Surgical Events Research Articles

Effects of dexamethasone combined with vitamin B12 on percutaneous endoscopic interlaminar discectomy early outcomes: a randomized controlled trial

BackgroundResidual low back and leg pain can occur after percutaneous endoscopic interlaminar discectomy (PEID) and compromise early surgical outcomes. This study aimed to determine the efficacy of combining dexamethasone with vitamin B12 (VB12) via epidural injection in improving the symptoms of low back and leg pain after PEID, and the underlying mechanism of action.MethodsPatients who underwent PEID for lumbar disc herniation (LDH) were enrolled and randomly assigned to the single surgery (SS) group, where disc removal was performed via PEID alone, or the combined treatment (CT) group, which received epidural injections of dexamethasone and VB12 alongside surgery. The outcome measures were the Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), serum inflammatory factor expression, adverse surgical events, duration of postoperative hospitalization, and modified MacNab criteria.ResultsCompared with the SS group, the CT group exhibited lower VAS scores for low back and leg pain at 1, 3, and 7 days post-surgery (P < 0.05). JOA and ODI scores were significantly improved in the CT group than in the SS group 7 days post-surgery (P < 0.05); however, no significant differences were observed at other time points. Serum inflammatory factors were lower in the CT group than in the SS group 3 days post-surgery (P < 0.05). The duration of postoperative hospitalization was shorter in the CT group (P < 0.05). Both groups had similar good outcomes (89.3% vs. 92.2%, P = 0.945).ConclusionsEpidural injection of dexamethasone and VB12 effectively reduces early postoperative low back and leg pain, lowers postoperative inflammatory factor expression, and improves early PEID outcomes. Its clinical adoption merits consideration.Trial registrationThis trial was registered with the China Clinical Trial Registration Center (Identifier: ChiCTR2400088854).

Revolutionizing spinal interventions: a systematic review of artificial intelligence technology applications in contemporary surgery

Leveraging its ability to handle large and complex datasets, artificial intelligence can uncover subtle patterns and correlations that human observation may overlook. This is particularly valuable for understanding the intricate dynamics of spinal surgery and its multifaceted impacts on patient prognosis. This review aims to delineate the role of artificial intelligence in spinal surgery. A search of the PubMed database from 1992 to 2023 was conducted using relevant English publications related to the application of artificial intelligence in spinal surgery. The search strategy involved a combination of the following keywords: "Artificial neural network," "deep learning," "artificial intelligence," "spinal," "musculoskeletal," "lumbar," "vertebra," "disc," "cervical," "cord," "stenosis," "procedure," "operation," "surgery," "preoperative," "postoperative," and "operative." A total of 1,182 articles were retrieved. After a careful evaluation of abstracts, 90 articles were found to meet the inclusion criteria for this review. Our review highlights various applications of artificial neural networks in spinal disease management, including (1) assessing surgical indications, (2) assisting in surgical procedures, (3) preoperatively predicting surgical outcomes, and (4) estimating the occurrence of various surgical complications and adverse events. By utilizing these technologies, surgical outcomes can be improved, ultimately enhancing the quality of life for patients.

Experience of Hyperbaric Chamber Usage in Aesthetic Plastic Surgery Practice for Recovery and Complication Prevention.

