Citations

BACKGROUND AND OBJECTIVES: Although the value of patient-reported outcomes (PROs) regarding assessing patient and quality-of-care outcomes is increasingly recognized within spine surgery, the benefits and challenges associated with the collection and clinical use of PROs remain to be established. The aim of this review was to discuss the published evidence on the wealth of clinically relevant data provided by PRO measures within spine surgery. METHODS: The peer-reviewed literature was searched for articles investigating the value of PRO data within spine surgery. Articles evaluating the collection and clinical use of PRO data within spine surgery, especially about monitoring clinical and quality-of-care outcomes, were critically analyzed. RESULTS: Although postoperative outcomes after spine surgery previously relied on the physician's evaluation of a patient's physical recovery, in 1978, a new evaluation scheme for patients undergoing surgery for lumbar spinal stenosis shifted the weight of postoperative outcome evaluation from objective physical measures to measures that depended on the party performing the evaluation, including the physician, patient, or family. Currently, several standardized PRO scales whose performance has been rigorously investigated in validation studies are used to assess patients' perception of pain and functional and psychometric outcomes after spine surgery. Overall, the benefits of using PROs in these patients include establishing patient involvement in their care, strengthening patient-provider rapport, and promoting patient-centered care, while further standardizing patient outcomes by incorporating the self-reported aspect of clinical outcomes into standardized outcome measures and creating a framework for further quality outcomes research and health care policymaking. CONCLUSION: Physician-reported outcomes are often unable to provide a comprehensive evaluation of clinical and quality-of-care outcomes within spine surgery. Incorporation of PROs in patient evaluation is an integral part of efforts aimed at achieving excellence in health care delivery, as PROs help gain insight into individual patients' experiences and integrate an appraisal of patients' perspectives into clinical practice.

Abstract Enterocutaneous fistulas (ECF) are challenging to treat contributing to high morbidity and high mortality rates, significantly impacting the quality of life of the patients. Its susceptibility to antibiotic‐resistant infections often leads to chronic inflammation, complicating treatment with conventional methods. Here, 18NC75‐10P‐1IL is reported, which is a multi‐functional shear‐thinning hydrogel comprised of gelatin and nanosilicates for injectability, an ionic liquid for bactericidal effects, and platelet rich fibrin fraction for pro‐healing properties; this biomaterial is engineered for the treatment of ECFs. Through rigorous testing, the mechanical properties of 18NC75‐10P‐1IL were tailored for catheter injection to achieve durable occlusion of fistulous tracts under external pressures simulating clinical scenarios. 18NC75‐10P‐1IL demonstrated pro‐healing effects and anti‐microbial activity against highly resistant patient‐derived bacteria known to be associated with ECF. Subcutaneous implantation and anorectal fistula models confirmed its biocompatibility, pro‐healing, anti‐inflammatory, and anti‐microbial properties compared to control materials, suggesting promising potential for clinical translation in the treatment of human ECFs.

ABSTRACT Objective Availability of surgical equipment and access to essential clinical services remains an important barrier to surgical care delivery, particularly in low‐ and middle‐income countries (LMICs). This study aims to characterize the relative availability of essential equipment for otolaryngology‐head and neck surgery (OHNS) care across World Bank income groups. Methods We conducted a cross‐sectional survey on otolaryngologists' perceptions on the availability of surgical equipment and ancillary services in their respective practice settings per a 5‐point Likert scale ranging from never to always available. The study was disseminated online via professional societies, personal contacts, and social media. Eligible participants included otolaryngologists from 194 WHO‐recognized countries, which were grouped by World Bank income group classification and WHO region. Results The study involved 146 otolaryngologists, 69 (47%) from high‐income countries (HICs), and 77 (53%) from LMICs. LMIC respondents were predominantly from the African and South‐East Asian regions, which comprised 48% and 7.8% of all LMIC respondents, respectively. Results revealed significant differences in the availability of otologic, rhinologic, and endoscopic airway equipment between HICs and LMICs. Differences existed among commonly used equipment such as tympanomastoidectomy equipment and rigid bronchoscopy, to subspecialized equipment such as functional endoscopic sinus surgery equipment and cochlear implants ( p < 0.05 each). Conclusions The study highlighted key disparities in the availability of essential equipment for baseline OHNS care, especially for pediatric airway and otologic conditions. These results can be used to guide investment and advocacy efforts to improve specialty‐specific surgical infrastructure relative to the global burden of OHNS diseases in low‐resource settings. Level of Evidence 3

