Intraoperative Factors Research Articles

Personalizing patient risk of a life-altering event: An application of machine learning to hemiarch surgery

ObjectiveThe study objective was to assess a machine learning model’s ability to predict the occurrence of life-altering events in hemiarch surgery and determine contributing patient characteristics and intraoperative factors. MethodsIn total, 602 patients who underwent hemiarch replacement at a high-volume aortic center from 2009 to 2022 were included. Patients were randomly divided into training (80%) and testing (20%) sets with various eXtreme gradient boosting candidate models constructed to predict the risk of experiencing life-altering events, including stroke, mortality, or new renal replacement therapy requirement. A total of 64 input parameters from the index hospitalization were identified, including 24 demographic characteristics as well as 8 preoperative and 32 intraoperative variables. A SHapley Additive exPlanation beeswarm plot was generated to identify and interpret the impact of individual features on the predictions of the final model. ResultsA life-altering event was noted in 15% (90/602) of patients who underwent hemiarch replacement, including urgent/emergency cases and dissections. The final eXtreme Gradient Boosting model demonstrated a cross-validation accuracy of 88% on the testing set and was well calibrated as evidenced by a low Brier score of 0.12. The best performing model achieved an area under the receiver operating characteristic curve of 0.76 and an area under the precision recall curve of 0.55. The SHapley Additive exPlanation beeswarm plot provided insights into key features that significantly influenced model prediction. ConclusionsMachine learning demonstrated superior accuracy in predicting hemiarch patients who would experience a life-altering event. This model may help to guide patients and clinicians in stratifying risk on an individual basis, which may in turn influence clinical decision-making.

(719) - Acute Kidney Injury After Lung Transplantation: Incidence, Pre- and Intraoperative Risk Factors - A Swedish Nationwide Retrospective Study

(719) - Acute Kidney Injury After Lung Transplantation: Incidence, Pre- and Intraoperative Risk Factors - A Swedish Nationwide Retrospective Study

(911) - Intraoperative Factors Associated with Acute Kidney Injury Following Lung Transplant

(911) - Intraoperative Factors Associated with Acute Kidney Injury Following Lung Transplant

Preoperative difficulty factors in delayed laparoscopic cholecystectomy: Tokyo Guidelines 2018 surgical difficulty score analysis.

Tokyo Guidelines 2018 (TG18) recommend early laparoscopic cholecystectomy (LC) for low-risk acute cholecystitis (AC); however, some patients undergo delayed LC (DLC) after conservative treatment. DLC, influenced by chronic inflammation, is a difficult procedure. Previous studies on LC difficulty lacked objective measures. Recently, TG18 introduced a novel 25 findings difficulty score, which objectively assesses intraoperative factors. The purpose of this study was to use the difficulty score proposed in TG18 to identify and investigate the predictors of preoperative high-difficulty cases of DLC for AC. We retrospectively reviewed 100 patients with DLC after conservative AC treatment. The surgical difficulty of DLC was evaluated using a difficulty score. Based on previous studies, the highest scores in each category were categorized as grades A-C. The severity of AC was mild in 51 patients and moderate in 49. Surgical outcomes revealed a distribution of difficulty scores, with grade C indicating high difficulty, showing significant differences in operative time, blood loss, achieving a critical view of safety, bailout procedures, and postoperative hospital stay compared with grades A and B. Regarding the preoperative risk factors, multivariate analysis identified age >61 years (p = .008), body mass index >27.0 kg/m2 (p = .007), and gallbladder wall thickness >6.2 mm (p = .001) as independent risk factors for grade C in DLC. The difficulty score proposed in TG18 provides an objective framework for evaluating surgical difficulty, allowing for more accurate risk assessments and improved preoperative planning in DLC for AC.

