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Background: Due to the low incidence of pediatric liver transplantations, short- and long-term data regarding their outcome, details on early postoperative complications and their risk factors are under-represented in the literature., Methods: We retrospectively reviewed 1645 LTx performed at Hannover Medical School between January 2005 and December 2021. Of these, 421 transplantations were performed in 405 pediatric recipients. Univariate and multivariate binary logistic regressions were performed to identify independent risk factors for the onset of selected perioperative complications requiring intervention within the first 30 days following transplantation and their influence on graft and patient survival., Results: Pleural effusions represent the most common postoperative complication observed in 49.4% (n = 208) of cases, followed by vascular complications in 22.6% (n = 95) and biliary complications in 20.0% (n = 84) of cases. Donor age (OR: 1.019; p = 0.010) and recipient age between 3 and 12 years (OR: 1.849; p = 0.008) were identified as independent risk factors for the onset of pleural effusions. Retransplantations within the first year after LTx were necessary in 11.4% of all cases (n = 48). Twenty (4.8%) patients died within the first year after LTx., Conclusion: Pleural effusions requiring postoperative intervention were observed in approximately half of the pediatric recipients. Therefore, the preemptive intraoperative placement of a chest drain under sterile conditions and general anesthesia should be considered. Our data further indicate that a two-stage procedure for biliary reconstruction may be the preferred procedure in patients at risk of early bile duct complications and retransplantation within the first year., (© 2024 The Author(s). Pediatric Transplantation published by Wiley Periodicals LLC.)

Introduction: Evidence about intra- and postoperative complication rates related to transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynecological conditions is still limited. We report and analyze data from a large cohort of patients operated in a single institution during 3.5 years., Material and Methods: To evaluate the safety and feasibility of vNOTES for benign gynecological indications, we performed a single-center observational study reporting and analyzing perioperative outcomes of 550 consecutive patients operated between 2020 and 2024., Results: Of the 550 included patients, 365 (66.4%) underwent a vNOTES hysterectomy, 167 (30.4%) a procedure limited to the adnexa, and 18 (3.3%) other interventions, including myomectomy, pelvic adhesiolysis, post-hysterectomy pelvic hematoma drainage, pelvic organ prolapse repair, and appendectomy. The mean age was 49.4 ± 12.2 years, and the mean BMI was 26.2 ± 5.8 kg/m 2 . The total complication rate was 6.5% (36 cases), of which 2.7% (15 cases) were intraoperative complications and 4.0% (22 cases) were postoperative complications. Patients presented postoperative complications classified as Clavien-Dindo (CD) grade I in 4 cases (0.7%), grade II in 10 cases (1.8%), and grade III in 8 cases (1.5%). We observed no CD grade IV and V complications. Three patients (0.5%) were rehospitalized for postoperative complications management. The conversion rate was 1.6%, with nine cases of conversion to conventional laparoscopy and none to laparotomy., Conclusions: The application of vNOTES appears safe and feasible for most benign gynecological surgeries. Our study focused on surgical complications and demonstrated a profile similar to those reported in previous studies., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Background: This study aimed to evaluate the 3-year outcomes of sleeve gastrectomy in non-diabetic individuals with class I obesity., Methods: A total of 78 participants with class I obesity and 78 participants with class II obesity, matched in terms of age, sex (93.6% female), and the rates of dyslipidemia and hypertension, were included in this prospective cohort study. Follow-up data, including metabolic features, body composition, nutritional characteristics, and surgery complications, were gathered at the baseline and 6, 12, 24, and 36 months post-bariatric surgery. Micronutrient deficiencies and comorbidities (hypertension and dyslipidemia) were evaluated in both groups using conditional logistic regression analysis, and Clavien-Dindo classification was used to compare surgical complications., Results: Baseline characteristics of the participants in both groups were similar (n = 78, mean age: 36.4 ± 8.5). The two groups were also comparable in terms of weight loss, cardiovascular risk factors, and remission of obesity-related comorbidities 3 years following sleeve gastrectomy. Overall values of Δ total weight loss (TWL)%, Δ excess weight loss (EWL)%, and β (95% CI) were - 1.86 (1.19), and - 2.56 (4.5) with a P value of 0.118 and 0.568, respectively. The occurrence of surgical complications and undesirable outcomes were also similar between the two study groups., Conclusion: Bariatric surgery is an effective and safe method to achieve weight loss and alleviate cardiovascular risk factors and obesity-related comorbidities in non-diabetic individuals with class I and class II obesity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Adhesions are a feared complication of abdominal surgery. There have been many new adhesion barriers developed and tested; however, there is no recent systematic review analyzing all the published literature. To address this, we aimed to analyze the different types of adhesion barriers, and determine their effects on postoperative outcomes in patients., Methods: A total of 14,038 articles utilizing adhesion barriers in abdominal surgery were retrieved from the PubMed, EMBASE, and Scopus databases. Inclusion criteria were: patients undergoing abdominal surgery, patients receiving an adhesion barrier, and reported postoperative outcomes. Two reviewers independently screened titles/abstracts and full-text articles using Covidence. The ROBINS-I tool was used to assess the quality of the included studies. Study protocol: Prospero CRD42023458230., Results: A total of 20 studies, with no overall high risk of bias, with 171,792 patients were included. Most studies showed an equivocal benefit for adhesion barriers, with no singular adhesion barrier type that had definitive superior outcomes compared to the others. Bioresorbable barriers emerged as the most extensively researched adhesion barrier type, exhibiting promising results in colorectal surgery. Starch-based adhesion barriers also exhibited a reduction in overall postoperative bowel obstructions and may be beneficial for stoma sites and port closures. On the other hand, many studies raised concerns regarding complications, including risk of abscess formation, fistula development, peritonitis, and anastomotic leakage., Conclusions: Adhesion barriers should be considered on a case-by-case basis, however, they should not be utilized prophylactically in all abdominal surgeries due to their risk of complications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Posterior cranial vault distraction osteogenesis (PCVDO) is a relatively new paradigm in the treatment of syndromic craniosynostosis, having first been introduced in 2009. PCVDO directly addresses the underdeveloped cranial vault and appears to allow for a larger increase in intracranial volume when compared to traditional techniques. Although reported as safe in the literature, critical appraisal is still required as PCVDO is a relatively uncommon procedure that may require greater numbers to detect true complication rates. The overall reported incidence of serious complications in PCVDO to date is low. This presentation highlights a rare case of sagittal sinus obstruction following posterior cranial vault distraction and raises questions as to the safest technical considerations when planning the operation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The primary objective of this study was to explore the potential disparity in postoperative fistula occurrence rates between patients who undergo (partial) lateral parotidectomy and those who undergo the extracapsular dissection technique for the management of benign parotid gland tumours., Methods: A consecutive series of 363 patients treated with (partial) lateral parotidectomy and extracapsular dissection technique for benign parotid gland tumours at one tertiary centre between 2018 and 2022 were included. To evaluate the impact of the surgical technique and possible other risk factors (tumour location, tumour size, Body Mass Index, age, smoking, diabetes mellitus, arterial hypertension) for the development of fistulas, multivariate logistic regression analyses using backward lection were applied to estimate odds ratios (ORs) and 95%-confidence intervals (CIs)., Results: In 363 patients, 21 patients (5.8%) developed a fistula. Patients who underwent (partial) lateral parotidectomy had three times higher chance of developing a fistula compared to patients who were operated using the extracapsular dissection technique (OR adjusted  = 2.6, 4.1% vs. 12.5%, p = 0.044). In the multivariate analyses, no other risk factors for the development of fistulas were statistically significant in this cohort. The incidence of facial nerve paralysis was not significantly different between the extracapsular dissection and lateral parotidectomy group (5/73 = 6.8% vs. 11/290 = 3.8%, p = 0.333)., Conclusion: Fistulas occur more often in patients treated by means of a (partial) lateral parotidectomy approach compared to patients treated using the extracapsular dissection technique. Therefore, surgeons should be vigilant about postoperative fistula risks in lateral parotidectomy and consider preventive measures., (© 2024 The Author(s). Clinical Otolaryngology published by John Wiley & Sons Ltd.)

Introduction: We report an unusual case of cochlear implant complication and eventual explantation secondary to an allergic reaction to silicone., Case Report: A 62-year-old man who underwent cochlear implantation for asymmetric hearing loss developed an allergic response to the implant within a few weeks of the surgery. This led to subsequent explantation. Patch testing using the various parts of the implant revealed a hypersensitive response to the silicone component of the receiver stimulator. There have only been 6 reported cases of cochlear implant explantation secondary to allergic reactions to cochlear implants. The inflammatory reaction has been to the silicone component of the cochlear implant found in the silicone used in Cochlear America's implants., Conclusion: Although rare, it's important to be aware of delayed hypersensitivity reactions to the silicone component of a cochlear implant. Attention should be made to associate symptoms such as pruritis, urticaria and loss of hair as symptoms and signs of possible allergic reaction to the implanted component. Steroids may help to alleviate symptoms; however, symptoms have been shown to recur after cessation of steroids. Treatment requires the removal of the device.

