Median Preoperative Score Research Articles

Association Between Cardiothoracic Fellows and Clinical and Financial Outcomes in Coronary Surgery.

Mounting financial pressures on academic institutions highlight the need to understand the effect on outcomes from trainee involvement in cardiac surgery. The purpose of this study is to examine the association between cardiothoracic fellows and clinical and financial outcomes in coronary artery bypass grafting (CABG). Data for all patients from 2017 to 2022 at a single institution who underwent nonemergent, isolated, open CABG were included in the study, with patients grouped by whether there was fellow operative participation. Financial and clinical outcomes were compared between the two groups using multivariable regression and generalized estimating equations to control for variation in patient characteristics and attending cardiac surgeon practices. A total of 1997 patients met criteria for study inclusion, with 632 (31.5%) cases that had fellow participation and 1365 (68.4%) that did not. Patients in the fellow participation group had a 0.8% higher median preoperative risk score than those that did not have fellow participation. Fellow participation was associated with significantly longer total case length (61mins) but no differences in postoperative clinical outcomes. There was an increased median total hospitalization cost of approximately $2200 in cases with fellow participation, likely attributable to increased intraoperative costs from longer case times. While CT surgery fellow participation was associated with longer operative times and a small increase in hospitalization cost in CABG, there were no significant differences in clinical outcomes. Continuing to train cardiothoracic surgery fellows in this procedure is safe and would not be expected to significantly impact reimbursement under bundled payment models.

The Impact of Extended Procedure Duration on Nasal Morbidity after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Macroadenomas

Objective: Nasal mucosa is susceptible to injury during endoscopic endonasal transsphenoidal resection of pituitary macroadenomas. Prolonged operative times may lead to increased instrumentation induced injury to nasal mucosa. Operative time influence on sinonasal morbidity has not been reported previously. Our objective is to determine preoperative drivers extending operative time and the impact of prolonged endoscopic endonasal transsphenoidal resection on nasal morbidity as measured by postoperative SNOT-22 questionnaire. Study Design: SNOT-22 scores were collected at each rhinology visit and intraoperative OR start and stop timestamps as recorded by nursing staff were extracted from the record. Setting: Cases of endoscopic endonasal transsphenoidal pituitary adenoma resection at a tertiary care center were identified. Methods: Multivariable regression was done analyzing factors influencing SNOT-22 scores and surgical time. Results: 222 patients were included. Median preoperative SNOT-22 score was 12.5 (IQR 4.00, 24.25) and median postoperative SNOT-22 score was 9 (IQR 2.00, 19.25), indicating overall improvement at 6 months. Median procedure duration was 200.4 minutes (IQR 164, 249). Multivariable regression of SNOT-22 showed only history of sinus surgery caused increased sinonasal morbidity (p=0.05). Factors including tumor size (p=0.01), surgical approach (p=0.01), and reconstruction technique (p=0.01) most significantly increased operative time. Conclusions: Only a history of prior sinus surgery was associated with increased nasal morbidity. Tumor size, functional tumors, surgical approach, reconstructive technique, and subtotal resection all prolonged operative time. Surgeons should consider counseling patients meeting these criteria on potential risk of increased morbidity and increased operative time with endoscopic endonasal transsphenoidal resection.

Abnormal electromyographical trigeminal activation through stimulation of the offending artery (Z-L response): An intraoperative tool during microvascular decompression for trigeminal neuralgia.

There are currently no intraoperative neurophysiological tools to assess the effectiveness of trigeminal nerve decompression during microvascular decompression surgery for drug-resistant trigeminal neuralgia. In microvascular decompression surgery for hemifacial spasm, an abnormal electromyographic activation of facial muscles after stimulation of the offending vessel was identified and named 'Z-L response'. We adapted a neurophysiological protocol to elicit a Z-L response during microvascular decompression surgery for trigeminal neuralgia and applied it to a prospective series of 18 surgical patients. Patients had suffered from trigeminal neuralgia for a median 9-year timeframe, and median preoperative Barrow Neurological Institute pain score was 4.5. Through monopolar stimulation, using rising amplitudes starting from 0.1 mA, we confirmed intraoperatively the true culprit vessel before decompression. In 4/18 cases, multiple offending vessels were identified (22 conflicts overall). After decompression, a significant increase in activation threshold (p < 0.0001) confirmed the effectiveness of the maneuver; in 10 cases, Z-L response was abolished. Using this technique, we obtained excellent or good outcome (Barrow Neurological Institute 1-3) in all patients, with a significant reduction in postoperative Barrow Neurological Institute score as compared with preoperative one (median Barrow Neurological Institute 1; p = 0.0002). we provide the first evidence on the applicability and clinical usefulness of Z-L response during microvascular decompression surgery for trigeminal neuralgia.

