Preoperative Screening Of Patients Research Articles

The relationship between the atherogenic index of plasma and postoperative myocardial injury following non-cardiac surgery under general anaesthesia: a retrospective cohort study

BackgroundThe atherogenic index of plasma (AIP) is a reliable lipid marker associated with coronary artery stenosis (CAS) and cardiovascular events. However, the relationship between AIP and myocardial injury after non-cardiac surgery (MINS) remains insufficiently explored.MethodsThis retrospective study included adult patients who underwent non-cardiac surgery under general anaesthesia. The primary exposure was preoperative AIP, with MINS as the primary outcome. The predictive accuracy of AIP for MINS was assessed using the area under the curve (AUC). Restricted cubic splines (RCS) were used to explore the potential nonlinear relationship between AIP and MINS. Logistic regression analysis was conducted to examine the association of AIP with MINS. Subgroup and interaction analyses were carried out across multiple factors, including age, gender, body mass index, medical history, and the type of surgery (emergency or elective).ResultsThe cohort consisted of 1,160 adult patients, with a median preoperative AIP of -0.05. The incidence of MINS was 7.9%. The AUC for AIP in predicting MINS was 0.719, surpassing the AUCs of triglycerides and high-density lipoprotein cholesterol (0.644 and 0.683, respectively). RCS analysis demonstrated a linear relationship between AIP and MINS (P for nonlinear = 0.165). Patients in the highest quartile of AIP had significantly higher odds of developing MINS than those in the lowest quartile (adjusted OR, 8.05; 95% confidence interval [CI], 3.44 to 18.80; P < 0.001). The results across most subgroups were consistent with the primary analysis, showing no significant interaction effects.ConclusionsA significant and independent linear relationship exists between preoperative AIP and the risk of MINS. As an economical and easily accessible lipid marker, AIP holds potential for preoperative screening of patients at risk of postoperative cardiovascular events.

Timing of surgery for spinal deformity patients during the COVID‑19 pandemic: experience from a prospective cohort at Peking Union Medical College Hospital.

The purpose of this study was to explore the optimal timing and associated risks of spinal deformity surgery during the COVID‑19 pandemic. All consecutive surgical cases for spinal deformity between November 2022 and April 2023 were included. The population was divided into several categories according to the time from diagnosis of SARS-CoV-2 infection to the day of surgery: without infection (pre-COVID-19), infection at 0 to 4weeks (peri-COVID-19), infection at 4 to 8weeks (early post-COVID-19), and infection over 8weeks (late post-COVID-19). The primary outcome and secondary outcomes were 90-day complication rate and total hospital stay. Postoperative complications and total hospital stay were analyzed using logistic regression and linear regression models, and we simultaneously showed the results from the crude model, minimally adjusted model and fully adjusted model. In addition, we performed various sensitivity analyses. A total of 60 consecutive patients were enrolled. The overall complication rate at 90days postoperatively was 41.6% (25 of 60 patients), and the total hospital stay for all patients was (10.1 ± 3.5) days. In the fully adjusted model, compared with pre-COVID-19 patients, peri-COVID-19 patients had a 5.1-fold increased risk of postoperative complications (OR = 6.1, 95% CI 1.1-31.9, P = 0.030), early post-COVID-19 patients and late post-COVID-19 patients were at essentially equal risk. In terms of total hospital stay, compared with patients not infected with SARS-CoV-2, peri-COVID-19 patients had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3-5.8, P = 0.032), early post-COVID-19 patients also had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3-6.0, P = 0.032), and late post-COVID-19 patients had the similar hospital stay (ꞵ = -0.4, 95%CI -2.9-2.1, P = 0.741). Sensitivity analysis showed that the conclusions were robust. With careful preoperative screening of patients for COVID-19, spinal deformity surgery can proceed safely during the epidemic. We recommend that spinal deformity surgery be delayed in patients with COVID-19 until 8weeks after SARS-CoV-2 infection.

