Postoperative Complications Research Articles

Evaluating the efficacy and safety of iontophoresis-assisted corneal cross-linking compared to standard CXL in the treatment of keratoconus.

To compare the outcomes of standard corneal cross-linking (S-CXL) and iontophoresis-assisted CXL (I-CXL) in Jordanian keratoconus patients over a 12-month follow-up period. This retrospective, observational cohort study included 107 keratoconus patients who underwent either S-CXL (n = 53) or I-CXL (n = 54) between January 2015 and December 2019. Data collected included demographic information, clinical history, and ophthalmic examinations. The primary outcome was the change in best-corrected visual acuity (BCVA) from baseline to 12 months post-procedure. Secondary outcomes included changes in spherical equivalent, cylindrical values, corneal curvature (K1, K2, Kmean, Kmax), and thinnest corneal location. Postoperative complications, such as corneal haze, keratitis, and the need for penetrating keratoplasty, were also assessed. Statistical analysis was performed using R statistical software. The mean age of patients was 25.0 years, with a male predominance (60%). Decreased vision was the most common symptom (63%). BCVA improvement was similar in both groups at all intervals. At 12 months, the mean BCVA change was 0.05 in the S-CXL group and 0.04 in the I-CXL group. No significant differences were observed in spherical equivalent values. Corneal curvature values (K1, K2, Kmean, Kmax) were significantly higher in the I-CXL group. Postoperative complications were minimal, with 40% of S-CXL patients and 93% of I-CXL patients experiencing no complications. Mild haze was more common in the S-CXL group (54%). S-CXL demonstrated superiority in improving corneal curvature at 6 and 12 months. Postoperative complications were minimal, with higher incidence of mild haze in the S-CXL group. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these results.

Peripheral Iridectomy With Goniosynechialysis and Goniotomy vs Trabeculectomy for Advanced PACG: A Randomized Clinical Trial.

The safety and effectiveness of combining surgical peripheral iridectomy (SPI) with goniosynechialysis (GSL) and goniotomy (GT) vs trabeculectomy for intraocular pressure (IOP) reduction remains unknown. To investigate the safety and effectiveness at 1 year of SPI + GSL + GT vs trabeculectomy in advanced primary angle-closure glaucoma (PACG) without cataract. This noninferiority randomized clinical trial was conducted at 8 tertiary eye centers in China. A total of 88 Chinese patients (88 eyes) with advanced PACG without cataract were enrolled from January 2022 to July 2023. Data were analyzed from August 2024 to September 2024. Mean (SD) patient age was 60.3 (7.3) years, and 52 patients (59.1%) were female. Forty-three patients were randomized to SPI + GSL + GT and 45 were randomized to trabeculectomy; 86 patients (97.7%) completed the 12-month follow-up. Participants were randomized 1:1 to receive SPI + GSL + GT or trabeculectomy. The primary outcome was IOP at 12 months (noninferior margin: 4 mm Hg). Secondary outcomes included surgical success (IOP: 5-18 mm Hg, ≥20% reduction from baseline, with or without antiglaucoma medications); postoperative complications and interventions, including bleb massage, suture lysis, or releasable sutures; and number of antiglaucomatous medications prescribed. At 12 months, the SPI + GSL + GT group had a mean (SD) IOP of 15.6 (4.0) mm Hg vs 14.9 (4.2) mm Hg in the trabeculectomy group (difference, 0.5 mm Hg; 95% CI, -1.2 to 2.2; P = .55), which was within the 4-mm Hg noninferiority margin. Qualified success rates were 38 of 43 participants (88.4%) for SPI + GSL + GT and 42 of 45 participants (93.3%) for trabeculectomy (difference, -5.0%; 95% CI, -19.6% to 8.5%; P = .48). However, complete success rates were lower in the SPI + GSL + GT group (26 participants [60.5%]) vs the trabeculectomy group (37 participants [82.2%]; difference, -21.8%; 95% CI, -40.2% to -2.4%; P = .03). Postoperative complications were present for 8 participants (18.6%) in the SPI + GSL + GT group vs 9 participants (20.0%) in the trabeculectomy group (difference, -1.4%; 95% CI, -17.9% to 15.1%; P = .71). Postoperative interventions were lower in the SPI + GSL + GT group (3 participants [7.0%] vs 25 participants [55.6%]; difference, 48.6%; 95% CI, 32.2%-65.0%; P < .001). Median (IQR) numbers of medications used decreased from 2 (0-3) to 0 (0-1) in the SPI + GSL + GT group and from 2 (2-3) to 0 (0-0) in the trabeculectomy group (difference, -0.81; 95% CI, -1.36 to -0.26; P = .004). In this randomized clinical trial among patients with advanced PACG without cataract, SPI + GSL + GT demonstrated noninferiority (4-mm Hg margin) to trabeculectomy for IOP at 12 months, with fewer interventions (including bleb massage, suture lysis, or releasable sutures) but no difference in postoperative medication use. This suggests SPI + GSL + GT as a potential alternative to trabeculectomy for similar cases, pending validation in larger sample sizes with smaller noninferiority margins. ClinicalTrials.gov Identifier: NCT05163951.

