Postoperative Patient Research Articles

Assessing the Relationship Between Mandibular Contouring and Iatrogenic Jowling in Facial Feminization Surgery.

Lower-third facial feminization procedures have been associated with the development of postoperative jowling, yet quantitative evaluations of this outcome remain limited. This study evaluated the relationship between patient risk factors and bony volume reduction with postoperative jowling. Chin and gonial angle bony measurements were obtained from preoperative and postoperative computed tomography imaging, whereas changes in jowling were assessed using a validated photonumeric jowling scale on preoperative and postoperative patient images. Associations between skeletal changes, demographic variables, and soft tissue outcomes were statistically analyzed. The study included 35 patients with a mean age of 36 ± 12 years. The average time between surgery and postoperative photographs was 10.0 ± 7.5 months. Gonial angle volume decreased by 9.48% (P < 0.001), whereas chin volume decreased by 3.06% (P = 0.051). Average jowling grade increased significantly from 2.3 to 2.6 postoperatively (P = 0.03), with higher age correlating to a greater increase in jowling (r = 0.35, P = 0.037). Postoperatively, only body mass index was significantly correlated with absolute jowling score (r = 0.51, P = 0.0018). However, no significant associations were found between changes in bony measurements and changes in jowling scores. These findings underscore the importance of further investigating the interplay between patient risk factors and bony and soft tissue changes in facial feminization surgery. Future studies will focus on expanded cohorts and more sensitive assessment tools to better define risk factors and optimize surgical strategies for minimizing jowling.

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.

D30 alleviates β2-microglobulin -facilitated neurotoxic microglial responses in isoflurane/surgery-induced cognitive dysfunction in aged mice

Post-operative cognitive dysfunction (POCD) is a common complication with no effective treatment in elderly patients. POCD and Alzheimer’s disease (AD), and many other cognitive diseases mostly involve neurotoxic microglia response, and recently, β2-microglobulin (B2M) has been suggested to play a pivotal role. A novel pyromeconic acid-styrene hybrid compound D30 was synthesized by our team and shown to be safe and effective in some neurodegenerative mouse models. Here we evaluated D30 on POCD and its potential mechanism. 14-18month-old male C57BL/6 mice were used to establish POCD through isoflurane anesthesia and surgery. Elderly patients’ plasmas were collected pre- and post-operatively. Primary mouse microglia were subjected to various stimulations in multiple experimental designs to imitate in vivo POCD-like conditions. Morris water maze, fear conditioning, western blot, immunofluorescent staining, and blood-brain-barrier (BBB) permeability were conducted in this study. D30 administration significantly improved learning and memory in aged mice following POCD. While neurotoxic M1 microglia cells were dramatically increased following POCD, manifested as morphologically changing into fewer and shorter branches, enlarged somatic areas, and upregulated expression of iNOS and C1q, Notably, following POCD, B2M was significantly upregulated in the plasma and the brain. D30 treatment significantly suppressed these pathological changes, by inhibiting the POCD-induced BBB breakdown while suppressing the surge of plasma B2M levels. D30 treatment suppressed POCD- induced surge of B2M and Aβ plaques in the brain, preserved adult hippocampal neurogenesis vulnerable to POCD. Furthermore, post-operative levels of B2M were significantly elevated over the preoperative levels in patients aged over 80 years and over. In parallel to mouse plasma after POCD, the post-operative patient plasma was also much more effective at activating M1 microglia. Of note, these POCD plasma-induced activation of M1 microglia were largely prevented by D30 treatment. Taken together, by inhibiting the surge of plasma B2M, protecting BBB integrity, and reducing inflammatory response, D30 protected aged mice from B2M-facilitated POCD.

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.

Investigating disparity in labor epidural analgesia management in black vs. white women: a retrospective case-control study (2018-2022).

