Efficacy of Neuroendoscopic Treatment for Septated Chronic Subdural Hematoma

Objective: Neuroendoscopic treatment is an alternative therapeutic strategy for the treatment of septate chronic subdural hematoma (sCSDH). However, the safety and efficacy of this strategy remain controversial. We compared the clinical outcomes of neuroendoscopic treatment with those of standard (large bone flap) craniotomy for sCSDH reported in our center. Furthermore, the safety and efficacy of the neuroendoscopic treatment procedure for sCSDH were evaluated.Methods: We retrospectively collected the clinical data of 43 patients (37 men and six women) with sCSDH who underwent either neuroendoscopic treatment or standard (large bone flap) craniotomy, such as sex, age, smoking, drinking, medical history, use of antiplatelet drugs, postoperative complications, sCSDH recurrence, length of hospital stay, and postoperative hospital stay. We recorded the surgical procedures and the neurological function recovery prior to surgery and 6 months following the surgical treatment.Results: The enrolled patients were categorized into neuroendoscopic treatment (n = 23) and standard (large bone flap) craniotomy (n = 20) groups. There were no differences in sex, age, smoking, drinking, medical history, antiplatelet drug use, postoperative complications, and sCSDH recurrence between the two groups (p > 0.05). However, the patients in neuroendoscopic treatment group had a shorter length of total hospital stay and postoperative hospital stay as compared with the standard craniotomy group (total hospital stay: 5.26 ± 1.89 vs. 8.15 ± 1.04 days, p < 0.001; postoperative hospital stay: 4.47 ± 1.95 vs. 7.96 ± 0.97 days, p < 0.001). The imaging and Modified Rankin Scale at the 6-month follow-up were satisfactory, and no sCSDH recurrence was reported in the two groups.Conclusions: The findings of this study indicate that neuroendoscopic treatment is safe and effective for sCSDH; it is minimally invasive and could be clinically utilized.

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

Comparison of the Functional and Radiological Outcomes of Single- and Two-Stage Bilateral Open Wedge High Tibial Osteotomy

Purpose This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO). Methods From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL). Results No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (− 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01). Conclusion SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.

Application of operation room optimization process with multidisciplinary collaborative management in hysteromyoma surgery

Objective: To explore the application of operation room optimization process with multidisciplinary collaborative management in hysteromyoma surgery. Methods: 500 patients who underwent hysteromyoma surgery from March to December 2018 were selected as the control group. 500 patients who underwent hysteromyoma surgery using operation room optimization process with multidisciplinary collaborative management from March to December 2019 were selected as the observation group. The scores of self-care ability (ESCA), psychological status (HAMA, HAMD score), time of postoperative early ambulation activity, comfort of ambulation activity, postoperative hospital stay and total hospital stay, postoperative complications, quality of life score (SF-36), satisfaction with care were compared between the two groups. Results: There was no significant difference in the scores of ESCA, HAMA and HAMD between the two groups before operation (P>0.05). On the 7th day after operation, the score of ESCA of tne two groups was increased (P <0.05), and that of the observation group was higher than that of the control group (P<0.05). The scores of HAMA and HAMD of the two groups were lower than that before operation (P<0.05) and that of the observation group was lower than that of the control group (P <0.05). The earliest time of postoperative ambulation activity of the observation group was earlier than that of the control group (P<0.05). Ambulation activity comfort was superior to the control group (P<0.05). The postoperative hospital stay and total hospital stay of patients in the observation group were shorter than that in the control group (P <0.05). There was no significant difference in preoperative SF-36 scores between the two groups (P>0.05). There was significant difference in SF-36 scores between the two groups after operation and after follow up for 3 months (P<0.05). The occurrence of adverse events in the observation group was lower than that in the control group (P<0.05). The satisfaction of nursing in the observation group was higher than that in the control group (P<0.05). Conclusion: The application of multidisciplinary collaborative management in hysteromyoma surgery can optimize the operation process, alleviate the patient's operation anxiety, promote the patient's postoperative rehabilitation, improve the patient's quality of lite and improve tne patients satisfaction, and therefore, it is worth popularizing.

