Operative Time Cost Research Articles

Quality differences in multifragmentary pertrochanteric fractures [OTA 31A2.2 and 31A2.3] treated with short and long cephalomedullary nails

ObjectivesThis study compares demographics, outcomes, and costs of patients with similar multifragmentary pertrochanteric (MP) fracture patterns treated with either a short or long cephalomedullary nail (CMN) to determine treatment efficacy and value during hospital admission. DesignRetrospective cohort study. SettingLevel-1 trauma center. Patients384 patients who presented with a MP fracture [AO/OTA 31A2.2 and 31A2.3] at 1 of 3 hospitals within a single academic medical center. InterventionSurgical treatment with either short or long CMNMain outcome measurements: Operative time, in-hospital complications, discharge disposition, procedural and total costs of admission. ResultsSixty-nine (18.0%) patients were treated with long CMNs compared to 315 patients treated with short CMNs. Patients treated with long CMNs had increased rates of transfusions of allogenic packed red blood cells (52.2% vs 34.0%, p = 0.005), discharge to rehabilitation facilities (91.3% vs 80.3%, p = 0.030), and had costlier hospital stays ($28,632.50 vs $23,024.86, p = 0.014) with longer (74.9 vs 52.3 min, p <0.001), costlier procedures and implants ($12,090.31 vs $9,647.41, p = 0.014) compared to patients treated with short CMNs. There were no differences in timing of radiographic healing, rates of readmission, nonunion, screw cut out, fixation failure, or peri‑implant fracture. ConclusionsShort and long CMNs are equally suitable implants for the most unstable intertrochanteric fracture patterns. Short CMNs correlate with reduced operative time and costs with non-inferior in-hospital complication rates, hospital quality measures, and less frequent rehabilitation facility discharges. Given the similar long-term outcomes demonstrated here and in the literature, this data suggests nail length selection should be driven more by cost and discharge considerations for MP fractures. Level of evidencelevel III.

The Volume-Cost Relationship: How Does Surgical Volume Affect Cost and Value in AIS Surgery.

Retrospective review. The objective of this study was to evaluate and compare distribution of hospital and operating room charges and outcomes during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) patients by high-volume (HV) and standard-volume (SV) surgeons at one institution and examine potential cost savings. Increased surgical volume has been associated with improved perioperative outcomes after spinal deformity correction. However, there is a lack of information on how this may affect hospital costs. Retrospective study of AIS patients undergoing posterior spinal fusion between 2013 and 2019. Demographic, x-ray, chart review and hospital costs were collected and compared between HV surgeons (≥50 AIS cases/y) and SV surgeons (<50/y). Comparative analyses were computed using Wilcoxon rank-sum, Kruskal-Wallis, and the Fisher exact tests. Average values with corresponding minimum-maximum rages were reported. A total of 407 patients (HV: 232, SV: 175) operated by 4 surgeons (1 HV, 3 SV). Radiographic parameters were similar between the groups. HV surgeons had significantly lower estimated blood loss (385.3 vs. 655.6 mL, P <0.001), fewer intraoperative transfusions (10.8% vs. 25.1%, P <0.001), shorter surgery time (221.6 vs. 324.9 min, P <0.001), and lower radiation from intraoperative fluoroscopy (4.4 vs. 6.4 mGy, P <0.001). HV patients had a significantly lower length of stay (4.3 vs. 5.3, P <0.001) and complication rate (0.4% vs. 4%, P =0.04).HV surgeons had significantly lower total costs ($61,716.24 vs. $72,745.93, P <0.001). This included lower transfusion costs ( P <0.001), operative time costs ( P <0.001), screw costs ( P <0.001), hospital stay costs ( P <0.001), and costs associated with 30-day emergency department returns ( P <0.001). HV surgeons had significantly lower operative times, lower estimated blood loss and transfusion rates and lower perioperative complications requiring readmission or return to emergency department resulting in lower health care costs. Level III.

