Surgical Revision Rate Research Articles

Outcomes of medicaid patients undergoing TJA with previous positive urine toxicology screens.

Previous studies have demonstrated that patients with positive preoperative urine toxicology (utox) screens prior to total joint arthroplasty (TJA) have higher readmission rates, greater complication rates, and longer hospital stays compared to patients with negative screens. The aim of this study was to investigate the effect of postponing surgery for patients with positive preoperative utox in the Medicaid population. This retrospective, observational study reviewed the Medicaid ambulatory database at a large, academic orthopedic specialty hospital for patients with a utox screen prior to TJA from 2012 to 2020. Patients were categorized into three groups: (1) controls with negative preoperative utox or a utox consistent with prescription medications (Utox-) with TJA completed as scheduled; (2) positive preoperative utox with TJA rescheduled and surgery completed on a later date (R-utox+); (3) positive preoperative utox inconsistent with prescription medications with TJA completed as scheduled (S-utox+). Primary outcomes included mortality, 90-day readmission rate, complication rate, and length of stay. Of the 300 records reviewed, 185 did not meet inclusion criteria. The remaining 115 patients included 80 (69.6%) Utox-, 5 (6.3%) R-utox+, and 30 (37.5%) S-utox+. Mean follow-up time was 49.6months. Hospital stays trended longer in the Utox- group (3.7 ± 2.0days vs. 3.1 ± 1.6 S-utox+ vs.2.5 ± 0.4 R-utox+, p = 0.20). Compared to the R-utox+group, the S-utox+ group trended toward lower home discharge rates (p = 0.20), higher in-hospital complication rates (p = 0.85), and more all-cause 90-day emergency department visits (p = 0.57). There were no differences in postoperative opioid utilization between groups (p = 0.319). Duration of postoperative narcotic use trended toward being longer in the Utox- patients (820.7 ± 1073.8days vs. 684.6 ± 1491.8 S-utox+ vs. 585.1 ± 948.3 R-utox+, p = 0.585). Surgical time (p = 0.045) and revision rates (p = 0.72) trended toward being higher in the S-utox+ group. Medicaid patients with positive preoperative utox who had surgeries postponed trended towards shorter hospital stays and greater home discharge rates. Larger studies should be conducted to analyze the implications of a positive preoperative utox on risk profiles and outcomes following TJA in the Medicaid population. Study design Retrospective cohort study.

(137) Surgical Outcomes at a Single Institution of Infrapubic insertion of Malleable Penile Prosthesis in Transmen after Phalloplasty

Abstract Introduction Penile reconstruction has allowed transmasculine individuals to attain the aesthetic appearance of male genitalia, however a penile prosthesis is needed to achieve the ridigity and bulk for penetration. High complication rates have been reported with penile prosthesis placement after phalloplasty, with the rate of reoperation exceeding 40% following both inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). We describe the experience of a single surgeon with the infrapubic approach for MPP placement after phalloplasty. Objective To review the surgical outcomes of the infrapubic approach to the insertion of the MPP after phalloplasty in transgender men. Methods The infrapubic prosthesis insertion after phalloplasty technique involves a horizontal incision anterior to the pubic symphysis, which allows dissection of the neophallus channel and the anchor site on the pubic symphysis. Surgical outcomes using the Spectra (Boston Scientific, Marlborough, MA) and Genesis (Coloplast, Minneapolis, MN) MPP were analyzed between October 2017 and May 2022. Complications were reviewed and categorized into erosions, infections, device malposition and malfunction, and less common events like necrosis. Results The infrapubic MPP technique was performed on 40 patients by a single surgeon; 35 patients had a prior radial forearm free flap (RFFF) phalloplasty, and 5 had a prior anterolateral thigh flap (ALT) phalloplasty. Of the 30 patients who have continued to follow-up, mean follow-up was 34.9 months. Complications were not mutually exclusive, with 7 implant detachments from the anchor site, 3 malpositions, 2 with pain/activity limitation, and 1 infection. Surgical revision was required in 12 patients (40.0%). There were no neophallus erosions, flap loss, seromas, nor urethral injuries. More complications occurred with the Spectra MPP (9/17 or 52.9%) compared to the Genesis MPP (3/13 or 23.1%). Conclusions Infrapubic MPP insertion in transmen after phalloplasty is associated with high prosthetic surgical revision rates. Fewer complications were identified in the Genesis cohort. Longer term studies with patient reported outcome measures are required for further evaluation. Disclosure No

