Rate Of Surgery Research Articles

Low Surgery Rates in Early Crohn's Disease: Results from a Prospective Population-Based Inception Cohort-The Inflammatory Bowel Disease in South-Eastern Norway III Study.

The emergence of biologic therapy has coincided with a decline in surgery rates for Crohn's disease (CD). This study aims to describe the disease course, including intra-abdominal surgery rates, biologic therapy use, and variables associated with biologic therapy initiation in a cohort of newly diagnosed CD patients. The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study. From 2017 to 2019, newly diagnosed inflammatory bowel disease patients were included for prospective follow-up. The present study included CD patients ≥ 18 years. Clinical, endoscopic, and demographic data were collected at diagnosis and 1-year follow-up. Data were analyzed by using the Kaplan-Meier method and regression analyses. In total, 424 CD patients (median age 37.0 years (range 18-80), female 55.0%) were included. At diagnosis, 50.5% presented with ileal disease and 80.7% with inflammatory behavior. Within a 1-year follow-up, 39.6% of patients received their first biologic therapy and 5.2% required intra-abdominal surgery. Systemic steroid treatment, CRP ≥ 5.0mg dL-1, Harvey-Bradshaw Index score > 4, ileocolonic disease and penetrating disease behavior at diagnosis were independently associated with increased risk of initiation of biologic therapy, while age > 40 years was associated with decreased risk. A high proportion of patients had ileal disease and inflammatory behavior at diagnosis. Still, nearly 40% started biologic therapy within the 1-year follow-up, while only 5% required intra-abdominal surgery.

Surgeon Adoption of Immediate Sequential Bilateral Cataract Surgery in the United States from 2018 to 2022: Immediate Sequential Bilateral Cataract Surgery.

To assess 5-years trends in the rate of immediate sequential bilateral cataract surgery (ISBCS) and surgeon characteristics associated with performing ISBCS. 100% Medicare Fee-for-service beneficiaries from 2018-2022. Cross-sectional study. ISBCS cases were identified among patients aged ≥ 65 years undergoing bilaterally performed cataract surgery (BPCS). Cochrane Armitage trend test was used to assess patient and surgeon characteristics over time. Multivariable logistic regression was used to evaluate surgeon characteristics associated with performing ISBCS. Among 1,190,169 BPCS, 3,954 (0.33%) were ISBCS. Quarterly ISBCS rate increased from 2.12 to 5.5 per 1,000 BPCS (p<0.001). Among 10,290 surgeons, 1,119 (10.87%) performed ISBCS on some patients. Proportion of surgeons performing ISBCS per 1,000 cataract surgeons increased from 15.63 during the first quarter of 2018 to 26.55 during the last quarter of 2022 (p<0.001). Among the ISBCS surgeons, the proportion of ISBCS cases per 1,000 BPCS doubled from 17.20 in 2018 to 35.50 in 2022 (p<0.001). On multivariable analysis, surgeons in the highest surgical volume quartile (OR: 1.21; 95% CI: 1.01-1.45; Ref: lowest quartile), recent graduates (0-10 years OR: 2.43, 95% CI: 1.87-3.15; Ref: ≥ 31 years) and surgeons in West (OR: 2.408, 95% CI: 2.052-2.826; Ref: South) had higher odds of performing ISBCS. There was an increased rate of ISBCS possibly suggesting greater interest among patients and surgeons. Although the overall ISBCS rate remained low, the number of surgeons performing ISBCS increased. Higher volume surgeons, recent graduates, and those practicing in the West were more likely to perform ISBCS.

