium syndrome is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. The popliteal pterygium (PP) affects ambulation due to severe knee flexion contracture and equinovarus deformities. Surgical treatment aims to correct these deformities while preserving limb sensibility. However, due to its rarity, surgical guidelines are lacking. A meta-analysis according to PRISMA guidelines was conducted to summarize and compare surgical methods for PP. 183 paper were identified in PubMed and data from 32 articles were analyzed, including patient demographics, treatment modalities (Ilizarov fixator, femoral osteotomy, skin/soft tissue procedures, hamstring release, nerve surgery, and amputation), pre- and post-operative abilities to walk, knee joint parameters, complications, and recurrent contractions. Among 58 patients (87 limbs), Ilizarov fixator demonstrated improved knee and ankle mobility postoperatively, but showed a relatively high surgical session count and complication rates. Femoral osteotomy achieved successful knee posture correction with fewer sessions and no complications. Isolated skin/soft tissue procedures improved flexion contracture and mobility, though they required several procedures. Hamstring release achieved notable contracture reduction but also necessitated multiple interventions. Nerve surgery and amputation had limited data, warranting further investigation. The management of PP demands a comprehensive approach, considering individual patient characteristics and treatment outcomes. While different surgical modalities offer distinct benefits, a classification or guideline to treat this deformity is still lacking. Further research is essential to validate findings, refine treatment approaches, and enhance the quality of life for individuals with PP.

342 Systematic Review of Disparities in Treatment, Surgical Management, Outcomes by Race and Insurance Status Disparities in Spine Oncology

INTRODUCTION: Healthcare disparities within neurosurgery and spine surgery have been documented with respect to race and insurance type. To date, there has not been a systematic review of disparities in spinal oncology access, treatment and outcomes. METHODS: A systematic review was performed following PRISMA guidelines with a strategy to identify disparities broadly within spine oncology using the following MeSH terms: “spinal neoplasms,” “healthcare disparities,” “race,” “insurance status,” and “socioeconomic status.” Studies were included and excluded based on pre-established criteria. RESULTS: Out of a total of 400 papers, 17 papers were reviewed. Black patients with spine oncologic conditions experienced decreased access to care and disparities in treatment modalities offered when compared to non-Black patients. Further, when minority and white patients were compared, differences were seen in the clinical presentation of symptoms and in-hospital outcomes. Minority patients were found to have longer postoperative length of stay and higher rates of surgical complications. A similar trend is seen when comparing Medicaid patients versus privately insured patients with respect to access to treatment and differences in treatment modality. Furthermore, patients with public insurance experienced higher rates of postoperative mortality compared to those with private insurance. CONCLUSIONS: Disparities within the treatment of spine oncology patients are present with respect to factors such as race, socioeconomic status, and insurance type. Further exploration into the root causes for these disparities should be performed to inform policy and programs aimed at establishing equity for the care of spine oncology patients.

Glucose Lability and Complications in Diabetic Ankle Fractures

Introduction/Purpose: Rotational ankle fractures in diabetics have long posed difficult clinical challenges, with several observational studies noting increased risk of complications and amputation following treatment of unstable ankle fractures in diabetics. Several treatment options exist, including non-operative management, external fixation, open reduction internal fixation, staged fixation, and fusion. Hemoglobin A1C produces a mean blood glucose level over a three-month period. There is mounting evidence that glucose variability may be an alternative predictor of complication profile in non-orthopedic procedures, as well as in the total joint arthroplasty literature. The purpose of this investigation is to retrospectively analyze complication rates for diabetics with rotational ankle fractures at a single institution and assess their association with both the hemoglobin A1C and glucose variability. Methods: After obtaining Institutional Review Board approval, all patients from 2015-2022 with a diagnosis of diabetes and ankle fracture were retrospectively identified based on ICD-9/ICD-10 codes. These charts were manually reviewed to determine fracture classification and treatment. For operatively and non-operatively managed ankle fractures, the patient’s hemoglobin A1C was recorded when available within 3 months of the date of injury. Glucose variability was calculated using a coefficient of variation. Results: Two-hundred patients were included for analysis, of which 29% (n=58) were treated non-operatively. The majority of surgically treated patients underwent acute ORIF (58%, n=116). 8.5% were treated with staged fixation, 3.5% with acute hindfoot fusion, and 1% with external fixation alone. The overall complication rate was 27.5% (n=55). There were no statistically significant differences in both A1C (7.81 +/- 1.89 vs 7.73 +/- 1.96) and glucose variability, as measured by the covariance of variation (0.23 +/- 0.15 vs 0.20 +/- 0.13) in patients who did and did not experience postoperative complications. Higher glucose variability did trend towards predicting complications, though not in a statistically significant fashion (OR=1.57, p=0.35). Conclusion: Ankle fractures in patients with diabetes pose a challenge for orthopedic surgeons, as evidenced by the high medical and surgical complication rate observed in this study and others. No statistical significance was found between higher A1C and complication rate or between glucose variability and complication rate. Further investigation on the impact of glucose variability on complication rates in a larger cohort of this patient population is warranted. Univariable logistic Regression Results for the association of the odds of post-operative complication with patient characteristics.

