Increase In Postoperative Complications Research Articles

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

A Novel Patellar Tendon Reconstruction Technique Using Semitendinosus Allograft

A Novel Patellar Tendon Reconstruction Technique Using Semitendinosus Allograft

Reevaluating Thrombocytosis as a Risk Factor in Free Flap Surgery

Introduction Thrombocytosis, defined as a platelet count >400,000, has been implicated as a risk factor in free flap failure. Despite proposed mechanisms of pedicle thrombosis, recent studies have suggested that thrombocytosis has no effect on free tissue transfer viability. Risk factors that may compromise successful free tissue transfer should be understood and elucidated, with particular attention to thrombocytosis and its conflicting evidence in the literature. We hypothesize that thrombocytosis has no bearing on free flap success or the rates of pedicle thrombosis. Methods Our institution performed a retrospective chart review on all patients who underwent free flap reconstruction over the past 6 years. Patient demographics, medical history, type and location of free tissue transfer, preoperative platelets, postoperative platelets, and flap outcomes and complications (wound dehiscence, infection, hematoma, seroma, and need for blood transfusion) were recorded. Independent t test, Mann-Whitney U tests, χ 2 test, and Fisher exact tests were used to determine P values to compare flap outcomes in patients with thrombocytosis (platelet count >400,000) and those with platelet counts less than 400,000. Results In our 502-patient cohort, 71 were found to have a platelet count >400,000 (35 preoperatively and 36 postoperatively) and 431 patients had platelet counts <400,000. There were 42 reconstructive failures (flap success rate of 91.6%) and 111 returns to the operating room (OR). For patients with postoperative thrombocytosis, 24 flaps returned to the OR (44.4%), whereas in patients without thrombocytosis, 87 flaps returned to the OR (19.4%; P < 0.001). In patients with postoperative thrombocytosis, 10 OR returns were due to pedicle venous thrombosis (18.5%), in comparison to 10 returns for venous thrombosis in those with normal platelets (2.2%; P < 0.001). There was a small difference in free flap success rates between those with postoperative thrombocytosis and normal platelets, 88.7% versus 92.11%; however, this was not statistically significant (P = 0.71). The thrombocytosis group had a higher incidence of overall postoperative complications (P = 0.002). Conclusions Thrombocytosis has historically been cited as a risk factor for free flap reconstruction failure with recent conflicting evidence in the literature. In patients with postoperative thrombocytosis, we found an increased risk of venous thrombosis; however, this did not result in increased flap failure. There was an increase in postoperative complications, which corresponds with National Surgical Quality Improvement Program data reported in the literature. We suspect that thrombocytosis is not a harbinger of free flap failure but rather a marker for overall inflammation, which may confer a higher rate of venous thrombosis requiring reoperation and postoperative complications.

Neurosurgical patients' morbidity and mortality during the COVID-19 pandemic: An integrated review

Objective: To assess mortality among neurosurgical patients during the COVID-19 pandemic period. Methods: This study entails an integrative literature review conducted by querying predefined descriptors in databases including Science Direct, PubMed®, and the Biblioteca virtual em saúde. Results: A total of 777 articles were identified. After applying inclusion and exclusion criteria, 14 studies were selected to constitute the foundation of this review. A disparity emerged across studies concerning alterations in mortality rates during the COVID-19 pandemic. While the majority of articles (n = 6) reported an increase in mortality, four studies observed no change in mortality rates when comparing the pandemic period with the pre/post-pandemic period. Regarding the number of neurosurgical procedures, a variable decline was observed across studies, ranging between 11.5% and 43%. The majority of articles documented a rise in postoperative complications during the pandemic. Conclusion: A significant impact of the SARS-CoV-2 pandemic on the surgical context was observed, as there was a notable reduction in the number of surgeries performed, leading to an increase in postoperative complications and potentially the mortality rate.

