Presence Of Postoperative Complications Research Articles

Modern approaches to surgical treatment of children with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a heterogeneous group of diseases with different types of inheritance, characterized by frequent fractures and deformities of the bone skeleton. Conservative and surgical treatment of children with this pathology is an integral part of a multidisciplinary approach. In the surgical treatment of bone deformities in children with OI, the method of choice is corrective osteotomies, and an effective method of fixation is intramedullary osteosynthesis. Surgical treatment of children with OI is aimed at reducing the number of fractures, correcting deformities and increasing motor activity. Aim of the study to determine the indications for intramedullary osteosynthesis of long tubular bones in children with the disease. To review the studies concerning treatment of children with OI. Consider the different types of metal fixers, their advantages and disadvantages. Today the technique of intramedullary fixation is the "gold" standard in the surgical treatment of children with OI. There is a clear advantage of telescopic rods in terms of the frequency of reoperations, but their use does not exclude the presence of postoperative complications.

Risk Factors for the Morbidity and Mortality of Stoma Closure.

To identify the risk factors for postoperative complications of stoma closures. Descriptive study. Department of General Surgery, Izmir University of Health Sciences, Tepecik Training and Research Hospital, Izmir Turkey from October 2008 to December 2018. A total of 179 patients were divided into two groups according to presence or absence of postoperative complications. Differences between these two groups were analysed with tests of proportion; p <0.05 value was considered statistically significant. The results are reported as odds ratios (ORs) with 95% confidence interval (CI). The median age of the patients with postoperative complications was 57.00 (40.00-67.00) and 30/55 (54.5%) of them were males. American Society of Anesthesiology (ASA) score and coronary artery disease had significant association with postoperative complications of stoma closure (p=0.033, p=0.024). Although colostomy was not associated with presence of postoperative complications, but when the authors analysed correlations of colostomy with postoperative complications separately, it was found that colostomy was a risk factor for postoperative ileus (OR 0.257, 95% CI 0.081-0.821; p= 0.026). ASA score and coronary artery disease should be considered as risk factors for complications of stoma closure. Colostomy should be considered as a risk factor for postoperative ileus. Key Words: Colostomy, Ileostomy, Stoma closure, Risk factors.

Differences of intraoperative outcomes and postoperative complications between intrahepatic cholangiocarcinoma and colorectal liver metastasis in different surgical methods.

BackgroundHepatectomy is the only potentially curable treatment for intrahepatic cholangiocarcinoma (IHCC) and colorectal liver metastasis (CRLM). This study aimed to explore the difference in intraoperative outcomes and postoperative complications between IHCC and CRLM in different surgical methods including major hepatectomy and minor hepatectomy.MethodsWe included 319 patients with IHCC or CRLM who underwent hepatectomy at our hospital. According to major hepatectomy and minor hepatectomy, eligible patients were divided into two groups. In each group, the clinicopathological characteristics of IHCC and CRLM patients were compared, then propensity score matching (PSM) was performed based on the results. Intraoperative outcomes and postoperative complications were compared between IHCC and CRLM before and after PSM. Intraoperative variables, including intraoperative blood transfusion, duration of operation, and intraoperative blood loss, were used to evaluate the intraoperative conditions of patients. The postoperative complications were measured according to the Clavien-Dindo classification. Grade III to V complications were defined as major complications.ResultsThe major hepatectomy group included 118 patients with IHCC and 93 patients with CRLM. IHCC patients presented a longer operation time and a higher postoperative complication rate than CRLM patients. The infection-related complication rate of the CRLM patients was significantly higher than the IHCC patients. In multivariate analysis, major hepatectomy for IHCC was independently associated with the presence of postoperative complications. The minor hepatectomy group included 146 IHCC patients and 62 CRLM patients. Compared with CRLM patients, IHCC patients presented a longer operation time. There was no significant difference in the intra-operative blood loss, postoperative complication rate, the major complications rate, and the minor complications rate between the IHCC patients and CRLM patients.ConclusionsThis study revealed major hepatectomy for IHCC led to significantly higher morbidity of postoperative complications than CRLM patients. For minor hepatectomy, there was no difference in postoperative complications between IHCC and CRLM. More attention should be paid to improving the preoperative planning and surgical management of hepatic malignancies especially in the setting of IHCC.

