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Esophageal cancer is on a steady rise and carries significant mortality and morbidity. Depending upon the clinical stage at presentation, either chemotherapy, radiotherapy with or without surgical resection is the treatments in practice. Traditionally, open esophagectomy was performed but over time, the importance of minimally invasive esophagectomy has been established. In this study, we aimed to report our data of totally minimally invasive esophagectomies performed for thoracic esophageal cancers in last four years. A prospective cross-sectional study was conducted at the Department of Upper GI Surgery, Dow University of Health Sciences, Karachi. All diagnosed cases of esophageal carcinoma undergoing minimally invasive esophagectomy, from 2019 to 2022 were included in this study. Outcomes measured were operative time, intra operative complications, conversion rate to open, postoperative complications, number of lymph nodes harvested, margin clearance, in-hospital mortality and 90-days mortality. A total of 53 cases were included in the study, the most prevalent histological type was squamous cell carcinoma 42(79.2%) as compared to adenocarcinoma 8(15.1%). Most common tumor site was lower thoracic esophagus (30–38 cm) in 20 (56.6%) cases. Neo-adjuvant chemotherapy was given in all 53(100%) cases, whereas neo-adjuvant radiation therapy was offered to 49(92.5%) patients. There was a significant and favorable patient response to the neo-adjuvant treatment in 37(69.8%) cases, leading to a decrease in tumor size. Laparoscopic McKeown Esophagectomies were performed in 44 (83.0%) and 9(17.0%) were Robot-assisted Minimally Invasive esophagectomy (RAMIE). Intraoperative injuries (i.e., lung parenchymal injury and bleeding) were reported in only 2(3.8%) patients. Post-operative complications were recorded in 12(22.6%) patients. Margin clearance was observed in 53 (100%) of the patients. The 90-day mortality rate was 3(5.7%), one due to bleeding and other two mortalities were due to COVID related respiratory complications. Minimally invasive esophagectomy was found to be safe and feasible technique with encouraging results in terms of decreased intraoperative and post operative complications as well as achieving the standard oncological surgery with acceptable lymph node yield and margin clearance and in hospital and 90 d a ys mortality. [ABSTRACT FROM AUTHOR]

Objectives: To report a case of a morbidly obese 17-year-old boy who presented 4 days post-tonsillectomy with acute deep venous thromboses and a massive pulmonary embolism. To describe a protocol and decision-making tree for providing anticoagulation in the immediate post-tonsillectomy period. Methods: A chart review and review of the literature. Results: The patient ultimately did well and had no bleeding from the tonsil beds or further thromboembolic complications. A review of the literature revealed no available data regarding the safety of anticoagulation in the immediate post-tonsillectomy period. Conclusions: We propose that if anticoagulation is needed within 14 days of tonsillectomy, submaximal anticoagulation with a reversible and titratable anticoagulant may be optimal. A multidisciplinary team approach is needed for these complex cases. Future reporting and investigation of anticoagulation post-tonsillectomy is needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the indications and management of grade III-IV postoperative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis. Retrospective study of prospectively collected data from patients who underwent a cytoreductive surgery by laparotomy for an epithelial ovarian cancer that required postoperative management of an open abdomen. An abdominal vacuum-assisted wound closure (VAWC) was applied in cases of abdominal compartmental syndrome (ACS) or intra-abdominal hypertension, to prevent ACS. The fascia was closed with a suture or a biologic mesh. The primary aim was to achieve primary fascial closure. Secondary outcomes considered included complications of cytoreductive surgery (CRS) and open abdominal wounds (hernia, fistula). Two percent of patients who underwent CRS required VAWC during the study's patient inclusion period. VAWC indications included: (i) seven cases of gastro-intestinal perforation, (ii) three necrotic enterocolitis, (iii) two intestinal ischemia, (iv) three anastomotic leakages and (v) four intra-abdominal hemorrhages. VAWC was used to treat indications (i) to (iv) (which represented 73.7% of cases), to prevent compartmental syndrome. Primary fascia closure was achieved in 100% of cases, in four cases (21.0%) a biologic mesh was used. Median hospital stay was 65 days (range: 18–153). Four patients died during hospitalization, three of these within 30 days of VAWC completion. VAWC for managing open abdominal wounds is a reliable technique to treat surgical post-CRS complications in advanced ovarian cancer and reduces the early post-operative mortality in cases presenting with severe complications. • Vacuum-assisted open abdomen enables the management of grade III-IV postoperative complications after ovarian cytoreduction. • Vacuum-assisted wound closure was applied in cases of abdominal compartmental syndrome. • Primary fascia closure was achieved in 100% of cases after open abdomen using vacuum-assisted wound closure. [ABSTRACT FROM AUTHOR]

