Risk Of Surgical Complications Research Articles

Effects of malnutrition on outcomes of patients with femoral head osteonecrosis undergoing total hip arthroplasty: A population-based study.

This study aimed to evaluate the impact of malnutrition on in-hospital outcomes in patients undergoing total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). This population-based retrospective study extracted data of patients undergoing THA for ONFH in the US National Inpatient Sample between 2005 and 2018. Factors associated with in-hospital mortality, medical and surgical complications, unfavorable discharge, and prolonged hospital stay were determined by logistic regression analysis. A total of 72,304 adults ≥18 years old with nontraumatic ONFH admitted for primary THA were included. Malnutrition was detected in 7152 (9.9%) patients using validated discharge codes. In-hospital mortality was 0.8% vs 0.1% for patients who were malnourished vs nonmalnourished. After adjusting for confounders, malnutrition was significantly associated with an increased risk of in-hospital death (adjusted odds ratio [aOR], 4.67; 95% CI, 2.43-8.97), medical complications (aOR, 1.49; 95% CI, 1.32-1.68), surgical complications (aOR, 1.78; 95% CI, 1.61-1.96), unfavorable discharge (aOR, 1.24; 95% CI, 1.11-1.39), and prolonged hospital stay (aOR, 1.90; 95% CI, 1.67-2.16) compared with adequate nutrition. Malnutrition was also associated with higher total hospital costs (adjusted β = $9620; 95% CI, 7.87-11.36). Furthermore, the association between malnutrition, any medical or surgical complications, and unfavorable discharge was stronger in patients younger than 50 years than those ≥50 years old. In US patients undergoing primary THA for ONFH, malnutrition increases the risk of unfavorable in-hospital outcomes. This patient subgroup may require special attention and better strategies to improve perioperative care.

Perioperative optimization and profitability (POP) in a high-volume bariatric surgery center.

Currently, bariatric surgery is the most effective long-term treatment of obesity. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the primary types of bariatric surgery performed worldwide. To minimize the risks of surgical complications and optimize cost-effectiveness, it is essential to develop fast-track protocols and patient logistics. At Aleris Hospitals in Denmark, a fast-track methodology in bariatric surgery has been implemented and continuously optimized over the last 15years. The main objective was to demonstrate timelines recorded during one consecutive year in a fast-track, high-volume bariatric surgery setting after logistic optimization. This study included 949 consecutive patients who had undergone primary bariatric surgery in 2021. The primary outcomes were length of hospital stay and perioperative timeline recordings that were prospectively collected. The secondary outcomes were mortality, complication rates, and weight loss data. The vast majority of our patients (99.1%) were discharged from the hospital within the day after surgery. The median total surgery time was 30min, after 12min of patient preparation and with a turnover time between patients of seven min. The median knife-to-knife time in one operating room was 56min. Mortality was zero, 30-day reoperation rate was 1.2%, and 30-day readmission rate was 0.8%. SG and RYGB patients had an excess weight loss after four months of 45.6% and 57.9%, respectively. Implementation of fast-track principles in the clinical practice of bariatric surgery allows for an optimized, cost-effective surgical organization supporting the quality of procedures and patient safety.

Breast tissue density as a predictor of complications in reconstructive and plastic surgery

