Incidence Of Early Postoperative Complications Research Articles

Early postoperative complications in open heart surgery patients: A review

Over the past few decades, open heart surgery has undergone significant progress in terms of technologies used, operative techniques and resuscitation care. This has led to a significant increase in patient survival and quality of life after discharge. However, there are still a number of challenges to be addressed, one of which is reducing the incidence of early postoperative complications. They are directly and primarily determined by patients’ demographic and clinical characteristics, as well as by the characteristics of the surgical intervention itself and are a major factor in the outcome of the surgery performed. This review presents the most important and frequent early complications, their epidemiological and clinical features. Their good knowledge is the key to achieving an optimal treatment approach and seeking effective opportunities for their prediction and incidence reduction.

Association between preoperative lactate level and early complications after surgery for isolated extremity fracture

BackgroundThe role of lactate level in selecting the timing of definitive surgery for isolated extremity fracture remains unclear. Therefore, we aimed to elucidate the use of preoperative lactate level for predicting early postoperative complications.MethodsThis was a single-center retrospective observational study of patients with isolated extremity fracture who underwent orthopedic surgery. Patients who underwent lactate level assessment within 24 h prior to surgery were included. The incidence of early postoperative complications was compared between patients with a preoperative lactate level of ≥ 2 and < 2 mmol/L. Moreover, subgroup analyses were performed based on the time from hospital arrival to surgery and fracture type.ResultsIn total, 187 patients were included in the study. The incidence of postoperative complications was significantly higher in patients with a preoperative lactate level of ≥ 2 mmol/L than those with a preoperative lactate level of < 2 mmol/L. This result did not change after adjusting for age and severity. Further, a high preoperative lactate level was associated with a greater incidence of postoperative complications in patients who underwent definitive surgery within 6 h after arrival.ConclusionA preoperative lactate level of ≥ 2 mmol/L was associated with a greater incidence of early postoperative complications in isolated extremity fractures. Nevertheless, this correlation was only observed among patients who underwent definitive fixation within 6 h after hospital arrival.

Impact of preoperative infection on the outcomes of liver transplant recipients: a national propensity score-matched retrospective cohort study in China.

Impact of preoperative infection on liver transplantation (LT) needs further investigation. From January 1, 2015 to December 31, 2022, 24,122 eligible patients receiving LT were enrolled from the China Liver Transplant Registry database. The outcomes of LT were compared after using the propensity score-matched analysis. Compared to the non-infection group, patients in the infection group were more likely to have postoperative effusion, infection, abdominal bleeding and biliary complications (all P<0.01), and they had shorter 30-day, 90-day survival and overall survival (OS) (all P<0.01). Cox proportional hazards regression analysis revealed that MELD score and cold ischemia time were risk factors for the OS in the infection group (both P<0.05). Besides, compared to the non-pulmonary group, patients in the pulmonary group were more likely to have postoperative effusion and infection (both P<0.0001), and less likely to have postoperative abscess and early allograft dysfunction (both P<0.05). Patients in the non-abdominal group also had a higher proportion of postoperative infection than those in the abdominal group (P<0.05). Furthermore, compared to the number=1 group, patients in the number≥2 group were more prone to postoperative effusion and infection (both P<0.01), and they also had shorter 30-day and 90-day survival (both P<0.05). Preoperative infection can result in a higher incidence of early postoperative complications and shorter survival in liver transplant recipients. The types and number of infection sites will also influence the prognosis of liver transplant recipients.

Compare the surgical outcome of Fistulectomy and Mucoal advancement flap in perianal fistula.

