Time Of Surgery Research Articles

Time to surgical treatment for hip fracture care.

Studies have demonstrated beneficial outcomes associated with timely surgical treatment of hip fracture. Subsequently, practice recommendations changed with 24-48 h as the recommended time for surgery from admission; however, recent data on timing of hip fracture surgery and how this impacts outcomes are lacking. This retrospective cohort study included patients who had a primary diagnosis of hip fracture and underwent a subsequent surgical repair within 3 days of admission (Premier Healthcare claims 2006-2021 data). The primary exposure of interest was time from hip fracture diagnosis to surgery (categorized as 0-1 day, 2 days, and 3 days). Outcomes included any major complication, mortality, and intensive care unit (ICU) admission. Mixed-effects models measured the association between timing of surgery and outcomes. We report odds ratios (OR) and 95% confidence intervals. Among 501,267 surgical hip fracture patients, 26.0%, 56.0%, and 18.1% of patients received surgery on days 0-1, 2, and 3, respectively. The median ages were 83, 84, and 84 years old, and there were 73.3%, 72.2%, and 68.8% female in each group respectively. Compared with repair on day 0-1, hip fracture surgical treatment on day 2 or day 3 was associated with increased odds of major complications (OR 1.06, 95% CI 1.03-1.08 and OR 1.17, 95% CI 1.13-1.2), mortality (OR 1.08, 95% CI 1.02-1.14 and OR 1.2, 95% CI 1.12-1.28), and ICU admission (OR 1.06, 95% CI 1.04-1.09 and OR 1.36, 95% CI 1.32-1.4) after adjusting major comorbidities; all p < 0.001. Despite the publication of society guidelines in 2015, most fracture patients still received surgery on day 2 or day 3 of admission and were associated with worse outcomes. Balancing optimization of clinical factors with timing of surgery can be challenging, and further research is needed. Nonetheless, our findings reiterate the importance of timely surgical intervention.

Research article Quantifying physical resilience after knee or hip surgery in older Australian women based on long term physical functioning trajectories.

To improve outcomes after knee or hip surgery, better insight is needed in long-term recovery patterns in the context of ageing-related decline. We examined long-term trajectories of physical functioning (PF) in older women with and without hip and knee surgery, and described profiles of cases with higher and lower resilience after surgery. This observational study used data from 10,434 women (73-79 yrs) who completed survey 2 of the Australian Longitudinal Study on Women's Health. Data were used from surveys 2 (1999) to 6 (2011). Covariable-adjusted linear mixed models were run to examine the surgery-by-time (-12 to +12 yrs) interaction in association with PF (SF-36 subscale). The differences between observed and expected PF were calculated, with positive/negative values reflecting higher/lower resilience, respectively. Women with hip surgery (n=982) had lower PF than those without surgery (n=8117) (p&lt;0.001). Among hip surgery patients, the decline was more rapid pre-surgery than post-surgery (Δslope=-0.7, p&lt;0.001). Women with knee surgery (n=1144) had lower PF than those without surgery (n=7971), but with a slower rate of decline (p=0.01). Among knee surgery patients, the rate of decline was similar pre- and post-surgery (Δslope =-0.3, p=0.25). Both in hip and knee patients, women with higher resilience had fewer comorbidities and symptoms, and were more often physically active and independent in daily activities than those with lower resilience (all p&lt;0.05). Compared with women without surgery, PF was lower and declined more rapidly around the time of hip surgery, but not for knee surgery. Women with better long-term recovery after surgery, had fewer health problems and were more independent around the time of surgery.

Validation of the Geriatrics at Risk Score (GeRi-Score) on 120-day follow-up, the influence of preoperative geriatric visits, and the time to surgery on the outcome of hip fracture patients: an analysis from the Registry for Geriatric Trauma (ATR-DGU).

