Better Radiographic Reduction and Lower Complication Rates With Combined Coracoclavicular and Acromioclavicular Ligament Reconstruction Than With Isolated Coracoclavicular Reconstruction

Background Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often used, but limited comparative evidence exists between these techniques. The central aim of this study was to prospectively compare the outcomes of 2 suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI). Methods Prospective data were collected on 112 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasty procedures. Outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand ( QuickDASH) questionnaire, Visual Analogue Scale (VAS) for pain, radiographic analysis, and lateral pinch strength. Patient demographic data and complications were also recorded. Results Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index and thus less subsidence than the LRTI group at 2 weeks (0.22 vs 0.17 [ P < .0001]) and 3 months (0.17 vs 0.15 [ P < .05]) postoperatively. TightRope suspensionplasty also had a significantly lower QuickDASH score at 2 weeks (64.7 vs 74.6 [ P < .05]), 3 months (20.7 vs 32.5 [ P < .05]), and 1 year postoperatively (7.57 vs 21.5 [ P < .05]) compared with the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, reoperation, or complications at any time point between groups. Conclusions Thumb CMC joint arthroplasty performed with a TightRope suspensionplasty versus LRTI yielded short-term improved resistance to subsidence, long-term greater improvement in clinical outcome by QuickDASH, and no difference in pain or complication rates.

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Non-target digital ischemia in an ulnar artery distribution following transradial access: Case report and review of best practice techniques

The Journal of Vascular Access ◽

10.1177/11297298211000897 ◽

2021 ◽

pp. 112972982110008

Author(s):

Patrick Kennedy ◽

Darren Klass ◽

John Chung

Keyword(s):

Best Practice ◽

Artery Aneurysm ◽

Ulnar Artery ◽

Complication Rates ◽

Endovascular Interventions ◽

Transradial Access ◽

Digital Ischemia ◽

Aneurysm Embolization ◽

Lower Complication ◽

Access Complications

Transradial access is a safe approach for visceral endovascular interventions, with lower complication rates compared to transfemoral access. This report describes an unusual case of ulnar artery thrombosis following splenic artery aneurysm embolization via left transradial approach, resulting in non-target digital ischemia and eventual amputation of the ring and little finger distal phalanges. Technical considerations to reduce the incidence of access complications are also reviewed, along with practice modifications undertaken at our institution following this case to improve outcomes.

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Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

Hip International ◽

10.1177/1120700020985067 ◽

2021 ◽

pp. 112070002098506

Author(s):

James R Onggo ◽

Mithun Nambiar ◽

Jason D Onggo ◽

Anuruban Ambikaipalan ◽

Parminder J Singh ◽

...

Keyword(s):

Functional Outcomes ◽

Meta Analysis ◽

Femoral Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Non Union ◽

Lag Screw ◽

Significant Difference ◽

Lower Complication ◽

Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

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Complications of neuroendoscopic septostomy

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.8.peds2165 ◽

2021 ◽

pp. 1-7

Author(s):

Travis J. Atchley ◽

Blake Sowers ◽

Anastasia A. Arynchyna ◽

Curtis J. Rozzelle ◽

Brandon G. Rocque

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Third Ventriculostomy ◽

Complication Rates ◽

Ventricular Size ◽

Current Procedural Terminology ◽

Operative Techniques ◽

Chi Square ◽

Intraoperative Complication ◽

Significant Difference ◽

Lower Complication

OBJECTIVE The advent of neuroendoscopy revolutionized the management of complex hydrocephalus. Fenestration of the septum pellucidum (septostomy) is often a therapeutic and/or necessary intervention in neuroendoscopy. However, these procedures are not without risk. The authors sought to record the incidence and types of complications. They attempted to discern if there was decreased likelihood of septostomy complications in patients who underwent endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) as compared with those who underwent other procedures and those with larger ventricles preoperatively. The authors investigated different operative techniques and their possible relationships to septostomy complications. METHODS The authors retrospectively reviewed all neuroendoscopic procedures with Current Procedural Terminology code 62161 performed from January 2003 until June 2019 at their institution. Septostomy, either alone or in conjunction with other procedures, was performed in 118 cases. Basic demographic characteristics, clinical histories, operative details/findings, and adverse events (intraoperative and postoperative) were collected. Pearson chi-square and univariate logistic regression analyses were performed. Patients with incomplete records were excluded. RESULTS Of 118 procedures, 29 (24.5%) septostomies had either intraoperative or postoperative complications. The most common intraoperative complication was bleeding, as noted in 12 (10.2%) septostomies. Neuroendocrine dysfunction, including apnea, bradycardia, neurological deficit, seizure, etc., was the most common postoperative complication and seen after 15 (12.7%) procedures. No significant differences in complications were noted between ventricular size or morphology or between different operative techniques or ventricular approaches. There was no significant difference between the complication rate of patients who underwent ETV/CPC and that of patients who underwent septostomy as a part of other procedures. Greater length of surgery (OR 1.013) was associated with septostomy complications. CONCLUSIONS Neuroendoscopy for hydrocephalus due to varying etiologies provides significant utility but is not without risk. The authors did not find associations between larger ventricular size or posterior endoscope approach and lower complication rates, as hypothesized. No significant difference in complication rates was noted between septostomy performed during ETV/CPC and other endoscopic procedures requiring septostomy.

