Postoperative Outcomes Research Articles

The Effects of Systemic Tranexamic Acid Administration on Drainage Volume, Duration of Drain Placement, and Length of Hospital Stay in Skin- and Nipple-Sparing Mastectomies with Immediate Expander-Based Breast Reconstruction

Background: Skin- (SSM) and nipple-sparing (NSM) mastectomies are frequently performed surgeries with a considerable risk for post-operative hematoma or seroma. Tranexamic acid (TXA) is a potent antifibrinolytic drug commonly used in many surgical fields but rather novel in plastic and, specifically, breast surgery. This study investigates the influence of TXA in patients undergoing SSM or NSM with expander-based reconstruction (EbR) on post-operative outcomes. Methodology: A retrospective study was conducted on 132 patients undergoing uni- or bilateral SSM or NSM with EbR between May 2015 and March 2022. Patients receiving systemic TXA treatment for 48 h following a standardized protocol were compared to those who received no treatment. Multivariable linear regression was performed to identify influencing factors and quantify their effect on drainage volume, duration of drain placement, length of hospital stay, post-operative bleeding, and seroma formation. Results: The 132 patients underwent a total of 155 mastectomies (72 in the TXA group, 83 in the control group). TXA significantly reduced drainage volume (−22.3 mL, p = 0.011). Duration of drain placement and length of hospital stay were significantly shorter in the TXA group (p < 0.001 and p = 0.001). No significant side effects were reported. Conclusion: TXA is a safe drug if administered respecting the well-defined contraindications. Systemic TXA administration significantly reduces drainage volume in patients undergoing SSM or NSM and should encourage surgeons to reconsider using drains in post-operative protocols. Duration of drain placement and length of hospital stay were significantly reduced in the TXA group but other factors like resection weight might have a more substantial impact.

Rouviere’s Sulcus: Frequency and Types among Patients presented to Wad Madani Teaching Hospital for Laparoscopic Cholecystectomy; Gezira State; Sudan

Scientific background: Laparoscopic cholecystectomy is the gold standard for surgical treatment of gallstones disease. Method: The study aimed to determine presence and types of Rouviere’s sulcus along with its association with gender, and postoperative morbidity among Sudanese patients presented for laparoscopic cholecystectomy, and operated on at Wad Madani Teaching Hospital, Gezira State, Sudan; during the period from November 2022 to November 2023. It was a comparative cross-sectional study. Study population were patients of more than 18 years old; where total coverage of them (150) was done. Data was collected from files and records of patients presented there during study period. Master sheet was used for data collection. SPSS version 25.0 was used for analysis. P-value ≤ 0.05 was considered significant. Results: Age of participants ranged from 17 to 85 years, with a mean age of 47.57 (SD ± 15.14). Majority of them were female (93.3%). Gallstones were present in 99.3%. Rouviere’s sulcus was identified intraoperatively among 92.7%. Identified sulcus type was: Open sulcus (54.0%), Close sulcus (27.3%), and Scar sulcus (11.3%). Postoperative operative outcomes: 95.3% experienced uneventful outcomes; and 4.7% experienced complications. Both postoperative complications and gender, had no statistical associations with the presence of Rouviere’s sulcus; P-value = 0.470, and 0.112 respectively. Also, there was no significant statistical association between gender and sulcus type (P-value 0.301). Conclusion and recommendations: No significant statistical association between both postoperative complications and gender with the presence of Rouviere’s sulcus, or between gender and sulcus type; was identified. Further study was highly recommended.

Multimodal corneal imaging before refractive cataract surgery.

To prospectively review the advances in diagnostics for refractive cataract surgery, focusing on multimodal corneal analysis. The article explores the considerations related to planning refractive cataract surgery, emphasizing its potential to enhance patients' vision performance and quality of life. This review explores preoperative analysis in cataract surgery, focusing on assessing the cornea and ocular surface using multimodal diagnostics, including Placido disk-based corneal topography, Scheimpflug tomography OCT (optical coherence tomography), and biomechanical assessment. Wavefront technology, gene therapy, and artificial intelligence are also relevant in enhancing surgical precision and outcomes. It highlights the importance of preoperative thorough evaluations and technological advancements in ophthalmology. The rapid evolution and advancement of technology enable excellent refractive outcomes in most cases following cataract surgery. Consideration of appropriate preoperative factors is essential for achieving the desired postoperative outcome.

