Risk Of Early Postoperative Complications Research Articles

537. ASSESSING THE EFFECT OF HIATAL HERNIA SIZE ON PERIOPERATIVE OUTCOMES AND HOSPITAL READMISSION RATES AFTER PRIMARY REPAIR

Abstract Background Minimally invasive hiatal hernia (HH) repair remains the gold standard for correcting mechanical defects due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms). However, several operative factors, including the HH size, may negatively impact the postoperative course. We aimed to determine if an increase in HH size was related to an increased risk of perioperative complications or hospital readmissions. Methods After IRB approval, we performed a retrospective analysis using a prospectively maintained database containing demographic, perioperative, and clinical data from all patients who underwent HH repair by a single experienced foregut surgeon between September 2016 and July 2023. Four groups were defined based on the proportion of stomach at the thoracic cavity determined during the surgery: A (small HH: <25%), B (moderate HH: 25-49%), C (large HH: 50-74%), and D (intrathoracic stomach [ITS]: ≥75%). Non-parametric tests were used to assess differences between the groups, and logistic regressions were used to determine the relevant odds ratios (OR). Results A total of 391 patients who underwent primary HH repair met the inclusion criteria (73.7% women; mean age 64.4±12.5 years; mean BMI 28.9±4.9 kg/m2). The distribution of groups was: A (n=160, 40.9%), B (n=63, 16.1%), C (n=64, 16.4%), and D (n=104, 26.6%). Patients presenting with ITS (group D) were older, had longer operative duration, greater blood loss (p<.001), and a significantly increased risk of presenting with early postoperative complications (OR 2.78 [CI95: 1.52-5.06]) and being admitted to the ICU (OR 12.35 [CI95: 3.41-44.71]). Conclusion The HH size, defined by the proportion of the stomach at the thoracic cavity, is associated with an increased risk of early postoperative complications and ICU admission; moreover, a trend toward higher 30- and 90-day hospital readmission rates was noted. This factor may be a consequence of the progressive nature of the disease; hence, it should be considered when choosing between continued medical observation and surgical treatment of patients presenting with asymptomatic HH. An early intervention may reduce the risk of postoperative comorbidity.

Complication rates are not higher after outpatient compared to inpatient fast-track total hip arthroplasty: a propensity-matched prospective comparative study.

Concerns remain with regards to safety of fast-track (FT) and especially outpatient procedures. The purpose of this study was to compare complication rates and clinical outcomes of propensity-matched patients who received FT total hip arthroplasty (THA) in outpatient versus inpatient settings. The hypothesis was that 90-day postoperative complication rates of outpatient FT THA would not be higher than after inpatient FT THA. This is a prospective study of consecutive patients who received FT THA at various rates of outpatient and inpatient surgery by 10 senior surgeons (10 centres). The decision between outpatient and inpatient surgery was made on a case-by-case basis depending on the surgeon and patient. All patients were followed until 90 days after surgery. Complications, readmissions and reoperations were collected, and their severity was assessed according to Clavien-Dindo. Patients completed Oxford Hip Score (OHS) at the latest follow-up. Compared to inpatient FT THA, patients scheduled for outpatient FT THA had no significant differences in 90-day postoperative complication rates (10.7% vs. 12.9%, p = 0.129). There were no significant differences between the 2 groups in 90-day readmission rates and reoperation rates, in severity of postoperative complications, and in time of occurrence of postoperative complications. There were no differences in rates of intraoperative complications, 90-day postoperative complications, readmissions, or reoperations between outpatient and inpatient FT THA. These findings may help hesitant surgeons to move towards outpatient THA pathways as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge.

