Rate Of Surgical Intervention Research Articles

Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland.

The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention. This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical). A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0-100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5-100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays. Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.

Standardization of the management of pediatric urolithiasis in the emergency department

The incidence of urolithiasis in the pediatric population is rising and medical expulsive therapy (MET) using alpha-adrenergic antagonists has been found to be effective in aiding in the passage of ureteral stones in children. A prior review of patients presenting to our quaternary children's hospital with urolithiasis found only 54% were prescribed MET and these patients had increased rates of spontaneous stone passage. Thus, an ED urolithiasis management protocol was created to standardize evaluation and care of children with suspected urolithiasis. To compare management of children with urolithiasis presenting to the ED before and after urolithiasis management protocol implementation. This is a retrospective review of patients with urolithiasis who presented to our children's ED from 2011 to 2022. The primary outcome was rate of MET prescribing before and after pathway implementation in July 2017, thus the pre-implementation group comprises patients who presented to the ED from July 2011 to July 2017, and the post-protocol group includes those who presented from August 2017 to April 2022. Secondary outcomes included CT utilization in the ED, surgical intervention rate, proportion with spontaneous stone passage, and frequency of urology consultation. Two-sample t-test and Fisher's exact test were used to compare the outcomes of interest before and after protocol implementation. Of 337 patients who presented to the ED after protocol implementation, 120 met inclusion criteria. When comparing outcomes before and after implementation of the protocol, there was significantly decreased use of CT scans (79% vs 50%, p<0.0001) and increased prescribing of MET (54% vs 82%, p<0.0001). There was a significant decrease in opioids prescribed (44% vs 26.7%, p=0.0040), and an increased rate of spontaneous stone passage (34% vs 46%, p=0.0483). Lastly, there was a significant reduction in the rate of surgery for stone management after the implementation of protocol (35% vs 17%, p=0.0020) DISCUSSION: As the ED is the primary site of presentation for many children with urolithiasis, standardization of evaluation and management provides an opportunity to improve outcomes in this population. We found that implementation of an ED urolithiasis management protocol was associated with decreased use of CT scans, decreased opioid prescribing, increased spontaneous stone passage, and decreased rate of surgical management for children with ureteral stones. This study demonstrates the positive impact of standardizing care for children presenting to the ED with urolithiasis.

The burden of scoliosis: a nationwide database study on demographics, incidence, and surgical rates.

Scoliosis is characterized as a three-dimensional deformity of the spine, affected by variety of factors, including biological, mechanical, hormonal, and genetics. Our study's primary objective was to delineate the demographics, incidence, and prevalence of scoliosis from a nationwide perspective, analyze the surgical intervention rates, with the aim of offering more insightful guidance to orthopedic physicians. This nationwide cohort study was conducted from digital database for healthcare information management. Relevant population data, for children under 18 years old, was extracted from the official government census within the period of January 2015 to December 2022. Utilizing diagnostic code of M41 [Scoliosis] was used to define the patient pool from ICD-10. Demographic variables, type of operations (posterior only, anterior only, or combined), and complications were documented. Incidence and prevalence values were calculated using population figures and case numbers. There were 276,521 patients with an average incidence of 129 per 100,000. Frequency of females was 1.45 times greater than that of males (p < 0.001). A total of 10,417 surgeries were performed in 10,311 patients during the inspection period (3.8% of all cases). Posterior fusion was by far the most common surgical approach (n = 10.111; 97%) followed by anterior fusion (n = 200; 1,9%). Our findings reveal a significant increase in the average incidence of scoliosis diagnosis, rising from 107 per 100,000 individuals in 2015 to 161 per 100,000 in 2022. Scoliosis now impacts an estimated 1.2% of children and adolescents in Turkey. The risk is 1.45 times higher in females than in males.

Prevalence of Heterotopic Ossification following Total Ankle Arthroplasty: A Systematic Review

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis is a debilitating pathology and is most commonly preceded by trauma. Surgical intervention via ankle arthrodesis or ankle arthroplasty is the mainstay management option. Heterotopic ossification (HO) is a common finding following joint arthroplasty. However, no consensus regarding the impact of heterotopic ossification on clinical outcomes following total ankle arthroplasty has been reached to date. The purpose of this systematic review and meta- analysis was to evaluate the prevalence and clinical outcomes of heterotopic ossification following total ankle arthroplasty. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting heterotopic ossification following TAA. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. Results: Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 45% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (120 patients, 33.9%). Random effects models of standardized mean differences found no difference in AOFAS, VAS and ROM between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 10.5%. Conclusion: This systematic review and meta-analysis found that HO is a common finding following TAA that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-severe, symptomatic HO following TAA. This study is limited by the significant heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAA.

