Postoperative Follow-up Visits Research Articles

Anterior segment optical coherence tomography for the detection of silicone oil emulsification on the iris surface.

To investigate the presence of silicone oil (SO)-emulsification on the anterior iris surface with anterior segment optical coherence tomography (AS-OCT). In this single-center cross-sectional study, vitrectomized eyes with SO tamponade that underwent AS-OCT imaging and gonioscopy examination during the postoperative follow-up visits, were reviewed. 45 eyes of 42 consecutive patients were included. In 35.6% of the eyes (n = 16) emulsified SO droplets were detected in the anterior chamber (AC) angle by gonioscopy and in 55.6% (n = 25) on the anterior iris surface by AS-OCT imaging. The presence of SO emulsifications in the AC-angle correlated with the presence of SO emulsifications on the anterior iris surface (OR = 13.4, 95% CI [2.179-82.130]; p = 0.005). The accuracy of the AS-OCT predicting the presence of SO in the AC-angle was 71.0% and the sensitivity was 87.5%. No significant association between SO droplets in the AC and other clinical parameters including endotamponade-duration or type of silicone oil were found. The presence of emulsified SO droplets on the anterior iris surface detected by AS-OCT was significantly correlated to postoperative IOP rise (p = 0.027). AS-OCT is a suitable method for the detection of SO on the anterior iris surface. SO droplets on the iris surface correlate with elevated postoperative IOP and with the presence of SO in the AC detected by gonioscopy, therefore AS-OCT might be used as a screening method for the detection of SO migration into the AC. Institutional Review Board of the Hamburg Medical Chamber (Ethik-Kommission der Ärztekammer Hamburg): 2023-300372-WF.

Patients at Greatest Risk of Missing Initial 1-Year Follow-Up After Pituitary Adenoma Resection

Routine evaluation and surveillance imaging after pituitary adenoma (PA) endoscopic endonasal transsphenoidal resection (EETS) is a neurosurgical practice to identify tumor recurrence. This study aims to identify social and clinical factors that may contribute to patients missing their initial one-year follow-up appointment and provide guidance for targeted education to improve patient adherence with postoperative treatment plans, ultimately reducing unknown adenoma recurrence. The authors performed a single-center retrospective review of patients who underwent EETS for PAs from 2007 to 2023. Patients who were analyzed for sociodemographic factors, presenting symptoms, time to surgery, surgical outcomes, and adherence to postoperative follow-up visits at one-year following surgery. 256 patients with PAs treated by EETS met inclusion criteria. 218 (85%) of these patients attended one-year follow-up; 38 (15%) missed this visit. Twenty-nine (76%) individuals who missed their one-year follow up were males (p-value=0.006). Divorced/widowed/separated patients were two times more likely to miss their follow-up compared to their married counterparts (p-value=0.008). Additional significant risk factors included older age, as the mean age for patients who missed their one-year appointment was 60.1 years compared to 54.7 years (p-value=0.028). Patients with visual field deficits at initial presentation were also less likely to follow-up at one-year (p-value=0.03). Risk factors of missed one-year follow-up appointments after PA resection include male sex, divorced/widowed/separated marital status, older age, and the presence of visual deficits at initial presentation. Increased education efforts can be selectively aimed at these at-risk patient cohorts to improve patient compliance and reduce consequences of undetected tumor recurrence.

Long-term results of multimodal treatment of the prostate using the Thulium Laser

Background and aims. To evaluate a novel multimodal treatment (TLP) that integrates the use of a thulium laser, bipolar transurethral resection of the prostate (TURP), and “button-type” bipolar plasma vaporization for the endoscopic treatment of benign prostatic hyperplasia (BPH). Methods. From March 2018 to December 2021, we prospectively evaluated 220 patients with symptomatic BPH who underwent TLP. Patients were assessed based on the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). Perioperative and postoperative follow-up data were analyzed. Results. The mean age at surgery was 66.74 years (SD 8.21). The median prostate size was 80 (IQR 70 - 110). The median operative time was 45 (IQR 35 - 55) minutes and the hospital stay was 2 (IQR 1 - 2) days. Patients were discharged with the urinary catheter in place, which was removed approximately 7 days after surgery when the histopathological result was discussed with the patient. Postoperatively, IPSS, QoL, Qmax and PVR showed a significant improvement starting at 3 months and continued through the postoperative follow-up visits (6- 12-24-36-48-60 months). Urethral stricture and bladder neck contracture occurred in 1 (0.45%) and 2 (0.91%) patients, respectively. Recurrence of BPH occurred in 2 patients (0.91%) who underwent a second procedure. Conclusions. In conclusion, we report that the multimodal surgical treatment of BPH consisting of combining Thulium laser vaporization, bipolar TURP and plasma vaporization (TLP) represents an efficient and durable therapeutic method for BPH patients with low a complication rate at 5-year follow-up.

