Significant Risk Factor For Conversion Research Articles

Risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia

Background: Inguinal hernia occurs in 1 to 5% of the general population. The development of laparoscopic inguinal hernia repair techniques as an alternative to conventional open surgery has improved results such as less postoperative pain, shorter hospital stays, and faster recovery. This study was conducted to assess the risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia. Method: A total of 200 patients who were scheduled to undergo TEP were enrolled. Complete demographic and clinical details of all the patients was obtained. A Performa was made and detailed intraoperative findings were evaluated. Baseline hemodynamic and biochemical profile was evaluated. Separate assessment of patients was done who were converted to open surgery. Comparison of patients was done among those with and without conversion. Various risk factors were evaluated which were responsible for conversion. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients was 49.2 years. 60.5 percent of the patients were of rural residence. Mean BMI of the patients was 24.8 Kg/m2. Incidence of conversion was 6.5 percent. Geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear and previous hernia surgery history was found to be significant risk factors for conversion. Conclusion: Laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia is an effective technique, but conversion to open surgery occurs in 6.5% of cases. Significant risk factors for conversion include geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear, and previous hernia surgery history. Identifying these risk factors can help optimize patient selection and improve outcomes for TEP repair.

Assessment of G10 Intraoperative Scoring System for Conversion in Patients Undergoing Laparoscopic Cholecystectomy: A Cross-Sectional Study From Nepal.

Various preoperative risk factors for conversion in laparoscopic cholecystectomy (LC) have been well studied. However, the assessment of intraoperative factors for conversion in patients with cholecystitis is unclear. The G10 scoring system, which incorporates 10 parameters, has tried to fill this void by developing a scoring system for the most commonly encountered surgical illnesses. So, we aimed to assess the utility of the G10 scoring system among patients presenting for LC for symptomatic cholelithiasis (both acute and chronic cholecystitis) in the clinical setting of a low- and middle-income country. All the patients undergoing LC were assigned a G10 value. Gallbladder surgery was considered easy if the G10 score was <2, moderate (2 ≦ 4), difficult (5 ≦ 7), and extreme (8 ≦ 10). All 10 risk factors were analyzed into a binary logistics model, and statistically significant risk factors were assessed. Among 177 patients, there were 36 males and 141 females. The median age of the patient was 42 years (range 11-79). There were 70 easy, 89 moderate, and 18 difficult cases. The overall mean G10 score was 2.32±1.5, which significantly increased as the severity progressed, with a mean value of 5.5±0.51 for difficult cases(P=0.0001). The mean G10 score for surgeries completed laparoscopically was 2.1±1.4, while it was 3.71±1.4 for open conversions[P=0.0001, AUC=0.79, CI=0.70-0.87]. There were 18 patients with G10 ≥5 with a conversion rate of 27.7%, while the overall conversion rate was 13.6%. Multivariate analysis showed free bile or pus outside the gallbladder [P=0.02, OR=5.1, CI=1.2-21.1] and fistula [P=0.01, OR=15.8, CI=1.9-129.8] as significant risk factors for conversion. Intraoperative risk factors for the prediction of conversion included the presence of free bile or pus outside the gallbladder and cholecystoenteric fistula. Based on the F1 score analysis, complemented with the Youden Index, the optimal cutoff value for conversion, based on the G10 score, lies around 4. Broader application and validation of the G10 scoring system are mandated to assess the utilization of this novel intraoperative scoring system.

Factors causing conversion in laparoscopic cholecystectomy

Introduction and purpose: Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure in the treatment symptomatic gall bladder disease. Conversion is not a failure or complication. It is only a step taken to ensure patient safety and to avoid complications. The objective of our study was to investigate the rate and the causative preoperative and intraoperative factors of conversion and to help surgeons have an idea about potential intraoperative challenges. Materials and methods: Laparoscopic cholecystectomy procedures performed on 4433 patients with signs and symptoms of cholelithiasis-cholecystitis who were diagnosed with abdominal ultrasonography were retrospectively reviewed. The patients were grouped on the basis of age, gender, length of hospitalization, history of preoperative endoscopic retrograde cholangiopancreaticography (ERCP), diabetes mellitus (DM), chronic fibrotic cholecystitis, gall bladder polyps, and urgent-elective surgery. The rate and causative factors of conversion were investigated. Statistical analyses were carried out using IBM SPSS for Windows, version 17.0 (IBM statistics for Windows version 17, IBM Corparation, Armonk, New York, United States) software package. Result: In our study, the conversion rate was 0.85%. Male gender, advanced age, increased length of hospitalization, history of preoperative ERCP, urgent surgery (acute-hydropic cholecystitis), and chronic fibrotic cholecystitis were the significant risk factors for conversion. DM had no effect on conversion. Conclusion: Conversion should not be necessarily regarded as a complication in laparoscopic cholecystectomy. Identifying patients with significant risk factors for conversion can significantly minimize the complications of the laparoscopic procedure. This may assist in identifying high-risk patients and reviewing surgical strategy in this patient group.

