Type Of Surgery Research Articles

Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records.

Bariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post-bariatric surgery weight loss remains unclear. This study aimed to investigate the association between patient portal engagement and postoperative BMI reduction among patients after bariatric surgery. This retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Vanderbilt University Medical Center between January 2018 and March 2021. Patient portal engagement was measured during 4 stages: early (within 3 months after surgery), early midterm (3-6 months), late midterm (6-9 months), and late (9-12 months). Using generalized estimating equations, we estimated the associations between patients' portal engagements at these stages and the percentage of BMI reduction (%BMIR) at 3, 6, and 12 months after surgery. Covariates included duration since surgery, patient's age at the time of surgery, sex, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage. The study included 1415 patients, predominantly female (n=1145, 80.9%), with a racial composition of 76.9% (n=1088) White and 19.9% (n=282) Black. Overall, 805 (56.9%) patients underwent Roux-en-Y gastric bypass and 610 (43.1%) underwent sleeve gastrectomy. By 1 year after surgery, the median %BMIR was 31.5% (IQR 25.2%-36.8%), and the median number of active days on the patient portal was 54 (IQR 33-80). Early portal engagement was significantly associated with %BMIR at various postoperative times. Specifically, each additional 10 days of early portal engagement was associated with a 0.37% (95% CI -0.55% to -0.18%; P<.001) lower expected %BMIR at 3 months, a 1.11% (95% CI 0.82%-1.41%; P<.001) higher expected %BMIR at 6 months, and a 0.78% (95% CI 0.25%-1.31%; P=.004) higher expected %BMIR at 12 months. Furthermore, early midterm portal engagement was associated with a 0.36% (95% CI -0.69 to -0.03; P=.03) lower expected %BMIR at 6 months, but it was not significant at 12 months (P=.88). Late midterm and late portal engagement were not significantly associated with %BMIR at 12 months (P=.27 and P=.12, respectively). Furthermore, early engagement in various portal functions, such as messaging and accessing medical records, was significantly associated with a lower %BMIR at 3 months and a higher %BMIR at both 6 and 12 months (all P<.05). Higher patient portal engagement within 3 months after surgery-suggestive of stronger adherence to postoperative instructions and improved communication with care teams-is associated with less favorable weight loss immediately after surgery but enhanced postoperative weight loss outcomes at 6 and 12 months. However, the limitations of retrospective data-driven studies highlight the need for future intervention-based studies to validate these associations and establish causality.

Compliance with care standards and professional knowledge of operating theatre personnel before, during and after laparoscopic bariatric surgery: A study in public hospitals in Iran.

By adhering to care standards, many adverse outcomes for patients, such as pressure injuries, tissue necrosis and patient falls, can be prevented. The aim of this study was to investigate the level of compliance with care standards before, during and after various types of bariatric surgeries. This study was a cross-sectional descriptive study conducted in the operating theatres of selected teaching hospitals in Isfahan (Iran). The study sample consisted of all operating theatre personnel in the selected teaching hospitals who met the inclusion criteria. Compliance with care standards was measured using a researcher-developed checklist. A researcher-developed questionnaire with 43 true/false questions was used to evaluate the operating theatre personnel's professional knowledge. The data were analysed using SPSS version 20 and descriptive and inferential statistics. The mean score of adherence to care standards and the mean score of professional knowledge of operating theatre personnel regarding care of laparoscopic bariatric surgery were 78.35 ± 9.49 and 29.45 ± 6.17, respectively. There is no significant relationship between these two variables, with a two-tailed significance (Sig.) of 0.056 and a correlation coefficient (r) of 0.199. In general, it can be concluded that the specific knowledge of the local operating theatre personnel regarding minimally invasive laparoscopic surgery care is at an intermediate level. Requirements for training in this area were therefore successfully identified. In addition, not all operating theatre personnel adhere to the standards of care for patients undergoing laparoscopic bariatric surgery. This non-adherence could be due to insufficient training or the absence of established standards in hospitals.

