Postoperative Bed Research Articles

Results of a German national survey to assess early mobilization versus bed rest in the postoperative management of incidental durotomy during lumbar surgery and the need for a randomized clinical trial.

Incidental durotomy during degenerative lumbar spine surgeries poses a complex medical challenge. Despite its relatively common occurrence, consensus on its management remains elusive due to the absence of robust, high-level evidence, resulting in significant variations in practice across medical institutions. The aim of this survey was to assess the current practices in Germany regarding early mobilization versus bed rest in the postoperative management of incidental durotomy during lumbar surgery to estimate the need for a randomized clinical trial. A digital survey titled "Postoperative management of incidental durotomy in lumbar spine surgery" was conducted among 119 neurosurgical departments in Germany. Key questions included the use of bed rest postsurgery, timing of mobilization, and whether the practice depended on the complexity of the surgery or the quality of the dural tear repair. The survey also explored the role of lumbar drains in management and respondents' potential participation in a multicenter study on the benefits of bed rest. Invitations were sent in November 2023, and responses were collected during November and December 2023. A total of 89 (75%) departments completed the survey. Among them, 75% reported using bed rest in the postoperative management of incidental durotomy. For 57%, this practice depends on the complexity of the surgical procedure or the quality of the surgical repair of the dural tear, while 18% apply it independently. Twenty-nine of the 89 departments (33%) answered that mobilization is allowed 24 hours after surgery, 13 departments (15%) allow mobilization after 48 hours, and 19 departments (21%) allow it after 72 hours. Additionally, 34% reported using a lumbar drain in cases of persistent postoperative CSF leakage, 36% use it for secondary surgical revision, and 30% do not use it in either case. Furthermore, 55 departments (62%) expressed potential interest in participating in a multicenter randomized trial addressing the postoperative management of incidental durotomy. The postoperative management of incidental durotomy during lumbar surgery exhibits significant variation across neurosurgical departments in Germany. Postoperative bed rest remains a common practice. To evaluate the true benefits of bed rest, a randomized multicenter study is recommended. A summary proposal for such a study is presented to address this need.

Physical and Psychological Burden of Bed Rest on Patients Following Free Flap Reconstruction of the Lower Limb: A Systematic Review and Possible Solutions

Background: Postoperative bed rest is considered essential after free flap reconstruction of the lower limb to ensure microsurgical success, but prolonged inactivity can lead to physical deconditioning and psychosocial challenges, even in otherwise healthy patients. While early mobilization protocols improve physical recovery, their impact on psychological wellbeing remains underexplored. This review evaluates the current literature on postoperative protocols in microvascular lower extremity reconstruction, focusing on both physical and mental health outcomes, and explores potential strategies for optimizing recovery. Methods: A systematic review was conducted following the PRISMA guidelines to search PubMed, Cochrane Library, and Embase databases. Studies were included if they explicitly described postoperative immobilization or mobilization protocols and their impact on recovery outcomes, including complications and psychological effects. Results: Sixteen studies met the inclusion criteria, highlighting the potential of early mobilization protocols in reducing complications such as pneumonia, deep vein thrombosis, and prolonged hospital stays. Structured mobilization strategies, such as early dangling and perfusion-controlled mobilization, demonstrated improved microcirculatory adaptation and enhanced recovery outcomes. However, limited to no research addressed psychological resilience and the impact of immobility on patient mental health. Conclusions: Early mobilization protocols significantly improve physical outcomes after free flap surgery, but the psychological and mental effects of postoperative bed rest remain insufficiently studied. Adapting strategies from space medicine, including structured routines, cognitive training, and social engagement, offers promising avenues for enhancing recovery. Future research should focus on integrating physical and psychological interventions into comprehensive, evidence-based recovery protocols to optimize patient outcomes.

A comparative study of transforaminal and interlaminar approaches in percutaneous endoscopic lumbar discectomy for L5-S1 disc Herniation: Systematic review.

Percutaneous Endoscopic Lumbar Discectomy (PELD) is a leading minimally invasive technique for lumbar disc herniation (LDH). The two primary approaches, transforaminal (PETD) and interlaminar (PEID), each present distinct advantages and challenges in treating L5-S1 LDH. This study aims to compare the efficacy and safety of these two approaches. A systematic review was conducted using the PUBMED and Science Direct databases (2014 to 2024), following PRISMA guidelines. Major variables included operative time, fluoroscopy duration, blood loss, postoperative bed rest duration, length of hospital stay, MacNab criteria assessment, Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and complications. This study included eight comparative studies involving 784 patients with L5- S1 LDH, with 389 undergoing PETD and 395 undergoing PEID. The meta-analysis revealed that PETD was significantly associated with longer operative time (MD, 12.10min; 95% CI, 6.41-17.01; P < 0.01), extended fluoroscopy duration (MD, 8.68 times; 95% CI, 7.14-10.22; P < 0.01), and shorter postoperative bed rest duration (MD, -0.91days; 95% CI, -1.75 to -0.07; P = 0.03). No significant differences were observed in blood loss, length of hospital stay, Macnab criteria assessment, VAS scores, ODI scores, or complication rates. PETD demonstrates comparable clinical efficacy and safety to PEID; however, PEID is superior in terms of operative time and fluoroscopy duration, while PETD offers the advantage of reduced postoperative bed rest duration. Our study provides clear insights into the advantages and challenges of each PELD approach for L5-S1 LDH.

