Operative Volume Research Articles

Socioeconomic inequalities in hospital access for prostate cancer before and after COVID-19

Prostate cancer is one of the most common cancers with 36,016 registered cases in 2020 in the United Kingdom. Access to cancer care remains a policy priority across OECD countries, but there are concerns that socioeconomic inequalities have been amplified following the COVID-19 pandemic due to accumulated backlogs. Using administrative data from the Hospital Episodes Statistics, this study examines socioeconomic inequalities in different dimensions of access to prostate cancer surgery in England in 2015–22, and whether such inequalities increased after COVID-19. Access is a multifaceted concept encompassing several dimensions along the patient pathway. We investigate socioeconomic inequalities in the volume of surgeries, waiting time of patients on the list (patient responsiveness), hospital length of stay (intensity of care), 30-day emergency readmissions and 3-year mortality (health outcomes). We find that, after controlling for a range of factors (e.g. age composition, ethnicity, rurality, primary care availability), the number of prostate surgeries for the most income-deprived quintile is 41.0 % lower than the least income-deprived quintile in the pre-COVID period. The gradient appears similar in the post-COVID period in proportionate terms when volume dropped. We generally find no evidence of inequalities in other dimensions of access, such as waiting times (from patient addition to treatment list) and length of stay (from hospital admission to discharge). We also find no evidence of inequalities in the probability of being readmitted as an emergency within 30 days from discharge. Instead, patients in the most income-deprived quintile have a higher mortality rate by at least one percentage point relative to the least-deprived quintile. This difference in mortality does not appear to be related to differences in the quality of care across hospitals. The analysis highlights the need to take a multidimensional approach when assessing socioeconomic inequalities in access to hospital care along the patient pathway.

Comparison of Hospital Volume and Risk-Standardized Mortality Rate as a Proxy for Hospital Quality in Complex Oncologic Hepatopancreatobiliary Surgery

BackgroundCentralization of hepatopancreatobiliary procedures to more experienced centers has been recommended but remains controversial. Hospital volume and risk-stratified mortality rates (RSMR) are metrics for interhospital comparison. We compared facility operative volume with facility RSMR as a proxy for hospital quality.Patients and MethodsPatients who underwent surgery for liver (LC), biliary tract (BTC), and pancreatic (PDAC) cancer were identified in the National Cancer Database (2004–2018). Hierarchical logistic regression was used to create facility-specific models for RSMR. Volume (high versus low) was determined by quintile. Performance (high versus low) was determined by RSMR tercile. Primary outcomes included median facility RSMR and RSMR distributions. Volume- and RSMR-based redistribution was simulated and compared for reductions in 90-day mortality.ResultsA total of 106,217 patients treated at 1282 facilities were included; 17,695 had LC, 23,075 had BTC, and 65,447 had PDAC. High-volume centers (HVC) had lower RSMR compared with medium-volume centers and low-volume centers for LC, BTC, and PDAC (all p < 0.001). High-performance centers (HPC) had lower RSMR compared with medium-performance centers and low-performance centers for LC, BTC, and PDAC (all p < 0.001). Volume-based redistribution required 16.0 patients for LC, 11.2 for BTC, and 14.9 for PDAC reassigned to 15, 22, and 20 centers, respectively, per life saved within each US census region. RSMR-based redistribution required 4.7 patients for LC, 4.2 for BTC, and 4.9 for PDAC reassigned to 316, 403, and 418 centers, respectively, per life saved within each US census region.ConclusionsHVC and HPC have the lowest overall and risk-standardized 90-day mortality after oncologic hepatopancreatobiliary procedures, but RSMR may outperform volume as a measure of hospital quality.

Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria.

