O48 PREOPERATIVE CT IMAGING IN PATIENTS WITH STRANGULATED ABDOMINAL WALL HERNIAS DELAYS SURGERY AND INCREASE RISK OF BOWEL RESECTION: A RETROSPECTIVE RECORD BASED STUDY

Aim “To investigate whether preoperative CT imaging in acute symptomatic hernia was associated with either surgical delays or increase risks of bowel ischemia and the need for resection.” Material and Methods “The data was collected retrospectively for patients who had emergency hernia surgeries in the period between June 2003 till January 2021. We studied the role of preoperative CT scan in delaying surgical intervention and its impaction on intra-operative surgical intervention, postoperative complication, HDU admission and hospital length of stay.” Results “Data analysis was performed for 505 patients, 191 had preoperative CT scan. Hernia types included inguinal in 164 patients (32.5%); umbilical in 164 (32.5%); femoral in 69 (13.7%); incisional in 69 (13.7%); epigastric in 30 (5.9%); Spigelian in 9 (1.8%). Preoperative CT scan was associated with surgery delay (22.0 hours vs 13.0 hours, P 9.77e-16). Delayed surgery had an impact on increasing postoperative complications (5.2% vs 3.5%, P 0.4741), longer mean postoperative hospital lengths of stay (9.23 days vs 5.12 days, P 2.2e-16), and increase HDU admission (11.0% vs 4.8%, P 0.01408). Increase bowel resection (12% vs 6.4%, P 0.04032) with surgery delay (20.0 hours vs 12.0 hours, P 0.003448) and also increase omentum resection (7.3% vs 5.4%, P 0.4974) with surgery delay (22.5 hours vs 13.5 hours, P 0.02083) were noted.” Conclusions “Pre-operative CT scan for emergent hernias leads to delay in surgical intervention. Surgery delay leads to more aggressive intra-operative intervention and worse postoperative outcomes.”

Optic nerve injury in preoperative imaging is associated with visual improvement outcome in endoscopic optic nerve decompression

Summary Objective To evaluate potential clinical parameters having an impact on visual outcome after endoscopic optic nerve decompression in acute optic neuropathy patients. Methods A retrospective chart review of patients with acute optic neuropathy, who underwent endoscopic optic nerve decompression between June 2001 and November 2018 at an academic center was performed. Patients were divided into groups according to visual improvement after surgical treatment (yes/no). Following clinical parameters were compared between groups: perioperative steroid use, evidence of optic nerve affection in preoperative neuroimaging, additional optic nerve sheath incision, surgery delay and preoperative C-reactive protein (CRP) levels. Further subgroups analyses were conducted based on etiology (trauma/tumor). Results Among 32 included cases, 16 patients (50%) reported visual improvement after endoscopic optic nerve decompression. There was no significant difference in visual improvement between etiology subgroups (trauma: n = 9/20 (45%) vs. tumor: n = 7/12 (58.3%), p = 0.465). Tumor subgroup patients with visual improvement had a significantly higher prevalence of optic nerve affection in preoperative neuroimaging than those without visual improvement (p = 0.018, φ = 0.683). Perioperative steroid administration was negatively associated with visual outcome (p = 0.034, φ = 0.375). Nerve sheath incision, surgery delay and preoperative CRP levels did not have a significant impact on visual outcome (p > 0.05). Conclusion Radiological findings can help as an indicator for surgical treatment since an affected optic nerve in preoperative neuroimaging resulted in better visual outcome after surgery. The use of steroids should be considered more carefully since it did not show any beneficial effect.

