Patient Satisfaction Outcomes Research Articles

Comparative Analysis of Patient Satisfaction and Sedation Outcomes in Bronchoscopy: Fentanyl/Chlorpheniramine vs. Ketamine/Chlorpheniramine

This randomized clinical trial aimed to assess and compare patient satisfaction and sedation outcomes in bronchoscopy procedures using two distinct sedation protocols: fentanyl/chlorpheniramine (FC) and ketamine/chlorpheniramine (KC). Ninety patients undergoing simple bronchoscopy and bronchoalveolar lavage were randomly assigned to receive either FC (1 µg/kg fentanyl and 10 mg chlorpheniramine) or KC (0.5 mg/kg ketamine and 10 mg chlorpheniramine). Lidocaine was also administered during bronchoscopy. Primary outcomes included patient satisfaction scores, while secondary outcomes encompassed sedation levels, bronchoscopist satisfaction, cough rates, lidocaine usage, and physiological parameters. Patients in the FC group exhibited significantly higher satisfaction levels compared to the KC group (P=0.002). Bronchoscopist satisfaction was also superior in the FC group (P=0.001). Although cough rates did not differ significantly, severe persistent coughs were more prevalent in the KC group. Physiological parameters such as oxygen saturation were comparable, but the KC group demonstrated higher increases in systolic blood pressure and heart rate. The use of fentanyl/chlorpheniramine resulted in higher patient and bronchoscopist satisfaction during simple bronchoscopy and bronchoalveolar lavage compared to ketamine/chlorpheniramine. This study suggests that the combination of fentanyl and chlorpheniramine may be a preferable sedation choice for bronchoscopy procedures.

The Digital Navigator: Standardizing Human Technology Support in App-Integrated Clinical Care.

Background: Mental health apps offer scalable care, yet clinical adoption is hindered by low user engagement and integration challenges into clinic workflows. Human support staff called digital navigators, trained in mental health technology, could enhance care access and patient adherence and remove workflow burdens from clinicians. While the potential of this role is clear, training staff to become digital navigators and assessing their impact are primary challenges. Methods: We present a detailed manual/framework for implementation of the Digital Navigator within a short-term, cognitive-behavioral therapy-focused hybrid clinic. We analyze patient engagement, satisfaction, and digital phenotyping data quality outcomes. Data from 83 patients, for the period spanning September 2022 to September 2023, included Digital Navigator satisfaction, correlated with demographics, mindLAMP app satisfaction, engagement, and passive data quality. Additionally, average passive data across 33 clinic patients from November 2023 to January 2024 were assessed for missingness. Results: Digital Navigator satisfaction averaged 18.8/20. Satisfaction was not influenced by sex, race, gender, or education. Average passive data quality across 33 clinic patients was 0.82 at the time this article was written. Digital Navigator satisfaction scores had significant positive correlation with both clinic app engagement and perception of that app. Conclusions: Results demonstrate preliminary support and patient endorsement for the Digital Navigator role and positive outcomes around digital engagement and digital phenotyping data quality. Through sharing training resources and standardizing the role, we aim to enable clinicians and researchers to adapt and utilize the Digital Navigator for their own needs.

320 Intraoperative Angiography in Neurosurgery: Temporal Trend, Access Site, and Operative Indication Considerations From a Six-year Institutional Experience

INTRODUCTION: Historically, the transfemoral approach (TFA) has been the most common access site for cerebral intraoperative angiogram (IOA). However, in line with trends in cardiac interventional vascular access preferences, transradial approach (TRA) and transulnar approach (TUA) are gaining popularity due to favorable safety and patient satisfaction outcomes. METHODS: Between July 2016 and December 2022, 317 angiograms were included based on our case definition, comprising 59 TRA cases, 11 TUA cases, 243 TFA, and four transpopliteal cases. Fluoroscopy time, contrast dose, reference air kerma (RAK), and dose area products (DAP) per target vessel catheterized were the primary endpoints of interest. Univariate and multivariate regression analyses were conducted to evaluate predictors of elevated contrast dose and radiation exposure metrics. RESULTS: Contrast dose per vessel catheterized was significantly lower in TRA/TUA cases versus TFA cases (p = 0.001), but radiation exposure metrics did not differ between access site groups. TRA/TUA versus TFA does not significantly predict elevated levels of radiation exposure or contrast dose. Aneurysm cases were associated with significantly lower odds of elevated radiation exposure for all radiation metrics (p < 0.05) whereas AVM cases had higher odds of elevated radiation exposure across all measures (p < 0.01). There was a significant relationship between case number and operative indication over the study period (p < 0.001) with a decrease in the proportion of cases for aneurysm treatment offset by increases in total cases for the management of AVF and AVM. CONCLUSIONS: TRA and TUA are safe and effective access site options for neurointerventional procedures and are increasingly employed. Cases using wrist access may be associated with a lower contrast dosing for patients.

