Short-term Morbidity Research Articles

Being Small for Gestational Age does not Change Short-Term Outcomes for Extremely Low Birth Weight Babies at Townsville University Hospital

Abstract Aim To determine whether being small for gestational age (SGA) is associated with increased mortality and short-term morbidity for extremely low birth weight (ELBW) babies at Townsville University Hospital (TUH). Methods All babies with a birth weight of <1,000 g born at TUH between January 1, 2010 and January 1, 2021 were included. Data from the neonatal unit's NeoDATA database were used to compare mortality and short-term morbidity outcomes for babies categorized as SGA (birth weight <10th centile) or not. Statistical analyses were used to determine associations between being SGA and survival to discharge, intubation for mechanical ventilation, duration of respiratory support, chronic neonatal lung disease (CNLD), home oxygen, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), sepsis, time to full enteral feeds, and duration of admission. Results Of 461 ELBW babies, 62 (13.4%) were SGA. The SGA babies were significantly smaller at 714 (580–850) versus 810 (700–885) g (p < 0.001) and of advanced gestational age at 28.6 (26.6–30.2) versus 25.4 (24.4–26.6) weeks (p < 0.001). No significant difference in mortality existed, with 85% of SGA babies and 84% of others surviving. On univariate analysis, being SGA was associated with significant reductions in intubation for mechanical ventilation (p < 0.001), duration of respiratory support (p < 0.001), intraventricular hemorrhage (p = 0.002), NEC (p = 0.037), and admission duration (p = 0.038). After controlling for confounding factors, no outcomes were independently associated with being SGA. Logistic regression found survival was associated with birth weight (p = 0.030), gestational age (p = 0.007), and antenatal corticosteroids (p = 0.008). Conclusions Being SGA is not an independent predictor of mortality nor adverse short-term morbidity for ELBW babies.

Validation of Boey's scoring system in predicting short-term morbidity and mortality in peptic ulcer perforation peritonitis

Aim: This study aims to assess the validation of Boey's scoring system in predicting short-term morbidity and mortality amongst patients with peptic ulcer perforation (PULP) peritonitis. Methodology: 110 patients with PULP peritonitis were included in this study. Boey's score was calculated based on three parameters, pre-operative shock, concomitant medical illness and duration of perforation >24 h. All patients with PULP were treated with exploratory laparotomy with peritoneal lavage and omental patch repair and the patients were then followed up throughout the data collection period to look for clinical outcomes. The main outcomes assessed were mortality and short-term morbidity (1 month). Data were analysed using SPSS (IBM, Delhi, India). Chi-square test was used to check for the association between the outcome variables and the categorised Boey's score. The level of statistical significance was assigned as a P < 0.05. Results: Amongst the 110 patients, half belonged to the age group of 31–50 years, and 90% were male. The most common site of perforation was the first part of duodenum (78%). The rate of mortality was 10%. With respect to the distribution of the Boey's score, the percentage of patients with Boey's score 0, 1, 2 and 3 was found to be 12.75%, 58.2%, 24.5% and 5%, respectively, and their corresponding mortality was found to be 0%, 4.7%, 25.9% and 40%, respectively. Their morbidity at 1 week was found to be 21.4%, 42.6%, 80% and 100%, respectively, and morbidity at 1 month was found to be 0%, 39.3%, 75% and 100%, respectively. Conclusion: There was a significant association between mortality and morbidity at 1 week and at 1 month with the distribution of Boey's score. This highlights the importance of Boey's score in determining the outcome amongst perforated peptic ulcer patients. Boey's score being an easily applicable score for day-to-day clinical practice can aid clinicians in predicting the outcome amongst perforated ulcer patients. Several studies have also shown better accuracy with Boey's scoring system when compared to the other scoring systems.