Numerous tools predict mortality among patients with hip fractures, but they include many variables, require time-consuming assessment, and are difficult to calculate. The GeRi-Score provides a quick method of pre-operative assessment. The aim of this study is to validate the score in the 120-day follow-up and determine the impact of a pre-operative visit by a geriatrician and timing of surgery on the patient outcome. A retrospective analysis of the AltersTraumaRegister DGU® from 2017 to 2021 was conducted, including all proximal femur fractures. The patients were divided into low-, moderate-, and high-risk groups based on the GeRi-Score. Mortality was analyzed using logistic regression. To determine the influence of the time to surgery and the preoperative visit by a geriatrician, matching was performed using the exact GeRi-Score, preoperative walking ability, type of fracture, and the time to surgery. The study included 38,570 patients, divided into 12,673 low-risk, 18,338 moderate-risk, and 7,559 high-risk patients. The moderate-risk group had three times the mortality risk of the low-risk group (OR 3.19 (95% CI 2.68-3.79; p<0.001)), while the high-risk group had almost eight times the mortality risk than the low-risk group (OR 7.82 (95% CI 6.51-9.93; p<0.001)). No advantage was found for surgery within the first 24 h across all groups. There was a correlation of a preoperative geriatric visit and mortality showing an increase in the moderate and high-risk group on in-house mortality. The GeRi-Score has predictive value for 120-day mortality. No advantage was found for surgery within 24 h. The analysis did not demonstrate a benefit of the preoperative geriatric visit, but more data are needed.

Multicentric short term and safety study of ineffective esophageal motility patients treated with RefluxStop device

Gastroesophageal reflux disease (GERD) presents a general health problem with a variety of symptoms and an impairment of life quality. Conservative therapies do not offer sufficient symptom relief in up to 30% of patients. Patients who suffer from ineffective esophageal motility (IEM) and also GERD may exhibit symptoms ranging from mild to severe. In cases where surgical intervention becomes necessary for this diverse group of patients, it is important to consider the potential occurrence of postoperative dysphagia. RefluxStop is a new alternative anti-reflux surgery potentially reducing postoperative dysphagia rates. In this bicentric tertiary hospital observational study consecutive patients diagnosed with PPI refractory GERD and IEM that received RefluxStop implantation were included. A first safety and efficacy evaluation including clinical examination and GERD-HRQL questionnaire was conducted. 40 patients (25 male and 15 female) were included. 31 patients (77.5%) were on PPI at time of surgery, with mean acid exposure time of 8.14% ± 2.53. The median hospital stay was 3 days. Postoperative QoL improved significantly measured by GERD HRQL total score from 32.83 ± 5.08 to 6.6 ± 3.71 (p < 0.001). A 84% reduction of PPI usage (p < 0.001) was noted. 36 patients (90%) showed gone or improved symptoms and were satisfied at first follow-up. Two severe adverse events need mentioning: one postoperative slipping of the RefluxStop with need of immediate revisional operation on the first postoperative day (Clavien–Dindo Score 3b) and one device migration with no necessary further intervention. RefluxStop device implantation is safe and efficient in the short term follow up in patients with GERD and IEM. Further studies and longer follow-up are necessary to prove long-lasting positive effects.

Impact of the COVID-19 Pandemic on the Surgical Management of Head and Neck Non-Melanoma Skin Cancers in a Maxillofacial Center of Cluj-Napoca.

Background: The COVID-19 era has been a bleak period for both cancer and non-cancer patients, with delayed non-emergency treatments, such as for non-melanoma skin cancer (NMSC). This study aimed to evaluate how the treatment of NMSC patients was influenced by the management of the COVID-19 pandemic in an Eastern European Maxillofacial Surgery center. Materials and Methods: A total of 176 patients with a histopathological diagnosis of head and neck NMSC who were surgically treated in Cluj-Napoca Emergency County Hospital between 2016 and 2022 were included in this study, and divided into two samples, pre-pandemic (2016-2019) and COVID-19 (2020-2022) periods. Results: The pandemic presented with a decrease of 46.15% in patients' hospitalization, with wealthy and educated patients being prevalent. Even if the waiting time for surgery was increased, the stage of cancer and preference method for reconstruction did not differ. Despite the lower addressability of NMSC patients during the pandemic, there were no changes in surgical treatment. Conclusions: During COVID-19, the number of patients was reduced, with a longer waiting time for surgery, but without any changes in tumor stage and treatment preferences. However, the benefit of removing a cancer tumor is higher compared to the risk of developing COVID-19 infection during hospitalization.