Dispensability of nasogastric tube after perforated peptic ulcer surgery: a randomized controlled trial

Introduction Every year, approximately 4 million individuals are affected by peptic ulcer disease (PUD). Among patients with PUD, the lifetime occurrence of perforation stands at ∼5%. Associated with this complication is a mortality rate spanning from 1.3 to 30%. Whether the surgery was done open or laparoscopic, the postoperative plan of management remained dogmatic for many years, especially regarding the presence of a nasogastric (NG) tube. Patients and methods This prospective, single-center, randomized controlled study of patients with perforated peptic ulcer (PPU) presented to Kasr Alainy Emergency Hospital was conducted to assess the dispensability of NG tube postoperatively in perforated peptic ulcer patients. Patients were randomly allocated into two groups, group A (NG tube control group): 40 patients and group B [Enhanced Recovery after Surgery (ERAS) group]: 34 patients. Results The study revealed a significant decrease in hospital stay by approximately 2 days for patients in the ERAS group, compared with those receiving standard care. This reduction in hospital stay was observed without any increase in postoperative complications among the ERAS group. However, this may be clinically nonsignificant due to a limited number of patients in our study. Conclusion The routine use of NG decompression and delayed oral feeding appears to be unnecessary. These practices contribute to prolonged hospital stays without yielding any beneficial effects on morbidity and mortality rates.

Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis.

Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair. We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. 1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR -1.02; 95% CI -1.87, -0.17; P = 0.02; I2 = 94%) and operative time (OR -9.21; 95% CI -16.82, -1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%). Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection.

WTP4.8 Management of Acute appendicitis during the COVID-19 pandemic A single centre retrospective cohort study

Abstract Background Management of Acute appendicitis changed significantly in the UK during COVID-19. The aim of study was to compare management of Acute appendicitis before and during COVID-19 pandemic. Materials and Methods We performed a single centre retrospective cohort study in UK comparing the management of acute appendicitis before the pandemic from March - August 2019 and during the Pandemic from March- August 2020. Results Over period of 6 months, a total of 179 patients were diagnosed with Acute appendicitis in 2019 versus 152 in 2020. In 2019, median age was 33 and 52% (n=93) patients were female. In 2020, median age was 37 and 48% (n=73) of the patients were female. At first presentation, in 2019, 97% of the patients (174/179) received surgical treatment compared to 70% (107/152) in 2020. 3% of the patients (n=5) were managed conservatively in 2019 as compared to 30% (n=45) in 202. Pre-Pandemic only 32% of the patients received imaging to confirm the diagnosis as compared to 53% during pandemic. During 2019, 92% (n=161) of the patients who received surgical treatment underwent laparoscopic surgery as compared to only 74% (n=95) in 2020. Post op complications occurred in 5% (n=9/176) of the surgical patients in 2019 as compared to 13% (n=16/128) in 2020. Mean length of hospital stay in 2019 was 3 (1-11) days versus 5 (1-35) in 2020. 30-day readmission rate was 5% (8/179) versus 19% (29/152). Conclusion Our study shows that the change in management of acute appendicitis during Pandemic was associated with longer length of hospital stay, more readmissions and increase in post-operative complications.

Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of gastro-oesophageal junctional adenocarcinomas: A 10-year cohort study

BackgroundGastro-oesophageal junctional (GOJ) cancers have been, more latterly, considered a distinct tumor entity with characteristic genetic profiles. The optimal multimodal therapy of advanced GOJ cancers remains debatable. In this comparative study, we analyzed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced GOJ adenocarcinomas. MethodsThis study included patients with locally advanced but resectable GOJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019 at our institution. Follow up to May 2021 was completed. The outcomes between CT and CRT groups were retrospectively analyzed. The long-term follow up data was obtained via direct contact with the patients during oncological clinics, cross-checked with hospital/national patients’ electronic databases. Results107 patients had GOJ cancers; 90 (84%) patients met our inclusion criteria. Perioperative chemotherapy was administrated in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups. ConclusionPreoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for GOJ adenocarcinomas compared to peri-operative chemotherapy, without an increase in postoperative complications or morbidity rates. However, it wasn't associated with improved overall or disease-free survival rates.

