Total Number Of Complications Research Articles

Prolonged 120-h meropenem antibiotic prophylaxis in radical cystectomy compared to 24h standard antibiotic prophylaxis: Final analysis of the randomized clinical trial

ABSTRACT Background Standard 24-h antibiotic prophylaxis (AP) is widely employed to minimize the risk of infection complications (ICs) within 30 days following a radical cystectomy (RC). However, a considerable variety of prophylaxis protocols do not prevent a high ICs rate after surgery (37–67%). Therefore, antibiotic’s type and its duration are still controversial for AP.( Objective To compare standard 24-h AP with a prolonged 120-h regimen in a multicenter randomized clinical trial. Methods Patients were randomized in a 1:1 ratio to standard 24-h AP regimen (Group A) versus the prolonged meropenem AP 120-h (Group B). The primary endpoint was an event rate defined as the frequency of ICs within 30 days. The secondary endpoint were biomarker’s analysis and antibiotic re-administration rate (ArAR). Results A total of 92 patients were enrolled. The Clavien-Dindo complications rate did not differ between the groups (p = 0.065), however the overall complication rate was higher in Group A (63.0% vs. 34.8%, p = 0.007). The infection complication rate was 2.75 times higher in the standard antibiotic prophylaxis group: 47.8% compared to 17.4% cases in Group B (p = 0.002). The new prolonged antibiotic regimen decreased the risk of ICs (OR 0.23; 95% CI 0.08–.598; p = 0.003). The event-free survival for ICs of clinical interest in group A was 7.00 days and in group B was 9.00 days (HR = 0.447; 0.191–1.050, p = 0.065). The ArAR was higher in Group A -47.8%, while in Group B it was only in 17.4% of the cases. The incidence of bacteriuria before RC was the same between groups (p = 0.666), however, after stent removal the risk of a positive culture was lower in group B (RR = 0.64; 95% CI 0.37–1.08; p = 0.05). Conclusions The administration AP over 120-h appears to be safe and feasible, demonstrating a reduction in the total number of complications and ArAR. Trial registration in Clinical Trials: NCT05392634. Trial registration in Clinical Trials: NCT05392634.

Postoperative complications and hernia recurrence after the use of various ventral hernia repair techniques

Prosthetic hernioplasty (HP) for ventral hernias (VH) has a complication rate of up to 27% and a hernia recurrence rate up of to 37%, depending on the chosen technique. The use of laparoscopic HP techniques allows for a shorter hospital stay and a lower risk of wound infection. There is a wide range of data on the superiority of laparoscopy over the open technique in terms of recurrence rates and various types of complications. The results of comparing HP with and without suturing of the hernia defect are controversial. Objective — to study the structure and incidence of postoperative complications, as well as the frequency of hernia recurrences after the use of open and laparoscopic HP for VH. Materials and methods. A multicenter prospective study, which included 482 patients diagnosed with VH, was conducted at the clinical base of the Department of General Surgery No. 2 at Bogomolets National Medical University. A total of 279 (57.9%) patients had primary VH, while 203 (42.1%) had incisional VH. The patients were divided into two groups, comparable in terms of age, sex, and hernia size distribution. Group 1 included 250 (51.9%) patients who underwent open HP with suturing of the hernia defect: subgroup 1a — open sublay (n=243; 50.4%), and subgroup 1b — open intraperitoneal onlay mesh technique (IPOM) (n=7; 1.5%). Group 2 included 232 (48.1%) patients who underwent laparoscopic HP using the IPOM technique: subgroup 2a — IPOM without suturing of the aponeurosis defect (n=81; 16.8%), subgroup 2b — IPOM with suturing of the aponeurosis defect (n=108; 22.4%), and subgroup 2c — IPOM+ with open aponeurosis defect suturing (n=43; 8.9%). Follow‑up evaluations were carried out at intervals of 2 weeks, 1 month, 6 months, and 1 year to assess the presence of complications, recurrence, and satisfaction with the cosmetic effect of the operation. Results. The overall frequency of complications after HP was 15.6%, while after open sublay it was 21.2%, and after laparoscopic IPOM it was 9.9%. All cases of complications belonged to Grades I—IIIb according to the Clavien‑Dindo classification. In both groups, there were no fatalities. In group 1, the frequency of seroma was 11.6% and hematoma was 5.6%, and in group 2, it was 7.3% and 0.9%, respectively. A statistically significant increase in the frequency of hematoma development was observed after open HP techniques compared to laparoscopic ones (p=0.004), while the frequency of seroma detection was comparable (p=0.148). Non‑suturing of the aponeurosis defect after laparoscopic IPOM in patients with VH did not result in an increase in the total number of complications or the percentage of recurrence (p >0.05). Laparoscopic IPOM with hernia suturing demonstrated significantly higher patient satisfaction with the appearance of the anterior abdominal wall compared to other HP techniques (р <0.05). Conclusions. The open sublay and laparoscopic IPOM HP procedures have a comparable recurrence rate of VH (p >0.05). The incidence of infectious complications and hematomas is significantly higher after open operations compared to laparoscopic ones (p=0.041 and p=0.004, respectively).

