Preoperative Testing Publications (5559)


Preoperative Testing Publications

Dentomaxillofac Radiol
Dentomaxillofac Radiol 2017 Jan 23:20160225. Epub 2017 Jan 23.
2 Department of Oral and Maxillofacial Radiology, Institute of Odontology, University of Gothenburg, Sweden.
Int. J. Surg. Pathol.
Int J Surg Pathol 2017 Jan 1:1066896916688083. Epub 2017 Jan 1.
1 University of Pisa, Pisa, Italy.

BRAF mutations represent the most common genetic alteration in papillary thyroid carcinoma (PTC). The p.V600E mutation is specific for the classic and tall-cell variants of PTC and has been associated with a more aggressive biologic behavior. Read More

On the other hand, the p.K601E mutation is peculiar to the follicular variant of PTC, and seems to be a favorable prognostic indicator. A 12-year-old boy presented with a 10-mm left-sided thyroid nodule. Fine-needle aspiration cytology reported the lesion as suspicious for a follicular neoplasm (Bethesda category IV). The patient underwent lobectomy, and histopathology revealed a follicular adenoma with normal surrounding tissue. The cytological smear was found to be positive for BRAF p.K601E mutation, and this was later confirmed on the corresponding paraffin block. This case was independently revised by 4 expert pathologists, all of whom confirmed the benign nature of the thyroid lesion. This article describes the presence of a BRAF mutation in a benign thyroid lesion. To the authors' knowledge, this is the fourth case of follicular adenoma carrying BRAF(K601E) reported in literature to date. BRAF(K601E) mutation can occur in benign thyroid lesions. This finding, in the context of the current literature and the recently proposed reclassification of the noninvasive encapsulated follicular variant of papillary thyroid carcinoma into a benign lesion, confirms the importance of preoperative BRAF p.K601E testing in offering patients a tailored treatment plan and avoiding overtreatment.

Am. J. Obstet. Gynecol.
Am J Obstet Gynecol 2017 Jan 16. Epub 2017 Jan 16.
Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.

A model that predicts a patient's risk of receiving a blood transfusion may facilitate selective preoperative testing and more efficient perioperative blood management utilization.
To construct and validate a model that predicts a patient's risk of receiving a blood transfusion after gynecologic surgery.
18,319 women who underwent gynecologic surgery at 10 institutions in a single health system by 116 surgeons between January 2010 and June 2014 were analyzed. Read More

The dataset was split into: 1) a model training cohort of 12,219 surgeries performed from January, 2010 to December, 2012 and a separate validation cohort of 6,100 surgeries performed from January, 2013 to June, 2014. Forty-seven candidate risk factors for transfusion were collected. Multiple logistic models were fit onto the training cohort to predict transfusion within 30 days of surgery. Variables were removed using stepwise backward reduction to the find the best parsimonious model. Model discrimination was measured using the concordance index. The model was internally validated using 1,000 bootstrapped samples and temporally validated by testing the model's performance in the validation cohort. Calibration and decision curves were plotted to inform clinicians about the accuracy of predicted probabilities and whether the model adds clinical benefit when making decisions.
The transfusion rate in the training cohort was 2% (95%CI 1.72 to 2.22). The model had excellent discrimination and calibration during internal validation (bias-corrected concordance index = 0.906, 95% CI: 0.890, 0.928) and maintained accuracy during temporal validation using the separate validation cohort (concordance index = 0.915, 95% CI: 0.872, 0.954). Calibration curves demonstrated the model was accurate up to 40% then it began to over-predict risk. The model provides superior net benefit when clinical decision thresholds are between 0% and 50% predicted risk.
This model accurately predicts a patient's risk of transfusion after gynecologic surgery facilitating selective preoperative testing and more efficient perioperative blood management utilization.

Hernia 2017 Jan 13. Epub 2017 Jan 13.
Department of Surgery, Lichtenstein Amid Hernia Clinic at UCLA, Los Angeles, CA, USA.

