Short-term Complication Rates Research Articles

Short-term Postoperative Complications of Lymphatic Malformation Surgical Excision: A 20-Year Institutional Review.

To evaluate outcomes and postoperative complications following surgical resection of lymphatic malformations (LMs) at a single multidisciplinary vascular anomalies center. A single-center retrospective review of all patients ≤21 years old who underwent surgical resection of a lymphatic malformation at a quaternary referral center with a multidisciplinary vascular anomalies team from 2004 to 2024. Data pertaining to postoperative outcomes and treatments was abstracted. A total of 109 surgical procedures were included and examined. The most common 30-day postoperative complications included: seroma (18.3%), superficial surgical site infection (18.3%), and wound dehiscence (12.8%), with lower rates of nerve palsy/injury (5.5%), lymphedema (2.8%), hematomas (3.7%), and abscesses (4.6%). An interventional radiology procedure within 30-days postoperatively was required for management of seroma in 8 patients (7.3%), while 7 (6.4%) patients required reoperation. Among patients who underwent attempted complete resection, recurrence of the LM was documented in 32.0% (16/50). Subjective quality of life improvement was noted in 69.7%. There was no difference in incidence of postoperative complications reported in patients who underwent preoperative sclerotherapy vs those that did not (p=0.980). Seroma and surgical site infection were the most reported short-term postoperative complications followed by wound dehiscence with low rates of other complications in surgical resection of LMs. Few patients required postoperative procedural intervention. Despite a relatively high rate of short-term complications, patients reported high satisfaction and symptom improvement following LM resection, which underscores the important role for surgical management of LMs in select patients. III. Cohort study.

Treating shock with norepinephrine administered in midline catheters in an intermediary care unit: a retrospective cohort study

ObjectivesA rising incidence of septic shock as well as recommendations for early vasopressor initiation has increased the number of patients eligible for norepinephrine (NE). Traditionally, NE has been administered through...

Liposomal bupivacaine was not associated with increased postoperative complications in dogs receiving closed anal sacculectomy: a retrospective study.

To compare the postoperative complication rates of anal sacculectomy procedures in dogs treated with or without liposomal bupivacaine (LB). Medical records of 397 client-owned dogs treated with closed anal sacculectomy between 2016 and 2023 were retrospectively identified and grouped on the basis of administration of LB (LB group) or not (non-LB group). Details of short-term (< 15 days) postoperative complications were recorded from physical examination and client communication notes as well as referral documents and compared between groups. Relative risks for complications were calculated. Univariable and multivariable logistic regressions were used to estimate ORs and test for the effects of LB use and other risk factors on complications. 267 dogs received LB and 173 did not. The overall short-term postoperative complication rate in the study was 24% (94 of 397; 95% CI, 20% to 28%), and the short-term postoperative complication rates for dogs in the LB and non-LB groups were 22% (95% CI, 17% to 27%) and 27% (95% CI, 20% to 35%), respectively. The relative risk for overall short-term postoperative complications was 0.80 (95% CI, 0.56 to 1.16), indicating that an association between LB and an increased risk of short-term postoperative complications was not found. No significant association of LB with an increase in postoperative complications following anal sacculectomy in dogs was found. Although, LB's efficacy in these cases was not evaluated. Liposomal bupivacaine may be suitable as a local anesthetic following anal sacculectomy in dogs.

Short-term postoperative complications in preterm neonates with surgical necrotizing enterocolitis: a multicenter retrospective cohort study.

Over half of preterm neonates with necrotizing enterocolitis (NEC) require surgery, making it essential to understand short-term postoperative outcomes and complication rates. Therefore, this study aimed to provide an overview of 30-day postoperative complications for NEC. Secondary, risk factors for minor and major short-term postoperative complications were identified. This retrospective study included all preterm infants (GA < 35w) surgically treated for NEC from 2008 to 2022. Postoperative complications were scored following the Clavien-Madadi classification. Risk factors were analyzed using multivariable logistic regression analysis. In this cohort of 326 patients, 204 received a stoma, 80 had a primary anastomosis, and 32 had both. Postoperative mortality was 19.0%. In total, 186 patients experienced 238 complications (57.1%), including 118 (63.4%) major and 68 (36.6%) minor complications. Most common complications were sepsis (19.4%), stoma-related (13.3%), and wound dehiscence (11.3%). Cardiovascular support between NEC diagnosis and surgery was a significant risk factor for major complications (OR: 1.92, 95%-CI 1.19-3.08, p = 0.007) and stoma creation for minor complications (OR: 6.73, 95%-CI 2.05-22.05, p = 0.002). This study showed a postoperative complication rate of 57.1%. We found cardiovascular support between NEC diagnosis and surgery as risk factor for major complications and stoma creation as risk factor for minor complications. These findings provide valuable insights for improving parental counseling on NEC outcomes. II.