C39 TOTALLY ENDOSCOPIC VALVE SURGERY: FEASIBILITY AND ADVANTAGES IN OBESE PATIENTS

Abstract Objective Obesity is a relative contraindication to Minimally Invasive Cardiac Surgery because of its technical challenges. Aim of the study is to evaluate if totally endoscopic approach is feasible in treating heart valve’s pathology in obese patients and if 30–days outcomes and complications are non–inferior to non–obese patients. Methods From January 2018 to June 2022, 1544 consecutive unselected patients underwent totally endoscopic heart valve treatment at our institution. Treated valves were aortic, mitral, tricuspid in various combination. Concomitant procedures and different etiology were included. Among them, 177 were obese people and 1367 were non–obese based on Body Mass Index (BMI). Main working port was obtained with limited skin incision: peri–areolar/sub–mammary for mitral and tricuspid treatment, right anterior mini–thoracotomy for aortic valve treatment. We used a 5 mm 30° endoscope and 2 additional 5 mm miniport for vent line and aortic clamp. Neo–chordae implantation plus annuloplasty ring was the preferred technique for mitral repair. Results Median BMI and 1°– 3° quartiles in non–obese group was 24 [22 – 26] and inferior to obese group 32 [30 – 33] (p < 0.01). In both group CPB and Cross Clamp median time was not statistically significant: 147 minutes [121 – 181] vs 150 minutes [126 – 195] (p = 0.69), 95 [77 – 120] vs 97 [79 – 122] (p = 0.39). Conversion to full sternotomy occurred in 14 cases (0.9%) in non–obese patients vs 2 cases (1.12%) in obese patients (p = 0.89). Oro–Tracheal intubation median time was 5 hours [4 – 7] in non obese versus 6 hours [4 – 8] in obese (p < 0.01). ICU median hours stay were 20 [16 – 40] vs 24 [18 – 48] respectively in non–obese and obese group (p < 0.01). Post–operative hospitalization median stay was 5 days [4 – 7] vs 6 days [4 – 8] in obese group (p = 0.06). Stroke occurred in 15 non–obese patients (0.9%) vs 3 obese patients (1.6%) (p = 0.42). Wound complications occurred in 9 non–obese patients (0.65%) vs 5 obese patients (2.8%) (p = 0.52). All cause of mortality was 18 (1.1%) in non–obese vs 6 (3.3%) in obese (p = 0.11). Conclusions Surgery was feasible in both groups with comparable CPB and Cross–Clamp time, no difference in surgical revision rate and sternotomic conversion. Obese patients had slightly longer OTI time and ICU stay. However hospitalization days, mortality, stroke and wound complications rate were not different. Totally endoscopic approach was essential to achieve these results.

MP71-08 TRENDS OVER 20 YEARS OF ANTIMICROBIAL PROPHYLAXIS FOR ARTIFICIAL URINARY SPHINCTER SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP71-08 TRENDS OVER 20 YEARS OF ANTIMICROBIAL PROPHYLAXIS FOR ARTIFICIAL URINARY SPHINCTER SURGERY Helen Sun, Michael Callegari, Eric Zhou, Stephen Rhodes, Aaron Brant, Erin Jesse, Megan Prunty, Jonathan Shoag, Kyle Scarberry, and Shubham Gupta Helen SunHelen Sun More articles by this author , Michael CallegariMichael Callegari More articles by this author , Eric ZhouEric Zhou More articles by this author , Stephen RhodesStephen Rhodes More articles by this author , Aaron BrantAaron Brant More articles by this author , Erin JesseErin Jesse More articles by this author , Megan PruntyMegan Prunty More articles by this author , Jonathan ShoagJonathan Shoag More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , and Shubham GuptaShubham Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Perioperative antimicrobial prophylaxis is crucial for prevention of patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) best practice statements. METHODS: The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, removal, and/or associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. Guideline-based regimens were defined as 1) aminoglycoside (AG) + 1st/2nd generation cephalosporin (CEP), 2) AG+vancomycin, 3) aztreonam and CEP, 4) aztreonam and vancomycin, 5) aminopenicillin, or 6) beta-lactamase inhibitor. AUS-related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline-based antibiotics was done via chi-squared and Kruskal Wallis tests. A logistic regression model was used to determine the odds ratio (OR) of complications. RESULTS: Of 9794 patients with primary AUS surgery, 4318 (44%) received guideline-based antibiotics. Probability of guideline-based regimen use increased 7.5% per year. Patients with guideline-based regimens had lower odds of any complication within 3 months vs. non-guideline regimens (OR 0.76, 95% CI 0.67-0.86); however, no significant difference in repair/removal was noted (OR 0.99, 95% CI 0.86-1.14). Each decade increase in age was associated with a 17% increase in complications (95% CI 1.11-1.24). No significant difference was noted with Charlson comorbidity index, region, or hospital size. CONCLUSIONS: Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over time. Use of guideline-based regimens was associated with lower likelihood of complications, however they did not appear to lower surgical revision rates. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1016 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Helen Sun More articles by this author Michael Callegari More articles by this author Eric Zhou More articles by this author Stephen Rhodes More articles by this author Aaron Brant More articles by this author Erin Jesse More articles by this author Megan Prunty More articles by this author Jonathan Shoag More articles by this author Kyle Scarberry More articles by this author Shubham Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

