Time Of Surgery Research Articles

Semiconstrained Distal Radioulnar Joint Arthroplasty: Functional Outcomes and Complications

Abstract Background: The semiconstrained distal radioulnar joint (DRUJ) prosthesis (Aptis Medical, Louisville, KY) is an option in the treatment of refractory DRUJ pathology that has shown promising results. Purpose: This study aims to evaluate the short- to midterm functional outcomes, complications, and factors affecting outcomes of semiconstrained DRUJ arthroplasty. Methods: We retrospectively reviewed 47 DRUJ arthroplasty procedures (on 46 consecutive patients) from a single surgeon between 2010 and 2022. Demographic data, range of motion, grip strength, and patient-reported outcome measures (PROMs: Quick Disability of the Arm, Shoulder, and Hand; Patient-Rated Wrist Evaluation; modified Mayo Wrist Score [mMWS]; and visual analog scale [VAS] for pain) were collected. Complications were classified as major (requiring surgery) or minor (treated conservatively). Results: The average follow-up was 3.37 years (standard deviation, 3.51; range, 0.04–15.62 years). A total of 30% of patients (n = 14) were followed for more than 5 years. Postoperatively, supination significantly increased and VAS pain scores improved significantly. Patients also experienced improved function in the operative wrist as assessed by the mMWS. Patients with prior DRUJ and/or triangular fibrocartilage complex surgery were more likely to have additional diagnoses at the time of definitive surgery and our postoperative outcomes varied based on prior surgery and additional diagnoses, with a trend toward higher pain levels and worse PROMs. The overall complication rate was 17%, with one major complication consisting of a posttraumatic periprosthetic ulna fracture. All other complications were minor. Implant survival was 100%. Conclusion: Semiconstrained DRUJ arthroplasty significantly improves pain levels and functional outcomes at short- to midterm follow-up. Patients who had undergone previous related surgeries were showed a trend toward higher postoperative pain levels and worse PROMs. Although complications were common, overall patient satisfaction and implant survivorship were high. Level of Evidence: IV

The impact of diurnal variations on emergence delirium following general anesthesia and surgery in children.

Emergence delirium (ED) is a widely recognized issue that prolongs mechanical ventilation and post-anesthesia care unit (PACU) resuscitation time, consequently increasing hospital costs and mortality. Postoperative disturbance in circadian rhythms, commonly leading to sleep disorders, has been identified as a significant risk factor for ED. However, the influence of surgery timing (morning vs. afternoon) on the incidence of ED in pediatric patients undergoing general anesthesia remains unknown. Patients aged 2-6 years who were operated on under general anesthesia with a bispectral index value between 50 and 60 were categorized based on anesthesia start time into either the morning surgery group (Group M, 8:00-12:00) or the afternoon surgery group (Group A, 13:00-17:00). The primary outcome was the post-extubation incidence of ED assessed by the Cornell Assessment of Pediatric Delirium (CAPD) score. Secondary outcomes included extubation time, duration of PACU stay, and adverse postoperative events and complications. We recruited a total of 560 patients, 280 in group M and 280 in group A. Compared to Group M, Group A exhibited a significantly higher incidence of ED (p < 0.001), elevated CAPD scores (p < 0.001), and prolonged PACU stays (p < 0.001). Notably, there was no significant difference in extubation time and anesthesia-related adverse events or other postoperative complications between the groups. Our study highlights that the time of surgery significantly affects the incidence of ED, CAPD scores, and PACU stay duration in children. Further validation of these findings may guide future strategies to reduce ED.

Comparative clinical efficacy of “Figure-8” Banding and double-row anchor suture-bridge fixation in arthroscopic management of tibial intercondylar eminence avulsion fractures