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Defining “early” cranioplasty to achieve lower complication rates of bone flap failure: resorption and infection

Acta Neurochirurgica ◽

10.1007/s00701-018-3749-8 ◽

2018 ◽

Vol 161 (1) ◽

pp. 25-31 ◽

Cited By ~ 3

Author(s):

Jang Hun Kim ◽

Soon-Young Hwang ◽

Taek-Hyun Kwon ◽

Kyuha Chong ◽

Won-Ki Yoon ◽

...

Keyword(s):

Bone Flap ◽

Complication Rates ◽

Flap Failure ◽

Lower Complication ◽

Early Cranioplasty

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The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

Canadian Urological Association Journal ◽

10.5489/cuaj.346 ◽

2013 ◽

Vol 7 (11-12) ◽

pp. 673 ◽

Cited By ~ 13

Author(s):

Ufuk Ozturk ◽

Nevzat Can Şener ◽

H.N. Goksel Goktug ◽

Adnan Gucuk ◽

Ismail Nalbant ◽

...

Keyword(s):

Shock Wave ◽

Shock Wave Lithotripsy ◽

Ureteral Stones ◽

Complication Rates ◽

Success Rates ◽

Retrograde Intrarenal Surgery ◽

Flexible Ureterorenoscopy ◽

Lower Complication ◽

Lower Complication Rate ◽

Invasive Method

Introduction: In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones.Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system.Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to bethe group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12).Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches.

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Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis

Asian Spine Journal ◽

10.4184/asj.2017.11.4.513 ◽

2017 ◽

Vol 11 (4) ◽

pp. 513-519 ◽

Cited By ~ 1

Author(s):

Adem Cobden ◽

Akif Albayrak ◽

Yalkin Camurcu ◽

Hakan Sofu ◽

Temel Tacal ◽

...

Keyword(s):

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Pedicle Screws ◽

Definitive Treatment ◽

Sacral Slope ◽

Complication Rates ◽

Level Of Evidence ◽

Radiological Results ◽

Lower Complication ◽

Clinical And Radiological Results

<sec><title>Study Design</title>Retrospective study (level of evidence: level 3).</sec><sec><title>Purpose</title>The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).</sec><sec><title>Overview of Literature</title>The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.</sec><sec><title>Methods</title>We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.</sec><sec><title>Results</title>Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (<italic>p</italic><0.05).</sec><sec><title>Conclusions</title>The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.</sec>

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Insights into complication rates, reoperation rates, and healthcare utilization associated with use of recombinant human bone morphogenetic protein–2 in patients with spine infections

Neurosurgical FOCUS ◽

10.3171/2018.10.focus18448 ◽

2019 ◽

Vol 46 (1) ◽

pp. E8 ◽

Cited By ~ 2

Author(s):

Mayur Sharma ◽

Nicholas Dietz ◽

Ahmad Alhourani ◽

Beatrice Ugiliweneza ◽

Dengzhi Wang ◽

...

Keyword(s):

Healthcare Utilization ◽

Bone Morphogenetic Protein 2 ◽

Complication Rates ◽

Index Hospitalization ◽

Outpatient Services ◽

Morphogenetic Protein ◽

Human Bone Morphogenetic Protein ◽

Lower Complication ◽

Reoperation Rates ◽

Recombinant Human Bone

OBJECTIVEUse of recombinant human bone morphogenetic protein–2 (rhBMP-2) in patients with spine infections is controversial. The purpose of this study was to identify long-term complications, reoperations, and healthcare utilization associated with rhBMP-2 use in patients with spine infections.METHODSThis retrospective study extracted data using ICD-9/10 and CPT codes from MarketScan (2000–2016). Patients were dichotomized into 2 groups (rhBMP-2, no rhBMP-2) based on whether rhBMP-2 was used during fusion surgery for spinal infections. Outcomes of interest were reoperation rates (index level, other levels), readmission rates, discharge disposition, length of stay, complications, and healthcare resource utilization at the index hospitalization and 1, 3, 6, 12, and 24 months following discharge. Outcomes were compared using nonparametric 2-group tests and generalized linear regression models.RESULTSThe database search identified 2762 patients with > 24 months’ follow-up; rhBMP-2 was used in 8.4% of their cases. The patients’ median age was 53 years, 52.43% were female, and 15.11% had an Elixhauser Comorbidity Index ≥ 3. Patients in the rhBMP-2 group had higher comorbidity indices, incurred higher costs at index hospitalization, were discharged home in most cases, and had lower complication rates than those in the no–rhBMP-2 group. There was no statistically significant between-groups difference in complication rates 1 month following discharge or in reoperation rates at 3, 6, 12, and 24 months following the procedure. Patients in the no–rhBMP-2 group incurred higher utilization of outpatient services and medication refill costs at 1, 3, 6, 12, and 24 months following surgery.CONCLUSIONSIn patients undergoing surgery for spine infection, rhBMP-2 use was associated with lower complication rates and higher median payments during index hospitalization compared to cases in which rhBMP-2 was not used. There was no significant between-groups difference in reoperation rates (index and other levels) at 3, 6, 12, and 24 months after the index operation. Patients treated with rhBMP-2 incurred lower utilization of outpatient services and overall payments. These results indicate that rhBMP-2 can be used safely in patients with spine infections with cost-effective utilization of healthcare resources and without an increase in complications or reoperation rates.