Study protocol of the FRENCH24-ANIS study: postoperative anti-infective strategy following pancreaticoduodenectomy in patients with preoperative biliary stents—an intergroup FRENCH-ACHBT-SFAR prospective randomized controlled trial

BackgroundDespite advances in surgical techniques and care, pancreatoduodenectomy (PD) continues to have high morbidity and mortality rates. Complications such as sepsis, hemorrhage, pulmonary issues, shock, and pancreatic fistula are common postoperative challenges. A key concern in PD outcomes is the high incidence of infectious complications, especially surgical site infections (SSI) and postoperative pancreatic fistula (POPF). Bacteriobilia, or bile contamination with microorganisms, significantly contributes to these infections, increasing the risk of early postoperative complications. The occurrence of SSI in patients who undergo hepatobiliary and pancreatic (HPB) surgeries such as PD is notably higher than that in patients who undergo other surgeries, with rates ranging from 20 to 55%. Recent research by D'Angelica et al. revealed that, compared to cefoxitin, piperacillin/tazobactam considerably lowers the rate of postoperative SSI. However, these findings do not indicate whether extending the duration of antibiotic treatment is beneficial for patients at high risk of bacterial biliary contamination. In scenarios with a high risk of SSI, the specific agents, doses and length of antibiotic therapy remain unexplored. The advantage of prolonged antibiotic prophylaxis following PD has not been established through prospective studies in PD patients following biliary drainage.MethodsThis is an intergroup FRENCH-ACHBT-SFAR multicenter, open-labelled randomized, controlled, superiority trial comparing 2 broad-spectrum antibiotic (piperacillin/tazobactam) treatment modalities to demonstrate the superiority of 5-day postoperative antibiotic therapy to antibiotic prophylaxis against the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents. The primary endpoint of this study is the overall SSI rate, defined according to the ACS NSQIP, as a composite of superficial SSI, deep incisional SSI, and organ/space SSI.In addition, we will analyze overall morbidity, antibiotic resistance profiles, the pathogenicity of bacteriological and fungal cocontamination, the impact of complications after bile drainage and neoadjuvant treatment on the bacteriological and fungal profile of biliculture and cost-effectiveness.ConclusionThis FRENCH24-ANIS study aims to evaluate 5-day post-operative antibiotic therapy combined with antibiotic prophylaxis on the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents.Trial registrationClinicaTrials.gov number, NCT06123169 (Registration Date 08–11–2023); EudraCT number 2021–006991-18; EUCT Number: 2024–515181-14–00.

EFFECT OF BODY MASS INDEX ON THE RISK OF POSTOPERATIVE COMPLICATIONS FOLLOWING TOTAL HIP ARTHROPLASTY

While obesity is associated with an increased risk of complications after total hip arthroplasty (THA) the relationship between body mass index (BMI) and the risk of early postoperative complications has not been fully characterized. This study sought to describe the relationship between BMI and the risk of early postoperative complications, including periprosthetic joint infection (PJI), composite surgical, and composite medical complications.Primary, elective THAs performed from 2016–2021 were identified using the Premier Healthcare Database (PHD). The study's primary outcome was the diagnosis of PJI within 90 days of THA. Using BMI as a continuous variable, logistic regression was used to develop restricted cubic splines (RCSs) to determine the impact of BMI on PJI risk. Bootstrap simulation was used to identify an inflection point in the final RCS model. The same technique was used to characterize the effects of BMI on composite medical and surgical complications.We found that PJI risk increased exponentially beyond a BMI cutpoint of 37.4 kg/m2. Relative to the cutpoint, patients with a BMI of 40 or 50 kg/m2 were at a 1.22- and 2.55-fold increased risk of developing PJI, respectively. Surgical complications increased at a BMI of 32 kg/m2 and medical complications increased at a BMI of 39 kg/m2. Relative to these cutpoints, patients with a BMI of 50 kg/m2 were at a 1.36- and 2.07-fold increased risk of developing medical and surgical complications, respectively.The results of this study indicate a non-linear relationship between patient BMI and early postoperative risk of PJI, composite medical complications, and composite surgical complications following THA. The identified cutpoints with associated odds ratios can serve as tools to help risk-stratify and counsel patients seeking primary THA.

