Postoperative Decrease Research Articles

Long-term changes in myocardial function after CABG assessed by speckle tracking echocardiography

Abstract Introduction Speckle-tracking echocardiography (STE) is an advanced imaging technique for assessing myocardial function, which is more sensitive and specific than standard parameters in detecting subtle changes in myocardial function. Purpose We evaluated global and regional left ventricular (LV) and left atrial (LA) function changes in patients undergoing coronary artery bypass grafting (CABG) using standard and advanced echocardiographic techniques. Methods The study group included 83 patients (72 men, 11 women; mean age 65,1±8,4 years) scheduled for CABG due to multivessel coronary artery disease (CAD). All patients underwent pre- and postoperative transthoracic echocardiographic examinations (TTE). Offline analysis of global functional parameters was performed, including left ventricular ejection fraction (LVEF), global systolic longitudinal strain (GLS), and global peak longitudinal strain (GPLS). Regional systolic and diastolic left ventricular function was analyzed by measuring peak systolic strain rate (SRS), peak diastolic longitudinal strain rate in the early (SRe) and late phase (SRa), and the post-systolic index (PSI). LA strain was also assessed. During the 2nd examination (7,9±3 days), 68 patients had sufficient image quality for analysis. 42 patients attended the 3rd examination (9±2,3 months). 30 patients attended the 4th examination (60,3±5,1 months). Results were compared to the 1st examination. Nine deaths were recorded in the study group. Results The mean baseline LVEF was 46±10%. During 2nd TTE, we noticed a reduction of LVEF to 41±10% (p=0.0016). LVEF remained reduced during the 3rd TTE, but returned to baseline at the 4th examination (50±8%). There was a significant decrease in global strain parameters observed during 2nd TTE. GLS decreased from -12,63±3,5% to -10,61±5,25% (p<0.0001), and GPLS from -13,46±3,4% to -11,77±4,52% (p<0.0001). Global strain parameters recovered at the 3rd and 4th examinations, with no significant differences from the 1st examination. Regional systolic and diastolic deformation parameters followed a similar trend, though only SRS showed a significant persistent reduction during the 4th TTE (0,73±0,15/s) compared to the 1st (0,82±0,17/s, p=0.0290). CABG did not impact LA function. Conclusion CABG leads to a significant postoperative decrease in global longitudinal LV deformation, which recovers over the long term. Revascularized territories show a similar trend. Recovery of global and regional strain parameters occurs earlier than LVEF recovery. CABG does not significantly impact LA function as assessed by STE.

A Non-invasive Lung Disease Study of Exhaled Breath Nitric Oxide Based on Ultraviolet Differential Absorption Spectroscopy Techniques.

In this study, a non-invasive device based on ultraviolet differential absorption spectroscopy (UV-DOAS) technology for detecting fractional exhaled nitric oxide (FeNO)was developed and clinically validated in patients with various lung diseases. The diagnostic potential of FeNO was explored by analysing subgroups of patients with lung cancer, nodules, and other disease. The results showed that FeNO concentrations were significantly higher in patients with malignant tumours than in healthy controls (p < 0.01). The diagnostic efficacy of FeNO in different lung diseases was confirmed by ROC analysis: the AUC values were 0.925 for malignant tumours, 0.925 for suspected malignant/benign tumours, 0.792 for benign lesions, and 0.938 for infectious/inflammatory diseases. The significant postoperative FeNO level decrease supports the diagnostic use of FeNO in different stages of the disease. Compared with conventional electrochemical, chemiluminescent and fluorescent probe methods, the UV-DOAS technique has significant advantages regarding sensitivity and portability, suggesting its potential for clinical application.

Inception of novel equations for estimation of differential renal function changes after successful pyeloplasty in children

ABSTRACT Introduction Ureteropelvic junction obstruction is the most common cause of pediatric hydronephrosis. Anderson Hynes dismembered pyeloplasty as the standard surgical treatment in such cases. Purpose To evaluate and detect factors that affect renal function changes (improvement) after successful pyeloplasty using Tc-99 m Diethylenetriaminepentaacetic (DTPA) renography in children and to predict renal scan changes after successful pyeloplasty. Methods This retrospective study was conducted on children ≤ 18 years of age who underwent successful pyeloplasty from May 2018 to May 2022. Pelvic-abdominal ultrasonography and radioisotope scan Tc-99 m DTPA were performed in all patients. Results Postoperative group showed a significant increase in renal parenchyma thickness, split renal function, and glomerular filtration rate with a decreased renal pelvis anteroposterior diameter (p < 0.05). There was a significant correlation between each postoperative decrease in the anteroposterior diameter of the renal pelvis and the postoperative increase in parenchyma thickness with the postoperative increase in split renal function. The equation used to detect postoperative split renal function and glomerular filtration rate had a high detection rate. Conclusions Pyeloplasty resulted in significant improvements in hydronephrosis, and renal parenchymal changes in association with renal pelvis diameter can predict Postoperative increase in split renal function and glomerular filtration rate.