Microgel-integrated, high-strength in-situ formed hydrogel enables timely emergency trauma treatment

High-strength hydrogels formed in situ through a convenient gel transition process are highly desirable for emergency treatment due to their ability to quickly respond to accidents. However, current in-situ formed hydrogels require a laborious precursor preparation process or lack sufficient mechanical strength. Herein, we reported a series of microgels that were capable of convenient in-situ transition to high-strength hydrogels from their easily portable form, thereby facilitating emergency treatment. Three kinds of microgels were derived from two types of hydrogen bonds (H-bonds; OH⋯OC, NH⋯OC) crosslinked preformed hydrogels, and all exhibited excellent stability when stored at room temperature. After mixing with water, all these microgels could undergo a quick hydration process and then transform into high-strength hydrogels in situ through H-bonds. Specifically, stronger H-bond crosslinked microgels could build hydrogels with higher mechanical strength, albeit at the cost of longer hydration and operation time. Nevertheless, the whole operation process could be finished within several minutes, and the resultant hydrogels could exhibit maximally megapascal-level compressive strength and tens of kilopascal storage modulus. In the comparison of emergency application performance with commercial chitosan hemostatic powder (CHP), we found that the microgels could stop accidental bleeding almost immediately, and the whole process from taking out the stored microgels to hemostasis could be completed within 15 s, which was superior to CHP. Overall, the results indicated that the in-situ formed microgel-based hydrogels with convenient gel-transition ability and high strength showed great potential in emergency treatments.

Moringa oleifera seed extract assisted electrocoagulation process for efficient direct dye removal from textile wastewater: Modelling, optimisation and techno-economic study

ABSTRACT This work reports the results of coupling Moringa oleifera seed extract (MOSE) with electrocoagulation (EC) for the remediation of Direct Red 80 azo dye (DR80) from contaminated synthetic aqueous solution and real textile wastewater. The electrochemical treatment was carried out using a pair of aluminium electrodes in monopolar-parallel mode. EC runs determined using Box-Behnken design under the response surface methodology (RSM) for three parameters including current density, pH, and operation time. The EC optimal conditions were current density 0.9 mA/cm2, pH 3, and time 10 min. The maximum experimental DR80 dye removal of 89.37% was close to the model prediction (76.4%). The kinetic study of the EC system represented that the removal of dye obeyed the first-order kinetic model. To improve dye removal efficiency from treated wastewater under optimal conditions, 2.5 mL/L of MOSE was added and the efficiency enhanced to above 98%. SEM and microscopic images of the sludge produced showed that the flocs formed in the hybrid system were denser and thicker than the conventional EC. The economic study revealed that switching from the EC to hybrid process reduced energy and electrode consumption from 0.015 to 0.008 kWh/m3 and 0.016 to 0.014 kg/m3, respectively, for 98% DR80 dye removal. MOSE has a substantial effect on the EC performance. Therefore, the EC/MOSE coupling process is recommended for the treatment of coloured wastewater due to its high efficiency, short operation time, and electrode and energy consumption costs.

Single surgeon versus co-surgeon bilateral mastectomy: Comparing outcomes and costs based on health economic modeling from the perspective of the hospital system.

Co-surgeon approach for bilateral mastectomy may lead to shorter operative times and improved outcomes compared with single-surgeon approach, but cost differences remain unclear. Economic models were applied to determine whether either approach offered a lower cost opportunity. A retrospective review of 409 patients undergoing single-surgeon or co-surgeon bilateral mastectomy between January 1, 2010 through April 30, 2016 was conducted. Outcomes included narcotic and antinausea doses, length of stay (LOS), and operative time. Analyses stratified by reconstruction and no reconstruction included Wilcoxon tests, Poisson regression, generalized linear models, and a cost calculator. Of 409 patients, 310 had reconstruction and 99 had no reconstruction. Compared with single-surgeon approach, co-surgeon approach was associated with less operative time and shorter LOS (233 vs. 250 min and 1.0 vs. 1.8 days no reconstruction; and 429 vs. 493 min and 2.2 vs. 2.8 days reconstruction). Economic analysis demonstrated less operative time, shorter LOS, and lower average cost for co-surgeon approach ($32,400 vs. $34,400 no reconstruction; and $76,700 vs. $79,400 reconstruction). Compared with the single-surgeon, the co-surgeon approach with reconstruction was associated with a statistically significant decrease in operative time and LOS. Economic analysis estimated the co-surgeon approach could lead to lower costs.

