Preoperative Status Research Articles

GIANT LUMBO-SACRAL TUMORS

Objectives Despite comprising just 8% of all spinal tumors, sacral tumors present a long list of issues that should be taken in consideration when neurosurgical approach is tempted. Their unique anatomic location, close relation with neural structures and pelvic organs and high-vascularity are just a few nuances of these type of conditions. This paper outline the importance of a good preoperative and intraoperative management in order to facilitate the maximum recovery of the patients. Material and Methods This paper analyses retrospectively a series of 2 cases of giant sacral tumors (>100 cm3) that were operated in our clinic in 2024 by a multidisciplinary team (neurosurgeons and general surgeons). Follow-up data were obtained from the charts and medical records. All the lesions were localised under L4 vertebra with invasion of sacrum. Results Our first case was a 47-years old man who accused diffuse mild lumbar pain for more than 2 years, but acutely aggravated in the last months with lumbosacral radicular pain, palsy of the inferior lumbar nerves, urinary incontinence and paraesthesia. MRI showed a giant L5-S2 mass and biopsy diagnostic was myxopapillary ependymoma. Second case was of a young woman with lumbosacral radicular pain debuted a few months ago, whose clinical state worsened rapidly becoming paralytic of lower limbs. MRI showed a giant sacral mass with invasion of the pelvic musculature and surrounding the iliac vessels (intraoperative aspect: sarcoma). Both patients ameliorated postoperatively, and are currently enrolled in a recovery program. Sub-total resection and near-total resection were obtained. Conclusions Sacral tumors exhibit a challenge in the field of spine surgery being clinical silence over a period of months and years, and then followed by gross deficit. We diagnosed sacral tumors based on clinical, radiographic and laboratory aspects. Prognostic factors were preoperative clinical status and gross-total resection.

Early versus delayed laparoscopic cholecystectomy for gallbladder perforation

BACKGROUND Gallbladder perforation occurs in 2% to 11% of patients with acute cholecystitis, with associated mortality estimated to be at 12% to 42%. Because of its low incidence, the data on management remain sparse. There is a lack of evidence to suggest whether early or delayed cholecystectomy is superior in the treatment of perforated cholecystitis. We hypothesize that an early definitive operation is associated with decreased total hospital length of stay (THLOS). METHODS Using the National Surgical Quality Improvement Program database from the American College of Surgery, we identified patients who underwent laparoscopic cholecystectomy for gallbladder perforation on an urgent or emergent basis from 2012 to 2021. We divided them into those who underwent early (<2 days from the date of admission to the date of operation) and delayed cholecystectomy (≥2 days from the date of admission to the date of operation). Our primary outcome was the THLOS. We created multivariate regression models to assess for the association of early versus delayed operation and THLOS. RESULTS The THLOS was found to be 2.94 days longer in the delayed group compared with the early group (p < 0.05). In those who did not present with sepsis on admission, the THLOS was noted to be 4.71 days longer in the delayed group compared with the early group (p < 0.05). Early versus delayed operation was not associated with a difference in the postoperative length of stay, 30-day postoperative complications, rate of readmission, and reoperation, regardless of preoperative sepsis status. CONCLUSION Early laparoscopic cholecystectomy for gallbladder perforation is associated with decreased THLOS, and there were no other differences in outcomes compared with delayed laparoscopic cholecystectomy. Patients with gallbladder perforation would likely benefit from an early operation within 2 days of admission. LEVEL OF EVIDENCE Therapeutic/Care management; Level III.

Predictors of nodal upstaging in clinical N1 nonsmall cell lung cancer

Abstract Background Surgical resection followed by adjuvant chemotherapy is currently the first choice for the treatment of clinical N1 (cN1) non-small cell lung cancer (NSCLC). However, diagnosing cN1 correctly can be difficult, even with current imaging diagnostic technologies. We aimed to analyze the diagnostic accuracy of preoperative nodal status and the predictive factors for nodal upstaging of cN1-NSCLC. Methods Patients receiving surgery for cN1-NSCLC in 2010 (n = 1040) were enrolled in the Japanese Joint Committee of Lung Cancer Registry Database. We investigated the diagnostic accuracy of cN1, predictive factors for nodal upstaging, and prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Results The 5-year OS and RFS for all patients were 58.2% and 42.7%, respectively. The postoperative pathological nodal status included N0 (36.6%), N1 (39.7%), N2 (23.6%), and N3 (0.1%). In multivariate analysis, younger age (P = .005), no history of smoking (P = .006), and adenocarcinoma (P < .001) were significant predictive factors for nodal upstaging. Older age (P < .001) and higher clinical T (cT) factor (P < .001) were significant indicators for worse OS, while older age (P = .02), higher cT factor (P = .019), high carcinoembryonic antigen value (P = .002), and adenocarcinoma (P = .008) were significant indicators for worse RFS. Conclusions The diagnostic accuracy of cN1 in this study was ~40%. No history of smoking and adenocarcinoma were significant predictors for nodal upstaging. Although younger age was a significant predictor for nodal upstaging, it was a significant factor for better prognosis.

