Surgery In Hospital Research Articles

Assessment of Patient Handover Process from Operating Room to Intensive Care Unit at Cardiovascular Surgery Hospital of Ain Shams University

Abstract Background Handovers of post-anesthesia patients to the intensive care unit are commonly unstructured and performed under time pressure. The cardiovascular patients are transferred directly to intensive care unit after the operation, as these vulnerable patients need more and faster care. Therefore, the handover processes are more susceptible to poor communication, loss of information and potential patient harm. Objective To identify the frequency of defects of current practice of healthcare providers during handover process from operating room to ICU after cardiovascular surgery and to determine the contributing factors that affect the transition of care process. Methods This descriptive Cross-sectional study was conducted after cardiovascular surgery the intensive care unit of Cardiovascular Surgery Hospital, one of Ain Shams University Hospitals between December 2021 to March 2022. A checklist was used to assess the performance of handover processes of 120 adult patients after cardiovascular operation, which included 8 main areas (Contributing factor, Pre-handover, Equipment and technology handover, Patient specific information, Anesthesia information, Surgical information, Duration of handover process, Distraction) Results The mean age of patients was 56.03 ± 10.77 years and most of them 85 (70.8%) were males. The median number of errors in pre-handover process was 0(0), patient specific information 3(1), anesthesia information 3(0), surgical information 4.5(2) and equipment handover 3(0). The mean duration of handover processes in minutes was 15.09 ± 5.69 (range 8–35) and 76 (63.3%) of the processes had distractions. There was no significant correlation between age, duration of surgery, duration of handover and number of errors regarding (pre- handover, patient information, anesthesia information, surgical information and equipment handover).The important items were not handed over at all(name of the patient, allergies to medication, estimated blood loss, medications given during surgery which need to be restarted) Conclusions and Recommendations The overall omission is low in spite of the expected to be zero, taking into consideration the type of procedures and the patient condition, so the critical situation need every elements must be fulfilled for patient safety and to avoid complications that may threat the patient life.

1016 Qualitative Account of an Arthroplasty Elective Experience at the Hospital for Special Surgery in New York

1016 Qualitative Account of an Arthroplasty Elective Experience at the Hospital for Special Surgery in New York

Better clinical outcomes and return to sport rates with additional medial meniscus root tear repair in high tibial osteotomy for medial compartmental knee osteoarthritis.

This retrospective study aimed to investigate whether the repair of medial meniscus posterior root tears (MMPRTs) is effective for improving clinical outcomes and return to sports rates in young patients (50 years old or younger) with medial compartment knee osteoarthritis (KOA) and MMPRTs. Between 2016 and 2019, 153 patients with KOA and MMPRTs who underwent open-wedge high tibial osteotomy (OWHTO) were retrospectively included. The patients were divided into OWHTO combined with MMPRT repair (n = 73) and isolated OWHTO (n = 80) groups. Lysholm scores, Hospital for Special Surgery (HHS) scores, Tegner scores, flexion contracture, range of knee flexion, return to sports rates and postoperative complications were compared. Radiological outcomes, including hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and Kellgren-Lawrence (K-L) grade, were compared between the two groups. After a mean follow-up of 30.1 ± 3.0 months, the OWHTO + Repair group observed better clinical outcomes compared with the OWHTO group (Lysholm score: 86.7 ± 7.4 vs. 81.6 ± 6.9, p = 0.023. HHS score: 85.4 ± 8.20 vs. 80.5 ± 7.1, p = 0.039). The OWHTO + Repair group had higher Tegner scores and return to sports rates than the OWHTO group (Tegner score: 6 vs. 5, p = 0.020; return to sports rates: 38% vs. 15%, p = 0.001). No fracture or major complications occurred. Radiological outcomes showed no significant differences between the two groups (HKA: 181.1 ± 2.7 vs. 180.1 ± 1.5 n.s; MPTA: 90.1 ± 1.8 vs. 89.2 ± 1.4, n.s; JLCA:1.9 ± 0.7 vs. 2.1 ± 0.7, n.s). Additional MMPRT repair during OWHTO was associated with better clinical outcomes and higher rates of return to sports in young patients with medial compartment KOA and MMPRTs. Level III.