Biomechanical changes following corneal crosslinking in keratoconus patients.

To evaluate the biomechanical and tomographic outcomes of keratoconus patients up to four years after corneal crosslinking (CXL). In this longitudinal retrospective-prospective single-center case series, the preoperative tomographic and biomechanical results from 200 keratoconus eyes of 161 patients undergoing CXL were compared to follow-up examinations at three-months, six-months, one-year, two-years, three-years, and four-years after CXL. Primary outcomes included the Corvis Biomechanical Factor (CBiF) and five biomechanical response parameters obtained from the Corvis ST. Tomographically, the Belin-Ambrósio deviation index (BAD-D) and the maximal keratometry (Kmax) measured by the Pentacam were analyzed. Additionally, Corvis E-staging, the thinnest corneal thickness (TCT), and the best-corrected visual acuity (BCVA) were obtained. Primary outcomes were compared using a paired t-test. The CBiF decreased significantly at the six-month (p < 0.001) and one-year (p < 0.001) follow-ups when compared to preoperative values. E-staging behaved accordingly to the CBiF. Within the two- to four-year follow-ups, the biomechanical outcomes showed no significant differences when compared to preoperative. Tomographically, the BAD-D increased significantly during the first year after CXL with a maximum at six-months (p < 0.001), while Kmax decreased significantly (p < 0.001) and continuously up to four years after CXL. The TCT was lower at all postoperative follow-up visits compared to preoperative, and the BCVA improved. In the first year after CXL, there was a temporary progression in both the biomechanical CBiF and E-staging, as well as in the tomographic analysis. CXL contributes to the stabilization of both the tomographic and biomechanical properties of the cornea up to four years postoperatively.

Comparison of transvaginal natural orifice transluminal endoscopic surgery versus conventional surgery for uterosacral ligament suspension in patients who had concomitant vaginal hysterectomy for subtotal uterine prolapse.

The study aimed to compare the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) versus nonendoscopic USLS in patients with subtotal uterine prolapse who had a concomitant vaginal hysterectomy. There were 51 patients who underwent vNOTES USLS, whereas the nonendoscopic conventional USLS group had 49 patients. The information about patient demographics, and perioperative data including the operative duration, blood loss, intraoperative and postoperative complications, and length of postoperative hospital stay were determined from the patients' files. Postoperative follow-up visits were scheduled at the first week and 1 month after surgery. The demographic variables including age, body mass index, menopausal status, and parity were comparable, and no significant differences were found. A total of 90.2% of the patients in the vNOTES group and 69.4% of the patients in the shull group were at menopause (p = .09). Operation time was significantly shorter in the shull group (p < .001), and the hospitalization period (p = .029) was significantly shorter in the vNOTES group. Ba, Bp, and D points and total vaginal length (TVL) were significantly behind the hymenal ring in patients who had vNOTES USLS procedure (p < .001). None of the patients who had intraoperative significant blood loss required transfusion. One patient in the vNOTES and two patients in the shull group had a postoperative cuff hematoma. vNOTES USLS has a good safety profile, higher percentage of adnexal surgeries with better improvement on POP-Q points Ba, Bp, D, and TVL compared with classic USLS in patients with subtotal uterine prolapse. Studies evaluating short- and long-term results of vNOTES versus conventional USLS are needed.

Minimally Invasive Method for Treatment of Syndromic Congenital Vertical Talus Deformity in Children.

Congenital Vertical Talus (CVT) is a rare form of rigid flatfoot commonly seen in patients with underlying neurologic syndromes. This study aims to evaluate the long-term effectiveness of the minimally invasive method for correcting CVT deformity in a large cohort of syndromic patients. A single author recorded preoperative, 2-week postoperative, 1-year postoperative, and most recent radiographic measurements and complications for 25 patients treated with the minimally invasive method from 2006 to 2021. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires were administered for 12 patients after January 1, 2015, when the institution began collecting PROMIS in all orthopaedic patients. Average follow-up was 55 months (13-111); 18 patients had minimum 24-month follow-up. Forty feet in 25 patients were analyzed. The average preoperative lateral talar axis-first metatarsal base angle (TAMBA) was 68.7 ± 21.3 vs 12.1 ± 8.9 after initial surgical intervention (P < .0001). There was a statistically significant increase in the lateral TAMBA between the initial postoperative and final follow-up visits (13.0 vs 21.6, P = .02). Radiographic recurrence of talonavicular deformity was noted in 12 feet (30.9%); 7 (15.55%) required corrective surgery. Larger preoperative lateral TAMBA was predictive of recurrence. Notably, patients with arthrogryposis experienced higher radiographic recurrence than other syndromic patients (45.0% vs 14.3%, P = .0384). PROMIS scores were within population norms. The study suggests that less than one-third of syndromic CVT patients experienced a radiographic recurrence of talonavicular deformity, with 15% requiring further surgical intervention at an average of 55 months following the initial procedure. A higher incidence of radiographic recurrence occurred in patients with distal arthrogryposis. These findings, along with the satisfactory patient-reported outcomes, suggest that the minimally invasive technique is an effective treatment method for syndromic CVT, underscoring the necessity for clinicians to provide detailed prognoses and consider more intensive follow-up for those at higher risk. Level IV, case series.

