Short-term Outcomes In Patients Research Articles

Short-term functional outcomes in patients undergoing primary total knee arthroplasty according to their body mass index

Background: The impact of an increased body mass index (BMI) in patients with ostheoarthritis who undergo total knee arthroplasty (TKA) remains a controversial variable in terms of risks and benefits. This study aimed to evaluate the influence of BMI in the functional outcomes of patients with ostheoarthritis who underwent TKA. Methods: We followed a cohort of patients who underwent total knee arthroplasty with a primary diagnosis of osteoarthritis. Patients were stratified into 3 groups according to the World Health Organization classification of BMI. We assessed the association between BMI group and functional scores using the Western Ontario and McMaster osteoarthritis index (WOMAC) over the time intervals of pre– and postoperatively at 1 month, 3 months and 1 year. Results: The difference in means between pre-surgical WOMAC and WOMAC at first follow-up according to each BMI group was divided as follows: normal 10.9 (p=0.195), overweight 15.7 (p≤0.001) and obese 20.6 (p≤0.001). Study participants with a higher BMI had worse preoperative WOMAC scores and had greater improvement from baseline to 1 month. After one year of follow-up, participants in all BMI groups had similar WOMAC scores. Conclusions: Patients with obesity who underwent TKA showed greater functional improvement one month after surgery compared to the other BMI groups. Subsequently, it was observed at the end of the 12-month follow-up that all patients, regardless of BMI, had improved functional outcomes, and the magnitude of improvement was similar in all BMI groups.

Impact of Meniscus Repair in Conjunction With Anterior Cruciate Ligament Reconstruction on Functional Outcomes at Six Months.

Background and aim Anterior cruciate ligament (ACL) injuries often occur along with menisci tears. ACL reconstruction with meniscectomy has long been the preferred technique for such injuries; however, it has been postulated to increase the chances of osteoarthritis (OA). Therefore, recent techniques have involved preserving menisci while reconstructing ACL to prevent OA and improve overall functional outcomes. This study aimed to evaluate the functional outcomes of arthroscopic meniscal repair performed concurrently with ACL reconstruction at six months post-surgery. Methodology We conducted a cross-sectional study at a tertiary care center after getting appropriate ethics committee approval. A total of 67 participants who met the inclusion and exclusion criteria were enrolled in the study after obtaining informed consent. Their demographics were recorded retrospectively from hospital records, while their Lysholm Knee Score (LKS) responses were collected prospectively during their sixth-month follow-up visit to our department. Analysis was done using MicrosoftExcel. Appropriate statistical tests including chi-square, analysis of variance (ANOVA), and independent t-tests were applied to keep an alpha of 0.05. Results We found that the mean age of participants was 35 years. The mean LKS of patients who underwent isolated ACL reconstruction (ACLR) was 86.02 ± 9.38.For those who underwent ACLR plus meniscus repair (MR), the mean LKS was marginally higher at 87.4 ± 7.41 during their sixth-month follow-up, with a P-value of 0.27. Furthermore, the mean LKS of patients who underwent ACLR plus meniscectomy was 86 ± 10.48. Comparing the means of all three groups revealed no statistical difference amongany surgical approach with a P-value of 0.69. A total of 33 (49.25%) participants achieved an LKSfalling within the Goodcategory (84-94). Comparing between three surgical groups and their LKS categories also revealed no statistical difference with a P-value of 0.7. Conclusions Short-term functional outcomes in patients undergoing ACLR or ACLR plus MR using patient-reported knee scores like LKS demonstrate favorable outcomes but fail to demonstrate statistical significance. On a longer follow-up period, a reduction in the prevalence of OA is a possibility with the preservation of menisci; however, conflicting evidence in the literature about the approach to ACL injuries with menisci involvement warrants large-scale randomized controlled trials to decide upon the standard of care.

Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case-control study.

