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Aim: This study aimed to evaluate the effects of Fried Frailty Phenotype Questionnaire (FFPQ) scores on patient‐reported postoperative outcomes. Methods: This secondary analysis of a prospective observational study included 230 inpatients aged ≥65 years undergoing elective abdominal cancer surgery. The primary outcome was the Quality of Recovery‐15 score on postoperative days 2, 4 and 7. The secondary outcomes included disability‐free survival, defined as a 12‐item World Health Organization Disability Assessment Schedule 2.0 score of <16% at 3 months. The associations of the FFPQ scores, ranging from 0 (robust) to 5 (frailty), with the primary and secondary outcomes were assessed using multiple analysis. Results: After confirming the linearity of the FFPQ score for the outcomes, multiple regression analysis adjusted for prominent factors showed that the FFPQ score was a significant factor influencing the decrease in the Quality of Recovery‐15 score on postoperative day 2 (β = −2.67, 95% confidence interval −5.20, −0.15), 4 (β = −3.54, 95% confidence interval −5.77, −1.30) and 7 (β = −3.70, 95% confidence interval −5.75, −1.65). The adjusted odds ratio of the FFPQ score for disability‐free survival postoperatively was 0.66 (95% confidence interval 0.49–0.90). Conclusions: Patients with higher FFPQ scores before elective major abdominal cancer surgery were likely to have lower postoperative Quality of Recovery‐15 scores and poor disability‐free survival. Geriatr Gerontol Int 2024; 24: 464–469. Patients with higher Fried Frailty Phenotype Questionnaire scores had lower postoperative Quality of Recovery‐15 scores and were unlikely to have disability‐free survival at 3 months postoperatively. Frailty assessment using the Fried Frailty Phenotype Questionnaire might assist geriatricians, surgeons and anesthesiologists in predicting postoperative recovery, underscoring the importance of preoperative frailty assessment. [ABSTRACT FROM AUTHOR]

Background: Diffusion magnetic resonsance imaging (dMRI) can potentially predict the postoperative outcome of cervical spondylotic myelopathy (CSM). Purpose: To explore preoperative dMRI parameters to predict the postoperative outcome of CSM through multifactor correlation analysis. Study Type: Prospective. Population: Post‐surgery CSM patients; 102 total, 73 male (52.42 ± 10.60 years old) and 29 female (52.0 ± 11.45 years old). Field Strength/Sequence: 3.0 T/Turbo spin echo T1/T2‐weighted, T2*‐weighted multiecho gradient echo and dMRI. Assessment: Spinal cord function was evaluated using modified Japanese Orthopedic Association (mJOA) scoring at different time points: preoperative and 3, 6, and 12 months postoperative. Single‐factor correlation and t test analyses were conducted based on fractional anisotropy (FA), mean diffusivity, intracellular volume fraction, isotropic volume fraction, orientation division index, increased signal intensity, compression ratio, age, sex, symptom duration and operation method, and multicollinearity was calculated. The linear quantile mixed model (LQMM) and the linear mixed‐effects regression model (LMER) were used for multifactor correlation analysis using the combinations of the above variables. Statistical Tests: Distance correlation, Pearson's correlation, multiscale graph correlation and t tests were used for the single‐factor correlation analyses. The variance inflation factor (VIF) was used to calculate multicollinearity. LQMM and LMER were used for multifactor correlation analyses. P < 0.05 was considered statistically significant. Results: The single‐factor correlation between all variables and the postoperative mJOA score was weak (all r < 0.3). The linear relationship was stronger than the nonlinear relationship, and there was no significant multicollinearity (VIF = 1.10–1.94). FA values in the LQMM and LMER models had a significant positive correlation with the mJOA score (r = 5.27–6.04), which was stronger than the other variables. Data Conclusion: The FA value based on dMRI significantly positively correlated with CSM patient postoperative outcomes, helping to predict the surgical outcome and formulate a treatment plan before surgery. Evidence Level: 1 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background: Multidisciplinary screening of bariatric surgery candidates is recommended, and some centers provide an additional preparation program (APP) to optimize patients preoperatively. Objective: To compare patients with APP to standard care 2 years after primary bariatric surgery regarding postoperative weight loss and resolution of obesity‐related comorbidities. Methods: A retrospective cohort study was conducted for patients undergoing primary Roux‐en‐Y gastric bypass and sleeve