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Introduction: Cesarean section it is the most frequently applied surgical application. Every surgical procedure creates an inflammation. Neutrophil to lymphocyte ratio (NLR), which can be easily obtained from complete blood count, is used as subclinical systemic inflammatory markers. In this study, our aim is to understand the effect of the duration of the cesarean section on subclinical inflammation by looking at the neutrophil/lymphocyte ratio and the effect of this period on blood loss and postoperative recovery Methods: We included a total of 188 operations between the ages of 18-45 in our study and created 2 groups according to the duration of the cesarean section. When grouped as short (0-39 min) and long (≥40 min) according to the operation time, NOL change was higher in the group with longer operation duration, but no significant difference was found in both groups. Similarly, although the decrease in hemoglobin was higher in the group with a long operation time, no significant difference was found. No difference was observed between the two groups in terms of wound healing on the postoperative 10th day. When we look at our other parameters, we found a significant relationship between those whose cesarean section ended within 40 minutes and those who had their first cesarean section. Results: As a result of our study, we could not detect a significant difference in the duration of the cesarean section operations performed in our clinic on the postoperative parameters. Conclusion: Although supportive studies are needed, it shows that the surgical rules of cesarean section operate correctly under optimal conditions. [ABSTRACT FROM AUTHOR]

Objective To study the clinical factors that affect the prognosis of patients with traumatic brain injury (TBI) and provide reference for improving the prognosis of TBI patients. Methods The clinical data of 220 TBI patients underwent surgery from January 2018 to December 2022 in Department of Neurosurgery, the Affiliated Lianyungang Hospital of Xuzhou Medical University were analyzed retrospectively. According to the Glasgow outcome score (GOS), they were divided into a good prognosis group (GOS≥4 points) and a poor prognosis group (GOS ≤ 3 points) . Univariate and multivariate logistic regression analysis were used to analyze the risk factors of poor prognosis in patients with TBI surgery. R software was used to construct a column chart model to predict the risk of poor prognosis in patients underwent craniocerebral injury surgery, and the calibration curve and decision analysis curve were used to verify the predictive performance of the model. Results Univariate analysis showed a significant correlation between age, GCS score, time from injury to emergency room, surgery time window, blood glucose concentration, D-dimer concentration, midline shift distance and bleeding site (P＜0. 05-0. 001) . The results of multivariate analysis showed that age ≥ 60 years (OR=2. 048, P=0. 037), GCS score ≤ 8 points (OR=2. 240, P=0. 037), surgery time window (OR=1. 239, P=0. 006), blood glucose concentration ≥ 8. 8 mmol/L (OR=2. 165, P=0. 027), D-dimer concentration (OR=1. 636, P=0. 002), midline shift distance＞1 cm (OR=5, 467, P＜0. 001) and subdural hemorrhage (OR=3. 031, P=0. 003) were independent risk factors in patients undergoing TBI surgery. Building a column chart model based on the above risk factors, the area under the curve of the model was 0. 838 (95％CI=0. 785-0. 891) . The calibration curve basically coincided with the ideal curve. Conclusions Age≥60 years old, GCS score≤8 points, surgery time window ≥6. 9 hours, blood glucose concentration ≥8. 8 mmol/L, D-dimer concentration ≥ 11 590 ng/mL, midline shift distance＞1 cm and subdural hemorrhage are influencing factors for poor prognosis in TBI surgery patients. TBI patients are transported to the hospital within 3. 8 hours after injury and undergo craniotomy within 6. 9 hours, resulting in a low incidence of poor prognosis. The column chart model constructed based on the above risk factors has certain predictive performance and clinical application value for the prognosis evaluation of TBI patients. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to compare the results of patients who underwent inguinal hernia repair with nonfixation pre-shaped three-dimensional (3D) mesh and fixation with polypropylene meshes (PPM) using the totally extraperitoneal (TEP) method. Materials and Methods: A total of 96 patients who underwent laparoscopic hernia repair with the diagnosis of inguinal hernia between April 2019 and September 2023 were retrospectively analyzed. The patients were divided into two groups according to the mesh type used: staple fixation (SF) group (n=52), in which lightweight PPM was used, and non-staple fixation (NSF) group (n=44), in which pre-shaped 3D mesh was used. Patients’ age, sex, body mass index (BMI), ASA score, comorbidities, hernia type, Visual Analog Scale (VAS) score at rest (VAS-rest) and while in motion (VAS-act), and chronic groin pain (CGP) were recorded. Postoperative follow-ups were performed at one, four weeks and three, and 12 months. Results: The surgical time was found to be shorter in NSF group patients than in the SF group (p=0.011). In the SF group, four patients developed seroma, one patient developed urinary retention, and two patients developed hematoma. In the NSF group, seroma developed in three patients, urinary retention developed in two patients, and one hematoma was observed. Recurrence was observed in two patients in the SF group at 10 and 14 months, and in one patient in the NSF group at eight months. In the NSF group, groin pain was found less frequently on Day 1 and at Week 1 than in the SF group, indicating a statistically significant difference (p<0.001 and p<0.001, respectively). Conclusion: Applying pre-shaped 3D mesh without any fixation is a safe and applicable method in inguinal hernia surgery. We recommend this method, as CGP is less than the polypropylene mesh fixation method and does not increase recurrence. This method can be performed by experienced surgeons with low complication rates. [ABSTRACT FROM AUTHOR]

