Objective To examine recovery trajectories of Physical Functioning (PF) and the Ability to Participate in Social Roles and Activities (APS) after major surgery, and identify preoperative predictors. Background Recovery after major surgery is typically evaluated at isolated time points, limiting insight into recovery dynamics. Understanding recovery trajectories and their determinants may inform prognostic model development. Methods This exploratory secondary analysis used data from a multicenter randomized controlled trial including adults undergoing major elective surgery. Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test PF and APS were assessed preoperatively and at 1, 3, 6, and 12 weeks post discharge. Recovery trajectories were modeled using linear mixed effects models with random intercepts and slopes. Preoperative characteristics were examined using interaction terms for time and time2. Results Among 369 patients, PF and APS followed curvilinear patterns. For PF, older age (β = −0.04, 95% CI [−0.06 to −0.02]), unintentional weight loss and higher comorbidity were associated with slower recovery. Higher baseline PF predicted with faster recovery. Differences exceeding the Minimal Important Change (MIC) were observed for age and baseline PF.For APS, older age was also associated with slower recovery (β = −0.04, 95% CI [−0.08 to −0.004]), and intermediate education (vs low) with differences in recovery curvature. Higher baseline APS predicted higher postoperative scores. MIC-exceeding differences were observed for baseline APS and age. Conclusions Early postoperative recovery is curvilinear. Multiple preoperative factors were associated with recovery trajectories, supporting their role as candidate predictors for future trajectory-based prognostic models. Trial registration This study was approved by the Medical Ethical Committee of Amsterdam University Medical Center, location VUmc, under registration number NL61503.029.18.
Background Whole-body computed tomography (WBCT) is frequently used in trauma, though its value in stable patients remains uncertain. We examined WBCT use after motor vehicle collision (MVC) and whether trauma center designation and American College of Surgeons Committee on Trauma (ACS-COT) verification were associated with imaging practices. Methods Using 2018–2021 Trauma Quality Improvement Program (TQIP) data, we identified adults aged 18–65 with blunt MVC who were stable (systolic blood pressure ≥ 100 and Glasgow Coma Scale 15) and received a CT scan. WBCT was defined as head, chest, and abdomen CT within 2 h of admission; selective CT (SCT) covered fewer than all three regions. Temporal trends by state-designated trauma level and ACS-COT verification were assessed using Cuzick's nonparametric test, and multivariable logistic regression identified factors associated with WBCT use. Results Among 288,264 stable MVC patients receiving CT, 78,796 (27.3%) underwent WBCT, and 209,468 (72.7%) SCT. WBCT utilization declined at ACS-verified (31.9 to 30.2%) and non-verified centers (22.0 to 18.4%), and at Level I (29.1 to 27.1%) and Level II (28.5 to 26.9%) facilities (all nptrend <0.001), with consistent declines across Injury Severity Score strata. After adjustment, ACS verification was associated with higher odds of WBCT (AOR 1.96, 95% CI 1.92–2.00), whereas non-profit or government ownership (AOR 0.55, 95% CI 0.54–0.57) was associated with lower odds. Conclusions In stable MVC patients, WBCT utilization declined from 2018 to 2021 across trauma levels and verification strata, while institutional characteristics remained strongly associated with WBCT.
Objective To identify factors associated with prolonged hospital stay after appendectomy for acute appendicitis in a Peruvian public hospital. Methods We conducted a retrospective case-control study of adults who underwent appendectomy for acute appendicitis at Hospital Jesús Nazareno, Ayacucho, Peru, between January 2021 and December 2024. Cases had a hospital stay of ≥5 days, corresponding to the 75th percentile of the institutional distribution, and controls had a stay of <5 days. From 96 eligible cases and 288 eligible controls, 73 patients from each group were selected by simple random sampling. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression. Results Median hospital stay was 6.0 days (IQR, 5.0–9.0) among cases and 2.0 days (IQR, 2.0–3.0) among controls. Complicated appendicitis was more frequent among cases than controls (97.3% vs. 27.4%), as was surgical site infection (38.4% vs. 1.4%). After multivariable adjustment, complicated appendicitis (adjusted OR, 38.62; 95% CI, 7.78–191.82) and surgical site infection (adjusted OR, 9.58; 95% CI, 1.14–80.55) remained associated with prolonged hospital stay. Conclusion Complicated appendicitis and surgical site infection were associated with prolonged hospital stay after appendectomy. Because the timing of surgical site infection onset was not captured, its temporal relationship with prolonged stay cannot be established. Timely management of complicated appendicitis and adherence to perioperative infection-prevention practices may help reduce prolonged hospitalization.
Tibialis anterior tendon (TAT) ruptures are uncommon and may occur acutely or present in a chronic, neglected form. Chronic ruptures, generally defined as those present for more than four weeks, are frequently associated with tendon retraction, degenerative stump tissue, and a segmental defect that precludes primary end-to-end repair. Established reconstructive options include tendon transfer, autograft interposition, and allograft interposition, each carrying trade-offs in donor site morbidity, tissue availability, and cost. We describe reconstruction of a chronic insertional TAT rupture in a 68-year-old male using a degradable synthetic polycaprolactone-based polyurethane urea matrix (FlexBand; Artelon, Inc., Marietta, GA, USA) secured to the medial cuneiform with two bone anchors and sutured to a debrided and lengthened proximal tendon stump. At final documented follow-up of 12 weeks, the patient ambulated without foot slap or compensatory gait deviation, with dorsiflexion and plantarflexion clinically symmetric to the contralateral limb and no restriction in activities of daily living. This report describes the technical feasibility of the approach.
