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BACKGROUND: Patients with recurrent pelvic malignancy have few treatment options, and surgery is fraught with complications. We sought to characterize the relationship between radiographic pelvic volume and postoperative complications after pelvic salvage surgery. METHODS: A retrospective chart review of all patients undergoing pelvic exenteration or abdominoperineal resection for recurrent malignancy between 1998 and 2013 was performed. Preoperative computed tomography was used to determine pelvic volume. RESULTS: Forty-two patients underwent surgery for recurrent rectal (26, 62%), prostate (8, 19%), or anal squamous cell cancer (8, 19%). Thirty-eight patients (90%) suffered complications and there was one (2%) perioperative death. Decreasing pelvic volume was associated with deep or organ space infections (P 5 .01), sepsis (P = .03), and fistula (P = .05) on univariate analysis. Infections remained significant on multivariate analysis (odds ratio, 1.01; P = .02). CONCLUSIONS: Pelvic salvage surgery for recurrent malignancy is associated with a high complication rate yet low mortality. Decreasing pelvic volume is associated with increasing risk of deep or organ space infections. [ABSTRACT FROM AUTHOR]

BACKGROUND: The external ear represents a site with high ultraviolet exposure and thin skin over-lying cartilage. The aim of this study was to determine if ear melanomas have different characteristics than cutaneous melanomas in other anatomic sites. METHODS: The evaluation of patients treated at a tertiary care center. RESULTS: Sixty patients were treated for ear melanoma (87% male, mean age = 56.7, mean thick-ness = 1.65 mm). Seven of thirty-two patients (22%) who underwent sentinel lymph node biopsy had positive nodes. Twenty (33%) patients had recurrence including 6 patients with negative sentinel lymph nodes (SLNs) and 5 patients with positive SLNs. Three of 10 patients (30%) treated with Mohs surgery had local recurrence. CONCLUSIONS: The overall local and systemic recurrences are similar to those previously reported. There is a higher recurrence rate than expected in patients with a negative SLN and a high local recur-rence rate after Mohs surgery. Our data suggest that SLN evaluation may be less accurate in ear mel-anomas and that Mohs surgery may be associated with a relatively high local recurrence rate. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgical energy-based devices emit energy, which can interfere with other electronic devices (eg, implanted cardiac pacemakers and/or defibrillators). The purpose of this study was to quantify the amount of unintentional energy (electromagnetic interference [EMI]) transferred to an implanted cardiac defibrillator by common surgical energy-based devices. METHODS: A transvenous cardiac defibrillator was implanted in an anesthetized pig. The primary outcome measure was the average maximum EMI occurring on the implanted cardiac device during activations of multiple different surgical energy-based devices. RESULTS: The EMI transferred to the implanted cardiac device is as follows: traditional bipolar 30 W .01 ± .004 mV, advanced bipolar .004 ± .003 mV, ultrasonic shears .01 ± .004 mV, monopolar Bovie 30 W coagulation .50 ± .20 mV, monopolar Bovie 30 W blend .92 ± .63 mV, monopolar instrument without dispersive electrode .21 ± .07 mV, plasma energy 3.48 ± .78 mV, and argon beam coagulator 2.58 ± .34 mV. CONCLUSION: Surgeons can minimize EMI on implanted cardiac defibrillators by preferentially utilizing bipolar and ultrasonic devices. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hypocalcemia is a frequent complication of thyroidectomy. Although typically mild and temporary, it can lead to an increased length of stay, readmission, and in some cases be permanent. Controversy exists as to whether vitamin D deficiency (VDD) contributes to post-thyroid-ectomy hypocalcemia. METHODS: This is a retrospective study of 152 patients who underwent thyroidectomy. Patients with or without VDD were compared. Data were analyzed for demographics, operative procedure, calcium levels, and complications of hypocalcemia. RESULTS: There was no difference in the rates of biochemical or symptomatic hypocalcemia or in the need for readmission between the VDD and non-VDD groups. A multivariate analysis controlling for central neck dissection, parathyroid autotransplant, and preoperative diagnosis confirmed no association between VDD and post-thyroidectomy hypocalcemia CONCLUSIONS: Despite VDD being common in patients undergoing thyroidectomy, our results do not suggest that this increases the rate of hypocalcemia. Thus, preoperative evaluation/repletion of VDD is unlikely to reduce post-thyroidectomy hypocalcemia rates [ABSTRACT FROM AUTHOR]