Poster 396: Performing Sports Medicine Procedures in Ambulatory Surgery Centers Is More Cost Effective than Hospital Outpatient Departments for Medicare Recipients

Objectives: To compare the overall cost of sports medicine procedures for Medicare beneficiaries in both ambulatory surgery centers (ASC) and hospital outpatient department (HOPD) settings. Secondary aims were to compare facility fees, surgeon fees, Medicare payments, and patient payments between ASCs and HOPDs. Methods: Publicly available data from The Centers for Medicare & Medicaid Services (CMS) was accessed via the Medicare Procedure Price Lookup Tool. Current Procedural Terminology (CPT) codes were used to identify sports medicine procedures approved for the outpatient setting by CMS. Facility fees, surgeon fees, total costs, Medicare payment, and patient payment were extracted. Descriptive statistics were used to calculate means and standard deviations. Cost differences were analyzed using Mann Whitney U tests. Results: Sixty-two CPT codes were identified. Shoulder procedures (n=25) at ASCs had lower total costs (3,622±1,156 vs 6,262±1,759; p<0.001), facility fees (2,777±1,020 vs 5,416±1,606; p<0.001), Medicare payments (2,898±928 vs 5,009±1,407 p<0.001), and patient payments (724±232 vs 1,252±352; p<0.001) compared to HOPDs. Knee procedures (n=31) at ASCs had lower total costs (4,236±2,741 vs 6,668±3,341; p=0.006), facility fees (3,408±2,507 vs 5,840±3,116; p=0.006), Medicare payments (3,389±2,193 vs 5,458±2,955; p=0.006), and patient payments (847±548 vs 1,209±429; p=0.011). Hip procedures (n=6) at ASCs had lower total costs (3,583±698 vs 6,671±1,451; p=0.025), facility fees (2,725±6689 vs 5,813±1,431; p=0.025), Medicare payments (2,866±558 vs 5,336±1,161; p=0.025), and patient payments (716±139 vs 1,333±290; p=0.025). Conclusions: Sports medicine procedures performed at ASCs for Medicare recipients were found to have overall average total cost savings of 40% compared to those performed at HOPDs (42% savings for shoulder, 36% for knee, and 46% for hip procedures). ASC use conferred lower facility fees, patient payments, and Medicare payments in all cohorts. These results inform surgeons, patients, and insurance officials of the cost-effectiveness of outpatient surgical facilities for Medicare recipients undergoing sports medicine procedures.

A controlled study of the hygienic technical evaluation of the transaxillary approach for inflation-free single-port lumpectomy versus conventional transcervical anterior open surgery in radical thyroid cancer resection

ObjectiveTo evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the conventional open anterior cervical approach (COACAS) in a controlled manner.MethodsThis work was a retrospective analysis of the clinical data of 60 patients admitted to our hospital for unilateral radical thyroid cancer surgery between 01/2021 and 12/2022. The control group underwent COACAS (30 patients), and the experimental group underwent TAWISES (30 patients). The patients’ operative time, intraoperative bleeding volume, 24-h postoperative pain index, drainage tube carrying time, hospitalization duration and complication rate were compared and analyzed. The patients were followed up for 3, 6 and 12 months postoperatively and evaluated based on numbness, muscular tightness, pain and other discomfort in the neck, as well as satisfaction with social adaptation and cosmetic incisions. The recurrence status was assessed for 1 year in both groups of patients. A questionnaire survey was conducted to assess patient acceptance of the two surgical approaches. The economic characteristics (cost-effectiveness and cost-utility) of the different approaches in our region were evaluated comprehensively.ResultsThe length of the incision, drainage tube carrying time and hospitalization duration were greater in the experimental group than in the control group (P < 0.05). The differences in complication rate, intraoperative bleeding volume, 24-h postoperative pain index and recurrence rate were not statistically significant between the two groups (P > 0.05). Neck discomfort was greater in the control group, and the difference was statistically significant at the 3-month postoperative follow-up (P < 0.05). The differences at the 6- and 12-month postoperative follow-ups were not statistically significant (P > 0.05). However, mild discomfort was significantly more common in the experimental group (63.33% > 36.67%, 80% > 53.33%, P < 0.05). The experimental group had better social adaptability, greater total medical costs, and better overall patient medical satisfaction than did the control group (P < 0.05). The acceptance of TAWISL was greater than that of COACAS (P < 0.05).ConclusionCompared with COACLAS, TAWISES is safe and effective and better meets the cosmetic, psychological and social adaptation needs of patients. TAWISES is also more cost effective and can be better utilized for the population in our region, filling the gap in surgical modalities for thyroid cancer in in our region.

Salvage surgery following tyrosine kinase inhibitor treatment for advanced non-small cell lung cancer

