BACKGROUND: In India, an estimated 200,000 congenital heart defects are diagnosed each year but only 50 pediatric cardiac health centers exist with capacity to perform pediatric cardiac surgeries (PCS). Majority of the centers are private and have high cost of care. Hrudaya Foundation, a non-profit, was started to cover in-hospital costs of pediatric cardiac surgery for poor families. For the study, risk factors of post-operative infection (major outcome of PCS) were evaluated and gaps in care faced by Hrudaya Foundation patients were identified. METHODS: To identify risk factors associated with POI, retrospective cohort study was conducted. Medical records and foundation notes of 1028 interventional CATH and open heart surgery patients were examined. Chisq tests and logistic regressions on socio-economic and clinical factors were run to identify risk factors of POI for open heart surgery patients. The study also tested associations of patients’ community characteristics with pre-operative conditions and POI, like lack of access to improved latrines, distance to hospital, under & unemployment rate, and maternal illiteracy rates. To identify gaps in care, the study collected and analyzed interviews with 11 staff and 27 parents. The semi-structured interviews focused on care pathway from birth to post-discharge follow-up, financial obstacles, and an asset assessment. RESULTS: Pediatric open heart surgery patients had a 19% post-operative infection rate and a 5% mortality rate. Post-operative infections were significantly associated with age of 12 months and under, severely underweight, history of prior cardiac intervention, high risk surgery (RACHS-1 score 3 & 4), delayed sternal closure, and re-operation within same admission when the other risk factors were kept constant. POI did not have a statistically significant correlation with community level characteristics. The study found several gaps in care. Parents had difficulty getting a referral to affordable specialty cardiac care after diagnosis. Even after a referral to Hrudaya Foundation, parents still had to borrow large sums of money due to travel, lodging, and follow-up expenses. Financial constraints created barriers to maintain wellness before and after intervention. Most parents did not have consistent income and they were not aware of many assets in their communities. CONCLUSION: Patients with significant risk factors for POI should have more aggressive infection management. Though close to 41% of the sample were severely underweight, the risk factor was not recognized as actionable. Patients should get nutrition supplementation prior to surgery admission and parents should be notified of their child’s malnutrition status at discharge. Additionally, BPL parents need additional resource and system navigation assistance to reduce financial constraints and maintain their child’s follow-up care and nutrition. / 2021-05-12T00:00:00Z

BACKGROUND: Skin cancer is the most common malignant neoplasm, with more than 5.4 million cases diagnosed annually in the United States. Treatment varies based on the type of neoplasm, its location, as well as primary vs. recurrent lesions. Nonetheless, surgical treatment remains the gold standard. Mohs micrographic surgery (MMS) is a commonly used surgical technique in the excision of such neoplasms. The technique of MMS allows for the precise removal of skin cancers while offering the highest cure rates with maximal preservation of surrounding tissue. Repairs of MMS defects are often done the same day if performed by the resecting Mohs surgeon. However, for more complicated reconstructive procedures, repairs are often performed by a separate reconstructive surgeon. When this occurs, MMS repairs may be delayed and performed on a different day due to a variety of factors such as surgical scheduling conflicts and patient tolerance. Researchers are urgently trying to explore the implications and postoperative complications of delayed MMS as compared to same day MMS. OBJECTIVE: This study compares same-day vs. next day eyelid reconstruction following MMS with attention to postoperative complications. Our aim is to investigate whether or not a delay in closure is associated with an increase in postoperative complications. METHODS: We performed a retrospective chart review of patients who underwent eyelid reconstruction following MMS from January 2008 to December 2018, by a single private practice oculoplastic surgeon. The timing of each patient’s reconstruction along with age, sex, comorbidities, such as diabetes, current smoking status, previous radiation therapy, anticoagulation treatment, and occurrence of postoperative complications were recorded. The specific location of the defect was recorded as well. The timing of reconstruction was classified as same-day or next-day reconstruction. No reconstructions took place more than 48 hours after tumor excision. The complications included in our analysis were: hematoma, wound infection, flap necrosis, dehiscence, and ectropion. Statistical significance was determined by Pearson’s chi-squared analysis. RESULTS: A total of 485 procedures were performed on 390 patients. 334 (69%) of those procedures were same-day reconstructions, while 151 (31%) of those procedures were next-day reconstructions. 19 (5.7%) of the 334 same-day reconstructions and 9 (5.9%) of the 151 next-day reconstructions were associated with complications (p=0.905). Therefore, a total of 28 (5.8%) procedures were associated with complications. More women (54%) than men (46%) underwent reconstruction. Multivariate logistic regression showed that males had a 1.274-fold higher risk of developing complication post reconstruction. Current smokers had a 1.054-fold higher risk of developing complications post reconstruction. CONCLUSIONS: There is no statistically significant difference in the postoperative complication rate when comparing same-day vs. next-day eyelid reconstruction following Mohs micrographic surgery.

