Risk Of Secondary Surgery Research Articles

A case report of a bleeding case after removal of chest drain after lung surgery.

Postoperative bleeding after lobectomy is relatively rare. By analyzing and discussing the case history and management of hemorrhagic shock caused by chest tube removal after lobectomy, we can achieve the purpose of preventing postoperative bleeding after thoracic surgery and reducing postoperative complications, which can help avoid the risk of second surgery, shorten the patient's hospital stay, reduce the cost of medical care, and improve the patient's quality of life. A case of bleeding from tube removal after lobectomy. The bleeding from chest drain removal on the 3rd day after thoracoscopic lobectomy resulted in hemorrhagic shock, which was stopped by thoracoscopic exploration again under active antishock, and there was no recurrence of bleeding after the operation, and the patient was discharged from the hospital after chest drain removal. Enhanced computed tomography of the chest revealed a space-occupying lesion in the middle lobe of the right lung. Thoracoscopy was performed again on the condition of active anti-shock. On the third day after thoracoscopic lobectomy, the patient underwent removal of the chest drain and subsequently experienced hemorrhagic shock. Given the necessity of maintaining anti-shock measures, the patient was subjected to a second thoracoscopic exploration with the objective of halting the hemorrhage. Following this procedure, the patient did not present with any further episodes of bleeding. Subsequently, a new chest drain was placed, and once the drainage flow had diminished to an acceptable level, the chest drain was removed. The patient subsequently made a full recovery and was discharged from the hospital. Even if the safely inserted drain tube is removed, the thoracic surgeon must be aware of possible vascular bleeding.

Patient Preferences for Operative Versus Nonoperative Treatment of LC1 Pelvis Fracture: A Discrete Choice Experiment.

To quantify how patients with lateral compression type 1 (LC1) pelvis fracture value attributes of operative versus nonoperative treatment. Discrete choice experiment. Three US Level 1 trauma centers. Adult survivors of an LC1 pelvis treated between June 2016 and March 2023 were identified from institutional registries. The choice experiment was administered as a survey from March through August 2023. Participants chose between 12 hypothetical comparisons of treatment attributes including operative or nonoperative care, risk of death, severity of pain, risk of secondary surgery, shorter hospital stay, discharge destination, and independence in ambulation within 1 month of injury. The marginal utility of each treatment attribute, for example, the strength of participants' aggregate preference for an attribute as indicated by their survey choices, was estimated by multinomial logit modeling with and without stratification by treatment received. Four hundred forty-nine eligible patients were identified. The survey was distributed to 182 patients and collected from 72 patients (39%) at a median 2.3 years after injury. Respondents were 66% female with a median age of 59 years (IQR, 34-69 years). Before injury, 94% ambulated independently and 75% were working; 41% received operative treatment. Independence with ambulation provided the highest relative marginal utility (21%, P < 0.001), followed by discharge to home versus skilled nursing (20%, P < 0.001), moderate versus severe postdischarge pain (17%, P < 0.001), shorter hospital stay (16%, P < 0.001), secondary surgery (15%, P < 0.001), and mortality (10%, P = 0.02). Overall, no relative utility for operative versus nonoperative treatment was observed (2%, P = 0.54). However, respondents strongly preferred the treatment they received: operative patients valued operative treatment (utility, 0.37 vs. -0.37, P < 0.001); nonoperative patients valued nonoperative treatment (utility, 0.19 vs. -0.19, P < 0.001). LC1 pelvis fracture patients valued independence with ambulation, shorter hospital stay, and avoiding secondary surgery and mortality in the month after their injury. Patients preferred the treatment they received rather than operative versus nonoperative care.

Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis.

