Outcomes Of Surgery In Patients Research Articles

Treatment of Persistent Post-traumatic Diplopia - An Algorithmic Approach to Patient Stratification and Operative Management.

Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma. Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes. A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005-2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified. Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair. Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery.

A Randomized Clinical Trial of Perfusion Modalities in Pediatric Congenital Heart Surgery Patients

BackgroundThe objective of this randomized clinical trial was to investigate the effects of perfusion modalities on cerebral hemodynamics, vital organ injury, quantified by the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) Score, and clinical outcomes in risk-stratified congenital cardiac surgery patients. MethodsThis randomized clinical trial included 159 consecutive congenital cardiac surgery patients in whom pulsatile (n = 83) or nonpulsatile (n = 76) perfusion was used. Cerebral hemodynamics were assessed using transcranial Doppler ultrasound. Multiple organ injury was quantified using the PELOD-2 score at 24, 48, and 72 hours. Clinical outcomes, including intubation time, intensive care unit length of stay (LOS), hospital LOS, and mortality, were also evaluated. ResultsThe Pulsatility Index at the middle cerebral artery and in the arterial line during aortic cross-clamping was consistently better maintained in the pulsatile group. Demographics and cardiopulmonary bypass characteristics were similar between the 2 groups. While risk stratification with The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Mortality Categories was similar between the groups, Mortality Categories 1 to 3 demonstrated more patients than Mortality Categories 4 and 5. There were no differences in clinical outcomes between the groups. The PELOD-2 scores showed a progressive improvement from 24 hours to 72 hours, but the results were not statistically different between the groups. ConclusionsThe Pulsatillity Index for the pulsatile group demonstrated a more physiologic pattern compared with the nonpulsatile group. While pulsatile perfusion did not increase plasma-free hemoglobin levels or microemboli delivery, it also did not demonstrate any improvements in clinical outcomes or PELOD-2 scores, suggesting that while pulsatile perfusion is a safe method, it not a “magic bullet” for congenital cardiac operations.

The Relation of Patient Expectations, Satisfaction, and Outcome in Surgery of the Cervical Spine: A Prospective Study.

We performed a prospective nonblinded single center observational study. To investigate the relationship between expectations, outcome, and satisfaction with the outcome in patients undergoing cervical spine stabilization surgery. In modern healthcare, patient-reported outcome measures and patient satisfaction have become an important aspect of quality control. Therefore, outcome benchmarks for specific diseases are highly desired. Numerous studies have investigated patient-reported outcome measures and what constitutes satisfaction in degenerative lumbar spine disease. In cervical spine surgery, it is less clear what drives the postoperative symptom burden and patient satisfaction and how this depends on the primary diagnosis and other patient factors. This was a prospective, single center, observational study on patients undergoing cervical spine stabilization surgery for degenerative disease, trauma, infection, or tumor. Using the visual analogue scale for neck and arm pain, the neck disability index (NDI), the modified Japanese Orthopedic Association Score (mJOA) and patient-reported satisfaction, patient status and expectations before surgery, at discharge, 6 and 12 months after surgery were evaluated. One hundred five patients were included. Score-based outcome correlated well with satisfaction at 6 and 12 months. Except for low NDI expectations (≥15 points) that correlated with dissatisfaction, expectations in no other score were correlated with satisfaction. Expectations did influence the outcome in some subgroups and meeting expectations resulted in higher rates of satisfaction. Pain reduction plays an important role for satisfaction, independently from the predominant symptom or pathology. Satisfaction correlates well with outcome. Meeting expectations did influence satisfaction with the outcome. The NDI seems to be a valuable preoperative screening tool for poor satisfaction at 12 months. In degenerative pathology, pain is the predominant variable influencing satisfaction independently from the predominant symptom (including myelopathy). 5.

