Shorter Hospital Research Articles

Comparative analysis of safety and effectiveness between natural orifice specimen extraction and conventional transabdominal specimen extraction in robot-assisted colorectal cancer resection through systematic review and meta-analysis.

The goal of this systematic review and meta-analysis is to evaluate the perioperative and oncologic results of natural orifice specimen extraction (NOSE) compared to conventional transabdominal specimen extraction (TASE) in robotic-assisted surgery for colorectal cancer. A comprehensive electronic search will be performed on PubMed, Embase, and the Cochrane Library to find research articles published from the beginning of the databases to July 2024 that focus on patients who have undergone robotic-assisted surgery for colorectal cancer. Specifically, this review will compare NOSE with conventional TASE. Only studies published in English will be considered. Literature screening will adhere closely to predetermined criteria for inclusion and exclusion, specifically targeting randomized controlled trials and cohort studies. The evaluation of quality will involve the use of the Newcastle-Ottawa Scale (NOS). Meta-analysis of the included studies' data will be performed using Review Manager 5.4.1. In the final analysis, 9 retrospective cohort studies comprising 1571 patients were included. Out of these, 732 patients opted for NOSE, while 839 patients chose conventional TASE in robotic colorectal surgery. Patients who received TASE experienced enhancements in hospital stay duration, time until first gas passage, wound infection rates, and time until the first intake of a liquid diet. Nevertheless, there were no notable distinctions noted between the two methods regarding surgery duration, projected blood loss, intestinal blockage, or frequency of anastomotic leakage. In patients undergoing robotic-assisted colorectal surgery, the safety and feasibility of NOSE are demonstrated. Compared to traditional TASE, it provides clear benefits including shorter hospital stays, earlier first flatus, quicker initiation of a liquid diet, and lower risk of wound infection.

Retroperitoneal vs transperitoneal laparoscopic pyelolithotomy; a single surgeon's experience.

To compare the outcomes of transperitoneal and retroperitoneal laparoscopic pyelolithotomy procedures. A total of 104 consecutive laparoscopic pyelolithotomy surgeries performed by a single surgeon on patients with staghorn or renal pelvic calculi larger than 20mm were evaluated. Intraoperative and postoperative clinical parameters from two groups, transperitoneal (TLPL) (N = 55) and retroperitoneal (RLPL) (N = 49), were compared. The surgeon performed TLPL for the first five years and then switched to the RLPL approach for the next five years. There were no significant differences in general demographic variables and stone size (26.55 vs. 24.73mm, P = 0.8). Operation time and change in serum creatinine levels did not significantly differ between the two approaches. However, patients who underwent TLPL had longer hospital stays than RLPL (3.23 ± 1.21 vs. 2.36 ± 1.10 days, P = 0.0001). Additionally, TLPL was associated with a greater drop in hemoglobin levels (1.53 ± 1.04 vs. 1.17 ± 0.68, P = 0.04), higher rates of postoperative fever (12.7% vs. 0.0%, P = 0.01). The retroperitoneal approach in laparoscopic pyelolithotomy for large renal pelvic stones resulted in fewer postoperative fevers, reduced hemoglobin drops, and shorter hospital stays than the transperitoneal approach. However, the stone-free rates were similar for both groups.

LGGL-01 “INTERVENTION OUTCOMES OF ENHANCED RECOVERY AFTER SURGERY PROTOCOL VERSUS STANDARD CARE FOR GLIOMA PATIENTS IN SELECTED HOSPITALS IN DEMOCRATIC REPUBLIC OF THE CONGO: RANDOMIZATION AND STRATIFICATION OF PROVIDERS AND HOSPITALS”

Abstract Enhanced Recovery after Surgery (ERAS) protocols aim to improve perioperative care and patient outcomes. A pragmatic, multicenter, randomized controlled trial will be conducted in the Democratic Republic of Congo (DRC) to assess ERAS’ efficacy compared to the current standard of care (SOC) for glioma patients. Eligible providers will be randomized at the surgical team level to ERAS or SOC, ensuring consistent practices within teams. Hospitals representing diverse healthcare settings will be included, and randomization will be stratified by hospital to ensure balance. 100 glioma patients (50 in each group) will be included, and primary analysis expects fewer post-operative complications and shorter hospital stays in the ERAS group, with higher patient satisfaction. Subgroup analyses will be conducted by hospital center. Randomization and stratification aim to mitigate provider and hospital-specific influences, enhancing the study’s validity and equitable representation. This unique trial design seeks to provide insights into ERAS benefits for glioma patients in resource-constrained settings, guiding clinical practice and healthcare policy to improve care and outcomes.