Revision surgery for OPLL is undesirable for both patients and physicians. However, the risk factors for reoperation are not clear. Thus, we sought to review the existing literature and determine the factors associated with higher reoperation rates in patients with OPLL. A search was performed using Pubmed, Embase, Web of Sciences, and Ovid to include studies regarding the risk factors of reoperation for OPLL. RoBANS (Risk of Bias Assessment tool for Nonrandomized Studies) was used for risk of bias analysis. Heterogeneity of studies and publication bias was assessed, and sensitivity analysis was performed. Statistical analysis was performed with a p-value < 0.05 using SPSS software (version 23). Twenty studies with 129 reoperated and 2,793 non-reoperated patients were included. The pooled reoperation rate was 5% (95% CI: 4% to 7). The most common cause of reoperation was residual OPLL or OPLL progression (n = 51, 39.53%). An increased risk of additional surgery was found with pre-operative cervical or thoracic angle(Standardized mean difference = -0.44; 95% CI: -0.69 to -0.19; p = 0.0061), post-operative CSF leak (Odds ratio, OR = 4.97; 95% CI: 2.48 to 9.96; p = 0.0005), and graft and/or hardware failure (OR = 192.09; 95% CI: 6.68 to 5521.69; p = 0.0101). Apart from the factors identified in our study, the association of other variables with the risk of second surgery could not be ruled out, owing to the complexity of the relationship and significant bias in the current literature.

Attitudes and understanding of premium intraocular lenses in cataract surgery: a public health sector patient survey.

To investigate patient understanding of, and attitudes to, premium (toric, extended depth of focus/multifocal) intraocular lenses (premIOLs) in public health sector patients undergoing cataract surgery (CS) in the UK. A 12 question survey with Likert scale questions was designed, to assess patient attitudes to post-operative spectacle dependence, refractive target and desirability of spectacle independence whilst considering possible complications of dysphotopsias and need for premIOL exchange/adjustment. 360 surveys were collected. CS had not been performed in 66.5%. Separate spectacles were worn for reading and distance in 28.8%, 19.2% had varifocals, 11.2% bifocals, 22.9% reading glasses only and 1.6% computer glasses only. Contact lenses were not worn in 95.7%. Only 41.6% were drivers. Most patients (85.8%) did not mind wearing glasses after CS, with 78.9% preferring reading glasses, compared with 29.7% preferring distance glasses. Most patients (75.3%) were not familiar with premIOLs, with 58.9% not willing to consider them in the context of a 2% risk of debilitating dysphotopsia and 54.2% rejecting a 5% risk of second surgery. There is a lack of awareness of premIOLs in public health sector (NHS) patients in the UK, suggesting limitations in the "fully informed" consent process for CS. Most NHS CS patients are currently willing to wear spectacles after CS, especially reading glasses. There is reluctance in such patients to consider premIOLs on a background of small risks of debilitating dysphotopsias and increased risks of a second operation.

DOP10 Early intestinal resection in Crohn’s Disease is not associated with severe long-term disease course

Abstract Background Crohn’s Disease patients (CD) with early complicated behaviour (stenosis and/or fistula) are thought to have a more severe long-term disease course. To address this question, we focused on ileal CD that requires early intestinal resection after diagnosis. We aimed to assess the impact of the time to surgery from diagnosis on the risk of severe disease course in patients with ileal CD undergoing a primary ileocecal resection (ICR) or ileal resection (IR). Methods All CD patients who underwent ICR or IR between January 2001 and December 2015 and followed in two Inflammatory Bowel Disease (IBD) tertiary centres in France were included. Data were retrieved using dedicated IBD database and patients’ medical records. Early resection was defined as a surgery performed within 6 months after diagnosis. Two control groups with patients who underwent the first surgery between 6 months and 2 years and between 2 and 5 years after diagnosis were enrolled. The primary outcome was second intestinal resection. Secondary outcomes included the need for biologic treatments after initial intestinal surgery. Patients were followed from the date of first surgery until September 2022. Kaplan Meier survival analysis and log-rank test were used to estimate the survival without second intestinal resection and biologic initiation according to the time of first intestinal resection to diagnosis. Results Among 404 patients who underwent ICR or IR within 5 years after diagnosis, 130 (32.2%) patients had undergone surgery within 6 months after diagnosis (Group A), 138 (34.2%) patients between 6 months and 2 years (Group B) and 136 (33.7%) patients between 2 and 5 years (Group C). Clinical data are shown in Table 1. The cumulative risk of a second ICR or IR ten years after the first surgery was 25.2% (95% CI 12.5 - 40.2) in group A, 16.6% (5.1 - 33.9) in group B and 22.8% (9.8 – 39.1) in group C, without statistically significant difference (p = 0.25) (Figure 1). The risk of biological exposure after the first surgery was not significantly different in the three groups (p = 0.12) (Figure 2). The cumulative risk to start a biologic therapy at ten years was 46.2% (35.0 – 56.6) in group A, 39.0% (26.2 – 51.5) in group B and 48.0% (36.3 – 58.8) in group C. Conclusion In a bicentric cohort with long-term follow-up, intestinal resection within 6 months of CD diagnosis was not associated with an increased risk of second surgery as compared to patients with primary ICR/IR later after diagnosis. Furthermore, patients with early intestinal resection did not need more biological therapies after the first surgery. These data suggest that early intestinal resection in CD is not a predictor of poor long-term prognosis compared to late resection.

