Reduce Complication Rates Research Articles

The use of the femoral neck system (FNS) leads to better outcomes in the surgical management of femoral neck fractures in adults compared to fixation with cannulated screws: A systematic review and meta-analysis.

Intracapsular femoral neck fractures are challenging to treat, with outcomes depending on the quality of reduction, and the stability of fixation. Cannulated cancellous screws (CCS) are the most commonly used implants to fix these fractures, but failure rates are significant. The recently introduced femoral neck system (FNS) may be a better option than CCS fixation and this review attempts to compare the results. Four electronic databases were searched for eligible articles that had comparative data on the outcomes of fixation of adult femoral neck fractures with FNS and CCS. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% confidence intervals. Eight studies with 509 cases having a mean age of 50.8years were included for final analysis. FNS was found to be associated with significantly reduced complication rates (p < 0.001), decreased incidence of postoperative femoral neck shortening (p < 0.001), quicker time to fracture union (p = 0.002), and better functional outcome scores (p < 0.001) compared to cannulated screws. FNS was also associated with a shorter operating time (mean difference 6.65min) although not statistically significant (p = 0.24). CCS group had significantly reduced mean blood loss (p < 0.001). The available literature supports FNS as a better option for adult femoral neck fractures, with a lower complication rate, quicker union, and better clinical outcomes. Level 3.

Lapidus with 1st Metatarsal-Intermediate Cuneiform Fixation Improves Rotational Correction of Hallux Valgus

Category: Bunion Introduction/Purpose: The modified Lapidus procedure offers effective correction of the triplanar deformity of hallux valgus; however, complications such as nonunion and recurrence range up to 15% when using a crossing lag screw fixation technique. An alternative form of fixation using a dorsomedial plate and first metatarsal-intermediate cuneiform (1MT-IC) screw has been proposed. This construct may reduce complication rates, facilitate earlier weightbearing and maintain 3-dimensional correction, especially rotation of the first ray. We investigated single-surgeon Lapidus patient cohorts utilizing cross screws (CS) versus plate and 1MT-IC screw (PS) fixation to compare patient reported outcomes, radiologic parameters on pre- and postoperative weightbearing CT (WBCT) and complications. We hypothesized that patients undergoing PS fixation would experience improved correction of first ray pronation. Methods: This single-center, IRB-approved retrospective study identified all patients who underwent first tarsometatarsal joint arthrodesis for hallux valgus by a single surgeon and divided them by CS or PS fixation. Patients were minimum 18 years old with at least 12 months of follow-up. Revision forefoot surgeries, concomitant flatfoot reconstruction or ankle replacement, and patients with history of rheumatoid arthritis or gout were excluded. PROMIS scores in six key domains were compared between groups both preoperatively and at one year postoperatively. Radiographic assessment of hallux valgus angle (HVA) and intermetatarsal angle (IMA) were performed on pre- and postoperative XR. Pronation of the first ray was measured on WBCT using the validated triplanar angle of pronation. Clinical notes were reviewed for complications and reoperations. The PS group began weightbearing at an average 3.6 weeks versus 6 weeks the PS group. Results: We compared 44 patients who underwent Lapidus with PS and 43 with CS fixation. The age, BMI and gender distribution in the two groups were similar. Both groups had significant improvement in HVA and IMA following Lapidus, (p&lt;0.001), with no difference between groups. Average first ray pronation among PS patients was corrected to 26.0 degrees (from 36.6 degrees preoperatively), which was lower than the final pronation of 30.5 degrees in the CS group, (p&lt;0.001). Both cohorts experienced improvement in PROMIS physical function, pain interference, pain intensity and global physical function. There were no differences in PROMIS score improvements between the cohorts. Weightbearing commenced earlier in the PS group without increased complications. Conclusion: The plate and 1MT-IC screw technique for Lapidus fixation has been described to provide better biomechanical stability and potentially maintain the desired hallux valgus correction by spanning the intermetatarsal joint. Prior studies have reported durable radiographic IMA correction with low nonunion rates. We found similar patient-reported outcomes and rates of complications compared with a group of cross-screw fixation patients. However, there was a significant difference in final pronation of the first ray, 26 vs 31 degrees, observed by weightbearing CT. Earlier weightbearing and improved rotational correction are advantages associated with PS fixation of Lapidus bunionectomy.