The purpose of this study is to compare peri-operative and short-term outcomes in patients who underwent elective total hip replacement (THA) for primary osteoarthritis (OA) with direct anterior approach (DAA) versus a pair-matched cohort of patients who underwent robotic-assisted THA with posterolateral approach. Data from consecutive patients who underwent elective hip replacement from 2021 to 2023 for primary OA were retrospectively retrieved and divided into two groups: the DAA group, who underwent THA with the DAA approach using conventional instruments, and the robotic posterolateral (R-PL group), who underwent robot arm-assisted THA with the posterolateral approach. Comparative assessed outcomes were: operative time, radiographical implant positioning, intake of rescue analgesics, blood loss, transfusion rate, leg length discrepancy and functional outcomes (Harris hip score and forgotten joint score). A total of 100 pair-matched patients were retrieved with a mean age of 66.7 ± 10.7 (range: 32-85) years and a mean follow-up of 12.8 ± 3.6 (range: 7-24) months. No differences in patients' characteristics were detected. Patients in the R-PL group required less rescue tramadol (p > 0.001), ketorolac (p = 0.028) and acetaminophen (p < 0.001). There was no significant difference in the operative time between (MD = 5.0min; p = 0.071). Patients in the DAA group had significantly lower Hb levels at day 1 (p = 0.002) without significant differences in transfusion rate (p = 0.283). Patients in the R-PL group had shorter length of stay (LOS) with a mean difference of 1.8days [p < 0.001; 95% confidence interval (CI) 1.4-2.3]. No difference in clinical outcomes was found [leg length discrepancy (LLD), p = 0.572; HHS, p = 0.558; forgotten joint score (FJS), p = 0.629]. No radiographical differences were measured in cup inclination (MD = 2.0°, p = 0.069), malpositioning [odd ratio (OR) = 0.2; p = 0.141], stem alignment (OR = 0.3; p = 0.485) and stem sizing (OR = 1.5; p = 1.000). There was no difference in complication rate except for lateral femoral cutaneous nerve damage, which was higher in DAA group (p < 0.001). R-PL and DAA THA had comparable short-term clinical and radiological outcomes along with similar complication rates. The R-PL group showed significantly lower Hb drop, rescue analgesic consumption and shorter LOS. This is a preliminary study and no strong recommendation can be provided. Further prospective randomized trials are requested to further investigate the cost-effectiveness of robotic surgery in THA. Level IV, case-control study.

Impact of Age, Gender, and Body Mass Index on Short-Term Outcomes of Patients With Cardiogenic Shock on Mechanical Circulatory Support

BackgroundThis single-center observational study assessed the impact of age, sex, and body mass index (BMI) in patients with cardiogenic shock on temporary mechanical circulatory support. MethodsAll adult patients admitted to the Cleveland Clinic main campus Cardiac Intensive Care Unit (CICU) between Dec 1st, 2015, to Dec 31st, 2019, CICU with cardiogenic shock necessitating MCS with Intra-Aortic Balloon Pump (IABP), Impella or Venous Arterial- Extra Corporeal Membrane Oxygenation (VA- ECMO) were retrospectively analyzed for this study. Baseline characteristics and 30-day outcomes were collected via physician directed chart review. The impact of age, sex, and BMI on 30-day mortality was assessed using multivariable logistic regression. Kaplan Meier survival curves were used to analyze the survival difference in specific subsets. ResultsA total of 393 patients with CS on temporary MCS were admitted to our CICU during the study period. The median age of out cohort was 63 years (IQR 54-70yrs), median BMI was 28.50 kg/m2 (IQR 24.62-29.72) and 70% (n=276) were males. 22 patients >80 years had received MCS compared to 372 patients<80 years. Patients>80 years on MCS had significantly higher 30-day mortality compared to those less than 80 years (81.8% vs 49.3%, p=0.006). Upon stratifying patients by BMI, 161 patients (41%) were found to have BMI≥30 kg/m2 whereas 232 patients (59%) had BMI<30 kg/m2. Comparison of 30-day mortality revealed that patients with BMI≥30 did significantly worse than patients with BMI<30 (59.6% vs 45.3%, p=0.007). There was no difference in 30-day mortality between men and women. On multivariable logistic regression both age and BMI had a positive linear relationship with adjusted 30-day mortality whereas sex did not have a major effect. ConclusionsAdvanced age and higher BMI are independently associated with worse outcomes in patients with CS on MCS. Utilizing a strict selection criterion for patients in CS is pertinent to derive the maximum benefit from advanced mechanical support.

Impact of reperfusion therapies on clot resolution and long-term outcomes in patients with pulmonary embolism

ObjectiveMajor progress in reperfusion strategies has substantially improved the short-term outcomes of patients with pulmonary embolism (PE), however, up to 50% of patients report persistent dyspnea after acute PE. MethodsA retrospective study of the PE response team registry and included patients with repeat imaging at 3 to 12 months. The primary outcome was to determine the incidence of residual pulmonary vascular obstruction following acute PE. Secondary outcomes included the development of PE recurrence, right ventricular (RV) dysfunction, chronic thromboembolic pulmonary hypertension, readmission, and mortality at 12 months. ResultsA total of 382 patients were included, and 107 patients received reperfusion therapies followed by anticoagulation. Patients who received reperfusion therapies including systemic thrombolysis, catheter-directed thrombolysis, and mechanical thrombectomy presented with a higher vascular obstructive index (47% vs 28%; P < .001) and signs of right heart strain on echocardiogram (81% vs 43%; P < .001) at the time of diagnosis. A higher absolute reduction in vascular obstructive index (45% vs 26%; 95% confidence interval, 14.0-25.6; P < .001), greater improvement in RV function (82% vs 65%; P = .021), and lower 12-month mortality rate (2% vs 7%; P = .038) and readmission rate (33% vs 46%; P = .031) were observed in the reperfusion group. No statistically significant differences were found between groups in the development of chronic thromboembolic pulmonary hypertension (8% vs 5%; P = .488) and PE recurrence (8% vs 6%; P = .646). ConclusionsWe observed a favorable survival and greater improvement in clot resolution and RV function in patients treated with reperfusion therapies.

