Impact of Preoperative Radiological Assessment on Surgical Outcomes in Orthopedic Procedures: A Retrospective Study

Introduction: Concomitant horizontal strabismus poses significant challenges in achieving optimal surgical outcomes, with risks of undercorrection or overcorrection remaining a concern. Preoperative assessment techniques, such as the Prism Adaptation Test (PAT) and Patch Test, have been utilised to better estimate the angle of deviation and plan surgeries accordingly. The PAT is thought to refine surgical corrections by revealing the maximum angle of deviation. However, its specific impact on surgical outcomes-especially in comparison to the patch test-remains underexplored. Aim: To evaluate the impact of preoperative PAT and patch test measurements on surgical outcomes in patients with concomitant horizontal strabismus, focusing on their role in optimising surgical corrections and minimising postoperative undercorrection and overcorrection. Materials and Methods: This prospective interventional study was conducted over 15 months at Department of Ophthalmology, Employees’ State Insurance Corporation (ESIC) Postgraduate Institute of Medical Sciences and Research (PGIMSR), Basaidarapur, New Delhi, India, from October 2017 to February 2018 and included 30 subjects diagnosed with concomitant horizontal strabismus. Preoperative deviation measurements were obtained using the Prism Bar Cover Test (PBCT) at three distances: near (33 cm), intermediate (6 m), and far (12 m). These measurements were recorded both before and after a one-hour monocular occlusion (patch test). Following this, participants underwent the PAT. Based on their responses to these tests, subjects were categorised into three groups: non responders, patch test responders, and PAT responders. Surgical corrections were planned and performed using the maximum deviation identified by the PAT. Postoperative outcomes were assessed eight weeks after surgery using Hirschberg’s test and the Prism Alternate Cover Test (PACT). The study’s parameters included analysing preoperative and postoperative deviations, categorisation of test responses, and surgical outcomes. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 17.0, and a p-value of <0.05 was considered statistically significant. Results: The study included a total of 30 participants, comprising 18 males and 12 females, with a mean age of 20.83±12.03 years. Among them, 14 individuals presented with esotropia, while 16 exhibited exotropia. The study found that PAT significantly improved surgical outcomes. The actual residual deviation postsurgery ranged from 0 to 16Δ with PAT measurements, compared to an estimated range of 5 to 25Δ if surgeries were based on PBCT measurements before occlusion and 0 to 21Δ after occlusion. The mean residual deviation was lowest in PAT responders (6.8±6.07Δ) compared to patch test responders (8.5±6.09Δ) and non responders (11.5±7.09Δ) (p-value=0.02). Satisfactory alignment was observed in 90% of PAT responders, 80% of patch test responders, and 50% of non responders (p-value <0.04). Conclusion: The study concludes that the PAT significantly improves surgical precision and outcomes in patients with concomitant horizontal strabismus. By providing a more accurate assessment of deviation angles, the PAT reduces the risk of undercorrection and overcorrection compared to conventional preoperative measurements. These findings highlight the importance of incorporating PAT into preoperative evaluations to achieve optimal postoperative alignment and minimise residual deviations. The study underscores PAT’s value in enhancing surgical planning and outcomes, suggesting its routine use in clinical practice. Further research is warranted to evaluate its long-term effects on binocular vision and overall quality of life.

Perioperative Outcomes of Laparoscopic Radical Nephroureterectomy and Regional Lymphadenectomy in Patients With Upper Urinary Tract Urothelial Carcinoma After Neoadjuvant Chemotherapy

