Preoperative Risk Factors For Failure Research Articles

Protocol for a systematic review and meta-analysis on preoperative risk factors for failure after fixed sling implantation for post-prostatectomy stress urinary incontinence

Background: Post-prostatectomy urinary incontinence (PPI) is a bothersome complication affecting patients undergoing prostate surgery that in up 10% of cases will require an invasive treatment with fixed slings or artificial urinary sphincters (AUS). Although fixed slings have several advantages over AUS, failure rates after slings range between 15% and 45% while current knowledge of predictors of sling efficacy remains limited. By systematically combining and summarizing all relevant literature, the present review and meta-analysis aim to address this research need assessing the association between preoperative risk factors and sling failure. Methods: Studies pertaining to fixed synthetic male perineal slings as treatment for adult male suffering from PPI, will be included. A systematic search will be conducted in PubMED, Scopus, Web of Science and Cochrane databases, and in the reference lists of retrieved articles. Independent reviewers will conduct study selection and data extraction. Outcomes will include failure to achieve the continence cure and overall success (cure plus improvement), measured as per included studies. Exposures will include any preoperative variables evaluated for association with sling failure. The QUIPS tool will be used for study quality assessment and a random-effects DerSimonian-Laird model, with Hartung-Knapp adjustment, will be used to pool adjusted and unadjusted odds ratios separately. Sensitivity analysis will be performed using the leave-one-out methodology and subgroup meta-analyses based on pre-specified studies’ characteristics will be conducted to explain the heterogeneity. Certainty of evidence will be assessed according to GRADE methodology and review reporting will comply with the PRISMA-P statement. Discussion: By summarising all relevant literature in the field, our results will help to incorporate available evidence into clinical practice assisting healthcare professionals managing PPI patients in treatment decision-making. The present review will also provide researchers with the necessary, evidence-based groundwork to perform future high-quality prognostic studies in the field. Registration: CRD42022307160.

Protocol for a systematic review and meta-analysis on preoperative risk factors for failure after fixed sling implantation for post-prostatectomy stress urinary incontinence

Background: Post-prostatectomy urinary incontinence (PPI) is a bothersome complication affecting patients undergoing prostate surgery that in up 10% of cases will require an invasive treatment with fixed slings or artificial urinary sphincters (AUS). Although fixed slings have several advantages over AUS, failure rates after slings range between 15% and 45% while current knowledge of predictors of sling efficacy remains limited. By systematically combining and summarizing all relevant literature, the present review and meta-analysis aim to address this research need assessing the association between preoperative risk factors and sling failure. Methods: Studies pertaining to fixed synthetic male perineal slings as treatment for adult male suffering from PPI, will be included. A systematic search will be conducted in PubMED, Scopus, Web of Science and Cochrane databases, and in the reference lists of retrieved articles. Independent reviewers will conduct study selection and data extraction. Outcomes will include failure to achieve the continence cure and overall success (cure plus improvement), measured as per included studies. Exposures will include any preoperative variables evaluated for association with sling failure. The QUIPS tool will be used for study quality assessment and a random-effects DerSimonian-Laird model, with Hartung-Knapp adjustment, will be used to pool adjusted and unadjusted odds ratios separately. Sensitivity analysis will be performed using the leave-one-out methodology and subgroup meta-analyses based on pre-specified studies’ characteristics will be conducted to explain the heterogeneity. Certainty of evidence will be assessed according to GRADE methodology and review reporting will comply with the PRISMA-P statement. Discussion: By summarising all relevant literature in the field, our results will help to incorporate available evidence into clinical practice assisting healthcare professionals managing PPI patients in treatment decision-making. The present review will also provide researchers with the necessary, evidence-based groundwork to perform future high-quality prognostic studies in the field. Registration: CRD42022307160.

Protocol for a systematic review and meta-analysis on preoperative risk factors for failure after fixed sling implantation for post-prostatectomy stress urinary incontinence

Protocol for a systematic review and meta-analysis on preoperative risk factors for failure after fixed sling implantation for post-prostatectomy stress urinary incontinence

Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint.

Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 (P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described. Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up. 340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35). LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients' age, comorbidity, clinical presentation and microorganism causing the infection.