The Concept of Palliative Lymphaticovenular Anastomosis.

Introduction: Lymphaticovenular anastomosis (LVA) is the first-line surgical treatment for lymphedema. The therapeutic effects of LVA, including edema reduction and cellulitis prevention, vary among patients. We examined cases of palliative LVA in patients with lymphedema who were in the terminal stage due to recurrence or distant metastasis of the primary disease, with a focus on the course and usefulness of palliative LVA. Methods and Results: A total of 13 palliative LVAs were performed in 12 patients undergoing palliative treatment. LVA was performed without interfering with chemotherapy or radiation. Data on site and stage of edema, compression treatment status, number of anastomoses, percentage change in circumferential diameter (the total circumference at six locations was compared), treatment efficacy, and patient prognosis were collected. Edema was present in the upper and lower extremities of 10 and 2 patients, respectively. The average postoperative decrease in circumferential diameter was 8.6%. Psychological evaluation was based on the self-reports of patients, and 11 out of 12 patients showed improvement in their mental state. Two patients died during the observation period due to deterioration in the underlying disease. Conclusion: We reported our experience with palliative LVA in patients with advanced malignancies. Many patients had favorable physical and psychological outcomes. Surgery can be performed safely with appropriate planning based on the condition of the patients. Palliative LVA may be a treatment option for patients with recurrent or distant metastases of the primary disease who are refractory to edema treatment.

Metabolic and Bariatric Surgery in Adolescents: A Single-Center Study of Efficacy and Outcome Predictors

Introduction: Some adolescents undergoing metabolic and bariatric surgery (MBS) have suboptimal responses to surgery, particularly over the longer term. This study aimed to quantify changes in weight loss over time in adolescents undergoing MBS and identify preoperative predictors of weight loss. Methods: This was a prospective, observational cohort study of 73 adolescents (12–19 years) living with obesity undergoing MBS. Absolute and relative changes in anthropometric and biochemical parameters were evaluated up to 30 months. Changes in anthropometric measures were assessed using a mixed residual maximal likelihood model. Univariable and multivariable logistic regression were used to identify predictors of a >35.0% reduction in BMI z-score from baseline to 12 months. Predictive accuracy was assessed by area under the receiver operating characteristics analysis. Results: Most patients (87.7%) underwent laparoscopic sleeve gastrectomy (12.3% underwent laparoscopic sleeve bypass). Weight, weight z-score, BMI, and BMI z-score significantly decreased over 30 months (p < 0.001) up to a −53.8% relative change in BMI z-score at 30 months. There was a significant increase (p = 0.02) in high-density lipoprotein cholesterol and a significant decrease in triglycerides (p = 0.0001) and ALT (p = 0.0004) after surgery. A higher preoperative BMI was associated with a reduced odds (OR 0.89, 95% CI 0.79–0.97, p = 0.03) of a >35% reduction in BMI z-score at 12 months. A baseline BMI >52.6 kg/m2 had a sensitivity of 100% and specificity of 40.6% for detecting a >35.0% postoperative decrease in BMI z-score. Conclusion: MBS results in sustained weight loss in adolescents. A high preoperative BMI predicts resistance to optimal weight loss after surgery and argues against delaying surgery once eligibility thresholds are met.

Progressive brain atrophy and cortical reorganization related to surgery in temporal lobe epilepsy.

Epilepsy is associated with progressive cortical atrophy exceeding normal aging. We aimed to explore longitudinal cortical alterations in patients with temporal lobe epilepsy (TLE) and distinct surgery outcomes. We obtained longitudinal T1-weighted MRI data in a well-designed cohort, including 53 operative TLE patients, 23 nonoperative TLE patients, and 23 healthy controls. According to seizure outcomes at 24 months after surgery, operative patients were divided into seizure-free (SF) and nonseizure-free (NSF) group. Operative patients were scanned before and after surgery, while nonoperative patients and healthy controls were rescanned with similar interval times. We measured gray matter volume (GMV) in all participants and compared longitudinal cortical alterations among groups. In nonoperative group, statistically significant GMV decrease was observed in ipsilateral median cingulate and paracingulate gyri and cerebellum crus I when compared with healthy controls. In operative group, postoperative GMV increase was discovered in many regions involving bilateral hemispheres, especially in the frontal lobe, without differences between SF and NSF group. Postoperative GMV decrease was found in ipsilateral inferior frontal gyrus, putamen, thalamus, and insula. GMV decrease in ipsilateral inferior frontal gyrus, putamen, and insula was more significant in SF group. Progressive cortical atrophy existed in nonoperative TLE patients. Cortical remodeling indicated by postoperative GMV increase may arise mostly from the surgery itself, rather than postsurgical seizure outcomes. More significant GMV decrease in ipsilateral inferior frontal gyrus, putamen, and insula may imply their closer connections with resected regions in seizure-free patients.