BackgroundInfective endocarditis is a life-threatening cardiovascular condition with high morbidity and mortality rates. Despite advances in surgical and medical care, outcomes vary widely, particularly among older patients and those with impaired cardiac function. The New York Heart Association (NYHA) classification is commonly used to assess functional status, and age is an established predictor of adverse postoperative outcomes.ObjectiveTo evaluate whether age and NYHA functional class are independently associated with postoperative recovery and 30-day mortality among patients undergoing surgery for infective endocarditis at a tertiary care center.MethodologyThis retrospective cohort study included adult patients diagnosed with infective endocarditis and treated surgically at the Peshawar Institute of Cardiology between January 2022 and December 2024. Patients were classified into high-risk (age ≥65 years and/or NYHA class III/IV) and low-risk (age <65 years and NYHA class I/II) groups. The primary outcome was recovery, defined as discharge without major complications, including reoperation or prolonged hospitalization beyond 14 days of surgery. The secondary outcome was 30-day mortality rate. Statistical analysis included chi-squared tests and multivariate logistic regression adjusted for sex, body mass index, diabetes mellitus, and hypertension. Model validity was assessed using the Hosmer-Lemeshow goodness-of-fit test and the area under the curve (AUC).ResultsOf the 260 patients, 130 (50.0%) were classified as high-risk. Recovery was significantly lower in the high-risk group than in the low-risk group (70.0% vs. 90.0%, P < 0.001), with 95% confidence intervals (CIs) of 62.0-77.1 and 83.7-94.5, respectively. Thirty-day mortality was higher in the high-risk group (15.4% vs. 5.4%, P = 0.002; 95% CI: 9.9-22.8 and 2.4-10.7, respectively). On multivariate analysis, age and NYHA class were independently associated with recovery and mortality (e.g., NYHA III/IV: odds ratio (OR) for mortality 3.50, 95% CI: 1.50-8.17; P = 0.004).ConclusionsAdvanced age and higher NYHA class were independently associated with poorer short-term surgical outcomes in patients with infective endocarditis. These simple, routinely available variables can be integrated into preoperative assessments to improve perioperative risk stratification and guide individualized surgical planning, particularly in resource-limited settings.

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The fee-for-service model in the United States healthcare system relies on work Relative Value Units (wRVUs), established by the Centers for Medicare and Medicaid Services (CMS). wRVUs are assigned to various clinical activities, including procedures and office visits, serving as a key metric for physician reimbursement and procedural valuation. While the number of wRVUs is reflective of multiple factors, physicians’ work such as effort, time, and technical expertise remain the primary determinants. Many orthopaedic foot and ankle (FA) procedures require substantial technical expertise, yet the adequacy of their compensation remains largely unexplored. This study evaluates whether orthopaedic FA surgeries are fairly compensated compared to other orthopaedic procedures. Methods: The National Surgical Quality Improvement Program (NSQIP) database from 2020 to 2022 was utilized for this study. Orthopaedic procedures performed by orthopaedic surgeons were identified using Current Procedural Terminology (CPT) codes. The CMS RVU dollar conversion factor was obtained from the 2025 CMS fee schedule. Identified procedures were categorized into orthopaedic FA group and non-FA group based on CPT codes. Compensation adequacy for FA procedures was assessed by comparing wRVUs, operative time, wRVU per hour (wRVU/h), and reimbursement rates ($/hour). We also analyzed the relationship between operative time and wRVU/h in FA procedures through polynomial regression analysis. Since a nonlinear relationship was identified in the linear regression analysis, polynomial regression analysis was performed. Additionally, perioperative complications, including mortality, readmission, and reoperation, were analyzed, along with secondary complications such as infections, thromboembolic events, respiratory complications, renal failure, transfusion, cardiac events, and sepsis, to compare procedural risk profiles between the two groups. Results: Twenty-three CPT codes for orthopaedic FA procedures accounting 8,684 cases were identified from 164 orthopaedic CPT codes. Compared to non-FA procedures, FA procedures demonstrated longer operative time (96.66 minutes Vs. 89.27 minutes, P&lt;.001), and lower mean wRVU number (11.35 Vs. 17.68, P&lt;.001). The mean wRVU/h and the reimbursement ($/h) were significantly lower in FA procedure group (8.77 Vs. 16.88, P&lt;.001 and 283.53 Vs.539.44, P&lt;.001, respectively). After adjusting for the effect of perioperative complication, the mean wRVU/h remained significantly (P &lt;.001). Further, there is a tendency for wRVU/h to decrease as operative time increases in orthopaedic FA procedures: P&lt;.001, R2=0.69, wRVU/h = 29.25 – 0.32*(operative time) + 0.000096*(operative time)2. The perioperative complication rate was higher in non-FA procedure group (11.88% Vs. 13.50%, P&lt;.001). Conclusion: The current wRVU scale may not adequately compensate for orthopaedic FA procedures. Compared to non-FA orthopaedic procedures, FA procedures have lower wRVU/h despite longer operative times. Furthermore, a significant trend shows a decline in mean wRVU/h as operative time increases in orthopaedic FA procedures. These findings suggest a potential undercompensating of FA procedures. Are Orthopaedic Foot and Ankle Surgeries Undercompensated? Assessment of Work Relative Value Units in Orthopaedic Foot and Ankle Procedures Compared to Other Orthopaedic Procedures