Abstract 4136013: Pre-operative Frailty Status and Short-term Complications Among Adults Undergoing Transcatheter Aortic Valve Replacement

Introduction: The use of Transcatheter Aortic Valve Replacement(TAVR) has provided a safer alternative to open surgical approaches. The introduction of frailty scoring systems has proven effective in improving healthcare approaches and outcomes in various aspects of medicine. As there is a paucity of data on the impact of frailty among TAVR patients, we aim to conduct a retrospective study to investigate further. Methods: Our study analyzed adult cases with a primary procedural code for TAVR among hospitalizations between 2016 and 2021 through the National Inpatient Sample(NIS). Frailty status was explored through the criteria of Gilbert’s frailty index. Multivariable regression models helped evaluate differences in short-term outcomes and complications between them. Results: Our study involved 374200 cases of TAVR that were divided into LFR(285425 cases, 76.3%), IFR(86005 cases, 23.0%), and HFR(2770 cases, 0.7%). Compared to patients with LFR, patients with MFR and HFR showed higher odds of several complications, including cardiogenic shock(MFR: aOR 6.933, p<0.001, HFR: aOR 13.303, p<0.001), acute kidney injury(MFR: aOR 9.737, p<0.001, HFR: aOR 26.685, p<0.001 ), use of invasive mechanical ventilation(MFR: aOR 10.763, p<0.001,HFR: aOR 39.432, p<0.001), events of acute myocardial infarction(MFR: aOR 3.32, p<0.001, HFR: aOR 6.021, p<0.001), need for transfusion of blood products(MFR: aOR 3.027, p< 0.001, HFR: aOR 5.938,p<0.001), post-procedural bleeding(MFR: aOR 2.475, p<0.001, HFR: aOR 3.277, p<0.001), IABP use(MFR: aOR 4.942, p<0.001, HFR: aOR 9.703, p<0.001), and need for pericardiocentesis(MFR: aOR 3.804, p<0.001, HFR: aOR 4.217, p<0.001). Moreover, patients with MFR and HFR reported higher mortality risks than those with LFR(MFR: aOR 6.375, p<0.001, HFR: aOR 16.035, p<0.001 )(Table 1). Conclusion: Our study confirms the higher odds of various complications with increasing frailty status, including all-cause in-hospital death. A careful assessment of pre-operative frailty status along with close monitoring of pre-, peri-, and post-operative status will help improve the outcomes and provide care in a timely fashion.

INNV-17. SAME-DAY DISCHARGE AFTER LASER INTERSTITIAL THERMAL THERAPY: A PROSPECTIVE COHORT PILOT STUDY WITH A MATCHED CONTROL GROUP

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for intracranial pathologies, offering precision and control over tissue damage. With implementation of enhanced recovery after surgery (ERAS) protocols within neurosurgery, identifying patients amenable for same-day discharge (SDD) is an important step towards streamlining perioperative care following LITT, and correspondingly, we aim to summarize our initial experience. METHODS We conducted a prospective study at the University of Miami Hospital of 7 patients who underwent LITT for intracranial pathologies and were discharged on the same day of ablation (post-ablation day 0, PAD0). We then performed a retrospective case-control study against a historic matched PAD1 cohort comparing categorical and continuous variables for statistical significance. RESULTS The mean age of the PAD0 cohort was 55 years with 71% males. Preoperative neurological status and comorbidities did not differ significantly between the PAD0 and PAD1 cohorts for KPS (median [IQR]: 80 [80-90] vs. 90 [80-90], p=0.40), mFI-5 (median [IQR]: 1 [1.5] vs. 0 [1], p=0.54), and mFI-11 (median [IQR]: 1 [1.5] vs. 1 [1], p=0.52). PAD0 outcomes demonstrated no immediate complications, neurosurgical readmissions, or significant neurological deficits within 6 months post-procedure and were non-significantly different than PAD1 patients. No PAD0 patient experienced intracranial hemorrhage or vasogenic edema following LITT that necessitated further intervention. CONCLUSIONS Our study demonstrates the safety and feasibility of same-day discharge following LITT for intracranial pathologies in the appropriately selected patient. Through meticulous patient selection and optimized perioperative protocols, expedited recovery without compromising patient outcomes was achieved. This approach holds potential for substantial cost savings and resource optimization within healthcare systems. Further research and quality improvement initiatives are warranted to refine patient selection criteria and maximize the benefits of same-day discharge in LITT practice.

