Preoperative Hospital Research Articles

Prospective Multicenter Surveillance Study of Surgical Site Infection after Spinal Surgery in Korea : A Preliminary Study.

ObjectiveThis study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following spinal surgery using data from a Korean SSI surveillance system that included diagnoses made by surgeons. MethodsThis was a prospective observational study of patients who underwent spinal surgeries at 42 hospitals in South Korea from January 2017 to December 2017. The procedures included spinal fusion, laminectomy, discectomy, and corpectomy. Univariate and multivariate logistic regression analyses were performed. ResultsOf the 3080 cases included, 30 showed infection, and the overall SSI rate was 1.0% (an incidence of 1.2% in spinal fusion and 0.6% in laminectomy). Deep incisional infections were the most common type of SSIs (46.7%). Gram-positive bacteria caused 80% of the infections, and coagulase-negative staphylococci, including Staphylococcus epidermidis, accounted for 58% of the grampositive bacteria. A longer preoperative hospital stay was significantly associated with the incidence of SSI after both spinal fusion and laminectomy (p=0.013, p<0.001). A combined operation also was associated with SSI after laminectomy (p=0.032). ConclusionAn SSI surveillance system is important for the accurate analysis of SSI. The incidence of SSI after spinal surgery assessed by a national surveillance system was 1.0%. Additional data collection will be needed in future studies to analyze SSI in spinal surgery.

Prospective Multicenter Surveillance Study of Surgical Site Infection after Intracranial Procedures in Korea : A Preliminary Study.

ObjectiveThis study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system. MethodsThis was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt. Univariate and multivariate logistic regression analyses were performed. ResultsOf the 1576 cases included, 30 showed infection, for an overall SSI rate of 1.9%. Organ/space infection was the most common, found in 21 out of the 30 cases (70%). Staphylococcus aureus was the most common (41%) of all bacteria, and Serratia marcescens (12%) was the most common among gram-negative bacteria. In univariate analyses, the p-values for age, preoperative hospital stay duration, and over T-hour were <0.2. In a multivariate analysis of these variables, only preoperative hospital stay was significantly associated with the incidence of SSI (p<0.001), whereas age and over T-hour showed a tendency to increase the risk of SSI (p=0.09 and 0.06). ConclusionSurveillance systems play important roles in the accurate analysis of SSI. The incidence of SSI after neurosurgical procedures assessed by a national surveillance system was 1.9%. Future studies will provide clinically useful results for SSI when data are accumulated.

Risk factors for postoperative infection after gastrointestinal surgery among adult patients with inflammatory bowel disease: Findings from a large observational US cohort study.

Background and AimPostoperative infection (POI) is a major source of morbidity and prolongation of hospitalization in inflammatory bowel disease (IBD) patients. This large observational study was conducted to further describe risk factors and to quantify the proportion of POIs that are preventable.MethodsWe conducted a retrospective cohort analysis of the Optum US health insurance claims database. The study population included adults with ulcerative colitis (UC) or Crohn's disease (CD) who underwent lower gastrointestinal (GI) surgery of small intestine, colon, rectum, or anus during September 2014 to September 2016. Multiple logistic regression was used to identify and quantify risk factors and determine the proportion of infections that are preventable.ResultsA total of 3360 adult IBD patients with lower GI surgery were included in the study. Their mean age was 51 years, 52.5% were women, and 59.5% had CD. The 30‐day POI incidence was 15.1% (95% confidence interval: 14.0–16.4%). We identified the following nonmodifiable or procedural risk factors: history of POI, open procedure, red blood cell transfusion within 6 months, preoperative hospital stay of at least 4 days, lower GI ostomy surgery, lower GI resection surgery, and a history of chronic obstructive pulmonary disease. Modifiable risk factors included corticosteroid use and anemia prior to surgery, but few infections were attributable to these modifiable factors.ConclusionsThis large, observational, real‐world evidence study from the US found that the majority of the observed risk factors were nonmodifiable or procedure‐related. Corticosteroid use and anemia before surgery were identified as modifiable risk factors.