ObjectiveThe objective of this study is to assess and compare the clinical efficacy of “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures.MethodA retrospective analysis was conducted on the medical records of 42 patients who underwent arthroscopic surgery for tibial intercondylar eminence fractures at our institution from June 2017 to June 2022. This cohort included 20 cases treated with “Figure-8” banding and 22 cases managed using double-row anchor suture-bridge fixation. Comparative assessments were made regarding operative duration, duration of fracture consolidation, postoperative knee joint range of motion, joint stability as assessed by the Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) functional score for both treatment groups.ResultsThe mean follow-up duration was 13.8 months. The analysis indicated that the double-row anchor suture-bridge group had a significantly longer operative duration compared to the “Figure-8” banding group (p < 0.05). Postoperative computed tomography (CT) scans confirmed successful reduction in both groups, with fracture consolidation achieved within an average of three months. Both groups showed significant improvements in postoperative knee range of motion, joint stability, and functional scores compared to preoperative measurements (p < 0.05). During the initial two-month post-surgery, the double-row anchor suture-bridge group demonstrated superior knee joint range of motion and functional scores compared to the “Figure-8” banding group (p < 0.05); however, these differences were not statistically significant beyond three months post-surgery (p > 0.05). By the one-year postoperative mark, joint stability outcomes were comparable between the two treatment groups (p > 0.05).ConclusionBoth “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures can achieve precise reduction and stable fixation. In addition, the figure-8 suture group has the characteristics of shorter surgery time and less cost. Notably, early postoperative knee function appears to be superior with double-row anchor suture-bridge fixation compared to “Figure-8” banding.

Kinematic Changes throughout Childhood in Youth with Cerebral Palsy: Influence of Age and Orthopaedic Surgery.

Abnormal gait kinematics are common in youth with cerebral palsy (CP), but prior studies have not analyzed their longitudinal change throughout childhood. This study examines how age and orthopaedic surgery influence gait kinematics throughout childhood in those with ambulatory CP. In this institutional review board-approved prospective cohort study, children with spastic CP (GMFCS I-III) were recruited at age 17-40 months. Instrumented gait analysis was performed at 3-year intervals from age 4 to 21 years, collecting longitudinal kinematic data in bare feet at a self-selected speed. The change in Gait Profile Score (ΔGPS) between each pair of gait analyses (intervals) was analyzed by age distribution (<10, 10-15, ≥15 years) and by presence/absence of orthopaedic surgery. The study included 31 children (GMFCS: I [13], II [14], III [4]). A baseline instrumented gait analysis was performed at age 5.8 ± 1.6 years with subsequent analysis at 2.5 ± 1.3-year intervals. Examining ΔGPS from baseline to final outcome, 87% of limbs were improved/unchanged; 298 intervals of ΔGPS were analyzed and classified as nonsurgical or surgical. Analysis revealed greater GPS improvement in intervals with surgery versus intervals without (p = 0.0004). Surgical intervals had significantly greater GPS improvement in the <10- vs. >15-year-old groups, p = 0.0063. Improvement in gait kinematics in children with CP is significantly influenced by age and timing of orthopaedic surgical intervention for gait correction, and was most pronounced for children <10 years old. Although surgery was associated with improved outcomes in all age groups, these improvements were significantly less for children >10 years old. These results reinforce the importance of considering the timing of orthopaedic surgery.

AUDIT TO EVALUATE CURRENT RADIOTHERAPY (RT) PLANNING PATHWAY: COULD CURRENT PRACTICE BE IMPROVED BY THE TIMING OF MAGNETIC RESONANCE IMAGING (MRI)?

Abstract AIMS To evaluate the current guidance for glioblastoma (GBM) and primary brain radiotherapy (RT) planning. Current practice in this centre utilises pre and post-surgical MRI for RT target delineation. This study aims to explore the practicality and impact of scheduling an RT planning-specific MRI no more than 2 weeks before RT treatment start date (TSD). Time from surgery to RT TSD will also be explored. METHOD Fifty GBM patients, treated between August 2022 and October 2023, were audited retrospectively. Included patients were treated with radical intent and must have had surgery or biopsy. Age, gender or performance status (PS) were excluded from audit criteria. Age of MRI used for RT planning and surgery to TSD was noted. RESULTS Early results showed that the average age of MRI used for RT planning was 7 weeks old and Surgery to TSD was 7 weeks. A new pathway was introduced after 37 patients as these results were considered unacceptable. The new pathway included 1 reserved MRI appointment and one reserved RT Mask/CT appointment per week. 13 patients’ pathways were audited after introduction of the new pathway. The results showed that the average age of MRI used for RT planning was 2 weeks old and surgery to TSD was 6 weeks. CONCLUSION Limitations of the audit included disparity between number of patients before and after introduction of the new pathway. This was because of the time limitation for completion of the study. Improvement was seen in timing of MRI to TSD. However, the small improvement in timing of surgery to TSD was impacted by human factors rather than organisational influence, for example, surgical deconditioning, delays for wound healing and patient choice. This study has shown that the ideal timing of MRI can be achieved.

