Postoperative Reoperation Research Articles

Low Complication Rates in Olecranon Fracture Fixation With Dual Plating.

Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related to prominence, insufficient fixation of sagittal fracture lines, and difficulty matching proximal ulna dorsal angulation (PUDA), dual medial and lateral plating (DP) has been developed. We hypothesized that olecranon fractures treated with DP would have low complication rates and low incidence of hardware removal compared with those treated with traditional methods of fixation. The database of a single institution was reviewed for the period January 2017 to April 2023 for adults with olecranon fractures receiving DP fixation. Open fractures, fracture dislocations, previous elbow injuries, and pathologic fractures were excluded. Demographics, pre- and postoperative imaging, reoperations, and range of motion were collected. PUDA and varus angulation measurements, intra-articular step off, and fracture distraction were recorded. A total of 42 fractures in 41 patients were reviewed. Mean follow-up was 8.7 months (range, 3-36 months). One patient reported symptomatic hardware at 6 weeks that had resolved by 3 months, and 1 reported persistent symptomatic hardware not bothersome enough to warrant removal. Five patients (11.9%) had at least 1 postoperative complication. The hardware removal rate was 2.4%. DP for olecranon fractures represents a valuable strategy in fracture treatment. We report a low hardware removal rate of 2.4%, with removal being done for infection, not symptomatic hardware. DP provides a reliable method of fixation, helps re-create native anatomy, and has a low complication rate compared with standard dorsal plating. [Orthopedics. 202x;4x(x):xx-xx.].

Should We Operate on Octogenarians with Cervical Myelopathy or Radiculopathy?

Retrospective Cohort. Investigate the disparities between octogenarians and non-octogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes. As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians. Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients <80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain. There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P=0.548), 90-day readmission (10.3% vs. 6.9%, P=0.548), and 12-month reoperation (3.4% vs. 2.3%, P=0.736) between octogenarians and non-octogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P=0.393), improvement in 3- and 12- month PROMs and MCID achievement. Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and non-octogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.

Laparoscopic transabdominal vs. totally extraperitoneal inguinal hernia repair: outcomes, healthcare utilization, and cost differences.

Laparoscopic inguinal hernia repair utilizes either a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The literature remains mixed on outcomes comparing TAPP versus TEP. The objective of our study was to assess outcomes, healthcare utilization, and cost differences between TAPP and TEP inguinal hernia repair. Adult patients who underwent elective inguinal hernia repair between 2013 and 2021 were retrospectively identified from our institution's electronic health record. Baseline characteristics and postoperative complications were compared using chi-squared test. Multivariable logistic regression was used to model the odds of experiencing a postoperative emergency department visit, readmission, and/or reoperation within 6months were surgery. Generalized linear models were used to investigate differences in cost between TAPP and TEP groups. 1086 patients underwent TAPP repair, while 1277 patients underwent TEP repair. TAPP patients had more than double the rates of readmissions (3.1% vs. 1.3%, p = 0.002) and reoperations (1.5% vs. 0.2%, p = 0.001) within 6months of surgery. On multivariable analysis, undergoing TAPP inguinal hernia repair was associated with higher odds of reoperations and/or readmissions within 6months of surgery (OR 2.8, CI [1.5, 5.1], p = 0.001). TAPP repair had a higher index surgery cost and higher costs associated with reoperations and readmissions compared to TEP repair. Although both approaches are very safe, TAPP inguinal hernia repair had higher rates of postoperative complications, increased healthcare utilization, and higher associated costs. Future studies should be directed toward decreasing postoperative healthcare utilization in order to decrease costs in inguinal hernia repair.

Comparison of dynamic hip screw with anti-rotation screw and femoral neck system internal fixation for the treatment of garden II-IV type femoral neck fractures.