Patient-reported outcomes after oncologic hepatic resection predict the risk of delayed readiness to return to intended oncologic therapy (RIOT)

BackgroundOptimal surgical recovery is critical to readiness to return to intended oncologic therapy (RIOT). The current study defined the value of patient-reported outcomes (PROs) in predicting the risk for delayed RIOT after oncologic hepatic resection. MethodsIn a prospective longitudinal study, perioperative symptoms were assessed using a valid PRO assessment tool, the MD Anderson Symptom Inventory module for hepatectomy perioperative care (MDASI-PeriOp-Hep), for 4 weeks after surgery. The timed up and go test (TUGT) was administered before surgery, by discharge day, and at the first postoperative follow-up visit. Multivariate logistic regression analysis assessed the predictive value of PROs for delayed RIOT. ResultsWe enrolled 210 patients and analyzed 148 patients who received adjuvant chemotherapy and contributed more than 3 PRO assessments postoperatively. About 36 percent of the patients had delayed RIOT (>5 weeks, range 1–14 weeks). MDASI scores for drowsiness, fatigue, dry mouth, and interference with general activity, walking, and work on day 7 after discharge and MDASI scores for incisional tightness, fatigue, dry mouth, shortness of breath, and interference with work on day 14 after discharge were associated with delayed RIOT (all P < 0.05). Walking and general activity items on the MDASI-Interference subscale on day 7 after discharge were highly correlated with prolonged TUGT scores at discharge (P < 0.01). ConclusionWe defined clinically meaningful PROs on MDASI-PeriOp-Hep after hepatic resection that predicted increased risk of delayed RIOT. These findings highlight the importance PROs for monitoring symptoms and functioning 1–2 weeks after discharge to be implementing into perioperative care.

The impact of early surgical intervention on aniseikonia in patients with epiretinal membrane: A prospective cohort study

Purpose: to investigate the efficacy of early surgical intervention in ameliorating aniseikonia among patients with epiretinal membrane (ERM). Methods: This prospective cohort study enrolled patients underwent surgery for ERM. Patients were divided into early (symptom onset within 1 year) and late (symptom onset ≥ 1 year) treatment groups. Changes in aniseikonia, best-corrected visual acuity, and tangential retinal displacement were assessed and compared at postoperative 6- and 12-months. Results: Of the 56 patients, 30 (53.6%) belonged to the early treatment group and 26 (46.4%) to the late treatment group. The early treatment group demonstrated a significant reduction in aniseikonia score at 6- and 12-month follow-up visits, (-1.10 ± 1.50 [P = 0.002] and -1.18 ± 1.79 [P = 0.003], respectively); however, no improvement was observed in the late treatment group (0.98 ± 4.62 [P = 0.310] and 1.52 ± 4.35 [P = 0.124], respectively). The early treatment group showed larger tangential retinal displacement at postoperative 12-month follow-up visit. In addition, the amount of tangential retinal displacement was associated with postoperative changes in aniseikonia. Conclusions: Early surgical intervention is helpful in improving aniseikonia in patients with ERM. The degree of recovery in inner retinal displacement was associated with the improvement of aniseikonia.

Success rate and complications of performing elective ureteroscopy in &lt;1 week versus over 1 week from renal colic initiation in ureteral stones larger than 6 mm

