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Item Spinal deformity surgery is accompanied by serious complications: report from the Morbidity and Mortality Database of the Scoliosis Research Society from 2013 to 2020(SPRINGER, 2022-01-01) Bivona, Louis J.; France, John; Daly-Seiler, Conor S.; Burton, Douglas C.; Dolan, Lori A.; Seale, J. Justin; de Kleuver, Marinus; Ferrero, Emmanuelle; Gurd, David P.; Konya, Deniz; Lavelle, William F.; Sarwahi, Vishal; Suratwala, Sanjeev J.; Yilgor, Caglar; Li, YingPurpose The Morbidity and Mortality (M\&M) report of the Scoliosis Research Society (SRS) has been collected since 1965 and since 1968 submission of complications has been required of all members. Since 2009, the SRS has collected information on death, blindness, and neurological deficit, with acute infection being added in 2012 and unintentional return to the operating room (OR) being added in 2017. In this report, we use the most recent data submitted to the SRS M\&M database to determine the rate of neurological deficit, blindness, acute infection, unintentional return to the OR, and death, while also comparing this information to previous reports. Methods The SRS M\&M database was queried for all cases from 2013 to 2020. The rates of death, vision loss, neurological deficit, acute infection, and unintentional return to the OR were then calculated and analyzed. The rates were compared to previously published data if available. Differences in complication rates between years were analyzed with Poisson regression with significance set at alpha = 0.05. Results The total number of cases submitted per year varied with a maximum of 49,615 in 2018 and a minimum of 40,464 in 2020. The overall reported complication rate from 2013 to 2020 was 2.86\%. The overall mortality rate ranged from 0.09\% in 2018 to 0.14\% in 2015. The number of patients with visual impairment ranged from 4 to 13 between 2013 and 2015 (no data on visual impairment were collected after 2015). The overall infection rate varied from 0.95 in 2020 to 1.30\% in 2015. When the infection rate was analyzed based on spinal deformity group, the neuromuscular scoliosis group consistently had the highest infection rate ranging from 3.24 to 3.94\%. The overall neurological deficit rate ranged from 0.74 to 0.94\%, with the congenital kyphosis and dysplastic spondylolisthesis groups having the highest rates. The rates of unintentional return to the OR ranged from 1.60 to 1.79\%. Multiple groups showed a statistically significant decreasing trend for infection, return to the operating room, neurologic deficit, and death. Conclusions Neuromuscular scoliosis had the highest infection rate among all spinal deformity groups. Congenital kyphosis and dysplastic spondylolisthesis had the highest rate of neurological deficit postoperatively. This is similar to previously published data. Contrary to previous reports, neuromuscular scoliosis did not have the highest annual death rate. Multiple groups showed a statistically significant decreasing trend in complication rates during the reporting period, with only mortality in degenerative spondylolisthesis significantly trending upwards.Item An international multi-institutional analysis of operative morbidity in patients undergoing elective diverticulitis surgery(ASSOC MEDICA BRASILEIRA, 2022-01-01) Altinel, Yuksel; Cavallaro, Paul; Ricciardi, Rocco; Ozben, Volkan; Ozturk, Ersin; Bleday, Ron; Aytac, Erman; Bordeianou, Liliana; Stu, Members Turkish DiverticulitisOBJECTIVE: We investigated surgical complications of elective surgery for diverticulitis in international multi-institution to identify a prediction model for potential opportunities of quality improvement. METHODS: We identified 1225 patients who underwent elective surgery for diverticulitis between January 2010 and January 2018. The data were obtained from the National Surgical Quality Improvement Program and the Turkish Diverticulitis Study Group Collaborative, retrospectively. RESULTS: We observed that the presence of chronic obstructive pulmonary disease (OR: 3.2, 95\%CI 1.8???5.9, p<0.001) or abscess at the time of surgery (OR: 1.4, 95\%CI 1.2???1.7, p??0.001) is associated with a higher rate of minor complications, while comorbidities such as dyspnea (OR: 2.8, 95\%CI 1.6???4.9, p??0.001) and preoperative sepsis (OR: 4.1, 95\%CI 2.3???7.3, p??0.001) are associated with major complications. The centers had similar findings in minor and major complications (OR: 0.8, 95\%CI 0.5???1.4, p=0.395). The major independent predictors for complications were malnutrition (low albumin) (OR: 0.5, 95\%CI 0.4???0.6, p<0.001) and the American Society of Anesthesiology score (OR: 1.7, 95\%CI 1.2???2.4, p=0.002). CONCLUSION: Regarding the major and minor complications of diverticulitis of elective surgery, the malnutrition and higher American