Background: The current study is aimed to compare the effect of fixed cuff volume and fixed cuff pressure technique on hemodynamic parameters and on postoperative complications. Methods: The prospective, randomised, controlled study was conducted in a tertiary care hospital with 100 patients aged between 18 to 60 yrs. The patients who are undergoing for elective surgeries under general anaesthesia were enrolled after obtaining ethical committee approval. Patients were randomized based on computer generated random numbers into two groups, fixed volume (7ml) group (group V, n-50) and fixed cuff pressure group (group P, n-50). The ETT cuff was filled with 7 ml of air in the fixed volume technique, and in the fixed cuff pressure group -cuff pressure was maintained at 20 cmH2O, after intubation. Tracheal tube cuff pressures were measured by AMBU cuff pressure gauge manometer. Hemodynamic parameters SBP, DBP, MAP and PR were noted at the time of cuff inflation, after extubation in the both the groups. Post-operative sore throat, hoarseness and cough was assessed at the time of extubation in the both the groups. Results: Mean age in both the groups was 41 years. Statistical significance (P< 0.0001) was observed in Group P in systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP, HR whereas no significance was seen in group V. The percentage of post-operative complications like hoarseness, cough, sore throat, and dysphagia were seen to be less in group P when compared to group V. Conclusion: With present data we could conclude that the fixed minimal cuff pressure (20 mm H2O) is an ideal and reliable technique in reducing the post-operative complications along with maintenance of hemodynamic parameters.

Objective: There is evidence to suggest adverse outcomes on patients' medical and surgical care when there is language discordance in patient-physician relationships. No studies have evaluated the impact of limited English proficiency (LEP) on complications after common surgical procedures in otolaryngology. Furthermore, no studies have evaluated how patients with LEP utilize remote resources to connect with otolaryngology providers to better triage such complications. The purpose was to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) comparing patients with LEP to those with English proficiency (EP). Patients with PTH were retrospectively evaluated to identify preceding telephone encounters, a marker of resource utilization. Methods: Demographics, English proficiency, and PTH management (surgical vs non-surgical) were evaluated in addition to PTH-associated triage telephone encounters with otolaryngology providers. Results: Of 2466 tonsillectomies, there were 141 episodes of reported hemorrhage (50 LEP vs 91 EP) in the 5 years studied. Rates were not significantly different between LEP and EP patients (4.9% vs 6.3%, P =.127). There was no statistically significant difference in rate of preceding telephone encounters between LEP and EP patients (24% vs 40%, P =.062). Of patients presenting directly to the Emergency Department without a triage telephone encounter, there was no difference in operative versus non-operative management when comparing LEP versus EP patients. However, patients presenting directly to the Emergency Department were nearly twice as likely to undergo operative intervention compared to patients with preceding telephone encounters (RR = 1.79). Conclusion: Patients with limited English proficiency are not at increased risk for developing PTH. There is equitable access to remote otolaryngologic triage care, although overall the utilization rate of this resource was low for both cohorts. [ABSTRACT FROM AUTHOR]

Gastrointestinal anastomoses are performed millions of times per year worldwide. The major complication they share is anastomotic leak. We describe the development and initial safety/efficacy of a novel luminal stent which aims to address this clinical issue. The stent was created out of two materials, a polyvinyl alcohol core and outer layer of acellular porcine small intestine submucosa. Ten healthy pigs underwent laparotomy, a portion of the colon was transected, and the stent was placed within the colonic lumen at the site of resection. Pigs were sacrificed at the end of postoperative week 2, and postoperative week 4. A portion of the descending colon was resected, and tissue samples from the anastomosis, intentional defect scar, and normal bowel overlying the stent were sent for histopathologic examination. All ten animals survived the study. None developed any clinical signs of obstruction, infection, leakage, fistula, wound complications, or bleeding. No evidence of colonic leak or luminal stenosis/stricture was noted. The results of this study show that a polyvinyl alcohol/acellular porcine small intestine submucosa stent sewn underneath a colonic anastomosis with a 2 cm intentional defect will result in no anastomotic complications. There were also no complications from placing this stent in any pigs. Additional studies with a control group should be conducted to see if this same stent can be built in different diameters, lengths, and configurations to prevent leaks in other organs. These encouraging results will hopefully lead to decreased leaks and the need for temporary ostomies in humans. [ABSTRACT FROM AUTHOR]

Objectives: To assess the feasibility of radial forearm free flap (RFFF) reconstruction of glossectomy defects without tracheostomy tube (TT). Methods: Retrospective review of patients with at least oral tongue defects who underwent RFFF reconstruction. Pre- and intra-operative factors were documented. Post-operative respiratory complications included inability to extubate, pneumonia, or need for re-intubation or TT within 30 days. Results: Twenty-one patients underwent RFFF reconstruction without TT, and 36 patients with TT. The average hospital length of stay was 1.5 days shorter in those without TT (P <.01). Two patients who underwent TT placement experienced a respiratory complication (P =.27). There were no respiratory complications among those without TT. After multivariate analyses, large tongue base defect (>25% resection, P <.001) and bilateral neck dissection (P <.001) were independently associated with TT placement. Conclusions: In our experience, RFFF reconstruction of glossectomy defects is feasible without TT among selected patients with small tongue base defects (≤25% resection) and unilateral neck dissection. [ABSTRACT FROM AUTHOR]

