Increase In Postoperative Complications Research Articles

Smoking's Impact on 30-Day Complications in Mesh and Nonmesh Prolapse Surgery.

Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood. This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair. We also examined whether these associations differed based on whether mesh was used. We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent minimally invasive apical pelvic organ prolapse repair from 2012 to 2022. Smoking in the last year was the exposure. Outcomes included postoperative infection, unplanned readmission, and reoperation within 30 days. We calculated adjusted risk ratios for complications and stratified results based on mesh use. Of 67,235 cases, 5,518 (8.2%) patients smoked in the past year. Smokers had a significantly higher likelihood of infection and unplanned readmission. Smoking did not increase the risk of unplanned reoperation. The association between smoking and 30-day complications did not differ based on mesh use (all P for interaction ≥0.24). Tobacco use was associated with an increase in postoperative complications within 30 days, though the absolute risk was low. There was no evidence of effect modification by mesh use; suggesting that mesh-augmented repairs could be considered in smokers who receive appropriate counseling.

The Efficacy of the Charlson Comorbidity Index and Its Age-Adjusted Version in Forecasting Mortality and Postoperative Outcomes Following Isolated Coronary Artery Bypass Grafting.

Background/Objectives: The Charlson Comorbidity Index (CCI) is designed for evaluating comorbidities and mortality risks, with the age-adjusted CCI (ACCI) combining age and comorbidity assessments. Despite its long-standing use, research on CCI's application in cardiac surgery patients is limited. This study assessed the effectiveness of CCI and ACCI in predicting in-hospital mortality and post-surgery outcomes for patients undergoing isolated coronary artery bypass grafting (CABG). Methods: CCI and ACCI scores were derived from medical records between 2016 and 2022. Patient demographics, surgical techniques, and postoperative complications were documented. Results: Totally 393 patients [297 (75.6%) males, 96 (24.4%) females] with an average age of 65 years were included. Median CCI and ACCI scores were 1 (1-2) and 4 (3-5), respectively. In-hospital mortality occurred in 5.9% (n = 23) of cases, with CCI being an independent predictor (OR 1.865, 95% CI 1.117-3.116; p = 0.017). Both CCI and ACCI scores negatively correlated with preoperative EF (%) and positively correlated with ICU and total hospital stay, cardiopulmonary bypass time, and cross-clamp time. ACCI score also positively correlated with extubation time. Patients categorized by CCI comorbidity severity (no comorbidity, mild, moderate, severe) showed a significant increase in postoperative complications with increasing severity, including postoperative VT (p = 0.000), acute renal failure (p = 0.009), pneumonia (p = 0.007), and in-hospital mortality (p = 0.001). Conclusions: Both CCI and ACCI are prognostic indicators for in-hospital mortality in isolated CABG surgery patients, effectively predicting postoperative complications, extended ICU stays, and prolonged hospital stays. Implementing these scoring systems could enhance patient care and improve surgical decision-making.

Liposomal bupivacaine was not associated with increased postoperative complications in dogs receiving closed anal sacculectomy: a retrospective study.

To compare the postoperative complication rates of anal sacculectomy procedures in dogs treated with or without liposomal bupivacaine (LB). Medical records of 397 client-owned dogs treated with closed anal sacculectomy between 2016 and 2023 were retrospectively identified and grouped on the basis of administration of LB (LB group) or not (non-LB group). Details of short-term (< 15 days) postoperative complications were recorded from physical examination and client communication notes as well as referral documents and compared between groups. Relative risks for complications were calculated. Univariable and multivariable logistic regressions were used to estimate ORs and test for the effects of LB use and other risk factors on complications. 267 dogs received LB and 173 did not. The overall short-term postoperative complication rate in the study was 24% (94 of 397; 95% CI, 20% to 28%), and the short-term postoperative complication rates for dogs in the LB and non-LB groups were 22% (95% CI, 17% to 27%) and 27% (95% CI, 20% to 35%), respectively. The relative risk for overall short-term postoperative complications was 0.80 (95% CI, 0.56 to 1.16), indicating that an association between LB and an increased risk of short-term postoperative complications was not found. No significant association of LB with an increase in postoperative complications following anal sacculectomy in dogs was found. Although, LB's efficacy in these cases was not evaluated. Liposomal bupivacaine may be suitable as a local anesthetic following anal sacculectomy in dogs.