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

To assess the ability of a modified frailty index (mFI-5) score, which includes the presence of congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status, and to identify patients at increased risk of complications after surgical treatment of long-bone nonunions/malunions. Retrospective. Hospitals participating in the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program. Patients in the American College of Surgeons National Surgical Quality Improvement Program database with upper extremity and lower extremity fractures were enrolled. Surgical repair of nonunions/malunions of upper and lower extremity long bones. Postoperative complications after long-bone nonunion/malunion surgery. Respective univariate analysis of the 2964 UE [1786 (60.3%) with mFI-5 of 0 and 386 (13.0%) with mFI-5 ≥2] and 3305 LE [1837 (55.6%) with mFI-5 of 0 and 498 (15.1%) with mFI-5 ≥2] showed that increasing mFI-5 score was associated with medical complications, extended longer length of stay, adverse discharge, and readmission. Binomial logistic regression showed that UE patients with mFI-5 ≥2 had increased risk of wound complications [odds ratio (OR) 2.512, 95% (confidence interval) CI: 1.037-6.086, P = 0.041), adverse discharge (OR 1.735, 95% CI: 1.204-2.499, P = 0.003), and unplanned readmission (OR 2.102, 95% CI: 1.038-4.255, P = 0.039), while LE patients with mFI-5 ≥2 had an increased risk of medical complications (OR 1.847, 95% CI: 1.307-2.610, P = 0.001), cumulative morbidity (OR 1.835, 95% CI: 1.342-2.510, P < 0.001), extended longer length of stay (OR 1.809, 95% CI: 1.233-2.654, P = 0.002), and adverse discharge (OR 1.841, 95% CI: 1.394-2.432, P < 0.001). mFI-5 score ≥2 is associated with significant increase in postoperative complications after surgical repair of long-bone nonunions/malunions. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Initiation of a Comprehensive Early Discharge Program at a Veterans Affairs Hospital.

Early discharge protocols have become a major surgical paradigm, but this protocol is not routinely used in the Veteran Affairs (VA) system. The primary objective was to demonstrate the feasibility of a comprehensive joint program (CJP) protocol, including same-day discharge, at a VA hospital. Secondary objectives are to determine whether an increase in postoperative complications, increased readmissions, and increased ER visits compared with previous management protocols occur. A retrospective review of patients undergoing primary total joint arthroplasty conducted before the initiation of CJP was compared with patients undergoing primary total joint arthroplasty conducted after the initiation of CJP. The two cohorts were subdivided further into total knee arthroplasty (TKA) and total hip arthroplasty (THA). Patients' demographics, medical comorbidities, discharge disposition, length of stay (LOS), surgery information, 30-day and 90-day postoperative complications, surgical site infections, and emergency room visits were collected and assessed with paired t -tests. A total of 200 control cases (101 TKA, 99 THA) were compared with 260 cases (165 TKA, 95 THA) in the CJP group. The mean LOS reduced from 4.38 days in the control group to 0.75 days in the CJP group ( P < 0.001), with 890 total inpatient days in the control group compared with just 200 total inpatient days with the CJP group. A total of 92 patients (34.5%) in the CJP group were discharged the same day compared with 0 in the control group ( P < 0.001). In the control group, 47.8% were discharged to rehabilitation centers compared with only 4.5% in the CJP group ( P < 0.001). The 30-day complication rate was reduced with CJP (5.6% vs. 10.3% control) ( P = 0.028). ER visits did not significantly change (8.9% control vs. 9.3% CJP; P = 0.77). Overall LOS and complication rates were reduced with the CJP, exemplifying the viability of such a protocol in the VA system. In addition, we demonstrated no increased risks accompanied with early discharge to home. This initiative can be used to reduce healthcare dollars in VA healthcare system nationally.

Preoperative hormone stimulation; does it increase hypospadias postoperative complications?

