Day Of Surgery Research Articles

Epidural versus intravenous analgesia for pain control in kidney donors, a retrospective cohort study. Is there a kinship relationship?

Aims: Best care must be provided for live kidney donors, including postoperative pain control. Treatment options include iv intermittent analgesics, iv or epidural patient-controlled analgesia (PCA). In this study we aimed to compare these modalities with respect to their analgesic efficacy. Methods: A retrospective analysis of fifty-eight live donor nephrectomy patients operated in a 7-year-period in a university hospital performed. Investigational Review Board approval has been obtained. Data of the patients’ postoperative analgesia methods, degree of kinship with the recipient, postoperative pain scores, and rescue analgesic and antiemetic use were obtained. Correlation of postoperative pain scores with the analgesia technique was investigated, as well as with the degree of kinship of the donor and recipient. Results: Patient-controlled analgesia provided better postoperative pain control, with the epidural PCA being the best. Moderate to severe pain at 6th postoperative hour in the iv intermittent, iv PCA, and epidural PCA groups was 76, 37, and 14%, respectively. Rescue analgesic use on the day of operation was 32% and 5% in the iv intermittent and iv PCA groups respectively, with no rescue analgesic use in the epidural PCA group. Postoperative antiemetic consumption was also less with the epidural PCA (P=0.024 and P=0.027 for postoperative days 1 and 2, respectively). No correlation was detected between the pain and the degree of kinship. Conclusion: Epidural patient-controlled analgesia provides better postoperative pain control after live donor nephrectomy, compared with intravenous intermittent or patient-controlled analgesia. Postoperative pain scores were not related to the degree of kinship.

Analysis of the progression rate of idiopathic macular holes and the optimal cut-off for baseline minimum linear diameter and base diameter.

To determine the cut-off points of minimum linear diameter (MLD) and base diameter (BD) at which the progression rate of idiopathic full-thickness macular holes (MHs) decreases before vitrectomy. A retrospective study. We investigated the differences in MLD and BD between baseline and operation days in patients with stages 2, 3, and 4 MHs using optical coherence tomography (OCT). Each difference in OCT parameters was divided by the time interval to calculate the MH progression rates and the cut-off points of MLD and BD. Overall, 269 patients (282 eyes) were included. It took an average of 36.02 ± 24.69 (7-197) days from baseline to operation. MLD and BD progressed faster in stages 2 and 3 without posterior vitreous detachment (PVD) than in stage 4 with PVD (MLD: p < 0.001 and p = 0.007; BD: p < 0.001 and p = 0.019, respectively). Simple linear regression showed the relationship between baseline MLD and BD, and the progression rate; the progression rate decreased as baseline MLD (p = 0.004) and BD increased ( p < 0.001). For baseline MLD and BD, the cut-off points where the progression rate decreased were 306.0 and 470.0μm, respectively. The group without PVD progressed faster than the group with PVD. Moreover, the progression rates were faster in MHs with MLD < 306.0μm and BD < 470.0μm. In these patients, vitrectomy without delay is expected to improve the visual prognosis.

Day surgery in the treatment of benign prostatic obstruction with photoselective vaporisation of the prostate: A single‐institution experience

AbstractAimTo assess the feasibility, efficacy and safety of performing photoselective vaporisation of the prostate (PVP) as a day‐surgery procedure for patients with benign prostatic obstruction.Patients and MethodsA prospective single‐arm observational study was performed involving patients with benign prostatic obstruction (BPO) who received PVP between 2017 and 2021. Data were collected on demographics, prostate volume by transrectal ultrasonography, mean peak flow rate (Qmax), post‐void residual urine volume, International Prostate Symptom Score (IPSS) with quality‐of‐life (QoL) index, length of stay, success in weaning off catheter on the day of operation and complications.ResultsPVP was performed successfully in all 37 men between 2017 and 2021. Their mean age was 67 years. The mean prostate volume was 54 mL. The mean duration of operation was 80 min. The mean peak urinary flow rate improved from 9.14 to 16.8, 17.3 and 15.4 mL/s at post‐operative 1, 3 and 12 months, respectively (P = .001). The mean IPSS score improved from 19.5 to 8.94, 6.40 and 5.63 at post‐operative 1, 3 and 12 months, respectively (P &lt; .001). The mean QoL index improved from 4.07 to 2.43, 2.25 and 1.81 at post‐operative 1, 3 and 12 months, respectively (P = .001). The mean duration of catheterisation after PVP was 5.81 h. Thirty‐three (89.2%) patients were discharged on the same day. Overall, the 30‐day complication rate was 27%. The most common complication was haematuria (6 patients, 16.2%). Five patients (13.5%) required readmission and inpatient care. There was one Clavien–Dindo grade III and IV complication (2.6%), respectively.ConclusionThis study demonstrated the feasibility of performing PVP as a day‐surgery procedure with good short‐ and medium‐term functional outcomes and safety profiles.

