Surgery Intervention Research Articles

Economic Benefits of Eye Care Interventions on Social Inclusion and Quality of Life

This study investigates the impact of Noor Dubai Foundation (NDF) cataract surgery intervention on social inclusion and quality of life in Katsina state. A survey method using 5-point Likert scale questionnaire was used to retrieve direct data from respondents. 300 respondents were recruited from the existing 5000 beneficiaries of the intervention. The result shows a significant enhancement in social inclusion and quality of life of respondents. These include less dependent on escorts, improvement in participation in social functions, freedom over choice of life, reduced discrimination arising from vision impairment, and general life sustainability. Precisely, 98% of the respondents agree that they depend less on escort; 98% of the respondents agree that their social function participation has improved; 99% of the respondents agree that their control over choice of life has significantly improved; 96% of the respondents agree that vision impaired discrimination has reduced and 96% of the respondents agree that life is more sustainable at present. The implication of these findings is that vision impairment reduces the chances for social inclusion and militates against the United Nations' efforts towards achieving sustainable development goals. Therefore, the state government should extend its collaboration with NDF for another few years in other to socially include more people with curable vision problems in the state.

Operative Digital Enhancement of Macular Pigment during Macular Surgery.

To describe the feasibility of intraoperative digital visualization and its contribution to the enhancement of macular pigmentation visualization in a prospective series of macular surgery interventions. A prospective, single-center, single-surgeon study was performed on a series of 21 consecutive cases of vitrectomy for various types of macular surgery using a 3D visualization system. Two optimized filters were applied to enhance the visualization of the macular pigment (MP). For filter 1, cyan, yellow, and magenta color saturations were increased. Filter 2 differed from filter 1 only in having a lower level of magenta saturation for the green-magenta color channel. Optimized digital filters enhanced the visualization of the MP and the pigmented epiretinal tissue associated with the lamellar and macular holes. In vitreomacular traction surgery, the filters facilitated the assessment of MP integrity at the end of surgery. Filter 1 enhanced MP visualization most strongly, with the MP appearing green and slightly fluorescent. Filter 2 enhanced MP visualization less effectively but gave a clearer image of the retinal surface, facilitating safe macular peeling. Optimized digital filters could be used to enhance MP and pigmented epiretinal tissue visualization during macular surgery. These filters open new horizons for future research and should be evaluated in larger series and correlated with intraoperative OCT.

Upper Lateral Cartilage Overlapping on the High Dorsum with the Let-Down Technique.

Rhinoplasty is one of the most common procedures among esthetic and plastic surgery interventions. Hump deformities are prevalent among Caucasians, and amputation of the hump is the traditional approach in these patients. The traditional hump reduction procedure is still popular among rhinosurgeons, and research on the management of hump deformities is still being conducted to obtain better outcomes. The present study aimed to investigate the effects of upper lateral cartilage overlapping in patients who underwent dorsal preservation rhinoplasty. In the present study, data from patients who applied to the author's private clinic for hump deformities were screened. According to the inclusion and exclusion criteria, 47 patients were included in the study (39 females and 8 males). The evaluation of patients was performed with the Rhinoplasty Outcome Evaluation (ROE) scale. The combination of upper lateral cartilage overlapping with the let-down technique was assessed. There was no hump relapse in any of the participants. The median initial ROE score was 50.00, and the median ROE increased to 91.00 after 12 months. The change in the median ROE score was found to be significant (p < 0.001). The patient satisfaction rate according to the ROE scale was found to be excellent in 89.9% (40/47) of patients. The combination of upper lateral cartilage overlapping with the let-down technique will provide an alternative approach for surgeons to operate on patients with a high hump and narrow dorsum. This technique will also result in better esthetic and functional outcomes with a lower risk of complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Electroencephalographic changes in neurologically free patients with tetralogy of Fallot after surgical repair: a cross section study in Egyptian children

