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Predicting Postoperative Delirium in Older Patients medRxiv. Surg. Pub Date : 2024-03-15 Shun-Chin Jim Wu, Nitin Sharma, Anne Bauch, Hao-Chun Yang, Jasmine L. Hect, Christine Thomas, Soeren Wagner, Bernd R. Foerstner, Christine A.F. von Arnim, Tobias Kaufmann, Gerhard W. Eschweiler, Thomas Wolfers
Background: The number of elective surgeries for older individuals is on the rise globally. Machine learning may improve risk assessment with impact on surgical planning and postoperative care. Preoperative cognitive assessment may facilitate early identification of postoperative delirium (POD). This study aim to estimate the predictive ability of machine learning models for POD using pre- and/or perioperative
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Trends in using intraoperative parathyroid monitoring during parathyroidectomy: Protocol and rationale for a cross-sectional survey study of North American surgeons medRxiv. Surg. Pub Date : 2024-03-14 Phillip Staibano, Tyler McKechnie, Alex Thabane, Michael Xie, Han Zhang, Michael Gupta, Michael Au, Jesse Pasternak, Sameer Parpia, JEM Young, Mohit Bhandari
Introduction Hyperparathyroidism is a common endocrine disorder that can be secondary to a single or multiple abnormal parathyroid glands and can occur in the context of chronic kidney disease (CKD). There are three types of hyperparathyroidism, and all are definitively managed via surgical extirpation of abnormal parathyroid gland tissue. Intraoperative parathyroid hormone (IOPTH) monitoring was introduced
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Preoperative COVID-19 Vaccination is Associated with Decreased Perioperative Mortality after Major Vascular Surgery medRxiv. Surg. Pub Date : 2024-03-13 Molly Ratner, Karan Garg, Heepeel Chang, Anjali Nigalaye, Steven Medvedovsky, Glenn Jacobowitz, Jeffrey J Siracuse, Virendra I Patel, Marc L. Schermerhorn, Charles DiMaggio, Caron Rockman
Background: The objective of this study was to examine the effect of COVID-19 vaccination on perioperative outcomes after major vascular surgery. Methods: This is a multicenter retrospective study of patients who underwent major vascular surgery between December 2021 through August 2023. The primary outcome was all-cause mortality within 30 days of index operation or prior to hospital discharge. Multivariable
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MuViSS : Muscle, Visceral and Subcutaneous Segmentation by an automatic evaluation method using Deep Learning medRxiv. Surg. Pub Date : 2024-03-13 Edouard WASIELEWSKI, BOUDJEMA Karim, Laurent SULPICE, Thierry PECOT
Purpose: Patient body composition is a major factor in patient management. Indeed, assessment of SMI as well as VFA and, to a lesser extent, SFA is a major factor in patient survival, particularly in surgery. However, to date, there is no simple, rapid, open-access assessment method. The aim of this work is to provide a simple, rapid and accurate tool for assessing patients' body composition. Material
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COLOFIT: Development and internal-external validation of models using age, sex, faecal immunochemical and blood tests to optimise diagnosis of colorectal cancer in symptomatic patients medRxiv. Surg. Pub Date : 2024-03-07 Colin J Crooks, Joe West, James Jones, Willie Hamilton, Sarah Bailey, Gary Abel, Ayan Banerjea, Colin J Rees, Andres Tamm, Brian D Nicholson, Sally C Benton, COLOFIT Research Group, david James Humes
Objective To develop and validate a model using available information at the time of Faecal Immunochemical testing (FIT) in primary care to improve selection of symptomatic patients for colorectal cancer (CRC) investigations. Design Population based cohort study. Setting All adults ≥ 18 years of age referred to Nottingham University Hospitals NHS Trust between 2018 and 2022 with symptoms of suspected
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Identifying High and Low Performing Emergency General Surgery Hospitals Using Direct Standardization medRxiv. Surg. Pub Date : 2024-03-02 Drew W Goldberg, Rachel R Kelz, Luke Keele, Chris Wirtalla, Solomiya Syvyk
Importance: Variation in outcomes for emergency general surgery conditions has been shown at the hospital level. Few have examined difference across hospitals for older adults who often present with the greatest risk. To date, no one has examined differences in the outcome for those undergoing operative and nonoperative treatment. Objective: Identify high and low performing emergency general surgery
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Development and Validation of Prediction Models for Sentinel Lymph Node Status Indicating Postmastectomy Radiotherapy in Breast Cancer: a Population-Based Study of 18 185 Women medRxiv. Surg. Pub Date : 2024-02-23 Miriam Svensson, Par-Ola Bendahl, Sara Alkner, Emma Hansson, Lisa Ryden, Looket Dihge
Background: Postmastectomy radiotherapy (PMRT) impairs the outcome of immediate breast reconstruction (IBR) in patients with breast cancer, and the sentinel lymph node (SLN) status is crucial in evaluating the need for PMRT. This study aimed to develop models to preoperatively predict the risk for SLN metastasis indicating the need for PMRT. Methods: Women diagnosed with clinically node-negative (cN0)
