Postoperative Time Period Research Articles

Comparison of midline lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for treatment of lumbar degeneration disease

Midline lumbar interbody fusion (MIDLIF) and minimally invasive transforaminal interbody fusion (MIS-TLIF) are two minimally invasive lumbar fusion methods that have gained popularity in the past two decades. MIDLIF involves the use of cortical bone trajectory screws, whereas MIS-TLIF uses traditional pedicle screws. However, there is a significant lack of research directly examining the clinical efficacy of these two methods in treating single-segment lumbar degenerative diseases. Hence, the objective of our retrospective study is to assess and contrast the surgical and clinical results of MIDLIF and MIS-TLIF. The study population comprised 133 patients diagnosed with single-segment lumbar degenerative disease that received treatment using either MIDLIF (n = 65) or MIS-TLIF (n = 68) in our department from January 2017 to January 2019. The fusion rates for MIDLIF were consistently lower than MID-TLIF at all post-operative time periods of follow-up, however, the differences between the two groups were not statistically significant. The 1-year fusion rates were 81.5% (MIDLIF) and 83.8% (MIS-TLIF) (P = 0.728), and the 2-year fusion rates were 87.7% (MIDLIF) and 91.2% (MIS-TLIF) (P = 0.513). The final follow-up fusion rates were 93.8% (MIDLIF) and 95.6% (MIS-TLIF) (P = 0.653). MIDLIF had several advantages over MIS-TLIF, including a shorter operative time (135.2 ± 15.70 vs. 160.1 ± 17.2 min, P < 0.001), decreased intraoperative blood loss (147.9 ± 36.4 vs. 169.5 ± 24.7 mL, P < 0.001), and a shorter length of hospital stay (10.8 ± 3.1 vs. 12.4 ± 4.1d; P = 0.014). No significant differences were seen between the groups in terms of the postoperative day of ambulation, Oswestry dysfunction index (ODI) scores, and visual analog scale (VAS) scores for leg and lower back pain (P > 0.05). Although not significant (P = 0.707), MIDLIF (13.8%) had fewer overall complications than MIS-TLIF (16.2%). Therefore, compared to MIS-TLIF, MIDLIF provides perioperative benefits while achieving the same outcomes as MIS-TLIF in terms of fusion rate, pain relief, functional improvement, and complication rate.

SP5.8 - A survey of the actual incidence of Low Anterior Resection Syndrome in our patients and its effect on their quality of life

Abstract Aim Following rectal surgery, bowel function is often affected and leads to a constellations of symptoms called Low Anterior Resection syndrome (LARS). Whilst several risk factors have been identified from previous studies, the most important question is how these symptoms impact the quality of life (QOL) of our patients. The aim of our study was to gain an overview of LARS among our patients, identify risk factors, quantify how it affects their daily lives and recommend preventive and management options. Method We contacted all patients who had undergone anterior resections 01/10/2020-01/10/2023 via a telephone consultation carried out by a single doctor. Using the LARS questionnaire which has been internationally validated, we quantified the severity of LARS symptoms and effects on QOL in our patients. Results A total 36 patients were included in the study. We found 75% patients had no LARS, 25% had minor LARS; no patients had major LARS. 15 patients experienced tenesmus, 11 urgency, 11 accidental leakage of stool, 10 inability to control flatus and 8 frequency. Only 8.33% reported their symptoms affecting their QOL; in this group, accidental leakage of stool was the common symptom. We found no correlation between the incidence of LARS and post-operative time period. None of our LARS patients had had pre-op radiotherapy; only 10% patients who had post- op chemo developed LARS. Conclusion In our cohort of Anterior resection patients, most had no LARS; none had major LARS. Though some patients had some symptoms, QOL was affected in only 8.33%. Those who had symptoms were directed to our LARS clinic in Lower GI physiology for further management.

Treatment of Hip and Knee Periprosthetic Joint Infection Requires Extensive Administrative Work

