Preoperative CT Scan Research Articles

Quantification of hemi-hepatic ischemia using real-time multispectral oxygenation imaging with single snapshot imaging of optical properties (SSOP).

Identifying liver ischemia is crucial in liver surgery. This study aimed to develop a hemi-hepatic ischemia model for assessing liver ischemia using single snapshot imaging of optical properties (SSOP), a noninvasive optical imaging modality that provides real-time measurements of tissue oxygen saturation (StO2). Twelve swine were randomly assigned to two groups: One undergoing total vascular inflow occlusion (TVIO) and the other undergoing hepatic artery occlusion (HAO). Preoperative 3D CT scans were used to locate the left-sided hepatic arteries and portal veins, which were clamped during surgery. Real-time SSOP imaging was conducted to measure StO2 in three lobes-the left lateral lobe (LL), left medial lobe (LM), and right medial lobe (RM)-as well as capillary lactate levels and Doppler blood flow. Measurements were recorded at baseline (T0), during ischemia (T1, 30min after clamping), and during reperfusion (T2, 30min after declamping). In the TVIO group, SSOP imaging revealed a distinct demarcation line on the liver surface. StO2 levels measured by SSOP significantly decreased from T0 to T1, dropping by 29.8% in the LL (46.0 ± 5.1 vs. 16.2 ± 5.1%, p = 0.011) and 36.3% in the LM (42.7 ± 5.9 vs. 6.4 ± 4.0%, p = 0.001). Additionally, capillary lactate levels increased substantially in the LL (1.3 ± 0.4 vs. 8.5 ± 2.4mmol/L, p = 0.041) and in the LM (1.3 ± 0.4 vs. 8.2 ± 2.1mmol/L, p = 0.021). In contrast, the HAO group showed a less pronounced reduction in StO2: 13.6% in the LL (32.7 ± 6.4 vs. 19.1 ± 5.4%, p = 0.007) and 19.8% in the LM (35.3 ± 8.2 vs. 15.5 ± 5.8%, p = 0.011), with no significant increase in capillary lactate levels. An inverse correlation was found between StO2 and capillary lactate levels (r = -0.76, p < 0.001). SSOP is a real-time, contrast-free imaging technique that effectively evaluates liver ischemia by accurately measuring tissue oxygenation, as validated by perfusion biomarkers.

Multimodal multiphasic pre-operative image-based deep-learning predicts hepatocellular carcinoma outcomes after curative surgery.

Hepatocellular carcinoma (HCC) recurrence frequently occurs after curative surgery. Histological microvascular-invasion (MVI) predicts recurrence but cannot provide pre-operative prognostication, whereas clinical prediction scores have variable performances. Recurr-NET, a multimodal multiphasic residual-network random survival forest deep-learning model incorporating pre-operative CT and clinical parameters, was developed to predict HCC recurrence. Pre-operative triphasic CT scans were retrieved from patients with resected histology-confirmed HCC from four centers in Hong Kong (Internal-cohort). The internal-cohort was randomly divided in an 8:2 ratio into training and internal-validation. External-testing was performed in an independent cohort from Taiwan. Among 1231 patients (Age 62.4, 83.1% male, 86.8% viral hepatitis, median follow-up 65.1 months), cumulative HCC recurrence at years 2 and 5 were 41.8% and 56.4% respectively. Recurr-NET achieved excellent accuracy in predicting recurrence from years 1-5 (Internal cohort AUROC 0.770-0.857; External AUROC 0.758-0.798), significantly out-performing MVI (Internal AUROC 0.518-0.590; External AUROC 0.557-0.615) and multiple clinical risk scores (ERASL-PRE, ERASL-POST, DFT, and Shim scores) (Internal AUROC 0.523-0.587, External AUROC: 0.524-0.620) respectively (all p<0.001). Recurr-NET was superior to MVI in stratifying recurrence risks at year 2 (Internal: 72.5% vs. 50.0% in MVI; External: 65.3% vs. 46.6% in MVI) and year 5 (Internal: 86.4% vs. 62.5% in MVI; External: 81.4% vs. 63.8% in MVI) (all p<0.001). Recurr-NET was also superior to MVI in stratifying liver-related and all-cause mortality (all p<0.001). The performance of Recurr-NET remained robust in subgroup analyses. Recurr-NET accurately predicted HCC recurrence, out-performing MVI and clinical prediction scores respectively, highlighting its potential in pre-operative prognostication.

