Results Of Surgical Treatment Research Articles

Significance of coping strategies on the outcome of surgical treatment of patients with prosoplegia

Aim: to evaluate the impact of coping strategies on the outcomes of surgical treatment of patients with prosoplegia. Material and methods: the analysis of the results of surgical treatment of 50 patients with prosoplegia that developed after removal of tumors of the posterior part of the skull, the lateral part of the skull base, and the parotid-masticatory region involved in reconstructive interventions on the facial nerve was performed. At the preoperative stage a clinical examination of patients was performed according to the House-Brackmann scale, Sunnybrook Facial Grading System (SFGS) scale, and a neurophysiological study was performed. A survey was carried out with the use of the Heim’s questionnaire, WCQ (version by Lazarus), CSI as an indicator of coping strategies before surgery and the Aaron Antonovsky’s Sense of Coherence Scale (SOC). Outcomes were evaluated according to the Johnny Chuieng–Yi Lu subjective scale “Satisfaction with surgical treatment”. Results: all patients from 6 to 10 months after surgery showed signs of muscle recovery, which in the majority (88%, n=44) was accompanied by an improvement in their condition. In 12% of cases (n=6) there were no positive dynamics, which caused unsatisfactory results of treatment. Such painful conditions are often interrupted or recommendations for self-rehabilitation are not followed. The above-described predominance of maladaptive coping strategies in patients with unsatisfactory initial operations is reliable. Adaptive treatment strategies were better developed in patients with favorable treatment outcomes. A high direct correlation was established between the outcomes of treatment, assessed by the Johnny Chuieng–Yi Lu scales, SGFS and SOC coherence scale, Conclusion: Systemic complex rehabilitation and self-rehabilitation have a significant impact on treatment outcomes. Prosoplegia leads to a violation of facial and emotional expression, causing social maladjustment and depressive disorders, minimizing the effects of reinnervation in combination with negative coping strategies. As a result, full-fledged surgical treatment of the facial muscles is currently a very difficult and sometimes insurmountable task.

Duodenum-preserving pancreatic head resection or pancreatoduodenectomy for the surgical treatment of paraduodenal pancreatitis: a retrospective cohort study

Paraduodenal pancreatitis (PDP) is an uncommon yet well-described type of focal chronic pancreatitis. The aim of our study was to compare the outcomes of surgical treatment of patients with PDP using pancreatoduodenectomy and duodenum-preserving pancreatic head resection (DPPHR). A retrospective analysis of 153 consecutive patients with PDP was performed. Patients who were treated with either DPPHR or PD were enrolled. The primary endpoint of the study was pain control achieved at the time of follow-up. The secondary endpoints of the study were complication rate (Clavien-Dindo > 2), hospital length of stay, and 90-day mortality. All patients were followed up after discharge for the assessment of pain cessation for a minimal period of 10 months. The final study population consisted of 71 patients. A total of 14 patients (19.7%) underwent pancreatoduodenectomy, and 57 (80.3%) were managed with DPPHR. Complication rate was significantly lower in DPPHR group at χ2 = 4.2677, p < 0.05. Mean hospital length of stay was 9.3 days (range 3-29) in DPPHR group and 13.9 days (range 7-35) in PD group (p < 0.05). No postoperative mortality was recorded. The mean follow-up period of the patients after surgery was 41.8 ± 20.6 months (range 10-88). Pain scores at the time of operation were calculated as 50.9 ± 12.1 in DPPHR group and 56.1 ± 11.4 in PD group. At the time of follow-up, pain scores improved significantly in both groups and were 10.3 ± 8.8 and 10.9 ± 8.6, respectively. DPPHR achieves similar results in pain control as PD with a lower complication rate and shorter hospital LOS.

