Total Perioperative Complications Research Articles

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.

Foraminoplasty Performed with a Trephine and a New Tool in Transforaminal Endoscopic Lumbar Discectomy: A Single-Center Retrospective Study.

Foraminoplasty is an important step in transforaminal endoscopic lumbar discectomy (TELD). A trephine is widely used in foraminoplasty. However, foraminoplasty using a trephine alone sometimes fails to remove the resected bone, resulting in the bone remaining in the foramen or spinal canal, which can potentially cause neurological irritation or injury. The objective of this study is to introduce a self-designed tool, referred to as an anchoring drill, for use with a trephine in foraminoplasty in TELD and to evaluate its advantages. A retrospective review was performed to identify patients who underwent L4-5 TELD between January 2019 to January 2022. Foraminoplasty was performed in all patients. Depending on whether the anchoring drill was used or not, patients were divided into two groups. Surgery-related parameters and complications were reviewed. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) scores were also assessed for all patients. SPSS statistical software was used for statistical calculation. A total of 100 patients were included (55 in the anchoring drill group and 45 in the trephine group). The incidence of residual bone fragments after foraminoplasty of the anchoring drill group was 9.09%, which was lower than that of the trephine group, at 33.33% (p < 0.05). The mean endoscopic operation time of the anchoring drill group was shorter than that of the trephine group (p < 0.05). The mean fluoroscopy time and duration of foraminoplasty showed no significant differences between the two cohorts. The total perioperative complication incidence was lower in the anchoring drill group, in which the neural irritation incidence showed a significant difference (anchoring drill group: 3.64%, trephine group: 17.78%, p < 0.05). VAS and JOA scores were significantly improved after the operation for all patients (p < 0.001), however, no statistical differences were found between the two groups at each follow-up visit. The combination of a trephine with an anchor drill was demonstrated to be safe and effective in foraminoplasty in TELD, improving the success rate of foraminoplasty and reducing neurological complications compared to using trephine alone.

Characteristics, comorbidities, and complications in multiple sclerosis (MS) and non-MS patients undergoing lumbar fusion for deformity.

We compared the characteristics, comorbidities, and complications in spinal deformity patients with and without multiple sclerosis (MS) undergoing primary lumbar spine fusion. We used the Nationwide Inpatient Sample (NIS) from 2003 to 2014, International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes to create experimental MS (842 patients) and non-MS control (165,726 patients) cohorts undergoing primary lumbar spine fusion. Characteristics, comorbidities, and complications in spinal deformity patients with and without MS were evaluated using univariate and bivariate analysis. MS spinal deformity patients undergoing primary lumbar spine fusion were younger, more likely to be female and more likely to undergo surgery at urban teaching hospitals. They also exhibited higher rates of depression and lower rates of diabetes without chronic complications, hypertension, and renal failure. However, no significant differences were found in mortality or total perioperative complication rates between MS and nonMS patients. We found that MS versus non-MS patients undergoing primary lumbar fusion for spinal deformity were younger, more likely to be female and had higher rates of depression but lower rates of diabetes, hypertension, and renal failure. Notably, both groups experienced comparable mortality and perioperative complication rates.

Outpatient parotidectomy: Outcomes, safety and satisfaction

Parotidectomies are rarely performed on an outpatient basis. The specific perioperative outcomes and their management remains insufficiently described to change daily practice. The objectives were to study the outcomes, the complications and the patient satisfaction rate in parotidectomy performed on an outpatient basis. We conducted a retrospective monocentric database study on 85 patients who underwent parotidectomy as a first and sole procedure from 2015 to 2020. We analyzed perioperative outcomes between outpatients and inpatients. Among 28 outpatients and 57 inpatients, no significant differences in total perioperative complications (p=.66; OR=1.25; 95% confidence interval (CI) [0.47; 3.36]), reoperations (p=.55), readmissions (p=1), or unplanned visits (p=.52) were shown in multivariate analysis. The conversion rate for surgical reasons was 8.6%, and the satisfaction rate was high. Although outpatient parotidectomies should be as safe as for inpatients, the high rate of minor complications requires specific perioperative management, such as a systematic early postoperative visit and optimized preoperative information in order to be carried out with minimal issues.

Coiling embolization strategy for medium-to-giant-sized intracranial aneurysms treated with pipeline embolization device: a propensity score-weighted study.