Development and Validation of a Nomogram for Predicting Second Surgery in Patients with Concomitant Esotropia.

This study developed and validated a nomogram for predicting the risk of second surgery in patients with concomitant esotropia (CE) based on a cohort in Beijing. In this retrospective cohort study, the inpatient and outpatient medical records of 419 patients with CE who underwent surgery at the Peking University First Hospital between January 1, 2005 and December 31, 2009 were collected. A total of 357 CE cases were included. For those cases 70% were randomly assigned to the training set (n = 234) and 30% to the validation set (n = 123). Demographic and clinical variables were ascertained at hospital admission and discharge and screened using multivariate Cox proportional hazards regression analysis to construct predictive models and generate a 1-, 4-, and 8-year overall survival nomogram. This nomogram provided an estimate of the risk of second surgery in patients with surgically treated CE. Internal validation was conducted using the concordance index (C-index) and calibration curve for the training and validation sets. Six independent prognostic factors were identified, namely age at surgery, age at onset, amblyopia, deviation angles, surgical amount, and deviation angles 1week after surgery, and these were entered into the nomogram. The proposed nomogram showed favorable discrimination and accuracy in the training and validation sets. The C-indexes of the training and validation sets were 0.84 (95%CI 0.79-0.89) and 0.80 (95%CI 0.78-0.82), respectively. The proposed nomogram can serve as a predictive tool for prognostic evaluation of CE surgery.

Long-Term Survivorship of Cervical Spine Procedures; A Survivorship Meta-Analysis and Meta-Regression.

Systematic Review. To conduct a meta-analysis on the survivorship of commonly performed cervical spine procedures to develop survival function curves for (i) second surgery at any cervical level, and (ii) adjacent level surgery. A systematic review of was conducted following PRISMA guidelines. Articles with cohorts of greater than 20 patients followed for a minimum of 36 months and with available survival data were included. Procedures included were anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (ADR), laminoplasty (LAMP), and posterior laminectomy and fusion (PDIF). Reconstructed individual patient data were pooled across studies using parametric Bayesian survival meta-regression. Of 1829 initial titles, 16 citations were included for analysis. 73811 patients were included in the second surgery analysis and 2858 patients in the adjacent level surgery analysis. We fit a Log normal accelerated failure time model to the second surgery data and a Gompertz proportional hazards model to the adjacent level surgery data. Relative to ACDF, the risk of second surgery was higher with ADR and PDIF with acceleration factors 1.73 (95% CrI: 1.04, 2.80) and 1.35 (95% CrI: 1.25, 1.46) respectively. Relative to ACDF, the risk of second surgery was lower with LAMP with deceleration factor .06 (95% CrI: .05, .07). ADR decreased the risk of adjacent level surgery with hazard ratio .43 (95% CrI: .33, .55). In cases of clinical equipoise between fusion procedures, our analysis suggests superior survivorship with anterior procedures. For all procedures, laminoplasty demonstrated superior survivorship.

Analysis of the Influencing Factors of Sentinel Lymph Node Metastasis in Breast Cancer.

