Lower Postoperative Mortality Research Articles

Association between geriatric co-management and receipt of rehabilitation services in the inpatient postoperative period among older adults with cancer.

Geriatric co-management is associated with a lower postoperative mortality among older adults with cancer. This might be due to a higher use of rehabilitation services such as physical therapy (PT) or occupational therapy (OT). In this study, we assess the relationship between geriatric co-management and PT /OT use. This is a retrospective cohort study of adults aged 75years and older with cancer who underwent elective surgery at Memorial Sloan Kettering Cancer Center between February 2015 and February 2018. We used two separate multivariable logistic regression models for PT and OT, adjusted for age at surgery, gender, American Society of Anesthesiology score, preoperative albumin, operative time, and estimated blood loss. We also evaluated the association between frailty and receipt of PT and or OT using separate models by additionally including frailty as a primary predictor. Of the 1650 patients, 308 (19%) did not receive PT or OT, 747 (45%) received only PT, and 593 (36%) received both PT and OT. Geriatric co-management was significantly associated with higher PT use (OR = 1.58, 95% CI = 1.19, 2.11, p = 0.002) and higher OT use (OR = 1.36, 95% CI = 1.08, 1.71, p = 0.010). The associations between geriatric co-management and rehabilitation service remained after additional adjustment for frailty. Higher degree of frailty was also associated with higher PT use (OR = 1.11, 95% CI = 1.01, 1.22, p = 0.033) and higher OT use (OR = 1.25, 95% CI = 1.15, 1.34, p < 0.0001). Geriatric co-management and frailty were associated with greater use of PT and OT. Future studies should investigate the impact of geriatric co-management on functional recovery.

Upfront Surgery vs. Endoscopic Stenting Bridge to Minimally Invasive Surgery for Treatment of Obstructive Left Colon Cancer: Analysis of Surgical and Oncological Outcomes.

Left colon cancer obstruction treatment is a debated topic in the literature. Stent placement is effective as a bridge-to-surgery strategy, but there are some concerns about the oncological safety for the reported higher risk of local and peritoneal recurrence. This study aims to compare the surgical and oncological outcomes of patients treated with stent followed by elective surgery with those treated with primary resection. This is a retrospective observational study. We included patients of both sexes, ≥18 years old, with a histological diagnosis of intestinal adenocarcinoma, and admitted to our hospital for left colon cancer obstruction demonstrated by CT scan without metastasis or perforation. They were treated through primary resection (PR) or stent placement followed by elective surgery (SR). The two groups were compared for general characteristics, surgical outcomes, and oncological outcomes (metastasis and local recurrence) at 30 days, 90 days, 1 year, and 3 years. Post-operative quality of life (QoL) was also investigated. The SR group showed a shorter hospital stay, a lower post-operative mortality, a lower stoma rate at 1 year, and a higher number of minimally invasive procedures. Oncological outcomes were not different compared to the PR group. The SR group demonstrated better QoL in two out of six items on the EQ-5D-5L test. Stent placement as a bridge-to-surgery strategy is feasible and provides better surgical outcomes in terms of post-operative complications, surgical approach, stoma rate, and QoL. Oncological outcomes were not reported differently, but further studies should be conducted to better evaluate this aspect.

Outcomes and Complications of Posterior Fossa Surgery in Sitting Versus Park-Bench Positions.

