Intraoperative Complication Rate Research Articles

Safety and perioperative outcomes of uniportal versus multiportal video-assisted thoracoscopic surgery.

Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently become an alternative approach for many minimally invasive thoracic procedures, but although its surgical effectiveness has been proven, still its feasibility and safety are debated and unclear. the objective of this study was to compare the safety and perioperative outcomes of U-VATS versus multiportal VATS (M-VATS). This was a comparative follow-up randomised controlled clinical trial, carried out on 36 randomly selected eligible patients, and fulfilling the inclusion and exclusion criteria for VATS, they were assigned randomly into two groups: Study Group I including 18 patients undergoing U-VATS with conventional treatment using standard chest tube drainage and Control Group II including 18 patients undergoing M-VATS) with the same conventional treatment using standard chest tube drainage and served as a comparable control group. Patients in the U-VATS Group 1 had faster operation time, and with reduced blood loss, pleural drainage and post-operative hospitalisation, they also experienced lower average post-operative pain score on comparison with those in M-VATS Group II (P < 0.001), respectively. For either group, there were no hospital deaths or infections. There was no noticeable difference between the two groups in terms of the number of resected lymph nodes or the rates of intraoperative or post-operative complications (P > 0.05). U-VATS is feasible and safe in eligible selected patients with favourable short-term perioperative outcomes (operative time, duration of pleural drainage, post-operative pain, early ambulation, duration of hospital stay as well as the risk of perioperative complications), and it can be considered the preferred approach in minimally invasive thoracic procedures that open up for the possibility of fast-track thoracic surgeries.

TO EVALUATE THE SELECTION PROTOCOL OF CATARACT PATIENTS ADMITTED THROUGH OUTREACH PROGRAMS (EYE CAMPS) UNDERGOING SURGERY IN A TERTIARY CARE CENTER OF CENTRAL INDIA

Aim: To evaluate the selection protocol of Cataract patients admitted through outreach programs (EYE CAMPS) undergoing surgery in a tertiary care center of Central India Study design: It is a prospective descriptive study conducted on camp patients at a charitable tertiary eye care hospital (Central India) from January 2023 to june2023. Wirtten informed consent was taken from patients for participation in this study. Setting:A prospective observational study was performed of all cataract patients admitted through outreach program (EYE Camp) for small incision cataract surgery in the department of Ophthalmology, Sri Aurobindo institute of medical sciences, Indore from January 2023 to june2023. Material and Methods: During the study period 332 patients were screened ..all patients above 40 years of age having senile cataract were included and Patients with age less than 40 years of age, Congenital cataract, complicated cataracts like traumatic, uveitic, subluxated or dislocated cataracts, patients having undergone previously any ocular surgery in the selected eye, patients not giving written informed consent were excluded from the study. Results: Out of 332 camp patients 306 (92%) patients under went small incision cataract surgery and the surgeries of 26 patients (8%) were postponed, as the patients were unfit due to ocular and systemic reasons out of 26 patients, 5 patients had uncontrolled blood sugar, 7 patients had uncontrolled blood pressure, 2 patients had cardiac problems, 1 patient was asthmatic. Conclusion:In our study, increasing age and female gender were commonly associated with cataract. Most of the patients had bilateral cataract and low vision at presentation. Hypertension and type 2 diabetes mellitus were commonly associated systemic disorders with cataract. This study highlights that high quality cataract surgery with a low intra-operative complication rate and good visual outcome can be attained even in camp patients operated in the base hospitals with standard protocols.

EVALUATION OF DEMOGRAPHIC PROFILE AND VISUAL OUTCOMES OF CATARACT PATIENTS OPERATED IN A CHARITABLE CAMP HOSPITAL IN CENTRAL INDIA