This study aimed to analyze multicenter patterns in cleft deformity surgeries and identify factors associated with the timing of primary cleft repair in Nigeria. A cross-sectional study of children managed for clefts from January 2009 to December 2020 at three Smile Train partner tertiary institutions situated in the east (Enugu), west (Ibadan), and northern (Jos) parts of the country using a prospectively collected database. Outcomes were the types of surgery performed, yearly volume of surgeries, methods of repair, and time of surgery (early versus late). Of 1043 cleft surgeries, nearly half (45.7%) involved infants (<12 months). Primary repairs of the lip or palate were performed in 83.4% of cases, with 58.4% for lip repairs and 25.1% for palate repairs. The most common cleft lip repair method was a variant of Millard rotation advancement flap. Over the study years, there was a shift from von Langenbeck palatoplasty to methods such as Bardach's palatoplasty and intravelar veloplasty. Patients with bilateral cleft lip defects were significantly more likely (P < 0.001) to undergo early repairs compared with those with unilateral defects. Late primary cleft lip repairs were significantly (P < 0.001) more common in Enugu. This study highlights the variability in cleft surgery patterns in Nigeria. Late primary cleft surgeries were associated with less severe cleft lip or cleft palate and were more prevalent in Enugu, Southeastern Nigeria. The findings contribute valuable insights for optimizing surgical approaches and resource allocation in the management of cleft deformities in the region.

Demystifying the association of center-level operative trauma volume and outcomes of emergency general surgery

BackgroundRecent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality. MethodsAdults (≥18 years) undergoing complex emergency general surgery operations (large and small bowel resection, repair of perforated peptic ulcer, lysis of adhesions, laparotomy) were identified in the 2016 to 2020 Nationwide Readmissions Database. Multivariable risk-adjusted models were developed to evaluate the association of treatment at a high-volume trauma center (reference: low-volume trauma center) with clinical and financial outcomes after emergency general surgery. To evaluate hospital quality, mortality among adult hospitalizations for acute myocardial infarction was assessed by hospital trauma volume. ResultsOf an estimated 785,793 patients undergoing a complex emergency general surgery operation, 223,116 (28.4%) were treated at a high-volume trauma center. Treatment at a high-volume trauma center was linked to 1.19 odds of in-hospital mortality (95% confidence interval 1.12–1.27). Although emergency general surgery volume was associated with decreasing predicted risk of mortality, increasing trauma volume was linked to an incremental rise in the odds of mortality after emergency general surgery. Secondary analysis revealed increased mortality for admissions for acute myocardial infarction with greater trauma volume. ConclusionWe note increased mortality for emergency general surgery and acute myocardial infarction in patients receiving treatment at high-volume trauma centers, signifying underlying structural factors to broadly affect quality. Thus, decoupling trauma and emergency general surgery services may not meaningfully improve outcomes for emergency general surgery patients. Our findings have implications for the evolving specialty of emergency general surgery, especially for the safety and continued growth of the acute care surgery model.

Numerical investigation on vortex characteristics in a low-head Francis turbine operating of adjustable-speed at part load conditions

In this paper, the vortex characteristics in a low-head Francis turbine operating of adjustable-speed at part load conditions are numerically investigated. First, the rules of fixed-speed and adjustable-speed operations are introduced in detail, aiming at operating limits extension. Second, comparative analysis on vortex rope is conducted, with emphasis on vortex rope volume, tail water excitation and spontaneous power swing. Finally, inter-blade vortex has been analyzed and successfully demonstrated, and its induced high amplitude pressure fluctuation characteristic is explored. It is found that at deep part load, vortex rope volume and power swing coefficient of adjustable-speed operation decreased by 69 % and 61 % respectively. The amplitude of Rheingans frequency decreased by 17 %, while the amplitude of blade passing frequency increased by 83 %. After decreasing runner speed, inter-blade vortex is stranded at blade suction surface leading-edge. In addition to low-frequency disturbance, pressure fluctuation shows high-frequency wide-band characteristics. It is concluded that adjustable-speed operation has beneficial effects on improvement of cavity cavitation and energy stability. As for hydraulic stability, the Rotor-Stator Interaction effect cannot be ignored. After changing runner speed, the inter-blade vortex becomes more serious, which could provoke low-cycle and high-cycle fatigue of the blades.

Variability in Surgical Case Volume Performed During ACGME-Accredited Orthopaedic Foot and Ankle Fellowship Training.