Impact of obesity on intensive care unit outcomes in older patients with critical illness: A cohort study.

Although the paradoxical association between obesity and improved survival has been reported in a variety of clinical settings, its applicability to intensive care unit (ICU) outcomes in older critically ill patients remains unclear. We sought to examine the association between obesity and 30-day mortality and other adverse outcomes in this population. We analyzed data of older patients (≥ 60 years) in the eICU Collaborative Research Database. Body mass index (BMI) was stratified according to the World Health Organization obesity classification. Logistic regression model was used to estimate adjusted odds ratios (ORs), and cubic spline curve was used to explore the nonlinear association between BMI and 30-day ICU outcomes. Stratified analysis and sensitivity analysis were also performed. Compared with class I obesity, under- and normal-weight were associated with higher all-cause, cardiovascular and noncardiovascular mortality, and class III obesity was associated with greater all-cause and cardiovascular mortality (OR, 1.18 [95% CI, 1.06-1.32], 1.28 [1.08-1.51]). Obesity classes II and III were associated with higher composite all-cause mortality, mechanical ventilation, or vasoactive drug usage risks (OR, 1.12 [95% CI, 1.04-1.20], 1.33 [1.24-1.43]). Mechanical ventilation was strongly positively associated with BMI. A significant BMI-by-sex interaction was observed for cardiovascular mortality, such that the association between severe obesity and mortality was more pronounced among older men than older women. The obesity paradox does not appear to apply to short-term ICU outcomes in older patients with critical illness, mainly due to increased all-cause and cardiovascular mortality in severely obese patients, particularly in men.

A126 IMPACT OF TIME OF DAY ON PROCEDURAL OUTCOMES IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): ANALYSIS FROM A TERTIARY REFERRAL CENTER

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an established diagnostic and therapeutic tool for hepatobiliary disease. Given its technical demands, it remains one of the highest-risk endoscopic procedures. Addressing modifiable factors, such as operator fatigue, may mitigate procedural risk. In colonoscopy, there is conflicting data on whether procedure time of day, as a surrogate of operator fatigue, affects outcomes, with some literature demonstrating decreased procedure completion and polyp detection rates in the afternoon. There is a paucity of data evaluating this potential relationship in ERCP. Aims To evaluate the impact of procedure time of day on procedural success and short-term adverse outcomes in patients undergoing ERCP. Methods A retrospective review of ERCP's performed on adult patients at our tertiary referral center from January 1, 2011 to December 31, 2020 was performed. The primary outcome was the procedural success rate, defined as successful navigation to the papilla, selective duct cannulation and cholangiography, and realization of the intended therapeutic goals. Secondary outcomes included procedure duration, rate of deep ductal cannulation, rate of sphincterotomy, and short-term (30-day) adverse events (immediate bleeding, delayed bleeding, pancreatitis, perforation). Statistical analysis was conducted using R. Categorical variables were compared using the Chi-square test of independence or Fisher’s exact test. Continuous variables were compared using T-tests or the Mann-Whitney-U test. Results A total of 5755 ERCP’s were performed between 8 AM – 6 PM; 2863 were performed before 12PM (AM group) and 2892 after 12PM (PM group). Baseline characteristics were similar between the two cohorts, with the exception of hypertension (33.7% AM vs 30.1% PM; p=0.003), and anticoagulation (20.3% AM vs 18.3% PM; p=0.05). In both groups, the most common ERCP indication was choledocholithiasis. The primary operators in both cohorts were clinical fellows. There was no difference in procedural success rate (87.0 % AM vs 86.7% PM; p = 0.72), procedure duration (33.6 minutes AM vs 32.9 minutes PM; p = 0.29), rates of deep cannulation (82.6% AM vs 83.0% PM; p = 0.81) and sphincterotomies (63.2% vs 62.7%; p = 0.68). Rate of adverse events were similar, with slightly higher rates of immediate bleeding in the AM group (5.0% AM vs 3.8% PM; p = 0.03). Results were similar in a subgroup analysis of patients with altered anatomy. Conclusions In this large retrospective review of ERCPs performed at a tertiary referral center, the procedure time of day did not impact procedural success rate. There were slightly higher rates of immediate bleeding in the AM group, though this may be explained by higher rates of anticoagulation in that group. Funding Agencies None

Influence of Obesity on Short-Term Surgical Outcomes in HFrEF Patients Undergoing CABG: A Retrospective Multicenter Study.