Objective: The objective of this study was to determine how rates of postoperative infectious complications after pelvic organ prolapse surgery differ based on perioperative antibiotic administered. In particular, we sought to determine whether anaerobic coverage is associated with reduced rates of infectious complications., Design: This was a retrospective cohort study., Setting: Premier Healthcare U.S. national database, a comprehensive all-payer dataset capturing patients from urban and rural non-profit, community, and teaching hospitals., Participants: Adult patients who underwent vaginal, laparoscopic, and/or abdominal prolapse surgery with or without hysterectomy from January 2000 to March 2020. Procedures with and without mesh were included., Interventions: Rates of infectious complications were compared among patients who received guideline-concordant antibiotic regimens, including those with anaerobic coverage. The primary outcome was any surgical site infection within 30 days of surgery without mesh or 90 days of surgery involving mesh., Results: Among 130,198 prolapse surgeries, the most common antibiotic regimens were cefazolin (n=97,058, 74.5%), second generation cephalosporin (n=16,442, 12.6%), clindamycin + aminoglycoside (n=8,397, 6.4%) and cefazolin + metronidazole (n=4,328, 3.3%). On multivariable logistic regression, only clindamycin + aminoglycoside was associated with a higher rate of surgical site infections (OR 1.37; 95% CI 1.09-1.72) and other infectious morbidity (OR 1.26; 95% CI 1.12-1.42) when compared to cefazolin alone. The addition of metronidazole to cefazolin was not associated with reduced rates of surgical site infections (OR 1.09; 95% CI 0.82 - 1.45). Obesity (OR=1.22; 95% CI 1.03-1.43), diabetes without complication (OR=1.30; 95% CI 1.08-1.57), Charlson comorbidity score >0 (OR=1.24; 95% CI 1.06-1.45), and tobacco use (OR=1.22, 95% CI 1.05-1.40) were also associated with increased composite surgical site infection., Conclusion: Compared with cefazolin alone, the use of alternative perioperative antibiotics, including those with anaerobic coverage, was not associated with reduced infectious complications after pelvic organ prolapse surgery in this U.S. national sample., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: Uterine fibroids are the most common indication for benign hysterectomy in the United States, but data regarding the association of hysterectomy type and outcomes for this indication are lacking., Objective: We aimed to describe the rate and odds of short-term (30 days) postoperative complications among patients undergoing minimally invasive total (TLH) compared to supracervical (LSCH) hysterectomy for uterine fibroids., Study Design: We conducted a cohort study of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020. We compared characteristics of women who underwent TLH and LSCH for uterine fibroids and identified risk factors associated with the occurrence of 30-days postoperative complications defined according to the Clavien-Dindo classification. Multivariable regression analysis including age, BMI, race, comorbidities, ASA classification, uterine weight and concomitant procedures, was performed to identify the adjusted odds of postoperative complications. The co-primary outcomes were the risk of (1) a composite of any postoperative complications and of (2) major postoperative complications according to surgical type., Results: A total of 44,413 and 6,383 patients underwent minimally invasive TLH and LSCH respectively. Operative time was shorter (143.0 vs. 150.6 minutes, p<.001), and the proportion of uterine weight >250 g was lower (39.4% vs. 45.1%, p<.001) in the TLH group. The rates of any (6.6% vs. 5.3%, p<.001), and major (2.7% vs. 1.6%, p<.001) complications were higher in the TLH group, while minor complications rate was comparable (4.4% vs. 4.1%, p=.309). In multivariable regression analysis, LSCH was independently associated with lower risk of any [aOR 95% CI 0.79 (0.70-0.88)], and major [aOR 95% CI 0.55 (0.44-0.69)] complications compared to TLH., Conclusion: Compared with TLH, LSCH is associated with a lower risk of short-term postoperative complications among patients with uterine fibroids. The current study findings can aid in shared decision-making prior to minimally invasive hysterectomy for uterine fibroids., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Adult spinal deformity (ASD) has a significant impact on trunk balance and quality of life in the elderly. Postoperative rod fractures pose significant challenges, but the mechanisms of their occurrence are underexplored compared to other complications such as proximal junctional kyphosis. This study investigated factors associated with rod fracture in patients with ASD., Methods: A retrospective single-center study analyzed 110 adult patients who underwent spinal deformity correction between 2012 and 2020. Comparative analysis and univariate and multivariate Cox regression analyses were employed to identify factors associated with rod fracture., Results: In this study, rod fracture occurred in 14.5% of patients. The rod fracture group exhibited a larger change in lumbar lordosis (LL), a higher proportion of patients with pre-operatively existing (pre-existing) vertebral fractures, and a greater percentage of patients with a rod diameter of 6 mm or less compared to the non-rod fracture group. Univariate Cox regression analysis revealed that rod fracture was associated with pre-existing vertebral fracture, LL change, preoperative sagittal vertical axis, and preoperative pelvic tilt. Multivariate Cox regression analysis identified pre-existing vertebral fractures and the amount of LL change as independent factors associated with rod fractures., Conclusion: Pre-existing vertebral fractures and the magnitude of lumbar lordosis correction are independent risk factors for rod fracture following ASD surgery. Surgeons should consider these factors during preoperative planning to reduce the risk of postoperative rod fracture., Level of Evidence: IV., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)

Background: The aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France., Methods: Retrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared., Results: 139 patients were included, with a median age of 8 [1-16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients., Conclusions: Diaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence., Clinicaltrials: NCT04862494, April 28, 2021., Level of Evidence: level III treatment study., Competing Interests: Conflicts of interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to determine the incidence of complications after thoracoscopic lobectomy in children according to a verified classification. Secondary aim was to evaluate the modifications made in our management protocol in order to decrease the rate of complications., Methods: Retrospective study of pediatric patients in whom a lobectomy was performed for congenital lung malformation (CLM) in our institution between 2003 and 2021. The following data were collected: demographics, preoperative clinical symptoms, surgical technical details, and postoperative complications following the Clavien-Dindo (CD) classification. Main outcome measure was the presence of complications in the first month after lung lobectomy., Results: 90 lobectomies were performed in 89 patients. There were 46 girls (51.6%) and 43 boys with a median age of 12.4 months. Most patients (86.6%) remained asymptomatic until the surgical procedure. Postsurgical complications were detected in 26 cases (28.8%) and distributed into their respective category according to CD classification. In our experience, closure of the bronchial stump with interrupted suture or placement of an endoloop showed a statistically significant association with complications (p = 0.022 and p = 0.006 respectively). Moreover, patients in which a device combining sealing and section was used showed significantly fewer complications (p = 0.006)., Conclusions: Thoracoscopic lobectomy continues to be a challenging procedure. The CD grading system for postoperative complications has proved to be useful in this setting. Evolving surgical strategies and new miniaturized endosurgical devices have enabled a safer and quicker procedure with a positive impact in the development of complications., Level of Evidence: III., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The operating room is a high-risk environment where proper patient positioning is crucial for minimizing injury and ensuring optimal access to surgical sites. This process requires effective collaboration among surgical team members, particularly operating room nurses who play a vital role in patient safety. Despite advancements in technology, challenges such as pressure injuries persist, with a significant incidence rate. Video-based training (VBT) emerges as a promising educational tool, enhancing knowledge retention and fostering a learner-centered approach. This study aims to evaluate the impact of VBT on adherence to surgical positioning standards, highlighting its potential to improve safety protocols in the operating room., Methods: In this clinical trial, 62 qualified operating room nurses (50 women, 12 men, average age: 28.90 ± 3.75 years) were randomly divided into control and intervention group (n = 31 in each group). The control group only received positioning recommendations, but in the intervention group, in addition to the recommendations, video-based surgical positioning training was performed for 1 month, at least 3 times a week. The performance of nurses in both groups was evaluated through a researcher-made checklist at baseline and post-intervention., Results: Based on findings, there was no significant difference between the two groups in compliance with surgical positioning standards at baseline (p = 0.07). However, after the intervention, compliance scores significantly improved in the VBT group compared to the control group (p < 0.001). The VBT group showed a mean improvement of 62.12 points, while the control group improved by 10.77 points (p < 0.001)., Conclusions: This preliminary study demonstrated a notable improvement in compliance with surgical positioning standards among operating room nurses following VBT intervention. Despite the promising results, the small sample size and preliminary nature of the research necessitate further studies to confirm these findings and assess long-term outcomes. These initial insights highlight the potential of innovative training methods in enhancing surgical practices., (© 2024. The Author(s).)