Impact on quality of life following inguinal hernia repair under local anaesthetic in a primary care setting.

Inguinal hernia repair remains one of the most common elective general surgical procedures. Previous studies have suggested high rates of chronic pain afterwards. The aim of this study was to evaluate changes in quality of life after local anaesthetic (LA) inguinal hernia surgery performed in a primary care setting. Quality of life (QoL) was measured in all patients both pre-operatively and at 6-months post-operatively using the European Hernia Society Scoring tool. Data was analysed by tertile grouping according to initial symptom score. 497 patients filled out pre-operative QoL forms between June 2020 and May 2022. Post-operative QoL scores were received from 179 patients (164 male (91.6%)). Median pre-operative score was 33 (IQR 20-48). Median post-operative score was 4 (IQR 1-11). Mean improvement in QoL score was 27.8. Nine patients had a worse score at 6-months compared to pre-op (5%). When the data was analysed by pre-op QoL group as expected the low symptom group (score 0-10) had minimal improvement in QoL (0.23) and 5 out of 13 patients (38%) had a worse score. The medium group (score 11-40) had a mean improvement in QoL of 17.25 with 3 out of 92 (3.2%) experiencing a worse score. The high symptom group (score 41-90) had a mean improvement in QoL of 45.4 with only 1 of 76 (1.3%) experiencing a worse score. LA Inguinal hernia repair improves QoL substantially 6-months after surgery. However, in those patients with low pre-operative scores (< 11) the gain is minimal and rates of chronic symptoms following surgery are very high. We recommend avoiding surgery in this group and instead adopting a surveillance approach.

Feasibility, safety and efficacy of high intensity focused ultrasound ablation as a preoperative treatment for challenging hysteroscopic myomectomy

Purpose To investigate the feasibility, safety and efficacy of high intensity focused ultrasound ablation (HIFU) as a preoperative treatment for challenging hysteroscopic myomectomies. Materials and methods A total of 75 patients diagnosed with types 0–III of uterine fibroids were enrolled. Based on the Size, Topography, Extension of the base, Penetration and lateral Wall position (STEPW) classification scoring system, 25 cases with a score ≥ 5 points were treated with HIFU followed by hysteroscopic myomectomy (HIFU + HM group), whereas 50 cases with a score < 5 points were treated with hysteroscopic myomectomy (HM group). Results The median preoperative STEPW score was 7 in the HIFU + HM group and 2 in the HM group. The average non-perfused volume (NPV) ratio achieved in fibroids after HIFU was 86.87%. Patients in the HIFU + HM group underwent hysteroscopic myomectomy one to four days after HIFU, and downgrading was observed in 81.81% of fibroids. The operation time for patients in the HIFU + HM group was 73 min and the success rate of myomectomy in a single attempt was 60%. The volume of distention medium used during the operation was greater in the HIFU + HM group than in the HM group (15,500 ml vs. 7500 ml). No significant difference was observed between the two groups in terms of intraoperative blood loss, the incidence of intraoperative and postoperative complications, menstrual volume score, or uterine fibroid quality of life score. Conclusion HIFU can be utilized as a preoperative treatment for large submucosal fibroids prior to hysteroscopic myomectomy. HIFU offers a novel approach in the management of this subset of patients.

Social Deprivation is Associated with Increased Pain in Patients Presenting with Neuropathic Pain.

