Outcomes of Robot-Assisted Versus Laparoscopic Surgery for Colorectal Cancer in Adults ≥ 75 Years Old: A Propensity Score Matched Analysis of the US Nationwide Inpatient Sample.

BACKGROUND: Robot-assisted surgery has been increasingly adopted in colorectal cancer resection. OBJECTIVE: The study aimed to compare the inpatient outcomes of robot-assisted versus conventional laparoscopic colorectal cancer resection in patients ≥ 75 years. DESIGN: A retrospective, population-based study. SETTINGS: This study analyzed data from the United States Nationwide Inpatient Sample from 2005 to 2018. PATIENTS: Colorectal cancer patients ≥ 75 years old and underwent robot-assisted or conventional laparoscopic resection. MAIN OUTCOME MEASURES: Postoperative complication, prolonged length of stay, and total hospital costs were assessed. RESULTS: Data from 14,108 patients were analyzed. After adjustment, any postoperative complications (aOR = 0.87, 95% CI: 0.77-0.99, p = 0.030) and prolonged length of stay (aOR = 0.78, 95% CI: 0.67-0.91, p = 0.001) were significantly less in the robotic than the laparoscopic group. In addition, robotic surgery was associated with significantly higher total hospital costs ($26.06 USD greater cost; 95% CI: 21.35-30.77 USD, p < 0.001). LIMITATIONS: The analysis was limited by its retrospective and observational nature, potential coding errors, and the lack of intraoperative factors such as operative time, laboratory measures, and information on surgeons' experience. CONCLUSIONS: In United States, patients with colorectal cancer ≥ 75 years who were undergoing tumor resections, compared to conventional laparoscopic surgery, robotic surgery is associated with better inpatient outcomes in terms of complication rate and risk of prolonged length of stay, especially among patients with colon cancer. However, robotic surgery is associated with higher total hospital costs.

Potential beneficial effects of long-term aspirin use on the prevalence of colorectal cancer: a population-based study of the US Nationwide Inpatient Sample.

PURPOSE: Whether long-term aspirin usage is associated with colorectal cancer (CRC) risk needs more evidence. The study evaluated the association between long-term aspirin use and prevalence of CRC in a large, nationally representative database. METHODS: Hospitalized patients aged ≥ 50 years during 2018 were identified in the United States (US) National Inpatient Sample (NIS). Patients without complete information of age, sex, race, income, and insurance status were excluded, as well as those with inflammatory bowel disease (IBD) or malignancies other than CRC. Propensity score matching (PSM) was applied to balance the characteristics between patients with and without long-term aspirin use. Logistic regressions were performed to determine the relationship between long-term aspirin use and the presence of CRC. CRC and aspirin use were identified through the administrative International Classification of Diseases (ICD) codes. RESULTS: Data from 3,490,226 patients were included, in which 688,018 (19.7%) had a record of long-term aspirin use. After 1:1 PSM, there remained 1,376,006 patients, representing 6,880,029 individuals in the US after weighting. After adjusting for confounders, long-term aspirin use was significantly associated with lower CRC odds (adjusted odds ratio [aOR] = 0.64, 95% confidence interval [CI] 0.62, 0.67). This association was not changed when stratified by age, sex, race, body mass index (BMI), and smoking. CONCLUSIONS: From a national inpatient dataset, US adults ≥ 50 years on long-term aspirin are less likely to have CRC, regardless of age, sex, race, BMI, and smoking status.

Outcomes of robot-assisted versus laparoscopic surgery for colorectal cancer in morbidly obese patients: A propensity score-matched analysis of the US Nationwide Inpatient Sample.

BACKGROUND AND AIM: Morbid obesity is associated with poorer postoperative outcomes in colorectal cancer (CRC) patients. We aimed to evaluate short-term outcomes after robotic versus conventional laparoscopic CRC resection in morbidly obese patients. METHODS: This population-based, retrospective study extracted data from the US Nationwide Inpatient Sample during 2005-2018. Adults ≥ 20 years old, with morbid obesity and CRC, and undergoing robotic or laparoscopic resections were identified. Propensity score matching (PSM) was applied to minimize the confounding. Univariate and multivariable regression was conducted to evaluate the associations between outcomes and study variables. RESULTS: After PSM, 1296 patients remained. The risks of any postoperative complication (adjusted odds ratio [aOR] = 0.99, 95% confidence interval [CI]: 0.80, 1.22), prolonged length of stay (LOS) (aOR = 0.80, 95% CI: 0.63, 1.01), death (aOR = 0.57, 95% CI: 0.11, 3.10), or pneumonia (aOR = 1.13, 95% CI: 0.73, 1.77) were not significantly different between the two procedures after adjustment. Robotic surgery was significantly associated with greater hospital cost (aBeta = 26.26, 95% CI: 16.08, 36.45) than laparoscopic surgery. Stratified analyses revealed that, in patients with tumor located at the colon, robotic surgery was associated with lower risk of prolonged LOS (aOR = 0.72, 95% CI: 0.54, 0.95). CONCLUSIONS: In patients with morbid obesity, risks of postoperative complication, death, or pneumonia are not significantly different between robotic and laparoscopic CRC resection. Among patients with tumor located at the colon, robotic surgery is associated with lower risk of prolonged LOS. These findings fill the knowledge gap and provide useful information for clinicians on risk stratification and treatment choice.

