Patient Postoperative Outcomes Research Articles

Neuroimaging predictors of favorable outcomes after shunting procedures in patients with Hakim-Adams syndrome: a pilot prospective randomized trial

To evaluate diagnostic properties of MRI data comprehensive assessment model compared to traditional invasive diagnostic method (spinal tap test) in prospective randomized trial. MRI data and postoperative outcomes in patients diagnosed with idiopathic normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between September 2022 and April 2024 were analyzed in prospective randomized study. In the study group, surgical decisions were based on MRI data, while the control group followed an algorithm incorporating invasive diagnostic method (spinal tap-test). Ventriculoperitoneal shunting with constant-pressure valve implantation was performed in all patients selected for surgery. The study included 54 patients (25 ones in the study group and 29 ones in the control group). Surgery was performed in 21 and 20 patients, respectively. We found no advantages of invasive diagnostic methods over comprehensive assessment of MRI data in predicting the effectiveness of surgical treatment. Comprehensive assessment of MRI findings allows for avoiding invasive diagnostic procedures in decision-making on cerebrospinal fluid shunting surgery in some patients with idiopathic normal pressure hydrocephalus.

Respiratory and Postoperative Outcomes in Early-onset Scoliosis Patients Treated With Vertical Expandable Prosthetic Titanium Rib: Single-center Experience of 20 Years.

This study examines the long-term effectiveness and safety of the vertical expandable prosthetic titanium rib (VEPTR) device, developed in 1989 to treat early-onset scoliosis (EOS) and thoracic insufficiency syndrome (TIS). Specifically, it assesses VEPTR outcomes over 20 years in a single center, focusing on spine deformity correction, pulmonary function, weight percentile changes, and complication rates. A retrospective analysis was conducted on 36 patients from the EOS clinic who underwent VEPTR implantation without prior spine surgery, with at least 2 years of follow-up. Data collected included age, sex, weight, height, BMI, weight percentiles, comorbidities, radiographic parameters, pulmonary function tests, and complications. Weight percentile (WP) was calculated as preoperative WP and last follow-up WP. Coronal and sagittal deformities were measured preoperatively, immediately postimplantation, and at the last follow-up. Pulmonary function tests included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) and were correlated with weight percentile changes. Complications were classified using established criteria. The mean age at VEPTR implantation was 86±34 months, with most cases attributed to neuromuscular scoliosis (56%). The initial coronal Cobb angle improved from 59±18 to 32±14 degrees postimplantation but increased to 60±25 at the final follow-up. Sagittal angles showed similar trends. Pulmonary function tests indicated a decline in FVC and FEV1 over time. There was no correlation between weight percentile changes and pulmonary function changes. Complication rates were high, affecting 63% of patients, which included hardware prominence, device migration, and infections as the most common. Although VEPTR devices initially corrected spinal deformities, their long-term benefits are limited as the correction becomes less pronounced over time. Expected improvement in pulmonary function is not observed. A different approach to treating EOS and TIS is necessary, as the significant complication rates challenge the implants' effectiveness. Level III.

Interactions Between Anesthesia and Sleep: Optimizing Perioperative Care to Improve Sleep Quality and Surgical Recovery Outcomes.

Sleep is a fundamental physiological process that supports immunity, cognition, memory, and metabolism, making it essential for overall health and well-being. Poor-quality sleep is associated with the onset of many diseases, including cardiovascular and mental health disorders. When using anesthesia, it is essential to have a thorough understanding of the metabolic dysfunction and immunosuppression linked to sleep loss to ensure appropriate perioperative management. Commonly used agents like propofol, sevoflurane, and ketamine affect consciousness, pain levels, and autonomic responses. Inhaled anesthetics (e.g., sevoflurane and isoflurane) and intravenous anesthetics (propofol) act on gamma-aminobutyric acid (GABA) receptors and influence stages of sleep and circadian rhythms. Ketamine may uniquely preserve some aspects of restorative sleep, while most anesthetics affect rapid eye movement (REM) and slow wave sleep (SWS), altering cognitive and physical recovery. Modifying anesthetic regimes depending on the patient's sleep history and risk factors can maximize sleep health and postoperative patient outcomes. The physiological effects of anesthesia on the central nervous system persist beyond the perioperative period by influencing sleep quality, circadian regulation, and postoperative outcomes. Effective pain management is a significant component in addressing sleep quality. Opioids, while effective for pain relief, disrupt sleep architecture by reducing REM and SWS, increasing awakening frequency, and potentially causing respiratory depression. Multimodal pain therapy, including non-opioid analgesics, can reduce dependence, improve sleep quality, and lower adverse effects. Anesthetic agents can influence the body's internal clock, leading to mood changes, fatigue, and cognitive deficits. This review exploits the relationship between sleep and anesthesia, detailing the effect of anesthetic agents on the quality, architecture, and recovery of sleep patterns post-surgery. It also explores how these agents influence sleep stages, such as REM and non-REM sleep, and their implications for patient outcomes. Incorporating sleep optimization techniques can enhance recovery timelines and patient well-being. Researching anesthetic techniques that support postoperative sleep health is essential for further improving patient outcomes.

