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in category surgery

95 results found. For more information, click each entry to expand.

41: Impacts on Surgery Resident Education at a first wave COVID-19 epicenter
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Posted 18 Aug 2020

Impacts on Surgery Resident Education at a first wave COVID-19 epicenter
347 downloads medRxiv surgery

Alexander Ostapenko, Samantha McPeck, Shawn Liechty, Daniel Kleiner

Background: This study aims to identify the effects of the COVID-19 pandemic on surgical resident training and education at Danbury Hospital. Methods: We conducted an observational study at a Western Connecticut hospital heavily affected by the first wave of the COVID-19 pandemic to assess its effects on surgical residents, focusing on surgical education, clinical experience, and operative skills development. Objective data was available through recorded work hours, case logs, and formal didactics. In addition, we created an anonymous survey to assess resident perception of their residency experience during the pandemic. Results: There are 22 surgical residents at our institution; all were included in the study. Resident weekly duty hours decreased by 23.9 hours with the majority of clinical time redirected to caring for COVID-19 patients. Independent studying increased by 1.6 hours (26.2%) while weekly didactics decreased by 2.1 hours (35.6%). The operative volume per resident decreased by 65.7% from 35.0 to 12.0 cases for the period of interest, with a disproportionately high effect on junior residents, who experienced a 76.2% decrease. Unsurprisingly, 70% of residents reported a negative effect of the pandemic on their surgical skills. Conclusions: During the first wave of the COVID-19 pandemic, surgical residents' usual workflows changed dramatically, as much of their time was dedicated to the critical care of patients with COVID-19. However, the consequent opportunity cost was to surgery-specific training; there was a significant decrease in operative cases and time spent in surgical didactics, along with elevated concern about overall preparedness for their intended career.

42: Seeing the light: Improving the usability of fluorescence-guided surgery by adding an optimized secondary light source
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Posted 12 Mar 2020

Seeing the light: Improving the usability of fluorescence-guided surgery by adding an optimized secondary light source
347 downloads medRxiv surgery

Jonathan T. Elliott, Dennis J. Wirth, Scott C. Davis, Jonathan D. Olson, Nathan E. Simmons, Timothy C. Ryken, Keith D. Paulsen, David W. Roberts

BackgroundTumors that take up and metabolize 5-aminolevulinic acid (5-AlA) emit bright pink fluorescence when illuminated with blue light, aiding surgeons in identifying the margin of resection. The adoption of this method is hindered by the blue light illumination, which is too dim to safely operate under, and therefore, necessitates switching back and forth from white-light mode. This paper examines the addition of an optimized secondary illuminant adapter (SIA) to improve usability of blue-light mode without degrading tumor contrast. MethodsWe used color science methods to evaluate the color of the secondary illuminant and its impact on color rendering index (CRI) as well as the tumor-to-background color contrast (TBCC). A secondary illuminant adapter was built to provide 475-600 nm light the intensity of which can be controlled by the surgeon and was evaluated in two patients. ResultsSecondary illuminant color had opposing effects on color rendering index (CRI) and tumor to background color contrast (TBCC); providing surgeon control of intensity allows this trade-off to be balanced in real-time. Experience in two cases suggests additional visibility adds value. ConclusionThe addition of a secondary illuminant may mitigate surgeon complaints that the operative field is too dark under the blue light illumination required for 5-ALA fluorescence guidance by providing improved CRI without completely sacrificing TBCC.

43: Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study.
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Posted 10 Apr 2020

Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study.
341 downloads medRxiv surgery

BHAVIN VASAVADA, hardik patel

IntroductionAim of study to evaluate 90 days mortality and morbidity after ERAS protocol and also weather there is any difference in morbidity and mortality between Open and Laparoscopic surgeries. Material and MethodsAll the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. ResultsWe performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79%. On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality ConclusionThere is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

44: Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery
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Posted 16 Jan 2020

Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery
339 downloads medRxiv surgery

Makoto Mori, Cornell Brooks, Erica Spatz, Bobak Mortazavi, Sanket S. Dhruva, George C. Linderman, Lawrence A. Grab, Yawei Zhang, Arnar Geirsson, Sarwat I. Chaudhry, Harlan Krumholz