Background/Objectives: Patient positioning during surgery can influence intra- and postoperative complications. Therefore, we assessed the impact of the sitting and park-bench positions on anesthetic parameters and complications in neurosurgical patients. Methods and Patients: For this retrospective study, 314 adults who underwent neurosurgical procedures for posterior fossa pathologies were divided into two groups: sitting (n = 231) and park-bench (n = 83). The following data were collected, monitored, recorded, and compared: age, sex, tumor type, surgical approach, cardiovascular and respiratory complications, and postoperative surgical complications. The association of hypotension with the position was further investigated through multivariate logistic regression models by adjusting for CO2 decrease, desaturation, and documented gas embolism. Results: The average age was significantly lower in the sitting group (55 years, interquartile range (IQR) = 43-63; female proportion = 59.74%) than in the park-bench group (62 years, IQR = 45-74; female proportion = 57.83%) (p < 0.001). Cerebellopontine angle tumors were detected in 37.23% of the patients who underwent an operation in the sitting position and in 7.26% who underwent an operation in the park-bench position (p < 0.001). Patients in the sitting position had significantly greater anesthetic complication (91.77% vs. 71.08%, p < 0.001), hypotension (61.9% vs. 16.87%), and >2 mmHg CO2 decrease (35.06% vs. 15.66%, p < 0.001) incidences. Hypoxemia and death occurred more frequently in the park-bench group (8.43% vs. 1.73% and 6.03% vs. 1.3%, respectively). Conclusions: Compared with the park-bench position, the sitting position was associated with a greater specific anesthetic complication incidence and lower postoperative mortality rate, indicating a need for careful risk-benefit assessment when selecting each individual patient's surgical position.

Use of selective internal radiation therapy with yttrium-90 as a bridge to liver resection: a 5-year single-center experience

Selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) has been historically reserved for unresectable liver malignancy. Evidence is emerging for the use of SIRT to increase future liver remnant (FLR), allowing for the resection of previously inoperable disease. This was a 5-year retrospective review of all patients undergoing SIRT with Y-90 at a tertiary institute. Patient demographics, clinicopathologic data, surgical details, and postoperative outcomes were reviewed. The primary outcome, safety of liver resection after SIRT, was evaluated with 90-day morbidity and mortality. A total of 134 SIRT procedures were performed on 113 patients. Post-SIRT complications occurred in 18 patients (15.9%), with a single 30-day mortality. In addition, 17 patients underwent SIRT with the intent to augment FLR for liver resection. After SIRT, mean hepatic mebrofenin extraction and FLR increased from 2.5%/min/m2 and 30.5% to 4.2%/min/m2 and 52.5% (P=.01 and P<.0001, respectively). Ten patients underwent resection, and there were 2 intraoperative complications. The median time from SIRT to resection was 5.2 months. The 90-day postoperative morbidity was 20% (n=2), and complications were analyzed according to the Clavien-Dindo II classification scale. There was no 30-day or 90-day postoperative mortality. Post-SIRT liver resection is a challenging procedure with low postoperative mortality and morbidity.

Management of thoracic aortic graft infections with combined omental and bilateral pectoralis major flaps

BackgroundAortic vascular graft/endograft infection (VGEI) has historically been managed through graft removal and re-replacement, but new approaches suggest vascularized tissue transfer is an effective adjunctive treatment. Here we describe our experience with treating thoracic aortic vascular graft infection with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps. MethodsAll patients undergoing combined flap closure by the senior author at a high-acuity cardiac surgery center from 1995-2023 were reviewed. Patients with clinical and radiographic signs of thoracic aortic vascular graft infection were included. ResultsComplete data were available for 598 patients with sternal and mediastinal wounds. Combined PMM and omental flaps were mobilized in 11 thoracic aortic vascular graft infection patients. Indications for flap management included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy due to hemodynamic instability (5/11; 45.5%). During chest exploration, 6/11 (54.5%) underwent complete removal of the infected graft, compared to 5/11 (45.5%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 6/11 (54.5%). Post-op complications included dehiscence (2/11; 18.2%), seroma (1/11; 9.1%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One patient (9.1%) died within 30 days of sternal reconstruction from mitral valve failure tachyarrhythmia. None has undergone reoperation for flap-related complications. ConclusionsDespite significant comorbidities, low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective adjunctive treatment to the antimicrobial and surgical management of select thoracic aortic vascular graft infections.

The Clinicopathological Characteristics and Surgical Treatment of Gastrointestinal Neuroendocrine Neoplasm-A 10-Year Single-Center Experience.