Disparities in labor epidural analgesia (LEA) management could reduce maternal satisfaction and increase risk. We compared times from the first administration of breakthrough pain medication (top-up) to LEA replacement to evaluate disparities across race. In this retrospective cohort study (01-01-2018 to 12-31-2022), all patients with LEA and maternal race/ethnicity of non-Hispanic White or Black were eligible. Patients with a scheduled cesarean delivery, previous back instrumentation, or maternal age<18 were excluded. We used a Cox Proportional Hazards model to evaluate our primary outcome. Predefined top-up medications given≥60minutes from initial LEA placement and before replacement were valid. Any replacement≥60minutes from the initial LEA was valid. We also studied secondary outcomes incidence of epidural replacement and postoperative patient satisfaction. There were 11,168 total patients receiving LEA, with 479 (5.5%) replacements in White patients and 127 (5.0%) in Black patients. There were 387 (3.5%) LEAs with a top-up followed by replacement within 24hours. After adjusting for confounders, no association was detected between race and LEA management (Hazard Ratio 0.82; 95% CI 0.63, 1.06; P=0.13). We failed to detect an association between patient race and the incidence of replacement (P=0.23). We found that race (P=0.02) and LEA replacement (P<0.001) were associated with increased odds of lower postpartum satisfaction. We didn't detect disparity in treatment at our institution with standardized LEA management protocols. However, Black women and those with LEA replacements were less satisfied. Future studies should evaluate the generalizability and explore interventions that improve patient satisfaction.

Inadvertent Harm: An Institutional Analysis of Iatrogenic Vascular Injuries and Management

Iatrogenic vascular injuries are unintended complications arising from medical or surgical procedures, posing significant risks to patient outcomes. These injuries can result from various interventions, such as catheter placements and stent insertions, and may lead to serious complications. This study analyzes a series of iatrogenic vascular injuries encountered at our institution, focusing on their management and outcomes to enhance patient safety and procedural techniques. From September 1, 2022, to May 31, 2024, a total of nine patients (six males and three females) were treated for iatrogenic vascular injuries at our institution. The injuries resulted from various procedures, including catheter placements, endovascular interventions, and chemo port insertions. Management strategies included both endovascular and open-surgical approaches, with outcomes measured based on postoperative recovery, complications, and overall patient prognosis. The injuries involved a range of complications, including pseudoaneurysms, misplaced guidewires, and arterial damage. Endovascular techniques, such as stent placement and guidewire retrieval, were successfully utilized in four cases, while open surgical interventions were necessary in the remaining four cases to control severe bleeding and repair complex arterial defects. Postoperative complications were minimal, and all patients recovered well, with no mortality reported. Iatrogenic vascular injuries, though challenging, can be effectively managed with a combination of endovascular and open surgical techniques. The choice of approach should be dictated by the specific nature of the injury, aiming to minimize complications and ensure optimal patient outcomes. The findings from this case series underscore the importance of tailored management strategies in improving patient safety in vascular interventions.

Clinical outcomes and patient-reported outcome measures among patients undergoing posterior lumbar fusion procedures with varying insurance payor status: a propensity score-matching study.

Posterior lumbar fusion (PLF) is a routinely used procedure for treatment of spinal pathology. Several studies have highlighted disparities in reoperation and postoperative complications and demonstrated associations between differing insurance providers, complication rates, and hospital resource utilization in spine surgery. Previous studies have examined broad spinal procedures but have not extended to uninsured patients, or adjusted for sociodemographic factors or comorbidity history. Understanding relationships between payor status and outcomes following fusion procedures is vital to promoting healthcare equity. The objective of this study was to assess whether patients' insurance impacts postoperative outcomes and patient satisfaction following PLF procedures. The Stanford University Medical Center inpatient registry was used to retrospectively analyze patients who underwent PLF procedures between 2016 and 2022. Propensity score matching was used to compare privately insured with Medicaid patients, as well as comparing uninsured patients with Medicaid patients based on age, sex, and comorbidities. Outcomes data, including 90-day postoperative complications, reoperation, and patient-reported outcome measures scores (Oswestry Disability Index and Patient Health Questionnaire) were collected. A total of 1904 patients fulfilled the inclusion criteria. In unmatched comparisons, statistically significant differences existed within specific types of complications including altered mental status, delirium, neurological complications, and pulmonary complications. A total of 292 privately insured patients were matched to 292 Medicaid patients. Within matched patient groups, the Medicaid group had higher rates of altered mental status (6.2% vs 2.7%, p = 0.042); delirium (9.9% vs 5.1%, p = 0.035); renal dysfunction (6.9% vs 4.1%, p = 0.020); and pulmonary complications (8.9% vs 3.8%, p = 0.049) compared to privately insured patients. Privately insured patients had lower postoperative Oswestry Disability Index scores (30.2 vs 34.4, p = 0.018) compared to Medicaid patients. Following propensity score matching of 88 Medicaid patients to 88 uninsured patients, large but not statistically significant differences existed for neurological complications (12.5% vs 5.7%, p = 0.165) and 5-year revision rates (3.4% vs 1.1%, p = 0.353). The findings indicate that the treatment outcomes, care quality, and patient satisfaction following PLF procedures differ between Medicaid and privately insured patients. Further investigation is warranted to explore relationships between insurance payor status and clinical outcomes in multicenter populations.