BackgroundNo standard therapy for non-small lung cancer patients that have acquired resistance to tyrosine kinase inhibitor (TKI) therapy has been established. Some can be effectively treated by salvage surgery, though indications for that procedure remain unclear. Reported here is the clinical course of a patient who experienced early post-operative distant metastases.Case presentationA 48-year-old woman without symptoms was referred to another hospital for abnormal chest radiography findings and diagnosed with adenocarcinoma of the left lower lobe (cT2aN3M1b, stage IVB; TNM staging 7th edition). Gene mutation analysis revealed positive for epidermal growth factor receptor exon 19 deletion. Afatinib treatment was started, resulting in partial response, though regrowth of the main tumor was noted 1.5 years later. Bronchoscopic re-biopsy findings revealed a T790M point mutation and afatinib was switched to osimertinib. At 1.5 years following the start of osimertinib administration, the primary tumor was found to have regrown again and stereotactic radiation therapy was administered. Findings at 3.5 years after osimertinib administration indicated that all lymph nodes and distant metastases, excluding the primary tumor, were well controlled, and the patient was referred to our hospital for salvage surgery. Osimertinib was discontinued, and a left lower lobectomy with a left lingular segmentectomy and pleural biopsy were performed. The patient was discharged following an uneventful postoperative course. Three days after discharge, glossodynia developed and examination findings revealed tongue metastasis. The symptoms improved following re-administration of osimertinib, though right adrenal gland metastasis appeared 8 months after surgery. Radiation therapy was performed for tongue and right adrenal gland metastases, and the patient was alive 1 year after salvage surgery without out-of-control lesion appearing after the radiation therapy under the administration of osimertinib.ConclusionThe present patient experienced multiple instances of systemic recurrence after undergoing salvage surgery. Experience with this case indicates that systemic therapy is essential for patients with distant metastatic lung cancer even following salvage surgery for the primary tumor.

의료미용 종사자의 WLB가 조직몰입과 조직성과에 미치는 영향

Recently, as a positive link between an organization and individuals, ‘work-life balance’ has been taken as a top priority among employees. In fact, people have desired to improve the quality of life in diverse fields as work-life balance regulates their lives and ensure a happy life. This study attempted to investigate the influence of work-life balance on organizational commitment and organizational performances against medical cosmetology workers to provide basic data needed to improve their working environments. For this, a questionnaire survey was performed against estheticians, nursing assistants and patient care coordinators who work at skin and plastic surgery clinics and hospitals across the country from July 27 to August 12, 2023. Among a total of 310 questionnaires distributed, 303 copies excluding 7 poorly answered ones were used for final analysis, and the results found the followings: First, work-life balance had a positive influence on organizational commitment with statistical significance. Second, work-life balance revealed a positive effect on organizational performances with statistical significance. It is anticipated that the above results would be available in developing training programs for work-life balance against medical beauty workers and those in other sectors.

Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality

A comprehensive review of the evidence exploring the outcomes of enhanced recovery after surgery (ERAS) guidelines has not been completed. To evaluate if ERAS guidelines are associated with improved hospital length of stay, hospital readmission, complications, and mortality compared with usual surgical care, and to understand differences in estimates based on study and patient factors. MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central were searched from inception until June 2021. Titles, abstracts, and full-text articles were screened by 2 independent reviewers. Eligible studies were randomized clinical trials that examined ERAS-guided surgery compared with a control group and reported on at least 1 of the outcomes. Data were abstracted in duplicate using a standardized data abstraction form. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Risk of bias was assessed in duplicate using the Cochrane Risk of Bias tool. Random-effects meta-analysis was used to pool estimates for each outcome, and meta-regression identified sources of heterogeneity within each outcome. The primary outcomes were hospital length of stay, hospital readmission within 30 days of index discharge, 30-day postoperative complications, and 30-day postoperative mortality. Of the 12 047 references identified, 1493 full texts were screened for eligibility, 495 were included in the systematic review, and 74 RCTs with 9076 participants were included in the meta-analysis. Included studies presented data from 21 countries and 9 ERAS-guided surgical procedures with 15 (20.3%) having a low risk of bias. The mean (SD) Reporting on ERAS Compliance, Outcomes, and Elements Research checklist score was 13.5 (2.3). Hospital length of stay decreased by 1.88 days (95% CI, 0.95-2.81 days; I2 = 86.5%; P < .001) and the risk of complications decreased (risk ratio, 0.71; 95% CI, 0.59-0.87; I2 = 78.6%; P < .001) in the ERAS group. Risk of readmission and mortality were not significant. In this meta-analysis, ERAS guidelines were associated with decreased hospital length of stay and complications. Future studies should aim to improve implementation of ERAS and increase the reach of the guidelines.

Analysis of quality of life in patients after transgastric natural orifice transluminal endoscopic gallbladder-preserving surgery.

