Incidence Of Operative Complications Research Articles

Comparison between Cardiac CTA and Echocardiography for Assessment of Ventricular Septal Rupture Diameter and Its Effect on Transcatheter Closure.

This study is aimed at comparing cardiac computed tomographic angiography (CTA) with echocardiography in the assessment of ventricular septal perforation diameter. A total of 44 ventricular septal rupture (VSR) patients undertaking transcatheter occlusion were included and randomly divided into the CTA group and echocardiography group with a 1 : 1 ratio. Clinical data, operation-related data, and 30 d follow-up data were collected and analyzed. Incidence of closure failure, occluder displacement, poor occluder molding, and occluder waist diameter shrinkage between the two groups were not statistically different. The mean residual shunt volume in the echocardiography group (4.2 (3.1, 5.9) mm) was significantly higher than that in the CTA group (2.1 (0, 4.0) mm) with a p value of 0.005. However, no significant differences were found in all-cause mortality and incidence of operative complications within 30 days after surgery. Within the CTA group, the correlation was strongest between postoperative occluder diameter and long diameter measured by CTA with a correlation coefficient of 0.799 and p < 0.001, followed by the correlation between postoperative occluder diameter and mean diameter measured by CTA with a correlation coefficient of 0.740 and p < 0.001. The diameter measured by echocardiography was not correlated to postoperative occlude diameter. Assessment of VSR diameter by cardiac CTA is more accurate than by echocardiography.

Minimally invasive thoracoscopic left atrial appendage occlusion compared with transcatheter left atrial appendage closure for stroke prevention in recurrent nonvalvular atrial fibrillation patients after radiofrequency ablation: a prospective cohort study.

BACKGROUNDTanscatheter left atrial appendage (LAA) closure and minimally invasive thoracoscopic LAA occlusion are local interventions of LAA for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, the safety and efficacy of these methods have not been compared. This prospective cohort study aimed to assess the safety and efficacy of those two treatment approaches for stroke prevention in NVAF patients.METHODSTwo hundred and nine recurrent NVAF patients who received radiofrequency ablation were enrolled. These patients were treated with transcatheter LAA closure or thoracoscopic LAA occlusion. The patients were followed up from the first postoperative day and evaluated for efficacy endpoints (stroke/transient ischemic attack (TIA), systemic embolism (SE), and death) and a safety endpoint (bleeding events). Perioperative complications were recorded.RESULTSAfter a median follow-up of 1.8 years (383 patient-years), the overall rate of the composite efficacy endpoints was similar between the two groups (3.8 vs. 2.7 events per 100 patient-years; HR = 0.71; 95% CI: 0.225−2.237; P = 0.559). However, regarding primary safety endpoint, there were 1.5 bleeding events per 100 patient-years in the thoracoscopic LAA occlusion group, compared with 6.4 in transcatheter LAA closure group (HR = 0.246; 95% CI: 0.074−0.819; P = 0.022). The incidence of operative complications was 3/138 (2.17%) in thoracoscopic LAA occlusion group and 1/71 (1.41%) in transcatheter LAA closure group. CONCLUSIONSThoracoscopic LAA occlusion and transcatheter LAA closure have similar efficacy in preventing stroke in NVAF patients. However, the thoracoscopic group had fewer bleeding events than the transcatheter group, but the former group required a longer hospital stay.

Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome.

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998-2006) and those who underwent surgery after (2007-2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