The impact of wait time on patient outcomes in knee and hip replacement surgery: a scoping review protocol

BackgroundTotal hip and total knee replacement surgery are in high demand, leading to long wait times for many patients. While on the waiting list, patients may experience worsening pain, reduced mobility, and deteriorating health. Given that long wait times are common for lower joint replacement surgery, it is important to understand how patient health changes during the wait period and whether this impacts patient outcomes after surgery. The aim of this scoping review will be to identify and describe the evidence regarding the impact of wait time on patient outcomes for patients who undergo total knee and total hip replacement surgery.MethodsThis scoping review was designed with guidance from the Joanna Briggs Institute Manual for Evidence Synthesis, and results will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. EMBASE, Medline, PubMed, Scopus, CINAHL, and Cochrane electronic databases will be searched for English language articles published after 1999. Studies of adult patients with osteoarthritis undergoing primary knee or hip replacement surgery, which measure patient outcomes over the wait period for surgery, will be included. Two independent reviewers will screen titles and abstracts followed by full article review. Data will be extracted by two reviewers using a standardized form. Outcomes assessed during the wait period will be identified and described in tables. Factors associated with changes in health status during the wait period will be qualitatively described.DiscussionThis review will map the evidence regarding wait times for lower extremity joint replacement surgery. Better understanding of how the impact of wait times on patient health status is measured over the perioperative period will inform future research on wait times.Scoping review registrationRegistered with Open Science Framework, Feb 14, 2021 DOI: https://doi.org/10.17605/OSF.IO/MV4FS

Surgical volume-patient outcome relationships for parathyroidectomy in the England: analysis of an administrative dataset for the Getting It Right First Time programme

Abstract Introduction Previous studies suggest a relationship between surgical volume and patient outcomes for parathyroid surgery. However, most studies are small and from outside the UK. The aim of this study was to use Hospital Episodes Statistics to investigate volume-outcome relationships for parathyroid surgery in England. Methods We examined a five-year period (April 2014-March 2019 inclusive) for elective, adult admissions for surgery for primary hyperparathyroidism without a diagnosis of multiple endocrine neoplasia, parathyroid cancer or renal disease. Volume was the number of procedures conducted in the same financial year as the index procedure. The primary outcome measure was emergency readmission at 30 days or length of stay greater than 2 days which were taken to represent poorer outcomes. Results We included 17,498 parathyroidectomies. Across the period the number of surgeons conducting parathyroid surgery changed little (280 in 2014/15 and 2018/19), although the number of procedures conducted rose from 3,331 to 3,848 per annum. From the lowest surgeon volume category (1–10 per annum) to the highest (≥ 60 per annum) the proportion of patients readmitted at 30 days or with an extended length of stay decreased 11.7% to 7.0%, diagnosis of hypoparathyroidism within one year from 16.3% to 10.9%, repeat parathyroid procedures within one year from 2.5% to 1.0% and mortality rate at one year from 1.0% to 0.5%. These differences persisted after adjustment for demographic and procedural covariates. Conclusion Higher surgeon annual volume is associated with improved patient outcomes for parathyroid surgery. BAETS should consider recommending a minimum yearly workload.

Effect on surgery outcomes owing to the interval between onset of symptoms and surgery of patients with acute type A aortic dissection

Abstract Background: This study aimed to identify whether the interval from onset of symptoms to surgery affects the outcomes of surgery in patients with acute type A aortic dissection (AAAD). Methods: This study retrospectively examined 249 patients with AAAD who underwent Sun's procedure. All patients were divided into 2 groups, hyperacute and acute, according to the interval from onset of symptoms to surgery. The primary endpoint was all-cause early mortality, and the secondary endpoint was early reoperation. Results: The surgery time, cardiopulmonary bypass time, clamp time, and selective cerebral perfusion time were not significantly different between the 2 groups. The intensive care unit length of stay and duration of mechanical ventilation of the 2 groups were 185.50 hours versus 185.00 hours (P = 0.970) and 41.50 hours versus 44.00 hours (P = 0.678), respectively. There were 52 early deaths: 29 in the hyperacute group and 23 in the acute group (21.6% vs. 20.0%, P = 0.751). The incidence of reoperation was 0.7% and 0.9% (P > 0.999), respectively. The incidence rates of postoperative acute heart failure (AHF), acute respiratory failure (ARF), nervous dysfunction, and acute kidney injury were 37.3% versus 25.2% (P = 0.041), 51.5% versus 51.3% (P = 0.976), 13.4% versus 7.0% (P = 0.096), and 37.3% versus 37.4% (P = 0.990), respectively. Multivariable analysis indicated that surgery in the hyperacute phase might be an independent risk factor for AHF (OR: 1.765; 95% CI: 1.021–3.052; P = 0.042). Conclusion: Surgery in the hyperacute phase of AAAD was associated with postoperative AHF. Therefore, early medical management or interventional therapy for complications before surgery performed by experienced surgeons is recommended, especially in the hyperacute phase.