Impact of Post-hospital Syndrome on Penile Prosthesis Outcomes: A Period of Global Health Risk

PurposePost-hospital syndrome is an acquired, transient period of health vulnerability following an inpatient admission. This study aims to assess the impact of a preoperative hospitalization on outcomes following penile prosthesis surgery and to optimize surgical timing following an inpatient admission. Materials and MethodsThe Healthcare Cost and Utilization Project State Inpatient and Ambulatory Databases for California (2007-2011) and Florida (2009-2014) were utilized. Patients were identified as having undergone prosthesis placement by ICD-9 and CPT codes. The primary exposure was post-hospital syndrome, defined as any inpatient admission ≤90 days prior to prosthesis placement. Patients were further categorized by how recently their inpatient hospitalization occurred. The primary outcome was 30 day readmissions. Secondary outcomes included length-of-stay, device complications and postoperative complications. Results16,923 patients who underwent penile prosthesis were identified. Of those, 477 (3%) had a PHS exposure ≤90 days prior to penile prosthesis placement. After risk-adjustment, PHS patients had higher odds of 30 day readmission (OR 3.0 (95% CI 2.2-4.1)), length-of-stay ≥2 days (OR 1.7 (95% CI 1.3-2.3)) and device complications (OR 1.7 (95% CI 1.2-2.5)). Categorizing patients in 30-day intervals, we demonstrated a linear decrease in risk of 30-day readmissions as interval between PHS exposure and prosthesis surgery increased. ConclusionsA post-hospital syndrome exposure is a risk-adjusted predictor of 30-day readmissions, prolonged length-of-stay, and device complication. Medical optimization and delaying surgery can help combat the adverse effects associated with a post-hospital syndrome exposure and may improve surgical outcomes.

Quantifying walking ability in Japanese patients with knee osteoarthritis: Standard values derived from a multicenter study

BackgroundWe aimed to determine useful parameters for quantifying walking ability in patients with knee osteoarthritis. MethodsThis study included 621 Japanese patients with knee osteoarthritis scheduled to undergo total knee arthroplasty at any of 14 participating hospitals. Sex, age, body mass index, osteoarthritis severity (Kellgren–Lawrence grade), laterality, prior contralateral surgery, and pain were analyzed for their influence on walking ability, which was evaluated in terms of the 5-m walk test and the Timed Up and Go test outcomes during preoperative hospitalization. Patients were stratified based on dichotomized values of the independent influencing factors of walking ability, and the standard values for parameters describing walking ability were obtained. ResultsMultiple regression analysis revealed that sex, age, and Kellgren–Lawrence grade were factors influencing walking ability (5-m walk test and Timed Up and Go test outcomes). Therefore, the patients were stratified by sex, age, and Kellgren–Lawrence grade. The standard values (median values) for walking time on the 5-m walk test among patients aged 60–74/75–89 years were: 3.90/4.64 vs. 4.27/5.12 s for men vs. women with Kellgren–Lawrence grade III; 4.26/5.60 vs. 4.80/6.05 s for men vs. women with Kellgren–Lawrence grade IV. Regarding walking speed on the 5-m test, the standard values were: 1.28/1.08 vs. 1.17/0.98 m/s for men vs. women with Kellgren–Lawrence grade III; 1.17/0.89 vs. 1.04/0.83 m/s for men vs. women with Kellgren–Lawrence grade IV. Finally, the standard values for time on the Timed Up and Go test were: 8.52/10.30 vs. 9.30/11.74 s for men vs. women with Kellgren–Lawrence grade III; 9.40/12.90 vs. 10.05/13.20 s for men vs. women with Kellgren–Lawrence grade IV. ConclusionsThe standard values reported in this study can be used to quantify walking ability decline in patients with knee osteoarthritis and to aid in the decision to consider total knee arthroplasty.