Users of chronic prescription opioids decrease in the first 12 months following bariatric surgery.

Obesity is an independent risk factor for chronic pain frequently treated with opioids. Our study investigated the effect of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on chronic opioid prescription use. Using the IBM MarketScan database (2010-2017), we analyzed adult chronic opioid users who underwent bariatric surgery. Opioid use was measured in morphine milligram equivalents (MME) for 6-month periods before and after surgery. Changes in MME for each 6-month interval were compared to preoperative exposure and across the different types of bariatric surgery. Of the 2197 patients identified, 29% discontinued opioids 6 months post surgery, further decreasing to 23.4% at 12 months. Discontinuation rates were similar for VSG and RYGB. Preoperative opioid exposure did not predict postsurgery discontinuation, but patients with multiple opioid prescription types were less likely to stop. Among those continuing opioid use, average MME increased at 6 months post surgery compared with 6 months pre surgery in both groups (mean [SD], RYGB: 49.4 [347.3]; VSG: 74.9 [533.4]). Although bariatric surgery reduced the number of chronic opioid users by nearly 25%, persistent users showed increased average opioid exposure after surgery. Further research to track long-term opioid use should be conducted, and providers should inform patients of these risks and attempt opioid dose reductions before surgery.

Laparoscopic resections for stage IV colorectal cancer - safety and effectiveness of the method as a guarantee for an uncomplicated postoperative period and optimal pharmacotherapeutic results

Introduction: Primary tumor resection can prevent future tumor-related complications in patients with stage IV colorectal cancer. This may influence the quality of life and prevent colostomies associated with the emergency surgery. Laparoscopic approach plays an important role in attempts to reduce perioperative complications in this specific group of patients. Purpose: The aim is to assess early perioperative results in a group of 17 patients with stage IV colorectal cancer—multiple incurable liver metastases and/or pulmonary/peritoneal metastases of the disease. On the other hand, postoperative complications may delay administration of chemotherapy and influence survival. Materials and methods: We analyze retrospectively the perioperative results in a group of 17 patients with laparoscopic palliative colorectal resections for stage IV colorectal cancer. Assessment includes perioperative complications, median hospital stay, perioperative blood loss, need for blood transfusion, operative time, and type of surgical procedure. Results: We performed totally laparoscopic 10 sigmoid resections, five left colectomies, and two right colectomies. Fourteen simultaneous liver biopsies were performed during laparoscopy. No perioperative deaths were registered. Perioperative mortality rate is 0%. Perioperative morbidity rate is 0%. No perioperative complications. The median perioperative stay is 5.3 days. Median blood loss is 47.9 mL. Overall, three units of blood were transfused. The median transfusion rate is 0.17 units per patient. The median operative time is 130.2 minutes. Conclusion: The laparoscopic approach is associated with very good perioperative results in patients with stage IV colorectal cancer and palliative resection of the primary tumor. Early hospital discharge and minimal operative trauma may not influence early administration of chemotherapy.

Pain level and analgesic requirements in patients who underwent vaginal pelvic floor surgery following general or spinal anesthesia.

This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent GA or SA during vaginal pelvic floor surgeries. A retrospective cohort study. Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery. During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, P=0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p=0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient's age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR= 0.33, p=0.008) and mid-urethral sling placement (aOR= 0.37, p=0.004). Limitaions: This is a rerospective study, thus the choice of anesthesia may be biased. SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries. GENERAL ANESTHESIA; SPINAL ANESTHESIA, ANALGESIA, PELVIC FLOOR SURGERY, PELVIC ORGAN PROLAPSE, STRESS URINARY INCONTINENCE, ERAS. Vaginal pelvic floor surgeries under spinal anesthesia is associated with less postoperative pain and intravenous analgesia requirement.

Peri-Operative Hypothermia in Trauma Patients: A Retrospective Cohort Analysis at a Busy District General Hospital Within the National Health Service (NHS).

