Similar Rates Of Postoperative Complications Research Articles

The safe and risk assessment of perioperative antiplatelet and anticoagulation therapy in inguinal hernia repair, a systematic review.

There is a lack of consensus on the continuation or cessation of perioperative antiplatelet and anticoagulation therapies in inguinal hernia repair, therefore, the local hospital protocols dealing with these agents vary. The aim of this study is to investigate the risk and safety of perioperative antiplatelet and anticoagulation therapies in patients undergoing elective inguinal hernia repair. The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through January 2019 were identified, using the keywords Aspirin, Clopidogrel, Warfarin, antiplatelet, anticoagulation, inguinal hernia repair, bleeding, hematoma, complications. All relevant articles and reference lists in these original studies were also obtained from the above databases. Thirteen articles were identified, ten studies reported the results of perioperative application of antiplatelet therapy during inguinal hernia repair, nine trials reported the outcomes perioperative use of anticoagulation therapy in inguinal hernia repair, and six articles reported the results of both agents. One study did not indicate the perioperative cessation or continuation of the corresponding agents. Cessation of antiplatelets was reported in three studies and continuation of antiplatelets was used in six studies, they all demonstrated similar incidence of the bleeding complications, as compared with controls. Continued perioperative anticoagulation with Warfarin was reported in six studies and Warfarin discontinuation 3days prior to operation was examined in two studies, both reported similar postoperative bleeding-related complication rates providing international normalized ratio (INR) < 3, and the postoperative hematoma incidence increased in the condition of INR > 3. Our results indicated that, for both open and laparoscopic inguinal hernia repair, there is no need to stop the antiplatelet therapy (Aspirin or Clopidogrel), and due to the limited evidence and the complexity of each patient' condition, the continuation or cessation of anticoagulation with Warfarin should be tailored on a case-by-case basis.

Impact of transfer status on real-world outcomes in nonelective cardiac surgery

ObjectiveTransfer from hospital to hospital for cardiac surgery represents a large portion of some clinical practices. Previous literature in other surgical fields has shown worse outcomes for transferred patients. We hypothesized that transferred patients would be higher risk and demonstrate worse outcomes than those admitted through the emergency department. MethodsAll patients undergoing cardiac operations with a Society of Thoracic Surgeons Predicted Risk of Mortality were evaluated from a multicenter, statewide Society of Thoracic Surgeons database. Only patients requiring admission before surgery were included. Patients were stratified by admission through the emergency department or in transfer. Transfers were further stratified by the cardiothoracic surgery capabilities at the referring center. ResultsA total of 13,094 patients met the inclusion criteria of admission before surgery. This included 7582 (57.9%) transfers, of which 502 (6.6%) were referred from cardiac centers. Compared with emergency department admissions, transfers had increased hospital costs despite lower operative risk (Predicted Risk of Mortality 1.5% vs 1.6%, P < .01) and equivalent postoperative morbidity (15.6% vs 15.3% P = .63). In risk-adjusted analysis, transfer status was not independently associated with worse outcomes. Patients transferred from centers that perform cardiac surgery are higher risk than general transfers (Predicted Risk of Mortality 2.5% vs 1.5, P < .01), but specialized care results in excellent risk-adjusted outcomes (observed/expected: mortality 0.81; morbidity or mortality 0.90). ConclusionsTransfer patients have similar rates of postoperative complications but increased resource use compared with patients admitted through the emergency department. Patients transferred from centers that perform cardiac surgery represent a particularly high-risk subgroup.

Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients

A minimally invasive surgical approach has proven to decrease peri- and postoperative complications and shorten duration of hospital stay; however, there are limited data evaluating the safety of robotic-assisted surgery and early hospital discharge in the elderly population. Because age is a well-known, independent risk factor for perioperative morbidity and gynecologists treat many elderly patients, this is an important area of study. The objective of the study was to evaluate discharge timing and surgical outcomes in elderly compared with younger patients undergoing robotic-assisted gynecologic surgery. This was a retrospective cohort study of all patients who underwent robotic-assisted gynecologic surgery at a high-volume, single institution from January 2013 through May 2016. Demographic information, discharge timing, and peri- and postoperative outcomes were compared for patients <65 years with those ≥65 years using univariate and multivariate analyses. There were 2757 patients included, with 2521 <65 years and 236 ≥65 years. Median age of the younger group was 42 years, while the median age of the elderly group was 69 years. Elderly patients had a higher body mass index (kilograms per square meter) (28 vs 26, P < .001) and higher American Society of Anesthesia classification (P < .001). Elderly were more likely to have malignancy as the indication for surgery (68% vs 11%, P < .001) and to undergo hysterectomy (81% vs 38%, P < .001) orsurgery with lymph node dissection (44.5% vs 7.1%, P < .001). Elderlypatients had a higher incidence of intraoperative complications (9%vs 4.6%, P= .002) and longer median hospital stay (17 vs 7 hours, P< .001) compared with younger patients. Same-day discharge was more common in younger patients (76% vs 45%, P < .001), and elderly patients were more likely to have admissions lasting >23 hours (13% vs3%, P < .001) on univariate and multivariate analysis. Analysis of postoperative outcomes included 2023 patients with available postoperative data (80% of total population) (1794 <65 years, 229 ≥ 65 years). There were no differences between elderly and younger patients in overall postoperative complications, reoperations, intensive care unit admissions, emergency room visits, or hospital readmission within 6 weeks of surgery. Despite having more preoperative risk factors and more surgically complex procedures, elderly patients undergoing robotic-assisted gynecologic surgery had similar postoperative complication rates, and almost half of elderly patients were safely discharged the day of surgery. Our data suggest that robotic-assisted gynecologic surgery and early hospital discharge are safe in elderly patients.

A Comparison of Outcomes between Lichtenstein and Laparoscopic Transabdominal Preperitoneal Hernioplasty for Recurrent Inguinal Hernia

There remain concerns about the optimal technique for repairing recurrent inguinal hernias because of the high risks of complications and recurrence. The aim of this study was to compare Lichtenstein hernioplasty with the transabdominal preperitoneal (TAPP) laparoscopic technique in the treatment of recurrent inguinal hernias. One hundred twenty-two patients who underwent surgery for recurrent inguinal hernia were prospectively randomized to receive either Lichtenstein (n = 63) or TAPP (n = 59) hernioplasty between January 2010 and December 2014. Baseline characteristics, intraoperative complications, and short- and long-term postoperative factors were evaluated. Preoperative factors were comparable between the two groups. The average follow-up period was 46.2 ± 8.5 months. The two groups had similar intraoperative and short-term postoperative complication rates, whereas the rate of long-term postoperative complications was lower for the TAPP group than the Lichtenstein group (6.8% vs 23.8%, respectively, P = 0.012). The TAPP group had significantly lower visual analogue scale scores, fewer analgesics consumption, and faster recovery than the Lichtenstein group (P < 0.05). Chronic pain was more prevalent in the Lichtenstein group than the TAPP group (15.9% vs 3.4%, respectively, P = 0.031). The recurrence rate was 4.8 per cent for the Lichtenstein group and 1.7 per cent for the TAPP group, with no significant difference (P = 0.62). Both the Lichtenstein and TAPP procedures are safe and effective methods for repairing recurrent inguinal hernia with low incidence rates of life-threatening complications and recurrence. The TAPP procedure is superior to the Lichtenstein repair in terms of reduced postoperative pain, shorter sick leave, faster recovery, and better cosmetic results. Careful selection of the surgical procedures and implementation of technical essentials are necessary.

Open mesh and laparoscopic total extraperitoneal inguinal hernia repair under spinal and general anesthesia.