Hyperbaric oxygen therapy (HBOT) increases oxygen concentration in affected tissues that enhance the cellular hypoxia recovery process, neovascularization, fibroblast proliferation, increased reactive oxygen species, suppression of proinflammatory states, and vascular compression. The aim of this article is to demonstrate the experience in the use of the hyperbaric chamber as an adjunctive management for the prompt recovery of patients who underwent aesthetic plastic surgery. A retrospective descriptive study was conducted between 2021 and 2023, involving 296 patients who received HBOT after aesthetic surgical procedures, to demonstrate the recuperation time rate and the complication incidence in postoperative patients using HBOT. Most participants were women, with a median age of 33.5 years. Surgical procedures were grouped in liposculpture, abdominoplasty, and breast interventions. Complications related to the surgical event were low (10.7%), with occurrences of hematomas (n = 14, 4.72%), anemias (n = 9, 3.04%), and wound dehiscence (n = 8, 2.70%). There were no reports of surgical site infections or necrosis. Recovery times to get back to work were 10 days for liposuction, 3 days for breast interventions, and 21 days for abdominoplasty. This study demonstrated the experience of using a postoperative hyperbaric chamber in aesthetic plastic surgery to promote recovery processes. The patient cohort in this study showed shortened recovery times than the data obtained from the major international plastic surgery organizations. Also, HBOT patients had a low complication rate, without infections, indicating the potential efficacy of this adjunctive therapy. Overall, this study underscores the promising role of hyperbaric chamber therapy in facilitating postoperative recovery and mitigating complications.

The Effect and Long-term Prognosis of Different Suturing Methods for Meniscus Repair Under Knee Arthroscopy.

This study aims to evaluate the efficacy and long-term prognosis of all-inside and outside-in suturing methods for meniscus repair under knee arthroscopy. A retrospective analysis was conducted on 120 patients with meniscus injuries who underwent surgical treatment at Yuhuan People's Hospital, Department of Joint Surgery, from January 2019 to March 2021. Based on the suturing method, patients were assigned into two groups: Group A (64 cases, all-inside suturing) and Group B (56 cases, outside-in suturing). Surgical indicators and adverse events were recorded for both cohorts. The variances in proprioception before and after surgery, International Knee Documentation Committee (IKDC) scores, Lysholm scores, knee range of motion (ROM), and Visual Analogue Scale (VAS) pain scores were compared between the two groups. Group A had significantly shorter operative time, postoperative immobilization, and hospital stay compared to Group B (p < 0.05). The overall incidence of adverse events was 12.50% in Group A and 16.07% in Group B, with no significant difference between the groups (p > 0.05). There were no substantial differences in preoperative knee proprioception difference values, IKDC scores, Lysholm scores, VAS scores, and knee ROM between the two groups (p > 0.05). At three months postoperatively, Group A exhibited lower proprioception difference values at 15°C, 45°C, and 75°C angles compared to Group B (p < 0.05). Additionally, at three months and three years postoperatively, Group A showed higher IKDC scores, Lysholm scores, and ROM and lower VAS scores compared to Group B (p < 0.05). Compared to the outside-in suturing approach, the all-inside suturing method for treating meniscus damage is more effective. It attenuates operative time, postoperative immobilization time, and hospital stay, ameliorates knee proprioception, promotes knee function recovery, alleviates pain, and is safe and reliable.

Morbidity related to major lung thoracoscopic resections in children.

In pediatric thoracic surgery, reported predictors for increased risk are symptoms and active/previous infections (RAP). We investigated the adverse events related to Video-Assisted Thoracic Surgery (VATS) in pediatric patients when considering RAP predictors. A retrospective analysis of pediatric VATS major lung resections in 2008-2021 was conducted at three institutions. We employed the pediatric surgical risk calculator to define patients' preoperative predicted risk (PredR). Postoperative complications were classified according to the Thoracic Morbidity & Mortality (TM&M) system. The observed TM&M rate (ObsR) and the PredR were compared. A subgroup analysis by RAP predictors was conducted. 37 patients (54% female) were included. Mean age and weight were 5.8 years and 22.8 kg. 56.7% had respiratory symptoms, 38.9% active infection and 59.5% history of infections (RAP subpopulations). VATS procedures were lobectomy (n=32), segmentectomy (n=3), bilobectomy (n=1) and pneumonectomy (n=1). The conversion rate was 5.4%. The mean PredR was of 4.43% (±1.8) and the overall ObsR was 45.94% with a median severity of II (I-III). This difference was significant and a higher PredR was not associated with complications development. PredR does not show association among the RAP vs non-RAP group. ObsR showed positive association with RAP, even if it reached statistical significance only for "respiratory symptoms" risk factor. ObsR reflected the number of bronchiectasis patients in our series (n=9), aligning with the hypothesis of "earlier and safer surgery". The risk calculator underestimates VATS morbidity. Multicentre studies will clarify the correlation between inflammation and surgical adverse events.

