Longer Operation Research Articles

The burden of adhesive bowel obstruction requiring surgery in children: a single-center retrospective review.

Investigate causes, predictors, and complications of adhesive bowel obstruction (ABO) necessitating surgery in children. Single-center retrospective review of operative cases classified as 'adhesive bowel obstruction ' between May 2014 and December 2023. Parameters assessed included previous surgeries, operative time (indicative of adhesion extent), length of stay and postoperative complications. Results were statistically analyzed afterward. We identified 71 patients with ABO; seven had recurrences. Age (11d-18y, median 5.9 y) and time after surgery (four days-16years, median 6.4months) varied considerably. Preceding appendicitis (16 cases), NEC (seven cases) and gastroschisis (five cases) were most prevalent. Operative time ranged from 43min to 8.4h, was longer after previous surgery during infancy (median 177 vs. 124min), recurrent ABO (median 213 vs. 150min) and significantly shorter after appendicitis (82 vs. 175min). ICU stay (median 2days) and hospital stay (median 11days) reduced with age. 32 patients (41%) suffered complications, doubling mean lengths of stay. Bowel resection and longer surgery were associated with complications, while age and enterostomy creation were not. ABO is an impactful complication with limited predictors. The high incidence of complications adds to the burden for patients, parents, and health systems.

Effects of Surgery on Hemodynamics and Postoperative Delirium in Stanford Type A Aortic Dissection.

To investigate the impact of surgical intervention on hemodynamic parameters and postoperative delirium in Stanford Type A aortic dissection patients. A retrospective analysis was conducted on 139 patients who underwent surgery for Stanford Type A aortic dissection from February 2022 to February 2024. Hemodynamic parameters, including maximum ascending aortic diameter (MAAD), left ventricular end-diastolic diameter (LVEDd), and ejection fraction (LVEF), were compared pre- and post-surgery. Patients were divided into two groups based on delirium occurrence postoperatively: Group A (n=49, with delirium) and Group B (n=90, without delirium). Differences in surgical factors and intensive care conditions were analyzed, and risk factors for postoperative delirium were identified. Group sizes differ due to retrospective categorization based on observed outcomes rather than controlled sampling. ① Hemodynamic parameters: Postoperative MAAD and LVEDd were significantly reduced, while LVEF increased compared to preoperative levels (P < 0.05). ② Surgical and postoperative conditions: Group A had longer surgery, cardiopulmonary bypass, and deep hypothermic circulatory arrest times than Group B (P < 0.05). ③ Univariate analysis of baseline data: Group A had higher rates of patients aged ≥60, hypertension, history of stroke, and elevated preoperative D-dimer levels (P < 0.05). ④ Multivariate logistic analysis: Independent risk factors for postoperative delirium included age ≥60, hypertension, history of stroke, surgery time >6hours, cardiopulmonary bypass time >3hours, and deep hypothermic circulatory arrest time >40minutes (OR > 1, P < 0.05). Surgical treatment of Stanford Type A aortic dissection has a good effect, significantly improving long-term cardiac function. However, the incidence of postoperative delirium is relatively high and is closely related to factors such as age, hypertension, history of stroke, surgery time, cardiopulmonary bypass time, and deep hypothermic circulatory arrest time.

Native nephrectomy in patients with autosomal dominant polycystic kidney disease in kidney transplant program: long-term single-center experience.

Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder that frequently leads to end-stage renal disease. In this study, we examine the indications, procedures, and outcomes of native nephrectomy (NN) in ADPKD patients at our transplant center. Drawing on 25 years of clinical practice, we aim to provide insights into the surgical management of ADPKD, focusing on the specific factors influencing NN. A retrospective study was conducted involving ADPKD patients who underwent KT and NN between 1999 and 2023. Collected data encompassed demographics and surgery parameters, such as duration, hospital stay length, blood loss, and complications. Patients were classified based on the urgency (acute/planned) of the NN and its type (unilateral/bilateral), followed by an analysis of the outcomes per group. Out of 152 patients post-KT for ADPKD, 89 (58.6%) underwent NN. The procedures were predominantly unilateral (71; 64%), with bilateral NN accounting for 40 (36%) cases. NN timing relative to KT was 31 (27.9%) pretransplant, 9 (8.1%) concomitant, 51 (45.9%) posttransplant, and 10 (9%) patients undergoing the sandwich technique. Acute NN were performed in 42 cases, while 69 were planned. Acute NNs were associated with longer surgeries, greater blood loss, and a higher incidence of perioperative complications compared to planned NNs. Specifically, unilateral acute NN had a 23.8% complication rate compared to 2.9% in planned cases; bilateral acute NN showed a 28.6% complication rate versus 4.3% in planned cases. This investigation accentuates the significance of planning and selection in NN for ADPKD, factoring in the heightened risk of complications. Acute NN are linked to worse outcomes, including higher rates of complications. The data emphasize the necessity of tailored surgical approaches based on individual patient circumstances.

The evolution of a large-scale facial gender affirmation program: A comparative outcomes analysis

BackgroundThe volume of facial feminization surgery (FFS) performed has increased tremendously over the last decade as new gender affirmation programs have formed. Advancements in surgical planning and treatment protocols have resulted in complex, multiprocedural FFS operations. This study examines the characteristics and outcomes of a large-scale FFS program over a 5-year lifespan. MethodsA retrospective analysis was performed of all patients who underwent FFS in a high-volume integrated healthcare system from program initiation in 2018-2019 (early cohort) to maturation in 2021-2022 (late cohort). Patient charts were reviewed for demographic factors, operative details, complications, postoperative Emergency Department or Urgent Care (ED/UC) visits, revisions, and readmissions. Patient characteristics and outcomes were compared between early and late cohorts. Results191 patients were included, with 109 in the early cohort and 82 in the late cohort. Patient demographics were similar except mean age (40.3 years early cohort versus 36.3 years late cohort, p=0.03). Patients in the late cohort had longer operations (5.40hours versus 6.16hours, p=0.008) with a greater percentage of patients receiving genioplasty, rhinoplasty, fat grafting, or lip lift. Despite this, fewer patients in the late cohort were admitted postoperatively (62.4% versus 13.4%, p<0.001). There were no differences in total complications, minor complications, revisions, ED/UC visits, or readmissions. However, major complications were significantly more common in the early cohort (4.6% versus 0.0%, p=0.05). ConclusionAs a nascent FFS program matures, the number of procedures in a single operation increased along with operative length. Major complications and postoperative admission rates decreased while total complications remained low.

Understanding the evolution of molybdenum-nitrogen doped carbon with long-term durability for efficient oxygen reduction reaction

The performance and durability of catalyst for Oxygen Reduction Reaction (ORR) still are challenges for fuel cell applications. Mo-NC catalyst system was established and showed the activity comparable with commercial Pt/C in alkaline conditions. An activation phenomenon during longer operation was confirmed with an obvious positive shift after 30 k cycles in accelerated degradation tests, which is rarely observed in the ORR process. The X-ray absorption fine structure (XAFS) indicated a coordination structure transform in electrochemical conditions cause the activated performance. The Density Function Theory (DFT) calculation reveals the transformation of the coordination structure is thermodynamically feasible and also conducive to lower the energy barriers of the key steps in the ORR performance, explaining the origin of the activate phenomenon. These findings give potential guidance to improve both activity and stability of catalyst.

Comparative analysis of percutaneous vertebroplasty and kyphoplasty in the treatment of Stage III Kummell’s disease without neurological symptoms: a retrospective study