BackgroundTreatment of periprosthetic joint infections (PJIs) typically requires more resource utilization than primary total joint arthroplasty. This study quantifies the amount of time spent in the electronic medical record (EMR) for patients who have PJI requiring surgical intervention. MethodsA retrospective analysis of EMR activity for 165 hip and knee PJIs was performed to capture work during the preoperative and postoperative time periods. Independent sample t tests were conducted to compare total time based on procedure, age, insurance, health literacy, sex, race, and ethnicity. ResultsThe EMR work performed by the orthopaedic team was 338.4 minutes (min) (SD 130.3), with 119.4 minutes (SD 62.8) occurring preoperatively and 219.0 minutes (SD 112.9) postoperatively. Preoperatively, the surgeon’s work accounted for 35.7 minutes (SD 25.4), mid-level providers 21.3 minutes (SD 15.9), nurses 38.6 minutes (SD 36.8), and office staff 32.7 minutes (SD 29.9). Infectious disease colleagues independently performed 158.9 minutes (SD 108.5) of postoperative work. Overall, PJI of the knees required more postoperative work. Secondary analysis revealed that patients who have hip PJI and a body mass index <30 and patients <65 years of age required more work when compared to the PJI of heavier and older individuals. There was no difference in total work based on insurance, health literacy, race, or ethnicity. ConclusionsOver 8 hours of administrative work is required for surgical management of PJI. Surgeons alone performed 451% more work for PJI during the preoperative period (7.9 versus 35.7 min) compared to primary total joint arthroplasty. In efforts to provide best care for our sickest patients, much work is required perioperatively. This work is necessary to consider when assigning value and physician reimbursement.

Beyond the “teachable moment”: Smoking cessation during cancer treatment remains challenging despite high motivation to quit.

e24141 Background: Continued smoking throughout cancer treatment, including surgery, is associated with treatment-related complications and a higher total symptom burden during treatment. This can lead to interruptions and delays in therapy that can compromise treatment efficacy and survival. Approximately 1 in 3 patients smoke at or around time of cancer diagnosis. Despite this “teachable moment” for smoking cessation, at least half of patients with cancer are unsuccessful in their attempts, and relapse rates for post-surgical cancer patients are high. Better understanding of quit motivation among these patients can help guide tobacco treatment interventions in the post-operative and adjuvant treatment time periods. Methods: This is an analysis of a longitudinal nationwide multicenter study of 1003 patients through the University of Rochester Cancer Center NCI Community Oncology Research Program (URCC NCORP) that assessed treatment type, treatment-related symptoms, smoking status, and motivation to quit smoking for patients with a new diagnosis of cancer. Patients supplied demographic and clinical information at enrollment with assessments at two weeks pre- adjuvant treatment, post adjuvant treatment, and 6 months. Chi-square, multinomial logistic regression, and ANOVA were used to analyze the difference between smokers and nonsmokers, and those with previous surgical treatment. Results: The majority of patients had surgery as part of their cancer treatment (n = 718, 71.6%). Of these (n = 222, 30.9%) had a diagnosis of a tobacco-associated cancer, which was associated with smoking status at pre-treatment (p &lt; 0.05). For those with previous surgery, n = 90 (68.7%, p &lt; 0.001) were current smokers before starting adjuvant treatment. Post-surgical patients who smoke had both higher total symptom burden ( M= 23.7 vs M= 17.0; p &lt; 0.05) and higher symptom severity ( M =1.97 vs M= 1.42; p &lt; 0.001) pre-adjuvant treatment and at 6 month follow up [( M =31.3 vs M= 22.2; p &lt; 0.05);( M= 2.6 vs M= 1.8; p &lt; 0.05)] compared to post-surgical patients who were not smokers. Motivation to quit was sustained among current smokers between the pre- and post- adjuvant treatment periods (p &lt; 0.001), as well as for those that had previous surgery (p &lt; 0.05). Despite motivation to quit among 64.4% of current smokers with previous surgery, 15.4% reported being able to quit by post-adjuvant treatment with 50% relapsing to smoking at 6-month follow up. Conclusions: For patients that continue to smoke after surgical treatment, cessation rates are much lower than motivation to quit with high rates of relapse. Early intervention around the time of surgery presents an ideal opportunity to optimize the “teachable moment” by providing longitudinal tobacco treatment as part of cancer care to improve treatment-related symptoms, as well as overall survival.

Effects of popliteal nerve blocks on postoperative pain management in fibula-free flap patients for head and neck cancer reconstruction.

