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Background: Sinonasal malignancy surveillance paradigms are often based on Head and Neck National Comprehensive Cancer Network guidelines, which do not recommend standard surveillance imaging beyond 6 months without concerning symptomatology or physical examination findings. Methods: This was a retrospective analysis of all patients who underwent resection of sinonasal malignancy at a tertiary care center over a 20‐year period from 2000 to 2020, with an ensuing surveillance period demonstrating recurrence. Results: Fifty‐two patients with sinonasal malignancy recurrence were included, with an average time to recurrence of 30.9 months and a follow‐up period of over 60 months. Recurrence was diagnosed by routine imaging or endoscopy in asymptomatic patients in a majority (60%) of cases, while the remaining minority of diagnoses followed new symptomatology. Asymptomatic recurrence was associated with perineural spread of tumor at initial resection (p = 0.025), but not with age (p = 0.85) or stage at diagnosis (p = 0.68). Expectedly, positron emission tomography/computed tomography (CT) more often detected regional or distant recurrence, while structural imaging (CT/magnetic resonance imaging) demonstrated more frequent detection of recurrence in those with perineural spread of tumor (p = 0.01). Conclusions: Our findings support high rates of asymptomatic recurrence in sinonasal malignancy, with the majority of recurrences diagnosed by routine endoscopy or imaging. Tailored and extended surveillance guidelines are necessary relative to those utilized for other head and neck mucosal cancers, and are especially appropriate when features such as perineural spread are present. [ABSTRACT FROM AUTHOR]

Post-operative recurrence is a critical issue in the surveillance of Crohn's disease after ileocecal resection. This meta-analysis aims to assess the diagnostic yield of enterography techniques in post-operative recurrence of Crohn's disease. A systematic electronic bibliographic databases search was conducted. The inclusion criteria of original articles were: Utilized MR enterography or CT enterography after ileocolonic resection; Documented recurrence by ileo-colonoscopy (Rutgeerts' score ≥ i2); Provided crude data of diagnostic performance. A random-effect method was used for analysis. Relative risk and diagnostic value of each imaging feature were calculated. Eleven studies (11 populations and 589 patients) were included (4 CTE and 7 MRE with 248 and 341 patients, respectively). The pooled sensitivity and specificity of the enterography were 91% (95% CI: 0.85–0.95) and 75% (95% CI: 0.56–0.87), respectively. The pooled sensitivity and specificity of CTE were 93% (95% CI: 0.87–0.96) and 67% (95% CI: 0.35–0.90), respectively. MRE revealed pooled sensitivity and specificity of 90% (95% CI: 0.78–0.96) and 78% (95% CI: 0.57–0.90), respectively. The inter-study heterogeneity was low for sensitivity (I2 = 29%, p-value = 0.17) and high for specificity (I2 = 85%, p-value < 0.01). Wall enhancement, anastomosis wall thickening, anastomosis stenosis, pre-anastomotic dilatation, penetrating lesion, comb sign, and perivisceral edema were significantly higher in POR patients. Wall thickening and penetrating lesion were the most sensitive (81%) and specific (97%) findings, respectively. MRE and CTE exhibit high sensitivity and acceptable specificity (especially MRE) for detection of recurrence in Crohn's disease which makes them an effective initial screening tool and reserves ileo-colonoscopy for those patients with inconclusive enterography results. [ABSTRACT FROM AUTHOR]

Purpose: To analyze recurrence patterns of chronic sinusitis with nasal polyposis (CRSwNP) in patients who underwent complete FESS and identify predisposing factors for different patterns of recurrence. Methods: Retrospective analysis of patients with CRSwNP who underwent complete FESS at our tertiary medical center. Recurrence patterns were classified into edema, polyp and normal endoscopy, as well as into early (within 6 months) and late recurrence. Statistical analysis to identify risk factors for recurrence included univariate, multivariate logistic regression and cox regression models. Results: 114 patients were included with an average follow-up of 27 months. 91% were categorized as type-2 inflammation. Recurrence was observed in 65.8% of patients within a mean of 12.9 months. 46.7% had polyp recurrence while 53.3% had edema recurrence. Early recurrence was observed in 41%. Serum eosinophilia > 500 cells/uL was found to be significantly associated with recurrence (RR = 1.62, p-value = 0.046), and particularly with polyp recurrence (RR = 3.9, p-value = 0.001). No predictive factors for early recurrence were identified. Edema recurrence was managed with intranasal corticosteroids while polyp recurrence required systemic therapy including biologic therapy. Conclusions: In this study, two thirds of patients experienced post operative recurrence, either mucosal edema or nasal polyps, with similar frequency during an average follow up of over 2 years. Early recurrence was noted in 41% of recurrent cases. Serum eosinophils > 500 cells/uL was the only risk factor for recurrence on multivariate analysis, more accurate markers are needed for improved treatment allocation to CRSwNP patients. [ABSTRACT FROM AUTHOR]

Surgical treatments are promising for the treatment of lymphedema. It is important for patients, healthcare providers, and lymphedema community to understand that surgical treatments currently are not a cure for lymphedema but have provided promising options for patients. Post-operative care for patients following surgical treatment of lymphedema is vital to optimize and sustain patient outcomes. This expert-consensus statement addresses current practice and research needs for standardized post-operative care, a core set of outcome measures, quality of care, and training of healthcare providers. Current research and clinical practice support non-surgical lymphedema therapy, also known as conservative therapy of lymphedema (e.g., compression therapy, or manual lymph drainage, or Complete Decongestive Therapy) as an essential part of post-operative care. Importantly, patient education should focus on patients' understanding that surgery is not a cure and the importance to adhere to post-operative care and life-long self-monitoring to sustain surgical results of limb volume reduction, relief of symptoms, and mitigate known or ongoing risk factors for recurrence of lymphedema. To optimize patient outcomes, it is crucial to have a multidisciplinary professional team consisting of well-qualified and credentialed healthcare providers participating in ongoing training and education. The essentials recommended by this expert-consensus are an initial and foundational step to build clinical standards for best practice and provide directions for future research. [ABSTRACT FROM AUTHOR]

This study aimed to determine the efficacy of using both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative partial weight-bearing (PWB) in reducing the incidence of delayed union in the ischium at one year after curved periacetabular osteotomy. We evaluated computed tomography images to clarify the incidence of delayed union at the osteotomy sites at one year post-operatively for 117 hips in 104 patients. Fifty-eight hips in 54 patients with use of both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative PWB were assigned to the oblique view and late PWB group (OL group) and 59 hips in 50 patients with use of only the postero-anterior image intensifier view intra-operatively and early start of post-operative PWB were assigned to the control group (C group). In univariate analyses, the incidence of delayed union in the ischium at one year post-operatively was significantly lower in the OL group (3.5%) than in the C group (22%). Use of both the postero-anterior and oblique image intensifier views during curved periacetabular osteotomy and late start of PWB were effective for reducing delayed union of the ischium at one year post-operatively. [ABSTRACT FROM AUTHOR]

