Minor Complication Rate Research Articles

Impact of Race and Ethnicity on Perioperative Outcomes During Hysterectomy for Endometriosis

To assess whether complications incurred during hysterectomy for the treatment of endometriosis differ among racial-ethnic groups. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2019. This database is a robust, comprehensive, multi-institutional database with nearly 700 participating hospitals. Patients with a diagnosis of endometriosis or with an endometriosis-associated symptom as the primary indication for surgery and surgical intraoperative documentation of endometriosis. Compare perioperative complications based on patient race and ethnicity. A total of 5639 patients underwent hysterectomy for endometriosis; of these, 4368 were White patients (77.5%), 528 Black patients (9.4%), 491 Hispanic patients (8.7%), 252 Asian patients (4.5%). There was no association between location of endometriosis and patient race and ethnicity. However, White patients had highest rate, and Asian patients had the lowest rate of laparoscopic hysterectomy, 85.3% vs 69.8%, respectively (p <.01). In addition, there were differences in concomitant procedures performed at time of hysterectomy based on race and ethnicity, with White patients having the highest rates of adnexal/peritoneal surgery at 12.5% (p <.01) compared with patients of the other racial and ethnic groups. Asian patients had the highest rate of ureteral surgery at 6.8% (p <.01) and highest rate of intestinal surgery at 16.3% (p <.01) compared with patients of other racial and ethnic groups. There was no association of rates of concomitant bladder surgery, appendectomy, or rectal surgery with patient race and ethnicity. Black patients had the highest rate of minor complications at 13.5% (p <.01) and the highest rate of major complications at 6.6% (p <.01) compared with patients of other racial and ethnic groups. After multivariable analysis, Black patients still had increased odds of having a major complication compared with patients of other racial and ethnic groups even after controlling for patient characteristics and perioperative factors such as endometriosis lesion location, surgical approach, and concomitant procedures (odds ratio 1.64; 95% confidence interval, 1.10-2.45). Endometriosis lesion location did not differ with patient race and ethnicity. However, patient race and ethnicity did have an impact on the surgical approach and the concomitant surgical procedures performed at time of hysterectomy. Black patients had the highest odds of major complications.

Short-term Complications for Proximal Humerus Fracture Surgery Have Decreased: An Analysis of the National Surgical Quality Improvement Program Database.

Multiple surgical treatments exist for proximal humerus fractures (PHFs), but current practice patterns and short-term complication profiles remain poorly understood. This is in part due to changes in treatment paradigms over the past decade. A more thorough understanding of the evolution in management over this time as well as an appreciation of the preoperative factors associated with both the chosen surgical modality and short-term complications will help inform future surgical considerations. In this study, we sought to: (1) characterize trends in the surgical management of PHFs over time, including usage rates of various surgical modalities and changes in complication rates; (2) identify preoperative variables associated with the selection of surgical modality; and (3) assess the independent covariates of acute 30-day complications, including demographic variables, injury characteristics, and treatment type. The National Surgical Quality Improvement Program (NSQIP) database was queried using Current Procedural Terminology and ICD-9 and ICD-10 codes to identify individuals with PHF undergoing open reduction and internal fixation (ORIF), hemiarthroplasty (HA), or reverse total shoulder arthroplasty (RTSA) from 2007 to 2018. The NSQIP database was utilized because of its collection of detailed preoperative demographic information and large repository of clinically derived data, which is felt to be more accurate than claims or administrative data. In total, 5889 patients with PHFs met the inclusion criteria. Patients 17 years or older were included. Patients with isolated greater tuberosity, humeral shaft, and distal humerus fractures; nonunions; malunions; and those undergoing revision procedures were excluded. A Cochran-Armitage test was used to evaluate surgical trends over time. Multivariable logistic regression models were created to identify covariates associated with surgical modality and complications. Although complications were either classified as major or minor, specific complications were also individually analyzed to avoid potentially misleading conclusions associated with pooling. The proportion of patients with PHFs undergoing RTSA (4% in 2007 and 34% in 2018; p < 0.001) and ORIF (46% in 2007 and 57% in 2018; p < 0.001) increased over time, and the proportion of those undergoing HA (50% in 2007 and 9% in 2018; p < 0.001) decreased. Across each surgical modality, minor complication rates decreased over time (RTSA: 10% in 2018; p < 0.001; ORIF: 5% in 2018; p = 0.01; and HA: 6% in 2018; p = 0.01). After controlling for confounding variables like diabetes, chronic obstructive pulmonary disease, congestive heart failure, dialysis, and preoperative blood transfusion, the following factors were independently associated with an increased odds of a patient undergoing RTSA rather than HA: older age, higher BMI, independent functional status, and smoking. The following factors were independently associated with a decreased odds of a patient undergoing ORIF rather than RTSA and HA: older age, higher BMI, higher American Society of Anesthesiologists (ASA) classification, smoking, steroid/immunosuppressant use, as well as three- and four-part fractures. After controlling for age, ASA classification, functional status, and preoperative blood transfusion, we also found that in the latter part of the study period, arthroplasty (RTSA and HA) was no longer independently associated with 30-day major or minor complications compared with ORIF. The increasing utilization of RTSA and decreasing short-term complication rates for fixation and arthroplasty alike represent a substantial change compared even with recent historic norms in the management of proximal humerus fractures. Quantifying demographics, injury characteristics, and comorbidities associated with both the choice of surgical modality and complications serves as the groundwork for decision support tools, which can inform patients and surgeons of the probability of a particular surgical modality being chosen and the risk of complications, based on national benchmarks. Future studies should investigate longer term complication rates, as many differences between the approaches being compared might occur beyond the perioperative period and our study had no means to address questions about complications beyond that period, but obviously those must be considered when choosing a treatment for patients with these injuries. Future work might also investigate the mechanisms behind the decreasing rates of short-term complications. Level III, therapeutic study.