Introduction: Surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are commonly performed in older adults, many of whom are also frail. A surgical risk calculator for older adults undergoing POP/SUI surgeries that incorporates frailty, a factor known to increase the risk of surgical complications, would be helpful for preoperative counseling but currently does not exist., Materials and Methods: Medicare Carrier, Outpatient, and MedPAR files were examined for beneficiaries undergoing POP and SUI surgery between 2014 and 2016. A total of 15 POP/SUI categories were examined. The Claims-Based Frailty Index (CFI), a validated measure of frailty in Medicare data, and Charlson Comorbidity Index were deconstructed into their individual variables, and individual variables were entered into stepwise logistic regression models to determine which variables were most highly predictive of 30-day complications and 1-year mortality. To verify the prognostic accuracy for each model for surgical complications of interest, calibration curves and tests of model fit, including C-statistic, Brier scores, and Spiegelhalter p values, were determined., Results: In total, 108 479 beneficiaries were included. Among these, 4.7% had CFI scores consistent with mild to severe frailty (CFI≥0.25). A total of 13 prognostic variable categories were found to be most highly predictive of postoperative complications. Calibration curves for each outcome of interest showed models were well-fit. Most models demonstrated high c-statistic values (≥0.7) and high Spiegelhalter p values (≥0.9), indicating good model calibration and excellent discrimination, and low Brier scores (<0.02), indicating high model accuracy., Conclusions: Urologic surgery for older Adults Risk Calculator serves as a novel surgical risk calculator that is readily accessible to both patients and clinicians that specifically factors in components of frailty. Furthermore, this calculator accounts for the heterogeneity of an aging population and can assist in individualized surgical decision-making for these common procedures., (© 2024 Wiley Periodicals LLC.)

Complications are plausible events during surgical operations. Surgical complications profoundly impact surgeons, often called "second victims" of adverse events. These complications trigger a range of emotional and psychological responses, including guilt, anxiety, heightened empathy, and the looming threat of burnout. Moreover, the toll extends to physical health, with chronic stress and sleep disturbances taking their toll. Surgeons' social lives are not immune to the fallout, and their career satisfaction may wane, pushing some towards defensive medicine practices. While mentorship, counselling, and peer support are crucial support mechanisms, they encounter barriers such as time constraints and the fear of negative perceptions. This paper suggests practical recommendations, including comprehensive wellness programmes, a streamlined badge card system for easy access to resources, and mindfulness training to mitigate stress and burnout. Recognising and proactively addressing these multifaceted impacts is imperative for cultivating a resilient medical community capable of providing optimal patient care., (© 2024. The Author(s).)

Background: Surgeries for treating pelvic organ prolapse involving the utilization of synthetic mesh have been associated with complications such as mesh erosion, postoperative pain, and dyspareunia. This work aimed to reduce the surgical implantation-associated complications by nanofibrous membranes on the surface of the polypropylene mesh. The nanofiber of the nanofibrous membrane, which was fabricated by co-axial electrospinning, was composed of polyurethane as fiber core and gelatin as the fiber out layer. The biocompatibility of the modified mesh was evaluated in vitro by cell proliferation assay, immunofluorescence stain, hematoxylin-eosin (HE) staining, and mRNA sequencing. Polypropylene mesh and modified mesh were implanted in a rat pelvic organ prolapse model. Mesh-associated complications were documented. HE and Picro-Sirius red staining, immunohistochemistry, and western blotting were conducted to assess the interactions between the modified mesh and vaginal tissues., Results: The modified mesh significantly enhanced the proliferation of fibroblasts and exerted a positive regulatory effect on the extracellular matrix anabolism in vitro. When evaluated in vivo, no instances of mesh exposure were observed in the modified mesh group. The modified mesh maintained a relatively stable histological position without penetrating the muscle layer or breaching the epidermis. The collagen content in the vaginal wall of rats with modified mesh was significantly higher, and the collagen I/III ratio was lower, indicating better tissue elasticity. The expression of metalloproteinase was decreased while the expression levels of tissue inhibitor of metalloproteinase were increased in the modified mesh group, suggesting an inhibition of collagen catabolism. The expression of TGF-β1 and the phosphorylation levels of Smad3, p38 and ERK1/2 were significantly increased in the modified mesh group. NM significantly improved the biocompatibility of PP mesh, as evidenced by a reduction in macrophage count, decreased expression levels of TNF-α, and an increase in microvascular density., Conclusions: The nanofibrous membrane-coated PP mesh effectively reduced the surgical implantation complications by inhibiting the catabolism of collagen in tissues and improving the biocampibility of PP mesh. The incorporation of co-axial fibers composed of polyurethane and gelatin with polypropylene mesh holds promise for the development of enhanced surgical materials for pelvic organ prolapse in clinical applications., (© 2024. The Author(s).)

Purpose: Depression is predicted to be the leading burden of disease worldwide by 2030 with a prevalence of 10% to 60% in the surgical population. Depressive symptoms in the perioperative population are associated with a myriad of grave complications, including higher morbidity and mortality. This systematic review aims to determine whether a single dose of intravenous ketamine can be used prophylactically as a routine resilience-enhancing agent in all high-risk adult patients undergoing surgery to mitigate depressive symptoms postoperatively by appraising evidence of existing literature., Design: An evidence-based systematic review., Methods: The databases PubMed, CINAHL, and Scopus were searched, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search and Medical Subject Headings (MeSH) terms used: "ketamine," "surgical procedures," "surgical," "surgery," "depression," and "depressive disorder.", Findings: In 9 randomized controlled trials (RCTs), bolus ketamine doses of 0.1 mg/kg to 1 mg/kg were administered intraoperatively or in the postanesthesia care unit. The primary outcome was the subjective feelings of depression as evaluated by different validated depression screening tools and seven RCTs observed statistically significant findings between the control and intervention (ketamine) groups with postoperative depression scores. Two RCTs did not find a significant change in depression scores., Conclusions: Research on the use of prophylactic ketamine as an antidepressant in the perioperative population offers insight into changing routine practices and can shape how mental health is viewed in hospitals. Further research is warranted on the safety profile of ketamine, and risk stratification with careful consideration of baseline depressive symptoms, timing, and its use across a wider variety of surgical subspecialties., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Purpose: This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use., Methods: We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique., Results: Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique's safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique., Conclusion: Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions., (© 2024. The Author(s).)