To determine if performing popliteal nerve blocks preoperatively in patients undergoing fibula-free flap surgery for head and neck cancer reconstruction decreases subjective pain scores decreases narcotic usage, and improves mobility in the acute postoperative time period when compared to alternative pain control regimens. A retrospective review of the medical records of patients who underwent fibula-free flap reconstruction for head and neck malignancy at SUNY Upstate Medical University during the time period from 2015 to 2022 was performed. Collected data consisted of patient demographics and clinical characteristics, postoperative pain management modalities, reported pain scores, postoperative narcotic usage, length of hospital stay, and days until out of bed without personal assistance. A total of 40 patients were included in the study. The average reported pain score was reduced in the nerve block group compared to the control group (1.7 vs. 4.0, p-value = .003). Similarly, the average maximum reported pain score was also lower in patients who received a nerve block (3.4 vs. 6.9, p-value = .002). None of the patients who received popliteal nerve blocks required pain control with parenteral narcotics postoperatively, whereas 82.9% of patients without a nerve block did. Patients who received a popliteal nerve block consumed an average of 103.5 MME, whereas those who did not receive a block consumed an average of 523.0 MME. No statistically significant difference was found between the groups regarding time from surgery until transfer without personal assistance or length of hospital stay. Popliteal nerve blocks can reduce postoperative pain in patients undergoing fibula-free flap reconstruction for head and neck cancer.

Gynecomastia Surgery in 4996 Male Patients Over 14 Years: A Retrospective Analysis of Surgical Trends, Predictive Risk Factors, and Short-Term Outcomes.

The high prevalence of benign male breast tissue enlargement (gynecomastia) has resulted in a marked increase of gynecomastia cases. While about one third of male adults experience some form of gynecomastia, gynecomastia surgery (GS) outcome research is limited to small study populations and single-center/-surgeon databases. In this study, we aimed to access the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify preoperative risk factors for complications and investigate postoperative outcomes of GS. In this retrospective study, we queried the ACS-NSQIP database from 2008 to 2021 to identify male adult patients who underwent GS. Postoperative outcomes involved the occurrence of any, surgical and medical complications, as well as reoperation, readmission, and mortality within a 30-day postoperative time period. Univariable and multivariable assessment were performed to identify risk factors for complications while adjusting for possible confounders. The study included 4,996 GS patients with a mean age of 33.7 ± 15 years and BMI of 28.2 ± 5.1 kg/m2. White patients constituted 54% (n = 2713) of the cohort, and 27% (n = 1346) were obese. Except for 2020, there was a steady increase in GS cases over the study period. Outpatient surgeries were most common at 95% (n = 4730), while general surgeons performed the majority of GS (n = 3580; 72%). Postoperatively, 91% (n = 4538) of patients were discharged home; 4.4% (n = 222) experienced any complications. Multivariable analysis identified inpatient setting (p < 0.001), BMI (p = 0.023), prior sepsis (p = 0.018), and bleeding disorders (p = 0.047) as independent risk factors for complications. In this study, we analyzed 4996 male adult GS patients from the ACS-NSQIP database, revealing an increased caseload and significant general surgeon involvement. Risk factors like bleeding disorders, inpatient status, and prior sepsis were linked to postoperative complications, while BMI was crucial for predicting adverse events. Overall, our findings may aid in enhancing patient care through advanced preoperative screening and closer perioperative management. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Should All Patients Receive Extended Oral Antibiotic Prophylaxis? Defining Its Role in Patients Undergoing Primary and Aseptic Revision Total Joint Arthroplasty

BackgroundPrior studies have demonstrated reduced periprosthetic joint infection (PJI) rates following extended oral antibiotics (EOAs) for high-risk patients undergoing primary total joint arthroplasty (TJA). This study compared 3-month PJI rates in all patients undergoing primary or aseptic revision TJA with or without EOA prophylaxis. MethodsIn total, 2,982 consecutive primary (n = 2,677) and aseptic revision (n = 305) TJAs were performed by a single, fellowship-trained arthroplasty surgeon from 2016 to 2022 were retrospectively reviewed. Beginning January 2020, all patients received 7 days of 300 mg oral cefdinir twice daily immediately postoperatively. Rates of PJI at 3 months were compared between patients who received or did not receive EOA. ResultsRates of PJI at 3 months in patients undergoing primary and aseptic revision TJA were significantly lower in those receiving EOA prophylaxis compared to those who did not (0.41 versus 1.13%, respectively; P = .02). After primary TJA, lower PJI rates were observed with EOA prophylaxis utilization (0.23 versus 0.74%, P = .04; odds ratio [OR] 3.85). Following aseptic revision TJA, PJI rates trended toward a significant decrease with the EOA compared to without (1.88 versus 4.83%, respectively; P = .16; OR 2.71). ConclusionsAll patients undergoing primary or aseptic revision TJA who received EOA prophylaxis were 3.85 and 2.71 times less likely, respectively, to develop PJI at 3 months compared to those without EOA. Future studies are needed to determine if these results are maintained at postoperative time periods beyond 3 months following primary TJA. Level of evidenceIII, Retrospective review.

