Number Of Operative Procedures Research Articles

Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion.

Prepectoral implant-based breast reconstruction is often supplemented by autologous fat grafting to optimize aesthetic outcomes. This usually entails several rounds of modest fat transfer to minimize risk of necrosis; however, the limits of fat grafting at expander exchange are not known. A single-institution retrospective review from July 2016 to February 2022 was performed of all patients who underwent (1) mastectomy, (2) prepectoral tissue expander placement, (3) expander exchange for implant, and (4) at least one round of autologous fat transfer. Student t test and χ 2 test were used. A total of 82 breasts underwent a single round of fat grafting during implant placement (group 1); 75 breasts underwent fat grafting that occurred in multiple rounds and/or in delay to implant placement (group 2). Group 1 received more fat at the time of implant placement (100 mL; interquartile range, 55-140 mL; P < 0.001) and underwent fewer planned operative procedures compared with group 2 (1.0 vs 2.2, P < 0.001). Total fat volume in group 2 did not significantly exceed that of group 1 until after 3 rounds of fat transfer (128.5 mL; interquartile range, 90-130 mL; P < 0.01). There was no difference in the rate of fat necrosis between groups after the first round (15.9% vs 9.3%, P = 0.2) and final round (15.9% vs 12.0%, P = 0.5) of fat grafting. Complication rates were similar between groups (3.7% vs 8.0%, P = 0.2). A 2-stage approach of prepectoral tissue expander placement with single round of larger volume fat transfer at expander exchange reduces overall number of operative procedures without increased risks.

The transferability of the minimal invasive surgeon’s skills to open surgery

Background Robot-assisted laparoscopic surgery has gained popularity, which has contributed to a decrease in the number of open procedures. Hence a growing concern regarding the ability of laparoscopically trained surgeons to perform open surgery (e.g. due to bleeding complications) has been raised. The aim of the study was to investigate the ability of conversion to open surgery following exclusively robotic or laparoscopic training. Methods Thirty-six medical students were randomized into three groups: Open surgery, laparoscopy, and robot-assisted laparoscopy. All underwent intensive simulation training in the allocated surgical modality. Subsequently, all study subjects performed an open bowel anastomosis in a pig model where anastomoses were tested for resistance to pressure and leak as a surrogate marker of surgical quality. Results The primary endpoint was the surgical quality of an open surgery model assessed as, leak pressure, which was 80.01 ± 36.16 mmHg in the laparoscopic training group, 106.57 ± 23.03 mmHg in the robotic training group, and 133.65 ± 18.32 mmHg in the open surgery training group (mean, SD). We found that there were no significant differences between the open surgery training group and the robotic training group whereas a significant difference was found when comparing laparoscopic and open surgery training groups in favor of open procedure training (p < 0.001). Conclusion In a surrogate open surgery model based on bowel anastomosis, we found that skills acquired through practice on robotic simulation platforms were not significantly worse when compared to skills acquired through training in open surgery, whereas skills acquired from laparoscopic training were significantly poorer when compared to open surgery practice.

258 Increase in Cycling Injuries During COVID-19: Unintended Consequences of Lockdown Restrictions in The United Kingdom

IntroductionHigher number of cycling injuries were observed during the COVID-19 period in the United Kingdom at our institution. Many were serious injuries requiring hospitalisation and some requiring surgery. We investigated whether the lockdown led to a legitimate increase in incidence of cycling related injuries, resulting in a higher number of aerosol generating procedures (AGPs). This would assess whether the guidance on exercise during lockdown was appropriate, shaping future regulation in the case of cyclical lockdowns.MethodRecords were screened retrospectively for cycling related injuries between April 1st and May 12th (lockdown) 2020 and for same period in 2019 as a control group. Injury severity, distribution and number of surgical procedures resulting from these were assessed.ResultsThe proportion of injuries due to cycling rose threefold (n = 55) during the COVID-19 lockdown. Injuries included fractures, soft tissue injuries and mixed injuries. An increase in the number of operative procedures (n = 13) and AGPs was also noted.ConclusionsVague guidance and allowance of one form of outdoor exercise per day may have unintentionally contributed to rise in cycling injuries as many took to cycling for recreation. To make the guidance appropriate, usual forms of exercise should be encouraged, risk taking behaviours discouraged and safe cycling practices endorsed.