External ventricular drainage in pediatric patients: indications, management, and shunt conversion rates.

Placement of an external ventricular drainage (EVD) is one of the most frequent procedures in neurosurgery, but it has specific challenges and risks in the pediatric population. We here investigate the indications, management, and shunt conversion rates of an EVD. We retrospectively analyzed the data of a consecutive series of pediatric patients who had an EVD placement in the Department of Neurosurgery at Hannover Medical School over a 12-year period. A bundle approach was introduced to reduce infections. Patients were categorized according to the underlying pathology in three groups: tumor, hemorrhage, and infection. A total of 126 patients were included in this study. Seventy-two were male, and 54 were female. The mean age at the time of EVD placement was 5.2 ± 5.0years (range 0-17years). The largest subgroup was the tumor group (n = 54, 42.9%), followed by the infection group (n = 47, 37.3%), including shunt infection (n = 36), infected Rickham reservoir (n = 4), and bacterial or viral cerebral infection (n = 7), and the hemorrhage group (n = 25, 19.8%). The overall complication rate was 19.8% (n = 25/126), and the total number of complications was 30. Complications during EVD placement were noted in 5/126 (4%) instances. Complications during drainage time were infection in 9.5% (12 patients), dysfunction in 7.1% (9 patients), and EVD dislocation in 3.2% (4 patients). The highest rate of complications was seen in the hemorrhage group. There were no long-term complications. Conversion rates into a permanent shunt system were 100% in previously shunt-dependent patients. Conversion rates were comparable in the tumor group (27.7%) and in the hemorrhage group (32.0%). EVD placement in children is an overall safe and effective option in children. In order to make further progress, carefully planned prospective and if possible randomized studies are needed controlling for multivariable aspects.

Clopidogrel versus newer P2Y12 inhibitors in the dual antiplatelet therapy for stent-assisted coil embolization of intracranial aneurysms: A meta-analysis.

Stent-assisted coil embolization (SACE) for cerebral aneurysms requires dual antiplatelet therapy (DAPT), commonly clopidogrel plus aspirin is preferable to ticagrelor or prasugrel plus aspirin. However, there are few studies assessing the safety of the association of ticagrelor or prasugrel plus aspirin. Compare the safety of newer P2Y12 inhibitors with clopidogrel in patients that underwent a SACE for cerebral aneurysms. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed and Embase for studies comparing newer P2Y12 inhibitors with clopidogrel in patients undergoing DAPT for SACE. Outcomes were total number of complications, number of hemorrhagic complications, and number of thromboembolic complications both intraoperative and follow-up. A random effects model was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). We included 1026 patients from six studies. Newer P2Y12 inhibitors were used in 562 (54,77%) patients. There were no significant differences between groups in total number of complications (OR 0.80; 95% CI 0.32, 1.99; p < 0.01; I2 = 78%), in intraoperative hemorrhagic complications (OR 0.66; 95% CI 0.09, 4.71; p = 0.68; I2 = 0%), follow-up hemorrhagic complications (OR 1.23; 95% CI 0.70, 2.15; p = 0.49; I2 = 0%), intraoperative thromboembolic complications (OR 0.43; 95% CI 0.14, 1.35; p = 0.25; I2 = 24%), and in follow-up thromboembolic complications (OR 0.89; 95% CI 0.33, 2.39; p = 0.03; I2 = 59%). In patients who underwent a SACE, newer P2Y12 inhibitors showed no differences in intraoperative and follow-up complications compared with clopidogrel.

Sentinel lymph node biopsy for melanoma in the older population: A prospective analysis of outcomes.