Favorable Outcomes of Liver Transplantation for Hepatopulmonary Syndrome

Hepatopulmonary syndrome (HPS) is a pulmonary vascular complication of chronic liver disease, which develops insidiously as a result of chronic liver disease. The prognosis for untreated patients with HPS is extremely poor, and liver transplantation (LT) serves as the only effective means for treating this condition. Here, we performed a retrospective analysis to evaluate the efficacy of LT on the survival and long-term prognosis of patients with HPS. Clinical data, including survival and postoperative efficacy, from patients with HPS from records as obtained over the period from January 1 to December 31, 2022. All records were from a waiting list for LT at the Beijing Friendship Hospital Affiliated with Capital Medical University. Among the 274 patients on the LT waiting list, 37 were diagnosed with HPS (13.50%) and were enrolled. Survival rates of patients with HPS receiving an LT were greater, whereas a statistically significant difference was obtained between patients with LT vs non-LT with moderate to severe HPS (P = .003). The overall time until death without LT was 4-72 days after their initial HPS diagnosis. Patients with HPS receiving an LT showed a significant improvement in the state of oxygenation after surgery (P = .001). Comprehensive preoperative screening of patients on the waiting list for LT is critical to identify those patients with HPS who would maximally benefit from LT. Survival rates of patients with moderate to severe HPS are significantly increased after LT, a procedure that should be performed as soon as possible in these patients with HPS.

Prehabilitation for patients with colorectal cancer: a snapshot of current daily practice in Dutch hospitals

BackgroundMultimodal prehabilitation programmes are increasingly being imbedded in colorectal cancer (CRC) pathways to enhance the patient’s recovery after surgery. However, there is no (inter)national consensus on the content or design of such a programme. This study aimed to evaluate the current practice and opinion regarding preoperative screening and prehabilitation for patients undergoing surgery for CRC throughout the Netherlands.MethodsAll regular Dutch hospitals offering colorectal cancer surgery were included. An online survey was sent to one representative colorectal surgeon per hospital. Descriptive statistics were used for analyses.ResultsResponse rate was 100% (n = 69). Routine preoperative screening of patients with CRC for frailty, diminished nutritional status and anaemia was the standard of care in nearly all Dutch hospitals (97%, 93% and 94%, respectively). Some form of prehabilitation was provided in 46 hospitals (67%) of which more than 80% addressed nutritional status, frailty, physical status and anaemia. All but two of the remaining hospitals were willing to adopt prehabilitation. The majority of the hospitals offered prehabilitation to specific subgroups of patients with CRC, such as the elderly (41%), the frail (71%) or high-risk patients (57%). There was high variability in the setting, design and content of the prehabilitation programmes.ConclusionsWhereas preoperative screening is sufficiently incorporated in Dutch hospitals, standardised enhancement of the patient’s condition in the context of multimodal prehabilitation seems to be challenging. This study presents an overview of current clinical practice in the Netherlands. Uniform clinical prehabilitation guidelines are vital to diminish heterogeneity in programmes and to produce useful data to enable a nationwide implementation of an evidence-based prehabilitation programme.

DWI-Based Radiomics Predicts the Functional Outcome of Endovascular Treatment in Acute Basilar Artery Occlusion.

Endovascular treatment is a reference treatment for acute basilar artery occlusion (ABAO). However, no established and specific methods are available for the preoperative screening of patients with ABAO suitable for endovascular treatment. This study explores the potential value of DWI-based radiomics in predicting the functional outcomes of endovascular treatment in ABAO. Patients with ABAO treated with endovascular treatment from the BASILAR registry (91 patients in the training cohort) and the hospitals in the Northwest of China (31 patients for the external testing cohort) were included in this study. The Mann-Whitney U test, random forests algorithm, and least absolute shrinkage and selection operator were used to reduce the feature dimension. A machine learning model was developed on the basis of the training cohort to predict the prognosis of endovascular treatment. The performance of the model was evaluated on the independent external testing cohort. A subset of radiomics features (n = 6) was used to predict the functional outcomes in patients with ABAO. The areas under the receiver operating characteristic curve of the radiomics model were 0.870 and 0.781 in the training cohort and testing cohort, respectively. The accuracy of the radiomics model was 77.4%, with a sensitivity of 78.9%, specificity of 75%, positive predictive value of 83.3%, and negative predictive value of 69.2% in the testing cohort. DWI-based radiomics can predict the prognosis of endovascular treatment in patients with ABAO, hence allowing a potentially better selection of patients who are most likely to benefit from this treatment.

