-
Therapeutics and Clinical Risk... 2024The management of patients with COVID-19 infection has placed great pressure on the healthcare systems around the world. The aim of this study was to investigate the...
INTRODUCTION
The management of patients with COVID-19 infection has placed great pressure on the healthcare systems around the world. The aim of this study was to investigate the impact of the COVID-19 pandemic on the treatment outcomes of patients with rectal cancer by comparing them to those of patients with the same diagnosis in the pre-pandemic period.
METHODS
Retrospective data analysis of patients undergoing multimodal treatment for rectal cancer at the four university hospitals during the COVID-19 pandemic (2020-2021) and the 2-year pre-pandemic period (2018-2019).
RESULTS
A total of 693 patients (319 in the pre-pandemic period and 374 in the pandemic period) with rectal cancer were included in the study. The demographic and clinical characteristics of patients in both study periods were comparable, as was the spectrum of surgical procedures. Palliative surgery was more common in the pandemic period (18% vs 13%, p=0.084). The proportion of patients undergoing minimally invasive surgery was higher during the COVID-19 pandemic (p=0.025). There were no statistically significant differences between the study periods in the incidence/severity of post-operative complications, 30-day mortality and length of hospital stay. The number of positive resection margins was similar (5% vs 5%). Based on these results, COVID-19 had no effect on the postoperative morbidity and mortality in patients undergoing surgery for rectal cancer. Neoadjuvant treatment was more common in the pre-pandemic period (50% vs 45%). Long-course RT was predominantly offered in the pre-pandemic period, short-course RT during the pandemic. Significantly shorter "diagnosis-surgery" intervals were observed during the pandemic (23 days vs 33 days, p=0.0002). The "surgery-adjuvant therapy" interval was similar in both analysed study periods (p=0.219).
CONCLUSION
Our study showed, that despite concerns about the COVID-19 pandemic, multimodal treatment of rectal cancer was associated with unchanged postoperative morbidity rates, increased frequency of short-course neoadjuvant RT administration and shorter "diagnosis-surgery" intervals.
PubMed: 38912517
DOI: 10.2147/TCRM.S455332 -
Journal of Surgical Case Reports Jun 2024Wound burping is a technique used to treat intraocular pressure spikes in the immediate postoperative period after cataract surgery. A 55-year-old man with no history of...
Wound burping is a technique used to treat intraocular pressure spikes in the immediate postoperative period after cataract surgery. A 55-year-old man with no history of glaucoma presented with painless blurring of vision in his left eye following cataract surgery 20 days earlier. Ophthalmic examination disclosed elevated intraocular pressure, mild conjunctival hyperemia, corneal microcystic epithelial edema, and mild anterior chamber reaction. In an attempt to lower the intraocular pressure quickly, the corneal wound was 'burped' at the slitlamp. Upon burping the wound, a large epithelial bulla formed instantly in the cornea. The patient's blinking caused the corneal epithelial bulla to burst and collapse. Examination the next day disclosed the detached epithelium had sloughed off completely. The epithelial defect healed gradually over 10 days. Wound burping to release aqueous humor after the corneal epithelium has healed over the surgical incision can result in corneal epithelial detachment and should be avoided.
PubMed: 38912434
DOI: 10.1093/jscr/rjae244 -
36-Month Outcomes of Ahmed ClearPath Glaucoma Drainage Device in Severe Primary Open Angle Glaucoma.Clinical Ophthalmology (Auckland, N.Z.) 2024To evaluate the safety and effectiveness of the Ahmed ClearPath (ACP) 250 mm glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG).
PURPOSE
To evaluate the safety and effectiveness of the Ahmed ClearPath (ACP) 250 mm glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG).
PATIENTS AND METHODS
This was a retrospective case series focused on adult patients diagnosed with severe POAG who underwent implantation of an ACP GDD. Over a 36-month follow-up period, data on intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded. The primary objectives were to assess the reductions from baseline in both IOP and medication usage, through 36 months. Secondary objectives included the proportion of eyes achieving an IOP reduction of ≥ 20% from baseline at 36 months. Intraoperative and postoperative complications were also assessed.
