Introduction Laboratory testing is done before surgery to identify body abnormalities that cannot be detected through clinical evaluation alone. Patients going in for low- or intermediate-risk surgeries are often encouraged to undergo a battery of tests as usual. This cross-sectional observational study evaluated the status of routine pre-operative laboratory tests in American Society of Anaesthesiologists (ASA) Grade I, II, and III adults undergoing elective surgery at a maternity hospital, as well as the impact of these tests on the outcome of the pre-anaesthetic check-up (PAC). Methods The present observational study was conducted on 500 patients scheduled for elective surgery under anaesthesia. The procedures included routine gynaecological and obstetric surgeries like abdominal hysterectomy, suction evacuation, laparotomy for ectopic pregnancy, diagnostic biopsy, and lower segment caesarean section, among others. A designated anaesthesiologist gathered information from the completed PAC sheets. As per the standard departmental policy, each patient underwent a clinical examination and routine investigations at the PAC clinic. In addition to demographic and other variables, laboratory test results and any peri-operative interventions performed due to abnormalities were assessed. Investigations already done, asked by anaesthesiologists, and referral services sought were noted. The impact of these investigations on anaesthetic decision-making was noted. Data were expressed in frequencies and percentages and statistically analysed using INSTAT software (GraphPad Prism Software Inc., La Zolla, USA). Results The age and weight of the patients range from 20 to 70 years and 55 to 95 kg. Most patients belonged to ASA Grade II (n=348, 69.6%). Hypothyroidism was the most common abnormal finding (n=122, 22.4%). Anaemia, hypertension, and diabetes were detected in n=8 (1.6%), n=82 (16.4%), and n=34 (6.8%) of patients, respectively. In 488 (97.6%) patients, one or more of the investigations from the list were pending. Based on the results of various preoperative laboratory investigations, 87 (17.4%) patients were advised of multiple specialty opinions before surgery. A total of 453 (90.6%) patients attending the clinic were recommended to review their PACs after their pending investigations and specialist consultations were completed. At the same time, n=41 (8.2%) was found to be fit for surgery, and n=6 (1.2%) was found unfit for surgery and was postponed. Conclusions The incidence of tests with abnormal results was a little high in our study. One reason could be that a particular group of patients is included in the study. Preoperative laboratory investigations substantially increase the costs. Not many patients with abnormal tests may require changes in their peri-anaesthetic management. Nonetheless, laboratory tests can help ensure the patient is in an ideal preoperative condition. Pre-operative laboratory investigations should be advised on a case-by-case basis to avoid inconveniencing the patient, delaying the surgical procedure, and driving up the cost of surgical treatment.

BACKGROUND: The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice.
METHODS: This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported.
RESULTS: In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients.
CONCLUSIONS: The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.

Over the last few decades, our understanding of the pathophysiology and natural history of sigmoid diverticulitis has greatly improved. This knowledge has challenged many of the traditional principles in the management for diverticulitis, such as routine antibiotic administration in all cases, number-based recommendations for elective surgery, and the necessity for an end colostomy in emergency surgery. This review will cover the breadth of management for sigmoid diverticulitis, covering both uncomplicated and complicated disease as well as elective and emergent disease presentations. New and emerging concepts in management will be highlighted with a particular focus on level-1 data, when available.

OBJECTIVE: Women undergoing surgery for apical pelvic organ prolapse have several medically sound options for specific surgical approaches.
METHODS: We review the principles of shared decision-making as they pertain to surgery for prolapse. We review the literature supporting the superior sacrocolpopexy as a durable treatment for prolapse and the factors that may differentiate it from other repairs in risk and benefit.
RESULTS: We emphasize the importance of collaboration between patients and surgeons in surgical decision-making.
CONCLUSIONS: All medically appropriate patients who desire reconstructive surgery for prolapse should be offered sacrocolpopexy.

Background and Objectives: This retrospective study aimed to investigate the impact of the COVID-19 pandemic on the most frequently performed elective pediatric surgical procedures and the number of hospitalizations and compare it to the pre-pandemic and post-pandemic periods. Materials and Methods: The subjects were patients under 18 years of age who were regularly admitted for selected elective procedures in a single tertiary center in Croatia from 1 March to 31 August of 2019, 2020, 2021, and 2022. Data were collected from the electronic logs of surgical procedures and hospital admissions, logs of one-day surgeries, patients\' medical records, and discharge letters. The primary outcome of this study was to determine the evolution of the number of elective surgical procedures before, during, and after the peak of the COVID-19 pandemic; also, we aimed to confirm and objectify global data and statements about the decrease in the number of hospital admissions and surgical procedures. Secondary outcome measures included the length of hospitalization, the number and types of complications, and readmissions. Results: In 2020, the number of elective procedures decreased by 28.3% and the number of hospitalizations decreased by 36.2%; in 2021, the number of elective procedures decreased by 30.8% and the number of hospitalizations decreased by 14.2% compared to the pre-pandemic period (2019). In 2022, there was a 22.8% increase in elective procedures and a 2.9% decrease in hospitalizations compared to 2019. No statistical difference was found in the rates of complications between the individual years studied in terms of complications (p = 0.869). Conclusions: The number of elective procedures and hospitalizations during the COVID-19 pandemic has decreased significantly compared to the pre-pandemic period. After the healthcare system adapted to the conditions of the pandemic, the number of elective procedures increased significantly despite COVID-19, while the number of hospitalizations remained approximately the same as before the pandemic.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reviewed the quality of care provided to adult patients undergoing surgery for Crohn\'s disease. The study reviewed elective, and emergency surgical pathways and the report highlighted clinical and organisational changes that should be made to improve patient care and outcomes.