Objective To analyze and discuss the influencing factors of sentinel lymph node metastasis in breast cancer. Methods A total of 469 breast cancer patients admitted in the Department of Pathology of Guangdong Women and Children Hospital from October 2016 to December 2021 were retrospectively analyzed. The general information, immunohistochemical expression, tumor molecular subtype, tumor size, histological grade, pathological type, and tumor location were collected and the relationship with sentinel lymph node metastasis was analyzed. Results For patients with different age, Ki-67 and Human epidermal growth factor receptor-2 (HER-2) immunohistochemical expression level (invasive cancer), molecular subtype (invasive cancer), tumor size, histological grade (invasive cancer) and pathological type. The results of multivariate logistic regression analysis showed that the age was less than or equal to 40 years; the molecular subtype was Luminal B and HER-2 overexpression (invasive cancer); tumor was larger; the histological grade (invasive cancer) was higher; the pathological type was invasive carcinoma, there were independent risk factors for sentinel lymph node metastasis in breast cancer. The sentinel lymph node metastasis rates of invasive lobular carcinoma, invasive micropapillary carcinoma, and metaplastic carcinoma (all met the criteria for squamous cell carcinoma and histological grade III) were higher than 50% in special invasive carcinomas. Conclusion Age, expression level of Ki 67 and HER-2, molecular typing, tumor volume and histological grade are all high-risk factors related to sentinel lymph node metastasis of breast cancer. When one or more of the above factors are involved in an examination, pathologists should be more cautious in making a sentinel lymph node frozen diagnosis. By standardizing the sampling and increasing the number of frozen sections (slicing more frozen tissue layers), the section quality can be improved. This may be conducive to reducing the false negative rate and reducing the pain and risk of secondary surgery.

Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee.

Septic arthritis is an orthopaedic emergency with high morbidity and mortality. The aim of this study is to determine the risk factors associated with secondary surgery for septic arthritis of the native knee joint. This is a retrospective study reviewing all patients who underwent surgery for septic arthritis of the knee from 2012 to 2019 in a single institution. A total of 117 patients were recruited. Patients were divided into 2 groups: Group I (79/117, 67.5%) underwent one surgery and Group II (38/117, 32.5%) underwent more than one surgery. Patients with a raised initial total white (TW) cell count of > 20 × 109/L had a significantly higher risk of secondary surgery. (Adjusted hazard ratio 2.42, p < 0.05) A decline of CRP level of less than 20% within 24h from initial operation was also a risk for secondary surgery. (Adjusted hazard ratio 0.34, p < 0.01) Patients in group II also had significantly higher post-operative median TW cell count and neutrophil count. There was no significant difference in the offending microbe, surgical approach, and duration of operation from initial presentation between the groups. Patients with septic arthritis of the native knee joint who present with raised initial total white cell count of > 20 × 109/L and decline of CRP level of less than 20% within 24h from initial operation are at higher risk of secondary operation. In these patients, more aggressive treatment strategies and appropriate counselling on the risks of repeated surgery are recommended. Level IV.

Lisfranc injuries: fix or fuse? : a systematic review and meta-analysis of current literature presenting outcome after surgical treatment for Lisfranc injuries.

AimsThis systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available.MethodsA systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis.ResultsA total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively.ConclusionThis is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making.Level of Evidence: ICite this article: Bone Jt Open 2021;2(10):842–849.

SURG-10. GRADE TWO GLIOMA SURGERY - A LARGE SINGLE CENTRE REVIEW OF CLINICAL, HISTOLOGICAL, GENETIC AND SURGICAL OUTCOMES

Abstract We analysed the surgical outcomes in a large series of operated grade two glioma patients with emphasis on surgical resection volumes, histology, genetics and survival. All adult glioma patients (200) operated between 2009 and 2016 with histological confirmation of grade two glioma from a single United Kingdom unit were included. Baseline clinical data was obtained along with radiological assessment of the extent of tumour resection, histological diagnosis, mutation status and survival data. Univariate and multivariate statistical analysis was performed. Preliminary analysis of an initial 63 patients had an average follow up of 51 months. A mean tumour resection of 73.9% (Range 14.4–100%), with an average pre-operative tumour volume of 42.2cm3 was achieved. 48 patients underwent awake surgery. There was no significant difference between pre-operative Karnofsky score (93.0) and post-operative (91.6) function. IDH-mutant diffuse astrocytoma (55.5%), IDH-mutant 1p19q co-deleted oligodendroglioma (33.3%) and IDH wildtype diffuse astrocytoma (14.3%) were the commonest histological diagnoses. 32 patients underwent post-operative adjuvant oncology treatment, with 22 requiring repeat operation. Extent of resection in repeat surgeries was 58.6%. Preliminary statistical analysis on this initial sample has demonstrated that every additional year of age at diagnosis however is associated with a 0.5% reduction in resection (p=0.02) and a 0.2% decline in Karnofsky performance (p=&amp;lt; 0.01). Patients with 1p19q co-deletion had a significant increase in progression free survival (PFS) (p=0.04). No significant variables were found to predict the risk of second surgery. Patients with eloquent tumour locations were significantly less likely to suffer post-operative neurological deficits (p&amp;lt; 0.01) Provisional analysis of our case series demonstrates an excellent extent of resection for our cohort of grade two glioma patients. 1p19q co-deletion in this group was significantly associated with improved PFS. Full analysis of the entire patient cohort will be available in time for presenting.