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Middle meningeal artery embolization for subdural hematoma: protocol for a systematic review and meta-analysis of randomized controlled trials medRxiv. Surg. Pub Date : 2024-02-23 Alick Pingbei Wang, Husain Shakil, Brian James Drake
Background: Middle meningeal artery embolization is an emerging neuroendovascular therapy for chronic subdural hematoma. Recently, a number of randomized control trials have been conducted to assess the efficacy of middle meningeal artery embolization to reduce the recurrence or progression of chronic subdural hematoma. Methods: A systematic review will be conducted following the Preferred Reporting
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Laser Ablation of Periventricular Nodular Heterotopia for Medically Refractory Epilepsy medRxiv. Surg. Pub Date : 2024-02-21 Ryan M McCormack, Arjun S Chandran, Samden D Lhatoo, Sandipan Pati, Zhouxuan Li, Katherine Harris, Giridhar Kalamangalam, Stephen Thompson, Nitin Tandon
Objective: Periventricular Nodular Heterotopia (PVNH) is the most common neuronal heterotopia, frequently resulting in pharmacoresistant epilepsy. PVNH has a deep location which renders localization of seizure onsets and traditional surgical therapy challenging and of limited success. Here we characterize variables that predict good epilepsy outcomes following surgical intervention using SEEG informed
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Management and outcomes of Chronic Subdural Hematoma in Africa: a protocol for a scoping review medRxiv. Surg. Pub Date : 2024-02-19 Victor M Kyaruzi, Berjo Takoutsing, Astel Dongmo, Michael Nana Yaw Yankey, Yvanah Owoundi Mbozoo, Nathan Ezie Kengo, Samuel Fodop, Mingo Naomi Younwi, Evert Foyenka, Tcheutchoua Kathy Foka, Yab Parfait Motah, Opara Oluwamayowa, Roland Nchufor, Yannick Onana, Ngaroua, Atangana Ernestine Renee Bikono, Ignatius Esene
Introduction: Chronic subdural hematoma (cSDH) is a common neurosurgical condition characterised by the accumulation of blood between the dura mater and the arachnoid membrane. It has a significant prevalence and high mortality. Over the years, the management of cSDH has been extensively studied in high-income countries. On the other hand, Africa, which is faced with a significant neurosurgical care
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Virtual Reality for Pediatric Trauma Education - A Face and Content Validation Study medRxiv. Surg. Pub Date : 2024-02-18 Fabio Botelho, Said Ashkar, Shreenik Kundu, TJ Mathews, Elena Guadagno, Jason Harley, Dan D Poenaru
Purpose: Pediatric trauma is a leading cause of death and disability among children. While trauma education can improve these outcomes, it remains expensive and available only to a few providers worldwide. Innovative educational technologies like virtual reality (VR) can be key to democratizing trauma education. This study, therefore, evaluates the face and content validity of a VR platform designed
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Cleft lip sidedness and the association with additional congenital malformations medRxiv. Surg. Pub Date : 2024-02-15 Matthew Fell, Kate J Fitzsimons, Mark J Hamilton, Jibby Medina, Sophie Butterworth, Min Hae Park, Jan Van der Meulen, Sarah Lewis, David Chong, Craig JH Russell
Objective To investigate the association between the sidedness of orofacial clefts and additional congenital malformations.
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The LYMPH Trial - Comparing Microsurgical with Conservative Treatment of Chronic Breast Cancer Associated Lymphedema: Study Protocol of a Pragmatic Randomized International Multicentre Superiority Trial medRxiv. Surg. Pub Date : 2024-02-13 Elisabeth A Kappos, Yvonne Haas, Alexandra Schulz, Florian Peters, Shakuntala Savanthrapadian, Julia Stoffel, Maria Katapodi, Rosine Mucklow, Benedict Kaiser, Alexander Haumer, Stephanie Etter, Marco Cattaneo, Daniel Staub, Karin Ribi, Jane Shaw, Tristan M Handschin, Steffen Eisenhardt, Giuseppe Visconti, Gianluca Franceschini, Lorenzo Scardina, Benedetto Longo, Marcus Vetter, Khalil Zaman, Jan A Plock
Introduction: Up to one fifth of breast cancer survivors will develop chronic breast cancer-related lymphedema (BCRL). To date complex physical decongestion therapy (CDT) is the gold standard of treatment. However, it is mainly symptomatic and often ineffective in preventing BCRL progression. Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are microsurgical techniques that
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MODIFIED AORTIC VALVE REIMPLANTATION IN PATIENTS WITH ACUTE AORTIC DISSECTION TYPE A medRxiv. Surg. Pub Date : 2024-02-08 Sergey Yuryevich Boldyrev, Valentina Nikolaevna Suslova, Mariya Vladimirovna Dontsova, Kirill Olegovich Barbukhatti, Vladimir Alekseevich Porkhanov
Background The question of choosing surgical tactics in patients with acute aortic dissection type A unresolved to now. In patients with massive destruction of the aortic root the «gold standard» is the Bentall procedure. Aortic valve reimplantation is an attractive alternative, especially in patients with preserved aortic valve leaflets anatomy.