IntroductionImproving postoperative patient recovery after cardiac surgery is a priority, but our current understanding of individual variations in recovery and factors associated with poor recovery is limited. We are using a health-information exchange platform to collect patient-reported outcome measures (PROMs) and wearable device data to phenotype recovery patterns in the 30-day period after cardiac surgery hospital discharge, to identify factors associated with these phenotypes and to investigate phenotype associations with clinical outcomes. Methods and analysisWe designed a prospective cohort study to enroll 200 patients undergoing valve, coronary artery bypass graft, or aortic surgery at a tertiary center in the U.S. We are enrolling patients postoperatively after the intensive care unit (ICU) discharge, and delivering electronic surveys directly to patients every 3 days for 30 days after hospital discharge. We will conduct medical record reviews to collect patient demographics, comorbidity, operative details and hospital course using the Society of Thoracic Surgeons (STS) data definitions. We will use phone interview and medical record review data for adjudication of survival, readmission, and complications. We will apply group-based trajectory modeling to the time-series PROM and device data to classify patients into distinct categories of recovery trajectories. We will evaluate whether certain recovery pattern predicts death or hospital readmissions, as well as whether clinical factors predict a patient having poor recovery trajectories. We will evaluate whether early recovery patterns predict the overall trajectory at the patient-level. Ethics and disseminationThe Yale Institutional Review Board approved this study. Following the description of the study procedure, we obtain written informed consent from all study participants. The consent form states that all personal information, survey response, and any medical records are confidential, will not be shared, and are stored in an encrypted database. Strengths and limitations of this studyO_LIThis study will assess the patient perspective on recovery after cardiac surgery at a high frequency within the 30-day postoperative period with surveys and activity monitoring via a health information platform and wearable devices. C_LIO_LIUsing longitudinal patient-reported outcomes measure (PROM) data, this study will define recovery patterns and factors associated with different recovery trajectories and guide the development interventions to improve recovery and support expansion of the study to additional sites. C_LIO_LIThe study is single center and the sample size is limited. C_LI

45: Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Experience
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Posted 08 May 2020

Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Experience
338 downloads medRxiv surgery

Gao Qing Wang, Dipesh K Yadav, Wei Jiang, Yongfei Hua, CaiDe Lu

Clinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discussed the risk factors of pancreatic fistula in order to interpret the clinical importance. All the patients who underwent DP in between January 2011 and January 2020 were reviewed retrospectively in accordance with relevant guidelines and regulations. The univariate and multivariate analysis was performed was performed to test an independent risk factors for pancreatic fistula. P<0.05 was considered statistically significant. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication 19.0%. The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct are more likely to develop pancreatic fistula. However, on multivariate analysis the soft texture of the pancreas (OR= 2.381, P= 0.001) and the ligation of main pancreatic duct (OR= 0.388, P= 0.002) were only an independent influencing factor for CR-POPF. As a conclusion, pancreatic fistula was the most common surgical complication after DP, and the texture of pancreas and ligation of main pancreatic duct can influence an incidence of CR-POPF.

46: Extrafascial transfissural approach with finger fracture technique approach for liver resection.Old is still gold?
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Posted 10 Apr 2020

Extrafascial transfissural approach with finger fracture technique approach for liver resection.Old is still gold?
338 downloads medRxiv surgery

BHAVIN VASAVADA, hardik patel

Background: Background: We evaluated our protocol of extrafascial transfissural approach for liver resection with intrafascial approach that we use in case of donor hepatectomy. Material and Method: We use extrafascial transfissural approach with finger fracture technique for liver resections and inftrafascial approach with clamp crush technique in case of donor hepatectomy. Major hepatectomy defined as resection of 2 or more adjacent segments.We compared these two techniques with regard to blood loss, operative time, morbidity and mortality.We also evaluated over all factors responsible for 90 days mortality.statistical analysis was done using SPSS version 23.(IBM).Categorical factors were evaluated using chi square test and numerical factors were analyzed using Mann Whitney U test. Multivariate analysis was done using logisitic regression method. Ethical approval for our clinical study was obtained by human research COA number SBI 3246. Results: We evaluated 26 liver resections done in last three years. 19 liver resections were done using extrafascial transfissural approach for various liver tumors and 7 living donor hepatectomies were done using itrafascial technique with clamp crush methods. Mean age of patients was 50.73 years.16 patients were males and 10 were females. Mean blood loss was 273.9 ml and mean operative duration was 184.7 minutes. 22 were major resections ,4 were minor liver resections. All minor liver resections were in transfissural approach however there was no statistical significant difference between them. Being live liver doners patients in intrafacial group they were younger than extrafascial transfissural group. (p=0.01). There was no statistical significant difference in blood loss, blood products requirements, morbidity, in hospital and 90 days mortality in both the groups. However extrafascial transfissural with finger fracture technique was associated with significant less operative time. (168.13 minutes vs 222.86 minutes) (p=0.006). 90 days mortality was associated with higher ASA grade (0.018) and blood loss (0.008). However in multivariate analysis no factor indepedently predicted mortality. Conclusion: Extrafascial transfissural approach significantly reduces operative time, without affecting morbidity and mortality in liver resection.

