Long-term Postoperative Outcomes Research Articles

Prehabilitation before major intra-abdominal cancer surgery: A systematic review of randomised controlled trials.

Although prehabilitation programmes for patients undergoing major intra-abdominal cancer surgery have been shown to improve pre-operative physical fitness, the conclusions regarding any postoperative benefits are inconsistent. The aim of this study was to evaluate the content of and the outcome measures used in studies of prehabilitation programmes for these patients. It was hypothesised that the content of prehabilitation programmes is often therapeutically invalid, and that the postoperative outcomes assessed are inadequate to evaluate the impact of complications. A systematic review of randomised controlled trials. Studies published between January 2009 and January 2019 were retrieved from PubMed, Embase and PEDro. Studies were included when they investigated the effects of prehabilitation in patients undergoing intra-abdominal surgery for cancer, reported pre-operative and/or postoperative outcome measures and were conducted as a randomised controlled trial. Studies for which the full text was not available were excluded, as were studies of patients undergoing nonabdominal cancer surgery. Eight studies (565 patients) were included. Therapeutic validity was low in five studies. Most studies included low-risk surgical patients and considerable variation was observed between prehabilitation programmes in terms of supervision, training context, frequency, intensity, duration and training type. Objective monitoring of training progression was typically not performed, and most trials did not include nutritional or psychological support. Postoperative complications were reported in seven studies, but no study reported the impact of postoperative complications, nor on long-term postoperative outcomes. The content of prehabilitation programmes was heterogeneous. Studies with a high therapeutic validity found unequivocal evidence that prehabilitation had beneficial effects on postoperative outcomes. Future research should focus on adequate selection and inclusion of high-risk surgical patients and provide personalised and probably multimodal (partly) supervised prehabilitation, with objective monitoring of progress. Measuring the incidence and impact of postoperative complications may contribute to demonstrating the clinical value of prehabilitation.

P15-F Intraoperative-neuromonitoring-recording effectiveness of the laryngeal-adductor-reflex (LAR) during thyroid surgery: Immediate and long-term EMG-ENT outcome correlation

Background Intraoperative-neuromonitoring (IONM) of vocal cord function is of vital importance as part of the recurrent-laryngeal-nerve (RLN) monitoring during thyroid-parathyroid surgeries. The most popular IONM technique includes both vagus and RLN direct stimulation. We have substituted this method with the IONM-recording of the LAR and correlated its changes with immediate and long-term EMG-ENT outcome in a case series of 45 patients. Methods All patients underwent pre-postoperative direct laryngoscopy and thyroarytenoid EMG assessment (ENT within 24-h, EMG within 4-weeks after surgery). LAR was elicited by applying a single electrical stimulus on the laryngeal mucosa from surface-electrodes (ES) embedded in the endotracheal-tube (ETT) (duration 0.1–1 ms, intensity 6–8 mA, frequency 1 Hz), with the recording of cR1 and cR2 responses from the ES of the TET contralateral to the stimulus and ipsilateral to the surgical field. Significant changes in LAR amplitude responses were the critical parameters for IONM interpretation. Results From 45 patients (9-males; 36-females; age 28–81 years) 38 underwent bilateral thyroidectomy, and seven underwent hemithyroidectomy. All cR1 responses were elicited bilaterally at the onset of surgery. There was a reversible-temporary unilateral cR1 decrease-response in 6 cases, all presented with normal ENT-EMG postoperative result. A sustained unilateral cR1 drop-response occurred in 6 cases, all six showing ENT (paresis-paralysis) and EMG (sub-acute denervation) postoperative dysfunctions. At all times when cR1 amplitude dropping occurred, there was a temporal correlation with RLN direct surgical maneuvres. Conclusion There is a good correlation between LAR amplitudes changes during thyroid surgery with immediate and long-term EMG-ENT postoperative outcomes.

Anterolateral ligament as a main stabilizing structure оf rotational stability оf the knee joint

Currently, anterior cruciate ligament grafting is one of the most popular operations on the knee joint, but despite the fact that the technique has been used for years, there is a high percentage of unsatisfactory long-term postoperative results, reaching 25%, according to various authors. The concern over this problem has led to an increase in the number of studies aimed at the understanding of the causes of these failures. Most researchers have concluded that the unsatisfactory results are associated with instability in the knee joint, which is caused by the damage of a ligamentous structure found in many dissections, namely, anterolateral ligament (ALL). In this literature review, we have analyzed the articles dedicated to the ALL, its anatomical and histological structure, its biomechanics, as well as its role in the anterolateral stability of the joint. Also in this review we consider the existing surgical methods for the correction of anterolateral instability associated with the ALL damage.