Analysis ofsurvivorship following periacetabular osteotomy forhip dysplasia based onthree-dimensional acetabular coverage.

Periacetabular osteotomy (PAO) is an established procedure for correcting acetabular coverage and preventing osteoarthritis progression in hip dysplasia. However, it is unclear how acetabular coverage changes three-dimensionally after PAO and how it affects survival. Therefore, this study aimed to investigate the change in three-dimensional acetabular coverage preoperatively and postoperatively and identify demographic, clinical and radiographic factors associated with conversion to total hip arthroplasty (THA) and radiographic osteoarthritis progression after PAO. We retrospectively reviewed 46 consecutive patients (66 hips) who underwent PAO, using preoperative and postoperative radiographs and pelvic computed tomography (CT). Three-dimensional acetabular coverage based on CT data was investigated. Kaplan-Meier survival analysis was performed, and hazard ratios were calculated using univariate Cox regression models to identify the risk factors associated with conversion to THA and radiographic osteoarthritis progression after PAO as the endpoints. Radiographic osteoarthritis progression was defined as a minimum joint space of <2.0 mm. The mean follow-up was 10.7 years. Post-PAO, acetabular coverage gradually increased from the anterosuperior to the superior to the posterosuperior direction. The survival rate after PAO was 98.0% at 10 years. Less postoperative superior acetabular coverage, with a hazard ratio of 0.93, was significantly associated with conversion to THA and radiographic osteoarthritis progression after PAO (P = 0.03). In this study, poor superior acetabular coverage after PAO was a significant risk factor for conversion to THA and radiographic progression of osteoarthritis. Therefore, surgeons should attempt to prioritize the correction of the superior acetabular coverage when performing PAO.

Assessment of a Real-world Learning Curve for the Endoscopic Resection of Gastric Gastrointestinal Stromal Tumors.

Endoscopic resection (ER) is a proven treatment for gastric gastrointestinal stromal tumors (gGISTs). We aimed to assess the learning curve (LC) associated with ER for gGISTs and identify determinants. We conducted an analysis of 289 patients who underwent the ER of gGISTs by an experienced endoscopist. To characterize the LC, we employed cumulative sum analysis of the duration of surgery. The participants were divided into an early phase (cases 1-50) and a later phase (case 51-289), which were compared. Furthermore, we identified risk factors for the conversion from endoscopic to laparoscopic resection (LR). The durations of surgery and hospitalization were shorter, and there were fewer complications and fasting days in the later phase. The conversion rates to LR were 6.0% and 2.5% in the early and later phases, respectively. The tumor diameter (≥3.0 cm) and invasion beyond the muscularis propria were significant risk factors for conversion to LR (odds ratio 17.92, 95% confidence interval 2.66-120.87; and 58.03, 6.40-525.84; respectively). The LC for ER of gGISTs lasts for approximately 50 cases. In addition, tumors ≥3.0 cm in diameter and those that invade beyond the muscularis propria are more likely to require conversion to LR.

Paper 12: Severity of Chondrolabral Junction Degeneration Predicts Conversion to Total Hip Arthroplasty after Arthroscopic Femoroacetabular Impingement Treatment at Minimum 10-Years Follow-Up

