Long-term healthcare use after postoperative complications: an analysis of linked primary and secondary care routine data

Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative

Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus recommendations for fluid management in patients undergoing surgery. This article provides a summary of the recommendations for perioperative fluid management of surgical patients from the preoperative period until hospital discharge and for all types of elective and emergency surgery, apart from burn injuries and head and neck surgery. Where evidence was lacking, recommendations for future research were generated. Specific recommendations are made for fluid management in elective major noncardiac surgery, cardiopulmonary bypass, thoracic surgery, neurosurgery, minor noncardiac surgery under general anaesthesia, and critical illness. There are ongoing gaps in knowledge resulting in variation in practice and some disagreement with our consensus recommendations. Perioperative fluid management should be individualised, taking into account the type of surgery and important patient factors, including intravascular volume status and acute and chronic comorbidities. Recommendations are made for further research in perioperative fluid management to address important gaps.

Advancements in Surgical Approaches for Sacrococcygeal Pilonidal Sinus: A Comprehensive Review

Sacrococcygeal pilonidal sinus (SPS) is a condition involving the formation of a cavity in the lower back region. It is more common among young adults and is influenced by factors such as sitting for long periods, body hair, and certain lifestyle habits. Surgical treatment is often necessary for recurring or severe cases, and various surgical techniques available, ranging from traditional surgical methods to newer, less invasive approaches. This comprehensive review examines the progress in surgical techniques for managing SPS, emphasizing the effectiveness, safety, and patient outcomes associated with different methods. It provides an overview of traditional procedures, such as excision with primary closure, and contrasts these with recent innovations like endoscopic and laser-assisted techniques. The review also considers advanced technologies, including the potential of robotic surgery and the use of specialized materials. By assessing clinical outcomes, recurrence rates, complications, and patient satisfaction, this review seeks to identify the most effective surgical strategies for SPS. Additionally, it discusses recent technological advancements and highlights areas needing further research to improve the management and treatment of this condition.

Association Between Race and Short-Term Outcomes Across 3988 Consecutive Single-Level Spinal Fusions

BACKGROUND AND OBJECTIVES

Race has implications for access to medical care. However, the impact of race, after access to care has been attained, remains poorly understood. The objective of this study was to isolate the relationship between race and short-term outcomes across patients undergoing a single, common neurosurgical procedure.

METHODS

In this retrospective cohort study, 3988 consecutive patients undergoing single-level, posterior-only open lumbar fusion at a single, multihospital, academic medical center were enrolled over a 6-year period. Among them, 3406 patients self-identified as White, and 582 patients self-identified as Black. Outcome disparities between all White patients vs all Black patients were estimated using logistic regression. Subsequently, coarsened exact matching controlled for outcome-mitigating factors; White and Black patients were exact-matched 1:1 on key demographic and health characteristics (matched n = 1018). Primary outcomes included 30-day and 90-day hospital readmissions, emergency department (ED) visits, reoperations, mortality, discharge disposition, and intraoperative complication.

RESULTS

Before matching, Black patients experienced increased rate of nonhome discharge, readmissions, ED visits, and reoperations (all P < .001). After exact matching, Black patients were less likely to be discharged to home (odds ratio [OR] 2.68, P < .001) and had higher risk of 30-day and 90-day readmissions (OR 2.24, P < .001; OR 1.91, P < .001; respectively) and ED visits (OR 1.79, P = .017; OR 2.09, P < .001). Black patients did not experience greater risk of intraoperative complication (unintentional durotomy).

CONCLUSION

Between otherwise homogenous spinal fusion cohorts, Black patients experienced unfavorable short-term outcomes. These disparities were not explained by differences in intraoperative complications. Further investigation must characterize and mitigate institutional and societal factors that contribute to outcome disparities.

Complications and consequences: short-term harm has long-term impact

In this editorial, we discuss a large observational study demonstrating increased healthcare usage and higher mortality over 2 yr in patients who experienced specific postoperative complications. These findings are in keeping with the existing literature and draw into focus the need for ongoing work to understand and communicate these long-term consequences to patients.