Background Obesity may increase morbidity after minimally invasive appendectomy (MIA). We evaluated 30-day outcomes by obesity status and severity. Methods Using the 2020-2024 ACS NSQIP Participant Use Files, patients with obesity (BMI ≥30 kg/m 2 ) were compared with those without obesity, and class III obesity (BMI ≥40 kg/m 2 ) with class I-II obesity. Propensity score matching (PSM) was performed. Outcomes included mortality, conversion to open surgery, surgical site infection (SSI), organ-related complications, operative time, and length of stay. Sensitivity analyses adjusted for residual comorbidity imbalance using multivariable logistic regression. Results Among 211,221 patients, 78,659 (37.2%) had obesity. PSM yielded 78,567 pairs for the main comparison and 14,203 for the subgroup comparison. Obesity was associated with higher odds of superficial SSI (OR 1.75; 95% CI 1.58-1.94), deep incisional SSI (OR 1.70; 95% CI 1.28-2.26), conversion (OR 1.33; 95% CI 1.06-1.67), and renal insufficiency (OR 1.62; 95% CI 1.32-1.98). Class III vs class I-II obesity was associated with higher odds of superficial SSI (OR 1.80; 95% CI 1.48-2.18), deep incisional SSI (OR 3.09; 95% CI 1.61-5.93), and renal insufficiency (OR 2.23; 95% CI 1.50-3.31). After additional adjustment, incisional SSI associations persisted in both comparisons, whereas conversion and renal insufficiency associations were no longer significant. Conclusions MIA showed a favorable safety profile in patients with obesity, with low absolute mortality and major complication rates. SSI associations persisted after adjustment, including class III vs class I-II obesity.
Hydrogen peroxide irrigation can generate a large oxygen burden, causing gas embolism, cardiovascular collapse, or neurologic injury. This narrative review integrates selected operative cases, quantitative physiological estimates, regulatory warnings, and contemporary gas embolism guidance. Complete decomposition of 1 mL of 3% weight-per-volume solution theoretically yields approximately 9.9 mL of oxygen at 0°C and 1 atmosphere, or 11.2 mL at 37°C at the same pressure. Operative reports describe suspected pulmonary, demonstrated intracardiac, and cerebral gas events; they establish neither incidence nor a safe exposure threshold. Clinical benefits are setting-specific and must be distinguished from laboratory antimicrobial effects. Management prioritizes exposure cessation, oxygenation, resuscitation, and urgent specialist assessment, with selective interventions and positioning adapted to context. A case table, evidence summary, and management algorithm separate peroxide-specific observations from broader gas embolism evidence. Prevention requires appropriate alternative irrigants, recognition of hazardous anatomy and delivery, and clear team communication.
Low-titer group O whole blood (LTOWB) reduces mortality in pediatric trauma when added to component therapy (CT;ie, any protocol based on ratios of isolated blood components). Despite this benefit, no cost-effectiveness analysis has compared the strategies. We built a decision tree comparing LTOWB+CT with CT alone for previously healthy children under 16 requiring massive transfusion. We used a 30-day horizon, a US Level I trauma center perspective, and a willingness to pay threshold of $100,000 per mortality averted. LTOWB+CT averted 2.7 additional deaths per 100 patients and cost $788.32 more per case. The incremental cost-effectiveness ratio was $29,571.17 per mortality averted; LTOWB+CT was cost-effective in 58% of iterations. Cost-effectiveness was lost below a willingness to pay of $25,000, above an LTOWB unit cost of $1,566.18, or more than 5.3 LTOWB or 9.1 packed red cell units. Low-titer group O whole blood is a cost-effective addition to pediatric massive transfusions protocols (MTP), but definable economic limits bind its value.
In robotic surgery, surgeons estimate tissue tension based on visual information. However, tactile sensation is essential for surgical manipulation, and its absence may limit surgical performance. Although advances in da Vinci 5 software allow for real-time monitoring of forceps, its clinical significance is not yet clear. The initial analysis of 31 cases performed by skilled surgeons was conducted. Patient factors, short-term outcomes, and oncological factors were obtained from medical records. The mean force applied to each forceps throughout surgery was analyzed. Verification using the least-squares method revealed a correlation between the load applied to the Cadiere forceps on the fourth arm and factors such as sex, body mass index (BMI), and surgical procedures (including right colectomy, left colectomy, and rectal resection), with a correlation coefficient R 2 = 0.64, and an adjusted R-square value of 0.58. This study may serve as the first step toward quantifying the loads applied to forceps during robot-assisted surgery and identifying correlations with surgical procedures and patient factors.
Background Since early-onset colorectal cancer (CRC) is a hallmark for a hereditary form of cancer, genetic counseling is recommended. However, the referral rates, uptake, and outcomes of cancer genetic counseling (CGC) for early-onset CRC have not been as fully explored as they have for average-onset CRC patients. Methods Utilizing billing records, patients undergoing resection of a primary CRC at a safety-net University Hospital were identified. Electronic medical records were reviewed for: immunohistochemistry, microsatellite instability testing and genomic DNA sequence analysis results. Compliance with universal tumor screening, CGC referral, and attendance were assessed. Results Between 2018 and 2022, 342 patients underwent primary CRC resection, of whom 66 (19%) were early-onset patients. Most early-onset patients (92%) were screened with at least immunohistochemistry. Overall, 80 patients met criteria for CGC referral. The referral rate was 57% for mismatch repair (MMR) deficient average-onset colorectal cancer and 67% for all early-onset cases ( P = 0.55). Although 60 (91%) of early-onset patients were MMR proficient, 32 attended CGC, of whom 29 had available germline results. Among those with available results, 12 (41%) had at least one reported germline variant, classified as pathogenic or of uncertain significance. Discussion Although universal tumor screening in a safety-net university hospital is feasible, opportunities for improving CGC referral and attendance rates exist, especially with the early-onset cohort, where germline variants may be detected even in mismatch repair proficient cases. It is incumbent upon surgeons to recognize these opportunities, especially in CRC not requiring multimodality therapy, where surgeons may be the sole provider.