Efficacy of Different Doses of Intra-Articular Tranexamic Acid for Reducing Blood Loss and Lower Limb Swelling After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial.

Both blood loss and lower extremity swelling after total knee arthroplasty (TKA) can affect a patient's postoperative recovery. The aim of this trial was to investigate whether different doses of intra-articular tranexamic acid (TXA) can reduce blood loss and postoperative lower limb swelling. In a prospective, randomized-controlled trial, a total of 225 patients were randomly assigned to three groups from September 2020 through January 2021: intra-articular injections of 3 g, 1 g of TXA, or placebo (saline solution). The primary outcome indicators were perioperative blood loss and decreased hemoglobin levels. The secondary outcome indicators were lower extremity swelling, functional recovery indicators (hospital for special surgery [HSS] scores, range of motion), visual analog scale [VAS] scores, and transfusion rates and safety outcomes, including thromboembolic events, incidence of wound-related complications, and length of hospital stay. One-way analysis of variance (ANOVA), post hoc Bonferroni correction, Pearson chi-square test and Fisher exact test were used for statistical analysis. Postoperative blood loss was lower in the 1 and 3 g TXA groups (754.00 ± 409.67 mL and 568.70 ± 408.27 mL, respectively) than in the placebo group (977.32 ± 418.69 mL) (p < 0.001). The maximum postoperative decrease in hemoglobin was lower in the 1 and 3 g TXA groups (2.4 ± 0.9 and 1.8 ± 0.9 g/dL, respectively) than in the placebo group (3.1 ± 1.2 g/dL) (p < 0.001). On postoperative Days 1, 2, and 3, the TXA group presented significantly reduced thigh, suprapatellar, and calf swelling and significantly reduced pain scores during exercise. Compared with that in the low-dose group, perioperative blood loss was further reduced in the high-dose TXA group (p = 0.006). However, while patients in the TXA group had improved pain scores, Hospital for Special Surgery scores, and joint range of motion at postoperative rest, these differences were not statistically significant. There were no significant differences in thromboembolic events or complication rates among the three groups. Topical TXA in total knee arthroplasty was effective in reducing postoperative blood loss by 24%-43% and in reducing postoperative lower extremity swelling and pain during exercise. Higher doses (3 g) of TXA further controlled perioperative blood loss without affecting postoperative lower extremity swelling, and there was no increase in the incidence of related complications during follow-up. This study was a single-center, prospective, randomized controlled trial (RCT). The trial was approved by the Clinical Trials and Biomedical Ethics Committee at our institution (number: 2018.676), all participants provided written informed consent, and the trial was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2000035271).

Has the Use of Enhanced Recovery Protocols in Colorectal Surgery Increased Postoperative Bleeding Complications?

Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways shown to improve postoperative complications and decrease length of stay after surgery. A critical component of an enhanced recovery after surgery protocol is the use of multimodal non-opiate analgesia using non-steroidal anti-inflammatory drugs and COX-2 inhibitors. To compare the incidence of postoperative gastrointestinal bleeding between patients treated with and without an enhanced recovery after surgery protocol. Retrospective review of a prospective maintained colorectal registry. Large colorectal referral center. Preoperative elective colorectal surgery requiring an anastomosis. Standardized enhanced recovery after surgery protocol included celecoxib and ketorolac. Postoperative outcomes included bleeding (+/- sequelae), reduction in hematocrit after operation, intervention for bleeding (transfusion, endoscopy or surgery), length of stay and hospital readmission. The enhanced recovery after surgery group (n = 630) and non-enhanced recovery after surgery groups (n = 739) were comparable in baseline clinical features except for surgical indication, with more inflammatory bowel disease and less malignant disease in the enhanced recovery after surgery group. Minimally invasive surgery was more commonly performed in the enhanced recovery after surgery group. Both bleeding with sequelae (p < 0.0001) and bleeding without sequelae (p = 0.0004) were significantly more common in the enhanced recovery after surgery group compared to the non-enhanced recovery after surgery group. In addition, there was a significantly larger hematocrit decline after operation noted in the enhanced recovery after surgery group (p < 0.0001). Both the need for transfusion and intervention for bleeding however did not significantly differ between patient groups. Factors associated with bleeding were the use of an enhanced recovery after surgery protocol (OR = 2.96; 95% CI, 1.57-5.58; p < 0.001) and performing a small to large bowel anastomosis (OR= 2.68; 95% CI, 1.49-4.81; p < 0.001). Retrospective observational design and inability to determine which component of the enhanced recovery after surgery protocol caused the bleeding. Use of an enhanced recovery after surgery protocol in patients undergoing colorectal surgery with an anastomosis is associated with an increased incidence of bleeding without significant difference in the need for transfusion or intervention. See Video Abstract.

