Major Complications Research Articles

Effect of increased systemic oxygen delivery on postoperative outcomes and quality of life in elderly undergoing major abdominal surgery: A randomised controlled trial.

Studies comparing the intentional increase in oxygen delivery and normal oxygen delivery during general anaesthesia in elderly patients undergoing major abdominal surgery are limited and have reported contradictory findings. Therefore, the study aimed to evaluate the effect of intraoperative increase in systemic oxygen delivery on postoperative outcomes and quality of life in elderly patients undergoing major abdominal surgery. This randomised, blinded, parallel-arm, pragmatic clinical trial included elderly patients of >60 years of age undergoing major abdominal surgery. The patients in the intervention arm received noradrenaline or increased fractional inspiration of oxygen to augment central venous oxygen saturation ⩾75%. The primary outcome measure was composite of in-hospital mortality and major organ complications. The secondary outcome measure included comparison of quality of life. A total of 160 patients were assessed for eligibility, and 146 were randomised in the study groups. The mean arterial and central venous oxygen saturation increased and were significantly higher in the intervention arm. The composite primary outcome occurred in 49.31% in the intervention arm and 57.53% in the usual care arm (relative risk; 95% confidence interval: 0.85; 0.63-1.16; absolute risk reduction; 8.22%; p = 0.32). Furthermore, quality of life at the end of three months was similar (0.658 ± 0.19 versus 0.647 ± 0.19; p = 0.771). In conclusion, central venous oxygen saturation-guided increase in systemic oxygen delivery during the intraoperative period of major abdominal surgery in elderly patients did not reduce predefined composite outcome of in-hospital mortality or organ-specific complications.

Enhancing sarcopenia risk assessment: Markedly low serum creatinine levels are independent predictors of major postoperative complications in gynecologic oncology patients

Enhancing sarcopenia risk assessment: Markedly low serum creatinine levels are independent predictors of major postoperative complications in gynecologic oncology patients

Esophagogastric cancer surgery characteristics and outcomes in bariatric patients, compared with non-bariatric patients.

The association between bariatric surgery and esophagogastric cancer (EGC) is debated. This study aimed to assess EGC characteristics and surgery outcomes comparing bariatric and non-bariatric patients. Single-center retrospective analysis of prospective EGC surgery database. EGC-surgery was performed in 269 patients, classified as bariatric (N.=10, 3.3%), and non-bariatric (N.=259, 96.6%) groups. Non-bariatric group was sub-classified into body mass index (BMI) <35 kg/m2 (N.=244) and >35 kg/m2 (N.=15). BMI was 35.3±5.6 vs. 25.7±16.1 and 37.8±8.7 kg/m2 in bariatric vs. non-bariatric-BMI <35 and >35, respectively (P<0.001). Bariatric patients were significantly younger (56.75±11 vs. 71±10 and 68.38±8.2 years; P<0.001). They tended to have lower rates of diabetes mellitus (30% vs. 43.9% and 73.3%; P=0.05) and significantly lower hypertension rates (50%, vs.86.5% and 93.3%, P<0.004). Bariatric procedures were performed 11.3 years (IQR 5.5-16.5) prior to EGC-surgery. Tumor characteristics were statistically comparable except a significantly higher number of positive LN in the bariatric group (6.9±13.6 vs. 2.7±4.9 and 1.9±4.8; P=0.006), and more bariatric patients received adjuvant treatment (P=0.035). Postoperative major complication rates (0% vs. 25.8%, and 33.3%; P=0.14) and length of hospital stay (14.1±15.3, vs. 23±28.5, and 21±18 days; P=0.59) were comparable. There was no significant difference in Disease- free survival (P=0.42) or overall survival (P=0.48) between patient-groups. Bariatric patients were diagnosed with EGC at a younger age, and tended to have worse nodal involvement. Although outcomes were comparable, clinical and endoscopic surveillance seem important as EGC can occur 10 years or earlier than in non-bariatric patients.

