Prolonged Duration Of Surgery Research Articles

Timing of osteosynthesis of fractures in children changes the outcome.

The search for optimal treatment strategies for fractures in children that require osteosynthesis is controversial and is still being debated. A major factor that has been under discussion is the impact of the timing of surgery: the time delay between the trauma and the operation, as well as the duration of the surgical procedure, and the time of day that the operation is performed are potential factors that might influence the outcome. Therefore, the aim of our study was to investigate the influence of these factors on the outcome after osteosynthesis of diverse fractures of the extremities in children. In a retrospective study, 387 patients aged 1-18years who presented with fractures of the extremities that underwent surgery were included. Patient records including radiological studies were analyzed. The follow up period lasted at least 12months or until recovery. Statistical significance was set at an alpha level of P ≤ 0.05. Delayed surgery, as well as a prolonged duration of surgery, and the mode of transportation of the patient significantly were related to a higher rate of complications. However, in this study, the complication rate was not found to be influenced by the mode of reduction of the fracture, or the time of day or the day of the week. A further parameter that significantly changed the outcome was the mechanism of injury. However, the rate of complications was unchanged if a resident or a consulting was the performing surgeon so that a resident can safely perform the procedure in the presence of a consultant. Timing of surgery for fractures of the extremities in children, including the time from trauma to surgery, the duration of the operation and the mode of transportation to the ER, were found to have a significant impact on the occurrence of complications in this study while the mode of reduction and the time of day did not change the outcome. Future studies with a focus on selected types of fractures are needed to further enlighten this topic. Retrospective comparative study, level III.

Appendectomy as Teaching Operation: No Compromise in Safety—An Audit of 17,106 Patients

In a surgical career, teaching of surgical procedures plays a central role. In this study we want to evaluate the influence of teaching in appendectomies on the in-hospital outcome. Retrospectively, 26,436 cases from the national quality measurement database (AQC) between the years 2009 and 2017 were evaluated using the diagnosis and the procedure codes. Included were all cases with appendicitis (International Classification of Diseases diagnostic codes K35-K37), surgical treatment (appendectomy), and a documented teaching status of the procedure. Variables were sought in bivariate and multivariate analyses. The occurrence of any complication was the primary outcome, whereas in-hospital mortality was the secondary outcome. A total of 17,106 patients with a mean age of 37 ± 19 years remained for final analysis. A total of 6267 operations (37%), were conducted as teaching-operations. Seventy-four percent of all teaching procedures were performed by residents. We found no statistical association between teaching operations and complication rates or mortality. However, the teaching group showed longer duration of surgery (+ 11%). There was no influence of the training status of the appendectomy procedure on complication rates and in-hospital mortality. However, there was a prolonged duration of surgery. Despite these statistically significant differences, a comparable clinical outcome was observed in all patients, thus justifying the benefits of resident training.

Prosthetic Joint Infection Microorganism Pattern and Risk Factor Profile: A Single Center Study

Introduction: Prosthetic joint infection (PJI) is a serious complication especially following arthroplasty surgeries. The outcome of these cases is affected by the pattern of infection, causative microorganism, and antibiotic resistance. This study was aimed to evaluate the prevalence of PJI, distribution of causative microorganism, antibiotic resistance, and risk factor profiling.Methods: A retrospective review was performed by arthroplasty registry evaluation from 2008-2018, followed by a medical record review and patient interview. Distribution of causative microorganisms, antibiotic resistance patterns, and the onset of infection was extracted. Risk factor evaluation was performed by assessing preoperative (age, body mass index (BMI), frailty index) and perioperative parameters (duration of surgery, number of previous surgeries, the interval between those surgeries). Results: Seventeen patients were diagnosed with PJI (13 hip and 4 knees), with a prevalence of 1.56% and 1.77% respectively. The most common causative organism was Staphylococcus aureus and Escherichia coli with multiple antibiotic resistance patterns. These infections mostly occurred in patients with the age of 40-60 years, BMI 30kg/m2, and pre-operative frailty index of 4. The perioperative risk factor was the duration of surgery for more than 3 hours, have undergone more than 3 surgeries with an average surgical interval of 2 months.Conclusions: The prevalence of PJI in this series was 1.56% in hip and 1.77% in the knee. The risk factor profile showed that most cases have high BMI, prolonged duration of surgery, and a high number of previous surgeries within a short interval.