Left Versus Right Liver Graft in Adult-to-Adult Living Donor Liver Transplantation: Comparable Outcome with an Optimal Approach to Overcome the Small-for-Size Syndrome

Introduction: Adult-to-adult living donor liver transplantation has been a dominant type of liver transplantation, especially in Asian countries where deceased donors are scarce. Many centers still prefer to choose the right liver graft (RLG) compared to the left liver graft (LLG) for better recovery of recipients. This study compared clinical outcomes of donors and recipients between the LLG and RLG. Method: The study cohort comprised of 25 (21.2%) patients in the LLG group and 93 (78.8%) in the RLG group. When both portal flow (≥300 ml/min/100gLW) and hepatic venous pressure gradient (≥10 mmHg) were increased, splenic artery ligation was performed for portal modulation. After the operation, somatostatin was administered when small-for-size syndrome (SFSS) was highly suspected. Results: In donor outcomes, graft-to-recipient weight ratio was lower in the LLG group than in the RLG group (median 0.93 [0.64–1.50] vs. 1.03 [1.00–1.66], P<0.001). Total bilirubin on POD 5 were lower in the LLG group than the RLG group (0.96 [0.50–2.47] vs. 1.50 [0.45–4.14], P=0.005). In recipient outcomes, SFSS frequently occurred in the LLG group compared to the RLG group (4 [16%] vs. 3 [3.2%], P=0.036). For portal modulation, 17 patients underwent splenic artery ligation, and 5 received intravenous continuous somatostatin after the operation. There was no significant difference in short-term surgical morbidity and mortality and long-term outcomes between the groups. Conclusion: This study demonstrates comparable outcomes between the LLG and RLG groups. With an optimal portal modulation strategy to overcome SFSS, LLG is safe and feasible to consider.

Short-Term Impact of Temporary Shutdown of a University-Affiliated Hospital on Patients With Colorectal Cancer During the Coronavirus Disease 2019 Pandemic.

Owing to in-hospital transmission of coronavirus disease 2019 (COVID-19), Uijeongbu St. Mary’s Hospital, a university-affiliated hospital in South Korea, was temporarily closed for disinfection in March 2020. This study aimed to investigate the impact of both the hospital shutdown and the prolonged COVID-19 pandemic on short-term outcomes of colorectal cancer (CRC) patients. We retrospectively reviewed the clinicopathologic data of 607 patients who were surgically treated for CRC from May 2018 to September 2021. Nodal upstaging, higher lymphatic invasion and abdominoperineal resection rates for 3 months after the hospital resumed surgery following the shutdown in the first wave of the COVID-19 pandemic were detected, without worse short-term morbidity or mortality. The incidence of adverse pathologic features of CRC such as lymphatic, venous, and perineural invasion was higher throughout the COVID-19 pandemic era. Further follow-up of CRC patients treated in the pandemic era for long-term oncologic outcomes is needed.

Cigarette smoking and complications in elective thoracolumbar fusions surgery: An analysis of 58,304 procedures.

ABSTRACTStudy Design:This was retrospective cohort study.Purpose:The current investigation uses a large, multi-institutional dataset to compare short-term morbidity and mortality rates between current smokers and nonsmokers undergoing thoracolumbar fusion surgery.Overview of Literature:The few studies that have addressed perioperative complications following thoracolumbar fusion surgeries are each derived from small cohorts from single institutions.Materials and Methods:A retrospective study was conducted on thoracolumbar fusion patients in the American College of Surgeons National Surgical Quality Improvement Program database (2006–2016). The primary outcome compared the rates of overall morbidity, severe postoperative morbidity, infections, pneumonia, deep venous thrombosis (DVT), pulmonary embolism (PE), transfusions, and mortality in smokers and nonsmokers.Results:A total of 57,677 patients were identified. 45,952 (78.8%) were nonsmokers and 12,352 (21.2%) smoked within 1 year of surgery. Smokers had fewer severe complications (1.6% vs. 2.0%, P = 0.014) and decreased discharge to skilled nursing facilities (6.3% vs. 11.5%, P < 0.001) compared to nonsmokers. They had lower incidences of transfusions (odds ratio [OR] = 0.9, confidence interval [CI] = 0.8–1.0, P = 0.009) and DVT (OR = 0.7, CI = 0.5–0.9, P = 0.039) as well as shorter length of stay (LOS) (OR = 0.9, CI = 0.9–0.99, P < 0.001). They had a higher incidence of postoperative pneumonia (OR = 1.4, CI = 1.1–1.8, P = 0.002). There was no difference in the remaining primary outcomes between smoking and nonsmoking cohorts.Conclusions:There is a positive correlation between smoking and postoperative pneumonia after thoracolumbar fusion. The incidence of blood transfusions, DVT, and LOS was decreased in smokers. Early postoperative mortality, severe complications, discharge to subacute rehabilitation facilities, extubation failure, PE, SSI, and return to OR were not associated with smoking.