ObjectiveThis study analyzes the safety and efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) treatments for Stage III Kummell’s disease without neurological symptoms, comparing the advantages and disadvantages of these two minimally invasive surgical methods.MethodsA retrospective analysis was conducted on 53 patients with non-neurological Stage III Kummell’s disease treated with PVP and PKP at our hospital from December 2018 to January 2023. Patients were divided into PVP (25 cases) and PKP (28 cases) groups based on the surgical method. There were no significant differences in general preoperative data between the two groups (all p > 0.05), ensuring comparability. The study compared surgical duration, volume of bone cement injected, distribution pattern of bone cement, rate of bone cement leakage, and preoperative, postoperative, and final follow-up scores of Visual analogue scale(VAS) and Oswestry disability index(ODI). Additionally, relative anterior height of the injured vertebrae, and Cobb angle of deformity, along with their changes at preoperative, postoperative, and final follow-up stages were calculated and analyzed.ResultsNo significant preoperative differences were observed between the groups (p > 0.05). The PKP group had longer surgeries, higher cement volumes (p < 0.001), and lower leakage rates (p < 0.05), with primarily chunky cement distributions versus mixed distributions in the PVP group. No complications other than cement leakage occurred. VAS and ODI scores showed no significant changes at various time points (p > 0.05) but improved significantly from preoperative (p < 0.001). Both groups saw improved vertebral heights and Cobb angles post-surgery (p < 0.05), with more significant improvements in the PKP group (p < 0.05). Over time, both groups experienced gradual vertebral height loss and increased Cobb angles, more pronounced in the PKP group (p < 0.05). At the final follow-up, there were no statistical differences in vertebral height and Cobb angle between the two groups (p > 0.05).ConclusionThe study evaluates the safety and efficacy of PVP and PKP for Stage III Kummell’s disease without neurological symptoms, comparing the merits of both minimally invasive techniques.

Analysis of membrane fouling during microfiltration of copper sulfide precipitates

Membrane filtration, particularly MF-UF, has previously been assessed as an attractive process for clarifying and recovering valuable metals from metal sulfide precipitation. Previous results of the high transmembrane flux achieved have shown to be promising. However, those studies were primarily focused on demonstrating the method’s feasibility and estimating its performance under different operational conditions. Based on that, this study represents a significant advancement in the field, assessing the fouling behavior and its impact on process performance during the microfiltration of metal sulfide precipitates. Different operational conditions were evaluated using commercial microfiltration membranes operating in batch and continuous regimes, varying Cu concentration in the feed solution (200 and 1800 mg/L), and cross-flow velocities (0.2 – 0.16 m/s). Batch recirculation tests had over 80 % better flux results than the long-term continuous-mode operation tests, mainly due to a progressive decline in the membrane flux observed at longer operation times.Moreover, the cross-flow velocity evaluation indicated that elevated tangential flow rates might result in a decline in the performance of particles with high aggregation behavior. Analyses with modified Hermia’s models and with SEM-EDX image characterizations demonstrated that cake filtration represents the primary fouling mechanism in this process under long-term operation. The present study offers crucial insights that will inform the further development of MF for the treatment of metal sulfide precipitates.

Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study.

Laparoscopic liver surgery is increasingly used for more challenging procedures. The aim of this study was to assess the feasibility and oncological safety of laparoscopic right hepatectomy for colorectal liver metastases after portal vein embolization. This was an international retrospective multicentre study of patients with colorectal liver metastases who underwent open or laparoscopic right and extended right hepatectomy after portal vein embolization between 2004 and 2020. The perioperative and oncological outcomes for patients who underwent laparoscopic and open approaches were compared using propensity score matching. Of 338 patients, 84 patients underwent a laparoscopic procedure and 254 patients underwent an open procedure. Patients in the laparoscopic group less often underwent extended right hepatectomy (18% versus 34.6% (P = 0.004)), procedures in the setting of a two-stage hepatectomy (42% versus 65% (P < 0.001)), and major concurrent procedures (4% versus 16.1% (P = 0.003)). After propensity score matching, 78 patients remained in each group. The laparoscopic approach was associated with longer operating and Pringle times (330 versus 258.5 min (P < 0.001) and 65 versus 30 min (P = 0.001) respectively) and a shorter length of stay (7 versus 8 days (P = 0.011)). The R0 resection rate was not different (71% for the laparoscopic approach versus 60% for the open approach (P = 0.230)). The median disease-free survival was 12 (95% c.i. 10 to 20) months for the laparoscopic approach versus 20 (95% c.i. 13 to 31) months for the open approach (P = 0.145). The median overall survival was 28 (95% c.i. 22 to 48) months for the laparoscopic approach versus 42 (95% c.i. 35 to 52) months for the open approach (P = 0.614). The advantages of a laparoscopic over an open approach for (extended) right hepatectomy for colorectal liver metastases after portal vein embolization are limited.