Closed-incision negative-pressure wound therapy (ciNPWT) to minimize wound-related complications in lower limb reconstruction after bone tumor resection: preliminary proof-of-concept study.

The purpose of this study was to compare the impact of postoperative closed-incision negative-pressure wound therapy (ciNPWT) and conventional dressings in wound-related complications after bone tumor resection and reconstruction. A total of 50 patients with bone tumors and clinical indication for wide resection and reconstruction were included and divided into two groups (A and B). Bone defect reconstructions were achieved with modular endoprosthesis or biologic techniques, mainly involving allografts with free vascularized fibula. Group A received ciNPWT, and Group B conventional dressings. Wound-related complications, including wound dehiscence, persistent wound leakage, surgical site infections (SSIs), and causes for surgical revision, were assessed. Nineteen patients were included in Group A and 31 in Group B. No significant differences were found between groups regarding epidemiologic and clinical presentation features, contrarily to reconstructive options, which were significantly different between both (Fisher = 10,100; p = 0.005). Additionally, Group A presented lower wound dehiscence rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), SSI rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), and surgical revision rate (5.3% vs. 32.3%; χ2(1) = 5.003; p = 0.025) compared to Group B. This is the first study reporting the impact of ciNPWT after bone tumor resection and reconstruction, and its results support a potential role for this technique in diminishing postoperative wound complications and SSIs. A multicentric randomized controlled trial may help clarify the role and impact of ciNPWT after bone tumor resection and reconstruction.

Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases

BackgroundDynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology in clinical practice. However, the advantages of DS method in medium and long-term follow-up remain controversial.ObjectiveTo compare the radiographic and clinical outcomes between DS and instrumented fusion in the treatment of degenerative lumbar spine disease with or without grade I spondylolisthesis with a minimum follow-up period of 2 years.MethodsWe conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases, Chinese National Knowledge Databases, and Wanfang Database for potentially eligible articles. Clinical outcomes were assessed in terms of VAS and ODI scores, screw loosening and breakage, and surgical revision. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated.ResultsSeventeen studies with 1296 patients were included in the meta-analysis. The DS group was associated with significantly lower postoperative VAS scores for low-back and leg pain, and lower rate of surgical revision than the fusion group. Moreover, the Dynesys group showed significantly less ASDeg than the fusion group but showed no significant advantage over the fusion group in terms of preventing ASDis. Additionally, the ROM at the stabilized segments of the fusion group decreased significantly and that at the adjacent segments increased significantly compared with those of the DS group.ConclusionDS showed comparable clinical outcomes and provided benefits in preserving the motion at the stabilized segments, thus limiting the hypermobility at the adjacent segments and preventing ASDeg compared with the fusion method in degenerative disease with or without grade I spondylolisthesis.

Abstract No. 55 Evaluating Percutaneous Transhepatic Biliary Drainage (PTBD) Factors Associated with Better Outcomes in the Treatment of Post-Surgical Benign Biliary Strictures