The use of sentinel lymph node biopsy (SLNB) in the older population, defined as those over 70 years old, has been debated since the adoption of SLNBinto routine practice. Interestingly, there remains a paucity of evidence, especially regarding the rates of SLNB positivity, complications, and subsequent adjuvant therapy in those with node positivity. Data on patient's comorbidities, positivity rates, complication rates, and subsequent adjuvant treatments were collected prospectively from 998 patients (644 patients < 70 and 354 patients ≥ 70 years old) between 2016 and 2022. Patients aged ≥ 70 were found to have a higher prevalence of comorbidities, including hypertension, diabetes and hyperlipidaemia. The mean Breslow thickness was 2.2 and 2.5 in the under and over 70 groups respectively (p = 0.03). The mean mitotic rate was found to be 3.3 in the under 70 s and 4.1 in the over 70 s (p = 0.02). Despite these results, no significant differences were observed in the positivity rates of sentinel lymph node biopsies or in the treatment options selected for positive results. The under 70 s were more likely to experience loss of sensation (p < 0.01), but no difference was found in the total number of complications between the two groups. Although patients aged 70 and above had a greater incidence of comorbidities, the study revealed that they had lower complications rates and there was no significant variation in the SLNB positivity rate or chosen treatment options between the two age groups. This study supports the move to physiological rather than chronological age assessments in SLNB of the elderly.

Evaluation of the results of the modified Blumgartpancreatic-intestinal anastomosis technique according to Satoi in pancreaticoduodenectomy at Bach Mai Hospital

Objectives: This study aims to research on the safety and effectiveness of the modified Blumgart pancreaticojejunostomy anastomosis by Satoi in Bach Mai Hospital. Research subjects: Seventy-three patients underwent modified Blumgart pancreaticojejunostomy anastomosis by Satoi after pancreaticoduodenectomy at Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Department, Bach Mai Hospital between October 2020 and April 2023. Method: Cross-sectional study combining retrospective and prospective studies. The Blumgart anastomosis was modified to simplify with 2 U-shaped sutures. Results: The average age of the study subjects was 58.49±12.69 years; the age group over 60 accounted for over 50%; male/female ratio was ~1. The number of patients with complications was 22/73; the total number of complications was 33, including 3 grade-III-or-above complications, according to Clavien-Dindo: 1 case had complications of grade C pancreatic fistula causing late hemorrhage, from the common hepatic artery wall, needs re-surgery, 1 case needs hemostasis under intervention radiology, 1 case needs to be drained under ultrasound guidance, and no patient deaths. Conclusion: The modified Blumgart pancreaticojejunostomy by Satoi is a safe and effective technique.

Application of Nursing Cooperation Path in Operating Room and Analysis of Complication Rate During Laparoscopic Hysterectomy

Objective: To explore the clinical benefits achieved by implementing the operating room nursing cooperation path for patients undergoing laparoscopic hysterectomy. Methods: 64 laparoscopic hysterectomy cases were divided into groups according to the order of admission. The control group received routine perioperative care. The observation group implemented the nursing cooperation path in the operating room on the same basis as the control group. The two groups’physiological responses, stimulus indicators, anxiety, and complication rates were compared. Results: The heart rate, blood pressure 0.5 hours after surgery, anxiety scores 1 day before and 3 days after surgery, and the total number of complications in the observation group were all lower than those in the control group (P &lt; 0.05). Conclusion: The development of a nursing cooperation path in the operating room can help patients undergoing laparoscopic hysterectomy reduce heart rate, blood pressure, stress responses, and the risk of complications, and is worthy of promotion.

Optimal access for Achilles Tendon Repair

Background. Despite the many accesses described in the literature for open Achilles tendon repair, there is no evidence of the benefits of this or that access confirmed by clinical observations.The aim is to determine and justify optimal access during open Achilles tendon repair.Material and methods. The article shows the result of the analysis of data from a literary search, experimental work on 12 lower limbs of 6 cadavers, a clinical study based on a retro-prospective analysis of the treatment of 128 people in the Department of Emergency Traumatology N.V. Sklifosovsky Research Institute from 2014 to 2022. The comparison group retrospectively included 47 patients (36.7%) with Achilles tendon injury, who underwent suture of the Achilles tendon from S and Z–shaped accesses from 2014 to 2017. The main group prospectively included 81 patients (63.3%) for 2018-2022, who underwent paramedial tendon access.Results. The analysis of a retrospective study showed that 3 patients from the comparison group with Achilles tendon injury in the postoperative period had ischemia of the wound edges with subsequent formation of necrosis and skin defect; 1 patient had a hypertrophic painful scar, which ulcerated from the constant traumatization of his shoe back (the total number of complications was 8.5%). In the patients of the main group, there were no complications in the postoperative period in any case. Conclusion. In our opinion, the paramedial tendon access is optimal, because there are no complications from the skin and leads to improved functional results.

