Wound Complication Rate Research Articles

Postoperative Complications in Patients Undergoing Nonabdominal Wall Flap Reconstruction after Laparoscopic or Robotic Abdominoperineal Resection

INTRODUCTION: Abdominoperineal resection (APR) is the treatment of choice for patients with rectal cancer. Typically, reconstruction after APR is done with a rectus abdominus myocutaneous (RAM) flap. Given the increased management with laparoscopic APRs, abdominally based flap reconstruction is inappropriate because of its invasiveness and significant abdominal wall morbidity. Therefore, a nonabdominal wall based free flap alternative, such as an anterior lateral thigh flap, gluteal flap, or gracilis flap, may be a superior approach looking forward. The aim of this study is to evaluate postoperative short- and long-term complication rates in patients undergoing nonabdominal wall flap reconstruction after laparoscopic or robotic APR. METHODS: We conducted a review of the literature to include adults with rectal cancer and looked at short-term complications such as increased healing time, seroma, hematoma, surgical site infection, dehiscence rates, reoperation rates, as well as long term complications such as perineal hernia rates. RESULTS: Our study included 64 articles and 306 flaps. The overall wound complication rate was 15.0%. In the short-term, 23 patients experienced hematomas, 16 patients experienced surgical site infection, 3 patients dehisced, and 4 required reoperations. The ALT flap offered the lowest rate of complications at 9.3%. CONCLUSION: In conclusion, the wound complication rate of 15.2% was comparable with literature findings of 14.3% in patients with RAM flap reconstruction. Nonabdominal wall-based flap reconstruction is effective after APR. Owing to its low complication rate, the ALT flap may serve as a superior treatment option for laparoscopic or robotic APR in patients with rectal cancer.

Smoking cessation prior to total shoulder arthroplasty: A systematic review of outcomes and complications.

We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery. A literature search was performed using the search terms "shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine]." Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges. Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly (p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications. Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended. Level III, Systematic Review.

Transfer of Obese Patients Who Undergo Emergency Colon Operation Is Associated with Worse Outcomes and Higher Mortality: An American College of Surgeons NSQIP Analysis

INTRODUCTION: The role of interfacility transfer for emergency colon operation is unclear. Generally, patients with comorbid conditions leading to worse outcomes are transferred more frequently. This study evaluates whether patients with obesity are transferred at an increased frequency and how this may affect outcomes. METHODS: The American College of Surgeons NSQIP database was queried for nonelective colon operation from 2016 to 2018. BMI was calculated from available data and patients were stratified according to BMI class and their location of origin. Subgroup analysis of patients with BMI >35 kg/m2 was performed. SPSS was used for statistical analysis. RESULTS: Of 43,607 patients undergoing urgent colon operation, 8,034 (18.4%) were transferred. Patients with BMI 35 to 40 kg/m2 or >40 kg/m2 were more likely to be transferred. When controlling for comorbid conditions with logistic regression, BMI >35 kg/m2 was an independent risk factor for transfer (odds ratio [OR] 1.362; p = <0.001). Subgroup analysis of BMI >35 kg/m2 (n = 6,248) revealed that transferred patients had higher rate of mortality compared with those not transferred (13.9% vs 7.8%, p < 0.001). These patients experienced lower rate of wound complication (11% vs 13.1%, p = 0.035) and readmission rate (12% vs 14.1%, p = 0.046), but higher rate of septic shock (22.7% vs 11.2%, p = 0.001) and return to operating room (13.6% vs 10.7%, p = 0.002). Controlling for other significant comorbid conditions, transfer status remained an independent risk factor for mortality (OR 1.362; p = 0.045). CONCLUSION: This demonstrates that patients with BMI >35 kg/m2 undergoing urgent colon operation are transferred more frequently than patients with lower BMI. In this population, transfer status is associated with higher mortality. Hospitals should consider whether interfacility transfer in this population is warranted.

