Short-term Postoperative Complications Research Articles

Association between elevated preoperative red cell distribution width and mortality after brain tumor craniotomy.

Red cell distribution width (RDW) has been recognized as a potential inflammatory biomarker, with elevated levels associated with adverse outcomes in various diseases. However, its role in predicting outcomes after brain tumor craniotomy remains unclear. We aimed to assess whether preoperative RDW influences mortality and postoperative complications in patients undergoing brain tumor craniotomy. This retrospective cohort study analyzed serum RDW levels in patients undergoing brain tumor craniotomy at West China Hospital. RDW was evaluated in two forms: RDW-CV and RDW-SD, and was categorized into four quartiles for analysis by using logistic regression and multivariate analysis to adjust for confounding. The study encompassed 10,978 patients undergoing brain tumor craniotomy. our analysis revealed no significant difference in 30-day mortality across various RDW-CV levels. However, we observed a dose-response relationship with preoperative RDW-CV levels in assessing long-term mortality risks. Specifically, patients with RDW-CV levels of 12.6-13.2% (HR 1.04, 95% CI 1.01-1.18), 13.2-13.9% (HR 1.12, 95% CI 1.04-1.26), and > 13.9% (HR 1.34, 95% CI 1.18-1.51) exhibited a significantly higher hazard of long-term mortality compared to those with RDW-CV < 12.6%. When preoperative RDW-CV was analyzed as a continuous variable, for each 10% increase in RDW-CV, the adjusted OR of long-term mortality was 1.09 (95% CI 1.05-1.13). we also observed significant associations between preoperative higher RDW-CV levels and certain postoperative complications including acute kidney injury (OR 1.46, 95% CI: 1.10-1.94), pneumonia infection (OR 1.19 95% CI: 1.05-1.36), myocardial infarction (OR 1.32, 95% CI: 1.05-1.66), readmission (OR 1.15, 95% CI: 1.01-1.30), and a prolonged length of hospital stay (OR 1.11, 95% CI: 1.02-1.21). For RDW-SD levels, there was no significant correlation for short-term mortality, long-term mortality, and postoperative complications. Our study showed elevated preoperative RDW-CV is significantly associated with increased long-term mortality and multiple postoperative complications, but no such association is observed with RDW-SD. These findings show the prognostic importance of RDW-CV, reinforcing its potential as a valuable tool for risk stratification in the preoperative evaluation of brain tumor craniotomy patients.

Surgical Complications Following Renal Transplantation in a Large Institutional Cohort.

Successful renal transplantation (RTx) relies on immunosuppression and an optimal surgical course with few surgical complications. Studies reporting the postoperative complications after RTx are heterogeneous and often lack systematic reporting of complications. This study aims to describe and identify postoperative short-term and long-term complications after RTx in a large institutional cohort and identify risk factors for a complicated surgical course. The study is a retrospective single-center cohort of 571 recipients who underwent living or deceased donor open RTx between 2014 and 2021. Data were collected on background information and perioperative and postoperative data. Complications were defined as short-term (<30 d) or long-term (>30 d) after transplantation and graded according to the Clavien-Dindo classification. Multivariable logistic regression was performed to evaluate risk factors for serious short-term complications and multivariable time-dependent Cox regression to evaluate risk factors for long-term complications. A total of 351 patients received a graft from a deceased donor, and 144 of these grafts were on perfusion machine before transplantation. One or more short-term complications occurred in 345 (60%) patients. Previous RTx was associated with short-term Clavien-Dindo >2 complications in recipients (odds ratio = 2.08; 95% confidence interval [CI], 1.18-3.69; P = 0.01). Being underweight (body mass index <18.5) in combination with increasing age increased the odds of short-term Clavien-Dindo >2 and vascular complications. Increasing blood loss per 100 mL was associated with increased odds of short-term Clavien-Dindo >2 (odds ratio = 1.11; 95% CI, 1.01-1.21; P = 0.032). No associations were found for long-term complications after RTx. The 5-y cumulative incidence of graft loss was 12.6% (95% CI, 8.9-16.3). Short-term complications are common after RTx, and risk factors for severe short-term complications include previous RTx, increasing age, and low body mass index. No risk factors were identified for severe long-term complications. Further studies should explore whether new surgical techniques can reduce surgical complications in RTx.

Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length

There is still controversy regarding the safety and efficacy of cold knife visual internal urethrotomy and laser incisions for the treatment of urethral stricture. This study aims to compare the results of postoperative long-term and short-term maximum urinary flow rates (Qmax), surgical time, postoperative complications, and 1-year recurrence rates between the cold knife and laser surgery. We searched databases including Embase, PubMed, Cochrane, and Clinical Trials.gov to identify relevant literature published in English up to September 2023. We used Stata to compare various parameters. This study is registered in PROSPERO (CRD42023471634). Nine comparative experiments were conducted, involving a total of 659 participants. The laser group showed significantly better results compared to the cold knife group in terms of postoperative 12-month maximum urinary flow rate (mean differences [MD] 2.131; 95% [1.015, 3.249], P < .0001), postoperative bleeding (RR 0.277, 95% [0.079, 0.977], P = .046), and 1-year recurrence rate (RR 0.667, 95% [0.456, 0.976], P = .037). However, there were no significant differences in postoperative 6-month and 3-month Qmax, surgical time, urethral leakage complications, overall complications, and Visual Analog Scale (VAS) scores. The current study results suggest that laser urethral incision has greater advantages in the long-term (12 months), 1-year recurrence rate, and bleeding complications compared to cold knife urethral incision in the treatment of urethral stricture (<2 cm). Therefore, laser urethral incision may be a better choice for patients with urethral stricture.

The Effect of Body Mass Index on the Risk of Postoperative Complications After Myomectomy [ID 2683654

INTRODUCTION: We aimed to evaluate the association of body mass index (BMI) and short-term postoperative complications after myomectomy. METHODS: Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we analyzed major and minor complications according to BMI for patients who underwent myomectomy between 2012 and 2020. RESULTS: A total of 29,305 cases were included. Postoperative complications occurred in 11.5% of cases (n=3,374), ranging from 10.2% among underweight patients to 15.9% among patients with obesity class 3 (P&lt;.001). In multivariable regression analysis, overweight patients experienced fewer postoperative complications (adjusted odds ratio [aOR] 95% CI, 0.89 [0.80–0.99]), both minor (aOR 95% CI, 0.89 [0.80–0.99]), and major (aOR 95% CI, 0.75 [0.58–0.98]), compared to patients with normal BMI. Patients with obesity class 1 also experienced fewer major complications compared to normal weight (aOR 95% CI, 0.61 [0.45–0.84]). Patients with obesity class 3 experienced more complications (aOR 95% CI, 1.21 [1.05–1.38]), both minor (aOR 95% CI, 1.17 [1.02–1.34]) and major (aOR 95% CI, 1.17 [1.02–1.35]), compared to the other BMI classes combined. When examining abdominal myomectomies only, compared to normal weight, overweight patients experienced fewer minor complications, and obesity class 1 patients had fewer major complications. Complications did not differ based on BMI when restricting the cohort to minimally invasive or vaginal myomectomies only. CONCLUSION: Class 3 obese patients are at increased odds for experiencing complications after myomectomy, whereas being overweight or slightly obese appears to be protective. These differences based on BMI are largely driven by complications experienced following abdominal, rather than minimally invasive, myomectomy.

Distinct risk profiles for short-term surgical complications and venous thromboembolism exist among extensor mechanism repair procedures.

Extensor mechanism injuries, which comprise patella fractures, patella tendon tearsand quadriceps tendon tears, are severely debilitating injuries and a common cause of traumatic knee pathology that requires surgical intervention. Risk factors for short-term surgical complications and venous thromboembolism (VTE) in this population have not been well characterised. The aim of this study was to identify perioperative risk factors associated with these short-term complications. The National Surgical Quality Improvement Program database was used to identify patients who underwent an isolated, primary extensor mechanism repair from 2015 to 2020. Patients were stratified by injury type. Demographic data were collected and compared. A multivariate logistic regression was used to control for demographic and comorbid factors while assessing risk factors for developing short-term complications. A total of 8355 patients were identified for inclusion in this study. Overall, 3% of patients sustained short-term surgical complications and 1% were diagnosed with VTE within 30 days of surgery. Patella fracture fixation had a nearly twofold higher risk for surgical complications compared to quadriceps tendon repair (p = 0.004). Patella tendon repair had a twofold higher risk for VTE (p = 0.045), specifically deep vein thrombosis (p = 0.020), compared to patella fracture fixation. Increasing age, smokingand American Society of Anesthesiologists Classifications 3 and 4 were also found to be risk factors for surgical complications (p = 0.012, p = 0.004, p = 0.011 and p = 0.032, respectively). This study used a nationally representative, widely validated, peer-reviewed database to provide valuable insights into risk factors for short-term postoperative complications associated with extensor mechanism repair procedures, revealing notable differences in risk profiles among distinct surgical procedures. The results of this study will inform surgeons and patients in enhancing risk assessment, guiding procedure-specific decision-making, optimising preoperative care, improving postoperative monitoringand contributing to future research of extensor mechanism injuries. Level III.