A Clinical Comparative Study of Ultrasound-Guided Tumescent Local Anaesthesia versus Epidural Anaesthesia in Great Saphenous Vein Stripping.

To compare the effects of ultrasound-guided tumescent local anaesthesia (TLA) and epidural anaesthesia (EA) in great saphenous vein stripping and to explore the feasibility of using TLA in this procedure. This study included 144 patients diagnosed with varicose veins of the great saphenous vein who required surgical treatment and were admitted to the Second People's Hospital affiliated with Fujian University of Traditional Chinese Medicine from March 2020 to November 2023. Patients were divided into two groups based on the anaesthesia method used, including the observation group (TLA) and the control group (EA), with 72 patients in each group. Both groups underwent high ligation, internal stripping, and microvenectomy of the great saphenous vein. Perioperative data were collected, and pain was assessed using the visual analogue scale (VAS) immediately after anaesthesia, immediately after surgery, 24 hours postsurgery, and 48 hours postsurgery. Intraoperative conditions, postoperative recovery, complications, and economic benefits were compared between the two groups. Compared with the control group, the observation group had lower VAS scores immediately after anaesthesia (3.6±1.4 vs. 4.5±1.7) and immediately after surgery (2.1±1.4 vs. 3.3±1.5) (P<0.05). Blood pressure fluctuations (113.8±9.8 vs. 120±8.9 mmHg) and heart rates (77.3±7.8 vs. 97.3±5.7 beats/min) during stripping were significantly lower in the control group (P<0.05). The observation group had a significantly shorter postoperative bed rest duration (45.5±11.9 vs. 93.6±13.8 min), postoperative urinary retention (0 vs. 6 patients), postoperative deep vein thrombosis (1 vs. 7 patients), total postoperative hospital stay (1.7±0.5 vs. 3.3±0.5 days), and hospitalization costs (¥7311.7±117.5 vs. ¥9234.3±87.5) (P<0.05). No significant differences were noted between the groups in terms of the VAS score at 24 and 48 hours postsurgery, operation time, postoperative nausea and vomiting, or incidence of postoperative incision infections (P>0.05). Ultrasound-guided tumescent local anaesthesia for great saphenous vein stripping reduces intraoperative pain, allows for earlier ambulation, and effectively minimizes postanaesthesia complications and deep vein thrombosis. This method enables quicker recovery and reduces hospitalization costs.

Enhanced recovery after surgery protocols for minimally invasive treatment of Achilles tendon rupture: Prospective single-center randomized study.

Achilles tendon rupture is a common orthopedic injury, with an annual incidence of 11-37 per 100000 people, significantly impacting daily life. Minimally invasive surgery, increasingly favored for its reduced risks and comparable fixation strength to open surgery, addresses these challenges. Despite advantages like accelerated recovery, perioperative care poses emotional support, pain management, and rehabilitation challenges, impacting treatment efficacy and patient experience. To address these gaps, this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery, aiming to develop personalized, standardized care guidelines for broader implementation. To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery, providing evidence-based early recovery indicators. This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups. The experimental group received perioperative rapid rehabilitation nursing care, while the control group received standard care. The primary outcome measure was the Oswestry disability index score, with secondary outcomes including quality of life, Barthel index, patient satisfaction with nursing, incidence of complications, and rehabilitation adherence. Statistical analysis included appropriate methods to compare outcomes between groups. The study was conducted in a specific setting, utilizing a randomized controlled trial design. All 160 patients completed the follow-up. The experimental group showed significantly greater improvements in key efficacy indicators: Postoperative Oswestry disability index score (8.688 vs 18.88, P < 0.0001), quality of life score (53.25 vs 38.99, P < 0.0001), and Barthel index (70.44 vs 51.63, P < 0.0001). The experimental group had a lower incidence of deep vein thrombosis (1.25% vs 10.00%, P = 0.0339) with a relative risk of 0.1250 (95% confidence interval: 0.02050-0.7421). Infection rates were lower in the experimental group (2.50% vs 11.25%, P = 0.0564). Hospital stay (5.40 days vs 7.26 days, P < 0.0001) and postoperative bed rest (3.34 days vs 5.42 days, P < 0.0001) were significantly shorter. Patient satisfaction was 100% in the experimental group vs 87.50% in the control group (P = 0.0031). The rapid rehabilitation intervention significantly reduced pain, shortened hospital stays, and lowered complication rates, improving joint function and patient satisfaction.