Perioperative hypothermia is defined as a patient's core body temperature of less than 36°C, whichcan lead to several complications. Even mild hypothermia increases the incidence of post-operative wound infection, post-operative ischaemic cardiac eventsand intra-operative blood loss and prolongs post-operative recovery. It is, hence, essential to maintain and provide normothermia during the perioperative phases for optimal surgical results and patient satisfaction. One of the most significant contributing factors to intra-operative hypothermia is the induction of general anaesthesia, where a significant amount of heat is shifted from the core to the peripheral circulation with consequent loss to an often-cold environment. The difference between the patient's skin and ambient temperature during the interval from entering the operating room through anaesthesia induction until draping and active warming may be significant. This study aims to look at the incidence of perioperative hypothermia in trauma and orthopaedics patients who present to a busy district general hospital in the National Health Service (NHS) and correlate this with the ambient theatre temperature and phases of surgery to draw a statistical significance. This retrospective observational study conducted at the North Manchester General Hospital's trauma and orthopaedics department included 300 patients listed in the trauma surgery list from 1 July 2023 to 31 August 2023. Inclusion criteria were trauma patients aged 16-85 years. Elective orthopaedic and other surgical speciality patients were excluded. The perioperative temperature measurements were collected from the anaesthesia records. Statistical calculations were conducted using the StatsDirect software (StatsDirect Ltd, Wirral, UK) from Manchester University NHS Foundation Trust, Manchester. Among the 300 patients, the overall incidence of hypothermia was 3% pre-operative, 18% pre-induction, 21% intra-operative, 21% post-operative, 3% in recovery and 0% post-recovery. Intra-operative hypothermia incidence was significant, given that active warming was applied to patients with pre-operative hypothermia. Multivariate regression analysis showed that pre-induction temperature and theatre ambient temperature were statistically significant in predicting intra-operative hypothermia. This study highlights the need for active interventions to recognise and prevent perioperative hypothermia in trauma and orthopaedics patients. Active pre-warming of patients and the operating rooms, regardless of surgery type and duration, is feasible and potentially beneficial. Further studies should include a randomised controlled trial comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

Surgical site infection in clean cases with or without antibiotics.

Objective: To assess the rate of infection in clean cases with antibiotics or without antibiotics. Study Design: Observational Prospective study. Setting: Surgical Unit 1, Independent University Hospital, Faisalabad. Period: Oct 2022 to February 2023. Methods: All patients were selected from surgical wards and OPD. Patients of any age group undergoing clean surgeries were included in this study. The demographic details such as age, gender and type of surgery were recorded for statistical analysis. Patients with Diabetes mellitus, hypertension and immune-compromised patients were excluded from these studies. All patients were kept under observation for 30 days to look any evidence of SSI. Results: One group is given antibiotics and the other does not. But No significant difference between the infection rate in both group. Conclusion: It was concluded that there is no role of antibiotics in infection control in clean cases.

Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative

Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus recommendations for fluid management in patients undergoing surgery. This article provides a summary of the recommendations for perioperative fluid management of surgical patients from the preoperative period until hospital discharge and for all types of elective and emergency surgery, apart from burn injuries and head and neck surgery. Where evidence was lacking, recommendations for future research were generated. Specific recommendations are made for fluid management in elective major noncardiac surgery, cardiopulmonary bypass, thoracic surgery, neurosurgery, minor noncardiac surgery under general anaesthesia, and critical illness. There are ongoing gaps in knowledge resulting in variation in practice and some disagreement with our consensus recommendations. Perioperative fluid management should be individualised, taking into account the type of surgery and important patient factors, including intravascular volume status and acute and chronic comorbidities. Recommendations are made for further research in perioperative fluid management to address important gaps.

Mohs Micrographic Surgery for the Treatment of Lentigo Maligna and Lentigo Maligna Melanoma: An Outcomes Study.

