Median BMI Research Articles

Patient centered outcomes of transoral robotic surgery for obstructive sleep apnea: a retrospective analysis.

Obstructive Sleep Apnea (OSA) is usually caused by collapse of the base of tongue (BOT) and impacts patients' overall health. Despite current conventional therapies, some patients do not achieve satisfactory results. Reduction of BOT using Trans Oral Robotic Surgery (TORS) emerges as a promising treatment. We evaluated the patient reported and clinical outcomes of TORS for OSA. We performed a retrospective cohort study of patients treated from 2018 to 2021 in a non-academic general hospital. Patients were eligible for TORS when apnea hypopnea index (AHI) was >5 in combination with obstruction at BOT level. Patients were included when 1-year follow up respiratory polygraphy was available. Changes in Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-35), MD Anderson Dysphagia Inventory (MDADI) scores and postoperative complications were evaluated. Surgical success rates were obtained. Out of 56 patients, 28 patients of which 22 (78.6%) males and 6 (21.4%) females, with OSA severity ranging from mild to severe and mean age of 49 (SD 11.8) with a median BMI of 28.1 (IQR 26.9-32.1) were included. ESS score declined from mean 5.9 (SD 3.8) to 2.2 (SD 2.0) (p<0.00). FOSQ-35 scores were all declined (p<0.05). MDADI scores were in normal range (80-100) and remained stable (p = 0.44). In 23 (82.1%) patients no postoperative complications were observed. Surgical success rates were 86%. TORS demonstrate to be effective and safe in OSA patients, and it can be used in both patients who are unresponsive to conventional therapies or as a primary therapy.

The Role of Helium Plasma-Assisted Liposuction in Lipoabdominoplasty After Weight loss.

Weight loss patients present with major deformities, leading to the rapid development of new body contouring techniques to address their specificities. Abdominal skin laxity is often major due to rapid weight loss and inflammation secondary to bariatric surgeries and is often present in both vertical and horizontal axes. Through this article, the authors wish to demonstrate the use of helium plasma radiofrequency technology for supraumbilical skin tightening following lipoabdominoplasty. A retrospective single-center cohort study was performed, including 100 consecutive patients undergoing HPRF-assisted lipoabdominoplasty. Patient characteristics, intra- and postoperative outcomes and complications were collected. A postoperative Likert scale evaluated patient satisfaction at 6-month follow-up. The mean age was 37, and the median preoperative BMI was 25.3. The median follow-up period was 19.7 months. Among the 100 included patients, no major complication occurred. Minor complications included wound dehiscence (1%), subcutaneous emphysema (2%), hyperpigmentation (8%), seroma (6%), and hematoma (2%). Overall satisfaction was high with 88% of 5/5 evaluations on the Likert scale. HPRF-assisted lipoabdominoplasty stands as a safe and efficient refinement in post-bariatric patients and can be used to avoid vertical scars and decrease scar tension. This technology seems, therefore, valuable to enhance body contouring procedures while minimizing morbidity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

La réinstillation distale du chyme des stomies : une technique efficace pour gérer le débit stomial postopératoire

Background: High output enterostomy leads to malnutrition and fluid/electrolyte loss which may be challenging to manage despite dietary modification, anti-motility, anti-secretory drugs, and parenteral nutrition. Distal infusion stomal enteroclysis (DISE) is an alternative to restore nutritional deficit and replace parenteral nutrition in resource-limited settings where treatment cost and availability of trained nurses are limiting factors.Objective: To assess the effectiveness and feasibility of DISE in managing postoperative enterostomal output.Methods: Consecutive patients who met the inclusion criteria and underwent enterostomy in one year were included. Postoperatively, DISE was started after the return of bowel movement. Stomal effluent was collected, filtered, and reinfused through the distal limb using a Foley catheter. The patients and caregivers were trained to perform under supervision. At discharge, they were encouraged to maintain regular contact and advised to report back when necessary.Results: Twenty-five patients received DISE, of which 22 were discharged and successfully continued to manage at home, while 3 expired. The median age was 36 years, the median BMI at admission and discharge was 18.99 kg/m2 and 17.76 kg/m2 respectively (the difference was statistically significant), and the male: female ratio was 2.5: 1. Thirty-day readmission was done for 2 patients to manage minor complications. The average stomal output was 820.20 ml/day initially and 477.55 ml/day at discharge. The median duration of DISE was 12 days. Thirteen patients (52%) needed parenteral nutritional support due to inadequate oral intake.Conclusion: DISE is a feasible and effective technique for managing high output enterostomies. It can be easily taught and performed with minimal resources at home.

Outpatient lateral lumbar interbody fusion: single-institution consecutive case series.

