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Maskal SM, Gentle CK, Ellis RC, Tu C, Rosen MJ, Petro CC, Miller BT, Beffa LRA, Chang JH, Messer N, Melland-Smith M, Jeekel J, Prabhu AS. Does selective intraoperative music reduce pain following abdominal wall reconstruction? A double-blind randomized controlled trial. Hernia 2024:10.1007/s10029-024-03092-y. [PMID: 38890182 DOI: 10.1007/s10029-024-03092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/09/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Although intraoperative music is purported to mitigate postoperative pain after some procedures, its application has never been explored in abdominal wall reconstruction (AWR). We sought to determine whether intraoperative music would decrease early postoperative pain following AWR. METHODS We conducted a placebo-controlled, patient-, surgeon-, and assessor-blinded, randomized controlled trial at a single center between June 2022 and July 2023 including 321 adult patients undergoing open AWR with retromuscular mesh. Patients received noise-canceling headphones and were randomized 1:1 to patient-selected music or silence after induction, stratified by preoperative chronic opioid use. All patients received multimodal pain control. The primary outcome was pain (NRS-11) at 24 ± 3 h. The primary outcome was analyzed by linear regression with pre-specified covariates (chronic opioid use, hernia width, operative time, myofascial release, anxiety disorder diagnosis, and preoperative STAI-6 score). RESULTS 178 patients were randomized to music, 164 of which were analyzed. 177 were randomized to silence, 157 of which were analyzed. At 24 ± 3 h postoperatively, there was no difference in the primary outcome of NRS-11 scores (5.18 ± 2.62 vs 5.27 ± 2.46, p = 0.75). After adjusting for prespecified covariates, the difference of NRS-11 scores at 24 ± 3 h between the music and silence groups remained insignificant (p = 0.83). There was no difference in NRS-11 or STAI-6 scores at 48 ± 3 and 72 ± 3 h, intraoperative sedation, or postoperative narcotic usage. CONCLUSION For patients undergoing AWR, there was no benefit of intraoperative music over routine multimodal pain control for early postoperative pain reduction. TRIAL REGISTRATION ClinicalTrials.gov: NCT05374096.
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Affiliation(s)
- Sara M Maskal
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA.
| | - Corey K Gentle
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Ryan C Ellis
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Chao Tu
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Michael J Rosen
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Clayton C Petro
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Benjamin T Miller
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Lucas R A Beffa
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Jenny H Chang
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Nir Messer
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Megan Melland-Smith
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
| | - Johannes Jeekel
- Erasmus Medical Center, Erasmus University, Rotterdam, Netherlands
| | - Ajita S Prabhu
- Cleveland Clinic Foundation, Crile Building, A100, 2049 E 100th Street, Cleveland, OH, 44195, USA
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Blake KE, Perlmutter B, Saieed G, Said SA, Maskal SM, Petro CC, Krpata DM, Rosen MJ, Prabhu AS. The impact of comorbidities on postoperative outcomes of ventral hernia repair: the patients' perspective. Hernia 2023:10.1007/s10029-023-02826-8. [PMID: 37410195 DOI: 10.1007/s10029-023-02826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Ventral hernia repair (VHR) outcomes can be adversely affected by modifiable patient co-morbidities, such as diabetes, obesity, and smoking. Although this concept is well accepted among surgeons, the extent to which patients understand the significance of their co-morbidities is unknown, and a few studies have sought to determine patient perspectives regarding the impact of their modifiable co-morbidities on their post-operative outcomes. We attempted to determine how accurately patients predict their surgical outcomes after VHR compared to a surgical risk calculator while considering their modifiable co-morbidities. METHODS This is a prospective, single-center, survey-based study evaluating patients' perceptions of how their modifiable risk factors affect outcomes after elective ventral hernia repair. Pre-operatively, after surgeon counseling, patients predicted the percentage of impact that they believed their modifiable co-morbidities (diabetes, obesity, and smoking) had on 30-day surgical site infections (SSI) and hospital readmissions. Their predictions were compared to the Outcomes Reporting App for CLinicians and Patient Engagement (ORACLE) surgical risk calculator. Results were analyzed using demographic information. RESULTS 222 surveys were administered