Preoperative Depression is Associated With Increased Complications Following Ankle Fracture Surgery

Background The effects of preoperative depression following ankle fracture surgery remains unknown. The purpose of this study is to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. Methods This retrospective study used the Truven MarketScan database to identify patients who underwent ankle fracture surgery from January 2009 to December 2018. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to determine the association between preoperative depression and postoperative complications following ankle fracture surgery. Results In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (odds ratio [OR]: 1.33, confidence interval [CI]: 1.20-1.46), wound complications (OR: 1.13, CI: 1.00-1.28), pain-related postoperative emergency department visits (OR: 1.58, CI: 1.30-19.1), 30-day and 90-day readmissions (OR: 1.08, CI: 1.03-1.21 and OR: 1.13, CI: 1.07-1.18), sepsis (OR: 1.39, CI: 1.12-1.72), and postoperative development of complex regional pain syndrome (OR: 1.46, CI: 1.18-1.81). Conclusion Preoperative depression is associated with increased complications following ankle fracture surgery. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor. Level of Evidence: 3

Combined Anterior and Posterior Decompression With Fusion for Cervical Ossification of the Posterior Longitudinal Ligament

Objective:Cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) is not uncommon among Asian ethnic groups. Despite reports comparing the pros and cons of anterior- and posterior-only approaches, the optimal management remains debatable. This study aimed to evaluate the outcomes of patients who underwent a combined anterior and posterior approach, simultaneous circumferential decompression and fixation, for cervical OPLL.Method:The study retrospectively reviewed patients with OPLL and who underwent circumferential decompression and fixation, combined anterior corpectomy and posterior laminectomy. The clinical outcomes were evaluated by the Visual Analog Scale of neck and arm pain, the Japanese Orthopedic Association scores, Neck Disability Index, and Nurick scores at each time-point of evaluation. Radiological evaluations included plain and dynamic radiographs and computed tomography for every patient within 2 years post-operation. Subgroup analyses were further performed between the groups, with and without intra-operative cerebrospinal fluid (CSF) leakage.Results:A total of 41 patients completed the follow-up for more than 2 years (mean = 39.8 months) and were analyzed. Continuous-type OPLL was the most common (44%), followed by segmental (27%), mixed (22%), and localized types (7%) in the cohort. Myelopathy and all other functional outcomes improved significantly at 2 years post-operation (all p < 0.05). There were 13 (32%) patients who had intra-operative CSF leakage. At 2 years post-operation, there were no differences in the demographics, functional outcomes, and complication rates between the CSF-leakage and no-leakage groups. The CSF-leakage group had more patients with continuous-type OPLL than the no-leakage group (77 vs. 29%, p = 0.004 < 0.05). During the follow-up, there was no secondary or revision surgery for pseudomeningocele, pseudarthrosis, or other surgery-related complications.Conclusions:Simultaneous circumferential decompression and fixation combine the surgical benefits of sufficient decompression by the posterior approach and direct decompression of OPLL by the anterior approach. It is an effective surgical option for patients with cervical myelopathy caused by OPLL, given that myelopathy unanimously improved without neurological complications in this study. The fusion rates were high, and reoperation rates were low. Despite higher rates of CSF leakage, there were no related long-term sequelae, and minimal wound complications.

Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III–IV calcaneal fractures

Purpose To investigate whether local administration of epsilon-aminocaproic acid (EACA) is effective and safe in reducing the post-operative blood loss in surgery for Sanders III–IV calcaneal fractures. Methods Patients with Sanders III–IV calcaneal fractures who were hospitalized in our hospital from January 2016 to February 2021 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the current study. Eighty five patients were randomly divided into two groups, EACA group (43) and control group (42). Twenty milliliters of 5% EACA solution or normal saline was perfused into the incision of patients in EACA group and control group, respectively. The volume of post-operative drainage was investigated as the primary outcome. Post-operative blood test, coagulation test, and wound complications were analyzed as the secondary outcomes. Results The volume of post-operative drainage at 24 and 48 h was 164.8 ± 51.4 ml, 18.9 ± 3.8 ml for patients in EACA group, and 373.0 ± 88.1 ml, 21.2 ± 4.4 ml for patients in the control group, respectively. EACA greatly reduced the post-operative blood loss compared to the control (normal saline). The difference between the two groups was statistically significant. No statistically significant difference was found between EACA group and control group with regard to the pre-operative, baseline characteristics. Post-operative blood test results demonstrated that haemoglobin and hematocrit were significantly higher in EACA compared to those of control group. No significant difference was found between EACA group and control group in terms of the platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications. Conclusion Local administration of EACA is effective in post-operative blood loss reduction in ORIF surgeries for Sanders III–IV types of calcaneal fractures without increasing the incidence of periwound complication.