Outpatient spine surgery could reduce hospital costs and improve patient outcomes. Outpatient lateral lumbar interbody fusion (LLIF) can be performed for select patients. This study identified and compared the demographic, clinical, and surgical characteristics of patients who underwent outpatient versus inpatient single-level LLIF. A retrospective review was conducted of a prospectively collected database of patients who underwent first-time single-level LLIF at a single institution performed by the same surgeon from January 1, 2017, through December 31, 2022. Demographic characteristics, including age, sex, BMI, and medical comorbidities, were collected. Surgical factors, such as level of surgery, operative duration, and estimated blood loss, were also collected. Length of stay and 30-day readmission were the primary outcomes of interest. Patients discharged on the day of surgery or the following day were considered to be in the outpatient group. ANOVA and chi-square tests were performed to compare continuous and categorical variables, respectively. Univariate logistic regression was used to examine the correlation between baseline demographic and surgical variables and outpatient surgery. If a variable significantly correlated with outpatient surgery on univariate analysis, it was subsequently used in multivariate logistic regression. A total of 107 patients underwent first-time single-level LLIF, and 48 (44.9%) did not have posterior instrumentation. Fifty-three (49.5%) patients were women. The median age and BMI were 66.3 years and 28.9, respectively. The mean length of stay was 1 day (range 0-4 days), with 71 (66.4%) of 107 single-level LLIFs managed on an outpatient basis. There were no readmissions within 30 days. Patients in the outpatient group were more likely than patients in the inpatient group to be male (59% [42/71] vs 25% [9/36], p = 0.002), have a low LACE (risk criteria based on length of stay, acuity of the admission, comorbidity of the patient, and emergency department use within 6 months before admission) readmission index (63% [45/71] vs 28% [10/36], p < 0.001), and have a stand-alone construct (62% [44/71] vs 11% [4/36], p < 0.001). The outpatient cohort also had a shorter mean operative duration (104.4 vs 175.5 minutes, p < 0.001) and lower mean estimated blood loss (20 vs 100 mL, p < 0.001). There was no difference in age between the groups. Factors that remained significant on multivariate logistic regression were male sex (OR 0.14, 95% CI 0.04-0.53; p = 0.004), lower LACE readmission index (OR 0.06, 95% CI 0.02-0.25; p < 0.001), and stand-alone construct (OR 8.17, 95% CI 1.49-44.74; p = 0.02). Multiple baseline and surgical characteristics were more common in the outpatient setting. With appropriate patient selection, single-level LLIF can be achieved on an outpatient basis.

Single-dock Robotic Bilateral Transversus Abdominis Release: Technique Description and Preliminary Outcomes.

Posterior component separation with transversus abdominis release (TAR) is a valuable adjunct to address incisional hernia defects. Currently, bilateral docking is a standard technique for robotic TAR. The aim of this study is to describe our technique for extended totally extraperitoneal (eTEP) repair with bilateral TAR through a bottom single-dock robotic approach for hernias at the level of the umbilicus or higher. We retrospectively reviewed a case series of patients who underwent robotic eTEP repair with bilateral TAR using a single bottom docking between November 2021 and November 2023. A comprehensive description of our patient selection, surgical technique, and short-term clinical outcomes is reported. Ten patients with incisional hernias were included. Their median age was 55 years (IQR: 49.5 to 61.25), 70% were male, the median BMI was 27.25kg/m (IQR: 22.95 to 33.53), and ASA class was ≥2 in 80%. Median hernia width was 10cm (IQR: 6.75 to 12.25) and length 11cm (IQR: 9.25 to 16.25). The median operative time was 178.5 minutes (IQR: 153.75 to 222), and the length of stay was 1 day (IQR: 0.75 to 1.75). At a median follow-up of 5 months (IQR: 2.6 to 9.7), 20% of patients developed a surgical site occurrence requiring procedural intervention. Bilateral TAR using a single bottom dock is a feasible and safe adjunct to robotic eTEP ventral hernia repair in appropriately selected patients.

Prevalence and association analysis of obstructive sleep apnea in India: Results from BLESS cohort

BackgroundDespite having the largest population in the world with 1.4 billion inhabitants, there is only scarce data on the prevalence of OSA from India. Research questionThis study aimed to find the prevalence of Obstructive Sleep Apnea (OSA) using Polysomnography (PSG) and current scoring rules (AASM 2012) in population and investigate OSA associations for cardiovascular and metabolic comorbidities. Study designand Methods: Participants were randomly selected among the accompanying attendants of patients admitted to a hospital in Bhopal, India and underwent level I PSG. Anthropometric measurements, blood investigations were taken. The primary outcome was prevalence of OSA, assessed by the Apnoea-Hypopnoea Index (AHI). ResultsLevel I PSG was performed on 1015 adult participants from December 2019 to February 2023; after excluding 57 participants with sleep time <240 min, 958 participants (age range 18–80 years) were finally included in this study. Median (IQR) age was 40.0 years (31.0, 49.0) while median (IQR) BMI was 23.5 (20.7, 26.8) Kg/m2. Prevalence (95 % CI) of moderate-to-severe OSA (AHI ≥15) and severe OSA (AHI≥30) was 30.5 % (28–34 %) and 10.1 % (8.3–12), respectively. The upper quartile of the AHI (Q4 ≥17) was independently associated with the presence of Diabetes Mellitus [OR 2.14 (95 % CI 1.07–4.44)], Hypertension [OR1.98 (95 % CI 1.20–3.28)] and Metabolic Syndrome [OR 2.36 (95 % CI 1.37–4.09)] compared to the first quartile AHI. InterpretationOSA prevalence was found to be significantly higher than previously estimated in Indian population. Association of OSA with diabetes, hypertension, and metabolic syndrome was observed.