A Systematic Review and Meta-Analysis of Autologous vs Irradiated Homologous Costal Cartilage Grafts for Dorsal Augmentation Rhinoplasty

Abstract Background Autologous costal cartilage (ACC) is commonly used for dorsal augmentation rhinoplasty due to its availability and strength, despite risks like hypertrophic scarring and pneumothorax for the patient. Irradiated homologous costal cartilage (IHCC) offers an alternative, potentially mitigating these complications. Previous reviews comparing these materials have been methodologically weak. Objectives Our aim was to perform a robust systematic review and meta-analysis comparing the outcomes of ACC and IHCC in dorsal augmentation rhinoplasty to guide clinical decision-making in nasal reconstruction. Methods MEDLINE, EMBASE, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Data extraction and quality assessment were performed by two independent authors. The primary outcomes of interest were warping, revision rates, infection rates, and displacement. Methodological quality and risk of bias were assessed using GRADE and Cochrane’s ROBINS I tool, respectively. Results Thirty-six articles were reviewed, including one comparative and thirty-five single-arm studies (ACC: 29, IHCC: 8), encompassing 2,526 patients from 13 countries. Adverse events included warping (ACC: 6%, p&amp;lt;0.0001; IHCC: 6%, p&amp;lt;0.0001). Resorption rates were 1% for ACC (p = 0.06) and 3% for IHCC (p &amp;lt; 0.0001). Revision surgery rates were similar (ACC: 4%, p&amp;lt;0.001; IHCC: 4%, p&amp;lt;0.001), as were infection rates (ACC: 1.8%, p=0.03; IHCC: 1.3%, p=0.03). Conclusions Current evidence does not demonstrate the superiority of ACC or IHCC for dorsal augmentation rhinoplasty. Both grafts are viable, with the choice guided by patient and surgeon preferences. Prospective, high-quality data with standardized outcomes are needed to improve clinical decision-making.

Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p &lt; 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom–Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients.

Outcomes and effectiveness of active surveillance for low-risk papillary thyroid carcinoma: a systematic review and meta-analysis.

This study aimed to evaluate the outcomes and effectiveness of active surveillance (AS) in patients with low-risk papillary thyroid carcinoma (PTC) and compare them to those of immediate surgery (IS). A systematic review and meta-analysis, including 14 comparative studies and 7 noncomparative studies, was conducted, encompassing a total of 9,397 patients. AS was associated with lower rates of familial history of thyroid cancer, multiplicity, and overall mortality compared to IS. The disease progression rate during AS was 14.53% (95% CI, 9.59-21.43%), and the delayed surgery rate was 14.91% (95% CI, 8.35-25.21%). No thyroid cancer-related mortality was observed in either the AS and IS groups. Clinicopathological characteristics showed no significant differences between delayed surgery and IS, except for higher rates of extrathyroidal extension and multiplicity in the delayed surgery group. Overall complication and recurrence rates were higher in the delayed surgery group than in the IS group. Quality of life and anxiety levels were similar between AS and IS, except for interest in sex, where AS was more beneficial. AS is a feasible and reliable option for managing low-risk PTC, with a relatively low rate of disease progression and no thyroid cancer-related mortality. However, AS should be undertaken with caution, given the higher rates of overall complications and recurrence in the delayed surgery group compared to the IS group. Further studies with larger sample sizes and long-term follow-up are needed to clarify the role and effectiveness of AS.

Five-Year Outcomes of Deep Sclerectomy in Pseudoexfoliation Glaucoma Compared to Primary Open-Angle Glaucoma.

Objectives: This study aimed to investigate the five-year outcomes of deep sclerectomy (DS) in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods: This retrospective, observational, unicentric study analyzed POAG and PEXG patients. Intraocular pressure (IOP), the number of IOP-lowering medications, peripapillary retinal nerve fiber layer (RNFL) thickness, the number of postoperative interventions, surgical success rates, and secondary surgery rates were evaluated at baseline and during follow-up appointments. Results: A total of 109 POAG and 153 PEXG eyes were included. Over the 5-year follow-up, IOP decreased in both groups (p = 0.17), from 22.8 ± 0.7 to 13.3 ± 0.6 mmHg (p < 0.001; POAG) and from 24.3 ± 0.8 to 16.6 ± 1.2 mmHg (p < 0.001; PEXG). The number of IOP-lowering medications decreased comparably (p = 0.99), from 3.1 ± 0.1 to 1.7 ± 0.3 (p = 0.001; POAG) and from 3.4 ± 0.1 to 1.7 ± 0.2 (p < 0.001; PEXG). Peripapillary RNFL thickness decreased in both groups (p = 0.31), from 60.6 ± 1.9 to 54.2 ± 2.4 µm (p < 0.001; POAG) and from 63.1 ± 1.7 to 58.0 ± 2.3 µm (p < 0.001; PEXG). The 5-year complete success rates were 33% and 12% for the POAG and PEXG groups, respectively (p = 0.01). The qualified success rates were 63% and 40% (p = 0.03). Secondary glaucoma surgery was required in 8% of POAG eyes and 21% of PEXG eyes (p = 0.04). Conclusions: DS resulted in comparable results for IOP, medications, and RNFL development in the PEXG and POAG groups but in less favorable outcomes concerning surgical success and further necessary repeated glaucoma surgery in patients with PEXG over the 5-year follow-up period.