Femoral neck fractures, which are fractures occurring from the femoral head to the base of the femoral neck, are prevalent in the elderly population. With the progression of societal aging, the incidence of femoral neck fractures has been steadily increasing, making it a significant global issue that urgently needs to be addressed. To compare the efficacy and safety of dynamic hip screw (DHS) with anti-rotation screw and femoral neck system (FNS) internal fixation for the treatment of Garden II-IV type femoral neck fractures. A total of 90 patients with Garden II-IV type femoral neck fractures were randomly assigned to either the control group (n= 45) treated with DHS and anti-rotation screw or the experimental group (n= 45) treated with FNS. Surgical outcomes, including incision size, blood loss, operation time, fluoroscopy frequency, and fracture healing time, were compared. Postoperative complication rates, reoperation rates, Harris scores, and visual analogue scale (VAS) scores were also assessed. The experimental group demonstrated significantly reduced incision length, blood loss, operation time, and fluoroscopy frequency compared to the control group (P< 0.01). No significant differences were observed in fracture healing time, Garden classification, or fracture reduction outcomes between the two groups (P> 0.05). At 6 months post-treatment, both groups showed significant improvements in Harris scores and VAS scores compared to pre-treatment (P< 0.05), with no significant differences between the groups (P> 0.05). The rates of internal fixation failure, nonunion, and avascular necrosis of the femoral head, as well as overall incidence of postoperative complications and reoperation rates, showed no significant differences between the two groups (P> 0.05). Both DHS with anti-rotation screw and FNS internal fixation demonstrated comparable efficacy and safety profiles in the treatment of Garden II-IV type femoral neck fractures. The experimental group showed advantages in terms of reduced incision length, blood loss, operation time, and fluoroscopy frequency, while maintaining similar clinical outcomes and complication rates.

Perioperative outcomes and trends of transurethral surgeries for benign prostatic hyperplasia in octogenarians: a comprehensive analysis using the NSQIP database (2011-2022).

Advances in health care have resulted in an increasing octogenarian population in the United States. The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in this subgroup exceeds 70%. This study attempts to evaluate perioperative outcomes of different transurethral techniques in octogenarians and define their utilization trends from 2011 to 2022. We extracted data from the American College of Surgeons NSQIP for octogenarian patients who underwent prostatectomy for BPH. Procedures were categorized using CPT codes, and outcomes included postoperative complications, readmission, 30-day reoperation, and utilization trends from 2011 to 2022. A total of 21,314 octogenarians were included. TURP was the most performed procedure (53.13-71.17%), followed by PVP and HoLEP. HoLEP utilization increased reaching up to 19% by year 2022. Higher American Society of Anesthesiologists (ASA) scores were observed more frequently in the TURP group. HoLEP consistently exhibits the longest operative times. Initially relatively higher transfusion rates for HoLEP decreased to 0% by 2022. Urinary tract infection rates did not significantly differ among the procedures most years. TURP remained the most performed modality for BPH management in octogenarians amongst NSQIP-participating institutions. However, from 2011 to 2021, the utilization of HoLEP increased nearly by 2.5 folds, from 2.5 to 6.4%.

Novel Risk Factors for Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion.

Retrospective cohort study. To investigate the correlation between comorbid chronic obstructive pulmonary disease (COPD), asthma, tobacco use, and the incidence of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF). Prior studies have identified general risk factors such as multilevel fusion and coagulopathy. However, specific coughing-related factors like COPD, asthma, and tobacco use have not been extensively investigated. Patients who underwent single or multilevel ACDF between 2011 and 2021 were identified using Current Procedural Terminology (CPT) codes in the PearlDiver database. The primary outcome was the occurrence of postoperative hematoma requiring reoperation within 30 days. χ2 tests and t tests compared groups, and multivariable logistic regression identified predictors for postoperative hematoma. Among 399,900 patients with ACDF, 901 (0.2%) developed postoperative hematoma requiring reoperation within 30 days. Patients with postoperative hematoma were older (58 vs. 55, P<0.001) and predominantly male (62.5% vs. 44.9%, P<0.001). After adjustment, tobacco use and comorbid COPD were associated with postoperative hematoma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.10-1.47; P<0.001 and OR, 1.41; 95% CI, 1.21-1.64; P<0.001, respectively). Comorbid asthma was not a significant risk factor. Additional risk factors included comorbid hypertension (OR, 1.46; 95% CI, 1.18-1.82; P<0.001), coagulopathy (OR, 1.50; 95% CI, 1.24-1.81; P<0.001), anemia (OR, 1.38; 95% CI, 1.17-1.62; P<0.05), and history of deep vein thrombosis (OR, 1.93; 95% CI, 1.44-2.54; P<0.001). Tobacco use and COPD were identified as novel risk factors for postoperative hematoma formation requiring reoperation after ACDF. Recognizing these modifiable factors, providers may consider postponing nonemergent ACDFs until patients undergo smoking cessation programs or receive optimal COPD management.