LAPAROSCOPIC ROBOT-ASSISTED PROSTATECTOMY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

ANNOTATION. The article presents a review of the literature over the past 15 years regarding the surgical treatment of patients with benign prostatic hyperplasia. It was established that during this period of time, new surgical methods of treating benign prostatic hyperplasia appeared in the arsenal of urologists, namely: laparoscopic and robot-assisted prostatectomy (including single-port). These minimally invasive operations dramatically reduced the percentage of open prostatectomies by reducing the number of intraand postoperative complications, reoperations, postoperative bed days, and wound pain. Laparoscopic robot-assisted prostatectomy, when compared with laparoscopic prostatectomy, allows for better visualization of the operative field, greater volume and accuracy of instrument movements in hard-to-reach areas, less intraoperative blood loss and postoperative bed-day. The authors presented the methods and results of laparoscopic robot-assisted prostatectomy according to the literature in patients with benign prostatic hyperplasia. The introduction of robot-assisted prostatectomy will improve the results of treatment of patients with benign prostatic hyperplasia in Ukraine.

Efficacy of Laparoscopic Left Hemihepatectomy Combined With Choledochoscopic Lithotomy for Complex Intrahepatic Bile Duct Stones and Its Impact on Postoperative Liver Function.

This study was designed to investigate the clinical efficacy of laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy for patients with complex intrahepatic bile duct stones. The clinical data of 97 patients with complex intrahepatic bile duct stones treated in our hospital between February 2019 and April 2022 were retrospectively collected. Patients were allocated into 2 groups based on their surgical approaches. In the control group, 46 patients underwent laparoscopic left hemihepatectomy, while in the combined group, 51 patients underwent laparoscopic left hemihepatectomy combined with choledochoscopic lithotomy. Parameters such as clinical efficacy, surgical indices, stress response markers (CRP, EP, COR), coagulation metrics (FIB, APTT, PT), liver function indicators (GGT, TBIL, ALT), complications, and quality of life were compared between the 2 groups. The combined group exhibited a significantly higher total effective rate compared with the control group (98.04% vs. 82.61%) ( P <0.05). The operation duration of the combined group was longer than that of the control group. However, the duration for postoperative anal exhaustion, postoperative bed mobility, postoperative drainage, and hospital stay was shorter in the combined group than in the control group ( P <0.05). CRP, EP, and COR concentrations were substantially elevated in both groups on the third postoperative day ( P <0.05), but were lower in the combined group. Similarly, levels of FIB, APTT, and PT were markedly increased in both groups on the third postoperative day ( P <0.05), but were lower in the combined group. On the seventh postoperative day, GGT, TBIL, and ALT were notably decreased in both groups, with the combined group exhibiting lower levels ( P <0.05). The incidence of complications in the combined group was lower than that of the control group (5.88% vs. 19.57%) ( P <0.05). At 3 months postoperatively, all GIQLI scores were markedly elevated in both groups, with superior scores observed in the combined group ( P <0.05). The combined laparoscopy and choledochoscopy demonstrate a remarkable efficacy for complex intrahepatic bile duct stones, which significantly facilitate liver function recuperation, reduce stress reactions, reduce complications, enhance the quality of life, and exert a minimal impact on coagulation functions.

Effect of Early Postoperative Mobilization on Functional Recovery, Hospital Length of Stay, and Postoperative Complications After Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects: A Prospective, Randomized Controlled Trial.

Patients undergoing perineal defect reconstruction with the internal pudendal artery perforator (IPAP) flap traditionally face 5days of postoperative bed rest (BR) to minimize surgical risks. However, prolonged BR can exacerbate postoperative physiologic changes such as increased fatigue, reduced body mass, and declining lung function, while also leading to complications such as pneumonia, delirium, deep vein thrombosis, and pressure injuries. This study assessed the effectiveness, feasibility, and safety of an adapted early mobilization (EM) program for these patients. This prospective, randomized, controlled clinical study involved 51 patients assigned to adapted EM (n = 25) or BR (n = 26). Whereas EM included core exercises, orthostasis training, gait training, muscle strengthening, and aerobic exercises after surgery, BR followed standard bed rest protocols. The primary outcome was independent ambulation for 3 m on postoperative day 5. The secondary outcomes included 6-min walk test (6MWT) distances on days 5 and 30, hospital length of stay, healing time, postoperative complications, fatigue prevalence, and quality of life. On day 5, EM improved ambulation significantly compared with BR (68.0% vs 38.5%; P = 0.035) and achieved greater 6MWT distances on days 5 (108.78 vs 47.73m; P = 0.041) and 30 (243.8 vs 166.29m; P = 0.018). The EM patients were discharged earlier (66.7% by day 10 vs 33.3% of the BR patients; P = 0.043), with comparable healing times (P = 0.06) and postoperative complication rates (68% vs 80.8%; P = 0.296). Fatigue prevalence and quality of life did not differ significantly between the two groups. Early mobilization after IPAP flap reconstruction is safe and feasible, promoting early ambulation and recovery and facilitating earlier discharge without increasing complications.

