Time Of Surgery Research Articles

Application of tissue pneumoperitoneum technique around lymph nodes in thoracoscopic lung cancer resection.

Thoracoscopic surgery is a primary treatment for lung cancer, with lobectomy and mediastinal lymph node dissection being the predominant surgical approaches for invasive lung cancer. While many thoracic surgeons can proficiently perform lobectomy, thorough and standardized lymph node dissection remains challenging. This study aimed to explore a safer and more efficient surgical method for mediastinal lymph node dissection in lung cancer. A prospective randomized controlled study was conducted, involving 100 patients with right lung cancer who were admitted to our hospital from January 2021 to April 2024 and met the inclusion criteria. These patients were randomly divided into an observation group (tissue pneumoperitoneum technique around lymph nodes group) and a control group (conventional surgery group). Thoracoscopic lobectomy and mediastinal lymph node dissection were performed. Intraoperative and postoperative related indicators were observed to validate the effectiveness and safety of the tissue pneumoperitoneum technique around lymph nodes. The observation group showed a significantly shorter lymph node dissection surgery time compared to the control group, with a statistically significant difference (p < 0.05). The number of lymph nodes dissected in the observation group was significantly higher than that in the control group, with a statistically significant difference (p < 0.05). Although the observation group had slightly more mediastinal lymph node stations dissected than the control group, the difference was not statistically significant (p > 0.05). The total drainage volume within three days postoperatively was comparable between the two groups, with no statistically significant difference (p > 0.05). The observation group had shorter chest tube indwelling time and postoperative hospital stay than the control group, with statistically significant differences (p < 0.05). The incidence of surgical complications was similar between the two groups, and there were no perioperative deaths. The tissue pneumoperitoneum technique around lymph nodes is a more efficient method for mediastinal lymph node dissection in lung cancer, demonstrating safety and feasibility, and is worthy of promotion.

The Use of Augmented Reality as an Educational Tool in Minimally Invasive Transforaminal Lumbar Interbody Fusion.

One of the major challenges in training neurosurgical and orthopedic residents the technique for minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the lack of visualization of surgical landmarks (pedicle, pars, lamina). This is due to the limited access to the bony spine through a tubular retractor, in addition to a smaller working corridor or patient-specific factors such as bony overgrowth, disk space collapse, and listhesis. These factors increase the possibility for surgical error and prolonged surgery time. With augmented reality (AR), relevant surgical anatomy can be projected directly into the user's field of view through the microscope. The purpose of this study was to assess the utility, accuracy, efficiency, and precision of AR-guided MIS-TLIF and to determine its impact in spine surgery training. At 2 centers, 12 neurosurgical residents performed a one-level MIS-TLIF on a high-fidelity lumbar spine simulation model with and without AR projection into the microscope. For the MIS-TLIF procedures with AR, surgical landmarks were highlighted in different colors on preoperative image data. These landmarks were visualized in the spinal navigation application on the navigation monitor and in the microscope to confirm the relevant anatomy. Postprocedural surveys (National Aeronautics and Space Administration Task Load Index) were given to the residents. Twelve residents were included in this trial. AR-guided procedures had a consistent impact on resident anatomical orientation and workload experience. Procedures performed without AR had a significantly higher mental demand (P = .003) than with AR. Residents reported to a significantly higher rate that it was harder work for them to accomplish their level of performance without AR (P = .019). AR can bring a meaningful value in MIS teaching and training to confirm relevant anatomy in situations where the surgeon will have less direct visual access. AR used in surgical simulation can also speed the learning curve.

Gestational Diabetes in Women with Fetal Spina Bifida Repair-Influence of Perioperative Management.