Triangle Operation: Our Early Experience

Introduction: The triangle tissue bounded by superior mesenteric artery (SMA), common hepatic artery (CHA), and portal vein (PV) is dissected while performing the vessel-oriented approach of pancreatoduodenectomy (PD) “the TRIANGLE operation”. This study aims to reveal the status of tumor positivity of the tissue at the angle between the confluence of SMA and coeliac trunk (CT), a common site of recurrence, in relation to the tumor positivity of tissue in the rest of the TRIANGLE. Method: This is a hospital-based prospective cross-sectional study conducted from September 2020 to February 2021. All consecutive patients subjected for PD for pancreatic malignancy were included. Triangle operation was performed in all these cases and the tissue at the angle between SMA and CT (tA) and the rest of the triangle (tR) were sent separately for histopathological examination. Results: 27 patients underwent the “TRIANGLE” operation during the period. Median age 65 ± 13.34 years (range 32–84 years). Median preoperative BMI 21.75± 2.5. In 20 patients both tA and tR were negative for tumor suggesting R0 resection. In 3 patients tA was negative but tR was positive, the other 4 patients had both tA and tR positive status. Morbidity (Clavien–Dindo grade 2or more) was noted in 8 patients with 1 mortality. Conclusions: Extensive tissue dissection during TRIANGLE operation helps to achieve R0 resection without significant short-term morbidity. Long-term result awaited.

High intraoperative blood product requirements in liver transplantation: risk factors and impact on the outcome.

Liver transplantation (LT) is associated with a significant bleeding and the high transfusion requirements (HTR) negatively affect the outcome of LT patients. Our primary aim was to identify potential predictors of intraoperative transfusion requirements. Secondarily, we investigated, the effect of transfusion requirements on different clinical outcomes, including short-term morbidity and mortality. Data collected in 219 adult LT from a deceased donor, grouped according to HTR (defined as the need of 5 or more red blood cell units), were compared. We found that previous portal vein thromboses (p=0.0156), hemoglobin (Hb) (p<0.0001), International Normalized Ratio (INR) (p=0.0010) at transplant and veno-venous by-pass (p=0.0048) independently predicted HTR. HTR was always associated with poorer outcomes, including higher simplified acute physiology II score at Intensive Care Unit admission (p=0.0005), higher rates of pulmonary infections (p=0.0015) and early rejection (p=0.0176), longer requirement of mechanical ventilation, (p<0.0001), more frequent need for hemodialysis after transplantation (p=0.0036), overall survival (p=0.0010) and rate of day-90 survival (p=0.0016). This study identified specific risk factors for HTR and confirmed the negative impact exerted by HTR on clinical outcomes, including recipient survival. Prospective investigations are worth to assess whether correcting pre-transplant Hb and INR levels may effectively reduce blood product need and improve prognosis.

Non-guideline-compliant endovascular abdominal aortic aneurysm repair in women is associated with increased mortality and reintervention compared with men.

