Surgical Management Of Patients Research Articles

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients - A Report by Society of Cardiovascular Anesthesiologists

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients - A Report by Society of Cardiovascular Anesthesiologists

TCT-92 Early Transcatheter or Surgical Aortic Valve Replacement Versus Conservative Management in Asymptomatic Patients With Severe Aortic Stenosis: A Systematic Review and Meta-analysis

TCT-92 Early Transcatheter or Surgical Aortic Valve Replacement Versus Conservative Management in Asymptomatic Patients With Severe Aortic Stenosis: A Systematic Review and Meta-analysis

Surgical treatments for older breast cancer patients: A systematic review and meta-analysis of real-world evidence

BackgroundOlder patients with breast cancer are often underrepresented in clinical trials, leading to a lack of evidence-based guidelines for surgical treatment in this cohort. Consequently, synthesizing real-world data is crucial for determining the optimal surgical management of geriatric patients with breast cancer. MethodsA comprehensive search was conducted of the PubMed, Embase, and Cochrane Library databases. The review included clinical studies evaluating treatments in patients aged ≥65 years with breast cancer. Comparisons were made between primary surgical treatment and endocrine therapy alone, breast-conserving surgery without radiotherapy versus mastectomy, sentinel lymph node biopsy versus omission of sentinel lymph node biopsy, and surgery plus axillary lymph node dissection versus omission of axillary lymph node dissection. ResultsA total of 44 studies were analyzed. Surgery significantly increased overall survival, breast cancer–specific survival, and recurrence-free survival compared with endocrine therapy alone. Pooled estimates revealed that mastectomy yielded significantly better prognoses than breast-conserving surgery without radiotherapy in terms of both overall survival and breast cancer–specific survival. Omitting sentinel lymph node biopsy and axillary lymph node dissection did not significantly reduce overall survival. ConclusionsFor older patients with breast cancer, primary surgical treatment significantly enhances survival and regional control compared with endocrine therapy alone without compromising quality of life. Frail patients with nonmetastatic breast cancer who are unwilling to undergo radiotherapy benefit from mastectomy, with no notable psychosocial decline compared with breast-conserving surgery alone. Sentinel lymph node biopsy omission does not increase recurrence rates or mortality, and avoiding axillary lymph node dissection may be viable for node-positive older patients due to its comparable survival outcomes.

Healthcare disparities in access to surgical management and outcomes of patients with nonmetastatic primary liver cancer: A population based study from Louisiana tumor registry

BackgroundThis study aims to identify factors associated with disparities in receipt and outcomes of surgical interventions in patients with primary nonmetastatic liver cancers. MethodsCases from 2010 to 2020 were identified using Louisiana Tumor Registry. Four surgical categories were utilized: none, ablation, resection, transplant. Bivariate relationships were assessed via Chi-square tests. Overall survival (OS) was visualized using Kaplan Meier plots, compared via log-rank test, and analyzed with Cox proportional hazards models. ResultsOnly 24.5 ​% of patients underwent surgical interventions. Black race had decreased odds of undergoing transplant and decreased OS with transplant. Uninsured, Medicaid, and rural residence had decreased odds of receiving surgical intervention. Older age and no domestic partner had decreased odds of transplant. Older age, male sex, no domestic partner, and rural residence had decreased OS post-transplant. ConclusionsIdentifying the population at risk for not receiving surgical intervention and allocating resources to access care is crucial to improve outcomes.

The Surgical Management of Intracranial Metastasis Secondary to Follicular Cell-Derived Thyroid Carcinoma.

Intracranial metastases (ICM) from follicular cell-derived thyroid carcinoma (FCDTC) are rare and are associated with a poor prognosis. The objective of this study is to report our experience in the surgical management of patients with ICM secondary to FCDTC. Patients with FCDTC who underwent surgical resection of an ICM were identified at our institution from 1998 to 2018. Thirty-two patients were included in this study. Nineteen patients (59%) had involvement of the brain parenchyma only, 8 (25%) had a dural-based metastasis, 3 (9%) had a calvarial metastasis with dural extension, and 2 (6%) had a skull base metastasis with dural extension. In patients who had an R0-1 resection, the estimated lesional control at the site of resection was 91% at 3 years. However, overall ICM control was 37% at 3 years due to the progression of other ICM lesions. The 1-year disease-specific survival (DSS) was 87% and 5-year DSS was 37%. ICM management in FCDTC is based on the size, number, and location of metastatic lesions. Complete resection of ICM may provide lesional control at the site of resection, however, DSS is poor due to the presence of other ICMs and metastases at multiple distant sites.