447. IMPACT OF PERIOPERATIVE MANAGEMENT BASED ON ERAS IN THORACIC ESOPHAGEAL CANCER SURGERY

Abstract Esophagectomy for esophageal cancer is one of the most invasive surgeries, thus it has high morbidity and mortality rates. A multidisciplinary perioperative management is required for improvement in surgical outcomes. Early recovery after surgery (ERAS) is now standard in the care of patients and has been associated with reduced complication rates and hospital stays. The aim of this study was to evaluate the impact of perioperative management based on ERAS for thoracic esophageal cancer patients. A total 357 patients performed esophagectomy between January 2009 and August 2020 were enrolled. Patients were classified into non-ERAS (NE) group (n = 174) and ERAS (E) group (n = 183). Operative outcomes were compared between two groups. Postoperative complications were graded according to Clavien-Dindo classification. The complication defined as above Grade 3. Nutritional Status was evaluated with Controlling nutritional status (CONUT). Changes in body weight (BW) and area of psoas muscle mass at 3 months after surgery were evaluated. Operative factors such as operative time and blood loss were not significant different between the NE and E groups. In E group, Postoperative any complications (p = 0.023), respiratory complications (p = 0.043) were significantly less than in NE group. CONUT score was lower on postoperative 1 month (p = 0.025) and 3 months (p = 0.044) in E group. Reduction rate of BW and psoas muscle mass index (PMI) on postoperative 3 months in E group was lower than in NE group (BW: 5.6 ± 6.4% vs 7.8 ± 5.2% (p = 0.045), PMI: 6.7 ± 14.9% vs 12.3 ± 13.3% (p = 0.021)). ERAS could be effective for maintenance of a better nutritional status and prevention of the postoperative respiratory complication and loss of the BW and PMI.

Regional-Controlled Tissue Expanders Increase Skin Expansion and Thickness Compared to Standard Tissue Expanders in a Rat Model.

Skin and soft-tissue expansion are widely used. However, the existing methods cannot expand targeted areas on the top flap. Thus, the authors developed a new expander with a partially thickened top. The authors hypothesized that pressure differences would lead to higher growth near nonthickened regions and lower growth near thickened regions, allowing targeted expansion. Eighteen male Sprague Dawley rats (8 weeks old) were used; 20-ml rectangular regional-controlled expanders ( n = 12) and ordinary expanders ( n = 6) were implanted. Flaps on regional-controlled expanders were divided into nonthickened and thickened regions and tattooed. Discontinuous inflation began 14 days postoperatively, 3 ml every 3 days, until the volume reached 50 ml. Tattooed skin area and thickness were measured. Immunofluorescence staining detected cell proliferation (proliferating cell nuclear antigen-positive) and vascular density (CD31 + ). Growth factors (transforming growth factor-β, epidermal growth factor, vascular endothelial growth factor, and basic fibroblast growth factor) were assessed by enzyme-linked immunosorbent assay. The expanded skin area of regional-controlled expansion nonthickened regions (396.2 ± 41.4 mm 2 ) was 33.8 ± 10.0 percent larger than that of thickened regions (297.8 ± 38.9 mm 2 ). Thickened regions had a 28.9 ± 14.6 percent thicker dermal layer (942.4 ± 55.5 µm) than nonthickened regions (737.1 ± 64.5 µm). Nonthickened regions had 295.0 ± 145.0 percent more proliferating cell nuclear antigen-positive cells (92.4 ± 16.2/mm 2 ) than thickened regions (25.6 ± 7.4/mm 2 ). The vascular density was 133.0 ± 61.7 percent higher in thickened regions (24.8 ± 4.7/mm 2 ) than in nonthickened regions (11.1 ± 2.7/mm 2 ) (all above, p < 0.05). Regional-controlled expansion specifically expands only the targeted area, causing thicker skin flaps with abundant vessels for defect repair. Although this technique has great clinical potential, it should be further validated with large animals and humans. ( Plast. Reconstr. Surg. 150: 1273, 2022.). This study presents the newly developed regional-controlled expansion technique that realized the targeted expansion. It is suitable for repairing defects and would contribute to shortening the expansion process and reducing complication rates.

Prevention of major biliary complications by fusion imaging for thermal ablation of malignant liver tumors adjacent to the bile ducts: a preliminary comparative study.