RADT-38. CLINICAL, MOLECULAR AND IMAGING FEATURES ASSOCIATED WITH LONG TERM SURVIVAL IN GLIOBLASTOMA PATIENTS

Abstract INTRODUCTION Glioblastoma (GBM) is the most common malignant brain tumor in adults and has poor prognosis despite standard of care treatment. Nevertheless, certain patients surpass survival expectations. This study seeks to identify the clinical, molecular, and imaging characteristics of GBM associated with extended patient survival. METHODS In this retrospective cohort study, we examined records of adult GBM patients (WHO 2016 classification) treated at Thomas Jefferson University Hospital from 2010 to 2023. Exclusion criteria included a preoperative Karnofsky Performance Status (KPS) below 60 and treatment with hypo-fractionated radiation therapy. Patients were categorized into two groups: short-term survivors (STS), who survived less than 36 months from diagnosis, and long-term survivors (LTS), who survived more than 36 months. We reviewed patient charts and pathology reports for comprehensive clinical and molecular data. For radiomics analysis, tumor segmentation was performed using CaPTk software on the initial diagnostic MRI (T1 pre and post-contrast, FLAIR and T2 sequences). The relationship between overall survival of more than three years was analyzed with univariable logistic models for potential predictors using R statistical software. RESULTS Of the cohort of 210 patients, 37 (17.6%) survived beyond three years. The median age at diagnosis was 55 years (range; 29-79) Twenty-two patients were male and 15 were female. Twenty-two percent had IDH mutation and 65% had MGMT methylation. Factors associated with long-term survival included younger age at diagnosis (p =0.007), MGMT hypermethylation (p =0.019), IDH mutation (p=0.001), absence of TERT mutation (p = 0.002), higher average number of adjuvant temozolomide cycles (10 vs. 5; p = 0.005), and smaller volume of enhancing tumor on T1 post-contrast imaging segmentation (p=0.022). But there was no significant difference in FLAIR abnormality or necrotic core volumes between the groups. CONCLUSION In our cohort of GBM patients, patients diagnosed at a younger age, MGMT hypermethylation, IDH mutation, absence of TERT mutation, receiving more cycles of adjuvant temozolomide treatment, and smaller enhancing tumor volume on preoperative T1 post-contrast imaging were associated with longer survival. Future research involving larger cohorts and validation of our findings is needed.

TMIC-14. RAPID EARLY PROGRESSION IN GLIOBLASTOMA: A COMPREHENSIVE REVIEW OF CLINICAL, IMAGING AND HISTOPATHOLOGICAL FEATURES

Abstract BACKGROUND In glioblastoma patients, Rapid Early Progression (REP) refers to tumour growth between the time of surgery and postoperative chemoradiotherapy. Despite its high incidence relatively little is known about it. The aim of this study was to characterise REP using a combination of clinical, imaging and histopathology data. METHODS Ethical approval was obtained. Supratentorial IDH-wildtype glioblastomas undergoing gross-total resection (GTR) between 2015-2021 were included. REP was defined as a nodular increase in enhancement located within or around the surgical cavity, occurring within 6 weeks of surgery, that was not accounted for by initial areas of diffusion-restriction. REP cases were propensity-score matched to controls on baseline characteristics. Imaging was compared using mean apparent diffusion coefficient (ADC) and T1-postcontrast radiomics. Tissue analyses included DNA methylation subtyping and immunohistochemistry for markers of T-cells (CD3), microglia (P2RY12) and proliferation (PHH3). RESULTS REP occurred in 8/60 GTR cases (13%) and these patients were matched to 16 controls. REP cases had a worse preoperative performance status (median Eastern Cooperative Oncology Group [ECOG] 2 vs. 1), overall-survival (p=0.038) and progression-free survival (p = 0.029). REP was more common in patients over 65 years (27%) and significantly fewer REP patients received radical postoperative chemoradiotherapy (p=0.023). REP and control cases were well matched with respect to preoperative T1-postcontrast radiomics and mean ADC in enhancing (p=0.99) and non-enhancing regions (p=0.67). There was no relative excess of any one DNA methylation subtype in REP cases. The two groups had a similar proportion of T-cells (p=0.81), but REP cases had a trend towards a higher proportion of microglia (31% vs. 17%; p=0.22), and a lower proliferation rate (3% vs. 9%; p=0.19). CONCLUSION REP cases had a worse performance status from diagnosis and received less radical postoperative chemoradiotherapy protocols compared to controls, yielding a significantly shorter median OS/PFS. Differences in immune landscape and proliferation rate should be further investigated.

