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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.

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.

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

Le cancer du sein est le diagnostic de cancer le plus fréquent chez la femme, et la chirurgie de reconstruction mammaire post-mastectomie est une procédure couramment pratiquée pour améliorer la satisfaction personnelle et la qualité de vie des patientes atteintes de cancer du sein [1-3]. Le lambeau abdominal de DIEP (Deep Inferior Epigastric Artery Perforator) est considéré comme la référence en reconstruction mammaire autologue, mais le long séjour hospitalier, les coûts élevés et les complications postopératoires associées à cette chirurgie représentent des défis pour les patientes [4, 5]. La mise en place d'un programme de récupération rapide, tel que ERAS (Enhanced Recovery After Surgery), qui utilise une approche globale multidisciplinaire des soins péri-opératoires, s'est avérée être une stratégie efficace pour réduire les complications chirurgicales et est largement acceptée dans diverses disciplines chirurgicales [6-8]. Dans cette étude menée au Centre hospitalier de l’Université de Montréal, nous avons évalué l'efficacité du protocole ERAS pour la reconstruction par lambeau de DIEP. Nous avons comparé une cohorte après la mise en œuvre d'ERAS à un groupe témoin utilisant un protocole standard (pré-ERAS) de manière rétrospective pour déterminer l'impact du protocole ERAS sur la durée de séjour à l'hôpital, l'utilisation d'opioïdes chez les patients hospitalisés et les complications postopératoires. Les résultats ont montré que les patients suivant le protocole ERAS ont eu des séjours hospitaliers plus courts (2,8 vs 4,5 jours ; p<0,001) et une utilisation totale d'opioïdes plus faible (50,6 mg vs 136,3 mg ; p<0,001), ainsi que moins de complications postopératoires. L'implémentation du protocole ERAS pour la reconstruction mammaire par lambeau DIEP peut significativement réduire la durée du séjour à l'hôpital, les besoins postopératoires en opioïdes et les complications postopératoires. / Breast cancer is one of the most common cancer diagnoses among women, and post mastectomy breast reconstruction surgery is a commonly performed procedure to improve personal satisfaction and quality of life for breast cancer patients [1][2][3]. The DIEP (Deep Inferior Epigastric Artery Perforator) flap is the gold standard in autologous breast reconstruction, but the lengthy hospital stay, high costs, and postoperative complications associated with this surgery present challenges for patients [4][5]. Implementing a rapid recovery program, such as ERAS (Enhanced Recovery After Surgery), which utilizes a comprehensive, multidisciplinary approach to perioperative care, has been shown to be an effective strategy for reducing surgical complications and is widely accepted in various surgical disciplines [6][7][8]. In this study, we aimed to examine the effectiveness of the ERAS protocol for DIEP flap reconstruction at the Centre hospitalier de l’Université de Montréal. We compared a cohort after the implementation of ERAS with a control group using a standard protocol (pre-ERAS) retrospectively to determine the impact of the ERAS protocol on hospital length of stay, opioid use among hospitalized patients, and postoperative complications. This study included patients with 80% undergoing immediate reconstruction, while the remainder had delayed immediate or delayed reconstruction. Patients in the ERAS group experienced shorter hospital stays (2.8 vs. 4.5 days; p<0.001) and lower total opioid use (50.6 mg vs. 136.3 mg; p<0.001). This reduction was evident in opiates per day of hospitalization (18.2 mg vs. 30.2 mg; p<0.001) and within the first 24 postoperative hours (35.7 mg vs. 67.6 mg; p<0.001). The control group had a higher incidence of postoperative complications. Implementing the ERAS protocol for DIEP flap breast reconstruction can significantly reduce hospital length of stay, postoperative opioid requirements, and postoperative complications without increasing adverse events, particularly for immediate reconstructions with DIEP flaps.