Date Of Surgery Research Articles

Investigation of the association of CTRB2 exon 6 deletion with time to progression and overall survival in pancreatic ductal adenocarcinoma.

770 Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis and limited treatment options. A 584 bp deletion in CTRB2 , which impairs chymotrypsin B2 function, has been linked to increased PDAC risk. This study investigates the impact of this deletion on progression and survival outcomes in patients with PDAC. Methods: There were 633 patients in whom CTRB2ex6 deletion was genotyped; 263 patients received chemotherapy and had time to progression (TTP) information. TTP was calculated from diagnosis date until earliest of 1) progression date (event), 2) surgery, death, or next chemotherapy date (competing risk), or 3) date last known to be alive (censor). Overall survival (OS) was calculated for the cohort from diagnosis until date of death (event) or date last known to be alive (censor). TTP was analyzed using cumulative incidence methods accounting for competing risks; OS was analyzed using Kaplan-Meier methods. Cox proportional hazard models adjusted for age and sex were used to test associations and compute hazard ratios (HR) and 95% confidence intervals (CI). Results: Median TTP in those with CTRB2ex6 deletion negative carrier status (n=209) was 1.3 years vs 5.9 years for those with positive carrier status (n=54). Estimated 3-year progression rates were 54.2% for patients with no CTRB2ex6 deletions, 43.7% for patients with one deletion (n=48), and 33.3% for patients with two CTRB2ex6 deletions (n=6). TTP was not associated with CTRB2 deletion carrier status (HR: 0.8, 95% CI: 0.6-1.3). Median OS for CTRB2ex6 deletion negative carriers (n=514) was 1.0 year vs 0.9 years for positive carriers (n=119); within deletion carriers, heterozygous carriers (n=110) had a median OS of 0.9 years, and homozygous carriers (n=9) had a median OS of 2.6 years. OS was not associated with CTRB2 deletion carrier status (HR: 1.0, 95% CI: 0.9-1.3). Conclusions: Although we did not detect statistically significant differences in TTP and OS by CTRB2ex6 deletion carrier status, there was an interesting trend toward longer TTP and OS in the small number of patients who carried homozygous CTRB2ex6 deletions. Larger studies are warranted to validate these findings.

Time until operation for elective endovascular aortic aneurysm repair in Canadian Vascular Centers using the Canadian Vascular Quality Initiative Registry.

Optimal timing for intervention for abdominal aortic aneurysms remains unclear. Given the increased rupture risk with larger aneurysms, timely intervention is critical. This study sought to examine endovascular aortic aneurysm repairs (EVAR) delays across Canadian centers, focusing on potential differences related to geography, sex and race. The Vascular Quality Initiative (VQI) dataset was obtained for all patients who underwent elective EVAR for asymptomatic AAAs between January 11th, 2016 and October 30th, 2020 in 6 participating Canadian vascular centers. Delay was defined as the time between the date of preoperative imaging and the operative date. Univariate and multivariable analysis were performed to evaluate predictors of long delay. A total of 659 patients were included in the analysis. Geographic disparities were significant, with patients in Quebec more likely to experience delays exceeding 8 weeks compared to Ontario (OR = 4.5, 95% CI: 2.8-7.1, p < 0.001). Patients with shorter delays (≤ 8 weeks) were more likely to have an unrestricted functional status (88.0% vs. 81.9% for delay > 8 weeks, p = 0.030) and larger aneurysms (83.1% vs. 67.0% for delay > 8 weeks, p < 0.001). Perioperative and postoperative complications were similar across both groups. Our study reveals significant disparities in the timing of elective EVAR cross Canadian centers, likely due to multifactorial causes. These findings highlight the need for targeted strategies to reduce delays and ensure equitable access to timely care. Future efforts should focus on improving healthcare system preparedness and addressing regional and demographic disparities.

