Long-term Postoperative Outcomes Research Articles

Short and long term outcomes after small-incision lenticule extraction: A tertiary referral centre experience

The objective of this study is to evaluate the preoperative and short- and long-term postoperative results in terms of visual acuity, refractive error, and corneal wavefront aberrations in patients with myopia and myopic astigmatism undergoing small incision lenticule extraction (SMILE). Seventy-nine eyes of 52 myopes with or without astigmatism (41 right and 38 left) were enrolled in this retrospective study. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and wavefront aberrations. All the measurements before and after SMILE surgery were systematically recorded. Mean preoperative UDVA was 1.19±0.24 logMAR and improved to 0.06±0.17 logMAR at the 3-year postoperative follow-up. At the conclusion of the 3-year follow-up, UDVA was better than or equal to 20/20 and 20/25 in 73% and 84% of eyes, respectively. At 1 month postoperatively, CDVA was 0.05±0.23 logMAR and significantly lower than the preoperative CDVA, 0.02±0.04 log MAR (P>0.05). However, at 1 year and 3 years after surgery, CDVA showed a significant increase compared to preoperative CDVA. At the conclusion of the 3-year follow-up, SE was -0.47 D, and 69.6% and 83.5% of the eyes were within±0.50 D and±1.00 D, respectively, of the intended correction. HOA's, coma, and spherical aberration increased significantly. No significant change in trefoil was detected. This study showed that SMILE produces a stable, safe outcome for surgical treatment of myopia and myopic astigmatism.

Are long-term auditory results following ossiculoplasty with bone cement as successful as early-middle period results?

Bone-cement (BC) ossiculoplasty is one of the options to solve ossicular chain problems. Many authors reported successful results in the early or mid-follow-up period; however, there is no long-term result in the literature. We aim to evaluate long term results of BC ossiculoplasty. Forty-eight patients who underwent BC ossiculoplasty as incudostapedial re-bridging by the same surgeon were invited to evaluation. Postoperative otomicroscopic examination was performed. Pre-operative and post-operative audiological results after longer follow up and graft success rate were noted. Fourteen patients came for control examination. The follow-up period was between 87 and 135months (mean 102months). None of the patients had graft failure. Ten patients had early postoperative follow-up results (between 10 and 52; mean 24months). In the comparison of preoperative and early postoperative air-bone gap, there were significant differences in all frequencies while the comparison of preoperative and long-term postoperative results showed a significant difference only in 250 and 500Hz. Early postoperative results were better than late with significant difference only in the 2000 and 4000Hz. As reported by many studies, bone cement application provides a significant auditory improvement in the early postoperative period. The results of the present study showed that this early auditory success may decrease over time with a long-term follow-up. Further studies should be conducted with larger patient groups to clarify the long-term benefits of this treatment and possible causes for its deterioration.

LAPAROSCOPIC PELVIC EVISCERATION IN MALE AND FEMALE PATIENTS

Abstract: treatment of patients with primary and recurrent locally advanced pelvic tumors represents an extremely complex problem of surgical oncology.Aim: to evaluate perioperative and long-term postoperative results of laparoscopic pelvic exenteration technique.Material and methods: in the period from 2011 to 2018, 21 pelvic exenteration was performed with laparoscopic access, (mean age 59.79 ± 8.5), sex distribution: 17 women and 4 men. Nosology distribution: in 6 patients cervical cancer was verified, 7 patients had bladder cancer, 4 patients had rectal cancer, 1 patient had vaginal cancer, 2 patients had recurrence of vaginal cancers after previous uterine extirpation and 1 patient with ovarian neoplasm.Results: the volume of the exenteration was as follows: 9 total, 7 anterior and 5 posterior. In all cases, it was possible to achieve a negative margin of resection line (R0). The duration of the operation, the volume of blood loss, the frequency and nature of intra- and postoperative complications were evaluated.Conclusion: laparoscopic access is accompanied by a smaller amount of blood loss, decrease of frequency of early postoperative complications, contributes to more comfortable postoperative period with early activation, less severe pain syndrome and leads to a reduction in the duration of inpatient treatment.

Intraspinal epidermoid and dermoid cysts-tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome.