Quantification of Head Shape and Cranioplasty Outcomes: Six-compartment Volume Method Applied to Sagittal Synostosis.

Premature fusion of the sagittal (midline) suture between 2 parietal bones is the most common form of craniosynostosis. Surgical correction is mandated to improve head shape and to decrease the risk of raised intracranial pressure. This study evaluated the utility of 3-dimensional (3D) imaging to quantify the volumetric changes of surgical correction. Currently there is no standardized method used to quantify the outcomes of surgery for craniosynostosis, with the cranial index (width: length ratio) being commonly used. A method for quantification of head shape using 3D imaging is described in which the cranium is divided up into 6 compartments and the volumes of 6 compartments are quantified and analyzed. The method is size invariant, meaning that it can be used to assess the long-term postoperative outcomes of patients through growth. The method is applied to a cohort of sagittal synostosis patients and a normal cohort, and is used to follow up a smaller group of synostotic patients 1, 2, and 3 years postoperatively. Statistical analysis of the results shows that the 6-compartment volume quantification method is more accurate in separating normal from synostotic patient head shapes than the cranial index. Spring-mediated cranioplasty does not return head shape back to normal, but results in significant improvements in the first year following surgery compared with the preoperative sagittal synostosis head shape. 3D imaging can be a valuable tool in assessing the volumetric changes due to surgery and growth in craniosynstosis patients.

(273) Acute Postoperative Opioid Trajectories and Long-Term Outcomes in Pediatric Patients after Surgery

The days following surgery encompass a critical period where the use of opioids predicts long-term outcomes in adults. It is currently unknown as to whether opioid consumption throughout the acute postoperative period is associated with long-term outcomes in pediatric patients. The aims of this study were to characterize opioid trajectories in the acute postoperative period, identify predictors of opioid trajectory membership and determine associations between opioid trajectories and long-term patient outcomes. Medication use, pain and mental health status were assessed at baseline in adolescents with idiopathic scoliosis who were schedule for spinal fusion surgery. Cumulative 6-hour opioid consumption was recorded for up to 5 days after spinal surgery. At 6 weeks and 6 months after surgery, medication use, pain and physical function were evaluated. Growth mixture modeling was used to identify opioid trajectories. The study included 106 patients. Mean cumulative opioid consumption in the acute postoperative period was 13.23 ± 5.20 mg/kg. The model with the best fit contained 5 acute postoperative opioid trajectories and a quadratic term (AIC = 6703.26, BIC = 6767.19). Opioid trajectories differed in the total amount of opioids consumed and the rate of opioid intake over the acute postoperative period. Intraoperative epimorphine dose predicted the opioid trajectory membership (p = 0.0498). Opioid trajectory groups were significantly associated with pain at 6 weeks (p = 0.0103) and 6 months (p = 0.0457) after surgery. Intraoperative epimorphine dose predicts the opioid consumption in the acute postoperative period. Opioid consumption during this period is associated with long-term pain. Understanding the acute postoperative period and its association with baseline predictors and long-term patient outcomes will allow for personalized perioperative care.

Impact of Obesity on Postoperative Outcomes following cardiac Surgery (The OPOS study): rationale and design of an investigator-initiated prospective study

IntroductionIncreasing levels of obesity worldwide have led to a rise in the prevalence of obesity-related complications including cardiovascular risk factors such as diabetes, hypertension and dyslipidaemia. Healthcare providers believe that...

1030 - Surgical and long-term postoperative outcomes of minimally invasive mesh sacrocolpopexy: A high-volume center experience

1030 - Surgical and long-term postoperative outcomes of minimally invasive mesh sacrocolpopexy: A high-volume center experience

Occlusion of the corpus cavernosum penis in bulls intended for estrus detection: 18 cases (2002-2016).

