Obesity and surgical wound healing: a current review

Epidemiology of surgical site infections post-cesarean section in Africa: a comprehensive systematic review and meta-analysis

BACKGROUND

Surgical site infections (SSIs) are among the most common postoperative complications following cesarean section, particularly in Africa. These infections pose maternal health risks, including prolonged hospitalization, increased healthcare costs, and mortality. This systematic review and meta-analysis aimed to evaluate the epidemiology, pooled prevalence, and risk factors for SSIs after cesarean section in Africa.

METHODS

A systematic search of PubMed/MEDLINE, Scopus, and Web of Science databases was conducted to identify studies published between January 2000 and December 2023. The review followed PRISMA 2020 guidelines, and 41 studies spanning 18 African countries met the inclusion criteria. Data on SSI prevalence and risk factors were extracted, and the quality of studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to estimate pooled prevalence, with subgroup analysis, sensitivity analyses, and meta-regression exploring variations across study characteristics. Publication bias was assessed using funnel plots.

RESULTS

The pooled prevalence of SSIs after cesarean section was 11% (95% CI: 9-12.9%) with substantial heterogeneity (I2 = 97%, < 0.001). Regional variations were observed, with the highest prevalence in Tanzania (34.1%) and Uganda (15%), and the lowest in Tunisia (5%) and Egypt (5.3%). Temporal trends revealed a peak in prevalence (16%) during 2011-2015, declining to 9.8% by 2016-2020. Prolonged rupture of membranes (PROM) was the most frequently reported risk factor (OR: 4.45-13.9), followed by prolonged labor (> 24 h) (OR: 3.48-16.17) and chorioamnionitis (OR: 4.37-9.74). Potential publication bias indicated by asymmetrical funnel plots.

CONCLUSION

SSIs following cesarean section remain a burden in Africa, with wide regional variations and multiple preventable risk factors. The findings highlight the need for targeted interventions, including improved infection control practices, antenatal care, and timely management of obstetric complications.

Increased Body Mass Index is Associated with Increased Cost for Primary Total Hip Arthroplasty Irrespective of Complications or Readmissions

INTRODUCTION

Surgeons participating in alternative payment models may encounter financial disincentives in caring for patients whose care requires higher costs for the treatment facility. While smaller studies have shown a positive relationship between body mass index (BMI) and cost in total hip arthroplasty (THA), this question has yet to be examined using data in a nationally representative dataset. We sought to leverage a national dataset to assess the relationship between BMI and cost in THA.

METHODS

We queried the healthcare dataset from 2016 to 2022 to identify primary THAs using Current Procedural Terminology (CPT) and International Classification of Disease-Procedure Coding System (ICD-PCS) codes (27130, 0SR90xx, 0SRB0xx) with a corresponding osteoarthritis diagnosis (ICD-10-CM: M16). Patient demographics, characteristics, and cost variables were extracted directly from the dataset. Cost was defined by supplies, labor, and equipment and assessed over a 90-day period starting with the index surgical encounter. A multivariate generalized linear model estimated costs across eight BMI categories (World Health Organization (WHO) BMI categories, with BMI > 40 patients grouped into BMI 40 to 45, BMI 45 to 50, and BMI > 50). A linear regression model assessed the effect of BMI on costs. Both models controlled for age, sex, payer, race, the Elixhauser comorbidity index (ECI), and ethnicity.

RESULTS

This study examined 10,366 primary THAs completed from 2016 to 2022. The mean BMI was 30.0 (SE ±0.1), the mean index cost was $14,632 (SE 52.9), and the mean 90-day cost was $16,527 (SE 145.4). Index and 90-day costs were lowest in the BMI 25 to 30 cohort ($14,344 and $15,865) and highest for the BMI > 50 cohort ($17,503 and $28,281), respectively. On multivariate analyses, index and 90-day cost increased by $23 and $69, respectively, for every one-point increase in BMI (P < 0.001).

CONCLUSIONS

Results from this nationally representative dataset demonstrate that increasing BMI is associated with increased index and 90-day costs for total hip arthroplasty. This information may be useful to stakeholders in the development of alternative payment models.

Body Mass Index Above 35 Has Increased Risk of Complications but Still Achieves Clinically Meaningful Improvement in Patient-Reported Outcomes After Anterior-Based Total Hip Arthroplasty

Background

Increased perioperative complications in obese patients undergoing total hip arthroplasty (THA) have previously been reported. There is a relative paucity of data evaluating these complications strictly in the context of anterior-based THA. In this study, we compare the outcomes following anterior-based THA as a function of body mass index (BMI).

Methods

A 1:1 matched retrospective cohort study was conducted. Patients undergoing anterior-based THA from January 2022 to June 2024 with a BMI >35 kg/m2 were matched 1:1 based on age and sex to patients with a BMI <35 kg/m2 from our division registry. Demographic data, surgical details, complications (intraoperative and postoperative), and patient-reported outcome measures (PROMs: 12-Item Short Form P/M, Western Ontario and McMaster Universities Osteoarthritis Index-P/S/F) were collected and analyzed.

Results

There were 280 patients included (140 per group). There were 27 postoperative complications in the BMI >35 kg/m2 group and 10 in the BMI <35 kg/m2 group (P < .01). There were 10 major complications (4 dislocations, 2 periprosthetic fractures, and 4 deep infections requiring incision and drainage) in the BMI over 35 kg/m2 group, with no major complications occurring in the lower BMI group. There were 3 intraoperative complications (periprosthetic fracture), all in patients with BMI >35 kg/m2. There was significant improvement in Western Ontario and McMaster Universities Osteoarthritis Index P/S/F scores and 12-Item Short Form pain in both groups at 3 months postoperatively, with greater improvements seen in the BMI >35 kg/m2 group.

Conclusions

The present study found that despite significant differences in postoperative complications, there were significant improvements in PROMs in patients with a BMI above and below 35 kg/m2 who underwent anterior THA.

Strain-Dependent Differences in Inflammatory/Immune Activity in Cutaneous Wound Tissue Repair in Rats: The Significance of Body Mass/Proneness to Obesity

Inflammatory/immune cells and mediators are substantial for wound healing because they orchestrate biological activities in this complex process. Among factors that affect wound healing, obesity, and metabolic diseases are among the most significant, particularly because of a relationship between obesity and a prediabetic state with immune reactivity. Using Dark Agouti (DA) and Albino Oxford (AO) rats, which differ in immune responses as well as in proneness to obesity, we examined the impact of these intrinsic factors on cutaneous wound healing. Dynamics of the process were monitored at days 3, 5, and 7 post-wounding parallel in both rat strains by analysis of selected basic aspects of the wound repair process (cytokine and growth factor responses) in granulation tissue. Strain-related differences in the extent of reduction of the wound area were shown, which coincided with differential proinflammatory and immune-regulatory cytokines, as well as growth factors response in these rats. Some of these differences seem related to their dissimilarities in the proneness to obesity. Results in this study extended so far known differences in inflammatory/immune responses to a variety of stimuli between AO and DA rats and showed, for the first time, immune-based differences in wound healing between rats that differ in body mass (BM) and obesity proneness (under ad libitum feeding conditions with normal rodent chow).

In-shoe plantar temperature, normal and shear stress relationships during gait and rest periods for people living with and without diabetes

Diabetic foot ulcers (DFUs) are a common complication of diabetes. This study aims to investigate the relationships between in-shoe plantar temperature, normal and shear stress during walking and rest periods for participants with and without diabetes. For this purpose, a novel temperature, normal and shear stress sensing system was developed and embedded in an insole at the hallux, first metatarsal head and calcaneus region. Ten participants living with diabetes with no history of previous ulceration and ten healthy participants were recruited. Participants walked on a treadmill for 15 min and then rested for 20 min wearing the sensing insole. Results showed high correlation (Spearman's rs ≥ 0.917) between heat energy, total plantar temperature change, during walking and strain energy, cumulative stress squared in all participants. Importantly, between-group comparisons showed indications of thermal regulation differences in participants with and without diabetes, with the first metatarsal head site showing significantly higher temperature at the end of the active period (P = 0.0097) although walking speed and mechanical stress were similar. This research demonstrates for the first time the correlation between strain energy and heat energy in-shoe during gait. Further research is needed to quantify relationships and investigate thermal regulation as a mechanism for DFU formation.

Implementation of Aseptically Processed Human Placental Membrane Allografts Within a Comprehensive Sternal Wound Closure Strategy: A Three-Phase Experience

Background: Sternal wound complications following median sternotomy result in poor outcomes. Novel approaches such as placental allografts are being explored to optimize wound closure. Methods: This study evaluated consecutive patients undergoing median sternotomy by a single surgeon as sternal closure strategies evolved. Initially, wires with autologous platelet-rich plasma (PRP) were used (Group 1). Subsequently, suture tapes with PRP and an aseptically processed amnion-chorion placental allograft (aACPA) were added (Group 2). Finally, PRP was discontinued (Group 3). Sternal infection, dehiscence, pain outcomes, hospital length of stay, and patient risk factors were analyzed. Results: Compared to Group 1, Groups 2 and 3 demonstrated significantly lower infection (0.7%, 0% vs. 9.3%, p = 0.0001) and dehiscence rates (0%, 0% vs. 8.7%, p < 0.0001). Significant postoperative pain at two weeks decreased from Group 1 to Groups 2 and 3 (18.7%, 4.7%, 3.1%, p < 0.0001), with similar improvements at one month (12.0%, 2.0%, 1.5%, p = 0.0005). Despite higher median risk factors in Group 3 than in Groups 1 and 2 (3 vs. 2, 2, p = 0.0305), a trend toward reduced hospital stay was observed (6 vs. 8, 7 days, p = 0.2298). Conclusions: Adding aACPA to sternal closure significantly reduced infections, dehiscence, and pain in high-risk cardiac surgery patients, with sustained benefits and no increase in operative times. These findings highlight aACPA's potential to mitigate sternal complications, warranting further study in larger cohorts.

