Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

State of Play of Anesthesia for Outpatient Medical and Surgical Procedures in the City of Kinshasa

Context and Objective: The practice of outpatient anaesthesia has many advantages over anesthesia with conventional hospitalisation, particularly in the reduction of post-operative complications and the faster resumption of activity, etc. No study has been carried out on this subject in our community;this study was carried out in order to come up with a concrete state of play when it comes to outpatient anesthesia for medical and surgical procedures in the city of Kinshasa. Methodology: This was a cross-sectional study, which took place in seven hospitals in the city of Kinshasa from 1 November 2020 to 31 January 2021. The population consisted of all patients who received outpatient anesthesia and the included patients had signed an informed consent. The variables of the study were the general profile of patients, surgical procedures and indications, anesthetic data and patient evolution. Statistical analyses were performed with SPPS 21.0 with p Results: We collected data from 971 patients who had undergone anesthesia in the seven medical facilities in the city of Kinshasa. Among these patients, 394 had benefited from outpatient anesthesia, i.e. a frequency of outpatient anesthesia estimated at 40.5%. Three hundred and ninety-four (394) patients were selected. They were 58.6% women and 41.4% men i.e. a sex ratio M/F of 0.7. The mean age was 39.3 ± 18.7 years with the extremes of 1 and 82 years. Gastroscopy was the most performed (operative) procedure (21.6%). Patients were classified as ASA 1 in 75.1%, narcosis (80.7%) using propofol (80.2%) was the most used anesthetic technique and performed by a specialist doctor in Anesthesia in 65.5%. Suxamethonium was the most used curare in 13.2%. Fentanyl was the most used opioid in 14.5%. Bupivacaine (10.9%) was the most widely used local anesthetic. Eleven patients or 3.2% had complications and, i.e. (0.8%) were hospitalized, class ASA II appeared to be a factor associated with complications. Conclusion: Ambulatory anesthesia is a reality in the city of Kinshasa;however, it is still underdeveloped and mainly concerns explorations (gastroscopy, colonoscopy, laparoscopy…) and some minor procedures. This anesthesia mainly uses propofol and is done by the specialist doctor. A high-powered study and an evaluation of this practice in the light of international recommendations would be useful.

Prevalence of Spinal Metastasis in Neurosurgical Procedures: A Descriptive Study

Objective: This study sought to identify the prevalence of operations for spinal epidural neoplastic metastases relative to other spine and neurosurgical operative procedures. Methods: This study was descriptive and involved a retrospective review of data collected from patients who underwent neurosurgeries between February 1997 and January 2015 at a single quaternary hospital. The examined population was distributed across five descriptive categories to perform numerical distributions among neurosurgical operative procedures. Results: A total of 12,802 neurosurgical procedures were identified. These procedures were classified as follows: Skull and brain, 11,192 (87.42%);spinal column and spinal nervous tissue, 1462 (11.42%);and peripheral nerves, 148 (1.16%). Surgical procedures for the 1462 (100%) cases of spinal column and spinal nervous tissue diseases were distributed by nosology as follows: Degenerative intervertebral disk and spondylosis, 768 (52.54%);neoplastic, 279 (19.08%);traumatic, 221 (15.11%);congenital, 163 (11.14%);infectious and inflammatory, 27 (1.85%);and vascular, 4 (0.28%). With respect to the distribution of the 279 (100%) surgical procedures for spinal column and spinal nervous tissue neoplastic diseases, 124 (44.44%) procedures were for intradural neoplasms, and 155 (55.56%) procedures were for epidural spinal column neoplasms. The 155 (100%) operations for epidural neoplastic diseases were distributed into two groups: Primary epidural neoplasms, 42 (27.10%);and secondary epidural neoplasms, 113 (72.90%). Spinal column epidural neoplastic metastases (secondary neoplasms) represented 0.88% of the 12,802 neurosurgical procedures. Conclusions: Surgical procedures for spinal metastasis are uncommon with respect to all neurosurgical operative procedures. Trend analysis reveals an unchanging trend of prevalence for these procedures.