Previous studies have demonstrated a positive correlation between case volume and outcomes in foot and ankle surgery. This study elucidates surgical case volume benchmarks for Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic foot and ankle fellowship training in the United States. The ACGME provided case logs for orthopaedic residents and foot and ankle fellows (2018-2021). Variabilities in reported fellowship case volumes were defined as the fold-difference between 90th and 10th percentiles. Reported case volumes were compared between training cohorts with parametric tests. Case logs from 65 orthopaedic foot and ankle fellows and 3146 orthopaedic residents were included. Fellows reported 1.3- to 1.5-fold more foot and ankle cases during fellowship training than during residency training (P < .001). On average, orthopaedic foot and ankle fellows reported 405.4 cases and most were arthrodesis (17%), forefoot reconstruction (17%), mid/hindfoot reconstruction (13%), tendon repair/transfer (12%), and trauma ankle hindfoot (11%). Case categories with the highest variabilities were amputation (14.8-fold difference), infection/tumor (11.6-fold difference), arthroscopy (9.2-fold difference), and calcaneus (8.7-fold difference). Case volume benchmarks can assist trainees and faculty during orthopaedic foot and ankle training. More research is needed to determine case minimum requirements needed for autonomous practice in foot and ankle surgery. Level III.

Determining Time for completion Construction Projects Using Time List

The main text of civil contracts consists of three main parts: the contract’s subject, the contract’s amount, and the contract’s time. Various techniques are used to specify the amounts of civil projects. The most conventional method is using basic price lists published by Iran’s Planning and Budgeting Organization. By the end of the second phase of studies and design and following the completion of all maps and execution details, as well as the specification of the materials to be consumed, the consulting engineer initially determines the volumes of all executive operations from the map and then uses the prices of the items contained in the price lists published by the organization mentioned above to specify the execution price of each of the working items. In the end, the engineer sums up the costs of executing the items and applies the overhead factor to specify the cost of executing the project to initiate the process of tender. To determining time for completion the construction project, however, there is no computational technique, and the [time for completion process] is usually performed by the order of the employer or by taking into consideration the construction time of similar projects by the consulting engineers. One of the techniques to schedule the project is to use the critical path network technique. Project execution time is the sum of the time allotted to perform various working packages within a critical path. The duration of each work package can be determined by using the items that make up that work package. The time to execute each working item involves a probable distribution similar to a normal distribution, and the most probable time to execute an activity is in the middle of a probable distribution diagram. In the schedule, the duration of the execution of each work package is determined by using the previous experiences of the experts. According to Goldart, when people are asked to estimate the timing of an activity, they apply a safe time to insure themselves against unforeseeable events, though they can perform their activities at shorter times, also .In this study, to determine the execution time of each item included in the price list, the item price breakdown tables that have been published by the Program and Budget Organization have been used, and a list similar to the price list called the time list has been proposed, with the difference that For each item, instead of the implementation cost, the implementation time of that item is included according to the unit of that activity. First, the time list for building items, the price list of mechanical facilities and the price list of electrical facilities have been extracted, and then by using them, the execution time of the items of each work package is determined according to the amount of each item and the number of available resources, and the total times The implementation of work packages is the critical time of project implementation. Finally, the sum of times allotted to execute working packages will be on the critical path of project execution time. It was concluded that time for completion construction project execution by the time list showed a 22.6% reduction [in execution time] compared to the time prediction technique using expert experiences.

Experimental investigation of air step cooling by the combination of spray and chord grid for mine cooling

To address the issues of heat and humidity hazards, as well as insufficient air volume in deep mining operations, a novel cooling method combining spray and chord grid is proposed. To investigate the cooling dynamics, an experimental platform integrating both spray and chord grid components is independently developed. Field boundary conditions are simulated to conduct orthogonal experimental research. Under the experimental parameters of an inlet air temperature of 32 °C, relative humidity of 88 %, and initial spray water temperature of 26 °C, the effects of water-air ratio, nozzle distance, and other parameters on inlet and outlet temperature, as well as moisture content, are quantified. These influencing factors are analyzed through range analysis. Results demonstrate that the water-air ratio has a greater impact on cooling compared to the nozzle distance. Notably, when the water-air ratio and nozzle distance reach critical values of 0.6 and 70 cm respectively, the cooling rate begins to plateau. Furthermore, comparative analysis of the cooling and dehumidification effects of single spray versus spray + chord grid reveals that the cooling capacity of single spray systems can be surpassed by incorporating a chord grid. Specifically, the combination of spray + chord grid achieves superior cooling effects with lower water consumption.