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Native Arterio-Venous Fistula for Hemodialysis: What to Expect Early after Creation?

The Journal of Vascular Access ◽

10.1177/112972980300400202 ◽

2003 ◽

Vol 4 (2) ◽

pp. 39-44 ◽

Cited By ~ 7

Author(s):

M. Leblanc ◽

E. Saint-Sauveur ◽

V. Pichette

Keyword(s):

Blood Flow ◽

Vascular Access ◽

Complication Rates ◽

Ultrasound Dilution ◽

Flow Monitoring ◽

Significant Difference ◽

Lower Complication ◽

Vascular Mapping ◽

Venous Fistula

Native arterio-venous fistulas (AVFs) are preferred for hemodialysis vascular access over synthetic grafts and long-term catheters. However, prevalence rates of native AVFs are variable around the world and have increased only slightly in United States since the DOQI guidelines. To increase rates of native AVFs, pre-operative vascular mapping by ultrasound has been found of major help for appropriate selection of the vessels. The minimal desirable lumen diameter of the artery should be > 2 mm and > 2.5 to 3 mm for the vein at the anatomosis. Early failure can be reduced to less than 10% when the feeding artery is > 2 mm, even in diabetics. If sizes of the vessels are smaller than those targets at the wrist, moving to the upper arm should be considered. The interval between creation and first cannulation varies from 2 weeks to 4 months. There might not be much advantage to wait for more than 4 weeks; however, in large dialysis units, observing a delay of 4 to 6 weeks may be worthwhile to avoid initial problems such as infiltrations and lacerations. Access flow monitoring is essential since it is a reliable predictor of vascular access dysfunction, reducing associated morbidity and costs. Early monitoring of recently created native AVFs has shown that the increase in intra-access blood flow occurs very soon after construction and becomes maximal after a few weeks. A recent prospective study involving all new native AVFs monitored by ultrasound-dilution between weeks 6 and 10 after creation, and every 3 to 6 weeks over 4 months, showed no statistically significant difference in access blood flow between the initial and final measurements (respective values of 1132 ± 681 and 1097 ± 644 ml/min). Access flow was higher in males, and in brachio-cephalic compared to radio-cephalic AVFs. Over the long-term, AVFs are associated with longer patency and lower complication rates, and efforts should be directed at further increasing their prevalence.

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Obesity Does Not Impact Outcomes for Appendicitis

The American Surgeon ◽

10.1177/000313481207800248 ◽

2012 ◽

Vol 78 (2) ◽

pp. 254-257 ◽

Cited By ~ 4

Author(s):

Daniel A. DeUgarte ◽

Rebecca Stark ◽

Amy H. Kaji ◽

Arezou Yaghoubian ◽

Amy Tolan ◽

...

Keyword(s):

Length Of Stay ◽

Univariate Analysis ◽

Laparoscopic Approach ◽

Infectious Complications ◽

Complication Rates ◽

Obese Patients ◽

Lower Complication ◽

Abstract Data ◽

Nonobese Patients ◽

The Impact

Obesity has long been considered a risk factor for surgery. The purpose of this study was to evaluate the impact of obesity on outcomes after appendectomy. A retrospective study was performed using discharge abstract data obtained from patients with documented body mass index (BMI) undergoing appendectomy for appendicitis (n = 2919). Complications and length of stay for different BMI categories were compared. Obese patients (BMI > 30 kg/m2) had similar rates of perforation (20%) and were as likely to undergo a laparoscopic approach (85%) as nonobese patients. On multivariable and univariate analysis, no significant differences were observed when comparing obese and nonobese patients for the outcomes of length of stay, infectious complications, and need for readmission. On multivariate analysis, laparoscopy predicted lower complication rates and decreased length of stay. In this study, obesity did not significantly impact rates of perforation, operative approach, length of stay, infectious complications, or readmission.

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