Reprogramming of iPSCs to NPCEC-like cells by biomimetic scaffolds for zonular fiber reconstruction

Ectopia lentis (EL), characterised by impaired zonular fibers originating from non-pigmented ciliary epithelial cells (NPCEC), presents formidable surgical complexities and potential risks of visual impairment. Cataract surgery is the only treatment method for EL, but it leads to the loss of accommodative power of the lens post-operatively. Furthermore, the challenge of repairing zonular ligaments in situ remains a significant global issue. Ocular tissue and aqueous humour samples from patients with EL were subjected to RNA sequencing and Olink high-throughput proteomic analysis, revealing the downregulation of pathogenic genes (FBN1, MFAP2) and upregulation of secretory proteins (IL-12, MMP-1). The high expression of FBN1 and MFAP2 in NPCECs suggests their potential as candidates for zonular fiber construction; however, the limited availability of donor sources restricts the feasibility of NPCEC transplantation therapy. The reprogramming and directional differentiation of induced pluripotent stem cells (iPSC) to NPCEC was successfully achieved using the developed biomimetic scaffolds that mimic the microstructures of natural radial zonular fibers. Excitingly, the single injection of induced NPCEC-like cells significantly contributed to restoring and enhancing mechanical properties in zonular fiber structures in a rabbit model with EL. This proposed in situ iPSC-based regeneration technique might serve as an innovative therapeutic strategy for clinical EL patients, reduce the cataract surgery rate, and retain the adjustment capacity of inherent lentis.

Modern anatomical locking plates are associated with increased postoperative wound complications and unplanned surgical revisions compared to standard tubular plates in the management of unstable ankle fractures: a comparative cohort study in 595 patients

Abstract Background The clinical benefit of locking plates in distal fibula fractures has not yet been proven. In addition, the risk of wound complications appears to be higher than with conventional tubular plates. We hypothesize that the benefits of locking plates in terms of biomechanical properties are outweighed by a higher risk of wound complications. Methods We conducted a retrospective review of fibula fractures treated by osteosynthesis with either a conventional one-third tubular plate or an anatomically shaped locking plate from January 1, 2015 to December 31, 2021. We recorded baseline data and relevant comorbidities and defined the need for revision surgery due to wound-related or mechanical complications as primary endpoints. Results A total of 595 out of 727 patients were eligible for our study. Of these 595 fractures, 526 were fixed with a one-third tubular plate, 69 with a locking plate. Revision surgery was required in 54 patients, in 51 cases due to wound complications. Three patients required revision surgery for mechanical reasons and all of them were younger than 40 years of age, have not been diagnosed with osteoporosis, but experienced complex fracture types. As the third tubular plate and locking plate groups differed in terms of age and comorbidities, we performed a 2:1 matching based on age and gender, leaving data from 138 patients receiving a third tubular plate. While the two groups were comparable in many aspects, the rate of wound complications was significantly higher in the locking plate group. Although the locking plate group had a higher percentage of diabetes mellitus, there was no correlation between this comorbidity and the higher revision rate in this group. Conclusions Our data do not support the general use of locking plates in the treatment of distal fibular fractures. The risk of mechanical complications in osteoporotic ankle fractures seems to be overrated, as there were no mechanical revisions in the osteoporotic subgroup. The rate of wound-related revision surgery was significantly higher after the use of locking plates. This might be attributed to the greater thickness of locking plates.