Clinical outcomes of patients with heterotopic pregnancy after laparoscopic surgery

ObjectiveThis retrospective study aims to analyze laparoscopic surgical management and clinical consequences of patients with heterotopic pregnancy (HP) who underwent in vitro fertilization and embryo transfer (IVF-ET) and laparoscopic surgical management. Material and methodsWe conducted a retrospective analysis of clinical characteristics and pregnancy results of patients with HP who underwent IVF-ET at the Affiliated Maternity and Child Health Care Hospital of Nantong University between January 2013 and December 2022. Results21 patients were diagnosed with HP, with an average diagnostic period of 49.1 ± 11.1 days. 11 cases (52.4 %) exhibited clinical manifestations such as abdominal pain and vaginal hemorrhage before the surgery, while 10 cases (47.6 %) were asymptomatic prior to diagnosis. All patients underwent laparoscopic surgery, resulting in 8 cases of miscarriage postoperatively (6.15 %), and all 13 neonates showed no anomalies at birth. ConclusionLaparoscopic surgery is a safe and effective treatment, and most patients can achieve satisfactory pregnancy outcomes after surgery.

Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative

Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus recommendations for fluid management in patients undergoing surgery. This article provides a summary of the recommendations for perioperative fluid management of surgical patients from the preoperative period until hospital discharge and for all types of elective and emergency surgery, apart from burn injuries and head and neck surgery. Where evidence was lacking, recommendations for future research were generated. Specific recommendations are made for fluid management in elective major noncardiac surgery, cardiopulmonary bypass, thoracic surgery, neurosurgery, minor noncardiac surgery under general anaesthesia, and critical illness. There are ongoing gaps in knowledge resulting in variation in practice and some disagreement with our consensus recommendations. Perioperative fluid management should be individualised, taking into account the type of surgery and important patient factors, including intravascular volume status and acute and chronic comorbidities. Recommendations are made for further research in perioperative fluid management to address important gaps.

Functional benefit of joint surgery in patients with non-vascular Ehlers-Danlos syndrome: results of a retrospective study

BackgroundEhlers-Danlos syndrome (EDS) is a hereditary disease characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Hypermobile EDS (hEDS is the more frequent subtype. Joint surgery may benefit certain patients after failure of medical treatments, but there is no consensus on the optimal surgical management of patients with hEDS. The aims of this retrospective study were to chart the surgical management of patients with hEDS, to determine the role of arthroscopy and to evaluate the functional results of joint surgery, including the reintervention rates.ResultsA total of 69 patients with non-vascular EDS were evaluated (60 female; 87%). Mean (SD) age at first surgery was 25.6 ± 11.1 years. Among the 69 patients, first surgeries were carried out on the knee (n = 50; 39.4%), ankle (n = 28; 22.0%), shoulder (n = 22; 17.3%), wrist (n = 18; 14.2%) and elbow (n = 9; 7.1%). One-fifth of all first operations (20.8%) were carried out by arthroscopy, most often on the knee (36% of knee surgery cases). At the time of primary surgery, the surgeon was alerted to the diagnosis or suspicion of hEDS in only 33.9% of patients. The rate of reoperations (2 to ≥ 5) was 35.7% (10/28) for the ankle, 40.9% (9/22) for the shoulder, 44.4% (4/9) for the elbow, 50% (9/18) for the wrist and 60% (30/50) for the knee. Local or regional anaesthesia was badly tolerated or ineffective in 27.8%, 36.4% and 66.6% of operations on the wrist, shoulder and elbow, respectively. Overall, the majority of patients (> 70%) were satisfied or very satisfied with their surgery, particularly on the non-dominant side. The lowest satisfaction rate was for shoulder surgery on the dominant side (58.3% dissatisfied).ConclusionsSurgery for joint instability has a greater chance of success when it is carried out in patients with a known diagnosis of EDS before surgery. The majority of patients were satisfied with their surgery and, with the exception of the knee, there was a low rate of reoperations (≤ 50%). Arthroscopic procedures have an important role to play in these patients, particularly when surgery is performed on the knee.