One Year Review Compairing Mortality Following DHS Vs PFN

Objective: The objective of my study is to compare the mortality following DHS vs PFN. Study Design: Observational retrospective study. Place of study: Department of Orthopedic &amp; Spine Surgery, Dr. Ziauddin Hospital. Duration: January 2020 to December 2021. Methodology: Patients were divided into 2 groups according to the surgical implant used. Group A with DHS implant, Group B with PFN and mortality is being checked in each group till 1-year post-operative time period by contacting each patient. Age, Gender, co morbidities, surgical procedure performed, fracture pattern (extracapsular, intracapsular) time of injury data was collected from registry of the hospital after taking permission from the authorities involved. Results: The study included 94 patients. Minimum age was 40 years and maximum age was 95 years, and mean age was 71.11. Out of which 61 (64.8%) patients are included in group A in which DHS was done, 33(35%) patients in group B with PFN implants, (Table 1) Mean age in group A is 72.9 (SD 14.0), group B 67.7 (SD 13.3), (Table 1) In group A 16 patients (26.2%) had mortality within 1 year. In group B 2 patients (6%) has mortality within 1 year. (Table 2) There is significant association of increased mortality in patients with DHS implants (group A) with p value &lt;0.005. (Table 2) Mortality was raised in males that is 10 (22.7%) and in females 8 patients (16%). However, no significant association was found p(0.33). (Table 3) Out of 94 patients 54 patients are ASA III with multiple comorbid and other are ASAII and ASA I. Mortality was higher in patients with ASA III 54 patients (57%) and it was not statistically significant with p (0.168). (Table 4) Conclusion: This study shows increased mortality in patients with DHS implants as compared to patients with PFN implants.

Research Electronic Data Capture (REDCap) in an outpatient oncology surgery setting to securely email, collect, and manage survey data.

Nursing interventions in the post-operative time period including psychological and emotional support, adverse event education, and instructions for follow-up care contribute patient satisfaction, safety, and quality of life. However, the time spent in the post-anesthesia care unit (PACU) and hospital continues to shorten around the world to reduce health care spending and improve patient outcomes. Nurses conducting research during the important post-operative recovery period need to utilize unique techniques and emerging technologies to contact, recruit and collect data outside of the hospital setting including the Research Electronic Data Capture (REDCap) platform. This paper describes the feasibility and acceptability, facilitators and barriers of the software application, REDCap, to complete a repeated-measures, descriptive correlational study in patients undergoing outpatient breast cancer surgeries. The recruitment, data collection and storage were completed utilizing the secure REDCap Platform. The Institutional Research Board (IRB)-approved study was a repeated-measures, descriptive, correlational study with data collection at three time points. The data points aligned with important transitions and routine visits to improve data collection feasibility and increase relevance to clinical practice. The sample consisted of women diagnosed with breast cancer undergoing breast conserving surgery between August 15 and October 15, 2020. There were 123 potential participants, of which 76 started the surveys and 75 participated (61%) responded and participated in the study on Post-operative Day 1. Fifty-nine participants (78%) completed the surveys on post-operative Day 14. As the frequency of outpatient treatment increases, nurses conducting post-operative research will need to collect the data outside of the hospital setting. Email provides a method of studying new phenomena by recruiting participants, providing information about the study, and collecting results in a non-traditional setting. REDCap provides a method to facilitate nursing research through a securely encrypted integrated process.

Outcomes of Diced Cartilage Dorsal Augmentation in Dorsal Aesthetic Deformities.

Objective: To investigate the effectiveness of diced cartilage graft for dorsal augmentation in rhinoplasty. Methods: In a retrospective study, patients who underwent rhinoplasty with dorsal augmentation using diced cartilage graft from June 2017 to December 2021 were identified. Patients with complete preoperative and at least one postoperative Standardized Cosmesis and Health Nasal Outcomes Survey-Cosmesis (SCHNOS-C) and visual analogue scale (VAS) scores were included in the study. Postoperative periods were classified into ≤6 and >6 months. Mean preoperative outcome scores were compared with postoperative scores utilizing a Paired t-test, and postoperative scores were compared utilizing a Wilcoxon rank-sum test. Results: A total of 71 patients with a median age of 36 years, range (18-74) fit inclusion criteria. Majority were female patients 49 (69%). The postoperative period ranged from 17 days to 3.5 years. The mean follow-up period (standard deviation) for ≤6 and >6 months was 2.8 (1.5) and 14.2 (6.3) months, respectively. A decrease in mean SCHNOS-C, SCHNOS item 8, and an increase in VAS scores (p < 0.0001) were seen at both postoperative time periods compared with preoperative levels. Conclusion: This study demonstrates that dorsal augmentation with diced cartilage graft is an effective technique in correcting dorsal aesthetic deformities.