Association between metabolic syndrome and colorectal cancer incidence and all-cause mortality: a hospital-based observational study.

BACKGROUND: Metabolic syndrome (MetS) is a worldwide pandemic and complex disorder associated with colorectal cancer (CRC). This study aims to identify the influence of number of MetS components on CRC incidence and mortality, using a national, longitudinal dataset of hospital care in Taiwan. METHODS: Patient data from the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2008 were extracted. Individuals with at least one inpatient diagnosis or 2 outpatient visits with any MetS component found within one year were identified and included. Subjects died within 12 months after the presence of MetS components or had any prior cancer were excluded. The study cohort were then divided into two groups: subjects who had more (i.e., 3 to 4) MetS components and those who had fewer (i.e., 1 to 2) MetS components. An 2:1 propensity score (PS) matching were performed to balance the baseline characteristics between the groups. Cox regression analyses were conducted to compare the CRC incidence and all-cause mortality at follow-up between subjects with more MetS components versus fewer components. RESULTS: After matching, a total of 119,843 subjects (78,274 with 1-2 and 41,569 with 3-4 MetS components) were analyzed. After adjusting for confounders, subjects with 3-4 MetS components had a significantly higher risk of CRC [adjusted hazard ratio (aHR), 1.28; 95% confidence interval (CI), 1.15-1.43, p < 0.001) and all-cause mortality (aHR, 1.13; 95% CI, 1.08-1.17, p < 0.001) than those with only 1-2 MetS components. In stratified analyses, the greatest increased risk of CRC incidence that 3-4 MetS components posed as compared to 1-2 MetS components was seen in subjects without CHD history (aHR, 1.41, 95% CI, 1.23-1.62, p < 0.001). In addition, 3-4 MetS components (vs. 1-2) led to greater all-cause mortality among the subjects < 65y, both genders, with or without CHD, subjects without CKD hisotry, both aspirin users and non-users, users of nonsteroidal anti-inflammatory drugs (NSAIDs), and users of statin. CONCLUSION: Compared with 1-2 components, subjects with 3-4 MetS components are at greater risk of CRC and death at follow-up. This study also demonstrates the risks for CRC and all-cause mortality in certain subgroups of individuals with 3-4 MetS components compared to 1-2 components. These findings may help clinicians on the CRC risk stratification according to individuals' characteristics, as well as to optimize the strategy of MetS surveillance and control in order to prevent CRC.

The impact of obesity on postoperative outcomes in colorectal cancer patients: a retrospective database study.

PURPOSE: Obesity is an independent risk factor for worse outcomes in various surgical settings. Whether obesity is a prognostic factor for postoperative morbidity and mortality of colorectal cancer (CRC) is inconclusive. This study aimed to determine the impact of obesity on short-term postoperative outcomes in CRC patients undergoing laparoscopic surgery. METHODS: Data of a total of 23,898 CRC patients aged ≥ 20 years and undergoing laparoscopic resection were extracted from the US National Inpatient Sample (NIS) database and analyzed. The study endpoints were in-hospital mortality, any postoperative complications, infection/sepsis, acute kidney injury (AKI), deep vein thrombosis (DVT)/pulmonary embolisms (PE), and extended hospital stay. Univariate and multivariate logistic regression analyses were performed to examine the associations between patients' obesity status (morbid obese: BMI > = 40 kg/m2; obese: BMI 30-39.9 kg/m2) and the study outcomes. RESULTS: In 23,898 CRC patients undergoing laparoscopic resection, the prevalence of obesity prevalence was 11.8%. After adjustment, the results revealed that morbid obesity was significantly associated with increased risk for in-hospital mortality (aOR = 2.06, 95%CI: 1.11-3.83), AKI (aOR = 1.78, 95%CI = 1.34-2.36), DVT/PE (aOR = 2.88, 95%CI = 1.70-4.88), and extended LOS (aOR = 1.21, 95%CI = 1.02-1.43), while non-morbid obesity was significantly associated with more DVT/PE (aOR = 2.12, 95%CI = 1.32-3.41) as compared with non-obesity. CONCLUSION: In patients with CRC undergoing laparoscopic surgery, morbid obesity is strongly associated with worse postoperative outcomes, including increased in-hospital mortality, postoperative AKI and DVT/PE, and extended LOS. The findings of the present study highlight the importance of obesity status in risk stratification for laparoscopic CRC surgery.