The Negative Impacts of Sarcopenia on Primary Total Knee Arthroplasty under the Enhanced Recovery after Surgery Protocol.

Sarcopenia, as an emerging public health concern, has been associated with postoperative adverse outcomes in various surgical procedures. However, the evidence regarding the impacts of sarcopenia on total knee arthroplasty (TKA) remained limited. This study aimed to assess the impacts of sarcopenia on primary TKA based on the enhanced recovery after surgery (ERAS) protocol. This retrospective study included 291 patients who received unilateral TKA from October 2017 to May 2018 in our institution. Sarcopenia was diagnosed based on the algorithm of Asian Working Group for Sarcopenia 2019. The handgrip strength was measured using a handheld dynamometer and the muscle mass was estimated by a previously validated anthropometric equation. Patients were classified into sarcopenia group and non-sarcopenia group. The outcomes included complications, postoperative length of stay (LOS), total hospitalization cost, operative time, total estimated blood loss, blood transfusion rate, and the 12-item forgotten joint score (FJS-12) at the follow-up. The propensity score matching (PSM) was used to adjust confounding factors. We compared continuous variables using Student's t-test and the Wilcoxon Mann-Whitney U test for normal and non-normal distributions, respectively, and categorical variables with chi-square tests. Of the 291 patients, 58 (19.9%) patients were identified as having sarcopenia. After PSM, each group matched 42 patients. All matched patients were followed-up at least 5 years. Patients with sarcopenia had higher rates of surgical complications compared to the non-sarcopenia group (p = 0.019), and no significant difference was observed in 30-day readmission, and periprosthetic joint infection. The sarcopenia group had significantly longer LOS (p = 0.038), higher total hospitalization (p = 0.015) than the non-sarcopenia group. For the FJS-12 scores at follow-up, patients with sarcopenia had significantly higher scores than the non-sarcopenia group (p = 0.024). Our findings indicated sarcopenia may be a risk factor for postoperative complications, prolonged LOS, increased hospitalization cost and reduced patient satisfaction.

Does complete pathological response increase perioperative morbidity risk in rectal cancer?

The optimal management of patients with clinical complete response after neoadjuvant treatment for rectal cancer is controversial. The aim of this study is to compare the morbidity between patients with locally advanced rectal cancer who have had a pathological complete response (pCR) or not after neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME). The study hypothesis was that pCR may impact the surgical complication rate. A retrospective cohort study was conducted of a prospectively maintained database in Australia and New Zealand, the Binational Colorectal Cancer Audit, that identified patients with locally advanced rectal cancer (<15 cm from anal verge) from 1 January 2007 to 31 December 2019. Patients were included if they had locally advanced rectal cancer and had undergone NCRT and proceeded to surgical resection. There were 4584 patients who satisfied the inclusion criteria, 65% being male. The mean age was 63 years and 11% had a pCR (ypT0N0). TME with anastomosis was performed in 67.8% of patients, and the majority of the cohort received long-course radiotherapy (81.7%). Both major and minor complications were higher in the TME without anastomosis group (17.3% vs. 14.7% and 30.6% vs. 20.8%, respectively), and the 30-day mortality was 1.31%. In the TME with anastomosis group, pCR did not contribute to higher rates of surgical complications, but male gender (p < 0.0012), age (p < 0.0001), preoperative N stage (p = 0.0092) and American Society of Anesthesologists (ASA) score ≥3 (p < 0.0002) did. In addition, pCR had no significant effect (p = 0.44) but male gender (p = 0.0047) and interval to surgery (p = 0.015) contributed to higher rates of anastomotic leak. In the TME without anastomosis cohort, the only variable that contributed to higher rates of complications was ASA score ≥3 (p = 0.033). Patients undergoing TME dissection for rectal cancer following NCRT showed no difference in complications whether they had achieved pCR or not.

Challenges in treating children with optic pathway gliomas: an 18-year experience from a middle-income country.