Novel Use of Olecranon Locking Plate With Achilles Allograft Augmentation for Fixation of Greater Trochanter Fractures After Total Hip Replacement

Introduction: The optimal fixation method for greater trochanteric fractures after a total hip replacement remains controversial. We present the surgical technique of a novel fixation method for greater trochanteric fractures with the use of an olecranon locking plate and Achilles tendon allograft augmentation. Patients and Methods: Five patients who had previously undergone a total hip arthroplasty for primary osteoarthritis were identified as presenting with displaced (&gt;2 cm) greater trochanter fractures between 2017 and 2021. They underwent open reduction internal fixation of the greater trochanter with an olecranon locking plate and Achilles tendon allograft augmentation an average of 8 months after their index procedure (range: 2 to 17 mo), all performed by a single surgeon. All 5 patients were women, the mean age was 59 years (range: 54 to 69 y) and the mean follow-up time was 16.1 months (range: 5 to 41 mo). Results: All 5 patients reported improved pain levels and functional status after open reduction internal fixation. Four of the patients demonstrated maintenance of the position of the trochanteric fragment with the olecranon plate whereas one patient who was unable to comply with postoperative restrictions had a catastrophic failure of the fixation. One of 5 trochanteric bones showed clear evidence of radiographic union. Conclusions: Utilization of olecranon locking plates is well suited for fixation of a greater trochanter fracture as this technique allows for the capture of small comminuted fragments by the proximal curvature of the plate. In addition, this minimizes the concurrent use of metallic cables close to or within the effective joint space. Weight-bearing restrictions and stability are of the utmost importance in the postoperative time period.

Clinical and cone beam computed tomography outcomes of maxillary anterior implant restorations after immediate implant placement with interim restorations: A 1- to 14-year retrospective analysis

Statement of ProblemAchieving and maintaining optimal tissue health and esthetics when immediately placing maxillary anterior implants with interim restorations has been challenging and the clinical outcomes heterogenous. PurposeThe purpose of this retrospective study was to evaluate the clinical outcomes of immediate placement of maxillary anterior implants with interim restorations and compare the tomographic and clinical results before and after implant placement in participants followed for 1 to 14 years. Material and methodsTwenty participants receiving 25 postextraction single implants in the anterior maxilla were studied. Clinical parameters included pink esthetic score (PES) and white esthetic score (WES), peri-implant phenotype, implant probing, plaque index, and cone beam computed tomography (CBCT) to compare initial and at least 1 year after crown placement (postoperative). For qualitative variables, a descriptive analysis was carried out. The PES and WES results were analyzed by using nonparametric statistics, the median (ME) and the interquartile range (IQR) were used as summary measures, and the Wilcoxon sum of signs test was used to compare the total scores between the intervention area and the contralateral tooth. To compare pre- and postoperative data points, the paired t test was used (α=.05). ResultsMean ±standard deviation (SD) time of follow-up was 7.6 ±4.2 years. Twenty participants with a mean ±SD age of 62.4 ±11.0 years old received 25 implants. Mean ±SD initial torque value at implant placement was 38.6 ±9.63 Ncm. Bone height at the top of the alveolar ridge (BH) and bone width at the middle of the alveolar ridge (BW2) showed a statistically significant decrease between the initial and subsequent CBCT measurements (both P<.001). Likewise, the bone width at the alveolar crest (BW1) showed a statistically significant decrease between the initial and post-CBCT measurements (P=.006). Facial bone integrity (FBI) revealed a statistically significant increase between the initial and postoperative time periods (P<.001). The PES index showed a median of 9.0 IQR (8-10), statistically lower than the contralateral tooth (P=.032). No significant differences were found for the WES index or for FBI, regardless of the peri-implant phenotype. ConclusionsImmediate implant placement in the maxillary anterior sextant was found to be a predictable procedure with good esthetic results when the protocol described was used. Labial bone loss is inevitable after tooth extraction but can be compensated for by filling the space with a xenograft material. Long-term gingival tissue integrity was maintained, regardless of phenotype, in periodontally healthy participants.