Path Analysis of the Impact of Obesity on Postoperative Outcomes in Colorectal Cancer Patients: A Population-Based Study.

BACKGROUND: Obesity is adversely affecting perioperative outcomes; however, long-term outcomes do not appear to be affected by excess body weight (the obesity paradox). The purpose of this study is to examine the association between obesity and surgical outcomes in patients with colorectal cancer (CRC) using data from the United States National Inpatient Sample (NIS). METHODS: Patients ≥20 years old diagnosed with CRC who received surgery were identified in the 2004-2014 NIS database. Patients who were obese (ICD-9-CM code: 278.0) were matched with controls (non-obese) in a 1:4 ratio for age, sex, and severity of CRC (metastasis vs. no metastasis). Linear regression and path analysis were used to compare outcomes between obese and non-obese patients. A total of 107,067 patients (53,376 males, 53,691 females) were included in the analysis, and 7.86% were obese. RESULTS: The rates of postoperative infection, shock, bleeding, wound disruption, and digestive system complications were significantly different between the obese and non-obese groups. The obesity group had increased incidence of postoperative infection by 1.9% (∂P/∂X = 0.019), shock by 0.25% (∂P/∂X = 0.0025), postoperative bleeding by 0.5% (∂P/∂X = 0.005), wound disruption by 0.6% (∂P/∂X = 0.006), and digestive system complications by 1.35% (∂P/∂X = 0.0135). Path analysis showed that obesity group had higher in-hospital mortality through mentioned above five complications by 66.65 × 10-5%, length of hospital stay by 0.32 days, and total hospital charges by 2384 US dollars. CONCLUSIONS: Obesity increases the risk of postoperative complications in patients with CRC undergoing surgery. It also increased in-hospital mortality, length of hospital stay, and total hospital charges. Therefore, patients with obesity might require a higher level of preoperative interventions and complications monitoring to improve outcomes.

Differential short-term outcomes of laparoscopic resection in colon and rectal cancer patients aged 80 and older: an analysis of Nationwide Inpatient Sample.

BACKGROUND: Approximately, 22.6% of colorectal cancer surgeries were performed on patients aged 80 or over. The present study aimed to evaluate the use of laparoscopic resection and its short-term surgical outcomes in patients who were aged 80 and older and diagnosed with colon cancer or rectal cancer in parallel. METHODS: In this retrospective population-based study, colon and rectal cancer patients ≥ 80 years undergoing laparoscopic resection or open resection were identified from the United States National Inpatient Sample (2005-2014). Primary outcomes were postoperative complication and in-hospital mortality. Logistic regression analyses were performed to assess the short-term effectiveness of laparoscopic and open resection. RESULTS: In this study, 40,451 colon cancer patients and 1117 rectal cancer patients were included. Multivariate analysis revealed that laparoscopic resection was significantly associated with lower risks for developing postoperative complications (aOR = 0.67; 95%, CI 0.64-0.71) and in-hospital mortality (aOR = 0.37; 95% CI 0.32-0.43) compared to open resection in colon cancer patients. For rectal cancer patients, multivariate analysis indicated that laparoscopic resection was significantly associated with a lower risk of developing postoperative complications (aOR = 0.41; 95% CI 0.32-0.52) but was not associated with in-hospital mortality. CONCLUSION: Compared to open resection, laparoscopic resection has better or similar short-term surgical outcomes in colon and rectal cancer patients ≥ 80 years.

The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy.

PURPOSE: This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. METHODS: The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. RESULTS: A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. CONCLUSION: The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.

Short-term postoperative outcomes of colorectal cancer among patients with chronic liver disease: a national population-based study.