Prevalence of femoral condyle injuries in the setting of tibial plateau fractures

BackgroundTibial plateau fracture patterns are influenced by the direction and energy of the impact, and the bone quality. Associated articular femoral injuries can result from the same impact but are insufficiently studied. This study quantifies the prevalence of three distinct articular femoral condyle injuries: (1) impaction fractures, (2) contusions, and (3) condyle fractures. For impaction fractures we assessed the depth, width, length, and surface area. MethodsWe retrospectively reviewed patients who had undergone surgery for a tibial plateau fracture in a tertiary trauma center. Two fellowship-trained radiologists analyzed preoperative CT scans for associated femoral condyle injuries. We defined (1) impaction fractures (depressions ≥ 1.5 mm) with a sclerotic band, a fracture line, or both; (2) contusions (depressions < 1.5 mm) with a sclerotic band; and (3) condyle fractures as sub- or osteochondral fractures. ResultsWe identified 149 patients (62 male) with a tibial plateau fracture with a CT scan available. The overall prevalence of articular femoral condyle injuries was 26% (n = 39). The prevalence of impaction fractures was 9.4% (n = 14), of contusions 14% (n = 21), and of condylar fractures 3.0% (n = 4). Factors associated with a higher prevalence of femoral condyle injury were younger age (p = 0.029), male sex (p = 0.014), and absence of comorbidity (p = 0.005). The mean depth of impaction fractures was 2.3 mm (SD: 0.78; range 1.6 to 4). ConclusionConcomitant articular femoral condyle injuries occur in one out of four patients with a tibial plateau fracture. Although most femoral injuries were subtle, and none underwent surgical treatment, they might harbor information regarding the likelihood of future joint degeneration and knee instability.Level of evidence: IV.

Intraoperative Surgical Guidance for DIEP Flap Harvest using Augmented Reality

SUMMARY: Augmented reality (AR) systems for surgical navigation provides the capability to project preoperative CT scans and segmented anatomical structures directly into the surgeon’s field of view, along with virtual displays akin to traditional monitors. Utilizing the Meta Quest 3 consumer AR headset, we found that it can achieve clinically acceptable accuracy in surgical navigation for deep inferior epigastric perforator (DIEP) surgeries. Notably, the Quest 3 can operate independently thanks to a novel registration technique employing hand tracking, suitable for use in sterile environments. The DIEP flap is a widely favored option for autologous breast reconstructions. Intraoperatively, the perforator arteries are selected to maximize tissue perfusion and minimize donor site morbidity. Conventionally, preoperative CT angiograms are used to locate perforators and visualize vessel courses, thus reducing DIEP flap harvest time and complication rates. Though, there are currently very limited means to reliably translate information found on preoperative imaging for use in the operating theater. The Meta Quest 3 was trialed in three DIEP flap surgeries by displaying segmented deep inferior epigastric arteries and DIEP arteries during preoperative and intraoperative phases of surgery. The AR projections facilitated the visualization of the DIEP arteries and efficient pedicle dissection by guiding the placement and length of the fascial incision. Furthermore, this work supports the hypothesis that AR will improve flap design, reduce harvest time, and improve safety during DIEP flap harvesting.

BN SO42 - Our experience of Emergency Laparoscopic Fundoplication in a DGH

Abstract Background Emergency presentation of hiatal hernias can be life-threatening and is associated with high morbidity and mortality rates. Elective Laparoscopic hiatus and paraoesophageal hernias are commonly performed with fundoplication. However, emergency cases are often repaired without an anti-reflux procedure. We present our experience of emergency Laparoscopic Hiatus/ Paraoesophageal hernia repair with fundoplication in a District General Hospital (Russells Hall Hospital, RHH). Method 6 cases of diagnosed hiatus/ paraoesophageal hernia that underwent Emergency fundoplication from 2019-2024. Results The mean age of the patients was 74 (56-83). All patients had a pre-op CT scan to confirm the diagnosis. 4 patients (66%) had a Type 3 Hiatus hernia and 2 (33%) had a Type 2 classic paraosephageal hernia. All patients underwent Emergency Laparoscopic Hiatus / Para oesophagal hernia repair with fundoplication. 2 patients required mesh for the repair. The mean length of stay was 5 days (3-7). There were no intra or post-op complications and on follow up 1 patient had a recurrence of symptoms after 1 year requiring redo fundoplication. Conclusion The choice of operation is mainly based on the patient’s clinical condition, the complexity of the hernia and the surgeon’s experience. Our experience at RHH shows that Laparoscopic Hiatus/ Paraoesophageal hernia repair with fundoplication is safe and feasible in patients with emergency presentation.