Background: The aim of this study was to compare the outcomes, success rate, and complications of performing elective ureteroscopy at different times: &lt;1 week from renal colic initiation (early) and more than 1 week from renal colic initiation (late) in patients with ureteral stone larger than 6 mm. Materials and Methods: This comparative observational study was conducted on 338 consecutive patients. Patients were evaluated in two groups: patients who underwent ureteroscopy in &lt;1 week (A) and patients who underwent ureteroscopy in more than 1 week (B) from renal colic initiation. Helical unenhanced computed tomography was used to assess the size, location, and hardness of stone for all patients. Operation success was defined as complete clearance of stone with no stone residue (stone free) at 2-week postoperative ultrasonography with no need to further interventions. Operation data were collected using medical records, and postoperative complications were investigated at 2 weeks postoperative follow-up visits. Results: Group A included 165 patients and Group B included 173 patients. The overall mean stone size was 8.60 ± 1.12 mm: for Group A 9.13 ± 0.94 mm and for Group B 8.10 ± 1.04 mm (P &lt; 0.001). Stone residues were found in 11 patients: 9 in Group A (5.4%) and 2 in Group B (1.1%) (P = 0.026). Nine patients needed repeated ureteroscopy: 8 (4.8%) in Group A and 1 (0.6%) in Group B (P = 0.015). A double-J stent was used for 85 (51.5%) patients in Group A and 66 (38.2%) patients in Group B (P = 0.016). Major intraoperative complications did not happen in any patients. Fifty-three (32.1%) patients in Group A and 28 (16.2%) patients in Group B suffered from postoperative complications (P = 0.001). Conclusion: Our study revealed that performing elective ureteroscopy with an interval of more than 1 week from the onset of renal colic in combination with medical treatments was associated with less need for double-J stent placement, less need for repeated ureteroscopy, and fewer postoperative complications compared to performing elective ureteroscopy in &lt;1 week from the renal colic onset in nonemergent patients with ureteral stone larger than 6 mm. Although the rate of ureteroscopy failure was higher among the patients who underwent ureteroscopy in &lt;1 week from their renal colic initiation, there was no statistically significant relationship between performing ureteroscopy in &lt;1 week and an increased risk for ureteroscopy failure.

Fitting-Shape-based Strategy for Topography-guided LASIK: A Prospective Study.

To assess and compare the visual acuity and refractive outcomes of topography-guided laser in situ keratomileusis (LASIK) based on the fitting-shape-based refractive compensated and Phorcides software strategies. Consecutive patients who underwent topography-guided LASIK were included in this study. Through double-masked simple randomization, patients were assigned to the Zhang & Zheng Auto-compensate Refraction (ZZ AR) group (the fitting-shape-based refractive compensated strategy using the ZZ AR calculator was used) or the Phorcides group (the topography analysis algorithm in Phorcides software [Phorcides LLC] was used). Only one eye per patient with binocular correction was randomly enrolled. The preoperative and postoperative visual acuities and refraction were analyzed at the 6-month follow-up visit. The ZZ AR and Phorcides groups comprised 156 and 147 eyes, respectively. At the 6-month postoperative follow-up visit, the median (range) absolute residual cylindrical refraction was 0.35 (1.01) and 0.47 (1.63) diopters (D) for the ZZ AR and Phorcides groups, respectively (P < .001). The percentages of patients with residual cylindrical power within 0.25 D were 29.49% and 13.61% for the ZZ AR and Phorcides groups, respectively (P = .001). Based on the percentages of patients with residual cylindrical powers within 0.50 and 1.00 D, the ZZ AR group showed better outcomes (P = .02 and .01). The percentage of patients with visual acuity better than 20/16 was significantly higher for the ZZ AR group than for the Phorcides group (P = .03). The fitting-shape-based refractive compensated strategy for topography-guided LASIK procedures can better optimize the visual acuity and astigmatic refraction than the Phorcides software strategy. [J Refract Surg. 2024;40(5):e336-e343.].

THE EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON THE INNER RETINAL LAYERS IN PATIENTS WITHOUT MACULAR PATHOLOGIC CONDITION.

To examine the effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathological condition. A prospective nonrandomized trial of patients undergoing pars plana vitrectomy with internal limiting membrane peeling for pathologic condition outside the macula was performed. Optical coherence tomography including macular ganglion cell layer, inner plexiform layer, and peripapillary retinal nerve fiber layer imaging was performed before surgery, 1, 3, and 6 months postoperatively, and at the end of follow-up (ranges between 4 and 17 months). Patients with any macular pathological condition on optical coherence tomography before surgery were excluded. The main outcome measure was change in thickness of the ganglion cell layer and inner plexiform layer. Ten patients who underwent pars plana vitrectomy with internal limiting membrane peeling for macula-on retinal detachment were included in the analysis. The mean age was 55 years, and the mean follow up was 10.8 months. All patients completed at least two postoperative follow-up visits that included an optical coherence tomography as per the protocol (range 2-6 months). There was an immediate reduction in the global (G), inferotemporal, superotemporal, and superior (S) ganglion cell layer thickness at the first follow up as compared with the preoperative state ( P = 0.028, P = 0.027, P = 0.026, and P = 0.027 respectively). From the first follow-up visit onward until the final follow-up, the thinning persisted, although there was no further statistically significant thinning. Peeling of the internal limiting membrane causes significant ganglion cell layer thinning in maculae without pathologic condition before surgery. At up to 17 months of follow-up, this effect seems to be immediate and nonprogressive.