Evaluation of risk factors for the development of bacteremia and complications in patients with brucellosis: Is it possible to predict the clinical course?

Brucellosis is often confused with other diseases or accompanies the conditions it imitates. It causes treatment delays, failure, relapse, and complications. This study aimed to investigate bacteremia and complication predictors in Brucellosis patients. Early detection may help reduce relapse rates, length of hospital stay, and surgical intervention rates by providing appropriate treatment. We examined 220 adult patients diagnosed with Brucellosis in our tertiary care hospital in the Black Sea Region between January 01, 2010, and January 01, 2022. Patients with and without bacteremia and complications were compared regarding demographic characteristics, clinical features, and laboratory parameters. The mean age was 46.4 ± 15.8 years (18-96 years), and 61% were male. Low back pain and absence of muscle pain were independent risk factors for predicting bacteremia (p = 0.049, p = 0.043, respectively). Weakness /fatigue, weight loss, and 1/320 Standard Tube Agglutination Test (STAT) or Brucella Coombs Gel Test (BCGT) titers were independent risk factors that reduced the risk of complications; in contrast, low back pain and splenomegaly were independent risk factors for development of complications. (p = 0.025, p = 0.007, p = 0.008, p = 0.003, p = 0.021 respectively). Thrombocytopenia was related to complications. When the platelet cut-off value was taken as 160,000/µL in predicting complications, the sensitivity was 31.30%, and the specificity was 97.73% (p = 0.011). The risk of clinical progression and complications could be predicted with symptoms and signs such as myalgia, low back pain, weakness/fatigue, weight loss, splenomegaly, and easily accessible laboratory parameters such as serum STAT/BCGT titer and platelet level.

Assessing Complication Risk of Pressure Equalizing Tube Placement in Children With Velocardiofacial Syndrome (22q11.2 Deletion Syndrome/DiGeorge Syndrome).

Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS. A retrospective case review including all patients with VCFS at a single large children's hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed. Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty (P > 1), myringoplasty (P > 1), or other surgical intervention rates (P = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates. This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status.

Decreasing utilization of surgical interventions amongst patients with pancreatic neuroendocrine tumor with liver metastases

BackgroundSince 2013, North American Neuroendocrine Tumor Society (NANETS) consensus-guidelines have endorsed consideration of surgical intervention for pancreatic- neuroendocrine tumors (PNET) with liver metastases. MethodsPatients with non-functional PNET with liver only metastases from 2010 to 2019 were identified from the National Cancer Database. Results34.7% underwent surgical intervention (13% PNET resection, 2.1% surgical management of liver metastases (SMLM), 19.5% PNET resection ​+ ​SMLM). In multivariable analysis, government insurance, year of diagnosis>2013, increasing primary tumor size were associated with lower rate of surgical intervention. Receiving treatment at an academic center (OR 3.59, 95%CI 1.81–7.11; P ​< ​0.001) or integrated cancer network (OR 3.21, 95%CI 1.57–6.54; P ​= ​0.001) was associated with a higher rate of surgical intervention. The overall rate of surgical intervention decreased from 45.7% in 2010 to 23.0% in 2019. ConclusionDespite guideline recommendations and the suggested survival benefits, only one-third of patients underwent surgical intervention, potentially influenced by the rising utilization of systemic therapy in the past decade.

Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review.

The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.

677 Amide Proton Transfer-Weighted Imaging Versus Diffusion-Weighted Imaging for Monitoring Treatment Response in Glioma Patients: A Systematic Review and Meta-Analysis