The effect of virtual reality on postoperative anxiety and pain in patients following cardiac surgery: a randomized controlled trial.

The VRECOVERY investigated the impact of virtual reality (VR) distraction therapy on postoperative pain, anxiety and quality of recovery in patients undergoing coronary artery bypass grafting surgery. A single-centre randomized controlled trial was conducted involving 192 participants, allocated to either the intervention or control group. Participants in the intervention group received VR distraction therapy on postoperative days 1, 2 and 3, while the control group received standard postoperative care. Primary outcomes were measured in both groups directly following the VR sessions of the intervention group. Outcomes included (i) postoperative pain [Numeric Rating Scale (NRS)], (ii) postoperative anxiety [State Trait Anxiety Inventory 6 questionnaire (STAI-6)] and (iii) quality of postoperative recovery [Quality of Recovery 15 questionnaire (QoR-15)]. A total of 100 participants completed the study, including 39 patients (mean age 69.1 ± 7.7 years) in the intervention group and 61 patients (mean age 66.8 ± 8.2 years) in the control group. Eighty-nine percent of participants was male. VR-distraction therapy demonstrated a significant difference in postoperative pain decrease between groups (NRS score; intervention group -1.45/day vs control group -0.73/day, P = 0.007), and an important overall difference in postoperative anxiety slopes (STAI-6 score; intervention group -0.60/day vs control group +0.09/day, P = 0.06). There was no effect observed on postoperative quality of recovery (P = 0.11). The VRECOVERY trial suggests a beneficial impact of VR distraction therapy in reducing postoperative pain. There was no significant effect on postoperative anxiety and quality of recovery.

Application of Microwave Ablation in Laparoscopic Partial Splenectomy.

Splenic hemangioma is the most common pathological classification of splenic tumors, and its surgical indication and treatment have been controversial. Before, open splenectomy was usually used to treat splenic hemangioma. Following the rapid development of laparoscopic techniques, people's requirements for minimally invasive treatment have gradually increased, and laparoscopic splenectomy has gradually become the main treatment method. However, through the deeper study of spleen function, it was found that partial splenectomy can cut down the incidence of postoperative thrombocythemia and decrease side effects on the physiological function of the body, so laparoscopic partial splenectomy came into being. However, due to the special anatomical structure, the incidence of hemorrhage during partial splenectomy is greater. Therefore, during the operation, we removed part of the splenic blood vessels, combined with microwave ablation, which perfectly solved the problem of intraoperative bleeding. Laparoscopic partial splenectomy combined with microwave ablation not only achieves the requirements of minimally invasive treatment but also reduces the risk of intraoperative bleeding, meriting clinical application and promotion.

Decreased Choriocapillaris Vessel Density in the Ipsilateral Eye after Carotid Artery Revascularization Detected by Widefield Swept-Source OCT Angiography

ObjectiveTo investigate the short-term blood flow changes and image features of the retina and choroid in patients undergo carotid artery revascularization (CAR) for severe carotid artery stenosis (SCAS) using widefield swept-source optical coherence tomography angiography (SS-OCTA). DesignProspective study. ParticipantsThis prospective study included 112 eyes (56 eyes of the ipsilateral side and 56 eyes of the contralateral side) of 56 participants with severe carotid artery stenosis. MethodsParticipants were examined using widefield SS-OCTA covering an area of 16*16mm centered on the fovea before and after carotid artery revascularization. Retinal parameters including central macular thickness (CMT), vessel density of the retinal superficial vascular complex (VDRSVC), vessel density of the retinal deep vascular complex (VDRDVC), and vessel density of the retina (VDR) and choroidal parameters including central choroidal thickness (CCT), vessel density of the choriocapillaris (VDCC), vessel density of the medium and large choroidal vessels (VDMLC), choroidal vessel volume ratio (CVV/a), and three-dimensional choroidal vascularity index (3D-CVI) were measured. Besides, preoperative and postoperative OCTA images were screened and compared. Main Outcome MeasuresRetinal and choroidal parameters obtained from SS-OCTA. ResultsIn the ipsilateral eye (56 eyes), increase of VDRSVC, VDR, CVV/a, CCT, and 3D-CVI and decrease of VDCC was found after CAR. 13 patients were identified with postoperative ipsilateral choriocapillaris flow voids (PICCFVs) with OCTA images, and presence of PICCFVs was associated with greater postoperative VDCC decrease. In the contralateral eye (56 eyes), we found increase of VDRSVC, VDRDVC, VDR, while no difference of choroidal parameters after CAR and no findings of PICCFVs. ConclusionsFindings of this study suggest that ocular microvascular perfusion is improved after CAR in the ipsilateral eye and the contralateral eye within a wide field of the fundus. The VDCC is decreased in the ipsilateral eye, which may indicate infarctions of choriocapillaris or ischemia-reperfusion injury of the choriocapillaris after CAR.