To assess the effect of Preoperative Hormone Stimulation (PHS) on glans size in proximal hypospadias with chordee and small glans, and to determine if PHS is associated with increased postoperative complications. Between 2014 and 2021, 101 cases of proximal hypospadias with small glans (12mm or less) were operated upon in our hospital and are the basis of this cohort. All patients underwent a standard two-stage surgical repair, undergoing a correction of the chordee in the first operation and urethroplasty in the second operation. All patients included were operated by the same surgeon. They were classified into two groups; Group A: 50 children were operated upon between 2014 and 2017 and did not receive PHS and Group B: 51 children operated between 2018 and 2021 and received PHS. Glans dimensions including Dorsal Longitudinal Length (DLL) and Glans Width (GW) were measured during the first operation. PHS was given 1-2 months before the second operation in Group B. The glans dimensions were measured again during the second operation after PHS. Follow up period ranged from 2 to 9 years (mean 5 years). Following PHS a statistically significant increase in glans length (p=0.042) and glans width (p=0.011) was observed at the second operation, with 36 patients (70%) showing a mean glans width increase of 2.78mm (range 2-8mm) after receiving PHS. There was no statistically significant difference in the complication rates between the two groups (p=0.556) with a fragility index of zero (FI=0). The present study separates itself from most other studies in the literature, in the fact that it has included only a specific group of proximal and perineal hypospadias with severe chordee and glans width of 12mm or less and that glans dimensions were always objectively and accurately measured under general anesthesia. The other major difference is that PHS in our study was given after and not before the first operation. Furthermore, the fact that all patients prior to 2018 did not receive PHS and all patients after 2018 received PHS, indicates that there was no selection bias. This study shows that PHS results in an increase the size of the glans in 70% of patients with hypospadias and a small glans without an increase in postoperative complications.

Incidence, Timing, and Possible Risk Factors for Post-Cesarean Wound Infection among Low-Risk Patients in Zaria, Nigeria: A Cross-Sectional Study

Context: Rising cesarean section rates worldwide have led to an increase in post-operative complications, especially wound infection, and endometritis. Low-risk cesarean sections are still at risk of these infections despite the absence of common risk factors. The burden and possible risk factors for these have not been widely documented in patients without major risk factors. Aim: To determine the incidence, timing of diagnosis, and possible risk factors for wound infection in low-risk cesarean sections. Settings and Design: A prospective cross-sectional study conducted among consenting women undergoing low-risk cesarean sections, defined as the absence of established risk factors for post-operative wound infection. Materials and Methods: Participants' sociodemographic and obstetric characteristics were documented in a structured proforma. The primary outcome measure was the incidence and timing of wound infection. Secondary outcome measures were the incidences of endometritis and febrile morbidity. The data were analyzed using SPSS version 21 and Windows WINPEPI. Results: The incidence of wound infection was 11.2% (19); endometritis—20.6% (35); febrile morbidity—4.1% (7). The mean timing of diagnosis of wound infection and endometritis were 10.22 ± 3.64 and 11.57 ± 3.34 days, respectively. Grandmultiparity (P = 0.007), low maternal educational levels (P = 0.014), endometritis (p = &lt;0.0001), and febrile morbidity (P = 0.017) were the demonstrated risk factors for wound infection. Conclusion: The incidence of wound infection in the study population was high and mostly diagnosed after discharge from the hospital. Risk factors for wound infection were grand multiparity, lower educational level, endometritis, and febrile morbidity.

Esophageal cancer operation in the COVID-19 era: are the outcomes different from its past in an observational cohort study?

This retrospective cohort study was performed as a single-centred study from March 2019 to March 2022 at Cancer institute, Tehran, Iran. Demographic data, cancer type, surgical procedures, and postoperative outcomes and complications were compared between the two groups pre-COVID-19 and during the COVID-19 pandemic. Totally, 120 patients enroled in the study, of which 57 underwent surgery before the COVID-19 pandemic, and 63 during the COVID-19 pandemic. The mean age in these groups was 56.9 (±12.49) and 58.11 (±11.43), respectively. Females included 50.9% and 43.5% of individuals who underwent surgery before and during the COVID-19 pandemic. The interval between admission and surgery was significantly shorter in patients underwent surgery during the COVID-19 pandemic (5.17 vs. 7.05; P=0.013). However, there was no significant difference between time interval between surgery and discharge [11.68 (7.81) vs. 12 (6.92); P=0.689]. Aspiration pneumonia was the most common complication in both groups. There was no significant difference between postoperative complications in both groups. Outcomes of oesophageal cancer surgeries in COVID-19 age in our institution were comparable with the year before the pandemic. The decrease in the time interval between surgery and discharge did not lead to an increase in postoperative complications and could be noted for post-COVID-19 era policymaking, too. This study suggests not postponing any of the surgical treatments for oesophageal cancer in the COVID-19 era.