Surgical complications and errors impact all surgeons throughout their career. Early career surgeons may be particularly vulnerable. In this invited manuscript the impact of surgical complications on early career surgeons is discussed. Review of current systems to aid in emotional support of complications is provided., Competing Interests: Declaration of competing interest All authors of this manuscript have directly participated in planning, execution, and/or analysis of this study. There are no financial disclosures relevant to this manuscript., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Endoscopic ventricular surgery (EVS) shows overall reduced morbidity compared to open craniotomy, but carries, however, the risk for neurocognitive impairment caused by fornix-, hypothalamus-, and injuries other structures adjacent to the ventricular system. Objective or subjective neurocognitive impairment after EVS is rarely reported. The aim of this study was to assess the subjective neurocognitive outcome in patients undergoing EVS for various pathologies., Methods: We conducted a retrospective cohort study in adult patients undergoing EVS at our institution between 2010 and 2021. The primary outcome was subjective neurocognitive outcome after EVS measured by patient-reported outcomes (PROs). Secondary outcomes were objective neurocognitive outcome, return-to-work rate, subjective quality of life and satisfaction with surgery. Descriptive and comparative statistics were conducted for all outcome parameters., Results: Fifty-one patients (median age 48 years, 62.7% female) were included. Patients commonly presented with subjective neurocognitive impairment (54.9%) and hydrocephalus was the most common indication for surgery (54.9%). Worse long-term subjective neurocognitive outcome was observed in 5 (21.7%) patients while 18 (78.3%) patients improved. Worse long-term objective neurocognitive outcome was seen in 2 cases (10.5%), of which 1 patient became worse trough surgery while 15 (78.9%) patients improved. Improved subjective and objective neurocognitive outcome correlated in 73.8% of the cases (r = 0.363, P = 0.018). Return to work was possible for 70% of the patients and subjective quality of life was improved or unchanged in 88.1% of the patients., Conclusions: Subjective neurocognitive outcome and quality of life improvement are often achieved after EVS and permanent neurocognitive impairment is rare. Further well-designed trials on subjective and objective neurocognitive outcome after EVS are warranted., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Open reduction and internal fixation (ORIF) remains the gold standard for adult distal humerus fractures (DHF). However, indications for total elbow arthroplasty (TEA) continue to expand and the incidence of primary and salvage TEA for DHF has increased. The objective of this study was to compare complication and reoperation rate for acute vs. delayed primary and salvage TEA performed for DHF., Methods: Patients who underwent TEA for DHF were identified in the PearlDiver database. Patients were sorted into 3 cohorts: (1) acute TEA (within 2 weeks of diagnosis), (2) delayed TEA (between 2 weeks and 6 months after diagnosis), and (3) salvage TEA (after failed ORIF, malunion, nonunion, delayed treatment between 6 months and 1 year or post-traumatic arthritis). Multivariate analysis was used to assess for confounding variables and covariates when identifying differences in complications between cohorts., Results: A total of 788 patients underwent acute TEA, 213 patients underwent delayed TEA, and 422 patients underwent salvage TEA after DHF. The incidence of periprosthetic joint infection (PJI) (8.5% vs. 3.4%, odds ratio [OR] 2.60, P = .002) and triceps injury (2.4% vs. 0.4%, OR 6.29, P = .012) were higher in the delayed compared to acute cohort. The incidence of revision (8.5% vs. 2.1%, OR 3.76, P < 0.001), periprosthetic fracture (4.3% vs. 1.1%, OR 3.64, P = .002), PJI (14.7% vs 3.4%, OR 4.36, P < .001), triceps injury (2.6% vs. 0.4%, OR 5.70, P = .008), and wound complications (6.9% vs 2.9%, OR 2.33, P = .002) were higher in the salvage compared to acute cohort. There was an increased rate of revision (8.5% vs. 1.9%, OR 6.08, P = .002) in the salvage compared to delayed cohort., Conclusion: Patients undergoing salvage TEA after DHF have increased rates of revision, periprosthetic fracture, PJI, triceps injury, and wound complications at 2 years post-operatively. The salvage cohort also had an increased risk of revision when compared to the delayed cohort. However, other than revision rates, patients in the salvage and delayed cohorts have similar postoperative complication rates., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effectiveness of adrenaline infiltration, topical adrenaline, systemic tranexamic acid, fibrin tissue sealants and alginate-based topical coagulants at reducing blood loss and post-operative bleeding in primary cleft palate repair., Design: Systematic review according to PRISMA-P guidelines, using Covidence systematic review software to facilitate 3-stage screening and data extraction by two reviewers., Setting: Academic cleft surgery center., Interventions: Any peri-operative intervention to reduce intra-operative and post-operative bleeding., Main Outcome Measures: Estimated blood loss, rate of post-operative bleeding, rate of return to theatre for haemostasis., Results: Sixteen relevant studies were identified, with a total of 1469 study participants. Nine studies examined efficacy of infiltrating vasoconstrictors and all concluded that 1:100,000-1:400,000 adrenaline infiltration reduced intra-operative blood loss, to the range of 12-60 ml. Secondary bleeding and re-operation for haemostasis were uncommon. Tranexamic acid was studied in five randomised controlled trials, two of which demonstrated a significant reduction in blood loss compared to a control group. Use of fibrin and gelatin sponge products was examined in 3 studies, all of which reported no or minimal bleeding, but did not have quantifiable outcome measures., Conclusions: Infiltration with vasoconstricting agents, administration of systemic tranexamic acid and application of fibrin sealants have a well-studied and favorable safety profile in pediatric cases, and likely contribute to the relatively low incidence of post-operative bleeding and intra-operative blood loss in primary cleft palate repair., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Across surgery, marginalized individuals experience worse postoperative outcomes. These disparities stem from the interplay between multiple factors., Methods: We introduced a novel framework to assess the role of barriers to access and bias in surgical complications (the uChicago Health Inequity Classification System, CHI-CS) in the setting of morbidity and mortality conference and assessed impact through pre and post implementation surveys., Results: Access and bias were related to surgical complications in 14 ​% of cases. 97 ​% reported enhanced M&M presentations with the grading system, and 47 ​% reported a change in decision-making or practice style. Although post-implementation response rate was low, there were improvements in self-reported confidence and comfort in recognizing and discussing these issues., Conclusions: Implementation of the CHI-CS framework to discuss bias and access to care positively impacted the way providers view, discuss, and process health inequities., Competing Interests: Declaration of competing interest I declare that the manuscript is original, has not been published before, and is not currently being considered for publication elsewhere and will not be sent to another journal until a decision is made concerning publication by The American Journal of Surgery. The authors have no relevant financial disclosures or conflict of interests. All authors have seen and approved the final version of this manuscript as well as fulfill the COPE (Committee on Publication Ethics) requirements for authorship., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The ventral and distal aspects of the corpora cavernosa are the thinnest, increasing the likelihood of cylinder extrusion or crossover complications pertaining to inflatable penile prosthesis procedures. A double distal corporal anchoring double stitch can be used to robustly secure impending lateral extrusions and crossovers of implant cylinders. It is a novel, effective corrective measure for the uncommon complication of migrated cylinders in inflatable penile prosthesis placement., Aim: To describe the surgical indications and technique for the double distal corporal anchoring fixation stitch for lateral penile implant cylinder extrusion., Methods: We discuss a double-stitch technique that is performed following corporoplasty and capsulotomy. A lateral incision is made subcoronally on the affected side to identify the crossover or lateral extrusion. The cylinder is repositioned properly within the native corpora to prevent further cylinder migration. Two 2-0 Ethibond sutures are threaded through the distal cylinder eyelet, and each suture is delivered through the glans with a Keith needle and tied off. An incision is made in the glans, and 1 arm of each suture is tied with the other to create a bridge between the sutures that can be positioned deep within the skin of the glans., Outcomes: Over the past 4 years, 66 patients with lateral cylinder extrusion underwent the double distal corporal anchoring fixation stitch procedure, with overall improved satisfaction (97%). Only 2 patients had surgical complications. One patient experienced repeated lateral extrusion of the penile implant cylinders 6 weeks following the double-anchoring stitches procedure. The second patient developed a painful suture granuloma that necessitated excision, which resolved this issue, and the penile implant cylinder remained in the proper position over a year later., Clinical Implications: This technique ensures the secure fixation of the affected cylinders in the surgical capsule by creating a bridge between 2 sutures holding each repositioned cylinder in place, and the ensuing fibrotic reaction helps to fixate the extruded cylinder within the midglandular tissue., Strength and Limitations: This surgical technique describes the double distal corporal anchoring stitch for lateral penile implant cylinder extrusion. Further studies are warranted to validate long-term outcomes and satisfaction., Conclusion: The double distal corporal anchoring fixation stitch is a safe and efficacious method to secure cylinders in the proper surgical capsule during revision procedures to correct distal crossovers or laterally extruded penile prosthesis implants., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background Appendicitis is a common surgical emergency with a global incidence rate of approximately 8%, necessitating prompt intervention to prevent complications. Appendectomy, either through open surgery or laparoscopy, is the standard treatment. Understanding the factors contributing to post-appendectomy complications is crucial for improving patient outcomes. Aim This retrospective study aimed to assess the surgical outcomes of various surgical approaches for appendicitis in Taif City, Saudi Arabia, specifically at King Abdulaziz Specialist Hospital. Methodology A total of 220 patients who underwent appendectomy in 2022 were included in the study. Data were obtained from medical files, and statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA). chi-square and Fisher's exact tests were utilized, with a significance level set at p < 0.05. Results The majority of patients fell within the 20-39 age group (n = 124, 56.4%), and males constituted 63% (n = 140) of the cohort. Mean complications post-surgery were observed in 5.5% (n = 12) of cases, with surgical site infection being the most common complication (n = 9, 75%). Patients with complicated appendicitis had a significantly higher rate of surgical complications (n = 8, 44.4%) compared to those without complicated appendicitis (n = 4, 2%, p = 0.000). Longer hospital stays were associated with a higher incidence of complications (p = 0.008). The American Society of Anesthesiologists classification showed a significant association with complications (p = 0.000). Conclusions Our study underscores the importance of early diagnosis, appropriate surgical management, and infection prevention strategies in reducing post-appendectomy complications. Factors such as complicated appendicitis, longer hospital stays, and higher ASA classification were associated with increased complication rates., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dobel et al.)