BackgroundZones 2 and 3 fifth metatarsal fractures are often treated with intramedullary fixation due to an increased risk of nonunion. A previous 3-dimensional (3D) computerized tomography (CT) imaging study by our group determined that the screw should stop short of the bow of the metatarsal and be larger than the commonly used 4.5 millimeter (mm) screw. This study determines how these guidelines translate to operative outcomes, measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Radiographic variables measuring the height of the medial longitudinal arch and degree of metatarsus adductus were also obtained to determine if these measurements had any effect on outcomes. And lastly, this study aimed to determine if morphologic differences between males and females affected surgical outcomes.MethodsWe retrospectively identified 23 patients (14 male, 9 female) who met inclusion criteria. Eighteen patients completed PROMIS surveys. Preoperative PROMIS surveys were completed prior to surgery, rather than retroactively. Weightbearing radiographs were also obtained preoperatively to assist with surgical planning and postoperatively to assess interval healing. Correlation coefficients were calculated between PROMIS scores and repair characteristics (hardware characteristics [screw length and diameter] and radiographic measurements of specific morphometric features). T tests determined the relationship between repair characteristics, PROMIS scores, and incidence of operative complications. PROMIS scores and correlation coefficients were also stratified by gender.ResultsThe average screw length and diameter adhered to guidelines from our previous study. Preoperatively, mean PROMIS PI = 57.26±11.03 and PROMIS PF = 42.27±15.45 after injury. Postoperatively, PROMIS PI = 44.15±7.36 and PROMIS PF = 57.22±10.93. Patients with complications had significantly worse postoperative PROMIS PF scores (p=0.0151) and PROMIS PI scores (p=0.003) compared to patients without complications. Females had non-significantly worse preoperative and postoperative PROMIS scores compared to males and had a higher complication rate (33 percent versus 21 percent, respectively). Metatarsus adductus angle was shown to exhibit a significant moderate inverse relationship with postoperative PROMIS PF scores in the overall cohort (r=−0.478; p=0.045). Metatarsus adductus angle (r=−0.606; p=0.008), lateral talo-1st metatarsal angle (r=−0.592; p=0.01), and medial cuneiform height (r=−0.529; p=0.024) demonstrated significant inverse relationships with change in PROMIS PF scores for the overall cohort. Within the male subcohort, significant relationships were found between the change in PROMIS PF and metatarsus adductus angle (r=−0.7526; p=0.005), lateral talo-1st metatarsal angle (r=−0.7539; p=0.005), and medial cuneiform height (r=−0.627; p=0.029).ConclusionPatients treated according to guidelines from our prior study achieved satisfactory patient reported and radiographic outcomes. Screws larger than 4.5mm did not lead to hardware complications, including screw failure, iatrogenic fractures, or cortical blowouts. Females had non-significantly lower preoperative and postoperative PROMIS scores and were more likely to suffer complications compared to males. Patients with complications, higher arched feet, or greater metatarsus adductus angles had worse functional outcomes. Future studies should better characterize whether patients with excessive lateral column loading benefit from an off-loading cavus orthotic or plantar-lateral plating.

Clinical effects of Apatinib combined with DOS neoadjuvant chemotherapy regimen in neoadjuvant chemotherapy for LAGC

Objective:To evaluate the clinical effects of apatinib combined with DOS regimen in the neoadjuvant chemotherapy for locally advanced gastric cancer (LAGC).Methods:Eighty patients with LAGC admitted to Baoding first Central Hospital from January 2018 to October 2020 were randomly divided into two groups (n=40, respectively). The control group received DOS chemotherapy regimen alone. The experiment group additionally orally took apatinib mesylate tablets. The changes in CEA, CA19-9 and other tumor markers, RO resection rate, incidence of operative complications, adverse reactions, and other indicators were compared between the two groups.Results:The overall response rate (ORR) of the experimental group was 72.5%, which was significantly better than that of the control group (50%) (p=0.03). After the treatment, the CEA and CA19-9 in the experiment group were significantly lower than those in the control group (p=0.00). The Ro resection rate was 77.5% in the experiment group and 57.5% in the control group (p=0.03). The operation time was shortened and amount of bleeding decreased in the experiment group, and the differences were statistically significant (p=0.00). The incidence of surgical complications in the experimental group was 17.5%, significantly lower than that in the control group (37.5%) (p=0.04).Conclusion:Apatinib combined with DOS regimen is effective for patients with LAGC without significantly increasing adverse reactions. Meanwhile, tumor markers are reduced significantly. Besides, the Ro resection rate and the incidence of operative complications are obviously superior to the DOS neoadjuvant chemotherapy regimen alone.

Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures.

Objectives:To observe the clinical value of 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in elderly patients with intertrochanteric fractures.Methods:Sixty elderly patients with intertrochanteric fractures of the femur who were treated in our hospital from January 2018 to January 2020 were selected and randomly divided into two groups. In the experimental group, 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation was used for treatment. While in the control group, traditional open reduction and dynamic hip screw internal fixation combined with postoperative conventional treatment was utilized. The duration of surgery, intraoperative blood loss, postoperative hospital stay, weight bearing time, fracture healing time and other surgical indicators were recorded respectively, and hip joint function recovery was evaluated prior to and 2 weeks after surgery. All patients were followed up for six months to observe the occurrence of complications within half a year, including deep vein thrombosis, incision infection, avascular necrosis of femoral head, hip joint stiffness, delayed fracture healing, etc. Subsequently, the differences in postoperative complications between the two groups were compared and analyzed.Results:The operation time, blood loss, postoperative hospital stay, weight bearing time and fracture healing time of the experimental group were better than those of the control group, and the difference was statistically significant (p<0.05). After treatment, the hip joint function of the experimental group was significantly improved compared with the control group, with a statistically significant difference(p=0.03). The incidence of operative complications in the experimental group was 10% (3/30) within six months postoperatively, significantly lower than the 33% (10/30) in the control group, with statistical significance (p=0.03).Conclusion:3D printing with early rehab proved to be effective treatment in our study. Such a combined treatment has the advantages of precise operative reduction, fast postoperative recovery, and certain safety and effectiveness.

Low-Grade Versus Medium-Grade Nuclear Sclerotic Cataract Density Produces Identical Surgical and Visual Outcomes: A Prospective Single-Surgeon Study.

