Higher Risk Of Postoperative Complications Research Articles

Impact of opioid-related disorders on complications in patients undergoing bariatric surgery: a propensity score-matched analysis of the national inpatient sample.

The opioid crisis caused a huge health concern in the United States. Despite this, few studies haveexamined the influence of opioid-related disorders (OD) on outcomes after bariatric surgery. The major goal of this study is to determine the impact of OD on in-hospital outcomes for patients undergoing bariatric surgery. The National Inpatient Sample (NIS) database from 2016 to 2020 was used to evaluate patients with OD who underwent bariatric operations including sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. The non-OD comparison group was created using a propensity score match (1:1). Weighted analysis was carried out utilizing NIS-provided weights. The odds ratios were obtained using multivariate logistic regression. A total of 159,455 patients who underwent bariatric surgery were evaluated. Propensity score matching and weighted analysis were used to compare 11,025 in the OD group and 11,025 in the non-OD group. OD was an independent predictor for postoperative complications (odds ratio: 1.29, 95% confidence interval: 1.19-1.39, p < 0.001). Among complications, OD was a predictor for bleeding complications, postoperative nausea and vomiting, anastomotic leak, and mechanical ventilation. In addition, the OD group experienced significantly longer lengths of stay (LOS) and a higher total hospital charges. In patients undergoing bariatric surgery, OD is associated with a significantly higher risk of postoperative complications, as well as increased LOS and total hospital charges. These patients may benefit from further preoperative optimization, including decreasing the opioid dose and closer postoperative monitoring.

Microinvasive intrascleral double continuous suture repair surgery for cyclodialysis clefts.

The traditional suturing method for cyclodialysis cleft usually requires an incision in the sclera for direct suturing, resulting in greater damage and a high risk of postoperative complications. The purpose of this work is to propose a newly intrascleral double continuous suture repair technique for the treatment of cyclodialysis clefts. Seven patients with cyclodialysis cleft underwent microinvasive intrascleral double continuous suture repair surgery to restore the attachment of the detached ciliary body to the sclera without scleral incision. All operations were performed by the same surgeon. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), slit lamp and corneal examination results, ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT) results were recorded. Closure of the cyclodialysis cleft was achieved in 7 eyes and no obvious complications occurred after the operation. Intraocular pressure increased from preoperatively 6.8 ± 1.35 mmHg (range: 4.8-8.0 mmHg) to postoperatively 12.5 ± 4.0 mmHg (range: 8.0-20.0 mmHg) (paired sample T test, P < 0.01). Best-corrected Snellen visual acuity improved from preoperatively range 20/2000-20/63 to range 20/200-20/25 at final follow-up. In short, intrascleral double continuous suture repair surgical is safe and effective in treating cyclodialysis cleft, with minimal surgical trauma.

Does computed tomography-derived volumometry and densitometry of psoas muscle really correlate with complications in rectal cancer patients after elective surgery?

Although sarcopenia is recognized as one of the risk factors for increased morbidity after resection for colorectal cancer, the question of the most appropriate way to identify and quantify it is still unresolved. This is a retrospective unicentric study following patients undergoing elective resection of the rectum for carcinoma with available staging computed tomography (CT) of the trunk. Psoas muscle density (PMD) and its area relative to patient height psoas muscle index (PMI) at the level of inferior vertebral end plate of third lumbar vertebra (L3) were assessed using an initial staging CT scan of the trunk. Post-operative complications, evaluated according to the Clavien-Dindo classification, and blood samples on post-operative days (POD) 3 and 5 were also recorded in the study population. Patients were divided into groups with complicated and uncomplicated post-operative course, and observed parameters were then statistically compared. The correlation of PMI values with the development of post-operative complications was not confirmed in a data set of 206 patients. PMD values were found to be borderline statistically significant in patients with complicated post-operative course, while in the group of patients with severe complications (Clavien-Dindo III-IV), there was no statistically significant difference in PMI or PMD values. The same results were obtained when comparing patients with anastomotic leak (AL). It was confirmed that operations on the lower rectum are riskier for the development of post-operative complications. The secondary objective of our study regarding serum C-reactive protein (CRP) levels of 3rd and 5th POD gave us the answer in the form of cutoff values of 115.7 mg/L (3rd POD) and 76 mg/L (5th POD). PMD appears to be a promising tool for predicting post-operative morbidity in patients after rectal resection, but a clear consensus on the method of measurement, interpretation of results and cutoff values is needed. Lower rectal resections are burdened with a higher risk of post-operative complications, especially AL. Monitoring of CRP levels remains an important marker in the prediction of AL due to its negative predictive value.