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BACKGROUND: Although elective procedures have life-changing potential, all surgeries come with an inherent risk of reoperation. There is a gap in knowledge investigating the risk of reoperation across orthopaedics. We aimed to identify the elective orthopaedic procedures with the highest rate of unplanned reoperation and the reasons for these procedures having such high reoperation rates.
METHODS: Patients in the NSQIP database were identified using CPT and ICD-10 codes. We isolated 612,815 orthopaedics procedures from 2018 to 2020 and identified the 10 CPT codes with the greatest rate of unplanned return to the operating room. For each index procedure, we identified the ICD-10 codes for the reoperation procedure and categorized them into infection, mechanical failure, fracture, wound disruption, hematoma or seroma, nerve pathology, other, and unspecified.
RESULTS: Below knee amputation (BKA) (CPT 27880) had the highest reoperation rate of 6.92% (37 of 535 patients). Posterior-approach thoracic (5.86%) or cervical (4.14%) arthrodesis and cervical laminectomy (3.85%), revision total hip arthroplasty (5.23%), conversion to total hip arthroplasty (4.33%), and revision shoulder arthroplasty (4.22%) were among the remaining highest reoperation rates. The overall leading causes of reoperation were infection (30.1%), mechanical failure (21.1%), and hematoma or seroma (9.4%) for the 10 procedures with the highest reoperation rates.
CONCLUSIONS: This study successfully identified the elective orthopaedic procedures with the highest 30-day return to OR rates. These include BKA, posterior thoracic and cervical spinal arthrodesis, revision hip arthroplasty, revision total shoulder arthroplasty, and cervical laminectomy. With this data, we can identify areas across orthopaedics in which revising protocols may improve patient outcomes and limit the burden of reoperations on patients and the healthcare system. Future studies should focus on the long-term physical and financial impact that these reoperations may have on patients and hospital systems.
METHODS: IV.

Introduction: Despite considerable national attention, racial disparities in surgical outcomes persist. We sought to consider whether race-based inequities in outcomes following major elective surgery have improved in the contemporary era. Methods: All adult hospitalization records for elective coronary artery bypass grafting, abdominal aortic aneurysm repair, colectomy, and hip replacement were tabulated from the 2016-2020 National Inpatient Sample. Patients were stratified by Black or White race. To consider the evolution in outcomes, we included an interaction term between race and year. We designated centers in the top quartile of annual procedural volume as high-volume hospitals (HVH). Results: Of ∼2,838,485 patients, 245,405 (8.6%) were of Black race. Following risk-adjustment, Black race was linked with similar odds of in-hospital mortality, but increased likelihood of major complications (Adjusted Odds Ratio [AOR] 1.41, 95%Confidence Interval [CI] 1.36-1.47). From 2016-2020, overall risk-adjusted rates of major complications declined (patients of White race: 9.2% to 8.4%; patients of Black race 11.8% to 10.8%, both P < .001). Yet, the delta in risk of adverse outcomes between patients of White and Black race did not significantly change. Of the cohort, 158,060 (8.4%) were treated at HVH. Following adjustment, Black race remained associated with greater odds of morbidity (AOR 1.37, CI 1.23-1.52; Ref:White). The race-based difference in risk of complications at HVH did not significantly change from 2016 to 2020. Conclusion: While overall rates of complications following major elective procedures declined from 2016 to 2020, patients of Black race faced persistently greater risk of adverse outcomes. Novel interventions are needed to address persistent racial disparities and ensure acceptable outcomes for all patients.

BACKGROUND: The era of biologics is associated with declining rates of surgery for Crohn\'s disease (CD), but the impact on surgery for stricturing CD is unknown. Our study aimed to assess nationwide trends in bowel resection surgery for obstruction in CD since the introduction of infliximab for CD in 1998.
METHODS: Using the Nationwide Inpatient Sample, we performed a nationwide analysis, identifying patients hospitalized for CD who underwent bowel resection for an indication of obstruction between 1998 and 2020 (era of biologics). Longitudinal trends in all CD-related resections and resection for obstruction were evaluated. Multivariable logistic regression identified patient and hospital characteristics associated with bowel resection surgery for obstruction.
RESULTS: Hospitalizations for all CD-related resections decreased from 12.0% of all hospitalizations in 1998 to 6.9% in 2020, while hospitalizations for CD-related resection for obstructive indication increased from 1.3% to 2.0%. The proportion of resections for obstructive indication amongst all CD-related bowel resections increased from 10.8% in 1998 to 29.1% in 2020. In the multivariable models stratified by elective admission, the increasing year was associated with risk of resection for obstructive indication regardless of urgency (nonelective model: odds ratio, 1.01; 95% CI, 1.00-1.02; elective model: odds ratio, 1.06; 95% CI, 1.04-1.08).
CONCLUSIONS: In the era of biologics, our findings demonstrate a decreasing annual rate of CD-related bowel resections but an increase in resection for obstructive indication. Our findings highlight the effect of medical therapy on surgical rates overall but suggest limited impact of current medical therapy on need of resection for stricturing disease.
In our nationwide analysis, rates of bowel resection for patients with Crohn’s disease have declined since the approval of infliximab in 1998. However, rates of resection for obstruction in patients with Crohn’s disease continue to increase.