Complication Rates Are Not Higher After Outpatient Versus Inpatient Fast-Track Total Knee Arthroplasty: A Propensity-Matched Prospective Comparative Study

BackgroundThis prospective study aimed to compare the complication rates and clinical outcomes of propensity-matched patients who received fast-track total knee arthroplasty (FT TKA) in outpatient versus inpatient settings. MethodsPatients (n = 629) who received FT TKA at various outpatient (n = 176) and inpatient (n = 462) surgery rates were prospectively followed until 90 days after surgery. The decision between inpatient versus outpatient FT TKA was made on a case-by-case basis, depending on consultation between the surgeon and patient. Complications were collected to distinguish between intraoperative complications, complications with no readmission, complications with readmission, and complications with reoperation. Propensity scores based on age, sex, body mass index, and the American Society of Anesthesiologists score were used to match outpatient to inpatient FT TKA. A cumulative incidence function was computed by taking the time to diagnose any postoperative complication in the first 90 days as the end point. ResultsPropensity score matching (1:2 ratio) for comparison resulted in 173 outpatient FT TKAs and 316 inpatient FT TKAs. No significant differences were observed between outpatient versus inpatient FT TKA for intraoperative complication rates (2% in both groups). At 90-day follow-up, no significant differences were observed between outpatient versus inpatient FT TKA for total complications with no readmission (8.0 versus 7.9%), complications with readmission but no reoperation (1.1 versus 0.6%), and complications with reoperation (4.0 versus 4.4%). A comparison of postoperative complication diagnosis time using the cumulative incidence function revealed no significant differences between outpatient versus inpatient FT TKA. ConclusionsThe present study revealed that there were no differences in 90-day postoperative complication rates between outpatient and inpatient FT TKA and that there were also no differences in rates of intraoperative complications, readmissions, or reoperations. These findings may encourage hesitant surgeons to move toward outpatient TKA pathways, as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge. Level of EvidenceLevel II.

Impact of comorbidity on surgical management of breast cancer in elderly patients.

e12596 Background: More than half of breast cancers are diagnosed above the age of 60 years, a quarter of which diagnosed with invasive breast cancer among those over 75 years of age. Treatment of breast cancer (BC) at this age remains a complex problem. Elderly patients often have various comorbidities that impose increased risks of complications with antitumor treatment. This leads to both excessive and insufficient treatment of BC. In patients over 75 years of age, an individual approach to treatment is recommended, taking into account their general health and life expectancy, the risk of death from breast cancer compared to other causes, as well as the advantages and disadvantages of treatment methods. Objective: To evaluate the influence of comorbidity on the risks of complications (early and delay) after surgical treatment in elderly and senile patients (pts). Methods: A retrospective analysis of the results of breast cancer treatment in 292 pts over 75 years of age, who underwent surgical treatment at the first stage in SBIH Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM from 2016 to 2019. The initial stages of breast cancer (I and IIA) were diagnosed in 257 (88.0%) pts, 35 pts (12.0%) has IIB and IIIA clinical stages. Radical mastectomy was performed in 171 (58.6%) cases, breast-conserving surgery was performed in the remaining 121 (41.4%). Forty-six (15.8%) patients had diabetes mellitus, 121 (41.4%) had cardiovascular disease, 36 (12.3%) had heart rhythm disorders, 38 (13.0%) had chronic cerebral ischemia, and the risk of grade 3 and 4 cardiovascular complications was found in 251 (86.0%) cases. Results: In the early postoperative period severe complications occurred in 1 (1.7%) patient (acute coronary syndrome) leading to death. No local recurrences were detected. The overall 3-year survival rate was 86.3% and the recurrence-free survival rate was 89.7%. In 10 (3.4%) cases, death was due to progression of RRMS, 30 (10.3%) patients died from other causes (acute cardiovascular failure, stroke, COVID-19). Conclusions: Comorbid conditions in elderly patients after surgery did not affect the development of complications in the early postoperative period. Preliminary preoperative preparation of elderly patients (correction and selection of drug therapy for concomitant chronic diseases) reduces the risk of early postoperative complications.

Early Outcome after Sublay versus Onlay Polypropylene Mesh Repair for Ventral Midline Incisional Hernia - A Single Center Retrospective Analysis.