A comparative study on clinical outcomes and safety of accurate anterior cervical ossified posterior longitudinal ligament en bloc resection versus piecemeal resection in patients with ossification of the cervical posterior longitudinal ligament: a propensity score-matching analysis

ObjectiveThe anterior approach for cervical ossification of posterior longitudinal ligament (OPLL) excision can improve long-term neurofunctional recovery by providing direct spinal cord decompression. The objective of the present study was to compare the clinical outcomes and complications between accurate anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) versus piecemeal resection (ACOP) using propensity score-matching analysis.MethodsIncluded in this study were 189 OPLL patients (65 female) who underwent anterior cervical surgery, with a mean age of 54.85 years. Of them, 105 patients (39 female) with a mean age of 55.69 years underwent ACOE, and the remaining 84 patients (26 female) with a mean age of 53.80 underwent ACOP. Of the 189 patients, 70 patients (37%) had a canal occupying ratio (COR) ≥ 50%, and therefore the patient data were stratified by COR with 50%. The clinical outcomes were compared between the two groups during a at least 27-month follow-up period.ResultsThe mean final follow-up JOA score in ACOE group was higher than that in ACOP group. The JOA recovery rate of patients with COR ≥ 50% was higher in ACOE group. The mean operative time and intraoperative blood loss were both lower in ACOE group. However, postoperative complications were not significantly different between the two groups.ConclusionThis study demonstrated that the ACOE technique gained higher JOA recovery rates and better neurological recovery than ACOP for OPLL patients with COR ≥ 50%. In addition, ACOE offered a shorter operative time and less intraoperative blood loss as compared with ACOP. Therefore, the postoperative complications were not more common between two groups.

Minimally Invasive Surgery For Posterior Temporary Fixation Through Intermuscular Approach in the Treatment of Odontoid Fractures: A Retrospective Cohort Study.

Retrospective study. This study aims to evaluate the effectiveness of temporary fixation through intermuscular approach in reducing intraoperative blood loss, postoperative pain, and preserving suboccipital musculature. Odontoid fractures pose significant treatment challenges, particularly regarding the preservation of cervical range of motion and minimizing disruption to the occipitocervical muscles. Conventional posterior open approaches are associated with a high incidence of postoperative occipitocervical pain, dysfunction, and substantial perioperative blood loss. We hypothesized that minimally invasive posterior temporary fixation through an intermuscular approach, which avoids significant disruption of the suboccipital musculature, would offer advantages over the standard open approach. This study included patients aged less than 65 years old and without osteoporosis who underwent posterior temporary fixation for odontoid fractures between 2015 and 2023. Outcomes measured included fracture healing rate, surgery duration, blood loss, Visual Analog Scale (VAS) scores, narcotic use, postoperative complications, hospital stay duration, and changes in muscle cross-sectional area (CSA). 45 patients were included (26 in the intermuscular group and 19 in the open group). No significant differences were found in fracture healing time or postoperative complications between the groups. The intermuscular group showed significantly lower intraoperative blood loss, shorter hospital stays, reduced postoperative VAS scores, and a decreased need for supplementary narcotics. Additionally, the intermuscular approach better preserved key occipitocervical muscles, with less CSA reduction compared to the open approach. No failures of internal fixation were observed in either group. Minimally invasive posterior temporary fixation through the intermuscular approach offers substantial benefits over traditional open surgery for odontoid fractures. These include reduced blood loss, lower postoperative pain, shorter recovery time, and better preservation of suboccipital musculature, all without compromising fracture healing. This technique provides an effective, muscle-sparing alternative for open temporary fixation in the treatment of odontoid fractures.

Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review.

Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery. We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications. Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I2 = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I2 = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I2 = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications. Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications. PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.

Impact of Routine Postoperative Care Versus Nurse-Led Lifestyle Interventions on Patient Outcomes After Radiofrequency Ablation: A Randomized Controlled Trial.

