Preoperative Activity Level Research Articles

Preoperative serum glutathione reductase activity and alpha-fetoprotein level are associated with early postoperative recurrence of hepatocellular carcinoma

Abstract Objectives The aim of this study is to investigate the correlation between preoperative serum glutathione reductase (GR) activity, alpha-fetoprotein (AFP) level, and early postoperative recurrence in patients diagnosed with hepatocellular carcinoma (HCC). Methods The data of 91 patients with HCC who underwent hepatectomy at Jinhua Hospital from January 2020 to December 2021 were retrospectively analyzed. A comparison of clinical characteristics between Non-Recurrent group and Recurrence group was conducted, and the association between GR activity, AFP levels, and early postoperative recurrence in HCC was investigated. Results Recurrence group (n=50) had a significantly higher AFP levels (median: 226.7 vs. 99.7 μg/L, p<0.001) and significantly lower GR activity (median: 55.0 vs. 68.0 U/L, p<0.0001) compared with Non-Recurrent group (n=41). The GR activity was negatively correlated with the AFP level (r=−0.4275, p<0.01). Low GR activity (OR=0.948; 95 % CI: 0.910–0.988; p=0.011) and high AFP levels (OR=1.003; 95 % CI: 1.000–1.006; p=0.036) independently contribute to an increased risk of early postoperative recurrence in HCC patients. The area under receiver operating characteristic curve of GR activity and AFP level for predicting early postoperative recurrence of HCC was 0.790 and 0.708, respectively. Patients with GR >60U/L had a higher early postoperative non-recurrence rate than patients with GR ≤60U/L (71.4 % [30/42] vs. 22.4 % [11/49]; HR=4.026; 95 % CI: 2.254–7.188; p<0.01); Patients with AFP ≤100 μg/L had a higher early postoperative non-recurrence rate than patients with AFP >100 μg/L (65.6 % [21/32] vs. 33.9 % [20/59]; HR=2.490; 95 % CI: 1.397–4.438; p<0.01). Conclusions The preoperative serum GR activity and AFP level hold significant predictive value for early postoperative recurrence in HCC patients.

The Million Dollar Question: Can I Return to Sports After Unicompartmental Knee Arthroplasty, Doc?

Knee osteoarthritis (OA) is a widespread and potentially debilitating condition that can interfere with the growing demand for a healthy and active lifestyle. In people under the age of 55, the prevalence of OA is expected to increase substantially in the coming decades. High tibial osteotomy and cartilage repair operations have been used to treat OA in young, active individuals; however, these procedures require lengthy rehabilitation periods and result in poor return to preoperative levels of activity that make them unsuitable for the young, active patient. Unicompartmental knee arthroplasty (UKA) is a less invasive treatment alternative, especially for younger, active, middle-aged persons with a desire to return to sporting activities. UKA yields successful return to activities with excellent functional outcomes and mid- to long-term survivorship. This article will review the ability of patients to return to sports after UKA, the type and nature of the sporting activities, as well as the timing to return to these sports.

PREOPERATIVE ACTIVITY LEVEL IN PATIENTS WHO UNDERWENT TOTAL HIP ARTHROPLASTY HAS A DISTINCT IMPACT ON POSTOPERATIVE RECOVERY PROCESS AND FJS-12

Recently, some smart media devices including portable accelerometers have been used to measure objective physical activity (OPA) after total hip arthroplasty (THA). The aim of this study was to longitudinally assess OPA changes in patients who underwent THA using a compact triaxial accelerometer and to investigate the impact of this recovery process on patient-reported outcomes.This prospective cohort study involved 163 consecutive patients who had unilateral osteoarthritis of the hip and were followed up for 12 months after THA. There were 132 women and 31 men with average age of 66 years. OPA was measured using a compact triaxial accelerometer preoperatively and at 1, 3, 6, and 12 months postoperatively. This study investigated the recovery process of OPA in four patient groups classified by the median of age and preoperative activity levels (younger and higher activity (YH), younger and lower activity (YL), older and higher activity (OH), and older and lower activity (OL)), and examined its impact on patient-reported outcomes, including forgotten joint score-12 (FJS-12).The target period for regaining preoperative activity levels was approximately 3 months for patients with lower preoperative activity, and about 6 months for those with higher preoperative activity. The OPA at 12 months postoperatively was higher in the patients with higher preoperative activity levels than in those with lower preoperative activity levels. In patients with higher preoperative activity levels, FJS-12 scores significantly increased between 6 and 12 months postoperatively (p=0.018). FJS-12 at 12 months postoperatively was best in YH (81.7±18.9), followed by YL (73.5±22.9), OH (73.2±17.4), and OL (66.3±21.8).Differences in the recovery process of postoperative activity levels impacted the duration required for improvement in FJS-12 scores. These results can serve as indicators for setting activity goals in patients undergoing THA.