Ultrasound (US)-guided thermal ablation (TA) may cause major biliary complications, particularly in patients with malignant liver tumors (MLTs) adjacent to the bile ducts. Fusion imaging (FI), is postulated to reduce complication rate; however, there is a lack of clinical data to support this theory. Thus, the aim of our study was to evaluate the safety and efficacy of FI for TA of MLTs proximal to the bile ducts. A retrospective single-center review was conducted on a total of 289 patients with 316 MLTs adjacent to the bile ducts. The patients were divided into two groups based on whether FI was used in the ablation procedures. The choice of the FI-assisted procedure always depends on different operation periods and whether registrations will succeed. The baseline demographics and outcomes of these patients were compared. The efficacy was determined at the 1-month follow-up using contrast-enhanced computed tomography/magnetic resonance. Biliary complications and local tumor progression were subsequently followed-up every 3-6months. The last follow-up visit was before August 30, 2019. Among the included tumors, the incidence rate of major biliary complications after ablation in the FI group was 1.6%, which was significantly lower than that in the non-FI group (7.9%, p = 0.005). There was no significant difference in the efficacy rates of the techniques [99.5% (185/186) versus 98.4% (123/125), p = 0.56] or local progression rates [3.8% (7/185) versus 5.7% (7/123), p = 0.61] between the FI and non-FI groups. FI for US-guided TA could be a noninvasive means to decrease major biliary complications. Trial registration number and date of registration: retrospectively registered.

Have all races experienced reductions in complication rates following total hip arthroplasty? A NSQIP analysis between 2011 and 2019.

Despite numerous articles in the orthopedic literature evaluating racial and ethnic disparities, inequalities in total joint arthroplasty outcomes remain. While the National Surgical Quality Improvement (NSQIP) database has been previously utilized to highlight these disparities, no previous analysis has evaluated how the rate of various perioperative complications has changed over recent years when segregating by patient race. Specifically, we evaluated if all races have experienced decreases in (1) medical complications, (2) wound complications, (3) venous thromboembolism (VTE), and (4) readmission/reoperation rates following total hip arthroplasty (THA) over recent years? Current Procedural Terminology (CPT) code 27,130 (total hip arthroplasty) was utilized to identify all THA procedures conducted between 2011 and 2019. Patients were segregated according to race and various demographics were collected. Linear regression was utilized to evaluate changes in each complication rate between 2011 and 2019. A multivariate regression was then conducted for each complication to evaluate whether race independently was associated with each outcome. Our analysis included a total of 212,091 patients undergoing primary THA. This included 182,681 (85.76%) White, 19,267 (9.04%) Black, 5928 (2.78%) Hispanic, and 4215 (1.98%) Asian patients. We found that for urinary tract infection (UTI), acute renal failure, superficial SSI, and readmission rates, White patients experienced significant reductions between 2011 and 2019. However, this was not consistent across all races. Black race was associated with a significantly increased risk of acute renal failure (OR: 2.03, 95% CI: 1.17-3.34; p = 0.008), renal insufficiency (OR: 2.33, 95% CI: 1.62-3.28; p < 0.001), deep vein thrombosis (DVT) (OR: 1.34, 95% CI: 1.07-1.66; p = 0.01), and pulmonary embolism (PE) (OR: 1.76, 95% CIL: 1.36-2.24; p < 0.001). Our analysis highlights specific complications for which further interventions are necessary to reduce inequalities across races. These include medical optimization, increased patient education, and continued efforts at understanding how social factors may impact-related care inequalities. Future study is needed to evaluate specific interventions that can be applied at the health systems level to ensure all patients undergoing THA receive the highest quality of care regardless of race.

Perioperative oral nutritional support for patients diagnosed with primary colon adenocarcinoma undergoing radical surgical procedures -Peri-Nutri Trial: study protocol for a randomized controlled trial

BackgroundColon cancer is one of the most common cancers in Finland and worldwide. Cancer-related malnutrition is a well-known risk factor for increased morbidity and mortality after surgery, and it is associated with complications and longer hospitalizations. There are no established recommendations on how to improve the nutritional status of colon cancer patients´ during the perioperative phase. Administration of simple oral nutritional supplements has been suggested to reduce complication rates, but evidence to support this practice is scarce.MethodsThe Peri-Nutri trial is a prospective, multicenter, randomized, controlled trial. Its primary endpoint is to evaluate whether perioperative oral nutritional support (ONS) decreases the number of complications during the 30-day follow-up after surgery. Secondary endpoints are to study the effect of ONS on quality of life after surgery, length of stay in institutional care, 90-day mortality rate, five-year disease-free survival and overall survival. The patients with a Nutritional risk screening 2002 (NRS-2002) questionnaire result between 2 and 5 (≥ 3 are classified at risk of malnutrition) will be randomized (1:1 ratio) into either the intervention or control group. The intervention group will receive preoperative ONS two weeks before the operation, and nutritional support will continue 10 days after the operation. The control group will not receive ONS. A total of 318 patients will be randomized into two groups and patients are followed five years.DiscussionPeri-Nutri study evaluate the impact of ONS to short-term and long-term postoperative morbidity and mortality rates of colon cancer patients undergoing curative surgery. If ONS will decrease patients´ morbidity and mortality, that has a huge impact on patients´ quality of life and also to financial cost.Trial registrationClinicalTrials.gov, NCT03863236, Registered 25 February 2019.

