Postoperative Complications Research Articles

Surgical treatment of hypospadias with lichen sclerosus: Long‐term outcomes from a single center

AbstractBackgroundHypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.ObjectivesTo report surgical strategies and outcomes for primary and redo hypospadias patients with LS.Materials and methodsWe conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.ResultsFor primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).ConclusionsFor primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively.

The perioperative frailty index derived from the Chinese hospital information system: a validation study.

There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11). A prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty. 335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0%) were females, and the Median(P25, P75)age at surgery was 69 (65,74) years. The prevalence of frailty in the study population was 16.4% (assessed by FI-32). After adjusting for concomitant variables including demographic characteristics (such as gender, BMI, smoking, drinking, average monthly income and educational level) and surgical factors (such as surgical approach, surgical site, anesthesia method, operation time, intraoperative bleeding, and intraoperative fluid intake), there was a statistically significant association between frailty and the development of postoperative complication after surgery (OR = 3.051, 95% CI:1.460-6.378, P = 0.003). There were also significant differences in mortality within 30 days of surgery, the length of hospital stay (LOS) and the hospitalization costs. FI-32, FRAIL and mFI-11 showed a moderate predictive ability for postoperative complications, the Area Under Curves (AUCs) were 0.582, 0.566 and 0.531, respectively. With adjusting concomitant variables associated with postoperative complications, the AUCs of FI-32, FRAIL and mFI-11 in the adjusted prediction models were 0.824, 0.827 and 0.820 respectively. The FI-32 has a predictive effect on postoperative adverse outcomes in elderly Chinese patients. Compared to FRAIL and mFI-11, the FI-32 had the same ability to predict postoperative complications, and FI-32 can be extracted directly from HIS, which greatly saves the time for clinical medical staff to evaluate perioperative frailty.

Risk factors for readmission following esophagectomy and gastrectomy for cancer.

Hospital readmission after surgery is a key quality indicator. This nationwide cohort study aimed to assess readmission rates following esophagectomy and gastrectomy for cancer and identify associated risk factors. Data were extracted from the Dutch Upper GI Cancer Audit (DUCA) for patients with esophagogastric cancer who underwent esophagectomy or gastrectomy with curative intent between January 2011 and June 2016. Logistic regression analysis identified risk factors for 30-day readmission. In total, 5566 patients were included. Readmission within 30days occurred in 483 of 3488 (13.8%) patients after esophagectomy and 243 of 2078 patients (11.7%) after gastrectomy. Both minor (Clavien Dindo 1-2) and major (Clavien Dindo ≥3) postoperative complications were independent predictors of readmission after esophagectomy (OR 2.99; 95%CI 2.23-4.02; p< 0.001 and OR 5.20; 95%CI 3.82-7.09; p< 0.001). Specific complications included pulmonary (OR 1.49; 95%CI 1.20-1.85; p< 0.001), gastrointestinal (OR 2.43; 95%CI 1.94-3.05; p< 0.001), and infectious (OR 2.27; 95%CI 1.60-3.22; p< 0.001). Prolonged length of stay (pLOS) was associated with higher readmission rates in patients without complications following esophagectomy (OR 1.91 95% CI 1.19-3.07; p= 0.008), but lower rates in those with complications (OR 0.65 95% CI 0.51-0.83; p< 0.001). For gastrectomy, postoperative complications were also linked to readmission (OR 3.18; 95%CI 2.30-4.40; p< 0.001), particularly gastrointestinal (OR 2.16; 95%CI 1.40-3.32; p< 0.001), and infectious (OR 3.80; 95%CI 2.53-5.71; p< 0.001). Readmission after esophagogastric resection is common, particularly among patients with both minor and major postoperative complications. Prolonged stay after esophagectomy impacts readmission risk differently based on the presence of complications.

The effect of clinically significant weight loss prior to open ventral hernia repair.