Epidemiological profile of patients undergoing hypospadias correction surgery at a hospital in Recife, Brazil, between 2022 and 2023

Problem: Hypospadias is the second most common genital anomaly after undescended testicles, occurring in approximately 1 in every 250 male newborns. Objectives: The present paper aims to evaluate the surgeries performed to hypospadias repair in a hospital in Recife city from March 2022 to March 2023. Methodology: A retrospective, descriptive study with a quantitative approach with secondary data from medical records. The study population consisted of 97 childrens and 99 surgeries. Results: The results showed that 49.5% of the patients presented with distal hypospadias. The most commonly used technique was Bracka, representing 31.3% of the cases. The mean age of the patients at the time of the first surgery was 5 to 9 years. Of the sample, 24.2% of the patients had complications, 41.7% of which were due to urethrocutaneous fistula. Conclusion: It was concluded that the age at the time of the first surgery was higher than that indicated in the literature. There was a slight prevalence of distal hypospadias to proximal hypospadias, evidencing a demand for complex hypospadias in this hospital.

The Importance of Patient Systemic Health Status in High-Grade Chondrosarcoma Prognosis: A National Multicenter Study

Background: Due to the relatively advanced age and high mortality rate of patients with high-grade chondrosarcoma (CS), it is important to holistically assess patient- and tumor characteristics in multidisciplinary team and shared decision-making with regard to treatment options. While current prognostic models include multiple tumor and treatment characteristics, the only patient characteristics that are commonly included are age and gender. Based on clinical experience, we believe that factors related to patient preoperative systemic health status such as the American Society of Anesthesiologists (ASA) score may be equally important prognostic factors for overall survival (OS). Methods: A retrospective nationwide cohort study was identified from four specialized bone sarcoma centers in The Netherlands. Patients with a primary CS grade II, III, and dedifferentiated CS were eligible. Prognostic factors including age at presentation, gender, ASA score, CVD, tobacco use, BMI, histological tumor grade, tumor size, pathological fracture, presentation after unplanned excision, type of surgery and surgical margin were evaluated. The outcome measure was OS at the time of surgery. The Kaplan–Meier methodology was employed to estimate OS; a log-rank test was used to assess the difference in survival. To study the impact of prognostic factors on OS, a multivariate Cox proportional hazard regression model was estimated. Results: In total, 249 patients were eligible for this study, and 89 were deceased at the end of follow-up. In multivariate analysis, histological grade (HR 2.247, 95% CI 1.334–3.783), ASA score III (HR 2.615, 95% CI 1.145–5.976, vs. ASA I), and age per year (HR: 1.025, 95% CI 1.004–1.045) were negatively associated with OS. No association was found between tobacco use, BMI, gender or cardiovascular disease and OS in this cohort. Pathological fracture and tumor size were only associated with OS in univariate analysis. Conclusions: This multicenter study is the first on sarcomas to include ASA in a prognostic model. Results show that ASA score as a proxy for patients’ systemic health status should be included when providing a prognosis for patients with a high-grade primary CS, besides the conventional risk factors such as tumor grade and age. Specifically, severe systemic disease (ASA score III) is a strong negative predictor. Conversely, we found no difference in OS between ASA scores I and II. These findings aid multidisciplinary team and shared decision-making with regard to these complex sarcoma patients that often require life-changing surgeries. Level of Evidence: Prognostic level III. See the instructions for authors for the complete description of levels of evidence.

Determination of Quality Indicators for Microvascular Grafts in Cranio-Maxillofacial Surgery-A Retrospective Analysis of 251 Free Flaps.

The use of microvascular grafts is the gold standard in oral and maxillofacial surgery for the reconstruction of soft tissue and bony and combined defects. Graft loss is one of the most serious complications in the field of reconstructive surgery. A comprehensive analysis of factors influencing this is, therefore, essential. This hypothesis-generating study analyzed 251 patient cases of oral and maxillofacial surgery at the University Hospital Düsseldorf from 2016 to 2020 regarding patient- and therapy-specific parameters for their impact on graft survival. Statistically significant influencing factors were found among the 80 parameters examined: treatment with antiplatelet medication and a BMI ≥ 24.5 at the time of surgery had a positive influence on graft survival, while existing diabetes mellitus, atrial fibrillation, tracheostomy, and a longer operation time had a statistically relevant negative influence. This work demonstrates the relevance of patient-specific risk stratification and the need for further research to develop a valid risk profile. Identifying high-risk patients with medium-sized defects, where alternatives to microvascular reconstruction are available, appears to be crucial for the clinical outcome.

