Tube Retention Research Articles (Page 1)

To investigate the effects of paravertebral block (PVB) on postoperative pancreatic fistula (POPF) and major complications in adult pancreatic surgery. All data of patients who underwent pancreatic surgery at Changhai hospital between January 2017 and June 2021 were retrieved. According to whether they received PVB or not, the patients were divided into the PVB and non-PVB groups. POPF-related factors were balanced by covariate balancing propensity score (CBPS) based inverse probability weighting. After that, the POPF and postoperative major complications between the two groups were compared. Another propensity score matching, multivariate logistic regression and instrumental variable regression were employed for sensitivity analysis. Results of sensitivity analysis were expressed as relative risk (RR) or odd ratio (OR) and 95% confidence interval (CI). A total of 3360 patients were included in the study, with 374 patients in PVB group and 2986 patients in non-PVB group. After CBPS, there was no significant difference in incidence (5.7% VS 6.2%, P = 0.785) between the groups (PVB VS non-PVB). Postoperative nasogastric tube retention time (2d VS 3d, P < 0.001), and length of hospital stay (11d VS 12d, P = 0.031) were significantly reduced in the PVB group. delayed gastric emptying (DGE) (RR 0.476; 95% CI 0.262-0.863; P = 0.014) and postpancreatectomy hemorrhage (PPH) (RR 0.426; 95% CI 0.287-0.630; P < 0.001) were reduced more than 50% in PVB group. PVB did not increase the risk of POPF, but reduced DGE and PPH by more than 50%, and improved postoperative recovery after pancreatectomy.

Robotic-assisted thoracic surgery (RATS) is increasingly acknowledged for its efficacy in managing early-stage non-small cell lung cancer (NSCLC), owing to its distinct technical advantages. Nevertheless, individuals with pronounced incomplete interlobar fissures often face higher rates of conversion to alternative procedures and an increased likelihood of postoperative complications. This retrospective study introduces a novel robotic surgical technique tailored to the challenges posed by incomplete fissures, evaluating both its safety and therapeutic outcomes.A retrospective analysis was performed on the clinical data of individuals who received robotic-assisted lobectomy for NSCLC at our center from March 2021 to September 2024. Altogether, 554 cases were incorporated and divided into two cohorts-those with fully developed fissures and those with partially developed fissures-based on the anatomical features of their lung fissures.Among the 554 patients analyzed, 302 were categorized as having complete fissures, while 252 were identified with incomplete fissures. Comparative evaluation revealed no statistically significant differences between these groups in terms of operative duration (p = 0.411), intraoperative blood loss (p = 0.822), chest tube retention time (p = 0.733), rate of prolonged air leakage (PAL, p = 0.805), or postoperative hospital stay (p = 0.962). Importantly, neither group exhibited cases of bronchopleural fistula, pneumonia, or perioperative death.Incomplete fissures do not increase the procedural difficulty of lobectomy when employing this robotic surgical approach. This newly developed, robot-specific technique ensures both safety and efficacy for patients with incomplete fissures.

Cerebral Microbleeds are Associated With Post-stroke Dysphagia in Spontaneous Intracerebral Hemorrhage Patients.

Association between temporalis and masseter muscle thickness and dysphagia in patients with spontaneous intracerebral hemorrhage.

PurposeTo evaluate the outcome and safety of transanal drainage tube (TDT) placement following surgical repair of chronic third- and fourth-degree perineal tears.Patients and MethodsA retrospective cohort study was conducted at Peking Union Medical College Hospital (2016–2024), including 31 patients with chronic perineal tears who underwent surgical repair. Patients were stratified into success (n=23) and failure (n=8) groups. Surgical failure was defined as persistence of fecal incontinence at six months postoperatively. Data included demographics, surgical details, TDT use, Wexner, and SF-12 scores.ResultsThe procedure demonstrated an overall success rate of 74.2% (23/31). Postoperative SF-12 and Wexner scores improved significantly in both the success and failure groups (p < 0.05). The success group had longer tube retention (9[7–11.5] vs 7[6–7] days, p=0.03). Further analysis revealed that prolonged drainage duration beyond 8 days was associated with improved success rates. Patients in the TDT group showed significantly greater improvement in Wexner scores (11.42 ± 3.13 vs 7.67 ± 3.37, p = 0.004). No major TDT-related complications occurred.ConclusionTransanal drainage tube placement may enhance anal sphincter function when used at the time of anal sphincteroplasty. Maintaining TDT for more than 8 days is associated with higher success rate. Both successful and unsuccessful repairs lead to significant improvements in quality of life and fecal incontinence symptoms.

