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Abstract Background Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. Methods In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. Results Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. Conclusions Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.

Background: Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. Methods: In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. Results: Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. Conclusions: Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions. [ABSTRACT FROM AUTHOR]

With ongoing advances in both medical and surgical management, the population of adults with congenital heart disease (CHD) continues to grow each year and has surpassed the number of pediatric cases. These adult patients will present to adult emergency departments with increasing frequency. Adults with CHD are at increased risk of developing not only cardiovascular complications, such as aortic dissection and thromboemboli, but also abdominopelvic and neurologic processes at younger ages. These individuals are also more likely to develop less urgent but clinically significant complications including end-organ dysfunction, baffle leaks, or bleeding collateral vessels. Ultimately, imaging can play a critical role in determining the triage, diagnosis, and management of adult CHD patients. To accomplish this goal, radiologists must be able to distinguish acute and chronic complications of treated CHD from benign processes, including expected post-surgical changes or imaging artifacts. Radiologists also need to be familiar with the various long-term risks and complications associated with both treated and untreated forms of CHD, particularly those in adults with complex lesions. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with melanoma have been found to be at greater risk of adverse outcomes including mortality after contacting COVID-19. Management of postsurgical complications presented additional challenges by potentially increasing exposure to COVID-19 through repeated inpatient admissions to hospital during the pandemic. We report four cases for which skin flaps, lymph ligation, and split-thickness skin graft (STSG) were successfully used in the treatment of complications in the trunk and extremities after wide local excision (WLE). This study details the operative experience in management of postsurgical complications for melanoma in the trunk and extremities during a 6-month period at the height of the COVID-19 pandemic. Case presentation We present 4 cases detailing management of complications that occurred after wide local excisions performed for melanoma during Feb. to Oct. 2020. Case 1: A 90-year-old man who experienced wound dehiscence and necrosis on the shoulder after non-radical excision for an aggressive melanoma and underwent the side-to-side closure after ellipse formed WLE with modified tangent-to-circle method. Case 2: An 80-year-old man who had undergone excision for melanoma in his left upper arm and histopathology did not show radically. Two weeks after the excision, he underwent a WLE and direct reconstruction with double rotation skin flap. Case 3: A 55-year-old man that experienced a large wound dehiscence on his back due to WLE. He underwent an advanced double skin flap operation. Case 4: A 36-year-old woman who had a lymphorrhea and graft necrosis after WLE and STSG on the right lower leg. A combination of micro lymph ligation and re-STSG was performed. One month after the operation, all wounds had healed. There was no clinical evidence of tumor recurrence after 8 months post procedure. Conclusions Severe complications (e.g., large wound dehiscence, necrosis, or lymphorrhea) following wide local excision of melanoma are infrequent but must be swiftly and appropriately managed, especially during the COVID-19 pandemic to decrease the likelihood of COVID-19 infection and impaired oncology outcomes from delaying systemic cancer therapy due to the complications in primary interventions.