IntroductionMesh placement is the main standard in repair of inguinal hernia, and laparoscopic repair is the standard of care via spinal, epidural, or combined anesthesia. Here, we compared open and laparoscopic total extraperitoneal (TEP) repairs under general (GA) and spinal anesthesia (SA).MethodsInguinal hernia patients (n=440) were analyzed retrospectively. There were four groups: Group 1 was TEP under GA (TEP-GA) (n=111); Group 2 was open mesh repair (OM) under SA (n=116) (OM-SA); Group 3 was open mesh repair under GA (n=117) (OM-GA); Group four was TEP under SA (n=96) (TEP-SA). The age, body mass index, duration of operation, hospital stay, postoperative Visual Analog Scale scores, recurrence, postoperative pain, urinary retention, headache, and patient satisfaction were all recorded.ResultsThere was no significant difference in terms of hypotension, vomiting, seroma and scrotal edema, recurrence, and wound infection incidence between the groups. However, the operation duration, hospital stay period, headache, urinary retention, postoperative Visual Analog Scale scores, chronic pain, and patient satisfaction showed significant differences between groups.ConclusionLaparoscopic TEP hernia repair is a safe and effective method along with its advantages of shorter hospital stay, less recurrence, less postoperative pain, higher patient satisfaction, and similar postoperative complication rates. SA has the disadvantage of higher incidence of headache and urinary retention compared to GA.

Outcomes of familial abdominal aortic aneurysm repair in the Vascular Quality Initiative

ObjectiveRecent investigations have reported increased rates of aneurysm-related complications after endovascular aneurysm repair (EVAR) in familial abdominal aortic aneurysm (fAAA) patients. The purpose of this study was to evaluate the outcomes of open aortic repair (OAR) and EVAR in sporadic AAA (spAAA) and fAAA patients in the Society for Vascular Surgery Vascular Quality Initiative. MethodsThis was a retrospective review of all AAA repairs in the Vascular Quality Initiative from 2003 to 2017. Patients' data were summarized, and standard statistical analysis was performed. Patients with known genetic syndromes and centers with long-term follow-up of <50% of patients were excluded. ResultsFrom 2003 to 2017, there were 1997 fAAA patients compared with 18,185 spAAA patients undergoing OAR and EVAR during the same study period. Compared with their spAAA counterparts, fAAA patients were younger (P < .001), were more likely to be living at home before surgery (P = .008), and demonstrated a lower incidence of coronary artery disease (P = .001) and hypertension (P = .039). Rates of smoking and end-stage renal disease did not differ between groups. However, fAAA patients were more likely to have aneurysmal degeneration of their iliac arteries (P < .001) and to undergo OAR (P < .001). When analyzing patients undergoing OAR, we found that fAAA patients were more likely to require concomitant renal bypass surgery (P = .012) but were extubated sooner (P = .005), received fewer blood transfusions (P < .001), and had a shorter length of stay (P = .018). Although individual complication rates did not differ between fAAA and spAAA groups after OAR, a composite end point of all early postoperative complications was decreased in fAAA patients (P = .020). When comparing fAAA and spAAA patients who underwent EVAR, we found a greater incidence of early lumbar branch endoleaks (type II) in fAAA patients; however, the rate of proximal type IA endoleaks (P = .279) and the rate of late reintervention for sac growth (P = .786), any endoleak (P = .439), or rupture (P = .649) did not differ between the groups. Whereas spAAA patients undergoing EVAR required longer postoperative intensive care unit stays (P < .001) and had a greater incidence of blood transfusions (P < .001), fAAA and spAAA patients had similar rates of postoperative complications (P = .510), 30-day mortality (P = .177), and long-term mortality (P = .259). ConclusionsThis study shows that patients with a familial form of AAA do not have increased morbidity or mortality after AAA repair. Our findings suggest that EVAR and OAR are both safe and effective for fAAA patients. Further studies with longer follow-up are needed to best care for this unique cohort of patients.

