Nature Of Surgery Research Articles

Male Sex, Revision Surgery, Low Volume of Anterior Cruciate Ligament Remnant, and Significant Instability Are Risk Factors for Posterior Root Tear of the Lateral Meniscus in Patients Undergoing Anterior Cruciate Ligament Reconstruction

PurposeThis multicenter study aimed to determine the incidence of lateral meniscus posterior root tears (LMPRTs) in patients undergoing ACL reconstruction and identify associated risk factors. MethodsWe conducted a retrospective, multicenter study using data from the Francophone Arthroscopic Society's registry. The study included all the patients in the registry who underwent ACL reconstruction surgery between June 2020 and June 2023, we excluded incomplete data. We compared delay from injury to surgery between LMPRTs group and No LMPRTs group. Variables investigated as potential risk factors for LMPRTs included age, sex, nature of surgery (primary or revision), pivot shift test result, side-to-side laxity under anesthesia, presence of ACL remnant, occurrence of medial meniscal tear, and presence of collateral ligament injury. Risk factors were analyzed using a logistic regression model. ResultsAmong the 5359 patients analyzed, LMPRTs occurred in 7.0% (n=375) of cases during ACL reconstruction. Mean age at surgery was 29.3 +/- 10.3 years old [11-77]. Concerning delay to surgery, the mean time was 8.4 +/- 23.1 weeks [0.0-347.2] in the No LMPRTs group and 6.5 +/- 10.2 weeks [0.2-61.6] in the LMPRTs group (p = 0.109). Univariate analysis revealed that male sex (p < 0.001), revision surgery (p < 0.001), medial meniscal injury (p = 0.007), ACL remnant (0% vs > 70%, <10% vs > 70%, 10 to 30% vs > 70%, 30 to 50% vs > 70%, 50 to 70% vs > 70%; p < 0.001) and higher pivot shift grade (p = 0.011) were significantly associated with a presence of LMPRTs. Age, side-to-side laxity, and collateral ligament injury were not found to be significant risk factor In multivariate analysis : male sex, revision surgery, pivot shift test result and a low volume of ACL remnant remained significant. Side to side laxity was also a significant factor in multivariate analysis. ConclusionThis study identified male sex, revision surgery, low volume of ACL remnant, side to side laxity and higher grade of pivot shift as significant risk factors for LMPRTs during ACL reconstruction.

Treatment of portal hypertension complicated by variceal bleeding

Background. Mortality in variceal bleeding (VB) on the background of portal hypertension (PH) is highest among patients with gastrointestinal bleeding. The treatment of PH complicated by VB is a complex problem that is far from being solved, especially in case of Child-Pugh class B and C decompensation. The aim of the study was to determine the causes of PH complicated by VB, features of conservative and interventional therapy, indications and nature of surgical procedures, treatment efficacy, as well as causes of complications and mortality. Materials and methods. We analyzed treatment outcomes of 923 inpatients with PH complicated by VB who were treated in the clinic of the Department of Surgery of the Faculty of Dentistry of Bogomolets National Medical University on the basis of the Kyiv City Clinical Emergency Hospital from 2012 to 2023. It was possible to talk about the cause of PH based on anamnestic data in 61 % of cases. In 711 (77 %) patients, the source of bleeding was detected endoscopically within 30–60 minutes from the moment of admission to the clinic. Conservative therapy included the administration of hemostatic and agents lowering pressure in the portal system, as well as vasoconstrictors that reduce portal blood flow. For the failure of conservative therapy, unstable hemostasis, and repeated previous bleedings, 59 (6.4 %) patients were operated. The methodology of the research analysis consisted in the fact that the arithmetic mean and standard error (M ± m) were determined as the characteristics of the groups for features with a distribution corresponding to the Gaussian law. This reference method of descriptive statistics was applied to evaluate surgical treatment in comparison with conservative therapy and interventional measures. Results. Endoscopic hemostasis by the ligature method was achieved in 97 (10.5 %) patients. Repeated endoscopy due to VB recurrence was done in 276 (29.9 %) participants. In cases of unsatisfactory endoscopic hemostasis, as well as recurrent VB, a Sengstaken-Blakemore probe was installed. In case of right-sided PH, the formation of varices in the esophagus is caused by the discharge of blood mainly through the coronary vein, which required its transection during еsophagogastric devascularization. In compliance with this rule, the patients underwent esophagogastric devascularization, circular transection of the esophagus, which provided portoazygous disconnection. The total mortality rate was 43.1 %, among operated people — 8.5 %, and among non-operated ones — 42.1 %. Conclusions. PH complicated by VB is evidence of decompensated processes in the liver parenchyma or obstruction in the portal system. Conservative therapy and interventional measures make it possible to stop bleeding and prepare the patient for elective surgery, if necessary. An operation that stops blood flow through dilated veins of the esophagus or stomach is an effective method of treating bleeding in portal hypertension.

