Type Of Surgery Research Articles

Anticoagulation for Minimally Invasive Glaucoma Surgery: An American Glaucoma Society Survey

Precis: Perspectives and practice patterns regarding perioperative anticoagulation management and minimally invasive glaucoma surgery were queried among surgeons of American Glaucoma Society. Management varied based on surgeon preference and type of procedure performed. Purpose: The purpose of this study was to characterize anticoagulation and antiplatelet practice patterns for minimally invasive glaucoma surgery (MIGS) in the perioperative period. Materials and Methods: This was a survey of surgeons of American Glaucoma Society (AGS) about anticoagulation decision-making for their most performed MIGS procedures. Results: A total of 103 surgeons completed the survey, with 43.6% in an academic setting, 49.5% in a private practice setting, and 6.8% in a mixed practice. Median MIGS per month was 10 (IQR 20-5). The two most performed MIGS were trabecular meshwork (TM) bypass with either device implantation (24.9%) or tissue excision (40.0%). Half of respondents (50.5%) deferred to the primary care physician about anticoagulation most/all the time. Most (59.3%) managed anticoagulation differently for MIGS compared to trabeculectomy and tube implantation. Respondents reported an average of 1.3 (SD 2.5) bleeding complications related to anticoagulation and MIGS in the last year. Bleeding risk perception depended upon the type of surgery (e.g., 74.0% reported no/mild concern regarding surgeries involving TM bypass with device implantation vs. 48.0% reported high concern for TM bypass with tissue excision). Respondents stopped blood thinners at the highest rates for procedures enhancing aqueous outflow through the subconjunctival space and stopped least frequently for iStent implantation. Antiplatelets were held for a longer duration than anticoagulants prior to surgery, and most resumed both agents within 1–4 days after surgery. Conclusions: Anticoagulation management is highly varied, and this study may help to inform practice guidelines and optimize surgical outcomes by elucidating surgeon perspectives toward MIGS and anticoagulation management.

The Incidence and Risk Factors of Persistent Opioid Use After Surgery—a Retrospective Secondary Data Analysis.

The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany. We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between postoperative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated. 203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than pre-existing risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and pre-existing treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]). The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.

Treatment and Early Outcomes of Capitellar Osteochondritis Dissecans.

Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results. To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement. Cohort study; Level of evidence, 3. Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes. A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures. Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.

Impact of the COVID-19 pandemic on breast cancer surgeries in a Canadian population.

The COVID-19 pandemic significantly impacted breast cancer (BC) surgeries. Most studies showing reduced BC surgical volumes during the pandemic are from single institutions, few have described volume changes in different types of surgical procedures. This study aimed to assess the impact of the pandemic on BC surgery volumes and types at a population level. Patients diagnosed with BC between January 1, 2018, and June 25, 2022, in Ontario, Canada, were analysed from population-based datasets. Time periods were defined as pre-pandemic (Jan 2018-Mar 2020), immediate pandemic (Mar-Jun 2020), and peri-pandemic (Jun 2020-Jun 2022). Weekly BC surgery volume and type (lumpectomy, mastectomy, or mastectomy with immediate reconstruction) were evaluated using segmented negative binomial regression models. Among 44 226 patients, 50 440 surgeries were performed. Weekly BC surgeries decreased by 16.9% during the immediate pandemic compared to pre-pandemic levels (180.5 vs. 217.1; p = 0.03). Surgical volumes recovered to pre-pandemic levels by June 2021. Mastectomies represented a higher proportion of BC surgeries during the pandemic (31.1% pre, 36.3% immediate, 32.4% peri-pandemic; p < 0.01). The proportion of mastectomies with immediate reconstruction remained stable during the immediate pandemic but increased in the peri-pandemic (20.1% vs. 17%; p < 0.01). There was a significant reduction in all BC surgeries during the pandemic. Mastectomies accounted for a higher proportion of BC surgeries in the pandemic period however access to reconstruction was maintained. Surgical volumes recovered within a year despite ongoing pandemic hospitalizations. Future studies are needed to explore the pandemic's long-term impact on BC care.