Aim: To Study the Demographic Profile and visual Outcomes of Cataract Patients Operated in a Charitable Camp in Central India Introduction Cataract is a leading cause of preventable blindness globally. Developing countries account for three quarters of cataract blindness worldwide. Despite the large number of corrective surgeries being performed globally cataract blindness is believed to be increasing by1–2 million/year. The present study was conducted in the patients residing in a peripheral rural area of Indore division (central India) to study the demographic and clinical profile of patients with cataract. This study supplements to understand the outcomes of such patients who were operated in camp at a tertiary care center. Study Design: It is a prospective descriptive study conducted on camp patients at a charitable tertiary eye care hospital (Central India) from December 2019 to February 2020.Wirtten informed consent was taken from patients for participation in this study. Setting: Department of Ophthalmology Choithram Netralaya, Indore from December 2019 to February 2020. Material and Methods: During the study period 139 surgeries were performed by the surgeon. All patients above 40 years of age having senile cataract with stable systemic condition were included. Patients with age less than 40 years of age, uncontrolled systemic condition, Patients with other ocular comorbidities, undergone previously any ocular surgery in the selected eye or not giving written informed consent were excluded.All the patients were screened for cataracts in the camps in the periphery by the trained optometrist and referred to the base hospital. Detailed pre-operative ocular examination of all the patients was performed and medical checkup with routine pre-operative profile was also done. Patients medically fit for cataract surgery underwent small incision cataract surgery with Posterior capsular IOL implantation (PCIOL) under local anesthesia. All the cataract surgeries were performed by a single surgeon using the same technique to avoid any bias. Results: It was observed that the mean age of presentation was 61.5 years with female preponderance of nearly (56.8%) . out of 139 patients 63 patients (45.3,%) had systemic comorbidities, which included ,33 patients (23.74%) with hypertension and 28 patients(20.14%) with Diabetes mellitus. Majority of patients i.e.101 (72.66%) patients had onset of ocular symptoms between 3 to 6 months . In this study bilateral immature nuclear cataract was commonly encountered cataract in 88.48% of patients and only 8 patients had mature cataract and 7 patients presented with hyper mature cataract respectively .On post-operative day one, 19 patients and 8 patients had blood clot in anterior hamber,5 patients had cortical matter in Anterior chamber On follow up at one week, majority of patients i.e 110 (79.13%) had visual acuity between 6/9-6/12.Patients after re-surgery had visual acuity of minimum up to 6/24 with possibility of getting better on further visits. Conclusion: In our study, increasing age and female gender were commonly associated with cataract. Most of the patients had bilateral cataract and low vision at presentation. Hypertension and type 2 diabetes mellitus were commonly associated systemic disorders with cataract.This study highlights that high quality cataract surgery with a low intra-operative complication rate and good visual outcome can be attained even in camp patients operated in the base hospitals with standard protocols.

Complications in single-incision laparoscopic surgery transabdominal preperitoneal (SILS-TAPP) for inguinal hernia

Objective: Single-incision laparoscopic surgery transabdominal preperitoneal (SILS-TAPP) inguinal hernia (IH) repair represents an innovative advancement in minimally invasive surgical techniques. However, there have been concerns about the complication rate of this technique. We aimed to systematically review the complications of SILS-TAPP in detail. Methods: We comprehensively searched the published literature between 1980 and 2022 on Pubmed, Embase, Scopus, Web of Science, and Proquest. Studies of IH patients aged &lt; 18 who underwent SILS-TAPP were included. The results must include the intraoperative and/or postoperative complications rate of surgery. Studies not in English, studies of patients who underwent another surgery apart from hernia repair, and review articles were excluded. The abstract and full-text screening were done. Results: Primary search on a major database platform gained 348 records of articles. After screening, 9 studies were included. Nine studies recruited 1561 patients. Men were dominant. Recurrent IH accounted for about 4%. Two studies reported using specialized laparoscopic instruments (Roticulator), while the other eight used conventional instruments. No major intraoperative complications were reported. Blood loss was minimal. There was only one case wherein an additional trocar was placed. Postoperative complications were observed in about 5% of cases, including seroma, hematoma, urinary retention, port site infection, ileus, foreign body sensation, and port site hernia. Recurrence was rare, accounting for about 0.3%. Conclusion: Complications of SILS-TAPP are not frequent and mild. The recurrent rate is small. Therefore, SILS-TAPP can be a good alternative for open and laparoscopic hernia repair.

Intraoperative Complications and Perioperative and Surgical Outcomes of Single-Port Robotics-Assisted Sacrocolpopexy.