Preoperative vs. Postoperative Functional and Pain Status in Arthroscopic ACL Reconstruction Using Quadriceps Tendon

Introduction: Anterior cruciate ligament (ACL) injuries significantly impact mobility and overall quality of life, necessitating prompt and effective intervention. The purpose of this study was to assess preoperative versus postoperative functional and pain status in arthroscopic ACL reconstruction using the quadriceps tendon. Aim of the study: The aim of the study was to evaluate preoperative versus postoperative functional and pain status in arthroscopic ACL reconstruction using the quadriceps tendon. Methods: This prospective interventional study was conducted in the Department of Orthopaedic Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2020 to August 2022, enrolling 30 patients with isolated anterior cruciate ligament (ACL) injuries. Informed consent was obtained, and diagnoses were established through X-rays and MRI. Outcome measures were evaluated using the Lysholm score, Tegner score, and Visual Analogue Scale (VAS) at follow-up intervals, with statistical analysis conducted using SPSS version 26.0. Result: The study of 30 patients (mean age 29.73 ± 7.00 years, 90% male) found significant improvements post-surgery: Lysholm scores rose from 48.57 to 89.63, Tegner scores from 3.03 to 7.10, and VAS pain scores dropped from 0.90 to 0.20 (all p < 0.001). Conclusion: Arthroscopic ACL reconstruction using the quadriceps tendon led to significant improvements in knee function, enhanced activity levels, and reduced pain, demonstrating its effectiveness in restoring pre-injury status.

Efficacy and safety of prostatic urethral lift according to preoperative urinary retention and prostate volume: A Japanese real-world multicenter data.

Prostatic urethral lift (PUL) for benign prostatic hyperplasia has recently been initiated in Asia; therefore, few studies with real-world data have been reported. This study evaluated the efficacy and safety of PUL using Japanese real-world multicenter data. Indications for PUL were based on relevant guidelines in Japan. The preoperative patient status, postoperative progress at 1 and 3 months, and perioperative complications were evaluated. Also, we compared preoperative urinary retention and nonurinary retention patients, and prostate volumes <30, 30 to <50, and ≥50 mL. A total of 160 patients were included in the study. The mean age was 75 years and the mean prostate volume was 44 mL. The International Prostate Symptom Score, quality of life score, maximum flow rate, and postvoid residual volume significantly improved 1 and 3 months postoperatively compared to preoperatively. The catheter-free rates in the preoperative urinary retention group were 58.1%, 72.1%, 83.7%, and 88.4% on postoperative days 1, 7, 30, and 90, respectively. The catheter-free rates in the nonurinary retention group were 94.9%, 98.3%, and 100% on postoperative days 1, 7, and 14, respectively. The group with a prostate volume ≥50 mL had a longer operation time and used significantly more implants; however, no difference was observed in the postoperative urinary status among the three groups. PUL can be considered a safe and effective procedure for both preoperative urinary retention and nonurinary retention patients with prostate volumes <100 mL in older patients with comorbidities.

Impact of Insurance Status on Postoperative Recovery After Microsurgical Breast Reconstruction.