Background/Objectives: Fetal spina bifida (fSB) is the most common neural tube defect, and intrauterine repair has become a valid treatment option for selected cases. If fSB repair is offered, the ideal time for surgery is from 24 to 26 gestational weeks (GWs). The preoperative steroids for lung maturation and preoperative tocolytics that are administered are known to increase the prevalence of gestational diabetes (GD), which normally occurs in about 10-15% of all pregnant women. This study assessed the prevalence, possible influencing factors, and consequences on the course of pregnancy regarding GD in this cohort. Methods: Between 2010 and 2022, 184 fSB cases were operated. Those patients operated on after 24 0/7 GWs received steroids before surgery. All the patients received tocolysis, and an oral glucose tolerance test was performed between 26 and 28 GWs at least 7 days after steroid administration. In 2020, we established an early postoperative mobilization protocol. The perioperative management procedures of those patients with and without GD were compared to each other, and also, the patients treated according to the early mobilization protocol were compared to the remaining cohort. Results: Nineteen percent were diagnosed with GD. Corticosteroids were administered in 92%. Neither the corticoid administration nor the interval between the administration and glucose tolerance test was different in patients with or without GD. Further, 99.5% received postoperative tocolytics for at least 48 h. The women with GD had significantly longer administration of tocolytics. The length of stay (LOS) was higher in those patients with GD. The gestational age (GA) at delivery was significantly lower in the cohort with GD. In the early mobilized group, we found a significantly higher GA at delivery (37.1 GWs vs. 36.2 GWs, p = 0.009) and shorter LOS (p < 0.001), and their GD rate was lower (10% vs. 20%), although not statistically significant. Conclusions: The GD incidence in the women after fSB repair was higher than in the usual pregnant population. Early mobilization, rapid tocolytics decrease, and shorter LOS could benefit the pregnancy course after fSB repair and may decrease the risk for GD in this already high-risk cohort without increasing the risk for preterm delivery.

Factors Affecting Outcome in Surgically Clipped Ruptured Anterior Circulation Aneurysms – A Retrospective Analysis

Abstract Introduction: Ruptured cerebral aneurysm is a life-threatening condition that requires urgent medical attention. Failure to diagnose, delay in admission to a neurosurgical centre and lack of facilities could lead to poor surgical outcomes. Aim: The purpose of this study was to identify the factors that predict the outcome of patients undergoing a surgical clipping of ruptured anterior circulation aneurysms. Materials and Methods: This was a single-centre retrospective study with review of medical records of 306 patients, who were surgically treated for ruptured intracranial aneurysms in a tertiary care centre from January 2011 to June 2018. Information collected were the patient demographic data, Glasgow Coma Scale prior to surgery, World Federation of Neurosurgical Societies Scale and timing between subarachnoid haemorrhage (SAH) ictus and surgery. The outcomes at discharge and 6 months post-surgery were assessed using the modified Rankin Scale (mRS). Only cases of proven ruptured aneurysmal SAH involving anterior circulation that underwent surgical clipping were included in the study. The data collected were analysed statistically. Results: The mean duration between ictus and time of surgery was found to be 9.89 days, maximum being 43 days. Patients with persisting disabilities (according to mRS) at the 1st month and 3rd month post-surgery had a mean duration of 16.69 and 16.95 days, from ictus to surgery. Conclusions: Delay in surgical clipping of anterior circulation aneurysms and poor grade at presentation were found to have unfavourable outcomes. Health education and training should be incorporated in primary healthcare setups regarding the identification of probable aneurysm rupture in early stage, so that prompt referral to higher centre can be carried out and delay in intervention be curtailed.

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction.

To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'. Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking. While current literature mostly suggests early treatment, there is also evidence preferring delayed treatment. Furthermore, evidence on the timing of postoperative rehabilitation is limited. Thus, the current multi-center randomized controlled study, the 'STaR trial', is expected to respond to these questions by adding new high-level evidence. The MLKIs are often associated with knee dislocation and constitute a highly complex entity, including concomitant injuries, such as neurovascular, meniscal, and cartilaginous injuries. The treatment of MLKIs usually aims to either repair or reconstruct the injured ligaments, however, there is no general consensus on the timing of surgery or rehabilitation following an MLKI surgery. This current review stresses the need for more high-level research to address the paucity of evidence-based treatment guidelines for the treatment of complex MLKIs.

Sarcopenia Is a Risk Factor for Postoperative Complications Among Older Adults With Inflammatory Bowel Disease.