Post Treatment Complications after Removal of impacted third molar: A Retrospective Study

AbstractIntroduction: Removal of third molar is that the most typical intervention performed procedure related to an honest array of complications. the foremost commonly encountered complications are pain, paraesthesia, trismus, swelling and mandibular fractures.&#x0D; Aim: The objective of this study was to study the complication associated with extraction of impacted third molar with age.&#x0D; Materials and Method: All the surgical removal of third molars which were performed within a private clinic during 1-year period from October 2019 – October 2020 were retrospectively analysed and included within the study. Presence of post-operative complications like pain (more than 3 days), paraesthesia, mandibular fracture, Alveolar osteitis (dry socket), bleeding, trismus or edema in conjunction with demographic features and thus the type of impaction was noted. Data was arranged during a tabulated form and analyzed using Epi Info software. Result: There are 59 males and 56 females who underwent transalveolar extraction of third molar. The mean age of females was 47.21 12.2 years and males were 48.32 11.5 years. It had been found that pain was the foremost commonly encountered complication, seen in 57.4% of the patients. Pain was followed by swelling which was seen in 42.2% of the themes. Trismus ranked third, seen in 23.2% of subjects. It was found that pain was most frequently seen among the age group of 20(21.6%) and least frequently seen amongst 20-40 years aged (15.2%). &#x0D; Conclusion: Pain was the foremost common complication followed by swelling and Trismus. Keywords: pain, paraesthesia, third, molar, complication.

Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study.

BackgroundOlder patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition.ObjectiveHerein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia.MethodsThe procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90.ResultsOur study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings.ConclusionsAs frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes.International Registered Report Identifier (IRRID)PRR1-10.2196/16846

Single-Use Digital Flexible Ureteroscopes as a Safe and Effective Choice for the Treatment of Lower Pole Renal Stones: Secondary Analysis of a Randomized-Controlled Trial.

Objective: To compare the efficacy and safety of a single-use digital flexible ureteroscope (FURS) and a reusable FURS for the treatment of lower pole stones (LPS) smaller than 20 mm. Patients and Methods: We analyzed the data of 49 patients with LPS from our previous multicenter, randomized, open-label clinical trial in four hospitals in China. All patients underwent FURS for LPS with a single-use FURS ZebraScope™ (trial group) or a reusable FURS URF-V (control group). The efficacy endpoints assessed were the 1-month postsurgical stone-free rate (SFR), operative time, length of postoperative hospital stay, and mean reduction in hemoglobin level. The safety outcomes assessed were the presence of adverse events (AEs), severe AEs (SAEs), and postoperative complications. Results: The demographic and preoperative parameters were comparable between the two groups. The 1-month SFR was 84.00% for the ZebraScope group and 58.33% for the reusable flexible ureteroscope (URF-V) group (p < 0.05). There was no difference between the two groups in the operative time (p = 0.665), length of hospital stay (p = 0.308), presence of postoperative complications (p = 0.307), presence of AEs (p = 0.483), and the presence of SAEs (p = 0.141). Conclusions: This study demonstrates that single-use digital FURS is a safe and effective option and can offer higher SFR than the reusable FURS in the treatment of LPS smaller than 20 mm. We recommend single-use digital FURS as an alternative to reusable FURS for the treatment of LPS. The Clinical Trial Registration number: ChiCTR1900021615.

Laparoscopic treatment for appendicitis during pregnancy: Retrospective cohort study

BackgroundAcute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus.We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature. Materials and methodsRetrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis. Resultsn = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3–30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1–16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %. ConclusionSurgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of “complication” in order to collate reliably the outcomes presented in the literature.

Definitive Surgery Is Safe in Borderline Patients Who Respond to Resuscitation.

We hypothesize that in adequately resuscitated borderline polytrauma patients with long bone fractures (femur and tibia) or pelvic fractures, early (within 4 days) definitive stabilization (EDS) can be performed without an increase in postoperative ventilation and postoperative complications. Retrospective cohort study. Level 1 trauma center. In total, 103 patients were included in this study; of whom, 18 (17.5%) were female and 85 (82.5%) were male. These patients were borderline trauma patients who had the following parameters before definitive surgery, normal coagulation profile, lactate of <2.5 mmol/L, pH of ≥7.25, and base excess of ≥5.5. These patients were treated according to Early Total Care, definitive surgery on day of admission, or Damage Control Orthopaedics principles, temporizing external fixation followed by definitive surgery at a later date. Timing of definitive surgical fixation was recorded as EDS or late definitive surgical fixation (>4 days). Primary outcome measured was the duration of ventilation more than 3 days post definitive surgery and presence of postoperative complications. Thirty-five patients (34.0%) received Early Total Care, whereas 68 (66.0%) patients were treated with Damage Control Orthopaedics. In total, 51 (49.5%) of all patients had late definitive surgery, whereas 52 patients (50.5%) had EDS. On logistic regression, the following factors were found to be predictive of higher rates of postoperative ventilation ≥ 3 days, units of blood transfused, and time to definitive surgery > 4 days. Increased age, head abbreviated injury score of 3 or more and time to definitive surgery were found to be associated with an increased risk of postoperative complications. Borderline polytrauma patients with no severe soft tissue injuries, such as chest or head injuries, may be treated with EDS if adequately resuscitated with no increase in need for postoperative ventilation and complications. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Factors related to compliance with adjuvant chemotherapy in patients with gastric cancer: A retrospective single-center study.