INEVITABLE MYOMECTOMY OF EXTRUDING INTRAMURAL FIBROID DURING CAESAREAN SECTION- A CASE REPORT

Myomectomy during caesarean sections have been avoided routinely in the past in the fear of massive hemorrhagewhich may lead to obstetric hysterectomy. However in the recent times with adequate facilities and expertise, caesarean myomectomies are being performed with good outcomes. Case Presentation: A35-year-oldprimi gravida was diagnosed to have intramural fibroid - anterior 4.6*4.3cm and posterior 1.8cm*2.8cm at 8 weeks of gestation.By 13 weeks, during her NT scan there was increase in the size of anterior wall fibroid 7.0*6.6cm, the rest of NT scan and first trimester screening was normal. She developed early onset intrauterine growth restriction in her anomaly scan. She was conservatively managed as the doppler flow was normal. Her scan at 36 weeks showed estimated fetal weight at 2nd centile with normal doppler flow in breech presentation and an anterior intramural fibroid of size 9.5*8.2cm.Hence an elective caesarean section was planned at 37 weeks.Baby was delivered by breech extraction. Manual removal of placenta was done. As the uterus started contracting, the intramural fibroid started extruding, became submucosal and bulging into uterine edges. Hence planned for myomectomy. Injection vasopressin was injected into the surface of myoma,enucleation of the myoma done and myoma bed closed in 2 layers followed by the closure of uterine edges. Intra operative blood loss was around 800ml. No primary or secondary PPH noted. Patient was discharged on 5th post operative day without any complaints. Conclusions: Routine myomectomy at the time of cesarean section is not a standard procedure worldwide. However, it may be considered in carefully selected patients in centers with good facilities to tackle complications by the experienced obstetricians.

Association of sleep quality on the night of operative day with postoperative delirium in elderly patients: A prospective cohort study.

Sleep disturbances in the peri-operative period have been associated with adverse outcomes, including postoperative delirium (POD). However, research on sleep quality during the immediate postoperative period is limited. This study aimed to investigate the association between sleep quality on the night of the operative day assessed using the Sleep Quality Numeric Rating Scale (SQ-NRS), and the incidence of POD in a large cohort of surgical patients. A prospective cohort study. A tertiary hospital in China. This study enrolled patients aged 65 years or older undergoing elective surgery under general anaesthesia. The participants were categorised into the sleep disturbance and no sleep disturbance groups according to their operative night SQ-NRS. The primary outcome was delirium incidence, whereas the secondary outcomes included acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively. In total, 3072 patients were included in the analysis of this study. Among them, 791 (25.72%) experienced sleep disturbances on the night of operative day. Patients in the sleep disturbance group had a significantly higher risk of developing POD (adjusted OR 1.43, 95% CI 1.11 to 1.82, P = 0.005). Subgroup analysis revealed that age 65-75 years; male sex; ASA III and IV; haemoglobin more than 12 g l -1 ; intra-operative hypotension; surgical duration more than 120 min; and education 9 years or less were significantly associated with POD. No interaction was observed between the subgroups. No significant differences were observed in the secondary outcomes, such as acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively. The poor subjective sleep quality on the night of operative day was independently associated with increased POD risk, especially in certain subpopulations. Optimising peri-operative sleep may reduce POD. Further research should investigate potential mechanisms and causal relationships. chictr.org.cn: ChiCTR1900028545.