Complications of Deep Brain Stimulation for Parkinson Disease and Relationship between Micro-electrode tracks and hemorrhage: Systematic Review and Meta-Analysis

Deep brain stimulation is a common treatment for Parkinson's disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative micro-electrode recording (MER) can enhance efficacy by improving lead accuracy. However, there is controversy as to whether MER increases risk of hemorrhage. To provide a comprehensive systematic review and meta-analysis reporting complication rates from deep brain stimulation in PD. We also interrogate the association between hemorrhage and MER. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were implemented while querying the Pubmed, Embase, and Cochrane databases. All included studies were randomized controlled trials and prospective case series with 5 or more patients. Primary outcomes included rates of overall revision, infection, lead malposition, surgical site and wound complications, hardware-related complications, and seizure. The secondary outcome was the relationship between number of MER tracks and hemorrhage rate. 262 articles with 21,261 patients were included in the analysis. Mean follow-up was 25.8months (range 0-133). Complication rates were: revision 4.9%, infection 4.2%, lead malposition 3.3%, surgical site complications 2.8%, hemorrhage 2.4%, hardware-related complications 2.4%, and seizure 1.9%. While hemorrhage rate did not increase with single-track MER (odds ratio, 3.49; P= 0.29), there was a significant non-linear increase with each additional track. Infection and lead malposition were the most common complications. Hemorrhage risk increases with more than one MER track. These results highlight the challenge of balancing surgical accuracy and perioperative risk.

OC-034 EVIDENCE-BASED CHANGES IN PERI-OPERATIVE PATIENT CARE IN A TERTIARY HERNIA CENTER(THC): PROSPECTIVE STUDY OF OUTCOMES OVER 18 YEARS AND 1842 OPEN PREPERITONEAL VENTRAL HERNIA REPAIRS(OPPVHR)

Abstract Background Over 18 years, a THC frequently changed patient-care protocols according to repeated reviews of our prospectively collected data outcomes, which have been published in peer-reviewed journals. This study aimed to describe these progressive, evidence-based changes and the subsequent results in PP-VHR. Methods Prospective, tertiary hernia center data(2004–2021) was examined for patients undergoing midline open PP-VHR with mesh. “Early”(2004–2012) and “Recent”(2013–2021) groups were based on surgery date. Results Comparison of Early(n=675) versus Recent(n=1,167) groups showed that Recent patients were older (56.9±12.6vs58.7±12.1 years;p&amp;lt;0.001), more comorbid(3.6±2.2vs5.2±2.6 diagnoses;p&amp;lt;0.001), lower BMI(33.5±8.3 vs 32.0±6.8 kg/m2; p=0.003), more prior failed VHR(46.5% vs 60.8%; p&amp;lt;0.001), larger hernia defects(199.7±232.8vs214.4±170.5 cm2;p&amp;lt;0.001), more CDC-class 3/4 wounds(11.3%vs18.6%;p&amp;lt;0.001), more biologic mesh(10.5% vs 25.4%;p&amp;lt;0.001), component separations(CST; 22.5%vs45.7%;p&amp;lt;0.001), and more pre-op Botox(0%vs12.3%;p&amp;lt;0.01). Wound complication(26.7%vs13.2%;p&amp;lt;0.001), mesh infection(3.1%vs0.9%;p&amp;lt;0.01), and hernia recurrence rates decreased over time(7.1%vs2.4%;p&amp;lt;0.001) with long-term follow-up(4.2±4.1vs2.2±1.8years;p&amp;lt;0.001). Comparing respective multivariable analyses (Early vs Recent), wound complications were associated with panniculectomy(OR[95%CI]:2.9[1.9–4.5],p&amp;lt;0.001 vs 2.1[1.4–3.3],p&amp;lt;0.01), contaminated wounds(2.1[1.1–3.7],p=0.02 vs 1.8[1.1–3.1],p=0.02), anterior CST(1.8[1.1–2.9], p=0.02 vs 3.2[1.9–5.3],p&amp;lt;0.01), and operative time(per minute:1.01[1.008–1.015], p&amp;lt;0.01 vs 1.004[1.001–1.007], p&amp;lt;0.01) in both time periods. Diabetes(2.6[1.7–4.0],p&amp;lt;0.01) and tobacco(1.8[1.1–2.9], p=0.02) were only significant in the Early group with the Recent group requirements for preop smoking cessation and a HgbA1C of &amp;lt;7.2. In both groups, recurrence was associated with wound complication(8.9[4.1–20.1],p&amp;lt;0.01 vs 3.4[1.3–8.2].p&amp;lt;0.01) and prior failed VHR hernias(4.9[2.3–11.5],p&amp;lt;0.01 vs 2.1[1.1–4.2],p=0.036). Conclusion Despite increased patient and hernia complexity over time, detecting and implementing best practices, as determined by repeated self-analysis of a THC's data, significantly improved patient outcomes, including wound and mesh complications and recurrence.