Intensive physical activity following total hip arthroplasty increased the revision risk after 15 years: a cohort study of 973 patients from the Geneva Arthroplasty Register.

Younger recipients of total hip arthroplasty (THA) highly prioritize returning to preoperative levels of physical activity (PA). Surgeons have tended to give cautious advice concerning high-impact sports participation, but there have been few long-term studies. The purpose of our study was to investigate the risk of revision arthroplasty in relation to postoperative PA levels. Patients registered in the Geneva Arthroplasty Register (GAR) who had elective THA when they were aged < 65 years were studied. Postoperative PA was collected prospectively 5-yearly using the UCLA activity scale. Cox proportional hazards models were used to estimate associations between PA and risk of revision THA. Amongst 1,370 eligible subjects, median age at THA 58 years (interquartile range 51-61), UCLA scores were available for 973 (71%). During follow-up over 15 years, there were 79 revisions, giving a cumulative risk of 7.4% (95% confidence interval [CI] 5.8-9.4). After adjusting for covariates, we found an increased risk of revision for each unit increase in postoperative PA (HR 1.2, CI 1.1-1.4), and among people performing the most intensive PA (HR 2.7, CI 1.3-5.6) compared with those who were inactive. The overall risk of revision was small but intensive and moderate PA may be associated with an increased risk of revision.

The impact of physical activity on patient-reported outcomes following deep inferior epigastric perforator flap breast reconstruction

IntroductionWhile higher pre-operative physical activity levels have been shown to be beneficial to post-operative recovery at large, their effect on patient reported outcomes after DIEP flap breast reconstruction has yet to be investigated. This study aims to correlate patient physical activity levels with patient-reported outcome measures. MethodsA prospectively maintained database of patients who underwent DIEP flap breast reconstruction between July 2021 and June 2022 was analysed. Physical activity levels were assessed using the Global Physical Activity Questionnaire (GPAQ) and patient-reported outcomes were measured using the BREAST-Q questionnaire, both pre-operatively and one year post-operatively. Patients were stratified into low (<1000 METs) and high (>1000 METs) physical activity groups. ResultsOf the 136 patients who underwent surgery, 51 completed both questionnaires, with 34 responses meeting completeness criteria for statistical analysis. The low-MET group (n=19) and high-MET group (n=15) were comparable in age and co-morbidities. Post-operatively, the low-MET group exhibited a 54% increase in physical activity levels, while the high-MET group showed a 17% decrease (p<0.01). The low-MET group experienced significant declines in psychosocial well-being (9.3%, p=0.04) and sexual well-being (14%, p=0.02), whereas the high-MET group did not show significant changes in these domains. Satisfaction with the unclothed abdomen increased significantly in the low-MET group (2.9 from 2, p=0.001), while the high-MET group showed a non-significant decrease (3.2 from 2.9, p=0.43). However, abdominal well-being significantly decreased in both groups, with a 56% decline in the high-MET group (p=0.006) and a 51% decline in the low-MET group (p=0.0002). The latter reflecting the perceived difference between aesthetic appearance and wellbeing. ConclusionsPatients with lower pre-operative physical activity levels showed improved activity post-surgery, potentially due to motivational factors from the reconstructive process. Conversely, those with higher pre-operative activity levels faced greater challenges in maintaining their activity levels post-surgery, potentially arising from disruptions in daily routines and donor site symptoms, indicating a need for targeted interventions to support this group. Concurrently, patients with higher baseline exercise levels did not show a decrease in psychosocial and sexual wellbeing, possibly reflecting a higher resilience to the operative process. These findings underscore the importance of integrating physical activity assessments into pre-operative evaluations to inform patient-centred care and optimize recovery outcomes.