47: A prospective study to identify rates of SARS-CoV-2 virus in the peritoneum and lower genital tract of patients having surgery
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Posted 01 Aug 2020

A prospective study to identify rates of SARS-CoV-2 virus in the peritoneum and lower genital tract of patients having surgery
337 downloads medRxiv surgery

Dominique Jones, David Faluyi, Sarah Hamilton, Nicholas Stylianides, Kenneth Ma, Sarah Duff, Nicholas Machin, Richard Edmondson

Introduction The risks to surgeons of carrying out aerosol generating procedures during the COVID pandemic are unknown. To start to define these risks, in a systematic manner, we investigated the presence of SARS-CoV-2 virus in the abdominal fluid and lower genital tract of patients undergoing surgery. Methods We carried out a prospective cross sectional observational study of 113 patients undergoing abdominal surgery or instrumentation of the lower genital tract. We took COVID swabs from the peritoneal cavity and from the vagina from all eligible patients. Results were stratified by pre operative COVID status. Results In patients who were presumed COVID negative at the time of surgery SARS-CoV-2 virus RNA was detected in 0/102 peritoneal samples and 0/98 vaginal samples. Peritoneal and vaginal swabs were also negative in one patient who had a positive nasopharyngeal swab immediately prior to surgery. Conclusions The presence of SARS-CoV-2 RNA in the abdominal fluid or lower genital tract of presumed negative patients is nil or extremely low. These data will inform surgeons of the risks of restarting laparoscopic surgery at a time when COVID19 is endemic in the population.

48: A new ischemic grading system to aid combat extremity vascular injury decision making
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Posted 07 Aug 2020

A new ischemic grading system to aid combat extremity vascular injury decision making
336 downloads medRxiv surgery

Amila S. Ratnayake, Viktor A Reva, Miklosh Bala, Achala Upendra Jayatilleke, Sujeewa PB Thalgaspitiya, David S Kauvar, Tamara J Worlton

Abstract Introduction In resource limited combat settings with frequent encounters of mass casualty incidents, the decision to attempt limb salvage versus primary amputation is refined over time based on experience. This experience can be augmented by grading systems and algorithms to assist in clinical decisions. Few investigators have attempted to explicitly grade limb ischemia according to clinical criteria and study the impact of limb ischemia on clinical outcome. We suggest a new ischemia grading system based on the Rutherford ischemic classification and the V.A. Kornilov classification which we adapted to apply to the combat setting. This new tool was then retrospectively applied to combat trauma patients from the Sri Lankan Civil War. Method We retrospectively queried a prospectively maintained, single surgeon registry containing 129 extremity vascular injuries managed at a Role 3 military base hospital (MBH) from 2008 December to June 2009 during the last phase of Sri Lankan Civil war. 89 patients were analyzed for early limb salvage according to the modified Kornilov extremity ischemia index (MKEII). Result According to the MKEII, subcohort analysis of C1 (viable), C2 (threatened), and C3 (irreversible) classified injuries demonstrated a statistically significant (P < 0.001) difference in limb salvage. Further statistical evaluation demonstrated injury to popliteal region (P=0.006), severe arterial injury (P=0.018) and venous injuries (P< 0.001) had statistically significant differences in distribution between C1, C2 and C3. Conclusion By application of the MKEII, combat surgeons can rapidly and correctly select and prioritize vascular injured extremities to optimally use limited resources to achieve realistic limb salvage goals. A rigid ankle was correlated with the worst index of extremity ischemia. Further investigation into this sign as an indication for primary amputation is warranted.

