Preoperative Assessment Research Articles

Nested Semi-Transparent Isosurface Simulated Volume-Rendering (NESTIS-VR) – An efficient on-device rendering approach for Augmented Reality headsets increasing surgeon confidence of kidney donor arterial anatomy

Background and objectiveVolume-renderings of computed tomography or magnetic resonance angiograms (MRAs) are routinely used by surgeons in the preoperative assessment of vascular anatomy in kidney donors. Stereoscopic headsets (OST-HMD) like Microsoft HoloLens allow intuitive interaction with three-dimensional content for more intuitive comprehension, but do not allow real-time ray-casting volume-rendering of medical volume datasets on-device due to computational limitations. MethodsWe introduce NEsted Semi-Transparent Isosurface Simulated Volume-Rendering (NESTIS-VR), as an on-device alternative to ray-casting volume-rendering and developed an application for HoloLens to render kidney donor MRAs with interactive control of fundamental rendering parameters. We compared NESTIS-VR with current standard pre-calculated 2D ray-cast volume-renderings in an observational study with 2 expert kidney transplant surgeons, measuring their confidence in pre-operatively assessing the kidney pedicle arterial anatomy in 20 potential donors. We also compared it against other 3D rendering techniques to understand which features contributed most to any improvements. ResultsReal-time stereoscopic three-dimensional (3D) NESTIS-VR in Augmented Reality significantly improves surgeons’ confidence compared with pre-calculated conventional two-dimensional (2D) ray-casting volume-rendered images (p = 0.0415/p = 0.00003). 2D non-stereoscopic NESTIS-VR was significantly superior to pre-calculated 2D ray-casting volume-rendered images for both surgeons (p = 0.044/p = 0.0003). Single isosurface 2D rendering was significantly superior than pre-calculated 2D volume-rendered images for one surgeon. There was no significant difference between binocular 3D display over 2D views with NESTIS-VR or between constrained and unconstrained vantage points for 2D viewing. ConclusionNESTIS-VR provides a new approach to rendering medical datasets in computationally limited OST-HMD headsets and significantly increases surgeons’ confidence of kidney donor arterial anatomy. The principal confidence benefit arises from providing surgeons interactive control over rendering parameters compared to pre-calculated renderings at preset parameters whilst rendering on-device and keeping the OST-HMD untethered from a workstation.

Surgical Outcomes in Thyroidectomy for Patients with Graves’ Disease: A Randomized Controlled Trial

Background: Thyroidectomy is a preferred protocol for patients with Graves’ disease. However, it may be a challenging option in post-surgical management of various factors. There, this study aims to compare the surgical outcomes of total thyroidectomy and subtotal thyroidectomy in patients with Graves’ disease to provide evidence-based surgical decision-making. Methods: This randomized controlled trial was conducted at Sheikh Zaid Hospital, Rahim Yar Khan, October 2023 to April 2024; enrolled 120 patients diagnosed with Graves’ disease using a simple random sampling technique were assigned to Group A (n=60) and B (n=60) who underwent total thyroidectomy, and subtotal thyroidectomy respectively. Preoperative assessments and surgeries were performed while postoperative outcomes, complications, and thyroid function tests were also monitored and represented using independent t-tests while a p<0.05 was considered significant. Results: It was revealed that operative time was significantly higher for total thyroidectomy than subtotal thyroidectomy 125.60±14.56 and 97.54±12.56 respectively, suggesting significantly lower time consumption in subtotal thyroidectomy procedure (p=0.001). Patients who underwent subtotal thyroidectomy had a significantly shorter hospital stay compared to those who underwent total thyroidectomy (p=0.02). Moreover, levels of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were significantly different between the two groups. Patients who underwent subtotal thyroidectomy had significantly lower T3 and T4 levels and higher TSH levels compared to those who underwent total thyroidectomy (p<0.05). Conclusion: Subtotal thyroidectomy demonstrated favorable outcomes, including shorter operative time, lower rates of postoperative complications, and thyroid function tests compared to total thyroidectomy. These findings help and support the consideration of subtotal thyroidectomy as a viable surgical approach for patients with Graves' disease. Keywords: Grave Disease, Thyroidectomy, Thyroxine, Triiodothyronine.