The Outcome of Salvage Liver Transplantation and Liver Resection for Recurrent Hepatocellular Carcinoma Using the 5-5-500 Rule, Japanese Extended Liver Transplantation Criteria for Hepatocellular Carcinoma

Liver transplantation (LT) for hepatocellular carcinoma (HCC) is limited to Child-Pugh class C patients according to the Japanese HCC treatment algorithm. However, extended criteria of LT for HCC, known as the 5-5-500 rule, were published in 2019. Hepatocellular carcinoma reportedly has a high recurrence rate after primary treatment. We hypothesized that the outcome of recurrent HCC would be improved if the 5-5-500 rule were adopted for patients with recurrent HCC. We, therefore, analyzed the outcomes of surgical treatment (liver resection [LR] and LT) for recurrent HCC using the 5-5-500 rule in our institute. Fifty-two patients younger than 70 years of age received surgical treatment for recurrent HCC using our institute's 5-5-500 rule from 2010 to 2019. We divided these patients into the LR and LT groups in the first study. The 10-year overall survival and re-recurrence-free survival were analyzed. The second study analyzed the risk factors of re-recurrence after surgical treatment for recurrent HCC. In the first study, the background characteristics of the 2 groups (LR and LT) showed no significant difference, except for age and Child-Pugh classification. There was no significant difference in the overall survival between groups (P=.35), but the re-recurrence-free survival in the LR group was significantly shorter than that in the LT group (P < .01). In the second study, the male sex and LR were risk factors of re-recurrence after surgical treatment for recurrent HCC. Child-Pugh's class did not contribute to re-recurrence. To improve the outcomes of recurrent HCC, LT is the better choice, regardless of the Child-Pugh class.

Oncologic outcomes of surgical treatments of advanced sinonasal malignancies

Objective: To investigate the prognoses of advanced (T3-T4) sinonasal malignancies (SNM). Methods: The clinical data of 229 patients with advanced (T3-4) SNM who underwent surgical treatments in the First Affiliated Hospital of Sun Yat-sen University from 2000 to 2018 were retrospectively analyzed, including 162 males and 67 females, aged (46.8±18.5) years old. Among them, 167 cases received endoscopic surgery alone, 30 cases received assisted incision endoscopic surgery, and 32 cases received open surgery. The Kaplan-Meier method was used to estimate the 3-year and 5-year overall survival (OS) and event-free survival (EFS). Univariate and multivariate Cox regression analyses were performed to explore significant prognostic factors. Results: The 3-year and 5-year OS were respectively 69.7% and 64.0%. The median OS time was 43 months. The 3-year and 5-year EFS were respectively 57.8% and 47.4%. The median EFS time was 34 months. The 5-year OS of the patients with epithelial-derived tumors was better than that of the patients with mesenchymal-derived tumors and malignant melanoma (5-year OS was respectively 72.3%, 47.8% and 30.0%, χ2=36.01, P<0.001). Patients with microscopically margin-negative resection (R0 resection) had the best prognosis, followed by macroscopically margin-negative resection (R1 resection), and debulking surgery was the worst (5-year OS was respectively 78.4%, 55.1% and 37.4%, χ2=24.63, P<0.001). There was no significant difference in 5-year OS between the endoscopic surgery group and the open surgery group (65.8% vs. 53.4%, χ2=2.66, P=0.102). Older patients had worse OS (HR=1.02, P=0.011) and EFS (HR=1.01, P=0.027). Patients receiving adjuvant therapy had a lower risk of death (HR=0.62, P=0.038). Patients with a history of nasal radiotherapy had a higher risk of recurrence (HR=2.48, P=0.002) and a higher risk of death (HR=2.03, P=0.020). Conclusion: For patients with advanced SNM, the efficacy of endoscopic surgery can be comparable to that of open surgery when presence of safe surgical margins, and a treatment plan based on transnasal endoscopic surgery as the main comprehensive treatment is recommended.

Outcomes of surgical treatment of diverticular abscesses after failure of antibiotic therapy