Onlay and retromuscular sublay mesh repairs are the most frequently used procedures in open repair of midline incisional hernias. The onlay placement of the mesh is simple and fast to perform, while the sublay retromuscular repair offers a supplementary protection against infection, but it is considered a more complicated procedure with a higher risk of early postoperative complications. The personal experience of the surgeons plays an important role in choosing the technique of mesh placement. This paper presents the results of a retrospective analysis of 220 consecutive patients operated on in the Surgical Clinic of the Mures Clinical County Hospital (Romania) between 31.01.2017 - 31.12.2019 with sublay or onlay polypropylene mesh repair for ventral midline incisional hernia. The patients were divided into two groups according to the position of the mesh. The two groups were identical in terms of age, sex distribution, incidence of comorbidities (obesity, diabetes mellitus, cardiac and respiratory diseases), number of previous operations and size of the defect (p value 0.05 for all the parameters). Results: Postoperative mortality was zero, with no statistically significant differences of the duration of the postoperative hospitalization between the two groups p 0.05. A total of 34 early reoperations were required for hematoma, skin necrosis, seroma, wound suppuration, and intestinal obstruction, with no statistically significant difference between the two groups (p 0.05 for the overall and separate incidence of each complication). The onlay placement of the mesh was associated with a later removal of the superficial drains p 0.0001 with a larger proportion of the patients who were discharged without removing the drains (group A 2/62 versus group B 141/168, p 0.0001). Conclusions: Both the onlay and the retromuscular sublay placement of polypropylene meshes may be used with good results for the treatment of midline incisional hernias. The lack of a supplementary early morbidity after the retromuscular sublay repair is an argument for a more frequent use of this technique which offers a supplementary protection against infection.

The Risk of Early Postoperative Complications Associated With Preoperative Immunosuppression in Patients Undergoing Total Elbow Arthroplasty

Patients considering total elbow arthroplasty (TEA) may be receiving immunosuppressive therapy; however, the relationship between immunosuppressive medications and postoperative complications is not well defined. Our purpose was to assess the relationship between preoperative immunosuppression and short-term complications following TEA. The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2005 to 2020 to identify patients undergoing TEA. Procedures indicated for malignancy or infection were excluded. Patients were grouped according to preoperative chronic immunosuppressive status. Demographic and operative characteristics were compared between groups. The 30-day incidence of complications and reoperations were compared between groups. Multiple logistic regression models, inverse-weighted by propensity scores, were used to calculate odds ratio (OR) of experiencing any complication or return to the operating room based on immunosuppression status and other demographic characteristics. A total of 769 patients undergoing TEA were included, of whom 142 (18.5%) received chronic immunosuppression. Distribution of age, sex, race, body mass index, diabetes, and American Society of Anesthesiologists classification differed significantly between groups. Most procedures were performed on an inpatient basis, and the median operative duration was 148 minutes. Most procedures were indicated for fracture in the nonimmunosuppressed group and rheumatoid arthritis in the immunosuppressed group. Overall complication rates were 7.0% for immunosuppressed patients and 10.2% for nonimmunosuppressed patients. The incidence of complications and reoperations did not significantly differ between groups. After controlling for confounding and adjusting for patient characteristics, immunosuppressed patients were 0.52 times less likely to experience a complication. Additionally, there was no association between immunosuppression status and odds of return to the operating room. Similar rates of complications were observed following TEA, regardless of preoperative immunosuppression status. Chronic immunosuppression does not appear to increase the rates of postoperative complications for patients undergoing TEA. Prognostic II.

Use of sodium thiopental and propofol for intravenous sedation and treatment of delirium in early postoperative period in surgical patient

In emergency surgery with volumetric surgical interventions, there are a number of indications for the continuation of intravenous sedation and artificial lung ventilation (ventilator) in the intensive care unit. Often, this need is due to both the magnitude of the surgical catastrophe and the severe concomitant comorbid back14 ground, high risk of early postoperative complications. There is also the development of delirium of various etiologies in the early postoperative period, which also affects the course of the postoperative process, the duration of stay in the intensive care unit.In connection with the above, on the basis of the Intensive care unit of the Multidisciplinary Hospital No. 1 a comparative characteristic of the effectiveness of the use of sodium thiopental and propofol for intravenous sedation and treatment of delirium in surgical patients was carried out in Karaganda.