Introduction: Currently there are few opioid prescribing guidelines for orthopaedic fractures. Long-term post-surgical analgesia requirements, understandably, vary between orthopaedic cases. Our study aims to provide detailed information to clinicians and policy makers, on the opioid requirement associations for patients sustaining tibial fractures. Methods: This study reviewed all patients sustaining an isolated tibial fracture at a major trauma centre that were operated on within 1 month of injury, from 2015 to 2022. The total opioid dosage used each month in morphine milligrams equivalents (MME) and the number of days opioids were used each month, within the first-year post-surgery were collected, representing the strength and coverage of opioid analgesia in the post-operative stage, respectively. We compared opioid strength and coverage requirements with types of definitive fracture fixations, location, fracture type and concurrent patient medical comorbidities to assess for any trends. Results: A total of 1814 patients sustaining a combined of 1970 fractures were included in the study. Tibial plateau fractures had the highest opioid strength and coverage requirements in each month and the entire year (p <.05). Across all fracture locations, Ex Fix frame showed higher opioid strength and coverage requirements compared to both IM nailing and plate ORIF. With regard to opioid coverage in the presence of specific comorbidities, only chronic kidney disease (quotient: 1.37, 95% Confidence interval [95%CI] = 1.19–1.55, p =.002) and hypertension (quotient: 1.34, 95%CI = 1.14–1.53, p =.009) showed significance at the 1-year overall level. For opioid strength, Chronic Kidney Disease (quotient: 1.72, 95%CI = 1.41–2.03 p =.005) and COPD (quotient: 1.90, 95%CI = 1.44–2.36, p =.014), show significance at the 1-year overall level. Conclusion: Our study details opioid requirements post-surgery amongst tibial fractures with subgroup analysis assessing opioid needs amongst specific fracture locations, types, surgical techniques and medical comorbidities. This framework aids clinicians in anticipating rehabilitation and assists in risk stratifying patients at injury onset. [ABSTRACT FROM AUTHOR]

Objective: Compare patient satisfaction between telemedicine and in-office visits and between providers post-operatively in an orthopedics setting with athletic trainers and physicians. Design: Cross-sectional study Methods: Patients from a Sports Medicine Clinic that received an orthopedic surgical intervention from March 2020-September 2021, and engaged in telemedicine, or an in-office visit post-operatively. Provider type included full-time athletic trainers, resident athletic trainers, physician (MD) resident/fellows, and float athletic trainers. Press-Ganey Patient Experience Surveys were collected at the time of follow up visit, with focus on items, "likelihood to recommend" and "how well staff worked together." Results: There was a total of 255 patients (age=50±17 years). Providers included the attending physician with full-time athletic trainers (n=134, 52.3%), resident athletic trainers (n=77, 30.1%), MD residents/fellows (n=38, 14.8%), or float athletic trainers (n=6, 2.3%). No significant difference was found with patient satisfaction between in-office (n=175, 68.4%), or telemedicine visits (n=80, 31.3%), (p>.44). Patients were more satisfied with care provided by the full-time athletic trainers compared to MD residents/fellows (p.18). Conclusions: This study demonstrates no significant differences with patient satisfaction between in-office or telemedicine visits. Patients seeing full-time athletic trainers had the highest patient satisfaction, demonstrating the capability of athletic trainers to effectively use telemedicine in a physician practice. [ABSTRACT FROM AUTHOR]

Introduction: Conservative and surgical approach timeline in post-operative spondylodiscitis (POS) following lumbar disc herniation (LDH) surgery is ill defined, and patients have a protracted recovery phase with social, psychological, and financial implications. Materials and methods: Retrospective analysis of patients operated by transforaminal lumbar interbody fusion (TLIF) in POS was done. Confirmed clinico-radiological diagnosed POS cases, not responding within three to four weeks were included. Normalisation of CRP and radiological stable reconstruction was assessed for objective clearance of POS and bony union. Results: Ninety-five patients were included in the study with minimum follow-up period of two years. The mean age was 51.63±13.63 years. There were organisms cultured in 55 patients (57.89%). The ODI improvement of the patients was noted to improve from 88.71±5.3 to 20.80±9.7 (8 weeks) and was incremental at 2 years follow-up (10.12±6.41) and maintained further at final follow-up at 9±4.3. Bony union achieved in all with stable reconstruction. The resumption of activities of daily living (ADL) was quick (15.90±8.20 days) and job (3.67±1.31 months) was achieved in all the patients. In poor outcomes, two patients didn’t respond, and one patient died due to uncontrolled infection. Conclusion: Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.

Abstract This study aimed to determine the efficacy of using both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative partial weight-bearing (PWB) in reducing the incidence of delayed union in the ischium at one year after curved periacetabular osteotomy. We evaluated computed tomography images to clarify the incidence of delayed union at the osteotomy sites at one year post-operatively for 117 hips in 104 patients. Fifty-eight hips in 54 patients with use of both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative PWB were assigned to the oblique view and late PWB group (OL group) and 59 hips in 50 patients with use of only the postero-anterior image intensifier view intra-operatively and early start of post-operative PWB were assigned to the control group (C group). In univariate analyses, the incidence of delayed union in the ischium at one year post-operatively was significantly lower in the OL group (3.5%) than in the C group (22%). Use of both the postero-anterior and oblique image intensifier views during curved periacetabular osteotomy and late start of PWB were effective for reducing delayed union of the ischium at one year post-operatively.

Abstract One of the earliest medical disorders to be identified is epilepsy. Strange and diverse forms of therapy have been used throughout history. A cure has not been found despite the popularity of ointments, medications, magic, enemas, exorcism, spiritualism, surgical and physical, as well as behavioural therapies. There is a notable deficiency of current literature about the management of seizures and epilepsy in neurosurgical patients, despite the fact that neurosurgeons are enrolled in the prescription of antiepileptic drugs (AEDs) for the seizures especially in perioperative periods. Neurosurgeons scope of management of epilepsy usually involve patients with either traumatic brain injury, neoplasms, subarachnoid haemorrhages, and brain abscess and infection. Depending on when they began, post-craniotomy seizures are categorised into three categories: promptly (before 24 h), early (before 1 week), and late (after 1 week). One-third of seizures can occur within the first month after a craniotomy, usually within the first 3 days, even though the risk of seizures persists for several post-operative months. There are multiple generations of AEDs, and further research is required to settle a clear recommendation for each and every case of seizures especially for hard population like the neurosurgical patients.

