Surgery Score Research Articles

Prediction of Clinical Response to Dupilumab for CRSwNP Based on the Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) Score.

Although the effectiveness of molecular antibodies has been established, evidence is still lacking on objective predictors of response. The aim of this study was to assess whether the extent of previous endoscopic sinus surgeries, assessed by means of the Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) score, may influence clinical outcomes in refractory CRSwNP patients treated with dupilumab. A consecutive sample of patients treated with dupilumab for previously operated recalcitrant CRSwNP were enrolled in the study. Every patient was required to undergo a CT scan at baseline (T0), at 3 (T1), and 12 (T2) months after treatment start. ACCESS score was calculated at baseline, whilst at every timepoint patients underwent assessment of Nasal-Polyp-Score (NPS), Lund-Kennedy-Score (LKS), and had to fill in the 22-item Sinonasal-Outcome-Test (SNOT-22) and Visual-Analog-Scales (VAS) for sinonasal symptoms. Favorable outcome was considered based on EUFOREA guidelines, namely improving at least 3 of the followings: (i) NPS; (ii) SNOT-22; (iii) VAS-olfaction; and (iv) need for systemic corticosteroids. Overall favorable outcome was achieved in 69.1% (n = 38/55) of cases at T1, while in 89.1% (n = 49/55) at T2. There were no differences in baseline characteristics between responders and non-responders at both timepoints. At T1, out of all the included variables, no statistically significant predictor of favorable outcome was observed. Conversely, at T2, ACCESS score was the only confirmed independent predictive factor of response to dupilumab treatment (OR = 0.81 [95% CI = 0.67-0.92], P = .010). Our findings suggest that the extent of previous endoscopic sinus surgeries may have a role in influencing clinical outcomes in patients with refractory CRSwNP undergoing treatment with dupilumab.

Analysis of the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures with coracoclavicular ligament injuries

ObjectiveTo investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries.MethodsA retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n = 23) and acromioclavicular Kirschner wire fixation (control group, n = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery.ResultsNo significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups (p > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different (p > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values (p < 0.05). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group (p < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up (p > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group.ConclusionIn the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes.

Analysis of prognosis and medical resource utilization in elderly patients with trauma: A retrospective cohort study in one trauma center

Background: Trauma is consistently among the top ten causes of death worldwide. The aging population, constituting 15.21% of adults aged over 65 in Taiwan as of November 2019, has significantly impacted healthcare expenditures. This study aimed to explore the prognosis and resource utilization in patients with geriatric trauma. Methods: This retrospective analysis included ER admissions between January 2015 and December 2017 at a Level I trauma center in southern Taiwan. Of the 5,185 eligible patients, 1,743 were elderly. Comparisons between the age groups assessed medical resource use, patient characteristics, trauma profiles, and management. Outcomes examined included mortality, complications, length of hospital stay, duration of ICU stay, and costs. Results: Elderly patients, predominantly women, exhibit more blunt injuries often resulting from accidental falls. They experienced longer hospital stays and higher medical expenses, as well as increased complication and mortality rates. Mortality predictors included age, GCS score, trauma severity score (≥16), complications, surgery, and initial hypotension. Complications correlated with prolonged length of hospital stay (LOS), early blood transfusion, and mortality, impacting overall expenditure along with trauma severity, ICU days, surgery, and AIS score (≥3). Conclusion: Elderly patients had a longer LOS, higher mortality and complication rates, and higher total medical costs. The required medical expenses for elderly trauma cases were relatively higher than those for younger individuals. Relevant authorities should consider patient age when formulating policies for trauma reimbursement. Based on our findings, healthcare resource utilization can be reduced by decreasing the length of hospital stay and mitigating trauma severity. We recommend collecting more detailed data, extending the study period, and engaging in multicenter collaborations to validate our findings and provide a roadmap for further research. We suggested that interventional studies are needed to test strategies aimed at reducing resource utilization and improving outcomes in elderly trauma patients, which would be valuable.

