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ABSTRACT: INTRODUCTION: For patients undergoing endoscopic pituitary surgery, the most common complications are epistaxis, diabetes insipidus, cerebrospinal fluid leak, and other general postoperative complications. Members of the department of neurological surgery identified gaps in patient education regarding postsurgical complication management after pituitary surgery. This quality improvement project aims to develop a comprehensive digital educational tool that empowers patients and caregivers with the knowledge to better recognize and manage common postoperative complications. METHODS: This project used a pretest-posttest design and was underpinned by the Ottawa Model of Research Use. A digital educational material (Adobe Spark) was created by an interprofessional clinical team and was distributed to 17 patients through QR code or text message who were scheduled to undergo pituitary surgery. RESULTS: The Adobe webpage was scanned and viewed a total of 161 times in 4 months. Of 12 patients who completed both pretest and posttest, mean knowledge scores increased from 3.17 out of 5 (1.03) to 4.25 (0.97) out of 5 (P = 0.009). CONCLUSION: The development of a webpage for pituitary surgery education is a low-cost and efficient means to better standardize and improve the quality of the presurgical education provided to patients and families.
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Educación del Paciente como Asunto , Hipófisis , Complicaciones Posoperatorias , Cuidados Preoperatorios , Humanos , Educación del Paciente como Asunto/métodos , Masculino , Complicaciones Posoperatorias/prevención & control , Femenino , Persona de Mediana Edad , Adulto , Mejoramiento de la Calidad , Hipófisis/cirugía , InternetRESUMEN
BACKGROUND: Older patients undergoing emergency abdominal surgery face high risks of mortality and complications. OBJECTIVE: Investigate whether a care pathway designed for older patients improves surgical outcomes. METHODS: This single-centre study investigated the effect of a care pathway for older patients undergoing emergency abdominal surgery, including preoperative frailty assessment, optimised perioperative care, and structured decision-making for severely frail patients. Following implementation of the pathway, patients aged ≥ 75 years were prospectively enrolled in the 'after' cohort (1 January 2020-16 April 2021) and compared with a historical 'before' cohort of patients (1 January 2016-31 December 2017). The primary outcome was the Comprehensive Complication Index (CCI), a composite measure encompassing 30-day mortality and postoperative complications. Secondary outcomes included 30-day postoperative mortality, the number of palliative patients, mortality at 1 and 3 years and postoperative complications. RESULTS: Among 154 patients in the 'after' cohort (median age 82 years [Q1-Q3: 78-86], 54% women, 53% frail), the primary outcome did not differ significantly from that of the 170 patients in the 'before' cohort (CCI mean [95% CI]: 44 [39-48] vs. 50 [46-55]; p = 0.15). Postoperative 30-day mortality was significantly reduced (22% vs. 13%, p = 0.04). During the intervention, severely frail patients triaged to palliation (n = 12) were excluded from the study and received palliative care. High postoperative mortality was observed at 1 (31%) and 3 years (49%). Pulmonary (44% vs. 69%, p < 0.001) and gastrointestinal complications (39% vs. 52%; p = 0.02) were significantly reduced. CONCLUSION: In this 'before-and-after' study a care pathway designed for older patients undergoing emergency abdominal surgery had no significant impact on the composite outcome of postoperative mortality and complications. Postoperative 30-day mortality, pulmonary and gastrointestinal complications were significantly reduced, while long-term mortality remained high. Although the results should be interpreted with caution, they highlight the importance of careful preoperative evaluation. In this study, outcomes of elderly patients undergoing emergency abdominal surgery were compared before and after implementation of a care pathway for elderly patients in a moderately sized single centre. Overall it is noted that implementation of this care pathway resulted in a decision to offer palliation instead of surgery to several patients. While the primary outcome of comprehensive complication index did not differ between the before-and after groups, several secondary outcomes were improved in the after group. It should be noted however that multiple confounders could explain the difference, including selection bias of a more robust population offered surgery. The one-and three year mortality of both groups was very high, stressing the importance of a careful and critical assessment of preoperative comorbidity and frailty, as well as the importance of ensuring that the treatment offered aligns with the overall goals of care for the individual patient.
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Abdomen , Vías Clínicas , Humanos , Femenino , Anciano de 80 o más Años , Masculino , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Abdomen/cirugía , Estudios Prospectivos , Anciano Frágil , Fragilidad , Atención Perioperativa/métodos , Estudios de CohortesRESUMEN
PURPOSE: Postoperative pancreatic fistula (POPF) is a severe complication of radical gastrectomy. Postoperative drain amylase levels (D-AMY) are correlated with POPF, but it's not for prevention. The aim of this study is to investigate whether intraoperative amylase levels (I-AMY) of intra-abdominal exudates is associated with increased D-AMY. METHODS: From April 2021 to September 2023, 112 consecutive GC patients underwent radical gastrectomy with lymphadenectomy were enrolled. We measured the I-AMY of fluid from the left upper abdominal cavity (Area A), caudate fossa at the right upper abdominal cavity (Area B), and Area B after lavage with 20 mL of saline (Lavage Area B). We analyzed the correlation of I-AMY and D-AMY on POD1 and POD3. In the most recent 39 patients, we tested the effectiveness of polyglycolic acid (PGA) sheets around the pancreas after lymphadenectomy to prevent POPF. RESULTS: In 73 patients without PGA sheets, I-AMY in Area B and Lavage Area B were significantly correlated with D-AMY on POD1 and POD3 (Area B: POD1, Pearson's r = 0.737, p < 0.001; POD3, r = 0.457, p < 0.001; Lavage Area B: POD1, r = 0.652, p < 0.001; POD3, r = 0.353, p = 0.0022). Based on a receiver operating characteristic curve analysis, the cutoff value of I-AMY for predicting Biochemical leak (BL) or POPF was 1197 U/L in Area B (sensitivity: 50%, specificity: 88%) and 32 U/L in Lavage Area B (sensitivity: 81%, specificity: 52%). Unexpectedly, PGA sheets did not reduce D-AMY levels. CONCLUSION: Intraoperative I-AMY measurement of exudates or lavage fluids in the caudate fossa may be useful for predicting BL or POPF after radical gastrectomy.