Objectives: To identify location and severity of intraoperative pathology at time of arthroscopic surgery for femoroacetabular impingement (FAI) as risk factors for conversion to total hip arthroplasty (THA) utilizing long-term follow-up (minimum 10 years). Methods: Retrospective study of prospectively collected data of adult patients (≥ 18 years) who underwent hip arthroscopy for FAI between 1998 and 2011 with minimum follow-up of 10 years. Location and severity of pathology at time of arthroscopic surgery were assessed as risk factors for later conversion to a primary outcome of THA. Patients with radiographic evidence of hip dysplasia and previous history of hip surgery were excluded. Patients were then grouped according to whether they had underwent THA. Differences in continuous variables including age, BMI, and center edge angle (CEA) were analyzed with independent t tests. Differences in categorical variables including type of treatment (debridement or repair), deformity (CAM vs pincer vs combined), Outerbridge grade, location of most severe chondral wear (anterosuperior acetabulum, posterosuperior acetabulum, femoral head), presence of chondral flap, and degree of chondrolabral degeneration (as measured by Beck classification) were analyzed with the Pearson’s Chi-squared test. For variables with greater than two levels (chondrolabral degeneration, etc.) adjusted residuals were calculated to determine which comparisons were statistically different, with a value of &gt;2 indicating a lack of fit with the null hypothesis of difference. A multivariable logistic regression model was constructed to estimate the influence of the exact location and severity of pathology on risk for conversion to THA. Model results are reported as odds ratios (OR) with corresponding 95% confidence intervals. Results: A total of 109 patients with a mean age of 39.41 ± 11.43 years and minimum follow-up of 10 years were eligible for inclusion in this study. The average follow-up was 12.29 ± 2.53 years. Average body mass index (BMI) was 26.19 ± 4.07 while average center edge angle (CEA) was 39.53 ± 7.24. 67 (61.5%) patients underwent debridement while 42 (38.5%) patients underwent labral repair. 32 (29.4%) patients subsequently converted to THA. BMI (1.7% difference, p = 0.072), CEA (0.3% difference, p = 0.832), sex (0.2% difference, p = 0.991), procedure type (11.8% difference, p = 0.565), and presence of a chondral flap (6.3% difference, p = 0.685) were not significantly associated with conversion to THA. FAI type, Outerbridge grade, chondrolabral junction degeneration, and location of most severe degenerative change were statistically significant, with adjusted residuals greater than 2 (Table 1). A multivariable logistic regression model demonstrated age (OR=1.08, 95% CI 1.03-1.14, p = 0.002), Grade 4 chondrolabral degeneration (OR = 3.26, 95% CI 1.16-9.17, p = 0.025) and combined FAI type (OR = 4.32, 95% CI 1.38 – 13.56, p = 0.012) as significant risk factors for conversion to THA. Conclusions: Grade 4 degeneration of the chondrolabral junction as well as combined FAI type and older age are significant risk factors for conversion to THA after arthroscopic treatment of FAI at minimum 10-years of follow-up. [Table: see text][Table: see text]

Age is predictive of higher rate of conversion to total hip arthroplasty after core decompression for osteonecrosis of the hip

BackgroundCore decompression may be performed for early osteonecrosis with a goal of improving symptoms and potentially delaying the need for total hip arthroplasty. The effectiveness and complication rate of this procedure is not well understood given the relatively rare nature of hip osteonecrosis. PurposeThe purpose of this study is to determine time to total hip arthroplasty (THA) after core compression, assess predictors of early conversion to THA, and to examine complications after hip core decompressions. MethodsUsing Current Procedural Terminology (CPT) codes, we queried the Mariner PearlDiver dataset for patients who underwent hip core decompression. Patient demographics were recorded and subsequent THA conversion within 2 years after surgery were tracked. Patient demographic factors, including age, sex, obesity, diabetes, prior fractures, steroid use, tobacco use, or alcohol use, were evaluated as possible predictors of early conversion to THA. International Classification of Diseases (ICD) codes were used to identify complications at 90 days after core decompression. Multiple linear regression was used to test if the patient demographics significantly predicted conversion to THA and complications after core decompression. ResultsBetween 2010 and 2020, 555 patients underwent hip core decompression. Within 2 years of core decompression, 226 patients converted to THA (40.7%). Age was the only significant risk factor for conversion to THA. The highest proportion of patients (61.1%, 138/226) who converted to THA were between age 40–59. The 90-day complication rate was 2.9% (16/555). The most common complication was femoral neck fracture (11/16 of all complications). DiscussionThere is a high failure rate following core decompression for hip osteonecrosis with over one third of patients converting to THA within 2 years. Age was the only variable predictive of conversion to THA. The overall complication rate after core decompression is low at 90 days. ConclusionPatients should be counseled regarding the risk of early conversion to THA if over 40 and the potential risk of femoral neck fracture.