gastrectomy between September 2017 and March 2019. The first 12 months patients received an APP, after September 2018, the APP was no longer part of the weight loss trajectory. A multivariable linear regression model was built. Results: Of the 384 patients receiving an APP advice, 50 were lost to follow up. In total, 192 (57%) received the APP and 142 (43%) received standard care. Percentage total weight loss after 2 years was significantly different, 28.8% for the APP group versus 32% for the standard group (p = 0.001). Postoperative weight loss after 2 years was increased in patients who had a gastric bypass, a higher baseline body mass index, and female gender in multivariable analysis. An APP was predictive for decreased postoperative weight. Diabetes mellitus was in remission significantly more often in the preparation group (84.1% of the cases) compared with the standard group (61.9%, p = 0.028). Conclusion: A weight loss trajectory is at least as effective without additional preparation in terms of 2 years postoperative %TWL for primary gastric bypass and sleeve procedures. For comorbidities, diabetes mellitus was in remission more often in the APP group. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic hepatectomy (LH) is nowadays considered as the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after LH in patients with severe comorbidities are still sparse. Methods: 247 patients, who underwent LH between January 2016 and March 2020 at European surgical center Aachen Maastricht (ESCAM) were retrospectively analyzed regarding surgical outcome. All patients were categorized according to the ASA guidelines and a propensity score matched (PSM) analysis was performed to compare patients with severe comorbidities with patients with minor or no comorbidities. Results: After PSM, no statistically significant differences regarding clinical characteristics were observed. We performed major resections in 26.4% of h‐ASA (ASA > 2) patients and 19.4% of l‐ASA (ASA≤2) patients, respectively (P =.322). Overall morbidity (Clavien‐Dindo≥1) was observed more frequently in the h‐ASA group (h‐ASA: 25.0% vs. l‐ASA: 8.3%; P =.007) while analysis of major morbidity (Clavien‐Dindo≥3b) showed a non‐significant tendency for more complications in h‐ASA patients (h‐ASA: 8.3% vs. l‐ASA: 1.4%; P =.053). A subgroup analysis identified major resection (HR = 5.05; P =.006) as an independent risk factor for the occurrence of any postoperative complication and chronic kidney disease (HR = 22.59; P =.030) and liver fibrosis (HR = 30.16; P =.031) as risk factors for the occurrence of major complications in h‐ASA patients. Conclusion: LH in patients with severe systemic comorbidities shows a strong tendency towards an increased rate of major complications. Careful patient selection with respect to the planned extent of resection and the presence of chronic kidney disease and liver fibrosis should be performed to improve perioperative results. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the postoperative visual outcome and complications of 25‐gauge pars plana vitrectomy (PPV) via a lateral approach without proptosis of the globe in dogs. Procedures: We reviewed the medical records of dogs diagnosed with giant rhegmatogenous retinal detachment (RRD) at Yokohama Animal Eye Clinic from 2016 to 2019 and treated by 25‐gauge PPV. Medical records included signalment, follow‐up time, etiology and duration of RRD, angle between the outermost trocar ports, immediate postoperative anatomic success rate, pre‐ and postoperative visual status, and postoperative complications. Results: Seventy‐two dogs (78 eyes, 13 breeds) were included. The most common breed was the Toy Poodle (48.6%), and the mean follow‐up time was 690.6 days. The most common etiology of RRD was cataract surgery (46.2%). The mean angle between the outermost trocar ports was 71.4º. Immediate postoperative anatomic success was noted in all eyes. Vision was regained or maintained in 87.2% of eyes, and the mean time to return of vision was 28.5 days. Maintenance of vision until the last known follow‐up was noted in 73.5% of eyes. The most common postoperative complication was glaucoma (40.3%), and glaucoma was the most common etiology of postoperative vision loss (88.9%). Conclusion: Twenty‐five gauge PPV via a lateral approach without proptosis of the globe is a successful method for treating canine giant RRD. [ABSTRACT FROM AUTHOR]

