Correlation between BMI, amount of aspirated fat and post-operative complications in VASER liposuction: A single centre experience.

Background: Vibration amplification of sound energy at resonance (VASER) liposuction is an innovative technique that allows surgeons to selectively remove fat and shape desired areas of the body, resulting in more precise and controlled outcomes compared to traditional liposuction techniques. VASER liposuction offers several advantages, including targeted action that reduces trauma to the surrounding tissues, limiting pain, swelling and recovery time. Purpose: This study compared the complication rates among patients who underwent VASER liposuction in relation to their body mass index (BMI) and the amount of fat aspirated. Methods: The authors reviewed the medical records of all patients who underwent VASER liposuction at Scalera Clinic in Naples, dividing them into two groups: the first with BMI < 24.9 kg/m2 and second with BMI >25.0 kg/m2. Results: The authors examined 117 patients who were operated on within a year (2022/2023), with 48 of them having BMIs < 24.9 kg/m2 and 69 showing BMIs >25.0 kg/m2. In patients with a BMI >25 kg/m2, the most common complications were contusion, hematomas and abnormal skin retraction, whereas no complications were observed in the patients with normal-weight. Conclusions: To minimise post-operative complications and maximise results, it is advisable to select patients based on their BMI assessment, the anatomy of the treated body area and the volume of fat to be removed. This approach aims to ensure that the patients are suitable for the procedure and the achieved results align with their aesthetic expectations.

Pre-operative clinical deterioration and long-term surgical outcomes in 41 patients with split cord malformation type 1.

PURPOSE: To document the pre-operative rate of clinical deterioration in a cohort of patients with split cord malformation type 1 (SCM 1) and the early- and long-term surgical outcome in these patients. METHODS: Data from 41 patients with SCM 1 operated upon by the same surgeon (VR) between January 2008 to June 2023 were retrospectively reviewed with respect to history of clinical deterioration prior to surgery and early and long-term surgical outcomes. RESULTS: The mean age of the patients at presentation was 79.3 months and the male to female ratio was 1:1.93. Twelve (29%) patients had congenital deficits whereas 4 (10%) patients had no neurological deficits. Twenty-six (63%) patients had kyphoscoliosis and 25 (61%) patients had motor dysfunction. Thirty-three (81%) patients (8/12 (67%) with congenital deficits) had clinical deterioration prior to surgery. By the age of 2 years, 56% of patients had clinical deterioration. After surgery, 18 (55%) patients with progressive symptoms had improvement in one or more of their symptoms on long-term follow-up (mean, 63.4 months). There were no predictors of surgical outcome. CONCLUSIONS: Since over half of our patients with SCM 1 developed progression of congenital deficits or developed deficits by the age of 2 years, surgery should be performed as soon as possible in these children. On long-term follow-up after surgery, improvement can be expected in over half the patients.

Advancing Precision Rhinoplasty: Preoperative Digital 3D Surgical Planning.

The aim of the study is to assess the efficacy and advantages of utilizing state-of-the-art three-dimensional (3D) reconstruction technology in preoperative planning for rhinoplasty surgery. It is a study of a single rhinoplasty case that was operated at a tertiary hospital. The patient was assessed through a detailed history, blood investigations, radiological investigations and preoperative 3D (three-dimensional) reconstruction of the face and nose. The study utilized high-resolution CT scans and 3D reconstruction software like 3D (three-dimensional) Slicer and Blender 3D (three-dimensional) to analyze nasal anatomy for preoperative planning in rhinoplasty. External and internal nasal measurements were taken, and axial cross-section analysis was conducted to assess nasal structure deviation. The benefits of 3D (three-dimensional) visualization in surgical planning were evaluated, and surgical management was based on preoperative reconstructions. Comprehensive preoperative evaluations were performed, adhering to ethical guidelines. Preoperative 3D (three-dimensional) reconstruction planning methods facilitated precise surgical planning and execution in rhinoplasty with satisfactory outcomes for both the patient and the surgeon. Incorporating 3D (three-dimensional) reconstruction technology in rhinoplasty preoperative planning enhances surgical precision and patient satisfaction, ensuring optimized surgical outcomes while adhering to ethical standards.

Progress in surgical approaches and outcomes of patients with pheochromocytoma and paraganglioma.

