Rates Of Other Complications Research Articles

The Experience and Complications of Lipoabdominoplasty for Chinese Post-bariatric Population.

The increasing prevalence of bariatric surgeries in China has led to a growing number of patients experiencing massive weight loss and abdominal skin laxity. However, there is a scarcity of reports addressing post-bariatric lipoabdominoplasty in these patients. This study aims to present our clinical experiences with lipoabdominoplasty in post-bariatric patients in China. We performed lipoabdominoplasty on patients who had abdominal skin laxity following bariatric surgery between March 2018 and October 2023. The procedure encompassed abdominal liposuction, plication of the rectus abdominis muscles, umbilical transposition and progressive tension sutures. Complications were recorded and analyzed. The cohort consisted of 23 post-bariatric patients who underwent lipoabdominoplasty, achieving aesthetically favorable results. The average age at the time of surgery was 31.5years, and the mean body mass index (BMI) was 25.1kg/m2.The overall complication rate was 34.8% (8 out of 23 patients), with hypertrophic scar being the most prevalent complication at 30.4%, followed by partial skin necrosis (4.3%). For the Chinese post-bariatric patients, traditional lipoabdominoplasty may be preferred over fleur-de-lis abdominoplasty. The primary complication observed in our patients is hypertrophic scar. Chinese patients experience a lower rate of other complications, potentially attributed to their lower pre-surgery BMI and younger age. 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 .

Comparative analysis of the safety and feasibility of laparoscopic and open approaches for right anterior sectionectomy

Laparoscopic hepatectomy has minimally invasive advantages, but reports on laparoscopic right anterior sectionectomy (LRAS) are rare. Herein, we try to explore the benefits and drawbacks of LRAS by comparing it with open right anterior sectionectomy (ORAS). Between January 2015 and September 2023, 39 patients who underwent LRAS (n = 18) or ORAS (n = 21) were enrolled in the study. The patients’ characteristics, intraoperative details, and postoperative outcomes were compared between the two groups. No significant differences in the preoperative data were observed between the two groups. The LRAS group had significantly lesser blood loss (P = 0.019), a shorter hospital stay (P = 0.045), and a higher rate of bile leak (P = 0.039) than the ORAS group. There was no significant difference in the operative time (P = 0.156), transfusion rate (P = 0.385), hospital expenses (P = 0.511), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels between the two groups (P > 0.05). Beside, there was no significant difference in disease-free survival (P = 0.351) or overall survival (P = 0.613) in patients with hepatocellular carcinoma between the two groups. LRAS is a safe and feasible surgical procedure. It may be preferred for lesions in the right anterior lobe of the liver.

Comparative Analysis of the Safety and Feasibility of Laparoscopic Versus Open Segment 7 Hepatectomy.

Laparoscopic hepatectomy has been widely accepted owing to its advantages as a minimally invasive surgery; however, laparoscopic segment 7 (S7) hepatectomy (LSH) has been rarely reported. We aimed to explore the safety and feasibility of LSH by comparing it with open surgical approaches. Twenty-nine patients who underwent S7 hepatectomy between January 2016 and January 2023 were enrolled in this study. The patients' characteristics, intraoperative details, and postoperative outcomes were compared between the 2 groups. No significant differences were observed in the preoperative data. The patients who underwent LSH had significantly shorter hospital stays (P=0.016) but longer operative times (P=0.034) than those who underwent open S7 hepatectomy. No significant differences in blood loss (P=0.614), transfusion (P=0.316), hospital expenses (P=0.391), surgical margin (P=0.442), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels were noted between the 2 groups (P>0.05). For hepatocellular carcinoma, the results showed no differences in either disease-free survival (P=0.432) or overall survival (P=0.923) between the 2 groups. LSH is a safe and feasible surgical procedure that is efficient from an oncological point of view. It may be the preferred technique for lesions in the S7 of the liver.

Modified Peritoneal Fenestration as a Preventive Method for Lymphocele after Kidney Transplantation: A Preliminary Report.

Background: We aimed to assess the safety of a modified peritoneal fenestration technique with clipping of the window edges during kidney transplantation (KTx) and to determine its impact on reducing lymphocele following KTx. We compared the outcomes of this modified method with those of peritoneal fenestration without clipping. Methods: Among 430 consecutive KTxs performed between 2015 and 2019, preventive peritoneal fenestration and clipping of the margins were performed in 25 patients. These patients were compared with 75 matched patients in whom the margins were not clipped. Postoperative lymphocele formation and other patient data were compared between these two groups. Results: The rate of clinically relevant lymphocele decreased by 2.7% after peritoneal fenestration with clipping, although this decrease was not statistically significant (p = 0.829). There was no significant increase in the rate of other complications in the modified fenestration group (p = 0.067). The incidence of clinically significant lymphocele formation was notably higher in patients with a body mass index greater than 25 kg/m2 (p = 0.028). Univariate analysis indicated that older recipients, individuals with a history of previous abdominal surgery, those receiving the kidney from deceased and older donors were at increased risk of developing a clinically relevant lymphocele. Conclusions: Our preliminary results suggest that peritoneal fenestration with clipping may be as effective as the conventional fenestration technique in preventing lymphocele formation. Further clinical trials with larger sample sizes are required to determine the exact role of preventive peritoneal fenestration with clipping in preventing clinically relevant lymphocele after KTx.