Antibiotic Stewardship through Use of a Preferred Antibiotic Regimen is Associated with Decreased Organ Space Surgical Site Infections in Uncomplicated and Complicated Pediatric Appendicitis.

Background: There is a lack of consensus on the optimal antibiotic regimen for pediatric appendicitis, and conflicting data exist regarding the need for extended-spectrum use in this population. We implemented an antibiotic stewardship program with a standard, preferred antibiotic regimen for both uncomplicated and complicated appendicitis and hypothesized that clinical outcomes would be equivalent. Methods: This is a single-institution, retrospective study of pediatric patients (≤18 y) who underwent appendectomy for acute appendicitis between October 2015 and May 2022. We used institutional data from our stewardship program supplemented by manual chart review. Patients were assigned to pre- and post-pathway cohorts on the basis of appendectomy date. Patients were further stratified on the basis of whether they met criteria for complicated appendicitis on the basis of intra-operative findings. Results: There were 752 patients that were included: 346 (46.0%) in the pre-pathway cohort and 406 (54.0%) in the post-pathway cohort. The pre-pathway cohort had a higher rate of complicated appendicitis (40.2 vs. 25.6%). However, pre- and post-pathway cohorts had similar rates of post-operative infections, readmissions, and reoperations. When separated by complicated operative findings, patients with uncomplicated appendicitis had a shorter length of stay post-pathway implementation (p < 0.001). After controlling for complicated operative findings and pertinent covariates, the preferred antibiotic regimen was independently associated with decreased odds of post-operative organ space surgical site infections (SSI) (adjusted odds ratio 0.22, 95% CI: 0.05-0.99). Discussion: Antibiotic stewardship to increase the use of a standardized, preferred antibiotic regimen did not result in worse clinical outcomes. The preferred regimen was significantly associated with a decreased rate of organ space SSI, even when controlling for complicated operative findings. The mechanism of this finding requires additional study.

Meta-analysis of routine abdominal drainage versus no drainage following distal pancreatectomy: Does the best available evidence overcome "HPB surgeon's paranoia"?

To evaluate comparative outcomes of routine abdominal drainage versus no drainage after distal pancreatectomy (DP). A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted (last search: 20th April 2024). All comparative studies reporting outcomes of DP with routine abdominal drainage and no drainage were included and their risk of bias were assessed. Overall perioperative complications, clinically-relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), postoperative haemorrhage, surgical site infections (SSIs), need for radiological intervention, reoperation, re-admission, and postoperative mortality were the evaluated outcome parameters. Eight comparative studies (2 randomised and 6 observational) reporting 8164 patients who underwent DP with (n=6394) or without (n=1770) routine abdominal drainage were included. Routine abdominal drainage was associated with significantly higher rates of CR-POPF (OR 2.87; 95% CI 2.34-3.52, p<0.00001), radiological intervention (OR 1.33; 95% CI 1.10-1.61, p=0.0003), SSIs (OR 2.47; 95% CI 1.29-4.72, p=0.006) or re-admission (OR 1.54; 95% CI 1.30-1.82, P<0.00001) compared to no use of drain. However, there was no significant difference in C-D III or higher postoperative morbidities (OR 1.25; 95% CI 0.98-1.60, p=0.08), DGE (OR 1.17; 95% CI 0.81-1.67, p=0.41), reoperation (OR 1.11; 95% CI 0.80-1.54, P=0.53), postoperative haemorrhage (OR 0.59; 95% CI 0.18-2.00, P=0.40), or mortality (RD 0.0; 95% CI -0.01-0.01, p=0.76) between two groups. The meta-analysis of best available evidence indicates safety of "no drain policy" in distal pancreatectomy considering its lower risk of CR-POPF, re-intervention and hospital re-admission. More randomised evidence is required to overcome the "HPB surgeon's paranoia".

Risk Factors for Postoperative Urinary Tract Infections in Paediatric Hydronephrosis: A Retrospective Analysis.