"Bottoms-up" minimally-invasive approach to inguinal lymph node dissection for penile cancer management. A single-center comparative study versus open approach and review.

Open inguinal lymph node dissection (OILND) plays a crucial role in penile cancer management, but in order to improve patient outcomes, minimally-invasive (MILND) approaches were developed. Our "bottoms-up" MILND is a novel endoscopic technique, changing the way the sequence of dissection is performed. This study aims to compare our approach to the current standard of OILND in terms of oncologic and perioperative outcomes. In our database, from 2016 to 2023, 12 patients underwent OILND and 16 had a "bottoms-up" MILND, which is performed with a three port configuration, starting the dissection under the fascia lata, dissecting the femoral vessels in the most distal part of the femoral fossa, followed by dissection of the proximal and superficial lymph nodes at the top of thefemoral triangle. For MILND, median operation time per groin was shorter (58 vs 64 minutes, p=0.34), patients presented shorter hospital stays (10 vs 18 days, p=0.32) and fewer days with drains (14 vs 24 days, p=0.01). Median lymph node yield per groin was higher for MILND (10 vs 9 nodes, p=0.7), but OILND had a higher median of positive lymph nodes (4 vs 3 nodes, p=0.63). MILND patients experienced a lower incidence of major complications (33% vs 58%, p=0.007). We have proved that our technique of MILND is not inferior to the current standard and we believe that it can further improve patient outcomes with a safer, simplified and easily reproducible approach.

Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients.

This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation. We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (n = 71), obese open surgery (n = 31), and nonobese endoscopic (n = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed. No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, P = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes. FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods. FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays.

Long-Term Outcomes of Elective Endovascular versus Open Repair of Popliteal Artery Aneurysms in the VISION Database

IntroductionThe best modality for elective popliteal artery aneurysm repair (PAR) remains controversial. Most single center studies suggest open popliteal aneurysm repair (OPAR) is more durable than endovascular (EPAR), but large randomized multicenter studies are lacking. This study compares long-term outcomes of EPAR and OPAR in the VQI-VISION database. MethodsVascular Quality Initiative (VQI) Medicare-linked VISION database (2010-2019) for peripheral vascular interventions and infrainguinal bypass were reviewed for elective PAR. Patients undergoing OPAR and EPAR were propensity-matched to compare outcomes. ResultsThere were 1,159 PAA repairs (65.1% open). EPAR patients were older (77 vs 73 years, p<0.001) and more likely to be on P2Y12 inhibitors (26.5% vs 17.0%, p<0.001). After matching, there were 396 patients in each group with similar baseline characteristics. EPAR patients were more likely to be discharged home (87.6% vs 48.5%, p<0.001) and have shorter hospital length-of-stay (1 vs 3 days, p<0.001). Kaplan-Meier curves showed no difference in mortality, reintervention, or major amputation at 1, 3, and 5 years. Cox proportional hazards regression showed no significant association between revascularization strategy and mortality, reintervention, or major amputation. Subgroup analysis of patients undergoing OPAR with great saphenous vein (GSV) bypass compared to EPAR showed that OPAR with GSV bypass was associated with lower mortality without difference in reintervention or major amputation. ConclusionElective EPAR is durable and comparable to OPAR in terms of limb outcomes, even when GSV is used as conduit. However, bypass with GSV was associated with increased survival after open popliteal aneurysm repair compared to endovascular therapy.