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Indexing Healthcare Access and Quality for Surgically Amenable Conditions: A Global Analysis of 204 Countries and Territories from 1990 to 2019 medRxiv. Surg. Pub Date : 2024-02-06 Siddhesh Zadey, Emily R. Smith, Catherine A. Staton, Tamara N. Fitzgerald, Joao Ricardo Nickenig Vissoci
Introduction Building on past frameworks, our aim was to systematically analyze the healthcare access and quality (HAQ) index for surgically treatable conditions, its progress over time, and the gap compared to non-surgical HAQ across 204 countries and territories from 1990 to 2019.
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Management of Intraductal Papilloma Using Vacuum Assisted Breast Surgery (VABB/VAE):- A Single Institute Study medRxiv. Surg. Pub Date : 2024-01-25 Rohan Khandelwal, Pooja Sharma, Dev Desai, Sambit Mohanty
Introduction: - Intraductal papilloma, although benign, has a high upgradation rate to malignant breast cancer. Surgical excision is necessary, but the rate of complications is high. Ultrasound-guided vacuum-assisted excision (US-VAE) is a new technique derived from the VABB biopsy method that can give better cosmetic results as well as fewer surgical complications. Objectives:- Understanding the utility
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Development and validation of a realistic type III esophageal atresia simulator for the training of pediatric surgeons medRxiv. Surg. Pub Date : 2024-01-12 Javier Arredondo Montero, Blanca Paola Pérez Riveros, Oscar Emilio Bueso Asfura, Nerea Martín-Calvo, Francisco Javier Pueyo, Nicolás López de Aguileta Castaño
Background The technical complexity and limited casuistry of neonatal surgical pathology limit the possibilities of developing the necessary technical competencies by specialists in training. Esophageal atresia constitutes the paradigm of this problem. The use of 3D models for training is a promising line of research, although the literature is limited.
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An assessment of the value of deep neural networks in genetic risk prediction for surgically relevant outcomes medRxiv. Surg. Pub Date : 2024-01-10 Mathias Aagaard Christensen, Arnór Sigurdsson, Alexander Bonde, Simon Rasmussen, Sisse R Ostrowski, Mads Nielsen, Martin Sillesen
Introduction Postoperative complications affect up to 15% of surgical patients constituting a major part of the overall disease burden in a modern healthcare system. While several surgical risk calculators have been developed, none have so far been shown to decrease the associated mortality and morbidity. Combining deep neural networks and genomics with the already established clinical predictors may
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Surgical diagnoses and post-operative outcomes of intestinal obstruction among adults at regional referral hospitals in Dar-es-Salaam, Tanzania: a prospective, observational hospital-based study medRxiv. Surg. Pub Date : 2024-01-02 Shadrack Samwel Mponzi, Wambura Boniphace Wandwi, Naboth Almasi Mbembati, Kelvin Melkizedeck Leshabari
Background There is limited available published information regarding surgical diagnoses and post-operative outcomes of intestinal obstruction among adult patients in East African hospitals. The observation is despite available anecdotal evidence of the condition to be among the commonest surgical emergencies in the area.
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Evaluation of the Efficacy and Safety of FFX Facet Cages Compared to Pedicle Screw Fixation in Patients with Lumbar Spinal Stenosis: A Long-Term Study medRxiv. Surg. Pub Date : 2023-12-19 Omar Houari, Arnaud Douanla, Mehdi Ben Ammar, Mustapha Benmekhbi, Jihad Mortada, Gabriel Lungu, Cristian Magheru, Jimmy Voirin, Pablo Ariel Lebedinsky, Mariano Musacchio, Federico Bolognini, Robin Srour
Objective: The study evaluated the long-term safety and efficacy of the FFX facet cage versus pedicle screw (PS) fixation in patients with lumbar spinal stenosis (LSS). Methods: A hybrid retrospective/prospective study design was used. Following a medical records review, subjects meeting the inclusion/exclusion criteria were consented and enrolled in the prospective arm of the study. CT-scans and dynamic
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Evaluation of gastric electrophysiology, symptoms and quality of life after pancreaticoduodenectomy medRxiv. Surg. Pub Date : 2023-12-17 Tim Hsu-Han Wang, Chris Varghese, Stefan Calder, Armen Gharibans, Gabriel Schamberg, Adam Bartlett, Sanket Srinivasa, Greg O’Grady
Background Pancreaticoduodenectomy (PD) is an operation performed for several indications, including pancreatic and biliary malignancies. Delayed gastric emptying (DGE) is a common post-operative complication and the underlying pathophysiology remains poorly understood. This study aimed to evaluate the gastric electrophysiology, symptoms and quality of life following PD, using the novel non-invasive
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THRomboprophylaxis in Individuals undergoing superficial endoVEnous treatment: a multi-centre, assessor blind, randomised controlled trial (THRIVE trial) medRxiv. Surg. Pub Date : 2023-12-19 Matthew Machin, Sarah Whittley, John Norrie, Laura Burgess, Beverley J. Hunt, Layla Bolton Saghdaoui, Joseph Shalhoub, Tamara Everington, Manjit Gohel, Mark Whiteley, Steven Rogers, Sarah Onida, Benedict Turner, Sandip Nandhra, Rebecca Lawton, Annya Stephens-Boal, Carolyn Singer, Joanne Dunbar, Alun Huw Davies, Daniel Carradice
Introduction Endovenous therapy is the first-choice management for symptomatic varicose veins in NICE guidelines, with 56-70,000 procedures performed annually in the UK. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and endothermal heat-induced thrombosis (EHIT), are known complications of endovenous therapy, occurring at a rate of up to 3.4%. In an
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Chemical/technical risk analysis of a new multi-directional nebulizer (MDN) and its clinical implementation for the safe administration of Pressurized Intraperitoneal Aerosol Chemotherapy (MDN-PIPAC) medRxiv. Surg. Pub Date : 2023-12-15 Fabian Kockelmann, Daniel Göhler, Sarah Barbey, Amayu Wakoya Gena, Hayder Alsaad, Conrad Voelker, Jürgen Zieren, Mehdi Ouaissi, Urs Giger-Pabst
Background/Aim To test the chemoresistance of a multi-directional nebulizer (MDN) and to establish and implement a perioperative clinical safety concept for its clinical use to deliver pressurised intraperitoneal aerosol chemotherapy (MDN-PIPAC).