Paediatric hydronephrosis frequently necessitates surgical intervention. However, postoperative urinary tract infections (UTIs) are common and challenging. This retrospective cohort study aimed to identify UTI risk factors following an operation for paediatric hydronephrosis. Paediatric patients with hydronephrosis who underwent operation from January to December 2023 were studied. Patients were categorised into no UTI and UTI groups. Demographics, surgical history, pre/postoperative factors, imaging, and lab values were compared. A total of 111 patients were enrolled, with 98 in the no-UTI group and 13 in the UTI group. The UTI group had significantly more previous surgeries and longer surgical duration (p < 0.05). Preoperative factors associated with UTI occurrence included higher hydronephrosis grade, absence of antibiotic prophylaxis, presence of vesicoureteral reflux (VUR), abnormal preoperative urine cultures, and ureteral stent placement (p < 0.05). The UTI group exhibited more extended hospital stays, higher rates of postoperative fever, reoperation, and readmission within 30 days (p < 0.05). Postoperative imaging and laboratory findings were also significantly different (p < 0.05). The UTI group had elevated white blood cell count, C-reactive protein levels, serum creatinine, and urine white blood cell count (p < 0.05). Other potential risk factors included constipation, family history of UTI, bladder dysfunction, history of recurrent UTI, and use of prophylactic antibiotics. Multivariate logistic regression analysis indicated that while antibiotic prophylaxis and preoperative urine culture results negatively correlated with UTI occurrence, other factors were positively correlated, with the number of previous surgeries having the most significant impact on UTI occurrence (odds ratio (OR) = 20.617; 95% confidence interval (CI): [0.718, 0.802]; p < 0.001). Multiple factors contribute to the risk of postoperative UTI for paediatric hydronephrosis, highlighting the need for tailored interventions to mitigate risks and improve outcomes.

A Suture Technique Combining Annulus Fibrosis with Posterior Longitudinal Ligament for Lumbar Disc Herniation under Endoscopy

PurposeTo investigate the clinical feasibility,efficacy and safety of a suture technique combining annulus fibrosus with posterior longitudinal ligament under full endoscopy in patients with lumbar disc herniation. MethodsRetrospective case-control study. A total of 412 patients with lumbar disc herniation treated in our hospital from January 2020 to November 2022 were enrolled and analyzed. There were 208 males and 204 females, aged from 26 to 54 years old(average 39.9±5.1). 208 patients were treated with combining annulus fibrous suture with posterior longitudinal ligament after percutaneous lumbar discectomy(PELD)(observation group).204 patients were treated with percutaneous lumbar discectomy(PELD) alone(control group).Operation time, blood loss, Visual Analogue scale(VAS), Oswestry disability index(ODI) ,Japanese Orthopedic Association(JOA), modified MacNab criteria and imaging examination were used to evaluate. ResultsAll the 412 patients successfully completed the surgery. Complete follow-up time was 12 to 18 months, with an average of 15.2±1.6 months. Postoperative symptoms were all significantly relieved. There was no statistically significant difference in baseline data between groups (P>0.05).The scores of VAS,ODI and JOA at different postoperative follow-up visits were significantly lower than those before surgery (P<0.05). There was significant difference in each group before and after surgeries (P<0.05). The postoperative recurrence rates and reoperation rates between groups were significant different(P<0.05). According to MacNab, the excellent and good rate was 96.2% (200/208) in observation group and 90.7% (185/204) in control group(P<0.05). ConclusionsThe suture technique combining annulus fibrosus with posterior longitudinal ligament under full endoscopy in patients with lumbar disc herniation has satisfactory short- and mid-term clinical effect,and can effectively reduce postoperative recurrence rate, which is a safe and ideal suture technique for annulus fibrosus rupture. Clinical trial numbernot applicable.

“Comparison of DIEP and PAP free flaps for breast reconstruction in the context of breast cancer: A retrospective study of 677 patients over 10 years”

BackgroundPAP (Profunda Artery Perforator) flap following cancer surgery has emerged as a relevant alternative for breast reconstruction but remains mainly used in cases where the DIEP (Deep Inferior Epigastric Perforator) flap cannot be performed. The aim of this work is to compare PAP and DIEP flaps’ surgical and aesthetics outcomes in breast reconstruction. MethodsWomen who underwent breast reconstruction by DIEP or PAP flap at the Plastic Surgery Department of Georges Pompidou European University Hospital, Paris, France, between January 2012 and December 2020 were included. Patient’s demographic characteristics were recorded as well as type, laterality and timing of reconstruction. Operative times, length of hospital stay, general and surgical complications were compared. The number of late surgical reoperations, their timing relative to the initial reconstructive procedure, and their purpose were also compared. ResultsA total of 677 patients were included, 559 of whom received a DIEP flap and 118 a PAP flap. PAP flap patients were significantly younger, thinner, and had a smaller initial bra cup size than those who received a DIEP (p<0.001) Operative time was similar for both groups (p=0.074). There was no difference in the number of early postoperative reoperations (p>0.554) or of late revisions (p>0.403) between DIEP or PAP. ConclusionProvided that the technical and human resources are available, PAP flap is a valid technique, with no increased risk of surgical complications and reoperations, nor lengthening of operative time. The PAP flap should be considered a primary therapeutic option and not only an alternative to the DIEP flap.