Significant advances have been made in the past few decades in surgical management and outcomes of patients with pheochromocytoma and paraganglioma. Improvements in preoperative hypertensive control with the implementation of alpha- and beta-adrenergic blockade has resulted in better intra-operative blood pressure control and less incidence of hypertensive crises, which had been a large source of morbidity in the past. Emphasis on anesthesia and surgical team communication has also assisted in minimizing intraoperative hypertensive events at critical points of the operation. Shifting away from open resection, the now standard-of-care laparoscopic and minimally invasive adrenalectomy offers less pain, shorter hospitalizations, and quicker recoveries. Patient underlying germline mutations can guide the timing, approach, and extent of surgery. Postoperative outcomes have significantly improved with recent advancements in perioperative care in addition to regimented biochemical and radiographic surveillance. Here, we highlight the recent advancements in surgical approaches and outcomes for patients with pheochromocytoma and paraganglioma.

ACTH stimulation and oral salt loading tests detect biochemical outcome early after primary aldosteronism surgery.

BACKGROUND: In primary aldosteronism (PA), the biochemical outcomes of the Primary Aldosteronism Surgical Outcome study are used to assess aldosterone hypersecretion 6-12 months after surgery. However, few studies have investigated whether the outcomes can be predicted in the early postoperative period. In this retrospective study, we evaluated whether the adrenocorticotropin stimulation test (AST) and oral salt loading test (OST) performed immediately after surgery could predict biochemical outcomes 1 year after surgery. METHODS: We assessed 268 patients with PA who underwent adrenalectomy at our hospital between 2008 and 2020, underwent AST and OST within 15 days of surgery, and were assessed for biochemical outcomes 1 year after surgery. Patients were divided into two groups: biochemical complete success (B-com; n = 219) and incomplete success (B-inc; n = 49). Patients were divided into clinical complete and partial success and absent success groups. The relationships between various AST and OST values and outcomes were analyzed. RESULTS: The B-inc group had significantly higher plasma aldosterone concentration (PAC) and PAC/serum cortisol ratio (PAC/Cort) at baseline and after ACTH loading in AST and 24-hour urine aldosterone in OST than the B-com group. PAC/Cort at 30 min after ACTH loading (area under the curve (AUC) = 0.76) and 24-hour urine aldosterone (AUC = 0.77) were relatively superior predictors of the outcome. Parameters after ACTH loading were better predictors of biochemical and clinical outcomes than baseline. CONCLUSIONS: AST and OST immediately after surgery can predict biochemical and clinical outcomes 1 year after surgery in patients with PA.

Surgical treatment delay in patients with headache disorders and neuralgia correlates with poor postoperative outcome.

INTRODUCTION: Although nerve decompression surgery has proven to be effective in reducing symptoms in patients with head and neck neuralgia and headache disorders, it is currently not part of the treatment algorithms for headache disorders. Therefore, patients wait an average of 20 years from the onset of symptoms to surgery, resulting in high conservative treatment costs ($989,275.65 per patient) and patient morbidity. This study evaluated the clinical impact of treatment delays on surgical outcomes. METHODS: Overall, 282 patients who underwent nerve decompression surgery at Weill Cornell Medicine and Massachusetts General Hospital between September 2012 and January 2024 were enrolled. Information regarding demographics, onset of symptoms, and headache characteristics was collected using patient surveys. The treatment outcome was evaluated by the percentage of symptom reduction in terms of frequency, duration, and pain intensity. An area under the receiver operating characteristic analysis was performed to determine the optimal timepoint to undergo surgery. RESULTS: Postoperative symptom reduction and time between the onset of symptoms and surgery were negatively correlated (r = -0.22; p < 0.001). The most significant difference in outcome was found at 2.9 years from symptom onset; patients who underwent surgery before this timepoint reported an average improvement of 79 ± 23% versus 67 ± 35% in those who were treated after the timepoint (p = 0.021). CONCLUSION: Our results indicate that delays in undergoing nerve decompression surgery beyond 2.9 years from symptom onset leads to less favorable postoperative outcomes, underscoring the need for timely referral to peripheral nerve surgeons when conservative management fails. Nonetheless, even with delays in surgical intervention, patients continued to experience significant symptom reduction.