Abstract Aim Monitoring treatment response in glioma (GM) patients remains a challenge, as tumour recurrence (TR) and treatment-related injury (TRI) both appear similarly on standard magnetic resonance imaging (MRI). Although diffusion-weighted MRI (DWI) is gold standard, equivocal patients still undergo invasive biopsies for diagnosis. Amide proton transfer-weighted MRI (APTw) may more accurately differentiate TR from TRI, reducing surgical intervention rates. Hence, this systematic review and meta-analysis aimed to determine how APTw compares to DWI in the identification of TR from TRI. Method A search strategy was used to select studies investigating the diagnostic ability of DWI or APTw in detecting TR from Ovid MEDLINE ®, Ovid Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Thai Clinical Trials Registry. Selection criteria were applied to retrieve studies and methodologies critically appraised according to the QUADAS-2 tool. Conclusions from studies were synthesised, and the sensitivity and specificity for TR detection pooled. Results 18 studies were included in the analysis (11 DWI, 6 APTw, 1 both). For TR, APTw signal measured significantly higher, whereas apparent diffusion coefficients derived from DWI images were significantly lower. In DWI studies, combined sensitivity and specificity for TR was 84.4% (95% CI, 72.5%-91.7%) and 81.2% (95% CI, 67.9%-89.8%) accordingly. Meta-analysis was not performed for APTw due to limited study numbers. In general, studies had low methodological quality and were associated with a risk of bias. Conclusions Overall, though comparisons between DWI and APTw in monitoring GM treatment were inconclusive, this study supports the potential use of APTw in neurosurgery.

Analysis of the Epidemiological Features and Treatment Results of Burn Injuries in a Burn Center in Turkey.

The aim of the study was to reveal the epidemiological characteristics and clinical course of burn patients who were hospitalized in our burn center between 2015 and 2020 and to compare the results between nationalities. The data were retrospectively evaluated in terms of age, gender, time of admission, the total body surface area burned, the degree of burn, the accident location, the presence of wound infection, surgical intervention, length of hospital stay, mortality, educational status of the parents, and nationality; 59.8% of 1496 cases were male, mean age was 40.38 months. The most common age range was 0-2 years. 78.4% were admitted within the first 24 hours; 50.5% of the admissions were from İzmir and its districts. Burn trauma most commonly occurred indoors in all age groups. The most common cause was scalding. Isolation of microorganism in wound cultures was most commonly detected in second degree burns. The most common infection agent was Pseudomonas aeruginosa. The surgical intervention rate was 19%. The mean length of hospitalization was 14.46 ± 12.17 days. Total burned surface, hospitalization time, the infection, and mortality rate were higher in patients who underwent surgical intervention. Parents were mostly primary school graduates. 11.6% of the patients were of foreign nationality. No significant difference was found in the analyzed parameters between nationalities. In conclusion; burn trauma is most commonly seen in the 0-2 age group, regardless of parental education levels. Therefore, it is of great importance to provide training on burns to families and those responsible for the care of children.

The Role of Renal Parenchyma to Hydronephrosis Area Ratio (PHAR) in Evaluation of Ureteropelvic Junction Obstruction in Children

Background The cortex/ pelvis ratio or parenchymal to pelvicalyceal area ratio can help initial evaluation and follow up of the children with uretropelvic junction obstruction as simple modality using the cut off which is 1.6 (pelvis/ cortex) ratio. There are many studies evaluating the various preoperative parameters which influence the post-operative outcomes after pyeloplasty. Practically there are many ultrasound parameters in the post-operative period which indicate the change in renal function. So, our rationale in this study is to evaluate the role of the parenchyma hydronephrosis area ratio (PHAR) in initial evaluation and follow up of UPJO patients in correlation to renal isotope studies. Objective To evaluate sonographic assessment of Renal Parenchyma to Hydronephrosis Area Ratio (PHAR) in the initial management and follow up of UPJO patients in correlation with the renal scan. Patients and Methods Site of the study: All patients were selected from the children who attended our outpatient department and have proven UPJO and meeting the criteria for the need of surgical intervention at Faculty of Medicine, Ain Shams University. Sample Size: 36 patients. Using PASS II Program for sample size calculation and according to (Rickard et al,2016), the expected AUC for PHAR prediction of future surgical intervention = 0.18, 30% rate of surgical intervention, setting power at 8% and error at 0.05, sample size of 36 patients will be needed. Results We enrolled 36 cases of children ≤ 16 years old (7.93 ± 0.83) with unilateral UPJO. Preoperative ultrasound parameters of the hydronephrotic kidneys [including degree of hydronephrosis, parenchymal thickness and PHAR] and renal isotope are measured &amp; compared with the same parameters after surgical repair of the UPJO (Anderson Hynes pyeloplasty) at 3rd months. After operation, 31 cases (86.1%) improved &amp; 5 cases not improved (13.9%). We find a significant change in all parameters at 3 months postoperatively (p &amp;lt; 0.01) as T ½ (25.22 ± 2.49 &amp; 17.57 ± 3.84) significantly decrease &amp; parenchymal thickness (9.42 ± 4.92 &amp; 15.12 ± 4.86), GFR of the affected kidney (34.31 ± 3.31 &amp; 48.32 ± 6.99) split renal function (37.30 ± 3.80 &amp; 44.03 ±4.11) and PHAR (0.86 ± 0.30 &amp; 2.45 ± 0.93) significantly increase post operatively. PHAR post operatively shows positive correlation with parenchymal thickness &amp; renal isotope while negative correlation with T ½. Conclusion PHAR is a promising parameter that can be estimated on presentation US to help predict the future need for surgery and follow up in children with ureteropelvic junction obstruction. Early identification of children who may require surgical intervention allows for closer surveillance of those patients as well as the opportunity for more selective ordering of invasive testing.