Surgical procedures of thoracic ossification of the ligamentum flavum

Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent

CHANGES OF INTERLEUKIN-6 AND RELATED FACTORS AS WELL AS GASTRIC INTRAMUCOSAL pH DURING COLORECTAL AND ORTHOPAEDIC SURGICAL PROCEDURES

Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation.Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol.pHi and plasma lactate were also measured at the same time points.Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation.CRP was not detectable until the first day after operation.Peak concentration of IL-6 had positive relationship with CRP.These variables changed more significantly in colorectal group than that in orthopaedic group (P<0.05).pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P<0.05).Conclusion IL-6 may reflect tissue damage more sensitively than CRP.Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

Reasonable choice of surgical procedures for patients with portal hypertension

OBJECTIVE: To assess individualized therapeutic protocol for patients with portal hypertension on the basis of accumulated knowledge about the mechanism of portal hypertension. DATA SOURCES: Patients data on shunt and other surgical procedures from Ruijin Hospital, Shanghai, China and the published papers. RESULTS: The direction of blood flow of the collateral vessels in the gastro-splenic region is an important factor in deciding surgical strategy because there is a close relationship between surgical risk and the classification of liver function. Clinically it is confirmed that each patient needs an individualized surgical procedure and that prophylactic operation is suitable for patients with splenomegaly, splenism associated with serious esophageal varices and hemorrhagic tendency under endoscopy but acceptable liver function. The shunt diameter (SD) (SD=0.67×PVD) is determined in our patients according to individualized hemodynamics. The rehemorrhagic rate after shunt being higher than that in others may be related to lesioned gastric mucosa caused by portal hypertension or bleeding and temporary melena. This finding is good for prevention of hepatic encephalopathy. The life quality and labor ability of patients will be improved because of hepatopetal flow in the portal vein. With strict indications for reoperation, selective operation is performed as soon as possible when hemorrhage is controlled conservatively and liver function improved. Once the patient with cirrhosis associated with portal hypertension is scheduled for liver transplantation, treatment of hemorrhage should aim to keep the patient in good condition and to avoid the protocol that may be disadvantageous to liver transplantation in the future. CONCLUSION: Surgical procedures for patients with portal hypertension should follow the principle of individualization. To obtain the best outcome, the choice of reasonable surgical procedure is expected.

Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

The goal in brain tumor surgery is to remove the maxi-mum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been in-troduced, including an operating microscope in the late 1950 s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging(DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging(DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resec-tion cavity and thus overcome this remaining uncer-tainty of intraoperative MRI in high grade brain tumor resection.

Surgical Procedures,Pathological Features and Prognosis in Young Women with Breast Cancer in China--a Single Institute Experience

Objective:To compare the differences in surgical procedures,pathological features and prognosis between young and elderly women with breast cancer in China.Methods:A retrospective study compared the data of surgical procedures,pathological features and prognosis of 61 cases of young females(≤40 years)and 507 cases of elderly females(>40 years),treated in our department from August 2011 to July 2018.This data was analyzed using SPSS 23.0 program.Results:10.74% of total cases,in this period of time,involve young females.In terms of surgical procedures,24.59%of young patients underwent breast conserving surgery(8.48% elderly,respectively),and 13.11%underwent reconstruction surgery(1.18% elderly,respectively),with statistically significant differences existing between the two groups(P<0.05).Progesterone receptor(PR)expression in young women was significantly higher than in elderly females(P<0.05).There were no significant differences between the two groups in the proportion of invasive ductal carcinoma(IDC),axillary lymph node metastasis(ALNM),expression of estrogen receptor(ER),human epidermal growth factor receptor-2(HER-2)and Ki-67,but the lymphatic metastasis stage showed an increasing rate with younger age.No significant difference was found in 3-year disease-free survival(DFS)and overall survival(OS).Conclusion:The selection rate of breast conserving and reconstructive surgery in young women with breast cancer is significantly higher than that in elderly women.The younger the patient,the more frequently the PR positive expression,and the more likely ALNM to occur.The 3-year prognosis of the young and elderly patients is similar.