Perioperative Dexamethasone Does Not Reduce Postoperative Opioid Use Following Anterior Cervical Discectomy and Fusion

(1) To determine whether dexamethasone administration reduced narcotic consumption during hospitalization and (2) to evaluate if patients who received dexamethasone refilled fewer opioid prescriptions postoperatively. We retrospectively identified all adult patients who underwent primary elective 1-4-level ACDF at a single center. Prescription opioid use was collected from governmental online prescription drug monitoring programs and in-hospital opioids were collected from each patient's medication administration record and recorded as milligrams of morphine equivalents (MMEs). Patients were categorized by whether or not intravenous dexamethasone was administered perioperatively. Dexamethasone protocols were considered high dose if weight-based dosing was >0.20 mg/kg and low-dose if <0.20 mg/kg Multivariable linear regression was conducted accounting confounders to assess the relationship between dexamethasone administration and MME prescribed at each time point. We included 249 patients, 167 (67%) of whom were administered dexamethasone. Patients in both groups utilized a similar quantity of opioids while hospitalized (no dexamethasone: 56.7 vs. dexamethasone: 39.4 MME/day, p=0.3499). Patients in both groups refilled a similar quantity of opioids in all postoperative time periods; 0-3 week (3.38 vs. 4.07 MME/day, p=0.5277), 3-6 week (0.36 vs. 0.75 MME/day, p=0.1979), 6-12 week (0.53 vs. 0.75MME/day, p=0.9000), and 3-month to one-year (0.28 vs. 0. MME/day, p=0.5310). On multivariable linear regression, dexamethasone was not associated with a reduction in opioid volume at any time point (all p>0.05). Administration of perioperative dexamethasone does not reduce in-hospital or home opioid usage regardless of weight-based dose. Analgesia should not be the primary driver of dexamethasone administration for ACDF.

Patient perspectives on post-bariatric surgery nutritional supplementation.

Bariatric procedures increase patient risk of long-term metabolic complications primarily due to nutrient deficiencies. The mainstay of prevention includes routine vitamin and mineral supplementation; however, patient-reported barriers to daily compliance are poorly understood. Post-bariatric surgery patients electively participated in an 11-point outpatient survey at a single academic institution. Surgical procedures included either laparoscopic sleeve gastrectomy (SG) or gastric bypass (GB). At the time of survey, patients ranged from 1-month to 15years from surgery. Survey items consisted of dichotomous (yes/no), multiple choice, and open-ended free response questions. Descriptive statistics were evaluated. Two hundred and fourteen responses were collected, 116 (54%) underwent SG and 98 (46%) underwent GB. Of these, 49% of samples were during short-term postoperative follow-up visits (0-3months), 34% intermediate follow-up (4-12months), and 17% long-term follow-up (> 1year). A total of 98% of patients reported that insurance did not cover their supplement cost. Most patients reported current vitamin use (95%), with 87% reporting daily compliance. Daily compliance was observed in 94%, 79%, and 73% of SG patients at short-, intermediate-, and long-term follow-up visits, respectively. While GB patients reported daily compliance in 84%, 100%, and 92% of short, intermediate, and long-term responses. Of those who were unable to take vitamins daily, non-compliance was attributed most to forgetting (54%), and less often to side effects (11%), or taste (11%). Patient-reported strategies for remembering to take vitamins included tying into daily routine (55%), use of a pill box (7%), and alarm reminders (7%). Daily compliance with post-bariatric surgery vitamin supplementation does not appear to vary based on postoperative time-period or surgical procedure. While a minority of patients struggle with daily compliance, factors associated with non-compliance include patient forgetting, side effects, and taste. Widespread utilization of patient-reported daily reminder strategies may lead to improved overall compliance and reduce incidence of nutritional deficiencies.

Healthcare costs of failed rotator cuff repairs

The goal of this study was to estimate the short-term (∼2 years) healthcare costs of failed primary arthroscopic rotator cuff repair (RCR) in the United States. A review of current literature was performed to estimate the number of RCR performed in the United States in the year 2022 and the rate of progression of these patients to lose repair continuity, reach clinical failure, and progress to nonoperative intervention and revision procedures. A review of the current literature was performed to estimate the costs incurred by these failures over the ensuing 2-year postoperative time period. The direct and indirect healthcare costs of structural and clinical failure of primary RCR performed in 2022 are estimated to reach $438,892,670 in the short-term postoperative period. The majority of the costs come from the estimated $229,390,898 in nonoperative management that these patients undergo after they reach clinical failure. The short-term healthcare costs of failed arthroscopic RCR performed in the United States in 2022 are predicted to be $438,892,670. Although RCR improves quality of life, pain, function, and is cost-effective, there remains great potential for reducing the economic burden of failed RCR repairs on the US society. Investments into research aimed to improve RCR healing rates are warranted. Although RCR improves quality of life, pain, function, and is cost-effective, this study provides evidence that there remains great potential for reducing the economic burden of failed RCR repairs on the US society. Investments into research aimed to improve RCR healing rates are warranted.