Are tinnitus burden and tinnitus exacerbation after cochlear implantation influenced by insertion technique, array dislocation, and intracochlear trauma?

IntroductionAlthough numerous studies suggest that cochlear implantation (CI) generally alleviates the overall burden of tinnitus, certain patients experience tinnitus exacerbation following CI. The exact cause of this exacerbation is still uncertain. This prospective study aimed to investigate whether cochlear trauma, resulting from scalar dislocation of the electrode array, affected postoperative tinnitus intensity, tinnitus burden, and speech perception. Additionally, the influence of CI insertion technique, insertion depth, insertion angle, and cochlear morphology on postoperative tinnitus was assessed.MethodsWe evaluated 66 CI recipients preoperatively at 2 days, 4 weeks, and 12- and 24-months following surgery. Digital volume tomography was employed to document scalar position, insertion depth, and cochlear morphology postoperatively. Speech perception was analyzed using Freiburg monosyllables. The tinnitus burden was evaluated using the tinnitus questionnaire, while the tinnitus intensity was quantified using a visual analog scale.ResultsStudy results pertaining to tinnitus intensity and burden did not reveal a significant difference in elevation regarding scalar position and dislocation after CI surgery compared to preoperative tinnitus levels. However, dislocation was only identified in four patients, and scala vestibuli insertions were observed in two patients. Comparing preoperative and 1-year postoperative outcomes, CI was noted to substantially reduce the tinnitus burden. When the speech processor was worn, the tinnitus intensity was significantly diminished. In comparison to round window (RW) insertion, the insertion technique cochleostomy (CS) did not exhibit a significant difference or a trend toward increased tinnitus intensity.ConclusionThis study demonstrates that CI significantly decreases the tinnitus burden. The observation implies that the electrical stimulation of the auditory pathway, facilitated by wearing the speech processor, significantly reduced the tinnitus intensity. The incidence of dislocations and scala vestibuli insertions has declined to the extent that it is no longer feasible to formulate statistically significant conclusions.

Diagnosis of Respiratory Sarcopenia for Stratifying Postoperative Risk in Non–Small Cell Lung Cancer

Physical biomarkers for stratifying patients with lung cancer into subtypes suggestive of outcomes are underexplored. To investigate the clinical utility of respiratory sarcopenia for optimizing postoperative risk stratification in patients with non-small cell lung cancer (NSCLC). This retrospective cohort study reviewed consecutive patients undergoing lobectomy and mediastinal lymph node dissection for NSCLC at 2 institutions in Tokyo, Japan, between 2009 and 2018. Eligible patients underwent electronic computed tomography image analysis. Follow-up began at the date of surgery and continued until death, the last contact, or March 2022. Data analysis was performed from April 2022 to March 2023. Respiratory sarcopenia was identified by poor respiratory strength (peak expiratory flow rate) and was confirmed by a low pectoralis muscle index (PMI; pectoralis muscle area/body mass index). Patients with poor peak expiratory flow rate but normal PMI received a diagnosis of pre-respiratory sarcopenia. Short-term and long-term postoperative outcomes were compared among patients with a normal status, pre-respiratory sarcopenia, and respiratory sarcopenia. Group differences were analyzed using the Kruskal-Wallis test and Pearson χ2 test for continuous and categorical data, respectively. Survival differences were compared using the log-rank test. Univariable and multivariable analyses were conducted using the Cox proportional hazards model. Of a total of 1016 patients, 806 (497 men [61.7%]; median [IQR] age, 69 [64-76] years) were eligible for electronic computed tomography image analysis. The median (IQR) duration of follow-up for survival was 5.2 (3.6-6.4) years. Respiratory strength was more closely correlated with PMI than pectoralis muscle radiodensity (Pearson r2, 0.58 vs 0.29). Respiratory strength and PMI declined with aging simultaneously (both P for trend < .001). Pre-respiratory sarcopenia was present in 177 patients (22.0%), and respiratory sarcopenia was present in 130 patients (16.1%). The risk of postoperative complications escalated from 82 patients (16.4%) with normal status to 39 patients (22.0%) with pre-respiratory sarcopenia to 39 patients (30.0%) with respiratory sarcopenia (P for trend < .001), as did the risk of delayed recovery after surgery (P for trend < .001). Compared with patients with normal status or pre-respiratory sarcopenia, patients with respiratory sarcopenia exhibited worse 5-year overall survival (438 patients [87.2%] vs 133 patients [72.9%] vs 85 patients [62.5%]; P for trend < .001). Multivariable analysis identified respiratory sarcopenia as a factor independently associated with increased risk of mortality (hazard ratio, 1.83; 95% CI, 1.15-2.89; P = .01) after adjustment for sex, age, smoking status, performance status, chronic heart disease, forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, C-reactive protein, albumin, carcinoembryonic antigen, histology, and pathologic stage. This study identified individuals at higher risk of poor outcomes by screening and staging respiratory sarcopenia. The early diagnosis of respiratory sarcopenia could optimize management strategies and facilitate longitudinal care in patients with NSCLC.

