Surgical technology international最新文献

Introduction: In the United States, intestinal fistulas accounts for $500 million (USD) of healthcare expenditures and 28,000 admissions annually. They are also associated with significant morbidity and mortality. Despite the high prevalence of intestinal fistulas, risk factors of mortality have yet to be fully elucidated. The aim of this study was to identify risk factors of mortality in emergently admitted patients with fistulas of the intestine, excluding the rectum and anus.

Materials and methods: Adult and elderly patients emergently admitted with intestinal fistulas, between 2004-2014 were investigated using the National Inpatient Sample Database, ICD-9-CM code 569.81. Clinical outcomes, therapeutic management, demographics, and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. The final multivariable regression model elucidated the odds ratios (95% confidence interval, p-value) of pertinent mortality risk factors.

Results: A total of 7,377 patients were included, of which the average adult and elderly ages were 48.9 and 74.6 years, respectively. Of these patients, 4,241 (57.5%) were female and 3,136 (42.5%) were male. Elderly patients demonstrated a higher mortality rate than adult patients-4.5% and 1.7%, respectively. In the adult group, the odds ratio for mortality was 1.020 for hospital length of stay in days (95% CI: 1.015-1.026, p<0.001), 1.035 for age (95% CI: 1.011-1.060, p=0.004), and 1.033 for days to the first procedure (95% CI: 1.021-1.044, p<0.001), among others. For the elderly group, the odds ratio for mortality was 1.012 for hospital length of stay in days (95% CI: 1.005-1.019, p=0.001), 1.075 for age (95% CI: 1.050-1.101, p<0.001), and 1.026 for days to the first procedure (95% CI: 1.009-1.043, p=0.002), among others.

Conclusion: In adult and elderly patients emergently admitted for intestinal fistulas, multiple comorbidities were risk factors for in-hospital mortality. In the elderly cohort, increased age and increased days to operation were additional risk factors for in-hospital mortality.

Introduction: The purpose of this article is to examine the risk of early clinical rotator cuff repair failures in high-risk patients who were augmented with a reinforced bio-inductive implant (RBI).

Materials and methods: A retrospective chart review was performed identifying full-thickness rotator cuff repairs (RCR) augmented with an RBI. Inclusion criteria for "high risk of retear" were: large (>3cm) and massive (>5cm, >/= 2 tendons) tears, anterior to posterior (AP) tear >2.5cm, infraspinatus fatty atrophy (Goutalier >/= 2), recurrent tears, and at least one comorbidity (diabetes, hypertension, active smoker). ROM, VAS, and ASES scores were collected at preoperative, three-month, six-month, and 12-month visits. Clinical failures were defined as complete retear based upon imaging, repeat rotator cuff surgery, VAS score >5 at one-year postoperative, and ASES MCID <27-point improvement.

Results: Forty-nine patients were found to have undergone RCR with an RBI augmentation. Mean follow up was 26.1 months. Clinical healing rate was 94% (46/49). The need for surgical intervention post RCR was 8.2% (4/49). The complication rate was 14.3% (7/49). VAS scores at three, six, and 12 months compared to preop revealed statistically significant decreases at all timepoints (D-3.9, D-4.6, D-5.2, respectively, p<0.001). ASES scores at three, six, and 12 months compared to pre-surgical scores met the MCID and were found to have statistically significant improvements at all timepoints (D30.7, D40.8, D49.8, respectively, p<0.001). Shoulder ROM (forward flexion/abduction) at three, six, and 12 months compared to preop was found to be statistically significant at all timepoints (p<0.01).

Conclusion: The addition of an RBI to RCR in patients at high risk of failure demonstrated favorable outcomes in terms of range of motion, pain, and functional outcome scores with a low rate of clinical retear at a minimum of one-year follow up.

Clinical relevance: Many risk factors have been attributed to high retear rates and poor clinical outcomes in patients undergoing RCR. Numerous variations to RCR have been explored to aid in outcomes and decrease failures. This manuscript is the first to examine the use of an RBI as an RCR augment. The implant's bio-inductive properties and strength profile demonstrate promising benefits at early timepoints in this study, indicating that it can improve patient-reported outcomes while decreasing clinical failures in patients at high risk of retear.

Recently, robotic-arm assisted total knee arthroplasties have become popular because of their promise to lead to enhanced accuracy and efficient planning of the procedure, as well as improved radiographic and clinical outcomes. One robotic system is based on computed tomography (CT) to help with preoperative planning, intraoperative adjusting, and bone cutting for these procedures. The purpose of this article is to describe the second-generation iteration of this CT-based robotic technique by describing the new features using an actual total knee arthroplasty case. This article then becomes a step-by-step guide to performing the procedure, as well as describing the new features of this upgraded system.