Predictors and outcomes of conversion to sternotomy in minimally invasive coronary artery bypass grafting.

This study aims to investigate the risk factors and surgical outcomes of conversion to median sternotomy in minimally invasive direct coronary artery bypass grafting. Between January 2017 and July 2022, a total of 274 patients (246 males, 28 females; mean age: 57.0±9.6 years; range, 33 to 81 years) who underwent conventional (n=116) or robot-assisted (n=158) minimally invasive direct coronary artery bypass grafting were retrospectively analyzed. The primary outcome measure of the study was conversion to median sternotomy, and the secondary outcome measures were operative mortality, length of intensive care unit and hospital stay. Conversion to median sternotomy was required in 26 (9.5%) patients. The most common cause of conversion was intramyocardial left anterior descending artery (27.0%). Among preoperative and operative characteristics, only age was statistically significant risk factor for conversion to sternotomy (odds ratio=1.06, p=0.01). Operative mortality occurred in one patient (0.36%) patient in the entire cohort. The length of intensive care unit and hospital stay was significantly longer in patients requiring conversion to median sternotomy (p=0.002 and p<0.001, respectively). There was no significant difference in other postoperative outcomes between the two groups (p>0.05). Intramyocardial left anterior descending artery is the most common reason for conversion to sternotomy, and older age increases the risk of conversion. Minimally invasive coronary artery bypass grafting can be performed with satisfactory results, even if it requires conversion to sternotomy.

Time to fellow eye involvement in patients with unilateral diabetic macular oedema.

To examine the time to onset of disease in the fellow eye of patients with unilateral DMO in routine clinical practice and to identify risk factors for development of bilateral DMO. Retrospective cohort study. One hundred forty treatment-naive patients 18 years or older with unilateral DMO presenting to Cole Eye Institute between January 2012 and July 2021. Records of patients with unilateral DMO were reviewed for development of DMO in the fellow eye. Demographic, diabetic, ocular, and systemic characteristics were collected at initial DMO diagnosis date. Bivariate and multivariate analyses were performed and significant factors were modelled using Kaplan-Meier curves. Fifty patients with conversion to bilateral DMO and 90 patients without conversion were identified. Average time to bilateral DMO was 15.0 ± 15.7 months. 64% of patients converted within 1 year and 90% converted within 3 years. HbA1c (p = 0.003), diabetic retinopathy duration (p = 0.029), and diabetic foot disease (DFD) (p = 0.002) were identified as significant risk factors for conversion. Patients with better visual acuity at time of initial diagnosis and history of panretinal photocoagulation (PRP) (p = 0.044) or focal laser (p = 0.035) in the primary eye were also more likely to convert. Participants were most likely to develop fellow eye DMO within the first year after initial DMO diagnosis. In routine clinical practice, poor glycaemic control and DFD were risk factors associated with bilateral eye involvement. Clinicians may consider screening the fellow eye of high-risk individuals at each appointment within the first year of diagnosis.

Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy

ObjectiveConversion to thoracotomy continues to be a concern during minimally invasive lobectomy. The aim of this propensity-matched cohort study is to analyze the outcomes and risk factors of intraoperative conversion during video-assisted thoracoscopic surgery (VATS) and robotic lobectomy (RL). MethodsData from consecutive lobectomy cases performed for clinical stage IA to IIIA lung cancer was retrospectively collected from the Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study consortium of 21 institutions from 2011 to 2019. The propensity-score method of inverse-probability of treatment weighting was used to balance the baseline characteristics across surgical approaches. Univariate logistic regression models were applied to test risk factors for conversion. Multivariable logistic regression analysis was conducted using a stepwise model selection method. ResultsSeven thousand two hundred sixteen patients undergoing lobectomy were identified: RL (n = 2968), VATS (n = 2831), and open lobectomy (n = 1417). RL had lower conversion rate compared with VATS (3.6% vs 12.9%; P < .0001). In the multivariable regression model, tumor size and neoadjuvant therapy were the most significant risk factors for conversion, followed by prior cardiac surgery, congestive heart failure, chronic obstructive pulmonary disease, VATS approach, male gender, body mass index, and forced expiratory volume in 1 minute. Conversions for anatomical reasons were more common in VATS than RL (66.6% vs 45.6%; P = .0002); however, conversions for vascular reasons were more common in RL than VATS (24.8% vs 14%; P = .01). The rate of emergency conversions was comparable between RL and VATS (0.5% vs 0.7%; P = .25) with no intraoperative mortalities. ConclusionsConverted minimally invasive lobectomies were not associated with worse perioperative mortality compared with open lobectomy. Compared with VATS lobectomy, RL is associated with a lower probability of conversion in this propensity-score matched cohort study.