The study aim was to assess the impact of clinically significant weight loss (CSWL; ≥5% weight reduction) on postoperative complications following abdominal wall reconstruction with the component separation technique (CST). A retrospective review of patients who underwent open ventral hernia repair (VHR) with CST from November 2008 to January 2022 was performed. Cohorts were stratified by presence of CSWL from baseline weight at preoperative consultation. Of 180 total patients, 40 (22.2%) achieved CSWL prior to VHR. Mean age was 59.6 ± 11.2 years. Patients in the CSWL cohort represented a higher average body mass index (BMI) (33.6 vs. 31.7kg/m2, p = 0.076), and were obese more frequently (80.0% vs. 56.4%, p = 0.007). The CSWL cohort had a higher proportion of patients in Ventral Hernia Working Group (VHWG) classification II (82.5% vs. 63.6%) while the non-CSWL cohort had more VHWG classification III/IV (20.0% vs. 10.0%, p = 0.078). Mean follow-up duration was 6.1 ± 13.4 months. Complications, including 30- and 90-day surgical site occurrence (SSO), return to operating room, readmission, and hernia recurrence (CSWL: 5.0% vs. non-CWL 1.4%, p = 0.179), were comparable between cohorts. BMI was an independent predictor of any complication (OR 1.07, p = 0.044) and 90-day SSO (OR 1.10, p = 0.043). Achievement of CSWL prior to open VHR utilizing CST results in similar post-reconstruction outcomes to patients who maintained a comparable BMI at baseline. Higher day-of-surgery BMI was more consequential to postoperative complications than percent weight loss.

Comparative analysis of free SMAS fold flap and ADM in facial depression after parotidectomy.

This study aimed to analyze the effects of anterior descending mandible (ADM) and free superior mesenteric artery (SMAS) folding flaps on post-parotidectomy facial depression. This retrospective study examined the effects of sex, age, surgical sample size, method, duration, and blood loss on postoperative complications in 65 patients. No significant differences involving sex, age, or sample size for surgical resection were observed between the two groups. The incidence of Frey syndrome (P = 0.175) and the locations of facial nerve injuries and tumors were not significantly different between the two groups. However, a statistically significant difference was observed in postoperative facial depression between the groups (P = 0.045, P < 0.05). No significant difference was found between facial nerve injury and Frey's sign in subgroup analysis of facial depression deformities. Within the facial depression group, tumor locations were significantly different (P = 0.021, P < 0.05). In the cases of facial depression after partial parotid resection, no significant difference was observed between ADM implantation and SMAS flap placement. A significant difference was noted between the ADM implantation and SMAS flap groups in the total parotidectomy group (P = 0.046 and P < 0.05, respectively). Women are more likely to experience facial depression after parotid surgery. Facial depression is most likely to occur after parotid resection if the tumor is located in the deep lobes of the parotid gland. The use of SMAS flaps can prevent facial depression, and both ADM and SMAS flaps can prevent Frey's syndrome. Partial parotid resection reduces the risk of facial nerve injury and facial depression.

A large single-center propensity score-matched cohort study on outcomes and complications based on the number of corrective bars used in the Nuss procedure.

The Nuss procedure is the most common corrective surgery for pectus excavatum. We analyzed treatment outcomes and complication rates in 1238 patients treated with the Nuss procedure from 2002 to 2021, focusing on the number of corrective bars used. Using Propensity Score Matching based on age, sex, BMI, pre-operative FEV1, and the Haller index, we created two groups: 546 patients with a single bar and 546 with two bars. Both groups achieved similar correction effects (Haller index: single bar = 2.58 vs. two bars = 2.56; p = 0.65). In the univariate analysis, in the two-bar group, the postoperative complications were observed more often (28.6% vs. 15.4%, p < 0.001), including pneumothorax (11.2% vs. 6.2%, p < 0.001), hemothorax (3.7% vs. 0.7%, p < 0.001), additional drainage (13.7% vs. 5.3%, p < 0.001), the need for thoracentesis (8.6% vs. 2.9%, p < 0.001), bar displacement (3.8% vs. 0.7%, p < 0.001), pleural effusion (10.6% vs. 3.1%, p < 0.001), and fever (6.6% vs. 3.8%, p < 0.041). In the logistic regression, two bars significantly increased the risk of postoperative complications (p = 0.019), including hematoma (p = 0.036), pleural effusion (p = 0.002), and the need for thoracentesis (p = 0.013). Using two corrective bars during the Nuss procedure is associated with a higher rate of postoperative complications but similar corrective results.

Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia.

Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. A retrospective cohort study was conducted between 2003 and 2023. We included all patients aged 18 years and older who underwent splenectomy. A description of clinical and operative variables with infectious outcomes was performed. Subgroup analyses were performed between open or laparoscopic approach and surgical setting. A total of 134 patients were included. Female patients constituted 52.99% (n = 71) of cases, with a mean age of 51.01 ± 20.79 years. The most frequent surgical indication for splenectomy was trauma in 31.34% (n = 42), and a laparoscopic approach was indicated in 41.79% (n = 56). Overwhelming post-splenectomy syndrome (OPSI) was evidenced in 2.24% (n = 3) of the population. Surgical characteristics such as operative time, intraoperative blood loss, and intensive care requirement and unit length of stay were higher in open and trauma patients. Our data describe the demographic, clinical and operative characteristics of patients undergoing splenectomy in Colombia, providing a solid basis for future research. The results obtained on overwhelming postsplenectomy syndrome (OPSI) and postoperative complications are comparable with those reported in the international literature, reinforcing the validity of our findings. Further prospective studies in this population are needed to optimize management strategies and improve clinical outcomes, particularly in higher risk subgroups.

Risk factors for urinary retention after robot-assisted radical cystectomy with orthotopic neobladder diversion: a multicenter study.

To determine risk factors for urinary retention (UR) after robot-assisted radical cystectomy (RALC) with orthotopic neobladder diversion. A total of 269 patients who underwent RALC with orthotopic neobladder diversion from 2008 to 2019 at seven tertiary hospitals were retrospectively analyzed. There were 68 patients who had UR (UR arm) and 201 patients who did not have UR (no-UR arm). UR was defined as voiding dysfunction without catheterization or more than 100mL of residual urine after voiding. Preoperative demographics, perioperative factors, pathology outcomes, and postoperative complications of UR and no-UR arms were compared and predictors of UR were identified. Among demographic factors, only gender proportion showed a difference, with male proportion being significantly lower in the UR arm than in the no-UR arm (81% vs 92%, p = 0.010). For perioperative outcomes, anastomosis site stricture (27% vs 11%, p = 0.003) and length of hospital stays (23days vs. 19days, p = 0.001) were significantly higher in the UR arm than in the no-UR arm. In multiple logistic regression analysis, female (OR 3.32, 95% CI: 1.43-7.72) and body mass index (BMI) (OR 1.10, 95% CI 1.00-1.20) were UR predictors. UR after RALC with orthotopic neobladder diversion is significantly increased in females. Multiple logistic regression analysis identified female and BMI elevation as UR predictors.

Percutaneous Ultrasound-Guided Radiofrequency Ablation as a Therapeutic Approach for the Management of Insulinomas and Associated Metastases in Dogs

Insulinomas are the most common neoplasms of the endocrine pancreas in dogs, leading to persistent hypoglycemia due to inappropriate insulin secretion. The standard treatment is surgical resection, but it carries significant risks, including pancreatitis and diabetes mellitus. This study investigates the efficacy and safety of percutaneous ultrasound-guided radiofrequency ablation (RFA) as an alternative to surgery. A total of 29 dogs diagnosed with insulinoma were treated with RFA, targeting both primary pancreatic tumors and metastases in regional lymph nodes or the liver. Blood glucose levels and tumor size were monitored before and after the procedure. RFA led to a significant increase in blood glucose levels and a reduction in tumor size in all patients, with minimal postoperative complications. The results suggest that RFA is a feasible and effective treatment option for insulinomas in dogs.

Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis.

Peritoneal drainage (PD) following laparoscopic appendectomy(LA) has long been considered beneficial for appendicitis patients, especially those with complicated appendicitis. However, recent research has raised doubts about the advantages of PD, as it not only fails to reduce postoperative complications but also prolongs the operative duration and hospital stay and incurs higher medical expenses. Given this controversy, we conducted a meta-analysis to determine whether drainage is necessary after LA for complicated appendicitis. This meta-analysis had registered in PROSPERO(ID: CRD42023472382). This study assessed current evidence regarding the efficacy, safety, and potential benefits of drainage versus no drainage following LA for complicated appendicitis. We conducted a comprehensive search of PubMed, Springer, and the Cochrane Library using the search terms "appendicitis", "laparoscopic appendectomy", and "drain" or "drainage" for studies published between January 1, 2000, and December 31, 2022. We employed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria for study inclusion and exclusion. Primary outcomes included postoperative intra-abdominal abscess, postoperative intestinal obstruction, postoperative stump leakage, wound infection and postoperative visual analog scale(VAS) score, while secondary outcomes consisted of operative time, postoperative recovery time and total hospitalization duration. Studies with at least two outcomes were considered for meta-synthesis. Depending on I2 values, fixed- or random effects models were used for data synthesis. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated for outcome comparisons between PD and no peritoneal drainage (NPD). Sensitivity analysis and meta-regression were performed to assess and investigate inter-study heterogeneity. After conducting our literature search and screening, twelve studies were analyzed, comprising 3374 cases. During the comparison of primary outcomes between PD and NPD, the incidence of wound infection and postoperative VAS score were significantly higher in the PD group(P < 0.05). While during the comparison of secondary outcomes, the operative duration, postoperative recovery time and hospitalization duration were significantly longer in the PD group than in the NPD group(P < 0.05). PD following LA for complicated appendicitis not only increases the incidence wound infection and aggravate patients' postoperative pain, but also prolongs the operative duration, postoperative recovery time and hospitalization duration. Therefore, routine PD after LA for acute complicated appendicitis is not recommended.

Comprehensive Analysis of Purpura Fulminans as an Uncommon Postoperative Complication: A Case Series

Comprehensive Analysis of Purpura Fulminans as an Uncommon Postoperative Complication: A Case Series

Arthroscopic assisted versus open core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis.

Minimally invasive treatment options for osteonecrosis of the femoral head (ONFH) have been a prominent area of research in recent years. Arthroscopic-assisted treatments have been applied in the clinical management of ONFH; however, high-quality evidence verifying their effectiveness and safety is still lacking. To systematically assess the clinical efficacy and safety of arthroscopic-assisted core decompression (AACD) in treating ONFH. A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and the Chinese BioMedical Literature Database, from inception to June 25, 2024. We identified randomized controlled trials and non-randomized controlled studies on AACD for the treatment of ONFH based on predefined inclusion and exclusion criteria. A meta-analysis was performed using Review Manager 5.4.1 and Stata 17.0 software. The analyzed outcomes included operative time, intraoperative blood loss, length of hospital stay, postoperative femoral head collapse rate, Harris hip score, and postoperative complication rate. The Grades of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to assess the quality of evidence for the outcome indicators. A total of fourteen studies were included in this meta-analysis, comprising 1,063 patients-541 in the core decompression (CD) group and 522 in the AACD group. The meta-analysis revealed no significant differences between the two groups in terms of intraoperative blood loss, length of hospital stay, 12-month postoperative Harris hip score, or overall postoperative complication rate (P > 0.05). However, the AACD group had a longer operative time (MD = 31.19, 95% Cl: 5.32 to 57.07, P = 0.02) and a lower overall postoperative femoral head collapse rate (RR = 0.49, 95% Cl: 0.27 to 0.89, P = 0.02) compared with the CD group. Additionally, the AACD group showed significant improvements in Harris hip scores at 3 months (MD = 6.39, 95% Cl: 5.44 to 7.33, P < 0.00001), 6 months (MD = 7.56, 95% Cl: 6.63 to 8.49, P < 0.00001), ≥ 24 months (MD = 7.00, 95% Cl: 4.80 to 9.21, P < 0.00001), and at the last follow-up (MD = 6.89, 95% Cl: 5.30 to 8.48, P < 0.00001) compared to the CD group. The GRADE evidence assessment indicated that the overall postoperative complication rate was supported by moderate-quality evidence, while the evidence for operative time, intraoperative blood loss, postoperative femoral head collapse rate, and Harris hip score was of low quality. The evidence for length of hospital stay was deemed very low quality. This meta-analysis suggests that AACD is an effective and safe treatment for patients with ONFH. However, due to the limited quantity and quality of the included studies, these results should be interpreted with caution. Further high-quality studies are recommended to confirm these findings.

