Total Complications Research Articles

Unilateral versus bilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion: a systematic review and meta-analysis of randomized controlled trials.

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) that adopts paramedian incisions and tubular retractors to perform the decompression and interbody fusion has been widely used in the surgery for lumber degenerative disease (LDD). Bilateral pedicle screw fixation (BPSF) and unilateral pedicle screw fixation (UPSF) are the primary fixing techniques in MIS-TLIF. We conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy and safety between UPSF and BPSF in patients undergoing MIS-TLIF surgery for LDD. We searched the PubMed, Embase, and Cochrane Library databases for potential RCTs till June 2023. The effects of the fixation methods on clinical outcomes were estimated using the odd ratio (RR), risk difference (RD), and mean difference (MD) with a 95% confidence interval (CI) and a random-effects model. We obtained six RCTs. There was no significant difference between UPSF and BPSF in fusion rate, hospitalization day, low back pain, leg pain, Oswestry Disability Index, and SF-36 for physical functioning at 3-6months and ≥ 6months after surgery. Neither the total complication nor the individual complications showed differences between the two methods. However, UPSF significantly decreased operation time (MD = -39.05; 95% CI: -53.50 to -24.67) and estimated blood loss (MD = -60.41; 95% CI: -79.09 to -41.73) compared with BPSF. UPSF is better than BPSF when operation time and estimated blood loss are considered. BPSF may be considered for patients with single-level LDD without high-grade spondylolisthesis.

Surgical Outcomes in Unicoronal Synostosis-A 23-Year Experience From a Single Supraregional Craniofacial Unit.

Unicoronal synostosis is a rare condition leading to anterior plagiocephaly with facial scoliosis and deformation of the anterior cranial fossa. Fronto-orbital advancement and remodelling (FOAR) is the standard of care for management, aiming to normalise the brow shape and position while ameliorating the risk of raised intracranial pressure (ICP) throughout childhood. Published long-term surgical outcome data for unicoronal synostosis is lacking. The authors present our series of 151 cases of FOAR for unicoronal synostosis between January 2000 and January 2023. The average age at surgery was 22.7 months, with an average follow-up of 87 months. Ninety-six patients (66.2%) had no comorbidity. Nineteen (13.1%) had named genetic or chromosomal disorders. There was a 33.1% dural tear rate with no related postoperative CSF leak. Ninety-three patients (67.8%) had a blood transfusion with average donor exposure <1. The total early complication rate was 8.6% most commonly infection and wound dehiscence at 3.4% and 2.8%, respectively. The most common late complication was temporal recession in 30 (20.1%) patients and 3 of these patients required revision surgery. None of our patients required investigation for, or treatment of, raised ICP after the primary surgery. There were no life-threatening complications or mortalities. The authors compare our results to a previous publication on trigonocephaly patients and other available published data. The authors present our recommendations, which include support for a supraregionalized service that encompasses high-volume workload and multidisciplinary care.

Advantages of subtotal gastrectomy for upper third gastric cancer: A systematic review and meta‐analysis

AbstractDistal gastrectomy with very small remnant stomach (subtotal gastrectomy, STG) is sometimes performed for upper third gastric cancer, instead of total gastrectomy (TG). However, the advantages of STG over TG remain fully unknown, in terms of survival outcomes, complication rates, nutritional status, and quality of life. Therefore, a systematic review was performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) extension statement for reporting systematic reviews. Meta‐analyses were performed regarding operation time, complication rates, body weight changes, and reflux esophagitis by using R software. Operation time was significantly shorter in STG than in TG (Mean difference: −20.79 [95% CI: −35.59 to −5.99]). We cannot conclude whether STG is better than TG in terms of survival because of inconsistency among reports. The total complication rates (≧ grade2 and 3) are significantly lower in STG than TG. Reflux esophagitis was lower in STG than in TG (0% vs. 7.7%), although the difference was not significant probably because of small sample size. Body weight change compared with preoperative value was significantly lower after STG than TG both at 6 and 12 months after the operation (6 months: mean difference −5.31% [95% CI: −6.95 to −3.67], 12 months: mean difference −6.13 [95% CI: −8.20 to −4.06]). We revealed that STG has its advantage on shorter operation time, less complication rates, and lower body weight loss by meta‐analysis. Although there are some controversies, STG can be an ideal option for patients with gastric cancer of upper third stomach.