Risk Factors of Post Dural Puncture Headache in Cesarean Section Patients: A Multivariate Analysis Study

Background: The use of spinal anesthesia in patients undergoing cesarean section (CS) is at risk of experiencing post-dural puncture headache (PDPH). This is influenced by several factors.Objective: This study aimed to assess the effect of risk factors on the occurrence of PDPH in patients undergoing CS under spinal anesthesia.Methods: The study design is a nested case-control study with independent variables influencing the incidence of PDPH in CS with spinal anesthesia. Samples were taken from CS patients with spinal anesthesia at the Central Surgical Installation of Dr. Kariadi General Hospital, who met the inclusion and exclusion criteria.Result: A total of 74 patients were included in the multivariate analysis, which showed that neurological disorders with p-value = 0.069; OR= 9,306; 95% CI = 0.842-102.828 and the number of punctures with p = 0.060; OR= 4.798; 95% CI = 0.997-23.075 is the most significant risk factor for the incidence of PDPH in CS patients. There was an additive effect which indicated that mobilization of more than 6 hours mutually reinforces the occurrence of PDPH in CS patients.Conclusion: Preoperative risk factors such as a history of neurological disorders increase the incidence of PDPH in CS patients. Intraoperative risk factors in this study were total puncture and needle size, increasing the incidence of PDPH in CS patients. Post-operative risk factors, in this case, immobilization, increase the incidence of PDPH in CS patients. Preoperative, intraoperative, and post-operative risk factors, together or separately, increase the incidence of PDPH in patients undergoing CS.

Factors associated with in-hospital mortality and morbidity of patients with dissection of aorta type A, undergoing repair surgery

Aim: Acute aortic dissection type A (AADA) is a life-threatening emergency with high mortality rates. Surgical intervention is the preferred and potentially life-saving treatment, but perioperative mortality remains a significant concern. Identifying the risk factors associated with surgical mortality, morbidity, and survival rates is essential. Therefore, this study aimed to characterize the preoperative and intraoperative risk factors for death during surgical repair of AADA. Material and Methods: We included 64 consecutive patients who underwent surgical repair between April 2013 and March 2021 in a tertiary heart center. Perioperative characteristics and variables were collected and analyzed to find any correlation between them and in-hospital Outcomes. Results: Aortic dissection surgery was performed on an average of 8 patients annually, accounting for approximately 1.7% (64/3757) of all open-heart surgery cases. The in-hospital mortality rate was 28% (18/64). The main predisposing factors for in-hospital death were cardiac failure (11.1%), stroke (16.7%), uncontrollable hemorrhage (27.8%), renal failure (11.1%), respiratory failure (11.1%), and postoperative multi-organ failure (22.2%). We found no associations between cardiopulmonary bypass duration and mortality. During the routine use of cerebral protective perfusion, we did not encounter any cases of coma. Left ventricular hypertrophy, a short distance of intimal tear to the aortic valve, and renal failure were associated with postoperative bleeding tendency. Conclusion: Our study showed that multiple factors such as heart failure, uncontrolled bleeding, and respiratory failure increase in-hospital mortality of patients with dissection of aorta type A, but duration of surgery does not have any association with in-hospital death.

Cerebral Aneurysm Characteristics and Surgical Outcomes: An In-Depth Analysis of 346 Cases Operated Using Microsurgical Clipping.

This comprehensive study analyzes 346 surgically treated intracranial aneurysms, emphasizing the importance of understanding risk factors and prevalent characteristics in patients. Intracranial aneurysms, primarily of the saccular or berry type, significantly contribute to nontraumatic subarachnoid hemorrhages and demonstrate a rising incidence due to advances in imaging techniques. The study highlights a gender discrepancy in aneurysm occurrence and a higher prevalence in individuals over 30 years old. The research delves into various aspects, including aneurysm localization, diameter, neck dimensions, and rupture status, with a focus on the anterior communicating artery and middle communicating artery as predominant locations. Significant findings include the prevalence of ruptured aneurysms and the impact of arterial hypertension, atherosclerosis, obesity, and diabetes on aneurysm epidemiology. The study also investigates the occurrence of vasospasm, a significant factor in delayed morbidity and mortality in aneurysmal subarachnoid hemorrhage. The utilization of the Glasgow Outcome Scale and other quantification scales aids in understanding the severity and postoperative outcomes of intracranial aneurysms. Challenges such as the incidence of reopenings and postoperative osteomyelitis are addressed, underlining the need for refined protocols and multidisciplinary approaches in treatment. The study's results contribute to the existing knowledge base on intracranial aneurysms, emphasizing the importance of ongoing research and tailored treatment strategies. The comprehensive nature of this analysis, covering preoperative, intraoperative, and postoperative factors, provides valuable insights into the complex interplay of risk factors and clinical outcomes in patients with intracranial aneurysms.

