Presence Of Postoperative Complications Research Articles

Evaluating Short-Term Patient-Reported Outcome Measures Following Total Hip and Knee Replacement: A Comprehensive Review.

Total hip replacement (THR) and total knee replacement (TKR) are widely performed surgical procedures to alleviate pain and improve function in patients with joint-related diseases. Short-term patient-reported outcome measures (PROMs) have become a key metric in assessing the success of these surgeries from the patient's perspective, focusing on early recovery, pain management, mobility, and quality of life. This comprehensive review evaluates the significance of short-term PROMs following THR and TKR, highlighting commonly used tools such as the Oxford Hip Score (OHS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short-form health survey (SF-36). The analysis explores the impact of various factors, such as age, preoperative health status, and surgical technique, on short-term outcomes. Findings from recent studies indicate that while patients generally report improvements in physical function and pain relief within the first six months post-surgery, individual outcomes can vary significantly. Factors like early rehabilitation, mental health, and the presence of postoperative complications can influence the trajectory of recovery and satisfaction levels. Moreover, the review addresses the limitations of current PROMs, including variability in reporting and sensitivity to different patient populations. This review emphasizes the need for more personalized and standardized approaches to PROM assessment to better capture patient experiences and optimize postoperative care. Future research should focus on integrating PROMs with long-term follow-up data and digital health tools to track real-time patient progress, thus enhancing the overall quality of care for THR and TKR patients. Short-term PROMs play a vital role in understanding patient outcomes and guiding clinical practice for joint replacement surgeries.

Effective factors on postoperative 30–90 and 360-day mortality in non-small cell lung cancer

PurposePostoperative mortality and morbidity are serious problems, and the identification of risky patient groups will reduce mortality and morbidity rates. The aim of our study was to determine the mortality at 30, 90, and 360 days in patients who underwent surgical resection for non-small cell lung cancer (NSCLC). MethodsIn this single-center retrospective study, 935 patients who were operated on for NSCLC were included. Demographic characteristics, laboratory data, tumor characteristics, surgical method used, type of resection, postoperative complications, and the relationship between 30, 90, and 360-day mortality were analyzed. ResultsIn-hospital mortality was observed in 21 (2.2 %) of the 935 patients; the 30-90-360-day mortality rate was respectively 3 %, 4.9 %, and 12.1 %. The 30- and 90-day mortality rates were close (3 %, 4.9 % respectively), and the only difference was the additional surgical procedure. The common factors that increased 30-, 90-, and 360-day mortality were advanced disease stage, additional surgical procedure, length of stay longer than 7 days, low % forced vital capacity (FVC), presence of comorbidities, presence of postoperative complications, and pneumonectomy. ConclusionIn this study, 30-, 90-, and 360-day mortality rates and common and independent risk factors affecting mortality were determined. Although 30-day mortality is the most often utilized time period for assessing postoperative mortality, 90-day mortality can be used to predict postoperative mortality following a major surgical procedure. Preoperative mortality and morbidity are expected to decrease with more detailed preoperative examination of high-risk patients and special follow-up programs in the postoperative period.

Edge De-epithelialization for Reducing Pharyngocutaneous Fistula in Patch Free Flap Reconstructions for Salvage Total Laryngectomy Defects: A Case-Control Study.

The leakage of saliva through the deep neck region from a pharyngocutaneous fistula could cause devastating complications, including vascular ruptures leading to mortality. While a partial pharyngoesophageal defect is created after total laryngectomy, a patch pattern of hypopharyngeal reconstruction is required, for which a fasciocutaneous free flap is usually applied. If radiotherapy fails to cure pharyngeal cancer, salvage total laryngectomy (STL) is needed. However, postradiation tissues tend not to heal well, and the incidence of pharyngocutaneous fistula therefore increases. We proposed an edge-epithelialization method to address this problem and conducted a retrospective study for comparison. The inclusion criteria were patients with head and neck cancer who underwent total laryngectomy that immediately required patch free flap reconstruction at a single medical center (January 2012-December 2021). Receipt of presurgical radiotherapy, hospitalization duration, and the presence of postoperative complications were recorded. The included patients were separated into two groups: Group A (edge de-epithelialization not adopted) (n=79) and Group B (edge de-epithelialization adopted) (n=51). Forty-four and twenty-two patients in Groups A and Group B, respectively, received preoperative radiotherapies and simultaneous STL and fasciocutaneous free flap reconstructions. The incidence of pharyngocutaneous fistula was significantly lower in Group B (p=0.0145). This phenomenon was the same for patients who underwent preoperative radiotherapy only (p=0.0470) but not for patients who did not receive preoperative radiotherapy (p=0.2363). Edge de-epithelialization is an effective method for reducing pharyngocutaneous fistula formation in patch free flap reconstructions after STLs.

Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

<i>Background: </i>Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. <i>Methods: </i>Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. <i>Results: </i>35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). <i>Conclusions:</i>. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

The necessity of suction drainage when intra-articular injection of tranexamic acid is used during primary total knee arthroplasty: a retrospective study

BackgroundSuction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed that the administration of tranexamic acid (TXA) may prevent postoperative bleeding following TKAs. Although numerous studies have reported regarding different dosages, timings of administration, or drain clamping times for intravenous and intra-articular TXA injections (IA-TXAs), few have examined whether suction drainage is necessary when TXA is administered. In this study, we compared using suction drainage without TXA administration and IA-TXA without suction drainage and aimed to examine the need for suction drainage during IA-TXA.MethodsThis retrospective study was conducted on 217 patients who had received TKA for osteoarthritis; 104 were placed on suction drainage after TKA without TXA (Group A), whereas the remaining 113 received IA-TXA immediately after surgery without suction drainage (Group B). Our clinical evaluation included assessments of the need for transfusion, presence of postoperative complications, incidence of deep vein thrombosis (DVT), and changes in hemoglobin (Hb), hematocrit (Hct), and D-dimer levels.ResultsNo significant differences were observed in terms of postoperative complications and preoperative Hb, Hct, or D-dimer levels between the two groups. Although the prevalence of DVT was significantly higher in Group B (p < 0.05), all cases were asymptomatic. Hb and Hct levels were significantly lower in Group A than in Group B at 1, 3, 7, and 14 days postoperatively (p < 0.05), although none of the cases required blood transfusions. D-dimer levels were significantly higher in Group A than in Group B at 1 and 3 days postoperatively (p < 0.05).ConclusionSuction drainage might not be necessary when IA-TXA is administered after TKA procedures.

RECURRENCE AFTER MINIMALLY INVASIVE REPAIR OF INGUINAL HERNIA: INCIDENCE AND ASSOCIATED FACTORS

Abstract Background Minimally invasive laparoscopic surgery for inguinal hernia allows an approach to the entire myopectineal orifice, leading to an expected lower recurrence rate and/or incidence of occult hernias. Nevertheless, the literature reports recurrence rates of up to 12%, depending on the reported follow-up time. Methods Retrospective analysis of laparoscopic surgical corrections of inguinal hernias between January 2018 and March 2023. Evaluation of recurrence rate and factors associated with its development. Results During the analyzed period, 388 patients underwent laparoscopic surgical correction of inguinal hernia. In 183 patients, the surgical correction was bilateral, corresponding to 571 operated hernias (82% via TAPP and 18% via TEP). During an average follow-up of 22 months (6–65), the recurrence rate was 2.1%, diagnosed on average 14 months after surgery. The presence of postoperative wound complications and chronic pain were the only factors significantly associated with recurrence (p = 0.026, p &amp;lt;0.001, respectively). Factors such as gender (p = 0.155), age (p = 0.13), BMI (p = 0.3), smoking (p = 0.52), technique used (p = 0.391), recurrent hernia (p = 0.42) did not show an association with hernia recurrence. In multivariate analysis, the presence of postoperative complications was the only independent risk factor for recurrence (p = 0.04, OR 4). Conclusion In our study, the recurrence rate aligns with what is described in the literature. Limitations include the fact that only patients who returned to our hospital were diagnosed, and the short follow-up time in some cases. The learning curve of surgeons, both residents and specialists, during the implementation of the technique in our service may also impact these results.

STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Modification of Conventional Antrostomy, A Retrospective Review.