Lentigo maligna (LM), a type of melanoma in situ (MIS), usually develops on sun-damaged skin in the elderly. If left untreated, it may advance to the point of dermal invasion, developing into lentigo maligna melanoma (LMM). While surgeons have achieved robust clinical outcomes for LM treated with Mohs micrographic surgery (MMS), performing this treatment for LMM remains controversial and is not standard amongst all Mohs surgeons. We examined survival outcomes in LM/LMM cases treated with MMS and wide local excision (WLE). Data from the National Cancer Institute Surveillance, Epidemiology, and End Results (NCI SEER) program, collected from 2000-2019, was retrospectively analyzed. Patients with microscopically confirmed diagnosis of LM/LMM who received surgical treatment with MMS or WLE were included. The effect of different surgery types on melanoma survival was evaluated. A total of 22,852 LM/LMM cases performed during the years 2000-2019 were considered for analysis. There were no significant differences in disease-specific survival comparing WLE to MMS. Our research hints at the utility of MMS for LM/LMM. We encourage practitioners to consider MMS for the management LM/LMM when appropriate. J Drugs Dermatol. 2024;23(12):1094-1099.&nbsp; doi:10.36849/JDD.7898.

Otosclerosis and the evolution of stapes surgery: A historical and otopathological study.

To explore the historical evolution of surgical techniques for otosclerosis treatment, viewed through the lens of human temporal bone pathology to aid in understanding the disease and refining surgical interventions. A review of historical literature on otosclerosis, surgical techniques, and otopathological findings was conducted. Eight temporal bone specimens from the Paparella Otopathology & Pathogenesis Laboratory, University of Minnesota, and one from the University of California, Los Angeles, were analyzed. We selected two temporal bones from donors who underwent four different types of surgical procedures for otosclerosis: stapes mobilization, fenestration, stapedectomy, and stapedotomy. One successful and one complication case was selected for each procedure. Histopathological analysis was performed to assess the outcomes and complications associated with each technique. The study chronicles the progression of otosclerosis surgery from the stapes mobilization to modern stapedectomy and stapedotomy techniques. Initial procedures, like stapes mobilization and fenestration, yielded limited and temporary results with significant complications. The introduction of stapedectomy marked a significant improvement, with better long-term outcomes. Histopathological analysis revealed insights into the causes of surgical failures and complications. Otosclerosis surgery has evolved significantly, driven by advances in otopathology and surgical technology. While earlier techniques offered limited success, modern procedures like stapedectomy and stapedotomy provide improved outcomes and fewer complications. Ongoing research promises further advancements in the field, improving patient care and surgical efficacy. NA.

Unilateral Versus Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review and Meta-analysis.

Previous studies have shown a higher complication rate in bilateral (BL) compared to unilateral (UL) deep inferior epigastric perforator (DIEP) flap breast reconstructions. This systematic review and meta-analysis aimed to offer an update by including recent studies to thoroughly assess the complication rates in UL versus BL DIEP flap reconstructions and provide clear guidance for clinicians and their patients. A systematic review of the literature and comparative meta-analysis were performed to assess the differences in complication rates between UL and BL procedures. Only comparative studies that reported on postoperative complications after UL and BL DIEP flap breast reconstructions were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Five studies representing 5120 patients who underwent either UL or BL DIEP flap breast reconstructions were included. BL DIEP flap reconstructions were associated with a higher risk of total flap loss, with an OR of 1.48 (95% CI, 1.02-2.14) and a P value of 0.04. Conversely, the risk of reexploration surgery was reduced, with an OR of 0.68 (95% CI, 0.55- 0.84) and a P value of 0.0002. BL DIEP flap breast reconstruction carries a higher risk of complete flap loss compared with UL reconstructions, with a moderate risk increase. Despite this increased risk, the significant benefits of BL reconstruction make it a viable and recommended option for women requiring this type of surgery.

Caught Between Stewardship and Resistance: How to Treat Acute Complicated Diverticulitis in Areas of Low Antimicrobial Susceptibility?