Hemodynamic Determinants of Cardiac Surgery-Associated Acute Kidney Injury.

Examine the: 1) relative role of hemodynamic determinants of acute kidney injury (AKI) obtained in the immediate postcardiac surgery setting compared with established risk factors, 2) their predictive value, and 3) extent mediation via central venous pressure (CVP) and mean arterial pressure (MAP). Retrospective observational study. The main outcome of the study was moderate to severe AKI, per kidney disease: improving global outcomes, within 14 days of surgery. U.S. academic medical center. Adult patients undergoing cardiac surgery between January 2000 and December 2019 (n = 40,426) in a single U.S.-based medical center. Pulmonary artery catheter measurements were performed at a median of 102 minutes (11, 132) following cardiopulmonary bypass discontinuation. None. The median age of the cohort was 67 years (58, 75), and 33% were female; 70% had chronic hypertension, 29% had congestive heart failure, and 3% had chronic kidney disease. In a multivariable model, which included comorbidities and traditional intraoperative risk factors, CVP (p < 0.0001), heart rate (p < 0.0001), cardiac index (p < 0.0001), and MAP (p < 0.0001), were strong predictors of AKI, and superseded factors such as surgery type and cardiopulmonary bypass duration. The cardiac index had a significant interaction with heart rate (p = 0.026); a faster heart rate had a differentiating effect on the relationship of cardiac index with AKI, where a higher heart rate heightened the risk of AKI primarily in patients with low cardiac output. There was also significant interaction observed between CVP and MAP (p = 0.009); where the combination of elevated CVP and low MAP had a synergistic effect on AKI incidence. Hemodynamic factors measured within a few hours of surgery showed a strong association with AKI. Furthermore, determinants of kidney perfusion, namely CVP and arterial pressure are interdependent; as are constituents of stroke volume, that is, cardiac output and heart rate.

Development of Machine Learning Algorithm to Predict the Risk of Incontinence After Robot-Assisted Radical Prostatectomy.

Introduction: Predicting postoperative incontinence beforehand is crucial for intensified and personalized rehabilitation after robot-assisted radical prostatectomy. Although nomograms exist, their retrospective limitations highlight artificial intelligence (AI)'s potential. This study seeks to develop a machine learning algorithm using robot-assisted radical prostatectomy (RARP) data to predict postoperative incontinence, advancing personalized care. Materials and Methods: In this propsective observational study, patients with localized prostate cancer undergoing RARP between April 2022 and January 2023 were assessed. Preoperative variables included age, body mass index, prostate-specific antigen (PSA) levels, digital rectal examination (DRE) results, Gleason score, International Society of Urological Pathology grade, and continence and potency questionnaires responses. Intraoperative factors, postoperative outcomes, and pathological variables were recorded. Urinary continence was evaluated using the Expanded Prostate cancer Index Composite questionnaire, and machine learning models (XGBoost, Random Forest, Logistic Regression) were explored to predict incontinence risk. The chosen model's SHAP values elucidated variables impacting predictions. Results: A dataset of 227 patients undergoing RARP was considered for the study. Post-RARP complications were predominantly low grade, and urinary continence rates were 74.2%, 80.7%, and 91.4% at 7, 13, and 90 days after catheter removal, respectively. Employing machine learning, XGBoost proved the most effective in predicting postoperative incontinence risk. Significant variables identified by the algorithm included nerve-sparing approach, age, DRE, and total PSA. The model's threshold of 0.67 categorized patients into high or low risk, offering personalized predictions about the risk of incontinence after surgery. Conclusions: Predicting postoperative incontinence is crucial for tailoring rehabilitation after RARP. Machine learning algorithm, particularly XGBoost, can effectively identify those variables more heavily, impacting the outcome of postoperative continence, allowing to build an AI-driven model addressing the current challenges in post-RARP rehabilitation.

