P-BN14 Differences in rate of complications between emergency and elective laparoscopic cholecystectomy at district general hospital

Abstract Background Current NICE guidelines recommend healthy low risk patients who present with acute biliary disease should be offered laparoscopic cholecystectomy on the same index admission. The increased complexity of the acute operations may impact on the operative complication rates; hence the aim of this study is to evaluate and compare the operative complication rates between elective and emergency laparoscopic cholecystectomies and additionally to assess the difference in surgical techniques comparing complete cholecystectomy versus subtotal versus open procedures. Methods Retrospectively, data was collected from emergency and elective Laparoscopic Cholecystectomies completed in the period 01/01/2021-01/06/2021 at the Queen Elizabeth Hospital Gateshead. The data set was gathered from an electronic theatre database and the individual cases were sub-analyzed further by delving into the electronic patient records database. Statistical analysis done by using Excel 2010. Results The average age of both groups was 50 years. There wasn’t a statistical significance on the rate of complication between the elective Vs emergency cholecystectomies (Elective 2%, Emergency 9% P = 0.17). Out of 42 Elective procedures, 4 had Sub-total cholecystectomy Vs 3 out of 42 patients on the emergency group who had Subtotal cholecystectomy (9% Vs 7%), implying there was no significant difference noted between the two groups. Average hospital stays was 5.6 days for the acute presentation with biliary disease Vs 0.14 days on the planned elective group. 2% of the elective group were noted to have a surgical drain inserted during the operation; whilst the emergency cohort had a slightly higher rate at 5%. Conclusions Overall there was no significant difference noted between the surgical complications arising in emergency cholecystectomy compared to planned surgeries. In addition to this the data also suggests that there is negligible difference in the rates of sub-total cholecystectomies in both cohorts.

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A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180030 ◽

2018 ◽

Vol 12 (5) ◽

pp. 509-514 ◽

Cited By ~ 1

Author(s):

M. Troy ◽

B. Shore ◽

P. Miller ◽

S. Mahan ◽

D. Hedequist ◽

...

Keyword(s):

Operative Time ◽

Surgical Techniques ◽

Leg Length Discrepancy ◽

Complication Rates ◽

Leg Length ◽

Treatment Groups ◽

Length Discrepancy ◽

Baseline Activity ◽

Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

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Rigid versus flexible neuroendoscopy: a systematic review and meta-analysis of endoscopic third ventriculostomy for the management of pediatric hydrocephalus

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.2.peds2121 ◽

2021 ◽

pp. 1-11

Author(s):

Daphne Li ◽

Vijay M. Ravindra ◽

Sandi K. Lam

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Statistical Significance ◽

Flexible Endoscopy ◽

Third Ventriculostomy ◽

Complication Rates ◽

Inclusion Criteria ◽

Related Complication ◽

Rigid Endoscopy ◽

Pediatric Hydrocephalus ◽

Significant Difference

OBJECTIVE Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus. METHODS A systematic MEDLINE search was conducted using combinations of keywords: “flexible,” “rigid,” “endoscope/endoscopic,” “ETV,” and “hydrocephalus.” Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood’s median tests. RESULTS Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored–matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5–57.5 vs 62.5, IQR 50–70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures. CONCLUSIONS Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.

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Prepectoral Direct-to-Implant Breast Reconstruction: Early Outcomes and Analysis of Postoperative Pain

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojz006 ◽

2019 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Rafi Fredman ◽

Cindy Wu ◽

Mihaela Rapolti ◽

Daniel Luckett ◽

Jason Fine ◽

...

Keyword(s):