OC-054 LONG-TERM OUTCOMES OF POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS RELEASE (TAR) IN LARGE AND OTHER COMPLEX VENTRAL HERNIAS: A SINGLE-SURGEON EXPERIENCE

Abstract Aim The application of component separation techniques for the repair of large and other complex ventral hernias, has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these very demanding ventral hernias. Material &amp; Methods A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR technique between January 2016 and May 2021 was performed. Selection of the type of inserted mesh was based on the risk of developing surgical site infection (SSI) and other surgical site occurrences (SSOs). Preoperative, intraoperative, and postoperative data were analyzed. Results A total of 167 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 156 (93.4%) had a history of previous abdominal surgery, 42 (25.1%) had a history of SSI and 11 (6.6%) had active fistulas, of which nine involved previous implanted meshes. Postoperatively, SSOs were presented in 12 patients (7.2%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 3 years, only one recurrence has been observed. Conclusions With a wound complication rate of less than 8% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of large and other complex ventral hernias.

90-Day Reoperation and Wound Complication Rates in Lateral Approach to Total Ankle Replacement for Post-Traumatic Arthritis

Category: Ankle Arthritis; Ankle; Diabetes Introduction/Purpose: Total ankle replacement (TAR) has achieved relatively successful outcomes with respect to postoperative complications; however, mixed evidence exists regarding early complication rates, reoperation, and infection1-5. The largest study of TAR to date indicates a statistically significant risk of postoperative infection in tobacco users and diabetic patients6. Unlike currently established anterior approaches to arthroplasty, the lateral transfibular approach potentially avoids disruption of perfusion to the skin, possibly decreasing postoperative complications7. The lateral ankle allows surgeons to correct malunion of the fibula in post-traumatic arthritis deformity cases and achieve appropriate coronal and sagittal implant alignment to achieve similar physiological joint orientation8,9. The purpose of this study was to report 90-day reoperation and wound complication rates in lateral approach to total ankle replacement for post-traumatic arthritis (PTA). Methods: A retrospective chart review of lateral TAR cases from 2016-2022 was conducted at a single institution. Only patients undergoing TAR for post-traumatic arthritis were included in this review. A total of 49 patients (22 females and 27 males) underwent total ankle replacement with the Zimmer Biomet Trabecular MetalTM Total Ankle by a single surgeon. Patient demographics, operative data, complications, and adverse events requiring corrective surgery were recorded within 90 days of arthroplasty. Results: The patient sample included 6 active smokers, 11 diabetics, and 32 patients with hypertension with an average age of 60.7 and average BMI of 34.3 (Table 1). Three of the 49 (6.1%) patients required secondary surgery within 3 months of surgery (Table 2). Revision surgery indications included: 1 (2.0%) for removing painful hardware, 2 (4.1%) due to infection, and 1 (2.0%) for tarsal tunnel syndrome after surgery. There were 0 nonunions of the fibula at 90 days and through 1 year follow up. Of the patients requiring secondary surgery for infection, 1 was a smoker and 1 had a history of ankle fusion nonunion and avascular necrosis which was converted to a TAR (Table 4). Conclusion: This retrospective study demonstrates a comparable rate of secondary surgeries following TAR via lateral approach in the early postoperative period (6.1%) while having a slightly higher rate of infection than those previously reported (4.1%)7,8. Notwithstanding, we observed a 100% healing rate of fibula osteotomies; however, we failed to demonstrate a lower incidence of wound complications than previously reported. Surgeons should counsel patients of these risks in those with PTA undergoing lateral TAR, especially in smokers and diabetics.

Minimally Invasive Intra-Calcaneal Fractures vs Conservative Treatment: A Propensity Score Matched Cohort Series

Category: Trauma; Hindfoot Introduction/Purpose: We prospectively assessed the impact of minimally invasive internal fixation of displaced intra-articular calcaneal fractures (DIACF) results in better health outcomes up to 2 years post- injury than non-operative management. Methods: All isolated calcaneal fractures were reviewed and the decision to treat was made by a multidisciplinary meeting. Operative-treatment protocol involved sinus-tarsi approach or per-cutaneous reduction &amp; internal fixation under the care of a fellowship-trained-foot and ankle surgeon. Non-operative protocol involved symptomatic management with no attempt at closed reduction. All fractures were classified, and the MOXFQ/EQ5D-L scores were used to assess general and disease-specific outcomes respectively. Secondary outcome measures included return to work and return to leisure activity levels. Statistical analysis was performed to assess normality of data (Shapiro Wilk test/Q-Q plots). Propensity matching was conducted using nearest neighbour matching, followed by regression analysis and modelling to compare baseline covariates between the two different groups. Results: Between 2015-2019 total of 93 patients met the inclusion criteria. After propensity score matching 44 patients were found in the surgical/ treatment group. The mean age was 40 (vs. 43.3) in the surgical group, no significant difference in age, sex, peripheral vascular disease, smoking status, laterality, and baseline Bohlers and Guisane angle in the propensity score matched sample. The surgically treated group had a higher Sanders class(p&lt;0.05), higher MOXFQ at 12 months (p&lt;0.05) and EQ-5DL scores at 24 months(p&lt;0.05) and were more likely to return to work at 12m (95% vs 77%)(p&lt;0.05), and physical activity levels at 12m (57% vs 36%)(p=0.054). The wound complication rate was 14.8%, no patients required further surgery; whilst non-operative- treatment mandated surgery for arthritis (6), and or/an injection (7 vs.3). Conclusion: Both non-operative and operative treatments are valid in DIACF. MIS-surgery offers better functional outcomes for severer injury patterns, and a less-likely need for arthritis intervention at 2yrs.