Application of Information Link Control in Surgical Specimen Near-Miss Events in a South China Hospital: Nonrandomized Controlled Study.

Information control is a promising approach for managing surgical specimens. However, there is limited research evidence on surgical near misses. This is particularly true in the closed loop of information control for each link. A new model of surgical specimen process management is further constructed, and a safe operating room nursing practice environment is created by intercepting specimen near-miss events through information safety barriers. In a large hospital in China, 84,289 surgical specimens collected in the conventional information specimen management mode from January to December 2021 were selected as the control group, and 99,998 surgical specimens collected in the information safety barrier control surgical specimen management mode from January to December 2022 were selected as the improvement group. The incidence of near misses, the qualified rate of pathological specimen fixation, and the average time required for specimen fixation were compared under the 2 management modes. The causes of 2 groups of near misses were analyzed and the near misses of information safety barrier control surgical specimens were studied. Under the information-based safety barrier control surgical specimen management model, the incidence of adverse events in surgical specimens was reduced, the reporting of near-miss events in surgical specimens was improved by 100%, the quality control quality management of surgical specimens was effectively improved, the pass rate of surgical pathology specimen fixation was improved, and the meantime for surgical specimen fixation was shortened, with differences considered statistically significant at P<.05. Our research has developed a new mode of managing the surgical specimen process. This mode can prevent errors in approaching specimens by implementing information security barriers, thereby enhancing the quality of specimen management, ensuring the safety of medical procedures, and improving the quality of hospital services.

Arcuate anterior jugular vein: a rare case report and its clinical relevance.

The present study describes a rare anatomical variation of the anterior jugular vein (AJV) and discusses its clinical relevance. A head and neck specimen fixed in 10% formaldehyde from a 42-year-old female cadaver was submitted to angio technique with pre-vulcanized latex and water-soluble ink. During a routine dissection for the discipline of topographic anatomy, the presence of an arcuate AJV was detected in the anterior triangle of the neck. An arcuate AJV was formed by the confluence of the submental and facial veins in the left submandibular region, which presented a complex network of anastomoses superficially to the left submandibular gland. After its origin, this vessel curved to the right at the level of the laryngeal prominence and followed the medial border of the right sternohyoid muscle to flow into the right AJV. In this topography, the arcuate AJV was located between the sternocleidomastoid muscle's anterior margin and the thyroid gland's right lobe. The presence of anastomoses between the two AJVs communicating the submandibular triangles was not detected. The arcuate AJV is a relevant anatomical variant in the superficial venous drainage of the neck that should be known by head and neck surgeons and radiologists to avoid surgical iatrogenic events.

Efficacy and safety of vancomycin for local application in the prevention of surgical site infection after joint arthroplasty: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to explore the effect of topical vancomycin powder (VP) in surgical site infection (SSI) prevention and adverse events after joint arthroplasty and to provide a specific theoretical basis for clinical treatment. The review process was conducted according to the PRISMA guidelines. Two independent researchers meticulously screened the literature based on predefined inclusion and exclusion criteria, evaluated the quality of the selected studies, and extracted relevant data. Data analysis was conducted using RevMan 5.4 software. This meta-analysis included 24 studies encompassing a total of 34 811 patients. The pooled analysis showed that the topical administration of VP significantly reduced the incidence of SSI. Subgroup analyses by doses, type of joint (hip and knee), and type of surgery (primary and revision) confirmed that vancomycin consistently lowered SSI rates. Moreover, the incidence of SSI caused by gram-negative germs and gram-positive germs decreased following the use of VP, although the reduction was not significant for infections caused by MRSA. However, the use of VP was associated with a significant increase in sterile complications at the incision site and delayed incision healing. The topical application of VP is effective in reducing the incidence of infections following joint arthroplasty. Despite an increased risk of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision-making. However, it should not be discarded due to side effects.