Computed tomography-guided single celiac plexus neurolysis analgesic efficacy and safety: a systematic review and meta-analysis.

To perform a systematic review and meta-analysis of published studies to evaluate the analgesic efficacy and safety of computed tomography (CT)-guided single celiac plexus neurolysis (CPN) with the injection of a neurolytic agent into the celiac plexus in one session (CT-guided single CPN). PubMed, the Cochrane Library, and Ichushi-Web were searched for English or Japanese articles published up to February 2022, which reported findings about patients who underwent CT-guided single CPN. The outcome measures assessed in the systematic review and meta-analysis were the pain measurement scales from 0 to 10 before and after the intervention and the rate of minor and major complications. The pooled pain measurement scales at pre-intervention and 1- or 2-, 7-, 30-, 60-, 90-, and 180-day post-intervention was 6.72 (95% confidence interval [CI], 4.77-9.46, I2 = 98%), 2.31 (95% CI 2.31-4.44, I2 = 92%), 2.84 (95% CI 1.39-5.79, I2 = 95%), 3.36 (95% CI 1.66-6.77, I2 = 98%), 3.19 (95% CI 1.44-7.08, I2 = 59%), 3.87 (95% CI 1.88-7.97, I2 = 0%), and 3.40 (95% CI 3.02-3.83, I2 = not applicable), respectively. The pooled minor complication rates of diarrhea, hypotension, nausea or vomiting, and pain associated with the procedure were 18% (95% CI 8-37%, I2 = 45%), 16% (95% CI 2-58%, I2 = 76%), 6% (95% CI 2-16%, I2 = 1%), and 7% (95% CI 2-21%, I2 = 17%), respectively. There was no major complication in the included studies. CT-guided single CPN can be performed safely and provides immediate analgesic efficacy although the amount of heterogeneity is characterized as large. Further investigation of its long-term analgesic efficacy is required.

Risk factors associated with early and late free flap complications in head and neck osseous reconstruction.

This study was designed to identify risk factors for post-operative complications in micro-anastomosed osteomyocutaneous free flaps (MOFF) and analyzed their consequences in long term. A retrospective review of 100 MOFF realized between May 2007 and October 2019 was performed. Demographic data, perioperative management and postoperative complications were enrolled and analyzed in a multivariate model. Patients were followed for ≥ 6months. Major surgical complication rate was 20% with 5% of overall free flap failure rate and 6% of anastomosis salvage surgery. Risk identified for major surgical complication was alcohol consumption (p = 0.0054). Minor surgical complications occurred in 26% of patients mostly due to infections (19%). No significant risk factor was associated to minor surgical complications. Major and minor medical complication rates were, respectively, 10% and 10%. Risk identified for major medical complication were age over 70 (p = 0.0253) and history of chemotherapy (p = 0.0277). Risk identified for minor medical complication were alcohol consumption p = 0.0232) and a history of radiotherapy (p = 0.0329). Alcoholism is an independent risk factor for the surgical complication of MOFF that must be taken into account before surgery. Patients with a history of chemotherapy, radiotherapy or who are over 70years of age are at greater risk of postoperative medical complications and require special attention.