AbstractAimAn estimated 5%–25% of women with endometriosis have colorectal involvement. Colorectal resection is the most suitable surgical management for cases with large bowel infiltration. However, this method is also associated with the highest rate of postoperative complications. Data focusing on surgeon speciality and surgical outcomes are currently limited. The aim of this work was to evaluate the surgical characteristics and short‐term postoperative outcomes following colorectal resection for endometriosis according to surgeon speciality.MethodUsing the National Surgical Quality Improvement Program (NSQIP) database, we included women who underwent colorectal resection for endometriosis between 2012 and 2020. Surgeries by general/colorectal surgeons were compared with those by gynaecological surgeons. The primary outcome was major complications according to the Clavien–Dindo classification.ResultsAmong 745 colorectal resections, 82.3% were performed by general/colorectal surgeons and 17.7% by gynaecologists. Racial and ethnic characteristics differed between groups, but other baseline characteristics were comparable. General/colorectal surgeons performed fewer minimally invasive surgeries (29.9% vs. 58.3%, p < 0.001). General/colorectal surgery cases had lower rates of any postoperative complications and minor complications (14.8% vs. 29.5%, p < 0.001; 10.1% vs. 23.5%, p < 0.001), while major complication rates were similar. Multivariable regression showed no association between major complications and surgical speciality. In a propensity score‐matched analysis, no significant differences were found between the two cohorts.ConclusionMost colorectal resections are performed by general/colorectal surgeons while a minimally invasive approach is more common among gynaecologists. There were no significant differences in outcomes between the two groups after adjusting for confounding variables. This suggests considering a multidisciplinary or dual surgery team approach to deep infiltrative endometriosis requiring bowel resection.

Abstract Background Persistent postural‐perceptual dizziness (PPPD) is a chronic functional vestibular disorder that is a potential sequela of traumatic brain injury (TBI). Currently, little is known about how patients with TBI associated PPPD respond to typical PPPD treatment modalities. Objective To investigate the prevalence of TBI as a precipitant for PPPD and assess outcomes of usual treatment. Design Retrospective cohort study. Setting Electronic medical records from a tertiary care center. Participants Patients ≥18 years of age diagnosed with PPPD secondary to TBI between January 2015 and December 2022 who underwent 6 months of treatment with at least one return clinic visit. Interventions Not applicable. Main Outcome Measure(s) Patients' best clinical global impression‐improvement scale (CGI‐I) score following 6 months of treatment were collected and then compared with previously published literature, with CGI‐I scores of 1 or 2 (indicating the patient was “very much” or “much” improved, respectively) considered treatment responders. Results In total, 134 (8.9%) of 1503 patients had a TBI as the triggering event for PPPD. The mean age of this cohort was 47.6 years with most of these cases occurring after a mild TBI (85.8%). The proportion of females with post‐TBI PPPD (58.2%) was significantly lower than the proportion with PPPD due to all causes ( p < .037). The most common treatment prescribed was vestibular therapy (82.2%), and 53.3% of patients were considered treatment responders after 6 months. Patients with TBI‐induced PPPD had a significantly worse mean CGI‐I score (2.49 ± 1.1) when compared to prior literature (1.71 ± 0.83) ( p < .001). Conclusions This study found a 9% prevalence of PPPD following TBI in the largest cohort studied to date. Patients who developed PPPD following TBI did not respond as well to standard treatments as patients with other causes of the disorder, and thus may require closer clinical follow‐up to assess treatment efficacy.

Mohave rattlesnakes ( Crotalus scutulatus ) are known to inhabit the deserts of southwestern United States, with their territory extending into southern Mexico. Envenomation can impart dramatic local and systemic effects on the body, ranging from local skin necrosis to neurotoxicity, depending on the protein complex in the venom. Kounis syndrome, or allergic angina, is an allergic response to a specific insult that results in myocardial injury often in the form of coronary artery vasospasm but can include myocardial infarction and coronary stent thrombosis. To our knowledge, there have not been any reports associating C scutulatus envenomation with Kounis syndrome. We describe a patient who developed Kounis syndrome presenting as an allergic myocardial infarction following envenomation by a Mohave rattlesnake. A second unique feature of this patient's envenomation is that he experienced respiratory failure secondary to right hemidiaphragmatic paralysis. Severe neurotoxicity from Mohave rattlesnake bites in humans has been reported rarely in the literature.