Objective: To describe the presentation and treatment of patients developing pulmonary embolism following translabyrinthine approach for vestibular schwannoma resection. Methods: This was a retrospective case series of patients at 2 academic tertiary medical centers who developed symptomatic pulmonary embolism post-operatively following translabyrinthine approach for vestibular schwannoma resection and were found to have evidence of sigmoid sinus thrombosis. Results: Three patients were identified to have post-operative pulmonary emboli after translabyrinthine approach for vestibular schwannoma resection with sigmoid sinus or internal jugular vein clots in the absence of lower extremity deep vein thrombosis. Caprini scores for these patients were 5 or lower. All patients underwent CT pulmonary angiography and were confirmed to have pulmonary emboli. Two were promptly anticoagulated with heparin drips and transitioned to long-term oral anticoagulation therapy and 1 had delayed anticoagulation. None of these patients suffered from intracranial hemorrhage post-operatively. Conclusions: Patients undergoing translabyrinthine approach for vestibular schwannoma can develop pulmonary embolism from sigmoid sinus entry or thrombosis. No clear guidelines exist for the management of this complication in the setting of recent craniotomy and the risk of intracranial hemorrhage must be considered prior to initiating anticoagulation. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the relationship between nutritional status and mortality and complication safter cardiac surgery. Materials and Methods: prospective cohort of 180 days, with patients in the postoperative e period of elective cardiac surgery. Results: 100 participants, 61% men, mean age 63.3 years, 89% sedentary, 28% obese. Overall mortality was 9% at 30 days and 13% at 180 days. Dea thwas related to intra operativ e complications (p<0.001), post operativ e complications (p<0.000) and obesity (p<0.05). In obese patients, ther isk of dea thwas 2.17 times greater. The Log rank statistical test was 4.05 (p<0.04), showingthattherewas a difference in mortality between obeseand non-obese individuals. The obesehad approximately 50% survival, while the non-obesehad approximately 85% survival. Conclusion: postoperativemortalitywasrelatedtoobesityands urgicalcomplications in the trans and post operative e period. [ABSTRACT FROM AUTHOR]

Low in dietary ω3 polyunsaturated fatty acid (PUFA) consumption has been associated with increased incidence of cancers. Many basic and clinical studies have been conducted over the last several decades. We previously reviewed multi-targeted therapy of cancer by omega-3 fatty acids in 2008, and since hundreds of new clinical trials are being conducted to validate the effectiveness of ω3 PUFA in cancer therapy. Because of the availability of such large amount of clinical trial data, in this update we summarize clinical data, sort out trials that show promising results, and discuss potential mechanism(s) responsible for the clinical outcomes. It appears that ω3 PUFA mainly affects cancer-associated symptoms, namely cachexia, inflammation, neuropathy, post operative complications and quality of life. Mechanisms responsible for these effects are possible regulation of skeletal muscle protein turnover, inflammatory response and neuron cell survive by ω3 PUFA. [ABSTRACT FROM AUTHOR]

Introduction: New techniques in bariatric surgery have allowed to reduce complications and surgical mortality. These improvements have made it possible to reduce the hospital stay and accelerate the recovery process, allowing a potential early discharge protocol. Aim: To describe the experience in the use of a protocol designed for an abbreviated stay, in post-operated bariatric surgery patients. Materials and Method: Analytical, retrospective cohort study. A cohort of patients who underwent bariatric surgery, at the Santa María Clinic, by a single surgeon, between July 2014 and April 2019 and submitted to a designed early discharge protocol was considered. Morbidity, mortality, readmissions, and reoperations were recorded in the established period of time. Results: A total of 775 patients were included, 654 patients undergoing laparoscopic sleeve gastrectomy (GEM) and 101 patients undergoing Roux-en-Y gastric bypass (RYGB). There were 8 complications, with no recorded mortality. The readmission/reoperation rate was 4.13%/2.27% for GEM and 4.55%/3.53% for RYGB. Conclusions: In this group of patients we were able to demonstrate a low rate of complications, which supports the idea that an early discharge protocol in patients undergoing bariatric surgery is a feasible and safe alternative. [ABSTRACT FROM AUTHOR]

Neurosurgery is one of the most complex disciplines, requiring skillfulness and ability to try to cure nervous pathologies. Despite the role of this surgery in the inviolability of life, complications are relatively likely. Complications are frustrating and they contribute to produce a wrong but physiologic guilty conscience. However, sometimes they can have a sense over the rationale.In our study, we present two examples of post-operative complications of common neurosurgical pathologies. We compared our experience with the complications reported in literature and analyzed the importance of seeing the patients in their entirety, so encouraging a mindful approach in our medical daily life. Mindfulness could be beneficial for both patients and physicians. A mindful patient would be more relaxed, trusty and more likely to have a better outcome; on the other hand, a mindful surgeon would be more sensitive, right and open-minded and more likely to have that brightened judgment needed in our daily mission. Thanks to this mindful, extensive approach, we could interpret that, sometimes, the following complications in a patient’s surgical history are only a fraction of his life and they could have implications that neither the surgeon, nor the patient could know.