Introduction: It is commonly believed that using abdominal binders or compression garments (CGs) after an abdominoplasty could encourage fluid to drain, which would prevent fluid from building up at the surgical site and reduce the risk of seroma and other similar problems. Objective: To evaluate the effect of the use of abdominal binders or CG on the post-operative outcomes following abdominoplasty. Design: Systematic review Method: Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to select relevant studies from 2004 to 2024. Data from the included studies were extracted to assess the quality and risk of bias using a modified Jadaad score. Main outcome: Post-operative seroma formation Secondary outcome: Ventilatory function, intra-abdominal pressure (IAP), and subcutaneous edema were the outcomes of interest. Results: Only 5 trials totaling 130 patients were included in this review. Utilizing post-operative CG following abdominoplasty showed a non-significant tendency to decrease seroma development, ventilatory function, and subcutaneous edema. The limited evidence available also suggested that using post-operative CG increases IAP. Conclusion: Weak evidence supports the beneficial use of abdominal binders following abdominoplasty. Limitations: Low-quality scientific evidence available from the scant data and low caliber of the literature support the use of CG post-abdominoplasty. Therefore, unified outcome reporting and rigid randomized clinical trials are necessary to obtain valid data.

Abstract Introduction Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers. Methods We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery. Results Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28‐day arrhythmia‐free survival was lower in patients undergoing lung and cardiovascular surgery (p

Introduction: To evaluate the duration of pediatric intensive care stay, hospitalization and the factors affecting mortality in patients who were operated by pediatric surgery and followed up in pediatric intensive care unit (PICU) in the postoperative period. Methods: One hundred forty-three patients who were operated between September 2018 and January 2020 and hospitalized in the PICU for post-operative follow-up were included in the study. Results: The median age of the 143 patients included in the study was 31.00 (1-205) months, and 76 (53.1%) were male. Ninety-six patients had no comorbidity, 47 patients had at least one comorbidity. The most frequent developed post-operative complications were sepsis (n=7) and intra-abdominal hypertension (n=7). The presence of sepsis extended the intensive care unit stay by 4.46 days, the need for inotropes by 3.61 days, the development of intra-abdominal hypertension by 3.33 days, and the presence of comorbidity by 0.86 days. The presence of sepsis extended the hospitalization period 28.04 days, the need for respiratory support 21.78 days, and the presence of malnutrition 14.42 days. Conclusion: It would be more appropriate to follow-up patients, who are operated by pediatric surgery, especially those with comorbidity and malnutrition, who need intraoperative blood products or who have the risk of developing complications in the postoperative period in PICUs.

One of the earliest medical disorders to be identified is epilepsy. Strange and diverse forms of therapy have been used throughout history. A cure has not been found despite the popularity of ointments, medications, magic, enemas, exorcism, spiritualism, surgical and physical, as well as behavioural therapies. There is a notable deficiency of current literature about the management of seizures and epilepsy in neurosurgical patients, despite the fact that neurosurgeons are enrolled in the prescription of antiepileptic drugs (AEDs) for the seizures especially in perioperative periods. Neurosurgeons scope of management of epilepsy usually involve patients with either traumatic brain injury, neoplasms, subarachnoid haemorrhages, and brain abscess and infection. Depending on when they began, post-craniotomy seizures are categorised into three categories: promptly (before 24 h), early (before 1 week), and late (after 1 week). One-third of seizures can occur within the first month after a craniotomy, usually within the first 3 days, even though the risk of seizures persists for several post-operative months. There are multiple generations of AEDs, and further research is required to settle a clear recommendation for each and every case of seizures especially for hard population like the neurosurgical patients. [ABSTRACT FROM AUTHOR]

Key Points Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post‐operative period has not been studied in live subjects and controversy exists in when to restart this post‐operatively. This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post‐surgical sphenoid sinus and the mid‐nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect. Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post‐operative period has not been studied in live subjects and controversy exists in when to restart this post‐operatively.This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post‐surgical sphenoid sinus and the mid‐nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect. [ABSTRACT FROM AUTHOR]

Objective: To compare the postoperative outcomes while using direct true lumen approach versus conventional cannulation approach in management of acute type-A aortic dissection patients. Study Design: Randomized Clinical Trial. Setting: Department of Vascular Surgery, Combined Military Hospital, Rawalpindi. Period: 1st June 2022 to 31st December 2022. Methods: A total of 22 patients age more than 18 years who presented in CMH Emergency Department with acute type A aortic dissection were included in this study. In group A (11 patients) were managed with direct true lumen cannulation while in group B (11 patients) were managed with conventional (axillary/femoral) cannulation. In both groups intra-operative parameters like procedure time, mean time of cardiopulmonary bypass, cross clamp and circulatory arrest time were measured. In both groups, outcome was measured in terms of occurrence of multi-organ failure, acute kidney injury, arrhythmias on ECG and in-hospital mortality. Data was analyzed using SPSS 26. Results: Mean age of our patients were 43.36±2.16yrs in group A while 43.36±2.94yrs in group B. Male gender predominates in both groups (gp A-81.8% & gp B-90.9%). We found no difference of statistical significance between two groups in terms of various intra-operative parameters like mean duration of procedure in group A was 428.15min and in group B was 427.36 min. Similarly mean circulatory arrest time was 31 min in group A and 29.09 min in group B. Patients in "direct true lumen cannulation" group had significantly shorter duration of intubation. In terms of post-operative outcomes, multi-organ failure occurred in 1 (9.09%) patient in group A while it occurred in 3(27.27%) patients in group B. In hospital mortality occurred in 2(18%) patients in group A as compared to 4(36%) in group B. So better results were observed in "direct true lumen cannulation" group as compared to "conventional (axillary/femoral) cannulation" group. Conclusion: In our study, acute type-A aortic dissection patients who had undergone direct true lumen cannulation during operative management showed better post-operative outcomes. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post‐caesarean section ultrasound‐guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment. No previous examination of surgical TAP blocks in patients having undergone emergency caesarean section has been undertaken.To investigate surgical TAP block and multimodal analgesic use during emergency caesarean section, the effect on surgical time, post‐operative analgesia use, and admission length.We performed a retrospective review of 250 patients who underwent emergency caesarean in 2022. Surgical TAP blocks were performed with 20 mL of 0.375% ropivacaine either side. Primary outcomes included surgical time, length of admission, time to first request of rescue opiate, opiate use in first post‐operative 24 h, total dose used during admission, and opiates prescribed on discharge.Ninety‐six patients received surgical TAP blocks, and 154 did not. There were no statistically significant differences in the primary outcomes. Subgroup analyses were performed in patients who did not receive intrathecal morphine, body mass index over 30 kg/m2, for patients whom this was their first caesarean, and for TAP blocks versus local infiltration to the wound. There were no significant differences in the primary outcomes in these subgroups.Surgical TAP blocks did not prolong surgical time or decrease post‐operative analgesia use or admission length in patients having undergone emergency caesarean. Patient‐tailored multimodal analgesia is encouraged, although more research is needed. [ABSTRACT FROM AUTHOR]