Development and validation of a novel pancreaticojejunostomy strategy based on the anatomical location of the main pancreatic duct that can reduce the risk of postoperative pancreatic fistula after pancreatoduodenectomy.

Postoperative pancreatic fistula (POPF) is a common complication after pancreaticoduodenectomy (PD). The effect of the location of the main pancreatic duct on POPF development is not completely elucidated. This study aimed to investigate the association between the location of the main pancreatic duct and POPF, and the effect of pancreaticojejunostomy based on the location of the main pancreatic duct on the risk of POPF. This retrospective study enrolled 871 patients who underwent PD between January 2018 and December 2021. Logistic regression analysis was performed to identify the independent risk factors associated with POPF. Predictive performance was evaluated using the receiver operating characteristic curves. In addition, a novel pancreaticojejunostomy strategy that could reduce the risk of POPF was adopted. Based on the multivariate analysis, the pancreatic texture and the location of the main pancreatic duct were the independent risk factors of POPF. A threshold ratio of 0.397 was used to distinguish the central from the eccentric pancreatic ducts. Notably, patients with the central pancreatic duct had a significantly lower incidence rate of POPF than those with the eccentric pancreatic ducts (10.6% vs. 44.8%, P<0.001). The novel group exhibited a significantly lower incidence rate of POPF than the conventional group (13.7% vs. 23.0%, P=0.02), and the incidence rate of other complications was not high. The location of the main pancreatic duct is associated with POPF development. However, implementing the novel pancreaticojejunostomy approach can effectively reduce the risk of POPF while ensuring safety.

Postoperative Complications of Direct-to-Implant and Two-Staged Breast Reconstruction: A Stratified Analysis.

Background: Post-mastectomy implant-based reconstruction can be performed as direct-to-implant (DTI) or two-staged reconstruction (TSR). Rigorous studies have explored postoperative complications between TSR or DTI, yet few have stratified outcomes by relevant populations, pre-operative findings, mastectomy characteristics, or plane of implant placement. We sought to compare the outcomes between these cohorts at our institution. Methods: All patients who underwent skin- or nipple-sparing mastectomy followed by DTI or TSR from 2011 to 2021 at a large academic medical center were included. Data included demographics, ADM use, mastectomy weight, plane of implant placement, and postoperative complications. Results: 295 patients were included. 271 (91.9%) received TSR, and 24 (8.1%) underwent DTI. Compared to TSR, DTI had a higher rate of NAC necrosis (P = .007) and dehiscence (P = .016). There was no difference in rate of other complications. Regardless of procedure, higher BMI (P = .002), higher grade ptosis (P = .01), and larger mastectomy weights (P = .022) were associated with increased risk of complication. Pre-pectoral placement was not associated with risk of NAC or mastectomy skin necrosis. Prior tobacco use was associated with higher risk of infection (P = .036) and dehiscence (P = .025). Neoadjuvant and adjuvant chemotherapy was associated with increased risk of capsular contracture(P = .009). Conclusions: Our study suggests that TSR may be preferred to minimize risk of NAC necrosis and wound dehiscence, especially in high-risk patients. Pre-pectoral placement did not significantly affect risk of mastectomy or NAC necrosis and should be considered in all cases to minimize morbidity. Higher risk conditions for alloplastic reconstruction include higher degrees of ptosis, history of tobacco use, and higher BMIs.