Perioperative Predictors in Patients Undergoing Lateral Lumbar Interbody Fusion for Minimum Clinically Important Difference Achievement

To identify perioperative predictors of minimum clinically important difference (MCID) for patients undergoing lateral lumbar interbody fusion (LLIF) for the patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Visual Analog Scale (VAS) Back, VAS Leg, Oswestry Disability Index (ODI), and Patient Health Questionnaire-9 (PHQ-9). Patients undergoing LLIF were identified through retrospective review of a single-surgeon database. Overall MCID achievement was determined as the number of unique patients achieving ΔPROM thresholds of PROMIS-PF=4.5, VAS Back=2.1, VAS Leg=2.8, ODI=14.9, and PHQ-9=3.0 over a 2-year postoperative time period. Univariate and multivariable logistic regression were utilized to determine perioperative predictors for MCID achievement. Two-hundred and ninety patients were identified. For PROMIS-PF MCID achievement, increased preoperative PROMIS-PF and POD 1 VAS pain were significant negative predictors. For VAS Back, primary fusion with revision decompression was a negative predictor, while increased preoperative VAS Back was a positive predictor of MCID achievement. For VAS Leg, increased preoperative VAS Leg was a positive predictor. For ODI, increased POD 0 VAS pain was a negative predictor, while increased preoperative ODI was a positive predictor. For PHQ-9, increased preoperative PHQ-9 was a positive predictor. In patients undergoing LLIF, perioperative predictors for MCID achievement were highly dependent on PROM. Preoperative PROM was the most consistent perioperative predictor for achieving MCID. Elevated acute postoperative pain and primary fusion after failed index decompression were significant predictors of failing to achieve MCID. Surgeons may use these findings in prognostication and management of postoperative expectations.

From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes.

While robotic-assisted hernia repair has increased the popularity of minimally invasive hernia surgery, selecting between the types of approaches is a challenge for both experts and novices alike. In this study, we compared a single surgeon's early experience transitioning from transabdominal hernia repair with sublay mesh in either the pre-peritoneal or retrorectus space (TA-SM) and enhanced-view totally extra-peritoneal (eTEP) ventral hernia repair in the peri-operative and long-term post-operative time periods. We conducted a retrospective review of 50 eTEP and 108 TA-SM procedures to collect demographics, intraoperative details, and 30-day and 1-year post-operative outcomes. Statistical analysis was performed utilizing Chi-square analysis, Fisher's test, and two sample t-tests with equal variances. There were no significant differences in patient demographics or comorbidities. eTEP patients had larger defects (109.1 cm2 vs. 31.8 cm2, p = 0.043) and mesh used (432.8 cm2 vs. 137.9 cm2, p = 0.001). Operative times were equivalent (158.3 ± 90.6min eTEP and 155.8 ± 65.2min TA-SM, p = 0.84), but conversion to alternate procedure type was higher for the transabdominal approach (4% eTEP vs. 22% TA-SM, p < 0.05). Hospital stay was less in the eTEP cohort (1.3days vs. 2.2days, p < 0.05). Within 30 days, there were no significant differences in emergency visits or hospital readmissions. There was a greater propensity for eTEP patients to develop seromas (12.0% vs. 1.9%, p < 0.05). At 1 year, there was no statistically significant difference in recurrence rate (4.56% eTEP vs. 12.2% TA-SM, p = 0.28) respective to average time to recurrence (9.17months eTEP vs. 11.05months TA-SM). The eTEP approach can be adopted safely and efficiently, and may have superior peri-operative outcomes including fewer conversions and reduced hospital stay.