Employing Algorithms in Cosmetic Facial Surgery

The aim is to evaluate the scientific literature on the creation and application of algorithms in clinical settings, with a focus on their efficacy. Material and methods. The literature search was performed using the databases Scopus, Medline (PubMed), eLibrary (in total: 32 scientific papers). Results. The acquisition of data pertaining to the principles of algorithm development was accomplished, and the notion that algorithms will increasingly be adopted across a range of plastic surgery specialties was validated. Conclusions. Based on scientific research data, it can be inferred that the development and implementation of algorithms play a significant role in an aesthetic surgeon’s work in surgical practice. All authors unanimously support the effectiveness of integrating algorithms into clinical practice, some of which were developed by them for the first time. When planning and executing surgical procedures, it is emphasized to base on individual patient data, as well as the relevance of such developments in improving the achievement of better surgical correction outcomes. In some instances, the implementation of algorithms in clinical practice has led to a significant improvement in patients' quality of life after the interventions. Each correction method has its unique effectiveness. The positive results of the work on the development and implementation of algorithms in clinical practice suggest that the development of this type for aesthetic interventions on the lower third of the face would allow for: 1) improved aesthetic outcomes, 2) enhanced intervention quality, 3) a reduction in the number of interventions necessary to achieve a positive and long-lasting effect, 4) a decrease in the likelihood of short-term and long-term postoperative complications, and 5) lower treatment costs and shorter treatment duration.

Body composition assessment by artificial intelligence can be a predictive tool for short-term postoperative complications in Hartmann’s reversals

BackgroundHartmann's reversal, a complex elective surgery, reverses and closes the colostomy in individuals who previously underwent a Hartmann's procedure due to colonic pathology like cancer or diverticulitis. It demands careful planning and patient optimisation to help reduce postoperative complications. Preoperative evaluation of body composition has been useful in identifying patients at high risk of short-term postoperative outcomes following colorectal cancer surgery. We sought to explore the use of our in-house derived Artificial Intelligence (AI) algorithm to measure body composition within patients undergoing Hartmann’s reversal procedure in the prediction of short-term postoperative complications.MethodsA retrospective study of all patients who underwent Hartmann's reversal within a single tertiary referral centre (Western) in Melbourne, Australia and who had a preoperative Computerised Tomography (CT) scan performed. Body composition was measured using our previously validated AI algorithm for body segmentation developed by the Department of Surgery, Western Precinct, University of Melbourne. Sarcopenia in our study was defined as a skeletal muscle index (SMI), calculated as Skeletal Muscle Area (SMA) /height2 < 38.5 cm2/m2 in women and < 52.4 cm2/m2 in men.ResultsBetween 2010 and 2020, 47 patients (mean age 63.1 ± 12.3 years; male, n = 28 (59.6%) underwent body composition analysis. Twenty-one patients (44.7%) were sarcopenic, and 12 (25.5%) had evidence of sarcopenic obesity. The most common postoperative complication was surgical site infection (SSI) (n = 8, 17%). Sarcopenia (n = 7, 87.5%, p = 0.02) and sarcopenic obesity (n = 5, 62.5%, p = 0.02) were significantly associated with SSIs. The risks of developing an SSI were 8.7 times greater when sarcopenia was present.ConclusionSarcopenia and sarcopenic obesity were related to postoperative complications following Hartmann’s reversal. Body composition measured by a validated AI algorithm may be a beneficial tool for predicting short-term surgical outcomes for these patients.

Preservation of the celiac branch of the vagus nerve reduces the incidence of postoperative diarrhea in gastric cancer: a cohort study