BackgroundPreoperative localization of pulmonary nodules is crucial for sublobar resection under thoracoscopy; however, controversy persists over the optimal localization method in terms of accuracy and safety. This study evaluates a novel technique integrating indocyanine green (ICG) with medical adhesive for pulmonary nodule localization.Materials and methodsIn this single-center retrospective cohort, 168 consecutive patients (188 pulmonary nodules ≤ 2 cm) undergoing preoperative localization followed by uniportal thoracoscopic resection (July 2023 to June 2024) were divided into two groups: ICG combined with medical adhesive group (n = 86) versus medical adhesive group (n = 82). Localization outcomes, related complications, surgical and pathological outcomes were compared between the two groups.ResultsThere were no deaths or serious complications. All nodules were successfully resected thoracoscopically. The combined group demonstrated a shorter operative duration than the medical adhesive group (46.3 ± 6.7 min vs. 53.1 ± 5.9 min, P < 0.001). No statistically significant differences were identified in surgical type, length of stay, duration of drain tube retention, and total postoperative drainage volume between the two groups (P > 0.05).ConclusionThe combined use of ICG and medical adhesive for preoperative localization in uniportal thoracoscopic sublobar resection of small pulmonary nodules reduces operative time compared with medical adhesive positioning and demonstrates favorable safety profiles.

Objective: To evaluate the clinical efficacy of ERAS (enhanced recovery after surgery) in intervening patients with ureteral calculi complicated with infection and its impact on quality of life. Methodology: This prospective study included 120 ureteral calculi patients with infection admitted to Affiliated Hospital of Hebei University from September 2023 to December 2024. They were randomly divided into control and experimental groups (60 cases each). The control group received standard perioperative care, while the experimental group received ERAS in addition. The groups were compared for emotional status, clinical outcomes (calculus clearance, complications like hemorrhage, infection and abdominal effusion), recovery, quality of life and satisfaction. Results: The experimental group showed significantly lower the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS) scores than the control group post-intervention (P=0.00). Their calculus clearance rate was higher (P=0.03), while complication rates were lower (P=0.02). Postoperative recovery times (nephrostomy tube retention, diet recovery, first exsufflation, ambulation and hospitalization) were significantly shorter (P=0.00). The experimental group also had better KPS and SF-36 scores (P=0.00) and higher satisfaction (100% vs. 88%, P=0.00). Conclusion: ERAS is a safe, effective approach that reduces negative emotions and complications, improves calculus clearance, enhances quality of life, boosts satisfaction and accelerates recovery.

Comparison of tympanostomy tube insertion with and without radiofrequency ablation eustachian tuboplasty for treating chronic otitis media with effusion.