An instance-based transfer learning model with attention mechanism for freight train travel time prediction in the China–Europe railway express

Since the inception of the China–Europe Railway Express (CRE), rail transportation has emerged as a predominant means of transporting goods across international borders. The quality and reliability of railway transport services are constrained by the precision of train travel times. However, the real-time data available for the CRE trains is rather limited due to the volume and duration of operations, which increases the difficulty of forecasting CRE train travel times. In order to enhance the accuracy of predictions, a novel two-stage transfer learning model with the Long Short-Term Memory attention (T.R2_LSTM_A) is introduced in this study. By incorporating attention mechanisms, the Long Short-Term Memory networks (LSTM) module, the two-stage TrAdaBoost.R2 algorithm, and transfer learning (TL), the model captures the inherent characteristics of time series data and attains a high level of accuracy in predictions. This approach effectively mitigates the limitations of current transfer learning methods, which are primarily caused by insufficient sample data. In the model, an instance-based TL method is utilized to address the shortcomings of insufficient data, and an attention-based LSTM is selected as a base learner to overcome the thorny issues of gradient disappearance and explosion. Additionally, LSTM Attention (LSTM_A), a novel attention mechanism, is introduced to improve the ability of the proposed model to capture complicated characteristics. The T.R2_LSTM_A model is systemically evaluated and shown to be superior to Random Forest (RF), Support Vector Regression (SVR), LSTM, convolution-based LSTM (CLSTM), AdaBoost_LSTM, LSTM with attention mechanism (LSTM_Attention), and TrAdaBoost.R2_RF (T.R2_RF) for predicting train travel time, using a real-life case study of CRE. The MSE, RMSE, MAPE, and MAE values for the T.R2_LSTM_A model are equal to 5.572, 2.361, 2.578, and 1.767, respectively. These values surpass those of other widely used prediction methods, indicating that the T.R2_LSTM_A model is well-suited for predicting train travel times in the CRE.

Assessment of electrical conductivity of polymer nanocomposites containing a deficient interphase around graphene nanosheet

In this study, a poor/imperfect interphase is assumed to express the effective interphase thickness, operative filler concentration, percolation onset and volume share of network in graphene–polymer systems. Additionally, a conventional model is advanced by the mentioned terms for conductivity of samples by the extent of conduction transference between graphene and polymer medium. The model predictions are linked to the experimented data. Likewise, the mentioned terms as well as the conductivity of nanocomposites are expressed at dissimilar ranges of various factors. The novel equations successfully predict the percolation onset and conductivity in the samples containing a poor/imperfect interphase. Thin and long nanosheets with high conduction transportation desirably govern the percolation onset and nanocomposite conductivity, but a bigger tunneling distance causes a lower conductivity.

A 16-Year Analysis of Aesthetic Surgery Volume and Its Association with U.S. Economic Performance

Abstract Goals/Purpose Historically, demand for plastic surgery has been associated with the performance of the United States (US) economy. Over the past two decades, the US has weathered a recession, several presidential election cycles, and has seen a rise in the use and influence of social media. Each of these events has led to varying effects on the economy, which undoubtedly have had an impact on plastic surgery demand and expenditures. Thus, this study aims to evaluate the relationship between indicators of economic performance and the popularity and profitability of aesthetic surgery from 2006 to 2022. Methods/Technique Data from the Aesthetic Society’s (AS) Aesthetic Plastic Surgery National Databank and the American Society of Plastic Surgeons’ (ASPS) Plastic Surgery Statistics Report was collected from 2006 to 2022. Surgical procedures analyzed included the most commonly performed cosmetic surgeries: breast augmentation, breast reduction, mastopexy, abdominoplasty, liposuction, blepharoplasty, facelift, and rhinoplasty. The non-surgical botox injections and dermal fillers were also included. A total of 24 variables were examined, including the 10 procedures and two composite variables—total surgical procedures and total injectables; case change percent difference and patient expenditures percent difference were recorded for each of these. Within the corresponding period, economic indices were collected, including personal disposable income per capita (PDI), consumer price index (CPI), medical care services CPI, average gross domestic product per capita (GDP), and annual average closing prices of the NASDAQ, S&amp;P 500, and the Dow Jones (DOW). Pearson correlation tests were used to analyze the strength of association between each financial indicator and case volumes and expenditures for each procedure included in the ASPS and AS reports. Results/Complications From 2006 to 2020 ASPS data demonstrated GDP year-over-year (YOY) change that was positively correlated with case volume and expenditures across 13 out of the 24 different procedure metrics (54.2%). From 2006 to 2016, AS data was positively correlated with the performance of NASDAQ, S&amp;P500, and DOW in 12 of the 24 procedure metrics (50%). GDP YOY change closely followed suit with positive correlations to 11 variables (45.8%). YOY change of PDI, CPI, and medical care services CPI were less frequently associated amongst both data sets. For ASPS data, YOY medical services CPI change was negatively associated with five variables, indicating that as medical services CPI increased, volume of procedures and expenditures decreased. PDI YOY change was not significantly associated with any variables. In the AS dataset between 2006 and 2016, CPI YOY change was not found to be significantly associated with any variables. Across 2019–2022, CPI YOY and disposable YOY change were found to be significantly associated with three variables each. Conclusion Our study suggests that aesthetic plastic surgery procedures and expenditures are most positively correlated with GDP. Stock market indices are additional financial indicators which have significant positive correlations with plastic surgery case volume and expenditures. Inflation indicators were less frequently correlated. Over this timeframe, several important financial events have occurred including the Great Recession, a stock market selloff in 2015 and 2016, and the COVID-19 pandemic. Each of these events, along with several election cycles and the increasing influence of social media and popular culture, have had variable impacts on consumers and the demand for aesthetic plastic surgery. Plastic surgeons should be familiar with US and global financial markets as they fluctuate with current events. While plastic surgery prices and demand may be difficult to anticipate, this study elucidates several factors that may be used by plastic surgeons as a bellwether for their practice.