The learning curve of totalrobotic jejunojejunostomy duringcholedochal cystexcision in pediatrics: a retrospective study.

We conducted this retrospective study to investigate the characteristics of the learning curve of totalrobotic jejunojejunostomy duringcholedochal cystexcision in pediatrics. The study analyzed a database of medical records from the first 54 consecutive patients who underwent total robotic jejunojejunostomy during choledochal cyst excision by a single surgeon. Baseline information and postoperative outcomes were collected, and learning curves were assessed using the cumulative sum (CUSUM) method. Patients were then divided into two groups (A and B) based on the learning curve's cut-off points, and the intraoperative characteristics and postoperative outcomes were compared between the two groups. CUSUM plots revealed that the cut-off point of the learning curve was 17 cases. The operative time of jejunojejunostomy in group A was (61.71 ± 13.47min), which was longer than that of group B (42.43 ± 2.97min) (p < 0.0001). No statistically significant differences were found in terms of the intraoperative bleeding, time to start diet after surgery, hospital stay, and total complications between the two groups (p > 0.05). The learning curve for total robotic jejunojejunostomy during choledochal cyst excision in pediatrics is 17 cases, which can serve as the basis for performance guidance during future training.

Preliminary study assessing the long-term surgical outcomes of TBX6-associated congenital scoliosis (TACS) patients using the propensity score matching method: exploring the clinical implications of genetic discoveries in congenital scoliosis

BackgroundCompound inheritance of TBX6 accounts for approximately 10% of sporadic congenital scoliosis (CS) cases. Such cases are called TBX6-associated congenital scoliosis (TACS). TACS has been reported to have certain common clinical phenotypes. However, whether the surgical outcomes of TACS patients differ from those of other CS patients remains unclear.MethodsWe retrospectively searched for patients who were diagnosed with scoliosis. TACS was identified in genetic testing for CS. After propensity score matching, patients with TACS were matched with patients with NTACS according to sex, age, main curvature, classification, deformity location, surgical methods, fusion segment and number of fusions. We evaluated and compared the coronal and sagittal radiographic parameters before surgery, immediately after surgery, and at the final follow-up. Surgical information, including surgical method, fusion segment, blood loss and complications, was also compared and analyzed.ResultsTwenty-eight TACS patients were propensity score matched with 28 NTACS patients among 473 CS patients. The preoperative matching parameters mentioned in the Methods section were similar between the TACS group and the NTACS group. In the TACS group, the correction rate of the cranial compensatory curve (64.9 ± 18.6% vs. 51.2 ± 24.0%, P = 0.014) and the correction rate of the caudal compensatory curve (77.4 ± 12.5% vs. 65.4 ± 22.7%, P = 0.011) were significantly greater than those in the NTACS group, and the loss rate of correction of the cranial compensatory curve in the TACS group (0.6 ± 19.2% vs. 26.7 ± 50.8, P = 0.002) was significantly lower than that in the NTACS group. The total complication rate (7.2% vs. 14.3%) and incidence of adding-on (0 vs. 7.1%) were lower in the TACS group than in the NTACS group. There were no significant differences between the two groups in terms of blood loss, revision rate, other correction parameters, balance parameters or incidence of complications.ConclusionsTACS patients had better surgical outcomes than NTACS patients, which means that genetic diagnosis of the TBX6 gene mutation in CS before surgery can help predict better surgical outcomes. The specific genetic mechanism is not yet clear and may be related to the relatively normal development of paravertebral tissues in TACS patients. Further research is needed.Level of evidenceLeve: III.

A comparative study of two full-endoscopic foraminoplasty techniques for lumbar disc herniation.