Increased risk of adverse events following the treatment of associated versus elementary acetabular fractures: a matched analysis of short-term complications

PurposeThis retrospective cohort study aims to compare short-term complication rates between patients receiving open reduction and internal fixation (ORIF) for associated versus elementary acetabular fractures, with a secondary objective of identifying independent risk factors for adverse outcomes.MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent ORIF for associated acetabular (CPT 27228) or elementary acetabular fractures (CPT 27226, 27227) from 2010 to 2021. Propensity score matching was employed to account for baseline differences and the short-term complication rates were compared between the cohorts.ResultsWe identified 1,330 patients who underwent ORIF for an acetabular fracture between 2010 and 2021, including 868 patients with elementary fractures and 462 with associated fractures. After matching, there were 462 patients in each cohort. The matched associated acetabular fracture group experienced higher rates of any adverse event (AAE, p = 0.029), transfusion (p = 0.010), and reoperation (p = 0.049). Increased age, increased operative time, higher body mass index (BMI), and prolonged hospital length of stay (LOS) augmented the risk of any complication.ConclusionThe findings of this study identify areas of greater risk of postoperative complications after ORIF in individuals with associated versus elementary acetabular fractures. Discussion of these heightened risks is critical to appropriate patient care. Understanding these risks plays an important role in the clinical decision-making process and may identify areas to monitor patients postoperatively.

Treatment for recurrent choledocholithiasis: endoscopic? or laparoscopic? A prospective cohort study.

Endoscopic and laparoscopic techniques are crucial for management of bile duct stone. The aim of this study was to share our initial experiences with endoscopic and laparoscopic treatments for recurrent choledocholithiasis, with a particular focus on long-term complications. From January 2014 to June 2017, a total of 153 patients with recurrent common bile duct stones were prospectively recruited in this study. Patients were scheduled for either an endoscopic procedure (ERCP/EST group, n = 84), or a laparoscopic procedure (LCBDE group, n = 69). Data were collected on comorbid conditions, presenting symptoms, bile duct clearance, and the incidence of both short-term and long-term complications. Patients in ERCP/EST group had a stone clearance rate comparable to that of the LCBDE group (94.2% vs 91.7%, p = 0.549). Minor (Clavien-Dindo grade 1 and 2) and major short-term complications (Clavien-Dindo grade 3 and above) were similar between patients in two groups (ERCP/EST group 17.9% versus LCBDE group 26.1%, and ERCP/EST group 7.1% versus LCBDE group 5.8%, p = 0.227 and p = 0.740, respectively). Patients in the ERCP/EST group had a shorter stone free interval than patients in the LCBDE group (28.5 ± 14.7months versus 43.3 ± 17.8months, p = 0.029). During a mean follow-up period of 67.0months, more patients in the ERCP/EST group experienced stone recurrence compared to those in the LCBDE group (26.1% vs 11.6%, p = 0.020). In the ERCP/EST group, 45.5% (10/22) of the recurrent cases experienced more than two recurrences, with three patients requiring choledochojejunostomy due to repeated recurrence. Among patients with a non-dilated common bile duct (d ≤ 8mm), both groups had comparable short-term and long-term complication rates (p = 0.151 and p = 0.404, respectively). Laparoscopic treatment is a safe and effective option for patients with recurrent choledocholithiasis, extending the stone free interval, reducing the likelihood of stone recurrence, and highlighting benefits of minimally invasive surgery.