OBJECTIVE To report surgical and long-term postoperative outcomes of bulls undergoing surgical occlusion of the corpus cavernosum penis (CCP) by acrylic injection and epididymectomy with or without penile fixation as preparation for use in estrus detection. DESIGN Retrospective case series. ANIMALS 18 client-owned bulls. PROCEDURES Medical records of bulls that underwent CCP occlusion between December 2002 and March 2016 were identified. Signalment, surgical data, and reported complications were recorded. Long-term (> 6 months after surgery) follow-up data were obtained from medical records or by telephone interview of bull owners with a questionnaire focused on postoperative outcome, use of the bull for estrus detection, and overall satisfaction with the procedure. RESULTS Intraoperative complications included difficulty isolating the penis, polymerization of the acrylic prior to injection, incomplete anesthesia of the surgical site, and fecal contamination of the site. Deposition of acrylic in an improper location led to urethral obstruction and euthanasia of 1 bull; another developed an abscess that was treated successfully. One bull was euthanized because of orchitis. Most (15/18) bulls were used for estrus detection (mean duration, 17.9 months). Libido was considered good or very good for 14 of 15 bulls; 1 was culled for loss of libido after 14 months. Ten of 12 bulls were reportedly unable to protrude the penis; 2 had or developed partial protrusion ability. Overall client satisfaction was high. CONCLUSIONS AND CLINICAL RELEVANCE In this population of healthy young bulls, CCP occlusion was generally well tolerated. Most bulls that underwent CCP occlusion (and epididymectomy with or without penile fixation) had adequate libido, and none were reported able to achieve intromission.

Impact of Body Mass Index on Short- and Long-Term Outcomes After Isolated First-Time Surgical Aortic Valve Replacement for Aortic Stenosis

To ascertain whether body mass index (BMI) has a clinical effect on short- and long-term postoperative outcomes after surgical aortic valve replacement in patients with severe aortic stenosis. Single-center, retrospective study. Tertiary referral hospital. The study comprised 1,561 patients who underwent isolated first-time aortic valve replacement between 2005 and 2012. Fourteen underweight patients were removed from the analysis. The remaining patients were divided into the following 4 groups according to their BMI: 418 as normal weight (≥18.5 to <25 kg/m2), 629 as overweight (≥25 to <30 kg/m2), 342 as obese (≥30 to <35 kg/m2), and 158 as very obese (≥35 kg/m2). Early mortality and postoperative complications were compared, and long-term survival rates were investigated. Thirty-day mortality was higher in the normal weight group but did not reach statistical significance (p = 0.054), and the incidence of postoperative complications was not different for cerebrovascular accident (p = 0.70), re-sternotomy for bleeding (p = 0.17), sternal wound infection (p = 0.07), and dialysis (p = 0.07). With a mean follow-up time of 4.92 ± 2.82 years, survival rate was better in the overweight group. A Cox proportional hazard model found BMI inversely correlated with long-term mortality when analyzed in a univariable fashion (hazard ratio 0.95; p = 0.009), but this apparent protective effect disappeared when adjusted for preoperative covariates (hazard ratio 0.98, 95% confidence interval 0.96-1.004; p = 0.12). Once adjusted for preoperative characteristics, obesity does not represent an independent predictor for long-term survival rates. There was a higher incidence of 30-day mortality in the normal weight group compared with the overweight and very obese groups. The incidence of deep sternal wound infection was higher in very obese patients.

Paraspinal muscle atrophy after posterior lumbar surgery with and without pedicle screw fixation with the classic technique

ObjectivesLumbar spine surgery causes a muscular injury during its approach that could worsen long-term postoperative functional results. This study aims to analyse the postoperative paraspinal atrophy associated with two types of intervention. Material and methodsClinical records and lumbar magnetic resonance imaging were collected from a group of 41 patients, 20 underwent laminectomy with lumbar fixation due to lumbar spinal stenosis (fixation group) and another group of 21 underwent hemilaminectomy without fixation due to lumbar disc disease (non-fixation group). In which muscle atrophy was analysed quantitatively. ResultsWe found a negative correlation between age and preoperative muscle, which was higher in those who underwent lumbar fixation (rho=−0.64 p=.002). We also found a positive correlation between preoperative muscle and postoperative atrophy (rho=0.32 p=.041). In the age, sex and fixation adjusted multivariate linear regression model (R2=0.31), laminectomy with fixation is attributed to 5.3% atrophy (IC95 1.4–9.5%, p=.017); preoperative musculature>70% is attributed to atrophy of 13.8% (95% CI 5.5–22%, p=.002). Age did not correlate with postoperative atrophy. ConclusionsParaspinal muscle atrophy after lumbar spinal surgery is greater if an extensive approach is performed such as complete laminectomy with bilateral facetectomy and transpedicular fixation. A greater previous musculature regardless of age, sex and type of surgery also predicts greater postoperative atrophy.