Laparoscopic hepatectomy versus microwave ablation for multifocal 3–5 cm hepatocellular carcinoma: a multi-centre, real-world study

Background: Researches comparing laparoscopic liver resection (LLR) with microwave ablation (MWA) for 3–5 cm multifocal hepatocellular carcinoma (MFHCC) are rare. Materials and methods: From 2008 to 2019, 666 intrahepatic tumours in 289 patients from 12 tertiary medical centres in China were included in this retrospective study. Propensity score matching (PSM) was performed to balance variables between the two treatment groups over time frames 2008–2019 and 2013–2019 to observe the potential impact of advancements in intervention techniques on overall survival (OS), disease-free progression (DFS) of patients. complications, hospitalization, and cost were compared. Results: Among 289 patients, the median age was 59 years [interquartile range (IQR) 52–66]. 2008–2019, after PSM, the median OS was 97.4 months in the LLR group and 75.2 months (95% CI 47.8–102.6) in the MWA group during a follow-up period of 39.0 months. The 1-year, 3-year and 5-year OS rates in the two groups were 91.8%, 72.6%, 60.7% and 96.5%, 72.8%, 62.5% [hazard ratio (HR) 1.03, 95% CI 0.62–1.69, P =0.920]; The corresponding DFS rates were 75.9%, 57.2%, 46.9%, and 53.1%, 17.5%, 6.2% (HR 0.35, 95% CI 0.23–0.54, P &lt;0.001). 2013–2019, the median OS time was not reached in either group during the 34.0 months of follow-up, the 1-year, 3-year and 5-year OS rates in the two groups were 90.2%, 67.6%, 56.7% and 96.5%, 76.7%, 69.7% (HR 1.54, 95% CI 0.79–3.01, P =0.210); The corresponding DFS rates were 69.6%, 53.9%, 43.3%, and 70.4%, 32.1%, 16.5% (HR 0.68, 95% CI 0.41–1.11, P =0.120). The incidence of major complications was similar in both groups (all P&gt; 0.05). MWA had shorter intervention times, hospitalization, and lower costs. Conclusions: For resectable MFHCC patients, LLR is preferable due to its lower recurrence rate. For patients who do not qualify for LLR, advances in ablation technology have promoted MWA as a promising alternative.

Incidence of Postoperative Complications among Patients with Active or Resolved COVID-19 Undergoing Elective Abdominal Wall Reconstruction

Background: The incidence of postoperative complications among patients with coronavirus disease 2019 (COVID-19) positivity undergoing elective surgical operations is poorly understood. This study aimed to identify differences in postoperative complications after elective abdominal wall reconstruction (AWR) in patients diagnosed with COVID-19 compared with patients presenting prepandemic. Methods: A single-institution, retrospective chart review was performed of patients undergoing AWR between January 2017 and September 2022. Patients were stratified by date: pre-COVID-19 (January 2017 to December 2019) and post-COVID-19 (January 2020 to September 2022). Patients confirmed as COVID-19-positive were also identified. Data collected included demographics, clinical characteristics, and complications. Univariate and multivariate analyses were performed. Results: We included 168 patients. The mean age was 54 years, and the mean body mass index was 33 kg/m2. Seventy-five patients underwent surgery pre-COVID-19 and 93 patients after. Of 93 patients, 16 (17%) had a positive COVID-19 test before surgery or during the perioperative period. These 2 groups were risk-matched. Patients with COVID-19 had no significant increase in postoperative complications. Major complications occurred at 13.3% in the pre-COVID-19 group and 7.5% in the post-COVID-19 group. Patients with COVID-19 were more likely to be younger (48 versus 57; P = 0.049) and more likely to have a shorter length of stay in the hospital (3 versus 5.8; P = 0.038). Conclusions: In our case series, there was an associated increase in the incidence of overall pulmonary-related complications in the postpandemic group. This study is limited by its small sample size. Further investigation should be carried out on this topic.