Comparison of Removal of Laryngeal Mask Airway in Deeply Anaesthetised and Awake Paediatric Patients and their Associated Complications: A Randomised Clinical Study

Introduction: The Laryngeal Mask Airway (LMA) is frequently used for managing paediatric airways for short surgical procedures. While it is easy to insert, it can lead to several complications if not removed at the appropriate plane of anaesthesia. Aim: To establish better timing for the removal of the LMA in deeply anaesthetised and awake paediatric patients by comparing the complications associated with each approach. Materials and Methods: The present randomised clinical study, enrolled 90 American Society of Anaesthesiologists (ASA) I and II paediatric patients aged 1 to 12 years, posted for elective short surgical procedures under general anaesthesia with airway management by Classical LMA. The patients were allocated into two groups: Group D (LMA removal under a deep plane/surgical plane of anaesthesia) and Group A (LMA removal in a fully awake state). At emergence from anaesthesia and during LMA removal, both groups were studied for complications including cough, desaturation (SpO2 &lt; 95%), excessive salivation, vomiting, and laryngospasm. Descriptive statistics were reported using mean±standard deviation or median (range) for continuous variables. Comparison of continuous variables was done using the Student’s t-test or Wilcoxon rank sum test. Results: Demographic data like age, weight, duration of surgery, heart rate, and respiratory rate were comparable in both groups. A significantly higher incidence of cough was found in group A compared to group D (p-value=0.001). The incidences of desaturation (p-value=1.000), excessive salivation (p-value=0.361), vomiting (p-value=1.000), and laryngospasm (p-value=0.142) were comparable between the two groups. Cough was the most frequent complication in group A (16 out of 45 patients), while laryngospasm was the most frequent complication in group D (8 out of 45 patients). The total number of complications (p-value=0.043) was significantly higher in group A compared to group D. Conclusion: The removal of the Classical LMA in paediatric patients can be safely carried out in a deeply anaesthetised state. Based on the results of present study, the removal of the LMA in deeply anaesthetised paediatric patients is associated with fewer complications compared to its removal in the awake state.

Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications-3 Years of a Single-Center Experience.

Atrial fibrillation (AF) is the most common arrhythmia presenting in emergency departments (EDs), vastly increasing mainly due to society's lifestyles leading to numerous comorbidities. Its management depends on many factors and is still not unified. Aims: The aim of this study was to compare different AF management strategies in the ED and to evaluate their influence on the length of stay (LOS) in the ED and their safety. We analyzed medical records over 3 years of data collection, including age, primary AF diagnosis, an attempt to restore sinus rhythm, complications, and length of stay. Patients were divided into three groups according to the treatment method received: only pharmacological cardioversion (MED), only electrical cardioversion (EC), and patients who received medications followed by electrical cardioversion (COMB). We included 599 individuals in the analysis with a median age of 71. The restoration of sinus rhythm and LOS were as follows: MED: 64.95%, 173 min; COMB: 87.91%, 295 min; SH: 92.40%, 180 min. The difference between the MED and EC strategies, as well as MED and COMB, was statistically significant (p < 0.001 in both). The total number of complications was 16, with a rate of 32.67%. The majority of them followed a drug administration, and the most common complication was bradycardia. Electrical cardioversion is a safe and effective treatment strategy in stable patients with AF in the ED. It is associated with a shortened LOS. Medication administration preceded the majority of complications.

The Impact of Standardized Emergency Care on Acute Stroke Treatment and Recovery Time

Objective: To investigate the clinical benefits derived from the implementation of standardized emergency care for patients experiencing acute strokes. Methods: One hundred cases of acute stroke were categorized based on the admission order, with 50 cases per group. The control group received routine emergency care, while the observation group received standardized emergency care. A comparison of the general observation indicators and complication rates of emergency care was conducted. Results: The observation group exhibited shorter pre-examination and assessment time, quicker physician reception time, faster emergency green channel treatment time, and reduced door-to-needle time compared to the control group (P &lt; 0.05). Moreover, the emergency treatment success rate was higher, and the total number of complications was lower in the observation group than in the control group (P &lt; 0.05). Conclusion: The implementation of standardized emergency care proves effective in reducing treatment and recovery times for acute stroke patients. It enhances the success rate of emergency treatment and diminishes the risk of associated complications. These findings underscore the significance of promoting standardized emergency care for acute stroke patients.

