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Purpose: Fractures around the hip are known to be an indicator for fragility and are associated with high mortality and various complications. A special type of fractures around the hip are periprosthetic femur fractures (PPF) after Total Hip Arthroplasty (THA). The aim of this study was to investigate the mortality rate associated with PPF after THA and to identify risk factors that may increase it. Methods: Consecutive patients (N = 158) who were treated for a PPF after THA in our university hospital between 2010 and 2020 were identified and mortality was assessed using the residential registry. Univariate (Kaplan-Meier-Estimator) and multivariate (Cox-Regression) statistical analysis was performed to identify risk factors influencing mortality. Results: One-year-mortality rate was 23.4% and 2-year mortality was 29.2%. Mortality was significantly influenced by age, gender, treatment, type of comorbidity and time of surgery (p < 0.05). Surgical treatment during regular working hours (8 to 18 h) reduced mortality by 53.2% compared to surgery on call (OR: 0.468, 95% CI 0.223, 0.986; p = 0.046). For every year of age, mortality risk increased by 12.9% (OR: 1,129, 95% CI 1.078, 1.182; p < 0.001). The type of fracture according to the Vancouver classification had no influence on mortality (p = 0.179). Plate fixation and conservative treatment were associated with a higher mortality compared to revision arthroplasty (plate: OR 2.8, 95% CI 1.318, 5.998; p = 0.007; conservative: OR 2.5, 95% CI 1.421, 4.507; p = 0.002). Conclusion: Surgical treatment during regular working hours is associated with lower mortality compared to surgery outside these hours. In this retrospective cohort, time to surgery showed no significant impact on all-cause mortality, and revision arthroplasty was associated with lower mortality than conservative treatment or plate fixation. Level of evidence: IV (Retrospective cohort study). [ABSTRACT FROM AUTHOR]

Summary: Background: The timing of elective surgery could affect clinical outcome because of diurnal rhythms of patient physiology as well as surgical team performance. Waiting times for elective surgery are increasing in many countries, leading to increasing interest in undertaking elective surgery in the evening or at night. We aimed to systematically review the literature on the effect of the timing of elective (but not urgent or emergency) surgery on mortality, morbidity and other clinical outcomes. Methods: We searched databases for relevant studies combining the terms 'circadian rhythm' and 'anaesthesia/surgery'. Additional relevant articles were found by hand‐searching the references. All studies were screened for bias. Included studies examined daytime vs. evening/night‐time surgery, morning vs. afternoon surgery, multiple timeslots or used time as a continuous variable. Results: Nineteen retrospective cohort studies, one prospective cohort study and one randomised controlled trial were included (n = 798,914). Evening/night‐time elective surgery was associated with a higher risk of mortality when compared with daytime procedures in three studies (n = 611,230), with odds ratios (95%CI) for mortality ranging from 1.35 (1.16–1.56) to 3.98 (1.54–10.30), while no differences were found in three other studies (n = 142,355). No differences were found for morning vs. afternoon surgery (four studies, n = 3277). However, most studies had a low quality of evidence due to their retrospective nature and because not all studies corrected for patient characteristics. Moreover, the studies were heterogeneous in terms of the reported time slots and clinical outcomes. Conclusions: We found that evening/night‐time elective surgery is associated with a higher risk of mortality compared with daytime surgery. However, the quality of evidence was graded as low, and thus, future prospective research should publish individual patient data and standardise outcome measures to allow firm conclusions and facilitate interventions. [ABSTRACT FROM AUTHOR]

Introduction: Congenital volvulus without a prenatal diagnosis of malrotation is an extremely rare cause of acute intestinal obstruction in the foetal and neonatal period with a high morbidity and mortality. The aim of this report is to describe prenatal imaging, pregnancy characteristics and clinical outcomes to identify a gold standard management approach for neonates affected by congenital volvulus through our experience with this case as well as a review of the literature. Case presentation: We describe an intrauterine case of volvulus without malrotation suspected by prenatal ultrasound at 28 weeks' gestation, with enlarged hyperechogenic loops without peristalsis in a 715g preterm boy born at 29 weeks' gestation. The discrepancy between the minimal clinical manifestations and the severity of intestinal pathology is highlighted. At explorative laparotomy following delivery, a congenital mesenteric defect was identified through which small bowel had herniated and volvulised, causing prenatal bowel dilatation and necrosis. The necrotic bowel was resected, and both an ileostomy and jejunostomy were created within 30 hours of birth. However, severe post-operative complications were encountered, which ultimately led to the newborn's death. Conclusion: Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. A high index of suspicion is required in cases of bowel dilatation, intestinal duplication or malrotation. Strict foetal follow up with serial ultrasound assessment and planned cesarean delivery are recommended. Multidisciplinary care is essential. Time of delivery and surgical intervention should be standardised to reduce the risk of neonatal mortality.