Poster 342: Return to Sport Rates and Objective Measures after ACL Reconstruction for High Level Basketball Players

Objectives: Return to sports (RTS) decisions for high-level basketball players after an anterior cruciate ligament reconstruction (ACLR) are multifactorial. The literature focuses mainly on sports performance metrics and lacks objective rehabilitation measures. The purpose of this study was to determine objective measure differences following an ACLR between basketball players competing at the college/professional, high school, and recreational levels. Our hypothesis was that basketball players competing at the college/professional level would have superior performance with objective measures following an ACLR, compared to those competing at the high school and recreational levels. Methods: Patients were retrospectively selected based on the following inclusion criteria: ACLR with a contralateral patellar tendon graft (PTG), preoperative activity level of ≥8 on the modified Tegner activity rating scale, ≤25 years old, and reported playing basketball. Exclusions included: revisions, bilateral procedures, or were missing data needed for analysis. Patients were split based on their preoperative activity level (level 8 = recreational, level 9 = high school, level 10 = college/professional). Each patient received a mini open, contralateral PTG utilizing the same surgical methods and followed the same accelerated rehabilitation approach. Postoperative outcome measures included the difference in extension range of motion (ROM) at 2 weeks, difference in flexion ROM at 3 months, percent deficit in isokinetic quadriceps strength and single leg hop for distance at 4 months, and the manual maximum difference on the KT arthrometer at 2 months. Statistical analysis included chi-square and analysis of variance where appropriate. Results: Of the 329 patients, 69 were level 8, 224 were level 9, and 36 were level 10 with mean ages of 19.6, 16.4, and 19.1 years, respectively. The percent of males differed by group with level 8 at 78.3%, level 9 at 29.5%, and level 10 at 27.8% (p &lt; 0.001). The overall rate of return to competitive basketball for the cohort was 96.0%. The rate of return to competitive basketball was not statistically significantly different among the groups with level 10 having the highest rate (97.2%), followed by level 9 (96.4%) and then level 8 (94.2%), p = 0.659. Level 10 athletes had the lowest strength deficit with a mean of 9.3%, compared to 12.5% for level 9, and 15.6% for level 8, p=0.017. Single leg hop deficit was also different among groups with level 10 at 6.9%, level 9 at 6.2%, and level 8 at 10.4%, p &lt; 0.001. Knee ROM and stability were not statistically different among the groups. Conclusions: The rate of return to competitive basketball is the same among all high-level basketball players. Objectively, level 10 athletes had superior strength and single leg hop performance compared to recreational basketball players. Although the return to competitive basketball rate is the same among all groups, recreational basketball players tend to be weaker than college/professional players, therefore, added emphasis on this aspect of their rehabilitation would be beneficial for this population.

Poster 321: Predictive Value of Functional Assessments During Perioperative Rehabilitation in Anterior Cruciate Ligament Reconstruction (ACLR)

