Postoperative Complications after Phacoemulsification and Implantation of Foldable Acrylic Intraocular Lenses in Dogs

Background: Despite significant advances in canine cataract surgery over the years, many post-operative complications persist and reduces the success rate of phacoemulsification procedure. The aim of current study was to evaluate post-operative complications encountered till 90 days after bimanual phacoemulsification with implantation of different acrylic Intraocular Lenses.Methods: The study was conducted on 24 canine eyes. All the clinical cases were subjected to detailed ocular, ultrasonography and neuro-ophthalmic tests for ascertaining cataract and associated neuro-ophthalmic pathology. Dogs were divided in four groups with 6 eyes in each group and subjected to phacoemulsification procedure for removal of cataractous lens and implanted with square edge or round edge hydrophilic or hydrophobicintra ocular lenses.Result: Statistically non-significant (p£0.05) variations were found for all the post- operative complications among the groups. Within the groups initially higher values were recorded and on subsequent days a declining trend of varying degrees were observed. The corneal opacity was a major postoperative complication leading to failure to achieve vision with other coinciding neuro-ophthalmic conditions.

Development of a Machine Learning Algorithm for Prediction of Complications and Unplanned Readmission Following Reverse Total Shoulder Arthroplasty

Background Reverse total shoulder arthroplasty (rTSA) offers tremendous promise for the treatment of complex pathologies beyond the scope of anatomic total shoulder arthroplasty but is associated with a higher rate of major postoperative complications. We aimed to design and validate a machine learning (ML) model to predict major postoperative complications or readmission following rTSA. Methods We retrospectively reviewed California's Office of Statewide Health Planning and Development database for patients who underwent rTSA between 2015 and 2017. We implemented logistic regression (LR), extreme gradient boosting (XGBoost), gradient boosting machines, adaptive boosting, and random forest classifiers in Python and trained these models using 64 binary, continuous, and discrete variables to predict the occurrence of at least one major postoperative complication or readmission following primary rTSA. Models were validated using the standard metrics of area under the receiver operating characteristic (AUROC) curve, area under the precision–recall curve (AUPRC), and Brier scores. The key factors for the top-performing model were determined. Results Of 2799 rTSAs performed during the study period, 152 patients (5%) had at least 1 major postoperative complication or 30-day readmission. XGBoost had the highest AUROC and AUPRC of 0.681 and 0.129, respectively. The key predictive features in this model were patients with a history of implant complications, protein-calorie malnutrition, and a higher number of comorbidities. Conclusion Our study reports an ML model for the prediction of major complications or 30-day readmission following rTSA. XGBoost outperformed traditional LR models and also identified key predictive features of complications and readmission.

What is the most important predictor of renal function after opened and robotic partial nephrectomy? A propensity score matched study.

701 Background: This study was designed to investigate the parameters that predict the short term and long term renal function after opened partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RPN). Methods: Medical records of 896 patients who underwent OPN and RPN between Feb 2004 to Apr 2017 at our institution were retrospectively reviewed. The propensity scores matching between of OPN and RPN group were performed with a ratio of 1:1. Postoperative outcomes were compared and multivariate logistic regression was performed to identify the parameters influencing acute kidney injury (AKI) and chronic kidney disease (CKD) progression. Results: No significant differences of preoperative characteristics were observed between two study groups after propensity score matching. RPN was significantly associated with longer warm ischemic time (WIT) (p < 0.001); yet, estimated blood loss (EBL), positive surgical margin (PSM) rate, major postoperative complication and CKD progression were significantly lower in RPN group (p values were < 0.001; 0.033; < 0.001; < 0.001 and 0.005 respectively). Multivariate analysis exhibited RPN is more favorable than OPN in terms of preserving renal function. Patients with a higher baseline estimated glomerular filtration rate (eGFR) were significantly associated with greater risk of AKI (OR = 1.036; 95% CI of OR 1.021-1.052; p < 0.001), but reduced risk of CKD progression (OR = 0.975; 95% CI of OR 0.955-0.994; p = 0.011). Other independent predictors of CKD progression included WIT (p = 0.025), age (p = 0.035), higher BMI (0.041) and diabetes mellitus history (p = 0.035). Conclusions: Age, BMI, diabetes mellitus history, baseline eGFR and WIT were the independent predictors of CKD progression after PN. RPN is more favorable than OPN for reducing EBL, PSM, major postoperative complication and renal function preservation.

Timing of surgery following neoadjuvant chemoradiation in rectal cancer: A retrospective analysis from an academic medical center.

