Risk Of Complications Research Articles

ASSESSMENT OF THE COMPETENCE APPROACH OF DENTISTS OF VARIOUS SPECIALTIES IN PROVIDING MEDICAL CARE TO PATIENTS WITH INCREASED TOOTH ABRASION

BACKGROUND. This study examines the main aspects of the competence-based approach of dentists in the treatment of patients with increased tooth erasure (TSL). TSL is a serious problem that can lead to various diseases of the oral cavity, as well as tooth loss. The competence-based approach of dentists in the treatment of patients with TSL plays a key role in the prevention and treatment of this disease. A study examining the knowledge of dentists in providing care to patients with TSL will reveal the level of training of specialists in this field. This will allow us to assess the need for additional training and advanced training of dentists for the effective treatment of patients with TSL. The results of the study can be used to improve the work of dental institutions and educational programs for dentists. This will improve the quality of dental care, improve the prognosis of the disease in patients with TSL and reduce the risk of complications. AIM. To evaluate the knowledge of dental care for patients with increased tooth abrasion among dentists of different specialties. MATERIALS AND METHODS: The research is based on the results of a sociological survey using the questionnaire method of 175 dentists of different specialties. The survey of doctors was conducted according to the questionnaire developed by the authors "Assessment of professional competence in the tactics of managing patients with TSL by dentists of different profiles." The questionnaire included general information about the respondent (age, specialty), questions related to TSL (concept, complaints, symptoms, prevention of TSL, treatment), assessment of the questionnaire procedure. RESULTS. The study demonstrated a relatively low competence approach of dentists of various specialties in the prevention and treatment of patients with TSL. CONCLUSION: Dentists have demonstrated a low competence approach to the prevention and treatment of TSL. The lack of interaction between dentists in the treatment of TSL was determined. The results of the conducted sociological study, along with the high prevalence of TSL, determined the need to develop clinical recommendations for the prevention and treatment of TSL.

EP349 - Use of Pre-operative Risk and Frailty Assessment in patients undergoing Emergency Laparotomy

Abstract Aims Formal preoperative assessment of risk of complications and death in all patients undergoing Emergency Laparotomy is recommended by NELA (National Emergency Laparotomy Audit) in the UK. In addition, frailty assessment in patients who are 65years or older and frail undergoing Emergency Laparotomy is also recommended. In a previous 2018 audit, we had recorded Preoperative Mortality Risk in 77% patients undergoing Emergency Laparotomy and Frailty was not part of our assessment in these patients. In this audit our aim was to evaluate documentation of preoperative frailty and risk assessment in patients undergoing Emergency Laparotomy from 2019 to 2023. Methods Details of all patients who underwent Emergency Laparotomy at a University Hospital under care of one surgical team between January 2019 and December 2023 were obtained from theatre logbooks. Patient notes were retrospectively reviewed to see if frailty assessment and preoperative risk assessment scores were recorded. This data was collected and analyzed using Microsoft Excel. Results During this period, sixty-seven patients were identified. The median age was sixty-seven with an age range from four to ninety-one. Of these 38 (57%) were females. A preoperative p-possum score was documented in 59 (88.1%), 39 (58.2%) patients were 65 years or older of these 26 (66.7%) had frailty assessment carried out. Conclusions Our data suggests that we have over time made progress in the use of Perioperative Risk assessment scores and incorporated frailty assessment in our perioperative practice in patient’s undergoing Emergency Laparotomy. However there remains room for improvement.

Hypertensive patients' experience of care: a qualitative study

Hypertension is an incurable disease, requiring patients to comply with treatment in order to reduce the risk of complications, including death. Therefore, this study aimed to explore the experience of individuals with hypertension in relation to compliance with treatment.The study adopted a qualitative descriptive design using semi-structured questions, and a total of 20 patients with hypertension participated.The result of this study found 5 themes, namely, not taking the medication regularly, adhering to a diet, using complementary medicine, stable blood pressure, and dizziness as the primary complaint.There were significant and exciting results from this study, namely, patients who do not take medication regularly and do not adhere to their diet.