and 157 were included in the analysis after excluding for incomplete data. 21% had diabetes, 85% were either overweight with body mass index (BMI) 25-29.9 or obese (BMI ≥ 30), and 22% were smokers. The overall mean SSI rate was 10.8%, SSOPI rate was 12.7%, and 30-day readmission rate was 10.2%. ORACLE predictions correlated with observed SSI rates (OR 1.31, 95% CI 1.12-1.54, p < 0.001), but patient predictions did not (OR 1.00, 95% CI 0.98-1.03, p = 0.868). The correlation between patient predictions and ORACLE calculations was weak ([Formula: see text] = 0.17). Patient predictions were on average 10.1 ± 18.0% different than ORACLE, and 65% overestimated their SSI probability. Similarly, ORACLE predictions correlated with observed 30-day readmission rates (OR 1.10, 95% CI 1.00-1.21, p = 0.0459), but patient predictions did not (OR 1.00, 95% CI 0.975-1.03, p = 0.784). The correlation between patient predictions and ORACLE calculations for readmissions was weak ([Formula: see text] = 0.27). Patient predictions were on average 2.4 ± 14.6% different than ORACLE, and 56% underestimated their readmission probability. Additionally, a substantial proportion of the cohort believed that they had a 0% risk of SSI (28%) and a 0% risk of readmission (43%). Education, income and healthcare employment did not affect the accuracy of patient predictions. CONCLUSIONS Despite surgeon counseling, patients do not accurately estimate their risks after VHR when compared to ORACLE. Most patients overestimate their SSI risk and underestimate their 30-day readmission risk. Furthermore, several patients believed that they had a 0% risk of SSI and readmission. These findings persisted regardless of level of education, income level, or healthcare employment. Additional attention should be directed toward setting expectations prior to surgery and using applications such as ORACLE to assist in this process.
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Affiliation(s)
- K E Blake
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA.
- Department of General Surgery, University of Tennessee Medical Center, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| | - B Perlmutter
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
| | - G Saieed
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
| | - S A Said
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
| | - S M Maskal
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
| | - C C Petro
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
| | - D M Krpata
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
| | - M J Rosen
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
| | - A S Prabhu
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10-133, Cleveland, OH, 44195, USA
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Schein J, Houle C, Urganus A, Cloutier M, Patterson-Lomba O, Wang Y, King S, Levinson W, Guérin A, Lefebvre P, Davis LL. Prevalence of post-traumatic stress disorder in the United States: a systematic literature review. Curr Med Res Opin 2021; 37:2151-2161. [PMID: 34498953 DOI: 10.1080/03007995.2021.1978417] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study synthesized evidence regarding the prevalence of post-traumatic stress disorder (PTSD) in the United States (US). METHODS A systematic literature review (SLR) identified recently published (2015-2019) observational studies of PTSD prevalence in the US via the MEDLINE, EMBASE, and PsycINFO databases. Eligible studies' most recent data were collected no earlier than 2013. Data elements extracted included study design, sample size, location, data source/year(s), study population(s), traumatic event type, prevalance estimates with corresponding look-back periods, and clinical metrics. RESULTS Data from 38 identified articles were categorized by population, diagnostic criteria, and lookback period. Among civilians, point prevalence ranged from 8.0% to 56.7%, 1-year prevalence from 2.3% to 9.1%, and lifetime prevalence from 3.4% to 26.9%. In military populations, point prevalence ranged from 1.2% to 87.5%, 1-year prevalence from 6.7% to 50.2%, and lifetime prevalence from 7.7% to 17.0%. Within these ranges, several estimates were derived from relatively high quality data; these articles are highlighted in the review. Prevalence was elevated in subpopulations including emergency responders, refugees, American Indian/Alaska Natives, individuals with heavy substance use, individuals with a past suicide attempt, trans-masculine individuals, and women with prior military sexual trauma. Female sex, lower income, younger age, and behavioral health conditions were identified as risk factors for PTSD. CONCLUSIONS PTSD prevalence estimates varied widely, partly due to different study designs, populations, and methodologies, and recent nationally representative estimates were lacking. Efforts to increase PTSD screening and improve disease awareness may allow for a better detection and management of PTSD.