Predictors for 1-year mortality in geriatric patients following fragile intertrochanteric fracture surgery

ObjectiveTo investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.MethodsThe medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan–Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.ResultsThe mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.ConclusionsPreoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are elderly, male, have dementia, have comorbidities, or are malnourished. Prompt nutritional reinforcement should be provided to patients with intertrochanteric fractures with comorbid hypoproteinemia and underweight. Furthermore, surgery should be performed as early as possible in patients with fewer comorbidities.

Oncological and Surgical Outcomes of Oncoplastic Reduction Mammoplasty: A Single-centre Retrospective Study.

Breast-conserving surgery is the preferred treatment for early-stage breast cancer but can often result in unsatisfactory cosmetic outcomes. Oncoplastic surgery aims to improve both oncologic and aesthetic outcomes by combining local excision with plastic surgery techniques. Using breast reduction techniques in breast cancer treatment has been shown to allow for wider margins of excision, leading to enhanced oncological safety and reduced recurrence rates without causing significant asymmetry. This study aimed to analyze the surgical and oncological outcomes of a large cohort of patients undergoing oncoplastic reduction mammoplasty (ORM). A retrospective analysis of postoperative surgical and oncological outcomes of all patients who underwent ORM at a single center between January 2018 and December 2023 was performed. Preoperative patient characteristics, operative and post-operative outcomes were recorded and analyzed. A total of 67 patients that underwent oncologic breast reduction were included in the final analysis - representing a total of 71 ORM, with a mean (SD) age of 53.1 (10.5) years and a mean (SD) BMI of 28.8 (5.9) kg/m2 A superomedial pedicle-based technique was the most frequently used (36.6%), followed by inferior pedicle-based technique (28.1%). A complication rate of 18.3% on the ipsilateral side was observed. Salvage surgery was necessary in five cases (7.0%) due to positive margins - with one patient (1.4%) requiring margin expansion surgery and four (5.6%) a completion mastectomy. This monocentric retrospective study shows that ORM is safe, with a complication rate on par with conventional breast reduction and offers satisfactory oncological outcomes.

Assessing the Effectiveness of a Short Form Screening Tool (COPs) for Body Dysmorphic Disorder in Cosmetic Surgery Patients: A Study of Pre- and Post-Operative Outcomes.

Recent regulatory changes in Australian cosmetic surgery necessitate preoperative screening for body dysmorphic disorder (BDD). This study, which focuses on patient outcomes, evaluates the COPs tool's efficacy and examines its implications on patients undergoing cosmetic procedures. A total of 189 patients were included: 78 underwent Medicare-classified "cosmetic" surgeries, and 111 underwent "medically necessary" procedures. Patients completed the COPs assessment pre- and post-operatively, with a score >40 indicating BDD susceptibility. Results show no significant pre- to post-operative change in COPs scores across different surgical procedures (body, breast, facial, and mixed) in both "cosmetic" (p = 0.2-0.4) and "itemised" groups (p = 0.15-0.33). However, overall, there was a marked reduction in COPs scores post-operatively (p < 0.001), indicating improved self-perception. Specifically, 91% of patients initially BDD-prone showed scores < 40 post-operatively. Conversely, 3.8% of initially low-scoring patients developed BDD-prone scores post-operatively. Comparison between cosmetic and itemised groups revealed higher preoperative COPs scores in the itemised group (p = 0.006), though post-operative scores did not differ significantly (p = 0.33). Incidences of post-operative BDD-prone scores or scores < 40 did not differ between groups (p = 0.61). Complication rates and the need for revision surgery were similar between groups. These findings suggest two plausible interpretations: First, preoperative screening with the COPs tool may positively influence self-perception related to BDD among cosmetic surgery patients, potentially serving as a therapeutic adjunct for those at risk. Second, while screening tools are beneficial, they may have limitations in predicting post-operative outcomes related to BDD development. Further research should explore these dynamics to refine screening practices and optimise patient outcomes in cosmetic surgery contexts. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dermoid Cysts of the Auricle: A Review of the Literature.