Background: Telehealth utilization rapidly increased following the pandemic. However, it is not widely used in the Veteran surgical population. We sought to evaluate postoperative telehealth in patients undergoing general surgery., Methods: Retrospective review of Veterans undergoing general surgery at a level 1A VA Medical Center from June 2019 to September 2021. Exclusions were concomitant procedure(s), discharge with drains or non-absorbable sutures/staples, complication prior to discharge or pathology positive for malignancy., Results: 1075 patients underwent qualifying procedures, 124 (12 ​%) were excluded and 162 (17 ​%) did not have follow-up. 443 (56 ​%) patients followed-up in-person (56 ​%) vs 346 (44 ​%) via telehealth. Telehealth patients had a lower rate of complications, 6 ​% vs 12 ​%, p ​= ​0.013. There were no significant differences in ED visits, 30-day readmission, postoperative procedures or missed adverse events., Conclusion: Telehealth follow-up after general surgical procedures is safe and effective. Postoperative telehealth care should be considered after low-risk general surgery procedures., Competing Interests: Declaration of competing interest Dr. Edward Jones is a consultant for Boston Scientific. Drs. Abbitt, Choy, Teresa Jones, Wikiel, Barnett, Moore and Robinson have no disclosures. Ms. Castle and Mr. Bollinger have no disclosures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Surgical readmissions are clinically and financially problematic. Our purpose is to determine if a decrease in postoperative ambulation (steps/day) is associated with hospital readmission., Methods: In this prospective cohort study, patients undergoing elective operations wore an accelerometer activity tracker to measure steps/day for 28 consecutive postoperative days. The primary outcome was hospital readmission. The change in steps/day over two consecutive days prior to the day of the readmission were examined. Predetermined thresholds for decreases of consecutive daily ambulation levels were used to calculate sensitivity and specificity for the outcome of hospital readmission., Results: 215 patients (aged 63 ± 12 years) were included. Readmission occurred in 10% (n = 21). For each of the first 28-postoperative days, the entire cohort had an average daily step increase of 136 ± 146 steps/day (Spearman correlation rho = 0.990; p < 0.001). A decrease in steps for two consecutive days of >50% from the prior day had a 79% sensitivity and 90% specificity for hospital readmission., Conclusions: A decrease of >50% daily ambulation (steps/day) over two consecutive post-discharge days accurately forecasts hospital readmission. The implications of these findings are that monitoring daily ambulation could serve as a form of outpatient telemetry aiding to forecast post-surgical readmissions., (Published by Elsevier Inc.)

Background: The benefit of elective laparoscopic paraesophageal hernia repair (eLPEHR) in the elderly is unclear. This study compared quality of life and symptom resolution and morbidity after eLPEHR between octogenarians and younger patients., Methods: A retrospective review was conducted comparing octogenarians (n = 23) to younger patients (n = 162) undergoing eLPEHR. Primary outcomes were pre and post-operative disease-specific quality of life (GERD-HRQL) and symptom scales (GERSS) and post-operative morbidity and length of stay (LOS)., Results: Octogenarians presented with higher ASA and lower preoperative BMI. Compared to controls, octogenarians exhibited higher overall morbidity (34.8% vs 16.1%, p = 0.03), including cardiac events (8.7% vs 0.6%) and mortality (8.7% vs 0%), and longer LOS (3 vs 2 days, p < 0.005). Post-operative reduction in GERD-HRQL/GERSS scores was comparable between groups., Conclusion: Octogenarians who undergo eLPEHR exhibit significant improvement in quality of life and symptom burden but may experience increased morbidity, suggesting a role for watchful waiting in this population., Summary: Symptom burden, quality of life, and immediate post-operative morbidity was compared between octogenarians and younger patients undergoing elective laparoscopic paraesophageal hernia repair at a single institution. While exhibiting comparable post-operative improvement in symptom burden and quality of life, octogenarians experience higher post-operative morbidity. This may suggest a role for watchful waiting in the elderly population., Competing Interests: Declaration of competing interest Drs Anahita Jalilvand, Edward Jones, Sara Martin Del Campo, and Kyle Perry have no conflicts to disclose. This work was presented as a poster presentation at SAGES 2017 in Houston, TX., (Copyright © 2019. Published by Elsevier Inc.)

Background: Post-operative delirium is associated with increased short term morbidity and mortality. Limited data exists on long term outcomes for older adults with postoperative delirium. We hypothesize that postoperative delirium is associated with increased 5-year mortality., Methods: Patients ≥50 years undergoing elective operations with planned intensive care unit (ICU) admissions were prospectively enrolled. The Confusion Assessment Method ICU (CAM-ICU) was used to diagnose delirium. The primary outcome variable was 5-year mortality., Results: 172 patients were enrolled with an average age of 64 years. The overall incidence of delirium was 44% (75/172). At 5-years post-operatively, mortality was higher (59%, 41/70) in patients with delirium compared to patients without delirium (13%, 12/94, p < 0.001). These results remained true after multivariable risk adjustment, showing the odds of five year mortality following delirium were 7.35 fold greater (95% CI: 1.49-36.18)., Conclusions: Postoperative delirium is associated with increased long term mortality., (Published by Elsevier Inc.)

Background: The utility of urinalysis (UA) to diagnose intra-abdominal (IA) or genitourinary (GU) injury after blunt trauma remains controversial. The purpose of this study was to determine the significance of UA in the blunt trauma patient., Methods: A retrospective review of patients admitted for blunt abdominal trauma from 2011 to 2013., Results: A total of 1,795 patients sustained blunt abdominal trauma: mean age of 44 ± 21 years; mean Injury Severity Score of 13 ± 10. Overall 810 patients had a negative UA (45%). Two patients (2/810 and .2%) had a GU injury and neither required intervention. Thirty-two patients (32/810 and 4.0%) had an IA injury, and 2 (2/810 and .02%) required intervention. The sensitivity for predicting GU injury requiring intervention was 1, and IA injury requiring intervention was .96. Negative predictive values were 1 and .99., Conclusions: A negative UA correlates with a low risk for GU and IA injury after blunt abdominal trauma. A negative UA should be evaluated prospectively as part of a clinical prediction score to rule out injury and avoid unnecessary radiation exposure from computed tomography imaging., (Copyright © 2016 Elsevier Inc. All rights reserved.)