Clinical analysis of 1,038 cases of odontogenic jawbone cysts.

This study aims to analyse the clinical characteristics of different types of odontogenic jawbone cysts (OJCs) and to provide a theoretical basis for prevention and clinical treatment. Data from 1,038 patients with OJCs were collected, and relevant information, such as sex, age, clinical symptoms and signs, imaging data, number of lesions, lesion location, pathological diagnosis, clinical treatment and prognosis, was statistically analysed. According to the World Health Organization (WHO) classification of OJCs in 2022, the highest incidence rate was observed for radicular cysts (RCs), accounting for 58.96% of the total number of cases, followed by dentigerous cysts (DCs), accounting for approximately 23.22% of cases. lateral periodontal cysts (LPCs) and calcifying odontogenic cysts (COCs) comprised the lowest number of cases. The age distribution of patients was between 4 and 89 years, and the high incidence age group was youth and middle age, accounting for 66.67% of the total number of cases. The male-to-female ratio of patients was 1.51:1, and there was a statistically significant difference between the sexes(p < 0.05).In terms of the site of incidence, odontogenic keratocysts (OKCs) were prevalent in the mandibular molar region. In addition, mandibular ramus, inflammatory collateral cysts (ICCs) and dentigerous cysts (DCs) were more common in the mandibular third molar, and radicular cysts (RCs) and calcifying odontogenic cysts (COCs) were prevalent in the maxillary anterior region. On imaging, 955 (92.0%) lesions were solitary, and 83 (8.0%) were multiple. The treatment included four types of surgery, including simple curettage, marsupialization, marsupialization followed by secondary curettage, and partial resection of the jaw, and a total of 921 patients were followed up, with a recurrence rate of 2.82%. OJCs are more common in males than in females, and a statistically significant difference is observed in the most prevalent types of cysts occurring at different ages and in various regions of the jawbone (p < 0.05). Early diagnosis should be made with the help of X-rays, age, location, and clinical symptoms. In addition, appropriate treatment methods should be selected, and long-term follow-up observation is needed.

Guidelines and consensus: Jejunoileostomy for diabetes mellitus-surgical norms and expert consensus (2023 version)

Diabetes mellitus (DM) is a group of diseases characterized by high blood glucose caused by insufficient absolute or relative secretion of insulin. Once diagnosed, patients need long-term treatment with hypoglycemic drugs. Currently, the existing first-line hypoglycemic drugs do not provide effective treatment for DM and its complications. In the past, the first generation and the second generation of weight loss surgery, such as gastric bypass and sleeve gastric surgery, had strict body mass index requirements. Moreover, post-surgery, patients are prone to fluctuating hypoglycemia, gastroesophageal reflux, and dumping syndrome. Hence, the curative effect of this type of surgery was compromised to a certain extent. Jejunoileostomy is a third-generation surgery for patients with DM, which has been shown to improve glucose and lipid metabolism, without changing the original gas-trointestinal tract structure. Different from previous weight loss surgeries, jejunoileostomy has been clinically observed to delay the development of DM-related complications. Additionally, the postoperative complications are mild and do not affect the patient’s quality of life. Based on our clinical observations from multi-center large samples, our team developed a consensus on the operative period and perioperative management of jejunoi-leostomy as a reference for clinical researchers.

Is fascia lata a viable graft for MPFL reconstruction? An overview of surgical technique and scoping literature review