Enhanced Recovery after Surgery and Endometrial Cancers: Results from an Initial Experience Focused on Elderly Patients

Endometrial cancer is the fifth most common cancer among French women and occurs most frequently in the over-70-year-old population. Recent years have seen a significant shift towards minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols in endometrial cancer management. However, the impact of ERAS on endometrial cancer has not been well-established. We conducted a prospective observational study in a comprehensive cancer center, comparing the outcomes between endometrial cancer patients who received care in an ERAS pathway (261) and those who did not (166) between 2006 and 2020. We performed univariate and multivariate analysis. Our primary objective was to evaluate the impact of ERAS on length of hospital stay (LOS), with the secondary objectives being the determination of the rates of early discharge, post-operative morbidity, and rehospitalization. We found that patients in the ERAS group had a significantly shorter length of stay, with an average of 3.18 days compared to 4.87 days for the non-ERAS group (estimated decrease −1.69, p &lt; 0.0001). This effect was particularly pronounced among patients over 70 years old (estimated decrease −2.06, p &lt; 0.0001). The patients in the ERAS group also had a higher chance of early discharge (47.5% vs. 14.5% in the non-ERAS group, p &lt; 0.0001), for which there was not a significant increase in post-operative complications. Our study suggests that ERAS protocols are beneficial for the management of endometrial cancer, particularly for older patients, and could lead to the development of ambulatory pathways.

Management and outcomes of obturator hernias: a systematic review and meta-analysis.

Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.

Impact of Introducing a PACU24 Concept on the Perioperative Outcome of Patients with Advanced Ovarian Cancer Treated with Cytoreductive Surgery.

Patients with ovarian cancer who undergo multivisceral surgery usually require intensive care monitoring postoperatively. In view of the ever-fewer numbers of high-care/intensive care beds and the introduction of fast-track treatment concepts, it is increasingly being suggested that these patients should be cared for postoperatively in 24-h Post Anesthesia Care Units (PACU24). No analyses have been carried out to date to investigate whether such a postoperative care concept might be associated with a potential increase in postoperative complications in this patient cohort. A PACU24 unit was set up in our institution in 2015 and it has become the primary postoperative care pathway for patients with ovarian cancer who have undergone cytoreductive (debulking) surgery. A structured, retrospective analysis of data from patients treated before (control group) and after (PACU group) the introduction of this care concept was carried out, with a particular focus on postoperative complications and secondary admission to an intensive care unit where necessary. The data of 42 patients were analyzed for the PACU group and 45 patients for the control group. According to the analysis, the preoperative and surgical data of both groups were comparable (age, ASA, BMI, FIGO stage, duration of surgery, blood loss). The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM score) as a measure for the risk of postoperative complications was higher in the PACU group (11.1% vs. 9.7%, p=0.001). Patients in the PACU group underwent bowel resection with anastomosis significantly more often (76.3% vs. 33.3%, p<0.001), although the extent of surgery was otherwise comparable. The total number, type and severity of postoperative complications and the duration of the overall stay in hospital did not differ between the two groups. None of the patients required secondary transfer from the PACU or normal ward to an intensive care unit (ICU). Our data support the assumption that the care concept of transferring patients to a PACU24 represents a safe and cost-saving care pathway for the postoperative care of patients even after complex gynecological-oncological procedures.