Background: This retrospective multicenter study investigates the impact of obesity on short-term surgical outcomes in patients with heart failure and reduced ejection fraction (HFrEF) undergoing coronary artery bypass grafting (CABG). Given the rising global prevalence of obesity and its known cardiovascular implications, understanding its specific effects in high-risk groups like HFrEF patients is crucial. Methods: The study analyzed data from 574 patients undergoing CABG across four German university hospitals from 2017 to 2023. Patients were stratified into 'normal weight' (n = 163) and 'obese' (n = 158) categories based on BMI (WHO classification). Data on demographics, clinical measurements, health status, cardiac history, intraoperative management, postoperative outcomes, and laboratory insights were collected and analyzed using Chi-square, ANOVA, Kruskal-Wallis, and binary logistic regression. Results: Key findings are a significant higher mortality rate (6.96% vs. 3.68%, p = 0.049) and younger age in obese patients (mean age 65.84 vs. 69.15 years, p = 0.003). Gender distribution showed no significant difference. Clinical assessment scores like EuroScore II and STS Score indicated no differences. Paradoxically, the preoperative left ventricular ejection fraction (LVEF) was higher in the obese group (32.04% vs. 30.34%, p = 0.026). The prevalence of hypertension, COPD, hyperlipidemia, and other comorbidities did not significantly differ. Intraoperatively, obese patients required more packed red blood cells (p = 0.026), indicating a greater need for transfusion. Postoperatively, the obese group experienced longer hospital stays (median 14 vs. 13 days, p = 0.041) and higher ventilation times (median 16 vs. 13 h, p = 0.049). The incidence of acute kidney injury (AKI) (17.72% vs. 9.20%, p = 0.048) and delirium (p = 0.016) was significantly higher, while, for diabetes prevalence, there was an indicating a trend towards significance (p = 0.051) in the obesity group, while other complications like sepsis, and the need for ECLS were similar across groups. Conclusions: The study reveals that obesity significantly worsens short-term outcomes in HFrEF patients undergoing CABG, increasing risks like mortality, kidney insufficiency, and postoperative delirium. These findings highlight the urgent need for personalized care, from surgical planning to postoperative strategies, to improve outcomes for this high-risk group, urging further tailored research.

Family resilience, patient-reported symptoms in young stroke dyads: The effect of caregiver readiness and social support.

To investigate empirically the direct effect and potential mechanism of family resilience on patient-reported outcomes among young stroke dyads in China. Young patients with stroke have been becoming an important public health issue. According to relevant theories and previous studies, we found that family resilience might play an important role in patient's symptoms. However, it is less clear about the specific relationship and potential mechanisms of these two variables. We used a prospective cross-sectional design. A multi-item questionnaire was used to assess the constructs of interest. Researchers progressively constructed and validated conditional process models. The PROCESS macro was used to verify the research hypotheses. A total of 560 questionnaires were collected in this study. We found that family resilience of stroke patients and their spouses had a direct effect on the physical, psychological and social aspects of patient-reported symptoms. We further revealed that caregiver preparedness partially mediated the relationship between family resilience and patient's symptoms in stroke patient-spouse dyads, while perceived social support moderated the relationship between caregiver preparedness and patient's symptoms. Finally, we observed that the impact of caregiver readiness and social support on patients' symptoms predominantly manifested in physical and physiological outcomes. Our research provides evidence about the positive impact of family resilience on patient-reported symptoms in young stroke dyads. Meanwhile, it further revealed how caregiver preparedness and perceived social support may play out in the relationship. Our research introduces a novel perspective and pathway to enhance short-term recovery outcomes for patients. It also furnishes clinicians and nurses with evidence to guide the implementation of interventions aimed at improving patient health outcomes and facilitating smoother transitions from the hospital to home. What problem did the study address? Families play a crucial role in a patient's recovery process from illness, with family resilience serving as an important force for families to overcome adversity. However, the impact on patient symptoms and the underlying mechanisms of this relationship are uncertain. Empirical research is required to validate these aspects. What were the main findings? Family resilience has a positive impact on the physical, psychological and social aspects of patient-reported symptoms in young stroke dyads. Both the actor effect and partner effect are supported. The impact of caregiver readiness and social support on patient-reported symptoms is primarily observed in physical and physiological outcomes. Where and on whom will the research have an impact? This study offers a novel approach to enhance the short-term recovery of stroke patients. The researchers believe that the findings of this study will play an even more significant role during patients' transition from the hospital to home. This study followed the STROBE statement of cross-sectional studies. The study was conducted by patients, their spouses, healthcare professionals and the research team.