Lateral patellar dislocation is irrefutably one of the most common knee injuries, while subsequent medial patellofemoral ligament (MPFL) damage requires proper orthopedic care. Treatment of these injuries is regularly associated with the need for MPFL reconstruction surgery. This operation, often in combination with other procedures, can result very fruitful in restoring knee kinematics. There is a considerable variety of options for the orthopedic surgeon to choose from regarding graft selection when performing MPFL reconstruction surgery, including the semitendinosus tendon, the gracilis and others. Notwithstanding, utilizing the fascia lata as an autograft or allograft for MPFL reconstruction has emerged as a promising alternative. Perusing the existing literature, not any review paper could be found examining the efficacy of fascia lata as a MPFL reconstruction graft. As a result, a thorough search was conducted in various databases to investigate and explore the studies analyzing this type of MPFL reconstruction surgery. The number of papers scrutinizing this operation was exceedingly narrow. However, out of these studies it can be concluded that opting for fascia lata grafts when executing MPFL reconstruction surgery features some considerable advantages, involving similar biomechanics to the native MPFL, no hamstrings damage and quicker rehabilitation among others. This paper accentuates the requirement for considering fascia lata as a viable graft option in MPFL reconstruction surgery and the necessity for more pertinent research in order to attain more reliable inferences.

Occult Urinary Incontinence, Diabetes, Obesity, Prolapse Severity, and Type of Surgical Repair as Risk Factors for De Novo Stress Urinary Incontinence in Women Undergoing Surgical Repair of Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis.

The International Continence Society and the International Urogynecological Association have not yet standardized the definition of de novo stress urinary incontinence. Recent studies define the development of stress urinary incontinence as occurring after surgical repair of pelvic organ prolapse in previously continent women. The mechanisms that cause de novo stress urinary incontinence are not yet clear. Knowledge of the predictive factors for this outcome after surgical correction of pelvic organ prolapse would be useful for assessing whether a concomitant anti-incontinence procedure should be performed. The aim of this systematic review and meta-analysis was to identify some of the risk factors for de novo stress urinary incontinence: high body mass index, pelvic organ prolapse stage before surgery, presence of occult urinary incontinence, type of surgery, and the presence of diabetes mellitus. The present study was registered in the PROSPERO database under number CRD42021293764, and the systematic review was carried out according to the MOOSE recommendations and with the PRISMA 2020 guidelines. A total of 2429 articles were identified. Nine cohort studies were included in the systematic review and seven in the meta-analysis. The risk of bias was assessed via the Newcastle-Ottawa scale and the certainty of evidence was assessed using the GRADE approach for each outcome. In the meta-analysis, associations were identified between de novo stress urinary incontinence and occult urinary incontinence (n: 422; OR: 2.01; 95% CI: 1.26-3.22; p = 0.004), diabetes (n: 1213; OR: 2.35; 95% CI: 1.30-4.26; p = 0.005), and advanced pelvic organ prolapse (n: 1003; OR: 1.94; 95% CI: 1.14-3.30; p = 0.01). Consulting a meta-analysis for the type of surgery was deemed impossible. A previous study comparing abdominal sacrocolpopexy with minimally invasive sacrocolpopexy revealed that women who underwent abdominal sacrocolpopexy were more likely to develop de novo stress urinary incontinence (n: 77; OR: 4.73; 95% CI: 1.56-14.34; p = 0.005). Another study found that pelvic organ prolapse repair using a transvaginal mesh was associated with higher levels of de novo stress urinary incontinence compared to robot-assisted sacrocolpopexy (n: 76; OR: 6.74; 95% CI: 1.35-33.75; p = 0.02). A meta-analysis of overweight or obesity was not possible due to the different assessment methods used in the studies. This meta-analysis revealed that occult incontinence, diabetes, and advanced pelvic organ prolapse before repair were associated with de novo stress urinary incontinence and these groups may therefore benefit from for anti-incontinence procedures concomitant with pelvic organ prolapse repair.

BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery

Abstract Background Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL). Method We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS. Results In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117). Conclusion A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.

Comparative evaluation of first-attempt intubation success rate using direct laryngoscope with Macintosh blade and video laryngoscope during rapid sequence induction in patients undergoing emergency surgery: A prospective randomised controlled trial.