Neuropathic pain following nerve injury can be debilitating and negatively impact quality of life. Targeted muscle reinnervation (TMR) is an efficacious technique for the management of neuropathic pain. However, this technique may be unequally available for many geographical locations. Therefore, the aim of this study was to evaluate the association between Area Deprivation Index (ADI) and preoperative pain in patients undergoing TMR for treatment of neuropathic pain. Patients who underwent TMR for neuropathic pain in the lower and upper extremities were prospectively enrolled at our tertiary care clinic. A chart review was conducted to obtain socioeconomic, surgery, and comorbidity parameters. Preoperative pain scores (0-10 pain score index), and the ADI, reflecting deprivation status on a 0-100 scale, were collected. A total of 162 patients from 13 different states were included, of which 119 were amputees (74%). The median ADI was 25 (IQR: 16-41) and the median preoperative pain score was 6 (IQR: 5-8). A higher ADI was independently associated with higher preoperative pain. The time interval from nerve injury to TMR was not associated with ADI. Patients undergoing surgical treatment of neuropathic pain from more socially deprived settings have increased pain experience upon initial evaluation, despite having similar time from nerve injury or amputation to TMR. These findings highlight the importance of identifying patients presenting from socially deprived settings, as this may impact their physical and mental health along with their coping mechanisms, resulting in increased pain.

Emergency decompressive surgery in patients with transtentorial brain herniation and pupillary abnormalities: the importance of improved pupillary response after osmotherapy and surgery.

The predictors of survival and functional recovery following emergency decompressive surgery in patients with transtentorial brain herniation, particularly those with pupillary abnormalities, have not been established. In this study, the authors aimed to assess the outcome of patients with intracranial mass lesions, transtentorial brain herniation, and nonreactive mydriasis, following emergency surgical decompression. A retrospective chart review was performed of all patients with transtentorial herniation and pupillary abnormalities who underwent craniotomy or craniectomy at two trauma and stroke centers between 2016 and 2022. The functional outcome was determined using the modified Rankin Scale (mRS). Forty-three patients, 34 men and 9 women with a mean age of 47 years (range 16-92 years), were included. The underlying etiology was traumatic brain injury in 33 patients, hemorrhagic stroke in 8 patients, and tumor in 2 patients. The median preoperative Glasgow Coma Scale score was 3 (range 3-8), and the median midline shift was 9 mm (range 1-29 mm). Thirty-two patients (74.4%) had bilaterally fixed and dilated pupils. The median time to surgery (from pupillary changes) was 133 minutes (mean 169 minutes, range 30-900 minutes). Eighteen patients (41.9%) died postoperatively. After a median follow-up of 12 months (range 3-12 months), 11 patients (26.8%) had a favorable functional outcome, while 10 remained severely disabled (mRS score 5). On univariate analysis, younger age (p < 0.001), less midline shift (p = 0.049), and improved pupillary response after osmotic therapy (p < 0.01) or decompressive surgery (p < 0.001) were associated with favorable outcomes at 3 months. With aggressive medical and surgical management, patients with transtentorial brain herniation, including those with bilaterally fixed and dilated pupils, may have considerable rates of survival and functional recovery. Young age, less midline shift, and improved pupillary response following osmotic therapy or decompressive surgery are favorable prognosticators.

Total Knee Replacement in Nonambulant Patients: Osteoporosis, Severe Fixed Flexion Deformity, and Weak Extensor Mechanism “the Terrible Triad”