Are asymmetric designs of tibial components superior to their symmetric counterparts for constrained condylar total knee arthroplasty using metal block augmentation?

PurposeIn total knee arthroplasty (TKA), asymmetric tibial components have been developed alongside symmetric tibial components to enhance bony coverage at the tibia. In primary TKA and revision TKA for patients with significant bone defects, augmentation is employed to fill the bone defect. However, there have been no reports on bony coverage of the tibial component of the revision system in the cases of bone defects. Therefore, we simulated bone defects using CT and compared the bony coverage of asymmetric and symmetric tibial components in the revision TKA system.MethodsThis study included 45 patients (50 knees involved) with medial osteoarthritis. Preoperative CT scans were used to simulate placement using ZedKnee. Three models were evaluated: Persona Revision PCCK (Zimmer) for the asymmetric component, NexGen LCCK (Zimmer) for the symmetric component, and the ATTUNE revision system (Depuy-Synthes). A 130-mm stem extension was utilized. Augmentations of each thickness were placed to simulate bone defects of 5, 10, and 15 mm. The coverage, overhang, and underhang rates were measured for each slice and compared among the models.ResultsIn terms of coverage, the rate was greater for PCCK at 0 mm, and only ATTUNE exhibited a significantly lower coverage at 5 and 10 mm. There was no significant difference in coverage at 15 mm. At 0 mm, PCCK demonstrated less posterior underhangs. At 5 and 10 mm, PCCK showed less anterior overhang but more anterior underhang. At 15 mm, PCCK had a less anterior overhang, with an overhang in the posterior region but less underhang. When overhang and underhang were combined and compared, the asymmetric component generally yielded superior results.ConclusionIn the cases of bone defects, asymmetric components demonstrated reduced anterior overhang and decreased posterior underhang, resulting in greater bone coverage. This may contribute to improved long-term outcomes in the revision TKA system.

Evaluation of the Accuracy of 3D Printed Patient-Specific Brain Biopsy Guide Using 3D Volume Rendering Technique in Canine Cadavers.

The objective of this study was to evaluate the accuracy of a CT-based, 3D-printed, patient-specific brain biopsy guide (3D-psBBG) through the application of a transfrontal approach in canine cadavers. A total of ten canine cadavers, with weights ranging from 4.36 to 14.4 kg, were subjected to preoperative CT scans to generate 3D skull models. Customized biopsy guides were created based on these models and manufactured using 3D printing technology. Twenty spinal needle insertions were performed, and the accuracy of needle placement was evaluated through both CT and 3D volume-rendering techniques. The mean needle placement error was 2.1 mm, with no significant differences observed between insertions targeting the fronto-olfactory and piriform lobes. The 3D volume-rendering method demonstrated superior accuracy compared to the CT method, with statistically significant differences in placement errors for both targets. The average time required for the design and manufacture of the guides was 249 min. These findings indicate the high accuracy and potential clinical application of CT-based 3D-psBBG for improving diagnostic outcomes in veterinary neurology.

The Correlation Between the Natural Course, Pathologic Properties With Ki-67 Expression in Lung Adenocarcinoma Presenting as Ground-Glass Nodules.

With the increasing use of lung cancer screening, the detection of ground glass nodules (GGNs) has risen. However, the natural course of GGNs and their relationship to pathologic features remains unclear. Differentiating between invasive and pre-invasive lesions based on GGN growth may improve clinical intervention timing. Ki-67, a proliferation marker, holds value in assessing tumor malignancy. This study analyzes the association between GGN growth, pathology, and Ki-67 expression to provide new insights into early-stage lung cancer management. We retrospectively evaluated 183 GGNs with at least two preoperative CT scans. Nodule location, type, natural course, and volume doubling time (VDT) were compared between invasive adenocarcinoma (IAC) and pre-IAC groups. We also assessed differences in Ki-67 expression and correlated VDT with Ki-67 levels. A total of 183 nodules were finally included; gender, nodule location, smoking history, and duration of follow-up did not differ between the IAC group and the pre-IAC group, whereas age was statistically different between the two groups. Of the 183 nodules, 52 showed growth and the predominant pathologic type was IAC, these IACs showed more PSN in nodule type, while the IAC group showed more significant differences in nodule type, nodules growth, and VDT than the pre-IAC group. There were also differences in pathologic type and VDT between different Ki-67 expression groups, and Ki-67 expression gradually increased as VDT decreased. Lung adenocarcinoma (LUAD) presenting as GGNs exhibit distinct natural courses among pathologic subtypes. VDT effectively distinguishes these growth characteristics, with IACs showing shorter VDT. The significant correlation between VDT and Ki-67 expression suggests that combining these parameters may provide valuable insights into the biological behavior and invasiveness of LUAD.