We aim to investigate associations between different coil strategies and outcomes in the aneurysms treated by a pipeline embolization device (PED). Patients with medium-to-giant-sized aneurysms treated by PED were included. The total cohort was divided into PED-alone and PED-coiling groups, and the PED-coiling group was further divided into loose and dense packing subgroups. Multivariate logistic analyses and stabilized inverse probability of treatment weighting (sIPTW) were performed to investigate the relationships between coiling strategies and outcomes. Restricted cubic spline (RCS) curves were used to describe the coiling degree and angiographic outcome relationship. A total of 398 patients with 410 aneurysms were included. Aneurysms treated with PED coiling had a lower incomplete occlusion rate (15.3% vs. 30.3%, p = 0.002), higher total perioperative complication rate (14.2% vs. 3.5%, p = 0.001), longer production time (142.14min vs. 101.26min, p < 0.001), and higher total cost ($45,158.63 vs. $34,680.91, p < 0.001) than those treated with PED alone. There were no differences in outcomes between the loose and dense packing subgroups. However, the total cost was higher in the dense packing group ($43,787.46 vs. $47,288.32, p = 0.001) than in the loose packing group. The result was still robust in the multivariate and sIPTW analyses. The RCS curves showed "L-shape" relationships between the coil degree and angiographic outcomes. Compared with PED alone, PED coiling could improve aneurysm occlusion. However, it could also increase the total complication risk, prolong procedure time, and increase the total cost. Compared with loose packing, dense packing did not enhance the treatment effectiveness but increased the treatment cost. The additional treatment effect from coiling embolization declines sharply after a certain point. Specifically, the aneurysm occlusion rate is roughly stable when the coil number is greater than 3 or the total coil length is longer than 150cm. • Compared with pipeline embolization device (PED) alone, PED combined with coiling can improve aneurysm occlusion. • Compared with PED alone, PED combined with coiling increases the total complication risk, cost, and prolongs procedure time. • Compared with loose packing, dense packing did not increase the treatment effectiveness but increased the cost.

Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma.

Determine whether perioperative outcomes differ between patients who have undergone single or multi-stage IMN procedures for impending or completed pathologic fractures. Patients were classified into single-stage single-bone (SSSB), single-stage multiple-bone (SSMB), and multi-stage multiple-bone (MSMB) based on procedure timing and number of bones involved. Outcome variables compared included length of stay (LOS), in-hospital mortality and survival, initiation of rehabilitation and adjuvant therapy, and perioperative complications. There were 272 IMNs placed in 181 patients (100 males, 81 females, 55.2% and 44.8%, respectively) with a mean age of 66.3 ± 12.1 years. MSMB had significantly longer LOS (24.3 ± 14.2 days) and rehabilitation initiation (3.4 ± 2.5 days) compared to SSSB (8.5 ± 7.7 and 1.8 ± 1.6 days) and SSMB (11.5 ± 7.6 and 2.0 ± 1.6 days) subjects, respectively (both; p < 0.01). Although total perioperative complication rates in SSMB and MSMB were comparable (33.3% vs. 36.0%), they were significantly higher than SSSB (18%) (p = 0.038). MSMB had significantly more (20%) cardiopulmonary complications than SSMB (11.1%) and SSSB (4.5%) (p = 0.027). All groups exhibited comparative survivorship (8.1 ± 8.6, 7.1 ± 7.2, and 11.4 ± 11.8 months) and in-hospital mortality (4.5%, 8.9%, and 4.0%) (all; p > 0.05). In comparison to MSMB, SSMB intramedullary nailing did not result in higher perioperative complication or in-hospital mortality rates in select patients with synchronous long-bone metastases but led to earlier postoperative discharge and initiation of rehabilitation.

OC-039 WHAT IS THE INFLUENCE OF FEMALE GENDER AND FEMORAL HERNIA ON PERIOPERATIVE OUTCOME IN GROIN HERNIA REPAIR?