The objective was to assess intraoperative and postoperative complication rates, along with perioperative and surgical outcomes, following single-port robotics-assisted sacrocolpopexy. This retrospective case series included 200 patients who underwent single-port robotics-assisted sacrocolpopexy to treat Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 symptomatic prolapse between April 2020 and August 2023 by a single surgeon. Intraoperative and postoperative complications and perioperative outcomes were evaluated for all the patients, whereas surgical outcomes for 74 patients were assessed at 1-year follow-up. Surgical failure was defined as the presence of any of the following: the presence of vaginal bulging symptoms, any prolapse beyond the hymen, or retreatment for prolapse. During the study period, 200 single-port robotics-assisted sacrocolpopexies were performed. The median age and body mass index were 65.0 years and 24.6kg/m2 respectively. Most patients had POPQ stage 3 or 4 prolapse and underwent concomitant total hysterectomy. The median total operation time was 212.0min, and none of the patients required conversion to laparoscopy or laparotomy. The intraoperative cystotomy rate was 2.5%, and one patient had a blood transfusion owing to presacral vessel injury. Postoperative complications of mesh exposure and wound hernia were 0.5% and 2.0% respectively. At 1 year postoperatively, the rate of composite surgical failure was 9.5%, with a 5.4% anatomical recurrence rate. None of the patients experienced apical prolapse recurrence, and one received anterior colporrhaphy for anterior compartment prolapse recurrence. Single-port robotics-assisted sacrocolpopexy is safe and effective, with low complication rates and favorable perioperative and surgical outcomes.

Complication Rates Are Not Higher After Outpatient Versus Inpatient Fast-Track Total Knee Arthroplasty: A Propensity-Matched Prospective Comparative Study

BackgroundThis prospective study aimed to compare the complication rates and clinical outcomes of propensity-matched patients who received fast-track total knee arthroplasty (FT TKA) in outpatient versus inpatient settings. MethodsPatients (n = 629) who received FT TKA at various outpatient (n = 176) and inpatient (n = 462) surgery rates were prospectively followed until 90 days after surgery. The decision between inpatient versus outpatient FT TKA was made on a case-by-case basis, depending on consultation between the surgeon and patient. Complications were collected to distinguish between intraoperative complications, complications with no readmission, complications with readmission, and complications with reoperation. Propensity scores based on age, sex, body mass index, and the American Society of Anesthesiologists score were used to match outpatient to inpatient FT TKA. A cumulative incidence function was computed by taking the time to diagnose any postoperative complication in the first 90 days as the end point. ResultsPropensity score matching (1:2 ratio) for comparison resulted in 173 outpatient FT TKAs and 316 inpatient FT TKAs. No significant differences were observed between outpatient versus inpatient FT TKA for intraoperative complication rates (2% in both groups). At 90-day follow-up, no significant differences were observed between outpatient versus inpatient FT TKA for total complications with no readmission (8.0 versus 7.9%), complications with readmission but no reoperation (1.1 versus 0.6%), and complications with reoperation (4.0 versus 4.4%). A comparison of postoperative complication diagnosis time using the cumulative incidence function revealed no significant differences between outpatient versus inpatient FT TKA. ConclusionsThe present study revealed that there were no differences in 90-day postoperative complication rates between outpatient and inpatient FT TKA and that there were also no differences in rates of intraoperative complications, readmissions, or reoperations. These findings may encourage hesitant surgeons to move toward outpatient TKA pathways, as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge. Level of EvidenceLevel II.

A Cataract Surgery in A Camp Patient; A Study on Visual Outcomes

Cataract is the leading cause of blindness and visual impairment among cataract patient globally including in Libya. Phacoemulsification is a commonly performed procedure to improve visual outcome among senile cataract patients because of its advantages compared to other techniques. This study was aimed to determine visual outcome improvement after phacoemulsification among cataract patient. A descriptive study was carried out among cataract patients who underwent phacoemulsification procedure. A total number of 100 operated eyes were followed-up to obtain their postoperative visual acuity (VA) and complications. There were significant improvements of VA resulting in an increase in the number of patients with good vision (normal to mild visual impairment) to 86% after phacoemulsification procedure. There was also low rate of postoperative complications. High quality cataract surgery with a low rate of intra-operative complications and good visual outcome can be attained in camp patients operated in the base hospitals, thus justifying more similar screening camps to clear the vast cataract backlog.

Unilateral nephrectomy in dogs is associated with a high rate of intraoperative and postoperative complications.