Effectiveness of open wedge high tibial osteotomy on medial unicompartmental knee osteoarthritis

To evaluate the effectiveness of open wedge high tibial osteotomy (OWHTO) in treatment of medial unicompartmental knee osteoarthritis (MUKOA). A clinical data of 61 cases with MUKOA who were treated with OWHTO between January 2015 and January 2017 were retrospectively analyzed. There are 14 males and 47 females with an average age of 52.8 years (mean, 44-60 years). The body mass index ranged from 19.1 to 34.7 kg/m 2 (mean, 25.3 kg/m 2). Twenty-seven cases were left side and 34 cases were right side. The disease duration was 1-9 years (mean, 5.3 years). The MUKOA was rated as stage Ⅱ in 33 cases and stage Ⅲ in 28 cases. Preoperative Hospital for Special Surgery (HSS) score was 56.0±3.7. Walking visual analogue scale (VAS) score was 4.6±1.0. The operation time was 49-85 minutes (mean, 66.5 minutes). The length of incision was 10-13 cm (mean, 11.0 cm). The total overt blood loss was 80-210 mL (mean, 139.1 mL). The postoperative bed-rest time was 1-10 days (mean, 4.7 days). All patients were followed up 12-24 months (mean, 17.3 months). The bearing area of tibial platform at 3 months after operation was 60.3%-66.8%, with an average of 63.4%. At 3 and 6 months after operation, the HSS score was 79.1±4.2 and 85.3±3.1 respectively, and the VAS score was 1.7±0.7 and 0.6±0.5 respectively, all showing significant differences ( P<0.05). OWHTO is an ideal choice for treating MUKOA with less postoperative complications. The force line could be corrected by OWHTO. However, the preoperative preparations are very important, especially that the open angle should be measured accurately.

Relationship between preoperative patient-reported outcomes and hospital length of stay: a prospective cohort study of general surgery patients in Vancouver, Canada.

As an aging population drives more demand for elective inpatient surgery, one approach to reducing length of stay is enhanced evaluation of patients' preoperative health status. The objective of this research was to determine whether patient-reported outcome measures collected preoperatively can identify patients at risk for longer lengths of stay. This study was based on a prospectively recruited cohort of patients who were scheduled for elective inpatient general surgery in Vancouver, Canada. All participants completed a number of patient-reported outcome measures preoperatively, including the EQ-5D for general health status, the Patient Health Questionnaire (PHQ-9) for depression, and the pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G), known as the PEG, for pain. Patient-reported outcome data were linked to hospital discharge summaries. Multivariate regression was performed to estimate risk of longer lengths of stay, adjusting for patient and clinical characteristics. The primary outcome was length of stay and its associated cost. Data collection took place between October 2012 and November 2016. Participation among the population of 2307 eligible patients was 50.5%, providing 1165 participants. Preoperative patient-reported outcomes were not concordant with hospital reported diagnoses of depression or pain. Patients' preoperative depression and pain scores were independently positively associated with longer length of stay after adjusting for patient-level characteristics. Patients whose PHQ-9 score was 10, representing clinically significant depression, were estimated to have a 1.53 day longer hospitalization, which was associated with an estimated incremental hospital cost of $1667. Preoperative self-reported assessment of depression and pain can assist with identifying patients at higher risk of longer lengths of stay. Patient's self-reported preoperative measures of depression and pain should be incorporated into patient pathways. They provide opportunities for improving management of general surgery patients and possibly play a role in aligning hospital funding with patients' needs.

Evaluation of Long-term Outcomes Following Plantar Fasciotomy.