Functional and Aesthetic Outcomes of Post-Mohs Nasal Reconstruction

BACKGROUND

Similar to patients undergoing rhinoplasty, patients undergoing post-Mohs micrographic surgery (MMS) nasal reconstruction are concerned with both nasal form and function.

OBJECTIVES

The objectives were to identify patient, defect, and surgical characteristics associated with post-MMS nasal reconstruction outcomes.

METHODS & MATERIALS

A retrospective single-institution cohort study was conducted of post-MMS nasal reconstruction surgeries occurring between 2015 and 2020. Patient, defect, and surgical details were collected along with nasal aesthetic and functional outcomes. Multivariable logistic regressions were used to analyze data.

RESULTS

A total of 167 nasal MMS defects among 160 patients met the inclusion criteria. The median age was 66 years, and 70% were female. A poor aesthetic outcome (n = 20, 12.0%) was associated with diabetes (aOR 6.277, 95% CI 2.193-17.965). Post-operative nasal obstruction (n = 17, 10.2%) was associated with obesity (aOR 20.976, 95% CI 2.406-182.845) and major revision surgery (aOR 12.192, 95% CI 2.838-52.382).

CONCLUSION

Post-MMS nasal reconstruction aesthetic and functional outcomes are associated with obesity, diabetes, and revision surgery. Improved standardization of functional and cosmetic outcomes is important to better understand these results in the future.

Beyond the numbers: Impact of obesity on obstetric anal sphincter injury (OASI) outcomes in women

OBJECTIVE

To compare the risk profiles, anatomical, and functional outcomes between obese and non-obese women who experienced obstetric anal sphincter injury (OASI).

METHODS

A retrospective electronic database study was conducted at Cork University Maternity Hospital (CUMH). Women with missing data/repairs conducted outside CUMH were excluded. Participants were categorized into obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) groups. Primary measure was a composite adverse outcome assessed 6 months post-delivery, including one or more of the following: resting pressure <40 mmHg, squeezing pressure <100 mmHg, defects in the internal and/or external anal sphincter. Statistical analyses were performed using SPSS version 28.

RESULTS

Among the 349 women included in the study, 285 (81.7%) had a BMI <30 kg/m2 and 64 (18.3%) had a BMI ≥30 kg/m2. Gestational diabetes was significantly higher in obese women. No significant differences were observed in newborn weight or mode of delivery. The majority of tears were classified as grade 3B in both groups. Attendance rates at the OASI clinic did not differ between the groups. Among those attending, no statistical differences were noted in manometry results, which were reduced in both groups. Rates of internal anal sphincter defects were lower in the obese group (7.0% vs 15.6%, P = 0.15) and external anal sphincter defects were significantly lower in obese women (0% vs 9.1%, P = 0.04). No difference was found in the rates of composite adverse outcomes between the groups.

CONCLUSION

Functional outcomes and manometry results did not differ, but non-obese women had higher rates of anatomical defects in OASI, requiring further study.

The Impact of Body Mass Index on Breast Reduction Outcomes: A Multi-Institutional Data Analysis of 45,000 Cases over 15 Years

BACKGROUND

The caseload of breast reduction is on the rise. Despite this popularity, the association between body mass index (BMI) and postoperative outcomes remains unclear. We hypothesize that BMI is a significant determinant of postoperative morbidity after breast reduction and leverage a multi-institutional database to investigate this correlation.

METHODS

We queried the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2022) to identify female adult patients who underwent breast reduction. We categorized all patients into six BMI subgroups, and compared their outcomes (i.e., 30-day surgical and medical complications, reoperation, readmission, and mortality) via multivariate logistic regression analyses.

RESULTS

45,373 patients (mean age: 40 ± 14 years; mean BMI: 31 ± 6.1 kg/m2) were identified, of whom 0.1% (n = 61) were underweight, 12% (n = 5635) healthy weight, 34% (n = 15,346) overweight, 30% (n = 13,795) had obesity I, 15% (n = 6843) obesity II, and 8.1% (n = 3693) obesity III. Overall, 2881 (6.4%) patients experienced complications, with 1936 (4.3%) cases of surgical complications and 317 (0.7%) cases of medical complications. The risk for complications increased stepwise above the healthy BMI range. Compared to women with healthy weight, patients with obesity I, II, and III had a significantly higher risk of any complication (OR 1.5, p < 0.001; OR 1.87, p < 0.001; and OR 2.6, p < 0.001, respectively), medical complications (OR 2.4, p = 0.005; OR 2.99, p = 0.001; and OR 5.2, p < 0.001, respectively), and surgical complications (OR 2.2, p < 0.001; OR 2.81, p < 0.001; and OR 4.2, p < 0.001, respectively). Overweight patients were also at higher risk for any complication (OR 1.2, p = 0.09), medical complications (OR 2.1, p = 0.02), and surgical complications (OR 1.4, p = 0.004). The odds for reoperation did not increase with higher BMI classes.

CONCLUSION

Our multi-institutional data analysis revealed a significant correlation between elevated BMI and the occurrence of both surgical and medical complications after breast reduction surgery. The postoperative risk increased progressively with BMI above the healthy range. These findings are essential for informing preoperative counseling, refining risk assessment, and developing tailored protocols.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Is Obesity a Risk Factor for Developing Trigger Finger? A Case-Control Analysis of 198 804 Patients

BACKGROUND

Trigger finger (TF) causes pain and functional impairment. Previous studies have associated TF with carpal tunnel syndrome, which has been linked to obesity. This study investigated the relationship between obesity and the prevalence of TF.

METHODS

A retrospective analysis was conducted using data from the TriNetX Research Network (2006-2024). Patients with risk factors for TF (rheumatoid arthritis, gout, amyloidosis, prior carpal tunnel release, spontaneous rupture of flexor tendons, hypothyroidism, Dupuytren disease, and diabetes mellitus) were excluded. Two cohorts were compared: (1) patients diagnosed with TF; and (2) those without. The groups underwent propensity score matching based on demographic attributes using a 1:1 nearest neighbor approach. Each patient's mean body mass index (BMI) was calculated by averaging all BMI measurements. Obesity was defined as a mean BMI greater than or equal to 30 kg/m2. Multiple linear regression and logistic regression, incorporating TF diagnosis, BMI, and matched covariates, were used to adjust for confounding factors and estimate risk and odds ratios.

RESULTS

Data from 198 804 patients (99 402 per group) were analyzed. The prevalence of TF was positively associated with increasing BMI. Multiple linear regression revealed that BMI accounted for a small portion of the variance in TF prevalence. Logistic regression demonstrated an adjusted risk ratio of 1.02 (95% CI = [1.01, 1.03]) and an odds ratio of 1.03 (95% CI = [1.01, 1.05]), indicating a 2% to 3% increased risk of TF in obese patients.

CONCLUSION

Obesity was independently associated with TF. Obese patients had a 2% increased risk of TF compared with nonobese patients.

Psychological, behavioural and relevant factors affecting wound healing, and the buffering role of interventions

Wound healing is a complex process accompanying numerous health conditions, and millions of people across the world experience deleterious impacts caused by wounds. There are many non-biological factors that can directly or indirectly affect the health outcomes of patients with wounds. The purpose of this review was to investigate the effects of psychological, behavioural and other relevant factors on wound healing. In addition, as the possible associations among these factors have, in the authors' view, not been addressed appropriately, we also aimed to examine if there were specific relationships among these factors and between these factors and health outcomes. Finally, we reviewed the role of various interventions in buffering negative impacts during health procedures.

[Multimorbid patients in visceral surgery-Upper gastrointestinal tract]

The treatment of multimorbid patients in oncological surgery of the upper gastrointestinal tract requires a differentiated consideration of every single risk factor in order to provide a holistic assessment. This article focuses on pre-existing diseases that are particularly relevant for elective esophageal and gastric surgery and have practical clinical consequences. In this way a differtiation is made between metabolic, vascular, cardiopulmonary and organ-specific risks. The aim of this work is to provide practical guidelines for complex and multimorbid cases. Given the multifactorial interrelationships, the importance of a thorough preoperative evaluation and interdisciplinary management cannot be overemphasized.

Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries

PURPOSE

The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes.

METHODS

We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications.