Comparison on curative effect of posterior decompression pedicle screw fixation and single posterior pedicle screw fixation for thoracolumbar fracture with greenstick lamina fracture

Objective To investigate the efficacy of posterior decompression pedicle screw fixation and single pedicle screw fixation for thoracolumbar fracture with greenstick lamina fracture. Methods A retrospective case series study was conducted to analyze the clinical data of 106 patients with thoracolumbar fractures combined with greenstick lamina fractures admitted to the 909th hospital from January 2011 to May 2016. There were 68 males and 38 females, aged 21-58 years [(39.5±7.1)years]. The fracture was located at T11 in 9 patients, at T12 in 6, at L1 in 28, at L3 in 11. A total of 58 patients underwent posterior decompression pedicle screw fixation including 37 males and 21 females, aged 23-58 years [(38.7±6.6)years]. The preoperative neurological function was evaluated according to ASIA grade: grade A for three patients, grade B for nine, grade C for 14, grade D for 27, and grade E for 53 patients. A total of 48 patients were treated with single posterior pedicle screws fixation including 31 males and 17 females, aged 21-57 years [(41.4±5.8)years]. Statistical indicators included operation time, intraoperative blood loss, anterior height ratio of injured vertebrae, sagittal Cobb angle, visual analogue scale (VAS), ASIA grading, dural tears and/or cauda equina entrapment, and complications. Results All patients were followed up for 24-72 months [(30.2±4.7)months]. The operation time ranged from 105 to 137 minutes [(113.5±21.3)minutes], and the intraoperative blood loss was 235-310 ml [(252.2±28.6)ml] in the posterior decompression and pedicle screws fixation group. In the posterior pedicle screw fixation group, the operation time ranged from 52 to 85 minutes [(65.3±9.6)minutes], and the intraoperative blood loss was 72-125 ml [(90.2±23.6)ml]. The anterior height ratio of injured vertebrae, sagittal Cobb angle and VAS score of the two groups were significantly improved immediately after operation and at the last follow-up (all P<0.01). At one year follow up, the ASIA grading in patients treated with single posterior pedicle screw fixation remained the same while the ASIA grading of patients treated with posterior decompression pedicle screw fixation was significantly improved compared with before operation. Dural tears were found in 12 patients and cauda equina entrapment were found in five patients during decompression. Three patients had neurological function injury after posterior pedicle screw internal fixation surgery, and they received a second decompression operation. Dural tears and/or cauda equina entrapment were subsequently found in all of the three patients. No complications related to internal fixation occurred during follow-up. Conclusions Both posterior decompression pedicle screw fixation and single pedicle screw fixation can effectively correct the kyphosis deformity, restore vertebral body height, and relieve pain in the treatment of thoracolumbar fracture with greenstick lamina fracture. Dural tears and/or cauda equina entrapment might be subsequently found in greenstick lamina fracture. Posterior pedicle screw fixation can not release the entrapped cauda nerve, so attention should be paid to the risk of secondary surgery. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal

Effect of age on radiographic outcomes of patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction.

This study aimed to investigate the effect of age on the rates of redislocation, avascular necrosis (AVN) of the femoral head, and final radiographic outcomes in patients with developmental dysplasia of the hip (DDH) treated with closed reduction. A total of 308 hips (276 patients) with DDH treated with closed reduction were included and divided into three groups according to age (<12, 12-18, 18-24 months). Tönnis grade, rate of redislocation and AVN, Severin radiographic grade, and risk of surgery were evaluated on radiographs. Tönnis grade significantly increased with age (P < 0.001). Redislocation occurred in 17 (5.5%) and AVN occurred in 36 (11.7%) hips. The rate of redislocation and AVN was similar among the three age groups in all Tönnis grades. However, redislocation rate significantly increased with Tönnis grade (P = 0.027). Overall, 246 hips (79.9%) had satisfactory final outcomes, and 62 hips (20.1%) had unsatisfactory outcome; no difference was observed among three age groups. A total of 103 hips (33.4%) were found to be at risk for secondary surgery. The surgical risk (25%) in patients younger than 12 months was lower than that of older patients (12-18 months: 34.4%; 18-24 months: 37.9%). Logistic regression analysis also confirmed that age was not a risk factor for redislocation, AVN, or poor radiographic outcome. In conclusion, age has no significant impact on redislocation and AVN in patients aged 6-24 months with DDH treated by closed reduction. Although older patients have a higher risk developing residual acetabular dysplasia, secondary pelvic surgery provides favorable outcomes in most patients.

