Background: Surgery is a major physiologic stress comparable to intense exercise. Diminished cardiopulmonary reserve is a major predictor of poor outcomes. Current preoperative workup focuses mainly on identifying risk factors, however little attention is devoted to improving cardiopulmonary reserve beyond counseling. We propose that patients could be optimized for a “surgical marathon” similar to the preparation of an athlete. Study Design: The Michigan Surgical and Health Optimization Program (MSHOP) is a formal prehabilitation program that engages patients in four activities before surgery: physical activity, pulmonary rehabilitation, nutritional optimization, and stress reduction. We prospectively collected demographic, intraoperative (first hour), and postoperative data for patients enrolled in MSHOP undergoing major abdominal surgery. Statistical analysis was performed using 2:1 propensity score matching to compare the MSHOP group (N=40) to emergency (N=40) and elective, non-MSHOP (N=76) patients. Results: Overall, 70% of MSHOP patients complied with the program. Age, gender, ASA classification, and BMI did not differ significantly between groups. One hour intraoperatively, MSHOP patients showed improved systolic and diastolic blood pressures and lower heart rate (Figure). There was a significant reduction in Clavien-Dindo class 3–4 complications in the MSHOP group (30%) compared to the non-prehabilitation (38%) and emergency (48%) groups (p=0.05). This translated to total hospital charges averaging $75,494 for the MSHOP group, $97,440 for the non-prehabilitation group, and $166,085 for the emergency group (p < 0.001). Conclusion: Patients undergoing prehabilitation prior to colectomy showed positive physiologic effects and experienced fewer complications. The average savings of $21,946 per patient represents a significant cost offset for a prehabilitation program, and should be considered for all patients undergoing surgery.

A perioperative bundle and monitoring system may help to reduce SSI rates after cranioplasty. This work also indicates how an active surveillance program can successfully change clinical practice.

Hyaluronic acid (HA) is one of the natural components of the human body with high biocompatibility, biodegradability, and nonimmunogenicity, which makes it the ideal biomedical filling agent currently available. However, for many medical practitioners, HA filler injections remain a relatively new item to carry out. Learning while practicing, it is inevitable to encounter some difficulties and adverse reactions in its application. Here we report two cases of adverse reactions to HA-based filler injections, including anaphylactic reaction on the face and vascular thrombosis after augmentation rhinoplasty with HA filler. In this report, we highlight the management and prevention of the adverse reactions, especially in case 2, because vascular thrombosis is one of the severe complications and injectors should know how to avoid it and how to deal with it, thereby increasing the safety of HA-based procedures.

PBs in the 'fast CICADA' group (<3 attempts to cease CPAP) (a) have longer gestational age and higher birth weight, (b) shorter mechanical ventilation and (c) lower incidence of patent ductus arteriosus. Attempts to cease CPAP decreased by 0.5 times per 1 week increase in GA and 0.3 times per 100-g increase in birth weight for PBs <30 weeks gestation.