Background: Post-operative nausea and vomiting (PONV) is a common cause of patient dissatisfaction following anaesthesia. Audit of adherence to PONV prevention guidelines is resource intensive when performed by manual chart extraction. Electronic audit can require costly anaesthetic and medical records.Objective: In our single-site study we sought to compare manual and electronic PONV audits by utilizing existing non-anaesthetic electronic medical records to avoid expensive additional software.Methods: The audits were performed from 13 January 2020 to 1 February 2020 for surgical inpatients. Two PONV periods were captured-the post-anaesthetic recovery unit and on the ward (to 24 h). Electronic PONV was defined as the administration of an anti-emetic medication. A 6-month electronic PONV rate was also calculated.Results: Manual audit captured 142 patients and electronic audit captured 294 patients, over the same time period. The manual PONV rate was 10% (95% confidence interval (CI) 5-16%) in the post-anaesthetic recovery unit and 20% (95% CI 14-28%) the next day. The electronic rate was 5% (95% CI 3-8%) in the post-anaesthetic recovery unit and 15% (11-19%) in a 24-h period. The 6-month electronic audit found 3510 patients, with a post-anaesthetic recovery unit and 24-h PONV rates of 5% (4-6%) and 14% (13-16%), respectively. Electronic audit did not identify 5.8% of PONV patients in the manual audit.Conclusion: Electronic audit enrolled more patients and identified a lower PONV rate than manual audit, likely from less enrolment bias. Electronic audit was easily repeated over a 6-month period. While electronic PONV audit is possible without additional software, an electronic anaesthetic chart would greatly improve audit quality. [ABSTRACT FROM AUTHOR]

Pediatric liver transplantation has evolved over the last few decades from an experimental therapy to standard of care in end stage liver disease. Apart from surgical expertise, the success of liver transplantation largely depends on perioperative care of the patient. Intensive care management plays a key role in supporting the pre-operative sick patient through the surgery and till the new liver graft starts to function and there is resolution of pre-operative morbidities. Pediatric patients are more challenging than the adult counterparts and demand minute attention to fluid volume status, hemodynamics and various organ-specific and graft specific issues. This review describes the various principles and challenges in the post-operative intensive care management of pediatric patients undergoing liver transplantation.

The aim of this study is to investigate the follow up and compliance of patients who sternly follow the post operative instructions after non surgical permanent tooth extraction. Data collection were taken from patients who reported to the college from a particular time period which is from June 2019 to March 2020. The number of extractions and reviewers were obtained from dental archiving software which is offered by the university. The statistical test that was run was the chi square test using statistical software SPSS by IBM. The results were represented in the form of graphs and pie charts. In this study, the most common age group were 41-50 years of age(20.38%) and >60 years of age for extractions (25.75%) and reviews respectively and the most common gender predilection was found to be male subjects more than female subjects (53.55%). The number of patients who returned for reviews were very less (3459 out of 21648) compared to the total number of extractions done. Hence, awareness programs must be initiated and people must be emphasised for vigorous oral hygiene maintenance. [ABSTRACT FROM AUTHOR]

Introduction: Surgery by itself will add a lot of stress to the patients. It is associated with a lot of morbidity, the problems related to the wound healing and its complications and mortality at times. There are battery of factors that can predict the problems related to the complications. It will be invaluable to have the predictors that can assess the complications before the operative procedures so that the deficit factors can be corrected in order to reduce the morbidity associated with the surgical procedures. This study is taken up to assess one of such important factors that is the effect serum albumin on the surgical out come. Aim: To study effect of protein (s.albumin) levels and the wound healing and related complications like wound infection, wound dehiscence and anastomotic leak. Materials & Methods: The study is conducted in the department of Surgery Shri. B.M. Patil Medical College. A total of 130 patients were studied over period of 2 years and were evaluated for serum albumin and the wound related complications. Results: Significant wound related complications were noted in hypoalbuminemic patients as compared to the patients with normal albumin levels. Conclusions: Serum albumin levels can be considered to be one of best predictors for the wound related complications.

Surgical complications are a part of every surgeon's practice. Managing your own complications or one from another provider requires carefully reviewing your patient's previous experience and surgery along with balancing their expectations. In order to provide the best treatment plan, a thorough analysis of the pre and postoperative period that contributed to the patient's outcome must be considered. Identifying what revision options are available and weighing the potential future complications that could arise from another surgery must be reviewed. Honest conversations regarding revision options and if revision surgery is even a viable option is vital for a good patient-physician relationship and outcome., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Cancer is responsible for approximately 13% of all causes of death worldwide, and 20% of cancer patients die because of malnutrition and its complications. Malnutrition is common in cancer of stomach and esophagus. Although it is widely accepted that malnutrition adversely affects the postoperative outcome of patients, there is little evidence that perioperative nutrition support can reduce surgical risk in malnourished cancer patients. This prospective study was carried out from December 2016 to July 2017 at the Kidwai Memorial Institute of Oncology, Bengaluru. After stratified for age, sex, and tumor localization, patients were selected non-randomly and assigned to study (n = 30, 14 women, 16 men) and control group (n = 30, 14 women, 16 men) as alternate patients. Within 48 h of admission, patients underwent nutritional assessment by the subjective global assessment. Perioperative nutrition was administered in the study group by enteral route only. Patients had a functioning gastrointestinal tract, and they received enteral nutrition (EN). Target intake of non-protein (25 kcal/kg per day) and protein (0.25 g nitrogen/kg per day) was provided using available enteral formulas. This was supplementary to standard hospital diet. Nutritional re-assessment after 15 days of intervention showed significant change in nutritional status, which was measured as gain in weight for each patient. There were significant differences in the mortality and complications between the two groups. The total length of hospitalization and postoperative stay of the control patients were significantly longer than those of the study patients. In conclusion, perioperative nutrition support can decrease the incidence of postoperative complications in moderately and severely malnourished gastric and esophageal cancer patients. In addition, it is effective in reducing mortality. Enteral nutrition support alone can be used in the management of malnourished patients undergoing gastric and esophageal surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze indications, surgical routes, complications, and histopathologic correlations with preoperative diagnoses for all patients who underwent hysterectomies at a new teaching hospital over 5 years. Materials and Methods: This retrospective observational study included all women who underwent hysterectomy at a new medical college hospital in India from 2013 to 2017. Results: Hysterectomy was performed in 1.4% women attending the hospital's gynecologic outpatient department. Abdominal hysterectomy (72.7%) was the most-common surgical approach, followed by vaginal (18.6%) and laparoscopic (8.6%) approaches. The most-common indications for hysterectomy were symptomatic fibroid uteri (39.8%) and uterovaginal prolapse (17.6%). The overall complication rate was 7.1%. Preoperative diagnoses were confirmed by histopathology in 88.2% cases. The highest correlation (94%) was for fibroids and lowest correlation (70%) was for premalignant cervical lesions. Conclusions: Hysterectomy, as a definitive surgery in symptomatic women with benign pathologies, provides permanent relief. Patient satisfaction far outweighs short-term complications. Vaginal hysterectomy should be the default route. Prophylactic oophorectomy should be considered only after assessing the potential consequences of estrogen deficiency or subsequent ovarian malignancy. An audit of hysterectomies and major gynecologic surgeries is an indirect health indicator. The gynecologic work in the first 5 years of the new medical college hospital was almost on a par with major studies across countries. Shared decision making is definitely preferred when considering hysterectomy. [ABSTRACT FROM AUTHOR]