Direct superior approach versus posterolateral approach in mid-term clinical outcomes of total hip arthroplasty: a prospective randomized controlled study

PurposeThe aim of this study is to compare mid-term clinical outcome of direct superior approach (DSA) and posterolateral approach (PLA) in THA.MethodSeventy-eight patients who underwent THA from January 2021 to June 2021 were prospectively enrolled and randomly allocated into DSA group and PLA group. The surgical duration, incision length, total blood loss, ambulation time, visual analogue scale (VAS), patient satisfaction, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, postoperative leg length discrepancy (LLD), abduction angle, anteversion angle and complications were compared between the two groups.ResultsThirty three patients were randomized to the PLA group and 32 patients allocated to the DSA group. The average follow-up period was 39.8 months in DSA group and 40.1 months in PLA group. Compared with PLA group, DSA group had longer surgical duration ([124.1 ± 11.2] min vs. [103.3 ± 20.7] min), less total blood loss ([482.4 ± 236.1] ml vs. [680.2 ± 299.4] ml), shorter incision ([8.7 ± 1.9] cm vs. [15.6 ± 1.7] cm), and earlier ambulation time ([15.8 ± 4.0] h vs. [20.5 ± 3.5] h), with statistically significant differences (P < 0.0001). Furthermore, the DSA group had significantly lower WOMAC Scores compared to the PLA group at 1-year postoperatively (P = 0.011), and had significantly lower WOMAC Function Scores and WOMAC Stiffness Scores both at 1-year postoperatively and at the last follow-up. The anteversion angle of the cup in the DSA Group was significantly smaller than the PLA Group at postoperative day (POD) 3 and the last follow-up (P = 0.006 and P = 0.010, respectively). However, there was no difference in postoperative patient satisfaction, complication, LLD or HHS between the two groups.ConclusionDSA demonstrated benefits in terms of reduced blood loss, improved pain scores, shorter incisions, and earlier ambulation. These advantages support the use of DSA for promoting early recovery and better mid-term functional outcomes.Trial registrationThe study protocol was registered on Chinese Clinical Trial Register (ChiCTR) with the register number ChiCTR2000041186 (registration date: 2020/12/21).

First branchial cleft anomalies in children: long-term outcome in 16 patients.

First branchial cleft anomalies (FBCA) are rare congenital head and neck malformations, often subject to incorrect diagnosis and treatment. We present our experience with FBCA, focusing on clinical presentation, diagnosis, perioperative relation to the facial nerve, surgical approach, complications and patient satisfaction. A consecutive cohort of 16 patients undergoing surgical treatment for FBCA between 1999 and 2021 was analyzed. Demographic and clinical information was extracted from their medical records. Additionally 14 patients were interviewed by telephone to assess postoperative outcomes and patient satisfaction using a Likert scale. Sixteen patients (11 females, 5 males) were surgically treated at an age ranging from 7months to 13years. Type I and type II FBCA were evenly distributed. Lesions presented as cysts (n = 4), sinuses (n = 7) or fistulas (n = 5). The main symptoms were swelling, inflammation and discharge. Otologic symptoms were present in 31%. In 80% of patients, magnetic resonance imaging was needed to reach the correct diagnosis. Ten patients (63%) had a history of a surgical attempt in another center before definitive surgical treatment in our center. Complete excision was accomplished in all patients. Postoperative complications included limited Frey syndrome (n = 4), temporary hypertrophic scarring (n = 4), minimal paresis of the marginal mandibular branch of the facial nerve (n = 1) and limited external auditory canal stenosis (n = 1). One patient experienced a recurrence at the level of the external auditory canal, that required minor revision surgery. The average patient satisfaction score was 13.64 out of 15. Thorough clinical examination, awareness of the different entities and awareness of expert head and neck radiological advice are crucial for correct FBCA diagnosis and typing, determining the correct surgical approach. It is crucial that patients diagnosed with FBCA undergo surgery in specialized centers. Despite the challenging surgery and its potential complications, the overall patient satisfaction remains high post- treatment.