AO/OTA type C3 distal humeral fractures in patients aged 75 years and older: Is ORIF with double precontoured anatomical locking plates a reliable treatment?

IntroductionThe incidence of osteoporotic distal humeral fractures (DHF) is on the rise. Their operative management is demanding. Fixation with non-locking reconstruction plates was associate with a high number of complications. Elbow arthroplasty (total or hemi) has been proposed as an alternative treatment, in spite of lifetime activity restrictions, and risk of complications, unknown implant survival and problematic revision surgery. Precontoured anatomical locking plates have increased the strength of the fixation in complex fractures. Hypothesis: double plating ORIF with precontoured anatomical locking plates is a safe and reliable treatment option for the management of AO/OTA type C3 DHF in patients aged 75 and older. Patients and methodsA retrospective case series study of patients aged 75 years old and older with an AO/OTA type C3 DHF treated with ORIF with double precontoured anatomical locking plates between 2007 and 2021. Pathologic fractures were excluded. Patients’ demographic, surgical, clinical, and radiological data were reviewed. ResultsA total of 27 women and 3 men, mean age of 80.1 years (range 75–93 years), were included. Mean Charlson index was 5 (range 3–8). Out of 30 patients, 19 had already died. Mean survival time after the surgical treatment was 72.3 months. Mean Mayo elbow performance score was 88.9 (range 60–100); 23 patients scored excellent or good. All fractures healed with no cases of delay union or non-union, hardware failure or loss of reduction. No patient needed a revision surgery to arthroplasty. The total number of complications was 12 (40%), mainly ulnar neuropathy (5) and cerclage removal (4). ConclusionORIF with double pre-contoured locking plates may be a safe and reliable treatment for type C3 DHF in patients aged 75 years and older, with a good functional outcome. Complications are expected but not related to loss of reduction, fixation failure or revision to elbow arthroplasty.

Comparison between 3-level and 4-level anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy: A meta-analysis

ObjectiveOur objective is to estimate the clinical effectiveness of 3-level and 4-level anterior cervical discectomy and fusion (ACDF) in the management of cervical spondylotic myelopathy (CSM). MethodsWe conducted a thorough search in English databases. We gathered the data on surgical variables and complications to contrast the clinical effectiveness between 3-level and 4-level. We utilized RevMan 5.3 and STATA 12.0 to analyze the data. ResultsFinally, eight studies met inclusion criteria of this study. Our findings indicated that operation time [p for heterogeneity = 0.23, I2 = 32 %, p＜0.00001, OR = −24.93, 95%CI (−32.39,-17.49)], blood loss [p for heterogeneity = 0.33, I2 = 10 %, p＜0.00001, OR = −60.87, 95%CI (−85.43,-36.32)] and the total number of complications [p for heterogeneity = 0.36, I2 = 0 %, p = 0.004, OR = 0.37, 95%CI (0.18,0.72)] in 3-level ACDF were significantly less than in 4-level ACDF. No marked difference was found in hospital stay, revision rate, fusion rate, the number of readmissions, infection, hematoma, or pseudarthrosis between 3-level and 4-level ACDF. ConclusionsIt is easy to understand that performing 4-level needs more operation time and blood loss. No obvious discrepancy was found with regard to the subgroups of complications between the two procedures, yet 4-level procedures had a more number of complications.