Assessment of Complications and Length of Hospital Stay Associated With Surgical Emergencies in Patients With Concurrent COVID-19 Infection.

The delivery of surgical services was profoundly affected by the COVID-19 pandemic, resulting in the postponement of elective surgeries and a shift in focus to essential emergency procedures. Our study aimed to assess the impact of concurrent COVID-19 infection on complications, hospital stay, and recovery following emergency surgery. A retrospective matched cohort study was conducted between July 2020 and February 2022 at a tertiary care hospital in India. Data from 48 patients with COVID-19 infection in the immediate preoperative period was compared with 48 matched controls not infected with the virus. The data collected included patient demographics, surgical procedures, duration of hospital stay, and postoperative complications. Patients with concurrent COVID-19 infection had notably longer mean hospital stays (13.44 days) than the controls (6.63 days) (P = 0.002). An elevated proportion of COVID-19-positive patients experienced discharge delays (36 out of 48, 75%), compared to just six of the 48 non-COVID-19 patients (12.5%) (P ≤ 0.001). Postoperative findings in the COVID-positive cohort revealed elevated rates of pulmonary complications (5/48, 10.4%), higher rates of postoperative ICU admissions (8/48, 16.7%), and persistently elevated D-dimer levels extending beyond postoperative day seven (18/48, 37.5%). This suggests that emergency surgery in patients with COVID-19 is linked to significantly lengthier hospital stays, increased discharge delays, and a greater prevalence of adverse events in the postoperative period when compared to controls. These findings underscore the need for enhanced perioperative strategies and preparedness for potential future pandemics.

Outcomes of Surgery for Inflammatory Bowel Disease Among Patients with Psychiatric Disorders.

BACKGROUND: Psychiatric disorders are common among patients with inflammatory bowel disease (IBD). Brain-gut dysfunction and psychotropic medications may have adverse effects on postoperative outcomes of IBD patients. The present work aimed to evaluate the association of psychiatric disorder with outcomes following surgery for IBD. METHODS: This was a retrospective study of adult IBD patients undergoing small bowel, colon, or rectal resection in the 2016-2021 Nationwide Readmissions Database. Psychiatric disorders including psychotic, mood, anxiety, eating, sleep, personality, and childhood-onset behavioral disorders were identified. Records with colorectal cancer were excluded. Multivariable regressions were used to examine the association of psychiatric disorder with outcomes. RESULTS: Of 81,955 patients included in the study, 26.6% had psychiatric disorders. Upon risk adjustment, psychiatric disorder was associated with significantly increased postoperative ileus (AOR 1.11 [95% CI 1.03-1.19]), length of stay (ß +1.4 days [95% CI 1.1-1.7]) and costs (ß +$2,100 [95% CI $1,200-3,100]) compared to no psychiatric disorder. Additionally, patients with psychiatric disorders experienced increased odds of non-home discharge (AOR 1.23 [95% CI 1.12-1.34]) and 30-day readmission (1.32 [1.22-1.43]). Over the study period, the prevalence of psychiatric disorders significantly increased from 24.3% to 28.5% (p<0.001), along with an increase in rates of ileus among patients with psychiatric disorders (8.1 to 15.8%, p<0.001). CONCLUSION: Psychiatric disorder is associated with significantly greater burden of adverse clinical and financial outcomes following IBD operations. Given the growing prevalence of mental health conditions among patients with IBD, further efforts to optimize preoperative psychiatric care may enhance quality of colorectal surgery.

The Surgical Outcomes of Modified Intraocular Lens Suturing with Forceps-Assisted Haptics Extraction: A Clinical and Basic Evaluation.