Epilepsy surgery offers a vital treatment option for drug-resistant mesial temporal lobe epilepsy (mTLE), with Temporal Lobe Resection (TLR) and Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) being fundamental interventions. This meta-analysis specifically examines seizure outcomes at extended follow-up periods exceeding 24 months, visual field deficits as measured by perimetry, and complication rates both overall and categorized based on duration as minor (transient <6 months) or major (persistent >6 months) to inform clinical decision-making. For seizure freedom, TLR was superior, with 72.5% [65.6%, 78.5%] of patients achieving postoperative seizure freedom compared to 57.1% [51.2%, 62.7%] for MRgLITT (P-value <0.01). Visual field deficits were observed in 79.4% [59.5%, 91.0%] of TLR patients and 49.8% [23.6%, 76.0%] of MRgLITT patients, a difference not reaching statistical significance (P-value: 0.08). Overall complication rates were 11.4% [7.4%, 17.2%] for TLR and 6.5% [3.3%, 12.3%] for MRgLITT (P-value 0.15). Major complications occurred in 2.0% [1.1%, 3.09%] of TLR cases and 2.7% [1.4%, 5.2%] of MRgLITT cases (P-value 0.54), while minor complications were significantly more frequent with TLR at 9.9% [6.4%, 15.0%] versus MRgLITT's 4.1% [1.9%, 8.4%] (P-value 0.04). MRgLITT had a more favorable outcome regarding confrontation naming while more studies are needed regarding verbal memory to be able to draw firm conclusions. TLR provides superior seizure freedom but comes with an increased risk of transient complications. Although there was no statistical significance in visual field deficits, the trend suggests a higher frequency with TLR. The study's extensive data analysis, including rigorous sensitivity checks, ensures the robustness of these conclusions, reflecting a comprehensive analysis of the available data at this time point., (Copyright © 2024. Published by Elsevier Inc.)

Split-thickness skin grafting (STSG) is a cornerstone technique in reconstructive surgery, offering solutions for covering wounds, burns, and other skin defects. This review compares meshed versus unmeshed STSG, focusing on their clinical implications and outcomes. Meshed grafts, created by perforating the skin graft to form a mesh-like pattern, are frequently used for larger or irregularly shaped areas due to their ability to expand and conform to the underlying tissue. In contrast, unmeshed grafts are applied as whole sheets, making them suitable for smaller or cosmetically sensitive regions where appearance is paramount. This review examines various aspects of these graft types, including graft survival rates, aesthetic and functional results, healing times, and complications such as infection and graft contraction. This study aims to identify the relative advantages and drawbacks of meshed versus unmeshed grafts by analyzing data from clinical trials, meta-analyses, and systematic reviews. The findings highlight that while meshed grafts offer improved coverage and reduced risk of graft failure, unmeshed grafts are preferred for their superior cosmetic outcomes. Understanding these differences is crucial for optimizing surgical strategies and improving patient outcomes. The review also addresses patient-specific factors and recommends selecting the appropriate graft type based on clinical scenarios., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Samuel et al.)

Introduction: Neovascular glaucoma (NVG) is a severe type characterized by forming new blood vessels on the iris and the anterior chamber angle, often resulting from ischemic retinal diseases. Pars plana vitrectomy (PPV) is a standard surgical procedure for treating various retinal and vitreous conditions. Understanding the risk factors associated with NVG development following PPV is crucial for improving patient outcomes., Objective: To identify and evaluate demographic, clinical, and surgical risk factors associated with developing NVG following PPV., Patients and Methods: A prospective cohort study was conducted over two years, involving 60 type 2 diabetes mellitus (T2DM) patients (31 males and 29 females; mean age 60.48±9.63 years) who underwent PPV at the Eye Clinic and Department of Clinical Immunology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina. Patients were thoroughly informed about the study, and written informed consent was obtained. Comprehensive data collection included demographic information, medical history, preoperative and postoperative eye examinations, and intraoperative details. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States)., Results:  Within 12 months postoperatively, 17 patients (28.3%) developed NVG. Significant preoperative risk factors for NVG included prolonged duration of T2DM (p=0.037), elevated preoperative intraocular pressure (IOP) (p=0.024), and higher levels of vascular endothelial growth factor (VEGF) (p=0.011). Intraoperative factors, such as sharp dissection (p=0.000) and operative complications (p=0.004), were also significantly associated with NVG development. Multivariate logistic regression analysis identified prolonged T2DM duration (OR 1.132, p=0.023), increased preoperative IOP (OR 1.192, p=0.029), elevated VEGF levels (OR 1.002, p=0.016), and intraoperative sharp dissection (OR 0.114, p=0.006) as independent risk factors., Conclusions: Multiple preoperative and intraoperative factors influence the development of NVG post-PPV. Prolonged T2DM duration, elevated preoperative IOP, high VEGF levels, and specific intraoperative techniques significantly increase the risk of NVG. These findings underscore the importance of careful preoperative assessment and tailored intraoperative strategies to mitigate NVG risk in PPV patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committe of the University Clinical Center Sarajevo issued approval 02-07-8095. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nisic et al.)

Objectives: To assess postoperative outcomes in immunosuppressed patients with facial fractures. Methods: TriNetX, a large de-identified health research database, was utilized to compare outcomes within 30 days of treatment between immunosuppressed and immunocompetent patients with facial fractures. Subgroup analysis was conducted based on use of immunosuppressive therapy, human immunodeficiency virus (HIV) status, diabetes, and chronic kidney disease (CKD). Results: Nine thousand four hundred seventy-five patients were identified. On subgroup analysis, 555 patients were on immunosuppressants, 429 patients had HIV, 619 patients had CKD, 1322 patients with liver disease, and 3133 had diabetes. Immunosuppressed patients more frequently experienced postoperative infections [odds ratio (OR) 1.37 (1.9-1.54), P < .001], thromboembolic events [OR 1.71 (1.33-2.20), P < .001], hemorrhage [OR 1.46 (1.10-1.92), P = .0087], hospital readmission [OR 1.36 (1.28-1.44), P < .001], subsequent emergency department encounters [OR 1.08 (1.01-1.15), P = .0249], and wound disruptions [OR 1.52 (1.17-1.97), P = .0017]. Analyses comparing outcomes by immunosuppression type found increased rates of infection [OR 1.59 (1.25-2.01), P < .001], thromboembolic events [OR 1.56 (1.07-2.26), P = .0196], wound disruption [OR 1.57 (1.03-2.39), P = .0357], and hospital readmission [OR 1.28 (1.16-1.42), P < .001] in diabetic patients. Patients with CKD [OR 1.7 (1-2.90), P = .0478] had higher rates of infection [OR 2.02 (1.18-3.46), P = .0092] and readmission [OR 1.43 (1.14-1.79), P = .0017]. Patients with liver disease had higher rates of infection [OR 1.54 (1.07-2.23), P = .0210], thromboembolic events [OR 2.84 (1.37-5.87), P = .0033], and readmission [OR 2.14 (1.83-2.51), P < .001]. No significant differences were seen between groups for HIV patients. Conclusions: Immunosuppressed patients with facial trauma have a higher prevalence of postoperative complications compared to immunocompetent patients. Diabetics had a higher prevalence of most complications while patients with CKD and liver disease had higher rates of infections. Surgeons may consider measures to decrease postoperative risk in these patients and to provide preoperative patient counseling., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To analyse surgical, functional, and mid-term oncological outcomes of robot-assisted nephroureterectomy (RANU) in a contemporary large multi-institutional setting., Patients and Methods: Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2.0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. The analysis included all consecutive patients undergoing RANU except those with missing data in predictors. Detailed surgical, pathological, and postoperative functional data were recorded and analysed. Oncological time-to-event outcomes were: recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, with a 3-year cut-off. A multivariable Cox proportional hazard model was built to evaluate predictors of each oncological outcome., Results: A total of 1118 patients underwent RANU during the study period. The postoperative complications rate was 14.1%; the positive surgical margin rate was 4.7%. A postoperative median (interquartile range) estimated glomerular filtration rate decrease of -13.1 (-27.5 to 0) mL/min/1.73 m 2 from baseline was observed. The 3-year RFS was 59% and the 3-year MFS was 76%, with a 3-year OS and CSS of 76% and 88%, respectively. Significant predictors of worse oncological outcomes were bladder-cuff excision, high-grade tumour, pathological T stage ≥3, and nodal involvement., Conclusions: The present study contributes to the growing body of evidence supporting the increasing adoption of RANU. The procedure consistently offers low surgical morbidity and can provide favourable mid-term oncological outcomes, mirroring those of open NU, even in non-organ-confined disease., (© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Background: Previous literature suggests that rates of postoperative complications following inflammatory bowel disease (IBD) surgery differ based on race., Aims: The purpose of this study was to examine the association between race and adverse events and wound complications in patients with IBD., Methods: This was a retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement Program Inflammatory Bowel Disease Collaborative from 2017 to 2022. The data was collected from 15 high-volume IBD centers across the United States. The data was analyzed using crude and multivariable logistic regressions., Results: 4284 patients were included in the study. Overall rates of adverse events and wound complications were 20.3% and 11.3%, respectively, and did not differ based on race on bivariate analysis. Rates of adverse events were 20.0% vs 24.6% vs 22.1%, p = 0.13 for white, black and other minority subjects, respectively. The adjusted odds of adverse events were higher for black subjects (1.46 [95%CI 1.0-2.1], p = 0.03) compared to white subjects. No difference in adverse events was found between other minority subjects and either black or white subjects (1.29 [0.7-2.3], p = 0.58). Race was not associated with likelihood of wound complications in the final analysis., Conclusions: We found that a subset of black patients with IBD continue to experience more adverse events compared to white patients, primarily driven by a higher need for postoperative blood transfusion. Nonetheless, known risk factors, including comorbid conditions, decreased BMI, open surgery, and emergency surgery have a stronger association with postoperative complications than race alone., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Adnexal torsion is characterised by the rotation of the ovary and, occasionally, the fallopian tube around their supporting ligaments by more than 45 degrees. It predominantly occurs during the first and second trimesters of pregnancy, with an incidence of up to 0.1% in the third trimester. Dermoid and functional ovarian cysts, most commonly associated with benign serous cystadenomas, are frequently identified among the torted adnexal masses. Case Presentation: We report the case of a 32-year-old primigravida with a known ovarian cyst diagnosed in the first trimester, which was managed conservatively throughout the pregnancy. At 36 weeks of gestation, she presented with abdominal pain and was subsequently managed with an emergency caesarean section at 37 weeks due to the development of an acute surgical abdomen. During the procedure, a torted left tubo-ovarian complex was excised, with partial preservation of the healthy-appearing ovarian tissue. Histopathological examination identified the mass as a benign serous cystadenoma. Conclusions: Ovarian torsion during pregnancy poses a significant diagnostic challenge. The decision between conservative management and surgical intervention is primarily guided by a high index of suspicion for torsion.