Short- and Long-Term Outcomes in Elderly Patients with Resectable Esophageal Cancer: Upfront Esophagectomy Compared to Surgery after Neoadjuvant Treatments.

Background/Objectives: Despite the increased incidence of esophageal cancer (EC) in elderly people, there are no clear guidelines for its treatment in these patients. The aim of this study was to compare the outcomes of patients ≥ 75 years with resectable EC, receiving either upfront esophagectomy or neoadjuvant treatment. Methods: We retrospectively identified 127 patients with resectable EC ≥ 75 years who underwent esophagectomy between January 2000 and December 2022 at our Clinic in the University Hospital of Padova. The included patients were stratified into two groups: patients undergoing upfront esophagectomy (SURG group) and patients receiving neoadjuvant treatment (NAT group). Results: There were no statistically significant differences in OS (p = 0.7708), DFS (p = 0.7827) and cancer-related survival (p = 0.0827) between the SURG and the NAT group, except for the OS of EAC with stage III-IV, where the NAT group experienced a significant benefit in OS (p = 0.0263). When comparing the two groups, patients receiving neoadjuvant treatment experienced a significantly higher rate of postoperative complications (p = 0.0266). At univariate analysis, neoadjuvant therapy was the only variable strongly associated with postoperative morbidity (p = 0.026). Conclusions: Considering the unique characteristics of elderly patients, the choice of a multimodal approach should be tailored to each case in a multidisciplinary setting and balanced with a potential higher risk of postoperative complications, as well as potential toxicity related to chemoradiation and reduced life expectancy.

The Klotho protein and FGF23 as well-known players in the aging process but underestimated in the process of individual development and selected diseases of childhood and adolescence – a systematic review

Introduction and objective: The FGF23–Klotho endocrine axis plays a pivotal role not only in processes associated with aging but also in metabolic pathways, with implications for paediatric disorders. The aim of this study was to systematically review the existing literature on Klotho and FGF23 in the paediatric population. Materials and methods: Based on the PubMed and Web of Science databases, we conducted a PRISMA-guided search using (klotho) AND (children); (FGF23) AND (children), adhering strictly to the PRISMA guidelines, and assessed evidence quality. Results: The systematic review included 66 studies. Altered Klotho and FGF23 serum levels were observed in paediatric metabolic conditions (chronic kidney disease, diabetes), cardiovascular, and growth and musculoskeletal disorders. In some of them, Klotho and FGF23 serum levels changed with disorder treatment. Elevated FGF23 and Klotho deficiency in renal failure adversely impacted the cardiovascular system. Lower Klotho levels were found in preterm neonates, especially with bronchopulmonary dysplasia. Early Klotho supplementation in a bronchopulmonary dysplasia model mitigated lung tissue changes and improved the cardiac function. Children with lower Klotho levels undergoing cardiac surgeries faced a higher risk of postoperative complications, especially acute kidney injury. In X-linked hypophosphataemia, excess FGF23 led to musculoskeletal consequences. FGF23 serum levels aided the diagnosis of hypophosphataemic rickets, and anti-FGF23 antibody emerged as a common X-linked hypophosphataemia treatment. Conclusions: Klotho and FGF23 serve as promising early markers for paediatric metabolic disorders, offering a valuable tool for assessing complication risks. Klotho supplementation holds promise as a treatment method for specific paediatric disorders, while anti-FGF23 antibody is already established in X-linked hypophosphataemia treatment.