Airway management skills form the cornerstone of routine anaesthesia practice. Its role becomes more significant in emergency areas where time is of the essence. Patients presenting for emergency surgery require definitive airway management with endotracheal intubation. Rapid sequence induction with direct laryngoscopy using a Macintosh blade has been used consistently with varying success. With the advent of video laryngoscopes, their utility is being explored in emergency areas. We aimed to assess the role of a video laryngoscope (Medizintechnik, Sulz, Germany) in rapid sequence induction and intubation during emergency surgeries. We hypothesised that video laryngoscope would improve the first-attempt intubation success rate in patients undergoing emergency surgery. In total, 76 patients presenting for emergency surgery were enrolled and randomly assigned into two groups (38 each), who were intubated with either a video laryngoscope or Macintosh blade during rapid sequence induction. This study aimed to compare and evaluate direct laryngoscopy using a Macintosh blade and a video laryngoscope during rapid sequence induction. The two groups were similar in the type and indication for surgery. Airway characteristics were also compared, and there were no significant differences in all airway parameters, including mouth opening, thyromental distance, Mallampati grading and neck circumference. The first-attempt intubation success rate was significantly higher in the video laryngoscope group (p = 0.017, χ2 = 5.684). The Cormack-Lehane grade distribution was compared in both groups, with better glottis visualisation in group video laryngoscope (p = 0.028, χ2 = 9.123). This prospective, randomised, controlled study aimed to compare the first-attempt intubation success rate using direct laryngoscopy with a Macintosh blade and a video laryngoscope during rapid sequence induction in patients undergoing emergency surgeries and observed that first-attempt intubation success rate was significantly higher in group video laryngoscope (86.8%) than in group direct laryngoscopy (63.2%). Therefore, video laryngoscopy offers an attractive alternative to conventional laryngoscopy while securing the airway in patients presenting for emergency surgery.

Analysis of the effectiveness of pain relief for wounded with combat surgical trauma of the extremities during medical evacuation to early care facilities

Objective. To analyze the effectiveness of pain relief for wounded with combat surgical trauma of the extremities during medical evacuation to early medical care facilities. Materials and Methods. We analyzed the effectiveness of pain relief for 100 wounded with combat surgical limb trauma at the beginning of interhospital transportation and at the end of it. Results. An increase in the level of pain in the dynamics with a statistically significant (p &lt; 0.05) difference between their values at the beginning of medical evacuation and at the end of it was revealed. Conclusions. Regardless of the type of surgery performed and the type of anesthetic support, the dynamics of pain levels during interhospital transportation of wounded was negative. Thus, optimization of pain relief for the wounded during medical evacuation is extremely important.

Abstract 4134863: Major Cardiovascular Events Following Non-Cardiovascular Surgeries in Minority Patients Compared to White Patients

Introduction: Racial disparities are pervasive in cardiovascular outcomes. Although disparities following cardiovascular surgery have been extensively studied, fewer current, nationwide reports exist for postoperative outcomes in non-cardiovascular surgery. Research Aim: To investigate the incidence of 30-day post-operative major adverse cardiac, cerebral and thrombotic events (MACCTE) following non-cardiovascular surgeries in non-White patients as compared to White patients. Methods: This retrospective cohort study used the 2018-2022 National Surgical Quality Improvement Program database. Patients aged 18 or older who underwent non-cardiovascular surgeries (general, gynecology, neurosurgery, orthopedics, otolaryngology, plastics, thoracic, urology, obstetrics, and interventional radiology) were included. Race/ethnicity was categorized as non-Hispanic White (Whites), Hispanic, non-Hispanic Asian (Asians), non-Hispanic Black or African American (Blacks), and non-Hispanic Others. MACCTE was defined as a composite of death, MI, cardiac arrest, stroke, PE, or DVT. Five multivariable logistic regression models were used to hierarchically adjust for age, gender, ASA class, surgical subspecialty, operation time, transfer status, and all other comorbidities. Results: Among the 3,775,920 patients: 70.9% were Whites, 11.8% Hispanics, 4.1% Asians, 11.6% Blacks, 1.5% of Other race, 58.9% female, and 46.7% had an ASA classification of 3 or greater. The MACCTE incidence was 1.95% overall and 2.01% in Whites, 1.27% Hispanics, 1.48% Asians, 2.11% Blacks, and 1.69% Others. Compared to Whites, Blacks had higher incidences of cardiac arrest (0.40% vs. 0.23%), stroke (0.17% vs. 0.15%), PE (0.47% vs. 0.34%), and DVT (0.55% vs. 0.48%), and Asians (0.18% vs 0.15%) and Others (0.21% vs. 0.15%) had a higher incidence of stroke (p&lt;0.001). With Whites as reference, the crude odds ratios, OR (95% CI) were 0.63 (0.61-0.65) in Hispanics, 0.73 (0.70-0.76) Asians, 1.05 (1.03-1.07) Blacks, and 0.84 (0.78-0.89) Others. The fully adjusted model odds ratios, OR (95% CI) were 0.88 (0.82-0.95) Hispanics, 0.89 (0.80-1.00) Asians, 1.11 (1.04-1.18) Blacks, and 0.80 (0.69-0.94) Others. Conclusion: Black patients experienced a higher MACCTE risk compared to Whites, even after adjustment for age, sex, ASA class, type of surgical procedure, and other comorbidities. These findings emphasize the importance of implementing comprehensive measures to prevent excess risk and promote equitable surgical care.