Impact of sustentaculum tali screw positioning on radiographic and functional outcomes in calcaneal fractures

BackgroundTo investigate whether accurate placement of sustentaculum tali screws have the impacts on the clinical efficacy of calcaneal fractures.MethodsA retrospective analysis of 72 cases (73 feet) of calcaneal fractures from September 2015 to September 2019 treated with open reduction and internal fixation with sustentaculum tali screws was conducted. Patients were divided into the sustentaculum tali fixation group (ST group) and the sustentaculum fragment fixation group (STF group) according to the location of the sustentaculum tali screw placement. The functional outcomes at preoperative, 7 days and 1 year postoperative were collected and analyzed.ResultsIn the ST group (40 feet), the Gissane's angle altered from (109.89 ± 12.13)° to (121.23 ± 9.34)° and (119.08 ± 8.31)° at 7 days and 1 year postoperative, respectively. For Böhler’s angles altered from (11.44 ± 5.94)°, to (31.39 ± 7.54)°, and (30.61 ± 7.94)° at 7 days and 1 year postoperative, respectively. In the STF group (33 feet), Gissane’s angle altered from (110.47 ± 14.45)°, to (122.08 ± 8.84)°, and (120.67 ± 9.07)° and Böhler’s angle altered from (11.32 ± 6.77)°, to (28.82 ± 8.52)°, and (28.25 ± 9.13)° (P < 0.001). However, there was no statistically significant difference in functional outcomes at 1 week after surgery and 1 year after surgery (P > 0.05). The AOFAS scores at the final follow-up of the two groups: ST group (88.95 ± 6.16) and STF group (89.78 ± 8.76); VAS scores, ST group (0.83 ± 0.98) and STF group (1.03 ± 1.59), all differences were not statistically significant (P > 0.05).ConclusionThe position of sustentaculum tali screws has no significant difference on the short-term clinical outcome in patients with calcaneal fractures, while reliable fixation of screws to sustentaculum tali fragment can achieve similar clinical outcome.Level of evidence V.

Thyroid Stimulating Hormone as a Possible Additional COVID-19 Outcome Marker.

Background and Objectives: The interaction between thyroid and SARS-CoV-2 is complex and not yet fully understood. This study aimed to identify a predictive value of serum TSH levels on the short-term and middle-term outcomes of patients hospitalized for COVID-19. Materials and Methods: We retrospectively analyzed electronic records (ERs) data for hospitalized COVID-19 patients between March 2020 and June 2021 and their ERs during outpatient visits, 6-8 weeks post-discharge, in cases of known serum TSH levels and no previous thyroid disorder. The short-term (length of hospital stay, MSCT findings of lung involvement, required level of oxygen supplementation, admission to the ICU, and death) and middle-term outcomes after 6 to 8 weeks post-discharge (MSCT findings of lung involvement) were analyzed. Results: There were 580 patients included: 302 males and 278 females, average age of 66.39 ± 13.31 years, with no known thyroid disease (TSH mean 1.16 ± 1.8; median 0.80; no value higher than 6.0 mIU/L were included). Higher TSH was observed in patients with less severe outcomes and was associated with significantly higher SpO2 during hospitalization. Patients who required overall more oxygen supplementation or HFOT, mechanical ventilation, and patients who were more frequently admitted to the ICU or were more often treated with corticosteroids had lower TSH than those who did not show these indicators of disease severity. Lower TSH was also present in non-survivors when compared to survivors (all p < 0.01). Patients with low TSH during hospitalization more often had persistent lung involvement during the post-COVID-19 period (p = 0.028). In the post-COVID-19 period, there was an overall, statistically significant increase in the TSH levels when compared to TSH during hospitalization (p < 0.001). Conclusions: Low/suppressed serum TSH levels during acute COVID-19 may be an additional laboratory test that should be included in the prediction of unfavorable short- and middle-term outcomes.