Postoperative tumor bed radiation versus T-shaped field radiation in the treatment of locally advanced thoracic esophageal squamous cell carcinoma: a phase IIb multicenter randomized controlled trial

BackgroundPostoperative radiotherapy (PORT) is crucial for patients with thoracic locally advanced esophageal squamous cell carcinoma (LA-ESCC, pT3-4aN0-3M0) following esophagectomy. However, the appropriate radiation volume has not been well established. This study aimed to determine the optimal PORT volume for LA-ESCC patients.MethodsLA-ESCC patients post-esophagectomy were randomly assigned to either the large-field irradiation (LFI, primary lesion and lymph node tumor bed plus elective nodal irradiation) group or the small-field irradiation (SFI, primary lesion and lymph node tumor bed alone) group. Stratification was based on T stage and the number of lymph node metastases. The primary endpoint was disease-free survival (DFS), while the secondary endpoints included overall survival (OS), adverse events, and patterns of initial failure.ResultsA total of 401 patients were randomly assigned to the intention-to-treat analysis(LFI group, n = 210; SFI group, n = 191). The median DFS of patients in the LFI group was 47.9 months and 48.1 months in the SFI group (HR = 0.87, 95%CI, 0.65 to 1.16; p = 0.32). The estimated one-year and three-year OS rates were 89.2% and 63.2% for patients in the LFI group, compared to 86.6% and 60.7% for the SFI group, respectively. The difference of OS between the two groups was not significant (HR = 0.86, 95%CI, 0.63 to 1.16; p = 0.35). Fewer patients in the LFI group experienced locoregional recurrence compared to the SFI group (12.9% vs 20.4%, p = 0.013). Additionally, locoregional recurrence-free survival of the LFI group was significantly longer than that of SFI group (HR = 0.54, 95%CI, 0.34–0.87; p = 0.01). The most common toxicity was grade 2 esophagitis, observed in 22.9% of the LFI group and 16.8% of the SFI group. Grade 3 adverse events occurred in 6.7% of the LFI group and 2.6% of the SFI group. No grade 4 or 5 toxicities were observed. Adverse events did not significantly differ between the two groups.ConclusionsPostoperative radiotherapy, with the specified radiation volume shows encouraging survival outcomes that are comparable to those of neoadjuvant chemoradiotherapy in patients with thoracic LA-ESCC. Both postoperative irradiation fields were found to be feasible and safe.

Analysis of 398 cases of intradural spinal tumor resection with primary dural closure: surgical outcomes based on the suture material.

Cerebrospinal fluid (CSF) leak after resection of intradural spinal tumors (IST) represents a significant postoperative challenge. Although various dura suture techniques and materials have been explored experimentally, direct clinical comparative studies are lacking. This study evaluated the effectiveness of specific suture materials in primary dural closure post-IST resection and identified associated risk factors for CSF leak. A retrospective review was conducted of patients who underwent IST resection surgery at a single institution from January 2012 to February 2021. Patients were categorized on the basis of the dura suture materials used. Eligibility for the study required a posterior midline surgical approach, primary dural closure after durotomy, and absence of closed-suction drainage. Of 398 patients who met the inclusion criteria, the overall CSF leak-related surgical complication rate was 4.27% (17/398). The sutures used were 6-0 Prolene for 163 patients and 5-0 silk for 235 patients. Significant differences were observed between the suture groups in the CSF leak rate (Prolene 1.8% vs silk 6.0%, p = 0.046), lumbar drainage insertion rate (Prolene 0.6% vs silk 4.3%, p = 0.031), and length of postoperative bed rest (Prolene 1.07 days vs silk 3.25 days, p < 0.001). Logistic regression analysis indicated a significant association of CSF leak with the use of 5-0 silk (OR 4.11, p = 0.006) and revision surgical procedures (OR 6.73, p = 0.001). Surgical complications related to CSF leaks were significantly lower with the use of 6-0 Prolene sutures compared to 5-0 silk sutures in primary dural closure after IST resection.