Hypersensitivity after tissue injury is an expression of neuronal plasticity in the central nervous system. This has been explored most extensively using in vitro preparations and animal models of inflammatory pain and chemical irritation. For pain after surgery, a similar process has been proposed. In the present study, we examined dorsal horn neuron (DHN) sensitization using the plantar incision model for post-operative pain. In behavioral experiments, the effect of a local anesthetic injection (or saline vehicle) 15min before plantar incision on pain behaviors several days after incision was studied. Bupivacaine injection before incision prevented pain behaviors until 4h afterwards; injection after incision produced the same effect. One day after incision, pain behaviors were not different between rats injected with saline or bupivacaine. In neurophysiologic experiments, however, bupivacaine injection blocked activation of DHNs during incision. One hour after incision, expansion of receptive fields (RFs) to pinch and increased background activity occurred in 14 of 16 neurons in the saline group but only in two of 22 neurons in the bupivacaine group. The difference was not due to a systemic effect of bupivacaine. Ten sensitized neurons were studied using the injection of bupivacaine 90min after incision. Increased background activity (n=7) and expanded RFs (n=7) were reversed by bupivacaine. Sensitization was re-established in seven of eight neurons 2h after injection as the local anesthetic dissipated. These results indicate that activation of DHNs during plantar incision and sensitization 1h later are not necessary for subsequent pain behaviors. Because sensitization was reversed 90min after plantar incision and then re-established as the local anesthetic effect diminished, enhanced responsiveness of DHN requires ongoing afferent input during the first day after incision.

No description available.

Introduction: Vasectomy is considered a safe and effective contraceptive method with fewcomplications. Complications are most often hematomas, pain or infection. Previous studiessuggest that the surgeon’s experience level is associated with potential complications. Aim: To evaluate complications after vasectomy and to investigate if specific patientcharacteristics and/or surgical experience can predict complications related to vasectomysurgeries. Methods: Five hundred consecutive journals of vasectomy patients at the Department of Urologyin Örebro University Hospital during 2019 and 2020 were investigated. Patient characteristics andinformation about the surgery were collected. Comparison was made between patient groups toinvestigate if complications were more common in patients with diabetes, cardiovascular diseaseor previous surgery in the scrotal/groin area, as well as in patients operated on by one versus twosurgeons, and residents versus specialized surgeons. Results: No statistically significant association could be found between patient characteristics(diabetes, cardiovascular disease, previous surgery) and complications. Furthermore, the numberof operating surgeons and the surgeons’ experience levels did not have any statistically significantassociation to complication rates. Conclusion: No patient factors could be used to predict vasectomy outcome. Complication ratesare the same in patients operated by surgical residents and specialized surgeons.

No description available.

No description available.

No description available.

INTRODUCTION: Racial disparities exist in both healthcare access and outcomes. Despite high poverty rates, less education, and worse access to healthcare, the Hispanic population as a whole experiences equal, if not better outcomes compared to their non- Hispanic White counterparts. We sought to determine if race was significantly associated with the development of serious post-operative complications (POC) among patients undergoing intra-abdominal general surgical procedures. METHODS: We performed a retrospective cohort study of patients undergoing appendectomy, cholecystectomy, or colectomy at a single healthcare system over a 12 month period. Medical records were reviewed for patient demographics, co-morbidities, operative variables, and the occurrence of selected post-operative complications. Variables found to be significantly associated with the development of a POC on univariate analysis were entered into a multivariate logistic regression model to determine the effect of Hispanic race on POC. Additionally, we constructed a propensity score adjusted logistic regression model as a confirmation of our findings. RESULTS: Among 456 patients, 48 (10.5%) developed a POC. Hispanic race, age, tobacco use, selected co-morbidities, surgical procedure and surgical approach were all associated with POC on univariate analysis. On multivariate logistic regression analysis, after adjusting for confounders, Hispanic race, age, tobacco use, and surgical approach were all significantly associated with POC. Hispanic race was the strongest independent predictor, and was found to be protective against the development of a POC (adjusted OR= 0.22, p-value=0.048). The propensity score adjusted regression model provided a similar estimate of the effect of Hispanic race on POC (adjusted OR= 0.20, p-value=0.03). CONCLUSIONS: We have demonstrated that Hispanic patients undergoing common intra-abdominal surgical procedures have lower rates of serious post-operative complications, even after adjusting for patient demographics, co-morbidities, and operative variables. This, and other existing data, suggests that Hispanic patients may incur some type of overall health advantage despite the socioeconomic hardships they often face. / Clinical Research and Translational Medicine

Bakgrund: En ökad mängd operationer genomförs i dagkirurgi, vilket innebär att fler patienter skrivs ut till hemmet utan professionell vård under det förlängda postoperativa förloppet. Därför behövs forskning för att undersöka patienternas perspektiv av återhämtning. Syfte: Syftet med denna studie var att analysera postoperativ återhämtning hos patienter som har genomgått ortopedisk dagkirurgi i regionalanestesi. Metod: En kvantitativ, icke experimentell retrospektiv tvärsnittsstudie genomfördes. En enkät skickades ut till 252 potentiella deltagare tre veckor efter operation med frågor avseende psykometriska aspekter och demografiska data. Av dessa erhölls 126 svar. Genom ett validerat instrument kvantifierades resultaten och beräknades till en poäng mellan 10 och 100, där en hög poäng speglade en god återhämtning som mätt med instrumentet. Resultat: Ingen statistisk signifikans kunde identifieras mellan poäng och utbildningsnivå, typ av operation, om sedering erhållits (ja/nej), civilstånd eller kön. Deltagare som hade genomgått en operation tidigare visade ett högre mått av återhämtning än de som inte hade gjort det. En korrelation identifierades mellan pre- och postoperativ ångest och poäng. Även en korrelation mellan pre- och postoperativt illamående identifierades.  Konklusion: Denna studie identifierade nyckelkomponenter som påverkar postoperativ återhämtning hos patienter som har genomgått dagkirurgi under regionalanestesi. Tidigare erfarenhet av operationer påverkade återhämtningen positivt relaterat till bättre förberedelse och strategier till postoperativa utmaningar. Medan en stark korrelation identifierades mellan postoperativ smärta och ångest, fanns inget signifikant samband mellan smärta eller illamående och generell återhämtning, vilket indikerar att andra faktorer kan spela större roll.