Total Postoperative Complication Rate Research Articles

Regional versus general anesthesia for total hip and knee arthroplasty: a nationwide retrospective cohort study

IntroductionWe aimed to determine whether regional anesthesia (RA) has any advantages over general anesthesia (GA) in total joint arthroplasty (TJA) in terms of mortality and postoperative complications.MethodsThis population-based retrospective cohort...

Laparoscopic liver resection as a treatment option for intrahepatic cholangiocarcinoma.

Laparoscopic liver resection (LLR) remains controversial in the treatment of intrahepatic cholangiocarcinoma (ICC). The aim of the present study is to investigate the outcomes of LLR for ICC compared to open liver resection (OLR). We retrospectively reviewed patients who underwent surgery for ICC between January 2013 and February 2020. OLR and LLR were compared after propensity score matching (PSM). Overall survival (OS) and recurrence-free survival (RFS) were compared between the matched groups. During the study period, 219 patients met the inclusion criteria (OLR = 170 patients, 77.6%; LLR = 49 patients, 22.4%). Two groups of 43 patients each were analyzed after PSM. The 5-year RFS and OS were 44.6% and 47.9% in the OLR group and 50.9% and 39.8% in the LLR group, respectively. Hospital stay and intensive care unit care were significantly shorter and lower in the LLR group than in the OLR group, respectively. Total postoperative complications and complication rates for those Clavien-Dindo grade 3 or higher were similar between the OLR group and the LLR group. Multiple tumors and lymph node metastases were predisposing factors for tumor recurrence and death in multivariate analysis. The present study suggests that LLR should be considered in selective ICC because of short hospitalization and similar oncologic outcome and overall survival.

Minimally invasive surgery for Inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques.

To evaluate outcomes of robotic versus conventional laparoscopic colorectal resections in patients with inflammatory bowel disease (IBD). Comparative studies of robotic versus laparoscopic colorectal resections in patients with IBD were included. Primary outcome was total post-operative complication rate. Secondary outcomes included operative time, conversion to open surgery, anastomotic leaks, intra-abdominal abscess formation, ileus occurrence, surgical site infection, re-operation, re-admission rate, length of hospital stay, and 30-day mortality. Combined overall effect sizes were calculated using random-effects model and the Newcastle-Ottawa Scale was used to assess risk of bias. Eleven non-randomised studies (n=5,566 patients) divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery were included. Robotic platforms were associated with a significantly lower overall post-operative complication rate compared with laparoscopic surgery (P=0.03).Laparoscopic surgery was associated with a significantly shorter operative time (P=0.00001). No difference was found in conversion rates to open surgery (P=0.15), anastomotic leaks (P=0.84), abscess formation (P=0.21), paralytic ileus (P=0.06), surgical site infections (P=0.78), re-operation (P=0.26), re-admission rate (P=0.48), and 30-day mortality (P=1.00) between the groups.Length of hospital stay was shorter following a robotic sub-total colectomy compared with conventional laparoscopy (P=0.03). Outcomes in the surgical management of IBD are comparable between traditional laparoscopic techniques and robotic-assisted minimally invasive surgery demonstrating the safety and feasibility of robotic platforms. Larger studies investigating the use of robotic technology in Crohn's disease and ulcerative colitis separately may be of benefit with specific focus on important IBD-related metrics.

Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors

ObjectiveComparing the clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors using meta-analysis.MethodsComputer retrieval of PubMed, Embase, The Cochrane Library, and Web of Science databases for literature comparing the clinical effects of video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) in treating mediastinal tumors, with the retrieval time limit from the establishment of the database to September 2023. Two evaluators independently screened the literature, extracted data, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.4.ResultsA total of 19 articles were included, with a total of 3517 patients. The results of the Meta-analysis showed that the RATS group had less intraoperative bleeding [MD = − 5.20, 95%CI (− 9.28, − 1.12), P = 0.01], lower rate of conversion to thoracotomy [OR = 0.41, 95%CI (0.23, 0.72), P = 0.002], lower rate of total postoperative complications [OR = 0.57, 95%CI (0.34, 0.95), P = 0.03], shorter postoperative drainage time [MD = − 0.72, 95%CI (− 1.13, − 0.32), P = 0.0004], and shorter postoperative hospital stay [MD = − 0.90, 95%CI (− 1.16, − 0.65), P < 0.001], in comparison with the VATS group. There was an insignificant difference between the two groups in terms of tumor size [MD = − 0.02, 95%CI (− 0.33, 0.30), P = 0.91] and operation time [MD = 0.17, 95%CI (− 7.61, 7.94), P = 0.97]. However, in regards to hospitalization costs [MD = 2634.75, 95%CI (991.62, 4277.88), P = 0.002], the RATS group was more expensive than the VATS group.ConclusionRobot-assisted mediastinal tumor resection surgery has more advantages in terms of intraoperative bleeding, conversion to thoracotomy rate, total postoperative complication rate, postoperative drainage time, and postoperative hospital stay, in comparison with thoracoscopic-assisted mediastinal tumor resection surgery. There is an insignificant difference in tumor size and operation time between the two surgeries. However, robot-assisted mediastinal tumor resection surgery increases hospitalization costs.