Persistent disparities in breast reconstruction access have been widely documented, yet a significant research gap remains in understanding the impact of social determinants of health (SDOH) on postoperative outcomes and complications. A retrospective chart review was performed on all patients who underwent abdominal-based free-flap breast reconstruction between August 2018 and December 2022 at a racially, ethnically, and socioeconomically diverse urban academic institute with a historically underserved patient population. Patients were stratified by the public (Medicare and Medicaid) versus private insurance as a proxy for SDOH. Patient demographics, length of stay (LOS), timing in progression through postoperative recovery milestones, and complications were compared. A total of 162 patients were included, and 57% of patients had public insurance, with this group more likely to be Hispanic (OR2.7; p=0.003) and Spanish-speaking (OR3.4; p=0.003). Privately insured patients were more likely to be non-Hispanic black (OR2.7; p=0.006). Patients with public insurance had a higher rate of unplanned return to the operating room within 90 days and a higher incidence of complications, though not statistically significant. They also experienced a significantly longer LOS than privately insured patients (3.6±1.0 days vs 3.0±0.7 days; p<0.0001). Logistic regression identified a LOS exceeding 3 days as independently associated with public insurance status (OR3.0; p=0.03), bilateral procedure (OR5.6; p=0.0007), preoperative functional-dependent status (OR7.0; p=0.04), and higher BMI (OR1.1; p=0.03). Patients with public insurance were more likely to encounter delays in achieving recovery milestones. Public insurance status, serving as a proxy for a disadvantage in SDOH, is predictive of extended LOS and postoperative recovery delays following microsurgical breast reconstruction. This underscores the need for future quality improvement efforts to address and mitigate these disparities.

Factors Associated With Return to Work Following Laminoplasty for Degenerative Cervical Myelopathy.

Retrospective cohort study. To identify factors predictive of returning to work within 90 days of laminoplasty for degenerative cervical myelopathy (DCM). DCM is a debilitating condition resulting from spinal canal stenosis and spinal cord compression. One surgical option for cord decompression is cervical laminoplasty. Factors influencing return to work (RTW) postsurgery are unknown. This study included adult patients previously employed, undergoing primary elective laminoplasty for DCM, and with documented RTW status. Variables included demographic information, medical history, illness characteristics, and baseline patient-reported outcomes. The primary outcome of interest was RTW status at 90 days. Statistical analyses were conducted to identify predictors. Forty-six patients (67.6%) returned to work within 90 days, whereas 22 (32.3%) either RTW between 90 and 365 days (n = 3) or did not RTW within 365 days (n = 19). Significantly more patients who RTW within 90 days worked full-time (90.9% vs 64.3%, P = 0.030). Patients who RTW within 90 days had significantly lower preoperative Neck Disability Index scores (23.7 ± 17.5 vs 35.6 ± 14.3, P = 0.008) and higher preoperative modified Japanese Orthopedic Association scores (13.7 ± 2.5 vs 12.2 ± 2.7, P = 0.018) compared with those who did not RTW. No differences were found in other baseline patient-reported outcomes. Patients who RTW within 90 days had significantly lower postoperative 3-month neck pain (2.0 ± 2.1 vs 3.8 ± 2.6, P = 0.007), 3-month arm pain (1.3 ± 1.9 vs 3.6 ± 2.8, P < 0.001), 12-month neck pain (1.4 ± 1.6 vs 3.1 ± 2.4, P = 0.019) and 12-month arm pain (1.1 ± 1.8 vs 2.4 ± 2.4, P = 0.048) compared with those who did not RTW within 90 days. Higher preoperative modified Japanese Orthopedic Association scores were significantly associated with truncated time to RTW (HR: 1.14, 95% CI: 1.01-1.29, P = 0.034). Patients with better preoperative neck and arm pain and functional scores were more likely to RTW within 90 days postlaminoplasty. Preoperative functional status plays an important role in assessing RTW postlaminoplasty. This information is valuable for preoperative patient counseling.

Impact of anesthesia type on surgical outcomes and medical complications in chronic subdural hematoma surgery

BackgroundsChronic Subdural Hematoma (CSDH) is common in elderly patients. Although general anesthesia (GA) has traditionally been used for CSDH surgeries, it may lead to postoperative complications, especially in older patients. We hypothesized that local anesthesia (LA) could reduce postoperative medical complications, including pneumonia, compared to GA. MethodsWe conducted a retrospective study from 2015 to 2019, of medical records of CSDH patients from two hospitals in addition to a comprehensive literature review. Inclusion criteria were a new CSDH diagnoses and treatment with burr-hole craniostomy (BHC) and drain insertion. Patients with recent ipsilateral craniotomies were excluded. Clinical variables included demographics, comorbidities, hematoma characteristics, and post-operative outcomes. ResultsOf 383 eligible patients, 63 underwent BHC under LA (LA group), and 320 under GA (GA group). Both groups exhibited similar baseline characteristics, hematoma characteristics, and surgical outcomes, including postoperative CT findings and ICU stay duration. There was also no significant difference in postoperative bleeding events between the groups. Although patients in the GA group experienced a higher incidence of postoperative pneumonia (3.8 % vs 1.6 %), multivariate analysis revealed that the occurrence of pneumonia was associated with a history of lung disease and preoperative neurological status (OR 7.28, p = 0.018, OR 3.40, p < 0.001, respectively) rather than with the type of anesthesia used. ConclusionOur study suggests that the type of anesthesia does not influence postoperative surgical and medical outcomes, including pneumonia, which is the most common medical complication of BHC for CSDH. Rather, preoperative neurological status and underlying morbidities appear to be more closely related to postoperative medical complications. Future large, prospective studies are needed to validate our findings.