Introduction: In the repair of focal chondral defects, there are several patient-reported outcome measures (PROMs) that are used to assess the patient's well-being. However, the question remains as to how well one scoring system relates to another, which may restrict the comparison of results from different studies. Therefore, we examined the strength of correlations between the Lysholm and KOOS scores.

Materials and methods: The data for this analysis was obtained from the Autologous Matrix-Induced Chondrogenesis (AMIC®; Geistlich Pharma AG, Wolhusen, Switzerland) knee registry, which is an ongoing, multicentre database designed to record changes over time in knee function and symptoms. This is done using the Lysholm score, the Visual Analogue Scale (VAS) for pain, and the five domains of the Knee injury and Osteoarthritis Outcome Score (KOOS). All patients had preoperative and postoperative scores at one-year follow up. The results were evaluated using the Spearman's rank correlation test.

Results: We identified 79 patients in the registry, all of whom were treated by the co-authors and had preoperative scores and postoperative scores at one year for the Lysholm, VAS, and the KOOS domains. The Lysholm score demonstrated a significant correlation (p<0.0001) to all KOOS domains. The correlation coefficients were 0.81, 0.82, 0.83, 0.84, and 0.76 for the KOOS domains of symptoms, pain, activities of daily living (ADL), quality of life (QoL), and Sport, respectively. The correlation between VAS pain and the KOOS domain for pain was significant (p<0.0001) but notably lower, with a correlation coefficient of 0.71.

Conclusion: Our data provides evidence that the outcome of the Lysholm knee score is strongly correlated with the KOOS scores, with the KOOS domains of ADL and pain exhibiting the highest correlation. Thus, it may be possible, through formulae calculations, to predict a KOOS score from the Lysholm score. With regard to assessment of outcomes over larger numbers of studies, the pooling of substantially more data could facilitate the conduct of systematic reviews and meta-analyses pertaining to the surgical treatment of chondral injuries of the knee.

Osteonecrosis of the femoral head (ONFH) is a chronic progressive debilitating disease that often affects young and active patients. It results from vascular interruption to the femoral head and can be caused by trauma, chronic corticosteroid use, chronic alcoholism, and coagulopathies. Treatment includes core decompression, a surgical procedure that may help delay or forestall disease progression if performed at the early stages of the disease. Technological advances have made the procedure more efficient and effective. There are several core decompression systems available in the market, giving healthcare providers options for core decompression technique: (1) The PerFuse™ Percutaneous Decompression System (Zimmer Biomet, Warsaw, Indiana) offers the advantage of utilizing autologous stem cell progenitor augmentation which has been shown to provide clinical benefits to patients; (2) The Advanced Core Decompression System (Stryker, Kalamazoo, Michigan) utilizes synthetic regenerative bone grafts, and these calcium-based synthetic grafts are well-accepted as the adjuvant modality for small defects; and (3) The Avascular Necrosis/Osteonecrosis Core Decompression Expandable Reamer System (Arthrex Inc., Naples, Florida) offers the unique ability for endoscopic-assisted core decompression, which may provide increased ability to treat early-stage ONFH by identifying necrotic lesions not visible radiographically. The preferred management of ONFH remains a topic of controversy and is reliant on the disease stage. Future randomized clinical trials comparing various core decompressions systems, with or without the use of bone marrow aspirates and arthro-endoscopy, may provide insight into the true clinical benefits of each method.

Introduction: Osteonecrosis of the femoral head (ONFH) poses a substantial burden to orthopaedic surgeons. However, the exact risk attributed by each specific patient factor for those who end up receiving a total hip arthroplasty (THA) are not well known. We assessed: (1) patient demographics (age and sex); (2) blood cell dyscrasias (sickle-cell disease and hypercoagulable states); and (3) substance use (oral corticosteroid use, tobacco use, and alcohol abuse).

Materials and methods: A retrospective search examined all patients who had a primary THA (n=715,100) between January 1, 2010 and April 30, 2020 using a national, all-payer database. Risk factors studied included age, sex, sickle-cell, hypercoagulable state, oral corticosteroid use, tobacco use, and alcohol abuse.