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Assessment of symptoms, quality of life and remnant gastric activity following gastric bypass using Gastric Alimetry® medRxiv. Surg. Pub Date : 2023-12-15 Tim Hsu-Han Wang, Chris Varghese, Stefan Calder, Armen Gharibans, Nicholas Evennett, Grant Beban, Gabriel Schamberg, Greg O’Grady
Background While most gastric bypass patients recover well, some experience long-term complications, including nausea, pain, stricture, and dumping. This study aimed to evaluate symptoms and quality of life (QoL) together with remnant stomach function using the novel Gastric Alimetry® system.
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Comprehensive Evaluation and Analysis of Multi-Rod Constructs in Adult Spinal Deformity medRxiv. Surg. Pub Date : 2023-12-13 Moatasem M Azzam
Adult Spinal Deformity (ASD) is a degenerative condition of the spinal column that is categorized by sagittal imbalance, iatrogenic spinal deformity, and abnormal spinal curvature and leads to diminished quality of life. ASD is frequently repaired via neurological or orthopedic spine surgery to restore normal curvature and alignment. Surgical correction often involves the use of single, dual, or multiple-rod
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Wearable Device-Measured Daily Step Count is an Independent Predictor of Postoperative Surgical Complications Among All of Us Research Participants medRxiv. Surg. Pub Date : 2023-12-09 Carson J. Gehl, Nathaniel B. Verhagen, Tahseen J. Shaik, Kaitlyn Nimmer, Xin Yang, Bradley W. Taylor, Mochamad M. Nataliansyah, Sarah L. Kerns, Anai N. Kothari
Background The association between preoperative wearable device step counts and surgical outcomes has not been examined using commercial devices linked to electronic health records (EHR) at a population level. This study measured the association between daily preoperative step counts and postoperative complications.
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WITHDRAWN: Comparison of the effects of methylene blue with adrenaline and Marcaine with adrenaline on pain control after hemorrhoidectomy medRxiv. Surg. Pub Date : 2023-12-12 Ramin Azhough, mohammad Reza Dashti, Sahar Taher, Pooya Jalali
The authors have withdrawn their manuscript owing to Improve the article. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
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Length of hospital stay and associated factors among adult surgical patients admitted to a surgical ward in Amhara Regional State Comprehensive Specialized Hospitals, Ethiopia medRxiv. Surg. Pub Date : 2023-12-09 Habtamu Hurisa Dadi, Netsanet Habte, Yenework Mulu, Yabibal Asfaw
Introduction Hospitals across the country are experiencing a rise in the length of hospital stays, ranging from 2% to 14%. As a result, patients who remain hospitalized for a prolonged period are three times more likely to suffer in-hospital deaths. Therefore, identifying contributing factors for prolonged hospital stays enhances the ability to improve services and the quality of patient care. However
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Effect of rural trauma team development on outcomes of motorcycle related injuries: A protocol for a multi-center cluster randomized controlled clinical trial (The MOTOR trial) medRxiv. Surg. Pub Date : 2023-12-09 Herman Lule, Micheal A. Mugerwa, Robinson SSebuufu, Patrick Kyamanywa, Till Bärnighausen, Jussi P. Posti, Michael Lowery Wilson
Background Injury is a global health concern whose mortality disproportionately impact low-income countries. Compelling evidence from high-income countries show that rural trauma team development courses (RTTDC) increase clinicians’ knowledge. There is a dearth of evidence from controlled clinical trials to demonstrate the effect of RTTDC on process and patient outcomes. We document a protocol for
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The Role of Early Brain Injury assessment in a-SAH in predicting Structural Brain Abnormalities in Cognitive Impairments medRxiv. Surg. Pub Date : 2023-12-07 Mingdong Wang, Qian-Hui Fu, Andrew Ni, Yun-Peng Yuan, Chun-Hui Li, Zhan Xiang WANG, Hong Wang
Background Early brain edema and/or Hematoma after aneurysmal subarachnoid hemorrhage (a-SAH) is an important impact determinant of clinical cognition outcomes. However, due to the lack of early assessment of the impact on cognitive structural systems, Therefore, there is a need to develop early predictive and/or decision-making models, termed the a-SAH Early Brain Edema/Hematoma Compression Neural
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Systematic Review Protocol of aetiology of mechanical bowel obstruction in Low-and-middle income countries: Has anything changed in the last two decades? medRxiv. Surg. Pub Date : 2023-12-06 Yakubu Kevin Kwarshak, Mohammed Nakodi Yisa, Oghenegare Asheaba Kigbu, Daniel Akut John, Karen Chineme Ubabuike, Nankam David Jimwan, Peter Mkurtar Yawe
Background: Despite various causes of mechanical obstruction, there appears to be a great deal of variation depending on geographical location and age. Geographically, postoperative adhesions and hernia have been documented as the most common aetiology of mechanical bowel obstruction in high-income and low-and-middle-income countries, respectively. Whether there has been a change in this trend in low-