OBJECTIVE: Patients with colorectal carcinoma (CRC) with pre-existing chronic liver disease (CLD) had a significantly higher 30-day mortality after CRC surgery compared with healthy controls. This study investigated the factors associated with postoperative complications and in-hospital mortality in patients with CRC with coexisting CLD (excluding cirrhosis) who underwent colorectal surgery. DESIGN: A retrospective, observational, population-based study. SETTING: Data were sourced from the National Inpatient Sample database, a part of the Healthcare Cost and Utilisation Project. PARTICIPANTS: This study analysed 7463 inpatients with CRC who underwent colorectal surgery on admission between 2005 and 2014. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint of this study was the prevalence of postoperative complications, and the secondary endpoint was in-hospital mortality. RESULTS: In the CLD group, 36.27% of patients had chronic hepatitis C, 28.36% had non-alcoholic fatty liver disease and 31.19% had other types of CLD. The median hospital stay was 7.0 (5.0-10.0) days in patients with no postoperative complications vs 17.0 (10.0-26.0) days, 8.0 (6.0-12.0) days, 8.0 (6.0-17.0) days, 9.0 (8.0-14.0) days and 10.5 (7.0-17.0) days for patients with postoperative infection, postoperative bleeding, cardiac arrest/heart failure, respiratory complications and digestive complications, respectively (all p<0.05). The presence of CLD was significantly associated with higher risk of postoperative bleeding (adjusted OR (aOR)=1.64, 95% CI 1.15 to 2.34, p=0.007). The presence of CLD (aOR=1.98, 95% CI 1.39 to 2.82, p<0.001) and length of hospital stay (aOR=1.06, 95% CI 1.04 to 1.08, p<0.001) were significantly associated with higher risk of in-hospital mortality. However, hyperlipidaemia was associated with a significantly lower risk of mortality (aOR=0.46, 95% CI 0.28 to 0.75, p=0.002). CONCLUSIONS: Postoperative complications prolonged the length of hospital stay. The presence of CLD and hyperlipidaemia were important factors impacting postoperative complications and in-hospital mortality in patients with CRC with underlying CLD.

Prognostic factors of overall survival and cancer-specific survival in patients with resected early-stage rectal adenocarcinoma: a SEER-based study.

The benefits of radiotherapy for colorectal cancer are well documented, but the impact of adjuvant radiotherapy on early-stage rectal adenocarcinoma remains unclear. This study aimed to identify predictors of overall survival (OS) and cancer-specific survival (CSS) in patients with stage II rectal adenocarcinoma treated with preoperative or postoperative radiation therapy. Patients with early-stage rectal adenocarcinoma in the postoperative state were identified using the Surveillance, Epidemiology, and End Results database. The primary endpoints were OS and overall CSS. Stage IIA patients without radiotherapy had significantly lower OS and CSS compared with those who received radiation before or after surgery. Stage IIB patients with radiotherapy before surgery had significantly higher OS and CSS compared with patients in the postoperative or no radiotherapy groups. Patients with signet ring cell carcinoma had the poorest OS among all the groups. Multivariable analysis showed that ethnicity (HR, 0.388, p=0.006) and radiation before surgery (HR, 0.614, p=0.006) were favorable prognostic factors for OS, while age (HR, 1.064, p<0.001), race (HR, 1.599, p=0.041), stage IIB (HR, 3.011, p=0.011), and more than one tumor deposit (TD) (HR, 2.300, p=0.001) were unfavorable prognostic factors for OS. Old age (HR, 1.047, p<0.00 L), stage IIB (HR, 8.619, p=0.005), circumferential resection margin between 0.1 mm and 10 mm (HR, 1.529, p=0.039), and more than one TD (HR, 2.688, p=0.001) were unfavorable prognostic factors for CSS. This population-based study identified predictors of OS and CSS in patients with early-stage resected rectal adenocarcinoma, which may help to guide future management of this patient population.

The First Hand Allotransplantation in Taiwan: A Report at 9 Months.