Aim: Identification of the risks of postoperative complications may be challenging in older patients with heterogeneous physical and cognitive status. The aim of this multicentre, observational study was to identify variables that affect the outcomes of colon cancer surgery and, especially, to find tools to quantify the risks related to surgery. Method: Patients aged ≥80 years with electively operated Stage I–III colon cancer were recruited. The prospectively collected data included comorbidities, results of the onco‐geriatric screening tool (G8), Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and Mini Nutritional Assessment‐Short Form (MNA‐SF), and operative and postoperative outcomes. Results: A total of 161 patients (mean 84.5 years, range 80–97, 60% female) were included. History of cerebral stroke (64% vs. 37%, p = 0.02), albumin level 31–34 g/l compared with ≥35 g/l (57% vs. 32%, p = 0.007), CFS 3–4 and 5–9 compared with CFS 1–2 (49% and 47% vs. 16%, respectively) and American Society of Anesthesiologists score >3 (77% vs. 28%, P = 0.006) were related to a higher risk of complications. In multivariate logistic regression analysis CFS ≥3 (OR 6.06, 95% CI 1.88–19.5, p = 0.003) and albumin level 31–34 g/l (OR 3.88, 1.61–9.38, p = 0.003) were significantly associated with postoperative complications. Severe complications were more common in patients with chronic obstructive pulmonary disease (43% vs. 13%, p = 0.047), renal failure (25% vs. 12%, p = 0.021), albumin level 31–34 g/l (26% vs. 8%, p = 0.014) and CCI >6 (23% vs. 10%, p = 0.034). Conclusion: Surgery on physically and cognitively fit aged colon cancer patients with CFS 1–2 can lead to excellent operative outcomes similar to those of younger patients. The CFS could be a useful screening tool for predicting postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: Previous positron emission tomography (PET) studies using [11C]ABP688 show reduced metabotropic glutamate receptor type 5 (mGluR5) allosteric binding site availability in the epileptogenic hippocampus of mesial temporal lobe epilepsy (MTLE) patients. However, the link between mGluR5 abnormalities and postsurgical outcomes remains unclear. Here, we test whether reduced PET [11C]ABP688 binding in cornu ammonis (CA) sectors more vulnerable to glutamatergic excitotoxicity relates to surgical outcomes. Methods: We obtained magnetic resonance imaging (MRI) and [11C]ABP688‐PET from 31 unilateral MTLE patients and 30 healthy controls. MRI hippocampal subfields were segmented using FreeSurfer. To respect the lower PET special resolution, MRI‐derived anatomical subfields were combined into CA1–3, CA4/dentate gyrus, and Subiculum. Partial volume corrected [11C]ABP688 nondisplaceable binding potential (BPND) values were averaged across each subfield, and Z‐scores were calculated. Subfield [11C]ABP688‐BPND was compared between seizure‐free and non‐seizure‐free patients. In addition, we also assessed subfield volumes and [18F]fluorodeoxyglucose (FDG) uptake in each clinical group. Results: MTLE [11C]ABP688‐BPND was reduced in ipsilateral (epileptogenic) CA1–3 and CA4/dentate‐gyrus (p <.001, 95% confidence interval [CI] =.29–.51) compared to controls, with no difference in Subiculum. [11C]ABP688‐BPND and subfield volumes were compared between seizure‐free (Engel IA, n = 13) and non‐seizure‐free patients (Engel IC–III, n = 10). In ipsilateral CA1–3 only, [11C]ABP688‐BPND was lower in seizure‐free patients than in non‐seizure‐free patients (p =.012, 95% CI = 1.46–11.0) independently of volume. A subset analysis of 12 patients with [11C]ABP688‐PET+[18F]FDG‐PET showed no between‐group significant difference in [18F]FDG uptake, whereas CA1–3 [11C]ABP688‐BPND remained significantly lower in the seven of 12 seizure‐free patients (p =.03, 95% CI = −3.13 to −.21). Significance: Reduced mGluR5 allosteric site availability in hippocampal CA1–3, measured in vivo by [11C]ABP688‐PET, is associated with postsurgery seizure freedom independent of atrophy or hypometabolism. Information derived from hippocampal CA1–3 [11C]ABP688‐PET is a promising imaging biomarker potentially impactful in surgical decisions for MRI‐negative/PET‐negative MTLE patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES To evaluate long‐term survival and institutionalization in onco‐geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score. DESIGN Prospective cohort study with long‐term follow‐up. SETTING International and multicenter locations. PARTICIPANTS Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229). MEASUREMENTS We assessed long‐term survival and institutionalization using the Preoperative Risk Estimation for Onco‐geriatric Patients (PREOP) score, developed to predict the 30‐day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal. RESULTS: We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7‐4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI =.7‐3.8]; 2 y, 2.2 [95% CI =.9‐5.5]). CONCLUSION: A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235–1241, 2020. [ABSTRACT FROM AUTHOR]