The impact of surgical treatment of benign ovarian tumors on the reproductive health of women, taking into account the International Classification of Functioning

The article presents a systematic analysis of studies evaluating the impact of surgical treatment of benign ovarian tumors on reproductive health, taking into account the criteria stated by the International Classification of Functioning, Disability and Health. To identify articles, foreign and domestic scientific databases were used (PubMed, Cochrane, eLibrary). After the initial identification of 704 scientific publications, 46 articles were selected using inclusion and exclusion criteria.The conducted systemic analysis allows us to formulate the conclusion that surgical interventions performed for benign ovarian tumors contribute to damage to ovarian tissue, and as a result, a decrease in the ovarian reserve of patients, which is associated with impaired fertility. A number of authors have demonstrated some recovery of anti-Mullerian hormone (AMH) levels 3-12 months after surgery. A significant portion of the studies have demonstrated a more pronounced postoperative decrease in AMH rates in patients with endometriomas compared with women operated on for non-endometrioid ovarian tumors. Lower AMH rates were noted in women with bilateral surgeries for bilateral ovarian tumors compared to patients who had unilateral surgeries. The performed systemic analysis showed higher postoperative AMH rates in patients with intraoperative suture hemostasis in comparison with the use of bipolar energy; in addition, there is a relationship between the number of coagulations and the severity of the decrease in AMH rates. In a few studies, it was noted that patients who underwent surgical treatment of ovarian tumors experienced an earlier onset of menopause. In connection with these possible functional disorders, further clinical studies of a high level of evidence are needed, aimed at developing effective strategies for preserving the functioning of the reproductive system after surgical treatment of benign ovarian tumors.

Comparison of mean postoperative decrease in hemoglobin level in patients undergoing transurethral resection of prostate with and without preoperative intraprostatic epinephrine.

Objective: To determine and compare the mean decrease in hemoglobin level from the baseline value in patients undergoing TURP with and without preoperative intraprostatic epinephrine injection. Study Design: Analytical Cross Sectional study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Nov 2023 to Feb 2024. Methods: After ERC approval and taking informed consent a total of 40 patients with enlarged prostate and scheduled for TURP, having comparable baseline clinical and laboratory characteristics such as age, preoperative prostate size and baseline hemoglobin were enrolled in the study &amp; were divided in two equal numbered groups called group A and group B, each having 20 patients in it. Before performing monopolar TURP group A patients were given 200mcg of intraprostatic epinephrine injection diluted in 20ml of normal saline (10ml in each right &amp; left lobe) under transrectal ultrasonic guidance via the transperineal route, while no such intervention was done before TURP in group B patients. One pint of whole blood was transfused to the patients of both the groups intraoperatively and blood samples were sent to laboratory on 1st post-operative day to determine the postoperative hemoglobin levels of patients of both the groups. Data was entered on the designated pro forma for analysis. Results: Postoperative hemoglobin levels were significantly higher in group A patients (mean and S.D 11.83 ±1.01 g/dl) as compared to the group B patients (mean and S.D 11.00 ± 1.06 g/dl) with a p value of 0.015, and hence drop of hemoglobin levels from the baseline values were lower in group A patients (mean and S.D 1.28 ± 0.89 g/dl) as compared to the group B patients (mean and S.D 2.31 ± 0.98 g/dl), confirming a statistically significant difference with p value of 0.001. Conclusion: The hemorrhage associated with TURP can be decreased significantly by giving preoperative intraprostatic epinephrine injection. This is a clinically safe technique that can not only reduce the postoperative blood transfusion requirements but can also allow the operating surgeon to resect more tissue within the desired time thus increasing the efficacy of TURP.

Biometric Changes Up to 2 Years After Hip Arthroscopy in National Collegiate Athletic Association Division I Athletes.