Sarcopenia has been associated with adverse postoperative outcomes in older age cohorts, but has not been assessed in older adults with inflammatory bowel disease (IBD). Further, current assessments of sarcopenia among all aged individuals with IBD have used various measures of muscle mass as well as cutoffs to define its presence, leading to heterogeneous findings. In this single-institution, multihospital retrospective study, we identified all patients aged 60 years and older with IBD who underwent disease-related intestinal resection between 2012 and 2022. Skeletal Muscle Index (SMI) and Total Psoas Index (TPI) were measured at the superior L3 endplate on preoperative computed tomography scans and compared through receiver operating characteristic curve. We then performed multivariable logistic regression to assess risk factors associated with an adverse 30-day postoperative outcome. Our primary outcome included a 30-day composite of postoperative mortality and complications, including infection, bleeding, cardiac event, cerebrovascular accident, acute kidney injury, venous thromboembolism, reoperation, all-cause rehospitalization, and need for intensive care unit-level care. A total of 120 individuals were included. Overall, 52% were female, 40% had ulcerative colitis, 60% had Crohn's disease, and median age at time of surgery was 70 years (interquartile range: 65-75). Forty percent of older adults had an adverse 30-day postoperative outcome, including infection (23%), readmission (17%), acute kidney injury (13%), bleeding (13%), intensive care unit admission (10%), cardiac event (8%), venous thromboembolism (7%), reoperation (6%), mortality (5%), and cerebrovascular accident (2%). When evaluating the predictive performance of SMI vs TPI for an adverse 30-day postoperative event, SMI had a significantly higher area under the curve of 0.66 (95% CI, 0.56-0.76) as compared to 0.58 (95% CI, 0.48-0.69) for TPI (P = .02). On multivariable logistic regression, prior IBD-related surgery (adjusted odds ratio [adjOR] 6.46, 95% CI, 1.85-22.51) and preoperative sepsis (adjOR 5.74, 95% CI, 1.36-24.17) significantly increased the odds of adverse postoperative outcomes, whereas increasing SMI was associated with a decreased risk of an adverse postoperative outcome (adjOR 0.88, 95% CI, 0.82-0.94). Sarcopenia, as measured by SMI, is associated with an increased risk of postoperative complications among older adults with IBD. Measurement of SMI from preoperative imaging can help risk stratify older adults with IBD undergoing intestinal resection.

Breast Modular Resection (BMR) in Nipple-Sparing Mastectomy (NSM) With Intraoperative Laser Speckle Contrast Imaging (LSCI) Monitoring Improved Surgical Training Outcome Among Fellows

BackgroundNipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR). MethodsThe records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared. ResultsSurgical training outcomes of BMR group (N = 52) were insignificantly improved compared to CPR group (N = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (P = .011) and surgery time (P < .001) was significantly reduced in BMR group (N = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (P < .001). The absolute PU values were significantly higher in BMR group (P = .002). ConclusionCompared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.

Effect of Delayed Parathyroidectomy on Risk of Future Cardiovascular and Nephrolithiasis Interventions in Adults with Primary Hyperparathyroidism [Original Study

To determine whether the timing of parathyroid surgery impacts the risk of renal stone retreatment and cardiovascular interventions. Long-term, untreated primary hyperparathyroidism is associated with significant morbidity including nephrolithiasis and cardiovascular disease. We conducted a Population-based Cohort study of New York and California state-wide data from 2000-2020. Adult patients who underwent renal stone treatment and subsequently diagnosed with primary hyperparathyroidism (pHPT) and underwent parathyroidectomy (PTX) were included. Patients were excluded if PTX was prior to index stone procedure, they underwent second stone treatment within 6 months, with stage V CKD, with secondary or tertiary hyperparathyroidism, with prior kidney transplant or hemodialysis, or with prior cancer diagnosis. Rate of renal stone retreatment and cardiovascular interventions after PTX in pHPT patients with nephrolithiasis who underwent parathyroid surgery at ≤ 2 years and >2 years after index stone procedure was measured. We identified 2,093 patients who underwent first-time stone treatment and subsequent PTX. The median time to PTX was 560 days (IQR 187-1477) and follow-up was 7.4 years (IQR 4.5-13.1). Delaying PTX for more than 2 years increased the risk of renal stone retreatment by 59% (HR 1.59; P<0.001), increased the risk of experiencing coronary disease or associated interventions by 118% (HR=2.18; P=0.01), and increased the risk of experiencing an overall cardiovascular event by 52% (HR 1.52; P<0.01). In symptomatic pHPT, delaying PTX significantly increases the risk of requiring future stone retreatment and cardiac/vascular surgical interventions. This highlights the importance of early surgical referral and multidisciplinary approaches to optimize outcomes and resource utilization in pHPT.