Aesthetic breast surgery is consistently a leading position in plastic surgery. According to the International Society of Aesthetic Plastic Surgery (ISAPS), in 2019, 1 795 551 breast augmentations were performed. However, as the number of primary surgeries increases, so does the percentage of complications and consequent patient dissatisfaction with the primary intervention results. Approximately 20% of women experience postoperative complications, such as breast asymmetry, implant displacement, double fold (“double bubble”), rippling, capsular contracture, seroma, hematoma, suture dehiscence, and others. Women with decreased breast tissue tone due to postinvolutive changes are at risk for postoperative complications. The risk of complications also increases when not just breast augmentation, but a combination of augmentation and mastopexy is required. In most cases, when a surgical intervention is recommended in several stages, patients are not willing to wait for a long time. This group of women is the most difficult for the clinician and therefore requires an analysis of all possible risk factors for complications development. Therefore, finding new possible ways to predict complications in reconstructive and plastic breast surgery is a relevant and priority direction.Purpose of a study: to develop a technique for preventing complications in reconstructive and plastic breast surgery.Material and methods. The results of 37 breast augmentation surgeries with T-shaped mastopexy in patients with different breast tissue density were analyzed, based on which an improved method of this operation was proposed. A comparative analysis of postoperative complications in early and late postoperative periods was carried out, and patients were surveyed before breast reconstruction and plastic surgery and 3, 6, and 12 months after plastic surgery to evaluate patient satisfaction with the outcome.Results. The analysis of the obtained data showed that breast tissue density plays a key role in choosing the tactics of breast augmentation with T-shaped mastopexy and is a predictor of complications development in the postoperative period.Conclusion. The planning of breast augmentation with T-shaped mastopexy should be carried out taking into account the determination of a patient's breast tissue density, which can affect the reduction of the risk of surgical complications during the surgery and in the postoperative period. The use of mastopexy technique with a preliminary marking of incisions with a margin of 1 cm to the central line from the classical V-shaped marking line is expedient in the presence of dense breast tissue in the patient.

Impact of preoperative frailty on the surgical and survival outcomes in older patients with solid cancer after elective abdominal surgery

Frailty is common in older patients with cancer; however, its clinical impact on the survival outcomes has seldom been examined in these patients. This study aimed to investigate the association of frailty with the survival outcomes and surgical complications in older patients with cancer after elective abdominal surgery in Taiwan. We prospectively enrolled 345 consecutive patients aged ≥65 years with newly diagnosed cancer who underwent elective abdominal surgery between 2016 and 2018. They were allocated into the fit, pre-frail, and frail groups according to comprehensive geriatric assessment (CGA) findings. The fit, pre-frail, and frail groups comprised 62 (18.0%), 181 (52.5%), and 102 (29.5%) patients, respectively. After a median follow-up of 48 (interquartile range, 40-53) months, the mortality rates were 12.9%, 31.5%, and 43.1%, respectively. The adjusted hazard ratio was 1.57 (95% confidence interval [CI], 0.73-3.39; p=0.25) and 2.87 (95% CI, 1.10-5.35; p=0.028) when the pre-frail and frail groups were compared with the fit group, respectively. The frail group had a significantly increased risk for a prolonged hospital stay (adjusted odds ratio, 2.22; 95% CI, 1.05-4.69; p=0.022) compared with the fit group. Pretreatment frailty was significantly associated with worse survival outcomes and more surgical complications, with prolonged hospital stay, in the older patients with cancer after elective abdominal surgery. Preoperative frailty assessment can assist physicians in identifying patients at a high risk for surgical complications and predicting the survival outcomes of older patients with cancer.

Ensuring our exstrophy-epispadias complex patients and families thrive.

Individuals with bladder exstrophy-epispadias complex (EEC) need long-term integrated medical/surgical and psychosocial care. These individuals are at risk for medical and surgical complications and experience social and psychological obstacles related to their genitourinary anomaly. This care needs to be accessible, comprehensive, and coordinated. Multiple surgical interventions, reoccurring hospitalizations, urinary and fecal incontinence, extensive treatment regimens for continent diversions, genital differences, and sexual health implications affect the quality of life for the EEC patient. Interventions must include psychosocial support, medical literacy initiatives, behavioral health services, school and educational consultation, peer-to-peer opportunities, referrals to disease-specific camps, mitigation of adverse childhood events (ACEs), formal transition of care to adult providers, family and teen advisory opportunities, and clinical care coordination. The priority of long-term kidney health will necessitate strong collaboration among urology and nephrology teams. Given the rarity of these conditions, multi-center and global efforts are paramount in the trajectory of improving care for the EEC population. To achieve the highest standards of care and ensure that individuals with EEC can thrive in their environment, multidisciplinary and integrated medical/surgical and psychosocial services are imperative.

Obesity does not increase the risk of side effects and complications of egg retrieval: delaying oocyte retrieval in obese patients is not a good strategy.