Isolation of Methicillin-Resistant Staphylococcus aureus from Wound Samples during the COVID-19 Pandemic: A Retrospective Study

Introduction: On March 11th, 2020, the World Health Organisation (WHO) declared the outbreak of the novel coronavirus disease caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARSCoV-2) virus as a pandemic. This recently discovered β-coronavirus spread instantaneously across mainland China due to human-tohuman transmission and crossed international borders aided by intercontinental travel. In most nations, the logarithmic growth of the cases very quickly overwhelmed the healthcare system which led to the overcrowding of the hospitals and led to a sudden surge in Hospital-Acquired Infections (HAIs). Implementation of contact precautions was implemented to control cross-infection. Aim: To determine the effect of Coronavirus Disease-2019 (COVID-19) on the prevalence of HAIs with special emphasis on Staphylococcus aureus (S. aureus). Materials and Methods: This three-year retrospective study (September 2018-August 2021) was undertaken at an apex tertiary care institute in Northern India. Wound swabs were collected and processed in the laboratory for the presence of aerobic bacterial isolates. S. aureus was identified using conventional methods and antimicrobial sensitivity was performed by the Kirby-Bauer disc diffusion method. Data was entered in Microsoft Excel and later analysed in International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A steady increase in the isolation of MethicillinResistant Staphylococcus aureus (MRSA) was noted during the study period (60.5% in 2018 to 78.1% in 2021). A statistically significant increase was noted in the detection of MRSA after the onset of the COVID-19 pandemic (p=0.018) despite the reduced number of surgeries conducted in the institution and rigorous execution of contact precautions. Conclusion: There was an increase in the rate of MRSA isolation during the study period. The increase was significantly affected by the onset of COVID-19. To contain the spread of MRSA, novel methods including preoperative screening of patients undergoing elective surgeries and periodic screening of hospital staff need to be implemented along with standard infection control precautions at all times.

A retrospective diagnostic test study on circulating tumor cells and artificial intelligence imaging in patients with lung adenocarcinoma.

Either tumor volume or folate-receptor-positive circulating tumor cells (FR+CTC) has been proven effective in predicting tumor cell invasion. However, it has yet to be documented to use FR+CTC along with artificial intelligence (AI) tumor volume to differentiate between pathological subtypes of lung adenocarcinoma (LUAD). Therefore, this study is aimed to evaluate the accuracy of FR+CTC and AI tumor volume for classifying the invasiveness of LUAD. A total of 226 patients who were diagnosed with LUAD were enrolled. The inclusion criteria were: (I) FR+CTC detection and AI imaging before anticancer therapy, and (II) definite histopathologic diagnosis, which is the gold diagnosis of LUAD and its subtypes. Use the CytoploRare® Detection Kit to quantify FR+CTC and the AI-assisted diagnosis system, ScrynPro, to measure tumor volume. The clinical data were used to construct univariate and multivariate logistic regression models. A nomogram was drawn based on the multivariate logistic regression model. The validity is evaluated by the calibration curve and Hosmer-Lemeshow goodness-of-fit test. The mean age of 146 patients (96 males, 49 females and 1 gender missing) retrospectively enrolled was 56.6. In the cohort, 41 and 105 patients were assigned to adenocarcinoma in situ (AIS) + minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA), respectively. There was no significant difference between the sex distribution and smoking history of the two groups (P=0.155 and P=0.442, respectively). In univariate analysis, the nodules type, maximum density, tumor volume and FR+CTC level were statistically significant with the invasiveness of LUAD (P<0.05). The multivariate analysis showed significant differences in FR+CTC and AI tumor volume (P<0.001). The area under the curves (AUCs) of FR+CTC and AI tumor volume in diagnosing tumor invasiveness were 0.659 and 0.698, respectively. A predictive model combining FR+CTC with AI tumor volume showed a sensitivity of 86.89% and a specificity of 70.94%, and the AUC was 0.841. The nomogram had good agreement with actual observation, and the Hosmer-Lemeshow test yielded non-significant goodness-of-fit. FR+CTC and/or AI tumor volume are independent indicators of the invasiveness of LUAD, and the nomogram based on them can be used for the preoperative screening of patients.