BackgroundSurgical correction of tetralogy of Fallot (TOF) is still one of the most frequently performed intervention in pediatric cardiac surgery. The occurrence of seizures after repair or palliation of congenital heart disease (CHD) is a marker for a central nervous system (CNS) injury and has been associated with adverse neurodevelopmental sequelae. The prognostic value of electroencephalogram (EEG) for outcome prediction is glowing in children with CHD undergoing open-heart surgery who are at risk for subsequent neurodevelopmental deficits. To our knowledge, this is the first study to detect the EEG changes in neurologically free TOF patients after surgical repairResultsOur study included 68 TOF cases and 32 sex- and age-matched control group; they were 66.0% males and 34.0% females. The mean age of the studied children was 11.41 ± 4.23 years. There was statistically significant difference between TOF patients and control group as regards alpha power and Delta% in left occipital region and Alpha% in right occipital region, with dominant alpha waves in patients’ right occipital region. None of our patients had epileptic waves. The duration after operation showed negative correlation with Delta% at left occipital region and positive correlation with Alpha% in right occipital region (p = 0.002, p = 0.044 respectively).ConclusionTOF cases showed changes in EEG parameters chiefly dominant alpha power and Delta% in left occipital region and dominant Alpha% in right occipital region. Duration after surgery correlated negatively with Delta% at left occipital region, and positively with Alpha% in the right occipital region. Subsequent assessment is recommended to study long-term hazards of these varied dominance of EEG waves in our patients, e.g., evaluation of the cognitive functions.

The Impact of Complete Revascularization in Symptomatic Severe Left Ventricular Dysfunction between Coronary Artery Bypass Graft and Percutaneous Coronary Intervention.

The study aimed to compare the clinical outcomes between the patients receiving coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the patients with symptomatic severe left ventricular (LV) dysfunction and coronary artery disease (CAD). Between February 2007 and February 2020, a total of 745 patients who received coronary artery angiography for reduced LV ejection fraction (LVEF) < 40% and symptomatic New York Heart Association (NYHA) functional class ≥ 3 were recruited. The patients (N = 236) who were diagnosed with dilated cardiomyopathy or valvular heart disease without coronary artery stenosis, those with prior history of CABG or valvular surgery (N = 59), those who presented ST-segment elevated myocardial infarction (STEMI), those with a CAD and SYNTAX score of ≦ 22 (N = 175), those who received emergent CABG for coronary perforation (N = 3), and those who had NYHA class ≦ 2 (N = 65) were excluded. Finally, 116 patients with reduced LVEF and those who had a SYNTAX score >22, who received CABG (N = 47) and PCI (N = 69), were recruited for this study. There was no significant difference in the incidence values of in-hospital course and those of in-hospital mortality, acute kidney injury, and postprocedural hemodialysis. There was no significant difference in the 1-yearfollow-up of recurrent MI, revascularization, or stroke between the groups. The 1-year heart failure (HF) hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (13.2% vs. 33.3%; p = 0.035); however, there was no significant difference in the same variable between the CABG group and the complete revascularization subgroup (13.2% vs. 28.2%; p = 0.160). The revascularization index (RI) was significantly higher in the CABG group than in all patients of the PCI group or complete revascularization subgroup (0.93 ± 0.12 vs. 0.71 ± 0.25; p < 0.001) and (0.93 ± 0.12 vs. 0.86 ± 0.13; p = 0.019). The 3-year HF hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (16.2% vs. 42.2%; p = 0.008); however, there was no difference in the same variable between the CABG group and the complete revascularization subgroup (16.2% vs. 35.1%; p = 0.109). In patients with symptomatic (NYHA class ≥ 3) severe LV dysfunction and CAD, CABG brought less HF admission when compared to patients in the PCI group, but this did not differ when compared to the complete revascularization subgroup. Therefore, an extensive revascularization, achieved by CABG or PCI, is associated with a lower HF hospitalization rate during the 3-yearfollow-up period in such populations.

Perioperative nutrition for gastrointestinal surgery: On the cutting edge.