Obesity is one of the main concerns for public health and is becoming an increasingly widespread problem worldwide. Women are more likely to require a cesarean section and have a longer hospital stay after delivery. Excess body weight can interfere with ovulation and make it more difficult for embryos to implant in the uterus. A high body mass index (BMI) has controversial effects on the outcomes of medically assisted reproduction treatments (IVF) and, if careful counseling is not performed, medical-legal risks may be incurred. While some researchers argue that obesity does not particularly affect ART outcomes, other studies claim that a high BMI does not interfere with embryonic development. Both the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) has stated that there is no clear evidence supporting a BMI limit for IVF treatment and that each patient should be evaluated on an individual basis. The purpose of our study was to evaluate whether performing in vitro fertilization on these patients increases the risk of medical, surgical, and anesthetic complications of oocyte retrieval. From January 2011 to December 2022, all patients with BMI higher than 25 were enrolled in the study (n=766). Complications and risks related to oocyte retrieval were evaluated, and patients were divided according to BMI groups. With the one-way ANOVA test, all groups were compared with the control group, and none showed statistically significant differences, only the number of produced embryos in the BMI group between 30-34.9 was lower and statistically significant. Only one study has analyzed these aspects, mainly focusing on the need for anesthesia drugs and any related complications, and the same author reported greater difficulty in performing oocyte retrieval. The same study recorded an increase in incomplete oocyte retrievals. Our work does not confirm any of these impressions.

Increased rate of complications following total knee arthroplasty in patients with systemic sclerosis.

Outcomes after total knee arthroplasty (TKA) for patients with systemic sclerosis (SSc) are poorly documented in the literature. The purpose of this study was to evaluate SSc as a potential risk factor for increased rate of complications after TKA. Using the PearlDiver Mariner database, 2,002 patients with SSc undergoing primary TKA were identified and compared to matched controls of 19,892 patients without SSc. Multivariable logistic regression analyses were done for medical complications up to 90days and surgical complications up to two years. 90-day ED-visit and inpatient readmission were also documented. Compared to the matched controls, patients with SSc demonstrated higher rates of medical complications such as cerebrovascular accident (1.5% vs 0.6%, p < 0.001), myocardial infarction (1.3% vs 0.3%, p < 0.001), and sepsis (1.1% vs 0.4%, p < 0.001). Additionally, patients with SSc displayed elevated rates of surgical complications, including wound complications (3.9% vs 2.2%, p < 0.001) and aseptic loosening at 90days (0.2% vs 0.1%; OR 3.53 [1.13-9.28]), one year (0.7% vs 0.4%; OR 1.78 [0.96-3.05]), and two years (1.4% vs 0.9%; OR 1.68 [1.10-2.45]). Patients with SSc also had higher rates of emergency department visits (21.2% vs 11.4%, p < 0.001). Patients with SSc are at higher risks of postoperative complications, encompassing both medical and surgical complications. Specifically, patients with SSc have a significantly higher likelihood of experiencing wound complications, cerebrovascular accident, and myocardial infarction. It is crucial for orthopaedic surgeons and patients alike to consider the elevated risks when determining a course of TKA for patients with SSc.

Axillary skin crease incision versus conventional posterolateral incision in open repair of patent ductus arteriosus for extremely low birth weight infants: a retrospective study

BackgroundThoracotomy with posterolateral incision (PLI) is commonly used for surgical repair of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Some reports have described thoracotomy for PDA using an axillary skin crease incision (ASCI) in consideration of cosmetic problems such as surgical wounds and thoracic deformities, but the details remain unclear.MethodsIn this study, we performed clipping ligation by thoracotomy with ASCI for ELBW infants with PDA from 2011 to 2015 for the purpose of improving cosmetic results, and retrospectively compared the results with those for conventional PLI cases performed from 2016 to 2020.ResultsASCI was found to be associated with serious surgical complications and showed a significant difference in outcome parameters only for surgery time, suggesting a safety problem for ASCI. Considering these results, PLI allows clipping of the nearby PDA from the thoracotomy wound while looking straight ahead, whereas the PDA in ASCI is positioned deep and oblique to the thoracotomy wound, so the clipping angle is limited and accurate completion of the procedure is difficult.ConclusionsRegarding PDA repair in ELBW infants, ASCI shows a high risk of serious surgical complications. Conventional PLI remains preferable for safe and accurate results.