Background: Gastrointestinal neuroendocrine neoplasms (GI-NENs) represent a diverse group of tumors, with surgical resection being the gold standard for treatment. Materials and Methods: A retrospective analysis was conducted on 63 patients (32 women, 31 men) who underwent surgery for GI-NENs at the Department of Digestive Tract Surgery from January 2013 to June 2023. Tumors were classified by stage (localized, regionally advanced, metastatic). Results: Clinical symptoms were reported by 42 (66.7%) patients, with abdominal pain being the most common symptom, affecting 28 (44.4%) patients. The majority of tumors (44, 69.8%) originated in the midgut. The most frequently performed surgery was right hemicolectomy, carried out on 33 (52.4%) patients. Radical tumor resection was performed in 35 (55.6%) patients. Postoperative complications occurred in 12 (19%) patients, with male gender identified as an independent predictive factor for complications (p = 0.04). Non-functioning tumors were more common (33, 52.4%), and most tumors were classified as grade 1 histopathologically (49, 77.8%). Distant metastases were present in 29 (46%) patients. The overall two-year survival rate was 94.9%, with a five-year survival rate also estimated at 94.9%. Conclusions: GI-NENs are often diagnosed at advanced stages, frequently with distant or lymph node metastases, and predominantly arise in the midgut. Despite low postoperative morbidity and mortality, male gender may be a predictor of postoperative complications. Overall, the prognosis for GI-NENs is favorable, reflected in high overall survival rates.

IMMEDIATE RESULTS OF MINIMALLY INVASIVE SURGERY FOR COMPLICATED PEPTIC ULCERS OF THE STOMACH AND DUODENUM

Objective: To enhance the immediate treatment outcomes of complicated peptic ulcers of the stomach and duodenum through the development and application of video-assisted organ-preserving surgeries. Materials and Methods: This study analyzed the treatment outcomes of 261 patients with complicated gastric and duodenal ulcers. The patients received the treatment in the surgical departments of Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Scientific Surgical Center named after M.A. Topchubashev, and Sabunchi Medical Center from 2015 to 2023. All patients with perforated and bleeding ulcers of the stomach and duodenum underwent clinical and instrumental examinations. The initial general condition of the patient was thoroughly assessed. Among the patients, there were 220 men (84.3%) and 41 women (15.7%), with ages ranging from 18 to 84 years. There were 75 (28.7%) patients complicated with bleeding of gastric and duodenal ulcer, and 186 (71.3%) patients with perforation. In the control group, traditional, "open" surgical interventions were performed in 164 (62.8%) patients, and minimally invasive endoscopic video-assisted operations were performed in 97 (37.2%) cases. Out of 186 patients, 124 (66.7%) underwent traditional suturing of a perforated gastroduodenal ulcer during laparotomy, while 62 (33.3%) underwent minimally invasive endosurgical interventions. In the control group, 12 (8.4%) patients underwent gastric resection, and 10 (5.4%) underwent vagotomy with pyloroplasty. The immediate results of radical operations for a perforated ulcer were characterized by a high percentage of early complications, with 5 (41.6%) cases. Results. Of the 186 patients operated on for perforated gastroduodenal ulcer, 12 individuals (6.5±2.9%) developed complications in the postoperative period: 9 (7.3%) in the comparison group, and 3 (4.8%) patients in the main group. We obtained a statistically significant shorter duration of a surgical intervention by 24.8 minutes and shorter hospital staying time due to a decrease in the duration of the postoperative period by 5.3 days, a lower number of postoperative complications by 2.5%, and a lower postoperative mortality by 2.4%. The duration of laparoscopic suturing of a perforated ulcer averaged 38.6 minutes. The duration of hospital staying averaged 6.9±1.2 days. The use of minimally invasive interventions for ulcerative duodenal bleeding was accompanied by a significant reduction in the rehabilitation period compared with that after traditional, "open" operations that amounted to 18.3+3.6 and 35.5±5.9 days, respectively. Postoperative mortality was 1.3% (1 patient in the control group died). Conclusion. The outcome of treatment depends on the age of patients, the timing of the onset of the disease, the severity of concomitant pathology, the severity and extent of peritonitis and the duration of ulcerative anamnesis.

Why are Joint Replacement Registries Needed?