Septoplasti ve Septorinoplasti Hastalarında Etmoid Çatı Derinliğinin ve Sinonazal Anatomik Varyasyonların Retrospektif Radyolojik Analizi

Aim: Computed tomography (CT) provides an accurate assessment of sinonasal anatomy and osseocartilaginous pathologies in patients complaining of sinonasal symptoms. Although it is not a routine practice, CT is frequently used in preoperative screening of patients planned for septoplasty and septorhinoplasty. In this study, anatomical variations and ethmoid lateral lamella depths in preoperative CT images of septoplasty and septorhinoplasty operations performed in our clinic were analyzed retrospectively and discussed with current literature.&#x0D; Material and Method: Septorhinoplasty and septoplasty surgeries performed in our clinic between January 2014 and August 2018 over the age of 18 years were reviewed retrospectively. Two hundred patients were included in the study. CT images were evaluated for anatomical variations and ethmoid lateral lamella depths.&#x0D; Results: Of the 200 patients included in the study, 158 (79%) underwent septoplasty and 42 (21%) underwent septorhinoplasty. Concha bullosa was detected in 95 (47,5%) of the patients and was determined as the most common anatomical variation. Onodi cell variation was detected in 62 (31%) of the patients. Haller cell was detected in 37 patients (18,5%). Paradoxical middle turbinate was detected in 19 patients (9,5%), pneumatized anterior clinoid process in 17 patients (8,5%), and pneumatized crista galli in 4 patients (2%). In lateral lamella measurements; the median value of the lateral lamella depth on the right was 4,20 mm (0,40-7,40 mm) and the median value of the lateral lamella depth on the left was 4,20 mm (1,70-7,30 mm).&#x0D; Conclusion: Anatomical variations that can be detected in CT imaging before septoplasty and septorhinoplasty operations and information about ethmoid roof anatomy will be useful in case management, surgical planning and complication management.

RAPID Software to the Clinical Application Value of Acute Basilar Artery Occlusion with Endovascular Treatment

ObjectiveTo investigate the clinical application value of RAPID software based on computed tomography perfusion imaging (CTP) in the endovascular treatment of acute basilar artery occlusion (BAO). Materials and MethodsThe data of patients with acute basilar artery occlusion who received endovascular treatment in Taizhou Hospital, Zhejiang Province, between January 2020 and April 2021 were retrospectively analysed. The patients were divided into a perfusion imaging and a no-perfusion imaging group based on whether the image analysis results were obtained by RAPID software. Age, preoperative National Institute of Health stroke scale (NIHSS) score, onset to puncture time (OPT), operation methods, good prognosis at 3 months after surgery (modified Rankin scale (mRS) score ≤3), symptomatic intracranial haemorrhage (sICH) and other clinical data were compared between the two groups. Multivariate logistic regression analysis was used to identify the independent factors affecting the prognosis of BAO patients. ResultsIn total, 61 patients with acute BAO were included: 31 patients in the perfusion imaging group and 30 patients in the no-perfusion imaging group. There were no statistically significant differences between the two groups in age, NIHSS score or operation methods (all P >0.05). However, OPT and the good prognosis rate were significantly higher in the perfusion imaging group than in the no-perfusion imaging group (χ2=8.176, 5.003, P < 0.05). SICH was significantly lower in the perfusion imaging group than in the no-perfusion imaging group (χ2=5.628, P < 0.05). Logistic regression analysis showed that the image analysis results of RAPID software influenced the prognosis of EVT in patients with acute BAO (OR=4.048, 95%CI: 1.276-12.840). ConclusionsRAPID software based on CTP can be used for preoperative screening of patients with acute basilar artery occlusion to identify those suitable for endovascular treatment, which is worthy of clinical promotion.

Association of Anger Score with the Development of Left Ventricular Hypertrophy: An Observational Study

Aim: The present study was undertaken to observe the correlation between the development of left ventricular hypertrophy (LVH) and anger score and its implication in outcome of surgical cases. Methods: Study design: This was a observational study. Study population: A total of 40 male and female patients in the age group of 30–60 years and those admitted to the cardiac center were enrolled in the study. Novaco anger inventory short form was used in the study. Results and Discussion: Socio-demographic data of participants are presented in Tables 1-3. Table 4 presents the frequency distribution of the degree of LVH among patients. Table 5 presents frequency distributions of levels of anger among patients. Table 6 presents the correlation between Anger and LVH among patients. The value of R = 0.9524. This is a strong positive correlation, which means that high anger variable scores go with high LVH (and vice versa). The value of R2, the coefficient of determination, is 0.9071. Conclusion: There is a strong positive correlation, which means that high anger variable scores go with high LVH. Further detailed studies recommended understanding the relationship between these two variables so that it can be recommended to manage anger also in patients with cardiac disorders along with regular treatment. These principles are to be used as guiding principles in pre-operative screening of patients with comorbidities posted for surgery in the planning processes.