Objectives: Performing orthopedic surgery in and out of working hours may affect the success of the surgery. Timing of surgery in tibial shaft fractures is controversial. In this study, the effect of the timing of surgery on the success and complications of intramedullary nailing of tibial fractures is examined. Methods: Archieves of patients with tibial shaft fractures treated with reamed intramedullary nails between 2010 and 2016 were retrospectively analyzed. Fifty-seven patients were included in the study. Patients were categorized by the time of the surgery. Day time (Group I) is between 7:00 am and 5:00 pm and after hour (Group II) is between 5:00 pm and 07:00 am. Group I (n: 40) and Group II (n: 17) were evaluated. Technical errors, surgery time, and length of hospital stay statistical analysis was performed between the two groups in terms of technical errors, complication rates, length of hospital stay, and duration of surgery. Results: The mean duration of operation (p=0.419), number of distal screws (p=0.847), time to union (p=0.454), experience of the surgeon (p=0.192), and technical error rate (p=0.654) did not differ significantly between two groups. Length of hospital stay and time to surgery from emergency were significantly higher in day time group. Conclusion: Technical errors and surgery time of intramedullary nailing of tibial shaft fractures are not higher at after hour before midnight than day time. Non-urgent tibial shaft fractures might be treated with intramedullary nailing at after hours before midnight for efficient use of hospitals. [ABSTRACT FROM AUTHOR]

Numerous types of prosthodontics surgical guides, with and without metallic sleeves, have been found to be useful in clinical studies. The aim of this in vitro research was to compare the time required to complete the surgical procedure with two differently designed surgical prosthetic templates. Ten identical prototype models of mandible based on a CBCT and optical scan of a partially edentulous patient with missing teeth numbers 37, 46, and 47 were prepared and then printed. Five of these models were used for implant site preparation with a surgical guide without metal sleeves and dedicated surgical kit, and the other five models were used for the same procedure performed with a surgical guide with metal sleeves and a dedicated surgical kit. The time of implant site preparation was measured and recorded. Statistical analysis was performed using Student’s t-test for independent samples. Differences between groups were found to be statistically significant (t = −9.94; df = 28; p = 0.0000) with a lower value in favor of the surgical templates without metallic sleeves. Different types of prosthodontics surgical guides, with or without metallic sleeves, seemed to be an important factor which can significantly impact the time of implant site preparation and, therefore, the overall surgical procedure.

ObjectiveTo develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome.MethodsA systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as "we recommend," whereas a weak recommendation is presented as "we suggest."ResultsConclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Quality of evidence for both recommendations was considered low.ConclusionsThese guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.

Background: There is a paucity of evidence surrounding the issue of delays on the day of surgery with respect to both causes and consequences. We sought to determine whether patients whose operations started late were at increased risk of post-operative complications. Methods: We conducted a retrospective cohort study of 1420 first-of-the-day common general surgical procedures, dividing these into "on-time start" (OTS) and "late-start" (LS) cases. Our primary outcomes were minor and major complication rate; our secondary objective was to identify factors predicting LS. Groups were compared using univariable and multivariable analysis. Results: LS rate was 55.3%. On univariable analysis, LS had higher rates of major and minor complications (7.3% vs. 3.5%, p = 0.002; 3.8% vs. 1.6%, p = 0.011). On multivariable analysis, LS was not associated with increased odds of any complications. Minor complications were predicted by operative duration [OR = 1.005 (1.002–1.008)], female sex [OR = 1.78 (1.037–3.061)], and undergoing an ileostomy closure procedure [OR = 10.60 (2.791–40.246)], and were reduced in those undergoing surgery on Wednesdays [OR = 0.38 (0.166–0.876)]. Major complications were predicted by operative duration [OR = 1.007 (1.003–1.011)] and ASA class [OR = 6.73 (1.505–30.109)]. Multivariable analysis using LS as an outcome identified that anesthesia time [OR = 1.35 (1.031–1.403)], insulin-dependent diabetes [OR = 1.91 (1.128–3.246)], and dyspnea upon moderate exertion [OR = 2.52 (1.423–4.522)] were predictive of LS. Conclusions: Most cases in our study started late. While this has significant efficiency and economic costs, it is not associated with adverse patient outcomes. This topic remains incompletely described. Further research is needed to improve efficiency and patient experience by investigating the causes of operative delays. [ABSTRACT FROM AUTHOR]

