Hamidreza Hosseinpour

Background: The incidence and timing of postoperative venous thromboembolism (VTE) across surgical specialties remains unclear. This study aimed to evaluate the incidence and temporal pattern of VTE among a nationally representative cohort of surgical patients. Methods: We analyzed data from the 2022 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Adult (≥18 years) patients undergoing common surgical procedures in general surgery, colorectal, vascular and plastic surgery, and surgical oncology and gynecology were included. Outcomes assessed included the incidence of postoperative VTE, defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), and time following surgery, in days, that the diagnosis was made. Results: Of a total of 525 726 patients, 0.8% developed VTE within 30 days of the index operation, with surgical oncology having the highest rate (3%), followed by colorectal surgery (2%). The median [IQR] time to VTE diagnosis was 9[4-16] days. Among those who developed VTE, 54% were diagnosed after discharge. Plastic surgery held the highest percentage of post-discharge VTE diagnosis at 77%, but longest median time to diagnosis (10.5 days). On multivariable regression analysis, surgical oncology (aOR:1.426, P < 0.001) and colorectal surgery (aOR:1.208, P < 0.001) showed the highest odds of developing postoperative VTE but the lowest proportion diagnosed following discharge. Conclusion: The temporal pattern of postoperative VTE varies substantially across surgical specialties. More than half of VTE events occurred after hospital discharge, with considerable differences in the length of time between surgery and diagnosis between groups. These findings suggest that postoperative VTE risk and temporal trends are influenced by specialty-specific perioperative practices, highlighting the need for tailored surveillance and prevention strategies.

Background: The optimal surgical approach for chronic diaphragmatic hernia (CDH) remains unclear. This study aimed to compare outcomes of thoracotomy vs laparotomy vs laparoscopic repair of CDH. Methods: We conducted a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2013-2022. Adult patients (≥18 years) with non-congenital non-hiatal CDH (with or without obstruction) who underwent thoracotomy, laparotomy, or laparoscopy were included. Outcomes assessed included postoperative complications, unplanned return to the operating room (OR), 30-day readmissions, and unfavorable discharge disposition. Results: A total of 610 patients underwent CDH repair: 156 thoracotomies, 275 laparotomies, and 179 laparoscopies. Chronic diaphragmatic hernia complicated by obstruction was present in 35.2% of patients. On univariate analysis, rates of complications ( P = 0.248), readmissions ( P = 0.971), unplanned return to OR ( P = 0.068), and discharge disposition ( P = 0.937) did not differ significantly among groups. On multivariable regression analysis, among patients presenting with obstruction symptoms, laparoscopy was associated with higher odds of unplanned return to OR (aOR: 3.91, 95% CI: 1.91-5.57) and unfavorable discharge (aOR: 1.50, 95% CI: 1.13-4.71), whereas laparotomy was associated with lower odds of both unplanned return to OR (aOR: 0.17, 95% CI: 0.01-0.36) and unfavorable discharge disposition (aOR: 0.41, 95% CI: 0.15-0.84), compared with thoracotomy. Conclusion: Across a decade of national data, outcomes were similar among thoracotomy, laparotomy, and laparoscopy for uncomplicated CDH. In patients with obstruction, however, laparoscopy, used in nearly one in five cases, was associated with increased risks of reoperation and unfavorable discharge disposition. These findings emphasize the importance of careful patient selection and surgical expertise in tailoring operative approach to CDH.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing hemorrhage control intervention, but its inevitable effect on time to operating room (OR) has not been assessed. The aim of our study is to assess the impact of undergoing REBOA before surgery (RBS) on time to definitive hemorrhage control surgery. In this retrospective analysis of 2017–2021 ACS-TQIP database, all adult (≥18 years) patients who underwent emergency hemorrhage control laparotomy (≤4 hours of admission) and received early blood products (≤4 hours) were included, and patients with severe head injury (Head-abbreviated injury score > 2) were excluded. Patients were stratified into those who did (RBS) vs those who did not undergo REBOA before surgery (No-RBS). Primary outcome was time to laparotomy. Secondary outcomes were complications and mortality. Multivariable linear and binary logistic regression analyses were performed to identify the independent associations between RBS and outcomes. A total of 32,683 patients who underwent emergency laparotomy were identified (RBS: 342; No-RBS: 32,341). The mean age was 39 (16) years, 78% were male, mean SBP was 107 (34) mmHg, and the median injury severity score was 21 [14–29]. The median time to emergency hemorrhage control surgery was 50 [32–85] minutes. Overall complication rate was 16% and mortality was 19%. On univariate analysis, RBS group had longer time to surgery (RBS 56 [41–89] vs No-RBS 50 [32–85] minutes, P < 0.001). On multivariable analysis, RBS was independently associated with a longer time to hemorrhage control surgery (β + 14.5 [95%CI 7.8–21.3], P < 0.001), higher odds of complications (aOR = 1.72, 95%CI = 1.27–2.34, P < 0.001), and mortality (aOR = 3.42, 95%CI = 2.57–4.55, P < 0.001). REBOA is independently associated with longer time to OR for hemorrhaging trauma patients with an average delay of 15 minutes. Further research evaluating center-specific REBOA volume and utilization practices, and other pertinent system factors, may help improve both time to REBOA as well as time to definitive hemorrhage control across US trauma centers. III Epidemiologic

Objective: To introduce a modified surgical method using bilateral buccinator flaps with posterior positioning of levator veli palatini muscles to treat velopharyngeal insufficiency. Design: Cross-sectional clinical study Patients: Non-syndromic patients with velopharyngeal insufficiency Intervention: We performed a modified surgical method using posterior positioning of levator veli palatini muscles and side-by-side bilateral buccinator flaps. Main outcome measures: Patients’ characteristics, severity of hypernasality, palatal lengthening size, and operative complications were recorded and described. The severity of hypernasality was determined by a speech therapist before and after the operation. Results: A total of 26 non-syndromic patients, with a median age of 8.5 years, were enrolled. All patients presented with severe hypernasality. Following the operation and during the follow-up period, 12 patients showed a complete resolution of hypernasality, while 9, 3, and 2 patients exhibited mild, moderate, and severe hypernasality, respectively. In addition, the mean palatal lengthening was measured to be 25.3 ± 3.5 mm. Overall, three patients experienced partial flap loss in one flap, which was successfully repaired with a secondary intention without the development of a fistula. In five cases, complete closure of the donor sites couldn’t be achieved and thus were treated with secondary intention. Additionally, postoperative food restrictions were observed in seven cases but were resolved within one month. No other complications were noted in the remaining patients. Conclusion: This modified palatal lengthening technique results in a significant lengthening of the palate while maintaining favorable speech outcomes. Future randomized clinical trials are warranted to validate our findings.