RESULTS

There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd's ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77-2.02), gestational hypertension (aOR = 1.84, CI = 1.65-2.05), preeclampsia (aOR = 1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44-2.87), and placenta previa (aOR = 0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06-1.34), chorioamnionitis (aOR = 1.24, CI = 1.03-1.51), caesarean deliveries (aOR = 1.28, CI = 1.18-1.38), wound complications (aOR = 1.65, CI = 1.31-2.08), and transfusions (aOR = 0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16-2.10).

CONCLUSION

Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications.

Bibliometric Analysis of Outpatient Hip and Knee Arthroplasty Research Evolution

Objectives

Total joint arthroplasty is an effective treatment for end stage osteoarthritis. As perioperative protocols are developed, outpatient arthroplasty has been gaining traction to facilitate earlier recovery and same day discharge. The aim of this manuscript is to analyze the trends in outpatient arthroplasty over a 17-year duration. This analysis seeks to predict emerging themes in the literature on patient optimization and outcomes in outpatient arthroplasty.

Methods

This study conducted a literature review on outpatient arthroplasty with the Web of Science Core Collection over a 17-year period between 2005 and 2022. Bibliometric data was imported and analyzed with Bibliometrix and VOSviewer.

Results

198 articles were identified demonstrating an annual growth of 19.61% with notable bursts in 2017 and 2021. United States was the top global contributor followed by Canada and European nations. There were significant contributions across 219 institutions and 758 authors, with the Journal of Arthroplasty being the most productive and influential journals. Key themes identified include the feasibility of outpatient surgery, pain management, and perioperative complications and costs.

Conclusion

This bibliometric analysis highlights the ongoing growth and development within outpatient arthroplasty since 2005. The United States remain the global leader within outpatient related arthroplasty research. Previous, current, and ongoing trends are highlighted within this field for further development as hotspots.

Efficacy of Fibrin Sealant in Submental Liposuction: A Prospective Randomized Study

BACKGROUND

The incidence rate of submental liposuction has been increasing in recent years. Although this procedure is relatively simple, serious complications, including fatalities, have been reported, primarily owing to intraoperative and postoperative bleeding.

METHODS

To enhance the safety of liposuction, we examined the efficacy of Beriplast® P (CSL Behring, Melbourne, Australia), a physiological tissue adhesive fibrin sealant, in reducing postoperative swelling. Swelling was measured using the image analysis software VECTRA® (Vectra AI, Inc., CA, USA). Twenty-nine cases of submental liposuction performed from February to August 2024 were analyzed for tissue volume changes immediately postoperatively and at the time of suture removal, comparing those who received the fibrin sealant to those who did not.

RESULTS

The group using the fibrin sealant had significantly less postoperative swelling compared to the group that did not use the fibrin sealant (p<0.001).

CONCLUSIONS

The fibrin sealant may be used to effectively suppress postoperative swelling, reducing the risk of complications and improving patient satisfaction, thereby enhancing the overall safety and effectiveness of cosmetic surgery.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Development and validation of a nomogram model for prolonged length of stay in spinal fusion patients: a retrospective analysis

OBJECTIVE

To develop a nomogram model for the prediction of the risk of prolonged length of hospital stay (LOS) in spinal fusion patients.

METHODS

A retrospective cohort study was carried out on 6272 patients who had undergone spinal fusion surgery. Least absolute shrinkage and selection operator (LASSO) regression was performed on the training sets to screen variables, and the importance of independent variables was ranked via random forest. In addition, various independent variables were used in the construction of models 1 and 2. A receiver operating characteristic curve was used to evaluate the models' predictive performance. We employed Delong tests to compare the area under the curve (AUC) of the different models. Assessment of the models' capability to improve classification efficiency was achieved using continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The Hosmer-Lemeshow method and calibration curve was utilised to assess the calibration degree, and decision curve to evaluate its clinical practicality. A bootstrap technique that involved 10 cross-validations and was performed 10,000 times was used to conduct internal and external validation. The were outcomes of the model exhibited in a nomogram graphics. The developed nomogram was validated both internally and externally.

RESULTS

Model 1 was identified as the optimal model. The risk factors for prolonged LOS comprised blood transfusion, operation type, use of tranexamic acid (TXA), diabetes, electrolyte disturbance, body mass index (BMI), surgical procedure performed, the number of preoperative diagnoses and operative time. The diagnostic performance of the nomogram model was satisfactory, with AUC values of 0.784 and 0.795 for the internal and external validation sets, respectively. Model discrimination was favourable in both the internal (C-statistic, 0.811) and external (C-statistic, 0.814) validation sets. Calibration curve and Hosmer-Lemeshow test showed acceptable agreement between predicted and actual results. The decision curve shows that the model provides net clinical benefit within a certain decision threshold range.

CONCLUSIONS

This study developed and validated a nomogram to identify the risk of prolonged LOS in spinal fusion patients, which may help clinicians to identify high-risk groups at an early stage. Predictors identified included blood transfusion, operation type, use of TXA, diabetes, electrolyte disturbance, BMI, surgical procedure performed, number of preoperative diagnoses and operative time.

The Impact of Higher BMI on Wound Complications Following Adolescent Breast Reduction: A Retrospective Study of 1215 Cases

BACKGROUND

Macromastia is a physically and psychologically distressing condition for adolescents. While reduction mammaplasty is often the best treatment, risk factors for adolescent wound complications remain unclear. This study aims to investigate the impact of obesity and other predictors of postoperative wound complications following adolescent reduction mammaplasty using a national database.

METHODS

The 2012-2019 National Surgical Quality Improvement Program Pediatric (NSQIP-P) databases were reviewed to identify primary reduction mammaplasty encounters. World Health Organization Body Mass Index (BMI), alongside patient and case characteristics, were assessed for association for 30-day wound disruption or surgical site complications. Statistical analyses were performed to identify independent predictors for complications and determine a potential BMI cutoff for risk stratification.

RESULTS

There were 1215 patients with an average age of 16.6 years. The average BMI was 30.7 kg/m2, and 593 (48.8%) patients were nonobese while 622 (51.2%) were obese. The incidence of complications was 5.27%. Independent predictors of complications included a BMI 35-39.9, BMI  > 40, and an American Society of Anesthesiologists (ASA) Classification  > 3. A receiver operating characteristic curve determined that a BMI of 34.6 can be a potential cutoff for increased complication risk.

CONCLUSIONS

Higher obesity increases risk of wound complications; however, complication rates remain low. A BMI of 34.6 is a potential screening metric for counseling and monitoring patients. Reduction mammaplasty should remain a viable option as it can significantly improve quality of life.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Brachytherapy for Soft Tissue Sarcoma: Maintaining Local Control While Minimizing Complications

BACKGROUND

This study aims to assess the clinical and oncologic outcomes of high-dose brachytherapy (BRT) versus both preoperative and postoperative external beam radiation therapy (EBRT) in the setting of high-grade soft tissue sarcoma.

METHODS

This is a retrospective cohort study of 144 patients treated surgically for soft tissue sarcoma at the same institution from 2010 to 2021. Patients treated for a soft tissue sarcoma with surgery and radiation therapy in the form of BRT, Neoadjuvant EBRT (Neo-EBRT) or adjuvant EBRT (AD-EBRT) were included.

RESULTS

56 patients were treated with BRT, 42 with Neo-EBRT, and 46 with AD-EBRT. There was a greater incidence of grouped wound complications in Neo-EBRT with 50% compared to both BRT with 25% and AD-EBRT with 28.3% (p = 0.02). Univariate and multivariate analysis showed that there was an increased risk of wound complications with Neo-EBRT when compared to brachytherapy (p = 0.03 and p = 0.007, respectively). Univariate and multivariate analysis showed that there was no difference in risk of LR between treatment groups (p = 0.28).

CONCLUSION

Brachytherapy is a valuable treatment modality that offers clinical and logistical advantages when compared to the conventional Neo-EBRT in soft tissue sarcomas. Brachytherapy offers a lower risk of wound complications and a comparable local control. This manuscript presents decision-making strategies for determining the appropriate radiation modality for specific circumstances.

Novel Use of an Aseptically Processed Amnion-Chorion Placental Allograft to Complement Wound Closure in High-Risk Sternotomy Patients: Clinical Safety and Outcomes

Objectives Wound dehiscence is defined as the partial or complete separation of the layers of a surgical wound. Wound dehiscence and infections are of significant concern in the field of surgery as they can lead to a range of complications, including infection, delayed healing, increased healthcare costs, and patient discomfort. For patients at high risk of sternal wound dehiscence and infection, optimization of wound closure is critical. Novel technologies are increasingly being developed to optimize wound closure following median sternotomy for cardiac surgery. Aseptically processed amnion-chorion placental allografts (aACPA) are one such example. Placental allografts maintain the inherent growth factors and matrix proteins native to the tissue, all of which are known in the literature for their roles within the natural closure of wounds Methods Twenty-six patients who underwent cardiac surgery requiring a median sternotomy at a single center undertaken by a single surgeon were included in this study. All patients included were deemed high-risk for sternal complications and had at least one sternal risk factor. Before closure, 160 mg of aACPA was added to the sternotomy wound to support wound repair. Data were collected for rates of sternal complications, as well as general demographics and past medical history of patients included in this study, and appropriate analyses were carried out. Results At their 14- and 30-day follow-up visits, none of the patients had experienced sternal wound dehiscence or infection, with their sternotomy wounds showing excellent signs of normal wound closure. A comprehensive sternal pain evaluation was carried out, which elicited no significant pain in any patients, a sign that sternal closure was successful and stable. The addition of the aACPA into our clinical practice has also contributed to no longer requiring postoperative chest stabilization adjuncts, resulting in significant financial and resource savings for our group. Conclusions In this study, the amnion-chorion placental allograft showed promise as an effective solution to support sternal wound closure in high-risk patients. Its inherent growth factors and ECM (extracellular matrix) may directly address the specific challenges faced by these high-risk individuals. This innovative treatment offers a novel and advanced approach to support wound closure in patient populations that are particularly vulnerable to complications.