Blood plasma lipid profile in glial tumors

Introduction. In glial tumors, lipid metabolism becomes abnormal. Analysis of lipid metabolism components can be an important characteristic of molecular and genetic profile of gliomas.Aim. To determine the correlation between plasma lipidome profile and immunohistochemical characteristics of glial tumors and to evaluate clinical significance of blood lipid spectrum analysis in preoperative assessment of molecular profile of gliomas.Materials and methods. Immunohistochemical measurement of O-6-methylguanine-DNA-methyl transferase (MGMT), Ki-67, p53, IDH1 tumor markers was performed using the corresponding antibody clones. Composition of plasma lipids was assessed using thin layer chromatography.Results. Even at the early stages of gliomagenesis, significant differences in cholesterol ethers, lysophosphatidylcholines, phosphatidylcholine (PC)/ lysophosphatidylcholine (LPC) ratio, neutral lipids (NL)/phospholipids (PL) in the blood were observed. Significant correlations between Ki-67, MGMT tumor markers and the above-mentioned lipidome parameters were found. The PC/LPC, NL/PL ratios in the blood of the patients from the groups with higher (above 10 %) and lower (below 10 %) Ki-67 mitotic indexes compared to healthy individuals were significantly lower. Therefore, the values of lipidome parameters allow to indirectly assess proliferative activity of gliomas which can be used for preoperative diagnosis of these tumors. No significant differences in the plasma PC/LPC and NL/PL ratios were found between the groups with MGMT promoter methylation and without it. No indirect predictor criteria for MGMT were found.Conclusion. It is impossible to determine decreased epigenetic activity of corresponding transcripts and preoperative prognosis for alkylating agent therapy based on the parameters of plasma lipid metabolism.

FREQUENCY OF EASY AND DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY FOR CHOLELITHIASIS

The prevalence of gallstone disease is influenced by factors such as age, gender, and marital status. Ultrasonography is important for screening. Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis, but some cases may require conversion to open surgery (OC). Preoperative ultrasound assessments, particularly the common bile duct (CBD) diameter, may help predict the difficulty of LC and prepare for potential complications. Objective: The objectives of this study are to assess the frequency of easy and difficult laparoscopic cholecystectomy in patients with cholelithiasis and to compare the mean diameter of the common bile duct between cases of easy and difficult laparoscopic cholecystectomy. Methods: This sctional study was conducted from February 10, 2023, to August 10, 2023, and included 170 patients (ages 18-60 years) undergoing laparoscopic cholecystectomy for cholelithiasis. Both genders were included. Variables such as age, gender, diabetes, hypertension, and cholecystectomy status were recorded. The mean and standard deviation (SD) were calculated for age and CBD diameter. An independent t-test was used to compare CBD diameters between easy and difficult LC cases. Chi-square tests were applied to control for effect modifiers. Results: The mean age of the patients was 52.32 ± 4.89 years. Other patient characteristics included an average height of 162.90 ± 9.25 cm, weight of 75.95 ± 12.32 kg, and BMI of 27.47 ± 4.72. The common bile duct diameter was 4.55 ± 1.42 mm. Gender distribution showed 54.7% male and 45.3% female patients. Of the 170 patients, 84 (49.4%) were classified as easy LC cases, while 86 (50.6%) were classified as difficult. The mean CBD diameter was significantly different between the two groups, measuring 3.54 ± 1.03 mm in easy cases and 5.52 ± 1.02 mm in difficult cases (p = 0.001). Conclusion: This study highlights the importance of preoperative assessment of common bile duct diameter in predicting the difficulty of laparoscopic cholecystectomy. Patients with a larger CBD diameter are more likely to experience a difficult LC, emphasizing the need for personalized surgical planning. These findings underscore the value of preoperative ultrasonography in optimizing patient outcomes and reducing the risk of conversion to open surgery.