P1026 Rectal stump surveillance in the IBD population

Abstract Background Patients with inflammatory bowel disease (IBD) may require surgical resection, including subtotal colectomy, to manage symptoms and improve quality of life. However, there remains a risk of colorectal cancer (CRC) within the retained rectal stump. Although robust national and international guidelines exist for CRC surveillance in IBD patients with an intact colon, there is a significant gap in guidance for those with a retained rectal stump. We examined the current surveillance practices for the rectal stump in IBD patients, aiming to clarify current practice and optimise long-term surveillance strategies. Methods We performed a single centre, retrospective observational study. Patients with IBD undergoing surgical resection were identified using the local surgical IBD database, between January 2012 and September 2023. Cases without a rectal stump were excluded. Data was collected regarding age, sex, date of IBD diagnosis, date of surgery, frequency of surveillance, endoscopic appearance at surveillance, histology at surveillance and histological appearance at resection – this was used to assess initial risk. The British Society of Gastroenterology (BSG) guidelines for surveillance frequency of IBD were used as a comparator. Results Of the 53 patients (median age = 52 (IQR = 32), 34% female, 66% male) included, 30.2% underwent surveillance following the BSG guidelines, according to their risk at formation of the rectal stump, determined by BSG guidelines. 39.6% of patients underwent surveillance but not in accordance with the BSG guidelines and 30.2% had no surveillance documented. 51.4% of patients had their risk reclassified at first surveillance, 48.6% had no change to their risk. No patients developed colorectal cancer on surveillance. 85% of patients underwent subtotal colectomy within 10 years of diagnosis. Conclusion Conclusion IBD patients with a retained rectal stump are susceptible to adjustment of their risk based on histological and endoscopic appearance at surveillance, when using risk at initial resection as a baseline. This implies close monitoring is required, to ensure any dysplasia or CRC is adequately identified. Surveillance was inconsistent, and many patients had no surveillance documented. This study highlights the need for surveillance guidelines for patients with IBD with a retained rectal stump. The BSG guidelines suggest a screening colonoscopy 10 years post-diagnosis, yet most patients underwent initial resection before this could take place. This raises the question whether patients should undergo surveillance 10-years post-resection, or if this would be required earlier, dependant on risk following resection. The answer to this requires further research, to ensure uniformity in practice.

P0888 Time-trends in the management of postoperative Crohn’s Disease and its impact on long-term surgical recurrence. Data from the ENEIDA registry

Abstract Background Anti-TNF availability has been associated with a decrease of first intestinal resections in patients with Crohn’s Disease (CD). However, few studies have evaluated the impact of the availability of biological therapies in the medical management of postoperative CD and its long-term outcomes. We aimed to assess the time trends in the strategies for the management of CD in the postoperative setting after a first intestinal resection and the rate of second surgeries (surgical postoperative recurrence –sPOR-) through the last three decades. Methods Adult patients with CD who underwent a first ileocolic resection with ileocolic anastomosis between 1990 and 2020 and with at least one year of clinical follow-up, were identified from the Spanish ENEIDA registry. Patients in whom ileocolic resection was due to cancer were excluded. Patients were grouped by the date of the first surgery (before biologicals era -BB- 1990-2000; early biological era -EB- 2001-2010; widespread biological era -WB- 2011-2020). Medical prevention for POR was defined as any immunomodulator or biological agent that was started within the first 6 months after the index surgery and maintained for at least 3 months. Treatment for POR was defined as any immunomodulator or biological that was started at least 6 months after index surgery. Surgical POR was defined as a second intestinal resection at least 6 months after the index surgery. Results 4,890 patients who were followed-up for a median of 125 months (IQR 70-204), were included. Baseline characteristics of each cohort are shown in Table 1. A significant increase in the proportion of patients starting medical prevention of POR with thiopurines and biologicals was observed over time as well as in the proportion of patients starting treatment with biologicals. The cumulative incidence of sPOR significantly decreased in both EB and WB cohorts (second surgery-free survival at 3, 5 and 10 years: BB 96%, 92%, 83%; EB 98%, 96%, 90%; WB 98%, 97%, 91%; P=&amp;lt;0.001). In the IPTW propensity model to weight differences for POR risk factors, both biologicals cohorts remained associated with a lower risk of sPOR. Conclusion In the last three decades, we observed a significant increase in the use of medical prevention for POR together with a significant increase in using biologicals to treat POR. These changes resulted in a significant decrease in the cumulative incidence of a second intestinal resection in the long-term.

Cognitive Trajectory Before and After Cataract Surgery: A Population-Based Approach.