Impact of serial clinical swallow evaluations and feeding interventions on growth and feeding outcomes in children with long-gap esophageal atresia after anastomosis: a retrospective cohort study.

Children undergoing surgical anastomosis for long-gap esophageal atresia (LGEA) often suffer from complications related to delayed oral feeding, which may impair their early development. Clinical swallow evaluation (CSE) is an effective technique to improve feeding outcomes. However, there are limited evidences on the application of CSE in these children. Since 2020, serial CSEs have been consistently implemented for children undergoing anastomosis for LGEA in our hospital. We conducted a retrospective study comparing 19 children who received CSE with 31 historical controls who did not. Inverse probability of treatment weighting (IPTW) was applied to balance preoperative characteristics. We compared the time from surgery to full oral feeding and the rate of postoperative complications between the two groups. Growth curves for length-for-age Z score (LAZ) and weight-for-age Z score (WAZ) up to age 3 were fitted using generalized additive mixed models. The median time to full oral feeding was 1.1months [interquartile range (IQR), 0.8-2.4] in the CSE group and 1.5months (IQR, 0.6-5.7) for controls. After IPTW, CSE was associated with a shorter time to full oral feeding, with a weighted hazard ratio of 2.26 [95% confidence interval (CI), 1.21 to 4.24]. LAZ growth curves significantly differed between groups (P = 0.001). CSE was associated with the expedited achievement of full oral feeding and a more favorable growth pattern before 3years of age.

Multicenter outcome analysis of different sheath sizes for Flexible and Navigable Suction ureteral access sheath (FANS) ureteroscopy: an EAU Endourology collaboration with the global FANS study group.

Flexible and navigable suction ureteral access sheath (FANS) is a potential game changer in flexible ureteroscopy (FURS). The influence of sheath size on outcomes needs research. The primary aim was to analyze 30-day single stage stone free status (SFS), zero fragment rate (ZFR) and complications when using 10/12Fr sheaths vis a vis other sheath sizes. The global FANS research group published the 30-day outcomes in patients who underwent FANS and reasoned this can be a potential game changer. We included 295 patients from this anonymized dataset with division into two groups: Group 1 (Smaller sheath) - 10/12Fr FANS, and Group 2 (Larger sheath) - 11/13Fr or 12/14Fr sheaths. Stone volume was similar between both groups (median 1320 mm3, p = 0.88). Ureteroscopy and total operative time was longer in the smaller sheath group (35 vs. 32min, p = 0.02 and 50 vs. 45min, p = 0.001, respectively). While 30-day computed tomography SFS (100% stone free or single residual fragment ≤ 2mm) were not significantly different (96% vs. 95%, p > 0.99), ZFR (100% stone-free) was better with smaller sheaths (68% vs. 53%, p = 0.02). There was no difference in postoperative complication rates, and no sepsis in both groups. Urologists should consider individualizing appropriate sheath size in normal adult kidneys. Sheath size did not affect complication rates, risk of perioperative injury to the pelvicalyceal system or ureteric injury, but smaller FANS sheaths had similar high SFS. The ZFR with smaller sheaths was better, but this needs to be validated. These smaller sheath outcomes need to be balanced with longer ureteroscopy time, operative time, reach to the lower pole, ease of suction and visibility during lithotripsy. Large volume studies in different types of pelvicalyceal anatomy can determine if indeed smaller FANS is the best choice in FURS.

