Preoperative Screening Research Articles

Robot-Assisted Urological Oncology Procedures, Outcomes, and Safety in Frail Patients: A Narrative Review of Available Studies.

In this study, we assess the impact of frailty on the success rate and risk of complications of robot-assisted urological procedures and introduce effective preoperative screening tools to evaluate frail patients' fitness to tolerate robot-assisted urological surgery. We performed a search of electronic databases for available studies, published up to August 2023, investigating the outcomes of robot-assisted urological oncology procedures and their safety in frail patients. Sixteen studies were ultimately selected, investigating the implications of frailty in robot-assisted radical cystectomy, robotassisted partial nephrectomy, and robot-assisted radical prostatectomy. All the studies used the Clavien-Dindo classification of complications with serious complications considered as Clavien-Dindo 3. Frail patients significantly benefit from robot-assisted urological procedures in comparison to open surgery, with lower rates of blood transfusion and a shorter length of stay. However, they also have a higher risk of postoperative complications than non-frail patients, as well as increased rates of conversion to open, total hospital costs, and in-hospital mortality after robot-assisted procedures. Robot-assisted urological procedures can improve the postoperative recovery of frail patients in comparison to open surgery. Reliable frailty indexes such as the Johns Hopkins indicator and simplified frailty index, as well as the Geriatric 8 screening tool, should be routinely used in the preoperative assessment of frail patients to optimize surgical decision-making.

Effect of three modalities on emergence agitation among post-traumatic stress disorder patients undergoing laparoscopy: a randomized controlled study

Background and aimEmergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls.MethodsThis study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05.ResultsHeart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation–agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 – 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932–1536.448), p<0.001) and group 3 was protected against agitation.ConclusionPre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective.

Influence of corneal diameter on the accuracy of corneal tomography in patients with forme fruste keratoconus or thin corneas

ABSTRACT Clinical relevance The detection of subclinical ectasia is important in preoperative screening for laser-refractive surgery. Previous studies have confirmed the impact of corneal diameter on the diagnostic accuracy of several ectasia indices in tomographically normal eyes. Background This study aimed to investigate the influence of corneal diameter on the diagnostic accuracy of Pentacam tomographic indices in eyes with forme fruste keratoconus (FFKC) and thin corneas. Methods One hundred and one eyes of 101 patients with FFKC (FFKC group), 104 eyes of 104 patients with a corneal thickness <490 μm (thin cornea group), and 200 eyes of 200 normal subjects (normal group) were analysed in the study. Pentacam ectasia indices were compared between the groups. Results The results of multiple linear regression analysis showed that the standardised coefficients for corneal diameter and overall deviation of normality (BAD-D) were −0.386, −0.552, and −0.552 for the FFKC, thin cornea, and normal groups, respectively (p < 0.001). Comparing for the classifications (normal versus abnormal) of the individual indices demonstrated that for corneal diameters ≤11.9 mm, the rates of abnormal cases were significantly higher in the FFKC group than in the normal group for seven indices and in the thin cornea group than normal group for nine indices. For corneal diameters >11.9 mm, the rates of abnormal cases were higher in the FFKC than normal group for three indices and higher in the thin cornea group than normal group for seven indices. Conclusion Belin/Ambrosio Enhanced Ectasia display indices may underestimate the risk of ectasia in patients with large corneas, especially those with FFKC.