Combined thoracoscopic and laparoscopic surgery for epiphrenic diverticulum with associated gastroesophageal reflux disease: a case report

BackgroundSurgery is indicated for symptomatic epiphrenic esophageal diverticula. Based on the features of a case, thoracoscopic or laparoscopic approaches may be used. Epiphrenic diverticula are often associated with esophageal motility disorders, but cases of reflux esophagitis have rarely been reported. In this report, we describe a case of an epiphrenic esophageal diverticulum with reflux esophagitis, which was successfully treated by thoracoscopic diverticulectomy and laparoscopic fundoplication.Case presentationA 69-year-old man visited the hospital with a chief complaint of eructation and hiccup. Upper gastrointestinal endoscopy revealed a diverticulum in the left wall of the esophagus, which was 37–45 cm distal to the incisors. High-resolution manometry (HRM) showed no esophageal motility disorders. Due to the large size of the diverticulum, a thoracoscopic resection of the esophageal diverticulum was performed. Additionally, the patient had reflux esophagitis due to a hiatal hernia. The anti-reflux mechanism would be more impaired during the diverticulectomy; therefore, we decided that anti-reflux surgery should be performed simultaneously. Thoracoscopic esophageal diverticulectomy and laparoscopic Dor fundoplication were performed. The patient had an uncomplicated postoperative course and was discharged on the tenth operative day. He has been symptom-free without acid secretion inhibitors for 21 months after the surgery.ConclusionsWe described a rare case of a large epiphrenic diverticulum with reflux esophagitis. A good surgical outcome was achieved by thoracoscopic resection of the diverticulum and laparoscopic Dor fundoplication.

Outcome of Early Active and Late Mobilization following Flexor Tendon Repair in Zone ΙΙ of Hand

The functional outcome of flexor tendon injury after repair depends on multiple factors. Postoperative rehabilitation protocol plays an important role after a good repair for better functional outcomes. The aim of this study is to compare the outcome between early active mobilizations versus late mobilizations after flexor tendon repair in zone-II of hand. This Quasi-experimental (Nonrandomized control trial) was conducted from July 2018 to June 2021. Total 30 patients of flexor tendon injury in Zone-II of hand presented within 3 weeks were divided into two equal groups according to envelope technique, late mobilization (No intervention group) group- A and early active mobilization (Intervention group) group-B. All the flexor tendons were repaired with polypropylene 4/0 double strand score sutures and 6/0 epitendinous continuous sutures. In group-A mobilization started after 3 weeks and in group–B, intervention was given by active mobilization which was started at the day of operation. Buck Gramcko functional criteria and Louisville system were used for assessment of final result after 6 months of surgery. Male was predominant, M: F ratio was 3.3:1. Mean age of the respondent was 32.53±9.86 years. Dominant (Right) hand involvement was 70%. Student and service holder were the common involved group. Nearly three fourth (73%) of them had sharp cutting injury. More than half (53.10%) of the injuries were found in ring and little fingers followed by index (20.30%), middle (20.30%) and thumb (6.30%). Mean time interval between injury and operation was 11 days. Adhesion formation was the commonest complication that was 40% in group A and 20% in group B. More satisfactory outcome (87.50%) was found in group- B (Intervention group), that is patients who received early active mobilization; where the level of satisfactory outcome was less (62.50%) in group-A (Non-intervention group), that is patients who received late mobilization (p-value was significant &lt;0.05). Early active mobilization following repair of flexor tendon in zone II of hand ensures better functional outcome with minimum complication compared to late mobilization. Bangladesh Med J. 2022 Sept; 51(3): 28-36

Prevalence of Delirium and Its Related Factors in Burn Patients; a Systematic Review and Meta-Analysis.