Predictors of vagus nerve stimulation complications among pediatric patients with drug-resistant epilepsy.

Complications from vagus nerve stimulator (VNS) procedures are common and can have important implications for morbidity and seizure control, yet predictors of complications are poorly understood. The objective of this study was to assess clinical factors associated with minor and major complications from VNS procedures among pediatric patients with drug-resistant epilepsy. The authors performed an 11-year retrospective review of patients who underwent VNS procedures for drug-resistant epilepsy at age < 21 years. The primary outcome was complications (minor or major) following VNS surgery. Preoperative and surgery characteristics were compared between patients who developed versus those who did not develop complications. Multivariable Poisson regression was performed to determine the association between preoperative characteristics and infection. Of 686 surgeries, 48 complications (7.0%) developed; there were 7 minor complications (1.0%) and 41 major complications (6.0%). Surgeries with minor complications were an average of 68 minutes longer than those without minor complications (p < 0.001). The incidence rate of infection was 1 per 100 person-years, with 3% of procedures complicated by infection. Poisson regression revealed that after adjusting for age at surgery, duration of surgery, and primarily motor seizure semiology, the incident rate of infection for revision surgeries preceded by ≥ 2 procedures was 19 times that of first-time revisions. The overall minor complication rate was 1% and the overall major complication rate was 6% for VNS procedures. Longer surgery duration was associated with the development of minor complications but not major complications. Repeat incisions to the VNS pocket may be associated with higher incident rate of infection, highlighting a need for longer-lasting VNS pulse generator models.

80. Early mobilization after incidental durotomy: a systematic review

<h3>BACKGROUND CONTEXT</h3> The conventional management of incidental dural tears involving a prolonged period of flat bed rest is highly debatable. There is no consensus regarding the need or ideal duration of postoperative bed rest following these dural tears. <h3>PURPOSE</h3> To systematically evaluate the relevant literature regarding the outcomes of mobilization within 24 hours after incidental durotomy with respect to the length of hospital stay, minor complications and reoperation rates. The data were compared to that of later mobilization (after 24 hours). <h3>STUDY DESIGN/SETTING</h3> A systematic review and meta-analysis. <h3>PATIENT SAMPLE</h3> Overall, 533 patients (mean age 61.1 years) had an incidental dural tear and were mobilized within 24 hours. Additionally, 203 patients of mean age 72.8 years (6 studies) were mobilized after 24 hours (24 – 144 hours). <h3>OUTCOME MEASURES</h3> We aimed to measure hospital stay, minor complications and reoperation rates in early mobilized patients after incidental durotomies. <h3>METHODS</h3> A systematic review of the English language literature dating to December 2021, was undertaken using search criteria ([dural tear or durotomy] and [mobilization or bed rest]) and the PRISMA guidelines. Isolated case reports were excluded. <h3>RESULTS</h3> The average hospital stay for early mobilized patients was 3.65 days. Twenty-two out of 533 (4.1%) patients (11 studies) had a major complication that required reoperation while the rate of minor complications was 27 out of 230 (11.7%) (9 studies). Comparing early to late mobilization, there was a significant reduction in the risk of minor complications due to early mobilization (13/102 [12.7%] vs 33/106 [31.1%] RR: 0.47, 95CI: 0.27, 0.80), but no significant difference in major complications (3 studies) (12/106 [11.3%] vs 11/134 [8.2%] RR: 1.55, 95CI: 0.72, 3.35). <h3>CONCLUSIONS</h3> This systematic review compared early and late mobilisers after incidental durotomies, finding that minor complications including headaches, nausea, tinnitus and vomiting were, in fact, significantly reduced with early mobilization. Indeed, early mobilization within 24 hours after incidental dural tears appears to be safe and did not need lead to a significantly higher re-operation rate compared to more prolonged bed rest. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

665 A Systematic Review of Breast Site Associated Complications Following Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction

Abstract Aim Breast reconstruction with autologous tissue provides durable reconstruction with native tissue. However, perioperative complications impact negatively on patient perception of success and increase the psychological trauma of mastectomy. The Deep Inferior Epigastric Perforator (DIEP) flap has a recognised low rate of donor site complications. This paper provides the first systematic review focussing on breast site associated complications. Method PRISMA guidelines informed a systematic search of Medline, Embase and Web of Science. Studies were screened against set inclusion and exclusion criteria; data was collated regarding demographics, flap characteristics and flap complications. Results Twenty-nine studies representing 21,680 flaps were included with the rate of major breast-associated complications ranging between 0 and 55.1% of flaps and 0 to 10.3% of patients; the rate of minor complications ranged between 0 and 48.2% of flaps and 0 to 16.3% of patients. All papers reported major complications including total flap loss (1–17.2% flaps, 0–7.4% patients), partial flap loss (0–44.8% flaps, 0–5% patients) and venous congestion or arterial compromise (1.5–55.1% flaps, 4.3–10.3% patients). Twenty-eight papers reported minor complications and included fat necrosis (1.8–48.2% flaps, 3–16.3% patients); wound problems (1–15.6% flaps, 3.7% patients); skin necrosis (9.2–17.8% flaps, 0.3–7.4% patients; seroma (0–4.9% flaps, 0–5.1% patients); haematoma (0.36–9.3% flaps, 0–8.4% patients) and infection (0.2–20% flaps, 0–6.3% patients). Conclusions This systematic review concludes that the DIEP flap has an acceptable level of breast site associated complications and should continue to be considered as gold standard in breast reconstruction. This review can be used in preoperative counselling and to inform consent.

Tibial Tuberosity Advancement Techniques (TTAT): A Systematic Review.

Simple SummaryThe aim of this manuscript is to report and critically review the currently available literature about so-called “new generation Tibial Tuberosity Advancement Techniques”. According to PRISMA guidelines, the authors investigated and reported data about preoperative planning, surgical procedure, outcome, and complications of these different techniques. The main problems addressed were the lack of prospective studies with a large study population and univocal data collection about preoperative planning and outcome.(1) Background: Several surgical techniques were described for the treatment of cranial cruciate ligament rupture in dogs. This report aims to critically review the available literature focused on preoperative planning, surgical procedure, follow-up, and complications of cranial cruciate ligament rupture treated by tibial tuberosity advancement techniques; (2) Methods: three bibliographic databases: PubMed, Google Scholar, and Scopus were used for a board search of TTAT (canine OR dog). Five GRADE recommendations according to Grading of Recommendations Assessment, Development and Evaluation and Joanna Briggs Institute Critical Appraisal Checklists were applied to the studies included. Data regarding preoperative planning (a measure of advancement), meniscal disease (meniscectomy, meniscal release, and late meniscal tears), and postoperative patellar tendon angle were recorded. Time frame, outcome, and complications were classified according to Cook’s guidelines; (3) Results: from 471 reports yielded, only 30 met the inclusion criteria. The common tangent method was the most commonly reported measurement technique for preoperative planning. The 40.21% of stifles presented meniscal tears at surgery, while 4.28% suffered late meniscal tears. In short-, mid-and long-term follow-ups examined showed a full/acceptable function was shown in >90% of cases. Among all new generation techniques, minor complications were reported in 33.5% of cases and major complications in 10.67%; (4) Conclusions: Compared to traditional TTA, new generation TTAT resulted effective in the treatment of cranial cruciate ligament failure, showing a lower rate of late meniscal injury but a higher rate of minor complications.

Rates of complication for dilation and evacuation versus induction of labor in treatment of second trimester intrauterine fetal demise

ObjectiveTo evaluate clinical differences in the safety of dilation and evacuation (D&E) and induction of labor (IOL) for the treatment of intrauterine fetal demise (IUFD) between 14 and 24 weeks gestation. Study DesignsA retrospective chart review was conducted at a single institution comparing rates of major and minor complications between patients who undergo D&E and those that undergo IOL in the treatment of IUFD between 14 and 24 weeks gestation. Demographic and medical variables were stratified by management method and analyzed using chi-squared and t-tests where appropriate. ResultsPatients who underwent IOL were of a more advanced gestational age and more likely to be uninsured. Patients who underwent D&E were more likely to be privately insured. Hospital time for an IOL was significantly longer than for D&E. Composite rates of complication did not differ significantly between management groups. Patients treated with D&E were more likely to require uterine aspiration. ConclusionsD&E and IOL are equally safe methods for the management of IUFD between 14 and 24 weeks gestation. Both options should be made available to patients who experience this rare pregnancy outcome.