Feasibility and financial impact of preoperative malnutrition screening and diagnosis

BackgroundMalnutrition is a common and underdiagnosed comorbidity in surgical patients. It negatively impacts wound healing, maintenance of muscle mass, survival rate, length of stay, and subsequent hospitalization costs in post-operative patients. Early diagnosis and treatment of malnutrition can potentially mitigate these complications. Our study looked at the feasibility of screening for malnutrition in a preoperative clinic, with subsequent dietician evaluation of patients with positive screens. We also examined the effect of diagnosis on reimbursement associated with these patients who incur increased hospital costs. MethodsThis prospective observational study included all surgical patients seen in the preoperative clinic at a large academic hospital in 2022. Patients were screened for malnutrition as part of the preoperative nursing assessment. Based on malnutrition score or surgical procedure, patients were referred to an in-clinic dietitian for preoperative evaluation and treatment. We tracked the number of patients screened, evaluated, and diagnosed with moderate or severe malnutrition. A financial analysis was undertaken to determine the reimbursement benefit of the diagnosis and documentation of malnutrition in the preoperative setting. Standard Medicare reimbursement coding rates were used to calculate the This may be Funding Agency. Please check.financial impact. Results17,464 patients were screened for malnutrition by preoperative clinic nurses during the study period. Among these patients, 1,366 underwent in-person or virtual evaluation by the dietitian based on screening results or surgical procedure. 309 patients were identified with moderate or severe malnutrition by a registered dietitian. In the financial analysis, documentation of moderate or severe malnutrition in 25 Medicare patients resulted in $441,635.37 in additional hospital reimbursement. Additionally, there were 6 Medicare patients where malnutrition was documented but not captured by the coding department, resulting in a missed opportunity of $86,273.61. ConclusionsPreoperative malnutrition is common and underdiagnosed. Preoperative malnutrition screening and intervention is feasible using a simple preoperative workflow. Improved documentation of malnutrition may also have positive financial implications for health systems, making this a cost-effective intervention program.

Screening of positive dysphotopsia before multifocal intraocular lens implantation.

To assess the photic phenomena (PP) and positive dysphotopsia in candidates for presbyopia or cataract surgery and to evaluate their relationship with cataract grading systems. Retrospective observational. Monocular data for 82 subjects measured during the preoperative screening were retrospectively retrieved from our database. The evaluated variables consisted of two methods for PP measurement: light distortion index (LDI) and parameters obtained from a simulator, both of which were combined with subjective bother related to PP. The cutoff for LDI that better predicted patients passing from slightly to moderately bothersome was estimated. The relationships between LDI and the following objective cataract grading methods were also assessed: objective scatter index (OSI), dysfunctional lens index (DLI), and Pentacam Nucleus Staging (PNS). LDI was the best method for measuring PP, which showed a significant correlation with the bothersome question (rho = 0.34, P = 0.002) and also with OSI (rho = 0.67, P < 0.0005), DLI (rho = -0.29, P = 0.007), and PNS (rho = 0.48, P < 0.0005). The number/percentage of patients who found it bothersome was as follows: "Not at all" (18/22%), "Slightly" (41/50%), "Moderately" (15/18.3%), and "Very" (8/9.7%). The cutoff value that predicted the transition from slightly to moderately bothersome was ≥15.20% according to LDI, which could be estimated with the following values for grading: ≥2.8 for OSI, ≤7.6 for DLI, and ≥2 for PNS. Patients reporting moderately or higher bothersome levels in the preoperative period and with LDI <15.20%, <2.8 for OSI, >7.6 for DLI, and <2 for PNS might deserve special attention in the multifocal intraocular lens selection.

Preoperative asymptomatic gallstone surgery might reduce the occurrence of cholangitis and cholecystitis after joint replacement surgeries – case series

Introduction: Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) have nowadays had good outcomes, there remain some concerns, such as complications, during and/or after surgeries. There have been some reports on the postoperative complications of joint arthroplasty. However, to the best of our knowledge, none exist on cholangitis after THA or TKA. Patient concerns: This patients’ agreement was obtained. Diagnosis and interventions: Here is the first kind of case series to show nine cases of cholangitis which required urgent endoscopic retrograde cholangiopancreatography after THA or TKA in the absence of preoperative abdominal ultrasound between June 2019 and May 2021. Outcomes: One case among 9 cases required open laparotomy for acute cholecystitis. Conclusion: Even 1 case of 9 cases, this study showed the importance of preoperative screening for gallbladder stones in order to evaluate the risk of cholangitis development after joint arthroplasty.