Preoperative prediction of post hepatectomy liver failure after surgery for hepatocellular carcinoma on CT-scan by machine learning and radiomics analyses.

No instruments are available to predict preoperatively the risk of posthepatectomy liver failure (PHLF) in HCC patients. The aim was to predict the occurrence of PHLF preoperatively by radiomics and clinical data through machine-learning algorithms. Clinical data and 3-phases CT scans were retrospectively collected among 13 Italian centres between 2008 and 2022. Radiomics features were extracted in the non-tumoral liver area. Data were split between training(70%) and test(30%) sets. An oversampling was run(ADASYN) in the training set. Random-Forest(RF), extreme gradient boosting (XGB) and support vector machine (SVM) models were fitted to predict PHLF. Final evaluation of the metrics was run in the test set. The best models were included in an averaging ensemble model (AEM). Five-hundred consecutive preoperative CT scans were collected with the relative clinical data. Of them, 17 (3.4%) experienced a PHLF. Two-hundred sixteen radiomics features per patient were extracted. PCA selected 19 dimensions explaining >75% of the variance. Associated clinical variables were: size, macrovascular invasion, cirrhosis, major resection and MELD score. Data were split in training cohort (70%, n=351) and a test cohort (30%, n=149). The RF model obtained an AUC=89.1%(Spec.=70.1%, Sens.=100%, accuracy=71.1%, PPV=10.4%, NPV=100%). The XGB model showed an AUC=89.4%(Spec.=100%, Sens.=20.0%, Accuracy=97.3%, PPV=20%, NPV=97.3%). The AEM combined the XGB and RF model, obtaining an AUC=90.1%(Spec.=89.5%, Sens.=80.0%, accuracy=89.2%, PPV=21.0%, NPV=99.2%). The AEM obtained the best results in terms of discrimination and true positive identification. This could lead to better define patients fit or unfit for liver resection.

The patient had a history of tuberculosis. The preoperative CT scan revealed atelectasis in the middle and lower lobes of the right lung. No obvious abnormalities were found in other lung lobes.

The patient had a history of tuberculosis. The preoperative CT scan revealed atelectasis in the middle and lower lobes of the right lung. No obvious abnormalities were found in other lung lobes.

Feasibility of augmented reality using dental arch-based registration applied to navigation in mandibular distraction osteogenesis: a phantom experiment

ObjectiveDistraction osteogenesis is a primary treatment for severe mandibular hypoplasia. Achieving the ideal mandible movement direction through precise distraction vector control is still a challenge in this surgery. Therefore, the aim of this study was to apply Optical See-Through (OST) Augmented Reality (AR) technology for intraoperative navigation during mandibular distractor installation and analyze the feasibility to evaluate the effectiveness of AR in a phantom experiment.MethodsPhantom was made of 3D-printed mandibular models based on preoperative CT scans and dental arch scans of real patients. Ten sets of 3D-printed mandible models were included in this study, with each set consisting of two identical mandible models assigned to the AR group and free-hand group. 10 sets of mandibular distraction osteogenesis surgical plans were designed using software, and the same set of plans was shared between the AR and free-hand groups. Surgeons performed bilateral mandibular distraction osteogenesis tasks under the guidance of AR navigation, or the reference of the preoperative surgical plan displayed on the computer screen. The differences in angular errors of distraction vectors and the distance errors of distractor positions under the guidance of the two methods were analyzed and compared.Results40 distractors were implanted in both groups, with 20 cases in each. In intra-group comparisons between the left and right sides, the AR group exhibited a three-dimensional spatial angle error of 1.88 (0.59, 2.48) on the left and 2.71 (1.33, 3.55) on the right, with P = 0.085, indicating no significant bias in guiding surgery on both sides of the mandible. In comparisons between the AR group and the traditional free-hand (FH) group, the average angle error was 1.94 (1.30, 2.93) in the AR group and 5.06 (3.61, 9.22) in the free-hand group, with P < 0.0001, resulting in a 61.6% improvement in accuracy. The average displacement error was 1.53 ± 0.54 mm in the AR group and 3.56 ± 1.89 mm in the free-hand group, with P < 0.0001, indicating a 57% improvement in accuracy.ConclusionAugmented Reality technology for intraoperative navigation in mandibular distraction osteogenesis is accurate and feasible. A large randomized controlled trial with long-term follow-up is needed to confirm these findings.Trial RegistrationThe project has been registered with the Chinese Clinical Trial Registry, with registration number ChiCTR2300068417. Date of Registration: 17 February 2023.