Regional Anaesthesia Techniques for Orthopaedic Surgery at Tertiary Care Teaching Hospital

Background: Regional anaesthesia has found its uses in many aspects of orthopaedic surgery including more recently, spine surgery. Neuraxial or regional anaesthesia are often the preferred techniques for surgical anaesthesia in patients with multiple comorbidities. For instance, osteoporosis-related complications such as hip fractures are common in the growing geriatric population. Orthopaedic surgery aims to recover functional capacity in patients but it carries a specific morbidity and mortality. Orthopaedic surgery conveys several challenges for the anaesthesiologist, including prevention of thromboembolic complications, reduction of peri- and postoperative bleeding and management of autologus blood transfusion and postoperative pain. Material and Methods: This is a prospective study was conducted in the Department of orthopaedic and Anaesthesia at Shadan Institute of Medical Sciences, Teaching Hospital and Research Center. Three hundred and ten consecutive cases posted for orthopaedic surgeries were taken up for study. Anaesthesia technique was decided based on the nature of surgery, willingness and medical status of the patient and experience of the anaesthesiologists. RA was planned whenever possible. In the morning of operation the RA technique was explained to the patients and intravenous (IV) access established. Preoperative medication was given using IV fentanyl and midazolam in titrated doses. Ketamine was used in children and appropriate block given using standard technique. Nerve stimulator was used wherever applicable Results: Age of the patients ranged from three months to 92 years. Maximum number of patients belonged to the age group of 21- 50 years (63.2%). As per the demographic data. In our study, Knee arthroscopy and repair was 28.38%, Femoral was 17.41%, Radius and ulna was 15.16% and least were Ankle and foot, Wrist and hand surgery was 1.93%. In our study Subarachnoid block was 40.96% followed by Combined spinalepidural 17.09%, General anaesthesia 12.90%. Conclusion: In a conclusion, the use of regional anesthesia techniques for postoperative outcomes in orthopedic surgeries has been investigated in lots of clinical studies and case reports. Most of the authors proposed that regional anesthesia in orthopedic patients may be associated with better postoperative pain control and a reduction in intraoperative blood loss when compared with general anesthesia. In the future regional anesthesia techniques will be more preferable anesthetic technique in orthopedic surgeries

THE HIPHOP STUDY: A FEASIBILITY STUDY FOR A RANDOMIZED CONTROLLED TRIAL OF HYBRID VERSUS CEMENTED TOTAL HIP ARTHROPLASTY

Studies have shown that 10–30% patients do not achieve optimal function outcomes after total hip replacement (THR). High quality randomised controlled trials (RCTs) evaluating the clinical and cost-effectiveness of techniques to improve functional outcomes after THR are lacking. We performed this study to evaluate the feasibility of a RCT comparing patient-reported functional outcomes after hybrid or fully cemented THR (ISRCTN11097021).Patients were recruited from two centres and randomised to receive either a fully cemented or hybrid THR. Data collection included Patient Reported Outcome Measures (PROMs), non-serious adverse events of special interest (AESI), serious adverse device effects (SADE) and NHS resource use. Qualitative interviews were undertaken to understand a) patient experiences of study processes and their reasons for taking part or not, and b) to understand surgeons’ perceptions of the study, factors affecting willingness to participate, and barriers to implementation of the future RCT findings.The target of 40 patients were successfully recruited for the feasibility RCT; the ratio of successful recruitment to eligible patients was 0.61 across both sites. Treatment crossovers occurred in four patients, all related to bone quality. Four patients were withdrawn due to not undergoing surgery within the study window because of the pandemic. Follow-up was 100% and PROMs were completed by all patients at all time points. The feasibility of conducting a within-trial cost-utility analysis was demonstrated. Interviews were conducted with 27 patients and 16 surgeons. Patients and surgeons generally found the study procedures acceptable and workable. Some declined participation because they did not want treatment allocated at random, or because blinding was off-putting. Surgeons’ perceptions of equipoise varied, and implementation of findings from the future RCT would need to recognise the ‘craft’ nature of surgery and the issue of training.We conclude that a full RCT with economic analysis will be both feasible and practicable, although mechanisms to safely implement potential changes to practice because of RCT findings may need consideration by the wider arthroplasty community.