Dermoid cysts are congenital anomalies that contain ectodermal elements such as teeth, bone, and nerves. The purpose of this study was to identify trends in the characteristics of dermoid cysts of the auricle and the demographics of the patient population they affect. A PubMed and EMBASE search for English-language publications that included cases of dermoid cyst(s) of the auricle from database inception to October 2022 was performed. A total of 38 cases of dermoid cysts of the auricle were identified from 20 publications. The age, sex, and Fitzpatrick skin type of the patients, locations of the dermoid cysts, associated anomalies, treatment methods, and postoperative outcomes were examined. Patients' ages ranged from 0 to 63 years, with 27.6% (8/29) in the 0-17 age range. 56.8% (21/37) were reported as male. Dermoid cysts were frequently present on the postauricular surface (18/24, 75.0%) and on light skin (Fitzpatrick types I-III; 18/22, 81.8%). Unilateral dermoid cysts were more commonly reported on the right ear (17/22, 77.3%); only one patient had bilateral cysts. Associated anomalies included microtia, prominent ears, foot polysyndactyly, hemifacial microsomia, and cryptotia. All auricular dermoid cysts were managed with complete surgical excision, and no postoperative complications or recurrences were reported. Dermoid cysts of the auricle are reported more frequently in individuals with lighter skin; however, this is likely due to reporting bias. Complete surgical excision can be used to treat patients successfully, with a very low risk of complications and no need for preoperative imaging.

The efficacy of partial versus total splenectomy in the treatment of hereditary spherocytosis in children: a systematic review and meta-analysis.

To explore the comparative postoperative efficacy of partial splenectomy (PS) and total splenectomy (TS) in the treatment of children with hereditary spherocytosis (HS). The relevant HS studies from databases were searched and screened, comparing the differences in hemoglobin concentration, reticulocyte percentage, bilirubin concentration before and after TS and PS surgery, and during the follow-up period, as well as the incidence of postoperative adverse events. Statistical analysis was performed using Review Manager 5.4. A total of 5 studies were included in this meta-analysis, with a cumulative enrollment of 312 children, 130 in the PS group and 182 in the TS group. The meta-analysis results showed that both PS and TS groups had statistically significant differences in postoperative hematological outcomes compared to before surgery, with TS showing better improvement than PS. In the postoperative follow-up, the changes in hematological outcomes between PS and TS were statistically significant for hemoglobin concentration: within 1year [MD = 1.85, 95%CI(1.09,2.60)], 1-2years [MD = 1.74, 95%CI(0.25,3.24)], not statistically significant for 4-6years [MD = 1.28, 95%CI(-1.75,4.32)]; for reticulocyte percentage: within 1year [MD = 2.23, 95%CI(0.80,3.66)] was statistically significant, not statistically significant for 4-6years [MD = 1.77, 95%CI(-2.04,5.59)]; for serum bilirubin concentration: within 1year [MD = 1.55, 95%CI(0.91,2.18)] was statistically significant, not statistically significant for 1-2years [MD = 1.77, 95%CI(-2.04,5.99)]. In the incidence of postoperative adverse events, the incidence of cholelithiasis [MD = 1.77, 95%CI(-2.04,5.99)] showed a statistically significant difference between PS and TS, while there were no statistically significant differences in other included events, such as postoperative infection rate, secondary surgery rate, thrombosis rate, postoperative hemorrhage rate, and transfusion therapy rate. Splenectomy is a beneficial surgical strategy for children with moderate-to-severe HS, reducing; early hematological outcomes of TS are more robust than PS in the follow-up period, and there is no difference between the two in the later period; for postoperative adverse events, the incidence of cholelithiasis in children after PS is higher than after TS, and there is a risk of requiring a second surgery for total splenectomy due to hemolytic recurrences.