Comparing the Exactech Equinoxe Reverse TSA for Fracture versus Degenerative Conditions: Five-Year Minimum Follow-Up

Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exists on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up. Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007-2018. Patients with a minimum follow-up of 5 years were then split into fracture and degenerative cohorts and matched 1:3 based on age, sex, and follow-up duration. Clinical and radiographic outcomes were compared between the cohorts including range of motion (ROM), patient-reported outcome measures (PROM), VAS pain score, complication and revision rates, implant characteristics, and scapular notching. This data was analyzed using Welch's t-test, Fisher's exact test, or Wilcoxon rank sum test. There were 384 total patients included in the study, with 96 fractures and 288 degenerative. At a mean follow-up of 6.4 years, the degenerative cohort had significant improvements in all PROMs and ROM, compared to their preoperative status. At the latest follow-up, the mean ASES score was 83 and the mean VAS pain score was 1.1 for both cohorts. Patients with degenerative indications had greater forward elevation which did not meet the minimally clinically important difference and greater internal rotation which did not meet the substantial clinical benefit threshold. Patient satisfaction was very high for both cohorts, with 97% in the degenerative cohort and 91% in the fracture cohort satisfied with the procedure (p=0.276). Complication and revision rates were similar between the two cohorts. Patients in the fracture cohort had a larger glenosphere diameter (p=0.045) and greater combined liner/tray offset (p=0.05). Patients in the elective cohort more frequently required an augmented baseplate (p<0.001). Scapular notching was 11% in the degenerative cohort and 9% in the fracture cohort (p=0.82). This study demonstrates no significant differences in the clinical or radiographic outcomes at a minimum of 5 years follow-up for patients undergoing rTSA for acute fracture versus degenerative conditions. Patients undergoing rTSA for either indication have similar rates of complications, revisions, and scapular notching, with high patient satisfaction. Patients undergoing rTSA for an acute fracture can expect similar results to those undergoing rTSA for degenerative conditions at minimum 5-year follow-up.

12056 Optimizing Pre-Operative Hemoglobin and Iron Status Prior to Gynecology Surgery: A Multidisciplinary Collaborative Approach

12056 Optimizing Pre-Operative Hemoglobin and Iron Status Prior to Gynecology Surgery: A Multidisciplinary Collaborative Approach

Predictors of self-care in kidney transplant patients according to preoperative dialysis: A comparative study

BackgroundPreemptive kidney transplantation (PKT) is associated with reduced dialysis-related morbidity and improved graft survival, which has led to an increase in the prevalence of PKT. The distinct clinical pathways of PKT and non-preemptive kidney transplantation (NPKT) patients may affect their ability to perform self-care, a key factor in post-transplant recovery. However, there is ongoing controversy regarding which group demonstrates better self-care abilities, highlighting the need to explore the factors influencing self-care in each group. ObjectivesThis study aims to identify and compare predictors of self-care in PKT and NPKT groups. MethodsWe collected data from 209 KT recipients, consisting of 101 PKT and 108 NPKT patients, using self-administered questionnaires. These questionnaires assessed general and disease-specific characteristics, stress, social support, and self-care behaviors. Data were analyzed using descriptive statistics, t-tests, ANOVA, and multiple regression analysis. ResultsThe study identified significant predictors of self-care among both PKT and NPKT patients. For PKT patients, marital status (β =.19, p=.033) and family support (β =.28, p=.006) are key predictors of self-care, with those having spousal support and strong family networks reporting better self-care levels. Conversely, in NPKT patients, significant predictors of self-care included marital status (β =.31, p=.001), employment status (β =.29, p=.007), post-transplantation duration (less than 36 month) (β =.-.22, p=.015), post-transplantation duration (36-72 month) (β =.-.33, p=.001), and stress levels (β =-.20, p=.028). ConclusionsThe study provides valuable insights into the predictors of self-care based on preoperative dialysis status, illustrating distinct predictors between the growing population of PKT and NPKT patients. These findings emphasize the need for personalized nursing strategies to enhance post-transplant self-care, tailored to individual patient characteristics.