Patients with venous leg ulcers can be managed safely in the community ----results of an observational comparison study in Singapore

AIM

To examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care.

METHOD

This was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two-or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS).

RESULTS

Forty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups.

CONCLUSION

This first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation.

Prevalence of Obesity in Abdominal Surgery Patients at a Tertiary Care Hospital: A Cross-Sectional Study

Background Obesity significantly impacts surgical outcomes, increasing the risk of postoperative complications, especially in abdominal surgery. Objective To determine the prevalence of obesity among patients undergoing abdominal surgery and to explore its association with postoperative complications. Methodology A cross-sectional study was conducted from January 2022 to December 2023. There were 428 adult patients in total, either for emergency or elective abdominal surgery. A BMI of ≥30 kg/m² was used by the World Health Organization to define obesity. We gathered and examined data on postoperative complications, surgical outcomes, comorbidities, and demographics. Chi-square and t-tests were used to assess the prevalence of obesity and its relationship to complications; a p-value of less than 0.05 was deemed statistically significant. Results Among 428 patients, 151 (35.28%) were obese. Obese patients had significantly higher rates of wound infections, with 36 (23.84%) compared to 28 (10.11%) non-obese patients (p = 0.001). Venous thromboembolism occurred in 18 (11.92%) obese patients versus nine (3.25%) non-obese patients (p = 0.002). Respiratory complications were more frequent in obese patients, with 27 (17.88%) compared to 31 (11.19%) non-obese patients (p = 0.045). Prolonged hospital stays (>7 days) were reported in 52 (34.44%) obese patients versus 39 (14.08%) non-obese patients (p < 0.001). Additionally, obesity was associated with longer surgery durations (124.35 ± 35.82 minutes in obese patients versus 108.65 ± 29.44 minutes in non-obese patients, p = 0.003) and extended recovery times (11.58 ± 5.67 days versus 8.73 ± 4.25 days, p = 0.002). Conclusion Patients having abdominal surgery are often obese, which is linked to an increased risk of complications and lengthier recovery times.

Lung cancer and obesity: A contentious relationship (Review)

The global obesity epidemic, attributed to sedentary lifestyles, unhealthy diets, genetics and environmental factors, has led to over 1.9 billion adults being classified as overweight and 650 million living with obesity. Despite advancements in early detection and treatment, lung cancer prognosis remains poor due to late diagnoses and limited therapies. The obesity paradox challenges conventional thinking by suggesting that individuals with obesity and certain diseases, including cancer, may have an improved prognosis compared with their counterparts of a normal weight. This observation has prompted investigations to understand protective mechanisms, including potentially favorable adipokine secretion and metabolic reserves that contribute to tolerating cancer treatments. However, understanding the association between obesity and lung cancer is complex. While smoking is the primary risk factor of lung cancer, obesity may independently impact lung cancer risk, particularly in non‑smokers. Adipose tissue dysfunction, including low‑grade chronic inflammation, and hormonal changes contribute to lung cancer development and progression. Obesity‑related factors may also influence treatment responses and survival outcomes in patients with lung cancer. The impact of obesity on treatment modalities such as chemotherapy, radiotherapy and surgery is still under investigation. Challenges in managing patients with obesity and cancer include increased surgical complexity, higher rates of postoperative complications and limited treatment options due to comorbidities. Targeted interventions aimed at reducing obesity prevalence and promoting healthy lifestyles are crucial for lung cancer prevention. The impact of obesity on lung cancer is multifaceted and requires further research to elucidate the underlying mechanisms and develop personalized interventions for prevention and treatment.

Can Obesity Serve as a Barrier to Minimally Invasive Mitral Valve Surgery? Overcoming the Limitations-A Multivariate Logistic Regression Analysis

Background/Objectives: Over the past two decades, significant advancements in mitral valve surgery have focused on minimally invasive techniques. Some surgeons consider obesity as a relative contraindication for minimally invasive mitral valve surgery (MIMVS). The aim of this study is to evaluate whether the specific characteristics of obese patients contribute to increased surgical complexity and whether this, in turn, leads to worse clinical outcomes compared to non-obese patients. Furthermore, we aim to explore whether these findings could substantiate the consideration of limiting this treatment option for obese patients. We investigated the outcomes of MIMVS in obese and non-obese patients at a high-volume center in Germany staffed by an experienced surgical team well-versed in perioperative management. Methods: A total of 934 MIMVS were performed in our high-volume center in Germany from 2011 to 2023. Of these, 196 patients had a BMI of 30 or higher (obese group), while 738 patients had a BMI below 30 (non-obese group), all of whom underwent MIMVS by right minithoracotomy. Demographic information, echocardiographic assessments, surgical data, and clinical outcome parameters were collected for all patients. Results: There was no significant difference in in-hospital, 30-day, and late mortality between groups (obese vs. non-obese: 6 [3.0%] vs. 14 [1.8%], p = 0.40; 6 [3.0%] vs. 14 [1.8%], p = 0.40; 13 [6.6%] vs. 39 [5.3%], p = 0.48, respectively). Respiratory insufficiency and arrhythmia occurred more frequently in the obese group (obese vs. non-obese: 25 [12.7%] vs. 35 [4.7%], p < 0.001; 35 [17.8%] vs. 77 [10.4%], p = 0.006). Conclusions: Obesity was not associated with increased early or late mortality in patients undergoing MIMVS. However, obese patients experienced higher incidences of postoperative complications, including respiratory insufficiency, arrhythmias, delirium, and wound dehiscence. Nonetheless, a multivariate logistic regression analysis indicated that obesity itself does not contraindicate MIMVS and should not be viewed as a barrier to offering this minimally invasive approach to obese patients.

Inhibition of angiogenesis and regenerative lung growth in Lepob/ob mice through adiponectin-VEGF/VEGFR2 signaling

Introduction

Obesity is associated with impairment of wound healing and tissue regeneration. Angiogenesis, the formation of new blood capillaries, plays a key role in regenerative lung growth after unilateral pneumonectomy (PNX). We have reported that obesity inhibits angiogenesis. The effects of obesity on post-PNX lung vascular and alveolar regeneration remain unclear.

Methods

Unilateral PNX is performed on Lep o b / o b obese mice to examine vascular and alveolar regeneration.

Results

Regenerative lung growth and expression of vascular endothelial growth factor (VEGF) and its receptor VEGFR2 induced after PNX are inhibited in Lep o b / o b obese mice. The levels of adiponectin that exhibits pro-angiogenic and vascular protective properties increase after unilateral PNX, while the effects are attenuated in Lep o b / o b obese mice. Post-PNX regenerative lung growth and increases in the levels of VEGF and VEGFR2 are inhibited in adiponectin knockout mice. Adiponectin stimulates angiogenic activities in human lung endothelial cells (ECs), which is inhibited by decreasing the levels of transcription factor Twist1. Adiponectin agonist, AdipoRon restores post-PNX lung growth and vascular and alveolar regeneration in Lep o b / o b obese mice.

Discussion

These findings suggest that obesity impairs lung vascular and alveolar regeneration and adiponectin is one of the key factors to improve lung regeneration in obese people.

Apelin Counteracts the Effects of Fusobacterium nucleatum on the Migration of Periodontal Ligament Cells In Vitro

To better understand the link between periodontitis and metabolic diseases, our in vitro study aimed to assess the influence of the adipokine apelin and/or the periodontal pathogen Fusobacterium nucleatum on periodontal cells. Periodontal ligament (PDL) cells were exposed to F. nucleatum in the presence and absence of apelin. Scratch assays were used to analyze the in vitro wound healing and velocity of cell migration. To investigate if F. nucleatum and/or apelin have a regulatory effect on cell proliferation and apoptosis, proliferation and viability assays were performed as well as an analysis of caspase 9 expression. Both the in vitro wound closure and the cell migration rate were significantly reduced by F. nucleatum. Simultaneous incubation with apelin counteracted the adverse effects of F. nucleatum. The proliferation assay demonstrated that neither apelin nor F. nucleatum significantly affected PDL cell proliferation. Furthermore, neither apelin nor F. nucleatum was cytotoxic or affected apoptosis after 48 h. Apelin could play a modulatory role in the pathogenesis of periodontitis, as it was able to compensate for the inhibitory effects of the periodontal pathogen F. nucleatum on PDL cell migration in vitro.

Clinical Impact of Obesity on Postoperative Outcomes of Patients With Thyroid Cancer Undergoing Thyroidectomy: A 5-Year Retrospective Analysis From the US National Inpatient Sample

BACKGROUND

The clinical impact of obesity on postoperative outcomes of patients undergoing thyroidectomy remains controversial.