Cognitive function in older adults with stroke: A latent profile analysis

BackgroundPost-stroke cognitive impairment (PSCI) is one of the major complications after a stroke. Therefore, it is necessary to identify different categories of cognitive function in older adults with stroke and to explore factors associated with different levels of cognitive function in older adults after stroke. MethodsA cross-sectional survey was conducted using convenience sampling to collect data from 1076 older adults with stroke from 5 hospitals in Lanzhou City, Gansu Province, China, from June 2022 to August 2023. Latent Profile Analysis (LPA) was used to identify cognitive function subgroups among older adults with stroke, and multinomial logistic regression was used to analyze the related factors. Results1076 older adults with stroke were identified and classified as class-1: cognitive impairment, class-2: mild cognitive impairment, class-3: normal cognitive function. Age, gender, education level, hemorrhagic stroke, cerebrovascular disease are associated with different levels of cognitive function in older adults after stroke. ConclusionsThese findings highlight the heterogeneity of cognitive function in older adults with stroke. Our research could assist healthcare professionals in China to identify older adults with a high risk of cognitive impairment and to develop individualized interventions based on their characteristics.

Comparison of Complications and Mid-term Results for Patients who Underwent Open Radical Prostatectomy for High-Risk and Oligometastatic Prostate Cancer: A Cross-Sectional Study from a Tertiary Reference Center.

This study aimed to evaluate perioperative complications and oncologic results for high-risk and oligometastatic prostate cancer patients. The data of patients who underwent surgery for prostate cancer in the authors' clinic between January 2012 and March 2022 were analyzed retrospectively. According to D'amico classification, 28 patients with high-risk prostate cancer and 23 patients in the oligometastatic stage were included in the study. The patients were divided into two groups: group 1 (high-risk prostate cancers) and group 2 (oligometastatic cancer). Demographic characteristics, oncologic data, pathologic data, and complications of the patients were recorded. The mean age of the patients was 67.84 years (range, 52-79 years). The average follow-up period was 45.48 months for group 1 and 46.36 months for group 2 (p = 0.84). The mean hemoglobin decrease was 1.53 g/dL in group 1 and 0.69 g/dL in group 2 (p = 0.046). Five patients(17.8%) in group 1 had biochemical recurrence at 14.55 months, whereas three patients (13%) in group 2 had biochemical recurrence at 9.87 months (p = 0.646). According to Clavien-Dindo classification, major complications developed in 7.2% of the group 1 patients and in 8.6% of the group 2 patients. Surgical margin positivity was detected in 6 group 1 patients (21.4%) and 12 group 2 patients (52.2%) (p = 0.023). During the follow-up period, four patients died. Only one of the patients died of cancer. The authors think that oligometastatic and high-risk prostate cancer surgeries do not differ significantly in terms of complications.

The Impact of Exclusively Virtual Preoperative Evaluation on Complications of Gynecologic Surgery

Study ObjectiveTo evaluate the impact of virtual versus in-person preoperative evaluation on perioperative complication rates in a minimally invasive gynecologic surgery (MIGS) practice. DesignRetrospective cohort study. SettingQuaternary care academic hospital in the United States. ParticipantsPatients who underwent surgery with a MIGS surgeon between January 2016 and May 2023. InterventionsPatients underwent either in-person or virtual preoperative visits (defined as the initial consultation and any subsequent follow-up or preoperative counseling visits). Those who had both an in-person and virtual preoperative visit were excluded. Complication rates among the virtual and in-person cohorts were compared, and logistic regression was performed to adjust for potential confounders. ResultsThe analysis included 2,947 patients, 1,196 (40.6%) with exclusively virtual preoperative visits and 1,751 (59.4%) with exclusively in-person visits. Following the implementation of telemedicine in 3/2020, 80.6% of patients had all their preoperative visits conducted virtually via videoconference. Surgical approach included conventional laparoscopy (78.8%), robotic-assisted laparoscopy (3.8%), laparotomy (2.1%), and other gynecologic procedures without abdominal entry (15.3%). The most common procedures were endometriosis excision (43.1%), myomectomy (34.0%), and hysterectomy (24.8%). Composite perioperative complication rates were similar between cohorts (5.9% virtual vs. 6.3% in-person, adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.58-1.17). There were no significant differences for major complications (2.3% virtual vs. 1.2% in-person, aOR 1.52, 95% CI 0.85-2.74) or minor complications (5.7% virtual vs. 6.1% in-person, aOR 0.83, 95% CI 0.59-1.19). Conversion to laparotomy was rare in both groups (0.1% virtual vs. 0.2% in-person). ConclusionImplementation of virtual preoperative visits within a MIGS practice did not impact composite surgical complication rates. For subspecialized gynecologic surgeons, a virtual preoperative evaluation may offer a safe alternative to the traditional in-person visit.