Intraspinal epidermoid/dermoid cysts are very rare, benign tumors arising from pathological displacement of epidermal cells into the spinal canal. Literature data about the long-term outcome after microsurgical resection with multimodal intraoperative neurophysiological monitoring (IONM) are lacking. We analyzed one of the largest case series with special regard to intraoperative characteristics and long-term outcome after IONM-aided surgery. All 12 patients (m:f = 1.4:1) who underwent microsurgical tumor resection with multimodal IONM for intraspinal epidermoid/dermoid tumors between 1998 and 2019 in our university hospital were included. We retrospectively investigated the patients' characteristics, imaging/surgical parameters, and postoperative long-term outcomes. Symptomatic tumor manifestation was seen during adulthood in 4 patients (median age 33.0years) and during childhood in 8 patients (median age 4.3years). Spinal dysraphism was the most often comorbidity (75%). The most frequent symptoms at diagnosis were spastic pareses (75%), ataxia (58%), and vegetative disorders (42%). Tumors were most often lumbosacral (L1-L5 42%, L5-S3 50%) and intradural-extramedullary (92%). For microsurgical resection, IONM with EMG, SSEPs, and TcMEPs of the limbs and pudendal nerve/anal sphincter was always applied and feasible; intraoperative corrective actions were initiated in three cases due to transient IONM deterioration. None of the patients showed a postoperative deterioration of the neurological status with a gross total resection rate of 92%. Pain situation, McCormick grade, and mJOA Score were improved at long-term follow-up (median 4.8years). IONM-aided resection of intraspinal epidermoid/dermoid tumors is feasible both in adult and pediatric cases and enables a satisfying clinical and surgical outcome.

Underestimated Value of Sarcopenia in Gastric Cancer Surgery

Surgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.

Clinical results of triple tibial osteotomy treatment in cranial cruciateligament-deficient dogs

Canine cranial cruciate ligament ruptures have become common with improved nutrition and nonselective breeding strategies. This study assessed 7 dogs of various breeds and ages with the diagnosis of cranial cruciate ligament ruptures. The triple tibial osteotomy TTO method was used to treat the rupture. All of the dogs were admitted to the clinic for varying degrees of lameness. Diagnosis was confirmed using both clinical and radiologic examinations. Body weights of the dogs were between 12 and 65 kg. Informed consent was given by the owners prior to surgery. Postoperatively, early evaluations were made using periodic radiographs and clinical examinations, but long-term evaluations were performed by phone interviews due to economic and other limitations by the owners. The TTO operation method was completed successfully in all of the cases and only with Case 5 was a major complication encountered tibial tuberosity fracture from the distal pivot hole . In 3 cases, the minor complication of wound contamination occurred due to poor wound care by the owners of the dogs. Owners were advised to restrict mobilization for a week following cast removal. Early, mid-, and long-term postoperative results showed functional recovery in all of the cases. All of the dogs returned to their pretrauma lives and those that had chronic symptoms had a significant increase in their mobility when compared to their previous states after cranial cruciate ligament rupture.

Characteristics and Long-Term Outcome of 20 Children With Intramedullary Spinal Cord Cavernous Malformations.

No prior reports have focused on the natural history and long-term outcomes of intramedullary spinal cord cavernous malformations (ISCCMs) in children. To investigate the clinical characteristics and long-term outcomes of pediatric ISCCMs and identify the risk of hemorrhage. We retrospectively reviewed a series of 20 pediatric patients (<18 yr old) from a consecutive series of 254 patients with ISCCMs evaluated at a single institution. Of the 20 pediatric patients, 9 (45.0%) presented with a severe neurological and disability status. The annual hemorrhagic rate in pediatric patients was 8.2%/patient/year. After initial overt hemorrhage events, the annual overt rehemorrhage rate increased to 30.7%/patient/year. In 234 adult patients, the respective rates were 2.8% and 7.4%. Thoracic or lumbar level lesions (P=.002, OR=3.425, 95% CI=1.588-7.387) and rehemorrhagic events (P=.005, OR=3.209, 95% CI=1.415-7.279) were more likely to follow an aggressive course. There were no significant differences in the sex distribution, location and size of lesions, types of symptoms, likelihood of a severe neurological and disability status, or immediate and long-term postoperative outcomes between pediatric and adult patients with ISCCMs. The annual overt hemorrhage rate and rehemorrhage rate of ISCCMs were higher in affected children than in affected adults. Surgical resection of pediatric ISCCMs remains the preferred therapeutic option and provides favorable outcomes.

Cosmetic Pterygium Surgery: Techniques and Long-Term Outcomes.