METHODS

Patients aged ≥ 18 years who were diagnosed with thyroid malignancy and underwent thyroidectomy between 2016 and 2020 were included, and divided into two groups: patients with body mass index (BMI) < 30 kg/m2 and those with BMI ≥ 30 kg/m2. Patients in the obese group were then subdivided into four groups: Group 1 (BMI 30.0-34.9 kg/m2), Group 2 (BMI 35.0-39.9 kg/m2), Group 3 (BMI 40.0-44.9 kg/m2), and Group 4 (BMI ≥ 45.0 kg/m2) to evaluate the association between degree of obesity and clinical outcomes. We performed propensity score matching, compared outcome variables between the groups, and conducted adjusted multivariate logistic regression analyses of postoperative outcomes.

RESULTS

A total of 6778 patients diagnosed with thyroid cancer who underwent thyroidectomy were screened, of whom 1299 (19.2%) patients were obese. Patients in the obese group had higher total hospital charges (p < 0.001) and an increased risk of overall postoperative complications (34.7% vs. 30.5%, p = 0.023). Specifically, patients in the obese group had increased odds of respiratory complication (adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) [1.26-2.19]), acute renal failure (aOR 1.87, 95% CI [1.13-3.09]), and wound complication (aOR 2.77, 95% CI [1.21-6.37]) than those in the non-obese group. Moreover, trend tests showed that the risks of unfavorable discharge, infection, acute renal failure, and respiratory complication all exhibited an upward trend with increased BMI.

CONCLUSION

Obesity is associated with an increased risk of postoperative complications in patients with thyroid cancer undergoing thyroidectomy. This finding suggests that obese patients should be treated with more caution during postoperative recovery.

Factor associated with postoperative complications of inguinal lymph node dissection for penile cancer Test

Background

Inguinal lymph node dissection (ILND) is the standard of care for palpable, biopsy-proven lymph node metastases or high-risk groups for nonpalpable lymph nodes in the treatment of penile cancer. ILND is associated with a significant incidence of complications and adverse events, specifically wound complications. Few studies have identified risk factors related to postoperative ILND complications.

Objective

The objective of this study was to assess the prevalence of 30-day postoperative complications and to identify risk factors associated with postoperative complications of ILND for penile cancer.

Materials and Methods

This was a retrospective review of medical records for all patients who had ILND for penile cancer between January 2012 and December 2022. According to the modified Clavien-Dindo classification, the 30-day postoperative complications were collected. Using an ordinal univariate logistic regression model and multivariate analysis, potential risk variables for complications were determined.

Results

A total of 60 patients were performed ILND. Sixty percent of the patients had a postoperative complication including wound infection 50%, wound dehiscence 36.7%, skin necrosis 26.6%, lymphocele 33.3%, leg edema 46.7%, and scrotal edema 16.7%. Higher grade of modified Clavien-Dindo classification was associated with body mass index (BMI) (odds ratio [OR] = 1.15; P = 0.03), diabetes mellitus (OR = 3.13; P = 0.04), American Society of Anesthesiologist classification ≥3 (OR = 1.14; P = 0.03), radical ILND (OR = 1.57; P = 0.01), and bilateral ILND (OR = 1.60; P = 0.02). In multivariate analysis, a higher grade of modified Clavien-Dindo classification was correlated with BMI (OR = 1.48; P = 0.01) and bilateral ILND (OR = 4.56; P = 0.01).

Conclusion

ILND is associated with high rates of complication. The severity of the modified Clavien-Dindo classification was associated with BMI and bilateral ILND.

A nomogram prediction model for postoperative seroma/hematoma in elderly subjects after TAPP

BACKGROUND

Formation of seroma/hematoma is one of the most common postoperative complications following laparoscopic inguinal hernia repair. This study aimed to identify risk factors associated with seroma/hematoma and construct a prediction model.

METHODS

Elderly subjects undergoing laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP) were included in this study. The observation endpoint was set as the occurrence of seroma/hematoma within 3 months after TAPP surgery. Independent risk factors were identified through preliminary univariate screening and binary logistic regression analysis. These risk factors were then used to construct a nomogram predictive model using R software.

RESULTS

A total of 330 patients were included in the analysis, of which 51 developed seroma/hematoma, resulting in an incidence rate of 15.5%. Obesity (OR: 3.54, 95%CI: 1.45-8.66, P = 0.006), antithrombotic drug use (OR: 2.73, 95%CI: 1.06-7.03, P = 0.037), C-reactive protein (CRP) ≥ 8 (OR: 2.72, 95%CI: 1.04-7.10, P = 0.041, albumin/fibrinogen ratio (AFR) < 7.85 (OR: 2.99, 95%CI: 1.28-7.00, P = 0.012), and lymphocyte/monocyte ratio (LMR) < 4.05 (OR: 12.62, 95%CI: 5.69-28.01, P < 0.001) were five independent risk factors for seroma/hematoma. The nomogram model has well predictive value for seroma/hematoma, with an AUC of 0.879.

CONCLUSIONS

The nomogram model based on obesity, antithrombotic drug, CRP, AFR, and LMR has a proved good predictive value and it has potential in clinical practice.

Robotic transversus abdominis release (TAR) for ventral hernia repairs is associated with low surgical site occurrence rates and length of stay despite increasing modifiable comorbidities

PURPOSE

Modifiable comorbidities (MCMs) have previously been shown to complicate postoperative wound healing occasionally leading to surgeon hesitancy to repair ventral hernias prior to preoperative optimization of comorbidities. This study describes the effects of MCMs on surgical site occurrences (SSOs) and hospital length of stay (LOS) following robotic transversus abdominis release (TAR) with poly-4-hydroxybutyrate (P4HB) resorbable biosynthetic mesh retromuscular sublay for ventral hernia repair in patients who had not undergone preoperative optimization.

METHODS

A single-surgeon retrospective review was performed for patients who underwent the robotic TAR procedure with P4HB mesh between January 2015 and May 2022. Patients were stratified by the amount of MCMs present: 0, 1, or 2 + . MCMs included obesity, diabetes, and current tobacco use. Patient data was analyzed for the first 60 days following their operation. Primary outcomes included 60-day SSO rates and hospital LOS.

RESULTS

Three hundred and thirty-four subjects met the inclusion criteria for SSO and prolonged LOS analysis. 16.8% had no MCM, 56.1% had 1 MCM, and 27% had 2 + MCMs. No significant difference in SSO was seen between the 3 groups; however, having 2 + MCMs was significantly associated with increased odds of SSO (odds ratio 3.25, P = .019). When the groups were broken down, only having a history of diabetes plus obesity was associated with significantly increased odds of SSO (odds ratio 3.54, P = .02). No group showed significantly increased odds of prolonged LOS.

CONCLUSION

2 + MCMs significantly increase the odds of SSO, specifically in patients who have a history of diabetes and obesity. However, the presence of any number of MCMs was not associated with increased odds of prolonged LOS.

A prospective study on risk factors associated with the development of isthmocele after caesarean section

OBJECTIVES

The primary objective was to detect the number of women developing isthmocele following lower segment caesarean section. The secondary objectives included analysing the risk factors associated with developing isthmocele and measuring the agreement between Transvaginal Ultrasonography (TVS) and Saline infusion Sonohysterography (SIS) in diagnosing Isthmocele.

METHODS

This study was conducted in the Department of Obstetrics and Gynecology and focused on women who had undergone Lower Segment cesarean Section (LSCS). The study aimed to detect any indentation of at least 2 mm in the scar site, known as isthmocele, using Transvaginal Ultrasound (TVS) and Saline Infusion Sonography (SIS) between 6 weeks and 6 months after delivery. Along with the primary objective, the study also evaluated several secondary outcomes such as maternal comorbidities, closure techniques, and labor details. The evaluation of isthmocele followed the 2019 modified Delphi consensus approach.

RESULTS

In our study, we found that 30% of our study population had isthmocele. We also observed that the number of previous caesarean deliveries, maternal BMI, duration of surgery, and characteristics of the previous CD scar were significantly associated with the development of isthmocele. When we compared the diagnostic methods, we found that TVS and SIS had similar limits of agreement for clinically important isthmocele parameters. However, we noticed a difference in the length and distance of isthmocele from the internal os, which we observed through Bland Altman plots.

CONCLUSION

Our research has shown that women who have undergone multiple caesarean deliveries, have a higher maternal body mass index (BMI), and experienced longer surgery duration are at a significantly higher risk of developing isthmocele. To prevent its development, it is recommended to promote vaginal birth after caesarean delivery whenever feasible, manage maternal obesity early on, and provide adequate surgical training to medical professionals. Additionally, transvaginal ultrasound (TVS) is an effective method for detecting isthmocele and can be used interchangeably with saline-infused sonography (SIS).

Surgical Outcomes and Sociodemographic Disparities Across All Races: An ACS-NSQIP and NHIS Multi-Institutional Analysis of Over 7.5 Million Patients

Background

This study aims to fill the gap in large-scale, registry-based assessments by examining postoperative outcomes across diverse races/ethnicities. The focus is on identifying disparities and comparing them with socioeconomic demographics.