ObjectiveTo evaluate the efficacy of gasless endoscopic thyroidectomy via the trans-subclavian approach in treating unilateral papillary thyroid carcinoma.MethodsA retrospective analysis was conducted on 140 patients who underwent surgical treatment for unilateral papillary thyroid carcinoma at the Department of Oral-Maxillofacial-Thyroid Oncosurgery, Jilin Cancer Hospital, between February 2023 and August 2024. Patients were divided into the endoscopic (n=70) and open surgery group (n=70). Clinical characteristics, surgical indicators (operation time, number of central lymph node dissections, intraoperative blood loss, 24-hour postoperative drainage volume, indwelling time of drainage tube, surgical cost, length of hospital stay), complication rates, neck discomfort, and incision satisfaction were compared.ResultsPatients in the endoscopic group were younger and had a higher proportion of women (p<0.05). The endoscopic group showed significantly longer operation times and higher 24-hour drainage volumes (p<0.05). No substantial differences were observed between groups in intraoperative blood loss, lymph node dissection count, drainage tube retention time, length of hospital stay, surgical cost, and postoperative complication rates (p>0.05). Neck discomfort was considerably lower, and incision satisfaction was significantly higher in the endoscopic group (p < 0.05).ConclusionGasless endoscopic thyroidectomy via the trans-subclavian approach is a safe and effective treatment for unilateral papillary thyroid carcinoma. It reduces postoperative neck discomfort and improves cosmetic outcomes, making it a viable and promotable surgical option.

Canalicular lacerations require timely and effective surgical repair to prevent epiphora and maintain lacrimal function. While various intubation techniques exist, there is no clear consensus on the optimal method. This study compares monocanalicular, bicanalicular, and annular intubation techniques in terms of success rates and complications. The patients who underwent canalicular repair surgery between January 1998 and August 2023 have been retrospectively reviewed. The study analyzed 3 intubation methods: monocanalicular, bicanalicular, and annular intubation. The evaluation parameters included anatomical success (patency confirmed by lacrimal lavage), functional success (absence of epiphora), complication rates, and the duration of tube retention. This study included 165 eyes from 165 patients, with a male-to-female ratio of 79.4% and 20.6%, and a mean age of 32.6 years. The most common intubation technique used was monocanalicular intubation (46.7%), followed by annular intubation (29.1%), and the least used was bicanalicular intubation (24.2%). Canalicular damage was predominantly traumatic (90.3%). The lower canaliculus was the most frequently affected. Anatomical and functional success rates were 95.7% and 90.7%, respectively, for all cases. The most common complications were slit-like punctum and conjunctival irritation, each observed in 2.4% of cases; 93.7% of cases had no issues related to intubation. Monocanalicular intubation was associated with the fewest complications, while bicanalicular intubation tends to lead to more complications (p = 0.047). There was a strong negative correlation between complications and anatomical success (ρ = -0.75, p < 0.01) and, surprisingly, a positive correlation with functional success (ρ = 0.560, p < 0.01). A weak negative correlation was observed between anatomical success and tube duration (ρ = 0.177, p < 0.05); however, it was not clinically significant. This study demonstrates that bicanalicular silicone intubation was associated with the highest complication rate, whereas monocanalicular intubation had the lowest. Indicating that the choice of intubation method influences the occurrence of complications. Despite this, no significant differences were observed between the intubation types in terms of anatomical or functional success, as both anatomical success and functional success were high across all groups. A strong negative correlation between complications and anatomical success, suggesting that more complications lead to poorer anatomical outcomes.

Frailty is a common multifactorial clinical syndrome in older patients that seriously affects their prognosis. However, most studies to date have ignored the dynamics of frailty. Therefore, we employed a one-month observational longitudinal study to explore frailty trajectories using a latent class growth model. In total, 155 older patients who underwent abdominal surgery involving the digestive system were assessed preoperatively, at discharge, and at the one-month follow-up, and multiple logistic regression analysis was conducted to identify factors influencing frailty trajectories. Four frailty trajectory patterns were identified: no frailty (13.5%), frailty exacerbation (40.0%), frailty improvement (20.0%), and persistent frailty (26.5%). Logistic regression analysis revealed that body mass index, the Charlson comorbidity index score, the type of surgery, the intraoperative drainage tube retention time (drainage time), the first time the patient got out of bed after surgery, the time of the first oral feed after surgery, postoperative complications, mobility, nutritional risk, and anxiety were associated with frailty trajectories. We identified four frailty trajectories in older patients undergoing abdominal surgery involving the digestive system and found that these trajectories were influenced by multiple factors. Focusing on individual specificity is conducive to accurately addressing frailty-associated clinical problems and guiding relevant nursing decisions.