Risk factors for conversion of forefoot or midfoot amputations to below knee amputation

This study aims to identify risk factors as well as proper indications for forefoot or midfoot amputations at the transmetatarsal, Lisfranc or Chopart level as a potential avenue for distal limb salvage and avoid below knee amputation (BKA). This study utilized the PearlDiver national database encompassing 91 million unique patients from 2010 to 3/31/2020 to identify patients who underwent foot amputation (CPT-28800, CPT-28805). The primary endpoint is conversion to BKA within 6 months. Propensity matched cohorts were created using age, gender and common comorbidities. Logistic regression utilizing the matched cohorts determined odds ratios for conversion to BKA based on indication. Indications included abscess, gangrene, osteomyelitis, and diabetic wounds. Analysis was repeated at 1, 2 and five years. Chi-square analysis was used to assess the impact of comorbid peripheral vascular disease (PVD) in a subgroup of patients with osteomyelitis. Time to conversion to BKA was tabulated. The database identified 17,875 patients who underwent forefoot or midfoot amputation . Conversion to BKA occurred in 2400 patients with median time of 71 days. Logistic regression of the matched cohorts revealed that gangrene was a significant risk factor for conversion to BKA, while osteomyelitis was protective. Subgroup analysis of the osteomyelitis cohort revealed a higher rate of conversion to BKA for patients with concomitant PVD (OR 1.44; P = 0.01). Based on our data, forefoot or midfoot amputation should be cautiously considered in patients with gangrene or osteomyelitis with concomitant PVD because of a significantly higher rate of conversion to BKA. IV. • This study aims to identify risk factors as well as proper indications for forefoot or midfoot amputations at the transmetatarsal, Lisfranc or Chopart level as a potential avenue for distal limb salvage and avoid below knee amputation (BKA). • Logistic regression of the matched cohorts revealed that gangrene and diabetes were a significant risk factors for conversion to BKA, while osteomyelitis was protective at 6 months. At 1, 2, and 5 year analyses; gangrene remained a risk factor, while osteomyelitis remained protective. • Subgroup analysis of the osteomyelitis cohort revealed a higher rate of conversion to BKA for patients with concomitant peripheral vascular disease. • Cost was significantly increased for conversion to BKA ($46, 471 vs $61,201).

Impact of prior abdominal surgery on short-term outcomes following laparoscopic colorectal cancer surgery: a propensity score-matched analysis.

Whether laparoscopic surgery after prior abdominal surgery (PAS) is safe and feasible for colorectal cancer (CRC) remains controversial. The present study aimed to evaluate the impact of PAS on short-term outcomes following laparoscopic CRC surgery. We performed retrospective analysis used propensity score-matched analysis to reduce the possibility of selection bias. Participants comprised 1284 consecutive patients who underwent elective laparoscopic CRC surgery between 2010 and 2020. Patients were divided into two groups according to PAS. Patients with PAS were then matched to patients without these conditions. Short-term outcomes were evaluated between groups in the overall cohort and matched cohort, and risk factors for conversion to laparotomy and severe postoperative complications were analyzed. After propensity score matching, we enrolled 762 patients (n = 381 in each group). Before matching, significant group-dependent differences were observed in sex, age, primary tumor site, pathological (p) T stage, and type of procedure. No significant difference was found between groups in terms of rate of conversion to laparotomy, estimated blood loss, rate of extended resection, length of postoperative stay, and postoperative complications. After matching, estimated operative time was significantly longer in the PAS group (p = 0.01). Significant differences were found between groups in terms of reason for conversion to laparotomy. Multivariate analyses identified significant risk factors for conversion to laparotomy as pT stage ≥ 3 (odds ratio [OR] 2.36; 95% confidence interval [CI] 1.05-5.26) and body mass index ≥ 25kg/m2 (OR 3.56; 95% CI 1.07-11.7). Multivariate analyses identified rectum in the primary tumor site as the only significant risk factor for severe postoperative complications (OR 2.37; 95% CI 1.08-5.20). Laparoscopic CRC surgery after PAS showed acceptable short-term outcomes compared to Non-PAS. The laparoscopic approach appears safe and feasible for CRC regardless of whether the patient has a history of PAS.