Introduction: Giant cell tumors of the bone (GCTB) are aggressive neoplasms, with rare occurrences in the posterior pelvis and sacral area. Surgical challenges in this region include the inability to apply a tourniquet and limited cementation post-curettage due to proximity to neurovascular structures, leading to potential complications. This case-control study explores the impact of preoperative embolization on GCTB located in the iliosacral region., Methods: Five surgeries (January-December 2021) for pelvic GCTB (3 sacrum, 2 posterior ilium) were performed on four patients. Diagnosis was confirmed through preoperative CT-guided biopsies. One surgery involved curettage with PMMA cement filling, while four surgeries had curettage without cavity filling. Preoperative embolization of the tumor feeding vessel occurred approximately 16 h before surgery in two cases. Denosumab treatment was not administered., Results: Tumor volume, assessed by preoperative MRI, was comparable between patients with and without preoperative embolization (p = .14). Surgeries without embolization had a mean intraoperative blood loss of 3250 ml, erythrocyte transfusion volume of 1125 ml, and a mean surgical time of 114.5 min for two surgeries. Surgeries with preoperative embolization showed a mean intraoperative blood loss of 1850 ml, no erythrocyte transfusion requirement, and a mean surgical time of 68 min., Conclusion: Curettage of GCTB in the posterior pelvis and sacrum presents challenges, with significant intraoperative blood loss impacting surgical time and transfusion needs. Preoperative embolization may be beneficial in reducing blood loss during surgery in these cases., Competing Interests: Declaration of competing interest None of the authors declare any conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Study Design: Monocenter case-control study.Objective: Effects of spinal surgical adverse events (SSAE) on clinical and functional outcome, length of stay, and treatment costs after traumatic cervical spinal cord injury (SCI).Summary Of Background Data: Traumatic SCI is a challenge for primary care centers because of the emergency setting and complex injury patterns. SSAE rates of up to 15% are reported for spine fractures without SCI. Little is known about SSAE after traumatic SCI and their outcome relevance.Methods: Acute traumatic cervical SCI patients were enrolled from 2011 to 2017. Cases with and without SSAE were compared regarding neurological recovery, functional outcome, secondary complications, mortality, length of stay, and treatment costs. Adjusted logistic regression and generalized estimating equation models were calculated for the endpoints ASIA impairment scale (AIS)-conversion and dysphagia. All analyses were run in the total and in a propensity score matched sample.Results: At least one SSAE occurred in 37 of 165 patients (22.4%). Mechanical instability and insufficient spinal decompression were the most frequent SSAE with 13 (7.9%) or 11 (6.7%) cases, respectively. The regression models adjusted for demographic, injury, and surgery characteristics demonstrated a reduced probability for AIS-conversion related to SSAE (OR [95% CI] 0.14 [0.03-0.74]) and additionally to single-sided ventral or dorsal surgical approach (0.12 [0.02-0.69]) in the matched sample. Furthermore, SSAE were associated with higher risk for dysphagia in the matched (4.77 [1.31-17.38]) and the total sample (5.96 [2.07-17.18]). Primary care costs were higher in cases with SSAE (median (interquartile range) 97,300 [78,200-112,300]) EUR compared with cases without SSAE (52,300 [26,700-91,200]) EUR.Conclusion: SSAE are an important risk factor after acute traumatic cervical SCI with impact on neurological recovery, functional outcome, and healthcare costs. Reducing SSAE is a viable means to protect the limited intrinsic capacity for recovery from SCI.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background: Although debilitating, proximal hamstring tendon avulsion injuries are rare and often overlooked or misdiagnosed. Consequently, delayed diagnosis and surgical treatment may result in poor outcomes. Studies investigating a correlation between postoperative functional outcomes and this delay in surgical treatment or other concomitant factors in large cohorts have not yet been performed to our knowledge. Purpose/Hypothesis: The purpose of this study was to conduct an investigation in a large patient group regarding factors that could influence a patient's functional outcome after hamstring surgery. We hypothesized that this outcome would significantly correlate to the time between trauma and surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients who received surgical treatment of proximal hamstring tendon avulsion injuries in our institution between the years 2010 and 2020 were asked to complete a validated, injury-specific outcome measurement, the Perth Hamstring Assessment Tool (PHAT; 0-100 points). In addition to calculating these outcomes, we evaluated the association of the obtained results with possible predictive factors such as age, sex, stump retraction shown on magnetic resonance imaging (MRI), and timing and duration of surgery. Results: A total of 226 patients (227 operations) were eligible for the study, and 204 cases of hamstring tendon avulsion injury met our inclusion criteria. The return rate for the PHAT questionnaire was 85.3%. The mean PHAT score revealed good results (79.8 ± 19.1). Irrespective of concomitant factors, the scores of male patients were significantly higher compared with those of female patients (83.8 ± 16.9 vs 75.8 ± 20.6 respectively; P =.004). The mean time to surgery was 5.7 weeks after trauma, and more delayed surgery correlated significantly with lower PHAT scores (P =.003; r = –0.228). The mean degree of stump retraction on MRI (5 cm) did not significantly influence PHAT scores (P =.525; r = –0.06). Conclusion: Delay of surgery and female sex were disadvantageous in terms of a good functional outcome measure (PHAT score) after hamstring tendon refixation surgery. By contrast, patient age as well as the retraction of the tendon stump on preoperative MRI did not influence PHAT scores in the present study. [ABSTRACT FROM AUTHOR]