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The influence of sidedness in unilateral cleft lip and palate on mid facial growth at 5 years of age medRxiv. Surg. Pub Date : 2023-12-05 Matthew John Fell, David Chong, Paras Parmar, Ting-Li Su, Lars Enocson, Bruce Richard
Objective: To determine whether facial growth at five years is different for children with a right versus left sided cleft lip and palate. Design: Retrospective cohort study Setting: Nine UK cleft centres Patients: Patients born between 2000-2014 with a complete unilateral cleft lip and palate (UCLP) Main outcomes measure: 5-Year-Olds Index scores Results: 378 children were included. 122 (32%) had
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WITHDRAWN: Epigenetic clocks and risk assessment in adult spinal deformity: A novel association between pace of aging with frailty, disability, and postoperative complications medRxiv. Surg. Pub Date : 2023-11-29 Michael M. Safaee, Varun B. Dwaraka, Justin M. Lee, Marissa Fury, Tavis L. Mendez, Ryan Smith, Jue Lin, Dana L. Smith, John F. Burke, Justin K. Scheer, Hannah Went, Christopher P. Ames
The authors have withdrawn their manuscript owing to altered the findings and conclusions related to complication data. The changes in results were due to further scrutiny of the datasets, and led to the removal of 3 patients due to incomplete data. This refinement led to updated results which changed the conclusion of the complication data. Therefore, the authors do not wish this work to be cited
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Differential Prognostic Value of Angiography-Derived Microcirculatory Resistance for Coronary Artery Bypass Grafting of Intermediate Coronary Stenosis medRxiv. Surg. Pub Date : 2023-11-23 Wenlong Yan, Yangyang Wang, Haoyu Hu, Wei Wang, Zhenfu Li, Xin Zheng, Sumin Yang
BACKGROUND For patients with intermediate coronary stenoses, the prognostic value of coronary artery bypass grafting (CABG) remains controversial. The prognostic impact of CABG may be different according to Murray law-based quantitative flow ratio (μQFR) and angiography-derived microcirculatory resistance (AMR) in patients with intermediate coronary stenoses.
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Impact of Physician Experience on Stroke or Death Rates in Transfemoral Carotid Artery Stenting: Insights from the VQI medRxiv. Surg. Pub Date : 2023-11-17 Gabriel Jabbour, Sai Divya Yadavalli, Sabrina Strauss, Andrew P Sanders, Vinamr Rastogi, Jens Eldrup-Jorgensen, Richard J Powell, Roger B. Davis, Marc L. Schermerhorn
Objective: With the recent expansion of the Centers for Medicare and Medicaid Services (CMS) coverage, transfemoral carotid artery stenting (tfCAS) is expected to play a larger role in the management of carotid disease. Existing research on the tfCAS learning curve, primarily conducted over a decade ago, may not adequately describe the current effect of physician experience on outcomes. This study
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Connectome reorganization associated with temporal lobe pathology and its surgical resection medRxiv. Surg. Pub Date : 2023-11-13 Sara Lariviere, Bo-yong Park, Jessica Royer, Jordan DeKraker, Alexander Ngo, Ella Sahlas, Judy Chen, Raul Rodriguez-Cruces, Yifei Weng, Birgit Frauscher, Zhengge Wang, Bratislav Misic, Golia Shafiei, Andrea Bernasconi, Neda Bernasconi, Michael D Fox, Zhiqiang Zhang, Boris Bernhardt
Network neuroscience offers a unique framework to understand the organizational principles of the human brain. Despite recent progress, our understanding of how the brain is modulated by focal lesions remains incomplete. Resection of the temporal lobe is the most effective treatment to control seizures in pharmaco-resistant temporal lobe epilepsy (TLE), making this syndrome a powerful model to study
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Development of a privacy preserving large language model for automated data extraction from thyroid cancer pathology reports medRxiv. Surg. Pub Date : 2023-11-08 Denise Lee, Akhil Vaid, Kartikeya Menon, Robert Freeman, David Matteson, Michael Marin, Girish Nadkarni
Introduction: Popularized by ChatGPT, large language models (LLM) are poised to transform the scalability of clinical natural language processing (NLP) downstream tasks such as medical question answering (MQA) and may enhance the ability to rapidly and accurately extract key information from clinical narrative reports. However, the use of LLMs in the healthcare setting is limited by cost, computing
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Characterisation of post-fundoplication gastric dysfunction using Gastric Alimetry medRxiv. Surg. Pub Date : 2023-11-06 William Xu, Tim Hsu-Han Wang, Daphne Foong, Gabe Schamberg, Nicholas Evennett, Grant Beban, Armen Gharibans, Stefan Alimetry, Charlotte Daker, Vincent Ho, Gregory O'Grady
Background Adverse gastric symptoms persist in up to 20% of fundoplication surgeries completed for gastroesophageal reflux disease, causing significant morbidity, and driving the need for revisional procedures. Non-invasive techniques to assess the mechanisms of persistent postoperative symptoms are lacking. We aimed to investigate gastric myoelectrical abnormalities and symptoms in patients after