Minimally invasive methods of treatment of single recurrent metastases in the lymph nodes of the neck of highly differentiated thyroid cancer

Papillary thyroid cancer is the most common type of cancer, which accounts for about 80—85% of malignant tumors of this organ. In 20—30% of patients, a relapse of the disease is detected after treatment. Repeated surgical intervention increases the likelihood of complications. Minimally invasive techniques give the possibility of effective ablation of individual metastases of the neck less traumatically and with lower costs. Objective — to evaluate the effectiveness of minimally invasive treatment methods of isolated recurrent metastases of highly differentiated thyroid cancer. Materials and methods. The study involved 34 patients with recurrent metastases of papillary thyroid cancer in neck lymph nodes. Patients were allocated into two groups depending on the use of minimally invasive methods: 31 underwent percutaneous ethanol sclerotherapy, three patients underwent laser‑induced interstitial thermotherapy. All patients underwent volume treatment: thyroidectomy, central and lateral neck dissection, lymphadenectomy followed by radioiodine therapy. Patients had solitary altered lymph nodes, metastases size &lt;1.5 cm3, at a safe distance from main vessels, trachea, or esophagus, high risk of postoperative complications, and/or refused repeated surgical intervention. Results. Percutaneous ethanol sclerotherapy technique in 28 patients resulted in the decrease in thyroglobulin levels by 33.6% at average; antibodies to thyroglobulin by 15.3%, and remission of the disease, according to ultrasound results. In three patients, the growth of a metastatic lymph node with an increase in the level of thyroglobulin was noted, which indicates that the described method wasn’t sufficiently effective. The laser‑induced interstitial thermotherapy procedure was performed only in three patients, this small group does not allow conducting a reliable analysis of the treatment results. Positive clinical, laboratory and pathomorphological effect was obtained in all three cases. Conclusions. Minimally invasive techniques have no sufficient effectiveness in comparison with surgery, but they are effective enough for patients with a high risk of postoperative complications, anesthetic risk, and/or for those who refused to undergo repeated surgery.

Preliminary results of Polish national multicenter LILEO study on ileostomy reversal

Introduction: Ileostomy reversal is a common surgical procedure and currently standardized perioperative and surgical protocols are lacking. Aim: LILEO study was designed to perform a multicenter analysis on numerous perioperative parameters and estimation of the incidence of postoperative complications.Materials and methods: The study is an open multicenter prospective cohort study. Preliminary results of the LILEO study after 3 months were available from 18 Polish surgical centers comprising full data of 59 patients who underwent ileostomy reversal.Results: Parameters such as preoperative care, surgical technique, postoperative course and complications were analyzed. Preoperative fasting was used in 49,1% of patients. Fifty nine percent of anastomosis were handsewn and in 72,9% of patients had primary single suture wound closure. Mean length of hospital stay was 7,9 days (min 2 days, max 26 days). Complications occurred overall in 20 patients (33,9%). In 11,9% of patient’s complications had grade 3 A/B in Clavien-Dindo classification. Discussion: The perioperative care in the group of patients undergoing ileostomy reversal still lacks standardized and optimized treatment.Conclusions: Ileostomy removal is a procedure with high risk of postoperative complications. Standardization of perioperative care based on further multicenter national study could result in a decrease of complications rate.

Predicting complication risks after sleeve lobectomy for non-small cell lung cancer.

Sleeve lobectomy is a challenging procedure with a high risk of postoperative complications. To facilitate surgical decision-making and optimize perioperative treatment, we developed risk stratification models to quantify the probability of postoperative complications after sleeve lobectomy. We retrospectively analyzed the clinical features of 691 non-small cell lung cancer (NSCLC) patients who underwent sleeve lobectomy between July 2016 and December 2019. Logistic regression models were trained and validated in the cohort to predict overall complications, major complications, and specific minor complications. The impact of specific complications in prognostic stratification was explored via the Kaplan-Meier method. Of 691 included patients, 232 (33.5%) developed complications, including 35 (5.1%) and 197 (28.5%) patients with major and minor complications, respectively. The models showed robust discrimination, yielding an area under the receiver operating characteristic (ROC) curve (AUC) of 0.853 [95% confidence interval (CI): 0.705-0.885] for predicting overall postoperative complication risk and 0.751 (95% CI: 0.727-0.762) specifically for major complication risks. Models predicting minor complications also achieved good performance, with AUCs ranging from 0.78 to 0.89. Survival analyses revealed a significant association between postoperative complications and poor prognosis. Risk stratification models could accurately predict the probability and severity of complications in NSCLC patients following sleeve lobectomy, which may inform clinical decision-making for future patients.