To report outcomes of post-surgical benign biliary strictures treated with percutaneous transhepatic biliary drainage (PTBD) and balloon dilation. Patients with a history of surgery and who developed a benign biliary stricture were included in this retrospective, IRB-approved study (n = 44). Patients having biliary leaks, or with complete occlusion of the bile duct due to surgical clips were excluded (n = 28). Drain size, type (internal-external or external), balloon dilation, and type and size of balloon used was evaluated for all biliary procedures. These characteristics were compared between patients needing (n = 8) and not needing (n = 36) surgical revision. Continuous variables are reported as median (IQR) and compared with Wilcoxon rank sum test, categorical variables as numbers with percentages and compared using chi-square test. Patients were 59 (42-67) years old with 67% being female. Hepaticojejunostomy was the most common surgery (30%) followed by Roux-en-Y gastric bypass (16%), pancreaticoduodenectomy (14%), transplant (14%), Billroth II (9%), cholecystectomy (7%) and others (9%). Duct to enteric anastomosis was present in 52%, duct to duct in 11% and no anastomosis in 36%. Prior non-PTBD interventions included ERCP dilation and stent placement in 9 (20%) and failed ERCP in 10 (23%) patients. The first PTBD was done 28 (6-98) months after surgery, with a drain size of ≥10F in 20 (45%) and < 10F in 24 (55%) patients. The drain was internal-external in 41 (93%) patients. Patients underwent a total of 4 (3-8) procedures before drain removal, with drain upsizing performed in 23 (52%) patients, leading to a largest drain size of ≤8F in 10 (23%), 10F in 17 (39%), 12F in 14 (32%) and ≥14F in 3 (6%) patients. Balloon dilation was performed in 40 (91%) patients, with the largest balloon size being ≤8 mm in 13 (30%), 10 mm in 20 (45%), 12 mm in 6 (14%), and 14 mm in 1 (2%) patient. A cutting balloon was used in 19 (43%) patients. Surgical revision was needed in 8 (18%) patients, with a repeat PTBD performed in 5 (11%) patients. The rate of surgical revision was lower in patients who received a largest drain of ≥10F (12%) compared with those who received a largest drain of <10F (40%, P = 0.042). The rate of surgical revision was 7.4% in patients who were dilated with a balloon of ≥10 mm compared with 30.7% in those who were dilated with a balloon of <10 mm (P = 0.053). The median drain-free survival was 41 (11-57) months for the entire cohort. Postsurgical benign biliary strictures treated with PTBD with a drain of ≥10F and dilated with a balloon of ≥10 mm are less likely to need surgical revision.

Early Revision Rate Following Primary Carpal Tunnel Release

The published revision rates after carpal tunnel release (CTR) vary from 0.3% to 7%. The explanation for this variation may not be fully apparent. The purpose of this study was to determine the rate of surgical revision within 1-5 years following primary CTR at a single academic institution, compare it with rates reported in the literature, and attempt to provide explanations for these differences. We identified all patients who underwent primary CTR at a single orthopedic practice by 18 fellowship-trained orthopedic hand surgeons from October 1, 2015, through October 1, 2020, using a combination of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD), 10th Revision, codes. Patients who underwent CTR because of a diagnosis other than primary carpal tunnel syndrome were excluded. Patients who required revision CTR were identified using a practice-wide database query using a combination of CPT and ICD-10 codes. Operative reports and outpatient clinic notes were reviewed to determine the cause of revision. Data on patient demographics, surgical technique (open vs single-portal endoscopic), and medical comorbidities were collected. A total of 11,847 primary CTR procedures were performed during the 5-year period on 9,310 patients. We found 24 revision CTR procedures among 23 patients, resulting in a revision rate of 0.2%. Of 9,422 open primary CTRs performed, 22 cases (0.23%) went on to undergo revision. Endoscopic CTR was performed in 2,425 cases, with 2 cases (0.08%) ultimately undergoing revision. The average length of time from primary CTR to revision was 436 days (range, 11-1,647 days). We noted a substantially lower rate of revision CTR within 1-5 years of primary release (0.2%) in our practice than that noted in previously published studies, although we accept that this does not account for out-of-area migration. There was no significant difference in the revision rates between open and single-portal endoscopic primary CTR. Therapeutic III.

Surgical Outcomes at a Single Institution of Infrapubic Insertion of Malleable Penile Prosthesis in Transmen

To describe our technique for the infrapubic approach for malleable penile prosthesis (MPP) insertion after phalloplasty in transgender men and review surgical outcomes. The infrapubic prosthesis insertion technique involves a horizontal incision anterior to the pubic symphysis, allowing dissection of the neophallus tract and anchor site on the pubic symphysis. Surgical outcomes by a single surgeon using a Spectra or Genesis MPP between October 2017 and May 2022 were retrospectively reviewed. Complications were categorized into erosions, infections, device detachment, device malposition, pain or activity limitation, urethral injury, and flap loss. Implant survival kinetics were assessed by evaluating time to surgical revision. Forty patients underwent infrapubic MPP insertion; 35 patients had a prior radial forearm free flap (RFFF) and 5 had a prior anterolateral thigh flap (ALT) phalloplasty. Of 30 patients who maintained follow-up, mean follow-up was 34.9 months. Complications were not mutually exclusive, with 7 implant detachments from the anchor site, 3 malpositions, 2 with pain/activity limitation, and 1 infection. Surgical revision was required in 12/30 patients (40%). There were no neophallus erosions, flap loss, nor urethral injuries. More complications occurred with the Spectra (9/17 or 53%) than the Genesis MPP (3/13 or 23%), but this was not statistically significant (P = .10). Infrapubic insertion in transmen after phalloplasty using commercially available MPPs is safe compared with other post-phalloplasty penile prosthesis insertion techniques, with similarly high surgical revision rates. Further study of techniques is needed to improve outcomes after penile prosthesis insertion in transmen.