Staged Bilateral Total Knee Arthroplasty: Differing Results Comparing the First and Second Knees

BackgroundPatients often prefer one knee over the other following staged bilateral total knee arthroplasty (BTKA). Our study compared patient-reported outcomes scores of each knee following BTKA and identified factors that may contribute to the identified discrepancies. MethodsAll patients who underwent staged BTKA between July 2014 and August 2022 were identified. The patient-reported outcomes were collected preoperatively and at 2 weeks, 6 weeks, 1 year, and 2 years postoperatively. Each knee’s results were compared using paired t-tests and McNemar tests. Preoperative Kellgren-Lawrence Grade (KLG), postoperative range of motion (ROM), reoperation rates, and manipulations under anesthesia (MUAs) were collected. Results were stratified based on time between TKAs (< 3 months, 3 to 12 months, 1 to 2 years, and > 2 years). ResultsThere were 911 patients who underwent staged BTKA, with a mean 4.1-year follow-up. The ROM, patient satisfaction, MUAs, and reoperations were not significantly different between knees. Comparing the KLG of the first and second knees, 71% had the same KLG for both knees, 21% had a lower KLG, and 7% of the second knees had a higher KLG. The first knee had greater pain reduction (−10.6 at 2 weeks, −27.4 at 6 weeks) compared to the second (9.3 at 2 weeks, −8.1 at 6 weeks) (P < .0001) and better improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score (8.5 at 2 weeks, 16.9 at 6 weeks) compared to the second (−5.8 at 2 weeks, 5.0 at 6 weeks) (P < .0001). The 1-year outcomes between first and second knees, or recovery curves, were not different when stratifying by time between TKAs. ConclusionsThe second knee in a staged BTKA has less delta improvement in KOOS JR and pain scores at early follow-up, likely due to higher starting KOOS JR and Patient-Reported Outcomes Measurement Information System scores, despite similar final patient satisfaction and clinical outcome measures. Lower KLG in the second total knee arthroplasty (TKA) may contribute to these findings. An MUA after the first TKA is highly predictive of an MUA after the second TKA.

Preoperative Temporary Fixation for Fractures around the Ankle Using a Simple Extensible External Fixator Significantly Improves Patient Comfort

BackgroundThe authors developed a simple extensible external fixator, which has the advantages of easy application and inexpensiveness. The present study aimed to make a comparison between this external fixator and calcaneal traction in preoperative temporary fixation for malaligned ankle fractures and pilon fractures. MethodsFrom May 2020 to February 2022, patients with malaligned ankle fractures or Rüedi-Allgöwer type 2 or 3 pilon fractures with obvious soft tissue swelling were retrospectively reviewed and divided into the calcaneal traction group and the external fixation group. The two groups of patients were matched 1:1 before making comparisons. ResultsA total of 38 patients were included. Higher General Comfort Questionnaire score and lower visual analog scale score were noticed in the external fixation group during hospitalization (p<0.05), while the operation latency time, total cost, patient satisfaction, and functional outcomes one year after surgery were not significantly different between the two groups. No wound complications were observed. ConclusionPreoperative temporary fixation for fractures around the ankle using this simple extensible external fixator significantly improves patient comfort when compared to calcaneal traction. Level of EvidenceIII, retrospective comparative study.

