Surgical Resources Research Articles

Immediate results of laparoscopic spleen-preserving distal pancreatectomy: Kimura vs Warshaw procedure

To study the immediate results of spleen-preserving distal pancreatectomy and to compare the outcomes after Kimura and Warshaw procedures. A retrospective non-randomized study included 27 patients with benign tumors of pancreatic tail and body who underwent spleen preserving distal pancreatectomy between 2020 and 2024. All patients were divided into 2 groups: 1 - Kimura procedure (n=16), 2 - Warshaw procedure (n=16). We excluded patients who underwent enucleations, central resections, and other interventions instead of distal pancreatectomy. Mean surgery time was 269.06±70.95 (95% CI 227.74 - 319. 95) and 197.27±42.09 min (95% CI 184.36 - 240.64), respectively (p=0.006). Blood loss, length of hospital day, incidence of laparotomy, splenectomy, splenic infarction, and redo surgeries were similar. Clinically significant postoperative fistula B-C was more common in 1st group (10 (62.4%) vs. 5 (45.5%) cases, p=0.028). There were no significant between-group differences in the incidence of postoperative complications Clavien-Dindo grade >III and mortality. Laparoscopic spleen preserving distal pancreatectomy is the «gold» standard for benign tumors of pancreatic body and tail. The Warshaw and Kimura techniques are safe and effective surgical approaches with similar results. The Warshaw procedure may be more advantageous regarding less surgical resources without deterioration of immediate postoperative results.

Classification Systems of Surgical Complexity: A Scoping Review of the Literature.

A robust system for classifying the technical complexity of surgical procedures has many applications, including optimization of hospital and surgeon-level surgical performance evaluations, reimbursement, and hospital resource utilization. However, little work has been done to distinguish surgical complexity from patient- and disease-associated surgical risk. Through a scoping review of the literature, we identified surgical subspecialty complexity classification systems which were purposed to quantify the technical complexity of a procedure and were validated with prospective or retrospective patientdata. We identified six validated surgical complexity classification systems and determined the methodology which most accurately determines surgical complexity is the level of training or expertise necessary to perform a procedure as determined by expert consensus. However, the existing literature largely validates complexity classification systems by their ability to predict morbidity and mortality which are measures of surgicalrisk. A surgical complexity classification system distinct from, but used in parallel with, surgical risk has significant potential for process improvement. While the technical demands of a surgical procedure may be associated with measures of surgical risk, we propose that surgical complexity is a process measure, best represented in the literature by the level of training/expertise necessary to perform a procedure as determined through expert consensus.

Office-based indocyanine green fluorescent angiography for surgical planning of pedicled flap division

Delayed pedicled flaps are a reliable reconstructive tool for limb salvage. Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications. Assessment of optimal timing has traditionally relied on arbitrary timing or subjective measures. This study explores the use of indocyanine green (ICG) angiography in the office setting as an objective guide for timing the delayed pedicled flap pedicle division, aiming to improve surgical outcomes and resource efficiency. In the outpatient setting, ICG is administered intravenously while the flap pedicle is under tourniquet control. If the distal flap opacifies with the tourniquet still applied, appropriate revascularization has occurred, and the pedicle may be safely divided. We present the example of a 47-year-old male with multiple previous flap reconstructions who eventually required a reverse sural artery flap. Initial intraoperative ICG imaging on postoperative day (POD) 23 revealed insufficient perfusion, prompting the postponement of pedicle division. Subsequent office-based imaging on POD 47 revealed a persistent lack of neovascularization. Adequate vascularization was demonstrated on POD 81, enabling successful pedicle division in the operating room on POD 121 without complications. ICG fluorescent angiography can guide the timing of division for delayed pedicled flaps. We recommend its use in the outpatient setting to decrease unnecessary operating room usage and anesthetic events and reduce the risk of wound healing complications from early pedicle division.

Widening Access to Surgical Education Through Free Digital Platforms: An Evaluation of the Mind the Bleep Surgical Team's Impact.