Assessing the perioperative gain of weight (Δweight) as a determinant of morbidity after kidney transplantation: a retrospective exploratory study

Kidney transplantation (KT) is associated with a substantial risk of postoperative complications (POC) for which performant predictors are lacking. Data showed that a perioperative gain of weight (ΔWeight) was associated with higher risk of POC, but it remains unexplored in KT. This retrospective study aimed to investigate the association between ΔWeight and POC after KT. ΔWeight was calculated on postoperative day (POD) 2. POC were graded according to the Dindo-Clavien classification. Primary endpoint was overall POC. A total of 242 patients were included and 174 (71.9%) complications were reported. Patients showed a rapid gain of weight after KT. Mean ΔWeight was 7.83 kg (± 3.20) compared to 5.3 kg (± 3.56) in patients with and without complication, respectively (p = 0.0005). ΔWeight showed an accuracy of 0.74 for overall POC. A cut-off of 8.5 kg was determined. ΔWeight ≥ 8.5 kg was identified as an independent predictor of overall POC on multivariable analysis (OR 2.04; 95% CI 1.08–3.84; p = 0.025). ΔWeight ≥ 8.5 kg appeared as an independent predictor of POC after KT. These results stress the need to monitor weight in KT and to further investigate this surrogate with future studies assessing its clinical relevance.

Opioid-free anaesthesia with dexmedetomidine and lidocaine versus remifentanil-based anaesthesia in cardiac surgery: study protocol of a French randomised, multicentre and single-blinded OFACS trial

IntroductionIntraoperative opioids have been used for decades to reduce negative responses to nociception. However, opioids may have several, and sometimes serious, adverse effects. Cardiac surgery exposes patients to a high...

Predicting Complications in 153 Lumbar Pedicle Subtraction Osteotomies by a Single Surgeon Over a 6-Year Period.

Pedicle subtraction osteotomy (PSO) is a complex surgical procedure that provides correction of moderate sagittal imbalance. Surgical complications have adverse effects on patient outcomes and healthcare costs, making it imperative for clinical researchers to focus on minimizing complications. However, when it comes to risk modeling of PSO surgery, there is currently no consensus on which patient characteristics or measures should be used. This study aimed to describe complications and compare the performance of various sociodemographic characteristics, surgical variables, and established risk indices in predicting postoperative complications, infections, and readmissions after lumbar PSO surgeries. A review was conducted on 191 patients who underwent PSO surgery at a single institution by a single fellowship-trained orthopaedic spine surgeon between January 1, 2018, and December 31, 2021. Demographic, intraoperative, and postoperative data within 30 days, 1 year, and 2 years of the index procedure were evaluated. Descriptive statistics, t-test, chi-squared analysis, and logistic regression models were used. Intraoperative complications were significantly associated with coronary artery disease (odds ratios [OR] 3.95, P = 0.03) and operating room time (OR 1.01, P = 0.006). 30-day complications were significantly cardiovascular disease (OR 2.68, P = 0.04) and levels fused (OR 1.10, P = 0.04). 2-year complications were significantly associated with cardiovascular disease (OR 2.85, P = 0.02). 30-day readmissions were significantly associated with sex (4.47, 0.04) and length of hospital stay (χ2 = 0.07, P = 0.04). 2-year readmissions were significantly associated with age (χ2 = 0.50, P = 0.03), hypertension (χ2 = 4.64, P = 0.03), revision surgeries (χ2 = 5.46, P = 0.02), and length of hospital stay (χ2 = 0.07, P = 0.03). This study found that patients with coronary vascular disease and longer fusions were at higher risk of postoperative complications and patients with notable intraoperative blood loss were at higher risk of postoperative infections. In addition, physicians should closely follow patients with extended postoperative hospital stays, with advanced age, and undergoing revision surgery because these patients were more likely to be readmitted to the hospital.

Cannabis Use Disorder Associated With Increased Risk of Postoperative Complications After Hip or Knee Arthroplasties: A Meta-analysis of Observational Studies.