Background/Objectives: Postoperative intraocular lens (IOL) tilt is a risk associated with IOL scleral fixation. However, the cause of IOL tilt during IOL suturing remains unclear. Therefore, this study aimed to evaluate the surgical outcomes of a modified IOL suturing technique and investigate the factors contributing to postoperative IOL tilt and decentration. Methods: We included 25 eyes of 22 patients who underwent IOL suturing between April 2018 and February 2020. A modified IOL suturing technique that decreased the need for intraocular suture manipulation was used. Factors contributing to IOL tilt and decentration were investigated using an intraoperative optical coherence tomography (iOCT) system. Results: The mean postoperative best-corrected visual acuity improved from 0.15 ± 0.45 to -0.02 ± 0.19 (p = 0.02). The mean IOL tilt angle at the last visit after surgery was 1.84 ± 1.28 degrees. The present study reveals that the distance of the scleral puncture site from the corneal limbus had a stronger effect on IOL tilt; meanwhile, the suture position of the haptics had a greater effect on IOL decentration. Conclusions: The modified IOL suturing technique, which avoids intraocular suture handling, had favorable surgical outcomes with improved postoperative visual acuity and controlled IOL tilt and decentration. Accurate surgical techniques and careful measurement of distances during surgery are crucial for preventing postoperative IOL tilt and decentration.

Impact of Minimally Invasive Surgery on Early and Late Outcomes of Patients With Gastric Cancer Treated Using Neoadjuvant Chemotherapy.

BACKGROUND: Gastric cancer is the fifth most common neoplasm and the third leading cause of cancer-related death worldwide. Neoadjuvant chemotherapy is recommended for Stages II-III resectable tumors, but the comparative effectiveness of minimally invasive surgery (MIS) versus open gastrectomy (OG) post-neoadjuvant therapy has not been adequately investigated. METHODS: A retrospective cohort analysis was performed on patients with clinical Stage II and III gastric adenocarcinoma who underwent neoadjuvant chemotherapy followed by either MIS or OG between 2007 and 2020. Propensity score matching was utilized to compare the clinical and surgical outcomes, morbidity, and mortality, and the influence of MIS on 3-year survival rates was evaluated. RESULTS: After matching, no statistical differences in clinical aspects were noted between the two groups. MIS was associated with increased D2 lymphadenectomy, curative intent, and complete neoadjuvant therapy. Furthermore, this therapeutic approach resulted in reduced transfusion rates and shorter hospital stays. Nonetheless, no significant differences were observed in global, clinical, or surgical complications or mortality between the two groups. Weight loss emerged as a significant risk factor for complications, but MIS did not independently affect survival rates. Extended resection and higher American Society of Anesthesiology scores were independent predictors of reduced survival. CONCLUSION: MIS after neoadjuvant chemotherapy for gastric cancer appears to be a viable option, with oncological outcomes comparable to those of OG, less blood loss, and shorter hospital stays. Although MIS did not independently affect long-term survival, it offered potential benefits in terms of postoperative recovery and morbidity. Further studies are needed to validate these findings, especially across diverse populations.

Persistent income-based disparities in clinical outcomes of cardiac surgery across the United States: A contemporary appraisal.

Objective: Although national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade. Methods: All adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database. Patients were stratified into quartiles of income, with records in the 76th to 100th percentile designated as highest and those in the 0 to 25th percentile as lowest. To evaluate the change in adjusted risk of in-hospital mortality, complications, and readmission over the study period, estimates were generated for each income level and year. Results: Of approximately 1,848,755 hospitalizations, 406,216 patients (22.0%) were classified as highest income and 451,988 patients (24.4%) were classified as lowest income. After risk adjustment, lowest income remained associated with greater likelihood of in-hospital mortality (adjusted odds ratio, 1.61, 95% CI, 1.51-1.72), any postoperative complication (adjusted odds ratio, 1.19, CI, 1.15-1.22), and nonelective readmission within 30 days (adjusted odds ratio, 1.07, CI, 1.05-1.10). Overall adjusted risk of mortality, complications, and nonelective readmission decreased for both groups from 2010 to 2020 (P < .001). Further, the difference in risk of mortality between patients of lowest and highest income decreased by 0.2%, whereas the difference in risk of major complications declined by 0.5% (both P < .001). Conclusions: Although overall in-hospital mortality and complication rates have declined, low-income patients continue to face greater postoperative risk. Novel interventions are needed to address continued income-based disparities and ensure equitable surgical outcomes.

Vaginal Packing After Pelvic Floor Reconstructive Surgery: Does the Soaking Agent Used for Packing (Bupivacaine, Estrogen or Saline) Impact Post-operative Pain Scores?"