49: COVID-19: how the pandemic impacted the emergency department and urgent surgical activity in a medium-size Italian hospital.
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Posted 20 Nov 2020

COVID-19: how the pandemic impacted the emergency department and urgent surgical activity in a medium-size Italian hospital.
327 downloads medRxiv surgery

Enrico Pinotti, Francesca Carissimi, Gianluca Baronio, Mauro Montuori, Deborah Ongaro, Michele Ciocca Vasino

BackgroundsCOVID-19 has grown rapidly in Lombardy, particularly in the province of Bergamo. To deal with the pressure the pandemic has exerted on the Italian health system; many hospitals have had to reorganize their medical and surgical activities. The aim of this study was to evaluate how the pandemic influenced the emergency department and urgent surgical activity in a medium-size hospital in the province of Bergamo. MethodsIn this retrospective observational study, we analyzed the number of admissions to the medical and surgical Emergency Room and their severity compared with those in the same period in previous years (2011-2019). Admission in the medical and surgical department and urgent surgical operation was also assessed. ResultsFrom March 7th to April 5th, 2020, we observe a reduction in emergency department access (-53%) when compared with the corresponding period of previous years. The number of medical admissions was similar to the past years (+0.9%), we observed a drastic reduction of surgical patients (-82.5%). We experienced a significant increase in hospitalizations in the medical department (+359%) and a reduction of admission in the surgical department (-71.2%). ConclusionSARS-CoV2 disease has spread so suddenly and severely that it has stressed Italian health system, in particular the Lombard one. Our data show the rise of critical medical ER accesses and the significant expansion in hospitalisation in the medical department with the necessary hospital reorganisation to face COVID-19 emergency. We also observed a reduction in both surgical ER accesses and urgent surgical activity.

50: Use of the Spatial Access Ratio to Measure Geospatial Access to Emergency Surgical Services in California
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Posted 29 May 2020

Use of the Spatial Access Ratio to Measure Geospatial Access to Emergency Surgical Services in California
326 downloads medRxiv surgery

Marta L. McCrum, Neng Wan, Steven Lizotte, Jiuying Han, Thomas Varghese, Raminder Nirula

Background: Emergency general surgery (EGS) diseases carry a substantial public health burden, accounting for over 3 million admissions annually. Due to their time-sensitive nature, ensuring adequate access to EGS services is critical for reducing patient morbidity and mortality. Travel-time alone, without consideration of resource supply and demand, may be insufficient to determine a regional health care system's ability to provide timely access to EGS care. Spatial Access Ratio (SPAR) incorporates travel-time, as well as hospital-specific resources and capacity, to determine healthcare accessibility which may be more appropriate for surgical specialties. We therefore compared SPAR to travel-time in their ability to differentiate spatial access to EGS care for vulnerable populations. Methods: We constructed a Geographic Information Science (GIS) platform using existing road networks, and mapped population location, race and socioeconomic characteristics, as well as all EGS-capable hospitals in California. We then compared the shortest travel time method to the gravity-based SPAR in their ability to identify disparities in spatial access for the population as a whole, and subsequently to describe socio-demographic disparities. Reduced spatial access was defined at >60 minutes travel time, or lowest three classes of SPAR. Results: 283 EGS-capable hospitals were mapped, 142 (50%) of which had advanced resources. Using shortest travel time, 36.98M people (94.8%) were within 20-minutes driving time to any EGS capable hospital, and 33.49M (85.9%) to an advanced-resourced center. Only 166, 950 (0.4%) experienced prolonged (>60 minutes) travel time to any EGS-capable hospital, which increased to 1.05M (2.7%) for advanced-resources. Using SPAR, 11.5M (29.5%) of people had reduced spatial access to any EGS hospital, which increased to 13.9M (35.7%) when evaluating advanced-resource hospitals. The greatest disparities in spatial access to care were found for rural residents and Native Americans for both overall and advanced EGS services. Conclusions: While travel time and SPAR showed similar overall patterns of spatial access to EGS-capable hospitals, SPAR showed greater differentiation of spatial access across the state. Nearly one-third of California residents have limited or poor access to EGS hospitals, with the greatest disparities noted for Native American and rural residents. These findings argue for the use of gravity-based models such as SPAR that incorporate measures of population demand and hospital capacity when assessing spatial access to surgical services, and have implications for the allocation of healthcare resources to address disparities.

