The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques

AbstractNonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques. A total of 75 patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients’s mean age at the beginning of treatment was 46 years. The mean follow-up period was 10 years and 11 months. The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression. The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay. Bone union was achieved in all of the 75 evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me = 6.00 vs. Me = 4.00). We observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group. The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union, length of hospital stay, duration of Ilizarov treatment, or ASAMI bone scores. For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression. The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.

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The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques

10.21203/rs.3.rs-76172/v1 ◽

2020 ◽

Author(s):

Łukasz Szelerski ◽

Andżelika Pajchert Kozłowska ◽

Sławomir Żarek ◽

Radosław Górski ◽

Paweł Małdyk ◽

...

Keyword(s):

Treatment Time ◽

Surgical Techniques ◽

Treatment Strategies ◽

Length Of Hospital Stay ◽

Bone Union ◽

Functional Score ◽

Ilizarov Method ◽

Results Of Treatment ◽

Functional Scores ◽

Aseptic Nonunions

Abstract INTRODUCTIONNonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques.MATERIALS AND METHODSA total of 75patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients’s mean age at the beginning of treatment was 46years.The mean follow-up period was 10years and 11months.The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression.The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay.RESULTS: Bone union was achieved in all of the75evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me=6.00vs.Me=4.00).DISCUSSIONWe observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group.The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union,length of hospital stay,duration of Ilizarov treatment,or ASAMI bone scores.For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression.The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.Level of EvidenceDiagnostic Level IV

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v2 ◽

2021 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract Background The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.Results In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).Conclusions Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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Role of postoperative antibiotics for prevention of infection after appendectomy in patients with complicated appendicitis

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15285 ◽

2016 ◽

Vol 18 (3) ◽

pp. 22 ◽

Cited By ~ 1

Author(s):

R Poudel

Keyword(s):

Hospital Stay ◽

Wound Infection ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

General Assumption ◽

Complicated Appendicitis ◽

Wound Complications ◽

Inclusion Criteria ◽

Medical Sciences

Background: Acute Appendicitis is the most common general surgical emergency. Despite improved asepsis and surgical techniques, postoperative complications are still common. The general assumption is that it is better to treat patients with complicated appendicitis (perforated or gangrenous) with antibiotics, in contrast to patients with simple appendicitis. Aim of this study was to compare outcomes of patients treated with antibiotics after appendectomy in complicated appendicitis with those of patients who were not treated with antibiotics.Methods: This was a retrospective study carried out in Universal College of Medical Sciences, Bhairawha, Nepal. Patients who underwent emergency appendectomy in 2 years period were included in the study. Patients with complicated appendicitis were analyzed on the basis of whether they received postoperative antibiotics or not. Main outcome measured were wound complications and length of hospital stay.Results: During the 2-year study period, a total of 203 patients met inclusion criteria. Complicated appendicitis was identified in 71 patients (34.97%). Postoperative antibiotics were administered to 42 (59.2%). On Univariate and multivariate analyses Postoperative antibiotics were not associated with decrease in wound infection. But it is associated with increase in length of hospital stay (p <0.01, 95% confidence interval 2.68-6.05).Conclusion: Use of Postoperative antibiotics does not decrease the rate of wound infection in patient with complicated appendicitis but result in increase length of hospital stay.

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Comparison of Early Postoperative Outcomes of Patients Undergoing Robot-Assisted and Transsternal Thymectomy

Journal of Medical and Surgical Research ◽

10.46327/msrjg.1.000000000000199 ◽

2021 ◽

pp. 973-978

Author(s):

Burcu Ancin ◽

Mesut Melih Ozercan ◽

Yigit Yilmaz ◽

Serkan Uysal ◽

Ulas Kumbasar ◽

...