Construction and Application Effect Analysis of Orthopedic Pain Care Ward under Multi-Disciplinary Cooperation Model

Aims/Background A multidisciplinary team (MDT) approach is a nurse-led pain management method that involves collaboration with staff from other departments. The purpose of this paper was to discuss the construction and application effect of a pain care ward in orthopedics utilizing the MDT approach. Methods A retrospective analysis of case data was conducted, selecting 90 patients with hip joint fractures who underwent hip replacement arthroplasty (HRA) at our hospital between February 2021 and February 2024. The patients were divided into two groups based on the nursing methods: a control group (n = 43), which received a conventional analgesic management program, and an intervention group (n = 47), which received the same conventional analgesic management program along with the implementation of an orthopedic pain care ward under the MDT approach. The study compared the pain knowledge and attitudes of the responsible nurses in both groups through questionnaires. Additionally, the accuracy of pain assessments and the awareness rates of patients’ pain-related health education were evaluated and compared between the two groups. Furthermore, the effectiveness of pain intervention, range of motion (ROM), and Hospital for Special Surgery (HSS) scores before and after the intervention were analyzed. The incidence of complications and overall nursing satisfaction were also compared between the two groups. Results The general knowledge, pain assessment, drug analgesia, comprehensive application, and total scores of nurses in the intervention group were significantly higher than those in the control group (p &lt; 0.05). The accuracy rate of nurses’ pain assessments and the awareness rate of patients’ pain health education in the intervention group were 91.49% and 93.62%, respectively, both significantly higher than the 72.09% and 79.07% observed in the control group (p &lt; 0.05). The total effective rate of pain intervention in the intervention group was 74.47%, significantly higher than the 53.49% in the control group (p &lt; 0.05). After the intervention, both the ROM and HSS scores in the intervention group were significantly higher than those in the control group (p &lt; 0.05). The overall incidence of complications in the intervention group was 6.38%, significantly lower than the 20.93% in the control group (p &lt; 0.05). Finally, the total satisfaction rate with nursing care in the intervention group was 91.49%, significantly higher than the 74.42% in the control group (p &lt; 0.05). Conclusion The construction and application of an MDT pain care ward can effectively enhance the accuracy of nurses’ pain assessments, increase patients’ awareness of pain-related health education, and improve the efficiency of pain interventions. Additionally, it can lead to better joint mobility and improved hip function, promoting the sustainable development of the pain care ward. These improvements contribute to higher patient satisfaction and enrich the quality of nursing services.

Clinical trial of arthroscopic debridement combined with functional exercise in the treatment of advanced knee osteoarthritis: A retrospective observational study.

Advanced knee osteoarthritis (KOA) impacts both knees, resulting in pain, deformity, and substantial restrictions in joint mobility. This study aims to examine the effectiveness of combining arthroscopic debridement with functional exercise in treating advanced KOA. A total of 296patients diagnosed with advanced KOA were divided into two groups: the observation group (n= 152) received arthroscopic debridement combined with functional exercise, while the control group (n= 144) underwent arthroscopic debridement only. The study compared and observed the outcomes between the two groups. There were no significant differences in knee joint function, inflammation level, and oxidative stress between the two groups before treatment (P> 0.05). Following treatment for six months, the observation group exhibited significantly lower visual analog scale (VAS) score, tissue inhibitors of metalloproteinase-1 (TIMP-1), tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), matrix metalloproteinase-3 (MMP-3), and malondialdehyde (MDA) levels compared to the control group (P< 0.05). Meanwhile, the observation group showed significantly higher levels of Lysholm score, hospital for special surgery (HSS) score, range of motion (ROM) of knee, peak torque (PT) and total work (TW) for knee extension and flexion, superoxide dismutase (SOD), total antioxidant capacity (T-AOC), and glutathione (GSH) compared to the control group (P< 0.05). Besides, the effective treatment rate in the observation group was notably higher than that in the control group (80.92% vs. 69.44%, P< 0.05). The combination of arthroscopic debridement with functional exercise is an effective treatment for advanced KOA. This approach not only enhances the function and strength of knee joint and reduces inflammatory response but also boosts the body's antioxidant capacity. The treatment exhibits encouraging outcomes and warrants broad implementation.

Development and validation of a novel comorbidity score specific for prostate cancer patients treated with robotic platform and its implication on DaVinci single-port system.