Objective The surgical population is ageing and often frail. Frailty increases the risk for poor post-operative outcomes such as delirium, which carries significant morbidity, mortality and cost. Frailty is often measured in a binary manner, limiting pre-operative counselling. The goal of this study was to determine the relationship between categorical frailty severity level and post-operative delirium. Methods We performed an analysis of a retrospective cohort of older adults from 12 January 2018 to 3 January 2020 admitted to a tertiary medical center for elective surgery. All participants underwent frailty screening prior to inpatient elective surgery with at least two post-operative delirium assessments. Planned ICU admissions were excluded. Procedures were risk-stratified by the Operative Stress Score (OSS). Categorical frailty severity level (Not Frail, Mild, Moderate, and Severe Frailty) was measured using the Edmonton Frail Scale. Delirium was determined using the 4 A's Test and Confusion Assessment Method-Intensive Care Unit. Results In sum, 324 patients were included. The overall post-operative delirium incidence was 4.6% (15 individuals), which increased significantly as the categorical frailty severity level increased (2% not frail, 6% mild frailty, 23% moderate frailty; P  < 0.001) corresponding to increasing odds of delirium (OR 2.57 [0.62, 10.66] mild vs. not frail; OR 12.10 [3.57, 40.99] moderate vs. not frail). Conclusions Incidence of post-operative delirium increases as categorical frailty severity level increases. This suggests that frailty severity should be considered when counselling older adults about their risk for post-operative delirium prior to surgery. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers. Methods: We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery. Results: Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28‐day arrhythmia‐free survival was lower in patients undergoing lung and cardiovascular surgery (p <.001). Patients who developed POAF had higher levels of C‐reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; p <.001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log‐scale = 1.81 (95% CI 1.18–2.79); p =.007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04–1.08); I <.001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65–98.73); p <.001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48–26.49; p =.013). Conclusions: Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia. [ABSTRACT FROM AUTHOR]

Background: Every year millions of patients undergo surgery. The prescribing pattern of medications in patients undergoing surgery may differ based on the hospital setup, profile of the patient, and type of surgical procedure. Hence, the present study is undertaken to know the prescribing pattern of pre-anesthetic, intraoperative, and post-operative agents in surgery and orthopedic department. Aims and Objectives: The aim of this study was to analyze the pattern of pre-anesthetic, intraoperative and post-operative medications used in surgery and orthopedic departments at a tertiary care teaching hospital. Materials and Methods: This cross-sectional, observational study was conducted in the departments of surgery and orthopedic in a tertiary care teaching hospital after taking approval from Institutional Ethics Committee. The details of demographic, clinical data and drugs prescribed during the pre-operative, intraoperative, and post-operative period were recorded in a preformed case record form and analyzed using descriptive statistics. Results: A total of 400 patients prescriptions were collected and analyzed which included 244 patients in orthopedic department and 156 patients in the surgery department. The average number of drugs per encounter was 10.01 and 7.25 in the surgery and orthopedic department, respectively. Preoperatively, the majority of patients received ondansetron (99.5%) followed by glycopyrrolate, midazolam, tramadol, and ranitidine. Surgery was done either under general anesthesia (sodium thiopental and sevoflurane) or local anesthesia (Bupivacaine). Skeletal muscle relaxants used along with general anesthetics included succinylcholine, atracurium, and vecuronium. Postoperatively, antimicrobial agents (AMAs) (831) were most commonly used followed by analgesic agents (368). The majority of AMAs were used from "Watch group" (50%) compared to "Access group" (38.88%) (World Health Organization-Access, Watch, Reserve classification). Conclusion: The present study gives an insight into the use of pre-anesthetic, intraoperative, and post-operative medications in our set-up. Generic medicines are used more which is good as it reduces the cost. Post-operative antimicrobial usage was more from the "Watch group" compared to the "Access group," which is a concern and needs implementation of antibiotic policy. [ABSTRACT FROM AUTHOR]

Abstract Background Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. Methods We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0–3). Results POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. Conclusion Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. Trial registration CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India).

Background and Aims: Regional anaesthesia has gained popularity in managing post-operative pain in paediatric patients. Quadratus lumborum block (QLB) is recognised as one of the peri-operative pain management techniques used during abdominal surgeries. However, no consensus about the best approach has been reached. Material and Methods: Sixty paediatric patients with ages ranging from 1 to 6 as well as classification I and II of the American Society of Anesthesiologists, scheduled for laparoscopic inguinal hernia, were allocated to receive either a posterior approach (Group I) or an anterior approach (Group II) QLB. Twenty four-hour morphine consumption, the face, legs, activity, cry, and consolability (FLACC) score, duration of analgesia, performance time, and block-related complications were recorded. Results: Group II showed significantly lower morphine consumption as well as a longer duration of analgesia (P = 0.039*, 0.020*, respectively), with an equivalent period for block performance being reported in the two groups (P = 0.080). At 2, 4, 6, and 12 hours post-operatively, the FLACC scores were substantially diminished in Group II compared to Group I (P = 0.001*, 0.012*, 0.002*, 0.028*, respectively). However, at twenty-four hours, comparable pain scores were observed between both groups (P = 0.626). In addition, there were no block-related complications. Conclusions: In paediatric patients scheduled for laparoscopic inguinal hernia repair, the ultra-sound-guided anterior approach of the QLB was associated with significantly reduced post-operative morphine consumption, a lower FLACC score, and a longer analgesia duration when compared to the posterior approach.

Background: Distal radius fractures are the most common fractures of upper limb. It accounts nearly 15- 20% of all fractures. Many surgical modalities are available for treatment of the same. It ranges from closed reduction &K-wiring to open reduction & fixation using plates. Objectives: To compare the radiological outcomes of distal radius fractures treated with various operative interventions by parameters like radial inclination, radial height and radial tilt. To find out appropriate modality of management for all varieties of distal end radius fracture. Correlation of the functional and radiological outcomes of various operative modalities and its comparison between different types of fractures. Methods: 110 patients were called for functional and radiological assessment. All the cases were classified according to fracture patterns for comparison of x-rays of operated and opposite wrist joint to analyse the radiological and functional outcomes. Result: Overall 110 patients were operated with slightly male preponderance, 62 male patients (56%) and 48 female patients (44%).Plating had superior outcomes followed by K-wiring. Conclusion: Distal radius fractures are increasingly common. Goal of treating distal radius fracture should be to achieve a painless, congruous wrist joint with anatomic reduction of the fracture along with faster and optimum recovery of functions which can be effectively assessed by radiological parameters.