BackgroundTo investigate the short-term and long-term outcomes of preserving the celiac branch of the vagus nerve during laparoscopic distal gastrectomy.MethodsA total of 149 patients with prospective diagnosis of gastric cancer who underwent laparoscopic-assisted distal gastrectomy (LADG) combined with Billroth-II anastomosis and D2 lymph node dissection between 2017 and 2018 were retrospectively analyzed. The patients were divided into the preserved LADG group (P-LADG, n = 56) and the resected LADG group (R-LADG, n = 93) according to whether the vagus nerve celiac branch was preserved. We selected 56 patients (P-LADG, n = 56) with preservation of the celiac branch of the vagus nerve and 56 patients (R-LADG, n = 56) with removal of the celiac branch of the vagus nerve by propensity-matched score method. Postoperative nutritional status, weight change, short-term and long-term postoperative complications, and gallstone formation were evaluated in both groups at 5 years of postoperative follow-up. The status of residual gastritis and bile reflux was assessed endoscopically at 12 months postoperatively.ResultsThe incidence of diarrhea at 5 years postoperatively was lower in the P-LADG group than in the R-LADG group (p < 0.05). In the multivariate logistic analysis, the removal of vagus nerve celiac branch was an independent risk factor for the occurrence of postoperative diarrhea (odds ratio = 3.389, 95% confidential interval = 1.143-10.049, p = 0.028). In the multivariate logistic analysis, the removal of vagus nerve celiac branch was an independent risk factor for the occurrence of postoperative diarrhea (odds ratio = 4.371, 95% confidential interval = 1.418-13.479, p = 0.010).ConclusionsPreservation of the celiac branch of the vagus nerve in LADG reduced the incidence of postoperative diarrhea postoperatively in gastric cancer.Trial registrationThis study was registered with the Ethics Committee of the First Affiliated Hospital of Dalian Medical University in 2014 under the registration number: LCKY2014-04(X).

Preoperative exercise training decreases complications of minimally invasive lung cancer surgery: A randomized controlled trial

ObjectiveLimited evidence exists regarding the efficacy of preoperative exercise in reducing short-term complications after minimally invasive surgery in patients with non–small cell lung cancer. This study aims to investigate the impact of preoperative exercise on short-term complications after minimally invasive lung resection. MethodsIn this prospective, open-label, randomized (1:1) controlled trial at Xiangya Hospital, China (September 2020 to February 2022), patients were randomly assigned to a preoperative exercise group with 16-day alternate supervised exercise or a control group. The primary outcome assessed was short-term postoperative complications, with a follow-up period of 30 days postsurgery. ResultsA total of 124 patients were recruited (preoperative exercise group n = 62; control n = 62). Finally, 101 patients (preoperative exercise group; n = 51 and control; n = 50) with a median age of 56 years (interquartile range, 50-62 years) completed the study. Compared with the control group, the preoperative exercise group showed fewer postoperative complications (preoperative exercise 3/51 vs control 10/50; odds ratio, 0.17; 95% CI, 0.04-0.86; P = .03) and shorter hospital stays (mean difference, −2; 95% CI, −3 to −1; P = .01). Preoperative exercise significantly improved depression, stress, functional capacity, and quality of life (all P < .05) before surgery. Furthermore, preoperative exercise demonstrated a significantly lower minimum blood pressure during surgery and lower increases in body temperature on day 2 after surgery, neutrophil-to-lymphocyte ratio, and neutrophil count after surgery (all P < .05). Exploratory research on lung tissue RNA sequencing (5 in each group) showed downregulation of the tumor necrosis factor signaling pathway in the preoperative exercise group compared with the control group. ConclusionsPreoperative exercise training decreased short-term postoperative complications in patients with non–small cell lung cancer.

Novel definition of textbook outcome in biliary system cancers and its influence on patients' survival and quality of life.

The definition of textbook outcome in biliary system cancers is a developing concept in need of expansion and investigation of its association with survival and quality of life. In this original research, we developed a novel "all or none" textbook outcome definition which addresses the rapid recovery of post-surgical indexes, in addition to short-term mortality, hospital re-admission, prolonged stay, surgical margin and postoperative complications. Based on the fulfillment of relevant criteria, patients were divided into textbook outcome and non-textbook outcome groups and their characteristics and survival data were analyzed. A customized "quality of life" questionnaire was developed to address short-term recovery and post-discharge life quality of patients. Association with quality of life improvement was then investigated. A total of 129 patients were included. Textbook outcome was achieved in 25.58% of patients (37.04% of gallbladder cancer patients and 17.8% of cholangiocarcinoma patients). Compared to non-textbook outcome group, patients with textbook outcome had lower rate of pre-operative biliary drainage (p = 0.026), higher rate of normal preoperative liver function (p < 0.001) and tumor markers (p = 0.001), reduced perioperative bleeding (p = 0.006) and blood transfusion (p = 0.005), and higher rate of N0 stage cases (p = 0.008). Textbook outcome was also associated with enhanced survival, significantly in older patients (<65 years) (1-year survival rate: 100% vs. 78.57% (p = 0.108), 2-year survival rate: 87.5% vs. 44% (p = 0.046)). Finally, textbook outcome was significantly associated with enhanced basic daily performance (p < 0.001), social life performance (p = 0.033), and personal evaluation (p < 0.001), and thus improved quality of life (p < 0.001). The novel definition of textbook outcome was able to address the specific nature of recovery after resection of biliary system cancers. Expanding the scope of textbook outcome and addressing the influence on survival and quality of life provides a comprehensive concept able to reflect physical, psychological and functioning enhancements in patients recovery.