Evaluation of ERAS protocol implementation on complex spine surgery complications and length of stay: a single institution study

BACKGROUND CONTEXTWith the goal of improving patient outcomes, the Integrated Spine Center at UT Southwestern Medical Center implemented an enhanced recovery after surgery (ERAS) protocol which includes pre- and postsurgery guidelines. Numerous studies have shown benefit of implementation of ERAS protocols to standardize perioperative care in line with best practices; however, the literature on complication rates, LOS, and readmissions shows mixed results. PURPOSEThe goal of this study was to investigate the impact of the ERAS protocol implementation on complication rates in the perioperative period, as well as hospital and ICU length of stay and hospital re-admission rates. STUDY DESIGN/SETTINGA retrospective cohort study was performed on all patients who underwent spine surgery between September 2016 and September 2021 at a single institution. Patients who met inclusion criteria were divided into non-ERAS and ERAS groups, and comparative statistics were used to evaluate ERAS protocol effectiveness. PATIENT SAMPLEAll patients who underwent spine surgery at UT Southwestern between September 2016 and September 2021 were evaluated for inclusion in the study. The patient sample was further refined to include only complex patient cases which were able to receive the full ERAS protocol (nonemergent admissions). OUTCOME MEASURESPresence of absence of postoperative complications including surgical site infection, AKI, DVT, MI, sepsis, pneumonia, PE, stroke, shock, and other complications were compared between groups, as were hospital and ICU length of stay, and 7, 30, and 90 day readmissions. Self-reported or functional measures were not used in outcome evaluation. METHODSA database of patient and surgery characteristics was built using an EMR query tool with spot checks performed by the authors. Control and treatment groups were matched for gender, age, BMI, ASA score, and surgery type. Total number of complication rates was compared between ERAS and non-ERAS groups, and comparative statistics were used to determine significance. RESULTSSignificant differences between ERAS versus non-ERAS groups were found in rates of UTI (6.8% vs 3.1%, respectively; p=.031), constipation (20.6% vs 11.4%, respectively; p=.001), and any complications (31.4% vs 19.4%, respectively; p<.001). There was no significant difference in the rates of other complications, in length of hospital or ICU stay, or readmissions at 7, 30, and 90 days. CONCLUSIONSImplementation of the ERAS protocol did not decrease complication rates or length of stay, and ERAS patients had significantly higher rates of UTI, constipation, and any complications. There may have been confounding factors due to the impact of COVID-19 on delivery of care, as well as misalignment between ERAS goals and outcome measures.

Colonoscopy Utilization in Elderly Patients with Dementia: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis

BackgroundIt is projected that the elderly population will continue to increase. Many will develop chronic conditions such as dementia.AimsOur aims are to describe the utilization of colonoscopy among patients with dementia and compare outcomes in those with and without dementia.MethodsThis population-based analysis utilized the National Inpatient Sample (NIS) during 2019. Patients with dementia over the age of 60 years receiving colonoscopy were identified utilizing ICD-10 codes. Logistic regression was used for propensity score matching between the comparison groups. A Greedy one-to-one matching algorithm was utilized along with standardized mean differences to assess balance. Mcnemar test, signed rank sum, and paired t-test were used to compare the outcomes.ResultsInitially, 50,692 patients without dementia were compared with 4323 patients with dementia. Patients with dementia were more likely to be female, older, less likely White, had lower income, and more likely to be on Medicare. In the matched comparison (4176 in each group), complication analysis showed that patients with dementia did not have higher colonoscopy-related complications. They did have higher rates of other complications including renal/AKI (p = 0.0042), pulmonary/pneumonia (p = 0.003), cerebrovascular accidents (p = 0.0063), and sepsis (< 0.0001). Patients with dementia were also less likely to have routine discharges (< 0.0001), had longer hospital stays (< 0.0001), and higher hospital costs (< 0.0001).ConclusionsElderly patients with dementia have similar colonoscopy-related complications as patients without dementia. However, they do have higher complications in general. The decision whether to perform colonoscopy in this patient population is multifactorial. A careful assessment of a dementia patient’s history can help with this decision.

Preoperative cognitive impairment and postoperative delirium among Holocaust survivors who achieved longevity.

Holocaust survivors (HS) experience higher rates of physiological and psychological morbidities, increasing their vulnerability to perioperative complications. Limited information exists regarding their perioperative neurocognitive disorders. This study aimed to assess the rates of preoperative cognitive impairment, postoperative delirium, and other complications among HS aged 75+ undergoing elective surgery. This is a single-center retrospective cohort study that analyzed prospectively collected data. All surgical patients born before 1945 who underwent elective noncardiac surgery at a tertiary hospital in Israel during 2020-2021 were included. The HS group was identified through the hospital's information system. Preoperative cognitive impairment was assessed using the Mini-Cog test. Postoperative delirium was defined as a combined outcome, which included a positive 4A's-Test (4AT) result during the postanesthesia care unit stay up to the second postoperative day, a positive 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) test administered by the geriatric team, and identification through the medical records using the Chart-based Delirium Identification Instrument (CHART-DEL). We used multivariable regression to assess the risk factors for postoperative delirium. Out of 1332 eligible patients, 422 (32%) were HS, while the others served as controls. Both groups had a similar rate of preoperative cognitive impairment (24%, p = 0.89) and postoperative delirium (16%, p = 0.95). HS exhibited a higher risk of the composite adverse events (24% vs. 20%, p = 0.05, aOR [95% CI] 1.3 [1.0-1.7]), driven mainly by falls during hospitalization (4% vs. 2%, p = 0.03, aOR 2.1 [1.1-4.1]). HS patients were more likely to be childless (33% vs. 11%, p = 0.001) and had higher rates of chronic antidepressant and benzodiazepine use. HS achieving longevity do not face increased risks of preoperative cognitive impairment and postoperative delirium. However, special care is still warranted due to their elevated rate of other complications during hospitalization.