Transoral Robotic Surgery and Radiation Volume Deintensification in Unknown Primary Squamous Cell Carcinoma of the Neck

Patients with unknown primary squamous cell carcinoma (CUP) with cervical metastases typically receive comprehensive radiotherapy (RT) of the pharynx and bilateral neck. Typically, these patients receive comprehensive RT of the pharynx and bilateral neck that may produce treatment-related toxic effects. To determine whether localization of occult oropharyngeal cancers with transoral robotic surgery (TORS) combined with reduced pharyngeal and neck RT volumes provides acceptable disease control. This phase 2, single-group nonrandomized controlled trial at a single institution accrued 32 prospective participants with p16-positive CUP without a primary squamous cell carcinoma on examination and imaging from 2017 to 2019, and 24-month follow-up. The data analysis was conducted from January 2021 to June 2022. Diagnostic- (n = 13) or therapeutic-intent (n = 9) TORS, with pharyngeal-sparing radiotherapy (PSRT) prescribed for negative margins or pT0, and unilateral neck RT (UNRT) prescribed for unilateral lymphadenopathy with lateralized primary tumor or pT0. Out-of-radiation treatment volume failure (<15% was hypothesized to be acceptable) and reports of local and regional recurrence, overall survival, toxic effects, swallowing outcomes (per the MD Anderson Dysphagia Inventory), and videofluoroscopic swallow (per Dynamic Imaging Grade of Swallowing Toxic Effects [DIGEST]) ratings. The study sample comprised 22 patients (mean [SD] age, 59.1 [5.7] years; 3 [14%] females and 19 [86%] male) with CUP. Of these, 19 patients (86%) had tumor stage cN1; 2 (9%), cN2; and 1 (5%), cN3. Five patients (23%), 14 patients (64%), and 3 patients (13%) had 0, 1, or 2 primary tumors, respectively. Twenty patients received RT; of these, 9 patients (45%) underwent PSRT and 10 patients (50%), UNRT. In the diagnostic-intent group, 8 patients (62%) and 5 patients (38%) underwent RT and RT-concurrent chemotherapy, respectively. In the therapeutic-intent group, 6 patients (67%) and 1 patient (11%) received adjuvant RT-concurrent chemotherapy, respectively; 2 patients declined RT. Two-year out-of-radiation treatment volume failure, locoregional control, distant metastasis control, and overall survival were 0%, 100%, 95%, and 100%, respectively. Grade 3 or 4 surgical, acute, and late toxic effects occurred in 2 (9%), 5 (23%), and 1 (5%) patients, respectively. PSRT was associated with lower RT dose to superior constrictors (37 vs 53 Gy; mean difference, 16 Gy; 95% CI, 6.4, 24.9), smaller decline in swallowing scores during treatment (19.3 vs 39.7; mean difference, -20.4; 95% CI, -34.1 to -6.1), and fewer patients with worsening DIGEST grade on findings of videofluoroscopic swallow studies at 2 years (0% vs 60%; difference, 60%; 95% CI, 30% to 90%). These findings indicate that TORS for p16-positive CUP allows RT volume deintensification with excellent outcomes and support future investigation in randomized clinical trials. ClinicalTrials.gov Identifier: NCT03281499.