Rectal Eversion as an Anus-sparing Technique in Laparoscopic Low Anterior Resection With Double Stapling Anastomosis: Long-term Functional Results.

Rectal eversion (RE) is a natural orifice specimen extraction (NOSE) method that allows anus-sparing resection in very low rectal tumors. This study aims to share the long-term results of RE in laparoscopic rectal resection performed with double stapling anastomosis. A single-center retrospective cohort study was conducted for patients who underwent laparoscopic low anterior resection with RE. Age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, type of surgery, distance of the tumor to the dentate line, specimen extraction site, cancer stage, preoperative chemoradiotherapy, postoperative complications, and postoperative clinical follow-up findings were recorded. Incontinence was assessed using the Wexner score (WS). Low anterior resection syndrome (LARS) is determined by the LARS score. A 7-point Likert scale was used to evaluate the satisfaction of the patients. A total of 17 patients underwent resection by RE for rectal tumors. Of the 11 patients included in the study, 4 were female and 7 were male. The mean age was 66.09±15.04 years. The mean follow-up was 64.18±16.83 months. The mean tumor diameter was 3.1cm (range: 0.9 to 7.2cm). The mean distance of the tumor from the dentate line was 2.7cm (range: 1.2 to 5.6cm). No anastomotic leak was observed in any patient. One patient had an anastomotic stenosis and was treated with balloon dilatation. The median LARS score was 16 (range 0 to 32) and 64% of the patients had no LARS. Two patients had minor LARS and 2 patients had major LARS. The median Wexner score was 3.5 (range 0 to 14). The median Likert scale was 7 (range 5 to 7). It was found that 55% of the patients were extremely satisfied, 18% were satisfied, and 27% were slightly satisfied with their surgery. There were no dissatisfied patients. RE is a safe NOSE technique in laparoscopic double stapling anastomosis for rectal resection. There is a high level of long-term patient satisfaction with anus-sparing procedures via RE, even in the presence of various symptoms.

Long-term risk of heart failure in patients with postoperative atrial fibrillation following non-cardiac surgery: Insights from a nationwide cohort.

Atrial fibrillation (AF) is associated with heart failure (HF). However, it is unclear if postoperative AF (POAF) following non-cardiac surgery differs from non-surgical AF in terms of the risk of HF. We compared the long-term rate of incident HF in patients developing new-onset POAF following non-cardiac surgery with patients who did not develop POAF following non-cardiac surgery and patients with non-surgical non-valvular AF (NVAF). Using Danish nationwide registries, all patients aged ≥30 years who developed POAF following non-cardiac surgery (1996-2020) were identified and matched in a 1:3 ratio by age, sex, surgery type (only for the surgery group), selected comorbidities, and inclusion year with patients without POAF following non-cardiac surgery and individuals with NVAF, respectively. A total of 2270 patients with POAF were matched with 6810 patients without POAF following non-cardiac surgery, and 1846 patients with POAF were matched with 5538 patients with NVAF. The median follow-up was 7.2 years. Compared with patients without POAF, those with POAF had a higher associated long-term rate of incident HF (2.6 vs. 1.2 events per 100 person-years; adjusted hazard ratio [HR] 2.39, 95% confidence interval [CI] 2.06-2.78). Compared with individuals with NVAF, patients with POAF did not have a significantly different rate of incident HF (2.7 vs. 3.0 events per 100 person-years; adjusted HR 0.89, 95% CI 0.78-1.03). Patients with new-onset POAF following non-cardiac surgery had a higher associated long-term rate of incident HF compared to those without POAF, with no significant difference in the rate of incident HF when compared to patients with NVAF.