This study aimed to compare the use of the endoscopic drill (ED) with the extra-endoscopic trephine (EET) in treating lumbar disc herniations with regard to efficiency, safety, and clinical outcomes. From January 2022 and June 2023, 136 patients who had the single-level LDH and received the transforaminal endoscopic surgery were divided into two groups according to the foraminoplasty technique: the EET group (n = 69) and the ED group (n = 67). Surgery-related parameters, complications, Visual Analogue Scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among two groups. The mean operation time and the foraminoplasty time of the EET group was significantly shorter than that of the ED group (P < 0.05). Patients in ED group reported less back pain on the VAS during foraminoplasty than EET group. Although the total complication rate was similar between two groups, the incidence of neural irritation in ED group was significantly lower than that in the EET group. There were no significant differences in VAS or ODI scores at each follow-up visit between two groups. The application of EET and ED were both effective for full-endoscopic foraminoplasty, and have achieved good clinical outcomes. Although the efficiency of EET is higher than that of ED, it faces some problems during use, such as a high risk of neural irritation, intense intraoperative pain, and the trephine displacement. The ED technique is safe and controllable, which can be used as an ideal method for supplementary foraminoplasty.

Surgical management of benign tumors of the parotid gland: the advantages of extracapsular dissection compared to traditional surgical techniques.

Salivary gland tumors represent only 3%-6% of all head and neck neoplasms, and approximately 70% of these tumors are located in the parotid gland. Most of these tumors are found in the more abundant superficial portion of the parotid gland, lateral to the facial nerve (FN). For many years, the location of the facial nerve between the superficial and deep segments of the parotid gland hindered adequate tumor extirpation. Several surgical options are available for the treatment of benign tumors in the parotid gland, but there remains no universal agreement on what the optimal surgical treatment is. In the early twentieth century, tumor enucleation was the standard treatment for parotid tumors to preserve the facial nerve, but high recurrence rates were the main downside of this procedure. To improve the outcome, superficial parotidectomy (SP) was implemented, which involves excision of the entire lateral segment of the parotid gland, superficial to the facial nerve. However, this surgical procedure may lead to severe postoperative complications, including facial nerve paralysis, in a significant number of patients. In recent years, more gland-preserving techniques were developed to reduce complication rates and improve the safety of procedures and patients' satisfaction, without increasing the risk of recurrence. This study compares our surgical experience with extracapsular dissection gland-sparing surgery (ECD) to traditional superficial parotidectomy in 56 patients who underwent surgery performed by the same surgical team. The superiority of ECD procedures compared to SP procedures was shown as far as total complication rates are concerned. In this case, Fisher's exact test statistic value was 0.0043 (significant at P < 0.05). ECD should be applied in properly selected cases and further prospective studies are needed to clarify the optimal indications.

Effectiveness of Perioperative Finger Sensory Rehabilitation in Patients Undergoing Fingertip Amputation and Reimplantation: A Retrospective Study.

Finger reimplantation is an effective method for the treatment of amputated fingertips. However, there are several shortcomings in traditional postoperative rehabilitation programs, which may affect a patient's functional recovery after surgery. Finger sensory rehabilitation is a comprehensive program that helps patients restore sensory and motor function to their fingers through the use of specific training methods and equipment. Thus, this study aimed to analyze the effect of finger sensory rehabilitation on a group of patients who had undergone fingertip amputation and reimplantation. The medical records of 106 patients having undergone fingertip amputation and reimplantation from January 2022 to January 2024 were retrospectively analyzed. The patients were classified into experimental group (n = 52, receiving conventional rehabilitation training + finger sensory rehabilitation training) and the control group (n = 54, receiving only conventional rehabilitation training). Patients in both groups participated in a 20-week rehabilitation training, and the Semmes-Weinstein monofilament test was used to evaluate the finger touch pressure sensation after completing the rehabilitation training in both groups, and the Visual Analogue Scale (VAS) score, Generic Quality of Life Inventory-74 (GQOLI-74) score to evaluate their pain sensation and quality of life on the 2nd postoperative day and at the end of rehabilitation training. After completing rehabilitation, a specialized method for assessing the patient's tactile sensory deficits was used, showing that the number of cases with light tactile hypoesthesia to single-fiber sensation in the reimplanted fingertips was higher in the experimental group than in the control group (p < 0.01), while there was no significant difference in the number of cases of protective hypoesthesia between the two groups (p > 0.05), the number of cases of protective sensory loss was significantly lower in the experimental group than in the control group (p < 0.01). There was no significant difference in the pain scores and comfort scores between the two groups before management (p > 0.05). However, the pain level of the two groups after management was significantly lower than that before management (p < 0.01), whereas the post-management comfort scores of both groups were significantly higher than that before management (p < 0.001). The experimental group's degree of improvement was significantly higher than that of the control group (p < 0.001). The pre-management GQOLI-74 scores were not significantly different between the groups (p > 0.05), whereas after management, the experimental group outperformed the control group in all dimensions of the scores, except in thinking ability (p < 0.01). Although not statistically significant (p > 0.05), the total perioperative complication rate of the experimental group was lower than that of the control group. The implementation of finger sensory rehabilitation training is effective for restoring tactile function, reducing pain levels, and improving quality of life among patients who had undergone fingertip amputation and reimplantation. This finding can inform the development and selection of subsequent rehabilitation programs.