STUDY OBJECTIVE: Vaginal packing is traditionally placed after pelvic floor reconstructive surgery (PFRS) to prevent hematoma formation. We seek to determine if there is a difference in post-operative pain scores after PFRS if vaginal packing is soaked with estrogen cream, bupivacaine, or saline. The primary outcome was pain as measured by a visual analog scale (VAS) at 2 hours, 6 hours, and 1 day post-operatively. Secondary outcomes include change in hemoglobin, urinary retention and length of stay (LOS) in hospital. DESIGN: Prospective cohort study SETTING: Tertiary care academic teaching hospital. All PFRS performed by fellowship-trained urogynecologists. PARTICIPANTS: Consenting patients undergoing PFRS. INTERVENTIONS: At the completion of surgery, gauze packing soaked with either estrogen cream 0.25% bupivacaine with 1% epinephrine, or normal saline was placed inside the vagina and removed on post-operative day 1. RESULTS: We included 210 patients (74 estrogen, 66 bupivacaine, 70 saline). There was no significant difference in mean post-operative pain scores between the groups (estrogen, bupivacaine, saline-soaked vaginal packs respectively) at 2 hours (2.66±2.25, 2.30±2.17, 2.24±2.07; p=.4656), 6 hours (2.99±2.38, 2.52±2.30, 2.36±2.01; p=.2181) or on post operative day 1 (1.89±2.01 vs. 2.08±2.15 vs. 2.44±2.19; p=.2832) as measured by VAS scores (0-10). There was no difference in the secondary outcomes of change in pre-/post-operative hemoglobin (21.8±10.73g/L, 20.09±11.55g/L, 21.7±9.62g/L, p=.68), urinary retention (37%, 45% and 48%, p=.45), LOS (1.05±0.46 days, 1.02±0.12, 1.03±0.24, p=.97) or in-hospital opioid usage during admission (represented in morphine milligram equivalents (median (IQR1, IQR3), Kruskal-Wallis test): 11.25mg (0,33), 7.5mg (0, 22.5) and 15mg (0, 33.88) p =0.41. CONCLUSION: There was no difference found between soaking vaginal packing with estrogen cream, bupivacaine, or saline after PFRS with respect to post-operative pain scores, LOS, in-hospital opioid usage, or urinary retention. Saline-soaked packing is an equivalent alternative to estrogen or bupivacaine vaginal packing. CLINICAL TRIAL REGISTRATION: NCT03266926. Registered February 1, 2017. https://clinicaltrials.gov/study/NCT03266926.

Early surgical outcome for Tetralogy Of Fallot In An African Setting; A Tanzanian experience using retrospective analysis of hospital data.

BACKGROUND: Tetralogy of Fallot (TOF) is typically treated in infancy but often done late in many resource-limited countries, jeopardizing surgical outcomes. This study examined the early results of children undergoing primary complete TOF repair at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania, an emerging cardiac center in Eastern Africa. METHODS: A retrospective cohort study of children ≤ 18 years undergoing primary TOF complete repair between 2019 and 2021 was conducted. Patients with complex TOF and those with obvious genetic syndrome were excluded. Data on socio-demography, pre-and postoperative cardiac complications, Intensive Care Unit (ICU) and hospital stay, and in-hospital and 30-day mortality were analyzed. Logistic regressions were employed to find the factors for mortality, ICU, and hospital stays. RESULTS: The I02 children underwent primary TOF complete repair were majority male (65.7%; n = 67), with a median age of 3.0 years (IQR: 2-6), ranging from 3 months to 17 years.Only 20 patients (19.6%) were below one year of age. Almost all (90%; n = 92) were underweight, with a mean BMI of 14.6 + 3.1 kg/m2 Haematocrits were high, with a median of 48.7 (IQR: 37.4-59.0). The median oxygen saturation was 81% (IQR:72-93). Over a third of patients (38.2%; n = 39) needed Trans annular patch (TAP) during surgery. The median ICU stay was 72 h (IQR:48-120), with ICU duration exceeding three days for most patients. The median hospital stay was 8.5 days (IQR:7-11), with 70 patients (68.2%)experiencing an extended hospital stay of > 7 days. Bacterial sepsis was more common than surgical site infection (5.6%; n = 6 vs. 0.9%;n = 1). No patient needed re-operation for the period of follow up. The in-hospital mortality rate was 5.9%, with no deaths occurring in children less than one year of age nor after discharge during the 30-day follow-up period. No statistically significant differences were observed in outcomes in relation to age, sex, levels of hematocrit and saturations, presence of medical illnesses, and placement of TAP. CONCLUSION: TOF repairs in this African setting at a national cardiac referral hospital face challenges associated with patients' older age and compromised nutritional status during the surgery. Perioperative mortality rates and morbidity for patients operated at an older age remain elevated. It's important to address these issues to improve outcomes in these settings.