Abstract 4136989: Association of alternating PR intervals with paroxysmal atrioventricular block in patients with right bundle branch block following cardiac surgery

Background: We previously observed a positive correlation between QRS duration and the preceding RP interval in sinus rhythm in certain patients experiencing new onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR). This unique phenomenon, termed inverse decremental conduction ( IDC ) or Yan conduction, prompted us to investigate whether IDC in the left bundle could manifest as AV conduction in an IDC pattern in patients with preexisting right bundle branch block (RBBB) and its association with atrioventricular block (AVB). Methods: 12 lead ECGs, available in-patient telemetry and mobile cardiac outpatient telemetry were reviewed in patients with sinus rhythm and preexisting RBBB who developed paroxysmal AVB requiring temporary or permanent pacemaker within 7 days following any types of cardiac surgery from 2014 to 2023 in Lankenau Medical Center. Results: A total of 9 patients (5 males) with a mean age of 71±15 years were identified to exhibit PR interval changes consistent with IDC prior to paroxysmal AVB. Among these patients, 6 had undergone TAVR, while the remaining 3 had undergone surgical aortic valve replacement, mitral valve repair, and ventricular septal defect repair, respectively. Specifically, PR interval alternation in the setting of RBBB occurred during sinus rhythm in a pattern that the longer RP interval is followed by a longer PR interval (Figure 1). This pattern exhibits the following features: 1) 8 of 9 patients had RBBB plus left anterior fascicular block (LAFB); 2) PR alternation occurred at sinus rates from 68 to 91 bpm within 5 days following surgical procedures; 3) proximal AVB occurred within 1 to 12 hours after PR interval alternation began. A positive correlation was established between PR and preceding RP interval in 2 of 9 patients whose telemetry data were available for analysis ( Figure 2A ). In a patient with RBBB who developed paroxysmal AVB without IDC changes in the PR interval post TAVR, intracardiac recording showed a decrease in AH interval but an increase in HV interval with slowing heart rates ( Figure 2B ), indicating that decremental conduction in AV node can mask IDC in Purkinje system. Conclusion: 1) PR alternation with longer PR following longer preceding RP interval in presence of RBBB, likely due to IDC in left bundle, heralds paroxysmal AVB; 2) PR interval changes resulting from IDC in left bundle in the setting of RBBB may be masked by decremental conduction in AV node.

Integrated surgical intervention for intradural extramedullary hemangioblastoma of the cervical spine: a case report and literature review

IntroductionThe incidence of hemangioblastoma is low, constituting only 1-5% of all spinal cord tumors. Specifically, intradural extramedullary hemangioblastoma without Von Hippel-Lindau syndrome represents an exceedingly rare condition.MethodsWe report the first documented case of cervical intradural extramedullary hemangioblastoma in China. A 53-year-old male patient presented with a 3-year history of mild right hemiplegia, segmental muscle strength and sensation impairment, and a positive pyramidal tract sign. MRI showed an abnormal oval signal focus in the intradural and extramedullary region at the C6-C7 vertebral level. Before surgery, angiography was performed to identify the supplying arteries and draining veins. Subsequent interventional therapy achieved over 90% occlusion of blood vessels, creating optimal conditions for complete resection of the spinal tumor.ResultsThe patient demonstrated satisfactory postoperative recovery with significant restoration of sensory and motor functions. Pathological examination showed a significant upregulation of CD31 in tumor cells and a substantial presence of the neuro-specific marker S100 in the tumor stroma, consistent with the diagnostic criteria for spinal hemangioblastoma.ConclusionThe rarity of cervical intradural extramedullary hemangioblastoma without Von Hippel-Lindau syndrome was reaffirmed by a comprehensive review of the existing literature. Complete tumor resection remains the optimal approach for managing this uncommon condition, generally resulting in a favorable prognosis. Traditional open fenestration surgery is linked to elevated risks of bleeding and trauma. Meanwhile, endovascular injection of embolic agents may lead to residual lesions and an increased risk of recurrence. Therefore, we recommend a one-time combined treatment conducted in a hybrid operating room to achieve complete resection and effectively reduce intraoperative bleeding risk. Despite presenting challenges and requiring high proficiency, we still recommend this type of combined surgery as a suitable therapeutic option for such diseases.