Abdominoplasty in Anchor with Staged Skin Resection: Evaluation of Outcomes

Conventional abdominoplasty in anchor (with “en bloc” resection of the vertical and horizontal skin components) for patients after massive weight loss is related to some disadvantages. This study aimed to evaluate the outcomes of patients undergoing abdominoplasty in anchor with staged skin resection. This was a retrospective case series based on clinical evaluation of patients undergoing abdominoplasty in anchor with the technique of staged skin resection (first the vertical skin component followed by the horizontal component). We evaluated patient data, postoperative complications, patient satisfaction, and esthetic analysis of the postoperative outcomes using photographs at 12 months after surgery (performed by three independent plastic surgeons through a scale from 0 to 10, in which scores were assigned to the visual parameters). The 24 patients included in this study had a mean age of 42.58 years and a pre-abdominoplasty body mass index of 26.94 kg/m2. The overall mean of complications was 45.8%; the most common postoperative complication was seroma (n = 6), followed by infection (n = 3), dehiscence (n = 2), hematoma (n = 2), hypertrophic scar (n = 2), unaesthetic scar (n = 1), and retraction of the umbilicus (n = 1). Postoperative esthetic evaluation provided an average score of 5.61 for these patients. Compared with the literature about the conventional technique of en bloc resection, abdominoplasty in anchor with staged skin resection showed a similar rate of postoperative complications, and the esthetic evaluation of postoperative outcomes was considered satisfactory.

Abdominoperineal excision or extralevator abdominoperineal excision: which is the best oncological treatment?

Surgery of tumors of the lower third of the rectum is particularly difficult due to the complex anatomy of the pelvis, which can lead to an incomplete radical resection. Abdominoperineal excision (APE) is the operation of choice for tumors of the low rectum that infiltrate levatorani or sphincter muscles. Regardless, APE causes an important morbidity, a higher incidence of circumferential resection margin (CRM) infiltration, iatrogenic tumor perforation incidence and worsens the mesorectum quality due to the conicity induced during surgery while dissection between both distal mesorectum and levatorani planes is performed. An extralevator abdominoperineal excision (ELAPE), which involves a broader resection of the pelvic floor muscles, would theoretically reduce the risk of CRM infiltration and tumor perforation rate, independently from the position (prone vs . supine) or the approach (open vs . laparoscopic). This review is focused on the analysis of the scientific evidence published so far comparing both techniques, APE or ELAPE. In spite of some publications observe a possible benefit in terms of reduction in CRM involvement, iatrogenic perforations or local recurrence, there is not enough evidence to affirm the superiority of ELAPE compared to conventional APE in terms of oncological results. In general, similar rates of postoperative complications are described for both techniques. Further prospective, controlled and randomized studies are needed to conclude which of the two techniques is the best oncological treatment.

Does previous abdominal surgery affect the course and outcomes of laparoscopic bariatric surgery?

BackgroundGlobal experiences in general surgery suggest that previous abdominal surgery may negatively influence different aspects of perioperative care. As the incidence of bariatric procedures has recently increased, it is essential to assess such correlations in bariatric surgery. ObjectivesTo assess whether previous abdominal surgery influences the course and outcomes of laparoscopic bariatric surgery. SettingSeven referral bariatric centers in Poland. MethodsWe conducted a retrospective analysis of 2413 patients; 1706 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) matched the inclusion criteria. Patients with no history of abdominal surgery were included as group 1, while those who had undergone at least 1 abdominal surgery were included as group 2. ResultsGroup 2 had a significantly prolonged median operation time for RYGB (P = .012), and the longest operation time was observed in patients who had previously undergone surgeries in both the upper and lower abdomen (P = .002). Such a correlation was not found in SG cases (P = .396). Groups 1 and 2 had similar rates of intraoperative adverse events and postoperative complications (P = .562 and P = .466, respectively). Group 2 had a longer median duration of hospitalization than group 1 (P = .034), while the readmission rate was similar between groups (P = .079). There was no significant difference between groups regarding the influence of the long-term effects of bariatric treatment on weight loss (percentage of follow-up was 55%). ConclusionsPrevious abdominal surgery prolongs the operative time of RYGB and the duration of postoperative hospitalization, but does not affect the long-term outcomes of bariatric treatment.

Abdominal Exploration in Neonates Using Transumbilical Exposure Compared with Transverse Laparotomies.