BS SO12 - Long-term impacts of emergency presentations following bariatric health tourism on patients and health services: A UK perspective

Abstract Background Bariatric surgery is an effective treatment for obesity. Whilst short-term complication rates are low, little is known about the longer-term impacts on patients and health services. Even less is known about the true impact of the increasing trend of Health Tourism (HT) in this field. This study aimed to explore this topic further to quantify the impact of HT on UK healthcare services and to subsequently inform future service planning. Method This was a retrospective study of consecutive emergency inpatient episodes related to bariatric surgery (presenting to ED or transferred from other hospitals) at a regional bariatric centre. The study included patients between January 2018- April 2023. Data on index procedure (type, time to presentation, location), complications (and associated management), and subsequent readmissions, diagnostic investigations, and interventions (surgical, radiological, endoscopic) following first discharge from our centre was collected. Results 308 patients (489 episodes) were included (188 patients had surgery in the UK, 77 HT, 43 unknown origin). Gastric band (50%) and gastric sleeve (39%) were the commonest causes for admission in UK and HT patients, respectively. 86 surgical interventions post discharge were required. An average of 2.0 diagnostic investigations were undertaken following discharge per patient (UK 2.3 vs HT 1.9). Following discharge, similar average rates of further readmissions (UK 0.6 v HT 0.6), surgical (UK 0.3 v HT 0.4), radiological (UK 0.2 v HT 0.2) and endoscopic interventions (UK 0.6 v HT 0.6) were seen between cohorts. Conclusion Patients presenting with emergencies following bariatric surgery require significant ongoing investigation and management following discharge from hospital. This ongoing burden is often overlooked in health services research. In our study, this demand was significantly increased by bariatric health tourism. This highlights the critical need to recognise this additional burden, improve service planning to accommodate increased service demand, and address underlying factors contributing to health tourism.

Comparison of Neoadjuvant Chemotherapy Followed by Radical Surgery with Chemoradiation in Stage IB2 to IIB of Cervical Cancer

Background: The management of locally advanced cervical cancer (stages IB2 to IIB) remains controversial, particularly in regions with limited radiotherapy (RT) resources. While chemoradiation therapy (CRT) is the standard treatment in many Western countries, neoadjuvant chemotherapy followed by radical surgery (NACT-RS) has emerged as an alternative approach. Objectives: The comparative effectiveness and safety of NACT-RS versus CRT in terms of side effects and recurrence rates remain unclear, necessitating further investigation. Methods: A cohort study was conducted from 2020 to 2023, involving 68 patients with cervical carcinoma (stages IB2 to IIB). The patients were stratified into two treatment groups: Neoadjuvant chemotherapy followed by radical surgery (N = 17) and CRT (N = 51). The study compared pathology reports, short-term treatment complications, and one-year recurrence rates between the two groups. Results: Minor complications occurred in 41.2% of the NACT-RS group and 39.2% of the CRT group (P = 0.886), while major complications were observed in 23.5% and 25.5% of the groups, respectively (P = 0.872). All NACT-RS patients responded to chemotherapy with significant tumor size reduction (47.7 ± 8.0 vs. 11.2 ± 8.6, P &lt; 0.001) and resolution of vaginal involvement. During the one-year follow-up, no recurrences were observed in the NACT-RS group, compared to eight out of 51 (16.7%) in the CRT group (P = 0.186). Conclusions: The similar short-term complication rates and potentially lower one-year recurrence rate in the NACT-RS group suggest that this approach may be a viable alternative to CRT, particularly for young patients with bulky tumors and in areas with limited RT facilities.

Obesity is highly associated with a non-home discharge following total ankle arthroplasty