Patients with optic pathway gliomas (OPG) have good survival rates although their long-term quality of life can be affected by the tumor or treatment-related morbidity. This retrospective study sought to describe the clinical presentation and outcomes of children with OPG at a tertiary center in Mexico. Consecutive patients <18 years-of-age with newly diagnosed OPG between January 2002 and December 2020 at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca in Guadalajara, Mexico were included. Thirty patients were identified with a median age of six years. The most frequent clinical manifestations were loss of visual acuity (40%) and headaches (23%). Neurofibromatosis-1 was found in 23.3% of the patients. Surgery, either biopsy or resection, was done in 20 of 30 patients. Two patients died shortly after initial surgery. The 5-year event-free survival (EFS) was 79.3% ± 10.8% and the 5-year overall survival was 89.5% ± 6.9%. Lower EFS was associated with age less than 3 years, intracranial hypertension at presentation, and diencephalic syndrome. Patients who received surgery as first-line treatment had a 3.1 times greater risk of achieving a performance score of less than 90 points at 6 months after diagnosis (p=0.006). Of 10 patients with vision testing, 5 had improvement in visual acuity, 4 had no changes, and one patient showed worsening. Our data suggests that favorable outcomes can be achieved with OPG in low- and middle-income countries, although a high rate of surgical complications was described leading to a lower overall survival. These data can be used prospectively to optimize treatment at this institute and other middle-income countries through a comprehensive, multidisciplinary approach.

Surgical complications of bariatric surgery among patients with rheumatic diseases.

Obesity is one the most prevalent diseases all around the world. Some studies have shown a relationship between obesity and the worsening of rheumatic disorders. Higher rates of surgical complications might also be seen among these patients. This retrospective-descriptive study was performed on 25 patients with rheumatic disease referred to Loghman Hakim Hospital (Tehran- Iran) and candidates for bariatric surgery (laparoscopic Roux-en-Y gastric and laparoscopic sleeve gastrectomy) from 2018 to 2020. Duration of hospitalization after surgery and history of post-operation surgical and rheumatic complications were assessed. Patients were followed through 6 months after surgery. The age (Mean±SD) of recruited patients was (38.4 ±10.0) years. The mean body mass index was 45.54 kg/m2 with the minimum and maximum values of 37.5 kg/m2 and 56.5 kg/m2. Among them, the prevalence of rheumatic disorders was rheumatoid arthritis 32%, psoriasis 28%, gout 16%, lupus erythematosus 8%, and other rheumatologic disorders 16%, respectively. One patient had a surgical complication that was a port site infection. One patient had a relapse of gout and other patients had remission and also, their therapeutic drugs were discontinued or reduced. Patients with rheumatic disorders revealed no higher surgical complication rate after bariatric surgery, and bariatric surgery helped disease remission among these patients.

Pedicle Subtraction Osteotomy Versus Multilevel Anterior Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion in the Treatment of Adult Spinal Deformity: Trends, Outcomes, and Cost.

Retrospective cohort study. The aim of this study was to compare the outcomes of pedicle subtraction osteotomy (PSO) with multilevel anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) in posterior long-segment fusion. PSO and ALIF/LLIF are 2 techniques used to restore lumbar lordosis and correct sagittal alignment, with each holding its unique advantages and disadvantages. As there are situations where both techniques can be employed, it is important to compare the risks and benefits of both. Patients aged 18 years or older who underwent PSO or multilevel ALIF/LLIF with posterior fusion of 7-12 levels and pelvic fixation were identified. 1:1 propensity score was used to match PSO and ALIF/LLIF cohorts for age, sex, and relevant comorbidities, including smoking status. Logistic regression was used to compare medical and surgical outcomes. Trends and costs were generated for both groups as well. ALIF/LLIF utilization in posterior long fusion has been steadily increasing since 2010, whereas PSO utilization has significantly dropped since 2017. PSO was associated with an increased risk of durotomy ( P < 0.001) and neurological injury ( P = 0.018). ALIF/LLIF was associated with increased rates of postoperative radiculopathy ( P = 0.005). Patients who underwent PSO had higher rates of pseudarthrosis within 1 and 2 years ( P = 0.015; P = 0.010), 1-year hardware failure ( P = 0.028), and 2-year reinsertion of instrumentation ( P = 0.009). Reoperation rates for both approaches were not statistically different at any time point throughout the 5-year period. In addition, there were no significant differences in both procedural and 90-day postoperative costs. PSO was associated with higher rates of surgical complications compared with anterior approaches. However, there was no significant difference in overall reoperation rates. Spine surgeons should select the optimal technique for a given patient and the type of lordotic correction required.