Comparison of spinal anesthesia and local anesthesia in percutaneous interlaminar endoscopic lumbar discectomy for L5/S1 disc herniation: a retrospective cohort study

BackgroundInterlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited.MethodsThe propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively.ResultsFifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05).ConclusionSA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia.

Evaluation of preoperative intraperitoneal injection of bupivacaine for intraoperative antinociception in cats undergoing ovariohysterectomy: A randomized clinical trial

ObjectiveTo determine if preoperative intraperitoneal bupivacaine can minimize intra- and postoperative nociception/pain in cats undergoing ovariohysterectomy. Study designProspective, randomized, investigator-blinded, placebo-controlled clinical trial. AnimalsForty-seven, intact female cats. MethodsCats were anesthetized using a standard protocol and randomized to receive ultrasound-guided intraperitoneal 0.9 % saline (US-S) or 0.25 % bupivacaine (US-IPLA) before ovariohysterectomy. On recovery, US-S cats received 2 mg/kg robenacoxib subcutaneously and US-IPLA cats received equivalent volume of 0.9 % saline subcutaneously. Intraoperative outcome variables included heart rate (HR), respiratory rate (fR), systolic arterial pressure (SAP), and vaporizer setting associated with relevant surgical events characterized by manipulation of each ovarian pedicle (OP1, OP2) and the uterine body (UB). The postoperative outcome variable was need for rescue analgesia, determined using the Glasgow Composite Measure Pain Scale during 6 h after tracheal extubation. Intraoperative data were analyzed using two-way ANOVA and Šidák's multiple comparisons test. The probability of postoperative rescue analgesia was analyzed using the Gehan–Breslow–Wilcoxon test. Significance was p < 0.05. ResultsCompared to baseline, all surgical events caused significant increases in HR and SAP in both groups, fR increased in US-IPLA but not in US-S, vaporizer settings remained unchanged during OP1, OP2 and UB in group US-IPLA, and were significantly higher only during OP1 in group US-S. There were no significant between-group differences in intraoperative variables and postoperative need for rescue analgesia. Conclusions and clinical relevancePreoperative intraperitoneal bupivacaine had minimal effects on intraoperative indicators of nociception. The need for rescue analgesia was not significantly different between groups.

Development and validation of a novel tool for identification and categorization of non-technical errors associated with surgical mortality.

Up to half of all surgical adverse events are due to non-technical errors, making non-technical skill assessment and improvement a priority. No specific tools are available to retrospectively identify non-technical errors that have occurred in surgical patient care. This original study aimed to develop and provide evidence of validity and inter-rater reliability for the System for Identification and Categorization of Non-technical Error in Surgical Settings (SICNESS). A literature review, modified Delphi process, and two pilot phases were used to develop and test the SICNESS tool. For each pilot, 12 months of surgical mortality data from the Australian and New Zealand Audit of Surgical Mortality were assessed by two independent reviewers using the SICNESS tool. Main outcomes included tool validation through modified Delphi consensus, and inter-rater reliability for: non-technical error identification and non-technical error categorization using Cohen's κ coefficient, and overall agreement using Fleiss' κ coefficient. Version 1 of the SICNESS was used for pilot 1, including 412 mortality cases, and identified and categorized non-technical errors with strong-moderate inter-rater reliability. Non-technical error exemplars were created and validated through Delphi consensus, and a novel mental model was developed. Pilot 2 included an additional 432 mortality cases. Inter-rater reliability was near perfect for leadership (κ 0.92, 95% c.i. 0.82 to 1.00); strong for non-technical error identification (κ 0.89, 0.84 to 0.93), communication and teamwork (κ 0.89, 0.79 to 0.99), and decision-making (κ 0.85, 0.79 to 0.92); and moderate for situational awareness (κ 0.79, 0.71 to 0.87) and overall agreement (κ 0.69, 0.66 to 0.73). The SICNESS is a reliable and valid tool, enabling retrospective identification and categorization of non-technical errors associated with death, occurring in real surgical patient interactions.