Prediction of Short-Term Postoperative Complications Following Open Reduction Internal Fixation of Acute Ankle Fractures

Introduction/Purpose: Acute ankle fractures are a common injury and represent a significant financial burden to the healthcare system. Reimbursement following ankle fractures is complicated by bundled payments within the 90-day global period which do not account for unpredictable complications. Comorbidity indices, such as the American Society of Anesthesiologists (ASA) classification, are often correlated with complications; however, the positive predictive value of these metrics have not been investigated. As insurers continue to transition towards bundled reimbursements, greater attentiveness towards providing efficient care is paramount. The purpose of this investigation is to develop a machine learning (ML) model that is predictive of complications following operative management of acute ankle fractures. This study will also compare ML algorithms to legacy indices to assess the predictive value in predicting complications. Methods: The American College of Surgeons-National Surgical Quality Improvement Program database was queried via Current Procedural Terminology (CPT) from 2015-2018 for open reduction internal fixation (ORIF) cases for ankle fractures, including ORIF of the medial malleolus, posterior malleolus, lateral malleolus, bimalleolar, trimalleolar, syndesmosis. Training and validation sets were created by randomly assigning 80% and 20% of the data set. Included variables were age, body mass index (BMI), operative time, smoking status, comorbidities, diagnosis, and preoperative hematocrit and albumin. Complications included any adverse event, transfusion, surgical site infection, return to the operating room, deep vein thrombosis or pulmonary embolism, pneumonia, urinary tract infection, cerebrovascular accident, cardiac arrest, myocardial infarction. Each ML algorithm was compared with one another and to a baseline model using American Society of Anesthesiologists (ASA) classification. Model strength was evaluated by calculating the area under the curve (AUC) for receiver operating characteristic (ROC) of any adverse event. Results: We identified a total of 28,736 ORIF cases. Mean age and BMI were 32.2 ± 18.6 years, 30.8 ± 7.6 kg/m^2, respectively. The overall incidence of any medical complication was 3.4% (n=975) with surgical site infection (1.3%, n=386) and return to operating room (1.3%, n=367) being the most common. Percentage hematocrit, BMI, operative time, and age were of highest importance in outcome prediction. Logistic regression (AUC: 72%) and gradient boosting (AUC: 72%) ML algorithms outperformed ASA classification (AUC: 69%) for predicting any adverse event following ORIF of ankle fractures. Conclusion: Legacy comorbidity indices are simple metrics that can be easily constructed from patient demographic variables and past medical history. However, the predictive power is limited as they have shown a low positive predictive value for predicting complications. Machine learning algorithms can calculate patient-specific risk for postoperative complications which may adjust perioperative care and site of surgery. These models have the capability to optimize utilization of healthcare resources and minimize excessive expenditure by providing patient-specific care. Receiver Operating Curve-Area under the Curve Analysis for Adverse Events Following ORIF of Ankle Fractures

An Efficient Saline-Linked Cautery (SLiC) Method for Robotic Liver Parenchymal Transection Using Simultaneous Activation of Saline-Linked Cautery and Robotic Suctioning: Detailed Technical Aspects and Short-Term Outcomes.

Introduction While there are several advantages to utilizing robotics in liver surgery compared to traditional open and laparoscopic approaches, the most challenging part of robotic liver resection (RLR) remains the liver parenchymal transection. This is primarily due to the constraints of the existing robotic tools and the absence of a standard procedure. This study presents detailed technical aspects of our novel saline-linked cautery (SLiC) method for RLR and assesses the short-term outcomes for both non-anatomical and anatomical RLRs. Methods In this study, 82 cases that underwent RLR utilizing the SLiC method at our hospital from September 2021 to December 2023 were examined. A novel SLiC method is introduced in this study for robotically transecting the liver parenchyma utilizing bipolar cautery or monopolar scissors. The technique involves activating the SLiC and robotic suctioning simultaneously. The included patients were divided into two groups: patients undergoing robotic anatomical hepatectomy (n=39), and those receiving robotic non-anatomical hepatectomy (n=43). Short-term outcomes, including intraoperative and postoperative complications, were assessed in patients receiving both anatomical and non-anatomical hepatectomies. Results In the whole cohort, 74% of patients had performance status 1 or 2, and 24% were classified as Child-Pugh class B. RLR was performed without Pringle's maneuver in more than 80% of cases in patients receiving robotic non-anatomical hepatectomy, and more than 80% of patients undergoing robotic anatomical hepatectomy required only four or fewer 15-minute Pringle's maneuvers. There was no conversion to open hepatectomy, no cases of grade B or C post-hepatectomy liver failure, and no mortality in the entire cohort. Four postoperative complications with CDC IIIa or higher occurred (small bowel obstruction in two cases, intraabdominal hemorrhage in one, and bile leak in another), but no differences in the frequency of complications were found between those undergoing non-anatomical and anatomical hepatectomy (p=0.342). Conclusions The SLiC method, which involves simultaneously activating SLiC and robotic suctioning with either monopolar scissors or bipolar cautery, appears to be a secure and convenient technique for liver parenchymal transection in RLR. This innovative method permits precise access to the major Glissonean and venous structures within the liver, making RLR more standardized and easily applicable in routine patient care.