Studies have shown that non-home discharge following orthopedic procedures is associated with a higher risk of 30-day complications and significantly increases medical costs. The purpose of this study was to identify risk factors for being discharged to a non-home destination following total ankle arthroplasty (TAA).We included patients undergoing TAA from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) between 2014 and 2019. TAA was identified using CPT codes 27702, 27703 and 27704. Logistic regression models were used to assess the association between discharge location (home versus non-home) and a series of exposure variables (e.g., patient demographics, patient health characteristics, and operative factors).A total of 1,704 patients were included, experiencing a 3.6% short term complication rate (61/1,704). 8.5% of the population were discharged to a non-home destination. In the final adjusted model, patients who were older [OR 1.11; 95%CI 1.08, 1.13], female [OR 2.94; 95%CI 2.04, 4.34], obese [OR 1.93; 95%CI 1.29, 2.89], had surgery in an inpatient setting [OR 5.73; 95%CI 1.78, 18.46], and ASA class IV [OR 10.65; 95%CI 1.03, 110.61] were at greater risk for a non-home discharge.People living with obesity experienced a nearly 2x greater likelihood of being discharged to a non-home destination after TAA despite their preoperative functional (e.g., ASA class) and metabolic status (i.e., diabetes). Opportunities to mitigate this risk will be needed to lessen the financial burden of TAA surgery as a growing number of obese patients become eligible for TAA in the US.

Outpatient Surgical Fixation of Complicated Calcaneal Fractures Pose No Excess Risk for 30-Day Complications

The purpose of this study was to identify if complicated open reduction internal fixation (ORIF) of calcaneal fractures (i.e. requiring bone graft) performed in the outpatient setting poses an excess risk for 30-day complications compared to inpatient procedures. We included patients who underwent complicated ORIF of the calcaneus involving the use of bone graft utilizing CPT code 28420 from the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) between 2014 and 2019. Postoperative complications, demographic data, patient characteristics, and operative factors were compared between groups. T-tests were performed to assess univariate associations between outpatient status and surgical/patient demographics for continuous variables while chi-squared tests were performed to evaluate categorical variables. A total of 113 patients were included, experiencing a 2.6% short term complication rate (3/113). All 3 complications occurred in the outpatient setting. 51.3% of surgeries were performed on an inpatient basis. In the univariate analysis, there were no statistically significant differences between inpatient and outpatient 30-day postoperative complication rates. Although more complications were recognized in the outpatient population, this did not reach statistical significance and suggests that complicated calcaneal ORIF procedures involving bone graft may be performed in the outpatient setting without posing an excess risk.

Is the complexity of arthroscopic temporomandibular joint surgery associated with short-term complication rates?

BackgroundArthroscopy is regarded as a minimally invasive surgical procedure, with complication rates ranging from 1.7% to 4.4%. It remains unclear whether the complexity of the arthroscopic procedure is associated with the frequency of complications. PurposeThe study purpose was to measure the association between the level of arthroscopic complexity and short-term postoperative complications. Study Design, Setting, SampleThe researchers implemented a prospective cohort study. Subjects presenting to Clinica Bupa Santiago, a tertiary care hospital in Chile between 2022 and 2023 who requires arthroscopy were enrolled. Inclusion criteria required subjects to have a history of joint disorder and a pre-operative MRI to be scheduled for an arthroscopic surgery with a 6-month follow-up. Subjects lacking six-month follow-up were excluded. Predictor VariableThe predictor variable was the arthroscopy complexity level: Level I (single puncture diagnostic sweep), Level II (double puncture with instrumentation or shaver), and Level III (discopexy or discectomy). Main Outcome VariableThe main outcome variable was intra and postoperative complications, which were defined as any unwanted development resulting in lasting consequences, additional surgeries, or unresolved issues, and these were coded as either present or absent. CovariatesThe covariates included age, sex, duration of symptoms, prior conservative therapies, history of previous open joint surgery, and Wilkes stage. AnalysesData were analyzed using descriptive statistics with statistical significance set at P-value <0.05. Chi-square or Fisher’s exact test was used depending on the variable type. ResultsA total of 165 subjects (285 joints) with a mean age of 28.9 years (SD 13.0) were included. Of these, 149 (90.3%) were female and 16 (9.7%) were male. Level I procedures were performed on 37 joints(13.0%) in 23 subjects(16.3%), Level II on 53 joints(18.6%) in 27 subjects(16.3%), and Level III on 195 joints(68.4%) in 116 subjects(69.9%). Complications occurred only in Level III (7 procedures, 2.5%, p=0.33), affecting 5 subjects(3.0%). Observed complications included transient frontal facial paresis, mouth floor edema, transient neuropathic pain, suture rejection, and emphysema ConclusionThe postoperative complication rate after arthroscopy was 2.5%, with no statistically significant association with operative complexity. Although more complications were observed in advanced arthroscopies, this increase was not significant.