Care from high-volume surgeons has been shown to improve patient outcomes and reduce revision rates, complications, and hospital stays. According to prior research, most shoulder arthroplasties are performed by lower volume surgeons. However, this research is limited as it does not account for the recent increase in case numbers and projected growth of shoulder arthroplasty, and was focused only to states with urban populations. The purpose of this study is to identify and compare contemporary shoulder arthroplasty practice patterns and volume distributions in the state of Iowa. The Iowa Hospital Association Databank was queried using International Classification of Diseases (ICD)-10 procedure codes for primary total shoulder arthroplasty. Surgeon and hospital volume were stratified according to procedures performed yearly as: low-volume <15 arthroplasties yearly, medium-volume 15-49, and high-volume ≥50 arthroplasties yearly. The proportion of surgeon and hospital volume, and number of procedures performed by each group were assessed. Distance traveled by patients to visit high-volume vs. low-volume surgeons and hospitals was compared. In 2019, 1847 primary shoulder arthroplasties were performed in the state of Iowa by 144 surgeons at 49 institutions. Seventy four percent (106/144) of these surgeons were considered low-volume, 20% (29/144) medium-volume, and only 6% (9/144) were high-volume. However, 43% (793/1847) of shoulder arthroplasties were performed by high-volume surgeons, and 18% (333/1847) by low-volume surgeons. Eighteen percent (9/49) of hospitals where shoulder arthroplasties were performed qualified as high-volume institutions, whereas 45% (22/49) were low-volume. Compared to previous results, 65% (1194/1847) of procedures were performed at high-volume institutions and 6% (118/1847) at low-volume institutions. There was a significant difference in median distance traveled for patients to access high vs. low-volume surgeons (34 vs. 14 miles, P <.0001), and high-volume vs. low-volume hospitals (30 vs. 14.5, P <.0001). In the state of Iowa, while only a small portion of surgeons are considered "high-volume", almost half of primary shoulder arthroplasties are performed by high-volume surgeons. These findings differ from the previous literature regarding volume distribution in shoulder arthroplasty. Furthermore, the results from this study demonstrate a shift from former documented trends which in the past had indicated that most shoulder arthroplasties were performed by low-volume surgeons. Data from this current study provides a glimpse into the evolution in practice patterns for shoulder arthroplasty. As practice patterns continue to evolve, further investigation may demonstrate improved patient outcomes in patients undergoing shoulder arthroplasty at higher volume hospitals with high-volume surgeons. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adverse events can complicate the rehabilitation process. In complex clinical situations, the therapeutic alliance can aid the therapist and patient in navigating clinical challenges and facilitate a successful outcome. CASE PRESENTATION: A 38-year-old male presented to physical therapy after sequential bilateral Achilles tendon repairs following a 2-year history of chronic bilateral Achilles tendinopathy that did not respond to limited conservative care. The patient subsequently experienced traumatic failure and infection of the left Achilles tendon repair, necessitating prolonged medical management and physical therapy care over 56 weeks. His goals were to return to high-level physical activity and collegiate basketball officiating. OUTCOME AND FOLLOW UP: Approximately 80 weeks following initial physical therapy evaluation, the patient had returned to collegiate basketball officiating and was fully participating in high-intensity interval-based circuit training, including strength training, plyometric training, and sprint training, 3 times per week. DISCUSSION: The primary physical therapist in this case sought to intentionally develop the therapeutic alliance with the patient through use of core components of the therapeutic alliance and components of psychologically informed practice. Specific strategies were utilized to develop the therapeutic alliance and leverage it in ways that positively influenced outcomes. This case report demonstrates the theories of the therapeutic alliance in practice and serves as an example to clinicians managing complex clinical cases. [ABSTRACT FROM AUTHOR]

Background: Patients with melanoma have been found to be at greater risk of adverse outcomes including mortality after contacting COVID-19. Management of postsurgical complications presented additional challenges by potentially increasing exposure to COVID-19 through repeated inpatient admissions to hospital during the pandemic. We report four cases for which skin flaps, lymph ligation, and split-thickness skin graft (STSG) were successfully used in the treatment of complications in the trunk and extremities after wide local excision (WLE). This study details the operative experience in management of postsurgical complications for melanoma in the trunk and extremities during a 6-month period at the height of the COVID-19 pandemic. Case presentation: We present 4 cases detailing management of complications that occurred after wide local excisions performed for melanoma during Feb. to Oct. 2020. Case 1: A 90-year-old man who experienced wound dehiscence and necrosis on the shoulder after non-radical excision for an aggressive melanoma and underwent the side-to-side closure after ellipse formed WLE with modified tangent-to-circle method. Case 2: An 80-year-old man who had undergone excision for melanoma in his left upper arm and histopathology did not show radically. Two weeks after the excision, he underwent a WLE and direct reconstruction with double rotation skin flap. Case 3: A 55-year-old man that experienced a large wound dehiscence on his back due to WLE. He underwent an advanced double skin flap operation. Case 4: A 36-year-old woman who had a lymphorrhea and graft necrosis after WLE and STSG on the right lower leg. A combination of micro lymph ligation and re-STSG was performed. One month after the operation, all wounds had healed. There was no clinical evidence of tumor recurrence after 8 months post procedure. Conclusions: Severe complications (e.g., large wound dehiscence, necrosis, or lymphorrhea) following wide local excision of melanoma are infrequent but must be swiftly and appropriately managed, especially during the COVID-19 pandemic to decrease the likelihood of COVID-19 infection and impaired oncology outcomes from delaying systemic cancer therapy due to the complications in primary interventions. [ABSTRACT FROM AUTHOR]

