Type Of Surgery Research Articles

Cardiac surgery during wartime in Israel

BackgroundThe war that began on October 7th, 2023, has impacted all major tertiary medical centers in Israel. In the largest cardiac surgery department in Israel there has been a surprising increase in the number of open-heart procedures, despite having approximately 50% of surgeons recruited to military service. The purpose of this study is to characterize this increase in the number of operations performed during wartime and assess whether the national crisis has affected patient outcomes.MethodsThe study was based on a prospectively collected registry of 275 patients who underwent cardiac surgery or extracorporeal membrane oxygenation (ECMO) during the first two months of war, October 7th 2023 – December 7th 2023, as well as patients that underwent cardiac surgery during the same period of time in 2022 (October 7th, 2022 – December 7th, 2022).Results120 patients (43.6%) were operated on in 2022, and 155 (56.4%) during wartime in 2023. This signifies a 33.0% increase in open-heart procedures (109 in 2022 vs. 145 in 2023, p-value 0.26). There were no significant differences in the baseline characteristics of patients when comparing the 2022 patients to those in 2023. No significant differences between the two groups were found with regards to intraoperative characteristics or the type of surgery. However, compared to 2022, there was a 233% increase in the number of transplantations in the 2023 cohort (p-value 0.24). Patient outcomes during wartime were similar to those of 2022, including postoperative complications, length of stay, and mortality.ConclusionsPatients who underwent cardiac surgery during wartime presented with comparable outcomes when compared to those of last year despite the increase in cardiac surgery workload. There was an increase in the number of transplants this year, attributed to the unfortunate increase in organ donors.

High Demand for Psychological Support in Patients Who Have Periprosthetic Hip and Knee Joint Infections: An Analysis of 13,976 Patients

BACKGROUNDThere is only sparse knowledge on the psychological burden of patients who have periprosthetic joint infections (PJI). The aim of our study was to assess the need for psychological support following total joint arthroplasty of the hip and knee. A special focus was set on patients who had aseptic and septic complications. METHODSA total of 13,976 patients who underwent total hip (THA, n = 6,926) or total knee arthroplasty (TKA, n = 7,050) between January 1st, 2012 and December 31st, 2019 at a single institution were retrospectively evaluated for the postoperative need for a psychological consultation. Data was collected on age, sex, type of surgery, and indications for revision procedures. The need for a psychological consultation was assessed during the daily postoperative visits, which were further coordinated by two institutional psychologists. RESULTSThe average age was 68 years (range, 12 to 100), and there were 63.5% women. The overall rate of psychological consultations was 1.7%. Patients who had a septic indication for revision surgery had an 18.7-fold higher rate of postoperative psychological consultations compared to patients following primary surgery and a 5.4-fold higher rate compared to patients who had an aseptic indication. In detail, this rate was 1.0% in the primary subgroup, compared to 7.7% following revision arthroplasty (P < 0.001). In the revision subgroup, the rate was 17.9% for septic and 3.3% for aseptic revision arthroplasty cases (P < 0.001). Postoperative psychological consultations were twice as frequent in women (2.1%) compared to men (1.0%), P < 0.001. CONCLUSIONSThe present study raises awareness of the markedly high psychological burden in revision arthroplasty cases, in the view of the high estimated number of unknown cases. There is a significant correlation between PJI and the postoperative need for a psychological consultation, with women being at an even higher risk. Health care providers should aim at offering psychological support for patients who have a septic complication, with affected patients being at risk for psychological stress.

Salvage surgery and conversion surgery for patients with non-small cell lung cancer: A narrative review.

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related deaths. With the development of screening, patient selection and treatment strategies, patients' survival outcomes and living quality significantly improved. However, some patients still have local recurrence or residual tumors after receiving definitive therapies. Salvage surgery has been regarded as an effective option for recurrent or residual NSCLC, but its effectiveness remains undetermined. Furthermore, conversion surgery is a special type of salvage surgery for tumors converted from "initially unresectable" to "potentially resectable" status due to a favorable response to systemic treatments. Although conversion surgery is a promising curative procedure for advanced NSCLC, its concept and clinical value remain unfamiliar to clinicians. In this narrative review, we provided an overview of the safety and efficacy of salvage surgery, especially salvage surgery after sublobar resection in early-stage NSCLC. More importantly, we highlighted the concept and value of conversion surgery after systemic treatment in advanced NSCLC to gain some insights into its role in the treatment of lung cancer.