Factors limiting the endoscopic submucosal dissection in colorectal tumors

Aim:to identify the risk factors for conversion of endoscopic submucosal dissection to abdominal surgery.Patients and methods: the prospective cohort study included 405 patients: 166 (40.9%) males and 239 (59.1%) females. The median age was 66 (59; 72) years old; the patients underwent endoscopic submucosal dissection of colorectal epithelial neoplasms.Results:the median size of the removed neoplasms was 3.0 (2.4; 4) cm, tumor was removed en bloc in 324/363 (89.2%) cases; and R0 resection margins were detected in 218/324 (67.3%) cases. Significant risk factors for conversion were: the tumor size ≥ 3.2 cm (OR 2.9, 95% CI 1.2–7.1, p = 0.017), lifting ≤ 3 mm (OR 41, 95% CI 15–105, p = 0.000002) and the tumor vascular pattern IIIa according Sano’s capillary pattern classification (OR 4.0, 95% CI 1.3–11.9, p = 0.013).Conclusion:endoscopic submucosal dissection is a safe way to remove colorectal neoplasms. However, the presence of conversion risk factors can influence the outcome of endoscopic treatment.

Predictors of conversion from major depressive disorder to bipolar disorder

The present study has two main aims: (1) To assess whether childhood trauma helps to differentiate Major Depressive Disorder (MDD) from Bipolar Disorder (BD) in a cross-sectional design; and (2) Describe the rate of conversion from MDD to BD, as well as the clinical and demographic predictors of conversion from MDD to BD in a prospective cohort design. We conducted a prospective cohort study in two phases, in the city of Pelotas, RS, Brazil. In the first phase, 565 subjects diagnosed with MDD, and 127 with BD according to the Mini International Neuropsychiatric Interview were included. In the second phase, only individuals with MDD were reevaluated for potential conversion to BD. The rate of conversion from MDD to BD in 3 years was 12.4%. Predictors of conversion from MDD to BD included lower educational level, use of illicit substances, younger age of the first depressive episode, and family history of BD. Childhood trauma was not a significant risk factor for conversion to BD in our prospective study. Our findings can contribute to the prevention and identification of conversion from MDD to BD, as well as to the establishment of more targeted therapeutic interventions, improving the prognosis of these individuals.

Factors Associated With Distal Femoral Osteotomy Survivorship: Data From the California Office of Statewide Health Planning and Development (OSHPD) Registry.

Background:Malalignment of the lower extremity can lead to early functional impairment and degenerative changes. Distal femoral osteotomy (DFO) can be performed with arthroscopic surgery to correct lower extremity malalignment while addressing intra-articular abnormalities or to help patients with knee osteoarthritis (OA) changes due to alignment deformities.Purpose:To examine survivorship after DFO and identify the predictors for failure.Study Design:Case series; Level of evidence, 4.Methods:Data from the California Office of Statewide Health Planning and Development, a statewide discharge database, were utilized to identify patients between the ages of 18 and 40 years who underwent DFO from 2000 to 2014. Patients with a history of lower extremity trauma, infectious arthritis, rheumatological disease, skeletal dysplasia, congenital deformities, malignancy, or concurrent arthroplasty were excluded. Failure was defined as conversion to total or unicompartmental knee arthroplasty, and the identified cohort was stratified based on whether they went on to fail. Age, sex, race, diagnoses, concurrent procedures, and comorbidities were recorded for each admission. Statistically significant differences between patients who required arthroplasty and those who did not were identified using the Student t test for continuous variables and a chi-square test for categorical variables. Kaplan-Meier survivorship curves were constructed to estimate 5- and 10-year survival rates. A Cox proportional hazards model was used to analyze the risk for conversion to arthroplasty.Results:A total of 420 procedures were included for analysis. Overall, 53 knees were converted to arthroplasty. The mean follow-up time was 4.8 years (range, 0.0-14.7 years). The 5-year survivorship was 90.2% (range, 85.7%-93.4%), and the 10-year survivorship was 73.2% (range, 64.7%-79.9%). The mean time to failure was 5.9 years (range, 0.4-13.9 years). Survivorship significantly decreased with increasing age (P = .004). Hypertension and a primary diagnosis of osteoarthrosis were significant risk factors for conversion to arthroplasty (odds ratio [OR], 3.12 [95% CI, 1.38-7.03]; P = .006, and OR, 2.42 [95% CI, 1.02-5.77]; P = .045, respectively), along with a primary diagnosis of traumatic arthropathy (OR, 10.19 [95% CI, 1.71-60.65]; P = .01) and a comorbid diagnosis of asthma (OR, 2.88 [95% CI, 1.23-6.78]; P = .02). Patients with Medicaid were less likely (OR, 0.11 [95% CI, 0.01-0.88]; P = .04) to undergo arthroplasty compared with patients with private insurance, while patients with workers’ compensation were 3.1 times more likely (OR, 3.08 [95% CI, 1.21-7.82]; P = .02).Conclusion:Older age was an independent risk factor for conversion to arthroplasty after DFO in patients ≥18 years but ≤60 years. Hypertension, asthma, and a diagnosis of osteoarthrosis or traumatic arthropathy at the time of surgery were predictors associated with failure, reinforcing the need for careful patient selection. The high survivorship rate of DFO in this analysis supports this procedure as a reasonable alternative to arthroplasty in younger patients with valgus deformities about the knee and symptomatic unicompartmental OA.