目的 初步探讨胰管-空肠 “支架管桥接式”内引流术作为胰腺中段切除术胰肠吻合的补充术式的可靠性及安全性。 方法 收集自2021年1月−2024年11月间由我团队完成的机器人胰腺中段切除术的28例患者数据资料，并随访患者的术后内、外分泌功能。根据消化道重建方式不同，将患者分为传统胰肠吻合组及胰管-空肠 “支架管桥接式”内引流组(胰肠架桥组)，主要比较两种吻合方式的手术时间、消化道重建时间以及近期并发症情况。 结果 在接受机器人胰腺中段切除术的患者中，胰肠架桥组患者消化道重建用时（31.1±6.3） min，传统胰肠吻合组（49.7±8.9） min，前者用时更短（t=5.168，P<0.001）；胰肠架桥组患者手术总时间（172.7±64.6） min，传统胰肠吻合组（200.1±52.7） min，两者差异无统计学意义（t=1.215，P=0.235）；胰肠架桥组1例患者发生术后生化瘘，14例患者发生B级胰瘘，B级胰瘘中1例合并胰瘘相关腹腔感染，13例带管时间超过21d，传统胰肠吻合组2例患者发生术后生化瘘，11例患者发生B级胰瘘，B级胰瘘中1例合并胰瘘相关腹腔感染，1例合并胰瘘相关腹腔出血及腹腔感染。两组患者均未发生术后胃瘫、术后胰腺炎、C级胰瘘。在两组患者术后总体并发症发生率（P=0.522）、术后胰瘘发生率（P=0.583）、术后腹腔感染（P=0.583）及出血发生率（P=0.464）差异均无统计学意义。 结论 胰管-空肠 “支架管桥接式”内引流术优化了胰腺中段切除术中远端胰腺与空肠的吻合步骤，缩短了消化道重建时间，降低了手术难度，同时并未增加术后近期严重并发症发生风险，该术式安全可行。

Though chest tube removal at the completion of an endoscopic thoracic procedure is well accepted in the pediatric and adult general surgery literature, this practice has never been studied in pediatric patients treated with anterior vertebral tethering (AVT) for AIS. This study retrospectively analyzed pulmonary complications in a large series of AIS patients consecutively treated with chest tube removal at the completion of AVT. The rate of pulmonary complication in this series was then compared with the published rate of pulmonary complication in patients managed with chest tube retention after AVT. A retrospective review of all AIS patients treated with AVT over a twelve year period yielded 257 consecutive patients (248 primary/9 revision) with 349 curves. Out of a total of 349 chest tubes placed intraoperatively, as a routine step of the procedure, 323 were removed at procedure completion while 26 were maintained for 2-5days post-operatively as warranted. Patient charts, radiographs, and CT scans were reviewed to confirm any pulmonary complications. In 257 AIS patients treated with AVT, 233 had chest tube removal at the completion of AVT with 4 (1.7%) peri-operative and 8 (3.4%) delayed pulmonary complications. Peri-operative complications included one symptomatic pneumothorax noted in the operating room that required chest tube reinsertion; one static pneumothorax that resolved without intervention; and two significant pleural effusions that resolved over time without intervention. Delayed complications included seven pleural effusions that occurred 2-6weeks post-operatively and one chylothorax that occurred 1week post-operatively. Several clinically significant pleural effusions (4/7) required thoracentesis or chest tube drainage but subsequently resolved. The chylothorax required chest tube drainage, dietary fat restriction, and treatment with octreotide. In 24 patients, 26 chest tubes were retained for 2-5days post-op for a persistent air leak with presumed parenchymal injury (14), revision with significant adhesions (6), bleeding disorder (2), or diaphragmatic repair related to renal eventration (1) or congenital diaphragmic hernia (1). This study demonstrated the relative safety of immediate chest tube removal at the completion of AVT in AIS patients. The rate of pulmonary complication in 233 patients with chest tube removal at the completion of AVT was 5.1% which compared favorably with a published rate of 10-11% after chest tube retention. In 24 patients with an indication for chest tube retention at the completion of AVT, chest tube retention for 2-5days resulted in no pulmonary complications.