Objective: To compare the fistulectomy with mucosal advancement flap in treatment of perianal fistula in terms of mean hospital stay, frequency of anal incontinence and wound healing time. Study Design: Randomized Control Trial. Setting: Surgical OPD, DHQ and Allied Hospital, Faisalabad. Period: 1st March 2019 to 28 February 2020. Methods: Conducted on 120 (60 in each group) patients with fistula in ano presenting. Sampling technique was Non probability consecutive sampling. All the Patient age ranges from 20-55 years of either gender having perianal fistula which are low lying fistulas and with single external opening are included in study. Patients having perianal abscess, pilonidal sinus, Inflammatory bowel disease (Crohn’s disease, Ulcerative colitis) or with history of tuberculosis, HIV disease, Complex high lying fistulas with multiple external openings are excluded. Results: In our study, group A underwent fistulectomy while on group B we perform mucosal advancement flap. About 56.67%(n=34) in Group A and 50%(n=30) in Group B were between 20-40 years of age while 43.33%(n=26) in Group A and 50%(n=30) in Group B were between 41-55 years of age, mean+SD was calculated as 38.78+9.07 years and 40.12+8.89 years respectively. According to gender division 86.67%(n=52) in Group A and 78.33%(n=47) in Group B were male while 13.33%(n=8) in Group A and 21.67%(n=13) in Group B were females, mean hospital stay was calculated as 93.93+4.56 hours in Group A and 107.95+4.66 hours in Group B, p value was calculated as 0.0001 showing a significant difference between the two groups. Comparison of anal incontinence in both groups was done showing that 13.33% (n=8) in Group A and 23.33%(n=14) in Group B had anal incontinence, p value was calculated as 0.15. At one month postoperative follow-up only 4 patient (6.7%) in group A showed complete wound healing while in group B 28 patients out of 60(46.6%)showed complete wound healing, P value was calculated as 0.00167 showing a significant difference while there is no significant difference in incidence of early post-operative complications. Conclusion: We concluded that hospital stay was significantly decreased in cases with fistulectomy when compared with MAF while there was no significant difference regarding anal incontinence in both groups.

Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study

Abstract Background and Aims: Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial neoplasm, as assessed by various scoring systems such as Cranio Score. This observational study evaluates the relationship between these factors and early postoperative neurological complications necessitating ICU admission. Material and Methods: In total, 119 patients, aged 18 years and above, of either sex, American Society of Anesthesiologists (ASA) grades I–III, scheduled for elective craniotomy and tumor excision were included. The primary objective was to evaluate the relationship between perioperative risk factors and the incidence of early postoperative complications as a means of validation of the Cranio Score. The secondary outcomes studied were 30-day postoperative morbidity/mortality and the association with patient-related risk factors. Results: Forty-five of 119 patients (37.82%) required postoperative ICU care with the mean duration of ICU stay being 1.92 ± 4.91 days. Tumor location (frontal/infratemporal region), preoperative deglutition disorder, Glasgow Coma Scale (GCS) less than 15, motor deficit, cerebellar deficit, midline shift &gt;3 mm, mass effect, tumor size, use of blood products, lateral position, inotropic support, elevated systolic/mean arterial pressures, and duration of anesthesia/surgery were associated with a higher incidence of ICU care. Maximum (P = 0.035, AOR = 1.130) and minimum systolic arterial pressures (P = 0.022, Adjusted Odds Ratio (AOR) = 0.861) were the only independent risk factors. Cranio Score was found to be an accurate predictor of complications at a cut-off point of &gt;10.52%. The preoperative motor deficit was the only independent risk factor associated with 30-day morbidity (AOR = 4.66). Conclusion: Perioperative hemodynamic effects are an independent predictor of postoperative ICU requirement. Further Cranio Score is shown to be a good scoring system for postoperative complications.

EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022

Introduction &amp; ObjectivesFiltration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy isgenerally a safe and effective procedure, complications can occur. The purpose of the study was todescribe the early postoperative complications in patients who had undergone filtration surgery.&#x0D; MethodsThis study was a retrospective study that uses secondary data from electronic medical records ofpatients who had filtration surgery between January 1, 2020, and December 31, 2022, in KariadiHospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, andtype of glaucoma. The incidence of early postoperative complications was described up to 3 weeks offollow-up.&#x0D; Results287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) hadphaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCEtrabeculectomy.Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type ofglaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%)experienced an early complication with trabeculectomy being more common (17.42%) thancombined surgery. The commonest complication found was hypotony in 69 eyes (24%). Othercomplications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), blebleakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinalhaemorrhage (0.35%).&#x0D; ConclusionThis study found the most common early postoperative complication of filtration surgery washypotony. This complication occurs frequently after trabeculectomy.

EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022

Introduction and Objective: Filtration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy is generally a safe and effective procedure, complications can occur. The purpose of the study was to describe the early postoperative complications in patients who had undergone filtration surgery. Methods: This study was a retrospective study that uses secondary data from electronic medical records of patients who had filtration surgery between January 1, 2020, and December 31, 2022, in Kariadi Hospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, and type of glaucoma. The incidence of early postoperative complications was described up to 3 weeks of follow-up. Results: 287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) had phaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCE-trabeculectomy. Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type of glaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%) experienced an early complication with trabeculectomy being more common (17.42%) than combined surgery. The commonest complication found was hypotony in 69 eyes (24%). Other complications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), bleb leakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinal haemorrhage (0.35%). Conclusion: This study found the most common early postoperative complication of filtration surgery was hypotony. This complication occurs frequently after trabeculectomy.

Rationale for early rehabilitation of patients with uterine corpus cancer

To study the dynamics of hemorheologic changes and the frequency of early complications of laparoscopic radical hysterectomy in patients with uterine corpus cancer depending on conducting rehabilitation activities in the early postoperative period. The number of patients with uterine corpus cancer equal 49 (mean age 54.8±2.2 years), divided into 2 comparable groups, was examined: experimental group - 23 patients, who received local magnetotherapy since the first day after surgery for 5-6 days, and control group - 26 patients without physiotherapy. Comparative group included 24 healthy women. The basic rheological parameters, namely blood viscosity at high and low shear rate, hematocrit, erythrocytes' aggregation and deformability, erythrocytes and platelets electrophoretic mobility, were evaluated in all patients initially, on the 1st and 5th days after surgery and in comparison group. There were changes in the rheological properties of the blood before surgery in patients of both groups: increase of blood viscosity, enhancement of aggregation activity of its formed elements, decrease of erythrocytes' deformability properties. The laparoscopic radical hysterectomy was accompanied by the exacerbation of these disorders. The early magnetotherapy in patients reduced hemorheological abnormalities up to the preoperative parameters (p<0.05) for 5 days, as well as reduced the incidence of early postoperative complications by 2.4 times compared to the control group. The application of local low-frequency low-intensity magnetotherapy since the first postoperative day allows to reduce the level of postoperative hemorheological abnormalities up to the level of preoperative parameters, as well as the frequency of early postoperative complications.

Comparison of asymmetric Z-plasty and Stallard Z-plasty in correction of epicanthus.

To investigate the clinical effect of asymmetric Z-plasty with central axis inward displacement and stallard Z-plasty in the correction of epicanthus. We retrospectively analyzed 193 patients who underwent epicanthal plasty in the Department of Plastic and Laser Cosmetology of Hunan Provincial People's Hospital from 2009 to 2019. The patients were divided into two groups according to different surgical methods: group A (n = 125) received the asymmetric Z-plasty with central axis inward displacement method and group B (n = 68) received the stallard Z-plasty method. The incidence of early postoperative complications, epicanthus retraction and scar concealment from 6 months after the operation were analyzed and evaluated. After 7 days postoperation, both group A and B of patients had grade A wound healing without any infection or poor wound healing. As for the retraction of the epicanthus, 97.6% of group A patients had no retraction and 2.7% had mild retraction, while 92.6% of group B patients had no retraction and 7.4% had mild retraction. The rank-sum test showed no statistically significant difference (p > 0.05) between the two groups. Regarding scar concealment, 35.2% of group A patients had partially hidden scars and 64.8% had completely hidden scars, while 72.1% of group B patients had no hidden scars and 27.9% had partially hidden scars, with a statistically significant difference (p < 0.05). Compared with stallard Z-plasty, asymmetric Z-plasty with central axis inward displacement has the advantages of concealed incision, easier scar concealment, less scar hyperplasia and stable effect, which results in higher postoperative satisfaction.