Does serum neutrophil gelatinase–associated lipocalin level predict acute kidney injury in patients with acute rhabdomyolysis in the emergency department? A multicentre prospective study

ObjectivesThe major complication of rhabdomyolysis is acute kidney injury (AKI), which requires prompt treatment. Currently, few biomarkers are available for the early detection of AKI. Serum neutrophil gelatinase–associated lipocalin (NGAL) has been suggested as an early biomarker for renal ischemia. However, its capacity to predict AKI in patients presenting with rhabdomyolysis in the emergency department (ED) remains unclear. The aim of this study was to evaluate the ability of NGAL to predict 48-hour AKI.DesignProspective, multicentre study.SettingFive adult EDs in France from August 2013 to December 2015.ParticipantsNGAL levels were measured on ED admission in patients with rhabdomyolysis. A total of 197 patients were enrolled, and 189 (96%) were analysed, of whom 89 (47%) were women. Patients were included if they presented to the ED with rhabdomyolysis and a creatine phosphokinase (CPK) level above 1000 IU/L. Exclusion criteria were pregnancy, presentation with acute coronary syndrome, the need for iodinated contrast, chronic dialysis or recent use of nephrotoxic drugs (within 72 hours prior to the ED visit). Patients who withdrew consent or had AKI due to other causes were also excluded.Primary and secondary outcome measuresThe primary outcome was AKI at 48 hours, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary outcomes included in-hospital mortality, length of hospital stay, admission to intensive care and the need for renal replacement therapy.ResultsOverall, 54 (29%) patients developed AKI by day 2. The area under the ROC curve (AUC-ROC) for NGAL in predicting AKI on day 2 was 0.60 (95% CI 0.51 to 0.70), with an optimal cut-off of 129 ng/mL. The sensitivity was 0.65, and specificity was 0.50. After adjustment for CPK levels, age, sex and oxygen saturation, the AUC-ROC for predicting AKI on day 2 increased slightly to 0.64 (95% CI 0.54 to 0.74).ConclusionNGAL has limited ability to predict day 2 AKI in patients presenting with acute rhabdomyolysis in the ED.Trail registration numberNCT01544231.Comité de Protection des Personnes Sud Méditerranée III n°2011-A01059-32.

Surgical Algorithm of Poland Syndrome Based on Thorax, Breast, and Nipple-areola Complex Classification.

Poland syndrome (PS) is a rare congenital syndrome characterized by unilateral pectoralis major muscle defect. In 2016, we proposed the thorax, breast, and nipple-areola complex (TBN) classification and a subsequent treatment algorithm, which included conservative and surgical procedures. Our aim is to report the results we obtained treating all thoracic anomalies according to the proposed algorithm in a cohort of adolescents affected by PS. Between January 2016 and June 2023, 52 patients with PS were treated using the TBN classification in our institute. Each patient was evaluated by a multidisciplinary team composed of pediatric and plastic surgeons and treated according to the algorithm. Surgical procedures included were minimally invasive pectus excavatum repair, open sternochondroplasty, patch, metal plate, 3-dimensional chest wall prosthesis, fat grafting, tissue expanders, and breast and pectoral implants. Conservative treatments included vacuum bell and corset. Half of the patients had no thoracic skeletal defect (T1), but all had soft-tissues defects. Nineteen patients required thoracoplasty, all of whom experienced T downstaging after treatment, and 90% were postoperatively reclassified as T1. Conservative treatment for T correction was proposed in 8 patients; 83% underwent fat grafting, and 88% had a breast/pectoral prosthesis implanted. There were no major complications registered. The mean follow-up was 5.9 years. The proposed algorithm can be considered a useful tool for standardized surgical decision-making in PS. Fat grafting can play a major role in a pediatric setting. A multidisciplinary and minimally invasive approach, whenever possible, should be prioritized in patients younger than 18 years.

The Relationship Between Surgeon Volume and Major Surgical Complications After Total Shoulder Arthroplasty: An Evaluation of 3177 US Orthopedic Surgeons.