PREVENTION OF PURULENT-NECROTIC INFLAMMATION OF THORACOTOMY WOUND TISSUES IN THE TREATMENT OF PURULENT MEDIASTINITIS WITH PROGRAMMED RETHORACOTOMY

The need to develop new therapeutic methods for diffuse purulent mediastinitis is still an urgent problem in surgery. The purpose of the study is to evaluate the effectiveness of temporary rib fixation in programmed rethoracotomy while treating diffuse purulent mediastinitis. Materials and Methods. The study involved 49 patients with diffuse purulent mediastinitis. All patients underwent programmed rethoracotomy and sanitation of pyogenic sources in the mediastinum. The subjects were divided into 2 groups: group 1 included 19 patients without preventive measures against wound complications; 30 patients of group 2 underwent temporary rib fixation, which contributed to the decrease of wound complications. To reduce trauma and infection of the thoracotomy wound tissue, a special device was created (RF patent No. 2474389). It consists of staples and locks that appose wound edges after rethoracotomy. During the study, we used V.B. Gavrilov and M.K. Mishkorudnaya’s spectrophotometric method; modified Stoke method; N.I. Gabrielian’s spectrophotometric method. Statistical assessment of parameters was carried out using variation statistics. Statistical significance of differences (t) was calculated by Student’s t-test. Results. Measures to prevent purulent-necrotic complications from a thoracotomic wound significantly contributed to their reduction. The indicators of the effectiveness of these measures were changes in the coefficient of lipid peroxidation, antioxidant activity and midmolecule peptides in the blood serum, the sum of infectious complications and wound complications. Conclusion. Temporary rib fixation contributes to a significant decrease in the number of patients with purulent-necrotic inflammation of thoracotomy wound tissues (p <0.05). Key words: diffuse purulent mediastinitis, programmed rethoracotomy, preventive method, wound infection, complications. Необходимость разработки новых методов терапии диффузного гнойного медиастинита всё ещё остаётся актуальной проблемой в хирургии. Цель исследования. Оценка эффективности использования способа временной фиксации ребер при выполнении программированной реторакотомии в лечении диффузного гнойного медиастинита. Материалы и методы. В исследовании приняли участие 49 пациентов с диффузным гнойным медиастинитом, которым при лечении проводились программированные реторакотомии и санации источника нагноения в средостении. Обследуемых разделили на 2 группы: в I группу вошли 19 пациентов, которым не осуществляли профилактику раневых осложнений; во II группе у 30 пациентов выполнили временную фиксацию ребер, которая создавала условия для снижения вероятности раневых осложнений. Для уменьшения травматизации и инфицирования тканей торакотомной раны был создан прибор (патент РФ на изобретение № 2474389), который состоит из скоб и замков, создающих сближение сторон раны после реторакотомии. При проведении исследования использовали спектрофотометрический метод В.Б. Гаврилова, М.К. Мишкорудной; модифицированный метод Stoke; спектрофотометрический способ по Н.И. Габриэляну. Статистическую оценку показателей осуществляли с применением вариационной статистики и расчета критерия достоверности различий (t) по формуле и таблице Стьюдента. Результаты. Меры предупреждения гнойно-некротических осложнений со стороны торакотомной раны достоверно способствовали их сокращению. Показателями результативности этих мер стали изменения коэффициента перекисного окисления липидов, антиоксидантной активности и среднемолекулярных пептидов в сыворотке крови, сумма инфекционных осложнений и осложнений со стороны раны. Выводы. Использование временной фиксации ребер способствует достоверному уменьшению числа пациентов с гнойно-некротическим воспалением тканей торакотомной раны (p<0,05). Ключевые слова: диффузный гнойный медиастинит, программированная реторакотомия, способ предупреждения, раневая инфекция, осложнения.

Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

Background. Wound complications were associated with worse satisfaction and additional costs in patients underwent posterior lumbar fusion(PLF) surgery ,the relationship between enhanced recovery after surgery(ERAS)pathway and wound complications remains poorly characterized.Methods. In this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between ERAS program and the incidence of postoperative wound related complications and other complications following PLF surgery, other outcomes included the length of stay(LOS), 90-day hospital and rehabilitation center readmission.Results. Average patient age was 65yr. There were more patients with old cerebral infarction in ERAS group (p<0.01), other demographics and comorbidities were similar between both groups. Patients in ERAS group had a lower incidence of postoperative wound-related complications compared with non-ERAS group(12.4 vs 17.8%, p=0.02).The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing(6% vs 3%, p=0.02). ERAS group had a lower incidence of server postoperative hypoalbuminemia(serum albumin less than 30g/L)(15.8% vs 9.0% p<0.01).Additionally, ERAS patients had a shorter postoperative LOS (8.0±1.5 vs 9.5±1.7 p<0.01), lower rate of readmission within 90 days (1.9% vs 6.4%, p<0.01) and discharge to rehabilitation center (4.2% vs 1.0%, p<0.01).Conclusion. ERAS pathway may help to decrease the rates of postoperative wound complications and server hypoalbuminemia following PLF surgery, additionally, we demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90-day.

Safety Profile of Synthetic Elastic Degradable Matrix for Soft Tissue Reconstruction in Foot & Ankle Surgery

Background Augmentation of soft tissue repairs has been helpful in protecting surgically repaired tissues as they heal. FlexBand (Artelon, Marietta, Georgia) is a synthetic, degradable, polycaprolactone-based polyurethane urea (PUUR) matrix that has been investigated and used for soft tissue repair in a variety of settings. The purpose of this study was to evaluate the safety profile of a PUUR matrix in a large cohort of patients undergoing soft tissue repairs about the foot and ankle. Methods A retrospective chart review of consecutive patients who underwent surgery using FlexBand to augment a soft tissue repair was performed to evaluate for major and minor complications related to the PUUR matrix. Results. A total of 105 patients with an average >6 months follow-up were included. The most common procedures were spring ligament repair, Achilles tendon repair, and Brostrom. There were 12 complications. Four major complications occurred with only 1 requiring PUUR matrix removal. Patients with wound complications had a higher body mass index (BMI) and rate of smoking. Conclusion Complication rates involving PUUR matrix in soft tissue foot and ankle reconstruction procedures are low and comparable with historical complication rates. The PUUR matrix is safe for use in a variety of soft tissue procedures about the foot and ankle. Level of Evidence: Level 4, Retrospective case-series

Complications of Modified Radical Neck Dissection in Patients at Tertiary Care Hospital

Objective: To determine frequency of complication of modified radical neck dissection in patients at a tertiary care hospital Karachi, Pakistan Material and Methods: Study design: This is a cross sectional section study, conducted at Department of ENT, for Six months from January 1, 2019 to July 1, 2019. All the patients who fulfilled the inclusion criteria and visited to department of ENT, were included in the study after taking informed consent. Patients were discharged by 48-72 hours postoperatively. Patients were assessed daily till the time of discharge for occurrence of nerve complication, wound complications and vascular complications. Data was entered and analyzed by SPSS 21 software. Mean, Frequency and percentage were given for continuous and discreet data respectively. Chi squire test was applied to detect significance. P value of < o.o5 was taken as significant. Results: Mean ± SD of age was 40.31±9.54 with C.I (38.62.......41.99) years. Out of 126 patients 84 (67%) were male and 42 (33%) were female. Out of 126 cases complication 46(37%) developed nerve complication, 47 (37%) had wound complication and vascular complication was documented in 27(21%) cases. Conclusion: surgical complications after modified radical neck surgery are not uncommon. Wound complication was found to be most common followed by nerve and vascular complication. Therefore proper antiseptic measures before, during and after surgery, patient care and careful surgical steps have a role in preventing these dreadful complications. Keywords: Modified Radical Neck Dissection, Complications, Nerve Complication, Wound Complication, Vascular Complication