Optimizing Fat Grafting Using a Hydraulic System Technique for Fat Processing: A Time and Cost Analysis.

Background Many authors have researched ways to optimize fat grafting by looking for a technique that offers safe and long-term fat survival rate. To date, there is no standardized protocol. We designed a “hydraulic system technique” optimizing the relationship among the quantity of injected fat, operative time, and material cost to establish fat volume cutoffs for a single procedure. Methods Thirty-six patients underwent fat grafting surgery and were organized into three groups according to material used: standard, “1-track,” and “2-tracks” systems. The amount of harvested and grafted fat as well as material used for each procedure was collected. Operating times were recorded and statistical analysis was performed to establish the relationship with the amount of treated fat. Results In 15 cases the standard system was used (mean treated fat 72 [30–100] mL, mean cost 4.23 ± 0.27 euros), in 11 cases the “1-track” system (mean treated fat 183.3 [120–280] mL, mean cost 7.63 ± 0.6 euros), and in 10 cases the “2-tracks” one (mean treated fat 311[220–550] mL, mean cost 12.47 ± 1 euros). The mean time difference between the standard system and the “1-track” system is statistically significant starting from three fat syringes (90 mL) in 17.66 versus 6.87 minutes. The difference between the “1-track” system and “2-tracks” system becomes statistically significant from 240 mL of fat in 15 minutes (“1-track”) versus 9.3 minutes for the “2-tracks” system. Conclusion Data analysis would indicate the use of the standard system, “1-track,” and “2-tracks” to treat an amount of fat < 90 mL of fat, 90 ÷ 240 mL of fat, and ≥ 240 mL of fat, respectively.

Comparison of efficacy, safety, and patient satisfaction between thermal ablation, conventional/open thyroidectomy, and endoscopic thyroidectomy for symptomatic benign thyroid nodules

Purpose Thermal ablation (TA) is a minimally invasive treatment method for symptomatic benign thyroid nodules (BTNs). This study aimed to evaluate the value of TA by comparing the efficacy, safety, and patient satisfaction with conventional/open thyroidectomy (ConT) and endoscopic thyroidectomy (ET) for symptomatic BTNs. Methods Patients with symptomatic BTNs who underwent ConT, ET, or TA therapy between January 2018 and January 2020 were included. Pre-operation data of the two comparisons (TA vs. ConT and TA vs. ET) was balanced using propensity score matching. The technique efficacy (volume reduction ratio ≥50%), nodule disappearance, and regrowth rate were calculated after ablation. The operation and hospitalization time, medical cost, complications, post-operative symptoms, and cosmetic scores were recorded and compared. Patient satisfaction was evaluated using a telephone survey. Results After a median 19-month follow-up (range, 12–36 months), the technique efficacy rate, nodule disappearance, and regrowth rate were 93.2% (119/129), 6.8% (10/129), and 0.8% (1/129), respectively. Operation time, hospitalization time, and medical costs were less for patients in the TA group than for patients in the ConT and ET groups (all p < 0.001). The incidence of complications, post-operative symptoms, cosmetic scores, and overall satisfaction were not significantly different among groups (all p > 0.05). Post-operative hypothyroidism was less frequent in the TA group than in the ConT and ET groups (all p < 0.05). Conclusions Compared to ConT and ET, TA has comparable efficacy, safety, and patient satisfaction and exhibits greater protection of thyroid function for the treatment of symptomatic BTNs.

Efficacy of Supercapsular Percutaneously-Assisted Total Hip Arthroplasty in the Elderly With Femoral Neck Fractures: A Meta-analysis.

IntroductionSupercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach is a novel minimally invasive surgical technique for total hip arthroplasty (THA). This meta-analysis was conducted to evaluate the outcomes following THA via the SuperPATH approach in elderly patients with femoral neck fractures (FNFs), compared with those via traditional surgical approaches.MethodsEligible studies were retrieved through searching 7 electronic databases and manually screening related references. Objectives were surgical-related parameters, functional outcomes, and incidence of postoperative complications.Results9 comparative studies were included. Pooled results suggested that at the cost of longer operative time (WMD: 14.25, 95% CI: 3.25 to 25.25), the SuperPATH technique was superior to traditional approaches regarding incision length (WMD: −4.51, 95% CI: −6.46 to −2.56), intraoperative blood loss (WMD: −80.47, 95% CI: −122.36 to −38.57), and hospital stays (WMD: −3.35, 95% CI: −5.05 to −1.65). SuperPATH groups exhibited significantly increased Harris Hip Scores within 1 month after surgery (7d, WMD: 9.85, 95% CI: 6.40 to 13.30; 14d, WMD: 10.68, 95% CI: 8.29 to 13.08; 1 month, WMD: 6.17, 95% CI: 3.56 to 8.78) and had a reduced incidence of overall complications (OR: .19, 95% CI: .09 to .41). No significant differences were found between the 2 groups regarding postoperative pain relief.ConclusionElderly patients with FNFs are potential candidates for THA treatment via the SuperPATH technique, which is associated with improved surgical outcomes, better short-term functional recovery, and lower risk of total complications as compared to traditional approaches. Additional studies are needed to further confirm our conclusions and validate the long-term efficacy of SuperPATH.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

Background: The submental island flap (SIF) has gained popularity as a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction.

Cost and Cost Driver Analysis of Anterior Cruciate Ligament Reconstruction Using Time-Driven Activity-Based Costing: Bone-Tendon-Bone Autograft Versus Hamstring Autograft.

Background:As health care transitions toward value-based care, orthopaedics has started to implement time-driven activity-based costing (TDABC) to understand costs and cost drivers. TDABC has not previously been used to study cost drivers in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to use TDABC to (1) calculate bone-tendon-bone (BTB) and hamstring ACLR total costs of care and (2) evaluate the impact of graft choice and other factors on ACLR costs.Methods:Data were collected from electronic medical records for primary ACLR from the institutional patient-reported outcome registry between 2009 and 2016 in 1 ambulatory surgery center. Patients receiving allograft, revision ACLR, or concomitant meniscal repair or ligament reconstruction were excluded. The total cost of care was determined using TDABC. Multivariate regression analysis was conducted between ACLR cost and group characteristics.Results:A total of 328 patients were included; 211 (64.3%) received BTB autograft and 117 (35.7%) received hamstring autograft. The mean cost was $2,865.01 ± $263.45 (95% confidence interval: $2,829.26, $2,900.77) for BTB ACLR versus $3,377.44 ± $320.12 ($3,318.82, $3,436.05) for hamstring ACLR (p < 0.001). Operative time was 103.1 ± 25.1 (99.7, 106.5) minutes for BTB ACLR versus 113.1 ± 27.9 (108.0, 118.2) minutes for hamstring ACLR (p = 0.001). The total implant cost was $270.32 ± $97.08 ($257.15, $283.50) for BTB ACLR versus $587.36 ± $108.78 ($567.44, $607.28) for hamstring ACLR (p < 0.001). Hamstring graft (p = 0.006) and suspensory fixation on the femoral side (p = 0.011) were associated with increased costs.Conclusions:The mean cost of care and operative time for BTB autograft ACLR are less than those for hamstring autograft ACLR. Operative time, implant choice, and graft choice were identified as modifiable cost drivers that can empower surgeons to manage primary ACLR costs while maximizing the value of the procedure.Level of Evidence:Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

Endoscopic-assisted lateral neck dissection and open lateral neck dissection in the treatment of lateral neck lymph node metastasis in papillary thyroid carcinoma: A comparison of therapeutic effect.