Surgical site infection is a serious complication of posterior lumbar interbody fusion surgery and is influenced by various factors. To construct a predictive nomogram of the risk of surgical site infection among patients after posterior luminal interbody fusion surgery. A total of 496 patients who underwent posterior lumbar interbody fusion surgery between January 2019 and December 2023 were included, and randomly assigned to a training or a validation queue following a 7:3 ratio. A nomogram prediction model was established based on the training queue, and evaluation of its accuracy and discriminative ability was done using calibration curves and receiver operating characteristic analysis. Decision curve analysis was used to estimate the clinical value of the nomograms. Seventeen cases (3.43%) of SSI were observed. The predictive factors included preoperative hypoalbuminemia (P = 0.048), drainage tube retention time (P = 0.002), number of fusion segments(P < 0.001), and postoperative white blood cell count (P = 0.003). The receiver operating characteristic analysis indicated that the model had good predictive performance (training cohort: 0.95; validation cohort: 0.903). The calibration curves showed good consistency between the predicted and actual values, and the decision curve indicated good clinical benefits. Preoperative hypoalbuminemia, drainage tube retention time, number of fusion stages, and postoperative white blood cell count were independent risk factors of surgical site infection in patients undergoing posterior lumbar interbody fusion surgery. The nomogram model had a good predictive performance and can provide an effective evaluation method to improve prediction accuracy.

Objective: To investigate the feasibility and effectiveness of robot-assisted surgery in children with cholangiectasis under 3 months of age. Methods: This is a retrospective cohort study. The clinical data of 53 children with cholangiectasis under 3 months admitted to Department of General Surgery of Children's Hospital Affiliated to Zhejiang University School of Medicine from April 2019 to December 2024 were included retrospectively. According to the surgical method, the patients were divided into robot-assisted surgery(RAS) group(5 males, 24 females, age (M(IQR)) 49.0(36.0)days (range: 19.0 to 90.0 days), weight 5.00(1.65)kg (range: 3.40 to 7.50 kg)) and laparoscopic-assisted surgery(LAS) group (5 males, 19 females, age 55.5(27.3)days (range: 18.0 to 87.0 days), weight 4.90 (1.62)kg (range: 3.50 to 6.20 kg)). Nineteen cases in each group were prenatally diagnosed. Data were statistically analyzed using the Mann-Whitney U test and the Pearson χ2 test, respectively. Results: No statistically significant differences were observed between the two groups in age, sex, weight, or preoperative biochemical indices(all P>0.05). All procedures were successfully completed without conversion to open surgery. Postoperative biochemical indices, fasting duration, cyst diameter, operative time, drainage tube retention time, and follow-up duration showed no significant differences between the groups(all P>0.05). Compared to the LAS group, the RAS group demonstrated significantly shorter postoperative hospital stays (9.0(5.0)days (range:7.0 to 18.0 days) vs. 11.5(5.5)days (range:7.0 to 38.0 days), U=236.5, P=0.044) and hepaticojejunostomy time (15.0(3.5)minutes (range:11.0 to 22.0 minutes) vs. 18.0(3.0)minutes (range:13.0 to 25.0 minutes), U=144.5,P=0.001). However, the RAS group incurred higher surgical costs (78 099.9(10 100.1)yuan (range: 72 148.7 to 112 898.6 yuan) vs. 30 158.6(15 283.1)yuan (range: 25 041.7 to 107 673.1 yuan),U=41.0, P<0.01). In the LAS group, 3 patients developed anastomotic leakage requiring reoperation, while the RAS group had 1 case of anastomotic stenosis 2 years postoperatively (received second hepaticojejunostomy) and 1 case of incision infection(received incision debridement and dressing of the abscess). Conclusion: Robot-assisted surgery can be used to treat children with cholangiectasis under 3 months of age and may achieve good results.