Prevalence of surgical site infections in a tertiary care teaching hospital in Goa, India: a cross-sectional study

Background: Surgical site infections (SSIs) are a major category of healthcare-associated infections (HAIs), particularly in surgical settings. They lead to extended hospital stays, increased morbidity, and financial burden. The study was conducted in the surgical wards of Goa medical college, a tertiary care hospital, to assess the prevalence of SSIs and identify the key bacterial pathogens and associated risk factors. Methods: A cross-sectional, prospective study design was employed, involving 378 patients aged over 18 years admitted for surgical procedures. Data collection included daily follow-up for signs of infection, identification of bacterial pathogens, and analysis of potential risk factors such as age, type of surgery, duration of postoperative drain, length of hospital stays, and wound classification. Statistical analyses were conducted using SPSS software, with significance set at p&lt;0.05. Results: The study identified an SSI prevalence of 12.69% among the participants, with Pseudomonas being the most common causative agent. Significant risk factors included extended postoperative drain duration, longer hospital stays, emergency surgical procedures, and surgeries involving contaminated or clean-contaminated wounds. Patients with prolonged postoperative drains had a markedly higher incidence of SSIs (63.63%). Conclusions: The findings reveal a considerable burden of SSIs in the studied setting, with high infection rates in patients undergoing prolonged drain usage, emergency surgeries, and surgeries on contaminated wounds. Strengthening infection prevention measures, particularly in high-risk cases, and enforcing strict adherence to hygiene and sterilization practices are critical. Enhanced infection surveillance programs and targeted interventions could help reduce SSI rates, improve patient outcomes, and minimize healthcare costs.

Treatment decision-making factors among patients with cervical myelopathy: a discrete-choice experiment.

Degenerative Cervical Myelopathy is a debilitating condition and current recommendations encourage shared decision-making between surgeons and patients. However, there is limited data on patients' values and preferences for surgical decision making. This study aimed to quantify and compare the relative importance of neurologic function, risk of future surgery, and complications to patients with cervical stenosis. Patients with cervical stenosis presenting for surgical evaluation, or post-operative cervical decompression patients, were recruited to participate. Demographic information including modified Japanese Orthopedic Association (mJOA) score, type of surgery, and complications were recorded and anonymized to study ID. Patients then completed an online discrete-choice experiment survey. In a series of 10 questions, respondents chose between two hypothetical health states defined in terms of five attributes, or "decision factors": (i) upper extremity neurologic function, (ii) lower extremity neurologic function, (iii) risk of cervical spine surgery, (iv) dysphagia, and (v) C5 palsy. Participants were asked to choose which 'life' they preferred, and a regression model was used to quantify the importance of each decision factor. We report three key findings that can aid clinicians in shared decision-making conversations: (i) all patients regard lower extremity neurologic function as the most important decision factor, (ii) dysphagia, a complication, and upper extremity neurologic function are equally important, and (iii) patients who have undergone surgery weigh neurologic function as less important, and complications as more important than patients who have not undergone surgery. Patient preferences for management of degenerative cervical myelopathy are influenced by several considerations including the experience of surgery itself. Communication of benefits and harms associated with surgical and conservative care can optimize shared decision making. Further research should be conducted to evaluate for decisional regret and the impact of complications to inform treatment conversations.