25 Baseline Copper Levels are Associated with Worse Outcome in Burn Patients with Overweight and Obesity

Abstract Introduction While copper (Cu) has been shown to be beneficial in wound healing, high levels of circulating Cu are also associated with increased oxidative stress. Interestingly, elevated baseline Cu levels have been seen in obese patients, and theoretically, this is associated with higher baseline oxidative stress. Overweight (OW) and Obesity (OB) are common conditions in the US; therefore, a significant proportion of burn patients will be potentially affected. We examined the interactive effects of Cu and obesity on outcomes of burn patients; specifically, we hypothesized that higher baseline Cu levels in OW and OB burn patients are associated with worse clinical outcomes. Methods A retrospective review of patients with burns ≥20% TBSA between 2015–2019. Patients were grouped according to body mass index (BMI) (i.e., NW:18–24.9; OW:25–29.9; and OB: ≥ 30 kg/m2). Baseline characteristics were compared using ANOVA and χ 2 tests. The interactions between baseline Cu and BMI groups on 1) lengths of ICU stay (ICUS), 2) overall hospital stay (LOS), and 3) the number of operative procedures, were examined in a series of multiple regression models in R. Results Data of 160 patients met eligibility (NW: OW: OB = 53: 38: 69). BMI groups did not differ significantly on demographics, TBSA, degree of burn, inhalational injury, or mortality. Regression models revealed that NW patients with high baseline Cu levels had shorter ICUS (p&amp;lt; 0.001) and LOS (p=0.003) and also had fewer operations (p = 0.001). While OW and OB were protective at low Cu levels, patients with OW or OB who had high baseline Cu levels had longer ICUS (p&amp;lt; 0.001 and p=0.033), LOS (p=0.001 and p=0.063), and a greater number of operations (p&amp;lt; 0.001 and p=0.066) (Table 1). Conclusions High baseline Cu seems to be beneficial for NW burn patients, yet associated with adverse outcomes in burn patients with OW and OB. While further evidence is needed to confirm this notion, caution is advised when supplementing Cu for burn patients with OW and OB.

Scattered radiation during osteosynthesis of the distal radius: A phantom study

Modern fracture surgery requires an increasing number of operative procedures utilising radiological control. During osteosyntheses patients receive scattered radiation when fluoroscopy is used. Unlike operating-room staff, patients are not protected during these procedures. The aim of this study was to measure the amount of scattered radiation in the phantom plane during a simulated osteosynthesis in order to evaluate the patient’s need for protection. A lower arm anthropomorphic phantom was irradiated with the use of a Philips BV Pulsera C-arm. The amounts of scattered radiation at distances from 10 to 160 cm and angles of 0 to 180 degrees in the phantom plane were measured with a real-time dosimeter. The same amount of measurements was repeated with a fixation plate on top of the phantom to simulate a fracture reduction operation. The maximum amount of scattered radiation was 1.63 µSv at a distance of 10 cm from the edge of the radiation beam. This phantom study shows that scattered radiation during osteosyntheses of the distal radius is negligible and therefore no patient protection is needed. The results should be interpreted carefully as this is a phantom study.

Pediatric Empyema Thoracis: Jabalpur Image-Based Staging and Stage-Directed Decision-Making Algorithm