A pedicled anterolateral thigh flap decreased the risk of empty pelvis syndrome following total pelvic exenteration.

Total pelvic exenteration (TPE) can be complicated by empty pelvis syndrome (EPS), and none of the currently available procedures completely mitigate this problem. The aim of this study was to evaluate the feasibility and effectiveness of a pedicled anterolateral thigh (p-ALT) flap for preventing EPS. All cases of TPE at the National Cancer Center Hospital in Tokyo between 2008 and 2022 were retrospectively reviewed. The main indication for TPE was colorectal cancer, with some other malignancies. Background factors, surgical outcomes and postoperative complications were compared between patients who underwent primary suture closure (the PC group) and those who underwent p-ALT flap reconstruction (the flap group). A total of 114 patients underwent TPE during the study period. Twenty patients in whom a different procedure was performed or a different flap was used for reconstruction were excluded, leaving 94 for analysis (PC group, n = 54; flap group, n = 40). There was no significant between-group difference in patient characteristics. Severe pelvic abscess developed in 12 patients (22.2%) in the PC group and 2 (5%) in the flap group. Multivariable analysis identified a significantly lower risk of severe pelvic abscess in the p-ALT flap reconstruction (OR 0.07, 95% CI 0.01-0.58, p = 0.01). EPS-related readmissions were more common in the PC group [37.0% (20/54) vs. 25% (10/40)]. The risk of severe pelvic abscesses and readmission for EPS was significantly lower after perineal reconstruction with a p-ALT flap. Perineal reconstruction with this flap is a feasible and effective method in TPE.

Total Elbow Replacement in Swine: Surgical Technique and Initial Clinical Experience in a Kunekune Sow.

The aim of this study was to describe the development of a total elbow replacement (TER) technique in swine and report the outcome of TER in a Kunekune sow (61 kg) with severe elbow osteoarthritis. The technique was developed by operating on three pig cadavers (Yorkshire 40-50 kg). The TATE Elbow implant fit was confirmed with modeling to the patient's computed tomography imaging. Patient-specific instrumentation was printed for attempted use. Total elbow replacement was performed using a lateral approach, including lateral epicondylar osteotomy, careful retraction of the radial nerve, and preservation of the lateral collateral ligament. Postoperative care included controlled exercise and physical therapy. A lateral approach to the pig elbow for TATE TER was successfully developed. The bulk of the lateral head of the triceps muscle precluded use of the patient-specific instrumentation; the procedure was performed using standard instrumentation. Radiographic evidence up to 9 months postoperatively showed adequate implant alignment and satisfactory osteointegration of humeral and radioulnar components. There were not any postoperative complications and the patient's comfort was improved by 6 months and sustained at 18 months. A lateral approach for TATE TER in a pig with advanced elbow osteoarthritis proved feasible and effective. With the expansion of the TATE Elbow line, it is possible that a larger range of pigs could be treated. This report suggests that a lateral approach for TATE TER in dogs could represent a suitable alternative to the medial approach currently used.