PurposeTo determine whether the incidence of major complications and postoperative corrected distance visual acuity are comparable for surgery on low-grade versus medium-grade nuclear sclerotic cataracts.DesignThis was a prospective, consecutive, single-surgeon, no-exclusion study of 1025 cataract cases with one-month follow-up.MethodsPatients were divided into two cohorts according to the nuclear sclerosis grade at presentation, as classified using the Lens Opacities Classification System (LOCS) III. Cohort A, representing low-grade nuclear sclerotic cataracts (grades 1-2), consisted of 739 eyes, while Cohort B, representing medium-grade nuclear sclerotic cataracts (grades 3-6), consisted of 286 eyes.ResultsThere was no significant difference in major intraoperative or postoperative complications (p>0.999) between Cohorts A and B. The mean logMar preoperative corrected distance visual acuity (CDVA) in Cohort A was 0.245 as compared with 0.346 in Cohort B (p<0.001). There was no significant difference between cohorts for postoperative CDVA at one day (-0.168 versus -0.118; p=0.070), one week (-0.180 versus -0.147; p=0.405), or one month (-0.185 versus -0.161; p=0.569).ConclusionsThere was no significant difference in the incidence of operative complications or postoperative CDVA between the cohorts. These findings suggest that, in experienced hands, surgery for medium-grade nuclear sclerotic cataracts is equally effective and safe as compared with that for low-grade nuclear sclerotic cataracts.

Grading evaluation of operative complications and analysis of related risk factors in patients with stage Ⅰ endometrial cancer treated by robotic-assisted and traditional laparoscopic surgery

Objective: To investigate the surgical complications in the treatment of stage Ⅰ endometrial cancer by robotic-assisted laparoscopy, the risk degree of Clavein-Dindo complications and the main risk factors affecting the occurrence of surgical complications. Methods: A retrospective case-control study was conducted in the First Affiliated Hospital of Zhengzhou University from October 2014 to June 2019. The patients were divided into robotic-assisted laparoscopy group and traditional laparoscopy group according to the operation mode, including 131 cases in robot group and 290 cases in traditional laparoscopy group. To compare the complications during and after operation and the risk degree of complications between the two groups by Clavein-Dindo classification standard, the age, body mass index (BMI), comorbidities, past history of pelvic surgery, American Society of Anesthesiologists (ASA) grade, preoperative anemia, number of pelvic lymph node resection, number of abdominal aortic lymph node resection, the total number of lymph node resection, operation time, surgical methods (robot surgery or traditional laparoscopic surgery) and other clinicopathological data were analyzed by logistic regression analysis. Results: (1) Complications of operation: the incidence of operative complications (including intraoperative and postoperative complications) in robot group was significantly lower than that in traditional laparoscopy group [(20.6%, 27/131) vs (34.8%, 101/290); χ(2)=8.620, P=0.003)]. The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group [1.5% (2/131) vs 6.2% (18/290); χ(2)=4.368, P=0.037]. The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group [0.8% (1/131) vs 5.2% (15/290); χ(2)=4.798, P=0.022]. The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group [19.1% (25/131) vs 28.6% (83/290); χ(2)=4.303, P=0.038], but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group [10.7% (14/131) vs 5.2% (15/290); χ(2)=4.279, P=0.039]. (2) Clavein-Dindo classification: the incidence of Clavein-Dindo Ⅰ, Ⅲ, Ⅲ, Ⅳ and Ⅴ grade between two groups were respectively 3.8% (5/131) vs 11.0% (32/290), 13.7% (18/131) vs 14.5% (42/290), 3.1% (4/131) vs 8.6% (25/290), 0 (0/131) vs 0.3% (1/290), 0 (0/131) vs 0.3% (1/290), and the incidence of grade Ⅰ (χ(2)=5.684, P=0.015) and Ⅲ (χ(2)=4.361, P=0.037) complications were statistically significant. The incidence of severe complications in robot group (grade Ⅲ and above) was lower than that in traditional laparoscopy group [3.1% (4/131) vs 9.3% (27/290); χ(2)=5.179, P=0.023]. (3) Analysis of influencing factors of surgical complications: univariate analysis showed that BMI (χ(2)=15.801, P=0.000), preoperative anemia (χ(2)=14.299, P=0.000), total number of lymph node resection (χ(2)=10.425, P=0.001), surgical methods (χ(2)=8.620, P=0.003) were related to the occurrence of surgical complications of endometrial carcinoma. Multivariate analysis showed that BMI (OR=0.289, 95%CI: 0.097-0.864, P=0.026), preoperative anemia (OR=0.309, 95%CI: 0.129-0.740, P=0.008), the total number of lymph node resection (OR=0.624, 95%CI: 0.403-0.966, P=0.034) and surgical methods (OR=3.491, 95%CI: 1.030-11.840, P=0.045) were independent risk factors for surgical complications of endometrial carcinoma. Conclusions: Compared with traditional laparoscopic surgery, robot-assisted laparoscopic surgery has fewer complications and lower incidence of severe complications. BMI, preoperative anemia, the total number of lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of stage Ⅰ endometrial cancer.