Abstract Groin hernias are rare in women compared to men. The proportion of women in the overall collective of operated groin hernias is between 8–12%. The rate of femoral hernias in women is higher than in men. Femoral hernias account for 3% of all primary groin hernias and 18% of all groin hernias in females. Very little is known about the influence of female gender and a femoral hernia on the outcome in groin hernia repair. For this retrospective analysis of prospectively collected data from the Herniamed Registry 347.054 primary elective unilateral groin hernia repairs were selected. 42.595 (12.3%) procedures have been performed in females. 10.265 (3%) patients had a femoral hernia. A multivariable analysis was undertaken to investigate the influence of confirmatory defined patient- and procedure-related characteristics on the perioperative outcome. A significantly favorable correlation was found between the total perioperative complication rate and female gender (OR =0.886; 0.844–0.931) p&amp;lt;0.001. Other factors with positive impact on the perioperative outcome are the laparo-endoscopic approach, smaller defects, medial defects and normal weight. A significantly unfavorable relation was identified between the total perioperative complication rate and a femoral hernia (OR =1.172; 1.095–1.254)p&amp;lt;0.001. Other unfavorable influencing factors on the perioperative outcome are higher age, higher ASA score, antithromboric medication, smoking, COPD and corticosteroid medication. The risk of perioperative complications is lower in female compared to male groin hernia repair, but not in femoral hernias.

One-Stage Versus Two-Stage Gastric Bypass as Redo Surgery After Failed Adjustable Gastric Banding—Observation Comparative Multicenter Study

This study investigates the outcome of one-stage and two-stage Roux-Y gastric bypass (RYGB) as a revision procedure after failed adjustable gastric banding (AGB). Data of patients who underwent a one-stage RYGB (OS-RYGB) or a two-stage RYGB (TS-RYGB) revision procedure after failing AGB between 2005 and 2019 were analyzed. Outcome criteria were perioperative complications, operating time, change in weight and BMI, and remission of comorbidities at 1-year follow-up. Data from 230 patients after OS-RYGB and 197 after TS-RYGB were analyzed. The total perioperative complication rates were not significantly different between the two groups (overall p > 5%). In the category of other complications, there was a significant difference between the two groups, with a lower rate in TS-RYGB than in OS-RYGB (p = 0.020). Wound infections occurred more frequently after TS-RYGB than after OS-RYGB (p = 0.015). Mean operating time differed significantly between the two groups (OS-RYGB (149.9min) and TS-RYGB 191min; p < 0.001). The change in hypertension was significantly higher in OS-RYGB (37.9 vs. 21.1%; p = 0.007). Other comorbidities showed no significant change within 1year after surgery. Regarding the change in BMI, %TWL, and %EWL, there were no significant benefits for either group (p = 0.574, 0.762, and 0.378, respectively). Removing a failed AGB using the OS- or TS-RYGB is safe and feasible. The decision between OS- and TS-RYGB is still individual and depends on the patient's general condition, the desired goal of the procedure, and the personal competence of the surgeon. Further studies are needed to clarify long-term outcome and effect of both procedures.

Urgent versus elective laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for high-risk grade II acute cholecystitis

The aim of this study was to evaluate the safety of urgent laparoscopic cholecystectomy (Lap-C) for grade II acute cholecystitis (AC) in high-risk patients who were defined by Tokyo Guideline 18 as having age-adjusted Charlson comorbidity index ≥6 or American Society of Anesthesiologists physical status classification (ASA-PS)≥3, compared with elective Lap-C following percutaneous transhepatic gallbladder drainage (PTGBD). In 73 grade II AC patients who underwent Lap-C from January 2012 to March 2021, 35 were identified as high-risk; 22 underwent urgent Lap-C (urgent group) and 13 PTGBD followed by elective Lap-C (elective group). Surgical and perioperative outcomes were analyzed. There was no significant difference in operation time (median: 101min vs 125min; P=0.371), blood loss (25ml vs 7ml; P=0.853), morbidity rate (31.8% vs 38.5%; P=0.726), or the incidence of total perioperative major complications (13.6% vs 15.4%; P=1.000) between the two groups. The total duration of treatment was significantly shorter in the urgent group than the elective group (11 days vs 71 days; P<0.001). Multivariate analysis revealed that blood loss ≥45ml [odds ratio (OS): 12.14, 95% confidence interval (CI): 2.03-72.42, P=0.006], and age ≥75 years with ASA-PS≥3 (OS: 9.85, 95%CI: 1.26-77.26, P=0.03) were the independent risk factors for total perioperative major complications. In well-selected high-risk patients with grade II AC, urgent Lap-C can be performed with comparable safety to elective Lap-C following PTGBD.