Adjuvant chemotherapy (AC) improves survival outcomes in patients with advanced gastric cancer (GC) after curative surgery; however, some patients do not receive or complete chemotherapy. This study aimed to identify factors related to patient compliance with chemotherapy after curative surgery for advanced GC. The data of patients who underwent curative gastrectomy for pathologic stage II-III GC between 2012 and 2016 were reviewed. Patients were divided into an AC completion group (group C), AC incompletion group (group I), and surgery-only group (group S). The AC regimen was either tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (XELOX). The study enrolled 417 patients; group C had 222 patients, group I had 110, and group S had 85. The most common reason for not initiating AC was poor general condition (36.5%), while chemotherapy-related complications was the common reason for AC incompletion (43.6%). In multivariate analysis, age over 65 years, Eastern Cooperative Oncology Group performance status ≥1, Charlson comorbidity index ≥1, and the presence of postoperative complications were independent risk factors for not initiating AC (odds ratio: 4.32, 2.62, 1.84, and 2.17, respectively). Age over 65 years, longer postoperative stay, and XELOX regimen were significant risk factors for incompletion of AC (odds ratio: 2.68, 1.72, and 2.23, respectively). Old age, poor performance status, comorbidities, and postoperative complications, longer postoperative hospital stay, and XELOX regimen were associated with poor compliance with AC in GC patients. Clinicians can improve compliance with AC by managing postoperative complications and selecting the most appropriate treatment regimen.

Testing methods for surgical treatment of endometrial cancer

Annotation. The urgency of the study is due to an increase in the incidence (more than 50%) of newly diagnosed uterine endometrial cancer, especially among young people. The main method of treatment for stage I-II endometrial cancer remains surgery. The study aimed to identify possible cytological conversion during laparoscopic procedures. The main method of research was a non-randomized, prospective cohort study with subsequent observation of the duration of hospitalization and 30 days after discharge for the period from 2010 to 2019. The duration of hospitalization was estimated, while in the perioperative period and within 30 days after discharge – the presence of postoperative complications. A total of 812 patients with stage I-IV endometrial cancer were analyzed, with a mean age of 52±5 years (25 to 75 years). The first group included patients who underwent laparotomy, the second – laparoscopic surgery. The presence of metastases and recurrences was confirmed by morphological, radiological, echoscopic and clinical methods. Standard methods of descriptive statistics were used for data processing; in particular, the average values were calculated with their standard errors when using the standard Student’s t-test at p&lt;0.05 using Microsoft Excel software packages. Conclusions were made about the volume and type of surgery, taking into account the histological type of tumor, lymphovascular invasion, clinical stage, presence or absence of obesity and other comorbidities that may affect metabolism, life history and the presence of surgery. The obtained data confirm the safety of laparoscopic hysterectomy for women with stage I endometrial cancer. However, there are no data on whether laparoscopy can lead to intra-abdominal dissemination of tumor cells.

Morbidity and mortality analysis in general surgery operations. Is there any room for improvement?

The aim of this work is to examine the performance of surgeries, by evaluating the results. The evaluation of the results, with particular attention to complications, is the corner stone to identify the causes leading to correction of any predisposing factors and reducing risks, to improve quality of care. We performed a retrospective analysis of 952 consecutive patients who had elective or emergency surgery from November 1, 2018, to October 31, 2019. We classified surgical intervention according to their complexity. The Clavien Dindo classification was used to categorize the complications. We performed a stepwise multivariate logistic-regression analysis, with the presence of postoperative complications as dependent variable and age, gender, BMI, ASA, type of surgery procedures, complexity of surgery, operative time as covariates. A total of 952 surgical procedures were included in this study. Abdominal procedures were the most frequent type of surgery performed (52.1%). Postoperative complications occurred in 120 surgical procedures (12.6%), these are related to the increase of the ASA score and the longer average operative time, with an increase of developing complication of 5% for each additional 10 minutes of surgery. Many factors influence postoperative morbidity and mortality. Particular attention was due to complication's evaluation, about all in abdominal surgery and high complexity procedures. We argue that key factors which influence the favorable surgical outcome are compliance with standardized safety procedures, volume of activity of the structure, presence of interdisciplinary care groups, and ability of health professionals in recognizing and promptly treating complications.