Introduction: Maxillary sinus pathology is commonly approached through endoscopic middle meatal antrostomy (MMA). However, MMA does not provide full exposure to certain aspects of the maxillary sinus, such as alveolar, zygomatic, and prelacrimal recesses. In these hidden maxillary sinus niches, a combination approach with MMA is required for better exposure and access. In this article, we present a modification of inferior maxillary antrostomy (IMA) to allow for a temporary intraoperative window with no significant postoperative consequences. Objectives: (1) To describe our modification of IMA. (2) To report the outcome of maxillary sinus disease, postoperative complications, and flap condition. Methods: This is a retrospective chart review study. It was performed on 20 patients where submucosal temporary inferior maxillary antrostomy (STIMA) was indicated in the period from January 1, 2020, and July 1, 2023. All patients were assessed for their demographics, diagnosis, indication for STIMA, maxillary disease outcome, presence of postoperative complications, and flap condition. Result: Total of 18 patients fulfilled our inclusion/exclusion criteria; of them, 13 were males while the remaining were females. Mean age of patients was 33 years; most common diagnosis was chronic sinusitis. Status of maxillary sinus mucosa was healthy in all except 4 patients having polypoidal mucosa while flap condition was intact in all patients except 2 patients with pinpoint defects. Postoperative complications assessment demonstrated no neural, orbital, lacrimal, or dental complications in all patients. Conclusion: This retrospective chart review showed promising technique to address challenging maxillary lesions in difficult-to-access locations where combined approaches are necessary.

Effect of in-hospital delay on acute appendicitis severity: does time really matter?

Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis. Patients were grouped into low, medium, and high preoperative risk for acute appendicitis based on the Alvarado scoring system. Appendicitis was defined as complicated in cases of perforation, abscess, or diffuse peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis. The study includes 804 patients: 278 (30.4%) had complicated appendicitis and median time delay to surgery in low-, medium-, and high-risk group was 23.15h (13.51-31.48), 18.47h (10.44-29.42), and 13.04 (8.13-24.10)h, respectively. In-hospital delay was not associated with the severity of appendicitis or with the presence of postoperative complications. It appears reasonably safe to delay appendicectomy for acute appendicitis up to 24h from hospital admission. Duration of symptoms was a predictor of complicated appendicitis and morbidity. Timing for appendicectomy in acute appendicitis should be calculated from symptoms onset rather than hospital presentation.

Short-Term Outcomes of Simultaneous Inguinal Hernia Repair at Laparoscopic Appendectomy in Children: Cohort Study

Background. Nowadays, simultaneous techniques have been widely adopted in abdominal pediatric surgery as they allow to perform surgical interventions for several diseases at the same time. However, the safety of such interventions requires further studies. Objective. The aim of the study is to analyze the short-term outcomes of simultaneous hernia repair in laparoscopic appendectomy in children. Methods. The study included data from patients hospitalized with suspected acute appendicitis in 2022–2023. The study group included children operated for acute appendicitis and who had signs of patent processus vaginalis. Percutaneous internal ring suturing (PIRS) was performed in all cases. The control group (no indirect inguinal hernia was revealed) was formed by pairwise matching of patients by gender, age (± 1 year), and appendicitis type. The surgery time, the blood loss volume, the beginning of enteral feeding, and the presence of postoperative complications were analyzed. Results. The compared groups (13 individuals each) were comparable in gender (38% boys), age (median age about 10 years), and appendicitis type (catarrhal — 31%, phlegmonous — 38%, gangrenous — 31%), and white cell count at admission, presence of serous exudate and omentum changes revealed during surgery. The beginning of enteral feeding, the stool, as well as total duration of hospital stay after surgery did not differ in two groups. Moreover, both groups were comparable in terms of surgery duration, intraoperative blood loss volume, pain syndrome severity. No pyo-inflammatory complications of abdominal cavity or postoperative wounds were revealed during the hospital stay. Conclusion. Simultaneous hernia repair via PIRS method is effective and safe method of surgical management of pediatric patients with combination of acute appendicitis and inguinal hernia.