Pain Predictors in Patients in the Postanesthesia Care Unit

To analyze the effects of pain-predicting factors on patients in the postanesthesia care unit (PACU). This is an observational and prospective study. This study was conducted at a University Hospital in the state of Minas Gerais (Brazil). To collect data on demographic, clinical, and surgical factors, a collection instrument was devised. The verbal numerical scale was employed to measure pain levels before and after surgery in the PACU. A path analysis was used to assess a predictive model. A total of 226 patients were included in this study. The incidence of pain in the PACU was 31.9%. A model with demographic, clinical, and surgical variables was tested. The final model, after including modification indices, obtained results that indicated an acceptable data fit (comparative fit index=0.996; root mean square error of approximation=0.08). Age (being young), sex (being a woman), oncological diagnosis as an indication for the surgical procedure, type of surgery (surgery of the digestive system), duration of surgery (longer surgeries), and high intraoperative doses of opioids were predictive variables for pain in the PACU. This study's findings provide support for pain management in the PACU. Furthermore, the results of this research can be used to anticipate the occurrence of acute postoperative pain and personalized perioperative analgesia needs.

The Impact of Gold Mining Activities on the Environment and Community in Nagari Tambang, IV Jurai District, South Pesisir District

Nagari Tambang has an area of 14.97 𝐾𝑚2 . The population consists of 1,948 1,030 men and 918 women. Population density 130.12 per 𝐾𝑚2 . The types of mining in Nagari Tambang are coal, gold, and sirtukil. The coal mine is no longer operating, but gold and copper are still active. The local community carries out this mining activity. Problem activity mining will have an impact: the increased threat of landslides, loss of ground cover vegetation, soil erosion, increased sedimentation, decreased water quality, reduced forest area due to mining that has penetrated the forest, seawater pollution due to coal barge loading and unloading activities, as well as impacts on existing biota around the sea. Meanwhile, the effects on society include Washing waste, hazardous substances for human health, and environmental damage caused by mining. Research methods carried out are quantitative. The research location is in Nagari Tambang, IV Jurai District, Pesisir Selatan Regency. The research population is people living in Nagari Tambang, IV Jurai District, Pesisir Selatan Regency. Samples were taken purposively. Research results: 1. The Impact activity mining gold on the environment is: decreasing the quality environment, because impact of mining gold carried by the people of Nagari Tambang. Such as: a). Morphology land changed namely: layers soil, color land, structure soil, and consistency land. b). River water discharge is reduced Because water catchment in the hills Already decrease and amount plants stand forests is also decreasing. c). Public health is disturbed, such as their skin becoming dry and itchy and there are problems with their breathing. d). Haven't done it yet waste water treatment remainder from the separation process gold with material other. 2. Impact activity mining gold to society: a). Decreased interaction social with the community, b) Many young people in Nagari Tambang do not continue education to Higher Education, c). Life public No increase in a way significant, because mining use method traditional Not yet there is a business entity.

Risk of acute kidney injury after lower urinary tract reconstruction with early NSAID therapy: A propensity matched retrospective analysis