A Case Series Evaluating Complications of Foot and Ankle Surgeries in Patients with Neuromuscular Disease

Category: Other Introduction/Purpose: Patients with neuromuscular diseases such as cerebral palsy often deal with foot and ankle deformity or dysfunction. These same patients are also living longer due to advances in medicine. This creates a significant population of patients that could benefit from corrective surgery. However, some surgeons are hesitant to offer surgery due to concern for complications. There is little in the literature to describe outcomes for foot and ankle surgery in this patient population. This study will provide information regarding complications associated with foot and ankle surgery in patients with neuromuscular disease. The primary study outcome was to describe the overall complication rates associated with foot and ankle surgery in patients with neuromuscular disease. Methods: The charts of neuromuscular patients undergoing foot and ankle surgery by the senior author from March 2010 to March 2020 were reviewed. Charts were analyzed for demographic data, medical history and diagnoses, and surgical treatment information. Index procedures were evaluated for any complications. For the purpose of our study, we identify an index procedure as the first surgical episode on a given extremity for a unique foot and ankle pathology. Charts were then analyzed for the presence or absence of a postoperative complication. We defined complication as the post-operative occurrence of wound dehiscence, superficial or deep infection, nonunion or delayed union, or a post-operative medical complication. Results: 46 patients with 57 extremities, and 66 index surgeries were identified. 20% of the index surgeries (13 of 66) had one or more complications. Patients ranged in age from 12 to 70 year of age with a mean of 33.8 years. Females comprised 61% of the patient cohort. CP was the most common neuromuscular diagnosis at 52% (24 of 46 patients). The number of procedures performed during a patient's index surgery ranged from 1 to 15 (mean: 3.4). Achilles lengthening was the most common procedure, performed in 44% of patients. A summary of complications can be seen in the attached table, along with patient demographic data. Conclusion: We identified an overall complication rate of 20%, with 12% wound complication rate and 7% nonunion rate. These rates were similar to previous literature on elective foot and ankle surgery. Our infection rate of 9% is higher than previously reported in the general foot and ankle literature. Of note, 31% of the total complications were in patients with spina bifida even though they made up just 9% of the population. We conclude that foot care of adult patients with neuromuscular disease s should be aware of the unique surgical challenges that this population faces.

Intramedullary Beaming Superconstructs for the Treatment of Midfoot Deformity in Patients with Charcot Arthropathy