Cataract surgery is the most common surgical procedure performed for older US adults. Cataracts are associated with poor cognition and higher rates of dementia, but whether cataract surgery improves cognition for US older adults is not known. We examined the relationship between cataract surgery and long-term change in cognition in the Health and Retirement Study, a population-based study of older US adults linked with Medicare billing data. We analyzed community-dwelling participants who underwent cataract surgery between 2000 and 2018, propensity-matched on age, sex, education (four levels), diabetes status (four levels), pre-procedural latent cognition, vision impairment, and interview timing and mode to older adults who did not have cataract surgery during the study period. Cataract surgery date was ascertained using Medicare billing data. We calculated latent value of cognition using biennial self/proxy cognitive assessments, and used linear mixed effects models adjusting for demographic and health factors to model cognition from 5 years before, to 5 years after, cataract surgery (or a simulated event, for controls). The primary measure was difference-in-differences estimate of latent cognition comparing the year prior, to the year after, cataract surgery or a simulated event. We analyzed 4384 older adults who underwent cataract surgery and 4384 matched controls (mean [SD] age 76.1 [6.8] years, 62.0% women, 83.9% non-Hispanic white). Across the first postoperative year, cataract surgical participants declined 0.002 (-0.002 to 0.006) units faster than nonsurgical controls (p = 0.37), equivalent to 8 (-10 to 26) days more cognitive aging. Post hoc subgroup analyses also found no difference in cognition for groups stratified by pre-procedural latent cognition (i.e., normal vs. cognitively impaired) or vision (i.e., vision-impaired vs. intact). Under typical United States practice, cataract surgery for older patients was not significantly associated with cognitive improvement or decline in the year after, compared with the year before, surgery.

Improved outcomes after groin hernia surgery in Sweden between 1992 and 2021: Swedish Hernia Register

PurposeSurgery for groin hernia is one of the most common operations in the world. Therefore, research concerning the outcomes of groin hernia surgery is extremely important both for the individual patient as well as for those providing the healthcare funding. The aim of this study is to evaluate the outcomes of hernia surgery in Sweden over a 30 year time period, from 1992 to 2021.MethodsAll groin hernia repairs in the Swedish Hernia Register between 1992 to 2021 were analyzed with emphasis on the surgical method, reoperation rate for recurrence and date of surgery, specifically 1992–2001, 2002–2011 and 2012–2021. By using personal identification numbers, a cumulative reoperation rate has been deduced for males and females separately.ResultsA total of 368,502 groin hernia operations identified in the Swedish Hernia Register between 1992 to 2021 were eligible for analysis. Since the register was begun, there have been significant changes in the choice of operative techniques, from suture repair in 1992 to open anterior mesh repair around the year 2000, until today, where an increasing proportion of hernias are repaired using laparo-endoscopic techniques. There has been a reduction in the reoperation rate for recurrence in both males and females, with the most pronounced improvement being seen in females. The laparo-endoscopic technique is associated with a reduced incidence of reoperation for recurrence in females.ConclusionGroin hernia surgery in Sweden has undergone substantial changes over the past 30 years. Reoperation for recurrence has decreased significantly during recent years, especially in females.

Survival benefits of adjuvant chemotherapy after conversion surgery in patients with advanced pancreatic cancer.

Oncologic outcomes of conversion surgery for advanced pancreatic cancer (PC) have scarcely been reported. Therefore, this study aimed to investigate the outcomes of conversion surgery with preoperative treatment of FOLFIRINOX or gemcitabine with nab-paclitaxel (GnP) for patients with advanced PC including locally advanced or metastatic PC. Using the National Health Insurance database between 2005 and 2020, we identified patients who underwent conversion surgery after chemotherapy with FOLFIRINOX or GnP for advanced PC. The patients were categorized based on preoperative treatment. Survival outcomes were evaluated based on the date of cancer diagnosis and conversion surgery. Among 69,183 patients with advanced PC, 476 underwent conversion surgery; 430 with FOLFIRINOX and 46 with GnP. The median duration from diagnosis to conversion surgery was 6.4 months. Overall survival (OS) was 31.2 months after cancer diagnosis and 23.5 months after conversion surgery. Adjuvant chemotherapy was a significant factor for OS, with hazard ratios (HRs) of 0.23 [95% CI 0.12-0.44, P < 0.01] from cancer diagnosis and 0.20 [95% CI 0.10-0.37, P < 0.01] from conversion surgery. No significant differences were noted between FOLFIRINOX and GnP. However, maintaining the same regimens as preoperative chemotherapy was a significant factor, with HRs of 0.67 [95% CI 0.47-0.95, P = 0.02] from cancer diagnosis and 0.69 [95% CI 0.49-0.98, P = 0.04] from conversion surgery. The incorporation of adjuvant chemotherapy with the same preoperative regimen could be an effective strategy for patients with advanced PC who would undergo conversion surgery.

Assessing the impact of perioperative anticoagulant continuation on DVT/PE rates in trauma patients.