Complications of Morbid Obesity in the Treatment of Acetabular Fractures: Re-evaluating Outcomes a Decade Later.

To determine the rate of perioperative complications between morbidly obese (body mass index greater than 40 kg/m2) and nonmorbidly obese patients undergoing operative treatment of acetabular fractures across 2 periods (2000-2005 and 2012-2019). Retrospective, case-control study. Level I academic trauma center. Four hundred thirty-five consecutive patients from 2000 to 2005 and 216 consecutive patients from 2012 to 2019 with acetabular fractures treated by a single surgeon. Operative fixation of acetabular fracture. Outcome variables include positioning time, operative time, estimated blood loss, hospital stay, wound complications, and perioperative complications. Twenty-eight morbidly obese and 188 nonmorbidly obese patients from 2012 to 2019, as well as 41 morbidly obese patients and 394 nonmorbidly obese patients from 2000 to 2005 were included in the study. The relative risk (RR) of wound complications between 2012 and 2019 groups was significantly higher for morbidly obese patients (RR = 5.31, P = 0.009) but has decreased significantly for morbidly obese patients between 2000-2005 and 2012-2019 (RR = 0.31, P = 0.017). The rate of total perioperative complications was similar between morbidly obese and nonmorbidly obese groups from 2012 to 2019 (21% vs. 8%, P = 0.230). For morbidly obese patients, the rate of total perioperative complications decreased significantly between 2000-2005 and 2012-2019 (63% vs. 21% P = 0.010). Acetabular fracture surgery can be safely performed in morbidly obese patients. Although obesity remains a significant risk factor for wound complications, the risk for morbidly obese patients has decreased significantly since our initial investigation because of adaptations to surgical techniques and surgeon's experience. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Impact of Morcellation Method and Site on Laparoscopic Hysterectomy Outcomes in Obese Patients

<h3>Study Objective</h3> To investigate the effect of morcellation method and site on perioperative outcomes in patients with class 3 obesity (body mass indices [BMIs] ≥40). <h3>Design</h3> Retrospective cohort study analyzing morcellation method (manual or electromechanical) and morcellation site (vaginal or abdominal). Primary outcome was 30-day perioperative complications. <h3>Setting</h3> Academic tertiary care center. <h3>Patients or Participants</h3> 159 patients with BMI ≥40. <h3>Interventions</h3> Laparoscopic hysterectomy requiring morcellation from 1/2006-10/2019. <h3>Measurements and Main Results</h3> Thirty-three (21%) patients underwent electromechanical morcellation; 126 (79%) underwent manual morcellation. Of manual morcellation cases, 46 (37%) underwent vaginal morcellation, while 80 (63%) underwent abdominal morcellation. There were no significant differences in age, BMI, parity, prior surgery, or medical comorbidities among the groups. Median specimen weight was larger for patients with abdominal versus vaginal morcellation (808g versus 455g; p<0.01), without a difference in operative time (274 versus 246 minutes; p=0.06). Urinary tract infection was more common in cases with vaginal compared to abdominal morcellation (8.7% versus 0%; p=0.02). However, collectively, vaginal versus abdominal site did not differ significantly in incidence of minor (32.6% versus 20.0%; p=0.11), major (4.4% versus 5.0%, p>0.99), or total perioperative (37.0% versus 28.8%; p=0.34) complications. When abdominal manual morcellation sites were stratified into umbilical, suprapubic, and lateral locations, no differences in minor, major, or total perioperative complications were detected. Electromechanical and manual methods of morcellation did not have significantly different rates of minor (24.6% versus 30.3%; p=0.51), major (4.8% versus 3.0%; p>0.99), or total perioperative (31.8% versus 36.4%; p=0.61) complications. After controlling for potential confounders, there was no difference in complications between electromechanical versus manual (aOR: 2.28; 95% CI: 0.76–6.84) and vaginal versus abdominal (aOR: 1.72; 95% CI: 0.724.13) morcellation. <h3>Conclusion</h3> In women with BMI ≥40, abdominal morcellation was associated with significantly larger specimen sizes, compared to vaginal morcellation, without an increase in perioperative complications or operative time. Manual and electromechanical morcellation had similar perioperative complication frequencies.