MODERN SURGICAL INTERVENTIONS IN PATIENTS WITH THYROID DISEASES

The study is based on the analysis of the results of surgical treatment of 298 patients with various diseases of the thyroid gland, who were examined and treated in the department of endocrine surgery of the City Clinical Hospital named after S. P. Botkin from 2012 to 2016. 147 (49.3%) patients of the I group were operated on using extrafascial technique with intersection of the prelaryngeal muscles and visualization of the recurrent laryngeal nerve. 151 (51.7%) patients of group II underwent extrafascial surgical interventions from reduced migratory approaches using modern, including original, methodological approaches. For the prevention of paresis of the larynx in the allocation of recurrent laryngeal nerves, microsurgical instruments and magnifying devices were used. For the prevention of postoperative hypoparathyroidism, in addition to carefully accounting for anatomical and topographic-anatomical features, a «stress-test» and a method of double visual-instrumental recording of the parathyroid gland-induced fluorescence were used. In the first group of patients with surgical treatment, the following complications were recorded: in 2 (1.4%) patients developed permanent, in 8 (5.4%) transient postoperative hypoparathyroidism, and in 3 (2.0%) - temporary unilateral laryngeal paresis. The overall incidence of operative complications was 8.8% (13 patients). In the postoperative period, the following complications were recorded in group II: 2 (1.3%) patients developed transient hypocalcemia, and 1 (0.7%) patient had unilateral laryngeal paresis. The overall incidence of operative complications was 1.99% (3 patients). Analysis of the cosmetic result of the intervention, assessed on the POSAS scale, showed that cosmetic effect was better in group II (p 0.05). Thus, modern surgical interventions in patients with thyroid diseases, including new methodological approaches, have improved the results of surgical treatment with a decrease of the number of complications and achieving a better cosmetic effect of the surgical intervention.

1891 A Prospective, Controlled Study Comparing Single Port Laparoscopic Sacrospinous Fixation and Transvaginal Sacrospinous Fixation in the Treatment of Pelvic Organ Prolapse

Study Objective The objective of the study was to compare operative time, intraoperative blood loss, recurrence and complication rates for single port laparoscopic sacrospinous fixation SSF and transvaginal (SSF) for the primary treatment of pelvic organ prolapse. Design Patients undergoing surgery for pelvic organ prolapse were included in a randomized, controlled study comparing single port laparoscopic SSF or transvaginal sacrospinous fixation. The examination included operative time, intraoperative blood loss, operative complication, and pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. Setting trendelenburg. Patients or Participants Of 20 randomized patients in Zhongnan Hospital of Wuhan University, from Jan.2018 to Mar.2019. Interventions 10 patients underwent single port laparoscopic SSF and 10 patients underwent transvaginal SSF. Measurements and Main Results All the operations were completed successfully. The operative time in the single port laparoscopic group (117.0±20.0 min) was longer than the transvaginal group (75.2±24.3 min). The intraoperative blood loss (54.9±24.1 ml) was less than the transvaginal group (87.6±12.3 min). The incidence of operative complications in the single port laparoscopic group (30.0%) was lower than transvaginal group (50.0%). There were no difference between the single port laparoscopic group and the transvaginal group in prolapse recurrence after 12 months occurred (P >0.05). No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. Conclusion Single port laparoscopic sacrospinous fixation is safe and feasible in the treatment of pelvic organ prolapse. The objective of the study was to compare operative time, intraoperative blood loss, recurrence and complication rates for single port laparoscopic sacrospinous fixation SSF and transvaginal (SSF) for the primary treatment of pelvic organ prolapse. Patients undergoing surgery for pelvic organ prolapse were included in a randomized, controlled study comparing single port laparoscopic SSF or transvaginal sacrospinous fixation. The examination included operative time, intraoperative blood loss, operative complication, and pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. trendelenburg. Of 20 randomized patients in Zhongnan Hospital of Wuhan University, from Jan.2018 to Mar.2019. 10 patients underwent single port laparoscopic SSF and 10 patients underwent transvaginal SSF. All the operations were completed successfully. The operative time in the single port laparoscopic group (117.0±20.0 min) was longer than the transvaginal group (75.2±24.3 min). The intraoperative blood loss (54.9±24.1 ml) was less than the transvaginal group (87.6±12.3 min). The incidence of operative complications in the single port laparoscopic group (30.0%) was lower than transvaginal group (50.0%). There were no difference between the single port laparoscopic group and the transvaginal group in prolapse recurrence after 12 months occurred (P >0.05). No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. Single port laparoscopic sacrospinous fixation is safe and feasible in the treatment of pelvic organ prolapse.