Comparison of the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy.

To compare the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy (DLC). From June 2021 to August 2022, data from 100 patients undergoing DLC at Nanjing Hospital of Traditional Chinese Medicine were analyzed retrospectively. Patients were divided into two groups: the experimental group (LC with the ampulla-guided realignment) and the control group (conventional LC with triangular gallbladder anatomy), with 50 patients per group. The intraoperative blood loss, operation time, postoperative drainage tube indwelling time, hospitalization time, bile duct injury rate, operation conversion rate, and incidence of postoperative complications were recorded and compared between the two groups. The pain response and daily activities of the patients in the two groups were evaluated 48 h after the operation. The amount of intraoperative blood loss, postoperative drainage tube indwelling time, hospital stay, operation conversion rate, pain degree at 24 and 48 h after operation, bile duct injury incidence, and total postoperative complication rate were shorter or lower in the experimental group than those in the control group (p < 0.05). The Barthel index scores of both groups were higher 48 h after the operation than before the operation, and the experimental group was higher than the control group (p < 0.05). The ampulla-guided alignment in DLC surgery was more beneficial in promoting postoperative recovery, reducing postoperative pain response, reducing the incidence of postoperative complications, and reducing bile duct injury.

996 Circumcisions in the Community; a New Initiative

Abstract Introduction The average waiting time for an initial outpatient appointment in urology at UHL is 23 weeks and waiting times for circumcisions are significantly longer. A new initiative in Leicester has enabled a proportion of fit and healthy NHS patients to have their circumcision under LA within the community. Our aim was to audit our practice to determine if this initiative could be trialled across other urological departments in the UK. Method A prospective database has been maintained and 76 patients who underwent a circumcision in the community between November 2021 and August 2022 were identified. 16 patients were excluded since they were not contactable via telephone. Online hospital records and GP records were used in addition to contacting patients via telephone to collect data. Results The mean satisfaction level with the service provided was 8.28. The total post-operative complication rate was 35% with a 25% post operative surgical site infection rate. There were 2 (3.3%) admissions to hospital secondary to penile abscesses and possible skin necrosis of which both required drainage in theatre. The average length of admission for these patients was 2.5 days. 3 (5%) patients were unhappy with cosmesis, and 2 patients have had/are awaiting a redo circumcision. Conclusions Through this new initiative 76 patients have been removed from the NHS waiting lists for circumcision thereby reducing waiting times with very high patient satisfaction. This indicates that this new initiative could be trialled in other departments and could also be used to reduce waiting lists for other minor procedures.

Evaluation of the double mesh and intraperitoneal onlay mesh techniques in giant incisional hernias

&lt;b&gt;Background:&lt;/b&gt; Giant incisional hernias are difficult to manage. The present study aims to comparatively evaluate the intraperitoneal onlay mesh (IPOM) technique to double-mesh repair techniques in patients with a midline abdominal wall incisional hernia larger than 15 cm (transvers width) that cannot be closed primarily.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; Patients who underwent repair surgery with the diagnosis of incisional hernia in our hospital between January 2017 and December 2019 were retrospectively evaluated. The repair was performed with open surgery using the IPOM technique in 19 patients and the double-mesh technique in 13 patients for 2 years to evaluate for postoperative complications, pain, and recurrence.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The mean age, gender distribution, body mass index, defect size, and American Society of Anesthesiologists scores were similar between the groups. The total rate of postoperative complications was 42.1% in Group A and 30.8% in Group B, with no significant difference between the groups (p &amp;gt; 0.05). Recurrence occurred in three patients (15.8%) in Group A, but it did not in Group B. Although the absence of recurrence in Group B was a remarkable finding, the difference was not statistically significant (p&amp;gt;0.05).&lt;br /&gt; &lt;b&gt;Discussion:&lt;/b&gt; The IPOM and double-mesh techniques can be used safely to perform tension-free abdominal wall reconstruction in patients with complex and giant incisional hernias. However, the double-mesh technique may be preferred owing to its lower recurrence rate.

