RoMed Kliniken

The impact of anastomotic leakage (AL) on quality of life (QoL) following low anterior resections (LAR) remains a pressing concern, particularly as advancements in surgical techniques and multimodal treatments have resulted in an increasing number of survivors. This study evaluated how AL affected health-related QoL in patients treated at the Department of Surgery, University hospital Mannheim of Heidelberg University from 2010 to 2021, utilizing the LARS score, the EORTC QLQ-C30, and the EORTC QLQ-CR29 questionnaires. The study included 20 patients in each group, with those having AL matched 1:1 to control subjects without AL, based on criteria such as age, gender, comorbidities, tumor location, and resection degree. Both groups showed impaired QoL in EORTC assessments, with no statistically significant differences except in the abdominal pain scale of EORTC QLQ-CR29, which was higher for AL patients (19.99 ± 22.68 vs. 6.66 ± 17.43; p = 0.03). Comparison of QoL between patients who received neoadjuvant radiotherapy and those who did not, independent of AL, revealed significantly reduced QoL in several scales of both the EORTC QLQ-C30 and QLQ-CR29 assessments. A statistically significant worsening of QoL was observed in the sore skin domain (36.66±34.81 for RT vs. 3.70±11.11 without RT; p = 0.02) of the EORTC QLQ-CR29 among AL patients who received neoadjuvant radiotherapy. AL patients treated with Endoscopic Vacuum Therapy (EVT) showed improved QoL. AL alone does not appear to be an independent risk factor for impaired QoL after LAR for rectal cancer. However, the combined effect of AL and neoadjuvant radiotherapy may contribute to worse functional outcomes, significantly impacting QoL. Effective AL management with EVT can help mitigate these effects and improve patient outcomes.

Treatment of pelvic fractures requires extensive human and material resources. The weekend is characterized by a reduced availability of these resources. In addition, weekend leisure activities lead to different injury patterns. The ‘weekend effect’, which describes these conditions, is controversially discussed in medicine. However, there is still a paucity of data, especially in traumatology and particularly in relation to pelvic injuries. The aim of this work is to assess the weekend effect on demographics, injury patterns and outcome in relation to the day of the accident. Demographic, clinical and operative parameters from the data of the German Pelvic Trauma Registry were retrospectively evaluated (n = 16,359). Differences between weekend and weekday accidents were statistically evaluated. Weekend accidents affect younger, more severely injured and less often female patients with fewer displaced fractures and a lower proportion of acetabular fractures. This results in less frequent operative treatment, but more emergency and early definitive surgery. In contrast to the numerous and significant differences in baseline conditions, the outcome in terms of quality of surgical treatment, morbidity and mortality showed only marginal and non-significant differences between weekend and weekday accidents. Weekend accidents differ from weekday accidents in their initial conditions. This does not lead to more frequent—yet more emergency and more early definitive surgeries. However, there are no differences in the quality of care or outcome according to the day of the accident.

While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement. The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals. The analysis was conducted with a subset of 546 hip and 492 knee replacement cases with longitudinal cost data from 24 statutory health insurances. Patients were randomised 1:1 to a PROM-based remote monitoring and alert intervention or to a standard care group. All patients were assessed at 12-months post-surgery via digitally collected PROMs. Patients within the intervention group were additionally assessed at 1-, 3-, and 6-months post-surgery to be contacted in case of critical recovery paths. For the effect evaluation, a PROM-based composite measure (PRO-CM) was developed, combining changes across various PROMs in a single index ranging from 0 to 100. The PRO-CM included 6 PROMs focused on quality of life and various aspects of physical and mental health. The primary outcome was the incremental cost-effectiveness ratio (ICER). The intervention group showed incremental outcomes of 2.54 units PRO-CM (95% confidence interval (CI) [0.93, 4.14]; p = 0.002) for patients with hip and 0.87 (95% CI [-0.94, 2.67]; p = 0.347) for patients with knee replacement. Within the 12-months post-surgery period the intervention group had less costs of 376.43€ (95% CI [-639.74, -113.12]; p = 0.005) in patients with hip, and 375.50€ (95% CI [-767.40, 16.39]; p = 0.060) in patients with knee replacement, revealing a dominant ICER for both procedures. However, it remains unclear which step of the multistage intervention contributes most to the positive effect. The intervention significantly improved patient outcomes at lower costs in patients with hip replacements when compared with standard care. Further it showed a nonsignificant cost reduction in knee replacement patients. This reinforces the notion that PROMs can be utilised as a cost-effective instrument for remote monitoring in standard care settings. Registration: German Register for Clinical Studies (DRKS) under DRKS00019916.