Multicenter analysis of the efficacy of early cholecystectomy and preoperative cholecystostomy for severe acute cholecystitis: a retrospective study of data from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology

BackgroundSevere acute cholecystitis (AC) is a challenging disease because it comprises coexisting systemic infections that lead to vital organ dysfunction. This study evaluated the optimal surgical timing and efficacy of preoperative percutaneous cholecystostomy (PC) for patients with severe AC.MethodsData of 142 patients who underwent cholecystectomy for severe AC between 2011 and 2021 were retrospectively collected from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology. Patients were divided into the early cholecystectomy (EC) group (within 72 h of symptom onset) and delayed cholecystectomy (DC) group. They were also subdivided into the upfront cholecystectomy group and preoperative PC before cholecystectomy group. The diagnosis and severity of AC were graded according to the Tokyo Guidelines 2018. Clinicopathological variables and outcomes were compared.ResultsNo significant differences in age, body mass index, American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index between the EC and DC groups were observed. Preoperative drainage was more commonly performed for the DC group than for the EC group. Local severe AC features were more commonly detected in the DC group than in the EC group. The postoperative outcomes of the EC and DC groups were comparable. Compared to the PC before cholecystectomy group, the upfront cholecystectomy group included more patients with ASA physical status ≥ 3 and more patients who used oral warfarin. Warfarin usage and cardiovascular dysfunction rates of the PC after cholecystectomy group were higher than those of the upfront cholecystectomy group. PC was associated with significantly less intraoperative bleeding and shorter hospital stays.ConclusionsPatients who can tolerate general anesthesia are good candidates for EC. Patients who use warfarin and those with cardiovascular dysfunction are considered to be at high risk for postoperative complications; therefore, to prevent AC recurrence during the waiting period, PC before cholecystectomy during the same admission is more appropriate than upfront cholecystectomy for these patients.

Robotics in Pediatric Urology: A Review

BackgroundRecent technological advances have enabled pediatric urologist to push the envelope of minimally invasive techniques. Recently, implementing robots into laparoscopic procedures has enabled the mitigation of certain drawbacks, opening the door for the implementation of minimally invasive techniques. The purpose of this review is to identify the current state surrounding robotic surgery and explore future directions for the field. MethodsThe authors undertook a literature search to explore the current state of robotic surgery in pediatric procedures. ResultsWhile operative times are longer for robotic surgery, robotic surgery operations have reported shorter post-operative hospital stays, lower pain medication use, and similar success rates relative to open procedures. New advances in training may enable improved training paradigms for novice surgeons, decreasing future operative times. ConclusionEvidence from the field suggests robotic surgery is an optimal alternative to open procedures, conferring advantages to both the patient and surgeon.

High-Sensitivity Cardiac Troponin T Reporting, Clinical Outcomes, and Health Care Resource Use

Despite being recommended by clinical guidelines, substantial concerns remain regarding the use of high-sensitivity cardiac troponin assays and whether it is associated with increased resource use, myocardial infarction (MI) or myocardial injury diagnoses, and procedural rates. To characterize the association of reporting high-sensitivity cardiac troponin T (hs-cTnT) to the lowest limit of quantification vs conventional troponin reporting with clinical outcomes. This cohort study used a historically controlled baseline and follow-up design to compare clinical outcomes after changing hs-cTnT reporting to the lowest limit of quantification. All patients aged 18 years or older presenting to any public emergency department (ED) in the state of South Australia between February 1, 2020, and February 28, 2021, who had an hs-cTnT test in the 6 months before and after the change in troponin reporting practice were included. Outcomes were assessed after adjusting for patient characteristics using inverse probability treatment weighting. The data analysis was performed between May 1, 2022, and July 27, 2023. hs-cTcnT reporting. The main outcomes were frequency of diagnosed MI, coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft (CABG); hospital length of stay; and ED discharge rate as measured using time-to-event Cox regression models. The secondary outcome was the composite 12-month event rate of all-cause mortality, MI, and myocardial injury. A total of 40 921 patients were included, of whom 20 206 were included in the unmasked hs-cTnT reporting group (median [IQR] age, 62.0 [46.0-77.0]; 10 120 females [50.1%]) and 20 715 were included in the conventional troponin reporting group (median [IQR] age, 63.0 [47.0-77.0] years; 10 752 males [51.9%]). Unmasked hs-cTnT reporting was associated with higher ED discharge rates (45.2% vs 39.0%; P < .001) and a shorter median hospital length of stay (7.68 [IQR, 4.32-46.80] hours vs 7.92 [IQR, 4.56-49.92] hours; P < .001). There was no difference in diagnosis of MI, coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft. The composite of all-cause mortality, MI, and myocardial injury at 12 months was similar (adjusted hazard ratio, 0.95; 95% CI, 0.90-1.01; P = .09). This cohort study found that unrestricted reporting of hs-cTnT results to the lowest limit of quantification was not associated with an increase in the diagnosis of MI, invasive coronary procedures, or harm at 12 months but may be associated with improved hospital resource use.