In the United States, deep vein thrombosis (DVT) and pulmonary embolism (PE) ranked high in terms of possibly preventable hospital deaths. Victims of trauma were at a higher risk of developing thromboembolic complications, and thus various agents were used for prophylaxis. Multiple studies recommended holding these agents in the perioperative period to decrease the potential complications of additional bleeding, wound issues, hematoma etc. However, the data regarding the timing and duration of withholding these agents was not consistent and at times surgeon specific. The aim of this study was to compare the incidence of DVT/PE in trauma patients before and after a June 2022 policy intervention to operate through prophylactic anticoagulation at an academic trauma center. We compared DVT/PE rates in trauma patients requiring surgery prior to and following policy change at our institution. The query included charts from January 1, 2018, through December 31, 2023. Clinical information relating to trauma date, surgery date, injury type, anticoagulant administration, DVT/PE development, and death, if applicable, was obtained from patient charts. We conducted a chi-square post hoc analysis to evaluate the incidence of DVT or PE before and after a policy change. The analysis focused on two categories: the presence or absence of DVT/PE. DVT/PE development was 14.553 times more likely pre-policy change when anticoagulation was held prior to surgery compared to post-policy change when anticoagulation was administered before surgery (X2 (3, N = 374) =14.553, p=.002). Mortality related to DVT/PE showed no significant difference between pre-policy and post-policy groups (X2 (1, N = 374) = 0.130, p = .718). After excluding patients over age 65, analysis of MVA blunt trauma charts showed no statistical difference in blood transfusions pre policy v. post policy (X2 (1, N = 174) = 0.2198, p = .639). Findings suggested that DVT/PE rates have significantly decreased post policy change without a significant increase in mortality and bleeding risk.

Preoperative Medication for Ovarian Endometrioma Reduces Cyst Size and PainBut Not rASRM score.

To investigate the impact of preoperative hormonal medication, including combined oral contraceptives (COCs) or dienogest, on operative findings in ovarian endometrioma surgery. A single-center, retrospective study. Department of Gynecology, Samsung Medical Center, Republic of Korea. Among patients who underwent ovarian endometrioma surgery for the first time at Samsung Medical Center between January 2020 and July 2023, those who started hormonal medication at another institution before their initial visit to our center, those with a waiting period of less than three months until the surgery date, and those with an endometrioma size of less than 4cm at the initial visit were excluded. A total 140 remaining patients were included in the study. The patients were divided into two groups: the group that received preoperative hormonal medication (COCs or dienogest) and the group that did not receive medication. To evaluate the impacts of preoperative hormonal medication on ovarian endometrioma patients, the operative findings were compared between the groups. Of the140 patients, 65 were in the no-medication group and 75 were in the medication group. Except for the median duration of follow-up and age, there were no differences in the baseline characteristics between the two groups. Operative findings were quantified using the revised American Society for Reproductive Medicine (rASRM) score. Although medication significantly reduced the size of the ovarian endometrioma, there were no significant differences in rASRM score between the two groups. However, the medication group experienced significant preoperative pain relief. Preoperative hormonal medication can reduce the size of ovarian endometriomas but does not significantly affect the overall operative findings. Nevertheless, preoperative medication is helpful in reducing pain in patients before surgery.

Laparoscopy-assisted versus open surgery for low rectal cancer (LASRE): 3-year survival outcomes of a multicentre, randomised, controlled, non-inferiority trial