An Evaluation of the Impact of Mental Illness on Postoperative Breast Reconstruction Revision Surgery.

A commercially available database of 91 million unique patients, PearlDiver, was used to identify patients with breast cancer who underwent autologous free flap breast reconstruction. An average number of revisions were calculated from each group of patients-those with a history of anxiety and/or depression and patients without a history of anxiety and/or depression. A logistic regression was performed to determine risk factors associated with patients undergoing revision surgery. A total of 39,683 patients with a history of breast cancer underwent autologous breast reconstruction between 2010 and 2020, of which 6308 (15.9%) patients had a history of GAD and/or depression before autologous reconstruction. A total of 13,422 (33.8%) patients received at least one revision surgery. Patients with GAD only, depression only, and concomitant GAD and depression received 1.40 revisions each with no significant differences between the control and any of the study groups (P = 0.956). Logistic regression did not find psychiatric history to be associated with patients undergoing revision surgery (OR, 0.94; 95% CI, 0.89-1.00). Patients who underwent autologous reconstruction for breast cancer demonstrated no difference in rates of secondary surgical revision, regardless of a concurrent mental health history.

The role of extended coagulation screening in adult cranial neurosurgery

IntroductionPostoperative hemorrhage after adult cranial neurosurgery is a serious complication with substantial morbidity and mortality. Research questionWe investigated if an extended preoperative screening and an early treatment of previously undetected coagulopathies may decrease the risk of postoperative hemorrhage. MethodsA prospective study cohort of patients undergoing elective cranial surgery and receiving the extended coagulatory work-up were compared to a propensity matched historical control cohort. The extended work-up included a standardized questionnaire on the patient's bleeding history as well as coagulatory tests of Factor XIII, von-Willebrand-Factor and PFA-100®. Deficiencies were substituted perioperatively. The primary outcome was determined as the surgical revision rate due to postoperative hemorrhage. ResultsThe study cohort and the control cohort included 197 cases each, without any significant difference in the preoperative intake of anticoagulant medication (p ​= ​.546). Most common interventions were resections of malignant tumors (41%), benign tumors (27%) and neurovascular surgeries (9%) in both cohorts. Imaging revealed postoperative hemorrhage in 7 cases (3.6%) in the study cohort and 18 cases (9.1%) in the control cohort (p ​= ​.023). Of these, revision surgeries were significantly more common in the control cohort with 14 cases (9.1%) compared to 5 cases (2.5%) in the study cohort (p ​= ​.034). Differences in mean intraoperative blood loss were not significant with 528 ​ml in the study cohort and 486 ​ml in the control cohort (p ​= ​.376). ConclusionPreoperative extended coagulatory screening may allow for revealing previously undiagnosed coagulopathies with subsequent preoperative substitution and thereby reduction of risk for postoperative hemorrhage in adult cranial neurosurgery.

Image quality and related outcomes of the ShuntScope for catheter implantation in pediatric hydrocephalus—experience of 65 procedures

PurposeVentricular catheter implantation in pediatric hydrocephalus can become a highly challenging task due to abnormal anatomical configuration or the need for trans-aqueductal stent placement. Transluminal endoscopy with the ShuntScope has been invented to increase the rate of successful catheter placements. This study aims to evaluate ShuntScope’s image qualities and related surgical outcomes in the pediatric population.MethodsA retrospective analysis of all pediatric patients undergoing ventricular catheter placement using the ShuntScope from 01/2012 to 01/2022 in the author’s department was performed. Demographic, clinical, and radiological data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into the categories of excellent, medium, and poor and compared to the postoperative catheter tip placement. Follow-up evaluation included the surgical revision rate due to proximal catheter occlusion.ResultsA total of 65 ShuntScope-assisted surgeries have been performed on 51 children. The mean age was 5.1 years. The most common underlying pathology was a tumor- or cyst-related hydrocephalus in 51%. Achieved image quality was excellent in 41.5%, medium in 43%, and poor in 15.5%. Ideal catheter placement was achieved in 77%. There were no intraoperative complications and no technique-related morbidity associated with the ShuntScope. The revision rate due to proximal occlusion was 4.61% during a mean follow-up period of 39.7 years. No statistical correlation between image grade and accuracy of catheter position was observed (p-value was 0.290).ConclusionThe ShuntScope can be considered a valuable addition to standard surgical tools in treating pediatric hydrocephalus. Even suboptimal visualization contributes to high rates of correct catheter placement and, thereby, to a favorable clinical outcome.