PurposeUse of neoadjuvant chemotherapy (NAC) for locally advanced colon cancer (LACC) remains controversial. An integrated analysis of data from high-quality studies may inform the long-term safety of NAC for this cohort. Our aim was to perform a systematic review and meta-analysis of randomised clinical trials (RCTs) and propensity-matched studies to assess the oncological safety of NAC in patients with LACC.MethodsA systematic review was performed as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Survival was expressed as hazard ratios using time-to-effect generic inverse variance methodology, while surgical outcomes were expressed as odds ratios (ORs) using the Mantel-Haenszel method. Data analysis was performed using Review Manager version 5.4.ResultsEight studies (4 RCTs and 4 retrospective studies) including 31,047 patients with LACC were included. Mean age was 61.0 years (range: 19–93 years) and mean follow-up was 47.6 months (range: 2–133 months). Of those receiving NAC, 4.6% achieved a pathological complete response and 90.6% achieved R0 resection (versus 85.9%, P < 0.001). At 3 years, patients receiving NAC had improved disease-free survival (DFS) (OR: 1.28, 95% confidence interval (CI): 1.02–1.60, P = 0.030) and overall survival (OS) (OR: 1.76, 95% CI: 1.10–2.81, P = 0.020). When using time-to-effect modelling, a non-significant difference was observed for DFS (HR: 0.79, 95% CI: 0.57–1.09, P = 0.150) while a significant difference in favour of NAC was observed for OS (HR: 0.75, 95% CI: 0.58–0.98, P = 0.030).ConclusionThis study highlights the oncological safety of NAC for patients being treated with curative intent for LACC using RCT and propensity-matched studies only. These results refute current management guidelines which do not advocate for NAC to improve surgical and oncological outcomes in patients with LACC.Trial registrationInternationalProspective Register of Systematic Review (PROSPERO) registration: CRD4202341723.

Introduction:Urolithiasis is one of the most common renal diseases with a significant burden on health-care system worldwide. Here, we evaluated the stone volume and its relationship with duration of operation, blood loss, and total stone clearance in patients with staghorn calculi.Materials and Methods:This was a prospective, single-center study conducted from October 2015 to September 2017. Patients of either sex aged more than 18 years of age with a confirmed diagnosis of staghorn calculus were eligible to participate in the study. Eligible patients were divided into three groups based on stone volume (assessed by three-dimensional computed tomography): Group 1 (≤5000 mm3), Group 2 (>5000 to ≤20,000 mm3), and Group 3 (>20,000 mm3).Results:A total of 85 patients were enrolled in the study (Group 1, n = 9; Group 2, n = 66; and Group 3, n = 10). The mean age was 43.68 years, and 62.4% of patients were male. The mean operative time increased significantly from Groups 1–3, (31.67, 60.14, and 92.30 min, respectively). The mean pre- and postoperative hematocrit was highest in Group 3 (2.82%) (P < 0.0001). Overall, the correlation between stone volume and operative time and difference in hematocrit showed a positive relationship. A total of five patients had residual calculus, and only four patients reported complications.Conclusions:The results showed that patients with larger stone volume need more operative time and may have more blood loss.

3D laparoscopy is associated with a better surgical outcomes in choledocholithiasis patients with abdominal adhesions compared with 2D: a propensity score analysis

Retrospective cohort study. To investigate the relationship between body mass index (BMI), spine flexibility index (FI), and their combined effects on adolescent idiopathic scoliosis (AIS) surgical outcomes. BMI and FI are two factors considered during presurgical planning for AIS correction, but there is sparse research about their relationship. We hypothesize that AIS patients with increased BMI may be associated with decreased FI-a combination which could lead to worsened surgical outcomes. AIS patients ages 11 to 19 at surgery, who underwent posterior fusion at a single center from 2011 to 2017, were reviewed. Patients without proper radiographs to assess FI, or a previous spine surgical history, were excluded. FI was categorized as stiff (FI<50) or flexible (FI≥50), and patients were separated by major curve region. BMI was categorized as underweight (less than fifth percentile), healthy weight (fifth-85th percentile), overweight (85th-95th percentile), or obese (>95th percentile). Regression analysis was conducted to test BMI and FI's effects on intraoperative, immediate postoperative, and two-year postoperative outcomes. A total of 543 patients (82% female), with an average age of 14.9 years, were included. In all, 346 patients had available two-year data. A 10% increase in BMI was associated with a 1.3% decrease in FI for patients with major thoracolumbar/lumbar curves ( P =0.01). Obese patients were most likely to have a postoperative complication ( P =0.003) or a two-year complication ( P =0.04). Revision surgery occurred after 58% of postoperative complications (15/26) and 80% of two-year complications (4/5). FI was negatively associated with initial curve magnitude ( P <0.001), operative time ( P =0.02), and blood loss ( P =0.02). Overweight patients with flexible curves were 10.0 times more likely to sustain a postoperative complication than healthy weight patients with stiff curves ( P =0.001). Elevated BMI was associated with decreased FI in patients with major thoracolumbar/lumbar curves. Patients with a high BMI and high FI were associated with the greatest risk of postoperative complication.