This study presents a detailed case analysis of a 40-year-old male patient with hemophilia A and severe chronic elbow arthropathy, exploring the surgical challenges and outcomes within the context of the current literature. The patient, with a history of multiple comorbidities including Hodgkin's lymphoma and cardiomyopathy, exhibited significant joint damage and functional impairment. A comprehensive approach was employed, collecting all relevant clinical data, including radiographic and MRI findings, to inform treatment decisions. Clinical findings and treatment decisions are presented as they occurred in real time, simulating the clinical reasoning process. Subsequent references to the clinical and instrumental findings as well therapeutic interventions are discussed in light of the current literature to reinforce the decision-making framework. This report underscores the importance of multidisciplinary care in optimizing patient outcomes and contributes to the ongoing discourse on the management of advanced musculoskeletal conditions in hemophilic patients. The findings emphasize the necessity for early intervention and specialized care to mitigate complications and improve long-term prognosis.

Postoperative altered mental status (AMS) is a prevalent and complex issue that poses a significant diagnostic challenge in the clinical setting. Clinical presentation consists of cognitive disturbances that can range from mild confusion to coma. Given the complexity and variability of AMS, each patient requires a careful and thorough evaluation to identify the underlying cause. Thus, we present a case of a 57-year-old male with confirmed left knee septic arthritis, whose admission was complicated by AMS following several incision and drainage procedures. We highlight the importance of considering a broad differential diagnosis when evaluating postoperative AMS, including electrolyte disturbances and systemic conditions. The case also discusses the importance of early recognition, interdisciplinary collaboration, and a comprehensive diagnostic strategy. By adopting a comprehensive and collaborative approach, healthcare providers can optimize patient outcomes and minimize complications in postoperative AMS cases. The patient's AMS was ultimately attributed to a combination of metabolic disturbances, drug-related factors, and systemic conditions. His severe psychiatric symptoms were successfully managed with targeted pharmacologic interventions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Villa et al.)

Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO 2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery., (© 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Purpose: Bladder outlet obstruction (BOO) is common in older adults. Many older adults who pursue surgery have additional vulnerabilities affecting surgical risk, including frailty. A clinical tool that builds on frailty to predict surgical outcomes for the spectrum of BOO procedures would be helpful to aid in surgical decision-making but does not currently exist., Materials and Methods: Medicare beneficiaries undergoing BOO surgery from 2014 to 2016 were identified and analyzed using the Medicare MedPAR, Outpatient, and Carrier files. Eight different BOO surgery categories were created. Baseline frailty was calculated for each beneficiary using the Claims-Based Frailty Index (CFI). All 93 variables in the CFI and the 17 variables in the Charlson Comorbidity Index were individually entered into stepwise logistic regression models to determine variables most highly predictive of complications. Similar and duplicative variables were combined into categories. Calibration curves and tests of model fit, including C statistics, Brier scores, and Spiegelhalter P values, were calculated to ensure the prognostic accuracy for postoperative complications., Results: In total, 212,543 beneficiaries were identified. Approximately 42.5% were prefrail (0.15 ≤ CFI < 0.25), 8.7% were mildly frail (0.25 ≤ CFI < 0.35), and 1.2% were moderately-to-severely frail (CFI ≥0.35). Using stepwise logistic regression, 13 distinct prognostic variable categories were identified as the most reliable predictors of postoperative outcomes. Most models demonstrated excellent model discrimination and calibration with high C statistic and Spiegelhalter P values, respectively, and high accuracy with low Brier scores. Calibration curves for each outcome demonstrated excellent model fit., Conclusions: This novel risk assessment tool may help guide surgical prognostication among this vulnerable population.

Background: Patients undergoing surgery deserve the best possible peri-operative outcomes. Each stage of the peri-operative patient journey offers opportunities to improve care delivery, with shorter lengths of stay, less complications, reduced costs and better value., Methods: These opportunities were identified through narrative review of the literature, with consultation and consensus at the hidden pandemic (of postoperative complications) summit 2, July 2023 in Adelaide, Australia RESULTS: Before surgery: Some patients who receive timely alternative treatments may not need surgery at all. The period of waiting after listing should be a time of preparation. Risk assessment at the time of surgical listing facilitates recognition of need for comorbidity optimisation and identifies those who will most benefit from prehabilitation, particularly frail and deconditioned patients., During Surgery: During the surgical admission, ERAS programs result in less postoperative complications, shorter length of stay and better patient experience but require agreement between clinicians, and coordinated monitoring of delivery of the elements in the ERAS bundle of care., After Surgery: At-risk patients need to have the appropriate levels of monitoring for cardiovascular instability, renal impairment or respiratory dysfunction, to facilitate timely, proactive management if they develop. Access to allied health in the early postoperative period is also critical for promoting mobility, and earlier discharge, particularly after joint surgery. Where appropriate, provision of rehabilitation services at home improves patient experience and adds value. The peri-operative patient journey begins and ends with primary care so there is a need for clear communication, documentation, around sharing of responsibility between practitioners at each stage., Conclusion: Identifying and mitigating risk to reduce complications and length of stay in hospital will improve outcomes for patients and deliver the best value for the health system., (© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Background: Artificial intelligence (AI) has the potential to enhance surgical practice by predicting anatomical structures within the surgical field, thereby supporting surgeons' experiences and cognitive skills. Preserving and utilising nerves as critical guiding structures is paramount in rectal cancer surgery. Hence, we developed a deep learning model based on U-Net to automatically segment nerves., Methods: The model performance was evaluated using 60 randomly selected frames, and the Dice and Intersection over Union (IoU) scores were quantitatively assessed by comparing them with ground truth data. Additionally, a questionnaire was administered to five colorectal surgeons to gauge the extent of underdetection, overdetection, and the practical utility of the model in rectal cancer surgery. Furthermore, we conducted an educational assessment of non-colorectal surgeons, trainees, physicians, and medical students. We evaluated their ability to recognise nerves in mesorectal dissection scenes, scored them on a 12-point scale, and examined the score changes before and after exposure to the AI analysis videos., Results: The mean Dice and IoU scores for the 60 test frames were 0.442 (range 0.0465-0.639) and 0.292 (range 0.0238-0.469), respectively. The colorectal surgeons revealed an under-detection score of 0.80 (± 0.47), an over-detection score of 0.58 (± 0.41), and a usefulness evaluation score of 3.38 (± 0.43). The nerve recognition scores of non-colorectal surgeons, rotating residents, and medical students significantly improved by simply watching the AI nerve recognition videos for 1 min. Notably, medical students showed a more substantial increase in nerve recognition scores when exposed to AI nerve analysis videos than when exposed to traditional lectures on nerves., Conclusions: In laparoscopic and robot-assisted rectal cancer surgeries, the AI-based nerve recognition model achieved satisfactory recognition levels for expert surgeons and demonstrated effectiveness in educating junior surgeons and medical students on nerve recognition., (© 2024. The Author(s).)

Objective: Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients., Data Sources: A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023., Summary of Findings: Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed., Conclusion: The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Editora Ltda.)