The opioid epidemic response led to increased use of postoperative, non-opioid analgesia. Some pediatric urologists do not routinely use non-steroidal anti-inflammatory drugs (NSAIDs) for fear of causing acute kidney injury (AKI). While previous studies have demonstrated the safety and efficacy of NSAIDs in children, safety after lower urinary tract reconstruction has not been well characterized. ptUsing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI (increase in creatinine ≥0.3mg/dL or increase in creatinine ≥1.5x baseline or urine output <0.5mL/kg/hr for 6h), we hypothesized there would be a difference in the incidence of postoperative AKI between patients who did and did not receive NSAIDs following surgery. Patients 2-18 years old who underwent lower urinary tract reconstruction (i.e., bladder augmentation and/or creation of a catheterizable channel) from 2009 to 2021 and had documented urine output were retrospectively reviewed. Chronic kidney disease (CKD) stage was calculated from creatinine and cystatin C within 6 months of surgery using the CKiD U25 equations. Patients who received NSAIDs were propensity matched on 11 characteristics with patients undergoing similar surgeries who did not receive NSAIDs. The primary outcome was incidence of AKI within 48h of surgery. The unmatched cohorts included 243 patients. Propensity matching identified 166 patients in the NSAID arm and 41 in the no NSAID arm. 26 patients with CKD stage 2-3 were included. There was no significant difference in the incidence of postoperative AKI based on any KDIGO criteria (17.1% no NSAID versus 16.3% NSAID, p=0.87). Median postoperative opioids fell from 0.88mg/kg in the no NSAID arm to 0.37mg/kg morphine equivalents in the NSAID arm, although this was not statistically significant. Log-rank testing by Kaplan-Meier analysis demonstrated no difference in time to incidence of low urine output between the groups (p=0.32). In the whole population not stratified by NSAID use, no differences were seen in AKI between those with and without CKD (16.7% with versus 17.9% without CKD). There was no difference in the incidence of postoperative AKI among patients who did and did not receive NSAIDs after lower urinary tract reconstruction, excluding those with advanced CKD. These results support that postoperative NSAIDs were an unlikely source of AKI. However, AKI remained a risk following these surgeries, regardless of NSAID use, likely owing to underlying disease, longer operations, and fluid shifts.

Short-term outcomes of surgical treatment for primary ileocaecal Crohn's disease: Results of the Crohn's(urg) study, a multicentre, retrospective, comparative analysis between inflammatory and complicated phenotypes.

Recent evidence challenges the current standard of offering surgery to patients with ileocaecal Crohn's disease (CD) only when they present complications of the disease. The aim of this study was to compare short-term results of patients who underwent primary ileocaecal resection for either inflammatory (luminal disease, earlier in the disease course) or complicated phenotypes, hypothesizing that the latter would be associated with worse postoperative outcomes. A retrospective, multicentre comparative analysis was performed including patients operated on for primary ileocaecal CD at 12 referral centres. Patients were divided into two groups according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. A total of 2013 patients were included, with 291 (14.5%) in the ICD group. No differences were found between the groups in time from diagnosis to surgery. CCD patients had higher rates of low body mass index, anaemia (40.9% vs. 27%, p < 0.001) and low albumin (11.3% vs. 2.6%, p < 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3% vs. 93.1%, p = 0.001) and higher conversion rates (9.3% vs. 1.9%, p < 0.001). CCD patients had a longer hospital stay and higher postoperative complication rates (26.1% vs. 21.3%, p = 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1% vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgery (OR 3.44, p = 0.001) and the requirement for multiple intraoperative procedures (OR 8.39, p = 0.030). Indication for surgery in patients who present with an inflammatory phenotype of CD was associated with better outcomes compared with patients operated on for complications of the disease. There was no difference between groups in time from diagnosis to surgery.

Unlocking the Role of Language and National Culture: Effects on Supply Chain Operations in a Global Context

We investigate how language, an essential part of culture, affects manufacturing firms’ supply chain operations management practices, including the cash conversion cycle and its components. Based on the Sapir–Whorf hypothesis, which theorizes that a language's structure may affect how its speakers think, prior studies have established that using the future tense to describe future events increases one's mental distance from the future, reducing a person's concern about it. Building upon this foundation, we hypothesize that firms in weak future-time reference countries are likely to be better prepared for future volatility in demand for their products and therefore carry higher inventory to avoid potential stockouts. We also hypothesize that firms in weak future-time reference countries are more apprehensive about long-term relationships with their customers and hence extend longer credit terms to them. Finally, we hypothesize that firms in weak future-time reference countries have longer operating and cash conversion cycles due to carrying higher levels of inventory and extending longer credit terms to customers. The empirical results using a large global sample of 193,625 firm-year observations from 45 countries support our hypotheses. In terms of economic significance, on average, the cash conversion cycle of firms in weak future-time reference countries is ∼ 11% longer than that of firms in strong future-time reference countries. We also find that the effect of language is dominant over the influence of traditional cultural dimensions. Together, the results suggest that time encoding in the language of a firm is a determining factor in its supply chain operations.