Postoperative Pain ◽

Breast Reconstruction ◽

Statistical Significance ◽

Complication Rates ◽

Level Of Evidence ◽

Trade Offs ◽

Technological Advances ◽

Significant Difference ◽

Aesthetic Results ◽

Postmastectomy Radiation Therapy

Abstract Background Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results in appropriate candidates. Most commonly, implants are placed in the subpectoral space which can lead to pain and breast animation. Surgical and technological advances have allowed for successful prepectoral implant placement which may eliminate these trade-offs. Objectives Here we present early outcomes from 153 reconstructions in 94 patients who underwent prepectoral DTI. We sought to determine whether these patients have less postoperative pain and narcotic use than subpectoral implant or expander placement. Methods A retrospective review was performed for all prepectoral DTI reconstructions at our institution from 2015 to 2016. Data were collected on postoperative pain and narcotic use while in hospital. Results The average follow-up time was 8.5 months (range, 3–17 months) and the overall complication rate was 27% (n = 41) with the most common complications being skin necrosis (9%, n = 13) and infection (7%, n = 11). No statistically significant difference in complications was found in patients who underwent postmastectomy radiation therapy. Patients who underwent prepectoral DTI reconstruction did not have a statistically significant difference in postoperative pain and narcotic use while in-hospital compared with other techniques. Conclusion Prepectoral DTI reconstruction provides good results with similar complication rates to subpectoral techniques. Prepectoral DTI eliminates the problem of breast animation. Although our series did not reach statistical significance in pain scores or requirement for postoperative narcotics, we believe that it is an important preliminary result and with larger numbers we anticipate a more definitive conclusion. Level of Evidence: 4

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Discrepancy in Postoperative Outcomes between Auditing Databases: A NSQIP Comparison

The American Surgeon ◽

10.1177/000313481808400839 ◽

2018 ◽

Vol 84 (8) ◽

pp. 1294-1298 ◽

Cited By ~ 3

Author(s):

William B. Lyman ◽

Michael Passeri ◽

Allyson Cochran ◽

David A. Iannitti ◽

John B. Martinie ◽

...

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Statistical Significance ◽

Postoperative Pancreatic Fistula ◽

Complication Rates ◽

Audit System ◽

Acs Nsqip ◽

Outcome Reporting ◽

Significant Difference ◽

Chi Squared

In 2014, ACS-NSQIP® targeted pancreatectomies to improve outcome reporting and risk calculation related to pancreatectomy. At the same time, our department began prospectively collecting data for pancreatectomy in the Enhanced Recovery After Surgery® Interactive Audit System (EIAS). The purpose of this study is to compare reported outcomes between two major auditing databases for the same patients undergoing pancreatectomy. The same 171 patients were identified in both databases. Clinical outcomes were then obtained from each database and compared to determine whether reported complication rates were statistically different between auditing databases. A combination of Wilcoxon rank sum and Pearson's chi-squared tests were used to calculate statistical significance. No significant difference was appreciated in captured demographics between EIAS and NSQIP. Significant differences in reported rates for renal dysfunction, postoperative pancreatic fistula, return to the operative room, and urinary tract infection were noted between EIAS and NSQIP. Although significant differences in reported complication rates were demonstrated between EIAS and NSQIP for pancreatectomy, much of the discrepancy is attributable to subtle differences in definitions for postoperative occurrences between the two auditing databases. It is vital for surgeons to understand the exact definition that determines the complication rate for a given database.

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Comparative analysis of the effectiveness of narrow-spectrum versus broad-spectrum antibiotics for the treatment of childhood pneumonia

SAGE Open Medicine ◽

10.1177/20503121211044379 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110443

Author(s):

Chilot Abiyu Demeke ◽

Getnet Mequanent Adinew ◽

Tamrat Befekadu Abebe ◽

Abebech Tewabe Gelaye ◽

Sisay G/Hana Gemeda ◽

...

Keyword(s):

Broad Spectrum ◽

Statistical Significance ◽

Community Acquired Pneumonia ◽

Referral Hospital ◽

P Value ◽

Data Set ◽

Treatment Regimens ◽

Narrow Spectrum ◽

Significant Difference ◽

The University

Objectives: The main objective of this study was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with community-acquired pneumonia (CAP) at the University of Gondar Referral Hospital, Gondar, Ethiopia. Methods: Institutional-based retrospective chart review was conducted at the University of Gondar Referral Hospital (GURH) pediatrics ward from 1 February 2016 to 30 April 2016. The collected data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were done to present the basic features and summary of the data set. In addition, binary logistics and multivariable logistic regression analysis were conducted to test for an association between the dependent and independent variables. A P value of <0.05 was taken to declare statistical significance at a 95% confidence interval. Result: A total of 147 patients with CAP were included in the study. Seven different treatment regimens were employed for the 147 children hospitalized. About 63 (42.9%) of the study participants received a narrow-spectrum antibiotic and 84 (57.1%) received a broad-spectrum antibiotic. There was no significant difference between the broad and narrow spectrum treatment groups in main treatment outcomes. The median length of stay (LOS) for the study population was 3 days. The median LOS was shorter among those receiving narrow-spectrum therapy compared with those receiving broad-spectrum therapy. Treatment dose and duration of therapy were significantly associated with treatment outcome (P < 0.0001 and P = 0.003), respectively. Conclusion: The effectiveness of narrow-spectrum therapy is similar to that of broad-spectrum therapy for children hospitalized with CAP. Treatment regimens for children with community-acquired pneumonia should be selected based on their safety profile and their tendency for antibiotic resistance.