Antimicrobial resistance is one of the main threats to public health, with multidrug-resistant (MDR) pathogens on the rise across continents. Although treatment guidelines generally recommend antimicrobial therapy for acute complicated diverticulitis, they do not specify treatment pathways according to local or national resistance profiles. There is sparse data regarding specific pathogens involved in Hinchey II–IV patients who undergo surgery. This study seeks to address these issues and determine how often and what types of MDR bacteria occur in patients undergoing emergency surgery. We prospectively enrolled patients admitted between 2020–2023 and who underwent emergency surgery for complicated acute diverticulitis. We analysed the inflammatory response parameters at admission, the type of surgery employed for source control, identified pathogens in the peritoneal samples, their antimicrobial susceptibility, the efficacy of antimicrobial empiric therapy, and mortality. Gram-negative bacteria were identified most often, with Escherichia coli being mostly MDR (43.9%) or extended-spectrum beta-lactamase producing (ESBL +ve) (24.4%), while most strains of Klebsiella pneumoniae were extended-spectrum beta-lactamase positive (ESBL +ve) (80%) and MDR (80%). Of the Enterococcus spp., 57.14% were vancomycin-resistant (VRE) strains. Patients with Hinchey III/IV were significantly more associated with MDR. Patients with multiple pathogens were significantly associated with ESBL+/VRE strains. Age, leucocytosis, and procalcitonin levels at admission were good indicators for mortality prediction, which occurred in four cases. In an age when antibiotic stewardship is advisable especially in emergency settings, the treatment should be tailored according to local profiles of MDR to ensure adequate outcomes for patients.

Multicenter study of OPRM1 A118G and promoter-region DNA methylation associations with opioid outcomes and chronic postsurgical pain after pediatric musculoskeletal surgery

Abstract Introduction: Mu opioid receptor gene (OPRM1) variant rs1799971 introduces a CpG site, which may influence DNA methylation (DNAm) and opioid/pain outcomes. Objectives: In this nested analysis, we investigated both OPRM1 A118G genotype and promoter/immediate downstream blood DNAm sequencing data for associations with opioid effects and chronic postsurgical pain (CPSP) in a surgical cohort. Methods: Prospectively recruited opioid naïve patients undergoing Nuss procedure or spinal fusion with rs1799971 genotypes (Illumina arrays), DNAm (next generation enzymatic methylation sequencing at Chr6:154,039,209-154,039,803) and outcomes—opioid analgesia (integrated opioid use + pain over postoperative days 0 and 1 normalized to surgery type), safety—respiratory depression (RD) in high opioid use groups, and CPSP (Numerical Rating Scale &gt;3/10 2-12 months postsurgery)—were included. Linear and logistic regression were performed to test genetic and epigenetic associations, adjusted for sociodemographics, cell types, and analgesics. Results: In this cohort (N = 112; 15.3 ± 2.0 years, 50% female, 83% White, 55% had CPSP, 13% had RD), DNAm at Chr6:154039216-154039217 was associated with CPSP (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.00-1.57; P = 0.03), Chr6:154039661-154039662 with acute integrated pain (β = −20.9, 95% CI, −40.70 to −1.10, P = 0.04), Chr6:154039520-154039521 (OR, 1.49; 95% CI, 1.09-2.03; P = 0.01), and Chr6:154039571-154039572 (OR, 1.47; 95% CI, 1.08-2.01; P = 0.02) with RD. Significant CpG sites were located in Repressed Polycomb chromatin states. Genotype was not associated with DNAm or outcomes. Conclusion: Our analyses support OPRM1 DNAm as predictors of acute and chronic pain/opioid outcomes in children after painful surgery. Study limitations included absent GG genotype, low sequencing coverage, and lack of correction for multiple testing.