Awake MIS-TLIF under Spinal Anesthesia: Screw Placement Accuracy and 1-year follow-up

We assessed the accuracy of pedicle screws placed during awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anesthesia and analyzed outcomes at the one-year follow-up. We included patients that underwent awake MIS-TLIF under spinal anesthesia at an academic center from February 2020 to February 2022. The Gertzbein-Robbins classification was used for screw accuracy rating. A total of 100 pedicle screws were inserted in 24 patients, with the most common level being L4-5. Median age was 63.5±16.5 (IQR) years, 42% male, median BMI 28±6 kg/m2, and median American Society of Anesthesiology class was 2±1. Two patients underwent a two-level fusion, and 22 patients underwent a one-level fusion. Median estimated blood loss was 35±25 ml, median length of stay was 0±1 days, with 54% of patients going home on the day of surgery, and the only intraoperative complication was one durotomy. Median procedure time was 112±23.5 minutes, and median operating room time (including the spinal block) was 159.5±32.7 minutes; 67% of the screws were placed with navigation, and 33% were robotic-assisted (Mazor X); 99% of the screws were Gertzbein Robins grade A, and 1% Grade E. At the one-year follow-up, the CT scans showed no evidence of pseudarthrosis, and all patients reported improvement of their presenting symptoms. Our study shows a high accuracy (99%) of pedicle screw placement in awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anesthesia, and significant improvement of their symptoms at the one-year follow-up.

Associations Between Body Appreciation, Body Weight, Lifestyle Factors and Subjective Health Among Bachelor Students in Lithuania and Poland: Cross-Sectional Study.

Background/Objectives: Positive body image is linked to improved mental and physical well-being, healthier lifestyles, and fewer unhealthy weight control behaviors. Cultural factors also play a role in influencing body appreciation. This study investigated the associations between body appreciation, body weight, lifestyle factors, and subjective health among bachelor's students in Lithuania and Poland. Methods: A cross-sectional online survey was conducted with 1290 students from universities in both countries. The Body Appreciation Scale-2 (BAS-2) measured body appreciation, while participants provided self-reported data on their dietary habits, physical activity, sleep, health perceptions, and body weight and height. Linear regression models explored associations between BAS-2 scores, actual and perceived body weight, lifestyle habits, and subjective health. Results: Gender and country-based differences in body appreciation were observed. Lithuanian female students reported a higher median BAS score of 33 compared to 32 among Polish female students (p = 0.02), despite having a higher median BMI (22.3 kg/m2 vs. 21.1 kg/m2, p = 0.001). Positive body appreciation was linked to healthier dietary behaviors, such as higher consumption of fruits, vegetables, fish, and regular breakfasts. Additionally, greater physical activity and sufficient sleep were associated with higher body appreciation, while higher intake of sweets, sugary drinks, and fast food correlated with lower BAS-2 scores. Both BMI and perceived weight were negatively associated with body appreciation, particularly among females. Conclusions: Body appreciation is closely linked to body weight, healthier lifestyle, and positive health perceptions, suggesting that promoting healthier habits may improve body appreciation.

Association of body mass index with pathologic agreement of preoperative and postoperative tumor grade in endometrial cancer.