Results of cranioplasty using individual titanium implants

Background. Despite its long history, cranioplasty remains a topical problem of neurosurgery, due to the increasing number of traumatic brain injury, the consequences of which are the main driver in preserving the population of patients with postcranioectomy skull defects. As a rule, these defects are extensive, and the use of individual implants in these cases is the method of choice. Over the past 5 years, the use of products created by medical additive manufacturing has increased, in this regard, the assessment of long-term results of surgical interventions with their use is an actual issue of modern medicine.Aim. To evaluate the results of surgical treatment of patients with skull defects of various etiologies using individual titanium implants made by three-dimensional printing.Materials and methods. The study analyzed 94 cases of cranioplasty using individual titanium implants made by three-dimensional printing using DMLS (Direct Metal Laser Sintering) technology. The minimum follow-up period was 12 months from the moment of the intervention. Traumatic brain injury and its consequences was the dominant cause of skull bone defects (n = 56, 59.6 %). The average area of defects in the study group was 99.2 ± 43.4 cm2. For men (n = 53), this parameter corresponded to 106.7 ± 44.7 cm2, for women (n = 41) – 89.5 ± 40.1 cm2.Results. The total number of complications in the study group was 12 (12.7 %) cases, of which 5 (5.3 %) cases were recorded during the in hospital stay of patients, 7 (7.4 %) – during outpatient follow-up. One complication was not related to the performed surgical intervention. Removal of the implant was required in 7 (7.4 %) cases. The terms of implant removal varied from 0 to 14 months from the moment of the performed intervention. The survival rate of individual titanium implants for more than 12 months was 92.6 %.Conclusion. The data on the presence of complications after cranioplasty vary from study to study, while the results of reconstructive interventions performed using individual titanium implants are of significant interest, the use of which has increased significantly over the past five years due to the introduction of additive medical production into clinical practice.

Magnetically controlled growing rod treatment for early-onset scoliosis: analysis of 52 consecutive cases demonstrates improvement of coronal deformity.

The purpose of this study was to report the radiographic results and complications of magnetically controlled growing rod (MCGR) treatment in patients with early-onset scoliosis (EOS). Patient records and radiographs from a consecutive series of patients treated with MCGR for EOS at two Swedish institutions were reviewed retrospectively. Radiographic analysis included Cobb angle, T1-T12 height, T1-S1 height, thoracic kyphosis, and lung height. Subgroup analyses were performed on primary versus conversion cases and single versus dual rods using one-way analysis of variance (ANOVA) and independent samples t-test. Fifty-two cases treated with MCGR (24 single rods, 28 dual rods) were included from local surgical records into this cohort study, 32 primary and 20 converted from other growth friendly surgical treatment. Mean age at MCGR implantation was 7.4 (2.0-14.6) years old in the primary group and 9.3 (5.0-16.1) years old in the converted group. Mean follow-up time was 3.7 (2.0-7.6) years. Mean (standard deviation; SD) Cobb angle of the major curve changed from 62° (17°) preoperatively to 42° (16°) postoperatively to 46° (18°) at final follow-up (P<0.001). Mean (SD) overall thoracic kyphosis changed from 41° (19°) preoperatively to 32° (14°) postoperatively to 39° (17°) at final follow-up (P=0.018). Mean T1-T12 height was 177 mm (34 mm) preoperatively, 183 mm (35 mm) immediate postoperative and 199 mm (35 mm) at final follow-up (P=0.047). The mean T1-T12 height increased significantly in the primary group but not in the converted group. The number of surgeries was 114 (78 planned, 36 unplanned). The rate of unplanned surgeries did not differ significantly between single and dual rods. The total number of complications was 70 of which 38 were implant related. The overall mean complication rate was 1.4 (0-4). There were no significant differences in complication rates between subgroups. MCGR treatment enabled and maintained correction of spinal deformity while allowing spinal growth. There were no significant differences in complication rates or unplanned surgeries between the groups treated with single or dual rods.

Circular external fixation for revision of failed tibia internal fixation.

The management of failed tibial fracture fixation remains a challenge for orthopaedic surgeons. This study investigate the utility and outcomes of circular external fixation in the management of failed internal fixation of tibial fractures. Retrospective review of a prospectively collected database of a complex limb reconstruction unit at a major trauma centre was done during December 2022. Patients with failed internal fixation of tibial fracture who underwent revision surgery with circular external fixation frame were included. 20 patients with a mean age of 47.8 ± 16.5years (range: 15-69) were included. Fourteen (70.0%) patients had failed plate and screws fixations, and the remaining six (30.0%) failed intramedullary nail fixation. The most common indication for revision surgery was development of early postoperative surgical site infection (5 patients; 25.0%). The mean duration of frame treatment was 199.5 ± 80.1days (range = 49-364), while the mean follow-up duration following frame removal was 3.2 ± 1.8years (range = 2-8). The overall union rate in this series was 100%; and all infected cases had complete resolution from infection. The total number of complications was 11, however, only two complications required surgical intervention. The most common complications reported were pin site infection (6; 30.0%) and limb length discrepancy of 2cm (2; 10.0%). Circular external fixation is a reliable surgical option in the treatment of failed internal fixation of tibia fractures. This technique can provide limb salvage in complex infected and noninfected cases with a high union rate and minimal major complications.