Minimally Invasive Surgery in Acute Bowel Obstruction: Should It Become the Standard of Care? A Prospective, Single Center, Observational Study.

Background/Objectives: This study was conducted to determine whether a structured clinical pathway can help to safely implement minimally invasive surgery (MIS) as the standard approach in surgery for acute bowel obstruction (ABO). Methods: A prospective analysis was performed on consecutive patients undergoing MIS for ABO at a single center in 2021 and 2022. Prior to the study onset, a structured treatment pathway was defined to apply MIS in all patients. The rate of success in the MIS and patient-, surgeon- and outcome-specific parameters with a focus on complication and conversion rates were analyzed. Results: Compared to a historical control group, the conversion rate from MIS to open surgery (OS) nearly doubled from 20.4% to 36.4% (p = 0.14). The complication rate in converted patients was 43.8% vs. 7.15% in non-converted patients (p < 0.05). Conclusions: A structured clinical pathway, including technical standardization and preoperative decisional processes, can be used to implement MIS as a primary surgical treatment in ABO. This is accompanied by high conversion rates and a significant increase in postoperative complications in patients undergoing conversion. Individual decision-making concerning the surgical approach remains paramount to prevent complications and high conversion rates.

Effects of preoperative caudal epidural block on surgical outcomes in distal hypospadias surgery

Aims: Hypospadias is an anomaly of the urogenital system with an incidence of approximately 0.5% in children. Caudal epidural block (CEB) is one of the most preferred analgesia methods in hypospadias surgery. Recently, there have been reports in the literature about an increase in postoperative complications (especially fistula) due to CEB after hypospadias surgery. In this study, we aimed to retrospectively evaluate the effect of CEB analgesia on surgical outcomes in distal hypospadias surgery performed in our center. Methods: The study included 63 pediatric patients operated for distal hypospadias between 2020 and 2023. These patients were divided into two groups according to whether CEB was applied during surgery or not. Patients were evaluated in terms of surgical technique, age, and complications. Results: A total of 63 pediatric surgeries with a mean age of 45.12±26.76 months and ranging from 1 to 10 years were analyzed. 63 cases with subcoronal hypospadias were included in the study. 26 cases(41.3%) underwent CEB, while 37 cases(58.7%) received intravenous analgesia (IA).The surgical complication rate in our study was 34.9%(n=22). There was no significant difference in postoperative complications between CEB and IA groups. Conclusion: In this study, there was no statistically significant difference in the incidence of postoperative complications between CEB and IA in children operated for distal hypospadias. CEB can be used as a safe pain management method in hypospadias repair. However, we think that prospectively designed studies with a larger number of patients will be more useful in clarifying the issue.

Perioperative severity of acute appendicitis during the confinement related to SARS COVID-19: a retrospective comparative cohort.

To evaluate the perioperative severity of acute appendicitis during the COVID-19 pandemic compared to the same periods in 2018 and 2019 in the Nancy-Metz region, France. Acute appendicitis is a common surgical emergency that can lead to severe complications if not treated promptly. The COVID-19 pandemic and subsequent lockdowns resulted in reduced hospital visits, potentially delaying treatment for appendicitis and increasing perioperative severity. This retrospective, bicentric cohort study included 634 adult patients who underwent emergency appendectomy at the Nancy University Hospital and Metz Regional Hospital. The study compared patients from the pandemic period (March 17, 2020, to December 14, 2020) with those from the same periods in 2018 and 2019. The primary outcome was perioperative severity, defined by a Gomes score ≥ 3 and/or a Clavien-Dindo classification ≥ 3. Secondary outcomes included time to treatment, severity of biological inflammatory syndrome, postoperative complications, and hospitalization metrics. Logistic regression analyses were performed with adjustments for ASA scores. The study included 194 patients from the COVID-19 cohort and 440 from the non-COVID cohort. The perioperative severity was higher during the COVID period (33.5% vs. 25.9%), though this difference was not statistically significant (p = 0.0845). Secondary outcomes such as time to treatment, severity of the inflammatory syndrome, and postoperative complications did not show significant differences between cohorts. However, the duration of postoperative antibiotic therapy was longer during the COVID period (6days vs. 5days, p = 0.0410). The COVID-19 pandemic led to a non-significant increase in perioperative severity of acute appendicitis. Despite the challenges posed by the pandemic, the French healthcare system maintained effective management of surgical emergencies, with no significant increase in postoperative complications. Further research is required to explore the broader impact of the pandemic on the management of appendicitis.