Postoperative Complications and Neurological Deficits After Petroclival Region Meningioma Resection: A Case Series.

Surgical management of meningiomas involving the petroclival junction remains a challenge because of nearby critical neurovascular structures. To describe surgical approach selection, outcomes, and factors associated with postoperative complications and neurological deficits in a series of patients undergoing resection of petroclival region meningiomas. Retrospective review of patients undergoing symptomatic petroclival region meningioma resection was performed. Logistic regression was performed to identify variables associated with postoperative complications and new neurological deficits. Sixty-five patients underwent 54 one-stage and 11 two-stage resections with median follow-up of 51 months. Most tumors were World Health Organization grade 1 (90.8%), and the median volume was 23.9 cm 3 . Posterior petrosectomy and anterior petrosectomy were performed in 67.1% and 6.6% of operations, respectively. The gross or near total resection rate was 15.4%, and 8 patients (12.3%) progressed on follow-up. The surgical complication rate was 26.2% with no perioperative mortalities. Postoperatively, 45.8% of patients had new, persistent neurological deficits, with cranial nerves VII palsy being most common. On multivariate analysis, higher body mass index (odds ratio [OR]: 1.1, P = .04) was associated with risk of surgical complications. Longer operative time (OR: 1.4, P = .004) and staged procedures (OR: 4.9, P = .04) were associated with risk of new neurological deficit on follow-up, likely reflecting more challenging tumors. Comparing early vs later career surgeries performed by the senior author, rates of severe complications and neurological deficits decreased 23.1% and 22.3%, respectively. Petroclival region meningiomas remain surgically challenging, but improved outcomes are seen with surgeon experience. These data help inform patients on perioperative morbidity risk and provide a guide for surgical approach selection.

Efficacy and safety of iliofemoral bypass using arm veins as an alternative conduit for chronic limb-threatening ischemia

ObjectiveThe use of basilic vein in iliofemoral revascularizations was previously described in the literature as an autologous option for the treatment of vascular prosthesis infection and as a primary conduit in patients at high risk of infectious surgical complications. However, the publications available include several different indications and are limited to case reports. Therefore, the aim of this study was to evaluate the outcomes of the use of arm veins as a safe and effective autologous alternative for iliofemoral reconstruction in patients with chronic limb-threatening ischemia (CLTI) and at high risk of prosthesis infection. MethodsWe performed a multicenter, retrospective cohort study with 53 consecutive iliofemoral bypasses using arm veins as an alternative conduit. The procedures were performed between November 2013 and November 2021, exclusively for patients with CLTI classified as TASC aortoiliac C or D with increased risk of postoperative surgical infection. Demographic, clinical variables, and outcomes were collected from a prospective database. Main endpoints were amputation-free survival (AFS) and major adverse cardiovascular events. Secondary endpoints included primary and secondary patencies and overall survival. Cox regression analysis was used to identify the predictors of AFS. Postoperative surgical complications and 30-day mortality were also assessed. ResultsThe mean age was 64.2 ± 8.4 years, with a predominance of male gender. The median follow-up period was 615 days. All patients had CLTI, with a predominance of tissue loss (n = 51; 96.2%) and a median ankle-brachial index of 0.28. The basilic vein was utilized in most procedures (69.8%). Thirty-day major adverse cardiovascular events occurred in five cases (9.4%), and the 30-day mortality rate was 3.8%. The AFS, primary patency, secondary patency, and overall survival in 720 days were 71%, 72%, 89%, and 75%, respectively. Cox regression analysis revealed no association between the variables analyzed for AFS. There was no graft late infection nor pseudoaneurysmal degeneration. ConclusionsIliofemoral bypass using arm veins as an autologous conduit proved to be an effective and safe procedure with low incidence of postoperative cardiovascular complications and high rates of AFS in patients with CLTI. Also, this suggests that arm veins can be an interesting and suitable autologous alternative conduit for iliofemoral reconstructions, especially in cases in which a prosthesis should be avoided or when it is not available.