Pneumonia in the pediatric age group is common and it can commonly progress to pediatric empyema thoracis (PET). The American Thoracic Society has described three stages of PET which have been the following: exudative, fibrinopurulent, and organized. We describe a new Jabalpur image-based staging system for empyema thoracis in children which has allowed focused intervention and improved outcomes. Pre-empted focused observation, gaps in the treatment and outcomes, and the triangulation of these resulted in the evolution of a new, image-based staging system for pediatric empyema thoracis. From 2009 to 2014, our team was a participant-observer of the usual practices to treat children up to 18 years of age with pneumonia who developed empyema. The prevalent classification into exudative, fibrinopurulent, and organized empyema was treated as per practice. Patients with chronic empyema, empyema necessitans, and tubercular and those with incomplete data were excluded. A staging system purely based on ultrasound (US) and computed tomography (CT) findings was evolved, and we call it Jabalpur image-based staging (JIBS) system for pediatric empyema thoracis. A decision-making algorithm was further evolved using the JIBS system to provide stage-directed treatment. This staging system and algorithm after a pilot run was prospectively applied to a set of patients accrued from January 2015 to December 2019 with PET which was strictly allocated as per new evolved staging and treated with discrete choices by all the methods inclusive of general supportive care, nutritional support, tube drainage, and open and video-assisted thoracoscopic surgery (VATS). The successful early outcome was defined statistically significant reduction of mean ICTD days, the number of CXRs, and the mean hospital days, which reflects earlier recovery. The long-term successful outcome was defined as the absence of fever, breathlessness, and adequate weight gain (according to age) at a minimum follow-up of 3 months. On the prospective evaluation of JIBS and the stage-directed decision-making algorithm on a set of 187 children accrued from January 2015 to December 2019, there was a significant improvement in the success of drainage and the number of VATS procedures, and their success significantly improved. There was a significant reduction in mean preoperative stay, mean intercostal tube drainage (ICTD) days, the number of chest x-rays (CXRs), mean hospital stay, and the number of open procedures in the prospective group. Accuracy of a new staging system to identify exudative, fibrinopurulent, and organized stages of PET was found to be 94.65%, 94.65%, and 97.86% respectively. The long-term successful outcome was observed in 179 (95.72%) children while 8 patients had chest deformity and a minimum secondary scoliosis which was addressed with physiotherapy. This study proposes a simple image-based staging system and stage-directed decision-making algorithm for empyema thoracis in children, which sharply defines the stages and allows the selection of appropriate surgical modality in cases of PET.

Infectious Flexor Tenosynovitis Following Trigger Finger Release: Incidence and Risk Factors.

Background: Trigger finger release (TFR) is one of the most commonly performed hand procedures and typically results in restoration of normal finger function. However, uncommon postoperative complications such as deep infection can have devastating consequences. The goal of this study was to evaluate the incidence, risk factors, and characteristics of infectious flexor tenosynovitis occurring after TFR. Methods: We searched billing records for the Current Procedural Terminology code for TFR to identify all adult patients who underwent TFR at our institution over a 10-year period. We defined infectious tenosynovitis as any case where the patient underwent tendon sheath drainage or postoperative wound debridement within 6 months of the index TFR procedure. Medical records were reviewed to obtain patient demographic information, body mass index (BMI), tobacco use, history of diabetes mellitus, surgical setting (clinic vs outpatient surgery center), and surgical digit for all patients. In those patients treated for infection, we recorded hospital length of stay, number of operative procedures, and any culture results. Results: We identified a total of 18 infections out of 2307 procedures (1827 patients), for an incidence of 0.99%. Current smokers had a significantly higher incidence of infection than nonsmokers (1.77% vs 0.29%). On univariate analysis, smoking was closely associated with infection (P ≤ .05). All infections occurred in overweight or obese patients by BMI criteria, but there was no difference in average BMI between patients with and without infection. History of diabetes, in-office surgery, patient age, and patient sex were not associated with a higher incidence of infection. Patients with infections spent an average of 4.1 days in the hospital, and 40% required multiple surgical procedures. The most common infectious organism cultured was Staphylococcus aureus, which was present in 67% of infections. Patients with isolated methicillin-sensitive S aureus on culture showed signs of infection within 3 weeks of the index procedure, whereas polymicrobial, coagulase-negative staphylococci or beta hemolytic streptococci were identified in patients presenting with infectious symptoms later. Conclusion: Infections after TFR are uncommon but are more likely to occur in patients who are current smokers and overweight or obese by BMI criteria. Methicillin-sensitive S aureus is the most likely causative organism, especially in patients presenting during the early postoperative course.

The Provision of Acute Pediatric Surgical Care by Adult Acute Care General Surgeons : Is There a Learning Curve?