With the legalization of marijuana in the United States, the number of patients with cannabis use disorder (CUD) in the joint arthroplasty population has increased markedly. The primary purpose of this meta-analysis was to determine whether there were differences in clinical and economic outcomes after total joint arthroplasty (TJA) between patients with and without perioperative CUD. We searched PubMed, Embase, Scopus, and Web of Science databases up to July 2018 to identify all eligible studies investigating the association of CUD with postoperative outcomes in patients undergoing TJA. Postoperative outcomes assessed consisted of complications, readmission, length of stay (LOS), implant revision, and cost of care. For dichotomous outcomes, pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. We identified 10 retrospective cohort studies with a total of 17,981,628 study participants. Patients with CUD had significantly higher odds of medical complications (OR 1.33 [95% CI 1.07 to 1.66], P = 0.01) and implant-related complications (OR 1.75 [95% CI: 1.64 to 1.88], P < 0.00001) than noncannabis users. Specifically, CUD was associated with significantly increased odds of cardiac complications (OR 1.95 [95% CI 1.50 to 2.54], P < 0.00001), cerebrovascular accidents (OR 2.06 [95% CI 1.66 to 2.57], P < 0.00001), postoperative infections (OR 1.68 [95% CI 1.34 to 2.10], P < 0.00001), periprosthetic fracture (OR 1.42 [95% CI 1.19 to 1.70], P < 0.0001), mechanical loosening (OR 1.54 [95% CI 1.42 to 1.66], P < 0.00001), and dislocation/instability (OR 1.88 [95% CI 1.32 to 2.68], P = 0.0005). Longer LOS and higher cost of care were also found in patients with CUD. This study strengthens the body of evidence that patients with CUD face higher risk of postoperative complications and greater financial burden after knee and hip arthroplasties. Physicians should inform patients about adverse outcomes and undertake appropriate risk adjustments before elective orthopaedic surgery. Level III.

Combination of Creatinine with Inflammatory Biomarkers (PCT, CRP, hsCRP) for Predicting Postoperative ICU Admissions for Elderly Patients.

The number of elderly patients who require surgery as their primary treatment has increased rapidly in recent years. Among 300million people globally who underwent surgery every year, patients aged 65years and over accounted for more than 30% of cases. Despite medical advances, older patients remain at higher risk of postoperative complications. Early diagnosis and effective prediction are essential requirements for preventing serious postoperative complications. In this study, we aim to provide new biomarker combinations to predict the incidence of postoperative intensive care unit (ICU) admissions > 24h in elderly patients. This investigation was conducted as a nested case-control study, incorporating 413 participants aged ≥ 65years who underwent non-cardiac, non-urological elective surgeries. These individuals underwent a 30-day postoperative follow-up. Before surgery, peripheral venous blood was collected for analyzing serum creatinine (Scr), procalcitonin (PCT), C-reactive protein (CRP), and high-sensitivity CRP (hsCRP). The efficacy of these biomarkers in predicting postoperative complications was evaluated using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) values. Postoperatively, 10 patients (2.42%) required ICU admission. Regarding ICU admissions, the AUCs with 95% confidence intervals (CIs) for the biomarker combinations of Scr × PCT and Scr × CRP were 0.750 (0.655-0.845, P = 0.007) and 0.724 (0.567-0.882, P = 0.015), respectively. Furthermore, cardiovascular events were observed in 14 patients (3.39%). The AUC with a 95%CI for the combination of Scr × CRP in predicting cardiovascular events was 0.688 (0.560-0.817, P = 0.017). The innovative combinations of biomarkers (Scr × PCT and Scr × CRP) demonstrated efficacy as predictors for postoperative ICU admissions in elderly patients. Additionally, the Scr × CRP also had a moderate predictive value for postoperative cardiovascular events. China Clinical Trial Registry, ChiCTR1900026223.