RESULTS
Twelve eyes from 11 patients (mean age: 71.3 ± 14.1 years) met the inclusion criteria and were included in the study. All patients had severe POAG (n=11), with the majority being Caucasian (n=8) and female (n=10). The mean (standard deviation) IOP and number of glaucoma medications at baseline were 29 (7.6) mmHg and 3 (0.9), respectively. At 36 months, mean IOP was reduced to 10.6 (5.5) mmHg (-61.8%; p= 0.0008) and mean number of medications was reduced to 0.9 (0.9) (-71.4%; p=0.0005), with 88.9% of eyes achieving an IOP reduction by ≥20%. No vision threatening complications were observed.
CONCLUSION
To our knowledge this is the first study to report 36-month outcomes of the novel ACP device in the treatment of refractory POAG. The safety profile and efficacy of the ACP was found to be comparable to that of other commonly utilized GDD models.
PubMed: 38912315
DOI: 10.2147/OPTH.S467894 -
Ochsner Journal 2024Bone-patellar tendon-bone (BPTB) autografts are often used to treat anterior cruciate ligament (ACL) tears in young, highly active patients. These grafts are robust and...
Patellar Tendon Reconstruction Using Tibialis Posterior Allograft for Treatment of Patellar Tendon Rupture After Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction.
Bone-patellar tendon-bone (BPTB) autografts are often used to treat anterior cruciate ligament (ACL) tears in young, highly active patients. These grafts are robust and provide adequate stability, allowing for return to sport and optimal functional outcomes in athletes. Patellar tendon rupture following BPTB ACL reconstruction is rare and can be difficult to treat. A 19-year-old collegiate wrestler injured his left knee during a match. On evaluation 7 days after the injury, he was found to have increased anterior translation of the tibia on Lachman testing and an abnormal pivot shift. Magnetic resonance imaging demonstrated a complete tear of the ACL, and he successfully underwent a BPTB ACL reconstruction without complication. He progressed appropriately in the acute postoperative period. Six weeks after his index surgery, the patient reinjured his left knee and was diagnosed with a patellar tendon rupture. The previously reconstructed ACL was intact. A posterior tibialis tendon graft was used to repair the patellar tendon via a transosseous tunnel in the tibial tuberosity. The patient's recovery was complicated by a superficial wound that resolved with treatment. He achieved full range of motion and was able to return to sport. No technique for treating patellar tendon rupture following BPTB ACL reconstruction has been widely accepted. The treatment of this injury is left to the preference of the surgeon. This case demonstrates that tibialis posterior allografts are a viable option for the treatment of such injuries.
PubMed: 38912180
DOI: 10.31486/toj.23.0104 -
Journal of Indian Association of... 2024Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical...
Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study.
INTRODUCTION
Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients.
MATERIALS AND METHODS
This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software.
RESULTS
The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups.
CONCLUSION
Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.
PubMed: 38912029
DOI: 10.4103/jiaps.jiaps_238_23 -
Journal of Indian Association of... 2024Closure of congenital body wall defects in children can be a challenging task for the pediatric Surgeon. Biological prosthesis has been increasingly used for high-risk...
AIMS
Closure of congenital body wall defects in children can be a challenging task for the pediatric Surgeon. Biological prosthesis has been increasingly used for high-risk wound closure in adult patients with excellent outcomes and use in the pediatric population has also been reported. Here, we aim to study the outcome of abdominal wound repair with a tissue-engineered acellular bovine pericardial patch.
METHODS
Over a period of 21 months, a total of 15 children had undergone abdominal wound repair with bioprostheses, i.e., bovine pericardial patch at our institute. Patient demographics, cause of defect, an indication of patch use, rate of infection, postoperative recovery, recurrence, and outcome were studied.