Return to Sport and Re-Operation Rates in Athletes Under the Age of 20 Following Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing Three Patient Groups Predicated Upon Skeletal Age

Objectives:ACL injury in the skeletally immature athlete has become an increasingly significant clinical problem in recent years. The high-risk population of athletes less than 20 years of age has the lowest return to sport (RTS) rates and highest second surgery rates following ACL reconstruction (ACLR). The purpose of this prospective study is to evaluate the two-year clinical outcomes of three groups of primary ACLR in pediatric and adolescent athletes under the age of 20 based on skeletal age, school grade distribution and ACLR technique with a focus on RTS and incidence of second surgery. We hypothesize that the youngest (Group 1) and oldest (Group 3) cohorts will have lower revision ACL rates and higher RTS rates compared to the middle (Group 2) cohort of athletes.Methods:306 patients less than 20 years of age underwent primary ACLR in the senior authors’ practice. Group 1 had 3-6 years of growth remaining and was comprised of lower and middle school athletes through 7th grade. Group 1 athletes received an all-epiphyseal (AE) hamstring autograft ACLR. Group 2 had 2-3 years of growth remaining and included predominantly 8th and 9th grade athletes. Group 2 was treated with either a partial transphyseal (PTP) or complete transphyseal (CT) hamstring autograft ACLR. Group 3 included skeletally mature high school & collegiate athletes treated with a CT ACLR using a bone-tendon-bone (BTB) autograft. Preoperative demographics, sport, mechanism of injury, intraoperative findings, RTS and second surgery data were collected. Athletes were followed for a minimum of 24 months with serial clinic visits.Results:The three cohorts included 47 athletes (15%) in Group 1 (mean age: 12.0 + 1.5y), 64 athletes (21%) in Group 2 (mean age: 14.3 + 1.3y), and 195 athletes (64%) in Group 3 (mean age: 16.2 + 1.8y). The rate of revision ACL was higher in Group 2 at 20% (13/64 athletes) as compared to Group 1 at 6% (3/47 athletes) and Group 3 at 6% (11/195 athletes) (p= 0.001). Group 2 athletes had a significantly lower RTS at 86% as compared to Groups 1 and 3 at 100% and 94% respectively (p=0.009). Group 2 athletes also had a significantly lower RTS at the same level 75% as compared to Groups 1 and 3 at 96% and 82% respectively (p=0.017). Using multivariate logistic regression, Group 2 athletes were nearly 5 times more likely to have a Revision ACLR compared to Group 3 BTB athletes (OR: 4.92, 95% CI: 1.19 - 20.34, p=0.028). Females were nearly 3 times more likely to have a contralateral ACLR as compared to males (OR: 2.83, 95% CI: 1.09 - 7.34, p=0.033).Conclusion:As we hypothesized, the rate of revision ACLR and overall incidence of second surgery was higher and the RTS rate lower in Group 2 athletes compared to Groups 1 and 3 athletes. Group 2 athletes may be at higher risk because upon completion of their rehabilitation and RTS clearance process they are joining a cohort of competitive, now skeletally mature high school athletes who have not lost a year of athletic competition and development of sport-specific skills. Ultimately, the athlete’s skeletal age determined the choice of surgical technique, but the grade levels noted above demarcated the three surgical cohorts with only a few outliers. We believe grade level is important as this will most often dictate the level of competition that the athlete in question is exposed to after recovery and return to sport. This age and school grade risk profile is useful to counsel athletes and parents preoperatively regarding the expectations of surgery with regard to RTS and the risk of second surgery.