BackgroundTo demonstrate the long-term results of enhanced cosmetic pterygium surgery with extensive Tenonectomy, adjunctive fibrin-glued amniotic membrane transplantation (AMT), and mitomycin C (MMC).MethodsRetrospective chart review of patients who had pterygium surgery with AMT and MMC between January 2001 to July 2017 and had completed at least 6 months of follow-up. Early and long-term postoperative cosmetic outcomes, recurrence rate, and complications were analyzed. Cosmetic outcomes were evaluated based on patient and surgeon reported outcome measures.ResultsThe study was conducted on a total of 603 eyes of 578 patients (316 males, 262 females) with an average age of 52.9 ± 15.1 years. At post-op day 1, patients reported no discomfort and could not tell which eye had surgery based on patient reported subjective grading scales. Over an average follow-up period of 23.1 ± 35 months (range: 6–216 months), there was one pterygium recurrence (0.2%), eighteen granulomas (2.9%), one self-resolving scleral melt (0.2%), one correctable restricted ocular motility (0.2%), one pupil abnormality (0.2%), one dellen (0.2%) and one correctable upper lid abnormality (0.2%). Planned laser vision correction was used for residual corneal scar in eleven eyes (1.8%) as a staged refractive approach.ConclusionThis study highlights an improved technique of an old concept of pterygium surgery that not only reduces the recurrence but also enhances cosmetic excellence and improves the quality of vision.

The Effectiveness of Autograft Used in Anterior Cruciate Ligament Reconstruction of the Knee: Surgical Records for the New Generations of Orthopedic Surgeons and Synthetic Graft Revisit.

ObjectiveIn this article, we aim to revisit the synthetic graft and review the advantages and disadvantages between different types of grafts for patients who underwent anterior cruciate ligament (ACL) reconstruction in a tertiary medical institute for the new generations of surgeons.Patients and MethodsRetrospectively, we identified 115 patients who underwent arthroscopic ACL reconstruction between 2006 and 2009. We were able to retrieve 74 patients from them. The 74 patients were divided into 32 patients who underwent primary arthroscopic ACL reconstruction with hamstring and patellar tendon autograft and 42 cases with an active biosynthetic composite (ABC) ligament. The mean the follow-up period for both groups was 7 years. The following information was obtained: standard demographic information (age, sex), clinical presentation, presence of trauma, associated injuries, types of grafts (autograft versus synthetic graft) and postoperative complications. Moreover, functional and clinical outcomes in addition to the satisfaction of patients using the international knee documentation committee (IKDC) score and knee injury and osteoarthritis outcome score (KOOS) were measured.ResultsWe found that the natural (autograft) was better in terms of clinical and functional outcome than the synthetic one (the scores of KOOS and IKDC were better in natural grafts). Furthermore, the immediate postoperative results for the pivot and Lachman tests were better in natural grafts. On the other hand, the rate of re-rupture was similar for both groups. However, the long-term inflammatory changes and stiffness that is attributed to the immunological reactions were more in the synthetic grafts.ConclusionThis study revisited the synthetic graft and provided evidence that the natural grafts are more beneficial with less complications, as they had better immediate and long-term postoperative clinical and functional outcomes. We recommend the utilization of autograft as first choice and the synthetic not to be used given the current criteria.

Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery-A Pilot Study.

Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels > 64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium.

Pre-operative chronic opioid or glucocorticoid use and mortality after noncardiac surgery: A retrospective cohort study.

The chronic use of opioids and glucocorticoids is associated with serious side effects. Moreover, both medications are related to poor long-term postoperative outcomes. The study aimed to investigate the association between pre-operative chronic opioid and glucocorticoid use and 90-day mortality after noncardiac surgery. Retrospective, population-based cohort study. Single tertiary academic hospital. The study enrolled adult (≥18 years of age) patients admitted to Seoul National University Bundang Hospital, between January 2012 and December 2018 for planned, elective, noncardiac surgery. The study compared the 90-day mortality for patients using opioids or glucocorticoids chronically (≥3 months) prior to surgery and for opioid-naïve and glucocorticoid-naïve patients. A total of 112 606 patients were included in the study. Among them, 107 843 (95.9%) were opioid-naïve and glucocorticoid-naïve patients; 3373 (3.0%), 1199 (1.1%) and 191 patients (0.2%) were chronic users of opioids, glucocorticoids or both, respectively. In the multivariable model, compared with opioid-naïve and glucocorticoid-naïve patients, the odds of dying within 90 days were significantly higher for chronic users of opioids [3.56-fold; 95% confidence intervals (CIs) 2.36 to 5.38; P < 0.001], glucocorticoids (4.17-fold; 95% CI 3.28 to 5.29; P < 0.001) and combined opioids and glucocorticoids (7.66-fold; 95% CI 3.91 to 15.01; P < 0.001). Chronic pre-operative use of opioids and glucocorticoids, together or individually, were associated with increased 90-day mortalities after noncardiac surgery, compared with opioid-naïve and glucocorticoid-naïve patients. Our results suggest that chronic pre-operative use of opioids and glucocorticoids should be managed carefully.