Preoperative immunonutrition and postoperative outcomes in patients with cancer undergoing major abdominal surgery: Retrospective cohort study.

Surgical resection is a first-line treatment for patients with cancer, but preoperative malnutrition is a risk factor for postoperative complications. This study aimed to evaluate the association between preoperative administration of an immunonutrition regimen and postoperative clinical outcomes in patients with cancer undergoing major abdominal surgery. The Surgical Prehabilitation Multimodal Oncology (SUPREMO) retrospective cohort study, conducted from January 2021 to December 2023, included patients with cancer undergoing major abdominal surgery. Patients were categorized based on whether they received a complete immunonutrition regimen or an incomplete or no regimen. Demographic and clinical data were extracted from electronic health records for descriptive analysis. Logistic regression was used to assess the impact of immunonutrition on the risk of infectious complications, with clinical and demographic variables as explanatory factors. A total of 620 patients were included, with 49% receiving a complete preoperative immunonutrition regimen. Bivariate analysis indicated that complete regimen administration was associated with lower intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and vasopressor support requirements (p=0.005, p=0.019, and p=0.032, respectively). The logistic regression model showed a significant reduction in in-hospital infectious complications (odds ratio 0.54, 95% confidence interval 0.31-0.98; p=0.044). Administering a complete preoperative immunonutrition regimen may be associated with reduced infectious complications, ICU and IMV requirements, and vasopressor support use.

The Impact of Surgical Prehabilitation on Postoperative Patient Outcomes: A Systematic Review.

Prehabilitation (preoperative rehabilitation) encompasses a range of patient health driven interventions with the potential to enhance surgical outcomes. This systematic review aims to assess the efficacy of prehabilitation on postoperative outcomes across surgical specialties, focusing on physical functionality and postoperative length of stay (LOS). Medline, Embase, CINAHL Plus, Cochrane Library, Scopus, and Clinicaltrials.gov databases were queried using the search terms prehabilitation, surgery, and related synonyms. Included publications were original, English-language, full-text studies conducted in the US with a cohort of ≥5 patients undergoing prehabilitation. After title (n=1817), abstract (n=1059), and full-text (n=411) screens, 26 articles met inclusion criteria. Of 26 included articles, 30.8% (n=8) assessed oncologic surgeries, 34.6% (n=9) assessed orthopedic surgeries, 19.2% (n=5) assessed general surgery procedures, and 15.4% (n=4) assessed cardiac, colorectal, urologic, and transplant surgeries. Physical function was the most common assessed primary outcome, with 46.2% (n=12) of studies measuring physical activity, functional status, range of motion, or muscle strength. The outcomes of six-meter walk test, sit-to-stand test, and LOS were reported in 26.9% (n=7), 23.1% (n=6), and 19.2% (n=5) of studies, respectively. Three studies found a significant improvement in the six-meter walk test, and four studies demonstrated a significant improvement in sit-to-stand test after prehabilitation. LOS outcomes had varied results across studies. Prehabilitation interventions have the potential to improve postoperative outcomes, including physical function and LOS in surgical patients. Further research is necessary to identify the most efficacious prehabilitation protocols and determine their optimal impact within diverse surgical subpopulations.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CRS): Age-Related Outcomes and a Look into the Future