Introduction Mind The Bleep (MTB) is an online medical education organisation run by United Kingdom-based resident doctors. It represents one of a number of free-open access online medical resources (FOAMed) that have increased in popularity, especially since the COVID-19 pandemic. The surgical team of MTB works to produce high-quality surgical educational resources aimed at early postgraduate doctors. This paper provides an appraisal of the teams' current methods of teaching and the learning points identified from these. Methods This was a retrospective mixed-method review analysing quantitative and qualitative data sources including website analytics and feedback surveys. Wilcoxon signed-rank tests were used to identify significant differences between pre- and post-session confidence levels in the subject matter. Results A total of 22 online targeted education programmes, with a total of 140 webinars were completed between November 2021 and August 2024. The total live viewership was 6733 participants with a mean of 48.1 per webinar. The total attendance including live and watched later was 10221 participants, with a mean of 73 total viewers per webinar. Of the total viewers, 4714 provided feedback (46.1%).Across all webinar series, we identified a statistically significant increase in participant-rated confidence (p<0.05). Discussion Our ability to produce consistent high-quality content is due to leveraging a near-peer teaching model and recruiting resident doctors as teachers. This method ensures cognitive congruence between participant and educator and provides doctors an opportunity to gain teaching experience. Our social media advertising has ensured wide reach. To the best of our knowledge, we provide the first large-scale breakdown of the work done by an online surgical education organisation. Limitations include a low feedback rate and feedback limited to Kirkpatrick type 1 learner reaction.

Characteristics, progression, management, and outcomes of NEC: a retrospective cohort study.

Necrotising enterocolitis (NEC) in preterm infants is associated with high morbidity and mortality. In most neonates, it is a progressive disease from medical NEC (mNEC) to surgical NEC (sNEC); however, in some, it presents as sNEC from onset. To evaluate the rate, the timing of progression, different surgical approaches, and outcomes of mNEC and sNEC in preterm neonates. A retrospective cohort study of preterm infants with diagnosis of NEC between 2010 and 2020 was conducted. Data on clinical presentation, NEC progression, treatment received, different surgical approaches, resource utilization, and outcomes were abstracted. Infants were classified into 3 groups: mNEC, mNEC that progressed to sNEC, and sNEC at presentation. Among 208 included infants with NEC, 109 (52%) were mNEC, 66 (32%) progressed from mNEC to sNEC, and 33 (16%) presented with sNEC. Gestational age, birth weight, and postnatal age at NEC were inversely associated with the development of sNEC. mNEC progressed to sNEC occurred after a median of 2.5 (IQR 1-4.25) days. Ninety (91%) of sNEC patients underwent interventions: peritoneal drain only in 19 (21%), laparotomy in 59 (66%), or both in 12 (13%). In comparison with mNEC, those with sNEC infants had longer duration on antibiotics, inotropes, respiratory support, length of stay, and time to reaching full enteral feeds; and were more likely to have recurrent NEC episodes, BPD, and mortality. There is a high burden of illness for sNEC cases. Insight into the expected clinical course of sNEC patients can facilitate anticipatory management and provide a window of opportunity for timely interventions that may ameliorate the course of sNEC.

A deep learning based automatic two-dimensional digital templating model for total knee arthroplasty