The effect of perioperative blood transfusion thresholds on patient outcomes in orthopaedic surgery: a literature review.

Blood transfusions are one of the most common interventions required perioperatively in orthopaedic patients. There exist two main schools of thought in relation to perioperative blood transfusion - transfusing at a haemoglobin level of 70 g/L or below (termed 'restrictive protocol' in the literature), versus transfusing at a haemoglobin threshold of 100 g/L (which the literature terms 'liberal'). Few reviews of the literature exist comparing the impact of different transfusion strategies on the postoperative outcomes of these orthopaedic patients. This review analyses the 11 currently available studies on transfusion protocols in orthopaedics and associated findings related to patient outcomes. The literature showed no clear consensus on whether one transfusion protocol is superior in the orthopaedic patient. There was strong evidence for reduced transfusion rates among groups receiving transfusion at <70 g/L, and hence a reduction in complication directly related to transfusions. Despite this, other measured patient outcomes, including length of stay, postoperative complication rate, and mortality rate, were unchanged between the groups. Some evidence exists that a Hb threshold of 100 g/L results in earlier postoperative ambulation in hip surgery patients. One study suggests using preoperative haemoglobin as a preoperative risk factor to aid in determining whether patients are more suited to one approach over the other. Further high-quality clinical trials in orthopaedic cohorts must become available to determine whether a haemoglobin threshold of 70 g/L can safely be adopted to reduce transfusion rates without adversely impacting patient outcomes.

Elective splenectomy in patients with non-Hodgkin lymphoma: Does the size of the spleen affect surgical outcomes?

Backgrounds/AimsSplenectomy in patients with non-Hodgkin lymphoma (NHL) is performed to relieve abdominal symptoms, treat hypersplenism or confirm diagnosis. Excision of a very large spleen is technically challenging and data on outcomes of surgery in patients with NHL are scanty. The aim of study was to evaluate the impact of spleen size on the surgical outcome of splenectomy in patients with NHL.MethodsPatients with NHL who underwent splenectomy, between 2006 and 2017, were included and divided into two groups: group 1, spleen ≤ 20 cm; group 2, spleen > 20 cm. Surgical approach, operative time, postoperative morbidity, mortality, hospital stay and re-admission rates were retrospectively compared between groups. Non-parametric data were evaluated with the Mann-Whitney U test. Differences in frequencies were analyzed with Fisher’s exact test.ResultsSixteen patients were included (group 1, 6; group 2, 10). Laparoscopy was successful in three patients of group 1, none of group 2 (p = 0.035), the intraoperative time did not differ significantly between groups. One patient in each group developed postoperative complications. The patient in group 1 died of pneumonia. Median length of stay was 8 days (range, 3-16 days) for group 1, 5.5 days (range, 3-10 days) for group 2, showing no significant difference between the two groups. No patient was readmitted to hospital.ConclusionsSpleen size does not affect the outcome of splenectomy in patients with NHL. If a mini-invasive approach is to be chosen, laparoscopy may not be feasible when the spleen size is > 20 cm.

Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients.

ObjectiveThe present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry. MethodsThe National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients’ data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5. ResultsBoth univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. ‘Severely frail’ patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21–35.44) for 30-day mortality, 3.02 (95% CI, 1.97–4.56) for major complications, and 2.94 (95% CI, 2.32–4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality. ConclusionIncreasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.