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Amilasas , Exudados y Transudados , Gastrectomía , Fístula Pancreática , Complicaciones Posoperatorias , Neoplasias Gástricas , Humanos , Masculino , Neoplasias Gástricas/cirugía , Femenino , Gastrectomía/efectos adversos , Persona de Mediana Edad , Amilasas/análisis , Amilasas/metabolismo , Fístula Pancreática/prevención & control , Fístula Pancreática/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Anciano , Exudados y Transudados/enzimología , Escisión del Ganglio Linfático/efectos adversos , Drenaje , Valor Predictivo de las Pruebas , Adulto , Relevancia ClínicaRESUMEN
BACKGROUND: The aims of this study were to evaluate the timing and trend of venous thromboembolism (VTE) prophylaxis initiation following surgical intervention, and the impact of VTE prophylaxis timing on the occurrence of VTE complications, across North American trauma centers in patients with complete traumatic cervical spinal cord injury (SCI). METHODS: This retrospective, observational cohort study utilized data from the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) from 2013 to 2020. We identified surgically treated patients with complete traumatic cervical SCI. Patient variables included age, sex, race, insurance coverage, and comorbidity status. Outcomes of interest included time to VTE prophylaxis following surgery and the occurrence of VTE complications. Mixed-effect regression models were constructed to evaluate the adjusted estimate for each outcome accounting for patient-, injury-, and hospital-level covariates. RESULTS: The study included 5,325 patients treated across 463 trauma centers. The mean age in the cohort was 46.7 ± 18.9 years, with male predominance (81.1%). Race was predominantly White (62.3%) and Black (23.0%). The mean time to VTE prophylaxis initiation was 90 ± 112 hours, and the median time was 65 hours (interquartile range, 39 to 105 hours). The annual trend of VTE prophylaxis initiation after surgery was a decrease by 5.2 hours per year over the 8-year study interval. This was associated with an annual reduction of 6.2% in the odds of VTE complication occurrence. Multivariable mixed-effect regression models demonstrated a significant reduction in time to VTE prophylaxis (mean difference, -3.7 hours per year [95% confidence interval [CI], -5.3 to -2.1 hours per year]; p < 0.001) and VTE complications (odds ratio, 0.93 per year [95% CI, 0.88 to 0.98 per year]; p = 0.01) over the study period, after adjustment. CONCLUSIONS: This analysis provides insight into VTE prophylaxis practice patterns following surgery for complete cervical SCI across North American trauma centers from 2013 to 2020. The timing of VTE prophylaxis initiation consistently decreased, which appeared to be associated with a significant reduction found in VTE complications. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Anticoagulantes , Vértebras Cervicales , Complicaciones Posoperatorias , Traumatismos de la Médula Espinal , Tromboembolia Venosa , Humanos , Masculino , Femenino , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/etiología , Traumatismos de la Médula Espinal/cirugía , Traumatismos de la Médula Espinal/complicaciones , Estudios Retrospectivos , Persona de Mediana Edad , Centros Traumatológicos , Adulto , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Vértebras Cervicales/lesiones , Factores de Tiempo , América del NorteRESUMEN
BACKGROUND AND AIMS: Division of the pancreatic arterial arcade during pancreaticoduodenectomy (PD) can precipitate visceral ischemia in patients with celiac artery stenosis (CAS). This study investigated optimal management of CAS for patients undergoing PD-particularly stenosis caused by median arcuate ligament (MAL) compression-through a systematic review and a nationwide survey. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for studies indexed with the Medical Subject Headings terms celiac artery stenosis, median arcuate ligament syndrome, and pancreaticoduodenectomy. In parallel, a questionnaire on CAS management during PD was distributed to 67 major hepatobiliary and pancreatic surgery centers in Japan. RESULTS: Fifty-five studies met the inclusion criteria, comprising eight retrospective studies, and 47 case reports/series. Meta-analysis showed a prevalence of CAS in 6.1% of patients undergoing PD or total pancreatectomy, while preemptive MAL release was performed in only 2.2%. The risk of postoperative ischemic complications increased substantially when stenosis exceeded 80%. Among 108 patients with detailed postoperative data, those diagnosed with CAS preoperatively experienced significantly fewer ischemic events (5/85, 5.8%) compared with those diagnosed intraoperatively or postoperatively (8/22, 36%, p = 0.0006). Survey results indicated that the gastroduodenal artery (GDA) clamping test, supplemented with intraoperative Doppler ultrasonography in addition to visual inspection, was a common method to guide immediate MAL release. Repeated flow measurements after MAL release with GDA clamping were often required to confirm adequate visceral perfusion. CONCLUSIONS: Accurate preoperative identification of CAS and deliberate surgical planning are essential when PD is anticipated. Intraoperative hemodynamic reassessment remains critical, with consideration of arterial reconstruction when MAL release alone fails to restore sufficient splanchnic perfusion.