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Three-Port versus Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24849 ◽

2019 ◽

Vol 21 (1) ◽

pp. 40-43

Author(s):

Rabin Koirala ◽

TM Gurung ◽

A Rajbhandari ◽

P Rai

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Hospital Stay ◽

Controlled Trial ◽

Open Cholecystectomy ◽

Analgesic Requirement ◽

Safe Alternative ◽

Average Hospital ◽

Significant Difference ◽

Conversion To Open Cholecystectomy

Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionally performed using four ports. With the aim of improving patient’s comfort, port numbers have been reduced to single port. But feasibility and the extra expense that comes with single and double port LC has made them less attractive. Three port LC can be a safe alternative to four port LC, and various research has shown its safety. This study compares the three port LC with the traditional four port LC with the objective of assessing feasibility and benefit of the decreased port number. We evaluated 217 patients who were randomly allocated for three port and four port LC. Both the groups were compared for operative time, assessment of postoperative pain, days of hospital stay and postoperative recovery time after discharge. The parameters were compared using Statistical Package for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LC and 94 underwent four port LC. The larger number were females (79.7%), and with comparable age group of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesic requirement, average hospital stay and port site infection rates were comparable in both groups of patients. The average time taken for operation was less in three port LC than the four port LC but this was not statistically significant. There is no significant difference between 3 port and 4 port LC in terms of time required for the surgery, conversion rate, complication and duration of hospital stay.

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Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes

ORL ◽

10.1159/000513890 ◽

2021 ◽

pp. 1-6

Author(s):

Nagihan Gülhan Yaşar ◽

Recep Karamert ◽

Hakan Tutar ◽

Mehmet Birol Uğur ◽

Burak Hazır ◽

...

Keyword(s):

Otitis Media ◽

Hearing Aids ◽

Surgical Techniques ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Complication Rates ◽

Speech Discrimination ◽

Mastoid Obliteration ◽

Significant Difference ◽

The Impact

Introduction: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. Methods: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. Results: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p > 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p > 0.05). Conclusion: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.

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Outcome of Early Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43023 ◽

2019 ◽

Vol 5 (2) ◽

pp. 161-166

Author(s):

Mohammed Masudur Rahman ◽

Kamrunnahar ◽

Shimul Akter ◽

AZM Shakhawat Hossain ◽

Fouzia Mujib Un Naz

Keyword(s):

Laparoscopic Cholecystectomy ◽

Early Group ◽

College Hospital ◽

Early Laparoscopic Cholecystectomy ◽

Conversion Rates ◽

Significant Difference ◽

Beneficial Impact ◽

Lower Treatment Cost ◽

Elective Group ◽

Elective Laparoscopic Cholecystectomy

Background: : The surgical management of patients presenting with acute calculus cholecystitis remains controversial. Objective: The aim of this study was to evaluate the safety and feasibility of early laparoscopic cholecystectomy for acute calculus cholecystitis and to document the outcome of early laparoscopic cholecystectomy. Methodology: This observational comparative study was carried out in the Department of General Surgery of Sylhet MAG Osmani Medical College Hospital, Sylhet from July 2006 to June 2008, a period of 24 months. The study group enrolled 101 patients of both sexes who underwent laparoscopic cholecystectomy surgery and divided into two groups. 51 patients with a diagnosis of acute calculus cholecystitis were assigned randomly to early laparoscopic cholecystectomy within 72 h of admission (early group, n=51) or to initial conservative treatment followed by elective laparoscopic cholecystectomy, 6 to 12 weeks later (elective group, n=50). Results: There was no significant difference in operation times (early, 81.98 vs elective, 79.96), conversion rates (early, 5.88% vs elective 10%) or postoperative complications (early 31,4% vs elective,24%).However, during early laparoscopic cholecystectomy distended gallbladder containing infected bile was more in 41 patients (80.01%) while 04 patients (09%) and 03 patients (7.20%) in elective laparoscopic cholecystectomy (p>0.05) and significantly (p<0.05) more modification in operative techniques in early group than elective group. In addition, early group had shorte hospital stay (8.37 vs 12.62 days0 and lower treatment cost (5243.13 vs 7327) which were statistically significant (p<0.05). Conclusion: In conclusion laparoscopic cholecystectomy during the early admission with acute calculus cholecystitis can be performed safely and successfully. Earlier surgery has a beneficial impact for patients and the National Health Service. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 161-166

