PURPOSE: Femur fractures are among the most common fractures treated surgically, representing a significant challenge for the orthopedic surgeon. Peri-implant femoral fractures (PIFFs) represent a rare complication of the surgical treatment. It is necessary to pay attention during osteosynthesis, evaluating not only the fracture site but the entire femoral skeletal structure, the characteristics of the fracture, the health comorbidities, and the risk of malunion and pseudarthrosis. There are few studies on the incidence, treatment, and outcomes of PIFFs near osteosynthesis. This study aimed to investigate PIFF after osteosynthesis of femoral fractures and evaluate the mortality after surgery and the morbidity associated with these types of fractures. METHODS: A retrospective cohort study was carried out at the IRCCS Galeazzi Orthopedic Institute, Milan, Italy, between January, 2017 and December, 2022. Inclusion criteria were the presence of a femur fracture around an intramedullary nail to treat a previous fracture, follow-up ≥ 12 months, and patients aged ≥ 65 years. Exclusion criterion was intraoperative periprosthetic fractures. The data were expressed as frequency and percentage. Continuous variables were expressed as mean ± standard deviation or median and range. RESULTS: Overall, 25 patients were enrolled (88.0% female) and the mean age was 84.5 years (range of 70 - 92 years). There were 20 patients having type B PIFF and 5 having type C. In 22 patients, multiple comorbidities were found with an average Charlson comorbidity score of 5.5 and the mean time to peri-implant fracture was 38 months. After surgery, 1 patient (4.0%) presented renal failure, 1 (4.0%) needed removal surgery for their loosening, and 2 (8.0%) presented surgical site infection. Nine patients (36.0%) died within 1 year with a mortality rate of 20.0% at 30 days, 8.0% at 3 months, and 8.0% at 12 months. CONCLUSIONS PIFFs in elderly patients are associated with high short-term mortality and morbidity, so careful planning for primary fracture surgery and patient awareness to ensure prolonged compliance and a healthy lifestyle are essential for prevention.
Humans ; Female ; Male ; Aged ; Femoral Fractures/mortality* ; Retrospective Studies ; Aged, 80 and over ; Periprosthetic Fractures/epidemiology* ; Fracture Fixation, Intramedullary/adverse effects* ; Postoperative Complications/mortality*

To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠor Ⅲ aortic dissection. The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ, =47)or type Ⅲ(group Ⅲ, =83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups. The 30-day mortality rate was 6.9%(=9)in the overall cohort,with no statistic difference between groupⅠand group Ⅲ(10.6% 4.8%;=0.803, =0.370).The incidence of major adverse events(38.3% 51.8%;=2.199, =0.138),5-year actuarial survival rate [(81.7±5.9)% (87.2±4.2)%;=0.483, =0.487],and 5-year actuarial freedom from all reinterventions [(84.5±6.7)% (85.5±4.8)%;=0.010, =0.920] showed no significant differences between these two groups. The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠ and type Ⅲ patients.However,studies with larger sample sizes are still required.
Aneurysm, Dissecting ; Aortic Aneurysm, Thoracic ; Blood Vessel Prosthesis Implantation ; Hospital Mortality ; Humans ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

PURPOSE: The purpose of this study was to determine whether poor preoperative nutritional status in elderly patients exhibited a negative influence on postoperative clinical outcomes.METHODS: The medical records of 645 elderly patients were examined retrospectively. The patients had undergone major surgery between January 2017 and January 2018. Their nutritional status was measured using the Nutritional Risk Screening 2002. The data were analyzed using the chi-squared test, the Mann-Whitney U test, logistic regression, linear regression, Cox proportional hazards regression, and the Kaplan-Meier analysis.RESULTS: Preoperative malnutrition was found in 73 patients (11.3%). Poor preoperative nutritional status was significantly associated with pressure ulcers, length of hospitalization, discharge to patient care facilities rather than home, and mortality rate at three months.CONCLUSION: Preoperative malnutrition in elderly patients was associated with negative postoperative clinical outcomes. These results indicate that an effective nutritional program before surgery can lead to a more rapid postoperative recovery.
Aged ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Linear Models ; Logistic Models ; Malnutrition ; Mass Screening ; Medical Records ; Mortality ; Nutritional Status ; Patient Care ; Postoperative Complications ; Pressure Ulcer ; Retrospective Studies