Comparison of two surgical methods for the treatment of intertrochanteric fractures of the femur in elderly patients with knee osteoarthritis

To explore the difference in the effectiveness between proximal femoral nail anti-rotation(PFNA) and proximal femoral locking compression plate(PFLCP) of intertrochanteric fracture in the elderly patients combined with knee osteoarthritis. The clinical data of 65 intertrochanteric femoral fractures combined with knee osteoarthritis between June 2015 and February 2021 were retrospectively analyze. They were divided into two groups according to the different surgical methods. PFNA group was composed of 36 patients, 12 males and 24 females, aged from 61to 88 years old with an average of (77.0±6.4)years old. There were 17 cases of left injury and 19 cases of right injury. According to modified Evans classification, there were 3 cases of typeⅡ, 19 cases of type Ⅲ, 10 cases of type Ⅳ, and 4 cases of type Ⅴ. PFLCP group was composed of 29 patients, 11 males and 18 females, aged from 60 to 92 years old with an average of (78.8±6.5) years old. There were 14 cases of left injury and 15 cases of right injury.According to modified Evans classification, there were 2 cases of typeⅡ, 18 cases of type Ⅲ, 7 cases of type Ⅳ, and 2 cases of type Ⅴ. Comparison of operation time, intraoperation blood loss, postoperative bed time, incidence of postoperative complications, Harris score at 6 months and 1 year postoperation. All 65 patients were followed up ranging from 12 to 24 months with an average of (16.9±3.6) months. In the PFNA and PFLCP groups, the operation time was respectively (57.6±6.8) min and (77.4±6.5) min, the intraoperative blood loss was (128.3±50.3) ml and (156.3±23.9) ml, postoperative bed time was (4.0±2.5) days and (8.1±2.0) days, Harris score at 6 months postoperative was (45.3±8.6) points and (36.3±7.0) points. There were significant differences between two groups(P<0.05). Incidence of postoperative complications was 19.4%(7/36)and 34.5%(10/29), Harris score at 1 year postoperative was (60.8±6.7) points and (59.0±8.1) points.There was no significant difference between the two groups(P>0.05). Compared with PFLCP, PFNA treatment of elderly patients with knee osteoarthritis between the femoral intertrochanteric fractures shorter surgical time, less intraoperative blood loss, bed rest after surgery, short-term hip function recovery better, when the affected knee joint can tolerate traction, can be used as a priority.

Comparison of spinal anesthesia and local anesthesia in percutaneous interlaminar endoscopic lumbar discectomy for L5/S1 disc herniation: a retrospective cohort study

BackgroundInterlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited.MethodsThe propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively.ResultsFifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05).ConclusionSA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia.

Factors Affecting Length of Stay for Children Hospitalized After Pediatric Surgical Procedures.

Understanding the postoperative length of stay (LOS) by surgical procedure is important for hospital medicine clinicians involved in surgical co-management. We assessed variation in postoperative LOS for children after elective surgical procedures and risk factors for prolonged LOS. This study is a retrospective analysis of pediatric patients undergoing elective surgical procedures between January 1, 2018 and October 1, 2021 with postoperative hospitalization for recovery at a freestanding children's hospital. The postoperative LOS (number of days) was compared across types of surgery and by the number of chronic conditions (assessed with the Agency for Healthcare Research and Quality Condition Indicator system) using multivariable quantile regression. The median (interquartile range) LOS across all 347 types of surgical procedures combined was 2 (interquartile range 1-4). Surgical procedures (n = 85) with a median LOS between 3.0 and <5.0 days (eg, spinal fusion, Chiari decompression) accounted for 20.9% of all hospitalizations (N = 12 139) and 23.1% of all postoperative bed days. Procedures (n = 46) with a median LOS of ≥5.0 days (eg, femoral osteotomy, bladder reconstruction) accounted for 15.0% and 46.8% of all hospitalizations and bed days, respectively. After controlling for the type of procedure, having ≥4 (versus none) chronic conditions was significantly associated with experiencing a prolonged LOS (90th percentile: 5.2 days); patients with 4 to 6, versus no, chronic conditions stayed a median of 1.4 (95% confidence interval [CI] 0.7-2.2) days longer, those with 7 to 9 chronic conditions stayed a median of 1.9 (95% CI 1.0-2.7) days longer, and those with ≥10 chronic conditions stayed a median of 4.0 (95% CI 3.3-4.7) days longer. Hospital medicine clinicians can use the type of surgery in combination with the number of chronic conditions to estimate postoperative LOS after elective surgical procedures in children.

Comparison of Superselective Renal Artery Embolization versus Retroperitoneal Laparoscopic Partial Nephrectomy in Ruptured Hemorrhagic Renal Angiomyolipoma: A Single-Center Study.