Objectives:To compare the therapeutic effect of endoscopic-assisted lateral neck dissection and open lateral neck dissection in the treatment of lateral neck lymph node metastasis of patients with papillary thyroid carcinoma (PTC).Methods:A retrospective analysis was carried out focusing on the general clinical data of 86 patients with PTC treated Baoding No.1 Central Hospital from January 2020 to September 2021. According to different surgical methods, enrolled patients were divided into the endoscopic surgery group (n = 34) and the open surgery group (n = 52). Further comparison was performed on the operation indexes [operation time, postoperative length of stay in hospital, number of dissected lymph nodes (central area, lateral cervical area), number of metastatic lymph nodes (central area, lateral cervical area), hospitalization cost], postoperative complications, postoperative neck pain, neck numbness discomfort score, and satisfaction with postoperative cosmetic effect.Results:The operation time and hospitalization cost of the endoscopic surgery group were higher than those of the open surgery group, and the intraoperative blood loss was lower than that of the open surgery group, with statistically significant differences (p<0.05). There was no significant difference in the length of stay in the hospital, the number of dissected lymph nodes, the number of metastatic lymph nodes and the detection rate of lymph nodes in zone II between the two groups (p>0.05). Furthermore, a statistically significant difference was observed in the incidence of postoperative complications between the two groups, which was lower in the endoscopic surgery group (29.4%) than that in the open surgery group (51.9%) (p<0.05). There was no significant difference in postoperative neck pain scores between the two groups (p>0.05). While the postoperative neck numbness discomfort score, and satisfaction score with postoperative cosmetic effect in the endoscopic surgery group were better than those in the open surgery group, and the difference was statistically significant (p<0.05).Conclusion:Endoscopic-assisted lateral neck dissection can reduce intraoperative blood loss and postoperative complication incidence in the treatment of lateral neck lymph node metastasis of PTC. However, it has the disadvantages of longer operation time and high hospitalization costs.

Comparative study on posterior cruciate ligament reconstruction with autologous hamstring tendon and LARS artificial ligament in the treatment of KD-Ⅲ-M knee dislocation

To observe the curative effect of one-stage reconstruction of anterior cruciate ligament(ACL), posterior cruciate ligament (PCL) and medial collateral ligament (MCL) in patients with KD-Ⅲ-M knee injury, and to compare the operation time, hospitalization cost and curative effect after arthroscopic reconstruction of PCL with LARS artificial ligament and autogenous hamstring tendon, ACL reconstruction with autogenous hamstring tendon and MCL repair combined with limited incision. From March 2016 to January 2019, a total of 36 patients met the criteria of this study. Twenty patients in group A were treated with autogenous hamstring tendon reconstruction of ACL and PCL and repair of MCL, including 17 males and 3 females, with an average age of (34.7±9.2) years old. Sixteen patients in group B with LARS artificial ligament reconstruction of PCL, with an autogenous hamstring tendon reconstruction of PCL and MCL repair as before as group B, including 15 males and 1 female, with an average age of (36.8±8.6) years old. The operation time, hospitalization time and total hospitalization cost were compared between the two groups. The preoperative and postoperative functions of the two groups were evaluated by Hospital for Sepcial Surgery (HSS) score and Lysholm score respectively, and the curative effects were compared within and between groups. All the patients in the two groups were followed up for at least 1 year. There were no complications such as infection and poor wound healing in both groups. There was significant difference in operation time between (120.25±9.55) min in group A and (106.63±8.85) min in group B (P<0.01). The average hospitalization days in group A was (10.60±1.64) days, while that in group B was (10.38±1.59) days. There was no significant difference between the two groups (P>0.05). The HSS score of group A increased from preoperative 32.95±5.03 to postoperative 84.70±5.72 (P<0.01), and that of group B increased from preoperative 33.81±4.10 to postoperative 85.00±5.25 (P<0.01). The Lyshlom score in group A increased from preoperative 21.10±3.46 to postoperative 80.25±5.75 (P<0.01), and in group B increased from preoperative 21.56±3.01 to postoperative 80.00±4.30(P<0.01). There was no significant difference in preoperative and postoperative scores between the two groups(P>0.05). There was no significant difference in the average hospitalization days between the two groups, but the operation time in group A was longerthan that in group B, and the hospitalization cost in group B was higher than that in group A. There was no difference in HSS score and Lysholm score before and follow-up for a certain period of time after operation.