Upcoming Italian clinical practice guidelines on endoscopic bariatric treatment of overweight and obesity: design and methodological aspects.

Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guidelines is based on an extended work made by a panel of 44 members and a coordinator. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide the aims, reference population, and target health professionals. Clinical questions have been created using the PICO (patient, intervention, comparison, outcome) conceptual framework. We will perform systematic reviews, formal meta-analyses, and network meta-analyses for each PICO and critical outcomes aimed at assessing and rating the efficacy and safety of endoscopic bariatric procedures in comparison with either no interventions, lifestyle interventions, or approved anti-obesity treatments in trials with a follow-up of at least 52 weeks. For PICO on temporary endoscopic bariatric treatments, we will also consider RCT with a minimum duration of 6 months. The panel proposed 8 questions, organized into four domains: A. Indication for endoscopic bariatric surgery; B. Revisional surgery; C. Temporary gastric and duodenal-jejunal procedures; D. Endoscopic diagnosis/treatment of bariatric and metabolic surgery complications. These guidelines will apply to patients aged ≥ 14 years) with body mass index (BMI) ≥ 27 kg/m2 and requiring endoscopic bariatric surgery or endoscopic diagnostic and/or therapeutic procedures. The areas covered by the clinical questions included indications of endoscopic bariatric surgery, types of surgery, revisional surgery, and management of bariatric and metabolic surgery complications.

Factors Associated with Postoperative Recurrence in Stage I to IIIA Non-Small Cell Lung Cancer with Epidermal Growth Factor Receptor Mutation: Analysis of Korean National Population Data.

Recent development in perioperative treatment of resectable non-small cell lung cancer (NSCLC) have changed the landscape of early lung cancer management. The ADAURA trial has demonstrated the efficacy of adjuvant osimertinib treatment in resectable NSCLC patients; however, studies are required to show which subgroup of patients are at a high risk of relapse and require adjuvant epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment. This study evaluated risk factors for postoperative relapse among patients who underwent complete resection. Data were obtained from the Korean Association for Lung Cancer Registry (KALC-R), a database created using a retrospective sampling survey by the Korean Central Cancer Registry (KCCR) and the Lung Cancer Registration Committee. A total of 3,176 patients who underwent curative resection was evaluated. The mean observation time was approximately 35.4 months. Among stage I to IIIA NSCLC patients, the EGFR-mutant subgroup included 867 patients, and 75.2%, 11.2%, and 11.8% were classified as stage I, stage II, and stage III, respectively. Within the EGFR-mutant subgroup, 44 (5.1%) and 121 (14.0%) patients showed early and late recurrence, respectively. Multivariate analysis on association with postoperative relapse among the EGFR-mutant subgroup showed that age, pathologic N and TNM stages, pleural invasion status, and surgery type were independent significant factors. Among the population that underwent complete resection for early NSCLC with EGFR mutation, patients with advanced stage, pleural invasion, or limited resection are more likely to show postoperative relapse.

Comparison of thulium and holmium lasers with conventional transurethral bladder resection for non-muscle invasive bladder cancer