Comparison of Ketamine/Diazepam and Tiletamine/Zolazepam Combinations for Anaesthesia Induction in Horses Undergoing Partial Intravenous Anaesthesia (PIVA): A Retrospective Clinical Study

The aim of this retrospective clinical study was to compare the combinations of ketamine/diazepam (KD group) and tiletamine/zolazepam (TZ group) for the induction of general anaesthesia in horses undergoing elective surgery. The data from the clinical and the anaesthetic records of 138 horses from 2021 to 2023 were evaluated, and the horses were divided in two groups: KD (n = 60) and TZ (n = 72). The horses were premedicated with romifidine and methadone IV; anaesthesia was induced with ketamine/diazepam for the KD group and tiletamine/zolazepam for the TZ group and was maintained with isoflurane and a constant rate infusion of romifidine. The data encompassed sex and neuter status, age, breed, weight, American Society of Anaesthesiologists physical status, type of surgical procedure performed under anaesthesia, induction time, induction score, surgery time, recovery time, and the recovery score using a descriptive scale. Baseline heart rate (HR), intraoperative HR, baseline respiratory rate (fR), intraoperative fR, mean arterial pressure (MAP), oxygen saturation (SpO2), and fraction of expired isoflurane (FE’Iso) were also recorded. The induction time was significantly longer (p = 0.004) in the TZ group (60 (40–120)) as compared to the KD group (50 (30–120)). Recovery time was also significantly longer (p ≤ 0.001) in the TZ group (46.5 (15–125)) as compared to the KD group (30 (5–105)). These findings suggested that, in adult horses undergoing elective surgery, TZ could be considered a valid alternative to KD for the induction of general anaesthesia. Additional experimental studies comparing the two induction regimens and their pharmacokinetic and pharmacodynamic characteristics are needed.

Impact of Intraoperative Nanocarbon Staining and parathyroid autotransplantation on parathyroid injury and recovery in adult thyroidectomy: a retrospective cohort study

BackgroundThyroid surgeries are intricate operations that carry the risk of damaging the parathyroid glands, which can result in hypocalcemia and potential long-term hypoparathyroidism. Innovative surgical techniques including Intraoperative Nanocarbon Staining (INS), aim to enhance the preservation of parathyroid glands. This study assesses the effectiveness of INS combined with parathyroid autotransplantation in reducing postoperative complications and preserving parathyroid function.MethodsThis retrospective cohort study assessed patients aged ≥ 18 who underwent thyroid surgery at a tertiary care hospital from January 2017 to December 2022. We compared the incidence of postoperative parathyroid injury, recovery rates of parathyroid function, and the incidence of permanent hypoparathyroidism between groups. Data on patient demographics, diagnosis, surgical details, parathyroid hormone levels, and calcium levels were collected and analyzed using chi-square tests, t-tests, and logistic regression.ResultsThe study included 198 patients, with 101 in the intervention group and 97 in the control group. Baseline characteristics such as sex ratio, age, BMI, and preoperative calcium levels showed no significant differences between groups. The intervention group demonstrated a significantly shorter duration of intravenous calcium supplementation (median 2 vs. 3 days, p < 0.001) and higher calcium nadir levels (median 8.36 vs. 7.85 mg/dL, p < 0.001) compared to controls. Furthermore, the incidence of postoperative parathyroid injury and permanent hypoparathyroidism was lower in the intervention group (15.84% vs. 20.62%, p = 0.045 and 4.95% vs. 15.46%, p = 0.003, respectively). Multivariate analysis revealed factors such as Blood iPTH monitoring level (OR 1.053, 95% CI 1.009–1.099, P = 0.018) and surgery type (Near Total Thyroidectomy) (OR 0.447, 95% CI 0.202–0.990, P = 0.047) were positively associated with surgical success. The intervention group also showed higher surgery success rates (OR 2.054, 95% CI 1.017–4.150, P = 0.045).ConclusionThe application of INS and parathyroid autotransplantation during thyroidectomy significantly improves postoperative parathyroid gland function, reducing the incidence of permanent hypoparathyroidism. These findings support the incorporation of these techniques into standard surgical practice for thyroidectomy.