Use of medialized trochanteric-entry intramedullary nail to improve alignment in proximal femur nonunions.

Proximal femur shaft nonunion is a challenging problem, often occurring after malreduction that results in postoperative malalignment and decreased healing potential. Correction of malalignment is critical to achieving osseous union. Here we present a novel technique for treating proximal femur nonunions with varus malalignment using an intramedullary nail inserted through a medialized trochanteric entry point. Patients who underwent a proximal femur shaft (subtrochanteric or proximal third shaft) nonunion operation at a single level 1 academic referral centre by two attending surgeons between 1/1/2014 and 1/1/2022 were identified. Radiographic imaging was reviewed to determine initial fracture classification and calculation of coronal plane alignment (CPA), which was measured on preoperative, immediate postoperative, and final follow-up radiographs. Postoperative complications, reoperations, infections, and osseous union were also collected. Twenty-one patients with a mean age of 49.9 years (66% male) were identified. Mean preoperative CPA was 125.6 degrees, immediate postoperative mean CPA was 132.6 degrees, and mean final follow-up CPA was 131.5 degrees. Mean change in CPA from immediate postoperative films to final follow-up was a decrease of 0.4 degrees. 17 patients had follow up for a minimum of 12 months or until osseous union, and all achieved union without any major complications. Exchange nailing with an antegrade trochanteric entry nail through a medialized trochanteric starting point is a safe and effective technique in the treatment of proximal femur nonunions. This technique results in improved postoperative alignment that is sustained throughout the postoperative course, and may lead to increased rates of osseous union.

Unilateral biportal endoscopic vs. open surgery in the treatment of young obese patients' lumbar degenerative diseases: a retrospective study.

Obesity accelerates the development of lumbar disease and increase the risk during surgery. Unilateral biportal endoscopic discectomy (UBE) is a newly developed minimally invasive technique, which refers to the spinal surgery under unilateral double-channel endoscopic surgery. Therefore, the purpose of this study is whether UBE decompression alone can bring good clinical results to young obese patients with lumbar degenerative diseases. The patients with lumbar diseases who underwent UBE and open surgery (open discectomy) in our hospital from February 2020 to February 2022 were selected as young (age ≤ 44 years old) and obesity (BMI ≥ 30 kg/m2). The patients were evaluated with VAS, ODI, JOA and modified Macnab score before operation, 1 month, 6 months and 12 months after operation. Nerve root function sensation, muscle strength and tendon reflex were evaluated. The operation time, estimated blood loss, postoperative hospital stay, incidence of postoperative complications and reoperation rate were recorded. MRI quantitative lumbar multifidus muscle (LMM) comparison was performed 12 months after operation. 77 patients were included, and the scores of VAS, ODI and JOA were similar in the two groups during the last follow-up. There were no difference in nerve root function sensation, muscle strength or tendon reflex. However, one month after operation, the VAS back score and ODI improvement in the UBE group were significantly better than those in the open group, which were 2.44 ± 0.97, 33.10 ± 6.78 and 2.93 ± 0.79 and 36.13 ± 5.84, respectively, with a statistically significant difference (p = 0.020 and 0.038). According to the modified Macnab criteria, UBE group, the excellent and good rate was 97.2%. The excellent and good rate of open group was 97.6%. The estimated blood loss and postoperative hospital stay in UBE group (36.81 ± 17.81, 3.92 ± 1.32) were significantly better than those in open group (104.88 ± 31.41, 6.41 ± 1.94), with a statistically significant difference (p = 0.010). There was no significant difference in operation time between the two groups (p = 0.070). The number of complications in UBE group was 2 (5.6%) and open group was 4 (9.8%). The fat infiltration rate of 19.3%+11.0% in UBE group was significantly lower than that of 27.0%±13.9% in open group (p = 0.010). UBE has the advantage of early recovery in the treatment of lumbar degenerative diseases in young obese patients, and reduces the damage to LMM, so it has a good clinical effect.