Addressing rising knee injury and surgery rates with real-word data; the need for a clinical knee injury registry

Addressing rising knee injury and surgery rates with real-word data; the need for a clinical knee injury registry

Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial

ObjectivesTo evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related...

Outcomes of internal fixation with Femoral Neck System (FNS) for intracapsular femoral neck fractures

Abstract Background: Internal fixation of hip fractures is associated with high reoperation rates. This study investigated the reoperation rates after internal fixation with the femoral neck system (FNS). Materials and Methods: A single-institution cohort study was conducted on patients aged 18 years or older who sustained intracapsular femoral neck fractures and underwent internal fixation with a fixed-angle implant. Surgeons, patients, and investigators were not blinded. The primary outcome was any hip reoperation at the final follow-up. Secondary outcomes were to characterize a cohort of patients regarding demographics, fracture classification, intraoperative findings, postoperative fracture complications and union rates, and postoperative pain. Results: This study found that internal fixation with FNS for intracapsular femoral neck fractures was associated with a 23% rate of revision surgery. Of the initial 94 patients who received FNS internal fixation, 44 patients were included for analysis; of those, 10 patients underwent revision surgery. Patients had a 22% rate of in-hospital medical adverse events with a 30-day readmission rate of 9%. Increasing body mass index was associated with increased revision rates (P = 0.037). Patients who sustained displaced femoral neck fractures had a significant decrease in SF-12 Mental Health Composite, SF-12 Physical Health Composite, and quality-of-life subscale scores. Conclusions: The FNS is a viable alternative for internal fixation of intracapsular femoral neck fractures. The observed rate of revision after internal fixation was comparable with previously published outcomes following fixation with cannulated screws and sliding hip screws. Level of Evidence: Level IV, Therapeutic Study.

Survival Outcomes and Disparities in Surgery Refusal for Papillary Thyroid Cancer.

Surgery is the cornerstone of treatment for papillary thyroid cancer (PTC), yet some patients refuse surgery, which may impact their survival outcomes. Understanding factors associated with surgery refusal could inform interventions to improve acceptance of recommended care. This retrospective cohort study evaluated the impact of surgery refusal on overall survival (OS) and identified associated demographic and clinical factors using data on patients with PTC from the National Cancer Database from 2004 to 2019. OS was analyzed using the Kaplan-Meier method, with survival curves compared using the log-rank test. Patient characteristics were analyzed using Pearson Chi-square tests or Wilcoxon Rank Sum tests. Of the 201,051 patients with PTC who were advised to undergo surgery, 200,656 (99.8%) underwent surgery, while 395 (0.2%) refused. Patients who refused surgery were older (mean age 55.2 years vs. 48.7 years), more often male (27.8% vs. 22.8%), and represented higher proportions of Black, Asian, Hispanic, lower-income, uninsured, and non-privately insured patients (p<0.001). OS rates were significantly lower in patients who refused surgery, with one-year and five-year survival rates of 87% and 34%, respectively, compared to 96% and 56% for those who underwent surgery. Surgery refusal in patients with PTC was associated with poorer OS outcomes and was more frequent among older adults, socioeconomically disadvantaged populations, and racial and ethnic minorities. Interventions addressing patient concerns and barriers to surgery are critical to improving treatment acceptance and survival among these groups.

Arthroscopic Autologous Minced Cartilage Implantation of Cartilage Defects in the Knee: A 2-Year Follow-up of 62 Patients.