Management of diverticular abscess (DA) is still controversial. Antibiotic therapy is indicated in abscesses ≤ 4 cm, while percutaneous drainage/surgery in abscesses > 4 cm. The study aims to assess the role of antibiotics and surgical treatments in patients affected by DA. We retrospectively analyzed 100 consecutive patients with DA between 2013 and 2020, with a minimum follow-up of 12 months. They were divided into two groups depending on abscess size ≤ or > 4 cm (group 1 and group 2, respectively). All patients were initially treated with intravenous antibiotics. Surgery was considered in patients with generalized peritonitis at admission or after the failure of antibiotic therapy. The primary endpoint was to compare recurrence rates for antibiotics and surgery. The secondary endpoint was to assess the failure rate of each antibiotic regimen resulting in surgery. In group 1, 31 (72.1%) patients were conservatively treated and 12 (27.9%) underwent surgery. In group 2, percentages were respectively 50.9% (29 patients) and 49.1% (28 patients). We observed 4 recurrences in group 1 and 6 in group 2. Recurrence required surgery in 3 patients/group. We administered amoxicillin-clavulanic acid to 74 patients, piperacillin-tazobactam to 14 patients and ciprofloxacin + metronidazole to 12 patients. All patients referred to surgery had been previously treated with amoxicillin-Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation clavulanic acid. No percutaneous drainage was performed in a hundred consecutive patients. Surgical treatment was associated with a lower risk of recurrence in patients with abscess > 4 cm, compared to antibiotics. Amoxicillin-clavulanic acid was associated with a higher therapeutic failure rate than piperacillin-tazobactam/ciprofloxacin + metronidazole.

Position statement: management of rotator cuff tears in adults.

We sought to compare success and re-tear rates of surgically treated full-thickness tears of the rotator cuff in men and women older than 18 years of age to develop a guideline intended for orthopedic surgeons and other health care providers who assess, counsel and care for these patients. We searched Medline, Embase and Cochrane databases through to Apr. 20, 2021, and included all English-language randomized trials comparing single-row versus double-row fixation via arthroscopic approaches; latissimus dorsi transfer (LDT) versus partial rotator cuff repair, lower trapezius transfer (LTT), and superior capsular reconstruction (SCR); and early versus late arthroscopic rotator cuff repair for traumatic tears. We also considered observational studies comparing LDT with LTT and partial repair and studies comparing early versus late treatment of traumatic rotator cuff tears. Outcomes of interest were functional outcomes, pain outcomes, and re-tear rates associated with these interventions. We rated the quality of the evidence and strength of recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This guideline will benefit patients seeking surgical intervention of full thickness rotator cuff tears by improving counselling on surgical treatment options and outcomes. It will also benefit surgical providers by expanding their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making.

Comparing midterm clinical outcome of surgical versus ultrasound guided needle aspiration of the calcific deposits for therapy resistant calcifying tendinitis of the shoulder. A comparative cohort study

PurposeComparing the midterm clinical outcome of surgical treatment versus ultrasound guided needle aspiration of the calcific deposits (NACD) treatment for conservative therapy resistant calcifying tendinitis (CT) of the shoulder. The hypothesis is that both surgical treatment and NACD treatment led to a comparable good clinical outcome. MethodsA comparative cohort study was performed (n = 76). The allocation to surgical group (n = 35) or NACD group (n = 41) was the result of a shared decision-making strategy. Primary outcome was decrease in VAS for pain (pVAS). Secondary outcomes were EQ-5D index, DASH score, ASES, VAS for satisfaction, recommendation of treatment, adverse events, cross-over between groups, additional treatments, and symptomatology after care as usual. ResultsAt midterm follow-up (5.5 years, SD 0.5 years) decrease in pVAS did not differ (p = 0.20) between two groups (60.6 mm, SD 23.3 mm vs 53.4 mm, SD 24.2 mm). Secondary clinical outcomes were also comparable. In 68.3% surgical treatment was avoided. At final follow-up none of the outcome scores differed significantly between the crossed-over patients (n = 13, 31.7%) and the initial surgical group. DiscussionAt midterm follow-up surgical and NACD treatment result in comparable clinical outcomes. In 68.3% a surgical treatment could be avoided. In 31.7% the patient eventually needed a surgical treatment after failed NACD treatment. After midterm follow-up these patients showed comparable good clinical outcomes. In our opinion, both NACD and surgical treatment could be considered as a next step treatment option for conservative therapy resistant CT of the shoulder. Though, one should be aware that after a midterm follow-up a high number of patients cross-over to surgical treatment after a NACD treatment.