The rate of revision total joint arthroplasties is expected to increase drastically in the near future. Given the recent pandemic, there has been a general push toward early discharge. This study aimed to assess for predictors of early postoperative discharge after revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA). There were 77 rTKA and 129 rTHA collected between January 1, 2019 and December 31, 2021. Demographic data, comorbidities, a comorbidity index, the modified frailty index (mFI-5), and surgical history were collected. The Common Procedural Terminology codes for each case were assessed. Patients were grouped into 2 cohorts, early discharge (length of stay [LOS] <24 hours) and late discharge (LOS >24 hours). In the rTHA cohort, age >65 years, a history of cardiac or liver disease, an mFI-5 of >1, a comorbidity index of >2.7, a surgical time >122 minutes, and the need for a transfusion were predictors of prolonged LOS. Only the presence of a surgical time of >63 minutes or an mFI-5 >1 increased patient LOS in the rTKA cohort. In both rTHA and rTKA patients, periprosthetic joint infection resulted in a late discharge for all patients, mean 4.8 and 7.1 days, respectively. Dual component revision was performed in 70.5% of rTHA. Only 27.6% of rTKA were 2-component revisions or placements of an antibiotic spacer. Several patient and surgical factors preclude early discharge candidacy. For rTHA, an mFI-5 of >2/5, comorbidity index of >4, or a surgical time of >122 minutes is predictive of prolonged LOS. For rTKA, an mFI-5 of >2/5, Charlson Comorbidity Index of >5, or a surgical time of >63 minutes predicts prolonged LOS. [ABSTRACT FROM AUTHOR]

To reduce the healthcare burden, the clinical results of arthroscopic rotator cuff repair and the cost of the implants used have recently been focused upon. This study compared implant cost, surgical time, short-term clinical results, and cuff repair integrity 2 years postoperatively between arthroscopic transosseous rotator cuff repair using lateral cortical augmentation (TOA) and arthroscopic transosseous-equivalent suture bridge (TOE). This study included 220 patients with rotator cuff repairs performed by a single surgeon between December 2013 and December 2018. Overall, 70 TOA and 68 TOE cases met the inclusion criteria. The same surgeon performed the procedures at two different hospitals, and the techniques differed between the facilities. A total of 42 TOA patients were matched with 42 TOE patients. The patients were matched using a propensity score analysis by gender, age, and cuff tear size. The minimum follow-up period was 2 years. Implant cost and surgical time were compared between the two methods. The range of motion, clinical outcomes, and visual analog scale were evaluated. Magnetic resonance imaging was performed to examine cuff repair integrity 2 years postoperatively. The follow-up rate was 81% (112/138 patients). Implant cost was significantly lower with TOA ($1,396 vs. $2,165; p < 0.001) than with TOE. The average surgical time in the TOA method was significantly shorter than that in the TOE method (82 vs. 109 min; p = 0.001). At a minimum 2-year follow-up, the mean active elevation, abduction, and clinical outcomes improved with both methods, although no improvements in external and internal rotations were observed with either method. There were no significant differences in the postoperative variables and retear rate (TOA, 12%; TOE, 19%; p = 0.548) between the two methods. TOA and TOE achieved comparable clinical results; however, TOA was more cost-effective and had a shorter surgical time than TOE. Level Ⅲ, retrospective matched control study. [ABSTRACT FROM AUTHOR]