Introduction: Peritoneal carcinomatosis presents significant treatment challenges. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) offers a promising therapeutic approach. Patient selection remains critical, and the role of age as an exclusion criterion requires further investigation. This study evaluates whether age influences postoperative outcomes in CRS-HIPEC patients. Methods: A retrospective review of a prospective comprehensive database of 271 CRS-HIPEC procedures performed between 2018 and 2023 was conducted. Logistic regression assessed the relationship between age and postoperative outcomes. Age groups (18–44, 45–69, ≥70 years) were compared based on demographic data, primary tumor site, Peritoneal Cancer Index scores, and key outcome measures. Results: Across the different age groups, there were no significant differences in PCI scores, recurrence, disease-free survival, 30-day morbidity, or mortality. Length of stay was longer in older patients (p = 0.009). Patients aged ≥70 had higher readmission rates (p = 0.041) and were more often discharged to transitional care facilities (p = 0.001). Older patients were also more likely to experience Clavien–Dindo grade III or higher complications (p = 0.008). Logistic regression confirmed these findings. Continuous age analysis yielded similar results and revealed significant differences in race and primary organ involvement. Conclusions: Age is not a significant predictor of 30-day morbidity, mortality, or survival outcomes in patients undergoing CRS-HIPEC. However, older patients require closer attention to discharge planning and readmission risk management. This study highlights the importance of comprehensive patient assessment beyond age and underscores the need for further research to better understand factors influencing outcomes in this population.

Virtual follow-up after cataract surgery: systematic review.

To examine the association between virtual postoperative follow-up care and patient outcomes after cataract surgery. Cataract surgery is a safe and commonly performed surgery. Follow-up visits are used to monitor for complications. It is uncertain whether virtual follow-up provides a safe alternative to in-person review. MEDLINE, Embase, and CINAHL were searched from inception to October 2023 for relevant articles containing original data. Studies that (1) included patients who were seen in a virtual follow-up (ie, telephone or video call) for postoperative appointments after cataract surgery and (2) reported patient outcomes were included. Risk of bias (RoB) was assessed using the Newcastle-Ottawa and RoB2 assessment tools. Descriptive statistics were used to summarize findings. The review was registered in PROSPERO (registration number, CRD42023477207), and PRISMA guidelines were followed. The search yielded 1710 records with 7 studies included in this review. The 7 studies reported on 2113 cataract surgeries in 1994 patients. The studies ranged between 2004 and 2020. Most of the studies (5/7) included only patients with uneventful cataract surgery. Virtual follow-ups were all conducted by telephone. The follow-up calls were made at varying timepoints including postoperative day 1 (n = 3), day 7 (n = 2), and day 14 (n = 1). 2 observational studies directly compared patients who had a telephone follow-up with a control group who had an in-person follow-up. There were no significant differences in complication rates ( P = .22) or visual acuity ( P = .28) between these follow-up groups. None of the studies reported serious adverse outcomes from replacing in-person follow-up with telephone follow-up. One study used virtual follow-up in conjunction with in-person visits for elderly patients and found that additional telephone follow-up was associated with decreased surgical recovery time and decreased patient anxiety. 3 studies reported on patient perceptions about telephone follow-up. A common theme was that patients preferred telephone reviews and found them to be more convenient than in-person follow-up. For patients with uneventful cataract surgery, virtual follow-ups seem to be a safe alternative to in-person visits and were preferred by patients. These conclusions are preliminary given the limited literature base, and further study is needed.

Clinical Outcomes following Elective Lumbar Spine Surgery in Patients Living with Dementia.