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot arthropathy is a debilitating condition often accompanied by rocker-bottom deformity and plantar ulcerations. Patients with this condition historically experienced poor results, with varying rates of postoperative wound complications, infection, and amputation. Intramedullary beaming in midfoot reconstructions has been previously identified as a viable treatment option for these patients. However, these studies have been limited to small case series. The purpose of this study was to report our experience with realignment and extended fusion with the use of intramedullary beaming superconstructs in patients with Charcot arthropathy and resultant midfoot deformity. Methods: We retrospectively reviewed patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct between January 2017 to January 2021. Bone resection and/or osteotomy were required to reduce the deformity. Intramedullary screws were placed, either antegrade or retrograde, across the arthrodesis sites. Additional hindfoot and/or tibio- talar arthrodesis was performed as indicated by the patient's deformity. Supplemental plate fixation was performed at the discretion of the treating surgeon. All patients were followed for a minimum of three months. Postoperative imaging was assessed to determine fusion at the arthrodesis site. Patient demographics and comorbidities were recorded to assess for risk factors. Patient deformities were classified according to the Brodsky classification. Postoperative rates of infection, limb salvage, reoperation, hardware fatigue, and return to walking were also recorded. Descriptive statistics, Fisher's exact test, Students T- test, and logistic regression were used to analyze outcomes. Results: Thirty-six patients were included. Limb salvage occurred in 35 (97%) patients, while one patient underwent below knee amputation. Fusion was achieved in 30 (83%) patients at an average time of 5.4+-1.3 months. A stable pseudarthrosis allowing ambulation was achieved in 5 (14%) patients. Thirty-three (92%) patients returned to ambulation. Seven patients (19%) required revision surgery (3 for recurrent ulcer, 4 for deep infection). Four (11%) patients experienced hardware fatigue, but all returned to ambulation. Five (14%) patients required assistive devices and seven (19%) required bracing. No patient characteristics were associated with non-union. Absence of supplemental plate fixation was associated with nonunion (P=0.04) and confirmed as an independent risk factor with regression analysis (P=0.03). Additional subtalar and/or hindfoot fixation was not associated with increased fusion rates. Conclusion: Open reduction and arthrodesis using an intramedullary beaming superconstruct for the surgical correction of midfoot collapse in patients with Charcot arthropathy provides a stable and reliable construct with high rates of limb salvage, fusion, and return to ambulation while minimizing complications. Supplemental plate fixation may provide increased construct stability and higher rates of union. However, this clinical importance of this is unknown.

Treatment of Acute Achilles Tendon Ruptures: A Systematic Review of Overlapping Meta-Analyses

Category: Ankle Introduction/Purpose: Acute Achilles tendon rupture (AATR) is a common injury of an incidence rate of up to 31 per 100,000 per year. The current meta-analyses on the treatment of AATR have conflicted data that may, in part, be due to the differences in their methodologies. The aim of this study is to systematically review and present the current meta-analyses for the treatment of AATR. The outcomes of this study can provide clinicians with a clear overview of the current literature to help decide on the optimal treatment for patients. Methods: Two independent reviewers searched PubMed and Embase on March 17, 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Assessment of evidence was two-fold: level of evidence (LoE) and quality of evidence (QoE). LoE was evaluated using published criteria by The Journal of Bone and Joint Surgery and the QoE by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) scale. Pooled complication rates were highlighted for significance in favor of 1 group or no significance. Statistical analysis was performed using a statistical software package (R version 3.5.1; R Foundation for Statistical Computing, Vienna, Austria). Descriptive statistics were calculated for each study and statistical parameters analyzed. Continuous variables were reported as mean +- standard deviation and categorical variables were reported as frequencies with percentages. P-values &lt; 0.05 was considered statistically significant. Results: 21 meta-analyses were included in the study. Re-rupture rates ranged between 2.3% to 5.0% for open repair/MIS and 3.9% to 13% for conservative treatment (p &lt; 0.05). Re-rupture rates were reported in 3 of 4 meta-analyses that ranged between 2.3% to 7.8% for conservative treatment earlier rehabilitation and 5.0% to 12.2% for conservative treatment later rehabilitation. Re-rupture rates were 2.5% for open repair earlier rehabilitation and 3.8% for open repair later rehabilitation. When comparing surgical techniques, re-rupture rates ranged between 1.4% to 3.1% for percutaneous repair/MIS and 2.2% to 2.7% for open repair. Infection rates ranged between 2.8% to 5.0% for open repair/MIS and 0% to 0.02% for conservative treatment. The majority of meta-analyses (3 of 5) significantly favored by effect size, open repair/MIS for total infection rates (p &lt; 0.05). Conclusion: The results of this study demonstrate that operative repair reduced the rate of re-rupture when compared to conservative treatment. There is currently conflicting information on whether early functional rehabilitation reduces the difference between the two treatments. Operative treatment has been shown to have a higher rate of wound complications, although the rates of deep wound infections remains to be determined. Percutaneous repair resulted in similar re-rupture rates when compared to open surgery but for the rates of other complications including wound infections, this was diminished. Further meta- analyses which compare all cohorts are needed to ascertain best evidence.