Central aortic blood pressure and pulse wave characteristics in patients with decscending thoracic and abdominal aortic aneurysm: features, dynamics, and prognostic significance

Aortic aneurysm (AA) is one of the most formidable cardiovascular diseases, characterized by subtle clinical manifestations and a high risk of complications. Predisposing factors in the development of AA are age, arterial hypertension (HTN), atherosclerosis, and inflammatory aortic diseases. Those are associated with changes in vascular stiffness. HTN causes increased tension in the aortic wall when the pulse wave of blood pressure (BP) rises in patients with AA. Indicators of central BP and vascular stiffness are of particular interest. They present as independent risk factors for cardiovascular events but are poorly studied among patients with AA. The purpose of the review is to summarize the ideas about the relationship of AA with the indicators of vascular stiffness and central hemodynamics in patients with non-operated AA, as well as after endovascular AA repair. Here we discuss the predictive accuracy and applicability of individual markers concerning AA progression and surgical treatment outcomes, as well as unresolved issues and prospects for further research.

Surgical management of primary liver cancers during the COVID-19 pandemic: overcoming the dilemma with standardization

BackgroundThe present study evaluates the impact of the pandemic on outcomes after surgical treatment for primary liver cancer in a high-volume hepatopancreatobiliary surgery center. MethodsPatients, who underwent liver resection for primary liver resection between January 2019 and February 2020, comprised pre-pandemic control group. The pandemic period was divided into two timeframes: early pandemic (March 2020–January 2021) and late pandemic (February 2021–December 2021). Liver resections during 2022 were considered as the post-pandemic period. Peri-, and postoperative patient data were gathered from a prospectively maintained database. ResultsTwo-hundred-eighty-one patients underwent liver resection for primary liver cancer. The number of procedures decreased by 37.1% during early phase of pandemic, but then increased by 66.7% during late phase, which was comparable to post-pandemic phase. Postoperative outcomes were similar between four phases. The duration of hospital stay was longer during the late phase, but not significantly different compared to other groups. ConclusionDespite an initial reduction in number of surgeries, COVID-19 pandemic had no negative effect on outcomes of surgical treatment for primary liver cancer. The structured standard operating protocol in a high-volume and highly specialized surgical center can withstand negative effects, a pandemic may have on treatment of patients.

Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a constellation of symptoms caused by the compression of neurovascular structures at the superior aperture of the thorax, properly referred to as the thoracic inlet. However, there is no consistent clinical presentation or definition. Based on a comprehensive literature review, this article presents the etiology, epidemiology, and clinical diagnostics of TOS, as well as the possibilities and outcomes of surgical treatment. The diagnosis and treatment are contentious, and some even question the existence of TOS. Its symptoms are often confused with those of distal compression neuropathies or cervical radiculopathies. The various surgical approaches for this syndrome are evaluated according to their ability to facilitate wide exposure, their potential morbidity, and their beneficial results. Most patients suffering from any form of TOS can benefit from surgical treatment. The duration of symptoms, socioeconomic factors and most notably, a stringent diagnostic workup and an adequate operative approach are important.

Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options.

Purpose This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. Methods A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group ( N = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group ( N = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group ( N = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group ( N = 12, mean age = 43 years, range = 28-67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°-70.7°; AC = 67°-74.5°; and OC = 48.9°-63.5°), whereas it remained unchanged for the NT group (46°-45°). Grip strength also improved in all intervention groups (ES = 17.9-29.9 kg; AC = 24.0-32.2 kg; and OC = 15.8-26.6 kg), while the NT group remained unchanged (25-24 kg). The radiographic scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2-1.9 mm; OC = 2.5-1.8 mm) and slightly worsened in the NT group (2.5-2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications-CRPS). Conclusion All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence Level III, systematic review of Level III-IV studies.