Treatment of patients with posttraumatic deformities of the thoracolumbar spine using Schwab 5 osteotomy through combined and posterior approaches

Objective. To analyze the results of surgical treatment of patients with rigid posttraumatic deformities of the thoracolumbar spine operated on using Schwab 5 osteotomy through combined and posterior approaches.Material and Methods. A retrospective cohort study was conducted. Study group included 60 patients (m/f = 25/35). Median age was 48 (26–58) years, median time since injury was 11 (9–14) months, and minimum follow-up period was 2 years. A two-stage intervention with resection of the vertebral body, correction of the deformity, and placement of an interbody implant through the anterior approach followed by final fixation through the posterior approach (VCRa+p group) was performed in 29 cases. Vertebral body resection through the posterior approach with correction of the deformity, installation of an interbody implant, and rigid transpedicular fixation (VCRp group) was performed in 31 cases. In all patients, the magnitude of correction was assessed, as well as the following parameters: frontal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. The results of treatment were evaluated in dynamics by the level of pain syndrome (VAS) and quality of life (ODI), as well as based on the analysis of postoperative complications.Results. The groups were comparable in terms of gender, age, magnitude of the kyphotic component of the deformity, level of pain syndrome and degree of initial neurological deficit (p &gt; 0.05). Correction of the deformity kyphotic component was significantly better in patients in the VCRp group compared to those in the VCRa+p group (p = 0.036). Both groups showed a significant decrease in the level of pain syndrome 3 months after surgery. However, further follow-up showed a tendency for back pain to increase on average one year after surgery in the VCRa+p group. A total of 67 complications were revealed in 40 (66.7 %) patients. Herewith, in the early postoperative period there were 55 complications in 31 patients, and in the late period there were 12 complications in 9 patients. Analysis of early complications showed a higher incidence of anemia (p = 0.002) and liquorrhea (p = 0.017) in the VCRp group compared to those in the VCRa+p group. The incidence of long-term complications did not differ significantly between groups (p = 0.866). An increase in back pain in the long-term period was observed in 12 (41.4 %) patients of the VCRa+p group and in 4 (12.9 %) patients of the VCRp group. Analysis of risk factors for this condition showed a tendency for back pain to increase in the long-term period in patients with residual local deformity against the background of low pelvic index values.Conclusion. Correction of the kyphotic component of deformity was significantly better in patients of the VCRp group, which was accompanied by greater surgical trauma and incidence of early postoperative complications. The tendency of patients’ quality of life to deteriorate in the long-term follow-up period seems to be related to the occurrence of pain syndrome in the lumbar spine in patients with residual kyphotic deformity against the background of initially low compensatory capabilities.

Oncological standards in the treatment of diffuse inflammatory diseases of the colon

Aim. To improve the effectiveness of cancer prevention and the results of surgical treatment in diffuse inflammatory diseases of the colon by identifying and using risk factors for malignancy, improving diagnostic methods, surgical strategy and tactics. Materials and methods. Using generally accepted oncological standards, 36 patients with diffuse inflammatory diseases of the colon were operated on. There were 20 (55.6 %) patients with ulcerative colitis and 16 (44.4 %) with Crohn’s disease of the colon. There were 19 (52.7 %) men and 17 (47.3 %) women. The patients’ age ranged from 21 to 56 years. When performing surgical interventions, we were guided by the studied risk factors for malignancy, the provisions of the surgical strategy and tactics, that included the indication choice, the surgical intervention extent, and the ensuring of oncoprevention. Results. The use of oncological standards, provisions of surgical strategy and tactics prevented the occurrence of postoperative mortality, malignancy of precancerous conditions, contributed to a decrease in the incidence of early postoperative complications to 5 (13.9 %), locoregional recurrence to 1 (2.8 %). Conclusions. Determination of risk factors for malignancy, improvement of diagnostic methods, surgical strategy and tactics in diffuse inflammatory diseases of the colon contribute to the timely detection of precancerous conditions, malignancy and colon cancer, justification for the feasibility of performing surgical interventions using generally accepted oncological standards. Performing surgical interventions with the use of generally accepted oncological standards, proven provisions of strategy and tactics have made it possible to prevent the occurrence of malignization of precancerous conditions, cases of postoperative mortality, reduce the frequency of early postoperative complications to 5 (13.9 %) and locoregional recurrences to 1 (2.8 %).