Symptomatic cartilage defects of the knee joint are frequently diagnosed and can be treated with different available surgical methods. Nevertheless, there is currently no gold standard treatment for all indications. Minced cartilage implantation is increasingly coming into focus as a refined surgical technique. To investigate the 2-year clinical and radiological outcomes of arthroscopic autologous minced cartilage repair with the standardized commercial implantation system AutoCart. Case series; Level of evidence, 4. A total of 62 consecutive patients were included and prospectively evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively. Outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), and Tegner activity scale at all follow-up time points. The examination of preoperative magnetic resonance imaging (MRI) was performed using the Area Measurement and Depth and Underlying Structures (AMADEUS) score, and the examination of MRI at 24 months was performed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score. There were 34 male and 28 female patients (mean age, 38.79 ± 10.78 years) with symptomatic cartilage lesions with a mean defect size of 2.53 ± 1.24 cm2. Lesions were predominantly International Cartilage Repair Society grade 3 located in the region of the femoral condyles. Concomitant surgery was performed in 40.3% of patients. The total KOOS score significantly improved from 62.4 ± 13.1 at baseline to 74.4 ± 15.9 at 24 months (P < .001). The secondary outcome measures of the VAS, WOMAC, and SANE showed a similar pattern, with score improvements in the follow-up period compared to baseline. The mean AMADEUS score was 64.75 ± 13.87, while the mean MOCART 2.0 score was 62.88 ± 9.86, among 20 available patients. The revision surgery rate was 8.1% mainly because of hypertrophy (6.5%). Among this cohort of patients, minced cartilage implantation demonstrated satisfying 2-year outcomes with increased patient-reported outcome measure scores from 3 to 24 months postoperatively. Regenerated tissue quality on MRI was comparable to that using other cartilage repair methods and showed no associations with patient characteristics or patient-reported outcome measures. Larger cohorts, longer postoperative intervals, and comparable trials are needed to further evaluate the role of this technique in treating cartilage defects.

Outcomes and Complications of Failed Anatomic Shoulder Arthroplasty Revised with Reverse Arthroplasty: A Systematic Review.

Reverse shoulder arthroplasty (RSA) is an increasingly utilized option to address complications following anatomic total shoulder arthroplasty (TSA). This systematic review aims to identify the patient outcomes, complication rates, and re-revision rates following revision to a reverse shoulder replacement from a failed anatomic total shoulder arthroplasty. MEDLINE, EMBASE, and CENTRAL were searched from inception until November 21, 2023 to identify studies reporting outcomes and/or complications for patients with a failed TSA revised to an RSA. Primary outcomes included the intra- and postoperative complication rate and secondary surgery rate. Secondary outcomes included the mean post-revision improvement in the ASES score, pain, Constant score, SST score, and range of motion. From 1,347 records, 26 studies (730 patients) assessing RSA following a failed TSA were included. The most common indications for revision were rotator cuff tear (32%), loosening (12%), and instability (12%). Postoperatively, clinically important improvements were found for the ASES score, VAS pain, Constant score, flexion, and abduction. Following revision to RSA, complications occurred in 22% of patients, with implant failure being the most prevalent (25%). Secondary surgery after RSA occurred in 12% of patients. The revision of a failed TSA to an RSA resulted in clinically significant benefits. The most common indication for TSA revision was due to rotator cuff pathology, followed by instability and loosening. Despite the high potential for improved patient outcomes post-revision, the procedure is accompanied by a higher complication rate relative to primary RSA, with implant failure and fractures being the most common.

Antithrombotic Agents after Free Tissue Transfer in the Pediatric and Adolescent Population.

Even for the experienced microsurgeon, free tissue transfer in pediatric patients is challenging, and large patient series remain scarce in the literature. Moreover, the added value of antithrombotic agents in pediatric free tissue transfer remains unclear. We conducted a retrospective outcome analysis of pediatric free tissue transfer with respect to postoperative antithrombotic treatment at our tertiary academic center. All patients aged 0 to 18 years who underwent free tissue transfer from 1998 to 2022 were included in the study. Seventy patients received 73 free tissue transfers. The most common indications were facial paralysis, trauma, and tumor (49.3, 21.9, and 20.5%, respectively). The most common recipient sites were the head and neck (56.1%) and lower extremity (32.8%). We observed a flap revision rate of 12.5% of the cases and one flap loss (1.4%). A total of 58.9% of the population received postoperative antithrombotic agents. The rate of flap revision surgery was similar (11.6 and 10.0%, respectively), with and without antithrombotic treatment (p > 0.05). There were no major bleeding complications or deep vein thrombosis. The antithrombotic treatment did not seem to affect the flap revision rate or the bleeding complications in our cohort. Hence, the data do not support the routine administration of antithrombotic treatment in pediatric free flap reconstruction. However, these findings should be solidified in prospective randomized trials.