Analysis of the risk of early postoperative complications after Bentall procedure

The aim – to investigate the frequency of early postoperative complications and to analyze possible predictors of the prolonged stay of patients in the intensive care unit (ICU) after Bentall procedure.Materials and methods. In the study, the medical histories of adult patients (from 18 to 75 years old) who underwent Bentall procedure for ascending aortic aneurysm at the State Institution «Heart Institute of the Ministry of Health of Ukraine» between 2012 and 2021 were analyzed. Univariate and multivariate analysis (logistic regression) was used to determine prognostic risk factors.Results. Patients with prolonged stay in intensive care unit were characterized by significantly older age (p = 0.005), more frequent presence of comorbidities of arterial hypertension (p = 0.044) and significantly lower initial values of glomerular filtration rate (p = 0.045). In addition, these patients were 3.6 times more likely (p = 0.0005) to use an autohemotransfusion device and almost 6 times more likely (p = 0.0037) to require rethoracotomy due to bleeding. Acute renal failure was recorded 4.3 times (p = 0.0002) and acute respiratory failure was recorded 3.3 times more often (p = 0.0004). The duration of mechanical ventilation (OR 1.204 (CI 1.053–1.377), p = 0.007) and the development of acute renal failure (OR 4.069 (CI 1.040–15.923), p = 0.044) were two independent predictors of prolonged stay of patients in ICU.Conclusions. For patients with risk factors for a prolonged ICU stay after surgery, more active treatment strategies before and after surgery are recommended to avoid possible complications and shorten hospital stay.

The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy: results from the Scandinavian Obesity Surgery Registry

BackgroundThe optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial. ObjectivesTo evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG. SettingNationwide registry-based study. MethodsThis study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35–36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30–32 Fr), shorter distances (1–4 cm), and extended distances (6–8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. ResultsThe study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17–1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed. ConclusionsUsing a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.

A Comparison of Postoperative Outcomes between Unilateral and Bilateral Palatoplasty: Analysis of 2015-2020 Pediatric NSQIP Data.

We sought to identify differences in 30-day medical and surgical complications in unilateral versus bilateral palatoplasty. The NSQIP-P 2015-2020 database was queried to identify cleft palate repairs using CPT codes. Cases were stratified as unilateral (Veau III) and bilateral (Veau IV) using ICD-9 and -10 codes. A nationally representative random sample. A total of 3791 cases were identified with 2608 undergoing unilateral repair and 1183 undergoing bilateral repair. The postoperative outcomes of interest included surgical complications (surgical site infections, wound dehiscence), medical complications (pneumonia, urinary tract infection, seizure, cardiac arrest, bleeding/transfusions, systemic sepsis, unplanned intubation), readmission, and reoperation. The bilateral cohort was older (696 days versus 619 days, P < .001) and had longer operative times (157.3 min versus 144.5 min, P < .001). The unilateral cohort had more comorbidities including developmental delay, structural CNS abnormalities, need for nutritional support, and bleeding disorders. The bilateral cohort had statistically significant higher occurrences of wound dehiscence (2.1% versus. 1.2%, P = .03) and readmission (3.2% versus 1.7%, P = .01). On multivariate analysis, bilateral cleft repair (OR: 1.83, CI: 1.176-2.840, P = .007) and ASA class 4 (OR: 13.1, CI 2.288- 62.586, P = .002) were associated with greater odds of readmission. Patients who underwent bilateral cleft repair had a higher proportion of 30-day postoperative complications and a two-fold increased odds of readmission. While palatoplasty is generally regarded as a safe procedure in the pediatric population, identifying factors related to an increased risk of early postoperative complications can help surgical teams better manage high-risk individuals.

Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures.

The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes. We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication. Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%). Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.

The use of intelligent analysis (IA) in determining the tactics of treating patients with nephrolithiasis.