Summary. Joint replacement registries are well established and have an important impact on decision making and clinical practice. The objective of this article was to review orthopedic registries to examine aspects of patient demographics, implant use, and revision outcomes in relation to knee replacement surgery. Six national arthroplasty registries with more than 10 years of data were selected for a review. Despite the geographic diversity, the demographics of patients referred for surgery and subcategories of surgery were remarkably similar. For cemented total knee replacement, minimally stabilized devices have been preferred in most countries, and a revision-free result can be expected in more than 94% of cases after 10 years. Partial replacements were used in 6% to 15% of primary cases and had higher revision rates than total replacements, but had lower postoperative mortality and fewer infectious complications. Patellofemoral replacements are used in 1% or less of cases and have a high revision rate.

Coronary Insufficiency: "surgery or angioplasty"

Surgery for coronary insufficiency begins with surgery to eliminate the pain of angina pectoris by cutting the sensory nerve pathways to the heart. Subsequently, surgeons attempted to revascularise the myocardium indirectly, by causing adhesions between the heart and various tissues, altering the direction of coronary circulation or creating artificial shunts in the myocardium by implanting the internal mammary artery directly into the left ventricle. But all these techniques proved insufficient, and surgeons turned to direct revascularisation of the coronary arteries. It was in 1968 that the first direct coronary revascularisation by bypass with the long saphenous vein was performed. Under the impetus of the pioneers of cardiac surgery, this type of surgery took off, helped by the development of extracorporeal circulation. Coronary surgery evolved at every level, with the development of microsurgical techniques for anastomoses, the use of arterial grafts, which are more durable than veins, and complete revascularisation. Over time, this surgery will prove to be reliable and reproducible, with excellent results and very low post-operative mortality and infarction rates. Above all, it will improve quality of life and long-term survival. Coronary surgery is still today an indispensable therapeutic tool in the treatment of ischaemic coronary disease.

Sub-lobar resections for peripheral non-small cell lung cancer measuring ≤ 2 cm: Insights from recent clinical trials

The findings of two well conducted trials that randomised 1803 patients with a peripheral non-small cell lung cancer measuring ≤ 2 cm to a lobar to sub-lobar resection have established the latter as a new standard of care. It is important for non-surgical oncologists to appreciate the details of study design and outcomes of both studies, given the possible impact they have for considerations of stereotactic ablative radiotherapy (SABR) for operable patients with early-stage NSCLC. Differences in overall survival between the study populations highlight the impact of confounding factors like smoking history and comorbidities on reported outcomes. For example, despite low post-operative mortality rates in both trials, the 5-year disease-free survival rate in the CALGB 140503 trial was only approximately 60 % with either surgical procedure. Both phase III trials required guideline recommended nodal staging, which does not reflect real world surgical practice, and which may limit the generalisability of the reported findings to local institutional outcomes. Furthermore, the emergence of other malignancies was recorded in 15–18 % of study patients during follow-up, and patients who underwent sub-lobar resections had a better long-term survival associated with a higher likelihood of undergoing additional curative treatments. These findings from the JCOG0802 and the CALGB 140503 will encourage more interest in enrolling patients into ongoing trials comparing surgical resection with SABR.

Why are Joint Replacement Registries Needed? Part 2. Overview of Several National Registries of Knee Arthroplasty

Summary. Joint replacement registries are well established and have an important impact on decision making and clinical practice. The objective of this article is to review orthopedic registries to examine aspects of patient demographics, implant use, and revision outcomes in relation to knee replacement surgery. Six best known national arthroplasty registries with more than 10 years of data were selected for a review. Despite the geographic diversity, the demographics of patients referred for surgery and subcategories of surgeries were remarkably similar. For a cemented total knee replacement, minimally stabilized devices have been preferred in most countries, and a revision-free result can be expected in more than 94% of cases after 10 years. Partial replacement (lateral lateral or medial unicompartmental) was used in 6% to 15% of primary cases and had higher revision rates than total replacement, but had lower postoperative mortality and fewer infectious complications. Patellofemoral replacements are used in 1% or less of cases and have a high revision rate.

Swedish registry study showed that 50% of paediatric operations were performed in university hospitals and mortality was low.