Is Preoperative Type and Screen High-value Care? A Cost-effectiveness Analysis of Performing Preoperative Type and Screen Prior to Urogynecological Surgery.

Routine preoperative type and screen (T&S) is often ordered prior to urogynecological surgery but is rarely used. We aimed to assess the cost effectiveness of routine preoperative T&S and determine transfusion and transfusion reaction rates that make universal preoperative T&S cost effective. A decision tree model from the health care sector perspective compared costs (2020 US dollars) and effectiveness (quality-adjusted life-years, QALYs) of universal preoperative T&S (cross-matched blood) vs no T&S (O negative blood). Our primary outcome was the incremental cost-effectiveness ratio (ICER). Input parameters included transfusion rates, transfusion reaction incidence, transfusion reaction severity rates, and costs of management. The base case included a transfusion probability of 1.26%; a transfusion reaction probability of 0.0013% with or 0.4% without T&S; and with a transfusion reaction, a 50% probability of inpatient management and 0.0042 annual disutility. Costs were estimated from Medicare national reimbursement schedules. The time horizon was surgery/admission. We assumed a willingness-to-pay threshold of $150,000/QALY. One- and two-way sensitivity analyses were performed. The base case and one-way sensitivity analyses demonstrated that routine preoperative T&S is not cost effective, with an ICER of $63,721,632/QALY. The optimal strategy did not change when base case cost, transfusion probability, or transfusion reaction disutility were varied. Threshold analysis revealed that if transfusion reaction probability without T&S is >12%, routine T&S becomes cost effective. Scenarios identified as cost effective in the threshold and sensitivity analyses fell outside reported rates for urogynecological surgery. Within broad ranges, preoperative T&S is not cost effective, which supports re-evaluating routine T&S prior to urogynecological surgery.

A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada.

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n=111 dietitians, n=72 physicians, n=42 allied HCPs), 96%-100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n=142/220; dietitians: 88%vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period (n=117) by dietitians (n=94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n=121/212), time (40%, n=84/212) and support from others (38%, n=80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier.

Impact of Preoperative Urinary Tract Infection Screening in Asymptomatic Women Undergoing Midurethral Sling.

There is limited information regarding the utility of preoperative urine culture (Ucx) screening to decrease postoperative UTI rates following midurethral sling (MUS). The primary objective of this study was to determine if the rate of postoperative UTI within the first 6 weeks after surgery is lower in women undergoing MUS when preoperative Ucx is obtained compared to when it is not. Secondary objectives were to determine clinical factors associated with postoperative UTI risk. This is a retrospective cohort study of women who did not have symptoms of or a diagnosis of cystitis at the time of their preoperative evaluation and are undergoing MUS. Patients were grouped into those who had preoperative Ucx screening within 6 weeks preceding surgery and those who did not. UTI rates 6 weeks following surgery were compared between groups. Additionally, factors impacting the risk of developing a UTI within 6 weeks of surgery were assessed. Among 661 patients, 13.2% had a UTI within the first 6 weeks. There was no significant difference in UTI rates between those who did and did not have preoperative Ucx, respectively (14.9% vs 10.2%, p = 0.09). On multivariable analysis, current smoker status (OR 3.02, 95% CI 1.10-8.26), history of recurrent UTI (OR 3.00, 95% CI 1.14-7.86), and requiring postoperative SIC (OR 8.75, 95% CI 1.83-41.74) were independently associated with a UTI within 6 weeks of MUS. Obtaining preoperative Ucx in asymptomatic women prior to MUS does not appear to be associated with lower postoperative UTIs rates within 6 weeks of surgery.

Preoperative sleep apnea screening protocol reduces medical emergency team activation in patients with atrial fibrillation.