Objective: To summarize and analyze the effect of facial nerve decompression surgery for the treatment of Bell's palsy and Hunt syndrome. Methods: The clinical data of 65 patients with facial nerve palsy who underwent facial nerve decompression in our center from October 2015 to October 2022 were retrospectively analyzed, including 54 patients with Bell's palsy and 11 patients with Hunter syndrome. The degree of facial paralysis（HB grade） was evaluated before surgery, and ENoG, pure tone audiometry, temporal bone CT and other examinations were completed. All patients had facial palsy with HB grade V or above after conservative treatment for at least 1 month, and ENoG decreased by more than 90%. All patients underwent facial nerve decompression surgery through the transmastoid approach within 3 months after onset of symptoms. The recovery effect of facial nerve function after surgery in patients with Bell's palsy and Hunter syndrome was summarized and analyzed. In addition, 15 cases in group A（operated within 30-60 days after onset） and 50 cases in group B（operated within 61-90 days after onset） were grouped according to the course of the disease（the interval between onset of symptoms and surgery） to explore the effect of surgical timing on postoperative effect. Results: There was no significant difference between the two groups of patients with Chi-square test（ P =0.54） in 42 patients（77.8%, 42/54） with Bell's palsy and 7 patients（63.6%, 7/11） in patients with Hunter syndrome who recovered to grade Ⅰ-Ⅱ. According to the course of the disease, 10 cases（66.7%, 10/15） in group A recovered to grade Ⅰ-Ⅱ after surgery. In group B, 39 patients（78.0%, 39/50） recovered to grade Ⅰ-Ⅱ after surgery, and there was no statistically significant difference between the two groups by Chi-square test（ P =0.58）. Conclusion: Patients with Bell's palsy and Hunter syndrome can achieve good results after facial nerve decompression within 3 months of onset, and there is no significant difference in the surgical effect between the two types of patients., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Aims: To evaluate the ocular and systemic factors involved in cataract surgery complications in a teaching hospital using artificial intelligence.Methods: One eye of 1,229 patients with a mean age of 70.2 ± 10.3 years old that underwent cataract surgery was selected for this study. Ocular and systemic details of the patients were recorded and then analyzed by means of artificial intelligence. A total of 1.25 billion simulations of artificial intelligence learning and testing were conducted on several variables and a customized model of analysis was developed.Results: A total of 73 complications were recorded in this study. According to the analysis performed, the main factors involved in cataract surgery complications were: a surgeon in training, axial length and intraocular lens power. The model predicted how long surgery would last with an error of

Epiretinal membrane(ERM)is a relatively common macular disease that forms along the surface of the internal limiting membrane(ILM)of the retina to some reason. The pathogenesis is not clear. Microincision vitrectomy surgery has been confirmed as a minimally invasive and very safe modality of treatment. Deciding when to perform a vitrectomy can be difficult. There are many factors which can affect the postoperative visual acuity, such as age, the thickness of macular, integrity of photoreceptor inner segment/outer segment(IS/OS)junction.

Background: Supracondylar humerus fractures account for more than 60% of all elbow fractures and about 1/5 of all pediatric fractures. Unfortunately, these fractures can be associated with risk of complications including neurovascular injuries, malunions and limb deformities. Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures., Aim: To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures., Methods: We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019. The data extracted included demographic data, fracture characteristics, surgical data, and follow-up outcomes. The collected data was analyzed and P values of < 0.05 were considered statistically significant., Results: Of the cohort, 11% of patients had documented post-operative complications, of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction. While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons, this did not reach statistical significance., Conclusion: In pediatric patients undergoing surgery for supracondylar fractures, we found a higher complication rate when surgeries were not performed during working hours. Surgeon level and training had no significant effect on the risk of post-operative complications., Competing Interests: Conflict-of-interest statement: All the authors have no relevant conflict of interests., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: Hip fractures in the elderly are usually associated with a high rate of morbidity and mortality and affect quality of life. On review of published data, the current guidelines in the literature indicate that early surgery should be performed within 24 h of injury because it is associated with better functional outcomes and lower rates of perioperative complications and mortality. The aim of this study was to evaluate whether any correlation exists between early surgical intervention and functional outcomes. Methods: In a retrospective study, we analyzed the records between January 2010 and December 2016 and 550 elderly patients between the age group of 65-95 were included. Results: The results of early surgery were promising, 451 (82%) patients did not have any complication, 42 (7.6%) has developed bed sore, 23 (4%) developed a hospital-acquired infection, 13 (2.3%) developed wound infection, 08 (1.4%) developed DVT, 04 (0.7%) developed implant failure, and 09 (01%) died of some or other complications. Conclusion: Still, there is conflicting evidence in the published data that early surgery would improve mortality and function. However, early surgery definitively improves outcome and reduces morbidity, bed sores, infection, and the length of hospital stay could be improved by reducing the waiting time of hip surgery following fracture. We concluded that it is beneficial to the elderly patients to receive surgical treatment as early as possible. [ABSTRACT FROM AUTHOR]