18 Clinical, Socioeconomic, and Facility Factors Influencing Receipt of Autologous Breast Reconstruction: Analysis of the National Cancer Database

OBJECTIVES/GOALS: The goal of this study is to leverage a national database to see if autologous reconstruction rates differ in patient and clinical characteristics, readmission rates, and overall survival (OS) compared to other forms of reconstruction. Autologous reconstruction has not been looked at in this way before. METHODS/STUDY POPULATION: • Aim 1: Use the National Cancer Data Base to construct three patient cohorts for women under 70 and above 18 treated surgically for breast cancer with A) mastectomy only, B) implant-based reconstruction, and C) autologous breast reconstruction. • Aim 2: Examine receipt rates of surgical intervention in Cohorts A vs. B vs. C based on clinical and patient demographic/socioeconomic characteristics. • Aim 3: Compare readmission and overall survival (OS) rates for Cohorts A vs. B vs. C while controlling for age and other key variables. RESULTS/ANTICIPATED RESULTS: Based on the literature, we expect rates of autologous reconstruction (Cohort C) to be lower for patients of minority backgrounds compared to white individuals. In addition, we do not expect overall survival to differ between implant-based (Cohort B) and Cohort C reconstruction. Still, we expect mastectomy-only (Cohort A) survival to vary from the two cohorts even when adjusting for different clinical factors, as similar but smaller studies have shown. Finally, we expect readmission rates to be higher for Cohort C, compared to Cohorts A &amp; B, as it is a more complicated procedure typically done in academic institutions with skilled surgeons. DISCUSSION/SIGNIFICANCE: Autologous reconstruction is now considered the gold standard due to its ability to restore the breast shape with higher patient satisfaction and superior long-term outcomes. Multiple studies have documented ongoing racial disparities in post-mastectomy breast reconstruction and autologous reconstruction, with lower rates and referrals.

Fostering Emotional Intelligence in Hospital Medicine Education

Emotional intelligence (EI) is our ability to identify, logically reason, and manage our emotions rather than act impulsively based on our feelings about a situation. Research indicates emotional intelligence positively influences patient satisfaction and clinical outcomes. Each trainee has a unique approach to learning. Hospital medicine doctors must be vigilant in tailoring their teaching methods according to the trainees’ knowledge, learning ability, and goals. This article explores the critical role of emotional intelligence in hospital medicine education, highlighting its impact on teaching effectiveness, communication improvement, knowledge sharing, and overall clinical performance.

Quadriceps Tendon Autograft ACL Reconstruction With Suture Tape Augmentation: Safe Results Based on Minimum 2-Year Follow-up MRI.

The potential intra-articular effects of ≥1 year after anterior cruciate ligament reconstruction (ACLR) with independent suture tape augmentation (STA) are not fully understood. To investigate whether incorporating suture tape in an all-soft tissue quadriceps tendon autograft (QTA) ACLR leads to satisfactory patient outcomes while having no intra-articular side effects as determined by magnetic resonance imaging (MRI). Case series; Level of evidence, 4. Included were 25 patients with a mean age of 19.9 years (95% CI, 17.3-22.5 years) who underwent QTA ACLR with STA between 2016 and 2019. All patients underwent MRI at ≥1 year postoperatively and had at least a 2-year follow-up (mean, 28 months [95% CI, 26.5-29.5 months]) that included physical examination with anterior laxity testing with KT-1000 arthrometer, radiographs, and patient-reported outcome measures (PROMs). At the final follow-up, the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for applicable PROMs were applied to each patient. Postoperative graft and joint integrity were assessed using the Howell classification and the MRI Osteoarthritis Knee Score (MOAKS) joint effusion/synovitis grade. The Mann-Whitney U test for continuous variables and the chi-square or the Fisher exact test for categorical variables were used for statistical analyses. The MRI assessment of the grafts demonstrated intact grafts in all patients. Overall, 96% of patients demonstrated grades 0 or 1 MOAKS for joint effusion/synovitis. All patient outcomes significantly improved from preoperatively to the final follow-up (P < .001), except for the Marx score, which decreased significantly (14.2 [95% CI, 12.7-15.8] vs 9.72 [95% CI, 7.3-12.2]; P = .0014). At least 68% of the patients achieved the MCID threshold, and 92% achieved the PASS threshold for all applicable PROMs. QTA ACLR with STA did not demonstrate adverse intra-articular changes on MRI at ≥1 year postoperatively. In addition, STA did not appear to negatively affect PROMs.

Outcome of Percutaneous Endoscopic Lumbar Discectomy in Relation to the Surgeon's Experience: Propensity Score Matching.