Introduction. The gold standard of treatment for intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) is transurethral resection of the bladder (TURB) in combination with intravesical therapy. However, this procedure may cause serious complications. At the same time, studies of various lasers for the treatment of NMIBC have demonstrated their safety and efficacy. Despite this, the topic has not yet been fully explored and is not widely practiced in clinical oncology, making further research necessary.Objective. To compare thulium and holmium lasers with conventional TURB for management of non-muscle-invasive bladder cancer (NMIBC).Materials &amp; methods. In our study, depending on the treatment approach, 84 NMIBC-patients were divided into three groups. Group 1 included 27 patients (34.14%), who underwent laser thulium bladder resection; group 2 included 25 patients (29.76%), who underwent laser holmium bladder resection, and group 3 included 32 patients (38.1%), who underwent standard TURB. Prior to surgery, all patients received a standard set of preoperative general clinical and instrumental examinations for bladder cancer, and the choice of surgical approach was based on informed patient consent, taking into account the benefits and risks of the three treatment options. All surgeries were performed in accordance with established protocols.Results. In the TURB group, the surgery time was the longest and totalled in 20.5 ± 7.4 min. Laser technologies reduce the surgery time to 16.3 ± 5.3 min for a holmium laser and to 14.7 ± 5.2 min for a thulium laser. Also, in groups 1 and 2, a shorter duration of postoperative bladder irrigation was noted (4.4 ± 1.8 and 4.7 ± 1.6 hours) and shorter periods of postoperative bladder catheterisation (1.5 ± 0.08 and 1.6 ± 0.08 days) compared to group 3, where these indicators were 16.4 ± 2.5 hours and 2.5 ± 0.13 days, respectively. Among patients undergoing either holmium or thulium surgery, a higher rate of disease-free survival has been noted. Independent prognostic factors that influence the prognosis of NMIBC in all groups include the type of surgery, history of bladder tumors, and pathological stage.Conclusion. The use of laser technology, such as thulium and holmium laser, in bladder wall resection for NMIBC shows promising results and provides a good clinical outcome that is comparable to (and in some cases, superior to) standard TURB.

An Inceptive Period of Gynecological Laparoscopic Surgery in Nepal Police Hospital – A Retrospective Cross-sectional Study

Introduction: Laparoscopy in gynecology has evolved historically from limited procedures like diagnostic laparoscopy and tubal ligations and now has developed to a multitude of advance gynecologic surgeries. The aim of this study was to review the early experience of gynecological laparoscopic surgery in Nepal police hospital. Methods: This is a retrospective study done in Nepal Police Hospital from April 14, 2018 to April 13, 2023. Data were obtained from the hospital records. All the laparoscopic Gynecological surgeries performed during this period were analyzed in terms of age group, entry technique, indication and type of surgical procedure, conversion to laparotomy and complications. Results: A total of 243 Gynecological laparoscopic surgeries were performed during the study period. The most common age group was between 26 to 30 years (24.69 %) and 31 to 35 years (17.69 %). The most common indication for laparoscopic surgery was adnexal cyst (36.21 %) and fibroid uterus (19.99 %). The most common surgery performed was cystectomy or Salpingo-oopherectomy for adnexal cyst (36.21 %) and Total Laparoscopic Hysterectomy (25.92 %). Conversion to laparotomy was 2.46 %. The incidence of major complication was 6.17 %. Conclusion: The increasing preference of laparoscopic surgery over the period of time in our institution indicates the improvement in surgical skills, satisfactory results and improved awareness of laparoscopic procedures among the patients.

Clinical characteristics and management outcome of acute infectious endophthalmitis.

This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE). This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded. In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21years, with a range of 1-88years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss. AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.

Screening for Cardiac Abnormalities in Asymptomatic Patients Undergoing low to Intermediate Risk Non-Cardiac Surgery

Abstract Background Perioperative cardiovascular complications are the predominant cause of morbidity and mortality in patients undergoing non cardiac surgery. Major cardiovascular and cerebrovascular complications, including death, myocardial infarction or stroke, occur in approximately 1 of every 33 hospitalizations for non-cardiac surgery. Objective To uncover hidden cardiac problems that may cause complications during and after non- cardiac major surgery. Patients and Methods This observational cross-sectional study was conducted on 250 asymptomatic patients coming to Ain Shams University Hospitals and police hospitals clinics for preoperative assessment to undergo low to intermediate risk non cardiac surgery. Results most of the study group were males (68%) with a mean age of 47 years. Diabetes and hypertension were found in 45% and 41% of patients respectively. Most patients had GIT operations (34%) followed by cataract extraction (14%), orthopedic operation was done in 11% of patients. clinical examination was normal in 98% of patients with 2% had AF and systolic murmur. Significantly abnormal ECG was found in 10% of patients. Preoperative significantly abnormal TTE was detected in 9% of patients. post-operative cardiovascular complications occurred in 7% of patients who had completely normal preoperative clinical, ECG and echocardiographic data. Most of these patients had orthopedic operations and hysterectomy. Conclusion The clinical and predictive value of routine preoperative ECG and echocardiography for major cardiac adverse events is limited especially in low-risk patients groups undergoing low to intermediate risk operations. However, it helps uncovering of hidden conditions that alter patient's plan of treatment. The type of surgery was an important factor for the occurrence of post-operative complications.