Life Expectancy After Diagnosis of a Vestibular Schwannoma in Patients 70 Years and Older

Over the past decades, the number of patients, especially in the older adult patient group, diagnosed with vestibular schwannoma (VS) has increased. Assuming that older adult patients have more comorbidities, a longer recovery period after surgery, a higher rate of surgical complications, and a higher mortality rate after VS surgery, a treatment strategy for this group of patients is warranted, based on clinical evidence on postsurgical survival. To evaluate the survival after diagnosis of a VS in patients 70 years and older, treated with either observation or surgery, and to compare these findings with the life span of an age-matched background population in Denmark. This was a retrospective cohort study of 624 patients 70 years and older diagnosed with VS in Denmark from 1976 to 2016. Since 1976, all patients with a VS have been registered in a national database, which contains 3637 patients. Of the included patients in this study, 477 were treated conservatively with the "wait-and-scan" strategy, and 147 were treated surgically with removal of the tumor. The survival of the patients was compared with a matched background population in Denmark. Data analysis was performed from January 1976 to January 2017. Surgery, radiotherapy, or none. The main outcome was survival among the patients and compared with the matched background population. A total of 624 patients were included (317 female patients [50.8%] and 307 male patients [49.2%]). The mean (SD) survival in the observed patients was 9.2 (4.7) years after diagnosis, whereas for the background population, the expected survival was 11 years from the mean age at diagnosis. For the surgically treated patients, the mean (SD) survival was 11.8 (6.6) years, and expected survival was 11 years for the matched background population. The mean (SD) survival was 10.7 (5.5) years in female patients and 8.9 (5.0) years in male patients. There was no significant difference in survival between treatment modalities, irrespective of tumor size. In this cohort study, survival after diagnosis of a VS in patients 70 years and older was similar in the surgical group compared with the age-matched background population. In the wait-and-scan group, the survival after diagnosis was marginally shorter, which may be associated with increased comorbidity.

Ganglioneuromas in Childhood: Hacettepe Experience With 70 Cases

BackgroundGanglioneuromas (GNs) are rare benign peripheral neuroblastic tumors (PNTs). We shared our institutional experience with childhood GNs. MethodsRecords of the children with PNTs between January 1995 and December 2021 were reviewed, and cases with histopathological diagnoses of GN were identified. Clinical, laboratory, radiological, and histopathological findings, image-defined risk factors (IDRFs), procedures, and overall outcomes were recorded. ResultsOf 668 cases with PNTs, 70 (10.4%) had GNs. The median age was 7.4 years (range, 2.6–15.7 years) (girls/boys, 41/29). Common presenting complaints were abdominal pain and cough; 33/70 cases (47.1%) were diagnosed incidentally. Primary tumors were in the abdomen in 41/70, the thorax in 25/70, the neck in 3 cases, and the pelvis in one. The median tumor size was 6.5 cm (range, 1.4–17). Fifty cases (71.4%) were staged as INRG-L1; 20 cases with IDRFs (15 single, five >1) were staged as INRG-L2. Complete and partial tumor resections were performed in 58/70 and 6/70 cases, while 6 had no resection. The overall complication rate was 17.1% (11/64). At a median follow-up of 9 years, five were lost to follow-up; 65 were alive. One patient with gross residue underwent total resection due to progression 13 years after the surgery, and one in the unresected group was lost to follow-up. Ten other cases without a complete resection experienced no tumor progression. ConclusionsGanglioneuromas are benign PNTs, and most are free of IDRFs. Even without complete resection, long-term outcomes are excellent. Guidelines should be devised considering the high surgical complication rates and benign course of GNs. Level of EvidenceCase series, IV.

Isolated Liner Exchange Versus All-Component Revision for Instability After Total Knee Arthroplasty

BackgroundInstability is a common cause for revision total knee arthroplasty (TKA). The risks and benefits of polyethylene liner exchange (LE) as compared to full metal component revision continue to be debated. The purpose of this study was to investigate the success rate and complication profiles of revision TKA for instability based on surgical procedure. MethodsThis was a retrospective study of patients undergoing revision TKA for instability from 2015 to 2019. Patients with prior revisions were excluded. 42 patients undergoing isolated polyethylene LE without an increase in constraint were compared with 48 patients undergoing full component revision revision (FCR) of both tibial and femoral components. The primary outcome was differences in rerevision for instability. Noninstability reoperations, 90-day readmissions, and lengths-of-stay were also compared. ResultsLEs had a 10.1% higher rerevision for instability rate that approached statistical significance (LE 14.3% versus FCR 4.2%, P = .092). Additionally, FCR had a 4.2% rate of aseptic loosening and a 4.2% rate of periprosthetic-joint-infection, whereas LE had none (P = .181). FCR also had a longer length-of-stay (FCR 3.0 ± 1.3 versus LE: 1.8 ± 0.9 days, P < .001). No differences were found in 90-day readmissions (LE 7.1% versus FCR 4.2%, P = .661). ConclusionAll component revision may have a higher success rate than isolated LE in addressing instability but is associated with higher rates of surgical complications. With appropriate patient selection and risk-benefit discussion, isolated LE may be a reasonable surgical option for TKA instability with a lower complication profile and length-of-stay.