Radiographic Measurements of Pes Planovalgus Do Not Predict Clinical Outcomes in Tarsal Coalition Excision.

Many patients who undergo tarsal coalition excision have persistent postoperative pain. Most studies have utilized cat scan (CT) scan parameters of pes planovalgus and heel valgus but have found this to be an inconsistent predictor of outcomes. Plain radiographic parameters have been less utilized in trying to predict outcomes after coalition excision. Radiographic talonavicular coverage angle correlates with pain in patients with flexible pes planovalgus (PPV) but has not been studied in tarsal coalition population. Furthermore, foot alignment is not understood to change after simple coalition excision. The purpose of this study was to compare plain radiographic parameters, including talonavicular coverage angle, with pain after tarsal coalition excision, as well as compare preoperative and postoperative weight-bearing radiographs. Seventy-seven feet that underwent excision of the tarsal coalition had clinical outcomes and radiographic data collected >1 year postoperatively. Measures of PPV on preoperative and postoperative weight-bearing radiographs and CT scans were evaluated. Patients were an average of 13 years old at excision. Of the total, 65% had calcaneonavicular (CN) coalitions, whereas the remainder had talocalcaneal coalitions. All patients had significant postoperative improvement in clinical outcomes but 34% (13/38) had continued pain at the most recent follow-up, more so in talocalcaneal than CN coalitions (55% vs 26%, P < 0.001). The subset with CN coalitions had more severe preoperative PPV but greater postoperative PPV improvement. Except for a weak correlation between radiographic weight-bearing (anterior-posterior) talus-first metatarsal angle and pain with activity (r = -0.54), there were no other correlations between preoperative radiographic parameters and clinical outcomes. Heel valgus on CT did not correlate with radiographic measurements of PPV or pain. We did not find a correlation of radiographic PPV with persistent pain after tarsal coalition excision. We did find improvement in radiographic PPV in CN coalitions after treatment with simple excision. Heel valgus on CT was not a useful metric for evaluating PPV in the setting of a tarsal coalition. Level III-prognostic study.

Endoscopic Posterior Cervical Craniolateral Inclinatory Foraminotomy

Study Design: Case series. Objective: Endoscopic posterior cervical foraminotomy gains attention for cervical radiculopathy due to its feasibility, better outcomes, and lower complications than traditional approaches, enabling efficient multilevel decompression in a single operation while avoiding anterior cervical diskectomy and fusion–related issues. However, with multilevel decompression, the remnant lamina becomes thin and fragile. We propose craniolateral inclinatory foraminotomy to minimize bone removal during laminotomy, reducing the risk of iatrogenic or postoperative lamina fractures in tandem decompression. Materials and Methods: From 2021 to 2022, 8 consecutive patients underwent the procedure and were followed up for at least 6 months. The VAS, NDI, and MacNab scores were recorded for clinical recovery and patient satisfaction evaluations. Preoperative and postoperative CT scans were utilized to measure the lamina preservation percentage at each level. Results: The clinical outcomes improved significantly in every patient. No postoperative neck pain, segmental instability, or lamina fracture were observed. The mean lamina preservation percentages of C5, C6, C7, and all vertebrae were 68.8%, 73.22%, 71.86%, and 72.18%, respectively. Conclusions: Ongoing technical adjustments will accompany endoscopic technique development to decrease complications and enhance benefits. Our reported technique avoids extensive laminotomy in multilevel tandem decompression, aiming to prevent lamina fractures and anticipate a reduction in postoperative neck pain. Level of Evidence: Level IV.