Impact of remimazolam on postoperative inflammatory markers and complications in thoracoscopic pulmonary lobectomy patients: A retrospective analysis.

Remazolam is widely used for procedural sedation in intensive care units. It has been shown to have anti-inflammatory and organ-protecting properties. However, the changes in inflammatory markers and analgesic effects of remazolam after thoracoscopic pulmonary lobectomy remain unclear. This study aims to assess the effects of the novel drug remimazolam on inflammatory factor levels and postoperative complications in thoracoscopic pulmonary lobectomy patients, providing a scientific basis for clinical use. This retrospective study analyzed 200 thoracoscopic pulmonary lobectomy patients, who were divided into a control group and a remimazolam group based on their anesthesia method. Patients in ramazolam group were anesthetized with ramazolam, while patients in control group were anesthetized with propofol. All patients were performed by the same physician team and anesthesia team. Inflammatory factors (including interleukin-6 [IL-6], C-reactive protein [CRP], including interleukin-8) were measured preoperatively and postoperatively, and postoperative complication rates were compared between the 2 groups. The levels of IL-6 and CRP were significantly higher in the remimazolam group at 7 days postoperatively compared to the control group. No significant differences were observed in preoperative inflammatory factors or postoperative including interleukin-8 levels between the 2 groups. Additionally, there were no significant differences in the overall incidence of postoperative complications or in specific complications such as pulmonary infection, atelectasis, subcutaneous emphysema, pneumothorax, surgical site infection, and arrhythmia. Patients receiving remimazolam had higher postoperative IL-6 and CRP levels compared to the control group, without an increase in postoperative complications. In clinical use, attention should be paid to the control of inflammatory indicators in patients using remazolam. However, due to potential confounding factors and the retrospective design, we cannot establish a causal relationship between remimazolam and elevated inflammatory markers. These findings suggest a possible association that requires cautious interpretation. Further research is needed to assess the clinical relevance and explore the underlying mechanisms.

Incidence of Postoperative Complications among Patients with Active or Resolved COVID-19 Undergoing Elective Abdominal Wall Reconstruction

Background: The incidence of postoperative complications among patients with coronavirus disease 2019 (COVID-19) positivity undergoing elective surgical operations is poorly understood. This study aimed to identify differences in postoperative complications after elective abdominal wall reconstruction (AWR) in patients diagnosed with COVID-19 compared with patients presenting prepandemic. Methods: A single-institution, retrospective chart review was performed of patients undergoing AWR between January 2017 and September 2022. Patients were stratified by date: pre-COVID-19 (January 2017 to December 2019) and post-COVID-19 (January 2020 to September 2022). Patients confirmed as COVID-19-positive were also identified. Data collected included demographics, clinical characteristics, and complications. Univariate and multivariate analyses were performed. Results: We included 168 patients. The mean age was 54 years, and the mean body mass index was 33 kg/m2. Seventy-five patients underwent surgery pre-COVID-19 and 93 patients after. Of 93 patients, 16 (17%) had a positive COVID-19 test before surgery or during the perioperative period. These 2 groups were risk-matched. Patients with COVID-19 had no significant increase in postoperative complications. Major complications occurred at 13.3% in the pre-COVID-19 group and 7.5% in the post-COVID-19 group. Patients with COVID-19 were more likely to be younger (48 versus 57; P = 0.049) and more likely to have a shorter length of stay in the hospital (3 versus 5.8; P = 0.038). Conclusions: In our case series, there was an associated increase in the incidence of overall pulmonary-related complications in the postpandemic group. This study is limited by its small sample size. Further investigation should be carried out on this topic.