Predicting short-term major postoperative complications in intestinal resection for Crohn's disease: A machine learning-based study.

Due to the complexity and numerous comorbidities associated with Crohn's disease (CD), the incidence of postoperative complications is high, significantly impacting the recovery and prognosis of patients. Consequently, additional studies are required to precisely predict short-term major complications following intestinal resection (IR), aiding surgical decision-making and optimizing patient care. To construct novel models based on machine learning (ML) to predict short-term major postoperative complications in patients with CD following IR. A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022. The study participants were randomly allocated to either a training cohort or a validation cohort. The logistic regression and random forest (RF) were applied to construct models in the training cohort, with model discrimination evaluated using the area under the curves (AUC). The validation cohort assessed the performance of the constructed models. Out of the 259 patients encompassed in the study, 5.0% encountered major postoperative complications (Clavien-Dindo ≥ III) within 30 d following IR for CD. The AUC for the logistic model was 0.916, significantly lower than the AUC of 0.965 for the RF model. The logistic model incorporated a preoperative CD activity index (CDAI) of ≥ 220, a diminished preoperative serum albumin level, conversion to laparotomy surgery, and an extended operation time. A nomogram for the logistic model was plotted. Except for the surgical approach, the other three variables ranked among the top four important variables in the novel ML model. Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complications in patients with CD, with the RF model showing more superiority. A preoperative CDAI of ≥ 220, a diminished preoperative serum albumin level, and an extended operation time might be the most crucial variables. The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.

Long-term impact of replaced right hepatic artery resection in pancreaticoduodenectomy.

The clinical impact of replaced right hepatic artery (rRHA) resection during pancreaticoduodenectomy (PD) has not been thoroughly investigated. We therefore assessed the short- and long-term effects of rRHA resection during PD, with special reference to alterations in the volumetric profile of the liver. Patients with rRHA were divided into two groups based on the presence (R group) or absence (nR group) of resection. The nR group included cases of rRHA resection and reconstruction. We compared the postoperative short-term complications and detailed liver volume profile by CT volumetry in the long term between the R and nR groups. Forty-seven patients were eligible for the analyses of short-term outcomes (R: n = 7, nR: n = 40), and no marked difference was observed in the incidence of short-term postoperative complications. The patient cohort for the long-term investigations included 34 cases (R: n = 6, nR: n = 28), excluding patients with early recurrence. There was no significant difference in the preoperative liver volume profiles between the two groups. At 12 postoperative months, although the whole liver (WL) volume did not significantly change in either group, the ratio of the volume of the anterior/posterior sections significantly increased in the R group (R: pre- vs. 12months, 1.01 vs. 1.28, p < 0.05; nR: pre- vs. 12months, 1.40 vs. 1.33, p = 0.99). Long-term rRHA resection did not significantly affect the WL volume with alteration of the liver volumetric profile of each section.

Short-Term Postoperative Complications in Flexor Tendon Repair: A Subcategory Analysis by Surgical Specialty