Introduction: Haemorrhoids or ‘Piles’ is a frequently observed disease in surgical practice. Various non surgical and surgical treatments are available. Open haemorrhoidectomy (Milligan-Morgan) is a widely used procedure. A recent novel technique called ‘Stapled haemorrhoidectomy’, first described and performed by Italian surgeon Antonio Longo is gaining worldwide recognition for its benefits. Aim: To compare Stapled haemorrhoidectomy with open (Miligan Morgan) haemorrhoidectomy in terms of post operative pain, resumption of daily activity, hospital stay, post operative bleeding, urinary retention and anal incontinence. Study Design: Prospective, comparative study from August 2011 to September 2013. Materials and Methods: A total of 100 patients between the age group of 20 and 70 years, diagnosed to have grade II, III or IV haemorrhoids were included in the study, divided into 2 groups, Group 1 undergoing Open haemorrhoidectomy (50 patients) and Group 2 undergoing Stapled haemorrhoidectomy (50 patients). Post operatively patients of both groups were reviewed at the time of discharge, at 7 days after discharge, at 1 month and 3 months post surgery. All patients were given a questionnaire and data collected verbally and analysed statistically. Comparative analysis between the two groups were done based on Independent sample ‘t’ test or students ‘t’ test using a SPSS version 20. Results: The mean age of patients in Open haemorrhoidectomy (OH) group was 40.68 and Stapler haemorrhoidectomy (SH) group was 39.52. 78% were males and 22% were females in OH group, 90% were males and 10% were females in SH group. Post operative bleeding in both OH and SH group had an incidence of 2%. Post operative urinary retention was seen in 4% and 8% in OH and SH group respectively. In both groups, post operative anal incontinence was not seen. Based on Independent sample ‘t’ test the post operative pain, Post operative hospital stay and duration of resumption of daily activity was less in SH group compared to OH group and statistically significant with p

Background: Interleukin-6 (IL6) gene polymorphism is an important inflammatory cytokine. It may play a major role in complications observed after CABG surgery. Therefore, the present study was designed to study the relationship between IL6 174G>C gene polymorphism and complications after CABG. The aim of this study was to investigate any probable relationship between IL6 174 G >C polymorphism and complications observed after CABG surgery. Methods: In this case-control study, whole blood samples were obtained from all patients hospitalized for CABG surgery in Sina Hospital, Isfahan. Subject were divided into two groups of patients with (POC) or without (NPOC) complications. Information such as age, sex, degree of hemorrhage after the surgery, time spent in the intensive care unit (ICU), ventilation time, and inotropic support after the surgery was collected. Statistical analysis of the obtained data was performed using t-test and chi-square test. Findings: We did not find a correlation between IL6 gene polymorphism and complications after CABG surgery (P = 0.126). However, a significant difference was observed. This difference for GG was P = 0.05 and for GC was P = 0.035 between two groups. Conclusion: GG genotype may play a role for the inflammation and complications after CABG. Further studies with larger number of patients are recommended.

Objective . In 2019, the University of Florida College of Medicine launched the MySurgeryRisk algorithm to predict eight major post-operative complications using automatically extracted data from the electronic health record. Approach . This project was developed in parallel with our Intelligent Critical Care Center and represents a culmination of efforts to build an efficient and accurate model for data processing and predictive analytics. Main Results and Significance . This paper discusses how our model was constructed and improved upon. We highlight the consolidation of the database, processing of fixed and time-series physiologic measurements, development and training of predictive models, and expansion of those models into different aspects of patient assessment and treatment. We end by discussing future directions of the model., (Creative Commons Attribution license.)