Has robot-assisted pyeloplasty reached outcome parity with laparoscopic pyeloplasty in children

Ureteropelvic Junction Obstruction (UPJO), is a major cause of pathological hydronephrosis in children. Minimally invasive surgery (MIS), including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), has gained popularity due to its known advantages. LP faces technical difficulties and a steep learning curve. RALP has overcome these limitations, making it safer and more effective for children. The study aims to assess the safety and effectiveness of LP and RALP in infants weighing ≤15kg. This is a retrospective analysis (2010-2022). The study included pediatric patients who had a confirmed diagnosis of UPJO and weighed ≤15kg. The patients were divided into two groups: LP and RALP. The study evaluated preoperative, intraoperative, perioperative, and follow-up data, including complications. Success was defined as no worsening of hydronephrosis on postoperative ultrasound in the first year of follow-up. The total patients were 94: 42 in the LP group, and 52 in the RALP group. The median age at the intervention was 17.5 months (LAP group) versus 29 months (RALP group) (p=0.01). The median weight at the time of intervention was 9.5Kg (LP group), and 11.6Kg (RALP group) (p=0.44). The median operative time was significantly longer in the LP group: 245min versus 125.5min in the RALP group (p=0.001). The median length of hospitalization was comparable: 4.3 days (LP group) and 3.5 days (RALP group) (p=0.42). No intraoperative complications were reported in either group. There were no statistically significant differences regarding postoperative complications. During follow-up, all patients remained asymptomatic, with no episodes of urinary tract infection or abdominal pain, and none of them had a recurrence of UPJ obstruction. Consequently, the two techniques are equally effective and safe in the short term. Both procedures offer excellent outcomes with comparable postoperative complications. LOS was similar for both groups, with no intraoperative complications or conversions, and a non-significant increase in postoperative complications. A notable finding was the significant difference in operation times between the procedures, emphasizing the importance of reduced surgical time in pediatric patients for minimizing anesthetic and intubation durations. For the absence of intra- and postoperative complications and recurrences, RALP is as effective as LP in pyeloplasty in children weighing 15kg or less. This finding reinforces the idea that RALP can be safely executed, benefiting from its advanced technology and the learning curve, for patients of any age regarding pyeloplasty for UPJO.

Exploring the impact of variable power outputs on the efficacy and safety during microwave ablation for lung carcinoma: a real-world study.

Microwave ablation (MWA) is an important method for the treatment of lung cancer, but there is still a lack of standard guidelines for the selection of power. This study aimed to explore the effectiveness and safety of MWA at different power levels. The study gathered individuals underwent MWA for lung cancer between January 2012 and December 2020. All patients were divided into low power group and high power group based on the power of MWA. By intergroup comparisons, we clarified the differences between the two groups. In this study, 265 participants were involved, with 192 in the low power group and 73 in the high power group. Compared to the low power group, the high power group had a significantly higher incidence of postoperative complications (63.0% vs. 24.0%). In the Kaplan-Meier analysis, overall survival (OS) and disease-free survival (DFS) of the high power group were both better than the low power group. We found through Cox regression analysis that smoking, tumor volume, tumor differentiation, gene mutation, neutrophil count, and lymphocyte count were independent factors affecting the OS of patients. Based on the above factors, we constructed a nomogram, with areas under the curve (AUCs) of 0.941, 0.903, and 0.905 for predicting 1-, 2-, and 3-year OS after MWA, respectively. While high-power MWA brings better long-term prognosis to patients, it also leads to an increase in postoperative complications. The application of a nomogram for stratifying the prognosis of patients may be a more feasible approach to further develop individualized treatment plans.