Clinical Trends and Outcomes in Technology-Assisted Total Hip Arthroplasty.

Background/Objectives: In recent years, there has been a widespread focus on implementing technology in total hip arthroplasty (THA) to further improve precision and outcomes. This study aimed to identify recent trends in the utilization, clinical variables, and rate of adverse events for technology-assisted THA (TA-THA) and compare the outcomes to those of conventional THA. Methods: This retrospective cohort analysis of the ACS-NSQIP database queried data on THA patients (CPT 27130) from 2015 to 2020. Technology assistance was identified with CPT 20985, 0054T, and 0055T. Matched cohorts were created to compare clinical comorbidities and adverse events. Results: This analysis included 219,216 conventional THAs and 2258 cases utilizing TA-THA. The number and percentage of surgeries utilizing technology, as well as the average operative time, consistently rose from 2015 to 2019, with all declining in 2020. Length of stay decreased yearly from 2015 to 2019, with an increase in 2020. There were no significant differences in the incidence of adverse events by year. Matched cohort analysis demonstrated that TA-THA led to longer operative times (102.6 ± 35.6 vs. 91.6 ± 37.4 min, p < 0.001) and a shorter average length of stay (1.6 ± 1.4 vs. 2.0 ± 1.9 days, p < 0.001). Transfusion rates were higher in the TA-THA cohort (6.0% vs. 4.4%, p = 0.013). Conclusions: The usage of TA-THA increased from 2015 to 2019, with declines during 2020. TA-THA led to longer operative times, increased transfusion rates, and no difference in the incidence of adverse events compared to conventional arthroplasty. These findings demonstrate that TA-THA is growing in popularity without a significant improvement in short-term complication rates.

Short-term outcomes of minimally invasive total vs supracervical hysterectomy for uterine fibroids: a National Surgical Quality Improvement Program study

BackgroundUterine fibroids are the most common indication for benign hysterectomy in the United States, but data regarding the association of hysterectomy type and outcomes for this indication are lacking. ObjectiveWe aimed to describe the rate and odds of short-term (30 days) postoperative complications among patients undergoing minimally invasive total (TLH) compared to supracervical (LSCH) hysterectomy for uterine fibroids. Study DesignWe conducted a cohort study of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020. We compared characteristics of women who underwent TLH and LSCH for uterine fibroids and identified risk factors associated with the occurrence of 30-days postoperative complications defined according to the Clavien-Dindo classification. Multivariable regression analysis including age, BMI, race, comorbidities, ASA classification, uterine weight and concomitant procedures, was performed to identify the adjusted odds of postoperative complications. The co-primary outcomes were the risk of (1) a composite of any postoperative complications and of (2) major postoperative complications according to surgical type. ResultsA total of 44,413 and 6,383 patients underwent minimally invasive TLH and LSCH respectively. Operative time was shorter (143.0 vs. 150.6 minutes, p<.001), and the proportion of uterine weight >250 g was lower (39.4% vs. 45.1%, p<.001) in the TLH group. The rates of any (6.6% vs. 5.3%, p<.001), and major (2.7% vs. 1.6%, p<.001) complications were higher in the TLH group, while minor complications rate was comparable (4.4% vs. 4.1%, p=.309). In multivariable regression analysis, LSCH was independently associated with lower risk of any [aOR 95% CI 0.79 (0.70-0.88)], and major [aOR 95% CI 0.55 (0.44-0.69)] complications compared to TLH. ConclusionCompared with TLH, LSCH is associated with a lower risk of short-term postoperative complications among patients with uterine fibroids. The current study findings can aid in shared decision-making prior to minimally invasive hysterectomy for uterine fibroids.

Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity-score matched analysis

BackgroundPrevious studies comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are often limited by retrospective designs, or in randomized controlled trials, by small sample sizes or limited follow-up durations. ObjectivesThis study aims to compare OAGB and RYGB during 5years of follow-up in terms of weight loss, remission of comorbidities, and complications. SettingThis longitudinal prospective study includes all patients who underwent a primary OAGB or RYGB between 2015 and 2016 in the Netherlands, utilizing data from the nationwide registry, Dutch Audit for Treatment of Obesity. MethodsA 1:1 propensity-score matched (PSM) comparison between patients with OAGB and RYGB. ResultsAfter 1:1 PSM, 2 nearly identical cohorts of 860 patients were obtained. OAGB was associated with more intraoperative complications (2.0% versus .6%; P = .031). Conversely, RYGB had a higher rate of short-term complications (7.6% versus 3.8%; P < .001). Five-year data were available from 40.7% of the patients with OAGB and 34.9% with RYGB. No significant differences were observed in percentage total weight loss after 5years (30.0% after OAGB and 28.8% after RYGB; P = .099). The total remission rate of diabetes mellitus was 60.5% for OAGB and 69.4% for RYGB (P = .656). However, OAGB resulted in a significantly higher remission rate of hypertension compared to RYGB (60.2% versus 45.5%; P = .015). ConclusionsOAGB and RYGB yield comparable weight loss outcomes. However, OAGB had more intraoperative complications, while RYGB had more short-term complications. Both procedures show similar efficacy in diabetes mellitus remission, but OAGB is more effective in achieving hypertension remission.

Short-Term Complications of Total Ankle Arthroplasty with and without Concomitant Bony and Soft Tissue Procedures: A Propensity Score Matched Analysis

Category: Ankle Arthritis; Ankle Introduction/Purpose: This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), either alone or with concomitant soft tissue or bony procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes in these groups. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent TAA (27702) between 2010 to 2021. Patients were then divided into cohorts consisting of patients who underwent TAA without concomitant procedures and patients who underwent TAA with one or more concomitant bony or soft tissue procedures. Procedures included in the development of cohorts are outlined in Table 1. Propensity score matching was then employed to account for any baseline demographic differences, and statistical analyses were performed to compare short-term complication rates between the matched cohorts. Results: A total of 2,225 patients undergoing TAA were identified, with 1,432 (64.4%) receiving TAA alone and 793 (35.6%) receiving TAA with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (172.8 vs. 144.1mins) and total length of hospital stay (LOS) (1.76 vs. 1.52 days). Rates for extended length of stay were significantly higher in the ancillary cohort compared to the simple cohort (21.2% vs 16.3%). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). When controlling for all other variables, ASA classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, p = 0.04). Conclusion: Extended length of stay was the only variable found to be significantly different between simple and concomitant TAA cohorts. Additionally, in a subgroup analysis excluding tendon lengthening procedures, we observed greater morbidity probability in the additional procedures group. The only independent risk factor for postoperative complications was ASA class 4 status. Without significant difference in rates of any AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of simple TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring TAA while having multiple foot and ankle pathologies.

Contemporary short-term peri-operative outcomes of open primary retroperitoneal lymph node dissection.

To provide current peri-operative outcomes and short-term complication rates for open primary retroperitoneal lymph node dissection (RPLND), with analysis of risk factors for complications. Using the Indiana University Testicular Cancer database, we performed a retrospective analysis of all patients who underwent open primary RPLND over the study period (2018-2021). The primary outcomes of interest were the preoperative profile of patients undergoing surgery, complication rates, and identification of risk factors associated with complications. We used chi-squared, Fisher's exact and unpaired t-tests in our analyses. A total of 165 patients were identified. The median body mass index (BMI) was 28.6 kg/m2. Patients most often had clinical stage IIA (39%) or IIB testicular cancer (36%). The median estimated blood loss was 150 mL, with no transfusions required. Higher BMI was noted in patients that sustained any complication vs those with normal recovery (34.95 vs 28 kg/m2; P = 0.0042). The median length of hospital stay was 3 days. The overall complication rate was low (8.48%), with two major postoperative complications, including one case of chylous ascites (0.6%), and no deaths in the 30-day period. The study was limited by its retrospective design and short-term follow-up. We found that open primary RPLND has an acceptable morbidity profile, even among a predominantly overweight cohort. Low blood loss, short hospital stay, minimal chylous ascites risk, and rare major postoperative complications should be the benchmark for retroperitoneal lymph node dissection.