The association of in-hospital medical emergency team activation (META) among patients with atrial fibrillation (AF) at risk for obstructive sleep apnea (OSA) is unclear. This study evaluates the performance of the DOISNORE50 sleep questionnaire as an OSA screener for patients with AF and determines the prevalence of META among perioperative patients with underlying AF who have a diagnosis or are at risk for OSA. A prospective perioperative cohort of 2,926 patients with the diagnosis of AF was assessed for DOISNORE50 questionnaire screening. Propensity-score matching was used to match patients' physical characteristics, comorbidities, length of stay, and inpatient continuous positive airway pressure device usage. META and intensive care unit admissions during the surgical encounter, 30-day hospital readmissions, and 30-day emergency department visits were evaluated. A total of 1,509 out of 2,926 AF patients completed the DOISNORE50 questionnaire and were enrolled in the OSA safety protocol. Following propensity-score matching, there were reduced adjusted odds of META in the screened group of 0.69 (95% confidence interval: 0.48-0.98, P < .001) in comparison to the unscreened group. The adjusted odds of intensive care unit admissions and emergency department visits within 30 days of discharge were statistically lower for the screened group compared with the unscreened group. Among perioperative AF patients, evidence supports DOISNORE50 screening and implementation of an OSA safety protocol for reduction of META. This study identified decreased odds of META, intensive care unit admissions, and emergency department visits among the screened group. The high-risk and known OSA group showed reduced odds of META following the implementation of an OSA safety protocol. Saha AK, Sheehan KN, Xiang KR, etal. Preoperative sleep apnea screening protocol reduces medical emergency team activation in patients with atrial fibrillation. J Clin Sleep Med. 2024;20(5):783-792.

Elderly patients benefit from minimally invasive mitral valve surgery: perioperative risk management matters.

The goal was to assess the single-centre results of minimally invasive mitral valve surgery (MIMVS) in the elderly population. All patients referred for minimally invasive valve surgery underwent a standardized preoperative screening. We performed a retrospective analysis of 131 consecutive elderly patients (≥75 years) who underwent endoscopic MIMVS through a right mini-thoracotomy. Survival and postoperative course were assessed in 2 groups: a repair group and a replacement group. Eighty-five patients underwent mitral valve repair, and 46 had mitral valve replacement. The mean age was 79 ± 2.9 years, and the median follow-up duration was 3.8 years. The cardiopulmonary bypass time (128.7 min vs 155.9 min, P = 0.012) and the cross-clamp time (84.9 min vs 124.1 min, P = 0.005) were significantly longer in the replacement group. Except for more reinterventions for bleeding in the replacement group (10.9% vs 0%, P = 0.005), there were no significant differences in the postoperative course between the 2 groups. Low mortality rates at the midterm follow-up were observed in both groups, and no differences were observed between the 4-and the 12-month follow-up. Survival rates after 1 year and 5 years were 97.6% and 88.6%, respectively, with no significant differences between the 2 groups. MIMVS is an excellent treatment option in vulnerable elderly patients with excellent short- and long-term results. Although other studies suggest that repair could be superior to replacement even in older patients, our experience suggests that replacement is equivalent to repair in terms of mortality and major adverse cardiac and cerebrovascular events. Experience and standardized preoperative screening are mandatory to achieve optimal results.

Design Principles for the Interface of an Automated Medical Reporting System: a User Study in Preoperative Screening

This paper presents a qualitative design science study into the interface of an Automated Medical Reporting (AMR) system in order to establish user-centered design principles. AMR has been proposed as a solution to conquer the administrative burden in healthcare to improve patient-doctor contact. In order to expand this vision by including interface design principles without overlooking the usability aspects, a case study was performed within the preoperative screening department of an academic hospital. In this research, the current screening procedures were investigated by a task analysis, a heuristic evaluation of the current Electronic Health Record system, and stakeholder interviews. The preoperative screenings analysis and the findings of the interviews were translated into design choices. Based on these design choices and IT expert feedback, a treatment design in the form of a high-fidelity prototype of an AMR system for preoperative screenings was developed. This treatment was evaluated by conducting think-aloud sessions and a focus group. Based on the evaluations, ten elementary design principles were formulated for the AMR system interface, which have been categorized into four themes: (1) system status visibility, (2) care provider control, (3) consultation traceability, and (4) patient privacy. We also experienced that medical specialists find it hard to envision the future of their workflow using an AMR system, and that many individual preferences exist.