Plantar fasciitis is a common condition prevalent in both athletic and nonathletic populations. Approximately 10% of patients do not respond to conservative treatment and suffer chronic recalcitrant plantar fasciitis. Outcomes following plantar fasciotomy vary but short-term studies have reported excellent early pain relief and return to activity, and significant improvements in symptoms. Previous study limitations include small patient cohorts, short-term duration of follow-up or lack of validated outcome measures. We therefore aimed to investigate the long-term outcomes following complete plantar fasciotomy. Patients who underwent complete plantar fasciotomy surgery from a single surgeon within the past 10 years (minimum 7 months) were invited to participate in this retrospective survey study. To evaluate patient-reported function, participants were asked to complete the Foot and Ankle Outcome Score (FAOS). To assess subjective outcome, the participants were provided a satisfaction survey. The satisfaction survey was designed to include the 3 key factors for assessing postoperative patient satisfaction, which are preoperative expectations, symptom relief, and hospital experience. A total of 74 questionnaires were returned. The median global satisfaction score was 85.4 (IQR=37.5) points out of 100. Significant correlations between the global patient satisfaction score and all FAOS subscale scores were identified. Only 3 participants (4%) reported a complication following surgery; however, 32 participants (44.4%) indicated that they still experienced swelling and/or tenderness in their foot at the time of the survey (mean follow-up time 4.8 ± 2.8 years) but for the majority of patients this was improved from before surgery. Long-term patient satisfaction was experienced by the majority of patients following plantar fasciotomy. Although 44% of patients continue to have postoperative complaints, 73% indicated that they were satisfied with their symptoms postoperatively, and 74% would undergo a similar procedure again. Level IV, case series.

3276The duration of the pre-operative hospitalization is associated with an increased risk of healthcare-associated infections after cardiac surgery

3276The duration of the pre-operative hospitalization is associated with an increased risk of healthcare-associated infections after cardiac surgery

Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial

The effects of ureteral stent diameters on ureteral stent-related symptoms were evaluated by using Turkish-validated Ureteral Stent Related Symptoms Questionnaire (USSQ). Datas on 126 patients underwent uncomplicated flexible ureterorenoscopy and 62 patients underwent uncomplicated semirigid ureteroscopy surgery without stent insertion (group 3) were collected. Patients were randomized preoperatively in a double-blind fashion to 4.8 French (group 1) and 6 French (group 2) ureteral JJ stents groups. The first follow-up visit was done at one week after surgery for all groups. Stents were removed on the third postoperative week for stented groups. The second follow-up visit was done at one week after stent removal for group 1 and group 2, and four week after surgery for group 3. Preoperative characteristics, operation time and hospitalization times were similar in both groups. Total USSQ scores were 91.9, 103.0, 44.2 at first visit and 54.3, 58.7, 28.5 at second visit in group 1, group 2, and group 3, respectively. At both first and second visits, the group 2 had significantly higher USSQ scores than the group 1 (p = 0.01 and p < 0.001, respectively). Group 1 and 2 had higher scores than group 3 at both visits. Ureteral stents are associated with poor effects on patients’ comfort and high USSQ scores. Using 4.8 Fr JJ stents improves stent-related symptoms and decreases the USSQ score more than 6 Fr JJ stents. Therefore, if ureteral stent is to be used after URS, we recommend using 4.8 Fr stent.

Associations of Hospital Length of Stay with Surgical Site Infections.

Surgical site infections (SSI) are a major cause of morbidity and mortality in surgical patients. Postoperative and total hospital length of stay (LOS) are known to be prolonged by the occurrence of SSI. Preoperative LOS may increase the risk of SSI. This study aims at identifying the associations of pre- and postoperative LOS in hospital and intensive care with the occurrence of SSI. This observational cohort study includes general, orthopedic trauma and vascular surgery patients at two tertiary referral centers in Switzerland between February 2013 and August 2015. The outcome of interest was the 30-day SSI rate. We included 4596 patients, 234 of whom (5.1%) experienced SSI. Being admitted at least 1day before surgery compared to same-day surgery was associated with a significant increase in the odds of SSI in univariate analysis (OR 1.65, 95% CI 1.25-2.21, p < 0.001). More than 1day compared to 1day of preoperative hospital stay did not further increase the odds of SSI (OR 1.08, 95% CI 0.77-1.50, p = 0.658). Preoperative admission to an intensive care unit (ICU) increased the odds of SSI as compared to hospital admission outside of an ICU (OR 2.19, 95% CI 0.89-4.59, p = 0.057). Adjusting for potential confounders in multivariable analysis weakened the effects of both preoperative admission to hospital (OR 1.38, 95% CI 0.99-1.93, p = 0.061) and to the ICU (OR 1.89, 95% CI 0.73-4.24, p = 0.149). There was no significant independent association between preoperative length of stay and risk of SSI while SSI and postoperative LOS were significantly associated.