General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy.

Postoperative pain and complications pose significant challenges following a hemorrhoidectomy. Attaining effective anesthesia with minimal complications is crucial. The ideal anesthesia method for ambulatory hemorrhoidectomy remains uncertain. This study aimed to investigate whether the combination of general anesthesia plus local infiltration (GAL) is associated with lower complications and reduced pain compared to spinal anesthesia (SA) in the context of hemorrhoidectomy. This retrospective single-center cohort study, conducted in a tertiary medical center in East Asia, evaluated excisional hemorrhoidectomies performed between January 1, 2017, and March 31, 2023, utilizing GAL or SA. Data on the six most common complications-pain, constipation, acute urine retention (AUR), bleeding, nausea, and headache-were extracted from medical records. A total of 550 hemorrhoidectomies were included: 220 in the GAL group and 330 in the SA group. Patient characteristics were comparable between the two groups. The AUR rate was significantly lower in the GAL group compared to the SA group (15.5% vs. 32.1%, P < 0.001). Although the proportion of pain scores ≥4 did not differ significantly between the GAL and SA groups (36.2% vs. 39.8%, P = 0.429), the pain score curve indicated a stable trend. Overall, the GAL group exhibited a lower rate of adverse effects (56.9% vs. 67.4%, P = 0.023). There were no significant differences in the rates of other complications and emergency department readmission between the GAL and SA groups. GAL emerges as a favorable choice for anesthesia in hemorrhoidectomy, demonstrating a lower incidence of urine retention and a prolonged analgesic effect in multiple hemorrhoidectomies. These findings support the conclusion that GAL represents an optimal anesthetic method for enhancing the postoperative experience in patients undergoing hemorrhoidectomy.

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures.

Dislocation rates after hemiarthroplasty reportedly vary from 1% to 17%. This serious complication is associated with increased morbidity and mortality rates. Approaches to this surgery are still debated, with no consensus regarding the superiority of any single approach. To compare early postoperative complications after implementing the direct anterior and posterior approaches (PL) for hip hemiarthroplasty after femoral neck fractures. This is a comparative, retrospective, single-center cohort study conducted at a university hospital. Between March 2008 and December 2018, 273 patients (a total of 280 hips) underwent bipolar hemiarthroplasties (n = 280) for displaced femoral neck fractures using either the PL (n = 171) or the minimally invasive direct anterior approach (DAA) (n = 109). The choice of approach was related to the surgeons' practices; the implant types were similar and unrelated to the approach. Dislocation rates and other complications were reviewed after a minimum follow-up of 6 mo. Both treatment groups had similarly aged patients (mean age: 82 years), sex ratios, patient body mass indexes, and patient comorbidities. Surgical data (surgery delay time, operative time, and blood loss volume) did not differ significantly between the groups. The 30 d mortality rate was higher in the PL group (9.9%) than in the DAA group (3.7%), but the difference was not statistically significant (P = 0.052). Among the one-month survivors, a significantly higher rate of dislocation was observed in the PL group (14/154; 9.1%) than in the DAA group (0/105; 0%) (P = 0.002). Of the 14 patients with dislocation, 8 underwent revision surgery for recurrent instability (posterior group), and one of them had 2 additional procedures due to a deep infection. The rate of other complications (e.g., perioperative and early postoperative periprosthetic fractures and infection-related complications) did not differ significantly between the groups. These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate (< 1%) than the PL.

Transperineal Versus Transrectal Magnetic Resonance Imaging–targeted and Systematic Prostate Biopsy to Prevent Infectious Complications: The PREVENT Randomized Trial