Physical Prehabilitation for Older Patients with Cancer before Complex Medical-Surgical Interventions: An Umbrella Review.

Prehabilitation has become a field of increasing interest over recent decades. However, few studies specifically investigated prehabilitation for older patients with cancer. The objective of this umbrella review was to summarize evidence on prehabilitation programs to identify the physical interventions that may be applied with benefit to older cancer patients who will undergo complex medical-surgical procedures. The protocol was registered in Prospero. Major databases, namely PubMed, Embase, CINAHL, Cochrane, Web of Science and Prospero, were searched until summer 2020 and a second search was performed until November 2023. All systematic reviews and meta-analyses were included, dealing with the major topic of prehabilitation for older patients with cancer diagnosis. Among 1425 records (633 until 2020, 792 until November 2023), 14 reviews were selected for inclusion. According to the AMSTAR-2 checklist, the median quality score was 11 (range: 5-12). Total duration of prehabilitation ranged from 1 to 5 weeks, session duration from 20 to 50 minutes, session frequency from 3 to 6 per week. Reported program modes were aerobic and resistance exercises. Concerning the outcome measures, the functional as well as the respiratory status was significantly affected. Quality of life did not benefit significantly, but showed a positive trend. The length of hospital stay was not significantly improved in the majority of the studies. In contrast, most systematic reviews reported significantly lower numbers of total postoperative complications. Functional recovery was enhanced in half of the found reviews. Prehabilitation is a growing field, notably also in reviews focussing on oncological care for elderly patients included in this umbrella review. Aerobic and resistance exercises are the core of the majority of the programs evaluated but their characteristics (total duration, frequency) are partly heterogeneous. Prehabilitation for older patients may also include other modalities of geriatric interventions like nutritional or psychological optimization.

The efficacy of hypothermia combined with thrombolysis or mechanical thrombectomy on acute ischemic stroke: a systematic review and meta-analysis.

Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. In recent years, the safety and efficacy of hypothermia combining thrombolysis or mechanical thrombectomy have attracted widespread attention. The primary objective of the study was to evaluate the effectiveness and safety of hypothermia by combining reperfusion therapy in acute ischemic stroke patients. A systematic search was performed in PubMed, EMBASE, Cochrane Library, and the Clinical Trial Registries on articles published until May 2024. The full-text articles were thoroughly reviewed, and relevant information regarding study characteristics and outcomes was extracted. Mantel-Haenszel (M-H) random-effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). In addition, subgroup analyses were performed focusing on the different hypothermia modalities and duration. After screening 2,265 articles, 10 studies were included in the present analysis with a total sample size of 785. Forest plots of clinical outcomes were as follows: modified Rankin Scale (mRS) ≤2 at 3 months (RR = 1.28, 95% CI 1.01-1.61, p = 0.04), mortality within 3 months (RR = 0.95, 95% CI 0.69-1.29, p = 0.73), total complications (RR = 1.02, 95% CI 0.89-1.16, p = 0.77) and pneumonia (RR = 1.35, 95% CI 0.76-2.40, p = 0.31). Subgroup analyses indicated a mild protective effect of selective cerebral hypothermia; however, the difference in mortality between the hypothermia and control groups was not statistically significant (RR = 0.88, 95% CI 0.57-1.35, p = 0.55). Patients undergoing hypothermia for 24-48 h experienced a higher rate of overall complications (RR = 1.37, 95% CI 1.01-1.86, p = 0.04) and pneumonia (RR = 2.84, 95% CI 1.05-7.66, p = 0.04). The preliminary evidence supports the safety and feasibility of hypothermia combined with reperfusion therapy, which should be further investigated in randomized controlled studies. https://www.crd.york.ac.uk/prospero/, identifier CRD42024556625.