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.

Direct Neck Skin Excision for Correction of Aging Signs Confined to Skin Laxity and Sagging Skin in the Neck: A Local Anesthesia-Based Day Surgery Optimal for Younger Women.

The removal of excessive neck skin is considered the key parameter in the best postoperative outcome after a neck rejuvenation surgery. To evaluate the utility of a local anesthesia-based direct neck skin excision surgery in patients with skin laxity and sagging skin in the neck in terms of postoperative aesthetic outcome and patient satisfaction within a 12-month follow-up period. A total of 47 female patients who underwent local anesthesia-based direct neck skin excision surgery for the rejuvenation of skin laxity and sagging skin in the cervical neck were included. Data on complications and patient-reported outcomes were recorded at the 12th month postoperatively. Postoperatively, none of the patients developed suture breakage or loosening, infection, or bleeding, while ecchymosis (21.3%) and hypertrophic scar (17.0%) were manageable. At the 12th postoperative month, 93.6% of patients reported improved appearance and high satisfaction with the postoperative outcome in terms of a sustained tighter appearance in the neck. The local anesthesia-based direct neck skin excision surgery in patients with skin laxity and sagging skin in the neck enables achievement and maintenance of a tighter appearance in the neck, with minor and manageable complications and high patient satisfaction.

P-393. Examining Breast Surgical Site Infections: A Case-Control Study on the Effect of Skin Antisepsis Agents and Other Contributing Factors

Abstract Background Postoperative surgical site infections (SSI) in breast mastectomy and reconstruction cases persist despite efforts to control extrinsic factors. SSI may lead to prolonged hospitalization, increased costs of patient and hospital, and patient hardship. Current skin antisepsis practices warrant strict observation, application, and exploration of efficacy, as Gram-positive microorganisms are most commonly associated with breast surgery. The use of an alcohol-based skin preparation has proven to be more effective than those that are aqueous-based, We evaluated potential patient and procedure risk factors for SSI, including the perioperative skin prep used in breast mastectomy, breast plastic reconstructive, and combination breast and plastic cases. Methods A case-control study of breast procedures was performed. Procedures were identified between January 1, 2022 and December 31, 2023 from two campuses in the same health system. Procedures were divided into three case types: breast-only, plastics-only, and combination of breast and plastics. In addition to skin prep solution, factors assessed for SSI risk were: age, in-patients, out-patients, body mass index, diabetes mellitus, duration of procedure, wound class, and ASA. Results 45 SSI cases were identified, and 92 controls were randomly selected. Factors associated with SSI included duration of case, BMI, case type, inpatient procedure, emergent procedure, and wound class. Most SSIs were superficial with Staphylococci the most common organism isolated. Iodophor paint and/or scrub were used in the majority of cases and controls; Chloraprep was used in 0 SSI cases and 3 controls. Conclusion Attention should be focused on the prevention of SSI due to its serious nature. Multiple factors can contribute to the development of SSI and its prevention. The incidence of SSI was higher in patients who underwent either plastics-only or a combination breast/plastics procedures; iodophor skin prep may also be an area of concern. Next steps include implementing a trial of Chloraprep skin prep for all breast procedures, continuing to evaluate other known risk factors, and investigating other potential opportunities, including postoperative patient management. Disclosures All Authors: No reported disclosures

The effectiveness of nurse-led visual rehabilitation on visual outcome among post-operative patients of sellar/suprasellar tumours-protocol of a randomized controlled trial