Length of stay and determinants of early discharge and extended stay after cesarean delivery in a resource-limited setting: southern Ethiopia, 2023

BackgroundFor mothers and newborns to obtain the recommended postnatal care follow-up and package, the healthcare facility has to provide a minimum length of stay following delivery. Early discharge may result in a shortened recovery time, less access to resources and support, and a prolonged stay, resulting in a greater risk of postpartum depression and financial constraints. In Ethiopia, there has been no study conducted on the length of hospital stays following a cesarean delivery. Therefore, this study aimed to determine the average length of stay and identify factors influencing both early discharges and prolonged stays after cesarean delivery in southern Ethiopia.MethodsA facility-based cross-sectional study was conducted between November 23, 2022, and March 23, 2023. A systematic sampling method was used to select 367 participants, and data were collected using the Kobo Toolbox mobile application. The mean length of stay was calculated in hours, and descriptive statistics were used to summarize the data. Multinomial logistic regression was employed to analyze the determinants of length of stay, with significance set at a p-value of &amp;lt;0.05.ResultsThe mean duration of the length of stay of mothers in health facilities after cesarean delivery is 65 h or approximately 2.71 days (SD ± 0.77). Determinants of shorter stay included women aged 20–24 years [AOR = 5.19; 95%CI 1.51–8.23], distance from hospital 30–60 min [AOR = 2.51; 95% CI 1.12–5.73], first antenatal booking [AOR = 0.16; 95%CI 0.05–0.25], monthly income &amp;lt;2,000 birr [AOR = 3.11; 95%CI 1.18–6.05], had health insurance [AOR = 0.35; 95% CI 0.26–0.37] and had counseled [AOR = 0.09; 95%CI 0.07–0.154]. Extended stays were associated with severe pre-eclampsia [AOR = 2.80; 95%CI 2.41–3.27], multiple births [AOR = 2.51; 95%CI 1.34–4.71], and postoperative complications [AOR = 3.52; 95%CI 1.35–5.01].ConclusionThe average post-cesarean hospital stay is 2.71 days, with duration influenced by factors such as age, distance to the hospital, access to antenatal care, income, insurance, and the presence of complications. Targeted interventions, such as improving access to antenatal care, providing financial support, and proactively managing complications, can improve outcomes.

High prevalence of sarcopenia in patients with neuroendocrine tumours and carcinoid heart disease, but no effect on postoperative complications or survival

High prevalence of sarcopenia in patients with neuroendocrine tumours and carcinoid heart disease, but no effect on postoperative complications or survival

Clinical study of percutaneous endoscopic thoracic spine surgery via trench technique for thoracic spinal cord ventral decompression

To evaluate the feasibility, safety, and early effectiveness of percutaneous endoscopic thoracic spine surgery via the trench technique for ventral decompression in central calcified thoracic disc herniation (CCTDH) and thoracic ossification of the posterior longitudinal ligament (T-OPLL). Seven patients with single-segment CCTDH or T-OPLL admitted between June 2017 and May 2020 and meeting the selection criteria were retrospectively analyzed. There were 3 males and 4 females with an average age of 51.7 years ranging from 41 to 62 years. There were 2 patients with T-OPLL (T 1, 2 in 2 cases) and 5 patients with CCTDH (T 1, 2 in 1 case, T 7, 8 in 1 case, T 10, 11 in 2 cases, T 11, 12 in 1 case). Five patients with thoracic axial pain and intercostal neuralgia had a preoperative visual analogue scale (VAS) score of 6.0 (5.0, 6.5), and 7 patients had a preoperative Japanese Orthopaedic Association (JOA) score of 21 (21.0, 22.0). Transforaminal approach was used in 4 cases and transpedicular approach in 3 cases. Ventral decompression of thoracic spinal cord was performed by thoracic endoscopy combined with trench technique. The operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded. Thoracic spine CT and MRI were performed preoperatively and postoperatively to evaluate the surgical decompression, VAS score was used to evaluate the pain of thoracic back and lower limbs, and JOA score was used to evaluate the functional recovery. Modified MacNab criteria was used to evaluate the effectiveness. All surgeries were successfully completed. The operation time ranged from 60 to 100 minutes, with an average of 80.4 minutes; the intraoperative blood loss ranged from 40 to 75 mL, with an average of 57.1 mL; the postoperative hospital stay ranged from 4 to 7 days, with an average of 5.4 days. CT and MRI examinations indicated that the decompression was adequate. All 7 patients were followed up 3-22 months, with an average of 13.3 months. One case developed postoperative wound infection, and 1 case developed pneumonia; the remaining patients did not have any complications such as wound infection or cerebrospinal fluid leakage. Five patients with thoracic axial pain and intercostal neuralgia had VAS scores of 2.0 (1.5, 2.5) at 1 day after operation and 2.0 (1.0, 2.0) at last follow-up, both of which were significantly lower than the preoperative scores ( P<0.05). At 1 day after operation, the JOA scores for all 7 patients were 22.0 (21.0, 24.0), which showed no significant difference compared to the preoperative score ( P>0.05); however, at last follow-up, the score improved to 24.0 (24.0, 26.0), which was significant compared to the preoperative scores ( P<0.05). At last follow-up, the effectiveness was assessed using the modified MacNab criteria, the results were excellent in 2 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 71.4%. Using the trench technique, percutaneous endoscopic thoracic spine surgery can achieve the ventral decompression in CCTDH and T-OPLL, providing a new approach for surgical treatment of CCTDH and T-OPLL.