No Progression of Radiological Adjacent Joint Arthritis Noted in Patients with Type II DM undergoing Total Ankle Replacement: A 5 Year Follow Up Study

Category:Ankle; Ankle Arthritis; DiabetesIntroduction/Purpose:Total Ankle Arthroplasty [TAR] is a recognized treatment for end stage osteoarthritis. Many of these patients also have Type 2 Diabetes. There is a lack of literature of patients undergoing TAR surgery who belong to this cohort and any available literature has shown negative outcomes in such surgery. We aim to study whether the radiological outcomes of such patients undergoing TAR is different to their non diabetic counterparts performed at our Tertiary center.Methods:We conducted a retrospective study of patients undergoing Total Ankle Replacements between 2006 and 2014. Both patients with Type 2 Diabetes and non-diabetic patients were included. Type 1 Diabetics were excluded. Pre-operative screening of patients included thorough clinical assessment including swelling, warmth, erythema and neurovascular assessment including proprioception, vibration and neuro-filament testing. True AP, lateral X-Ray weight bearing views were obtained. MRI or CT scan was carried out on all patients pre-operatively. Patients were reviewed with X-Ray at 3, 6, and 12 month post operatively. Any radiolucency was defined as gap >2mm between the implant and the bone which was not seen at 3 month post op x-ray. Painful ankle replacement implants were investigated by SPECT CT scan.Results:9(3.9%) of the 230 patients were diabetic. Pre-operative radiographs revealed disease confined to OA, MRI and CT scans showed no evidence of bone debris, fragmentation of articular surfaces, translation of Talus or symptomatic OA in the Subtalar or Talo-navicular joint requiring treatment. Radiological analysis at 5 years demonstrated no evidence of loosening, implant subsidence, migration or periprosthetic cysts. No x-ray progression of arthritis was noted in the Subtalar, Talo-navicular or midfoot joints in Diabetic patient group. At the latest follow up, no radiological features of Charcot arthropathy was noted in the peri-prosthetic area.Conclusion:Our radiological outcome study has demonstrated that at minimum of 5 years, patients with diabetes who underwent TAR did not show any progression of arthritis in adjacent joints. Our study highlights that in the absence of diabetic neuropathy, it is safe to offer TAR in patients with Type II DM.

Venous Duplex Ultrasound Surveillance in the Neurosurgical Population: A Single-Center Quality Improvement Initiative

Venous thromboembolism (VTE) represents a significant source of morbidity and mortality in the inpatient population and is considered a leading preventable cause of death among inpatients. Neurosurgical inpatients are of particular interest because of the greater rates of immobility, steroid use, and potential consequences of postoperative hemorrhage. A consensus protocol for VTE screening in this population has not yet been developed, and institutional protocols vary widely. We performed a retrospective review of lower extremity venous duplex ultrasonography (VDUS) usage at our institution and applied this information to the development of a neurosurgery department protocol, with consideration of high-risk patient risk factors and indications for VDUS ordering. We then implemented this protocol, which consisted of preoperative screening of patients at high risk of VTE and limited postoperative surveillance, for a 6-month period and compared VDUS usage and VTE occurrence. Preoperative VDUS screening before nonemergent neurosurgical procedures in high-risk patients with active cancer, an inability to ambulate, or a history of deep vein thrombosis (DVT) identified proximal DVTs that were then treated. Postoperative routine surveillance VDUS scans only diagnosed incidental isolated calf DVT for which no clinically relevant sequelae occurred. Overall, postoperative surveillance VDUS usage decreased significantly (66.9% vs. 13.5%; P= 0.001). Our findings lend support to preoperative screening of high-risk patients and suggest that routine postoperative VDUS surveillance of asymptomatic patients is unnecessary.

The Frequency and Risk Factors Identified for HBsAg and Anti-HCV in a Preoperative Screening of Patients Admitted in the Surgical Department at Al-Tibri Medical College Hospital.