51: Fully Automated Delineation of the Optic Radiation for Surgical Planning using Clinically Accessible Sequences
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Posted 18 Jul 2020

Fully Automated Delineation of the Optic Radiation for Surgical Planning using Clinically Accessible Sequences
324 downloads medRxiv surgery

Lee B. Reid, Eloy Martínez-Heras, Jose B Manjón, Rosalind L Jeffree, Hamish Alexander, Julie Trinder, Elisabeth Solana, Sara Llufriu, Stephen Rose, Marita Prior, Jurgen Fripp

Quadrantanopia caused by inadvertent severing of Meyer's Loop of the optic radiation is a well-recognised complication of temporal lobectomy for conditions such as epilepsy. Dissection studies indicate that the anterior extent of Meyer's Loop varies considerably between individuals. Quantifying this for individual patients is thus an important step to improve the safety profile of temporal lobectomies. Previous attempts to delineate Meyer's Loop using diffusion MRI tractography have had difficulty estimating its full anterior extent, required manual ROI placement, and/or relied on advanced diffusion sequences that cannot be acquired routinely in most clinics. Here we present CONSULT - a pipeline that can delineate the optic radiation from raw DICOM data in a completely automated way via a combination of robust preprocessing, segmentation, and alignment stages, plus simple improvements that bolster the efficiency and reliability of standard tractography. We tested CONSULT on 694 scans of predominantly healthy participants (538 unique brains), including both advanced acquisitions and simpler acquisitions that could be acquired in clinically acceptable timeframes. Delineations completed without error in 99.4% of the scans. The distance between Meyer's Loop and the temporal pole closely matched both averages and ranges reported in dissection studies for all tested sequences. Median scan-rescan error of this distance was 1mm. When tested on two participants with considerable pathology, delineations were successful and realistic. Through this, we demonstrate not only how to identify Meyer's Loop with clinically accessible sequences, but also that this can be achieved without fundamental changes to tractography algorithms or complex post-processing methods.

52: THE INFLAMMATORY MICROENVIRONMENT IN SCREEN-DETECTED PREMALIGANT ADENOMATOUS POLYPS: EARLY RESULTS FROM THE INTEGRATED TECHNOLOGIES FOR IMPROVED POLYP SURVEILLANCE (INCISE) PROJECT
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Posted 17 Aug 2020

THE INFLAMMATORY MICROENVIRONMENT IN SCREEN-DETECTED PREMALIGANT ADENOMATOUS POLYPS: EARLY RESULTS FROM THE INTEGRATED TECHNOLOGIES FOR IMPROVED POLYP SURVEILLANCE (INCISE) PROJECT
317 downloads medRxiv surgery

David Mansouri, Stephen T McSorley, James H Park, Clare Orange, Paul G Horgan, Donald C McMillan, Joanne Edwards

Introduction Around 40% of patients who attend for colonoscopy following a positive stool screening test have adenomatous polyps. Identifying which patients have a higher propensity for malignant transformation is currently poorly understood. The aim of the present study was to assess whether the type and intensity of inflammatory infiltrate differs between high-grade (HGD) and low-grade dysplastic (LGD) screen detected adenomas. Methods A representative sample of 207 polyps from 134 individuals were included from a database of all patients with adenomas detected through the first round of the Scottish Bowel Screening Programme (SBoSP) in NHS GG&C (April 2009 to April 2011). Inflammatory cell phenotype infiltrate was assessed by immunohistochemistry for CD3+, CD8+, CD45+ and CD68+ in a semi-quantitative manner at 20x resolution. Immune-cell infiltrate was graded as absent, weak, moderate or strong. Patient and polyp characteristics and inflammatory infiltrate were then compared between HGD and LGD polyps. Results CD3+ infiltrate was significantly higher in HGD polyps compared to LGD polyps (74% vs 69%, p<0.05). CD8+ infiltrate was significantly higher in HGD polyps compared to LGD polyps (36% vs 13%, p<0.001) where as CD45+ infiltrate was not significantly different (69% vs 64%, p=0.401). There was no significant difference in CD68+ infiltrate (p=0.540) or total inflammatory cell infiltrate (calculated from CD3+ and CD68+) (p=0.226). Conclusions This study reports an increase in CD3+ and CD8+ infiltrate with progression from LGD to HGD in colonic adenomas. It may therefore have a use in the prognostic stratification and treatment of dysplastic polyps.