Future of U.S. living donor liver transplant: Donor and recipient criteria, transplant indications, transplant oncology, liver paired exchange, and non-directed donor graft allocation.

In the United States, living donor liver transplant (LDLT), from both directed and nondirected living donors, has expanded over the past several years. LDLT is viewed as an important opportunity to expand the overall donor pool for liver transplantation (LT), shorten waiting times for a life-prolonging LT surgery, and reduce LT waitlist mortality. The LT community's focus on LDLT expansion in the United States is fostering discussions around future opportunities, which include the safe expansion of donor and recipient candidate eligibility criteria, broadening indications for LDLT including applications in transplant oncology, developing national initiatives around liver paired exchange, and maintaining vigilance to living donor and recipient candidate risk/benefit equipoise. Potential opportunities for expanding living liver donor and recipient candidate criteria include using donors with more than minimal hepatic steatosis, evaluating older donors, performing LDLT in older recipients to facilitate timely transplantation, and providing candidates who would benefit from an LT, but may otherwise have limited access (ie, lower MELD scores), an avenue to receive a life-prolonging organ. Expansion opportunities for LDLT are particularly robust in the transplant oncology realm, including leveraging LDLT for patients with advanced HCC beyond Milan, intrahepatic cholangiocarcinoma, and nonresectable colorectal cancer liver metastases. With ongoing investment in the deliberate growth of LDLT surgical expertise, experience, and technical advances in the United States, the LT community's future vision to increase transplant access to more patients with end-stage liver disease and selected oncology patients may be successfully realized.

Analgesic Effect of Dexmedetomidine-Nalbuphine Combination vs. Dexmedetomidine Alone in Donkeys Undergoing Field Castration under Total Intravenous Anesthesia.

This study evaluated the antinociceptive effect of dexmedetomidine-nalbuphine vs. dexmedetomidine alone in jacks undergoing field castration under total intravenous anesthesia. Jacks were premedicated with intravenous (IV) dexmedetomidine (5 µg/kg), either alone (Group D, n = 6) or in combination with 0.3 mg/kg nalbuphine (Group DN, n = 6). IV ketamine (1.5 mg/kg) and propofol (0.5 mg/kg) were used to induce general anesthesia, which was maintained by a continuous propofol (0.2 mg/kg/min) IV infusion. The quality of anesthesia, analgesia, and recovery were evaluated. A simple descriptive scale (SDS) was used to measure pain from the recovery time to 6 h later. The DN group exhibited improvements in analgesic and recovery quality and SDS of pain at 1-, 2-, and 3-h post-recovery. There was an apparent improvement in cardiac status, as evidenced by the enhanced heart rate and electrocardiogram findings compared to group D during surgery and recovery time. The DN group had a lower level of inflammatory cytokines, both during the surgery and shortly after recovery. Therefore, the dexmedetomidine-nalbuphine combination prior to IV anesthesia of ketamine and propofol in jacks undergoing field castration resulted in a stable surgical plane of anesthesia, improved antinociception, less pain postoperatively, and better cardiac stability.

Solid organ transplant in recipients with ongoing SARS-CoV-2 infection: A systematic review of case reports and series

BackgroundWhether solid organ transplant (SOT) can be safely performed in recipients with ongoing SARS-CoV-2 infection is still a debated question. MethodsA systematic review of the literature on recipients with ongoing SARS-CoV-2 infection at the time of surgery and the associated outcomes. ResultsFrom 29 studies, we identified 54 recipients; their median age was 47.5 years, and over half (23/54, 54.85%) were affected by fewer than two comorbidities. Kidney was the most common transplanted organ (24/54, 44.4%). SOT was performed without knowing the ongoing infection in 11.1% (6/54) of patients. On average, 16.1 (SD 23.2) days elapsed between SARS-CoV-2 infection and SOT, with a mean Ct value at diagnosis and transplantation of 29 and 31.9, respectively. Most patients (25/39,64.1%) had received previous COVID-19 vaccinations. Twenty-four patients (45.3%) received an anti-SARS-CoV-2 therapy. Ten patients (18.5%) required oxygen support, while seven (13.7%) were admitted to the intensive care unit. There were two reported cases (3.7%) of all-cause death, while there were no cases of COVID-19-related death. ConclusionsDeliberate SOT of recipients with ongoing SARS-CoV-2 is performed worldwide in candidates of nonlung transplant who are fit, immunized against the virus, and displaying a nonsevere disease course. No COVID-19-related deaths were recorded.