BackgroundTo investigate the current situation of nosocomial infections in oral cancer patients after surgery, explore possible risk factors for nosocomial infections, screen high-risk populations for nosocomial infections after oral cancer surgery in the early stage, and provide scientific basis for the prevention and control of nosocomial infections in oral cancer patients after surgery.Methods201 patients with oral cancer who underwent surgery in the Department of Oral and Maxillofacial Surgery of our hospital from January 2019 to December 2023 were collected, and their clinical data were observed. Statistics on the incidence of nosocomial infections, infection sites, and pathogenic bacteria in patients undergoing oral cancer surgery. Through univariate analysis and multivariate logistic regression analysis, identify the risk factors for nosocomial infections in oral cancer patients after surgery.ResultsThis study included 201 patients undergoing oral cancer surgery, with 24 cases of nosocomial infections and a nosocomial infection rate of 11.91%. Surgical incision infection is the most common site of infection, accounting for 45.83%, followed by pulmonary infection, accounting for 33.33%. Through pathogen examination, a total of 22 strains of pathogens were found, including 14 Gram negative bacteria (63.64%) and 7 Gram positive bacteria (31.82%). The univariate analysis found that 11 items included: smoking history, drinking history, diabetes, operation duration, skin flap repair, intraoperative bleeding, preventive use of antibiotics, tracheal intubation, gastric tube retention time, venous thromboembolism on the operation day, preoperative oral scaling, which may be the risk factors for nosocomial infection after oral cancer surgery. Logistic regression analysis showed that six independent risk factors of nosocomial infection after oral cancer surgery included: diabetes, skin flap repair, intraoperative bleeding, tracheal intubation, gastric tube retention time, and venous thromboembolism on the day of operation.ConclusionOral cancer surgery patients are at high risk of infection, and targeted monitoring of oral cancer surgery patients should be strengthened. Preventive measures should be taken for risk factors to reduce nosocomial infection rates.

The impact of DJ tube retention time on renal function has received scant attention from researchers. Nevertheless, there is a plethora of clinical evidence indicating that protracted stent retention can result in renal insufficiency, or even renal atrophy, which can consequently lead to loss of renal function or nephrectomy.A comprehensive review of the medical records of all patients who underwent DJ tube placement between 1 January 2010 and 1 September 2024 in our hospital was performed. Cases with a duration of DJ tube placement exceeding two years were selected for further analysis, as supported by previous studies. The final study population comprised 74 cases with indwelling DJ tubes for a minimum of two years. Renal size/glomerular width (PW) was measured on the basis of CT coronal scanning, and the mean value of PW and the rate of change of PW were calculated before the first placement of the DJ tube and at the last follow-up, respectively. Furthermore, the study recorded eGFR, serum creatinine (Scr), blood urea nitrogen (BUN), and blood uric acid (UA) at two time points: before and after DJ tube placement. The mean duration of indwelling DJ tubes was 67.94 ± 48.26 months in the unilateral DJ tube indwelling group (including isolated kidney cases) and 50.22 ± 29.65 months in the bilateral group. During the mean retention time of 67.94 ± 48.26 months, the mean PW change rates of unilateral DJ tube stented kidneys and healthy kidneys/unilateral kidneys were − 39.01 ± 26.1% and 16.52 ± 25.4%, respectively, which were statistically significant (P < 0.01). The mean rate of change in PW in the left and right sides of the bilateral DJ tube retention group was − 18.31 ± 36.3% over a mean retention time of 50.22 ± 29.65 months, which was statistically significant (P < 0.01). Furthermore, a statistically significant decrease of -37.81 ± 51.2% in eGFR was observed before and after bilateral DJ tube placement (P < 0.01). No statistically significant difference (P > 0.05) was observed in eGFR in the unilateral DJ tube placement group (including isolated kidney cases) and in Scr, BUN, and UA values in the unilateral and bilateral DJ tube placement groups before and after DJ tube placement. In the unilateral DJ tube-placement group, the duration of DJ tube placement exhibited a negative correlation with the rate of change in mean PW percentage (Pearson correlation coefficient r = -0.470, P = 0.002) and a positive correlation with the rate of change in eGFR (Pearson correlation coefficient r = 0.653, P < 0.01). Conversely, in the bilateral DJ tube retention group, DJ tube retention duration exhibited no significant correlation with the change in mean percentage of PW.However, it demonstrated a negative correlation with the rate of change in eGFR (Pearson correlation coefficient r = -0.443, P = 0.03). In patients with unilateral or bilateral indwelling DJ tubes, renal size may decrease over time despite the presence of an indwelling DJ tube, especially in patients with bilateral indwelling DJ tubes.