Neurectomy of the inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy inguinal pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique. Read More

Longitudinal (preoperative, immediate postoperative, and late postoperative) dermatomal sensory mapping and a comprehensive QST protocol were conducted in CPIP patients with unilateral, predominantly neuropathic inguinodynia presenting for triple neurectomy (n = 13). QST was conducted in four areas on the affected, painful side and in one contralateral comparison site. QST variables were compared according to sensory mapping outcomes: (o)/normal sensation, (+)/pain, and (-)/numbness. Diagnostic ability of the sensory mapping outcomes to detect QST-assessed allodynia or hypoesthesia was estimated through calculation of specificity and sensitivity values.
Preoperatively, patients exhibited mechanical hypoesthesia and allodynia and pressure allodynia and hyperalgesia in painful areas mapped (+) (p < .05); sensory mapping outcome (+) demonstrated high ability to detect mechanical allodynia [sensitivity 0.74 (95% CI 0.61-0.86), specificity 0.94 (0.84-1.00)] and pressure allodynia [sensitivity 0.96 (0.89-1.00), specificity 1.00 (1.00-1.00)], but not thermal allodynia. Postoperatively, mapped areas of numbness (-) were associated with mechanical and thermal hypoesthesia (p < .05); (-) showed high sensitivity and specificity to detect mechanical and cold hypoesthesia.
Sensory mapping provides an accurate clinical neuropathic assessment with strong correlation to QST findings of preoperative mechanical and pressure allodynia, and postoperative mechanical and thermal hypoesthesia in CPIP patients undergoing neurectomy.

Surg Obes Relat Dis
Surg Obes Relat Dis 2016 Nov 11. Epub 2016 Nov 11.
Cleveland Clinic Lerner College of Medicine, Cleveland, OH.

Psychosocial factors contribute to poorer weight loss outcomes following bariatric surgery; however, findings on associations between preoperative psychiatric diagnoses, psychological testing, and weight loss are inconsistent.
Examine associations between presurgical psychiatric diagnoses derived from a semi-structured clinical interview and test scores from the Minnesota Multiphasic Personality-Inventory-2 - Restructured Form (MMPI-2-RF) and 5-year Body Mass Index (BMI) outcomes.
Cleveland Clinic Bariatric and Metabolic Institute METHODS: 446 consecutively consented patients who underwent a Roux-en-Y gastric bypass (RYGB) at least 5 years prior were included in the study. Read More

A majority were women (74.2%) and Caucasian (66.2%). Patients' mean presurgical BMI was 49.14 kg/m(2) [SD = 9.50 kg/m(2)]. Psychiatric diagnoses were obtained from a presurgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their presurgical evaluations. BMIs were collected at 4 postoperative time points across a 5-year trajectory. This prospective design utilized latent growth curve modeling.
Older patients evidenced a slower rate of BMI reduction over time. A presurgical diagnosis of Binge Eating Disorder predicted higher BMIs at the 5-year outcome. Scores on MMPI-2-RF measures of emotional and behavioral dysfunction domains incrementally predicted poorer weight loss outcomes.
Preoperative indicators of psychopathology, notably indicators that are dimensional in nature, are important in predicting postoperative outcomes. Closer follow-up with patients who evidence presurgical psychological factors, both before and after surgery, may help improve outcomes.

Arthroscopy 2017 Jan 11. Epub 2017 Jan 11.
Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A.. Electronic address:

To determine if a difference exists in brake reaction time (BRT) before and after hip arthroscopy for femoroacetabular impingement (FAI) and labral tear compared with age- and gender-matched controls.
Consecutive adult subjects undergoing primary hip arthroscopy were eligible for this prospective investigation. Individuals with symptomatic FAI and labral tear that underwent hip arthroscopy with minimum 8 weeks follow-up were included. Read More