Failure After Modern Total Knee Arthroplasty: A Prospective Study of 18,065 Knees

BackgroundWe sought is to determine the mechanism of failure among primary total knee arthroplasties (TKAs) performed at a single high-volume institution by asking the following research questions: (1) What are the most common failure modes for modern TKA designs? and (2) What are the preoperative risk factors for failure following primary TKA? MethodsFrom May 2007 to December 2012, 18,065 primary TKAs performed on 16,083 patients at a single institution were recorded in a prospective total joint arthroplasty registry with a minimum of 5-year follow-up. We retrospectively reviewed patient charts to determine a cause of failure for primary TKAs. A cox proportional hazard model was used to determine the risk of revision surgery following primary TKA. ResultsThe most common reasons for failure within 2 years after TKA were infection and stiffness. The multivariable regression identified the following preoperative risk factors for TKA failure: history of drug abuse (hazard ratio [HR] 4.68; P = 0.03), deformity/mechanical preoperative diagnosis (HR 3.52; P < .01), having a constrained condylar knee implant over posterior-stabilized implant (HR 1.99; P < .01), post-traumatic/trauma preoperative diagnosis (HR 1.78; P = .03), and younger age (HR 0.61; P < .01) ConclusionThese findings add to the growing data that primary TKAs are no longer failing from polyethylene wear-related issues. This study identified preoperative risk factors for failure of primary TKAs, which may be useful information for developing strategies to improve outcomes following TKA.

External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy.

The Cleveland Clinic has proposed a prognostic model of preoperative risk factors for failure of restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis. The model incorporates four predictive variables: completion proctectomy, handsewn anastomosis, diabetes mellitus and Crohn's disease. The aim of the present study was to perform an external validation of this model in a new cohort of patients who had RPC. Validation was performed in a multicentre cohort of 747 consecutive patients who had an RPC between 1990 and 2015 in three tertiary-care facilities, using a Kaplan-Meier survival analysis and Cox regression analysis. The performance of the model was expressed using the Harrell concordance error rate. The primary outcome measure was pouch survival with maintenance of anal function. During the study period, 45 (6.0%) patients experienced failure at a median interval of 31months (interquartile range 9-82months) from the original RPC. Multivariable analysis showed handsewn anastomosis to be the only significant independent predictor. The Harrell concordance error rate was 0.42, indicating poor performance. Anastomotic leakage and Crohn's disease of the pouch were strong postoperative predictors for pouch failure and showed a significant difference in pouch survival after 10years (P<0.001). The poor performance of the Cleveland Clinic prognostic model makes it unsuitable for daily clinical practice. Handsewn anastomosis was associated with pouch failure in our cohort with relatively few events. A prediction model for anastomotic leakage or Crohn's disease of the pouch may be a better solution since these variables are strongly associated with pouch failure.

Descemet stripping automated endothelial keratoplasty after failed penetrating keratoplasty: survival, rejection risk, and visual outcome.

Descemet stripping automated endothelial keratoplasty (DSAEK) for isolated endothelial dysfunction has become the preferred surgical option for many corneal surgeons. However, there are limited large-scale reports on DSAEK survival and clinical variables affecting the risk of rejection and failure after failed penetrating keratoplasty (PK). To report the survival, risk factors for graft rejection and failure, and visual outcome of DSAEK after failed PK. A multicenter retrospective interventional case series included patients recruited from 6 tertiary referral surgical centers: 3 in the United States, 2 in Europe, and 1 in Asia. A total of 246 consecutive eyes (246 patients) that underwent DSAEK after failed PK, with a minimum follow-up period of 1 month, was included. Data comprising demographic details, preoperative and postoperative risk factors, time to rejection, time to failure, and corrected distance visual acuity were collected. Cumulative probability of graft survival, hazard ratio estimates for survival, and corrected distance visual acuity were determined. The mean (SD) recipient age was 63.2 (16.6) years and the median follow-up period was 17 months (interquartile range, 6-30 months). One-third of the grafts (n = 82) had follow-up data for more than 2 years; 18.3% had more than 1 failed PK before DSAEK. In total, 19.1% (47 of 246) of DSAEK grafts failed. The cumulative probability of DSAEK survival after a failed PK was 0.89 (95% CI, 0.84-0.92), 0.74 (95% CI, 0.64-0.81), and 0.47 (95% CI, 0.29-0.61) at 1 year, 3 years, and 5 years, respectively. Based on multivariate analysis, significant preoperative risk factors for failure were young recipient age (hazard ratio [HR], 5.18 [95% CI, 1.57-17.18]), previous tube filtration surgery (HR, 5.23 [95% CI, 1.47-7.33]), and rejection episodes before PK failure (HR, 3.28 [95% CI, 1.47-7.33]); single-surgeon centers had a protective effect. Any rejection episode prior to PK failure was a significant predictor of post-DSAEK rejection, which in turn was a significant predictor of DSAEK failure. After a median follow-up of 17 months, 33.3% of the grafts achieved 0.3 or greater logMAR (20/40) corrected distance visual acuity. Descemet stripping automated endothelial keratoplasty after failed PK combines greater wound stability and reduced suture-related complications, with visual outcomes and graft survival rates comparable to those of a second PK.