RADT-16. ADJUVANT CHEMO-RADIATION THERAPY AS A RISK FACTOR FOR POSTOPERATIVE HYDROCEPHALUS FOLLOWING RESECTION OF HIGH-GRADE GLIOMA: A PROPENSITY-MATCHED CASE SERIES

Abstract The discovery of the neural glymphatic network in the past decade has significant implications for clinical investigations on hydrocephalus. With emerging understanding of how meningeal lymphatics and perivascular pathways impact cerebrospinal fluid dynamics, it is conceivable that inflammatory and fibrotic changes induced by radiation and chemotherapy may contribute to the pathogenesis of postoperative hydrocephalus, a well-documented sequela of resective neurosurgery. This study investigates differences in adjuvant chemo-radiation therapy patterns between patients who develop hydrocephalus following high-grade glioma resection and those who do not experience this postoperative complication. A retrospective chart review identified 328 adult patients who underwent tumor resection at our institution between 2010-2020, of which 257 had high-grade gliomas. Demographic and clinical data were collected, including resection history and adjuvant chemotherapy and radiation history. Propensity Score Matching generated comparative cohorts (n=27) using covariates sex, age at first surgery, surgery type, tumor location, extent of first resection, tumor-associated seizures, ventricular opening, number of additional resective surgeries, and pre-surgical Karnofsky Performance Scale score. Independent t-tests assessed differences in adjunctive chemo-radiation trends between patients who developed hydrocephalus within 3 years postoperatively and those who did not. 27 of 257 patients (10.5%) who underwent resection for high-grade glioma developed hydrocephalus within 3 years of their first surgery. Patients who developed hydrocephalus were more likely to have initiated the Stupp protocol(P=0.004), completed the Stupp protocol(P=0.02), and undertaken multiple cycles of the Stupp protocol(P=0.0004). Additionally, these patients had a smaller time window between surgery and adjuvant chemo-radiotherapy initiation than patients who did not develop hydrocephalus (P=0.02). Importantly, engagement in other clinical trial regimens with chemotherapy or radiation therapy did not differ significantly between groups(P=0.08, P=0.49, respectively). Shortened time to initiation of chemo-radiation therapy postoperatively and increased number of chemo-radiation cycles may increase a patient’s susceptibility to develop postoperative hydrocephalus following resection of high-grade glioma.

Pericapsular nerve group block reduces opioid use and pain after hip surgery: A systematic review and meta-analysis of randomized controlled trials.

While the pericapsular nerve group (PENG) block has become increasingly popular for managing pain after hip surgery, its efficacy remains controversial. We systematically searched Pubmed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials to assess current evidence about the efficacy of the PENG block. Patients who received PENG block were compared to those who received sham/no block in terms of opioid consumption and pain within 24h after surgery, time to first opioid requirement, functional recovery, risk of nausea and vomiting, and patient dissatisfaction. The quality of evidence was assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system. We meta-analyzed six trials involving 416 patients who received preoperative PENG block and 415 who received sham/no block. Patients did not receive any other type of multimodal analgesia. Within 24 h after hip surgery, PENG block significantly reduced postoperative opioid consumption (MD = -12.03, 95% CI: -21.47 to -2.59, P < 0.01, I2 = 97%), particularly in subpopulations undergoing hip replacement, hip fracture, or who had spinal anesthesia, and it significantly decreased dynamic pain scores, but not static scores, without increasing risk of nausea or vomiting or patient dissatisfaction. Individual studies suggested that the PENG block can prolong the time to the first opioid requirement and can improve functional recovery. Most meta-analyses provided evidence of moderate quality according to the GRADE system. The available evidence indicates that preoperative PENG block can significantly decrease opioid consumption and pain early after hip surgery, and it may also promote early functional rehabilitation. However, the limited number of included studies and sample size make it difficult to draw firm conclusions. The decision on whether to apply the PENG block should take into account the patient's age and the type of surgery and anesthesia.