To develop and validate a novel Comorbidity score for Robotic Surgery (CRS) in predicting severe complications after robot-assisted radical prostatectomy (RARP). Furthermore, we investigated the impact of the surgical platform (Multi-Port - MP vs Single-Port - SP) according to this score. We included 2085 ("development cohort") and 595 ("validation cohort") patients undergoing RARP at two tertiary referral centers between 2014 and March 2024 in a retrospective study. Statistical analyses included validation of the Charlson Comorbidity Index (CCI) to predict 30-day severe complications (Clavien-Dindo ≥ 3a), development and external validation of CRS using calibration plots and decision curve analysis. Lastly, locally weighted scatterplot smoothing (LOWESS) analysis was used to graphically explore the impact of the robotic platform according to novel CRS. CCI exhibited limited predictive ability for severe complications (60% in the validation cohort). In multivariable logistic regression analyses testing the correlation between each condition included in CCI and severe complications, diabetes and myocardial infarction resulted as independent predictors (OR 1.75 [95%CI 1.05-2.82]; OR 1.92 [95%CI 1.26-2.88]) and were subsequently fitted into a multivariable logistic model including age, previous abdominal surgery and obesity (BMI > 30). The resulting predictive model demonstrated superior discrimination and clinical net benefit in predicting severe complications compared to CCI (AUC 64 vs 60%). At LOWESS analysis, SP platform was associated with lower risk of severe complications as CRS increased compared to MP system. The validated CRS showed better accuracy compared to CCI in predicting severe complications after RARP. Additionally, the use of SP robotic platform may reduce the risk of severe complications in highly comorbid patients according to CRS.

The Predictive Value of the CatLet Scoring System for Long-Term Prognosis After Percutaneous Coronary Intervention in Patients With Chronic Coronary Syndrome.

Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system is a newly developed vascular scoring for assessing the degree of coronary artery stenosis and coronary artery variability. Preliminary studies have demonstrated its superiority over the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score in predicting outcome in patients with acute myocardial infarction (AMI). This study aimed to assess the predictive value of the CatLet score in long-term prognosis after PCI for chronic coronary syndrome (CCS). A total of 201 patients, who were diagnosed with chronic coronary syndrome, undergoing coronary DES implantation and calculable Catlet score at the Second Affiliated Hospital of Wannan Medical College in China were consecutively enrolled from January 2020 to June 2021. The primary endpoint was major adverse cardiac events (MACEs), defined as a composite of myocardial infarction, recurrent angina, cardiac death, heart failure and ischemia-driven revascularization, were stratified according to CatLet score tertiles: 0 ≤ CatLet_low ≤ 23(n = 66), CatLet_mid 24-43(n = 68), and CatLet_top ≥ 44(n = 67), respectively. The CatLet score predicted long-term prognosis with a median follow-up of 3.0 years. Of 201 patients analyzed, the rates of MACEs and cardiac death were 25.37% and 3.98%, respectively. The Kaplan-Meier curves for all endpoints showed increasing outcome events with the increasing tertiles of the CatLet score, with p-value < 0.05 on the trend test. For MACE and cardiac death, the area under the curve (AUC) of the CatLet score was 0.744 (95% confidence interval [CI]: 0.668-0.820) and 0.804 (95% CI: 0.672-0.936), respectively; Alone or after adjusting for risk factors, the multivariable-adjusted hazard ratio (95% CI)/unit higher score was 9.41 (3.18-27.85) for MACEs and 1.85 (1.20-2.84) for cardiac death, respectively. The CatLet score is an independent predictor of long-term clinical outcomes in patients with chronic coronary syndrome after percutaneous coronary intervention.

Effect of femoral prosthesis flexion angle on unicompartmental knee arthroplasty with mobile platform

ObjectiveTo investigate the effect of the flexion angle of a femoral prosthesis on the postoperative clinical outcome of patients with knee osteoarthritis who are undergoing unicompartmental knee arthroplasty.MethodsPatients were divided into three groups according to the flexion angle of the femoral prosthesis following unicompartmental knee arthroplasty. Group A comprised patients with a flexion angle of the femur prosthesis of less than 5°, Group B included those with a flexion angle of 5° to 10°, and Group C consisted of patients with a flexion angle of the femur prosthesis greater than 10°. The basic clinical data, visual analog scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM) were subjected to statistical analysis and comparison between the groups.ResultsNo significant differences were observed in the basic data of the patients in each group. The ROM and VAS scores for the knee in the first month following unicompartmental knee arthroplasty in groups B and C were significantly greater than those in group A. The HSS scores for the knee joint in Group B indicated superior outcomes in the initial postoperative month and the third postoperative month, as evidenced by the WOMAC scores, which demonstrated a statistically significant difference between Group B and the other two groups within the six-month postoperative period.ConclusionThe short-term recovery of patients in Group B was the fastest. These results provide a new reference for the installation of femoral prostheses in unicompartmental knee arthroplasty.