Assessment of Functional Outcome and Quality of Life in Patients after Total Hip Replacement in Indian Population: A Prospective Cohort Study

Introduction: Hip osteoarthritis is a major public health issue associated with a considerable loss of Health-related Quality of Life (HR-QoL). However, not all patients achieve the same level of functional improvement after Total Hip Arthroplasty (THA) and it is unclear which factors are associated with it. Aim: To determine the functional outcome and QoL in patients who underwent Total Hip Replacement (THR) in an Indian set-up. Materials and Methods: The present prospective cohort study was conducted in the Department of Orthopaedics, Eras Lucknow Medical College and Hospital, Uttar Pradesh, India, from March 2020 to September 2021. A total of 100 patients who underwent THA were included through convenience sampling. Demographic and clinical information, like name, age, gender, Body Mass Index (BMI), duration of symptoms, co-morbidity, Visual Analogue Scale (VAS) score and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, were noted from the medical records. A single follow-up of all the patients who underwent THA was conducted to assess the complications, functional outcomes and QoL using VAS score (preoperative and postoperative), WOMAC score (preoperative and postoperative), Harris Hip Score (HHS) (postoperative), Short Form-36 (SF-36) health survey (postoperative) questionnaire. The data was analysed using Statistical Package for the Social Sciences (SPSS) software version 25.0. Continuous variables were analysed using the Wilcoxon signed-rank test for paired data. Correlation assessment was done using Pearson’s correlation coefficient for continuous factors and Spearman’s correlation coefficient for categorical factors. Results: The average age of the patients who underwent THR was 58.90±15.93 years, with a range of 17-95 years. There were 72 males and 28 females. The mean VAS score preoperatively was 7.41±1.20, which decreased significantly to 2.93±0.81 in the postoperative follow-up (p-value&lt;0.001). The mean total WOMAC score improvement was 38.51±10.26 (p-value&lt;0.001). The average postoperative HHS was 73.53±16.16, suggesting a good outcome. The average postoperative SF-36 score was 68.89±12.88. A correlation coefficient of 0.21 (p-value=0.033) suggested that the WOMAC score improvement became higher with an increase in follow-up duration. Patients with postoperative complications had a significantly lower WOMAC improvement (r-value=-0.26, p-value=0.0084). It was observed that the follow-up duration (p-value=0.047) and postoperative complications (p-value=0.016) were significant factors of WOMAC score improvement. Conclusion: Follow-up duration and the presence of postoperative complications were important factors in the functional outcome of patients who underwent THA. Knowledge of these factors can help the clinician to plan the management accordingly while counseling the patients and their relatives regarding any possible adverse outcomes.

Симптомокомплекс дивертикула уретры у женщин.

Introduction. Urethral diverticulum in women is one of the rarest urological diseases, its frequency ranges from 0.02 to 6%. Urethral diverticulum clinically manifests itself in patients between the third and fourth decades of life and its diagnosis is often difficult because urethral diverticulum can mimic other pelvic floor diseases. Often, incorrect diagnosis leads to the prescription of erroneous treatment for recurrent urinary infection, overactive bladder, urinary incontinence, chronic pelvic pain, etc. The aim of this article is to determine the correlation between the topographic-anatomical parameters of the diverticulum, clinical manifestations and results of surgical treatment. Methods and materials. For the purposes of the study, 50 patients with urethral diverticulum were included in the study. All patients were examined and operated on at the Department of Urology of A.I. Yevdokimov Moscow State University of Medicine and Density, on the basis of the S.I. Spasokukotsky State Clinical Hospital in the 3rd and 4th urological departments in the period 2019 to 2022. The duration of postoperative follow–up is 2 years. The results of the study were statistically processed. Results. Most often, patients with urethral diverticulum experience the classic triad of symptoms: dysuria, dispareunia, dribbling, as well as symptoms associated with an infectious-inflammatory process in the bladder and urethra. Analysis of symptoms showed that their presence and severity do not correlate with the size of the diverticulum. A statistically significant relationship was revealed between the size of the urethral diverticulum and the presence of postoperative complications. The larger the diverticulum, the higher the chance of complications in the postoperative period. The location of the urethral diverticulum does not affect the development of complications in the postoperative period. Conclusions. Based on the results of the study and analysis of the data obtained, the dependence of the frequency of complications (periodic increase in body temperature, weak stream during urination and stress form of urinary incontinence) after diverticulectomy via vaginal access on the size of the urethral diverticulum can be traced.