The use of modern information technologies allows to increase confidence in the choice of a surgical treatment method of kidney stones, as well as to improve the quality of treatment due to an adequate combination of therapeutic techniques. In our study we analyzed the treatment results of 625 patients with kidney stones. We created a register with the information on more than 50 parameters for each patient. Each example had an output parameter representing a predefined treatment strategy (extracorporeal shock-wave lithotripsy [ESWL]-1, percutaneous nephrolithotomy [PCNL]-2, pyelolithotomy or nephrolithotomy-3). The initial database served as the basis for training the neural network estimation technique. The aim of our study was to assess the possibility of using neural network algorithms in choosing a method for surgical treatment of urolithiasis. A prospective study was conducted to assess the clinical effectiveness of implementing the recommendations of the system. The average number of sessions in the group using the neural network assessment technique was 1.4. Residual fragments remained at the time of discharge in seven (15.6%) patients: four in the kidney, three in the lower third of the ureter "stone path." Inversion of therapeutic tactics-PCNL-was performed in four cases. The efficiency of the ESWL was 91.1%. The indicators of the ESWL in the comparison groups differed statistically significantly: in the second group, the efficiency was higher due to more stone fragmentation, with lower energy costs (the average number of sessions was 0.4 less). The presented technique can be of help for a practicing urologist to choose the optimal treatment method for each patient, thereby minimizing the risk of early postoperative complications.

The relationship between preoperative opioid use and adverse events following total shoulder arthroplasty.

Few studies have analyzed the effect of preoperative opioid use on postoperative outcomes after total shoulder arthroplasty (TSA). Patients undergoing TSA were identified in the Pearldiver Humana Claims Dataset and stratified by level of preoperative opioid use. Primary outcomes were 90-day complications, readmissions, and revision surgery. Chi-square test and ANOVA were used to evaluate categorical and continuous variables respectively. A multivariable logistic regression analysis and a sub analysis excluding fracture as a primary diagnosis were completed. 18,791 patients underwent aTSA and rTSA including 9933 opioid naïve patients, 3016 sporadic opioid users and 5842 persistent opioid users. Significant differences were found in complications (6.0% vs 6.1% vs 9.1%, p < .001), readmission (7.6% vs 8.2% vs 12.6%, p < .001), and revision procedures (1.1% vs 1.1% vs 2.3%, p < .001) which remained significant after excluding fractures. After adjusting for comorbidity burden, persistent opioid use was associated with increased likelihood of complications (OR 1.4, 1.2-1.6), readmission (OR 1.6, 1.5-1.8) and revision procedures (OR 1.9, 1.5-2.4). This association remained after excluding fractures. Persistent preoperative opioid use is associated with increased risk of early postoperative complications, readmission, and revision surgery for patients undergoing shoulder arthroplasty.

Evaluation of the coexistence of pilonidal sinus disease and hirsutism in female patients: a retrospective cross-sectional study.

The demographic and clinical data of 164 female patients who underwent surgery for PSD between January 2007 and May 2014 were evaluated for this retrospective cross-sectional study. Data collected for this study were age, BMI, the modified Ferriman and Gallwey scale (mFGS) for hirsutism, main symptoms, type of surgery, early postoperative complications (wound infection, wound dehiscence), recurrence, and follow-up. The independent variables are hirsutism (mFGS scores) and BMI. Dependent variables are early postoperative complications and recurrence. The median age was 20 years (95% CI for median: 19-21 years). According to the BMI, 45.7, 50.6, and 3.7% of patients were considered normal, overweight, and obese, respectively. According to the mFGS, 11, 9.8, 52.4, and 26.8% of patients were considered to have none, mild, moderate, or severe hirsutism, respectively. Fourteen (8.5%) patients had developed recurrence. Recurrence developed in six patients with primary closure, five patients with Limberg flaps, two patients with Karydakis, and one with marsupialization. There was no statistical difference between recurrent and nonrecurrent patients in terms of BMI (P=0.054) and mFGS (P=0.921). On the other hand, BMI was statistically significantly higher in those who developed early postoperative complications than in those who did not (P<0.001). PSD is no longer a 'men's only disease'. BMI increases the risk of early postoperative complications, but this association was not found between BMI and recurrence. Prospective multicenter studies are needed on the relationship between PSD and hirsutism.