ObjectiveThe aim of this study is to determine the frequency and risk factors for hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (Anti-HCV) in a preoperative screening of patients admitted at the surgical unit of Al-Tibri Medical College and Hospital and Lyari General Hospital, Karachi.Materials and methodsThis study was conducted at the surgical units of Al-Tibri Medical College Hospital and Lyari General Hospital, Karachi. This study was conducted for six months from 30th June 2017 to 31st December 2017. This observational study was performed using a non-probability convenient sampling technique. All patients who were undergoing elective and emergency surgical procedure were selected for the study and screened for HBsAg and anti-HCV by immunochromatographic test (ICT) method at the hospital laboratory. The risk factors identified as parenteral injections, past surgical procedure, blood transfusion, etc. along with demographic data as age, gender, and district residential status were recorded on a specially designed proforma. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23. Descriptive statistics were applied, and the qualitative data were expressed as the mean and standard deviation.ResultsAmong a total of 360 patients included in the study, 63 (21.38%) were found with anti-HCV positive, and 14 (3.88%) were HBsAg positive with none of the patients found to have co-infection. The male-to-female ratio was 2.3:1. The mean age of patients was 32.34±4.3 years. The age range affected commonly in the study population was 21-30 years, 24(31%). The commonest risk factor for transmission of viral infection was parenteral injection abuser 31(40.2%), followed by surgical procedure 13(18.1%), blood transfusion 10(12.9%), and barber shave 7(9.1%).ConclusionIt was predicted in our study that hepatitis C was more common in patients screened preoperatively for surgery. However, the most frequent risk factor in these patients was parenteral abuse history. The preoperative screening is an important investigative tool for the identification of silent cases in the community for preventive measures adoption and treatment for silent carriers.

Development of a preoperative Early Warning Scoring System to identify highly suspect COVID-19 patients.

Background and Aims:The coronavirus disease 2019 (COVID-19) is spreading at an unprecedented speed. Lack of resources to test every patient scheduled for surgery and false negative test results contribute to considerable stress to anesthesiologists, along with health risks to both caregivers and other patients. The study aimed to develop an early warning screening tool to rapidly detect 'highly suspect' among the patients scheduled for surgery.Methods:Review of literature was conducted using terms 'coronavirus' OR 'nCoV 2019' OR 'SARS-CoV-2' OR 'COVID-19' AND 'clinical characteristics' in PUBMED and MedRxiv. Suitable articles were analysed for symptoms and investigations commonly found in COVID-19 patients. Additionally, COVID-19 patient's symptomatology and investigation profiles were obtained through a survey from 20 COVID-19 facilities in India. Based on literature evidence and the survey information, an Early Warning Scoring System was developed.Results:Literature search yielded 3737 publications, of which 195 were considered relevant. Of these 195 studies, those already included in the meta-analyses were not considered for independent assessment. Based on the combined data from meta-analyses and survey, risk factors of COVID-19 disease identified were as follows: history of exposure, fever, cough, myalgias, lymphocytopaenia, elevated C-reactive protein (CRP)/lactate dehydrogenase (LDH) and radiographic infiltrates.Conclusion:Development of this Early Warning Scoring System for preoperative screening of patients may help in identifying 'highly suspect' COVID-19 patients, alerting the physician and other healthcare workers on the need for adequate personal protection and also to implement necessary measures to prevent cross infection and contamination during the perioperative period.

Incidence and Radiological Findings of Incidental Sinus Opacifications in Patients Undergoing Septoplasty or Septorhinoplasty.

Although the routine use of computed tomography (CT) is controversial, it is employed in the preoperative screening of patients undergoing septoplasty or septorhinoplasty. The aim of this study was to evaluate the incidence and radiological characteristics of incidentally found sinus pathologies on screening CT in patients who underwent elective septoplasty or septorhinoplasty. We retrospectively reviewed the patients who underwent septoplasty and septorhinoplasty performed by a single surgeon (Y.J.J.) at Asan Medical Center between January 2016 and December 2017. CT images of 372 patients who had agreed to undergo preoperative CT were reviewed to determine the location and extent of incidental sinus opacifications. Of the 372 patients, 107 (28.8%) showed incidental sinus lesions on CT images. Opacifications were mainly found in the maxillary sinus (73, 68.2%), followed by the ethmoid (34, 31.8%), sphenoid (10, 9.3%), and frontal (3, 2.8%) sinuses. The most common sinus lesion was retention cyst (55, 51.4%), and the second most common one was opacification and mucosal thickening (46, 43%). Other lesions such as osteoma (3, 2.8%), dental cyst (2, 1.9%), and mucocele (1, 0.9%) were rarely found. In patients undergoing septoplasty or septorhinoplasty, the incidence of incidental sinus lesions was approximately 28.8% (107/372). This results indicate that preoperative CT in patients undergoing septoplasty or septorhinoplasty might be helpful to surgeons not only for better understanding the anatomical detail but also for detecting hidden paranasal sinus disease.