Preoperative opioid use and its association with postoperative complications

ABSTRACT Background The negative impact of opioid use in the U.S. has led providers to seek alternative methods for pain control. More specifically, preoperative opioid usage has been demonstrated to adversely affect patients and clinical outcomes. This study aims to assess the extent of the relationship between preoperative opioid use on postoperative outcomes across surgical disciplines using statewide population databases. Methods The study used the Utah All Payers Claims Database and Utah Population Database to identify a cohort of adult patients who underwent a single surgery between 2013 and 2016 and had continuous insurance enrollment. Preoperative opioid prescription within one year prior to the index surgery was the independent variable, while complications and hospital admissions one year following the index surgery were the primary outcomes. Results Our model of 18,647 patients found that the odds of any complication with preoperative opioid use was 1.28. Depression (OR 1.17) and drug misuse (OR 1.41) were also associated with a higher risk of postoperative complications. Rates of hospital readmission in the preoperative opioid use group compared to the opioid naïve group were increased (19.43% vs. 12.44%, p < .01). Conclusion The data can be used to guide patient-physician conversations and better inform prescribing habits perioperatively.

Racial Disparities in Outcomes Following Surgical Fixation of Traumatic Thoracolumbar Fractures: A National Database Analysis

This study aims to assess race as an independent risk factor for postoperative complications after surgical fixation of traumatic thoracolumbar fractures for African American and Asian American patients compared with White patients. The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. Patient comorbidity burden was assessed using a modified 5-item frailty index score (mFI-5). Chi-squared and ANOVA tests were used to compare baseline clinical characteristics between groups. Multivariate analysis was performed to compare African American and Asian American patients with White patients controlling for age, BMI, and American Society of Anesthesiologists (ASA) score. African American patients experienced longer operative times compared to Asian American and White patients (3.74±1.87hours vs. 3.04±1.71hours and 3.48±1.81hours, P < 0.001). African American and Asian American patients demonstrated higher comorbidity burden with mFI-5>2 compared to White patients (30.7% and 25.6% vs. 19.9%, P < 0.001). African American and Asian American patients had a higher risk of postoperative complications than White patients (22.4% and 20% vs. 19.7%, P < 0.001). African American race was an independent risk factor of postoperative 30-day morbidity (OR 1.19, CI 1.11-1.28, P < 0.001). African American and Asian American patients undergoing thoracolumbar fusion surgeries exhibit disproportionate comorbidity burden, longer LOS, and greater postoperative complications compared with White patients. Furthermore, the African American race was associated with an increased rate of 30-day postoperative complications.

Bariatric surgery in inflammatory bowel disease: a comparative analysis of 450,000 patients

BackgroundStudies were conducted to investigate the outcomes of bariatric surgery (BS) among inflammatory bowel disease (IBD) patients. ObjectivesWe aimed to analyze previous literature, comparing the outcomes of BS between IBD and non-IBD patients. SettingNot applicable. MethodsPubMed, Scopus, and Web of Science were searched on 25/9/2023 for comparative studies on outcomes of BS in IBD patients. RevMan Software v5.4 was used to conduct the analysis. ResultsOur analysis revealed an insignificant difference in the change of body mass index (BMI) at 1-year post-BS between IBD and non-IBD patients. IBD patients had a higher risk of acute renal failure, hemorrhage, and readmission following BS (RR: 2.16, 95% CI: 1.55–3, RR: 1.57, 95% CI: 1.22–2.04, RR: 1.56, 95% CI: 1.17–2.08, respectively). No significant difference was observed between both groups regarding wounds, leak/intra-abdominal infection, thromboembolic complications, and bowel obstruction. A higher incidence of postoperative complications was seen among IBD patients undergoing RYGB compared with SG (RR: 2.21, 95% CI: 1.43–3.41). There was a significant decline in steroid use following BS in IBD patients (RR: .67, 95% CI: .53–.84). Comparison between UC and Crohn’s disease (CD) revealed insignificant differences in treatment escalation or de-escalation. Both IBD and non-IBD patients had similar lengths of hospitalization. ConclusionsBS is equally effective in IBD and non-IBD patients in terms of weight loss at 1-year follow-up. Nevertheless, IBD patients are at a higher risk of postoperative complications, micronutrient deficiency, and readmission. Both UC and CD reported a decline in steroid use following surgery without a preferential advantage to a particular IBD sub-type.