PURPOSE: Peritoneal carcinomatosis (PC) has been considered a terminal condition and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIEPC) is regarded as an alternative therapeutic option. This study aimed to evaluate the 30-day clinical outcomes of CRS/HIPEC and the feasibility of the surgery by investigating the morbidity and mortality in Inje University Hospital.METHODS: Data were retrospectively collected from 19 patients with PC who underwent CRS/HIPEC at Inje University Hospital in 2018. We evaluated pre-, intra-operative parameters and postoperative clinical outcomes and early complications.RESULTS: The mean operating time was 506.95 minutes and the mean blood loss was 837.11 mL. Six cases (31.58%) had morbidity of grade III or above. A longer operating time (≥560 minutes, P=0.038) and large blood loss (≥700 mL, P=0.060) were positively correlated with grade III or worse postoperative complications.CONCLUSION: Our early experience with CRS/HIPEC resulted in a 31.58% morbidity rate of grade III and above, with risk factors being longer operating time and greater intraoperative blood loss. As the surgical team's skills improve, a shorter operating time with less intraoperative blood loss could result in better short-term outcomes of CRS/HIPEC.
Carcinoma ; Drug Therapy ; Humans ; Korea ; Mortality ; Postoperative Complications ; Retrospective Studies ; Risk Factors

OBJECTIVE: This study aimed to assess the surgical results of the intradural transpetrosectomy for petrous apex meningiomas (PAMs). In addition, we describe the methods and techniques used to expose and manage superior petrous vein and greater superficial petrosal nerve.METHODS: The authors conducted a retrospective study of 16 patients with PAMs operated by the senior author via the intradural transpetrosectomy between February 2012 to May 2017. We reviewed patient data regarding the general characteristics, surgical technique and surgery-related outcomes and adopted a combined follow-up strategy of clinic and telephone contacts to evaluate postoperative complications.RESULTS: Simpson grade I and II resection was performed in 10 out of 16 cases (62.5%), and grade III resection were reported in the remaining six cases (37.5%) with no resultant mortality. The mean Karnofsky Performance Status score was 85.6 preoperatively and improved to 91.9 postoperatively, with a mean follow-up period of 34.4 months (range, 6–66 months). Tumor recurrence was found in two patients and they underwent the second surgical operation.CONCLUSION: PAMs could be completely resected by the intradural transpetrosectomy with an improved survival rate and postoperative life quality. Superior petrous vein and greater superficial petrosal nerve should be managed properly in avoidance of postoperative complications. Finally, most meningioma inside cavernous sinus or adhered to brainstem could be totally removed without postoperative complications.
Brain Stem ; Cavernous Sinus ; Follow-Up Studies ; Humans ; Karnofsky Performance Status ; Meningioma ; Mortality ; Neurosurgical Procedures ; Petrous Bone ; Postoperative Complications ; Quality of Life ; Recurrence ; Retrospective Studies ; Survival Rate ; Telephone ; Veins

Aged ; Aged, 80 and over ; Analgesics, Opioid ; adverse effects ; Benzodiazepines ; adverse effects ; Cognitive Dysfunction ; chemically induced ; mortality ; Female ; Humans ; Male ; Postoperative Complications ; Randomized Controlled Trials as Topic ; Risk Factors

PURPOSE: The optimal method for intracorporeal esophagojejunostomy remains unclear because a purse-string suture for fixing the anvil into the esophagus is difficult to perform with a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique to fix the anvil into the esophagus. MATERIALS AND METHODS: This retrospective study included 202 patients who were treated at our institution with an intracorporeal circular esophagojejunostomy in a laparoscopy-assisted total gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopy-assisted proximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 of the esophageal wall, a hand-sewn purse-string suture was placed on the esophagus. Next, the anvil head of a circular stapler was introduced into the esophagus. Finally, the circular esophagojejunostomy was performed laparoscopically. The clinical characteristics and surgical outcomes were evaluated and compared with those of other methods. RESULTS: The average operation time was 200.3 minutes. The average hand-sewn purse-string suturing time was 6.4 minutes. The overall incidence of postoperative complications (Clavien–Dindo classification grade ≥II) was 26%. The number of patients with an anastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12 (6.0%), respectively. All patients with stenosis were successfully treated by endoscopic balloon dilatation. There was no mortality. Regarding the materials and devices for anvil fixation, only 1 absorbable thread was needed. CONCLUSIONS: Our procedure for hand-sewn purse-string suturing with the double ligation method is simple and safe.
Anastomotic Leak ; Classification ; Constriction, Pathologic ; Dilatation ; Esophagus ; Gastrectomy ; Head ; Humans ; Incidence ; Laparoscopy ; Ligation ; Methods ; Mortality ; Postoperative Complications ; Retrospective Studies ; Sutures