At our hospital, acute surgical care of children aged 6 and older is managed by adult acute care surgeons. Previously published data from a 10-year experience with this model demonstrated no differences in outcomes when compared with pediatric surgical benchmark data. This study assesses for the effects of a learning curve in the care of pediatric patients by comparing outcomes of patients treated in the first three years with those treated in the last 3 years during a 10-year experience with this model. This was a retrospective study of pediatric patients aged 6 and older who underwent an emergent or urgent, nontrauma surgical procedure by a general surgeon. Data was obtained via chart review and descriptive statistics were compared between patients operated on between January 1, 2009-January 1, 2012 and January 1, 2016-January 1, 2019. In all, 208 cases were performed in the early cohort and 192 cases in the late cohort. Appendectomy was the most common procedure in both intervals (88% early, 94.8% late). Although there was a significant decrease in open procedures in the later cohort (22.6% vs 4.7%, P < .001), there was no significant change in disease-specific complications or negative appendectomies. No consults to a fellowship-trained pediatric surgeon were required during either time period, although one was available if needed. Our data demonstrated a decrease in the number of open procedures in the later cohort. This may be due to an increased comfort level with pediatric laparoscopy over time. However, no significant changes in outcomes were observed. This study supports that acute care general surgeons can provide comparable care to pediatric patients within this age demographic and that although a learning curve, appears to exist with respect to pediatric laparoscopy, it is insignificant in terms of its effect on overall outcomes.

Secondary cleft deformities: case report and review of literature

&lt;p class="abstract"&gt;The aim of this paper is to highlight the iatrogenic aspect of secondary cleft deformity, methodologies to treat them and the importance of reporting such cases. Secondary deformities are common in cleft lip and palate patients. Primary aim of treatment in cleft patients is to enhance their normal growth and development and minimize morbidity and number of operative procedures. Meticulous diagnosis, treatment planning and execution of primary surgery are of utmost importance in such cases to prevent majority of secondary deformities. Treatment of secondary deformity depends on the degree of deformity and the severity of impact on normal functions and growth. Following is a case of 16-year-old female patient who incurred secondary cleft deformities after undergoing multiple surgical interventions for congenital bilateral cleft lip alveolus and palate, last of which was conducted at the age of 6 years. Lip revision and tongue flap surgeries to close the palatal fistula were performed to address the patient’s complaint and improve quality of life. Performing a tongue flap for anterior palatal fistula was more successful than Bardach’s palatoplasty technique.&lt;strong&gt; &lt;/strong&gt;It is important that each case encountered at various congenital defect care facilities is reported in literature to make the masses aware of probably outcomes and also help maintain a database to have more accurate data of such cases.&lt;/p&gt;

Unreamed Intra-Medullary Nail Versus Half Pin External Fixator in Grade III [A & B] Open tibia fractures

BackgroundTibia fracture is the most common long bone fracture. The fractures of tibia are commonly open fractures due to subcutaneous position of the tibia. The choice of technique for stabilization of open tibia fractures includes - External fixation, unreamed intra-medullary nails [URTN], Reamed intra-medullary nails, ORIF with Plating. ObjectivesTo evaluate & compare the results of Unreamed Intra-Medullary Nail Versus Half Pin External Fixator in Grade III [A & B] Open tibia fractures. MethodsThis prospective clinical study [Randomized chit box] was done on 50 patients presenting to our institute within 24 h of injury. Only those who were skeletally mature with open tibia fracture Grade IIIA & IIIB [Gustilo-Anderson] were included in this study. After initial management, radiological assessment was done. Following this adequate wound debridement, skeletal stabilization with either primary URTN or external fixator was done. Inspection and debridement were repeated at 48-h intervals until the wound was considered clean. Results50 cases [25 each group] were compared in terms of - Final Alignment of the Fracture, Presence of Infection/Non-union/Mal-union, Hardware failure, Time to Bone Union, Number of Operative Procedures after index admission. Mean time to full weight bearing was 20.96 weeks in URTN group versus 24.8 weeks in Ex-fix group. 5 in URTN group required further surgery for non-union versus 11 patients in Ex-fix group. There were 6 significant pin track infection. Removal of nail was required in 1 case of deep infection. ConclusionThis study supports the use of the URTN over External fixator in the treatment of severe open tibia fractures.