Objectives: Perioperative rehabilitation is critical to restoring function and preventing reinjury in ACLR patients. Single-leg hop and isokinetic strength testing are commonly utilized by clinicians to assess patient progress. The impact of early stage progress on later stage outcomes is, however, not well understood. This study aimed to identify the effects of early postoperative isokinetic quadriceps strength and single-leg hop performance on functional recovery after primary ACLR, to determine the manner in which changes in these parameters during perioperative rehabilitation relate to fast and successful functional recovery. Methods: Patients having a primary ACLR were consented into a long-term study and were retrospectively reviewed with the following inclusion criteria: ACLR using a contralateral patellar tendon graft with normal extension ROM and stability at 2 months postoperative, per the International Knee Documentation Committee (IKDC) objective form. Patients were excluded with a preoperative modified Tegner level &lt;7. Predictor variables included 180°/second isokinetic quadriceps strength test (preoperative, 2 months, 4 months) and single leg hop for distance (preoperative and 4 months). Strength was assessed using limb symmetry index (LSI) with the ACLR knee strength being divided by the graft donor knee strength, percent of preoperative normal, and percent change over time at each interval, while hop testing was normalized to height. Outcome variables assessed were return to sport (RTS) time in months, return to preoperative modified Tegner level in the first 12 months after surgery (yes/no), and Cincinnati Knee Rating System (CKRS) at 12 months postoperative. Stepwise multiple regression analysis was used to predict RTS time, return to preoperative modified Tegner level, and CKRS based on demographics and objective measures. Results: A total of 1093 patients were eligible for analysis and 607 were used for the RTS model, 724 for the return to preinjury Tegner level model, and 705 for the CKRS model. Mean age for the cohort was 19.6 ± 5.5 years (range, 11.9-39.7) and 52.1% were male. In the model predicting RTS time, the following variables reduced RTS time: female sex, younger age, higher preoperative LSI, higher ACLR knee strength gains from preoperative to 2 month, and higher normalized single leg hop distance. In the model predicting a return to preoperative Tegner level, the following variables increased the likelihood: younger age, lower preoperative Tegner level, lower strength deficits with LSI at 2 months, and higher normalized single leg hop distance. In the model predicting CKRS scores, the following variables increased the score: younger age and higher normalized single leg hop distance. Model statistics can be seen in Table 1. Conclusions: The study found several early rehabilitation performance measures significantly influenced key outcomes. Perioperative rehabilitation should promote early relative gains in quadriceps strength for the ACLR knee, maintaining limb symmTaetry, and maximizing single leg hop distance to encourage faster RTS, higher subjective scores, and improve the likelihood of patients returning to preoperative activity levels. By quantifying the importance and predictiveness of these rehabilitation performance metrics, clinicians may improve their protocols to promote superior outcomes following ACLR.

Effect of home-based prehabilitation on objectively measured physical activity in patients undergoing elective major cardiac and non-cardiac surgery. Data from a randomized controlled trial

Abstract Background Low functional capacity in patients undergoing major elective surgery is associated with postoperative complications. Prehabilitation aims to increase functional capacity by increasing preoperative physical activity. Low functional capacity in patients eligible for major surgery is associated with high age and comorbid burden. In this population, center-based prehabilitation is a barrier for participation. Therefore, we developed a multimodal home-based prehabilitation intervention. Data regarding the effectiveness of a home-based prehabilitation intervention to increase physical activity before surgery is limited. We hypothesize that home-based prehabilitation leads to an increase in physical activity in patients undergoing major cardiac and non-cardiac surgery. Methods We included patients aged over 65 with a proven low functional capacity and/or ventilatory efficiency measured by preoperative cardiopulmonary exercise testing. Patients were randomized to either standard of care or intervention. The intervention group received a home-based prehabilitation intervention 2-4 weeks before surgery. As part of the multimodal intervention, patients were prescribed a walking regimen according to the physical activity guidelines published by the World Health Organization (WHO). Patients were followed-up with weekly telephone calls by a physiotherapist to increase adherence and motivation. All patients were provided a wrist-worn tri-axial accelerometer at the baseline visit. The accelerometer was collected at the ward once the patient entered the hospital for surgery. Physical activity was estimated by calculating the average Euclidean norm minus one (ENMO, milligravity [mg]) per day. Baseline characteristics were tested by Wilcoxon rank-sum test and a linear model for the primary outcome was performed to adjust for confounders. Data analysis was performed using R Studio. Results 37 patients scheduled for cardiac and 62 for non-cardiac surgery were included (Table 1). Mean group difference of daily physical activity levels in non-cardiac surgery patients was 3.01 mg (p = 0.03, 95% CI [0.3, 5.6]). Mean group difference of daily physical activity levels in cardiac surgery patients was 0.27 mg (p = 0.95, 95% CI [-4.1, 5.0]) (Figure 1). Patients undergoing cardiac surgery had higher overall activity levels compared to non-cardiac also when adjusted for age. Conclusion Home-based prehabilitation increases preoperative physical activity levels in patients undergoing major non-cardiac surgery, but not in patients undergoing major cardiac surgery. Higher activity levels in cardiac surgery patients was unexpected, but may be explained by previous inclusion of patients with cardiac diseases in exercise-based rehabilitation and physical activity recommendations at routine cardiac follow-up visits. Table 1 Figure 1

Risk Factors for Development of Incisional Hernia after Aortic Aneurysm Repair: Secondary Analysis of the OVER Randomized Controlled Trial