Abstract 595: Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases

Abstract Objective: Postoperative pneumonia (POP) is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC) surgery. Methods: Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later. Results: The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP. Conclusion: Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care. Citation Format: Jieyun Xu, Pei Yu, Weiwang Wang, Zehang Zhuang, Xiqiang Liu. Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 595.

Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy-dependent Pediatric Patients.

Limited literature exists as to whether preoperative gastrostomy (GT) evaluation may predict which patients will go onto require gastrojejunostomy (GJ) tube feeding. The goal of this study was to compare the preoperative evaluations between patients maintained on GT feeds versus patients who required conversion to GJ feeds. We identified patients at Boston Children's Hospital who underwent GT tube placement and required GJ feeding between 2006 and 2012. GT patients were matched according to age, neurologic, and cardiac status with GJ-converted patients. Preoperative characteristics, rates of total hospitalizations, and respiratory-related admissions were reviewed. A total of 79 GJ patients (median interquartile range (IQR): age 15 (4.3, 55.7) months; weight 8.8 (4.6, 14.5) kg) were matched with 79 GT patients (median (IQR): age 14.6 (4.7, 55.7) months; weight 8.5 (5, 13.6) kg). Median time from GT to GJ conversion was 8 (IQR 3, 16) months. Both groups had similar rates of successful preoperative nasogastric feeding trials (GT (84.5%) versus GJ (83.1%), P = 1.0), upper gastrointestinal series (GT (89.1%) versus GJ (93.2%), P = 0.73), abnormal videofluoroscopic swallow studies (GT (53.8%) versus GJ (62.2%), P = 0.4), and completion of gastric emptying studies (GT (10.1%) versus GJ (5.1%), P = 0.22). No differences were seen in preoperative hospitalization rates (P = 0.25), respiratory admissions (P = 0.36), although GJ patients had a mean reduction in the number of hospitalization of -1.5 ± 0.5 days, P < 0.001, after conversion. No differences in preoperative patient characteristics or diagnostic evaluations were seen in GT fed versus GJ converted patients. GJ patients did experience an overall decrease in total admissions after GJ conversion.

Análise da morbimortalidade dos pacientes com fraturas peritrocantéricas tratadas cirurgicamente com haste intramedular de fêmur proximal

ObjectiveTo analyzes the morbidity and mortality of patients with pertrochanteric fractures treated with intramedullary nailing and their relation to the length of hospital stay, the time to perform the surgical procedure, and the patients’ comorbidities. MethodsAn observational, analytic, and retrospective study was carried out through the evaluation of the medical records data of a total of 74 patients who underwent surgical treatment of peritrochanteric fractures with intramedullary proximal femoral nail during the period from 2011 to 2014 in a hospital unit. ResultsThe mean age at the moment of the fracture was 79.7 years and the mean total hospitalization time was 16.7 days, with an average of 11.3 days until surgery and 5.4 days after surgery at discharge. The incidence of complications during hospitalization in the group with age greater than or equal to 78.5 years was 47.6%, while in the younger group it was 19.4% (p = 0.013). The incidence of hospitalization complications in the group that underwent surgery over six days after the fracture was significantly higher, 42.9% (p = 0.019). It was also observed that the incidence of complications during hospitalization is significantly associated with cardiac risk index ≥ 3 (p = 0.001) and diabetes mellitus (p = 0.001). ConclusionComplications related to pertrochanteric fractures are significantly related with high cardiac risk index (grades 3 and 4), diabetes mellitus, age (˃ 78.5), and prolonged preoperative hospitalization time (˃ 6 days).