Readmissions at 30 days after inguinal hernia repair: A series of 5126 patients.

The evaluation of the re-admission rate within 30 days of inguinal hernia repair represents a patient management quality indicator. The goal of our study was to evaluate the re-admission rate at 30 days after inguinal hernia repair and identify the risk factors for re-admission. Based on a prospective national registry, patient data were collected during two years. The number of and reasons for re-admissions were compiled. A total of 5126 patients, mean age 61 years, underwent inguinal hernia repair. Ambulatory surgery was performed in 4013 (78%) patients. Failed ambulatory surgery was recorded for 100 (2%) patients. Thirty-three (0.64%) patients were re-admitted within 30 days following surgery for 34 various reasons. The re-admission rate after ambulatory surgery was 0.5%. Half of patients re-admitted presented with a severe complication that required re-intervention. In multivariable analysis, emergency hernia repair (OR 4.899[1.309-18.327]; P=0.01) and prolonged duration of operation (OR 1.023[1.009-1.037]; P=0.001) were identified as independent risk factors for re-admission within 30 days after surgery. Within this prospective national cohort, the overall re-admission rate after inguinal hernia repair was 0.64%, slightly less among the patients undergoing ambulatory surgery. Half of re-admitted patients required surgical re-operation. Emergency hernia repair and prolonged duration of operation were risk factors for re-admission.

Gynecological hysterectomy in Northern Tanzania: a cross- sectional study on the outcomes and correlation between clinical and histological diagnoses

BackgroundHysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Documented complications rates and their correlates are reported from high income countries while data from low- and middle-income countries including Tanzania is scare.MethodsThis was a hospital based cross-sectional study conducted at a tertiary facility in northern Tanzania where 178 women who underwent elective gynecological hysterectomies in the department of obstetrics and gynecology within the study period were enrolled. Logistic regression was performed to determine the association between risk factors and occurrence of surgical complication where p-value of < 0.05 was considered statistically significant. The degree of correlation between pre-operative clinical and histological diagnosis was determined by kappa correlation test.ResultsA total of 75 (42%) of women had surgical complications within 10 days of surgery. Blood transfusion and intra-operative bleeding were the most common complications observed in 34 (19.1%) and 17 (9.6%) women respectively. Independent risk factors for complications included obesity (OR 3.9; 95% CI 1.44–10.46), previous abdominal operations (OR 8.44; 95% CI 2.52–28.26) and longer duration of operation (> 2 h) (OR 5.02; 95% CI 2.18–11.5). Both uterine fibroid and adenomyosis had good correlation of clinical and histological diagnosis (p-value < 0.001).ConclusionBleeding and blood transfusion were the most common complications observed in this study. Obesity, previous abdominal operation and prolonged duration of operation were the most significant risk factors for the complications. Local tailored interventions to reduce surgical complications of hysterectomy are thus pivotal. Clinicians in this locality should have resources at their disposal to enhance definitive diagnosis attainment before surgical interventions.