Effects of different forced-air warming systems on the core temperature of patients: a manikin and multi-center clinical study

BackgroundThe use of forced-air warming (FAW) blankets is widely recognized for preventing shivering and hypothermia in patients under general anesthesia. Various types of products are currently available for hospitals, and we have conducted a preliminary evaluation of insulation equipment based on expert opinions and initial parameters. However, we lack real-world experiments and accurate clinical data to validate these parameters and the accuracy of our decision-making results. This study aims to confirm the effectiveness of different FAW systems by assessing the thermal protection and operational characteristics of the equipment in both experimental and clinical settings, thereby enhancing our evaluation database.MethodsIn the manikin test, we conducted six tests including heat distribution and heating rate, heater outlet temperature stability, etc. In the clinical study, patients were randomly assigned to four groups [Group A (Bair Hugger Therapy, 3 M, St. Paul, MN, USA; 63500); Group B (EQUATOR® level I, Smith Medical ASD, MN, USA; Snuggle Warm, SW-2013); Group C (Jiang Men Da Cheng Medical Devices Co., Ltd, China; IOB-006); and Group D (Shang Hai Nest Tech Medical Materials Co., Ltd, China; BH-017)], with each group comprising 30 individuals. At the start of anesthesia induction, the FAW blanket was activated and set to 43 °C until the completion of surgery. The primary endpoint was the average core body temperature during surgery. Secondary endpoints included hemodynamic and surgical variables, adverse events, and recovery metrics.ResultsIn the manikin test, the observed results of the experimental parameters (heat distribution, air pressure difference, and hole observation test) for Group A are superior to those of the other groups. In the clinical study, although the mean perioperative core body temperature remained above 36 °C across all groups [Group A: 36.31 ± 0.04; Group B: 36.26 ± 0.06; Group C: 36.17 ± 0.03; Group D: 36.25 ± 0.05], patients in Group A maintained higher temperatures compared to the other groups (p < 0.001).ConclusionsAmong patients undergoing laparoscopic radical resection of colorectal cancer with general anesthesia, all four FAW systems effectively prevented perioperative hypothermia. However, the system in Group A minimized heat loss more effectively than the others, providing superior thermal protection.Trial registrationChiCTR2200065394, 03/11/2022.

Rural-Urban Disparities in Hospital Services and Outcomes for Children With Medical Complexity

Limited availability of inpatient pediatric services in rural regions has raised concerns about access, safety, and quality of hospital-based care for children. This may be particularly important for children with medical complexity (CMC). To describe differences in the availability of pediatric services at acute care hospitals where rural- and urban-residing CMC presented for hospitalization; identify rural-urban disparities in health care quality and in-hospital mortality; and determine whether the availability of pediatric services at index hospitals or the experience of interfacility transfer modified rural-urban differences in outcomes. This retrospective cohort study examined all-payer claims data from Colorado, Massachusetts, and New Hampshire from 2012 to 2017. Analysis was conducted from May 2023 to July 2024. Participants included CMC younger than 18 years residing in these states and hospitalized during the study period. Rural or urban residence was determined using Rural-Urban Commuting Area codes. Hospitals were categorized as children's hospitals or general hospitals with comprehensive, limited, or no dedicated pediatric services using American Hospital Association survey data. Interfacility transfers between index and definitive care hospitals were identified using health care claims. In-hospital mortality, all-cause 30-day readmission, medical-surgical safety events, and surgical safety events were operationalized using Agency for Healthcare Research and Quality measure specifications. Among 36 943 CMC who experienced 79 906 hospitalizations, 16 525 (44.7%) were female, 26 034 (70.5%) were Medicaid-insured, and 34 008 (92.1%) were urban-residing. Rural-residing CMC were 6.55 times more likely to present to hospitals without dedicated pediatric services (rate ratio [RR], 6.55 [95% CI, 5.86-7.33]) and 2.03 times more likely to present to hospitals without pediatric beds (RR, 2.03 [95% CI, 1.88-2.21]) than urban-residing CMC, with no significant differences in interfacility transfer rates. In unadjusted analysis, rural-residing CMC had a 44% increased risk of in-hospital mortality (RR, 1.44 [95% CI, 1.03-2.02]) with no significant differences in other outcomes. Adjusting for clinical characteristics, the difference in in-hospital mortality was no longer significant. Index hospital type was not a significant modifier of observed rural-urban outcomes, but interfacility transfer was a significant modifier of rural-urban differences in surgical safety events. In this cohort study, rural-residing CMC were significantly more likely to present to hospitals without dedicated pediatric services. These findings suggest that efforts are justified to ensure that all hospital types are prepared to care for CMC.