Low Rates of 30-Day Postoperative Complications After Meniscal Allograft Transplantation: A Retrospective Study Using the National Surgical Quality Improvement Program Database

PurposeThe purpose of this study is to determine the short-term (30-day) postoperative complication rates in patients undergoing meniscus allograft transplantation (MAT). MethodsAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who had undergone MAT from 2014 to 2021 using Current Procedural Terminology (CPT) codes. Patients were excluded if they did not have sufficient demographic data – namely those without data for age, sex, BMI, preoperative functional status, ASA classification, operative time, and length of hospital stay. Post-operative complications within 30 days were identified and rates of complications were examined as the primary outcome of this study. As a secondary outcome, multivariate logistic regression was used to identify risk factors associated with the thirty-day incidence of post-operative complications. Subgroup analysis was performed to analyze differences in postoperative outcomes following isolated MAT versus MAT with concomitant ligament reconstruction/repair, cartilage preservation, or realignment osteotomy. ResultsA total of 396 meniscal transplants were identified, with mean age of 35.2 ± 14.9, mean body mass index (BMI) of 29.6 ± 6.7, mean length of stay of 0.5 ± 1.8 days. 11 patients experienced any adverse event (AAE), Specific complications included surgical site infections (5), deep vein thrombosis (DVT) (1), urinary tract infection (UTI) (3), and return to the operating room (OR) (2). On subgroup analysis, there was no significant difference between AAE rates in patients undergoing MAT with concomitant procedures compared to patients undergoing isolated MAT (7 vs 4, p=0.5). ConclusionPatients who underwent MAT had an overall complication rate of 2.8% in the short-term postoperative period (≤30 days). Patients undergoing MAT with concomitant ligament reconstruction/repair, cartilage preservation, and realignment osteotomy had similar rates of all postoperative complications when compared to patients undergoing isolated MAT. Level of EvidenceLevel IV, therapeutic case series.

205. MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH TOTAL MEDIASTINAL LYMPHADENECTOMY FOR THORACIC ESOPHAGEAL CANCER: SHORT- AND LONG-TERM OUTCOMES IN 139 PATIENTS

Abstract Background The McKeown approach is a standard surgery for thoracic esophageal cancer in Japan, as lymph node dissection of upper mediastinum and neck is mandatory. The thoracoscopic approach allows access to the lymph node chain along the laryngeal nerves from the chest and led us to introduce minimally invasive Ivor Lewis esophagectomy (MIILE) with radical lymphadenectomy for middle and lower esophageal cancer. Although circular-stapled anastomosis is popular in MIILE, the frequency of anastomotic complications has been reported to be high. We introduced MIILE with linear-stapled anastomosis in 2010. Methods To evaluate the short- and long-term outcomes of MIILE with radial lymphadenectomy and linear stapled anastomosis, we performed a retrospective cohort study of 139 consecutive patients. The endpoints included overall complications, anastomotic leak rate, nutritional status at 12 months after MIILE, and 5-year overall survival, and disease-free survival. Surgical Procedure After laparoscopic gastric tube construction, thoracoscopic or robotic esophagectomy with total mediastinal lymphadenectomy was done in the prone position. ICG angiography was used to assess gastric tube viability and sacrifice the ischemic portion in recent cases. Esophago-gastric anastomosis was performed using a linear stapler. The opening was closed with interrupted sutures and covered with the omentum to secure the anastomosis. Results There was 122 male and 17 female patients with median age of 69 years. Preoperative diagnosis was stage I/II/III/IV in 44/46/37/12 patients. Pathology results were SCC in 108 cases. Tumor location was middle/lower/EGJ in 58/64/17 patients. Preoperative chemotherapy or CRT was administered in 77 patients. Median thoracic surgery time was 297 minutes and blood loss was 53 mL. Median hospital stay was 17 days. The short-term complication rate of grade IIIa or higher was 8.7%. Anastomotic leak occurred in 8 patients (5.8%), three of whom required intervention. No leakage occurred after introduction of intraoperative ICG angiography. 90-day mortality was 0.7%. With a median follow-up of 41 months, 5-year overall survival rate was 68.3% and disease-free survival rates was 56.7%. For the 65 SCC patients with clinical stage II/III disease, 5-year OS rate was 58.7%. During follow-up period, 2 patients (1.4%) required balloon dilatation due to anastomotic stenosis. At 12 months after MIILE, the mean weight loss was 11.6% and the mean albumin level was 3.9. Discussion Compared to benchmark complication rates reported by the international Esophagectomy Complication Consensus Group (ECCG), the overall complication rate (47% vs. 59%) was not significantly lower, but the anastomotic leak rate was significantly lower (5.8 vs. 11.4%). Overall survival, disease-free survival, and nutritional outcomes were similar to those reported in Japanese clinical trials. Conclusions MIILE with linear-stapled anastomosis is a safe procedure with a low rate of serious complications. Survival and nutritional outcomes were excellent. It may be recommended as a standard procedure for lower and middle esophageal cancer. https://www.dropbox.com/scl/fi/z6zyllnmie9qh3zhz2wd5/Okabe_ISDE.wmv?rlkey=4mig28fv5z2vhaui31tbk0mr9&amp;dl=0