Since the risk of mortality from rupture is elevated, elective repair of abdominal aortic aneurysms (AAAs) is often recommended. Currently, over 80% of elective repairs are carried out using an endovascular approach. While open repair has similar late survival and fewer reintervention outcomes when compared to endovascular repair, incisional hernia is a frequent complication with morbidity and cost implications. The Open versus Endovascular Repair (OVER) trial was the largest randomized trial of endovascular versus open repair of AAA in the United States. The purpose of this study was to determine risk factors associated with incisional hernia development following AAA repair via secondary analysis of the OVER data. This was a multisite trial conducted within the Veterans Affairs health-care system. Study participants (N=881) were enrolled from 2002 to 2008 and followed until 2011 with additional administrative data collection until 2016. Eligible patients had AAA for which elective repair was planned and randomized 1:1 to either open or endovascular repair. Incisional hernia was a prespecified end point in the OVER protocol, specifically assessed at each protocol follow-up visit. Technical details were extracted from each operative report, repair case report form(s), and adverse event form(s). Patient demographics, comorbid conditions, reported preoperative activity level, and operative details including initial approach, blood loss, and closure methods were analyzed using Bayesian hierarchical Weibull survival regression modeling. Incisional hernias were recorded among 46 participants (5.2%). The average time to hernia diagnosis was 3.5years. Of the 437 participants randomized to open treatment, 427 received an open repair including crossovers from endovascular treatment assignment. Transperitoneal repair was performed in 81%, running suture in 96%, and absorbable suture in 71% of cases. Randomization to endovascular repair was associated with reduced risk of hernia (hazard ratio [HR] 0.70, 95% credible interval [CI] 0.49-0.94). Higher activity level was associated with increased hernia risk (HR 1.39, 95% CI 1.06-1.84). Approach, suture closure techniques, body mass index, diabetes, and smoking status were not associated with increased risk of hernia development. Incisional hernia is a frequent complication associated with open repair of abdominal aortic aneurysm and commonly required reintervention. Endovascular repair was associated with reduced risk of hernia. Patients with increased activity experienced a higher incidence of hernia. However, no other modifiable patient, operative, or technical factors were found to be associated with hernia development.

THE ARTHROSCOPIC MANAGEMENT OF TALAR BODY FRACTURES

Talar body fractures are high energy intraarticular injuries that are best management by anatomical reduction and secure fixation to improve outcomes. The talus is relatively inaccessible surgically and requires extensive soft tissue dissection and/or osteotomies to gain adequate open visualisation. There are a small number of case reports on arthroscopic assisted fixation in the literature. This case series reports on the technique and early outcomes of six patients all of whom presented with significant intraarticular displacement and who were managed entirely arthroscopically.The fractures were of the main body of the talus involving the ankle and subtalar joints and all had preoperative CT scans. All six patients underwent posterior ankle and subtalar arthroscopy with cannulated screws used to stabilise the fractures after reduction. Visualisation of the fracture reduction was excellent. After 10 days in a backslab, the patients were protected in a boot and encouraged to actively move their ankles. Weight bearing was permitted once union appeared complete.There were no early complications of infection, avascular necrosis or VTE. There was one patient that had a non-clinically significant migration of a screw. Two patients were lost to follow up early due to being visitors. The mean length of follow up was 12 months in the remainder. The remaining four patients all returned to their preoperative level of activity. All had demonstrable subtalar stiffness. There was no early post-traumatic arthritis.This series represents the largest so far published. The main flaw in this report is the lack of long term follow up. While this report cannot state superiority over open techniques it is a safe, effective and acceptable technique that has significant conceptual benefits.

Predicting the association of different levels of physical activity on postoperative pulmonary complications using the international physical activity questionnaire in patients undergoing thoracoscopic lung surgery under general anaesthesia: protocol for a prospective cohort study

IntroductionPostoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has...

Trends in Preoperative Outcome Measures From 2013 to 2021 in Patients Undergoing Primary Total Joint Arthroplasty.