At present, laparoscopic cholecystectomy (LC) is the main surgical treatment for gallstones. But, after gallbladder removal, there are many complications. Therefore, it is hoped to remove stones while preserving the function of the gallbladder, and with the development of endoscopic technology, natural orifice transluminal endoscopic surgery came into being. To compare the quality of life, perioperative indicators, adverse events after LC and transgastric natural orifice transluminal endoscopic gallbladder-preserving surgery (EGPS) in patients with gallstones. Patients who were admitted to The First Affiliated Hospital of Xinjiang Medical University from 2020 to 2022 were retrospectively collected. We adopted propensity score matching (1:1) to compare EGPS and LC patients. A total of 662 cases were collected, of which 589 cases underwent LC, and 73 cases underwent EGPS. Propensity score matching was performed, and 40 patients were included in each of the groups. In the EGPS group, except the gastrointestinal defecation (P = 0.603), the total score, physical well-being, mental well-being, and gastrointestinal digestion were statistically significant compared with the preoperative score after surgery (P < 0.05). In the LC group, except the mental well-being, the total score, physical well-being, gastrointestinal digestion, the gastrointestinal defecation was statistically significant compared with the preoperative score after surgery (P < 0.05). When comparing between groups, gastrointestinal defecation had significantly difference (P = 0.002) between the two groups, there was no statistically significant difference in the total postoperative score and the other three subscales. In the surgery duration, hospital stay and cost, LC group were lower than EGPS group. The recurrence factors of gallstones after EGPS were analyzed: and recurrence was not correlated with gender, age, body mass index, number of stones, and preoperative score. Whether EGPS or LC, it can improve the patient's symptoms, and the EGPS has less impact on the patient's defecation. It needed to, prospective, multicenter, long-term follow-up, large-sample related studies to prove.

Effect of home-based prehabilitation on objectively measured physical activity in patients undergoing elective major cardiac and non-cardiac surgery. Data from a randomized controlled trial

Abstract Background Low functional capacity in patients undergoing major elective surgery is associated with postoperative complications. Prehabilitation aims to increase functional capacity by increasing preoperative physical activity. Low functional capacity in patients eligible for major surgery is associated with high age and comorbid burden. In this population, center-based prehabilitation is a barrier for participation. Therefore, we developed a multimodal home-based prehabilitation intervention. Data regarding the effectiveness of a home-based prehabilitation intervention to increase physical activity before surgery is limited. We hypothesize that home-based prehabilitation leads to an increase in physical activity in patients undergoing major cardiac and non-cardiac surgery. Methods We included patients aged over 65 with a proven low functional capacity and/or ventilatory efficiency measured by preoperative cardiopulmonary exercise testing. Patients were randomized to either standard of care or intervention. The intervention group received a home-based prehabilitation intervention 2-4 weeks before surgery. As part of the multimodal intervention, patients were prescribed a walking regimen according to the physical activity guidelines published by the World Health Organization (WHO). Patients were followed-up with weekly telephone calls by a physiotherapist to increase adherence and motivation. All patients were provided a wrist-worn tri-axial accelerometer at the baseline visit. The accelerometer was collected at the ward once the patient entered the hospital for surgery. Physical activity was estimated by calculating the average Euclidean norm minus one (ENMO, milligravity [mg]) per day. Baseline characteristics were tested by Wilcoxon rank-sum test and a linear model for the primary outcome was performed to adjust for confounders. Data analysis was performed using R Studio. Results 37 patients scheduled for cardiac and 62 for non-cardiac surgery were included (Table 1). Mean group difference of daily physical activity levels in non-cardiac surgery patients was 3.01 mg (p = 0.03, 95% CI [0.3, 5.6]). Mean group difference of daily physical activity levels in cardiac surgery patients was 0.27 mg (p = 0.95, 95% CI [-4.1, 5.0]) (Figure 1). Patients undergoing cardiac surgery had higher overall activity levels compared to non-cardiac also when adjusted for age. Conclusion Home-based prehabilitation increases preoperative physical activity levels in patients undergoing major non-cardiac surgery, but not in patients undergoing major cardiac surgery. Higher activity levels in cardiac surgery patients was unexpected, but may be explained by previous inclusion of patients with cardiac diseases in exercise-based rehabilitation and physical activity recommendations at routine cardiac follow-up visits. Table 1 Figure 1

Mothers' Experiences of Children Undergoing Congenital Heart Disease Surgery: A Qualitative Study

Background: Surgery for children with congenital heart disease (CHD) elevates maternal physical and mental stress, potentially impacting the quality of care provided to the child. Objectives: This study aimed to elucidate mothers' experiences surrounding their child's CHD surgery. Methods: In this qualitative content analysis study, we included 20 mothers of children admitted to Tehran Children's Medical Center Hospital for CHD surgery using purposive sampling. Unstructured interviews and field notes were utilized perioperatively for data collection. Analysis was conducted concurrently with data collection employing the Graneheim and Lundman content analysis approach. Rigor was ensured using Lincoln and Guba’s criteria. Results: The findings were categorized into four themes: (1) "The Bitter and Difficult Motherhood Experience" stemming from the shock of the child's abnormality and subsequent challenges in caregiving; (2) mothers engaged in "In Search of Reassurance," striving for accurate diagnosis and optimal treatment quality through information seeking and accessing superior medical services; (3) "Tides in Supportive Networks" reflected varying degrees of support from personnel, peers, and surrounding individuals, ranging from conscientiousness to stressfulness; (4) Mothers attained a state of "Relative Calm After the Storm" by navigating through the surgery ordeal with spirituality and hope despite enduring anxieties. Conclusions: The journey through a child's CHD surgery proved harrowing for mothers due to the initial shock and ongoing caregiving challenges. Care provision should prioritize maternal readiness and empowerment, emphasize professional conduct, reassurance, spiritual care, and steer social support networks towards positive contributions.