470 Survival Stratification After Proximal Femoral Fracture Surgery Using the Modified Glasgow Prognostic Score

Abstract Aim Proximal femoral fracture (PFF) after blunt trauma is common and significantly associated with mortality. A simple scoring system based on systemic inflammation, the modified Glasgow Prognostic Score (mGPS), has been shown to stratify survival in patients with malignant disease and we wished to assess its usefulness in the trauma cohort. Method Patient demographics, albumin, C-reactive protein (CRP), and survival data were retrospectively obtained from a previous local hip fracture audit of 278 adult (&amp;gt;18 years) patients whose PFFs were repaired between October 2012 and April 2014 at the Queen Elizabeth University Hospital, Glasgow. Follow-up was for 18 months allowing the generation of survival curves and univariate analysis using Kaplan-Meier and Log Rank analyses. Multivariate survival analysis and hazard ratios were calculated using Cox Regression. Results The median survival was 26.5 months with a 41.4% 1-year mortality. On univariate analysis, one year mortality was associated with advanced age (&amp;gt;80 years, p&amp;lt;0.0001), American Society of Anaesthesiology (ASA) score(p&amp;lt;0.0001), CRP (&amp;gt;10mg/L, p=0.027), Albumin (&amp;lt;35g/L, p=0.007), type of surgery (p=0.005) and mGPS (p=0.016). On multivariate analysis advanced age (p&amp;lt;0.001), male gender (p=0.016), ASA score (p&amp;lt;0.001) and mGPS (p=0.027) retained significance as predictive factors for 1-year mortality. A higher mGPS was associated with a shorter median survival (37.4, 27.6 and 24.0 months for mGPS 0, 1 and 2 respectively (p=0.048)). Conclusions This study demonstrated a statistically significant survival association with advanced age, ASA score, male gender and mGPS. This is the first study looking at mGPS as a predictive factor for one year mortality following PFF.

The Efficacy of Ultrasound Guided Bilateral Transversus Thoracic Plane Block for Postoperative Pain Control in Cardiac Surgery

Abstract Background Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of strategies intended to improve patients' experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. Aim of the Work The aim of the study was to evaluate the effect of postoperative bilateral US guided TTPB block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia. Patients and Methods This study is a randomized clinical trial study at Ain-shams University Hospitals, Cairo, Egypt. In our study, patients were randomly allocated into two groups with 40 patients in each group. Group 1 (study group) received TTP block., whereas Group 2(control group) received systemic analgesics. The two groups were compared regarding their demographic data (age, sex, body weight and height), A numerical rating scale (NRS) for sternal pain, morphin consumption during 24 hours after extubation and time of first rescue analgesia, heart rate and blood pressure in icu, time of extubation, ICU length of stay, total length stay of the hospital. Results Our study showed that when compared to general anesthesia with systemic opioids, TTPB block is associated with significantly better postoperative pain control. Conclusion Tranversus thoracic plaine block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.