The importance of follow-up and re-diagnosis of patients with demyelinating syndrome suspicion - a case study of a conversion from radiologically isolated syndrome to clinically definite multiple sclerosis

Introduction. Radiologically isolated syndrome (RIS) is a term to describe criteria of diagnosis for the individuals, who underwent brain MRI because of other reasons than multiple sclerosis (MS) suspicion, but turned out to have white matter lesions similar to those present in patients with diagnosed MS. RIS is a separate entity with the presence of MR detected lesions strongly suggestive of MS in patients with no neurological manifestations. Although RIS is not the first stage of MS in every individual, 30-45% of them will present clinical symptoms later. There is a consensus, that about 1/3 of RIS patients will convert to clinically definite MS (CDMS) within 5 years of follow-up. There are some significant predictors of conversion, such as: age (&lt; 37 when diagnosed), male sex and presence of lesions in spinal cord.Case report. We describe a case of a 35-year-old female patient who was initially diagnosed with RIS after MRI performed due to migraine. After about year and a half of follow-up she presented first clinical manifestation (temporary left eye blindness) followed by second episode (in the second eye), a progression in MRI and appearance of oligoclonal bands in cerebrospinal fluid.Discussion. Among individuals with incidentally found lesions in MRI, only few happen to have white matter findings similar to demyelinating lesions in patients with CDMS. Non-specific MRI white matter lesions are much more often than than those fulfilling 2017 MAGNIMS criteria.There is more research needed to determine significant risk factors for conversion from RIS to CDMS. In RIS patients watchful neurological supervision is indispensable.

Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis.

The aim of this study was to discuss indications and outcomes for conversion to thoracotomy during thoracoscopic lobectomy. Patients who underwent lobectomy for non-small cell lung cancer between January 2012 and December 2016 were evaluated retrospectively. The study included 129 patients who underwent video-assisted thoracoscopic lobectomy (group-V) and 18 patients converted from thoracoscopic lobectomy to thoracotomy due to unexpected intraoperative complications (group-T). The two patient groups showed no statistical differences in terms of demographic characteristics. Causes of unexpected conversions to thoracotomy were hemorrhage in six patients, dense pleural adhesions in seven patients, fused fissure in one patient, and fibrocalcified lymph nodes around the vascular structures in four patients. Operative time was 180.37 ± 68.6min in group-V and 235 ± 72.6min in group-T (p = 0.003). Intraoperative blood loss was 263.9 ± 180.6mL in group-V, compared to 562.7 ± 296.2mL in group-T (p < 0.001). Patient age ≥ 70years was a significant risk factor for conversion to thoracotomy (p = 0.015, odds ratio 4.73). The 5-year survival rate in group-V was 71.4% {mean: 65.2months [95% confidence interval (CI) 59.6-70.8]}, while that in group-T was 80% [mean 54.9months (95% CI 45.9-63.8)] (p = 0.548). Advanced age was identified as the main risk factor for conversion to thoracotomy. However, early- and long-term outcomes were similar in the two groups, indicating that video-assisted thoracoscopic surgery is a safe and applicable method.