While anterior temporal lobe (ATL) resection is an effective treatment for temporal lobe epilepsy, surgery on the dominant hemisphere is associated with variable decline in confrontation naming. Accurate prediction of naming impairment is critical to inform clinical decision making, and while there has been some degree of success using task‐based functional MRI (fMRI) paradigms, there remains a growing interest in the predictive utility of resting‐state connectivity as it allows for relatively shorter scans with low task demands. Our objective was to assess the relationship between measures of preoperative resting‐state connectivity and postoperative naming change in patients following left ATL resection. We compared the resting language network connectivity of each patient to a normative healthy control template using a novel measure called "matrix similarity," and found that patients with more abnormal global language‐network connectivity—particularly of regions spared from surgery—showed greater postoperative naming decline than those with normative patterns of connectivity. When we interrogated the degree centrality of to‐be‐resected regions in a more targeted approach of the pathological temporal lobe, we found that greater functional integration of those regions with the rest of the language network at rest was related to greater decline in naming following surgery. Finally, we found that matrix similarity was a better predictor of postoperative outcome than degree within to‐be‐resected regions, network clustering, modularity, and language task fMRI laterality. We provide some of the first evidence that using this novel measure, a relatively short preoperative resting scan can be exploited to inform naming ability following ATL resection. [ABSTRACT FROM AUTHOR]

Introduction There are two general surgical approaches for operative treatment of end-stage haemophilic ankle arthropathy: ankle arthrodesis and total ankle replacement ( TAR). Aim The aim of this study was to determine intraoperative and postoperative complications and evaluate the mid-term clinical and radiographic outcomes of TAR in patients with haemophilic arthropathy. Methods Fourteen patients with a mean age of 51.4 ± 10.2 years (range = 32.9-63.7) were treated for end-stage haemophilic ankle arthropathy. Nine procedures were primary arthroplasties, five procedures were conversions of painful ankle arthrodesis to TAR. The mean duration of follow-up was 5.8 ± 2.3 years (range = 2.0-9.2). Component stability and alignment was assessed with weight-bearing radiographs. Clinical assessment was performed. Results One patient sustained an intraoperative medial malleolar fracture. In two patients, delayed wound healing was observed. In one patient, open arthrolysis was performed due to painful arthrofibrosis. Both components were neutrally aligned. Visual analogue scale (VAS) significantly decreased from 8.5 ± 0.9 (range = 8-10) to 1.3 ± 1.6 (range = 0-6). Significant functional improvement including range of motion (ROM) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was observed. The summarized components of the SF-36 physical and mental outcomes score significantly improved at the latest follow-up. Complication rates and clinical/radiographic outcomes were comparable in patients with primary TAR and conversion of ankle arthrodesis to TAR. Conclusion The mid-term results following TAR or a conversion procedure in patients with haemophilic arthropathy are encouraging. However, for postoperative success, access to an experienced, multidisciplinary team including a haematologist is mandatory. [ABSTRACT FROM AUTHOR]

von Willebrand disease ( VWD) is a recognized cause of secondary ankle osteoarthritis ( OA). Few studies have examined orthopaedic complications and outcomes in VWD patients treated for end-stage ankle OA with total ankle replacement ( TAR). To determine the clinical presentation, intraoperative and postoperative complications and evaluate the mid-term outcome in VWD patients treated with TAR. Eighteen patients with VWD with mean age 47.3 years (range = 34.0-68.7) were treated for end-stage ankle OA with TAR. The mean duration of follow-up was 7.5 years (range = 2.9-13.2). Intraoperative and perioperative complications were recorded. Component stability was assessed with weight-bearing radiographs. Clinical evaluation included range of motion ( ROM) tests using a goniometer and under fluoroscopy using a lateral view. Clinical outcomes were analysed by a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score and Short Form (36) Health Survey ( SF-36) health survey. One patient sustained an intraoperative medial malleolar fracture. In two patients delayed wound healing was observed. Two secondary major surgeries were performed. Pain level decreased from 8.2 ± 0.9 (range = 7-10) preoperatively to 1.1 ± 1.2 (range = 0-4) postoperatively. Significant functional improvement including ROM was observed. All categories of SF-36 score showed significant improvement in quality of life. Mid-term results of TAR in patients with VWD are encouraging. The total rate of intraoperative and postoperative complications was 33.3%. However, longer term outcomes are necessary to fully understand the clinical benefit of TAR in patients with VWD. [ABSTRACT FROM AUTHOR]