BRT was measured using the RT-2S reaction time tester a maximum of 6 weeks preoperatively and every 2 weeks postoperatively for 8 weeks. Sit-to-stand test (STST) was measured at each BRT testing session. An age- and gender-matched control group without hip or lower extremity symptoms were selected and completed both BRT and STST. Continuous pre- and postoperative BRT values were compared with Mann-Whitney and analyses of variance. Association of BRT and STST tests was performed with Spearman correlation. An a priori sample size calculation determined that minimally 18 subjects per group (surgery group vs control group) were necessary to detect, with 80% power (difference of 0.2 seconds in BRT).
Nineteen subjects (age 37.1 ± 12.7 years, 10 women, 11 right hip) were analyzed. All subjects underwent arthroscopic labral repair and FAI correction. There was no difference between preoperative (604 ± 148 milliseconds [ms]) and postoperative (608 ms 2 weeks; 566 ms 4 weeks; 559 ms 6 weeks; 595 ms 8 weeks) BRT. There was no difference between controls and subjects at any time point. There was a strong negative correlation between BRT and STST preoperatively and at 4 and 6 weeks postoperatively and a moderate negative correlation at 2 weeks postoperatively.
After hip arthroscopy for FAI and labral tear, BRT is not different from preoperative values or that of controls. In addition, BRT had a significant correlation with STST in the first 6 weeks after surgery.
Level II, diagnostic, prospective.


Background: The objective of this study is to determine subclinical changes in hand sensation after brachial plexus blocks used for hand surgery procedures. We used Semmes-Weinstein monofilament testing to detect these changes. We hypothesized that patients undergoing brachial plexus nerve blocks would have postoperative subclinical neuropathy detected by monofilament testing when compared with controls. Read More

Methods: In total, 115 hand surgery adult patients were prospectively enrolled in this study. All patients undergoing nerve-related procedures were excluded as well as any patients with preoperative clinically apparent nerve deficits. Eighty-four patients underwent brachial plexus blockade preoperatively, and 31 patients underwent general anesthesia (GA). Semmes-Weinstein monofilament testing of the hand was performed preoperatively on both the operative and nonoperative extremities and postoperatively at a mean of 11 days on both hands. Preoperative and postoperative monofilament testing scores were compared between the block hand and the nonoperated hand of the same patient, as well as between the block hands and the GA-operated hands. Results: There were no recorded clinically relevant neurologic complications in the block group or GA group. A statistically significant decrease in sensation in postoperative testing in the operated block hand compared with the nonoperated hand was noted. When comparing the operated block hand with the operated GA hand, there was a decrease in postoperative sensation in the operated block hand that did not reach statistical significance. Conclusions: Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations.

Otol. Neurotol.
Otol Neurotol 2017 Jan 10. Epub 2017 Jan 10.
*Mechanical Engineering †Otolaryngology, Vanderbilt University Medical Center ‡Electrical Engineering, Vanderbilt University, Nashville, Tennessee.

An image-guided robotic system can safely perform the bulk removal of bone during the translabyrinthine approach to vestibular schwannoma (VS).
The translabyrinthine approach to VS removal involves extensive manual milling in the temporal bone to gain access to the internal auditory canal (IAC) for tumor resection. This bone removal is time consuming and challenging due to the presence of vital anatomy (e. Read More

g., facial nerve) embedded within the temporal bone. A robotic system can use preoperative imaging and segmentations to guide a surgical drill to remove a prescribed volume of bone, thereby preserving the surgeon for the more delicate work of opening the IAC and resecting the tumor.
Fresh human cadaver heads were used in the experiments. For each trial, the desired bone resection volume was planned on a preoperative computed tomography (CT) image, the steps in the proposed clinical workflow were undertaken, and the robot was programmed to mill the specified volume. A postoperative CT scan was acquired for evaluation of the accuracy of the milled cavity and examination of vital anatomy.
In all experimental trials, the facial nerve and chorda tympani were preserved. The root mean squared surface accuracy of the milled cavities ranged from 0.23 to 0.65 mm and the milling time ranged from 32.7 to 57.0 minute.
This work shows feasibility of using a robot-assisted approach for VS removal surgery. Further testing and system improvements are necessary to enable clinical translation of this technology.