As the population ages and surgical techniques improve, more elderly patients with dementia are being considered for treatment of spinal disorders. However, the combined impact of procedural intensity and anesthesia exposure can exacerbate surgical risks, leading to more complex recoveries and post-operative morbidity. To compare post-surgical outcomes of patients living with dementia who received elective lumbar spine surgery with a comparable group of patients without dementia. Retrospective analysis using national Medicare claims. We identified Medicare beneficiaries living with dementia who underwent elective lumbar spine surgery between 2017-2018. This cohort was compared to Medicare beneficiaries who received comparable surgeries but without a diagnosis of dementia. The primary outcome was any adverse event (AAE) within 180 days of surgery, with post-operative intensive interventions considered in parallel with other clinical outcomes. We employed inverse probability of treatment weights to adjust for confounding. We compared outcomes between cohorts using adjusted hazard ratios (aHR) from Cox-proportional hazard models and Fine-and-Gray models considering death as a competing risk. We included 101,313 patients. Within 180 days of surgery, patients with dementia had an increased hazard of AAE than those without dementia (aHR 1.30; 95% CI 1.21,1.40). Patients with dementia also demonstrated a greater hazard of mortality (aHR 1.75, 95%CI 1.33, 2.29) and post-operative intensive interventions (aHR 1.64, 95% CI 1.08, 2.49) over the same time frame. We found a significantly increased risk of adverse events among patients living with dementia undergoing lumbar spine surgery. We believe these risks were previously underappreciated because of the focus on urgent procedures (e.g. hip and odontoid fractures) in prior research evaluating post-operative outcomes for patients with dementia. Our results suggest the need for greater caution when recommending elective, high-intensity, surgical interventions for patients living with dementia.

Effect of Whey Protein Supplementation on Postoperative Outcomes After Gynecological Cancer Surgery: A Randomized Controlled Trial.

Whey protein's biochemical properties make it an ideal nutritional supplement for patients with cancer, especially in perioperative care. Thus, the present study aims to assess the efficacy of whey protein supplementation (WPS) compared to standard care in enhancing postoperative outcomes for patients undergoing comprehensive surgical staging for gynecological cancer. In an open-label, randomized controlled trial conducted at Rajavithi Hospital between November 28, 2023 and July 8, 2024, 61 patients scheduled for comprehensive surgical staging were enrolled. Participants were randomized in a 1:1 ratio to either the WPS group (n = 30) or the control group (n = 31). The WPS group received isolated whey protein powder (20 g of protein per serving), administered at 6 pm before surgery and 6 am on the first postoperative day. The control group received standard postoperative care. The primary endpoint was the length of hospital stay (LOHS), with secondary outcomes including gastrointestinal function recovery, postoperative analgesic use, complications, and potential WPS-related adverse events such as transaminitis, acute kidney injury, and electrolyte imbalances. The WPS group had a significantly shorter LOHS than the control group (79.0 ± 6.7 vs. 93.3 ± 28.4 h, P = 0.021). Additionally, the WPS group demonstrated significant improvements in gastrointestinal function, with shorter times to first flatus (P < 0.001), first defecation (P = 0.013), and first ambulation (P = 0.043). No significant differences were observed between the groups regarding postoperative analgesic use or complications, including fever, nausea/vomiting, wound infection, and readmission (P > 0.05). Furthermore, no WPS-related adverse events were reported. The use of WPS in the perioperative operative management of gynecological cancer surgery yields promising results by significantly reducing the LOHS and accelerating the recovery of gastrointestinal function while maintaining a favorable safety profile.

Postoperative Brace Prescription Practices for Elective Lumbar Spine Surgery: A Questionnaire-Based Study of Spine Surgeons in Japan.

The efficacy of postoperative braces for degenerative lumbar disorders has long been debated, with conflicting reports regarding the promotion of bone fusion and pain relief. The current aspects of postoperative brace prescriptions have been previously reported in Western countries but not in Asia. This study aimed to elucidate prescription practices in Japan and identify factors influencing prescription decisions. The survey was conducted at a spine group research meeting comprising spine surgeons from multiple institutions. The questionnaire assessed aspects of postoperative brace prescription, including the type, purpose, and duration of usage, categorized by surgical procedures for degenerative lumbar disorders: endoscopic decompression, open surgery decompression, and fusion involving 1 or more than 3 levels. The respondents' backgrounds, scientific knowledge of postoperative braces, nonscientific reasons, and basis for prescription decisions were also investigated. There were 63 valid responses. The overall postoperative brace prescription rate was 83%, with 66% for decompression and 98% for fusion procedures, surpassing the rates reported in Western studies. The primary prescription purpose was to slow down patient activity (83%, double the previously reported rates). Prescription rates for endoscopic and open surgical decompression were significantly correlated with facility attributes and annual number of surgeries. Scientific knowledge of postoperative braces was lacking in 56% of respondents, with scientific evidence being the least frequent decision for brace prescription (14%). Nonscientific reasons influenced the prescription decisions of 84% of participants. The postoperative brace prescription rate among spine surgeons in Japan was significantly higher than that in Western studies, largely due to nonscientific factors such as physician reassurance and the intention to slow down patient activity. Comprehensive, evidence-based guidelines are needed regarding consistent brace usage to optimize patient outcomes. This study highlights the high postoperative brace prescription rates among spine surgeons in Japan, which are significantly influenced by nonscientific factors, such as tradition, physician reassurance, and patient satisfaction, rather than scientific evidence. These findings underscore the need for evidence-based guidelines to improve consistency in postoperative brace usage. The results are particularly relevant in regions with aging populations and a high prevalence of osteoporosis, providing insights for improving postoperative management strategies and patient outcomes in Japan as well as in similar demographic settings globally.