'I've just got to take that risk and have faith . . .': The challenge of gaining and maintaining trust in patients undergoing knee surgery with a regional anaesthetic.

Traditionally, the focus of the operating theatre has been on conducting safe, efficient surgery with unconscious patients. However, the care of awake patients is now a prominent feature of modern perioperative practise as the volume of surgery performed under regional anaesthesia increases. The aim of this novel study was to understand the experience of being a conscious patient during regional anaesthesia and knee surgery in the perioperative environment. Data were gathered through observation and ethnographic interview and analysis followed a constant comparative grounded theory approach. The concepts of Trust and Faith are identified as recurrent themes highlighted in the data. This article identifies the need to understand patients' expectations regarding the clinical encounter and how subsequent treatment will develop, so that, reasons for any deviation can be discussed openly and an explanation provided. Each clinical encounter takes place within a relationship based upon an uneven distribution of power, enacted through the interaction itself, with the health care professional in a dominant role. It is the responsibility of health care staff to recognise and negate this power imbalance and reinforce trusting relationships so information and treatment options are not presented as a 'fait accompli' but negotiated through jargon free easy to understand language.

Current trends for venous thromboembolic prophylaxis for hip arthroscopy: a modified Delphi and nominal group technique consensus study

ABSTRACT The overall risk of venous thromboembolism (VTE) after hip arthroscopy (HA) is reported to range from 0.2% to 9.5%, but a clear set of recommendations for VTE prophylaxis in HA patients remains scarce. The aim is to survey high-volume hip arthroscopists about their current trends regarding VTE prophylaxis use. A combination of two consensus group methods was used in this study: nominal group technique (NGT) and modified Delphi. A preliminary questionnaire was prepared, and rounds of discussion were completed between NGT members. The final version of the survey was administered to 35 high-volume hip surgeons. Delegates’ mean volume of annual hip arthroscopic surgery was 109. Approximately 22% of their patients are revision HA procedures. A total of 91.4% of delegates use chemoprophylaxis, 28.6% use sequential compression devices and 91.4% believed that chemoprophylaxis is necessary for more prolonged and complex procedures (strong consensus). Aspirin was the choice for all participants, and the duration was 2–3 weeks (31.4%), 1 month (65.7%) and 2–3 months (2.9%). History of VTE, hypercoagulable status, and malignancy were considered risk factors. No consensus was achieved for the discontinuation of oral contraceptive and smoking preoperatively. However, the optimal length of VTE prophylaxis is unclear. A total of 97.1% of the experts responded that they administer aspirin between 2 and 4 weeks. High-volume arthroscopic surgeons do consider VTE prophylaxis to be important and warranted in the postoperative setting. Aspirin is the mainstay of chemoprophylaxis, although the appropriate duration is unknown.

Operative trends for pancreatic and hepatic malignancies during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic disrupted routine health care, including many elective and non-cancer operations in the United States. Most hepato-pancreato-biliary malignancy patients require outpatient imaging, tissue sampling, and staging, and many undergo neoadjuvant therapy before operative intervention. The aims of this study were to evaluate the effect of the COVID-19 pandemic on hepato-pancreato-biliary oncologic operations and to determine whether trends in neoadjuvant therapy were altered by the pandemic. MethodsAdult patients in the United States undergoing oncologic operations for pancreatic, primary and secondary hepatic malignancies, with or without neoadjuvant therapy, were extracted from the Vizient Clinical Data Base. Control chart analysis was used to plot trends over time and to determine whether changes were statistically significant. Wilcoxon rank-sum tests also compared monthly operative volume from pre-pandemic (12 month) and pandemic (28 months) periods. ResultsA total of 36,553 patients were identified over 40 months. Mean monthly pancreatic oncologic operations were unaffected by the pandemic (P = .257). Operations for pancreatic oncologic operations with prior neoadjuvant therapy increased throughout the pandemic (P = .002). Oncologic operations for primary and secondary hepatic malignancies were significantly reduced for 4 and 2 months, respectively, at the beginning of the pandemic but returned to their pre-pandemic baseline within 4 months (P = .169 and P = .598). ConclusionPancreatic operation volumes for cancer did not change, but pancreatic operations after neoadjuvant therapy continued to increase during the pandemic. Operations for hepatic malignancy were transiently disrupted but quickly normalized. These observations suggest that surgery for hepato-pancreato-biliary malignancies was prioritized during the pandemic.