Considering the importance of delirium disorder in burn patients and its complications, the present systematic review and meta-analysis aimed to determine the prevalence of delirium and its related factors in burn patients. A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, and Web of Science, as well as Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Prevalence", "Delirium", and "Burns" from the earliest to the 17th of July, 2023. In total, 2,710 burn patients participated in ten original studies. Among the participants, 64.6% were male. In the ten studies, the reported pooled prevalence of delirium among burn patients was 20.5% (95% CI: 10.9% to 35.0%; I2=96.889%; P<0.001). Also, factors such as total body surface area, duration of hospitalization, mortality, days on ventilator, alcoholism, benzodiazepine dose, methadone dose, age, male gender, ICU days, operation days, wound care under anesthesia, and opioid dose had a significant correlation with the prevalence of delirium in burn patients. Health managers and policymakers can reduce the prevalence of delirium in burn patients by eliminating or reducing factors associated with it.

An Efficiency Model for Decreasing Operative Room Turnover Time for Total Joint Arthroplasties.

Despite an increased demand for total joint arthroplasty (TJA), rising health-care costs and bundling of payments by payers have shifted the focus to improving operating room (OR) efficiency. This study aimed to assess the efficacy of an efficiency model that optimized instrument trays on decreasing OR turnover time (TOT) and the benefits made possible by this improved efficiency. All primary TJA procedures performed by a single fellowship-trained surgeon from January 2022 to August 2023 were reviewed. The surgeon partnered with Zimmer Biomet to condense the total knee and total hip arthroplasty instrument trays from seven to three trays each. Patient in OR time and patient out of OR times were collected and used to calculate TOT. Mean TOTs pre-efficiency model implementation (January - October 2022) and post-efficiency model implementation (March - August 2023) were compared. Annual cost savings were calculated based on an average cost per one minute of OR time of $47.99 and an average cost for the Sterile Processing Department (SPD) to process a single TJA tray of $79.41. Following implementation of the efficiency model, the average OR TOT significantly decreased by 19 minutes (P < 0.0001), a greater than 44% reduction in TOT. At this surgeon's current case volume, conservatively estimated at 280 primary TJA cases per year, annual savings in OR and SPD processing costs were $169,597 and $88,939, respectively. Moreover, this led to increased case volume per operative day. A small-scale intervention such as optimizing instrument trays for TJA is a valuable and sustainable solution to improve efficiency in the OR by decreasing OR TOT, thereby generating considerable cost-savings and opportunity to increase surgical volume.

Physiological parameters of dental fear and anxiety in adults related to surgical extraction of impacted third molars

Background/Aim: Dental fear and anxiety (DFA) are psychological phenomena normally arising and developed in the dental office during various kinds of dental procedures and interventions. The most usual stressors for the DFA appearance are those related to dental pain, no matter if the pain has already been caused, or potentially will be committed. There are a few main dental pain-provoking factors related to endangering body integrity in the oral cavity, and tooth extraction is the strongest one. The research aimed to observe, notify, and analyze physiological parameters of DFA in adults related to oral surgical therapy procedures of removing impacted third permanent molars. Material and Methods: After inclusive selection 500 patients entered into the study. The study protocol included preoperative assessment of DFA presence with Corah's Dental Anxiety Scale (CDAS) on examination day, preoperative assessment of physiological parameters on examination day and operative day before the treatment, as well as their postoperative assessment followed by evaluation of postoperative pain, on the day after the treatment. Results: The results of our research indicated that an increase in DFA led to increased values of the measured physiological parameters for all preoperative measurement days. The postoperative decrease in the physiological parameters values could be explained by the fact that the oral-surgical procedure was completed, so the psychological burden of the patients was also less. Conclusions: Patients with higher values of the DFA presence have also declared more postoperative pain.

Route capacity in designing urban public passenger transportation

Public transport is of crucial importance for urban agglomerations - it is the only transport system that can satisfy the mobility of the population with acceptable quality at minimum cost with less negative impact on the environment. In the tasks of designing public transport, ensuring the capacity of the routes is of particular relevance. This problem does not have an unambiguous solution, and in the majority of research, possible excess of capacity of vehicles, as a rule, are ignored. The paper presents the developed mathematical model, which allows us to calculate the highest intensity passenger flow from the transport demand for a day of transport operation and on this basis to determine the necessary throughput capacity at the established limits of rolling stock capacity. An example of calculation of dependence of intensity and interval of movement on nominal capacity of rolling stock is given, in which an example of the performance of restrictions of the capacity of rolling stock is provided on a section of a route with passenger flow of the greatest capacity.