Effect of periarticular cocktail of analgesia on immediate post-operative clinical outcomes after bilateral simultaneous total knee arthroplasty: a randomized placebo controlled, split-body superiority trial

IntroductionTotal knee arthroplasty is the commonest procedure being done for Osteoarthritis of knee in current practice. In spite of its success many patients suffer from post-operative pain especially in the early post-operative period. The study aimed to evaluate the pain relief and functional benefit of periarticular cocktail infiltration. MethodologySixty-four patients undergoing simultaneous bilateral total knee were randomised to receive peri-articular cocktail injection in one knee and a similar amount of normal saline in contralateral knee. Cocktail consisted of ketorolac, ropivacaine and epinephrine. Patients’ visual analog pain score (VAS), knee range of motion, quadriceps strength, single step test (SST) were recorded post-operatively. ResultsThe cocktail infiltrated knee had significantly lesser pain scores during the first 48 h. Intervened knee achieved better knee range of motion at 72 h and 14 days post-surgery. Quadriceps power and SST had better results in cocktail injected knees at 72 h, but no significant difference was detected at 14-day follow-up. ConclusionUse of peri-articular cocktail injection is an effective modality to achieve better pain relief in early post-operative period. Though the benefits are not long lived, but its superior effects can be utilised for early functional recovery after TKA and improved patient rehabilitation. Level of evidenceI, Randomized Controlled Trial.

Open Reduction and Internal Fixation Is a Feasible Alternative to Femoral Revision Arthroplasty in Geriatric Patients with Vancouver B2/3 Type Periprosthetic Fractures: A Study Analyzing In-Hospital Outcomes

Purpose: The surgical management of periprosthetic femoral fractures is particularly challenging in geriatric patients due to physiological limitations. The choice between open reduction and internal fixation (ORIF) and hip revision arthroplasty for treating Vancouver B2 and B3 fractures remains controversial. This study aims to contribute further evidence by analyzing the in-hospital outcomes in geriatric patients with Vancouver B2/3 fractures. Methods: This retrospective study analyzed 133 patients treated for Vancouver B2/3 fractures at a level I trauma center from 2017 to 2023. Data were collected on preclinical characteristics, comorbidities, Vancouver classification, surgery-related parameters, and postoperative outcomes for an age- and gender-matched analysis. A subgroup analysis was also conducted on patients classified as American Society of Anesthesiologists (ASA) class 3 and 4. Results: Among the 133 patients, 85 suffered Vancouver B2 fractures and 48 Vancouver B3 fractures. Age-and-gender-matched analysis revealed that ORIF was more commonly performed in patients with higher ASA grades. A subgroup analysis of ASA 3 and 4 patients and an age-and-gender-matched analysis showed that ORIF resulted in shorter operation times and less blood loss. No significant differences were found in mortality or complication rates. Conclusions: ORIF is associated with shorter operation times, less bleeding, and comparable in-hospital outcomes in treating Vancouver B2/3 fractures in higher-risk geriatric patients compared to revision arthroplasty. The retrospective design and small sample size in the ORIF group are limitations of the study. Further studies with functional evaluation are still required.

Robotic Single Anastomosis Duodenal-ileal Bypass With Sleeve Gastrectomy (SADI-S) for Morbid Obesity: A Systematic Review.

The global obesity epidemic has seen a dramatic increase in prevalence since 1975, posing significant health and economic challenges worldwide. Robotic-assisted single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising surgical intervention for morbid obesity, offering potential advantages over traditional laparoscopic approaches in terms of precision, safety, and recovery outcomes. This study aimed to evaluate the efficacy and safety of robotic-assisted SADI-S, focusing on perioperative and postoperative outcomes including intraoperative complications, operative time, conversion rates, mortality, length of hospital stay, weight loss, and postoperative complications. A comprehensive literature search was conducted on PubMed, Scopus, and Cochrane Library, adhering to inclusion and exclusion criteria focused on obese adult humans undergoing robotic SADI-S. Seven studies, published between 2015 and 2024, involving 204 patients, were ultimately included for analysis. The analysis revealed a low rate of intraoperative complications (0.49%), no mortality, and varied operative times (138 to 205.7 min). The median hospital stay ranged from 2 to 6.7 days, with minimal readmission rates. Postoperative complications occurred in 6.37% of patients, but no late complications (>30 days) were reported. Notably, significant weight loss outcomes were documented, with mean excess weight loss (EWL) up to 113.74% at 24 months follow-up. Robotic-assisted SADI-S demonstrates a favourable safety profile with promising weight loss outcomes, highlighting its potential as a primary or revisional treatment for morbid obesity. Further research, including randomized controlled trials, is needed to establish its long-term efficacy and cost-effectiveness compared to traditional laparoscopic methods.