We aim to study association of BMI of EC patients, with the level of agreement between preoperative and postoperative tumor grade. A retrospective study. We included patients with EC diagnosed in an outpatient clinic which had surgical staging as in our division. We categorized patients into BMI categories according to the World Health Organization; (BMI < 18.5kg/m2), (BMI 18.5-24.9kg/m2), (BMI 25-29.9kg/m2), (BMI 30-34.9kg/m2), (BMI 35-39.9kg/m2), and (BMI ≥ 40kg/m2). We further dichotomized the study population for obesity, defined as BMI ≥ 30.0. We analyzed agreement between preoperative and postoperative tumor grade, stratified by patient's BMI. Overall, 623 women met study inclusion criteria, with a median age of 64 [interquartile range (IQR) 57-72]. Among the study cohort, the median BMI was 30.7 [IQR 25.6-38.8], with 330 (53.0%) patients being obese. EC grade 1 was diagnosed preoperatively in 353 (56.7%), grade 3 in 148 (23.8%), and grade 2 in 122 (19.6%). Endometrioid histology was diagnosed in 463 (74.3%), serous in 78 (12.5%), mixed histotype in 51 (8.2%), clear cell in 20 (3.2%) and carcinosarcoma in 11 (1.8%). In 68.7% (n = 428), there was no change in postoperative grade, and in 24.9% (n = 155), there was upgrading of tumor, and in 6.4% (n = 40), there was a tumor downgrade. There were 3 (0.5%) cases in which no tumor was found on final pathology. The rate of no change was higher in preoperative grade 3 (89.9%) vs. grades 1 (63.5%) and grade 2 (58.2%), p < .001). There was no difference in grading agreement when obese patients were compared to non-obese, p = .248. There was no difference in grading agreement when comparing the various BMI categories, with no change proportion ranging between 58.2% in BMI 30.0-34.9 mg/kg2 and 79.7% in BMI 35.0-39.9 mg/kg2, p = .104. ROC analysis of BMI as predictor of no-change yielded an area under the curve of 0.466 (95% confidence interval 0.418-0.515) with a maximal performance at a BMI of 33.8 mg/kg2. The agreement between preoperative and postoperative tumor grade among all patients was kappa = 0.517. The agreement did not differ when compared between obese patients (kappa = 0.456) and non-obese (kappa = 0.575). Our study found no significant association between BMI and the agreement between preoperative and postoperative tumor grading in EC.

Association of Low Protein-to-Carbohydrate Energy Ratio with Cognitive Impairment in Elderly Type 2 Diabetes Patients.

The relationship between macronutrient intake and cognitive decline in older adults with type 2 diabetes mellitus (T2DM) remains underexplored. This cross-sectional study aimed to evaluate the association between the protein-to-carbohydrate energy ratio (%E:P) and cognitive impairment among 192 elderly T2DM patients. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Self-Administered Gerocognitive Exam (SAGE), while dietary intake data, including (%E:P), was gathered using a validated semi-quantitative food frequency questionnaire. Participants had a mean age of 71 ± 6 years, 46.4% were female, and the median BMI was 30 ± 4 kg/m2. After adjusting for confounding variables, patients in the highest (%E:P) tertile showed significantly higher MoCA and SAGE scores compared to those in the lowest tertile (p < 0.005). We identified an optimal (%E:P) threshold of 0.375 for predicting cognitive impairment, with a sensitivity of 53% and specificity of 64%. These findings suggest that a lower (%E:P) ratio may be a risk factor for cognitive impairment in elderly T2DM patients. Monitoring this ratio may serve as an early detection tool for cognitive deterioration. Moreover, current protein intake recommendations for older adults with T2DM may be insufficient to prevent cognitive impairment. Further research is needed to establish optimal dietary guidelines for this population.

BS SO04 - Intragastric Balloons - are they for the long term?

Abstract Background Intragastric balloons are a bridging therapy to bariatric metabolic surgery. When sufficient weight loss to facilitate surgery is not achieved, a second balloon may be considered. Traditionally, balloons were used for 6 months prior to removal. The COVID-19 pandemic limited patient interactions and treatment duration was doubled. We assessed outcomes (weight loss trends and safety) in patients with severe obesity undergoing sequential balloon treatment. The study period accounts for changes in balloon protocol instigated during the pandemic, addressing a current literature gap. Method Consecutive patients who underwent balloon treatment between May 2014 and February 2023 were identified. Only patients deemed fit enough for potential adjuvant bariatric surgery at presentation were included in the study. Outcomes recorded included: weight and BMI at 3-monthly intervals until balloon removal, progression to surgery and morbidity. Results 45 patients were identified. Median BMI on balloon insertion was 62kg/m2. Median weight loss with the first balloon was 15.2kg (8.8% weight loss). 11 patients (24.4%) had a second balloon, with median weight loss of 3.3kg (1.9%). 22 patients (48.8%) met criteria for surgery, only one had multiple balloons. Weight loss was observed during the first three quartiles of balloon treatment, however median 2kg was gained during months 9-12. 16 (35.6%) first balloon patients had complications. 2 (18.2%) second balloon patients had complications. Median time from insertion to complication was 14 days. Conclusion The present study concludes that, although not associated with increased complication risk, sequential IGB use as a bridging treatment to definitive bariatric surgery does not significantly contribute to weight loss in super obese patients. Optimal treatment is achieved with a single IGB, although weight loss is not uniform across a 12 month treatment period and weight gain can result after 9 months.