To investigate the distribution of paediatric surgery in various hospitals and to study postoperative risk factors of mortality. Retrospective registry-based cohort study of children aged 0-14 years undergoing surgery from 2017 to 2021. Data were extracted from the Swedish Perioperative Registry. A mixed logistic regression was applied for the all-risk mortality analysis. A total of 126 539 cases were identified, 50% in university, 36% in county and 14% in district hospitals. The dominating operations were appendectomy in 6667, orchidopexy in 5287, inguinal hernia repair in 4200 and gastrostomy in 1152 children. Among children under 1 year of age or American Society of Anesthesiologists Physical Status classification (ASA-PS-Class) 3-5, the majority underwent surgery in university hospitals. The 30-day mortality in university hospitals was 0.5% and in county hospitals 0%. The proportion of emergency surgery was similar in university and county hospitals. Independent risk factors of mortality were being under 1 year of age, ASA-PS-class 4-5, emergency surgery and surgery at university hospitals. Half of all operations in children were performed in university hospitals, with low postoperative mortality despite effective centralisation of high risk patients <1 year of age or ASA-PS-Class 3-5.

Minimally Invasive Gastrointestinal Surgery: A Review.

Minimally invasive surgery uses several procedures with fewer side effects (bleeding, infections, etc.), a shorter hospital stay, and less discomfort following minimally invasive surgery. Laparoscopy was one of the first forms of minimally invasive surgery. It involves doing surgery while using tiny cameras through one or more small incisions, surgical tools along with tubes. Robotic surgery is another kind of minimally invasive procedure.Along with supporting accurate, flexible, and regulated surgical procedures, it provides the physician with a three-dimensional, enlarged view of the operative site. Minimally invasive surgery continues to advance, making it an advantage for patients with a variety of illnesses.Nowadays, many surgeons prefer it to traditional surgery, which frequently necessitates a longer hospital stay and requires larger incisions. Since then, numerous surgical specialties have greatly increased their use of minimally invasive surgery. A minimally invasive procedure is preferred for the majority of patients who require gastrointestinal surgery. Minimally invasive gastrointestinal procedures are just as successful as open procedures and, in some situations, may result in more effective outcomes. While recovery from open surgeries frequently takes five to ten days in the hospital, minimally invasive surgeries are less painful for patients and hasten recovery. It is safe from the perspective of the patient and has a lower postoperative mortality rate. This procedure involves a learning curve among surgeons.

Abstract 13814: Combined Omental and Bilateral Pectoralis Major Flaps for Treatment of Thoracic Aortic Graft Infections

Introduction: Aortic graft infections have historically been managed through graft removal and replacement. However, coverage with vascularized tissue flaps may provide an effective alternative, particularly in patients who are not able to undergo extended extra-anatomic bypass procedures. Hypothesis: Here we describe our experience treating thoracic aortic graft infections with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps. Methods: All patients undergoing sternal wound treatment with PMM flaps by the senior author (JAA) at a high-volume cardiac surgery center from 1996-2023 were reviewed. Patients with evidence of aortic graft infection were included. Results: Complete data were available for 598 patients, 11 of whom had combined PMM and omental flaps mobilized for aortic graft infections. ASA score was &gt;4 in 9/11 (81.9%). At the index cardiac surgery, 11/11 (100%) underwent aortic root repair/replacement, and 9/11 (81.9%) also underwent aortic valve repair/replacement. Indications in this group for flap surgery included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy incision due to hemodynamic instability (5/11; 45.5%). During chest exploration, 7/11 (63.6%) underwent complete removal of the infected graft, compared to 4/11 (36.4%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 4/11 (36.4%). Intraoperative mediastinal cultures were positive in 3/11 (27.3%). Post-operative complications included dehiscence (1/11; 9.1%), seroma (2/11; 18.2%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One (9.1%) patient died within 30 days of sternal reconstruction from mitral valve failure and a tachyarrhythmia. None have undergone reoperation for flap-related complications, while one patient underwent elective resection due to aesthetic complaints. Conclusions: Low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective treatment for aortic graft infections.