Treatment of Intracranial Vertebral Artery Dissecting Aneurysms Using Pipeline Embolization Devices : AMulticenter Cohort Study.

Intracranial vertebral artery dissecting aneurysm (IVADA) is arare type of aneurysm with high morbidity and mortality. Recently, the application of pipeline embolization devices (PEDs) has been extended to IVADAs. Here, we aim to investigate the safety and effectiveness of PEDs for IVADAs. We retrospectively reviewed the PLUS database to identify patients who had IVADAs and were treated with PEDs from 2014 to 2019 at 14centers across China. Data including patient and aneurysm characteristics, procedure details, angiographic and clinical results, relationship with the ipsilateral posterior inferior cerebellar artery (PICA), and patency of the PICA following PED coverage were analyzed. In this study 52 consecutive patients with 52IVADAs were included. The mean age was 52.33years and 82.7% were male. With amedian follow-up of 10.5months, the complete occlusion rate was 93.8% (45/48) and no recurrence or in-stent stenosis was detected. The total postoperative complication rate and mortality were 11.5% and 1.9%, respectively. Complications occurred in 9.6% (5/52) of patients within 30days after the operation, including ischemic stroke in3 and hemorrhagic stroke in2. Another patient suffered an ischemic stroke at follow-up, 78.8% (41/52) PICAs were covered by PEDs, 1 case (2.4%) had afunctional disability due to PICA occlusion, while 39.0% (16/41) had reduced flow during follow-up but hardly caused any obvious neurological deficits. Patients with IVADA involving PICA had atrend towards more complications (66.7% vs. 51.1%; P = 1). Treating IVADAs with PEDs may be asafe and effective option, with favorable clinical and angiographic outcomes; however, complications associated with this treatment should not be ignored. http://www. gov . Unique identifier: NCT03831672.

Effect of sinus resection combined with vacuum-assisted closure on sacrococcygeal pilonidal sinus.

This study was aimed at investigating the effect of sinus removal combined with vacuum-assisted closure in the treatment of sacrococcygeal pilonidal sinus. From January 2019 to May 2022, 62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected at our hospital. These patients were randomly divided into two groups: an observation group (n = 32) and a control group (n = 30). The control group underwent a simple sinus resection and suture, while the observation group received a sinus resection combined with closed negative pressure drainage of the wound. A retrospective analysis of the data obtained was conducted. Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared between the two groups, and the recurrence rate at six months after the operation was recorded. Through this study, we found that the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05). Additionally, the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67% (P < 0.05). The visual analog scale (VAS) score at 6, 12, and 24 h after the operation was significantly lower in the observation group compared with the control group (P < 0.05). Although the differences were not significant (P > 0.05), the observation group had decreased white blood cell, neutrophil, and C-reactive protein levels after the operation. Moreover, the total occurrence rate of postoperative complications in the observation group was significantly lower (6.25%) than that of the control group (26.67%; P < 0.05). The observation group also had significantly lower scores on the postoperative scar scale and higher satisfaction scores than the control group (P < 0.05). However, there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05). Our study demonstrated that sinus resection combined with vacuum-assisted closure was more effective in treating sacrococcygeal pilonidal sinus compared with simple sinus resection and suture. This approach significantly reduced surgery time, hospital stay, and return time. It also effectively relieved postoperative pain, reduced the occurrence of postoperative complications, resulted in smaller postoperative scars, and yielded better aesthetic outcomes and higher patient satisfaction.