Randomized Controlled Trial Investigating Perioperative Immunonutrition for Patients Undergoing Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

Immunonutrition has been shown to reduce hospital stay and postoperative morbidity in patients undergoing gastrointestinal, and head and neck surgery. However, its use has not been demonstrated in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). This study aims to determine the effectiveness of perioperative immunonutrition on patients undergoing CRS-HIPEC in reducing length of hospitalization and postoperative complications. From April 2017 to December 2018, patients undergoing CRS-HIPEC for peritoneal metastases in a single center were enrolled in a randomized controlled trial. Patients with evidence of intestinal obstruction or with diabetes mellitus were excluded. Patients were randomly assigned in a 1:1 fashion to receive perioperative oral immunonutrition or standard nutritional feeds. Length of hospital stay and rates of wound infection and complications were recorded and compared between the two groups in an intention-to-treat manner. A total of 62 patients were recruited and randomized into two groups. Compliance to nutritional feeds in the preoperative period was significantly higher in the standard nutrition group (95.2% versus 75.4%, p = 0.004). There was no difference in postoperative compliance rates. Length of hospital stay and rates of wound infection and postoperative complications were higher in the standard nutrition group when compared with patients on immunonutrition (15.5 versus 11.1 days, p = 0.186; 19% versus 9.7%, p = 0.473; 16% versus 9.7%, p = 0.653; respectively). Patients undergoing CRS-HIPEC who received perioperative immunonutrition had shorter hospitalization and less wound infections and postoperative complications, although the differences with the standard nutrition group were not statistically significant. Potential benefits of perioperative immunonutrition need to be further evaluated in larger studies.

Complications and risk factors after digital subtraction angiography: 1-year single-center study.

Digital subtraction angiography (DSA) is an imaging technique used to diagnose and confirm abnormal lesions of cerebral blood vessels in various situations. Several complications such as cerebral infarction, contrast-induced allergy, and angio-site hematoma or infection can occur after DSA. We investigated complication rates and risk factors related to DSA. All patients who underwent DSA at Incheon St. Mary's Hospital from January to December 2021 were included. Those who underwent emergency DSA due to stroke or who underwent endovascular surgery within 1 week after DSA were excluded. Complications that occurred within 1 week after DSA were included in the study and was classified into three categories (neurologic complications, contrast-induced allergy, and wound complications). The mean age was 57.7±13.2 years old and the female was dominant at 63.9%. The overall complication rate was 5% (n=20/407). Regarding neurologic complications, the presence of malignancy (p<0.01), and a longer procedure time (>15 minutes, p=0.04) were statistically significant factors. Contrast-induced allergy did not show any statistically significant difference in any parameter. The wound complication rate was higher in men (p=0.02), trans-femoral approach (p=0.02), frequent alcohol drinkers (p=0.04), those taking anticoagulants (p=0.03), and longer procedure time (>15 minutes, p<0.01). DSA is an invasive diagnostic modality and can cause several complications. Patients with cancer should be more careful about the occurrence of cerebral infarction, and men taking anticoagulants or drinking frequently should be more careful about the occurrence of angio-site hematomas.

424. ROBOT-ASSISTED AND CONVENTIONAL MINIMALLY INVASIVE ESOPHAGECTOMY ARE ASSOCIATED WITH BETTER POSTOPERATIVE RESULTS COMPARED TO HYBRID AND OPEN TRANSTHORACIC ESOPHAGECTOMY

Abstract Currently 4 surgical techniques are performed for transthoracic esophagectomy (open esophagectomy (OE), hybrid esophagectomy (HE), conventional minimally invasive esophagectomy (MIE) and robot assisted minimally invasive esophagectomy (RAMIE). Aim of this study was to compare these 4 different esophagectomy approaches regarding postoperative complications and short term oncologic outcomes. Between 2008 and 2019, consecutive patients who underwent esophagectomy with gastric conduit reconstruction were included in this single center study. The primary outcome of this study was the incidence of postoperative complications. Overall 422 patients (OE (n = 107), HE (n = 101), MIE (n = 91) and RAMIE (n = 123)) were evaluated. Uncomplicated postoperative course was observed in 27% (OE), 34% (HE), 53% (MIE), and 63% (RAMIE) of patients (p &amp;lt; 0.001). Pulmonary complications were observed in 57% (OE), 44% (HE), 28% (MIE), and 21% (RAMIE) of patients (p &amp;lt; 0.001). Cardiac complications were present in 25% (OE), 23% (HE), 9% (MIE), and 11% (RAMIE) of patients (p &amp;lt; 0.001). MIE and RAMIE were associated with fewer wound infections (p &amp;lt; 0.001). Median hospital stay was shorter for MIE and RAMIE went compared to OE and HE (p &amp;lt; 0.001). The lymph nodes yield differ significantly between the techniques (p &amp;lt; 0.001). Total minimally invasive esophagectomy (MIE, RAMIE) was associated with a lower overall, pulmonary, cardiac and wound complication rate as well as a shorter hospital stay compared to open or hybrid approach (OE, HE). RAMIE resulted in higher lymph node harvest than MIE.