The vertical transumbilical incision (TU) technique during neonatal abdominal exploration involves dissection and ligation of umbilical vessels, which allow access to all quadrants of the abdomen and complete bowel evisceration with minimal violation to the anterior abdominal wall. We compared patient characteristics and outcomes for neonates undergoing TU with standard transverse exploration. A single-center retrospective review of neonates who underwent abdominal exploration between January 2010 and September 2015 was conducted after obtaining Institutional Review Board approval. Data included patient demographics, indication for operative intervention, operative details, complications, including incisional hernias, and long-term outcomes. There were 88 neonates under 4 months of age who underwent abdominal exploration, with a median age of 5.5 ± 17 days and a median gestational age of 32.8 ± 16 weeks. Exploration was emergent in 38 patients (43%) and 49 (56%) required ostomy formation. A transverse incision (TV) was used in 30 patients and a TU in 58 patients. Both groups had similar postoperative complication rates; 27 (47%) in the TU group and 11 (36%) in the TV group, P = .51. Median length of follow-up in the TU group was 5.1 ± 18 months and 6.2 ± 16 months in the TV group, P = .48. The TU group had 4 incisional/umbilical hernias (7%), none have required repair. TUs for abdominal explorations in neonates have similar outcomes as the standard TV while preserving the integrity of the anterior abdominal wall.

Retrospective analysis of 1211 operated patients due to groin hernia with open surgical approach - single center experience

Bacground/Aim. Groin hernias are common pathology among men population. Only curative treatment is surgical reparation with various surgical procedures for groin hernia solving. The aim of this study was to evaluate the most prevalent surgical procedures and early postoperative complications after groin hernia reparation in large series of operated patients, and to assess the morphologic characteristics of groin hernias. Methods. The retrospective study included all patients with groin hernia who underwent surgical reparation from 2009 to 2012. In all patients a demographic characteristics, including gender and age, clinical characteristics and hernia type were analyzed. The surgical procedure for hernia solving and early postoperative complications were assessed. Results. The study included 1,211 patients. The male/female ratio was 1,127/84 (p &lt; 0.001). Inguinal hernia was found in 1,195 patients (94.5% males). Femoral hernia was found in 16 patients (25% males and 75% females). Significant difference in distribution of inguinal and femoral hernia between genders was found (p &lt; 0.001). In males right sided inguinal hernia was present in 57.6%. In females right sided inguinal hernia was present in 7 and left sided in 5 patients. Sixsten patients had bilateral inguinal hernia, all in males. There was no significant difference in side of inguinal hernia occurrence and gender. Right sided and left sided femoral hernias were present in the same percent in males. In females a higher occurrence in femoral hernia was found on the right side then on the left one (7:5) without significant difference. There were 71.1% of patients in the age group of 51?80 and 27.2% of patients in the age group of 61?70. Surgical procedures included: Lichtenstein in 51.2% of patients, nylondarn in 29.6% of patients, Bassini in 16.2% of patients, Lothaissen in 1.7% of patients, and Halsted in 1.4% of patients. Overall, postoperative complications were present in 78 (6.4%) of patients. Wound infection was the most common complication, occurred in 2.4% of patients. Conclusion. Prevalence of inguinal hernias is higher in men population, while femoral hernias are more common in females. The most affected population is at the age between 61 and 80 years. The most commonly used open surgical procedures for groin hernia reparation are Lichtenstein and nylon-darn. Both methods have low and similar incidence rates of postoperative complications.

Evaluation of Low Tidal Volume During General Anesthesia in Prone Position on Respiratory Functions

<i>Background:</i> Surgery is accompanied by postoperative pulmonary functions impairment especially in the prone position. There is evidence suggested that using low tidal volume during general anesthesia may decrease post-operative lung injury. This study aimed to evaluate the effect of low tidal volume on lung functions during mechanical ventilation for general anesthesia while patients lying in the prone position. A prospective clinical trial was performed on 88 patients ASA I&II scheduled for elective surgery while patients lying prone and were randomly assigned to either protective ventilation group A with tidal volume; 5-7 ml/kg, 10 cm H₂O positive end expiratory pressure (PEEP) with recruitment maneuver (RM) or conventional group B with Tidal Volume; 10-12 ml/kg, without both PEEP and RM. The primary efficacy variables were assessed by pulmonary function tests, performed before surgery, and 6, 12 and 24 hours postoperatively. Improvement of lung functions were found in the first post-operative 6 and 12 hours in the low tidal volume group and significant difference was found in all parameters P value 0.001 except PaO₂/FIO₂ ratio P value 0.4. After 24 hours there were significant difference in the FVC, predicted FEV1 and FVC and FEV1/FVC ratio being higher in the low tidal volume group with P value 0.001. Patients in both groups showed similar rates of postoperative chest complications without significant difference. Lung protective ventilation improved lung functions in the first post-operative 24 hours. There was no significant postoperative chest complications difference between the two groups.