Total shoulder arthroplasty (TSA), which includes anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), is a technically demanding procedure and limited data exist on the relationship between case volume and complications. We sought to identify volume thresholds for TSA, aTSA, and rTSA at which risk of a major surgical complication decreased and to compare complications of patients treated by high-volume surgeons with those of patients treated by low-volume surgeons. Primary, elective TSAs (aTSA and rTSA) from January 1, 2016, to December 31, 2019, were identified in the Premier Healthcare Database. Multivariable logistic regression with restricted cubic splines modeled the relationship between annual TSA, aTSA, and rTSA surgeon volume and 90-day risk of major surgical complications. The 90-day complications of patients treated by high- and low-volume surgeons were compared. From 2016 to 2019, 3177 surgeons performed 78,639 TSAs. Increasing annual volume was associated with decreasing major surgical complication risk (thresholds: 50 TSAs, 25 aTSAs, and 36 rTSAs). High- and low-volume surgeons performed 24,595 and 54,044 TSAs, respectively. Patients of high-volume surgeons had lower risk of major surgical complications (adjusted odds ratio [aOR], 0.69; 95% CI, 0.56-0.84), myocardial infarction (aOR, 0.59; 95% CI, 0.36-0.97), and readmission (aOR, 0.71; 95% CI, 0.62-0.81). Importantly, 74.9% of high-volume and 93.0% of low-volume surgeon-year units had major surgical complication rates below the mean of all recorded surgeons. While most high- and low-volume surgeons had major surgical complication rates below the cohort average, increasing TSA volume was associated with a decreased risk of complications. [Orthopedics. 202x;4x(x):xx-xx.].

Heart rate variability analysis for the prediction of pre-arousal during propofol-remifentanil general anaesthesia: A feasibility study.

Accidental awareness during general anaesthesia is a major complication. Despite the routine use of continuous electroencephalographic monitoring, accidental awareness during general anaesthesia remains relatively frequent and constitutes a significant additional cost. The prediction of patients' arousal during general anaesthesia could help preventing accidental awareness and some researchers have suggested that heart rate variability (HRV) analysis contains valuable information about the patient arousal during general anaesthesia. We conducted pilot study to investigate HRV ability to detect patient arousal. RR series and the Bispectral IndexTM (BISTM) were recorded during general anaesthesia. The pre-arousal period T0 was defined as the time at which the BISTM exceeded 60 at the end of surgery. HRV parameters were computed over several time periods before and after T0 and classified as "BISTM<60" or "BISTM≥60". A multivariate logistic regression model and a classification and regression tree algorithm were used to evaluate the HRV variables' ability to detect "BISTM≥60". All the models gave high specificity but poor sensitivity. Excluding T0 from the classification increased the sensitivity for all the models and gave AUCROC>0.7. In conclusion, we found that HRV analysis provided encouraging results to predict arousal at the end of general anaesthesia.

Expandable Intravertebral Titanium Implants for Thoracolumbar Burst Fractures Without Neurological Deficits

Objective: A thoracolumbar burst fracture (TLBF) is defined as the failure of the anterior and middle columns of the vertebra due to high-energy trauma, such as motor vehicle collisions and falls from heights. Debate has continued for decades regarding the standard treatment, especially for TLBFs without neurological deficits (TLBF-WONDs). The aim of this study was to understand the role of expandable intravertebral titanium implants (EITIs) in treating TLBF-WONDs.Methods: We included patients aged 18–65 years who presented at our hospital Emergency Department with severe back pain (visual analogue scale [VAS] score ≥ 8), were neurologically intact, were diagnosed with TLBF-WOND by either computed tomography or magnetic resonance imaging, underwent percutaneous bilateral transpedicular EITI implantation, and were followed-up for ≥12 months. Radiological and clinical outcomes were analyzed.Results: Thirty patients satisfied the study inclusion criteria, including 9 men and 21 women, with an average age of 48.2 years. Thirteen A3 and 17 A4 burst fractures were included. The mean duration of hospitalization was 3.3 days. The mean follow-up period was 4.4 years. All patients exhibited significant improvements in radiographical (anterior, middle, and posterior vertebral heights); vertebral kyphotic angle (p&lt;0.001); and functional outcomes (VAS and Oswestry Disability Index scores, p&lt;0.001). One case of cement leakage into the paraspinal muscle was observed; however, no major complications occurred.Conclusion: Percutaneous bilateral transpedicular EITI placement with cement augmentation under local anesthesia may be an effective strategy for the treatment of high-energy traumatic TLBFs with neurological integrity.