To analyze the clinical efficacy of superselective renal artery embolization and retroperitoneal laparoscopic partial nephrectomy for the treatment of ruptured hemorrhagic renal angiomyolipoma and to provide a reference for the selection of treatment methods for ruptured hemorrhagic renal angiomyolipoma. A retrospective analysis was conducted on the clinical data of 24 patients who were diagnosed with ruptured hemorrhagic renal angiomyolipoma at the Second Hospital of Tianjin Medical University between January 2019 and December 2021. Among them, 10 patients were treated with superselective arterial embolization (SAE), and 14 patients were treated with retroperitoneal laparoscopic part nephrectomy (RLPN). The differences between the two treatment methods in terms of hospital stay, hospital costs, anesthesia method, operation time, intraoperative blood loss, postoperative bed rest time, antibiotic dosage, postoperative complication rate, tumor diameter changes, creatinine value changes, hemoglobin value changes, tumor recurrence rate, and reoperation rate were compared. All patients completed the treatment and were discharged. There were no significant differences in length of hospital stay, hospital costs, creatinine change values, or postoperative complication rates between the two groups (p > 0.05). However, there were statistically significant differences (p < 0.05) in surgical time (85.50 ± 19.94 min vs. 141.07 ± 76.33 min), intraoperative blood loss (21.50 ± 14.72 mL vs. 153.57 ± 97.00 mL), postoperative bed rest time (22.7 ± 1.56 h vs. 41.21 ± 3.57 h), preoperative hemoglobin levels (94.7 ± 23.62 g/L vs. 113.79 ± 17.83 g/L), and hemoglobin changes (-6.60 ± 10.36 g/L vs. -15.21 ± 8.79 g/L) between the two groups. Both groups of patients had an average follow-up period of 22 months, and patients in the SAE group had a mean reduction of 3.33 cm in tumor diameter within the follow-up period compared with the pre-embolization period (p < 0.05). None of the patients in the SAE group experienced rebleeding, and there was no tumor recurrence in either group. SAE and RLPN are effective treatments for ruptured renal angiomyolipoma with good outcomes. Furthermore, compared to RLPN, SAE offers advantages such as simplicity of operation, minimal trauma, shorter surgical time, minimal impact on hemoglobin levels, shorter bed rest time, faster postoperative recovery, and maximal preservation of renal units.

First initiation of mobilization out of bed after cardiac surgery – an observational cross-sectional study in Sweden

BackgroundCardiac surgery is associated with a period of postoperative bed rest. Although early mobilization is a vital component of postoperative care, for preventing complications and enhancing physical recovery, there is limited data on routine practices and optimal strategies for early mobilization after cardiac surgery. The aim of the study was to define the timing for the first initiation of out of bed mobilization after cardiac surgery and to describe the type of mobilization performed.MethodsIn this observational study, the first mobilization out of bed was studied in a subset of adult cardiac surgery patients (n = 290) from five of the eight university hospitals performing cardiothoracic surgery in Sweden. Over a five-week period, patients were evaluated for mobilization routines within the initial 24 h after cardiac surgery. Data on the timing of the first mobilization after the end of surgery, as well as the duration and type of mobilization, were documented. Additionally, information on patient characteristics, anesthesia, and surgery was collected.ResultsA total of 277 patients (96%) were mobilized out of bed within the first 24 h, and 39% of these patients were mobilized within 6 h after surgery. The time to first mobilization after the end of surgery was 8.7 ± 5.5 h; median of 7.1 [4.5–13.1] hours, with no significant differences between coronary artery bypass grafting, valve surgery, aortic surgery or other procedures (p = 0.156). First mobilization session lasted 20 ± 41 min with median of 10 [1–11]. Various kinds of first-time mobilization, including sitting on the edge of the bed, standing, and sitting in a chair, were revealed. A moderate association was found between longer intubation time and later first mobilization (ρ = 0.487, p < 0.001). Additionally, there was a moderate correlation between the first timing of mobilization duration of the first mobilization session (ρ = 0.315, p < 0.001).ConclusionsThis study demonstrates a median time to first mobilization out of bed of 7 h after cardiac surgery. A moderate correlation was observed between earlier timing of mobilization and shorter duration of the mobilization session. Future research should explore reasons for delayed mobilization and investigate whether earlier mobilization correlates with clinical benefits.Trial registrationFoU in VGR (Id 275,357) and Clinical Trials (NCT04729634).

ОЦЕНКА РЕЗУЛЬТАТОВ ПРИМЕНЕНИЯ АЛГОРИТМА ВЫБОРА ОПТИМАЛЬНОГО ХИРУРГИЧЕСКОГО ДОСТУПА К ЗАБРЮШИННОМУ ПРОСТРАНСТВУ У ПАЦИЕНТОВ С РАЗЛИЧНЫМИ ПАРАМЕТРАМИ КОНСТИТУЦИИ.