Carotid endarterectomy outcomes according to anesthesia method: General anesthesia or regional anesthesia?

Aim: Surgical strategies in carotid endarterectomy (CEA) vary according to the method of anesthesia, neurological monitoring, shunt use, and closure methods, and the gold standard method has not yet been determined. In this study, we aimed to analyze the superiority and feasibility of CEA under general anesthesia and regional anesthesia. Material and Methods: Demographic characteristics, operative information and follow-up results of 237 patients who underwent CEA between January 2015 and June 2020, 165 patients under regional anesthesia (RA: Group 1) and 72 under general anesthesia (GA: Group 2), were retrospectively analyzed. In Group 1, carotid shunt was placed in patients with a negative awake test (n: 21, 12.7%) and in Group 2 carotid shunt was placed in all cases. Results: There was no statistically significant difference in postoperative stroke, transient ischemic attack (TIA) and cardiovascular mortality (p: 0.48; p: 0.30; p: 0.63, respectively). Although the operation and clamp time were shorter in Group 1, no significant difference was observed (97.93±11.02 min, 101.46±9.49 min p: 0.23; 19.60±5.62 min, 25.62±7.47 min p: 0.24, respectively). The duration of intensive care unit (ICU) stay was shorter and statistically significant in Group 1. (p: 0.003). There was no significant difference for restenosis rates (p: 0.34). Conclusion: There was no significant increase in postoperative complications in the RA group compared to the GA group despite shunting according to the awake test. Also, patients who underwent RA stayed in ICU for a shorter period of time. CEA can be performed under both GA and RA with similar complication rates.

Postoperative complications and mortality after thoracic surgery of COVID-19 omicron hospital infections: A retrospective multicenter study

BackgroundPostoperative complications and mortality of Omicron hospital infection, who have undergone thoracic surgery, are scarce. MethodsBased on real-time reverse transcription polymerase chain reaction results in-hospital using nasal or pharyngeal swab samples, the patients who had undergone thoracic surgery were categorized into two groups: G1 (Omicron hospital infection) group and G2 (non- Omicron hospital infection) group. The occurrence of postoperative complications was assessed using the Clavien–Dindo classification. Both groups were compared using propensity score matching (PSM) to evaluate the occurrence of complications and mortality. The trail was enrolled in the clinical trail (NCT06040606). Results119 patients (G1, 53 and G2, 66) were included. The occurrence of postoperative complications was significantly higher in G1 group than G2 group (37.7% vs. 10.6%, respectively) (P < 0.001) and the mortality also increased (7.5% vs. 0). The logistic regression analysis identified Omicron hospital infection as the risk factors for postoperative complications (95% CI, 3.989 to 33.858). The PSM analysis indicated significant increase in postoperative complications and mortality in the G1 vs. G2 group (P < 0.01, NA). But, there was no significant difference in the occurrences of grade ≥3 complications and mortality between lung surgery and upper gastrointestinal operation, as the PSM analysis. ConclusionThe occurrences of complications and mortality significantly increased in thoracic surgery recipients with Omicron hospital infection.

Impact of progressive chronic kidney disease stage on postoperative outcomes in metabolic surgery—a propensity-matched analysis using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement database

BackgroundMetabolic surgery (MS) is effective in improving renal parameters for individuals with obesity and chronic kidney disease (CKD). Despite recognized benefits, concerns linger about the perioperative safety of patients with CKD undergoing MS. This study aimed to identify the CKD stage associated with the most significant increase in postoperative complications. MethodsThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (2017–2021) was used to identify patients undergoing laparoscopic gastric sleeve (SG) or Roux-en-Y gastric bypass (RYGB). Propensity matching was used to quantify the risk for adverse outcomes associated with progressive CKD stage. ResultsIn total, 688,583 patients (483,898 without CKD and 204,685 with CKD stages I-V) were examined. Endpoints included length of stay (LOS) >5 days, infection, serious complications, major adverse cardiovascular events (MACE), and death. Both SG and RYGB exhibited a linear increase in risk of infection and death. For SG, patients who were stage IIIa/IIIb demonstrated the greatest risk for LOS >5 days (odds ratio [OR] 1.23; 95% confidence interval [CI] (1.05–1.45); P = .011), serious complications (OR 2.83; 95% CI 1.87–4.30; P < .001), and MACE (OR 2.82; 95% CI 1.81–4.37; P < .001). For RYGB, patients who were stage IIIa/IIIb the exhibited greatest risk of MACE (OR 1.67; 95% CI 1.06–2.62; P = .027). ConclusionsAlthough it is generally accepted that worsening CKD correlates with greater surgical risk, this analysis identified CKD stage III as a major inflection point for risk of LOS >5 days, serious complications, and MACE. These findings are useful for counseling and procedure selection and suggest a need for heightened attention to CKD stage III patients undergoing MS.