Evidence on perioperative nutrition interventions in gastrointestinal surgery is rapidly evolving. We conducted a narrative review of various aspects of nutrition support, including formula choice and route of administration, as well as duration and timing of nutrition support therapy. Studies have demonstrated that nutrition support is associated with improved clinical outcomes in malnourished patients and those at nutrition risk, emphasizing the importance of nutrition assessment, for which several validated nutrition risk assessment tools exist. The assessment of serum albumin levels has fallen out of favor, as it is an unreliable marker of nutrition status, whereas imaging evidence of sarcopenia has prognostic value and may emerge as a standard component of nutrition assessment. Preoperatively, evidence supports limiting fasting to reduce insulin resistance and improve oral tolerance. Benefits to preoperative carbohydrate loading remain unclear, whereas literature suggests preoperative parenteral nutrition (PN) may reduce postoperative complications in high-risk patients with malnutrition or sarcopenia. Postoperatively, early oral feeding is safe with benefits in time to return of bowel function and reduced hospital stay. There is a signal for potential benefit to early postoperative PN in critically ill patients, though evidence is sparse. There has also been a recent emergence in randomized studies evaluating the use of ω-3 fatty acids, amino acids, and immunonutrition. Meta-analyses have reported favorable outcomes for these supplements, though individual studies are small and with significant methodological limitations and risk of bias, emphasizing the need for high-quality randomized studies to guide clinical practice.

The Assessment of Antimicrobial Resistance in Gram-Negative and Gram-Positive Infective Endocarditis: A Multicentric Retrospective Analysis.

Background and Objectives: Multidrug-resistant microorganisms have made treating bacterial infections challenging. Resistance to antibiotics is expected to overcome efforts to produce new, effective antibacterial medication that is lifesaving in many situations. Infective endocarditis (IE) is a life-threatening infection that affects 5-15 per 100,000 patients annually and requires rapid antibiotic therapy to prevent morbidity and mortality. Materials and Methods: The present research assessed IE cases over five years, from a multicentric database, with the main objective of determining the degree of antibiotic resistance in these patients, stratified by Gram-positive and Gram-negative bacteria. Results: Bad oral hygiene was present in 58.6% of patients from the Gram-negative group (vs. 38.7% in the Gram-positive group). Non-valvular heart disease was identified in approximately 40% of all patients, and valvopathies in approximately 20%. It was observed that 37.9% of Gram-negative IE bacteria were resistant to three or more antibiotics, whereas 20.7% were susceptible. Among Gram-positive infections, S. aureus was the most commonly involved pathogen, with a multidrug-resistant pattern in 11.2% of patients, while Acinetobacter baumannii had the highest resistance pattern of all Gram-negative pathogens, with 27.4% of all samples resistant to three or more antibiotics. Patients with Gram-negative IE were 4.2 times more likely to die. The mortality risk was 4 times higher when bacteria resistant to two or more antibiotics was involved and 5.7 times higher with resistance patterns to three or more antibiotics than the reference group with no antibiotic resistance. Peripheral catheters were the most common cause of multi-resistant IE, followed by heart surgery, dental procedures, and ENT interventions. Conclusions: Even though Gram-positive infections were the most frequent (83.0% of all cases), Gram-negative IE infections are substantially more deadly than Gram-positive IE infections. However, it was also observed that patients with Gram-negative infections were more likely to have underlying comorbidities, be institutionalized, and be underweight. Although the Gram-negative infections were more severe, their resistance patterns were similar to Gram-positive bacteria. As resistance patterns increase, more efforts should be made to prevent a healthcare catastrophe. At the same time, careful prophylaxis should be considered in patients at risk, including those with central catheters, undergoing dental procedures, and with poor oral hygiene.

Point-of-Care Viscoelastic Hemostatic Assays in Cardiac Surgery Patients: Comparison of Thromboelastography 6S, Thromboelastometry Sigma, and Quantra

Viscoelastic tests allow a reduction in blood product transfusion. Three modern devices are currently available (rotational thromboelastometry [ROTEM] sigma, thromboelastography [TEG] 6S, and Quantra). No study has compared the performances of these 3 devices simultaneously. An observational, nonrandomized cohort study. A single-center of cardiac surgery in a university hospital. A total of 30 consecutive measurements from at least 10 adult patients presenting significant bleeding in the intensive care unit after cardiac surgery INTERVENTION: Viscoelastic tests using ROTEM sigma, TEG 6S, and Quantra were performed concomitantly with conventional coagulation measurements MEASUREMENTS AND MAIN RESULTS: The authors included 16 patients with 31 blood samples. After the exclusion of missing values, 27 samples were analyzed. Correlation with platelet count was as follows: ROTEM, r=0.84 [0.66-0.93], p < 0.0001; Quantra, r=0.83 [0.64-0.92], p < 0.0001; TEG 6S, r=0.64 [0.29-0.83], p=0.001. Correlation with fibrinogen (Clauss assay) was as follows: ROTEM, r=0.85 [0.68-0.93], p < 0.0001; Quantra, r=0.88 [0.74-0.95], p < 0.0001; TEG 6S, r=0.79 [0.55-0.91], p < 0.0001. No difference was observed for the detection of residual circulating heparin (anti-Xa activity >0.1), with 87% of correct identification for Quantra and 80% for both ROTEM and TEG 6S (p=0.3). Time to first results after the beginning of the test was shorter for Quantra than ROTEM and TEG 6S (136 [126-152] seconds v 205 [176-221] seconds, p=0.003 and v 450 [372-516] seconds, p < 0.0001 respectively). ROTEM sigma, TEG 6S, and Quantra performed similarly for exploring platelet count or residual circulating heparin. Thromboelastography 6S presented a weaker correlation with fibrinogen Clauss.