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Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors (NETs): Risks and benefits of multimodality surgical treatment for NETs involving liver medRxiv. Surg. Pub Date : 2023-11-03 Alexander Ostapenko, Stephanie Stroever, Lud Eyasu, Minha Kim, Krist Aploks, Xiang Dong, Ramanathan Seshadri
Background: Resection of hepatic metastasis from neuroendocrine tumors (NETs) improves qual-ity of life and prolongs 5-year survival. Ablation can be utilized with surgery to achieve complete resection. Although several studies report long-term outcomes for patients undergoing ablation, none have explored perioperative effects of ablation in patients with metastatic NETs. Our goal was to determine
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Classification and management strategy of spontaneous carotid artery dissection medRxiv. Surg. Pub Date : 2023-10-25 Baoning Zhou, Chong Li, Zhaohui Hua, Zhouyang Jiao, Hui Cao, Peng Xue, Shirui Liu, Zhen Li
Background and Purpose—Spontaneous carotid artery dissections (sCAD) are the main cause of stroke in young people. There is still a lack of clinical classification to guide the management of sCAD. We reviewed our experience with 179 sCAD patients and proposed a new classification for sCAD with prognostic and therapeutic significance. Methods—This is a retrospective review of prospectively collected
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Prospective validation of a predictive non-invasive SNP-based biomarker signature in resectable pancreatic cancer: a study protocol. medRxiv. Surg. Pub Date : 2023-10-25 Nico Seeger, Stefan Gutknecht, Irin Zschokke, Isabella Fleischmann, Nadja Roth, Juerg Metzger, Markus Weber, Stefan Breitenstein, Lukasz Grochola
Background: A growing body of work suggests that inherited genetic variants can be utilized as non-invasive biomarkers to predict cancer-specific patient outcomes and guide therapy after resection of pancreatic ductal adenocarcinoma (PDAC). Specifically, two recent retrospective analyses led to the identification and retrospective validation of three single nucleotide polymorphisms (SNPs) in the CD44
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Quality and sustainability of Ethiopia’s national surgical indicators medRxiv. Surg. Pub Date : 2023-10-25 Kayleigh Cook, Zebenay B Zeleke, Ephrem Gebrehana, Daniel Burssa, Bantalem Yeshanew, Atkilt Michael, Yoseph Tediso, Taylor Jaraczewski, Chris Dodgion, Andualem Beyene, Katherine R Iverson
In 2015, the Ethiopian Federal Ministry of Health (FMOH) developed the Saving Lives through Safe Surgery (SaLTS) initiative to improve national surgical care. Previous work led to development and implementation of 15 surgical key performance indicators (KPIs) to standardize surgical data practices. The objective of this project is to investigate current practices of KPI data collection and assess quality
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Systematic assessment of early brain injury severity at admission with aneurysmal subarachnoid hemorrhage medRxiv. Surg. Pub Date : 2023-10-24 Sheri Tuzi, Beate Kranawetter, Veit Rohde, Dorothee Mielke, Vesna Malinova
Background: Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) has been increasingly recognized as a risk factor for delayed cerebral ischemia (DCI). While several clinical and radiological EBI biomarkers have been identified, no tool for systematic assessment of EBI severity has been established so far. This study aimed to develop an EBI grading system based on clinical signs
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Percent Thrombus Outperforms Size in Predicting Popliteal Artery Aneurysm Related Thromboembolic Events medRxiv. Surg. Pub Date : 2023-10-10 Tiffany R Bellomo, Guillaume Goudot, Srihari Lella, Brandon Gaston, Natalie Sumetsky, Shiv S Patel, Ashley Brunson, Jenna Beardsley, Nikolaos Zacharias, Anahita Dua
Introduction: Popliteal artery aneurysms (PAAs) are associated with high morbidity and mortality and current Society for Vascular Surgery (SVS) recommend operative repair for PAAs with a diameter greater than 20 mm, which is based on limited evidence. To help risk stratify patients for surgery, our aim was to identify anatomic characteristics of PAA associated with limb threatening and thromboembolic
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Lessons Learned from Development and Implementation of the National Surgical, Obstetric and Anaesthesia Plan in Ethiopia: a qualitative study medRxiv. Surg. Pub Date : 2023-10-06 Amanuel Belay, Medhanit Getachew, Abebe Bekele, Andualem Deneke Beyene, Amezene Tadesse, Justine Davies, Andrew JM Leather, Charlotte Hanlon
Background The Saving Lives Through Safe Surgery (SaLTS) project was launched in 2016 by the Ethiopian Ministry of Health to improve access and quality of surgical and anaesthesia care throughout Ethiopia. A key action of SaLTS was to develop a National Surgical, Obstetric and Anaesthesia Plan (NSOAP). The aim of this study was to explore barriers and facilitators in the development and implementation