Percutaneous endoscopic lumbar discectomy (PELD) presents a challenging learning curve, and the correlation between surgeon experience and clinical outcomes remains contentious. This retrospective study aimed to compare the outcomes of PELD performed by a single surgeon at beginner and experienced stages. Propensity score matching selected 150 patients (75 per group) with a minimum 3-year follow-up. Clinical and radiological outcomes, perioperative complications, and adverse events were assessed. Baseline characteristics, pain improvement, patient satisfaction, and radiological outcomes did not differ between the groups. However, operation time was longer in the beginner group than in the experienced group (57.5 min [IQR, 50.0-70.0] versus 50.0 min [IQR, 45.0-55.0], p < 0.001). The beginner group had higher perioperative complication rates (eight patients [10.7%] versus one patient [1.3%], with a hazard ratio of 8.836 [95% CI, 1.077-72.514], p = 0.034) and lower 3-year survival without adverse events (19 patients [25.3%] in the beginner group and 10 patients [13.3%] in the experienced group, p = 0.045). Our findings indicate that the clinical outcomes were more favorable in patients operated on at the experienced stage compared to those treated at the beginner stage.

From clinical competence to human connection: A reflective journey to patient‐centred care

AbstractIntroductionThis reflective essay explores a medical student's evolving understanding of the relative roles of technical and interpersonal skills in shaping the patient experience.MethodsThe author's personal reflections on the relative roles of technical and interpersonal skills are supplemented with discussion of relevant literature.Results and DiscussionInitially focused on the technical aspects of medicine, the author's perspective shifts upon entering clinical practice. The essay begins by emphasising the importance of interpersonal skills in patient satisfaction, drawing on personal experiences from general practice and supporting literature. However, a pivotal experience on a respiratory ward reveals the profound impact of interpersonal skills on both patient satisfaction and clinical outcomes. With further reflection incorporating relevant literature, it becomes clear that this case in‐fact underscores the interplay between technical knowledge and interpersonal skills.ConclusionThe reflective exploration concludes with the insight that these skillsets are not independent but interdependent and synergistic. The essay thus advocates for an integrated approach (combining technical expertise with strong interpersonal communication) to foster patient partnerships and enhance the overall patient experience.

Management of periprosthetic humerus fractures after shoulder arthroplasty

Background The purpose of this retrospective study was to analyze time to fracture union, complications, and outcomes of postoperative periprosthetic humerus fractures after primary shoulder arthroplasty. Methods Retrospective review of patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty at a single institution. Fractures were classified according to the Worland Classification system. Both non-operatively and operatively treated patients were included. The primary study outcomes were time to union and complications. Results There were 46 patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty, 18 were treated non-operatively and 28 were treated operatively. There were seven (25%) patients who underwent surgery after failed non-operative management. There was only one (2.2%) patient who had a nonunion at final follow-up. The average American Shoulder and Elbow Surgeons Shoulder Score, Single Assessment Numeral Evaluation, and visual analog scale pain scores were 73.5 ± 22.7, 66.5 ± 23.1, and 2.2 ± 2.4, respectively. Conclusion There was a high rate of union for both non-operatively and operatively treated periprosthetic fractures. However, there was a high rate of cross-over from non-operative to operative treatment and a high complication rate for both cohorts. For properly indicated patients, non-operative and operative treatment can result in satisfactory patient outcomes.

Modified Valente Technique for Cauliflower Ear: Outcomes in Children at Two-Year Follow-Up

BackgroundCauliflower ear deformity, a common sequela of auricular trauma, presents an esthetic and reconstructive challenge. Existing surgical techniques have limitations, including complexity, donor site morbidity, and variable long-term outcomes.Materials and MethodsIn this case series, we present a novel and minimally invasive surgical approach for the correction of cauliflower ear deformity that adapts the Valente otoplasty technique; it combines cartilage debulking with helical rim release and Mustardé mattress stitches to restore ear contour and reduce the risk of recurrence. The procedural steps include bielliptic post-auricular skin and soft tissue incision, release of the cartilaginous spring, removal of excess fibrocartilaginous tissue, cartilage reshaping with suture to restore contour, and tissue redistribution to promote adherence of skin to the cartilage framework.ResultsOutcomes were evaluated in 7 patients (9 ears) with cauliflower ear deformity, assessing surgical duration, complications, patient satisfaction, and esthetic outcomes at two years after surgery. The mean surgical duration per patient was 52 ± 17 minutes, including 2 bilateral procedures. Follow-up at 24 months showed favorable esthetic outcome in all patients with sustained improvements in auricular contour and symmetry with neither loss of the shape nor recurrence of deformity. Patients reported high satisfaction and improved quality of life, with mean Glasgow Children Benefit Questionnaire scores of 99.3 ± 6.3.ConclusionsThis technique thus demonstrated lasting correction of cauliflower ear with favorable cosmetic outcomes, low risk of complications, and high patient satisfaction. Further investigations and longer-term follow-up are warranted to validate the technique's durability and expand its application to older and more diverse patient populations.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266.