BackgroundNasoenteric feeding tubes are necessary in hospitalized children to deliver nutrition and medication. Traditionally, adhesive tape secures these feeding tubes but fails to prevent 40% of tube dislodgements. The nasal bridle, a thin plastic anchor placed around the vomer bone, is an increasingly used method for tube securement. Our objective is to compare AMT Bridle Pro® nasal bridle versus conventional tape to safely reduce tube dislodgement in pediatric patients.MethodsA prospective, open-label randomized controlled trial was carried out between February 2020 and January 2021 at a tertiary pediatric hospital. Infants, children, and adolescents less than 18 years of age with an order to place a nasogastric or post-pyloric feeding tube were approached for enrollment. Exclusion criteria included facial trauma, nasal airway obstruction, or thrombocytopenia. After obtaining consent, patients were randomized to AMT Bridle Pro® nasal bridle or conventional tape to secure the feeding tube. The primary outcome was the frequency of feeding tube dislodgement, defined as unintentional tube removal or change in position. Secondary outcomes included days to feeding tube dislodgement, number of dislodgements per 10 tube days, resource use, and complications from tube securement.ResultsA total of 35 patients were randomized and equally split to the bridle (n = 17) and tape arm (n = 18). The primary analysis revealed the rate of feeding tube dislodgement over 30 days was significantly higher in the tape group compared to the bridle group with an attributable risk reduction of 57% (hazard ratio = 6.3, 95% CI 2.4–16.5, p < 0.001). After 30 days, tubes dislodged at a proportion 88% (15) in the tape arm compared to 31% (5) in the bridle arm (risk ratio = 2.82; 95% CI: 1.34–5.96; p = 0.001). There were no serious adverse events. Four patients in the tape group developed erythema and skin breakdown where the tube was secured with tape. One patient was withdrawn from the bridle group because they developed erythema on the nasal septum after placement, which resolved quickly upon removal of the bridle.ConclusionSecuring nasoenteric feeding tubes with the AMT Bridle Pro® can effectively reduce tube dislodgements in hospitalized children.Trial registrationClinicalTrials.gov NCT04621734. Registered on November 3, 2020. https://clinicaltrials.gov/search?cond=NCT04621734.

In single-ventricle circulation, pulmonary vascular resistances (PVR) play a crucial role at various stages of surgical palliation. Increased PVR detected at cardiac catheterization represents a contraindication to Fontan completion and may lead to an early circuit failure in the postoperative period. Pulmonary vasodilator therapy (PVT) may lower PVR and enhance pre- and post-surgical outcomes in Fontan patients. This study reports the experience with the use of PVT in a tertiary center, focusing on its role in lowering PVR before Fontan procedure and assessing its impact on postoperative outcomes. We analyzed 151 pediatric patients with single-ventricle heart diseases in pre-Fontan stage at our institution from January 2014 to December 2023, collecting demographics, anatomical diagnoses, clinical history, administration of PVT, surgical complications, pre-Fontan hemodynamic parameters, duration of intubation, chest tube retention, oxygen therapy needs, and total hospitalization time. In 17 out of 18 patients (94.4%)who were previously considered unsuitable for Fontan completion, a significant decrease in PVR (p = 0.006) was observed after starting PVT, enabling surgery to be performed. Among 113 patients (74.8%) undergoing Fontan, no differences in postoperative outcomes were observed between those who received PVT in the pre-Fontan stage and those who did not. PVT was started in 50 out of 113 patients (44.2%) after surgery, primarily due to elevated pulmonary pressures on invasive monitoring; among them, 24 patients (48%) had already been on therapy prior to the operation. PVT in the postoperative period was associated with worse outcomes compared to patients not receiving therapy, likely due to the more severe conditions of treated patients. The use of PVT during the pre-Fontan stage increases the number of individuals eligible for surgical palliation, with minimal impact on postoperative outcomes.