Double reverse traction repositor assisted closed reduction and internal fixation versus open reduction and internal fixation for treatment of lateral tibial plateau fractures among the elderly.

In elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs. From January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications. The DRTR assisted CRIF group experienced a 43.6mL decrease in intraoperative blood loss (161.3ml vs 204.9ml, p = 0.033), and the operation duration was 32.1min shorter than the ORIF group (83.8min vs 115.9min, p < 0.001). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) immediately after surgery and at the last follow-up. No differences in malreduction (p = 0.566) or reduction loss (p = 0.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 ± 15.8 vs 83.4 ± 5.1, p = 0.934; 89.3 ± 7.8 vs 86.9 ± 6.2, p = 0.172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, p = 0.008). Both types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs.

Postoperative Telemedicine Use: Satisfaction and Safety After Benign Gynecologic Surgery: A Randomized Controlled Trial [ID 2683391

INTRODUCTION: Telemedicine for postoperative care can be appropriate after minimally invasive surgery, but few studies have examined this option in gynecologic surgery. The objective of this randomized controlled trial was to determine whether virtual, compared to in-person postoperative care, after minimally invasive gynecologic procedures would increase patient satisfaction without negative safety concerns. METHODS: Patients were randomized to a telemedicine or in-person visit 2 weeks postoperatively. Eligible participants included women undergoing elective, minimally invasive gynecologic surgery. All participants completed the PSQ-18 form with addendum questions at their 6-week postoperative visit. Chart review was performed to assess frequency of postoperative adverse events. The Wilcoxon rank sum and Fisher exact test were used. RESULTS: Of 51 participants enrolled, 29 were randomized to standard (in-person) visits versus 22 randomized to intervention (telehealth). There was no statistical difference in the overall satisfaction with the postoperative care received between the intervention and the standard groups (93.8% agree or strongly agree versus 95.7%; P=1). There was no increase in postoperative complications in the intervention arm of the study, with an overall complication rate of 12.5% in all cases. CONCLUSION: It is reasonable to use telemedicine as an option for postoperative care based on shared decision-making with appropriate patients. A virtual postoperative visit is a safe option for patients who may not be able to travel to the office. Future study is ongoing to confirm statistical significance.

Simultaneous Free Flap Breast Reconstruction Combined With Contralateral Mastopexy or Breast Reduction: A Propensity-Matched National Surgical Quality Improvement Program Study on Postoperative Outcomes.