One month and one year mortality of hip fractures in a tertiary care hospital in south India- A retrospective cohort study

: Worldwide incidence of hip fractures is estimated to increase by 4.50-6.26 million by 2050 and half of that being in Asia. With a 30-day death rate between 5% and 10% and a one-year mortality rate as high as 40%. This should be a great health burden to India. Our aim is to look at 1 month and 1 year mortality rate in this high-risk group and factors which might influence them. This 2-year retrospective cohort analysis was carried out at our hospital which is a Level III Trauma Care Hospital in South India. Case notes were analyzed, and telephone interview was done to check one year mortality. : 167 patients in total, with a mean age of 70.8, were evaluated; 90 of these patients (53.9%) were men, and 77 (46.1%) were women. Of the 167 patients, 51 (30.53%) underwent hemiarthroplasty, 84 (50.29%) proximal femur nails, and 24 (14.37%) Total hip replacements (THR). In our study 4 patients (2.4%) died within 30 days of admission, and 25 (14.9%) died within a year following surgery. As the patients' ASA grade increases, the mortality rate also increases. Postoperative complications were another one of the strongest predictors of death. The most significant contributing factor to mortality in hip fractures is found to be timing of surgical intervention. Our mortality rate is comparable to or lower than that of developed nations. ASA grade, Presence of postoperative complication, time delay to surgery were significant contributing factors in our study.

Evaluation of tissue blood supply during esophagectomy using fluorescent diagnostics and diffuse scattering spectroscopy in visible region

BackgroundThe success of the surgical treatment of a tumor or obstruction of the esophagus with subsequent anastomosis application depends on the level of blood supply to the stitched tissues. Intraoperative assessment of blood flow is widely used in medicine and can be used as a diagnostic method that affects the outcome of surgery and reduces the frequency of postoperative complications for the patient. MethodsIn this work, the assessment of blood supply during esophageal resection operations was carried out using two techniques sequentially: fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation by diffuse scattering spectroscopy in the visible wavelength range. The first method was used to assess the integrity of the vascular network structure in the area of anastomosis and blood flow through the sutured tissues, the second one – for local assessment of hemoglobin oxygen saturation in the investigated area. ResultsConducted clinical study involved the participation of nine patients with malignant neoplasms (six cases) or esophageal obstruction (three cases). The presence of postoperative complications was compared with the measurement results. Anastomosis failure was observed in only one patient. According to the results of the study, with the use of the investigated method of assessing blood supply, there is a tendency towards a decrease in the frequency of anastomosis leaks (11.1 % compared with 21.4 %). ConclusionsTherefore, fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation using diffuse scattering spectroscopy were affirmed as methods that allow increasing the safety of surgical procedures by assessing the risk of postoperative complications, including anastomosis failures.

Indications and Outcomes of Maternal and Neonatal Health among Emergency Cesarean Section- a Retrospective Study

Introduction: The rate of cesarean sections is rising globally, with varying indications and outcomes. This study aims to analyze the indications and outcomes of emergency cesarean sections in a Bangladeshi context, focusing on maternal and neonatal health. Methods: This retrospective observational study was conducted at Netrokona Medical College, Bangladesh, from July 2021 to June 2022. It included 100 cases of emergency cesarean sections, excluding elective cases and those with incomplete records. Data on maternal age, gravidity, socioeconomic status, gestational age, BMI, indications for cesarean section, and maternal and neonatal outcomes were collected and analyzed. Result: The majority of cesarean sections were performed on women aged 21-30 (67%). The most common indication was a previous cesarean section (42%), followed by fetal distress (16%) and placenta previa (11%). Maternal outcomes showed 82% of women had no complications, with fever (12%) and excessive blood loss (8%) being the most common issues. Neonatal outcomes were generally positive, with 97% having APGAR scores ≥7. The gender distribution was 59% male and 41% female, and most neonates had normal or healthy birth weights. Conclusion: The study highlights a high prevalence of emergency cesarean sections among younger women, primarily due to previous cesarean sections. While maternal and neonatal outcomes were largely favorable, the presence of postoperative complications indicates the need for enhanced care. These findings underscore the importance of careful assessment in emergency cesarean sections and postoperative monitoring, particularly in resource-limited settings like Bangladesh.