Learning from experience: a qualitative study of surgeons’ perspectives on reporting and dealing with serious adverse events

IntroductionIn surgery, serious adverse events have effects on the patient journey, the patient outcome and may constitute a burden to the surgeon involved. This study aims to investigate facilitators and...

Coronary Artery Bypass Grafting in the Elderly: Are We Doing the Right Thing? Should These Patients Be Left Alone?

Coronary artery bypass grafting (CABG) in the ageing population is always a debatable topic in most heart centres. Are we doing the right thing by intervening and performing isolated CABG in patients aged ≥75 years? This study aimed to investigate the predictive ability of EUROSCORE II, the revascularisation success of CABG with the survival outcomes of these patients. A retrospective analysis was performed of all patients aged ≥75 years who underwent CABG plus concomitant procedures in this single large tertiary institution during the last 8 years from 2015 to present. Predictive risk ability using EuroSCORE II, revascularisation success, and survival outcomes were analysed. The mean age, gender predominance, nature of surgery, elective vs emergency, duration of cardiopulmonary bypass, length of intensive care unit (ICU) stay, inotropic support, use of intra-aortic balloon pump, ventilation period in ICU, blood products transfusion rate, in-patient mortality rate with survival ratio, and overall 30-day mortality were calculated. EuroSCORE II predictive ability risk was calculated. Patient selection is the key. It is reasonable and rational to perform CABG in the elderly population, bearing in mind that they will have longer ICU and hospital stays, with a longer postoperative recovery period. Frailty risk models may establish a prediction of true operative risk.

Surgical Site Infections in Clean and CleanContaminated Surgeries at a Tertiary Care Centre: A Longitudinal Study

Introduction: Surgical Site Infections (SSIs) are very common and the most frequently studied Hospital-Acquired Infection (HAI) in developing countries. Up to 5% of patients undergoing surgery develop SSIs, which can cause significant morbidity and, in some cases, be fatal. Aim: To determine the prevalence of SSI and compare the factors related to its development between clean and cleancontaminated surgeries. Materials and Methods: This longitudinal study was conducted at a rural tertiary care centre in the Department of General Surgery from May 2020 to April 2021. A total of 1,020 patients who underwent clean and clean-contaminated surgeries were clinically examined, investigated, and provided standard treatment modalities. Dirty and contaminated cases were excluded from the study. Clean and clean-contaminated surgeries were defined according to the guidelines provided by the Centres for Disease Control and Prevention (CDC). Demographic and risk factors, such as sex, age, nature of surgery, wound irrigation, American Society of Anaesthesiologists (ASA) score, smoking, preoperative stay, duration of surgery, hair removal, drains, immunosuppression, Diabetes Mellitus (DM), and Hemoglobin (Hb) levels, were observed and compared between the two groups. The development of SSI was diagnosed based on CDC guidelines. SSI cases were followed up longitudinally in both groups. Continuous variables were analysed using an unpaired t-test, while categorical variables were analysed using a chi-square test. A p-value of &lt;0.05 was considered statistically significant. Results: Out of the 1,020 patients, a total of 93 (9.11%) developed SSI. Among the males (573, 56.17%), 39 (6.8%) developed SSI, while among the females (447, 43.83%), 54 (12.08%) developed SSI. The study found that 24 (3.46%) clean operations and 69 (21.1%) clean-contaminated surgeries developed SSI (p-value&lt;0.0001). There was a significant association between SSI and risk factors such as ASA &lt;2 (p-value&lt;0.01), smoking (p-value&lt; 0.01), DM (p-value&lt; 0.01), Hb &lt;8 gm% (p-value&lt;0.01), shorter preoperative stay (p-value&lt;0.01), prolonged surgery (p-value&lt;0.01), use of drains (p-value&lt;0.01), and immunosuppression (p-value&lt;0.01). The majority of SSIs were caused by Staphylococcus aureus (24 cases, 25.8%), followed by Pseudomonas aeruginosa (18 cases, 19.3%) and Escherichia coli (12 cases, 12.9%). Patients who developed SSI had a mean postoperative stay of 32.35 days, compared to 7.19 days for those who did not develop SSI. Conclusion: The study concluded that SSI was significantly more common in clean-contaminated surgeries compared to clean surgeries. Proper surveillance can help document SSI even after hospital discharge. Prompt identification of organisms can facilitate clinical recovery.