Anesthetic management of a patient with mandibular hypoplasia, deafness, progeroid features, lipodystrophy syndrome: a case report

BackgroundMandibular hypoplasia, deafness, progeroid features, and lipodystrophy (MDPL) syndrome is a rare autosomal dominant disorder that presents unique challenges for anesthetic management due to its multisystemic manifestations. This report outlines the anesthetic considerations for MDPL patients based on our case experience.Case presentationA 15-year-old male with MDPL syndrome underwent testicular extraction under general anesthesia. Insertion of a peripheral venous catheter was challenging due to scleroderma-like skin. Although the facial features of MDPL syndrome suggested a difficult airway, intubation with a McGrath™ Mac video laryngoscope was successful. Despite MDPL syndrome’s association with hypertriglyceridemia due to lipodystrophy, this patient’s triglyceride levels were normal. Thiamylal and sevoflurane were used without issues such as delayed emergence from anesthesia.ConclusionsMDPL syndrome requires careful preoperative assessment and tailored anesthetic management due to potential airway challenges arising from its distinctive facial features and the possibility of altered anesthetic pharmacokinetics associated with lipodystrophy.

Concordance between Preoperative #ENZIANi Score and Postoperative #ENZIANs Score Classification-Why Do We Choose #ENZIAN and How Does It Impact the Future Classification Trend?

Objectives: To assess the concordance of the preoperative application of the #ENZIAN classification (#ENZIANi) with the postoperative result (#ENZIANs) using surgical findings as the reference standard. Methods: This retrospective study included 282 consecutive patients with deep endometriosis undergoing surgical treatment. Preoperative assessment with transvaginal sonography and magnetic resonance imaging was compared with postoperative assessment. Concordance and diagnostic test evaluation were calculated. Results: The highest concordance was observed in the F (abdominal wall endometriosis) with k Cohen of 0.837, following the values for pelvic locations, with 0.795 for T left, 0.791 for T right, 0.776 for F (adenomyosis), 0.766 for C (rectum), and 0.75 and 0.72 for O right k and O left, respectively. The highest sensitivity was demonstrated for the P compartment *(98%), T compartment (both sides 97%), and A, B, C (94-96%), corresponding with deep endometriosis. Conclusions: Preoperative assessment using TVS/TAS + MRI with the ENZIANi score correlates well with the ENZIANs postoperative score and demonstrates good concordance in the detection and localization of deep endometriosis, thereby minimizing false negative results and ensuring accurate preoperative staging. The ENZIAN classification is well-suited to surgeon needs and benefits from continuous development. Future improvements, such as adding the expanded C module, may be considered in the next edition.

Examining the relationship between preoperative nutritional and symptom assessment and postoperative atrial fibrillation in esophageal squamous cell carcinoma patients: a retrospective cohort study

ObjectiveThe study aimed to examine the relationship between preoperative nutritional status, symptom burden, and the occurrence of postoperative atrial fibrillation in Esophageal Squamous Cell Carcinoma patients.MethodsThe study, conducted in the Department of Thoracic Surgery at the Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, applied the NRS 2002, SGA and MSAS scoring systems as measures of nutritional status and symptom occurrence in patients diagnosed with ESCC. Univariate and multivariate logistic regression analysis were performed to evaluate the association between nutritional scores, symptom scores, and postoperative complications.ResultsThe research found a significant correlation between high MSAS scores and postoperative atrial fibrillation. Patients with high symptom burden also tended to have nutritional risk or malnutrition according to the NRS2002 and SGA scores.ConclusionThere is a need for healthcare providers to pay attention to ESCC patients’ physical and psychological symptoms. Close monitoring of nutritional status and timely nutritional interventions should be integrated into these patients’ care plans as they have been found to be related to postoperative complications such as atrial fibrillation.