Imminent risk of LVEF decline in asymptomatic patients with primary mitral regurgitation.

2020 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines state that the ideal time for mitral valve surgery in primary mitral regurgitation (PMR) is when the LV approaches but has not yet reached echocardiographic LV ejection fraction (EF) < 60% or LV end-systolic dimension (ESD) > 40 mm. However, it is difficult to know the imminent risk of crossing this threshold when the surgical outcome is less optimal. Using machine learning and statistical models, we have shown that cardiac magnetic resonance (CMR) LV sphericity index (SI) and LV mid circumferential strain rate (SRcirc) added to LVEF and LVESD predict LVEF < 50% after mitral valve surgery. Here we test the hypothesis that these CMR features predict LVEF < 60% in asymptomatic PMR patients at 18 months. 33 asymptomatic PMR patients with moderate to severe mitral regurgitation had CMR with tissue tagging at baseline and every 6 months for 18 months. Two types of models were employed to predict LVEF < 60% at 18 months: a model using CMR features at a single time point (e.g., baseline) and a model utilizing repeated measurements over time. CMR LVEF decreased below 60% in 13 patients over 18 months. LVEF varied over time with an inverse relation to mean arterial pressure and mean end-systolic wall stress. Random Forest models utilizing LV SI, LV mid SRcirc, LVESD, and LVEF at a single time point (baseline) had a predictive accuracy of 64%. LV SI, LV mid SRcirc, LVESD and LVEF at baseline, 6, and 12 months achieved a higher predictive accuracy of 79%, improved sensitivity from 57% to 85% than baseline alone and identified a threshold of CMR LVEF 63%-64% signaling LVEF < 60%. The variability of LVEF due to blood pressure dependence may require a longitudinal study that incorporates LVEF, LVESD, SRcirc at multiple time points to identify the threshold at which LVEF is at risk for decline to less than 60%.

Classification of Emerging Scoliosis in Congenital Scoliosis After Hemivertebra Resection and Short Segmental Fusion.

Emerging scoliosis (ES) is a rare phenomenon after hemivertebra (HV) resection and short segmental fusion. Since the introduction of the ES, there have been rare in-depth studies. The aim of the present study was to further analyze the characteristics, risk factors, treatment, and prognosis of ES. A retrospective study analyzed patients with congenital scoliosis due to a single HV who underwent posterior correction and short fusion from 2002 to 2022. ES was defined as a Cobb angle ≥20° from its initial value and an apical vertebra located ≥2 levels away from the fusion region. ES patients and non-ES patients were matched at a 1:2 ratio. Both demographics and radiological parameters were compared. Univariate analysis and multivariate logistic analysis were used to identify the risk factors of ES. Among 261 patients, 13 patients (5.0%) experienced ES. There were eight females and five males. The mean age of the ES patients at the time of primary surgery was 6.6 ± 3.7 years old (2.0-13.2 years old), with a mean follow-up of 64.2 ± 47.9 months (12-156 months). The ES could be further divided into three types: balance-related ES, complication-related ES, and separated ES. There were three balance-related ESs, six complication-related ESs, and four separated ESs. At the last follow-up, six patients were under observation, six patients underwent brace treatment, and one patient underwent revision surgery. Multivariate logistic analysis showed that the magnitude of postoperative compensatory curve (CC) was an independent risk factor for ES (OR = 1.172, p = 0.014). ES is an extraordinary phenomenon after HV resection and short fusion, and it can be divided into three types. The magnitude of postoperative CC was an independent risk factor for ES. According to the severity of ES, observation, brace, or surgery can be chosen.

Do the results of the OXYGEN trial change if analyzed as “as-treated?”: A secondary analysis of the OXYGEN trial