Use of medialized trochanteric-entry intramedullary nail to improve alignment in proximal femur nonunions.

Proximal femur shaft nonunion is a challenging problem, often occurring after malreduction that results in postoperative malalignment and decreased healing potential. Correction of malalignment is critical to achieving osseous union. Here we present a novel technique for treating proximal femur nonunions with varus malalignment using an intramedullary nail inserted through a medialized trochanteric entry point. Patients who underwent a proximal femur shaft (subtrochanteric or proximal third shaft) nonunion operation at a single level 1 academic referral centre by two attending surgeons between 1/1/2014 and 1/1/2022 were identified. Radiographic imaging was reviewed to determine initial fracture classification and calculation of coronal plane alignment (CPA), which was measured on preoperative, immediate postoperative, and final follow-up radiographs. Postoperative complications, reoperations, infections, and osseous union were also collected. Twenty-one patients with a mean age of 49.9 years (66% male) were identified. Mean preoperative CPA was 125.6 degrees, immediate postoperative mean CPA was 132.6 degrees, and mean final follow-up CPA was 131.5 degrees. Mean change in CPA from immediate postoperative films to final follow-up was a decrease of 0.4 degrees. 17 patients had follow up for a minimum of 12 months or until osseous union, and all achieved union without any major complications. Exchange nailing with an antegrade trochanteric entry nail through a medialized trochanteric starting point is a safe and effective technique in the treatment of proximal femur nonunions. This technique results in improved postoperative alignment that is sustained throughout the postoperative course, and may lead to increased rates of osseous union.

Risk factors of complications after thermal ablation for hepatocellular carcinoma: the role of assessment of liver background.

To use an elastography technology and other clinical and radiological data for assessment of liver background and analyze risk factors of complications after thermal ablation in patients with hepatocellular carcinoma. Demographics, laboratory analyses, and radiological characteristics were collected from all patients. Main elastography-related indicators included F index (fibrosis index), A index (inflammation index), ATT (attenuation coefficient), E (kPa), AREA (area of blue parts), and CORR (correlation). All complications after thermal ablation were collected. Univariate analysis was performed to detect significant variables, which subsequently entered a stepwise logistic regression analysis (conditional forward selection) to identify independent variables. A total of 218 patients from October 2020 to June 2023 with 291 thermal ablation sessions were enrolled. 115 patients (52.8%) developed complications. Fifteen patients (6.9%) developed major complications. Minor complications included postoperative pain (20.6%), fever (19.3%), effusion (22.5%), and hyperammonemia (1.8%). AREA (P = 0.034), tumor size (P = 0.005), and abnormal aspartate aminotransferase (AST) (P = 0.018) were independent predictors for complications. F index (P = 0.021), tumor size (P < 0.001), and abnormal AST (P = 0.047) were independent predictors for effusion. The results of univariate analysis of infection showed that tumor size, CORR, ATT, diabetes, Child-Turcotte-Pugh grade, abnormal AST, total protein, and albumin were significant (all P < 0.05). Several radiological and combinational elastography indicators related to liver fibrosis, steatosis, or inflammation were significantly correlated with the occurrence of complications. Clinical assessment of the liver background should not be neglected in the management of postablation complications.

A Systematic Review of the Complications Associated with Free Fibular Flaps in Adult and Pediatric Spinal Reconstruction.

