Delayed gastric emptying after aggressive surgery for retroperitoneal sarcoma - Incidence, characteristics, and risk factors

Delayed gastric emptying (DGE) after aggressive resection of retroperitoneal sarcoma (RPS) has rarely been described. This study aimed to determine the incidence and characteristics of DGE after surgery for RPS and explore its potential risk factors. Patients with RPS who had undergone surgery between January 2010 and February 2021 were retrospectively analyzed. DGE was defined and graded according to the International Study Group of Pancreatic Surgery classification and classified as primary or secondary to other complications. Patients with clinically relevant DGE (crDGE, grade B+C) were compared to those with no or mild DGE (grade A). Multivariate logistic regression analysis of clinicopathological and surgical parameters was performed to identify risk factors for crDGE. Of the 239 patients studied, 69 (28.9%) had experienced DGE and 54 (22.6%) had experienced crDGE. Patients with primary and secondary DGE accounted approximately half and half. The most common concurrent complications included abdominal infection, postoperative pancreatic fistula, and abdominal bleeding. Patients with crDGE were more likely to have multifocal tumors and the liposarcoma subtype, with a larger tumor size, longer operating time, more resected organs, and a history of combined resection of the stomach, pancreas, small intestine, and/or colon. In multivariate analysis, the tumor size, operating time, and combined pancreatic resection were independent risk factors for crDGE. In conclusion, the current results indicated that approximately one-fourth of patients experienced DGE after aggressive surgery for RPS and that DGE was primary or secondary to other underlying conditions. A large tumor involving long, difficult surgery and combined pancreatic resection highly predicted the incidence of crDGE. The prevention and management of DGE remain challenging.

The Learning Curve for Thermal Ablation of Liver Cancers: 4,363-Session Experience for a Single Central in 18 Years

This study aimed to explore the special efforts required to achieve proficiency in performing thermal ablation of liver cancers, including tumors in difficult locations, and clarify the effects of handing-down teaching on the corresponding process. Major complications of patients receiving percutaneous thermal ablation of liver cancer were analyzed. Polynomial fitting was used to describe the connection between major complication rates and special experience. Learning curve of major complications was plotted both for the whole group and for each operator, respectively. Tumors in difficult locations were further studied. A total of 4,363 thermal ablation sessions were included in this study. 143 of 4,363 patients had major complications, corresponding to an incidence rate of 3.27%. 806 thermal ablation sessions were performed for tumors in difficult locations. The major complication rate of these sessions is 6.33%. According to the trend of the learning curve of the 4363 patients, the experience of the whole group can be classified into five stages, that is, the high-risk, relatively stable, unstable, proficient and stable periods. A learning curve for an individual operator can be classified into the high-risk, proficient and stable periods. The major complication rates for the chronologically first, second and third operator of the group are 3.23, 3.35, and 3.31%, respectively. The special experience needed to bypass the first stage corresponds to 410, 510, and 440 sessions, the second stage, 1850, 850, and 870 sessions, by the three operators, respectively. The major complication rates for the tumors in difficult locations for the first, second and third operator were 7.04, 5.53, and 5.98%, respectively. For the tumors in difficult locations, the special experience needed to bypass the first stage corresponds to 150, 130, and 140 sessions, the second stage, 290, 175, and 185 sessions, by the three operators, respectively. In conclusion, the learning process of an operator percutaneous thermal ablation for liver cancer can be classified into three stages. The major complication rate for tumors in difficult locations were higher than that for all tumors. Handing-down teaching can make an operator arrive at the third stage earlier but not the second stage.

Early Recognition and Diagnosis of Buried Bumper Syndrome: A Report of Three Cases

Buried bumper syndrome (BBS) was described as a complication of percutaneous endoscopic gastrostomy (PEG) that occurs when the internal stump of the probe migrates and is located between the gastric wall and the skin. The increase of compression between the internal stump and the external stump of the gastrostomy tube causes pain and the inability to feed. We present the cases of three patients with BBS managed by the metabolic and nutritional support department. These cases intend to illustrate one of the less frequent complications of PEG, clinical presentation, risk factors, diagnosis, and especially clinical management. Although there are no defined gold standards for its management, the most important points in the management of this condition are early recognition, recommendations to avoid ischemic process at the moment of the insertion of the tube, specific care of the gastrostomy tube, and a periodic nutrition evaluation to avoid overweight, which causes traction and excessive pressure in the gastric wall. It is important for physicians to be aware of the recommendations to prevent BBS and its complications, especially in patients in whom communication can be difficult secondary to their pathologies and comorbidities.

Do rheumatoid arthritis patients have more major complications and length of stay after lower extremities fracture surgery?: A nationwide data with propensity score matching

Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular diseases and fractures. This retrospective cohort study explored whether patients with RA face higher complication risks or longer hospital stays than other patients when they had a lower limb fracture that required the surgery. Patients aged >45 years who received lower limb fracture surgeries between 2005 and 2012 were selected from the National Health Insurance Research Database, and 10 related variables including sex and age were used in propensity score matching to pair RA patients with non-RA patients in a 1:4 ratio. The final study sample comprised 1109 patients with RA and 4436 non-RA patients. The results indicated that 5.57% of the study sample had postoperative complications, accounting for 5.05% of patients with RA and 5.70% of the control group. After conditional logistic regression analysis was performed, the risk of major complications has no significant differences between patients with RA and the control group (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.61-1.24; P > .05). However, the comorbidity severity score exerted a significant effect on complications; patients with scores ≥3 were 2.78 times more likely to experience complications (OR = 2.78; 95% CI 1.52-5.07). When considering different types of complications, patients with RA were less likely to be exposed to the risk of stroke (OR = 0.48). After controlling all related factors, no significant differences were observed in the complication risks or deaths between the 2 groups (P > .05). Regarding hospitalization length, the average stay for all patients was 8.12 days; after controlling related factors, the hospitalization length for patients with RA was 0.97 times that of the control group, which was nonsignificant (P > .05). These results may provide some information to healthcare professionals when providing treatments.