Outcomes of Adolescent and Young Adults Receiving High Ligation and Mesh Repairs: A 16-Year Experience.

Interestingly, the pediatric and adult surgeons perform vastly different operations in similar patient populations. Little is known about long-term recurrence and quality of life (QOL) in adolescents and young adults undergoing inguinal hernia repair. We evaluated long-term patient-centered outcomes in this population to determine the optimal operative approach. The medical records of patients 12-25 years old at the time of a primary inguinal hernia repair at our institution from 2000 to 2016 were retrospectively reviewed. Patients then completed a phone survey of their postoperative courses and QOL. Outcomes of high ligation performed by pediatric surgeons were compared to those of mesh repairs by adult general surgeons. The primary outcome was recurrence. Secondary outcomes included time to recurrence, postoperative complications, and patient-centered outcomes. A Cox regression analysis was used to determine associations for recurrence. Of 213 patients identified, 143 (67.1%) were repaired by adult surgeons and 70 (32.9%) repaired by pediatric surgeons. Overall recurrence rate for the entire cohort was 5.7% with a median time to recurrence of 3.5 years (interquartile range 120-2155 days). High ligation and mesh repairs had similar rates of recurrence (6.3 versus 5.8, P = .57) and postoperative complications (17% versus 16%, P = .45). 101/213 (47%) patients completed the phone survey. Of those surveyed, 20% reported postoperative pain, 10% had residual numbness and tingling, and 10% of patients complained of intermittent bulging. Overall, a survey comparison showed no differences among subgroups. In adolescents and young adults, the long-term recurrence rate after inguinal hernia repair is ∼6% with time to recurrence approaching 4 years. Outcomes of high ligation and mesh repair are similar, highlighting the need for individualized approaches for this unique population.

Comparison of elliptical excision versus punch incision for the treatment of epidermal inclusion cysts: A prospective, randomized study

Comparison of elliptical excision versus punch incision for the treatment of epidermal inclusion cysts: A prospective, randomized study

Assessing the Different Oncologic Disease Distribution and Postoperative Complications of Octogenarian and Nonagenarian Head and Neck Oncology Patients

The admission rate of patients aged 80years or older (oldest-old) with head and neck (HN) oncologic disease is on the rise. Our goal was to study the demographic characteristics, reasons for admission, types of surgical procedures, and postoperative complications of the oldest-old patients with HN malignancy. We conducted a retrospective cohort study including all inpatients aged 80years or older who were admitted to the department of otolaryngology-head and neck surgery or department of oral and maxillofacial surgery because of HN oncologic disease between 2009 and 2013. The control group was composed of a matched number of randomly selected patients aged 60 to 79years. We compared the demographic characteristics, diagnoses, comorbidities, surgical interventions, and postoperative complications of the 2 age groups to characterize the oldest-old patients' admissions and determine whether age alone increases the risk of postoperative complications. The study included 109 oldest-old patients (median age, 83years) and 107 patients in the control group (median age, 68years). Although the oldest-old patients had significantly more underlying diseases (4.41 vs 2.86) and drugs prescribed (4.76 vs 3.21), similar rates of postoperative complications occurred in both groups. An important finding was that ischemic heart disease and chronic lung disease were the only significant risk factors for postoperative complications among the oldest-old patients (odds ratio on multivariate analysis of 5.5 and 4.5, respectively). Although comorbidities and prescribed drugs are more prevalent in the oldest-old patients, the rate of postoperative complications did not differ between the age groups, suggesting that age alone should not be a factor in the surgical treatment of HN malignancies.

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion.