Background and objectiveThe transrectal biopsy approach is traditionally used to detect prostate cancer. An alternative transperineal approach is historically performed under general anesthesia, but recent advances enable transperineal biopsy to be performed under local anesthesia. We sought to compare infectious complications of transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis. MethodsWe assigned biopsy-naïve participants to undergo transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis (rectal culture screening for fluoroquinolone-resistant bacteria and antibiotic targeting to culture and sensitivity results) through a multicenter, randomized trial. The primary outcome was post-biopsy infection captured by a prospective medical review and patient report on a 7-d survey. The secondary outcomes included cancer detection, noninfectious complications, and a numerical rating scale (0–10) for biopsy-related pain and discomfort during and 7-d after biopsy. Key findings and limitationsA total of 658 participants were randomized, with zero transperineal versus four (1.4%) transrectal biopsy infections (difference –1.4%; 95% confidence interval [CI] –3.2%, 0.3%; p = 0.059). The rates of other complications were very low and similar. Importantly, detection of clinically significant cancer was similar (53% transperineal vs 50% transrectal, adjusted difference 2.0%; 95% CI –6.0, 10). Participants in the transperineal arm experienced worse periprocedural pain (0.6 adjusted difference [0–10 scale], 95% CI 0.2, 0.9), but the effect was small and resolved by 7-d. Conclusions and clinical implicationsOffice-based transperineal biopsy is tolerable, does not compromise cancer detection, and did not result in infectious complications. Transrectal biopsy with targeted prophylaxis achieved similar infection rates, but requires rectal cultures and careful attention to antibiotic selection and administration. Consideration of these factors and antibiotic stewardship should guide clinical decision-making. Patient summaryIn this multicenter randomized trial, we compare prostate biopsy infectious complications for the transperineal versus transrectal approach. The absence of infectious complications with transperineal biopsy without the use of preventative antibiotics is noteworthy, but not significantly different from transrectal biopsy with targeted antibiotic prophylaxis.

Longitudinal Follow-Up of Children With HLHS and Association Between Norwood Shunt Type and Long-Term Outcomes: The SVR III Study.

In the SVR trial (Single Ventricle Reconstruction), newborns with hypoplastic left heart syndrome were randomly assigned to receive a modified Blalock-Taussig-Thomas shunt (mBTTS) or a right ventricle-to-pulmonary artery shunt (RVPAS) at Norwood operation. Transplant-free survival was superior in the RVPAS group at 1 year, but no longer differed by treatment group at 6 years; both treatment groups had accumulated important morbidities. In the third follow-up of this cohort (SVRIII [Long-Term Outcomes of Children With Hypoplastic Left Heart Syndrome and the Impact of Norwood Shunt Type]), we measured longitudinal outcomes and their risk factors through 12 years of age. Annual medical history was collected through record review and telephone interviews. Cardiac magnetic resonance imaging (CMR), echocardiogram, and cycle ergometry cardiopulmonary exercise tests were performed at 10 through 14 years of age among participants with Fontan physiology. Differences in transplant-free survival and complication rates (eg, arrhythmias or protein-losing enteropathy) were identified through 12 years of age. The primary study outcome was right ventricular ejection fraction (RVEF) by CMR, and primary analyses were according to shunt type received. Multivariable linear and Cox regression models were created for RVEF by CMR and post-Fontan transplant-free survival. Among 549 participants enrolled in SVR, 237 of 313 (76%; 60.7% male) transplant-free survivors (mBTTS, 105 of 147; RVPAS, 129 of 161; both, 3 of 5) participated in SVRIII. RVEF by CMR was similar in the shunt groups (RVPAS, 51±9.6 [n=90], and mBTTS, 52±7.4 [n=75]; P=0.43). The RVPAS and mBTTS groups did not differ in transplant-free survival by 12 years of age (163 of 277 [59%] versus 144 of 267 [54%], respectively; P=0.11), percentage predicted peak Vo2 for age and sex (74±18% [n=91] versus 72±18% [n=84]; P=0.71), or percentage predicted work rate for size and sex (65±20% versus 64±19%; P=0.65). The RVPAS versus mBTTS group had a higher cumulative incidence of protein-losing enteropathy (5% versus 2%; P=0.04) and of catheter interventions (14 versus 10 per 100 patient-years; P=0.01), but had similar rates of other complications. By 12 years after the Norwood operation, shunt type has minimal association with RVEF, peak Vo2, complication rates, and transplant-free survival. RVEF is preserved among the subgroup of survivors who underwent CMR assessment. Low transplant-free survival, poor exercise performance, and accruing morbidities highlight the need for innovative strategies to improve long-term outcomes in patients with hypoplastic left heart syndrome. URL: https://www. gov; Unique identifier: NCT0245531.