COMPARISON OF DEXMEDETOMIDINE AND CLONIDINE AS ADDITIVE WHEN GIVEN SEPARATELY, PREMIXED WITH 0.25% ROPIVACAINE IN PEDIATRIC CAUDAL BLOCK, ON INTRA OPERATIVE ANESTHETIC/ ANALGESIC DRUG REQUIREMENT AND DURATION OF POST OPERATIVE ANALGESIA IN HYPOSPADIAS REPAIR SURGERIES

Aim:Comparison of dexmedetomidine and clonidine as additive when given separately, premixed with 0.25% ropivacaine in pediatric caudal block,on intra operative anesthetic/ analgesic drug requirement and duration of post operative analgesia in hypospadias repair surgeries. Methods and Materials:Children,whose parents or guardians,were willing to give consent and fulfilled inclusion criteria were selected for the study.Thepatients were randomly allocated, by double blinding into two groups. Group RD received 0.25% ropivacaine 1 ml/kg +2µg/kg dexmedetomidine (in 0.5 ml volume).Group RC received 1 ml/kg of 0.25% ropivacaine + 1 µg/kg of clonidine (in 0.5 ml volume). Results:Mean age of patients receiving dexmedetomidine and clonidine was 3.20±1.821 and 4.47±1.727 years respectively. No significant difference was obtained in terms of mean age.Blood pressure,Heart rate and Saturation was maintained by both dexmedetomidine and clonidine similarly as revealed by the insignificant p value of &gt;0.05 across the time points during hypospadias repair surgeries.Requirement of adjuvant analgesics intraoperativery and post operative complicationsand was found to be similar in both the groups as revealed by the insignificant P value of 0.309. Time for rescue analgesic postoperatively (min) was significantly (p&lt;0.001) longer among patients receiving dexmedetomidine (706.73±107.428) than clonidine (504.33±97.573). Conclusion:We observed that a single caudal injection of dexmedetomidine (2µg/kg) added to ropivacaine 0.25% offers an advantage over a similar injection of clonidine (1µg/kg) added to ropivacaine 0.25% for postoperative pain relief in children undergoing hypospadias repair surgeries without increase in post operative complications.

Outcomes of breast reconstruction in patients with stage IV breast cancer

Patients with Stage IV breast cancer are living longer but breast reconstruction in this setting remains controversial. There is limited research evaluating the benefits of breast reconstruction in this patient cohort. Drawing from the Mastectomy Reconstruction Outcomes Consortium (MROC) dataset, a prospective cohort study that involved 11 leading medical centers in the US and Canada, we compared patient-reported outcomes (PROs) assessed utilizing the BREAST-Q, a condition-specific, validated patient-reported outcome measure (PROM) for mastectomy reconstruction, as well as complications between a cohort of patients with Stage IV disease undergoing reconstruction and a control group of women with Stage I-III disease also receiving reconstruction. Among the MROC population, 26 patients with Stage IV and 2613 women with Stage I-III breast cancer underwent breast reconstruction. Preoperatively, the Stage IV cohort reported significantly lower baseline scores for satisfaction with breast (p=0.004), psychosocial well-being (p=0.043) and sexual well-being (p=0.001), compared with Stage I-III women. Following breast reconstruction, Stage IV patients' mean PRO scores improved over baseline and were not significantly different from those of Stage I-III reconstruction patients. There were also no significant differences in overall/any (p=0.782), major (p=0.751) or minor complication (p=0.787) rates between the two groups at two years following reconstruction. The findings in this study suggest that breast reconstruction offers significant quality-of-life benefits for women with advanced breast cancer with no increase in postoperative complications and thus may be a reasonable option in this clinical setting.

Management of Acute Appendicitis During the COVID-19 Pandemic: A Single-Centre Retrospective Cohort Study.