Laparoscopic surgery is increasingly used for rectal cancer, but the long-term oncological outcomes for low rectal cancer have not been fully established. We aimed to evaluate the 3-year survival outcomes of laparoscopic surgery versus open surgery in the treatment of low rectal cancer. This multicentre, randomised, controlled, non-inferiority trial was conducted at 22 tertiary hospitals in China. Individuals aged 18-75 years with histologically confirmed cT1-2N0, cT3-4aN0, or cT1-4aN1-2 rectal adenocarcinoma within 5 cm from the dentate line were eligible for inclusion. Participants were randomly assigned (2:1) to undergo laparoscopic surgery or open surgery. Central randomisation was conducted using a web response system, and was stratified by clinical stage, age, sex, BMI, and American Society of Anesthesiologists classification. Investigators, patients and statisticians were not masked to group allocation. The primary outcome was 3-year disease-free survival, defined as the time from the date of surgery to the date of locoregional recurrence, distant metastasis, or death from any cause, whichever occurred first. Non-inferiority was defined as a lower limit of one-sided 97·5% CI for group difference (laparoscopic surgery group minus open surgery group) of greater than -10%. The primary analyses were performed in the modified intention-to-treat population, which excluded patients with distant metastasis discovered during surgery and those who did not undergo surgery or underwent local resection only. The trial is registered with ClinicalTrials.gov, NCT01899547, and has been completed. Between Nov 12, 2013, and June 6, 2018, 1070 patients were enrolled and randomly assigned to treatment. 1039 patients (685 in the laparoscopic surgery group and 354 in the open surgery group; median age 57 years, IQR 50 to 64; 620 [60%] male and 419 [40%] women) were included in the modified intention-to-treat analysis. 3-year disease-free survival was 81·4% (95% CI 78·2 to 84·1) in the laparoscopic surgery group and 79·8% (75·2 to 83·6) in the open surgery group (hazard ratio [HR] 0·92, 95% CI 0·69 to 1·23; p=0·56). The difference between groups was 1·60% (one-sided 97·5% CI -3·34 to ∞, p<0·0001 for non-inferiority). 3-year overall survival was 91·7% (95% CI 89·3 to 93·5) in the laparoscopic surgery group and 93·7% (90·6 to 95·8) in the open surgery group (HR 1·34, 95% CI 0·82 to 2·19; p=0·24). 3-year locoregional recurrence was 3·7% (95% CI 2·5 to 5·3) and 2·3% (1·1 to 4·3), respectively (HR 1·64, 95% CI 0·74 to 3·63; p=0·22). 5-year overall survival was 84·6% (95% CI 81·5 to 87·1) and 86·6% (82·5 to 89·8) in the open group (HR 1·16, 95% CI 0·82 to 1·64; p=0·41). Laparoscopic surgery performed by experienced surgeons is non-inferior to open surgery for 3-year disease-free survival among patients with low rectal cancer. These results support the use of laparoscopic surgery for low rectal cancer. The Key Clinical Specialty Discipline Construction Program of the National Health and Family Planning Commission of China; Minimally Invasive Medical Center Construction Program, Fujian Province, China; and Joint Funds for the Innovation of Science and Technology, Fujian Province, China.

Predicting College Closures and Financial Distress

In this paper, we assemble the most comprehensive dataset to date on the characteristics of colleges and universities, including dates of operation, institutional setting, student body, staff, and finance data from 2002 to 2023. We provide an extensive description of what is known and unknown about closed colleges compared with institutions that did not close. Using this data, we first develop a series of predictive models of financial distress, utilizing factors like operational revenue/expense patterns, sources of revenue, metrics of liquidity and leverage, enrollment/staff patterns, and prior signs of significant financial strain. We benchmark these models against existing federal government screening mechanisms such as financial responsibility scores and heightened cash monitoring. We document a high degree of missing data among colleges that eventually close and show that this is a key impediment to identifying at risk institutions. We then show that modern machine learning techniques, combined with richer data, are far more effective at predicting college closures than linear probability models, and considerably more effective than existing accountability metrics. Our preferred model, which combines an off-the-shelf machine learning algorithm with the richest set of explanatory variables, can significantly improve predictive accuracy even for institutions with complete data, but is particularly helpful for predicting instances of financial distress for institutions with spotty data. Finally, we conduct simulations using our estimates to contemplate likely increases in future closures, showing that enrollment challenges resulting from an impending demographic cliff are likely to significantly increase annual college closures for reasonable scenarios.

International web-based survey of patients with non-hydrocephalic symptomatic pineal cysts

ObjectivesTo report the results of an international patient-reported survey that adds to the growing body of evidence surrounding the role of surgery in the management of a subset of patients with non-hydrocephalic symptomatic pineal cyst.DesignAn international web-based survey of health outcomes in patients with nhSPC.SubjectsAll survey participants who self-reported a diagnosis of symptomatic pineal cyst without hydrocephalus after radiological imaging.MethodsThe survey was developed in collaboration with the patient group Pineal Cyst UK. It was publicised and distributed via several online platforms and social media. Data collected included demographics, cyst size, symptom frequency and severity, number of appointments with healthcare professionals, treatment options trialled, and whether patients underwent surgery.Results543 participants (mean age 38.6 years, range 1–83) were included in the analysis, of which 82 (mean age 38.9 years, range 16–72) had undergone cyst resection. After a median period of 18.3 months between date of surgery and date of questionnaire completion, 72 (90%) of the surgical cohort reported overall improvement, and all symptoms improved overall, whereas no symptoms improved overall in the non-surgical cohort. Of the non-surgical cohort (n = 461), 269 participants received some form of conservative treatment, of whom 194 (72.1%) did not experience symptom improvement on any treatment offered.ConclusionsA cohort of patients with nhSPC who participated in this international survey reports substantial and durable improvement in symptom severity and quality of life after pineal cyst resection.

Peri-operative complications following endoscopic-assisted transoral resection of parapharyngeal space tumors: retrospective analysis of 100 patients.