EXPERIMENTAL STUDY OF CONDENSATION OF WATER ON POLYDIMETHYLSILOXANE-COATED COPPER SURFACES

Modification of surfaces to enable dropwise condensation (DWC) is a promising approach for achieving high condensation rates. In this work, we present an experimental study on condensation of water on copper surfaces coated with an ultrathin, 5-10 nm thick polydimethylsiloxane (PDMS) layer. This hydrophobic coating possesses a very low thermal resistance, which in combination with copper substrate enables achieving high condensation rates in heat transfer applications. The PDMS-coated copper substrates have been fabricated with a newly developed method, which involves turning, sanding, polishing, oxidation, and polymer coating steps. The measured static contact angle was 110&amp;deg; &amp;#177; 1&amp;deg;, and the contact angle hysteresis was 2&amp;deg;. The achieved very low hysteresis is advantageous for promoting DWC. The surface showed no aging effects during 100 repetitions of advancing and receding contact angle (ARCA) measurements. Condensation heat transfer on uncoated and PDMS-coated copper surfaces surfaces has been studied experimentally in a saturated water vapor atmosphere at 60°C. An enhancement factor for heat flux and heat transfer coefficient of up to 1.6 was found on PDMS-coated copper surfaces compared to uncoated surfaces, which decreased to 1.1 on the second and third day of condensation operation. Images of the condensation surface were recorded while conducting condensation experiments and post processed to evaluate drop departure diameter and frequency of drop sweeping events. It has been shown that the behavior of the heat transfer coefficient correlates with the frequency of the sweeping events.

Neurosensory Recovery Following Skeletonization of Mental Nerve During Open Reduction &amp; Internal Fixation for Mandibular Fractures

Background: Intraoral open reduction and internal fixation (ORIF) procedures used to treat mandibular fractures can result in neurosensory abnormalities due to soft tissue and nerve manipulation. While treating fractures located in the parasymphysis and anterior body regions, where the inferior alveolar and mental nerves are located, there is limited access which can impede correct reduction and hinder the use of optimal fixation. To counter these problems, better access can be gained through skeletonization of the mental nerve, which is known to result in neurosensory disturbances. However, the extent of neurosensory deficits that may result from these procedures and the degree of their recovery remain unknown in current literature. Objective: The primary purpose of our study was to evaluate and correlate the objective and subjective neurosensory recovery of the mental nerve following skeletonization during Open Reduction and Internal Fixation of mandibular fractures. Study Design: This was a prospective observational study. Settings: The adult subjects having mandibular fractures treated at Jinnah Hospital, Lahore Pakistan, a level III tertiary care hospital. Duration: The study duration was from July 1, 2022 and December 31, 2022. Methods: Demographic details were taken and preoperative objective and subjective neurosensory assessment was performed. Following surgery, postoperative objective and subjective neurosensory assessment was performed on post op day 1, after 1 and 6 weeks. Collected data was analysed with significance level of &lt;0.05. Results: Twenty four subjects who completed regular follow-up visits for 6 weeks were included in this study. All subjects had objective or subjective neurosensory deficit preoperatively. Following surgery, all the subjects had FSR grade S0 and subjective loss of sensation at immediate postoperative assessment after surgery. 87.5% of the subjects had complete objective and subjective neurosensory recovery at the end of 6 weeks. There was a significant negative correlation between objective and subjective neurosensory recovery during the initial stages of the study, which became non-significant by the end of 6 weeks. Conclusion: Following mental nerve skeletonization during ORIF of subjects with mandibular fractures having some degree of preoperative paraesthesia, a majority of subjects achieved complete neurosensory recovery 6 weeks postoperatively. Therefore, it is expected for a skeletonized mental nerve to return to normal function within 2 months after ORIF for mandibular fractures.