Perioperative bridging anticoagulation in patients with oral cancer surgery: a multicenter retrospective study

The number of patients administered oral antithrombotic drugs who require elective surgery has increased. Perioperative heparin bridging needs to be considered for patients at a high risk of thromboembolism. The present study investigated the effects of perioperative heparin bridging therapy on perioperative complications (postoperative bleeding and thrombotic events) in oral cancer surgery. The medical records of 98 patients who underwent oral cancer surgery with perioperative bridging therapy were retrospectively analyzed. Postoperative hemorrhage occurred in 16 patients (16.3%) and thrombotic events (deep venous thrombosis) in 5 (5.1%), which were higher than in other surgeries. A multivariate analysis identified the administration of prostaglandins as the only significant independent risk factor for postoperative hemorrhage, and a longer duration of postoperative heparin bridging therapy was associated with the incidence of deep venous thrombosis. The present results suggest a higher incidence of thrombotic and bleeding events in patients who underwent oral cancer surgery with heparin bridging, and the nature of surgery (such as revascularization and prolonged bed rest) may be a contributing factor. Future studies are needed to establish whether heparin bridging is effective in oral cancer surgery.

Caesarean Myomectomy: Safety and Feasibility of The Procedure

Introduction: Frequency of uterine myomas has increased these days with factors like delayed child bearing and IVF conception in elderly pregnant women. The vascularity of uterus increased and thus myomectomy during caesarean was considered a risk. With advanced surgical techniques the risk has become minimal these days. Case Report: 42 year G4P3L3 presented with 36 weeks gestation with USG s/o 3 large uterine fibroid, 2 subserosal fibroids with largest of size 7.1 x 6.3 x 7.2 cms, and 1 intramural fibroid. Emergency LSCS was done for her due to fetal indication. Due to emergency nature of surgery the option of preoperative uterine artery embolisation was not feasible and hence decision of stepwise de-vascularisation was taken. The de-vascularisation was done at the level of B/L uterine arteries, utero ovarian anastomosis bilaterally followed by removal of the three myomas. Discussion: Majority of myomas do not require surgical intervention during pregnancy or delivery. It has been repeatedly stated in the literature that routine myomectomy during cesarean section should be avoided and should only be carried out in carefully selected patients. In our case, stepwise devascularisation was required to control the bleeding. Proper devascularization and experienced obstetricians can reduce the incidence of haemorrhage and hysterectomy. The approximate blood loss was only 400 ml signifying the importance of this approach to myomectomy during caesarean section.

Psychological distress among elderly surgical patients who had their surgery postponed during the COVID-19 pandemic

BackgroundMany institutions withheld elective lists and triaged surgeries during the peak of coronavirus disease 2019 (COVID-19) pandemic. As a result, older surgical patients have had to wait for rescheduled dates in a long waitlist. This study aimed to identify the psychological impact in these patients when they returned for surgery.MethodsThis was a cross-sectional study which included 153 patients aged ≥ 65 years undergoing elective surgery. Trained interviewers recruited and assessed psychological status pre-operatively with two validated questionnaires - Hospital Anxiety and Depression Scale (HADS) and 36-item Short Form Health Survey (SF-36). Specific questions were asked about their postponed surgeries, appetite and fear.ResultsA total of 36 out of 153 (23.5%) patients had their procedures deferred during the first wave of COVID-19 pandemic. Postponed cases were significantly based on the nature of surgery (p = 0.002), cancer diagnosis (p = 0.006) and surgical specialty (p = 0.023). Median HADS scores were higher for patients who were postponed (2.00 versus 4.00 for anxiety, p = 0.180 and 0.00 versus 1.00 for depression, p = 0.424) although no statistical significance was shown. In the whole study population, anxiety was a significant predictor for depression and vice versa (p < 0.001) with other predictive risk factors for anxiety that were age ≥ 85 years old (odds ratio [OR] 6.14, p = 0.018), female (OR 2.41, p = 0.024), cancer (OR 2.19, p = 0.039) and major surgery (OR 2.39, p = 0.023). Similarly, older patients ≥ 85 years old (OR 10.44, p = 0.003) and female (OR 6.07, p = 0.006) had higher risk for depression. Both anxiety and depression were significant risks for loss of appetite (p = 0.005 and 0.001). Lastly, the fear of disease progression due to rescheduling was more frequent in cancer patients (p = 0.035).ConclusionThe mental health and disease burden of older surgical patients should be taken into careful consideration when cases need to be postponed in our healthcare system.