A nomogram for predicting outcomes following pedicled flap reconstruction of the lower extremity

IntroductionLower extremity reconstructions with soft tissue flaps account for a significant proportion of reconstructive surgery. Pedicled flaps are a procedure of choice, particularly in multimorbid patients and those with small to medium-sized defects. Complication rates are high and should not be underestimated, with accurate preoperative risk factor assessment being imperative. MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program Database (2008–2021), we analyzed all patients who underwent pedicled flap reconstruction of the lower extremity. Demographic data, comorbidities, and perioperative data were extracted. We identified risk factors of major surgical complications within 30 days of surgery through uni- and multivariate regression analyses. On this basis, a nomogram for predicting the risk of complications was developed to allow for feasible point-of-care risk assessment. ResultsA total of 6475 adult patients were identified. The most common comorbidities were hypertension (n = 3363, 51.9%) and obesity (n = 2306, 35.6%) and most common American Society of Anesthesiologists (ASA) class was class 3 (n = 3703, 57.2%). The most common complication was bleeding/transfusion (n = 1293, 19.9%). Multivariate regression revealed longer procedures, inpatient setting, higher ASA scores, hypertension, and procedures performed by orthopedic and vascular surgeons as predictors for higher risk of post-operative complications. ConclusionLeveraging a risk- and case-mix-adjusted multi-institutional database, a nomogram for post-operative surgical complications within 30 days after pedicled flap reconstruction in the lower extremity was developed. This broadly applicable risk prediction tool can aid in decision-making when assessing patient eligibility.

Pecial features of surgical approach for patients with Dupuytren's contracture (our experience)

Objective. Although many years history of study, the issue of treating patients with Dupuytren's contracture keeps on being relevant. It is due to high incidence of this pathological condition among the population (up to 8.2%), the lack of a unified surgical treatment approach, and a high risk of postoperative complications (up to 40%). Existing approaches to the treatment do not ensure the absence of condition recurrence and are related to a long recovery period (up to 12 months).Purpose of the study: to improve the outcomes and reduce the treatment period of the patients with Dupuytren's contracture by creating and integrating algorithm for choosing the optimal surgical intervention in clinical practice.Material and methods. The study involved two parts. In the first part data of surgical treatment performed for 8962 patients with Dupuytren's contracture (10213 surgeries) operated during the period of 2007–2022 were analyzed. 6632 male (74%) and 2330 female (26%) were enrolled in the study. The patients’ mean age was (57 ± 6) years old (from 24 to 92 years old). 9396 needle fasciotomies (92%), 562 subtotal fasciectomies (5.5%), and 255 inspection interventions for recurrence after subtotal fasciectomy (2.5%) were performed.In the second part of the study, we suggested a universal algorithm for choosing the optimal technique of surgical treatment of patients with Dupuytren's contracture, depending on the severity, the presence of concomitant skin problems in the operation site (tightening scars or trophic lesions), the number of recurrences, and the method having caused them.Results and discussion. The follow-up period ranged from 3 to 15 years. Treatment outcomes were assessed using the qDASH scale and the treatment satisfaction subjective scale. Perfect treatment outcomes were obtained in 56.8% of cases, good – in 28.2%, satisfactory – in 11.1%, and unsatisfactory – in 3.9% of cases. Complications (iatrogenic damage to the dactylar nerves and arteries, flexor tendons, ruptures and deep skin cracks, and superficial infectious complications) occurred in less than 8% of patients. Contracture recurrences were noted in 5370 cases (52.6%).The analysis of our own 15-year experience (more than 10000 surgeries) as well as the study of colleagues’ experience (according to the literature) allowed us to formulate the guidance for choosing the approach of treating the patients with various forms of Dupuytren's contracture.In primary Dupuytren's contracture, we recommend needle fasciotomy (or collagenase injections) as a quick, minimally invasive surgical procedure causing minimal complications and contraindications (less than 8%). In severe cases, rehabilitation under the monitoring of a hand physician is recommended after the surgery.If the recurrence takes place after needle fasciotomy, a repeated minimally invasive procedure may be conducted. The condition recurring three or more times, we recommend considering the open surgery – subtotal fasciectomy accompanying by obligatory epidermic grafting (not palmar skin): cross-finger flap, dorsal metacarpal artery bond flap (Quaba/Maruyama), or full-thickness free skin graft taken from the forearm.The recurrence after subtotal fasciectomy occuring, the presence of tightening scars and trophic lesions should be assessed. In some cases, the tightening scars lack, a needle fasciotomy may be conducted by specialists having mastered the technique. In other cases, trophic lesions absent, we consider the inspection subtotal fasciectomy accompanied by the obligatory closure of the soft tissue defect using a full-thickness skin autograft or bond flap (not palmar skin) must be performed.Obligatory patients’ follow-up for two years (medical examinations every six months) after the surgery to identify the early signs of recurrence, collagenase or steroids injections into the palmar aponeurosis nodes (and/or physiotherapy with Fermencol) in case of disease progression, or prophylactic radiotherapy immediately after the surgery virtually allow to eliminate the risk of the condition recurrence.Conclusions. Analysis of the treatment outcomes of patients with Dupuytren's contracture of varying severity allowed us to work out a universal algorithm for choosing the optimal tactics of surgical treatment of the condition enabling improving the outcomes, reducing the recovery period, and decreasing the risk of recurrence.

