Results Of Procedure Research Articles

The Effect of Nature of Critical Audit Matters and Outcome Indication on Investors’ Decisions

ABSTRACT Two aspects of critical audit matter (CAM) disclosure are (1) whether it relates to complexity in audit judgments (complex CAM) or uncertainty in underlying management estimates (uncertain CAM) and (2) whether an indication of the outcome of audit procedures performed to address the CAM is included in the disclosure. We use two controlled experiments to examine the joint effects of CAM nature and the presence of a CAM outcome indication on investors’ judgments of investment attractiveness. In the first (second) experiment, we used a stronger (weaker) outcome indication, which provides stronger (weaker) conclusions about the audit procedures performed to address the CAM. We find that the provision of a stronger (weaker) outcome indication increases investment attractiveness judgments to a greater (an equal) extent for an uncertain CAM than for a complex CAM. Data Availability: Please contact the authors.

Anterior Opening-Wedge Proximal Tibial Osteotomy for Symptomatic Genu Recurvatum and Osteochondral Autograft Transfer for Osteochondral Defect

Acute knee hyperextension injuries are more frequently sustained during athletic trauma and can cause symptomatic pain, soft-tissue laxity of the knee, malalignment, and ligament strain. Decreased posterior tibial slope is correlated with a higher degree of knee hyperextension, and although not the only cause, it can contribute to symptomatic genu recurvatum. In the context of acute knee hyperextension, chondral lesions may occur secondarily but are more often caused by limb malalignment and overuse. In the setting of symptomatic genu recurvatum and an osteochondral defect, it is vital to restore the native joint biomechanics. We describe the use of anterior opening-wedge proximal tibial osteotomy to correct symptomatic genu recurvatum and osteochondral autograft transfer to repair a full-thickness chondral defect. Past studies have shown long-term successful functional outcomes for both anterior opening-wedge proximal tibial osteotomy and osteochondral autograft transfer procedures, with most patients returning to their preinjury activity levels.

Long-term outcomes of direct total cavopulmonary connection versus extracardiac conduit in Fontan circulation

ObjectiveThe long-term outcomes of direct total cavopulmonary connection in Fontan circulation have not been reported yet. This study aimed to compare the long-term outcomes of the direct total cavopulmonary connection procedure with the extracardiac conduit procedure in patients undergoing the Fontan. MethodsFrom October 2004 to August 2021, 297 patients undergoing the Fontan operation by extracardiac conduit (n = 268) or direct total cavopulmonary connection (n = 29) procedure at our institution were retrospectively reviewed. The propensity score–matching method was used to match the extracardiac conduit and direct total cavopulmonary connection groups in a 1:2 ratio, yielding 23 patients in the direct total cavopulmonary connection group and 40 patients in the extracardiac conduit group. ResultsThe in-hospital morbidity and mortality were similar between the 2 groups in both prematched and matched cohorts (P > .05). The estimated transplantation-free survival at 10 years in the matched direct total cavopulmonary connection group was 89.7% ± 7.0%, in contrast to 92.8% ± 5.0% in the matched extracardiac conduit group (P = .55). The estimated 10-year estimated freedom from Fontan failure in the matched direct total cavopulmonary connection group was 85.2% ± 8.0%, also similar to the 85.9% ± 6.7% in the matched extracardiac conduit group (P = .72). The direct total cavopulmonary connection pathways at the follow-up were significantly larger than those before Fontan surgery (P < .05). ConclusionsThe direct total cavopulmonary connection procedure is a feasible and effective strategy for highly selected Fontan candidates who have well-developed pulmonary arteries of adequate length and size. This approach not only allows for the potential growth of direct total cavopulmonary connection pathways but also demonstrates noninferior short-term and long-term outcomes in contrast to the extracardiac conduit strategy.