A Comparative Study Between Pneumatic and Laser Lithotripsy for Proximal Ureteric Calculus

Introduction: There are various modalities of breaking urinary tract calculus. The aim of this study was to compare outcome between laser and pneumatic lithotripsy in patients with upper ureteric calculus in terms of stone free rate, proximal migration and complication. Methods: This was a prospective comparative study done in 210 patients with upper ureteric calculus. The patients were randomized into two groups (Laser Lithotripsy and Pneumatic Lithotripsy) from April 2018 to June 2019. The main objective of both the procedures was to break stone into particles less than 3 mm which was confirmed by X-ray KUB and ultrasonography of abdomen and pelvis after six weeks and to compare effectiveness in terms of immediate stone free rate, proximal migration, operative duration and post-operative complication. Results: There was no difference in age, gender and stone size in both groups. Immediate stone free rate was 99.05% in Laser Lithotripsy and 76.19% in Pneumatic Lithotripsy (p value<0.001). Proximal migration in Laser Lithotripsy was 0.95% and 23.81% in Pneumatic Lithotripsy (p<0.001). There was significantly prolonged operative duration in Pneumatic Lithotripsy (14.7±4.77 min vs 13.31±3.24 in Laser Lithotripsy, p=0.014). Complications were more in Pneumatic Lithotripsy group, which was statistically significant (p=0.017). Conclusion: Both pneumatic and laser lithotripsy are effective and safe modalities for treating upper ureteric calculus, however laser has less chances of proximal migration and higher immediate stone free rate with less complication

Postoperative delayed trapped temporal horn in patients with lateral ventricular trigone meningioma: Risk factors, surgical management, and literature review

ObjectTo assess the risk factors for and surgical treatment of delayed trapped temporal horn (dTTH) in patients who had undergone removal of lateral ventricular trigone meningioma. MethodPatients with lateral ventricular trigone meningioma treated at our institution from 2011 to 2015 were identified. Predictors for dTTH were determined using logistic regression. Literature review and pooled analysis were also conducted to evaluate the comparative effectiveness of surgical treatment for dTTH. ResultsA total of 110 cases were included in the analysis. Thirteen (11.8%) cases developed dTTH following surgery. Multivariable logistic regression demonstrated an association of longer operative duration with higher incidence of dTTH (OR, 1.34; 95% CI, 1.00–1.80; p = 0.049). As surgical duration prolonged from less than 3 hours to 5 hours or more, the incidence of dTTH increased in a consistent, linear fashion from 7.7% to 13.9% (p = 0.03). Six cases (46.2%, 6/13) of dTTH underwent surgical treatment for their life-threatening symptoms. Seven studies including 13 cases of dTTH in the literature were identified. Literature data, including the current series, revealed a total of 24 procedures were performed in 19 cases. Endoscopic fenestration trended toward fewer complications than shunt (7.7% vs 25.0%, p = 0.530). There were no significant differences in failure rates between the two groups (23.1% vs 25.0%, p = 1.000). ConclusionPatients with prolonged operative duration may be at higher risk of dTTH. Endoscopic fenestration is considered in preference to shunt placement, since it possesses equivalent success rates with fewer complications and avoids the need for a permanent implant.

Surgical Antibiotic Prophylaxis Use and Surgical Site Infection Pattern in Dessie Referral Hospital, Dessie, Northeast of Ethiopia.

Background Surgical site infections are the third (14%-16%) most frequent cause of nosocomial infections among hospitalized patients. They still form a large health problem and result in increased antibiotic usage, increased associated costs, and prolonged hospitalization and contribute to increased patient morbidity and mortality. Therefore, studies on surgical site infections and surgical antibiotic prophylaxis contribute to identifying surgical site infection rate and risk factor associated with it as well as for identifying the gap in surgical antibiotic prophylaxis practice. Objective To assess surgical antibiotic prophylaxis practice and surgical site infection among surgical patients. Method A hospital-based prospective observational study was conducted in 68 patients who underwent major surgery in Dessie Referral Hospital adult surgical wards between March 24 and April 25/2017. Descriptive and logistic regression analyses were performed to determine infection rate and risk factors for surgical site infections. Result Assessment of 68 patients who underwent major surgery revealed an overall surgical site infection rate of 23.4%. Prophylactic antibiotics were administered for 59 operations; of these, 33 (48.6%) had inappropriate timing of administration. A combination of ceftriaxone and metronidazole 28 (47.46%) was frequently used. Factors associated with surgical site infection were wound class, patient comorbid condition, duration of the procedure, the timing of administration, and omitting prophylaxis use. Conclusion This study indicated a higher rate of surgical site infection and also revealed that wound class, preexisting medical condition, prolonged duration of surgery, omitting of prophylaxis use, and inappropriate timing of administration were highly associated with surgical site infection.