A Systematic Review and Meta-Analysis of Synthetic Mesh Outcomes in Alloplastic Breast Reconstruction.

Mesh implants are frequently employed in alloplastic breast reconstruction. Notably, no mesh to date has FDA approval for this indication. Several synthetic meshes have been introduced with heterogeneous properties and outcomes. This study aims to systematically review synthetic mesh use in alloplastic breast reconstruction, describe rates of short-term complications, and analyze these outcomes in reports comparing synthetic and biologic meshes. The authors hypothesized data from comparative and noncomparative studies would show no significant differences between synthetic and biological meshes. The authors conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-one studies reporting the use of synthetic mesh and clinical outcomes were included. Eight studies directly comparing synthetic mesh and biological mesh were meta-analyzed for relative risk (RR). Nineteen noncomparative studies were analyzed for meta-rates. Outcomes, including seroma, infection, reoperation, and explant, were assessed on a per-breast basis. Resultant models were challenged for sensitivity and bias. Meta-analysis of comparative studies demonstrated no difference in the risk of infection with synthetic mesh (RR = 0.53; 95% CI [0.26-1.10]), but a reduced risk of reoperation (RR = 0.54; 95% CI [0.33-0.89]) or explant (RR = 0.43; 95% CI [0.21-0.87]). Meta-analysis of noncomparative studies demonstrated rates of seroma = 3%; 95% CI [1%-6%], infection = 4%; 95% CI [3%-6%], reoperation = 10%; 95% CI [7%-13%], and explant = 3%; 95% CI [2%-5%]). Studies comparing synthetic and biologic meshes demonstrated noninferiority of synthetic in all outcomes assessed. Noncomparative studies demonstrated rates of seroma, infection, reoperation, and explant similar to literature values for biological mesh.

A Monocentric Analysis of Implantable Ports in Cancer Treatment: Five-Year Efficacy and Safety Evaluation.

Daily clinical practice requires repeated and prolonged venous access for delivering chemotherapy, antibiotics, antivirals, parenteral nutrition, or blood transfusions. This study aimed to investigate the performance and the safety of totally implantable vascular access devices (TIVADs) over a 5-year follow-up period through a standardized well-trained surgical technique and patient management under local anesthesia. In a retrospective, observational, and monocentric study, 70 patients receiving POLYSITE® TIVADs for chemotherapy were included. The safety endpoints focused on the rate of perioperative, short-term, and long-term complications. The performance endpoints included vein identification for device insertion and procedural success rate. The study demonstrated no perioperative or short-term complications related to the TIVADs. One (1.4%) complication related to device manipulation was identified as catheter flipping, which led to catheter adjustment 56 days post-placement. Moreover, one (1.4%) infection due to usage conditions was observed, leading to TIVAD removal 3 years and 4 months post-surgery. Catheter placement occurred in cephalic veins (71.4%), subclavian veins (20%), and internal jugular veins (8.6%). The procedural success rate was 100%. Overall, the implantable ports typically remained in place for an average of 22.4 months. This study confirmed the TIVADs' performance and safety, underscored by low complication rates compared to published data, thereby emphasizing its potential and compelling significance for enhancing routine clinical practice using a standardized well-trained surgical technique and patient management.