Application of Plan-Do-Check-Action cycle and fishbone diagram analysis in optimizing surgical procedures to improve satisfaction degree of doctor-nurse-patient

Background:To study the application of management tools such as Plan-Do-Check-Action(PDCA)cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.Methods:The fundus surgery nursing team of our hospital began to implement the PDCA cycle management mode to optimize the surgical procedure from July 2017,set up a project activity improvement team,unified the surgical labeling processing plan,and made the fundus surgery procedure,and established the preoperative health education for surgical patients,and standardized the training content of post-rotating doctors and interns.Results:The satisfaction degree to surgical procedure after implementation of doctors and nurses was higher than that before implementation.Conclusions:Using PDCA cycle and fishbone diagram analysis tools to manage the surgical procedure optimization can better integrate doctor-nurse medical care,improve the efficiency and accuracy of the surgical procedure delivery and operation,and optimize the satisfaction of the three parties of doctor-nurse-patient.

Comparison of the Efficacy of Ultrasound-Guided Microwave Ablation of Parathyroid Adenoma with Surgical Procedures

Objective: To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. Methods: The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. Results: The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion: Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.

Surgical Approaches in Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis Comparing Vitrectomy vs. Vitrectomy Combined with Scleral Buckling, Lens-Sparing vs. Phako Procedures

Aim: This study aimed to assess and compare the functional and anatomical results of pars plana vitrectomy (PPV) alone versus PPV combined with scleral buckling (SB), and lens-sparing versus phaco-procedures for treating rhegmatogenous retinal detachment. Methods: A comprehensive literature search was performed using the Web of Science, MEDLINE, EMBASE, and Cochrane Library databases to retrieve comparative studies. The main objective was to assess the BCVA, while reattachment rates and ocular adverse events were considered secondary measures. Rev Manager software was used for statistical analysis. Results: The literature search identified 10 articles comprising 1518 eyes, with 682 eyes in the PPV group, 193 eyes in the lens-sparing versus phaco-procedure group, and 643 eyes in the combined PPV and SB surgery group. Quality assessment revealed a low risk of bias in most domains. The meta-analysis results revealed a significant difference in postoperative BCVA between the PPV and PPV combined with SB groups (WMD = −0.17, 95% CI [0.27, 0.07], p = 0.001). The primary reattachment rates were 82.80% for PPV alone and 87.52% for PPV combined with SB (p = 0.34). The final reattachment rates did not differ significantly between PPV and PPV combined with SB (99% vs. 99.8%;RR = 1.00, 95% CI [1.01, 0.99], p = 0.96). PPV alone demonstrated a significantly reduced risk of macular edema compared to PPV combined with scleral buckling (9.9% vs. 23%;p = 0.006). The incidences of macular hole development (p = 0.46), recurrent retinal detachment (p = 0.27), proliferative vitreoretinopathy development (p = 0.48), epiretinal membrane proliferation (p = 0.77), and limited choroidal hemorrhage (p = 0.69) were not significantly different between the two groups. Conclusions: These findings suggest that PPV alone may be a more effective treatment option in terms of visual acuity (VA) improvement, lower risk of macular edema and cataract development. However, there was no significant difference in VA improvement or complication rates between the lens-sparing and phaco-procedure groups. .

Navigating medial patellotibial ligament reconstruction:Clinical perspectives and surgical strategies

The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.

Prediction and stratification for the surgical adverse events after minimally invasive esophagectomy:A two-center retrospective study

BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.

Enhancing postoperative pain control by surgically-initiated rectus sheath block in abdominal aortic aneurysm open repair: A case report

BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.

Surgical site soft tissue thickness as a predictor of complications following arthroplasty

Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.

Estimation of Physiologic Ability and Surgical Stress scoring system for predicting complications following abdominal surgery: A metaanalysis spanning 2004 to 2022