Переваги тангенціального висічення з одночасною аутодерматопластикою для лікування опікових ран

Burn trauma remains an important health problem, among which thermal burns of the limbs are one of the most common and complex due to the need to restore limb function and reduce aesthetic defects. Early tangential excision with simultaneous autodermoplasty is a complex technique that is also a significant stress for the patient, but it allows achieving all the set goals. Purpose - to evaluate the effectiveness of tangential excision with simultaneous autodermoplasty for treating burn wounds compared to the classical method of treatment. Materials and methods. The study included 24 patients with burns of the upper and/or lower limbs, from which two groups were formed: an experimental group (12 patients) and a control group (12 patients) who were equal in terms of patient sex, age, etiology of burn wounds, affected area. Tangential excision with simultaneous autodermoplasty was applied to patients in the experimental group, while delayed sequential necrectomy, xenoplasty (if necessary), and delayed autodermoplasty were performed on patients in the control group. Results. Patients in the experimental group stayed in the hospital for an average of 10.5±4.5 days, which was almost half as long as in the control group (20.2±3.5 days). The number of surgical interventions in the experimental group was 1.3±0.5 operations, while in the control group it was 2.7±0.8 operations, and the number of general anesthesia procedures in the experimental group was significantly lower (1.3±0.5) than in the control group (4.6±1.1; p&lt;0.05). In the experimental group, the number of dressings for each injury was 4.3±1.6, while in the control group it was almost three times as many (12.7±3.0; p&lt;0.05). The duration of healing of burn wounds in the experimental group was 13.3±4.3 days, which was shorter than in the control group (24.2±3.9 days; p&lt;0.05). The prevalence rate of infectious complications in the experimental group was 21.1% (4 cases), while in the control group it was significantly higher (58.8%). However, the prevalence rate of other complications, such as lysis of skin grafts, was only slightly lower in the experimental group (15.8%, or 3 cases) compared to the control group (29.4%, or 5 cases). 2 (18.2%) burn wounds in the experimental group required secondary reconstruction, while in the control group, 7 (70.0%) wounds required it. Conclusions. Treatment of burn wounds of the upper and/or lower limbs using the method of tangential excision with simultaneous autodermoplasty allows for a reduction in the length of hospital stay, a decrease in the number of surgical interventions, general anesthesia procedures, dressing changes, and ensures faster wound healing, as well as reduces the frequency of complications and the need for secondary reconstruction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Impact of Two Urethral Stent Types on Complications after One-Stage Hypospadias Repair Using the Duckett Procedure.

The authors evaluated whether the new nickel-titanium alloy stent (NTAS) is superior to the traditional silicone stent used in hypospadias repair surgery in preventing complications such as urinary fistula. This retrospective cohort study included 576 patients with hypospadias who underwent NTAS or traditional silicone stent placement after hypospadias surgery between March of 2002 and August of 2019. The primary outcome was the rate of urinary fistula occurrence at 4 weeks (stent removal time), and the secondary outcomes were the rate of other complications, such as urethral stricture, urethral diverticulum, infection, and so on. The occurrence of complications in both groups was compared, and the important contributing factors of urinary fistula and urethral stricture were determined. Among 576 patients, 398 were assigned to the NTAS group, and 178 were assigned to the silicone group. Thirty-five patients in the NTAS group and 30 in the silicone group developed urinary fistula, with a rate of 8.8% and 16.9%, respectively ( P = 0.005). Subgroup analysis showed that the differences were mainly in preschool patients (6 years or younger) ( P = 0.004) and those with the penile type of hypospadias ( P = 0.008). In addition, urethral stricture complicated five patients in the NTAS group and two in the silicone group, with a rate of 1.3% and 1.1%, respectively ( P = 1.000). Logistic regression showed that hypospadias type ( P = 0.001) and stent type ( P = 0.001) are the important risk factors for urethral fistula. The NTAS reduced the occurrence of urinary fistula complications after hypospadias repair in preschool patients, and can be presented as a better choice for hypospadias surgery. Therapeutic, III.

Impact of Initial Filling Medium on Outcomes of Subpectoral, Two-Stage, Implant-Based Breast Reconstruction: Air versus Saline.

In two-stage expander-based breast reconstruction, the use of air as the initial filling medium has been suggested to confer clinical advantages over conventional saline, but this has not been demonstrated in a large series. This study aimed to evaluate the association between material type (air versus saline) for initial expander filling and postoperative outcomes. This retrospective study included patients who underwent immediate, subpectoral, tissue expander-based breast reconstruction between January of 2018 and March of 2021. The participants were categorized into two groups according to the material used for initial filling: saline-inflated expanders, which were used during the first 22 months consecutively, and air-inflated expanders, which were used during the latter 17 months consecutively. Complications including mastectomy flap necrosis and postoperative expansion profiles were compared. Multivariable analyses were performed to identify independent predictors of postoperative complications. A total of 443 breasts (400 patients), including 161 air-filled and 282 saline-filled breasts, were analyzed. The two groups had similar baseline characteristics. The air-filled group showed a significantly lower rate of mastectomy flap necrosis; this difference remained significant after adjustment for other variables in the multivariable analysis. The rates of other complications did not differ between the two groups. The air-filled group had fewer office visits and a shorter period to complete expansion. The use of air for initial expander filling could provide safe and reliable outcomes with reduced patient discomfort during postoperative expansion; thus, air-filled expanders might be an effective alternative to saline-filled expanders. Therapeutic, III.