The prevalence of total joint arthroplasty (TJA) continues to increase exponentially. Patient-reported outcome measures (PROMs) are used to define clinical and quality-of-life improvement and for reimbursement. Temporal trends of preoperative PROMs and specifically how COVID-19 has affected these PROMs is lacking. This study evaluated preoperative PROMs over time, whether medical factors affected preoperative PROMs, and what correlations the COVID-19 pandemic had with these trends in PROMs. A total of 3,014 patients who underwent primary total hip total hip arthroplasty or total knee arthroplasty from 2013 to 2021 were retrospectively reviewed for covariates and preoperative PROMs. Commonly reported preoperative PROMs were evaluated in univariate and multivariate models. Preoperative activity level steadily increased from 2015 to 2021 for THAs and steadily increased from 2015 to 2019 for TKAs, followed by a decrease in 2020. Preoperative KOOS JR scores increased from 2016 to 2019 and then decreased in 2020 and 2021. Preoperative knee pain with level walking and climbing stairs steadily increased from 2013 to 2019, with additional increases in 2020. The COVID-19 era was significantly associated with higher activity levels for THAs, higher levels of pain with level walking, and lower KOOS JR scores. Preoperative PROM scores demonstrated correlations with postoperative PROM scores, which differed from that during the COVID era (rho range 0.105 to 0.391) at a mean of 2.0 years postoperatively. Surgical delays because of COVID-19 were associated with increased preoperative disability as evidenced by lower activity levels. Aside from this pandemic era, patient activity levels increased over time, indicating that modern TJA patients are more active preoperatively and likely to demand higher levels of function after surgery. Additional studies should evaluate the clinical effect of these statistically significant findings. Providers should consider the trends in preoperative PROMs over time when counseling patients on expectations after TJA.

The activity advantage: Objective measurement of preoperative activity is associated with postoperative recovery and outcomes in patients undergoing surgery with gynecologic oncologists

ObjectiveTo examine the association between objectively-measured preoperative physical activity with postoperative outcomes and recovery milestones in patients undergoing gynecologic oncology surgeries. MethodsProspective cohort study of patients undergoing surgery with gynecologic oncologists who wore wearable actigraphy rings before and after surgery from 03/2021–11/2023. Exposures encompassed preoperative activity intensity (moderate- and vigorous-intensity metabolic equivalent of task-minutes [MAVI MET-mins] over seven days) and level (average daily steps over seven days). Intensity was categorized as <500, 500–1000, and >1000 MAVI MET-mins; level categorized as <8000 and ≥8000 steps/day. Primary outcome was 30-day complications. Secondary outcomes included reaching postoperative goal (≥70% of recommended preoperative intensity and level thresholds) and return to baseline (≥70% of individual preoperative intensity and level). ResultsAmong 96 enrolled, 87 met inclusion criteria, which constituted 39% (n = 34) with <500 MET-mins and 56.3% (n = 49) with <8000 steps preoperatively. Those with <500 MET-mins and <8000 steps had higher ECOG scores (p = 0.042 & 0.037) and BMI (p = 0.049 & 0.002) vs those with higher activity; all other perioperative characteristics were similar between groups. Overall, 29.9% experienced a 30-day complication, 29.9% reached postoperative goal, and 64.4% returned to baseline. On multivariable models, higher activity was associated with lower odds of complications: 500–1000 MET-mins (OR = 0.26,95%CI = 0.07–0.92) and >1000 MET-mins (OR = 0.25,95%CI = 0.07–0.94) vs <500 MET-mins; ≥8000 steps (OR = 0.25,95%CI = 0.08–0.73) vs <8000 steps. Higher preoperative activity was associated fewer days to reach postoperative goal. ConclusionPatients with high preoperative activity are associated with fewer postoperative complications and faster attainment of recovery milestones. Physical activity may be considered a modifiable risk factor for adverse postoperative outcomes.