Context Clinical trials have investigated the effect of probiotics on postsurgical complications in colorectal cancer (CRC). However, so far, there are no systematic reviews evaluating the effect of probiotics and synbiotics on the clinical or infectious postsurgical complications of colorectal cancer. Objective The objective of this review was to synthesize the best available evidence on the effects of the use of probiotics or synbiotics on pre-, peri-, and post-operative complications of CRC surgical resection. Data Sources A search of the PubMed, Embase, LILACS, Scopus, Cochrane, Web of Science, ProQuest, and Google Scholar databases was conducted for clinical trials published up until January 2022. Data Extraction The population characteristics, period and protocol of supplementation, and postoperative complications were extracted and reported. A random-effects model was used to estimate the effect of probiotic and synbiotic treatment on these variables. Data Synthesis In total, 2518 studies were identified, of which 16 were included in the qualitative synthesis and 13 in the meta-analysis. Overall, probiotic supplementation reduced the incidence of ileus (odds ratio [OR] = .13, 95% confidence interval [CI]:.02,.78), diarrhea (OR = .32, 95% CI:.15,.69), abdominal collection (OR:.35, 95% CI:.13,.92), sepsis (OR = .41, 95% CI:.22,.80), pneumonia (OR = .39, 95% CI:.19,.83), and surgical site infection (OR = .53, 95% CI:.36,.78). The results of the subgroup analysis indicated that lower dose (<109 colony-forming units), higher duration of supplementation (>14 days), and being administrated ≤5 days before and >10 days after surgery was more effective at reducing the incidence of surgical site infection. Conclusion Probiotics and synbiotics seem to be a promising strategy for the prevention of postoperative complications after CRC surgery. Larger, high-quality randomized controlled trials are needed to establish the optimal treatment protocol for the use of probiotics and synbiotics in preventing postoperative complications for CRC surgery. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort.Objective: Due to anterior cervical discectomy and fusion (ACDF) popularity, it is important to predict postoperative complications, unfavorable 90-day readmissions, and two-year reoperations to improve surgical decision-making, prognostication, and planning.Summary Of Background Data: Machine learning has been applied to predict postoperative complications for ACDF; however, studies were limited by sample size and model type. These studies achieved ≤0.70 area under the curve (AUC). Further approaches, not limited to ACDF, focused on specific complication types and resulted in AUC between 0.70 and 0.76.Materials and Methods: The IBM MarketScan Commercial Claims and Encounters Database and Medicare Supplement were queried from 2007 to 2016 to identify adult patients who underwent an ACDF procedure (N=176,816). Traditional machine learning algorithms, logistic regression, and support vector machines, were compared with deep neural networks to predict: 90-day postoperative complications, 90-day readmission, and two-year reoperation. We further generated random deep learning model architectures and trained them on the 90-day complication task to approximate an upper bound. Last, using deep learning, we investigated the importance of each input variable for the prediction of 90-day postoperative complications in ACDF.Results: For the prediction of 90-day complication, 90-day readmission, and two-year reoperation, the deep neural network-based models achieved AUC of 0.832, 0.713, and 0.671. Logistic regression achieved AUCs of 0.820, 0.712, and 0.671. Support vector machine approaches were significantly lower. The upper bound of deep learning performance was approximated as 0.832. Myelopathy, age, human immunodeficiency virus, previous myocardial infarctions, obesity, and documentary weakness were found to be the strongest variable to predict 90-day postoperative complications.Conclusions: The deep neural network may be used to predict complications for clinical applications after multicenter validation. The results suggest limited added knowledge exists in interactions between the input variables used for this task. Future work should identify novel variables to increase predictive power. [ABSTRACT FROM AUTHOR]