Laparoscopic surgery for colorectal cancer in an elderly population with high comorbidity: a single centre experience.

The use of laparoscopic surgery for colorectal cancer in elderly patients with high comorbidity is a controversial subject. This retrospective analysis aims to compare two different age groups with respect to short and long term clinical and oncological outcomes. All laparoscopic colorectal resections for cancer performed between February 2011 and October 2017 with curative or palliative intention were evaluated. Among 128 completed resections, the rate of major complications, length of hospital stays, 30-day mortality, 2-year recurrence rate, and the survival after palliative surgery were comparable between group A (< 75years; n = 76) and B (≥ 75years; n = 52). Patients in group B showed an extraordinarily high proportion of ASA III stage (73.1% vs. A: 35.5%; p < 0.01) and, in this context, an increased rate of minor postoperative complications (17.3% vs. A: 6.6%; p < 0.05) and lower overall 2 and 5-year survival rates. Within the first 2years, they died sooner in the event of recurrence (57.1% vs. A: 18.2%; p < 0.05), and their survival after rectal resection, especially for low rectal carcinoma, was significantly reduced (58.8% vs. A: 96.7%; p < 0.001). Laparoscopic surgery for colorectal cancer can be strongly advocated for elderly patients even in the face of high comorbidity. Whether very old patients with low rectal carcinoma also benefit from minimally invasive surgery or should undergo alternative therapies would need to be clarified primarily by examining the quality of life.

Risk Factors for Postoperative Complications Following Aesthetic Breast Surgery: A Retrospective Cohort Study of 4973 Patients in China.

The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality. To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China. A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated. Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction-mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161). The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Standardized right artery first approach during laparoscopic pancreaticoduodenectomy for periampullary neoplasms: technical aspects and perioperative outcomes.

The most debated aspects of laparoscopic pancreaticoduodenectomy (LPD) concern the dissection of the pancreas from the surrounding vessels and the achievement of adequate resection margins, especially in patients with pancreatic cancer. Data of consecutive patients undergoing LPD with right artery first approach from September 2020 to September 2021 for periampullary neoplasms (pancreatic, ampullary, duodenal, distal common biliary duct) were prospectively collected and retrospectively analyzed. The overall cohort was divided into two groups: patients affected by pancreatic carcinoma (PC) and patients affected by other periampullary neoplasms (OP). Surgical and postoperative outcomes between PC and OP were compared. Thirty-one patients (15 PC and 16 OP) were selected. No difference was found between PC and OP in terms of baseline characteristics. Median resection time and overall surgical time of the entire cohort were 275min and 530min, respectively, without difference between the groups (p = 0.599 and 0.052, respectively). Blood loss was similar between the groups, being 350ml in PC and 325ml in OP (p = 0.762). One patient (3.2%) was converted to laparotomy. No difference was found between the groups in terms of pathological outcomes. Median number of retrieved lymph nodes was 17. The majority of the patients (83.9%) received an R0 resection (73.3% and 93.7% in PC and OP, respectively; p = 0.172). Postoperative surgical outcomes did not differ between the groups, excepting for overall complication rate that was higher in the OP group (26.7% vs 68.7% in PC and OP, respectively; p = 0.032). Standardized right artery first approach during LPD was feasible and did not show worse surgical and postoperative outcomes in patients with pancreatic cancer as compared to those affected by other periampullary neoplasms, except for a higher rate of minor complications.

Outcomes of Wrist-Access Deep Venous Embolization Following Percutaneous Fistula Creation: A Two-Year Single Center Experience