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Arteria Celíaca , Síndrome del Ligamento Arcuato Medio , Pancreaticoduodenectomía , Complicaciones Posoperatorias , Humanos , Pancreaticoduodenectomía/efectos adversos , Síndrome del Ligamento Arcuato Medio/cirugía , Síndrome del Ligamento Arcuato Medio/complicaciones , Arteria Celíaca/cirugía , Consenso , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Constricción Patológica/cirugíaRESUMEN
Aim To evaluate the efficacy and safety of a new 3D navigation-guided technique for transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and a high risk of atrioventricular (AV) conduction disorder.Material and methods The study presents the results of a single-center prospective randomized pilot study. Sixty patients meeting inclusion and exclusion criteria with at least one criterion of a high risk for AV conduction disorder were enrolled in the study. All included patients were randomized 1:1 into two groups. In Group 1, TAVI was performed using a 3D navigation-guided technique, while in Group 2, the classical TAVI technique was used. The primary endpoint was the composite incidence of permanent pacemaker (PP) implantation and new-onset complete left bundle branch block (LBBB) at 6 months.Results In the early postoperative period, the 3D navigation-guided TAVI group had a lower incidence of new-onset LBBB (10.3% vs. 33.3%; p=0.03), better parameters of intraventricular conduction according to electrophysiology study (EPS) (H-V interval 79.1±13.5âms vs. 96.0±39.9âms; p=0.03) and electrocardiography (QRS complex duration 108.0±16.3âms vs. 119.0±22.6âms; p=0.04). The incidence of PP implantation during the hospital stage, A-H interval duration, and Wenckebach point in the AV junction according to EPS did not differ significantly between the groups. The incidence of the primary endpoint (PP implantation + new-onset LBBB) during the 6-month follow-up period was 43.3% in the classical technique group and 16.7% in the 3D navigation-guided TAVI group (p=0.02). There were no statistically significant differences between the groups in the incidence of procedural complications or major adverse cardiovascular and cerebrovascular outcomes.Conclusion This study demonstrated the efficacy and safety of a new 3D navigation-guided TAVI technique in reducing the composite rate of implantation PP and LBBB at 6 months post-procedure, with comparable rates of procedural complications and major adverse cardiac and cerebrovascular events (MACCE) during long-term follow-up. Implementation of these findings into clinical practice will enable personalization and optimization of transcatheter treatment outcomes in patients with severe AS.
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Estenosis de la Válvula Aórtica , Bloqueo Atrioventricular , Imagenología Tridimensional , Complicaciones Posoperatorias , Cirugía Asistida por Computador , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/fisiopatología , Masculino , Femenino , Proyectos Piloto , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/efectos adversos , Anciano de 80 o más Años , Resultado del Tratamiento , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/prevención & control , Anciano , Imagenología Tridimensional/métodos , Índice de Severidad de la Enfermedad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Estudios ProspectivosRESUMEN
OBJECTIVES: Since Japan's public insurance covered robot-assisted radical prostatectomy (RARP) in 2012, it has become standard. Despite widespread use, variability exists among surgeons in approaches, nerve-sparing, lymph node dissection (LND), and postoperative management. This study examined the practices of surgical technique selection, energy settings, and postoperative management in RARP across Japan to identify standardization opportunities. MATERIALS AND METHODS: A 50-item questionnaire was distributed between October and December 2023 to physicians performing robotic surgeries at 44 institutions affiliated with Kyoto University and other universities. The survey addressed the surgeons' experience, robotic platforms, energy settings, surgical approaches, LND, anastomosis, complication prevention, and postoperative management. Responses from 147 physicians were analyzed. RESULTS: All respondents used the da Vinci system, with the half of institutions performing over 50 RARP annually. Most surgeons preferred the transperitoneal approach (over 80%) and standard LND (65.7%), while 20% performed an extended pelvic lymph node dissection. Monopolar and bipolar energies were set to Effects 3 and 4, respectively. Barbed sutures were used for anastomosis in 90% of the cases with posterior wall reconstruction. Drains were placed in 70% of the cases, and catheters were removed on postoperative days 5-7 in over 90%. Variations were noted in dorsal venous complex management, nerve-sparing, hernia prevention, and imaging before catheter removal. CONCLUSIONS: This survey revealed the diversity of RARP techniques and postoperative protocols among Japanese surgeons. While fundamental elements, such as LND templates and barbed anastomosis, have converged, significant procedural variability persists. A two-tiered educational model, which standardizes essential safety techniques while allowing case-specific flexibility, may promote consistent nationwide RARP practices.
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Pautas de la Práctica en Medicina , Prostatectomía , Neoplasias de la Próstata , Procedimientos Quirúrgicos Robotizados , Prostatectomía/métodos , Prostatectomía/efectos adversos , Prostatectomía/estadística & datos numéricos , Prostatectomía/normas , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/normas , Masculino , Japón , Escisión del Ganglio Linfático/métodos , Escisión del Ganglio Linfático/estadística & datos numéricos , Neoplasias de la Próstata/cirugía , Encuestas y Cuestionarios , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Cirujanos/estadística & datos numéricos , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/estadística & datos numéricos , Próstata/cirugíaRESUMEN
OBJECTIVE: To evaluate the effectiveness of neuromuscular compression bandage in preventing seroma after surgical treatment of breast cancer. METHODS: This randomized clinical trial included women over 18 years old undergoing mastectomy. The control group followed the institution's standard routine of using a suction drain, whereas the intervention group was assigned to receive a compressive bandage for 1 week in addition to the drain. RESULTS: A total of 124 women were assigned to the intervention group and 125 to the control group. There was no statistically significant difference in sociodemographic, clinical, or treatment variables, nor in the incidence of seroma between groups (odds ratio [OR], defined as the ratio between the odds of an event occurring in the intervention group versus the control group = 1.59; 95% CI: 0.91-2.76; p = 0.102). Seroma was the most frequent complication (71.1%). After 7 days, the drain was removed in 66.3% of participants, 53.3% in the control group, and 46.7% in the intervention group (OR = 0.69; 95% CI: 0.41-1.17; p = 0.166). The median total punctured volume was 154 mL. There was no significant difference in the frequency of punctures > 154 mL between the groups (39.8% vs. 60.2%; OR = 1.77; 95% CI: 0.98-3.22; p = 0.059). CONCLUSION: The use of a compressive neuromuscular bandage was not effective in preventing seroma after mastectomy.