Introduction: We aimed to investigate and compare the 30-day postsurgical complication rates and total operative times for hand or wrist flexor tendon injury repair procedures. Methods: We performed a retrospective cohort analysis of the American College of Surgeon National Quality Improvement Program database between 2015 and 2019. Patients were included in our study if they were 18 years or older and underwent surgical repair of a wrist or hand flexor tendon by a plastic surgeon, general surgeon, or orthopedic surgeon. Primary endpoint of the study was 30-day postsurgical complications. Secondary endpoint included subcategory analysis of 30-day postsurgical complications. Another variable of interest included total operative time. Results: There were 2614 surgeries performed for wrist or hand flexor tendon injury repair during the 5-year period. Orthopedic surgeons performed the majority of the operations (1548, 59.2%). Repair or advancement of the flexor tendon zone 2 without grafts (1284, 49.1%) were the most common surgeries performed. Overall surgical site complication rate was 2%, with no significant associations between the complication and the surgical specialty performing the operation. A significant difference in total operative time between surgical specialties was only found in single flexor tendon repairs ( P &lt; .001). Conclusions: Surgical repair for hand and wrist flexor tendon injury is a safe surgical procedure with a low short-term postoperative complication rate. Despite variations in training, complications remain similar between specialties for flexor tendon repairs.

Early and late complications arising from various bariatric surgical procedures in a tertiary center in Saudi Arabia

Background Individuals who are obese or morbidly obese face a significantly higher risk of experiencing postoperative complications. To evaluate high-risk patients undergoing bariatric surgery and mitigate the likelihood of further postoperative complications, various indicators are utilized. There are no prior reports about bariatric surgical procedures-related early/late complications that came out from the western region of Saudi Arabia. Aim This retrospective study aims to evaluate both short-term and long-term postoperative complications after several bariatric surgeries, including sleeve gastrectomy, Roux-en-Y gastric bypass, and revisional bariatric surgery. Patients and methods The assessment of complications in 328 patients who underwent bariatric surgery involved analyzing demographic data, medical and surgical history, preoperative and postoperative BMI, histopathologic findings, and early and late complications. These data were obtained from a prospectively maintained database. Results Of the total participants, 241 underwent sleeve gastrectomy, 43 underwent gastric bypass, and 44 had revisional bariatric surgery. Complication rates varied among the different bariatric surgeries. Specifically, SG patients had the lowest early major complication rate (2.1%), while gastric bypass patients had a rate of 4.7%. Conversely, the ‘revisional’ operations reported the highest rate of early complications at 9.1%. Late complications demonstrated varying rates, with sleeve gastrectomy patients experiencing the highest incidence of gastroesophageal reflux disease at 39%, and gastric bypass patients showing the highest rate of nutritional deficiency at 58%. Conclusion The study found that the baseline characteristics of patients did not exert a statistically significant influence on the occurrence of postoperative complications. However, different types of bariatric surgeries presented varying complication rates. Patients who underwent gastric bypass tended to have the highest rate of nutritional deficiency, while sleeve gastrectomy patients exhibited the highest rate of gastroesophageal reflux disease. Selecting the appropriate bariatric surgical procedure warrants careful consideration of patients’ preferences, demographic characteristics, presence of other medical conditions, and a comprehensive understanding of the potential advantages and disadvantages of each surgical option. Collectively, our findings would help discussing the expected outcome with the patients before surgery.

A Comparison Between the Transoral Endoscopic Thyroidectomy Vestibular Approach and the Transareolar Approach Regarding Perioperative Complications: A Systematic Review and Meta-Analysis.

The global adoption of remote thyroidectomy is increasing, with the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transareolar approach (TAA) emerging as predominant methods. However, existing meta-analyses comparing these approaches to operative surgeries and short-term postoperative complications have significant limitations. To address this gap, our meta-analysis provides a comprehensive comparison between the TOETVA and TAA, focusing on operation time, intraoperative blood loss, postoperative drainage, and hospital stay duration. It aims to offer robust insights into their relative efficacy and safety profiles. We searched SCOPUS, PubMed, Web of Science, MEDLINE, and Cochrane Library from June 2015 to January 2024 for studies comparing transoral endoscopic thyroidectomy with the vestibular approach and areolar thyroidectomy using keywords, including "transoral thyroidectomy" and "scarless thyroidectomy."Studies were included if they were randomized controlled trials, case-control studies, or prospective/retrospective cohort studies comparing the TOETVA and TAA. Exclusion criteria removed case series, cross-sectional studies, editorials, non-English language, animal studies, and irrelevant articles. Data on operative time, postoperative drainage, intraoperative blood loss, and hospital stay were extracted. The Newcastle-Ottawa Scale was used to assess study quality (all studies scored 7-8). The findings revealed that the operative time was longer among the TOETVA group, with less intraoperative blood loss (odds ratio (OR) = 13.31, 95% confidence interval (CI) = 4.44-22.19); OR = -1.61, 95% CI = -2.82 to -0.39, respectively). Regarding hospitalization duration and postoperative drainage, no discernible difference was observed between the endoscopic TAA (ETAA) and TOETVA (OR = -0.04, 95% CI = -0.24 to 0.16; OR = -6.74, 95% CI = -20.08 to 6.60, respectively). The TOETVA has advantages over the TAA in terms of intraoperative blood loss and shorter operation times. However, both approaches exhibited comparable outcomes in terms of hospital stay duration and postoperative drainage. Furthermore, extensive randomized trials are warranted.