BN SO39 - Laparoscopic Release of Median Arcuate Ligament Syndrome: A Case Series

Abstract Background Median arcuate ligament syndrome (MALS) is a recognized, but rare condition, which is characterized by compression of the celiac artery and ganglion by median arcuate ligament. The entity often presented with chronic post-prandial abdominal pain, vomiting, and weight loss. These patients often undergo comprehensive investigation prior to diagnosis of MALS. This report presents our experience and short-term outcomes of patients with laparoscopic release of MALS at our center. Method Between 2022-2024, five patients with MALS underwent laparoscopic release at a tertiary HPB center under a single surgeon (TS). Data on patient demographics, presenting symptoms and duration, preoperative diagnostic tests, intraoperative findings and complications, postoperative complications, symptom recurrence and follow-up were prospectively maintained. All patients were discussed at a tertiary Vascular and HPB MDT; MALS was confirmed on US doppler (USD) and CT angiogram (CTA) (fish-hook type configuration of Celiac Truck with post-stenotic dilatation). Results Two male and three female patients, with a median (range) age of 41 (25-70) years, underwent laparoscopic MALS release. The median (range) preoperative symptom duration was 54 (24-67) months, with most common presentation of post-prandial abdominal pain and weight loss. The median (range) BMI was 19.61 (18.30-17.82). The median (range) operative time was 313 (166-330) minutes. One patient required conversion to open due to bleeding from celiac trunk. The median (range) LOS was 7 (4-7) days. No postoperative complications occurred. The median follow-up was 10 months. One patient re-experienced abdominal pain, with no evidence of recurrence on USD and CTA. Conclusion Median Arcuate Ligament Syndrome should be considered as a differential in patients presenting with chronic post-prandial abdominal pain and weight loss. Thorough investigation (USD and CTA) along with discussion at Vascular MDT should be undertaken. Laparoscopic release of MALS is a safe and effective treatment option in this cohort.

BS SO09 - Use of ursodeoxycholic acid in preventing gallstone formation after bariatric surgery – introduction of a new clinical pathway

Abstract Background Rapid weight loss is a risk factor for symptomatic gallstone formation. Managing gallstone disease such as choledocholithiasis can be more challenging after Bariatric Surgery (BS) due to altered anatomy. Ursodeoxycholic acid (UDCA) is a low-cost and low-risk method of reducing the risk of symptomatic gallstone disease and cholecystectomy by almost a third in patients who have had BS. However, it is not yet included in national guidelines for bariatric surgery. We audited prescription rates of UDCA in patients who underwent BS with a view to introducing it into our standard post BS care bundle. Method Data was collected from 30 consecutive patients who underwent a sleeve gastrectomy or Gastric bypass in November and December 2023. The results informed our practice and a UDCA prescribing pathway was developed using evidence from randomized trials. The pathway was circulated to all members of the bariatric service on 17/1/2024 and discussed at the departmental meeting. The audit loop was closed by collecting data from a further 30 consecutive patients. Demographic data, type of operation, BMI, history of gallstone disease, prescribing data and reasons for non-compliance were collected. The compliance rate to the UCDA pathway was expected to be 100%. Results Data was collected from 60 patients (85% female; median BMI 49; median age 45). No patient who could have benefited received UDCA prior to the intervention. After the intervention, 15/30 (50%) of patients were correctly prescribed UDCA. Therefore, correct prescription of UDCA did not meet target compliance rates. No patient was incorrectly prescribed UCDA. Reasons for non-compliance include human error, concern about the size of the tablet, inadequate knowledge about how to administer (e.g. crushing in liquid) and misconceptions of oral intake after BS. Conclusion UCDA can reduce incidence of symptomatic gallstones following BS, yet use of UDCA in bariatric centres in the UK is thought to be low. We discovered that more time should be dedicated to educating the team about administration methods and how it interacts with the current postoperative diet plan. A UCDA pathway and education of bariatric teams can improve compliance with appropriate UDCA prescribing. Further intervention is required and planned in our centre such as utilising e-prescribing as a prompt to include UDCA in the discharge prescription and considering the use of the drug's liquid form in the short term.

Abstract 4141440: Pharmacokinetics and pharmacodynamics of SC furosemide in patients with HF and obesity