Modified 5-Item Frailty Index (mFI-5) may predict postoperative outcomes after pancreatoduodenectomy for pancreatic Cancer.

Pancreatic Ductal Adenocarcinoma (PDAC) primarily affects older individuals with diminished physiological reserves. The Modified 5-Item Frailty Index (mFI-5) is a novel risk stratification tool proposed to predict postoperative morbidity and mortality. This study aimed to validate the mFI-5 for predicting surgical outcomes in patients undergoing pancreatoduodenectomy (PD) for PDAC. Our retrospective PDAC database included patients who underwent PD between 2014 and 2023. Patients were stratified by mFI-5 scores (0 best - 5 worst), which assess preoperative CHF, diabetes mellitus, history of COPD or pneumonia, functional health status, and hypertension requiring medication. Associations between mFI-5 scores and outcomes, including postoperative complications and mortality, were analyzed using logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analysis. Among 250 PDAC patients undergoing PD, 142 (56.8%) had mFI-5 scores ≤ 1, and 25 (10%) had scores ≥ 3. No patients had scores > 4. Higher mFI-5 scores correlated with older age (p < 0.001) and tobacco use (p = 0.036). Multivariate analysis identified age (RR 1.02, p = 0.038), ASA class (ASA III; RR 2.61, p < 0.001; ASA IV; RR 2.63, p = 0.026), and moderate alcohol consumption (RR 0.56, p = 0.038) as frailty predictors. An mFI-5 score > 2 independently associated with higher mortality (HR 2.08, p = 0.026). Median overall survival was significantly lower for patients with mFI-5 scores > 2 than for those with scores ≤ 2 (21.3 vs. 42.1 months, p = 0.022). The mFI-5 is a valuable tool for predicting postoperative morbidity and mortality in PDAC patients undergoing PD. Integrating frailty assessment into preoperative evaluations can enhance patient selection and surgical outcomes. Future research should focus on incorporating frailty assessments into surgical planning and patient management to improve outcomes in this vulnerable population.

A Comparative Study of Postoperative Outcomes: Open Cholecystectomy versus Laparoscopic Cholecystectomy

Background: Surgery is usually necessary to treat gallstones, or cholelithiasis. Because laparoscopic cholecystectomy is less intrusive than open cholecystectomy, it is now the treatment of choice. Objectives: To evaluate and compare the postoperative results of open and laparoscopic cholecystectomies with regard to duration of hospital stay, complication rates, and amount of discomfort experienced during the procedure. Methods: A prospective comparative study was conducted on one hundred patients with symptomatic cholelithiasis who were to undergo elective cholecystectomy. Patients were randomized into two groups: Among the patients, 50 patients were operated for Laparoscopic Cholecystectomy and 50 for Open Cholecystectomy. The data on the postoperative results of the operation, including the time spent during the operation, as well as the time spent on pain, the length of stay in the hospital, and complications were collected and compared using statistical methods with the chosen level of significance equals to p ≤0.05. Results: The mean operative time of Laparoscopic Cholecystectomy was less than Open Cholecystectomy (48. 5 ± 12. 4 vs. 68. 5 ± 15. 3 minutes; p≤0.05). The overall postoperative pain was less in patients who undertook Laparoscopic Cholecystectomy with the mean pain period of (18. 3 ± 5.2) hours compared with 30. 7 ± 7. For Open Cholecystectomy patients the time taken was 1 hours. The length of the hospital stay was also lesser in Laparoscopic Cholecystectomy group which was (1.8 ± 1.2) days compared to Open Cholecystectomy group of (4.8 ± 1.5) days. Also, the Laparoscopic Cholecystectomy group had less complication rate at 12% compared to the Open Cholecystectomy at 38% with p ≤0.05 Conclusion: Laparoscopic Cholecystectomy is shown to be more beneficial in terms of postoperative results than Open Cholecystectomy in terms of the operating time, pain, hospital stay, and complications. Thus, these results shows Laparoscopic Cholecystectomy as the most appropriate surgical management for patients with symptomatic cholelithiasis; however, Open Cholecystectomy will still be required for cases that are not suitable for Laparoscopic Cholecystectomy.

Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 3 Palatal Surgery, Outcomes and Follow-Up, Complications, and Post-Operative Management.

Background/Objectives: Exploring and establishing a consensus on palatal surgery, the outcomes and follow-up after the palatal surgery, the complications of palatal surgery, and the post-operative management after palatal surgery for snoring and obstructive sleep apnea (OSA) among sleep surgeons is critical in the surgical management of patients with such conditions. Methods: Using the Delphi method, a set of statements was developed based on the literature and circulated among a panel of eight European experts. Responses included agreeing and disagreeing with each statement, and the comments were used to assess the level of consensus and to develop a revised version. The new version with the level of consensus and anonymized comments was sent to each panel member as the second round. This was repeated over a total of five rounds. Results: The final set included a total of 111 statements, 27 of which were stand-alone questions and 21 of which contained 84 sub-statements. Of the 34 statements regarding palatal surgery, consensus was achieved among all eight, seven, and six panelists for 50%, 35.3%, and 5.9% of the questions, respectively. Of the 43 statements regarding the outcomes and follow-up after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 53.5%, 23.3%, and 4.7% of the questions, respectively. Of the 24 statements regarding complications after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 91.7%, 0%, and 4.2% of the questions, respectively. Of the 10 statements regarding post-operative management after palatal surgery, consensus was achieved among all eight, seven, and six panelists for 10%, 30%, and 30% of the papers, respectively. Conclusions: This consensus provides an overview of the work of European sleep surgeons to develop a set of statements on palatal surgery for the treatment of snoring and OSA, the outcomes and follow-up, the complications, and the post-operative management of palatal surgery. We believe that this will be helpful in everyday practice. It also indicates key areas for further studies in sleep surgery.

Postoperative Outcomes of Breast Cancer Surgery in Tertiary Care Units in Pakistan: A Cross-Sectional Study

Background: Breast cancer is a serious health problem in Pakistan and has high incidence and mortality rate. This paper seeks to compare and contrast surgical care and patient management by analyzing postoperative results of breast cancer operations in tertiary health care centers of Pakistan. Methods: It was a cross-sectional study designed in tertiary care unit of Nishtar hospital Multan where medical records of female breast cancer patients who underwent surgery between January 2024 to June 2024 were analyzed. The demographic data, surgical procedures, postoperative morbidities, hospital stays, and readmission rates data were analyzed using multivariate statistics. Results: In total 300 patients were selected in the study. The rate of developing post-operative complications was 20%, and the most frequent of them were infections (12%). The mean days to recovery including those who were discharged and stayed at home was twenty-one days with a readmission ratio of fifteen percent. Specific factors that were found to have a significant influence on the outcomes consisted of age, comorbidities as well as the surgical method used with the latter having a (p ≤ 0.01). Conclusion: This finding of study stated that the postoperative outcomes of breast cancer surgeries in Pakistani tertiary care units were determined by patients’ characteristics, medical co morbidities, and surgical procedures. Implementing standard of care and making available better surgical modalities can improve the patient care and post-surgical care maybe reduced the rate of further complications among breast cancer patients.

WP4.19 - The Emergency General Surgeon: what is their current operative role?

Abstract Aims Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice. Conclusions Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.

WP8.9 - Laparoscopic Cholecystectomy Performed by a Surgical Care Practitioner: Review of Outcomes

Abstract Introduction Surgical Care Practitioners (SCPs) are non-medical workers involved in various aspects of management of surgical patients. The role includes assisting and performing surgical procedures. Over 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. Materials and Methods A retrospective review of a prospectively collected database was performed. Primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. Results 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis 30 (17.6%) and pancreatitis in 13(7.6%). Mean operating time was 65 minutes (Range 35-152). 53 operations were assisted by a consultant, 110 by a senior SAS grade and 7 by a CT2. 139 (81.7%) patients were discharged on the day of surgery. 24 (14.1%) stayed one night in hospital. There were no major complications. Four patients required readmission. Two with pain and 2 with port site infections. There were no conversions or transfusions required. Conclusion There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.