Sex-based disparities in surgical outcomes have emerged as an important focus in contemporary healthcare delivery. Likewise, the appropriate usage of endovascular abdominal aortic aneurysm repair (EVAR) in the United States remains a subject of ongoing controversy, with a significant number of U.S. EVARs failing to adhere to the Society for Vascular Surgery (SVS) clinical practice guideline (CPG) diameter thresholds. The purpose of the present study was to determine the effect of sex among patients undergoing EVAR that was not compliant with the SVS CPGs. All elective EVAR procedures for abdominal aortic aneurysms without a concomitant iliac aneurysm (≥3.0cm) in the SVS Vascular Quality Initiative were analyzed (2015-2019; n= 25,112). SVS CPG noncompliant repairs were defined as a size of<5.5cm for men and<5.0cm for women. The primary endpoint was 30-day mortality. The secondary endpoints were all-cause mortality, complications, and reintervention. Logistic regression was performed to control for surgeon- and patient-level factors. Freedom from the endpoints was determined using the Kaplan-Meier method. Noncompliant EVAR was performed in 9675 patients (38.5%). Although men were significantly more likely to undergo such procedures (90% vs 10%; odds ratio [OR], 3.1; 95% confidence interval [CI], 2.9-3.4; P< .0001), the 30-day mortality was greater for the women than the men (1.8% vs 0.5%; P= .0003). Women also experienced significantly higher rates of multiple complications, including postoperative myocardial infarction (1% vs 0.3%; P= .006), respiratory failure (1.4% vs 0.6%; P= .01), intestinal ischemia (0.7% vs 0.2%; P= .003), access vessel hematoma (3% vs 1.2%; P= .0006), and iliac access vessel injury (2.4% vs 0.8%; P< .0001). Additionally, women experienced increased overall 1-year reintervention rates (11.5% vs 5.8%; P< .0001). In the adjusted analysis, 30-day mortality and any in-hospital complication risk remained significantly greater for the women (30-day death: OR, 3.1; 95% CI, 1.6-5.8; P= .0005; in-hospital complication: OR, 1.9; 95% CI, 1.4-2.6; P< .0001). Women also experienced increased reintervention rates over time compared with men (OR, 1.5; 95% CI, 1.1-2.2; P= .02). Although men were more likely to undergo non-CPG compliant EVAR, women experienced increased short-term morbidity and 30-day mortality and higher rates of reintervention when undergoing non-CPG compliant EVAR. These unanticipated findings necessitate increased scrutiny of current U.S. sex-based EVAR practice and should caution against the use of non-CPG compliant EVAR for women.

Expectant Management of PPROM Improves Neonatal Outcome-A Retrospective Study of 562 Patients.

Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities. Material and methods: We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications. Result: The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28–31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32–34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%). Conclusion: Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period.

Prise en charge aiguë des hémorragies intracérébrales spontanées

Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients’ outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.

Post-cesarean ileus: An assessment of incidence, risk factors and outcomes

ObjectiveTo estimate the frequency of post cesarean paralytic ileus and to identify associated risk factors and outcomes. Study designA retrospective cohort study of woman who underwent cesarean delivery between 2005 and 2019. All parturients who had cesarean delivery were stratified and compared according to whether or not they were diagnosed with a paralytic ileus. Women were excluded if they had an intestinal injury or repair during the cesarean or if they suffered from a post cesarean mechanical bowel obstruction diagnosed during re-laparotomy. Basic demographics, obstetric history, current delivery characteristics, re-suturing indications and outcomes were obtained and analyzed. Univariate analyses were followed by a multivariate analysis (adjusted Odds Ratio (aORs) ; [95% Confidence Interval]). ResultsA total of 23,486 women met the inclusion and exclusion criteria of which 135 (0.6%) were diagnosed with paralytic ileus whilst 23,347 (99.4%) did not and served as the control group. Multivariate analysis revealed that an estimated intra-operative blood loss ≥ 1000 ml was the most significant risk factor for post cesarean paralytic ileus (aOR 2.27 (1.18–4.36)), followed by multifetal gestation (aOR 2.08 (1.24–3.51)), corporeal uterine incision (aOR 1.97 (1.07–3.63)), use of topical hemostatic agents (aOR 1.78 (1.19–2.66)) and increasing maternal age (aOR 1.78 (1.19–2.66)). Regarding maternal outcomes, post cesarean paralytic ileus was associated with higher rates of postpartum hemorrhage (44.4% vs. 13.4%, p < 0.01), transfusion of blood products (23.7% vs. 3.9%, p < 0.01), post-cesarean exploratory laparotomy (4.4% vs. 0.1%, p < 0.01) and prolonged hospital stay (32.6% vs. 5.2%, p < 0.01). ConclusionIn our population, whilst post cesarean paralytic ileus is infrequent, when it occurs it is associated with increased short-term maternal morbidity.