During percutaneous arteriovenous (pAVF) fistula creation, deep venous embolization is recommended to encourage superficial venous flow development. The safety of crossing adjacent to the newly formed fistula from wrist venous access has not been established. The purpose of this study was to evaluate the safety and efficacy of antegrade deep venous embolization after creation of the pAVF. A retrospective analysis was performed of all procedural data related to pAVF creation using the Wavelinq device from October 2019 to November 2021. Patient data from the hospital information systems were collected where the venous access for fistula creation was from the wrist-access (ulnar or radial vein) and where deep venous embolization was performed after forming the fistula and crossing adjacent to the anastomosis. Thirty-nine patients were identified. Twenty pAVFs were created from wrist ulnar vein access and 19 from radial vein access. The accessed veins were used for embolization of the brachial veins central to the newly created anastomosis. No pAVFs were lost by crossing adjacent to the anastomotic area to perform deep venous embolization at time of creation. There were no major complications, specifically bleeding, infection, pseudoaneurysm formation. Rates of minor complications consisted of two coil migrations to the right atrium requiring uneventful retrieval (5%). Follow-up ultrasound data showed no evidence of delayed complications. In this single center experience crossing alongside the anastomosis of a newly formed percutaneous fistula from an antegrade venous approach was safe with no risk of loss of the pAVF.

Bleeding events in the emergency department with warfarin versus novel oral anticoagulants: A five-year analysis.

Although warfarin is the most effective treatment approved to prevent atrial fibrillation-associated stroke, it remains underused in clinical practice due to patient noncompliance. Therefore, novel oral anticoagulants (NOACs) have been developed. This study aimed to identify bleeding complications in patients who were taking oral anticoagulants and compare the rates of major and minor bleeding events between NOACs and warfarin groups. We conducted a retrospective, observational study of warfarin- and NOAC-treated patients who presented to an emergency department between January 2015 and December 2019 with bleeding events. We compared patients with major and minor bleeding in terms of age, gender, comorbid diseases, type of anticoagulant, and site of bleeding. An electronic search yielded 95 (21.9%) cases of patients taking a NOAC (i.e., dabigatran [19], rivaroxaban [45], apixaban [29], or edoxaban [6]) and 354 taking warfarin. There were no significant differences between the warfarin and NOACs groups in the frequency of minor bleeding complications. Similarly, there were no significant differences between the groups in the frequency of major bleeding complications. No significant difference in intracranial bleeding was seen between the NOACs- and warfarin-treated patients, although the incidence of gastrointestinal bleeding was significantly higher in the NOACs (P = 0.102 and P = 0.021, respectively). Our findings indicate that rates of major and minor bleeding complications in patients taking NOACs are similar to those in patients taking warfarin. While warfarin was associated with fewer complications than NOACs in terms of gastrointestinal bleeding, the risk of intracranial bleeding, was similar between the groups.

The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review.

Background:Implant-based breast reconstruction can be accomplished in a variety of ways and can result in vastly different postoperative experiences for patients. The COVID-19 pandemic and recent trends have resulted in a shift toward outpatient management of these patients.Methods:A systematic review of PubMed and Embase databases was conducted. A total of 1328 articles were identified on initial search, and after several rounds of review, a total of four met inclusion and exclusion criteria. Manuscripts were included if postmastectomy alloplastic breast reconstruction was performed, and there was documentation of same-day discharge. This cohort of patients was compared with traditional, planned overnight admission cohorts found in the literature. Objective data compared between groups included preoperative patient factors and postoperative complication rates.Results:Four studies representing data on a total of 574 patients were included: 289 were same-day discharge and 285 were overnight admission. Patient characteristics of body mass index, radiation, smoking, and bilateral procedures were comparable. Tissue expanders were used more frequently than implants in both cohorts. The rate of overall complications was 33% for same-day discharge and 34% for overnight admission. Rates of major and minor complications, including infection, seroma, and hematoma, were similar. There was no increase in reoperations or readmissions reported in any of the studies.Conclusions:Same-day discharge after mastectomy with immediate alloplastic reconstruction is a safe approach to treatment in both the ambulatory and hospital setting. There are comparable rates of common complications such as infection, seroma, and hematoma, with no increase in readmission or reoperation.

Central perforated VRAM flap and neurostimulated levator augmentation for functional and aesthetical reconstruction after abdominoperineal excision in cancer.

Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery. Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty. 14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained. Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients. The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.

Experience of the First 100 OAGB in China: OAGB In Situ Technique.