Preoperative nutritional status and serum insulin-like growth factor of children with cyanotic and acyanotic congenital heart disease

BackgroundMalnutrition is common among children with congenital heart disease (CHD). We compared the anthropometric indices, serum insulin-like growth factor (IGF), and IGF acid-labile subunit (IGFALS) of children with cyanotic and acyanotic CHD before corrective surgery. MethodsThis 82-patient case-control study included 1- to 24-month-old CHD patients referred for corrective surgery. (41 with tetralogy of Fallot [TOF] and 41 with ventricular septal defect [VSD] or atrial septal defect [ASD]). Anthropometric indices represented as Z-scores were used to determine nutritional status. Serum IGF-1 and IGFALS levels were measured. ResultsThe median [quartile] age of the acyanotic group was 8 [7,11] months which was lower than the cyanotic group (11 [8,14.5] months). The prevalence of underweight (weight for age Z [WAZ] < −2), wasting (weight for length Z [WLZ] < −2), and thinness (body mass index Z [BMIZ] < −2) was significantly higher in children with acyanotic than cyanotic children with. WAZ, WLZ, and BMIZ were significantly lower in acyanotic children than cyanotic children with CHD (-2.5±1.2 vs -1.0±1.2, p<0.001 for WAZ, -2.5± 1.5 vs -0.8±1.4, p<0.001 for WLZ, and -2.5±1.5 vs -0.8±1.4, p<0.001 for BMIZ), but length for age Z was not different between the two groups (-1.2±1.0 vs -0.8±1.1, p=0.31). A comparison of preoperative serum albumin, IGF-1, and IGFALS showed no differences. ConclusionsIn CHD children without corrective surgery, moderate to severe underweight and wasting were more common in acyanotic CHD (VSD and ASD) than in cyanotic CHD (TOF), but the higher prevalence of malnutrition was not associated with lower IGF-1 and IGFALS levels.

Preoperative nutritional scores to predict mortality after liver transplantation: a retrospective cohort study.

Malnutrition is a well-known risk factor for mortality and morbidity. We investigated whether preoperative malnutrition, diagnosed using an objective nutritional index, was associated with postoperative mortality in patients undergoing liver transplantation (LT). This retrospective cohort observational study assessed the preoperative nutritional status of 440 patients who underwent LT, using the Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score. We evaluated the association between preoperative malnutrition and 3-year postoperative mortality using the Kaplan-Meier curve and log-rank test. In addition, we identified prognostic factors for mortality using Cox proportional hazard analysis. Malnutrition was identified in 72.7% (n = 320), 66.1% (n = 291), and 97.3% (n = 428) of patients as assessed by the NRI, PNI, and CONUT score, respectively. The Kaplan- Meier survival curve demonstrated that mortality increased with the presence and severity of malnutrition risk, as assessed by the NRI and PNI, respectively; however, NRI was the only index identified as an independent risk factor for mortality, along with preoperative renal replacement therapy, platelet count, and C-reactive protein. After adjustment, lower NRI was associated with a higher risk of mortality (hazard ratio 0.97, 95% confidence interval 0.95- 0.99, P = 0.009). The malnutrition group (NRI ≤ 100) had a significantly greater incidence of postoperative acute kidney injury than that of the normal group. Preoperative NRI is an independent risk factor for mortality after LT, and therefore it would be a helpful tool for mortality risk stratification in patients undergoing LT.

The role of surgery in recurrent local cerebral metastases: a multi-institutional retrospective analysis.

Local recurrent brain metastases are defined as lesions that recur in the brain at the same site after a previous local therapy. In patients already submitted to surgery, a second operation may be potentially challenging due to scar formation, infiltration of cerebral vessels or eloquent brain areas and local effect of previous radiotherapy. The aim of this study is to retrospectively review the results and complications of a second surgical treatment in a series of local recurrent lesions and to review the literature on this topic. 37 patients submitted to surgery for a local, histologically confirmed, recurrent brain metastases between 2000 and 2022 were retrospectively analyzed with respect to the following parameters: age, histology, anatomic location, time to recurrence, previous radiotherapy, size of recurrent tumors, preoperative and postoperative Karnofsky Performance Status(KPS) score, recursive partitioning analysis (RPA) class and graded prognostic assessment (GPA) score, surgery-related complications and the presence of further cerebral metastases. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariate Cox proportional hazard model was developed using stepwise regression (forwards selection) with predictive variables that were significant in the univariate analyses. A significant improvement of post-operative KPS status was obtained after second surgery. At multivariate analysis better results in terms of OS were achieved in patients with a pre-operative KPS ≥ 70 and in patients who had received radiotherapy after the initial surgery. No significant postoperative complications related to previous treatments were observed. Surgical resection of local recurrent brain metastases may improve patients ́ neurologic conditions allowing more time for systemic therapies to act with a low incidence of surgery-related morbidity and mortality. However, careful patient selection with a fair pre-operative clinical status seems mandatory to achieve the best post-operative results, since uniform treatment-paradigms cannot be established yet, due to the highly heterogeneous patient cohort.