Comparative study of three-dimensional versus two-dimensional laparoscopic C1 radical hysterectomy for cervical cancer

Objective: To compare the clinical effects and the subjective perception of surgeons with three-dimensional (3D) and two-dimensional (2D) laparoscopic C1 radical hysterectomy surgeries for cervical cancer. Methods: The retrospective cohort study was conducted. The clinicopathological data of 101 patients with cervical cancer who received C1 laparoscopic radical hysterectomy (C1-LRH) surgery from June 2015 to August 2017 were collected. Of all patients, 42 cases undergoing 3D laparoscopic surgery and 59 cases undergoing 2D laparoscopic surgery were respectively allocated into the C1-3DLRH group or C1-2DLRH group. The clinical effect and the subjective perception of surgeons were compared between the two groups. Results: (1) There was no significant difference between the C1-3DLRH group and C1-2DLRH group in terms of age, body mass index (BMI), International Federation of Gynecology and Obstetrics (FIGO) stage, pathologic type, etc. (all P>0.05). Compared with C1-2DLRH group, the operation time was significantly shortened [(192±54) vs (221±54) minutes, P<0.01], blood loss was significantly less [(102±88) vs (167±117) ml, P<0.01], and the success rate of inferior hypogastric plexus (IHP) bladder branch preservation was significantly increased [86% (36/42) vs 66% (39/59), P<0.05] in C1-3DLRH group. There were no significant difference in the number of lymph nodes, the incidence of operative complications, the infection rate, the time of catheterization and the length of hospitalization between the two groups (all P>0.05). The long-term bladder function was evaluated at the twelfth month after operation, 39 patients in the C1-3DLRH group and 53 patients in the C1-2DLRH group were completed the survey. The results showed that 13% (5/39) of the patients in the C1-3DLRH group had long-term bladder dysfunction, which was lower than that 21% (11/53) of the C1-2DLRH group, but there was no significant difference between the two groups (χ(2)=0.980, P=0.322). (2) A total of 251 laparoscopic surgeons questionnaires were eligible. The incidence of side effects in the first and second generation of 3D and 2D laparoscopic surgeons was 20.4% (10/49), 6.9% (6/87) and 3.5% (4/115), respectively. The incidence of side effects in the first generation of 3D laparoscopic surgeons was higher than that in the second generation of 3D (χ(2)=5.463, P=0.019) and 2D laparoscopic surgeons (χ(2)=12.475, P<0.01). There was no difference between the second generation of 3D and 2D laparoscopic surgeons (χ(2)=1.208, P=0.272). Conclusions: 3D laparoscopy is advantageous to the preservation of autonomic nerve in C1-LRH operation and may improve the quality of operation compared with 2D laparoscopy. The second generation of 3D laparoscopic device might overcome the side effects of the surgeons.

Complications of endoscopic surgical treatment of upper urinary tract urolithiasis

Urolithiasis is one of the most common pathological conditions in the world, it is registered in 5-15% of the population. In Ukraine, urolithiasis accounts for 30-40% of all urological diseases. In the Odessa region, the prevalence of urolithiasis is one of the highest in Eastern Europe, exceeding 10.0%, the prevalence is particularly high in rural areas of Bessarabia and Budjaka. Percutaneous nephrolithotomy is considered the “gold” standard for the treatment of nephrolithiasis. The study was conducted on the basis of the Center for Reconstructive and Reconstructive Medicine (University Hospital) ONMedU (Odessa) from 2017 to 2018. The results of endoscopic interventions in 181 patients regarding the calculi of the upper urinary tract were analyzed. The patients were between the ages of 20 and 78, the average age was 49.5±2.6, of which 54.2% were men and 45.8% women. PNLT was performed by 17.8% of patients with coral-like nephrolithiasis, 40.7% of patients with multiple (two or more) calculi and 41.5% of patients with single calculus of the pelvis-pelvis system The incidence of intraoperative and postoperative complications was assessed by the classification of surgical complications of Clavien-Dindo: I degree of complications was observed in 17.6% of cases; II degree of complications was observed in 9.3% of cases; Grade III complications were observed in 5% of cases; IV degree of complications was observed in 2.8% of cases; V degree of complications – 0 cases (death of the patient). Thus, the incidence of operative complications was 34.8% of these in-operation – 19.3%; postoperative – 15.5% According to the Clavien-Dindo classification, complications were observed in 17.6% – I grade; 9.3% – II steps; 5% – III steps; 2.8% – IV degree; 0 – V steps.

"Freshman effect" in gynecologic surgery at a teaching hospital.