Introduction: With a progressive rise in the number of total hip arthroplasties (THA) over the past decades, the proportion of patients sustaining peri-prosthetic fractures (PPF) has been substantially increasing. In this context, the need for clearly understanding the factors predisposing patients to PPF following THA and the impact of these adverse complications on the overall healthcare burden cannot be understated. Materials and methods: Based upon the Nationwide Inpatient Sample (NIS) database, the patients who underwent THA in the United States between 2016 and2019 (with ICD-10 CMP code) were identified. The patients were divided into 2 groups; group A – patients who sustained PPF and group B – those who did not. The information about the patients' demographic profile, medical comorbidities; and hospital admission (including length of stay and expenditure incurred) were analysed; and compared between the 2 groups. Results: Overall, 367,890 patients underwent THA, among whom 4,425 (1.2%) sustained PPF (group A). The remaining patients were classified under group B (363,465 patients). On the basis of multi-variate analysis (MVA), there was a significantly greater proportion of females, elderly patients, and emergent admissions (p < 0.001) in group A. The length of hospital stay, expenditure incurred and mortality were also significantly higher (p = 0.001) in group A. Based on MVA, Down's syndrome (odd's ratio 3.15, p = 0.01), H/O colostomy (odd's ratio 2.09, p = 0.008), liver cirrhosis (odd's ratio 2.01, p < 0.001), Parkinson's disease (odd's ratio 1.49, p = 0.004), morbid obesity (odd's ratio 1.44, p < 0.001), super obesity (odd's ratio 1.49, p = 0.03), and H/O CABG (coronary artery bypass graft; odd's ratio 1.21, p = 0.03) demonstrated significant association with PPF (group A). Conclusion: Patients with PPF require higher rates of emergent admission, longer hospital stay and greater admission-related expenditure. Female sex, advanced age, morbid or super obesity, and presence of medical comorbidities (such as Down's syndrome, cirrhosis, Parkinson's disease, previous colostomy, and previous CABG) significantly enhance the risk of PPF after THA. These medical conditions must be kept in clinicians' minds and close follow-up needs to be implemented in such situations so as to mitigate these complications. [ABSTRACT FROM AUTHOR]

Aim: To develop a nurse‐led model of analgesia to manage post‐operative pain in the surgical neonate. Design: A four‐round e‐Delphi study was conducted from March to December 2022. Methods: An e‐Delphi method was used seeking a consensus of 70% or greater. Fifty‐one experts were invited to join the panel. Members consisted of multi‐disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free‐text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse‐controlled analgesia was presented along with a further opportunity to provide feedback on the final version. Results: Four rounds of statements and voting were required to reach consensus on a model of neonatal nurse‐controlled analgesia. The model consists of criteria for use, over‐arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time‐lapsed post‐surgical procedure. Conclusion: A comprehensive model of neonatal nurse‐controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts. Impact: This study provides a multi‐modal family‐integrated model to manage neonatal post‐operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care. Reporting Method: This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies. Patient or Public Contribution: No patient or public contribution was utilized for this study. [ABSTRACT FROM AUTHOR]

To identify risk factors associated with post-pericardiotomy syndrome (PPS) in patients undergoing surgical repair of atrial septal defects (ASD). A single-center retrospective study. Tertiary academic hospital. Included were patients of all ages who underwent surgical ASD repair, while exclusion criteria included the absence of post-operative electrocardiogram (ECG), lack of follow-up post-discharge and factors hindering ECG interpretation. Demographic and clinical data, including ECG changes indicative of pericardial inflammation, were collected. The primary outcome measure was the development of PPS, determined based on the standardized European Society of Cardiology (ESC) criteria. Among 190 patients who underwent surgical ASD repair, 154 (81%) met the inclusion criteria. Of these, 25 (16%)in total developed PPS, of which 60% were ≥ 18 years of age and 56% female. Significant associations relating both early ECG changes and pre-discharge pericardial effusion with subsequent occurrence of PPS were found in both univariate and multivariate analyses. The study establishes correlations of both early post-operative ECG changes indicative of inflammation and pre-discharge pericardial effusion with subsequent occurrence of PPS in patients undergoing surgical ASD repair. Both utilizing the standardized ESC definition of PPS and incorporating a physician-validated ECG evaluation strengthened the methodologic approach in establishing these relationships. The results also highlight the importance of considering age as a potential risk factor for PPS. Further research is needed to validate these findings and explore additional risk factors predicting early identification and management of patients at high risk for PPS following surgical ASD repairs. [ABSTRACT FROM AUTHOR]

Key points: Hospital frailty risk score (HFRS) correlates with complications, length of stay, and non‐routine discharge.HFRS is a better predictor of postsurgical sequelae than age and Elixhauser comorbidity index. [ABSTRACT FROM AUTHOR]

Background: Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. Methods: We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0–3). Results: POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. Conclusion: Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. Trial registration: CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India). [ABSTRACT FROM AUTHOR]

Background: Budesonide high-volume saline irrigations (HVSIs) are routinely used to treat chronic rhinosinusitis (CRS) due to improved sinonasal delivery and efficacy compared to intranasal corticosteroid sprays. The off-label use of budesonide is assumed to be safe, with several studies suggesting the systemically absorbed dose of budesonide HVSI is low. However, the actual budesonide dose retained in the sinonasal cavity following HVSI is unknown. The objective of this study was to quantify the retained dose of budesonide after HVSI. Methods: Adult patients diagnosed with CRS who had undergone endoscopic sinus surgery (ESS) and were prescribed budesonide HVSI were enrolled into a prospective, observational cohort study. Patients performed budesonide HVSI (0.5 mg dose) under supervision in an outpatient clinic, and irrigation effluent was collected. High-performance liquid chromatography was employed to determine the dose of budesonide retained after HVSI. Results: Twenty-four patients met inclusion criteria. The average corrected retained dose of budesonide across the cohort was 0.171 ± 0.087 mg (37.9% of administered budesonide). Increased time from ESS significantly impacted the measured retained dose, with those 3 months post-ESS retaining 27.4% of administered budesonide (P =.0004). Conclusion: The retained dose of budesonide in patients with CRS after HVSI was found to be significantly higher than previously estimated and decreased with time post-ESS. Given that budesonide HVSI is a cornerstone of care in CRS, defining the retained dose and the potential systemic implications is critical to understanding the safety of budesonide HVSI. [ABSTRACT FROM AUTHOR]