Burr-Hole Craniostomy with T-Tube Drainage as Surgical Treatment for Chronic Subdural Hematoma

We sought to investigate the effect of burr-hole craniostomy with T-tube drainage to treat chronic subdural hematoma (CSDH). Eighty-seven patients with CSDH who were recruited from January 2012 to June 2017 at the Department of Neurosurgery, The First Affiliated Hospital of Xi'an Medical University, were divided into 2 groups according to the method of drainage: T-tube drainage system (n= 45) and conventional subdural drainage system (n= 42). Retrospective analysis of clinical data and efficacy was performed between the 2 groups. There were no significant differences in age, preoperative Markwalder grade scale, preoperative hematoma volume, hospitalization days, and discharge Markwalder grade scale between the 2 groups (P > 0.05). The incidence of postoperative complications and hematoma recurrence in the group of patients with T-tube drainage was significantly reduced when compared with conventional subdural drainage systems (P < 0.05). Both methods were effective in the treatment of CSDH; however, we found a lower overall surgical complication rate following treatment with burr-hole craniostomy and T-tube drainage. This indicates that it may be a better therapeutic option for management of CSDH.

PMS12 - The Association Between Preoperative Hemoglobin Values and Hospitalization Outcomes Following Elective Primary Total Joint Replacement

PMS12 - The Association Between Preoperative Hemoglobin Values and Hospitalization Outcomes Following Elective Primary Total Joint Replacement

Clinical study of bone transport combined with bone graft and internal fixation at the docking site in the treatment of large segmental bone defect in lower limb

Objective To explore the feasibility and clinical value of Ilizarov bone transport technique combined with bone graft and internal fixation at the docking site in the treatment of large segmental bone defect of the lower limbs. Methods Thirty patients with large lower limbs bone defects were prospectively divided into two groups according to the random number table: pure bone transport group (Ilizarov bone transport technique alone, n=15, 10 males and 5 females, average age 34.4±4.6 years old, 2 cases bone defect of femur, 13 cases tibia, and the length of bone defect 6.2±2.4 cm), and combined bone transport group (Ilizarov bone transport technique with bone graft and internal fixation at the docking site, n=15, 12 males and 3 females with the average age of 33.8±5.2 years, 1 case of bone defect and 14 tibia, and the length of bone defect 6.5±2.2 cm). The preoperative hospital for special surgery (HSS) knee functional scores, Baird-Jackson ankle function scores, external fixation time, external fixation index, bone union time, bone union index, postoperative ASAMI scores and incidence of complications were compared between the two groups. Results All patients were followed up for 9 to 24 months (mean 16.2 months). Pure bone transport group was followed up for 9 to 24 months (mean 16.2 months), and combined bone transport group was 10 to 24 months (mean 16.4 months). In pure bone transport group, the external fixation time was 17.6±5.4 months, and the bone union time was 11.2±3.1 months with the average bone union index 42.4±4.6 d/cm. While in combined bone transport group, the external fixation time of group B was 8.4±2.1 months, and the bone union time was 7.2±2.1 months with the average bone union index 21.1±2.7 d/cm. The external fixation index of pure bone transport group was 32.4±2.1 d/cm, while in combined bone transport group it was 32.1±2.5 d/cm, and there was no significant difference between these two groups (t=0.812, P=0.884) . According to the bone and function score of the ASAMI, in pure bone transport group, bone healing: excellent 6 cases, good 6 cases, fair 2 cases, poor 1 case, excellent rate was 80%. While in combined bone transport group: excellent in 8 cases, good 6 cases, fair 1 case, excellent rate was 93.3%. The difference between the two groups was statistically significant (χ2=10.6, P=0.032). The lower limb function in pure bone transport group: excellent in 5 cases, good in 5, fair in 4, poor in 1, excellent rate was 66.7%; while in combined bone transport group: excellent in 6 cases, good in 7, fair in 2, excellent rate was 86.7%. There was also a significant difference in the incidence of complications between the two groups. Conclusion Both the pure Ilizarov bone transport technique and the Ilizarov technique with bone graft and internal fixation at the docking site could satisfactorily treat the large bone defect and shortening of the lower limb. But the latter technique had shorter healing time, higher healing rates, better limb function and fewer complications. Key words: Ilizarov technique; Femur; Tibia; Internal fixators