960 Quality of Life Outcomes of Metabolic and Bariatric Surgery Tourism: A Single-Centre Survey-Based Study

Abstract Global obesity affects one in three adults, prompting increased demand for metabolic and bariatric surgery (MBS). Despite its effectiveness, limited access to MBS has led to more people seeking it through medical tourism for lower costs and shorter wait times. However, ethical concerns arise due to limited follow-up care and potential complications. This study compares the quality of life (QOL) of native MBS patients (n = 69) to those engaged in MBS tourism (n = 36) from 11 different countries, utilizing the Bariatric Quality of Life Index (BQLI). Conducted in Lahore, Pakistan, with 105 participants who had MBS in the last 3 years, the survey-based study aims to assess the impact of MBS tourism on QOL and the efficacy of bariatric surgery for weight loss. The study revealed no significant difference in the quality of life between MBS tourism participants and native patients (p &amp;gt; 0.05). Both cohorts experienced considerable weight reduction post-MBS (p = 0.00001). A higher total weight loss percentage (TWL%) correlated positively with increased BQLI scores (p = 0.01). Younger patients experienced significantly improved quality of life after MBS compared to their older counterparts (r = -0.3, p = 0.005). The TWL% exhibited a progressive increase as the months advanced post-MBS (r =0.3, p = 0.004). The type of bariatric surgery (SG, RYGB, OAGB, SADI) didn't significantly affect post-MBS quality of life (p &amp;gt; 0.05).

Role of CT Scan in Preoperative Evaluation of Bone Loss in Anterior Shoulder Instability Using the On Track and Off Track Concept

Abstract Purpose The purpose of this study was to assess the role of CT scan in preoperative evaluation of glenoid and humeral head bone loss in cases of recurrent anterior shoulder joint dislocation using on track and off track concept and whether it can be used to predict engagement during arthroscopy. Patients and Methods In the period from June 2019 to October 2022, this study was conducted in Ain Shams University hospitals including 40 cases with recurrent anterior shoulder dislocation. CT scan with 3D reconstruction was done to calculate the width of the glenoid track using the best fit circle method as well as the Hill Sachs interval. We used the on-track off-track method to predict engagement and these results were compared with the findings related to engagement seen during arthroscopy Results Using the on-track /off-track technique on CT images, 22 of the 25 engaging (off-track) lesions was predicted correctly (sensitivity, 88%).While 13 of the 15 cases that did not engage (on-track) was correctly predicted (specificity, 86.7%). Overall, the accuracy of the on-track off-track method was 87.5% with a positive predictive value (PPV) of 91.7% and negative predictive value (NPV) of 81.3%. The on-track /off-track method was found to be a significant predictor of engagement as there is no statistically significant difference (p = 0.18) between this method and arthroscopic findings. Conclusion Our study showed that using the on-track off-track method by CT scan can accurately assess the glenoid and humeral head bone losses seen in patients with anterior shoulder instability for predicting the presence of engagement, or off-track, lesions. This technique can be used for preoperative evaluation to help in deciding the type of surgical procedure performed on patients with anterior shoulder instability.

Quantification of Cephalometric Changes in Gonial Angle Morphology Following Facial Feminization Surgery.

Facial feminization surgery (FFS) is a type of gender-affirming surgery aimed at bringing masculine facial features more in line with typically feminine characteristics. Specifically, mandibular contouring can create a softer jawline and help create a more round, feminine face. As the popularity of FFS continues to increase, improving surgical techniques and patient satisfaction is imperative. However, no quantitative measurement system currently exists to measure these changes. In this study, the authors describe the use of a novel segmentation technique using computerized tomography imaging to quantify the bony changes that occur during gonial angle reduction. Further, authors utilize this technique to describe changes in a cohort of 13 patients, and how these changes correlate with patient satisfaction. The authors found that gonial angle volume and surface area significantly decreased, as well as the intergonial:interzygomatic ratio, with a smaller ratio associated with more feminine features. In addition, patient satisfaction significantly increased post-operatively both specifically regarding jawline appearance (P = 0.0014) and regarding overall social and psychological function (P = 0.0021 and P = 0.0032, respectively), as captured by the FACE-Q and World Health Organization Quality of Life (WHOQOL) surveys. Patients with greater changes in surface area reported greater improvements in WHOQOL psychological scores (P = 0.0086), and patients with greater changes in the intergonial:interzygomatic ratio reported greater improvements in WHOQOL social scores (P = 0.0299). Overall, our novel technique captures significant changes in gonial angle shape and can be applied to a wide range of future studies to improve the quality and accessibility of FFS.

Diabetic Foot Osteomyelitis Undergoing Amputation: Epidemiology and Prognostic Factors for Treatment Failure.