The Snails: A Simple Technique for Reduction of Frontal Bossing in Children With Scaphocephaly

Objective: Scaphocephaly represents the most frequent single-suture craniosynostosis, with a male prevalence. In many cases, prominent frontal bossing (sphenocephaly) is the major aesthetic concern, typically in school-aged children. This aspect is also usually found in patients with late presentation (after 1 year of age). Several techniques have been described for the correction of frontal bossing in these patients, most involving wide frontal bone exposure and reconstruction. The authors describe a different, less invasive technique, useful in severe sphenocephalic patients, independently from age. Methods: Thirteen children aged from 3.5 to 22 months were operated on in our institution between 2016 and 2023 using the snails technique, in addition to the treatment for the craniosynostosis itself. The technique is described, consisting in spiral frontal impacted craniotomies. Transfusional rate and duration of surgery are reported and compared with 15 randomly selected patients treated at the same time without Snails technique. Postoperative follow-up is almost 1 year. Results: Cosmetic postoperative results, based on parental and clinician’s satisfaction as well as on radiographic and photographic assessment, showed rapid improvement of frontal bossing, which remains stable during years. Transfusion rate during scaphocephaly repair with Snails technique is not different from control, even if time of procedure is longer. Conclusion: Among several techniques described to directly correct frontal bossing, the snail technique is more simple and less invasive, avoiding further craniotomies over the superior sagittal sinus, and does not imply consistent blood loss.

Impact of asthma severity on surgical outcomes in patients with chronic rhinosinusitis comorbid with asthma

BackgroundPatients with chronic rhinosinusitis with nasal polyps comorbid with asthma often experience poor outcomes following endoscopic sinus surgery. ObjectiveThis study was designed to evaluate the impact of asthma severity on the long-term outcomes after surgery in these patients. MethodsEighty-three patients with chronic rhinosinusitis with nasal polyps comorbid with asthma who underwent endoscopic sinus surgery were prospectively enrolled in this study. Patients were classified into mild, moderate, and severe asthma groups based on their preoperative asthma severity. Clinical symptom scores, nasal endoscopy scores, and asthma control test results were recorded preoperatively, and at 1 year and 12 years postoperatively. ResultsSeventy-one patients completed the 12-year follow-up. All patients showed significant improvement in nasal symptom scores and nasal endoscopy scores. However, 48 of 71 (67.6%) patients experienced nasal polyp recurrence, and 22 (31.0%) of them underwent revision surgery. Patients in the severe asthma group had the highest rate of nasal polyp recurrence (P=0.02) and revision surgery (P=0.01), and the least improvement in smell disturbance (P=0.04) and general symptom (P=0.02) compared with the other asthma groups. ConclusionPreoperative asthma severity significantly influenced the outcome of endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps comorbid with asthma, in whom endoscopic sinus surgery had a long-term beneficial effect.

Early physiotherapy referral for low back pain reduces healthcare utilisation for advanced imaging and specialist spine surgery consultations.