Methods

In a registry-based cohort study using the 2008 to 2020 American College of Surgeons National Surgical Quality Improvement Program, we evaluated 24 postoperative outcomes through multivariable analysis, incorporating 28 preoperative risk factors. In a separate, independent analysis of the 2019 to 2020 National Health Interview Survey (NHIS) database, we examined sociodemographic racial/ethnic normative data.

Results

Among 7,504,734 American College of Surgeons National Surgical Improvement Database patients specifying race, 83.8% were White (WT), 11.8% Black or African American (B/AA), 3.3% Asian (AS), 0.7% American Indian or Alaska Native (AI/AN), 0.4% Native Hawaiian or Pacific Islander (NH/PI), 7.3% Hispanic. Reoperation trends reveal favorable outcomes for WT, AS, and NH/PI patients compared with B/AA and AI/AN patients. AI/AN patients exhibit higher rates of wound healing issues, while AS patients experience lower rates. AS and B/AA patients are more prone to transfusions, with B/AA patients showing elevated rates of pulmonary embolism, deep vein thrombosis, renal failure, and insufficiency. Disparities in discharge destinations exist. Hispanic patients fare better than non-WT Hispanic patients, contingent on race. Racial groups (excluding Hispanic patients) with superior surgical outcomes from the NSQIP analysis were found in the NHIS analysis to report higher wealth, better healthcare access, improved food security, greater functional and societal independence, and lower frailty.

Conclusions

Our study underscores racial disparities in surgical outcomes. Focused investigations into these complications could reveal underlying causes, informing healthcare policies to enhance surgical care universally.

Risk factors contributing to morbidity associated with feeding tubes placed for esophageal cancer patients undergoing esophagectomy: a single-center retrospective study

Background

Perioperative nutritional optimization of patients undergoing esophagectomy for cancer is important as this population is prone to malnutrition associated with poor outcomes. Nutritional supplementation has been achieved via enteral nutrition through percutaneous feeding tubes such as gastrostomy (G-tubes) and surgical jejunostomy tubes (J-tubes). While they are often routinely placed for patients undergoing esophagectomy, these are associated with adverse events including infections, dislodgement, increased healthcare visits, among others. The morbidity associated with feeding tubes has not been well characterized. We aim to determine factors associated with adverse outcomes after feeding tube placement to guide appropriate use of feeding tubes in esophageal carcinoma patients.

Methods

Patients who underwent esophagectomy for carcinoma and had at least one feeding tube placed from November, 2017 to October, 2021 at a single institution were retrospectively reviewed. Subgroup analyses were performed testing for relevant characteristics. Univariate and multivariate logistic regression analyses were conducted evaluating outcomes of interest. The primary outcome was the overall rate of tube-related complications.

Results

A total of 144 patients were included with 212 feeding tubes placed (75 G-tubes; 137 J-tubes). The rate of any adverse event related to feeding tubes was 39%. Of these, 11% were wound infections, 16% required procedural intervention, 11% visited the emergency department (ED), and 2.5% required admission due to feeding tube-related complications. Factors independently associated with adverse events included smoking history [odds ratio (OR), 2.80; 95% confidence interval (CI): 1.34-6.23], being female (OR, 2.98; 95% CI: 1.36-6.72), induction treatment (OR, 2.65; 95% CI: 1.14-6.55), and J-tubes (OR, 2.07; 95% CI: 1.09-4.03). Laparoscopically placed J-tubes were associated with increased unplanned admissions compared to those placed via laparotomy (9.4% vs. 0%, P=0.01). Though not statistically significant, there was a trend toward more complications in those who were high risk for malnutrition [body mass index (BMI) <18 kg/m2, weight loss >10%] and comorbid (Charlson Comorbidity Index 5-6).

Conclusions

There is significant morbidity related to feeding tubes. The risk profile of these tubes for individual patients should be carefully weighed against the nutritional benefits prior to placement. Patients should be carefully counselled on the possible adverse events and care requirements.

Phase angle is a predictor for postoperative complications in colorectal cancer

Aim

The aim of this study was to develop a validated nomogram to predict the risk of postoperative complications in colorectal cancer (CRC) patients by analyzing the factors that contribute to these complications.

Methods

We retrospectively collected clinical information on patients who underwent CRC surgery at a single clinical center from January 2021 to December 2021. Univariate and multivariate logistic regression analysis to identify independent risk factors for postoperative complications and to develop a predictive model. A receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) to assess the predicted probability. Calibration curve was drawn to compare the predicted probability of the nomogram with the actual probability, and decision curve analysis (DCA) was employed to evaluate the clinical utility of the nomogram.

Results

A total of 190 CRC patients were included in this study. We retrospectively collected baseline information, clinical information, surgical information, and nutrition-related indicators for all patients. Through multivariate logistic regression analysis, preoperative albumin (p = 0.041, OR = 0.906, 95% CI = 0.824-0.996), surgical time (p = 0.009, OR = 1.006, 95% CI = 1.001-1.010), waistline (p = 0.049, OR = 1.011, 95% CI = 1.002-1.020) and phase angle (PA) (p = 0.022, OR = 0.615, 95% CI = 0.405-0.933) were identified as independent risk factors for postoperative complications in CRC, and a nomogram prediction model was established using the above four variables. The AUC of 0.706 for the ROC plot and the high agreement between predicted and actual probabilities in the calibration curves suggested that the prediction model has good predictive power. The DCA also confirmed the good clinical performance of the nomogram.

Conclusion

This study developed a nomogram to predict the risk of postoperative complications in CRC patients, providing surgeons with a reliable reference to personalized patient management in the perioperative period and preoperative nutritional interventions.

The rat as an animal model in chronic wound research: An update

The increasing global prevalence of chronic wounds underscores the growing importance of developing effective animal models for their study. This review offers a critical evaluation of the strengths and limitations of rat models frequently employed in chronic wound research and proposes potential improvements. It explores these models in the context of key comorbidities, including diabetes, venous and arterial insufficiency, pressure-induced blood flow obstruction, and infections. Additionally, the review examines important wound factors including age, sex, smoking, and the impact of anesthetic and analgesic drugs, acknowledging their substantial effects on research outcomes. A thorough understanding of these variables is crucial for refining animal models and can provide valuable insights for future research endeavors.

Midterm complications after primary obstetrical anal sphincter injury repair in France

BACKGROUND

Incidence of complications following obstetrical anal sphincter injury (OASI) during vaginal delivery are poorly defined. They are only studied in high level maternities, small cohorts, all stages of perineal tear or in low-income countries. The aim of our study was to describe complications after primary OASI repair following a vaginal delivery in all French maternity wards at short and midterm and to assess factors associated with complication occurrence.

METHODS

We conducted a historical cohort study using the French nationwide claim database (PMSI) from January 2013 to December 2021. All women who sustained an OASI repair following a vaginal delivery were included and virtually followed-up for 2 years. Then, we searched for OASIS complications. Finally, we evaluated factors associated with OASIS complication repaired or not and OASIS complication repairs.

RESULTS

Among the 61,833 included women, 2015 (2.8%) had an OASI complication and 842 (1.16%) underwent an OASI complication repair. Women were mainly primiparous (71.6%) and 44.3% underwent an instrumental delivery. During a follow-up of 2 years, 0.6% (n = 463), 0.3% (n = 240), 0.2% (n = 176), 0.1% (n = 84), 0.06% (n = 43) and 0.01% (n = 5) of patients underwent second surgery for a perineal repair, a fistula repair, a sphincteroplasty, a perineal infection, a colostomy and a sacral nervous anal stimulation, respectively. Only one case of artificial anal sphincter was noticed. Instrumental deliveries (OR = 1.56 CI95%[1.29;1.9]), private for-profit hospitals (OR = 1.42 [1.11;1.82], reference group "public hospital"), obesity (OR = 1.36 [1;1.84]), stage IV OASIS (OR = 2.98 [2.4;3.72]), perineal wound breakdown (OR = 2.8 [1.4;5.48]), ages between 25 and 29 years old (OR = 1.59 [1.17;2.18], refence group "age between 13 and 24 years old") and 30 and 34 years old (OR = 1.57 [1.14; 2.16], refence group "age between 13 and 24 years old") were factors associated with OASIS complication repairs.

CONCLUSIONS

Maternal age, stage IV OASIS, obesity, instrumental deliveries and private for-profit hospitals seemed to predict OASIS complications. Understanding factors associated with OASIS complications could be beneficial for the patient to inform them and to influence the patient's follow-up in order to prevent complications, repairs and maternal distress.