When treating diabetic foot osteomyelitis (DFO), it remains difficult to determine the presence of residual infection and the optimal treatment after bone resection. In this study, we aimed to investigate the clinical characteristics of and prognostic factors in patients with DFO undergoing amputation. This retrospective study involved 101 patients with DFO who underwent amputation. Data on their demographics, clinical characteristics, tissue culture, and surgery type were collected. Patients were grouped according to primary closure status and clinical outcome postamputation. A good outcome was defined as a successful complete remission, characterized by the maintenance of complete wound healing with no sign of infection at 6 months postamputation. Multivariate logistic regression analysis was performed. Outcomes according to surgery type were also analyzed. Staphylococcus aureus (17%) and Pseudomonas species (14%) were the most prevalent pathogens. Gram-negative bacteria were isolated from 62% of patients. In patients with primary closure, hemodialysis and ankle brachial index (ABI) <0.6 were associated with poor outcomes. In patients with DFO, ABI <0.6 was the only prognostic factor associated with treatment failure. Antimicrobial stewardship allows patients who underwent major amputation to reduce the duration of antibiotic therapy compared to those after minor amputation, although it did not contribute to reducing mortality. Peripheral artery disease and hemodialysis were associated with poor outcomes despite radical resection of the infected bone. Vigilant monitoring after amputation and antimicrobial stewardship implemented based on microbiological epidemiology, prognostic factors, and the type of surgery are important. A multidisciplinary team could assist in these activities to ensure treatment success.

Association Between Single-Injection Regional Analgesia and Postoperative Pain in Cardiac Surgery Patients – A Single-Center Retrospective Cohort Study

ObjectivesEffective pain control after cardiac surgery may facilitate recovery. This study aimed to assess the utilization and association of ultrasound-guided single-injection chest wall blocks with liposomal bupivacaine on postoperative pain scores and short-term opioid requirements after cardiothoracic surgery at a single institution. DesignRetrospective cohort study. SettingMidwestern academic hospital. ParticipantsAdult patients who underwent cardiothoracic surgery between July 1, 2020 and June 30, 2022. InterventionsUltrasound-guided single-injection chest wall block with liposomal bupivacaine. Measurements and Main ResultsOf the 1,038 patients included in this study, 301 (29%) received a perioperative nerve block for postoperative sternotomy pain, and 737 (71%) did not. Most of the single-shot blocks were bilateral parasternal intercostal plane blocks (n=294, 98%) performed post-induction before surgical incision (n=280, 93%). After adjusting for age, gender, ASA status, select comorbidities, and surgical procedure type, mean postoperative pain scores were not significantly different between groups in the immediate postoperative period at all time points assessed (12 hours ±2, 24 hours ±4, 48 hours ±8, and 72 hours ±12). Similarly, there was no difference in mean opioid requirements (milligram morphine equivalents) at 72 hours between groups (68.6 [95% CI, 56.3-83.4] vs. 62.9 [95% CI, 52.8-74.9], p = 0.195). ConclusionsIn this retrospective study, the implementation of single-shot chest wall nerve blocks with liposomal bupivacaine was not associated with decreased postoperative pain scores or opioid consumption at 72 hours in select cardiac surgical patients at one institution.

Gabapentin and Rapidity of Recovery Among Patients Undergoing Minimally Invasive Ambulatory Uro-Oncologic Surgeries.