Surgical treatment of chest wall defects after purulent arthritis of the sternoclavicular joint

The frequency of purulent arthritis of the sternoclavicular joint is less than 1 % of all joint infections. As a rule, the cause is the hematogenous spread of a generalized infection or trauma.Material and methods. The result of treatment of 24 patients (18 men, 6 women, mean age 38.4 years) with purulent arthritis of the sternoclavicular joints in the period from January 1, 2012 to December 30, 2022 is presented. The causes, clinical manifestations, options for surgical intervention and treatment outcome.Results. Most patients (20 people) complained of pain and tissue swelling in the area of the affected joint. In 4 patients, the main symptom was pain and limited mobility of the arm on the side of inflammation, while no external manifestations of the infectious process were detected. The main laboratory indicators of the inflammatory process were leukocytosis (mean (12 ± 1.6)·109/l) and an increase in CRP from 4 to 86 mg/l (mean 22 ± 4.2 mg/l). 50 % of patients had type 2 diabetes. In 14 patients, in addition to the destroyed sternoclavicular joint, there was damage to the rib/ribs, sternum. In 5 patients, the infectious process was bilateral. Each patient underwent resection of the clavicle and sternum together with the sternoclavicular joint; if the ribs were affected, they were resected. Intraoperative complication was registered in 1 case – erosive bleeding from the right subclavian vein. All patients were treated in two stages. The main pathogen was Staphilococcus aureus. After cleansing the wound, it was closed with local or displaced tissues. Histological examination of removed macropreparations in 18 patients revealed signs of acute osteomyelitis. 5 patients needed intensive care, of which 4 patients died: from progressive sepsis against the background of multiple organ failure and from progressive heart failure against the background of pulmonary edema. Recurrence of the infectious process in the surgical area occurred in 1 patient.Conclusions. Purulent arthritis of the sternoclavicular joint is not an independent disease. Hematogenous damage to this area is associated with a decrease in immunity and the development of a generalized infection. Treatment should be complex, aimed at surgical removal of pathologically altered structures and tissues, as well as intensive therapy to compensate for organ dysfunctions.

The Beneficial Effect of Preoperative Exercise on Postoperative Clinical Outcome, Quality of Life and Return to Work after Microsurgical Resection of Spinal Meningiomas.

While outcomes of surgical treatment for spinal meningiomas are well-described within the literature, factors affecting early return to work as well as long-term health related quality of life remain unclear. In this retrospective study, patients with spinal meningioma and surgical treatment from two university-level neurosurgical institutions between 2008 and 2021 were analyzed. Time to return to work, physical activities and long-term health related quality of life (assessed by telephone interviews using the EQ-5D-5L health status measure and visual analogue scale (EQ VAS) were analyzed. We identified a total of 196 patients who underwent microsurgical resection of spinal meningioma between January 2008 and December 2021. Of those, 130 patients of working age were included and analyzed. The median follow-up time was 96 months. All included patients returned to work. The median time of return to work was 45 days for the whole cohort. Patients who preoperatively performed physical activity returned to work significantly earlier compared to patients who did not (p < 0.001). Furthermore, younger age (p = 0.033) and absence of obesity (p = 0.023) correlated significantly with earlier return to work. Significant differences were also observed in all 5 EQ-5D-5L dimensions between patients with and without preoperative physical activity. Despite the benign nature of spinal meningioma preoperative physical activity and physiological body weight are associated with favorable postoperative outcome, higher quality of life and early return to work.

Outcomes of Surgical Treatment of Diaphyseal Fractures of Long Bones in Children and Adolescents through Open Reduction and Intramedullary K-Wire Fixation at Yopougon Teaching Hospital, Abidjan (Côte d’Ivoire)

Outcomes of Surgical Treatment of Diaphyseal Fractures of Long Bones in Children and Adolescents through Open Reduction and Intramedullary K-Wire Fixation at Yopougon Teaching Hospital, Abidjan (Côte d’Ivoire)

Patients with Primary Malignant Retroperitoneal Tumor: Surgical Treatment Outcomes