BACKGROUND: In non-small-cell lung cancer patients, high peak oxygen uptake (peak ...) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak ... METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC+, n = 19; NAC-, n = 15). RESULTS: Adjusted peak ... was lower in NAC + compared with NAC- subjects (-5.3 mL/min/kg [95% CI -8.3 to -2.2], P = .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC+ subjects, whereas peak heart rate and breathing reserve were similar. NAC+ subjects presented lower values of diffusion capacity for carbon monoxide (DLCO) (P = .035) and hemoglobin concentrations (P < .001). DLCO was strongly correlated with peak ... (r² = 0.56). Adjustment for DLCO reduced the effect of NAC on peak ... without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak ... in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity. [ABSTRACT FROM AUTHOR]

Changes in management of the surgical colic patient over the last 30 years have resulted in considerable improvement in post operative survival rates. However, post operative complications remain common and these impact negatively on horse welfare, probability of survival, return to previous use and the costs of treatment. Multiple studies have investigated risk factors for post operative complications following surgical management of colic and interventions that might be effective in reducing the likelihood of these occurring. The findings from these studies are frequently contradictory and the evidence for many interventions is lacking or inconclusive. This review discusses the current available evidence and identifies areas where further studies are necessary and factors that should be taken into consideration in study design. [ABSTRACT FROM AUTHOR]

Hemorrhoids are amongst the most frequent anorectal conditions affecting approximately 4-36 % of the general population. The study was carried out to assess the clinical consequences of stapled hemorrhoidectomy comparing results with other published literature regarding postoperative pain, bleeding, incontinence, and other complications. A total of 120 patients were included in this study with symptomatic grade 3 or 4 prolapsed hemorrhoids, who underwent stapled hemorrhoidectomy from January 2006 to January 2012 at the Civil Hospital Karachi, Pakistan. In 92 patients (76.6 %), proctological examination showed grade 3 hemorrhoids. Fourth degree hemorrhoids were found in 28 cases (23.4 %). Hospitalization time ranged between 1 and 3 days (median time was 34 h). Seventy-eight patients were discharged on the first postoperative day, without severe pain, and the remaining 42 patients were discharge on the third day. Two cases of postoperative pain and thrombosis were found as postoperative complications. Stapled hemorrhoidectomy is a safe and quick procedure associated with less pain, better outcome, and early recovery with shorter hospital stay. [ABSTRACT FROM AUTHOR]

Background: A prospective, analytical study conducted to compare the results of total thyroidectomy with subtotal thyroidectomy in the management of multinodular goitre. Objective: comparison of total thyroidectomy and subtotal thyroidectomy for the management of multinodular goitre in terms of postoperative complications. Patients and Methods: A prospective review of 120 patients with benign multinodular goitre (bilateral) undergoing total thyroidecotmy (Group A=60) and subtotal thyroidecotmy (Group B=60) during 2 years period (2011-12) was undertaken. Evaluation of results was done by analyzing the data in SPSS version 17. Results: In group A, total thyoidectomy was done, the postoperative complications were lesser (13.33%) than group B in whom subtotal thyroidectomy was done (16.67%). The complications seen in group A were seroma formation 1(1.67%), external laryngeal nerve (ELN) palsy 2 (3.34%), recurrent laryngeal nerve (RLN) palsy (temporary) 2 (3.34%) and hypoparathyroidism 3 (5.00%). The complications seen in group B were tension haematoma 01 (1.67%), seroma formation 2 (3.34%), ELN palsy 2 (3.34%), RLN palsy (temporary) 3 (5.00%) and hypoparathyroidism 2 (3.34%). No mortality was seen in both groups. Conclusions: Total thyroidectomy is better procedure than subtotal thyroidectomy for the treatment of benign mulitnodular goitre. This procedure also prevents future need of surgery for recurrence and incidental thyroid cancer. [ABSTRACT FROM AUTHOR]