Characterisation of frailty phenotypes and analysis of the association with peri-operative/interventional complications in elderly cardiac patients

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Identifying the key frailty phenotypes that impact functional health outcomes in older cardiovascular patients (CVD) in clinical practice is a step towards solving the complex "Rubik's Cube" of frailty. It should be pointed out which frailty phenotypes representing the patient's physical (e.g. mobility, strength, gait speed), cognitive (e.g. dementia) or nutritional status (e.g. risk of malnutrition, protein levels) correlate with major complications (e.g. mortality, delirium) in elderly patients. Phenotypes of frailty that correlate with complications could be used to identify patients at higher risk of poor postoperative outcomes and could be addressed through preventive strategies (e.g. prehabilitation). Purpose Identification of physical, nutritional and cognitive frailty phenotypes and investigate the correlation with complications in elderly patients undergoing cardiac surgery (e.g. coronary artery bypass graft, isolated single valve) or transcatheter aortic valve implantation (TAVI). Methods Between 06/2021 and 07/2022, patients (77.6 ± 4.3) referred for elective cardiac surgery or TAVI were included in the study. At hospital admission, physical frailty was identified by the simultaneous presence of: low gait speed (5-meter Walk Test), moderate impaired mobility (Timed Up-and-Go), reduced handgrip (dynamometer) and legs strength (5-repetitions chair rise). Mild dementia (Mini-Mental State Examination) characterised cognitive frailty and risk of malnutrition (Mini Nutritional Assessment) plus low serum protein level (serum albumin) nutritional frailty. The primary outcome was the presence of perioperative complications (mortality and major morbidity, e.g. delirium, pneumonia). Additionally, the total number and type of complications and the length of hospital stay (LoS) were collected. Correlations between frailty phenotypes, complications and LoS were calculated (Spearman). Results In total, 63 patients were referred to cardiac surgery (n=34, 54%) or TAVI (n=29, 46%) and were included (Table 1). Overall, 20 patients (36%) were characterized as physically frail. 33 patients (52%) were found to be cognitively frail, and 17 patients (26%) identified as nutritionally frail; no significant differences were found between the surgical and TAVI groups (Figure 1). Altogether, 37 patients (59%) experienced ≥ 1 complication such as need of transfusion (n=24, 38%), atrial fibrillation (n=14, 22%), delirium (n=12, 19%), pneumonia (n=8, 13%) or renal failure (n=6, 10%); one patient died. Physical and nutritional frailty correlate with the presence and total number of complications and prolonged LoS, but only in TAVI patients (Figure 1). Conclusion If these results are confirmed in a multivariate analysis, preventive strategies targeting physical and nutritional frailty should be considered, especially in TAVI patients, to reduce the incidence of complications and prolonged LoS.

A Propensity Score-Matched Comparison of Perioperative Outcomes in Prepectoral Smooth Versus Textured Tissue Expander Breast Reconstruction.

Textured tissue expanders (TEs) had previously gained popularity due to minimizing expander migration, rotation, and capsule migration. Recent studies, though, have revealed increased risk of anaplastic large-cell lymphoma associated with certain macrotextured implants, prompting surgeons at our institution to switch to smooth TEs; evaluation is thus required for specific viability and similarity of outcomes of smooth TEs. Our study aims to evaluate perioperative complications in prepectoral placement of smooth versus textured TEs. Our retrospective study evaluated perioperative outcomes of patients who underwent bilateral prepectoral TE placement, with either smooth or textured TE, at an academic institution between 2017 and 2021 performed by 2 reconstructive surgeons. The perioperative period was defined as the interval between expander placement until conversion to flap/implant or removal of TE due to complications. Our primary outcomes included hematoma, seroma, wounds, infection, unspecified redness, total number of complications, and returns to operating room secondary to complications. Secondary outcomes included time to drain removal, total number of expansions, hospital length of stay, length of time until the next breast reconstruction procedure, next breast reconstruction procedure, and number of expansions. Two hundred twenty-two patients were evaluated in our study (141 textured, 81 smooth). After propensity matching (71 textured, 71 smooth), our univariate logistic regression showed no significant difference in perioperative complications between smooth and textured expanders (17.1% vs 21.1%; P = 0.396) or complications that required a return to the operating room (10.0% vs 9.2%; P = 0.809). No significant differences were noted for hematoma, seroma, infections, unspecified redness, or wounds between both groups. A significant difference was noted in days to drain out (18.57 ± 8.17 vs 20.13 ± 0.07, P = 0.001) and type of the next breast reconstruction procedure (P < 0.001). Our multivariate regression showed that breast surgeon, hypertension, smoking status, and mastectomy weight were significant for increased risk for complications. Our study demonstrates similar rates and effectiveness of smooth versus textured TE when used for prepectoral placement, making smooth TEs a safe and valuable alternative for breast reconstruction because of their decreased risk of anaplastic large-cell lymphoma compared with textured TEs.