Introduction . Determining the most optimal tactics for the diagnosis and treatment of primary malignant retroperitoneal tumors is highly relevant today. This can be attributed to a number of reasons, including: lack of versatile approach to the treatment of primary malignant retroperitoneal tumors, lack of effective ways to prevent the disease progression, small number of publications on this issue. All this motivates oncologists engaged in the treatment of patients with this pathology to accumulate and analyze the results of treatment of each patient. Materials and methods. The study was based on data analysis of 32 patients with primary retroperitoneal tumors, 26 of which were treated at the Yaroslavl Clinical Oncological Hospital from 2016 to 2021 with the diagnosis of primary malignant retroperitoneal tumors. Results and discussion. 13 patients out of 26 (50%) had T4N0M0. Stage 3B was detected in 73.08% of patients. Histologically verified: liposarcoma — 19.23%, leiomyosarcoma and myxoid liposarcoma — 15.38% each, the remaining formations comprised 3.8% each and consisted to different types of sarcomas from mesodermal rudiments. 22 patients (84.62%) had high-grade tumors, 4 patients (15.38%) had low-grade tumors. 22 patients underwent radical surgical treatment. Isolated resection of the tumor was performed in 11 patients (50%), and 11 operations (50%) were accompanied by combined or concurrent tumor resection. No postoperative complications were reported. Histologically confirmed tumor invasion was detected in 50% of operated patients. The most frequently involved organ was the kidney. Conclusion . The obtained data indicate high resectability rates for tumors of this localization. Analysis of the excised tumor volume revealed direct correlation with the degree of tumor malignancy. High rates of one-, three- and five-year survival of patients testify to the effectiveness of radical surgical resection both in case of isolated resection and combined or concurrent resection. However, frequent recurrences and, therefore, repeated surgical interventions lead to a regressive reduction in survival.

Peyronie's Disease: A Brief Overview.

Peyronie's disease is an acquired connective tissue disease of the tunica albuginea of the penis which usually presents with penile curvature/deformity and a palpable penile plaque. It is more common in Caucasian men over the fifth decade of life, but it is an under-reported disease. Conservative and non-surgical options are supported by limited evidence except for intralesional injection of collagenase clostridium histolyticum and have limited success. The improved outcome of surgical treatment is accompanied by the risk of erectile dysfunction. This is a brief overview of Peyronie's disease, its impact on the patient, and the available treatment options.

A tale of 2 conversions: Dichotomous decision in the spectrum of Shone syndrome is still a dilemma

A tale of 2 conversions: Dichotomous decision in the spectrum of Shone syndrome is still a dilemma

665 A Nationwide Study Characterizing the Risk and Outcome Profiles of Multilevel Fusion Procedures in Neuromuscular Scoliosis Patients With Neurofibromatosis Type 1

INTRODUCTION: Spine abnormalities are a common manifestation of Neurofibromatosis Type 1 (NF1); however, the outcomes of surgical treatment for NF1-associated spinal deformity are not well explored. METHODS: The National Inpatient Sample was queried for NF1 and non-NF1 patient populations with neuromuscular scoliosis who underwent multilevel fusion surgery involving eight or more vertebral levels between 2004 and 2017. Multivariate regression modeling was used to explore the relationship between perioperative variables and pertinent outcomes. RESULTS: Of the 55,485 patients with scoliosis, 533 patients (0.96%) had NF1. Patients with NF1 were more likely to have comorbid solid tumors (p &lt; 0.0001), clinical depression (p &lt; 0.0001), peripheral vascular disease (p &lt; 0.0001), and hypertension (p&lt;0.001). Following surgery, NF1 patients had a higher incidence of hydrocephalus (0.6% vs. 1.9% p=0.002), seizures (4.9% vs. 5.7% p = 0.006), and accidental vessel laceration (0.3% vs. 1.9% p = 0.011). Although there were no differences in overall complication rates or in-hospital mortality, multivariate regression revealed NF1 patients had an increased probability of pulmonary (OR 0.5, 95% CI 0.3-0.8, p = 0.004) and neurological (OR 1.8, 95%CI 1.0-3.3, p = 0.053) complications. There were no significant differences in utilization, including non-home discharge or extended hospitalization; however, patients with NF1 had higher total hospital charges (OR -$18739, SE 3384, p &lt; 0.0001). CONCLUSIONS: These findings indicate that NF1 is associated with certain complications following multilevel fusion surgery but does not appear to be associated with differences in quality or cost outcomes. These results provide some guidance to surgeons and other healthcare professionals in their perioperative decision making by raising awareness about risk factors for NF1 patients undergoing multilevel fusion surgery. We intend for this study to set the national baseline for complications after multilevel fusion in the NF1 population.