A transoral surgical corridor can provide adequate exposure for extirpation of benign tumors arising from the parapharyngeal space (PPS). However, peri-operative complications following a transoral approach to the PPS have not been sufficiently described. This study retrospectively reviewed patients with PPS tumor extirpated via an endoscopic-assisted transoral approach, aiming to evaluate the safety of this approach and summarize the peri-operative complications. One hundred consecutive patients who underwent an endoscopic-assisted transoral resection of PPS benign tumors at a university hospital were enrolled. Indices including intraoperative catastrophic bleeding, cerebral spinal fluid (CSF) leak, post-operative respiratory airway swelling, cranial neural injury, operative field infection, oral suture dehiscence and venous thrombosis, were assessed from the date of surgery to 3 months after the surgery. Tumors in the PPS were safely and successfully removed via an endoscopic-assisted transoral approach for all 100 patients. Intra-operative CSF leak occurred in 3 patients, while the CSF leak was appropriately repaired intraoperatively without long-term post-operative CSF leak. No catastrophic bleeding, respiratory airway swelling, and operative field infection occurred. Cranial neuropathy occurred in 16 patients, five of whom fully recovered, while the remainder demonstrated permanent neural deficits. Oral suture dehiscence occurred in 13 patients, and all patients healed well after wound packing. Deep vein thrombosis was observed in three patients and pulmonary embolism in one patient, however, no severe consequences happened. An endoscopic-assisted transoral corridor is safe and effective for benign tumor extirpation in the PPS with few peri-operative complications.

Validating the Q1.6 Inguinal Hernia application using prospective data from a randomised clinical trial.

The Q1.6 Inguinal Hernia application remotely and continuously collects patient-reported outcomes from inguinal hernia patients. Previous research has explored its technical, legal, and ethical aspects, along with face, content, and construct validity assessments. This study aims to examine its concurrent validity by comparing prospective data with that from the ENTREPPMENT trial, a randomised study. A small cohort of patients participating in the ENTREPPMENT trial were asked to use the Q1.6 application in addition to their standard care. Corresponding prospective data points, in terms of content and timing relative to the operation date, were identified. Correlation coefficients were calculated for matching variables, and a repeated measures model was created to analyse pain and limitation measures during the first two postoperative weeks. Twenty-eight patients were analysed. Preoperative variables, such as hernia side and painkiller use, demonstrated a predominantly high level of agreement between the two measurement methods, ranging from 'substantial' (0.61-0.8) to 'perfect' (1.0) agreement. Evaluating immediate postoperative outcomes, including pain and limitation scores, revealed a prevalent 'substantial' (0.61-0.8) to 'almost perfect' (0.81-1.0) agreement. In a repeated measures model, the overall within-subjects correlation demonstrated levels of agreement ranging from 'moderate' (0.41-0.6) to 'almost perfect' (0.81-1.0). This study demonstrates strong agreement between data from the Q1.6 Inguinal Hernia application and the ENTREPPMENT trial, supporting its concurrent validity. This makes the application a reliable tool for collecting PROs before and immediately after inguinal hernia repair, offering a promising alternative to traditional follow-up methods. Future research will focus on enhancing compliance and refining functionality.

Study of factors leading to cancellation of elective surgeries in a tertiary care hospital

Background: The postponement of elective surgeries is a major problem that increases the time for patients on surgical waiting lists and can negatively affect psychologically and physically to patients and their families. Cancellation rates reported within the literature are highly variable with considerable differences depending on type of hospital, national health care systems or policies, geographical region, patient population, providers, and also the perioperative management practices present at specific institution. Aims and Objectives: The current study was to thoroughly understand the causes to minimize such cancellations in our institute. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery in a tertiary care teaching hospital in North India. All the patients admitted for elective surgeries in the Department of General Surgery over a period of December 1st, 2022–May 30th, 2023 were noted and out of them, details of patients in whom surgery was cancelled were taken and they were followed for 2 months. Results: Out of a total 1065 patients, 92 patients got cancelled during the study period. Out of them, 67 patients (67.8%) were cancelled on the scheduled date of surgery or after reaching operation theatre whereas, 25 patients (27.2%) were cancelled on day before scheduled date of surgery. Maximum number of cancelled patients were of cholelithiasis planned for laparoscopic cholecystectomy followed by inguinoscrotal swellings. Maximum number of patients were deferred due to administrative-related factors, followed by medical related factors. Conclusion: This study will act as a quality improvement initiative by reducing the surgery cancellation rate thus improving utilization of limited resources and valuable time to provide better health care services in our institute. Such cancellations can be minimized by better planning and active inter-departmental communication regarding proposed plan of surgery.