Long-Term Outcomes Following Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana.

Objective: To assess long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Background: Task sharing of surgical care with nonsurgeons can increase access to essential surgery. Long-term safety and outcomes of task sharing are not well-described for hernia repair. Methods: This prospective cohort study was conducted in Ho, Ghana. After completing a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repairs with mesh on men with primary, reducible hernias. The primary outcome of this study was hernia recurrence at 5 years. The noninferiority limit was 5 percentage points. Secondary endpoints included pain and self-assessed health status at 5 years. Results: A total of 242 operations in 241 participants were included, including 119 hernia repairs performed by the medical doctors and 123 performed by the surgeons. One hundred and sixty-nine participants (70.1%) were seen in follow-up at 5 years, 29 participants (12.0%) had died and 43 (17.8%) were lost to follow-up. The overall 5-year recurrence rate was 4.7% (n = 8). The absolute difference in recurrence rate between the medical doctor group (2 [2.3%]) and the surgeon group (6 [7.3%]) was -5.0 (1-tailed 95% confidence interval, -10.5; P = 0.06), demonstrating noninferiority of the medical doctors. Participants experienced improvements in groin pain and self-assessed health status that persisted at 5 years. Conclusions: Long-term outcomes of elective mesh inguinal hernia repair in men performed by medical doctors and surgeons in Ghana were excellent. Task sharing is a critical tool to address the substantial morbidity of unmet hernia surgery needs in Ghana.

Surgical Outcomes and Sociodemographic Disparities Across All Races: An ACS-NSQIP and NHIS Multi-Institutional Analysis of Over 7.5 Million Patients.

Background: This study aims to fill the gap in large-scale, registry-based assessments by examining postoperative outcomes across diverse races/ethnicities. The focus is on identifying disparities and comparing them with socioeconomic demographics. Methods: In a registry-based cohort study using the 2008 to 2020 American College of Surgeons National Surgical Quality Improvement Program, we evaluated 24 postoperative outcomes through multivariable analysis, incorporating 28 preoperative risk factors. In a separate, independent analysis of the 2019 to 2020 National Health Interview Survey (NHIS) database, we examined sociodemographic racial/ethnic normative data. Results: Among 7,504,734 American College of Surgeons National Surgical Improvement Database patients specifying race, 83.8% were White (WT), 11.8% Black or African American (B/AA), 3.3% Asian (AS), 0.7% American Indian or Alaska Native (AI/AN), 0.4% Native Hawaiian or Pacific Islander (NH/PI), 7.3% Hispanic. Reoperation trends reveal favorable outcomes for WT, AS, and NH/PI patients compared with B/AA and AI/AN patients. AI/AN patients exhibit higher rates of wound healing issues, while AS patients experience lower rates. AS and B/AA patients are more prone to transfusions, with B/AA patients showing elevated rates of pulmonary embolism, deep vein thrombosis, renal failure, and insufficiency. Disparities in discharge destinations exist. Hispanic patients fare better than non-WT Hispanic patients, contingent on race. Racial groups (excluding Hispanic patients) with superior surgical outcomes from the NSQIP analysis were found in the NHIS analysis to report higher wealth, better healthcare access, improved food security, greater functional and societal independence, and lower frailty. Conclusions: Our study underscores racial disparities in surgical outcomes. Focused investigations into these complications could reveal underlying causes, informing healthcare policies to enhance surgical care universally.

K-Line Tilt May Influence the Short-Term Surgical Outcomes After Laminoplasty in Patients With Degenerative Cervical Myelopathy.