Preoperative risk factors for nonsatisfaction after lumbar interbody fusion

IntroductionLow back pain (LBP) is a common cause of impaired quality of life and disability and studies regarding surgical management of patients with LBP show a high variation in patient-reported success rate. Research questionTo find valuable preoperative clinical risk factors and variables associated with a non-satisfactory patient-reported outcome following surgery. Materials and methodsThe Danish surgical spine database (DaneSpine) was used to collect eight years of pre- and postoperative data on patients undergoing single-level fusions with either posterior- (PLIF) or transforaminal lumbar interbody fusions (TLIF). The primary outcome was patient nonsatisfaction. We collected data on European Quality of Life–5 Dimensions (EQ-5D), visual analogue scale (VAS), Oswestry Disability Index (ODI) score, pain intensity, duration of back pain, previous discectomy, and expectations regarding return to work after surgery at 2-year follow-up. ResultsThe cohort included 453 patients of which 19% reported treatment nonsatisfaction. The nonsatisfaction group demonstrated higher preoperative VAS scores for back pain (75 ± 19 vs. 68 ± 21, p = 0.006) and leg pain (65 ± 25 vs. 58 ± 28, p = 0.004). The preoperative EQ-5D score was significantly lower in the nonsatisfaction group (0.203 + 0.262 vs. 0.291 ± 0.312, p = 0.016). There was no statistical significance between patient nonsatisfaction and preoperative ODI score, age, body mass index, duration of back pain or expectations regarding return to work after surgery. Discussion and conclusionLow preoperative EQ-5D scores and high VAS leg and back pain scores were statistically significant with patient nonsatisfaction following surgery and may prove to be valuable tools in the preoperative screening and alignment of patient expectations.

Estimating effectiveness of nasal decolonization in prevention of peri-prosthetic joint infection in nasal carriers of Staphylococcus aureus undergoing arthroplasty in a tertiary care institution

Introduction: Peri-prosthetic joint infection (PJI) is one of the most challenging complications after total joint arthroplasty (TJA) surgeries. This study aims to (i) compare overall PJI rates with and without pre-operative nasal screening and decolonization for Staphylococcus aureus; (ii) estimate the difference in SSI rates between carriers and non-carriers undergoing TJA; and (iii) determine the efficacy of decolonization in reducing PJI rate in nasal carriers. Methods: A total of 760 patients were included in the study; with 399 patients in the study group, who underwent pre-operative screening and decolonization for nasal colonization with S. aureus; and 361 patients in the control group, who did not undergo pre-operative screening for nasal colonization. Patients were followed for 90 days post-surgery, and PJI rates were recorded following the Centers for Disease Control SSI criteria. Results: Twenty-one (5.26%) out of 399 patients in the study group developed PJI as opposed to 38 (10.53%) out of 361 patients in the control group. PJI rate due to either MSSA or MRSA was 2.5% in the study group (10/399) as opposed to 7.75% in the control group (28/361), with “P value” of 0.002 (&lt;0.05). Discussion: The overall SSI incidence was reduced by 51% after implementing the decolonization protocol. Regarding specific S. aureus SSI, 7.5% of the SSIs in the control group were caused by S. aureus, while only 2.5% were caused by this microorganism after implementing the screening and decolonization protocol. Conclusion: Implementing a screening and decolonization protocol for S. aureus before TJA can lead to a significant reduction in S. aureus surgical site infections.

Effect of corneal diameter on preoperative screening results for corneal refractive surgery.