Large-volume lipolysis assisted by low-level multifrequency laser in obesity: Short-term weight trajectories and postoperative complications

Introduction: Obesity is a chronic and complex syndrome resulting from the interactions of genetic, environmental, metabolic, and psychological factors. Current pharmacologic treatments often yield limited, unsustainable weight loss; thus, bariatric surgery and large and giant-volume liposuction have emerged as viable options for its control. Objective: This study aimed to assess Laser-assisted with large-volume liposuction in weight reduction effectiveness in obese adults and to describe the early postoperative complications of this procedure.

The Impact of Laparoscopic Appendectomy and Open Appendectomy on B7-H3-Mediated Intrinsic Immune Response in Children with Acute Suppurative Appendicitis.

Surgery impairs immune function and increases postoperative complications. B7H3, a co-stimulatory molecule, plays a crucial role in immune regulation. The present study examined the impact of B7H3 on the postoperative immune response in children with acute suppurative appendicitis (ASA) by comparing preoperative and postoperative B7H3 levels in laparoscopic surgery (LA) and open appendectomy (OA). 198 pediatric ASA patients were enrolled. The researcher group performed LA, while the control group performed OA. Perioperative time, recovery time of gastrointestinal function, time to pass gas, length of incision, and length of hospitalization were compared in the perioperative period. Additionally, an ELISA assay was conducted to examine the levels of inflammatory factors and B7H3 and CD28. Short-term postoperative complications were also evaluated. Compared with the control group, the research group had a short operative time, gastrointestinal function recovery time, gas time, and hospitalization time. The short-term complication rate was significantly lower in the research group. More importantly, B7H3 and CD28 were insignificantly different preoperatively, but they were all reduced postoperatively. Moreover, the reduction was more pronounced in the research group. The same results were noted in inflammatory factors and immune markers, which were non-significant different preoperatively and were typically reduced postoperatively, particularly in the research group. Finally, postoperative B7H3 was positively correlated with both inflammatory factors and immune cell levels. B7H3 was reduced in both postoperative periods, and the reduction was more pronounced in the LA group. B7H3 may be involved in postoperative recovery by modulating postoperative inflammation and immune responses.

Regional compared to general anesthesia for total shoulder arthroplasty

BackgroundTotal shoulder arthroplasty (TSA) is a common procedure for numerous shoulder pathologies, including glenohumeral arthritis, rotator cuff tears, and proximal humerus fractures. Prior literature has shown that patients undergoing total hip and knee arthroplasty under regional anesthesia (RA) are at significantly lower risk of postoperative complications and reoperation compared to general anesthesia (GA). The purpose of this study is to compare GA vs. RA in patients undergoing primary elective TSA. MethodsThe National Surgical Quality Improvement Program database was queried from 2010 to 2019 to identify all patients who underwent primary elective TSA with the use of GA (n = 24,563) or RA (n = 475). After matching based on age, sex, and the American Society of Anesthesiologists classification score, 475 matched pairs of patients undergoing TSA using GA or RA were compared. Relevant demographic characteristics and postoperative complication, readmission, and reoperation rates within 30 days of surgery were compared between groups. Operative time and total hospital length of stay (LOS) were also compared. Chi-squared tests were used to compare categorical variables. Continuous variables were compared using independent sample t-test and one-way ANOVA for binomial and multinomial groups, respectively. ResultsRA patients exhibited significantly higher rates of readmission (P < .001) and reoperation (P = .034) compared to GA patients. GA patients showed higher operative times than RA patients when comparing the two cohorts and stratifying patients by body mass index. GA patients also exhibited significantly increased LOS (P=<.001) compared to RA patients. Except for increased readmission and reoperation rates, there was no significant difference in the remaining medical complication rates between the groups. ConclusionRA patients were found to have higher rates of readmission and reoperation within 30 days of surgery compared to GA patients. GA was associated with longer operative times compared to RA across various body mass index groups. GA was associated with longer LOS compared to RA. However, for all perioperative and short-term postoperative medical complications, patients undergoing TSA under RA had similar rates to GA patients. These findings can be used to guide clinical decision-making when selecting the appropriate anesthetic strategy for patients requiring elective primary TSA.