Long-term outcomes of anterior shoulder instability treated with open latarjet procedure - a systematic review of outcomes at a minimum 15-year follow-up.

To systematically review the literature to evaluate the outcomes following an open Latarjet (OL) procedure at a minimum 15-year follow-up. Two independent reviewers performed a literature search using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using 3 databases. Only studies reporting outcomes of OL procedure with a minimum of 15 years of follow-up were included. Nine studies composed of 326 shoulders (78.2% males) in 313 patients were included (average age 26.9 ± 3.2 years (15-58)), with a mean follow-up of 271.9 ± 69.2 months (180-420) At a minimum 15-year follow-up, 93.5% (286 of 306) patients reported being satisfied with their OL procedure, whilst 86.8% (177 of 204) reported good/excellent outcomes at final follow-up. All nine of the included studies reported an overall rate of recurrent instability was 7.7%, with re-dislocations and subluxation at 3.4% and 5.8%, respectively. The rate of surgical revision was 5.15%; 3.5% of cases were revised for recurrent instability. Instability arthropathy was reported across all included studies as 41.0%. The OL procedure results in satisfactory clinical outcomes, low rates of recurrent instability and surgical revision at a minimum 15-year follow-up. Although high levels of radiological instability arthropathy and residual pain are found over the same period, these appear stable from a minimum of 10-year follow-up data. IV; a systematic review of all levels of evidence.

Comparison of percutaneous transluminal angioplasty and surgical revision after intraoperative dilatation with biliary tract probes for arteriovenous fistula stenosis at juxta-anastomosis.

Percutaneous transluminal angioplasty (PTA) is widely used for stenosis of vascular access (VA) for hemodialysis. We aimed to evaluate the effectiveness of both PTA and surgical revision after intraoperative dilatation with biliary tract probes for juxta-anastomotic stenosis in autogenous radiocephalic arteriovenous fistulas (RCAVFs). We performed a retrospective analysis of PTA and surgical revision after intraoperative dilatation with biliary tract probes; these were the first interventions after RCAVF establishment in 112 patients with juxta-anastomotic stenosis. Anatomical (number of stenoses) and clinical variables (age and gender of the patient, time of hemodialysis, AVF age, presence of diabetes mellitus, and cause of end-stage renal disease) were reviewed. Technical success, clinical success, and post-intervention primary patency were evaluated. Our study enrolled 35 patients in the PTA group and 77 patients in the surgical revision group. Clinical and technical success rates of both groups were 100%. There were no complications, such as bleeding or hematomas. Using the Kaplan-Meier method, the post-intervention primary patency rates at 3, 6, 9, 12, 18, and 24months in the PTA group were 100%, 94.28%, 77.1%, 60%, 54.29%, and 45.71%, respectively, and those in the surgical revision group were 100%, 94.81%, 92.2%, 90.91%, 81.82%, and 76.62%, respectively. The post-intervention primary patency rates at 9-24months in the surgical revision group were significantly higher than those in the PTA group (χ2 = 19.04, p < 0.0001). The post-intervention long-term primary patency rate of surgical revision after intraoperative dilatation with biliary tract probes is higher than that of PTA for the first intervention of patients with juxta-anastomotic stenosis in RCAVFs. The surgical revision method is safe and effective, especially in hospitals that have not yet carried out PTA.

Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications

PurposeDelay of elective surgeries, such as total joint replacement (TJR), is a common procedure in the current pandemic. In trauma surgery, postponement is associated with increased complication rates. This study aimed to evaluate the impact of postponement on surgical revision rates and postoperative complications after elective TJR.MethodsIn a retrospective analysis of 10,140 consecutive patients undergoing primary total hip replacement (THR) or total knee replacement (TKR) between 2011 and 2020, the effect of surgical delay on 90-day surgical revision rate, as well as internal and surgical complication rates, was investigated in a university high-volume arthroplasty center using the institute’s joint registry and data of the hospital administration. Moreover, multivariate logistic regression models were used to adjust for confounding variables.ResultsTwo thousand four hundred and eighty TJRs patients were identified with a mean delay of 13.5 ± 29.6 days. Postponed TJR revealed a higher 90-day revision rate (7.1–4.5%, p < 0.001), surgical complications (3.2–1.9%, p < 0.001), internal complications (1.8–1.2% p < 0.041) and transfusion rate (2.6–1.8%, p < 0.023) than on-time TJR. Logistic regression analysis confirmed delay of TJRs as independent risk factor for 90-day revision rate [OR 1.42; 95% CI (1.18–1.72); p < 0.001] and surgical complication rates [OR 1.51; 95% CI (1.14–2.00); p = 0.04].ConclusionAlike trauma surgery, delay in elective primary TJR correlates with higher revision and complication rates. Therefore, scheduling should be performed under consideration of the current COVID-19 pandemic.Level of evidenceLevel III—retrospective cohort study.