Uropathogenic Infection Associated with Prostate Hypertrophy and Transurethral Resection of Prostate

Benign prostatic hyperplasia (BPH) is a prevalent condition among elderly and middle-aged men characterized by symptoms such as dysuria, urinary incontinence, and frequent micturition. The gold standard procedure for relieving BPH symptoms is transurethral resection of the prostate (TURP). However, some patients undergoing TURP are at risk of developing urinary tract infections (UTIs) due to uropathogenic bacteria. This prospective study aimed to investigate post TURP bacteruria alongside with multifactoria risk factors that implicated postoperatively compared to preoperative and intraoperative periods. Ninety patients undergoing TURP and 30 control subjects were included in the study. Urine specimen for urine analysis from pateints were conducted on three occasions: (60 mid-stream urine and 30 catheterized urine samples) were taken preoperatively, (90 samples via cystoscopy) were taken intraoperastively, and (90 mid-stream urine samples after catheter removal) were taken at the third day post-TURP procedure. The study findings were analyzed in correlation with various pre-, intra-, and postoperative potential risk factors to underscores the vulnerability of BPH patients to UTIs, particularly during the postoperative recovery phase. The Escherichia coli was the most commonly isolated uropathogen preoperatively, while Pseudomonas aeruginosa emerged as the primary pathogen intra- and post-operatively. Several risk factors were identified as significantly associated with post-TURP bacteriuria. These include preoperatively, positive pre-operative culture analysis, diabetic patients, and preoperative catheterization. Additionally, intraoperative factors such as prolonged operation duration were also implicated. Postoperatively, persistent bacteriuria was significantly linked with the duration of catheterization. In conclusion, the findings highlight the complex interplay of factors contributing to post-TURP UTIs and stresses the significance of thorough risk evaluation and customized preventative measures to reduce infection risks among BPH patients undergoing TURP.

Incidence of Post-Thyroidectomy Hypoparathyroidism and Associated Preoperative and Intraoperative Risk Factors.

Thyroidectomy technique and extent are related to parathyroid injury and hypoparathyroidism. Total thyroidectomy is one of the most commonly performed endocrine surgeries, and the majority of patients recover completely without any complications. However, persistent hypoparathyroidism is the most prevalent long-term consequence following total thyroidectomy. While it is seldom deadly, it can cause severe morbidity for the patient and raise healthcare expenses. This retrospective cohort study was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia. We included all confirmed thyroid cancer cases that underwent thyroidectomy with or without neck dissectionbetween July 2016 and August 2022. The data was collected from a chart review of the electronic medical record system (BEST-care), and a data collection sheet was utilized. SPSS version 26 was used to analyze the data. A total of 192 patients undergoing thyroid surgery were enrolled. One hundred forty-three (74.5%) were females and the mean age of participants was 45.29 ± 16.88 years. Most patients, 170 (88.5%), had a papillary histological type, and total thyroidectomy was performed in 150 (78.1%). A significant association was found between the type of surgery and postoperative hypoparathyroidism (p=<0.05*). In addition, hypocalcemia was seen in 147 (76.6%) of the patients. Postoperative hypoparathyroidism was significantly higher among patients who had asymptomatic postoperative hypocalcemia and those who received IV calcium gluconate (p=<0.05*). Moreover, postoperative hypocalcemia, hypomagnesemia, and hyperphosphatemia were significantly associated with postoperative hypoparathyroidism (p=<0.05*). The incidence of postoperative hypoparathyroidism is significantly higher among patients who underwent total thyroidectomy and had a normal level of preoperative parathyroid hormone (PTH) and magnesium (Mg) levels. Identifying these factors is a crucial step to minimize the occurrence of such complications.