Inadvertent Perioperative Hypothermia and Important Risk Factors during Major Abdominal Surgeries.

A relation between inadvertent perioperative hypothermia and possible important risk factors during major abdominal surgeries was investigated. Cross-sectional descriptive study. Trakya University Hospital, Edirne, Turkey during 2016-2018. Five hundred and twenty-nine patients undergoing major abdominal surgey were divided into two groups depending on postoperative body core temperature (CTM) by the use of tympanic membrane measurement. Patients with a temperature of less than 36oC indicated hypothermia group; whereas, patients with a temperature between 36 and 37.5oC indicated normothermia group. The parameters that were considered as risk factors for hypothermia include; baseline characteristics, American Society of Anesthesiologists (ASA) status, comorbidities, operative type, duration of surgery, patient and operative room temperatures, intraoperative hemodynamic parameters, transfusion of fluids and packed red blood cells (PRBCs), labaratory data, and adverse events. Correlation between these parameters and inadvertent hypothermia was sought. A p-value of less than 0.05 was considered statistically significant. The risk factors that showed a correlation with hypothermia include: male gender, advanced age, high ASA scores, smoking, prolonged duration of operation, transfusion of fluids and PRBCs (p<0.05). In hypothermia group, duration of operation time was longer, need for transfusion was greater, hematocrit and hemoglobin values were lower than Normothermia Group of patients (p<0.05). Hypothermia was detected in 335 (63.3%) of patients. In this study, important risk factors for inadvertent hypothermia were found as; male gender, advanced age, high ASA scores, smoking, prolonged duration of operation, transfusion of fluids and/or PRBCs.

Study of ureteral and renal morphometry on the outcome of ureterorenoscopic lithotripsy: The critical role of maximum ureteral wall thickness at the site of ureteral stone impaction.

Purpose:The purpose is to study the association of stone, ureteral, and renal morphometric parameters with the relevant outcome variables, i.e., complication rate, stone-free rate (SFR), and operating time of ureterorenoscopic lithotripsy. Although a safe procedure, it still occasionally has major complications. Computed tomography (CT) scan is often performed to diagnose ureteral calculi, providing opportunities for ureteral morphometry that may have a bearing on the outcome of the procedure.Materials and Methods:Ureteric, renal, and stone morphometric parameters were measured from CT of the abdomen and pelvis of the 110 patients with ureteral calculi who underwent ureteroscopic lithotripsy (URSL). Data were collected retrospectively in 25 patients and prospectively in 85 patients. Association of these parameters with the outcome variables of the procedure mentioned above was studied.Results:On univariate analysis, body mass index, stone size, and maximum ureteral wall thickness (MUWT) were found to have a significant association with URSL complications, SFR, and duration of surgery. On multivariable analysis, only MUWT was found to be an independent risk factor for URSL complications. In 90% of total patients with residual stones, MUWT was found to be >4.8 mm.Conclusion:Ureteral wall thickness of >4.8 mm is associated with prolonged duration of surgery and lower SFR. Patients with ureteral wall thickness of >4.8 mm at the site of ureteral stone who are planned for URSL must be counseled about the higher chances of residual stones and the need for additional procedure.