Robotic Versus Laparoscopic Versus Open Surgery for Non-Metastatic Pancreatic Neuroendocrine Tumors (pNETs): A Systematic Review and Network Meta-Analysis.

Background: This systematic review, using pairwise and network meta-analyses, aimed to compare the intraoperative, short-term, and long-term postoperative outcomes of minimally invasive surgery (MIS) and open surgery (OS) for the management of pancreatic neuroendocrine tumors (pNETs). Methods: Studies reporting on the effects of robotic, laparoscopic, and open surgery on pNETs published before November 2023 on PubMed, Scopus, and CENTRAL were analyzed. Results: Thirty-two studies with 5379 patients were included in this review, encompassing 2251 patients undergoing MIS (1334 laparoscopic, 508 robotic, and 409 unspecified MIS) and 3128 patients undergoing OS for pNETs management. Pairwise meta-analysis revealed that the MIS group had a significantly shorter length of hospital stay ((a low certainty of evidence), MD of -4.87 (-6.19 to -3.56)); less intraoperative blood loss ((a low certainty of evidence), MD of -108.47 (-177.47 to -39.47)); and decreased tumor recurrence ((a high certainty of evidence), RR of 0.46, 95% CI (0.33 to 0.63)). Subgroup analysis indicated a higher R0 resection rate and prolonged operative time for laparoscopic surgery than for OS. The network meta-analysis ranked the robotic approach as superior in terms of the length of hospital stay, followed by the laparoscopic and OS arms. Furthermore, it favored both MIS approaches over OS in terms of the R0 resection rate. No significant differences were found in severe postoperative complications, postoperative fistula formation, mortality, readmission, reoperation, or conversion rates. Conclusions: This review supports the safety of MIS for the treatment of pNETs. However, the varying certainty of evidence emphasizes the need for higher-quality studies.

Lower extremity osteotomies for limb preservation: Indications, outcomes, and risk factors

ObjectivesTo delineate the key factors associated with treatment success or failure for patients undergoing lower extremity osteotomies to address a spectrum of lower extremity joint and limb deformities at an Integrated Limb Preservation Center (ILPC). MethodsDesign: Retrospective cohort study.Setting: Level I Academic Trauma Center.Patient selection criteria: Patients of the ILPC with at least 1-year of follow-up data regarding previous surgery to correct trauma-or developmental-related deformities between January 1, 2005, and October 1, 2022.Outcome measures and comparisons: Patients were categorized first based on etiology (developmental vs. traumatic) and then based on the nature of deformity (joint, limb, nonunion). Treatment data, demographics including age, sex, body mass index (BMI), tobacco use history, insurance status, marital status, mental health history, and history of comorbidities, concurrent procedures, and post-operative infection, revision, reoperation, and bone healing status were extracted from the medical record and compared. Treatment failure was defined as conversion of the limb preservation surgery (ies) to amputation of any type. Results139 patients were included for analysis; 47 patients in the developmental-related cohort, and 92 patients in the trauma-related cohort. The treatment success rate in terms of preserving the affected limb for patients undergoing lower extremity osteotomies was 94.7 % for the developmental-related cohort and 92.4 % for the traumatic-related cohort. 57.4 % of patients in the developmental-related cohort and 59.8 % of patients in the trauma-related underwent unplanned secondary procedures Concurrent osteomyelitis debridement (p = 0.01) and postoperative infection (p = 0.049) were the only factors measured significantly associated with conversion to amputation. ConclusionsPatients undergoing osteotomies at an ILPC to address developmental-related or trauma-related joint and/or limb deformities experienced high short-term success (>90 %) with respect to preserving the affected limb. However, 56 % of patients required subsequent unplanned surgeries and improvements in PROMs were only statistically significant in patients with trauma-related deformities. Level of evidenceIII.

Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection.