Background: Tumour or mass of the suprasellar region are common pathologies and are also important due to their adjacency to the vital anterior visual apparatus. They may cause serious ocular signs and symptoms in addition to neurological complications resulting from increased intracranial pressure, cranial nerve impairment, or brain compression. Increased ICP may lead to headache, double vision and loss of peripheral vision, can lead to sinus pain or ear pain, drooping eyelid and seizures. After surgery, patients may continue to experience neuropsychological symptoms, physical symptoms and develop complications. Methods: Randomized controlled trial. A computer random table with allocation concealment will be used to recruit and assign patients with visual complaints resulting from sellar/suprasellar tumors operated on at PGIMER to the experimental and control groups. Enrolment will be done on 5th to 7th day of surgery and intervention will be provided on the same day until discharge and booklet with nurse-led visual rehabilitation will be provided for continuous practice at home. The post-op follow-up will be done at 1 month and 3rd month of surgery. Conclusions: This aim of the study is to determine the effectiveness of “nurse-led visual rehabilitation” on visual outcome among post-op patient with sellar/suprasellar tumours at 1 month and 3 months. The comprehensive nurse-led visual rehabilitation will be designed with the inputs from all nursing and clinical specialist in neurosurgery and ophthalmology, has the ability to work well with the dynamic care of postoperative patients experiencing visual problems from suprasellar and sellar tumors. CTRI registration number: CTRI/2023/08/056030 ON 2/8/23

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.

Evaluation of surgical strategy for low anterior resection syndrome using preoperative low anterior resection syndrome score in China.

Despite improved survival rates in rectal cancer treatment, many patients experience low anterior resection syndrome (LARS). The preoperative LARS score (POLARS) aims to address the limitations of LARS assessment by predicting outcomes preoperatively to enhance surgical planning. To investigate the predictive accuracy of POLARS in assessing the occurrence of LARS. This study enrolled a total of 335 patients who underwent laparoscopic or robotic low anal sphincter-preserving surgery for rectal tumors. Patients were categorized into three groups according to their POLARS score: no LARS (score 0-20), minor LARS (score 21-29), and major LARS (score 30-42). The QLQ-C30/CR29 scores were compared among these groups, and the agreement between POLARS predictions and the actual LARS scores was analyzed. The study population was divided into three groups: major LARS (n = 51, 27.42%), minor LARS (n = 109, 58.6%), and no LARS (n = 26, 13.98%). Significant differences in the QLQ-C30 scales of social function, diarrhea, and financial impact were detected between the no LARS and major LARS groups (P < 0.05) and between the minor LARS and major LARS groups (P < 0.05). Similarly, significant differences were detected in the QLQ-CR29 scales for blood and mucus in the stool, fecal incontinence, and stool frequency between the no LARS and minor LARS groups (P < 0.05), as well as between the minor LARS and major LARS groups (P < 0.05). The predictive precision for major LARS using the POLARS score was 82.35% (42/51), with a recall of 35.89% (42/117). The mean absolute error (MAE) between the POLARS score and the actual LARS score was 8.92 ± 5.47. In contrast, the XGBoost (extreme gradient boosting) model achieved a lower MAE of 6.29 ± 4.77, with a precision of 84.39% and a recall of 74.05% for predicting major LARS. The POLARS score demonstrated effectiveness and precision in predicting major LARS, thereby providing valuable insights into postoperative symptoms and patient quality of life. However, the XGBoost model exhibited superior performance with a lower MAE and higher recall for predicting major LARS compared to the POLARS model.

Preoperative risk assessment scores for Difficult Laparoscopic cholecystectomy-do we need them in Pakistan?