BackgroundOne anastomosis gastric bypass (OAGB) is gradually accepted worldwide but still new in China.Materials and MethodsRetrospective review of the patients who received OAGB in a new bariatric/metabolic surgical center in China and compared the data with a center of excellence in Taiwan. All in-patient and outpatient follow-up data were analyzed. The main outcome measures were (1) operation risk (2) weight loss (3) diabetes remission.ResultsBetween August 2019 and October 2021, 100 consecutive patients who received OAGB in situ in China and 225 patients who received OAGB with the same technique were recruited from Taiwan. Taiwan patients were older (39.2 ± 10.6 vs. 33.3 ± 8.8 years old, p < 0.001), and to have more diabetes (32.4% vs. 20.0%, p = 0.022) comparing to the patients of China. Operation time was significantly longer for Taiwan patients (172.4 ± 36.9 vs. 128.5 ± 29.8, p < 0.001). Taiwan patients lost more blood during the operation (35.5 ± 25.2 vs. 22.4 ± 15.6, p < 0.001) but patients in China need more time to postoperative flatus passage (1.3 ± 0.5 vs. 2.0 ± 0.5, p < 0.001). There was no major surgical complication in this study, minor complication rates were similar low for both groups (1.0% vs. 1.8%, p = 0.891). At 1 year after surgery, %TWL and %EWL of both centers were similar (33.9 ± 7.43% vs. 32.6 ± 11.2%, p = 0.91; 81.9 vs. 19.8 vs. 85.4 ± 13.2, p = 0.798). T2DM remission (HbA1c < 6.5%) was 100% for patients of China and 95.9% for patients of Taiwan (p = 0.836).ConclusionsOAGB in situ is a safe and effective bariatric/metabolic surgery. With proper training and proctorship, these results are reproduceable in a new bariatric/metabolic surgical center in China.Graphical abstract

Poster 147: Operative Treatment of Acromioclavicular Injuries in the Military: Trends and Complications

Objectives:To identify the demographics and characteristics of operative acromioclavicular joint separations, as well as characterize reconstruction techniques and associated complications.Methods:The United States Military Health System Data Repository was queried for patients with a Current Procedural Terminology (CPT) code for coracoclavicular ligament reconstruction between October 2013 and March 2020. Patient demographics, radiology and operative reports, and clinical notes were reviewed to characterize reconstruction techniques and associated postoperative complications.Results:A total of 956 coracoclavicular ligament reconstructions (896 primary repairs or reconstructions, 60 revision reconstructions) were performed between October 2013 and March 2020. The 896 primary coracoclavicular ligament reconstructions were indicated for a range of acromioclavicular joint separation severities: three grade two separations, 392 grade three separations, 48 grade four separations, and 386 grade 5 separations; the remaining 67 patients did not have a definitive injury grade defined by the treating surgeon. Of the primary procedures, 356 were performed acutely within 6 weeks of injury, while 538 were performed greater than 6 weeks after injury. Two hundred and twenty eight primary procedures were categorized as repairs, while 652 were categorized as reconstructions utilizing a graft. Following these procedures, there were 104 major complications requiring return to the operating room, including 48 symptomatic failures requiring revision, 18 fractures of the clavicle or coracoid, 25 deep surgical site infections and 9 cases of symptomatic hardware requiring removal of hardware, and 4 cases of adhesive capsulitis requiring manipulation under anesthesia. There were 160 minor postoperative complications, including 5 non-operative fractures of the clavicle or coracoid, 16 superficial surgical site infections, 7 cases of non-operative adhesive capsulitis, 57 cases of neuropathy, 1 deep venous thrombosis, and 74 cases of persistent acromioclavicular joint pain. There were no significant differences in complication rates between injury grade, acute versus chronic treatment, repair versus reconstruction, or suspensory versus non-suspensory technique. The rate of major complications was 1.8 per 100 person-years and the rate of minor complications was 2.77 per 100 person-years. The overall complication rate was 4.57 per 100 person-years. At the conclusion of the acromioclavicular joint separation care, 60 service members necessitated medical separation from the military.Conclusions:Coracoclavicular ligament reconstruction is a relatively common and safe procedure in a physically active population. The rate of major complication was 1.8 per 100 person-years, while the overall complication rate in our series was 4.57 complications per 100 person-years. Complications are rare, however, when they occur, they frequently require one or more secondary surgeries to treat.

Frame-based stereotactic implantation of cystoventricular shunts for treating acquired intracerebral cysts.