Evaluation of postoperative complications of hypospadias using high-frequency ultrasound imaging

PurposeVarious complications following hypospadias surgery present distinct manifestations when examined with ultrasound. Utilizing high-frequency ultrasound, clinicians can promptly identify these complications and initiate appropriate treatment. The aim of this study is to catalogue the ultrasonographic presentations of various postoperative complications following hypospadias surgery, thereby providing a reference for ultrasonographic diagnosis.MethodsUltrasonic images of post-hypospadias surgery from October 1, 2015, to June 30, 2023, recorded at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, serve as the basis for this investigation. Drawing on patient clinical diagnoses, this study compiles and selects representative ultrasound images of diverse complications.ResultsThe study encompassed a total of 121 subjects; 26 demonstrated urethral stricture on ultrasonic images, two presented local urethral dilation, six showed intraurethral hair-like structures, 17 revealed intraurethral septum, two exhibited intraurethral fold, one had urethral calculus, one displayed urethral calcification, 12 indicated intraurethral urine accumulation, and two showed urethral diverticulum.ConclusionUltrasound examination is helpful for postoperative diagnosis following hypospadias, detecting complications such as urethral stricture, urethral hair growth, and urethral diverticulum, which can help doctors choose appropriate clinical treatment strategies.

Role of post‐hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection

AbstractAimsPortal venous pressure frequently increases after a major hepatectomy. We aimed to assess the outcomes of patients with hepatocellular carcinoma (HCC) with different post‐hepatectomy portal pressure statuses and the predictive factors correlated with prognosis and post‐hepatectomy portal hypertension (PHPH).MethodsData from consecutive patients who underwent curative‐intent hepatectomy for HCC at the Eastern Hepatobiliary Surgery Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2008 and December 2016 were retrospectively analyzed. Patients were followed up until March 1, 2022. PHPH was defined as new‐onset portal hypertension (PH) in patients without preoperative PH within 1 month of hepatectomy. Patients were classified into two groups according to the presence or absence of PHPH: non‐PH and PHPH. The clinicopathological characteristics were compared between the two groups. Univariate and multivariate analyses were used to identify independent risk factors for early and late recurrence of HCC, overall survival (OS), and PHPH.ResultsDisease‐free survival rates were significantly higher in the non‐PH group (n = 1068) than those in the PHPH group (n = 423) (62.0%, 39.0%, and 31.0% vs. 46.2%, 24.5%, and 19.3% at 1, 3, and 5 years, respectively; all p &lt; 0.001). The 1‐, 3‐, and 5‐year OS rates were 91.0%, 66.4%, and 51.4% in the non‐PH group and 80.0%, 48.9%, and 32.6% in the PHPH group, respectively (all p &lt; 0.001). Multivariate analysis revealed that PHPH was independently associated with early recurrence of HCC and poor OS (hazard ratio [HR] 1.476, 95% confidence interval [CI] 1.279–1.704, p &lt; 0.001 and HR 1.601, 95% CI 1.383–1.853, p &lt; 0.001, respectively). Furthermore, hepatitis B virus infection, cirrhosis, preoperative alanine aminotransferase &gt; 40 U/L, and major hepatectomy were identified as independent risk factors for PHPH.ConclusionsPHPH was associated with early recurrence of HCC and poor OS but not with late recurrence. Therefore, PHPH may be an attractive target for therapeutic interventions and follow‐up surveillance to improve prognosis.

Surgical Technique and Preliminary Outcomes of Double-Level Osteotomy for Valgus Deformity.