53: Titanium Fasteners In Endoscopic Mitral Valve Surgery
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Posted 05 Jun 2020

Titanium Fasteners In Endoscopic Mitral Valve Surgery
316 downloads medRxiv surgery

Rafik Margaryan, Giacomo Bianchi, Tommaso Gasbarri, Giovanni Concistre, Marco Solinas

Objective We sought to review our experience of new titanium knot fastener devices. We hypothesized that it might reduce the cardiop-polmonary bypass time, aortic cross-clamping time and intervention time. Materials We reviewed our electronic records in order identify the patients who underwent mitral valve (MV) repair and replacement in totally endoscopic setup. Surgical approach was trough limited right periareolar or inframmamary thoracotomy with mainly femoro-femoral arterio-venous cannulation. A part of patients underwent interventions using fast knotting system (FK group,Cor-Knot Device, ISL Solutions Inc) and remaining patients served as control group (conventional hand knotting, HK). We identified the FK patients and performed propensity score matching to match 1:1 ratio from main cohort using FK versus HK. Results A total of 306 patients underwent mitral valve repair or replacement on via right thoracotomy, 265 (87%) patients underwent using FK, remaining. There were on average 2.6 minutes of CPB time reduction (p = 0.64), and 3.1 minutes of CXC time reduction (p = 0.47). However, when dividing into procedures based on complexity, there were on average 8.6 minutes of CPB time reduction (p = 0.18), and 6.9 minutes of CXC time reduction (p = 0.16) in simple cases; on average in complex cases 12 minutes of CPB time was augmented (p = 0.24), and 2.5 minutes of CXC time was augmented(p = 0.76). In propensity matched population the effect of CPB and CXC reduction was consistent and repeated and there were on average 0.5 minutes of CPB time reduction (p = 0.12), and 3.6 minutes of CXC time augmentation (p = 0.05). However, when dividing into procedures based on complexity, there were on average 0.2 minutes of CPB time reduction (p = 0.16), and 2.7 minutes of CXC time augmentation (p = 0.06) in simple cases; on average 5 minutes of CPB time augmentation (p = 0.34), and 14.2 minutes of CXC time augmentation (p = 0.58) in complex cases. Conclusions Titanium fasteners are useful tool to have in minimally invasive approaches, especially in complex cases and redo interventions. Titanium are comfortable and fast in many cases then conventional knot tying, but it is also expensive the traditional knotting. The titanium fasteners do not offer significant time reduction. In matched group the pattern of time saving were identical to main cohort.

54: Protection of health care workers from exhaled air of patients operated under local, regional, spinal or epidural anaesthesia during COVID 19 pandemic
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Posted 02 Dec 2020

Protection of health care workers from exhaled air of patients operated under local, regional, spinal or epidural anaesthesia during COVID 19 pandemic
312 downloads medRxiv surgery

Kuldeep Atodaria, Mayank Singh, Vimalkumar S Prajapati, Kush Shaileshkumar Shahkush, Pradipkumar Raghuvirsinh Atodaria

The SARS-CoV-2 (COVID-19) pandemic mandates the use of N-95/FFP-2 masks for healthcare workers, especially in operation room (OR) for surgical or aerosol producing pro-cedures. During pandemic, surgical interventions such as limb trauma, limb amputations, and limb malignancies continued to flow into the hospitals and are normally performed un-der local, regional or spinal anaesthesia. N-95/FFP-2 masks normally do not prevent escape of exhaled air to surrounding and to avoid the escape of exhaled unfiltered air, sealing masks by taping its edges to face possibly serves the purpose, but causes significant discomfort to patients. HEPA filters, high vacuum suction apparatus, and negative pressure operating-room may protect partially against the-risk of infection if patients exhaled air is infected. In order to reduce risk of transmission from patients exhaled air to the healthcare workers, a technique has been designed to divert the patients exhaled air to outside the-OR using a suction machine. This technique is easy, simple and cost-effective and trial has been per-formed with four-volunteers to see feasibility to breathe through N-95 mask sealed by stick-ing its edges to face using tape. The trial reflected reduction in SpO2, causing increased res-piratory-rate, tachycardia and hypertension, in-addition an un-acclimatized volunteers had difficulty in breathing through sealed N-95 masks, which was relieved by supplying oxygen to them. Attaching suction system to remove the-exhaled air aids to comfort levels. Treating exhaled-air with sodium-hypochlorite and diverting it externally to an open-space outside the-OR added to safety for the patients, surgical team and the hospital surroundings.