Objective The objective of the study was to characterize interictal 18-fluorodeoxyglucose-positron emission tomography (18FDG-PET) whole-brain voxel-based metabolic patterns among distinct subtypes of temporal lobe epilepsy (TLE), as defined by stereo-electroencephalography (SEEG) and to determine predictive value of PET result on postoperative outcome. Methods Fifty-four consecutive patients with pharmacoresistant TLE were enrolled retrospectively after a comprehensive presurgical evaluation. This evaluation defined: 7 lateral TLE, 17 mesial TLE, 14 'plus' TLE, and 16 bilateral TLE. Whole-brain voxel-based brain metabolism was studied in each group of patients, in comparison to 23 healthy subjects, and individual classification was evaluated by cross-validation using the found clusters. An 18FDG-PET index was moreover calculated for each patient, based on the individual Z-score of the most significant cluster extracted on the comparison between patients' subgroup and healthy subjects. Logistic regression analysis was used to estimate factors associated with postoperative outcome (Engel's classes III-IV vs. I-II), including age, gender, disease duration, seizure frequency, as well as magnetic resonance imaging (MRI) and PET findings. Results Different patterns of hypometabolism were found inside and outside the epileptogenic zone, among patients with distinct subgroups of TLE, in comparison to healthy subjects (p < 0.001, corrected for the cluster). At individual level, cross-validation showed satisfactory discrimination between the four groups with 71.4-88.2% overall accuracy. Multivariate analysis shows that 18FDG-PET index was the only significant predictor of postoperative outcome to distinguish between Engel's classes I-II and III-IV (p = 0.037). Significance Overall, this whole-brain voxel-based analysis validates specific patterns of hypometabolism, inside and outside the EZ, in distinct subgroups of patients with TLE, as defined by SEEG gold standard, and in relation with postoperative outcome. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to reduce the complication rate and postoperative morbidity after transurethral prostatectomy by routine urine culture before surgery. Patients and Methods Urine culture was saved 2 weeks prior to surgery for all patients undergoing transurethral prostatectomy at the United Christian Hospital from May 2013 to October 2013. The urine culture result was screened before surgery. Antibiotic treatment was given according to the bacteria-sensitivity profile if the culture was positive. Urine culture was repeated 1 h before surgery to review the efficacy of antibiotic treatment. Postoperative outcome measures included urinary tract infection (UTI) rate, postoperative fever rate, hospital stay and 30-day readmission rate. A retrospective comparison was made with patients undergoing surgery from November 2012 to April 2013. Results A total of 247 cases were included in the study, with 97 cases (39.3 per cent) in the study group and 150 (60.7 per cent) in the control group. Overall, 8.5 per cent of patients had postoperative UTI. Episodes of postoperative fever (11.3 per cent vs 22 per cent, P = 0.032) were lower and postoperative hospital stay was shorter for the study group. The 30-day unplanned readmission rate (8 per cent vs 19.3 per cent, P = 0.017) was also significantly lower in the study group. Multivariate analysis showed that the treatment of preoperative bacteriuria was the only significant variable determining the length of hospital stay ( P = 0.001). Total resection time ( P = 0.017), days of postoperative bladder irrigation ( P = 0.007) and the presence of postoperative fever ( P = 0.035) were significant variables with a positive correlation for 30-day readmission. Conclusion Routine reviews of urine culture and treatment of bacteriuria before transurethral prostatectomy can reduce episodes of postoperative fever, hospital stay and the 30-day unplanned readmission rate after surgery. [ABSTRACT FROM AUTHOR]