Divergent Trends in Postoperative Length of Stay and Postdischarge Complications over Time

There is a push toward shorter length of stay (LOS) after surgery by hospitals, payers, and policymakers. However, the extent to which these changes have shifted the occurrence of complications to the postdischarge setting is unknown. The objectives of this study were to (1) evaluate changes in LOS and postdischarge complications over time and (2) assess factors associated with postdischarge complications. Patients who underwent surgery across five specialties (colorectal, esophageal, hepatopancreatobiliary [HPB], gynecology, and urology) were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) procedure-targeted database (2014-2019). Trends in the proportion of postdischarge complications within 30 days of surgery and predictors of postdischarge complications were assessed using multivariable logistic regression. Among 538,172 patients evaluated, median LOS decreased from 3 (2014) to 2 days (2019) (p < 0.001). Overall, 12.2% of patients experienced a 30-day complication, with 50.4% occurring postdischarge. with the highest in hysterectomy (80.9%), prostatectomy (74.6%), and cystectomy (54.6%). The overall postoperative complication decreased, but the proportion of postdischarge complications increased from 44.6% (2014) to 56.4% (2019) (p < 0.001), including surgical site infection (superficial/deep/organ space/wound dehiscence), other infection (pneumonia/urinary tract infection/sepsis), cardiovascular (myocardial infarction/cardiac arrest/stroke), and venous thromboembolism. Factors associated with an increased odds of postdischarge complications included Hispanic or other race, higher American Society of Anesthesiologists class, dependent functional status, increased body mass index, higher wound class, inpatient complication, longer operation, and procedure type (HPB/colorectal/hysterectomy/esophagectomy, vs. prostatectomy) (all p < 0.001). This comprehensive retrospective analysis across five representative surgical specialties highlighted that although LOS has decreased over time, the proportion of postdischarge complications has increased over time. Focusing on the development of a comprehensive, proactive, postdischarge monitoring system to better identify and manage postdischarge complications is necessary.

An Interdisciplinary, Comprehensive Recovery Pathway Improves Microsurgical Breast Reconstruction Delivery.

Free-flap (autologous) breast reconstruction demonstrates superiority over alloplastic approaches but is offered infrequently. Enhanced recovery protocols can address postoperative challenges, but most literature is limited to inpatient interventions and outcomes. This study describes an adoptable, longitudinally comprehensive and multidisciplinary recovery pathway for autologous reconstruction which adds to the current guidelines. The authors aimed to allow perioperative outcomes comparable to alloplastic reconstructions. All autologous Comprehensive Recovery Pathway (CRP) subjects from a single surgeon were retrospectively included. A comparator group of equal size was randomly selected from institutional subpectoral and dual-plane tissue expander patients having Enhanced Recovery After Surgery guideline-directed care. All subjects in both cohorts received preoperative paravertebral regional blocks. Operative detail, inpatient recovery, longitudinal morphine equivalents (MEs) required, and complications were compared. Each cohort included 71 cases (99 breasts). Despite longer operations, intraoperative MEs were fewer in autologous cases ( P = 0.02). Morphine equivalents during inpatient stay were similar between cohorts, with both being discharged on median day 2. Multivariate regression demonstrated a 0.8-day increased stay for autologous subjects with additional contribution from bilateral cases, body mass index, and age ( P < 0.05). Autologous subjects were regularly discharged postoperative day 1 (17%) and postoperative day 2 (39%), with trend toward earlier discharge ( P < 0.01). Outpatient MEs were significantly fewer in autologous subjects, corresponding to a 30- to 150-mg oxycodone difference ( P < 0.01). Major complication occurred in 12.7% of autologous and 22.5% of alloplastic subjects ( P = 0.11). Flap loss occurred in 1 autologous subject versus 11 alloplastic failures ( P < 0.01). This study details partnership between the plastic surgery service, regional and acute pain anesthesia services, and dedicated nursing with longitudinal optimizations allowing perioperative outcomes improved over current literature. Patients in the CRP used fewer opioids from operation through follow-up with comparable length of stay and significantly fewer reconstructive failures than alloplastic subjects. The pathway may be quickly adopted into academic practice patterns and mitigates traditional barriers, allowing extension of autologous reconstruction offerings.