Paroxysmal atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity. Radiofrequency ablation (RFA) is a widely used treatment, but postoperative complications and recurrence remain concerns. Nurse-led lifestyle interventions have been proposed as a strategy to improve patient outcomes after RFA. The objective of this randomized controlled trial was to compare the effects of routine (usual) care versus a nurse-led lifestyle intervention on postoperative outcomes in patients undergoing RFA for paroxysmal AF. A total of 160 patients undergoing RFA for paroxysmal AF were randomly assigned in a 1:1 ratio to either the intervention group or the usual-care group. The intervention group received tailored lifestyle interventions managed by a nurse-led multidisciplinary team, focusing on exercise, diet, medication adherence, and psychological support. The usual-care group received standard postoperative care. The primary outcomes were quality of life (Short Form-36 scores) and recurrence of AF. Data were collected at baseline, 6 months, and 12 months. The nurse-led lifestyle intervention group showed significant improvements in Short Form-36 scores for Physical Functioning, Role Limitations, Vitality, General Health, and Social Functioning compared with the usual-care group at 6 months (P < .05). The recurrence rate of AF at 12 months was significantly lower in the nurse-led lifestyle intervention group (12.5%) compared with the usual-care group (26.3%, P = .021). The incidence of postoperative complications was also reduced in the nurse-led lifestyle intervention group. These findings suggest that nurse-led care models may provide a valuable approach to optimizing postoperative outcomes for AF patients, emphasizing the need for structured, personalized interventions in clinical practice.

Noninferiority of coiling versus coiling with particles in middle meningeal artery embolization: A technical note and case series.

To investigate the possibility of using coils as a standalone treatment for middle meningeal artery embolization. Four patients (3 females, 1 male, median age 77.5) with bilateral subdural hematomas were treated with bilateral MMA embolization. One hematoma of each patient was treated with coils and PVA, and the other was treated exclusively with coils. New or resolved symptoms, radiographic imaging demonstrating hematoma change, and complications were recorded and compared between the two treatment modalities. Minimum follow-up time was three months. All patients demonstrated symptomatic and radiographic improvement at three month follow-up. None of the patients in this cohort received surgical evacuation of the hematoma prior to or after embolization. One patient had previously been treated for hydrocephalus with a VP shunt. There were no postoperative complications. In the hematomas treated with a combination of coils and particles, three showed complete resolution with one showing interval improvement on imaging. All hematomas treated with coils alone demonstrated complete resolution after three months. Middle meningeal artery embolization with coils alone has demonstrated noninferior results to embolization with a combination of particle embolisate and coils in this small cohort.

Reduced Returns to ED With Post-Tonsillectomy and Adenoidectomy Chat Program: Outcomes and Costs.

Patients who participate in the post-surgical chat programs will have lower rates of emergency department (ED) visits when compared to those who do not participate. Data from a texting program was used to stratify patients into those participating versus those not participating with the program. Individual patients' charts were reviewed for demographic information, if a postoperative ED visit related to surgery occurred, and if the ED visit was caused by a failure of patient education regarding the treatment plan or by expected postoperative symptoms. Odds ratios compared the ED visit rates between participating and non-participating families. Cost was analyzed by comparing published data on ED visit costs with internal data on chat program cost. During the study (2/2022-3/2023), 1059 unique patients (children/caregiver dyads) were enrolled in the chat. Five hundred and fifty-eight patients (52.7%) participated in one or more chats while 501 patients (47.3%) did not participate. Of note, patients with public insurance were less likely to participate. Non-participants were 9.12 times more likely to visit the ED postoperatively due to a communication lapse (p = 0.047). Estimated savings from 1 year of avoided ED visits did not outweigh the chat program's expense. Utilization of an automated messaging system for frequently asked questions after pediatric tonsillectomy demonstrated a statistically significant reduction in ED visits and readmissions related to postoperative complications and questions, but an increase in health care costs.

The mentoring effects of learning curve of total extraperitoneal hernioplasty: the CUSUM analysis of the pioneer and second-generation surgeon.

