TY - JOUR A1 - Knödler, Samuel A1 - Schliermann, Rainer A1 - Knödler, Leonard A1 - Wu, Mengfan A1 - Hansen, Frederik J. A1 - Matar, Dany Y. A1 - Obed, Doha A1 - Vervoort, Dominique A1 - Haug, Valentin A1 - Hundeshagen, Gabriel A1 - Paik, Angie A1 - Kauke-Navarro, Martin A1 - Kneser, Ulrich A1 - Pomahac, Bohdan A1 - Orgill, Dennis P. A1 - Panayi, Adriana C. T1 - Impact of sarcopenia on outcomes in surgical patients: A systematic review and meta-analysis JF - International journal of surgery N2 - BACKGROUND Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, we aimed to synthesize the available literature and investigate the impact of sarcopenia on peri- and postoperative outcomes across all surgical specialties. METHODS We systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Our primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at one, three, and five years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population, and on those of higher quality or prospective study design. RESULTS A total of 294 studies comprising 97,643 patients, of which 33,070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P<0.00001). A significantly lower survival rate in patients with sarcopenia was noted at one, three, and five years (all P<0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P<0.00001), cardiovascular (both P<0.00001), and emergency (P=0.03 and P=0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia (P<0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients (P=0.007). Sensitivity analysis based on higher-quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P<0.00001). CONCLUSION Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons to identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical sub-specialties. KW - Sarcopenia KW - Aging KW - Muscle Loss KW - Muscle KW - Surgical Outcomes KW - Surgery Y1 - 2023 U6 - https://doi.org/10.1097/JS9.0000000000000688 PB - Wolters Kluwer ET - accepted ER - TY - JOUR A1 - Knödler, Leonard A1 - Berkin, Özdemir A1 - Moog, Philipp A1 - Prantl, Lukas A1 - Broer, P. Niclas A1 - Knödler, Christoph A1 - Rieger, Ulrich M. A1 - Perl, Markus A1 - von Isenburg, Sarah A1 - Gassner, Ulrich M. A1 - Obed, Doha A1 - Haug, Valentin A1 - Panayi, Adriana C A1 - Knödler, Samuel T1 - Thinking like a Lawyer - Human Rights and Their Association with the Plastic Surgeon of Today JF - Aesthetic Plastic Surgery N2 - Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR). KW - European Convention on Human Rights KW - European Law KW - German Basic Law KW - Human Rights KW - Reconstructive Surgery Y1 - 2022 U6 - https://doi.org/10.1007/s00266-022-02990-9 VL - 114 PB - Springer-Verlag GmbH CY - Heidelberg ER - TY - JOUR A1 - Knoedler, Leonard A1 - Baecher, Helena A1 - Kauke-Navarro, Martin A1 - Prantl, Lukas A1 - Machens, Hans-Günther A1 - Scheuermann, Philipp A1 - Palm, Christoph A1 - Baumann, Raphael A1 - Kehrer, Andreas A1 - Panayi, Adriana C. A1 - Knoedler, Samuel T1 - Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science JF - Journal of Clinical Medicine N2 - Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow. Y1 - 2022 U6 - https://doi.org/10.3390/jcm11174998 VL - 11 IS - 17 PB - MDPI CY - Basel ER -