Different interventions for the treatment of patent ductus arteriosus in children: a protocol for a network meta-analysis

IntroductionPatent ductus arteriosus (PDA) is one of the most common congenital heart diseases. Once the PDA is diagnosed, it needs to be dealt with in time. At present, main methods include pharmacological treatment, surgical closure, and interventional closure for treatment of PDA. However, the effect of different interventions in PDA management is still controversial. Thus, our study aims to assess the effectiveness of different interventions together and estimate the sequence of these therapies for PDA children. Meanwhile, it is necessary to conduct a Bayesian network meta-analysis to compare the safety of different interventions comprehensively.Methods and analysisTo the best of our knowledge, this is the first Bayesian network meta-analysis comparing the efficacy and safety of different interventions for the treatment of PDA. PubMed, Embase, Cochrane Library, Web of Science, gray literature, and trial registry databases were searched from inception to December 2022. We will extract and report data according to methodological guidelines for Bayesian network meta-analysis by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Primary PDA closure, overall PDA closure, technical success, surgical success rate, mortality during hospital stay, operation time, intensive care unit stay, intraoperative radiation dose, radiation exposure time, total postoperative complication rate, and postoperative major complication rate will be defined as the outcomes. The quality of all random studies will be assessed using ROB, and quality of evidence for all outcomes will be judged by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Ethics and disseminationThe results will be disseminated through peer-reviewed publication. Since no private and confidential patient data will be contained in the reporting, there are no ethical considerations associated with this protocol.Systematic review registrationINPLASY2020110067.

The clinical effect of a strategy called transcystic gallbladder-preserving cholecystolithotomy based on endoscopic retrograde cholangiopancreatography for cholecystolithiasis: A retrospective study from a single center.

Choledocholithiasis complicated with cholecystolithiasis is a common disease. This study explores a novel strategy, called ERCP-based transcystic gallbladder-preserving cholecystolithotomy, for the simultaneous removal of common bile duct stones and gallbladder stones. From December 2018 to June 2021, all patients with cholecystolithiasis and common bile duct stones who met the criteria for gallbladder preservation in our hospital were included in the study and prospectively followed up. We included 48 patients, including 20 patients with acute biliary pancreatitis. All patients successfully underwent ERCP to remove common bile duct stones. One patient had gallbladder perforation during gallbladder-preserving cholecystolithotomy. The guide wire successfully entered the gallbladder, and the transpapillary gallbladder metal-covered stent was successfully placed in 44 patients. The technical success rate was 91.67% (44/48). All stones were removed in 34 patients, for a clinical success rate of 77.27% (34/44). The total postoperative complication rate was 6.25% (3/48), with 2 cases of pancreatitis (4.17%) and 1 case of cholangitis (2.08%). Three patients were lost to follow-up. Among the 31 patients who were followed up for a mean of 27 months (6-40), 5 patients (16.13%) experienced gallstone recurrence. The recurrence rates at 12 months, 18 months, 24 months, 30 months and 36 months were 0%, 3.23%, 6.45%, 12.9%, and 16.13%, respectively. For patients with cholecystolithiasis and common bile duct stones, ERCP-based transcystic gallbladder-preserving cholecystolithotomy without gallbladder incision can preserve gallbladder structure, and this procedure is safe and feasible for the protection of gallbladder function.Clinical trial registration: The study was registered in the Chinese Clinical Trial Registry, and the registry number is ChiCTR1900028006.

Effect of medical care linkage-continuous management mode in patients with posterior circulation cerebral infarction undergoing endovascular interventional therapy.

BACKGROUNDAcute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction (PCCI). PCCI affects the structure of the posterior circulation brain, because posterior part of the brain, which has more complex anatomical structures and more prone to posterior circulation vascular variation. Therefore, improving the prognosis of PCCI patients is necessary.AIMTo explore the effect of medical care linkage-continuous management mode (MCLMM) on endovascular interventional therapy (EIT) for PCCI.METHODSSixty-nine patients with PCCI who received EIT and conventional nursing intervention were selected as the control group, and 78 patients with PCCI who received EIT and MCLMM intervention were selected as the observation group. The incidence of postoperative complications, compliance and disease self-management behavior after six months of intervention, modified Rankin scale (mRS) and Barthel index (BI) scores in the acute phase and after one year of intervention, and recurrence within one year were compared between the two groups.RESULTSThe total incidence rate of postoperative complications in the observation group (7.69%) was lower than that in the control group (18.84%) (P < 0.05). The scores for medical compliance behavior (regular medication, appropriate diet, and rehabilitation cooperation rates) and disease self-management behavior (self-will, disease knowledge, and self-care ability) in the observation group were higher than those in the control group (P < 0.05). After one year of intervention, in the observation group, the mRS score was significantly lower, and the BI score was significantly higher than those in the control group (P < 0.05). The recurrence rate within one year in the observation group (3.85%) was significantly lower than that in the control group (13.04%) (P < 0.05). CONCLUSIONMCLMM can reduce the incidence of complications after EIT for PCCI, improve patient compliance behavior and disease self-management ability, and promote the recovery of neurological function.

Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: A single-center retrospective study.

BackgroundTo compare the incidence of complications and constructive effects of cranioplasty with polyetheretherketone (PEEK) and titanium mesh after decompressive craniectomy, and to further explore potential risk factors of postoperative and post-discharge complications.MethodsA retrospective study was conducted on 211 patients who underwent PEEK or titanium mesh cranioplasty in the Department of Neurosurgery of Zhujiang Hospital, Southern Medical University, between July 2017 and September 2021. Demographic data, imaging data, and postoperative complications were recorded and statistically analyzed. Long-term effects and satisfaction degree were evaluated based on following-up telephone survey. Univariate and multivariate logistic regression models were used to analyze risk factors of postoperative and post-discharge complications of PEEK and titanium cranioplasty.ResultsThe total postoperative complication rates of the PEEK and titanium mesh groups were 38.7 and 51.4% (p = 0.063), and post-discharge complication rates were 34.7 and 36.0% (p = 0.703), respectively. The incidence of pneumocephalus during hospitalization (33.3% vs. 6.6%, p < 0.001) and epidural effusion in the titanium mesh group were significantly higher than that in the PEEK group (18.0 vs. 6.6%, p = 0.011). Patients in PEEK group were less likely to occur subcutaneous effusion after discharge than in TI group (2.0 vs. 10.5%, p = 0.013). Multivariate logistic regression analysis revealed a history of ventriculoperitoneal shunt (VPS) before CP was an independent risk factor for postoperative overall complications (p = 0.023). Either superficial (p < 0.001) or intracranial infection (p = 0.001) was a risk factor for implant failure. Depressed skull defects (p = 0.024) and cranioplasty with titanium cranioplasty (p < 0.001) were associated with increased incidence of early pneumocephalus.ConclusionThere were no differences in overall postoperative and post-discharge complication rates between the titanium mesh and PEEK. A history of VPS before cranioplasty was an independent risk factor for postoperative overall complications, and infection was a risk factor for implant failure. Finally, depression skull defects and titanium mesh implants increased the incidence of postoperative pneumocephalus. Our results aim to promote a better understanding of PEEK and titanium cranioplasty and to help both clinicians and patients make better choices on implant materials.

When is the optimum time for the initiation of early rehabilitative exercise on the postoperative functional recovery of peri-ankle fractures? A network meta-analysis.

ObjectiveThe purpose of this study was to explore the safe and most effective initiation time for the functional recovery of patients with peri-ankle fractures after surgery.MethodWe searched electronic databases, including the Cochrane Library, Embase, PubMed and the reference lists of relevant articles published from inception to October 30, 2021. Two researchers independently performed literature screening and data extraction and evaluated the quality of the included literature using the Newcastle–Ottawa Scale. Network meta-analysis, including consistency testing, publication bias, and graphical plotting, was performed using Stata (v16.0).ResultsA total of 25 articles involving 1756 patients were included in this study. The results of the meta-analysis showed that functional exercise within 2 days after surgery may result in lower VAS scores compared to other techniques (P < 0.05). Functional exercise within 12 months may lead to higher AOFAS scores than that of other techniques (P < 0.05). The total postoperative complication rate, including deep vein thrombosis, showed no statistically significant differences between any two interventions (P > 0.05). The results of the surface under the cumulative ranking (SUCRA) showed that functional exercise within two days postoperatively may have the lowest VAS scores (SUCRA = 82.8%), functional exercise within 1 week postoperatively may have the lowest deep vein thrombosis rate (SUCRA = 66.8%), functional exercise within 10 days postoperatively may have the fewest total postoperative complication rate (SUCRA = 73.3%) and functional exercise within 12 months postoperatively may contribute to the highest AOFAS scores (SUCRA = 85.5%).ConclusionThe results of this study suggest that initiation of rehabilitation within two days after surgery may be the best time to reduce postoperative pain; rehabilitation interventions within 10 days after surgery may be the optimal time for reducing the total postoperative complication rate, including deep vein thrombosis; and continued functional exercise within 12 months after surgery may steadily and ideally improve the function of the ankle joint.Systematic Review Registration: doi: 10.37766/inplasy2021.12.0030, identifier: INPLASY2021120030