Perioperative outcomes following pelvic floor reconstruction in women with hereditary disorders of connective tissue: a retrospective cohort study.

Women with hereditary disorders of connective tissue (HDCT) are at increased risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesized that patients would have increased incidence and severity of perioperative complications up to 6weeks after surgeries for POP/SUI. Secondary objectives were to compare pre- and post-operative pelvic floor symptoms and anatomical support as well as pelvic floor disorder recurrence. In this multi-center retrospective cohort study, we identified patients with HDCTs by patient history and ICD-9 codes over an 11-year period. Controls without HDCTs were matched 2:1 to the primary POP or SUI procedure and surgeon. Demographic characteristics, perioperative pelvic floor information and complications were collected. A sample size of 65 HDCT patients and 130 controls was calculated to detect a 20% difference in complications with 80% power and alpha of 0.05. We identified 59 HDCT patients and 118 controls. Of the women with HDCTs, 49% had Ehlers-Danlos, 22% joint hypermobility syndrome, 15% Marfan syndrome, and 14% had others. Compared with controls, HDCT patients had more total perioperative complications (46% vs 22%, p =0.002); an age-adjusted relative risk of complications was 1.4 (CI 0.7-2.6). HDCT patients had more Clavien-Dindo grades I and II complications (p =0.02, 0.03) and more hospital readmissions (14% vs 3%, p =0.01) than controls. There was no difference in the incidence of specific complications nor was there a difference in recurrence of POP (10%) or SUI (11%) between groups. Patients with HDCTs had more Clavien-Dindo grade I and II complications following pelvic floor reconstructive surgery and more readmissions.

Assessment of Complications of Inguinal Hernia Surgery

Hernia repair is a frequent elective surgical operation. Unsatisfactory results in some cases have led to the persistence of a variety of different operative methods. Our study aimed to determine the frequency of postoperative complications with different surgery methods and evaluate the correlation of complications with patient characteristics and health. Materials and methods: We examined 403 patients with an inguinal hernia who underwent hernioplasty, including 98 by the method of Liechtenstein, 74 by the method of Gvenetadze, 231 by the laparoscopic method. Patients were aged 18-80 years with a mean age of 56.914.6 years. Statistical analysis was performed using SPSS 22. Results: The frequency of total perioperative complications of surgery was 52 (53.06 %), according to the method of Lichtenstein, 13 (17.57%) according to the method of Gvenetadze, and 23 (9.96 %) according to laparoscopic surgery. The following postoperative complications were observed: damage to the colon, bleeding from the lower epigastric vessels, urinary retention, neuralgia, hematomas, and delayed postoperative wound healing, higher in patients undergoing Lichtenstein surgery (p &lt;0.05). The Liechtenstein method significantly increases the likelihood of complications; odds ratio OR=8.23 (95% CI: 4.87-13.94), with the Gvenetadze method, the relative chance decreases insignificantly OR=0.722 (95% CI: 0.30-1.39), with the laparoscopic method, the relative chance of complications are significantly reduced OR=0.20 (95% CI: 0.12- 0.34). Conclusions: The odds ratio of postoperative complications of hernioplasty increases with the Liechtenstein method and decreases with laparoscopy. A comparison of the open methods of hernioplasty shows an advantage of the Gvenetadze method over the Liechtenstein method.

Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis

IntroductionAdult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied.MethodsWe evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis.ResultsOne hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003).ConclusionsOur study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.

Perioperative outcome in groin hernia repair: what are the most important influencing factors?

Using registry analyses, a large number of influencing factors on the perioperative outcome of groin hernia repair has been identified. The interactions between several influencing factors and differences in the influencing value have to date been inadequately investigated. This retrospective analysis of prospectively collected data from the Herniamed Registry included all fully documented cases with minimum age of 16years and groin hernia repair. Patients were assigned to the risk groups unilateral, bilateral, recurrent and emergency groin hernia repair. Multivariable analysis was performed to investigate the influence of confirmatory defined patient- and procedure-related characteristics on the outcome parameters intraoperative, postoperative general and postoperative surgical complications, complication-related reoperation and total perioperative complications. A highly significantly unfavorable association with the total perioperative complication rate was identified for emergency groin hernia repair, scrotal hernia, anticoagulant medication and coagulopathy. A significantly unfavorable relation with the total perioperative complication rate was found for recurrence procedure, bilateral repair, high age, ASA score III/IV, femoral hernia, antithrombotic medication, smoking, COPD and corticosteroid medication. A significantly favorable correlation with the total perioperative complication rate was observed for the laparo-endoscopic techniques, smaller defects, female gender, normal weight and medial hernia. Both the number of potential influencing factors and their influencing value on the perioperative outcome should be considered when estimating the individual risk of a patient with groin hernia repair.