Results of Modified Stenströms Technique Otoplasty and Patients' Satisfaction at King Fahad Armed Forces Hospital (KFAFH).

Background Globally, the prevalence of protruding ears is relatively frequent. Ear deformities manifest due to underdevelopment of the antihelical fold, conchal hypertrophy, and/or an obtuse conchoscaphal angle. The availability of multiple approaches proves that there isn't a single optimal accepted procedure. The Modified Stenström otoplasty technique supports the surgeon in the management of underdeveloped antihelix fold, conchal hypertrophy, and obtuse conchoscaphal angle among other deformities. We are the first to evaluate the clinical effects and measure the satisfaction rate post-otoplasty using the modified Stenström technique with a case series study. Methods Six patients were included in the study with a total of 12 ears operated on between February 2021 and July 2022. Utilizing the modified Stenström technique for bilateral protruding ears. All patients had six postoperative follow-up visits with fixed intervals; one week, three weeks, six weeks, three months, six months, and one year. During their one-year postoperative follow-up appointment, all patients completed thesatisfaction survey questions. Results Six individuals were studied, three males and three females with a mean age of 23.1 (range, 7-53 years old). There were no complications or recurrences observed. Based on the responses we collected, all patients reported a high satisfaction rate at one-year postoperative follow-up. Conclusion The modified Stenström technique yields good naturally appearing ears. It is an easy and safe technique to apply. It has a short recovery period, and no hospital stay is required. All contribute to a high satisfaction rate among studied patients.

A Randomised Controlled Trial on the Effect of Hamulectomy on Hearing Outcomes in Cleft Palate Patients - A Comparative Study

Abstract Introduction: Cleft palate, a common congenital craniofacial defect, requires surgical repair and many surgical approaches have been employed for the same to reduce the risk of post-operative complications and improve outcomes. In order to achieve tension free closure, fracture of pterygoid hamulus has been advised. However, the effect of this manoeuvre on auditory functions remains debatable. The study was designed to evaluate the effect of hamulectomy on auditory function during the post-operative period after palatoplasty. Materials and Methods: The present study enrolled 100 participants aged 10 months–2 years with isolated cleft palate defect. They were randomly divided into two groups: palatoplasty with hamulectomy (n = 50) and palatoplasty without hamulectomy (n = 50). Hearing outcomes were evaluated using objective measures (otoscopy, tympanometry, and otoacoustic emission [OAE] tests) at 1-month and 6-month post-operative follow-up visits. The Chi-square test was used to analyse the data and significance level was kept at P ≤ 0.05. Results: The findings of otoscopy, tympanometry and OAE tests were statistically similar between the two study groups (P &gt; 0.05; Chi-square test) at both one month and six months follow-up visits. Another noteworthy observation was improvement in auditory function during follow-up period indicating recovery of middle ear function following palatoplasty. Discussion: The addition of hamulectomy to the palatoplasty treatment may improve the hearing outcomes for cleft palate patients and can be adopted to achieve tension free closure.

Perioperative and safety outcomes following tissue-sparing posterior cervical fusion to revise a pseudarthrosis: A multicenter retrospective review of 150 cases.

Posterior cervical fusion (PCF) with lateral mass screws is a favorable treatment option to revise a symptomatic pseudarthrosis due to reliable rates of arthrodesis; however, this technique introduces elevated risk for wound infection and hospital readmission. A tissue-sparing PCF approach involving facet fixation instrumentation reduces the rates of postoperative complications while stabilizing the symptomatic level to achieve arthrodesis; however, these outcomes have been limited to small study cohorts from individual surgeons commonly with mixed indications for treatment. One hundred and fifty cases were identified from a retrospective chart review performed by seven surgeons across six sites in the United States. All cases involved PCF revision for a pseudarthrosis at one or more levels from C3 to C7 following anterior cervical discectomy and fusion (ACDF). PCF was performed using a tissue-sparing technique with facet instrumentation. Cases involving additional supplemental fixation such as lateral mass screws, rods, wires, or other hardware were excluded. Demographics, operative notes, postoperative complications, hospital readmission, and subsequent surgical interventions were summarized as an entire cohort and according to the following risk factors: age, sex, number of levels revised, body mass index (BMI), and history of nicotine use. The average age of patients at the time of PCF revision was 55 ± 11 years and 63% were female. The average BMI was 29 ± 6 kg/m2 and 19% reported a history of nicotine use. Postoperative follow-up visits were available with a median of 68 days (interquartile range = 41-209 days) from revision PCF. There were 91 1-level, 49 2-level, 8 3-level, and 2 4±-level PCF revision cases. The mean operative duration was 52 ± 3 min with an estimated blood loss of 14 ± 1.5cc. Participants were discharged an average of 1 ± 0.05 days following surgery. Multilevel treatment resulted in longer procedure times (single = 45 min, multi = 59 min, P = 0.01) but did not impact estimated blood loss (P = 0.94). Total nights in the hospital increased by 0.2 nights with multilevel treatment (P = 0.01). Sex, age, nicotine history, and BMI had no effect on recorded perioperative outcomes. There was one instance of rehospitalization due to deep-vein thrombosis, one instance of persistent pseudarthrosis at the revised level treated with ACDF, and four instances of adjacent segment disease. In patients initially treated with multilevel ACDF, revisions occurred most commonly on the caudal level (48% of revised levels), followed by the cranial (43%), and least often in the middle level (9%). This chart review of perioperative and safety outcomes provides evidence in support of tissue-sparing PCF with facet instrumentation as a treatment for symptomatic pseudarthrosis after ACDF. The most common locations requiring revision were the caudal and cranial levels. Operative duration and estimated blood loss were favorable when compared to open alternatives. There were no instances of postoperative wound infection, and the majority of patients were discharged the day following surgery.