Patient-centred care in thoracic surgery: a holistic approach-A review of the subjects of enhanced recovery after surgery, rehabilitation, pain management and patient-reported outcome measures in thoracic surgery.

The symposium Patient-centered care in thoracic care: a holistic approach was held on June 22, 2021, as a virtual event in the context of the European conference on general thoracic surgery. Its aim was to explore how to improve patient outcomes in thoracic surgery by using enhanced recovery after surgery (ERAS®) frameworks and collaboration within healthcare. During the four presentations, topics on patient mobilization and physical rehabilitation, pain management, and the role of chest drainage in facilitating perioperative care were discussed. Strategies to minimize opioid consumption and incorporate patients’ experiences as quality indicators were described. There were two main ideas that were considered pivotal to achieve optimal care: (I) the use of simple, easily implementable perioperative protocols and practices to improve compliance from both patients and the healthcare team, and (II) promote a better recovery with early mobilization and reducing the patient’s levels of pain. Among the key learnings that emerged from the presentations are the importance of taking the patient’s experiences into account, including what they value the most after surgery, and how technology can enable better care. The use of digital chest drainage systems emerged as a way for improving patient outcomes and experiences across several key indicators.

Elevated hemoglobin A1c level and bariatric surgery complications.

In cardiac and orthopedic surgery, elevated glycosylated hemoglobin (HbA1c) is a modifiable risk factor for postoperative complications. However, in bariatric surgery, there is insufficient evidence to assess the effectiveness of preoperative HbA1c assessment and its association with postoperative complications.The objective of this study was to assess the impact ofHbA1con early postoperative outcomes in bariatric surgery patients. Patients who underwent laparoscopic sleeve gastrectomy and laparoscopic Roux-En-Y Gastric Bypass between 2017 and 2018 were selected for a retrospective review from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP) database. The study population of 118,742 patients was analyzed for our primary outcome which was defined as a composite of any postoperative complications occurring within 30 days. Two groups were defined by HbA1c cutoff: comparison point A (≤ 8% vs > 8%) and comparison point B (≤ 10% vs > 10%). Procedure-related complications were also examined on subgroup analysis. Propensity score matching (PSM) was used with one-to-one matching. The complication rates before and after PSM were calculated and assessed by Fisher's exact test and conditional logistic regression, respectively. After PSM, demographic and clinical characteristics were all balanced and elevated HbA1C was not associated with worse outcomes. After adjusting for underlying comorbidities, there was no statistically significant difference seen in the composite outcome for comparison point A HbA1C ≤ 8 and HbA1C > 8 (p = 0.22). For comparison point B, patients with HbA1C ≤ 10 had more composite complications compared to patients with HbA1C > 10 (p < 0.001). Also, on subgroup analysis after PSM for procedure-specific complications, patients above the cutoff threshold of 8 did not have worsened composite outcomes (p = 0.58 and 0.89 for sleeve and bypass, respectively). Again, at cutoff threshold of 10, patients in HbA1C ≤ 10 had more composite complications (p = 0.001 and 0.007 for sleeve and bypass, respectively). In this study of bariatric patients, elevated HbA1c > 8% or 10% was not associated with increased postoperative complications. HbA1c lower than 10% was associated with some types of adverse outcomes in this bariatric dataset. More studies are needed to investigate these findings further. A high HbA1c alone may not disqualify a patient from proceeding with bariatric surgery.