Preoperative Diffusion Tensor Imaging and Neurite Dispersion and Density Imaging in Isocitrate Dehydrogenase-Mutant Grade 2 and 3 Gliomas: Definition of Tumor-Related Epilepsy and Predictive Factors of Seizure Outcomes Based on a Single-Center Retrospective Case Series.

Understanding and managing seizure activity is crucial in neuro-oncology, especially for highly epileptogenic lesions like isocitrate dehydrogenase (IDH)-mutant gliomas. Advanced MRI techniques such as diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) have been used to describe microstructural changes associated with epilepsy. However, their role in tumor-related epilepsy (TRE) remains unclear. This study aims to investigate the role of DTI and NODDI tumor-derived metrics in defining TRE and predicting postoperative seizure outcomes in patients undergoing surgical resection for IDH-mutant grade 2 and 3 gliomas. This was a single-center retrospective study. Preoperative DTI parameters included fractional anisotropy and mean diffusivity. NODDI parameters included neurite density index (NDI), orientation dispersion index, and free-water fraction (FWF). These metrics were calculated within three volumes of interest (fluid-attenuated inversion recovery [FLAIR] tumor volume, FLAIR peripheral zone, and FLAIR central zone [Fcz]) and correlated with seizure presentation, type, and postoperative control, which was reported according to the Engel classification system. Fifty-seven patients were included in this study. Increased NODDI-derived FWF-Fcz (P = .031) and NDI-Fcz (P = .046) values correlated with preoperative generalized seizure presentation, although only the FWF-Fcz confirmed its statistical significance (P = .047) in the multivariate analysis. Lower mean diffusivity-FLAIR tumor volume correlated with poor postoperative seizure control both in the univariate (P = .015, P = .026) and multivariate analyses (P = .024, P = .036), while a trend toward significance was found between higher NDI-FLAIR peripheral zone and worse seizure control (P = .055). DTI and NODDI tumor-derived quantitative parameters may define TRE and predict postoperative seizure outcomes in patients with IDH-mutant gliomas. Notably, DTI metrics were found to be independent predictors of postoperative seizure outcomes, while preoperative NODDI parameters correlated with seizure presentation. Further research is warranted to validate our findings and to better understand the underlying mechanisms driving TRE.

Effect of Rheumatoid Arthritis on Postoperative Outcomes in Patients with Lumbar Spinal Disorders: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis. This study aimed to determine whether rheumatoid arthritis (RA) is associated with clinical outcomes following spinal surgery for lumbar spinal disorders. MEDLINE, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform were comprehensively searched for observational studies comparing clinical outcomes after lumbar spine surgery in patients with and without RA (>18years). Quality assessment was conducted using the Quality in Prognosis Studies assessment tool. Pooled odds ratios (ORs) and hazard ratios were calculated for reoperation and surgical site infection by using a random effects model. Subgroup analyses were conducted to examine the effect of surgery type. Seven studies with 72,969 patients, including 7518 patients with RA, were analyzed. All studies had a moderate risk of bias. Patients with RA had a significantly higher odds of reoperation (OR: 5.57; 95% confidence interval [CI]: 1.10-28.26; I2 = 92%; P = 0.04) and higher odds of surgical site infection (OR: 1.47; 95% CI: 1.28-1.69; I2 = 2%; P < 0.01). No statistically significant difference was found in reoperation-free survival between patients with RA and those without RA (hazard ratio: 1.15; 95% CI: 0.94-1.40; I2 = 100%; P = 0.16). Patients with RA had higher complication rates, with incidence rates ranging from 13.5% to 57%, compared with those without RA. Compared with patients without RA, patients with RA may be more likely to undergo reoperations and suffer from complications following surgery for lumbar spine lesions.