Surgical Site Infection at a Central Academic Hospital in Johannesburg: A One-year Audit

<i>Introduction</i>: Surgical site infection accounts for approximately 38% of hospital-acquired infections globally and is associated with increased length of hospitalization and mortality. The aim of the study was to determine the incidence of surgical site infection, causative organisms and factors which were associated with its occurrence at a central hospital in South Africa. <i>Methods:</i> A retrospective review of records of patients who developed surgical site infection over a 12-months period was conducted. Data were extracted from records of weekly morbidity and mortality meetings of the Department of Surgery. Data retrieved included demographic information, co-morbidities, nature of surgery, class of surgical site infection and microscopy, culture and sensitivity results and overall outcome including the length of hospital stay. <i>Results</i>: During the study period 3 005 surgical procedures were performed of which 46.8% were elective operations. A total of 147 records of patients who developed surgical site infection were found. The mean age of these 147 patients who developed surgical site infection was 47.3±17.21 years. The incidence of reported surgical site infection was 4.8% (147/3 005) with 72.6% (93/147) occurring in males. Nineteen of the 147 cases had to be excluded and thus only 128 patient files were suitable for the study. Of patients who developed surgical site infection, 30.5% (39/128) had diabetes mellitus, 21.9% (28/128) had hypertension and 18.8% (24/128) had both diabetes and hypertension, while 15.6% (20/128) of patients were known to be HIV positive. Sixty-four percent (64.1%: 82/128) of the patients who developed SSI had positive culture results and the two most commonly cultured organisms were <i>E. coli</i> (44%, 36/82) and <i>P. aeruginosa </i>(29.3%, 24/82). <i>Conclusion: </i>The overall rate of occurrence of surgical site infection was 4.8% and most of the infections were diagnosed in male patients. The two most commonly cultured organisms were <i>E. coli</i> and <i>P. aeruginosa</i>. Thirty-one percent who had surgical site infection had diabetes mellitus.

Effects of enhanced recovery after surgery practices on postoperative recovery and length of stay after unilateral primary total hip or knee arthroplasty in a private hospital.

Enhanced recovery after surgery (ERAS) practices improve postoperative recovery and reduce postoperative length of stay (LOS) in patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our study investigated whether these promising results could be reproduced in a private hospital setting. In total, 228 patients were included in the study cohort: the conventional group comprised 117 patients from 2012 to 2014, while the ERAS group comprised 111 patients from 2017 to 2018. All patients had undergone unilateral primary THA or TKA at a private hospital in Hong Kong. The outcome was postoperative LOS; factors affecting LOS were also investigated. No significant differences were found in any baseline parameters between the two groups of patients. The mean LOS was significantly shorter in the ERAS group than in the conventional group (3.28 ± 1.04 vs 5.16 ± 2.06 days, P<0.001). Moreover, a significantly greater proportion of patients could be discharged on or before postoperative day 3 in the ERAS group, compared with the conventional group (77.5% vs 13.7%, P<0.001). A significant difference in LOS was observed between general ward and private ward patients (3.06 ± 0.59 vs 3.66 ± 1.46 days, P=0.003). Sex, age, and nature of surgery (TKA vs THA) did not have significant effects on LOS. The ERAS practices yielded a significant improvement in postoperative LOS, compared to conventional practices, among patients who underwent unilateral primary THA or TKA in a private hospital.