The purpose of this study was to determine the existence of the freshman effect in patients who underwent gynecologic surgery at a teaching hospital by comparing surgical outcomes and morbidity rates between the first academic quarter and other quarters. All data were collected prospectively. Between January 2015 and March 2018, patients who underwent gynecologic surgeries during the first academic quarter (March, April, and May in Korea) were retrospectively compared with patients who underwent gynecologic surgeries during other academic quarters (June through February). The primary outcome measure was the incidence of operative complication. Secondary outcomes were the operative time, operative blood loss, and length of hospital stay. Among 1241 patients who underwent gynecologic surgery during the study period of 39months, 1136 patients were analyzed for this study and divided into groups according to the first academic quarter (n = 335) and other academic quarters (n = 801). The baseline characteristics were not different between the groups. No significant difference in operative complications was found between the first and other academic quarters (1.5% versus 3.0%; P = 0.143). Moreover, there was no significant difference in operative time, operative blood loss, and length of hospital stay between the groups. This study did not demonstrate the existence of a "freshman effect", i.e., an increase in morbidity, at a Korean teaching hospital providing gynecologic surgical care. Patients undergoing gynecologic surgery can be reassured of their safety during the first academic quarter.

Effects of evidence-based nursing on the psychological status and complications after interventional embolization of intracranial aneurysms

Objective To investigate the effects of evidence-based nursing on the psychological status, operation associated complications and short-term prognosis of patients with intracranial aneurysms after interventional embolization. Methods A total of 150 patients undergoing elective interventional embolization in the hospital from May 2012 to May 2016 were randomly divided into the control group and the observation group with 75 patients each. The control group were given routine nursing care while the observation group were given evidence-based nursing. The incidence of operation associated complications and postoperative cerebral vasospasm were compared between the two groups. The changes in scores of the Self-Rating Anxiety Scale (SAS) , Self-Rating Depression Scale (SDS) , Somatization Symptom Checklist (SCL-90) and Glasgow Outcome Scale (GOS) before and after intervention were compared. Results No postoperative cerebral vasospasm was observed in the observation group, and the incidence of operative complications was 4%. In the control group, cerebral vasospasm occurred in 7 cases, and the incidence of operative complications was 17.3%. Before discharge, SAS score (42.26±3.77) and SDS score (40.67±6.44) in the observation group were lower than those in the control group (t=8.478, 4.507; P<0.001) . No death cases in these two groups. Three months later after operation, patients with GOS grade 5 in the observation group was 30.67%, and it was 13.33% in the control group. There was significant difference of GOS classification between the two groups (H=15.520, P<0.01) . Conclusions Evidence-based nursing can help reduce the incidence of cerebral vasospasm after interventional embolization in patients with intracranial aneurysms, improve their anxiety and depression, and optimize short-term prognosis. Key words: Intracranial aneurysm; Evidence-based nursing; Cerebral vasospasm; Interventional embolization

Diagnosis and treatment experience of 161 cases of pancreatic serous cystic neoplasm in single center and analysis of cause of preoperation misjudgement

Objective: To analyze the causes of preoperative miscarriage of pancreatic serous cystadenoma (SCN) and find the ways to improve it. Methods: Clinical data of 425 pancreatic cystic neoplasm patients who underwent surgical resection from January 2006 to December 2016 in Department of Pancreatic Surgery in Huashan Hospital were retrospectively analyzed.Excel database was created which covered 128 fields of 7 fields: general information of patients, preoperative blood biochemical indexes, tumor markers, surgical related data, postoperative complications, imaging findings and pathology.One hundred and sixty-one cases of SCN were analyzed in depth, mainly in three aspects: surgical benefit, preoperative imaging diagnostic value and interference factors in preoperative judgement.The classification data were analyzed by χ(2) test and the quantitative data were analyzed by t test.The Logistic regression model was used for multiple factor analysis. Results: Of the 425 PCN cases surgically removed, 161 cases (37.9%) were SCN, the incidence of operative complications was 40.4%(65/161), the hospitalization days was (20.7±12.1)days and the medical cost was (75 267±37 866) yuan.Only 3 of 161 cases of SCN were accurately diagnosed by preoperative imaging methods, 61 cases were diagnosed as "cystic lesions of pancreas" (37.9%) and 52 cases were diagnosed as "pancreatic cystadenoma" (32.3%). SCN was misdiagnosed as MCN(32.3%) and IPMN(28%) before operation.25.5% of them were diagnosed as SCN before operation, but still underwent radical operation.The rate of preoperative imaging diagnosis for identifying SCN was 62.8%.The lack of preoperative endoscopy and the lack of understanding of the image characteristics and biological behavior of SCN were the most important factors affecting the accuracy of preoperative judgment.Statistics found that gender, age, CA125 and tumor location can be used as independent factors contribute to the clinical identification(χ(2)=8.995, P=0.003; χ(2)=10.019, P=0.007; t=3.157, P=0.002; χ(2)=6.790, P=0.009). Logistic analysis showed that women, older than 60 years old, the tumors located in the pancreatic body and tail were the independent factors of SCN classification and diagnosis (OR=0.481, 0.376, 0.577, 0.666, 95% CI: 0.305-0.759, 0.199-0.710, 0.361-0.924, 0.433-1.024, P=0.002, 0.003, 0.022, 0.064). Conclusions: SCN has more benign biological behavior.Although surgical excision is acceptable for clinical safety, the corresponding benefit is very limited.It is possible to improve the rationality of SCN clinical operation decisions to some extent by performing endoscopic examination, imaging doctors to improve the SCN feature recognition and surgeons to enhance the awareness of SCN.