Comparing Postoperative Outcomes of Isolated Anterior Cruciate Ligament Reconstruction and the "Terrible Triad" Anterior Cruciate Ligament Reconstruction With Medial Meniscus Ramp and Lateral Meniscus Root Repairs.

A new "terrible triad" has been reported to be an anterior cruciate ligament (ACL) tear with a concomitant medial meniscus ramp tear and lateral meniscus root tear. Patient-reported outcomes (PROs) for isolated ACL reconstruction (ACLR) versus an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs are not well known. To compare postoperative outcomes between isolated ACLR and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs. Cohort study; Level of evidence, 3. An initial cohort of 1228 patients with ACLRs were retrospectively identified between April 2016 and November 2021. A total of 41 patients with isolated ACLR (isolated cohort) were age and sex matched to 41 patients who had an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Patients in the triad cohort were identified consecutively by date of surgery. Preoperative and ≥2-year postoperative PROs were evaluated to compare the isolated cohort with the triad cohort. Statistical analysis was performed with unpaired t tests and chi-square tests. Both the isolated cohort and triad cohort demonstrated significant differences between preoperative and postoperative PROs in all questionnaire categories assessed. Postoperative scores for the International Knee Documentation Committee (isolated, 88.8; triad, 86.2; P = .392), Cincinnati (isolated, 91.1; triad, 88.1; P = .295), and Lysholm (isolated, 92.1; triad, 90.1; P = .472) PROs demonstrated no significant differences between the cohorts. No significant difference was found between the isolated and triad cohorts for all preoperative questionnaire categories. Additionally, no significant difference was found in revision or reoperation rates between isolated and triad patients (P = .733). No significant differences in PROs were found at minimum follow-up of 2 years postoperatively between the patients who underwent isolated ACLR (isolated cohort) and those who underwent ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Inferior outcomes were not observed in the triad cohort when revision rates, reoperation rates, and postoperative PROs were compared. Given the optimistic short-term outcomes for isolated versus triad ACLR patients and the known biomechanical consequences of these untreated meniscal injuries, medial meniscus ramp and lateral meniscus root repairs should be performed when encountered concurrently with an ACL tear when possible.

Concurrent Panniculectomy With Abdominal Wall Reconstruction: A Propensity-scored Matched Study of Quality Improvement Outcomes.

Concurrent panniculectomy with abdominal wall reconstruction (CP-AWR) as a single-stage operation has reported increased complications, but constant quality improvement can improve results. This study describes outcomes for 21 years, impacted by evidence-based-practice changes. Prospectively maintained database was reviewed for CP-AWR and separated by surgery date: "early" (2002-2016) and "recent" (2017-2023). A 1:1 propensity-scored matching was performed based on age, tobacco use, body mass index (BMI), American Society of Anesthesiologists (ASA) score, wound class, and defect size. Of 701 CP-AWRs, 196 pairs matched. Match criteria were not significantly different between early and recent groups, except for BMI (34.6 ± 7.2 versus 32.1 ± 6.01 kg/m2; P = 0.001). Groups were comparable in sex and diabetes, but recent patients had fewer recurrent hernias (71.4% versus 56.1%; P = 0.002). Recent patients had more biologic (21.9% versus 49.0%; P < 0.001) and preperitoneal mesh (87.2% versus 97.4%; P = 0.005). Readmission and reoperation did not significantly differ, but length of stay (8.3 ± 6.7 versus 6.5 ± 3.4 d; P = 0.001) and wound complications decreased over time (50.5% versus 25.0%; P < 0.001). Hernia recurrence rates improved (6.6% versus 1.5%; P = 0.019), but follow-up was shorter (50.9 ± 52.8 versus 22.9 ± 22.6 months; P < 0.0001). Despite patient complexity, outcomes of CP-AWR improved with implementation of evidence-based-practice changes in preoperative optimization, intraoperative technique, and postoperative care. This large dataset demonstrates the safety of a single-stage repair that should be part of hernia surgeons' repertoire.

Development of Modic Changes After Percutaneous Endoscopic Transforaminal Lumbar Discectomy: From Risk Analysis to Prediction Modeling.