Maximal surgical effort increases the risk of postoperative complications in the treatment of advanced ovarian cancer

IntroductionSurgery is the cornerstone of the treatment for advanced ovarian cancer. Reaching complete cytoreduction resulting in no gross residual disease often requires complex surgery. The aim of this study was to assess the impact of increased surgical radicality on the risk of complications in the treatment of advanced ovarian cancer. Materials and methodsAll consecutive patients with advanced ovarian cancer (FIGO Stage IIIB-IVB) who had undergone primary or interval debulking surgery during a six-year study period were identified. In the midst of the study period, a surgical practice change towards maximal surgical effort occurred. Two groups were formed for the analysis: cohort A, that consisted of patients operated before the surgical paradigm shift and cohort B, that consisted of patients operated under the period of increased surgical radicality. Results252 patients were included in the analysis. Complete resection (R0) was achieved in 21.3% of surgeries in cohort A and in 51.2% in cohort B. The total postoperative complication rate was 76.2%. Most of the complications (86.5%) were minor (Clavien-Dindo I-IIIA). The patients in cohort B were at increased risk for complications, OR 2.94 (95%CI 1.58–5.47; p = 0.001). As for the approach to cytoreduction (primary vs. interval debulking), there was no statistically significant association with the occurrence of postoperative complications (p = 0.659). ConclusionIn the present study more extensive surgeries led to better surgical results but increased postoperative morbidity. Postoperative complication rates were similar in both primary and interval debulking surgeries.

Application of Smart Healthcare in Comparative Analysis of Effect of Early External Fixator and Plate Internal Fixation Treatment on Postoperative Complications and Lower Limb Function Recovery of Patients With Unstable Pelvic Fracture.

ObjectiveTo comparatively analyze the effect of early external fixator and plate internal fixation treatment on postoperative complications and lower limb function recovery of patients with unstable pelvic fracture based on smart healthcare.MethodsThe clinical data of 98 patients with unstable pelvic fractures treated in our hospital from August 2018 to August 2021 were collected for retrospective analysis, and the patients were split into group A (plate internal fixation, n = 49) and group B (early external fixator treatment, n = 49) according to the surgical modalities. The time of operation, intraoperative blood loss, postoperative complications, etc. were compared between the two groups.ResultsBetween the two groups, group B had significantly better clinical indicators (P < 0.001), a greatly higher good rate of fracture reduction and postoperative Harris score (P < 0.05), and obviously lower VAS score and total incidence rate of postoperative complications (P < 0.05).ConclusionThrough the analysis based on smart healthcare, it is found that compared with plate internal fixation treatment, early external fixator treatment presents a better effect in treating patients with unstable pelvic fracture, because it is a reliable method to accelerate fracture healing, reduce postoperative complications, and improve lower limb function.

No-drain management after thoracoscopic lung wedge resection with a novel intraoperative sealing test.

Although previous studies have reported the safety of no-drain management after thoracoscopic wedge resection, most of those studies were non-inferiority trials. The aim of this study was to evaluate whether no-drain management with an optimal sealing test affects post-operative complications in patients after thoracoscopic wedge resection. A total of 906 patients who underwent thoracoscopic lung wedge resection for various disorders except secondary pneumothorax between 2011 and 2020 were analyzed. According to intraoperative findings from the sealing test, patients were divided into groups with chest drain placement (Drain group, n = 514) or no-drain management (no-drain group, n = 392). Our intraoperative sealing test used a flexible drain (Blake®, 19-Fr; Ethicon, Somerville, NJ) connected to the chest drain bag (-10cmH2O) to monitor intrathoracic pressure and detect occult alveolar air leakage. Propensity score matching was conducted to balance baseline characteristics of the two groups and reduce selection bias. A total of 250 pairs were matched and standardized differences suggested proper matching had been achieved. Mean length of post-operative hospital stay (4.6days vs. 3.2days, p < 0.001) was significantly lower in the no-drain group. Total post-operative complication rates were significantly lower in the no-drain group (6.4% vs. 2.4%, p = 0.03). No-drain management after thoracoscopic wedge resection was associated with fewer post-operative complications and shorter hospital stay in selected patients. Our novel intraoperative sealing test may be useful for no-drain management of select patients.

Modern Appraisal of Patency and Complications in Cerebral Bypass Surgery: A Single Institution Experience.