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Background: The proximal humerus is the third most common fractured bone in the body, making up about 4%-5% of all fractures. Incidence occurs mostly after distal radius fractures and hip fractures. Fractures of the proximal humerus are more common among the elderly. Studying the outcomes of proximal humeral nailing fixation for two- and three-part proximal humeral fractures was the primary focus of this prospective observational study. This study was conducted to assess the clinical, radiological and functional outcome of treating Neer 2, 3-part proximal humerus fracture using intramedullary proximal humerus nailing and to know the advantages, disadvantages and complications of the procedure. Materials and Methods: A prospective study was conducted in K A P V govt Medical College& MGMGH, Trichy. This study included the patients with fracture of proximal humerus requiring surgical interventions, after taking their consent, were analyzed clinically and radiologically. All the patients selected for the study were evaluated as per the history & mode of injury, necessary clinical and laboratory investigations. The pre-operative and immediate postoperative X-ray were evaluated. The patients were evaluated clinically and radiologically in their subsequent follow-up every 6 weeks till fracture union and at 1 year after surgery. Results: The time for union (weeks) was 11 to 14 weeks in86.66% of the participants. Most of the patients had follow-up till one year. The mean post op NEER score 75.17 ± 5.85 at 6 weeks, it was 79.63 ± 5.3 at 3 months, it was 83.23 ± 5.28 at 6 months, it was 88.5 ± 5.48 at final score.36.67% and 63.33% of the participants had NEER 2 and 3part type of fracture injury. Among the study population with post-op complication, 10.00% of them had varus malunion, 6.67% of them had rotator cuff injury, 3.33% of them had glenohumeral protrusion. We found that 63.33% of them had excellent outcomes, 26.67% of them had satisfactory outcomes, 10.00% of them had unsatisfactory outcomes. Conclusion: We discovered that individuals with both two and three-part fractures exhibit successful fracture union. Post-operative NEER score was improved with the patients treated. We found that there was a good outcome with a smaller number of complications found in the treatment of proximal humeral nailing. [ABSTRACT FROM AUTHOR]

Background and Aims: Regional anaesthesia has gained popularity in managing post-operative pain in paediatric patients. Quadratus lumborum block (QLB) is recognised as one of the peri-operative pain management techniques used during abdominal surgeries. However, no consensus about the best approach has been reached. Material and Methods: Sixty paediatric patients with ages ranging from 1 to 6 as well as classification I and II of the American Society of Anesthesiologists, scheduled for laparoscopic inguinal hernia, were allocated to receive either a posterior approach (Group I) or an anterior approach (Group II) QLB. Twenty four-hour morphine consumption, the face, legs, activity, cry, and consolability (FLACC) score, duration of analgesia, performance time, and block-related complications were recorded. Results: Group II showed significantly lower morphine consumption as well as a longer duration of analgesia (P = 0.039*, 0.020*, respectively), with an equivalent period for block performance being reported in the two groups (P = 0.080). At 2, 4, 6, and 12 hours post-operatively, the FLACC scores were substantially diminished in Group II compared to Group I (P = 0.001*, 0.012*, 0.002*, 0.028*, respectively). However, at twenty-four hours, comparable pain scores were observed between both groups (P = 0.626). In addition, there were no block-related complications. Conclusions: In paediatric patients scheduled for laparoscopic inguinal hernia repair, the ultra-sound-guided anterior approach of the QLB was associated with significantly reduced post-operative morphine consumption, a lower FLACC score, and a longer analgesia duration when compared to the posterior approach. [ABSTRACT FROM AUTHOR]

Background: Several risk calculating tools have been introduced into clinical practice to provide patients and clinicians with objective, individualised estimates of procedure-related unfavourable outcomes. The currently available risk calculators (RCs) have been developed by well-endowed health systems in Europe and the USA. Applicability of these RCs in low-middle income country (LMIC) settings with wide disparities in patient population, surgical practice and healthcare infrastructure has not been adequately examined. Patients and Methods: Through this single tertiary care, LMIC-centre, retrospective cohort study, we investigated the accuracy of the two most widely validated RCs - American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) RC and ColoRectal Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) - for the prediction of mortality in patients undergoing elective and emergency colorectal surgery (CRS) from March 2013 to March 2020. Online RCs were used to predict mortality and other outcomes. Accuracy was assessed by Brier score and C statistic. Results: Of 105 patients, 69 (65.71%) underwent elective and 36 (34.28%) underwent emergency CRS. The 30-day overall mortality was 12 - elective 1 (1.4%) and emergency 11 (30.5%). ACS-NSQIP RC performed better for the prediction of overall (C statistic 0.939, Brier score 0.065) and emergency (C statistic 0.840, Brier score 0.152) mortality. However, for elective CRS mortality, Brier scores were similar for both models (0.014), whereas C statistic (0.934 vs. 0.890) value was better for ACS-NSQIP. Conclusions: Both ACS-NSQIP and CR-POSSUM were accurate for the prediction of CRS mortality. However, compared to CR-POSSUM, ACS-NSQIP performed better. The overall performance of both models is indicative of their wider applicability in LMIC centres also. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic cholecystectomy, being minimally invasive, is widely accepted in comparison to open cholecystectomy. The major benefits are small incision, less wound pain, rapid recovery, shorter hospital stay and earlier return to activities. Although, trauma and injury are limited in laparoscopic cholecystectomy; it is not a pain free surgery. Hence, we aimed to find out the prevalence of pain at wound site after laparoscopic cholecystectomy at various time intervals in post-operative period. Methods: The descriptive cross-sectional study was conducted among 125 American Society of Anesthesiologists grade I/II patients, with diagnosis of symptomatic gallstone disease from October 2022 to September 2023 in a tertiary care hospital after ethical approval was obtained from Institutional Research Committee (Reference number: MEMG/483/IRC). Total sampling was done in this study. The post-operative pain at wound site was measured at 12, 24, 36 and 48 hours. Data were analyzed using SPSS 21.0. Results: At 12 hours postoperatively, 2 (1.60%) patients complained of severe pain, 120 (96%) patients reported moderate pain and 3 (2.40%) patients expressed their pain as being mild. Likewise, at 24, 36 and 48 hours postoperatively, none of the patients suffered from severe pain. At 24 hours post-operative, 105 (84%) patients reported moderate pain which gradually declined over 48 hours. At 36 and 48 hours post-operative mild pain was reported by 85 (68%) and 117 (93.60%) patients respectively. The moderate pain was complained by 40 (32%) and 8 (6.40%) patients respectively. Conclusions: The majority of patients suffered from mild to moderate pain after laparoscopic cholecystectomy, the intensity of which decreased over 48 hours.

Introduction: Total Knee Arthroplasty (TKA) has been widely reported to improve outcomes and quality of life (QoL) in patients with knee osteoarthritis (KOA), but there are still 15 - 20% of patients still experience pain, physical limitations, and other complications after TKA. Therefore, it is necessary to identify various factors that correlate with QoL from current evidence. The objective is to review the literature on factors that correlate with QoL in patients who underwent TKA. Materials and methods: A literature search was conducted on five databases, i.e. ProQuest, CINAHL, Medline, Embase, and Scopus, using the following keywords: total knee arthroplasty (TKA), post-operative, quality of life (QoL), and outcome. There were no restrictions on the research design. Results: This review found 14 articles (7 prospective studies and 7 retrospective studies) involving 15,972 patients who underwent TKA, with an age range of 32 - 94 years. All articles reported improvement in QoL after TKA. The review revealed 30 factors, of which 15 factors were significantly correlated with QoL after TKA. The factors were grouped into four types: demographic, socioeconomic, clinical, and psychosocial factors. Conclusion: Information regarding factors that correlate with QoL after TKA can be used for directing treatment and discharge planning according to the patient's factors.