Abstract Background: Knee osteoarthritis is among the most disabling disorders in elderly. With delay in proper management, muscular weakness, progressive flexion deformity (FD), and disuse osteoporosis “the terrible triad” are serious consequences, which could be major obstacles for the planned total knee replacements (TKRs). High risk for iatrogenic fractures, difficult gap balancing and failure to promote the patient activity are common expectations. Materials and Methods: A retrospective analysis of all TKRs that were done in a university specialized unit between January 2015 and January 2021 searching for nonambulant-patients was done. Twenty-two replacements for 15 patients who were unable to walk at least 3 months before surgery were found. The median fixed FD (FFD) before anesthesia was 45°. Osteopenia was evident on X-rays and bone thickness intraoperatively. Quadriceps muscle strength was not more than grade four. The median preoperative functional KSS was 0°. The median preoperative WOMAC score was 90.63. Results: Twelve knees had remaining FFD 1 year after surgery with a median of 5°. Ten had iatrogenic fractures mostly affected the medial femoral condyle. One patient could not regain walking capability and 11 patients could not walk without assistance. The median postoperative functional KSS and WOMAC scores were 61 and 21.36, respectively. Conclusion: TKRs in nonambulant patients with evident terrible triad (muscle weakness, osteoporosis, and FFD) is a risky procedure. Common complications include iatrogenic fractures and inability to regain normal physical capabilities. Despite the magnificent improvement in function, we do not recommend performing TKRs in such patients without strict patient counseling with possible drawbacks.

MID-TERM OUTCOMES OF TROCHLEOPLASTY IN THE TREATMENT OF SEVERE TROCHLEAR DYSPLASIA

IntroductionTrochleoplasty is an effective surgical procedure for patients with severe trochlear dysplasia and recurrent patella instability. Previous work has suggested patients demonstrate early improvements in knee function and quality of life. However, concerns regarding longer term outcomes due to the development of stiffness and patellofemoral osteoarthritis remain a concern for these patients. Our aim was to assess mid-term patient-reported outcome and quality of life measures for trochleoplasty performed at a single centre for severe trochlear dysplasia.MethodsRetrospective review of 28 knees (23 patients) having undergone trochleoplasty for severe trochlear dysplasia were reviewed. Due to the non-parametric nature of the data, median and interquartile range (IQR) were determined for pre-operative and mid-term follow-up scores. Statistically significant differences between groups were assessed using paired Wilcoxon-signed rank test with statistical significance set at p&lt;0.05. Data were analysed using a statistical software package (IBM® SPSS® Statistics 26.0).ResultsMedian time from surgery to follow-up for all patients in the series was 5.3 years (IQR 3.9 – 7.0 years). Median pre-operative Kujala score improved from 57.0 (IQR 45 – 66) to 96.3 (IQR 83 -100). Median pre-operative IKDC score improved from 42.6 (IQR 35.9 – 51.3) to 92.6 (IQR 71.6 – 98.7). Median EQ-5D score also improved from 0.691 (IQR 0.414 – 0.727) to 1.000 (IQR 0.8178 – 1.000). Improvement in Kujala scores, IKDC scores and EQ-5D were all statistically significant with p&lt;0.001 in all domains.DiscussionOur data suggests patients experience significant improvements in knee function and quality of life following trochleoplasty surgery for severe dysplasia. We demonstrate an absolute improvement in scores at a mean of 5.3 years follow-up of 39.3 points for Kujala, 50 for IKDC and 0.309 for EQ-5D. Minimal clinically important differences (MCID) have been reported to be in the region of 10 for the Kujala score, 8.8–15.6 for IKDC and 0.085 for EQ-5D. Our data shows improvements which far exceed the published MCID, suggesting trochleoplasty confers a large treatment effect and patients benefiting from sustained improvements in knee function and overall quality of life at mid-term follow-up.ConclusionFollowing trochleoplasty for severe trochlear dysplasia, patient reported outcomes demonstrate continued improvements in knee function and quality of life at mid-term (5-year) follow-up. There is a large absolute treatment effect which likely impacts on both physical and psychological wellbeing for these patients. Continued surveillance of patient reported outcomes in this clinically complex cohort is indicated.

CT-Guided Radiofrequency Ablation Targeting the Herniation Edge of the Cervical Disc for the Treatment of Neck Pain: A Retrospective Study.

Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People's Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42months. At 6months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1month, 1.4 ± 1.38 at 3months and 1.72 ± 1.41 at 6months after RFA (p < 0.01). The numbers of patients with ≥ 50% of their neck pain relieved were 84% (141/168), 87% (147/168), 87% (147/168) and 79% (133/168) at 1day, 1month, 3months and 6months after RFA, respectively. No serious complications related to treatment or long-term complications were observed. This study highlights that CT-guided RFA targeting the edge of cervical disc herniation to destroy the sinuvertebral nerves can effectively relieve neck pain, and the computed tomography (CT)-guided RFA treatment strategy has the advantages of having few complications.