CT imaging analysis of the C7 pedicle and lateral mass in children aged 0–14 years

Background and objectiveThere is currently a lack of anatomical research on the C7 pedicle and lateral mass in children aged 0–14 years, and experience with pediatric lower cervical spine surgeries remains limited. This study aims to investigate the anatomical structure of the C7 pedicle and lateral mass in a large pediatric sample to understand their growth patterns, providing imaging and anatomical references for pediatric lower cervical spine surgeries and the design of pediatric C7 screws. MethodsWe measured 12 parameters, including the width, length, height, and angles of the C7 pedicle and lateral mass in children aged 0–14 years. The t-test was used to analyze bilateral and gender differences, and least squares regression was applied for curve fitting analysis. ResultsThe size parameters of the C7 pedicle and lateral mass generally increased with age, while angular parameters fluctuated within specific ranges. The average values for each parameter between ages 0–14 were as follows: D1: 2.78–5.28 mm, D2: 18.15–30.54 mm, D3: 2.44–6.01 mm, angle A: 38.05–44.48°; D4: 6.81–10.94 mm, D5: 5.37–11.23 mm, D6: 8.07–13.28 mm, D7: 1.94–4.88 mm, D8: 5.67–9.39 mm, angle C: 18.50–28.80°, angle D: 43.23–52.01°, angle E: 33.74–44.96°. Bilateral analysis showed no significant differences for most parameters across most age groups, with differences mainly observed in angle A, angle C, D6, and D8. Gender differences were primarily noted in length parameters across different age groups, especially in the 3–4, 6–7, 9–11, and 13–14 age groups. Regression analysis indicated that most parameters followed cubic function curves, while a few followed power or quadratic function curves. ConclusionThis study provides detailed CT imaging anatomy of the C7 pedicle and lateral mass in children aged 0–14 years. Preoperative thin-slice CT scans and careful measurements of key parameters are essential for pediatric lower cervical spine surgeries. The findings offer valuable imaging and anatomical references for pediatric posterior cervical fixation surgery and screw design.

Revisiting the Surgical Outcomes of Non-Acute Subdural Hematomas among Retired Military Personnel : A Single Tertiary Hospital Retrospective Analysis in the Philippines.

Subdural hematomas (SDH) are classified clinically and/or radiologically as acute (ASDH), subacute (SSDH) and chronic (CSDH). The management differ depending on their classification, with only the ASDH having a definite accepted surgical guideline. Non-acute SDH, specifically SSDH and CSDH have no clear surgical guidelines but are managed similarly in some literature. This study was conducted to determine if there is a difference in outcomes among surgically managed non-acute SDH in a specific elderly population of retired military personnel. This is a pre-pandemic retrospective study that utilized data obtained from January 2016 to April 2019, in a subspecialty tertiary hospital that caters to retired military personnel or veterans, in the Philippines. After chart review and application of inclusion and exclusion criteria, twenty-one patients were included, all military retirees, with age 56 years old and above. Chart review and electronic database were retrieved to extract relevant information. In this study, a term 'mixed-type subdural hematoma' (MSDH) was proposed to encompass SDH that have mixed hypo-and-hyperdensity on preoperative CT scan and were subsequently found to have bright red liquefied hematoma instead of the classic engine machinery oil fluid found in a CSDH. Based on the observed cohort, 9 out of 11 CSDH patients attained the Glasgow Outcome Scale Extended (GOS-E) score of 8 while all the respondents in the MSDH group attained the same GOS-E score underscoring the need for early intervention in patients with non-acute subdural hematoma. Moreover, the outcomes of both MSDH and CSDH are comparable with low mortality rate (~9.5%) and immediate postoperative improvement (~90%). MSDH and CSDH, although classified separately using clinical and/or radiologic means, can collectively be categorized as a non-acute SDH and can be managed safely and effectively with burr hole surgery.

Role of preoperative CT imaging in penetrating thoraco-abdominal injuries: A multicenter study of urban trauma centers

IntroductionManagement of penetrating thoracoabdominal (PTA) injuries with signs of hemorrhage have warranted operative intervention but improved imaging capabilities have redefined interventions required. We examined outcomes of hemodynamically stable patients undergoing preoperative CT imaging with the hypothesis that CT imaging would decrease OR time without delaying OR arrival. MethodsA retrospective multicenter study was performed amongst four urban trauma centers examining hemodynamically stable patients with PTA injuries requiring operative intervention from January 2017–December 2021. The primary outcome was OR time. Secondary outcomes included length of stay (LOS), ICU LOS, and mortality. A multivariable logistic regression with random intercept for trauma center was fit to assess whether preoperative CT affected time in the OR. ResultsOf 534 hemodynamically stable patients with penetrating injuries, 322 (60.3 ​%) received preoperative CT. The median time in OR were 130 (IQR: 84,180) and 140 (IQR: 100, 180) minutes for patients with and without preoperative CT, respectively. Median time to OR was 68 (IQR: 47, 110) and 26 (IQR 17,38) minutes in patients with and without preop CT, respectively. Median ICU LOS were 0 vs 1 day, the median hospital LOS were 7 vs 8 days for patients with and without pre-op imaging respectively. The multivariable model showed that obtaining a pre-op CT scanning was not independently associated with time spent in OR. (Adjusted OR:0.94; 95 ​% CI: 0.85, 1.04). ConclusionIn patients with PTA injuries and hemodynamic stability, preoperative CT scanning was not associated with decreased OR time, postoperative complications, or mortality.