Impact of the COVID-19 Pandemic on the Surgical Management of Head and Neck Non-Melanoma Skin Cancers in a Maxillofacial Center of Cluj-Napoca

Background: The COVID-19 era has been a bleak period for both cancer and non-cancer patients, with delayed non-emergency treatments, such as for non-melanoma skin cancer (NMSC). This study aimed to evaluate how the treatment of NMSC patients was influenced by the management of the COVID-19 pandemic in an Eastern European Maxillofacial Surgery center. Materials and Methods: A total of 176 patients with a histopathological diagnosis of head and neck NMSC who were surgically treated in Cluj-Napoca Emergency County Hospital between 2016 and 2022 were included in this study, and divided into two samples, pre-pandemic (2016–2019) and COVID-19 (2020–2022) periods. Results: The pandemic presented with a decrease of 46.15% in patients’ hospitalization, with wealthy and educated patients being prevalent. Even if the waiting time for surgery was increased, the stage of cancer and preference method for reconstruction did not differ. Despite the lower addressability of NMSC patients during the pandemic, there were no changes in surgical treatment. Conclusions: During COVID-19, the number of patients was reduced, with a longer waiting time for surgery, but without any changes in tumor stage and treatment preferences. However, the benefit of removing a cancer tumor is higher compared to the risk of developing COVID-19 infection during hospitalization

Effectiveness of 3D visualization technologies in planning and performing reconstructive plastic surgeries in patients with elbow contractures caused by ossification

Background. Open reconstructive plastic surgeries are the most radical method of treating patients with elbow contractures caused by ossification. However, these surgeries pose a serious problem due to the large number of unsatisfactory results. The aim of the study is a comparative assessment of the effectiveness between standard techniques and 3D visualization technologies in the surgical treatment of patients with elbow contractures caused by ossification. Methods. Using random number generation, all patients (n = 71) were randomized into two groups. The first group included 34 patients with elbow contractures caused by ossification that underwent surgical intervention using 3D technologies to assess the ossification process. The second group enrolled 37 patients with a similar nosology that underwent standard examination and surgical treatment. The results were evaluated intraoperatively and 180 days after the surgery. The data were obtained from primary medical records and further survey. Results. The application of new planning technology and tactics for onstructive plastic surgeries made it possible to reduce the surgery time by 1.2 times (p0.05), reduce blood loss by 1.3 times (p0.05) and increase the relative number of patients with sufficient movement volume by 10.6% (p0.05). The assessment of various performance parameters (range of motion, pain syndrome, quality of life etc.) showed that after 6 months in the main group, the relative number of patients with problems related to the operated joint was significantly lower than in the control group: 20.5% vs 84.7% (p0.05). Conclusions. The data obtained indicate that the use of the new technique for planning and performing reconstructive plastic surgery in patients with elbow contractures caused by ossification contributes to a less invasive intervention and achievement of better intraoperative and medium-term treatment results.

Clinical characteristics and long-term outcome of patients with bioprosthetic mitral valve– Experience from a South Asian country

Objectives: Due to rheumatic heart disease, young people are more likely to develop valvular heart disease in developing countries. In countries like Pakistan, surgeons implant more bioprosthetic mitral valves (MVs) in younger patients. However, bioprosthetic valves degenerate rapidly in younger people, leading to bioprosthetic MV dysfunction (BMVD). This study aims to evaluate the clinical characteristics and long-term outcomes of patients with bioprosthetic MV replacement (MVR) at a tertiary care hospital in a South Asian country. Material and Methods: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bioprosthetic MVR from the year 2006 to 2020. Clinical and surgical characteristics along with transthoracic echocardiographic findings (pre-surgery and recent most follow-up studies) were noted. Follow-up data were also collected. Results: Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. MVR was done as an elective procedure due to the New York Heart Association (NYHA) II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 ± 2.99 years, BMVD was observed in 183 (36.5%) patients. However, re-do MV surgery was done in only 49 (9.8%) patients. Patients were divided into two groups based on normal functioning bioprosthetic MV and BMVD. Comparing the two groups, individuals with normal functioning bioprosthetic MV had a mean age of 51.6 ± 14.27 years, while those with BMVD had a mean age of 45.639 ± 14.33 years at the time of index surgery (P = 0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%), and death (n = 6, 3.28%) in the BMVD group which were statistically significant. Conclusion: This study is distinct because it demonstrates the outcomes of bioprosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bioprosthetic valve in younger patients, significant number of patients developed BMVD along with poor long-term clinical outcomes, even at a short follow-up period of &lt;10 years. These findings are similar to international data and signify that mechanical MVR may be a more reasonable alternative in younger patients.

Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study

Abstract Objectives Three-dimensional (3D) planning and Patient Specific Instrumentation (PSI) can help the surgeon to obtain more predictable results in Medial Opening Wedge High Tibial Osteotomy (mOW-HTO) than the conventional techniques. We compared the accuracy of the PSI and standard techniques and measured the learning curve for surgery time and number of fluoroscopic shots. Methods We included the first 12 consecutive cases of mOW-HTO performed with 3D planning and PSI cutting guides and the first 12 non-supervised mOW-HTO performed with the standard technique. We recorded surgery time and fluoroscopic time. We calculated the variation (Δ delta) between the planned target and the postoperative result for Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA) and tibial slope (TS) and compared it both groups. We also recorded the complication rate. We then calculated the learning curves for surgery time, number of fluoroscopic shots, Δ from target in both groups. CUSUM analysis charts for learning curves were applied between the two groups. Results Mean surgical time and mean number of fluoroscopic shots were lower in PSI group (48.58±7.87 vs. 58.75±6.86 min; p=0.034 and 10.75±3.93 vs. 18.16±4.93 shots; p&lt;0.001). The postoperative ΔHKA was 0.42±0.51° in PSI vs. 1.25±0.87° in conventional, p=0.005. ΔMPTA was 0.50±0.67° in PSI vs. 3.75±1.48° in conventional, p&lt;0.001; ΔTS was 1.00±0.82° in PSI vs. 3.50±1.57° in conventional, p&lt;0.001. ΔJLCA was 1.83±1.11° in PSI vs. 4±1.41° in conventional, p&lt;0.001. The CUSUM analysis favoured PSI group regarding surgery time (p=0.034) and number of shots (p&lt;0.001) with no learning curve effect for ΔHKA, ΔMPTA, ΔJLCA and ΔTS. Conclusions PSI cutting guides and 3D planning for HTO are effective in reducing the learning curves for operation time and number of fluoroscopic shots. Accuracy of the procedure has been elevated since the first cases.

1203 Early Surgery on Patients with Aneurysmal Subarachnoid Haemorrhage WFNS Grades 4 and 5

Abstract Aim This review aims to evaluate timing and approach of management of poor-grade aneurysmal subarachnoid haemorrhage, WFNS grade IV and V. Method We used PubMed, Cochrane Library, and the reviews and reference lists of relevant articles to search for studies published from 1999 till 2018 to review 16 articles, with a total of 2032 patients, for ultra-early, early, or late timing of surgery and 7 articles, with a total of 1294 patients, for surgical clipping or endovascular coiling. Results Studying the outcome of timing of surgery of total population revealed, 50.6% of patients had favourable outcome: 18.4% receiving ultra-early surgery, 20.5% early and 11.8% late surgery. While 42.6% of patients had poor outcome: 20.2% undergoing ultra-early surgery, 14.3% early surgery and 8% late surgery. Analysing the total population for modality of choice revealed, 25.6% of patients who underwent surgical clipping had favourable outcome compared to 15.8% who received endovascular coiling, while 32.1% and 20.9% of patients had unfavourable outcome. In addition to 3.9% of patients refusing the aneurysmal treatment, all suffered poor outcome. Conclusions All the reviewed articles agreed on the consensus that management within 24 hours from ictus is the timing of choice in managing poor grade SAH, which can reduce the increased intracranial pressure and increase cerebral perfusion to improve outcomes. Outcomes of both neurosurgical clipping and endovascular coiling were not appreciably different. However, clipping is preferred in small aneurysm with wide neck and MCA aneurysms. Coiling is preferred in larger aneurysms and aneurysms in ICA and posterior circulation.