702 Background: Neoadjuvant chemoradiotherapy has been proven to achieve decreased local recurrence in rectal cancer with lower toxicity but data confirming the optimal timing of surgery following neoadjuvant cares is less robust. Methods: The University of Iowa Cancer Registry was queried to identify all patients with rectal cancer between 2000-2012. Individual records were reviewed for all patients with Stage II-III disease who received neoadjuvant chemoradiation. Primary endpoints were time interval from last day of chemoradiation to surgery (TI) and overall survival (OS). Secondary endpoints included hospital length of stay following surgery (LOS), intraoperative blood loss (BL), and major postoperative complication including infection, anastomotic failure, and thromboembolic event. Patient characteristics such as personal and family history of malignancy were studied, and treatment regimens including chemotherapy type, radiation technique and quality of resection were also compared. All postoperative pathology slides were reviewed for completeness of resection by a single pathologist. Univariate logistic regression analyses were used to study the association between TI and OS to help define the optimal interval. Results: 88 patients were identified with Stage II and III rectal cancer after imaging and endoscopic study. There was no significant association between OS and TI when comparing less than 8 weeks to greater than 8 weeks (p = 0.14) or when considering TI as a continuous variable (p = 0.99). There was no significant association between TI and surgical complications including BL (p = 0.60) or LOS (median = 7.00 days, p = 0.06), though patients undergoing pelvic exenteration experienced notably longer LOS (n = 4, mean 24.25 days, max 60 days). Conclusions: Our findings indicate that overall survival is not significantly impacted by longer intervals between chemoradiation and surgery. The incidence of major postoperative complication was rare but cost patients and the healthcare provider significant resources; thus, our results implicate potential benefits to treating some Stage II and III rectal cancers solely with chemoradiotherapy.

Early and long-term outcome data on 2,298 patients with pseudomyxoma peritonei of appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

532 Background: Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of this study was to evaluate the outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an International Registry study. Methods: A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International (PSOGI). Results: 2298 patients from 16 specialized units underwent CRS for PMP. Treatment related mortality was 2% and major operative complication was 24%. The median survival was 196 months (16.3 years) and the median progression-free survival was 98 months (8.2 years) with a 10- and 15-year survival rate of 63% and 59% respectively. Multivariate analysis identified prior chemotherapy treatment (P<0.001), PMCA histopathological subtype (P<0.001), major postoperative complication (P=0.008), high PCI (P=0.013), debulking surgery (CCR2/3) (P<0.001), not using HIPEC (P=0.030) as independent predictors for a poorer progression-free survival. Older age (P=0.006), major postoperative complication (P<0.001), debulking surgery (CCR2/3) (P<0.001), prior chemotherapy treatment (P=0.001) and PMCA histopathological subtype (P<0.001) were independent predictors of a poorer overall survival. Conclusions: The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10-years. Minimizing non-definitive operative and systemic chemotherapy treatments prior to definitive cytoreduction may facilitate the feasibility and outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.

Lower Extremity Glandography (LEG): A New Concept to Identify and Enhance Lymphatic Preservation

BackgroundLower extremity edema remains a major postoperative complication after inguinal lymphadenectomy for vulvar cancer. This study documents the lymphatic drainage of the vulva versus the lymphatic drainage of the lower extremity coming through the femoral triangle.MethodsSeven patients underwent either unilateral or bilateral inguinal lymphadenectomy in conjunction with a radical vulvar resection. Preoperatively, patients had technetium-99 injected into the vulvar cancer. Isosulfan blue was injected into the medioanterior thigh 10 cm below the inguinal ligament. The femoral triangle was opened, and a neoprobe was used to locate the "hot" node bearing the technetium-99. Gentle dissection located the blue lymphatic channel and any blue lymph nodes. The blue and hot nodes were resected and submitted separately. The patients then underwent a complete inguinal lymphadenectomy.ResultsA total of 11 groin dissections were performed. In 9 of the 11 groins, the hot node was identified, and in 8 of the 11 groins, blue node or lymphatic channel was identified. The hot nodes were uniformly located on the superior medial aspect of the femoral triangle. The blue nodes were uniformly located on the lateral aspect of the femoral triangle just anterior to the femoral artery or vein. Three patients had hot lymph nodes containing cancer. Of those 3 patients, one had an additional node positive. None of the blue lymph nodes contained cancer.ConclusionsThis procedure demonstrates the alternative lymphatic drainage of the leg versus the vulva. Larger studies are necessary to document the exclusivity of these 2 drainage systems. Preservation of the lymphatic drainage of the leg may result in decreased lymphedema.

Long-Distance Procured Homograft-valved Conduit Replacement for Congenital Heart Disease: Initial Experience with 10 Cases

We review our experience from January 1987 to September 1992 with the surgical treatment of complex congenital malformations requiring an extracardiac homograft-valved conduit. There were 10 patients in the series; 7 pulmonary and 3 aortic homografts were implanted. Ages ranged from 1 month to 26 years (mean 7.9). There were 4 cases of hospital mortality, none related to the homograft itself. The major postoperative complication was low cardiac output syndrome. The 6 survivors have been followed between 3 months and 5 years and no dysfunction of the valved homograft, thromboembolism, or hemolysis have been recorded. All the survivors are symptom-free with a good quality of life. The use of homografts is advised in selected cases of right and left ventricular tract reconstruction for congenital heart disease; homografts are easy to handle and offer several technical advantages over prosthetic tissues.