The effect of body mass index on short-term outcomes in patients undergoing off-pump coronary artery bypass grafting surgery: a retrospective study from a single cardiovascular center

ObjectiveThis study is designed to investigate the impact of body mass index (BMI) on the short-term outcomes of patients undergoing off-pump coronary artery bypass graft (OPCAB) surgery.MethodsData was obtained from 1006 Chinese patients who underwent isolated, primary OPCAB at a high-traffic cardiovascular center during 2020. Subjects were categorized, by BMI, into a low & normal weight (LN) group (BMI < 24 kg/m2), an overweight (OVW) group (24 ≤ BMI < 28 kg/m2), and an obese (OBS) group (BMI ≥ 28 kg/m2). Information pertaining to patients’ short-term outcomes (including incidence of mortality and morbidities; duration of postoperative mechanical ventilation; length of stay in the ICU and hospital; postoperative bleeding; etc.) were extracted, and the data from each group were compared.ResultsThe incidences of in-hospital mortality and morbidities were similar for all three groups. The volume of fluid infusion, postoperative bleeding within 24 h and total bleeding in LN group were higher than those in the OBS group (P < 0.001). The hemoglobin level was lower in the LN group than that in the OBS group (P < 0.001). Duration of mechanical ventilation and length of stay in the ICU in the LN group were longer than those in the OBS group (P < 0.001).ConclusionsOur results demonstrate that BMI is not significantly related with short-term outcomes in OPCAB patients. However, we suggest that OPCAB patients with low-normal BMI are more susceptible to post-operative blood loss.

Current Use and Impact of Pulmonary Artery Catheters on the Short-Term Outcomes in Patients With Cardiogenic Shock Treated With an Impella: Findings From the Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD).

This study aimed to investigate the current use and impact of pulmonary artery catheters (PACs) in patients with cardiogenic shock (CS) who underwent Impella support. This was a prospective multicenter observational study between January 2020 and December 2021 that registered all patients with drug-refractory acute heart failure and in whom the placement of an Impella 2.5, CP, or 5.0 pump was attempted or successful in Japan. Cardiac ICUs in Japan. Between January 2020 and December 2021, a total of 3112 patients treated with an Impella were prospectively enrolled in the Japan registry for percutaneous ventricular assist device (J-PVAD). Among them, 2063 patients with CS were divided into two groups according to the PAC use. None. The primary endpoint was the 30-day mortality, and the secondary endpoints were hemolysis, acute kidney injury, sepsis, major bleeding unrelated to the Impella, and ventricular arrhythmias within 30 days. PACs were used in 1358 patients (65.8%) who underwent an Impella implantation. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) was significantly higher in the patients with PACs than in those without. Factors associated with PAC use were the prevalence of hypertension, out-of-hospital cardiac arrest, New York Heart Association classification IV, the lesser prevalence of a heart rate less than 50, and the use of any catecholamine. The primary and secondary endpoints did not significantly differ according to the PAC use. Focusing on the patients with VA-ECMO use, the 30-day mortality and hemolysis were univariately lower in the patients with PACs. The J-PVAD findings indicated that PAC use did not have a significant impact on the short-term outcomes in CS patients undergoing Impella support. Further prospective studies are required to explore the clinical implications of PAC-guided intensive treatment strategies in these patients.

Origin and Clinical Impact of Early Multidrug-Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy

Introduction: Infections caused by multidrug-resistant bacteria (MDR) occur more frequently after pancreaticoduodenectomy (PD) compared to other abdominal surgeries, and infective complications represent a major determinant of postoperative morbidity following PD. Preoperative biliary stent (PBS) placement often leads to biliary contamination, which plays a significant role in postoperative infections. The aim of this study is to evaluate the impact of MDR contamination on short-term postoperative outcomes in patients undergoing PD and to evaluate the relationship between MDR bacteria, PBS, and bile contamination. Methods: This is a retrospective study based on a prospectively maintained database including 825 consecutive patients who underwent pancreaticoduodenectomies (PDs). All procedures were performed by experienced pancreatic surgeons at a high-volume center and the patients were managed according to the same perioperative enhanced recovery protocol. Results: MDR bacteria were present in 17.5% of bile cultures, exclusively within the stented group. At the multivariate analysis, the development of major postoperative complications (MPC) was correlated with the presence of MDR bacteria in the bile (OR 1.66, 95% CI: 1.1–2.52; p = 0.02). MDR bacteria were detected early in the surgical drainage in 144 out of 825 patients (12.1%), with 72.2% having a previous biliary stent placement and 27.8% without stents (p &lt; 0.001). Moreover, the development of an MPC was associated with the presence of MDR bacteria in the drainage (OR = 1.81, 95% CI: 1.21–2.73, p = 0.0042). Conclusions: We demonstrated that MDR contamination worsens the short-term outcomes of patients undergoing PDs. Specifically, when MDR bacteria are present in both the bile and drainage, there is a statistically significant increase in the incidence of major postoperative complications (MPC). Our data suggest that the majority of MDR surgical site infections stem from biliary contamination resulting from the placement of a preoperative biliary stent (PBS).

The rise of robotic colorectal surgery: better for patients and better for surgeons.