Simultaneous free flap breast reconstruction combined with contralateral mastopexy or breast reduction can increase patient satisfaction and minimize the need for a second procedure. Surgeon concerns of increases in operative time, postoperative complications, and final breast symmetry may decrease the likelihood of these procedures being done concurrently. This study analyzed postoperative outcomes of simultaneous contralateral mastopexy or breast reduction with free flap breast reconstruction. By using the American College of Surgeons National Surgical Quality Improvement Program database (2010-2020), we analyzed 2 patient cohorts undergoing (A) free flap breast reconstruction only and (B) free flap breast reconstruction combined with contralateral mastopexy or breast reduction. The preoperative variables assessed included demographic data, comorbidities, and perioperative data. Using a neighbor matching algorithm, we performed a 1:1 propensity score matching of 602 free flap breast reconstruction patients and 621 with concurrent contralateral operation patients. Bivariate analysis for postoperative surgical and medical complications was performed for outcomes in the propensity-matched cohort. We identified 11,308 cases who underwent microsurgical free flap breast reconstruction from the American College of Surgeons National Surgical Quality Improvement Program database from the beginning of 2010 to the end of 2020. A total of 621 patients underwent a free flap breast reconstruction combined with contralateral mastopexy or breast reduction. After propensity score matching, there were no significant differences in patient characteristics, perioperative variables or postoperative medical complications between the 2 cohorts. Simultaneous free flap breast reconstruction combined with contralateral mastopexy or breast reduction can be performed safely and effectively without an increase in postoperative complication rates. This can improve surgeon competence in offering this combination of procedures as an option to breast cancer survivors, leading to better patient outcomes in terms of symmetrical and aesthetically pleasing results, reduced costs, and elimination of the need for a second operation.

Retrospective analysis of acute appendicitis in COVID-19 pandemic – A clinical study of 100 cases

Acute appendicitis is a very common abdominal emergency condition. The incidence varies from 5.7 to57 patient /lakh population per year in the world wide survey. It is frequent in both sexes, But highest in children &amp; adolescences. Presentation of this condition is some time so confusing that it should be distinguished from other acute abdominal conditions in proper time and appropriate measures should be taken to treat the patients to avoid unwanted complications, this complication is probably more complicated in COVID-19 pandemic period. This study is designed to compare acute appendicitis cases in relation to clinical features, gradation of disease &amp; post operative complications before COVID-19 (June 2019-March 2020) and during COVID-19 pandemic period (April 2020-October 2021). METHOD-Cases of the study were divided into 2-groups.Group-A (65 cases) in pre- pandemic period and Group-B (35 cases) in pandemic period. The study is based on the clinico-radiological features, laboratories investigations and gradation of disease. Gradation: Grade-I (probably appendicitis), Grade-II (definite appendicitis), Grade-III (perforation of appendices), Grade-IV (appendicular abscess), Grade-V (complicated appendicitis/ appendicular lump). Out of 100 enrolled cases 65 belongs to pre pandemic and 35 in pandemic period. It was found that increase in post-operative complications, were more in higher grade groups during pandemic periods. The COVID-19 pandemic has great impact on diagnosis, treatment and increased complications in post operative period of acute appendicitis, probably due to late presentation in emergency department. Pandemic directly or indirectly affect the outcome of a disease process and management.

Postoperative outcomes after total sevoflurane inhalation sedation using a disposable delivery system (Sedaconda-ACD) in cardiac surgery.

The COVID-19 pandemic prompted our team to develop new solutions for performing cardiac surgery without intravenous anesthetics due to a shortage of these drugs. We utilized an anesthetic conserving device (Sedaconda-ACD) to administer total inhaled anesthesia because specific vaporizers were unavailable for administering inhaled agents during cardiopulmonary bypass (CPB) in our center. We documented our experience and postoperative cardiovascular outcomes. The primary outcome was the peak level of troponin, with secondary outcomes encompassing other cardiovascular complications. A single-center retrospective study was conducted. We performed a multivariate analysis with a propensity score. This investigation took place at a large university referral center. Adult patients (age ≥ 18) who underwent elective cardiac surgery with CPB between June 2020 to March 2021. During the inclusion period, two anesthesia protocols for the maintenance of anesthesia coexisted-total inhaled anesthesia with Sedaconda-ACD and our classic protocol with intravenous drugs during and after CPB. Troponin peak level recorded after surgery (highest level recorded within 48 h following the surgery). Out of the 654 included patients, 454 were analyzed after matching (intravenous group = 297 and inhaled group = 157). No significant difference was found between the groups in postoperative troponin peak levels (723 ng/l vs. 993 ng/l-p = 0.2). Total inhaled anesthesia was associated with a decreased requirement for inotropic medications (OR = 0.53, 95% CI 0.29-0.99, p = 0.04). In our cohort, the Sedaconda-ACD device enabled us to achieve anesthesia without intravenous agents, and we did not observe any increase in postoperative complications. Total inhaled anesthesia with sevoflurane was not associated with a lower incidence of myocardial injury assessed by the postoperative troponin peak level. However, in our cohort, the use of inotropic drugs was lower.