BackgroundPreoperative templating is an important step for total knee arthroplasty (TKA), facilitating hospital personnel in the anticipation and preparation of necessary surgical resources. Despite its importance, this process currently lacks automation. This study aimed to develop an artificial intelligence (AI) model to automate implant size prediction.MethodsA total of 13,281 (2938 anteroposterior, 10,343 lateral) knee radiographs obtained from the authors’ institute were utilized for model training, with 2302 (1034 anteroposterior, 1268 lateral) images set apart for validation and testing. The templating AI model integrates a pipeline composed of multiple steps for automated implant size estimation. To predict implant size, anterioposterior (AP) and lateral radiograph predictions were merged, selecting the smaller of the predicted sizes to prevent implant overhang. The model’s size predictions were validated with 81 real TKA data set apart from the training data, and its accuracy was compared to that of manual templating by an orthopedic specialist. Predictions matching the actual implanted sizes were labeled “exact” and those within one size, “accurate.” The influence of patient characteristics on the model’s prediction accuracy was also analyzed. The measurement time elapsed for implant sizing was recorded for both the AI model and the orthopedic specialist. Implant position predicted by the model was validated by comparing insert locations with postoperative images.ResultsCompared with data from 81 actual TKA procedures, the model provided exact predictions for 39.5% of femoral and 43.2% of tibial components. Allowing a one-size margin of error, 88.9% of predictions were deemed “accurate” for both components. Interobserver reliability (Cohen’s kappa) were 0.60 and 0.70 for femoral and tibial implants, respectively, both classified as “substantial.” The orthopedic specialist produced results accurate within one-size margin of error in 95.1% and 100% of cases for femoral and tibial components, respectively. Interobserver reliability between the orthopedic specialist and ground truth was 0.76 and 0.8 for femoral and tibial components, respectively. The measurement time per case was 48.7 s for the AI model, compared with 97.5 s for the orthopedic specialist. Compared with postoperative radiographs, predicted implant position had an error of less than 4 mm on average.ConclusionsAn AI-based templating tool for TKA was successfully developed, demonstrating satisfactory accuracy and efficiency. Its application could significantly reduce the clinical workload in TKA preparation.

The anesthesia human resources crisis in Canada.

Human resources are essential to the safe and effective functioning of any health care system. Pressure on the health care workforce is of active global concern. There appears to be an anesthesia service delivery crisis in Canada. Recent media headlines have featured vacant physician anesthesiologist positions, closure of maternity units, and postponement of elective surgeries because of a shortage of anesthesiologists. This shortage is most serious in rural and remote communities. This has prompted the Canadian Anesthesiologists' Society to publish a position statement on "Strategies to Address the Surgical Backlog and Health Human Resource Issues in Anesthesia."In this article, we discuss the composition and organization of the anesthesia workforce in Canada. We compare the Canadian anesthesia workforce to other Organisation for Economic Co-operation and Development countries. We contend that the current anesthesia provision model in Canada is not meeting population needs and outline potential solutions to the anesthesia human resources crisis. These include increasing the numbers of anesthesiologists in training, encouraging international medical graduates to migrate to Canada, and various different approaches to task shifting and task sharing.

Qualitative exploration of 3D printing in Swedish healthcare: perceived effects and barriers

BackgroundThree-dimensional (3D) printing produces objects by adding layers of material rather than mechanically reducing material. This production technology has several advantages and has been used in various medical fields to, for instance, improve the planning of complicated operations, customize medical devices, and enhance medical education. However, few existing studies focus on the adoption and the aspects that could influence or hinder the adoption of 3D printing.ObjectiveTo describe the state of 3D printing in Sweden, explore the perceived effects of using 3D printing, and identify barriers to its adoption.MethodsA qualitative study with respondents from seven life science regions (i.e., healthcare regions with university hospitals) in Sweden. Semi-structured interviews were employed, involving 19 interviews, including one group interview. The respondents were key informants in terms of 3D printing adoption. Data collection occurred between April and May 2022 and then between February and May 2023. Thematic analysis was applied to identify patterns and themes.ResultsAll seven regions in Sweden used 3D printing, but none had an official adoption strategy. The most common applications were surgical planning and guides in clinical areas such as dentistry, orthopedics, and oral and maxillofacial surgery. Perceived effects of 3D printing included improved surgery, innovation, resource efficiency, and educational benefits. Barriers to adoption were categorized into organization, environment, and technology. Organizational barriers, such as high costs and lack of central decisions, were most prominent. Environmental barriers included a complex regulatory framework, uncertainty, and difficulty in interpreting regulations. Technological barriers were less frequent.ConclusionsThe study highlights the widespread use of 3D printing in Swedish healthcare, primarily in surgical planning. Perceived benefits included improved surgical precision, innovation, resource efficiency, and educational enhancements. Barriers, especially organizational and regulatory challenges, play a significant role in hindering widespread adoption. Policymakers need comprehensive guidance on 3D printing adoption, considering the expensive nature of technology investments. Future studies could explore adoption in specific clinical fields and investigate adoption in non-life science regions within and outside Sweden.