Patient satisfaction and patient-reported outcomes do not vary by BMI class in total hip arthroplasty.

Obesity has been identified as a risk factor for postoperative complications in patients undergoing total hip arthroplasty (THA). This study aimed to investigate patient-reported outcomes, pain, and satisfaction as a function of body mass index (BMI) class in patients undergoing THA. 1736 patients within a prospective observational study were categorized into BMI classes. Pre- and postoperative Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), satisfaction, and pain scores were compared by BMI class using one-way ANOVA. Healthy weight patients reported the highest preoperative HOOS JR (56.66 ± 13.35) compared to 45.51 ± 14.45 in Class III subjects. Healthy weight and Class III patients reported the lowest (5.65 ± 2.01) and highest (7.06 ± 1.98, p < 0.0001) preoperative pain, respectively. Changes in HOOS JR scores from baseline suggest larger improvements with increasing BMI class, where Class III patients reported an increase of 33.7 ± 15.6 points at 90days compared to 26.1 ± 17.1 in healthy weight individuals (p = 0.002). Fewer healthy weight patients achieved the minimal clinically important difference (87.4%) for HOOS JR compared to Class II (96.5%) and III (94.7%) obesity groups at 90days postoperatively. Changes in satisfaction and pain scores were largest in the Class III patients. Overall, no functional outcomes varied by BMI class postoperatively. Patients of higher BMI class reported greater improvements following THA. While risk/benefit shared decision-making remains a personalized requirement of THA, this study highlights that utilization of BMI cutoff may not be warranted based on pain and functional improvement.

An Analysis of Dermatology-Related Red-Light Therapy Patient Questions on Reddit.

Reddit is one of the world's most popular social media platforms and is increasingly used as a health information resource for patients on topics such as red-light (RL) therapy. In this article, the authors present an analysis of prevalent patient questions and concerns regarding RL therapy. All posts on the "Hot" page of the r/redlighttherapy subreddit were analyzed and categorized. A total of 930 questions from 664 posts were analyzed. The most commonly asked question category was related to product recommendations or feedback (29.7%), followed by usage instructions (15.3%), safety and side effects (12.6%), and indications and efficacy (12.3%). Understanding patient concerns and questions about RL, as expressed on online platforms like Reddit, can help clinicians improve patient satisfaction, education, and clinical outcomes. The study offers an innovative approach by using social media to uncover valuable patient insights that might not be easily observable within clinical settings.

Effective Communication in Providing Medication Information and Patient Satisfaction: A Cross-sectional Survey in Denpasar

Background: Pharmacy personnel should provide pharmaceutical care concerning the applicable standards. Furthermore, pharmacy management must consider patient satisfaction to ensure business continuity. Patient subjective factors strongly influence satisfaction. Meanwhile, patient perceptions of pharmaceutical services will change as their experience increases. The pharmacy must improve its services effectively and efficiently. Factors that affect patient satisfaction can assist pharmacies in improving service quality. Effective communication does not require additional resources to improve service quality. The same information can have different effects when presented in different ways.Objectives: Predict the domain of effective communication that influences patient satisfaction.Methods: The cross-sectional survey using a valid and reliable questionnaire was conducted in Denpasar. The research involved 100 pharmacy consumers and was taken with a convenience sampling technique. Data were analyzed descriptively, followed by a Chi-square test and multivariate analysis using logistic regression. The research involved four independent variables: pharmacy atmosphere, pharmacist performance, pharmaceutical technical competence, and interpersonal communication competence. Patient satisfaction is the dependent variable in this study. Results: Communication factors generally affect patient satisfaction in providing drug information. Among all the independent variables tested, interpersonal communication competence plays a significant role in predicting patient satisfaction with a p-value of 0.043 (Logistic regression with 95% confidence level).Conclusion: Patients who perceive pharmacists as having good interpersonal communication competence are 3,133 times more likely to be satisfied. Thus, pharmaceutical staff must train interpersonal communication skills to provide drug information to achieve patient satisfaction outcomes in pharmaceutical services.