Association between attention deficit hyperactivity disorder and outcomes after metabolic and bariatric surgery: a nationwide propensity-matched cohort study.

The risks and benefits of metabolic and bariatric surgery for patients with attention deficit hyperactivity disorder (ADHD) remain to be investigated. The aim of this study was to assess short- and long-term outcomes after metabolic and bariatric surgery in patients with previous ADHD compared with matched control individuals. Registry based. This 2-staged matched-cohort study included all adults with a body mass index of ≥30 kg/m2 who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy from 2007 until 2017 registered in the Scandinavian Obesity Surgery Registry. Patients with prescribed medication for ADHD were matched with control individuals without ADHD with a follow-up of up to 11 years after surgery. Among 1431 patients with ADHD and 2862 control individuals (mean body mass index, 42 kg/m2; mean age, 35 years), no difference in weight loss or follow-up attendance over 2 years was seen. ADHD was associated with a higher risk for early postoperative complications (odds ratio [OR] = 1.31; 95% confidence interval [CI], 1.05-1.63), self-harm (hazards ratio [HR] = 1.39; 95% CI, 1.11-1.75), and substance abuse (HR = 1.34; 95% CI, 1.16-1.55), while associations with overall mortality (HR = 1.42; 95% CI, .99-2.03), major adverse cardiovascular and cerebrovascular events (HR = 1.93; 95% CI, .98-3.83), and effects on obesity-related diseases were uncertain. ADHD was associated with a lower health-related quality of life in all aspects before surgery. These differences increased for mental and obesity-related aspects but remained unchanged over time for physical aspects. Compared with patients without ADHD, patients treated pharmacologically for ADHD experience similar weight loss and remission of obesity-related diseases without an increased risk for serious complications but report a lower health-related quality of life and havean increased risk of substance abuse and self-harm. This further emphasizes the need for closefollow-up care for this group of individuals.

DOP89 Impact of biologics on the risk of early postoperative complications in Crohn’s disease: a French nationwide study

Abstract Background While the effect of anti-TNFs on postoperative outcomes in patients with Crohn’s disease (CD) has been widely studied, the impact of vedolizumab and ustekinumab on the risk of postoperative complications remains poorly known. Methods All consecutive patients who underwent intestinal resection for CD between July 2014 and April 2022 within 22 French centers were included in a retrospective cohort. The risk of early post-operative complications (≤30days) in patients exposed to biologics was compared to patients not exposed by logistic regression and propensity score-matched analysis adjusted for age, previous intestinal resection, corticosteroids or immunosuppressants exposure, disease activity, presence of abscess, urgent surgery and initial stoma (preoperative contra-indication to anastomosis). Results Among the 1201 patients included, respectively 491 (41%), 76 (6.3%) and 57 (4.7%) were exposed to anti-TNFs, ustekinumab, or vedolizumab within six months before surgery. A total of 317 (26.4%) patients had at least one complication of which 123 (38%) were considered as severe (DINDO III/IV). New surgery was necessary in 69 (5.7%) patients and secondary stoma in 23 (1.9%). Three deaths were observed (0.25%). The rates of overall complications in patients not exposed to biologics, exposed to anti-TNFs, ustekinumab or vedolizumab were respectively 26.1%, 25.1%, 34.7% and 29.8%. The risks of intra-abdominal infectious complications in these four groups were respectively 13.5%, 11.1%, 13.3% and 8.8%. In multivariate analysis, age [OR, 1.02 (1.01-1.04); p=0.004], disease activity [OR, 8.36 (1.79 – 149); p=0.037], the presence of an abscess [OR, 2.01 (1.25-3.20); p=0.004] and initial stoma [OR, 1.70 (1.10 –2.61); p=0.016] were significantly associated with intra-abdominal infectious complications. Conversely, preoperative enteral nutrition [OR, 0.12 (0.01 -0.59); p=0.040] was associated with a reduction in this risk. Exposure to anti-TNFs [OR, 0.80 (0.51-1.24); p=0.31], ustekinumab [OR, 1.17 (0.39-3.51); p=0.78] and vedolizumab [OR, 1.28 (0.32-5.17); p=0.72] within the 3 months before surgery were not associated with the risk of intra-abdominal infectious complications. Similar results were observed in patients exposed to these treatments in the month before surgery. Conclusion In this large cohort, a quarter of patients operated on for CD presented an early postoperative complication and 10% a severe complication. Preoperative exposure to anti-TNFs, vedolizumab or ustekinumab was not associated with an increased risk of early postoperative complications. Preoperative enteral nutrition was associated with a reduced risk of intra-abdominal infectious complication.