Contrast-Enhanced Mammography Accuracy in Assessing Preoperative Breast Tumor Size

Background. Breast cancer is a leading type of cancer in women. Imaging techniques (ultrasound, mammography, and magnetic resonance imaging (MRI)) play a crucial role in tumor detection and evaluation. The last emerging technique is contrast-enhanced mammography (CEM) which provides both morphological and functional information.Objective: to evaluate CEM accuracy in measuring breast tumor lesions. Material and methods. The study involved 69 patients followed by the Breast Unit from January 2018 to September 2023. Breast tumor dimensions measured in CEM in the pre-operative stage by three experienced radiologists were compared to the dimension obtained at the histological examination, the current gold standard in assessing tumor size. Results. We observed a slight overestimation by CEM compared to histology, with a difference between the two measurements not more than 10 mm. CEM underestimated the dimensions in 12 of 69 cases. Conclusion. The study demonstrated excellent CEM accuracy in preoperative assessment of breast tumors, consistent with previous findings in the literature. CEM could prove to be a valid and safer alternative to MRI in preoperative breast tumor measuring.

Systematic preoperative approach for bariatric surgery, perioperative results, and economic impact.

Obesity is a complex systemic condition, involving numerous anatomical and metabolic changes. Therefore, a comprehensive preoperative assessment is essential for each patient contemplating bariatric surgery. This study presents the findings of a proposed protocol designed to streamline the pre-anesthesia consultation process. Our aim was to compare the efficiency and costs of consultations guided by the protocol with those conducted without a specific strategy. The secondary outcomes assessed included postoperative (PO) length of hospital stay and surgical duration. We conducted a retrospective cross-sectional analysis involving 206 clinical cases. Statistical analyses, including the chi-squared test, Student's t-test, and Mann-Whitney U test, were utilized based on the type of variables. The results showed a significant reduction in the costs, pre-anesthesia consultation duration, time spent in the recovery unit, and the need for referrals. However, no statistically significant differences were observed in the delay before surgery and length of hospital stays, measured in days. This algorithm offers a promising approach for optimizing perioperative management in bariatric surgery, demonstrating its effectiveness in cutting costs and reducing the need for referrals.

Awake thoracoscopic non-anatomic pulmonary resections under thoracic paravertebral block: Results of a tertiary referral centre.

Awake video-assisted thoracoscopic surgery (VATS) helps to avoid the adverse effects of general anaesthesia (GA) with single-lung ventilation. Its usage in anatomic and non-anatomic pulmonary resections has spread worldwide, and it is mostly performed under thoracic epidural analgesia (TEA). We herein report our surgical experience with awake VATS non-anatomical resections under the thoracic paravertebral block (TPB). This retrospective, single-centred study reviewed patients undergoing awake VATS non-anatomical pulmonary resection under TPB, who voluntarily accepted awake VATS despite being suitable for GA and were found unsuitable for GA based on pre-operative assessment results. Demographic, pre-, per- and post-operative data were collected, analysed and compared with the literature data. Twenty-four patients (16 patients with normal pre-operative assessment results and 8 patients having high risk for GA) were selected. Fourteen bullectomies for recurrent spontaneous pneumothorax and 10 wedge resections (nine for metastasectomy and one for lung biopsy) were performed. Global in-operating room time was 77 ± 31 min. The morbidity rate was 20.8% (n = 5), including prolonged air leak in three and pneumonia in two patients. The mean duration of the chest tube was 1.9 ± 1.5 days and mean duration of hospital stay was 3.5 ± 2.1 days. There was no in-hospital mortality. Our results were mostly similar to the literature data. Non-anatomical lung resections by VATS can be performed easily and safely under TPB in awake patients. Although the perioperative and post-operative outcomes are not superior to other anaesthesia approaches, preferring TPB may help to avoid the serious potential complications of TEA.

Exploring adverse effects of deep brain stimulation: the need for personalized care and long-term monitoring.