The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH.

Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes.

To compare the clinical features, management, and outcomes between orbital cellulitis patients with subperiosteal abscess (SPA) and those with orbital abscess (OA). A retrospective study was conducted at a tertiary care center through medical record search to identify patients with orbital cellulitis from January 1, 2000 to December 31, 2022. Charts were screened for those with radiographic evidence of SPA or OA. Demographic data and presenting clinical features were compared between the 2 cohorts. Primary outcomes compared included rates of surgical intervention, reoperation, and readmission; and length of hospital stay and final vision. A total of 189 patients, 162 with SPA and 27 with OA, met the criteria. The OA group (mean 46.5 ± 18.6 years) was older than the SPA group (mean 19.1 ± 21.4 years). Comorbid sinusitis was significantly more common in the SPA cohort (95.7% SPA; 70.4% OA; p < 0.001), while OA was more likely to occur with orbital trauma (29.6% vs. 8.0%; p = 0.003), implanted hardware (11.1% vs. 0.6%; p = 0.005), and comorbid diabetes (22.2% vs. 4.3%; p = 0.001). OA patients more often presented with a relative afferent pupillary defect (21.7% vs. 3.9%; p = 0.005), vision worse than 20 of 50 (42.3% vs. 16.2%; p = 0.005), and methicillin-resistant Staphylococcus aureus infection (20.8% vs. 5.8%; p = 0.036). OA was associated with a higher reoperation rate (47.8% vs. 21.3%; p = 0.019), readmission rate (18.5% vs. 5.6%, p = 0.047), and limited extraocular motility at follow-up (4.3% vs. 25%; p = 0.013); while mean length of hospital stay and final visual acuity were similar. OA may affect an older population with a divergent risk factor profile compared with SPA. OA may cause more severe functional impairment on presentation, warranting more aggressive management to achieve visual outcomes similar to SPA.

Six years of experience with the nationwide newborn ultrasonographic hip screening program in Turkey: a considerable change in the type of surgical interventions in developmental dysplasia of the hip.

This study aims to assess whether or not the nationwide newborn ultrasonographic hip screening program has influenced the rate of different types of surgical interventions performed in developmental dysplasia of the hip (DDH) in children in Turkey. A retrospective analysis of the nationwide data obtained from the National Registry System between January 1, 2015, and December 31, 2020, was carried out. The rate of minor and major surgical interventions was calculated by dividing the total number of primary closed/open reductions with or without tenotomies and the total number of primary pelvic or periacetabular osteotomies with or without femoral osteotomies by the total number of live births in the country per year, respectively. The rates of primary minor surgical interventions were found to be 0.47/1000 in 2015, 0.71/1000 in 2016, 1.07/1000 in 2017, 1.00/1000 in 2018, 1.06/1000 in 2019, and 0.89/1000 in 2020. The rates of primary major surgical intervention were found to be 0.74/1000 in 2015, 0.40/1000 in 2016, 0.33/1000 in 2017, 0.31/1000 in 2018, 0.32/1000 in 2019, and 0.21/1000 in 2020. The introduction of the nationwide newborn hip screening program has significantly changed the surgical treatment modalities in children with DDH. A nearly twofold increase in the rate of primary closed/open reduction and hip spica casting and nearly three quarters decrease in the rate of primary bony procedures were observed within 6 years.

Racial, Ethnic, and Socioeconomic Disparities in Burn Care Access: A Single-Center Retrospective Study.