Background: Post-operative acute kidney injury (AKI) poses significant risks. Identifying intraoperative determinants is crucial for enhancing patient outcomes and tailoring surgical interventions. Aims and Objectives: This study aimed to investigate the onset of post-operative AKI in patients subjected to various surgical interventions and identify potential intra-operative determinants. Materials and Methods: In this observational investigation conducted at our institution, 100 patients who underwent diverse surgical procedures were included in the study. AKI diagnosis was based on the kidney disease: improving global outcomes guidelines. The parameters assessed encompassed patient demographics, intraoperative fluid management, surgical and anesthetic durations, and post-operative AKI incidence. Determinants of AKI were identified using multivariate logistic regression. Results: The cohort comprised 58% males, with a mean age of 65±12 years. Key comorbidities included hypertension (42%), diabetes mellitus (28%), chronic kidney disease (15%), and cardiovascular disease (20%). Intraoperatively, the average fluid volume administered was 2.5 ± 0.8 L. Fluid management primarily included balanced crystalloids (70%), followed by normal saline (20%), and colloids (10%). Anesthesia was maintained for an average of 3.5 ± 1.2 h. Post-surgery, 15% of the patients developed AKI. A detailed evaluation revealed a strong association between positive intraoperative fluid balance and AKI onset. The statistical analysis pinpointed elevated intraoperative fluid balance (odds ratio: 5.89; 95% confidence interval [CI]: 1.72–20.15; P=0.004) and extended anesthesia duration (odds ratio: 2.12; 95% CI: 1.01–4.47; P=0.046) as significant predictors. Conclusion: AKI onset post-surgery is closely tied to intraoperative factors, notably fluid balance, and anesthesia duration. This underscores the importance of personalized fluid management and vigilant post-operative renal function monitoring to mitigate AKI risks.

Background: Several risk calculating tools have been introduced into clinical practice to provide patients and clinicians with objective, individualised estimates of procedure-related unfavourable outcomes. The currently available risk calculators (RCs) have been developed by well-endowed health systems in Europe and the USA. Applicability of these RCs in low-middle income country (LMIC) settings with wide disparities in patient population, surgical practice and healthcare infrastructure has not been adequately examined. Patients and Methods: Through this single tertiary care, LMIC-centre, retrospective cohort study, we investigated the accuracy of the two most widely validated RCs - American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) RC and ColoRectal Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) - for the prediction of mortality in patients undergoing elective and emergency colorectal surgery (CRS) from March 2013 to March 2020. Online RCs were used to predict mortality and other outcomes. Accuracy was assessed by Brier score and C statistic. Results: Of 105 patients, 69 (65.71%) underwent elective and 36 (34.28%) underwent emergency CRS. The 30-day overall mortality was 12 - elective 1 (1.4%) and emergency 11 (30.5%). ACS-NSQIP RC performed better for the prediction of overall (C statistic 0.939, Brier score 0.065) and emergency (C statistic 0.840, Brier score 0.152) mortality. However, for elective CRS mortality, Brier scores were similar for both models (0.014), whereas C statistic (0.934 vs. 0.890) value was better for ACS-NSQIP. Conclusions: Both ACS-NSQIP and CR-POSSUM were accurate for the prediction of CRS mortality. However, compared to CR-POSSUM, ACS-NSQIP performed better. The overall performance of both models is indicative of their wider applicability in LMIC centres also.

OBJECTIVE: This study aims to assess upper ipsilateral limb function clinically as well as the effects of specific post-surgical complications that arise following mastectomy by either intervening with an early rehabilitation program or not. To look at the physical morbidity following surgery and sentinel lymph node dissection (SLND/axillary lymph node dissection, ALND). METHODOLOGY: This study used samples of 40 post-operative mastectomies, with 20 in each Group taken using a non-probability consecutive sampling technique. The data were gathered using an observational sheet on physical therapy; bivariate analysis was used, and the Whitney test was used to analyze the upper arm condition in the control and intervention groups pre- and post-early physical therapy intervention. RESULT: This study showed the influence of early physical therapy of the upper arm on recovery postoperative mastectomy patients at p-value = 0.000 (p

The article presents a case study of a 9-month-old child who developed a wide complex tachycardia in a bigeminal pattern following heart surgery for Tetralogy of Fallot. It states that despite treatments including Amiodarone, Ivabradine, and electrical cardioversion, the tachycardia persisted. It mentions that diagnosis suggested junctional tachycardia with echo bigeminy, a rare arrhythmia in pediatric congenital heart surgery patients, likely exacerbated by perioperative inotropic agents.

Objective: This study aimed to compare the efficacy and safety of intravenous (IV) infusion of dexmedetomidine versus IV infusion of propofol for post-operative sedation in the intensive care unit (ICU). Methods: A prospective, randomized controlled trial was conducted involving 300 postoperative ICU patients. Patients were randomly assigned to receive either dexmedetomidine or propofol for sedation. Sedation depth was assessed using the Richmond Agitation-Sedation Scale (RASS), monitoring vital signs, and adverse events. Baseline demographic data, including age, sex, BMI, comorbidities, surgery duration, and APACHE II scores, were recorded. Statistical analysis employed t-tests, chi-square tests, and Fisher's exact tests for comparison. Results: Both groups (dexmedetomidine and propofol) comprised 150 patients each. Baseline characteristics were similar between groups. Sedation depth, assessed by RASS scores, and time within the target sedation range (-2 to +1) were comparable between the groups. Hemodynamic parameters remained stable with no significant differences. Adverse events such as bradycardia, hypotension, and respiratory depression were infrequent and similar in both groups. Conclusion: Dexmedetomidine and propofol demonstrated comparable efficacy in achieving and maintaining sedation depth, ensuring hemodynamic stability, and exhibiting low rates of adverse events in post-operative ICU patients. The choice between these agents may depend on individual patient needs and specific clinical scenarios, considering their distinct pharmacological profiles. Further research exploring long-term outcomes and cost-effectiveness is warranted to guide optimal sedation strategies in the ICU. [ABSTRACT FROM AUTHOR]