Deep Brain Stimulation (DBS), an FDA-approved treatment for movement disorders such as Parkinson's Disease (PD), is increasingly used for various neurological and neuropsychiatric conditions. A recent systematic review and meta-analysis by Bahadori et al. highlighted a significant increase in Body Mass Index (BMI) among patients post-DBS, with most participants having PD. The study, however, noted moderate heterogeneity (I² = 67.566%) without thoroughly addressing its potential causes or proposing strategies to mitigate it. The review's limited patient diversity and short follow-up period also challenge its generalizability and long-term implications. In addition to BMI changes, DBS has been linked to motor, cognitive, and psychiatric side effects. Patients undergoing subthalamic nucleus (STN) stimulation, for example, face risks of motor complications, including speech and gait issues, while cognitive declines, particularly in verbal fluency and executive function, are also concerning. Psychiatric side effects such as depression, anxiety, and psychosis further complicate treatment outcomes. These findings underscore the importance of personalized treatment strategies, preoperative assessments, and ongoing patient education to minimize adverse effects and optimize the therapeutic potential of DBS.

Comparative analysis of functional outcomes in arthroscopic repair for traumatic and non-traumatic rotator cuff injuries

BackgroundThe impact of the etiology of rotator cuff injury (RCI) on outcomes after rotator cuff repair remains unclear. This study aimed to evaluate the postoperative outcomes of patients with RCIs of different etiologies and identify the risk factors affecting prognosis.MethodsThis study included 73 patients with RCI who underwent arthroscopic rotator cuff repair. The patients were categorized into either a traumatic group or a non-traumatic group based on their history of trauma. Preoperative and postoperative assessments included shoulder range of motion, muscle strength, and physical examination findings specific to the shoulder for both groups. Clinical differences between arthroscopic repair of traumatic and non-traumatic RCIs were evaluated using univariate analysis. Logistic regression analysis determined independent risk factors for rotator cuff repair prognosis.ResultsAmong the 73 patients, 31 were in the traumatic group and 42 in the non-traumatic group, with a minimum postoperative follow-up of 12 months and a mean follow-up of 13.8 months. The duration of the disease was significantly longer in the non-traumatic group compared with the traumatic group (P < 0.001). The mean tear area was more significant in the traumatic group than in the non-traumatic group (P = 0.003), and the preoperative pain level and functional scores were better in the non-traumatic group compared with the traumatic group. Postoperatively, there were no differences between the two groups regarding scores, joint mobility, strength, and complications. At 12 months postoperatively, multivariate regression analysis indicated that full-layer tear (OR = 5.106, 95% CI: 1.137–22.927, P = 0.033), fat infiltration (OR = 6.020, 95% CI: 1.113–32.554, P = 0.037), and tear area (OR = 6.038, 95% CI: 2.122–17.177, P < 0.001) significantly affected the University of California at Los Angeles (UCLA) score.ConclusionCompared with non-traumatic RCI, traumatic RCI presents with more pronounced pain and impaired joint function preoperatively yet demonstrates comparable postoperative clinical outcomes. Full-layer tears, fat infiltration, and large tear areas are unfavorable factors affecting rotator cuff repair, and postoperative rehabilitation management of these patients should be emphasized.

Prevalence and clinical burden of venous thromboembolic events (VTEs) in contemporary total knee arthroplasties (TKAs) in US hospitals