ObjectiveTo determine if the results of the OXYGEN trial changed using an “as-treated” approach instead of the original “intention-to-treat” approach. The multi-center randomized controlled OXYGEN trial aimed to determine the effectiveness of high FiO2 in decreasing infection rates for high-risk tibial plateau, tibial pilon, and calcaneus fractures. MethodsA secondary analysis of a multi-center randomized controlled trial conducted at 29 US trauma centers was performed. A total of 1231 patients aged 18–80 years with tibial plateau, tibial pilon, or calcaneus fractures thought to be at elevated risk of infection were enrolled. Patients were randomly assigned to receive inspired oxygen at a concentration of 80 % FiO2 (treatment) or 30 % FiO2 (control). Adherence was defined using two different criteria. Criterion 1 required at least 80 % of the surgery time ≤40 % FiO2 for the control group or ≥70 % FiO2 for the treatment group. Criterion 2 required at least 80 % of surgery time within 20–40 % (control) or 70–90 % FiO2 (treatment). The primary outcome was surgical site infection (SSI) within 182 days of definitive fracture fixation. Secondary outcomes were deep and superficial surgical site infections within 90, 182, and 365 days of definitive fixation. ResultsUnder Criterion 1, the primary outcome occurred in 7 % (38/523) and 10 % (49/471) of patients in the treatment and control groups, respectively (p = 0.10). Deep infection occurred in 30 (6 %) treatment and 30 (6 %) control patients (p = 0.75). Superficial infection occurred in 9 (2 %) treatment and 20 (4 %) control patients (RR, 0.41; p = 0.03). Using Criterion 2, the primary outcome occurred in 7 % (36/498) of treatment and 10 % (48/468) of control patients (p = 0.12). Deep infection occurred in 28 (6 %) treatment and 29 (6 %) control patients (p = 0.81). Superficial infection occurred in 9 (2 %) treatment and 20 (4.3 %) control patients (RR = 0.43; p = 0.03). ConclusionsWhen re-analyzing based on which patients actually received high or control levels of perioperative oxygen fraction, the results are somewhat consistent with the original “intent-to-treat” analysis. Specifically, high perioperative oxygen lowered the risk of superficial SSI but did not affect deep infections.

NODESAFE Nomogram: A Novel Score System to Predict Lymph Node Involvement at the Time of Nephrectomy or Nodal Recurrence in Nonmetastatic Renal Cell Carcinoma

ObjectiveWe sought to develop a preoperative nomogram called NODESAFE (NODE SAFEty) to predict nodal involvement (NI) at time of surgery or subsequent follow up in localized renal cell carcinoma (RCC), as the role of lymphadenectomy in localized RCC remains controversial. MethodsWe conducted a multicenter retrospective analysis of RCC patients who underwent primary surgical resection. Patients with clinical metastasis at presentation were excluded. NI was defined as presence of histological RCC with lymphadenectomy at time of surgery, or subsequent development histologically proven NI. The dataset was divided into training (70%) and testing subsets to facilitate model evaluation which was constructed through a stepwise multivariable logistic regression (MLR) model. Accuracy was tested with receiver operator characteristic estimated area under the curve (AUC). ResultsTotal 3308 patients (2221 [67.1%] male) met inclusion criteria. During follow-up 25 patients (0.76 %) experienced nodal recurrence, and 22/25 were preoperatively classified as cN0. In our cohort, 112 (3.4%) patients had clinical lymphadenopathy preoperatively (cN1), and 34/112 were pN1. The following covariates were found to be statically significant on a MLR model: hypertension (Odds ratio [OR] 3.35, < .001), Charlson Comorbidity Index ≥ 5 (OR 1.93 P = .025), tumor size ≥ 6 cm (OR 2.63, P = .001), tumor necrosis at CT scan (OR 1.83, P = .036), cN1 (OR 5.59, P < .001) and CRP ≥ 8.5 mg/L (1.96, P = .018). Testing the prediction performance of the model in the validation set AUC of the model was 0.89. NODESAFE demonstrated a sensitivity of 83.9%, specificity of 86.1% and 99.1% negative predictive values using a 4% threshold probability. ConclusionCombining clinical features, serum biomarkers and radiographic findings, we developed a model capable of predicting NI with high degree of accuracy. NODESAFE may refine clinical decision making with respect to the performance of lymphadenectomy at the time of surgery, postsurgical surveillance, and spur consideration for adjuvant therapy.