Comparison of Implant Placement Accuracy Between Manual, Robot-Assisted, Computer-Navigated, Augmented Reality Navigated, Patient-Specific Instrumentation, and Accelerometer Navigated Total Hip Arthroplasty: A Systematic Review and Network Meta-Analysis.

Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Enhanced recovery after surgery for hip and knee arthroplasty: A systematic review and meta-analysis on randomized control trials

ObjectivesThis review aimed to compare the efficacy and safety of enhanced recovery after surgery (ERAS) versus traditional care in patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsAll randomized controlled trials (RCTs) were acquired via a comprehensive search of multiple databases. A meta-analysis was performed using Cochrane Collaboration's RevMan 5.4 software to calculate effect sizes. ResultsThis meta-analysis included 850 patients in the ERAS group and 845 patients in the control group (patients who received traditional care). The outcomes suggested no significant difference in operative time, intraoperative blood loss, visual analogue scale, 30-day readmission rate, and mortality rate between the two groups. However, the ERAS group was associated with a significant decrease in transfusion rate, hospital length of stay, and postoperative complications. Moreover, the ERAS group had higher Hospital for Special Surgery scores and satisfaction rates. ConclusionsPatients who underwent THA and TKA would benefit more from ERAS than traditional care.

Meta-analysis of the efficacy of the erector spinae plane block after spinal fusion surgery.

To investigate the efficacy of erector spinal plane block (ESPB) after spinal fusion surgery in this study. The PubMed, Embase, Cochrane library, and Web of Science databases were searched with a search deadline of March 30, 2024, and Stata 15.0 was used to analyze the data from the included studies. Nine randomized controlled trials involving 663 patients were included. Meta-analysis showed that EPSB could reduce pain scores at 2h (standard mean difference (SMD) = -0.78, 95% CI [-1.38 to -0.19], GRADE: Moderate), 6 h (SMD = -0.81, 95% CI [-1.23 to -0.38], GRADE: Moderate), 12 h (SMD = -0.59, 95% CI [-1.05 to -0.13], GRADE: Moderate), 24 h (SMD = -0.54, 95% CI [-0.86 to -0.21], GRADE: Moderate), 48 h (SMD = -0.40, 95% CI [-0.75 to -0.05], GRADE: Moderate) after spinal fusion surgery, as well as the PCA (analgesia medication use) (SMD = -1.67, 95% CI [-2.67 to -0.67], GRADE: Moderate). However, EPSB had no effect on intraoperative blood loss (SMD = -0.28, 95% CI [-1.03 to 0.47], GRADE: Low) and length of hospital stay (SMD = -0.27, 95% CI [-0.60-0.06], GRADE: Low). Combined with the current findings, EPSB may reduce pain scores in spinal fusion surgery, possibly reducing the use of postoperative analgesics. However, due to the limitations of the study, we need more high-quality, multi-center, large sample randomized controlled trials to merge.

Association of TRI-SCORE with clinical outcomes after percutaneous tricuspid annuloplasty