Postoperative Analgesic Effect of Dexamethasone Added To Ropivacaine for Fascia Iliaca Compartment Block Following Femoral Fracture Surgeries

Introduction: Pain is associated with higher perioperative morbidity in fracture patients. Fascia iliaca compartment block is a simple, inexpensive, and effective method of analgesia for femoral fracture surgeries. Many adjuvants have been used with local anaesthetics to prolong post-operative analgesia.&#x0D; Aims: To assess the effects of dexamethasone as an adjuvant to fascia iliaca compartment block on prolongation of post-operative analgesia in patients undergoing femoral fracture surgeries.&#x0D; Methods: Seventy patients aged, 18-65 years with American Society of Anaesthesiologist-Physical Status I and II, undergoing femoral fracture surgery, were randomly assigned to two groups, n=35 each, who received standard subarachnoid block. Ultrasound guided Fascia iliaca compartment block was given after completion of surgery with 20ml of 0.35% ropivacaine + 2ml normal saline to group one or 20ml of 0.35% ropivacaine + 2ml dexamethasone(4mg/ml) to group 2. Total duration of analgesia and total rescue analgesic requirement in the first post operative day were noted after successful block.&#x0D; Results:The demographic information for the two groups was comparable. The duration of postoperative analgesia was prolonged in patients receiving dexamethasone adjuvant (541 ± 167 vs. 638± 165 mins, p = 0.018; Mean difference -97). Patients receiving dexamethasone adjuvant required significantly less postoperative rescue analgesics for the first 24 hours (tramadol 88 ± 32 vs 65 ± 23 mg, p = 0.001; Mean difference 23).&#x0D; Conclusion: Dexamethasone, added to Fascia Iliaca Compartment Block, as an adjuvant, significantly prolongs the postoperative analgesic effect thereby, reducing the need for rescue analgesic in the first postoperative day.

Efficacy of Modified Toggle Splint with Nylon Suture for ‎‎Stabilization of Coxofemoral ‎Luxation in Dogs

Coxofemoral luxation is a common orthopedic lesion in dogs. This study aimed to evaluate ‎the effectiveness of a modified toggle splint with nylon suture as a prosthetic teres ligament ‎for reducing and fixing coxofemoral luxation in dogs. Five adult mongrel dogs weighing ‎‎15±2 kg were used in this experimental study. The toggle splint was fabricated from a ‎Steinmann pin (1cm length, 2mm diameter) by drilling 0.5 mm hole in the center. ‎Stabilization of coxofemoral joint was performed by a modified Toggle splint technique. A ‎tunnel, from the major trochanter through the fovea capitis to the acetabulum, was ‎performed in which the toggle splint was passed through, and nylon suture was used for ‎fixation. Dogs were scored for lameness severity at 0-, 14-and 42-day post-operation using a ‎numerical rating scale (NRS) with 5 levels, and reductions were assessed radiographically ‎at three-time points the day of operation, day 28th, and day 42nd. The results showed that the ‎treatment splint was effective in achieving good reduction and fixation in four out of five ‎‎(80%) dogs at all time points. Reluxation was observed only in one dog (20%) up to week 6 ‎post-operation. The mean lameness score on day 14 (2.0±0.87) and 42 (0.60±0.60) were ‎significantly lower (P&lt;0.001) compared to day 0. These results indicate that the modified ‎toggle splint with nylon suture is a promising treatment option for canine coxofemoral ‎luxation.

More than 30 Years of POSSUM: Are Scoring Systems Still Relevant Today for Colorectal Surgery?

The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) weights the patient's individual health status and the extent of the surgical procedure to estimate the probability of postoperative complications and death of general surgery patients. The variations Portsmouth-POSSUM (P-POSSUM) and colorectal POSSUM (CR-POSSUM) were developed for estimating mortality in patients with low perioperative risk and for patients with colorectal carcinoma, respectively. The aim of the present study was to evaluate the significance of POSSUM, P-POSSUM, and CR-POSSUM in two independent colorectal cancer cohorts undergoing surgery, with an emphasis on laparoscopic procedures. For each patient, an individual physiological score (PS) and operative severity score (OS) was attributed to calculate the predicted morbidity and mortality, respectively. Logistic regression analysis was used to evaluate the possible correlation between the subscores and the probability of postoperative complications and mortality. The POSSUM equation significantly overpredicted postoperative morbidity, and all three scoring systems considerably overpredicted in-hospital mortality. However, the POSSUM score identified patients at risk of anastomotic leakage, sepsis, and the need for reoperation. Logistic regression analysis demonstrated a strong correlation between the subscores and the probability of postoperative complications and mortality, respectively. Our results suggest that the three scoring systems are too imprecise for the estimation of perioperative complications and mortality of patients undergoing colorectal surgery in the present day. Since the subscores proved valid, a revision of the scoring systems could increase their reliability in the clinical setting.