Our study aim was to assess the neurological outcomes of surgical decompression and stabilization within 5 and 24 h after injury. We performed a multi-center, retrospective cohort study in adolescents and adults 15-85 years of age presenting cervical spinal cord injury (CSCI) at one of 6 Austrian trauma centers participating in the Austrian Spinal Cord Injury Study (ASCIS). Neurological outcomes were measured using the American Spinal Injury Association Impairment Scale (AIS) grade according to the International Standards For Neurological Classification Of Spinal Cord Injury (ISNCSCI) form after at least 6 months of follow-up (FU). Of the 49 enrolled patients with acute CSCI, 33 underwent surgical decompression within 5 h (mean 3.2 h ± 1.1 h; very early group) after injury, and 16 underwent surgical decompression between 5 and 24 h (mean 8.6 h ± 5.5 h; early group). Significant neurological improvement was observed among the entire study population between the preoperative assessment and the FU. We identified a significant difference in the AIS grade at the last FU between the groups the using Jonckheere-Terpstra test for doubly ordered crosstabs ( p = 0.011) and significantly different AIS improvement rates in the early group (Poisson model, p = 0.018). Improvement by one AIS grade was observed in 31% and 42% of the patients in the early and very early groups, respectively ( p = 0.54). Improvement by two AIS grades was observed in 31% and 6% of the patients in the early and very early groups, respectively ( p = 0.03; relative risk [RR], 5.2; 95% CI, 1.1-35). Improvement by three AIS grades was observed in 6% and 3% of patients in the early and very early groups, respectively ( p = 1.0). Decompression of the spinal cord within 24 h after SCI was associated with an improved neurological outcome. No additional neurological benefit was observed in patients who underwent decompression within 5 h of injury. [ABSTRACT FROM AUTHOR]

Background: To determine the impact of time taken on the surgical outcome of extradural hematoma in patients with road traffic accidents. Methods: Sixty adult patients with history of road traffic accident with extradural hematoma on axial images of CT scan brain were included. All patients were allocated into three groups with 20 patients in each group. Patients in Group I were those in whom time from the occurrence of trauma to the surgical evacuation of hematoma was < 1 hour, 1 to 6 hours in group II and > 6 hours in group III. Results: In group I, majority (90 %) showed favourable outcome. In group II, 70 % showed favourable outcome. In group III, 50 % showed favourable outcome. Significant association was found between outcome and time of surgery (p<0.05). Conclusions: Frequency of favourable outcome after surgical evacuation was significantly higher in patients in whom surgery was performed within one hour after the trauma (P<0.05). [ABSTRACT FROM AUTHOR]

Introduction: The objective of the present study was to evaluate the relationship between clinical outcome and time of day of surgery and experience level of the surgeon. Secondly, we examined the relationship between the length of hospital stay and the time of day of surgery. Methods: This retrospective cross-sectional cohort design study included patients treated with intramedullary nailing at Aalborg University Hospital from 1998 to 2008 after tibial shaft fractures ( N = 294). At follow-up, the participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS). Age, sex, complications, length of hospital stay, start time of surgery, and education level of surgeons were recorded. Results: The long-term analysis of the KOOS assessment shows no significant association between time of day of surgery and the level of surgeon experience. There was no difference in complication rates between time of day of surgery and the level of surgeon experience. The secondary outcome analysis showed an estimated increased risk of 25 % ( p = 0.001), for a longer length of hospital stay when operated by a trainee at night-hours compared to day-hours, and an estimated increased risk of 17 % ( p = 0.002) for longer length of stay, when operated at day-hours by a trauma surgeon compared to a trainee. Conclusion: Complication rates and KOOS outcome after surgery with intramedullary nailing were not influenced by time of day of surgery and experience level of the surgeon. The lengths of hospital stay increase significantly when surgery is performed at night by trainee surgeons, but not when performed by trauma surgeons. [ABSTRACT FROM AUTHOR]

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Congenital volvulus without a prenatal diagnosis of malrotation is an extremely rare cause of acute intestinal obstruction in the foetal and neonatal period with a high morbidity and mortality. The aim of this report is to describe prenatal imaging, pregnancy characteristics and clinical outcomes to identify a gold standard management approach for neonates affected by congenital volvulus through our experience with this case as well as a review of the literature. We describe an intrauterine case of volvulus without malrotation suspected by prenatal ultrasound at 28 weeks' gestation, with enlarged hyperechogenic loops without peristalsis in a 715g preterm boy born at 29 weeks' gestation. The discrepancy between the minimal clinical manifestations and the severity of intestinal pathology is highlighted. At explorative laparotomy following delivery, a congenital mesenteric defect was identified through which small bowel had herniated and volvulised, causing prenatal bowel dilatation and necrosis. The necrotic bowel was resected, and both an ileostomy and jejunostomy were created within 30 hours of birth. However, severe post-operative complications were encountered, which ultimately led to the newborn's death. Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. A high index of suspicion is required in cases of bowel dilatation, intestinal duplication or malrotation. Strict foetal follow up with serial ultrasound assessment and planned cesarean delivery are recommended. Multidisciplinary care is essential. Time of delivery and surgical intervention should be standardised to reduce the risk of neonatal mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54±13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46±9.36 vs. 22.5±7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.