Preoperative and postoperative risk factors in laparoscopic cholecystectomy converted to open surgery.

Laparoscopic cholecystectomy (LC) is nowadays the gold standard in the surgical treatment of cholelithiasis and gallbladder diseases. But sometimes it may be inevitable to convert it to open surgery to safely end the procedure. In this study, we aimed to investigate the risk factors for conversion to open surgery from LC. The records of patients that underwent LC in Malatya State Hospital (Malatya, Turkey) between January 2013 and May 2014 were prospectively examined. One hundred and forty-five patients were involved in this study. The patients were divided into 2 groups: LC patients and patients converted to open surgery. For the patients in both groups, the preoperative age, gender, body mass index (BMI), disease history, previous abdominal operations, and preoperative laboratory findings were recorded, as well as the fact if the abdominal ultrasonography (US) and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Of 145 patients involved in this study, 127 (87.5%) were female and 18 (12.5%) were male; their mean age was 46.54 years. Nineteen of the patients were operated on after ERCP due to acute cholecystitis and 6 patients were operated on after ERCP due to choledocholithiasis. In 134 of the patients (92.4%), the operations were completed laparoscopically, while the process was converted to open surgery in 11 cases (7.6%). Male gender, chronic disease history, normal BMI level, increased thickness of the gallbladder wall, increased preoperative blood glucose level, leukocytosis, preoperative ERCP history, grade 3 or 4 (Blauer scoring system) adhesions determined during the operation, and multiple stone presence in the bladder were found to be statistically significant risk factors for conversion to open surgery. Patients in the risk group should be informed by experienced laparoscopic surgeons about the potential conversion to open surgery and decision on such conversion should be made when necessary.

Laparoscopic nephrectomy for urolithiasis: when is better to avoid it.

to investigate the risk factors for conversion to open surgery in laparoscopic nephrectomy (LN) for urolithiasis. we reviewed data on all patients over 18 years of age submitted to LN between January 2006 and May 2013 at our institution. We analyzed the Charlson's index, the ASA score, renal function by the equation and stage of MDRD (Modification of Diet in Renal Disease), preoperative computed tomography (CT) findings, complications by the Clavien-Dindo classification and conversion rate. We used logistic regression analysis to determine the risk factors for conversion. eighty-four patients underwent LN, 16 (19%) sustaining convertion to open surgery due to the strong adhesion of the renal hilum to the adjacent organs. Other causes associated with conversion were excessive bleeding (n=6) and lesion of the large intestine (n=3). In the univariate analysis, previous renal surgery, perirenal fat blurring, renal abscess, perirenal abscess, pararenal abscess, fistula, adherence to the liver or spleen, and adherence to the intestine were associated with conversion. In the multivariate analysis, pararenal abscess and adherence to the intestine were significant risk factors for conversion. pararenal abscess and bowel adhesions demonstrated in the preoperative CT are risk factors for conversion to open surgery in LN due to urolithiasis.

Effect of the Initial Strategy for Active Endocarditis Complicated With Acute Heart Failure

Early surgery for infective endocarditis (IE) with acute heart failure (AHF) is recommended, despite clinical results being unclear. We investigated the effect of initial treatment in such patients. Methods and Results: Outcomes for 470 patients with active IE who underwent valvular surgery during 2009-2016 were reviewed. Of them, 177 had symptomatic AHF when diagnosed with IE (excluding those with cardiogenic shock or intubated for AHF). They were divided into 2 groups based on initial treatment: Group S (underwent valvular surgery immediately; n=74) and Group M (received initial medical treatment for infection and HF; n=103). The median (interquartile range) waiting period from diagnosis to surgery in Groups S and M was 1 (1-3) and 15 (8-33) days, respectively (P<0.001). The 5-year survival rate was higher in Group S than Group M (80% vs. 64%; P=0.108). Group M was divided into Group P (initial medical treatment was effective and elective surgery was performed; n=62) and Group E (emergency surgery was necessary during medical treatment; n=41); overall 5-year survival was significantly worse in Group E than Group P (42% vs. 79%; P<0.012). In Group M, multivariate analysis indicated that Staphylococcus aureus infection (odds ratio 3.82; 95% confidence interval 1.19-13.3; P=0.024) was a significant risk factor for conversion to emergency surgery. Considering poor outcomes of emergency surgery for medically refractory HF, early surgery may be a reasonable option for IE patients, especially those with S. aureus infection.