Perioperative airway complications in infants and children with Crouzon and Pfeiffer syndromes: A single-center experience.

Crouzon and Pfeiffer syndromes are rare genetic disorders characterized by craniosynostosis, exorbitism, and maxillary hypoplasia. Patients with these syndromes frequently require general anesthesia for various diagnostic and surgical procedures and may present a challenge to anesthetists with regard to airway management. The primary aim of this study was to determine the incidence, timing, and management of perioperative upper airway obstruction in infants and children with Crouzon and Pfeiffer syndromes. The secondary aim was to determine the degree of difficulty in performing endotracheal intubation. A retrospective review of 812 anesthetic encounters in 67 patients was conducted. The following were recorded: timing and management of episodes of perioperative upper airway obstruction, from induction of anesthesia to discharge from recovery, degree of difficulty with laryngoscopy using the Cormack-Lehane grading system and number of intubation attempts required, patient demographics, respiratory comorbidity, surgical procedure, and anesthetic airway management techniques. Upper airway obstruction at induction of anesthesia was very common, with an incidence of 31% (167/542 anesthetic encounters affecting 54 patients). In a quarter of these incidents, bag-valve-mask ventilation was challenging, but a laryngeal mask airway was almost always effective. Upper airway obstruction on emergence from anesthesia was less common, with an incidence of 2.7% (14/515 anesthetic encounters affecting 10 patients). Contributing factors included patient comorbidity (obstructive sleep apnea, nasal stenosis) and the nature of surgery (craniofacial or airway procedures). Intubation was rarely difficult in this cohort, with 85% of laryngoscopies rated Cormack-Lehane grade 1 or 2 (n=373), and 89% of intubations successful on the first attempt (n=306). Upper airway obstruction at induction of anesthesia is common in patients with Crouzon and Pfeiffer syndrome. These patients are likely to present some difficulties with perioperative airway management, especially bag-valve-mask ventilation, but rarely endotracheal intubation.

Challenges in chronic pelvic pain: Diffuse uterine capillary haemangioma simulating a clinical picture of adenomyosis

Introduction: Adenomyosis is a heterogeneous condition of difficult diagnosis that stands out in our patients for causing abundant menstrual bleeding, dyspareunia and dysmenorrhoea. However, in chronic pelvic pain units it is important to consider other conditions of similar symptomatologies, such as vascular malformations. These include capillary haemangiomas which, although rare in the reproductive tract, can produce serious symptoms. Case description: We present the case of a 31-year-old woman under observation by the chronic pelvic pain unit for dysmenorrhoea and dyspareunia since menarche. Ultrasound and magnetic resonance findings were compatible with adenomyosis. The patient showed no improvement with hormonal treatment. Upon failure of the medical treatment and taking into account the patient’s lack of gestational desire, a laparoscopic hysterectomy was performed. The pathological report revealed a diffuse capillary haemangioma as the cause of the symptoms. Given the completely curative nature of surgery for this type of condition, the patient was discharged from our unit. Conclusion: The preoperative diagnosis of adenomyosis is still a challenge and units specializing in chronic pelvic pain must consider all possible diagnostic options so as not to overlook rarer conditions such as vascular malformations.

Incidence and risk factors for maternal surgical site infection after cesarean section.

Objective: To ascertain the frequency and risk factors for post-operative surgical site infection (SSI) in cesarean section. Study Design: Cross-sectional study. Setting: Departments of Gynecology &amp; Obstetrics and Anesthesiology, Secondary Care Hospital. Period: January to December 2017. Material &amp; Methods: After the approval of hospital ethical committee, 337 parturient who underwent cesarean section were included in our study. Outcomes were: frequency and risk factors for post-cesarean wound infection. Data was analyzed by SPSS version 20. Qualitative data presented as frequency and percentage. Chi-square (Fishers test) used to analyze significance. P-value ≤ 0.05 taken as significant. Results: A total of 337 patients were included in our final analysis. The frequency of wound infection was 15 (4.4%). The mean age was 27.5 years ± 5.8 in our study population. There was no difference in age (p=0.781), parity (p=0.898), antenatal visits (p=0.319), referral from doctor (p=0.205), anemia (p=0.731), nature of surgery (elective or emergency LSCS) p=0.548, severity of anemia (p=0.962), blood grouping Rh-factor (p=0.531), chorioamnionitis (p=0.707), labor (p=0.955), premature rupture of membrane (p=0.427) and antepartum hemorrhage (p=0.769). 11 (3.3%) of the patients with SSI were treated conservatively while 4 (1.2%) required debridement and secondary suturing. None of our patients required referral to tertiary care hospital for treatment of SSI. Conclusion: The incidence of SSI after cesarean section was less in our study and we didn’t find maternal age, gestational age, previous cesareans delivery, antenatal visits, PROM, labor before LSCS, anemia to be associated with risk of SSI.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