Outcomes of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19 Patients: A Multi-Institutional Analysis

In March 2020, COVID-19 was announced as a global pandemic. The first COVID-19 patient was connected to an ECMO device in Israel during that time. Since then, over 200 patients have required ECMO support due to COVID-19 infection. The present study is a multi-institutional analysis of all COVID-19 patients requiring veno-venous (VV) ECMO in Israel. The aim was to characterize and compare the survivors and deceased patients as well as establish risk factors for mortality. This retrospective multi-institutional study was conducted from March 2020 to March 2021 in eleven of twelve ECMO centers operating in Israel. All COVID-19 patients on VV ECMO support were included in the cohort. The patients were analyzed based on their comorbidities, procedural data, adverse event on ECMO, and outcomes. Univariate and multivariate analyses were used to compare the deceased and the surviving patients. The study included 197 patients, of which 150 (76%) were males, and the mean age was 50.7 ± 12 years. Overall mortality was 106 (54%). Compared with the deceased subjects, survivors were significantly younger (48 ± 11 vs. 53 ± 12 years), suffered less from ischemic heart disease (IHD) (3% vs. 12%), and were ventilated for a significantly shorter period (≤4 days) prior to cannulation (77% vs. 63%). Patients in the deceased group experienced more kidney failure and sepsis. Rates of other complications were comparable between groups. Based on this study, we conclude that early cannulation (≤4 days) of younger patients (≤55 years) may improve overall survival and that a history of IHD might indicate a reduced prognosis.

A 10-year review of the visual outcomes of early versus late pars plana vitrectomy in eyes with dropped lens fragment or nucleus during phacoemulsification

Background: Pars plana vitrectomy (PPV) is a routine surgical option for the removal of dropped lens fragment or nucleus in the vitreous cavity due to complicated cataract surgery; however, its optimal timing is controversial. Therefore, we aimed to determine the visual outcomes of early versus late PPV in eyes with dropped lens fragment or nucleus due to complicated phacoemulsification cataract surgery.&#x0D; Methods: This descriptive-analytical retrospective study collected data of patients who underwent early (less than or equal to 1 week) versus late (&gt; 1 week) PPV for the management of dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery over a 10-year period at Imam Khomeini Tertiary Referral Hospital, Ahvaz, Iran. Demographic characteristics, the interval between complicated phacoemulsification and PPV, pre- and postoperative intraocular pressures, best-corrected distance visual acuity (BCDVA), and postoperative complications were extracted from each patient’s record.&#x0D; Results: Fifty-one eyes of 51 patients with a mean (standard deviation [SD]) age of 64.66 (6.54) years and a male-to-female ratio of 33 (64.7%) to 18 (35.3%) were included over 10 years. The mean (SD) BCDVA before PPV was 1.87 (0.53) logarithm of the minimum angle of resolution (logMAR), which improved significantly to 0.54 (0.46) logMAR at the final postoperative visit (P &lt; 0.001). The mean (SD) BCDVA was significantly better after early PPV than after late PPV (0.41 [0.30] versus 0.62 [0.52] logMAR; P &lt; 0.05). There was no significant difference in the final BCDVAs among the three methods of lens fragment removal (P &gt; 0.05). The rates of post-PPV complications were as follows: 29 (56.9%) eyes with corneal edema, 16 (31.4%) eyes with uveitis, 10 (19.6%) eyes with cystoid macular edema, 8 (15.7%) eyes with rhegmatogenous retinal detachment, and 8 (15.7%) eyes with other complications (optic nerve atrophy, choroidal neovascularization, vitreous hemorrhage, or epiretinal membrane formation). No significant differences were observed in the rates of complications according to the time interval between complicated phacoemulsification and PPV (all P &gt; 0.05). The frequency of corneal edema was significantly higher when removing lens fragments using the trans-limbal method than using the other methods (P &lt; 0.05), yet the rates of other complications were comparable among the three methods of lens fragment removal (all P &gt; 0.05).&#x0D; Conclusions: Early PPV and removal of a dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery are recommended to achieve better visual outcomes. Future studies with longer follow-up, greater sample sizes, and analysis of other parameters of visual function, such as contrast sensitivity, visual field, color vision, and stereopsis, could provide more conclusive results and help verify our preliminary findings.