RETROSPECTIVE ANALYSIS OF MESH RELATED INFECTIONS IN A TERTIARY CARE CENTRE

Background: The use of synthetic mesh was a landmark breakthrough in management of hernia repair and has significantly reduced recurrence rates. It is a foreign material, and a slightest breach in asepsis can lead to favourable environment for bacterial proliferation and forms a ‘biofilm’ and thus mesh infection. Identifying the risk factors associated with mesh infection will help us prevent the vicious cycle of hernia surgery leading to mesh infection, re surgery to address the infected mesh and so on. Methods: A retrospective descriptive study was conducted in our centre for a period of two years (November 2017 to November 2019) to study the incidence of mesh infection after hernia repair and the factors associated with it. All primary hernia repairs were done on elective basis and antibiotics was given as per the protocol of our hospital. Patient demographics like age, sex and other factors associated with mesh infection like history of tobacco consumption, BMI, ASA grade, duration of surgery, type of hernia, type of repair, type of mesh used, were taken from medical records and their association with mesh infection was analysed. The results were statistically expressed in the form of mean, standard deviations and percentages. Results: A total of 10 cases of mesh infection were recorded out of 485 hernia surgeries. In contrary to other studies, in our study mesh infection was more common after laparoscopic surgeries. It was detected that there was a lapse in the sterilisation of laparoscopic instruments which led to the infection, which was rectified by vigilant sterilisation of the laparoscopic instruments and. Two laparoscopic hernioplasty were performed as the second surgery in the day, i.e was followed by laparoscopic cholecystectomy which was suspected be one of the cause for increased incidence in mesh infection after laparoscopic surgery. Laparoscopic instruments were reused in these two procedures which were avoided thereafter. It was more common in obese patients with an average BMI of 31.70+/-1.68 kg/m2. Supporting other studies our study had higher incidence among elderly men, obese patients, uncontrolled Type2 DM, patients with tobacco consumption, higher BMI and higher ASA grade. Conclusions: Strict sterilisation of laparoscopic instruments is a must for laparoscopic hernia surgery. Laparoscopic hernia repair should be preferably performed as the first surgery of the day. Modifiable causes of prolonged duration of surgery like orientation of the operating and nursing staff to the procedure, availability of the instruments can prevent unnecessary delay in the procedure and thus prevent mesh infection. Optimization of the patient factors like reduction of weight, quitting tobacco consumption and tight control of Type 2 DM are measures to be taken to prevent mesh infection.

Comparison Study Between Laparoscopic Radical Prostatectomy versus Robotic Radical Prostatectomy in Patient with TUR-P History

Background: The number of men with benign prostate hyperplasia undergoing transurethral resection of prostate (TURP) with the subsequent development of prostate cancer has been increasing. This study aimed to compare the surgical, oncological, and functional outcomes of robotic and laparoscopic radical prostatectomy techniques in patients with the history of TURP.Methods: Literature search of electronic databases was performed through Pubmed, Science Direct, SCOPUS, and CENTRAL databases. Cochrane Risk of Bias Tool was then employed to assess the risk of bias in each study. Grey literature was also searched from sources such as Cancer Care Ontario and conference abstracts. Critical appraisals of included studies were conducted using the Newcastle-Ottawa Scale.Results: The searches located 1258 citations, but only 11 studies were included in the final selection. Most studies had a good methodological quality based on the Ottawa Scale. The mean age of samples was varied among each study from 61.8 to 70.8 years. The TURP history significantly affects biochemical recurrences (OR 2.29, 95% CI 1.14–4.59), intraoperative blood loss (MD 57 ml; 95% CI 6–108 m), prolonged operative duration (MD 20 minutes; 95% CI 3–37 minutes), and surgical complications (OR 2.54, 95% CI 1.79–3.60) following radical prostatectomy for prostate cancer. In the subgroup analysis, only prolonged operative duration and surgical complications were significant both in laparoscopic and robotic radical prostatectomy. There was no association between the TURP history and the positive surgical margin rate in total and subgroup analyses. Conclusions: The previous TURP history affects the outcomes of patients who underwent radical prostatectomy, either laparoscopic or robotic.