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Neoplasias de la Mama , Vendajes de Compresión , Mastectomía , Complicaciones Posoperatorias , Seroma , Humanos , Femenino , Seroma/prevención & control , Seroma/etiología , Seroma/epidemiología , Neoplasias de la Mama/cirugía , Persona de Mediana Edad , Mastectomía/efectos adversos , Mastectomía/métodos , Anciano , Drenaje/métodos , Adulto , Complicaciones Posoperatorias/prevención & control , Resultado del TratamientoRESUMEN
BACKGROUND: This study aimed to evaluate the impact of perioperative immunonutrition (IN) versus standard enteral nutrition (EN) on short-term postoperative outcomes in patients with head and neck cancer (HNC). METHODS: A prospective randomized controlled trial was conducted with 34 HNC patients (17 in the intervention group and 17 in the control group). Five days before surgery, the intervention group received 3 sachets of IN (arginine, omega 3, nucleotide), whereas the control group received 3 boxes of a standard EN product. Postoperatively, both groups continued their respective nutritional regimens for 10 days from the (nasogastric) tube. Measurements included body composition, food consumption, nutritional risk score (NRS)-2002, quality of life, biochemical parameters, complications, antibiotic use, and length of hospital stay (LOS). RESULTS: There were no significant changes in anthropometric measurements or NRS-2002 scores. Albumin levels in both groups decreased on the 10th postoperative day compared with the preoperative period (Pâ <â .05). While the C-reactive protein levels of all patients increased on the 10th postoperative day (Pâ =â .002), they decreased on the 40th postoperative day (Pâ =â .045). There were no significant differences between the groups in terms of complications or LOS (Pâ >â .05). The functional scales and physical, occupational, and cognitive function scores of the intervention group were higher than those of the control group (Pâ <â .05) on postoperative 40th day. CONCLUSION: Perioperative IN support did not differ significantly from standard EN in terms of anthropometric measurements, biochemical findings, LOS, or complication rates. Nutritional counseling by a dietitian is essential for patients with HNC.
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Nutrición Enteral , Neoplasias de Cabeza y Cuello , Atención Perioperativa , Humanos , Femenino , Masculino , Neoplasias de Cabeza y Cuello/cirugía , Persona de Mediana Edad , Nutrición Enteral/métodos , Estudios Prospectivos , Anciano , Atención Perioperativa/métodos , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Arginina/administración & dosificación , Arginina/uso terapéutico , Ácidos Grasos Omega-3/administración & dosificación , Estado Nutricional , Calidad de Vida , Resultado del Tratamiento , Dieta de InmunonutriciónRESUMEN
This study aims to explore the impact of early mobilization on postoperative complications in adult patients after craniocerebral surgery. There is no meta-analysis study on early rehabilitation training in the prevention of postoperative complications of craniocerebral surgery yet. Patients after craniocerebral surgery often face various complications, including infection, hemorrhage and functional disorders, etc., which adversely affect their recovery quality. This study compared the effects of early activities (such as elevating the head of the bed, sitting up, standing, walking, etc.) within a defined postoperative time window, with traditional bed rest (full lying for ≥ 48 h after surgery, with the head of the bed elevated ≤ 30°) on patient outcomes. A systematic literature search and screening of randomized controlled trials (RCTs) were performed. Quality assessment was conducted using the ROB2 tool. Data extraction and statistical analyses were carried out using R software and relevant statistical packages. The results showed that the pooled relative risk (RR) of postoperative complications in the early rehabilitation intervention group was 0.51 (95% confidence interval [CI]: 0.35-0.74; P = 0.0005), indicating a significant reduction in the incidence of postoperative complications with early mobilization. Sensitivity analyses demonstrated that excluding any single study did not alter the RR being less than 1 or the P value remaining below 0.05, thereby enhancing the robustness of the findings. The odds ratio (OR) for postoperative recurrence was 1.59 (95% CI: 0.53-4.79; P = 0.4119), and the OR for the Glasgow Outcome Scale-Extended (GOSE) score was 0.92 (95% CI: 0.51-1.63; P = 0.7683). Although the results for GOSE scores and postoperative recurrence rate after surgery was 1.59, the 95% confidence interval (CI) was [0.53,4.79], and P = 0.4119; The OR value of the GOSE score was 0.92, the 95%CI was [0.51,1.63], and P = 0.7683. Although the results of GOSE score and postoperative recurrence rate were not statistically significant, this study provides evidence supporting the safety of early rehabilitation interventions in reducing the risk of postoperative complications. Future research should prioritize high-quality trials to further investigate the potential impact of early mobilization on patient prognosis.