Predictors of Readmission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

BackgroundRisk factors for hospital readmission after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are poorly understood. MethodsThe American College of Surgeons–National Surgical Quality Improvement Program databases from 2011 to 2016 were used to identify all patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative variables were examined using logistic regression to identify factors associated with 30-d postoperative readmission. ResultsAmong 618 patients who underwent CRS-HIPEC, 96 (15.5%) required hospital readmission within 30 d of surgery. The incidence of readmission decreased over the study period (18.3% in 2011 to 4.8% in 2016). Among the 59 patients who were readmitted and had complete data available, readmission occurred on mean postoperative day 18.5 ± 5.5; the most common reasons for readmission were digestive complications (39.0%), postoperative infections (25.4%), uncontrolled pain (8.5%), and venous thromboembolism (5.1%). On multivariate logistic regression analysis, increasing age (OR 1.02, 95% CI 1.00-1.05), number of operative procedures (OR 1.12, 95% CI 1.00-1.25), perioperative complication (OR 7.06, 95% CI 3.96-12.59), need for reoperation (OR 10.21, 95% CI 3.50-29.83), and length of stay (OR 0.93, 0.90-0.97) were associated with hospital readmission. ConclusionsIn this population-based analysis of patients undergoing CRS-HIPEC, older age, perioperative complications, need for reoperation, and extent of cytoreduction were associated with hospital readmission. The American College of Surgeons–National Surgical Quality Improvement Program database is a powerful research tool that can be used to identify opportunities to improve the perioperative care of surgical patients.

Outcomes in Bilateral Vocal Fold Immobility: A Retrospective Cohort Analysis.

To test the hypothesis that the etiologies of bilateral vocal fold mobility impairment (BLVFI), bilateral vocal fold paralysis (BVFP), and posterior glottis stenosis (PGS) have distinct clinical outcomes. To identify patient-specific and procedural factors that influence tracheostomy-free survival. Retrospective cohort study. Johns Hopkins Medical Center from 2004 to 2015. Case series with chart review of 68 patients with PGS and 17 patients with BVFP. Multiple logistic regression analysis determined factors associated with airway prosthesis dependence at last follow-up and the procedural burden (defined as number of operative procedures per year). PGS comprised the majority of BLVFI (76%). PGS injury arose primarily after endotracheal intubation (91%), while BVFP most commonly was due to iatrogenic surgical injury to bilateral recurrent laryngeal nerves (88%, P < .001). Overall in BLVFI, 66% were tracheostomy free at last follow-up (62% in PGS, 82% in BVFP). Of those who underwent an operative intervention to be decannulated, 88% were decannulated (90% PGS, 80% BVFP). Patients with PGS required higher procedural burden to achieve decannulation compared with the BVFP cohort (3.1 ± 5.2 vs 0.71 ± 1.4, P = .002). In multivariate analysis of PGS, smoking was a risk factor for tracheostomy dependence (P = .026). BLVFI is primarily an iatrogenic complication. There are high rates of tracheostomy dependence in BLVFI, with procedural intervention needed for decannulation. Compared with BVFP, patients with PGS had a higher procedural burden overall and to achieve decannulation. Patients with PGS should be counseled that smoking, a modifiable risk factor, may increase the risk of tracheostomy dependence.

DRG revenues and costs of multimorbid patients in the German DRG system - Analysis of the surgical treatment of chronic wounds at a university hospital based on the example of pressure ulcers

The treatment of complex patients with chronic wounds, such as pressure ulcers, is often not adequately reimbursed in patients with need for daily intensive care due to multimorbidity and chronic co-diagnoses. The present study analyses revenues, principle cost factors as well as possible complications. We analysed 51 patients with the DRG principle diagnosis of decubitus stage III and IV, treated in our maximum care clinic in 2014 and 2015. Duration of stay, count of surgical procedures as well as frequency and type of complication were analysed. Costs and revenues per patient were calculated and compared to the mean costs stated by the institute of revenue and costs calculations (InEK). In 25 of 51 cases, the costs exceeded the revenues, which was due to an excessively long stay at the hospital, complications or a large number of operative procedures. On average, the patients could not be treated cost-efficiently at our clinic. The treatment of most multimorbid patients with decubital ulcers is often not adequately reimbursable within the German DRG system. A strict treatment algorithm with a reduced number of operations and intensive patient care are helpful approaches, but may not be sufficient to reduce cost-intensive complications. It seems important to re-evaluate the current DRG codes for these cases.