Keyword(s):

Minimally Invasive ◽

Hospital Stay ◽

Chest Tube ◽

Operative Time ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Robot Assisted ◽

Minimally Invasive Surgical ◽

Significant Difference ◽

Robotic Thymectomy

Objective: Robot-assisted thoracoscopic surgery (RATS) is a minimally invasive technique that has been used in thymectomy operations in recent years. Minimally invasive surgical techniques offer less postoperative pain, a shorter length of hospital stay, and faster recovery compared to conventional surgical techniques. In our study, we aimed to compare the outcomes of robotic and transsternal thymectomies by analyzing the operative and postoperative data of these two approaches. Methods: Twelve robotic thymectomy patients and 16 transsternal thymectomy patients who were operated on in our clinic in 2018 were included in the study. Results: There was no significant difference between the two groups in terms of operative time (p=0.231). The median chest tube duration was 1.5 [range, 1-2] days in robotic thymectomy and 2.5 [range, 1-3.75] days in transsternal thymectomy. However, there was no statistically significant difference between the two groups (p=0.082). The amount of chest tube drainage was significantly lower in the robotic thymectomy group (p=0.006). The length of hospital stay was also significantly shorter in robotic thymectomy patients (p<0.001). Conclusion: The amount of chest tube drainage was lower and the length of hospital stay was shorter in the robotic surgery compared to the transsternal approach. There was no significant difference between the two techniques in terms of operative time. Within today's minimally invasive surgical techniques, robotic thymectomy can be considered a practical, comfortable, and safe technique with better early postoperative outcomes. Keywords: Robot-Assisted Thymectomy, Thymectomy, Transsternal Thymectomy

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Impact of an Acute Care Surgery Model on the Management of Acute Appendicitis in South Korea: A Retrospective Cohort Study

Emergency Medicine International ◽

10.1155/2021/5522523 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Background. The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods. This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann–Whitney U-test were used for continuous and nonnormally distributed data, respectively. Results. In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3 ± 3.2 days vs. 7.2 ± 9.6 days, p = 0.039 ). Conclusions. Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.

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The Benefit of Modified Rehabilitation and Minimally Invasive Techniques in Total Hip Replacement

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x285900 ◽

2008 ◽

Vol 90 (5) ◽

pp. 406-411 ◽

Cited By ~ 2

Author(s):

Anastasios K Lilikakis ◽

Beryl Gillespie ◽

Richard N Villar

Keyword(s):

Minimally Invasive ◽

Hospital Stay ◽

Total Hip Replacement ◽

Hip Replacement ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Minimally Invasive Techniques ◽

Rehabilitation Protocol ◽

Total Hip ◽

Invasive Techniques

INTRODUCTION We wished to assess if an intensive rehabilitation regimen alone, or one combined with modified anaesthetic and surgical techniques, can change the speed of rehabilitation or the length of hospital stay after total hip replacement. PATIENTS AND METHODS We compared 44 patients who had followed a traditional care pathway, with 38 patients who had rehabilitated under a new rehabilitation protocol, with 40 patients who had also received modified, minimally invasive techniques. The speed of rehabilitation was measured in terms of three specific milestones accomplished on the day after surgery. RESULTS We found a statistically significant improvement in the day after surgery each activity was possible. The length of hospital stay was reduced from 6.5 days to 5.4 days to 4.1 days, a difference which was also statistically significant. CONCLUSIONS The data support the view that a new rehabilitation protocol alone can reduce the length of hospital stay and hasten rehabilitation. The combination of modified anaesthetic and minimally invasive surgical techniques with the new rehabilitation regimen can further improve short-term outcome after total hip replacement.

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Gunsight sutures significantly reduce surgical-site infection after ileostomy reversal compared with linear sutures

Gastroenterology Report ◽

10.1093/gastro/goaa075 ◽

2020 ◽

Author(s):

Chuang-Kun Li ◽

Wei-Wen Liang ◽

Huai-Ming Wang ◽

Wen-Tai Guo ◽

Xiu-Sen Qin ◽

...