Can Surgery Be Proposed to Adolescent Idiopathic Scoliosis Patients With Structural Lumbar Curves Associated With Nonreducible Iliolumbar Angle?

Lower instrumented vertebra (LIV) selection for adolescent idiopathic scoliosis (AIS) with structural lumbar curves (Lenke 3, 5, and 6) remains debated. The iliolumbar angle (ILA) measurement is useful for assessing the lumbosacral junction flexibility. If it is nonreducible, surgeons need to make a difficult choice between a potential "imperfect" L4, associated with a residual lumbosacral curve, or a more distal fusion performed later in life due to poorer functional outcomes. The goal of this study was, therefore, to evaluate the postoperative radiographic and functional outcomes of AIS patients with nonreducible ILA. All consecutive AIS patients (2017 to 2022) with a structural lumbar curve and a posterior fusion ending on L4 were retrospectively included. Radiographic and functional outcomes (SRS-30 score) were reported with a minimum 2-year follow-up. Standing low dose stereoradiographs in both erect and maximum lateral bending positions were performed in all patients, and 2 groups of subjects were compared based on preoperative ILA flexibility [reducible group (R) or nonreducible group (NR)]. A total of 122 patients were included (30% NR and 71% R). At a mean follow-up of 2.3±0.1 years, surgery was efficient in correcting the major curve (77% reduction rate in the R group and 76% in the NR group, P<10-5), and significantly improved coronal balance (R, P<10-5 and NR, P=0.03) as well as the ILA [mean ILA gain 14 degrees (R group), P<10-5 and 16 degrees (NR group), P<10-5]. The proportion of excellent results was higher in the R group, but 97% of outcomes were either excellent or acceptable in the NR group, and only 1 case of poor result (residual ILA >10 degrees) was reported in each group. No significant difference was found in SRS 30 scores between groups, but scores were significantly improved in the NR group for the excellent outcomes' subgroup [self-image (P=0.04) and satisfaction (P=0.02) domains]. The current study confirms that posterior fusion ending on L4 can still be proposed to young AIS patients with structural lumbar curves, even if the lumbosacral flexibility is limited. Level III-comparative study.

Prognostic Nutritional Index (PNI) As a Preoperative Screening Tool in Predicting Clinical Outcomes of Postoperative Pediatric Cardiac Surgery Patients.

The authors sought to evaluate the role of nutritional indices such as Onodera's prognostic nutrition index (PNI), World Health Organization (WHO)-based anthropometric measurements such as weight for age (w/a), height for age, weight for height, and perioperative serum albumin levels in the determination of postoperative clinical outcomes in pediatric patients who undergo surgery for congenital cardiac defects and surgical complexity (risk-adjusted congenital heart surgery score) and its correlation with postoperative course. In this prospective observational study, 108 post-pediatric cardiac surgery patients under the age of 18 months were enrolled between January 2023 and August 2023. Through receiver operating characteristic curve analysis we have found the cutoff value for PNI is ≤66.5 and >66.5. The above mentioned parameters were analyzed for postoperative clinical outcomes such as length of intensive care unit (ICU) stay, length of hospital stay, and duration of mechanical ventilation. Significant negative correlation was found between length of ICU stay and hospital stay with lower PNI (P = .019 and <.001, respectively.). Analysis of low versus high PNI groups was suggestive of a remarkable increase in mechanical ventilation time (P = .03), length of ICU stay (0.01), and hospital stay (P ≤ .001) in the low PNI group. Lower WHO-based w/a Z score was found to be significantly associated with low PNI (<66.5), after adjusting for preoperative albumin, postoperative albumin drop, and C-reactive protein (odds ratio = 1.411 per unit 0.28 increment in W/azs, P = .004). Preoperative Onoderas PNI is an effective and efficient tool for predicting postoperative clinical morbidity in pediatric patients undergoing congenital heart surgery.