Liver Transplantation Is Highly Effective in Children with Irresectable Hepatoblastoma

Background and Objectives: In children, hepatoblastoma preferentially is managed by liver resection (LR). However, in irresectable cases, liver transplantation (LT) is required. The aim of our study was to compare short- and long-term results after LR and LT for the curative treatment of hepatoblastoma. Materials and Methods: Retrospective analysis of all patients treated surgically for hepatoblastoma from January 2000 until December 2019 was performed. Demographic and clinical data were collected before and after surgery. The primary endpoints were disease free survival and patient survival. Results: In total, 38 patients were included into our analysis (n = 28 for LR, n = 10 for LT) with a median follow-up of 5 years. 36 patients received chemotherapy prior to surgery. Total hospital stay and intensive care unit (ICU) stay were significantly longer within the LT vs. the LR group (ICU 23 vs. 4 days, hospital stay 34 vs. 16 days, respectively; p < 0.001). Surgical complications (≤Clavien–Dindo 3a) were equally distributed in both groups (60% vs. 57%; p = 1.00). Severe complications (≥Clavien–Dindo 3a) were more frequent after LT (50% vs. 21.4%; p = 0.11). Recurrence rates were 10.7% for LR and 0% for LT at 5 years after resection or transplantation (p = 0.94). Overall, 5-year survival was 90% for LT and 96% for LR (p = 0.44). Conclusions: In irresectable cases, liver transplantation reveals excellent outcomes in children with hepatoblastoma with an acceptable number of perioperative complications.

Effect of pressurised intraperitoneal aerosol chemotherapy on the survival rate of patients with peritoneal carcinomatosis of gastric origin

INTRODUCTION: Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical technique, developed for the treatment of initially unresectable peritoneal carcinomatosis (PC). The objective of this study was to compare the results of PIPAC associated with systemic chemotherapy (PIPAC_CHEM) with those of systemic chemotherapy alone (ONLY_CHEM) in patients with gastric PC without metastasis other than peritoneal, and WHO performance status < 3. METHODS: This was a retrospective, single centre, comparative and non-randomised study. Seventeen PIPAC_CHEM patients were compared to 29 ONLY_CHEM patients. The primary endpoint was overall survival at 6 months from diagnosis of PC. RESULTS: 98 patients were screened and 46 were included (PIPAC_CHEM, n = 17; ONLY_CHEM, n = 29). The 6-month survival rate was significantly higher in the PIPAC_CHEM group than in the ONLY_CHEM group 16/17 (94.1% [65-99.2]) vs 19/29 (65.5% [45.4–79.7]), respectively; p = 0.029. The median total hospital stay at 6 months was significantly shorter for PIPAC_CHEM (median 2 days [2–7]) vs (median 11 days [3–21]) (p = 0.045). Over the entire follow-up, the median survival [95% CI] in PIPAC_CHEM was 12.8 months [7.2–34.3] vs 9.1 months [5.4–11.5] for the ONLY_CHEM group; p = 0.056. CONCLUSION: The overall survival at 6 months after the diagnosis of carcinomatosis was significantly better for PIPAC_CHEM patients. This difference appears to continue until at least 18 months. The total hospital stay at 6 months was significantly shorter in the PIPAC_CHEM group.

Prevalence and risk factors of preoperative deep venous thrombosis in closed patella fracture: a prospective cohort study

Background The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence, the associated risk factors, and the locations of deep venous thrombosis (DVT) in patients with closed patella fracture. Methods Patients who sustained closed patella fracture between January 1, 2016, and April 1, 2019, were included. Blood analyses and ultrasonography of bilateral lower extremities were routinely performed. Data of demographics, comorbidities, mechanism of injury, fracture type, total hospital stay, time from injury to DVT, and laboratory indexes were prospectively collected and compared between groups with and with non-DVT. Multivariate logistic regression analyses were performed to determine the independent risk factors of DVT. Results Among the study cohort of 790 patients, 35 cases occurred in preoperative DVTs, indicating a prevalence of 4.4%, with 3.2% distal and 1.2% proximal DVT. Age ≥ 65 years old (OR, 3.0, 95% CI, 1.1–8.1), D-dimer > 0.5 mg/L (OR, 2.3, 95% CI, 1.1–4.8), and albumin < 35 g/L (OR, 2.5, 95% CI, 1.2–5.3) were identified to be risk factors of DVT in closed patella fracture. Among the DVTs, 30 cases (85.7%) occurred in the injured extremity, 3 cases (8.6%) in bilateral extremities, and 2 cases (5.7%) solely in the uninjured extremity. Conclusion The prevalence of preoperative DVT in closed patella fracture was 4.4%, with 3.2% for distal and 1.2% for proximal DVT. We recommend individualized risk stratification and early anticoagulation for patients with risk factors (age ≥ 65 years, D-dimer > 0.5 mg/L and albumin < 35g/L).

Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis

AimChildren with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis.MethodPubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen’s d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies’ control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared.ResultsThe 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=−0.435, p<0.001; 95% CI −0.567 to −0.302), medium-sized motor impairment (d=−0.610, p<0.001; 95% CI −0.769 to −0.451) and medium-sized language impairment (d=−0.670, p<0.001; 95% CI −0.914 to −0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex.InterpretationThis study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up.

Falls from Great Heights: Risk to Sustain Severe Thoracic and Pelvic Injuries Increases with Height of the Fall

Falls from a height are a common cause of polytrauma care in Level I Trauma Centers worldwide. The expected injury consequences depend on the height of the fall and the associated acceleration, as well as the condition of the ground. In addition, we further hypothesize a correlation between the cause of the fall, the age of the patient, and the patient’s outcome. A total of 178 trauma patients without age restriction who were treated in our hospital after a fall >3 m within a 5-year period were retrospectively analyzed. The primary objective was a clinically and radiologically quantifiable increase in the severity of injuries after falls from different relevant heights (>3 m, >6 m, and >9 m). The cause of the fall, either accidental or suicidal; age and duration of intensive care unit stay, including duration of ventilation; and total hospital stay were analyzed. Additionally, the frequency of urgent operations, such as, external fixation of fractures or hemi-craniectomies, laboratory parameters; and clinical outcomes were also among the secondary objectives. Sustaining a thoracic trauma or pelvis fractures increases significantly with height, and vital parameters are significantly compromised. We also found significant differences in urgent pre- and in-hospital emergency interventions, as well as organ complications and outcome parameters depending on the fall’s height.

AB0680 SARCOPENIA RATE IN COVID-19 SURVIVORS

Background:COVID-19 survivors may have high risks of developing sarcopenia, which is associated to handicap, poor quality of life, higher healthcare costs, increased risk of falls, increased mortality (1).Objectives:To assess sarcopenia rate (which has not been described yet) following COVID-19 hospitalization and to highlights features associated with sarcopenic vs. non-sarcopenic patients.Methods:Major confirmed COVID-19 patients undergoing intensive care unit (ICU) or Pneumology Department admission in Strasbourg University Hospital between March and June 2020 were prospectively included. Muscle and cardio-respiratory evaluations were performed 3 months after discharge. Sarcopenic patients were compared to non-sarcopenic ones. A second muscle assessment 6 months after discharge was performed in patients with pathologic muscle tests.Results:127 patients were included, 39 (30.7%) not requiring ICU care, 88 (69.3%) requiring ICU care. The cohort consisted of 71% male patients, with a median age of 63 years [28-82]. Forty-one-percent were obese (BMI>30 kg/m2). Most individuals had preexisting comorbidities (82 patients, 70%), mainly hypertension and diabetes mellitus. The median total hospital stay duration was 22 days and up to 89 days. At the 3 months assessment, 17/127 (13%) patients were diagnosed with sarcopenia which comprised 6/17 (35%) severe sarcopenia (4.7% of the total cohort). At the 6 months assessment, only 4/15 (27%) of the initial sarcopenic patients remained sarcopenic (3% of the total cohort) and 3 of these 4 patients had severe sarcopenia. BMI (26,3 vs. 29,3, p=0.03), COPD (20% vs. 3%, p=0.03), comorbidities (93% vs. 67%, p=0.04), total hospital stay duration (33 vs. 20 days, p=0.03) and ICU stay duration (33 vs. 13 days, p=0.01) were significantly associated with sarcopenic vs. no sarcopenic patients. However, there was no significant difference concerning cardio-pulmonary evaluations between these two groups.Conclusion:We here highlighted a sarcopenia prevalence at 3 and 6 months following a hospitalization for COVID-19 of 13% and 3% respectively, occurring mainly in patients with comorbidities. Sarcopenia was not associated to worse cardio-pulmonary results in comparison with non-sarcopenic patients.References:[1]Di Filippo L, De Lorenzo R, D’Amico M, Sofia V, Roveri L, Mele R, et al. COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study. Clinical Nutrition [Internet]. oct 2020. https://linkinghub.elsevier.com/retrieve/pii/S0261561420305896Disclosure of Interests:None declared