Outcomes of surgery in patients 90 years of age and older: A retrospective cohort study

BackgroundImportant trade-offs of risks versus benefits of surgery need to be discussed with older adults, in particular nonagenarians who are candidates for surgery. Data that examine specific outcomes of surgical interventions in this age group are sparse. We aimed to evaluate the clinical presentation and postoperative outcomes of nonagenarians undergoing surgery. MethodsA retrospective cohort study of consecutive patients 90 years of age and older who underwent surgery between 2014 and 2018 in general surgical ward of a large-volume academic center. Subgroups were designed according to type of surgery (elective versus emergency surgery) and diagnosis (oncology versus non-oncology).Preoperative assessments included Malnutrition Universal Screening Tool, Norton Scale, Morse Scale, Katz, and Lawton-Brody indices. ResultsA total of 198 nonagenarians underwent surgery, of which 38% were elective and 62% were emergency surgery. Median follow-up was 26 months. More patients in the elective group compared with the emergency group had oncology diagnoses (42.1% and 14.7%, respectively, P < .001), resided preoperatively at home (93.4% and 77.9%, respectively, P = .003), and were functionally independent (71.1% and 41.8%, respectively, P = .0005). Postoperative 30-day mortality frequency was 6.6% in the elective group and 39.3% in the emergency group (P < .001). Two-year survival frequency of non-oncology group was 72.7% in elective surgeries and 40.6% in emergency surgeries (P < .001). Two-year survival frequency of oncology group was 37% in elective surgeries and 27.8% in emergency surgeries (P = .12). ConclusionElective surgery in adults aged 90 and above can be safely performed with acceptable 2-year outcomes. Emergency surgery for oncology diagnoses carries dismal outcomes, so palliative approaches should be considered.

Early outcomes of growth friendly instrumentation in children with Williams syndrome.

Although scoliosis and kyphosis have been associated with Williams Syndrome (WS), no previous literature has reported on surgical treatment for early onset scoliosis (EOS) in WS. The aim of this case series is to report on the outcomes of spine deformity surgery in patients with EOS and WS and any perioperative anesthetic or cardiovascular complications. One multicenter database was queried for all patients with WS who underwent growth-friendly (GF) treatment before age 12 between 2000 and 2017. Demographics, surgical, and growth-friendly data were queried. Radiographs were measured for curve magnitude, T1-T12 length, and T1-S1 length. Seven patients were analyzed (3 males, 4 females). Patients were at a median age of 2.8years at initial surgery with median follow-up 3.6years (range 2.0-12years) after index surgery. The initial surgical treatments were as follows: 2 traditional growing rods (TGR), 2 magnetically controlled growing rods (MCGR), and 3 vertical expandable prosthetic titanium ribs (VEPTR). The median duration of growth-friendly treatment was 5.0years (range, 2.6-10.4years) with a median number of 9 device lengthenings. The median improvement in coronal curve magnitude from preoperative to most recent follow-up was 19° (range, 54°-9°). Three patients have completed GF treatment: one underwent definitive fusion, and two are under observation with apparent spontaneous fusion and retain the original GF implants. No peri-operative anesthetic or cardiovascular complications occurred. Few studies have reported on surgical outcomes in WS patients with EOS. In this case series, 6/7 patients experienced curve improvement with growth-friendly spine instrumentation. This study suggests that growth-friendly instrumentation for severe EOS in WS can be used for control of spinal deformity while allowing for further growth. Associated complications were typical of distraction-based EOS surgical treatment. There were 62 total procedures with general anesthesia, but no perioperative cardiac complications occurred.

Aortic Valve and Arch Replacements in a High-Risk Patient with Essential Thrombocythemia

Reports of the clinical results of cardiac surgery in patients with Essential Thrombocythemia (ET) are rare. In addition, cases of aortic arch aneurysm in ET have not been previously reported. We present a successful aortic valve and arch replacements with the frozen elephant trunk technique using hypothermic circulatory arrest in an ET patient with grade 3 aortic regurgitation and arch aneurysms. Reducing platelet count via the administration of anagrelide and the careful balancing of antiplatelets and anticoagulants is essential in determining the outcome of surgery.