Preterm prelabor rupture of membranes without microbial invasion of the amniotic cavity and intra-amniotic inflammation: a heterogeneous group with differences in adverse outcomes

Objective The absence of microbial invasion of the amniotic cavity and intra-amniotic inflammation at the time of hospital admission is the most common condition associated with preterm prelabor rupture of membranes (PPROM). Although the intensity of intra-amniotic inflammatory response does not exceed the threshold for the diagnosis of intra-amniotic inflammation in this subgroup of PPROM, whether there could be differences in outcomes concerning the intensity of intra-amniotic inflammatory response remains unclear. Therefore, the main aims of this study on PPROM without microbial invasion of the amniotic cavity and intra-amniotic inflammation were (i) to characterize the association between the intensity of intra-amniotic inflammatory response, measured according to amniotic fluid interleukin (IL)-6 concentrations, and the presence of acute histological chorioamnionitis and acute inflammation in the amnion; (ii) to characterize the association between the intensity of intra-amniotic inflammatory response and fetal inflammatory response, and (iii) to describe the short-term morbidity of infants based on the intensity of intra-amniotic inflammatory response. Methods This retrospective study included 131 women with singleton pregnancies with PPROM without microbial invasion of the amniotic cavity and intra-amniotic inflammation between gestational ages of 24 + 0 and 36 + 6 weeks and who had delivered within 72 h of membrane rupture. Microbial invasion of the amniotic cavity was assessed based on a combination of cultivation and non-cultivation methods. Intra-amniotic inflammation was characterized based on the amniotic fluid IL-6 concentration. In addition, a histopathological assessment of the placenta was performed. Fetal inflammatory response syndrome was characterized according to IL-6 concentration in the umbilical cord blood of >11 pg/mL. Based on the quartiles of IL-6 concentrations in the amniotic fluid, these women were divided into four subgroups (from the lowest to the highest IL-6 concentrations). Results IL-6 concentrations in amniotic fluid were higher in women with acute histological chorioamnionitis (median: 819 pg/mL vs. 520 pg/mL; p = .003) and with acute inflammation of the amnion (median: 1116 pg/mL vs. 533 pg/mL; p = .0002) than in women without these complications. The rates of acute histological chorioamnionitis and acute inflammation of the amnion were the highest in the subgroup with IL-6 concentrations above the 75th percentile in amniotic fluid (chorioamnionitis, p = .02; amnion, p = .0002). No differences in IL-6 concentrations in amniotic fluid were identified between women with and without a fetal inflammatory response syndrome (p = .40). The rate of fetal inflammatory response syndrome did not vary among the amniotic fluid IL-6 quartile subgroups of women. Moreover, no differences were noted in short-term neonatal outcomes among the amniotic fluid IL-6 quartile subgroups. Conclusion A higher intensity of the intra-amniotic inflammatory response, measured by amniotic fluid IL-6 concentrations, is associated with a higher rate of acute inflammatory lesions in the placenta in the subset of PPROM pregnancies without microbial invasion of the amniotic cavity and intra-amniotic inflammation.

Effect of minimally invasive mitral valve surgery compared to sternotomy on short- and long-term outcomes: a retrospective multicentre interventional cohort study based on Netherlands Heart Registration.