Analysis of the benefits and risks of 1 to 4 centimetre well-differentiated thyroid carcinoma with lobectomy

Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery. Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC (May 2014 to June 2015) were retrospectively reviewed, and the patients with preoperatively known high-risk characteristics were excluded. One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines. The proportion of patients who need secondary surgery was estimated basing on pathological characteristics. Result In this group, 49% patients would have to undergo a secondary surgery if they took lobectomy as the initial operation. Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery. Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation. Key words: Thyroid neoplasms; Guidebooks; Two-stage thyroidectomy; Treatment outcome

The Americleft Project: Burden of Care from Secondary Surgery.

Background:The burden of care for children with cleft lip and palate extends beyond primary repair. Children may undergo multiple secondary surgeries to improve appearance or speech. The purpose of this study was to compare the use of secondary surgery between cleft centers.Methods:This retrospective cohort study included 130 children with complete unilateral cleft lip and palate treated consecutively at 4 cleft centers in North America. Data were collected on all lip, palate, and nasal surgeries. Nasolabial appearance was rated by a panel of judges using the Asher-McDade scale. Risk of secondary surgery was compared between centers using the log-rank test, and hazard ratios estimated with a Cox proportional hazards model.Results:Median follow-up was 18 years (interquartile range, 15–19). There were significant differences among centers in the risks of secondary lip surgery (P < 0.001) and secondary rhinoplasty (P < 0.001). The cumulative risk of secondary lip surgery by 10 years of age ranged from 5% to 60% among centers. The cumulative risk of secondary rhinoplasty by 20 years of age ranged from 47% to 79% among centers. No significant differences in nasolabial appearance were found between children who underwent secondary lip or nasal surgery and children who underwent only primary surgery (P > 0.10).Conclusions:Although some cleft centers were significantly more likely to perform secondary surgery, the use of secondary surgery did not achieve significantly better nasolabial appearance than what was achieved by children who underwent only primary surgery.

Tobacco use as a risk factor for reoperation in patients with stress urinary incontinence: a multi-institutional electronic medical record database analysis.

Recurrence rates of stress urinary incontinence after surgery are reported to be between 8 to 15%. Both surgical technique and non-surgical risk factors have been shown to affect post-operative outcomes. Tobacco use is a possible risk factor that may increase the surgical failure rate, however, there are currently conflicting reports in the literature regarding the affect of tobacco use on surgical outcomes. Our objective is to evaluate the effect of tobacco use on the risk of repeat surgery for stress urinary incontinence (SUI). We performed a retrospective cohort analysis using a de-identified clinical database from a large multi-institution electronic health records data web application EPM:ExploreTM (Explorys Inc, Cleveland, Ohio) to identify women with and without a history of tobacco use who underwent reoperation for stress urinary incontinence within 2 years of the first surgery. We then evaluated previously described risk factors for reoperation: diabetes mellitus (DM), pelvic organ prolapse (POP), anti-muscarinic (AM) use at initial surgery, obesity, and advanced age on rate of reoperation and the impact of tobacco use on these risk factors. Tobacco use was associated with an increased rate of a second surgery for SUI (OR=1.43, p <0.001), as was anti-muscarinic use (OR = 1.68, p<0.001), DM (OR = 1.21, p = 0.005), age >50 years (OR= 1.16, p = 0.040), and BMI > 30 kg/m2 (OR = 2.97 p<0.001). The odds of a second surgery for SUI in patients who used tobacco and anti-muscarinic medications or had pelvic organ prolapse were lower when compared to non-users. The odds of a second surgery for SUI were higher in patients who used tobacco and had asthma when compared to non-users who had asthma. Tobacco increases the overall risk of second surgery for SUI, however, in patients with specific risk factors, tobacco use is associated with a decrease risk of reoperation.

Timing of Pharmacological Treatment for Patent Ductus Arteriosus and Risk of Secondary Surgery, Death or Bronchopulmonary Dysplasia: A Population-Based Cohort Study of Extremely Preterm Infants