WP1.8 - No, we can’t repair your hernia: An audit to assess pre-operative optimisation for umbilical hernia repair

Abstract Aims The European Hernia Association recently published guidelines which clearly outline the importance of pre-operative optimisation for those undergoing elective umbilical/epigastric hernias. The main factors of importance are: smoking cessation and BMI <35. This audit aimed to identify if we are adequately optimising our patients. Methods We retrospectively evaluated all elective umbilical hernia repairs from 1st January 2022- 31st December 2022 within a district general hospital setting. Clinic letters and pre-operative records were used to ascertain smoking status, BMI and diabetic control (HbA1c). Results 60 umbilical hernias were performed in our district general hospital setting from 1st January 2022- 31st December 2022. Of these patients, 12% (N=7) were known smokers and 13% (N=8) had a BMI of over 35 documented. Additionally, only in 15 cases, was there clear documentation of the patient smoking status. Out of these patients, 9 were subsequently found to be non-smokers and 6 remained smokers despite being given smoking cessation advice. Furthermore, in 10% (N=6) of these cases, there was poor diabetic control (HbA1c > 48), which was not addressed in clinic pre-operatively. Conclusion Patient factors such as smoking, obesity and diabetic control have been shown to significantly increase the rate of post-operative wound infections and complications. Patients are not being adequately optimised for elective procedures which puts them at increased risk of complications and increases the burden on limited NHS resources.

ThP6.13 - A closed loop clinical audit on adherence of weight-based and renal function-adjusted venous thromboprophylaxis prescribing to local guidelines in emergency general surgical patients

Abstract Aims to audit adherence of venous thromboembolism (VTE) prophylaxis according to local trust guidelines in a single-centre emergency general surgery department, adjusting doses based on weight and renal function (creatinine clearance). Following initial audit of practice, intervention to improve local practice was implemented with informative posters and teaching sessions, aiming to improve overall adherence to guidelines and limit risk of complications from incorrect dosing. Methods A two-cycle snapshot audit of VTE prophylaxis prescribing was conducted in a district general hospital emergency general surgery department against local guidelines concerning VTE prophylaxis. All current inpatients admitted under general surgery were included in the study reviewing baseline characteristics including age, weight, and creatinine clearance. Results The first cycle audited the adherence of departmental practice against guidelines in 57 inpatients. 49 (86.0%) were prescribed VTE prophylaxis in accordance with local guidelines. Of the 8 patients who did not adhere to guidelines, 5 (62.5%) had no VTE prophylaxis prescribed, while 3 (37.5%) had incorrect doses prescribed for their weight or renal function. The second cycle audited 43 inpatients. 39 (90.7%) adhered to guidelines. All re-audited patients had the correct VTE prophylaxis prescribed, although there was no VTE prophylaxis prescribed in 4 (9.3%) patients. There were no bleeding or thromboembolic complication in any patients over the course of admission in both cycles of this audit. Conclusion Adherence to local guidelines concerning VTE prophylaxis was increased following intervention. This eliminated VTE prophylaxis prescribing errors, although did not improve the amount of VTE prophylaxis prescription omissions.

The effect of high-normal preoperative international normalized ratios on postoperative outcomes and complications following posterior cervical spine surgery