Perioperative Medicine for Ambulatory Surgery.

Ambulatory anesthesia for same-day surgery is a fast-growing and ever-improving branch of modern anesthesia. This is primarily driven by the involvement of anesthesiologists as perioperative physicians working in multidisciplinary groups. These groups work together to improve patient safety, patient outcomes, and overall efficiency of both in-patient and out-patient surgery. Appropriate patient selection and optimization are critical to maintain and improve the foundational entities of best ambulatory anesthesia practice. In this review article, a selection of considerations in the field of ambulatory anesthesia are featured, such as the aging population, sleep apnea, obesity, diabetes, cardiac disease, substance abuse, preoperative medication management, multimodal analgesia, social determinants of health, and surgical facility resources.

BN SO35 - A Novel Ambulatory Pathway in the Management of Acute Pancreatitis

Abstract Background Acute Pancreatitis (AP) accounts for 20000 admissions per year, resulting in an average hospital stay of 5 days. Over 90% of patient have mild or moderate disease severity. Validated risk stratification tools such as the Harmless Acute Pancreatitis (HAP) score utilised alongside biochemical markers and clinical acumen can predict up to 97% of patients with a mild disease course. A pathway was introduced at two NHS centres to enable diagnosis and ambulatory management of patients with predicted mild AP with the aim of improving patient experience by preventing unnecessary admission, reducing pressure on surgical departments and providing safe outpatient management. Method The study took place at two sites: a district general hospital (DGH) and a tertiary referral centre. Pathway development occurred in parallel to pilot. Ambulation was defined as no overnight stay in a hospital bed. An initial retrospective review of all AP admissions was undertaken to understand current burden of disease and severity in our centres. Suitable patients were identified prospectively and data (demographics, biochemical markers, modified HAP score, severity of disease, complications, re-admission rate, surgical or endoscopic intervention) were collected for up to 30 days after discharge. AP ‘proforma’ were created to understand surgeons decision-making surrounding ambulation versus admission. Results Between November 2023 and May 2024, 99 patients with AP presented to the DGH surgical unit. Causes of AP included gallstones (n=55), idiopathic (n=21), alcohol (n=17), and post-ERCP (n=2). 38 patients (38%) were ambulated, with 23/38 (61%) returning for planned review within 72 hours. There were no mortalities in the ambulatory group. Three (7%) ambulated patients were re-admitted within 30 days for pain control (n=2) and post-cholecystectomy complications (n=1). Reasons for non-ambulation included: pain (n=30), inpatient cholecystectomy (n=4), poor oral intake (n=4), social reasons (n=3). In 4-week tertiary data collection, 5/17 (29%) eligible patients were ambulated, with 1 (20%) re-admission. Conclusion Pilot of a novel pathway to identify and ambulate patients with a predicted mild course of AP has been successful across two NHS centres. Use of validated risk scores alongside biochemical markers and clinical acumen produces a safe, sustainable and effective pathway that reduces burden on inpatient surgical resources. It is safe and feasible to ambulate patients with AP whilst undertaking diagnostic imaging, managing symptoms, facilitating expedited cholecystectomy and arranging specialist review in the outpatient setting. Further work is required with stakeholders to refine the pathway and replicate these results in other surgical units.