Most studies demonstrated that the learning curve of total extraperitoneal hernioplasty (TEP) is around 30-80 cases. All these studies were performed by a single surgeon who had little or no experience of TEP repair before. However, with mentoring by experienced surgeon, the second-generation surgeon may get more familiar with the anatomy and procedures of TEP than the pioneer surgeon. Besides, the surgical caveats would be further understood and pitfalls avoided by mentoring with the pioneer surgeon. The aims of this study were to investigate the effects of mentoring by pioneer surgeon to the second-generation surgeon in the TEP operation by comparing the learning curve and complications of pioneer and second-generation surgeon. We retrospectively reviewed our TEP cases performed by the two surgeons, the pioneer surgeon and the second-generation surgeon, in general surgery department in Chang Gung Memorial Hospital, Keelung division. The reviewed period was between January 2016 and December 2021. The pioneer surgeon performed the TEP surgery by himself. The second-generation surgeon attended 20-30 cases of TEP done by pioneer surgeon. Then, the pioneer surgeon mentored the second-generation surgeon's first 10 TEP cases. By comparing the operation time, the intraoperative and post-operative complications, cumulative sum (CUSUM) learning curve was used for analysis. The CUSUM analysis reveals that the learning curve of TEP is around 45 procedures in the pioneer surgeon and 30 procedures in the second-generation surgeon. The median operation time in pioneer surgeon and second-generation surgeon is 103.5 vs 90 min (p = 0.03). The overall intraoperative and post-operative complications between pioneer and second-generation surgeon reveal no significant difference. After crossing the learning curve, the operation time of pioneer surgeon and the second-generation surgeon decreased significantly, from 114 to 93 min (p = 0.008) and from 103 to 87.2min (p = 0.032), respectively. However, there was no significant difference in the overall post-operative complications. By mentoring with the pioneer surgeon, the second-generation surgeon may achieve the learning curve quicker than the pioneer surgeon in terms of operation time. After reaching the learning curve, the operation time before and after learning curve reveal significant different in both surgeons while the overall post-operative complications reveal no significant different.

Long-Term Outcomes of Lymphedema After Immediate Lymphatic Reconstruction Following Axillary Lymph Node Dissection.

Breast cancer-related lymphedema (BCRL) significantly affects quality-of-life after axillary lymph node dissection (ALND). Although immediate lymphatic reconstruction (ILR) may reduce BCRL incidence, its long-term outcomes and predictors remain unclear. We report long-term BCRL prevalence in patients undergoing ILR and delineate factors associated with BCRL after ILR. We retrospectively studied consecutive patients who underwent ILR following ALND between 2017 and 2024 across six hospitals in the Indiana University network. Primary outcome was BCRL prevalence, defined as ≥ 2-cm limb difference at two contiguous points. Secondary outcomes included BCRL predictors, postoperative complications, and compression garment use. We identified 172 patients with a mean age 50.9 ± 11.6years, body mass index of 29.5 ± 6.9kg/m2, and follow-up time of 23.1 ± 15.2 months. Most patients (57.7%) underwent mastectomy, ALND with breast reconstruction. The median number of lymph nodes removed during ALND was 15 (interquartile range [IQR] 10.0-21.0), and median number of positive lymph nodes was 2.0 (IQR, 0.0-4.0). The cumulative BCRL incidence was 7.0% (n = 12 patients). Median time to significant limb swelling was 4.5 (IQR, 1.0-11.3) months. Fifty-five patients (32.0%) used postoperative compression garments. Breast-related complications occurred in 30.2% of patients. Black/African American patients had significantly higher lymphedema rates than White patients (18.8% vs. 4.5%, p = 0.005). In adjusted analyses, Black/African American race was an independent predictor (odds ratio [OR], 6.38; p < 0.006) of BCRL. Immediate lymphatic reconstruction following ALND demonstrated low BCRL rates, although Black or African American patients remain at disproportionately higher risk, warranting targeted interventions and further investigation.

Soft-tissue volume augmentation during early, delayed, and late dental implant therapy: A systematic review and meta-analysis on professionally determined esthetics and self-reported patient satisfaction on esthetics.