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: preoperative optimisation

Preoperative patient optimisation is a key point of enhanced recovery after thoracic surgery pathways. This could be particularly advantageous when considering video-assisted thoracic surgery (VATS) lobectomy, because reduced trauma related to minimally invasive techniques is one of the main factors favouring improved postoperative outcome. Main specific interventions for clinical optimisation before major lung resection include assessment and treatment of comorbidities, minimizing preoperative hospitalization, optimisation of pharmacological prophylaxis (antibiotic and thromboembolic) and minimizing preoperative fasting. Literature data and clinical evidences in this setting are reported and discussed.

Total Knee Replacement in Genu Valgum

AbstractBackground: The treatment of Genu valgum with grade IV OA is a challenge in TKR. For this reason it is important to correct the deformity during surgery even if it does not completely eliminate the increased risk of failure.Methods: This is a prospective study was conducted on 25 knees (22 patients) suffering from grade IV OA with genu valgum presented to Al-Azhar University Hospitals and Agouza Charity Hospital from October 2013 to November 2016, mean follow-up duration is 24 months no missed patients in the follow-up, three of this patients (12%) had bilateral genu valgum. Only 15 knee (60%) had about 10 degrees valgus deformity (type 1), 5 knees (20%) had about 11-20 degrees valgus deformity (type 2) and 5 knees (20%) had 21-30 degrees valgus deformity (type 3). Patients had a mean age at the time of surgery of 59 years (range from 50 to 68 years), the group of patients included 17 females (77%) and 5 males (23%), 11 patients (50%) had the right knee only replaced (9 females and two males), 8 patients (36%) had left one only (6 females and two males), while 3 patients (12%) had bilateral TKR (2 females and one male).Result: At the last follow-up for all patient's the average Hospital for Special Surgery knee score was 87.82 (ranging from 72 to 94) compared with average preoperative Hospital for special surgery knee score of 66.32 (ranging from 48 to 78), with an average increase of 21.50.Conclusion: In type I valgus deformity we do medial parapetellar approach, release of the posterolateral capsule then we may proceed in our sequence of soft tissue release, we prefer to use PS implant. In type II valgus deformity we do medial parapetellar approach, then we proceed in our sequence of soft tissue release (ITB, POP, LCL, LHG + LCL, POP, ITB + LHG). The choice of the level of constraint was on the operative field, based on the integrity and functionality of the MCL. If there is a medial residual instability do not perform a medial tightening, but switch to a higher constrained implant (CCK) instead of PS implant. In type III valgus deformities we do lateral parapetellar approach ± TTO then we prefer to use a CCK implant.

Predictive factors of surgical site infections in abdominal wall hernias

Background: Surgical site infections (SSI) are infections presents in any location along the surgical tract after a surgical procedure. Knowledge of predictive factors associated with SSI is important for planning remedial measures. Abdominal wall hernia repair is a common procedure in general surgery practice and knowing the predictors of SSI in these clean surgeries requiring placement of mesh is the aim of the present study.Methods: In a hospital based longitudinal study the subjects were diagnosed cases of anterior abdominal wall hernias undergoing planned or emergency surgeries. Patients of either gender and age group of 18 to 80 years were included in the study. Patients undergoing laparoscopic hernia repair were excluded. The study factors were patient and the surgeon related factors like laboratory parameters, surgeon experience etc. The outcome was SSI assessed with up to 30 days post-operative follow up.Results: Total 198 patients were enrolled with a mean age of 42.49±15.72 years and male preponderance. Overall SSI rate was 9.09% and in planned cases it was 7.07% and 50% in emergency cases. Pre-operative hospital stays of &gt;5 days was the only patient factor associated with increased risk of SSI (p=0.0004) and operating surgeon’s experience was associated with increased risk if SSI i.e. cases operated by junior surgeons had a higher risk of SSI (p=0.013).Conclusions: The only modifiable factor associated with SSI was pre-operative hospital stay of &gt;5 days while high incidence of SSI with junior surgeons cannot be modified in a teaching institute.