In recent times, robot-assisted surgery has been prominently gaining pace to minimize overall postsurgical complications with minimal traumatization, due to technical advancements in telerobotics and ergonomics. The aim of this review is to explore the efficiency of robot-assisted systems for executing breast surgeries, including microsurgeries, direct-to-implant breast reconstruction, deep inferior epigastric perforators-based surgery, latissimus dorsi breast reconstruction, and nipple-sparing mastectomy. Robot-assisted surgery systems are efficient due to 3D-based visualization, dexterity, and range of motion while executing breast surgery. The review describes the comparative efficiency of robot-assisted surgery in relation to conventional or open surgery, in terms of clinical outcomes, morbidity rates, and overall postsurgical complication rates. Potential cost-effective barriers and technical skills were also delineated as the major limitations associated with these systems in the clinical sector. Furthermore, instrument articulation of robot-assisted surgical systems (for example, da Vinci systems) can enable high accuracy and precision surgery due to its promising ability to mitigate tremors at the time of surgery, and shortened learning curve, making it more beneficial than other open surgery procedures. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this review is to characterize the literature addressing postprocedural complications in persons undergoing gender-affirming surgeries.Methods: A literature search using the OVID MEDLINE and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender persons from 1946 to April 2021. The studies describing postsurgical complications were categorized based on anatomic site, type of complication, study design, publication region, and date.Results: Thirty-nine studies describing postsurgical complications in transgender women were identified. The most common sites of postprocedural pathology included the breasts and neovagina, with additional studies including buttocks and thighs, cutaneous sites, and the pulmonary system. Most of the literature comprised case reports, followed by case series and comparative studies. The search did not identify any studies of complications secondary to masculinizing surgeries.Conclusions: This body of literature is small but growing. Most studies are case reports. There are significant gaps in the literature. The literature in this area is not yet mature enough to support a meta-analysis. [ABSTRACT FROM AUTHOR]

Purpose: To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery. Methods: A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classified according to Clavien-Dindo scale. Results: One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P = 0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2 ± 11.16 vs 6.2 ± 6.82, P < 0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n = 16), followed by hypoglycaemia in six patients and acute renal failure in four patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm. Conclusion: Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications. [ABSTRACT FROM AUTHOR]