The objective of the study was to assess the effect of soft-tissue volume augmentation during early, delayed, and late dental implant therapy in terms of professionally determined esthetics and self-reported patient satisfaction on esthetics. For this,a comprehensive electronic literature search was performed to identify randomized clinical trials (RCTs) and controlled clinical trials (CCTs) reporting professionally determined esthetic outcomes and self-reported patient satisfaction on esthetics (primary outcomes) during early, delayed, and late dental implant placement comparing soft-tissue volume augmentation to the absence of soft-tissue grafting (control) (PICO 1) or comparing various soft-tissue augmentation techniques, procedures, and materials (PICO 2). Secondary outcomes were mucosal thickness (MT), intra- and postoperative complications, marginal soft-tissue-level changes, keratinized tissue width, radiographic marginal bone levels, and clinical parameters for the diagnosis of peri-implant tissue health. The standard mean differences (SMD)/weighted mean differences (WMD) were estimated for the Pink Esthetic Score (PES), self-reported patient satisfaction assessed by Visual Analog Scale (VAS) and MT gain for PICO 1 and PICO 2 by employing a random effect model. Five RCTs were included for PICO 1, whereas 7 RCTs and 1 CCT addressed PICO 2. PICO 1: The SMD for the PES between autogenous soft-tissue grafting (SCTG) and the absence of grafting (control group) was 0.47; 95% CI [-0.15, 1.09; p = 0.14] based on 5 RCTs. The SMD for the VAS values for patient-reported satisfaction on esthetics in the SCTG and control group was 0.46; 95% CI [-0.12, 1.03; p = 0.12] (2 RCTs). The WMD for gain of MT amounted to 1.06 mm; 95% CI [0.81, 1.31; p = 0.00] in favor of the SCTG group (3 RCTs). PICO 2: The SMD for the PES comparing collagen-based matrices (CM group) to the SCTG group was -0.32; 95% CI: (-0.57, -0.07; p = 0.01), in favor of the SCTG group (5 RCTs and 1 CCT). The SMD for the VAS for patient-reported satisfaction on soft-tissue esthetics was 0.24; 95% CI: (-0.31, 0.78; p = 0.40) (2 RCTs comparing CM vs. SCTG). The WMD for gain of MT was -0.27 mm; 95% CI: (-0.36, -0.17; p = 0.00), significantly favoring the SCTG group (4 RCTs). Professionally and patient-assessed outcomes showed no substantial differences between autogenous soft-tissue grafting and the absence of grafting for early, delayed, and late implant placement. However, autogenous soft-tissue grafts led to significantly improved esthetic outcomes as assessed by professionals compared to soft-tissue substitutes. Patient-assessed outcomes, nevertheless, were similar regardless of the grafting material (i.e., SCTG or soft-tissue substitute). Therefore, autogenous soft-tissue grafting, though, resulted in a considerably higher gain in mucosal thickness compared to both the absence of soft-tissue grafting and the use of soft-tissue substitutes. Complications and adverse events were rarely reported by the included studies, thus suggesting that many trials underreport harms (e.g., complications).

A China-Based exploration of surgical timing for polytrauma with a focus on fracture reconstruction

BackgroundFor patients with severe polytrauma and fractures, early fracture reconstruction surgery under stable conditions can significantly reduce pulmonary and other complications. However, premature surgical intervention may heighten infection risk, adversely affecting the patient’s prognosis. Consequently, determining the optimal timing of surgery is crucial for patients with multiple traumatic injuries. Given China’s healthcare context, this study will assess injury severity and perform definitive fracture reconstruction at specified post-trauma intervals. Postoperative infection rates, including wound infections, other complication incidences, hospital stay duration, treatment costs, and long-term outcomes will be observed and compared to identify the optimal timing for surgical intervention. This study also aims to develop effective polytrauma management models. By applying accessible criteria and choosing suitable timing for fracture reconstruction, we can better assess patient conditions, reduce complications, and minimize the surgery’s “second hit” effect, addressing an important research gap regarding optimal surgical timing for polytrauma in China.MethodsThis study collected data on 200 patients treated at our hospital between March 2023 and March 2024, with an average age of 47.24 ± 16.56 years and an average Injury Severity Score (ISS) of 25.85 ± 13.35. A total of 250 fractures received definitive fixation in the initial surgery, including femoral fractures (n = 75), spinal fractures (n = 46), pelvic ring fractures (n = 49), tibial fractures (n = 25), acetabular fractures (n = 12), humeral fractures (n = 12), and other fractures (n = 5) (including clavicle, radius and ulna, calcaneus, and patella). Among these patients, 151 underwent single-fracture reconstruction, 42 had two fractures reconstructed, and 5 had three fractures treated during the first surgery. The study protocol excluded patients with absolute contraindications, including bacteremia and infections near the surgical site. Additional inclusion criteria required stable vital signs (temperature < 38.5 °C with a downward trend, systolic blood pressure > 100 mmHg, stable traumatic brain injury status) and blood routine (white blood cell count < 22.0 × 10⁹/L with a neutrophil percentage < 90%, both trending downward; platelet count > 50 × 10⁹/L; hemoglobin > 90 g/L). Based on these criteria, historical cohorts were identified and assigned to either an experimental group or a control group. Observed outcomes included postoperative complications, wound healing grades, inflammatory markers, changes in vital signs, length of hospital stay, costs, and long-term follow-up results.ResultsAmong the patients, 97 underwent surgery after meeting the specified criteria for fracture reconstruction, while 103 received surgery without meeting these criteria. Patients who met the surgical criteria demonstrated superior outcomes, with lower complication rates (including pneumonia and respiratory distress syndrome), improved surgical incision healing, faster postoperative consciousness recovery, shorter overall and ICU stays, reduced hospitalization costs, greater joint mobility at the 9-month follow-up, and higher quality of life assessments compared to those who did not meet the criteria. Among patients who met the criteria, those with spinal fractures experienced better quality of life outcomes, and those with femoral fractures showed improved fracture healing.ConclusionsFor polytrauma patients with fractures, performing surgery once surgical requirements are met results in fewer early postoperative pulmonary complications, quicker recovery of consciousness, lower wound infection rates, shorter hospital and ICU stays, reduced costs, and improved postoperative outcomes. This protocol is safe and effective for most polytrauma patients requiring fixation, particularly those with mechanically unstable femoral, pelvic, acetabular, or spinal fractures.