Data are limited regarding the surgical technique or outcomes of double-level osteotomy (DLO) combining medial closing-wedge distal femoral osteotomy and medial closing-wedge high tibial osteotomy in patients with moderate-to-severe valgus deformity. To describe the surgical technique and assess the short-term outcomes and surgical accuracy of DLO in patients with a moderate or severe valgus deformity. It was hypothesized that this technique would result in good clinical outcomes with precise deformity correction. Case series; Level of evidence, 4. Eight patients (mean age, 44.2 ± 10.9 years) with a moderate or severe valgus knee treated with DLO (9 knees; mechanical tibiofemoral angle [mTFA], 10.3°± 3.5°) were included. The mean follow-up was 25.1 ± 11.1 months. Preoperative to postoperative changes in radiographic parameters (mTFA, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, joint line convergence angle) and clinical scores (Hospital for Special Surgery score, Oxford Knee Score, Lysholm score) were assessed. Surgical accuracy was calculated by subtracting the achieved postoperative correction from the preoperatively planned targeted correction. The mTFA changed significantly from 10.3°± 3.5° preoperatively to -1.8°± 3.4° postoperatively (P < .001); the mechanical lateral distal femoral angle and mechanical medial proximal tibial angle changed significantly by 5.1°± 2.7° and 5.9°± 2.2°, respectively (P < .001 for both); and the posterior distal femoral angle decreased significantly from 85.9°± 3.1° to 84.2°± 2.4° (P < .01). There was no significant difference between pre- and postoperative joint line convergence angles (3.3°± 2.3° to 2.6°± 2.1°). The accuracy of the correction was high: the mTFA achieved postoperatively differed from the mTFA planned preoperatively by a mean of 2.7°± 1.9° (range, 0.6°-6.6°). Significant pre- to postoperative improvement was seen for all outcome scores (Hospital for Special Surgery, from 67 ± 11 to 93 ± 4; Oxford Knee Score, from 29 ± 7 to 43 ± 3; Lysholm, from 41 ± 24 to 89 ± 8; P < .001 for all). High surgical accuracy was achieved, and patients who underwent varus DLO for valgus knees showed improved knee function at short-term follow-up. Varus DLO can be a surgical option to restore the optimal alignment and joint line obliquity in patients with moderate or severe valgus malalignment.

Fusobacterium nucleatum to promote esophageal squamous cell carcinoma progression via CCL20/CCR6-mediated migration of macrophages to the tumour micro environment.

e14668 Background: Esophageal squamous cell carcinoma (ESCC) is one of the most common digestive malignant tumor in China. Recent studies have shown that Fusobacterium nucleatum ( F. nucleatum) promotes ESCC progression through various mechanisms. One of them is about changing the tumor micro- environment through cytokine–cytokine receptor interaction. Methods: From January 2022 to June 2023, a total of 34 patients with ESCC from 4th Hospital of Hebei Medical University thoracic surgery were enrolled. All of the patients did not apply any neoadjuvant therapy before and received radical resection. Real-time reverse transcriptase - PCR (RT-PCR) were performed to examine the expressions of F. nucleatum in tumor tissues and para-tumor tissue. According to the CT values of the RT-PCR results, the level of the F. nucleatum infection could be separated in two groups - positive group and negative group. Immunohistochemistry (IHC) staining were used to examine the expressions of chemokine CCL20 in both groups. Immunofluorescence (IF) was characterised homing receptors CCR6 on CD206+ macrophages. In addition, transwell assay was carried on to quantify macrophages migration ability towards chemokines CCL20 in vitro. Results: F. nucleatum DNA positivity was significantly associated with higher expression of chemokine CCL20 and accumulation of CD68+CD206+ macrophages. F. nucleatum DNA positivity was also significantly correlated with worse histopathological grading. Otherwise, there were no significant correlation between F. nucleatum infection and gender, age, tobacco or alcohol use, T or N grade, TNM stage, tumor locations, blood vessel or nerve invasion and tumor size. IHC showed that the expression of CCL20 were higher in F. nucleatum DNA positive tumor tissue. After coculture with F. nucleatum and KYSE30 cell lines in vitro, the CCL20 production by KYSE30 cells were accelerated. In addition, immunofluorescence showed that CCL20 could recruit M2-like macrophages into the tumor environment by bonding CCR6 existed on the cell surface. Furthermore, the migration ability of macrophages was distinctly elevated by CCL20 result from F. nucleatum infection. Conclusions: F. nucleatum promotes esophageal squamous cell carcinoma progression via CCL20/CCR6-mediated migration of M2-like macrophages to the tumor micro- environment and deteriorates the suppression of the local immune micro- environment within the tumor. Such bacteria may be a biomarker to predict the efficacy of immunotherapy in ESCC. [Table: see text]

Analysis of Clinical Characteristics and Laboratory Indicators in Patients with Solid Malignant Tumor-Associated Venous Thromboembolism