Gabapentin has been used in enhanced recovery after surgery (ERAS) pathways for pain control for patients undergoing ambulatory uro-oncologic surgery; however, it may cause undesirable side effects. We studied the causal association between gabapentin and rapidity of recovery and perioperative pain management after minimally invasive uro-oncologic surgery. We identified 2397 patients ≤ 65 years undergoing prostatectomies or nephrectomies between 2018 and 2022; 131 (5.5%) did not receive gabapentin. We tested the effect of gabapentin use on time of discharge and perioperative opioid consumption, respectively, using multivariable linear regression adjusting for potential confounders including age, gender, BMI, American Society of Anesthesiologists score, and surgery type. On adjusted analysis, we found no evidence of a difference in discharge time among those who did vs did not receive gabapentin (adjusted difference 0.07 hours shorter on gabapentin; 95% CI -0.17, 0.31; P = .6). There was no evidence of a difference in intraoperative opioid consumption by gabapentin receipt (adjusted difference -1.5 morphine milligram equivalents; 95% CI -4.2, 1.1; P = .3) or probability of being in the top quartile of postoperative opioid consumption within 24 hours (adjusted difference 4.2%; 95% CI -4.8%, 13%; P = .4). We saw no important differences in confounders by gabapentin receipt suggesting causal conclusions are justified. Our confidence intervals did not include clinically meaningful benefits from gabapentin, when used with an ERAS protocol, in terms of length of stay or perioperative opioid use. These results support the omission of gabapentin from ERAS protocols for minimally invasive uro-oncologic surgeries.

Intravesical bupivacaine in reducing catheter-related bladder discomfort and lower urinary tract symptoms after transurethral surgery: A randomized controlled trial

ABSTRACT Introduction: The objectives of this study were to investigate the efficacy and safety of intravesical bupivacaine instillation in reducing catheter-related bladder discomfort (CRBD) and lower urinary tract symptoms (LUTS) after transurethral surgery. Methods: The study enrolled 100 American Society of Anesthesiologists (ASA) grade I–III patients aged ≥18 years undergoing transurethral resection of the prostate or transurethral resection of the bladder tumor, randomly assigned to Group B (intravesical bupivacaine) or Group S (saline). Double blinding was employed. Independent variables included demographics, surgery type, ASA grade, and intervention details. Dependent variables comprised CRBD severity, Patient Perception of Bladder Condition (PPBC), Pelvic Pain Urgency Frequency (PUF), Visual Analog Scale (VAS) for pain, need for additional analgesics, and International Prostate Symptom Score (IPSS). SPSS version 19 was used for analysis with a significance level of P &lt; 0.05. Side effects such as hematuria were also recorded. Results: Group B reported significantly lower “moderate” CRBD immediately (2% vs. 40%, P &lt; 0.001) and at 12 h (0% vs. 18%, P = 0.003) post-instillation compared to Group S and also required fewer additional analgesics (4% vs. 46%). The PPBC at catheter removal also favored Group B (P = 0.003) and day 1 (P &lt; 0.001). The PUF scores were also significantly lower in Group B at catheter removal (P = 0.001) and at day 1 (P = 0.028). The IPSS was also significantly lower in the Group B on day 1 (P = 0.003) and 7 (P = 0.001). The VAS scores also favored the Group B consistently and although the side effects were higher in Group B but this was not statistically significant. Conclusion: Intravesical bupivacaine administration has the potential to alleviate CRBD and postoperative LUTS following lower urinary tract transurethral electrosurgery. The study’s findings underscore the importance of personalized pain management strategies in optimizing the patient comfort during the postoperative recovery.

Investigation of Clinical Course and Possible Drug Interactions in Patients with Multiple Sclerosis and Breast Cancer.

This study aims to investigate the clinical course and potential drug interactions of breast cancer patients diagnosed with multiple sclerosis (MS). Ten patients diagnosed with MS and breast cancer, who were followed up and treated in the authors' centre between January 2000 and December 2020, were retrospectively scanned from the Hospital's electronic registry system and included in the study. The patients' age, gender, history of MS diagnosis, drugs used, date of breast cancer diagnosis, stage at diagnosis, pathological features, treatment information, surgery types, recurrence or metastasis history and regions, and side effects observed during anticancer treatment were recorded. Key Words: Multiple sclerosis, Breast cancer, Drug-drug interactions.

Ways to improve the effectiveness of glaucoma filtering surgery

The article presents a variety of ways to increase the efficiency of glaucoma filtering surgery. Special attention is given to maintaining the ocular surface healthy through optimal glaucoma therapy. The duration of the disease should be taken into account when choosing the type of hypotensive surgery and designing an algorithm for its pharmacological support: preoperative preparation, prolonged postoperative anti-inflammatory treatment and cornea protection.