Background: Obesity is increasingly prevalent in patients with heart failure (HF). Subcutaneous (SC) furosemide (Furoscix) is available as a 5-hour SC infusion via an on-body delivery device for the management of congestion, independent of ejection fraction. In a PK/PD study, the average bioavailability of Furoscix across the BMI spectrum was 99.6% with comparable diuresis and natriuresis to IV furosemide. However, the potential effects of obesity on the absorption and diuretic efficacy of Furoscix remain unknown. Goal: To evaluate PK/PD of SC furosemide compared to IV administration, stratified by BMI. Methods: Post-hoc analysis of SC furosemide pivotal PK/PD study was conducted to compare PK and urine output (UO) to IV furosemide, stratified by BMI. SC furosemide 80mg was administered over 5 hours per the typical biphasic administration schedule. IV furosemide was given as two 40mg injections, 2 hours apart. Plasma was collected to determine furosemide concentrations and UO was quantified over 8 hours. Descriptive statistics were reported. Results: Sixteen patients were included for UO and 15 for the PK analysis. Median BMI was 31.2kg/m 2 ; PK stratified by BMI is listed in Table 1. Peak plasma furosemide concentration (C max ) was lower in the BMI &gt;31.2kg/m 2 group with no difference in t 1/2 and greater UO at 8 hours in this cohort. There was no difference in any of the variables between the SC and IV agents across the BMI spectrum. Conclusion: Although Furosemide C max was lower in the cohort with BMI &gt;31.2kg/m 2 , total UO at 8 hours was higher. These findings were similar for the SC and IV formulations. Our data suggests that SC furosemide absorbs independent of BMI and provokes a reliable clinical response as measured by UO. Importantly, PK and UO results are consistently similar between the Furoscix and IV formulation across the BMI spectrum. Future research is warranted to investigate the reasons behind the increased UO in the population with higher BMI.

Augmented Reality Versus Freehand Spinopelvic Fixation in Spinal Deformity: A Case-Control Study.

This study sought to compare screw placement accuracy and outcomes between freehand (FH) and AR-guided pelvic fixation. While pelvic fixation is a critical technique in spinal deformity surgery, S2-alar iliac (S2AI) screw placement poses challenges. We conducted a case-control study of 50 consecutive patients who underwent spinopelvic fixation at a single institution. AR guidance was performed using a head-mounted display (Xvision, Augmedics). Patient demographics, surgical characteristics, spinopelvic parameters, and screw breach grade were compared using univariate and multivariate statistics. Pelvic fixation was performed FH in 21 patients (median age, 64; female, 38.1%; median BMI 32.3kg/m2) and AR-guided in 29 patients (median age, 66; female, 51.7%; median BMI 28.4kg/m2). Mean follow-up was longer in the FH group (28 mos vs 11 mos, P < 0.001). Pelvic fixation in the FH group was performed using either S2AI (90.5%) or dual S2AI (9.5%) screws. There were no significant differences in length of surgery (FH, 439 minutes; AR, 490 minutes; P = 0.1) or estimated blood loss (FH, 2.1L; AR, 1.9L; P = 0.7). Accuracy of FH pelvic fixation was 95.6% (43/45 screws) and accuracy of AR pelvic fixation was 96.5% (55/57 screws). Multivariable logistic regression for screw breach revealed no significant association with AR guidance when controlling for age, BMI, osteoporosis, and smoking. We present the first case-control study of AR-guided spinopelvic fixation, with findings suggesting parity between FH and AR-guidance, serving as foundation for prospective controlled studies with longitudinal follow-up to interrogate the benefits of AR-guidance in spinal deformity surgery.

Neurosurgery in a Pacific archipelago: how to provide optimal care. Experience of the opening of a first-line neurosurgery department

IntroductionIn the beginning of November 2023, the authors launched a neurosurgery department in Nouméa, New Caledonia. Emergency cranial surgeries are performed by orthopedic surgeons. All other cases are transferred to Australia or mainland France.Opening a neurosurgery department matches the current needs of the population. The department opened 10 inpatient beds on February 1st, 2024. First neurosurgical experienceDuring the first 3 months, 108 surgeries were performed: 32 cranial and 76 spinal. Surgical indications were mostly traumatic, degenerative, infectious, tumoral, vascular pathology, and cerebrospinal fluid resorption disorder. Patient characteristicsThere were 93 patients: 58 male, 35 female; median age, 53 years [IQR, 42 ; 65]. Median body mass index was 27.8 [23.4 ; 31.9]. Seven patients were admitted for spontaneous infection (7.5%). Eight (8.6%) were operated on for postoperative infection, including one cranial and one spinal infection initially managed elsewhere. These 15 patients had a median BMI of 31 [24.9 ; 34.4]. ConclusionThe permanent presence of two neurosurgeons seems justified. Some pathologies can be managed on-site, but transfers to centers in Australia or mainland France will remain necessary. We strongly recommend having such a first-line neurosurgery department in this type of isolated territory.

Comparisons of 30-day outcomes after ventral hernia repair by body mass index and surgical approach: a retrospective cohort study.