Laparoscopic totally extraperitoneal vs robotic transabdominal preperitoneal inguinal hernia repair: Assessment of short‐ and long‐term outcomes

In this study, we aimed to compare short- and long-term outcomes between laparoscopic totally extraperitoneal (L-TEP) and robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair. Patients were classified into two groups: L-TEP and R-TAPP. The groups were case-matched in a 1:1 ratio based on age, gender, and body mass index (BMI). Out of 86 patients, 43 patients were matched in each group based on the study criteria. Demographics were comparable between the groups. Operative time was significantly longer for the R-TAPP compared to L-TEP (129.1 ± 47.2 min vs 92.5 ± 28.3 min; P < .001). VAS scores at 24 hours after surgery were significantly higher in the L-TEP compared to R-TAPP (36.8 ± 20.1 vs 20.3 ± 18.7; P < .001). Total hospital costs were 4778$ for R-TAPP and 3852$ for L-TEP. The current study demonstrates similar long-term postoperative outcomes and recurrence rates between robotic and laparoscopic inguinal hernia repair in a case-matched fashion.

Comparison of long-term results after manual and femtosecond assisted corneal trephination in deep anterior lamellar keratoplasty for keratoconus.

To compare long-term postoperative outcomes of manual and femtosecond assisted corneal trephination in deep anterior lamellar keratoplasty (FS-DALK) for keratoconus. In the retrospective study, 17 consecutive eyes that underwent vertical side cut incision FS-DALK and 22 eyes that underwent trephine incision DALK were collected over a 2-year period. Main measurements included postoperative uncorrected-visual acuity (UCVA), corrected distance visual acuity (CDVA), refractive sphere and cylinder, manifest refraction spherical equivalent (MRSE), flat and steep corneal keratometry (K1 and K2), endothelial cell density (ECD), and time of epithelium healing and suture removal. Groups were comparable for diagnosis and preoperative visual acuity. Follow-up averaged 23mo (range, 12-36mo). At 12mo, the mean UCVA was better in the manual-DALK group (P=0.039), and the refractive sphere was lower in the FS-DALK group (P=0.040). MRSE between groups differed at 1, 6, and 12mo postoperatively (P=0.047, 0.025, 0.042, respectively). Mean CDVA, cylinder, K1, K2, corneal astigmatism, ECD, and time of epithelium healing were similar between groups. Stability of MRSE, ECD, and K1 returned sooner after FS-DALK. Initial loosened suture removal time was earlier in the manual-DALK group (P=0.042) while complete suture removal time was similar (P=0.122). Manual and femtosecond assisted corneal trephination in DALK are options for advanced keratoconus. FS-DALK do not result in improved visual acuity but it is more stable during the follow-up period. FS-DALK in the present form show limited benefit, so surgical design and parameters still need to be optimized and explored.

Impact of technically qualified surgeons on laparoscopic colorectal resection outcomes: results of a propensity score-matching analysis.