Comparison of Short-Term Results of Total Extraperitoneal Repair Using Balloon Dissection with Mesh Fixation Versus Telescopic Dissection Without Mesh Fixation.

Background: Total extraperitoneal (TEP) hernia repair is a minimally invasive method for the treatment of inguinal hernia. In this study, one group with balloon dissection and mesh fixation was compared with another group that underwent telescopic dissection without mesh fixation. This study aims to compare both methods in terms of effectiveness, complications, pain scores, and clinical outcomes. Material and methods: This study is a retrospective evaluation of prospectively acquired data from patients in a single-center setting. Patients were divided into two groups: Group 1, who underwent balloon dissection with mesh fixation, and Group 2, who underwent direct telescopic dissection without mesh fixation. All operations were performed by the same surgical team. Predefined data for both groups were compared statistically. Results: Among the 115 patients, 66 (57.4%) were in Group 1 and 49 (42.6%) in Group 2. No significant difference was found between demographic characteristics and clinical features for two groups. Surgical times for unilateral and bilateral repairs were similar between the groups. Hospital stay duration was also comparable. The conversion rates to transabdominal preperitoneal were 4.5% in Group 1 and 8.2% in Group 2. Postoperative complications were similar between the groups. However, significant differences were found in pain scores, with Group 1 experiencing higher pain levels on the first day, after 1 week, and after 6 months compared to Group 2. Conclusion: Both balloon dissection with mesh fixation and direct telescopic dissection without mesh fixation are safe and effective techniques for TEP hernia repair with similar short-term outcomes. However, balloon dissection and mesh fixation may result in higher postoperative pain levels and incur higher costs. The choice of technique should be guided by available resources, surgeon experience, and patient-specific factors. Further studies are needed to evaluate the long-term outcomes and cost-effectiveness of both approaches.

Surgical management and outcomes of ankylosing spondylitis fractures in adults: a systematic review and meta-analysis.

Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the vertebral column. Surgical management of traumatic spinal fractures in patients with AS is often the first line treatment, however it has a high risk of perioperative complications. This systematic review explored current operative techniques and their outcomes in patients with AS sustaining traumatic spinal fractures. A PRISMA-compliant systematic review was conducted, and databases Embase, Pubmed/Medline and Cochrane were searched from inception to April 2024. Studies were included if they had complete individual patient data. Data was synthesized qualitatively and quantitatively. Univariate and multivariate logistic regression and ordinal regression was performed on R, to evaluate the relationship between surgical outcomes and independent patient and operative factors. Seven studies with complete individual patient data were included, involving 150 patients. Increasing age was a significant predictor of mortality (OR 1.08, 95% CI 1.04-1.13, p < 0.001) and post-operative complications (OR 1.07, 95% CI 1.04-1.10, p < 0.001). Fixation and decompression of the thoracic level was also strongly associated with higher complications (OR 6.4, 95% CI 1.28-40.14, p < 0.05). Single level compression improved post-operative ASIA outcomes (OR 0.43, 95% CI 0.17-0.97, p < 0.05). A higher pre-operative ASIA score (C, D or E) was related with improved post-operative neurological recovery. This study emphasizes the impact of age, level of spinal involvement, and surgical approach on surgical outcomes of traumatic spine fractures in AS. Future randomised controlled trials in the field can help further refine surgical strategies and improve patient care.