Clinical efficacy and safety analysis of laparoscopic cholecystectomy in patients with chronic cholecystitis and cholecystolithiasis

Objective To discuss the effect of laparoscopic cholecystectomy open cholecystectomy on liver function, inflammatory factors and immunoglobulin in patients with chronic cholecystitis and cholecystolithiasis. Methods One hundred and five cases of chronic cholecystitis and cholecystolithiasis patients in the First Hospital of Danjiangkou City were selected form May 2015 to May 2017 by taking a retrospective analysis, and divided into experimental group (treated with laparoscopic cholecystectomy, n=52) and control group (treated with traditional open cholecystectomy, n=53) according to the different ways of treatment, recorded and compared the indicators of the operation process, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), gamma glutamyl transpeptidase (GGT), tumor necrosis factor-ɑ(TNF-α), interleukin-6(IL-6), interleukin-8 (IL-8), C reactive protein(CRP), IgA, IgG, IgM. The measurement data were expressed by (±s), and the t test was used comparison between groups, and the χ2 test was used comparison between enumeration data, the comparison of the incidence of postoperative complications between the two groups was used the rank sum test, repeated measurement data using repeated measurement variance analysis. Results The operation time, intraoperative blood loss, postoperative anal exhaust time, first defecation time after operation, hospitalization time and hospitalization costs of experimental group were (73.71±11.62) minutes, (60.73±6.88) ml, (24.38±3.72) hours, (37.21±2.79) hours, (5.68±1.78) days, (6 600±1 600) yuan respectively, the control group were (118.48±25.52) minutes, (121.24±13.29) ml, (32.77±4.46) hours, (56.85±5.81) hours, (9.29±2.89) days, (4 900±1 100) yuan respectively, which were statistically significant(the values of t were 3.584, 4.183, 3.397, 3.245, 3.489, 2.938 respectively, all P 0.05). The immunoglobulin indexes IgA, IgG, IgM in the control group were significantly lower than preoperative all P<0.05, the 1, 3, 5 days IgA, IgG, IgM of the control group after operation were significantly lower than the experimental group (all P<0.05). The incidence of operative complications of experimental group 5.77%(3/52) was significantly lower than the control group 15.09%(8/53), which was statistical difference (Z=5.118, P=0.000). Conclusion The therapeutic effect of Laparoscopic cholecystectomy on chronic cholecystitis and cholecystolithiasis is reliable, small trauma and short hospitalization time, although patients with postoperative liver function increase significantly but can be quickly restored, the level of inflammatory factors in the patients is significantly improved, and there is little effect on the immune function, and the incidence of postoperative complications is low, so it is worth popularizing in clinical practice. Key words: Cholecystectomy, laparoscopic; Cholecystitis; Immunoglobulins; Liver function; Inflammatory factors

Simulation-Based Testing of Pager Interruptions During Laparoscopic Cholecystectomy

To determine if pager interruptions affect operative time, safety, or complications and management of pager issues during a simulated laparoscopic cholecystectomy. Twelve surgery resident volunteers were tested on a Simbionix Lap Mentor II simulator. Each resident performed 6 randomized simulated laparoscopic cholecystectomies; 3 with pager interruptions (INT) and 3 without pager interruptions (NO-INT). The pager interruptions were sent in the form of standardized patient vignettes and timed to distract the resident during dissection of the critical view of safety and clipping of the cystic duct. The residents were graded on a pass/fail scale for eliciting appropriate patient history and management of the pager issue. Data was extracted from the simulator for the following endpoints: operative time, safety metrics, and incidence of operative complications. The Mann-Whitney U test and contingency table analysis were used to compare the 2 groups (INT vs. NO-INT). Level I trauma center; Simulation laboratory. Twelve general surgery residents. There was no significant difference between the 2 groups in any of the operative endpoints as measured by the simulator. However, in the INT group, only 25% of the time did the surgery residents both adequately address the issue and provide effective patient management in response to the pager interruption. Pager interruptions did not affect operative time, safety, or complications during the simulated procedure. However, there were significant failures in the appropriate evaluations and management of pager issues. Consideration for diversion of patient care issues to fellow residents not operating to improve quality and safety of patient care outside the operating room requires further study.

