Compared with haemorrhoidectomy, dearterialization led to less pain in grade III/IV haemorrhoids.

Purpose: To evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures. Methods: We retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid or Medicare vs private), smoking history, employment status, and history of surgery to determine which demographic factors led to an increased risk of elective case cancellation. Results: Patients who canceled were significantly older (46.5 years vs 41.5 years, t ¼ 2.432, P ¼ .015) than those who do not. In addition, current smokers (22.5% vs 10.9%, c 2 ¼ 10.85, P ¼ .001), patients with Medicare or Medicaid versus private insurance (16.7% vs 10.0%, c 2 ¼ 5.35, P ¼ .021), noneEnglish-speaking patients (29.5% vs 11.6%, c 2 ¼ 11.43, P ¼ .001), and patients without a history of surgery requiring anesthesia (18.8% vs 9.6%, c 2 ¼ 9.96, P ¼ .002) were all more likely to cancel. When all studied variables were examined in a logistic regression analysis, of the above demographic variables, only insurance status was no longer significant, given its correlation with age and language. Conclusions: Increased age (46.5 years), non-English speaking, smoking, lack of a history of surgery requiring anesthesia, and Medicaid or Medicare insurance were found to contribute to an increased risk of elective orthopaedic surgery cancellation. Level of Evidence: Level III, case-control study.

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Simulated colonoscopy training in a low-cost physical model improved the performance of surgery interns with decreased procedure time, increased rates of complete colonoscopy and appropriate scope withdrawal.

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Acute traumatic spondyloptosis (ATS) is a rare condition in the orthopedic literature, with few cases reported. We present a case of ATS in a 35-year-old Hispanic male with multilevel injury, without neurological deficits at the time of injury. The patient was treated in a two-stage method consisting of combined anterior and posterior spinal decompression and fusion. At the six-month follow-up, the patient had no motor/sensory deficits, he remained stable during the one-year period. Conclusion: ATS is rarely seen in patients without neurological deficits on presentation. Although surgical intervention presents significant risks of iatrogenic neurologic compromise, surgical fixation is warranted.

Study Design: Retrospective review. Objective: The objective of this study was to evaluate and compare distribution of hospital and operating room charges and outcomes during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) patients by high-volume (HV) and standard-volume (SV) surgeons at one institution and examine potential cost savings. Summary of Background Data: Increased surgical volume has been associated with improved perioperative outcomes after spinal deformity correction. However, there is a lack of information on how this may affect hospital costs. Methods: Retrospective study of AIS patients undergoing posterior spinal fusion between 2013 and 2019. Demographic, x-ray, chart review and hospital costs were collected and compared between HV surgeons (≥50 AIS cases/y) and SV surgeons (<50/y). Comparative analyses were computed using Wilcoxon rank-sum, Kruskal-Wallis, and the Fisher exact tests. Average values with corresponding minimum–maximum rages were reported. Results: A total of 407 patients (HV: 232, SV: 175) operated by 4 surgeons (1 HV, 3 SV). Radiographic parameters were similar between the groups. HV surgeons had significantly lower estimated blood loss (385.3 vs. 655.6 mL, P<0.001), fewer intraoperative transfusions (10.8% vs. 25.1%, P<0.001), shorter surgery time (221.6 vs. 324.9 min, P<0.001), and lower radiation from intraoperative fluoroscopy (4.4 vs. 6.4 mGy, P<0.001). HV patients had a significantly lower length of stay (4.3 vs. 5.3, P<0.001) and complication rate (0.4% vs. 4%, P=0.04). HV surgeons had significantly lower total costs ($61,716.24 vs. $72,745.93, P<0.001). This included lower transfusion costs (P<0.001), operative time costs (P<0.001), screw costs (P<0.001), hospital stay costs (P<0.001), and costs associated with 30-day emergency department returns (P<0.001). Conclusion: HV surgeons had significantly lower operative times, lower estimated blood loss and transfusion rates and lower perioperative complications requiring readmission or return to emergency department resulting in lower health care costs. Level of Evidence: Level III.

Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG). It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT) after LSG. Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation. Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.