BACKGROUND: Pulmonary thromboembolism (PTE) is a life-threatening disease with high mortality. This study aimed to assess the outcomes of surgical embolectomy and to clarify the sustained long-term effects of surgery by comparing preoperative, postoperative, and long-term follow-up echocardiography outcomes. Of 22 survivors, 21 were followed up for a mean (median) period of 6.8±5.4 years (4.2 years). METHODS: We retrospectively reviewed 27 surgical embolectomy cases for massive or submassive acute PTE from 2003 to 2016. Immediate and long-term follow-up outcomes of surgical embolectomy were assessed on the basis of 30-day mortality, long-term mortality, postoperative complications, right ventricular systolic pressure, and tricuspid regurgitation grade. RESULTS: The 30-day and long-term mortality rates were 14.8% (4 of 27) and 4.3% (1 of 23), respectively. Three patients had major postoperative complications, including hypoxic brain damage, acute kidney injury, and endobronchial bleeding, respectively (3.7% each). Right ventricular systolic pressure (median [range], mm Hg) decreased from 62.0 (45.5–78.5) to 31.0 (25.7–37.0, p<0.001). The tricuspid valve regurgitation grade (median [range]) decreased from 1.5 (0.63–2.00) to 0.50 (0.50–1.00, p<0.05). The improvement lasted until the last echocardiographic follow-up. CONCLUSION: Surgical embolectomy revealed favorable mortality and morbidity rates in patients with acute massive or submassive PTE, with sustained long-term improvements in cardiac function.
Acute Kidney Injury ; Blood Pressure ; Cardiopulmonary Bypass ; Echocardiography ; Embolectomy ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypoxia, Brain ; Mortality ; Postoperative Complications ; Pulmonary Embolism ; Retrospective Studies ; Survivors ; Tricuspid Valve Insufficiency

BACKGROUND: The endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft. METHODS: We retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications. RESULTS: Among 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was 37.86±30.73 months (range, 0–124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively. CONCLUSION: The use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.
Aorta, Thoracic ; Aortic Diseases ; Aortic Rupture ; Blood Vessel Prosthesis ; Emergencies ; Endoleak ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Freedom ; Gyeonggi-do ; Hospital Mortality ; Humans ; Incidence ; Pneumonia ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies ; Spinal Cord Injuries ; Stents ; Stroke ; Survival Rate

PURPOSE: There are several commercially approved stent grafts in Korea for the treatment of abdominal aortic aneurysms (AAAs). Each device has its advantages and disadvantages based on the patient’s anatomy and the clinical situation. The Zenith device allows accurate and precise endograft placement, whereas the Endurant device has improved flexibility and trackability. We reviewed 5 cases in which a combination of the Zenith main body and the Endurant iliac limb was used. MATERIALS AND METHODS: From January 2010 to February 2015, 90 patients with AAA underwent endovascular aneurysm repair (EVAR) using the Zenith body at Daegu Catholic University Hospital. Among them, 5 patients who underwent EVAR with the Zenith body and Endurant iliac limb were included in this study. RESULTS: The mean age of the patients was 74.20±3.35 years. All patients were men. The main reason for use of the Endurant iliac limb was aortoiliac angulation. Type III endoleak, stent migration, and stent kinking were not noted. Comparing 85 patients who received a Zenith endograft with 5 patients who received the hybrid endograft, there were no statistical differences in clinical characteristics, intraoperative details and post procedural complications. The mean admission duration was 19.00±13.60 days, and the mean follow-up duration was 1,018.11±925.34 days. In the hybrid endograft group, there was no mortality during the follow-up duration. CONCLUSION: Although the material, radial force, diameter, and length of the overlap zone differ between the two devices, EVAR with the hybrid endograft is safe and effective.
Aneurysm ; Aortic Aneurysm, Abdominal ; Blood Vessel Prosthesis ; Daegu ; Endoleak ; Endovascular Procedures ; Extremities ; Follow-Up Studies ; Humans ; Korea ; Male ; Mortality ; Pliability ; Postoperative Complications ; Stents