To determine the incidence of complications in the intraoperative and postoperative period for dogs undergoing nephrectomy for renal disease. 69 dogs. Medical records of dogs undergoing nephrectomies for renal disease were reviewed for signalment, date of surgery, results of blood analyses, and intra- and postoperative complications. Long-term follow-up was obtained via client telephone interview or referring veterinarian medical records. A Fisher exact test was used to assess the relationship between postoperative acute kidney injury and NSAID administration with long-term development of chronic kidney disease. Complications occurred in 44.9% and 42.6% of dogs in the intraoperative and postoperative periods, respectively. Most of these were lower-grade complications, though a total of 7 dogs died during the postoperative period. An acute kidney injury was diagnosed in 12 dogs postoperatively, with 2 dogs euthanized due to the severity of the injury. Long-term follow-up was available for 53 dogs, with 24 (45.3%) dogs developing chronic kidney disease. Postoperative acute kidney injury (P = .385) and NSAID administration (P = .519) were not statistically associated with the development of chronic kidney disease in this population. Unilateral nephrectomy is associated with high intraoperative and postoperative complication rates in dogs. Chronic kidney disease was diagnosed in almost 50% of the population with available long-term follow-up.

Related factors of perioperative low body temperature and incidence of postoperative shivering in patients undergoing complex percutaneous nephrolithotomy and the effect analysis of composite insulation nursing intervention

This study aimed to analyze the factors associated with intraoperative hypothermia and postoperative shivering rates in patients undergoing complex percutaneous nephrolithotomy (PCNL) and investigate the effects of combined insulation nursing intervention. A total of 168 patients were included, with 103 patients in the control (Ctrl) group receiving routine care and 65 patients in the nursing (Nur) group receiving combined insulation nursing intervention measures. General information, surgical data, temperature, intraoperative hypothermia incidence, postoperative shivering, and complication rates were statistically analyzed between the two groups. Patient temperature, blood pressure, and blood gas indicators including pH value, bicarbonate, and lactate levels were recorded at admission (T0), before anesthesia (T1), 30 min after spinal-epidural combined anesthesia (T2), 60 min (T3), 90 min (T4), 120 min (T5), and postoperatively (T6). The results demonstrated that the average intraoperative temperature of patients in the Nur group was significantly higher than that of the Ctrl group (P < 0.001), and their incidence of hypothermia was significantly lower than that of the Ctrl group (P < 0.01). Additionally, the Nur group exhibited shorter recovery time (18.36 ± 3.58 min), extubation time (28.01 ± 3.12 min), and length of hospital stay (8.45 ± 2.14 days) compared to the Ctrl group (P < 0.05). The incidence of postoperative shivering was 4.62 %, significantly lower than that of the Ctrl group (P < 0.001). Multifactorial analysis revealed that age ≥60 years, stone diameter ≥3.0 cm, irrigation volume ≥3000 mL, nursing intervention measures, and surgical duration were the main factors influencing the occurrence of intraoperative hypothermia. Age ≥60 years, nursing intervention measures, surgical duration, and intraoperative temperature<36 °C are identified as major risk factors for postoperative shivering. This indicates that specialized nursing care and combined insulation nursing intervention measures in patients undergoing complex percutaneous nephrolithotomy contribute to reducing the incidence of intraoperative hypothermia and postoperative shivering. It is recommended to promptly address the risk factors associated with hypothermia and shivering during and after surgery to mitigate the risk of perioperative complications.

Comparison of complications and visual outcomes of combined phacovitrectomy vs stand-alone phacoemulsification: multicenter database study.

To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) with those with stand-alone phacoemulsification. A multicenter database study across 8 ophthalmology departments in the United Kingdom. Retrospective, nonrandomized, multicenter comparative study. We extracted data for patients who underwent Phaco-PPV and stand-alone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME postoperatively. The study included 2222 eyes in the combined Phaco-PPV group and 112 689 in the stand-alone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs 1.7%), dropped lens fragments (0.5% vs 0.2%), suprachoroidal hemorrhage (0.4% vs 0.1%), and CME (3.6 vs 1.1%) ( P < .001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs 20/100) in the stand-alone phacoemulsification group ( P < .001). VA at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs 0.22 logMAR (Snellen ∼20/100 vs 20/32), P < .001). Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative VA, when compared with stand-alone phacoemulsification surgery.

The Evolution of Enhanced Recovery After Surgery: Assessing the Clinical Benefits of Developments Within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery.