Outcomes of Congenital Heart Diseases in Duhok, Kurdistan Region of Iraq

Background: Congenital heart diseases (CHD) are the most common birth defects worldwide, significantly impacting morbidity and mortality, especially in low- and middle-income countries where early diagnosis and access to surgical care are limited. In Iraq, congenital heart surgeries are relatively new, and few studies have investigated CHD outcomes in this context. Aim: This study aimed to evaluate the prevalence, distribution, and surgical outcomes of congenital heart diseases among patients treated at the Azadi Heart Center in Duhok, Kurdistan Region of Iraq. Patients and Methods: A retrospective, cross-sectional study was conducted involving 111 patients aged 1-69 years with CHD who underwent surgery at the Azadi Heart Center between March 2019 and March 2024. Data were collected on demographic characteristics, clinical profiles, surgical details, and postoperative complications, including mortality rates. Statistical analysis was performed using Microsoft Excel, with data presented as means, standard deviations, frequencies, and percentages. Results: The average age of patients in the study was 13 years (±16), with congenital heart disease (CHD) being most common among children, who made up 80.18% of cases. Male patients accounted for 54.95%. The most frequent CHD types observed were Tetralogy of Fallot (25%), isolated Ventricular Septal Defect (20%), and Atrial Septal Defect (10%). The surgeries were highly successful, with a 95.5% success rate. However, some patients experienced postoperative complications, such as pneumonia (11.71%), arrhythmias (10.96%), and surgical site infections (5.41%). The overall mortality rate was 10.81%, with infections being a leading cause of death after surgery. Conclusions: CHD is prevalent among young patients in Duhok, with favorable surgical outcomes and acceptable complication rates. These findings highlight the need for early detection, enhanced surgical resources, and continued surveillance to improve outcomes for CHD patients in Iraq.

Higher Socioeconomic Status is Associated with Greater Rates of Surgical Resource Utilization Prior to Spine Fusion Surgery

Previous research has demonstrated an association between socioeconomic status (SES) and patient health, specifically noting that patients of lower SES have poor health outcomes. Understanding how social factors, including socioeconomic status (SES), relate to disparities in health outcomes is critical to closing gaps in equitable care to patients. While several studies have examined the effect of SES on postoperative spine outcomes, there is limited spine literature evaluating SES in the context of barriers to spine care. The primary objective of this study was to determine if socioeconomic status is associated with resource utilization prior to spine surgery consultation. As part of a sub-analysis, this paper also explores the effect of other social factors on pre-visit resource utilization. Retrospective cohort study. Adult patients who underwent elective cervical or lumbar spinal fusion between 2020 and 2021. Pre-visit resource utilization including 1) epidural steroid injection, 2) opioid use, 3) physical therapy, 4) prior spine surgeon, and 5) prior spine surgery METHODS: Each patient was assigned a "distressed score" using the Distressed Communities Index (DCI) and a socioeconomic status (SES) score using the Social Vulnerability Index (SVI) based on their zip code. Patient charts were manually reviewed to collect data regarding pre-visit resource utilization. The cohort was analyzed based on DCI quintile and SVI quartile. Additional analyses were conducted based on marital status and race. Our study included 996 patients in the final analysis. Based on DCI, patients from prosperous communities were more likely to have previously visited a spine surgeon (13.2% (prosperous) vs. 7.58% vs. 6.92% vs. 9.09% vs. 3.70% (distressed), p=0.015) and to have had prior spine surgery (11.1% (prosperous) vs. 9.57% vs. 9.09% vs. 2.52% vs. 6.36% (distressed), p=0.015). Similarly, when evaluated based on SES SVI, patients who lived in a low-risk community were more likely to have previously visited a spine surgeon (13.0% low-risk vs. 7.26% low-medium risk vs. 16.9% medium-high risk vs. 10.6% high risk, p=0.049) and to have had prior spine surgery (13.0% low-risk vs. 7.26% vs. 16.9% vs. 10.6% high risk, p=0.030). When evaluated based on marital status, there was no difference in any resource utilization. Non-black and non-white patients were more likely to have tried physical therapy compared to their black and white counterparts (76.9% (other) vs. 60.9% (Black) vs. 54.3% (White), p=0.026). This study examined the relationship between socioeconomic status and resource utilization and found a positive correlation between higher social standing and access to spine surgery and spine surgeons. These findings demonstrate a propensity for earlier evaluation of spine-related conditions among patients from prosperous communities compared to patients from less prosperous communities.