Analysis influencing factors on deep vein thrombosis formation on patients with traumatic brian injury

Objective We discussed the influencing factors on deep vein thrombosis formation on patients with traumatic brain injury. Methods A retrospective study was conducted among 289 traumatic brain injury patients who underwent craniotomy procedures at Beijing Tiantan Hospital, Capital Medical University from January 2016 to December 2018. Among them, 47 patients suffered deep vein thrombosis after surgery. We analyzed the influencing factors on deep vein thrombosis formation using multi-factor Logistic analysis. Results Multivariate logistic regression analysis revealed that preoperative Glasgow Coma Scale (GCS) 3.1 h (P=0.040, OR=3.171, 95%CI 2.031-3.922) are factors that may influence deep veins thrombosis in traumatic brain injury patients. Conclusions For traumatic brain injury patients who have lower GCS, shorter prothrombin time, subarachnoid hemorrhage and prolonged surgery duration, clinicians should pay attention to the incidence of deep vein thrombosis. Key words: Traumatic brain injury; Deep vein thrombosis; Influencing factors

Influence of administration of antimicrobial medications after tibial plateau leveling osteotomy on surgical site infections: A retrospective study of 308 dogs.

To determine the influence of prophylactic administration of oral antimicrobial medications after tibial plateau leveling osteotomy (TPLO) on surgical site infections (SSI) and antimicrobial-resistant infections. Retrospective study. Dogs treated with unilateral TPLO (n = 308) between January 2013 and December 2015. Medical records were reviewed for signalment, surgically treated limb, duration of surgery and anesthesia, postoperative administration of antimicrobial medications, antibiotic agent, surgeon, and development of SSI. Statistical analyses included descriptive statistics, simple linear regression, analysis of variance, Fisher's protected least significant difference, and χ2 testing. Data were collected from records of 31 dogs that did not receive antimicrobial medications and 277 dogs that did receive oral antimicrobial medications for 14 days after TPLO. Superficial incisional SSI was detected in two of 31 dogs that did not receive antimicrobial medications and in 48 of 277 dogs that did receive antimicrobial medications (P = .1194). Deep incisional SSI occurred in two of 31 dogs that did not receive antimicrobial medications and in 27 of 277 dogs that did receive antimicrobial medications (P = .5513). Antibiotic-resistant deep incisional SSI occurred in two of 31 dogs that did not receive antimicrobial medications and in 18 of 277 dogs that did receive antimicrobial medications (P = .9920). Body weight correlated with deep incisional SSI and resistant infections. Prolonged duration of surgery and anesthesia were associated with superficial incisional SSI, deep incisional SSI, and antibiotic resistance. Surgeons influenced deep incisional SSI. Previously reported predisposing factors for infection were confirmed, but postoperative administration of antimicrobial medications was not protective against SSI nor did it predispose to antibiotic resistance in our clinical setting. This study does not provide evidence to support administration of prophylactic oral antimicrobial medications after unilateral TPLO.

Comparative Cost-Effectiveness of Cranioplasty Implants.

The aim of this study was to compare operative duration and total hospital costs incurred for patients undergoing elective cranioplasty with a variety of materials, including manually shaped autogenous bone graft and titanium mesh, custom patient-specific titanium mesh, polymethyl methacrylate (PMMA) acrylic, and polyetheretherketone (PEEK) implants. A single-centre retrospective chart review was used. Patient demographics, defect characteristics, total operative time, and length of hospital stay were obtained. Total costs were sourced from Sunnybrook and standardized to the 2014 to 2015 year. Bivariate and age-controlled multivariate analyses were performed with (n = 119) and without (n = 101) outliers. When outliers were removed, an age-controlled analysis revealed that autogenous implants resulted in an operative time of 178 ± 37 minutes longer than manually shaped titanium implants (P < .01). The average cost of cranioplasty was CAD$18 335 ± CAD$10 265 for manually shaped titanium implants, CAD$31 956 ± CAD$31 206 for custom patient-specific titanium implants, CAD$20 786 ± CAD$13 075 for PMMA, CAD$14 291 ± CAD$5562 for autogenous implants, and CAD$27 379 ± CAD$4945 for PEEK implants (P = .013). When outliers were removed, cranioplasty with PMMA and PEEK incurred greater costs, CAD$4442 ± CAD$2100 and CAD$13 372 ± CAD$2728, respectively, more than manually shaped titanium implants (P < .01). Manually shaped titanium mesh is the most cost-effective implant choice for small cranial defects. Large unknown defects and frontal paranasal sinus defects are most effectively treated with autogenous bone or titanium mesh. Despite prolonged operative duration and inpatient admission, total costs were not significantly increased. Both PMMA and PEEK implants were significantly more costly, which may be a result of higher complications necessitating reoperation.