Anterior vertebral body tethering as a treatment for scoliosis in skeletally immature patients

A relatively new surgical procedure called Anterior Vertebral Body Tethering (AVBT) is used to treat scoliosis in patients with immature skeletons. It is a growth modulation fusionless system that Crowford and Lenke first described in 2010. We present our observations from 25 patients. Improvement in the mean coronal Cobb angle, from mean 57° preoperative to mean 34° postoperative, was 40%. Additionally, we noted that the mean thoracic hypokyphosis improved from 16° to 24° on average after surgery. Complication rates were 16% and surgical revision rates were 12%. All patients who demonstrated improvement in pain, function, and self-image underwent administration of the SRS-24 questionnaire. These data, according to the literature, show that AVBT is a reliable technique that enables scoliosis correction in skeletally immature patients and maintains that correction while utilizing remaining growth potential to achieve further correction, avoiding spinal fusion, and maintaining spine mobility.

Post-traumatic necrosis of the humeral head-Endoprosthesis or joint preservation

Humerus fractures play amajor role in daily clinical routine, and subsequent osteonecrosis is common after osteosyntheses. The current paper highlights the incidence and cause of osteonecrosis after proximal humerus fractures, with respect to presentation of anatomy and risk factors. Display of the literature and therapy options for humerus fracture and subsequent necrosis. Humerus fractures are the seventh most frequent fractures in humans. The complication rate is 40%, and the described rate of necrosis is up to 34%. Accordingly, the surgical revision rate is at 19% according to recent literature. The treatment of humerus head fracture must consider numerous variables. The individual type of fracture and the current individual situation of the patient must be included in the process of choosing the right treatment. Modern implants with screw locking features should be used, and for certain circumstances the direct implantation of aprosthesis should be considered. Thereby the expectations of the patient with respect to the postoperative activity level play amajor role.

Separation of congenital embryonic syndactylies in children: dorsal or volar flap? About a comparative retrospective series.

Congenital syndactylies account for 1 to 2 out of 2000 birth defects. Although several types of syndactylies exist, we only studied embryonic syndactylies. The goal of our study was to compare 2 types of coverage flap for the reconstruction of the finger web spaces: a volar flap described by Blauth and a dorsal flap described by Gilbert. Between 1993 and 2015, children affected by simple and complex syndactylies (partial or complete) were treated in 2 french pediatric hospitals and were selected for our analytic, comparative, retrospective review. The 2 hospitals used different surgical techniques: one used a volar flap described by Blauth and the other a dorsal flap described by Gilbert. The children were followed up to look for signs according to the stages of the Classification of Withey and to evaluate a global result according to the score of Withey. Our secondary criteria of judgement were the aspect of the surgical scar according to the VSS (Vancouver Scar Scale) and the satisfaction of the parents and children. The age of the children, need for a surgical revision and time of last follow- up were also studied. We found statistically significant differences between group I (volar flap) and group II (dorsal flap) in favor of the volar flap: higher scores of Withey (even when the number of commissures was increasing) and better VSS (regardless of the number of web spaces treated). There was no statistically significant difference between the 2 groups in terms of age, follow-up, or rate of surgical revision. All in all, the volar flap presented less sequelae in terms of scar retraction. Regardless of the flap used, the cosmetic results of the full-thickness skin graft used impacted the result both on the receiving site (dyschromia, hairiness) and the donor site.

P152. Is short segment fracture fixation appropriate for AO spine type B and C injuries?