Objective: To analyze the impact of high or low levels of anatomical risk of hepatic alveolar echinococcosis (HAE) on complications after radical resection., Methods: The baseline, surgical, and complication data were retrospectively collected from hepatic alveolar echinococcosis patients who underwent radical resection at the Ganzi Branch Hospital, West China Hospital, Sichuan University from 2015 to 2022. The patients were divided into anatomical low-risk (ALR) and anatomical high-risk (AHR) groups based on the PNM staging system designed by the World Health Organization (WHO-PNM). Complications were analyzed according to the Clavien-Dindo classification. Univariate and multivariate logistic regression analyses were performed to assess the effect of high and low risks of lesion anatomy on complications., Results: Radical surgery was performed in 216 HAE patients and 102 of whom were in the AHR group. The median operative time was 230 (175, 300) min, the median intraoperative blood loss was 600 mL, and 129 (59.7%) patients developed complications. The complication rate was 73.5% (75/102) in the AHR group and 47.4% (54/114) in the ALR group, demonstrating statistically significant difference ( P <0.05). The incidence of serious complications was 36.3% (37/102) in the AHR group and 13.2% (15/114) in the ALR group, demonstrating statistically significant difference ( P <0.05). There was significant difference in the proportions of patients having postoperative complications of bile leak, anemia, fever, pleural effusion and ascites between the AHR group and the ALR group ( P <0.05). Multivariate logistic regression analysis suggested that AHR was the only independent risk factor for complications, including bile leak, anemia, fever, and pleural effusion, and severe complications., Conclusion: The anatomical risk of hepatic alveolar echinococcosis is independently associated with the development of multiple postoperative complications, and physicians should choose surgical procedures cautiously according to the actual situation when dealing with patients defined as AHR according to WHO-PNM., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Background Laparoscopic cholecystectomy performed less than 72 hours from hospital admission for acute cholecystitis has shown to decrease hospital cost without an increase in length of stay (LOS). Very few studies have examined clinical and cost outcomes of performing cholecystectomy less than 24 hours from hospital admission. The aim of this study was to examine the cost and LOS of laparoscopic cholecystectomy performed on an early (less than 24 hours from admission) and late (more than 24 hours from hospital admission) basis. Methods We performed a retrospective observational study of 569 patients at Baystate Medical Center, Springfield, USA, who underwent urgent laparoscopic cholecystectomy for acute cholecystitis between January 1, 2018 and February 28, 2020. We evaluated preoperative/postoperative LOS, operative duration, hospital cost, and patient complications. Results 468 patients underwent urgent laparoscopic cholecystectomy for acute cholecystitis during our study period. Early cholecystectomy (less than 24 hours from admission) had an overall decreased LOS (43.6 hours versus 102.9 hours, p-value < 0.01) and decreased hospital cost ($23,736.70 versus $30,176.40, p-value < 0.01) compared to late cholecystectomy (more than 24 hours from admission). There was also a significantly higher rate of bile leak in patients who underwent surgery more than 24 hours from hospital admission compared to those who had surgery less than 24 hours from admission (5.9% versus 0.4%, p-value < 0.01). Additionally, those procedures performed greater than 24 hours from hospital admission were significantly more likely to be converted to an open procedure (6.9% versus 2.2%, p-value = 0.02).  Conclusion Urgent laparoscopic cholecystectomy performed within 24 hours of hospital admission for acute cholecystitis decreased hospital cost, LOS, and operative complications in our institution's patient population. Our data suggests that performing laparoscopic cholecystectomy within 24 hours of hospital admission would be beneficial from a patient and hospital standpoint., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kirkendoll et al.)

Chylothorax, a relatively rare congenital heart disease early postoperative complication, is occurring more frequently due to complexity of cardiac surgeries. We present a 9-month-old boy who had hypoplastic left heart (HLH) syndrome with interrupted inferior vena cava (IVC) and bilateral superior vena cava (SVC) palliated with left sided modified Blalock-Taussig (MBT) shunt during neonatal period and second stage palliation with left sided bidirectional glen (BDG) procedure and right sided Kawashima procedure develop bilateral chylothorax two weeks after discharge. This is the first reported case in the literature of a patient who developed chylothorax with relatively low Fontan systemic venous pressures after a Kawashima procedure. Clinically important chylothorax may be a marker of poor long-term outcomes, demonstrating an inability to handle overwhelming lymphatic congestion. Early diagnosis of chylothorax in complex cardiac surgeries may permit successful conservative management. • This is the first documented chylothorax occurrence in the context of normal central venous pressure and pulmonary artery pressures in a patient palliated with Kawashima procedure. • Additional screening measures for structural lymphatic abnormalities may be necessary in such patients. • There is a need for new techniques to investigate the altered physiologic relationship between the lymphatic and cardiovascular circulation to improve early postoperative outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Outpatient tonsillectomy has gained favor in recent years, however patients with obstructive sleep apnea/hypopnea syndrome have been excluded from outpatient surgery criteria. It is the practice of the senior author to discharge patients after tonsillectomy with a respiratory disturbance or apnea hypopnea index of 5 or less. The purpose of this study is to examine the respiratory complication rate based on respiratory disturbance or apnea hypopnea index, and co-morbidities in order to determine which pediatric patients with obstructive sleep apnea/hypopnea syndrome can be safely discharged after tonsillectomy. Methods: All patients undergoing tonsillectomy with the diagnosis of obstructive sleep apnea made by polysomnography by a single surgeon from 2008 to 2011 were included. Decision to admit was based on respiratory disturbance or apnea hypopnea index, body mass index, and comorbidities. All inpatient notes, phone calls, and follow up visit documentation were monitored and reviewed for post operative complications. Results: 104 patients were included, 74 patients were admitted post operatively, and 30 were discharged home. There were no complications in the group that was discharged home. In the group that was admitted, there was two minor and two intermediate complications, including desaturations to 92% and 83% requiring oxygen, and wheezing requiring breathing treatment. All complications occurred in patients with respiratory disturbance or apnea hypopnea index of 11 or greater. Conclusion: Our data suggest there is a correlation between higher respiratory disturbance or apnea hypopnea index and post operative complications. Patients with an RDI of <5.0, and minimal co-morbidities can be safely discharged home following tonsillectomy for OSAHS. Complications related to sleep apnea were not seen in patients with RDI <11.0, suggesting that patients with an RDI between 5 and 10, who are not obese and have no significant comorbidities may also be sent home after surgery. [Copyright &y& Elsevier]