PURPOSE: Hand transplantations have been initiated and have been encouraged by promising results for more than 1 decade. The aim of this study was to present the first case of hand transplantation performed in Taiwan. MATERIALS AND METHODS: On September 3, 2014, we transplanted the left distal forearm and hand of a brain-dead managed 37 years to a man aged 45 years who had traumatic amputation of the distal third of his right forearm 30 years ago. The total ischemic time during the transplantation was 6 hours and 45 minutes. Immunosuppression included anti-thymocyte globulins, and methylprednisolone (Solumedrol) was used for the induction. Maintenance therapy included systemic tacrolimus, mycophenolic acid [mycophenolate mofetil (MMF)], and prednisone. A combination of systemic (tacrolimus/MMF/prednisolone) and topical immunosuppressant cream (clobetasol and tacrolimus) was applied if acute rejection occurred. Follow-up included routine posttransplant laboratory tests, skin biopsies, intensive physiotherapy, and psychological support. RESULTS: The initial postoperative course was uneventful. No surgical complications were observed. Immunosuppression was well tolerated using tacrolimus, MMF, and prednisone, except for some immune-related complications. One episode of mild clinical and histological signs of cutaneous rejection was seen at 105 days after surgery. These signs disappeared after pulse therapy with Solumedrol and the topical application of immunosuppressive creams (tacrolimus and clobetasol). One infection episode occurred due to local cellulitis and axillary lymphadenopathy on day 140 and was successfully treated with antibiotics. The patient developed cytomegalovirus infection at 7 months that responded to medication. Intensive physiotherapy led to satisfactory progress in motor functioning. Sensory progress (Tinel sign) was good and reached the wrist by 3 months for the median and ulnar nerves, and could be felt in the finger tip by 9 months in response to deep pressure and light touch sensations. The patient has a lateral pinch that allows him to pick up and grip objects during daily living, although his muscle power is still insufficient. CONCLUSIONS: Hand allotransplantation is technically feasible. Currently available immunosuppression methods seem to control vascularized composite tissue allotransplantation rejection. A combination of topical and systemic immunosuppressants is a useful method to prevent acute hand allotransplant rejection.

Young age, male sex, and end-stage renal disease with secondary hyperparathyroidism as risk factors for intraoperative hyperkalemia during parathyroidectomy.

STUDY OBJECTIVE: The aim of this study was to investigate the risk factors of intraoperative hyperkalemia in end-stage renal disease patients undergoing parathyroidectomy (PTx) with autotransplantation (AT). DESIGN: Prospective observational study. SETTING: Operating room of a tertiary care medical center. PATIENTS: Thirty-two adult, American Society of Anesthesiologists physical status 2 and 3 patients with secondary hyperparathyroidism aged between 31 and 72 years scheduled for PTx with AT. MEASUREMENTS: Laboratory chemistries (intact parathyroid hormone, Na, K, Ca, P, arterial blood gas) were obtained before surgery and at 2 time points during surgery. The first chemistry levels during surgery were checked after the first 2 parathyroid glands had been removed, and the second levels were checked after wound closure. Statistical analysis was performed using t test, Fisher exact test, the receiver operating characteristic curve method, as appropriate. MAIN RESULTS: Eight patients (25%) developed hyperkalemia during surgery. The hyperkalemia patients had younger age (42±11.44 years vs 52.58±11.83 years, P=.044) and a male dominance (odds ratio, 11.4; P=.01; 95% confidence interval, 1.74-74.65). The cutoff for age was 40.5 years, according to the highest value for sensitivity plus specificity of the receiver operating characteristic curve. There was a higher incidence of intraoperative hyperkalemia in younger patients than in older patients (odds ratio, 8.33; P=.023; 95% confidence interval, 1.39-49.87) as well as a significant increase in potassium level during surgery in younger male patients (P=.005 and .002, respectively). CONCLUSIONS: The anesthesiologist should be aware of the complications of intraoperative hyperkalemia during PTx with AT, especially in male end-stage renal disease patients younger than 40 years.

The impact of general anesthesia on radiofrequency ablation of hepatocellular carcinoma.

This study investigates the impact of general anesthesia (GA) on percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). A total of 118 treatment-naïve HCC patients in Barcelona Clinic Liver Cancer curative stage were enrolled. Patients who underwent RFA with GA were designated as the GA group, and the others were identified as the non-GA group. All the percutaneous RFA procedures were performed by the same hepatologist. The GA group comprised 42 (44.1%) patients with 71 tumors (mean size, 2.53 cm) and the non-GA group had 66 patients (55.9%) with 90 tumors (mean size, 2.35 cm). Complete tumor ablation was achieved after one session in 92.3% of the 52 GA patients, and after one to three sessions in 92.4% of 66 non-GA patients. The GA group required significantly fewer RFA sessions to obtain a similar treatment effect (p < 0.001) and the duration of hospitalization was also shortened among the GA patients (4.4 ± 0.9 days vs. 5.1 ± 1.9 days, p = 0.044). The 2-year overall survival and recurrence-free survival rates were not significantly different between the two groups. Overall, performing RFA with GA can decrease the number of sessions required to achieve complete tumor ablation in early stage HCC patients and shorten the hospitalization duration.