During the coronavirus disease 2019 (COVID-19) pandemic, the management of acute appendicitis shifted towards non-operative management in the United Kingdom (UK). The open approach was recommended over the laparoscopic approach due to the risk of aerosol generation and subsequent contamination. The aim of this study was to compare the overall management and surgical outcomes of the patients treated for acute appendicitis before and during the COVID-19 pandemic. We performed a retrospective cohort study at a single district general hospital in the UK. We compared the management and outcome of the patients diagnosed with acute appendicitis before the pandemic, from March to August 2019, and during the pandemic, from March to August 2020. We looked at the patient demographics, methods of diagnosis, management, and surgical outcomes for these patients. The primary outcome of the study was the 30-day readmission rate. Secondary outcomes included length of stay and post-operative complications. Over the period of six months, a total of 179 patients were diagnosed with acute appendicitis in 2019 (Pre-COVID-19 pandemic, from March 1, 2019, to August 31, 2019) versus 152 in 2020 (during the COVID-19 pandemic, from March 1, 2020, to August 31, 2020). For the 2019 cohort, the mean age of the patients was 33 (range 6-86 years), 52% (n=93) were female, and the mean BMI was 26 (range 14-58). For the 2020 cohort, the mean age was 37 (range 4-93 years), 48% (n=73) of the patients were female, and the mean BMI was 27 (range 16-53). At the first presentation, in 2019, 97.2% of the patients (174 out of 179) received surgical treatment compared to 70.4% (107 out of 152) in 2020. Three per cent of the patients (n=5) were managed conservatively in 2019 (two out these failed conservative management) as compared to 29.6% (n=45) in 2020 (21 of these failed conservative management). Pre-pandemic, only 32.4% (n= 57, ultrasound (US) scan: 11, computer tomography (CT) scan): 45, both US and CT: 1) of the patients received imaging to confirm the diagnosis as compared to 53.3% during pandemic (n=81, US scan: 12, CT scan: 63, both US and CT: 6). Overall, the CT to US ratioincreased. We found that during 2019, 91.5% (n=161/176) of the patients who received surgical treatment went through laparoscopic surgery as compared to only 74.2% (n=95/128) in 2020 (p<0.0001). Postoperative complications occurred in 5.1% (n=9/176) of the surgical patients in 2019 as compared to 12.5% (n=16/128) in 2020 (p<0.033). The mean length of hospital stay in 2019 was 2.9 days (range 1-11) versus 4.5 days in 2020 (range 1-57) (p<0.0001). The 30-day readmission rate was 4.5% (8/179) versus 19.1% (29/152) (p<0.0001). The 90-day mortality rate was zero for both cohorts. Our study shows that the management of acute appendicitis changed due to the COVID-19 pandemic. More patients went through imaging, especially CT scans for diagnosis and received non-operative management with antibiotics only. The open surgical approach became more common during the pandemic. This was associated with longer lengths of hospital stay, more readmissions, and an increase in postoperative complications.

A meta-analysis of postoperative outcomes of patients with and without chronic hepatitis C undergoing primary total hip or knee arthroplasty.

This investigation provides a rigorous systematic review of the postoperative outcomes of patients with and without chronic hepatitis C who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA). We queried PubMed, Embase, Cochrane Database of Systematic Reviews, Scopus, Web of Science and the 'gray' literature, including supplemental materials, conference abstracts and proceedings as well as commentary published in various peer-reviewed journals from 1992 to present to evaluate studies that compared the postoperative outcomes of patients with and without chronic hepatitis C who underwent primary THA or TKA. This investigation was registered in the PROSPERO international prospective register of systematic reviews and follows the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In our literature search, we identified 14 articles that met our inclusion criteria and were included in our fixed-effects meta-analysis. The postoperative outcomes analyzed included periprosthetic joint infection (PJI), aseptic revision, non-homebound discharge and inpatient mortality. Our statistical analysis demonstrated a statistically significant increase in postoperative complications of patients with chronic hepatitis C who underwent primary THA or TKA including PJI (odds ratio (OR): 1.98, 95% CI: 1.86 - 2.10), aseptic revision (OR: 1.58, 95% CI: 1.50 - 1.67), non-homebound discharge (OR: 1.31, 95% CI: 1.28- 1.34) and inpatient mortality (OR: 9.37, 95% CI: 8.17 - 10.75). This meta-analysis demonstrated a statistically significant increase in adverse postoperative complications in patients with chronic hepatitis C who underwent primary THA or TKA compared to patients without chronic hepatitis C.