Secondary Pharmacological Prevention of Coronary Artery Disease among Patients Submitted to Clinical Management, Percutaneous Coronary Intervention, or Coronary Artery Bypass Graft Surgery.

Secondary prevention is recommended for patients with evidence of coronary artery disease (CAD) regardless of the indication for treatment by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). This study evaluated whether clinical treatment, PCI or CABG had an influence on adherence to the pharmacological secondary prevention in patients with stable CAD. This cohort included patients aged ≥40 years with stable CAD confirmed by coronary angiography. The decision for medical treatment alone, or additionally with PCI or CABG, was made by the attending physicians. Adherence to the prescribed drugs recommended by the guidelines for secondary prevention (optimal pharmacological treatment), including antiplatelet agents, lipid-lowering drugs, beta-blockers, and renin-angiotensin-aldosterone system blockers, was assessed at follow-up. Differences were considered significant for p values <0.05. From 928 patients enrolled at baseline, 415 had mild CAD and 66 moderate to severe CAD. The average follow-up was 5.2 ± 1.5 years. Patients submitted to CABG were more likely to receive the optimal pharmacological treatment than those submitted to PCI or treated clinically (63.5% versus 39.1% versus 45.7% respectively, p=0.003). Baseline factors independently associated with greater probability of having a prescription of optimal treatment at follow-up were CABG [39% higher (6% - 83%, p=0.017) and diabetes [25% higher (1% - 56%), p=0.042] than their counterparts treated by other methods and participants without diabetes, respectively. Patients with CAD submitted to CABG are more commonly treated with optimal pharmacological secondary prevention than patients treated by PCI or exclusively with medical therapy.

EVALUATION AND PROGNOSTIC CORRELATION OF ACUTE PANCREATITIS USING CT SEVERITY INDEX

Background: Of all abdominal emergencies, pancreatitis is one of the most complicated and clinically difcult. The preferred imaging technique for determining the severity of acute pancreatitis and its consequences is computed tomography (CT). To evaluate the clinical outcome of acute pancreatitis and Aim: prognostic correlation based on the CT severity index. We included 30 patients with suspected acute pancr Settings and Design: eatitis attending department of Radio Diagnosis, KVG medical college and hospital during the study period (January 2022 to May 2022). All the patients were evaluated by contrast enhanced CT. The severity of pancreatitis was scored using CT severity index (Balthazar), modied severity index (Mortele) and revised Atlanta classication and the cases were classied into mild, moderate and severe. The outcome parameters studied were Length of hospital stay, Need for surgery or percutaneous intervention, incidence of infection or organ failure and death. The age group of patients was 16 Results: to 69 years with maximum patients (36%) between 25 and 35 years. Majority were males (81%). According to Modied CT Severity Index, 15% patients had mild, 42% patients had moderate and 43% had severe pancreatitis. Majority of the cases (44%) were categorized as severe pancreatitis according modied Mortele CT score. Majority of the cases were categorized as mild pancreatitis according Balthazar CTSI score and revised Atlanta classication. 38% patients are considered to have end organ failure. Hepatic failure is the most common system failure seen in 22% patients. 36% patients had evidence of systemic infection. 10% patients required surgical interventions. The score is simpler to calculate and the inter-ob Conclusions: server variability is decreased using the modied CT severity index

Wrist-ankle acupuncture for the treatment of acute orthopedic pain after surgery: a meta-analysis