EP160 - A comparison of pre-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital

Abstract Aims Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients pre-rotation. Identify areas where further support could be given to improve confidence levels. Methods Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one open question. Cohort One (August 2022) were asked to reflect in December 2022. Cohort Two (December 2022) and Cohort 3 (April 2023) were surveyed at the start of their general surgical rotation. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 100% (10/10) cohort one, 75% (6/8) cohort two and 100% (10/10) cohort three completed the survey. Pre-rotation confidence levels mostly improved between the first cohort and last cohort. Areas where modal scores were below three in the last cohort were in managing the acutely unwell general surgical patient, managing biliary disease and managing non-specific abdominal pain. Common concerns of FY1 doctors were not being able to contact a senior in theatre and the busyness of the specialty. Most FY1 doctors felt that group teaching would be the preferred method to increase understanding of general surgery. Conclusions Confidence levels were higher in the final cohort. This suggests core skills are picked up in different specialties which are transferrable to aspects of general surgery. Further work needs to be done to target improvement in areas of lower confidence.

WP6.16 - A comparison of post-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital

Abstract Aims Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients post-rotation. Identify areas where further support could be given to improve confidence levels. Methods August 2022, December 2022 and April 2023 cohorts were surveyed following the end of their four-month rotation. Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one was an open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 100% (10/10) August 2022 cohort, 38% (3/8) December 2022 and 80% (8/10) April 2023 cohort completed the survey. Modal post-rotation confidence levels were mostly four and five across all cohorts. August 2022 and December 2022 cohorts had a modal value of three for confidence in speaking with a patient’s family when a patient was dying. August 2022 cohort had a modal value of three for confidence in speaking to a patient when their condition was unknown. Common concerns of FY1 doctors were managing a deteriorating patient and being unable to contact a senior. Most FY1 doctors felt that case-based discussion would be the preferred method to increase understanding of general surgery. Conclusions Confidence levels were high post-rotation and increased throughout the year. This could suggest that FY1 doctors are receiving a good understanding of general surgery by the end of their rotation. Further work needs to be done to target improvement in areas of lower confidence.

Drugs used for pain management in gastrointestinal surgery and their implications.

Pain is the predominant symptom troubling patients. Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy. Various groups of drugs are used for dealing with this; however, they have their own implications in the form of adverse effects and dependence. In this article, we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.

Operative versus conservative management for inguinal hernia: a methodology scoping review of randomized controlled trials.

There is a lack of consensus on the management of inguinal hernia with limited symptoms. To address this issue a systematic review of existing randomized clinical trials (RCTs) was performed to critically appraise all existing data on asymptomatic hernia management, focusing on generalizability. A scoping review to identify all RCTs comparing surgical and conservative management of patients with inguinal hernias was undertaken. Medline, Embase, Cochrane and ClinicalTrials.gov databases were searched. Data collected included study characteristics and definitions of population, intervention/comparator, and outcomes; and limitations of each study were also extracted. The quality and generalizability of included RCTs were evaluated using Cochrane's ROB-2 and the PRECIS-2 tool, respectively. Searches returned 661 papers; 14 full-text papers were assessed and three RCTs were identified. All RCTs included only male patients with a mean age above 55 years. All RCTs included asymptomatic patients and two included those with minimal symptoms. Different definitions for 'minimally symptomatic' were used in RCTs and none provided details of what was meant by conservative treatment. Follow-up periods varied between studies (1, 2, 3 years). All RCTs had an overall high risk of bias. According to PRECIS-2, two RCTs were classified as pragmatic, and one was equally pragmatic and explanatory. This systematic review highlights a high risk of bias but a good generalizability of the findings from the RCTs conducted on minimally symptomatic inguinal hernia patients. To improve the guidelines for the management of this group of patients, more generalizable data are needed.

Preoperative breast MR imaging influences surgical management in patients with invasive lobular carcinoma.

The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment. This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected. Mean pathological tumour size was 36.4 mm (range 5-140 mm). Dense breasts had larger tumours compared to non-dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE. Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.

Increased Risk of Patellofemoral Instability Events and Surgical Management in Patients With Joint Hypermobility Syndromes: A Matched Cohort Analysis

Increased Risk of Patellofemoral Instability Events and Surgical Management in Patients With Joint Hypermobility Syndromes: A Matched Cohort Analysis