Clinical efficacy of the topical application of tranexamic acid in tendon release in the hand: A randomized controlled trial

PurposeTo study the clinical effectiveness of the topical application of tranexamic acid in hand tendon release. MethodsThis was a randomized controlled trial conducted after receiving approval from the local ethics committee according to guidelines from the Helsinki Declaration. Eighty patients who underwent hand tendon release operation in our hospital from January 2021 to December 2022 were included and randomly divided into 2 groups. Patients in the tranexamic acid group (40 cases) received intraoperative topical application of 2 g of tranexamic acid after tendon release, while patients in the conventional group (40 cases) did not receive topical application of tranexamic acid during operation. The operation time, perioperative hemoglobin changes, total blood loss, incidence of early postoperative complications, and total active movement (TAM) before surgery and 6 months after surgery were compared between the 2 groups. The continuous variable which follows normal distribution expressed by mean ± SD and used t-test to compare between groups. Meanwhile, categorical variables were used by chi-square test, and a p < 0.05 indicated that the differences were statistically significant. ResultsBoth groups were followed up for 7 to 18 months, with a mean of 10.3 months. Postoperative decrease in hemoglobin was significantly less in the tranexamic acid group than in the conventional group (t = 7.611, p < 0.05). The total blood loss in the tranexamic acid group (74.33 ± 20.50) mL was less than that in the conventional group (83.05 ± 17.73) mL, and the difference was statistically significant (p < 0.05). Both groups showed improvement in thumb/finger flexion and extension range of motion after surgery, and the TAM improved compared with those before surgery, and the difference was statistically significant (p < 0.05). The TAM improved more significantly in the tranexamic acid group (87.68° ± 10.44°) than in the conventional group (80.47° ± 10.93°) at 6 months after surgery, with a statistically significant difference (t = 3.013, p < 0.05). There was no significant difference in operation time and incidence of early postoperative complications between the 2 groups (p > 0.05). ConclusionThe topical application of tranexamic acid during hand tendon release can significantly reduce postoperative bleeding and improve surgical efficacy, which is worth promoting.

Comparison of complications and results of early vs. delayed surgery for pediatric supracondylar humeral fractures.

Pediatric supracondylar humerus fracture (SCHF) is one of the most common elbow fractures in children aged 5-7 years. There is a continuous discussion regarding the optimal timing for conducting surgery for fractures of this nature. Therefore, we aimed to determine whether the timing of surgery in pediatric SCHFs has an impact on the frequency of early postoperative complications. Between January 2018 and March 2020, pediatric SCHF patients who underwent surgery at our hospital were retrospectively reviewed. Patients operated on within 12 hours after the fracture and those operated on later were respectively included in the early and late groups. Early postoperative complications, including neurological deficits, iatrogenic ulnar nerve injury, vascular injury, compartment syndrome, K-wire migration, and unexpected returns to the operating room, were compared between the two groups. We investigated surgical duration, reduction, and perioperative radiographic data. For modified Gartland type II or type III fractures, there was no significant difference in the incidence of early complications between the early and delayed groups. Additionally, there were no noticeable differences between the two groups in terms of perioperative radiographic data, reduction procedure, or surgical duration. Delayed surgery in type II or type III supracondylar humerus fractures was not associated with an increased incidence of early postoperative complications. The difficulty or effectiveness of reduction is not influenced by the timing of surgery.

Is the self-adhesive mesh a solution for chronic postoperative inguinal pain after TAPP: A single centre preliminary experience?