Background: The optimal timing of pharmacological treatment for patent ductus arteriosus (PDA) in extremely preterm infants is unknown. Objective: To investigate whether timing of pharmacological PDA treatment is associated with a risk of secondary PDA surgery or death before 3 months of age, or bronchopulmonary dysplasia (BPD) in extremely preterm infants. Methods: In this population-based cohort of infants born before 27 gestational weeks in Sweden in 2004-2007, 290/585 infants (50%) received pharmacological PDA treatment. Cox proportional hazards regression estimated the hazard ratio (HR, with 95% confidence interval, CI) of secondary PDA surgery or death as a composite outcome in relation to postnatal age at the start of pharmacological treatment: early (0-2 days); intermediate (3-6 days); late (≥7 days). Furthermore, the odds ratio (OR, with 95% CI) of BPD was estimated in relation to postnatal age at PDA treatment by conditional logistic regression. Results: The median postnatal age at the start of pharmacological PDA treatment was 4 days. 102 infants had secondary PDA surgery. Timing of PDA treatment was not associated with risk of PDA surgery or death; adjusted HRs were 0.89 (95% CI 0.57-1.39) after an intermediate start and 1.10 (95% CI 0.53-2.28) after a late start, compared to an early start of treatment. Compared to the early start of PDA treatment, the intermediate start was not associated with any risk of BPD, while late PDA treatment was associated with a lower BPD risk; adjusted ORs were 0.83 (95% CI 0.42-1.64) and 0.28 (95% CI 0.13-0.61), respectively. Conclusion: Timing of pharmacological PDA treatment after extremely preterm birth is not associated with the risk of secondary PDA surgery or death. Moreover, expectant PDA management is not associated with an increased risk of BPD. © 2014 S. Karger AG, Basel

Simultaneous Bilateral Video-Assisted Thoracoscopic Surgery for the Treatment of Primary Spontaneous Pneumothorax.

We determined the feasibility and clinical efficacy of simultaneous bilateral video-assisted thoracoscopic surgery (VATS) for treating primary spontaneous pneumothorax (PSP). We performed a retrospective analysis of the efficacy of simultaneous bilateral resection of pulmonary bullae using VATS in 21 PSP patients that were treated at our hospital from February 2010 to August 2013. We found bilateral bullae in all patients through the intraoperative exploration. Surgical procedures were successfully completed in all patients without conversion to thoracotomy. The mean time of surgery was 128.76 ± 13.82 min (range 100–150 min). Total amount of intraoperative bleeding was 80–200 ml. Total drainage of bilateral thoracic ducts was 200–500 ml at the 1st postoperative day with a mean drainage of 321.42 ± 82.66 ml. Bilateral thoracic ducts were removed 4–8 days postoperatively with a mean time of 4.7 days. The duration of postoperative hospitalization was 5–9 days with a mean duration of 7 days. No patient had serious complication(s) and all patients were discharged after full recovery. The patients were followed up for 6–18 months after the surgery and no relapse occurred. In conclusion, treating the unilateral PSP by simultaneous bilateral VATS is safe and effective. It reduces patients’ risk of second surgery and also minimizes patients’ suffering and costs incurred.

Analysis of the causes of reoperation and countermeasures of intra-and extrahepatic bile duct stones after op-eration

Objective To explore the extrahepatic bile duct stones after reoperation cause analysis and coun-termeasures.Methods Clinical data of 150 patients with liver surgery gallstone surgery again were retrospectively analyzed,according to the first reason for liver from gallstone surgery will be divided into the three groups：group hepa-tolithiasis （ group A,100 cases） ,gallstones group （ group B,30 patients） ,common bile duct stones group （ group C, 20 cases） .The reasons for reoperation were analyzed.Results In intrahepatic bile duct stones reoperation patients, the recurrence of liver gallstones was 98 cases（65.3%）,common bile duct cysts and Caroli disease was 35 cases （23.3%）,anastomotic stenosis in 17 cases（11.3%）;The postoperative complication rate of group A（44.0%） was significantly higher than that of group B（13.3%） and group C（15.0%）（χ2 =9.32,5.88,all P〈0.05）;The sec-ondary and post-operative inflammation stone recurrence within 5 years of group A was 32.0%,which was significant-ly higher than 6.7%of group B and 10.0%of group C（χ2 =7.67,3.97,all P〈0.05）.Conclusion The intrahe-patic bile duct stones are the main types of reoperation after liver gallstones,gallstones and liver recurrence is the main cause of its secondary surgery.It should be make clear the disease cause of preoperation, take a different surgical options for patients with different types of stones,prevention,and avoid the occurrence of postoperative complications, which can effectively reduce the risk of secondary surgery to alleviate the suffering of patients. Key words: Calculi Bile Ducts; Intrahepatic Bile Ducts; Extrahepatic Reoperation