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Source of data for artificial intelligence applications in vascular surgery - a scoping review. medRxiv. Surg. Pub Date : 2023-10-04 Katarzyna Powezka, Luke T Slater, Michael Wall, Georgios Gkoutos, Maciej Juszczak
Background: Applications of Artificial Intelligence (AI) are gaining traction in healthcare, including vascular surgery. While most healthcare data is in the form of narrative text or audio recordings, natural language processing (NLP) offers the ability to extract structured information from unstructured medical records. This can be used to develop more accurate risk prediction models, and to identify
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The impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: a multi-specialty, prospective cohort study in 25 countries medRxiv. Surg. Pub Date : 2023-10-03 William Xu, TASMAN Collaborative
Background Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. Concern about inadequate analgesia after discharge contributes to excessive opioid prescribing, but the benefits of opioid prescription following discharge remains unclear. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia
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Patterns of opioid use after surgical discharge: a multicentre, prospective cohort study in 25 countries medRxiv. Surg. Pub Date : 2023-10-02 TASMAN Collaborative, Chris Varghese
Background Excessive post-surgical opioid prescribing is contributing to the growing opioid crisis. Prescribing practices are modifiable, yet data to guide appropriate prescription of opioids at surgical discharge remain sparse. We therefore aimed to evaluate the factors associated with opioid consumption following discharge from surgery. Methods We performed an international, prospective, multicentre
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ReMIND: The Brain Resection Multimodal Imaging Database medRxiv. Surg. Pub Date : 2023-09-15 Parikshit Juvekar, Reuben Dorent, Fryderyk Kogl, Erickson Torio, Colton Barr, Laura Rigolo, Colin Galvin, Nick Jowkar, Anees Kazi, Nazim Haouchine, Harneet Cheema, Nassir Navab, Steve Pieper, William M. Wells, Wenya L Bi, Alexandra Golby, Sarah Frisken, Tina Kapur
The standard of care for brain tumors is maximal safe surgical resection as the first step. Neuronavigation augments the surgeon's ability to achieve this but loses validity due to brain shift as surgery progresses. Moreover, many gliomas are difficult to distinguish from adjacent healthy brain tissue. Intraoperative MRI (iMRI) is a useful surgical adjunct that can be used to visualize the residual
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Identification of new angio-architectural features of at-risk cranial dural arteriovenous fistulas using machine learning approaches medRxiv. Surg. Pub Date : 2023-09-03 Katharina Frank, Paiman Shalchian-Tehran, Mihai Manu, Zafer Cinibulak, Joerg Poggenborg, Makoto Nakamura
Background. Cranial arteriovenous fistulas are rare complex vascular malformations that have a bleeding risk with potential lethal consequences. Despite this, knowledge of the vascular architectural features associated with the rupture risk are not always clearly defined. Methods. We retrospectively analyzed cranial arteriovenous fistulas in terms of their anatomical and angio-architectural features
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Impact of treatment of varicose veins with polidocanol foam compared to conventional surgery on quality of life medRxiv. Surg. Pub Date : 2023-08-28 Lissa Severo Sakugawa, Felipe Soares Oliveira Portela, Andressa Cristina Sposato Louzada, Maria Fernanda Cassino Portugal, Marcelo Passos Teivelis, Cynthia de Almeida Mendes, Alexandre Fioranelli, Nelson Wolosker
Background and objective: Lower limb varicose veins are very prevalent and there are several treatment options available, including conventional surgery and polidocanol foam sclerotherapy. Few studies analyze therapeutic modalities based on PROMs (patient-reported outcome measures). The aim of this study was to evaluate the impact of treatment with polidocanol foam sclerotherapy compared to conventional
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The role of Decompressive Craniectomy after Surgical Aneurysm Repair: Analysis of an Australian Cerebrovascular Registry medRxiv. Surg. Pub Date : 2023-08-23 Tom JM O'Donohoe, Christopher Ovenden, George Bouras, Seevakan Chidambaram, Stephanie Plummer, Andrew Davidson, Timothy Kleinig, Amal Abou-Hamden
Background: Decompressive craniectomy (DC) remains a controversial intervention for established or anticipated intracranial hypertension among patients with aneurysmal subarachnoid haemorrhage (aSAH). Methods: We identified aSAH patients who underwent DC following microsurgical aneurysm repair from a prospectively maintained cerebrovascular registry and compared their outcomes with a propensity-matched
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ASSESSING THE VALUE OF DEEP NEURAL NETWORKS FOR POSTOPERARTIVE COMPLICATION PREDICTION IN PANCREATICODUODENECTOMY PATIENTS medRxiv. Surg. Pub Date : 2023-08-22 Mikkel Bonde, Alexander Bonde, Haytham Kaafarani, Martin Sillesen, Andreas Millarch