To investigate the impact of different corneal diameters on corneal morphology and biomechanical outcome during preoperative screening for corneal refractive surgery. A retrospective analysis was conducted on 300 patients who underwent corneal refractive surgery at Eye and ENT Hospital, Fudan University between October 2023 and December 2023. All patients had no history of keratoconus or previous corneal surgery. Patients were categorized into two groups based on corneal topography measurements: (1) normal corneal diameter group (n=159), those with corneal diameter ranging from 11.5 mm to 12.0 mm; (2) abnormal corneal diameter group (n=141), those with corneal diameter smaller than 10.0 mm or larger than 12.5 mm. Corneal thickness, morphologic data, and biomechanical data were measured using Pentacam corneal topography. Correlation analysis was conducted to explore the relationship between corneal diameter and various corneal topography and biomechanical data. Significant differences were observed in corneal topography data including BFSf (F=43.21), BFSb (F=30.24), Df (F=15.32), Dp (F=32.36), Da (F=9.66), D (F=58.36), PPIavg (F=32.64), and ARTmax (F=12.06) between the groups (P<0.05). Additionally, BFSf, BFSb, Db, Dp, D, and PPIavg exhibited statistically significant differences between any two groups (P<0.05). Significant differences were also found in Df, Da, and ARTmax between small and large corneas, as well as between normal-sized and large corneas (P<0.05). Correlation analysis indicated negative correlations between corneal diameter and A1V (r=-0.12), HCdArcLength (r=-0.17), CBI (r=-0.27), bIOP (r=-0.13), Df (r=-0.025), PPIavg (r=-0.028), and TBI (r=-0.27). Conversely, BFSf (r=0.009), BFSb (r=0.001), PD (r=0.15), and ARTH (r=0.37) displayed positive correlations with corneal diameter. Corneal diameter significantly affects preoperative screening for corneal refractive surgery. Smaller corneal diameters exhibit a greater influence on the corneal topography BAD analysis system.

Keratoconus: exploring fundamentals and future perspectives - a comprehensive systematic review.

New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way. This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies. A multidimensional comprehensive systematic narrative review. A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed. Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes. The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients. The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.

Impact of COVID-19 infection during the postoperative period in patients who underwent gastrointestinal surgery: a retrospective study.

The coronavirus disease 2019 (COVID-19) pandemic has led to significant global casualties. This study examines the postoperative impact of COVID-19 on patients who underwent gastrointestinal surgery, considering their heightened vulnerability to infections and increased morbidity and mortality risk. This retrospective observational study was conducted at a tertiary center and patients who underwent gastrointestinal surgery between January 2022 and February 2023 were included. Postoperative COVID-19 infection was defined as the detection of severe acute respiratory syndrome coronavirus 2 RNA by RT-PCR within 14 days after surgery. Propensity score matching was performed including age, sex, American Society of Anesthesiology physical status classification, and emergency operation between the COVID-19-negative (-) and -positive (+) groups. Following 1:2 propensity score matching, 21 COVID-19(+) and 42 COVID-19(-) patients were included in the study. In the COVID-19(+) group, the postoperative complication rate was significantly higher (52.4% vs. 23.8%, P = 0.023). Mechanical ventilator requirement, intensive care unit (ICU) admission, and readmission rate did not significantly differ between the 2 groups. The median length of ICU (19 days vs. 4 days, P < 0.001) and hospital stay (18 vs. 8 days, P = 0.015) were significantly longer in the COVID-19(+) group. Patients with COVID-19 had a 2.4 times higher relative risk (RR) of major complications than patients without COVID-19 (RR, 2.37; 95% confidence interval, 1.254-4.467; P = 0.015). COVID-19 infection during the postoperative period in gastrointestinal surgery may have adverse outcomes which may increase the risk of major complications. Preoperative COVID-19 screening and protocols for COVID-19 prevention in surgical patients should be maintained.