The application of enhanced recovery after surgery protocol after distal gastrectomy for patients with gastric cancer: a prospective randomized clinical trial

BackgroundThis study aimed to evaluate the clinical outcomes and efficacy of enhanced recovery after surgery (ERAS) protocol in patients undergoing distal gastrectomy for gastric cancer (GC). MethodsPatients were randomly assigned to the ERAS group (EG) and the conventional care group (CG) by stratified randomization according to age and sex. The primary endpoint was adjusted postoperative hospital stay, calculated using discharge criteria developed to evaluate recovery. Nutritional data and quality of life (QoL) (European Organisation for Research and Treatment of Cancer [EORTC] C30 and STO22) during the perioperative period were also analyzed. ResultsWe enrolled 198 eligible patients with GC for the study between June 2017 and January 2019. A total of 147 patients were finally enrolled in this study (full analysis set) and were assigned to EG (n = 71) and CG (n = 76). First flatus was faster significantly in EG (3.6 ± 1.5 vs 4.1 ± 1.2 days, P = .019). EG showed a faster start of the sips and soft diet than CG (1.3 ± 0.7 vs 3.1 ± 0.4 days, P < .001; 2.4 ± 0.9 vs 5.2 ± 0.7 days, P < .001) according to the protocol. The recorded hospital stay was not significantly different; however, adjusted hospital stay was significantly shorter in EG than in CG (6.5 ± 3.1 vs 7.8 ± 2.1 days, P = .005). There was no difference in morbidity, and no mortality occurred in both groups. EG did not show significant superiority in nutritional outcome and QoL improvement, except for pain scale in EORTC-STO22. ConclusionThe application of the ERAS protocol could reduce the adjusted hospital stay without an increase in postoperative complications. There was no significant difference in long-term nutritional outcome and QoL of the 2 groups.

The Sonopet iQ® Ultrasonic Bone Aspirator in Craniofacial Surgery: A Scoping Review and Qualitative Analysis

Background: The Sonopet iQ® Ultrasonic Aspirator is a surgical tool used for the fragmentation and emulsification of bone and soft tissue. Ultrasonic vibrations emulsify bone with cited benefits of decreased damage to surrounding soft tissue and minimal heat dispersion. Despite these potential benefits, there is a paucity of published articles on the safety and efficacy of the Sonopet® in the setting of craniofacial surgery. Methods: In accordance with PRISMA guidelines, MEDLINE and Pubmed were searched for articles that studied use of the Sonopet® for osteotomies in the craniofacial setting. Studies exclusively investigating soft tissue aspiration were excluded. Results: Out of 61 articles discovered, 22 met inclusion criteria and discussed a total of 816 patients. Of the 22 articles, there were 8 retrospective chart reviews, 7 case series, 5 cadaver models, and 2 case reports. Studies spanned multiple disciplines including otolaryngology, ophthalmology, craniofacial surgery, neurosurgery, and oral and maxillofacial surgery. Despite its frequent use in orthognathic and cranial vault remodeling surgery, only 4 studies described its use in these fields. The most commonly cited benefits of the Sonopet® were enhanced ergonomics and safety, discussed in 20 of the included studies. Eighteen studies claimed the Sonopet® was safer to use in surgically tight spaces compared to traditional drills. Four studies found decreased bone dust generation by the Sonopet® compared to conventional cutting devices. No studies reported an increase in postoperative complications due to the device. The most commonly cited disadvantage was the cost of the device, however, the majority of authors believed the benefits of the device outweighed the increase in cost. Conclusions: There is a dearth of research investigating the use of the Sonopet® in craniofacial surgery. Available studies emphasize the ergonomic and safety benefits of the Sonopet® and encourage expanded use of the device despite its cost.