The clinical research of transurethral diode laser en bloc resection combined with gemcitabine intravesical chemotherapy for non-muscle invasive bladder tumor

Objectives To evaluate the safety and efficacy of transurethral diode laser en bloc resection combined with gemcitabine intravesical chemotherapy for the treatment of non-muscle invasive bladder tumor. Methods From July 2014 to July 2015, clinical data of 62 patients with non-muscle invasive bladder tumor were retrospectively analyzed.All patients received transurethral diode laser en bloc resection and gemcitabine intravesical chemotherapy.The operative time, intraoperative blood loss, incidence of operative complications, bladder irrigation time, days for urethral catheterization, duration of hospitalization after surgery and recurrence were recorded. Results The mean operative time was (30.5±12.8)min with less amount of blood loss, and the obturator nerve reflex, perforation, water intoxication, urinary leakage and secondary hemorrhage did not occur.The mean time of bladder irrigating was(6.15±2.33)h, the mean time of catheterization was (7.33±1.54)d and the mean time of hospitalization after surgery was(8.21±1.26)d. Patients were followed up for 6 to 18 months, with 3 cases of ectopic recurrence. Conclusions Transurethral diode laser en bloc resection combined with gemcitabine intravesical chemotherapy for the treatment of non-muscle invasive bladder tumor is safe and effective.The operation can provide accurate tumor classification and staging information, and it is worthy of wide clinical application. Key words: Urinary Bladder Neoplasms; Cystectomy; Lasers

Effects of decompressive cervical surgery on blood pressure in cervical spondylosis patients with hypertension: a time series cohort study.

BackgroundPatients with cervical spondylosis myelopathy (CSM) and complicated with hypertension are often experiencing a blood pressure decrease after taking cervical decompressive surgery in clinical observations, but how this blood pressure reduction is associated with the surgery, which cut cervical sympathetic nervous, has never been rigorously assessed. Thus, the purpose of this study is to investigate the effect of cervical decompressive surgery on blood pressure among CSM patients with hypertension.Methods/DesignThe study will be a time series cohort study. Fifty eligible patients will be selected consecutively from the Peking University First Hospital. Two 24-h ambulatory blood pressure measurement (ABPM) will be taken before the surgery, apart by at least 3 days. The patients will be followed up for another two ABPMs at 1 and 3 months after the surgery.We will recruit subjects with cervical spondylosis myelopathy meeting operation indications and scheduled for receiving cervical decompressive surgery, aged 18–84 years, have a history of hypertension or office systolic blood pressure ≥140 mmHg on initial screening, and willing to participate in the study and provide informed consent. Exclusion criteria includes a history of known secondary hypertension, visual analogue scale (VAS) score ≥4, and unable to comply with study due to severe psychosis.The change in systolic ABPs over the four times will be analyzed to observe the overall pattern of the blood pressure change in relation to the surgery, but the primary analysis will be the comparison of systolic ABP between the 2nd and 3rd , 4th measurements (before and after the surgery). We will also calculate the regression-to-the-mean adjusted changes in systolic ABP as sensitivity analysis. Secondary endpoints are the changes in 24 h ABPM diastolic blood pressure, blood pressure control status, the use and dose adjustment of antihypertensive medication, and the incidence of operative complications. Primary outcome analyses will be carried out using analysis of covariance, as well as the first secondary endpoint.DiscussionThis study will inform us the important knowledge about cervical sympathetic nervous system (SNS) and blood pressure. Once confirmed, it may help to produce new method for control of hypertension, which is the leading cause of death in the world.Trial registrationThe study is registered to Clinical Trials.gov (NCT02016768).

Prevalence, ocular associations and perioperative surgical complications of pseudoexfoliation syndrome in patients scheduled for cataract surgery

Purpose The aim of this work was to study the prevalence, possible ocular association, and perioperative surgical complications of pseudoexfoliation syndrome (PXF) in patients with age-related cataract scheduled for surgery in Najran district, south Saudi Arabia. Design Retrospective comparative study. Patients and methods In this retrospective comparative study, 681 consecutive patients scheduled for routine cataract surgery were included. All patients were aging 60 years old or more. Full ophthalmological examination including visual acuity, refraction, slit-lamp examination, Goldmann applanation tonometry, gonioscopy, type of cataract, and dilated-pupil fundus examination was performed. Intraoperative and early postoperative complications of surgery were reported and statistical analysis was done. Results Pseudoexfoliation was identified in eyes of 192 patients with overall incidence of 28.19%. It was found unilaterally in 46.87% and bilaterally in 53.13% of patients. The mean age for PXF group was 73.47 ± 22.36 years and 72.36 ± 21.63 years for non-PXF group. The occurrence of pseudoexfoliation was found to be significantly higher with advancement of age. Ocular hypertension and glaucoma were reported in PXF group more than in non-PXF group. Nuclear, hypermature, and cortical cataracts were found to be more frequently associated with pseudoexfoliation compared with those without pseudoexfoliation. Association of PXF with some ocular conditions as well as with perioperative complications was reported and discussed. Conclusion PXF is a common age-related disorder in patients with age-related cataract in Najran area, south Saudi Arabia with overall incidence of 28.19%. PXF was found to be associated with certain types of cataract, glaucoma, other ocular conditions as well as increased incidence of operative complications.