S932 Outcomes of Endoscopic Procedures in Patients With High-Risk Cardio-Pulmonary Disease: A Population-Based Study

S932 Outcomes of Endoscopic Procedures in Patients With High-Risk Cardio-Pulmonary Disease: A Population-Based Study

Long-term outcomes of ovary preserving procedure for neonatal ovarian cysts

Objective: We aim to evaluate the long-term outcomes of ovarian preserving surgery for neonatal ovarian cysts. Method: The clinical data of neonatal ovarian cysts treated in our hospital from January 2015 to December 2022 were retrospectively analyzed. Results: Our study included 22 patients, of which 21 were unilateral and 1 was bilateral. There were 13 cases of simple cysts and 9 cases of complex cysts, and one cyst changed from simple to complex. The mean largest diameter of simple cysts was 5.7±2.1cm, and that of complex cysts was 4.6±2.0cm. There was no significant difference between the two groups (P=0.2264). Among the 22 patients, 21 underwent laparoscopic cystectomy. The only patient with bilateral cysts underwent percutaneous drainage of the right simple cyst. Twenty-one histological specimens were reviewed, of which 18(85.7%) contained viable ovarian tissues. Five cases lost follow-up after surgery, and the remaining 17 cases had a follow-up period of 6 months to 5 years. The last ultrasound follow-up showed that 9 cases had bilateral normal ovaries, and 8 cases lost the ipsilateral ovary. The ovarian preservation rate of simple cyst was 90% (9/10), which was significantly higher than that of complex cyst (12.5%, 1/8) (P=0.003). Conclusions: Simple cysts (≥ 4cm) had an excellent prognosis, with a long-term ovarian preservation rate of 90%. The long-term ovarian preservation rate of complex cysts after surgery was relatively low. Our study suggested that surgical treatment did not increase the chances of preserving the ovaries of patients with complex cysts.

Development of a Uniform Apheresis Case Report Form forStandardized Collection of Apheresis Data.

Apheresis is performed worldwide for an increasing number of indications. The development of common data elements (CDE) for apheresis related areas may facilitate conduct of new research, enhance quality initiatives including benchmarking, and improve patient care. This report describes the systematic development of the Uniform Apheresis Case Report Form (UACRF) as part of the Apheresis in the United States (ApheresUS) program. A consensus panel of 17 diverse experts in apheresis, related specialties, and electronic case report form (eCRF), and database development was assembled. The panel met via online conferencing from November 17, 2020 to December 1, 2021. A draft document was posted online for public comment from October 11, 2021 to November 10, 2021. Feedback was collected using an online survey tool. The consensus panel revised the UACRF. This version was converted to an eCRF with additional changes made to improve usability in this format. The final version of the UACRF was created on August 24, 2023. The UACRF contains 16 modules: procedure and subject eligibility, patient demographics, general procedure information, laboratory parameters, vascular access, common procedure elements, eight procedure specific modules (mononuclear cell collection and seven therapeutic modalities), outcomes, and site information. A total of 137 data elements were created, including 57 with one or more subelements. The UACRF is the first systematic attempt to develop CDE for therapeutic apheresis and white blood cell collections. Further validation of the UACRF is necessary to confirm the tool's ability to collect the relevant data elements and determine the usability of the form.

S397 Procedural and Clinical Outcomes Associated with Prior Manipulation of Large Colonic Polyps Referred for Advance Tissue Resection: A Systematic Review and Meta-Analysis

S397 Procedural and Clinical Outcomes Associated with Prior Manipulation of Large Colonic Polyps Referred for Advance Tissue Resection: A Systematic Review and Meta-Analysis

92EMF Improving Procedural Safety, Efficacy, and Patient Outcomes for Ultrasound Guided Nerve Blocks in the Emergency Department via Objective Competency Measures

92EMF Improving Procedural Safety, Efficacy, and Patient Outcomes for Ultrasound Guided Nerve Blocks in the Emergency Department via Objective Competency Measures