Risk-Adapted Use of Vancomycin in Secondary Scoliosis Surgery May Normalize SSI Risk in Surgical Correction of High-Risk Patients.

Introduction: Intrawound application of vancomycin is becoming increasingly controversial for the prevention of surgical site infection (SSI). As children undergoing spinal fusion for secondary scoliosis are at high risk for SSIs, evidence regarding the impact of intraoperative vancomycin installation on SSI rates in these patients is of utmost importance. Methodology: A single surgeon cohort of patients under 18 years of age undergoing surgery for secondary scoliosis in 2017 was analyzed with regard to the development of SSIs requiring surgical revision and adverse events. Use of vancomycin was restricted to cases with higher risk of infection. Patients undergoing distraction surgery for growing devices were excluded. Results: After exclusions, 64 patients remained (vancomycin n = 39, control n = 25). The SSI rates were 12.8% in patients receiving vancomycin (n = 5/39) and 4% in the control group (n = 1/25, p = 0.785). None of the patients suffered from adverse events. Univariable logistic regression revealed younger age (p = 0.03) and meningomyelocele as predictors for SSI (p = 0.006), while the high-risk group receiving vancomycin was not at higher odds for SSI, also after adjustment for possible confounders such as age or MMC (p = 0.031; p = 0.009). Discussion: SSI rates were comparable between groups, suggesting a normalization of SSI risk in the vancomycin-treated patients with a preoperatively increased risk of SSI. Future, larger studies in these rare diseases are needed to confirm these results.

Deep learning for surgical workflow analysis: a survey of progresses, limitations, and trends

Automatic surgical workflow analysis, which aims to recognize the ongoing surgical events in videos, is fundamental for developing context-aware computer-assisted systems. This paper reviews representative surgical workflow recognition algorithms based on deep learning, outlining their merits, limitations, and future research directions. The literature survey was performed on three large bibliographic databases, covering 67 lary sources, which were comparatively analyzed in terms of spatial feature modeling, spatio-temporal feature modeling, input pre-processing, regularization and post-processing algorithms, as well as learning strategies. Then, common public datasets and evaluation metrics for surgical workflow recognition are also described in detail. Finally, we discuss all literature from different perspectives, and point out the challenges, possible solutions and future trends. The need for more diverse and larger datasets, the potential of unsupervised and semi-supervised learning approaches, comprehensive and equitable metrics, establishing complete regulatory and data standards, and interoperability will be key challenges in translating models to clinical operating rooms. And we propose that surgical activity anticipation and employing large language model as training assistant are interesting research directions in surgical workflow analysis.

Delayed Gastric Emptying and Other Adverse Outcomes in Patients Undergoing Classic Whipple Versus Pylorus-Sparing Pancreatoduodenectomy.