Relevance. Despite the rapid development and predominance of endovideosurgical techniques in the treatment of pathologies of organs and structures of the retroperitoneal space, the implementation of transperitoneal or retroperitoneal approaches for open surgical interventions remains a routine activity. Surgical treatment of various pathologies of retroperitoneal localization leads to the development of nonspecific life-threatening complications in 23.8% - 30% of clinical observations, and associated mortality - 7.2% - 11% of cases. Previously, our works presented the results of comparing the number of this type of complications when using laparotomy or retroperitoneal access, depending on the constitutional parameters of the patient. An assessment was made of the significance of the influence of constitutional parameters on the development of nonspecific life-threatening complications, on the basis of which an algorithm for choosing the optimal surgical access to the structures of the retroperitoneal space was developed [patent application No. 2024113445 dated May 17, 2024]. Purpose of the study. To evaluate the effectiveness of using an algorithm for selecting the optimal surgical approach in the surgical treatment of pathologies of organs and structures of retroperitoneal localization. Materials and methods. Comparative analysis of the results of surgical treatment of patients with various surgical pathologies of the retroperitoneal space. Group I (n = 167), where the choice of surgical approach was determined using the “optimal surgical approach selection algorithm.” Group II (n = 284), in which the choice of access to the structures of the retroperitoneal space was not unified and was chosen without taking into account the constitutional parameters of the patient. In the perioperative period, the duration of surgical intervention, the volume of intraoperative blood loss, the number of days of stay in the intensive care unit, the time of postoperative respiratory support, the duration of postoperative intestinal paresis and the number of postoperative bed days were assessed. Criteria assessed in the postoperative period: development of myocardial infarction, acute cardiovascular failure, ARDS with the development of respiratory failure, acute kidney injury; cases of development of ischemic colitis and small intestinal obstruction, requiring repeated interventions, as well as the phenomenon of multiple organ failure. Wound complications included failure of retroperitoneal and laparotomy wounds, including eventration. To calculate quantitative characteristics, the median (Me) and percentiles (Q0.25 - Q0.75) were determined. Calculation of statistical significance between groups was performed using the Mann-Whitney U test**, for comparison of qualitative indicators - the Chi-square test* in IBM SPSS Statistics 25 software. Results. In group I, compared with group II, there was a shorter surgical intervention time [140.8 vs 179.5] min, p = 0.031**, a smaller volume of intraoperative blood loss [280.4 vs 413.3] ml, p = 0.024* *; postoperative respiratory support [4.5 vs 8.5] hours, p = 0.041**; length of stay in the intensive care unit [1.8 vs 3.4] days, p = 0.021**; postoperative intestinal paresis [1.2 vs 4.8] days p = 0.024**; and duration of total postoperative hospital stay [9.1 vs 16.4] days p = 0.003**. The number of postoperative nonspecific life-threatening and wound complications in group I was 24 (14.4%), and in group II - 64 (22.5%) cases (p = 0.023*). The number of complications-related deaths in group I was 9 (5.4%); in group II - 32 (11.26%) cases (p = 0.037*). Conclusion. The use of an algorithm for selecting the optimal surgical approach for surgical treatment of pathologies of organs and structures of the retroperitoneal localization of the access leads to a reduction in the number of nonspecific life-threatening complications to 14.4%, and associated deaths to 5.4%.

Construction and validation of a predictive model for lower extremity deep vein thrombosis after total knee arthroplasty.

The aim was to investigate the independent risk factors for lower extremity deep vein thrombosis (DVT) after total knee arthroplasty, and to establish a nomogram prediction model accordingly. Data were collected from total knee replacement patients from January 2022 to December 2023 in our hospital. Unifactorial and multifactorial logistic regression analyses were used to determine the independent risk factors for lower extremity DVT after total knee arthroplasty and to establish the corresponding nomogram. The receiver operating characteristic curves were plotted and the area under the curve was calculated, and the calibration curves and decision curves were plotted to evaluate the model performance. A total of 652 patients with total knee arthroplasty were included in the study, and 142 patients after total knee arthroplasty developed deep veins in the lower extremities, with an incidence rate of 21.78%. After univariate and multivariate logistic regression analyses, a total of 5 variables were identified as independent risk factors for lower extremity DVT after total knee arthroplasty: age > 60 years (OR: 1.70; 95% CI: 1.23-3.91), obesity (OR: 1.51; 95% CI: 1.10-1.96), diabetes mellitus (OR: 1.80; 95% CI: 1.23-2.46), D-dimer > 0.5 mg/L (OR: 1.47; 95% CI: 1.07-1.78), and prolonged postoperative bed rest (OR: 1.64; 95% CI: 1.15-3.44). the nomogram constructed in this study for lower extremity DVT after total knee arthroplasty has good predictive accuracy, which helps physicians to intervene in advance in patients at high risk of lower extremity DVT after total knee arthroplasty.

Biomarker-driven radiation therapy dose reduction after transoral robotic surgery for the treatment of HPV-positive oropharyngeal cancer.