Treatment of recalcitrant femur nonunion with pedicled corticoperiosteal medial femoral condyle flap

Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn’t any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.

Sex differences in patients with primary hyperparathyroidism

BackgroundDifferences in presenting symptoms of primary hyperparathyroidism and outcomes of parathyroidectomy between sexes have been described, but whether these can be assessed by perioperative use of a validated tool, such as the Pasieka Parathyroidectomy Assessment Score, is unknown. MethodAll patients with primary hyperparathyroidism were asked to complete symptom assessment at the preoperative and postoperative visits. The assessment included a query for 13 Pasieka Parathyroidectomy Assessment Score parameters evaluated using a visual analog scale as described by Pasieka (summative score 0–1,300), and general quality of life and wellness. A review of a prospectively maintained database of primary hyperparathyroidism patients (January 2016–December 2019) was performed, and those who had a 6-month cure after initial parathyroidectomy were included. ResultsThe study cohort was mostly women (77%, 541/701). The median preoperative Pasieka Parathyroidectomy Assessment Score was higher in women (155, 0–1,190) than in men (80.5, 0–855, P < .001), although there were similar rates of asymptomatic primary hyperparathyroidism (Pasieka Parathyroidectomy Assessment Score = 0, 12.5% vs 7%, P = .042). After curative parathyroidectomy, women reported a substantial reduction in symptomatology, with Pasieka Parathyroidectomy Assessment Score declining by 35% at initial postoperative visit (median, 155 vs 100, P < .001), further decreasing to 48% by 6 months (155 vs 80, P < .001). The Pasieka Parathyroidectomy Assessment Score in men did change but to a much smaller degree at both the initial postoperative visit (80.5 vs 70; P = .036) and at 6 months (80.5 vs 57.5; P = .048). ConclusionWhen assessed with the Pasieka Parathyroidectomy Assessment Score, improvement in symptoms was clearly demonstrated for women after curative parathyroidectomy. Whether symptom improvement also occurs in men is less apparent but may be due to disparities in the development and validation of outcomes tools in general.

OGBN P22 The safety and efficacy of the Gastric Electrical Stimulator (GES) for gastroparesis in pregnancy

Abstract Background Gastroparesis, a severe illness, can considerably complicate pregnancies. A large proportion of patients suffering from gastroparesis are female and often of child bearing age. This study explored the Gastric Electrical Stimulator's (GES) safety during pregnancy and evaluated outcomes such as symptom control and Quality of Life (QoL). Methods We examined our gastroparesis patient database to identify pregnant women with in-situ GES. The key outcomes included GES safety and efficacy during pregnancy. Metrics such as QoL SF36 scores, nausea, vomiting, pain, satiety, bloating, hospital stay, admissions, and feeding support were evaluated pre- and post-operatively. Results Twelve women with in-situ GES became pregnant. Median age at surgery was 29 years (IQR: 26-31 years), with 58% having diabetes as their gastroparesis cause. A majority (67%) underwent robotic GES insertion. Post-operative improvement was seen across several metrics, including nausea score (from 4 to 1), vomiting score (from 4 to 0), pain score (from 4 to 1), satiety score (from 4 to 0), and bloating score (from 4 to 0). SF36 scores significantly increased from a median pre-operative score of 261 (IQR: 178-65) to 1,783 (IQR: 765-3,527, p&amp;lt;0.001). Also, 58% transitioned from assisted feeding to no feeding support. Conclusions For pregnant patients, GES implantation safely improved gastroparesis symptoms, enhanced QoL as per SF36 scores, and reduced feeding support reliance. More extensive research is required to confirm these findings and understand GES's implications in pregnancy-related gastroparesis.

Pain Medication Use Two Years After Adolescent Idiopathic Scoliosis Fusion Surgery.