1047 Umbilical Hernia Emergency Care: A Scoping Review

Abstract Aim Umbilical hernias may become acutely symptomatic, strangulated, or obstructed, requiring emergency treatment. Robust evidence is required for high-quality care in this field. This study presents a scoping review on emergency care of umbilical hernias. Method The study is reported in line with PRISMA-ScR guidance. EMBASE, MEDLINE &amp; CENTRAL databases were searched using a predefined strategy. A secondary hand-search was also performed. Eligible studies were primary research, reporting any aspect of emergency umbilical hernia care, published in the English language. Where emergency umbilical hernia care was not the primary focus, subsets of relevant data should be extractable. Two authors screened s and full texts, disagreement resolved by discussion and third author. Data were charted according to core concepts addressed by each study. A narrative synthesis was performed. Results The search generated 299 s, with 32 full texts for assessment and 15 included for final review. This encompassed 52,089 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/15), equally split between single (7/15) and multi-centre (8/15) studies with only one RCT. Most multi-centre studies were from national databases (7/8). Themes arising included risk profile (n=4), timing of surgery (n=5), investigations (n=2), repair method (n=9, 5 mesh vs suture; 4 laparoscopic vs open), and outcomes (n=12). Most common outcomes reported were mortality (n=10), morbidity (n=8), and length of hospital stay (n=6). Conclusions This scoping review demonstrates paucity of high-quality data for this condition. There is a need for randomised trials addressing timing and technical aspects of repair, with umbilical hernia-specific patient reported outcomes measures.

Study of heart rate and corticosterone variability in the simulation of rhino-surgical interventions in biological objects.

Aims: to assess changes in the time range of heart rate variability (HRV) and plasma corticosterone concentration in rats after simulating septoplasty. Materials and methods: a septoplasty was simulated in 30 mature male Wistar rats weighing 210-290 g. An ECG was recorded with subsequent analysis of the time domain of HRV, as well as blood sampling for changes in the concentration of corticosterone in the blood plasma. Results: SDNN significantly increased in comparison with the control on days 2 and 3 (p &lt;0.001), but decreased on days 4-5 (p &lt;0.001) and 6 days (p &lt;0.01 ). rMSSD changed in waves with two irregular peaks on days 1 and 6. SDNN / rMSSD, in comparison with the 1st day of the postoperative period, increased on the 2nd day and continued to grow (p &lt;0.05), and on the 4th day it began to decrease (p &lt;0.01). The total power of HRV was low throughout the postoperative period (p &lt;0.001), except for the 3rd day, when it was equal to the control data. The increase in the total power indicator fell on the 3rd day after the operation (p &lt;0.01), after which its decline occurred again. The concentration of corticosterone in the blood plasma in rats was significantly higher than before (p &lt;0.001). From the 2nd to the 4th postoperative day, its plateau was determined. Conclusion: Simulation of septoplasty leads to changes in the time range of HRV, an increase in the concentration of corticosterone in the blood plasma in rats with its maximum at the time of surgery and after 24 hours, the formation of a "plateau" from the 2nd to the 4th postoperative days, which coincides with changes of HRV.

Minimally Invasive Sinus Tarsi Approach versus Extensile Lateral Approach for Sanders Type II &amp; III Calcaneal Fractures (Systematic Review &amp; Meta-analysis)

Abstract Background Open reduction and internal fixation (ORIF) is becoming more common in Calcaneal fractures of Sanders types II and III. The extensile lateral approach (ELA) appears to be the gold standard. Aim of the Work We aimed to compare the clinical outcomes of intra- articular calcaneus fractures treated with open reduction and internal fixation with via Extensile lateral approach (routine treatment) versus those via a sinus tarsi approach (minimally invasive treatment). Materials and Methods This systematic review conducted on 7 studies enrolled 734 patients with Sanders type II &amp; III calcaneal fractures comparing he clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation (ORIF) via Extensile lateral approach (routine treatment). The outcome measures considered: Postoperative wound complications, AOFAS score, Time to surgery, Surgical operative time, 24 hours Postoperative VAS score, Bohler's angle improvement, Gissane's angle improvement, Calcaneus width reduction, Recovery of calcaneus length, Length of hospital stay. Results Regarding postoperative wound complication, minimal invasive procedure significantly reduced the rate of wound complications other than open reduction. Concerning American Orthopedic Foot and Ankle Society score (AOFAS) score, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to time to surgery, there was a significant difference between ORIF and minimally invasive (MI) method. As regard surgical operative time, MI had a significant reduction in operative time. According 24 hours Post operative VAS score, there was no significant difference between ORIF and minimally invasive (MI) method. Concerning Bohler's and Gissane's angles improvement, there was no significant difference between ORIF and minimally invasive (MI) method. With reference to calcaneus width reduction, there was no significant difference between ORIF and minimally invasive (MI) method. According recovery of calcaneus length, the current study showed no significant difference between ORIF and minimally invasive (MI) method. Concerning length of hospital stay, the ORIF consume more hospital stay than minimally invasive methods. Conclusion In contrast to ELA, minimal invasive procedure (STA) reduced the rate of wound complication. There was no significant difference between ELA and STA regarding the anatomical and functional outcome. The STA showed significant reduction in time to surgery and operative time.

Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)

Abstract Background Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive Objective To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases. Patients and Methods This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department. Results In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p &amp;lt; 0.01) In the study, The mean hospital stay score was 1.77 ±0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p &amp;lt; 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p &amp;lt; 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied. Conclusion We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.

1287 Timing of Surgery for Operable Non-Small Cell Lung Cancer and Concordance Between Clinical and Pathological Staging: The Aftermath of the Covid-19 Pandemic

Abstract Aim The present study assessed the concordance between clinical and pathological staging of non-small cell lung cancer (NSCLC) in patients who were referred with operable tumors. Method We retrospectively reviewed case records of 123 consecutive patients with operable NSCLC, who underwent curative surgery and whose pathology was evaluated at our institution between January 1, 2021, and December 31, 2021. Histopathology reports, imaging information, and multidisciplinary (MDT) team notes were retrieved from hospital digital records. Results The cohort included 73 (59%) women and 50 (41%) men in the age range of 46-88 years (median age 73 years [IQR 67-77]). Median time interval between staging CT and surgery (91 days [IQR 76.5-117.5]), and PET and surgery (70 days [IQR 57.5-92.0]) indicated that UK guidelines of &amp;lt;62 days between initial referral and commencement of definitive treatment were not being met in the majority of cases. EBUS-TBNA was performed for 15 (12%) patients and the median interval between EBUS-TBNA and surgery was 44 days (IQR 41.0-66.5). Discordant clinical and pathological TNM staging was evident in 65% of cases, including 45% of clinically understaged cases; and four patients with undetected pT4 disease. Six tumors staged postoperatively as N1 had been staged clinically as N0. For five cases with unforeseen N2, clinical staging was N0; surgery might not have been necessary for these patients. Conclusions Discordance between clinical and pathological staging of NSCLC is associated with treatment delays. Reduced time interval between staging CT/PET and surgery may have avoided inappropriate resections.

370 Do Prolonged Surgery Waiting List Times Affect the Incidence of Post-Tonsillectomy Haemorrhage, in the Context of the COVID-19 Pandemic?

Abstract Aim The United Kingdom was affected by the COVID-19 pandemic with the reduction of many services within the NHS, including suspension of elective surgical procedures from March 2020. We hypothesised that delayed surgery caused by the pandemic may increase the risk of post-tonsillectomy haemorrhage due to increased episodes of tonsillitis. The aims of this review were to investigate the relationship between prolonged waiting times and post-tonsillectomy haemorrhage. Method We performed a single-site, retrospective review from March 2019 to August 2023, with data collected from electronic hospital records. Both adults and children were included in the analysis and only procedures performed for recurrent tonsillitis were included. Results We identified 234 cases: 184 adeno/tonsillectomies in the pre-COVID (March 2019-20) and 50 in the post-COVID (August 2020-21) cohort. In the pre-COVID cohort, 7.6% (n=14) experienced a post-tonsillectomy haemorrhage, with 1.1% (n=2) experiencing a primary haemorrhage and 6.5% (n=12) experiencing secondary haemorrhage. The return to theatre rate was 2.2% (n=4). Median waiting time for surgery was 78 days. In the post-COVID cohort, secondary haemorrhage occurred in 6.0% (n=3). No patients experienced a primary haemorrhage and return to theatre rate was 0%. Median waiting time was 345 days. Simple logistic regression was performed which showed no significant association between waiting times and post-tonsillectomy haemorrhage across the whole (p = 0.90, 95% CI [-0.0002, 0.0002]) cohort. Conclusions Our cohort demonstrated no significant relationship between prolonged waiting times and post-tonsillectomy haemorrhage. Small sample size was a significant limitation; we recommend a larger scale, multi-centre study to investigate this further.

Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)

Abstract Background Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive. Objective To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases. Patients and Methods This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department. Results In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p &amp;lt; 0.01) In the study, The mean hospital stay score was 1.77 ± 0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p &amp;lt; 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p &amp;lt; 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied. Conclusion We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.