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Craneotomía , Ambulación Precoz , Complicaciones Posoperatorias , Humanos , Complicaciones Posoperatorias/prevención & control , Craneotomía/efectos adversos , Craneotomía/rehabilitación , Ambulación Precoz/métodos , Resultado del Tratamiento , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Patients who have undergone corrective surgery for adolescent idiopathic scoliosis (AIS), especially those with a major lumbar curve, may have persistent postoperative coronal imbalance (PCI) due to an insufficient ability to compensate for lumbar curve overcorrection. However, the optimal amount of curve correction required to prevent PCI remains uncertain. Therefore, this study aimed to evaluate the use of the intraoperative crossbar coronal-balancing technique as a strategy to minimize the risk of PCI in patients with AIS with a major lumbar curve (Lenke type-5 and 6 curves), and to confirm that the tilt angle of the lowest instrumented vertebra (LIV), intraoperatively and at the final follow-up, could be predicted from the preoperative supine right-side-bending (RSB) radiograph that was used to guide the correction. METHODS: This study involved 39 patients with Lenke 5 or 6 AIS who underwent posterior spinal fusion and had a minimum 2-year follow-up. The median age was 14 years, 15% were male, and all were of Malaysian ethnicity: 84.6% Chinese, 12.8% Malay, and 2.6% Indian. The LIV tilt angle measured on the preoperative supine RSB radiograph, adjusted according to the pelvic obliquity (PO) measured on the erect radiograph (α angle), was used as a guide for the intraoperative LIV tilt angle (ß angle). Following curve correction, the crossbar was centered over the sacrum intraoperatively. The position of the C7 vertebra was then assessed relative to the crossbar, and the amount of correction was adjusted to ensure that the proximal portion of the crossbar bisected the C7 vertebra under fluoroscopy. Outcomes included the coronal balance distance (CBD) and the LIV tilt angle at the final follow-up (δ angle). RESULTS: Only 2 (5.1%) of the patients in the cohort had PCI at the final follow-up. At that time, the mean CBD was -6.6 ± 9.2 mm and the mean δ angle was -12.4° ± 4.8°. There were no significant differences between the α and ß angles (p = 0.799) or between the α and δ angles (p = 0.705). The α angle correlated strongly with the ß angle (ρ = 0.707) and the δ angle (ρ = 0.730, p < 0.001). CONCLUSIONS: The intraoperative crossbar coronal-balancing technique was shown to be an effective method to minimize the risk of PCI in patients with AIS with a major lumbar curve. Guided by the α angle measured preoperatively, this approach may help facilitate the determination of the optimal intraoperative LIV tilt angle (ß), which corresponds to the LIV tilt angle at the final folow-up (δ). LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Vértebras Lumbares , Complicaciones Posoperatorias , Escoliosis , Fusión Vertebral , Humanos , Escoliosis/cirugía , Escoliosis/diagnóstico por imagen , Adolescente , Masculino , Femenino , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Complicaciones Posoperatorias/prevención & control , Niño , Radiografía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: Robot-assisted spine surgery (RASS) enables precise pedicle screw insertion via pre-planned trajectories, and yet complications remain a notable concern. Prior work suggests that osseous pedicle wall breaches from instrumentation and ensuing complications related to robotic surgery may be from shifting of the reference frame or improper methodology. In this study, we hypothesized that the introduction of standardized institutional guidelines for RASS would reduce complications associated with robotic screw placement. METHODS: This retrospective cohort study included patients who underwent RASS using 2 robotic systems at a single institution. We analyzed the cases of 264 patients in a historical cohort before, and 290 patients after, the implementation of a standardized institutional protocol developed to ensure safety with robotic placement of pedicle screws. The protocol provided surgeons with detailed guidelines for reference-frame placement, intraoperative screw trajectory and alignment checks, depth of drill insertion, verification of screw positioning, neuromonitoring for thoracic instrumentation, and postoperative imaging. Patient demographics, preoperative diagnoses, surgical characteristics, and complications were collected for all patients. RESULTS: There was no difference between the pre-protocol and post-protocol groups with respect to patient demographics. In the pre-protocol cohort, 6 (2.3%) of the patients experienced robot-related complications, including nerve injury, durotomy, and malpositioned screws, with half of these complications attributed to reference-frame errors. Following the implementation of the protocol, no patient (0%) experienced a robot-related complication among 290 cases involving 2,030 screws placed with robotic assistance, representing a significant reduction (p = 0.01). The number of patients with open surgery (versus minimally invasive surgery) did not differ significantly between the pre-protocol (132 patients, 50%) and post-protocol (143 patients, 49.3%) groups. The mean number of instrumented levels per patient post-protocol was 3.3 ± 2.1. Non-robot-related complication rates were similar post-protocol (19.7%) versus pre-protocol (26.1%) (p > 0.05). Notably, post-protocol, there were no instances of a pedicle breach with neurostimulation or on postoperative imaging. CONCLUSIONS: Following the implementation of standardized robotic surgery guidelines, no robot-related screw complications occurred in a post-protocol cohort of 290 patients. This study underscores the importance of protocol standardization, alongside technological advancements, in optimizing patient safety and improving outcomes in RASS. Well-designed institutional protocols may notably reduce robotic surgery complications and can be a valuable model for other institutions. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Tornillos Pediculares , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados , Fusión Vertebral , Humanos , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/normas , Procedimientos Quirúrgicos Robotizados/métodos , Masculino , Femenino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Anciano , Tornillos Pediculares/efectos adversos , Adulto , Fusión Vertebral/métodos , Fusión Vertebral/instrumentación , Seguridad del Paciente , Protocolos Clínicos , Guías de Práctica Clínica como AsuntoRESUMEN