Retrospective cohort. To investigate the impact of evolving Enhanced Recovery After Surgery (ERAS) protocols on outcomes after cervical deformity (CD) surgery. ERAS can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, there remains a paucity of literature assessing how developments have impacted outcomes after adult CD surgery. Patients with operative CD 18 years or older with pre-baseline and 2 years (2Y) postoperative data, who underwent ERAS protocols, were stratified by increasing implantation of ERAS components: (1) early (multimodal pain program), (2) intermediate (early protocol + paraspinal blocks, early ambulation), and (3) late (early/intermediate protocols + comprehensive prehabilitation). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors, and complication rates were assessed through Bonferroni-adjusted means comparison analysis. A total of 131 patients were included (59.4 ± 11.7 y, 45% females, 28.8 ± 6.0 kg/m 2 ). Of these patients, 38.9% were considered "early," 36.6% were "intermediate," and 24.4% were "late." Perioperatively, rates of intraoperative complications were lower in the late group ( P = 0.036). Postoperatively, discharge disposition differed significantly between cohorts, with late patients more likely to be discharged to home versus early or intermediate cohorts [χ 2 (2) = 37.973, P < 0.001]. In terms of postoperative disability recovery, intermediate and late patients demonstrated incrementally improved 6 W modified Japanese Orthopedic Association scores ( P = 0.004), and late patients maintained significantly higher mean Euro-QOL 5-Dimension Questionnaire and modified Japanese Orthopedic Association scores by 1 year ( P < 0.001, P = 0.026). By 2Y, cohorts demonstrated incrementally increasing SWAL-QOL scores (all domains P < 0.028) domain scores versus early or intermediate cohorts. By 2Y, incrementally decreasing reoperation was observed in early versus intermediate versus late cohorts ( P = 0.034). The present study demonstrates that patients enrolled in an evolving ERAS program demonstrate incremental improvement in preoperative optimization and candidate selection, greater likelihood of discharge to home, decreased postoperative disability and dysphasia burden, and decreased likelihood of intraoperative complications and reoperation rates.

The role of videolaryngoscopy in cleft surgery: A single center comparative study before and during the COVID-19 pandemic

BackgroundCleft lip and palate (CLCP) surgeries necessitate precise airway management, especially in pediatric cases with anatomical variations. The Covid-19 pandemic posed unprecedented challenges to anesthesiology practices that required adaptations to ensure patient safety and minimize viral transmission. Videolaryngoscopy (VL) emerged as a valuable tool in airway management during the pandemic, offering improved intubation success rates and reduced aerosol generation risks. MethodsThis retrospective study compared anesthesiology practices in CLCP surgeries before (2015–2019) and during the Covid-19 (2019–2022) pandemic at a tertiary care center. Patient demographics, anesthesia techniques, intubation difficulty, airway management, and intraoperative and postoperative follow-up were analyzed from anesthesia records. ResultsThis study included 1282 cases. Demographics were similar between periods. During the pandemic, there was a significant decrease in the number of patients under one year old (p < 0.001) and a higher prevalence of micrognathia and comorbidities (p = 0.001 and p = 0.038, respectively). Difficult intubation and intraoperative complication rates decreased during the pandemic, but they were not statistically significant. VL usage during the pandemic contributed to improved extubating success (p < 0.001). ConclusionsVL usage and improved patient outcomes were observed during the pandemic, potentially due to proactive measures and infection control protocols. Decision-making processes for extubation and intensive care unit stay became crucial during the pandemic. Understanding the role of VL and its adaptations during the Covid-19 pandemic is vital for optimizing perioperative care in CLCP surgeries and other procedures requiring airway management. The findings highlight the resilience of healthcare systems and the importance of evidence-based practices under challenging circumstances.

Anatomical total shoulder arthroplasty revision to reverse shoulder arthroplasty using convertible glenoid: a systematic review of clinical and radiological outcomes.

The aim of the present systematic review is to collect all the available evidence regarding the clinical and radiological results of revision to reverse shoulder arthroplasty (RSA) of modular anatomic shoulder prostheses (TSA) using a convertible metal-backed glenoid (MBG). This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies investigating revision of TSA to RSA utilizing a convertible MBG and reporting clinical and radiological outcomes were identified. A total of five studies on the use of convertible modular glenoid component in the setting of TSA revision to RSA were finally included in the present systematic review. A total of 60 procedures were reported. Mean operative times was 65min. Intraoperative complications included 3 cases of glenoid loosening. Only one case of dislocation was reported as postoperative complication. At mean follow-up of 32.3months post-revision, no glenoid loosening was reported, VAS score decreased from 7.7 to 1.5, Constant Score increased from 24.8 to 57.6. Revision to RSA after failed TSA using a convertible modular glenoid component was associated with a low rate of intraoperative and postoperative complications, low surgical time and led to good results in term of pain relieve and functional outcomes. Given the complexity and risk associated with revision of anatomic shoulder prosthesis having a convertible glenoid may help to simplify the procedure and improve clinical results.