Emergency Department Visits After Total Joint Arthroplasty in a Closed Urban Setting: A Report of 1,000 Consecutive Cases.

Rates of emergency department (ED) visits and readmissions after total joint arthroplasty (TJA) have been cited as indicators of TJA quality. Understanding the incidence and nature of these events is critical for prevention. The purpose of this study was to analyze readmission rates 30 and 90 days after TJA at a safety-net hospital in an urban setting and to compare this readmission rate with that for non-safety-net hospitals found in the current literature. In addition, we aimed to quantify the readmissions in our safety-net hospital that led to future complications. This would help us identify if there is a high incidence of preventable readmission rates in this unique socioeconomic environment. Using our institutional electronic medical record system, we retrospectively studied 1000 consecutive TJA encounters between 2014 and 2019 to determine the rates of treat-and-release ED visits within 30 and 90 days after surgery. The ED charts were reviewed, and patients who returned to the operating room (OR) for a TJA complication within 1 year of surgery were identified. We compared the OR return rates of people who had ED visits with those in the control group. A total of 110 (11%) and 191 (19.1%) patients visited the ED within 30 and 90 days of surgery, respectively. Fisher exact test confirmed that having an ED visit within 90 days of TJA because of lower extremity pain and/or swelling or a social issue was associated with returning to the OR within a year of TJA. Having an ED visit within 30 or 90 days of total hip replacement was associated with returning to the OR for total hip replacement complications. ED visits after TJA at an urban safety-net hospital were markedly higher than those reported in the literature for nonurban safety-net hospitals. In addition, postoperative ED visits for specific diagnoses may predict complications. This indication may have implications for a risk adjustment in programs such as bundled payments. Our results also indicate overutilization of the ED by avoidable ED visits. This represents a call for alternatives to the ED for patients after TJA in environments served by safety-net hospitals.

Overcoming the Odds: Total Knee Replacement in a Contralateral Above-knee Amputee

Total knee arthroplasty (TKA) in patients with a contralateral above-knee amputation (AKA) is an uncommon and challenging clinical scenario. Altered gait biomechanics in these patients lead to increased mechanical stress on the contralateral limb, predisposing it to accelerated osteoarthritis and total knee replacement-related complications like accelerated wear. We report the case of a 68-year-old female with severe osteoarthritis of the right knee and a history of left AKA following gangrene. She underwent right TKA and reported excellent functional outcomes and pain relief. This report highlights the multidisciplinary approach to such cases, such as preoperative planning and tailored physical rehabilitation and counseling, emphasizing the potential for successful outcomes in such patients.

Systematic review of shoulder arthroplasty outcomes: What sample size is meaningful?

Shoulder arthroplasty is increasingly performed for shoulder conditions such as arthritis, rotator cuff arthropathy, and traumatic injuries. Registries and other compilations of patient data provide the opportunity to detect meaningful differences in outcomes between alternative techniques and implants. A wide range of outcome measurements are reported after shoulder arthroplasty, but the sample sizes needed to identify meaningful differences has not been studied systematically. This review systematically analyzes common clinical outcomes reported for shoulder arthroplasty and reports the sample sizes necessary to confirm a clinically meaningful and statistically significant difference for these outcome measures. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies evaluated outcomes of anatomic or reverse total shoulder arthroplasty (TSA) with a minimum of two years of follow-up data. Outcome measures reported in three or more studies were combined to establish an overall mean and standard deviation for each measure. Using these combined measures, the sample size needed to detect clinically and statistically meaningful differences were established using published MCIDs with the assumptions of significance at α =0.05 and power at β =0.20. A total of 43 studies (29 anatomic TSA; 13 reverse TSA) met inclusion criteria, comprising of 84,503 shoulders. Outcome measures analyzed were: revision rate, range of motion (ROM), patient reported outcomes (PROs) (ASES, Constant-Murley, WOOS, DASH, SST and VAS scores), and complication rates. The sample size needed to detect meaningful differences is much lower for continuous measures (ROM and PROs) than for dichotomous outcomes (revisions and complications). For example, ROM outcome requires a minimum of 13 patients per treatment group to demonstrate a 15º change. PROs required a minimum of 6 patients to demonstrate a minimally clinically important difference (MCID). For a 20% difference in treatment groups, revision rates required a minimum of 8,527 patients and total complications required a minimum of 1,854. Large patient databases provide the opportunity to improve patient outcomes based on measured evidence. However, comparative studies need to utilize appropriate outcome measures with adequate sample sizes to provide meaningful results. This review has identified the minimum sample size needed to provide clinically meaningful conclusions for various outcomes reported in studies. Binary outcomes (revision rate, complication rate) are less sensitive and require larger sample sizes, while continuous outcomes (ROM, PROs) require smaller sample sizes. This should be considered when establishing patient registries, publishing results, and analyzing studies on shoulder arthroplasty.