The safety and efficacy of laparoscopic surgery versus laparoscopic NOSE for sigmoid and rectal cancer.

Laparoscopic surgery with natural orifice specimen extraction (La-NOSE) is being performed more frequently for the minimally invasive management of sigmoid and rectal cancer. The objective of this meta-analysis was to compare the clinical and oncological safety and efficacy of La-NOSE versus conventional laparoscopy (CL). A search of the PubMed, Web of Science, and Cochrane databases was performed for studies that compared clinical or oncological outcomes of conventional laparoscopic resection using NOSE with conventional laparoscopic resection for sigmoid and rectal cancer. Compared with CL group, the length of hospital stay and the pain score on the first day were shorter in the La-Nose group. The La-NOSE group had a lower incidence of total perioperative complications (OR 0.46; 95% CI [0.32 to 0.66]; I2 = 0%; P < 0.0001) and a lower incidence of surgical site infections (SSIs) (OR 0.11; 95% CI [0.04 to 0.29]; I2 = 0%; P < 0.0001) than the CL group, while the anastomotic leakage showed no significant difference between the La-Nose group and the CL group (P = 0.19). 5-year disease-free survival (DFS) and 5-year overall survival (OS) were no significant difference between the La-Nose group and the CL group (P = 0.43, P = 0.40, respectively). La-NOSE can achieve oncological and surgical safety comparable to that of CL for patients with sigmoid and rectal cancer. La-NOSE in patients was associated with a shorter hospital stay, shorter time to first flatus or defecation, less postoperative pain, and fewer surgical site infections (SSIs) and total perioperative complications. In general, the operative time in La-NOSE was longer than that in CL. The long-term oncological efficacy of La-NOSE seems to be equivalent to that of CL.

Patient Outcomes After Single-level Coflex Interspinous Implants Versus Single-level Laminectomy.

Retrospective cohort analysis. The aim of this study was to compare postoperative outcomes of Coflex interspinous device versus laminectomy. Coflex Interlaminar Stabilization device (CID) is indicated for one- or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse. Patients ≥18 years' old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID, or single-level laminectomy alone were included with a minimum 90-day follow-up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. χ2 and independent samples t tests were used for analysis. Eighty-three patients (2007-2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 ± 9.4 vs. laminectomy 64.2 ± 11.0, P = 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 ± 0.73 vs. laminectomy 2.17 ± 0.48, P = 0.020). CID patients had higher estimated blood loss (EBL) (97.50 ± 77.76 vs. 52.84 ± 50.63 mL, P = 0.004), longer operative time (141.91 ± 47.88 vs. 106.81 ± 41.30 minutes, P = 0.001), and longer length of stay (2.0 ± 1.5 vs. 1.1 ± 1.0 days, P = 0.001). Total perioperative complications (21.7% vs. 5.4%, P = 0.035) and instrumentation-related complication was higher in CID (10.9% vs. 0% laminectomy group, P = 0.039). There were no other significant differences between the groups in demographics or outcomes. Single-level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher EBL compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow-up.Level of Evidence: 3.