Current situation of complications related to reconstructive surgery for pelvic organ prolapse: a multicenter study

Introduction and hypothesis This study aimed to investigate the evaluation and management of complications after pelvic floor reconstructive surgery for pelvic organ prolapse in China. Methods Complications of pelvic floor reconstructive surgery for pelvic organ prolapses from 27 institutions were reported from November 2017 to October 2019. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and the International Continence Society (ICS). The severity of the complications was graded by the Clavien-Dindo grading system. Four scales were used to evaluate patient satisfaction and quality of life after management of the complications: the Patient Global Impression of Improvement (PGI-I), the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7), the Pelvic Organ Prolapse Symptom Score (POP-SS), and a 5-point Likert-type scale that evaluated the patient’s choice of surgery. Results Totally, 256 cases were reported. The occurrence of complications related to transvaginal mesh (TVM) and laparoscopic sacrocolpopexy (LSC) had a significantly longer post-surgery delay than those of native tissue repair surgery (p < 0.001 and p = 0.010, respectively). Both PFIQ-7 and POP-SS score were lower after management of complications (p < 0.001). Most respondents (81.67%) selected very much better, much better, or a little better on the PGI-I scale. Only 13.3% respondents selected unlikely or highly unlikely on the 5-point Likert-type scale. Conclusions The occurrence of complications related to TVM surgery and LSC had a longer post-surgery delay than native tissue repair surgery. Long-term regular follow-up was vital in complication management. Patient satisfaction with the management of TVM complications was acceptable.

The evidence of surgery delay after viscosupplementation is increasing

Osteoarthritis (OA) is a widespread disease throughout the world and prosthetic replacement is considered an effective and definitive treatment. However, some patients do not want or cannot undergo this type of invasive procedure due to the risk of complications. Besides, this kind of surgery is a very expensive treatment for the healthcare system. Real life studies have shown, with growing evidence, that repeated cycles of intra-articular injections of hyaluronic acid (HA) resulted in a significant reduction in pain symptoms as well as an improvement in joint function. Moreover, an important reduction in analgesics consumption was observed. Some studies have shown a delay of total knee replacement (TKR) for up to 2 years. There is minimal data available about the impact of HA injections on the delay of total hip replacement (THR). This review has also evaluated, in addition to clinical research studies, several papers with data from administrative databases suggesting that viscosupplementation possesses the potential to delay or obviate the need for surgery in patients with knee or hip OA. Further studies are necessary to understand the predictors of response, the diversity of response to different HA products, the appropriate dosage and cyclicity in relation to the radiological and clinical stage of the disease.

Impact of Delirium on Short-term Prognosis in Geriatric Patients with Hip Fracture

Background: To explore the effect of delirium on postoperative early prognosis of geriatric patients with hip fracture. Methods: According to whether postoperative delirium (POD) appeared in elderly patients with hip fracture, all cases were divided into two groups: delirium and non-delirium. General parameters, operative parameters, length of stay (LOS), and perioperative complications were recorded. Recurrent fracture, new stroke, and mortality within 1 year postoperatively were followed up and compared between the two groups. Results: Of 358 cases, 55 (15.4%) developed delirium. Compared with the non-delirium group, the delirium group had longer operative times (P=0.031); increased platelet (P=0.002) and C-reactive protein (P<0.001) levels; and reduced hemoglobin (P<0.001), calcium (P=0.040), albumin (P<0.001), prealbumin (P<0.001), and total cholesterol (P=0.019) levels. Complications occurred to some extent in 196 cases (54.7%). In the delirium group, complication rates of pulmonary infection (P=0.005), hypoalbuminemia (P<0.001), electrolyte disorder (P<0.001), dyspepsia (P=0.027), bedsore (P=0.012) and anemia (P=0.007) were higher. In addition, LOS was significantly longer (15.71 ± 4.72 vs 14.00 ± 5.30 days; P=0.026) in the delirium group. Within 1 year postoperatively, 31 individuals (8.7%) had died, 13 were treated for recurrent fracture, and 42 had a new stroke. In the delirium group, mortality within 1 year postoperatively was higher (27.3% vs 5.3%, P<0.001). Conclusions: The morbidity of POD is high in geriatric patients with hip fractures. There was longer surgery delay, higher complication rate, longer LOS, and increased mortality in the delirium group. Early intervention of POD has important clinical significance.