Patient Perception and Experience of Laparoscopic Excision vs. Ablation of endometriosis: a crowd-sourced comparative evaluation of symptom and Quality of Life outcomes

Study Objective: To compare laparoscopic Ablation and Excision in terms of symptom and Quality of Life outcomes as perceived by endometriosis patients. DesignA Cohort, Method comparison Questionnaire-based study SettingEndometriosis-focused Social Media site PatientsEndometriosis patients with history of Laparoscopic Ablation and Excision. InterventionsOn-line questionnaire focused on pre and post procedure (ablation and excision) outcomes across 63 measures in 5 realms: Physical Symptoms, Functional Impact, Psycho-emotional Impact, Social/Sexual Impact, Economic/Educational Impact. Measurements and Main Results232 respondents with surgical history that included laparoscopic ablation and excision (without concomitant or interposed hysterectomy) identified for ablation only physical symptom improvement of 11.3% and 8.5% for dysmenorrhea and menorrhagia respectively. Ablation provided no significant improvement in any other physical symptom measure. Excision was identified as providing improvements across all symptoms ranging from 28% to 46%.In terms of Functional Impact, ablation provided non-significant improvements or worsening of status. Excision demonstrated significant improvement for patients across most measures of Functional Impact.In terms of Psycho-emotional Impact, a worsening of QoL status is identified in 23 of 24 measures following ablation. Excision demonstrated improvement in 22 of 24 measures.For Social-Sexual Impact, ablation resulted in worsened status across all measures with excision demonstrating improvements in all measures, significantly so in most.For Economic/Educational Impact, significant worsening of measures or insignificant improvements were demonstrated following ablation. Excision demonstrated significant improvement in most measures.In all realms, pre-Excision status was worse than pre-Ablation.Allowing for a more focused comparison of ablation and excision, 113 respondents with a surgical history of ablation sequentially followed by excision demonstrated outcomes similar to the larger group: overall worsening of status resulting from ablation and overall improvement in status following excision with pre-Excision morbidity higher than pre-Ablation. ConclusionIn this cohort of patients undergoing laparoscopic endometriosis excision after having undergone endometriosis ablation, the former demonstrated greater beneficial effect over a broad spectrum of symptom and QoL measures.

TCT-566 Impact of Isolated Side Branch Lesions on Procedural Techniques and Outcomes of Bifurcation Percutaneous Coronary Intervention

TCT-566 Impact of Isolated Side Branch Lesions on Procedural Techniques and Outcomes of Bifurcation Percutaneous Coronary Intervention

TCT-624 Association of Baseline Mitral Valve Area With Procedural and Clinical Outcomes of Transcatheter Edge-to-Edge Repair

TCT-624 Association of Baseline Mitral Valve Area With Procedural and Clinical Outcomes of Transcatheter Edge-to-Edge Repair

TCT-383 Mechanistic Effects of Coronary Hertz Contact Intravascular Lithotripsy on Treatment of Calcified Lesions: PINNACLE I OCT Substudy Procedural Imaging Outcomes

TCT-383 Mechanistic Effects of Coronary Hertz Contact Intravascular Lithotripsy on Treatment of Calcified Lesions: PINNACLE I OCT Substudy Procedural Imaging Outcomes

Comprehensive surgical technique for the neonatal and infant Ross Konno procedure – technical pearls

The Ross Konno procedure is a technically demanding operation in neonates and infants, particularly in small babies and those with significant aortic annular and left ventricular outflow tract hypoplasia. There are several key technical considerations for harvesting the pulmonary autograft with care to preserve the left main coronary artery and the septal perforating arteries in addition to ensuring an optimal muscle cuff on the base of the autograft. Accommodation of the autograft deep within the native aortic valve annulus by performing an appropriate Konno incision and ensuring correct suture placement is essential. Adequate epicardial mobilisation and subsequent reimplantation of the coronary arteries into the autograft neo-aortic root is also a key consideration given the significant radial displacement of the coronary arteries required to accommodate the often much larger autograft into the space of a previously very small aortic root. Although the overall technical details of the Ross Konno procedure have previously been described by others the specific granular technical detail and meticulous approach required for a successful procedural outcome in neonates and infants remains to be fully elucidated. Key technical considerations such as suture spacing, positioning of the autograft with in the Konno incision and management of the coronary arteries require detailed description. We describe our institutional approach to the Ross Konno procedure in neonates and infants to clarify these important technical considerations.