Diagnosis and Therapy of Acute Achilles Tendon Ruptures

Diagnosis and Therapy of Acute Achilles Tendon Ruptures Abstract. Acute Achilles tendon ruptures are a common pathology and often affect young athletic patients. Diagnosis is mostly clinical and by ultrasound. Conservative and operative treatment algorithms exist. The result of the treatment is mostly influenced by the elongation of the tendon during healing. Operative procedures tend to lead to less elongation but have a complication risk. After-treatment should be functional to reduce complication rate and faster rehabilitation. Treatment results are good in general, but some weakness is often found on the injured side.

Navigation Techniques in Endoscopic Spine Surgery.

Endoscopic spine surgery (ESS) advances the principles of minimally invasive surgery, including minor collateral tissue damage, reduced blood loss, and faster recovery times. ESS allows for direct access to the spine through small incisions and direct visualization of spinal pathology via an endoscope. While this technique has many applications, there is a steep learning curve when adopting ESS into a surgeon's practice. Two types of navigation, optical and electromagnetic, may allow for widespread utilization of ESS by engendering improved orientation to surgical anatomy and reduced complication rates. The present review discusses these two available navigation technologies and their application in endoscopic procedures by providing case examples. Furthermore, we report on the future directions of navigation within the discipline of ESS.

219. Comparative analysis of prone lateral versus single position lateral decubitus positioning in achieving optimal outcomes and reducing complication rates in minimally invasive spine surgery

<h3>BACKGROUND CONTEXT</h3> Recent literature has pointed to the rising use of prone lateral versus lateral decubitus positioning in minimally invasive spine surgery (MISS) as a method to reduce operative time, increase patient safety, and aid in surgical accessibility. However, there is a paucity of literature as to how prone lateral and lateral decubitus positioning compares in terms of reaching optimal postoperative outcomes and reducing complication rates. <h3>PURPOSE</h3> To assess differences between prone lateral and single-position lateral decubitus positioning compares in terms of reaching optimal postoperative outcomes and reducing complication rates. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospective MIS database. <h3>PATIENT SAMPLE</h3> A total of 524 MIS patients. <h3>OUTCOME MEASURES</h3> HRQLs; complications; surgical factors. <h3>METHODS</h3> MISS patients with BL) and 2-year(2Y) postop radiographic/HRQL data were included. Patients positioned in the prone latera (PL) or single-position lateral decubitus (LD) position were isolated. At 2Y, an optimal outcome score was calculated using 4 equally weighted criteria: 1) achieving ideal PT per SRS-Schwab at 2Y, 2) Achieving ideal PI-LL per SRS-Schwab at 2Y, 3) No complication requiring reoperation, 4) Achieving NRS MCID by Salaffi et al. criteria; optimal score threshold was set at meeting 2 of 4 criteria. Means comparison analysis assessed differences in radiographic and clinical outcomes at BL and 1Y postoperatively. ANCOVA assessed estimated marginal means adjusting for BL age and revision status. <h3>RESULTS</h3> Thirty-four PL and 36 LD patients were included (54.40±12.49 years, 40% female, 30.93±6.52 kg/m2, mean CCI: 2.23±1.55) were included. At baseline, patients were comparable in age, gender, BMI and CCI (all p>.05). Perioperatively, PL patients demonstrated significantly lower operative time (200.09 vs 284.54 min, p=.007) and EBL (332.35 vs 192.05 mL, p=.027). Though optimization scores were equivalent between groups (p=.160), PL patients demonstrated significantly lower perioperative complication rates (p=.012), neurological complication rates (p=.006), and had a fewer number of total complications by 2Y (p=.014). When controlling for BL age and revision status, the PL patients demonstrated consistently fewer intra- and perioperative complications as well (both p<.015). In terms of patient-reported outcomes, PL patients also demonstrated significantly improved NRS-Leg scores compared to LD patients by 1Y (p=.038). <h3>CONCLUSIONS</h3> Patients placed in the PL position during minimally-invasive adult spinal deformity surgery demonstrate decreased mean operative times and decreased intraoperative invasiveness and blood loss versus patients operated on via single-position LD positioning. Though overall rates of achieving optimal outcome remain comparable, PL approach should be considered as there may be significant additional benefit in reducing peri- and postoperative complications by 2Y. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