While frailty has gained attention for its utility in risk stratification, no studies have directly compared them to existing risk calculators. The objective of this study was to compare the risk stratification of the American College of Surgeons Surgical Risk Calculator (ACS-SRC), the Revised Risk Analysis Index (RAI-rev), and the Modified Frailty Index (5-mFI). The primary outcomes were 30-day postoperative morbidity, 30-day postoperative mortality, unplanned readmission, unplanned reoperation, and discharge disposition other than home. Patients undergoing anatomic lung resection for primary, nonsmall cell lung cancer were identified within the ACS National Quality Improvement Program (ACS NSQIP) database. Tools were compared for discrimination in the primary outcomes. 9663 patients undergoing anatomic lung resection for cancer between 2012 and 2014 were included. The cohort was 53.1% female. Median age at diagnosis was 67 (IQR 59-74) years. Perioperative morbidity and mortality rates were 10.9% (n = 1048) and 1.6% (n = 158). Rates of 30-day postoperative unplanned readmission and reoperation were 7.5% (n = 725) and 4.8% (n = 468). The ACS-SRC had the highest discrimination for all measured outcomes, as measured by the area under the receiver operating curve (AUC) and corresponding confidence interval (95% CI). This included perioperative mortality (AUC 0.74, 95% CI 0.71-0.78), compared to RAI-rev (AUC 0.66, 95% CI 0.62-0.69) and 5-mFI (AUC 0.61, 95% CI 0.57-0.65; p < 0.001). The RAI-rev and 5-mFI had similar discrimination for all measured outcomes. ACS-SRC was the perioperative risk stratification tool with the highest predictive discrimination for adverse, 30-day, postoperative events for patients with cancer treated with anatomic lung resection.

The Long-Term Clinical and Radiographic Outcomes of Cerclage Cable Fixation for Displaced Acetabular Fractures Using a Posterior Approach: A Retrospective Cohort Study.

Background and Objectives: Cerclage cable fixation with 2 mm multiple-braided cables for displaced acetabular fractures has shown good midterm functional and radiographic outcomes. We retrospectively evaluated the clinical and radiographic outcomes of cerclage cable fixations over ten years. Materials and Methods: We extracted data for patients who underwent cerclage cable fixation for acetabular fractures at a single institution from 2007 to 2012. We adopted this procedure for acetabulum fractures with posterior column fractures. Postoperative reduction quality, complications, reoperations, and Japanese Orthopedic Association (JOA) hip objective functional scores were analyzed. Postoperative reduction quality was classified using plain radiography and computed tomography. Results: We evaluated nine patients with a mean follow-up period of 14.1 ± 2.6 years (range: 10.8-18.1 years). The mean age was 47.1 ± 15.5 years old (range: 28-74 years); the mean injury severity score was 13.6 ± 4.7 (range: 9-22). The most frequent type of fracture was a both-column fracture. Anatomical reduction quality was achieved in five cases. Four patients had hip osteoarthritis at the last follow-up; among them, one patient had worsening hip arthritis > 5 years after surgery, and one patient developed osteoarthritis > 10 years after surgery. Their postoperative reduction quality was worse than their anatomical reduction quality, and both engaged in physical labor. None of the patients underwent revision total hip arthroplasty. The mean JOA hip score was 90.9 ± 7.9 (range: 74-100); seven patients scored >90 at the last follow-up. Conclusions: Cerclage cable fixation showed satisfactory postoperative reductions and favorable long-term clinical outcomes. Long-term follow-up might be necessary for patients whose postoperative reduction is not anatomical to detect late occurrence of hip osteoarthritis, even if osteoarthritis is not evident during short-term follow-up periods.

Laparoscopic versus open repair for peptic ulcer perforation: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Time to conclude!

The aim of this study was to investigate comparative outcomes of laparoscopic and open repair for peptic ulcer perforation (PUP). A PRISMA-compliant systematic review with a PROSPERO-registered protocol (registration number CRD42024529286) was conducted. All randomised controlled trials (RCTs) involving PUP patients managed by laparoscopic or open repair were identified and their risk of bias assessed. Outcome syntheses for perioperative mortality and morbidities, need for reoperation, procedure time and length of hospital stay were conducted using random-effects modelling to calculate risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI). Nine RCTs met the inclusion criteria, enrolling 670 patients of whom 317 were randomised to receive laparoscopic surgery and 353 were managed with open surgery. Laparoscopic repair of PUP significantly reduced mortality (RR 0.37, p = 0.03), total complications (RR 0.57, p = 0.0009), ileus (RR 0.43, p = 0.04), wound complications (RR 0.36, p < 0.0001) and length of hospital stay (MD -2.37, p = 0.0003) compared with the open approach. There were no significant differences in rate of postoperative leak (RR 2.00, 95% CI 0.74-5.41, p = 0.17), abdominal collection (RR 1.19, 95% CI 0.46-3.07, p = 0.72), sepsis (RR 1.17, 95% CI 0.39-3.52, p = 0.65), respiratory complications (RR 0.68, 95% CI 0.32-1.46, p = 0.32), reoperation (RR 1.74, 95% CI 0.57-5.30, p = 0.33) and operating time (MD 15.31, 95% CI -4.86 to 35.47, p = 0.14) between the two groups. Laparoscopic repair of PUP is associated with significantly lower mortality and morbidity and shorter length of stay compared with the open approach. The laparoscopic approach should be the management of choice subject to the existence of laparoscopic expertise.