Current evidence on aortic remodeling after endovascular repair.

Anatomical changes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) are thoroughly studied as they could affect the long-term postoperative outcome. The aim of the present study was to review the literature and summarize the recent data regarding the aortic remodeling and its clinical significance. A continuous aortic neck expansion is observed after EVAR and is more rapid at the first month and during the third postoperative year. This aortic neck dilation is not influenced by the type of proximal stent-graft fixation, is comparable to open surgical aneurysm repair and is most probably related with the natural progression of aneurismal disease. Aortic neck angulation reduces significantly immediately after EVAR and then continues to reduce slowly and gradually. Neck angulations ≥60° have a greater reduction compared to neck angulations <60°. An expansion of the common iliac arteries at the distal landing zone is also observed after EVAR and is more prominent in the first six postoperative months. A postoperative increase of the distance between superior mesenteric artery and iliac bifurcations (aortoiliac elongation) is described and is associated with increased type I endoleaks and reinterventions. The aneurysm sac diameter most frequently reduces after EVAR in absence of an endoleak and this aneurysm sac regression has been associated with the stent-graft type.

ALPPS in overcoming small remnant liver volume in alveolar echinococcosis

Aim.To evaluate the possibilities and indications for ALPPS, immediate and long-term results of surgical treatment of alveolar echinococcosis including great vessels invasion in case of small remnant liver volume.Material and methods. There were 30 ALPPS procedures. Seven patients had small future liver remnant (FLR) — 24.5% (22.4—26.7%). Bile ducts repair with Roux-en-Y procedure for biliodigestive anastomosis during the first surgical stage was performed in 5 patients (71.4%). ALPPS combined with great vessels resection (portal vein or portal vein and left hepatic vein) was required in 4 patients (57.1%). RO-resections were carried out in all patients.Results.Mean duration of ALPPS stage I was 365 (330—415) min, intraoperative blood loss — 800 (700—1000) ml. Time of stage II was 85 (70—110) min, intraoperative blood loss — 200 (100—300) ml. The second stage of ALPPS was performed in 6—7 days (max 8 days) after preliminary assessment of FLR volume according to CT-volumetry, which was 570 (430—630) ml (37.9% (31.9—52.4%) in relation to FLR volume before the first stage of ALPPS. Augmentation of FLR volume was 200 (150—290) ml (60.9% (48.3—80.6%)). The daily increase of FLR volume was 29 (23—46) ml. Overall postoperative morbidity was 42.9% (complications grade I were noted in 2 patients (28.6%), grade IV — in 1 patient (14.3%). Incidence of post-hepatectomy liver failure grade A (ISGLS, 2011) after ALPPS stage II was 42.9% (n = 3). Bile leakage grade A (ISGLS, 2011) occurred in 28.6% of cases (n = 2). Mortality was absent. Postoperative hospital-stay after stage II was 22 (18—35) days. Maximum follow-up was 50 months. Long-term disease-free survival was 100%, median survival — 29 months.Conclusion.ALPPS technique is feasible, followed by desired increase of FLR volume and safe hepatectomy. The procedure leads to good immediate and long-term postoperative results in patients with alveolar echinococcosis and small FLR volume regard less invasion of afferent and/or efferent liver vessels.

Extracorporeal resections and autotransplantation of the liver: an experience of 4 clinical cases

Aim. To evaluate short-term outcomes of ex situ, ex vivo liver resection in patients with lesion of liver veins confluence and inferior vena cava who were undesirable for conventional liver resection. Matherial and methods. There were 4 procedures of ex situ liver resection and autotransplantation without veno-venous bypass. Results. Postoperative complications developed in all cases, complications grade IIIa and over — in 50% of patients. Three patients are alive without signs of disease, follow-up ranged from 8 months to 2 years. One patient died after surgery. Conclusion . Comprehensive planning of such procedures is a key for good early and long-term postoperative outcomes. It is strongly recommended to perform liver autotransplantation in well experienced specialize center due to difficult and traumatic surgery.

Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids \u2013 early and long-term postoperative results

BackgroundA variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results.MethodsThe conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients’ satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0.ResultsThere was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients’ satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802).ConclusionsDoppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients’ selection.Trial registration(retrospectively registered) researchregistry3090.

Short-term Outcomes of Transanal versus Laparoscopic Total Mesorectal Excision: A Systematic Review and Meta-Analysis of Cohort Studies.

Introduction: The TaTME surgery has been developed to overcome the difficulties encountered in the practice of laparoscopic surgery for rectal cancer, especially in male, obese patients with a narrow pelvis and mid and low rectal tumours. Although the TaTME shows some promising results regarding oncological and operative outcomes, some pitfalls have been indicated. Thus, the real benefits of this novel technique over the laparoscopic surgery remain unknown. The aim of the present study was to perform a systematic review and meta-analysis of the currently available literature on the outcomes of TaTME in comparison with laparoscopic procedure.Methods: A systematic literature search was conducted using the web-based databases MEDLINE, EMBASE, and Cochrane CENTRAL, followed by a manual search of the references of the initially identified articles. The study information, patient characteristics, oncological outcomes, perioperative outcomes, as well as short- and long-term postoperative outcomes were collected and critically evaluated.Results: Nine retrospective cohort studies were identified, comprising 751 patients (348 with TaTME, 403 with LaTME). The positive circumferential resection margin (P = 0.01) was better in patients treated with TaTME; whereas the quality of mesorectum, circumferential resection margin, distal resection margin, and harvested lymph nodes were comparable. The TaTME was associated with shorter operative time (P = 0.05; P = 0.0006 in subgroup analysis), less blood loss (P = 0.02), less conversion (P = 0.007), and shorter hospital stay (P = 0.06; P = 0.003 in subgroup analysis). The intraoperative complications were similar. As for the postoperative outcomes, the overall postoperative complications (P = 0.02) and the readmission (P = 0.003) were found less in patients treated with TaTME; however, the individual postoperative complications were found comparable.Conclusion: The present systematic review and meta-analysis suggested some advantages of TaTME, in terms of circumferential resection margin involvement, operative time, blood loss, conversion, hospital stay, overall postoperative complications, and readmission. It appears that the TaTME procedure achieved a better resection quality and smoother recovery in selected patients, without compromising the short-term safety. Nevertheless, it is too early to draw any conclusion, since results of high quality clinical evidence from randomized controlled trials have to be awaited. As it is technically demanding, the procedure needs to be taught and learned systematically to ensure safe implementation.

Anatomical rationale for surgical treatment of trigeminal neuralgia combined with cerebellopontine angle tumors

We performed a retrospective analysis of 51 patients (38 females and 13 males aged 22 to 77 years) with TN and ipsilateral CPA tumors. Space-occupying lesions were represented by 29 meningiomas of the petrous apex, 11 epidermoids, 9 vestibular schwannomas, 1 hemangioma, and 1 cavernoma. Intraoperatively, we identified 6 types of the anatomical relationships among the TNR, tumors, and CPA vessels: type I - the TNR is completely surrounded by the tumor (4 epidermoids); type II - the tumor compresses and displaces the TNR (21 meningiomas, 4 schwannomas, and 6 epidermoids); type III - the tumor occurs inside the TNR (1 cavernoma); type IV - the tumor together with the vessel compresses the TNR (3 meningiomas and 1 epidermoid); type V - the tumor displaces the TNR towards the vessel (5 meningiomas and 5 schwannomas); type VI - the tumor does not contact the TNR that is compressed by the vessel (1 hemangioma). Preoperative MRI and intraoperative findings revealed compression and deformity of the brain stem at the TNR entry level in all but two patients. Vascular compression of the TNR (usually by the superior cerebellar artery) was found in 15 of 51 patients. Microvascular decompression (MVD) was performed using various techniques: interposition of implants between vessels and the TNR, transposition of the compressing vessels from the TNR, or transposition of the nerve root. In all patients, except 1, pain syndrome regressed immediately after tumor removal and MVD. In 1 case, the pain syndrome did not regress after total removal of epidermoid and MVD, and TN was resolved by percutaneous radiofrequency rhizotomy. Long-term postoperative follow-up results showed complete elimination of TN in all cases; there were no persistent neurological complications and postoperative mortality. TN may result from direct compression and deformation of the TNR and brain stem by CPA tumors. In some cases, the cause of TN is combined compression of the TNR by the tumor and vessels. Assessment of the neurovascular relationships requires detailed examination of the entire TNR after tumor removal. In the case of vascular compression of the TNR, various MVD techniques can be used for treatment of TN.