Minimally invasive surgery for groin hernia has expanded significantly over the last two decades and has demonstrated better outcomes in terms of pain and quality of life. A major contributing factor related to chronic post-operative inguinal pain (CPIP) is mesh fixation. An alternative to the standard fixation methods is the self-adhesive surgical mesh. Prospective data analysis was performed of all patients undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair in a single centre for the period 1 st January, 2022-15 th December, 2022. A standardised surgical technique was used with a lightweight self-adhesive mesh without additional fixation. The analysis has encompassed early and late post-operative complications as well as the assessment of pain with an emphasis on CPIP. The study enrolled 52 patients where a total number of 64 elective hernia repairs were performed: 92.2% ( n = 59) primary and 7.8% ( n = 5) recurrent. Fifty-one patients received post-operative follow-up: 100% at 1 month and 78.8% ( n = 41) at 3 months. The incidence of early postoperative complications was 7.7% ( n = 4): one patient developed a seroma, two patients - port site hematomas and one a transient subileus that were all managed conservatively. No patients suffered a recurrence. The average pain score according to the Visual Analogue Scale was 3.3 (0-8) at discharge, 0.6 (0-4) at 1 month and there was no incidence of CPIP after the 3 rd month. Laparoscopic TAPP repair for inguinal hernia with a self-adhesive mesh is an adequate surgical technique with the potential to reduce CPIP, but more research is needed to evaluate this method.

Experience of implementing enhanced recovery program in pancreatic surgery

Aim. To assess the feasibility of enhanced recovery program for patients undergoing pancreatic surgery. Materials and methods. Between January 2019 and May 2022, 47 patients with various pancreatic diseases underwent surgery at the University Clinic of A.I. Evdokimov Moscow State University of Medicine and Dentistry and FMBA of Russia. Male patients comprised 24 (51%), female – 23 (49%); the age of patients was 22 to 78 years (mean age 43.5 years). Pancreaticoduodenal resection was performed in 30 patients, distal pancreatic resection in 17 patients. All patients received some elements of the enhanced recovery program. Results. An uneventful postoperative period was observed in 36 patients (76.6%). Gastric stasis developed in 4 cases (8.5%), pancreatic fistulas in 4 (8.5%), postoperative pancreatitis in 3 (6,4%). A reoperation was performed in 1 case (2.1%) with intra-abdominal bleeding. The average length of stay in the intensive care unit comprised 1.8 days. Conclusion. The use of Fast Track in pancreatic surgery does not significantly increase the incidence of early postoperative complications, meanwhile it reduces the length of hospital stay after surgery and provides more cost- effective results. However, the development of a clear protocol for the management of patients requires further research and accumulation of data.

Outpatient Deep Brain Stimulation Surgery Is a Safe Alternative to Inpatient Admission.

Deep brain stimulation (DBS) is usually performed as an inpatient procedure. The COVID-19 pandemic effected a practice change at our institution with outpatient DBS performed because of limited inpatient and surgical resources. Although this alleviated use of hospital resources, the comparative safety of outpatient DBS surgery is unclear. To compare the safety and incidence of early postoperative complications in patients undergoing DBS procedures in the outpatient vs inpatient setting. We retrospectively reviewed all outpatient and inpatient DBS procedures performed by a single surgeon between January 2018 and November 2022. The main outcome measures used for comparison between the 2 groups were total complications, length of stay, rate of postoperative infection, postoperative hemorrhage rate, 30-day emergency department (ED) visits and readmissions, and IV antihypertensive requirement. A total of 44 outpatient DBS surgeries were compared with 70 inpatient DBS surgeries. The outpatient DBS cohort had a shorter mean postoperative stay (4.19 vs 39.59 hours, P = .0015), lower total complication rate (2.3% vs 12.8%, P = .1457), and lower wound infection rate (0% vs 2.9%, P = .52) compared with the inpatient cohort, but the difference in complications was not statistically significant. In the 30-day follow-up period, ED visits were similar between the cohorts (6.8% vs 7.1%, P = .735), but no outpatient DBS patient required readmission, whereas all inpatient DBS patients visiting the ED were readmitted ( P = .155). Our study demonstrates that DBS can be safely performed on an outpatient basis with same-day hospital discharge and close continuous monitoring.