Characteristics and Outcomes of Home-Ventilated Children Undergoing Noncardiac Surgery.

To determine the frequency of children with chronic respiratory failure (CRF) and home ventilator dependence undergoing surgery at a tertiary children's hospital, and to describe periprocedural characteristics and outcomes. We conducted a retrospective cohort study of patients with CRF and home ventilator dependence who underwent noncardiac surgery from January 1, 2013, to December 31, 2019. Descriptive statistics were used to report patient and procedural characteristics. Univariable and multivariable analyses were used to assess for factors associated with 30-day readmission. We identified 416 patients who underwent 1623 procedures. Fifty-one percent of patients used transtracheal mechanical ventilation (trach/vent) support at the time of surgery; this cohort was younger (median age 5.5 vs 10.8 years) and more complex according to American Society of Anesthesiologists status compared with bilevel positive airway pressure-dependent patients. Postoperatively, compared with bilevel positive airway pressure-dependent patients, trach/vent patients were more likely to be admitted to the ICU with longer ICU length of stay (median 5 vs 2 days). Overall 30-day readmission rate was 12% (n = 193). Presence of chronic lung disease (adjusted odds ratio 1.65, 95% confidence interval 1.01-1.69) and trach/vent dependence (adjusted odds ratio 1.65, 95% confidence interval 1.02-2.67) were independently associated with increased odds for readmission. Children with CRF use anesthetic and surgical services frequently and repeatedly. Those with trach/vent dependence have higher hospital and ICU resource utilization. Although overall mortality for these patients is quite low, underlying diagnoses, nuances of technology dependence, and other factors for frequent readmission require further study to optimize resource utilization and outcomes.

Mucosal LTE4, PGD2 and 15(S)-HETE as potential prognostic markers for polyp recurrence in chronic rhinosinusitis

BackgroundAltered biosynthesis of eicosanoids is linked to type 2 inflammation in chronic rhinosinusitis with nasal polyps (CRSwNP), but their role in recalcitrant NPs is unclear. ObjectivesWe sought to identify endotypes that are linked to recalcitrant CRSwNP, based on eicosanoids, their biosynthetic enzymes, and receptors as well as cytokines and the presence of eosinophils and mast cells in recurrent NPs. MethodsMucosal tissue collected at the time of sinus surgery from 54 patients with CRSwNP and 12 non-CRS controls were analysed for leukotriene (LT) E4, prostaglandin (PG) D2, 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE) and 17 cytokines with ELISAs and Bio-Plex immunoassays. Patient subgroups were identified by cluster analysis and the probability of NP recurrence were tested with logistic regression analyses. Gene expressions were analysed with qPCR. Tryptase and eosinophil-derived neurotoxin (EDN) were measured with ELISAs as indications of the presence of mast cells and eosinophils, respectively. ResultsClustering of patients showed that an inflammatory signature characterised by elevated LTE4, PGD2, 15(S)-HETE and IL-13 was associated with NP recurrence. Previous NP surgery as well as aspirin-exacerbated respiratory disease were significantly more common among these patients. Expression of cyclooxygenase 1 was the only gene associated with NP recurrence. Levels of EDN, but not tryptase, were significantly higher in patients with recurrent NPs. ConclusionDistinguishing endotypes that include LTE4, PGD2, 15HETE and conventional biomarkers of type 2 inflammation could help predict recurrent nasal polyposis and thus identify cases of recalcitrant CRSwNP.