"nDespite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54 ± 13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46 ± 9.36 vs. 22.5 ± 7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.

Study Design: Retrospective cohort.Objective: To compare time to discharge for anterior cervical discectomy and fusions (ACDF) when performed as either a first case versus later surgical start times.Summary Of Background Data: ACDF is a commonly performed spinal procedure that typically has a short acute recovery period. With an increasing focus on reducing hospital costs and a shift toward outpatient surgical practices, early patient discharge has become a priority for hospitals and physicians alike. However, the impact of surgery start time on the ability for same-day discharge has not been explored in spine surgery.Methods: A surgical database of patients who underwent ACDF from 2013 to 2015 was reviewed. Patients were stratified into two cohorts: those whose surgery was the first of the day (early cohort), and those who underwent later surgeries. Baseline patient characteristics and perioperative variables were compared between cohorts using Student t test and χ test. Same-day discharge was tested for association with surgical start time using Poisson regression with robust error variance controlling for preoperative variables.Results: A total of 106 patients, divided into early and late cohorts of 60 and 46 patients, respectively, were included in the analysis. There were no significant differences in pre- or perioperative characteristics between cohorts (). Same-day discharge was achieved in 36.8% (n = 39) of all ACDF patients. The later cohort was significantly more likely to require an overnight stay compared with the early cohort (RR = 1.61 ± 0.30; P = 0.010).(Table is included in full-text article.)CONCLUSION.: Patients undergoing ACDF later in the day are at a higher risk for staying overnight than those who have the first surgery of the day. These results may influence operative scheduling, as performing ACDFs early in the day may result in a greater likelihood of same-day discharge, eliminating the increased resource utilization associated with an overnight hospital stay.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

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Aim The aim of this experimental in vitro study was to evaluate the effects of the piezoelectric device in temperature and time variations in standardized osteotomies performed with similar tip inserts in bovine bone blocks. Methods Two different piezosurgical devices were used the OE-F15® (Osada Inc., Los Angeles, California, USA) and the Surgybone® (Silfradent Inc., Sofia, Forli Cesena, Italy). Serrated inserts with similar geometry were coupled with each device ( ST94 insert/test A and P0700 insert/test B). Osteotomies 10 mm long and 3 mm deep were performed in bone blocks resembling type II (dense) and type IV (soft) bone densities with and without irrigation. Thermal changes and time variations were recorded. The effects of bone density, irrigation, and device on temperature changes and time necessary to accomplish the osteotomies were analyzed. Results Thermal analysis showed significant higher temperatures during piezosurgery osteotomies in hard bone without irrigation ( P < 0.05). The type of piezosurgical device did not influence thermal variations ( P > 0.05). Time analysis showed that the mean time values necessary to perform osteotomies were shorter in soft bone than in dense bone ( P < 0.05). Conclusions Within the limitations of this in vitro study, it may be concluded that the temperature increases more in piezosurgery osteotomies in dense bone without irrigation; the time to perform the osteotomy with piezosurgery is shorter in soft bone compared to hard bone; and the piezosurgical device have a minimal influence in the temperature and time variations when a similar tip design is used during piezosurgery osteotomies. [ABSTRACT FROM AUTHOR]

Objectives: Performing orthopedic surgery in and out of working hours may affect the success of the surgery. Timing of surgery in tibial shaft fractures is controversial. In this study, the effect of the timing of surgery on the success and complications of intramedullary nailing of tibial fractures is examined., Methods: Archieves of patients with tibial shaft fractures treated with reamed intramedullary nails between 2010 and 2016 were retrospectively analyzed. Fifty-seven patients were included in the study. Patients were categorized by the time of the surgery. Day time (Group I) is between 7:00 am and 5:00 pm and after hour (Group II) is between 5:00 pm and 07:00 am. Group I (n: 40) and Group II (n: 17) were evaluated. Technical errors, surgery time, and length of hospital stay statistical analysis was performed between the two groups in terms of technical errors, complication rates, length of hospital stay, and duration of surgery., Results: The mean duration of operation (p=0.419), number of distal screws (p=0.847), time to union (p=0.454), experience of the surgeon (p=0.192), and technical error rate (p=0.654) did not differ significantly between two groups. Length of hospital stay and time to surgery from emergency were significantly higher in day time group., Conclusion: Technical errors and surgery time of intramedullary nailing of tibial shaft fractures are not higher at after hour before midnight than day time. Non-urgent tibial shaft fractures might be treated with intramedullary nailing at after hours before midnight for efficient use of hospitals., Competing Interests: None declared., (©Copyright 2023 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: The timing of surgery for femoral neck fractures in young adults remains controversial. Nonetheless, the debate continues about whether orthopedic trauma cases should be operated daytime or after hours., Aim: This study compared the clinical and radiological outcomes of surgery on femoral neck fractures during daytime versus after-hours., Patients and Methods: A total of 124 patients aged 18-60 years who were operated for femoral neck fractures between 2015 and 2020 were included in the study. The patients were separated into two groups. Seventy-two patients operated between 08:00 and 17:00 hours were defined as the daytime group and 52 patients operated between 17:01 and 07:59 hours were defined as the after-hours group. Demographic data, reduction quality, duration of operation, intraoperative estimated blood loss (EBL), postoperative complications, revision rates, and postoperative Harris hip score results of the two groups were recorded for analysis., Results: There was no significant difference between the groups in terms of age, gender, body mass index, smoking, fracture type and follow-up time, reduction quality, postoperative complication rates, revision rates, and Harris hip score results. Waiting times until surgery, operation duration, and intraoperative EBL amounts were, in the daytime group, significantly higher than in the after-hours group., Conclusion: In this study comparing femoral neck fractures operated on daytime and after-hours in adults, the waiting time until surgery was found to be higher in the daytime group. Operation duration and EBL were higher in the after-hours group., Competing Interests: None

Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54±13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46±9.36 vs. 22.5±7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.

BACKGROUND: Acute cholecystitis is an acute inflammation of the gallbladder, with laparoscopic cholecystectomy (LC) being the treatment of choice, although, timing of the intervention still remains controversial. OBJECTIVE: To determine the relationship between timing of intervention and postoperative stay of patients who underwent laparoscopic cholecystectomy. PATIENTS AND METHODS: Cross-sectional study. Medical records of patients undergoing laparoscopic cholecystectomy at Dr. Gustavo Fricke Hospital in Vina del Mar, Chile between January and October 2011 were analized. Inclusion criteria: Age between 18 and 80 years old; diagnosis of acute cholecystitis and indication of laparoscopic cholecystectomy. Exclusion criteria: Patient according to American Society of Anesthesiologists physical status classification system (ASA) 4 or 5. The variables considered were: age, gender, ASA score, previous abdominal surgery, hospital stay, operative time and occurrence of complications. RESULTS: Data of 88 patients was analyzed. 31 of them were operated within 72 hours of beginning of symptoms (late LC) and 57 patients after 72 hours (early LC). The median hospital stay in late LC group was nine days and in the early LC group three days (IQR 2-4), which was statistically significant (p = 0.00001). No other significant differences were found in relation to demographic and clinical characteristics, operative time, complications, and postoperative stay. DISCUSSION: Regardless a lack of difference in postoperative stay, operative time and complication rate, it seems advisable to perform LC within 72 hours of symptom onset in patients with acute cholecystitis, given the reduction of total hospital stay. [ABSTRACT FROM AUTHOR]

Acute cholecystitis is one of the most common acute surgical diseases. There is a consensus that laparoscopic cholecystectomy is recommended as the treatment of choice; however, there is a controversy about the best time for surgery. In contrast to delayed cholecystectomy after initial antibiotic treatment, early or immediate cholecystectomy seems to have some advantages. Recent studies and meta-analyses have several limitations due to small patient numbers and inhomogeneity in treatment design. Nevertheless, international guidelines tend to recommend early cholecystectomy but the most recent concept of immediate cholecystectomy within 24 h after diagnosis independent of the onset of symptoms is not considered. A current prospective multicenter, randomized controlled trial will shortly bring more clarity to this topic (ACDC trial). [ABSTRACT FROM AUTHOR]

Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54±13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46±9.36 vs. 22.5±7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm. [ABSTRACT FROM AUTHOR]

Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54 ± 13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46 ± 9.36 vs. 22.5 ± 7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm. [ABSTRACT FROM AUTHOR]

Several surgical procedures have been reported for the treatment of acute subdural hematoma. We compared the results of treatments for acute subdural hematoma achieved by decompressive craniectomy with wide opening of the dura versus multidural fenestrations. Forty-five patients with acute subdural hematoma underwent surgery at our hospital from August 2002 to July 2007. Our patients were classified into 2 groups according to the operative procedure: group A, decompressive craniectomy with wide opening of the dura (n=21) and group B, multidura fenestrations (n=24). Glasgow Outcome Scale at time of discharge from hospital, duration of surgery, and length of hospital stay (LOS) were compared between the 2 groups of patients who were operated upon with the different surgical techniques. Glasgow Outcome Scale was not statically different between the 2 groups of patients, but when comparing craniectomy group and multidural fenestration group (groups A and B), duration of surgery and LOS were statistically lower in group B than in group A. Duration of surgery in group B was one-third of group A. Mean of LOS was 24±8.83 in group A and 18±6.72 in group B. Such results indicate that multifenestration of dura can be considered as an alternative treatment option in patients with acute subdural hematoma. [ABSTRACT FROM AUTHOR]