Prediction of the risks of developing clinically significant frontal imbalance in surgical treatment of severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve

Objective. To create a multifactorial model for predicting the risks of developing clinically significant frontal imbalance in surgical treatment of severe idiopathic scoliosis based on the identification of predictors influencing the main clinical parameters of trunk asymmetry.Material and Methods. The results of surgical treatment of 288 patients with severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve of types 1, 2, 3 according to Lenke (mean 97.6° ± 15.5° according to Cobb) who underwent surgery in 1999–2019 using posterior segmental instrumentation with hook, hybrid and transpedicular fixation, were analyzed. There were 243 female (84.4 %) and 45 male patients (15.6 %). The average age of patients at the time of surgery was 15.3 [10–39] years. The average postoperative follow-up period was 3.5 [2.0–19.5] years. The analysis included clinical and radiological data obtained in the preoperative, postoperative and late postoperative periods. Predictors of the occurrence of frontal imbalance (the distance from the plumb line to the navel and intergluteal fold more than 15 mm, the tilt of the shoulder girdles more than 5° and the tilt of the scapula more than 15°) were identified by building single- and multivariate logistic regression models.Results. In the total cohort, 41 (14.2 %) patients with clinically significant frontal imbalance were identified, including 10 (3,0 %) – with an increase in the distance from the plumb line to the umbilicus of more than 15 mm, 12 (4.2 %) – with an increase in the distance from the plumb line to the intergluteal fold of more than 15 mm, 8 (2.8 %) – with a shoulder girdle tilt of more than 5°, and 11 (3.8 %) – with a scapular tilt of more than 15°. A significant predictor of the risk of developing frontal imbalance was determined as postoperative thoracic scoliotic curve of more than 63°. Multiplicative predictors of the risk of frontal imbalance were identified: postoperative increase in the distance from the plumb line to the umbilicus by more than 15 mm and a tilt of the shoulder girdles by more than 5° with a sensitivity of 88.9 % and 100.0 %, and a specificity of 89.5 % and 100.0 %, respectively (p &lt; 0.001).Conclusion. Identification of multiplicative predictors of the risk of frontal imbalance allows predicting the risk of increasing the distance from the plumb line to the navel by more than 15 mm and the risk of shoulder girdle tilt by more than 5°. To eliminate the risk of frontal imbalance, it is necessary to strive for maximum correction of the thoracic scoliotic curve. When planning surgical treatment using transpedicular fixation for the correction of severe thoracic scoliosis, it is necessary to take into account the patient’s gender and the presence of concomitant neurosurgical, cardiological and pulmonological pathology to prevent shoulder girdle imbalance.

Outcomes of open reduction for hip dislocations in children with connective tissue disorders.

While children with hypermobility and/or ligamentous laxity due to coexisting connective tissue disorders might be expected to have worse outcomes after open reduction for hip dislocations, there is minimal prior research on this topic. All open reduction surgeries for hip dislocations performed at a single urban, tertiary-care children's hospital from 2009 to 2023 were reviewed retrospectively. Those with connective tissue disorders secondary to a diagnosed syndrome or genetic disorder were included. Patients with <1 year of follow-up or hip instability in the setting of Trisomy 21 were excluded. Clinical and radiographic data was collected. Instances of re-dislocation, proximal femoral growth disturbance, residual acetabular dysplasia, and arthrofibrosis were recorded. Twenty-three hips (15 patients) were included. Mean age at the time of surgery was 19.6 months (Range: 8.2-36.0 months), and mean follow-up was 4.3 years. The most common connective tissue disorder condition included was Ehlers-Danlos syndrome (13%). A majority of open reductions were performed via an anterior approach (96%). Seven hips (30%) underwent a concomitant pelvic osteotomy without femoral osteotomy and seven hips (30%) underwent both pelvic and femoral osteotomies. Twenty-two hips (96%) were International Hip Dysplasia Institute grade 1 at the final follow-up. Re-dislocation occurred in four hips (17%); eight hips (35%) demonstrated residual acetabular dysplasia, five hips (22%) demonstrated proximal femoral growth disturbance, and nine hips (39%) developed stiffness postoperatively. Patients with connective tissue disorders and ligamentous laxity have comparable rates of residual acetabular dysplasia, proximal femoral growth disturbance, and (surprisingly) stiffness as typical developmental dysplasia of the hip following open hip reduction surgery. Although the re-dislocation rate in the connective tissue disorders group was approximately 2-3 times higher, the difference did not reach statistical significance. Given that the study was limited by a low sample size, however, it is possible that the findings of no difference in residual acetabular dysplasia and proximal femoral growth disturbance were potentially due to a lack of power. IV.