J. Thorac. Cardiovasc. Surg.
J Thorac Cardiovasc Surg 2016 Nov 16. Epub 2016 Nov 16.
Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex; Department of Surgery, Texas Children's Hospital, Houston, Tex. Electronic address:

Routine preoperative laboratory testing (RLT) is common practice in pediatric cardiothoracic surgery and is associated with significant cost burden to patients and families. We sought to examine the value of RLT in patients undergoing elective pediatric cardiothoracic surgery.
We conducted a retrospective study of all scheduled elective pediatric cardiothoracic surgery at our institution from 2012 to 2014. Read More

Inpatients were excluded. Patient charts were reviewed to obtain preoperative laboratory values and determine relationship to case cancellation. RLT includes complete blood count, prothrombin time, partial thromboplastin time, urinalysis, 7 chemistry metabolic panel, electrocardiogram, and 2-view chest radiograph.
RLT was completed for 1106 scheduled elective cases. Six (0.5%) cancellations were related to abnormal preoperative laboratory test results: 5 complete blood counts and 1 urinalysis. Hospital charge for RLT averaged $2064 per patient. Based on this incidence, we estimated that 184 routine preoperative laboratory tests, which generated a total hospital charge of $379,776, were required to capture 1 abnormal test significant enough to cancel surgery. An estimated charge of $2,169,552 was generated on prothrombin time, partial thromboplastin time, 7 chemistry metabolic panel, electrocardiogram, and 2-view chest radiograph, and none of these tests resulted in a cancellation.
RLT does not significantly impact decision-making in elective pediatric cardiothoracic surgery. The decision to order a specific screening test should be clinically driven. Selective preoperative laboratory testing may have a positive impact on healthcare costs without affecting outcomes.

Int. J. Radiat. Oncol. Biol. Phys.
Int J Radiat Oncol Biol Phys 2017 Feb 19;97(2):381-388. Epub 2016 Oct 19.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Hospital Foundation Policlinico Tor Vergata, Rome, Italy.

The identification of predictive biomarkers for neoadjuvant chemoradiation therapy (CRT) is a current clinical need. The heterodimer Ku70/80 plays a critical role in DNA repair and cell death induction after damage. The aberrant expression and localization of these proteins fail to control DNA repair and apoptosis. Read More

sClusterin is the Ku70 partner that sterically inhibits Bax-dependent cell death after damage in some pathologic conditions. This study sought to evaluate the molecular relevance of Ku70-Ku80-Clu as a molecular cluster predicting the response to neoadjuvant CRT in patients with locally advanced rectal cancer (LARC).
Patients enrolled in this study underwent preoperative CRT followed by surgical excision. A retrospective study based on individual response, evaluated by computed tomography and diffusion-weighted magnetic resonance imaging, identified responder (56%) and no-responder patients (44%). Ku70/80 and Clu expression were observed in biopsy specimens obtained before and after treatment with neoadjuvant CRT from the same LARC patients. In vitro studies before and after irradiation were also performed on radioresistant (SW480) and radiosensitive (SW620) colorectal cancer cell lines, mimicking sensitive or resistant tumor behavior.
We found a conventional nuclear localization of Ku70/80 in pretherapeutic tumor biopsies of responder patients, in agreement with their role in DNA repair and regulating apoptosis. By contrast, in the no-responder population we observed an unconventional overexpression of Ku70 in the cytoplasm (P<.001). In this context we also overexpression of sClu in the cytoplasm, which accorded with its role in stabilizing of Bax-Ku70 complex, inhibiting Bax-dependent apoptosis. Strikingly, Ku80 in these tumor tissues was lost (P<.005). In vitro testing of colon cancer cells finally confirmed the results observed in tumor biopsy specimens, proving that Ku70/80-Clu deregulation is extensively involved in the resistance mechanism.
These results strongly suggest a potential role of these proteins as a new prognostic tool to predict the response to chemoradiation in LARC.