Anesthesia management and patient outcomes in robotic assisted laparoscopic surgery: A single center experience

Robotic surgical techniques aimed to improve patient outcomes and satisfy patient outcomes while reducing surgical morbidity and mortality. One of the most performed surgeries, robotic assisted laparoscopic radical prostatectomy (RALRP), is characterized by many factors such as steep Trendelenburg position, and challenging access to the patient. We planned to evaluate anesthesia management and postoperative patient outcomes in RALRP. Patients planned for RALRP between January 2017 and June 2021 were included. Demographic data, additional diseases and Charlson Comorbidity Index (CCI) of the patients were recorded. The methods used in anesthesia maintenance, muscle relaxant and sugammadex dose, postoperative pain treatment protocol, duration of anesthesia and surgery, length of stay (LOS) in ICU or hospital, early postoperative complications and Clavien Dindo Classification (CDC) were evaluated by examining the follow-up forms in the intraoperative and postoperative period. Two hundred and sixteen patients underwent robotic assisted laparoscopic surgery between January 2017 and June 2021 and, 141 of them (65.3%) had RALRP. The mean age of the patients was 62.38±6.94, the body mass index was 27.60±3.94, and the mean CCI was 4.08±0.93. Total intravenous anesthesia (TIVA) (n=108, 76.6%) was mostly used for anesthesia maintenance. The median time spent during anesthesia was 278.5±63.6 minutes. The median time for surgery was 239.5±65.9 minutes. According to the CDC, grade-I was 5.7%, grade-II was 2.1%, grade-IVa 7.8%. The most common complication was acute kidney injury (11, 7.8%), followed by atelectasis (4, 2.8%). 98.6% of all patients were sent to the ward from PACU, except two. The mean LOS in hospital was 4.57±2.34 days. Robotic assisted laparoscopic radical prostatectomy is most performed surgery among all robotic surgeries. We think that, patient optimization and communication between surgeon and anesthesiologist is crucial to avoid the negative effects of steep Trendelenburg position and pneumoperitoneum in terms of improving outcome.

Obesity Increases Risk for Surgical Site Infections and Wound Dehiscence after Pediatric Foot Surgery: A Retrospective Cohort Review using the NSQIP-Pediatric Database

Category:OtherIntroduction/Purpose:Both the incidence of childhood obesity and the number of obese children undergoing surgical procedures are increasing in pediatrics. As such, pediatric orthopaedic surgeons will likely encounter obese patients more frequently in their practice and a better understanding of the unique risks associated with obesity is valuable to maximize patient safety. The purpose of this study is, therefore, to retrospectively evaluate the relationship between obesity and post-operative outcomes in pediatric orthopaedic surgery patients across multiple institutions using a large national database.Methods:Pediatric patients who had undergone foot surgery were retrospectively identified by cross-referencing reconstructive foot-specific CPT codes with ICD-9/ICD-10 diagnosis codes using the American College of Surgeons 2012-2017 Pediatric National Surgical Quality Improvement (ACS-NSQIP-Pediatric) database. Patients were stratified into normal weight and obese cohorts based upon Center for Disease Control BMI-to-age growth charts. Patient demographics, comorbidities, intra-operative, and post- operative factors were compared between these two cohorts via univariate analysis with false discovery rate adjustment.Multivariable logistic regression models were then generated to assess for obesity as an independent predictor of post-operative complications.Results:Of the 3,924 patients identified, 1,063 (27.1%) were obese. Obese patients were more often male (64.7% vs 58.7%; p=0.001) and taller (56.3in vs 51.3in; p<0.001) than normal weight patients. There were no differences in pre-operative comorbidities between the two cohorts. Obese patients had a higher overall post-operative complication rate compared to normal weight patients (3.01% vs 1.32%; p=0.001). There was a significantly higher rate of wound dehiscence in obese patients (1.41% vs 0.59%; p=0.039) as well as a higher surgical site infection (SSI) rate that trended towards, but did not reach, statistical significance (1.32% vs. 0.59%; p=0.061). No differences were noted in unplanned readmissions (1.03% vs 0.9%; p=0.968) or unplanned reoperations (1.03% vs. 0.45%; p=0.175) within 30 days of surgery between the two groups. In multivariate analysis, obesity was found to be an independent predictor of both wound dehiscence (adjusted OR=2.16; 95%CI=1.05-4.50; p=0.037) and SSI (adjusted OR=3.03; 95%CI=1.39-6.61; p=0.005).Conclusion:Obese children undergoing foot surgery had higher overall complication rates than normal weight patients. Obese children undergoing foot surgery may be at higher risk for wound complications and surgical site infections than those of normal weight. This information may be useful in assessing and discussing surgical risks with patients and their families.