"Capsule drape wrap"-a new technology for iridoschisis management during phacoemulsification.

To introduce a new technique for iridoschisis management during phacoemulsification: "capsule drape wrap". "Capsule drape wrap" technique was used for an 80-year-old man with idiopathic iridoschisis in the right eye during phacoemulsification. The inserted flexible nylon iris hooks to hold anterior capsule in place, the margin of the anterior capsule could act as drape wrap, tracking the fibrillary iris strands firmly from free floating and stabilizing the capsular bags simultaneously. The eye with iridoschisis was successfully treated. Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there were no intraoperative complications such as tear of the iris, hyphema, iris prolapse, loss of mydriasis, or rupture of the posterior lens capsule during phacoemulsification. The best-corrected visual acuity was increased by 0.1 (logMAR) 6mo after the surgery. "Capsule drape wrap" for iridoschisis is easily manageable, prevents further disruption to the loose iris fibers and ensures the stability of capsule-iris complex simultaneously, consequently minimizing the risk of surgical complications in phacoemulsification.

Update to Management of Acute Scaphoid Fractures.

The scaphoid is the most commonly fractured carpal bone. With high clinical suspicion and negative radiographs, expedient evaluation by CT or MRI has been recommended. When treating nondisplaced or minimally displaced scaphoid waist and distal pole fractures, immobilization below the elbow without inclusion of the thumb is an option. Comparatively, early surgical intervention for nondisplaced or minimally displaced scaphoid waist fractures allows for quicker return of function, but with increased risk of surgical complications and no long-term outcomes differences compared with cast immobilization. For most patients with such fractures, consideration for aggressive conservative treatment involving 6 weeks of immobilization with CT assessment to guide the need for continued casting, surgical intervention, or mobilization is advocated. Determination of union is best done with a CT scan at 6 weeks and at least 50% continuous trabecular bridging across the fracture site deemed sufficient to begin mobilization. Nonsurgical and surgical management of scaphoid fractures requires a thorough understanding of fracture location, fracture characteristics, and patient-specific factors to provide the best healing opportunity of this notoriously difficult fracture and return the patient to full function.

A Vascular Centered Surgical Approach to Radical Hysterectomy: Laparoscopic Anatomy of Pelvic Vascular System Revisited

As a standard therapy for locally invasive cervical cancer, radical hysterectomy (RH) has been in routine medical practice for more than a century [1]. However, challenges still exist due to the troublesome bleeding during parametrium dissection and resection, which could increase the risk of surgical complications and may probably affect surgical outcomes ultimately [2]. This video illustrated the three-dimensional anatomy of the pelvic vascular system with particular emphasis on "deep uterine vein" and further introduced a vascular-centered surgical approach to performing RH, which could facilitate parametrium dissection with less blood loss and obtain enough resection margins. A step-by-step, narrated video demonstration SETTING: A university hospital INTERVENTIONS: After systemic pelvic lymphadenectomy, ureter was then identified along the medial leaf of the broad ligament. By continuously exploring the pelvic cavity along the ureter, communicating branches of the uterine artery to the ureter, urinary bladder, corpus uteri, uterine cervix, and upper vagina were clearly identified in a cranial to caudal direction, demonstrating the arterial network surrounding the urinary system. Coagulating and cutting these blood vessels could free the ureter from retroperitoneum and subsequently excavate the ureteral tunnel easily. Next, a precise dissection of the area below the ureter revealed the whole distribution of currently named "deep uterine vein". Originated from an internal iliac vein, it is much more like a venous confluence than an accompanying vein, with branches crossing directly into the bladder, dorsally to the rectum, and traveling caudally to the anterolateral side of the uterus and vagina in a crisscross fashion, which mandates us to describe it as pampiniform-like venous plexus instead of "deep uterine vein" due to its anatomical distribution and function. Finally, after complete exposure of venous network, enough extent of parametrium could be adequately separated and resected by accurate coagulation of blood vessels on an individualized requirement. Recognizing the precise anatomy of pelvic vascular system, especially the entire distribution of currently named "deep uterine vein" and isolating the venous branches connecting to all three parts of parametrium, are key to the RH procedure. Careful attention to the complex vascular anatomy is critical to reducing intraoperative bleeding and avoiding complications in RH.