Retrolisthesis and lumbar disc herniation: a postoperative assessment of outcomes at 8-year follow-up

BACKGROUND CONTEXTLumbar disc herniation and retrolisthesis have been shown to be significant degenerative changes that can be associated with back pain. Current literature has shown evidence that retrolisthesis is associated with similar baseline function in patients with L5–S1 disc herniation, but worse postoperative outcomes 2 years after lumbar discectomy. However, literature comparing long-term postoperative outcomes at 8-year follow-up in patients with L5–S1 disc herniation with retrolisthesis is lacking. PURPOSEThe purpose of the present study is to compare long-term postoperative outcomes at 8-year follow-up in patients with retrolisthesis and L5–S1 disc herniations to patients with L5–S1 disc herniations without retrolisthesis. STUDY DESIGNRetrospective review of prospectively collected data from the Spine Patients Outcomes Research Trial (SPORT) database. PATIENT SAMPLESixty-five patients who underwent lumbar discectomy for L5–S1 disc herniations with 8-year follow-up from the SPORT. OUTCOME MEASURESShort Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index, Sciatica Bothersomeness Index, and reoperation rate. METHODSBaseline surgical parameters, length of stay, complication rates, reoperation rates, and outcome measures were recorded in the SPORT database. Follow-up data were collected at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, 6 years, 7 years, and 8 years. Retrolisthesis was defined as posterior subluxation ≥8%. Patients with and without retrolisthesis were compared using a mixed-effects model of longitudinal regression. Outcomes were calculated as time-weighted averages over 8 years. Reoperation rates were compared using the log-rank test based on time to first reoperation. RESULTSOne hundred-twenty five patients met inclusion criteria for the present study, including 29 patients with retrolisthesis (23.3%) and 96 patients who did not have retrolisthesis (76.7%). The greatest difference in clinical outcome measures was found at 2 years postoperatively. This was the only point at which both the Short Form-36 Bodily Pain scale (SF-36 BP) and PF showed significant differences between the retrolisthesis and nonretrolisthesis group. At 3 years, SF-36 BP was significantly lower in patients with retrolisthesis (39.9 vs. 52, p=.046).At 8-year follow-up, the presence of retrolisthesis in patients undergoing L5–S1 discectomy was not associated with worse outcome measure scores based on the area under the curve analysis for any metric investigated (SF-36 BP 41.4 vs. 47.1, p=.18; SF-36 Physical Function scale 38.9 vs. 45.4, p=.12; Oswestry Disability Index −39.4 vs. −34.8, p=.23; −11.6 vs. −10.4, p=.25) or a difference in reoperation rate (retrolisthesis group 10%, nonretrolisthesis group 17%, p=.41). CONCLUSIONSWhile retrolisthesis can contribute to low back pain and dysfunction in patients undergoing lumbar discectomy for L5–S1 herniated nucleus pulposus in early follow-up, no significant difference was found in postoperative outcomes after 3 years. Additionally, retrolisthesis was not found to be associated with different reoperation rates at 8 years postoperatively.

Memorial Sloan Kettering-Frailty Index (MSK-FI): Validation and its relationship with postoperative outcomes of older survivors of cancer.