Objective Thoracolumbar region is one of the most common sites of injury throughout the spine. Among these ,burst fractures are commonly seen and. still a plenty of controversies exists about their preferred treatment and surgical time itself. In this study ,we evaluate the efficacy of surgical time on clinical and radiologic outcome of unstable thoracolumbar burst fractures. Methods This prospective study was carried on the surgically operated patients with unstable thoracolumbar burst fractures from 2001 to 2006 and followed at least for 2 years. We considered patients who underwent only posterior spinal fusion and instrumentation. We divided our patients into two A (operated <15 days after injury) and B (operated 15-33 days after injury) groups,according to the time of surgery. We recorded all data included imaging parameters, time to surgical treatment, and any intra-or postoperative complications and statistical analysis was performed. P value 0. 05 was considered significant, statistically. Results 70 patients (49 male and 21 female) were included in this research with a ratio of M/F:7/3. Mean age of the patients was 36 (ranged 14 to 56) years. 50 cases group A; while group B included 20 patients. In group A the anterior vertebral height ( A. V. H ) was improved from a median preoperative of 20. 5 mm to 39. 5 mm (95% correction ) ,and sagittal alignment ( S. A ) was improved from a mean preoperative kyphosis of 20. 4 degrees to 1. 5 degrees (95% correction ). In group B the A. V. H was improved from a mean preoperative of 20. 3 mm to 34. 2 mm ( 70 % correction ) and S. A was improved from a mean preoperative kyphosis of 20. 5 degrees to 4. 4 degrees( 80% correction ) . In comparing the pre-and postoperative parameters inside the individual groups ,all of them were significantly changed (P <0. 001) , although; there was no significant difference between tow A and B groups (P = 0. 528). Conclusion As the time passed from the injury event in thoracolumbar burst fractures, the radiologic outcome of surgical spinal realignment decreased appropriately; although, with a delay of about one month ,the satisfactory results can still be obtained by posterior fusion and instrumentation. [ABSTRACT FROM AUTHOR]

The early operative treatment of injuries of the spine without any neurological damage brings the chance of rapid mobilization and early functional exercising of the patient. This avoids secondary risks or complications due to long-term immobilization. Furthermore, there is no risk of collateral spinal cord damage by secondary dislocation. The duration of stay in hospital is minimized and the highest possible level of comfort for patients results from this form of treatment. In cases of spinal cord injury early operative treatment has to be regarded as the gold standard. The goal of this procedure is reconstruction of the canal size and the restoration of spinal alignment to prevent further deterioration of the existing neurological deficit. [ABSTRACT FROM AUTHOR]

The indication for arthroplasty following trauma is generally established on the basis of the severity and type of the fracture, as well as on patient age. Thus, the initial situation in terms of surgery, as a result of these conditions alone, is significantly worse than in the case of primary endoprosthetic treatment of degenerative joint disease. Surgical planning also requires a more sensitive and usually more intensive diagnostic workup than for elective surgery, in addition to which arthroplasty following trauma is associated with a higher complication rate. For this reason, the present article examines the following questions: Is emergency endoprosthetic treatment following fracture justifiable? How should the procedure be explained to the patient? Does endoprosthetic treatment always represent “programmed surgery” and, if so, when is the optimal time for surgery? Does elective treatment even for simple medial femoral neck fractures count as a classic indication for endoprosthetic treatment following bone fracture? What are the particular surgical features of endoprosthetic fracture treatment and which surgeon can and should perform this type of surgery? [ABSTRACT FROM AUTHOR]

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

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

Abstract: Introduction: A prevailing perception regarding night time surgery is that the probability of complications may be higher due to decreased availability of support staff, surgeon fatigue and other logistical factors. However there is little data supporting this notion in hip fracture surgery and we studied this in the context of Inter-trochanteric fractures fixed with dynamic hip screws (DHS). Methods: All patients who underwent DHS fixation for inter-trochanteric fracture from January 2005 to December 2010 were included. Patients were divided into two groups. An after-hours group was defined as an operation done between 5:00 P.M. to7:00 A.M. and a daytime group was defined as surgery done between 7:00 A.M. to 5:00 P.M. Data was analyzed using SPSS version 19. Results: During this period 194 patients underwent DHS fixation. One hundred and fourteen patients were included in the daytime group and 80 patients in the after-hours group. There was no difference in the rates of wound infection, length of hospital stay, postoperative ambulation status, intra op blood loss, type of anesthesia, and mortality between the two groups. Tip apex index was found to be similar between the two groups. Two patients in the daytime surgery required revision surgery compared to 5 patients in the after-hours group, however this difference was not statistically significant. Discussion: Outcomes in terms of adequacy of fixation, post-operative complications and post-operative 30-day mortality are comparable to routine day time surgery while offering the benefits of early fixation and mobilization to the patient. This also has a positive impact on the financial burden on this population as early fixation translates into decreased length of stay and reduced cost of treatment. [Copyright &y& Elsevier]