Dorsal laminectomy for the treatment of lateralised cervical intervertebral disc extrusions in dogs-Prognosis and complications.

Describe the complication rate, expected hospitalization time and prognosis associated with dorsal laminectomy for the treatment of lateralised cervical intervertebral disc extrusion (IVDE) in dogs. This is a single-center retrospective case series study. Databases were reviewed from 2012 to 2022 for dogs that had a dorsal laminectomy to treat a lateralised cervical IVDE. Dogs were excluded if additional surgical techniques were performed, or other comorbidities were found on MRI. Fifty two dogs were included the study. French bulldogs represented 28.8% of the cohort. Patient median age was 6 years and median weight 15 kg. Thirty-five dogs (67.3%) presented clinical signs for <3 days and almost half (44.2%) were ambulatory but presented cervical pain and neurological deficits. Median surgical time was 85 min. Minor intraoperative complications were reported in 22 (42.3%), with hypothermia being the most common. Thirteen (25%) needed revision surgery due to persistent cervical pain with (9/13) or without (4/13) neurological deficits. Re-extrusion or persistent extrusion was found in 92.3% of cases needing surgical revision. Median hospitalization time was 6 days. Forty-seven (90.4%) cases had a good outcome. Despite the relatively high rate of intraoperative complications and cases needing revision surgery, dorsal laminectomy as surgical treatment for lateralised cervical IVDE is still associated with good long-term prognosis in most of cases. Prognosis is good even when revision surgery is necessary but expected hospitalization time seems to be higher when compared to an alternative surgical technique.

Nationwide Association of Surgical Performance of Minimally Invasive Esophagectomy With Patient Outcomes

Suboptimal surgical performance is hypothesized to be associated with less favorable patient outcomes in minimally invasive esophagectomy (MIE). Establishing this association may lead to programs that promote better surgical performance of MIE and improve patient outcomes. To investigate associations between surgical performance and postoperative outcomes after MIE. In this nationwide cohort study of 15 Dutch hospitals that perform more than 20 MIEs per year, 7 masked expert MIE surgeons assessed surgical performance using videos and a previously developed and validated competency assessment tool (CAT). Each hospital submitted 2 representative videos of MIEs performed between November 4, 2021, and September 13, 2022. Patients registered in the Dutch Upper Gastrointestinal Cancer Audit between January 1, 2020, and December 31, 2021, were included to examine patient outcomes. Hospitals were divided into quartiles based on their MIE-CAT performance score. Outcomes were compared between highest (top 25%) and lowest (bottom 25%) performing quartiles. Transthoracic MIE with gastric tube reconstruction. The primary outcome was severe postoperative complications (Clavien-Dindo ≥3) within 30 days after surgery. Multilevel logistic regression, with clustering of patients within hospitals, was used to analyze associations between performance and outcomes. In total, 30 videos and 970 patients (mean [SD] age, 66.6 [9.1] years; 719 men [74.1%]) were included. The mean (SD) MIE-CAT score was 113.6 (5.5) in the highest performance quartile vs 94.1 (5.9) in the lowest. Severe postoperative complications occurred in 18.7% (41 of 219) of patients in the highest performance quartile vs 39.2% (40 of 102) in the lowest (risk ratio [RR], 0.50; 95% CI, 0.24-0.99). The highest vs the lowest performance quartile showed lower rates of conversions (1.8% vs 8.9%; RR, 0.21; 95% CI, 0.21-0.21), intraoperative complications (2.7% vs 7.8%; RR, 0.21; 95% CI, 0.04-0.94), and overall postoperative complications (46.1% vs 65.7%; RR, 0.54; 95% CI, 0.24-0.96). The R0 resection rate (96.8% vs 94.2%; RR, 1.03; 95% CI, 0.97-1.05) and lymph node yield (mean [SD], 38.9 [14.7] vs 26.2 [9.0]; RR, 3.20; 95% CI, 0.27-3.21) increased with oncologic-specific performance (eg, hiatus dissection, lymph node dissection). In addition, a high anastomotic phase score was associated with a lower anastomotic leakage rate (4.6% vs 17.7%; RR, 0.14; 95% CI, 0.06-0.31). These findings suggest that better surgical performance is associated with fewer perioperative complications for patients with esophageal cancer on a national level. If surgical performance of MIE can be improved with MIE-CAT implementation, substantially better patient outcomes may be achievable.