The treatment of symptomatic, progressive or recurrent acquired intracerebral cysts is challenging, especially when they are localized in eloquent structures. In addition to resection, endoscopic fenestration, or stereotactic puncture, the implantation of a cystoventricular shunt by stereotactic guidance (SCVS) has been reported as a minimally invasive procedure; however, only scarce data are available regarding its feasibility and efficacy. Here, the authors evaluated the feasibility and efficacy of frame-based SCVS in patients with acquired intracranial cysts. In this single-center retrospective analysis, the authors included all patients with acquired intracerebral cysts treated by SCVS following a standardized prospective protocol between 2012 and 2020. They analyzed clinical symptoms, complications, and radiological outcome with regard to cyst volume reduction by 3D volumetry. Thirty-four patients (17 females and 17 males; median age 44 years, range 5-77 years) were identified. The median initial cyst volume was 11.5 cm3 (range 1.6-71.6 cm3), and the mean follow-up was 20 months (range 1-82 months). At the last follow-up, 27 of 34 patients (79%) showed a cyst volume reduction of more than 50%. Initial symptoms improved or resolved in 74% (n = 25) and remained stable in 24% (n = 8). No permanent clinical deterioration after treatment was observed. The total complication rate was 5.9%, comprising transient neurological deterioration (n = 1) and ventriculitis (n = 1). There were no deaths. The overall recurrence rate was 11.8%. In this study, SCVS proved to be a safe, minimally invasive, and effective treatment with reliable long-term volume reduction, resulting in clinical improvement and a minor complication rate.

A Retrospective Study Assessing the Outcomes of Immediate Prepectoral and Subpectoral Implant and Mesh-Based Breast Reconstruction.

Simple SummaryThe aim of the study is to compare the outcomes of implant and synthetic TIGR mesh-based breast reconstructions in breast cancer patients and women, who have higher lifetime risk for breast cancer, with mutated (changed) copy of genes: BRCA1, BRCA2, PALB2 or CHEK2. This study included 170 patients after 232 mastectomies and immediate breast reconstructions. Preoperative chemotherapy was associated with more frequent minor complications, but not major ones, while postoperative chemotherapy was related to more frequent serious postoperative complications. Postoperative radiotherapy was associated with a higher rate of minor complications than no-radiotherapy. Our research found complications to be significantly associated with expander, big- volume breast, mastectomy in breast cancer patients vs risk-reducing mastectomy/prophylactic surgery in women with mutated gene and postoperative chemotherapy. Patients in whom prepectoral (prosthesis is placed above the pectoralis major muscle) surgeries were performed demonstrated shorter hospitalization time, and lower minor complication rates, but similar major complication rates. Implant-based breast reconstruction with the use of synthetic mesh is a safe and effective method of breast restoration, associated with low morbidity and good cosmesis. Nevertheless, further studies are needed to evaluate the benefits of such treatments.(1) Introduction: In response to patient concerns about breast cancer recurrence, increased use of breast magnetic resonance imaging and genetic testing, and advancements in breast reconstruction techniques, mastectomy rates have been observed to rise over the last decade. The aim of the study is to compare the outcomes of prepectoral and subpectoral implants and long-term, dual-stage resorbable mesh-based breast reconstructions in mutation carriers (prophylactic surgery) and breast cancer patients. (2) Patients and methods: This retrospective, two-center study included 170 consecutive patients after 232 procedures: Prepectoral surgery was performed in 156 cases and subpectoral was performed in 76. (3) Results: Preoperative chemotherapy was associated with more frequent minor late complications (p < 0.001), but not major ones (p = 0.101), while postoperative chemotherapy was related to more frequent serious (p = 0.005) postoperative complications. Postoperative radiotherapy was associated with a higher rate of minor complications (31.03%) than no-radiotherapy (12.21%; p < 0.001). Multivariate logistic regression found complications to be significantly associated with an expander (OR = 4.43), skin-reducing mastectomy (OR = 9.97), therapeutic mastectomy vs. risk-reducing mastectomy (OR = 4.08), and postoperative chemotherapy (OR = 12.89). Patients in whom prepectoral surgeries were performed demonstrated significantly shorter median hospitalization time (p < 0.001) and lower minor complication rates (5.77% vs. 26.32% p < 0.001), but similar major late complication rates (p = 0.915). (4) Conclusions: Implant-based breast reconstruction with the use of long-term, dual-stage resorbable, synthetic mesh is a safe and effective method of breast restoration, associated with low morbidity and good cosmesis. Nevertheless, prospective, multicenter, and long-term outcome data studies are needed to further evaluate the benefits of such treatments.