Observational case control. The objective of this study was to evaluate the prevalence of opioid use two years after surgical correction of adolescent idiopathic scoliosis (AIS) and its association with preoperative mental health. Studies of opiate use have reported that up to 80% of users began their addiction with misuse of prescription opioids. Identifying opioid use and those at risk in the AIS population is critical for optimal outcomes. A query of a multicenter prospective AIS surgical fusion registry was performed to identify patients of all curve types with responses to question 11 on the Scoliosis Research Society-22 questionnaire at two years postoperative. Question 11 asks about pain medication usage for the patient's back with five specific responses: narcotics daily, narcotics weekly or less, non-narcotics daily, non-narcotics weekly/less, or none. Ordinal regression was used to evaluate the association between preoperative Scoliosis Research Society-22 Mental Health (MH) domain scores and two-year postoperative pain medication usage. A total of 2595 patients who underwent surgery from 2002 to 2019 met inclusion. The average primary curve was 56±12°, average age 14.7±3 years, and 81.5% were female. Forty (1.5%) patients reported utilizing opioids two years after surgery, and a significant difference in preoperative MH scores was observed. Patients taking daily opioids postoperatively had the lowest median preoperative MH score (3.75), followed by non-narcotic group (4), and no medication (4.2, P <0.001). Three patients reporting opioid use postoperatively reported preoperative usage. The rate of two-year postoperative medication use based on the year of surgery demonstrated a small linear decrease in opioid use over time, with a slight increase in nonopioid daily use. Less than 2% of patients reported taking opioids for back pain two years after surgical correction of AIS. A lower MH score before surgery may place a patient at increased risk for opioid use two years after surgery. An analysis of the year of surgery suggests that changes in prescription practices over time may be occurring. 4.

Analyzing Resilience in the Orthopedic Sports Medicine Patient Population.

Little research has been done to compare resilience, as measured by the Brief Resilience Scale (BRS), across common sports medicine patient populations. Our purpose was to investigate resilience levels across sports medicine patient populations. All patients who underwent reconstruction of the anterior cruciate ligament (ACLR), partial meniscectomy (PM), meniscal repair (MR), rotator cuff repair (RCR), or shoulder stabilization (SS) between January 1 and June 30, 2020, were screened for inclusion. At our institution, BRS scores are routinely collected during the preoperative period. Patients with preoperative BRS scores available were included for analysis. Patients who were eligible on the basis of ACLR who underwent concomitant PM or MR were included in the ACL group. A total of 655 patients with a median age of 49 years were included in analysis. The median preoperative resilience score across all patients was 3.83 (interquartile range, 3.50-4.17), and the highest scores were seen in the ACLR group (median, 4.00; interquartile range, 3.67-4.17). On multivariate regression, scores were significantly and independently lower in the PM and RCR groups. Male patients were found to have significantly higher scores than female patients overall (P=.028), but in subgroup analysis by pathology, this effect was only seen in the SS and PM groups. Psychological factors are important to consider when surgically treating patients, and resilience specifically may play a role in predicting treatment success. Patients undergoing PM and RCR tend to report lower resilience scores than patients undergoing ACLR at preoperative baseline. [Orthopedics. 2024;47(2):95-100.].

Results of sclerotherapy and mucopexy with haemorrhoidal dearterialization in II and III degree haemorrhoids. A 4 years' single centre experience.