COMPARATIVE STUDY OF VARIOUS TECHNIQUES TONSILLECTOMY

Objective: The purpose of the study was to compare intraoperative factors and postoperative outcomes between the image-guided acute dissection technique and the endoscopic image-guided acute dissection technique. Material and methods: The study was conducted in 153 patients (81 men and 72 women, average age 26.4 years) who underwent tonsillectomy (2018-2023). Patients were randomly assigned 2 group 52% percent of patients(group1) underwent tonsillectomy with acute dissection technique under visual control, and 48% of patients (group 2) underwent tonsillectomy with acute dissection technique under endoscopic visualization using a 4.0 mm 0° endoscope (Karl Storz, Tuttlingen, Germany). Indications for tonsillectomy were hypertrophy of the tonsils in 82 patients, recurrent tonsillitis in 23 patients and focal infection of the tonsils in 48 patients. Tonsillectomy was performed under general anesthesia using an oral speculum specifically designed for tonsillectomy. All patients were assessed and compared for postoperative pain, bleeding, recurrence, or tonsil tissue growth in the immediate and late postoperative period. The removed adenoid is sent for histology. Clinical diagnosis: Chronic decompensated tonsillitis. Pathohistological diagnosis: Within the limits of the examined material, the histological picture corresponds to chronic tonsillitis, hypertrophy of nasopharyngeal adenoid tissue. Results: There were no serious intra- or postoperative complications. Bleeding points were identified in 47 patients (31 patients group1 and 16 patients group 2). The source of bleeding was observed in the central deep part of the adenoids - in 18 patients, in the lateral parts of the adenoids - in 16 patients, adenoids on both sides in 13. Remnants of adenoid tissue were found in 23 patients, (17 patients group 1 and 6 patients group 2). Remnants of adenoid tissue were removed using bipolar diathermy under image guidance. The operation time for endoscopic tonsillectomy is shorter than for traditional procedures. Conclusions: The visibility provided Tonsillectomy by endoscopic techniques improves the ease and precision of surgery. Clinical significance determines the need for further testing of already proposed means and methods.

Primary abandonment of the sac in the management of scrotal hernias: a dual-institution experience of short-term outcomes.

Management of scrotal hernias presents as a common challenge, with operative interventions to address these hernias associated with higher rates of morbidity compared to those of less-complex pathology. Surgeons have advocated for the use of techniques such as primary abandonment of the distal sac as a potential means to reduce complications for operative intervention, with preliminary findings demonstrating feasibility. We sought to assess outcomes related to primary sac abandonment among patients undergoing minimally invasive (MIS) repair of scrotal hernias. A review of prospectively maintained databases among two academic hernia centers was conducted to identify patients who underwent MIS inguinal hernia repairs with primary sac abandonment. Patient demographics, hernia risk factors, intraoperative factors, and postoperative outcomes were evaluated. Short-term outcomes related to patient-reported experiences and surgical-site occurrences requiring procedural intervention were queried. Sixty-seven male patients [median age: 51.6years; interquartile range (IQR): 45-65years] underwent inguinal hernia repair with primary sac abandonment. Anatomic polypropylene mesh was used in 98.5% cases. Rates of postoperative complications were low and included postoperative urinary retention (6%), clinically identified or patient-reported seromas/hematomas within a 30-day follow-up period (23.9%), deep venous thrombosis (1.5%), and pelvic hematoma (1.5%). No seromas or hematomas necessitated procedural interventions, with resolution of symptoms within three months of their operation date. We report a multi-center experience of patients managed with primary abandonment of the sac technique during repair of inguinoscrotal hernias. Utilization of this technique appears to be safe and reproducible with a low burden of short-term complications.

Early Marginal Ulcer After Roux-en-Y Gastric Bypass: MBSAQIP Database Analysis of Trends and Predictive Factors.

Marginal ulcer (MU) is a known complication after Roux-en-Y gastric bypass (RYGB) that carries significant morbidity. First, we aimed to determine the trends and the rates of readmission, reintervention, and reoperation of 30-day MU. Second, we aim to determine the predictive factors associated with this complication. Patients who had 30-day marginal ulcer (MU) after LRYGB were identified using the 2015-2021 MBSAQIP database. Those who had a 30-day complication other than MU were excluded. Bivariate and logistic regression analyses were performed. Among 213,104 patients undergoing laparoscopic RYGB, 638 (0.3%) showed 30-day MU. This group of patients required endoscopic interventions, readmissions, and reoperations at rates of 88%, 72%, and 9%, respectively. Predictive factors for 30-day MU after RYGB were renal insufficiency, history of DVT, previous cardiac stent, African American race, chronic steroid use, COPD, therapeutic anticoagulation, anastomotic leak test, GERD, and operative time > 120min. Additionally, patients who had 30-day MU showed significantly higher rates of overall complications such as pulmonary, cardiac and renal complications, unplanned ICU admission, blood transfusions, venous thromboembolism (VTE), and non-home discharge (p < 0.05). The MU group showed similar rates of 30-day mortality as those without this complication (0.2% vs 0.1%, p = 0.587). The incidence of 30-day MU following RYGB was 0.3%. Patients with MU required endoscopic interventions, readmissions, and reoperations at rates of 88%, 72%, and 9%, respectively. Some preoperative and intraoperative factors contributed to an increased risk of 30-day MU.