Minimally invasive mitral valve surgery (MIMVS) has been performed increasingly for the past 2 decades; however, large comparative studies on short- and long-term outcomes have been lacking. This study aims to compare short- and long-term outcomes of patients undergoing MIMVS versus median sternotomy (MST) based on real-world data, extracted from the Netherlands Heart Registration. Patients undergoing mitral valve surgery, with or without tricuspid valve, atrial septal closure and/or rhythm surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching analyses were performed. In total, 2501 patients were included, 1776 were operated through MST and 725 using an MIMVS approach. After propensity matching, no significant differences in baseline characteristics persisted. There were no between-group differences in 30-day mortality (1.1% vs 0.7%, P = 0.58), 1-year mortality (2.6% vs 2.1%, P = 0.60) or perioperative stroke rate (1.1% vs 0.6%, P = 0.25) between MST and MIMVS, respectively. An increased rate of postoperative arrhythmia was observed in the MST group (31.3% vs 22.4%, P < 0.001). A higher repair rate was found in the MST group (80.9% vs 76.3%, P = 0.04). No difference in 5-year survival was found between the matched groups (95.0% vs 94.3%, P = 0.49). Freedom from mitral reintervention was 97.9% for MST and 96.8% in the MIMVS group (P = 0.01), without a difference in reintervention-free survival (P = 0.30). The MIMVS approach is as safe as the sternotomy approach for the surgical treatment of mitral valve disease. However, it comes at a cost of a reduced repair rate and more reinterventions in the long term, in the real-world.

Falciform ligament tubular graft for mesenteric-portal vein reconstruction during pancreaticoduodenectomy.

Portal vein resection and reconstruction in locally advanced pancreatic cancer represents a potentially curative treatment in selected patients without increasing surgical mortality. However, vascular reconstruction after segmental venous resection is challenging. The parietal peritoneum has emerged as a venous substitute but few reports include its use as a tubular graft. We report a retrospective series of portal vein reconstruction using a falciform ligament tubular graft during pancreaticoduodenectomy. Technical aspects and short-term morbidity and mortality after pancreaticoduodenectomy with falciform ligament tubular graft interposition were analyzed. Among 21 patients who used parietal peritoneum for venous substitution between 2015 and 2019, eight underwent pancreaticoduodenectomy with venous resection and reconstruction using interposition of falciform ligament tubular graft. The mean duration of surgery and clamping time were 350 and 27 min, respectively. No perioperative blood transfusion was required. All the grafts were patent the day after surgery. No complication related to venous obstruction was detected during the hospital stay. Two patients had postoperative pancreatic fistula. No further intervention was needed. The 90-day mortality was null. The use of interposition of falciform ligament tubular graft for portal venous reconstruction during pancreaticoduodenectomy seems to be a reliable, inexpensive, and safe procedure.

Commentary: Overlap Before the Critical Step of Lumbar Fusion Does Not Lead to Increased Short-Term Morbidity.

Commentary: Overlap Before the Critical Step of Lumbar Fusion Does Not Lead to Increased Short-Term Morbidity.

Prevalence of vitamin B12 and folate deficiency in children with malignancy and association with short term morbidities - A prospective study

Prevalence of vitamin B12 and folate deficiency in children with malignancy and association with short term morbidities - A prospective study

The role of multiple bowel resections in advanced ovarian cancer: survival and surgical outcomes—a narrative review

: Ovarian cancer (OC) is the fifth most common cancer-related cause of death in women and the most lethal gynecologic malignancies in developed countries. In more than two thirds of the cases it is diagnosed as an advanced stage disease. The treatment requires a surgical step, aiming to remove the macroscopically visible disease, either as a primary debulking surgery or interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). In both cases radical, complex and invasive surgical procedures are needed in order to achieve complete resection of the tumor, frequently involving bowel surgery. Considering the spread of the disease in the abdominal cavity, involvement of multiple bowel segments is common. Multiple bowel resections (MBR) are often needed to a complete cytoreduction but are linked to a higher rate of bowel diversion and postoperative morbidity, including severe postoperative complications, as anastomotic leakage (AL), and even death. These complications not only affect short term morbidity but may even postpone the administration of adjuvant chemotherapy, thus significantly affecting the outcomes of the treatment. NACT may help reducing the aggressiveness of debulking surgery and therefore the rate of its complications. This strategy represents a valid therapeutic option, especially in fragile patients, reducing the surgical related morbidity and the risk of bowel resections, without affecting the overall survival.

The Early Changes in Emergency General Surgery Following Implementation of UK COVID-19 Policy: A Retrospective Cohort Study.