Dual mobility device reduces the risk of prosthetic hip instability for patients with degenerated spine: A case-control study

IntroductionThe pelvic incidence is an anatomical and biomechanical pelvic parameter determining spine sagittal morphology and kinematics. Stiffening of the lumbo-pelvic complex, a result of degeneration, affects the functional cup positioning, putting prosthetic hip patients at risk of instability. The anti-dislocation dual mobility (DM) device may be clinically advantageous by reducing the risk of prosthetic instability for older patients with spine ageing. Our study aims to answer the following questions: (1) is there a relationship between prosthetic hip instability and the standing cup position, (2) is there a relationships between prosthetic hip instability and the pelvic incidence, (3) is there a relationships between prosthetic hip instability and the severity of the spine degeneration?, (4) is the DM cup device an effective option for reducing the risk of prosthetic instability related to spine degeneration? HypothesisThere is a relationship between prosthetic hip instability and the standing cup position and pelvic parameters. MethodsCase-control study on prospectively collected data since 2009. From 1672 conventional total hip replacements (THR–5.4% dislocation rate) and 1056 DM-THRs (1.1% dislocation rate) performed at our institute since 2009, we created three groups: 33 patients with unstable THR (group 1–case), 41 patients with stable THR (group 2–control), and 42 patients with stable DM-THR (group 3–control). The cup orientation was measured on standing pelvic radiographs and the spino-pelvic parameters were measured on standing EOS™ biplanar images or lateral full spine radiographs. ResultsBy comparing patients from group 1 with those of group 2 we found they had similar cup position (57% versus 51% fitting the safe zone, p=0.58), higher pelvic incidence (58° versus 51°, p=0.01), and more severe spine degeneration (smaller anterior pelvic plane Tilt (2° versus 7° [p=0.002]), a larger pelvic incidence–lumbar lordosis mismatch (17° versus 8° [p=0.005]), and a higher proportion of spino-sacral angle<127° (70% versus 43%, (p=0.02)). Patients from group 3 had similar cup position, pelvic incidence, and spine degeneration compared to patients from group 1. Discussion/ConclusionPatients with spine-hip relation type 2C/D (high pelvic incidence and severe spine degeneration) have an increased risk of instability that is partly compensated for by the use of a DM device. Preoperative screening of patients with abnormal spine-hip relation would improve THR planning and reduce the risk of prosthetic hip instability. The use of a DM device on spine-degenerated elderly patients is probably sound. Level of evidenceIII, case-control study.

HbA1c predicts long-term postoperative mortality in patients with unknown glycemic status at admission for vascular surgery: An exploratory study.

Peripheral arterial disease (PAD) and diabetes mellitus (DM) represent major public health challenges and are tightly associated. To facilitate early diagnosis, HbA1c has been implemented as the preferred diagnostic tool for the diagnosis of type 2 DM. In this study, we compared and evaluated HbA1c, fasting plasma glucose (FPG), and 2-hour post-load glucose values to determine which test best predicted mortality in patients with PAD. In all, 273 PAD patients with unknown glycemic status admitted to Haukeland University Hospital for elective surgery between October 2006 and September 2007 were included in the study. All 273 patients underwent a standard oral glucose tolerance test (OGTT) in addition to determination of HbA1c; patients were then grouped into those with DM, intermediate hyperglycemia, and normoglycemia according to World Health Organization and International Expert Committee criteria. All-cause mortality was 40% over a 9-year follow-up period. After adjusting for age, sex, and relevant medication, HbA1c was a predictor for mortality (hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.03-2.32]; P = 0.04). The association did not achieve statistical significance in a fully adjusted Cox regression model, although the effect estimation of HbA1c on all-cause mortality remained largely unchanged (HR 1.39; 95% CI 0.92-2.09; P = 0.13). The OGTT was not a predictor of long-term mortality. The results indicate that HbA1c is a useful marker in the preoperative screening of patients of unknown glycemic status at the time of admission for vascular surgery, and may identify people at high risk of long-term mortality following surgical treatment for PAD.

The Effect of Depression on Patient-Reported Outcomes After Total Joint Arthroplasty Is Modulated by Baseline Mental Health: A Registry Study.