Abstract Background Significant tricuspid regurgitation (TR) has been associated with excess mortality and heart failure. Functional TR is associated to progressive right ventricular remodeling and dysfunction, leading to comorbidities which elevate the perioperative mortality of isolated tricuspid regurgitation surgery, with an in-hospital mortality between 6-10% according to series. Transcatheter tricuspid annuloplasty is a promising therapeutic alternative in patients with high surgical risk. Appropriate risk stratification and patient selection is essential to ensure benefits of this intervention. European System for Cardiac Operative Risk Evaluation (EUROSCORE) II and the Society of Thoracic Surgeons (STS) score are widely spread in-hospital mortality risk scores in valvular surgery. TRI-SCORE is focused on isolated TR surgery; nevertheless, application of these scores to transcatheter annuloplasty has not been specifically studied yet. Purpose To analyze the utility of surgical scores (EUROSCORE-II, STS and TRISCORE) to predict all-cause mortality in patients undergoing transcatheter tricuspid annuloplasty. Methods A cohort of 49 patients with significant TR was followed up prospectively after the transcatheter tricuspid annuloplasty with Cardioband between 2019 and January 2024 (mean follow-up 18,43 ± 10,95 months). Every score was evaluated in all patients. According to the TRI-SCORE –– 6 points was the 75-percentile and taken as cutoff value –– we divided the cohort in two groups: a low score group (≤6 points) and a high score group (&amp;gt;6 points). Survival was analyzed in the whole cohort and in both subgroups. The curves are depicted using Kaplan-Meier method and were compared using log rank test. Results The study included 49 patients, with mean age of 77,6 ± 7,67 years, 77,6% being women. All the patients had a secondary etiology of TR and 46,9% massive or torrential TR before the intervention. 49% had previous left heart surgery. The median surgical risk values are represented in Table 1. All-cause mortality during follow-up occurred in 9 patients (18,3%). Survival analysis based on EUROSCORE II and STS did not find statically significant association (Table 1). TRI-SCORE had a hazard ratio (HR) of 1,59, also without statically significant association (CI 0.93 – 2.71; p 0.089). Survival analysis in high score group found an increased risk of all-cause mortality (HR 8.5; p 0.025). According to our findings TRI-SCORE &amp;gt; 6 before the procedure confers significant risk of all-cause death (log rank p = 0.009). Figure 1. Conclusions Transcatheter tricuspid annuloplasty is a promising therapy for patients with significant TR regurgitation who are at high surgical risk. According to our findings, TRI-SCORE is an appropriate scoring model to predict all-cause mortality after percutaneous annuloplasty with band. It is not so for other surgical risk scores. Extended follow-up and broader experienced are needed to corroborate these results.Surgical scores: median and mortalitySurvival curves TRI-SCORE

Comparison of the prognosis between complete and incomplete revascularization among moderate to severe chronic kidney disease patients with acute coronary syndrome

Abstract Background Complete revascularization (CR) in acute coronary syndrome patients with multivessel disease (MVD) is recommended in current clinical practice guidelines. However, the benefit of CR in moderate to severe chronic kidney disease (CKD) patients remains controversial. We aimed to compare the clinical outcomes between complete and incomplete revascularization among moderate to severe CKD patients who presented with ACS. Methods Of 1,924 ACS patients who underwent percutaneous coronary intervention (PCI) in our center, 127 patients were CKD. CR was defined as residual SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score ≤ 3. The primary outcome was the patient oriented clinical outcome (POCO) at 1 year, including all-cause death, any myocardial infarction, any revascularization, and heart failure requiring hospitalization. Results The mean age of the patients was 73.89±9.07 years. The median estimated glomerular filtration rate (eGFR) was 32.56±10.68 ml per minute per 1.73 m2. The rate of POCO at 1 year was significantly lower in the CR group (16.3% vs 39.3%; HR 0.36; 95%CI, 0.16-0.81; p=0.014). The primary outcome was mainly driven by 1-year all-cause death which was significantly lower in the CR group (14.0% vs 39.3%; HR 0.32; 95%CI 0.13-0.76; p=0.017). The rate of initiation of renal replacement therapy was comparable (4.7% vs 2.4%; p=0.55). Conclusion CR with a target SYNTAX score ≤ 3 improved 1-year prognosis of POCO and all-cause death in ACS patients with moderate to severe CKD without increasing the rates of renal replacement therapy.1-year POCOPrespecified Subgroup Analysis of POCO

Coronary bypass surgery guided by multislice computed tomography angiography in a low surgical risk population