BackgroundThe Endoscopic Surgical Skill Qualification System (ESSQS) was introduced in Japan to improve the quality of laparoscopic surgery. This cohort study investigated the short‐ and long‐term postoperative outcomes of colorectal cancer laparoscopic procedures performed by or with qualified surgeons compared with outcomes for unqualified surgeons.MethodsAll laparoscopic colorectal resections performed from 2010 to 2013 in 11 Japanese hospitals were reviewed retrospectively. The procedures were categorized as performed by surgeons with or without the ESSQS qualification and patients' clinical, pathological and surgical features were used to match subgroups using propensity scoring. Outcome measures included postoperative and long‐term results.ResultsOverall, 1428 procedures were analysed; 586 procedures were performed with ESSQS‐qualified surgeons and 842 were done by ESSQS‐unqualified surgeons. Upon matching, two cohorts of 426 patients were selected for comparison of short‐term results. A prevalence of rectal resection (50·3 versus 40·5 per cent; P < 0·001) and shorter duration of surgery (230 versus 238 min; P = 0·045) was reported for the ESSQS group. Intraoperative and postoperative complication and reoperation rates were significantly lower in the ESSQS group than in the non‐ESSQS group (1·2 versus 3·6 per cent, P = 0·014; 4·6 versus 7·5 per cent, P = 0·025; 1·9 versus 3·9 per cent, P = 0·023, respectively). These findings were confirmed after propensity score matching. Cox regression analysis found that non‐attendance of ESSQS‐qualified surgeons (hazard ratio 12·30, 95 per cent c.i. 1·28 to 119·10; P = 0·038) was independently associated with local recurrence in patients with stage II disease.ConclusionLaparoscopic colorectal procedures performed with ESSQS‐qualified surgeons showed improved postoperative results. Further studies are needed to investigate the impact of the qualification on long‐term oncological outcomes.

Postoperative Long-term Outcomes of Patient with Craniopharyngioma Based on CyberKnife Treatment.

ObjectiveThe results of CyberKnife treatment in patients with craniopharyngiomas are excellent, but reports of long-term follow-up are rare. Hence, considering the possibility of a long-term follow-up of five years or more, we examined the long-term prognoses of these patients.Materials and MethodsOf 33 patients, 12 were males and 21 were females. On postoperative evaluation, three patients experienced recurrence after total resection and were treated using CyberKnife. Twenty-five patients were treated with CyberKnife after partial resection. The mean age at treatment was 47 years, and the follow-up period was 61 to 129 months.ResultsOf the cases assessed as totally resected in the postoperative evaluation, three recurred after 18 months. CyberKnife treatment was administered immediately in recurrent cases; subsequently, no recurrences were observed for 25 months or more. No recurrences were observed in any patients treated with CyberKnife on the residual site after surgical treatment. Many cases had improved pituitary function, but none had deteriorated. In addition, no case of visual function deterioration was reported. ConclusionTwenty years have passed since the introduction of CyberKnife treatment; however, only a few reports have examined the long-term prognosis of patients with craniopharyngiomas who underwent this treatment. We have been aware of the efficacy of CyberKnife treatment for ten years or more; its long-term results are evident, and the good growth control and low adverse effects are impressive. We are confident that we can maintain good treatment results by combining conservative surgical resection with minimal complications and CyberKnife treatment for new patients in the future.

Vestibular schwannoma: predictive factors of long-term postoperative neurological outcome

Introduction: Vestibular schwannoma (VS) is a slow-growing, benign tumor that is usually diagnosed when symptoms develop. Surgical management aims to reduce long-term sequelae (LTS) associated with late diagnosis.Objective: Identify predictive factors of LTS after VS surgery and clinical outcome measured by modified Rankin scale (mRS).Methods: This cohort study included patients submitted to VS surgery from 1999 to 2014, with a mean follow-up of 6.4 ± 4.5 years. Disability was assessed across the mRS the primary outcome was defined by scores 3 to 6, which implied poor outcome in neurological recovery. Predictive factors were identified through multivariate logistic regression.Results: A total of 101 patients were included in this study. Fifty-one (50.49%) presented mRS ≥ 3 on the late postoperative period. Men comprise 22.8%, and the mean age was 47.1 ± 16.0 years (range19–80). Patients with mRS ≥ 3 presented larger tumors (3.7 ± 1.1 cm vs. 3.2 ± 1.0 cm, p < .001), less total resection (50% vs. 76.7%, p < .010) and more neurofibromatosis II(NFII) (84.9% vs. 64.3%, p = .023). On multivariate analysis NFII, tumor size and type resection were predictive of degree of autonomy (mRS ≥3: NF II (OR 3.5, 95% CI 1.08–11.36, p = .036) and tumor size (each 1 cm, OR1.51, 95% CI 0.96–2.38, p = .050).Conclusion: Tumor size, presence of NFT II, type of surgical approach and number of surgeries were identified as predictive factors of functional sequelae in long-term follow-up after VS surgery.HighlightsOne-third of our patients presented some degree of disability that impact in autonomy (mRS ≥ 3) in the late postoperative period.Tumor size, NFII, surgical approach were predictive to comprise independency.Considering the cranial nerve monitoring and late diagnosis, our results can give some contribution to understanding the Brazilian profile of VS surgery.Our findings suggests the need to look over what it is well recognized and identify aspects that affect the prognosis such as functional disabilities in VS surgery.