A COMPARATIVE ANALYSIS OF PERFORMANCE INDICATORS FROM THE SURGICAL DEPARTMENT OF A MULTIDISCIPLINARY HOSPITAL IN DYNAMIC OVER 5 YEARS (2017-2021)

Many countries have actively implemented reforms over the last two decades to incrеase the productivity of their healthcare systems and the effectiveness of treatment and prevention activities. And the classical indicators of hospital performance such as the use of hospital beds and the quality of hospital care are the main indicators of good management in a hospital. Material and methods. The object of the study is the medical and statistical performance indicators of the surgical department and the surgical day hospital of the multidisciplinary hospital in Almaty for 5 years (2017–2021). As a source of information, an electronic database of the statistical department of the hospital was used. Medical statistical analysis was applied as a method of study. This type of study is a cross-sectional study based on a retrospective descriptive analysis of official statistics. Results. In terms of dynamics, the structure of those treated in the surgical department does not change. However, there is a significant decrease in the amount of planned surgical pathology compared to the slight drop in hospitalization (a decrease of -40%), possibly due to a decrease in the volume of government orders (a decrease of -43.4%). Within the framework of the state order, the indicator of the average length of stay of a patient in a hospital, in general, tends to decrease from 8,5 in 2017 to 8,2 in 2021. A higher level of surgical activity in the surgical department (76,4% vs. 62,6% in surgical departments in 2021), a lower postoperative complication rate (0,2% vs. 0,3%), and a lower postoperative mortality (0,7% vs. 1,1%) were stated as positive indicators of surgical service. In 2021, the frequency of emergency operations in the surgical department was roughly the same, at 19,1%; the total share of outpatient surgery (for all profiles) in the structure of all surgery was 11,3%. Conclusion. The identified deterioration in the use of hospital beds in the surgical department (decrease in bed turnover, increase in the average duration of one case of hospitalization, decrease in the planned number of bed days) requires improvement of the planning and control system for hospitalization. Perhaps this problem is relevant for many multidisciplinary hospitals

Atuais técnicas em cirurgia bariátrica e seus benefícios: Uma revisão da literatura

Introduction: Bariatric, restrictive and mixed (predominantly restrictive or malabsorptive) surgery is a therapy to reduce weight and control associated diseases. This literature review discusses the relevance of procedures approved by the Federal Council of Medicine (CFM) according to bibliographic references of significant scientific evidence. Objectives: To review the techniques currently used in bariatric surgery, advantages and disadvantages. Methods: Literature review of the techniques employed in bariatric surgery, by descriptors in Portuguese (techniques in bariatric surgery, gastric banding, vertical gastrectomy, Roux-en-Y gastric bypasses and biliopancreatic bypass). Results: Gastric banding is a silicone prosthesis wrapped around the stomach, which generates weight regain. Vertical gastroplasty reduces the stomach by a ring-mediated suture with good results but high recurrence. The intragastric balloon is the introduction of a silicone prosthesis with methylene blue, which must be removed after 6 months. Gastric bypass has low mortality and high efficacy, being the most used in Brazil. Vertical gastrectomy preserves the small intestine and partially the stomach, and its low postoperative mortality determines its frequent indication. The Scopinaro technique is 5% of the procedures performed in Brazil, the duodenal switch or vertical gastrectomy with intestinal detour generates nutritional deficiency. Conclusion: Comparing the surgical methods, it is up to the surgeon and the team, the particular analysis to decide which fits best for the patient. However, regardless of the technique used, scientifically it is the conduct with more positive results in the long term, compared to clinical approaches.

Effects of early enteral nutrition on pancreatic fistula and long-term prognosis after distal pancreatectomy or enucleation of pancreatic tumours in a major academic university hospital in China: protocol for a single-centre randomised controlled trial

IntroductionPostoperative pancreatic fistula (POPF) remains one of the main complications following pancreatic resection. Despite pancreatic fistula having a low postoperative mortality rate, the readmission and intervention rates in patients with...

Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis.