ROLE OF ENDOVASCULAR INTERVENTION IN ILIAC ARTERY DISEASE TASC C AND D CLASSIFICATION

Background: For more than forty years, endarterectomy and bypass grafting have been the primary means of surgically revascularizing peripheral vessels threatened by atherosclerotic diseases. However, with today's endovascular technology, stenosis and occlusions in nearly every circulatory system can he approached intraluminally with balloon dilation and intravascular stents. Objective: To evaluate the technical success rates, primary patency, limb salvage, patient survival and complications for TASC C, and D iliac lesions treated by endovascular procedure. Additionally, the influence of the access site and the clinical outcomes were analyzed. Patients and Method: Between 2017 and 2019, data from 40 consecutive patients at Al-Zahra’a University Hospital and Damanhor Teaching Hospital with 47 chronic iliac artery stenosis, and/or occlusion who were treated with EVT were reviewed. Results: The procedure time was longer for TASC D lesions than for TASC C lesions (180.43 ± 45.97 VS131.69 ± 37.49: p= 0.001). There were two postoperative deaths in the TASC D lesion group, with the cause being one myocardial infarction, and one postoperative hospital acquired pneumonia. The total perioperative complication occurred in the TASC D lesions was [four (10%) vs. zero; p = 0.011] TASC C lesions. Corresponding 2-year primary patency rates were 100% in TASC C lesions, 71.4% in TASC D lesions, and for all cases were 87.5%. Conclusion: The outcomes of EVT for TASC C and D aorto-iliac lesions were acceptable, with better technical success in TASC C lesions than in TASC D lesions. The 2-year patency rate for both TASC C and TASC D lesions was acceptable, and brachial access was useful for complex anatomy.

ROLE OF ENDOVASCULAR INTERVENTION IN ILIAC ARTERY DISEASE TASC C AND D CLASSIFICATION

Background: For more than forty years, endarterectomy and bypass grafting have been the primary means of surgically revascularizing peripheral vessels threatened by atherosclerotic diseases. However, with today's endovascular technology, stenosis and occlusions in nearly every circulatory system can he approached intraluminally with balloon dilation and intravascular stents. Objective: To evaluate the technical success rates, primary patency, limb salvage, patient survival and complications for TASC C, and D iliac lesions treated by endovascular procedure. Additionally, the influence of the access site and the clinical outcomes were analyzed. Patients and Method: Between 2017 and 2019, data from 40 consecutive patients at Al-Zahra’a University Hospital and Damanhor Teaching Hospital with 47 chronic iliac artery stenosis, and/or occlusion who were treated with EVT were reviewed. Results: The procedure time was longer for TASC D lesions than for TASC C lesions (180.43 ± 45.97 VS131.69 ± 37.49: p= 0.001). There were two postoperative deaths in the TASC D lesion group, with the cause being one myocardial infarction, and one postoperative hospital acquired pneumonia. The total perioperative complication occurred in the TASC D lesions was [four (10%) vs. zero; p = 0.011] TASC C lesions. Corresponding 2-year primary patency rates were 100% in TASC C lesions, 71.4% in TASC D lesions, and for all cases were 87.5%. Conclusion: The outcomes of EVT for TASC C and D aorto-iliac lesions were acceptable, with better technical success in TASC C lesions than in TASC D lesions. The 2-year patency rate for both TASC C and TASC D lesions was acceptable, and brachial access was useful for complex anatomy.

Management of sodium-glucose cotransporter 2 inhibitors during the perioperative period: A retrospective comparative study.

Current guidelines recommend withholding sodium-glucose cotransporter 2 inhibitors perioperatively due to concerns of euglycaemic diabetic ketoacidosis. However, such guidelines are largely based on case reports and small case series, many extrapolated from non-surgical patients. The aim was to investigate whether withholding sodium-glucose cotransporter 2 inhibitors as per current perioperative guidelines was associated with a reduction in serious adverse events, including euglycaemic diabetic ketoacidosis. Instances of perioperative management of sodium-glucose cotransporter 2 inhibitors, over a four-year period were classified into two categories: those where sodium-glucose cotransporter 2 inhibitors were withheld as per guidelines and those where sodium-glucose cotransporter 2 inhibitors were administered in the perioperative period. The primary outcome was 'total major perioperative complications': a composite of serious adverse events including euglycaemic diabetic ketoacidosis, diabetic ketoacidosis, acute kidney injury, urosepsis and death. Eighty-two instances in 64 patients were included. Withholding sodium-glucose cotransporter 2 inhibitors was associated with an increased incidence of total major perioperative complications and poorer glycaemic control postoperatively. Multivariable logistic regression analysis revealed that withholding sodium-glucose cotransporter 2 inhibitors perioperatively (OR = 13.15; 95% CI = 1.8-138.9) and preoperative urea (OR 1.85 (95% CI = 1.17-3.43) were independently associated with an increase in total major postoperative complications. Withholding sodium-glucose cotransporter 2 inhibitors as per current guidelines was associated with an increase in postoperative complications and reduced glycaemic control.