Liposuction-Only Breast Reduction: A Systematic Review of Outcomes.

Over the past few decades, there have been multiple reports of liposuction assisted breast reduction. This technique appeals to patients due to the limited scars and complication profile, compared to traditional reduction mammaplasty techniques. We aimed to systematically review the literature, to elucidate the outcomes and safety of liposuction-only breast reduction. A systematic review was performed using the Ovid (Medline/PubMed) database, in accordance with the PRISMA checklist. In total 7 articles were included within this systematic review. A total of 652 patients were included. Liposuction-only breast reduction appears to lead to improvements in subjective outcome measures, patient satisfaction, and objective outcomes such as moderate breast volume reduction and reduction in breast ptosis. Overall, the procedure had a low complication profile. Liposuction did not preclude further surgery. No evidence of malignancy or difficulty in future breast cancer screening was noted. Macromastia leads to a considerable health burden, especially in health-related costs. From the current evidence base, liposuction-only breast reduction appears to be a safe and effective procedure, especially in patients requiring a mild-moderate breast volume reduction and mild ptosis correction. More research is required, with standardised subjective and objective outcome measures, and longer follow-up periods to confirm the effectiveness and safety of this technique. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Primary All-Soft Tissue Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation Resulted in Satisfactory Patient Outcomes and a Low Graft Failure Rate in High School and Collegiate Athletes

To evaluate ≥2-year patient outcomes after primary all-soft tissue quadriceps tendon autograft (ASTQ) anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation (STA) in skeletally mature high school and collegiate athletes. All high school and collegiate athletes who underwent primary ASTQ ACLR with STA with a minimum of 2-year follow-up were analyzed retrospectively. Patients were administered validated patient-reported outcome measures (PROMs) pre- and postoperatively. The minimal clinically important difference was calculated for each PROM based on this study population and applied to the individual patient. Return to sport, subsequent surgical intervention including contralateral ACLR, and KT-1000 arthrometer measurements for knee laxity were collected. Complications were assessed by physical examination, radiologic studies, or obtained via telephone. In total, 60 patients were included in the final data analysis, with a mean age of 16.8 years (95% confidence interval 13-23) and mean final follow-up of 37.1 months (95% confidence interval 33.1-41.1). Twelve patients (20%) required subsequent surgery on the ipsilateral knee, which included 7 patients having a subsequent meniscal procedure and 3 patients who underwent arthrolysis. None sustained a graft failure, and 6 patients sustained a contralateral ACL injury necessitating surgery. All PROMs improved at the final follow-up (P < .001). In addition, KT-1000 arthrometer measurements significantly improved postoperatively at 1-year clinical follow-up (P < .001). Most patients obtained the minimal clinically important difference thresholds for each PROM at the final follow-up. There were 48 patients (80%) who participated in pivoting sports. The return-to-sport rate at same level was 54 patients (90%), with 6 patients (10%) not returning to the same level because of graduation. ASTQ ACLR with STA in a young athletic patient population may result in a low graft failure rate while maintaining satisfactory patient outcomes at short-term follow-up, including a return to sport at the same level of 90%. Level IV, retrospective case series.

Long-term outcomes of surgical or endovascular treatment of adult with midaortic syndrome: A single-center retrospective study over a 14-year period

ObjectiveMidaortic syndrome is a rare clinical condition that has been mainly studied in juveniles through case reports and series. This study aims to report the anatomic characteristics and long-term outcomes of 41 adult patients with midaortic syndrome who received open surgical treatment or endovascular treatment over a 14-year period. MethodsA consecutive cohort of 41 adult patients diagnosed with midaortic syndrome at our center between January 2008 and November 2021 were enrolled in the study. Patients’ baseline and anatomic characteristics were collected and analyzed. Primary follow-up outcomes included death and reintervention. Other follow-up outcomes included hypertension and complications. ResultsThe study enrolled 41 adult patients with midaortic syndrome with a mean age of 37.5 ± 13.4 years. Twenty-five patients received open surgical treatment, and 16 patients received endovascular treatment. Isolated infrarenal lesions were more likely to be found in the endovascular treatment group (P = .005), whereas patients with multiple (P = .002) or intravisceral involvement (P = .001) were more likely to be found in the open surgical treatment group. The open surgical treatment group was more likely to have a lower postoperative peak systolic pressure gradient (P = .020). The 5- and 10-year reintervention-free survivals were 87.7% and 71.7% in the open surgical treatment group and 92.3% and 79.1% in the endovascular treatment group, respectively. ConclusionsBoth open surgical treatment and endovascular treatment showed satisfactory long-term efficacy outcomes for adult patients with midaortic syndrome. Given the patients’ relatively young age and long life expectancy, strict and regular lifelong follow-up is necessary.