Impact of body mass index on in-hospital outcomes in patients receiving leadless pacemakers: A five-category analysis

BackgroundThe adoption of leadless pacemakers (LPMs) is increasing, yet the impact of body mass index (BMI) on procedural outcomes remains underexplored. ObjectiveThe purpose of this study was to explore the impact of BMI on in-hospital outcomes for patients receiving LPM implantation. MethodsData from the National Inpatient Sample from 2018–2021 were analyzed for patients older than 18 years who underwent LPM implantation, with specific inclusion and exclusion criteria applied. Patients were identified using International Classification of Diseases 10th Revision codes and categorized into BMI groups: underweight, normal, overweight, obese, and morbidly obese. The primary outcome assessed was in-hospital mortality. Secondary outcomes included blood transfusion, pericardial complications, infection/inflammation, removal/revision, and other complications. ResultsThe study included 3832 patients who underwent LPM implantation between 2018 and 2021, weighted to represent 19,610 patients, with 3540 having an appropriate BMI designation. Mortality was lower in the obese group (2.3%) compared to the nonobese group (2.7%) (adjusted odds ratio [aOR] 0.462, 95% confidence interval [CI] 0.259–0.623, P = .009). Compared to the normal weight group, those categorized as overweight, obese, and morbidly obese demonstrated a lower risk of in-hospital mortality (aOR 0.432, 95% CI 0.299–0.734, P = .009; aOR 0.465, 95% CI 0.238–0.721, P <.001; aOR 0.299, 95% CI 0.153–0.586, P <.001, respectively). ConclusionThese findings support the existence of the obesity paradox in patients with LPM implantation, where higher BMI categories are associated with improved mortality outcomes, meeting our prespecified primary endpoint. Further studies are needed to clarify the mechanisms behind these observations.

TCT-477 Procedural Outcomes in 25 Years of Alcohol Septal Ablations at a Tertiary-Level Medical Center

TCT-477 Procedural Outcomes in 25 Years of Alcohol Septal Ablations at a Tertiary-Level Medical Center

Emergency Surgical Management of Meningiomas: Factors Affecting Early Outcomes and Complications

Abstract Objective Intracranial meningiomas constitute a third of all brain tumors and are among the most common indications for neurosurgical procedures performed worldwide. Most meningiomas present with an indolent, longstanding history. However, the data on outcomes of emergency surgeries for meningioma is limited. This study aims to present our experience of urgent surgical intervention in patients with meningiomas presenting acutely. We also analyze the factors influencing early neurological outcomes and complications. Materials and Methods All nonelective meningioma surgeries done on an emergency basis between January 2015 and December 2019 were retrospectively reviewed. Patients' demography, clinical, and radiological details were recorded for analysis. The surgical procedure, complications, and follow-up outcomes were also included for statistical comparison. Results Forty-four patients qualified for the study with a mean age of 49.4 ± 13.4 years. The average presenting Glasgow Coma Scale (GCS) was 13; 47.7% of cases presented with altered sensorium. The most common lesion location was convexity (25, 56.8%), and the mean tumor volume was 74.1 ± 36.5 mL. Gross peritumor edema with mass effect was seen in 16 patients (36.4%). The mean Karnofsky Performance Status at 3 months' follow-up was 89.3 ± 18.2. Patient age and tumor size did not affect outcomes. The presenting GCS of &lt; 15 (odds ratio [OR] 8.8, confidence interval [CI] 0.95–80.72, p 0.03) and the occurrence of postoperative complications (OR 25.71, CI 2.65–249.2, p 0.001) were associated with unfavorable outcomes. Although not statistically significant, a poor tumor grade was also associated with worse clinical outcomes (p 0.20). Conclusion Emergency meningioma surgery has comparable outcomes and complication rates with routine elective procedures. Grade II/III meningiomas are more likely to present with acute neurological deterioration and carry a relatively worse prognosis. Poor presenting GCS and postoperative complications are the most critical factors associated with poor patient outcomes in our study.