Abstract Background In patients with three-vessel disease and/or left main disease, selecting revascularization strategies based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography(ICA).(1) Purpose The FASTTRACK CABG trial aims to assess the feasibility and safety of using CCTA and FFRCT as guidance for planning and performing CABG in patients with 3VD and/or LMCAD. Methods In this multicentre study, coronary artery bypass grafts (CABG) were planned and performed based on CCTA without knowledge of ICA. CABG strategy was recommended by a central Core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular events (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals(CI) for feasibility ≥75%.(2) Results The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX Score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Three patients did not undergo CABG due to the patient’s preference for percutaneous treatment (n=1) or lack of graft material. Unblinding ICA was required in one case, yielding a feasibility of 99.1% (95%CI: 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Team was 82.9% with a moderate kappa of 0.58 (95%CI:0.50-0.66). The concordance and agreement in revascularization planning between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95%CI:0.53-0.68). The 30-day follow-up CCTA was performed in 102 (91.9%) of the 111 operated patients, which showed an anastomosis patency rate of 92.6%. At 30 days, the incidence of MACCE was 7.2% whereas major bleeding was 2.7%. Conclusions CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.

Comprehensive classification and its value of capitellar cartilage injury concomitant with radial head fracture

BackgroundThere are defects in the existing classification of capitellar cartilage injury (CCI) concomitant with radial head fracture (RHF). This study aimed to introduce a comprehensive classification of CCI and to analyze its surgical guidance value.MethodsAccording to the affected site and severity, CCI was classified into four types: Type I - partial-thickness loss of articular cartilage, Type II - full-thickness loss of articular cartilage, Type III - full-thickness loss of articular cartilage with subchondral bone loss, Type IV - full-thickness loss of articular cartilage with thin cortex loss on the border of the capitellum; Different types suggest different surgical methods. Between January 2017 and January 2023, this comprehensive CCI classification was applied in 31 operated patients with CCI concomitant with RHF. The ranges of motion (ROM), Mayo Elbow Performance Index (MEPI) score, Hospital for Special Surgery (HSS) score and visual analog scale (VAS) for pain, were used to evaluate the functional recovery of the affected limb.ResultsMason Type I-IV RHF accounted for 6.45%, 38.71%, 48.39%, and 6.45%, respectively. Type I-IV CCI accounted for 12.90%, 35.48%, 45.16% and 6.45%, respectively. There was no relationship between the CCI and RHF types (p > 0.05). At the end of the follow-up period of 11–26 months with an average of 16 months, the elbow flexion and extension ROM recovered to (147.39 ± 9.84)°, forearm rotation ROM recovered to (168.74 ± 11.70)°, MEPI score recovered to (89.19 ± 4.17), HSS score recovered to (88.74 ± 4.62), VAS score recovered to (0.50 ± 0.57), indicating significant differences compared to preoperative measurements (p < 0.05). According to the MEPI and HSS scores, the excellent and good rate of functional recovery was 100%.ConclusionDifferent types of CCI differ not only in pathology but also in treatment methods. Surgical strategy according to the comprehensive CCI classification introduced in this paper may lead to a satisfactory outcome.

Risk Factors for Postoperative Complications Following Mandibular Fracture Repair.

Complications following mandibular fracture repair (MFR) may carry significant morbidity to patients. The purpose of our study is to determine the risk factors for postoperative complications following MFR. The authors conducted a retrospective cohort study of trauma patients who underwent MFR in 2018 and 2019. Excluded were patients below 18 years old and those with postoperative follow-up <2 weeks. The primary outcome was the incidence of major and minor postoperative complications following MFR. Of n=275 patients included, mean (SD) age was 35 (14) years and median (IQR) follow up was 49 (26-117) days. Most patients [n=208 (76%)] underwent both maxillomandibular/intermaxillary fixation (MMF/IMF) and open reduction and internal fixation (ORIF). The incidence of major postoperative complications was 19% (n=51) including malunion [n=8 (2.9%)], malocclusion [n=21 (7.6%)], and unplanned reoperation [n=26 (9.5%)]. The incidence of minor postoperative complications was 61% (n=167). Alcohol use at the time of surgery and greater MISS score were associated with greater odds of major complications [adjusted odds ratio (aOR) 95% CI: 3.4 (1.2-9.0), 1.09 (1.02-1.160), respectively]. Smoking at the time of surgery and moderately (>2mm) and severely displaced fractures (>4mm) were associated with greater odds of minor complications [aOR (95% CI): 2.1 (1.04-4.2), 2.7 (1.2-6.4), 2.7 (1.1-6.6), respectively]. Alcohol use, smoking, greater MISS score, and displaced fractures >2mm were significant risk factors for postoperative complications following MFR. Our findings can help guide informed decision making and surgical planning in patients with mandibular fractures.