Introduction: Pancreaticoduodenectomy (PD) for patients with pancreatic ductal adenocarcinoma (PDAC) is associated with a high risk of postoperative complications (PoCs) and risk prediction of these is therefore critical for optimal treatment planning. We hypothesize that novel deep learning network approaches through transfer learning may be superior to legacy approaches for PoC risk prediction in
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Diagnostic accuracy of CEUS in identifying Solid Pancreatic Lesions:- A meta analysis medRxiv. Surg. Pub Date : 2023-08-16 Dev Desai, Shimolee Patel, Hetvi Shah, Abhijay Shah, Anushka Verma, Maria Eleni Malafi
Background- Solid pancreatic lesions are crucial to identify because of their high incidence rate and their poor survival rate. Surgical biopsy, ultrasonography, computed tomography, MRI, and PET-CT are examples of diagnostic tools. Although common, endoscopic ultrasonography guided biopsy carries a risk of needle track seeding. A more effective and affordable method for determining the differential
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Exploring Burn First Aid Knowledge and Water Lavage Practices in Uganda: A Cross-Sectional Study. medRxiv. Surg. Pub Date : 2023-08-15 Brian Kasagga, Joseph Baruch Baluku, Felix Bongomin, Derrick Kasozi, Eria Muwanguzi, Mercy Namazzi, Yusuf Sadiq, Rose Alenyo, Edris Kalanzi, Darius Balumuka, Alex Emmanuel Elobu
Background: Low- and middle-income countries experience higher burn-related morbidity and mortality compared to high-income countries. Prehospital Burn First Aid (BFA) has been proven effective in reducing such outcomes. This study aimed to assess BFA knowledge and water lavage practices and their associated factors among burn victims, their caretakers and visitors at a tertiary health facility in
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Machine learning based prediction of recurrence after curative resection for rectal cancer medRxiv. Surg. Pub Date : 2023-08-06 Youngbae Jeon, Young-Jae Kim, Jisoo Jeon, Kug-Hyun Nam, Tae-Sik Hwang, Kwang-Gi Kim, Jeong-Heum Baek
Purpose Patients with rectal cancer without distant metastases are typically treated with radical surgery. Post curative resection, several factors can affect tumor recurrence. This study aimed to analyze factors related to rectal cancer recurrence after curative resection using different machine learning techniques. Methods Consecutive patients who underwent curative surgery for rectal cancer between
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The impact of intracranial pressure telesensors: an observational propensity matched-control analysis of service demand and costs medRxiv. Surg. Pub Date : 2023-08-04 Anand S Pandit, Muhammad A Kamal, Gerda Reischer, Yousif Aldabbagh, Mohammad Alradhawi, Faith MY Lee, Priya P Sekhon, Eleanor M Moncur, Ptolemy DW Banks, Simon Thompson, Lewis Thorne, Laurence D Watkins, Ahmed K Toma
Background: Implantable telemetric intracranial pressure sensors (telesensors) enable routine, non-invasive ICP feedback, aiding clinical decision-making and attribution of pressure-related symptoms in patients with CSF shunt systems. Here, we aim to explore the impact of these devices on service demand and costs in patients with adult hydrocephalus. Methods: We performed an observational propensity
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Diagnostic performance of urinary 5-Hydroxyindoleacetic Acid in acute appendicitis:a systematic review and diagnostic test accuracy meta-analysis medRxiv. Surg. Pub Date : 2023-08-02 Javier Arredondo Montero, Oscar Emilio Bueso Asfura, Blanca Paola Perez-Riveros, Maria Rico-Jimenez
Background: This study aimed to analyze the diagnostic performance of urinary 5-Hydroxyindoleacetic Acid (5-HIAA) in acute appendicitis (AA). Methods: We conducted a systematic review of the literature in the main databases of medical bibliography. Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of
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A prospective observational cohort study to investigate the effect of frailty on mortality of adults following lower limb amputation medRxiv. Surg. Pub Date : 2023-07-30 Silje Welsh, John Gale, Ben Carter, Keith Hussey, Douglas Orr, Terence J. Quinn, Philip Braude
Introduction: Frailty is common in patients with atherosclerotic disease and is associated with substantially increased morbidity, mortality and significant economic and resource implications. Major limb amputation (MLA) secondary to critical limb threatening ischaemia (CLTI) is also associated with high mortality rates. This study aims to examine the association between frailty, as defined by the
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Evaluating Capabilities of Large Language Models: Performance of GPT4 on Surgical Knowledge Assessments medRxiv. Surg. Pub Date : 2023-07-24 Brendin Beaulieu-Jones, Sahaj Shah, Margaret T Berrigan, Jayson S Marwaha, Shuo-Lun Lai, Gabriel A Brat
Abstract Background: Artificial intelligence (AI) has the potential to dramatically alter healthcare by enhancing how we diagnosis and treat disease. One promising AI model is ChatGPT, a large general-purpose language model trained by OpenAI. The chat interface has shown robust, human-level performance on several professional and academic benchmarks. We sought to probe its performance and stability