STUDY DESIGN: A retrospective study. OBJECTIVES: To explore the relationship between K-line tilt and short-term surgical outcomes following laminoplasty in patients with multilevel degenerative cervical myelopathy (DCM), and to evaluate the potential of K-line tilt as a reliable preoperative predictor. METHODS: A retrospective analysis was performed for 125 consecutive patients who underwent laminoplasty for multilevel DCM. The radiographic parameters utilized in this study encompassed T1 slope (T1S), C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope minus C2-C7 lordosis (T1S-CL), C2-C7 range of motion (ROM), and K-line tilt. The neurological recovery was evaluated using the Japanese Orthopaedic Association (JOA) score. Pearson correlation coefficients were calculated to assess the relationship between K-line tilt and other classical cervical parameters. Logistic regression analysis was employed to examine the association between K-line tilt and surgical outcomes. RESULTS: Of the 125 patients, 89 were men. The mean age of the patients was 61.74 ± 11.31 years. The results indicated a correlation between the K-line tilt and the cSVA (r = 0.628, P < 0.001), T1S (r = 0.259, P = 0.004), and T1S-CL (r = 0.307, P < 0.001). The K-line tilt showed an association with the failure of the JOA recovery rate (RR) to reach the minimal clinically important difference (MCID) and the occurrence of postoperative kyphotic deformity. We identified cutoff values for the K-line tilt which predict the failure of the JOA RR to reach the MCID and postoperative kyphotic deformity as 10.13° and 9.93°, respectively. CONCLUSIONS: The K-line tilt is an independent preoperative risk factor associated with both the failure of the JOA RR to reach the MCID and the occurrence of postoperative kyphotic deformity in patients with multilevel DCM after laminoplasty.

Surgical outcomes following neoadjuvant chemotherapy with and without immunotherapy in patients with triple-negative breast cancer.

PURPOSE: Adding pembrolizumab to neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) improves pathologic complete response (pCR) rates and event-free survival. The impact of adding immunotherapy to NAC on surgical outcomes is unknown. This study compares 90-day post-surgical complications (PSCs) and time to adjuvant treatment among patients undergoing NAC for TNBC with and without immunotherapy. METHODS: Patients treated with NAC alone or with immunotherapy (NAC-I) for stage I-III TNBC between 2018 and 2022 were retrospectively identified at a single academic institution. Kruskal-Wallis rank sum and Fisher's exact tests compared patient sociodemographic and clinical characteristics. Multivariable logistic regression determined odds ratios (OR) predicting PSCs. RESULTS: Of 54 patients, 29 received NAC alone and 25 received NAC-I. Compared to NAC patients, NAC-I patients had more advanced stage tumors (p = 0.038), and had slightly higher rates of mastectomy with reconstruction (p = 0.193). 72.0% of NAC-I patients experienced a pCR, compared with 44.8% of NAC patients (p = 0.193). There were 10 PSCs (34.5%) in NAC patients compared to 9 PSCs (36.0%) in NAC-I patients (p > 0.99). Regression analysis demonstrated no association of PSCs with NAC-I (OR 0.83, 95% CI 0.19-3.60). Time to adjuvant therapy was shorter for NAC-I patients (28 days vs 36 days, p = 0.013). CONCLUSIONS: Patients with TNBC receiving NAC-I have higher pCR rates and do not appear to have added 90-day PSCs or delays to adjuvant therapy despite trending toward more extensive surgical procedures compared to NAC alone. Larger studies are needed to further evaluate the surgical safety of immunotherapy.

Impact of congenital spinal stenosis on the outcome of three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy: a retrospective study.

PURPOSE: To investigate whether congenital cervical spinal stenosis (CCSS) affects the outcome of three-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM). METHODS: One hundred seventeen patients with CSM who underwent three-level ACDF between January 2019 and January 2023 were retrospectively examined. Patients were grouped according to presence of CCSS, which was defined as Pavlov ratio ≤ 0.75. The CCSS and no CCSS groups comprised 68 (58.1%) and 49 (41.9%) patients, respectively. RESULTS: The Japanese Orthopaedic Association (JOA) score did not significantly differ between the two groups at any postoperative time point (p > 0.05). The JOA improvement rate was lower in the CCSS group 1 month after surgery (41.7% vs. 45.5%, p < 0.05), but showed no difference at any follow-up time point after one month. Multivariate logistic regression identified preoperative age (OR = 10.639), JOA score (OR = 0.370), increased signal intensity (ISI) in the spinal cord on T2-weighted MRI (T2-WI) (Grade 1: OR = 6.135; Grade 2: OR = 29.892), and degree of spinal cord compression (30-60%: OR = 17.919; ≥60%: OR = 46.624) as independent predictors of a poor one year outcome (JOA recovery rate < 50%). CONCLUSION: Although early JOA improvement is slower in the CCSS group, it does not affect the final neurological improvement at 1 year. Therefore, CCSS should not be considered a contraindication for three-level ACDF in patients with CSM. The main factors influencing one year outcome were preoperative age, JOA score, ISI grade, and degree of spinal cord compression.