Haemorrhoidal disease (HD) affects a considerable portion of the adult population. The aim of this study is to confirm the safety and efficacy of the treatments and to report the long-term outcomes of Sclerotherapy (ST) and Mucopexy and Haemorrhoidal Dearterialization (MHD) performed over the last 4 years in a single tertiary centre. The secondary outcome is to evaluate the usefulness of both techniques and to demonstrate how those can be associated as a bridge to surgery. Patients affected by second-third-degree haemorrhoids and undergoing ST or non-Doppler guided MHD between 2018 and 2021 were enrolled. Safety and efficacy, recurrence rate, Haemorrhoid Severity Score (HSS) and pain resulting from both techniques were evaluated. Out of 259 patients, 150 underwent ST. Further, 122 (81.3%) patients were male and 28 (18.7%) were female. The mean age was 50.8 (range 34-68) years. Most of the patients (103, 68.6%) were affected by second-degree HD, while 47 (31.4%) were affected by third-degree HD. The overall success rate was 83.3%. The median pre-operative HSS score was 3 (IQR 0-4, p = 0.04) and at 2 year the median HSS was 0 (IQR 0-1, p = 0.03). No intraoperative complications and no drug-related side effects occurred. The mean follow-up for ST was 2 years (range 1-4; SD ±0.88). MHD was performed on 109 patients. In detail, 80 patients (73.4%) were male while 29 patients (26.6%) were female. The mean age in this group was 51.3 (range 31-69). Further, 72 patients (66.1%) were affected by third-degree HD and 37 (33.9%) by second-degree HD. The median HSS score was 9 (IQR 8-10, p = 0.001) preoperatively two years after treatment was 0 (IQR 0-1, p = 0.004). Major complications occurred in three patients (2.75%). The overall success rate was 93.5% (second degree 89.2% vs. third degree 95.8%). The mean follow-up for MHD was 2 years (range 1-4; SD ±0.68). The results confirm the usefulness of those techniques, which can be considered safe and easily repeatable procedures, with a low recurrence rate after 2 years of median follow-up.

P.104 Grade 3 meningioma survival, recurrence and functional outcomes in an international multicenter cohort

Background: Meningiomas are the most common intracranial tumor, graded from 1 (benign) to 3 (malignant). The aim of this study was to identify clinical features associated with overall survival (OS), progression-free survival (PFS) and functional status for malignant meningiomas. Methods: Demographic, clinical and histopathological data from grade 3 intracranial meningioma cases were identified in the clinical databases from seven sites in North America and Europe from 1991-2022. Summary statistics and Kaplan-Meier OS and PFS curves were generated. Results: We identified 108 patients, with a median age 65 years (IQR: 52, 72) and 53.7% were female. Median OS was 109 months (95% CIs: 88, 227), and 5-year OS rate was 65% (95% CIs: 56, 76). Median PFS was 38 months (95% CIs: 24, 56) and 5-year PFS rate was 37% (95% CIs: 28, 49). OS and PFS were significantly lower in patients aged ≥65 years. Median preoperative KPS score was 80 (IQR: 70, 90), postoperatively KPS was 90 (IQR: 70, 98) and 1-year follow-up KPS was 70 (IQR: 50, 80). Conclusions: This study provides robust survival, recurrence and functional data for grade 3 meningiomas in North America and Europe over a 30-year period.

Wide Awake Local Anesthesia No Tourniquet Surgery of Carpal Tunnel Syndrome: Patients' Experience and Recall Bias in a Day-Care Setting.

Background and Objective: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a technique of local anesthesia commonly used in the surgical treatment of a wide variety of conditions affecting the upper extremity, including Carpal Tunnel Syndrome (CTS). The recent retrospective studies investigated patient experiences in a wide variety of hand disorder-related cases. The aim of our study is to evaluate patient satisfaction regarding open surgical treatment for CTS using the WALANT technique. Material and Methods: we enrolled 82 patients with CTS without medical record of surgical treatment for CTS. For WALANT, a hand surgeon used a combination of 1:200,000 epinephrine, 1% lidocaine, and 1 mL 8.4% sodium bicarbonate solution without tourniquet application and sedating the patient. All patients were treated in a day-care setting. For assessment of patient experience, Lalonde's questionnaire was adapted. Participants completed survey twice: one month and six months after the surgical treatment was performed. Results: the median pre-operative pain score for all patients was 4 (range 0-8) after one month and 3 (range 1-8) after six months. The median intraoperative pain score for all patients was 1 (range 0-8) after one month and 1 (range 1-7) after six months. The median post-operative pain score for all patients was 3 (range 0-9) after one month and 1 (range 0-8) after six months. More than half (61% after one month and 73% after six months) of the patients responded by stating that their real experience of WALANT was better than their initial expectations. An absolute majority of patients (95% after one month and 90% after six months) would recommend WALANT treatment to their relatives. Conclusions: overall, patient satisfaction with treatment for CTS using WALANT is high. Furthermore, complications related to the performed treatment and persistent post-operative pain could be associated with more reliable patient recall of this healthcare intervention. A longer period of time between intervention and assessment of patient experience could possibly be a reason for recall bias.