Treatment of Acute Achilles Tendon Ruptures: A Systematic Review of Overlapping Meta-Analyses

Category: Ankle Introduction/Purpose: Acute Achilles tendon rupture (AATR) is a common injury of an incidence rate of up to 31 per 100,000 per year. The current meta-analyses on the treatment of AATR have conflicted data that may, in part, be due to the differences in their methodologies. The aim of this study is to systematically review and present the current meta-analyses for the treatment of AATR. The outcomes of this study can provide clinicians with a clear overview of the current literature to help decide on the optimal treatment for patients. Methods: Two independent reviewers searched PubMed and Embase on March 17, 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Assessment of evidence was two-fold: level of evidence (LoE) and quality of evidence (QoE). LoE was evaluated using published criteria by The Journal of Bone and Joint Surgery and the QoE by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) scale. Pooled complication rates were highlighted for significance in favor of 1 group or no significance. Statistical analysis was performed using a statistical software package (R version 3.5.1; R Foundation for Statistical Computing, Vienna, Austria). Descriptive statistics were calculated for each study and statistical parameters analyzed. Continuous variables were reported as mean +- standard deviation and categorical variables were reported as frequencies with percentages. P-values &lt; 0.05 was considered statistically significant. Results: 21 meta-analyses were included in the study. Re-rupture rates ranged between 2.3% to 5.0% for open repair/MIS and 3.9% to 13% for conservative treatment (p &lt; 0.05). Re-rupture rates were reported in 3 of 4 meta-analyses that ranged between 2.3% to 7.8% for conservative treatment earlier rehabilitation and 5.0% to 12.2% for conservative treatment later rehabilitation. Re-rupture rates were 2.5% for open repair earlier rehabilitation and 3.8% for open repair later rehabilitation. When comparing surgical techniques, re-rupture rates ranged between 1.4% to 3.1% for percutaneous repair/MIS and 2.2% to 2.7% for open repair. Infection rates ranged between 2.8% to 5.0% for open repair/MIS and 0% to 0.02% for conservative treatment. The majority of meta-analyses (3 of 5) significantly favored by effect size, open repair/MIS for total infection rates (p &lt; 0.05). Conclusion: The results of this study demonstrate that operative repair reduced the rate of re-rupture when compared to conservative treatment. There is currently conflicting information on whether early functional rehabilitation reduces the difference between the two treatments. Operative treatment has been shown to have a higher rate of wound complications, although the rates of deep wound infections remains to be determined. Percutaneous repair resulted in similar re-rupture rates when compared to open surgery but for the rates of other complications including wound infections, this was diminished. Further meta- analyses which compare all cohorts are needed to ascertain best evidence.

Endobronchial valves: 1st Multicenter retrospective study on the 2-step approach

BackgroundAlthough the endobronchial valves (EBV) were successfully developed as treatment for severe emphysema, its main complication, pneumothorax, remained an important concern. ObjectiveTo assess whether the placement of Zephyr© endobronchial valves throughout 2 procedures instead of 1 minor the frequency of pneumothorax without lowering the benefits of such treatment. MethodsThis retrospective study was conducted in 15 pulmonology department in France. All the patients met the inclusion criteria of the recommendation set by the expert panel on the Endoscopic Lung Volume Reduction (ELVR) updated in 2019. As recommended, all the scan were analyzed with the StratX© (PulmonX Corporation, Redwood city, CA) protocol, and completed by a Chartis© (PulmonX Corporation, Redwood city, CA) in case of questionable fissure. During the first procedure, all but the most proximal sub-segment of the targeted lobe were occluded. One month after, EBV were placed in the bronchus of the last subsegment. All patients were evaluated before and 3 months after the second procedure. ResultsBetween March 2019 and December 2020, 96 patients received EBV treatment. 12 patients (12.5%) presented a pneumothorax (3 after the 1st step and 9 after the 2nd procedure). Beside pneumothorax, the main adverse event was exacerbation (10.4%) and pneumonia (4.1%). No death were reported. Significant improvement were found for FEV1 (14.6 ± 25.3%), RV (- 0.69 ± 2.1 L), 6MWT (34.8 ± 45.9 m), BODE Score (-1.41 ± 1.41pts), and mMRC scale (-0.85 ± 0.7pts). These results are compared not only to the results previously published using the usual approach but also to our previous publication evaluating the 2-step approach. Some patients presented authentic segmental atelectasis despite infralobar treatment. ConclusionPlacing EBV during 2 procedures instead of one led to a significant decrease of post treatment pneumothoraces without increasing the rate of other complications. It does not seem to alter the benefits of such therapy for severe emphysema. These results must be confirmed by launching a multicenter, prospective, randomized, controlled study to compare the frequency of pneumothorax and the efficacy of this new approach with the usual one-time procedure.