Obesity is a known risk factor for postoperative complication after ventral or incisional hernia repair (VIHR). Whether minimally invasive techniques can mitigate this risk for certain patients remains unknown. This study investigates whether MIS approaches offer advantages in reducing any medical or surgical complication after VIHR across clinically meaningful BMI categories. This study analyzes data from the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC COHR). The registry is a representative, random sample of adult patients from 70 Hospitals across the state of Michigan. This study includes adult patients receiving VIHR between Jan 2020 and September 2023. All elective VIHRs captured in the MSQC database were included in analysis. Univariate statistics were used for cohort summary and multivariate logistic regression was used to estimate the probability of any 30-day postoperative complication while controlling for age, sex, the interaction of BMI and surgical approach, medical comorbidities, hernia size, mesh use, use of component separation, and previous hernia repair. A total of 11,886 people met the study inclusion criteria. The median (IQR) age was 55.0 (44-65) and 5,111(43.0%) were female. The median (IQR) BMI was 31.7 (27.6-36.3). 5,260(44.3%) cases were performed with an MIS approach and 6,626(55.7%) were performed with an open approach. The adjusted relative risk of experiencing a complication after open repair when compared to MIS repair was 1.34 (95% CI [1.04-1.70], p = .02) in Obesity Class I, 1.62 (95% CI [1.23-2.14], p < .001) in Obesity Class II, and 2.31 (95% CI[1.49-3.56]) for Obesity Class III. MIS repair was associated with improved 30-day outcomes for patients with class I, II, and III obesity, but not for healthy to overweight patients. In clinical scenarios where delay for severely obese patients may be difficult, electing to use an MIS repair may be the optimal strategy to reduce risk of complications.

Physical training augmented with whole body electronic muscle stimulation favorably impacts cardiovascular biomarkers in healthy adults – A pilot randomized controlled trial

BackgroundPhysical activity is protective against cardiovascular disease (CVD) and favorably improves CVD risk profile. However, more than 25 % of American adults report no participation in physical activity. Whole body electronic muscle stimulation (WB-EMS) training is a novel FDA-cleared technology which offers a time-efficient and adaptable method for physical training by simultaneously stimulating the main muscle groups using percutaneous electrical impulse transmission. Studies have demonstrated increased muscle mass, reduced fat mass, and improved functional capacity in sedentary individuals after training with WB-EMS, but studies evaluating the role of WB-EMS training on CVD risk profile are lacking. MethodsWe performed a pilot randomized controlled trial in healthy adults randomized to physical training with versus without WB-EMS for one session of 20 min duration per week across 16-weeks. Study participants were asked to perform their usual activities but to abstain from any strength training during the study. During each training session, all study participants wore a specifically designed vest and arm and leg straps that were connected with electrical wires to the WB-EMS device (Miha Bodytec Gersthofen, Germany). Biphasic electrical stimulation was delivered through the vest and straps (4 s on, 4 s off) at a frequency that elicited a score of 5 or 6 on the Borg rating of perceived exertion scale from study participants when each of the following muscle groups was stimulated: thighs, buttocks, lower back, upper back, latissimus dorsi, abdomen, chest and arms. These frequencies were ‘titrated’ during the first 4 weeks and were then fixed at each muscle group for each participant. Individuals randomized to no WB-EMS wore the same equipment but received no electrical stimulation. Physical training sessions were provided by personal trainers certified for WB-EMS training and consisted of a fixed number of exercises and repetitions. We measured and compared several clinically important cardiovascular parameters at baseline and post-intervention. ResultsSeventy-eight participants were recruited between January 2021 and March 2022 with a mean age of 35.9 ± 11.2, 61.3 % females, median BMI 24.3 (21.8, 28.1); N = 46 were randomized to intervention group and N = 32 were randomized to the control group. Eighteen (23 %) participants dropped out of the trial, including 9 participants from the EMS arm (19.6 %), and 9 participants in control arm (28.1 %). There was no significant differences in the rate of dropping out of the WB-EMS and control groups (p = 0.27). Those in the intervention group compared to controls exhibited the following changes after 16-weeks of training: waist:hip ratio (∆ -0.03 ± 0.05, p = 0.01 vs. -0.01 ± 0.0, p = 0.1), peripheral endothelial function, measured using reactive hyperemia peripheral arterial tonometry (∆: 0.02 ± 0.1, p = 0.5 vs. -0.20 ± 0.3 p = 0.05), high-sensitivity C-reactive protein (∆: 0.06 ± 0.7, p = 0.3 vs. 0.20 ± 2.3 p = 0.02), total cholesterol (∆: −1.7 ± 25.1, p = 0.3 vs. 19.2 ± 26.5, p < 0.001), high density lipoprotein (∆: 2.02 ± 6.6, p = 0.2 vs. 3.6 ± 7.5 p = 0.01) and low density lipoprotein cholesterol (∆: 0.5 ± 26.7, p = 0.4 vs. 17.1 ± 23.2, p < 0.001). ConclusionOnce weekly physical training with WB-EMS in healthy adults resulted in either improved or stable biomarkers of cardiovascular risk, which either remained stable or worsened in those undergoing conventional training alone. Thus WB-EMS may provide an effective and time-efficient form of physical training that may be considered in those unable or unwilling to perform exercise conventionally.