Free fibular flaps have been suggested as a modality of reconstruction for complex spinal deformities. However, there is limited data that describes associated postoperative outcomes. The purpose of this systematic review was to characterize outcomes after spinal reconstruction using the free fibular flap for both adults and children. Thirty-nine articles among four databases were identified as having met inclusion criteria. Patient demographics, indications for spinal reconstruction as well as location and anastomosis, history of chemotherapy and radiation therapy, and postoperative outcomes including complications were identified. Major complications were defined as complications requiring reoperation, while minor complications were those that did not require reoperation. Systemic complications were defined as complications affecting sites or organ systems beyond the local donor and recipient sites. Statistical analysis was performed using Fischer's exact, chi-squared, and t-tests. We identified 218 adult patients (mean age 47.7 years, 56.4% male) and 27 pediatric patients (mean age 12.7 years, 55.6% male). While there was no significant difference in the rates of bony union between the two groups (adults: 90.8%, children: 90%, p > 0.9), adults had significantly higher rates of major (27% vs. 7.4%, p = 0.026), minor (26.1% vs. 7.4%, p = 0.032), and systemic (14.2% vs. 0%, p = 0.047) complications. Free fibular flaps are effective for spinal reconstruction for both adults and children, as evidenced by the high rates of bony union. However, adults exhibited significantly higher complication rates. Further research is required to better understand the patient and clinical risk factors associated with increased rate of complications.

Cost-consequence analysis of the enhanced recovery after surgery protocol in major lung resection with minimally invasive technique (VATS).

ERAS is an evidence-based multimodal perioperative protocol focused on stress reduction and promoting a return to function. The aim of this work is to perform a cost-consequence analysis for the implementation of ERAS in major lung resection by means of minimally invasive surgery (VATS) from the public health service perspective, evaluating resource consumption and clinical outcomes with respect to a control group of past patients, which did not adopt an ERAS protocol. Outcome differences (re-intervention rates, major and minor intraoperative and postoperative complications, readmissions, and mortality) as well as the costs of preoperative, operative, and postoperative care were estimated. The sample consisted of 64 consecutive patients enrolled in the ERAS programme between April 2021 and August 2022, compared to a control group (historical cohort) comprising 31 patients treated from April 2020 to December 2020, prior to the implementation of the ERAS programme. The study sample comprises patients who fulfil the established ERAS protocol inclusion criteria, including general criteria (acceptance of the protocol, proximity of residence, absence of contraindications to physiotherapy and early mobilisation), surgical criteria (anatomical lung resection up to lobectomy, absence of extensive resection, good possibility of conducting the operation in VATS) and anaesthesiologic criteria (ASA ≤2). Costs were quantified using the national health system perspective. The average length-of-stay was at least one day shorter in the ERAS group [<0.001. Average total costs including entire pathway healthcare costs were substantially reduced for ERAS-VATS patients (mean: € 5,955.71 vs. €6,529.41 Δ = -573.70 p = 0.018)]. Specifically, the median costs of the admission phase were significantly different between the two groups (median: €4,648.82 vs. €5,596.58, p = 0.008), with a reduction in hospital stay expenditure in the ERAS-VATS group (median: €1,599.62 vs. €2,399.43, p = 0.025). No significant differences were found regarding major clinical outcomes. The implementation of an ERAS programme is a dominant strategy, representing an intervention capable of reducing overall costs in the context of elective anatomical lung resection with VATS without any significant differences in major complications and re-intervention rates.

Comparison of strategies for vascular ACCESS closure after transcatheter aortic valve implantation: the ACCESS-TAVI randomized trial.

Data from randomized trials investigating different access closure strategies after transfemoral transcatheter aortic valve implantation (TF-TAVI) remain scarce. In this study, two vascular closure device (VCD) strategies to achieve hemostasis after TF-TAVI were compared. The ACCESS-TAVI (Comparison of Strategies for Vascular ACCESS Closure after Transcatheter Aortic Valve Implantation) is a prospective, multicenter trial in which patients undergoing TF-TAVI were randomly assigned to a strategy with a combined suture-/plug-based VCD strategy (suture/plug group) using one ProGlideTM/ProStyleTM (Abbott Vascular) and one Angio-Seal® (Terumo) versus a suture-based VCD strategy (suture-only group) using two ProGlidesTM/ProStylesTM. The primary endpoint was a composite of major or minor access site-related vascular complications during index hospitalization according to Valve Academic Research Consortium (VARC)-3 criteria. Key secondary endpoints included time to hemostasis, VARC-3 bleeding type ≥2 and all-cause mortality over 30 days. Between September 2022 and April 2024, 454 patients were randomized. The primary endpoint occurred in 27% (62/230) in the suture/plug group and 54% (121/224) in the suture-only group (relative risk [RR] 0.55 [95% confidence interval: 0.44;0.68]; p<0.001). Time to hemostasis was significantly shorter in the suture/plug group compared to the suture-only group (108±208 s vs. 206±171 s; p <0.001). At 30 days, bleeding type ≥2 occurred less often in the suture/plug group compared to the sutureonly group (6.2% vs. 12.1%, RR 0.66 [0.43;1.02]; p=0.032), with no significant difference in mortality. With regard to the composite of major or minor access-related vascular complications, a combined suture-/plug-based VCD strategy was superior to a suturebased VCD strategy for vascular access closure in patients undergoing TF-TAVI.