Schatzker IV tibial plateau fractures involving the posterolateral column: Higher incidence of lateral meniscus and anterior cruciate ligament injuries with suboptimal postoperative outcomes

BackgroundCurrent literature offers scant insights into Schatzker IV tibial plateau fractures (TPFs) that affect the posterolateral (PL) column. This study seeks to elucidate the prevalence of meniscal and ligamentous injuries in the knee, as well as the clinical outcomes, in Schatzker IV TPF cases, both with and without PL column involvement. MethodsWe conducted a retrospective analysis of clinical and imaging data from patients with Schatzker IV TPFs who received surgical treatment at our institution between January 2018 and January 2022. Patient demographics and surgical details were meticulously documented. The study participants were categorized into two groups based on the involvement of the PL column in the Schatzker IV TPF. Group A comprised patients without PL column fractures, whereas Group B included those with such fractures. We compared soft tissue injuries affecting knee stability, namely meniscal and ligamentous injuries, between two groups using Magnetic Resonance Imaging (MRI) and surgical records. Further, Group B was divided into subgroups based on the presence or absence of knee subluxation. Within Group B, we measured the lateral plateau depression (LPD) and lateral plateau widening (LPW). Additionally, we investigated the frequency of meniscus entrapment in patients with PL column fractures. Clinical outcomes were assessed using The American Hospital for Special Surgery (HSS) and Rasmussen scores. ResultsThe study comprised 66 patients with Schatzker IV TPFs. Of these, 12 patients had no PL column fracture, while 54 had a PL column fracture. Group B demonstrated a 57.4 % and 64.8 % incidence of lateral meniscus (LM) and anterior cruciate ligament (ACL) injuries, respectively, significantly higher than that in Group A (25 %, 8.3 %) (p = 0.044, p < 0.001). Within Group B, those with knee subluxation showed a marked increase in LPD (14.5 ± 5.3 mm) and LPW (9.3 ± 4.9 mm), correlating with a higher rate of meniscus entrapment (76.0 %) (p < 0.001). Patients in Group B had lower HSS and Rasmussen scores compared to Group A (p = 0.048, p = 0.006). ConclusionThis investigation reveals that Schatzker IV TPFs involving the PL column are highly associated with increased rates of LM and ACL injuries. Additionally, these fractures correlate with a greater likelihood of knee subluxation and meniscus entrapment, ultimately leading to poorer prognostic outcomes.

Lower Levels of Vitamin D Are Associated with Higher Vasoactive-Inotropic Scores in Major Cardiac Surgery.

The vasoactive-inotropic score (VIS) predicts unfavorable outcomes after cardiac surgery in both children and adults. In our adult population, we investigated whether preoperative levels of vitamin D can predict the VIS and whether both vitamin D and the VIS can predict adverse outcomes following major heart surgery. Between 1 October 2021 and 28 February 2022, 300 patients underwent major cardiac surgery at our institution. Eighty-three of them had their 25-OH vitamin D levels measured before surgery. For this cohort, we calculated the VIS based on doses of vasoactive and inotropic medications administered post-surgery. Utilizing receiver operating curves, the predictive accuracy of vitamin D levels and the VIS in predicting acute kidney injury was assessed. The median age of the cohort was 66 (IQR 61-71) years, with 59% being male and a median BMI of 28.4 (IQR 25.2-31.6). The most common procedures were aortic valve replacement, mitral valve replacement, coronary artery bypass grafting, aortic valve and ascending aorta repair, and ASD correction. There was a significant difference in the postoperative VIS between patients with vitamin D deficiency, i.e., <20 ng/mL, and patients with vitamin D values > 20 ng/mL (3.5 vs. 1.3 p < 0.04). We also found a significant correlation between the VIS and the days of hospitalization (r = 0.335; p = 0.002), the days of stay in the intensive care unit (r = 0.547; p < 0.00001), and the mechanical ventilation time (r = 0.327; p = 0.025). Both vitamin D levels and the VIS predicted postoperative acute kidney injury (p < 0.05). Vitamin D deficiency is correlated with the VIS in adults undergoing major cardiac surgery. Both vitamin D levels and the VIS can predict unfavorable postoperative outcomes.