Background and objective Pancreatoduodenectomy (PD), or the Whipple procedure, has many variants. There is a lack of data in the literature in terms of comparing various types of this procedure. This study aimed to comparethe classic Whipple procedure with the pylorus-sparing Transverso-Longmire technique, focusing on postoperative complications and delayed gastric emptying (DGE). Methodology We conducted a retrospective observational study including 97 adult patients who underwent either the classic Whipple procedure or the pylorus-sparing technique at Hospital Médica Sur from 2016 to 2021. Data on patient demographics, comorbidities, type of surgery, clinical presentation, and postoperative complications were collected. DGE was defined according to the International Study Group of Pancreatic Surgery(ISGPS) criteria. Results Among the 97 patients, 50.5% were men, and the median age of the cohort was 65 years. Almost all patients underwent surgery for malignancy (96.9%). The classic Whipple group had fewer cases of DGE (9.8% vs. 30.6%, p=0.01), shorter hospital stays (7 vs. 11 days, p=0.001), and lower readmission rates (13.1% vs. 33.3%, p=0.017). The pylorus-sparing PD was associated with a lower incidence of bile leak [odds ratio (OR)=0.62, 95% confidence interval (CI): 0.53-0.73]. However, this technique was associated with a higher incidence of DGE (OR=4, 95% CI: 1.34-12.1), overall hospital admission rates (OR=3.3, 95% CI: 1.2-9.2), and admissions that resulted in a surgical event (OR=1.9, 95% CI: 1.21-2.96). DGE was associated with the need for a second surgery (OR=10.5, 95% CI: 2.8-39.5) and hospital readmission (OR=10, 95% CI: 3.1-32.3). Conclusions While the pylorus-sparing technique is associated with reduced bile leaks, it results in a higher incidence of DGE, prolonged hospital stays, and increased readmissions. Clinicians opting for the pylorus-sparing technique should ensure careful patient selection and rigorous postoperative monitoring.

Techniques for Managing Adverse Intraoperative Events During Direct Surgery of Ruptured Cerebral Aneurysms

Ruptured cerebral aneurysms have a higher incidence of direct surgery-related adverse events compared to unruptured aneurysms owing to challenging surgical conditions, such as difficulties in surgical exposure, cerebral edema, and intraoperative aneurysmal rupture, that increase the intraprocedural difficulty. The most common surgical adverse event is intraoperative rupture, with uncontrolled ruptures(during pre-dissection or from a tear in the aneurysm neck) often resulting in poor clinical outcomes. The key strategies for intraoperative rupture include staying calm, controlling bleeding, and ensuring hemostasis through appropriate methods. Given the advances in endovascular therapy for intracranial aneurysms, the number of microsurgical procedures has been decreasing. Thus, neurosurgeons at each facility need to prepare and gain experience in handling intraoperative ruptures.

Outcomes of cobalt-chrome 3D-printed total talus replacement with and without combined total ankle replacement

BackgroundCollapse of the talus and peri-talar arthritis pose treatment challenges due to the anatomy and location of the talus as a keystone of the foot and ankle. Custom 3D-printed total talus replacement (TTR) and combined total ankle total talus replacement (TATTR) have emerged as treatment options for these pathologies. However, the safety and efficacy of these implants is unknown due to the limited number of cases and short follow-up durations. MethodsThis was a retrospective study to assess surgical outcomes of patients who underwent a TTR and TATTR with or without subtalar fusion. Patient demographics, intraoperative parameters, device related surgical and non-surgical events, imaging and clinical evaluations, and patient reported outcome (PRO) measures were compiled. ResultsA total of 38 patients received a custom 3D-printed implant with mean follow-up time of 22.1 (range: 12–45) months. In this cohort, 7 (18.4 %) required secondary surgery and 3 (7.9 %) required implant removal. Multivariate logistic regression revealed that patient diagnosis of depression was a significant predictor of secondary surgery with an OR 17.50 (p = 0.037). Significant postoperative improvements were observed in the talocalcaneal height (p = 0.005) and talar declination angle (p = 0.013) for the TATTR group. VAS and PROMIS pain interference (PI) scores demonstrated an initial significant improvement in pain, but this improvement did not maintain significance at most recent follow-up. However, there was a significant increase in the PROMIS physical function (PF) scores (p = 0.037) at most recent follow-up. ConclusionThese results demonstrate that TTR and TATTR provide significant improvement in post-operative radiographic foot and ankle alignment and physical function at the two-year timepoint. PRO findings suggest that patients are more active after surgery. Surgeons considering proceeding with either of these procedures should counsel patients about pain and functional outcomes as well as realistic expectations in patients with depression. Level of evidenceLevel 3

Awake versus asleep deep brain stimulation for Parkinson's disease: a comprehensive systematic review and meta-analysis.