Usefulness of lateral-anteroposterior dimeter ratio in patients with tracheomalacia associated with esophageal atresia.

Tracheomalacia (TM) is commonly associated with esophageal atresia (EA) and compression by the brachiocephalic artery is a factor for TM. Previous research has focused on the lateral-to-anteroposterior tracheal diameter ratio (LAR). This study aimed to assess the LAR and postoperative outcomes of EA patients. Patients undergoing thoracoscopic repair for EA between March 2020 and October 2023 were enrolled. Posterior tracheopexy (PT) was performed during thoracoscopic repair of EA on patients with bronchoscopy-confirmed TM; clinical courses and LAR were retrospectively analyzed. Overall, 18 patients were enrolled; 14 patients underwent PT. Their median preoperative and postoperative LARs were 2.26 and 1.50, respectively; this difference was statistically significant. Four patients without TM did not undergo PT and their median LAR was 1.59. Median LAR for patients without PT was lower than that of preoperative patients with PT and no statistical differences were observed from that of postoperative patients with PT. The patients whose LAR improved with PT did not require further surgical intervention for TM. One patient who had a postoperative LAR of 2.25 required external tracheal stenting. LAR is a useful index for determining the severity of TM associated with EA. LAR can reflects the efficacy of PT.

Postoperative outcome of special primary aldosteronism undergoing surgery based on adrenal vein sampling results

To further demonstrate the gold standard role of adrenal vein sampling (AVS) in the subtyping diagnosis of primary aldosteronism (PA). In this study, 9 patients with special PA, whose functional advantages indicated by AVS were contrary to the results of CT examination, were selected. Laparoscopic adrenalectomy was performed based on AVS results, and the surgical outcome was followed up. Nine patients, aged[M(Q1, Q3)] 58.0 (52.0, 63.0) years, including 7 males and 2 females, were followed up for 12 (9, 12) months. CT revealed unilateral morphological abnormalities in 5 cases (the functional advantage side indicated by AVS was contrary to the results of CT examination), and bilateral abnormalities in 4 cases (AVS results confirmed unilateral abnormalities). During the follow-up, all 9 patients achieved complete biochemical remission, 4 patients achieved complete clinical remission, and 5 patients achieved partial clinical remission. The study indicates that compared with CT imaging, AVS has better accuracy in PA subtyping, and selecting surgical side based on AVS results is a reliable and effective strategy.

Supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) versus retrograde intrarenal surgery for large volume isolated upper calyceal stones: a prospective randomized analysis

To assess outcomes of supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) and retrograde intrarenal surgery (RIRS) in isolated large volume upper calyceal stones (UCS). This was a prospective randomized study including patients with isolated UCS > 20mm. The patients were randomized into two groups: group (P) (SUGA-PNL) and group (R) (RIRS). Patients’ demographics, stones characteristics, operative, and postoperative outcomes essentially the stone free rate (SFR) and complications rate were documented. The stone clearance was defined as no fragments or residual fragments less than 2mm in the one month non contrast CT scan follow up. Eighty-nine patients opted to undergo the procedure according to the preoperative randomization. Four patients, 2 patients from each group, lost to follow up and other 2 patients were excluded from group (R) due to a tight ureter. Both groups were comparable as regards the preoperative demographics and stone characteristics. There were statistically significant differences regarding total operative time, the change in hemoglobin level, and postoperative pain score (P: 0.024, 0.010 and 0.032 respectively). The SFR was 88.1% in group (P) compared to 73.2% in group (R) (P: 0.019). Moreover, it did not differ significantly between both groups regarding the intraoperative and postoperative complications. No visceral and thoracic injuries were documented in group (P). On other side, 6 patients (14.6%) from group (R) had different grades of ureteral injury during access sheath placement. SUGA-PNL is a safe and effective treatment modality for UCS > 20mm with a higher SFR than RIRS.