Spontaneous Nasal Cerebrospinal Fluid Leak Repaired With Single-Layer Mucoperichondrial Graft: Long-term Results.

Background Spontaneous cerebrospinal fluid leak (sCSFL) has been historically related to obesity and elevated intracranial pressure (ICP), with a lower rate of success of endoscopic repair reported in the literature. Moreover, defects related to this condition have been largely repaired with multilayer reconstructions and pedicled flaps. Long-term postoperative results have not been appropriately discussed yet. Objective The aim of this study is to investigate the outcome of a cohort of patients treated with single-layer mucoperichondrial graft. Methods A retrospective review of clinical records of a consecutive series of patients who underwent endonasal endoscopic surgery for sCSFL was carried out at a tertiary care referral center for skull base pathologies. All patients underwent reconstruction with single-layer mucoperichondrial free graft. Local flap failures and postoperative outcomes, in terms of recurrence of sCSFL or brain herniation, were registered. Results Neither intraoperative nor perioperative complications were reported. Definitive closure was achieved in 27 of 29 (93%) patients after the first attempt, while in 2 cases, a revision surgery was required. In both of these, an inadequate position of the graft was detected and was repaired likewise with the same mucoperichondrial graft. None of the patients required postoperative lumbar drain placement. After a median follow-up period of 57 months, only 1 patient developed a meningocele without CSFL about 2 years after surgery at the contralateral lateral recess of the sphenoid sinus. None of the patients reported symptoms referable to elevated ICP nor underwent ventricular derivation. Conclusions Single-layered mucoperichondrial free graft was safe and effective in the majority of the examined patients. In 7% of the study population, a surgical revision was necessary due to local failure of the graft. However, during long-term follow-up, only 1 case of recurrent meningocele without CSFL was reported in a patient who presented borderline ICP.

Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery \u2013 a retrospective cohort study

BackgroundWhile short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery.MethodsA retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio.ResultsThe one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02–4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16–1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87–0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53–4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62–10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01–1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29–3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85–5.52), p < 0.001).ConclusionsOur study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients’ decision making and care planning.

Use of the pedometer in the evaluation of the effects of rehabilitation treatment on deambulatory autonomy in patients with lower limb arthroplasty during hospital rehabilitation: long-term postoperative outcomes.

[Purpose] To provide data on the applicability of pedometers in the evaluation of the results of rehabilitative treatment on total daily walking activity after total knee arthroplasty (TKA) and total hip arthroplasty (THA). [Participants and Methods] One hundred fifty six hospitalized patients (age 63.9 ± 12.2 years) involved. On the day of hospitalization and at the end of the rehabilitation treatment the following were performed: clinical examination, X-ray examination and weight. On the same day the pedometer was applied and removed after 48 hours. Only on 30 participants, the same evaluation was carried out 5 days before the hospitalization to measure reliability and responsiveness. Compliance was measured by a face-to-face interview. Visual analogic scale (VAS), Barthel Index (BI) and Ambulation Index (AI) were used to better describe the analyzed sample. [Results] VAS, BI and AI improved by 29.8%, 19.4 and 60.6% respectively. The data obtained on testing-retesting showed a good reliability and a mean Total Error of 7.3% for steps and 15.8% for distance. A good response in the test-retest was detected. The deambulatory autonomy of patients passed from 2,070 ± 740 m to 3,100 ± 810 m. Average improvement in the number of daily steps is 25%. [Conclusion] The data showed a good applicability of pedometer. The results on responsiveness can be used to better interpret the results of rehabilitative treatment on total daily walking activity after THA and TKA.

Complete myocardial revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts for coronary artery bypass surgery

Complete revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts is still actual problem for cardiac surgeons. The main causes of the absence of conduits for coronary artery bypass surgery are aging of population, increased incidence of repeated coronary artery bypass surgery and prevalence of varicose vein disease of the lower extremities. The most perspective approaches characterized by acceptable early and long-term postoperative outcomes are bilateral internal mammary artery grafting, sequential bypass including autoarterial grafts, as well as hybrid revascularization methods. However, treatment strategy is individualized in each patient.