Comparison of spinopelvic fixation and iliosacral screw fixation for posterior pelvic ring injuries.

There is no consensus in the literature regarding the optimal treatment method for posterior pelvic ring injuries. This study aims to compare the radiologic and clinical outcomes, as well as complications of spinopelvic fixation (SPF) and iliosacral screw fixation (ISF) in patients with posterior pelvic ring injuries. This retrospective study analyzed 54 patients (37 females, 17 males; mean age 38.9±18.7 years) with pelvic ring injuries classified as Tile type B and type C involving the posterior pelvic ring. These patients were treated with either SPF or ISF and followed for at least one year at two centers between 2016 and 2023. Of these, 28 patients comprised the SPF group, and 26 patients were in the ISF group. Comparisons were made regarding perioperative data (hemoglobin loss, blood product replacement, hospitalization duration, intensive care unit stay, surgery time, and fluoroscopy duration) and clinical outcomes (limb length discrepancy, Majeed score, visual analogue scale (VAS) score, and Short Form-36 (SF-36) score). Radiological outcomes were assessed using Matta outcome grading. Complications were also investigated. Hemoglobin loss (median 2.2 vs. 1 g/dL; p=0.027) and surgery time (67±10.6 vs. 37.7±11.3 minutes; p<0.001) were higher in the SPF group, whereas fluoroscopy duration (median 2 vs. 51.5 seconds; p<0.001) was higher in the ISF group. Other perioperative parameters did not differ between the groups. At a minimum follow-up of one year, clinical scores (Majeed score, VAS, SF-36), limb length discrepancy, and Matta outcome grades were similar between the groups. The SPF group had higher total complication rates (46.4% vs. 19.2%; p=0.034) and infection rates (42.9% vs. 3.8%; p<0.001), while rates of neurological deficits, screw malposition, and other hospitalization complications (e.g., thromboembolic or cardiovascular events, pulmonary complications, sepsis) were not significantly different. Both spinopelvic fixation and iliosacral screw fixation techniques are similarly effective in terms of clinical and radiological outcomes, with both methods demonstrating a low rate of complications. However, SPF was associated with higher infection rates and greater hemoglobin loss, while ISF required increased fluoroscopy exposure.

Radiofrequency ablation versus microwave ablation for lung cancer/lung metastases: a meta-analysis.

Both radiofrequency ablation (RFA) and microwave ablation (MWA) are commonly used non-surgical treatment methods for lung cancer/lung metastases (LC/LM). However, there is still debate over which one is superior. The meta-analysis was conducted to evaluate the effectiveness and safety between the two groups. Seven databases were systematically searched for relevant literature comparing RFA versus MWA in the treatment of LC/LM. The primary outcome assessed was survival, while secondary outcomes included ablation efficacy rate, recurrence, and complications. Ten studies were included, comprising 433 patients in the RFA group and 526 in the MWA group. The RFA group exhibited longer overall survival (OS) time (mean difference [MD]: 1.95 [0.43, 3.48] months) and progression-free survival (PFS) time (MD: 3.00 [2.31, 3.69] months) compared to the MWA group. Progression-free survival rates (PFSR) at 1 and 2 years were superior in the RFA group, with the advantage of PFSR increasing with prolonged survival time. However, the ablation duration (MD: 5.78 [3.54, 8.01] min) was longer in the RFA group. Both groups showed similar rates of recurrence, complete ablation (initial and subsequent sessions), total complications, as well as grade 1-2 and grade 3-4 complications. The top 5 complications in the total population were pneumothorax (26.63%), pleural effusion (17.22%), subcutaneous emphysema (14.31%), intra-alveolar haemorrhage (9.72%), and post-ablation syndrome (8.88%). RFA appears to be more effective than MWA in the treatment of LC/LM, showing improved survival (OS and PFS) and comparable safety.