Patients who undergo hip arthroscopy for femoroacetabular impingement (FAI) require lower extremity immobilization for an extended period of time. Periods of immobilization combined with surgery have been associated with decreased muscle mass and bone mineral density (BMD). The purpose of this study was to characterize postoperative body composition and BMD changes after arthroscopy for FAI. It was hypothesized that both lean mass and BMD would decrease postoperatively and then normalize over time. Case series; Level of evidence, 4. This was a retrospective review of 23 National Collegiate Athletic Association Division I athletes who underwent hip arthroscopy between 2017 and 2019 and had a dual-energy x-ray absorptiometry scan preoperatively and at 3, 6, 12, or 24 months postoperatively. Linear mixed-effects models were used to compare pre- with postoperative lean and fat mass values for the total body and total leg (both operative and nonoperative sides) as well as trunk, pelvic, and spinal BMD. For total-leg, femur, and femoral BMD, linear mixed-effects models were used to evaluate the influence of time, side (operative vs nonoperative), and their interaction on each outcome measure. Regarding pelvic BMD, compared with baseline (mean, 1.41 g/cm2 [95% CI, 1.33-1.49]), significant decreases were seen at postoperative 3 months (mean, 1.36 g/cm2 [95% CI, 1.28-1.45 g/cm2]; P < .001) and 6 months (mean, 1.39 g/cm2 [95% CI, 1.27-1.52 g/cm2]; P < .01) but not at 12 months (mean, 1.42 g/cm2 [95% CI, 1.33-1.51 g/cm2]; P = .319). Total-leg BMD for the operative side increased significantly from baseline (mean, 1.52 g/cm2 [95% CI, 1.43-1.61 g/cm2]) to ≥2 years postoperatively (mean, 1.56 g/cm2 [95% CI, 1.47-1.65 g/cm2]) (P = .005). Combined leg fat mass was increased from baseline (mean, 6427 g [95% CI, 4855-7999 g]) to ≥2 years (mean, 11645 g [95% CI, 7845-15,446 g]) (P < .01). There were no significant differences in total-body fat or lean mass or combined-leg lean mass. In this patient population, a postoperative decrease in pelvic BMD that resolved by 12 months and an increase in total-leg BMD on the operative side at ≥2 years were observed. While hip arthroscopy for FAI may have significant benefits for long-term body composition and bone mass, clinicians should be aware of the potential implications of decreased bone mass for up to 12 months postoperatively.

A Readmission Risk Assessment Tool Is Not Predictive of 90-Day Readmission After Total Joint Arthroplasty at an Urban Tertiary Referral Hospital.

Readmission within 90 days of total joint arthroplasty (TJA) via an emergency department (ED) encounter represents a significant economic burden to the healthcare system. We aimed to determine the utility of a previously described readmission risk assessment tool (RRAT) in predicting readmission after presentation to the ED within 90 days of primary TJA. At a single academic tertiary referral medical center, a retrospective chart review was used to collect demographic data, surgery type, medical history, reason for presentation in the ED, and ED disposition for the 1,576 patients who underwent TJA between April 1, 2016, and December 31, 2018. The RRAT score of patients was calculated and compared between patients who were discharged home versus readmitted to inpatient care. We identified 244 patients (328 encounters) who presented to the ED within 90 days of primary TJA, resulting in a 3.1% readmission rate. No statistical difference was found between the RRAT scores of readmitted and discharged patients (p=0.24). The most common reason for presentation to the ED for discharged patients was surgical site pain compared to medical concerns (cardiac, hematological, and renal concerns) in the readmitted group. Although the RRAT score alone is not predictive of readmission within 90 days of TJA, the reason for presentation to the ED between discharged and readmitted patients does differ. These results present an opportunity for orthopedic surgery providers to discuss with other providers ways to optimize postoperative pain management and decrease readmissions. This study underscores the need for improved postoperative pain and chronic condition management to reduce ED visits and readmissions and highlights the necessity for larger, multi-center studies to better assess the RRAT score's predictive value.

Speckle tracking echocardiography for evaluation of myocardial functions before and after mitral valvuloplasty in dogs.

Myxomatous mitral valve disease (MMVD) is the most common acquired heart disease in dogs. Mitral valvuloplasty (MVP) addresses regurgitation, but the pre- and postoperative changes in myocardial function remain uncertain. This study evaluated myocardial motion before and after MVP using two-dimensional speckle-tracking echocardiography (2D-STE). Eight client-owned dogs undergoing MVP for MMVD. Myocardial deformation was assessed by 2D-STE before surgery and at 1- and 3-months post-surgery. Measurements included left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), cardiac twist, and right ventricular free wall GLS (RVFW-GLS). Postoperative decreases were observed in left ventricular internal dimensions, left atrial size, and early diastolic myocardial velocity, with an increase in peak late diastolic velocity. LV-GLS decreased at 1 month (-14.4%) and 3 months (-16.3%) compared to preoperative values (-24.4%) (p = 0.0078, p = 0.015). GCS decreased at 1 month (-12.9%) and 3 months (-14.8%) compared to preoperative values (-21.7%) (p = 0.0078). GRS decreased at 1 month (27.7%) and 3 months (32.0%) compared to preoperative values (67.7%) (p = 0.0078). No significant changes were observed in RVFW-GLS. Peak systolic twist increased at 3 months (9.1° vs. 4.9°, p = 0.039). Peak systolic apical rotation showed an upward trend at 3 months (p = 0.109). Left ventricular twist was mildly affected by LVIDd, LVIDDN, and sphericity index (R 2 = 0.187, p = 0.034; R 2 = 0.33, p = 0.0029; R 2 = 0.22, p = 0.019). Postoperative myocardial motion approached reference values, indicating significant improvement, particularly in left ventricular twisting motion. These findings highlight the positive impact of surgery on cardiac function in dogs with MMVD.