55: Safety and efficacy of three-cavity clearance in the management of cryptoglandular perianal abscess: A multicentre randomized controlled study
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Posted 15 Apr 2020

Safety and efficacy of three-cavity clearance in the management of cryptoglandular perianal abscess: A multicentre randomized controlled study
309 downloads medRxiv surgery

xinyi zhang, Chen cheng, Ping wei, Yu-Yao Wang, Li-Jiang Ji, Qiong Zhang, Chunxia zhang, Heiying Jin

OBJECTIVE: To evaluate the safety and efficacy of three-cavity clearance in the management of cryptoglandular perianal abscess. METHOD: This was a multicentre randomized controlled study. The study was designed and approved by the ethics committee of the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The study was registered in the Chinese Clinical Trial Register centre (ChiCTR1800016958).Patients with cryptoglandular perianal abscess in 5 Hospitals from Sept.2018 to Sept. 2019 were included.The anal fistula rate, anal incontinence, abscess recurrence, success rate, postoperative pain , wound healing time, and hospitalization duration were compared. RESULTS: Total 334 patients were enrolled in the study, who were 162 in the three-cavity clearance group and 172 in the control group. The anal fistula rate and abscess recurrence rate were 6.2% and 1.9% in the three-cavity clearance group (P=0.001) and 18.0% and 8.1% in the control group (P=0.009). No patients experienced fecal incontinence. The success rate in the three-cavity clearance group was 92.0% and that in the control group was 73.8% (P=0.00001). The postoperative pain on day 3 was lower in the three-cavity clearance group than that in the control group (P=0.002). The hospitalization duration was 9.0 days in the three-cavity clearance group and 10.41days in the control group (P=0.049). The wound healing time was 27.1 days in the three-cavity clearance group and 28.2 days in the control group (P=0.764). CONCLUSIONS: This randomized controlled study showed that three-cavity clearance is a safe and effective management of cryptoglandular perianal abscess.

56: Impact of bariatric surgery on multiple health outcomes:a protocol for umbrella review of systematic review and meta-analysis.
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Posted 25 Aug 2020

Impact of bariatric surgery on multiple health outcomes:a protocol for umbrella review of systematic review and meta-analysis.
307 downloads medRxiv surgery

Min Seo Kim, Jong Yeob Kim, Sungsoo Park

The number of bariatric surgery rises as the prevalence of obesity and metabolic comorbidities consistently increases[1]. Although bariatric surgery was originally developed for glycemic control and weight reduction, increasing evidence suggested extra-metabolic health outcomes are followed by bariatric surgery; incidences on diverse types of cancer[2], perinatal outcomes[3], sexual function[4], and even degree of physical activity[5] are known to be altered after bariatric surgery. We aim to conduct umbrella review for metabolic and other multiple health outcomes following bariatric surgery, and systematically appraise the context and quality of the relevant evidence.

57: The Role of Social Media in Disseminating Plastic Surgery Research: The Relationship between Citations, Altmetrics and Article Characteristics
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Posted 01 Sep 2020

The Role of Social Media in Disseminating Plastic Surgery Research: The Relationship between Citations, Altmetrics and Article Characteristics
305 downloads medRxiv surgery

Michael C Grant, Ryckie G Wade, Kai R Scott-Bridge

Background: Social media (SoMe) enables publishers and authors to disseminate content immediately and directly to interested end-users, on a global scale. Alternative metrics (altmetrics) are non-traditional bibliometrics which describe the exposure and impact of an article on freely available platforms such as Twitter, Facebook, Wikipedia and the news. Altmetrics are strongly associated with ultimate citation counts in various medical disciplines, except plastic surgery which represents the rational for this study. Methods: Altmetric explorer was used to extract altmetrics and citation rates for articles published during 2018 in Plastic and Reconstructive Surgery (PRS), the Journal of Plastic, Reconstructive and Aesthetic Surgery, the Annals of Plastics Surgery and Plastic Surgery (also known as Chirurgie Plastique). Multivariable negative binomial regression was used to estimate the relationship between citations and predictors (presented as the incidence rate ratio, IRR with 95% confidence interval, CI). Results: Overall, 1215 plastic surgery articles were captured which were cited 3269 times. There was a strong and independent association between the number of mentions in SoMe and the number of times an article was cited (adjusted IRR 1.01 [95% CI 1.01, 1.1]), whereby each mention in SoMe (e.g. Tweets or Facebook posts) translated to one additional citation. Evidence synthesis articles (e.g. systematic reviews) were cited twice as often as other articles and again, the use of SoMe to advertise these outputs was independently associated with more citations (IRR 2.0 [95% CI 1.3, 3.2]). Conclusions: Dissemination of plastic surgery research through social media channels increases an articles impact as measured by citations.