VIS, a quantitative index of pressor support, has been shown to be a predictor of morbidity and mortality in infants younger than six months who underwent CPB. Data on its prognostic utility following pediatric OHT are lacking. This study compared clinical outcomes in children with differential VIS after pediatric OHT. A retrospective cohort study of 51 consecutive heart transplants from 2004 to 2011 was performed at a pediatric tertiary care facility. Peak VIS was computed within initial 24 and 48 h after OHT and was weighted for peak dose and administration of any or all of six pressors. Patients with peak VIS ≥ 15 constituted high VIS group. Children who persistently required a higher magnitude of pressor support for the first 48 h after OHT, as reflected by high peak VIS, had significantly longer ICU stay (30.2 vs. 15.9 days, p = 0.01), pressor (11.4 vs. 6.8 days, p = 0.02) and ventilatory durations (12.4 vs. 5.9 days, p = 0.05), and higher rates of short-term morbidities. Patients with longer CPB (213 vs. 153 min, p = 0.005) time have higher peak VIS. High peak VIS at 48 h is an effective, yet simple clinical marker for adverse outcomes in pediatric OHT recipients. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to map the temporal and extratemporal 18-fluorodeoxyglucose positron emission tomography (FDG-PET)–defined hypometabolism in mesial temporal lobe epilepsy (MTLE). We hypothesize that quantitative analysis will reveal extensive extratemporal glucose hypometabolism (EH), that the EH is related to seizure propagation beyond the temporal lobe, hypometabolism restricted to one temporal lobe predicts a good outcome following surgery, and EH predicts a poor outcome. Methods: Sixty-four patients were studied who had undergone temporal lobectomy for intractable MTLE and had at least 2 years of postoperative follow-up. Spatial preprocessing and statistical analysis on preoperative interictal FDG-PET using statistical parametric mapping (SPM 2) identified significant regions of hypometabolism compared to normal controls. The predictors of outcome were determined by univariable and multiple logistic regression analyses. Results: EH was common and widespread, occurring most frequently in the ipsilateral insula and frontal lobe. The extent of EH was not significantly associated with age of onset or the duration of epilepsy. Presence of secondarily generalized tonic-–clonic seizures (SGTCS) was associated with a larger extent of remote hypometabolism (RH, p < 0.005). Multiple logistic regression analysis identified the extent of RH and the age at surgery as independent predictors of seizure outcome. Discussion: Our results indicate that RH in MTLE is associated with a poorer surgical outcome, especially if seen in the contralateral hemisphere. The extent of RH relates to SGTCS but not to duration of epilepsy. [ABSTRACT FROM AUTHOR]

Preoperative anemia in patients undergoing cardiac surgery is associated with a higher transfusion risk and poorer outcomes. This retrospective study was undertaken to assess the prevalence of preoperative anemia and its associated risk factors, as well as its influence on postoperative outcomes, in 576 patients undergoing elective cardiac surgery (52.3% with cardiopulmonary bypass) for myocardial revascularization, valve replacement, coronary + valve, or miscellaneous pathology at a single institution. Perioperative data were reviewed according to the presence or absence of preoperative anemia (hemoglobin < 13 g/dL for men, hemoglobin < 12 g/dL for women). Overall, 210 patients (36.5%) presented with anemia. Logistic regression analysis revealed that age, chronic kidney disease, and consumption of proton pump inhibitors histamine H2 receptor antagonists and diuretics were independent risk factors for the presence of preoperative anemia. Postoperatively, anemic patients received transfusions and inotropic support and stayed longer than 4 days in the recovery unit more frequently than non-anemic patients, but there were no differences in the composite outcome variable (stroke, myocardial infarction, renal failure or death). In conclusion, our data seem to indicate that preoperative anemia has a high prevalence among elective cardiac surgical patients and increases postoperative morbidity. Therefore, we need to address two specific areas about preoperative anemia in these patients: early recognition and evaluation, and appropriate and timely treatment. [ABSTRACT FROM AUTHOR]