Related Factors and Risk Prediction of Chronic Pain after Knee Replacement.

This study aimed to explore potential risk factors associated with chronic pain after total knee arthroplasty (TKA) and to establish the risk prediction model of chronic postoperative pain (CPSP). This study retrospectively analyzed the clinical data of 160 patients who underwent TKA in our hospital between January 2021 and January 2024. Relevant data such as the baseline characteristics, past medical history, CPSP condition, and pain numerical rating scale (NRS) were retrieved from the medical information system. Logistic regression analysis was performed on the risk factors affecting the postoperative CPSP of the patients. The identified risk factors were incorporated to develop a risk-prediction model. Among the 160 patients, 67 (41.88%) had CPSP at or around the operation incision. The NRS pain score was significantly higher in the CPSP group than in the non-CPSP group during exercise preoperative and 3 months post-operation. Furthermore, the CPSP group had a higher NRS score than the non-CPSP group at rest 3 months after the procedure (p < 0.05). We observed that the preoperative NRS score, preoperative hospital for special surgery (HSS) score, postoperative functional training, and postoperative adverse events were the independent factors influencing the occurrence of CPSP after TKA (p < 0.05). Additionally, there was a significant positive correlation between preoperative NRS score, postoperative adverse events, and CPSP pain severity, and a significant negative correlation between preoperative HSS score, postoperative functional training, and CPSP pain severity (p < 0.05). The receiver operating characteristic (ROC) curve had excellent calibration and prediction capabilities for the predictive model of CPSP after TKA, with the area under the curve (AUC) of 0.868 (95% CI: 0.811-0.925). In this study, the predictive model of CPSP risk for patients after TKA surgery was initially constructed, which can help medical staff predict the risk of CPSP in patients after surgery individually, thereby preventing the occurrence of CPSP.

Simultaneous bilateral and staged total knee arthroplasty combined with unicompartmental knee arthroplasty in the treatment of bilateral knee osteoarthritis: comparison of early clinical outcomes, complications, and prosthesis survival

ObjectiveKnee osteoarthritis (KOA) is usually bilateral. In many patients, the degree of bilateral knee degeneration varies, with one side involving multiple compartments and the other a single compartment degeneration. Therefore, the objective of this study was to compare the early clinical efficacy of simultaneous bilateral and staged total knee arthroplasty (TKA) combined with unicompartmental knee arthroplasty (UKA) in the treatment of bilateral KOA with different degrees.MethodsWe compared clinical data from 71 simultaneous bilateral TKA/UKA (SB-TKA/UKA) patients with 52 Staged TKA/UKA (Staged-TKA/UKA) patients. Staged-TKA/UKA is defined as TKA on one knee followed by UKA on the other knee. The comparison included Hospital for Special Surgery (HSS) score, range of motion(ROM), complication rate and prosthetic survival rate at the last follow-up between the two groups.ResultsThe follow-up time of SB-TKA/UKA group was (69.08 ± 14.35) months, and that of Staged-TKA/UKA group was (73.25 ± 18.39) months. Staged-KA/UKA group had a shorter hospital stays, less hospitalization costs and shorter operating time (p < 0.001 for hospital stay, p < 0.001 for hospitalization costs and p < 0.001 for operating time). There were no significant differences in HSS and ROM between the two groups at the last follow-up (p > 0.05). There was no significant difference in complication rate between the two groups (χ2 = 0.56, p = 0.454). For the TKA-side knee joint, there was no significant difference in the prosthetic survival rate (χ2 = 0.05, p = 0.824) and the prosthetic survival curve (χ2 = 0.052, p = 0.82) between the two groups. For UKA-side knee joint, there was no significant difference in prosthetic survival rate (χ2 = 0.08, p = 0.777) and prosthetic survival curve (χ2 = 0.074, p = 0.786) between the two groups.ConclusionsCompared to Staged-TKA/UKA, SB-TKA/UKA has the same early clinical efficacy, shorter operating time and hospital stays, less hospitalization costs, and no increased postoperative complications and prosthesis revision rates. Therefore, SB-TKA/UKA may be recommended for patients who can tolerate simultaneous bilateral surgery as assessed before surgery.