BackgroundWrist-ankle acupuncture (WAA) has been reported in the treatment of acute pain in orthopedic surgery. However, the effects of WAA on acute pain were controversial in the current studies. Therefore, the purpose of this meta-analysis was to critically evaluate the effects of WAA on acute pain in orthopedic surgery.MethodsSeveral digital databases were searched from the inception of databases to July 2021, including CNKI, VIP, Wanfang, CBM, Pubmed, Cochrane Central Register of Controlled Trials, Embase, Medline, and Web of Science Core Collection. The risk of bias was evaluated using the Cochrane collaboration criteria. The primary outcome indicators included pain score, pain killer dosage, analgesia satisfaction, and adverse reaction incidence. All analyses were performed with Review Manager 5.4.1.ResultA total of 10 studies with 725 patients with orthopedic surgery (intervention group: 361, control group: 364) were included in this meta-analysis. The results demonstrated that the pain score of the intervention group was lower than the control group, and the difference was statistically significant [MD = − 0.29, 95%CI (− 0.37, − 0.21), P < 0.0001]. Compared with the control group, the patient in the intervention group used smaller amounts of pain killer [MD = − 0.16, 95%CI (− 0.30, − 0.02), P = 0.02]. The satisfaction of patients on pain relief was also higher in the intervention group, and the difference was statistically [OR = 0.25, 95%CI (0.15,0.41), P < 0.0001].ConclusionWAA has a certain effect on acute pain in orthopedic surgery, and the effect of WAA combined with other therapies is better than that of not using WAA therapy.

The Public Health Value of Coding Surgery in South Africa Using the International Classification of Health Interventions

The lack of a national intervention coding system and the current intervention coding in South Africa through the use of multiple billing and coding systems does not support quality intervention data collection and patient outcomes reporting for general surgery. This presents difficulties in the understanding of the different types of general surgical interventions performed in hospitals, the associated resources, risks, complications, outcomes reporting, public healthcare delivery, and determination of barriers to care. This study illustrates the use of accurate data on health interventions in South Africa's acute care general surgery coding to assist in improved resource allocation, using the new WHO International Classification of Health Interventions (ICHI). ICHI has over 8000 codes and consists of three axes: Target (the entity on which the Action is carried out), Action (a deed performed by an actor to a target), and Means (the processes and methods by which the Action is carried out). A key benefit of ICHI is that it can be used collectively with the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF). to evaluate the suitability of ICHI for general surgery interventions by coding intervention descriptions to ICHI codes; to identify gaps in the ICHI system; and to provide a rationale for ICHI to be a nationally regulated system. This study adopted a retrospective, descriptive design; in total, 3000 in-patient intervention data files, captured in an electronic database from April 2013 to August 2019 at three academic hospitals in Johannesburg, were extracted randomly, and coded using ICHI. Quantitative data analysis techniques were utilized to assess the overall degree of match between ICHI codes and the intervention descriptions. Of the 3000 patient case entries that were coded, there was an agreement of 67.6% of the coded data amongst the three coders, leaving a variability of 32.4%. The variability was largely due to the coders' experience and the quality of healthcare documentation. ICHI has the ability to cater for the broad range of general surgery interventions, thus indicating that ICHI is suitable for general surgery coding.

Fibrinolysis-Related Bleeding Troubles

An intricate enzymatic process called fibrinolysis is used to eliminate blood clots and stop vascular clogging. Numerous cofactors that make up the fibrinolytic system regulate fibrin breakdown and uphold the hemostatic balance. Different disease events that promote prothrombotic or hemorrhagic states based on the form of aberration are linked to the dysregulation of fibrinolysis. This review is centered on fibrinolysis ailments that can be either heritable or acquired and affect both adults and children. A shortage of one of the fibrinolysis inhibitors deficiencies, such as Plasminogen Activator Inhibitor Type 1 (PAI-1) or 2-plasmin inhibitor, or an overabundance of one of the activators, such as tissue-type plasminogen activator or urokinase-type plasminogen activator, can lead in hyperfibrinolytic bleeding. Delayed bleeding following trauma, surgery and dental interventions is a hallmark of fibrinolytic illnesses with a bleeding phenotype. Bleeding in states like menorrhagia and epistaxis, which has significant fibrinolytic activity, is also frequent. The most extreme bleeding episodes are experienced by patients with 2-plasmin inhibitor deficiency. Interestingly, it was found that, particularly in patients with PAI-1 deficiency, hyperfibrinolytic diseases are linked to a high prevalence of obstetric problems such as miscarriage and preterm delivery. Due to ignorance and a lack of reliable diagnostic tools, hyperfibrinolytic diseases are likely to be underdiagnosed. The vast majority of individuals whose bleeding was deemed to be “of unknown origin” may have a hyperfibrinolytic disease. Because these conditions may typically be successfully treated with antifibrinolytic drugs, early detection is crucial.