Background: Although rare in non-endemic areas, benign nodular goitre may cause acute airway obstruction and the clinical management of this condition remains a challenge. Methods: From 1996 to 2005, a total of 1115 patients underwent thyroid surgery at our institution and of these, 7 patients were identified to have a benign nodular goitre leading to acute airway obstruction. They were retrospectively reviewed with reference to the aetiology, presentation, perioperative management and postoperative outcome. Results: All seven patients were elderly women with a history of symptomatic goitre and concomitant medical problems. Five patients required emergency tracheal intubation, whereas two patients underwent urgent tracheostomy. Total thyroidectomy was successfully carried out for all patients and there was no hospital death. Perioperative complications included three patients with pneumonia, two with renal failure and one with perforated duodenal ulcer. Surgically related complications included transient recurrent nerve palsy in one patient and transient hypocalcaemia in four. After a median follow up of 22 months (range, 4–53 months), two patients died of cerebrovascular accident. Conclusion: Prompt airway protection followed by total thyroidectomy within the same hospital admission should be recommended and can be associated with favourable outcome. [ABSTRACT FROM AUTHOR]

Abstract: Influence of interferon (IFN) therapy on postoperative outcomes in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) is still inconclusive. Of 518 patients who underwent hepatic resection for HCV-related HCC, 312 patients with Japan integrated staging score 0–2 were included in this study. Of 50 patients underwent IFN therapy, 29 patients who obtained a normalized alanine aminotransferase (ALT) activity irrespective of disappearance of serum HCV RNA were classified as the response group, while 21 patients were classified as the non-response group because their ALT activities were not normalized and serum HCV RNA persisted. The non-IFN group included 262 patients who had not received IFN therapy. The tumor-free and the overall survival rates for patients in the response group were significantly higher than those in other groups. Only one patient in the response group died of HCC recurrence, and the proportion of deaths associated with liver disease (HCC recurrence or cirrhosis) was significantly lower in the response group than other two groups. IFN therapy can improve postoperative outcomes in patients with HCV-related HCC because of suppression of recurrence and preventing progress of cirrhosis, especially when IFN therapy has controlled their active hepatitis. [Copyright &y& Elsevier]

Purpose: Mood disturbance is a common comorbid condition of temporal lobe epilepsy before and after seizure surgery. Few studies have examined mood disturbance in patients undergoing resections outside the temporal lobe (extratemporal resections). This study aimed to compare the early, postoperative evolution of mood disturbance in temporal and extratemporal lobe epilepsy patients to examine the effect of site of surgical resection on mood outcome. Methods: The study used a longitudinal design and was qualitative in nature. Sixty seizure surgery patients (43 temporal resections, 17 extratemporal resections) were assessed before surgery and at discharge, 1 month, and 3 months after surgery, by using the Austin CEP Interview. Psychosocial adjustment, psychiatric difficulties, including depression and anxiety, and seizure frequency were assessed. Results: Before surgery, both temporal and extratemporal patients had significant psychiatric histories with similarly high rates of depression (33 and 53%, respectively) and anxiety (23 and 18%, respectively). After surgery, significantly more temporal patients were seizure free at each of the reviews compared with extratemporal patients. Temporal patients also reported significantly higher levels of depression (26%), anxiety (42%), and psychosocial adjustment difficulties (64%) at the 1-month review than did extratemporal patients. Mood disturbance was significantly associated with adjustment difficulties in both groups, but was not related to seizure outcome at any review period. Conclusions: A general increase in mood disturbance was evident after surgery, particularly in temporal resection patients at the 1-month review. Site of surgery and psychosocial adjustment showed significant associations with postoperative mood disturbance, supporting the role of both neurobiological and psychosocial factors in mood outcome. [ABSTRACT FROM AUTHOR]

Although interferon (IFN) therapy suppresses the development of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC), the relationship between response to previous IFN therapy and postoperative outcome has not been clarified in patients who underwent curative resection for HCC. Of 175 patients who underwent curative hepatic resection for HCV-related HCC, 24 patients had HCC detected after IFN therapy. 