Identification of the ilioinguinal and iliohypogastric nerves during open inguinal hernia repair: a nationwide register-based study

BackgroundChronic pain remains prevalent after open inguinal hernia repair and nerve-handling strategies are debated. Some guidelines suggest sparing nerves that are encountered; however, the nerve identification rates are unclear. This study aimed to investigate the nerve identification rates in a register-based nationwide cohort.MethodsThis study was reported according to the RECORD guideline and used prospective, routinely collected data from the Danish Hernia Database, which was linked with the National Patient Registry. We included patients ≥ 18 years old, undergoing Lichtenstein hernia repair with information on nerve handling of the iliohypogastric and ilioinguinal nerves.ResultsWe included 30,911 open hernia repairs performed between 2012 and 2022. The ilioinguinal nerve was identified in 73% of the repairs and the iliohypogastric nerve in 66% of repairs. Both nerves were spared in more than 94% of cases where they were identified. Female patient sex, emergency and recurrence surgery, general anesthesia, medial and saddle hernias, and large defect size all result in lower nerve identification rates for both nerves.ConclusionThe Ilioinguinal nerve was recognized in 73% of cases, while the iliohypogastric nerve was recognized in 66% with almost all identified nerves being spared during surgery. Several pre- and intraoperative factors influenced identification rates of the ilioinguinal and iliohypogastric nerve.

Pre- and intra-operative risk factors predict postoperative respiratory failure after minimally invasive oesophagectomy.

Severe pulmonary complications such as postoperative respiratory failure can occur after minimally invasive oesophagectomy. However, the risk factors have not been well identified. The goal of this study was to develop a predictive model for the occurrence of postoperative respiratory failure with a large sample. We collected data from patients with oesophageal cancer who had a minimally invasive oesophagectomy at Shanghai Chest Hospital from 2019 to 2022. Univariable and backward stepwise logistic regression analysis of 19 pre- and intra-operative factors was used before model fitting, and its performance was evaluated with the receiver operating characteristic curve. Internal validation was assessed with a calibration plot, decision curve analysis and area under the curve with 95% confidence intervals, obtained from 1000 resamples set by the bootstrap method. This study enrolled 2,386 patients, 57 (2.4%) of whom developed postoperative respiratory failure. Backward stepwise logistic regression analysis revealed that age, body mass index, cardiovascular disease, diabetes, diffusion capacity of the lungs for carbon monoxide, tumour location and duration of chest surgery ≥101.5 min were predictive factors. A predictive model was constructed and showed acceptable performance (area under the curve: 0.755). The internal validation with the bootstrap method proves the good agreement for prediction and reality. Obesity, severe diffusion dysfunction and upper segment oesophageal cancer were strong predictive factors. The established predictive model has acceptable predictive validity for postoperative respiratory failure after minimally invasive oesophagectomy, which may improve the identification of high-risk patients and enable health-care professionals to perform risk assessment for postoperative respiratory failure at the initial consultation.

The analysis of preoperative or intraoperative factors in predicting the escalation of surgical pathological staging of patients with clinical stage I endometrioid carcinoma: A retrospective clinical study.