RESULTS
A total of 15 patients underwent abdominal wall closure with acellular bovine pericardial patch. Nine out of 15 patients were neonates, of whom five had gastroschisis, two had a congenital diaphragmatic hernia, and two had ruptured omphalocele major. Of the rest 6 patients, 2 were patients of bladder exstrophy, 2 were older children of congenital diaphragmatic hernia with incisional hernias, and 2 were older children with omphalocele major. Out of the five patients with gastroschisis, two died during the early postoperative period due to sepsis. The wound healed in the rest 13 patients with mild skin dehiscence in two patients. Only one child had a recurrence.
CONCLUSION
Reconstruction with acellular bovine pericardial patch is a viable option in children with high-risk abdominal wounds as it allows tensionless repair with excellent healing and minimal complications. Recurrence, if any, may disappear with time as remodeling of the prosthesis occurs along with the growth of the body wall of the child.
PubMed: 38912025
DOI: 10.4103/jiaps.jiaps_230_23 -
Revista Brasileira de Ortopedia Jun 2024Complex regional pain syndrome (CRPS) requires further understanding. Thus, the present study aimed to analyze if pre- and intraoperative factors may be related to...
Complex regional pain syndrome (CRPS) requires further understanding. Thus, the present study aimed to analyze if pre- and intraoperative factors may be related to the development of CRPS in the postoperative period. We reviewed 1,183 medical records of patients undergoing forearm and hand surgeries from 2015 to 2021. The data of interest, that is, diagnosis, incisions, synthesis material, and anesthesia, were collected, tabulated, and statistically analyzed, with subsequent calculation of the odds ratios. Most patients were female, aged between 30 and 59 years, and sought the service electively (67% of the cases). The diagnoses included soft tissue trauma (43%), bone trauma (31.6%), and compressive syndromes (25.5%). During this period, 45 (3.8%) subjects developed CRPS. The statistical analysis showed that the chance of developing CRPS is twice as high in patients with compressive syndrome, especially carpal tunnel syndrome (CTS), which represented most surgeries performed in our service (24%). Two or more incisions occurred in 7.6% of the cases, which tripled the chance of developing postoperative CRPS. Gender, age, use pf synthetic material, type of anesthesia type did not statistically increase the risk of developing postoperative CRPS. In short, the incidence of CRPS is low; however, it is critical to know and recognize the risk factors for prevention and active screening in the postoperative period.
PubMed: 38911893
DOI: 10.1055/s-0044-1785659 -
Anatomic Total Shoulder Arthroplasty Outcomes Were Not Negatively Affected by the COVID-19 Pandemic.Revista Brasileira de Ortopedia Jun 2024To investigate whether patients undergoing anatomic total shoulder arthroplasty (ATSA) between January and March 2020 experienced different postoperative outcomes...
To investigate whether patients undergoing anatomic total shoulder arthroplasty (ATSA) between January and March 2020 experienced different postoperative outcomes than patients in 2019. We hypothesized that patients in 2020 would have less access to physical therapy (PT) and experience different postoperative outcomes. Records from patients who received ATSA between January 1st, 2019, and March 17th, 2019, and January 1st, 2020, to March 17th, 2020, were analyzed. Patient data, including demographic information, range of motion (ROM), strength, and PT was collected and compared between the two groups. The 2020 patients were contacted by phone during October 2022 and patient-reported metrics were gathered. The present study identified 24 patients in 2019 and 27 patients in 2020 who underwent ATSA during the specified time frame and had a minimum 1-year follow-up. Patients in 2019 experienced improvements in forward elevation (FE) ROM (125.4° to 146.7°; = 0.008), external rotation (ER; 33.0° to 47.7°; < 0.001), and internal rotation (IR; S1 to L4; = 0.019). Patients in 2020 also experienced significant improvements in FE (120.2° to 141.1°; = 0.009), ER (32.9° to 42.0°; = 0.037), and IR (S1 to L3; = 0.002). Patients in 2020 terminated PT earlier (2019: 125.8 days; 2020: 91.1 days; = 0.046) and completed fewer sessions (2019: 21.4 sessions; 2020: 13.1 sessions; = 0.003). At the final follow-up, patients in 2020 reported an average Visual Analogue Scale (VAS) pain score of 1.67 ± 1.1. Despite decreased PT, patients who underwent ATSA in 2020 had significant improvements in ROM and strength and were comparable to patients in 2019.
PubMed: 38911891
DOI: 10.1055/s-0044-1785661 -
Revista Brasileira de Ortopedia Jun 2024To describe the clinical and radiographic outcomes of a cohort of patients with acetabular fractures treated with the modified Stoppa approach. We conducted a...
To describe the clinical and radiographic outcomes of a cohort of patients with acetabular fractures treated with the modified Stoppa approach. We conducted a prospective analysis of adult patients with acetabular fractures treated using the modified Stoppa approach from June 2020 to June 2021, with a minimum follow-up period of 12 months. The analysis included demographic, epidemiological, and perioperative data, as well as postoperative radiographic and functional outcomes. The study included 15 cases, with 14 men (93.3%) and 1 woman (6.67%). A postoperative tomographic evaluation revealed an anatomical reduction in 50%, an imperfect reduction in 13.6%, and a poor reduction in 36.4% of the subjects. Regarding the functional scores, the Harris Hip Score ranged from 56 to 100, with a mean value of 92.5. The Majeed Pelvic Score classified the functional outcome as excellent in 36.5%, good in 40.6%, moderate in 18.7%, and poor in 4.2% of the cases. The present case series study demonstrated positive statistical relevance between reduction quality and functional outcomes and between the time until surgery and the reduction quality. The functional outcomes at a one-year of follow-up demonstrate that this approach can be an excellent alternative for anterior acetabulum fractures.
PubMed: 38911878
DOI: 10.1055/s-0044-1785506 -
Annals of Surgery Open : Perspectives... Jun 2024To evaluate the feasibility, safety, and effectiveness of a comprehensive regional program, including the Minimally Invasive Recovery and Empowerment Care (MIREC)...
OBJECTIVE
To evaluate the feasibility, safety, and effectiveness of a comprehensive regional program, including the Minimally Invasive Recovery and Empowerment Care (MIREC) pathway, that can significantly reduce hospital stays after laparoscopic gastrectomy without increasing adverse events.
BACKGROUND
Cost-effectiveness and improving patient outcomes are crucial in providing quality gastric cancer care worldwide.
METHODS
To compare the outcomes of gastric cancer surgery using 2 different models of care within an integrated healthcare system from February 2012 to March 2023. The primary endpoint was the length of hospital stay. The secondary endpoints were the need for intensive care unit care, emergency room (ER) visits, readmission, reoperation, and death within 30 days after surgery.
RESULTS
There were 553 patients, 167 in the pre-(February 2012-April 2016) and 386 in the post-MIREC period (May 2016-March 2023). Perioperative chemotherapy utilization increased from 31.7% to 76.4% ( < 0.0001). Laparoscopic gastrectomy increased from 17.4% to 97.7% ( < 0.0001). Length of hospitalization decreased from 7 to 2 days ( < 0.0001), with 32.1% and 88% of patients discharged home on postoperative day 1 and postoperative day 2, respectively. When comparing pre- and post-MIREC, intensive care unit utilization (10.8% vs. 2.9%, < 0.0001), ER visits (34.7% vs. 19.7%, = 0.0002), and readmission (18.6% vs. 11.1%, = 0.019) at 30 days were also considerably lower. In addition, more patients received postoperative adjuvant chemotherapy (31.4% to 63.5%, < 0.0001), and the time between gastrectomy and starting adjuvant chemotherapy was also less (49-41 days; = 0.002).
CONCLUSION
This comprehensive regional program, which encompasses regionalization care, laparoscopic approach, modern oncologic care, surgical subspecialization, and the MIREC pathway, can potentially improve gastric cancer surgery outcomes. These benefits include reduced hospital stays and lower complication rates. As such, this program can revolutionize how gastric cancer surgery is delivered, leading to a higher quality of care and increased value to patients.
PubMed: 38911627
DOI: 10.1097/AS9.0000000000000408