Depression and poor mental health are known to be negative predictors of patient-reported outcomes after total joint arthroplasty. Although previous studies have examined these risk factors in isolation to each other, they are, in reality, closely related, and yet each represents a different aspect of one's psychological well-being. The objective of this study was to investigate the association between depression and patient-reported outcomes, taking into account patients' baseline mental health. Our prospective, institutional joint registry was queried for patients who had undergone primary elective total joint arthroplasty and had a minimum follow-up of 1 year. Baseline mental health was measured by the Short Form-12 Mental Component Summary (SF-12 MCS). Four cohorts were analyzed on the basis of the presence or absence of depression and patients' SF-12 MCS scores at the time of the surgical procedure, which were categorized as either poor or good on the basis of previously defined cutoffs. The primary outcomes were the net changes in SF-12 MCS, SF-12 Physical Component Summary (PCS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at 4 and 12 months postoperatively. Univariate and mixed-effects model analyses were performed to control for potential confounding factors. Patients with depression but good baseline mental health achieved gains in patient-reported outcomes that were comparable with those of normal controls (p > 0.05). Patients with poor baseline mental health achieved significant gains in all patient-reported outcomes, but the changes were largest for those without depression (p < 0.05). Only patients with depression and poor baseline mental health did not cross the threshold for good mental health at the time of the latest follow-up despite achieving similar gains in physical function compared with their counterparts who did not have depression. The effect of depression on patient-reported outcomes is more complex but less pessimistic than previously thought. Patients with depression undergoing total joint arthroplasty may have significant improvements in their patient-reported outcomes, but the net gains are modulated by their mental health at the time of the surgical procedure. Preoperative screening of patients with depression using the SF-12 MCS may help to identify those who are at risk for attaining suboptimal patient-reported outcomes and may benefit from counseling or psychiatric referral for optimization before undergoing a surgical procedure. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Improving the preoperative diagnostic accuracy of acute appendicitis. Can fecal calprotectin be helpful?

Background Is the patient really suffering from acute appendicitis? Right lower quadrant pain is the most common sign of acute appendicitis. However, many other bowels pathologies might mimic acute appendicitis. Due to fear of the consequences of delayed or missed diagnosis, the indication for emergency appendectomy is liberally made. This has been shown to be associated with high rates of negative appendectomy with risk of potentially serious or lethal complications. Thus there is need for a better preoperative screening of patients with suspected appendicitis. Methods This prospective single center single-blinded pilot study was conducted in the Department of surgery at the HELIOS Universitatsklinikum Wuppertal, Germany. Calprotectin was measured in pre-therapeutic stool samples of patients presenting in the emergency department with pain to the right lower quadrant. Fecal calprotectin (FC) values were analyzed using commercially available ELISA kits. Cut-off values for FC were studied using the receiver-operator characteristic (ROC) curve. The Area under the curve (AUC) was reported for each ROC curve. Results The mean FC value was 51.4 ± 118.8 μg/g in patients with AA, 320.9 ± 416.6 μg/g in patients with infectious enteritis and 24.8 ± 27.4 μg/g in the control group. ROC curve showed a close to 80% specificity and sensitivity of FC for AA at a cut-off value of 51 μg/g, AUC = 0.7. The sensitivity of FC at this cut-off value is zero for enteritis with a specificity of 35%. Conclusion Fecal calprotectin could be helpful in screening patients with pain to the right lower quadrant for the presence of acute appendicitis or infectious enteritis with the aim of facilitating clinical decision-making and reducing the rate of negative appendectomy.

Distress thermometer for preoperative screening of patients with oral squamous cell carcinoma

In this study, we evaluate the association between distress, various demographic and medical variables, and the prevalence of psychosocial distress in preoperative patients with oral squamous cell carcinoma. A total of 100 consecutive patients were recruited into the study and asked to complete the Distress Thermometer (DT) form with the Problem List questionnaire prior to surgical intervention; the average distress score was 5.7 ± 2.7. The distress score was neither correlated with age (r = −0.025; p = 0.804) nor with tumor size (r = 0.028; p = 0.785). General worries, anxiety, sadness, depression, pain, exhaustion, sleeping disorders, or problems with nutrition resulted in significantly higher distress scores compared to patients without these complaints. Individuals with a DT score of 5 or higher (p = 0.006) were advised to seek out psychological support. There is a strong correlation between a high DT score and emotional disorders, as well as physical problems.