Evaluation of efficacy of oral calcium phosphate as an adjunct to standard-of-care regular phototherapy in cases of neonatal jaundice: a hospital-based double-blind, randomised, placebo-controlled trial

ObjectiveNeonatal jaundice is the most common cause of neonatal morbidity and rehospitalisation in the first week of life, affecting approximately 60% of term and 80% of preterm neonates, with 10%...

Modified reconstruction approach after pancreaticoduodenectomy optimizes postoperative outcomes: Results from a multivariate cohort analysis.

Despite technical advances in recent decades and a decrease in hospital mortality (<5%), pancreaticoduodenectomy (PD) is still associated with major postoperative complications, even in high-volume centers. The present study aimed to assess the effect of a modified reconstruction technique on postoperative morbidity and mortality. A cohort study of all patients (n=218) undergoing PD between January 2010 and December 2019 was performed at Attikon University Hospital (Athens, Greece). Several variables were studied, including demographic data, past medical history, perioperative parameters, tumor markers and pathology, duration of hospitalization, postoperative complications, 30-day-survival, postoperative mortality and overall survival using multivariate logistic regression and survival analysis techniques. In this cohort, 123 patients [modified PD (mPD) group] underwent a modified reconstruction after a pylorus-preserving pancreaticoduodenectomy, which consisted of gastrojejunostomy and pancreaticojejunostomy on the same loop and an isolated hepaticojejunostomy on another loop. In the standard PD (StPD) group, 95 patients underwent standard reconstruction. The median age was 67 years, ranging from 25 to 89 years. Compared with in the StPD group, the mPD group had significantly lower rates of grade B and C pancreatic fistula (4.9% vs. 28.4%), delayed gastric emptying (7.3% vs. 42.1%), postoperative hemorrhage (3.3% vs. 20%), intensive care unit admission (8.1% vs. 18.9%), overall morbidity (Clavien-Dindo grade III-V: 14.7% vs. 42.0%), perioperative mortality (4.1% vs. 14.7%), and shorter hospitalization stay (11 days vs. 20 days). However, no difference was noted regarding median survival (35 months vs. 30 months). In this single-center series, a modified reconstruction after PD appears to be associated with improved postoperative outcomes. However, further evaluation in larger multi-center trials is required.

One-Stage Intraoperative ERCP combined with Laparoscopic Cholecystectomy Versus Two-Stage Preoperative ERCP Followed by Laparoscopic Cholecystectomy in the Management of Gallbladder with Common Bile Duct Stones: A Meta-analysis.