Impact of Either Trendelenburg or Reverse Trendelenburg Positioning for Ureteroscopy Lithotripsy Procedures: A Systematic Review and Meta-Analysis.

Urologists encounter multiple challenges in managing ureteral stones with ureteroscopic laser lithotripsy. This meta-analysis assesses the effectiveness of alternative surgical positioning, Reverse Trendelenburg (RevTren) and Trendelenburg (Tren), in reducing stone migration and enhancing outcomes compared with standard dorsal lithotomy positioning. A systematic review was conducted following PRISMA guidelines, searching Medline, Embase, Scopus, Cochrane, and WoS up to March 2024. This review focused on studies evaluating RevTren or Tren positioning during ureteroscopic lithotripsy compared with standard dorsal lithotomy, analyzing end points such as stone migration, conversion rates, success rates, complications, and operative time. Of 137 studies identified, 8 met the inclusion criteria, encompassing 1374 patients. RevTren significantly reduced ureteral stone migration (odds ratio [OR], 0.20; 95% CI, 0.08-0.47), lowered the need for conversion to a flexible ureteroscope (OR, 0.28; 95% CI, 0.12-0.67), and improved success rates (OR, 2.90; 95% CI, 1.88-4.48). Tren increased migration of ureteral and calyceal stones toward upper renal calyces (OR, 2.12; 95% CI, 1.48-3.04) and achieved a higher success rate (OR, 3.56; 95% CI, 2.15-5.92). Complications were comparable across all positions. Adjusting patient positioning during ureteroscopic laser lithotripsy can enhance procedure outcomes. RevTren effectively reduces ureteral stone migration and the necessity for flexible ureteroscopes, whereas Tren facilitates ureteral and calyceal stone migration toward upper calyces, increasing success rates. Both positioning techniques offer significant advantages over standard positioning and can be safely adopted in clinical practice without compromising patient safety.

Impact of smoking on procedural outcomes and all-cause mortality following acute myocardial infarction: A misleading early-stage pseudoparadox with ultimately reduced survival

BackgroundSmoking has conflicting results on outcomes following acute myocardial infarction (AMI). We evaluated the independent influence of smoking status on patient outcomes. MethodsWe included patients with AMI undergoing invasive coronary angiography with available self-reported smoking status. The incidence of death of any cause was evaluated during a median follow-up of 1.14 years (range 0.36–3.40 years). Association between smoking status and long-term mortality was evaluated using multivariable adjusted Cox regression analysis. ResultsFrom 1612 AMI patients (aged 65.7 ± 13.3 years, 72.1 % male), 378 patients (23.4 %) were current-smokers, 311 (19.3 %) ex-smokers, and 923 (57.3 %) non-smokers. Compared with non-smokers, current-smokers were younger (68.5 ± 13.0 vs. 58.6 ± 12.5, p < 0.0001) and more frequently presented with STEMI (21.6 % vs. 35,4 %, p < 0.0001), while ex-smokers with similar frequency of STEMI-manifestation as non-smokers (22.5 %, p = 0.79) constituted an intermediate-group in terms of age (65.8 ± 11,6 years). Although smoking status was not significantly associated with long-term survival in unadjusted-analysis, active-smokers had 56 % higher long-term mortality than non-smokers when adjusting for age, gender, medications and other traditional risk factors, whereas ex-smokers possessed comparable survival probability (current-smokers: 1.56[1.14–2.14], p = 0.006, ex-smokers 1.16[0.84–1.59], p = 0.37). Current-smokers had unadjusted lower NT-proBNP and modestly higher absolute in-hospital left ventricular global longitudinal strain (LV GLS) values that did not differ among groups after the same adjustments (NT-proBNP: −0.08[-0.31; 0.15], p = 0.5, LV GLS: 0.65[-0.26; 1.55], p = 0.16). ConclusionActive smoking is associated with increased adjusted long-term mortality, earlier onset and more frequent manifestation as STEMI, compared to non-smoking. Comparable adjusted results for LV GLS and NT-proBNP between groups support the presence of the pseudoparadox.