<h3>BACKGROUND CONTEXT</h3> The AO Spine Classifications are associated with a hierarchical injury severity score. "Type A" fractures represent the most stable injuries and "Type C" represent the most severe and unstable injuries. "Three column" subaxial cervical spine and thoracolumbar injuries are designated as Type B (tension band) and Type C (fracture dislocation). Although the load sharing classification describes burst type fractures, Type B and C injuries are often minimally comminuted but grossly unstable due to "three-column" disruption. Therefore, the load sharing classification may not be appropriate to guide short- or long-segment fixation. <h3>PURPOSE</h3> To identify if construct length affects the rate of surgical complications or instrumentation revision following Type B and C subaxial or thoracolumbar injuries. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> All patients with cervical or thoracolumbar Type B and Type C injuries between 2006-2021 were identified from a prospectively collected database. Only patients who underwent operative intervention were included. <h3>OUTCOME MEASURES</h3> Surgical complications (persistent cerebrospinal fluid leak, wound dehiscence, epidural hematoma, surgical site infection) and reoperations (instrumentation revision and/or exchange). <h3>METHODS</h3> Patients were divided based on the number of levels instrumented above and below the injured level (>2 levels (long-segment) versus < 2 levels (short-segment)). Patient demographics, surgical characteristics and clinical outcomes were collected and compared. Independent t-tests or Mann-Whitney U tests compared continuous variables, while Pearson's chi-square tests compared categorical variables. Bivariate logistic regression measured the effect of fixation construct length (long-segment fixation) on the likelihood of having a surgical complication and reoperation for instrumentation revision and/or exchange. Alpha was set at P<0.05. <h3>RESULTS</h3> A total of 180 patients representative of 187 fractures were included. Of the 187 injuries, 69 (36.9%) underwent long-segment fixation. Patients who underwent long-segment fixation were older (61.1 vs 51.5 years, p=0.005), were more likely to have comorbid ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperosteosis (DISH) (47.8% vs 21.2%, p<0.001), and were more likely to have an injury that involved a thoracic vertebra (53.6% vs 30.5%, p=0.008). Further, patients who underwent long-segment fixation were more likely to undergo posterior-only fixation (85.5% vs 60.2%, p<0.001) in comparison to anterior-only and combined anterior-posterior fixation. There was no significant difference in the proportion of long-segment versus short-segment constructs that included bilateral, unilateral or no pedicle screws within the injured vertebrae (p=0.371). Bivariate logistic regression demonstrated that a long-segment fixation construct had a non-significant increase in complication rates (OR=2.08, p=0.176) and reoperations for instrumentation revision or exchange (OR=2.99, p=0.142). We subanalyzed the 58 fractures with AS/DISH compared to the 129 fractures without AS/DISH. Injuries with AS/DISH had a mean 2.57+ 1.01 and 2.34 + 0.81 levels instrumented above and below the injury compared to injuries without AS/DISH, mean 1.97 + 1.04 and 1.90 + 0.96 levels instrumented above and below the injury (p<0.001), respectively. However, there was no difference in the rate of surgical complications (8.62% vs 7.75%, p=0.780) or instrumentation revision (6.90% vs 3.10%, p=0.256) between the two groups based on construct length. <h3>CONCLUSIONS</h3> Long-segment fixation of Type B or C subaxial cervical spine or thoracolumbar spine injuries resulted in a non-significant increase in complications and spine reoperations for instrumentation revision. Instrumentation technology has improved since the load sharing classification. This exploratory study suggests short segment fixation may be appropriate even for unstable spine fractures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Does the use of intrawound povidone-iodine irrigation and local vancomycin powder impact surgical site infection rate in adolescent idiopathic scoliosis surgery?

Surgical site infection (SSI) is a major complication after adolescent idiopathic scoliosis (AIS) surgery, with an incidence ranging from 0.5 to 7%. Intraoperative wound decontamination with povidone-iodine (PVP-I) irrigation and/or vancomycin powder in adult spinal surgery has gained attention in the literature with controversial results. The aim of this study was to investigate the impact of using intrawound PVP-I irrigation and local vancomycin powder (LVP) on the incidence of early SSI in AIS surgery. All AIS patients who underwent posterior spinal fusion between October 2016 and December 2019 were retrospectively reviewed. The incidence of early SSI was reported and compared between 2 groups defined by the treating spinal surgeons' preferences: group 1-intrawound irrigation with 2L of PVP-I and application of 3g LVP before closure and control group 2-patients that did not receive either of these measures. Nine early cases of SSI (2.9%) were reported among the 307 AIS posterior spinal fusion patients. Incidence of SSI in group 1 (2/178 = 1.1%) was significantly lower than in group 2 (7/129 = 5.4%; p = 0.04). There were no adverse reactions to the use of PVP-I and LVP in our study. At latest follow-up, rate of surgical revision for mechanical failure with pseudarthrosis was significantly lower in group 1 (2/178 = 1.1%) than in group 2 (9/129 = 7.0%; p = 0.01). Intraoperative use of intrawound PVP-I irrigation and vancomycin powder is associated with a significant reduction of early SSI after AIS spine surgery. Retrospective study.