Racial disparities in postsurgical complications are often presumed to be due to a higher preoperative co-morbidity burden among patients of black race, although being relatively healthy is not a prerequisite for a complication-free postoperative course. To examine the association of race with short-term postbariatric surgery complications in seemingly healthy patients. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (2015–2018). We studied a relatively healthy (American Society of Anesthesiologists physical status 1 or 2), propensity score–matched cohort of adult non-Hispanic black and non-Hispanic white bariatric surgery patients. We compared the risk-adjusted incidences of postoperative complications, serious adverse events, and measures of postoperative resource utilization across racial groups. We identified 44,090 matched pairs of relatively healthy black and white bariatric surgery patients. Patients of black race were 72% more likely than those of white race to develop 1 or more postoperative complications (.7% versus.4%, respectively; odds ratio [OR], 1.72; 95% confidence interval [CI], 1.32–2.24; P <.01). Measures of postbariatric resource utilization were significantly higher in patients of black race than those of white race, including unplanned reoperations (1.3% versus 1.0%, respectively; OR, 1.28; 95% CI, 1.07–1.52; P =.01), unplanned readmissions (4.5% versus 3.0%, respectively; OR, 1.53; 95% CI, 1.38–1.69; P <.01), unplanned interventions (1.6% versus 1.2%, respectively; OR, 1.36; 95% CI, 1.16–1.60; P <.01), and extended hospital lengths of stay (51.2% versus 42.7%, respectively; OR, 1.41; 95% CI, 1.36–1.46; P <.01). Even among relatively healthy patients, race appears to be an important determinant of postbariatric surgery complications and resource utilization. Research and interventions aimed at narrowing the racial disparities in bariatric surgery outcomes may need to broaden the focus beyond the racial variation in the preoperative co-morbidity burden. • Short and long-term post-bariatric surgery complications are commoner among patients of Black race compared to their White peers. Although the mechanistic underpinnings are largely unknown, preoperative health status appears to play a role. • We found that even among a cohort of relatively healthy bariatric surgery patients, being Black relative to being White was associated with significantly higher rates of 30-day postoperative complications. • Our findings suggest that the racial differences in post-bariatric surgery complications may not be wholly explained by preoperative health status. • Research and interventions aimed at narrowing the racial disparities in bariatric surgical outcomes may need to broaden the focus beyond the racial variation in preoperative comorbidity burden. [ABSTRACT FROM AUTHOR]

Background: Prolonged urinary leakage after nephrostomy tube removal leads to increased morbidity of PCNL and increased hospitalization. Objective: To evaluate factors affecting post nephrostomy removal urinary leakage after percutaneous nephrolithotomy. Patients and Methods: One hundred eight (108) patients older than 18 years who underwent PCNL were studied prospectively. The reasons that can affect urinary leakage postoperatively were divided into 4 categories according to individual factors including age, gender, and body mass index; Renal factors; including, previous operation, history of ESWL, parenchymal cortical thickness, and grades of hydronephrosis; stone factor (stone burden); and surgical factors including the number of tracts, presence of double J stent, nephrostomy tube diameter and stay duration. These data were compared for postoperative urine leak. Results: Urinary leakage was revealed in 76 of 108 patients (70.3%). There was no statistically significant relationship between individual factors and urinary leakage (P >0.05). Among renal factors, just parenchymal cortical thickness and grade of hydronephrosis were strongly related to the urinary leakage (P 0.05). Among surgical factors, placing of ureteral double-J stent highly minimized the incidence of urinary leakage (P

Abstract Background Perioperative complications occur in 30–40% of non-cardiac surgical patients and are the leading cause of early postoperative morbidity and mortality. Regular visits by trained health professionals may decrease the incidence of complications and mortality through earlier detection and adequate treatment of complications. Until now, no studies have been performed on the impact of routine postsurgical anesthesia visits on the incidence of postoperative complications and mortality. Methods TRACE is a prospective, multicenter, stepped-wedge cluster randomized interventional study in academic and peripheral hospitals in the Netherlands. All hospitals start simultaneously with a control phase in which standard care is provided. Sequentially, in a randomized order, hospitals cross over to the intervention phase in which patients at risk are routinely followed up by an anesthesia professional at postoperative days 1 and 3, aiming to detect and prevent or treat postoperative complications. We aim to include 5600 adult patients who are at high risk of developing complications. The primary outcome variable is 30-day postoperative mortality. Secondary outcomes include incidence of postoperative complications and postoperative quality of life up to one year following surgery. Statistical analyses will be performed to compare the control and intervention cohorts with multilevel linear and logistic regression models, adjusted for temporal trends and for clusters (hospitals). The time horizon of the economic (cost-effectiveness) evaluation will be 30 days and one year following surgery. Discussion TRACE is the first to study the effects of a routine postoperative visit by an anesthesia healthcare professional on mortality and cost-effectiveness of surgical patients. If the intervention proves to be beneficial for the patient and cost-effective, the stepped-wedge design ensures direct implementation in the participating hospitals. Trial registration Nederlands Trial Register/Netherlands Trial Registration, NTR5506. Registered on 02 December 2015.