Modified gluteus maximus transfer for hip abductor deficiency

Transfer of the gluteus maximus with refixation at the greater trochanter for treatment of abductor deficiency. Symptomatic abductor deficiency with atrophy and fatty degeneration of the gluteal muscles > 50% (grade3 by quartile) with good strength of the gluteus maximus. Low atrophy or fatty degeneration of less than 50% of the gluteal muscles, limited strength of the gluteus maximus, infection. First, the fascia lata is incised dorsally to the tensor fascia latae muscle, with the incision extending approximately 1.5 cm proximal to the iliac crest. Asecond incision divides the gluteus maximus muscle longitudinally along the muscle fibers and continues towards the fascia lata distal to the greater trochanter. These incisions result in atriangular muscle flap, which is elevated and divided into anterior and posterior portions. The posterior flap is positioned ventrally over the femoral neck and fixed to the anterior capsule and the anterior edge of the greater trochanter. The anterior flap is placed directly on the proximal femur. For this purpose, agroove is prepared in the area of the proximal femur using aspherical burr to freshen up the future footprint. The anterior flap is positioned from the tip of the greater trochanter towards the insertion of the vastus lateralis muscle. Subsequently, the anterior flap is fixed to the created groove with transosseous sutures and positioned under the elevated vastus lateralis muscle in 15° abduction of the leg. To provide additional stabilization to the tendinous part of the anterior flap, ascrew is inserted distally to the greater trochanter. The vastus lateralis muscle is attached to the distal tip of the anterior flap, and the remaining gluteus maximus muscle is sutured to the fascia lata to cover the anterior flap. Additionally, aflap of the tensor fascia latae muscle can be mobilized and adapted to the reconstruction. Layered wound closure is performed. The technique of agluteus maximus transfer represents amethod for the treatment of chronic abductor deficiencies and improves abduction function as well as the gait pattern in short-term follow-ups. Fifteen patients (mean age at time of surgery 62years) had after amean follow-up of 2.5years. The modified Harris Hip Score (mHHS) improved from 48points preoperatively to 60points at follow-up. Preoperatively, 100% had apositive Trendelenburg sign; at follow-up, this was about 50%.

The Wagner Cone Stem for Atypical Femoral Anatomy in Total Hip Arthroplasty: A Report of 320 Cases with Minimum 5-Year Follow-up.

The Wagner Cone Prosthesis was designed to address complex femoral deformities during total hip arthroplasty (THA), but its mid-term component survivorship and functional outcomes remain undetermined. The objectives of this study were to determine the implant survivorship, patient satisfaction, functional outcomes, osseointegration as seen radiographically, implant subsidence, and complications of THA using the Wagner Cone Prosthesis stem at intermediate-term follow-up. This study involved 302 patients with proximal femoral deformities, including developmental hip dysplasia and Legg-Calvé-Perthes disease, who underwent a total of 320 primary THAs using the Wagner Cone Prosthesis. The average age at the time of surgery was 49.4 ± 14.5 years (range, 18.8 to 85.6 years). Patient satisfaction was recorded using a self-administered questionnaire assessing satisfaction in 4 domains. The University of California at Los Angeles (UCLA) activity score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score (OHS), the Forgotten Joint Score (FJS), radiographic outcomes, and complications were recorded. The mean follow-up time was 10.1 years (range, 5.2 to 15.5 years). Survivorship of the Wagner Cone Prosthesis was 98.7% (95% confidence interval [CI]: 97.2% to 100%) with stem revision as the end point and 95.8% (95% CI: 93.5% to 98.2%) with reoperation for any reason as the end point at 10 years postoperatively. In total, 3 stems were revised: 2 for infection and 1 for chronic hip dislocation. The median patient satisfaction score was 95 (interquartile range [IQR], 80 to 100), median UCLA score was 6 (IQR, 6 to 7), median WOMAC score was 18 (IQR, 16 to 22), median OHS was 40 (IQR, 36 to 47), and median FJS was 80 (IQR, 76 to 88) at the time of final follow-up. All Wagner Cone stems that were not revised showed radiographic evidence of osseointegration, with a mean stem subsidence of 0.9 ± 0.8 mm at the most recent follow-up. The use of the Wagner Cone Prosthesis stem in patients with complex femoral anatomy undergoing primary THA is associated with excellent component survivorship, high levels of patient satisfaction, good functional outcomes, and reliable osseointegration with minimal stem subsidence as seen on radiographs at intermediate-term follow-up. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Intracameral anaesthetic mydriatic versus topical mydriasis in Pediatric Cataract Surgery: a randomised control study