The Association between Storage Duration of Platelet Concentrates and Clinical Outcomes in Cardiac Surgery Patients: An Observational Cohort Study

The Association between Storage Duration of Platelet Concentrates and Clinical Outcomes in Cardiac Surgery Patients: An Observational Cohort Study

General surgery admissions, operations, and patient outcomes during the COVID-19 pandemic

General surgery admissions, operations, and patient outcomes during the COVID-19 pandemic

Evaluating Predictive Value of Preoperative Clinical and Imaging Findings on the Short-Term Outcome of Surgery in Patients Undergoing Lower Lumbar Discectomy.

Objective: The most common indications for spinal surgery are low back pain and associated disabilities caused by disc herniation. Given the high prevalence of low back pain, the critical nature of pain assessment in these patients, and knowledge about the influencing and predisposing factors, we sought to evaluate the clinical and radiologic findings associated with pain relief and postoperative recovery in patients who underwent bilateral lumbar discectomy.Methods: From March 2016 to October 2020, a prospective cohort study was conducted. This study included adult patients with symptomatic disc herniation in the L4-L5 and L5-S1 segments who were candidates for bilateral discectomy. Before and after surgery, patients were evaluated for lumbar and radicular pain and the Oswestry Disability Index (ODI) score and at the four, 12, and 24-week follow-up. Meanwhile, a variety of demographic, clinical, and radiologic factors was collected and statistically analyzed.Results: This study enrolled 30 patients. The average age of the patients was 41.2 years, with 22 males and eight females. Twelve of these patients had disc involvement in the L4-L5 region, while 18 had disc involvement in the L5-S1 region. Statistical analysis revealed that radicular pain and disability associated with low back pain significantly decreased following surgery (P=0.001). However, there was no significant reduction in back pain (P>0.05). Patients with a higher body mass index (BMI) and neurological claudication had a lower reduction in radicular pain (P<0.05). Moreover, a higher BMI and the presence of instability pain are associated with an increased likelihood of postoperative lumbar pain relief (P<0.01). Among the radiological variables, increased disc height was associated with a more rapid recovery from low back disability (P=0.003). Furthermore, a larger diameter of paraspinal muscles at the level of the herniated disc was associated with a more rapid improvement of lower back pain (P=0.021).Conclusion: The use of discectomy in patients with lumbar disc herniation significantly alleviates postoperative and follow-up radicular pain. Age, BMI, neurological claudication, instability pain, and paraspinal muscle diameter played a role in postoperative pain relief. Increased disc height was associated with a more rapid decline in the ODI score. Future studies with larger sample sizes are recommended.

Relationship between the Controlling Nutritional Status Score and Infrainguinal Bypass Surgery Outcomes in Patients with Chronic Limb-threatening Ischemia.

Objective: We investigated the association between Controlling Nutritional Status (CONUT) scores and the outcomes of bypass surgery in patients with chronic limb-threatening ischemia (CLTI).Methods: We retrospectively calculated preoperative CONUT scores in 118 patients (127 limbs) with CLTI who underwent infrainguinal bypass surgery. Survival, graft patency, and limb salvage were compared between the high and low CONUT score groups based on the respective cutoff points.Results: The median and mean CONUT scores were 5 and 4.8, respectively. The postoperative survival rate was lower in the high CONUT score (3–12) group than in the low CONUT score (0–2) group (P=0.0043). The limb salvage rate after arterial reconstruction was also significantly lower in the high CONUT score (8–12) group than in the low CONUT score (0–7) group (P=0.0009).Conclusions: The CONUT score can predict infrainguinal bypass surgery outcomes in patients with CLTI. (This is a translation of J Jpn Coll Angiol 2020; 60: 35–41.)