BackgroundIn 2022/2023, Influenza A and Respiratory Syncytial Virus (RSV) reappeared in hospitalized patients, which was in parallel to ongoing SARS-CoV-2 infections. The aim of our study was to compare the characteristics and outcomes of these infections during the same time.MethodsWe included patients of all ages with a positive polymerase chain reaction (PCR) test for Influenza A/B, RSV, or SARS-CoV-2 virus hospitalized in the neurological, internal or paediatric units of the RoMed Hospital Rosenheim, Germany, between October 1st 2022 and February 28th 2023.ResultsA total of 906 patients were included (45.6% female; median age 68.0 years; 21.9% Influenza A, 48.2% SARS-CoV-2, 28.3% RSV). Influenza B (0.2%) and co-infections (1.5%) played a minor role. In patients aged ≥ 18 years (n = 637, 71%), Influenza A, SARS-CoV-2 and RSV groups differed in age (median 72, 79, 76 years, respectively; p < 0.001). Comorbidities, particularly asthma and COPD, were most prevalent for RSV. 103 patients were admitted to the intensive care unit (ICU) (16.3% Influenza A, 15.3% SARS-CoV-2, 19.2% RSV; p = 0.649), 56 died (6.8% Influenza A, 9% SARS-CoV-2, 11.1% RSV; p = 0.496). RSV showed the highest frequencies of low-flow oxygen supplementation for admission and stay. Differences in the length of stay were minor (median 7 days). Conversely, in patients aged < 18 years (n = 261, 28,8%), 19.5%, 17.6% and 60.2% were in the Influenza A, SARS-CoV-2 and RSV groups, respectively; 0.4% showed Influenza B and 2.3% co-infections. 17 patients were admitted to ICU (3.9% Influenza A, 9.6% RSV, 0% SARS-CoV-2); none died. RSV showed the highest frequencies of high- and low-flow oxygen supplementation, SARS-CoV-2 the lowest.ConclusionWhen comparing infections with Influenza, SARS-CoV-2 and RSV in the winter 2022/2023 in hospitalized adult patients, rates of ICU admission and mortality were similar. RSV showed the highest frequencies of obstructive airway diseases, and of oxygen supplementation. The latter was also true in children/adolescents, in whom RSV dominated. Thus, in the situation of declining importance of SARS-CoV-2, RSV showed a disease burden that was relatively higher than that from Influenza and SARS-CoV-2 across ages, and this might be relevant for the seasons coming.

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; The 30th Albanian Surgical Conference (ACS 2023) and the 7th Albanian Congress of Trauma and Emergency Surgery (ACTES 2023) represent a significant milestone in the medical community. These concurrent events provide a platform for the exchange of knowledge, collaboration, and the advancement of surgical science in Albania.&#x0D; ACS 2023 &amp; ACTES 2023 gather experts, scholars, practitioners, and enthusiasts from the field of surgery, both in traumatic and non-traumatic areas, in the vibrant city of Tirana. The comprehensive program encompasses a diverse range of surgical topics, from abdominal and chest injuries to vascular injuries, emergency surgery, and the challenge of nurse services in the new millennium.&#x0D; The theme of this year's events, "Surgery and not only...," reflects the commitment to innovation, best practices, and groundbreaking discoveries. The programs include plenary sessions with renowned experts, scientific presentations, panel discussions, networking opportunities, an industry exhibition, poster awards, cultural and social activities, and Continuing Medical Education (CME) credits.&#x0D; Participants can expect a professionally enriching experience that also offers personal rewards. ACS 2023 &amp; ACTES 2023 value the role of each attendee in contributing to the advancement of surgical knowledge and patient care. The events promise to chart new horizons in the field of surgery and foster international collaboration.&#x0D; The 30th Albanian Surgical Conference and the 7th Albanian Congress of Trauma and Emergency Surgery are poised to create lasting memories, and their success hinges on the active participation of every attendee. It is an opportunity to inspire, collaborate, and make a lasting impact on surgical care worldwide.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;