Objective: As the population ages, vascular surgeons are treating progressively older, multimorbid patients at risk of peri-operative complications. An embedded physician has been shown to improve outcomes in general and orthopaedic surgery. This systematic review and meta-analysis aimed to investigate the impact of surgeon-physician co-management models on morbidity and mortality rates in vascular inpatients., Data Sources: PubMed, Scopus, Embase, conference abstract listings, and clinical trial registries., Review Methods: Studies comparing adult vascular surgery inpatients under co-management with standard of care were eligible. The relative risks (RRs) of death, medical complications, and 30 day re-admission between co-management and standard care were calculated. The effect of co-management on the mean length of stay was calculated using weighted means. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies, and certainty assessment with the GRADE analysis tools., Results: No randomised controlled trials were identified. Eight single institution studies between 2011 and 2020 with 7 410 patients were included. All studies were observational using before-after methodology. Studies were of high to moderate risk of bias, and outcomes were of very low GRADE certainty of evidence. Co-management was associated with a statistically significant lower relative risk of death (RR 0.64, 95% confidence interval [CI] 0.44 - 0.92; p = .02), cardiac complications (RR 0.47, 95% CI 0.25 - 0.87; p = .02), and infective complications (RR 0.49, 95% CI 0.35 - 0.67; p < .001) in vascular inpatients. No statistically significant differences in length of stay (standard mean difference -0.6 days, 95% CI -1.44 - 0.24 days; p = .16) and 30 day re-admission (RR 0.96, 95% CI 0.84 - 1.08; p = .49) were noted., Conclusion: Early results of physician and surgeon co-management for vascular surgery inpatients showed promising results from very low certainty data. Further well designed, prospective studies are needed to determine how to maximise the impact of physicians within a vascular service to improve patient outcomes while using hospital resources effectively., (Copyright © 2024 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Objective: This study aimed to evaluate if placement of transverse cesarean skin incision above or below the overhanging pannus is associated with wound morbidity in morbidly obese patients., Study Design: We identified a cohort of patients with body mass index (BMI) ≥40 kg/m 2 undergoing cesarean delivery at a single center from 2017-2020 with complete postpartum records. Data was abstracted after institutional review board exemption, and patients were grouped by low transverse or high transverse skin incision. The primary outcome was a composite of wound infection, fascial dehiscence, incisional hernia, therapeutic wound vacuum, and reoperation. Secondary outcomes included the individual components of the composite, blood transfusion, operative time, and immediate neonatal outcome. T test and χ 2 were used for continuous and categorical comparisons. Logistic regression was used to compute adjusted odds ratios for categorical outcomes and linear regression to compare operative times adjusting for factors associated with wound complications and surgical duration respectively., Results: 328 patients met inclusion criteria: 65 with high transverse (infraumbilical and supraumbilical) and 263 with low transverse (Pfannenstiel) incision. 11% of patients had wound morbidity; high transverse incision was associated with 3.64-fold increased odds of composite wound morbidity (23.1% vs 8%, aOR 3.64, 95% CI 1.52-8.70) and 5.73-fold increased odds of wound infection (13.8% vs. 4.9%, aOR 5.73, 95% CI 1.83-17.96). Time from skin incision to delivery was 1.87 min longer (11.09 vs 14.98 min, β = 1.87, 95% CI 0.17-4.61). There was no significant difference in neonatal outcomes, non-low transverse hysterotomy, or total operative time., Conclusion: High transverse skin incision for cesarean delivery was strongly associated with increased wound morbidity in morbidly obese patients.

Background: To determine the association of trainees involvement with surgical outcomes of abdominal and laparoscopic myomectomy including operative time, rate of transfusion, and complications., Methods: A retrospective cohort study of 1145 patients who underwent an abdominal or laparoscopic myomectomy from 2008-2012 using the American College of Surgeons National Surgical Quality Improvement Program database (Canadian Task Force Classification II-2)., Results: Overall, 64% of myomectomies involved trainees. Trainees involvement was associated with a longer operative time for abdominal myomectomies (mean difference 20.17 minutes, 95% Confidence Interval (CI) [11.37,28.97], p  < 0.01) overall and when stratified by fibroid burden. For laparoscopic myomectomy, there was no difference in operative time between trainees vs no trainees involvement (mean difference 4.64 minutes, 95% CI [-18.07,27.35], p  = 0.67). There was a higher rate of transfusion with trainees involvement for abdominal myomectomies (10% vs 2%, p  < 0.01; Odds Ratio (OR) 5.62, 95% CI [2.53,12.51], p  < 0.01). Trainees involvement was not found to be associated with rate of transfusion for laparoscopic myomectomy (4% vs 5%, p  = 0.86; OR 0.82, 95% CI [0.16,4.14], p  = 0.81). For abdominal myomectomy, there was a higher rate of overall complications (15% vs 5%, p  < 0.01; OR 2.96, 95% CI [1.77,4.93], p  < 0.01) and minor complications (14% vs 4%, p  < 0.01; OR 3.71, 95% CI [2.09,6.57], p  < 0.01) with no difference in major complications (3% vs 2%, p = 0.23). For laparoscopic myomectomy, there was no difference in overall (6% vs 10% p  = 0.41; OR 0.59, 95% CI [0.18,2.01], p  = 0.40), major (2% vs 0%, p  = 0.38), or minor (5% vs 10%, p  = 0.32; OR 0.52, 95% CI [0.15,1.79], p  = 0.30) complications., Conclusion: Trainees involvement was associated with increased operative time, rate of transfusion, and complications for abdominal myomectomy, however, did not impact surgical outcomes for laparoscopic myomectomy.

Objective: Achondroplasia is associated with foramen magnum stenosis (FMS), which can lead to sudden unexpected death in infants. There is no wide consensus regarding the best management of FMS. This study aimed to analyze the prevalence of FMS in a cohort of children with achondroplasia and to evaluate screening and neurosurgical interventions of FMS regarding its effects and complications., Methods: The authors conducted a retrospective cohort study including all children with achondroplasia assessed or treated at Karolinska University Hospital between September 2005 and June 2020. The severity of FMS was graded using the MRI Achondroplasia Foramen Magnum Score (AFMS). The AFMS was correlated with neurological examinations and polysomnography (PSG) results., Results: Severe FMS (AFMS 3-4) was present in 35% of the 51 children included in the study. As many as 65% of the children in the cohort underwent foramen magnum decompression (FMD). Neurological examination had a high specificity (94%) but a low sensitivity (28%) for severe FMS. Signs of central apnea on PSG did not correlate with severity of FMS (p = 0.735). Surgery improved FMS (p < 0.001) with a nonsignificant trend of decreased central apnea (p = 0.070), but carried a 9% risk of severe surgery- and anesthesia-related complications., Conclusions: This study confirmed previous reports that severe FMS is common in children with achondroplasia, that neurological symptoms may be absent even in severe FMS, and that FMD improves FMS and may improve central apnea. The finding that neurological examination had a low sensitivity for severe FMS supports the recommendation that all children with achondroplasia should undergo early MRI.

Background: Complications are common after major visceral surgery. Besides the patients, also surgeons may experience negative feelings by the patients suffering. Some studies have evaluated the mental burden caused by complications, mainly focusing on residents in different surgical specialties. No evidence exists on the mental burden of board-qualified visceral surgeons in Germany., Materials and Methods: A point prevalence study was conducted using an online questionnaire. For the inclusion of participants, all departments of visceral surgery at German university hospitals were addressed. The objective of the online questionnaire was to elaborate the perception of complications and the coping mechanisms used by the surgeons with the aim to characterize the mental burden and possible improvement strategies., Results: A total of 113 questionnaires were answered, 98 being complete. 73.2% of the participants were male, 46.9% were consultants and had a working experience of 11-20 years. Most common specialties were colorectal and general surgery and 91.7% claimed to have caused complications Clavien-Dindo grade IV or V. Subsequently, predominant feelings were anger, grief, self-doubt and guilt. The fear of being blamed by colleagues or to lose reputation were high. Especially female and younger surgeons showed those fears. Coping mechanisms used to overcome those negative feelings were interaction with friends and family (60.6%) or proactive training (59.6%). Only 17.2% of the institutions offered professional support. In institutions where no support was offered, 71.6% of the surgeons asked for support., Conclusion: Surgical complications cause major psychological burden in surgeons in German university hospitals. Main coping mechanisms are communication with friends and families and professional education. Vulnerable subgroups, such as younger surgeons, may be at risk of suffering more from perceived mental distress. Nonetheless, the majority did not receive but asked for professional counselling. Thus, structured institutional support may ameliorate care for both surgeon and patient., (© 2024. The Author(s).)