Background: Burn contractures are a common complication in the pediatric population, leading to significant functional limitations and decreased quality of life. This study aimed to investigate the impact of surgical access time on burn contracture outcomes in pediatric patients, particularly wound quality and hand function. Materials and Methods: This retrospective study included 27 pediatric patients with upper-extremity burn contractures between November 2022 and August 2023. Patients with underlying medical conditions or medications were excluded from this study. A variety of surgical procedures were performed, and complications, follow-up times, access times, and postoperative evaluations were assessed. Contracture locations were divided into four groups: axilla (Group I), elbow (Group II), wrist (Group III), and fingers (Group IV). Access time was defined as the time from symptom onset to first surgical intervention. Results: Among the 27 patients with pediatric burn contractures, Group II had significantly longer access times than the other groups (P < 0.05). This delayed access was associated with lower Patient and Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHQ) scores in Group II (P < 0.05), indicating worse wound quality and hand function in Group II. Correlation analysis in Group II revealed a significant negative correlation between access time and POSAS (−0.8, P = 0.036) and MHQ scores (r = −0.43, P = 0.039). The changes in Groups I, III, and IV are statistically significant in terms of range of motion (P < 0.05). Conclusion: This study suggests that access time is an important factor for pediatric burn contractures. Early surgical intervention has been associated with improved wound quality and hand function.

Background: Burn contractures are a common complication in the pediatric population, leading to significantfunctional limitations and decreased quality of life. Thisstudy aimed to investigate the impact ofsurgical accesstime on burn contracture outcomesin pediatric patients, particularly wound quality and hand function. Materials and Methods: This retrospective study included 27 pediatric patients with upper‑extremity burn contractures between November 2022 and August 2023. Patients with underlying medical conditions or medications were excluded from this study. A variety of surgical procedures were performed, and complications, follow‑up times, access times, and postoperative evaluations were assessed. Contracture locations were divided into four groups: axilla (Group I), elbow (Group II), wrist (Group III), and fingers (Group IV). Access time was defined as the time from symptom onset to first surgical intervention. Results: Among the 27 patients with pediatric burn contractures, Group II had significantly longer access times than the other groups (P < 0.05). This delayed access was associated with lower Patient and Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHQ) scores in Group II (P < 0.05), indicating worse wound quality and hand function in Group II. Correlation analysis in Group II revealed a significant negative correlation between accesstime and POSAS (−0.8, P = 0.036) and MHQ scores(r = −0.43, P = 0.039). The changesin GroupsI, III, and IV are statistically significant in terms of range of motion (P < 0.05). Conclusion: This study suggests that access time is an important factor for pediatric burn contractures. Early surgical intervention has been associated with improved wound quality and hand function. [ABSTRACT FROM AUTHOR]

Background: The relative safety and more widespread utility of an adhesive surface electrode-based neuromonitoring (ABM) system may reduce the time and cost of traditional needle-based neuromonitoring (NBM). Methods: This retrospective cohort review included one- and two-level transforaminal lumbar interbody fusion procedures (2019-2023). The primary variables studied included were time (in minutes) from patient entry into the operating room (OR) to incision, time from patient entry into the OR to closure, and time from incision to closure. Univariate and bivariate analyses were performed to compare the outcomes between the ABM (31 patients) and NBM (51 patients) modalities. Results: We found no significant differences in the time from patient entry into the OR to incision (ABM: 71.8, NBM: 70.3, P = 0.70), time from patient entry into the OR to closure (ABM: 284.2, NBM: 301.7, P = 0.27), or time from incision to closure (ABM: 212.4, NBM: 231.4, P = 0.17) between the two groups. Further, no patients from either group required reoperation for mal-positioned instrumentation, and none sustained a new postoperative neurological deficit. The ABM approach did, however, allow for a reduction in neurophysiologist-workforce and neuromonitoring costs. Conclusion: The introduction of the ABM system did not lower surgical time but did demonstrate similar efficacy and clinical outcomes, with reduced clinical invasiveness, neurophysiologist-associated workforce, and overall neuromonitoring cost compared to NBM. [ABSTRACT FROM AUTHOR]

Spinal anesthesia usually lasts up to two hours, but an infusion of IV dexmedetomidine can prolong it to three to four hours. We report two cases where single spinal anesthesia with IV dexmedetomidine was maintained for more than six hours during tibia fracture surgery. The spinal anesthesia was maintained for 350 and 390 minutes without another medication, and the sensory level confirmed after the surgery was T10 and L1. Dexmedetomidine can very-prolong the duration of spinal anesthesia beyond what has been reported. However, longer infusion times can also result in longer recovery times.