Incidence of post open appendectomy incisional hernia in Erbil City

Background: since acute appendicitis is the most common presenting diseases in the surgical emergency departments, Appendectomy regarded as a common emergency surgical procedure that is done by the surgeons in the general surgery specialty. The complication of an incisional hernia development after open appendectomy is rare, found in about 0.12% of the appendectomy operations; interstitial type of incisional hernia complication following open appendectomy surgery is extremely rare condition, small number of reports found to deal with the incisional hernia development at the site of appendectomy in a range of (0.4-0.7%).&#x0D; Objective: To assess the incidence of incisional hernia following open appendectomy in Erbil province – Kurdistan region- Iraq.&#x0D; Patients and Methods: This retrospective study involved 598 cases between the period of first of July 2015 to 30th of April 2020, the cases presented with features of acute appendicitis, after admission and complete history taking, surgical intervention (open appendectomy) has been done for all of them, follow up for the diagnosis of the post appendectomy incisional hernia development done throughout revising the files and ID s of the patients and contacting them or their close relatives via personal mobile numbers, others re-consulted us for any operation site discomforts, any patient with suspicion of operation site problems asked to return to the outpatient surgical room for follow up and excluding or confirmation of operation site incisional hernia. The patients followed up for about 2-3 years after the operation days and contacting period with the patients or their close relatives to exclude incisional hernia development at open appendectomy site took about 6 months.&#x0D; Results: Out of 598 cases included in this retrospective study, 286 cases were male and 312 cases were female, the ages ranged between 5 and 91 years old with a mean and Standard Deviation (SD) 24.13, the age group of up to 10 years old included 13 cases, 2nd decade age group included 258 cases, while the third age group (21 – 30 years old) was included 167 cases. Risk factors for development of incisional hernia assessed among all cases, 56.85% of all cases had at least one of the risk factors and the remaining 43.15% devoid of any risk factors, the risk factors distributed among constipation (19.4%), pregnancy among female patients (18.9%), followed by diabetes mellitus, chronic cough and heavy working occupations (4.85% ,4.52% and 3.34% respectively), and BPH and anemia with other immunocompromised risk factors made only about 5.8%, only three patients (0.5%) developed incisional hernia after open appendectomy.&#x0D; Conclusion: Post open appendectomy incisional hernia is rare in patients without risk factors of wound dehiscence, with minimizing the risk factors of incisional hernia and wound dehiscence, the incidence of open appendectomy wound incisional hernia can be minimized to lowest rate.

The Financial Implications of Pancreatic Surgery: The Hospital Is the Big Winner, Not the Surgeon!