Background: Current recommendations advocate the achievement of an optimal glucose control (HbA1c < 69 mmol/mol) prior to elective surgery to reduce risks of peri- and post-operative complications, but the relevance for this glycaemic threshold prior to Bariatric Metabolic Surgery (BMS) following a specialist weight management programme remains unclear. Methods: We undertook a retrospective cohort study of patients with type 2 diabetes mellitus (T2DM) who underwent BMS over a 6-year period (2016–2022) at a regional tertiary referral following completion of a specialist multidisciplinary weight management. Post-operative outcomes of interest included 30-day mortality, readmission rates, need for Intensive Care Unit (ICU) care and hospital length of stay (LOS) and were assessed according to HbA1c cut-off values of < 69 (N = 202) and > 69 mmol/mol (N = 67) as well as a continuous variable. Results: A total of 269 patients with T2D were included in this study. Patients underwent primary Roux en-Y gastric bypass (RYGB, n = 136), Sleeve Gastrectomy (SG, n = 124), insertion of gastric band (n = 4) or one-anastomosis gastric bypass (OAGB, n = 4). No significant differences in the rates of complications were observed between the two groups of pre-operative HbA1c cut-off values. No HbA1c threshold was observed for glycaemic control that would affect the peri- and post-operative complications following BMS. Conclusions: We observed no associations between pre-operative HbA1C values and the risk of peri- and post-operative complications. In the context of a specialist multidisciplinary weight management programme, optimising pre-operative HbA1C to a recommended target value prior to BMS may not translate into reduced risks of peri- and post-operative complications. [ABSTRACT FROM AUTHOR]

An uncomplicated appendectomy in children is common. Safely minimizing the post-operative length of stay is desirable from hospital, patient, and parent perspectives. In response to an overly long mean length of stay following uncomplicated appendectomies in children of 2.5 days, we developed clinical pathways with the goal of safely reducing this time to 2.0 or fewer days. The project was conducted in an urban, academic children's hospital. The pathways emphasized the use of oral, non-narcotic pain medications; the education of parents and caregivers about expectations regarding pain control, oral food intake, and mobility; and the avoidance of routine post-operative antibiotic use. A convenience sample of 46 patients aged 3–16 years old was included to evaluate the safety and efficacy of the intervention. The mean post-operative length of stay was successfully reduced by 80% to 0.5 days without appreciable complications associated with earlier discharge. The hospital length of stay following an uncomplicated appendectomy in children may be successfully and safely reduced through the use of carefully devised, well-defined, well-disseminated clinical pathways. [ABSTRACT FROM AUTHOR]

Objective: Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. Materials and methods: The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. Results: Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. Conclusion: Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation. [ABSTRACT FROM AUTHOR]

Background: Post-operative acute kidney injury (AKI) poses significant risks. Identifying intraoperative determinants is crucial for enhancing patient outcomes and tailoring surgical interventions. Aims and Objectives: This study aimed to investigate the onset of postoperative AKI in patients subjected to various surgical interventions and identify potential intraoperative determinants. Materials and Methods: In this observational investigation conducted at our institution, 100 patients who underwent diverse surgical procedures were included in the study. AKI diagnosis was based on the kidney disease: improving global outcomes guidelines. The parameters assessed encompassed patient demographics, intraoperative fluid management, surgical and anesthetic durations, and post-operative AKI incidence. Determinants of AKI were identified using multivariate logistic regression. Results: The cohort comprised 58% males, with a mean age of 65±12 years. Key comorbidities included hypertension (42%), diabetes mellitus (28%), chronic kidney disease (15%), and cardiovascular disease (20%). Intraoperatively, the average fluid volume administered was 2.5 ± 0.8 L. Fluid management primarily included balanced crystalloids (70%), followed by normal saline (20%), and colloids (10%). Anesthesia was maintained for an average of 3.5 ± 1.2 h. Post-surgery, 15% of the patients developed AKI. A detailed evaluation revealed a strong association between positive intraoperative fluid balance and AKI onset. The statistical analysis pinpointed elevated intraoperative fluid balance (odds ratio: 5.89; 95% confidence interval [CI]: 1.72-20.15; P=0.004) and extended anesthesia duration (odds ratio: 2.12; 95% CI: 1.01-4.47; P=0.046) as significant predictors. Conclusion: AKI onset post-surgery is closely tied to intraoperative factors, notably fluid balance, and anesthesia duration. This underscores the importance of personalized fluid management and vigilant post-operative renal function monitoring to mitigate AKI risks. [ABSTRACT FROM AUTHOR]

Background: Thyroglobulin is a well-established disease marker during follow-up in paediatric differentiated thyroid cancer. However, no conclusive data on the role of endogenously stimulated thyroglobulin after thyroidectomy (ptTg) in predicting disease-specific outcomes are available. This review aims to establish the prognostic value of ptTg in children with DTC. Methods: Online medical databases were searched for studies evaluating the association between ptTg and disease-specific outcomes in DTC-affected children. Documents not in English, preclinical studies, other review articles, case reports, and small case series were excluded. The risk of bias was assessed with the QUADAS-2 tool. Results: Twelve studies, analysing 1043 children in total, were included in the review. They all had a retrospective design and were published between 2016 and 2022. Of all patients, 1008 (97%) and 849 (81%) had undergone thyroidectomy and RAI, respectively. Eight studies (756 children) evaluated the correlation between ptTg and disease persistence/relapse: six reported a significant association between these parameters; a specific ptTg cut-off (10–14 ng/ml) was identified at the multivariate analysis in three studies. The remaining four studies assessed the link between ptTg levels and disease extension, with three reporting a correlation between ptTg and lung/nodal metastases. Discussion: ptTg is a readily available and inexpensive parameter, bearing a strong prognostic power in identifying disease persistence, relapse, and the presence of metastases in children affected by DTC. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aims to assess upper ipsilateral limb function clinically as well as the effects of specific post-surgical complications that arise following mastectomy by either intervening with an early rehabilitation program or not. To look at the physical morbidity following surgery and sentinel lymph node dissection (SLND/axillary lymph node dissection, ALND). METHODOLOGY: This study used samples of 40 post-operative mastectomies, with 20 in each Group taken using a non-probability consecutive sampling technique. The data were gathered using an observational sheet on physical therapy; bivariate analysis was used, and the Whitney test was used to analyze the upper arm condition in the control and intervention groups pre- and post-early physical therapy intervention. RESULT: This study showed the influence of early physical therapy of the upper arm on recovery postoperative mastectomy patients at p-value = 0.000 (p <0.05). CONCLUSION: Multifactorial physical therapy (i.e. stretching, exercises) and active exercises were practical to treat post-operative pain and impaired ROM after treatment for breast cancer, so early physical therapy can improve function disabilities without causing post-operative complications. It is concluded that early physical therapy intervention following a mastectomy can reduce the adverse effects of the procedure, including shoulder immobility recovery. Patients with breast cancer should be advised to undergo early rehabilitation following a mastectomy, thereby decreasing their length of immobilization. [ABSTRACT FROM AUTHOR]