172 Background: Older cancer patients are at higher risk for poor postoperative outcomes. We tested the validity and utility of Memorial Sloan Kettering-Frailty Index (MSK-FI) in this setting. Methods: In a single institution, prospective cohort study, patients age 75+ received comprehensive geriatric assessment (CGA) by the Geriatrics service during preoperative evaluation. The MSK-FI was developed based on the modified Frailty Index, incorporating 10 comorbid conditions and one item related to basic and instrumental activities of daily living. With the total score ranging from 0 to 11, a score of ≥ 3 was considered frail. We validated the MSK-FI against the CGA, and assessed the relationship between MSK-FI frailty with short term (hospital length of stay (LOS), intensive care unit (ICU) admission) and long-term (overall survival) postoperative outcomes utilizing multivariable linear, logistic, and cox regression models, adjusting for age, duration of surgery, American Society of Anesthesiologists physical status classification, and preoperative albumin level. Results: In total, 1,137 cancer patients (median age 80) were included in the study. The prevalence of frailty based on MSK-FI was 41%. Frail patients were more likely to have poor Karnofsky Performance Status (56% vs. 29%), be dependent in basic and instrumental activities of daily living (72% vs. 40% and 64% vs. 34%), experienced a fall in the past year (30% vs. 18%), have slower gait speed (49% vs. 22%),be depressed (66% vs. 49%), have limited social activity (62% vs. 43%), take ≥ 5 medications (63% vs. 25%), experienced significant weight loss (24% vs. 16%), and suffer from polycomorbid conditions (87% vs. 26%). Frailty was associated with longer LOS in the hospital (1.9 days, p &lt;0.0001) and higher odds of ICU admission (OR = 2.34, p = 0.005). With the median follow up of 12.1 months for survivors, frail patients were at higher risk for overall mortality (HR = 1.67, p &lt; 0.001). Conclusions: MSK-FI is a valid instrument in predicting short and long-term postoperative outcomes of older adults with cancer. Future studies should assess the impact of administering MSK-FI on surgical decision-making, postoperative health care process, and outcomes.

Postoperative translation of the upper instrumented vertebra in thoracic adolescent idiopathic scoliosis.

OBJECTIVEThe aim of this retrospective study was to analyze the influence of upper instrumented vertebra (UIV) translation from the C7 plumb line (C7PL) on the long-term postoperative results of patients with main thoracic (MT) adolescent idiopathic scoliosis (AIS).METHODSTwenty-five patients had been treated surgically for AIS with a Lenke type 1 curve and had been followed up for a mean period of 18.2 years. Radiographic parameters, pulmonary function measurements, and clinical outcomes were compared between the patients (n = 15) with UIV translation < 20 mm and those (n = 10) with UIV translation ≥ 20 mm at the final follow-up. Correlations between UIV translation and radiographic or pulmonary function parameters were analyzed.RESULTSPatients with ≥ 20 mm UIV translation at the final follow-up had a significantly larger preoperative UIV translation than that in the patients with < 20 mm UIV translation at follow-up. The former group also had a significantly lower correction rate of the MT curve, higher chest cage ratio, and lower radiographic shoulder height (p = 0.01, 0.005, and 0.025, respectively) at the final follow-up. The Scoliosis Research Society (SRS)-30 Questionnaire scores were equivalent between the two groups. Correlation analysis showed that the following parameters were significantly associated with UIV translation: MT curve correction rate (r = -0.481, p = 0.015), chest cage ratio (r = 0.673, p < 0.001), and percent-predicted forced expiratory volume in 1 second (r = -0.455, p = 0.033).CONCLUSIONSThe UIV translation should be considered an important factor that influences postoperative results. In MT AIS patients whose preoperative upper end vertebra (UEV) is distant from the C7PL, the UIV should be selected above the UEV to prevent large UIV translation at the postoperative follow-up.

Postoperative outcome of three different procedures for childhood glaucoma.

PurposeTo investigate the long-term postoperative outcome of three surgical procedures for childhood glaucoma.Patients and methodsIn this retrospective study, the patients were divided into a goniotomy group, a trabeculotomy group, and a filtering surgery group, based on the initial surgical procedure. Failure was defined as an IOP ≥21 mmHg with medication at two consecutive visits. A Kaplan–Meier analysis was applied to calculate the probability of success. Additional metrics included IOP, number of additional operations, eye drop scores, and visual acuity.ResultsWe studied 40 eyes of 25 patients, 21 eyes of 15 patients, and 12 eyes of 7 patients in the goniotomy, trabeculotomy, and filtering surgery groups, respectively. The 10- and 20-year probability of success was 65.2% and 65.2%, 42.2% and NA (no data for 20 years), and 91.7% and 80.2% for the goniotomy, trabeculotomy, and filtering surgery groups, respectively.ConclusionAll three procedures maintained an IOP of less than 21 mmHg for up to 10 years in 65.2%, 42.2%, and 91.7% of childhood glaucoma cases.