To compare the pupil dynamics using premixed intracameral anaesthetic mydriatic combination (ICAM) of phenylephrine (0.31%), tropicamide (0.02%) and lidocaine (1%) vs topical mydriatics (TM) constituting Tropicamide 0.8% Phenylephrine 5% combination and cyclopentolate 0.5% drops in pediatric cataract surgery. Design: Randomised, Masked, Fellow-Eye Controlled Trial SETTING: Tertiary eye care facility STUDY POPULATION: Children aged ≤ 12 years with bilateral cataracts planned for surgery. One eye was randomised to receive ICAM and the other eye(control) topical mydriatics INTERVENTION: Commercially available ICAM which was injected at the beginning of surgery or TM three times at an interval of 30 minutes, one hour before the scheduled time of surgery. The other treatment was administered for the second eye cataract surgery. Pupil dynamics at various points of surgery were studied by a masked observer. Sixty three patients(126 eyes) were randomised to receive ICAM in one eye (Group 1) and topical drops (Group 2) in the other. The mean age of the study children was 15.7 ± 24.3 months (range 3 months-5 years). Adequate mydriasis with single injection was achieved in 93.5% in Group 1 and 88.8% in Group 2 without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.78 mm to 5.1 mm after injection of one unit of ICAM and from 1.75 mm to 6.06 mm with topical mydriatics (p < 0.0001). Maximum pupillary dilation achieved was 6.06 ± 1.17 in Group 1 and 6.75 ± 1.07 mm in Group 2 (p=0.004). The average change in pupillary size from injection of drug till end of surgery was positive in Group 1 (0.75 ± 0.98 mm) and negative in Group 2 (-0.3348 ± 2.57), i.e. there was a relative miosis in Group 2 towards the end of surgery (p=0.001). Topical drugs achieved larger maximum pupil size as compared to ICAM. However, Intracameral mydriatic anaesthetic combination provided adequate and stable mydriasis without need for augmentation as compared to topical drops in children undergoing cataract surgery.

Outcomes After Implementation of a Fragility Fracture Pathway in Ground Level Falls

IntroductionFragility fractures occur due to low energy mechanisms and result in significant morbidity and mortality. This study reviews the implementation of a fragility fracture program at a level I trauma center. In this pathway, trauma surgery provides clearance followed by admission and management with medical service and orthopedic consultation for injuries which meet fragility fracture criteria. MethodsThis pathway, implemented in July 2021, includes patients with isolated fractures secondary to a low energy mechanism. We compared cohorts 2-ys before (PRE) and after (POS) pathway implementation. Demographics (age, sex, fracture location, injury severity score, American Society of Anesthesiologists score) and outcome data were collected and analyzed using between-subjects analyses. Measured outcomes included deep vein thrombosis/pulmonary embolism, hospital mortality, disposition to hospice, nonoperative rate, unplanned intensive care unit admission, time to surgery (TTS), and length of stay (LOS). ResultsThe study included n = 1137 patients (n = 564 PRE and n = 573 POS). POS patients had a higher injury severity score (P = 0.003) and different fracture location (P = 0.017), but no other demographics were different. Trauma admission decreased after implementation (P < 0.001; PRE: 21.5%, POS: 1.8%) with no differences in outcomes except increases in LOS (P < 0.001; PRE: 114 h, POS: 124 h) and TTS (P < 0.001; PRE: 15 h, POS: 18 h). ConclusionsMorbidity and mortality did not correlate with pathway implementation; however, TTS and LOS increased. Although TTS increased, it remained under the American Academy of Orthopedic Surgery 48-h recommendation. The TTS and LOS increases were potentially from COVID-19 or cohort demographic differences. Decreased trauma as admitting service demonstrates pathway adherence. These findings highlight the need for investigation to better understand fragility fracture pathways.