Is it inevitable to have dynamic horizontal acromioclavicular joint instability with a single tightrope?

Background and purpose Literature showed that single Tightrope fixation in acromioclavicular joint (ACJ) dislocation cases does not secure horizontal joint stability. A positive clinical cross-body adduction test is a usual outcome finding. We hypothesized that some cases might have some degree of horizontal stability, which might be confirmed with ultrasound examination. Methods This clinical study was performed on 27 patients who underwent single Tightrope application in acute ACJ dislocation. Patients were divided into group A which had an arthroscopic technique, and group B which had an open technique augmented with trans-ACJ fixation using two k-wires for 6 weeks. A clinical examination of the operated shoulders was done, and the results were compared with the sound shoulder examination in the same patient at the last 24 months postoperative follow-up visit. Besides, the results of the cross-body adduction test were correlated with ultrasound findings at the same visit. Records, operative details, and postoperative radiography were reviewed to assess if any factors would diminish the dynamic horizontal stability of the ACJ. Body mass index (BMI) was calculated per case. Results Group A had 17 patients (three patients had grade III dislocations, and 14 patients had grade V dislocations). Group B had 10 patients (four patients had grade III dislocations, and six patients had grade V dislocations). The clinical cross-body adduction test gave gross positive results in 14 patients out of group A patients while it gave gross positive results in six patients out of group B patients. Group A patients with negative results were 3, while group B patients with negative results were 4. By ultrasound, differences in horizontal translation of the clavicle within the ACJ in resting and cross-arm positions were more obvious in all operated shoulders than in all sound shoulders. Conclusion The less the Rockwood grading, the more potential to secure more horizontal stability. An open approach also gives more horizontal stability. With increased BMI, horizontal instability is usually masked. So, some factors may diminish, or mask clinical dynamic horizontal instability, which can be confirmed or rolled out with ultrasound usage.

Anatomic total shoulder arthroplasty for B2 glenoids treated with asymmetric reaming has equivalent survivorship and patient outcomes compared with type A glenoids at a mean 9-year follow-up

BackgroundWalch B2 glenoids can present a challenge to shoulder arthroplasty surgeons. Short-term studies have demonstrated that corrective reaming to 10° of retroversion in anatomic total shoulder arthroplasty (aTSA) can result in good outcomes, however there is little data reporting the long-term outcomes in this cohort. B2 glenoids treated with high-side reaming present a theoretical risk of early glenoid component failure as one may ream into the subchondral bone. This study aimed to demonstrate that 1) B2 glenoids treated with corrective reaming have durable results and 2) offer similar results to Walch A1/2 in long-term follow-up. MethodsPatients who underwent aTSA by a single surgeon (E.L.F.) were identified from a shoulder arthroplasty registry. Inclusion criteria included Walch A1, A2 or B2 glenoid, a diagnosis of primary shoulder osteoarthritis, and a minimum radiographic and clinical follow-up of 5 years. 43 patients with B2 glenoids were compared to a cohort of 42 patients with A1 or A2 glenoids. Preoperative computed tomography (CT) and radiographs were utilized to assess deformity, glenoid version, and posterior subluxation of the humeral head. Postoperatively, patients were assessed with radiographs and patient-reported outcome measures including American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, and Visual Analog Scale (VAS). Results85 shoulders (82 patients, 42 B2 and 43 A1/A2 glenoids) with an average follow-up of 9.4 years were included. In the B2 cohort, the average retroversion was 21.1° and posterior subluxation was 69.4% compared with 10.6°(p<0.001) and 57.5% (p<0.001) in the A1 or A2 cohort. The cohort demographics were similar except for male sex (B2 69.8% vs A1 or A2 37.2%, p=0.008). There was no difference between the cohorts in their improvement in ASES (p=0.807), SST (p=0.586), or VAS (p=0.930) scores. There was no difference in lateral humeral offset (p=0.889) or acromial humeral interval (p=0.468) between initial postoperative and final follow-up visits. Survivorship for B2 glenoids was 97.6%, 94.1% and 73.3% at 5, 10 and 15 years, respectively compared to 97.6%, 91.9% and 83.5% in type A glenoids. The revision rate was similar between the two groups (p=0.432). Lazarus score (p=0.682) and rates of humeral radiolucency (p=0.366) and humeral osteolysis (p=0.194) were similar between the two cohorts at final follow-up. ConclusionAsymmetric reaming of patients with B2 glenoids is a reliable method of glenoid preparation with excellent mid- to long-term clinical results, patient reported outcomes, and low revision rates similar to their A1 and A2 counterparts.