Evidence appraisal of Cheng H, Clymer JW, Chen BPH, et al. Prolonged operative duration is associated with complications: a systematic review and meta‐analysis. J Surg Res. 2018;229:134‐144.

Evidence appraisal of Cheng H, Clymer JW, Chen BPH, et al. Prolonged operative duration is associated with complications: a systematic review and meta‐analysis. J Surg Res. 2018;229:134‐144.

Incidence of facial pressure ulcers following surgery in the prone position - experience in a tertiary care hospital in Singapore

Introduction: The development of facial pressure ulcers after prone positioning is a well-known complication and a common source of patient dissatisfaction. Several risk factors have been identified in past studies. However, few studies have focused on the Asian population. We therefore set forth to identify the incidence of facial pressure ulcers following surgery in the prone position in our local population, as well as determine possible risk factors for their development. Methods: We recruited 132 patients who underwent elective surgery in a prone position under general anaesthesia in our tertiary hospital. The occurrence of facial pressure ulcers was analysed against several demographic and intraoperative factors. Statistical significance was taken as p Results: A total of 114 patients were included in the final analysis. The overall incidence of facial pressure ulcers was 35%. The most common locations were the cheeks (75%), and the forehead (43%). Increased age (OR 1.04 per year, p=0.035) and a prolonged duration of surgery (OR 2.05 per hour, p Conclusion: Facial pressure ulcers are common following surgery in a prone position in our local context. This first study on the Southeast Asian population corroborates with known risk factors for pressure ulcer development. Future studies may explore possible risk reduction measures to reduce the incidence of facial pressure ulcers in Southeast Asian populations.

A pilot study to assess the safety and usefulness of combined transurethral endoscopic mucosal resection and en-bloc resection for non-muscle invasive bladder cancer

BackgroundTransurethral resection (TUR) is the standard operation used for non-muscle invasive bladder cancer (NMIBC). Although most solid tumors are principally removed via single block resection without incising the mass, disruption of the lesion is unavoidable in traditional TUR. Furthermore, pathological diagnosis is often difficult due to heat-related denaturation of tissues in TUR. Although transurethral en-bloc resection is useful for judging tumor invasion, it is associated with a prolonged operative duration. We attempted to show the safety and usefulness of combined endoscopic mucosal resection (EMR) and en-bloc resection in NMIBC patients.MethodsWe investigated 39 patients with clinical NMIBC who were treated using our original EMR + en-bloc resection technique, which involved removal of the tumor mass that protruded from the mucosa, using a polypectomy snare similar to that used for EMR. The residual lesion was removed using en-bloc resection. The operative period, duration of hospitalization, and recurrence rates were compared with those of conventional TUR (n = 31).ResultsThe mean (standard deviation, range) time interval for EMR and total operative duration were 1.6 (1.1, 1–5) min and 18.3 (10.5, 3–48) min, respectively. The total operative duration was comparable to that of TUR (17.3 min, p = 0.691). The mean duration of catheterization in the EMR + en-bloc resection group (4.2 days) was also similar to that in the TUR group (3.7 days; p = 0.285). No severe complications were observed with EMR + en-bloc resection. The pathologists were able to determine tumor invasiveness with considerable certainty in all specimens obtained via the EMR + en-bloc procedure than via TUR, and the difference in the ease of diagnosis was statistically significant (p = 0.016). Recurrence rates were comparable (p = 0.662) between the EMR + en-bloc (15.4%) and TUR groups (19.4%).ConclusionsOur results demonstrated that the EMR + en-bloc resection technique is feasible, safe, and useful for treating patients with NMIBC. Furthermore, this technique helps provide a more accurate pathological diagnosis.