To retrospectively analyze the preoperative and intraoperative influencing factors in predicting the escalation of surgical pathological staging in patients with clinical stage I endometrioid carcinoma. Patients with clinical stage I endometrioid carcinoma at Women's Hospital, School of Medicine, Zhejiang University, between January 2002 and December 2015 were enrolled in this study. Due to preoperative or intraoperative surgical exploration, the patients with one or more preoperative or intraoperative high-risk factors underwent total hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy, totaling 535 cases. The preoperative and intraoperative influencing factors that could lead to the escalation of postoperative surgical pathological staging were further analyzed. 1. There were 535 patients diagnosed with clinical stage I endometrioid carcinoma before surgery, 125 patients were upgraded with postoperative pathological staging, for a rate of 23.36%. 2. Kaplan-Meier survival curve analysis showed that the prognosis in postoperative surgical pathological staging upgraded cases was worse than that in nonupgraded cases. The tumor-free survival and overall survival rates in the 2 groups were significantly different (P < .001). 3. Univariate analysis showed that preoperative degree of myometrial infiltration, intraoperative visual myometrial infiltration depth, massive size of tumor (diameter ≥ 4 cm) and preoperative abnormal serum cancer antigen 125 (CA125) level were associated with the escalation of surgical pathological staging (P < .05). Multivariate analysis indicated that massive size of tumor and preoperative serum abnormal CA125 level were independent predictors of whether postoperative pathological staging would be upgraded (P < .05). 4. The receiver operating characteristic curve drawn with the massive size of tumor and/or the preoperative serum CA125 level abnormality could be used to predict the probability of postoperative pathological upstaging. The results showed that the area from the combination of the 2 factors under the receiver operating characteristic curve was 0.723 (95% confidence interval, 0.672-0.773), suggesting that the combination of massive size of tumor and abnormal preoperative serum CA125 level may serve as an influencing factor for predicting the postoperative pathological staging upgrades. The clinical stage I endometrioid carcinoma patients with massive size of tumor and abnormal preoperative serum CA125 level need to be fully evaluated to ensure appropriate management as soon as possible, since they are more likely to experience postoperative pathological staging upgrades.

Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis

BackgroundEarly chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal.MethodsThis retrospective study enrolled patients who underwent thoracoscopic anatomical pulmonary resections in our unit. We defined ALE as any airflow ≥ 10 mL/min recorded in the follow-up charts based on the digital thoracic drainage device. Multivariate regression analysis was used to control for preoperative and intraoperative confounding factors. The ALE prediction algorithm was constructed by combining an additive ALE risk-scoring system using the coefficients of the significant predictive factors with the intraoperative water-sealing test.ResultsIn 485 consecutive thoracoscopic major pulmonary resections, ALE developed in 209 (43%) patients. Statistically significant ALE-associated preoperative factors included male sex, lower body mass index, radiologically evident emphysema, lobectomy, and upper lobe surgery. Significant ALE-associated intraoperative factors were incomplete fissure and pleural adhesion. The ALE risk scoring demonstrated an average area under the receiver operating characteristic curve of 0.72 in the fivefold cross-validation test. The ALE prediction algorithm correctly predicted ALE-absent patients at a negative predictive value of 80%.ConclusionsThe algorithm may promote the optimization of the chest tube-dwelling duration by identifying potential ALE-absent patients for accelerated tube removal.

Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up

Background: Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied. Purpose: To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture). Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion. Results: In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P < .001 for all). Conclusion: Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.

Microsurgical treatment of ruptured intracranial aneurysms: An Ethiopian experience

IntroductionIn this ambispective cohort study, the authors share their experience with surgical outcomes of intracranial aneurysms in a resource-limited setting. MethodsThe study spans a 10-year period (January 2010 to December 2022) at Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia. Patient data, aneurysm characteristics, preoperative, intraoperative, and postoperative factors, along with patient outcomes, were collected using a structured questionnaire. Data analysis employed SPSS version 25, utilizing descriptive statistics and Multivariable logistic regression to identify independent predictors of outcomes. The primary outcome measure was the Glasgow Outcome Scale (GOS) at discharge. ResultsThe study included 71 patients with ruptured intracranial aneurysms, with 63 aneurysms clipped in 62 patients. No sex predilection was observed. Aneurysms were predominantly in the anterior cerebral circulation (98.6%), with 60.6% in the anterior communicating artery. Aneurysm size was less than 10 mm in 75.76% of cases. Favorable outcomes were achieved in 83.9% of patients, while 16.10% had unfavorable outcomes. Unfavorable outcomes correlated with a worsening neurological grade assessed by the Glasgow Coma Scale (GCS). The occurrence of delayed vasospasm and hemiparesis showed strong predictive value. ConclusionThe study demonstrated acceptable mortality and favorable outcomes. Patient outcomes in ruptured cerebral aneurysms were primarily influenced by non-modifiable factors, such as GCS on admission and neurological deficit. GCS exhibited a superior predictive value for outcomes compared to commonly used WFNS and Hunt–Hess scales in patients with intracranial aneurysms.