IntroductionCurrent guidelines recommend that the International Normalized Ratio (INR) be less than 1.5 prior to spine intervention. Recent studies have shown that an INR > 1.25 is associated worse outcomes following anterior cervical surgery. We sought to determine the risk of complications associated with an INR > 1.25 following elective posterior cervical surgery.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was queried. Patients undergoing elective posterior cervical surgery from 2012 to 2016 with an INR level within 24 h of surgery were included. Primary outcomes were hematoma requiring surgery, 30-day mortality, and transfusions within 72-hours. There were 815 patients in the INR ≤ 1 cohort (Cohort A), 410 patients in the 1 < INR ≤ 1.25 cohort (Cohort B), and 33 patients in the 1.25 < INR ≤ 1.5 cohort (Cohort C).ResultsCohort C had a higher rate of transfusion (4% Cohort A; 6% Cohort B; 12% Cohort C; p = 0.028) and the rate of mortality within 30 days postoperatively trended toward significance (0.4% Cohort A; 0.5% Cohort B; 3% Cohort C; p = 0.094). There was no significant difference in the rate of postoperative hematoma formation requiring surgery (0.2% Cohort A; 0% Cohort B; 0% Cohort C; p = 0.58). On multivariate analysis, increasing INR was not associated with an increased risk of developing a major complication.ConclusionAn INR > 1.25 but ≤ 1.5 may be safe for posterior cervical surgery. An INR > 1.25 but ≤ 1.5 was associated with a significantly higher rate of transfusions. However, increasing INR was not significantly associated with increased risk of any of the major complications.

Central Nervous System Infections in Patients With Ventriculoperitoneal Shunts Admitted for Primary Abdominal Infections: A US Nationwide Cohort Analysis.

Although ventriculoperitoneal (VP) shunts are a common treatment for hydrocephalus, there are complication risks including infections. Late complications such as ventriculitis from ascending abdominal infections can have severe consequences. However, the incidence of central nervous system (CNS) infections in VP shunt patients with abdominal infections is not well understood. We aimed to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections. Using the National Inpatient Sample, we studied patients from 2016 to 2019 to determine the incidence of CNS infections in VP shunt patients admitted with abdominal infections. Results were compared with VP shunt patients admitted for primary pneumonia. Among 725 VP shunt patients presenting with abdominal infections, 20 (2.8%) had CNS infections. Chronic obstructive pulmonary disease, hypertension, older age, and a smoking history were more common in patients with CNS infections and primary abdominal infection (P < .05). Patients who developed CNS infection had a significantly higher likelihood of both blood transfusion and coma but a lower likelihood of seizures. VP shunt patients with CNS infections were more likely to undergo shunt removal (odds ratio [OR] = 23.167, P < .001). 4.1% of VP shunt patients with primary abdominal infections died during admission. In a population of primary abdominal infection and pneumonia patients with VP shunts, a multivariate logistic regression analysis controlling for age, sex, and comorbidities identified abdominal infection as an independent risk factor for both CNS infection (OR = 51.208, P < .001) and inpatient death (OR = 3.417, P < .001). Among 6620 VP shunt patients admitted with primary pneumonia, only 5 (0.1%) had CNS infection compared with 20 (2.8%) in those with a primary abdominal infection (OR = 37.532, P < .001), and mortality was 1.6% vs 4.1% for those with a primary abdominal infection (P < .05). CNS infections in VP-shunted patients with abdominal infections are relatively rare but may lead to increased risks of death and other serious adverse outcomes.

Correction of osteopetrosis in the neonate oc/oc murine model after lentiviral vector gene therapy and non-genotoxic conditioning

IntroductionAutosomal recessive osteopetrosis (ARO) is a rare genetic disease, characterized by increased bone density due to defective osteoclast function. Most of the cases are due to TCIRG1 gene mutation, leading to severe bone phenotype and death in the first years of life. The standard therapy is the hematopoietic stem cell transplantation (HSCT), but its success is limited by several constraints. Conversely, gene therapy (GT) could minimize the immune-mediated complications of allogeneic HSCT and offer a prompt treatment to these patients.MethodsThe Tcirg1-defective oc/oc mouse model displays a short lifespan and high bone density, closely mirroring the human condition. In this work, we exploited the oc/oc neonate mice to optimize the critical steps for a successful therapy.ResultsFirst, we showed that lentiviral vector GT can revert the osteopetrotic bone phenotype, allowing long-term survival and reducing extramedullary haematopoiesis. Then, we demonstrated that plerixafor-induced mobilization can further increase the high number of HSPCs circulating in peripheral blood, facilitating the collection of adequate numbers of cells for therapeutic purposes. Finally, pre-transplant non-genotoxic conditioning allowed the stable engraftment of HSPCs, albeit at lower level than conventional total body irradiation, and led to long-term survival and correction of bone phenotype, in the absence of acute toxicity.ConclusionThese results will pave the way to the implementation of an effective GT protocol, reducing the transplant-related complication risks in the very young and severely affected ARO patients.