Usefulness of the Global Leadership Initiative on malnutrition (GLIM) criteria in preoperative nutritional assessment of patients with primary lung cancer

The Global Leadership Initiative on Malnutrition (GLIM) developed a new method for evaluating malnutrition; however, no consensus has been reached regarding the use of these criteria. Therefore, this study aimed to investigate the association between nutritional status assessed using the GLIM criteria and outcomes of lung cancer after surgery. Patients with non-small cell lung cancer who underwent lung resection and bioelectrical impedance analysis to estimate muscle mass before surgery were included. Their background, pathological stage, recurrence, and prognosis were investigated. Patients were divided into two groups according to the GLIM criteria: normal nutrition and malnutrition groups. The normal and malnutrition groups comprised 110 and 88 patients, respectively. Malnutrition was significantly associated with poor overall survival after surgery (P=0.025) but not with disease-free survival. Multivariate analysis showed that malnutrition (hazard ratio [HR]:2.374, P=0.020), advanced pathological stage of lung cancer (HR: 1.919, P=0.002), and the presence of postoperative complications (HR: 2.035, P=0.047) were significantly associated with poor overall survival. Malnutrition assessed using the GLIM criteria was associated with the prognosis of patients with postoperative non-small cell lung cancer. Preoperative assessment using the GLIM criteria would allow for effective nutritional and rehabilitative interventions to improve prognosis.

Effect of raw electroencephalogram-guided anesthesia administration on postoperative outcomes in elderly patients undergoing abdominal major surgery: a randomized controlled trial

BackgroundEEG monitoring techniques are receiving increasing clinical attention as a common method of reflecting the depth of sedation in the perioperative period. The influence of depth of sedation indices such as the bispectral index (BIS) generated by the processed electroencephalogram (pEEG) machine to guide the management of anesthetic depth of sedation on postoperative outcome remains controversial. This research was designed to decide whether an anesthetic agent exposure determined by raw electroencephalogram (rEEG) can influence anesthetic management and cause different EEG patterns and affect various patient outcomes.MethodsA total of 141 participants aged ≥ 60 years undergoing abdominal major surgery were randomized to rEEG-guided anesthesia or routine care group. The rEEG-guided anesthesia group had propofol titrated to keep the rEEG waveform at the C-D sedation depth during surgery, while in the routine care group the anesthetist was masked to the patient’s rEEG waveform and guided the anesthetic management only through clinical experience. The primary outcome was the presence of postoperative complications, the secondary outcomes included intraoperative anesthetic management and different EEG patterns.ResultsThere were no statistically significant differences in the occurrence of postoperative respiratory, circulatory, neurological and gastrointestinal complications. Further EEG analysis revealed that lower frontal alpha power was significantly associated with a higher incidence of POD, and that rEEG-guidance not only reduced the duration of deeper anesthesia in patients with lower frontal alpha power, but also allowed patients with higher frontal alpha power to receive deeper and more appropriate depths of anesthesia than in the routine care group.ConclusionsIn elderly patients undergoing major abdominal surgery, rEEG-guided anesthesia did not reduce the incidence of postoperative respiratory, circulatory, neurological and gastrointestinal complications. rEEG-guided anesthesia management reduced the duration of intraoperative BS in patients and the duration of over-deep sedation in patients with lower frontal alpha waves under anesthesia, and there was a strong association between lower frontal alpha power under anesthesia and the development of POD. rEEG-guided anesthesia may improve the prognosis of patients with vulnerable brains by improving the early identification of frail elderly patients and providing them with a more effective individualized anesthetic managements.