Socioeconomic inequalities in patients undergoing abdominal wall reconstruction in the North-West of England, UK: a three-centre retrospective cohort study.

PURPOSE: Patients from deprived areas are more likely to experience longer waiting times for elective surgery, be multimorbid, and have inferior outcomes from elective and emergency surgery. This study aims to investigate how surgical outcomes vary by deprivation for patients undergoing elective abdominal wall reconstruction. METHODS: A three-centre retrospective cohort study was conducted across three hospitals in North-West England, including patients with complex ventral hernias undergoing abdominal wall reconstruction between 2013 and 2021. Demographic data, comorbidities, and index of multiple deprivation quintiles were recorded. RESULTS: 234 patients (49.6% female), age 57 (SD 13) years, underwent elective abdominal wall reconstruction. Significantly higher unemployment rates were found in the most deprived quintiles (Q1 and Q2). There were more smokers in Q1 and Q2, but no significant deprivation related differences in BMI, diabetes, chronic kidney disease or ischaemic heart disease. There were also higher rates of Clavien-Dindo 1-2 complications in Q1 and Q5, but no difference in the Clavien-Dindo 3-4 outcomes. Patients in Q1 and Q5 had a significantly greater hospital length of stay. CONCLUSION: The association between deprivation and greater unemployment and smoking rates highlights the potential need for equitable support in patient optimisation. The lack of differences in patient co-morbidities and hernia characteristics could represent the application of standardised operative criteria and thresholds. Further research is needed to better understand the relationship between socioeconomic status, complications, and prolonged hospital length of stay.

The impact of facility type on surgical outcomes in colon cancer patients: analysis of the national cancer database.

BACKGROUND: The type of facility where patients with colon cancer are treated may play a significant role in their outcomes. We aimed to investigate the influence of facility types included in the National Cancer Database (NCDB) on surgical outcomes of colon cancer. METHODS: Retrospective cohort analysis of all patients with stage I-III colon cancer included in the NCDB database between 2010 and 2019 was performed. Patients were grouped based on facility type: Academic/Research Programs (ARP), Community Cancer Programs (CCP), Comprehensive Community Cancer Programs (CCCP), and Integrated Network Cancer Programs (INCP). Study outcomes included overall survival, 30- and 90-day mortality, 30-day readmission and conversion to open surgery. RESULTS: 125,935 patients were included with a median age of 68.7 years (50.5% females). Most tumors were in the right colon (50.6%). Patient were distributed among facility types as ARP (n = 34,321, 27%), CCP (n = 12,692, 10%), CCCP (n = 54,356, 43%), and INCP (n = 24,566, 19%). In terms of surgical approach, laparoscopy was more commonly used in ARP (46%) (p < 0.001). Laparotomy was more common in CCP (58.7%) (p < 0.001), and conversely, CCP had the least amount of robotic surgery (3.9%) (p < 0.001). Median overall survival was highest in ARP (129 months, 95% CI 127.4-134.1) and lowest in CCP (103.7 months, 95% CI 100.1-106.7) (p < 0.001). Conversion rates were comparable between ARP (12%), CCCP (12%) and INCP (11.8%) but were higher in CCP (15.5%) (p < 0.001). 30-day readmission rates and 30-day mortality rates were significantly lower in ARP compared to other facility types (p < 0.001). CONCLUSION: Our findings display differences in surgical outcomes of colon cancer patients among facility types. The findings suggest better outcomes in terms of operative access and survival at ARP as compared to other facilities. These findings underscore the importance of understanding facility-specific factors that may influence patient outcomes and can guide resource allocation and targeted interventions for improving colon cancer care.