Electroacupuncture combined with extracorporeal shock wave lithotripsy is beneficial for the expulsion of ureteral calculi: a prospective randomized trial.

To evaluate the therapeutic efficacy and safety of electroacupuncture (EA) combined with extracorporeal shock wave lithotripsy (ESWL) in treating ureteral calculi. This prospective randomized controlled trial included 207 patients with ureteral calculi who were randomly allocated to an experimental group that underwent EA plus ESWL (n = 95) and a control group that underwent only ESWL (n = 112). Imaging examinations were performed at 1, 2, and 4 weeks after the operation, followed by comparing the stone-clearance rate, time to first stone expulsion, and incidence of major complications between the two groups. The stone-clearance rates at 1 (59.1 vs. 37%, P = 0.002), 2 (86.4 vs. 59.3%, P = 0.000), and 4 (90.9 vs. 77.8%, P = 0.013) weeks after the operation in the experimental group were significantly higher than those in the control group. The time to first stone expulsion in the experimental group was significantly lower than that in the control group (1.29 ± 1.55 vs. 2.45 ± 3.11 days, respectively; P = 0.001). However, we found no difference in the incidence of major complications between the two groups (15.9 vs. 17.6%, P = 0.754). EA-assisted ESWL significantly improved stone clearance and shortened the time to stone expulsion without elevating the complication risk. However, a large-scale multicenter, prospective study is required to corroborate our conclusions.

The beneficial effect of fermented Spirulina platensis on reducing oxidative stress in patients with type 2 diabetes mellitus.

Oxidative stress caused by hyperglycemia can lead to the intensification of hyperglycemia and an increased risk of diabetes complications. Spirulina platensis is a potent free-radical scavenger; it has the potential to be used as a substrate for fermentation by lactic acid bacteria. This study aimed to formulate two functional foods with antioxidant capacity (yogurt containing S. platensis powder / fermented S. platensis powder) for Type 2 Diabetes Mellitus (T2DM) patients and compare the antioxidant effects in diabetic subjects. In this article, for the first time, the antioxidant effect of fermented and non-fermented Spirulina was compared in a clinical study in 'T2DM' patients. By blood sampling, clinical parameters such as FBS, GSH, FRAP, MDA, and CRP before and after each treatment were measured and results were compared between two groups of intervention. Both products as functional foods have a positive effect on the health of diabetic patients by reducing FBS and increasing total antioxidant capacity, and this positive effect is more obvious when yogurt contains fermented lactic acid S. platensis is consumed by T2DM patients.

Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery.

CYSTOSTOMY DIVERSION REDUCED COMPLICATIONS FOLLOWING HYPOSPADIAS REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: This study aims to investigate the associations between the use of cystostomy diversion and the incidence of complications following hypospadias repair. Material &amp; Methods: An extensive search of PubMed, ScienceDirect, Embase, and the Cochrane Library, was performed to identify studies that assessed the impact of cystostomy diversion on complication rates after hypospadias repair. To evaluate potential biases, the RoB 2 tool was applied for randomized controlled trials (RCTs), while the ROBINS-I tool was used for observational studies. Data analysis was conducted using Review Manager 5.4. Results: This review included ten studies involving 1.120 patients who underwent hypospadias repair. The overall complication was 16.9%. The meta-analysis revealed that opting against cystostomy diversion after hypospadias repair led to a notably increased risk of complications, as evidenced by a pooled odds ratio (OR) of 1.48 (95% confidence interval (CI) 1.07–2.03). The significant negative effect of not performing cystostomy on the risk of complications was consistent in sub-analysis of distal hypospadias (OR 1.97; 95% CI 1.11–3.51) and primary hypospadias repair (OR 1.80; 95% CI 1.19–2.73). In the funnel plot, there was no significant publication bias identified. Conclusion: Our meta-analysis demonstrated that cystostomy diversion reduces the incidence of complications following hypospadias repair. The positive effects were consistent in both distal hypospadias and primary hypospadias repair. Keywords: Complications, cystostomy, hypospadias.