Outcome of meconium ileus in a tertiary care hospital

Background: Meconium ileus is a common form of congenital intestinal obstruction. The condition results from the accumulation of sticky inspissated meconium in distal ileum. In about half the cases, however, the pathologic condition is complicated by volvulus, gangrene, perforation with meconium peritonitis. Relief of the obstruction is commonly accomplished with a variety of operative procedures. A number of operative procedures are in use, including Bishop-Koop enterostomy, Mikulicz ileostomy and primary closureObjective: Aim of this study was to evaluate the outcome of meconium ileus and its complications in two commonly practiced enterostomy procedure.Method: In this retrospective study from July 2007 to Jun 2017, a total of 52 cases of meconium ileus were included. Diagnosis of suspected cases was confirmed after laparotomy. Two commonly practiced ileostomy procedure were Mikulicz ileostomy and Bishop Koop ileostomy in this study. Survivors of all primary enterostomy underwent ileostomy closure after 3-6 months.Result: Mikulicz enterostomy was done in 38 cases and Bishop Koop ileostomy in 14 cases. After primary ileostomy 5 patients died following Mikulicz ileostomy and 2 after Bishop Koop ileostomy Among the 41 cases those who reached ileostomy closure, 35 were survived.Conclusion: Complications were more common after Mikulicz ileostomy and difficult to manage in our observation. Overall survival of meconium ileus was 66% in our study without any facilities of intensive neonatal care.Bang Med J (Khulna) 2017; 50 : 31-34

Are humans encroaching too much? man versus bear

Background: Uttarakhand is a hilly state inhabited by various wild animals. Human encroachment into the forest areas has increased the encounters between humans and wild animals. Encounters have been on the rise and bear mauling seems to be one of the leading causes of wild animal attacks with grievous results.Methods: The study was conducted in the Department of Plastic and Reconstructive Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, Uttarakhand, India from November 2016 to February 2017. After obtaining written informed consent from the patient a data pertaining to history of injury, time of hospital arrival, number of operative procedures, time of hospital stay, complications were recorded.Results: The injury timing of bear mauling was maximum during 12pm-8pm in 3 cases. Mean length of hospital stay was 19 days. Three cases (42.85%) of wound dehiscence were due to margin necrosis. Amongst the permanent damages suffered, were loss of vision in one eye in 1 case (14.28%), facial disfigurement in the form of contour deformities in 2 cases (28.57%), ectropion and facial nerve palsy in 1 case (14.28%) and parotid fistula in 1 case (14.28%).Conclusions: Encroachment and deforestation have led to an increase in injuries caused by the Himalayan black bears. Ominous effects seen in the changing climatic pattern largely due to global warming could be a possibility of causing altered living habitat for the bears in this Garhwal region getting more aggressive day by day.

Multiple-Drug Resistance in Burn Patients: A Retrospective Study on the Impact of Antibiotic Resistance on Survival and Length of Stay.

Despite improvements in early treatment, survival following burn injury remains challenged by sepsis and multiple organ dysfunction syndrome (MODS). Additionally, susceptibility to infections and growing antibiotic resistance places burn patients at increased risk for infections with multiple-drug resistant organisms (MDROs). We therefore aimed to evaluate the impact of MDRO infections on survival and hospital length of stay, as well as examine the role of these organisms in the development of complications, such as acute kidney injury, sepsis, and MODS. To study this, we included all burn patients with infections, admitted between January 1, 2012, and December 31, 2013. Patients were divided into two groups: patients with infections caused by MDROs and patients with infections caused by susceptible organisms. Data were collected on all available cultures, as well as demographic, injury, and treatment-related variables from the medical record. The number of operative procedures (median: 2 vs 1, P < .0001), ventilator days (21 vs 0 days, P < .0001), total antibiotic days (21 vs 7days, P < .0001), and length of hospitalization (39 vs 14 days, P < .0001) were significantly different in the MDRO group vs the nonresistant group. While MDRO infection was not associated with patient mortality, univariable logistic regression analyses demonstrated >20% TBSA (odds ratio [OR] = 4.30, 95% confidence interval [CI]: 1.14-16.29, P = .03), acute kidney injury (OR = 10.93, 95% CI: 2.74-43.57, P = .001), sepsis (OR = 19.20, 95% CI: 3.79-97.27, P < .001), and MODS (OR = 85.49, 95% CI: 12.97-563.28, P < .0001) significantly increased the odds of patient mortality. These findings suggest that infections with MDROs are associated with a greater number of surgical procedures, longer duration of mechanical ventilation, more antibiotic days, and longer hospitalization.