Society of Anesthesiology score showed higher impact among the quality improvement initiatives.Item Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses(ELSEVIER SCIENCE BV, 2016-01-01) Terzi, Hasan; Hasdemir, Pinar Solmaz; Biler, Alper; Kale, Ahmet; Sendag, FatihObjective: The aim of this study was to investigate whether uterine weight has a deleterious effect on the operation time, complication rates, length of hospital stay and incidence of intraoperative haemorrhage during total laparoscopic hysterectomy operation. Methods: A total of 282 patients who underwent total laparoscopic hysterectomy for benign gynaecologic indications were retrospectively analyzed. The median operation time of 70 min was accepted as an index number, and a cut-off point of >= 300 g was calculated for uterine weight by using reciever operator characteristics (ROC) curve analysis. Results: There was no statistically significant relationship between the uterine weight and haemoglobin drop rate (1.27 +/- 0.89 vs 1.21 +/- 0.88, p = 0.905), complication rate (10.83\% vs 9.26\%, p = 0.062) and length of hospital stay (3.27 +/- 1.23 vs 3.37 +/- 1.35 days, p = 0.505) based on this cut. Lee-Huang point was preferred for abdominal entry in cases with uteruses reached the level of umbilicus -2 cm in physical examination. Conclusions: Uterine weight was not effected the complication rate, estimated blood loss and length of hospital stay in total laparoscopic hysterectomy operation. A cut-off value of 300 g could be used for an increased operation time. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.Item Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis(PAGEPRESS PUBL, 2021-01-01) Mourmouris, Panagiotis; Argun, Omer Burak; Tzelves, Lazaros; Tuna, Mustafa Bilal; Gourtzelidou, Maria; Tziotis, Andreas; Kural, Ali Riza; Skolarikos, AndreasPurpose: To test the efficacy and safety profile of robotic radical nephroureterectomy compared to the open approach. Methods: We enrolled 45 consecutive patients who suffered from non-metastatic, upper urinary tract urothelial carcinoma from September 2019 to March 2021 and underwent radical nephroureterectomy. Patients were divided in two groups: group A consisted of 29 patients (open approach) and group B consisted of 16 patients (robotic approach). The factors which were taken into consideration were age, sex, body mass index, tumour size, side and grade, cancer stage, ASA score, operation time, drain removal time, foley time, hospitalization time, estimated blood loss, surgical margins, preoperative and postoperative creatinine, Hct and bladder recurrences. Statistical analysis was performed with the use of SPSS version 26 and p < 0.05 was the cut-off for reaching statistical significance. Results: The mean age in group 1 was 67.12 years and in group 2 68.12 years, whereas the mean body mass index (BMI) in group 1 was 26.54 kg/m(2) and in group 2 25.20 kg/m(2). Operative time was better in group A (124 vs 186 mins p < 0.001) and estimated blood loss were better in group B compared to group A (137 vs 316 ml p < 0.001). Length of stay (LOS) was significantly less in the robotic group (5.75 vs 4.3 days p = 0.003) and the same applied for time required for drain removal (4.5 vs 33 days p = 0.006). Conclusions: Robotic radical nephroureterectomy is a safe and efficient alternative to open approach. It provides a favorable perioperative profile in patients suffering from upper urinary tract carcinoma without metastasis.Item Tracheostomy in Pediatric Intensive Care Unit: When and Where?(KOWSAR CORP, 2016-01-01) Ertugrul, Ilker; Kesici, Selman; Bayrakci, Benan; Unal, Omer FarukBackground: Tracheostomy was first observed in Egyptian drawings in 3600 BC and performed frequently during the 1800's diphtheria epidemic. Objectives: The aim of this study was to elucidate the indications, complications, mortality rate, and the effect of pediatric tracheostomy on length of PICU or hospital stay. Materials and Methods: Demographic characteristics, diagnosis at admission, duration of ventilation of 152 patients were analyzed retrospectively. Results: The most common tracheostomy indication was prolonged intubation. The mean duration of mechanical ventilation before tracheostomy was 23.8 days. Forty five percent of the tracheostomy procedures were performed at bedside. Neither the place nor the age had any effect on the development of complications (P = 0.701, P = 0.622). The procedure enabled 62\% of the patients to be discharged from hospital. Conclusions: Tracheostomy facilitates discharge and weaning of mechanical ventilation. Although the timing of tracheostomy has to be determined for each individual patient, three weeks of ventilation seems to be a suitable period for tracheostomy. Tracheostomy can be performed at bedside safely but patient selection should be made carefully.