BackgroundNeoadjuvant systemic therapy has shown promising results in the treatment of high-risk stage III melanoma; however, the effects on surgery are currently unknown. This study aims to compare the surgical outcomes, in terms of postoperative complications, postoperative morbidity, duration of surgery and textbook outcomes, of patients with high-risk stage III melanoma who received neoadjuvant systemic therapy followed by lymph node dissection with patients who received an upfront lymph node dissection. MethodsIn this retrospective cohort study, patients with high-risk stage III melanoma treated with neoadjuvant anti-PD1 and anti-CTLA4 in the OpACIN (NCT02437279) and OpACIN-neo (NCT02977052) trial between October 2014 and August 2018 were included and compared to patients who received upfront surgery in the same time period. ResultsA total of 120 patients were included in this study, of whom 44 received neoadjuvant systemic therapy and 76 underwent upfront surgery. There was no significant difference in the overall rate of postoperative complications between the neoadjuvant group and the upfront surgery group (31.8% versus 36.8%, p = 0.578) and neither in rate of postoperative morbidity (seroma 56.8% versus 57.9%, p = 0.908) (lymphedema 22.7% versus 13.2%, p = 0.175). There was a non-significant difference towards a slightly longer duration of surgery after neoadjuvant immunotherapy (105 versus 90 min, p = 0.077). There were no differences in textbook outcomes (50% versus 49%, p = 0.889). ConclusionThis study shows that the surgical outcomes for patients who underwent a lymph node dissection after neoadjuvant systemic immunotherapy or underwent upfront lymph node dissection for high-risk stage III melanoma are comparable.

Robot-assisted Radical Prostatectomy Performed with Different Robotic Platforms: First Comparative Evidence Between Da Vinci and HUGO Robot-assisted Surgery Robots

5-Hydroxytryptamine (5-HT; serotonin) has been implicated in the perception of exercise-induced fatigue. Sumatriptan is a selective 5-HT(1B/D) receptor agonist which does not cross the blood-brain barrier. The aim of the present study was to determine the effect of sumatriptan on exercise capacity. Ten healthy male subjects (mean age 28.4+/-10.8 years) performed a maximal treadmill exercise test according to the Bruce protocol with expired gas analysis on two occasions. Either 6 mg of sumatriptan or placebo was administered subcutaneously in a randomized, double-blind, placebo-controlled, cross-over design. Exercise time was greater after placebo compared with sumatriptan [914 and 879 s respectively; 95% confidence interval (CI) of difference 12.1 s, 59.1 s; P = 0.008]. There was no significant effect on peak oxygen consumption (placebo, 50.6+/-6.3 ml.min(-1).kg(-1); sumatriptan, 51.7+/-7.6 ml.min(-1).kg(-1)). Sumatriptan administration resulted in decreases in both heart rate (sumatriptan, 188+/-14 beats/min, placebo, 196+/-12 beats/min; 95% CI of difference 12.6, 2.6; P = 0.008) and respiratory exchange ratio (sumatriptan, 1.23+/-0.06; placebo, 1.26+/-0.07; 95% CI of difference 0.05, 0.01; P = 0.01) at peak exercise. There were no significant differences in blood pressure, heart rate or submaximal oxygen consumption between sumatriptan and placebo treatments at any stage of exercise. Thus sumatriptan reduces maximal exercise capacity in normal males. The failure to demonstrate any haemodynamic or cardiorespiratory effect suggests that sumatriptan enhances perception of fatigue by a peripheral mechanism affecting 5-HT modulation.