Preventive myocardial revascularization prior to abdominal aortic repair in patients without cardiac symptoms: long-term results

To evaluate the long-term influence of preoperative invasive coronary screening and preventive myocardial revascularization on mortality and cardiac complications after open surgery for abdominal aortic aneurysms (AAA). We present long-term outcomes after open surgery for AAA between 2011 and 2022. Patients without clinical or objective signs of coronary artery disease were included. In the 1st group, routine coronary angiography was performed before surgery. Prophylactic myocardial revascularization was performed in 12 cases. Long-term data on 45 patients were obtained. In the 2nd group, 53 patients underwent repair without invasive coronary screening, and data on 48 patients were obtained in this group. The median follow-up was 32 and 79 months, respectively. Kaplan-Meyer overall 48-month survival was 87.3% and 82.1%, respectively (p=0.278). In the first group, 2 patients developed angina pectoris in the same period. In the second group, we observed 2 cases of myocardial infarction and 3 cases of angina pectoris without infarction. Analysis of survival curves found no significant differences (p=0.165). In our study, invasive coronary screening and preventive myocardial revascularization in patients without clinical and objective signs of coronary artery did not improve 4-year long-term period after abdominal aortic repair. Perhaps, differences will appear after 4 years, and this requires further follow-up after coronary angiography. However, there is a tendency towards more common onsets of coronary artery disease that dictates the need for cardiac monitoring of such patients.

Impact of asymptomatic detection of non-SARS-CoV-2 respiratory viruses on pediatric cardiac surgical outcomes.

Preoperative nasopharyngeal viral screening may reduce clinical uncertainty of upper respiratory infections prior to pediatric cardiac surgery but with unclear benefit. From March 2018 to March 2020, patients aged <3 years were screened for respiratory viruses and had substantial rates of viral detection (40%) but no observed differences in outcomes.

Is Potential Malnutrition Associated with Increased Morbidity in Total Hip and Knee Joint Arthroplasty? A Prospective Cohort Study

Introduction: Malnutrition is considered a risk factor for post-operative complications in total hip and knee arthroplasty, though prospective studies to investigate this assumption are lacking. The aims of this study were to prospectively analyze the 90-day post-operative complications, post-operative length of stay (LOS), and readmission rates of patients undergoing primary total hip and total knee arthroplasty using albumin, total lymphocyte count (TLC), and transferrin as serum markers of potential malnutrition. Materials and Methods: Six hundred and three primary hip and 823 primary knee arthroplasties over a 3-year period from a single center were prospectively analyzed. Body mass index, demographic, and comorbidity data were recorded. Complications were categorized as surgical site infection (SSI), venous thromboembolism (VTE) (deep vein thrombosis and pulmonary embolus), implant-related (such as dislocation), and non-implant-related (such as pneumonia). Outcomes were compared between groups, with malnutrition, defined as serum albumin &lt;3.5 g/dL. Results: Potential malnutrition was present in 9.3% of the study population. This group experienced a longer average LOS at 6.5 days compared to the normal albumin group at 5.0 days (P = 0.003). SSI rate was higher in the malnourished group (12.5 vs. 7.8%, P = 0.02). There was no difference between the two groups in implant-related complications (0.8 vs. 1.0%, P = 0.95) medical complications (7.8 vs. 13.3%, P = 0.17), rate of VTE (2.3 vs. 2.7%) or 90-day readmission rate (14.1 vs. 17.0%, P = 0.56). TLC and transferrin were not predictive of any of the primary outcomes measured (P &gt; 0.05). Pacific Island (P &lt; 0.001), Indian (P = 0.02), and Asian (P = 0.02) patients had lower albumin than NZ European. Conclusion: This study demonstrates an association between low albumin levels and increased post-operative LOS and SSI in total joint arthroplasty, providing support for the consideration of pre-operative nutritional screening. Keywords: Knee arthroplasty, hip arthroplasty, malnutrition, post-operative complications, hypoalbuminemia.