The use of buttress plates in the management of acetabular fractures with quadrilateral plate involvement: is it still a valid option?

The primary aim of this study was to report on the mid-term outcomes after quadrilateral plate reconstruction of acetabular fractures using a buttress/spring plate through an ilioinguinal approach. Between 2003 and 2011, 30 adult patients (25 males) with mean age 54 years (range 17-80) who underwent surgical fixation for an acetabular fracture and had minimum follow up of 24 months (mean 46.2, range 24-78.6) were retrospectively reviewed. Standard demographics, admission and hospitalization data (concomitant injuries, number of operative procedures, time to operating theatre, early and late complications) were correlated to the clinical (Harris Hip Score) and radiological (Matta Reduction Score and Matta Arthritis Score) outcome. Three patients underwent a Total Hip Replacement. Functional score was excellent in 17 (56.6 %), good in 4 (13.3 %), fair in 6 (20 %) and poor in 3 (10 %) cases. Surgery-related complications included two patients with temporary lateral femoral cutaneous palsy and three with heterotopic ossification. The quality of the postoperative reduction was associated to Harris Hip Score (p = 0.015) and postoperative arthritis (p = 0.010). Strong association was evident between age and both post-operative reduction (p = 0.010) and arthritis (p = 0.014). The presence of quadrilateral plate comminution and gull-sign were associated to poor post-operative reduction (p = 0.016) and low Harris Hip Score (p = 0.049) respectively. Quadrilateral plate reconstruction with a buttress plate though the ilioinguinal approach remains a valid method of fixation in acetabular surgery. Additional studies are needed to compare the efficiency of this method to new surgical approaches and fixation implants.

Hyperbaric Oxygen in Lower Limb Trauma (HOLLT); protocol for a randomised controlled trial

IntroductionOpen fractures with significant soft tissue injury are associated with high rates of complications, such as non-union, infection, chronic pain and disability. Complications often require further inpatient care, and in...

National operative case log growth charts in otolaryngology-head and neck surgery training.

To report national standard case log growth curves for operative procedures in otolaryngology and to describe a method by which program directors can chart surgical case numbers over resident training to longitudinally assess sufficiency of cases and parity between residents. Data visualization and analysis. American Council for Graduate Medical Education (ACGME) national case log data for otolaryngology residency. National data set; no individual subjects. National statistical case log reports for otolaryngology were obtained from the ACGME for each postgraduate year (PGY) level in 2009, 2010, and 2011. Estimated means and standard deviations were calculated. The mean and increments of standard deviation were graphed against time to create case log growth charts, similar to pediatric growth charts. Case log growth charts were made for each ACGME Otolaryngology Residency Review Committee key indicator procedure. Progress of an individual resident or of a cohort of residents may be graphed against this growth chart background over their training time. National operative case log growth charts allow residents and program directors to graphically assess progress in obtaining a sufficient variety and number of operative procedures over time throughout training. This can provide early identification when residents begin to fall below the growth curve during training.

Current status of robotic training in the UK – a trainees perspective

The validation of robotic surgery in a growing number of operative procedures has increased its acceptance nationwide and its usage is becoming widespread. Training needs to reflect this fast paced environment to ensure that surgeons continue to progress competently and safely. Current surgical training in the UK is validated through the Intercollegiate Surgical Curriculum Programme (ISCP) with progression assessed through an Annual Review of Curriculum Progress (ARCP). There has been some resistance to this since its introduction and many trainees remain dissatisfied with this programme. Training in robotic surgery is currently focused through fellowships with little regular exposure to urology trainees at more junior levels. Robotic simulation provides a useful adjunct to training for both technical and non-technical skills. Its usage is particularly valuable to more inexperienced trainees but may be of limited benefit in those with more advanced skills. Training programmes such as the fundamental skills in robotic surgery (FSRS) have been created to facilitate robotic training and it is likely that the future of robotic surgery training will include a combination of theoretical learning, training programmes and fellowship training. ------------------------------------------------------- Cite this article as : Chan KE, Vasdev N. Current status of robotic training in the UK – a trainees perspective. Int J Cancer Ther Oncol 2014; 2(1):02013. DOI: http://dx.doi.org/10.14319/ijcto.0201.3