GPER deficiency impedes murine myocutaneous revascularization and wound healing

Estrogens regulate numerous physiological and pathological processes, including wide-ranging effects in wound healing. The effects of estrogens are mediated through multiple estrogen receptors (ERs), including the classical nuclear ERs (ERα and ER β ), that typically regulate gene expression, and the 7-transmembrane G protein-coupled estrogen receptor (GPER), that predominantly mediates rapid "non-genomic" signaling. Estrogen modulates the expression of various genes involved in epidermal function and regeneration, inflammation, matrix production, and protease inhibition, all critical to wound healing. Our previous work demonstrated improved myocutaneous wound healing in female mice compared to male mice. In the current study, we employed male and female GPER knockout mice to investigate the role of this estrogen receptor in wound revascularization and tissue viability. Using a murine myocutaneous flap model of graded ischemia, we measured real-time flap perfusion via laser speckle perfusion imaging. We conducted histologic and immunohistochemical analyses to assess skin and muscle viability, microvascular density and vessel morphology. Our results demonstrate that GPER is crucial in wound healing, mediating effects that are both dependent and independent of sex. Lack of GPER expression is associated with increased skin necrosis, reduced flap perfusion and altered vessel morphology. These findings contribute to understanding GPER signaling in wound healing and suggest possible therapeutic opportunities by targeting GPER.

A meta-analysis examining the impact of obesity on surgical site wound complications in patients undergoing primary ovarian cancer surgery

The meta-analysis sought to evaluate and compare the effect of obesity on surgical site wound problems in subjects after primary ovarian cancer surgery. The results found by this meta-analysis were analyzed, and then odds ratio (OR) and mean difference (MD), at 95% confidence intervals (CIs), were calculated. These models might be dichotomous or contentious, random, or fixed effect models. The current meta-analysis included nine exams from 2009 to 2023, including 4362 females with primary ovarian cancer surgeries. Obesity had a significantly higher risk of surgical site wound infections (OR, 2.90; 95% CI, 2.27-3.69, p < 0.001), and wound problems (OR, 4.14; 95% CI, 1.83-9.34, p < 0.001) compared to non-obesity in females with primary ovarian cancer surgeries. It was revealed, by examining the data, that obesity was associated with significantly higher incidence of surgical site wound infections, and wound problems compared to non-obesity in females with primary ovarian cancer surgeries. However, attention should be given to the values because some of the comparisons included a small number of chosen studies,.

Acute Surgical Site Complications in Direct Anterior Total Hip Arthroplasty: Impact of Local Subcutaneous Tissue Depth and Body Mass Index

Background

Body mass index (BMI) is an imperfect measure of patients' adiposity and operative risk. Radiographic and direct subcutaneous measurements have been utilized in attempts to more accurately characterize the risk of postoperative complications, including surgical site infection. This study aims to evaluate whether direct tissue depth measurement is a more accurate predictor of skin complication following direct anterior total hip arthroplasty (THA).

Methods

A retrospective chart review of patients who underwent elective THA between April 30, 2020, and January 31, 2023, was performed. Baseline demographics, antibiotics, anticoagulation, and intraoperatively measured tissue depths at proximal, middle, and distal portions of the incision were recorded. Patient follow-up was reviewed to assess the development of skin complication in the acute postoperative period.

Results

Data were collected from 280 patients who underwent THA via direct anterior approach by a single surgeon. The mean age was 66.0 years, and 52.1% were female. A total of 18/280 (6.4%) patients developed an abrasion (5/18) or superficial surgical site infection (13/18) within the first 60 days postoperatively. Patients who developed skin complications had a significantly higher BMI (33.7 kg/m2 vs 29.9 kg/m2; P = .0021). Patients with a BMI >30 kg/m2 had more than 5 times increased odds of developing a superficial skin complication in the acute 60-day postoperative period compared to those with a BMI <30 kg/m2 (Odds ratio = 5.318, P = .0059). None of the measured tissue depths, nor their average together, were shown to be significant predictors of skin complications.

Conclusions

This study showed that BMI is a significant predictor of acute skin complications in direct anterior THA patients. No other significant predictors were found to be associated with increased risk, including proximal, middle, and distal tissue depths.

Complications after Oncoplastic Breast Reduction and Impact on Time to Adjuvant Therapy

Background

Although lumpectomy with oncoplastic breast reduction (OBR) improves cosmetic results and ameliorates symptomatic macromastia, associated complications may delay adjuvant therapy.

Methods

This was a single-institution, retrospective study of OBRs (2015-2021). A major complication was defined as need for IV antibiotics, and/or operation under general anesthesia. Association of complications with delay to adjuvant therapy (chemotherapy, radiation) was assessed.

Results

In total, 282 patients were included. The major complication rate was 3.9%, and overall complication rate was 31.2%. The most common complication was incisional dehiscence (23.4%). Body mass index [BMI >35 (P < 0.0001)], diabetes (P = 0.02), and HgbA1c [>6.5 (P = 0.0002)] were significantly associated with having a major complication. The occurrence of any complication was associated with a delay in time to radiation (median 7 versus 8 weeks, P < 0.001). The occurrence of a major complication was associated with a more meaningful delay to radiation (median 7 versus 15 weeks, P = 0.002). Occurrence of any complication, or a major complication, was not associated with delay to chemotherapy.

Conclusions

The overall complication rate observed after OBR falls within the range reported in the literature. Patients with a BMI more than 35, diabetes, and/or HgbA1c more than 6.5 were at increased risk for a major complication, which was associated with a meaningful delay to radiation. Consideration may be given to partial mastectomy alone without oncoplastic reduction in patients with small tumors when the priority to avoid radiation delay is high (eg, high-risk tumors), or the risk of delay is high (eg, diabetic or BMI >35).

Skull Base Osteomyelitis: A 5-Year Review and Prognostic Outcome in a Single Tertiary Institution

Objective

The primary objective of this study is to review the clinical parameters associated with skull base osteomyelitis (SBO), with a secondary aim of studying their association with patient outcomes 1 and 6 months after treatment initiation.

Study Design

This is a single-center restrospective observational study.

Setting

The study was conducted from January 2018 to December 2022 at the University Malaya Medical Center in Kuala Lumpur.

Methods

Patients aged over 15 years with a diagnosis of SBO were included in the study. Clinical parameters, investigations, and follow-up records were recorded. The disease outcomes were analyzed at 1 and 6 months after treatment initiation using multivariable analyses.

Results

The study identified 31 patients with SBO, the majority of whom were elderly males with comorbidities such as diabetes and hypertension. Otalgia and otorrhea were the most common symptoms, and computed tomography scans were used for diagnosis. Pseudomonas aeruginosa was the most commonly identified pathogen, and intravenous broad-spectrum antimicrobials were used to treat all patients. Surgical intervention was required for 25% of patients, and underlying ischemic heart disease, anemia, and single nerve palsy were significantly associated with an unfavorable prognosis. Patients with higher body mass index and elevated C-reactive protein showed poorer outcomes after 1 and 6 months of treatment, respectively.

Conclusion

Early recognition, prompt treatment, better control of comorbidities, nutrition, and monitoring can improve SBO outcomes and reduce complications. Therefore, as the prevalence of SBO increases, diagnostic criteria or management guidelines should be established to guide the best clinical practice.

Approach to the Atypical Wound

The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.

Cutaneous Wound Healing and the Effects of Cannabidiol

Cutaneous wounds, both acute and chronic, begin with loss of the integrity, and thus barrier function, of the skin. Surgery and trauma produce acute wounds. There are 22 million surgical procedures per year in the United States alone, based on data from the American College of Surgeons, resulting in a prevalence of 6.67%. Acute traumatic wounds requiring repair total 8 million per year, 2.42% or 24.2 per 1000. The cost of wound care is increasing; it approached USD 100 billion for just Medicare in 2018. This burden for wound care will continue to rise with population aging, the increase in metabolic syndrome, and more elective surgeries. To heal a wound, an orchestrated, evolutionarily conserved, and complex series of events involving cellular and molecular agents at the local and systemic levels are necessary. The principal factors of this important function include elements from the neurological, cardiovascular, immune, nutritional, and endocrine systems. The objectives of this review are to provide clinicians engaged in wound care and basic science researchers interested in wound healing with an updated synopsis from recent publications. We also present data from our primary investigations, testing the hypothesis that cannabidiol can alter cutaneous wound healing and documenting their effects in wild type (C57/BL6) and db/db mice (Type 2 Diabetes Mellitus, T2DM). The focus is on the potential roles of the endocannabinoid system, cannabidiol, and the important immune-regulatory wound cytokine IL-33, a member of the IL-1 family, and connective tissue growth factor, CTGF, due to their roles in both normal and abnormal wound healing. We found an initial delay in the rate of wound closure in B6 mice with CBD, but this difference disappeared with time. CBD decreased IL-33 + cells in B6 by 70% while nearly increasing CTGF + cells in db/db mice by two folds from 18.6% to 38.8% (p < 0.05) using a dorsal wound model. We review the current literature on normal and abnormal wound healing, and document effects of CBD in B6 and db/db dorsal cutaneous wounds. CBD may have some beneficial effects in diabetic wounds. We applied 6-mm circular punch to create standard size full-thickness dorsal wounds in B6 and db/db mice. The experimental group received CBD while the control group got only vehicle. The outcome measures were rate of wound closure, wound cells expressing IL-33 and CTGF, and ILC profiles. In B6, the initial rate of wound closure was slower but there was no delay in the time to final closure, and cells expressing IL-33 was significantly reduced. CTGF + cells were higher in db/bd wounds treated with CBD. These data support the potential use of CBD to improve diabetic cutaneous wound healing.