No Difference in Major Complication and Readmission Rates Following Simultaneous Bilateral vs Unilateral Total Hip Arthroplasty

BACKGROUND

Simultaneous bilateral total hip arthroplasty (THA) is an attractive option for patients with osteoarthritis as it requires a single anesthetic and hospitalization. Nonetheless, serious concerns remain over the perioperative safety and rate of hospital readmission. The purpose of the present study was to compare the rate of 30-day major complications and hospital readmissions between patients undergoing simultaneous bilateral vs unilateral THA using the National Surgical Quality Improvement Program database.

METHODS

The National Surgical Quality Improvement Program database was queried from 2011 to 2015 inclusively to identify all cases of elective, primary simultaneous bilateral THA and match them to a control group of unilateral THA cases. A multivariable regression analysis was then used to assess the relationship of simultaneous bilateral vs unilateral THA on major complications and readmissions.

RESULTS

A total of 575 bilateral THA patients were matched to 2290 unilateral THA patients using a 4:1 ratio based on age, sex, and American Society of Anesthesiologists scores. Bilateral THA patients were more likely to undergo general anesthesia (77% vs 58.7%, P < .0001), required more postoperative transfusions (29.2% vs 15.9%, P < .0001) and were more often discharged to a rehabilitation facility rather than home (39.4% vs 20.8%, P < .0001). However, the adjusted odds of a major complication (odds ratio = 0.72, 95% confidence interval [0.41-1.24], P = .24) and 30-day readmission (odds ratio = 0.67, 95% confidence interval [0.38-1.19], P = .17) were similar between the 2 groups.

CONCLUSION

Although patients who underwent simultaneous bilateral THA were more likely to be discharged to a rehabilitation facility and required significantly more perioperative transfusions compared to those undergoing unilateral THA, the odds of a 30-day major complication and readmission were similar between groups.

LEVEL OF EVIDENCE

III.

Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty: A Comparison of 30-Day Readmission Rates and Major Complications

We queried the National Surgical Quality Improvement Program to compare the rate of 30-day readmissions and major complications between simultaneous bilateral and unilateral total knee arthroplasty (TKA). We identified 1771 patients who underwent simultaneous (same-day) bilateral TKA and matched them to a control group of 6790 patients who underwent unilateral TKA. The simultaneous bilateral TKA patients had longer surgery, were more commonly performed under general anesthesia, had a higher rate of postoperative transfusion, and a greater proportion of patients discharged to rehabilitation facilities. Simultaneous bilateral TKA has a low incidence of major complications and was not associated with more readmissions as compared to unilateral TKA (3.6% versus 3.5% respectively). Nonetheless, the odds of major complications was slightly higher following simultaneous bilateral TKA (OR=1.58).

Diaphragmatic perforation with colonic herniation due to hepatic radiofrequency ablation: A case report and review of the literature

Radiofrequency ablation (RFA) has been widely accepted as an alternative treatment for unresectable primary and metastatic hepatic tumors, with satisfactory rates of local response and significant improvements in rates of overall survival. Numerous large series studies have shown that RFA is safe and effective, with a low mortality rate and a low major complication rate. Major complications, including diaphragmatic perforation and hernia, have rarely been previously reported. The current case report presents a case of diaphragmatic hernia with perforation of the incarcerated colon in the thoracic cavity 12 months following hepatic RFA, and reviews nine previously reported cases of diaphragmatic hernia. Comprehensive analysis of the nine cases demonstrated possibilities leading to diaphragmatic hernia following diaphragmatic thermal injury as a consequence of hepatic RFA. Clinicians and radiologists must consider diaphragmatic thermal damage following hepatic RFA for liver tumors adjacent to the diaphragm, particularly for patients with symptoms of ileus, dyspnea, chest pain, pleural effusion and right shoulder pain.

Review of 17 cases of pneumonia caused by Streptococcus pyogenes

Streptococcus pyogenes is an uncommon cause of community-acquired pneumonia and there have been few recent specific accounts of the condition. To describe the current nature of this disease in the UK, data was gathered on patients with clinical pneumonia from whom Streptococcus pyogenes was cultured principally from blood or other relevant normally sterile sites. In the Harrogate and Northallerton districts of North Yorkshire, pneumonia accounted for nine (20%) cases and a quarter of all deaths in a complete sequence of 45 patients with Streptococcus pyogenes bacteraemia detected during the 16-year-period 1981-1996. An analysis is presented of those cases together with eight recent cases from counties York, Durham and Isle of Wight during 1995-1997. Of the total 17 cases, nine occurred in women and eight in men; the age range was 30-92 years. The organism was isolated from blood culture in 15 (88%) patients. Eight (47%) patients died, five within 1 day of hospitalisation. Fourteen (82%) cases occurred in the winter months October to March, including all the fatal cases and all eight in which a clinical 'viral' prodrome was observed. Predisposing medical or surgical conditions were present in 65% of the patients. Major complications included septicaemia, pleural reaction, shock, pulmonary cavitation, osteomyelitis and metastatic abscesses. Seven serotypes of Streptococcus pyogenes were encountered, with M-type 1 predominating (the cause in 60% of cases). All infections were community acquired; two small clusters of fatal pneumonia were seen.