602 Using Plastic Surgery Techniques in Abdominal Wall Surgery

Abstract Complex Abdominal Wall Hernias (CAWH) present a huge challenge to surgeons and patients often requiring Abdominal Wall Reconstruction (AWR). AWR aims to restore abdominal wall anatomy, improve function, and reduce the risk of future herniation. Plastic surgery techniques can be used including primary closure, skin grafts, flaps, tissue expansion and small bite, small stitch technique. Below are two cases where some of these techniques were utilised. Case 1 LC is a 65 y/o female with CAWH. Her gastric band became infected requiring a laparotomy for perforation of gastroesophageal junction. She subsequently had primary open repair of abdominal hernia using Permacol. It became infected requiring 5 debridements and application of a VAC device. Her hernia was a Ventral Hernia Working Group (VHWG) grade 3 at 10cm×16cm. Her CAWH was repaired using a Rives-Stoppa technique and a Surgimend mesh. The epigastric component of her wound was closed using a superiorly based local rhomboid flap and a Prevena VAC dressing. Case 2 KH is a 37 y/o female with a para-ileal conduit skin granuloma that was painful and refractory to other treatments such as silver nitrate and steroid topical treatments. She had excision of the area of granulation and her wound was closed using a local advancement flap taking account of previous scars raised and a prevena VAC dressing. Discussion CAWH requiring AWR is a complex operation benefiting from plastic surgical specialists. Plastic surgical techniques can help with closure of the abdominal wall and reduce complication rates including wound infections and incisional hernia.

WE6.5 Back to the future: Does increasing the proportion of local anaesthetic inguinal hernia repairs help achieve a #NetZeroNHS?

Abstract Aim To investigate whether increasing the proportion of local anaesthetic (LA) inguinal hernia repairs (IHR) provides benefit across the sustainability ‘triple bottom line’ of environmental, financial, and social improvement. Methods After establishing suitability criteria for LA IHR, the IHR waiting list was screened and 20 patients were deemed suitable for LA repair. Data was collated on clinical outcomes, surgical timings, medical equipment usage and patient satisfaction. Trust data on our pre-pandemic (2019) practises was analysed to provide environmental and financial estimates. Extensive carbon footprinting was performed of the resources used in LA and general anaesthetic (GA) cases. Results Of the 20 cases identified, 10 IHRs were performed under LA and 10 under GA. LA IHR had a 53.2% shorter length of stay (LOS) and a 40% reduced complication rate. Analysis of our 2019 data mirrored this with the LA IHR patients having a 4.75-hour shorter LOS. In 2019, only 27.7% of cases were performed under LA, far below that in published literature (Sanjay 2007) of 64%. LA IHR saved 10.2kgCO2e/case. If we increased our annual LA rate to 64%, we would save 2005.12kg/CO2e/year. Financially, our trust would save £15, 984.54/year. Our patient surveys did not identify a difference in quality-of-life outcomes, however our improved clinical outcomes support the superiority of LA IHR for patients. Conclusion Increasing the number of LA IHRs would provide significant benefits across the triple bottom line. Our carbon emission savings alone is equivalent to driving from London to Edinburgh 12.5 times.

TH2.3 Elective versus emergency management of gallstone disease at a tertiary referral centre amidst the COVID-19 pandemic - should the protocol be altered?

BackgroundGallstones are a common pathology affecting approximately 15% of the population in UK, 20% of which are symptomatic. It is suggested symptomatic patients undergo cholecystectomies. Guidelines recommend this is performed within one week of initial emergency presentation or 52 weeks for elective case. Surgical capacity to manage emergency cholecystectomies was limited due to the COVID pandemic. We assessed wait time discrepancy between elective and emergency cholecystectomies.MethodsA retrospective review of all patients undergoing cholecystectomies between January and November 2021 in a major tertiary referral centre in London was undertaken. Initial pathology at the time of presentation, elective vs emergency presentation, pre-surgical biliary complications along and wait times were reviewed.Results219 (74 elective, 145 emergency) patients underwent surgery, mean age 48 years (23% Male and 77% Female). Average wait times for elective cholecystectomies were 69.7 days (min 0, max 246) in comparison to 68.9 days (min 1, max 253) for emergency surgery. 22 (15%) of the patients of initial emergency presentation re-attended hospital and 6 (4%) had adverse events such as gallbladder perforation or pancreatitis due to delayed treatment. Comparatively, 9 (12%) elective patients attended A&E due to pain, with no adverse outcomes.ConclusionsOverall wait time of emergency vs elective cholecystectomies were similar. This review indicates emergency cases require prioritisation over elective cholecystectomies due to the higher number of re-attendance and adverse events. Emergency cases need to be prioritised to meet guidelines, which could also reduce complication rates whilst awaiting surgery and lead to fewer adverse outcomes.