Inferior surgical outcomes following reverse total shoulder arthroplasty for nonunion and malunion compared to acute arthroplasty: a nationwide matched cohort analysis

BackgroundReverse total shoulder arthroplasty (rTSA) has become popularized in the management of acute proximal humerus fractures (PHFs). Limited evidence exists to compare the outcomes of acute rTSA to management following failed open reduction and internal fixation. We aimed to analyze the differences between acute rTSA for PHF compared to subsequent rTSA for nonunion/malunion. MethodsPatients who underwent primary rTSA from 2016 to 2020 were identified in the Premier Healthcare Database. Nonunion, malunion, and hardware complication patients were identified using International Classification of Diseases Tenth Revision diagnosis codes and compared to acute PHF controls. Patients were matched in a 1:1 fashion to acute fracture based on age (±3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, patient comorbidities, and 90-day complications were assessed and compared between the two cohorts. Descriptive statistics and regression analysis were employed with significance set at P < .05. ResultsPrior to matching, 8561 nonunion/malunion cases and 11,134 acute rTSA controls were identified. Patients undergoing acute rTSA for PHF were older, had longer length of stay, and higher total costs (P < .0001). When compared to acute rTSA for fracture, nonunion/malunion patients were at increased risk of multiple surgical complications including periprosthetic joint infection (odds ratio [OR]: 4.56; 95% confidence interval [CI]: 2.95-7.04; P < .0001), periprosthetic fracture (OR: 2.86; 95% CI: 2.09-3.93), stiffness (OR: 2.01; 95% CI: 1.17-3.44; P = .01), and dislocation (OR: 2.37; 95% CI: 1.80-3.12; P < .0001). However, patients undergoing acute rTSA had higher rates of all medical complications investigated, including deep vein thrombosis, pulmonary embolism, pneumonia, myocardial infarction, acute kidney infection, and sepsis (P < .001). ConclusionrTSA after nonunion/malunion of PHFs is associated with increased risk of surgical complications compared to acute rTSA. Initial rTSA for PHFs may mitigate subsequent increased risk of surgical complication and should be considered as the initial treatment option in patients with PHFs. However, the increased risk of medical complications seen in acute PHF warrants attention and diligent medical optimization from providers.

The predictive value of perioperative circulating markers on surgical complications in patients undergoing robotic-assisted radical prostatectomy

BackgroundThe occurrence of postoperative complications was associated with poor outcomes for patients undergoing robotic-assisted radical prostatectomy. A prediction model with easily accessible indices could provide valuable information for surgeons. This study aims to identify novel predictive circulating biomarkers significantly associated with surgical complications.MethodsWe consecutively assessed all multiport robotic-assisted radical prostatectomies performed between 2021 and 2022. The clinicopathological factors and perioperative levels of multiple circulating markers were retrospectively obtained from the included patients. The associations of these indices with Clavien-Dindo grade II or greater complications, and surgical site infection were assessed using univariable and multivariable logistic regression models. Further, the models were validated for the overall performance, discrimination, and calibration.ResultsIn total, 229 patients with prostate cancer were enrolled in this study. Prolonged operative time could independently predict surgical site infection (OR, 3.39; 95% CI, 1.09–10.54). Higher RBC (day 1-pre) implied lower risks of grade II or greater complications (OR, 0.24; 95% CI, 0.07–0.76) and surgical site infection (OR, 0.23; 95% CI, 0.07–0.78). Additionally, RBC (day 1-pre) independently predicted grade II or greater complications of obese patients (P value = 0.005) as well as those in higher NCCN risk groups (P value = 0.012). Regarding the inflammatory markers, NLR (day 1-pre) (OR, 3.56; 95% CI, 1.37–9.21) and CRP (day 1-pre) (OR, 4.16; 95% CI, 1.69–10.23) were significantly associated with the risk of grade II or greater complications, and both the indices were independent predictors in those with higher Gleason score, or in higher NCCN risk groups (P value < 0.05). The NLR (day 0-pre) could also predict the occurrence of surgical site infection (OR, 5.04; 95% CI, 1.07–23.74).ConclusionsThe study successfully identified novel circulating markers to assess the risk of surgical complications. Postoperative increase of NLR and CRP were independent predictors for grade II or greater complications, especially in those with higher Gleason score, or in higher NCCN risk groups. Additionally, a marked decrease of RBC after the surgery also indicated a higher possibility of surgical complications, especially for the relatively difficult procedures.