Advances in Three-Dimensional Printing for Craniomaxillofacial Trauma Reconstruction: A Systematic Review.

Craniomaxillofacial (CMF) fractures present significant challenges for plastic surgeons due to their intricate nature. Conventional methods such as autologous bone grafts have limitations, necessitating advancements in reconstructive surgery techniques. This study reviewed the use of three-dimensional printing for CMF trauma reconstruction using human studies. A systematic search of PubMed, EMBASE, and Google Scholar was conducted in February 2024 for case reports, case series, and clinical trials related to CMF trauma reconstruction using three-dimensional printing technology. The authors' systematic review included 20 studies and a total of 170 participants with CMF bone defects. In general, the authors observed low bias risk in analyzed case reports and series, serious bias risk in nonrandomized controlled trials, and moderate bias risk in randomized controlled trials. The printed objects included CMF structure model prototypes, patient-specific implants, and other custom surgical devices. Studies reveal successful outcomes, including restored facial symmetry and function, restored orbital occlusion, resolved enophthalmos and diplopia, achieved cosmetically symmetrical lower face reconstruction, and precise fitting of surgical devices, enhancing patient and surgeon comfort. However, complications such as local infection, implant exposure, and persistent diplopia were reported. Three-dimensional printed devices reduced surgery time but increased preparation time and production costs. In-house production options could mitigate these time and cost expenditures. Three-dimensional printing holds potential in CMF trauma reconstruction, addressing both functional and esthetic restoration. Nevertheless, challenges persist in implementing this advanced technology in resource-limited environments.

Transanal proximal rectosigmoidectomy: a single-center experience in surgically treated severe medically refractory idiopathic constipation.

To present the functional results after a transanal proximal rectosigmoidectomy in patients with severe idiopathic constipation in which medical treatment has failed. Patients with severe idiopathic constipation who underwent transanal proximal rectosigmoidectomy (TPRS) at Children's Hospital Colorado between June 2019 and March 2024 were included in the study. We compared multiple pre- and post-operative outcome measures and the patient's bowel regimen before and after resection. Fourteen patients underwent TPRS, 10 of whom were male. The average age at the time of surgery was 10.1years (range 5-19). Seven patients have moderate to severe autism. Constipation-related clinic visits, family calls, procedural intervention, emergency room visits, and hospitalizations notably decreased frequency after TPRS. Laxative dosages and enema volume requirements were also reduced after surgery. Before surgery, all the patients suffered from daily fecal accidents, while post-operatively, all were completely free of stool accidents. In our experience, for patients who suffer from severe medically refractory idiopathic constipation, TPRS has provided improvement in their symptoms and decreased the complications inherent to this chronic disease. Parents and patients attest to a profound positive transformation in their quality of life after surgery.

Total RAMIE with three-field lymph node dissection by a simultaneous two-team approach using a new docking method for esophageal cancer.

Thoracic esophageal cancer surgery using robotic approaches for the thoracic and abdominal parts has recently been reported as total robot-assisted minimally invasive esophagectomy (RAMIE). We herein present the first report of a new technique for esophageal cancer: total RAMIE with three-field lymph node dissection (3FLND) by a simultaneous two-team approach using a new docking method. We reviewed 20 patients who underwent total RAMIE with 3FLND by a simultaneous two-team approach at the National Cancer Center East Hospital from March 2023 to September 2023. Short-term surgical outcomes and the safety and efficacy of this technique were analyzed. The mean operative time for abdominal surgery with this new docking technique was 135 ± 19.6min. The total operative time was 488 ± 42.9min, and the time from the end of abdominal manipulation to the end of surgery was 80.1 ± 15.6min. The intraoperative blood loss was 116.7 ± 64.4mL. The incidence of anastomotic leakage, postoperative vocal cord paralysis, and postoperative pneumonia was 10%, 5%, and 10%, respectively. The median postoperative hospital stay was 14days (range 11-63days). No in-hospital deaths occurred, and R0 resection was possible in all cases. The average number of lymph nodes dissected was 87.7. These results demonstrate that total RAMIE with a simultaneous two-team approach using the new docking method can be safely introduced. The simultaneous cervical and abdominal manipulation with the new docking method allowed total RAMIE without prolonging the operating time, suggesting that it may be a valuable approach for esophageal cancer surgery.