Background: The Laparoscopic Approach to Cervical Cancer study results revolutionized our understanding of the best surgical management for this disease. After its publication, the guidelines state that the standard and recommended approach for radical hysterectomy is an open abdominal approach. Nevertheless, the effect of the Laparoscopic Approach to Cervical Cancer trial on real-world changes in the surgical approach to radical hysterectomy remains elusive., Objective: This study aimed to investigate the trends and routes of radical hysterectomy and to evaluate postoperative complication rates before and after the Laparoscopic Approach to Cervical Cancer trial (2018)., Study Design: The National Surgical Quality Improvement Program registry was used to examine radical hysterectomy for cervical cancer performed between 2012 and 2022. This study excluded vaginal radical hysterectomies and simple hysterectomies. The primary outcome measures were the trends in the route of surgery (minimally invasive surgery vs laparotomy) and surgical complication rates, stratified by periods before and after the publication of the Laparoscopic Approach to Cervical Cancer trial in 2018 (2012-2017 vs 2019-2022). The secondary outcome measure was major complications associated specifically with the different routes of surgery., Results: Of the 3611 patients included, 2080 (57.6%) underwent laparotomy, and 1531 (42.4%) underwent minimally invasive radical hysterectomy. There was a significant increase in the minimally invasive surgery approach from 2012 to 2017 (45.6% in minimally invasive surgery in 2012 to 75.3% in minimally invasive surgery in 2017; P<.01) and a significant decrease in minimally invasive surgery from 2018 to 2022 (50.4% in minimally invasive surgery in 2018 to 11.4% in minimally invasive surgery in 2022; P<.001). The rate of minor complications was lower in the period before the Laparoscopic Approach to Cervical Cancer trial than after the trial (317 [16.9%] vs 288 [21.3%], respectively; P=.002). The major complication rates were similar before and after the Laparoscopic Approach to Cervical Cancer trial (139 [7.4%] vs 78 [5.8%], respectively; P=.26). The rates of blood transfusions and superficial surgical site infections were lower in the period before the Laparoscopic Approach to Cervical Cancer trial than in the period after the trial (137 [7.3%] vs 133 [9.8%] [P=.012] and 20 [1.1%] vs 53 [3.9%] [P<.001], respectively). In a comparison of minimally invasive surgery vs laparotomy radical hysterectomy during the entire study period, patients in the minimally invasive surgery group had lower rates of minor complications than in those in the laparotomy group (190 [12.4%] vs 472 [22.7%], respectively; P<.001), and the rates of major complications were similar in both groups (100 [6.5%] in the minimally invasive surgery group vs 139 [6.7%] in the laparotomy group; P=.89). In a specific complications analysis, the rates of blood transfusion and superficial surgical site infections were lower in the minimally invasive surgery group than in the laparotomy group (2.4% vs 12.7% and 0.6% vs 3.4%, respectively; P<.001; for both comparisons), and the rate of deep incisional surgical site infections was lower in the minimally invasive surgery group than in the laparotomy group (0.2% vs 0.7%, respectively; P=.048). In the multiple logistic regression analysis, the route of radical hysterectomy was not independently associated with the occurrence of major complications (adjusted odds ratio, 1.02; 95% confidence interval, 0.63-1.65)., Conclusion: Although the proportion of minimally invasive radical hysterectomies decreased abruptly after the Laparoscopic Approach to Cervical Cancer trial, there was no change in the rate of major postoperative complications. In addition, the hysterectomy route was not associated with major postoperative complications., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Razorback deformity with stiff thoracic scoliosis creates a complex three-dimensional deformity. Posterior spinal fusion (PSF) and thoracoplasty can correct rib hump deformity and improve patient satisfaction. However, conventional thoracoplasty may impair pulmonary function and increase complications. We present a modified thoracoplasty (MTP) technique for addressing rib hump deformity in stiff thoracic scoliosis patients, emphasizing its clinical efficacy and safety., Methods: This study included 44 patients with stiff thoracic scoliosis and razorback deformity who underwent surgery between January 2010 and May 2021. Patients were divided into PSF + MTP (n = 27) and PSF (n = 17) groups. Surgical parameters, complications, radiographic improvements, pulmonary function, and Scoliosis Research Society-22 scores were evaluated preoperatively and at 3 months and 2 years postoperatively., Results: There were no significant differences in baseline characteristics between the 2 groups, except for the rib hump height, which was higher in the PSF + MTP group. The PSF + MTP group showed superior correction of the thoracic curve and rib hump height compared to the PSF group, with significant improvements in self-image scores. No significant differences were observed in pulmonary function between the groups. The operative time was longer in the PSF + MTP group, but there were no significant differences in intraoperative blood loss, hospitalization costs, or major complications. Regression analysis indicated that the type of surgery, thoracic Cobb angle, and preoperative self-image scores were significant predictors of postoperative self-image scores., Conclusions: MTP provides enhanced correction of thoracic curve and rib hump deformity without significantly increasing pulmonary function impairment or complication rates. It also improves patients' self-image, making it a valuable addition to PSF in treating stiff thoracic scoliosis with rib hump deformity., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Hypoparathyroidism is a common complication following thyroidectomy, resulting in significant disturbances in calcium homeostasis due to low parathyroid hormone (PTH) levels. This comprehensive review examines the risk factors associated with transient and permanent hypoparathyroidism post-thyroidectomy, emphasizing surgical, patient-related, and perioperative factors. Transient hypoparathyroidism, characterized by temporary hypocalcemia resolving within weeks to months, is often managed with short-term calcium and vitamin D supplementation. In contrast, permanent hypoparathyroidism persists beyond six months post-surgery, necessitating lifelong supplementation and potentially PTH replacement therapy. The review delves into the anatomy and physiology of the parathyroid glands, mechanisms leading to hypoparathyroidism, and incidence rates. Surgical factors such as the extent of thyroidectomy, surgeon expertise, and intraoperative parathyroid gland preservation are critical in determining the risk of hypoparathyroidism. Patient factors, including age, sex, pre-existing conditions, and perioperative management, influence outcomes. Diagnostic and monitoring strategies, along with management protocols for both transient and permanent hypoparathyroidism, are discussed. Prevention strategies, emerging research, future surgical techniques, and intraoperative monitoring directions are highlighted to improve clinical outcomes. This review aims to enhance understanding, inform surgical practices, and optimize postoperative care to minimize the incidence and impact of hypoparathyroidism in thyroidectomy patients., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Maheshwari et al.)

The use of 3-dimensional (3D) technology has become increasingly popular across different surgical specialities to improve surgical outcomes. 3D technology has the potential to be applied to robotic assisted radical prostatectomy to visualise the patient's prostate anatomy to be used as a preoperative and peri operative surgical guide. This literature review aims to analyse all relevant pre-existing research on this topic. Following PRISMA guidelines, a search was carried out on PubMed, Medline, and Scopus. A total of seven studies were included in this literature review; two of which used printed-3D models and the remaining five using virtual augmented reality (AR) 3D models. Results displayed variation with select studies presenting that the use of 3D models enhances surgical outcomes and reduces complications whilst others displayed conflicting evidence. The use of 3D modelling within surgery has potential to improve various areas. This includes the potential surgical outcomes, including complication rates, due to improved planning and education., (© 2024. The Author(s).)

Purpose: The primary objective of this study was to investigate the association between preoperative chronic steroid use and postoperative complications following open reduction internal fixation (ORIF) for proximal humerus fractures (PHF)., Methods: The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for all patients who underwent PHF ORIF between 2015 and 2021. A total of 6,273 patients were included in this study, of which 3.4% (n = 212) were in the chronic steroid use cohort. Patient characteristics including demographics, comorbidities, and 30-day postoperative complications after PHF ORIF were collected. Bivariate logistic regression and multivariate logistic regression analysis, adjusted for all significantly associated variables, was conducted to investigate the relationship between preoperative chronic steroid use and postoperative complications., Results: Chronic steroid use was significantly associated with age ≥ 75 (p < 0.001), male gender (p =0.006), dependent functional status (p = 0.008), American Society of Anesthesiologist (ASA) ≥ 3 (p < 0.001), CHF (p = 0.007), hypertension (p < 0.001), COPD (p < 0.001), bleeding disorder (p = 0.007), ascites (p = 0.040), disseminated cancer (p< 0.001), and systemic sepsis (p < 0.001). After adjusting for all significantly associated variables, chronic steroid use was independently associated with major complication (OR 1.60, 95% CI 1.06-2.43; p = 0.026), and non-home discharge (OR 1.05, 95% CI 1.01-1.08; p = 0.014)., Conclusion: Preoperative chronic steroid use is associated with increasing rate of postoperative complications following PHF ORIF. Better understanding and characterizing chronic steroid use as a preoperative risk factor can aid physicians in risk stratification to reduce rates of postoperative complications following PHF ORIF., Level of Evidence: III. Retrospective Cohort Comparison; Prognosis Study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)