OBJECTIVE Given the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures. METHODS The authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0-29.9 kg/m2), obese I (30.0-34.9 kg/m2), or obese II-III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics. RESULTS Two hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II-III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05). CONCLUSIONS Patients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

Reduced Impact of Smoking Status on 30-Day Complication and Readmission Rates After Elective Spinal Fusion (≥3 Levels) for Adult Spine Deformity: A Single Institutional Study of 839 Patients.

Smoking status has been shown to affect postoperative outcomes after surgery. The aim of this study was to determine whether patients' smoking status impacts 30-day complication and readmission rates after elective complex spinal fusion (≥3 levels). The medical records of 839 adult spinal deformity patients undergoing elective complex spinal fusion (≥3 levels) at a major academic institution from 2005 to 2015 were reviewed. We identified 124 (14.8%) smokers and 715 (85.2%) nonsmokers. Patient demographics, comorbidities, intraoperative and postoperative complications, and 30-day readmission rates were collected for each patient. The primary outcome investigated in this study was the rate of 30-day postoperative complication and readmission rates. Patient demographics and comorbidities were similar between both groups, including age, sex, and body mass index. Median [interquartile] number of fusion levels and operative time were similar between the cohorts (smoker: 5 [4-7] vs. nonsmoker: 5 [4-8], P= 0.58) and (smoker: 309.6 ± 157.9 minutes vs. nonsmoker: 287.5 ± 131.7 minutes, P= 0.16), respectively. Both cohorts had similar postoperative complication rates and lengths of hospital stay. There was no significant difference in 30-day readmission between the cohorts (smoker: 12.9% vs. nonsmoker: 10.8%, P= 0.48). There were no observed differences in 30-day complication rates, including pain (P= 0.46), UTI (P= 0.54), hardware failure (P= 0.36), wound dehiscence (P= 0.29), and wound drainage (P=0.86). Smokers had greater rates of 30-day cellulitis (smoker: 1.6% vs. nonsmoker: 0.3%, P= 0.05) and DVT (smoker: 0.8% vs. nonsmoker: 0.0%, P= 0.02). Our study suggests that smoking does not significantly affect 30-day readmission rates after complex spinal surgery requiring ≥3 levels of fusion. Further studies are necessary to corroborate our findings.

Safety and Feasibility of Umbilical Diverting Loop Ileostomy for Patients with Rectal Tumor.

Fashioning an ileostomy in the umbilicus and combining the trauma from extraction of colorectum with that from ileostomy should be less invasive and lead to improved cosmetic outcomes. However, there are only a few reports regarding umbilical ileostomy. We retrospectively collected data for 121 consecutive patients with rectal tumor who underwent elective laparoscopic rectal resection with diverting loop ileostomy between 2010 and 2015 at Osaka University Hospital, Japan. The safety and feasibility of umbilical diverting loop ileostomy and its influence on stoma care were investigated. A total of 83 patients were included in this study; of these, 30 underwent umbilical diverting loop ileostomy and 53 underwent conventional diverting loop ileostomy, which was created in the right lower quadrant of the abdomen. The umbilical and conventional groups showed similar rates of postoperative and stoma-related complications (26.7 vs. 32.1%, p=0.804 and 3.3 vs. 3.8%, p=1.000, respectively). Level of parastomal dermatitis was evaluated by DET score at three time points (stoma self-management establishment, first outpatient review post-discharge, and just before stoma closure). DET scores at any time points did not differ significantly between the two groups. Umbilical diverting loop ileostomy is comparable to conventional ileostomy with regard to safety and feasibility. Our methods for umbilical ileostomy using the umbilical skin flap were less invasive and did not have a negative impact on stoma care and parastomal dermatitis. Umbilical ileostomy may be a promising alternative to conventional ileostomy in selected cases.