Optimal timing of surgery for inguinal hernia in premature neonates

AbstractAimThe surgical repair of inguinal hernias represents a significant risk for premature infants. Despite ongoing discourse, the optimal approach to hernia management remains contentious. Our investigation aims to establish the most favourable timing for inguinal repair in premature neonates.Patients and MethodsOur investigation involved the analysis of medical records for 536 neonates, born prematurely, who underwent inguinal hernia repair from January 2018 to December 2023. We dichotomised the cohort into two groups: those who received early repair and those who underwent late repair. The timing of the surgery was primarily determined by the surgeon's decision, in conjunction with familial consent to the surgical intervention. The primary endpoints were the incidence of recurrence or incarceration within 1 year after surgery. The secondary endpoints encompassed length of neonatal intensive care unit stay, post‐operative ventilator dependency, and frequency of return visits, whether to the inpatient and emergency department or an outpatient clinical setting, for hernia‐related issues.ResultsThe analysis encompassed a total of 454 neonates born prematurely, of which 163 underwent early repair, while 291 received late repair for inguinal hernia. The demographic data between the two groups demonstrated no significant differences. The occurrences of hernia recurrence and post‐operative apnoea presented similar trends across both cohorts. Notably, the late repair group exhibited an increased incidence of preoperative incarceration and return visits due to hernia complications. In this group, testicular atrophy or ovarian necrosis was observed in five cases, despite the overall absence of significant differences.ConclusionsOur findings suggest that the surgical repair of inguinal hernia in preterm neonates, performed at the time of presentation to our clinics, is both safe and feasible. However, a delay in hernia repair appears to be associated with a heightened risk of severe complications, such as testicular atrophy or ovarian necrosis.

The Comparison of Partial Hemivertebrae Resection Versus Total Hemivertebrae Resection in Children With Congenital Scoliosis.

The surgical intervention for hemivertebra removal is complex, leading to a lack of a definitive solution. We aim to compare the clinical efficacy of less invasive, partial hemivertebra resection vs total hemivertebra resection in children. Between 2011 and 2016, a retrospective study was conducted on a cohort of 43 patients diagnosed with congenital scoliosis coexisting with hemivertebrae. This study evaluated the outcomes of a posterior-only surgical approach, dividing the cohort into 2 groups based on the surgical technique applied: 23 patients underwent total hemivertebrae resection (TR), whereas 20 patients received partial hemivertebrae resection (PR), accompanied by short-segment fusion. There were 43 patients with congenital scoliosis associated with hemivertebrae in both the PR and TR groups. The average age at the time of surgery was 6.3 ± 2.0 years for the PR group and 6.0 ± 1.9 years for the TR group. The PR group exhibited a comparable correction rate of the Cobb angle at postoperation (4.3 ± 4.9 and 2.2 ± 3.2, P = .174) and the last follow-up (7.8 ± 1.3 and 5.5 ± 2.3, P = .113) compared with the TR group. Partial hemivertebra resection is efficient and secure. A less invasive technique obtained an equivalent, well-maintained correction rate to the total hemivertebra resection. However, this is the initial result, and the patients continue to be followed; we will await the results of the outcome at full-growth sprouts.

A Structured Social-Media Health Support intervention Program after Bariatric Surgery.

Social media networks have been found to provide emotional, instrumental, and social support, which may contribute to improved adherence to post-bariatric surgery care recommendations. To evaluate the impact of an online social media-based, healthcare professional-led, educational and support program on patients' long-term engagement with and adherence to follow-up guidelines, self-care recommendations, and weight management after bariatric surgery. An observational cohort study, employing mixed methods, accompanied a 12-week interactive, structured, social-media psychoeducational intervention program delivered on Facebook. Program participants, who had undergone one bariatric surgery within the past 1-7 years and were at least 18 years old at the time of surgery, were invited to join the program via posts online. Interested individuals were provided information about the program and the accompanying evaluation study, and those who met requirements completed study questionnaires before and after the program. Questionnaires included demographic and anthropometric information; postoperative recommendations received and their clarity and implementation; attitudes towards recommendation adherence; and well-being. Daily system data on program engagement were collected from the Facebook website. Of the 214 participants enrolled in the program, 101 (80.2% female, mean age 43.8±9.1 years and mean BMI 30.2±6.8 kg/m2, 1-7 years after bariatric surgery) completed both baseline and end-of-program questionnaires and were included in the analysis. Following the program, improvements were observed in most aspects of participants' adherence to postoperative recommendations and well-being. Close to half of the participants (44.6%) reported reaching their postoperative target weight at the end of the program or maintaining it throughout the program. Video posts drew higher participant engagement than other media, and content about proteins received the highest number of reactions. However, participants' active engagement gradually declined over time. Interactive health support on social media can positively enhance patient engagement, adherence to treatment recommendations, health outcomes, and overall well-being.