BACKGROUND Postoperative complications remain a paramount concern for surgeons and healthcare practitioners.AIM To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress(E-PASS)scoring system’s efficacy in predicting postoperative complications following abdominal surgery.METHODS A systematic search of published studies was conducted,yielding 17 studies with pertinent data.Parameters such as preoperative risk score(PRS),surgical stress score(SSS),comprehensive risk score(CRS),postoperative complications,post-operative mortality,and other clinical data were collected for meta-analysis.Forest plots were employed for continuous and binary variables,withχ2 tests assessing heterogeneity(P value).RESULTS Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications[mean difference and 95%confidence interval(CI)of PRS:0.10(0.05-0.15);SSS:0.04(0.001-0.08);CRS:0.19(0.07-0.31)].Following the exclusion of low-quality studies,results remained valid with no discernible heterogeneity.Subgroup analysis indicated that variations in sample size and age may contribute to hetero-geneity in CRS analysis.Binary variable meta-analysis demonstrated a correlation between high CRS and increased postoperative complication rates[odds ratio(OR)(95%CI):3.01(1.83-4.95)],with a significant association observed between high CRS and postoperative mortality[OR(95%CI):15.49(3.75-64.01)].CONCLUSION In summary,postoperative complications in abdominal surgery,as assessed by the E-PASS scoring system,are consistently linked to elevated PRS,SSS,and CRS scores.High CRS scores emerge as risk factors for heightened morbidity and mortality.This study establishes the accuracy of the E-PASS scoring system in predicting postoperative morbidity and mortality in abdominal surgery,underscoring its potential for widespread adoption in effective risk assessment.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

The Timing of Primary Neurosurgical Repair and Wound-Site Infection in Children with Myelomeningocele

Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to repair-site infection that can lead to increased morbidity and prolonged hospital stays. It is on this basis that recommendations have utilized 48 - 72 hours post birth as ideal time of closure. This is not only prevent infection at the site but also prevent ventriculitis and neural structure damage. We therefore, hypothesized an increase in wound infection rates in those patients with delays in myelomeningocele repair. Methods: We retrospectively reviewed the records of 103 children with myelomeningocele treated between 2016 and 2023. At discharge the patients were followed up at the post-operative clinic visit 2 weeks later. Children were assigned to 1 of 2 groups, those who underwent primary neurosurgical repair within 72 hours of delivery (Group 1) and those undergoing repair after 72 hours (Group 2). We compared the infection rates. Results: 103 children who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Eight (7.8 %) patients were noted to have post-repair surgical site complications. There was no significant difference in rates of infection between Group 1 and Group 2 repair times. The presence of infection was associated increased length of stay when compared to neonates without infection. Conclusion: In children with myelomeningocele, the timing of primary neurosurgical repair appears not to have a significant impact on surgical site infection. Closure of the spinal lesion within the first 72 hours of life may be more favorable for neural damage prevention. These results suggest that early myelomeningocele repair may not impart significantly on the rate of wound-site infection.

Effect of different minimally invasive gastric cancer surgical approaches on postoperative intestinal mucosal barrier function

Background:The aim of this study was to investigate the effects of different minimally invasive surgical procedures on intestinal muco-sal barrier function.Methods:In this study,76 patients who underwent minimally invasive gastric cancer surgery were selected,and peripheral blood was collected to test the levels of serum plasma D-lactic acid,diamine oxidase,and bacterial endotoxin before and 1 and 3 days after sur-gery.These markers were compared at different time points before and after surgery to understand the recovery of the intestinal muco-sal barrier function in patients after surgery.Results:On the first postoperative day,the change in serum D-lactic acid relative to the preoperative levels was significantly(P<0.05)lower in the laparoscopic surgery group(4.05[-0.195,6.917 mmol/L])than in the robot-assisted surgery group(7.56[5.190,12.145 mmol/L]).Both the serum D-lactic acid and bacterial endotoxin levels were significantly higher on the first postoperative day compared with preoperative levels,and although they showed a gradual decrease by the third day,they remained significantly higher than the pre-operative levels(P<0.05).The Student-Newman-Keuls method for pairwise comparison of the measurements at each time point dem-onstrated that the differences in D-lactic acid and bacterial endotoxin levels between the preoperative sample and the sample collected on the third postoperative day were statistically significant(P<0.05).Conclusions:Compared with the laparoscopic surgery group,the robotic surgery group showed larger changes in the postoperative serum D-lactic acid level,suggesting that the robotic surgery resulted in greater damage to the barrier function of the intestinal mucosa.The serum D-lactic acid and bacterial endotoxin levels were significantly higher in postoperative patients and showed a trend to gradually decrease,suggesting that the intestinal mucosal barrier function of patients after minimally invasive gastric cancer surgery is damaged and then gradually recovers.