The Assessment of Early Complications and Risk Factors Affecting Their Occurrence in Breast Reconstructive Procedures

The presence of postoperative complications may have a significant impact on the outcome of the breast reconstruction. The aim of this study was to investigate early postoperative complications and the risk factors for their occurrence. A prospective analysis was carried out to evaluate surgical outcomes after breast reconstructive surgeries performed over a 2-year period. Procedures included expander/implant (TE/IMP), pedicle transverse rectus abdominis musculocutaneous (pTRAM), and latissimus dorsi (LD) techniques. All adverse events which occurred within 6 weeks of surgery were ranked according to severity based on the contracted Accordion grading system. Outcomes were assessed for their association with surgical, demographic, and clinical variables. Sixty-one consecutive breast reconstruction procedures were analyzed. The overall complication rate was 60.7% (n = 37), and 8 patients (13.1%) required reoperation. The lowest complication rate was observed in implant-based reconstructions (TE/IMP, 18.8%; pTRAM, 72.7%; LD, 78.3%; p = 0.008). Mild complications occurred significantly more often after LD reconstructions (LD, 60.9%; pTRAM, 22.7%; TE/IMP, 12.5%; p = 0.031), while severe complications were significantly more frequent after the pTRAM procedures (pTRAM, 27.3%; TE/IMP, 6.2%; LD, 8.7%; p = 0.047). Severe complications were associated with higher rehospitalization rate (p = 0.010) and longer hospital stay. Study revealed a significant impact of the operative method on the incidence and severity of early complications after breast reconstruction procedures with little effect from other demographic and clinical factors.

The results of high-position anal fistula treatment using the LIFT (ligation of intersphincteric fistula tract) procedure. A retrospective, single-center study.

Ligation of the intersphincteric fistula tract (LIFT) is an established method for the treatment of high- and lowposition anal fistulas. Numerous meta-analyses confirm the high healing success rate with simultaneous low risk of sphincter damage. The aim of the study was to evaluate the results of the treatment of patients with high-position and complex transsphincteric fistulas using the LIFT procedure. Twelve patients (M - 9, F - 3) aged between 28 and 69 years (median age 50) undergoing surgery for complex and high-position transsphincteric anal fistulas, either primary or recurrent, in the period of 2016 to 2020, were included in the study. The inclusion criterion consisted in the presence of a fistula encompassing more than 30% of the anal sphincter volume as confirmed by transrectal ultrasound. All patients were subjected to surgical treatment by means of the LIFT procedure. The follow-up period was between 6 and 51 months (average of 16 months). Follow-up visits were held at 1 and 4 weeks as well as 6 months after surgery. During the postoperative period, data were collected on the curative effect or recurrence of transsphincteric fistulas (the primary endpoint) and on the presence of postoperative complications (the secondary endpoint). A total of 10 patients (83.3%) were healed, with 2 patients (16.7%) experiencing complications as manifested by recurring intersphincteric fistula. Full recurrence of the disease was observed in 2 patients (16.7%). Slight disturbances of continence were observed in 2 out of 12 patients (16.7%).

Use of carbon nanotube sensor for detecting postoperative abnormal respiratory waveforms.

BackgroundThis feasibility study aimed to detect respiratory waveforms from thoracic movements and evaluate if postoperative complications could be predicted using a carbon nanotube sensor.MethodsFifty patients who underwent lung resection for lung tumors were enrolled. The lung monitoring system of the carbon nanotube sensor was placed on bilateral chest walls across the 6th–9th ribs to measure chest wall motion. We examined the respiratory waveform in relation to surgical findings, postoperative course, and complications using Hilbert transform and Fast Fourier Transform (FFT).ResultsOf 50 patients (37 males, 13 females), 22 were included in the normal lung function group and 28 were included in the low lung function group. The respiratory rate and waveform indicated a regular pattern in the normal lung function group and the respiratory rate could be detected. Conversely, irregular respiratory pattern was detected in 70% of patients in the low lung function group. There was no significant different overall envelope peak value between operated side and non-operated side (0.195±0.05 and 0.18±0.06). In contrast, there was significantly high peak value in the presence of postoperative complications (P<0.05). And there was a significantly higher peak value in air leakage presence than air leakage absence in operated side (P=0.045).ConclusionsThe present study confirmed the feasibility of the sensor. It is promising in visualizing the respiratory state and detecting respiratory changes postoperatively.