Persistent malperfusion after central aortic repair in acute type I aortic dissections

ObjectiveAcute dissection involving the ascending aorta and extending beyond the innominate artery (DeBakey type I) may be associated with acute ischemic complications owing to branch artery malperfusion. The purpose of this study was to document the prevalence of noncardiac ischemic complications associated with type I aortic dissections that persisted after initial ascending aortic and hemiarch repair, necessitating vascular surgery intervention. MethodsConsecutive patients presenting with acute type I aortic dissections between 2007 and 2022 were studied. Patients who underwent initial ascending aortic and hemiarch repair were included in the analysis. Study end points included the need for additional interventions after ascending aortic repair and death. ResultsThere were 120 patients (70% men; mean age, 58 ± 13 years) who underwent emergent repair for acute type I aortic dissections during the study period. Forty-one patients (34%) presented with acute ischemic complications. These included 22 (18%) with leg ischemia, 9 (8%) with acute strokes, 5 (4%) with mesenteric ischemia, and 5 (4%) with arm ischemia. After proximal aortic repair, 12 patients (10%) had persistent ischemia. Nine patients (8%) required additional interventions for persistent leg ischemia (n = 7), intestinal gangrene (n = 1), or cerebral edema (craniotomy, n = 1). Three other patients with acute stroke had permanent neurologic deficits. All other ischemic complications resolved after the proximal aortic repair despite mean operative times exceeding 6 hours. Comparing patients with persistent ischemia with those whose symptoms resolved after central aortic repair, there were no differences in demographics, distal extent of dissection, mean operative time for aortic repair, or need for venous-arterial extracorporeal bypass support. Overall, 6 of the 120 patients (5%) suffered perioperative deaths. Hospital deaths occurred in 3 of the 12 patients (25%) with persistent ischemia vs none of 29 patients who had resolution of the ischemia after aortic repair (P = .02). Over a mean follow-up of 51 ± 39 months, no patient required an additional intervention for persistent branch artery occlusion. ConclusionsOne-third of patients with acute type I aortic dissections had associated noncardiac ischemia, prompting a vascular surgery consultation. Limb and mesenteric ischemia most often resolved after the proximal aortic repair and did not require further intervention. No vascular interventions were performed in patients with stroke. Although the presence of acute ischemia at presentation did not increase hospital or 5-year mortality rates, persistent ischemia after central aortic repair seems to be a marker for increased hospital mortality after type I dissections.

Multi-vessel Disease Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients with Chronic Kidney Disease

Background: Revascularization of the coronary arteries is associated with better short term and long term prognosis in patients having multivessel coronary artery disease (MV-CAD) and chronic kidney disease (CKD). However, whether revascularization using coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) using drug eluting stents (DES) is better remains unknown.&#x0D; Objectives: To compare the outcomes of revascularization by multi-vessel PCI using DES versus revascularization by CABG in patients with CKD having multivessel CAD, regarding in-hospital and one-year major adverse cardiovascular and cerebrovascular events (MACCE).&#x0D; Methods: This was a retrospective analysis of the data of a group of patients having CKD with eGFR less than 60 ml/min with multivessel CAD who underwent revascularization by PCI or revascularization by CABG and were compared as regards in-hospital and one-year MAACE.&#x0D; Results: A total of 565 patients were reviewed in this study, 230 patients had multivessel PCI using DES while 335 patients had CABG. Comparing both revascularization groups regarding in-hospital MACCE, patients who had mutli-vessel PCI had significantly lower in-hospital mortality, cerebrovascular events (stroke/TIA) and lower total MACCE than patients who had CABG (P-value = 0.03 &amp; 0.01 &amp; 0.04 respectively). When comparing both revascularization groups regarding one-year MACCE, patients who had mutli-vessel PCI had significantly lower cerebrovascular events and total MACCE than those patients who had CABG (P-value = 0.02 &amp; 0.03 respectively).&#x0D; Conclusion: This is a retrospective study to determine which strategy is better for revascularization of CKD patients having multivessel CAD; we can conclude that multi-vessel PCI using DES for CKD patients and multivessel CAD had advantages over CABG regarding in-hospital and one-year cerebrovascular accidents (TIA/stroke) and regarding total MACCE. Larger randomized controlled trials are required to confirm our findings.