Using PROMIS Scores to Provide Cost-Conscious Follow-up After Foot and Ankle Surgery.

National campaigns in the United States, such as Choosing Wisely, emphasize that decreasing low-value office visits maximizes health care value. Although patient-reported outcomes (PROs) are frequently used to quantify postoperative outcomes, they have not been assessed as a tool to help guide clinicians consider alternatives or discontinue in-person follow-up visits. The purpose of this study is to assess the frequency and cost of in-person follow-up visits after patients report substantial improvement defined as 2 consecutive improvements above preoperative Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores. Retrospective PROMIS PI data were obtained between 2015 and 2020 for common elective foot (n = 759) and ankle (n = 578) surgical procedures. Patients were divided into quartiles according to their preoperative PI score. Multivariable Cox proportional hazards models were used to investigate time to substantial improvement. Substantial improvement was defined as having 2 consecutive postoperative minimal clinically important differences (MCIDs) above preoperative PROMIS PI scores. MCID was measured using the distribution-based method. Multivariable negative binomial models were used to determine the number of visits and direct associated costs after substantial improvement. The cost to payors was estimated using reimbursement rates. Within 3 months, 12% to 46% of foot and 16% to 61% of ankle patients achieved substantial improvement. Results vary by preoperative pain quartile, with patients who report higher preoperative pain scores achieving earlier improvement. After achieving substantial improvement, foot and ankle patients averaged 3.60 and 4.01 follow-up visits during the remaining 9 months of the year. Visit costs averaged $266 and $322 per foot and ankle patient respectively. Postoperative follow-up visits are time-consuming and costly. Physicians might consider objective measures, such as PROMIS PI, to determine the need, timing, and alternatives for in-person follow-up visits for elective foot and ankle surgeries after patients demonstrate reliable clinical improvement. Level III, retrospective cohort study at a single institution.

Association of reduced cerebrospinal fluid NPTX2 levels with postoperative delirium in patients undergoing knee/hip replacement: a prospective cohort study

BackgroundPostoperative delirium (POD) is a common complication with poor prognosis in the elderly, but its mechanism has not been fully elucidated. There is evidence that the changes in synaptic activity in the brain are closely related to the occurrence of POD. And neuronal pentraxin 2 (NPTX2) can regulate synaptic activity in vivo.AimsThis study aims to explore whether decreased NPTX2 levels affects POD and whether the cerebrospinal fluid (CSF) biomarkers of POD mediate this association.MethodsIn this prospective cohort study, we interviewed patients with knee/hip replacement 1 day before surgery to collect patient information and assess their cognitive function. CSF was extracted for measuring the CSF levels of NPTX2 and other POD biomarkers on the day of surgery. And postoperative follow-up visits were performed 1–7 days after surgery.ResultsFinally, 560 patients were included in the study. The patients were divided into POD group and NPOD (non-POD) group. The POD group had a median age of 80 years, a female proportion of 45%, a median BMI of 24.1 kg/m2, and a median years of education of 9 years. The Mann–Whitney U test showed that CSF NPTX2 levels were significantly lower in POD group, compared with the NPOD group (P < 0.05). Univariate binary logistic regression analysis showed that reduced CSF levels of NPTX2 protected against POD (crude OR = 0.994, 95% CI 0.993–0.995, P < 0.001). The receiver-operating characteristic (ROC) curve indicated that CSF NPTX2 level had high predictive value for POD. Mediation analyses showed that CSF T-tau (mediating proportion = 21%) and P-tau (mediating proportion = 29%) had significant mediating effects on the association between CSF NPTX2 and POD.ConclusionCSF NPTX2 levels were associated with the occurrence of POD. Low CSF NPTX2 levels may be an independent protective factor for POD. CSF T-tau and P-tau could mediate the association between CSF NPTX2 and POD occurrence.Clinical trial registrationThe trial registration number (TRN): ChiCTR2200064740, Date of Registration: 2022-10-15.