The importance of monitoring neurological manifestations in rehabilitation after radical hysterectomy

Background. Hysterectomy is currently one of the most frequently performed surgical operations in obstetrics and gynecology, second only to cesarean section. However, such intervention is often associated with the risk of complications, including neurological ones. Neurological consequences, due to their characteristics, go beyond physical manifestations and exert psycho-emotional pressure on patients.Objective: to determine the need for monitoring neurological manifestations in women undergoing rehabilitation after hysterectomy.Material and methods. The search and selection of studies in Russian and English languages were conducted according to PRISMA recommendations in scientific databases and electronic libraries: PubMed/MEDLINE, ScienceDirect, Google Scholar, Microsoft Academic, DOAJ, eLibrary, CiberLeninka. In total, 2569 publications were revealed; after subsequent screening 57 articles were selected, which were devoted to the study of neurological adverse effects of hysterectomy and met all the screening criteria.Results. Among all the neurological complications mentioned, the most common is chronic postoperative pain. It is detected in 30% of cases. At the same time, in the vast majority of cases, such pains are rare and are tolerated as mild discomfort. However, there is no unambiguous understanding of the nature of this complication. There is a theory about the essential role of estrogen production and substance P ratio in pain manifestations. Thus, a decrease in estrogen production with unchanged synthesis of substance P significantly reduces the pain threshold in patients, which is the cause of the observed chronic pain. A certain contribution to the formation of this neurological complication is made by residual ovarian syndrome, which is associated with incomplete removal of the ovaries during ovariectomy, traumatic neuroma and mononervopathy. Damage to the nerves or their plexuses in the pelvic area can cause intestinal and urinary disorders, leading to a decrease in the quality of life of patients. Excessive anxiety and depression are additional risk factors for the development of chronic pain after hysterectomy, and the accompanying postoperative changes often have a physical manifestation, for example, in the form of insomnia, restless legs syndrome and sexual dysfunction.Conclusion. Hysterectomy is certainly an effective way to treat a number of gynecological diseases, but it often causes complications that require correction of the rehabilitation program. Neurological negative manifestations need special monitoring, since the depressive state of patients may lead to chronicity of pathological processes.

Short-term outcomes of Transrectal Natural Orifice Specimen extraction compared with conventional minimally invasive surgery for selected patients with colorectal cancer: a propensity score matching analysis and literature review

PurposeConventional minimally invasive surgery requires mini-laparotomy to extract the pathological specimen. However, by using a natural orifice as the delivery route, natural orifice specimen extraction (NOSE) surgery avoids the need for a large incision. This study analyzed the short-term outcome of NOSE compared with conventional mini-laparotomy (CL) for colorectal cancer surgery.MethodsWe conducted a retrospective analysis of 1,189 patients who underwent surgery for primary colorectal cancer between the cecum and upper rectum. Propensity score analyses were applied to the NOSE and CL groups in a 1:1 matched cohort.ResultsAfter propensity score matching, each group included 201 patients. The NOSE group and CL group did not differ significantly in terms of baseline characteristics. Postoperative morbidity and mortality rates were comparable. Compared with the CL group, the NOSE group experienced a shorter time to first flatus (1.6 ± 0.8 vs. 2.0 ± 1.2 days, p < 0.001), first stool (2.7 ± 1.5 vs. 4.1 ± 1.9, p < 0.001), liquid diet (2.3 ± 1.3 vs. 3.6 ± 1.8 days, p < 0.001), soft diet (3.9 ± 2.0 vs. 5.2 ± 1.9 days, p < 0.001) and a shorter hospital stay (5.1 ± 3.5 vs. 7.4 ± 4.8 days, p < 0.001). The NOSE group exhibited lower mean pain intensity and lower highest pain intensity on postoperative days 1, 2, and 3.ConclusionNOSE has several advantages over conventional mini-laparotomy following minimally invasive surgery for colon cancer. These advantages include reduced time to oral intake, shorter hospital stays, and less postoperative pain. NOSE can be adopted and applied to highly selective patients without additional risk of short-term complications.