Background: Interleukin-6 (IL6) gene polymorphism is an important inflammatory cytokine. It may play a major role in complications observed after CABG surgery. Therefore, the present study was designed to study the relationship between IL6 174G>C gene polymorphism and complications after CABG. The aim of this study was to investigate any probable relationship between IL6 174 G >C polymorphism and complications observed after CABG surgery. Methods: In this case-control study, whole blood samples were obtained from all patients hospitalized for CABG surgery in Sina Hospital, Isfahan. Subject were divided into two groups of patients with (POC) or without (NPOC) complications. Information such as age, sex, degree of hemorrhage after the surgery, time spent in the intensive care unit (ICU), ventilation time, and inotropic support after the surgery was collected. Statistical analysis of the obtained data was performed using t-test and chi-square test. Findings: We did not find a correlation between IL6 gene polymorphism and complications after CABG surgery (P = 0.126). However, a significant difference was observed. This difference for GG was P = 0.05 and for GC was P = 0.035 between two groups. Conclusion: GG genotype may play a role for the inflammation and complications after CABG. Further studies with larger number of patients are recommended. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Incidence and etiology of persistent pain after stapled hemorrhoidectomy remain uncertain. Characteristics, clinical course and management of this complication have not yet been assessed. Purpose of this essay is to describe our experience with persistent pain in our series of patients with this technique. Methods: This retrospective study evaluated 126 cases of stapled hemorrhoidectomy treated from 2006 to 2009. We gathered information on each patient regarding type of prolapsed hemorrhoids, number of haemostatic suture placed, histology of each doughnut and post operative complications. A close follow up was done in those patients complaining about pain. Results: Early and late complications occurred in 11.9% and 16.7% of patients respectively. At two weeks from surgery 18 patients (14.3%) were complaining of persistent pain. The average number of haemostatic sutured placed in this group and in all series is 4.5 and 2.5 respectively. Eight patients (6.34%), 3 (2.4%) and 2 (1.6%) patients were still complaining of persistent pain at 1 month, 4 months and 6 months of follow up, respectively. In these patients, endoanal manometry was normal at 4 months from surgery, while endoanal ultrasound showed retained staples in 3 of them. At 7 months from surgery a staples removal was performed in 2 patients that were still complaining of pain. Conclusions: Incidence of pain at 2 weeks after surgery resulted in 14.3% of patients. In most patients its etiology remains unclear but we reckon it might be related to the high number of haemostatic sutures placed. Staples removal resulted successfully. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the post operative complications when distal femoral fractures in adults is fixed using dynamic condylar screw. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Study conducted in Orthopedics department, Dow OJHA Hospital and Civil Hospital Karachi, from July 2014 to December 2015. METHODOLOGY: Although patients' with simple and closed supracondylar fractures of the femur were treated by dynamic condylar screw system, however for this study inclusion criteria was patients having closed supracondylar fracture of the femur of either gender aged between 20 to 65 years and presented earlier. Follow up of all these patients was done. Data was analyzed by using SPSS statistical package version 20. RESULTS: Out of 46 patients, 41(89.13%) patients were males and 5(10.86%) were females. Mean age of the patient in this study was 31.1+3.5 years. 33(71.73%) patients sustained injury following Road Traffic Accident (RTA), 7(15.21%) presented with history of assault and 6 (13.04%) patients sustained injury following fall. The post operative complications observed in this study was infection in 4(8.69%), shortening in 3(6.52%), deformities in 3(6.52%) cases, nonunion in 1(2.17%) case and implant failure in 2(4.34%) cases. CONCLUSION: Dynamic condylar screw may confidently be used in the management of supracondylar fractures. The procedure is technically manageable with minimum post operative complications. [ABSTRACT FROM AUTHOR]

Objective. To examine the necessity of routine cervical dilatation during elective cesarean delivery (ECD). Material and methods. A retrospective cohort study including all ECD during 2005 was performed, comparing post operative complications between patients with and without cervical dilatation. Results. Out of 666 ECD, 348 underwent routine cervical dilatation. No significant differences were found between the cervical dilatation and the comparison group regarding postpartum febrile morbidity (5.1 and 3.1%, respectively; p = 0.071), hospitalisation duration (4.1 ± 1.4 and 4.1 ± 2.0 days; p = 0.95), wound infection (0.9% and 1.25%, p = 0.451) or anemia rate (9.50 ± 0.73 and 9.54 ± 0.65, p = 0.91). Nevertheless, among patients following a previous vaginal delivery, cervical dilatation was significantly associated with post-operative fever (OR = 5.8; 95%CI 1.2-38.0; p = 0.021). Conclusion. Routine cervical dilatation during ECD does not reduce post operative morbidity. Moreover, among patients with a previous vaginal delivery cervical dilatation is a risk factor for febrile morbidity. [ABSTRACT FROM AUTHOR]

Purpose: To describe a rare case of Mucor endophthalmitis that occurred in well-controlled diabetes after cataract surgery. Design: Interventional case report. Methods: Description of case and review of literature. Results/Conclusion: Mucor endophthalmitis may occur after cataract surgery and should be considered in the differential for patients with unresolving postoperative uveitis. [ABSTRACT FROM AUTHOR]

While endoscopic surgery is largely replacing microsurgery, many of the principles of trans-sphenoidal surgery are common to both techniques. For the novice surgeon there are many potential pitfalls that can, however, be avoided by attention to detail and careful planning. This article provides a practical overview from one surgeon's extensive experience. [ABSTRACT FROM AUTHOR]