The Posterior Ligamentous Complex: Anatomic and Biomechanical Considerations in Injury Classification and Management.

The posterior ligamentous complex (PLC) provides critical structural support in the thoracolumbar spine. Its role in resisting progressive flexion is particularly important at the thoracolumbar junction due to the transition from the rigid thoracic spine to the more mobile lumbar region. Each component of the PLC contains anatomic features that contribute to both the structure and function of the PLC as a whole. Understanding the nuances of each structure is important in determining injury severity and may serve as a foundation for future directions of research. Violation of the PLC results in an unstable spine, thus requiring surgical management. It is associated with greater injury severity and neurologic deficit in patients who sustain thoracolumbar fractures, which adds complexity to the postoperative course and patient outcomes. Although plain radiographs and CT scans provide reliable indirect measures of PLC disruption, these modalities may be subject to diminished sensitivity based on patient positioning and do not directly measure soft-tissue injury. Modern classification systems include the integrity of the PLC in surgical decision making, and care must be taken to scrutinize the possibility of ligamentous disruption before proceeding with nonsurgical management to avoid adverse patient outcomes.

The impact of depression and anxiety disorders on postoperative outcomes for patients having total hip or knee arthroplasty: Protocol of a meta-analytic study from cohort studies.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are widely performed surgeries for end-stage joint disease, yet the influence of depression and anxiety on postoperative outcomes remains unclear. This study aims to consolidate current evidence on the relationship between preoperative depression and/or anxiety disorders and postoperative outcomes in adult patients undergoing primary THA or TKA. Given the potential for these psychiatric conditions to affect recovery, pain management, and overall satisfaction, the results of this study are crucial to inform targeted perioperative interventions and improve patient-centered care. We will search PubMed, Embase, Cochrane Library and PsycINFO from inception to the November 2024, adopting a comprehensive search strategy with no language restrictions. Eligible studies will include cohort studies evaluating adults with a diagnosis of depression and/or anxiety before THA or TKA compared to those without such disorders. Inclusion criteria will focus on preoperative psychiatric diagnoses, clearly defined postoperative outcomes (such as complications, functional recovery measures, pain, length of stay, and patient-reported outcomes). Risk of bias assessment will be performed using the Newcastle-Ottawa Scale. Meta-analysis will be conducted using a random-effects model to calculate pooled risk estimates and 95% confidence intervals for each outcome. Heterogeneity will be quantified with the I2 statistic, and a threshold of I2 > 50% will indicate substantial heterogeneity. Sources of heterogeneity will be explored via subgroup analyses or meta-regression if possible. Potential publication bias will be visually assessed using funnel plots and statistically tested using Egger's test. Sensitivity analyses will be carried out to evaluate the robustness of the results for each outcome through leave-one-out procedure. This study will introduce a systematic and rigorous approach to synthesizing evidence from multiple cohorts, providing a comprehensive understanding of the impact of depression and anxiety on THA and TKA outcomes. The findings will guide clinicians in recognizing and managing mental health issues to optimize postoperative recovery and ultimately improve patient satisfaction and quality of life. Study registration: CRD42024500008.

Utilization of smartphone technology and wearable technology following TKA.

The widespread adoption of smartphones and wearable technology has introduced innovative approaches in healthcare, particularly in postoperative rehabilitation. These technologies hold significant promise for improving recovery following lower extremity arthroplasty, especially total knee arthroplasty (TKA). Despite growing interest, the evidence on their effectiveness and long-term impact remains variable. This narrative review evaluates the utilization of smartphone applications, wearable devices, and their combined use in postoperative recovery after TKA. Key studies assessing adherence, functional outcomes, patient satisfaction, and healthcare utilization were analyzed to synthesize insights into their effectiveness compared to traditional rehabilitation approaches. Smartphone applications have demonstrated improvements in adherence to rehabilitation plans, pain management, and functional outcomes. For instance, interventions using text-based prompts or interactive platforms enhanced physical activity, reduced narcotic use, and improved patient-reported outcomes such as PROM adherence and range of motion (ROM). Similarly, wearable devices provided accurate feedback on activity levels and step counts, promoting early mobility and strength recovery. Combined approaches leveraging both technologies further enhanced adherence, functional recovery, and patient engagement while reducing healthcare utilization. The integration of smartphone and wearable technologies in TKA rehabilitation shows potential for improving recovery outcomes. While findings generally indicate noninferiority or superiority to conventional methods, limitations exist in standardization, data accuracy, and long-term benefits. Future research should focus on refining these technologies, establishing standardized guidelines, and evaluating their cost-effectiveness in diverse populations. Smartphone and wearable technologies represent safe and effective tools for enhancing postoperative outcomes in TKA patients. Their integration into clinical practice could optimize rehabilitation protocols, improve patient engagement, and potentially reduce healthcare costs.