Comparative analysis of clinical outcomes of talocalcaneal coalition resection: subtalar joint middle and posterior facet involvement versus isolated posterior facet involvement – a retrospective cohort study

BackgroundDespite coalition resection being the preferred treatment for talocalcaneal coalition (TCC), postoperative complications, suboptimal functional recovery, and recurrence risks remain challenges. Although current TCC classification systems guide personalized surgical plans, the impact of middle and posterior facet coalitions on TCC resection surgery’s effectiveness is still poorly understood. Therefore, this study aims to compare the clinical outcomes of TCC patients with and without involvement of the subtalar joint’s (STJ) middle and posterior facets undergoing coalition resection to explore the potential impact of these coalitions on surgical outcomes.MethodsWe conducted a retrospective study on 115 patients who underwent coalition resection surgery due to symptomatic TCC between November 2009 and February 2023. According to preoperative CT scan results, patients were divided into an isolated posterior facet coalition (P-type) group and a middle-posterior facet coalition (MP-type) group. Demographic characteristics (including age, sex, body mass index (BMI), follow-up time, and medical history duration), pre-and postoperative assessments (including Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Pain Interference (PI) and Physical Function (PF) scores from the Patient-Reported Outcomes Measurement Information System (PROMIS)), as well as postoperative self-assessment of efficacy (excellent, good, fair, poor) and hindfoot stiffness, were compared between the two groups. Postoperatively, TCC recurrence was evaluated through imaging follow-up examinations.Results69 patients meeting the inclusion criteria were included, with 30 patients in the P-type group and 39 in the MP-type group. There were no statistically significant differences between the two groups in demographic characteristics (P<0.05). There were also no statistically significant differences between the two groups in preoperative VAS score, AOFAS score, PI score, and PF score. However, postoperatively, there were statistically significant differences between the two groups in VAS score (1(1,1.5) vs. 2(1,2), P<0.01), AOFAS score (92.5(87,96.5) vs. 82(69.5,87), P<0.01), PI score (39(39,43) vs. 39(39,51), P = 0.014), PF score (73(61,73) vs. 55(51,73), P = 0.001), fair or poor outcome (4(13%) vs. 14(35.9%), P = 0.034), and hindfoot stiffness (3(10.3%) vs. 16(37.2%), P = 0.011). There was no statistically significant differences in the recurrence rate between the two groups postoperatively (0(0%) vs. 3(7.69%), P = 0.252).ConclusionEven with complete coalition resection during surgery and rehabilitation following standardized protocols, the surgical outcomes in MP-type TCC patients are still inferior to those in P-type patients.

The Association Between Hounsfield Units and Mechanical Failure in ASD Patients.

Retrospective Cohort Study. Low bone mineral density (BMD) is a known risk factor for revision surgery in patients with adult spinal deformity (ASD). Hounsfield units (HUs) on CT scans have been suggested as a proxy for assessing BMD. This study aimed to determine HUs in the lumbar region and their association with mechanical failure in patients undergoing ASD surgery. We included ASD patients undergoing surgery from 2010-2020 with minimum 2-year follow-up. We excluded patients without preoperative CT scans, or a CT scan more than 1year before surgery. Mechanical failure was defined as proximal junctional failure, pseudarthrosis, or implant failure requiring revision surgery. On preoperative CT scans, HUs were measured on 3 axial slices on each vertebra from L1-L5 and, if available, at UIV and UIV + 1. We included 170 patients, mean age 63 (±12) years, with 108 (64%) females, and 13 [IQR 10-16] instrumented levels. Mechanical failure occurred in 27% (n = 46) of patients at 2-year follow-up. Mean lumbar HUs were 146 (±51) in the mechanical failure group and 135 (±52) in those without revision (P = .232). Area under the curve was 0.58 (95% CI: 0.48-0.68), corresponding to no to low discriminatory power in predicting mechanical failure using lumbar HUs. Univariate logistic regression revealed no significant difference between mechanical failure and lumbar HUs (OR = 1.00, 95% CI: 1.00-1.01, P = .239). We found no association between mechanical failure and HUs on preoperative CT scans in ASD patients. Thus, we cannot recommend using HUs to predict mechanical failure in these patients.