Appendectomy Open Versus Laparoscopic in Developing World Scenario

Background: Laparoscopic surgery is an expanding field which is recognized as gold standard for cholecystectomy, it is being increasingly used by many surgical subspecialties with advantage of being minimal invasive and being both diagnostic and therapeutic. Objectives: This study was done to evaluate the feasibility of laparoscopic appendectomy in a developing world scenario.Material and Methods: This observational cross-sectional study was conducted under department of general surgery from September 2019 to August 2021. The patients presenting to the ER department were evaluated based on Alvarado score. Alternate patients underwent laparoscopic appendectomy (LA) and open appendectomy (OA). Based upon clinical and imaging signs of acute appendicitis (i.e. Alvarado score of 7 or more) and consent to be the part of study, were used as inclusion criteria, while pregnancy, patients who could not tolerate increased intra-abdominal pressure/prolonged anesthesia, patients under 10 years of age and patients with evidence of appendicular mass formation were excluded from the study. The standard surgical techniques were performed for both groups and the patients were followed up in immediate post-operative period, at 6 months and one year. Results: The parameters observed were duration of surgery average 25 minutes (range 15-50 mins) for OA and 70 minutes (range 40-90 mins) for LA (P-Value 1.41E-70), return to preoperative activity level was 13 days (range 10-17 days) for OA and 10 days (range 9-14 days) for LA (P-Value 6.69034E-22), and average cost for OA was PKR 35279.00 while for LA was PKR 72168.00 (P-Value 1.24442E-60). Remaining parameters were not significantly different.Conclusion: The evidence available clearly demonstrates that laparoscopic appendectomy is superior to open appendectomy in terms of hospital stay, post-operative pain and return to work, however in a few situations the procedure needs to be converted therefore the surgeon must be conversant with open appendectomy for complicated case. Moreover, cost is a major factor determining the choice of procedure specially in the developing countries. Keywords: Appendectomy, Developing world, Laparoscopic Appendectomy, Open versus Laparoscopic Appendectomy, Pakistan,

Functional knee and ankle outcomes of a peroneus longus tendon autograft for primary reconstruction of the anterior cruciate ligament

Background Peroneus longus tendon (PLT) autograft is commonly used for anterior cruciate ligament (ACL) reconstruction because it is easily harvested and has the same size and strength as the ACL. There are few studies in the literature that discussed donor site complications after ACL reconstruction by PLT. PLT was used as an autograft for reconstructions of the medial patellofemoral ligament and deltoid ligament. We evaluated clinical and functional outcomes for knee, foot, and ankle joints after the use of PLT as an autograft in primary isolated ACL reconstruction. Patients and methods We retrospectively reviewed all patients who were operated for primary ACL reconstruction by PLT autograft from May 2020 to May 2021. Preoperatively and postoperatively, all patients were examined clinically for knee stability by anterior drawer, Lachman, and pivot shift tests, applying the International Knee Documentation Committee as well as the Lysholm score. American Orthopedic Foot and Ankle Score, Foot and Ankle Ability Measure, and ankle range of motion were used for the evaluation of postoperative foot and ankle functions. Return time to the sport was also evaluated. Results Sixty-five patients with ACL-injured knees were included. Their mean age was 29.81 ± 8.33 years and ranged from 20 to 45 years, and males were 54 (83%) and females were 11 (17%). The mean postoperative follow-up period was 32.5 ± 3.1 months. Mean of American Orthopedic Foot and Ankle Score was 99.33 and Foot and Ankle Ability Measure was 99.7 after 12 months. Postoperative Lysholm score mean±SD was 95.30 ± 4.65, and the International Knee Documentation Committee mean±SD was 93.47 ± 9.82 with P value less than 0.001. Return to sport ranged from 4 to 8 months with mean±SD of 5.67 ± 0.75. Conclusion PLT autograft for primary reconstruction of isolated ACL injury did not affect foot and ankle functions with good knee stability and restoration of knee functions postoperatively, which facilitated the return to preoperative sports activity level.

Ultrasound-guided electrocoagulation of neovascularisation for persistent patellar tendinopathy in athletes: a cohort study of 25 patients with a mean follow-up of 5 years from the SANTI Study Group

BackgroundPatellar tendinopathy (PT) is a common condition characterised by persistent patellar tendon pain and dysfunction, particularly in athletes. Neovascularisation is frequently observed in the PT and is associated with increased...