Low back pain (LBP) is one of the most common presenting complaints among patients and the costliest orthopaedic condition. This study aimed to compare the healthcare utilisation rates of advanced imaging and specialist consultations for LBP between patients presenting with early physiotherapy (EPT) before specialist review and routine physiotherapy (RPT) after specialist review. Consecutive patients who (n = 311) had been referred to specialist spine surgery for LBP in 2021 were retrospectively reviewed. Baseline demographics, healthcare utilisation rates and clinical outcomes were compared between those who attended EPT before spine surgery consultation and those who attended RPT after specialist consultation. There were no significant differences in baseline demographics or clinical outcomes of Visual Analogue Scale pain scores, EuroQol 5-Dimension scores and surgery rates between the EPT (n = 183) and RPT (n = 128) groups. At 6 months follow-up, EPT was associated with significantly lower magnetic resonance imaging (MRI) rates (P = 0.026), decreased likelihood of requiring MRI (odds ratio [OR] 0.865, 95% confidence interval [CI] 0.757-0.990), reduced number of specialist spine surgery consultations (P < 0.001), decreased likelihood of requiring additional specialist consultations (OR 0.770, 95% CI 0.655-0.905), fewer physiotherapy sessions (P = 0.001) and decreased likelihood of requiring additional physiotherapy sessions (OR 0.835, 95% CI 0.553-1.261). Early physiotherapy reduces the (a) overall treatment duration from the first referral by the primary physician, (b) number of advanced imaging ordered (and thus, associated imaging costs), and (c) total number of clinic and therapy sessions, and it is safe and allows patients to achieve comparable functional outcomes to their counterparts undergoing RPT. These findings support the implementation of EPT for patients with LBP to reduce healthcare utilisation and associated costs for patients, providers and healthcare systems.

Long-term Outcomes of a Modified Straight-line Palate Repair Technique: Low Speech Correcting Surgery and Fistula Rates.

The goal of cleft palate (CP) repair is to restore normal speech, however, rates of velopharyngeal insufficiency (VPI) after palatoplasty remain high. We present a modified straight-line palate repair (SLR) technique that facilitates velum length to alleviate VPI. The technique releases nasal mucosa with the levator muscle off the hard palate. This study assesses speech outcomes of this modified SLR technique. Secondary aims are to assess fistula outcomes. A retrospective review evaluated non-syndromic patients with Veau III or IV CP ± cleft lip who underwent SLR from 1993-2023. Patients undergoing modified SLR were compared to those receiving traditional SLR. Outcomes included postoperative palatal fistula, fistula location, fistula repair rates, and velopharyngeal insufficiency (VPI) correcting surgery rates. Multivariable logistic regression was performed. Overall, 343 patients were included (160 modified SLR, 183 traditional SLR). Average length of follow-up from palatoplasty was 6.4±5.3 years. Modified SLR was associated with fewer fistulas than traditional SLR (3.1% vs 15.3%, Odds Ratio [OR]: 0.19; p=0.001), lower fistula repair rates (0.6% vs 13.1%, OR: 0.26; p=0.022), and lower secondary speech surgery rates (0.8% vs 16.0%, OR: 0.046; p=0.003). The modified SLR technique resulted in lower rates of VPI surgery, as well as fewer fistulas and lower rates of fistula repairs compared to traditional SLR at six years postoperatively. We hypothesize that releasing the nasal mucosa off the hard palate facilitates more posterior positioning of the levator muscle and less restricted medial mobilization of the oral mucosa, which lengthens the velum to alleviate VPI.

Completion Thyroidectomy Trends and Rates: A Systematic Review and Meta-Analysis.

In January 2016, the American Thyroid Association (ATA) published an update to the guidelines concerning the management of adult patients with thyroid nodules and well-differentiated thyroid cancers. One of the revised recommendations states that lobectomy is a reasonable surgical approach for low-risk patients. This systematic review compares the rates of completion thyroidectomy surgeries before and after the publication of the recent ATA guidelines. A systematic review was conducted according to the PRISMA guidelines of the preferred reporting items for systematic reviews and meta-analyses. PubMed and Embase databases were searched to find articles which demonstrate the rates of completion thyroidectomy surgeries in the last 6 years, before and after the recent ATA guidelines publication. Overall, 8744 titles and abstracts were screened, and 964 articles were fully assessed for eligibility. Eventually, 40 studies were included for data extraction. More than 48 000 patients with thyroid malignancy were included in the review, and were divided into three time periods according to the publication date of 2015 ATA guidelines. We found that the rate of completion thyroidectomy was 51.8% before 2016 and 43.1% after the 2015 ATA guidelines publication. We observed a 17% reduction of early completion thyroidectomy surgeries since the 2015 ATA guidelines publication relative to previous periods, among patients with malignant pathology. Apparently, more centres worldwide implemented the new guidelines and prefer a conservative surgical approach as compared to the pre-ATA 2015 era.