Objective: To determine the preventive effect of a WeChat platform-based rehabilitation exercise prescription on deep vein thrombosis (DVT) after total knee arthroplasty (TKA). Methods: Prospective data were collected from patients who underwent TKA at the First Affiliated Hospital of Kunming Medical University between December 2023 and March 2025 (set as the experimental group). Retrospective clinical data were collected from patients who underwent TKA at the same hospital between January 2022 and October 2023 (set as the conventional group). All surgeries were performed by the same senior chief physician, and preoperative bilateral lower extremity vascular ultrasound showed no thrombosis in any patient. One day before surgery, the patients in the experimental group received a personalized Quick Response (QR) code for a WeChat public platform from a rehabilitation specialist nurse. After scanning the code, patients could access rehabilitation exercise videos. The rehabilitation nurse explained key points and precautions for the exercises. Patients began rehabilitation training as early as postoperative day 0. The conventional group followed a paper-based rehabilitation exercise prescription and received guidance from rehabilitation nurses on key points and precautions. The incidence of DVT within one week after surgery, postoperative length of stay, total inpatient medical costs (including material costs and non-material costs), and Knee Society Score (KSS) (including clinical and functional scores) were compared between the two groups. Results: A total of 118 patients were enrolled, with 59 in the conventional group and 59 in the experimental group. In the conventional group, there were 14 males and 45 females, aged (68.0±7.2) years. In the experimental group, there were 11 males and 48 females, aged (66.5±7.4) years. There was no statistically significant differences in gender, age, operation time, preoperative thrombosis risk score, or anticoagulant dosage between the two groups (all P>0.05). The incidence of DVT in the operated limb was lower in the experimental group than that in the conventional group [35.6% (21/59) vs 66.1% (39/59), P=0.001]. The postoperative hospital stay was shorter in the experimental group [(6.9±2.7) vs (8.9±2.5) d, P<0.001]. The total inpatient medical costs were lower in the experimental group [18 873 (17 561, 20 880) vs 23 492 (18 362, 45 027) yuan, P<0.001], with both material costs [2 214 (2 214, 5 379) vs 2 899 (2 214, 30 500) yuan, P=0.028] and non-material costs [15 344 (13 837, 16 157) vs 15 912 (14 563, 19 046) yuan, P=0.011] in the experimental group were both lower than those in the conventional group. The clinical score of KSS was higher in the experimental group [(76.5±5.7) vs (68.5±3.6) points, P<0.001], while no significant difference was found in the functional score of KSS between the two groups (P=1.692). Conclusion: The WeChat public platform-based rehabilitation exercise prescription can reduce the incidence of DVT, shorten the hospital stay, and decrease total inpatient medical costs in patients after TKA.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Terapia por Ejercicio , Complicaciones Posoperatorias , Trombosis de la Vena , Humanos , Artroplastia de Reemplazo de Rodilla/rehabilitación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Trombosis de la Vena/prevención & control , Estudios Retrospectivos , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Femenino , Masculino , Anciano , Persona de Mediana EdadRESUMEN
BACKGROUND/AIM: Splenectomy is performed in ovarian cytoreductive surgery when pre-operative imaging and intra-operative examination suggest disease involvement. This study aimed to evaluate the incidence of splenectomy, the diagnostic accuracy of pre-operative imaging and intra-operative assessment, and the associated short- and long-term peri-operative complications. PATIENTS AND METHODS: We conducted a single institution retrospective study to assess rates of splenectomy, accuracy of imaging and intra-operative assessment, peri-operative complications and patient compliance with prophylactic antimicrobial therapy and immunizations. RESULTS: Over a period of 8 years (2014-2022), 469 cytoreductive surgeries for International Federation of Obstetrics and Gynaecology (FIGO) stage III-IV epithelial ovarian cancer were undertaken. A splenectomy was performed in 61 (13%) patients. Complete cytoreduction was achieved in 50 cases (82%) undergoing a splenectomy. On pre-operative imaging assessment, splenic disease was suspected in 36 patients (7.7%) and a further 23 (4.9%) patients had malignancy suspected at intraoperative assessment. In five patients (1%), the spleen was removed due to omental disease inseparable from the spleen. In three (0.6%) cases a splenectomy was performed due to intraoperative trauma. Postoperative pathology confirmed splenic disease in 49 (80.3%) patients. A biochemical leak of no clinical significance was identified in 15/61 (24.6%) splenectomy cases, and one case (1.6%) of post-operative pancreatic fistula (POPF) was identified. Remaining living patients were audited for adherence to recommended post-operative management. Seventeen of the eighteen patients (94%) had received recommended vaccinations between 2-6 weeks post-surgery, and 17/18 (94%) consistently continued ongoing vaccinations. Additionally, 16 (88.9%) adhered to prescribed daily prophylactic antibiotics. CONCLUSION: Splenectomy, integral to ovarian cytoreduction, facilitates high rates of complete cytoreduction. Preoperative and intraoperative assessments can predict the existence of malignancy in the spleen, confirmed by pathology. Traumatic splenectomy was rare. Emphasising adherence to a post-splenectomy protocol is crucial to mitigate post-splenectomy complications such as POPF, which can significantly delay the initiation of chemotherapy.
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Carcinoma Epitelial de Ovario , Procedimientos Quirúrgicos de Citorreducción , Neoplasias Ováricas , Esplenectomía , Humanos , Femenino , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/patología , Neoplasias Ováricas/diagnóstico , Esplenectomía/métodos , Esplenectomía/efectos adversos , Persona de Mediana Edad , Procedimientos Quirúrgicos de Citorreducción/métodos , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Anciano , Adulto , Estudios Retrospectivos , Profilaxis Antibiótica/métodos , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento , Inmunización , Carcinoma Epitelial de Ovario/cirugía , Anciano de 80 o más Años , Cooperación del PacienteRESUMEN
Cranioplasty (CP) is performed after decompressive craniectomy (DC), with complication rates of 15-40%. Risk factors and ideal timing for CP are unclear. This study investigates risk factors for complications after CP and the best time to perform a CP. This retrospective single-center study includes patients admitted to the neurosurgical department of the University Hospital Zurich between 01.2013 and 05.2023, who underwent a CP following a supratentorial DC. Demographics, comorbidities, indication for the DC, material used, complications, time between DC, CP and onset of complication were collected. The investigated complications are infections, bleeding, bone flap resorption or others requiring surgery. A multivariable logistic regression was performed to identify risk factors for the occurrence of complications. A Classification and Regression Tree (CART) was performed to identify the best time for CP. The result was tested with a Cox regression and a ROC analysis. Overall, 141 patients were included, of whom 39% (n=55) developed a complication. No difference in sex, age, comorbidities, DC-indication, material used was found, except for a trend for CP-time (shorter time for patients with vs without complication, 84±44 vs 102±70 days, p=0.065). In the CART analysis, day 122.5 was the best time cut-off for reducing complications (sensitivity 87%). In our case-series, we could not identify risk factors for complications after CP, except possibly for CP-timing. A longer time between DC and CP seems to be associated with less complications, with day 122.5 as the cut-off time.