Short-term and Long-term Clinical Outcomes of Combined Caudate Lobectomy for Intrahepatic Cholangiocarcinoma Involving the Hepatic Hilus: A Propensity Score Analysis.

Extended hepatectomy combined with caudate lobe resection has been approved for the radical resection of hilar cholangiocarcinoma. There was a lack of credible research on the clinical value of caudate lobectomy (CL) for intrahepatic cholangiocarcinoma involving the hepatic hilus when combined with hepatectomy. We aimed to compare the short-term and long-term outcomes of the combined procedure with those of only CL for curative resection of intrahepatic cholangiocarcinoma involving the hepatic hilus. This single-center retrospective cohort study of patients with hilar cholangiocarcinoma was conducted from January 2007 to December 2021. Patients who underwent radical resection were enrolled in this study. The short-term and long-term clinical outcomes of the groups were compared before and after propensity score matching (PSM). A total of 282 patients were included. There were no statistically significant differences in perioperative clinical outcomes between the CL group and the non-CL group before and after PSM. Compared to patients in the non-CL group, patients in the CL group had significantly longer overall survival before and after PSM (p=0.007 before PSM, p=0.033 after PSM). Moreover, compared to the non-CL group, the CL group had longer disease-free survival before and after PSM (p<0.001 before PSM, p=0.019 after PSM). The postoperative complications of the CL group were comparable to those of the non-CL group. CL improved the long-term survival of patients with intrahepatic cholangiocarcinoma involving the hepatic hilus when combined with hepatectomy. Therefore, hepatectomy combined with caudate lobe resection should be performed for patients with hilar cholangiocarcinoma.

Subjective outcomes of female genital cosmetic procedures: a prospective study with a median follow-up of 18 months

Aims: To investigate the affects of labiaplasty and/or vaginoplasty on sexual function and satisfaction, as well as the potential to improve body image and genital self-image. Methods: A total of 131 heterosexual sexually active women receiving either a vaginoplasty and/or labioplasty were included in the study population. Patients were subsequently divided into three groups: labioplasty (LP) (n=44), vaginoplasty (VP) (n=44), and labioplasty-vaginoplasty (LVP) (n=43) for statistical evaluation. All participants were administered preoperatively and postoperatively validated questionnaires including Body Image Scale (BIS); Female Sexual Function Index (FSFI), Sexual Quality of Life Questionnaire-Female (SQOL-F), Female Sexual Distress Scale (FSDS), Female Genital Self-Image Scale (FGSIS), and Quality of Sexual Experience Scale (QSES). Results: The median follow-up was 18 months after the female genital cosmetic procedure (FGCP). FGSIS, BIS, SQOL-F, QSES, and FSDS postoperative questionnaires total scores improved significantly in the LP, VP, and LVP groups. FSFI postoperative total scores improved among all groups, but no statistically significant difference was detected in the LP group, unlike the VP and LVP groups. No intraoperative complications occurred. Postoperative complications were detected in 2 (4.5%) women in the LP group and 1 (2.3%) woman in the LVP group. These complications were wound dehiscence (