Background: Prolonged urinary leakage after nephrostomy tube removal leads to increased morbidity of PCNL and increased hospitalization. Objective: To evaluate factors affecting post nephrostomy removal urinary leakage after percutaneous nephrolithotomy. Patients and Methods: One hundred eight (108) patients older than 18 years who underwent PCNL were studied prospectively. The reasons that can affect urinary leakage postoperatively were divided into 4 categories according to individual factors including age, gender, and body mass index; Renal factors; including, previous operation, history of ESWL, parenchymal cortical thickness, and grades of hydronephrosis; stone factor (stone burden); and surgical factors including the number of tracts, presence of double J stent, nephrostomy tube diameter and stay duration. These data were compared for postoperative urine leak. Results: Urinary leakage was revealed in 76 of 108 patients (70.3%). There was no statistically significant relationship between individual factors and urinary leakage (P >0.05). Among renal factors, just parenchymal cortical thickness and grade of hydronephrosis were strongly related to the urinary leakage (P <0.001). The renal stone burden did not affect urinary leakage (P >0.05). Among surgical factors, placing of ureteral double-J stent highly minimized the incidence of urinary leakage (P<0.001), and the urinary leakage significantly correlated with the increased diameter of the nephrostomy tube and staying duration (P<0.05). Conclusion: After PCNL surgery, some factors show to influence post-PCNL urinary leakage. however most of the urinary leakage was treated conservatively, but it increases morbidity and hospitalization. [ABSTRACT FROM AUTHOR]

Background: Evidence on the burden of postsurgical complications is mainly from studies in western countries, and little is highlighted in the Asia‐Oceania region. This study aimed to identify and compare the burden of postsurgical complications in major cardiac surgeries in Asia‐Oceania countries. Methods: A systematic search was performed in PubMed, Embase, and CENTRAL between January 2000 and July 2018. Inclusion criteria were: (a) observational studies or randomized control trials; (b) studied in coronary artery bypass graft (CABG) and/or heart valve procedures; (c) measured postsurgical clinical outcomes; and (d) conducted in Asia‐Oceania countries. Pooled effects were calculated using a random‐effects model. Results: Of the 6032 articles screened, 472 studies with a total of 614 161 patients met the inclusion criteria. The pooled incidences (95% confidence interval) of hospital mortality and 30‐day mortality were similar at 2.38% (2.16%‐2.59%) and 2.33% (2.16%‐2.50%), respectively. Length of stay (LOS) was 14.07 days (13.44‐14.71 days). The incidence for atrial fibrillation (AF) and stroke/cerebrovascular accident (CVA) was 17.49% (15.99%‐18.99%) and 1.64% (1.51%‐1.78%), respectively. Below outcomes tended to be better in studies on CABG compared to heart valve procedures, including the incidence of hospital mortality (1.97%[1.75%‐2.18%] vs 3.97% [3.29%‐4.65%]), AF (16.47% [14.85%‐18.10%] vs 21.98% [17.41%‐26.54%]), stoke/CVA (1.51% [1n 37%‐1.65%] vs 2.55% [2.07%‐3.04%]), and mean LOS (days) (13.08 [12.51‐13.65] vs 19.58 [16.72‐22.45]). Similarly, all postsurgical complications tended to be higher in studies involving high‐risk patients vs non‐high‐risk patients. Conclusions: There are opportunities to improve clinical outcomes of patients with high surgical risks and those undertaking heart valve procedures, as they tend to have poorer survival and higher risk in developing postsurgical complications. [ABSTRACT FROM AUTHOR]