Variation between surgeons in rate of reoperation after horizontal strabismus surgery among Medicare beneficiaries: associations with patient and surgeon characteristics and adjustable sutures.

Objective: To quantify variation between surgeons in reoperation rates after horizontal strabismus surgery, and to explore associations of reoperation rate with surgical techniques, patient characteristics, and practice type and volume. Methods: Fee-for-service payments in a national database to providers for Medicare beneficiaries having strabismus surgery on horizontal muscles between 2012 and 2020 were analyzed retrospectively to identify same calendar year reoperations. Multivariable linear regression was used to determine predictors of each surgeon's reoperation rate. Results: The reoperation rate for 1-horizontal muscle surgery varied between 0.0% and 30.8% among 141 surgeons. Just 7.8% of surgeons contributed over half of the reoperation events for 1-horizontal muscle surgery, due to the presence of high-volume surgeons with high reoperation rates. Surgeon seniority, gender, surgery volume, and use of adjustable sutures were not independently associated with surgeon reoperation rate. We explored associations of reoperation with patient characteristics, such as age and poverty. Surgeons in the South tended to have a higher reoperation rate (p=0.03) in a multivariable model. However, the multivariable model could only explain 16.3% of the inter-surgeon variation in reoperation rate for 1-horizontal muscle surgery. Discussion: Strabismus surgery is similar to other areas of medicine, in which large variations in outcomes between surgeons are observed. Future work can be directed towards explaining this variation. Conclusions: Patient-level analyses that fail to consider variation between surgeons will be dominated by a small number of high-reoperation, high-volume surgeons. Order-of-magnitude variations exist in reoperation rates among strabismus surgeons, the cause of which is largely unexplained.

Surgical treatment of degenerative stenotic lesions of the lumbar spine. Own experience of using minimally invasive techniques

Lumbar spinal stenosis is a multifactorial progressive condition mainly affecting older individuals, characterized by narrowing of the natural anatomical pathways passage of nerve structures, resulting in typical clinical symptoms. The disease affects about 103 million people in worldwide with an incidence of absolute lumbar spinal stenosis 19.4% among individuals aged 60-69 years. In the United States, about 600,000 surgical interventions for lumbar spinal stenosis are performed annually. This disease is one of the most common causes of lumbar pain and lower limbs in the elderly individuals, accompanied by claudication and ultimately leading to disability. The main cause of clinical symptoms of the lumbar spinal stenosis is the discrepancy between the sizes of nerve structures and their osteofibrous sheaths, resulting from gradually developing degenerative-dystrophic changes. Objective: To compare the outcomes of surgical treatment of patients with degenerative stenotic lesions of the lumbar spine using open and minimally invasive methods. Materials and methods. The results of surgical treatment of 97 patients with lumbar spinal stenosis aged from 28 to 81 years on the basis of the Department of Minimally Invasive and Laser Spinal Neurosurgery of the State Institution " A.P. Romodanov Neurosurgery Institute, Ukraine", " Neurosurgical Department №20 of Vinnytsia Regional Clinical Psychoneurological Hospital named after Acad. O.I. Yushchenko" of Vinnytsia Regional Council and "Spinex" Medical Center following all clinical research protocols. Patients were divided into four groups depending on the surgical intervention method. Results. The development of concepts regarding the mechanisms of occurrence and treatment methods of lumbar spinal stenosis are highlighted, as well as personal experience of using minimally invasive treatment techniques for this pathology in combination with the use of the ERAS (Enhanced Recovery After Surgery) protocol of perioperative patient management. It was found that the duration of hospital stay for patients with lumbar spinal stenosis statistically significantly desreased when using minimally invasive decompression (p≤0.05) and the ERAS rehabilitation protocol (p≤0.05). When comparing the average length of stay in the hospital of patients of the four groups, a statistically significant (p≤0.05) shorter length of stay in the hospital was observed for patients who underwent minimally invasive decompression using the ERAS rehabilitation protocol. The greatest reduction in pain intensity (according to the Numeric Pain Scale (NPS)) at 6 months post- intervention and rehabilitation was also noted in patients of this group. Conclusions. The use of minimally invasive techniques, the correct choice of surgical procedure volume (interbody fusion is desirable in surgery for degenerative spinal diseases) combined with Enhanced Recovery after Surgery protocol (ERAS) significantly improves postoperative well-being of patients, accelerates patient mobilization, and reduces the length of stay in the hospital.