Frequency and clinical characteristics of children and young people with type 2 diabetes at diagnosis from five world regions between 2012 and 2021: data from the SWEET Registry.

The diagnosis of type 2 diabetes is increasing in young people worldwide. This study evaluated the frequency and clinical characteristics of young people presenting with type 2 diabetes from the multinational SWEET e.V Registry 2012-2021, including the first years of the COVID-19 pandemic. This is a longitudinal observational study based on the SWEET Registry, which collects demographic and clinical data on children and adolescents with diabetes from centres worldwide, with the diagnosis and classification of diabetes provided locally by each centre according to International Society for Paediatric and Adolescent Diabetes definitions. By July 2022, the SWEET Registry included 96,931 individuals from 130 centres with a total of 1,154,555 visits. Data were analysed by region: Europe (EU), Australia and New Zealand (AU/NZ), South America (SA), North America (NA) and Asia/Middle East and Africa (AS/AF). Trends in proportions for the two-year periods, calculated as cases with type 2 diabetes diagnoses over all cases with diabetes diagnoses, were estimated using logistic regression models adjusted for age at onset and sex. Overall, there were 2819 of 58,170 new cases (4.8%) with type 2 diabetes: 614 in EU, 293 in AU/NZ, 79 in SA, 1211 in NA and 622 in AS/AF. The proportion of type 2 diabetes increased from 3.2% to 6.0% from 2012/2013 to 2020/2021, a relative rate of increase of 9% per two-year period (95% CI 5.9, 12.3; p<0.001). In the two-year period of the COVID-19 pandemic, type 2 diabetes continued to follow the observed trend, with a proportion of 6.0% in 2020-2021 compared with 5.4% in 2018-2019. High variability in the proportion of type 2 diabetes was observed across regions, with the lowest values observed in EU and the highest in NA. A significant increase in the proportion of type 2 diabetes was observed in EU, AU/NZ and NA. The median HbA1c was not uniform and was highest in AS/AF (85 mmol/mol [9.9%]; IQR 55-111 [7.2-12.3%]) and lowest in EU (63 mmol/mol [7.9%]; IQR 48-99 [6.5-11.2%]), and the difference between EU and NA (median value 73 mmol/mol [8.8%]; IQR 50-105 [6.7-11.8%]) was statistically significant (p=0.047). There was also a difference in BMI SD score by region: the lowest median BMI SD score was 2.2 (IQR 1.4-2.7) in AS/AF and the highest was 3.1 (IQR 2.5-3.6) in AU/NZ. The multinational SWEET data from the years 2012 to 2021 inclusive support recent findings of a worldwide increase in type 2 diabetes in young people, albeit with regional differences. This increase highlights the need for ongoing preventive measures and available advanced treatment modalities worldwide.

Risk of Hematuria-related Complications Associated With Anticoagulant and Antiplatelet Medications: A Single-Institution Retrospective Cohort Study

ObjectiveTo evaluate enteral and parenteral anticoagulant and antiplatelet medications and their associated risks of hematuria-related complications. Materials and MethodsThis was a single-institution, retrospective cohort study. Primary outcomes were counts of ED visits, hospital admissions, and urologic procedures to manage gross hematuria that occurred while patients were exposed to anticoagulant/antiplatelet medications. Multivariable negative binomial regression was used to identify incidence density rates and rate ratios for hematuria-related complications associated with each anticoagulant/antiplatelet medication. ResultsAmong 119,528 patients in the study cohort, 10,601 were exposed to rivaroxaban and 108,927 were not exposed to rivaroxaban. Patients who were prescribed rivaroxaban were more likely to be male (55.5% vs. 52.0%, p <.001), of white race (95.9% vs. 92.8%, p <.001), and have higher BMIs (median BMI, 29.3 vs. 28.3, p <.001). Those not exposed to rivaroxaban had lower incidence density rates than those exposed to rivaroxaban for any hematuria-related complication (29.4 vs. 39.3). Exposure to enoxaparin compared to rivaroxaban was associated with higher rates of any hematuria-related complication (adjusted risk ratio (aRR) 2.74, 95% CI 2.43-3.10), emergency department visits related to hematuria (aRR 3.34, 95% CI 2.73-4.11), and hematuria-related hospitalizations (aRR 4.58, 95% CI, 3.70-5.70). All other oral anticoagulant and antiplatelet medications studied were associated with lower risk than rivaroxaban for hematuria-related complications. ConclusionsAmong enteral and parenteral anticoagulant and antiplatelet medications studied, enoxaparin is associated with the highest rates of hematuria-related events. Further work is needed to elucidate the mechanisms by which distinct anticoagulant and antiplatelet medications contribute to hematuria.