Treatment of Paraclinoid Aneurysms With Stent-Assisted Coiling Versus Flow Diversion Techniques: A Systematic Review and Meta-Analysis.

The stent-assisted coiling (SAC) and flow-diverter stent (FDS) techniques are widely used in the endovascular treatment of paraclinoid aneurysms. This article compares the occlusion rate, periprocedural complications, and clinical outcomes of SAC and FDSs. Between January 2010 and December 2020, a systematic search of electronic databases identified 2283 articles for screening. After the application of inclusion and exclusion criteria, data were extracted for a meta-analysis of the proportions. Of 23 articles containing 4 comparative studies, 27 cohorts were included, and 1208 patients with 1328 aneurysms were analyzed: In 10 cohorts, 381 (28.7%) patients were treated with SAC, whereas in 17 cohorts, 947 (71.3%) patients were treated with FDSs. In the comparative studies, no significance was observed between the 2 treatments. In the pooled cohorts, complete occlusion was achieved in 85% of aneurysms after treatment with FDSs (95% CI: 0.81-0.88, I2=34.7%) and 76% after treatment with SAC (95% CI: 0.70-0.81, I2=16.6%); the subgroup analysis was statistically significant (P=0.003). New visual complications were observed in 5% of the FDS-treated group (95% CI: 0.02-0.09, I2=76.9%) and in 1% of the SAC-treated group (95% CI: 0.00-0.02, I2=0%); the subgroup analysis was statistically significant (P=0.018). Other observational indices, including total procedure-related complications; hemorrhagic, thrombotic, and ischemic complications; permanent morbidities, and favorable neurological outcomes, showed no statistical significance between the groups. Compared with SAC, treatment with FDSs may have a higher complete occlusion rate at follow-up. The similarly low rates for procedure-related complications and permanent morbidities indicate that both treatments are safe. A higher rate of new visual complications was noted in the FDS-treated group. Further research is required for direct comparisons along with a complete ophthalmological examination.

Nail-plate combination constructs versus single traditional constructs for distal femur fractures: a systematic review and meta-analysis of comparative studies.

Distal femur fractures (DFF) are frequently treated surgically with single traditional constructs (STC), such as with a lateral plate or intramedullary nail, although nail-plate combination constructs (NPCC) are gaining attention. The purpose of this study is to compare outcomes between NPCC and STC for surgical fixation of DFF to guide surgeon decision-making. Data Sources: This study is a systematic review and meta-analysis using PubMed, CINAHL, MEDLINE, Web of Science, Science Direct, and SPORTDiscus from database inception until January 10th, 2024. Inclusion criteria were comparative studies that examined clinical outcomes and complications for NPCC versus STC for DFF in adult patients. Data included operative time, estimated blood loss (EBL), length of stay (LOS), as well as likelihood of total complications, total unplanned reoperations, and malunion. Statistical analysis included a random-effects model using unstandardized mean difference or odds ratio (OR). Five retrospective comparative studies (n = 1,368 patients; mean age: 52.3 ± 8.1 years; 134 patients in the NPCC group) were included. There was no statistically significant difference in operative time (p = 0.696), EBL (p = 0.408), or LOS (p = 0.963) between patients in the NPCC group as compared to patients in the STC group after DFF. Patients in the NPCC group had a statistically significant lower number of total complications (p = 0.009; OR: 0.31; 10.6% versus 16.0%) and total unplanned reoperations (p = 0.027; OR: 0.42; 8.2% versus 14.8%) as compared to patients in the STC group after DFF. However, there was no statistically significant difference in the number of malunion cases between groups (p = 0.130), although the NPCC group had far fewer cases than the STC group (2.9% versus 10.5%). Patients treated with NPCC had significantly fewer cases of total complications and total unplanned reoperations without significant differences in operative time, EBL, or LOS as compared to patients treated with STC for DFF, although these associations are limited by sample size. Level IV.