Regeneration of Partial Anterior Cruciate Ligament Tears Using the Technique of Biologic Augmentation with Bone Marrow Concentrate and Platelet-Rich Plasma Under Arthroscopic Visualization

To present clinical outcomes in a preliminary patient cohort using a biologic augmentation technique consisting of intra-ligamentous and intra-articular infiltration of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) under arthroscopic visualization for treatment of isolated and acute partial anterior cruciate ligament (ACL) tears. Athletes with an acute symptomatic partial ACL injury with clinical examination findings of increased anterior tibial translation without rotational instability were treated with the biologic augmentation technique. Patients were followed for 2 years postoperatively. The Lysholm Knee Questionnaire, IKDC Objective score, physical examination findings, MRI, and the KT-1000 arthrometer were used to assess clinical outcomes. Five patients were included in the analysis with a median age of 22. All patients were determined to have a healed ACL on MRI 8 months postoperatively. The median Lysholm Score at the final follow-up of 99 was significantly increased from the median pre-operative score (p = 0.042). In addition, the objective IKDC score improved in all patients postoperatively, and no clinical examination findings of knee instability were identified at the final follow-up. The median side-to-side difference in KT-1000 arthrometer testing was 3 mm pre-operatively and 0 mm at the last follow-up (p = 0.038). The treatment of appropriately indicated partial ACL injuries in this study has demonstrated that restoration of ligamentous structure and function may be achieved by a biologic augmentation technique using intra-ligamentous and intra-articular infiltration of BMAC and PRP. This technique is performed with minimal technical difficulty, leading to excellent 2-year clinical outcomes in this preliminary series of patients.

Preoperative MR T2WI signal characteristics of adenomyosis are closely related with the outcome of high-intensity focused ultrasound ablation: a propensity score-matched cohort study

To evaluate the correlation of magnetic resonance (MR) T2-weighted image (T2WI) signal characteristics of adenomyosis and the efficacy of high-intensity focused ultrasound (HIFU) ablation. Based on the presence or absence of patchy hyperintense foci on preoperative MR T2WI, the patients with adenomyosis undergoing HIFU treatment were divided into homogeneous signal group and heterogeneous signal group, and the heterogeneous group was further divided into heterogeneous hypointense group and heterogeneous isointense group according to signal intensity of the lesions. The patients in heterogeneous signal group were matched with the patients in the homogeneous group at a 1:1 ratio using the propensity score matching, and similarly, the patients in the heterogeneous hypointense group were matched with those in the heterogeneous isointense group at a 1:1 ratio. The non-perfused volume ratio (NPVR) and relief of dysmenorrhea were used to assess the therapeutic efficacy in the 4 groups. A total of 299 patients were enrolled, who had a median preoperative dysmenorrhea score of 7.0 (6.0, 8.0) and a median NPVR of 53.5% (35.4, 70.1)%. After propensity score matching, the NPVR in homogeneous signal group was significantly higher than that in heterogeneous signal group [(60.3 ± 21.8)% vs (44.6±21.6)%, P < 0.05]. At 3, 6 and 12 months after HIFU, dysmenorrhea relief rates were higher in homogeneous signal group than in heterogeneous signal group, and the difference was statistically significant at 12 months (91.1% vs 76.8%, P < 0.05). The NPVR of heterogeneous hypointense group was higher than that of heterogeneous isointense group [(54.0±22.0) % vs (47.3± 22.9) %, P < 0.05]. At 6 months after HIFU, dysmenorrhea relief rate was significantly higher in heterogeneous hypointense group than in heterogeneous isointense group (91.5% vs 80.9%, P < 0.05). The signal characteristics of adenomyosis on T2WI are closely related with the outcome of HIFU ablation, and its efficacy is better for homogeneous than for heterogeneous adenomyosis, and better for heterogeneous hypointense adenomyosis than for heterogeneous isointense adenomyosis.