Prolonged Opioid Usage Following Hip Fracture Surgery in Opioid-Naïve Older Patients

BackgroundWhile the risk of long-term dependence following the opioid treatment of musculoskeletal injury is often studied in younger populations, studies in older patients have centered on short-term risks such as oversedation and delirium. This study investigated prolonged opioid usage after hip fracture in older individuals, focusing on prevalence, risk factors, and changes over time. MethodsIn this retrospective cohort study of 47,309 opioid-naïve patients aged ≥ 60 years who underwent hip fracture surgery (2009 to 2020), outpatient opioid use was evaluated in 3 postoperative time periods: P1 (day 0 to 30 postsurgery); P2 (day 31 to 90); and P3 (day 91 to 180). The primary outcome was prolonged outpatient opioid use, defined as having one or more opioid prescriptions dispensed in all 3 time periods. ResultsThe incidence of prolonged opioid usage among patients surviving to P3 was 6.3% (2,834 of 44,850). Initial prescription quantities decreased over time, as did the risk of prolonged opioid usage (from 8.0% in 2009 to 3.9% in 2019). In the multivariable analyses, risk factors for prolonged opioid usage included younger age, women, current/former smoking, fracture fixation (as compared to hemiarthroplasty), and anxiety. Prolonged opioid usage was less common among patients who were Asian or had a history of dementia. ConclusionsWhile prior research on the hazards of opioids in the elderly has focused on short-term risks such as oversedation and delirium, these findings suggest that prolonged opioid usage may be a risk for this older population as well. As initial prescription amounts have decreased, declines in prolonged opioid medication usage have also been observed.

Declining Incidence of Postoperative Neonatal Brain Injury in Congenital Heart Disease

BackgroundBrain injury is common in neonates with complex neonatal congenital heart disease (CHD) and affects neurodevelopmental outcomes. ObjectivesGiven advancements in perioperative care, we sought to determine if the rate of preoperative and postoperative brain injury detected by using brain magnetic resonance imaging (MRI) and associated clinical risk factors have changed over time in complex CHD. MethodsA total of 270 term newborns with complex CHD were prospectively enrolled for preoperative and postoperative brain MRIs between 2001 and 2021 with a total of 466 MRI scans. Brain injuries in the form of white matter injury (WMI) or focal stroke and clinical factors were compared across 4 epochs of 5-year intervals with logistic regression. ResultsRates of preoperative WMI and stroke did not change over time. After adjusting for timing of the postoperative MRI, site, and cardiac group, the odds of newly acquired postoperative WMI were significantly lower in Epoch 4 compared with Epoch 1 (OR: 0.29; 95% CI: 0.09-1.00; P = 0.05). The adjusted probability of postoperative WMI declined significantly by 18.7% from Epoch 1 (24%) to Epoch 4 (6%). Among clinical risk factors, lowest systolic, mean, and diastolic blood pressures in the first 24 hours after surgery were significantly higher in the most recent epoch. ConclusionsThe prevalence of postoperative WMI has declined, whereas preoperative WMI rates remain constant. More robust postoperative blood pressures may explain these findings by minimizing periods of ischemia and supporting cerebral perfusion. These results suggest potential modifiable clinical targets in the postoperative time period to minimize the burden of WMI.

Effect of Preexisting Sarcopenia on Acute and Late Postoperative Pneumonia Among Patients With Oral Cavity Squamous Cell Carcinoma.

Whether preexisting sarcopenia is an independent risk factor for postoperative pneumonia (POP) for patients with oral cavity squamous cell carcinoma (OCSCC) remains unclear. Therefore, we conducted a propensity score-matched population-based cohort study to compare the risk of acute and late POP for patients with sarcopenic and nonsarcopenic OCSCC who underwent curative surgery. We included patients with OCSCC who underwent curative surgery and categorized them into 2 groups depending on whether they had preexisting sarcopenia. The patients in the sarcopenic and nonsarcopenic groups were matched at a ratio of 2:1. The matching process yielded 16,257 patients (10,822 without sarcopenia and 5,435 with sarcopenia). In multivariate Cox regression analyses, the adjusted hazard ratio of POP for the group with OCSCC with preexisting sarcopenia was 1.20 (95% CI, 1.14-1.26; P<.0001) compared with the nonsarcopenic group. Among the patients with OCSCC who received curative surgery, those in the sarcopenic group exhibited a higher POP risk than those in the nonsarcopenic group for the following postoperative time periods: 31st to 90th day, 91st day to first year, first to second year, second to third year, third to fourth year, and fourth to fifth year. The high incidence of pneumonia persists for a long time in patients with OCSCC who receive curative surgery; this high incidence may even persist for 5 years after surgery, especially in patients with sarcopenia. For susceptible patients who are at risk for OCSCC, sarcopenia prevention measures (eg, exercise and early nutrition intervention) should be implemented.