Five-Year Outcomes of Gastric Bypass in Young versus Older Diabetic Adults

Abstract Background Timely metabolic surgery improves glycemic control and reduces cardiovascular risk for patients with type 2 diabetes. Young age is a known predictor of metabolic success but RYGB is often delayed due to the reported vulnerability of young adults. Aims To compare diabetes remission, metabolic outcomes and surgical adverse events in young (18-35 years) and older (&amp;gt;35 years) adults in the first five years following Roux-en-Y gastric bypass (RYGB). Methods We analysed prospective registry data from a single center on young (29.4 years, [standard deviation (SD)=5]) and older (47.7 years, [SD=6.7]) non-insulin-dependent diabetic adults undergoing RYGB. Younger adults were matched one to two to their older counterparts for sex, body mass index, duration of preoperative diabetes and American Society of Anaesthesiologist score. The rate of diabetes remission and adverse events in both groups were compared. Results A total of 78.2% (43/55) of the young and 75.4% (86/114) of the older adults attended the five-year follow-up. Diabetes remission occurred significantly earlier in the young adults group with a hazard ratio of 0.57 [95% confidence interval (CI) 0.23-0.87] and a median time to remission of 12 months [95% CI 3.2-20.8] compared to 24 months [95% CI 10.5-37.4, p=0.031] for older adults. There were no significant differences in loss to follow-up, percent weight change, and all-cause adverse events. Conclusions Diabetes remission occurred earlier and more frequently in young adults within the first 5 years after RYGB. The risk of surgical complications, nutritional deficiency or failure to achieve successful weight loss did not increase in the investigated young adult group.

Autoimmune diseases and orthognathic surgery: A case series of 12 patients

Autoimmune diseases result from the immune system attacking native cells and tissues due to the recognition of "self" antigens as foreign antigens. This group of disorders is associated with an increased risk of complications after surgical interventions, as the immune system may cause tissue destruction. The study aimed to investigate the risk of surgical complications in patients with autoimmune diseases, who are at a higher risk of complications due to their condition. Among 886 patients who underwent orthognathic surgery, twelve types of autoimmune diseases with 22 patients were identified. For this case-series study, 12 patients were selected with a follow-up period of at least two years. The surgical procedures were executed by a single surgical team, which involved single or multi-piece Le Fort I osteotomy, Hunsuck/Epker modification of bilateral sagittal split osteotomy (BSSO), and/or genioplasty. The recorded outcome variables were postoperative adverse events, including respiratory or blood-related complications, wound infection, neurosensory disturbances, temporomandibular joint (TMJ) complications, and relapse. Only two patients recovered after surgery without any postoperative complications, whereas others had delayed recovery from neurosensory disturbance (5/12), infection (5/12), TMJ complications (2/12), and other complications. The findings of this study suggest that patients with autoimmune diseases undergoing orthognathic surgery are at higher risk of complications, highlighting the importance of careful consideration of patient selection and risk stratification before surgical intervention. The study also emphasizes the importance of close postoperative follow-up to detect and manage complications promptly.

Effects of anti-osteoporosis therapy on the risk of secondary fractures and surgical complications following surgical fixation of proximal humerus fracture in older people.