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Craniectomía Descompresiva , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Humanos , Craniectomía Descompresiva/efectos adversos , Craniectomía Descompresiva/métodos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Adulto , Anciano , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
This study aimed to investigate the impact of enhanced recovery after surgery (ERAS) nursing on perioperative blood pressure stability, postoperative outcomes, and quality of life in hypertensive patients undergoing laparoscopic colorectal cancer resection. Clinical data from 120 hypertensive patients who underwent laparoscopic colorectal cancer surgery between January 2022 and December 2023 were retrospectively analyzed. According to perioperative care strategies, patients were categorized into the ERAS group (nâ =â 60) or the conventional care group (nâ =â 60). Perioperative blood pressure control, complication rates, recovery indicators, quality of life (Short Form-36), and nursing satisfaction were compared. Logistic regression analysis was performed to identify predictors of postoperative complications. Patients receiving ERAS nursing showed more stable postoperative blood pressure at 24, 48, and 72 hours, with a higher achievement rate of target blood pressure at 72 hours (88.3% vs 73.3%, Pâ =â .044). The ERAS group also experienced fewer complications (10.0% vs 33.3%, Pâ =â .001), shorter hospital stay (7.45â ±â 1.21 vs 9.23â ±â 1.64 days, Pâ <â .001), earlier ambulation (25.54â ±â 5.12 vs 32.34â ±â 6.10 hours, Pâ <â .001), and lower analgesic use within 48 hours (52.35â ±â 10.45 vs 65.46â ±â 12.33â mg, Pâ <â .001). Furthermore, their Short Form-36 scores and satisfaction levels were significantly higher (Pâ <â .05). Multivariate analysis identified ERAS nursing as an independent protective factor against complications (odds ratioâ =â 0.387, Pâ =â .002), whereas older age increased risk (odds ratioâ =â 1.53, Pâ =â .041). ERAS nursing promotes perioperative hemodynamic stability, reduces complications, accelerates recovery, and improves quality of life in hypertensive patients undergoing laparoscopic colorectal cancer surgery. It represents a safe and effective perioperative care model deserving wider clinical implementation.
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Neoplasias Colorrectales , Recuperación Mejorada Después de la Cirugía , Hipertensión , Laparoscopía , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Laparoscopía/efectos adversos , Hipertensión/complicaciones , Hipertensión/enfermería , Persona de Mediana Edad , Estudios Retrospectivos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Anciano , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/enfermería , Neoplasias Colorrectales/complicaciones , Calidad de Vida , Presión Sanguínea/fisiología , Tiempo de Internación/estadística & datos numéricosRESUMEN
BACKGROUND: Complex breast surgery, including immediate breast reconstruction and oncoplastic procedures, is increasingly performed to optimise oncologic and aesthetic outcomes. Postoperative wound healing complications remain a major concern, particularly in high-risk patients. Negative pressure wound therapy (NPWT) has been shown to improve wound healing in various surgical fields. However, its effectiveness in oncologic breast surgery remains insufficiently studied. This study aims to evaluate the efficacy of NPWT in reducing wound healing complications in complex breast cancer surgery. METHODS: The TPN-SEIN study is a prospective, randomised, controlled, open-label, multicentre, phase III clinical trial. A total of 254 patients undergoing complex breast cancer surgery will be randomised either to arm 1 (NPWT immediately postoperatively for 7 days) or arm 2 (standard wound care). The primary endpoint is the rate of wound healing complications at day 30, defined as at least one of the following: deep postoperative infection of the prosthetic pocket, wound dehiscence or incomplete healing. Secondary endpoints include surgical site infection at day 90, reoperation rate, hospital readmission rate, time to complete healing, time to adjuvant treatment initiation, quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life questionnaire and breast cancer-specific quality of life questionnaire (QLQ-C30)), patient satisfaction and medico-economic outcomes. ETHICS AND DISSEMINATION: The study was approved by the French national ethics committee (Comité de Protection des Personnes Est II, 5 December 2024, reference 24.04416.000295) and the institutional review board (IRB-COMERE, reference ICM-RCM 2024/11). The French National Agency for the Safety of Health Products has been notified. The study results will be presented at both national and international conferences and will also be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT06265558.