Spinal anesthesia usually lasts up to two hours, but an infusion of IV dexmedetomidine can prolong it to three to four hours. We report two cases where single spinal anesthesia with IV dexmedetomidine was maintained for more than six hours during tibia fracture surgery. The spinal anesthesia was maintained for 350 and 390 minutes without another medication, and the sensory level confirmed after the surgery was T10 and L1. Dexmedetomidine can very-prolong the duration of spinal anesthesia beyond what has been reported. However, longer infusion times can also result in longer recovery times. [ABSTRACT FROM AUTHOR]

Provide an update on our institution's experience with utilizing transoral robotic surgery (TORS) in pediatric airway surgery and compare these results to surgery by traditional methods. Pediatric patients who underwent TORS for treatment of upper airway pathology between 2010 and 2021 at our institution were retrospectively identified and compared to patients with the same or similar pathology who underwent a traditional (open or endoscopic) surgical approach over the same time period. Outcomes of interest included patient demographics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow (MBSS) results. Forty children (19M, 21F) underwent 46 TORS procedures. Mean age was 6.4 years (range: 6 days-17 years). Most commonly treated pathology included: laryngeal clefts (LC) (n = 18), lymphatic malformations (n = 9), and base of tongue masses (n = 7). Surgical time was decreased in traditional type I LC repairs (mean: 111 vs 149 min, P = 0.04) and lymphatic malformation excisions (59 vs 120 min, p = 0.005). Hospital LOS was increased in TORS type I LC repairs (2.6 vs 1.2 days, P = 0.04). Adverse event rate was similar between TORS and traditional cohorts (17 % vs 16 % cases, P = 0.9). Postoperative MBSS results were improved for TORS type I LC repairs at 6 months (70 % vs 33 %, P = 0.09) and 12 months (82 % vs 43 %, P = 0.05). Pediatric TORS is practical and safe and has comparable outcomes to traditional surgery. Robotic-assisted LC repair displayed improved postoperative swallow results versus traditional approaches and may be particularly useful in recurrent cases. 3. [ABSTRACT FROM AUTHOR]

Operating room (OR) efficiency has an impact on surgeon productivity and patient experience. Accuracy of case duration estimation is important to optimize OR efficiency. The purpose of this study was to identify factors associated with inaccurate case time estimates in outpatient hand surgery. A better understanding of these findings may help to improve OR efficiency and scheduling. All outpatient hand surgical cases from 2018 to 2019 were reviewed. Poorly-estimated cases (i.e., poor scheduling accuracy) were defined as those cases where the actual operative time differed from the predicted time by >50% (either quicker by >50% or slower by >50% than the predicted time). The percentages of poorly-estimated cases were analyzed, categorized, and compared by surgeon, procedure type, and scheduled case length. A total of 6,620 cases were identified. Of 1,107 (16.7%) cases with poorly estimated case durations, 75.2% were underestimated. There was no difference in the likelihood of poor estimation related to start time. Well-estimated cases tended to have longer scheduled case duration, but shorter realized case duration and surgical time. Our systems analysis identified specific surgeons and procedures as predictable outliers. Cases scheduled for 15–30 minutes frequently were inaccurate, whereas cases scheduled for 30–45 and 106–120 minutes had accurate estimates. The accuracy of case time estimations in a standard outpatient hand surgery practice is highly variable. Nearly one-fifth of outpatient hand surgery case durations are poorly estimated, and inaccurate case time estimation can be predicted based on surgeon, procedure type, and case time. Maximizing OR efficiency should be a priority for surgeons and hospital systems. With multiple surgeries done per day, the efficiency of the OR has an impact on surgeon productivity and patient experience. [ABSTRACT FROM AUTHOR]

Introduction: Greater Trochanteric Pain Syndrome (GTPS) is a multifactorial clinical condition affecting the lateral area of the hip. Although conservative treatment shows good results, some patients may still require surgical bursectomy, which can be performed either openly or endoscopically. One of the main technical difficulties of the endoscopic procedure is intraoperative bleeding, which can hinder the medical team's vision and increase the operation time for endoscopic treatment of GTPS., Hypothesis: An instillation of vasoconstrictors and local anesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time., Materials and Methods: A prospective cohort was retrospectively divided based on the use or absence of a preoperative instillation of physiological saline solution with epinephrine and lidocaine. Surgical time was measured in each procedure and compared between the two groups., Results: One hundred thirty-nine hips from 139 patients were included in the analysis. One hundred two patients were included in the instillation group versus 37 in the control group. The surgical time was significantly shorter in the instillation group than in the control group, with an average (standard deviation) of 52.01 (14.71) and 72.30 (11.70) minutes, respectively (P<.001)., Conclusion: The instillation of a physiological saline solution with epinephrine and lidocaine prior to the surgical treatment of GTPS is effective in reducing surgical times, likely due to a reduction in intraoperative bleeding. Future research should focus on more direct outcomes such as intraoperative blood loss and between different instillation protocols., (Copyright © 2024 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