Defining of the nasal anthropometry on facial computed tomography in subjects with epilepsy and healthy subjects.

Epilepsy is a frequent chronic and genetic brain disease. In diagnose of genetic and craniofacial disease, the face is one of the gold standard phenotypic features. This study was carried out to determine the angle and linear measurements of face region in Turkish healthy and epilepsy subjects, and to apply a feature selection method to identify the most important attributes that affect epilepsy decision. The retrospective and observational study was conducted with 120 subjects with epilepsy aged between 18 to 60 years (56 males; 64 females) and 60 healthy subjects aged between 18 and 55 years (29 males, 31 females). Pyramidal angle performed from 3 reference points, nasal bone length, the width of piriform aperture, nasofrontal angle, nasolabial angle, distance between glabella and nasion were measured on computed tomography. Also, we used supervised machine learning to learn classification models to detect epilepsy as our dataset has class label where 1 means epilepsy, 2 means healthy. The well-known classification model learning algorithms implemented in Weka (with version 3.8.6) machine learning toolkit were applied. All parameters excluding nasal bone length were higher in epilepsy patients than in healthy subjects. Also, there was a significant difference in nasal pyramidal angle nasal bone, nasal pyramidal angle nasal tip, piriform aperture, and nasal bone lengths between epilepsy and healthy subjects. However, age related changes for healthy subjects were no seen in healthy subjects. In epilepsy subjects there was a significant difference in 6 measurements all nasal pyramidal angles, piriform aperture width, nasofrontal angle, and nasolabial angle. Gender related changes were found in only nasal pyramidal angle nasal root and nasal bone of healthy subjects, in nasal pyramidal angle nasal bone, nasal bone length, nasofrontal angle of epilepsy subjects. We can say epilepsy may affect the some facial parameters and these, although anthropometric measurements are affected by age and gender parameters. Comprehensive knowledge of this region's normal references ranges is essential for planning, proper selection of silicone implants or osteotomy determining the limitations of the surgical field and minimizing the risk of complication and performing aesthetic facial surgery or rhinoplasty in epilepsy patients.

Flap-Based Reconstruction in Patients with Autoimmune Disease: An Institutional Experience with the Deep Inferior Epigastric Perforator Flap and Review of the Literature.

Autoimmune diseases are associated with characteristic chronic inflammation, aberrations in tissue perfusion, and hypercoagulability, and thus have considerable implications for local and free-flap reconstruction. We seek to summarize the current evidence on outcomes of flap-based reconstruction in patients with pre-existing autoimmune disease and present our experience with autologous breast reconstruction in this population. PubMed, Embase, Scopus, Cochrane, and Web of Science were searched for relevant articles, and pertinent data were presented qualitatively. Institutional data were queried for patients who underwent autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flaps between 2015 and 2024. A retrospective review was conducted to identify DIEP patients with a history of autoimmune disease. Data on patient demographics, medication history, flap outcomes, and perioperative complications were collected. The majority of existing studies found no increased independent risk of flap complications. However, other complications, predominantly wound dehiscence, were independently associated with autoimmune disease. Regarding immunosuppressant therapy, the literature demonstrated that perioperative glucocorticoid use was consistently associated with all complications, including seroma, infection, wound disruption, and partial flap loss.Our 13-patient institutional experience identified no cases of total flap loss or microvascular thrombotic complications. There was one case of partial flap necrosis further complicated by abdominal site cellulitis, and one case of recipient-site dehiscence managed with local wound care. No patients required re-operation for flap or donor-site complications. The literature suggests that flap reconstruction can be performed safely in patients with autoimmune conditions, which was also supported by our institutional experience. While there is likely minimal risk of microsurgical complications in the context of free tissue transfer, donor-site morbidity and wound dehiscence remain major concerns for patients with a history of autoimmune disease. Limiting the use of immunosuppressive agents, especially corticosteroids, may potentially improve outcomes of flap reconstruction.