Effectiveness of sacroiliac screw implantation assisted by three-dimensional printed faceted honeycomb guide plate in treatment of posterior pelvic ring fracture

To investigate the effectiveness of sacroiliac screw implantation assisted by three-dimensional (3D) printed faceted honeycomb guide plate in the treatment of posterior pelvic ring fracture. The clinical data of 40 patients with posterior pelvic ring fractures treated with sacroiliac screw implantation between December 2019 and December 2022 were retrospectively analyzed. Among them, 18 cases were treated with sacroiliac screws fixation assisted by 3D printed faceted honeycomb guide plate (guide plate group), and 22 cases were treated with sacroiliac screws percutaneously fixation under fluoroscopy (conventional group). There was no significant difference in baseline data ( P>0.05) such as gender, age, time from injury to operation, and Dennis classification between the two groups. The implantation time, frequency of C-arm X-ray fluoroscopy, frequency of guide pin adjustment of each sacroiliac screw, and postoperative complications and bone healing were recorded. Majeed score was used to evaluate the functional recovery at 6 months after operation, and CT was used to observe whether the screw penetrated the bone cortex. The deviation between the virtual position and the actual position of the screw tip, the sacral foramen, and the screw entry point was measured on the sagittal CT images of the guide plate group. The number of screws implanted in S 1 and S 2 vertebral bodies was 14 and 16 respectively in the guide plate group, and 17 and 18 respectively in the conventional group. The implantation time of each sacroiliac screw, the frequency of C-arm X-ray fluoroscopy, and the frequency of guide pin adjustment in S 1, S 2, and all vertebrae in the guide plate group were significantly less than those in the conventional group ( P<0.05). Patients in both groups were followed up 8-48 months, with an average of 19.7 months. There was no incision infection, screw displacement, or internal fixation loosening in both groups. Callus growth was observed in all patients at 12 weeks after operation, and bone healing was achieved in all patients. The healing time ranged from 12 to 24 weeks, with an average of 15.7 weeks. No sacroiliac screw penetrated the bone cortex in the guide plate group; 2 patients in the conventional group had sacroiliac screws penetrating the bone cortex without damaging blood vessels or nerves. In the guide plate group, the deviation between the virtual position and the actual position of the screw tip, the sacral foramen, and the screw entry point were (2.91±1.01), (2.10±0.74), and (1.67±0.70) mm, respectively, with an average deviation of (2.19±1.22) mm. There was no significant difference in Majeed function evaluation between the two groups at 6 months after operation ( P>0.05). The application of 3D printed faceted honeycomb guide plate in sacroiliac screw implantation for posterior pelvic ring fracture can shorten the screw implantation time, reduce the frequency of fluoroscopy and guide pin adjustment, and reduce the risk of screw penetration through the bone cortex.