Results: Several risk factors were found to be significantly predictive for ONFH requiring THA: age <55 years (odds ratio [OR] 1.02, 95% confidence interval [CI] of 1.01 to 1.02, p<0.001), men (OR 1.07, 95% CI of 1.04 to 1.10, p<0.001), oral corticosteroid use (OR 1.21, 95% CI of 1.17 to 1.25, p<0.001), tobacco use (OR 1.15, 95% CI of 1.11 to 1.18, p<0.001), and alcohol abuse (OR 1.05, 95% CI of 1.01 to 1.08, p=0.009).

Conclusions: Based on the results of this study, young age, men, oral corticosteroid use, tobacco use, and alcohol abuse are risk factors for patients who have ONFH and had a THA. The degree of risk from greatest to least were: oral corticosteroid use, tobacco use, men, alcohol abuse, and age <55 years old.

Periprosthetic joint infection (PJI) is a serious postoperative complication in joint arthroplasty procedures that carries substantial morbidity and mortality associated with it. Several strategies have been developed both in the preoperative, perioperative, and postoperative periods to both combat and prevent the development of this devastating complication. Intraoperative irrigation is an important modality used during arthroplasty procedures prior to the implantation of final components that seeks to eradicate any biofilm formation. In this updated review, we discuss the XPERIENCE™ Advanced Surgical Irrigation solution (Next Science, Jacksonville, Florida) and the various completed, ongoing, and planned basic science and clinical investigations associated with it. Although there is already an impressive body of literature supporting its widespread utilization, future basic and clinical trials will continue to be performed to comprehensively characterize the effect this antimicrobial solution has on eliminating the risk of PJI following arthroplasty procedures.

Introduction: The persistent shortage of donor hearts for transplantation has prompted exploration into Donation after Circulatory Death (DCD) as a promising avenue for organ procurement. This comprehensive review aims to examine recent advancements in DCD heart procurement and preservation techniques to address the critical need for donor organs and improve transplant outcomes.

Materials and methods: A systematic review was conducted to identify relevant studies and innovations related to DCD heart procurement and preservation. Electronic databases including PubMed, MEDLINE, and Google Scholar were searched using keywords such as "DCD heart donation," "organ preservation," and "transplantation." Studies with statistical analyses on transplant outcomes were included for further evaluation.

Results: A meta-analysis of DCD heart transplantation outcomes revealed a statistically significant increase in successful transplants utilizing hearts procured after circulatory death (p<0.05). Normothermic machine perfusion demonstrated a 20% reduction in ischemic time compared to traditional cold storage methods, leading to improved post-transplant cardiac function and reduced rates of primary graft dysfunction. These findings highlight the potential of DCD heart procurement and preservation techniques to address the critical shortage of donor hearts while enhancing transplant outcomes.

Conclusion: Recent innovations in DCD heart procurement and preservation techniques show promise in overcoming the challenges of donor organ scarcity and improving transplant success rates. Continued research and development in this field are essential to further optimize these techniques and meet the growing demand for donor hearts worldwide.

Synthetic extracellular matrices are artificial polymers that are elongated and deposited as a matrix of nanofibers which mimic the native extracellular matrix. RenovoDerm® Anthem™ Wound Matrix (Columbus, Ohio) is comprised of polyglycolic acid and poly (L-lactide-co-caprolactone) which degrade by hydrolysis into a-hydroxy and fatty acids, lowering the pH and promoting regenerative cellular activity including angiogenesis. Amniotic allografts contain growth factors, cytokines, amino acids, extracellular matrix proteins, and hyaluronic acid which are recognized as intrinsic to the wound healing process. Synthetic extracellular matrices alone or in combination with amnio allografts do not have large bodies of evidence which demonstrate their effectiveness in the treatment of wounds. Presently, no prior studies have been performed to assess what impact these therapies may have on wound healing when used concurrently. The aim of this investigation was to assess whether a synergistic effect is produced with combination therapy using synthetic extracellular matrix and amniotic allografting. In this article, we present four cases of diabetic foot ulcerations treated with combination therapy. An amniotic fluid allograft, and/or membrane amniotic allograft, was implanted with a synthetic extracellular matrix dressing over top of the graft(s) at weekly intervals. All wounds demonstrated a greater than 80% decrease in wound size within four applications and achieved more than 95% wound closure after six applications.

Given recent advancements in artificial intelligence and robotic surgery, attention has now been paid to the concept of autonomous surgery. As robotic surgery has developed and matured, examples of autonomous surgery have arisen through the assistance of artificial intelligence. As with any new technology, ethical and legal considerations also arise, and there are special considerations that should be taken into account with the adaptation of new technology involving patient care. In this paper, we will describe autonomous surgery used in general surgery and lower extremity joint arthroplasty, and we will highlight the current ethical and legal considerations associated with this technology.