The association and impact of radiographic, pathological emphysema and spirometric airway obstruction on patients with resectable lung adenocarcinoma

BackgroundDestruction of alveoli structure and lung function are interrelated, however, their correlation and clinical significance have been not well defined in patients with lung cancer. Thus, this study aimed to examine the association among radiographic, pathological emphysema and spirometric airway obstruction in patients with resectable lung cancer as well as explore their impact on postoperative pulmonary complications (PPCs) and long-term prognosis.MethodsLung adenocarcinoma (LUAD) patients who performed chest CT, spirometry, and curative resection were included from a prospective three-institution database. CT-defined emphysema at baseline was assessed visually and quantitatively, pathological emphysema was reviewed on postoperative specimen. Multivariable regression models, propensity score matching, stratified analysis, and subgroup analysis were adopted to reduce selection bias.ResultsOur cohort included 902 patients, with a median follow-up of 5.6 years. CT-defined emphysema was present in 163 patients (18.1%) and most of them (86.5%) were validated with pathological evidence. 169 had spirometric airway obstruction, while only 29.6% patients overlapped with CT-defined emphysema. Multivariable logistic regression models showed CT-defined emphysema, not airway obstruction, was associated with an increased risk of PPCs (adjusted odds ratio, 2.35; 95% CI, 1.40–3.93; P = 0.001). After adjusting for age, sex, body mass index, smoking history, tumour stage, vascular invasion, pleural invasion, multivariate cox analysis identified CT-defined emphysema, not airway obstruction, as an independent prognostic factor for OS (adjusted hazard ratio, 1.44; 95%CI, 1.05–1.97; P = 0.022). Patients with both radiographic and pathological emphysema experienced worse OS (log-rank P < 0.001). In the propensity score-matched cohort, stratified analysis, and never-smokers subgroup analysis, CT-defined emphysema remained a strong and statistically significant factor related to poor survival.ConclusionsThe presence of radiological and pathological emphysema in resectable LUAD was associated with frequent PPCs and decreased survival.Clinical trial numberNot applicable.

Aspiration risk and strategic approach for patients receiving GLP-1 receptor agonists undergoing elective surgery.

Perioperative management of patients receiving a glucagon-like peptide-1 receptor agonist (GLP-1 RA) remains challenging for the anesthesiologist. Despite the approval of GLP-1 RAs 2 decades ago, the recent reports of aspiration and postoperative pulmonary complications drew attention to this group of medications and resulted in multiple societal guidelines that would provide recommendations for anesthesiologists and proceduralists on the appropriate perioperative management of GLP-1 RAs. However, despite these guidelines and proposed options, there was a lack of adequate evidence to support holding versus continuing the medication, as well as data related to the role of gastric ultrasound in that decision-making process. The release of multiple societal guidelines and studies evaluating the impact of GLP-1 RAs on perioperative outcomes resulted in more controversy and uncertainty for the clinician anesthesiologist to follow. The ultimate goal for perioperative management of these medications is to evaluate an individual patient's risk of aspiration, rather than assuming the risk is low when holding the medication appropriately or high if not holding it. Furthermore, it is unclear whether holding these types of medicines or unnecessary postponing of surgery may result in adverse outcomes. In this narrative review, we present a summary of the existing literature on the topic with a focus on the risk of aspiration and a recommendation for perioperative management to include the utilization of gastric ultrasound for surgery patients based on their risks.

Surgical Strategy Analysis of Chiari Malformation With or Without Type II Basilar Invagination According to the Morphological Types of the Atlanto-Occipital Joint: A Retrospective Study of 212 Patients.