In recent literature, a Spanish study defines ‘difficult’ laparoscopic cholecystectomy (DLC) as the presence of at least one of the following conditions in an intraoperative setting: bile duct injury, Mirizzi syndrome, Calot triangle inflammation, conversion to laparotomy, and pericholecystic abscess.1 The standardisation of a criteria is important to provide scores that could predict difficulty preoperatively and have lasting implications on surgical safety and postoperative patient recovery. The 2020 World Society of Emergency Surgery (WSES) guidelines for the management of bile duct injury during cholecystectomy recommend a thorough preoperative work-up to detect at-risk patients, signifying the need for a preoperative assessment scale.2 Clinically, there are numerous predictive assessment scores in practice globally, each specific to a certain demographic, unique in limitations and employing diverse clinical, laboratory and radiological parameters. Currently, use of predictive assessment scores for DLC is not a common practice in Pakistan, however, studies have determined advanced age, obesity, previous abdominal surgery, deranged alkaline phosphatase (ALP) and multiple stones, as potential risk factors in our population. A value of C reactive protein(CRP) greater than 11 mg/dl was identified as having good sensitivity and specificity for predicting DLC in Pakistan.3 Concurrently, male gender was concluded to be an independent risk factor for DLC (P = 0.041) on account of more adhesions and inflammation.4 This data offers unique insight into our population, and can become grounds for establishing a novel standard predictive score for clinical use in Pakistan. A score by Randhawa et al could be our foundation due to similar demographics and identified potential risk factors of our population could be incorporated in a new scoring method.5 In a developing country like Pakistan, a standard score for this relatively common surgical procedure could prove pivotal in resource management. Better selection of out-patient procedures and targeted surgical planning can save money, manpower and equipment. This approach will allow better preoperative counselling regarding prognosis and aid in undertaking informed consent. Identification and hands-on training of low risk procedures could be pivotal for our residency training programs. Further randomised prospective studies with large sample size are required to determine an efficient scoring system for the Pakistani population. However, any study which attempts to do so should keep in mind the limited resources in various hospitals across pakistan. A generalised scale that relies more on clinical parameters and accessible lab markers and less on expensive radiology and high expertise should be preferred.

High Modified 5 Factor Frailty Index is Associated With Worse PROMs and Decreased Return to Activities After 1 or 2 Level MI-TLIF.

Retrospective cohort study. Frailty is defined as a state of minimal "physiologic reserve." The modified 5 factor frailty index (mFI-5) is a recently proposed metric for assessing frailty and has been previously studied as a predictor of morbidity and mortality. However, its utility in predicting postoperative patient reported outcomes (PROMs) and return to activities remains understudied. This is a retrospective cohort study of patients undergoing 1 or 2 level minimally invasive transforaminal lumbar interbody fusion queried from a prospectively maintained multi-surgeon registry. Comorbidities including hypertension, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and functional status were utilized to calculate the mFI-5. Patients were separated into 3 cohorts, "non-frail," "moderately frail" or "severely frail" based on their mFI-5. Patient outcomes were compared between the cohorts. 392 patients were included of which 227 patients were non-frail, 134 were moderately frail, and 31 were severely frail. Frail patients had longer operative time (P = 0.002), greater estimated blood loss (P = 0.038). Despite similar preoperative PROMs, at a longer term follow up, frail patients also had worse PROM scores for ODI (P = 0.009), VAS-back (P = 0.028), and VAS-leg (P = 0.004). Frail patients had worse preoperative (P = 0.017) and postoperative (P < 0.001) SF-12 PCS. At 1-year, frail patients had lower rates of fusion (P = 0.002). Frail patients also demonstrated lower rates of returning to work (P = 0.018), returning to driving (P = 0.027), and discontinuation of narcotics (P = 0.004). Frail patients as measured by the mFI-5 index demonstrated worse postoperative outcomes following 1 or 2 level MI-TLIF. Careful patient selection and preoperative optimization may be especially important in frail patients.

Chest wall perforator flap reconstruction in breast conserving surgery: quality of life and limited complications in outpatient treatment