Late rescue of proximal endograft failure using fenestrated and branched devices

Endovascular aneurysm repair (EVAR) will fail over time in a percentage of patients. Mechanical failure of the device, progression of aortic disease, or interface complications between the device and the native vasculature may contribute. Our aim was to evaluate the role of fenestrated and branched endografts as treatment options for failed devices. Between January 2001 and June 2013, 970 patients were enrolled into a physician-sponsored investigational device exemption (PSIDE) study and treated with a fenestrated/branched endograft. All patients treated for nonurgent proximal neck failure of an infrarenal endoprosthesis previously implanted during EVAR comprised the study group. Patients treated for a primary aneurysm within the PSIDE were evaluated as a comparison group to identify preoperative risk factors for failure. A retrospective review was undertaken to determine the details of the initial EVAR, whereas the prospective PSIDE database was used to assess outcomes of secondary treatment. Three-dimensional imaging techniques were used to define all morphologic measurements. Statistical analysis included comparisons between categoric variables with the χ(2) test and between continuous variables with the Wilcoxon rank sum test between patients with late failures and those with native aortic repair. Kaplan-Meier curves were used to analyze overall survival. Of 970 patients enrolled in the PSIDE, 54 (5.6%) had late failure of a prior endograft. Fenestrated/branched devices were used to address the failure in each patient. The etiology of failure was related to a proximal neck issue in all patients: type Ia endoleak in 38, stent migration in 18, neck degeneration in 28, or some combination of these factors. The endovascular rescue procedure took place a mean of 61 months after the primary procedure. The mean aneurysm diameter at reintervention was 67 mm. Patients requiring a secondary fenestrated procedure were younger at the time of their primary intervention (P = .039) and were more likely to have a history of chronic renal insufficiency (P = .05) compared with other patients in the PSIDE. Technical success rate in the study group was 85% (44 of 52). Successful stenting was achieved in 71 of 77 (92%) target vessels. Thirty-day mortality was 3.8% (two of 52). Fluoroscopy dose and operating time were longer in the rescue group (P = .07) than in the control group (P = .008). Secondary interventions were required in 36.5% (19 of 52) of patients. Our series demonstrates the risk for late failure after EVAR is greater in patients who are younger and have chronic renal impairment at the time of implantation. Branched and fenestrated repair after failed EVAR is more complex than repair in the native aorta. More research is needed to identify patients at higher risk of failure after EVAR to prevent the need for rescue in the future.

Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis

PurposeLaparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy (OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy (CA) has several disadvantages. We retrospectively determined preoperative risk factors for failure of LA and subsequent conversion to OA.MethodsConsecutive cases of preoperative computed tomography (CT) and attempted LA were retrieved from our hospital database and grouped by procedure (LA versus CA). Patients with negative appendectomies (n = 28), opened appendectomy (n = 210), delayed interval appendectomy (n = 3), or who were <14 years of age were excluded.ResultsAverage patient age, preoperative C-reactive protein (CRP) level, and diffuse peritonitis were significantly different between the groups. CT inflammation and occurrence of complicated appendicitis were significantly higher in CA than LA. Conversion to OA was mostly because of dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation from surgical point of view. Postoperative complications were significantly lower in LA than CA, although the rate of intraoperative abscess was not different.ConclusionMost patients with acute appendicitis can be successfully treated with LA. We identified the following significant risk factors of CA: CT inflammation grade 4 or 5; complicated appendicitis; higher preoperative CRP level; and diffuse peritonitis.