Activating Relatives to Get Involved in Care After Surgery: Protocol for a Prospective Cohort Study

Postoperative complications and readmissions to hospital are factors known to negatively influence the short- and long-term quality of life of patients with gastrointestinal cancer. Active family involvement in activities, such as fundamental care activities, has the potential to improve the quality of health care. However, there is a lack of evidence regarding the relationship between active family involvement and outcomes in patients with gastrointestinal cancer after surgery. This protocol aims to evaluate the effect of a family involvement program (FIP) on unplanned readmissions of adult patients undergoing surgery for malignant gastrointestinal tumors. Furthermore, the study aims to evaluate the effect of the FIP on family caregiver (FC) burden and their well-being and the fidelity of the FIP. This cohort study will be conducted in 2 academic hospitals in the Netherlands. The FIP will be offered to adult patients and their FCs. Patients are scheduled for oncological gastrointestinal surgery and have an expected hospital stay of at least 5 days after surgery. FCs must be willing to participate in fundamental care activities during hospitalization and after discharge. Consenting patients and their families will choose to either participate in the FIP or be included in the usual care group. According to the power calculation, we will recruit 150 patients and families in the FIP group and 150 in the usual care group. The intervention group will receive the FIP that consists of information, shared goal setting, task-oriented training, participation in fundamental care, presence of FCs during ward rounds, and rooming-in for at least 8 hours a day. Patients in the comparison group will receive usual postoperative care. The primary outcome measure is the number of unplanned readmissions up to 30 days after surgery. Several secondary outcomes will be collected, that is, total number of complications (sensitive to fundamental care activities) at 30 and 90 days after surgery, emergency department visits, intensive care unit admissions up to 30 and 90 days after surgery, hospital length of stay, patients' quality of life, and the amount of home care needed after discharge. FC outcomes are caregiver burden and well-being up to 90 days after participating in the FIP. To evaluate fidelity, we will check whether the FIP is executed as intended. Univariable regression and multivariable regression analyses will be conducted. The first participant was enrolled in April 2019. The follow-up period of the last participant ended in May 2022. The study was funded by an unrestricted grant of the University hospital in 2018. We aim to publish the results in 2023. This study will provide evidence on outcomes from a FIP and will provide health care professionals practical tools for family involvement in the oncological surgical care setting. DERR1-10.2196/38028.

Frailty, length of stay and cost in hip fracture patients.

Hip fractures account for an increasing number of hospital admissions around the world and are associated with high rates of morbidity and mortality. Frailty is increasingly recognized to be associated with adverse outcomes and increased costs. The purpose of this study is to determine the association of the Hospital Frailty Risk Score (HFRS) with the healthcare cost and outcomes in older adults who present with a hip fracture. A retrospective analysis was performed on 1014 patients ≥ 60years who presented with a hip fracture between January 2016 to June 2020. Each patient was classified into HFRS low, intermediate or high frailty cohorts. Demographics, hip fracture type, comorbidities, Charlson Comorbidity Index (CCI), American Society of Anesthesiologist score (ASA), costs, length of stay, time to surgery, complications, readmission rate and mortality were compared between the cohorts. Median total hospitalization costs were significantly higher in the highest HFRS (SGD$22,432) patients as compared to intermediate (SGD$18,759) and low HFRS (SGD$15,671) patients. The difference between the high and low groups remains significant after adjusting for covariates using quantile regression. Similar results were shown for median length of stay (14 vs 10 vs 8days), total number of complications (2 vs 1 vs 0) and adjusted time to surgery (p < 0.05). HFRS was not associated with 30-day readmission or 30-day or 1-year mortality. Frailty is associated with a marked increase in total costs in hip fracture patients. HFRS proved useful in estimating LOS and outcomes for older patients with hip fractures.