11 patients who had a biochemical response (a normalized alanine aminotransferase (ALT) activity with or without disappearance of serum HCV RNA) were classified as the response group, while 13 patients were classified as the non-response group because they had no decrease in their ALT activity and had persistence of serum HCV RNA. The non-IFN group included 151 patients who had not received previous IFN therapy. The clinicopathologic findings and surgical outcomes were compared among these three groups. The serum activities of the aspartate aminotransferase and ALT just before surgery were significantly lower in the response group than in the other groups. Although no significant differences were noted in the other clinicopathologic findings or the operation method among these groups, the tumor-free survival rate of the response group was significantly higher than that of the two other groups. By multivariate analysis, the response group had an independently lower risk for postoperative recurrence (risk ratio, 0.07; P=0.0072). Hepatic resection offers hope for low incidence of postoperative recurrence in patients with HCC, especially when previous IFN therapy has controlled their active hepatitis associated with HCV. [Copyright &y& Elsevier]

Objectives: To identify demographic and clinical variables independently associated with patients' decisions against their physicians' recommendations for resective epilepsy surgery or further scalp video-EEG monitoring (sca-VEM), semi-invasive (sem-)VEM with foramen ovale and/or peg electrodes, and invasive (in-)VEM., Methods: Consecutive patients, who underwent presurgical assessment with at least one sca-VEM between 2010 and 2014, were included into this retrospective analysis. Multivariate analysis was used to identify independent variables associated with patients' decisions., Results: Within the study period, 352 patients underwent 544 VEM sessions comprising 451 sca-, 36 sem-, and 57 in-VEMs. Eventually, 96 patients were recommended resective surgery, and 106 were ineligible candidates; 149 patients denied further necessary VEMs; thus, no decision could be made. After sca- or additional sem-VEM, nine out of 51 eligible patients (17.6%) rejected resection. One hundred and ten patients were recommended in-VEM, 52 of those (47.2%) declined. Variables independently associated with rejection of in-VEM comprised intellectual disability (OR 4.721, 95% CI 1.047-21.284), extratemporal focal aware non-motor seizures ("aura") vs. no "aura" (OR 0.338, 95% CI 0.124-0.923), and unilateral or bilateral vs. no MRI lesion (OR 0.248, 95% CI 0.100-0.614 and 0.149, 95% CI 0.027-0.829, respectively)., Conclusions: During and after presurgical evaluation, patients with intractable focal epilepsy declined resections and intracranial EEGs, as recommended by their epileptologists, in almost 20% and 50% of cases. This calls for early and thorough counseling of patients on risks and benefits of epilepsy surgery. Future prospective studies should ask patients in depth for specific reasons why they decline their physicians' recommendations., (© 2020 The Authors. Acta Neurologica Scandinavica published by John Wiley & Sons Ltd.)

Background: Although long-term outcomes following laparoscopic fundoplication for gastro-oesophageal disease have now been reported as very satisfactory, a small, but important, minority of patients are unhappy with the outcome, often due to recurrent reflux symptoms or new-onset dysphagia. In this study, we sought to establish whether various parameters that can be determined before surgery, can predict the long-term outcome of surgery. Methods: Data collected prospectively were evaluated to determine factors that were associated with outcome at 5 years following laparoscopic fundoplication. Inclusion criteria were complete preoperative assessment data and 5-year follow-up data. Data examined included information on preoperative age, sex, weight, home address, health insurance status, duration of reflux symptoms, previous surgery, operating surgeon, endoscopy and 24-h pH monitoring. In addition, lower oesophageal sphincter resting and residual relaxation pressures were evaluated before and after surgery. The postoperative symptoms of heartburn and dysphagia, as well as overall satisfaction 5 years following surgery was determined using a 0-10 visual analogue scale. The association of the pre- and perioperative factors and outcome at 5 years was determined by univariate and linear regression analysis. Results: Two hundred and sixty-two patients from an overall experience of over 1000 laparoscopic anti-reflux procedures met the entry criteria. There was no association between patient address, age, weight, duration of symptoms, the presence of endoscopically proven oesophagitis, operating surgeon, the necessity for conversion to an open procedure, change in lower oesophageal sphincter residual relaxation pressure and the outcome parameters. Using univariate analysis, a higher heartburn score was associated with previous abdominal surgery, female sex, no private health insurance, and a normal preoperative 24-h pH study. A higher dysphagia score was associated with... [ABSTRACT FROM AUTHOR]