Application of Mid-Pancreatectomy with End-to-End Anastomosis in Pancreatic Benign Tumors.

Mid-pancreatectomy combined with end-to-end anastomosis is a surgical procedure used to treat benign pancreatic tumors. It involves removing the tumor from the middle section of the pancreas and connecting the proximal and distal ends through an anastomosis. The traditional surgical approach for resecting the middle segment of the pancreas involves closing the proximal pancreas and creating a Roux-en-Y anastomosis with the jejunum. However, this approach carries a double risk of pancreatic stump fistula and pancreatico enteric anastomotic leak postoperatively. In this paper, a new procedure is described where stent tubes were placed into the proximal and distal sides of the pancreatic ducts after ensuring sufficient freedom from the proximal distal pancreas. The pancreatic parenchyma was then sutured continuously under direct vision to achieve pancreatic end-to-end anastomosis. This procedure helps preserve pancreatic function, reducing the risk of postoperative pancreatic insufficiency. However, due to the complexity and risks involved, thorough evaluation and preparation are necessary before surgery. We carefully assess the patient's history, serology, and imaging results to determine the feasibility and effectiveness of the procedure. During surgery, we consider the use of a suitable pancreatic duct stent to ensure the flow of pancreatic juice into the intestine through physiological pathways. Our goal is to remove the tumor while preserving as much normal pancreatic tissue as possible for the anastomosis. After the operation, it is crucial to monitor the patient's pancreatic function, paying close attention to blood glucose levels, drainage fluid volume, and amylase value of the pancreatic anastomosis. During the postoperative follow-up visit, the patient's pancreatic function was assessed, and there was no significant change in quality of life compared to before the surgery. This indicates that mid-pancreatectomy combined with end-to-end anastomosis is a safe and effective procedure for treating pancreatic benign neoplasms.

(048) Synchronous Management of Urethral Stricture Disease and Penile Prosthesis Implantation: A Case Series

Abstract Introduction Urethral stricture disease (USD) is found in approximately 0.9% of all men in developed countries; however, the prevalence of USD is expected to increase with time due to an aging population, a rising incidence of prostate cancer, the use of radiotherapy, and increasing utilization of endoscopic procedures in urology. Due to an increasing prevalence of USD, surgeons may encounter an undiagnosed urethral stricture at increasing rates during penile prosthesis (PP) implantation, and there is currently limited data to evaluate the risk of treating the stricture at that time. Objective Our study aims to monitor the outcomes of PP placement in the event of a urethral stricture. Methods A retrospective IRB-approved review (IRB00205900) was performed using the Johns Hopkins EMR for patients that had undergone PP implantation and incidentally found USD at the time of procedure from 2009 to 2023. Patients undergoing PP implantation without incidentally finding USD were excluded. Cases that could proceed as planned were classified as “completed,” while cases that could not proceed were classified as “aborted.” Stricture characteristics (location, size), procedural information, pertinent demographic data, and comorbidities were noted. Successful management was defined as the absence of complications requiring explantation, including device infection, erosion, or failure, within 90 days of the procedure. Recurrence of stricture was defined as the presence or worsening of obstructive lower urinary symptoms at any post-operative follow-up visits. Results Of the 2375 PP implantations performed from 2009 to 2023, twenty-four cases were identified in which an incidental USD was found. Out of the twenty-four patients, eighteen patients (75%) had IPPs implanted, while six patients (25%) had their procedures aborted. Of the eighteen patients, thirteen (13/18, 72.2%) underwent urethral dilation with Amplatz dilators, three patients (3/18, 16.7%) had passive dilation with a 16 F flexible cystoscope, and two patients (2/18, 11.1%) received a direct vision internal urethrotomy (DVIU). Within 90 days after the procedure, only one patient presented with urinary retention four days after the procedure (1/18, 5.6%). No PP infections were reported within 90 days in any patient. Only one patient (1/18, 5.6%) had their device explanted due to extrusion five years after the procedure. One patient had a recurrence of their stricture after four years (1/18, 5.6%). Of the six patients that had their procedures aborted, three patients (3/6, 50.0%) underwent urethroplasty. One patient (1/6, 16.7%) underwent urethral dilation and suprapubic tube placement, and two patients (2/6, 33.3%) underwent a DVIU. Five of these six cases had strictures greater than 2 cm with urethral lumens between 8-10F (5/6, 83.3%), while one patient had an obliterated urethra (1/6, 16.7%). Conclusions This retrospective case study of patients receiving synchronous USD management and PP implantation yielded high success and low complication rates. While a large, multi-institutional study should be performed, our study displays promising results and creates a framework that other surgeons may follow. Disclosure No.