High triglyceride-glucose index is associated with low postoperative satisfaction in patients with posterior instrumented lumbar fusion.

This study aimed to determine the effect of the preoperative triglyceride-glucose (TyG) index on the postoperative quality of life, patient satisfaction, and surgical outcomes in patients who underwent posterior lumbar instrumentation and fusion surgery. This was a retrospective single-center cohort study (n = 136). Patients were divided into three groups according to the TyG index: < 25th percentile (L), 25-75 percentile (N), and > 75th percentile (H). Pearson correlation analysis was used to evaluate the relationship between the TyG index and the quantitative variables. Scatterplot and receiver operating characteristic (ROC) curve analysis were used to assess the relationship of the preoperative TyG index with postoperative Oswestry disability index (ODI) and physical function (PF) scores. The TyG index showed a significant correlation with postoperative ODI score. TyG index showed a significant negative correlation with postoperative PF score. On ROC curve analysis, postoperative ODI score ≥ 38 (optimal cut-off) had 79% sensitivity and 92% specificity for predicting high TyG index (group H) (p = 0.016). Postoperative PF score ≤ 80 predicted group H patients with 97% sensitivity and 75% specificity (p = 0.001). The area under the ROC curve was 0.74 (p = 0.016) for the postoperative ODI and 0.79 (p = 0.001) for the postoperative PF. In patients who underwent posterior lumbar instrumentation and fusion surgery, a high preoperative TyG index may predict poor postoperative ODI and PF scores, indicating lower patient satisfaction.

Replantation of digit-tip amputation caused by crush injuries with supermicrosurgery technique.

Digit-tip amputation caused by crush injury is a common emergency scenario, and the management is full of challenges. The objective of this study was to demonstrate the application of the supermicrosurgery technique in replantation procedures for complex digit-tip amputations resulting from crush injuries, while also assessing functional and aesthetic outcomes. We conducted a retrospective analysis of the data from 12 patients who underwent replantation of 15 digits in our department between July 2022 and June 2023. The outcomes of replantation, functional recovery (including return to work, cold tolerance, bone union, DASH score, VAS score, and two-point discrimination test), aesthetic results (including digit appearance, nail deformity, and pulp atrophy), and patient satisfaction were assessed. The amputation of 7 digits occurred within Tamai zone I level, 8 digits within Tamai zone II level, while 4 digits occurred within Ishikawa zone I level, 3 digits within Ishikawa zone II level, 7 digits within Ishikawa zoneIII level, and 1 digit within Ishikawa zone IV level. The replanted digits all survived (100%) without any indications of arterial insufficiency or venous congestion. The follow-up procedures were conducted on all 12 patients, with an average duration of 9.6months (range, 6 to 18months). The fracture successfully underwent healing at 9.2weeks (range, 8 to 13weeks). The mean VAS score was 1.75 points (range 0 to 4 points), the mean two-point discrimination test result was 5.72mm (range 4.0 to 7.0mm), and the mean DASH score was 9.78 points (range 3.33 to 22.5 points). All patients demonstrated cold tolerance and successfully resumed their pre-injury occupational activities. The nail deformity was observed in one digit following replantation within Tamai zone I, and in three digits following replantation within Tamai zone II; moreover, eight digits exhibited varying degrees of pulp atrophy. All patients expressed satisfaction with both functional and aesthetic outcomes. The successful replantation of digit-tip amputation caused by crush injury can be achieved through the application of supermicrosurgery technique, resulting in improved functional and aesthetic outcomes. Digit-tip replantation is a favorable and meaningful procedure with high patient satisfaction.