Endocrine Surgery and Pediatic Surgery Partnership Reduces Complication Rate of Pediatric Thyroidectomy

Endocrine Surgery and Pediatic Surgery Partnership Reduces Complication Rate of Pediatric Thyroidectomy

High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

ObjectiveTo evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation.Research MethodsThis systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: reintubation rate, mortality, complication rate, and ICU length of stay.ResultsEight studies were included, with a total of 612 subjects, including 297 in the HFNC group and 315 in the NIV group. The effect of HFNC and NIV on the reintubation rate of AECOPD patients after extubation, RR (1.49 [95% CI,0.95 to 2.33], P = 0.082). Subgroup analysis with or without hypercapnia according to the included AECOPD population, with hypercapnia, RR (0.69 [95% CI,0.33 to 1.44], P=0.317), without hypercapnia, RR (2.61 [95% CI,1.41 to 4.83], P=0.002). Mortality, RR (0.92 [95% CI,0.56 to 1.52], P = 0.752). ICU length of stay, MD (−0.44 [95% CI,-1.01 to 0.13], P = 0.132). Complication rate, RR (0.22 [95% CI,0.13 to 0.39], P = 0.000). After subgroup analysis, the reintubation rate of HFNC and NIV has no statistical difference in patients with hypercapnia, but NIV can significantly reduce the reintubation rate in patients without hypercapnia. In the outcome measures of complication rate, HFNC significantly reduced complication rate compared with NIV. In mortality and ICU length of stay, analysis results showed that HFNC and NIV were not statistically different.ConclusionAccording to the available evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, but in the patients without hypercapnia, HFNC is less effective than NIV.

The impact of obesity class on perioperative outcomes in minimally invasive surgery for endometrial cancer (594)

<b>Objectives:</b> Minimally invasive surgeries (MIS) have been shown to reduce complication rates and length of hospital stays in patients with obesity. However, there is limited data analyzing outcomes for specific obesity classes (Class I [30-34.9 kg/m2], Class II [35-39.9 kg/ m2], and Class III [≥40.0 kg/m2]). This study aimed to evaluate differences in perioperative outcomes, stratified by obesity class, in obese patients undergoing minimally invasive surgery for endometrial cancer. <b>Methods:</b> This is an IRB-exempt retrospective cohort study investigating women who underwent MIS for treatment and staging of endometrial cancer. Inclusion criteria were age 18 years or older, MIS performed for endometrial cancer, and BMI of 30 kg/m² or greater. We excluded those who underwent neoadjuvant chemotherapy or radiation therapy. Data were collected from the de-identified National Surgical Quality Improvement Program (NSQIP) between 2012-2018. The primary outcome was intraoperative complications, such as bowel injury, urologic injury, and conversion to laparotomy. Secondary outcomes were unplanned re-admission, unplanned reoperation, and postoperative infection. Chi-square and Kruskal- Wallis rank-sum tests were used as appropriate for categorical and continuous variables, respectively. P-values of < 0.05 were considered significant. Statistical analysis was performed using SAS 9.4v (SAS Institute Inc., Cary, NC, USA). <b>Results:</b> We identified 12,956 patients who met the inclusion criteria within NSQIP. Of these, 29.3% (<i>n</i> = 3,801) patients were Class I (avg. BMI 32.5 kg/m²), 26.7% (<i>n</i>= 3,467) were Class II (avg. BMI 37.4 kg/m²), and 43.9% (<i>n</i> = 5,688) were Class III (avg. BMI 47.5 kg/m²) (see Table 1). The average ages were 64.1, 62.7, and 59.2 years old for Class I, II, and III, respectively. Intraoperatively, there were no statistically significant differences among the three classes for bowel injury, urologic injury, or conversion to laparotomy (p= 0.575). Re-admission rates were higher for Class III patients (4.1%) than Class I and II (3.1%, p=0.005). There was a higher rate of superficial surgical site infection in Class III obese patients versus Class I and II (0.6% vs 1.1% vs 1.3%, respectively; p=0.005). There were no significant differences among Class I, Class II, and Class III obesity for deep wound (0.1%, 0.1%, and 0.3%, respectively, p=0.052) and organ space (0.9%, 1.2%, 1.4%, respectively, p=0.101) surgical site infections. <b>Conclusions:</b> In conclusion, among obese women undergoing MIS for endometrial cancer, there were no statistical differences between the risks of intraoperative complications, such as bowel injury, urologic injury, and conversion to laparotomy, when assessing the different obesity classes. However, postoperatively, patients with Class III obesity had higher re-admission rates and superficial surgical site infections when compared to Class I and Class II obese patients.