This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC). A systematic literature search was performed until December 2022 using the Scopus, Medline/PubMed and Web of Science databases. Seventeen studies have been included with a total of 783,672 patients (32,634 treated with PTGBD vs. 4663 who underwent laparoscopic cholecystectomy, 343 who had open cholecystectomy and 746,032 who had some form of cholecystectomy, but without laparoscopic or open approach being specified). An analysis of the results shows that PTGBD, despite being less invasive, is not associated with lower morbidity with respect to EC (RR 0.77 95% CI [0.44 to 1.34]; I2 = 99%; p = 0.36). A lower postoperative mortality was reported in patients who underwent EC (2.37%) with respect to the PTGBD group (13.78%) (RR 4.21; 95% CI [2.69 to 6.58]; p < 0.00001); furthermore, the risk of hospital readmission for biliary complications (RR 2.19 95% CI [1.72 to 2.79]; I2 = 48%; p < 0.00001) and hospital stay (MD 4.29 95% CI [2.40 to 6.19]; p < 0.00001) were lower in the EC group. In our systematic review, the majority of studies have very low-quality evidence and more RCTs are needed; furthermore, PTGBD is inferior in the treatment of AC in high-risk patients. The definition of high-risk patients is important in interpreting the results, but the methods of assessment and definitions differ between studies. The results of our systematic review and meta-analysis failed to demonstrate any advantage of using PTGBD over ER as a definitive treatment of AC in critically ill patients, which suggests that EC should be considered as the treatment of choice even in very high-risk patients. Most likely, the inferiority of PTGBD versus early LC for high-risk patients is related to an association of various patient-side factor conditions and the severity of acute cholecystitis.

Congenital Cystic Adenomatoid Malformation: A Case Report

The case report is being done to increase the knowledge of Congenital Cystic Adenomatoid Malformation (CCAM) along with to better understand about the disease and its management &amp; raise awareness. A female infant (aged 9 months and birth weight 2500 gm) was selected as participant. After physical examination, the state of the participant was good (fever:37.6ºC, heart rate: 120/min, respiratory rate: 40/min). Holding a good health certificate, a cystic image was identified at pulmonary artery in chest X-ray report. The histology findings were consistent with CPAM Type I. CPAM surgery, generally favorable, results in low postoperative morbidity and mortality. CPAM is a rare developmental malformation of lung that causes pulmonary compression and hypoplasia leading to respiratory distress but the postnatal management of asymptomatic CPAM remains controversial.

A COMPARISON OF FIVE-YEAR MORTALITY RATES FOLLOWING REVISION HIP ARTHROPLASTY FOR PERIPROSTHETIC FRACTURE, ASEPTIC LOOSENING, OR INFECTION AT A TERTIARY REFERRAL CENTRE

Mortality following revision hip surgery for periprosthetic fracture (PPF) has been reported to be as high as 60% at 5 years. The aim of this study was to determine the mortality rate for PPF revisions, compared to revision for aseptic loosening or infection at our tertiary referral centre.Revision arthroplasty procedures performed for PPF, aseptic loosening or infection between January 2014 and December 2015 at our institution were identified using a prospectively collected PPF referral database and locally collected NJR data. Comparisons were made between the 3 groups for baseline demographics, admission to higher-level care, length of stay, complications, and Kaplan-Meier failure (mortality) at 1 &amp; 5 years post-operative (with log-rank test for equality).There were 37 PPF, 71 infected and 221 aseptic revisions. PPF had a higher proportion of females (65% vs. 39% in infection and 53% in aseptic; p = 0.031) and grade 3 and 4 ASA patients (p = 0.006). Median time to surgery from injury for PPF was 8 days (95% CI, 6–16). Single-stage procedures were performed in 84% of PPF, 42% of infection and 99% of aseptic revisions (p &lt; 0.001). 19% of PPF revisions required HDU admission, 1% in the aseptic group and none in the infection group (p&lt;0.001). Median length of stay was significantly different (PPF 10; infection 14; aseptic 8 days (p &lt; 0.001). The Kaplan-Meier estimate of 1-year mortality were: PPF = 0%; infection = 2.8% (0.7–11.1%); aseptic = 0.9% (0.2–3.5%). 5-year mortality estimates were: PPF = 17.1% (8–34%), infection = 8.7% (4–18.3%), aseptic = 12% (8.4–17%). Log-rank test of equality was not significant, p=0.833.Despite the PPF group having an average delay to surgery of 8 days, higher ASA grades and more admissions to HDU there was no significant difference in mortality rates between the groups at 1 and 5 years postoperatively. Using a coherent MDT approach with dedicated healthcare professionals this service demonstrates a low post operative mortality rate which merits further investment and development.