Background: The treatment of kidney cancer usually involves surgery, and in some cases systemic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to control postsurgical pain in patients undergoing nephrectomy for renal cancer. Nevertheless, the association between these drugs and adverse postsurgical outcomes, including deterioration of renal function, is not fully established. Methods: This retrospective cohort study included patients >18 years old with kidney cancer undergoing nephrectomy between January 2006 and January 2018. The primary endpoint was to determine the impact of postsurgical analgesic therapy (NSAIDs vs. acetaminophen) on renal function and postsurgical complications. This study was approved by our scientific and bioethical committee. Results: One hundred patients were included in the final analysis. Clear-cell renal-cell carcinoma was the most frequent histologic subtype. Adequate acute pain control was accomplished in 91% of the patients during hospitalization. Twenty percent of the patients presented postsurgical complications. Bleeding-related complications were the most frequent (9%), followed by surgical-site infection (6%) and acute renal injury (6%). The administration of NSAIDs was not related to any postsurgical complication in comparison with the use of acetaminophen (21.3 vs. 17.9%, respectively). The length of hospital stay did not differ between patients treated with NSAIDs and those treated with acetaminophen (the average stay was 4 days for both groups, p = 0.32). Conclusion: The use of NSAIDs was not related to acute kidney injury, postsurgical complications, or prolonged hospital stay in patients with renal cancer undergoing nephrectomy. [ABSTRACT FROM AUTHOR]

Objective: to identify the socio-demographic and clinical factors in laparoscopic cholecystectomy in two decades of experience in the Military Hospital of the city of Cuenca. Cholecystectomy is the most common surgery to treat pathologies such as cholelithiasis, acute cholecystitis and vesicular polyposis, currently the laparoscopic technique is the treatment of choice. Materials and Methods: a descriptive, retrospective study of patients undergoing laparoscopic cholecystectomy in the last two decades; we worked with 468 clinical records that met the inclusion criteria. Results: 61,8% were women and 38,2% were men with a mean age of 50,77 years and standard deviation (SD) of 0,727. The surgical indications were cholelithiasis 60,2%, acute cholecystitis 29,2%, vesicular polyposis 4,7%, choledocholithiasis 4,5%, sclerotrophic vesicle 0,9%. The postoperative stay was 80,6% less than three days and 19.4% equal to or greater than 4 days; with an average of 1,09 and DS = 0,292. The conversion percentage to open surgery was 0,4%. The surgical time was 50,2% within 31-60 min and 46,2% more than 60 minutes with an average of 42,43min and DS = 0,564. When the age and operative time were related, it was evidenced that in those older than 60 years, they had more days of hospitalization with statistical significance, with a value of p = 0,0006. Conclusion: laparoscopic cholecystectomy decreases the operative and hospitalization times, contributing directly to the decrease in morbidity and mortality due to this type of pathologies and allowing health services in developing countries to improve the quality of care for their populations. [ABSTRACT FROM AUTHOR]

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

Background. The authors updated a previously published systematic review to assess the effects of low-level laser therapy (LLLT) on reducing complications after the removal of impacted mandibular third molars. Types of Studies Reviewed. The authors searched for randomized clinical trials in which the investigators evaluated the efficacy of LLLT compared with that of placebo or no treatment. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The authors used random effects model meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence. Results. The authors included 21 studies. There was low-certainty evidence that LLLT results in less pain at 2 days after surgery (mean difference [MD], -1.42 on a 10 point scale; 95% confidence interval [CI], -2.18 to -0.67) and moderate certainty that it results in negligibly less pain at 7 days (MD, -0.59; 95% CI, -0.96 to -0.22); moderate-certainty evidence that LLLT has a negligible benefit on reducing trismus at 2 days (MD, -3.42 millimeters; 95% CI, -5.34 to -1.50) and at 7 days after surgery (MD, -2.30 mm; 95% CI, -3.96 to -0.64); lastly, there was moderate-certainty evidence that LLLT results in less postoperative swelling at 2 days (standardized MD, -0.82; 95% CI, -1.28 to -0.35) and low-certainty evidence that LLLT results in negligibly less postoperative swelling at 7 days after surgery (standardized MD, -0.17; 95% CI, -0.4 to 0.07). Low-quality evidence suggests that LLLT will not cause adverse effects. Conclusions and Practical Implications. LLLT probably has negligible benefits but may not result in adverse events. Evidence does not support the use of LLLT in clinical practice to reduce complications after impacted mandibular third-molar surgical extractions. [ABSTRACT FROM AUTHOR]