Concomitant gallbladder and common bile duct (CBD) stones, known as cholecystocholedocholithiasis, are clinically prevalent. There is currently no consensus on sequential versus simultaneous management approaches, and, if simultaneous, which approach to adopt. This meta-analysis evaluates the safety and efficacy of one-stage laparoscopic cholecystectomy (LC) with intraoperative endoscopic retrograde cholangiopancreatography (ERCP) versus two-stage ERCP followed by LC for treating concomitant gallbladder and CBD stones. A comprehensive literature search was conducted in five databases, PubMed, Embase, Web of Science, VIP, and Wanfang, for all randomized controlled trials (RCTs), cohort and retrospective studies published up to February 2024. Data extraction was performed independently by two reviewers. The primary outcomes were CBD stone clearance rate and postoperative complications morbidity. Secondary outcomes included conversion to other procedures and length of hospital stay. Statistical analyses were performed using R (v.4.3.2) with weighted mean differences and odds ratios (ORs) calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs). A total of 17 studies involving 2120 patients have been included, with 898 patients receiving single-stage and 1222 patients undergoing two-stage treatment. Of these studies, 9 were RCTs and 8 were retrospective cohort study. The one-stage group demonstrated superior outcomes in terms of CBD stone clearance (OR=2.07, p=0.0004), overall morbidity (OR=0.35, p<0.0001), post-operative pancreatitis (OR=0.49, p=0.006), conversion to other procedures (OR=0.38, p=0.0006), and length of hospital stay (MD=- 2.6456, 95% CI -3.5776; -1.7136, p<0.0001). No significant differences were observed in post-operative cholangitis (OR=0.44, p=0.12), post-operative bleeding (OR=0.76, p=0.47), or bile leakage (OR=1.28, p=0.54). For patients with concomitant gallbladder and CBD stones, the one-stage approach combining ERCP and LC appears safer and more effective, with advantages including higher stone clearance rates, reduced postoperative complications (particularly pancreatitis), shorter hospital stays, fewer residual stones, and decreased need for additional procedures. However, additional high-quality clinical trials are needed to establish the optimal treatment approach for various patient scenarios.

Efficacy of Azvudine Therapy in Patients with Severe and Non-Severe COVID-19: A Propensity Score-Matched Analysis.

Azvudine is used to treat patients with the coronavirus disease 2019 (COVID-19). This study evaluated the clinical efficacy of azvudine in hospitalized patients with different severities of COVID-19 because few studies have described this in patients with severe and non-severe COVID-19. This retrospective study included hospitalized patients with COVID-19 in Guizhou Provincial People's Hospital between December 2022 and January 2023. Azvudine-treated patients and controls were matched for sex, age, and disease severity at admission. Laboratory results and outcomes, including all-cause mortality, invasive mechanical ventilation, intensive care unit admission, and hospital stay length, were evaluated. Stratified analysis was used to explore the difference in the efficacy of azvudine in severe and non-severe COVID-19 patients. No significant differences in all-cause mortality were observed between the 303 azvudine recipients and 303 matched controls. However, azvudine-treated patients had shorter hospital stays (8.34±4.79 vs 9.17±6.25 days, P=0.046) and higher lymphocyte improvement rates (21.5% vs 13.9%, P=0.019), with a more pronounced effect in patients with non-severe COVID-19 (length of hospital stay, 8.07±4.35 vs 10.00±6.29 days, P=0.001; lymphocyte improvement rate, 23.8% vs 12.8%, P=0.015). Azvudine treatment shortens hospital stay length and increases the rate of lymphocyte count improvement in patients with non-severe COVID-19, suggesting that azvudine may be a treatment option for these patients.

Comparison of radiation exposure and fluoroscopy time between minimally invasive common bile duct exploration and endoscopic retrograde cholangiopancreatography for choledocholithiasis