Routine Use of Closed Suction Drains Following Revision Arthroplasty May Not be Necessary

BackgroundThere are numerous studies demonstrating that closed suction drainage (CSD) usage after primary total joint arthroplasty (TJA) has little to no benefit. There are little data on the role of CSDs after revision TJA. The purpose of our study was to evaluate whether there is any clinical advantage to CSD usage after revision TJA. MethodsThis retrospective study evaluated the clinical records of 2,030 patients undergoing revision TJA between 2007 and 2021. CSD was used in 472 patients and not used in 1,558 patients. Primary outcome was blood transfusion rate and secondary outcomes included total blood loss (TBL), as determined by Gross formula, wound complications (hematoma, infection, and dehiscence), and length of hospital stay. Patients undergoing revision TJA for oncologic reasons or those with incomplete datasets were excluded. ResultsThere were no statistically significant differences in rates of allogeneic blood transfusion, TBL, and wound complications (hematoma, infection, and dehiscence) between the two groups (P = .159, .983, .192, .334, and .548, respectively). When adjusted for demographic and surgical confounders, there was no difference in transfusion and TBL rates between groups (Odds Ratio 1.04, 95% Confidence Interval 0.78-1.38, P = .780 and estimate −105.71 mL, 95% confidence interval −333.96 to 122.55, P = .364, respectively). CSD cohort had a shorter length of stay (4.30 versus 5.82 days, P < .001). ConclusionWe acknowledge that there is a role for CSD usage in a selected group of patients. Nevertheless, our study revealed that routine use of CSD after revision TJA does not provide an additional clinical benefit.

Prospective Evaluation of Complications and Associated Risk Factors in Breast Cancer Surgery.

Surgical site infection (SSI) is a well-known complication after breast cancer surgery. The primary aim was to assess risk factors for SSI. Risk factors for other wound complications were also studied. In this prospectively registered cohort study, patients who underwent breast-conserving surgery (BCS) or mastectomy between May 2017 and May 2019 were included. Data included patient and treatment characteristics, infection, and wound complication rates. Risk factors for SSI and wound complications were analyzed with simple and multiple logistic regression. The study cohort consisted of 592 patients who underwent 707 procedures. There were 66 (9.3%) SSI and 95 (13.4%) wound complications. "BMI > 25," "oncoplastic BCS," "reoperation within 24 hour," and "prolonged operative time" were risk factors for SSI with simple analysis. BMI 25-30 and >30 remained as significant risk factors for SSI with adjusted analysis. Risk factors for "any wound complication" with adjusted analysis were "mastectomy with/without reconstruction" in addition to "BMI 25-30" and "BMI > 30." The only significant risk factor for SSI on multivariable analysis were BMI 25-30 and BMI > 30. Significant risk factors for "any wound complication" on multivariable analysis were "mastectomy with/without reconstruction" as well as "BMI 25-30" and "BMI > 30".

Sinus tarsi approach in high-risk patients with displaced intra-articular calcaneus fractures: A case series

PurposeThough research exists regarding calcaneal fractures, the treatment approach for displaced intra-articular calcaneal fractures (DIACF) remains controversial. The most common approach, the extensile lateral approach (ELA), for the treatment of DIACFs has high rates of wound complications reported. In contrast, the sinus tarsi approach (STA) is becoming more popular due to its minimally invasive technique. The objective of this retrospective study is to investigate the incidence of wound complications in high-risk patients with DIACF following operative fixation via the STA. MethodsFollowing IRB approval, a retrospective chart review was performed between 2007 and 2013 to assess high-risk patients for the presence of wound complications, including deep infections and delayed wound healing, following the use of STA for the management of DIACF's (n = 36). Demographics, risk factors, and secondary outcomes such as time to surgery were recorded. ResultsOf the 36 high-risk patients included in our study, seven had post-operative complications following operative fixation via the STA. Specifically, four patients had delayed wound healing, and three developed deep infections. Time to surgery had the greatest negative effect on postoperative complications and was influenced by age, sex, and the presence of a concomitant injury. ConclusionIn conclusion, this study demonstrates that the STA is a viable option for high-risk patients with displaced intra-articular fractures. Additionally, time to surgery should be minimized, when possible, to reduce risks of post-operative complications, including infections and delayed wound healing.