IntroductionTotal knee arthroplasty (TKA) is a highly demanded procedure in orthopedic surgery, with over 1.3 million joint arthroplasties performed annually in the U.S. The increasing need for TKAs is driven by an aging population, rising obesity rates, and advances in surgical techniques. Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), significantly impacts TKA patients' mortality and morbidity. Despite advances in prophylaxis and Enhanced Recovery After Surgery (ERAS) protocols reducing VTE incidence, survival rates have not markedly improved. This study aims to identify preoperative predictors of PE and DVT in TKA patients and examine their impact on hospital stays and mortality. MethodsA retrospective observational study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, focusing on 367,365 TKA patients from 2016 to 2021. Preoperative variables, including demographic factors, comorbidities, and functional status, were analyzed. Primary endpoints were PE and DVT predictors; secondary endpoints included 30-day mortality and prolonged hospital stay. Univariate and logistic regression analyses were performed using SPSS version 26. ResultsUnivariate analysis revealed significant associations of male gender, older age, Hispanic ethnicity, smoking, dyspnea, CHF, and COPD with DVT and PE. Multivariate analysis confirmed female sex, younger age, Hispanic ethnicity, and COPD as independent DVT predictors, and independent functional status, smoking, COPD, CHF, and metastatic malignancy as PE predictors. VTE prevalence was 1.09 % (0.67 % DVT, 0.42 % PE), with PE associated with higher mortality (0.78 %) and prolonged hospital stays. ConclusionDemographic and clinical variables significantly influence VTE risk post-TKA. Tailored interventions and comprehensive preoperative assessments are crucial for optimizing patient outcomes and reducing thrombotic risks.

Assessing the Risk of Postoperative Delirium Through Comprehensive Geriatric Assessment and Eastern Cooperative Oncology Group Performance Status of Elderly Patients With Gastric Cancer.

Postoperative delirium is especially common and often problematic among elderly patients undergoing surgery. This study aimed to explore factors that can predict postoperative delirium in elderly patients undergoing gastric cancer surgery. This cohort study included 255 patients age 75 years or older who underwent gastric cancer surgery between July 2010 and December 2020. All the patients underwent preoperative comprehensive geriatric assessment (CGA) evaluation by a geriatrician. In addition to the CGA items, this study investigated the association between postoperative delirium and clinicopathologic factors, including Eastern Cooperative Oncology Group performance status (ECOG-PS). The most common postoperative complication was delirium, present in 31 patients (12.2%). The group with delirium was significantly more likely to have ECOG-PS≥2, diabetes mellitus, cardiovascular disease, or cerebral infarction. The CGA showed frailty in the Instrumental Activities of Daily Living scale (IADL), the Mini-Mental State Examination (MMSE), the Vitality Index (VI), and the Geriatric Depression Scale 15 (GDS-15). In the multivariate analysis, the independent risk factors for delirium were ECOG-PS ≥2 (P=0.002) and MMSE-frailty (P<0.001). Using an MMSE score of ≤23 and an ECOG-PS score of ≥2 as cutoffs, postoperative delirium was predicted with a sensitivity of 80.7% and a specificity of 74.1%. Postoperative delirium might be more easily predicted based on the combination of MMSE and ECOG-PS for elderly patients with gastric cancer undergoing gastrectomy.

Perioperative management and fast track in knee arthroplasty

Knee arthroplasty is an established surgical treatment for advanced osteoarthritis of the knee. In view of the rising number of surgical procedures, increasing costs in the healthcare system with aparallel increase in patient age and comorbidities, an evidence-based perioperative management is gaining importance. Fast Recovery concepts comprise arange of evidence-based strategies for optimizing the perioperative course. By reducing perioperative risks and optimizing pre-, peri- and postoperative processes, complications can be reduced, as well as perioperative morbidity, while comprising faster convalescence. This review is based on asystematic literature search in the PubMed, Cochrane Library and Web of Science databases on the topic of perioperative optimization and evidence for Fast Recovery programs in knee resurfacing. In knee arthroplasty, Fast Recovery protocols lead to asignificant reduction in the length of stay in hospital without an increase in complication rates. Patients also benefit from afaster return to mobility and areduced level of postoperative pain. The involvement of multidisciplinary teams, the optimization of pain therapy, the minimization of blood loss and early mobilization are key elements of these protocols. The implementation of Fast Recovery protocols in the perioperative care of patients is an effective strategy to improve surgical outcomes. Essential for the success of such programs is individualized multidisciplinary patient care with preoperative risk assessment, optimized pain management and early physiotherapeutic mobilization. Future research should focus on the long-term effects of these approaches and their adaptation to different patient populations.

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Association of computed tomography-derived body composition and complications after colorectal cancer surgery: A systematic review and meta-analysis.