Development of a system of integrated assessment of efficiency of cardiac care in the Russian Federation regions

Highlights. Methodology for the development of a system of indicators for the integral assessment of effectiveness and efficiency of cardiac care (cardiovascular surgery) in the subjects of the Russian Federation is proposed and tested.Indicators, such as the length of stay, the number of operations on the heart and blood vessels, the number of ambulatory patients have high overall rating and consistency of expert opinions.Aim. To develop a system of indicators for assessment of the effectiveness of cardiac care, cardiovascular surgery in particular, in the Russian Federation regions.Methods. The study using expert surveys was conducted in the form of a structured interview. At the first stage, the primary selection of indicators was carried out using the annual public and field reports of the national medical research center. At the second stage, experts were selected and the level of expert competence was assessed. In total, out of 14 interviewed specialists, 10 were defined as experts. The average expert authority coefficient was 0.89. To quantify the degree of agreement between the experts` answers, Kendall's coefficient of concordance (W) was calculated. The significance of differences was assessed using the nonparametric Friedman test.Results. The following indicators are recommended as indicators for rating efficiency of cardiac care in the regions of the Russian Federation: mortality after heart surgery, vascular surgery and percutaneous coronary interventions; mortality from diseases of the circulatory system; the number of ambulatory patients; the ratio of the number of endovascular interventions to the total number of discharged patients who suffered from acute coronary syndrome.Conclusion. The selected indicators can be used both for the rating of the constituent entities of the Russian Federation, and in the development of federal projects or ministerial target programs. The results of the study can also be used to organize a system for monitoring the effectiveness of the implementation of these projects and programs.

High and Low Septal Strip Excision on Dorsal Preservation Rhinoplasty to Fix Septal Deviation.

Rhinoplasty is one of the leading procedures among aesthetic and plastic surgery interventions. Dorsal hump and nasal deviation deformities are prevalent among the general population. Patients who have both dorsal hump and nasal deviation deformities can be considered challenging for rhinosurgeons. Dorsal preservation techniques are of great interest for obtaining better and more satisfactory aesthetic and functional results. Dorsal strip excision plays a considerable part in dorsal preservation techniques. In this study, the author defines a new method that includes excisions of low and high septal strips in the subdorsal area to straighten deviation in the lower part of the distal septum and fix it on the middle line. The present study was designed as retrospective. Sixty-nine patients met the inclusion and exclusion criteria, and their records were assessed (49 females and 20 males). The patients who were included in the study have undergone surgery with high and low septal strip excision through either push-down or let-down techniques. Patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) questionnaire before and 12 months after surgery. The follow-up period ranged between 12 and 20 months (median, 16.3 months). All procedures were performed by the same surgeon between October 1, 2018, and April 1, 2020. The ROE scores ranged between 82 and 100 points after 1 year. The initial median ROE score was 56.5, and it increased to 93.00 points 12 months after surgery (P < 0.001). Patient satisfaction was excellent in 88.76% of the included patients. The combination of let- and push-down methods with low to high septal strip excision resulted in favorable outcomes in patients who had concomitant hump and septal deviation deformities. This new approach presents a suitable and easy method to the surgeons who are interested in dorsal preservation rhinoplasty.