National trends in surgical treatment and clinical outcomes among patients with aneurysmal subarachnoid hemorrhage in the Republic of Korea.

In this study, changes in treatment methods and patient prognosis were analyzed using a Korean nationwide medical insurance information database. Patients with subarachnoid hemorrhage who received surgical treatment for cerebral aneurysm from 2005 to 2020 were included. The specific surgery type was classified using the surgical code and according to whether stents were used. Yearly trends in mortality rates and poor prognosis, using tracheostomy as proxy, were analyzed by a simple regression analysis. A multistep logistic regression analysis was performed to evaluate the risk factors of mortality and poor prognosis. Overall, 83,587 patients were included. Females were predominant (64.5%). Microsurgical clip usage rate decreased by approximately two-thirds from 78.8% in 2005 to 24.4% in 2020. Contrarily, endovascular treatment proportion gradually increased, and stent-assisted coil embolization rate surpassed microsurgical clip usage rate in 2020 (24.6% vs. 24.4%). In the multivariate analysis, endovascular treatment correlated positively with 3-month mortality (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 1.07-1.19, P<0.0001), although correlated negatively with poor prognosis (tracheostomy) (HR: 0.93, 95% CI: 0.89-0.98, P=0.0050). According to the treatment trend analysis, during the 16 years studied, for patients with subarachnoid hemorrhage due to ruptured cerebral aneurysm, the endovascular treatment rate increased rapidly and stent-assisted coil embolization rate surpassed that of microsurgical clip ligation. Diversification of treatment methods has led to a decrease in mortality and improved prognosis.

Optimal timing of chemoradiation after resection or biopsy of glioblastomas: a nationwide population-based study

BackgroundThis study investigated the optimal timing of concurrent chemoradiotherapy (CCRT) following surgery for patients with newly diagnosed glioblastoma (GBM). The focus was on understanding whether the interval between surgery and CCRT impacts survival outcomes.MethodsData from the Korean National Health Insurance Research Database (https://opendata.hira.or.kr/) were collected to retrospectively review 3,586 patients diagnosed with GBM in South Korea between 2008 and 2021. Patients were divided into early CCRT (≤ 21 days between surgery and CCRT) and late CCRT (> 21 days between surgery and CCRT) groups and further categorised based on the type of surgery (biopsy alone or surgical resection). The study estimated overall survival (OS) and conducted univariable and multivariable Cox regression analyses.ResultsThe median overall survival (OS) for the entire cohort was 19.98 months (95% Confidence Interval [CI]: 19.12–20.86 months). In univariable analysis, the late CCRT group demonstrated a longer median OS compared to the early CCRT group (20.47 vs. 17.94 months, P = 0.0002, log-rank test). However, this difference was not significant in multivariable analysis (Hazard Ratio [HR] = 0.98, 95% CI: 0.782–1.091, P = 0.6663). Subgroup analysis revealed that late CCRT was associated with prolonged OS in patients who underwent surgical resection (adjusted HR = 0.85, 95% CI: 0.752–0.955, P = 0.0065), whereas in the biopsy-alone group, late CCRT was associated with shorter OS (adjusted HR = 1.80, 95% CI: 1.378–2.346, P < 0.0001).ConclusionsPatients who initiated CCRT more than 21 days post-resection demonstrated improved overall survival (OS) compared to those who began CCRT earlier. In contrast, among patients who underwent biopsy alone, initiating CCRT within 21 days was associated with better outcomes. These findings suggest that the optimal timing for CCRT initiation in GBM may depend on the extent of residual tumour.