Effect of perioperative erythropoietin on postoperative morbidity and mortality after cardiac surgery: a meta-analysis of randomized controlled trials

ObjectiveCardiac surgery is known to have high rates of perioperative red blood cell (RBC) transfusions which are associated with increased postoperative mortality and morbidity. Perioperative erythropoietin (EPO) has been suggested to lower perioperative RBC transfusions, and the effect on postoperative morbidity or mortality is unknown. MethodsThe registered study protocol is available on PROSPERO (CRD42022314538). We searched the Pubmed, EMbase, and Cochrane CENTRAL databases for randomized controlled trials (RCT) of EPO in cardiac surgery. Outcomes were short-term mortality, acute kidney injury (AKI), re-operation, cerebrovascular accident (CVA), perioperative myocardial infarction (MI), infectious complications, and RBC transfusions. RCT studies of perioperative EPO that reported at least one prespecified outcome of interest were included. ResultsA total of 21 RCT’s (n = 2,763 patients) were included. Mortality analysis included 17 studies (EPO 1,272 patients, control 1,235) and showed no significant difference (risk difference (RD) 0.0004, 95%CI: −0.016, 0.009). EPO did not reduce the incidence of AKI (RD −0.006, 95% CI: −0.038, 0.026) and reoperation (RD 0.001, 95% CI: −0.013, 0.015). The incidence of CVA (RD −0.004, 95% CI: −0.015, 0.007) and perioperative MI (RD −0.008, 95% CI: −0.021, 0.005) was similar between the groups. ConclusionsAlthough EPO had been proven to reduce perioperative RBC transfusions, we did not find that it reduces the incidence of postoperative short-term mortality, AKI, and reoperation. The study results support that perioperative EPO is also safe, with no rise in thrombotic events, including CVA and perioperative MI.

Comparison of Outcomes after Autologous Breast Reconstruction: Latissimus Dorsi with Immediate Fat Transfer versus Abdominally Based Free Flaps.

Autologous breast reconstruction confers favorable patient reports of satisfaction and quality of life compared with implant-based reconstruction over a lifetime. The latissimus dorsi with immediate fat transfer (LIFT) is an alternative approach to abdominally based free flaps (Ab-FF), which expands fully autologous reconstruction to nonmicrosurgeons. This study compared the 2 procedures concerning their clinical and patient-reported outcomes 1 year postoperatively. The authors conducted a retrospective review of LIFTs and Ab-FFs performed between March of 2017 and August of 2022. The primary outcomes were postoperative complications, reoperations, and longitudinal BREAST-Q scores. BREAST-Q modules included Satisfaction with Breasts, Satisfaction with Abdomen, Satisfaction with Back, Psychosocial Well-being, Physical Well-being: Chest, Physical Well-being: Abdomen, Physical Well-being: Back, and Sexual Well-being. Of the 281 included patients (408 breasts), 211 received Ab-FF and 70 received LIFT. One-year follow-up (median [interquartile range], 12 [12] months) demonstrated that Ab-FF independently predicted dehiscence, reoperation procedures, and revisional surgery. LIFT independently increased the odds of seroma. Obesity predicted dehiscence, and bilateral reconstructions predicted revisional fat grafting. BREAST-Q scores fluctuated over time but were similar across all measured domains by 1 year postoperatively. Although Ab-FF is the standard approach for fully autologous reconstruction, LIFT procedures may be associated with a less complicated postoperative course while eliciting similar patient-reported outcomes. LIFT may be preferred to limit postoperative complications, particularly in patients with obesity. LIFT can be used by plastic surgeons who are not trained in microsurgical procedures or do not have an environment that fosters Ab-FF. Therapeutic, III.