ObjectiveThe objective is to systematically gather relevant research to determine and quantify the risk factors and pooled prevalence for pneumonia after a radical gastrectomy for gastric cancer.MethodsThe reporting procedures of this meta-analysis conformed to the PRISMA 2020. Chinese Wan Fang data, Chinese National Knowledge Infrastructure (CNKI), Chinese Periodical Full-text Database (VIP), Embase, Scopus, CINAHL, Ovid MEDLINE, PubMed, Web of Science, and Cochrane Library from inception to January 20, 2024, were systematically searched for cohort or case–control studies that reported particular risk factors for pneumonia after radical gastrectomy for gastric cancer. The pooled prevalence of pneumonia was estimated alongside risk factor analysis. The quality was assessed using the Newcastle–Ottawa Scale after the chosen studies had been screened and the data retrieved. RevMan 5.4 and R 4.4.2 were the program used to perform the meta-analysis.ResultsOur study included data from 20,840 individuals across 27 trials. The pooled prevalence of postoperative pneumonia was 11.0% (95% CI = 8.0% ~ 15.0%). Fifteen risk factors were statistically significant, according to pooled analyses. Several factors were identified to be strong risk factors, including smoking history (OR 2.71, 95% CI = 2.09 ~ 3.50, I2 = 26%), prolonged postoperative nasogastric tube retention (OR 2.25, 95% CI = 1.36–3.72, I2 = 63%), intraoperative bleeding ≥ 200 ml (OR 2.21, 95% CI = 1.15–4.24, I2 = 79%), diabetes mellitus (OR 4.58, 95% CI = 1.84–11.38, I2 = 96%), male gender (OR 3.56, 95% CI = 1.50–8.42, I2 = 0%), total gastrectomy (OR 2.59, 95% CI = 1.83–3.66, I2 = 0%), COPD (OR 4.72, 95% CI = 3.80–5.86, I2 = 0%), impaired respiratory function (OR 2.72, 95% CI = 1.58–4.69, I2 = 92%), D2 lymphadenectomy (OR 4.14, 95% CI = 2.29–7.49, I2 = 0%), perioperative blood transfusion (OR 4.21, 95% CI = 2.51–7.06, I2 = 90%), and hypertension (OR 2.21, 95% CI = 1.29–3.79, I2 = 0%). Moderate risk factors included excessive surgery duration (OR 1.51, 95% CI = 1.25–1.83, I2 = 90%), advanced age (OR 1.91, 95% CI = 1.42–2.58, I2 = 94%), nutritional status (OR 2.62, 95% CI = 1.55–4.44, I2 = 71%), and history of pulmonary disease (OR 1.61, 95% CI = 1.17–2.21, I2 = 79%).ConclusionsThis study identified 15 independent risk factors significantly associated with pneumonia after radical gastrectomy for gastric cancer, with a pooled prevalence of 11.0%. These findings emphasize the importance of targeted preventive strategies, including preoperative smoking cessation, nutritional interventions, blood glucose and blood pressure control, perioperative respiratory training, minimizing nasogastric tube retention time, and optimizing perioperative blood transfusion strategies. For high-risk patients, such as the elderly, those undergoing prolonged surgeries, experiencing excessive intraoperative blood loss, undergoing total gastrectomy, or receiving open surgery, close postoperative monitoring is essential. Early recognition of pneumonia signs and timely intervention can improve patient outcomes and reduce complications.