Postoperative decrease in serum albumin as predictor of early acute periprosthetic infection after total knee arthroplasty

PurposePatients with hypoalbuminemia, (serum albumin (SA) < 3.5 g/dL) are at greater risk for complications after surgery, including increased postoperative infection rates after total knee arthroplasty (TKA). This study aimed to analyze both preoperative and postoperative SA in patients who experienced acute periprosthetic infection within the first 4 weeks after surgery.MethodsWe retrospectively analyzed data from 490 consecutive TKAs (314 patients). Five patients developed early acute infection requiring surgical treatment. SA data were collected preoperatively (SA0) and 1 week postoperatively (SA1W) to evaluate SA dynamics. Multiple patient and operative parameters that could influence SA were also analyzed.ResultsNo statistical differences were found in parameters expected to influence SA values between the surgically treated (STG) and non-treated groups (non-STG). None of the patients in STG had SA0 and SA1W below 3.5 g/dL. However, the amount and rate of SA reduction before and after surgery were significantly greater in STG than in non-STG.ConclusionSA dynamics revealed a greater reduction in both the amount and rate in STG before and after surgery than in non-STG. No correlation was found between early acute periprosthetic infection after TKA and each SA0 and SA1W time point. Further evaluation of the SA value of 3.5 g/dL as a threshold for acute early acute infection is warranted.

Cystoid macular edema after low-energy femtosecond-assisted cataract surgery.

This study aimed to evaluate the occurrence of pseudophakic cystoid macular edema (PCME) post low-energy femtosecond laser-assisted cataract surgery (FLACS) in a high-volume surgical setting. The medical records of 242 FLACS patients were retrospectively reviewed. The central subfield macular thickness (CSMT) was measured via optical coherence tomography (OCT) before and 4-6weeks after surgery, and the results were compared for PCME detection. Macular edema was defined as a 10% increase in CSMT, a new onset of intraretinal fluid, or a decrease in visual acuity (VA). VA development in PCME patients was reviewed at 2-3months and 6months. The median patient age was 72years (49-92years). Among 242 eyes, seven eyes (2.89%) developed PCME. The median preoperative CSMT in these eyes was 255μm (minimum 231μm, maximum 326μm), whereas the median CSMT at 4-6weeks after surgery was 317μm (minimum 255μm, maximum 463μm). 4- to 6-week postoperative visual acuity decreased in comparison with 1-week postoperative values in three eyes of two patients, remained stable in two patients, and improved in one patient, whereas one patient did not return for his 1-week appointment but improved from 0.4 to 0.2 logMAR 2.5months postoperatively. By 3-6months, all eyes with PCME had gained visual acuity in comparison with their preoperative values. None of the PCME patients had diabetes or used prostaglandin analogues. Three patients were receiving anticoagulation medication. A 2.89% incidence of PCME after low-energy FLACS matched published standard phacoemulsification rates. In our series of uncomplicated cases, PCME caused only a transient postoperative decrease in visual acuity. What is known Increased prostaglandin levels have been detected in the aqueous humour of cataract patients after femtosecond laser application. Prostaglandins are mediators of inflammation. Femtosecond lasers come in low energy and high energy variants. There is contrasting evidence of increased incidence of PCME after femtosecond laser assisted cataract surgery (FLACS) What is new The incidence of PCME after low-energy FLACS in our high volume surgical setting is 2.89% Low-energy FLACS does not seem to have a causative effect on PCME.