Is the robotic approach the future of distal pancreatectomy with splenectomy? A propensity score matched analysis.

Our study provides a comparative analysis of the Laparo-Endoscopic Single Site (LESS) and robotic surgical approaches for distal pancreatectomy and splenectomy, examining their cosmetic advantages, patient outcomes, and operative efficiencies through propensity score matching (PSM). We prospectively followed 174 patients undergoing either the LESS or robotic procedure, matched by cell type, tumor size, age, sex, and BMI from 2012 to 2023. Propensity score matching (PSM) was utilized for data adjustment, with results presented as median (mean ± SD). Post-PSM analysis showed no significant differences in age or BMI between the two groups. LESS approach exhibited a shorter operative duration (180(180 ± 52.0) vs. 248(262 ± 78.5) minutes, p = 0.0002), but increased estimated blood loss (200(317 ± 394.4) vs. 100 (128 ± 107.2) mL, p = 0.04). Rates of intraoperative and postoperative complications, length of hospital stay, readmissions within 30days, in-hospital mortalities, and costs were comparably similar between the two procedures. While the robotic approach led to lower blood loss, LESS was more time-efficient. Patient outcomes were similar in both methods, suggesting that the choice between these surgical techniques should balance cosmetic appeal with technical considerations.

Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and open partial nephrectomy A single-site, two-surgeon, retrospective cohort study.

In 2019, our center attempted to transition all partial nephrectomies (PNs) to robotic-assisted laparoscopic PN (RALPN). The purpose of this study was to compare RALPN outcomes to laparoscopic PN (LPN) and open PN (OPN) at our institution, as there is limited literature from Canadian centers. In this single-center, two-surgeon, retrospective cohort study, we compared RALPN outcomes during the early phase of our robotics program to OPN and LPN performed just before the introduction of RALPN. A total of 106 patients underwent OPN, 83 LPN, and 82 RALPN during the study period. Median RALPN REN AL score was 7 vs. 6 for LPN (p<0.05) and 8 for OPN (p=0.10). Median RALPN length of stay (LOS) was two days vs. three and four days for LPN and OPN (p<0.05), respectively. OPN median procedure time was 104 minutes vs. 94 and 82 minutes for LPN and RALPN (p<0.05), respectively. Median OPN operating room (OR) time was 160 minutes vs. 150 and 146 minutes for LPN and RALPN (p<0.05), respectively. There were no significant differences in intraoperative (p=0.92) or postoperative complication rates (p=0.47). RALPN warm ischemia time (WIT) was 17 minutes vs. 14.5 and 15 minutes for OPN and LPN (p<0.05), respectively. Median RALPN estimated blood loss (EBL) was 165 ml vs. 250 ml for OPN (p<0.05) and 125 ml for LPN (p=0.15). Although patients who underwent RALPN had longer WIT, they had similar rates of complications, required less total OR time, and had shorter procedure times and LOS compared with OPN and LPN despite similar REN AL scores compared to OPN and greater scores than LPN.

192 Feasibility of Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor Patients With Low Skull Density Ratio

INTRODUCTION: Magnetic resonance-guided focused ultrasound (MRgFUS) is a safe, effective treatment for essential tremor (ET). Skull density ratio (SDR), the ratio between the densities of cancellous bone and cortical bone, affects energy penetration of the skull. Major clinical trials and guidelines have excluded patients with low skull density ratio due to concerns of disrupted treatment, though these patients represent nearly 40% of ET patients. METHODS: In this single-surgeon cohort study of prospectively collected and retrospectively analyzed data, we report the characteristics and clinical outcomes of all ET patients with low SDR (&lt;0.40) vs. high SDR (=0.40) treated at Brigham and Women’s Hospital between June 2019 and February 2023. Clinical outcomes were determined by Fahn-Tolosa-Marin (FTM) scores in the affected limb and percentage of patients with clinical improvements. RESULTS: Thirty-one patients had low SDR. 239 patients had high SDR. Mean (±SD) SDRs in the low SDR and high SDR groups were 0.36 (±0.02) and 0.51 (±0.08), respectively. There were no significant differences between the two groups in the following characteristics: sex, handedness, duration of tremor, total preoperative Fahn-Tolosa-Marin (FTM) score, intention + posture preoperative FTM score, age at treatment, treatment laterality, and rate of intraoperative complications. While there were significant differences in the clinical outcomes of low SDR vs. high SDR patients on postoperative day 1 (POD1), the clinical outcomes between the two groups were not significantly different at every follow-up time point, including up to three years post-treatment. CONCLUSIONS: While clinical outcomes were significantly different on POD1, low SDR and high SDR patients had similar long-term clinical outcomes, suggesting that MRgFUS of ET patients with SDR &lt; 0.40 is feasible and effective.

Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis.

to systematically review comparative studies reporting revision rates, clinical outcomes, or radiographic outcomes of total hip arthroplasty (THA) using collared versus collarless conventional-length uncemented hydroxyapatite (HA)-coated stems. In adherence with PRISMA guidelines, a literature search was performed on Medline, Embase, and Scopus. Comparative clinical studies were eligible if they reported outcomes of collared versus collarless uncemented HA-coated stems for primary THA. Two reviewers screened titles, abstracts, and full-texts to determine eligibility; then performed data extraction; and assessed the quality of studies according to Joanna Briggs Institute (JBI) checklist. The search returned 972 records, 486 were duplicates, and 479 were excluded after title/abstract/full-text screening. Three further studies were included from the references of eligible studies and from discussions with subject matter experts, resulting in 11 included studies. The JBI checklist indicated six studies scored ≥7 points and four studies ≥4 points. Pooled data revealed collared stems had significantly lower revision rates (OR = 0.45; 95% CI = 0.31-0.64) and subsidence (MD = -1 mm; 95% CI = -1.6--0.3), but no significant difference in intraoperative complication rates (OR = 0.94; 95% CI = 0.67-1.32) in the short term to mid-term. Unpooled data indicated that collared stems provide equivalent survival, equivalent or better outcomes, and equivalent or lower complication rates. In comparative studies, collared stems have lower revision rates than collarless stems, as well as equivalent or better clinical and radiographic outcomes. Differences could be due to a protective effect that the collar offers against subsidence, particularly in undersized or misaligned stems. Further studies are warranted to confirm long-term results and better understand differences between registry data and clinical studies.

155 Safety and Efficacy of Endovascular Versus Microsurgical Treatment of Unruptured Wide-necked Middle Cerebral Artery Aneurysms: A Propensity-Matched Analysis of the Neurovascular Quality Initiative-Quality Outcomes Database (NVQI-QOD)

INTRODUCTION: There is clinical equipoise regarding the best treatment for unruptured wide-necked middle cerebral artery (WN-MCA) aneurysms. METHODS: The NVQI-QOD registry was queried for patients with unruptured WN-MCA aneurysms. Wide-neck was defined as aneurysm neck = 4 mm or dome:neck ratio = 2. Demographics, aneurysm characteristics, and safety data were queried. Aneurysm occlusion status and modified Rankin score (mRS) at discharge and last follow up were evaluated. Propensity score matching was utilized to match aneurysm size, number of aneurysms treated, patient age and aneurysm status (asymptomatic or symptomatic). RESULTS: Of 670 unruptured MCA aneurysms, 319 were wide-necked. Thirty operations were excluded as the aneurysm was previously treated. 289 operations in 282 patients were assessed (203 EVT, 86 MS). After propensity score matching, there were 86 operations in each group. The median aneurysm size was 5.6 mm (EVT) versus 5.3 mm (MS), p = 0.243. Patients who underwent MS were more likely to have complete occlusion at discharge (90.4% vs. 58.8%, p &lt; 0.001). The median follow up was 404 days in the EVT group versus 157.5 days in the MS group (p = 0.241). Patients who underwent EVT were more likely to have a mRS of zero at discharge (50/59 (84.8%) versus 29/54 (53.7%), p &lt; 0.0003) and last follow up (36/55 (65.5%) versus 13/36 (36.1%), p = 0.006). Safety data showed similar intra-operative (7% EVT vs. 3.5% MS, p = 0.496) and post-operative (4.7% EVT vs. 7% MS, p = 0.750) complication rates. CONCLUSIONS: This report describes the largest-to-date, modern cohort of propensity matched patients undergoing treatment of unruptured WN-MCA aneurysms. Patients undergoing EVT had better functional outcomes at discharge and last follow up though there was significant loss to follow up. Patients undergoing MS were more likely to have complete aneurysm occlusion. Safety data was similar in both groups.