Different DLCO Parameters as Predictors of Postoperative Pulmonary Complications in Mild Chronic Obstructive Pulmonary Disease Patients with Lung Cancer.

Numerous studies have investigated methods of predicting postoperative pulmonary complications (PPCs) in lung cancer surgery, with chronic obstructive pulmonary disease (COPD) and low forced expiratory volume in 1 second (FEV1) being recognized as risk factors. However, predicting complications in COPD patients with preserved FEV1 poses challenges. This study considered various diffusing capacity of the lung for carbon monoxide (DLCO) parameters as predictors of pulmonary complication risks in mild COPD patients undergoing lung resection. From January 2011 to December 2019, 2,798 patients undergoing segmentectomy or lobectomy for non-small cell lung cancer (NSCLC) were evaluated. Focusing on 709 mild COPD patients, excluding no COPD and moderate/severe cases, 3 models incorporating DLCO, predicted postoperative DLCO (ppoDLCO), and DLCO divided by the alveolar volume (DLCO/VA) were created for logistic regression. The Akaike information criterion and Bayes information criterion were analyzed to assess model fit, with lower values considered more consistent with actual data. Significantly higher proportions of men, current smokers, and patients who underwent an open approach were observed in the PPC group. In multivariable regression, male sex, an open approach, DLCO <80%, ppoDLCO <60%, and DLCO/VA <80% significantly influenced PPC occurrence. The model using DLCO/VA had the best fit. Different DLCO parameters can predict PPCs in mild COPD patients after lung resection for NSCLC. The assessment of these factors using a multivariable logistic regression model suggested DLCO/VA as the most valuable predictor.

Thirty-Day Complication Rates After Gender-Affirming Bottom Surgery: An Analysis of the NSQIP Database From 2010 to 2020.

Gender-affirming bottom surgeries (GABS) play a central role in treating gender dysphoria to improve quality of life for transgender and nonbinary (TGNB) patients. However, there exists limited data on operative risks and outcomes for patient populations undergoing GABS. The goal of this study is to identify sociodemographic and clinical risk factors for determining 30-day postoperative complications in patients undergoing GABS. The ACS-NSQIP database from 2010 to 2020 was used to identify patients undergoing gender affirmation surgery (GAS) using Current Procedural Terminology (CPT) codes included in transfeminine and transmasculine bottom surgery. IBS-SPSS software was used to perform a multivariate analysis to determine risk factors for increased 30-day postoperative complications including unplanned reoperation and readmission rates. A total of 1809 GABS were performed in the NSQIP database from 2010 to 2020. There was an upward trend in GABS procedures throughout the years, with 2017 having the most GABS (n = 629). Transmasculine patients with a BMI of 29 and over were at a greater risk for wound complications (P < 0.05). Diabetic transfeminine patients were also at a greater risk for wound complications (P < 0.05). This study identified that several sociodemographic and clinical risk factors, such as BMI and diabetes mellitus type 2, had increased postoperative complications for patients undergoing gender-affirming bottom surgeries. Wound care management and patient education are essential in GABS to prevent long-term complications. Physician awareness of risk factors and social determinants of health can help prevent and improve postoperative care education and patient compliance.

Clinical application of cluster analysis in patients with newly diagnosed type 2 diabetes.