Automated traffic monitoring of neurosurgical operating room

Operating room (OR) traffic disrupts airflow and increases particle count, which predisposes patients to surgical site infections, particularly in longer surgeries with hardware placement. The aim of this study is to evaluate the rate of traffic during neurosurgical procedures, as well as reasons for and perceptions of OR traffic. This is a single-center, multimethod study monitoring neurosurgical OR traffic through direct observation, automated monitoring, and interviews. Traffic was observed between the skin incision and closure. Personal interviews with OR teams including surgeons, anesthesia, and nurses were conducted to evaluate their perceptions of the frequency of OR traffic and reasons for OR traffic. Direct observation reported OR door opening an average of 18 times, with 20 people entering or exiting per hour. The exact reason for traffic was not verified in all traffic cases and was able to be confirmed in only a third of the cases. Automated monitoring resulted in an average of 31 people entering or exiting the OR per hour. The procedure length was significantly associated with the number of people entering or exiting the OR per hour (P<.0001). Interviews highlighted that OR teams reported traffic to be significantly lower than observed and automated monitoring results, with approximately <6 people entering or exiting per hour. OR traffic is higher than staff expected, and updated processes are required to reduce the number of times the OR door opens. Implementing automated observation of OR traffic could reduce the OR traffic and the risk for surgical site infection.

P433 Short-term outcomes of surgical treatment in primary ileocecal Crohn’s disease patients. Results of Crohn’s(urg) study, multicenter, retrospective, comparative analysis between indications for luminal and complicated phenotype

Abstract Background Recent evidence challenges the current standard of offering surgery to patients with ileocecal Crohn’s disease only when they present complications of the disease. Methods A retrospective, multicenter comparative analysis was performed including patients operated for primary ileocecal CD at 12 referral centers. Patients were divided in 2 groups, according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. Patients operated on for primary isolated ileocaecal CD (last 50 cm of the terminal ileum and cecum), either for predominantly inflammatory phenotype or for complications of the disease (stricturing or fistulizing pattern), between January 2012 - December 2021 were considered eligible to participate in this study. Patients with previous abdominal procedures for CD, and patients who had activity of the disease in other intestinal segments other than the ileocaecal region at the time of surgery, were excluded from the study. Results 2013 patients were included, 291 (14.5%) in the ICD group. No differences were found between groups in time from diagnosis to surgery or in the levels of exposure to biologic drugs before indication of surgery. CCD patients had higher rates of low BMI, anemia (40.9 vs. 27%, p: &amp;lt; 0.001), and low albumin (11.3 vs. 2.6%, p: &amp;lt; 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3 vs. 93.1%, p: 0.001), and higher conversion rates (9.3 vs. 1.9%, p: &amp;lt; 0.001). CCD had longer hospital stay and higher postoperative complication rates (26.1 vs. 21.3%, p: 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1 vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgeries (OR: 3.44, p: 0.001) and requirements of multiple intraoperative procedures (OR: 8.39, p: 0.030). Conclusion Indication of surgery in patients who present an inflammatory phenotype of CD was associated with better outcomes when compared to patients operated on for complications of the disease, without a difference between groups in time from diagnosis to surgery.

