Notes

Growth along with Validation from the McMaster Recommending Expertise Assessment for Health care Factors (MacPCA).
Both mortality and morbidity are affected by the duration of ischemia and the local and systemic complications of reperfusion injury. Complications of acute aortic occlusion can be reduced by a more prompt diagnosis, rapid intervention, and a more rapid and complete reestablishment of perfusion.PURPOSE Chronic postoperative endophthalmitis is a known complication of cataract surgery. Here, we report a case of chronic endophthalmitis following uncomplicated cataract surgery secondary to the atypical bacterium Aquamicrobium terrae. METHODS Retrospective case report of a single patient with endophthalmitis secondary to A. terrae. RESULTS A 61-year-old healthy patient presented with recurrent iridocyclitis following uncomplicated cataract surgery. Repeated attempts to taper off topical steroid eyedrops were unsuccessful. Anterior chamber paracentesis cultures and vitrectomy cultures grew the same gram-negative bacillus, A. terrae, on six different occasions. The patient was treated initially with a series of intravitreal ceftazidime injections and adjuvant oral minocycline with recurrence of inflammation necessitating pars plana vitrectomy with intraocular lens removal and total capsulectomy. 4μ8C clinical trial Inflammatory episodes recurred until residual capsule fragments were ablated using endoscopic vitrectomy. Since ablation over 18 months ago, no further recurrences have occurred and the patient has excellent visual outcome. CONCLUSION A. terrae is a gram-negative bacillus recovered from polluted soil. This is the first case of postoperative endophthalmitis secondary to A. terrae and the first description of human infection caused by this newly identified microbe.STUDY DESIGN This was a retrospective cohort study using a nationwide inpatient database. OBJECTIVE The objective of this study was to evaluate the perioperative complications post-anterior fusion (AF) and posterior fusion (PF) for osteoporotic vertebral fractures (OVFs) with a large National Inpatient Database. SUMMARY OF BACKGROUND DATA OVF of the thoracolumbar spine often occur because of bone fragility and low-energy trauma in elderly patients. Though AF and PF are 2 representative surgical methods, there have been few studies focusing on perioperative complications of each method. MATERIALS AND METHODS The total 2446 (AF 435 cases, PF 2011 cases) patients who diagnosed thoracic or lumbar OVF and received either AF or PF were included from 2012 to 2016 with the Diagnosis Procedure Combination (DPC) database. After one-to-one propensity score-matching, total 866 cases were analyzed to evaluate systemic and local complication rates, reoperation rates, costs, and mortality. RESULTS A total of 433 pairs were made between the surgical procedures after matching. At least 1 systemic complication was seen in 26.6% of the AF group compared with 16.9% of the PF group (P=0.001). Specifically, the incidence of pulmonary embolism (P=0.045), urinary tract infection (P=0.012), and pleurisy (P=0.004) were significantly higher in the AF group. Blood transfusion (P=0.007) and the operation for systemic complications (P=0.020) were required more often in the AF group. The cost for hospitalization was also higher in the AF group (P less then 0.001). There were no differences in the mortality rates between the 2 groups. CONCLUSIONS More systemic complications were observed in the AF group. Surgeons need to take careful consideration of the merits and demerits described in this study when deciding the surgical method for OVF. LEVEL OF EVIDENCE Level 3.STUDY DESIGN This is a retrospective comparative review. OBJECTIVE The objective of this study was to identify the influence of body mass index (BMI) on postsurgical complications and patient reported outcomes measures (PROMs) following lumbar decompression surgery. SUMMARY OF BACKGROUND DATA Current literature does not accurately identify the impact of BMI on postsurgical complications or outcomes. MATERIALS AND METHODS Records from a single-center, academic hospital were used to identify patients undergoing 1 to 3-level lumbar decompression surgery. Patients under 18 years of age, those undergoing surgery for infection, trauma, tumor, or revision, and those with 35.0 kg/m. Absolute PROM scores, the recovery ratio and the percent of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed. RESULTS A total of 195 patients were included with 34 (17.4%) patients in group I, 80 (41.0%) in group II, 49 (25.1%) in group III, and 32 (16.5%) in group IV. Average age was 60.0 (58.0, 62.0) years and average follow-up was 13.0 (12.6, 13.4) months. All patients improved significantly within each group, except for class III and class IV patients, who did not demonstrate significant improvements in terms of Mental Component Score (MCS-12) scores (P=0.546 and 0.702, respectively). There were no significant differences between BMI groups for baseline or postoperative PROM values, recovery ratio, or the percent of patients reaching minimum clinically important difference. Multiple linear regression analysis revealed that BMI was not a significant predictor for change in outcomes for any measure. The 30-day readmission rate was 6.2% and overall revision rate at final follow-up was 5.1%, with no significant differences between groups. CONCLUSION This study's results suggest that BMI may not significantly affect complications or patient outcomes at 1-year in those undergoing lumbar decompression surgery. LEVEL OF EVIDENCE Level III.PURPOSE Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to reduce perioperative blood loss and blood transfusion, but the dosage and efficacy of TXA in posterior lumbar spinal surgery are not fully clear. The aim of this study was to investigate the efficacy and safety of TXA and to determine whether 2 doses of TXA could reduce the blood loss in primary single-segment or double-segment posterior lumbar fusion surgery. MATERIALS AND METHODS A total of 150 patients with lumbar degenerative disease undergoing posterior lumbar interbody fusion surgery between October 2017 and February 2019 were randomized to 3 groups. Group A was treated with 0.9% normal saline solution without TXA, group B was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery, and group C was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery; then, the same dose was administered again 3 hours later. The assessed outcomes were the operation time, the total blood loss, the hidden blood loss, postoperative drainage, blood transfusions, incidence of venous thromboembolism, and incision infection.
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