The hemodynamic effect of an intravenous antispasmodic on propofol requirements during colonoscopy: A randomized clinical trial.

PURPOSE: Hemodynamic status during induction of anesthesia may modify the amount of propofol needed to induce loss of consciousness (LOC). This study was aimed to evaluate the effect of antispasmodic-induced tachycardia on the concentration of propofol at the effect-site for inducing LOC when deep sedation was executed for colonoscopy. METHODS: One hundred and sixteen adult patients were randomly assigned to receive either 20 mg of the antispasmodic Buscopan intravenously (Buscopan group; n = 58) or normal saline (control group; n = 58) for colonoscopy. After administration of Buscopan, the antispasmodic or normal saline, propofol was given by means of target-controlled infusion to induce LOC. We recorded patient characteristics, hemodynamic profiles, effect-site propofol concentration upon LOC, total propofol dosage for colonoscopy, and colonoscopy outcomes. RESULTS: There were no significant differences in the characteristics between the two groups. Although the patients receiving Buscopan had a higher heart rate than those of the control group (101 ± 15 beats/minute vs. 77 ± 13 beats/minute; p < 0.001), we found no significant difference between two groups in the effect-site propofol concentration for inducing LOC (3.9 ± 0.6 µg/mL vs. 3.8 ± 0.6 µg/mL; p = 0.261) nor total propofol dosage required for colonoscopy (3.2 ± 1.4 mg/kg vs. 3.1 ± 1.1 mg/kg; p = 0.698). Both groups had comparable colonoscopy outcomes, including percentage of patients completing the procedure and total procedure time. CONCLUSION: The hemodynamic responses to intravenous Buscopan neither affected the effect-site propofol concentration needed to induce LOC, nor the total propofol dosage required for colonoscopy in this study. There is no need to modify the dosage of propofol in patients subject to Buscopan premedication in colonoscopy.

The role of meperidine in reduction of postanesthetic shivering and its possible impact on flap outcomes.

Postoperative vascular compromise is a common but critical complication requiring emergent re-exploration, and remains a chief cause of free flap failure. This study investigated the relationship between postanesthetic shivering (PAS) and the development of postoperative complications associated with free flap reconstruction. One hundred thirty-six patients who underwent head and neck cancer resection and free flap reconstruction were retrospectively enrolled. Fifteen patients were assigned to the PAS group, while the others were assigned to the non-PAS (NPAS) group. The odds ratios of acute re-exploration or total failure of the free flap in the PAS group was 3.5 and 14.9, respectively. The dose of meperidine was positively correlated with PAS prevention in our statistical ROC curve analysis. The minimum effective dose of meperidine for PAS prevention was 0.35 mg/kg with 75% sensitivity and 60% specificity. These findings indicate that an optimal dose of meperidine could prevent PAS, which is shown to be associated with a decrease in the incidence of the early post-surgical re-exploration rate of these free flaps related to circulatory compromise.

Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure hemorrhoidectomy for symptomatic hemorrhoids in adults.

This purpose of the meta-analysis was to compare treatment outcomes for adult patients with symptomatic hemorrhoids treated by stapled hemorrhoidopexy or LigaSure hemorrhoidectomy. A search of public medical databases was made to identify randomized controlled trials (RCTs) comparing stapled hemorrhoidopexy (SH) with LigaSure hemorrhoidectomy (LH) for the treatment of adult patients with symptomatic grade 3 and grade 4 hemorrhoids. Postoperative pain as measured using a visual analog scale was the primary outcome, and rate of recurrent prolapse and postoperative bleeding were secondary outcome measures. Four RCTs were identified that met the inclusion criteria. Data for the pooled outcomes were analyzed using odds ratio (OR) analysis. None of the studies in the analysis indicated a significant difference between SH and LH for the outcomes VAS pain score, recurrence rate, or postoperative bleeding. Pooled analysis revealed a significant OR in favor of the SH method for recurrent prolapse (OR = 5.529, P = 0.016) for up to 2 years after surgery. No significant differences between the two methods were identified for VAS pain scores (OR = -1.060, P = 0.149) or postoperative bleeding OR = 1.188, P = 0.871). Pooled analysis of RCT results comparing SH to LH for symptomatic hemorrhoids revealed a significantly greater incidence of recurrent prolapse for SH. The two techniques were associated with similar levels of postoperative pain and postoperative bleeding.