58: Changes in back pain scores after bariatric surgery in obese patients: A systematic review and meta-analysis
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Posted 31 Aug 2020

Changes in back pain scores after bariatric surgery in obese patients: A systematic review and meta-analysis
296 downloads medRxiv surgery

Froukje W. Koremans, Xiaolong Chen, Abhirup Das, Ashish D Diwan

Objective: To evaluate if back pain scores in morbidly obese patients change after bariatric surgery. Summary Background Data: Obese patients often complain of low back pain (LBP), however the underlying mechanism is not fully understood. Recent research shows that, next to mechanical loading, the chronic low-grade inflammation that arises in obese patients is contributing to LBP due to intervertebral disc degeneration. Therefore, it is hypothesized that bariatric surgery will have an effect on the LBP in obese patients. Methods: We searched four online databases for randomized controlled trials and observational studies. In obese patients, eligible for bariatric surgery, the changes in pre- and postoperative pain scores, assessed by Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Effect size (ES) and their 95% confidence intervals (CI) were evaluated. Results: Eight observational studies met the eligibility criteria. All studies showed a reduction of LBP following bariatric surgery, with a mean change of -2.9 points in NPS and of -3.8 cm in VAS. Among the patients undergoing bariatric surgery, based on a fixed effect estimated by pain assessment, the pain score decreased significantly in both groups; in NPS (ES -3.49, 95%CI [-3.86, -3.12]) and in VAS (ES -3.975, 95%CI [-4.45, -3.50]). Conclusions: From this meta-analysis, the data of back pain improvement following bariatric surgery seems encouraging. Substantial weight loss following bariatric surgery might be associated with a reduction in back pain intensity.

59: The impact of patient body mass index on surgeon posture during simulated laparoscopy
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Posted 27 Nov 2020

The impact of patient body mass index on surgeon posture during simulated laparoscopy
292 downloads medRxiv surgery

Ryan Sers, Massimiliano Zecca, Steph Forrester, Esther Moss, Stephen Ward

Laparoscopy is a cornerstone of modern surgical care. Despite clear advantages for the patients, it has been associated with inducing upper body musculoskeletal disorders amongst surgeons due to the propensity of non-neutral postures. Furthermore, there is a perception that patients with obesity exacerbate these factors. Therefore, novice, intermediate and expert surgeon upper body posture was objectively quantified using inertial measurement units and the LUBA ergonomic framework was used to assess the subsequent postural data during laparoscopic training on patient models that simulated BMIs of 20, 30, 40 and 50 kg/m^2. In all experience groups, the posture of the upper body significantly worsened during simulated surgery on the BMI 50 kg/m^2 model as compared to on the baseline BMI model of 20 kg/m^2. These findings suggest that performing laparoscopic surgery on patients with severe obesity increases the prevalence of non-neutral upper body posture and may further increase the risk of musculoskeletal disorders in surgeons.

60: Prognostic significance of compound physiology variables in oesophageal cancer
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Posted 19 Apr 2020

Prognostic significance of compound physiology variables in oesophageal cancer
291 downloads medRxiv surgery

Arfon G Powell, Catherine Eley, Alexandra coxon, Carven Chin, Damian M. Bailey, Wyn G Lewis

Aims: Objective identification of patient risk profile in Oesophageal Cancer (OC) surgery is critical. This study aimed to evaluate to what extent cardiorespiratory fitness and select metabolic factors predict clinical outcome. Methods: Consecutive 186 patients were recruited (median age 69 yr. 160 male, 138 neoadjuvant therapy). All underwent pre-operative cardiopulmonary exercise testing to determine peak oxygen uptake (V O2Peak), anaerobic threshold (AT), and ventilatory equivalent for carbon dioxide (V E/V CO2). Cephalic venous blood was assayed for serum C-reactive protein (CRP), albumin, and full blood count. Primary outcome measures were Morbidity Severity Score (MSS), and Overall Survival (OS). Results: MSS (Clavien-Dindo >2) developed in 33 (17.7%) and was related to elevated CRP (AUC 0.69, p=0.001) and lower V O2Peak (AUC 0.33, p=0.003). Dichotomisation of CRP (above 10mg/L) and V O2Peak (below 18.6mL/kg/min) yielded adjusted Odds Ratios (OR) for MSS CD>2, of 4.01 (p=0.002) and 3.74 (p=0.002) respectively. OC recurrence occurred in 36 (19.4%) and 69 (37.1%) patients died. On multivariable analysis; pTNM stage (Hazard Ratio (HR) 2.20, p=0.001), poor differentiation (HR 2.20, p=0.010), resection margin positivity (HR 2.33, p=0.021), and MSS (HR 4.56, p<0.001) were associated with OS. Conclusions: CRP and V O2Peak are collective independent risk factors that can account for over half of OC survival variance.

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