Surgical and oncological outcomes of sentinel lymph node sampling in elderly patients with intermediate to high-risk endometrial carcinoma (547)

To compare surgical outcomes in patients with benign diseases who underwent laparoscopically assisted vaginal hysterectomy (LAVH) to determine the association between surgical outcomes and resident participation in the gynecologic field. A single-center retrospective study was conducted of patients diagnosed with benign gynecologic diseases who underwent LAVH between January 2010 and December 2015. Clinicopathologic characteristics and surgical outcomes were compared between the resident involvement and non-involvement groups. The primary endpoint was the 30-day postoperative morbidity. Observers were propensity matched for 17 covariates for resident involvement or non-involvement. Of the 683 patients involved in the study, 165 underwent LAVH with resident involvement and 518 underwent surgery without resident involvement. After propensity score matching (157 observations), 30-day postoperative morbidity occurred in 6 (3.8%) and 4 (2.5%) patients in the resident involvement and non-involvement groups, respectively (P = 0.501). The length of hospital stay differed significantly between the two groups: 5 days in the resident involvement group and 4 days in the non-involvement group (P < 0.001). On multivariate analysis, Charlson Comorbidity Index >2 (odds ratio [OR] 8.01, 95% confidence interval [CI] 2.68-23.96; P < 0.001), operative time (OR 1.02, 95% CI 1.01-1.03; P < 0.001), and estimated blood loss (OR 1.00, 95% CI 1.00-1.00; P < 0.001) were significantly associated with 30-day morbidity, but resident involvement was not statistically significant. There was no significant difference in the 30-day morbidity rate when residents participated in LAVH. These findings suggest that resident participation in LAVH may be a viable approach to ensure both residency education and patient safety.

BackgroundAdnexal torsion is a gynecologic emergency that requires surgical treatment. In this study, we reviewed the surgical outcomes of women with adnexal torsion in eastern Taiwan (Hualien county, area 4,629 km2, 330,000 residents).MethodsThis retrospective study included 42 women diagnosed with surgically-proven adnexal torsion from January 1, 2010, to September 31, 2015. We compared the symptoms, objective findings, and surgical outcomes of patients who underwent laparotomy or laparoscopy.ResultsThe laparoscopy and laparotomy groups included 27 and 15 patients, respectively. The most common symptom and sign was abdominal pain, followed by nausea and vomiting. In all patients, an adnexal tumor was detected through ultrasound. The median and range of time from admission to surgery was 1.5 (1–11.5) and 1.0 (1–11) hours in the laparotomy and laparoscopy groups, respectively. Compared with those undergoing laparotomy, the smaller tumor size [7 (4.2–10) vs. 10 (7–17) cm] and shorter hospital stay [4 (2–8) vs. 6 (3–9) days] in patients undergoing laparoscopy were significantly noted, respectively (P < 0.01). No differences were observed in age, operative time, and blood loss between both groups. The surgeries performed were mostly detorsion with cystectomy and adnexectomy. The most common pathology was a simple ovarian cyst, followed by teratoma. Regarding the surgical types, older age is the only risk factor for radical surgery.DiscussionAcute onset of abdominal pain with a presenting ovarian tumor is the most common feature of adnexal torsion. Laparoscopic surgical group showed a small tumor size and a short ER hospital stay than laparotomy. Older age is the risk factor for radical surgery.

The endonasal endoscopic transsphenoidal approach (ETA) is the standard approach for pituitary adenomas (PAs). Chronic sinusitis is a prevalent condition affecting 2%-15% of the general population. However, the impact of preoperative sinusitis on the outcomes of ETA for PA remains unknown. This study investigated the impact of preoperative sinusitis on the outcomes of ETA for PA. A retrospective cohort analysis was conducted using the TriNetX database. Propensity score matching (PSM) was performed to form two balanced groups to compare patients with and without preoperative chronic sinusitis who underwent subsequent ETA for PAs. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the TriNetX platform to compare the perioperative and neuroendocrine outcomes. The crude cohort included a total of 10,675 patients. After PSM, 842 patients were included in both the sinusitis and nonsinusitis groups. The mean age at ETA was 54.3 and 55.0 years in the sinusitis and nonsinusitis groups, respectively. Compared to the nonsinusitis group, patients in the sinusitis group had a higher incidence of postoperative CSF leakage (OR 1.47, 95% CI 1.06-2.03; p = 0.021), meningitis (OR 2.47, 95% CI 1.25-4.87; p = 0.007), postoperative diabetes insipidus (DI) (OR 1.47, 95% CI 1.17-1.83; p = 0.001), desmopressin use (OR 1.77, 95% CI 1.34-2.33; p = 0.001), and steroid use (OR 1.46, 95% CI 1.15-1.85; p = 0.002). Sensitivity analysis demonstrated consistent results across the different matching models. In patients who underwent ETA for PAs, preoperative sinusitis was associated with an increased risk of postoperative CSF leakage, meningitis, DI, desmopressin use, and steroid use.