To analyze the clinical features and laboratory indicators in patients with solid malignant tumor-associated venous thromboembolism (Ta-VTE), and to study the risk factors for Ta-VTE. The hospitalized patients with VTE in Guizhou Provincial People's Hospital from January to December 2020 were enrolled, and they were divided into Ta-VTE group and pure VTE group based on the presence or absence of solid malignant tumor. The differences in clinical data and laboratory indicators between the two groups were analyzed, and the indicators with significant differences were included in logistic regression model to analyze the risk factors of Ta-VTE. A total of 288 patients with VTE were included in this study, including 64 cases in Ta-VTE group and 224 cases in pure VTE group, respectively. There were significant differences in the following indexes between the two groups, including the hospitalization time (14.20±15.29 d vs 10.05±6.90 d, t=3.112, P =0.002), pain (35.94% vs 65.18%, χ2=17.554, P =0.000), recent surgery (75.00% vs 37.50%, χ2=28.196, P =0.000), D-dimer [2.8 (0.92, 7.55) μg/ml vs 5.69 (2.25, 13.91) μg/ml, Z=-2.710, P =0.007], PLR[198.59 (139.54, 312.16) vs 149.76 (114.08, 233.66), Z=-2.924, P =0.003] and TBIL[10.90 (7.63, 15.68) μmol/L vs 12.90 (9.33, 18.28) μmol/L, Z=-2.066, P =0.039]. There was no significant difference in the other indicators (P >0.05). The result of multivariate logistic regression analysis showed that elevated PLR (OR =1.003, 95%CI : 1.000-1.006, P =0.027), recent surgery (OR =4.312, 95%CI : 2.093-8.885, P =0.000) and prolonged hospitalization (OR =1.037, 95%CI : 1.002-1.074, P =0.038）were independent risk factors for Ta-VTE. However, pain (OR =0.274, 95%CI : 0.133-0.564, P =0.000) was a protective factor. Elevated PLR level, recent surgery and prolonged hospital stay are independent risk factors for Ta-VTE patients, and rational use of these indicators is helpful for the clinical diagnosis and treatment of Ta-VTE patients.

Predictive factors for conversion to laparotomy in women undergoing laparoscopic hysterectomy. A re-evaluation of clinicopathological factors in the era of minimally invasive gynaecology.

Abdominal hysterectomy has been largely replaced by minimally invasive surgery. Nevertheless, in some situations, a minimally invasive intervention must be converted to laparotomy. Factors associated with conversion to laparotomy are still a matter of debate. The aim of this study was to evaluate the clinicopathological factors associated with the conversion of laparoscopic hysterectomy to laparotomy. The risk factors for conversion of a preplanned laparoscopic procedure to laparotomy were retrospectively evaluated in 441 patients undergoing a hysterectomy for a benign indication between 2016 and 2020. Associations between the clinical factors were analysed using Pearson's chi-square and Fisher's exact test, and predictive values for conversion were assessed through multivariate logistic regression. Conversion occurred in 32 (7.3%) of the cases. Significant differences were detected for uterus weight (576.9gr vs 174.6gr, p<0.001), myoma size (7.0 cm vs. 1.8 cm, p<0.001), and presence of triple diagnosis consisting of leiomyoma, adenomyosis uteri, and pathological adnexal findings (p<0.013). The conversion resulted in prolonged surgery time (181.6 min vs. 119.6 min, p<0.001) and hospital stay (4.0 vs. 3.1 days, p<0.001), as well as an increased rate of wound infection (15.6% vs. 3.4%, p<0.001). A 10g increase in uterus weight raised the risk of conversion by 7.0%, and a 1cm increase in myoma diameter by 7.3%, while adnexal pathologies and extensive adhesions increased the odds of conversion to laparotomy threefold (ORs of 3.2, 1.09-9.6 and 3.6, 1.3-10.0, respectively). Uterus weight, myoma size, the coexistence of pathological adnexal findings, and non-physiological adhesions are independent risk factors for conversion. This study provides data regarding the risk and factors increasing this risk for conversion to laparotomy during laparoscopic hysterectomy.

Primary and secondary resistance to immune checkpoint inhibitors in hepatocellular carcinoma.