Are all robotic technologies created equal? Comparing one of the latest image-free robotic technologies to all other robotic systems for total knee arthroplasty

BackgroundRobotic-assisted technologies have been developed to increase surgical precision and reduce surgical variability in total knee arthroplasty (TKA). Several different robotic systems have been introduced in the last decade for TKA. The DePuy Synthes VELYS™ Robotic-Assisted Solution (VRAS) is an imageless system designed to eliminate the need for preoperative CT scans and is one of the latest entrants in the rapidly evolving field of robotic technology in TKA. This study compared the clinical and economic outcomes associated with VRAS and other robotic-assisted technologies for primary TKA.MethodsA retrospective cohort study using the Premier Healthcare Database included patients who underwent primary TKA with VRAS or other robotic-assisted technologies from January 1, 2022, to April 30, 2023. The primary outcome for the study was hospital follow-up visits (revisits) within 90 days post-TKA. Secondary outcomes included readmission and revision rates within 90 days post-TKA, operating room time, length of stay, discharge status and hospital costs. Cohorts were balanced using propensity score fine stratification, and generalized linear models were constructed to evaluate outcomes.ResultsThis study included 827 VRAS TKA patients and 16,428 TKA patients treated with other robotic-assisted technologies. The 90-day all-cause and knee-related revisit rates were significantly lower for VRAS than for other robotic-assisted technologies (all-cause 13.9% vs. 22.8% and knee-related 2.8% vs. 5.4%, respectively; p value < 0.01). The all-cause and knee-related 90-day readmission rates were also lower for VRAS, although the differences were not statistically significant. The 90-day revision rates were similar for VRAS and other robotic-assisted technologies (0.48% vs. 0.45%), as was the operating room time (138 vs. 137 min). The 90-day knee-related cost for the VRAS cohort was $15,048 compared to $16,867 for other robotic technologies.ConclusionsThis database study demonstrated that early postoperative revisit rates and total cost of care are lower for VRAS than for all other robotic-assisted technologies for TKA, while operating room time and discharge status were similar. These are important findings in ever-evolving healthcare systems that are increasingly cost conscious and cognizant of principles associated with value-based care.

Closed traumatism of the distal pancreas (A case series of 6 patients)

Introduction and importanceThe aim of this retrospective study was to present six cases of trauma to the distal pancreas, highlighting the challenges associated with their diagnosis and management, while underlining their seriousness and the various complications potentially encountered. Our case series highlights individual patient outcomes, demonstrating the diversity of clinical presentations and the importance of customized treatment strategies. Case seriesBetween January 2015 and December 2020, six cases of distal pancreas trauma were identified. In two cases, the diagnosis was made based on emergency abdominal CT scans, while in the other four patients, the diagnosis was made directly intraoperatively, mainly because of the severity of the associated lesions, which necessitated laparotomy for exploration. Clinical discussionOut of 115 cases of closed abdominal trauma, injury to the distal pancreas was identified in 6 patients, (5.2 %), with a mean age of 21 years. Despite the use of abdominal CT scans for all patients, pancreatic trauma was directly diagnosed intraoperatively in 4 cases (67 %). All patients presented with concomitant abdominal injuries (100 %), and 3 patients (50 %) exhibited multiple severe injuries. Additionally, a significant elevation in pancreatic serum markers was observed in 3 patients (50 %). The pancreatic injuries predominantly involved the tail of the pancreas (67 %), while the body was affected in one patient, and the isthmus was completely transected in another.Three of our patients developed a pancreatic fistula (50 %) and two patients (33 %) passed away; the first had severe associated lesions, and the second, despite undergoing several iterative laparotomies, succumbed to postoperative complications following a left pancreatectomy. ConclusionClosed traumatism of the distal pancreas, although rare, is a significant problem. It is often diagnosed during emergency laparotomy but can sometimes be found on preoperative CT scans. When the patient's condition permits, it is highly advisable to undergo a left pancreatectomy. Simple external drainage is reserved for certain specific situations.