Our previous study categorized atlas occipital joint (AOJ) morphology into three types, with types II and III-AOJ associated with Chiari malformation (CM) with and without Type II basilar invagination (II-BI), respectively. This study aimed to assess the feasibility of tailoring surgical strategies for patients with CM based on AOJ morphological types. We retrospectively studied 212 CM patients who underwent foramen magnum decompression (FMD) or combined occipitocervical fusion (OCF). Patients were divided into four groups: (1) pure CM with II-AOJ who underwent FMD (CM-II-FMD); (2) pure CM with III-AOJ who underwent FMD + OCF (CM-III-OCF); (3) CM-III-FMD; and (4) CM + II-BI with III-AOJ who underwent FMD + OCF (BI-III-OCF). Clinical data, including manifestations, imaging findings, surgical details, and neurological assessments, were analyzed at the final follow-up to assess surgical efficacy. Patients in the BI-III-OCF, CM-III-OCF, and CM-II-FMD groups exhibited a significant improvement in clinical symptoms (pain, sensory disturbances, motor weakness, gait ataxia, and bladder and bowel dysfunction) compared to preoperative levels (p < 0.05). Results from the Japanese Orthopedic Association scale and Neck Disability Index indicated a significant reduction in the degree of neurological impairment within these groups (p < 0.05). Furthermore, the Chicago Chiari Outcome Scale scores indicated superior surgical outcomes for patients in these groups. Imaging analyses demonstrated significant reductions in the syringomyelic segment, syringomyelia width, and tonsillar herniation distance among these patients (p < 0.05). However, the CM-III-FMD group did not significantly improve in these areas (p > 0.05). Postoperative complications occurred in 4.3% of FMD + OCF patients and 3.3% of FMD-only patients. AOJ morphological types can guide surgical treatment strategies for CM with or without II-BI. FMD alone is suitable for II-AOJ cases, whereas III-AOJ cases should be treated with FMD combined with OCF.

A Review of Postoperative Complications in Colon Cancer Surgery: The Need for Patient-Centered Therapy

A Review of Postoperative Complications in Colon Cancer Surgery: The Need for Patient-Centered Therapy

Optimizing timing for elective surgery in cancer patients following COVID-19 infection; a post-pandemic analysis

IntroductionThe COVID-19 pandemic introduced challenges including delaying elective surgery. For cancer patients, reducing delays is preferred to prevent unfavorable outcomes. there is a lack of consensus regarding the optimal timing of elective surgery following a SARS-CoV-2. This study aimed to find the optimal time to elective surgery to minimize 30-day postoperative morbidity and mortality.MethodsThis is a retrospective chart review of all adult patients who underwent elective surgery with a confirmed preoperative COVID-19 diagnosis between September 2020 and April 2023. Patients’ elective surgeries delays were examined to determine the optimal time to surgery in terms of postoperative complications. Analysis was controlled for age, ASA score, comorbidities, and smoking status.Results358 records examined, 94.7% had delayed surgery and 5.3% had cancelled surgery. The optimal time to surgery was ≥ 17 days to minimize postoperative pulmonary complications [OR: 0.299, p = 0.048], other postoperative complications [OR: 0.459, p = 0.01], and a decrease in length of hospital stay. In multivariate analysis, the only significant predictors for postoperative complications were time to surgery; surgery ≥ 17 days after diagnosis had better postoperative outcomes [p < 0.001], and COVID-19 symptoms status [p = 0.019].ConclusionThe best time to surgery in this cohort is at least 17 days (or a range of 2–3 weeks) for optimal results. Further research is needed to investigate the effect of such delays on oncological outcomes in this cohort.

Accessory lung lobectomy in dogs: 11cases (2009-2023).

To describe accessory lung lobectomy, via right or left intercostal thoracotomy, intraoperative and postoperative complications and outcome in a small population of dogs. The medical records of 11 dogs that underwent accessory lung lobectomy at three veterinary institutions between 2009 and 2023 were reviewed. Signalment, history, physical examination, diagnostics, duration of hospitalisation, surgical approach, type of lobectomy, concurrent procedures, intraoperative and postoperative complications, duration of indwelling thoracic drain and short-term outcomes were recorded. Dogs underwent accessory lung lobectomy either via right (n = 9) or left (n = 2) intercostal thoracotomy. Partial (n = 6) or total lobectomy (n = 5) with stapler devices (n = 10) or surgical ligation (n = 1) was performed. Histopathology was performed in ten of 11 dogs and was consistent with pneumonia due to an infectious process or a migrating vegetable foreign body (n = 5), pulmonary carcinoma (n = 2), severe chronic neutrophilic and macrophagic pleuropneumonia (n = 1), pulmonary bullae (n = 1) or blastomycosis infection (n = 1). Iatrogenic trauma to the left caudal lung lobe occurred in one dog via left intercostal thoracotomy. The mean duration of indwelling thoracic drain was 2.7 days (range 1to 4). Complications occurred postoperatively in six dogs. In five of six cases, short-term postoperative complications were classified as minor and included wound infection (n = 1), cough (n = 1), dyspnoea (n = 1), adverse reaction to medication (n = 1) and inappetence (n = 1). One case developed a major complication, pneumothorax with dehiscence of the lobectomy site, and revision surgery was required. All dogs survived hospital discharge. Accessory lung lobectomy is uncommon and can be performed either via left- or via right-sided intercostal thoracotomy.