While racial, ethnic, and socioeconomic disparities in burn care have been identified in the literature, there is a paucity of research into specific underlying causes of these disparities. Here, we sought to characterize whether time to initial burn consult might contribute to racial, ethnic, and socioeconomic differences in burn care outcomes. We performed a retrospective review of all patients evaluated by the burn surgery service at a single regional ABA-verified burn center between June 2020 and April 2022. Patients without data for the time of onset of burn injury were excluded. Time to burn consult was defined as the time from onset of burn injury to the time of first burn consult. Three hundred and sixty-five patients met the inclusion criteria. Average age was 33.3 years, and 65.8% of patients were male. Average time to burn consult for all patients was 17 hours and 07 minutes. There were no significant differences in this variable among our cohort when stratified by race, ethnicity, or insurance status. Rates of surgical management (Chi-squared P = 0.05) and length of stay (ANOVA P < 0.0001) significantly differed by insurance status, but not among racial or ethnic groups. Medicare patients had the highest rates of surgical intervention and longer hospital stays; patients without insurance had the lowest rates of surgical intervention and shorter hospital stays. These results indicate that time from burn onset to burn consult is unlikely to contribute meaningfully to racial, ethnic, and socioeconomic disparities in burn care. Further studies are needed to better understand other aspects of burn care that may contribute to the noted disparities.

CT Findings in Laryngeal Trauma and the Clinical Implications.

Acute traumatic osseous and cartilaginous injuries to the larynx are rare injuries presenting to the emergency department. Despite the low reported incidence, laryngeal trauma carries ahigh morbidity and mortality. The purpose of this study is to identify fracture and soft tissue injury patterns in laryngeal trauma and explore associations with patient demographics, mechanisms of injury, urgent airway and surgical intervention. Aretrospective review of patients with laryngeal injury who underwent multidetector computed tomography (MDCT) imaging was performed. The CT findings of laryngeal and hyoid fracture location, fracture displacement, and soft tissue injuries were recorded. Clinical data including patient demographics, mechanisms of injury, frequency of airway and surgical intervention were also recorded. Correlation of imaging characteristics with patient demographics, mechanism of injury and interventions were assessed for statistical significance using χ2 and Fisher's exact tests. The median patient age was 40years old with astrong male predominance. The most common mechanisms of injury included motor vehicle collisions and penetrating gunshot wounds. Thyroid cartilage fractures were the most common fracture type. Findings of fracture displacement and airway hematoma had ahigher correlation with requiring urgent airway management. Radiologists' early recognition and prompt communication of laryngeal trauma to the clinical service is important to reduce associated morbidity and mortality. Displaced fractures and laryngeal hematomas should be promptly conveyed to the clinical service as they are associated with more complex injuries and higher rates of urgent airway management and surgical intervention.

A Comprehensive Research on the Prevalence and Evolution Trend of Orthopedic Surgeries in Romania.

Accurate knowledge of the prevalence and trends of orthopedic surgeries can facilitate the design of medical plans for effective treatments. The National Endoprosthetic Registry (NER) in Romania provides statistics on endoprosthetic activity (hip, knee), cases of fractures and bone tumors as a result of the legal obligations to report interventions performed by all orthopedic traumatology hospitals/wards in the country. The aim of this study is to describe the annual volumes of orthopedic surgeries between 2001 and 2022 in Romania and analyze the current and future evolution trends of the studied surgeries, gender differences and regional differences based on a complete survey carried out at a national level. For the period 2001-2022, we extracted from the NER the annual volumes of orthopedic interventions performed. With these data, we studied the prevalence and estimated, with the support of an original calculation methodology, the variation trends of orthopedic surgeries in two situations: over the entire 21-year period, respectively, and over the period 2001-2020, which does not include the pandemic period. For hip replacement surgery and knee replacement surgery, we showed the prevalence by subcategory of interventions, gender distribution, regional prevalence and regional density calculated by the annual averages of the total number of cases reported per 100,000 people in the 40 counties of the country and the capital, Bucharest. We also determined the variations in hip and knee arthroplasty revision burdens, calculated as a percentage between the number of revisions and the number of primary interventions in the same period. We determined the regional densities of revision burdens. The total number of orthopedic surgeries in the period 2001-2022 was 1,557,247, of which 189,881 were hip replacement surgeries; 51,035 were knee replacement surgeries; 11,085 were revision hip arthroplasty; 1497 were revision knee arthroplasty; 541,440 were operated fractures; and 16,418 were operated bone tumors. The growth rates of surgical interventions are hip replacement surgery, +8.19%; knee replacement surgery, +19.55%; revision hip arthroplasty, +9.43%; and revision knee arthroplasty, +28.57%. With these data, we have estimated a doubling of the volume of primary and revision interventions of the hip until 2034 and the knee until 2027, respectively. Operated bone tumors register an annual decrease of -4.52% thanks to modern treatments. There are clear gender differences; for primary hip interventions, the proportion of women is 58.82%, and for knee interventions, the proportion of women is 76.42%. This is the first research that, with the support of exhaustive data from the NER, analyzes for the period 2001-2022 the annual number of orthopedic surgeries in Romania. It allows knowledge of the large, anticipated increases in orthopedic surgery and provides a quantitative basis for future policy decisions related to the need for medical personnel and material resources.