Impact of routine pre-operative risk assessment on patients undergoing emergency major abdominal surgery in a regional Victorian hospital.

Routine preoperative risk assessment (RPRA) using objective risk prediction tools may improve the perioperative outcomes of emergency major abdominal surgery (EMAS). This project aims to identify whether the introduction of RPRA with the 'National Emergency Laparotomy Audit (NELA) Calculator' as standard-of-care for EMAS at a regional Victorian hospital has improved postoperative outcomes, reduced unplanned postoperative critical care unit (CCU) admission rates, and impacted the 'no-lap' rate. An audit was performed including all adult general surgery patients who required EMAS at Bendigo Health between September 2017 and August 2022, including those palliated up-front. Patients requiring surgery for uncomplicated appendicitis, cholecystitis, trauma, and diagnostic laparoscopy were excluded. Patient demographics, preoperative NELA score, CCU admission data and postoperative outcomes were collected and compared between patients undergoing surgery before and after the introduction of RPRA. Six hundred and ninety-one patients were included in the analysis. Median NELA score was 5 (IQR 1.5-11.75). 2.60% of patients were palliated up-front and did not proceed to surgery. Among the 673 operative patients, 30-day mortality was 5.20%. Following the introduction of RPRA there was a significant reduction in the unplanned CCU admission rate, from 9.14% to 3.48% (P = 0.04). There was no change in postoperative mortality, severe complication rate or planned CCU admission rate. RPRA reduced rate of unplanned CCU admissions. Postoperative mortality and complication rates did not change following introduction of RPRA. RPRA appears useful in guidance of preoperative palliative decision-making, but further study is required to validate its use in this context.

Gender differences in long-term survival after coronary artery bypass surgery is womens cardiovascular health at risk?

Abstract Introduction Cardiovascular healthcare for women tends to be influenced by various factors. This patient group is generally associated with a worse prognosis following coronary artery bypass surgery (CABG). Aims To assess the impact of gender on long-term survival after CABG and the potential effect of age on this association; to compare the survival of these patients with the expected survival of the general national population, and to compare immediate postoperative outcomes between genders. Methods Longitudinal, retrospective, single center study, involving consecutive patients who underwent isolated primary CABG between 2004 and 2014. Exclusion criteria included emergency/salvage surgeries or the use of extracorporeal circulation without aortic clamping. Included patients were categorized into age subgroups: ≤60, 60-70, and ≥70 years. All-cause mortality was assessed in February 2023, and a time-to-event analysis was performed using Kaplan-Meier curves, Log-Rank tests, and multivariable Cox regressions. To compare expected mortality (matched for sex and age with the general population) with observed mortality in the patient cohort, survival tables for the years 2004-2022 were consulted. Kaplan-Meier curves for the reference population, stratified by gender, were constructed and compared to the surgical cohort using one-sample Log-Rank tests with specific software. Standardized mortality ratios (SMR) were estimated. The mean follow-up time was 11 years, with a maximum of 19 years. Results From 3978 patients included patient’s, 21% were women (W). W were older (mean age 67±9 vs. 63±10 years, p&amp;lt;0.001) and had a higher prevalence of cardiovascular risk factors and severe chronic kidney disease compared to men (M). M more frequently had peripheral arterial disease and smoking habits. Although three-vessel disease was similar between sexes (p=0.111), W were less frequently implanted with ≥3 grafts (p&amp;lt;0.001). At 5,10 and 15 years of follow-up, cumulative survival for MvsW was 89%vs88%, 73%vs68%, and 57%vs46%, respectively (Log-rank test p&amp;lt;0.001). After stratification by age, Log-Rank tests showed no differences between sexes. Multivariable adjustment did not identify gender as an independent predictor of long-term survival in any age subgroup. However, a time-stratified analysis at 10 years of follow-up in the ≥70 years subgroup showed that W had a higher risk than M after 10 years of follow-up (HR:0.7[0.5-0.9],p=0.03). Comparing with the survival of the Portuguese population, CABG allowed M to equalize the risk of mortality to what was expected (SMR =1.1;95%CI:0.9-1.1), but W showed a higher risk of mortality after CABG than W in the reference population (SMR =1.6,95%CI:1.3-1.8). Conclusion Women undergoing isolated primary CABG at an age &amp;gt;70 years, with longest periods follow-up, exhibited poorer long-term survival than men of the same age.Women demonstrated inferior survival outcomes compared to the general population.