Risk assessment model used to predict discharge care after total hip and total knee arthroplasty: A population-based study

BackgroundTransfer to a post-acute care facility or hospital readmission after total joint arthroplasty represent additional costs and increased surgical and health care resource utilization. Accurate prediction of post-acute care factors could help providers to plan the patient's discharge destination and have a positive impact on postoperative outcomes and readmission rates. ObjectiveTo develop a risk assessment model to predict discharge care after total hip arthroplasty (THA) and total knee arthroplasty (TKA). DesignA retrospective longitudinal observational study. Settingsand participants: This study included 209 patients who underwent primary unilateral THA or TKA at a major academic medical center in Switzerland from January 2018 to December 2019. MethodsA collection of computerized- and paper-recorded data identified the discharge destination, socio-demographic factors, comorbidities, and other factors related to the patient. Univariate and multivariate analyses were performed to describe the predictors of post-surgical discharge destinations. ResultsThe characteristics associated with post-acute care after primary unilateral THA or TKA were the absence of a caregiver, advanced age, female gender, presence of walking aids, high ASA score, and comorbidity severity. A prediction model demonstrated that these six characteristics were associated 52 % with discharge to a post-acute care destination. ConclusionsThis study allowed us to identify predictors of discharge to a post-surgical destination. Predictive models can be efficiently used to better predict which patients are predisposed to post-acute care after hospital discharge. Further studies are needed to determine the optimal criteria for different destinations.

Piloting an Assessment Tool to Organize Surgical Care in Armed Conflicts: Findings From Cameroon

IntroductionArmed conflict is increasing globally and is dramatically disrupting surgical care more than ever before. To address this, the PIPESS (Personnel, Infrastructure, Procedures, Equipment, Supplies, and Standard) tool was designed to facilitate assessment of hospital capacity. It assesses 6 key categories at 3 timepoints: preconflict, during conflict, and postconflict. This tool was piloted to assess the impact of conflict and COVID-19 on surgical care delivery at the Buea Regional Hospital in Cameroon. MethodsThis was a cross-sectional, qualitative study combining in-depth interviews and on-site observations of the surgical care unit. The data collected during the interviews were then applied to the modified PIPESS tool to calculate a preconflict score based on recall and a during conflict score to quantify differences before and during conflict. ResultsWe interviewed 12 key informants: 6 patients, 3 doctors, and 3 other staff. The themes extracted from the preconflict period highlight major barriers including rudimentary prehospital care and referral limitations from remote areas, lack of funding and training, and a demand exceeding the supply of care. COVID-19 resulted in an influx of resources into the region and did not disrupt care to the extent of the conflict. Quantitatively, the PIPESS score for preconflict was 110, and the PIPESS score during conflict was 115, showing an increase in resources, specifically in personnel and infrastructure during conflict. ConclusionsThe conflict increased the burden on existing health centers and strained resources for trauma care. Paradoxically, surgical resources increased during the conflict likely because of increased international support along with local displacement of staff toward the hospital. Further data should be collected during the postconflict setting.

Development and dissemination of a series of surgical skills and procedures video tutorials using a novel, low-cost, and sustainable simulation kit (GlobalSurgBox)

IntroductionSurgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator. MethodsWe created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS). ResultsVideos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ​± ​1.05 and GQS of 3.06 ​± ​0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty. ConclusionsThis study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility.

Novel surgical video-based education resource for surgical case preparation among medical students: results from a randomized controlled trial

Novel surgical video-based education resource for surgical case preparation among medical students: results from a randomized controlled trial

The Long Haul to Surgery: Long COVID Has Minimal Burden on Surgical Departments.

Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as "Long COVID". Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departments. A previously constructed database of survey respondents who tested positive for COVID-19 was queried, identifying patients reporting experiencing symptoms consistent with Long COVID. Additional chart review determined whether respondents had a surgical or non-routine invasive procedure on or following the date of survey completion. Outcomes from surgeries on patients reporting Long COVID symptoms were compared to those from asymptomatic patients. A total of 17.4% of respondents had surgery or a non-routine invasive procedure in the study period. A total of 48.8% of these patients reported experiencing symptoms consistent with Long COVID. No statistically significant differences in surgical outcomes were found between groups. The results of this analysis demonstrate that Long COVID does not appear to have created a significant burden of surgical disease processes on the healthcare system despite the wide range of chronic symptoms and increased healthcare utilization by this population. This knowledge can help guide surgical operational resource allocation as a result of the pandemic and its longer-term sequelae.

Socioeconomic Indices Are Associated With Increased Resource Utilizations, but Not 90-Day Complications Following Total Hip and Knee Arthroplasty

BackgroundSocioeconomic disadvantage has been associated with negative outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The area deprivation index (ADI) and distressed communities index (DCI) are composite rankings that score socioeconomic status (SES) using patients’ home addresses. The purpose of this study was to examine the association of ADI and DCI with outcomes following THA and TKA while controlling for potential confounding covariates. MethodsA series of 4,146 consecutive patients undergoing primary THA and TKA between January 2018 and May 2023 were queried from our institutional total joint registry. The 90-day medical and surgical complications and resource utilization were collected. The ADI and DCI scores were obtained for each patient, and the association between these scores and postoperative outcomes was analyzed. ResultsThe ADI and DCI were both associated with patient age, sex, race, comorbidity burden, and smoking status. After controlling for these variables, higher ADI and DCI scores were associated with increased length of stay (P = 0.003 and P = 0.008, respectively), but were not associated with the occurrence of any 90-day complication, reoperation, or revision. ConclusionsThe SES, as quantified by ADI and DCI, was associated with multiple known risk factors for complications following THA and TKA, but was not independently associated with complications, reoperations, or revision surgeries at 90 days postoperatively. While convenient metrics for the quantification of SES, in some populations, ADI and DCI may not be independently associated with detrimental outcomes following THA and TKA.

Patients’ perspectives on ethical principles to fairly allocate scarce surgical resources during the COVID-19 pandemic in the Netherlands: a Q-methodology study

ObjectivesDuring the COVID-19 pandemic, healthcare professionals were faced with prioritisation dilemmas due to limited surgical capacity. While the views of healthcare professionals on fair allocation have been given considerable attention,...

Mesenchymal Tumor Management: Integrating Surgical and Non-Surgical Strategies in Different Clinical Scenarios.

Mesenchymal tumors originate from mesenchymal cells and can be either benign or malignant, such as bone, soft tissue, and visceral sarcomas. Surgery is a cornerstone treatment in the management of mesenchymal tumors, often requiring complex procedures performed in high-volume referral centers. However, the COVID-19 pandemic has highlighted this need for alternative non-surgical approaches due to limited access to surgical resources. This review explores the role of non-surgical treatments in different clinical scenarios: for improving surgical outcomes, as a bridge to surgery, as better alternatives to surgery, and for non-curative treatment when surgery is not feasible. We discuss the effectiveness of active surveillance, cryoablation, high-intensity focused ultrasound, and other ablative techniques in managing these tumors. Additionally, we examine the use of tyrosine kinase inhibitors in gastrointestinal stromal tumors and hypofractionated radiotherapy in soft tissue sarcomas. The Sarculator tool is highlighted for its role in stratifying high-risk sarcoma patients and personalizing treatment plans. While surgery remains the mainstay of treatment, integrating advanced non-surgical strategies can enhance therapeutic possibilities and patient care, especially in specific clinical settings with limitations. A multidisciplinary approach in referral centers is vital to determine the optimal treatment course for each patient.