Fatores prognósticos e complicações atribuídas à ressecção cirúrgica de mastocitoma cutâneo em 62 cães atendidos no hospital veterinário da UNESP-Jaboticabal de 2013 a 2019

Mast cell tumors, which are neoplasms with variable behavior, from less aggressive to highly metastatic tumors, account for 16%–21% of cutaneous neoplasms in dogs. The diagnosis and grading of mast cell tumors are based on cytological analysis and histological evaluation, which facilitate appropriate planning for surgical and chemotherapeutic treatment. Surgical resection with safety margins of 2–3 cm is considered the best therapeutic option; however, postoperative complications, such as delayed healing, necrosis, suture dehiscence, and occurrence of seroma, are reported. It is essential to understand the biology of mast cell tumors because prognostic factors directly influence the efficacy of the treatment and the quality of life of the patient. Here, we conducted a retrospective study of dogs submitted to surgical resection of cutaneous mast cell tumors, and analyzed the prognostic factors and occurrence of postoperative complications. The results showed that low grade mast cell tumors were associated with a lower occurrence of ulceration, metastasis, recurrence, lack of need for adjuvant therapy, and occurrence of paraneoplastic syndrome compared to those of a higher grade. We also compared the association between demanding or compromised margins with the presence of postoperative complications. The results showed that high grade mast cell tumors have a greater metastatic potential and that the presence of neoplastic cells in the adjacent tissues leads to a greater malignancy and postoperative complications.

The effect of body mass index and preoperative weight loss in people with obesity on postoperative outcomes to 6 months following total hip or knee arthroplasty: a retrospective study

BackgroundFew studies have investigated the association between obesity, preoperative weight loss and postoperative outcomes beyond 30- and 90-days post-arthroplasty. This study investigated whether body mass index (BMI) and preoperative weight loss in people with obesity predict postoperative complications and patient-reported outcomes 6 months following total knee or hip arthroplasty.MethodsTwo independent, prospectively collected datasets of people undergoing primary total knee or hip arthroplasty for osteoarthritis between January 2013 and June 2018 at two public hospitals were merged. First, the sample was grouped into BMI categories, < 35 kg/m2 and ≥ 35 kg/m2. Subgroup analysis was completed separately for hips and knees. Second, a sample of people with BMI ≥ 30 kg/m2 was stratified into participants who did or did not lose ≥ 5% of their baseline weight preoperatively. The presence of postoperative complications, Oxford Hip Score, Oxford Knee Score, EuroQol Visual Analogue Scale and patient-rated improvement 6 months post-surgery were compared using unadjusted and adjusted techniques.ResultsFrom 3,552 and 9,562 patients identified from the datasets, 1,337 were included in the analysis after merging. After adjustment for covariates, there was no difference in postoperative complication rate to 6 months post-surgery according to BMI category (OR 1.0, 95%CI 0.8–1.4, P = 0.8) or preoperative weight loss (OR 1.1, 95%CI 0.7–1.8, P = 0.7). There was no between-group difference according to BMI or preoperative weight change for any patient-reported outcomes 6 months post-surgery.ConclusionPreoperative BMI or a 5% reduction in preoperative BMI in people with obesity was not associated with postoperative outcomes to 6 months following total knee or hip arthroplasty.

POSSIBILITIES OF USING THE ANALYSIS OF OXIDANT-ANTIOXIDANT METABOLIC PROCESSES AND ION EXCHANGE IN PREDICTING THE DEVELOPMENT OF POSTOPERATIVE COMPLICATIONS IN SMALL BOWEL SURGERY