TPS6119 Background: HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is a highly curable cancer with a considerable burden of treatment-related toxicities. Transoral surgery (TOS) is a treatment option for patients with early-stage disease; however, adjuvant radiotherapy (RT) is often recommended and can add to these late toxicities. Circulating tumor HPV DNA (ctHPVDNA) is a sensitive marker of tumor recurrence, and undetectable post-operative ctHPVDNA is associated with improved recurrence-free survival. We hypothesize that patients with undetectable post-TOS ctHPVDNA without high risk pathologic factors can safely undergo de-escalation of adjuvant RT to 36 Gy, and this reduction will improve long-term swallowing function. Methods: We opened a multi-institutional phase II study (NCT05387915) including patients with pT1-2, N0-1, M0 HPV-related OPSCC who had TOS resection of their primary site and at least ipsilateral neck dissection. Pertinent inclusion criteria include a &lt;10 pack-year smoking history, or a &lt;30 pack-year smoking history if &gt;10 years since last tobacco consumption, and pathologic findings of one or more intermediate risk factors: close margin (1 – 4 mm), perineural invasion, 2 – 4 positive lymph nodes or a single lymph node &gt;3 cm. Patients with high risk factors (positive margin, extranodal extension, 5 or more positive lymph nodes) are excluded. Patients must have a detectable pre-operative ctHPVDNA and a post-operative ctHPVDNA drawn 7-14 days after TOS; if negative, patients receive 36 Gy of adjuvant RT in 15 fractions of 2.4 Gy delivered daily; if positive, they receive care per the discretion of the treating radiation oncologist. If the final surgical margins at the site of the primary tumor are &gt;2mm, patients are eligible for omission of the primary tumor post-operative bed from the radiation volume. Our primary endpoint is 1-year swallowing function as measured by the composite MD Anderson Dysphagia Index (MDADI) score. Secondary endpoints include overall/progression-free survival and other quality of life metrics. The study is powered to detect an 8.5-point improvement in MDADI composite score at one year over the historical control from ECOG 3311 Arm B. With an alpha of 0.05 and a power of 0.90 we require 27 evaluable patients. Accounting for dropout and patients lost to follow-up, we aim to enroll 35 total patients. Since accrual began in June 2022, we have enrolled 18 patients as of January 2024. We recently opened the study at a second institution and are in the process of opening at a third institution. Clinical trial information: NCT05387915 .

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61-69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1-10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688-1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4-82·5) in the no ADT group and 80·4% (76·6-83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population. Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society.

Effect of Early Rehabilitation Exercise on Lower Limb Function and Psychological State After Coronary Artery Bypass Grafting: A Randomized Controlled Trial

Background: While early rehabilitation exercise has been shown to improve cardiopulmonary function and functional outcomes after revascularization in individuals who have undergone coronary artery bypass grafting (CABG), further research is still needed to fully understand the importance of psychological status and limb functional rehabilitation following CABG. Therefore, the purpose of this study was to investigate the effects of early rehabilitation exercise on lower limb function and mental health after coronary artery bypass grafting. Methods: Eighty patients who underwent CABG were randomly divided into a routine exercise group and an early rehabilitation exercise group. The degree of lower limb swelling, the amount of incision complications, the first time the patient got out of bed after the operation, the length of postoperative hospital stay, activity tolerance and postoperative psychological state were compared between the two groups. Results: The incidence of postoperative lower extremity oedema was 30% in the early rehabilitative exercise group as compared to 52.5% in the routine exercise group. Between the two groups, there was a statistically significant difference (p &lt; 0.05) in the incidence of postoperative lower limb edema as well as the amount of swelling in the thighs and ankles on postoperative days 1, 3, and 5. In the routine exercise group, the first time the patients got out of bed was 3.45 ± 1.09 days, and the length of postoperative hospitalization was 12.75 ± 5.06 days. In the early rehabilitation exercise group, the first time the patients got out of bed was 1.93 ± 0.57 days, and the length of postoperative hospitalization was 9.50 ± 2.92 days. There were statistically significant differences in these two indices between the two groups (p &lt; 0.05). The activity tolerance of patients in the routine exercise group was 46.10 ± 19.09 min at 2 months after surgery and 69.88 ± 19.05 min at 3 months after surgery. The activity tolerance of patients in the early rehabilitation exercise group was 56.40 ± 17.42 min at 2 months after surgery and 105 ± 23.04 min at 3 months after surgery, and there was a significant difference in activity tolerance between the two groups at these time points following surgery (p &lt; 0.05). In addition, there were statistically significant differences in the Patient Health Questionnaire-9, Generalized Anxiety Self-Assessment Scale-7 and Pittsburgh Sleep Quality Index scores between the two groups (p &lt; 0.05). Conclusions: Early rehabilitation exercises can promote the recovery of lower limb function after CABG to a certain extent, shorten the postoperative bed rest time and hospital stay, and effectively improve postoperative psychological well-being and sleep quality.