Short-term outcomes of robotic inguinal hernia repair during robotic prostatectomy – An analysis of the Abdominal Core Health Quality Collaborative

BackgroundConcomitant robotic-assisted laparoscopic prostatectomy (RALP) and robotic inguinal hernia repair (RIHR) has been reported. Nevertheless, data on its safety is lacking and some surgeons avoid performing both operations concurrently due to the potential risk of mesh related complications in the setting of a fresh vesicourethral anastomosis. We aimed to investigate differences in 30-day outcomes between patients undergoing RALP+RIHR and those undergoing RIHR alone. MethodsPatients who have undergone concomitant RALP and RIHR with 30-day follow-up available were identified within the Abdominal Core Health Quality Collaborative. Using a propensity score algorithm, they were matched with a cohort of patients undergoing RIHR alone based on confounders such as body mass index, age, ASA class, smoking, hernia size and recurrent status and prior pelvic operation. The groups were compared for 30-day rates of surgical site infection (SSI), surgical site occurrences (SSO), surgical site occurrences requiring operative intervention (SSOPI) and hernia recurrence. Results24 patients underwent RALP + RIHR and were matched to 72 patients who underwent RIHR alone (3:1). Median age was 64 years, 33% were obese and 17% smokers. No significant differences were found on 30-day rates of overall complications (21% RALP + RIHR vs. 15% RIHR, p = 0.53) and surgical site occurrences (12% RALP + RIHR vs.11% RIHR, p = 0.85). No patient in the RALP + RIHR group had a 30-day SSI, SSOPI or early recurrence. ConclusionRALP+RIHR appears not to result in increased rates of wound complications, overall complications or early recurrence when compared to patient undergoing RIHR alone. Prospective, controlled studies with larger number of patients are needed to confirm our findings.

Re-excision After Unplanned Excision of Soft Tissue Sarcoma is Associated with High Morbidity and Limited Pathologic Identification of Residual Disease.

Patients with unplanned excision (UPE) of trunk and extremity soft tissue sarcoma (STS) present a significant management challenge for sarcoma specialists. Oncologic re-resection has been considered standard practice after UPE with positive or uncertain margins. A strategy of active surveillance or "watch and wait" has been suggested as a safe alternative to routine re-excision. In this context, the current study sought to evaluate short-term outcomes and morbidity after re-resection to better understand the risks and benefits of this treatment strategy. A retrospective, single-institution study reviewed patients undergoing oncologic re-resection after UPE of an STS during a 5-year period (2015-2020), excluding those with evidence of gross residual disease. Short-term clinical outcomes were evaluated together with final pathologic findings. The review identified 67 patients undergoing re-resection after UPE of an STS. Of these 67 patients, 45 (67%) were treated with a combination of external beam radiation therapy (EBRT) and surgery. Plastic surgery was involved for reconstruction in 49 cases (73%). The rate of wound complications after re-resection was 45 % (n = 30), with 15 % (n = 10) of the patients experiencing a major wound complication. Radiation therapy and plastic surgery involvement were independently associated with wound complications. Notably, 45 patients (67%) had no evidence of residual disease in the re-resection specimen, whereas 13 patients (19 %) had microscopic disease, and 9 patients (13%) had indeterminate pathology. Given the morbidity of re-resection and limited identification of residual disease, treatment plans and discussions with patients should outline the expected pathologic findings and morbidity of surgery.

Prophylactic and Therapeutic Fasciotomy for Acute Compartment Syndrome after Revascularization for Acute Lower Limb Ischemia—Renal and Wound Outcomes

Acute Compartment Syndrome (ACS) is a significant complication after revascularization for acute lower limb ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. A retrospective cohort study including 76 patients undergoing PF (n=40) or TF (n=36) after revascularization for ALI between 2006 and 2018. Estimated glomerular filtration rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (analysis of variance) groups. Wound complications and healing time were compiled from the complete wound healing period and compared between groups with Pearson's chi-squared-and log-rank test, respectively. E-GFR improved over the in-hospital period with 8.2ml/min/1.73m2 (95% confidence interval [CI] 2.4-14.1, P=0.007) in the PF group and 4.4ml/min/1.73m2 (95% CI 1.2-7.7, P=0.010) in the TF group, with no significant difference between the 2 groups (0.3ml/min/1.73m2, 95% CI -6.7 to 7.4, P=0.93). The wound infection rate was higher after TF (PF=60.6 % and TF=82.4 %, P=0.048), whereas rate of other wound complications (PF=61.3 % and TF=35.3%, P=0.036) was higher after PF. Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciotomies and reduce wound complications, while holding the potential to sufficiently preserve renal function if fasciotomy is needed for ACS. This would be possible and safe if an early diagnosis and treatment of ACS can be ensured.