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC-2) to predict the requirement for early postoperative tracheal re-intubation: a hospital registry study.

Postoperative pulmonary complications are associated with an increase in mortality, morbidity and healthcare utilisation. The Agency for Healthcare Research and Quality recommends risk assessment for postoperative respiratory complications in patients undergoing surgery. In this hospital registry study of adult patients undergoing non-cardiac surgery between 2005 and 2017 at two independent healthcare networks, a prediction instrument for early postoperative tracheal re-intubation was developed and externally validated. This was based on the development of the Score for Prediction Of Postoperative Respiratory Complications. For predictor selection, stepwise backward logistic regression and bootstrap resampling were applied. Development and validation cohorts were represented by 90,893 patients at Partners Healthcare and 67,046 patients at Beth Israel Deaconess Medical Center, of whom 699 (0.8%) and 587 (0.9%) patients, respectively, had their tracheas re-intubated. In addition to five pre-operative predictors identified in the Score for Prediction Of Postoperative Respiratory Complications, the final model included seven additional intra-operative predictors: early post-tracheal intubation desaturation; prolonged duration of surgery; high fraction of inspired oxygen; high vasopressor dose; blood transfusion; the absence of volatile anaesthetic use; and the absence of lung-protective ventilation. The area under the receiver operating characteristic curve for the new score was significantly greater than that of the original Score for Prediction Of Postoperative Respiratory Complications (0.84 [95%CI 0.82-0.85] vs. 0.76 [95%CI 0.75-0.78], respectively; p<0.001). This may allow clinicians to develop and implement strategies to decrease the risk of early postoperative tracheal re-intubation.

Complications of early Cholecystectomy in acute Biliary Pancreatitis

Introduction: Pancreatitis, inflammation of pancreas, is an acute emergency having mortality rate 2 to 7%. Acute pancreatitis can be caused by various factors, like drugs, alcohol, toxins, gallstones, trauma, infection etc. and amongst these, gallstones are the most common cause and is seen in around 75% of the cases. Regarding gall stones, the size of it and number are important parameters. Management usually depends upon the clinical scenario, underlying conditions of pancreas, presence of co morbid conditions and cholecystectomy. This can be done immediately or with an interval while the acute episode of pancreatitis is settled; each having their own benefits and complication rates.&#x0D; Objective: To determine the complications of early cholecystectomy in acute biliary pancreatitis.&#x0D; Methodology: A descriptive cases series study was carried out at Mayo Hospital Lahore during June through December 2017. The cases of either gender aged 18 years and above of acute biliary pancreatitis diagnosed clinically with epigastric pain, tenderness and vomiting with raised pancreatic enzymes with history of gall stones were selected purposively. The cases underwent open laparoscopic cholecystectomy in the same admission within 5 days of admission. These subjects were then followed to lo ok for duration of surgery, duration of hospital stay and recurrence of pancreatitis. Final outcome was seen at 3 months to look for recurrence.&#x0D; Results: We took 50 cases of acute biliary pancreatitis. There were 20 (40%) males and 30 (60%) females. The mean age at presentation was 43.56± 4.68 years. The mean duration of surgery was observed as 54.56 ±12.33 minutes. Total complications were seen in 9 (18%) of the cases; few had combination of these. The most common complication seen was prolonged duration of hospital stay (18%), followed by prolonged duration of surgery (10%) and recurrent pancreatitis (8%).&#x0D; Conclusion: Early cholecystectomy has higher compilations rate and the most common is long duration of hospital stay.&#x0D; &#x0D; Key words: Pancreatitis, Early cholecystectomy