P867 Cost-effectiveness and cost-only studies for Inflammatory Bowel Disease surgery: a scoping review

Abstract Background Studies examining the relative cost-effectiveness of surgical procedures and surgery-related interventions for patients with inflammatory bowel disease (IBD) remain limited. This dearth of studies hampers decision-makers’ assessment of surgery-related interventions for IBD patients. The purpose of this study was to conduct a scoping review of available literature for cost-effectiveness analyses of IBD-related surgery. Methods We performed a comprehensive search of English-language articles in MEDLINE, EMBASE, Cochrane Reviews, and Scopus from each database's inception to May 1, 2022. Preplanned controlled vocabulary related to IBD and its subtypes, surgery, and measures of costs were used. We defined study selection criteria to include all IBD-related surgical interventions (including preoperative, intraoperative, and postoperative) in all age groups that also reported a measure of costs of care. Studies comparing medical versus surgical interventions for refractory IBD were excluded. All search findings were screened by two reviewers using titles, abstracts, and ultimately full-length manuscripts. Full screened studies were then extracted for study characteristics and findings to facilitate a qualitative synthesis of results. Results We identified 1,804 citations for screening and ultimately found 10 formal cost-effectiveness studies and 56 cost-only studies. Cost-effectiveness studies assessed intraoperative (50%) and postoperative interventions (50%) mostly in patients with Crohn's disease (60%). Topics included comparisons of surgical approach (50%), venous thromboembolism prophylaxis (30%), and surveillance for postoperative recurrence (2%). Of the cost-only studies, the majority focused on intraoperative interventions (89%), particularly in ulcerative colitis patients (60%). Areas of interest included costs associated with healthcare resource utilization during a surgery-related admission (89%), venous thromboembolism prophylaxis (4%), and others (7%). Pre-defined areas of interest with no reported interventions included IBD-specific roles of Enhanced Recovery After Surgery interventions such as alvimopan, robotic surgery, timing to surgery, surgical therapies for perianal disease, pediatric Crohn's Disease, and genetic testing. Conclusion A scoping review found minimal literature using cost-effectiveness techniques to inform IBD-related surgical care. There are many more cost-only than cost-effectiveness studies related to these clinical topics. This asymmetry highlights immediately available opportunities for broadening the use of cost-effectiveness analysis of IBD-related surgical interventions.

Outcome of patients with tetralogy of Fallot with pulmonary atresia.

Tetralogy of Fallot patients with pulmonary atresia (TOFPA) have a largely varying source of pulmonary perfusion with often hypoplastic and even absent central pulmonary arteries. A retrospective single center study was undertaken to assess outcome of these patients regarding type of surgical procedures, long-term mortality, achievement of VSD closure and analysis of postoperative interventions. 76 consecutive patients with TOFPA operated between 01.01.2003 and 31.12.2019 are included in this single center study. Patients with ductus dependent pulmonary circulation underwent primary single stage full correction including VSD closure and right ventricular to pulmonary conduit implantation (RVPAC) or transanular patch reconstruction. Children with hypoplastic pulmonary arteries and MAPCAs without double supply were predominantly treated by unifocalization and RVPAC implantation. The follow up period ranges between 0 and 16,5 years. 31 patients (41%) underwent single stage full correction at a median age of 12 days, 15 patients could be treated by a transanular patch. 30 days mortality rate in this group was 6%. In the remaining 45 patients the VSD could not be closed during their first surgery which was performed at a median age of 89 days. A VSD closure was achieved later in 64% of these patients after median 178 days. 30 days mortality rate after the first surgery was 13% in this group. The estimated 10-year-survival rate after the first surgery is 80,5% ± 4,7% showing no significant difference between the groups with and without MAPCAs (p > 0,999). Median intervention-free interval (surgery and transcatheter intervention) after VSD closure was 1,7 ± 0,5 years [95% CI: 0,7-2,8 years]. A VSD closure could be achieved in 79% of the total cohort. In patients without MAPCAs this was possible at a significant earlier age (p < 0,01). Although patients without MAPCAs predominantly underwent single stage full correction at newborn age, the overall mortality rate and the interval until reintervention after VSD closure did not show significant differences between the two groups with and without MAPCAs. The high rate of proven genetic abnormalities (40%) with non-cardiac malformations did also pay its tribute to impaired life expectancy.

Long-Term Follow-Up of a Nonprogressive Left Main Coronary Artery Fistula to Right Atrium

Coronary artery fistula is a rare cardiac abnormality, occurring more frequently in young patients and treated with cardiac surgery or percutaneous interventions in most cases. We present the case of a 63-year-old man with an incidental diagnosis of coronary artery fistula, treated with conservative strategy. (Level of Difficulty: Intermediate.)