MP07-16 RACIAL DISPARITIES IN COMPLICATIONS AFTER SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 Apr 2023MP07-16 RACIAL DISPARITIES IN COMPLICATIONS AFTER SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE Arshia Aalami Harandi, Anjali Kapur, and Jason Kim Arshia Aalami HarandiArshia Aalami Harandi More articles by this author , Anjali KapurAnjali Kapur More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic organ prolapse (POP) is a common condition with a 12.5% risk of surgical treatment by age 80. Prior studies have shown racial differences in outcomes of surgical treatment of POP in the US. Our study investigates whether there are racial disparities in adverse outcomes following surgical treatment of POP in the American College of Surgeons National Surgical Quality Improvement Program (NSPIQ) database. METHODS: Patients were collected from the NSPIQ database between 2011-2020 with current procedural terminology codes for minimally invasive and open sacrocolpopexy, vaginal vault suspension, anterior colporrhaphy, vaginal repair, enterocele/rectocele repair, and obliterative surgery. Reported complications were aggregated into composite Clavien-Dindo I-II and III-IV classifications. Multivariate logistic regression was utilized to calculate adjusted odds ratios (aOR) for complications. Age, BMI, past medical history, smoking history, surgical treatment, and ASA score were included as covariates in the regression model. RESULTS: Within Clavien Dindo III-IV complications, African Americans had a 35% increased risk (aOR: 1.35, p<.01), while Asians and Hispanics had a 42% (aOR: 0.58, p<.01) and 23% (aOR: 0.77, p<.01) decreased risk, respectively. Asian race was associated with a 19% decreased risk of Clavien-Dindo I-II complications (aOR: 0.81, p<.05) compared to White patients, with all other ethnicities bearing similar risk. Age >65 was associated with a 14% decreased risk of Clavien-Dindo I-II complications (aOR: 0.86, p<.01) and 15% decreased risk of Clavien-Dindo III-IV complications (aOR: 0.85, p<.01). Comorbidities of dyspnea, severe COPD, ascites, CHF, disseminated cancer, open wound/infection, steroids/immunosuppression, smoking history, and BMI >30 were significantly associated with higher odds of Clavien-Dindo III-IV complications (p<.05) (Table 1). CONCLUSIONS: African American women receiving surgical treatment for POP have increased risk of high-grade complications even when adjusted for age, past medical history, smoking status, and type of surgery. Further research is needed to elucidate implicit biases or disparities in healthcare that may contribute to adverse outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e91 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arshia Aalami Harandi More articles by this author Anjali Kapur More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Return to Play After Thumb Ulnar Collateral Ligament Injuries Managed Surgically in Athletes—A Systematic Review

The purpose of this systematic review was to summarize the available data on how surgical management of injuries to the thumb ulnar collateral ligament (UCL) complex affects athletes and their return-to-play (RTP) and postinjury performance metrics in addition to evaluating rehabilitation guidelines. A systematic search was performed on PubMed and Embase databases for articles on outcomes of surgical treatment of thumb UCL injuries in athletes. Articles with expert recommendations on postoperative management and RTP guidelines were also included separately. Study characteristics were recorded, including sport, RTP rates, and data on performance. Recommendations were summarized by sport. The Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess methodological quality. The authors also present their recommended return-to-sport algorithm. Twenty-three articles were included, including 11 with reports on patients and 12 expert opinions on guiding RTP. The mean MINORS score for the applicable studies was 9.4. In the 311 patients included, RTP was 98.1% in aggregate. No performance detriments were noted in athletes after surgery. Thirty-two (10.3%) patients had postoperative complications. The recommendations on timing to RTP vary by sport and author, but all recommended initial thumb protection when returning to sport. Newer techniques, such as suture tape augmentation, suggest the permission for earlier motion. Return-to-play rates after surgical treatment of thumb UCL injuries are high, with reassuring return to preinjury level of play with few complications. Recommendations for surgical technique have trended toward suture anchors and, now, suture tape augmentation with earlier motion protocols, although rehabilitation guidelines vary by sport and author. Current information on thumb UCL surgery in athletes is limited by the low quality of evidence and expert recommendations. Prognostic IV.