Postoperative complications and its relationship with the severity of postoperative pain in patients undergoing thoracic surgery

Aim: To investigate the complications that occur in our patients who underwent thoracic surgery, as well as the relationship between postoperative pain and complications. Method: Of the 117 patients who underwent surgery between January 2018 and December 2018, there were 99 patients with pain and the other parameters whose data’s were complete. Medical records of the patients were investigated in terms of age, gender, smoking status and frequency, diagnosis, treatment, length of stay in the hospital, postoperative complications and visual analog scale (VAS). The postoperative complications and VAS values were compared statistically. Results: The mean age of the patients was 50.52±18.46 years, 26 (26.3%) patients were female and 73 (73.7%) were male. The average length of stay in hospital was 4.08±3.06 days and average pain severity was 3.92±2.07. The most common diagnosis in our cases was lung cancer, and the most common complication was prolonged air leakage. There was a significant relationship between the severity of pain and the presence of postoperative complications in our patients (p=0.001). However, the correlation relationship was found to be low (r=0.322). Conclusion: The results of our study revealed that optimal postoperative pain control is an important factor for preventing postoperative complications.

A comparative analysis of clinical and morphological features of retinal detachment in pediatric and adult practice

Рurpose. A comparative analysis of clinical and morphological features of retinal detachment (RD) in pediatric and adult practice.Materials and methods. A retrospective analysis of 100 case histories of patients with a confirmed diagnosis of RD in children aged 7 to 18 (mean age 12.6 ± 1.2 years) and adults aged 19 to 80 (mean age 56.8 ± 2.4 years) was performed prior to standard surgery (subtotal vitrectomy with endolaser coagulation and filling of the vitreous cavity with tamponade substances) and 6 months after it. The main parameters for the comparative analysis were gender, age, RD type, cause (risk factor), stage of development of proliferative vitreoretinopathy (PVR), best corrected distance visual acuity, intraocular pressure, presence of postoperative complications, anatomical adherence of the retina after surgery, the fact of reoperation. Statistical analysis was carried out according to two criteria — chi-square and Fisher's test.Results. Statistically significant differences in the type and cause (risk factors) of RD, were found. In children, rhegmatogenous RD was less common than in adults (69 % of cases compared with 80 % of cases), while traction RD was more common in children (29 % of cases compared to 19 % of adult cases). The C stage of PVR development in children were found to be almost twice as common as in adults. Postsurgical outcomes were found to be significantly higher in adults compared with children.Conclusion. RD type, causes and outcomes are statistically different in pediatric and adult practice. Significantly less successful functional and anatomical results of RD surgery in children reflect differences in etiology, pathogenetic features (PVR stage) of the disease, as well as an increased risk of postoperative complications.

Preoperative and intraoperative factors predictive of complications and stricture recurrence following multiple urethroplasty techniques

ObjectivesTo investigate factors predictive of postoperative recurrence and complications in patients undergoing urethroplasty for stricture repair at a single center.Patients and methodsWe retrospectively reviewed the records of 108 men who underwent urethroplasty for urethral stricture disease (USD) at a single center from 2016 to 2020. Demographic data, comorbidities, stricture history including etiology and prior treatments, patient‐reported symptoms, and outcomes data were collected for analysis. Data were analyzed in aggregate, then, stratified by type of urethroplasty performed. Descriptive statistics, univariate analysis, multivariate logistic regression, and intergroup comparisons were completed using STATA, with an alpha value of 0.05 and a confidence interval of 95%.ResultsThe median age of our patients was 58 years (interquartile range: 42‐69; range: 29‐83), with a median stricture length of 2.0 cm (interquartile range: 1.0‐4.5; range: 0.5‐10). The most common stricture etiology was iatrogenic (n = 33, 31%) and the most common urethroplasty was anterior anastomotic urethroplasty (n = 38, 35%), followed by buccal mucosal graft (BMG) urethroplasty (n = 35, 32%). Twenty‐four patients (22%) had stricture recurrence. Within the aggregate data, recurrence was significantly predicted by obesity (BMI > 30) (Odds Ratio [OR] 3.2, 95% Confidence Interval [CI]: 1.06‐10), and the presence of postoperative complications (OR 6.3, CI: 1.9‐21). The presence of any postoperative complications within 90 days was significantly predicted by stricture length ≥ 5 cm (OR 3.5, CI 1.09‐12) and recurrence (OR 6.0, CI 1.7‐21).ConclusionDespite serving as the most definitive treatment for urethral stricture management, stricture recurrence and postoperative complications are not uncommon after urethroplasty. Obesity and stricture length negatively impact outcomes while a penile stricture location is associated with a lower recurrence rate, though this is not statistically significant.