ImportanceRadiation exposure causes dose-dependent deleterious effects and efforts should be made to decrease patient exposure to ionizing radiation. Patients with choledocholithiasis are commonly exposed to ionizing radiation as fluoroscopy-guided interventions including minimally invasive common bile duct exploration (MICBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferred treatment modalities for common bile duct (CBD) stone clearance. However, radiation exposure and fluoroscopy times have not been compared between these two treatment modalities. ObjectiveTo compare fluoroscopy time (FT) and radiation exposure (RE) between MICBDE and ERCP in patients with choledocholithiasis. DesignThis is a retrospective analysis of a prospectively maintained database of a single surgeon performing MICBDE at an academic referral center between May 2021 and June 2023 compared to a retrospective analysis of all ERCPs performed between January 2020 and February 2021. Patient demographics, procedural details, fluoroscopic details, and post operative outcomes were compared between the MICBDE and ERCP. SettingSingle institution academic referral center located in the American Southwest. Participants109 patients with choledocholithiasis were divided into 2 groups. 53 patients (48.62%) underwent ERCP, and 56 patients (51.38%) underwent MICBDE. Inclusion criteria were; all patients presenting with choledocholithiasis and subsequently underwent ERCP or MICBDE. Patients who underwent ERCP for non-choledocholithiasis related reasons were excluded. Main outcomes and measuresPrimary outcomes include FT measured in minutes and RE measured in milligray (mGy). Secondary outcomes were successful clearance of the common bile duct, complications, procedural time, and reinterventions. ResultsA significant difference (P<.001) between fluoroscopy times was identified between ERCP (3.1mins) and MICBDE (1.54mins). Median RE doses between the ERCP group (38 mGy) and the MICBDE group (38.41 mGy) were not statistically different (p=0.88). Technical success of CBD clearance was similar in both groups (91% in MICBDE group vs 93% in ERCP group; p=0.711). Conclusion and RelevanceAdvantages of MICBDE over ERCP include; treatment of choledocholithiasis at the time of cholecystectomy, which reduces the risk of additional anesthesia episodes and the introduces the potential for shorter hospital length of stay. This study shows that MICDBE has lower FT compared to ERCP and comparable RE. Given the advantages of MICBDE, it should be strongly considered at the time of laparoscopic cholecystectomy.

Perioperative considerations in anesthesia for minimally invasive repair of pectus excavatum, Nuss procedure

Pectus excavatum (PE) is a common anterior chest wall deformity that affects the heart and lungs depending on the severity of compression. The Nuss procedure, a minimally invasive repair of pectus excavatum, has evolved over the years with thoracoscopic assistance and minimal incision. Despite improved surgical techniques, pain and nausea are often the most common factors determining hospital length of stay. This review will explore the preoperative, intraoperative, and postoperative anesthetic considerations necessary for improving patient outcomes, reducing surgical stress, and shortening hospital stays for patients undergoing the Nuss procedure.

EP.07A.14 The Postoperative Chest Tube Drainage Strategy of "Lesstube" Can Reduce Patient Pain and Shorten Hospital Stay

EP.07A.14 The Postoperative Chest Tube Drainage Strategy of "Lesstube" Can Reduce Patient Pain and Shorten Hospital Stay

Ten-year survival outcomes of video-assisted thoracic surgery vs. open major lung resection for stage I-III non-small cell lung cancer: a large cohort study in China.

Despite the widespread adoption of video-assisted thoracoscopic surgery (VATS) for major lung resection, the 10-year long-term survival outcomes of non-small cell lung cancer (NSCLC) treated with VATS compared with open major lung resection is lacking. The purpose of this study was to analyze the short- and long-term outcomes of VATS vs. open major lung resection for NSCLC. The perioperative outcomes and long-term survival of p-stage I-III NSCLC patients who underwent major lung resection via VATS vs. open major lung resection in the Western China Lung Cancer Database (WCLCD) between May 2006 and June 2018 were studied using propensity score matching (PSM). Of the 10,167 patients who underwent surgery for lung malignancies, 6,405 patients with stage I-III NSCLC were included in the study, including 4,224 in the VATS group and 2,181 in the open group. PSM resulted in 1,487 patients in both the VATS and open groups. The patients were matched by patient demographics, Charlson comorbidity index (CCI), tumor histology and TNM stage. Compared with open surgery, major lung resection via VATS resulted in less blood loss (median: 50 vs. 100 mL, P<0.001) and a shorter postoperative hospital stay (7.6±6.0 vs. 8.6±4.9 days, P<0.001) but higher total hospital costs (52.5±21.2 vs. 45.0±16.4 kRMB, P<0.001). The matched cohort showed that patients who underwent major lung resection via VATS had better overall survival (OS) and recurrence-free survival (RFS) than did patients who underwent major lung resection via open surgery (5-year survival: 64.9% vs. 57.7%, P<0.001; 5-year RFS: 50.3% vs. 45.3%, P=0.003). Patients who underwent VATS had a better 10-year OS rate (47.8% vs. 42.6%). According to the subgroup analysis, patients with stage II NSCLC who underwent major lung resection via VATS had better OS and RFS (OS: P<0.001; RFS: P=0.004), while there were no significant differences in OS or RFS between stage I and III NSCLC patients. Major lung resection via the VATS should be the preferred surgical option for stage I-III NSCLC patients due to its superior long-term survival outcome and advantages of less blood loss and shorter postoperative hospital stays.