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Early Outcomes in Anterior Cruciate Ligament Reconstruction: Full Tibial tunnel technique compared to all-inside technique

Revista de Chimie ◽

10.37358/rc.18.12.6835 ◽

2019 ◽

Vol 69 (12) ◽

pp. 3753-3755

Author(s):

Octav Marius Russu ◽

Emilian Ciorcila ◽

Andrei Marian Feier ◽

Radu Fleaca ◽

Sandor Gyorgy Zuh ◽

...

Keyword(s):

Postoperative Pain ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Statistical Significance ◽

Tibial Tunnel ◽

Surgical Techniques ◽

Assessment Tools ◽

Significant Difference ◽

Tunnel Technique

The all-inside technique for ACL reconstruction uses the semitendinous muscle tendon as a graft, and postoperative pain is slightly reduced. Through the full tibial tunnel technique, better anatomical graft placement is obtained with promising results, yet there are only few scientific articles comparing the two techniques. The main objective is evaluation of results after ACL reconstruction by comparing the clinical results of the two surgical techniques. A prospective study was conducted that included 63 eligible patients according to pre-established criteria. The technique used was randomly indicated to each patient. Demographics and clinical examination results were collected and subsequently stored. The assessment tools used were the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) and the Visual Analogue Scale (VAS) with a 6-month follow-up period. The statistical analysis was performed for preoperative follow-up scores, at 3 and 6 months. All patients were operated by the same surgical team under spinal anesthesia with nerve block and tourniquet applied.In regards to IKDC and KOOS scores, the difference between the two interventions was not statistically significant (p = .579 and p = .710). Postoperative pain was slightly reduced in patients in the all-inside\ group but without any statistical significance compared to full-tibial tunnel technique(p = .259). There were no graft ruptures or late postoperative complications. Regarding IKDC, KOOS and VAS evaluating tools, there is no statistically significant difference between the two evaluated methods for ACL reconstruction, all-inside and full tibial tunnel at 3 months and 6 months after surgery.

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Outcomes following abdominoperineal resection 6 years retrospective study at a rural district general hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210862 ◽

2021 ◽

Vol 9 (3) ◽

pp. 665

Author(s):

Deeksha Arora ◽

Michael Tang ◽

Thomas Seddon ◽

Milind Rao

Keyword(s):

Retrospective Study ◽

Wound Closure ◽

Surgical Techniques ◽

Perineal Wound ◽

Biological Mesh ◽

Wound Complications ◽

Complication Rates ◽

Patient Factors ◽

Mesh Group ◽

Significant Difference

Background: A range of surgical techniques are used for perineal wound closure following Abdominoperineal Excision of the Rectum (APER). The aim of this study was to assess the safety and effectiveness of using a biological mesh for perineal wound closure and to compare the outcomes following conventional suture and mesh closure of the perineal wound.Methods: A single-centre retrospective study of a cohort of patients undergoing surgery for low rectal cancer between January 2013 and December 2018. Patient records were analysed for outcomes including perineal complication rates, length of hospital stay and impact of patient factors on complication rates in mesh vs no mesh group.Results: Of the total 43 patients included in the study, 13 (30%) had a conventional perineal closure whereas 30 patients (70%) had a biological mesh reconstruction. Early perineal wound complications were seen in 21/43 (49%) patients. Of those, 6 (29%) patients were in the no mesh group compared to 15 (71%) patients in the mesh group (p = 0.81). 84% of the patients who received neo adjuvant radiotherapy (NART) developed perineal wound infection. There was no statistically significant difference in the mesh and no mesh groups. None of the patient factors, other than preoperative anaemia, had a statistically significant association with the rate of complications in either of the groups.Conclusions: There was no statistically significant difference in the complication rate between primary and biological mesh closure. Biological mesh is safe for perineal reconstruction following APER.

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