The association between surgical start time and spine surgery outcomes

ObjectiveNeurosurgical operations, including spine surgeries, often occur outside “normal business hours” due to the urgent or emergent nature of cases. This study investigates the association of surgical start time (SST) with spine surgery outcomes. MethodsA retrospective cross-sectional study was performed using electronic health record data from a multi-hospital academic health system from 2017 to 2024. Eligible patients included adults who underwent spine surgery with a recorded SST. Patients were separated into a regular hours group (7:00 A.M. to 5:00 P.M.) and an afterhours group (SST outside this time window). The association between SST and extended length of stay (greater than 3 days), readmission, and discharge disposition was examined. ResultsThe sample included 12,658 patients with 10,737 (84.8 %) patients in the regular hours group and 1921 (15.2 %) patients in the afterhours group. Afterhours SST had significantly increased rates of extended length of stay, non-home discharge disposition, and readmission compared to regular hours SST. Adjusting for age, comorbidities, case classification, the time from admission to SST, and surgery type, afterhours SST was significantly associated with non-home discharge disposition (OR 1.27, 95 % CI 1.12 – 1.45, p < 0.001). ConclusionThis is the largest study to examine the association of SST with outcomes of spine surgery. Controlling for potential confounders, afterhours SST was significantly associated with non-home discharge disposition.

Analysis of surgical volume and short‐term outcomes for upper gastrointestinal cancer post‐COVID‐19: Evidence from a nationwide Japanese database

AbstractAimPrevious studies indicated that short‐term outcomes for gastroenterological surgeries did not worsen during the COVID‐19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre‐ and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short‐term outcomes.MethodsData from the Japan's National Clinical Database (NCD) were analyzed for patients who underwent esophagectomy for esophageal cancer and gastrectomy for gastric cancer between January 2018 and December 2023. We evaluated changes in surgical volume, intensive care unit (ICU) use, morbidity, mortality rates, and the standardized morbidity and mortality ratio (SMR)—a comparison of observed versus expected outcomes using an NCD‐established risk calculator. Key metrics included 30d mortality, surgical mortality, and four major morbidities like pneumonia and anastomotic leakage.ResultsEsophagectomy volumes remained stable from 2018 to 2023, while gastrectomy volumes decreased notably over the past 6 y. The proportion of patients over 70 increased significantly in both surgery types. Morbidity and mortality rates showed no significant deterioration postpandemic, as indicated by SMR values.ConclusionsThis study analyzed changes in surgical volume and short‐term outcomes for upper gastrointestinal cancer in the post‐COVID‐19 era using a Japanese nationwide database. It found that surgical treatments for gastrectomy and esophagectomy remained safe even after the pandemic.

Student Perspectives of Access to Surgery Under General Anaesthetic in the Undergraduate Dental Curriculum

ABSTRACTIntroductionDelivering dental graduates who are competent to carry out extractions and surgical extractions can be challenging. Access to general anaesthetic (GA) operating provides an opportunity not only for hands‐on experience but also to reinforce teaching in oral and maxillofacial surgery. The aim of this study was to determine what our final year students' perceptions were of exposure to GA operating lists.Materials and MethodsThis was a mixed‐methods prospective study involving an anonymous online questionnaire followed by a focus group. All final year students (n = 60) were invited to participate by email at the end of the academic year and involvement in the focus group was voluntary. Information collected included the type of surgery observed, clinical experience gained and their impression of the experience and whether it influenced career aspirations.ResultsForty‐one students completed the questionnaire (68%) and 10 students participated in the focus group (17%). All students observed treatment under GA and 38 (93%) treated cases under GA. Thirty‐nine (95%) students attended an oral surgery list and 33 (80.5%) attended an OMFS list. Most students carried out deciduous extractions (78%) and 15% carried out dentoalveolar surgery. Treatment observed was primarily oncological (70%) and dentoalveolar cases (54%). Access to GA was well received by the students who felt it provided improved teaching opportunities and helped to conceptualise the didactic teaching on the subject and place their dentistry within a wider healthcare context. Some students indicated a desire to pursue a career in oral surgery (37%) or OMFS (10%).ConclusionThe results presented here are indicative that students appreciate the learning opportunity afforded by the GA experience and our recommendation would be to perpetuate access to GA lists and the associated surgical exposure.