age-related fragility fractures cause significant burden of disease. Within an ageing society, fracture and complication prevention will be essential to balance health expenditure growth. to assess the effect of anti-osteoporotic therapy on surgical complications and secondary fractures after treatment of fragility fractures. retrospective health insurance data from January 2008 to December 2019 of patients ≥65years with proximal humeral fracture (PHF) treated using locked plate fixation (LPF) or reverse total shoulder arthroplasty were analysed. Cumulative incidences were calculated by Aalen-Johansen estimates. The influence of osteoporosis and pharmaceutical therapy on secondary fractures and surgical complications were analysed using multivariable Fine and Gray Cox regression models. a total of 43,310 patients (median age 79years, 84.4% female) with a median follow-up of 40.9months were included. Five years after PHF, 33.4% of the patients were newly diagnosed with osteoporosis and only 19.8% received anti-osteoporotic therapy. A total of 20.6% (20.1-21.1%) of the patients had at least one secondary fracture with a significant reduction of secondary fracture risk by anti-osteoporotic therapy (P < 0.001). An increased risk for surgical complications (hazard ratio: 1.35, 95% confidence interval: 1.25-1.47, P < 0.001) after LPF could be reversed by anti-osteoporotic therapy. While anti-osteoporotic therapy was more often used in female patients (35.3 vs 19.1%), male patients showed significantly stronger effects reducing the secondary fracture and surgical complication risk. a significant number of secondary fractures and surgical complications could be prevented by consequent osteoporosis diagnosis and treatment particularly in male patients. Health-politics and legislation must enforce guideline-based anti-osteoporotic therapy to mitigate burden of disease.

Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgical procedures but carry a risk of harmful and costly surgical site complications (SSCs). This systematic review and meta-analysis examined the impact of closed incision negative pressure therapy (ciNPT) on the risk of SSCs following THA and TKA. A systematic literature review identified studies published between January 2005 and July 2021 comparing ciNPT (Prevena Incision Management System) to traditional standard-of-care dressings for patients undergoing THA and TKA. Meta-analyses were performed using a random effects model. A cost analysis was conducted using inputs from the meta-analysis and cost estimates from a national database. Twelve studies met the inclusion criteria. Eight studies evaluated SSCs, where a significant difference was seen in favor of ciNPT (relative risk [RR]: 0.332, P < .001). Significant benefits in favor of ciNPT were also observed for surgical site infection (RR: 0.401, P= .016), seroma (RR: 0.473, P= .008), dehiscence (RR: 0.380, P= .014), prolonged incisional drainage (RR: 0.399, P= .003), and rate of return to the operating room (RR: 0.418, P= .001). The estimated cost savings attributed to ciNPT use was $932 per patient. The use of ciNPT after TKA and THA was associated with a significant reduction in the risk of SSCs, including surgical site infections, seroma, dehiscence, and prolonged incisional drainage. The risk of reoperation was reduced as were the costs of care in the modeled cost analysis, suggesting a potential for both economic and clinical advantages for ciNPT over standard-of-care dressings, particularly in high-risk patients.

Long-Term Safety, Efficacy, Indications, and Criteria of Arteriovenous Fistula Ligation Following Kidney Transplant: A Patient-Driven Approach.

In patients with end-stage renal disease, arteriovenous fistulas are the standard of care to ensure long-term vascular access. Recent studies suggest some long-term posttransplant cardiac benefits and quality of life improvements in kidney transplant recipients due to arteriovenous fistula ligation. However, there are no guidelines regarding arteriovenous fistula management after transplant. Our study objective was to evaluate the long-term safety of arteriovenous fistula ligation and the frequency of returning to hemodialysis after ligation. Retrospective chart review from February 2014 to December 2020 identified 578 adult patients who underwent successful kidney transplant at our center. Of these patients, 47 underwent subsequent arteriovenous fistula ligation. Both medically driven and patient-driven cases were assessed and approved by a transplant nephrology team with regard to allograft function and ligation suitability. Our results showed that, of the 47 renal transplant patients, 70.2% chose to undergo arteriovenous fistula ligation due to aneurysmal formation, 44.7% due to pain, and 14.9% due to high-output heart failure. In total, 68.1% of arteriovenous fistula ligations performed were primarily patient driven. There was an average follow-up of 2.9 years after ligation, with 1 unrelated reoperation and no returns to dialysis for all patients who underwent arteriovenous fistula ligation. In our study, the long-term risks of surgical complications and allograft impairment after ligation were negligible. As a result of our current findings and known positive cardiovascular benefit, patient-driven arteriovenous fistula ligation after kidney transplant should be routinely considered in patients with stable allograft function.