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

The safety and benefits of single stage bilateral total knee arthroplasty (SSBTKA) among older patients as compared to unilateral TKA remains controversial. This study aimed to evaluate the influence of age and comorbidities on complications and early outcomes for unilateral and BTKA in patients over and under 70years of age. This prospective study compared postoperative complications and early patient-reported outcomes at 6weeks of 142 unilateral TKA patients (N = 75, ≤ 70; N = 67, > 70) and 89 SSBTKA patients (N = 48, ≤ 70; N = 41, > 70). Patients completed the KOOS JR and PROMIS Global Mental (GMH) and Global Physical Health (GPH) surveys. Knee Society Scores for Knee (KSS-K) and Function (KSS-F) were completed in the clinic. Parametric tests were performed for comparisons of unilateral and BTKA outcomes and complications for patients over and under 70. While patient demographics were similar, patients > 70 had more comorbidities than patients ≤ 70 (p < 0.004). There were no significant differences in postoperative complications or readmissions between age groups or procedures. Unilateral TKA patients > 70 had significantly lower pre- (p < 0.001) and post-operative (p = 0.011) KSS-F scores compared to those ≤ 70. SSBTKA patients > 70 had significantly higher preoperative GMH (p = 0.029), postoperative KSS-K (p = 0.027), KOOS JR scores (p = 0.039) and satisfaction (p = 0.048) compared to those ≤ 70. Age did not influence the risk of early postoperative complications. Additionally, the greater improvements in KOOS JR and higher patient satisfaction for SSBTKA patients > 70 suggests that SSBTKA may meet elderly patient expectations and should not necessarily be discouraged due to safety concerns.

Obesity paradox among patients undergoing total knee arthroplasty: a retrospective cohort study

BackgroundObesity has been recognized as the risk factor for postoperative complication for surgical patients. However, recent studies have showed protective effect of obesity in surgical and non-surgical patients. Our study is to examine the association of body mass index(BMI) with early postoperative complications in patients undergoing total knee arthroplasty.Materials and methodsAll patients who had primary total knee arthroplasty between January 2014 and December 2019 were included. Medical records were retrospectively reviewed and BMI was categorized as underweight(BMI < 18.5), normal weight(18.5 < BMI < 24.9), overweight I(25 < BMI < 27.4), overweight II(27.5 < BMI < 29.9), obese I(30 < BMI < 34.9) and obese II(BMI ≥ 35). The association between BMI and occurrence of early postoperative complications was examined and logistic regression was used to calculate relationship between BMI and early postoperative complications.ResultsA total of 2969 patients were included in our analysis. The overall complication rate in patients undergoing total knee arthroplasty was 14.8%, with the highest complication being 22.2% in the underweight group, the second highest in the normal weight group(17.5%), the lowest in the overweight I(13.8%) and obese I(12.0%) group and then higher again in obese II group(16.7%). In multivariable analyses, overweight I (OR 0.737, 95% CI 0.559–0.972, P = 0.031) and obese I (OR 0.631, 95% CI 0.449–0.885, P = 0.008) were associated with lower risk of early postoperative complications after total knee arthroplasty.ConclusionIn this retrospective study, overweight and obese patients had a lower risk of early postoperative complications after total knee arthroplasty. Further studies are necessary to confirm and investigate the mechanism of obesity paradox in this surgical population.Trial registrationThis study had been registrated in www.chictr.org.cn on 25/10/2021 and the registration ID was ChiCTR2100052408.