Robotic colorectal surgery represents a major technological advancement in the treatment of patients with colorectal disease. Several recent randomized controlled trials comparing robotic colorectal surgery with laparoscopic surgery have demonstrated improved short-term patient outcomes in the robotic group. Whilst the primary focus of research in robotic surgery has been on patient outcomes, the robotic platform also provides unparalleled benefits for the surgeon, including improved ergonomics and surgeon comfort, with the potential to reduce occupational injuries and prolong career longevity. It is becoming clear that robotic surgical systems improve patient outcomes and may provide significant benefits to the surgical workforce.

Effects of cardiovascular risk factors and pre-existing diseases on the short-term outcome of Takotsubo syndrome.

The effects of cardiovascular risk factors (CVRF) on the development of most acute cardiac conditions are well established; however, little is known about the frequency and effects of CVRF in Takotsubo syndrome (TTS) patients. The aim of our study was to compare the frequency of CVRF and pre-existing diseases (PD) of TTS patients to ST-elevation myocardial infarction (STEMI) patients and analyze their effects on short-term outcome. We analyzed the frequency of CVRF (hypertension, hyperlipidemia, type II diabetes mellitus, smoking, chronic kidney disease, family history) as well as somatic and psychiatric PD at admission in TTS patients and compared them with STEMI patients. Their effect on short-term outcome was calculated using acombined endpoint of cardiogenic shock, cardiopulmonary resuscitation, mechanical ventilation, and/or in-hospital death. In total, 150 TTS and 155 STEMI patients were included in our study. We observed ahigher frequency of psychiatric (30% vs. 7%, p < 0.001), neurological (5% vs. 0%, p = 0.01), and pulmonary (18% vs. 5%, p < 0.001) PD in TTS patients as compared to STEMI patients. There were less smokers (47% vs. 61%, p = 0.03) and patients with hyperlipidemia (24% vs. 51%, p < 0.001) in the TTS cohort than in the STEMI cohort. None of the CVRF or PD behaved as an independent predictor for adverse short-term outcome in TTS patients. Psychiatric, neurological, and pulmonary pre-existing diseases are more common in TTS than in STEMI patients. Interestingly, PD and CVRF do not seem to have any impact on the short-term outcome of TTS patients.

Short-term radiographic and clinical outcomes of patients treated with anatomic total shoulder arthroplasty using a modern-generation implant with a metal-backed glenoid component

BackgroundA leading cause of anatomic total shoulder arthroplasty failure continues to be glenoid component loosening. Historically, metal-backed glenoids (MBG) have shown decreased performance compared to polyethylene-backed glenoid (PEG) components. Previous studies have shown that MBG components have higher revision rates and shorter time to prosthetic failure compared with PEG components. However, the negative outcomes of many of these studies may have been linked to an examination of older generations of MBG implants, and do not account for newer technology. Thus, our study aims to assess the short-term radiographic and clinical outcomes of patients treated with anatomic total shoulder arthroplasty using the current and more modern generation of implants with a universal metal-backed glenoid component. MethodsWe conducted a retrospective chart review of patients who had their primary anatomic shoulder replacement performed from 2017 to 2022 by a single surgeon, and used one of two currently available implants that incorporated a metal-backed glenoid component with a convertible baseplate. After the exclusion of those lost to follow-up, we included 26 patients in this study, 3 of whom underwent bilateral shoulder replacement surgery at staggered time intervals. The primary outcome measure was evidence of radiographic change via in-office X-ray. Analysis of radiographic changes was conducted for each postoperative visit, which was aimed for 2 weeks, 6 weeks, 12 weeks, 1 year, and annually thereafter. Secondary analysis tracked clinical progression and utilized DASH scores, range of motion evaluation, strength testing, and instability examination using evidence of apprehension and sulcus signs at each time interval. ResultsIn our study, radiographic changes at each time interval and the longest follow-up appointment demonstrated no evidence of hardware loosening of either the glenoid or the humeral component and no evidence of periprosthetic fracture or hardware failure of any kind for MBG implants. There were no revisions performed due to polyethylene wear. The overall average range of motion, strength, and DASH scores were improved at each postoperative visit. ConclusionPrevious studies have suggested that TSA implants with MBG components may be inferior to PEG implants. However, the results of many of these studies may not be as representative of the current implant designs available today. While additional studies are necessary to assess the long-term survivability of the implant and its effects on glenoid bone stock, our findings suggest that university MBG components have minimal complications, do not demonstrate loosening, and have acceptable outcomes in short-term follow-up.

Outcome in acute ischemic stroke patients treated with intravenous thrombolysis - a retrospective and statistical analysis of five years' experience.