Palliative primary tumor resection in minimally symptomatic (asymptomatic) patients with colorectal cancer and synchronous unresectable metastases versus chemotherapy alone: a metaanalysis

AIM: to evaluate outcomes (overall survival, rate of surgical intervention due to complications of first treatment, 30-day mortality rate) of palliative primary tumor resection (PTR) followed by chemotherapy and chemotherapy/ radiotherapy (chemo/RT) alone in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.MATERIALS AND METHODS: a meta-analysis based on Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines was conducted on PubMed and Cochrane database. Odds ratio (OR) and 95% confidence interval (95% CI) were used as the treatment effect measure for comparing results. Combined overall effect measures were calculated for a random effect model. All analyses were performed using the Review Manager 5.3 software.RESULTS: eighteen non-randomized studies, including a total of 2,999 patients (1,737 PTR and 1,262 chemo/RT) were identified. Gender, age, site of primary tumor and distant metastasis of patients were comparable between groups in all analyzed studies. Two-year (38.2% vs. 21.1%; OR 0.42; 95% CI 0.28–0.64; p &lt; 0.0001) and 5-year (12.7% vs. 5.3%; OR 0.45; 95% CI 0.21–0.97; p = 0.04) overall survival rates were significantly higher in the PTR group than in the chemo/RT group. No significant differences in 30-day mortality rate between the two groups (1.7% vs. 1%; OR 1.92; 95% CI 0.79–4.68; p = 0.15). However, the rate of surgical intervention due to complications of first treatment was significantly lower in the PTR group comparing to the chemo/RT group (2.3% vs. 14.53%; OR 0.18; 95% CI 0.08–0.40; p &lt; 0.0001). At the same time, one hundred and fourteen patients (13.8%; OR 0.19; 95% CI 0.09–0.40; p &lt; 0.0001) in the chemo/RT group required surgery for symptoms associated with a primary tumor.CONCLUSIONS: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases significantly improves overall survival, allows to prevent surgical intervention due to complications related to primary tumor and is not associated with increased postoperative mortality rate comparing to systemic chemotherapy/radiotherapy as a treatment of first line. The current data are based on non-randomized comparative studies and data from early terminated randomized controlled trials (RCTs) and further well-designed RCTs are required.

Transcatheter Tricuspid Valve Interventions: A Triumph for Transcatheter Procedures?

Tricuspid regurgitation (TR) is a common valvular pathology, estimated to affect 1.6 million people in the United States alone. Even though guidelines recommend either medical therapy or surgical treatment for TR, the misconception of TR as a benign disease along with the high mortality rates of surgical intervention led to undertreating this disease and commonly describing it as a "forgotten" valve. Recently, the development of transcatheter interventions for TR show promising potential for use in the clinical setting. There are currently few approved and numerous tested percutaneously delivered devices, which can be categorized, based on their mechanism of action, to either valve repair or valve replacement procedures. Both procedures were tested in clinical trials and show an echocardiographic reduction in TR sustained for at least 1 year after the procedure, as well as symptom relief and functional improvement of the patients. Device selection should be personalized, taking into consideration the anatomy of each valve and the available options at each heart center. Moreover, appropriate patient selection and timing of the procedure are also crucial for the success of the procedure. In this review, we analyze the clinical trials available for all devices currently approved or tested, aiming to provide a comprehensive summary of the most recent evidence in the field of transcatheter TR interventions.

Comparison analysis of safety outcomes and the rate of subsequent spinal procedures between interspinous spacer without decompression versus minimally invasive lumbar decompression

IntroductionTreatment for degenerative lumbar spinal stenosis (LSS) typically begins with conservative care and progresses to minimally invasive procedures, including interspinous spacer without decompression or fusion (ISD) or minimally invasive lumbar...