A comparative study based on surgical and functional outcome of proximal tibia fractures between unicondylar and bicondylar fractures

Background: Tibia plateau fractures constitute 1%of all fractures. Bicondylar fractures account for 10-30%, whereas isolated medial and lateral condyle fractures constitute the remaining injuries. Although only 3% of these fractures are open injuries, many of them have closed degloving, deep abrasions or severe soft tissue injuries which require careful consideration in deciding the timing and the nature of surgery. Proximal tibia fractures may be difficult to treat even in experienced hands due to intraarticular extension, comminution, cartilage damage and soft tissue injuries of the cruciate ligaments and menisci. Aim: To compare the functional and surgical outcomes of operative treatment of unicondylar and bicondylar fractures. Materials and Methods: It was a prospective and comparative study of Surgical and functional outcome of proximal tibial fractures in the department of orthopaedics from July 2019 to December 2019. Clearance was obtained from the hospital ethical committee. Fifty patients were taken into consideration for the study. All patients are selected on the basis of history, clinical examination and radiography. The Schatzker’s classification was used to classify these fractures. The patients were followed up for an average period of 6 to 12 months. The patients were divided into two groups. Twenty-five patients in the unicondylar fracture group 1and 25 patients in the bicondylar fracture group 2. Results: The mean age of group 1 patients was 45.7210.85 years, and that of group 2 patients was 46.408.602 years (p>0.05). In group 1 there were 18 (72%) males and 7 (28%) females, in group 2 there were 21 (84%) males and 4 (16%) females. In group 1, the mean union time was 3.04 0.351 and in group 2 was 3.1 0.433(p>0.05). In group 1, the mean follow-up time was 12.81 2.09 and in group 2 was 13.04 2.28 (p>0.05). The mean functional score of group 1 was 91.212.27, and in group 2, it was 8718.2 (p>0.050). In group1 mean WOMAC score was

Salvage chemoradiation therapy for recurrence after radical surgery or palliative surgery in esophageal cancer patients: a prospective, multicenter clinical trial protocol

BackgroundCurrently, adjuvant therapy is not recommended for patients with thoracic esophageal squamous cell cancer (TESCC) after radical surgery, and a proportion of these patients go on to develop locoregional recurrence (LRR) within 2 years. Besides, there is no evidence for salvage chemoradiation therapy (CRT) in patients with residual tumor after esophagectomy (R1/R2 resection). In addition, factors like different failure patterns and relationship with normal organs influence the decision for salvage strategy. Here, we aimed to design a modularized salvage CRT strategy for patients without a chance of salvage surgery according to different failure patterns (including R1/R2 resection), and further evaluated its efficacy and safety.MethodsOur study was designed as a one arm, multicenter, prospective clinical trial. All enrolled patients were stratified in a stepwise manner based on the nature of surgery (R0 or R1/2), recurrent lesion diameter, involved regions, and time-to-recurrence, and were further assigned to undergo either elective nodal irradiation or involved field irradiation. Then, radiation technique and dose prescription were modified according to the distance from the recurrent lesion to the thoracic stomach or intestine. Ultimately, four treatment plans were established.DiscussionThis prospective study provided high-level evidence for clinical salvage management in patients with TESCC who developed LRR after radical surgery or those who underwent R1/R2 resection.Trial registrationProspectively Registered. ClinicalTrials.govNCT03731442, Registered November 6, 2018.

COVID-19 consent and return to elective orthopaedic surgery: allowing a true patient choice?