Femoral versus Acetabular Containment Procedures in Perthes Disease: A Systematic Review and Meta-analysis

Abstract Background Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of femur is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis. There is limited data about surgical options in treatment of Perthes disease. The authors conducted this systematic review and meta-analysis to compare between femoral versus acetabular containment in the management of Perthes disease in terms of efficacy and complications, however there is a debate about the ideal way of treatment in Perthes disease. Objective To compare between femoral varus and acetabular containment osteotomies in children with Perthes disease, regarding the efficacy, long-term outcomes and complications. Methods This systematic review and meta-analysis examined studies that compared FVO and Pelvic Osteotomy. The authors searched the Medline database via PubMed, EMBASE, and Cochrane Library for studies published between 2012 and 2022. Results A total of 1051 patients were analyzed for different procedures, including 429 patients in the pelvic arm, 459 patients in FVO arm, and 163 patients in the combined arm. The number of hips included in the current analysis was 1069 hips, including 437 in pelvic arm, 469 in FVO arm, and 163 in the combined arm. The mean age for the included patients was 9.5±7.74 years, with 859 (81.8%) males and 192 (18.2%) females. There was an apparent predominance in males vs. females in all arms. The mean follow-up of the included studies was 8.6±8.32 years. We compared between the three procedures clinically, radiographic and complications. (FVO: Femoral varus osteotomy). Conclusion Femoral varus osteotomy and Pelvic osteotomy have shown comparable clinical and radiological improvement in treatment of perthes disease. The FVO group has shown higher rate than pelvic or combined osteotomies regarding post-operative arthritis and decrease range of motion. The pelvic group has shown higher rate than FVO and combined osteotomies regarding post-operative impingement and leg length discrepancy. There was no significant difference between the pelvic, femoral and combined osteotomies regarding range of motion, Trendelenberg, limping, post-operative pain and secondary knee deformity. In summary, this review provides evidence that femoral and pelvic osteotomies are safe, effective methods in treatment.

Arthroscopically Assisted Deep Deltoid Ligament Reconstruction Utilizing Suture Tape Augmentation for Treatment of Medial Ankle Instability in Acute Ankle Fractures: A Novel Technique and Case Series

Category: Arthroscopy; Ankle Introduction/Purpose:Objective: To present a novel technique for deep deltoid ligament reconstruction using suture tape augmentation for medial ankle instability in acute ankle fractures and conduct a case series. Background: Circular movements involving ankle supination-external rotation, pronation-external rotation, or pronation-abduction are among the most common mechanisms behind acute ankle fractures. As a result of rotational fractures, the deltoid ligament–consisting of a superficial and deep component–is often damaged or ruptured. Disruption of the deltoid ligament is associated with medial ankle instability, thus warranting further repair; which has been historically done open. Using an arthroscopic approach will allow for direct visualization and increased accuracy of surgical management . Combining arthroscopy and with our novel suture tape augmentation technique may improve postoperative functional outcomes, stability, and decrease post-traumatic arthritis. Methods: This is a retrospective case study using de-identified patient data from 2 separate hospital systems. Data was obtained via chart review including pre-operative, intraoperative, and post-operative follow ups. Variables such as age, weight, body mass index (BMI), sex, side, history of previous ankle surgery, preoperative ambulatory status, length of hospital stay, as well as disposition were documented. Radiographs were reviewed for evidence of restoration of the medial clear space as well as hardware position and bony union. In addition, a technique guide was developed using two expert surgeons experience and opinion for using suture tape augmentation with the Arthrex InternalBrace system (Naples, FL). In addition, we present a novel technique for reconstruction of the deep deltoid ligament complex using our experience from these cases. Included in this guide are details on indications, setup, technique, postoperative protocol, and radiographic assessment. Results: We retrospectively reviewed 12 patients who had bimalleolar equivalent, tri-malleolar equivalent, or Maisonneuve-type fractures of the ankle with increased medial clear space widening and were surgically treated with this novel technique. All patients were initially non-ambulatory after their fracture and prior to their procedure. All patients had significant reduction in the medial clear space postoperatively. Additionally, all patients progressed to walking without assistance and returned to full weight bearing postoperatively. One patient developed a keloid scar that required a corticosteroid injection. One patient showed widening of the syndesmosis on follow up x-rays; which was managed with a CT scan of the ankle, and bilateral weight bearing radiographs. The patient was clinically asymptomatic and advanced to weight bearing as tolerated before 6 months. Conclusion: Arthroscopically assisted deep deltoid ligament reconstruction utilizing suture tape augmentation is a successful procedure for restoring ankle function and radiographic parameters of the medial clear space when used in conjunction with accepted open reduction and internal fixation (ORIF) techniques for bimalleolar ankle fracture equivalents or tri-malleolar fractures. Since this procedure is performed with a minimally invasive arthroscopic approach, it may be a preferred technique in the future with direct visualization of the superficial and deep deltoid ligament. We have also presented a novel technique for reconstruction of the deep deltoid ligament complex utilizing suture tape augmentation via an arthroscopically-assisted approach. Arthroscopic deltoid technique Drill sleeve arthroscopically, radiographic confirmation of talus K-wire, and insertion of FiberTak/ sutures arthroscopically