Waiting times spillovers in a National Health Service hospital network: a little organizational diversity can go a long way

BackgroundThe objective of this study is to assess if waiting times for elective surgeries within the Portuguese National Health Service (NHS) are influenced by the waiting times at neighboring hospitals. Recognizing these interdependencies, and their extent, is crucial for understanding how hospital network dynamics affect healthcare delivery efficiency and patient access.MethodsWe utilized patient-level data from all elective surgeries conducted in Portuguese NHS hospitals to estimate a hospital-specific index for waiting times. This index served as the dependent variable in our analysis. We applied a spatial lag model to examine the potential strategic interactions between hospitals concerning their waiting times.ResultsOur analysis revealed a significant positive endogenous spatial dependence, indicating that waiting times in NHS hospitals are strategic complements. Furthermore, we found that NHS contracts with private not-for-profit hospitals not only reduce waiting times within these hospitals but also exert positive spillover effects on other NHS hospitals.ConclusionsThe findings suggest that diversifying the organization of the NHS hospital network, particularly through contracts with private entities for marginal patients, can significantly enhance competitive dynamics and reduce waiting times. This effect persists even when patient choice is confined to a small fraction of the patient population, highlighting a strategic avenue for policy optimization in healthcare service delivery.

Optimizing the role of scrub nurses during robotic surgery console time

At our institution, scrub nurses leave the surgical field during the console time for robotic surgeries to attend to other duties. The first assistant then assumes their responsibilities, allowing for efficient use of staff time and resources. This practice improves teamwork and can be presented as a cost-saving measure for hospital administrations.

Clinical efficacy analysis of endoscopic band electrocision ligation surgical method in the treatment of small submucosal tumors of the gastric fundus

Background The aim of this study was to compare and analyze the clinical effects of endoscopic submucosal dissection (ESD) and endoscopic band electrocision ligation (EEL) in the removal of gastric submucosal tumors (SMTs). Method We analyzed the clinical data of 130 patients with gastrointestinal SMTs (diameter ≤10 mm) who underwent endoscopic resection, including 62 cases in the EEL group and 68 in the ESD group, and compared indicators such as surgical time, intraoperative and postoperative complications, postoperative hospital stay, and surgical cost, between the EEL and ESD group. Results EEL surgery time (8.9 ± 1.1 min) was significantly shorter than the ESD group (62.3 ± 2.8 min) (p < .05), EEL surgery cost (5126.8 ± 26.5 yuan) was significantly lower than the ESD group (15721.3 ± 39.6 yuan) (p < .05), and intraoperative blood loss was also markedly lower in the EEL group (5.6 ± 1.7 ml) compared to the ESD group (42.3 ± 3.5 ml) (p < .05). There was no statistically significant difference in postoperative hospitalization time or postoperative complication incidence between the two groups (p > .05). Conclusions In treating gastric muscular, mucosal, or submucosal tumors with a diameter of less than 10 mm, the EEL surgical method was superior to the ESD surgical method in terms of surgical time, intraoperative blood loss, and cost. There was no difference in hospital stay and postoperative complication rate between the two methods, which was worthy of clinical application.

Evaluating the Impact of the Level of Robustness in Operating Room Scheduling Problems.

Managing uncertainty in surgery times presents a critical challenge in operating room (OR) scheduling, as it can have a significant impact on patient care and hospital efficiency. Objectives: By incorporating robustness into the decision-making process, we can provide a more reliable and adaptive solution compared to traditional deterministic approaches. Materials and methods: In this paper, we consider a cardinality-constrained robust optimization model for OR scheduling, addressing uncertain surgery durations. By accounting for patient waiting times, urgency levels and delay penalties in the objective function, our model aims to optimise patient-centred outcomes while ensuring operational resilience. However, to achieve an appropriate balance between resilience and robustness cost, the robustness level must be carefully tuned. In this paper, we conduct a comprehensive analysis of the model's performance, assessing its sensitivity to robustness levels and its ability to handle different uncertainty scenarios. Results: Our results show significant improvements in patient outcomes, including reduced waiting times, fewer missed surgeries and improved prioritisation of urgent cases. Key contributions of this research include an evaluation of the representativeness and performance of the patient-centred objective function, a comprehensive analysis of the impact of robustness parameters on OR scheduling performance, and insights into the impact of different robustness levels. Conclusions: This research offers healthcare providers a pathway to increase operational efficiency, improve patient satisfaction, and mitigate the negative effects of uncertainty in OR scheduling.

A Comparative Study of Hand-Sewn and Stapled Anastomosis in Gastrointestinal Surgeries.