This paper represents a retrospective study on 252 patients with acute ischemic stroke (AIS), who received thrombolytic therapy between 2019-2023, in the Department of Neurology at the Emergency County Hospital in Craiova, Romania. We aimed to evaluate treatment complications and short-term outcomes of patients with AIS, treated with intravenous (i.v.) recombinant tissue plasminogen activator (rtPA; Alteplase), within 4.5 hours from onset. We also tried to assess the correlations between classical risk factors, such as diabetes, hypertension, atrial fibrillation, smoking and the outcome of these patients. Two hundred and fifty-two patients were treated with i.v. thrombolysis in our Department between October 2019 and December 2023. Out of the total thrombolysed patients, 146 were men and 106 were women. Our focus was on the clinical evolution of our patients and on the complications, especially on hemorrhagic transformation and death, and we tried to see if there were any correlations between gender, age, vascular risk factors such as diabetes, smoke, obesity, hypertension, atrial fibrillation and the outcome of our thrombolysed patients. Out of the total of 252 thrombolysed patients, only 55 (21.83%) had hemorrhagic transformation. Analyzing the differences between the occurrence of hemorrhagic transformation, respectively death, depending on the location and type of stroke, we did not identify statistically significant differences. The only comparison where a difference close to the significance limit is observed is that related to the frequency of deaths depending on the type of stroke - patients with cardioembolic stroke had a higher death rate.

Abstract TP230: Atrial Fibrillation and Short-Term Outcomes After Cancer-Related Ischemic Stroke

Introduction: Atrial fibrillation (AF) and cancer are both independently associated with worse outcomes in patients with acute ischemic stroke. Few studies have evaluated the impact of AF on outcomes of cancer-related stroke. We aimed to determine if AF is associated with worse short-term outcomes in patients with stroke and comorbid cancer. Methods: Using the 2016-2019 National Inpatient Sample, we identified all hospitalizations with diagnosis codes for cancer and ischemic stroke. The primary exposure was a diagnosis of AF. The primary outcome was in-hospital mortality. The secondary outcomes were length-of-stay and discharge other than to home. We used multivariable logistic and linear regression models, as appropriate, adjusted for age, gender, race-ethnicity, and the Charlson Comorbidity Index, to examine the association between AF and study outcomes. Results: Among 150,200 hospitalizations with diagnoses of cancer and ischemic stroke (mean age 72 years, 53% male), 40,084 (26.7%) included comorbid AF. Compared to hospitalizations without AF, hospitalizations with AF had higher rates of in-hospital mortality (14.8% vs 12.1%, p&lt;0.001) and non-home discharge disposition (83.5% vs 75.1%, p&lt;0.001) as well as longer mean length-of-stay (8.4 days vs 8.2 days, p&lt;0.001). In multivariable analyses, AF remained independently associated with higher odds of in-hospital mortality (adjusted OR, 1.34; 95% CI, 1.24-1.46), non-home discharge disposition (adjusted OR, 1.32; 95% CI, 1.23-1.42), and longer length-of-stay (adjusted mean difference, 13.7%; 95% CI, 10.9%-16.7%). Conclusions: In cancer-related ischemic stroke, comorbid AF is associated with worse short-term outcomes, including higher odds for in-hospital mortality, worse discharge disposition, and longer hospital stays.

Weekday Surgery Associated With Short-Term Outcomes in Patients With Colorectal Cancers

IntroductionThe “weekday effect” on elective surgery remains controversial. We aimed to examine the association between the day of surgery and short-term outcomes after elective surgery for stage I-III colorectal cancer (CRC). MethodsWe performed a multicenter retrospective analysis of 2574 patients who underwent primary colorectal resection for CRC between January 2017 and December 2019 at 15 institutions belonging to the Hiroshima Surgical Study Group of Clinical Oncology. Patients were divided into two groups according to the day of surgery: Friday and non-Friday (Monday to Thursday). After propensity score matching (PSM), we compared 30-day mortality and postoperative outcomes. ResultsOut of the total, 368 patients underwent surgery on Fridays, and the remaining 2206 underwent surgery on non-Fridays. The overall mortality rate was 0.04% (n = 1). In 1685 patients with colon cancer, the proportion of American Society of Anesthesiologists scores was significantly lower in the Friday group than in the non-Friday group before PSM. After PSM of patient, tumor, and operative characteristics, operative time was slightly more prolonged and blood loss was slightly greater in the Friday group; however, these differences were not clinically meaningful. In the 889 patients with rectal cancer, the proportion of patients with abnormal respiratory patterns was significantly lower in the Friday group than in the non-Friday group before PSM. After PSM, the Friday group had a higher incidence of morbidity (≥ Clavien–Dindo 3a), higher incidence of digestive complications, and prolonged postoperative hospital stay. ConclusionsThe results may be useful in determining the day of the week for CRC surgery, which requires more advanced techniques and higher skills.