Emergency Removal of Ingested Foreign Bodies in 586 Adults at a Single Hospital in China According to the European Society of Gastrointestinal Endoscopy (ESGE) Recommendations: A 10-Year Retrospective Study.

BackgroundThe 2016 European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend that ingested foreign bodies in the upper gastrointestinal (GI) tract are removed as an emergency within 6 hours, with an endoscopic approach that is individualized according to the type of foreign body identified. This retrospective study evaluated the 10-year experience of a single hospital in China performing emergency removal of ingested foreign bodies in 586 adults.Material/MethodsBetween 2011 and 2020, medical records of 642 adults with a diagnosis of foreign bodies ingestion were retrospectively screened. The timing of endoscopic intervention was classified according to ESGE recommendations. Uni- and multivariate analyses were performed.ResultsWe included 586 patients. The median (range) diameter of foreign bodies was 2.5 (1–24) cm: for sharp ones it was 2.5 (1.5–4.0) cm and for long ones it was 16.9 (10–24) cm. The most common site of foreign body lodgment was the esophagus (n=481; 82.1%); 45.6% (n=252) received emergent removal within 6 hours, while 32.2% (n=178) underwent urgent removal within 24 hours. There were 583 (99.5%) foreign bodies removed successfully and the complication rate was 17.9%. Major complications occurred in 45 patients (7.7%). Female sex and non-emergent endoscopy after 6 hours were significantly associated with a higher overall complications rate. For major complications, older age, time interval >24 hours, and sharper objects were associated with major complications.ConclusionsThe findings from this retrospective study support the ESGE statement that endoscopic removal of ingested foreign bodies from the upper GI tract within 6 hours reduces complication rates for adults in the emergency setting.

O016 Antibiotics versus appendicectomy for uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials

Abstract Introduction Previous meta-analyses of randomised controlled trials (RCTs) on patients with uncomplicated acute appendicitis have demonstrated reduced complication rates with primary antibiotic therapy when compared with appendicectomy. This aim of this systematic review and meta-analysis of RCTs was to provide an update of the efficacy of antibiotic therapy compared with appendicectomy in adult patients with uncomplicated acute appendicitis. Methods MEDLINE, EMBASE and CENTRAL databases were searched with no date or language restriction. Data on complications of treatment, treatment efficacy (defined in the antibiotic group as not undergoing appendicectomy at 1 year, versus surgery without complications or negative histology in the appendicectomy group), readmissions, and length of stay (LOS) were extracted. Results We included 8 RCTs involving 3203 participants (1613 antibiotics/1590 appendicectomy; 2041 males/1162 females). Antibiotics had a reduced treatment efficacy compared with primary appendicectomy (RR 0.75, 95% CI 0.63–0.89). There was no significant benefit of primary antibiotic treatment on complication rates (RR 0.66 95% CI 0.41–1.04). In total 1010/1613 (62.6%) patients had successful antibiotic treatment at 1 year. In the 5 studies which explicitly reported hospital re-admission as an outcome, primary antibiotic treatment had a six-fold increase in readmissions (RR 6.28 95% CI 2.87–13.74). There was no difference in index admission LOS [Mean Difference 0.15 days (95%CI -0.05–0.35)]. Conclusion Primary antibiotic treatment for acute appendicitis is associated with a reduced treatment efficacy and a significant readmission rate, without any benefit on complications or LOS. Approximately 40% of patients initially treated with antibiotics will require surgery within 1 year. Take-home message Contrary to previous meta-analyses, the current study suggests that although primary antibiotic therapy may be tried for uncomplicated acute appendicitis in adults, it is not definitive treatment in the long term.

Negative-Pressure Wound Therapy versus Standard Surgical Dressings after Malignant Tumor Resection: A Systematic Review and Meta-Analysis.