The prediction of the risk of developing complications after colorectal surgery for colorectal carcinoma remains imprecise. Body composition measurements on a computed tomography (CT) scan can potentially contribute to a better preoperative risk assessment. The aim of this systematic review is to evaluate the evidence for the use of body composition measurements on CT scans to predict short-term complications after colorectal cancer surgery. A literature search (in PubMed, Embase and Web of Science) was performed up to 1 August 2022. Two researchers independently screened the articles, extracted data and assessed the quality of the studies using the Quality in Prognosis Studies tool. The primary outcome measure was the occurrence of complications within 30days after surgery. Meta-analysis was conducted using a random-effects model to synthesize a pooled odds ratio (OR). The study protocol was registered in PROSPERO (CRD42021281010). Forty-five articles with a total of 16537 patients were included. In total, 26 body composition measures were investigated: 8 muscle-related measures, 11 adipose tissue measures, 4 combined muscle and adipose tissue measures, and 3 other measures. These were investigated as potential predictors for more than 50 differently defined postoperative complications. Meta-analysis was only possible for two measurements and showed that higher amounts of visceral fat increase the risk of developing overall complications (OR: 2.52 [1.58-4.00], P<0.0001) and anastomotic leakage (OR: 1.76 [1.17-2.65], P=0.006). A wide variety of body composition measurements on preoperative CT scans have been investigated as a predictive factor for postoperative complications. Visceral fat appeared to be associated with overall complications and anastomotic leakage; however, the association is weak, and its clinical relevance or applicability is questionable. The current evidence is limited by methodological heterogeneity and the risk of bias. To improve comparability of results across studies and improve decision-making, future studies should use standardized methods for measuring body composition on CT scans, outcome definitions and statistical analyses.

8760 Does an Increased Size of Thyroid Nodules Correlate with a Higher Probability of Intermediate or High-Risk Histopathological Features for Recurrence?

Abstract Disclosure: R. Pishdad: None. N. Yousefzadeh: None. E. Gough: None. L. Rooper: None. J.S. Mammen: None. Does an increased size of thyroid nodules correlate with a higher probability of intermediate or high-risk histopathological features for recurrence? Background: The existing practice guidelines recommend total thyroidectomy for solitary nodules exceeding 4 cm regardless of other pre-operative findings. We hypothesize that through comprehensive pre-operative assessments, particularly including a thorough neck ultrasound, even nodules exceeding 4 cm that would otherwise meet ATA criteria for lobectomy (i.e., lacking extrathyroidal extension and suspicious lymphadenopathy) will not exhibit occult high-risk features at a higher rate compared to nodules measuring 1-4 cm. Consequently, these larger nodules would not necessitate a higher rate of completion thyroidectomy. Methods: Solitary thyroid nodules with a largest dimension ≥ 1 cm and operated on at a single institution between 2005 to 2023 were assessed to identify those that would have met ATA criteria for lobectomy. Surgical pathology reports were reviewed to perform risk stratification following ATA guidelines. Preoperative cytopathology, ultrasound characteristics, and patient demographics were considered as covariables. Statistical analyses were performed with R programming language. Simple logistic regression and multivariable logistic regression were performed to analyze the finding of occult intermediate or high-risk features based on size. Results: We identified 461 cases of solitary nodules without extrathyroidal extension or lymph node involvement (406 nodules 1-4 cm; 60 nodules ≥ 4 cm). Patients with larger nodules were more likely to be male than those with smaller nodules (52% versus 26%; P value &amp;lt;0.001). Interestingly, while the majority of smaller nodules meeting criteria for lobectomy were suspicious or malignant by cytopathology (Bethesda 5 and 6), only 20% of larger nodules that met criteria were malignant, with 68% either Bethesda 3 or 4 (p&amp;lt;0.001). There were no statistically significant associations between size or other variables such as age, race, sex, or positive family history and post-operatively assessed high/intermediate risk for recurrence. Conclusion: In this analysis of solitary nodules with larger sizes, the dimension itself did not emerge as a risk factor for occult intermediate or high-risk surgical pathology. Thus, the rates of completion thyroidectomy in appropriately screened patients would be acceptable even in patients with nodules greater than 4 cm. The majority of larger nodules that fulfill preoperative ATA criteria for lobectomy were assessed to be ACUS or a follicular neoplasm on pre-operative fine-needle aspiration. This suggests that the higher risk of more aggressive disease previously reported with larger nodules can be detected during preoperative assessment, emphasizing the essential role of neck US in the comprehensive evaluation of larger nodules. Presentation: 6/2/2024