Deep brain stimulation (DBS) has become an effective and safe treatment in patients with Parkinson's disease (PD) not responding to conventional treatments. With the growing body of literature regarding the use of DBS in different movement disorders, there remain controversies regarding performing awake or asleep DBS. This systematic review provides the most comprehensive review of the literature comparing the two techniques from various aspects in detail. A systematic review of the PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted. All studies comparing any aspects of asleep and awake DBS were included. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool. Meta-analysis was conducted with consideration of baseline characteristics. Thirty-one studies with 2563 PD patients were included. A total of 1423 patients underwent asleep DBS. The two groups were comparable regarding their baseline characteristics. The follow-up ranged from 3 to 60 months. The two DBS techniques were comparable in terms of motor symptom improvements and levodopa equivalent daily doses. However, the asleep technique showed slightly better improvements in Mattis Dementia Rating Scale and Parkinson's Disease Questionnaire scores. Moreover, the asleep technique was associated with more surgical adverse events, whereas pneumocephalus and psychological disorders such as mood, affect, and cognitive disorders were more common in the awake technique. Subgroup analyses revealed no significant differences in outcomes between asleep and awake DBS when categorized by targeted brain nuclei, use of intraoperative or preoperative imaging, and whether microelectrode recordings were used. These findings suggest comparable clinical outcomes between the two DBS approaches. The two methods had their salient differences in terms of lead passes and specific adverse events. The decision to perform awake or asleep DBS should be based on the patient's preference, the surgeon's experience, the availability of advanced intraoperative imaging, and the patient's tolerance for specific adverse events.

Complementary Chinese Herbal Medicine Treatment is Associated with a Reduction of Surgical Rate in Patients with Dysfunctional Uterine Bleeding: A Propensity-Score Matched Cohort Study.

Many patients with dysfunctional uterine bleeding (DUB) seek traditional medicine consultations. This study intended to investigate the association of complementary Chinese herbal medicine (CHM) with the surgery rate in patients with DUB in Taiwan. We enrolled 43,027 patients with newly diagnosed DUB (ICD-9-CM codes 626.8) from the National Health Insurance Research Database in Taiwan during the period of 1997 to 2010. Among them, 38,324 were CHM users, and 4703 did not receive CHM treatment. After performing a 1:1 propensity-score match based on patients' age (per 5 years), comorbidities, conventional drugs, childbirth status, duration from the diagnosis year of DUB and index year, there were an equal number (n=4642) of patients in the CHM cohort and non-CHM cohort. The outcome measurement was the comparison of incidences of surgical events, including hysterectomy and endometrial ablation, in the two cohorts before the end of 2013. CHM users had a lower incidence of surgery than non-CHM users (adjusted HR 0.27, 95% CI: 0.22-0.33). The cumulative incidence of surgery was significantly lower in the CHM cohort during the follow-up period (Log rank test, p < 0.001). A total of 146 patients in the CHM cohort (4.99 per 1000 person-years) and 485 patients in the non-CHM cohort (20.19 per 1000 person-years) received surgery (adjusted HR 0.27, 95% CI: 0.22-0.33). CHM also reduced the risk of surgery in DUB patients with or without comorbidities. Regardless of childbirth status or whether patients took NSAIDs, tranexamic acid or progesterone, fewer patients in the CHM cohort underwent surgery than in the non-CHM cohort. The most commonly prescribed single herb and formula were Yi-Mu-Cao (Herba Leonuri) and Jia-Wei-Xiao-Yao-San, respectively. The real-world data revealed that CHM is associated with a reduced surgery rate in DUB patients. This information may be provided for further clinical investigations and policy-making.