Varus osteotomy as a salvage procedure for young patients with symptomatic patellofemoral arthritis and valgus malalignment at short- to mid-term follow-up: a case series

PurposeThe purpose of the study was to report the clinical, functional and radiological outcome following varus osteotomy as a salvage procedure in young to middle-aged patients with patellofemoral arthritis (PFA) and associated valgus malalignment. It was hypothesized that a significant improvement in knee function and reduction in pain would be achieved. Moreover, no conversion to patellofemoral joint arthroplasty could be observed.Material and methodsPatients (< 50 years of age) that underwent varus osteotomy between 08/2012 and 01/2020 for the treatment of symptomatic PFA and associated valgus malalignment were consecutively included (minimum follow-up: 24 months). Patient-reported outcome measures (PROM; International Knee Documentation Committee subjective knee form [IKDC]), Visual Analog Scale [VAS] for pain, Tegner Activity Scale [TAS], and satisfaction with the postoperative results (1–10-scale, 10 = highest satisfaction) and weight-bearing whole-leg anteroposterior radiographs were conducted pre- and postoperatively. The change in PROM and femorotibial angle (FTA) were tested for statistical significance.ResultsIn total, 12 patients (14 knees) were included (66.7% female; mean age: 33.8 ± SD 6.6 years). In ten cases, lateral opening-wedge distal femoral osteotomies (DFO) were performed, of which three cases included a concomitant femoral derotation. Three medial closing-wedge DFO and one medial closing-wedge high tibial osteotomy were performed. At follow-up (55.3 ± 29.3 months), a significant improvement in knee function (IKDC: 56.4 ± 14.4 to 69.1 ± 11.2, p = 0.015) and reduction in pain (VAS for pain: 3.5 [interquartile range 2.3–5.8] to 0.5 [0–2.0], p = 0.018) were observed. Patients were able to reach their preoperative sporting activity level (TAS: 3.0 [3.0–4.0] to 3.5 [3.0–4.0], p = 0.854) and were highly satisfied with the postoperative result (9.0 [6.5–10]). Additionally, a significant correction of valgus malalignment was observed (5.0° ± 2.9° valgus to 0.7° ± 3.2° varus, p < 0.001). Regarding complications, two re-osteosyntheses were performed due to loss of correction and delayed union. No conversion to patellofemoral arthroplasty occurred.ConclusionIn patients with symptomatic PFA and associated valgus malalignment, varus osteotomy as a salvage procedure achieved a significant improvement in knee function and reduction in pain. No conversion to patellofemoral joint arthroplasty occurred at short- to mid-term follow-up.Level of evidenceRetrospective case series, Level IV.

Outcomes Vary by Pre-Operative Physical Activity Levels in Total Knee Arthroplasty Patients.

Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA.

Influence of perioperative step volume on complication rate and length of hospital stay after colorectal cancer surgery (IPOS trial): study protocol for a randomised controlled single-centre trial at a German university hospital

BackgroundPerioperative mobilisation and physical activity are critical components of postoperative rehabilitation. Physical inactivity is a significant risk factor for complications and prolonged hospitalisation. However, specific recommendations for preoperative and postoperative...

Impact of Patient Body Mass Index on Post-Operative Recovery from Robotic-Assisted Hysterectomy.

A longitudinal, descriptive, prospective, and prolective study of individuals with endometrial or cervical cancer/pre-cancer diagnoses and high BMI (over 35 kg/m2) undergoing RH was conducted. Of the 53 participants recruited, 3 (6%) were converted to open surgery. The 50 RH participants had median BMI 42 kg/m2 (range 35 to 60): the range 35-39.9 kg/m2 had 17 cases; the range 40-44.9 kg/m2 had 15 cases; 45-49.9 kg/m2 8 cases; and those ≥50 kg/m2 comprised 10 cases. The mean RH operating time was 128.1 min (SD 25.3) and the median length of hospital stay was 2 days (range 1-14 days). Increased BMI was associated with small, but statistically significant, increases in operating time and anaesthetic time, 65 additional seconds and 37 seconds, respectively, for each unit increase in BMI. The median self-reported time for individuals who underwent RH to return to their pre-operative activity levels was 4 weeks (range 2 to >12 weeks). There was a significant improvement in pain and physical independence scores over time (p = 0.001 and p < 0.001, respectively) and no significant difference in scores for overall QOL, pain, or physical independence scores was found between the BMI groups. Patient-reported recovery and quality of life following RH is high in individuals with high BMI (over 35 kg/m2) and does not appear to be impacted by the severity of obesity.