Comparison of different localization needles and postures in localization of pulmonary nodules

BackgroundWith advancements in imaging testing and surgical procedures, an increasing number of nodules with smaller diameters and deeper locations have been deemed suitable for surgical intervention. The preoperative localization of these nodules has become essential. In this retrospective single-center study, we aimed to compare the effectiveness and patient comfort associated with the use of a four-hook needle versus a hook-wire needle for preoperative localization. Additionally, we sought to evaluate the impact of different patient postures on localization effectiveness.MethodsWe retrospectively analyzed the data of 692 patients following preoperative CT-guided localization. The patients were categorized into different groups based on the type of localization needles used and their respective postures during localization.ResultsThere was no statistical difference in total complications between the four-hook needle group and the hook-wire needle group (P > 0.05). The chest pain score in the four-hook needle group was lower than the hook-wire needle group (P = 0.001). The incidence of decoupling in the four-hook needle group was significantly lower than the hook-wire needle group (P < 0.05). The four-hook needle group had better performance in terms of localization operation time, operation time, intraoperative bleeding and first-day drainage (P < 0.05). Compared with the supine and lateral groups, the prone posture group had better performance in total complications and localization operation time, and worse performance in decoupling and chest pain (P < 0.05).ConclusionsThe four-hook needle has better effectiveness on localization and comfort in patient than the hook-wire needle, which is worthy of clinical promotion and application. The patient’s different postures during localization procedure may affect the localization results.

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer.

Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-day postoperative complications between these two techniques. We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications. A cohort of 8,403 breast cancer patients was analyzed. A total of 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years (p < 0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, p < 0.001), exhibited a higher body mass index (31.73 vs. 26.93, p < 0.001), had a greater prevalence of diabetes mellitus (11.0 vs. 5.0%, p < 0.001). They also had a higher ASA classification (2.33 vs. 2.15, p < 0.001), shorter operative time (173.39 vs. 216.20 minutes, p < 0.001), and a higher proportion of outpatient procedures (83.7 vs. 39.5%, p < 0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients (4.2 vs. 10.9%, p < 0.001), including lower rates of surgical complications (2.2 vs. 8.0%, p < 0.001) and wound complications (1.9 vs. 4.8%, p = 0.005) compared with MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications. OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared with MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.

Standing balance impairment in persons with type 2 diabetes is predicted by peripheral neuropathy and vestibulopathy.

The three main sensory complications of Type 2 Diabetes are diabetic peripheral neuropathy (DPN), diabetic retinopathy (DR), and diabetic vestibulopathy (DV). Current screening for these has been found to be insufficient, and balance testing may be a way to improve screening practices. This study aims to assess if the presence of sensory complications can be used to predict balance scores. 52 participants with T2D were recruited for this study. Participants anthropometric measures, demographic, socioeconomic, and information related to the participants T2D were recorded. Participants completed the modified Clinical Test of Sensory Integration in Balance (mCTSIB) and scores were recorded. Bivariate analysis was conducted on all variables related to mCTSIB total balance scores. A multivariable linear regression model was created using mCTSIB total scores as the outcome and T2D sensory complications as the predictor while controlling for sex and age. Bivariate analysis revealed significant (p < 0.05) associations between mCTSIB total scores and T2D sensory complications, education, employment, annual income, and age. The final multivariate linear regression model was found to be significant (Adj R2 = 0.45, p < 0.01). This model showed that those with DPN (β = 121.03 cm, CI = 77.71-164.35, p < 0.01) or DV (β: 60.65, CI = 5.17-116.13, p = 0.04) had significantly higher balance scores compared to those that did not have a sensory complication, adjusting for sex and age. Sensory complications of T2D have the potential to predict balance scores and provides the first evidence that balance assessments may also be able to screen for DPN and DV.