This study examines the occurrence of Modic changes (MC) within the first year following percutaneous endoscopic transforaminal lumbar discectomy (PETD) and investigates associated risk factors. This study adopted a retrospective cohort design. Between January 2019 and June 2023, 538 patients diagnosed with single-level lumbar disc herniation and treated with PETD were included. The patients were divided into a training set and a validation set based on their surgery dates. Preoperative radiographic parameters and perioperative indicators were evaluated. Univariate analysis examined risk factors for postoperative MC. Gender-specific subgroups were analyzed. Binary logistic regression developed a predictive model for postoperative MC, assessed using ROC, calibration, and decision curves. The incidence of MC at one year after PETD was 24.8%. Logistic regression identified 8 significant risk factors for MC after PELD: longer symptom duration, proximity of herniated segment to sacrum, severe disc degeneration, reduced disc height, greater vertebral endplate concavity angle, segmental instability, and lumbar-sacral fusion. Menopause and herniation type were identified as female-specific risk factors. In males, total cholesterol levels were additionally found to be a risk factor for postoperative MC. The male and female subgroup models exhibited satisfactory performance across ROC analysis, calibration plots, and decision curve analysis. Specifically, for male patients, the area under the curve (AUC) was 0.831 for the training set and 0.820 for the validation set; for female patients, the AUC was 0.911 for the training set and 0.868 for the validation set. A nomogram was developed to visualize the model. This study explored the relevant risk factors of MC after PETD and visualized the prediction model by nomogram, which is beneficial to optimize the surgical scheme of PETD to improve the clinical efficacy.

Intraoperative Frontal EEG Alpha Power is Associated with Post-Operative Mortality and Other Adverse Outcomes.

With estimated global post-operative mortality rates at 1-4% leading to approximately 3-12 million deaths per year, an urgent need exists for reliable measures of perioperative risk. Existing approaches suffer from poor performance, place a high burden on clinicians to gather data, or do not incorporate intraoperative data. Prior work demonstrated that intraoperative anesthetics induce prefrontal EEG oscillations in the alpha band (8-12Hz) that correlate with post-operative cognitive outcomes. We analyzed a retrospective cohort of 1,081 patients undergoing surgery with general anesthesia at Massachusetts General Hospital with intraoperative EEG recordings. The association between EEG alpha power and adverse outcomes were characterized using statistical models that were fitted on propensity weighted data. Our primary outcome was post-operative mortality, measured from date of surgery to date of death or last follow-up. Secondary outcomes included mortality within pre-specified time windows (30-days, 90-days, 180-days, and 1-year), hospital and PACU lengths of stay, discharge to long-term care, and 30-day hospital readmission. Alpha power was associated with mortality risk (HR = 0.92, 95% CI:[ 0.85, 0.99], p=0.039). Within specified time windows, alpha power was associated with 30-day mortality (OR = 0.81, 95% CI: [0.66, 0.95], p=0.010), 90-day mortality (OR = 0.68, 95% CI: [0.55, 0.79], p<0.001), 180-day mortality (OR = 0.75, 95% CI: [0.66, 0.83], p<0.001), and 1-year mortality (OR = 0.85, 95% CI: [0.79, 0.91], p<0.001). Additionally, alpha power was associated with discharge to long-term care (OR = 0.91, 95% CI: [0.86, 0.96], p<0.001). We did not find significant associations among alpha power and 30-day readmission and hospital or PACU lengths of stay. Intraoperative EEG alpha power is independently associated with post-operative mortality and adverse outcomes, suggesting it could represent a broad measure of post-operative physical resilience and provide clinicians with a low-burden, personalized measure of post-operative risk.

The impact of COVID-19 on pancreaticoduodenectomy outcomes in a hepatopancreatobiliary centre of excellence.

At the beginning of the COVID-19 pandemic, access to "planned" surgical care was restricted as the health care system responded to the coronavirus. We hypothesized that the pandemic resulted in diagnostic and therapeutic delays, leading to stage migration among patients with malignancies treated with a Whipple procedure. This study is a retrospective review of adults who underwent surgical exploration for a planned pancreaticoduodenectomy for malignancy at St. Joseph's Health Centre between March 11, 2019, and March 11, 2021. We included 180 patients in the study. Baseline characteristics, pathologic diagnoses, and perioperative outcomes were similar between the 2 cohorts. The post-COVID group had longer median wait times from date of consent (p < 0.001), and from computed tomography (CT) scan (p < 0.001), to surgery. There were increased rates of R1 margin positivity in the post-COVID group (p = 0.01). We saw an association between higher wait times from consent and the last CT scan to the date of operation, and increased rates of R1 margin positivity in the first year of the pandemic. This study demonstrated the importance of prioritizing care during a pandemic and provided evidence for potential long-term consequences when there are delays in surgery for aggressive gastrointestinal malignancies.