Cerebral bypass is a valuable surgical technique in well-selected patient populations. Updated clinical guidelines and improved surgical techniques warrant a contemporary reevaluation of the complications and patency to inform clinical practice and enhance postoperative patient care. To assess the complication rates and postoperative graft patency for the 3 most common indications for bypass surgery: moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms. Perioperative notes of 175 consecutive bypass patients at a single institution were retrospectively identified to evaluate the clinical course and complications of surgery. The rate of total postoperative complications between moyamoya disease (9 of 98, 9.2%), intracranial atherosclerotic disease (7 of 57, 12.3%), and intracranial aneurysm (4 of 20, 20%) was not statistically different (P = .33). Immediate postoperative bypass patency was significantly higher in moyamoya disease (90 of 96, 93.8%) and intracranial atherosclerotic disease (48 of 51, 94.1%) than in intracranial aneurysm (13 of 18, 72.2%; P = .02). Intravenous heparin administration during bypass suturing was negatively associated with immediate postoperative patency (87% heparin patency vs 99% no heparin patency; P = .02). Double-barrel bypass trended toward an increased risk of wound healing complications (2 of 13, 15.4%) compared with the single-barrel bypass technique (4 of 156, 2.6%; P = .07). Cerebral bypass surgery remains an excellent surgical treatment for moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms. This study suggests bypass is safer in moyamoya disease and intracranial atherosclerosis. Additional studies to clarify the risk of single-barrel vs double-barrel bypass and intraoperative heparin-stratified complications may be beneficial.

Relationship between postoperative complications of esophageal cancer surgery and season: a retrospective study

BackgroundEsophageal cancer in China accounts for nearly half of the global esophageal cancer cases. The relationship between the occurrence of postoperative complications of esophageal cancer surgery and seasonal changes is not clear. Our purpose is to clarify the relationship between postoperative complications of esophageal cancer and season, so as to reduce the incidence of complications.MethodsWe retrospectively analyzed the medical records of patients undergoing esophageal cancer surgery in our hospital between January 2013 and December 2014. Patients were divided into the summer group (March–August) and the non-summer group (September–February) according to the seasonal climate. Pulmonary, cardiac, and other complications were recorded. Differences in postoperative complications were compared between the two groups by the chi-squared test.ResultsIn the 251 patients enrolled, the total postoperative complication rate was 37.8%. The occurrence of incision complications in the summer group was significantly higher than that in the non-summer group (10.1% vs. 3.5%, P=0.044). Pulmonary and cardiac complications in summer group were significantly rarer than those in the non-summer group (16.7% vs. 27.4%, P=0.039; and 8.0% vs. 16.8%, P=0.032, respectively).ConclusionsDuring the warm months of the year, clinicians should focus on preventing postoperative incision complications, and they should focus on preventing pulmonary and cardiac complications during the cold months.

Customized polyetheretherketone (PEEK) implants are associated with similar hospital length of stay compared to autologous bone used in cranioplasty procedures

ObjectiveCranioplasty is the surgical repair of cranial defects. Throughout its history, a number of different materials have been used, however, there is still no consensus on which material or method is best. The purpose of this study was to analyze the viability of polyetheretherketone (PEEK) cranioplasty to autologous cranioplasty modalities. MethodsA single-institution retrospective analysis of patients undergoing cranioplasties was performed. Patients were divided to PEEK and autologous cranioplasty cohorts. Parameters of interest included patient demographics and perioperative outcomes. A p-value <0.05 was considered statistically significant. ResultsA total of 66 patients met the inclusion criteria (PEEK: 22, autologous: 44). There were 36 males (54.5%) and 30 females (45.5%). Mean age of the entire cohort was 51.7 years (range 19–85 years). Baseline demographics were similar in both cohorts as measured by the modified frailty index (mFI) (p = 0.67). Univariate analysis revealed a significantly longer hospital length of stay (LoS) associated with the autologous group (p = 0.02). However, multivariate analysis did not yield such an association (p = 0.06) after controlling for mFI. Although the individual postoperative complication rates were similar between the two cohorts, autologous cranioplasty was associated with a significantly higher rate of total postoperative complications (65.9% vs 36.4%, p = 0.02). ConclusionOverall, PEEK biomaterials may offer a superior complication profile with similar hospital LoS compared to autologous bone implants used in cranioplasty. Future studies are warranted to validate our findings and further evaluate the utility of PEEK in cranioplasty.