e16209 Background: Immunotherapy have revolutionized the therapeutic landscape of hepatocellular carcinoma (HCC). However, clinical features affecting immune resistance remain largely unknown. This retrospective cohort study aims to investigate the outcomes and characteristics of pts with resistance to immunotherapy in HCC. Methods: Pts with HCC who received immune checkpoint inhibitors (ICIs) of PD-1/PD-L1 antibodies at Eastern Hepatobiliary Surgery Hospital between 2016 and 2021 were retrospectively enrolled and screened for eligibility. Recommended by the Society for Immunotherapy of Cancer (SITC), primary resistance was defined as when pts were exposed to ICIs therapy for at least 6 weeks and with the best overall response (BOR) of PD or SD for less than 6 months. Secondary resistance was defined as pts having disease progression after the initial objective response (CR/PR) or SD for more than 6 months. The durable response group consists of pts with the durable response (CR, PR, or SD) for more than 6 months without progression at data cutoff. Time to progression (TTP), overall survival (OS) and clinicopathological features of HCC pts were compared between groups. Subsequent management after resistance and post-progression survival (PPS) were also analyzed. Results: Of 496 pts included, 229 (46.2%) and 141 (28.4%) pts developed primary resistance and secondary resistance, and 126 (25.4%) pts achieved a durable response. The median follow-up was 22.8 months. For pts with primary resistance, secondary resistance, and durable response, the median TTP was 2.83 [2.56-3.09] months, 11.93 [10.45-13.40] months, and not reached, respectively. Whereas the median OS was 12.83 [10.36-15.30] months, 31.53 [28.09-34.97] months and not reached, respectively. Multivariate logistic regression revealed that the Child-Pugh score (Child-Pugh B versus A, OR 3.28 [1.51-7.13], p= 0.003), BCLC stage (BCLC B versus A, OR 3.55 [1.70-7.43], p= 0.001; BCLC C versus A, OR 2.88 [1.47-5.65], p= 0.002), and combinational therapies (ICIs+bevacizumab versus monotherapy, OR 0.14 [0.04-0.51], p= 0.003; ICIs plus lenvatinib+monotherapy, OR 0.43 [0.26-0.72], p= 0.001) were independently associated with primary resistance, and only the combination of ICIs plus bevacizumab (ICIs+bevacizumab versus monotherapy, OR 0.10 [0.01-0.52], p= 0.007) was independently associated with secondary resistance. AFP levels and post-progression therapies were independently associated with PPS in pts with primary resistance, while post-progression therapies were independently associated with PPS in pts with secondary resistance. Conclusions: Risk for resistance was significantly lower among pts who received ICIs plus bevacizumab.High AFP levels independently predict the survival of pts after primary resistance to immunotherapy. ICI-based maintenance therapy after resistance may provide a significant survival advantage for HCC pts.

Can Verbal Interview Decrease Preoperative Anxiety and Postoperative Discomfort in Oral and Maxillofacial Surgery Patients?: A Randomized Clinical Trial

BackgroundPreoperative anxiety is a condition that can be seen frequently in oral and maxillofacial surgery patients and affects the recovery process. PurposeThe aim of this study was to determine the effect of preoperative educational/informative interviews on preoperative anxiety levels and postoperative discomfort in patients undergoing oral and maxillofacial surgery. Study design, setting, sampleThis prospective randomized clinical trial involved patients who underwent oral and maxillofacial surgery at Aydın-Adnan-Menderes University, Oral and Maxillofacial Surgery Hospital. Patients with neurological or psychological disorders, a history of previous psychiatric drug use, those who used anxiolytic or sedative drugs before surgery, those who required postoperative anxiolytic and opioid administration, or patients who underwent nonstandard surgical and anesthesia protocols were excluded. Exposure VariablePreoperative educational/informative interview is the exposure variable. Subjects were randomly assigned to the intervention and control groups. Main outcome variablesThe primary outcome variable was preoperative anxiety measured by the Spielberger State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information scale (APAIS). The secondary outcome variables were postoperative pain measured by Visual Analog Scale (VAS) at the first and sixth hours, postoperative nausea (repeated gagging or spitting), and postoperative vomiting (active vomiting)were observed within 6 hours following general anaesthesia. CovariatesThe study’s covariates were age, weight, sex, American Society of Anes-thesiologists Physical Status Classification System (ASA) score, marital status, edicational background, surgery procedure, anesthesia procedure, duration of surgery, recovery time. AnalysesThe chi-square and student t-tests were used to compare primary predictor and covariates against outcome variables. A p-value <.05 was considered significant. ResultsA total of 92 patients were included in this study, with 46 randomized to intervention group and 46 to control group. The mean age (37.78±13.94 years vs 33.34±15.17 years, p=0.16) and sex differences (female/male: 16/30(34.8/65.2) vs 26/20(56.5/43.5), p=0.06) were comparable between groups. While higher values were recorded in the average anxiety scores in the control group than in the study group, statistically significant differences were found [STAI-S (37.36±10.87 vs 52.39±12.13) (p<0.01), APAIS-T (15.82±5.35 vs 21.39±6.69) (p<0.01), APAIS-A (4.17±2.12 vs 6.47±2.15) (p<0.01), APAIS-B (5.76±2.03 vs 7.65±2.60) (p<0.01), and APAIS-C (6.04±2.47 vs 7.21±2.38), (p<0.05)]. At the same time, there was also a significant difference in terms of early postoperative pain [(2.08±2.77 vs 3.43±2.86), (p=0.02)] and postoperative nausea [12/34 (26.1/73.9) vs 25/21(54.3/45.7), (p=0.01)]. Conclusions and RelevanceOral and maxillofacial surgery causes significant situational anxiety. This study showed that preoperative educational/informative interviews reduced preoperative anxiety levels and postoperative discomfort such as early postoperative pain, nausea, and vomiting.

Vascular surgery care and hospital reform: do we need a full survey?

Vascular surgery care and hospital reform: do we need a full survey?