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Neoplasias de la Mama , Mastectomía , Terapia de Presión Negativa para Heridas , Complicaciones Posoperatorias , Infección de la Herida Quirúrgica , Humanos , Femenino , Neoplasias de la Mama/cirugía , Terapia de Presión Negativa para Heridas/métodos , Estudios Prospectivos , Complicaciones Posoperatorias/prevención & control , Cicatrización de Heridas , Calidad de Vida , Mastectomía/efectos adversos , Infección de la Herida Quirúrgica/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como Asunto , Ensayos Clínicos Fase III como Asunto , Adulto , Mamoplastia/efectos adversos , Persona de Mediana EdadRESUMEN
Gastrointestinal (GI) dysfunction is a common complication after colorectal cancer surgery, often leading to prolonged hospitalization and reduced quality of life. This study aims to evaluate the impact of combining foot acupoint massage (FAM) and medium-frequency electrical stimulation (MFES) on the recovery of GI function after colorectal tumor surgery. A total of 135 patients were retrospectively categorized into 3 groups according to the nursing interventions recorded in their medical records: the control group (routine care), the FAM group (routine careâ +â FAM), and the FAM/MFES group (routine careâ +â FAMâ +â MFES), with 45 patients in each group. The primary outcomes included postoperative pain (Visual Analog Scale score), time to first flatus, time to first bowel movement, time for bowel sounds to return, time to resume normal diet, abdominal distension score, and the incidence of postoperative ileus. Compared with the other 2 groups, the FAM/MFES group showed superior results in postoperative pain, time to first flatus, time to first bowel movement, time for bowel sounds to return, and time to resume normal diet (Pâ <â .05). The abdominal distension score was also significantly lower in the FAM/MFES group (Pâ =â .016). However, there was no significant difference in the incidence of postoperative ileus between the groups (Pâ =â .240). The combination of FAM and MFES significantly promotes GI function recovery after colorectal surgery, providing a promising adjunctive treatment approach for postoperative care.
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Puntos de Acupuntura , Neoplasias Colorrectales , Terapia por Estimulación Eléctrica , Masaje , Humanos , Masaje/métodos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Neoplasias Colorrectales/cirugía , Anciano , Recuperación de la Función , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Terapia por Estimulación Eléctrica/métodos , Pie , Resultado del Tratamiento , Dolor Postoperatorio , Terapia CombinadaRESUMEN
Background: China is currently developing standards for Food for Special Medical Purposes (FSMP) targeting for oncology patients. However, substantial challenges remain in defining optimal fortification levels of omega-3 polyunsaturated fatty acids (ω-3 PUFAs). Accumulating evidence suggests that ω-3 PUFA intake improves postoperative prognosis by modulating oncological parameters in colorectal cancer (CRC) patients. This meta-analysis aimed to evaluate the therapeutic efficacy of ω-3 PUFA supplementation in enhancing postoperative safety and recovery stability following CRC surgery, to address critical gaps in nutritional interventions for optimizing clinical outcomes. These findings are expected to FSMP standard development, clinical nutrition protocols and product innovation. Methods: A systematic literature search was conducted, in accordance with PRISMA guidelines, across major databases until June 16, 2025. Data were analyzed using RevMan v5.4 (Cochrane Collaboration). Results: Thirty-four randomized controlled trials (RCTs) (n = 2889) were included. Compared to controls, the ω-3 PUFAs group showed significantly increased levels of nutritional markers: total protein (p < 0.00001), albumin (p = 0.001); immunological parameters: CD3+/CD4+/CD8+ T-cells, CD4+/CD8+ ratio (all p < 0.0001); Karnofsky Performance Status (KPS) scores (p = 0.04); and serum ω-3 PUFA concentrations (p = 0.0004). Significant reductions were observed in inflammatory markers, such as procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) (p = 0.004 to < 0.00001); and clinical outcomes, such as hospitalization duration (p < 0.00001), infectious complications (p < 0.00001), anastomotic leakage (p = 0.0005), surgical site infections (p = 0.03). No significant intergroup differences were detected for white blood cells, transcription factor activity, mortality, or crypt cell proliferation indices (p = 0.06-0.55). Conclusions: Overall, ω-3 PUFA supplementation significantly attenuates postoperative inflammation, enhances immune function, shortens hospitalization, and improves the quality of life in CRC patients, though without mortality benefit. Notably, post hoc dose-response analysis identified a supplementation range of 0.16-0.30 g/kg/day as a potentially optimal supplementation range for Chinese CRC populations, providing foundational evidence for clinical practice and FSMP standardization.
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Neoplasias Colorrectales , Suplementos Dietéticos , Ácidos Grasos Omega-3 , Humanos , Ácidos Grasos Omega-3/administración & dosificación , Neoplasias Colorrectales/cirugía , Complicaciones Posoperatorias/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Femenino , Masculino , Periodo Posoperatorio , Persona de Mediana EdadRESUMEN
INTRODUCTION: Intertrochanteric (IT) hip fractures are increasingly common among older adults and are associated with significant morbidity and mortality. Cephalomedullary nailing is widely adopted for the treatment of intertrochanteric (IT) fractures; however, implant cut-out or cut-through (COCT) continues to be a significant complication. Polymethylmethacrylate (PMMA) augmentation has been introduced to mitigate this risk, though its use is associated with potential drawbacks including thermal necrosis and cement leakage into the joint or fracture site. Therefore, the aim of this study was to determine which patients are most likely to benefit from PMMA augmentation. METHODS: We conducted a retrospective cohort study of patients who underwent short TFNA™ fixation for fragility IT hip fractures between January 2019 and December 2022 at a tertiary hospital in Singapore. Demographic, biochemical, radiological, and surgical data were collected. The primary outcome was implant COCT. Multivariate analysis was used to identify independent predictors of COCT. RESULTS: Among 286 patients (median follow-up 12 months), implant COCT occurred in 16 (5.6%). Firth's regression showed higher neck-shaft angle increased COCT risk (aOR 1.09, p = 0.028), while PMMA augmentation (aOR 0.27, p = 0.054) and male sex (aOR 0.22, p = 0.085) were protective. Anterior cortical support and tip-apex distance were not significant on multivariate analysis. Median time to COCT was longer with cemented fixation (345 vs. 84 days, p = 0.011). CONCLUSION: PMMA augmentation reduces the risk and delays the onset of implant COCT in TFNA™ fixation of fragility IT fractures. However, potential complications with PMMA highlight the need for selective use. Further research involving larger cohorts is needed to develop an evidence-based criteria for guiding PMMA augmentation in clinical practice.