Negative-pressure wound therapy offers many advantages over standard surgical dressings in the treatment of open wounds, including accelerated wound healing, cost savings, and reduced complication rates. Although contraindicated by device manufacturers in malignancy-resected wounds because of hypothesized risk of tumor recurrence, negative-pressure wound therapy is still applied postoperatively because of limited clinical support. The authors performed a systematic review with meta-analysis to compare negative-pressure wound therapy outcomes with those of standard surgical dressings on open wounds, with their null hypothesis stating there would be no outcome differences. A systematic review of the literature on negative-pressure wound therapy and standard surgical dressings on malignancy-resected wounds was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Embase, CINAHL, and Cochrane Central databases. Meta-analysis compared group outcomes, including malignancy recurrence, wound complication, and surgical site infection rates, with a random effects model. A total of 1634 studies were identified and 27 met eligibility criteria, including four randomized controlled trials, four prospective cohort studies, and 19 retrospective reviews. Eighty-one percent of articles ( n = 22) recommended negative-pressure wound therapy in malignancy-resected wounds. Meta-analysis determined that the treatment yielded significantly lower overall surgical site infection ( p = 0.004) and wound complication ( p = 0.01) rates than standard surgical dressings; however, there were no statistically significant differences found for other outcomes between the two groups. This review demonstrates favorable outcomes of negative-pressure wound therapy over standard surgical dressings for malignancy-resected wounds without an increased risk of malignancy recurrence. However, because limited randomized controlled trials (detailing only incisional wounds for limited malignancies and anatomic regions) are available, additional high-power randomized controlled trials are recommended.

The role of sentinel lymph nodes in breast cancer

Introduction. The problem of improving early diagnosis and prognosis of breast cancer remains one of the most actual for current oncological practice. Taking into account a close correlation between the general prevalence of breast neoplasms and mortality from breast cancer, this problem is not only of professional interest, but also has medical-social and socio-economic significance.&#x0D; The purpose of the study is to improve the quality of the sentinel lymph node detection in patients with breast cancer using ICG.&#x0D; Material and methods. At the period 2009–2016, 400 patients with T1-T3N0M0 breast cancer were operated on. All the patients were divided into two groups using two dyes – Patent Blue and ICG. The patients after mastectomy with a sentinel lymph node biopsy had a clinical diagnosis of T2-T3N0M0 breast cancer more often.&#x0D; In group I, 100 patients had the sentinel lymph node biopsy. Lymph node staining was performed using Patent Blue dye.&#x0D; In group II, sentinel lymph nodes biopsy was conducted with the Patent Blue dye and another fluorescent dye — ICG, which was also injected on the affected side of the breast. After ICG dye introduction, in 15 minutes the stained green lymph nodes were detected using special equipment.&#x0D; Criteria for inclusion of patients in the clinical trial:&#x0D; 1) breast cancer patients of any age with T1-3N0M0, I-II AB disease stage;&#x0D; 2) patients with clinically unaffected lymph nodes N0 after examination.&#x0D; Criteria for exclusion of patients from the clinical trial:&#x0D; The exceptions were T3-T4 tumors &gt; 5 cm in diameter, or the skin and chest wall invasion, as well as palpable axillary lymph nodes, 3 or more affected lymph nodes with sentinel lymph node biopsy;&#x0D; 3) patients after radiation therapy.&#x0D; Results. The tumor histology was performed after the node trephine biopsy. The main aims of sentinel nodes detection were staging and improving the breast cancer patients’ life quality after surgical treatment. The post-mastectomy syndrome, the main manifestation of which is swelling of the upper extremity is a big problem for patients because it affects their life quality and disturbs their usual lifestyle. The sentinel lymph node detection, in contrast to axillary lymph node dissection of I-II level, significantly minimizes all the risks of postmastectomy syndrome, in particular, impaired lymphatic drainage in the form of lymphatic edema of the upper extremity, impaired venous outflow in the form of stenoses or the axillary and/or subclavian veins occlusion, rough scars which limit the function of the extremity in the shoulder joint, and brachioplexitis.&#x0D; Conclusions. The study of sentinel lymph nodes significantly improves the results of surgical treatment of breast cancer patients. Based on the clinical-laboratory and histological examinations, new data were obtained concerning the sentinel lymph node detection using two dyes, the choice of the surgical intervention volume and reduction of complications rate at the postoperative period. We found that fluorescent lymphography is highly effective, which allows to recommend it for implementation into the clinical practice. The frequency of sentinel lymph node detection in breast cancer patients is 98% in the control group, 100% – in the main group.&#x0D; On the basis of the obtained results, the sentinel lymph node detection algorithm and the surgical management of patients with breast cancer was developed and implemented into practice, which allowed to reduce the number of complications with using two dyes for the sentinel lymph node detection from 19% to 2% (χ2 =15.37, p&lt;0.001). Recurrence of breast cancer fell from 13% to 8%.