Weighing the outcomes: the role of BMI in complex robotic esophageal and hepatobiliary operations

BACKGROUND

The correlation between body mass index (BMI) and surgical outcomes has emerged as a critical consideration in complex abdominal operations. While elevated BMI is often associated with increased perioperative risk, its specific effects on the outcomes of robotic surgeries remain inadequately explored. This study assesses the impact of BMI on perioperative variables of complex esophageal and hepatopancreaticobiliary (HPB) robotic operations.

METHODS

Following IRB approval, we prospectively followed 607 patients undergoing pancreaticoduodenectomy, trans-hiatal esophagectomy (THE), major liver resection or distal pancreatectomy with splenectomy, all performed robotically. Perioperative data retrieved included operative duration, estimated blood loss (EBL), intraoperative and postoperative complications, conversions to an 'open' operation and length of stay (LOS). Z scores were assigned to each variable to standardize operations, and the variables were then regressed against BMI. For illustrative purposes, data are presented as median(mean ± standard deviation).

RESULTS

Between 2012 and 2020, surgeries included 71 THE, 122 distal pancreatectomies with splenectomies, 129 major hepatectomies and 285 pancreaticoduodenectomies. Median age was 67(65 ± 12.5) years old, and BMI was 27(28 ± 5.5) kg/m2. Operative duration for all operations was 349(355 ± 124.5) min and had a positive correlation with increasing BMI (p = 0.004), specifically for robotic THE and robotic pancreaticoduodenectomy, with both operative durations having positive correlation with increasing BMI (p = 0.02 and p = 0.05). No significant correlation with BMI was found for EBL, intraoperative or postoperative complications, conversion to 'open' surgery, or LOS.

CONCLUSION

Elevated BMI is associated with longer operative durations in select robotic surgeries, such as trans-hiatal esophagectomy and pancreaticoduodenectomy, and highlights the need for strategic planning in these patients.

Body Mass Index Greater Than 46 Associated With Increased Risk of 30 Day Complications Following Adult Tonsillectomy: A Retrospective Cohort Study

Background: The study aimed to identify data-driven body mass index (BMI) thresholds that are associated with varying risk of 30 day complications following adult tonsillectomy. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized to conduct a retrospective cohort analysis of patients undergoing adult tonsillectomy from 2005 to 2019. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven BMI strata that maximized the likelihood of 30 day complications following adult tonsillectomy. Patient demographics and clinical comorbidities were compared using chi-squared analysis and student t tests, where appropriate, for each stratum. Multivariable regression analysis was conducted to confirm association between identified data-driven strata with 30 day complication rates. Results: In total, 44,161 patients undergoing adult tonsillectomy were included in this study. SSLR analysis identified 2 BMI categories: 18 to 45 and 46+. Relative to the 18 to 45 BMI cohort, the 46+ BMI cohort was more likely to have 30 day all-cause complications after surgery [odds ratio (OR): 1.62, P = .007]. Specifically, the 46+ BMI cohort had significantly higher odds for 30 day major medical complications (OR: 2.86, P = .001), pulmonary domain complications (OR: 1.86, P = .041), unplanned reintubation (OR: 2.65, P = .033), and deep vein thrombosis (OR: 6.54, P = .026). Conclusions: We identified a BMI threshold of 46+ that was associated with a significantly increased risk of 30 day all-cause complications following adult tonsillectomy. These BMI strata can guide preoperative planning and risk-stratifying models for predicting 30 day complications in tonsillectomy surgery.

Genitourinary Fistula: epidemiology, changing trends in etiology and management: A tertiary care institute's perspective

INTRODUCTION

Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times.

METHODS

This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively.

RESULTS

In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients.

CONCLUSION

Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.

Achilles tendon rupture primary repair technique: A comparative retrospective study between graft versus no-graft

Introduction

Achilles tendon rupture is one of the most common musculoskeletal injuries and accounts to 20 % of all large tendon ruptures The surgical choice of a procedure might play a role in the incidence of postoperative complications. This study aimed to estimate and compare the incidence of complications occurring within a 30-day window following primary surgical repair of the Achilles tendon with or without a graft.

Methods

A retrospective cohort study was conducted using the ACS NSQIP database from 2005 to 2021. Patients were divided into 2 cohorts (primary surgical repair with and without graft).

Results

A total of 7010 patients were included in the analysis. Among the graft group, 10.9 % reported any complication which was double the percentage of complications in the no graft group. Only 3.8 % of the no graft patients had reported systemic complications compared to 8.3 % in the graft group. Chronic steroid use was found to be an effect modifier in the incidence of any complications after primary surgical repair when comparing graft versus no graft (P-value 0.016).

Conclusion

Surgical repairwith tendon graft develops more complications than repairing without graft. Therefore, it is imperative for physicians to strive for an early diagnosis, as any delay in treatment significantly raises the likelihood of complications.

Levels of evidence

III, Retrospective Cohort Study.

Localized trans-browning and pro-angiogenesis inductive self-assembled collagen resveratrol bio-matrix for tissue repair and regeneration in obese conditions

The present study probes into the complexities of wound management in obesity by proposing a novel biomaterial designed to reprogram the altered skin physiology prevalent in obese conditions. The strategy involves the development of a multifunctional biomaterial addressing issues such as excessive exudate, pressure ulcers, and reduced vascularity. The bio-matrix demonstrates the localized transformation of white adipocytes through trans-browning, coupled with the simultaneous induction of angiogenesis at obese wound sites, resulting in expedited wound closure. The collagen bio-matrices, stabilized with Resveratrol (Rsv), exhibit remarkable thermal, mechanical, and biological stability. The porous 3D microstructure of the Rsv-stabilized collagen bio-matrix closely resembled the natural extracellular matrix, facilitating effective cell adhesion. The bio-matrix exhibited the unique capability to induce localized thermogenesis in the subcutaneous fat layer while concurrently activating angiogenesis. In vivo wound healing studies conducted on DIO-C57BL6 mice demonstrated complete healing within 10 days, showcasing accelerated tissue regeneration, blood vessel formation, robust collagen deposition, and significant activation of browning in the subcutaneous adipose layer. This study introduces the concept of tailored regenerative biomaterials with the ability to reprogram the challenging wound environment associated with obesity. This innovative approach opens up new avenues for enhanced wound care strategies, particularly for bariatric patients.

Understanding wound healing in obesity

Obesity has become more prevalent in the global population. It is associated with the development of several diseases including diabetes mellitus, coronary heart disease, and metabolic syndrome. There are a multitude of factors impacted by obesity that may contribute to poor wound healing outcomes. With millions worldwide classified as obese, it is imperative to understand wound healing in these patients. Despite advances in the understanding of wound healing in both healthy and diabetic populations, much is unknown about wound healing in obese patients. This review examines the impact of obesity on wound healing and several animal models that may be used to broaden our understanding in this area. As a growing portion of the population identifies as obese, understanding the underlying mechanisms and how to overcome poor wound healing is of the utmost importance.

Apigenin Self-Assembled Collagen Biomatrix for Reprogramming the Obese Wound Microenvironment for Its Management and Repair

Wound management in obesity is complicated by excessive exudates from wounded areas, pressure ulcerations due to stacking of the fat layer, and vascular rarefaction. The current study explored the development of biomaterials for reprogramming the altered wound microenvironment under obese conditions. Self-assembled collagen biomatrix with trans and de novo browning activator, apigenin, was fabricated as a soft tissue regenerative wound dressing material. The as-synthesized self-assembled collagen biomatrix exhibited excellent thermal, mechanical, and biological stability with a superior wound exudate absorption capacity. The apigenin self-assembled collagen biomatrix exhibited porous 3-D microstructure that mimicked the extracellular matrix that promoted cell adhesion and proliferation. The apigenin self-assembled collagen multifunctional biomatrix triggered adaptive localized thermogenesis in the subcutaneous fat layer, resulting in the activation of angiogenesis and fibroblast spreading and migration. The in vivo wound healing assay performed in DIO-C57BL6 mice showed faster tissue regeneration within 9 days, with well-defined neo-epidermis, blood vessel formation, thick collagen deposition, minimal inflammation, and significant activation of browning in the subcutaneous adipose layer. This study paves the way forward for the development of specialized regenerative biomatrices that reprogram the obese wound bed for faster tissue regeneration.

Improving heart rate monitoring in the obese with time-of-flight photoplethysmography (TOF-PPG): a quantitative analysis of source-detector-distance effect

Commercial photoplethysmography (PPG) sensors rely on the measurement of continuous-wave diffuse reflection signals (CW-DRS) to monitor heart rate. Using Monte Carlo modeling of light propagation in skin, we quantitatively evaluate the dependence of continuous-wave photoplethysmography (CW-PPG) in commercial wearables on source-detector distance (SDD). Specifically, when SDD increases from 0.5 mm to 3.3 mm, CW-PPG signal increases by roughly 846% for non-obese (NOB) skin and roughly 683% for morbidly obese (MOB) skin. Ultimately, we introduce the concept of time-of-flight PPG (TOF-PPG) which can significantly improve heart rate signals. Our model shows that the optimized TOF-PPG improves heart rate monitoring experiences by roughly 47.9% in NOB and 93.2% in MOB when SDD = 3.3 mm is at green light. Moving forward, these results will provide a valuable source for hypothesis generation in the scientific community to improve heart rate monitoring.