Upaya Peningkatan Program Keagamaan Melalui Kegiatan Perayaan 1 Muharram Dan Pelestarian MDA Al-Abror Di Desa Aek Godang

Real work education (KKN) is a service to the community carried out by students through the guidance of lecturers. This service aims to establish synergy between universities and the community, especially for students to apply the knowledge gained from higher education. In welcoming the month of Muharram, the people of Aek Godang have never celebrated 1 Muharram and also the MDA School in Aek Godang Village experienced obstacles because one of the facilities was that students did not meet the capacity they should have to carry out learning at the MDA. This research aims to practice 1 Muharram and also preserve MDA which is no longer operating. The results of this research reveal that: 1. The practice of Muharram 1 in Aek Godang village, Hulu Sihapas sub-district, North Padang Lawas Regency, namely the implementation of recitations by inviting teachers to deliver tausiyah regarding the Islamic New Year.2. Conservation of MDA Al ABROR Aek Godang Village, Hulu Sihapas District, North Padang Lawas Regency, namely socializing to children that studying religion is just as important as gaining general knowledge and also telling children that studying religion is an important thing because it is guides and also guidelines for the life of Muslims.

Clinical Features and Postoperative Mobilization following Total Aortic Arch Replacement.

Open thoracic aortic surgery is believed to necessitate more intensive rehabilitation. This study aimed to compare the progress of postoperative rehabilitation between standard and delayed mobilization. A retrospective review was conducted on 199 patients who underwent isolated total aortic arch replacement via median sternotomy. Cases of in-hospital mortality and postoperative stroke were excluded. Based on the current guidelines for cardiovascular rehabilitation of the Japanese Circulation Society, patients were categorized into standard mobilization (could sit on the edge of bed within 2 days) and delayed mobilization (could not do so) groups. Rehabilitation progress was compared among both groups. Initial mobilization was delayed in 100 patients (delayed mobilization group), primarily because of respiratory failure (46.0%). Preoperative risk characteristics, including EuroSCORE II (median, 2.9 versus 3.5), were similar between the standard and delayed mobilization groups. The delayed mobilization group had longer operation (median, 6.1 versus 8.0 hours, P < 0.001) and cardiopulmonary bypass (median, 3.2 versus 4.1 hours, P < 0.001) times. Independent ambulation occurred earlier in the standard mobilization group (median, 6.0 versus 8.0 days, P < 0.001).In conclusion, early initiation of sitting on the edge of the bed within 2 days was associated with earlier independent ambulation during postoperative rehabilitation, which supports the current guidelines. Longer operation and cardiopulmonary bypass times were associated with delayed mobilization initiation, suggesting the need for more tailored approaches in such cases.

Эпилептический статус в раннем послеоперационном периоде у пациентов с диффузными глиомами головного мозга

Study objective. To develop knowledge of the epileptic status (ES) in early post-op period in patients with diffuse brain gliomas. Design. Single-centre retrospective study. Materials and methods. The study group included 280 patients with diffuse brain gliomas: 156 males (55.71%) and 124 females (44.29%). The average age of subjects was 45.81 ± 15.90 years. To identify the diffuse glioma sub-type, 118 patients underwent an examination of frequent mutations of genes IDH1 (exon 4) and IDH2 (exon 4) in tumour tissue using a high-resolution analysis of PCR product melting profile and sequencing. Results. ES in early post-op period developed in 3.57% of cases (n = 10) and manifested predominantly with motor symptoms (paroxysmal, myoclonic, focal motor symptoms). Epilepsy diagnosed before surgery was not a risk factor of ES in early post-op period. Awake surgeries, aiming at determination of the functionally significant (verbal, motor) areas of the brain, as well as the use of intraoperative neurophysiological monitoring (direct cortex stimulation during surgery) did not increase the rate of ESs. It has been demonstrated that ES in patients with diffuse brain gliomas can develop after a longer surgery (p = 0.0129) or longer anaesthesia (p = 0.0251). The association between ES in early post-op period and cerebral complications has been reported: in patients with complications, the rate of ESs was 17.07% vs. 1.26% (p &lt; 0.00001). in patients without complications. The rate of early ESs did not drop with preventive antiepilepsy drugs prescribed to patients with diffuse brain gliomas without pre-op epilepsy, as well as with prolonged sedation with propofol and artificial lung ventilation. Conclusion. ES in early post-op period requires separate diagnostic and treatment algorithms. Keywords: diffuse brain gliomas, post-op period, epilepsy, epileptic status, antiepilepsy drugs.