Management of pediatric ankle fractures: comparison of biodegradable PLGA implants with traditional metal screws.

The relevance of biodegradable implants has gained more importance in modern clinical practice. The study aimed to evaluate the effects and outcomes of ankle fracture treatment with absorbable implants compared to metal screws. These implants are made from poly l-lactic-co-glycolic acid (PLGA), however, there are several other materials available on the market. In a retrospective review, a total of 128 patients were under observation, with distal tibial fracture types ranging from Salter-Harris II-IV. In the absorbable group, patients were treated with the implants (n = 76). The metal group included patients treated with titanium or steel screws (n = 52). The extremities were placed in a cast for six weeks after surgery and were utilized for another 6-8 weeks. Patients were followed up for 12-30 months and were evaluated accordingly. The authors examined several aspects such as age, gender, open or closed repair, mechanism of injury, length of hospitalization, type of fracture, time of recovery, and complications. There were no statistically significant differences between the groups regarding demographic qualities, such as age, type of fracture, side of injury, and length of cast application (p > 0.05 in all cases). Out of 76 patients in the PLGA group, only two presented with complications, so reoperation took place. The rest healed without complications or refractures. Two of those treated with metal screws (n = 52) had minor, and four had major complications with reoperation. In pediatric cases, PLGA implants may present excellent results for treating ankle fractures. They do not disturb the growth plate and do not require reoperation. For this reason, they reduce the burden on the patient and the healthcare provider while simultaneously decreasing the risk of complications, such as infections or problems due to general anesthesia.

The prognostic significance of modified frailty index-5 in patients undergoing pneumonectomy for lung cancer.

In some centrally located lung cancers, complete excision of the mass cannot be achieved with parenchymal-sparing procedures and pneumonectomy may be required. The mortality and morbidity rates of pneumonectomy were reported to be considerably high. Here, we investigated the effectivity of modified frailty index-5 (MFI-5) in patients undergoing pneumonectomy for non-small cell lung cancer. Data of patients who underwent pneumonectomy for non-small cell lung cancer between January 2018 and December 2023 were reviewed retrospectively. The MFI-5 score was determined by preoperative diabetes mellitus, hypertension, chronic obstructive pulmonary diseases, congestive heart failure and functional status. The effectiveness of the MFI-5 score for the presence of postoperative major complications and 30-day mortality was investigated by multivariate logistic regression analysis. A P-value <0.05 was considered statistically significant. A total of 107 patients who met the inclusion criteria were included in the study. Eight (7.5%) of patients were female, and the mean age was 61.4 ± 8.7. The MFI-5 score was 0 in 48 patients (44.9%), 1 in 27 patients (25.2%) and 2 in 20 patients (18.7%). Postoperative 30-day mortality was detected in 4 patients (3.7%), and the major complications occurred in 42 patients (39.3%). In multivariate analysis, an MFI-5 score of 2 or higher (P = 0.008, OR: 4.9) was statistically significant for complications, whereas age, gender, side of the operation, <2 MFI-5 score, tumor diameter, type of surgery and lymph node metastasis status were not statistically significant (P > 0.05). The MFI-5 score is a significant indicator for predicting major postoperative events in patients who underwent pneumonectomy for non-small cell lung cancer. 2024-323, approved by Gazi University Local Ethics Committee.