Treating a Challenging Giant Aneurysm of Middle Cerebral Artery (MCA) with a Staged Procedure of Endovascular Coiling and Flow Diverter (FD): Case Report

Background: Giant intracranial aneurysms pose significant challenges in treatment due to a high risk of postoperative complications, including delayed rupture, cerebral edema, and aggravation of mass effect. Endovascular approaches, such as adjunctive coiling and flow diverter (FD) procedures, have become increasingly recommended for wide-necked, large, and giant aneurysms. Case Description: In this report, we present a challenging case of a staged coiling and FD procedure in a giant unruptured middle cerebral artery (MCA) aneurysm. The patient, a 26-year-old adult female, was admitted to our hospital with a history of convulsions. Digital Subtraction Angiography (DSA) revealed a massive aneurysm measuring 40 mm × 27 mm in the M1 segment of the MCA. To mitigate the risk of mass effect aggravation, we performed a two-staged procedure with a seven-day interval between the interventions. The first step involved partial endovascular coiling to shrink the aneurysm, followed by successful flow diversion. The patient did not experience further convulsions or neurologic deficits, and the follow-up angiogram showed no residual flow to the aneurysm. Conclusion: We report one of the very first cases of adjunctive coiling and FD in ‘unruptured’ giant aneurysms. Our neurovascular intervention provides valuable insights into the approach and treatment of unruptured giant aneurysms in cerebral arteries. By employing a staged procedure, effective flow diversion can be achieved even in giant unruptured aneurysms. Although further research is necessary to confirm its superiority and address critical issues, our findings may contribute to the future management of giant aneurysms and inspire avenues for research in the neurosurgical community. Bang. J Neurosurgery 2023; 12(2): 129-136

Exercise capacity prior to major cancer surgery: A cross-sectional observational study of the validity of the 6-minute walk and 30-second sit-to-stand tests.

Cardiopulmonary exercise testing (CPET) is the gold standard for measuring exercise capacity, however, it is resource intensive and has limited availability. This study aimed to determine: 1) the association between the 6-min walk test (6MWT) and the 30-s sit-to-stand test (30STS) with CPET peak oxygen uptake (VO2peak) and anaerobic threshold (AT) and 2) 6MWT and 30STS cut points associated with a higher risk of postoperative complications. A cross-sectional study, retrospectively analyzing data collected from a tertiary cancer center over a 23-month period. Measures included CPET VO2peak and AT, 6MWT and 30STS test. Correlations were used to characterize relationships between variables. Receiver operating characteristic curve analyses determined 6MWT and 30STS cut points that aligned with CPET variable cut points. Note that, 156 participants were included. The 6MWT and 30STS displayed moderate correlations with VO2peak, rho=0.65, p=0.01 and rho=0.52, p<0.005 respectively. Fair correlations were observed between AT and 6MWT (rho=0.36, p=0.01) and 30STS (rho=0.41, p<0.005). The optimal cut points to identify VO2peak<15mL/kg/min were 493.5m on the 6MWT and 12.5 stands on the 30STS test and for AT<11mL/kg/min were 506.5m on the 6MWT and 12.5 stands on the 30STS test. Both the 6MWT and 30STS test could be used as alternative tools for measuring exercise capacity preoperatively in the cancer setting where CPET is not available. A range of 6MWT and 30STS cut points, according to sensitivity and specificity levels, may be used to evaluate risk of postoperative outcomes.