The role of synthetic slings in male stress incontinence

ObjectiveOur primary aim was to compare the outcomes of synthetic bone-anchored male slings (BAMS) and transobturator male slings (TOMS), to identify preoperative risk factors for failure, and to evaluate patient satisfaction with each procedure. Patients and methodsCharts were reviewed retrospectively of patients who underwent synthetic BAMS or TOMS from 2000 to 2011. Data were categorised into groups based on outcomes of ‘dry’, ‘improved’ and ‘failure’. Success was defined as completely dry or an improvement by >50% in daily pad use. The data analysed included demographics, daily pad use before and after surgery, previous urethral insult, type of prostatectomy, and urodynamic study variables. Data were analysed using logistical regression, the t-test and chi-square analysis, where appropriate. ResultsSixty-eight men were analysed (30 in each group; eight patients were excluded). Daily pad use for the TOMS group changed from 3.5 before to 1.5 after surgery (P=0.001), whilst the BAMS group was unchanged from 3.9 to 3.5 (P=0.747). The TOMS group had a success rate of 23/30 (77%) and a mean (SD) patient global impression of improvement score of 1.67 (0.90), whilst the BAMS group had a success rate of 11/30 (37%) and mean (SD) score of 2.64 (1.12). Urethral insult (P=0.001) and preoperative pad use (P=0.047) were significant predictors of failure. ConclusionTOMS gave better outcomes than BAMS in both performance and patient satisfaction. Patients with a greater severity of incontinence and evidence of urethral insult before surgery should be counselled about the likelihood of suboptimal outcomes with any type of sling placement.

Risk Factors for Male Slings: A Comparative Study of Two Techniques

To improve patient selection for male slings. Our primary aim was to identify preoperative risk factors for failures. Our secondary aim was to compare bone-anchored male sling (BAMS) to transobturator male sling (TOMS) and patient satisfaction accordingly. A retrospective review was performed from 2000 to 2010 of males who received male slings. Exclusions had follow-up<1.5 months. Data examined included demographics, urodynamic parameters, pad usage, presence of detrusor overactivity (DO), and previous urethral diseases. Failure was defined as ≥4 pads used per day or ≤50% improvement by Patient Global Impression of Improvement (PGI-I). Preoperative risk factors for failure were analyzed for statistical significance. Sixty-four patients (mean age, 69.8±9.2 years) were analyzed. Forty-one received BAMS and 23 received TOMS with median follow-up of 46 months (range, 1.5-112) and 18 months (range, 3-33), respectively (P=.01). Perioperative decrease in pad usage was statistically significant in the TOMS group (range, 4.0-1.8, P=.00) compared with the BAMS group (range, 4.3-3.9, P=.37). Failure rate was 68.3% (28/41) in BAMS and 30.4% (7/23) in TOMS (P=.01). The PGI-I demonstrated increased satisfaction with TOMS (P=.005). Preoperative risk factors suggest increased pad usage, low maximal urethral closure pressure (MUP), low abdominal leak point pressure (ALPP), decreased functional length (FL), and presence of DO and urethral disease favor failure. Patients with preoperative risk factors, such as increased pad usage, low MUP, low ALPP, decreased FL, and presence of DO and urethral disease may not be appropriate sling candidates. Findings support TOMS, whichhas fewer failures and higher patient satisfaction but may be secondary to improved patient selection.

Are Multichannel Urodynamics Required Prior to Surgery in a Woman with Stress Urinary Incontinence?

The National Institute for Clinical Excellence recommends that cystometry need not be performed before conservative therapy for incontinence in women, nor is cystometry routinely recommended in the small group of women with a clearly defined diagnosis of pure stress incontinence. Nonetheless, it is frequently utilized in the assessment of women with stress urinary incontinence in the hope that results will shed light on preoperative risk factors for failure or postoperative voiding dysfunction. The ability of urodynamic studies to characterize these parameters reliably remains under investigation. Because urodynamic studies are invasive, costly, and not always available, it is imperative that its benefit be carefully explored. This review highlights the recent arguments for and against this recommendation.

Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence

Objectives To determine significant preoperative risk factors for failure of transobturator tapes. Methods Secondary analysis of data from the E-TOT (Evaluation of Transobturator Tapes) study. Patient-reported outcomes (n = 310) and objective outcomes (n = 297) were analyzed using univariate and multivariate analyses. Results On univariate analysis, body mass index (BMI) ≥ 35, maximum urethral closure pressure (MUCP) ≤ 30 cm H 2O, preoperative mixed incontinence on urodynamics, history of at least one previous incontinence procedure, and preoperative symptoms of urgency, nocturia, or urgency incontinence were associated with failure. On multivariate regression, BMI ≥ 35 (OR 6.37; 95% CI, 1.73–23.44; P = 0.005), nocturia (OR 2.18; 95% CI, 1.04–4.58; P = 0.039), urgency incontinence (OR 3.35; 95% CI, 1.07–10.51; P = 0.039), and previous incontinence surgery (OR 2.33; 95%CI, 1.1–5.48; P = 0.048) were independently associated with patient-reported failure. MUCP ≤ 30 cm H 2O (OR 7.06; 95% CI, 2.85–17.48; P < 0.001) and previous incontinence procedure (OR 6.22; 95%CI, 2.34–16.52; P < 0.001) were independently associated with objective failure. Conclusion History of previous incontinence surgery was the only independent risk factor for failure of transobturator tapes based on both the patient-reported and objective outcome.

Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence (SUI) with urodynamic testing (UDS) enhances surgical outcomes. Nonetheless, UDS is frequently utilized in the assessment of women with SUI in the hopes that results will shed light on preoperative risk factors for failure or postoperative voiding dysfunction. Poorer outcomes for stress incontinence surgery are primarily attributed to intrinsic sphincter deficiency (ISD), detrusor overactivity (DO), and voiding dysfunction. The ability of UDS to identify and characterize those parameters reliably remains under investigation. Furthermore, debate continues regarding the association of each of those factors with postoperative success for various SUI procedures. Since UDS is invasive, costly, and not always available, it is imperative that its benefit be carefully explored. In this review, we discuss the value of UDS in identifying risk factors for poor outcome and how those risk factors are associated with surgical failure.

Survival of closing-wedge high tibial osteotomy: Good outcome in men with low-grade osteoarthritis after 10–16 years

Background and purpose High tibial valgus osteotomy (HTO) is a well-accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment in relatively young and active patients. Controversies about the factors affecting survival of HTO still exist. We assessed preoperative risk factors for failure of closing-wedge HTO at long-term follow-up.Patients and methods A cohort of 100 patients with a mean age of 49 (24–67) years, who had closing-wedge HTO performed between January 1991 and December 1996, were analyzed retrospectively. A survival analysis was carried out according to the Kaplan-Meier method. Logistic regression analysis was used to assess the association between failure of the osteotomy and known potential preoperative risk factors.Results The probability of survival for HTO was 75% (SD 4%) at 10 years with knee replacement as the endpoint. Female sex and osteoarthritis of grade ≥ 2 were identified as preoperative risk factors for conversion to arthroplasty 10 years after HTO.Interpretation Our findings suggest that ideal candidates for corrective osteotomy are men with symptomatic medial compartmental osteoarthritis of Ahlbäck grade 1, who, 10 years after surgery, have an almost tenfold lower probability of failure of HTO than women with more advanced osteoarthritis.

Risk factors for surgical failures in rhegmatogenous retinal detachment

The evaluation of further risc factors predesposing failure in retinal detachment surgery than those already known to be associated with PVR was the goal of this retrospective study. The data from 130 cases with unilateral rhegmatogenous retinal detachment treated initially with buckling procedures, were retrospectively reviewed to investigate pre-, intra- and postoperative factors which may predispose anatomical failure in retinal detachment surgery. None of the selected consecutively operated eyes had risk factors, which have already been associated with an unfavourable outcome, such as the presence of preoperative macular holes, PVR or assumed PVR-inducing factors, such as ocular trauma, giant retinal tears, vitreous hemorrhage, previous vitrectomy, cryopexy and laser photocoagulation. The anatomic success rate after scleral buckling procedures was 78.5% and the overall success rate after multiple surgery including vitrectomy increased to 94.6%. 102 (78.5%) cases, treated with a maximum of two scleral buclking operations were statistically compared to the 28 cases which needed further vitreoretinal surgery. The statistical analysis revealed as preoperative risk factors for failure in rhegmatogenous retinal detachment surgery 1) retinal detachment exceeding two retinal quadrants (p < 0.05) and 2) size of the retinal tear larger than 60 degrees (p < 0.05), whereas postoperative risk factors were 1) presence of subretinal hemorrhage (p < 0.01) and 2) persistent subretinal fluid at least two days after surgery (p < 0.01). Eyes with preoperative visual acuity less than 0.1, pseudophacic eyes with posterior chamber intraocular lenses and eyes with severe intraoperative hypotony also showed a tendency to unfavourable outcome, but without a statistically significant level. Possible ways of interfering in the retinal reattachment process and the clinical importance of these evaluated factors are discussed. They should be taken in consideration for the prognosis of the postoperative anatomical result and treatment modalities if further surgery is required.