Summary. Introduction. The work is devoted to the study of the possibilities of using the analysis of oxidant-antioxidant metabolic processes and ion exchange in predicting the development of postoperative complications during operations on the small intestine in conditions of a compromised abdominal cavity.&#x0D; The aim of the study. To determine the peculiarities of the flow of oxidant-antioxidant metabolic processes and ion exchange during operations on the small intestine in conditions of intra-abdominal infection and to study the clinical effectiveness of their assessment.&#x0D; Materials and methods. Research was conducted at the Institute of General and Emergency Surgery of the State University named after V.T. Zaitsev National Academy of Sciences of Ukraine”. The study properly included 88 patients who were divided into three groups: a control group (20 patients), a study group (50 patients).&#x0D; Results and discussion. The most common criteria for assessing the viability of an ischemic intestine are subjective assessments of color, motility, and pulsation of mesenteric vessels both during examination and after physical or pharmacological effects. However, such an assessment is subjective, does not always correspond to the actual condition of the intestinal wall, which leads either to an unjustified expansion of the scope of the intervention, or to an erroneous overestimation of the vital function of the damaged intestine.&#x0D; As a result of the research, a decrease in the phagocytic activity of neutrophils was found in patients who underwent resection of intestinal segments. In these patients, the development of endogenous intoxication was characterized by a decrease in the level of platelets and indicators of the blood anticoagulation system, leukopenia and methemoglobinemia, which requires antioxidant, antitoxic, as well as anticoagulant and immunological correction.&#x0D; The study of the exchange of metal ions in the blood serum of operated patients revealed dynamic changes in their content, iron ions (Fe2+); zinc (Zn2+); copper (Cu2+). The study of ion exchange of metals in the serum of the studied patients revealed significantly (p&lt;0.05) higher levels of iron and copper, which can have an important diagnostic and prognostic value when justifying the scope of surgical intervention.&#x0D; The results of studying the state of oxidant-antioxidant processes in the studied patients revealed an increase in the level of lipid peroxidation products: malondialdehyde (secondary products) and diene conjugates (end products); since the LPO system is a primary predictor of future immunodeficiency.&#x0D; The correlation analysis revealed a direct correlation between the initial content of cryoglobulins and the presence of postoperative complications (r=0.56, p=0.07 and r=0.53, p=0.052). Detection of high concentrations of cryoglobulins in the blood serum of operated patients already in the first hours allowed us to assume the presence of maximal autoimmune changes in intra-abdominal infection.&#x0D; The study of the spectrum of serum protein fractions, lipid peroxidation, the state of antioxidant protection, the activity of liver enzymes, factors of humoral and cellular immunity, revealed pronounced endotoxicosis, functional damage to hepatocytes, a violation of the immune status of the body, which correlated with the severity of pathological changes against the background of intra-abdominal infection.&#x0D; Conclusions. Analysis of oxidant-antioxidant metabolic processes, bioenergetic state testified to the stimulation of free radical processes, activation of lipid peroxidation, inhibition of antiradical protection in the studied patients, which in the complex stimulates the development of membrane pathology against the background of endogenous intoxication and inhibition of bioenergetics; there are processes of primary inhibition of non-specific resistance of the organism, in combination with a violation of the regeneration of individual links of the immune system.

Outcomes of Open Reduction and Internal Fixation for Supracondylar Humeral Fractures in Children

Objectives: The aim of this study was to evaluate the results of open reduction and internal fixation of humeral supracondylar fractures in pediatric patients. Patients and methods: A retrospective descriptive study conducted from 2006 to 2016, including 24 patients who underwent open reduction and internal fixation for the treatment of condylar fractures, adjusted by the closed method. The patients were clinically and radiographically evaluated according to the Gartland’s classification. Data collection also included postoperative radiological assessment, range of motion, presence of postoperative complications, and satisfaction questionnaire with treatment received. Results: Patient’s age: Mean 9.46 ± 2.07; Males : 15 (62.5%), Femeals: 9 (37.5%); Injured elbow: Left 17 (70.8%), Right 07 (29,2%); Injury/Sugery Interval (days): 2.2 ± 0.78; Gartland’s classification: Type II: 6 (25%), Type III: 17 (70.8%), Type IV: 1 (4.2%); Foll-up Period (months): 44. 08 ± 5.78; Baumann angle: 16.12° ± 2.23°; Final loss of flexion: averaged 5.9°; loss of extension: 0.73°. The KW was removed was 4.2 months (range: 3 - months). Complications: KW Pierce through brachial artery (intra - Operatively) 1 (4.2%), Iatrogemic ulnar injury 1 (4.2%), Cubitus varus 1 (4.2%). Evaluation: Satisfactory 22 (91.7%), Unsatisfactory 02 (8.3%). Conclusions: Conservative treatment is recommended for Gartland type I and nondisplaced type II fractures. Open reduction with two or three pins is the preferred treatment option for most supracondylar fractures. The use of appropriate criteria is wise in managing these cracks; Prognosis in the event of complications or possible complications should be explained.