The duration of several types of glaucoma surgery and reimbursement amounts per minute of surgery remain unknown. This study compared the surgical duration of glaucoma procedures (ab interno trabeculotomy, PreserFlo, ab externo trabeculotomy, bleb revision, EXPRESS, trabeculectomy, Ahmed, and the Baerveldt implant) and their reimbursement amounts in Japan. We retrospectively analyzed 30 consecutive surgeries of each type of glaucoma surgery. The reimbursement amount per surgical hour was calculated by subtracting the implant cost from the total medical fees. Amounts were converted to dollars based on an exchange rate of 1 USD = 133 JPY. The average surgical time was as follows: ab interno trabeculotomy, 7.8 ± 2.1; PreserFlo, 13.5 ± 4.0; ab externo trabeculotomy, 15.2 ± 4.1; bleb revision, 15.6 ± 2.3; EXPRESS, 16.9 ± 2.7; trabeculectomy, 18.5 ± 3.1; Ahmed, 35.8 ± 8.2; and Baerveldt, 39.2 ± 6.2. The reimbursement amounts after implant deduction were as follows: ab interno trabeculotomy, $1,089; PreserFlo, $1,538; ab externo trabeculotomy, $1,430; bleb revision, $259; EXPRESS, $1,600; trabeculectomy, $1,774; Ahmed, $1,600; and Baerveldt, $1,765. Reimbursement amounts per minute varied, with the highest and lowest for ab interno trabeculotomy and bleb revision at $140 per minute and $17 per minute, respectively. Reimbursement amounts per minute of surgery for eight types of glaucoma surgery vary by up to eightfold., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Wakuda et al.)

Background: Posterior malleolar involvement can drastically affect patient outcomes. Literature has supported the use of preoperative Computed Tomography (CT) to assess posterior malleolar fracture morphology. The purpose of this study is to determine whether preoperative CT is associated with significant improvement in surgical time, postoperative complications, reoperation rates in trimalleolar ankle fractures. Surgeons were also asked to complete survey regarding use of CT scans to gauge utility preoperatively., Methods: Adult patients with trimalleolar ankle fractures who underwent operative fixation between 2018-2020 were retrospectively reviewed. Primary outcomes included surgical time, postoperative complications, and reoperations. Secondary outcome was presence of posterior malleolar fixation. 15 surgeons who performed ankle ORIF were surveyed to gain information regarding why or why not preoperative CT scan was obtained., Results: 288 patients with trimalleolar ankle fractures were included, 94 had preoperative CT scans (32.6%). No significant differences found in patient age, gender, BMI, smoking status between the groups that did and did not have preoperative CT scan. No significant differences were observed in AO/OTA classification between groups. Average surgical time was significantly higher in group that received a preoperative CT (114 without CT vs. 145 with CT, p<0.05). Complications (10.3% no CT vs 7.4% with CT, p=0.55) and reoperations (6.7% without CT vs. 7.4% with CT, p=0.16) not significantly different between groups. No significant difference was observed in rate of posterior malleolus fixation between groups (43.8% without CT vs 39.4% with CT; p=0.52). Of surveyed surgeons, 87% reported they don't routinely obtain preoperative CT scan for trimalleolar ankle fractures. Most common reasons for preoperative scans were deciding on approach/positioning, assessing for impaction, determining the size of the posterior malleolus., Conclusion: Although preoperative CT scans are obtained in one third of patients with operative trimalleolar ankle fractures, we did not find an improvement in surgical time, complications, and reoperation. Level of Evidence: III ., Competing Interests: Disclosures: Mai P. Nguyen is a paid lecture/consultant for AO North America, committee/board member for the Orthopaedic Trauma Association, and has received funding from the OTA Resident Grant. The other authors certifies that there are no funding or commercial associations that might post a conflict of interest in connection with the submitted article related to the author or any immediate family members., (Copyright © The Iowa Orthopaedic Journal 2024.)