Predictors of functional recovery following surgical repair of quadriceps tendon rupture: insights from a German multicentre study.

More extensive and cohesive studies on quadriceps tendon rupture (QTR) repair surgery are required to guide effective treatment strategies. Therefore, in this study, we aimed to identify predictors of subjective functional recovery following QTR repair surgery. This multicentre retrospective cohort study enrolled 191 adults (age ≥ 18years) who underwent surgical unilateral QTR repair (2010-2022) and had ≥ 1-year postoperative follow-up at three trauma centres in Germany. Multiple linear regression and moderation analyses evaluated seven patient-centred factors and eight treatment-related predictors of the International Knee Documentation Committee (IKDC) and Tegner-Lysholm Knee scores. The participants ( meanage = 62.3years) had mean (standard deviation) IKDC and Tegner-Lysholm Knee scores of 67.4 (19.4) and 74.8 (22.5), respectively. Male sex, lower body mass index (BMI), shorter time to surgery, and early rehabilitation adoption predicted higher functional scores (p < 0.05). Smoking and suturing techniques showed no significantmain effects. Age was negatively correlated with IKDC scores when transosseous sutures were applied but not when suture anchors were used. Notably, 6% of the cohort were affected by complications such as re-rupture or deep vein thrombosis. Patient-centred factors (sex and BMI) and treatment-related factors (timing of surgery and rehabilitation protocols) significantly influence postoperative functional outcomes in patients with QTR. Early surgical intervention and dynamic rehabilitation protocols are important for optimising recovery, and suture anchor techniques may be advantageous in older patients. Further research is essential to improve QTR management strategies and enhance patient outcomes. IV-Retrospective cohort study without a comparison group.

ASO Author Reflections: The Effects of Perioperative Corticosteroids on Postoperative Complications After Pancreatoduodenectomy: A Debated Topic of Systematic Review and Meta-analysis.

Pancreatoduodenectomy (PD) is a complex surgery with high morbidity and mortality, often associated with complications like post-pancreatectomy hemorrhage (PPH) and postoperative pancreatic fistulas (POPF). The corticosteroids administered intraoperatively has been shown to improve postoperative outcomes in patients undergoing surgery. However, their impact on complications following PD remains controversial. A comprehensive review of literature found no significant impact of perioperative corticosteroids on postoperative complications in PD, including postoperative major complications (PMCs), POPF, infectious complications, delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), bile leakage, reoperation, or 30-days mortality. Other medications, such as octreotide, antibiotics, and probiotics, have shown potential in reducing complications, but further research is needed, especially for corticosteroids in PD. In the near future, more randomized controlled trials should be conducted, along with well-designed clinical studies, to provide high-level evidence for the potential benefits of corticosteroids in PD for targeted populations.

Improving postoperative outcomes in patients with pancreatic cancer: Inflammatory and nutritional biomarkers

This editorial assesses the prognostic value of preoperative inflammatory and nutritional biomarkers in patients undergoing surgical resection for pancreatic cancer. Lu et al evaluated the ability of seven biomarkers to predict postoperative recovery and long-term outcomes. These biomarkers were albumin-to-globulin ratio, prognostic nutritional index (PNI), systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, nutritional risk index, and geriatric nutritional risk index. The PNI was found to be a strong predictor of both overall and recurrence-free survival, underscoring its clinical relevance in managing patients with pancreatic cancer.