ASSOCIATION OF RADIAL ARTERY ACCESS WITH REDUCED INCIDENCE OF ACUTE KIDNEY INJURY

Acute kidney injury (AKI) is a serious complication following cardiac procedures, leading to increased morbidity and mortality. The choice of vascular access site may influence the incidence of AKI, with radial artery access potentially offering protective benefits compared to femoral artery access. Objective: To evaluate the association between radial artery access during cardiac procedures and the incidence of acute kidney injury among patients. Methods: This retrospective cohort study was conducted at the National Institute of Cardiovascular Disease from January 2023 to January 2024. A total of 370 patients who underwent cardiac procedures were included, comprising 200 patients in the radial artery access group and 170 in the femoral artery access group. Data were collected retrospectively from medical records, including demographic information, baseline renal function, procedural details, and serum creatinine levels before and after the procedure. The incidence of AKI was determined based on established criteria for changes in serum creatinine. Statistical analyses were performed using appropriate tests, with a significance level set at p &lt; 0.05. Results: Patients in the radial artery access group had a shorter average hospital stay (2.5 ± 1.2 days) compared to the femoral group (3.8 ± 1.5 days, p = 0.001). The mortality rate was lower in the radial group (1.5%) versus the femoral group (4.1%), although this difference was not statistically significant (p = 0.09). The incidence of major adverse cardiovascular events (MACE) was 2.5% in the radial group compared to 5.9% in the femoral group (p = 0.07). Acute kidney injury occurred in 10.0% of patients in the radial artery access group (20 out of 200) versus 17.6% in the femoral artery access group (30 out of 170), indicating a significant reduction in AKI incidence with radial access. Conclusion: Using radial artery access during cardiac procedures significantly reduces the incidence of acute kidney injury compared to femoral artery access. These findings support the preference for radial artery access to minimize the risk of AKI and improve patient outcomes.

Clinical Effectiveness and Biochemical Impacts of Minimally Invasive versus Open Transforaminal Lumbar Interbody Fusion: A Meta-Analysis

Objective: This meta-analysis aimed to assess and compare the clinical effectiveness, safety, and biochemical impacts of two spinal surgery techniques: open transforaminal lumbar interbody fusion (open-TLIF) and minimally invasive TLIF (MIS-TLIF). Methods: A comprehensive search of the literature up to April 2023 was conducted across several databases, including PUBMED, Cochrane Library, SCOPUS, Web of Science, EMBASE, and CNKI. The search focused on the terms "transforaminal lumbar interbody fusion" or "TLIF" combined with "minimally invasive" or "open." From this search, 44 studies met the inclusion criteria and were analyzed. Results: The meta-analysis revealed that MIS-TLIF is associated with increased intraoperative radiological exposure but reduced intraoperative blood loss, decreased postoperative drainage volumes, shorter hospital stays, and improved outcomes as measured by the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Biochemically, MIS-TLIF is linked to lower levels of CRP, creatine kinase-muscle/brain (CK-MM), and creatine phosphokinase (CPK) at 24 hours post-operation compared to open TLIF. Conclusions: MIS-TLIF offers superior clinical effectiveness, improved safety profiles, and reduced muscular injury relative to conventional open TLIF. These findings suggest that MIS-TLIF may be a preferable option in spinal surgery settings where the reduction of tissue trauma and rapid recovery are prioritized.

Complications in Minimally Invasive Spine Surgery in the Last 10 Years: A Narrative Review.

Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements. A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers. The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach. MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes.