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Background: Orthopedic surgeons use manual measurements, acetate templating, and dedicated software to determine the appropriate implant size for total knee arthroplasty (TKA). This study aimed to use deep learning (DL) to assist in deciding the femoral and tibial implant sizes without manual manipulation and to evaluate the clinical validity of the DL decision by comparing it with conventional manual procedures. Methods: Two types of DL were used to detect the femoral and tibial regions using the You Only Look Once algorithm model and to determine the implant size from the detected regions using convolutional neural network. An experienced surgeon predicted the implant size for 234 patient cases using manual procedures, and the DL model also predicted the implant sizes for the same cases. Results: The exact accuracies of the surgeon's template were 61.54% and 68.38% for predicting femoral and tibial implant sizes, respectively. Meanwhile, the proposed DL model reported exact accuracies of 89.32% and 90.60% for femoral and tibial implant sizes, respectively. The accuracy ± 1 levels of the surgeon and proposed DL model were 97.44% and 97.86%, respectively, for the femoral implant size and 98.72% for both the surgeon and proposed DL model for the tibial implant size. Conclusion: The observed differences and higher agreement levels achieved by the proposed DL model demonstrate its potential as a valuable tool in preoperative decision-making for TKA. By providing accurate predictions of implant size, the proposed DL model has the potential to optimize implant selection, leading to improved surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: Orthopedic surgeons use manual measurements, acetate templating, and dedicated software to determine the appropriate implant size for total knee arthroplasty (TKA). This study aimed to use deep learning (DL) to assist in deciding the femoral and tibial implant sizes without manual manipulation and to evaluate the clinical validity of the DL decision by comparing it with conventional manual procedures. Methods: Two types of DL were used to detect the femoral and tibial regions using the You Only Look Once algorithm model and to determine the implant size from the detected regions using convolutional neural network. An experienced surgeon predicted the implant size for 234 patient cases using manual procedures, and the DL model also predicted the implant sizes for the same cases. Results: The exact accuracies of the surgeon's template were 61.54% and 68.38% for predicting femoral and tibial implant sizes, respectively. Meanwhile, the proposed DL model reported exact accuracies of 89.32% and 90.60% for femoral and tibial implant sizes, respectively. The accuracy ± 1 levels of the surgeon and proposed DL model were 97.44% and 97.86%, respectively, for the femoral implant size and 98.72% for both the surgeon and proposed DL model for the tibial implant size. Conclusion: The observed differences and higher agreement levels achieved by the proposed DL model demonstrate its potential as a valuable tool in preoperative decision-making for TKA. By providing accurate predictions of implant size, the proposed DL model has the potential to optimize implant selection, leading to improved surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: There is wide variation in stress test utilization before major vascular surgery and adherence to practice guidelines is unclear. We defined rates of stress test compliance at our institution and led a quality improvement initiative to improve compliance with American Heart Association (ACC/AHA) guidelines. Methods: We implemented a stress testing order set in the electronic medical record at one tertiary hospital. We reviewed all patients who underwent elective, major vascular surgery in the 6 months before (Jan 1, 2022 – Jul 1, 2022) and 6 months after (Aug 1, 2022 – Jan 31, 2023) implementation. We studied stress test guideline compliance, changes in medical or surgical management, and major adverse cardiac events (MACE). Results: Before order set implementation, 37/122 patients (30%) underwent stress testing within the past year (29 specifically ordered preoperatively) with 66% (19/29) guideline compliance. After order set implementation, 50/173 patients (29%) underwent stress testing within the past year (41 specifically ordered preoperatively) with 80% (33/41) guideline compliance. In the pre- and postimplementation cohorts, stress testing led to a cardiovascular medication change or preoperative coronary revascularization in 24% (7/29) and 27% (11/41) of patients, and a staged surgery or less invasive anesthetic strategy in 14% (4/29) and 4.9% (2/41) of patients, respectively. All unindicated stress tests were surgeon-ordered and none led to a change in management. There was no change in MACE after order set implementation. Conclusions: Electronic medical record-based guidance of perioperative stress testing led to a slight decrease in overall stress testing and an increase in guideline-compliant testing. Our study highlights a need for improved preoperative cardiovascular risk assessment prior to major vascular surgery, which may eliminate unnecessary testing and more effectively guide perioperative decision-making. [ABSTRACT FROM AUTHOR]

Background: Many studies have reported the use of preoperative oral carbohydrates (CHO) in children, but the results are inconsistent. The aim of this meta-analysis is to assess the effectiveness and safety of oral CHO administration in children prior to surgery, with the goal of offering a dependable reference for clinical nursing practices and surgical interventions. Methods: Two authors searched PubMed, Clinical trials, Web of Science, Embase, Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang and Weipu databases for randomized controlled trial (RCT) on the effects of preoperative oral CHO in children up to April 12, 2024. We used RevMan 5.4 software for data analysis. Results: Nine RCTs involving a total of 1279 children were included. The meta-analysis showed that there was statistical difference in the pH of gastric juice (MD = 1.54, 95%CI: 1.40–1.67, p <.001), intraoperative sedation score (MD = 0.62, 95%CI: 0.27–0.97, p <.001), and the incidence of postoperative nausea and vomiting (OR = 0.40, 95%CI: 0.20–0.80, p =.009) between the CHO and control groups. There was no statistical difference in the RGV (MD = −0.23, 95%CI: −0.47–0.01, p =.06) and the postoperative blood glucose level (MD = −0.91, 95%CI: −5.03–3.21, p =.67) between the CHO and control groups. Egger regression analysis showed that there were no publication biases amongst the synthesized outcomes (all p >.05). Conclusion: The administration of oral CHO to children before surgery is safe and practicable. There is a need for additional, well-conducted studies with more participants to further elucidate the role of preoperative CHO administration. [ABSTRACT FROM AUTHOR]

Background: The role that preoperative Satisfaction with Breast plays in a patient's postoperative course after postmastectomy breast reconstruction (PMBR) is not understood. The aim of this study is to understand the impact of the preoperative score on postoperative outcome as an independent variable. Methods: We examined patients who underwent PMBR between 2017 and 2021 and who completed the BREAST-Q Satisfaction with Breasts at 1 year postoperatively. Two multiple linear regression models (Model 1 with the preoperative Satisfaction with Breasts score and Model 2 without the preoperative score), likelihood ratio tests, simple t-statistics, and sample patient dataset to predict the 1 year score were performed. Multiple imputation was used to account for missing preoperative scores. Results: Overall, 2324 patients were included. Model 1 showed that the preoperative score is significantly associated with the postoperative score (β = 0.09, 95% confidence interval 0.04–0.14; p < 0.001). Comparing Model 1 and Model 2 demonstrated that including preoperative Satisfaction with Breasts in a regression significantly improves model fit (test statistic = 10.04; p = 0.0021). Using the absolute value of the t-statistics as a measure of variable importance in linear regression, the importance of the preoperative score was quantified as 3.39—more important than neoadjuvant radiation, mastectomy weight, body mass index, bilateral prophylactic mastectomy, and race, but less than adjuvant radiation, reconstruction type, and psychiatric diagnoses. Conclusion: Preoperative Satisfaction with Breasts scores are an important independent predictor of postoperative satisfaction after PMBR. Just as vital sign and work-up are carefully documented before surgery, preoperative scores should be collected to pre-emptively gauge patients' satisfaction and optimize postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: Hip fractures in the elderly are a common traumatic injury. Due to factors such as age and underlying diseases, these patients exhibit a high incidence of acute heart failure prior to surgery, severely impacting surgical outcomes and prognosis. Objective: This study aims to explore the potential risk factors for acute heart failure before surgery in elderly patients with hip fractures and to establish an effective clinical prediction model. Methods: This study employed a retrospective cohort study design and collected baseline and preoperative variables of elderly patients with hip fractures. Strict inclusion and exclusion criteria were adopted to ensure sample consistency. Statistical analyses were carried out using SPSS 24.0 and R software. A prediction model was developed using least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression. The accuracy of the model was evaluated by analyzing the area under the receiver operating characteristic (ROC) curve (AUC) and a calibration curve was plotted to assess the model's calibration. Results: Between 2018 and 2019, 1962 elderly fracture patients were included in the study. After filtering, 1273 were analyzed. Approximately 25.7% of the patients experienced acute heart failure preoperatively. Through LASSO and logistic regression analyses, predictors for preoperative acute heart failure in elderly patients with hip fractures were identified as Gender was male (OR = 0.529, 95% CI: 0.381–0.734, P < 0.001), Age (OR = 1.760, 95% CI: 1.251–2.479, P = 0.001), Coronary Heart Disease (OR = 1.977, 95% CI: 1.454–2.687, P < 0.001), Chronic Obstructive Pulmonary Disease (COPD) (OR = 2.484, 95% CI: 1.154–5.346, P = 0.020), Complications (OR = 1.516, 95% CI: 1.033–2.226, P = 0.033), Anemia (OR = 2.668, 95% CI: 1.850–3.847, P < 0.001), and Hypoalbuminemia (OR 2.442, 95% CI: 1.682–3.544, P < 0.001). The linear prediction model of acute heart failure was Logit(P) = -2.167–0.637×partial regression coefficient for Gender was male + 0.566×partial regression coefficient for Age + 0.682×partial regression coefficient for Coronary heart disease + 0.910×partial regression coefficient for COPD + 0.416×partial regression coefficient for Complications + 0.981×partial regression coefficient for Anemia + 0.893×partial regression coefficient for Hypoalbuminemia, and the nomogram prediction model was established. The AUC of the predictive model was 0.763, indicating good predictive performance. Decision curve analysis revealed that the prediction model offers the greatest net benefit when the threshold probability ranges from 4 to 62%. Conclusion: The prediction model we developed exhibits excellent accuracy in predicting the onset of acute heart failure preoperatively in elderly patients with hip fractures. It could potentially serve as an effective and useful clinical tool for physicians in conducting clinical assessments and individualized treatments. [ABSTRACT FROM AUTHOR]

Background: To investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA). Methods: We enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes. Results: An under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888–0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50–2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30–37.3 g/L, 25–30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37–1.99, P < 0.001), 5.4 (95% CI 3.08–9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively. Conclusion: In TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion. Trial registration: 28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844. [ABSTRACT FROM AUTHOR]

Background: Ovarian cancer is the most frequent type of gynecological cancer following malignancies of the cervix and uterus and has the greatest death rate among gynecological malignancies. Almost two thirds of the patients have extensive intra-abdominal illness, ascites and cachexia due to malnourishment. Furthermore, systemic inflammation is crucial for the development and advancement of cancer. Therefore, it is imperative to identify relative biomarkers to forecast treatment outcomes and prognosis. Aim: To evaluate the importance of preoperative prognostic nutritional index (PNI) in ovarian cancer. To assess retrospectively association between preoperative Prognostic Nutritional Index and prognosis in patients with ovarian cancer, and to evaluate its important on disease free survival and overall survival. Methods: This study retrospective cohort observational study was conducted at Medical Oncology Department, Faculty of Medicine, Zagazig University. The preoperative peripheral blood neutrophil count was computed as follows: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Using the web application "Cutoff Finder," the ideal PNI cut off value for overall survival (OS) was determined. Results: The 47.895 cutoff value discriminated patients into the high-PNI and low-PNI groups. There was significant difference between the two groups. A low preoperative PNI was associated with an advanced FIGO stage, CA125, ascites, residual of disease, body mass index and significant longer OS and progression free survival in patients with high-PNI. Conclusions: Preoperative PNI can be used as a simple and useful marker for predicting chemotherapeutic response and survival prognosis in patients with Ovarian Cancer. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether 6 months of preoperative apalutamide for intermediate‐risk prostate cancer (IRPCa) reduces the aggregate postoperative radiotherapy risk and to evaluate associations of molecular perturbations with clinical outcomes in this study cohort. Patients and Methods: Between May 2018 and February 2020, eligible patients with IRPCa (Gleason 3 + 4 or 4 + 3 and clinical T2b‐c or prostate‐specific antigen level of 10–20 ng/mL) were treated with apalutamide 240 mg/day for 6 months followed by radical prostatectomy (RP) in this single‐arm, phase II trial. The primary endpoint was presence of any adverse pathological feature at risk of pelvic radiation (pathological T stage after neoadjuvant therapy [yp]T3 or ypN1 or positive surgical margins). Translational studies, including germline and somatic DNA alterations and RNA and protein expression, were performed on post‐apalutamide RP specimens, and assessed for associations with clinical outcomes. Results: A total of 40 patients underwent a RP, and only one patient discontinued apalutamide prior to 6 months. In all, 40% had adverse pathological features at time of RP, and the 3‐year biochemical recurrence (BCR) rate was 15%, with 27.5% being not evaluable. Genomic alterations frequently seen in metastatic PCas, such as androgen receptor (AR), tumour protein p53 (TP53), phosphatase and tensin homologue (PTEN), or BReast CAncer associated gene (BRCA1/2) were underrepresented in this localised cohort. Adverse pathological features and BCR at 3‐years were associated with increased expression of select cell cycle (e.g., E2F targets: adjusted P value [Padj] < 0.001, normalised enrichment score [NES] 2.47) and oxidative phosphorylation (Padj < 0.001, NES 1.62) pathways. Conclusions: Preoperative apalutamide did not reduce the aggregate postoperative radiation risk to the pre‐specified threshold in unselected men with IRPCa. However, transcriptomic analysis identified key dysregulated pathways in tumours associated with adverse pathological outcomes and BCR, which warrant future study. Further investigation of preoperative therapy is underway for men with high‐risk PCa. [ABSTRACT FROM AUTHOR]

Background: Anxiety before surgery is one of the most challenging aspects of preoperative care. Preoperative anxiety has a number of postoperative complications. There are only a few studies that report on preoperative anxiety in surgical patients in Ethiopia, and their prevalence differs from one study to the next. Objective: The aim of this study was to assess the level of preoperative anxiety and associated factors among surgical patients admitted at public hospitals in southern Ethiopia. Methods: From July to August 2022, a facility-based cross-sectional study was conducted among patients admitted to surgical wards at public hospitals. Data collection was conducted using a pretested, structured questionnaire administered by an interviewer. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory scale. The data were coded and entered in Epi Data Version 4.6, then exported to Statistical Package for Social Sciences version 25 for analysis. To describe the study variables, descriptive statistics were used. The associated factors were then identified using bivariate and multivariate logistic regression analyses. Results were declared at a p-value of less than 0.05 based on an adjusted odds ratio with a 95% confidence interval. Result: A total of 220 patients were enrolled, with a 99.5% response rate. The observed preoperative anxiety level was 57.5% (95%CI: 54.63–62.35). High preoperative anxiety was associated with no formal educational status (AOR: 3.75; 95%CI = 1.36, 10.39), fear of death (AOR =2.01; 95%CI = 1.09, 3.73), fear of waking up in middle of surgery (AOR =3.42; 95%CI =1.19, 9.77), fear of postoperative pain (AOR = 2.56; 95%CI = 1.15, 5.74). Conclusion: This study found that five out of ten patients scheduled for surgery in public hospitals had high levels of preoperative anxiety. Anxiety levels were associated with factors such as the educational status of respondents, fear of death, fear of waking up in the middle of surgery, and fear of postoperative pain. Preoperative anxiety assessments should be conducted regularly in each hospital, and appropriate anxiety-reducing methods must be implemented. [ABSTRACT FROM AUTHOR]

Summary: Surgery and general anaesthesia have deleterious effects on sleep and disrupted perioperative sleep health is a risk factor for poor surgical outcomes. The objective of this systematic review was to summarise preoperative interventions that report sleep outcomes. Studies that delivered an intervention initiated >24 h prior to surgery among an adult sample without a diagnosed sleep disorder were included. Studies were excluded if they were preclinical or were not published in English. MEDLINE, MEDLINE ePubs Ahead of Print and In‐process Citations, Embase, Cochrane Central Register of Controlled Trials, APA PsycINFO, CINAHL, and the Web of Science were searched on February 2, 2023. This review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42021260578). Risk of bias was assessed using the Cochrane Risk‐of Bias 2 tool for randomised trials and the Risk Of Bias In Non‐randomised Studies ‐ of Interventions for non‐randomised trials. Certainty of findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. The searching yielded 10,938 total citations, and after screening resulted in 28 randomised and 19 non‐randomised trials (47 total) with 4937 participants. Sleep was a primary outcome in 16 trials; a sleep outcome was significantly improved relative to comparator in 23 trials. This review demonstrates that preoperative sleep is modifiable via a variety of interventions, including pharmacological, non‐pharmacological, and nursing interventions delivered preoperatively or perioperatively. Our results should be considered with caution due to an overall intermediate to high risk of bias in the included trials, and low to very low certainty of evidence. This review supports the modifiability of sleep health among surgical patients and provides the groundwork for preoperative sleep optimisation research. [ABSTRACT FROM AUTHOR]

Breast conserving treatment typically involves surgical excision of tumor and adjuvant radiotherapy targeting the breast area or tumor bed. Accurately defining the tumor bed is challenging and lead to irradiation of greater volume of healthy tissues. Preoperative stereotactic body radiotherapy (SBRT) which target tumor may solves that issues. We conducted a systematic literature review to evaluates the early toxicity and cosmetic outcomes of this promising treatment approach. Secondary we reviewed pathological complete response (pCR) rates, late toxicity, patient selection criteria and radiotherapy protocols. We retrieved literature from PubMed, Scopus, Web of Science, Cochrane, ScienceDirect, and ClinicalTrials.gov. The study adhered to the PRISMA 2020 guidelines. Ten prospective clinical trials (7 phase II, 3 phase I), encompassing 188 patients (aged 18–75 years, cT1-T3 cN0-N3 cM0, primarily with ER/PgR-positive, HER2-negative status,), were analyzed. Median follow-up was 15 months (range 3–30). Treatment involved single-fraction SBRT (15-21Gy) in five studies and fractionated (19.5–31.5Gy in 3 fractions) in the rest. Time interval from SBRT to surgery was 9.5 weeks (range 1–28). Acute and late G2 toxicity occurred in 0–17% and 0–19% of patients, respectively, G3 toxicity was rarely observed. The cosmetic outcome was excellent in 85–100%, fair in 0–10% and poor in only 1 patient. pCR varied, showing higher rates (up to 42%) with longer intervals between SBRT and surgery and when combined with neoadjuvant systemic therapy (up to 90%). Preoperative SBRT significantly reduce overall treatment time, enabling to minimalize volumes. Early results indicate excellent cosmetic effects and low toxicity. [ABSTRACT FROM AUTHOR]

Aim: To evaluate preoperative and postoperative levels of anxiety according to visual acuity and sociodemographic characteristics in patients undergoing cataract surgery. Materials and Methods: The study included 100 patients who were planned to undergo cataract surgery because of reduced vision. One day preoperatively and at one month postoperatively, all the patients were administered the sociodemographic data form and the Spielberger State-Trait Anxiety Inventory (STAI TX-1 and TX-2). All the patients underwent a detailed preoperative and postoperative ophthalmological examination. Visual acuity was evaluated with a logMAR Chart. Results: The visual acuity on the LogMAR chart of the patients was mean 1.1±0.3 preoperatively and 0.1±0.1 postoperatively. Visual acuity was determined to have significantly increased postoperatively and the STAI FORM TX-2 points significantly decreased (p=0.04). The postoperative decrease in the LogMAR chart was statistically significant (p<0.001). A significant positive correlation was determined between the preoperative STAI FORM TX-1 points and the preoperative STAI FORM TX-2 points. The mean STAI FORM TX-1 points of the patients with an education level of middle school or below were found to be significantly higher than those of patients educated to university level or higher (p=0.012). The visual acuity (LogMAR) of patients who had previously received psychiatric treatment were found to be significantly lower than those of patients who had not received any psychiatric drug treatment (p=0.027). Conclusion: Patients with cataracts are anxious in a general sense, independently of surgery. The increase in vision after cataract surgery is important in respect of decreasing levels of trait anxiety. [ABSTRACT FROM AUTHOR]

A total of 151 patients with 151 operations were observed and retrospectively recorded. All medical staff (including doctors, nurses, and midwives) participating in the preparation of patients were invited to participate in the study. A total of 38 health workers were observed and evaluated. Seven in-depth interviews and focus group discussions were performed. Compliance preparation for preoperative preparation among medical staff is low, with only 45.7% adherence to the process, while 76.8% comply with physical preparation. The overall compliance rate is 67.5%. The study also reveals incomplete surgical review systems, inadequate human resources, and insufficient supervision. Type of surgery and surgical department are factors associated with poor preoperative preparation. Study results highlighted that the level of compliance with the pre-operative patient preparation process of the private hospital in this study was still low. Appropriate strategies are needed to improve human resource barriers and monitor and improve administrative systems, thereby improving the ability of medical staff to comply with the process at the hospital. [ABSTRACT FROM AUTHOR]

Purpose: To build an Mult-Task Learning (MTL) based Artificial Intelligence(AI) model that can simultaneously predict clinical stage, histology, grade and LNM for cervical cancer before surgery. Methods: This retrospective and prospective cohort study was conducted from January 2001 to March 2014 for the training set and from January 2018 to November 2021 for the validation set at Beijing Chaoyang Hospital, Capital Medical University. Preoperative clinical information of cervical cancer patients was used. An Artificial Neural Network (ANN) algorithm was used to build the MTL-based AI model. Accuracy and weighted F1 scores were calculated as evaluation indicators. The performance of the MTL model was compared with Single-Task Learning (STL) models. Additionally, a Turing test was performed by 20 gynecologists and compared with this AI model. Results: A total of 223 cervical cancer cases were retrospectively enrolled into the training set, and 58 cases were prospectively collected as independent validation set. The accuracy of this cervical cancer AI model constructed with ANN algorithm in predicting stage, histology, grade and LNM were 75%, 95%, 86% and 76%, respectively. And the corresponding weighted F1 score were 70%, 94%, 86%, and 76%, respectively. The average time consumption of AI simultaneously predicting stage, histology, grade and LNM for cervical cancer was 0.01s (95%CI: 0.01–0.01) per 20 patients. The mean time consumption doctor and doctor with AI were 581.1s (95%CI: 300.0-900.0) per 20 patients and 534.8s (95%CI: 255.0-720.0) per 20 patients, respectively. Except for LNM, both the accuracy and F-score of the AI model were significantly better than STL AI, doctors and AI-assisted doctors in predicting stage, grade and histology. (P < 0.05) The time consumption of AI was significantly less than that of doctors' prediction and AI-assisted doctors' results. (P < 0.05 Conclusion: A multi-task learning AI model can simultaneously predict stage, histology, grade, and LNM for cervical cancer preoperatively with minimal time consumption. To improve the conditions and use of the beneficiaries, the model should be integrated into routine clinical workflows, offering a decision-support tool for gynecologists. Future studies should focus on refining the model for broader clinical applications, increasing the diversity of the training datasets, and enhancing its adaptability to various clinical settings. Additionally, continuous feedback from clinical practice should be incorporated to ensure the model's accuracy and reliability, ultimately improving personalized patient care and treatment outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Estimating the risk of postoperative complications is important for shared decision-making with the patient. This also helps multidisciplinary teams to plan preoperative management and postoperative care and predict duration of recovery. In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological–oncological (GO) robotic surgery (RS). We were able to demonstrate that the ACS-NSQIP risk tool showed 90% accuracy in prediction of five major complications and mortality. Purpose: In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological–oncological (GO) robotic surgery (RS). Methods: Retrospective data collection undertaken through a dedicated GO database and patient notes at a tertiary referral cancer centre. Following data lock with the actual post-op event/complication, the risk calculators were used to measure predictive scores for each patient. Baseline analysis of 153 patients, based on statistician advice, was undertaken to evaluate P-POSSUM and ACS-NSQIP validity and relevance in GO patients undergoing RS performed. Results: P-POSSUM reports on mortality and morbidity only; ACS-NSQIP reports some individual complications as well. ACS-NSQIP risk prediction was most accurate for venous thromboembolism (VTE) (area under the curve (AUC)-0.793) and pneumonia (AUC-0.657) and it showed 90% accuracy in prediction of five major complications (Brier score 0.01). Morbidity was much better predicted by ACS-NSQIP than by P-POSSUM (AUC-0.608 vs. AUC-0.551) with the same result in mortality prediction (Brier score 0.0000). Moreover, a statistically significant overestimation of morbidity has been shown by the P-POSSUM calculator (p = 0.018). Conclusions: Despite the limitations of this pilot study, the ACS-NSQIP risk calculator appears to be a better predictor of major complications and mortality, making it suitable for use by GO surgeons as an informed consent tool. Larger data collection and analyses are ongoing to validate this further. [ABSTRACT FROM AUTHOR]

Copyright of Pferdeheilkunde is the property of Hippiatrika Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Bimaxillary surgery is an elemental procedure in the field of cranio-maxillofacial surgery. It allows for the correction of even the most challenging cases of maxillomandibular disorders, malocclusion, facial asymmetry, and disproportion. The osteotomies and maneuvers carried out during the procedure result in changes to the surrounding tissues, including the maxillary sinuses (MS). The aim of this study was to assess the change in the maxillary sinus volume and the thickness of the mucosa after maxillomandibular advancement (MMA) surgeries. Methods: A group of 25 patients who underwent MMA surgery were included in the study. Computed tomography (CT) of the head and neck region was performed 2 weeks preoperatively and 6 months postoperatively. Acquired Digital Imaging and Communications in Medicine (DICOM) files were analyzed using different software programs to calculate the medium MS mucosa thickness and MS volume. Results: A statistically significant reduction in MS volume was observed (p = 0.015). The change in the median thickness of the MS mucosa was not statistically significant. The median sella-nasion-A point angle (SNA angle) value of the group increased from 80.2 to 83.4 degrees. A weak negative correlation between the SNA delta and the MS volume delta was observed. Spearman's rank coefficient: (ρ s = −0.381, p = 0.060). Conclusions: The MMA surgery results in a reduction in the MS volume. The amount of forward movement of the maxilla may be correlated with the extent of the MS volume reduction. [ABSTRACT FROM AUTHOR]

Purpose: Depression is one of the main psychological responses experienced by patients with breast cancer perioperatively. Therefore, this review aimed to synthesize the prevalence rate of depression preoperatively among patients with breast cancer. Methods: Six databases were searched for published articles, which recruited female patients aged 18 years and above, diagnosed with breast cancer and planned for breast surgery. Grey literatures were searched from ProQuest Theses and Dissertations, Science.gov and CogPrints. Studies published in English from the inception of databases to January 2023 were considered. Two reviewers screened, extracted, and appraised the data independently. Joanna Briggs Institute data collection form was used for data collection. Hoy's Risk of Bias Tool was utilized to assess the individual study's quality. Review Manager 5.4 software was utilized for meta-analysis. Subgroup analyses were conducted to explore the reasons for any heterogeneity. Publication bias was evaluated by Egger's test and funnel plot. Results: Twenty studies involving 32,143 patients with breast cancer were included. Meta-analyses revealed an overall preoperative prevalence of 30% among all studies. Subgroup analyses showed that studies conducted in the Middle East and North Africa used purposive sampling, with patients undergoing mastectomy and lumpectomy and with moderate risk of bias reported higher prevalence of preoperative depression (54%, 44%, 40%, and 49%, respectively) as compared to other respective subgroups. Conclusion: The high prevalence of preoperative depression among women with breast cancer indicated the need for health care professionals to provide more psychological support to them. [ABSTRACT FROM AUTHOR]

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Introduction: The views of patients and carers are important for the development of research priorities. This study aimed to determine and compare the top research priorities of cancer patients and carers with those of multidisciplinary clinicians with expertise in prehabilitation. Materials and methods: This cross-sectional study surveyed patients recovering from cancer surgery at a major tertiary hospital in Sydney, Australia, and/or their carers between March and July 2023. Consenting patients and carers were provided a list of research priorities according to clinicians with expertise in prehabilitation, as determined in a recent International Delphi study. Participants were asked to rate the importance of each research priority using a 5-item Likert scale (ranging from 1 = very high research priority to 5 = very low research priority). Results: A total of 101 patients and 50 carers participated in this study. Four areas were identified as research priorities, achieving consensus of highest importance (> 70% rated as “high” or “very high” priority) by patients, carers, and clinical experts. These were “optimal composition of prehabilitation programs” (77% vs. 82% vs. 88%), “effect of prehabilitation on surgical outcomes” (85% vs. 90% vs. 95%), “effect of prehabilitation on functional outcomes” (83% vs. 86% vs. 79%), and “effect of prehabilitation on patient reported outcomes” (78% vs. 84% vs. 79%). Priorities that did not reach consensus of high importance by patients despite reaching consensus of highest importance by experts included “identifying populations most likely to benefit from prehabilitation” (70% vs. 76% vs. 90%) and “defining prehabilitation core outcome measures” (66% vs. 74% vs. 87%). “Prehabilitation during neoadjuvant therapies” reached consensus of high importance by patients but not by experts or carers (81% vs. 68% vs. 69%). Conclusion: This study delineated the primary prehabilitation research priorities as determined by patients and carers, against those previously identified by clinicians with expertise in prehabilitation. It is recommended that subsequent high-quality research and resource allocation be directed towards these highlighted areas of importance. [ABSTRACT FROM AUTHOR]

Management of stage II–III non-small cell lung cancer (NSCLC) has been dramatically revolutionized by studies testing the addition of immunotherapy (IO) to chemotherapy in the pre- or perioperative setting. That is because the integration of chemoimmunotherapy (chemo-IO) with surgery has consistently shown a significant improvement in pathological complete response (path CR) rate, event-free survival, and, more recently, overall survival, versus preoperative chemotherapy alone. Particularly, resectable stage III NSCLCs represent a disease entity with a high risk of distant recurrence after radical surgery, for whom pre- or perioperative chemo-IO should be considered as the preferential treatment option. However, owing to the heterogeneity of stage III NSCLC, a standard definition of resectability is not established yet, being often subjective according to the expertise and clinical background of the thoracic surgeon. In addition, careful patient selection on the basis of tumor biomarkers, meticulous staging of the disease, and accurate monitoring of treatment-related adverse events are critical factors that could prevent the ineligibility for surgery of patients treated with pre- or perioperative chemo-IO. Finally, the impact of downstaging for initially borderline resectable tumors, as well as the exact number of preoperative chemo-IO cycles needed and the indications for adjuvant IO, still need to be fully elucidated. In this podcast, we will touch upon the above-mentioned topics from the perspectives of the thoracic surgeon and the oncologist, and suggest a shared agreement between two of the main actors involved in the treatment of resectable stage III NSCLCs. Podcast audio available for this publication. [ABSTRACT FROM AUTHOR]

Background: Oncologic surgical resection is the standard of care for extremity and truncal soft tissue sarcoma (STS), often accompanied by the addition of pre- or postoperative radiation therapy (RT). Preoperative RT may decrease the risk of joint stiffness and fibrosis at the cost of higher rates of wound complications. Hypofractionated, preoperative RT has been shown to provide acceptable outcomes in prospective trials. Proton beam therapy (PBT) provides the means to decrease dose to surrounding organs at risk, such as the skin, bone, soft tissues, and adjacent joint(s), and has not yet been studied in patients with extremity and truncal sarcoma. Methods: Our study titled "PROspective phase II trial of preoperative hypofractionated protoN therapy for extremity and Truncal soft tissue sarcOma (PRONTO)" is a non-randomized, prospective phase II trial evaluating the safety and efficacy of preoperative, hypofractionated PBT for patients with STS of the extremity and trunk planned for surgical resection. Adult patients with Eastern Cooperative Group Performance Status ≤ 2 with resectable extremity and truncal STS will be included, with the aim to accrue 40 patients. Treatment will consist of 30 Gy radiobiological equivalent of PBT in 5 fractions delivered every other day, followed by surgical resection 2–12 weeks later. The primary outcome is rate of major wound complications as defined according to the National Cancer Institute of Canada Sarcoma2 (NCIC-SR2) Multicenter Trial. Secondary objectives include rate of late grade ≥ 2 toxicity, local recurrence-free survival and distant metastasis-free survival at 1- and 2-years, functional outcomes, quality of life, and pathologic response. Discussion: PRONTO represents the first trial evaluating the use of hypofractionated PBT for STS. We aim to prove the safety and efficacy of this approach and to compare our results to historical outcomes established by previous trials. Given the low number of proton centers and limited availability, the short course of PBT may provide the opportunity to treat patients who would otherwise be limited when treating with daily RT over several weeks. We hope that this trial will lead to increased referral patterns, offer benefits towards patient convenience and clinic workflow efficiency, and provide evidence supporting the use of PBT in this setting. Trial registration: NCT05917301 (registered 23/6/2023). [ABSTRACT FROM AUTHOR]

Background: Oncologic surgical resection is the standard of care for extremity and truncal soft tissue sarcoma (STS), often accompanied by the addition of pre- or postoperative radiation therapy (RT). Preoperative RT may decrease the risk of joint stiffness and fibrosis at the cost of higher rates of wound complications. Hypofractionated, preoperative RT has been shown to provide acceptable outcomes in prospective trials. Proton beam therapy (PBT) provides the means to decrease dose to surrounding organs at risk, such as the skin, bone, soft tissues, and adjacent joint(s), and has not yet been studied in patients with extremity and truncal sarcoma. Methods: Our study titled "PROspective phase II trial of preoperative hypofractionated protoN therapy for extremity and Truncal soft tissue sarcOma (PRONTO)" is a non-randomized, prospective phase II trial evaluating the safety and efficacy of preoperative, hypofractionated PBT for patients with STS of the extremity and trunk planned for surgical resection. Adult patients with Eastern Cooperative Group Performance Status ≤ 2 with resectable extremity and truncal STS will be included, with the aim to accrue 40 patients. Treatment will consist of 30 Gy radiobiological equivalent of PBT in 5 fractions delivered every other day, followed by surgical resection 2–12 weeks later. The primary outcome is rate of major wound complications as defined according to the National Cancer Institute of Canada Sarcoma2 (NCIC-SR2) Multicenter Trial. Secondary objectives include rate of late grade ≥ 2 toxicity, local recurrence-free survival and distant metastasis-free survival at 1- and 2-years, functional outcomes, quality of life, and pathologic response. Discussion: PRONTO represents the first trial evaluating the use of hypofractionated PBT for STS. We aim to prove the safety and efficacy of this approach and to compare our results to historical outcomes established by previous trials. Given the low number of proton centers and limited availability, the short course of PBT may provide the opportunity to treat patients who would otherwise be limited when treating with daily RT over several weeks. We hope that this trial will lead to increased referral patterns, offer benefits towards patient convenience and clinic workflow efficiency, and provide evidence supporting the use of PBT in this setting. Trial registration: NCT05917301 (registered 23/6/2023). [ABSTRACT FROM AUTHOR]

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n = 111 dietitians, n = 72 physicians, n = 42 allied HCPs), 96%–100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n = 142/220; dietitians: 88% vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period (n = 117) by dietitians (n = 94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n = 121/212), time (40%, n = 84/212) and support from others (38%, n = 80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier. [ABSTRACT FROM AUTHOR]

Introduction: Outcomes of long-term (5–10-year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12 week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery. Methods: Data were collected prospectively from a bariatric center (2008–2022). Excess weight loss (EWL) ≥ 50% and ≥ 70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL ≥ 50% and ≥ 70%. Results: Three hundred thirty-nine patients (median age, 49 years; median follow-up, 7 years [0.5–11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both < 10.5% and > 10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p < 0.001) and EWL ≥ 70% (HR 3.24, p < 0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥ 50% (OR, 2.36; p = 0.013) and EWL ≥ 70% (OR, 2.03; p = 0.011) at the end of follow-up. Conclusions: IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing use of preoperative ultrasound evaluation for melanoma, there is limited research on the use of this technique for Acral Melanoma (AM). Methods: This retrospective study analyzed the electronic medical records of patients who underwent preoperative evaluation for cutaneous melanoma maximum thickness using an 18 MHz probe and histopathological examination between December 2017 and March 2021 at the Department of Dermatology in Xiangya Hospital, Central South University. Results: A total of 105 patients were included in the study. The mean tumor thicknesswas 3.9mm(s.d., 2.3), with 63%of the specimens showing ulceration and 44 patients showing lymph node metastasis. The results showed a good correlation between the high-frequency ultrasonography (HFUS) and histopathological thickness measurements, with a Spearman's correlation coefficient of 0.83 [(95% CI 0.73-0.90) (P < 0.001)]. The positive predictive value (PPV) of sonography in identifying tumor thickness was also found to be high. Conclusion: Our study suggests that high-frequency 18 MHz ultrasonography is an effective tool for the preoperative evaluation of AM thickness. The HFUS measurements correlated well with the histopathological thickness measurements, making it a valuable and reliable method for clinicians to assess the thickness of melanoma lesions preoperatively. [ABSTRACT FROM AUTHOR]

Purpose: The utility of pulmonary function testing (PFT) in pectus excavatum (PE) has been subject to debate. Although some evidence shows improvement from preoperative to postoperative values, the clinical significance is uncertain. A high failure-to-completion rate for operative PFT (48%) was identified in our large institutional cohort. With such a high non-completion rate, we questioned the overall utility of PFT in the preoperative assessment of PE and sought to evaluate if other measures of PE severity or cardiopulmonary function could explain this finding. Methods: Demographics, clinical findings, and results from cardiac MRI, PFT (spirometry and plethysmography), and cardiopulmonary exercise tests (CPET) were reviewed in 270 patients with PE evaluated preoperatively between 2015 and 2018. Regression modeling was used to measure associations between PFT completion and cardiopulmonary function. Results: There were no differences in demographics, symptoms, connective tissue disorders, or multiple indices of pectus severity and cardiac deformation in PFT completers versus non-completers. While regression analysis revealed higher RVEF, LVEF, and LVEF-Z scores, lower RV-ESV/BSA, LV-ESV/BSA, and LV-ESV/BSA-Z scores, and abnormal breathing reserve in PFT completers vs. non-completers, these findings were not consistent across continuous and binary analyses. Conclusions: We found that PFT completers were not significantly different from non-completers in most structural and functional measures of pectus deformity and cardiopulmonary function. Inability to complete PFT is not an indicator of pectus severity. [ABSTRACT FROM AUTHOR]

As part of their treatment, lung cancer patients frequently endure thoracic oncological surgery, with preoperative chemotherapeutic interventions being the common approach. However, the potential impact of these chemotherapeutic regimens on cutaneous wound healing outcomes following surgery remains the topic of considerable clinical interest. This meta‐analysis sought to evaluate comprehensively the effect of preoperative chemotherapeutic regimens on cutaneous wound healing in lung cancer patients following thoracic oncological surgery. Extensive literature searches were conducted using the leading databases PubMed, Embase, Cochrane Library and Scopus. Eight studies out of 1342 identified satisfied the inclusion criteria. Consideration was given to both randomized controlled trials (RCTs) and observational studies. Data pertaining to study characteristics, patient demographics, chemotherapeutic regimens and wound healing outcomes were extracted with great attention to detail. The examination of these varied studies provided insights into the fluctuations in rates of recovery following treatment, incidences of wound infections and frequencies of surgical complications. The research studies provided odds ratios for recovery that varied significantly in magnitude from 0.95 to 0.38, with regard to the probability of wound infection. Furthermore, a range of odds ratios for complications were disclosed, with certain odds ratios displaying narrow confidence intervals. The complexity of the effect of preoperative chemotherapy on wound closure subsequent to thoracic oncologic surgery is highlighted by our findings. The results underscore the need for individualized treatment strategies for lung cancer patients undergoing surgical procedures that strike a balance between patient safety and optimal clinical outcomes. [ABSTRACT FROM AUTHOR]

Cancer surgery places a significant burden on a patients' functional status and quality of life. In addition, cancer surgery is fraught with postoperative complications, themselves influenced by a patient's functional status. Prehabilitation is a unimodal or multimodal strategy that aims to increase a patient's functional capacity to reduce postoperative complications and improve postoperative recovery and quality of life. In most cases, it involves exercise, nutrition, and anxiety-reducing interventions. The impact of prehabilitation has been explored in several types of cancer surgery, most commonly colorectal and thoracic. Overall, the existing evidence suggests prehabilitation improves physiological outcomes (e.g., lean body mass, maximal oxygen consumption) as well as clinical outcomes (e.g., postoperative complications, quality of life). Notably, the benefit of prehabilitation is additional to that of enhanced recovery after surgery (ERAS) programs. While safe, prehabilitation programs require multidisciplinary coordination preoperatively. Despite the existence of numerous systematic reviews and meta-analyses, the certainty of evidence demonstrating the efficacy and safety of prehabilitation is low to moderate, principally due to significant methodological heterogeneity and small sample sizes. There is a need for more large-scale multicenter randomized controlled trials to draw strong clinical recommendations. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). Materials and Methods: A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. Results: This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473–799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350–624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11–32%), and vagal nerve deficits in 22% (95% CI 13–31%). Conclusion: This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data. [ABSTRACT FROM AUTHOR]

The general world population is aging and patients are often diagnosed with early-stage lung cancer at an advanced age. Several studies have shown that age is not itself a contraindication for lung cancer surgery, and therefore, more and more octogenarians with early-stage lung cancer are undergoing surgery with curative intent. However, octogenarians present some peculiarities that make surgical treatment more challenging, so an accurate preoperative selection is mandatory. In recent years, new artificial intelligence techniques have spread worldwide in the diagnosis, treatment, and therapy of lung cancer, with increasing clinical applications. However, there is still no evidence coming out from trials specifically designed to assess the potential of artificial intelligence in the preoperative evaluation of octogenarian patients. The aim of this narrative review is to investigate, through the analysis of the available international literature, the advantages and implications that these tools may have in the preoperative assessment of this particular category of frail patients. In fact, these tools could represent an important support in the decision-making process, especially in octogenarian patients in whom the diagnostic and therapeutic options are often questionable. However, these technologies are still developing, and a strict human-led process is mandatory. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are a serious health concern among the elderly, particularly in patients with hypertension, where the incidence of acute heart failure preoperatively is high, significantly affecting surgical outcomes and prognosis. This study aims to assess the risk of preoperative acute heart failure in elderly patients with hypertension and hip fractures by constructing a predictive model using machine learning on potential risk factors. Methods: A retrospective study design was employed, collecting preoperative data from January 2018 to December 2019 of elderly hypertensive patients with hip fractures at the Third Hospital of Hebei Medical University. Using SPSS 24.0 and R software, predictive models were established through LASSO regression and multivariable logistic regression analysis. The models' predictive performance was evaluated using metrics such as the concordance index (C-index), receiver operating characteristic curve (ROC curve), and decision curve analysis (DCA), providing insights into the nomogram's predictive accuracy and clinical utility. Results: Out of 1038 patients screened, factors such as gender, age, history of stroke, arrhythmias, anemia, and complications were identified as independent risk factors for preoperative acute heart failure in the study population. Notable predictors included Sex (OR 0.463, 95% CI 0.299–0.7184, P = 0.001), Age (OR 1.737, 95% CI 1.213–2.488, P = 0.003), Stroke (OR 1.627, 95% CI 1.137–2.327, P = 0.008), Arrhythmia (OR 2.727, 95% CI 1.490–4.990, P = 0.001), Complications (OR 2.733, 95% CI 1.850–4.036, P < 0.001), and Anemia (OR 3.258, 95% CI 2.180–4.867, P < 0.001). The prediction model of acute heart failure was Logit(P) = -2.091–0.770 × Sex + 0.552 × Age + 0.487 × Stroke + 1.003 × Arrhythmia + 1.005 × Complications + 1.181 × Anemia, and the prediction model nomogram was established. The model's AUC was 0.785 (95% CI, 0.754–0.815), Decision curve analysis (DCA) further validated the nomogram's excellent performance, identifying an optimal cutoff value probability range of 3% to 58% for predicting preoperative acute heart failure in elderly patients with hypertension and hip fractures. Conclusion: The predictive model developed in this study is highly accurate and serves as a powerful tool for the clinical assessment of the risk of preoperative acute heart failure in elderly hypertensive patients with hip fractures, aiding in the optimization of preoperative risk assessment and patient management. [ABSTRACT FROM AUTHOR]

Introduction: Frailty has become a worldwide health burden that has a large influence on public health and clinical practice. The incidence of frailty is anticipated to increase as the ageing population increases. Myocardial injury after noncardiac surgery (MINS) is associated with short-term and long-term mortality. However, the incidence of MINS in frail geriatric patients is unknown. Methods and analysis: This prospective, multicentre, real-world observational cohort study will be conducted at 18 designated centres in China from January 2023 to December 2024, with an anticipated sample size of 856 patients aged 65 years and older who are scheduled to undergo noncardiac surgery. The primary outcome will be the incidence of MINS. MINS is defined as a fourth-generation plasma cardiac troponin T (cTnT) concentration ≥ 0.03 ng/mL exhibited at least once within 30 days after surgery, with or without symptoms of myocardial ischaemia. All data will be collected via electronic data acquisition. Discussion: This study will explore the incidence of MINS in frail patients. The characteristics, predictive factors and 30-day outcomes of MINS in frail patients will be further investigated to lay the foundation for identifying clinical interventions. Clinical trial registration: https://beta.clinicaltrials.gov/study/NCT05635877, NCT05635877. [ABSTRACT FROM AUTHOR]

Background and Objectives: Almost one third of cancer patients in the United States will develop brain metastases on an annual basis. Surgical resection is indicated in the setting of brain metastases for reasons, such as maximizing local control in select patients, decompression of mass effect, and/or tissue diagnosis. The current standard of care following resection of a brain metastasis has shifted from whole brain radiation therapy to post-operative stereotactic radiosurgery (SRS). However, there is a significant rate of local recurrence within one year of postoperative SRS. Emerging retrospective and prospective data suggest pre-operative SRS is a safe and potentially effective treatment paradigm for surgical brain metastases. This trial intends to determine, for patients with an indication for resection of a brain metastasis, whether there is an increase in the time to a composite endpoint of adverse outcomes; including the first occurrence of either: local recurrence, leptomeningeal disease, or symptomatic radiation brain necrosis - in patients who receive pre-operative SRS as compared to patients who receive post-operative SRS. Methods: This randomized phase III clinical trial compares pre-operative with post-operative SRS for brain metastases. A dynamic random allocation procedure will allocate an equal number of patients to each arm: pre-operative SRS followed by surgery or surgery followed by post-operative SRS. Expected outcomes: If pre-operative SRS improves outcomes relative to post-operative SRS, this will establish pre-operative SRS as superior. If post-operative SRS proves superior to pre-operative SRS, it will remain a standard of care and halt the increasing utilization of pre-operative SRS. If there is no difference in pre- versus post-operative SRS, then pre-operative SRS may still be preferred, given patient convenience and the potential for a condensed timeline. Discussion: Emerging retrospective and prospective data have demonstrated some benefits of pre-op SRS vs. post-op SRS. This study will show whether there is an increase in the time to the composite endpoint. Additionally, the study will compare overall survival; patient-reported outcomes; morbidity; completion of planned therapies; time to systemic therapy; time to regional progression; time to CNS progression; time to subsequent treatment; rate of radiation necrosis; rate of local recurrence; and rate of leptomeningeal disease. Trial registration number: NCT03750227 (Registration date: 21/11/2018). [ABSTRACT FROM AUTHOR]

Opinion statement: Neoadjuvant chemotherapy is safe for patients with locally advanced colon cancer (LACC). The FOxTROT trial demonstrated a reduction in residual and recurrent cancer at 2 years with neoadjuvant chemotherapy for patients with cT3-4 LACC. Preoperative chemotherapy should be avoided, if possible, for patients with dMMR LACC, as over 50% of dMMR cancers have no pathologic response. Early universal testing of MMR status is critical to selecting the appropriate neoadjuvant therapy. Concerns about CT staging of LACC have limited uptake of neoadjuvant chemotherapy, as approximately 25% of patients with cT3-T4 cancer on CT have low-risk stage II disease. Development of CT criteria for malignant nodes should reduce the risk of over-staging. A multidisciplinary approach is needed to identify patients for neoadjuvant therapy. Neoadjuvant immunotherapy is safe and results in dramatic pathologic responses in patients with dMMR LACC. Longer follow-up is needed to determine if the exceptionally high pathologic response rates observed will translate into long-term remission. Remarkably, neoadjuvant immunotherapy has been found to cause major pathologic responses in a subset of patients with pMMR LACC, indicating the potential to cure more patients with this common cancer. Patients with cT4 LACC, whether stage II or III, have a substantial risk of recurrence despite adjuvant fluoropyrimidine plus oxaliplatin chemotherapy. We recommend neoadjuvant systemic therapy for all patients with cT4b LACC (dMMR and pMMR). Features of T4b disease are routinely reported by radiology. We use three cycles of FOLFOX chemotherapy for patients with cT4b pMMR LACC, due to the high rate of compliance and improvement in residual and recurrent disease. Patients with cT4b dMMR LACC should receive neoadjuvant immunotherapy, if there are no contraindications. Clinical trials of neoadjuvant therapy for LACC are of great interest and should provide training for radiologists to identify eligible patients. Results are anticipated from multiple ongoing trials of neoadjuvant chemotherapy, immunotherapy, and targeted therapy for pMMR LACC and immunotherapy for dMMR LACC. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether preoperative administration of silodosin can facilitate the placement of ureteral access sheath (UAS) prior to flexible ureteroscopy (F-URS) and reduce the occurrence of ureteric injury in challenging cases. Methods: This prospective randomized clinical trial was carried out on 147 patients diagnosed with upper ureteric stone or stone kidney, non-stented. The patients were randomly divided into two equal groups. Group A (silodosin group) included patients in whom F-URS was done with daily preoperative intake of 8 mg silodosin for 1 week and group B (placebo/control group) included patients in whom F-URS was done with daily preoperative intake of placebo tablets. Results: In group A, a total of 23 (33.3%) experienced ureteral wall injury following UAS insertion, while in group B, this occurred in 40 patients (59.7%). There was a statistically significant difference in the grade of ureteral wall injury between the two groups (P < 0.001). In the multiple regression analysis, age, operative time and silodosin were found to be significant risk factors for ureteral wall injury (P = 0.007, 0.041 and < 0.001, respectively). Conclusions: The administration of silodosin prior to retrograde intrarenal surgery (RIRS) effectively prevented significant ureteral wall damage and reduced initial postoperative discomfort. [ABSTRACT FROM AUTHOR]

Background: The WHO 2021 introduced the term pituitary neuroendocrine tumours (PitNETs) for pituitary adenomas and incorporated transcription factors for subtyping, prompting the need for fresh diagnostic methods. Current biomarkers struggle to distinguish between high- and low-risk non-functioning PitNETs. We explored if radiomics can enhance preoperative decision-making. Methods: Pre-treatment magnetic resonance (MR) images of patients who underwent surgery between 2015 and 2019 with available WHO 2021 classification were used. The tumours were manually segmented on the T1w, T1-contrast enhanced, and T2w images using 3D Slicer. One hundred Pyradiomic features were extracted from each MR sequence. Models were built to classify (1) somatotroph and gonadotroph PitNETs and (2) high- and low-risk subtypes of non-functioning PitNETs. Feature were selected independently from the MR sequences and multi-sequence (combining data from more than one MR sequence) using Boruta and Pearson correlation. Support vector machine (SVM), logistic regression (LR), random forest (RF), and multi-layer perceptron (MLP) were the classifiers used. Data imbalance was addressed using the Synthetic Minority Oversampling TEchnique (SMOTE). Performance of the models were evaluated using area under the receiver operating curve (AUC), accuracy, sensitivity, and specificity. Results: A total of 222 PitNET patients (train, n = 149; test, n = 73) were enrolled in this retrospective study. Multi-sequence-based LR model discriminated best between somatotroph and gonadotroph PitNETs, with a test AUC of 0.84, accuracy of 0.74, specificity of 0.81, and sensitivity of 0.70. Multi-sequence-based MLP model perfomed best for the high- and low-risk non-functioning PitNETs, achieving a test AUC of 0.76, accuracy of 0.67, specificity of 0.72, and sensitivity of 0.66. Conclusions: Utilizing pre-treatment MRI and radiomics holds promise for distinguishing high-risk from low-risk non-functioning PitNETs based on the latest WHO classification. This could assist neurosurgeons in making critical decisions regarding surgery or alternative management strategies for PitNETs after further clinical validation. [ABSTRACT FROM AUTHOR]

More than 25% of older adults in Europe have diabetes mellitus. It is estimated that 45% of patients with diabetes are currently undiagnosed, which is a known risk factor for perioperative morbidity. We investigated whether routine HbA1c screening in older adult patients undergoing surgery would identify patients with undiagnosed diabetes. We included patients aged ≥65 years without a diagnosis of diabetes who visited the preoperative assessment clinic at the Amsterdam University Medical Center and underwent HbA1c screening within three months before surgery. Patients undergoing cardiac surgery were excluded. We assessed the prevalence of undiagnosed diabetes (defined as HbA1c ≥ 48 mmol·mol−1) and prediabetes (HbA1c 39–47 mmol·mol−1). Using a multivariate regression model, we analysed the ability of HbA1c to predict days alive and at home within 30 days after surgery. From January to December 2019, we screened 2015 patients ≥65 years at our clinic. Of these, 697 patients without a diagnosis of diabetes underwent HbA1c screening. The prevalence of undiagnosed diabetes and prediabetes was 3.7% (95%CI 2.5–5.4%) and 42.9% (95%CI 39.2–46.7%), respectively. Preoperative HbA1c was not associated with days alive and at home within 30 days after surgery. In conclusion, we identified a small number of patients with undiagnosed diabetes and a high prevalence of prediabetes based on preoperative HbA1c screening in a cohort of older adults undergoing non-cardiac surgery. The relevance of prediabetes in the perioperative setting is unclear. Screening for HbA1c in older adult patients undergoing non-cardiac surgery does not appear to help predict postoperative outcome. [ABSTRACT FROM AUTHOR]

Background: Alcohol‐based skin preparations were first approved for surgical use in 1998 and have since become standard in most surgical fields. The purpose of this report is to examine incidence of surgical fires because of alcohol‐based skin preparation and to understand how approval and regulation of alcohol‐based skin preparations impacted trends in fires over time. Methods: We identified all reported surgical fires resulting in patient or staff harm from 1991 through 2020 reported to the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. We examined incidence of fires because of these preparations, trends after approval and regulation, and common causes. Results: We identified 674 reports of surgical fires resulting in harm to patients and surgical personnel, in which 84 involved an alcohol‐based preparation. The time‐adjusted model shows that from 1996 through 2006, there was a 26.4% increase in fires followed by a 9.7% decrease from 2007 to 2020. The decrease in fires was most rapid for head and neck and upper aerodigestive tract surgeries. Qualitative content analysis revealed improper surgical site preparation as well as close proximity of surgical sites to an oxygen source as the most common causes of fires. Conclusion: Since FDA approval, alcohol‐based preparation solutions have been associated with a significant percentage of surgical fires. Warning label updates from 2006 to 2012 coupled with increased awareness efforts of associated risks of alcohol‐based surgical solutions likely contributed to the decrease in fires. Improper surgical site preparation technique and close proximity of surgical sites to oxygen continue to be risk factors for fires. Level of Evidence: 4 Laryngoscope, 134:607–613, 2024 [ABSTRACT FROM AUTHOR]

Background An early report has shown the clinical benefit of the asymptomatic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening test, and some clinical guidelines recommended this test. However, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to investigate the cost-effectiveness of universal preoperative screening of asymptomatic patients for SARS-CoV-2 using polymerase chain reaction (PCR) testing. Methods We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model from a payer perspective, assuming that the test-positive rate was 0.07% and the screening cost was 8500 Japanese yen (JPY) (approximately 7601 US dollars [USD]). The input parameter was derived from the available evidence reported in the literature. A willingness-to-pay threshold was set at 5 000 000 JPY/quality-adjusted life-year (QALY). Results The incremental cost of 1 death averted was 74 469 236 JPY (approximately 566 048 USD) and 291 123 368 JPY/QALY (approximately 2 212 856 USD/QALY), which was above the 5 000 000 JPY/QALY willingness-to-pay threshold. The incremental cost-effectiveness ratio fell below 5 000 000 JPY/QALY only when the test-positive rate exceeded 0.739%. However, when the probability of developing a postoperative pulmonary complication among SARS-CoV-2–positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of how high the test-positive rate became. Conclusions Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base case analysis. The cost-effectiveness mainly depends on the test-positive rate, the frequency of postoperative pulmonary complications, and the screening costs; however, no matter how high the test-positive rate, the cost-effectiveness is poor if the probability of developing postoperative pulmonary complications among patients positive for SARS-CoV-2 is sufficiently reduced. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative education is an essential nursing task that can be affected by the nurses' perception. Patients may be receiving insufficient vital information before surgery. However, the essential information that should be provided to patients undergoing surgery is not fully addressed. Objective: To assess the essential elements of preoperative information as perceived by the surgical nurses. Methods: This was a cross-sectional study. A convenience sample of 224 registered nurses who were working at surgical units was recruited from two hospitals. A preoperative teaching questionnaire was used. Results: Details about the operation (4.39 ± 0.61) and preoperative preparation (4.36 ± 0.61) were the most important domains of preoperative education as perceived by nurses. The results show significant differences between the perceived and actual preoperative educational practice across all domains except the preoperative preparation. Conclusions: The delivery of preoperative education could be affected by nurses' perceptions. Efforts to facilitate the implementation of effective education as perceived by nurses should be conducted by minimizing potential barriers. [ABSTRACT FROM AUTHOR]

Background: The WHO 2021 introduced the term pituitary neuroendocrine tumours (PitNETs) for pituitary adenomas and incorporated transcription factors for subtyping, prompting the need for fresh diagnostic methods. Current biomarkers struggle to distinguish between high- and low-risk non-functioning PitNETs. We explored if radiomics can enhance preoperative decision-making. Methods: Pre-treatment magnetic resonance (MR) images of patients who underwent surgery between 2015 and 2019 with available WHO 2021 classification were used. The tumours were manually segmented on the T1w, T1-contrast enhanced, and T2w images using 3D Slicer. One hundred Pyradiomic features were extracted from each MR sequence. Models were built to classify (1) somatotroph and gonadotroph PitNETs and (2) high- and low-risk subtypes of non-functioning PitNETs. Feature were selected independently from the MR sequences and multi-sequence (combining data from more than one MR sequence) using Boruta and Pearson correlation. Support vector machine (SVM), logistic regression (LR), random forest (RF), and multi-layer perceptron (MLP) were the classifiers used. Data imbalance was addressed using the Synthetic Minority Oversampling TEchnique (SMOTE). Performance of the models were evaluated using area under the receiver operating curve (AUC), accuracy, sensitivity, and specificity. Results: A total of 222 PitNET patients (train, n = 149; test, n = 73) were enrolled in this retrospective study. Multi-sequence-based LR model discriminated best between somatotroph and gonadotroph PitNETs, with a test AUC of 0.84, accuracy of 0.74, specificity of 0.81, and sensitivity of 0.70. Multi-sequence-based MLP model perfomed best for the high- and low-risk non-functioning PitNETs, achieving a test AUC of 0.76, accuracy of 0.67, specificity of 0.72, and sensitivity of 0.66. Conclusions: Utilizing pre-treatment MRI and radiomics holds promise for distinguishing high-risk from low-risk non-functioning PitNETs based on the latest WHO classification. This could assist neurosurgeons in making critical decisions regarding surgery or alternative management strategies for PitNETs after further clinical validation. [ABSTRACT FROM AUTHOR]

Accurate preoperative localization is crucial for successful minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT). Preoperative localization can be challenging in patients with recurrent and/or multigland disease (MGD). This has led clinicians to investigate multiple imaging techniques, most of which are associated with radiation exposure. Magnetic resonance imaging (MRI) offers ionizing radiation-free and accurate imaging, making it an attractive alternative imaging modality. The objective of this systematic review is to provide an overview of the diagnostic performance of MRI in the localization of PHPT. PubMed and Embase libraries were searched from 1 January 2000 to 31 March 2023. Studies were included that investigated MRI techniques for the localization of PHPT. The exclusion criteria were (1) secondary/tertiary hyperparathyroidism, (2) studies that provided no diagnostic performance values, (3) studies published before 2000, and (4) studies using 0.5 Tesla MRI scanners. Twenty-four articles were included in the systematic review, with a total of 1127 patients with PHPT. In 14 studies investigating conventional MRI for PHPT localization, sensitivities varied between 39.1% and 94.3%. When employing more advanced MRI protocols like 4D MRI for PHPT localization in 11 studies, sensitivities ranged from 55.6% to 100%. The combination of MR imaging with functional techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy, with sensitivities ranging from 84.2% to 100% in five studies. Despite the limitations of the available evidence, the results of this review indicate that the combination of MR imaging with functional imaging techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy. Further research on emerging MR imaging modalities, such as 4D MRI and PET/MRI, is warranted, as MRI exposes patients to minimal or no ionizing radiation compared to other imaging modalities. [ABSTRACT FROM AUTHOR]

Background: Glomus jugulare tumors are slow-growing neuroendocrine paragangliomas located in the temporal bone. Surgical excision, the standard treatment option, carries a high risk of intraoperative bleeding due to the vascular nature of these lesions. To mitigate this risk, current practice involves performing intra-arterial embolization prior to surgery. Objectives: The objectives of this study were to assess postintervention safety, technical success, and the rate of vascular blush size reduction in a group of patients with Glomus jugulare tumors who were planned for surgery and underwent pre-surgical intra-arterial embolization of the lesion. Patients and Methods: In this retrospective cohort study, all patients who underwent intravascular embolization for Glomus jugulare tumors from 2017 onwards were included. The study comprised 61 patients scheduled for surgery following embolization. All embolizations were completed in one session and were primarily performed via external carotid artery branches using polyvinyl alcohol (PVA). The size of the vascular blush was measured before and after embolization in coronal, supero-inferior sagittal, and antero-posterior sagittal planes, and the rate of blush size reduction was calculated. Procedure complications, including post-embolization pain, were recorded. In the statistical analysis, vascular blush size was compared between pre- and post-embolization times. Results: Pain after embolization was reported in 11 patients (18%). There were no other complications among the patients, indicating a high level of safety. All procedures were technically successful. The mean pre-embolization vascular blush diameter in the coronal plane was 29.1 ± 133 mm, which decreased to 16.8 ± 7.1 mm after embolization, representing an average diameter reduction of 38.5% (P < 0.001). Conclusion: The findings of this retrospective cohort study suggest that intra-arterial embolization for Glomus jugulare tumors is safe, technically successful, and effective in reducing vascular blush before surgery. [ABSTRACT FROM AUTHOR]

Background: The aim of this article is to evaluate radiological and pathological response rates and correlate them after neoadjuvant short-course radiotherapy (SCRT) followed by chemotherapy in resectable locally advanced adenocarcinoma of the rectum (LARC). Materials and Methods: It is a single institutional, prospective observational study from January 2021 to March 2022 including 45 patients with resectable adenocarcinoma of the rectum. Radiotherapy was delivered to a dose of 25 Gy in 5 Gy per fraction using image-guided radiotherapy followed by mFOLFOX-based chemotherapy. After completion of 4–8 cycles of chemotherapy, tumor regression grade (TRG) was evaluated using magnetic resonance imaging and whole-body positron emission tomography. In case of a satisfactory response on imaging (mrTRG), patients underwent appropriate locoregional surgery. Histopathological examination of the surgical specimen was carried out and response to neoadjuvant treatment was assessed (pTRG). Results: A significant downstaging of T and N stages (60% and 72%, respectively, p <.0001) was observed after neoadjuvant therapy with a pathological complete response rate of 16%. Conversion of positive circumferential resection margin (CRM) to negative CRM was observed in 71.4% patients. A poor agreement between mrTRG and pTRG (k 0.133, p.16) was noted. Conclusion: Preoperative SCRT in LARC is feasible and well-tolerated with encouraging radiological and pathological response rates. A significant number of patients achieve negative CRM, thereby improving the chances of R0 resection. Significant relief in pain and bleeding can be achieved rapidly leading to an improved quality of life. [ABSTRACT FROM AUTHOR]

This was a retrospective study that evaluated a total of 280 patients who underwent surgery for complete removal of endometriosis to develop and validate the predictive model for stage IV endometriosis. The differences between stage I-III and stage IV endometriosis were performed by logistic regression. A model for the prediction of stage IV endometriosis was constructed, which was subsequently validated. The independent variables were visual analogue scale (VAS)≥4 [3.855, 95% confidence interval (CI): 1.675–8.871, p = 0.002], painful nodularity on uterosacral ligaments (13.954, 95% CI: 1.658–117.423, p = 0.015), and bilateral endometriosis (5.933, 95% CI: 1.931–18.225, p = 0.002). The AUC of the model was 0.777, with a sensitivity of 71.9% and specificity of 76.3% for stage IV endometriosis. Therefore, a complete collection of patient information prior to surgery, asking about pain and VAS scores, careful completion of pelvic examinations, and application of imaging techniques are conducive to better diagnosis and prediction of advanced endometriosis. What is already known on this subject? Endometriosis, a chronic disease causing pain and infertility, is characterised by endometrial-like tissue outside the uterine cavity, which is often treated via surgery at present. Considering the risks of surgery, it is necessary to identify patients with stage IV endometriosis through non-invasive predictive models for adequate preparation for surgery. However, there is no reliable non-invasive predictive model now, despite utilisation of patient medical history, symptoms especially pain-related ones, pelvic examinations, laboratory examinations, and images in the preoperative diagnosis of endometriosis in the clinic. What do the results of this study add? A model developed based on three simple, accessible and non-invasive indicators displays good performance in predicting stage IV endometriosis. What are the implications of these findings for clinical practice and/or further research? It is conducive to diagnosing and predicting advanced endometriosis before surgery, so as to reduce the difficulty and improve the safety of surgery. [ABSTRACT FROM AUTHOR]

Gynecologic surgeries are often complex interventions that require extensive communication and planning to ensure favorable patient outcomes. Many gynecologic surgery patients present with a vast range of systemic comorbidities that need adequate workups and plans for care prior to undergoing anesthesia. Enhanced recovery after surgery (ERAS) protocols are vital for organizing patient-centered discussions preoperatively, allowing the patient, anesthesia, and surgical teams to address all clinical concerns directly to minimize perioperative risks. A multidisciplinary approach in preoperative patient-management decisions helps optimize the care of each patient's comorbidities and medications and is essential to ensure best patient outcomes. (J GYNECOL SURG 39:278) [ABSTRACT FROM AUTHOR]

Introduction: While robotic-assisted laparoscopic radical prostatectomy (RRP) is a standard mode for localized prostate cancer (PC), the risk of complications in older patients with chronic diseases and complex medical conditions can be a deterrent to surgery. Surgical and medical co-management (SMC) is a new strategy to improve patients' healthcare outcomes in surgical settings. Methods: We reviewed the clinical data of older patients with chronic diseases who were cared for with SMC undergoing RRP in our hospital in the past 3 years and compared them with the clinical data from the general urology ward. Preoperative conditions and related indicators of recovery, and incidence of postoperative complications with the Clavien Grade System were compared between these two groups. Results: The indicators of recovery were significantly better, and the incidence rates of complications were significantly reduced in the SMC group at grades I-IV (p < 0.05), as compared to the general urology ward group. Conclusions: The provision of care by SMC for older patients focused on early identification, comorbidity management, preoperative optimization, and collaborative management would significantly improve surgical outcomes. The SMC strategy is worthy of further clinical promotion in RRP treatment in older men with chronic diseases and complex medical conditions. [ABSTRACT FROM AUTHOR]

Background: Anterior cervical discectomy and fusion (ACDF) is a common procedure for neck arthritis, typically alleviating pain and improving function. Preoperative dehydration has been correlated with postoperative infection, acute renal failure, deep vein thrombosis, and increased hospital length of stay. However, some studies have suggested that preoperative dehydration has a minimal relationship with postoperative outcomes, specifically in arthroplasty and lumbar surgery candidates. Methods: Patients who underwent ACDF from 2015 to 2020 as part of the American College of Surgeons National Surgical Quality Improvement Program database were identified. We excluded patients who presented with acute trauma. Dehydration was determined using the accepted definition of preoperative blood urea nitrogen to creatinine ratio greater than 20. Lengths of stay and 30-day postoperative adverse events were compared between dehydrated and nondehydrated cohorts, adjusting for baseline features using standard multivariate regression. Results: We identified 14,932 patients, and 4206 (28.1%) of whom were preoperatively dehydrated. Dehydrated patients had significantly higher odds of wound, hematological, and pulmonary complications; Clavien-Dindo grade IV, delayed length of stay (>5 days); and a lower likelihood of being discharged home (P < 0.005), even after controlling for demographic features (eg, sex, age, body mass index, race, and ethnicity). Furthermore, linear regression suggested an overall half-day increased length of hospital stay for dehydrated patients (95% CI [0.36, 0.60], P < 0.001). Conclusion: Preoperative dehydration is common among ACDF surgery patients and appears to correlate with an increased risk of postoperative complications and prolonged length of hospital stay. Evaluation of a patient's hydration status from standard preoperative laboratory metrics can be employed for risk stratification, patient counseling, and timing of ACDF surgeries. [ABSTRACT FROM AUTHOR]