Prevalence and prognostic value of thrombocytopenia in aortic valve replacement surgery: bioprosthesis versus mechanical prosthesis

Abstract Background Thrombocytopenia is a frequent complication of valve surgery, and is associated with different postoperative outcomes. Concern has recently arisen about thrombocytopenia following aortic valve replacement (AVR), as some authors have reported increased postoperative thrombocytopenia with certain biological aortic valves. In adittion, it is unclear whether thrombocytopenia predicts mortality in this type of surgery. Purpose The aim of this study was to determine the prevalence and prognostic value of thrombocytopenia in biological and mechanical aortic valve replacement. Methods The study was an observational analysis of patients undergoing AVR with or without associated coronary artery bypass grafting (CABG) at a single center between October 2014 and October 2023. Cardiac Surgery database was computerized and prospectively completed. Preoperative and first 4 days postoperative platelet counts were analyzed. Thrombocytopenia was defined as platelet count &amp;lt; 100 × 10³/mm³. To obtain comparable populations, a propensity score matching analysis was performed. Results A total of 1,197 patients underwent AVR with (n = 494) or without CABG (n = 703). Patients received either a mechanical prosthesis (n = 320), or a biological prosthesis (n = 877). The mean population age was 68 years (SD 6), with the majority being male (68%). Univariate analysis of the baseline characteristics of both groups of patients showed that they were not comparable. A risk-adjusted subanalysis was performed according to a propensity score (n=278). The nadir of bioprostheses was on the third postoperative day with an average of 93.8 × 10³/mm³, while in mechanical prostheses was also on the same day but with an average of 114.7 × 10³/mm³ (p: 0.001). (Figure 1) Bioprosthesis implantation was significantly associated with a higher prevalence of thrombocytopenia (72.7% vs. 45.3%, p&amp;lt;0.001). The presence of postoperative thrombocytopenia has been associated with higher in-hospital mortality (6.7% vs. 0.9%, p=0.019); but not with other postoperative complications. (Figure 2) Conclusions Patients undergoing AVR with bioprostheses had a significantly higher prevalence of thrombocytopenia, and also lower platelet counts than mechanical prothesis within the first 4 postoperative days. Thrombocytopenia was associated with higher in-hospital mortality in a risk score-adjusted population.Platelet counts after AVROutcomes according to platelet count

Laparoscopic Robotic-Assisted Restorative Proctocolectomy and Ileal J-Pouch-Anorectal Anastomosis in Children: Shifting to a Two Stage-Approach.

Background: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the gold standard surgical treatment for patients with ulcerative colitis (UC) unresponsive to medical therapy and those with familial adenomatous polyposis. Robotic IPAA is a safe and feasible option for the surgical treatment of UC in children. The feasibility of IPAA without ileostomy has been demonstrated in adult in the modified two-stage approach. Aim: The aim of the study was to examine feasibility, outcomes, and complications of robotic modified two-stage approach for RPC with IPAA in pediatric patients comparing it with robotic three-stage approach. Methods: All patients aged 4-18 years who underwent operative treatment for medically refractory UC were included. Demographic and clinical features, age at colectomy and at reconstructive surgery, intraoperative details and complications, and postoperative outcomes were analyzed. Results: Thirteen patients were included in the study (6 males, 7 females). Ileostomy was fashioned in 8 patients at the time of RPC and IPAA (Group 1); in 5 patients the bowel continuity was reintegrated at the time of IPAA (Group 2). No intraoperative complications and no conversions were recorded. One patient of Group 1 had a postoperative pouch complication. The 5 patients who underwent a two-stage procedure did not show short-term complications. No statistical differences were found between the groups in short-term (P = .48) and long-term complications (P = .07). Conclusions: Modified two-stage IPAA is a safe and feasible option in pediatric patients with UC, and RALS offers advantages over other techniques for the precision of rectal dissection and ileo-anal anastomosis.