Dynamic Predictive Maintenance Scheduling Using Deep Learning Ensemble for System Health Prognostics

Modern engineering systems are usually equipped with a variety of sensors to measure real-time operating conditions. Based on the condition monitoring data from multiple sensor sources, this paper deals with a dynamic predictive maintenance scheduling using deep learning ensemble for system health prognostics. The deep learning ensemble model is composed of deep autoencoder and bidirectional long short-term memory in series, and aims to accurately estimate the system health state and remaining useful life. The deep autoencoder is used to extract the deep representative features hidden in condition monitoring data, whereas the inclusion of the bidirectional long short-term memory allows learning the temporal correlation information of features in both forward and backward time directions. Thus, the combination of the two models forms an effective model. With obtained prognostic information, optimal maintenance decisions are determined by two designed rules. The first rule presets a reliable remaining useful life threshold to dynamically judge whether maintenance is carried out at current inspection time, while the second one selects a degradation state to dynamically determine whether to place a spare part order. The performance of the proposed dynamic predictive maintenance strategy is measured by the maintenance cost per unit operating time (cost rate) using the aero-engine dataset from NASA. Its effectiveness is demonstrated by comparing with recent publications.

In patients with localized bronchiectasis, does thoracoscopic lung resection result in improved clinical outcomes compared to open surgery?

SummaryA best evidence topic was constructed according to a structured protocol. The question addressed was whether video-assisted thoracoscopic surgery (VATS), compared to open lung resection, resulted in improved postoperative clinical outcomes, in patients with localized bronchiectasis indicated for surgery. A total of 1352 papers were found using the reported search, of which 5 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All of the identified studies were retrospective. The conversion rate from VATS to open procedure ranged from 0% to 15.3%. In comparison to thoracotomy, VATS resulted in a significant reduction of postoperative blood loss (1 study), length of hospital stay (2 studies), postoperative complication rate (2 studies), pain scales (2 studies) and chest tube duration (1 study). However, there was a significant increase in operative time (1 study) and whole cost (2 studies). There was no significant difference in the clinical recovery, which was defined by the disappearance or improvement of preoperative symptoms during the follow-up period (3 studies). We conclude that although there is limited high-level evidence, retrospective studies have suggested that VATS could significantly reduce complications rate, postoperative blood loss, pain scales, length of hospital stay and chest tube duration compared to open lung resection in selected patients with localized bronchiectasis.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Cost of a Surgeon's Learning Curve

Minimally invasive transforaminal interbody fusion has become an increasingly common approach in adult degenerative spine disease but is associated with a steep learning curve. We sought to evaluate the impact of the learning experience on mean procedure time and mean cost associated with each procedure. We studied the first 100 consecutive minimally invasive transforaminal interbody fusion procedures of a single surgeon. We performed multivariable linear regression models, modeling operating time, and costs in function of the procedure order adjusted for patients' age, sex, and number of surgical levels. The number of procedures necessary to attain proficiency was determined through a k-means cluster analysis. Finally, the total excess operative time and total excess cost until obtaining proficiency was evaluated. Procedure order was found to impact procedure time and mean costs, with each successive case being associated with progressively less procedure time and cost. On average, each successive case was associated with a reduction in procedure time of 0.97 minutes (95% confidence interval 0.54-1.40; P < 0.001) and an average adjusted reduction in overall costs of $82.75 (95% confidence interval $35.93-129.57; P < 0.001). An estimated 58 procedures were needed to attain proficiency, translating into an excess procedure time of 2604.2 minutes (average of 45 minutes per case), overall costs associated with the learning experience of $226,563.8 (average of $3974.80 per case), and excess surgical cost of $125,836.6 (average of $2207.66 per case). Successive cases were associated with progressively less procedure time and mean overall and surgical costs, until a proficiency threshold was attained.

Comparative study of the functional outcomes of combined medial-lateral approach arthrolysis with or without external fixation for severe elbow stiffness

BackgroundTo evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation.MethodsWe retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared.ResultsThe average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation.ConclusionCombined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness.Level of evidenceTherapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Surgical management of suspected gallbladder cancer: The role of intraoperative frozen section for diagnostic confirmation.