BackgroundBreast conserving surgery (BCS) with partial breast reconstruction (PBR) results in less morbidity, better cosmetic outcomes, and improved patient satisfaction compared to mastectomy. Perforator flap reconstruction can attenuate defects prone to breast deformity after BCS. Usually, postoperative drains and inpatient admission are part of this treatment. The main objective of this study is to report on postoperative complications and patient satisfaction after drainless perforator flap reconstruction by a dedicated breast surgeon.MethodsIn a retrospective case series, 42 patients were included. All patients underwent BCS with drainless perforator flap reconstruction, planned and performed by a single breast surgeon. Outcomes were complication incidence and patient satisfaction reported in the Breast-Q Breast Conserving Therapy (BCT) module.ResultsIn the study cohort, the median age was 59.5 (49.8–71.3) years. Tumour types were ductal carcinoma in situ (DCIS, four patients, 9.5%), invasive no special type (NST, 22 patients, 52.4%), invasive lobular (12 patients, 28.6%), and other invasive cancers (4 patients, 9.5%). Complication incidence was seven of 42 patients (16.7%), including hematoma, seroma, wound dehiscence, fat necrosis, and lymphedema, all Clavien Dindo grade 0–1, without readmission or reoperation. Reported Breast-Q scores (median of 17 months after surgery) were 87/100 for psychosocial well-being, 82/100 for breast satisfaction, and 71/100 for physical well-being. Outpatient treatment was successful in 38 patients (90.5%), and 13 patients (31.0%) had an unplanned visit to the outpatient clinic.ConclusionDrainless perforator flap reconstruction performed by the breast surgeon results in high patient satisfaction and limited complications, both in number and severity. The use of drains and hospital stays after perforator flap reconstruction must be discouraged.

Outcomes of a Post-Surgical Follow-Up ProgramME Using Telemedicine in a General and Digestive Surgery Service

Abstract Introduction The digital revolution has significantly transformed healthcare, particularly in the adoption of telemedicine. This study aims to evaluate the initial postoperative progress, patient experience, and outcomes perceived by individuals who underwent surgery in the General and Digestive Surgery services at our hospital. Methods Our hospital employs a fully integrated electronic health record (EHR) system, which includes the mobile application Patient Portal. This platform allows patients to access their complete medical history, schedule consultations, engage in web-based communication, participate in video calls, and interact with a Chatbot, enabling a robust bidirectional communication system. Following discharge, patients received standardized postoperative follow-up forms through the Patient Portal. These forms, which allowed patients to attach multimedia files, were designed to monitor their recovery and progress. Physicians subsequently reviewed the completed forms to assess each patient’s condition. Results Between January 2020 and April 2024, 19,944 telemedicine-based follow-ups were conducted within the Surgery department. These included initial postoperative reviews, long-term follow-ups, pathology monitoring, and test result discussions. All patients reported being satisfied or very satisfied with the care provided via this system. Conclusion Telemedicine can enhance access to postoperative care, offering a safe and efficient follow-up approach without compromising the quality of care perceived by patients or surgeons.

Novel technique and outcomes of umbilical reconstruction during cytoreductive surgery; a multi-centre study

BackgroundThe goal of cytoreductive surgery for peritoneal malignancy is to remove all macroscopic disease, which occasionally requires the excision of the umbilicus. While the absence of the umbilicus can be aesthetically undesirable for patients, umbilical reconstruction is rarely performed due to the perceived complexity and increased risk of wound infections (Sakata et al. in Colorectal Dis 23:1153–1157, 2021). This study aims to evaluate the outcomes, cosmetic results and patient satisfaction of umbilical reconstruction during cytoreductive surgery.MethodsConsecutive patients from a prospectively maintained database who underwent cytoreductive surgery with umbilical excision and reconstruction were evaluated. Our technique for umbilical reconstruction involved recreating the subcutaneous fat space and fashioning umbilical skin flaps that anchor to the anterior fascia. Outcomes assessed included post-operative infection rate, wound dehiscence, seroma formation, wound appearance and patient satisfaction.ResultsUmbilical reconstruction was performed on 50 patients, with 12 (24%) experiencing wound-related complications. Of these, eight patients (16%) had superficial wound infections, while one patient (2%) developed a deep wound infection; three patients (6%) required local wound drainage, though none needed surgical revision. There were no reports of wound seromas, skin necrosis, wound widening nor umbilical stenosis. All patients reported satisfaction with the outcome of their reconstruction.ConclusionsOur novel technique for umbilical reconstruction during cytoreductive surgery did not negatively impact wound healing outcomes. Recreating the umbilicus improved cosmetic results and patient satisfaction, enhancing body image for those undergoing major abdominal surgery. This approach should be considered for patients undergoing major laparotomies that necessitates umbilical excision.