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Odds Ratio ◽

Wound Closure ◽

Loop Ileostomy ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Skin Closure ◽

Site Infection ◽

Ileostomy Reversal

Abstract Background Surgical-site infection (SSI) was one of the most common post-operative morbidities of ileostomy reversal. Although several skin-closure procedures had been developed to reduce the rate of SSI, the optimal procedure remains unclear. In this study, we compared the effect of two surgical techniques for wound closure following ileostomy reversal: gunsight suture (GS) and linear suture (LS). Methods A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study. These patients were divided into two groups: the LS group and the GS group. We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI. Results Both groups successfully underwent surgery. The rate of SSI was significantly lower in the GS group (n = 2, 0.02%) than in the LS group (n = 16, 12.00%, P = 0.007). The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group (8.1 ± 3.2 vs 10.8 ± 5.4 days, P < 0.001). Multivariate analysis showed that GS was an independent protective risk factor for SSI (odds ratio = 0.212, P = 0.048). Conclusions Compared with the LS technique, the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery. The GS technique may be recommended for wound closure following ileostomy reversal.

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v3 ◽

2021 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract BackgroundThe acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea.MethodsThis single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.ResultsIn total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).ConclusionsSince the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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Timing of Femoral Shaft Fracture Fixation Affects Length of Hospital Stay in Patients with Multiple Injuries

The Open Orthopaedics Journal ◽

10.2174/1874325001509010324 ◽

2015 ◽

Vol 9 (1) ◽

pp. 324-331 ◽

Cited By ~ 6

Author(s):

Saam Morshed ◽

Christopher Mikhail ◽

Theodore Miclau III

Keyword(s):

Length Of Stay ◽

Confidence Interval ◽

Hospital Stay ◽

Femoral Shaft Fracture ◽

Treatment Time ◽

Length Of Hospital Stay ◽

Femoral Shaft ◽

Shaft Fracture ◽

Definitive Treatment ◽

Median Length

Purpose : Appropriate timing of definitive fracture care in the setting of polytrauma remains controversial. The aim of this study is to determine whether timing of definitive fixation of femur fractures impacts subsequent length of hospital stay, a surrogate for postoperative morbidity, in patients with multi-system trauma. Methods : Secondary analysis of data from the National Trauma Data Bank (January 1, 2000 to December 31, 2004) was performed. Adult patients who: (1) had an open or closed femoral shaft fracture, (2) had an injury severity score (ISS) greater than or equal to 15, (3) and underwent definitive internal fixation were included. Time to fixation was divided into 5 time periods based on commonly used cut-off points from the literature: (1) 12 hours or less, (2) between 12 and 24 hours, (3) between 24 and 48 hours, (4) between 48 and 120 hours, and (5) more than 120 hours. Because we consider length of stay a surrogate for adverse outcome causally affected by treatment time, the outcome variable was calculated as the duration of hospitalization following definitive treatment. Time to definitive fixation and its effect on post-treatment length of hospital stay was analyzed using median regression with inverse probability of treatment-weighting (IPTW) to control for confounding factors. Results : Compared to fixation during the first 12 hours after admission, median length of hospital stay was significantly higher (2.77 days; 95% confidence interval, 0.54 to 4.72) when fixation occurred between 48 and 120 hours from admission. Among the other time intervals, only treatment between twelve to twenty-four hours after admission was shown to reduce length of stay (-0.61 days; 95% confidence interval, -1.53 to 0.42) versus the referent interval of the first 12 hours, though this result did not achieve statistical significance. In order to assess the impact of shorter recorded length of stay for deceased patients, sensitivity analysis was conducted excluding all patient that underwent definitive treatment and died. Results were nearly identical for the second analysis, showing a higher post-treatment length of stay estimated for the population treated between 48 and 120 hours versus had they been treated within the first 12 hours from admission (2.53 days, 95% confidence interval, 0.27 to 4.13). Conclusion : Delayed fixation of femoral shaft fractures in patients with multiple injuries between 2-5 days may lead to an increase in adverse outcomes as evidenced by increased median length of hospital stay. This finding supports prior clinical reports of a perilous period where a “second hit” resulting from definitive internal fixation can occur. Whether there is an optimal window for fixation during which physiologic stress of fracture fixation does not adversely lengthen hospital stay should be the subject of future prospective study.

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v1 ◽

2020 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract BackgroundThe acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. MethodsThis single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.ResultsIn total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).ConclusionsSince the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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