Outcomes of thyroid operations in patients of different age groups

Objectives: To determine the effects of age on preoperative findings and on outcomes of thyroid surgeries. Methods: In this retrospective study, we analyzed the demographics, surgical and pathological data, postoperative complications and biochemical results including calcium, phosphorus and parathyroid hormone (PTH) levels of patients who undertaken thyroid operations. Results: Totally 288 consecutive patients operated for thyroid diseases were included in the study. The patients were grouped regarding their ages as patients in the 3rd decade (n = 26), 4th decade (n = 60), 5th decade (n = 81), 6th decade (n = 77) and 7th decade (n = 44). There was not any significant difference between groups regarding the preoperative diagnoses (p = 0.09). With an advance in age, the presence of multiple nodules in preoperative period was increasing (p = 0.015). On postoperative period, the pathological diagnosis was malignant in 46 (15.9%) patients. There was not any significant difference between groups regarding the tumor type (p = 0.80). The most common tumor type was papillary carcinoma in all age groups. Postoperative complications were determined in 68 (23.6%) patients and there was not any significant difference regarding the presence of postoperative complications in all age groups (p = 0.26). Conclusions: In conclusion, there was not any significant difference regarding postoperative outcomes in patients operated for thyroid diseases who were in the different decades of their lives. We can suggest that, thyroid surgeries are as safe in elderly patients as in younger patients.

Multimodal Protocol for the Treatment of Odontogenic Keratocysts

Purpose: The aim of this study is to evaluate longitudinally the effectiveness of a multimodal protocol based on decompression followed by enucleation combined with the use of liquid nitrogen under local anesthesia for the treatment of odontogenic keratocysts. Methods: Seven patients with a diagnosis of odontogenic keratocyst were evaluated longitudinally to clinical and histological features, and pre- and postoperative radiographs were analyzed. Data were collected on the epidemiological profile of patients and on cysts, including the presence of recurrence, duration of drainage device use, lesion site, and presence of postoperative complications. Results: No recurrence was observed during follow-up. Mean follow-up was 59.57 months (range, 18-96 months). No pathological fracture was observed. None of the patients had persistent paresthesia of the inferior alveolar nerve. Substantial reduction in cyst size and epithelial differentiation were observed in all patients after multimodal treatment. Conclusion: Based on these results, the multimodal protocol proposed here was effective in the treatment of odontogenic keratocysts by reducing lesion size, avoiding possible damage to adjacent anatomical structures, and allowing a surgical procedure with less morbidity. The longitudinal follow-up of patients showed that this treatment modality is associated with a low recurrence rate compared with alternative therapies.

Thrombocytosis Predicts Surgical Site Infection in Head and Neck Microvascular Surgery‐ A Pilot Study

Early and objective prediction of complications in head and neck reconstructive surgery could decrease morbidity and prolonged hospital stays but unfortunately most complications are not identified until their effect is fully realized. There are limited data regarding the association of platelet levels and post-operative complications. Post-operative thrombocytosis (POTCT) is proposed as a possible indicator for complications following free-flap reconstruction. Retrospective review. A multisite retrospective chart review of patients undergoing free tissue transfer between 2013 and 2018 was undertaken. POTCT was recorded and data normalized between institutions. Data were compared between groups using t-tests and logistic regression (P < .05). A lag-1 difference was used to compare the rate of change in platelet values. A total of 398 patients were included. POTCT and a rate of change of 30 K between POD5 and POD6 was significantly associated with the presence of post-operative complication (P=.007). Additionally, lag-1 difference demonstrated a significant association of change in daily platelet counts and complication rates. Isolated POTCT may be an early predictor of complications in HNC patients undergoing free-flap reconstruction. 4 Laryngoscope, 131:1542-1547, 2021.