Background Bowel anastomosis is a key part of gastrointestinal surgery where two sections of the intestines are connected. It is a critical step as it restores the digestive tract's continuity after removing damaged or diseased bowel. Stapler devices are a new method that helps connect bowel loops faster and with less tissue damage. This study aimed to evaluate and compare the safety and effectiveness of stapled anastomosis versus hand-sewn anastomosis in surgeries involving the bowel. Methods In this prospective non-randomized study, the study population included 60 patients with various gastrointestinal surgeries admitted to our institution from August 2022 to June 2024 within a single unit. The inclusion criteria included all patients aged over 18 years who underwent surgeries such as gastrojejunostomy, hemicolectomy, and small bowel resection with anastomosis. The exclusion criteria were age under 18, pregnancy, and immunocompromised states. Patients were divided into two groups based on how their digestive tract was reconstructed: 28 had stapled anastomoses and 32 had hand-sewn anastomoses, either as elective or emergency surgery. We examined multiple outcomes such as surgery duration in hours, time until bowel function returned post surgery, length of hospital stay in days, anastomotic leak rate, albumin levels to leak rate, post-surgery pain, and surgical site infection (SSI) rate for the two groups. Southampton wound grading system and the visual analog scale (VAS) were used to assess the SSI and pain score, respectively. Results When comparing the operation time for the suture and staple groups among the elective cases, the p-value was significant (0.02), with 15 patients having prolonged surgery in the suture group compared to only five in the staple group. Regarding the time until the return of bowel sounds post surgery, the p-value was significant (0.02) for elective cases in the two groups, with nine patients having their bowel sounds returning after the third postoperative day (POD) in the suture group. When comparing the duration of stay in the hospital for elective cases for the staple and suture groups, the p-value was significant (0.04), with eight patients staying after the seventh POD in the suture group. When comparing the leak rates for the two groups for elective cases, the p-value was significant (0.04), with four leaks in the suture group and no leaks in the staple group. On comparing the association between the albumin level and anastomotic leak, the p-value was significant at 0.001 and 0.0006 for the suture and staple groups, respectively, with more leaks associated with an albumin level of <3 mg/dl. When comparing pain scores of the suture and staple groups separately in elective and emergency settings, the p-values were both 0.4, which is not significant. Among the elective cases comparing SSIs for the suture and staple groups, the p-value was significant (0.04), with six patients having SSIs in the suture group compared to one patient in the staple group. Among the emergency cases, when comparing SSIs for the suture and staple groups, the p-value was not significant (0.1). Conclusion In elective surgeries, stapled anastomosis reduces surgery time, accelerates bowel function recovery, enables earlier discharge, and lowers anastomotic leak rates compared to sutures. The staples group showed no difference from sutures in the leak rate to albumin levels and pain while offering superior SSI prevention.

Risk factors for mortality in periprosthetic femur fractures about the hip-a retrospective analysis.

Fractures around the hip are known to be an indicator for fragility and are associated with high mortality and various complications. A special type of fractures around the hip are periprosthetic femur fractures (PPF) after Total Hip Arthroplasty (THA). The aim of this study was to investigate the mortality rate associated with PPF after THA and to identify risk factors that may increase it. Consecutive patients (N = 158) who were treated for a PPF after THA in our university hospital between 2010 and 2020 were identified and mortality was assessed using the residential registry. Univariate (Kaplan-Meier-Estimator) and multivariate (Cox-Regression) statistical analysis was performed to identify risk factors influencing mortality. One-year-mortality rate was 23.4% and 2-year mortality was 29.2%. Mortality was significantly influenced by age, gender, treatment, type of comorbidity and time of surgery (p < 0.05). Surgical treatment during regular working hours (8 to 18h) reduced mortality by 53.2% compared to surgery on call (OR: 0.468, 95% CI 0.223, 0.986; p = 0.046). For every year of age, mortality risk increased by 12.9% (OR: 1,129, 95% CI 1.078, 1.182; p < 0.001). The type of fracture according to the Vancouver classification had no influence on mortality (p = 0.179). Plate fixation and conservative treatment were associated with a higher mortality compared to revision arthroplasty (plate: OR 2.8, 95% CI 1.318, 5.998; p = 0.007; conservative: OR 2.5, 95% CI 1.421, 4.507; p = 0.002). Surgical treatment during regular working hours is associated with lower mortality compared to surgery outside these hours. In this retrospective cohort, time to surgery showed no significant impact on all-cause mortality, and revision arthroplasty was associated with lower mortality than conservative treatment or plate fixation. IV (Retrospective cohort study).