7094 Post Unilateral Adrenalectomy Hyporeninemic Hypoaldosteronism: Requiring Long Term Fludrocortisone In Managing Hyperkalemia And Renal Dysfunction

Abstract Disclosure: R. Rani: None. K. Bidani: None. R. Roy: None. Adrenalectomy, seen as a potentially curative measure for unilateral aldosterone-producing adenoma (APA), targets both biochemical and clinical resolution. However, postoperative challenges may arise, including acute renal failure and hyperkalemia, due to inadequate aldosterone secretion, a consequence of prolonged suppression of the renin-angiotensin-aldosterone system (RAAS) on the contralateral side. Our case underscores the postoperative challenge of isolated aldosterone deficiency leading to renal function deterioration and hyperkalemia, necessitating fludrocortisone therapy. We are presenting case of 71-year-old male with a history of uncontrolled hypertension for over 30 years with hypokalemia (taking KCL 20mEq daily). Initial laboratory findings revealed elevated aldosterone levels 79ng/dL and an aldosterone-to-renin ratio (ARR)&amp;gt; 20, K- 3.2mmol/L, creatinine 1.32mg/dl, Na-145 mmol/L with normal cortisol and plasma metanephrines levels. CT abdomen disclosed a 21 x 18 mm right adrenal adenoma, with subsequent confirmation of lateralization through Adrenal vein sampling. The patient underwent right adrenalectomy. Two weeks post-surgery, he presented to the emergency department with symptoms of fatigue and weakness. Laboratory results indicated hyperkalemia (K- 6.5 mmol/L) and elevated creatinine (3.52mg/dl) with undetectable aldosterone and renin levels. Urinalysis and CT abdomen ruled out other causes of acute renal injury. Initial management included intravenous fluids and Potassium supplementation. However, due to persistent hypokalemia, the patient was initiated on fludrocortisone (0.1 mcg daily). Subsequent follow-up demonstrated improvement in renal function and potassium levels, however, his aldosterone and renin levels remain undetectable. Hyperkalemia incidence post-adrenalectomy in primary aldosteronism (PA) ranges from 6.3% to 29.1%. Notably, older age and preexisting impaired renal function, particularly in cases with prolonged hypertension are identified as potential risk factors for postoperative hyperkalemia and renal failure. Understanding the potential for a further decline in the glomerular filtration rate (GFR) post-surgery becomes crucial. This decline might manifest as a transient or permanent issue, necessitating prolonged fludrocortisone treatment. This case highlights the importance of tailored preoperative assessment and postoperative management to mitigate complications in high-risk populations. Presentation: 6/1/2024

"Cancer Integrin" α v β 6 Imaging With 68 Ga-Trivehexin PET/CT in Assessment of Ovarian Carcinoma.

Peritoneal cancer index is an integral parameter for preoperative assessment of peritoneal disease. Current imaging modalities including 18 F-FDG PET/CT, though superior to CT, underestimate the disease extent, mainly due to its high physiological background activity. Novel "cancer integrin" targeting imaging with 68 Ga-trivehexin demonstrates limited physiological activity in the abdomen with superior target-to-background ratio than 18 F-FDG PET/CT. Thus, we describe the first case demonstrating potential utility of novel "cancer integrin" αvβ6 imaging agent 68 Ga-trivehexin for assessment of disease burden in advanced epithelial ovarian cancer.