A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury

BackgroundNow, using a suture-button device to treat distal tibiofibular syndesmotic injuries is overwhelming due to its advantages over screw fixation. Current systematic review was conducted to make a comparison between suture-button fixation and traditionally screw fixation in the treatment of syndesmotic injuries. The outcomes included functional outcomes, implant removal, implant failure, malreduction, post-operative complications (except implant failure and malreduction), and cost-effectiveness aspects.MethodA literature search in the electronic databases of Medline, Embase, the Cochrane Library, Web of Science was conducted to identify studies until March 2017. The references of the included articles were also checked for potentially relevant studies. Only English articles were included. We followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review.ResultsFinally, 10 studies were identified, encompassing a total of 390 patients. The mean American Orthopaedic Foot and Ankle Society ankle score (AOFAS) score of 150 patients treated with the suture-button device was 91.06 points, with an average follow-up of 17.58 months, and the mean AOFAS score of 150 patients treated with syndesmotic screws was 87.78 points, with an average follow-up of 17.73 months. Implant removal was reported in 5 of 134 (3.7%) patients treated with the suture-button device, and in 54 of 134 (40.2%) patients treated with the syndesmotic screw. No patient in the suture-button fixation group had implant failure, however the rate of implant failure in the screw fixation group was 30.9%. Malreduction was reported in 1 of 93 (1.0%) patients treated with the suture-button device, and in 12 of 95 (12.6%) patients treated with the syndesmotic screw. The rate of post-operative complications in the suture-button fixation group was 12.0% and 16.4% in the screw fixation group. There was only one publication demonstrated about cost-effectiveness aspects, it showed that patients treated with the suture-button device spent on average $1482 less and had a higher quality of life by 0.058 quality-adjusted life-year compared with patients who received fixation with 2 syndesmotic screws in supination-external rotation type 4 injuries.ConclusionBased on our research, though the suture-button fixation group had similar functional outcome (measured on the AOFAS score) and post-operative complication rate compared with the syndesmotic screw fixation group, the suture-button device could lead to better objective range of motion (ROM) measurements and earlier return to work. Besides, the suture-button fixation group had lower rate of implant removal, implant failure, and malreduction. However, high-quality randomized controlled trials with more uniformity in outcome reporting are desirable to determine the long-term effects and cost-effectiveness of the suture-button device.

Long-term Outcomes of Single-Site Laparoscopic Colectomy With Complete Mesocolic Excision for Colon Cancer: Comparison With Conventional Multiport Laparoscopic Colectomy Using Propensity Score Matching.

Complete mesocolic excision has been suggested to improve oncological outcomes for patients with colon cancer. However, the long-term outcomes of single-site laparoscopic colectomy with complete mesocolic excision remain unclear. We evaluated the long-term outcomes of single-site laparoscopic colectomy with complete mesocolic excision compared with conventional multiport laparoscopic colectomy for colon cancer, as well as the short-term outcomes. This is a single-center, retrospective study. The study was conducted at Osaka University Hospital in Japan. A total of 971 consecutive patients who underwent laparoscopic surgery for colon cancer between 2008 and 2014 were included. Of these patients, 517 were analyzed using propensity score matching (231 with single-site laparoscopic colectomy and 286 with conventional multiport laparoscopic colectomy). Recurrence, survival, intraoperative morbidity, and postoperative complications were analyzed. Before propensity score matching, the single-site laparoscopic colectomy group had greater proportions of women and of patients with right-sided and early stage tumors compared with the conventional multiport laparoscopic colectomy group. After matching, the 2 groups each included 200 patients and did not significantly differ in any patient characteristics. The median follow-up period was 41.4 months. The 2 groups showed similar rates of intraoperative morbidity (p = 0.22) and postoperative complications (p = 0.87). Rates of 3-year disease-free and overall survival in single-site laparoscopic colectomy and conventional, multiport, laparoscopic colectomy groups were 95.5% and 91.3% (p = 0.44) and 100.0% and 98.7% (p = 0.24). The 3-year disease-free and overall survival rates in each stage did not significantly differ between the 2 groups. This study was limited by its retrospective nature. Single-site laparoscopic colectomy with complete mesocolic excision for colon cancer provided acceptable perioperative outcomes and oncological outcomes, similar to those achieved with conventional multiport laparoscopic colectomy. Evidence accumulation from randomized controlled trials will be necessary to promote the wide acceptance of single-site laparoscopic colectomy. See Video Abstract at http://links.lww.com/DCR/A326.