Short-term outcomes and long-term quality of life after undergoing radical proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis for Siewert type II and III adenocarcinoma of the esophagogastric junction: A propensity score matching analysis

Objective: To evaluate the effects on short-term clinical outcomes and long-term quality of life of laparoscopic-assisted radical proximal gastrectomy with esophageal gastric tube anastomosis versus total gastrectomy with Roux-en-Y anastomosis for adenocarcinoma of the esophagogastric junction. Methods: This was a propensity score matching, retrospective, cohort study. Clinicopathological data of 184 patients with adenocarcinoma of the esophagogastric junction admitted to two medical centers in China from January 2016 to January 2021 were collected (147 in the First Affiliated Hospital of Xiamen University and 37 in the Affiliated Hospital of Qinghai University). All patients had undergone laparoscopic-assisted radical gastrectomy. They were divided into two groups based on the extent of tumor resection and technique used for digestive tract reconstruction. A proximal gastrectomy with reconstruction by esophageal gastric tube anastomosis group comprised 82 patients and a total gastrectomy with reconstruction by Roux-en-Y anastomosis group comprised 102 patients. These groups differed significantly in the following baseline characteristics: age, preoperative hemoglobin, preoperative albumin, tumor length, tumor differentiation, and tumor TNM stage (all P<0.05). To eliminate potential bias caused by unequal distribution between the two groups, 1∶1 matching was performed by the nearest neighbor matching method. The 13 matched variables comprised sex, age, height, body mass, body mass index, preoperative glucose, preoperative hemoglobin, preoperative total protein, preoperative albumin, neoadjuvant radiotherapy, tumor length, degree of differentiation, and pathological TNM stage. Postoperative complications, postoperative nutritional status, incidence of reflux esophagitis 1 year after surgery, and quality of life were compared between the two groups. Results: After propensity score matching, 60 patients each were enrolled in the proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis groups. The baseline characteristics were comparable between these groups (all P>0.05). There were no significant differences between the two groups in operative time, intraoperative bleeding, time to semifluid diet, postoperative hospital days, tumor length, and total hospital costs (P>0.05). Patients in the proximal gastrectomy with esophageal gastric tube anastomosis group had earlier postoperative gastric tube and abdominal drainage tube removal time than those in the total gastrectomy with Roux-en-Y anastomosis group (t=-2.183, P=0.023 and t=-4.073, P<0.001, respectively). In contrast, significantly fewer lymph nodes were cleared and significantly fewer lymph nodes were positive in the proximal gastrectomy with esophageal gastric tube anastomosis group than in the total gastrectomy with Roux-en-Y anastomosis group (t=-5.754, P<0.001 and t=-2.575, P=0.031, respectively). The incidence of early postoperative complications was 43.3% (26/60) in the total gastrectomy with Roux-en-Y anastomosis group; this is not significantly higher than the 26.7% (16/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group (χ2=3.663，P=0.056). The incidences of pulmonary infection (31.7%, 19/60) and pleural effusion (30.0%, 18/60) were significantly higher in the total gastrectomy with Roux-en-Y anastomosis group than in the proximal gastrectomy with esophageal gastric tube anastomosis group (13.3%, 8/60 and 8.3%, 5/60, respectively); these differences are significant (χ2=8.711, P=0.003 and χ2=11.368, P=0.001, respectively). All early complications were successfully treated before discharge. The incidence of long-term postoperative complications was 20.0% (12/60) in the total gastrectomy with Roux-en-Y anastomosis group and 35.0% (21/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group; this difference is not significant (χ2=3.386，P=0.066). The incidence of reflux esophagitis was 23.3% (14/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group; this is significantly higher than the 1.7% (1/60) in the total gastrectomy with Roux-en-Y anastomosis group (χ2=12.876, P<0.001). Body mass index had decreased significantly in both groups 1 year after surgery compared with preoperatively; however, the difference between the two groups was not significant (P>0.05). The differences in hemoglobin and albumin concentrations between 1 year postoperatively and preoperatively were not significant (both P>0.05). Quality of life was assessed using the Visick grade. Visick grade I dominated in both groups. The percentage of patients with Visick II and III in the total gastrectomy with Roux-en-Y anastomosis group was 11.7% (7/60), which is significantly lower than the 33.3% (20/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group (χ2=8.076, P=0.004). No patients in either group had a grade IV quality of life. Conclusions: Both proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis laparoscopic-assisted radical surgery for adenocarcinoma of the esophagogastric junction are safe and feasible. However, both procedures have their own advantages and disadvantages in terms of postoperative complications. The incidence of reflux esophagitis is higher after proximal gastrectomy with esophageal gastric tube anastomosis, whereas the long-term quality of life is lower than that of patients after total gastrectomy with Roux-en-Y anastomosis.

No bladder irrigation versus continuous bladder irrigation after HoLEP: a propensity score matching analysis

PurposeIn this study, the feasibility of a no bladder irrigation strategy after transurethral holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH) was studied.MethodsFrom August 2021 to December 2021, the clinical data of 62 patients who received no bladder irrigation after HoLEP (Group A) were studied. The control group contained the clinical data of 150 patients in the same therapy group (from January 2021 to July 2021) who received continuous bladder irrigation after HoLEP (Group B). The baseline was consistent after using the propensity score matching (PSM) method, and the differences between groups were compared. The pre- and postoperative complications, international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR) of the two groups were compared, accompanied by a follow-up evaluation of surgical effects.Results47 pairs of patients were successfully matched by PSM. There was no statistically significant difference in the intraoperative conditions and the incidence of early postoperative complications between the two groups (P > 0.05). Before and one month after the surgery, significant differences were also found in the IPSS, QOL, Qmax, and PVR of both groups (P < 0.05). Within one month after the surgery, no statistically significant difference was found in IPSS, QOL, Qmax, PVR, or the incidence of early postoperative complications between the two groups (P > 0.05).ConclusionFor appropriately selected patients according to the exclusion criteria, the no bladder irrigation strategy after HoLEP for BPH is safe and effective.

Can single-stage bilateral unicompartmental knee arthroplasty be safely performed in patients over 70?

BackgroundFor patients with bilateral, symptomatic unicompartmental knee arthritis, single-stage bilateral unicompartmental knee arthroplasty (ssBUKA) presents an attractive option. However, most studies have examined younger patient cohorts and the safety of ssBUKA remains controversial for older individuals. Therefore, the purpose of this study was to compare complication rates following ssBUKA for patients ≤70 and > 70 years old. MethodsA retrospective chart review of 238 patients having undergone ssBUKA was performed, including 134 patients ≤70 and 104 patients >70. Post-operative complications were recorded at the six-week post-operative visit, along with emergency room visits and hospital readmissions within 90 days. ResultsCompared to patients ≤70, patients >70 were more frequently female (43.3% and 55.8%, respectively) (p = 0.037) and had significantly lower body mass index (30.41 ± 4.64 and 27.30 ± 3.68, respectively) (p < 0.001). Patients >70 were discharged home (50%) less commonly than patients ≤70 (73.1%) (p < 0.001). Two patients ≤70 (1.5%) and two patients >70 (1.9%) sought emergency room treatment (p = 0.589), with respiratory complications most common. There were no differences regarding any postoperative complications between patients ≤70 and > 70 years old. ConclusionThese results suggest that patients >70 can safely undergo ssBUKA, as it does not appear to increase the incidence of early post-operative complications compared to patients ≤70. However, 50% of patients >70 were not able to discharge directly home following surgery.

Excess visceral fat area as an independent risk factor for early postoperative complications in patients with obesity undergoing bariatric surgery.

Few studies have investigated the correlation between visceral fat area (VFA) and early postoperative complications in patients with obesity undergoing bariatric surgery. This study aimed to investigate the relationship between VFA and early postoperative complications in patients with obesity following bariatric surgery. The study was conducted at a tertiary university hospital. Patients with obesity who underwent laparoscopic sleeve gastrectomy between June 2016 and October 2020 were divided into two groups based on umbilical level VFA: high-VFA group (umbilical level VFA ≥ 100 cm2) and low-VFA group (umbilical level VFA < 100 cm2). Baseline characteristics, intraoperative and postoperative conditions, and early postoperative complications were compared between the groups. The primary outcome was early postoperative complications, and the secondary outcome was postoperative hospital stay. The study included 152 patients, with 82 patients in the low-VFA group and 70 patients in the high-VFA group. The high-VFA group had a higher incidence of early postoperative complications (14.29% vs. 2.44%, P = 0.013) than the low-VFA group. The length of postoperative hospital stay did not differ significantly between the groups. Our study suggests that excess VFA is an independent risk factor for early postoperative complications following bariatric surgery, and VFA may be used in preoperative evaluations.