AimsThe exact risk to patients undergoing surgery who develop COVID-19 is not yet fully known. This study aims to provide the current data to allow adequate consent regarding the risks of post-surgery COVID-19 infection and subsequent COVID-19-related mortality.MethodsAll orthopaedic trauma cases at the Wrightington Wigan and Leigh NHS Foundation Trust from ‘lockdown’ (23 March 2020) to date (15 June 2020) were collated and split into three groups. Adult ambulatory trauma surgeries (upper limb trauma, ankle fracture, tibial plateau fracture) and regional-specific referrals (periprosthetic hip fracture) were performed at a stand-alone elective site that accepted COVID-19-negative patients. Neck of femur fractures (NOFF) and all remaining non-NOFF (paediatric trauma, long bone injury) surgeries were performed at an acute site hospital (mixed green/blue site). Patients were swabbed for COVID-19 before surgery on both sites. Age, sex, nature of surgery, American Society of Anaesthesiologists (ASA) grade, associated comorbidity, length of stay, development of post-surgical COVID-19 infection, and post-surgical COVID-19-related deaths were collected.ResultsAt the elective site, 225 patients underwent orthopaedic trauma surgery; two became COVID-19-positive (0.9%) in the immediate perioperative period, neither of which was fatal. At the acute site, 93 patients underwent non-NOFF trauma surgery, of whom six became COVID-19-positive (6.5%) and three died. A further 84 patients underwent NOFF surgery, seven becoming COVID-19 positive (8.3%) and five died.ConclusionAt the elective site, the rate of COVID-19 infection following orthopaedic trauma surgery was low, at 0.9%. At the acute mixed site (typical district general hospital), for non-NOFF surgery there was a 6.5% incidence of post-surgical COVID-19 infection (seven-fold higher risk) with 50% COVID-19 mortality; for NOFF surgery, there was an 8.3% incidence of post-surgical COVID-19 infection, with 71% COVID-19 mortality. This is likely to have significance when planning a resumption of elective orthopaedic surgery and for consent to the patient.Cite this article: Bone Joint Open 2020;1-9:556–561.

MANAGEMENT OF LUNG HYDATID DISEASE: REVIEW OF 100 CASES FROM THI-QAR / IRAQ

&nbsp; Objective: To present the advantages of elimination of the residual cavity after lung hydatid cyst removal by capitonnage associated with closure of the bronchial openings and partial pericystectomy via thoracotomy and to compare our study made at Al – Hussein Teaching Hospital in Thi-Qar governorate with those done in other centers and hospitals in Iraq and outside our country. Patients: This is a retrospective study of 100 patients for whom thoracotomy for lung hydatid cyst(s) was carried out over a period of about three years (from 1st of January 2013 till 1st of February 2016). Methods: The case sheets of relevant patients for whom thoracotomy for lung hydatid cyst(s) were carried out were reviewed to collect information like patient's sex, age, nature of surgery, method of obliteration of residual cavity after removal of hydatid cyst(s), etc… Results: All patients were admitted into Al-Hussein teaching hospital and thoracotomy was done for all of them regardless the age. Most of our patients suffered only from lung hydatid cyst(s) and several patients had also concomitant liver hydatid cyst(s) for which phrenotomy was carried out at the same session of thoracotomy to deal with the liver hydatid cyst(s). This concomitant phrenotomy to deal with the liver hydatid cyst(s) made the patient in no need for another surgery (laparotomy) in the future and the number of incisions and operations. A large number of our patients had no or mild symptoms&nbsp;&nbsp; at time of examination. Higher number of patients had cough and several patients complained from hemoptysis. All patients were exposed to chest X-ray, chest CT – scan and abdominal U/S before surgery. During the operation, the hydatid cyst(s) was/were removed and the evacuation technique was most commonly applied and lobectomy was very rarely carried out. After removal of hydatid cyst(s), the residual cavity was mostly obliterated (capitonnage) to prevent collection of blood, exudate and possibly pus inside residual cavity and to seal the bronchial fistulae completely and ensure rapid expansion of lung. Conclusions: Pulmonary hydatid disease is endemic in Iraq and is diagnosed by imaging investigations and can be treated with minimal morbidity and mortality by lung preserving surgery. Elimination of the residual cavity after hydatid cyst removal by capitonnage was most commonly carried out. Hydatid disease affects children and young aged people and the management is always by surgery and there is no way for conservative treatment except for dead and calcified hydatid cysts.