High-volume pancreatic surgery centers require a significant investment in expertise, time, and resources to achieve optimal patient outcomes. A detailed understanding of the economics of major pancreatic surgery is limited among many clinicians and hospital administrators. A greater consideration of these financial aspects may in fact have implications for enhancing clinical care and for a broader sustainability of high-volume pancreatic surgery programs. In this retrospective observational study, patients who underwent pancreaticoduodenectomy (PD), total pancreatectomy, or distal pancreatectomy at one academic medical center during the fiscal year 2021 were evaluated. Detailed hospital charges and professional fees were obtained for patients using the Qlik perioperative database. Clinical data for the study cohort were gathered from a prospectively maintained, IRB-approved pancreatic surgery database. Charges for the 91-day perioperative period were included. A P < 0.05 was considered significant. During the study period, 159 evaluable patients underwent 1 of 3 designated pancreatic resections included in the analysis. Ninety-seven patients (61%) were diagnosed with adenocarcinoma and 70% (n = 110) underwent PD. The total charges (combined professional and hospital charges) for the cohort encompassing the entire perioperative period were $20,661,759. The median charge per patient was $130,306 (interquartile range [IQR], $34,534). The median direct cost of care was $23,219 (IQR, $6321) and the median contribution margin per case was $10,092 (IQR, $22,949). The median surgeon professional fee charges were $7700 per patient (IQR, $1296) as compared to $3453 (IQR, $1,144) for professional fee receipts (45% of the surgeon charge). The differences between the professional fee charges and receipts per patient were also considerable for other health care professionals such as anesthesiologists ($4945 charges vs $1406 receipts [28%]) and pathologists ($3035 charges vs $680 receipts [22%]). The surgeon professional fees were only 6% of the total charges, while the professional fees for anesthesiology and pathology were 4% and 2% of the total charges, respectively. Supply charges were 3% of the total charges. Longer operative time was correlated with increased hospital and anesthesia charges, without a significant increase in surgeon charges (P < 0.001, P < 0.001, and P = 0.2, respectively). Male sex, diabetes, and low serum albumin correlated with greater total hospital charges (P = 0.01, P = 0.01, and P = 0.03, respectively). The role of the surgeon in the perioperative clinical care of major pancreatic resection patients is crucial and important and is by no means limited to the operative day. Nevertheless, in the context of the current US health care system, the reimbursement to the surgeon in the form of professional fees is a relatively small fraction of the total health care receipts for these patients. This imbalance necessitates a substantial financial partnership between hospitals and their pancreatic surgery units to ensure the long-term viability of these programs.

Clinical assessment of corneal complications of manual small incision cataract surgery at tertiary care centre

: To assess corneal complications and visual outcome of manual small incision cataract surgery.: This study comprises of 227 patients in a tertiary care centre in Kolar district, who underwent MSICS were examined for corneal complications and visual outcome postoperatively on Day 1, 1 week, and at the end of 6 week also visual acuity (VA) assessment, anterior segment evaluation with slit lamp biomicroscopy, posterior segment evaluation using indirect ophthalmoscopy, and keratometry was done.227 participants were included in the study, of whom 138 (61%) were female and 89 (39%) were male. The maximum number of patients being in the age group of 61-70 (42.7%). OCTET grading was done for corneal edema patients and on post op Day 1, total 62 patients who had corneal edema in the study were graded according to OCTET classification, and 6 patients (9.6%) had grade 1, 17 patients (27.4%) had grade 2 and 39 patients (63%) had grade 3. At the end of 6 week postoperatively, 45 patients had clear cornea, and 5 patients (8%) had grade 1, 6 patients (9.5%) had grade 2, and 7 patients (11.1%) had grade 3, and 82.3% of patients had VA of 6/6 to 6/9 followed by 11% had 6/12 to 6/18 and 6.6% had 6/24 to 6/36.: Small incision cataract surgery is most cost-effective surgery if corneal endothelium is protected during surgery and will have early visual rehabilitation.

Study of tear film status in patients undergoing phacoemulsification surgery

The present study was undertaken to study the tear film status preoperatively and post-operatively in patients undergoing phacoemulsification surgery. The study was conducted as prospective study on 100 patients undergoing phacoemulsification surgery during the study period of 1 year. Work up for tear film status including Schirmer’s test, staining of cornea and conjunctiva with fluorescein dye, TBUT (tear film break up time) was done preoperatively and postoperatively after phacoemulsification. Mean Schirmer’s value at preoperative assessment was 27.45±4.95 whereas that at post operative day 7, 15 and 30 was 9.09±2.19, 16.73±5.12 and 24.45±4.05 respectively. Similarly, mean TBUT at preoperative level was 11.11±1.16 which reduced to 6.63±1.57 at day 7, 7.37±1.44 at day 15 and 9.77±0.91 at day 30. Test of significance (ANOVA) showed statistically significant difference in mean Schirmer’s and TBUT values at various follow ups post-operatively as compared to baseline (p&amp;#60;0.01). Cataract surgery can lead to dry eye due to incision itself as well as due to intra-operative exposure to the microscope light. Thus, artificial tears must be prescribed to improve the quality of life during immediate post-operative period. However, gradually, tear film status improved. We only followed up patients till one month, a long term follow up is recommended to assess the time taken for the tear film to recover to its preoperative status.