The Disaggregated Oswestry Disability Index: What is the Most Predictive Subsection for Patient Satisfaction After Lumbar Surgery?

Retrospective review of cohort studies. To analyze how different ODI subsections and their improvement affect patient satisfaction 2 years after elective lumbar surgery for degenerative lumbar spondylolisthesis (DLS). The Oswestry Disability Index (ODI) is crucial in evaluating outcomes of spinal disorders and provides valuable insights into a patient's preoperative status. There is limited information available on the individual characteristics of its subsections and their relation to postoperative patient satisfaction. Pre- and 2-year postoperative ODI and patient satisfaction were assessed. The analysis included preoperative scores and improvements in each ODI subsection 2 years postoperatively. Satisfaction was rated on a scale of 1 to 5, with scores ≥4 deemed satisfactory. Univariate linear regression and ROC analysis established cutoffs for subsection improvement and postoperative target values to achieve postoperative satisfaction. 265 patients (60% female, 67±8 years) were included. ODI improvement was achieved in 91%, and postoperative patient satisfaction in 73%. Patients with lower postoperative subsection scores and greater differences between pre- and postoperative scores were more likely to be satisfied (all P<0.001). A postoperative subsection target score of ≤1 was associated with patient satisfaction. Change in degree of pain was the most predictive subsection for satisfaction, with an AUC of 0.84 (sensitivity 79%, specificity 86%). Walking (AUC 0.83, sensitivity 87%, specificity 65%), pain intensity (AUC 0.82, sensitivity 79%, specificity 79%), personal care (AUC 0.82, sensitivity 83%, specificity 68%), and standing (AUC 0.82, sensitivity 83%, specificity 83%) all had an AUC greater than 0.80. The postoperative subsection with the lowest predictability was sleeping (AUC 0.69). Pain domains, walking, standing, and personal care were the subsections with the highest predictability for patient satisfaction. These findings on the correlation between different ODI subscales and patient satisfaction are valuable for improving preoperative education, addressing disability, and ensuring postoperative satisfaction.

Effects of multilevel OSA surgery on patients with poor cardiopulmonary performance: A prospective pilot study

ObjectiveMultilevel airway surgery for obstructive sleep apnea/hypopnea syndrome (OSA) has benefits in improving sleep quality, but its effect on polysomnography (PSG) and 6-minute walk test (6MWT) parameters, including walking distance and cardiopulmonary performance, in patients with poor pre-operative cardiopulmonary performance remains understudied, which should be further investigated. MethodsThis prospective pilot study enrolled 27 consecutive OSA patients with poor pre-operative 6MWT results. All patients received multilevel OSA surgery, and the alterations of sleep parameters and 6MWT profiles were studied. The pre- and post-operative values of polysomnographic data and 6MWT profiles were analyzed using the Wilcoxon signed-rank tests. The relationships among changes of the indices of PSG and 6MWT were further investigated with the Spearman's correlations. ResultsAfter surgery, the sleep parameters and certain cardiopulmonary indices improved. When analyzing the correlations among changes of the indices of PSG and 6MWT, the improvement of daytime sleepiness (with ESS) was found related to farther walking distance (ρ=-0.414, p = 0.032) and higher percentage of “distance/target distance” (ρ=-0.435, p = 0.023). Moreover, the change of maximal expiratory pressure was the only index associated with the changes of AHI (apnea/hypopnea index, /hr.; ρ=-0.407, p = 0.035) and AHI in REM (ρ=-0.502, p = 0.009) among the cardiopulmonary performance parameters. ConclusionThis pilot study showed that OSA patients with poor pre-operative cardiopulmonary status undergoing multilevel sleep surgery could experience improvement in the sleep study and 6MWT to some extent. The relatively better walking distance and cardiopulmonary performance after the operation might potentially result from the improvement of daytime sleepiness and better respiration.