A 16-Year Analysis of Aesthetic Surgery Volume and Its Association With US Economic Performance.

Abstract Background Historically, demand for plastic surgery has been associated with the performance of the United States (U.S.) economy. Objectives This study evaluates the relationship between economic performance indicators and the popularity and profitability of aesthetic surgery from 2006 to 2022 considering several recessions and the rise of social media. Methods Data was collected from the Aesthetic Society's (AS) Aesthetic Plastic Surgery National Databank and the American Society of Plastic Surgeons’ (ASPS) Plastic Surgery Statistics Report from 2006 to 2022. Procedures analyzed included the most performed cosmetic surgeries, as well as neuromodulator injections and dermal fillers. Pearson correlation tests were used to analyze the strength of association between eight financial indicators and case volumes and expenditures for each procedure. Results From 2006 to 2020, ASPS data demonstrated gross domestic product (GDP) per capita year-over-year (YOY) change that was positively correlated with case volume and expenditures across 13 out of the 24 different procedure metrics (54.2%). From 2006 to 2016, AS data was positively correlated with the YOY change of the NASDAQ, S&amp;P500, and Dow Jones in 12 of the 24 variables (50%). This was followed by GDP YOY change, with positive correlations to 11 variables (45.8%). YOY change of consumer-level finances and inflation indicators were less frequently associated amongst both data sets. Conclusion Our study shows that aesthetic plastic surgery procedures and expenditures correlate with GDP. While aesthetic surgery demand may be difficult to anticipate, this study elucidates several factors plastic surgeons may use as a bellwether for their practices.

Influence of the volume of surgical intervention on the severity of pain in patients after orthognathic surgery

BACKGROUND: The treatment of patients with jaw abnormalities involves orthognathic surgery, a consequence of which is postoperative pain. Considerable research is allocated to the study of pain and its management because pain affects the comfort of patients during rehabilitation. Currently, the factors that are responsible for the severity of postoperative pain syndrome remains debatable. Additionally, before surgical treatment, patients are concerned about the intensity of postoperative pain and its relationship with the extent of surgery. Owing to existing disagreements, primarily regarding the relationship between the volume of surgical intervention and the intensity of pain, conducting this study is critical.&#x0D; AIM: To identify factors that directly influence postoperative pain experienced by patients.&#x0D; MATERIALS AND METHODS: Pain intensity in patients on day 2 following orthognathic surgery was measured using visual analog scale (VAS).&#x0D; RESULTS: During the study, patients after orthognathic surgery were divided into groups based on the extent of surgery, sex, age, and duration of surgery to compare their VAS pain intensity scores. No significant difference was found in the average VAS scores of patients’ pain intensity (p 0.05) between the groups.&#x0D; CONCLUSION: The volume and duration of orthognathic surgery, age, and sex of the patients did not affect the intensity of pain.

Integral haematological indices and homocysteine in posthepatectomy liver failure

Background. The increase in the volume and number of hepatic surgeries is causing a rise in the frequency of postoperative complications, such as acute posthepatectomy liver failure.Aim. This article investigates changes in integral haematological indices and plasma homocysteine depending on the degree of development of posthepatectomy liver failure.Materials and methods. The article presents the results of the study of the value of leukocyte indices of cellular reactivity and plasma homocysteine level in 40 patients with different classes of acute posthepatectomy liver failure (PHLF). Patients were divided into three groups: those with postoperative class A, B and C PHLF. Data were analysed before surgical intervention, postoperatively and upon discharge.Results. A comparison of the average leukocyte indices in groups B and C of PHLF before surgery, postoperatively and upon discharge revealed a rise in most metrics. The notable increase in indicators of the progression and extent of endotoxicosis and inflammatory response suggests their potential use as screening markers for diagnosing and predicting this complication. Moreover, the considerable rise in plasma homocysteine levels in B and C PHLF groups during the postoperative phase indicates a disruption in the synthesis of the acid and correlates with functional liver failure.Conclusion. The haematological intoxication indices and plasma homocysteine levels ensure early detection of inflammatory response development and are diagnostically significant in identifying acute PHLF.