IntroductionCoronavirus disease 2019 (COVID-19) has rapidly spread worldwide. On 23rd March 2020, the UK introduced measures in an effort to curb the disease spread. The aim of this study was to analyse the effect of government and Royal College measures on the general surgical take.Materials and methodsA retrospective analysis of patients referred to the acute general surgical take between 2nd March 2020 and 5th April 2020, including acuity at the time of referral, management, and patient outcomes, was undertaken. Data fit into a ‘pre-COVID measures’ cohort (prior to 23rd March 2020) and a ‘post-COVID measures’ cohort (on or after 23rd March 2020).ResultsA total of 465 patient referrals were included. There was a decrease in admissions rate in the post-COVID measures’ cohort (p=0.001), but with an increase in patient acuity with white cell count (WCC) (p=0.024) and C-reactive protein (CRP) (p=0.036). Laparoscopic surgery decreased (p=0.004); however, the proportion of patients having an operation remained constant. There was no increase in short-term morbidity and mortality or length of stay (LOS).DiscussionThe data suggests that UK lockdown introduction influenced people’s behaviour. Fewer patients presented to the surgical take; however, these patients were of higher acuity. Despite changes in royal college guidelines, there was no decrease in the proportion of patients undergoing operations; however, a higher proportion were open procedures. The change in national and college guidelines did not affect short-term morbidity, mortality or LOS.

Overlap Before the Critical Step of Lumbar Fusion Does Not Lead to Increased Short-Term Morbidity.

Few studies have assessed the impact of overlapping surgery during different timepoints of neurosurgical procedures. To evaluate the impact of overlap before the critical portion of surgery on short-term patient outcomes following lumbar fusion. In total, 3799 consecutive patients who underwent single-level, posterior-only lumbar fusion over 6 yr (2013-2019) at an academic hospital system were retrospectively studied. Outcomes included 30-d emergency department (ED) visit, readmission, reoperation, mortality, overall morbidity, and overall morbidity/surgical complications. Duration of overlap that occurred before the critical portion of surgery was calculated as a percentage of total beginning operative time. Univariate logistic regression was used to assess the impact of incremental 1% increases in the duration of overlap within the whole population and patients with beginning overlap. Subsequently, univariate analysis was used to compare exact matched patients with the least (bottom 40%) and most amounts of overlap (100% beginning overlap). Coarsened exact matching was used to match patients on key demographic factors, as well as attending surgeon. Significance was set at a P-value <.05. Increased duration of beginning overlap was associated with a decrease in 30-d ED visit (P=.03) within all patients with beginning overlap, but not within the whole population undergoing lumbar fusion. Duration of beginning overlap was not associated with any other short-term morbidity or mortality outcome in either the whole population or patients with beginning overlap. Increased duration of overlap before the critical step of surgery does not predict adverse short-term outcomes after single-level, posterior-only lumbar fusion.

What We Know about the Long-Term Risks of Hysterectomy for Benign Indication—A Systematic Review

Hysterectomy is the most common treatment option in women with uterine fibroids, providing definitive relief from the associated burdensome symptoms. As with all surgical interventions, hysterectomy is associated with risk of complications, short-term morbidities, and mortality, all of which have been described previously. However, information on the potential long-term risks of hysterectomy is only recently becoming available. A systematic literature review was performed to identify studies published between 2005 and December 2020 evaluating the long-term impact of hysterectomy on patient outcomes. A total of 29 relevant studies were identified. A review of the articles showed that hysterectomy may increase the risk of cardiovascular events, certain cancers, the need for further surgery, early ovarian failure and menopause, depression, and other outcomes. It is important to acknowledge that the available studies examine possible associations and hypotheses rather than causality, and there is a need to establish higher quality studies to truly evaluate the long-term consequences of hysterectomy. However, it is of value to consider these findings when discussing the benefits and risks of all treatment options with patients with uterine fibroids to allow for preference-based choices to be made in a shared decision-making process. This is key to ensuring that patients receive the treatment that best meets their individual needs.