Preoperative diagnosis for suspected gallbladder cancers is challenging, with a risk of overtreating benign disease, for example, xanthogranulomatous cholecystitis, with radical cholecystectomies. We retrospectively evaluated the surgeon's intraoperative assessment alone, and with the addition of intraoperative frozen sections, for suspected gallbladder cancers from a tertiary hepatobiliary multidisciplinary team (MDT). MDT patients with complex gallbladder disease were included. Collated data included demographics, MDT discussion, operative details, and patient outcomes. A total of 454 patients with complex gallbladder disease were reviewed, 48 (10.6%) were offered radical surgery for suspected cancer. Twenty-five underwent frozen section that led to radical surgery in 6 (25%). All frozen sections were congruent with final histopathology but doubled the operating time (p < 0.0001). Both the surgeon's subjective and additional frozen section's objective assessment, allowed for de-escalation of unnecessary radical surgery, comparing favourably to a 13.0% cancer diagnosis among radical surgery historically. The MDT process was highly sensitive in identifying gallbladder cancers but lacked specificity. The surgeon's intraoperative assessment is paramount in suspected cancers, and deescalated unnecessary radical surgery. Intraoperative frozen section was a safe and viable adjunct at a cost of resources and operative time.

Comparative Study between Lichtenstein Repair and Trans Abdominal Pre Peritoneal Repair of Inguinal Hernia (TAPP)

Abstract Background Inguinal hernia repair is one of the most widely performed surgical procedure. Among the techniques used, the open Lichtenstein repair is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the trans-abdominal pre- peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and early recovery. Objective s: This study aims to compare between lichtenstein repair of inguinal hernia and trans-abdominal pre-peritoneal repair of inguinal hernia (TAPP) as regard their hospital stay, cost, intra-operative &amp; post-operative complications and short term recurrence. Patients and Methods Our study was carried out on (50) male patients with inguinal hernia, 25 patients underwent laparoscopic TAPP repair and 25 patients underwent open Lichtenstein repair. We found a highly significant difference of laparoscopic TAPP Repair in decreasing post-operative pain than in open repair. Results Comparative study between the 2 groups revealed non-significant difference as regards age and sex of the patients. Comparative study between the 2 groups revealed non-significant difference as regards all socio-demographic data. Comparative study between the 2 groups revealed non-significant difference as regards type and side of hernia. Comparative study between the 2 groups revealed; highly significant increase in operative duration in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in post-operative pain score and post-operative hospital stay; in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in intra-operative complications in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Conclusion Our study showed that laparoscopic TAPP approach for inguinal hernia repair reduces early post-operative pain. Furthermore, it is related to less complications, although it takes a longer operative time and higher cost.

Finned heat sinks with phase change materials and metal foams: Pareto optimization to address cost and operation time

• Finned heat sinks with phase change materials and metal foams are examined. • Geometry and foam morphology are optimized to address operation time and cost. • Pareto optimization is conducted via the genetic algorithm NSGA-II. • Pareto solutions have operation time of 2000–6000 s, cost of 200–275 € per device. • Effects of heat sink geometry and foam morphology are comprehensively described. Finned heat sinks equipped with phase change materials to store and release large amounts of thermal energy and metal foams to increase overall thermal conductivity are a promising solution for heat transfer surfaces thermal management. These devices need to be properly designed in order to achieve an optimal trade-off between fundamental objectives like cost minimization and operation time maximization. Nowadays there are no studies available that figure out how to combine design variables to reach these goals. In the present study, a mathematical model based on volume-averaged porous media equations is employed to predict surface operation time. After comparisons with literature data, multi-objective Pareto optimization of such devices is performed with a genetic algorithm because of the large explored domain of solutions referred to heat sink geometry and foam morphology. The results show that the derived Pareto front covers operation time and device cost between about 2000–6000 s and 200–275 € per device, respectively, while the optimum according to the utopia criterion features an operation time of 4000 s with a cost of about 225 € per device. Data presented here can be a very useful tool to design such devices for heat transfer management in an optimized form.

Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi.

Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi.Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group.Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications.Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.