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Pancreatic cancer is the fourth leading cause of cancer-related death. Early detection is challenging because symptoms are relatively nonspecific. Imaging is vital in detecting and staging pancreatic tumors, and management depends on imaging findings. Radiologists should be aware of current surgical treatments for pancreatic neoplasms, as surgeons rely on interpretation of cross-sectional imaging for presurgical planning. Understanding postsurgical anatomy is critical to assess for complications and recurrence. This review will emphasize the role of the radiologist in planning for surgery and will review postoperative changes based on surgical intervention and common complications. [ABSTRACT FROM AUTHOR]

Background: Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. However, the socioeconomic factors that relate to postoperative complications are still unclear as they can be heterogeneous based on communities, types of surgical services, and sex and gender., Methods: In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We built statistical logistic regression models of postsurgical complications with social vulnerability index as the independent variable along with sex interaction., Results: We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection., Conclusions: Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could be related to health outcomes. This suggests that the domain of preventive medicine should place social vulnerability as a priority to achieve its goals., Competing Interests: Competing interests The authors declare no competing interests

Objective: To examine the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications.Data Sources: Healthcare Cost and Utilization Project, 2011 State Inpatient Databases; American Hospital Association Annual Survey of Hospitals; Area Health Resources Files; Centers for Medicare & Medicaid Services Hospital Compare database.Methods: Nonlinear hierarchical modeling was conducted to examine the odds of patients experiencing any in-hospital postsurgical complication, as defined by Agency for Healthcare Research and Quality Patient Safety Indicators.Principal Findings: A total of 5,474,067 inpatient surgical discharges were assessed using multivariable logistic regression. Clinical risk, payer coverage, and community-level characteristics (especially income) completely attenuated the effect of race on the odds of postsurgical complications. Patients without private insurance were 30 to 50 percent more likely to have a complication; patients from low-income communities were nearly 12 percent more likely to experience a complication. Private, not-for-profit hospitals in small metropolitan or micropolitan areas and higher nurse-to-patient ratios led to fewer postsurgical complications.Conclusions: Race does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect. A population-based approach that includes improving the socioeconomic context may help reduce disparities in these outcomes. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy is considered a safe procedure, considering the relatively low rate of complications. Despite several complications have been described following this surgical procedure, the present event has not yet been described. The purpose of the present study is to report an unpublished complication following hip arthroscopy, after reviewing 162 hip arthroscopies and finding iliotibial band syndrome (ITBS) in the knee during followup. Materials and Methods: A retrospective review of 162 hip arthroscopies performed between September 2007 and June 2011 was carried out, evaluating patients who presented ITBS during followup. Indication for hip arthroscopy was failure of conservative treatment in patients with symptomatic femoroacetabular impingement. Results: During a minimum followup of 2 years, nine patients (5.5%) developed ITBS. All patients were diagnosed with ITBS within the first 45 postoperative days. Conservative treatment was successful in 6 patients while 3 had to undergo surgery. The increased internal rotation, synovitis and increased adduction of the hip can be attributed as predisposing factors to the development of ITBS. Conclusions: This is a newly described observation within followup of hip arthroscopy. These findings may help orthopedic surgeons when planning rehabilitation after hip arthroscopy, including stretching exercises to prevent this syndrome. [ABSTRACT FROM AUTHOR]