Early prevention and treatment of type 2 diabetes mellitus (T2DM) is still a huge challenge for patients and clinicians. Recently, a novel cluster-based diabetes classification was proposed which may offer the possibility to solve this problem. In this study, we report our performance of cluster analysis of individuals newly diagnosed with T2DM, our exploration of each subtype's clinical characteristics and medication treatment, and the comparison carried out concerning the risk for diabetes complications and comorbidities among subtypes by adjusting for influencing factors. We hope to promote the further application of cluster analysis in individuals with early-stage T2DM. In this study, a k-means cluster algorithm was applied based on five indicators, namely, age, body mass index (BMI), glycosylated hemoglobin (HbA1c), homeostasis model assessment-2 insulin resistance (HOMA2-IR), and homeostasis model assessment-2 β-cell function (HOMA2-β), in order to perform the cluster analysis among 567 newly diagnosed participants with T2DM. The clinical characteristics and medication of each subtype were analyzed. The risk for diabetes complications and comorbidities in each subtype was compared by logistic regression analysis. The 567 patients were clustered into four subtypes, as follows: severe insulin-deficient diabetes (SIDD, 24.46%), age-related diabetes (MARD, 30.86%), mild obesity-related diabetes (MOD, 25.57%), and severe insulin-resistant diabetes (SIRD, 20.11%). According to the results of the oral glucose tolerance test (OGTT) and biochemical indices, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hBG), HbA1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride-glucose index (TyG) were higher in SIDD and SIRD than in MARD and MOD. MOD had the highest fasting C-peptide (FCP), 2-hour postprandial C-peptide (2hCP), fasting insulin (FINS), 2-hour postprandial insulin (2hINS), serum creatinine (SCr), and uric acid (UA), while SIRD had the highest triglycerides (TGs) and TyG-BMI. Albumin transaminase (ALT) and albumin transaminase (AST) were higher in MOD and SIRD. As concerms medications, compared to the other subtypes, SIDD had a lower rate of metformin use (39.1%) and a higher rate of α-glucosidase inhibitor (AGI, 61.7%) and insulin (74.4%) use. SIRD showed the highest frequency of use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i, 36.0%) and glucagon-like peptide-1 receptor agonists (GLP-1RA, 19.3%). Concerning diabetic complications and comorbidities, the prevalence of diabetic kidney disease (DKD), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and hypertension differed significantly among subtypes. Employing logistic regression analysis, after adjusting for unmodifiable (sex and age) and modifiable related influences (e.g., BMI, HbA1c, and smoking), it was found that SIRD had the highest risk of developing DKD (odds ratio, OR = 2.001, 95% confidence interval (CI): 1.125-3.559) and dyslipidemia (OR = 3.550, 95% CI: 1.534-8.215). MOD was more likely to suffer from NAFLD (OR = 3.301, 95%CI: 1.586-6.870). Patients with newly diagnosed T2DM can be successfully clustered into four subtypes with different clinical characteristics, medication treatment, and risks for diabetes-related complications and comorbidities, the cluster-based diabetes classification possibly being beneficial both for prevention of secondary diabetes and for establishment of a theoretical basis for precision medicine.

Postoperative bleeding complications in breast conserving surgery and the role of antithrombotic medications: retrospective analysis of 4712 operations

BackgroundThis study aimed to evaluate the risk and timing of postoperative bleeding complications following breast-conserving surgery (BCS), with or without axillary surgery, especially in relation to perioperative management of antithrombotic medications.MethodsData from all patients who underwent BCS for breast cancer between 2010 and 2022 at a single university hospital were collected. Medical records were reviewed for reoperations, unplanned admissions, and patient characteristics.ResultsIn total, 4712 breast-conserving surgeries and 3631 axillary surgeries were performed on 3838 patients. The risk of any bleeding complication was 1.1% (40/3571) in breast-conserving surgery, 0.3% (9/2847) in sentinel lymph node biopsy, and 0.5% (4/779) in axillary lymph node dissection. Upon arrival for treatment, 645 (17%) patients were taking antithrombotic medications. The risk of bleeding complications was not elevated in patients whose medication was discontinued at least a day before the surgery (OR 0.84, p = 0.76); but it was almost four-fold (OR 3.61, p = 0.026) in patients whose antithrombotic medication was continued. However, the absolute risk for bleeding complication was low in these patients as well (2.0%, 15/751). The majority of bleeding complications (85%, 47/55) occurred within 24 h after the surgery.ConclusionThe risk for bleeding complications was elevated, but still low, after BCS with or without axillary surgery, when antithrombotic medications were continued through the surgical period. Discontinuing antithrombotic medications is not obligatory in these patients.