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Affiliation(s)
- Jeffrey Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | | | | | | | - Yao Wang
- Analysis Group, Inc, Boston, MA, USA
| | | | | | | | | | - Lori L Davis
- Tuscaloosa Veteran Affairs Medical Center, Tuscaloosa, AL, USA
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
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Haisley KR, Vadlamudi C, Gupta A, Collins CE, Renshaw SM, Poulose BK. Greatest Quality of Life Improvement in Patients With Large Ventral Hernias: An Individual Assessment of Items in the HerQLes Survey. J Surg Res 2021; 268:337-346. [PMID: 34399356 DOI: 10.1016/j.jss.2021.06.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/20/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ventral hernia repair (VHR) has been shown to improve overall quality of life (QOL) by the validated 12-question Hernia-Related Quality-of-Life survey (HerQLes). However, which specific aspects of quality of life are most affected by VHR have not been formally investigated. METHODS Through retrospective analysis of the Abdominal Core Health Quality Collaborative national database, we measured the change in each individual component of the HerQLes questionnaire from a pre-operative baseline assessment to one-year postoperatively in VHR patients. RESULTS In total, 1,875 VHR patients had completed both pre- and post-operative questionnaires from 2014-2018. They were predominately Caucasian (92.3%), 57.9 ± 12.4 Y old, and evenly gender split (50.5% male, 49.5% female, P = 0.31). Most operations were performed open (80.5%) with fewer laparoscopic (7.5%) or robotic cases (12.1%). For each of the 12 individual categories, improvement in QOL from baseline to 1-Y was found to be statistically significant (P < 0.0001). This held true with subgroup analysis of small (<2 cm), medium (2-6 cm), and large (>6 cm) hernias (P < 0.0001), though a larger improvement was seen in 8 of 12 components in hernias >6 cm (P < 0.001). Operative approach did not carry a significant effect except in medium hernias (2-6 cm), where an open approach saw a greater improvement in the "accomplish less at work" item (P = 0.02). CONCLUSIONS VHR is associated with improvement in each of the 12 components of QOL measured in the HerQLes questionnaire, regardless of the size of their hernia. The amount of improvement, however, may be dependent on hernia size and approach.
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Affiliation(s)
- Kelly R Haisley
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Minimally Invasive Surgery, Columbus, Ohio.
| | | | - Anand Gupta
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Courtney E Collins
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Savanah M Renshaw
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Surgical Health Assessment Research and Policy (SHARP), Columbus, Ohio
| | - Benjamin K Poulose
- Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Minimally Invasive Surgery, Columbus, Ohio
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Grove TN, Muirhead LJ, Parker SG, Brogden DRL, Mills SC, Kontovounisios C, Windsor ACJ, Warren OJ. Measuring quality of life in patients with abdominal wall hernias: a systematic review of available tools. Hernia 2021; 25:491-500. [PMID: 32415651 PMCID: PMC8055629 DOI: 10.1007/s10029-020-02210-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Abdominal wall herniation (AWH) is an increasing problem for patients, surgeons, and healthcare providers. Surgical-site specific outcomes, such as infection, recurrence, and mesh explantation, are improving; however, successful repair still exposes the patient to what is often a complex major operation aimed at improving quality of life. Quality-of-life (QOL) outcomes, such as aesthetics, pain, and physical and emotional functioning, are less often and less well reported. We reviewed QOL tools currently available to evaluate their suitability. METHODS A systematic review of the literature in compliance with PRISMA guidelines was performed between 1st January 1990 and 1st May 2019. English language studies using validated quality-of-life assessment tool, whereby outcomes using this tool could be assessed were included. RESULTS Heterogeneity in the QOL tool used for reporting outcome was evident throughout the articles reviewed. AWH disease-specific tools, hernia-specific tools, and generic tools were used throughout the literature with no obviously preferred or dominant method identified. CONCLUSION Despite increasing acknowledgement of the need to evaluate QOL in patients with AWH, no tool has become dominant in this field. Assessment, therefore, of the impact of certain interventions or techniques on quality of life remains difficult and will continue to do so until an adequate standardised outcome measurement tool is available.
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Affiliation(s)
- T N Grove
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - L J Muirhead
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
| | - S G Parker
- Abdominal Wall Reconstruction Unit, Department of Surgery, University College Hospital, London, UK
| | - D R L Brogden
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - S C Mills
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
| | - C Kontovounisios
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK.
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK.
- Department of Surgery, Royal Marsden Hospital, London, UK.
| | | | - O J Warren
- Abdominal Wall Reconstruction Unit, Department of Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster and the Royal Marsden Campus, London, UK
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Santos Filho PVD, Santos RS, Leão SC, Duarte IX, Lima SO. Experimental evaluation of intra-abdominal adhesions comparing two different intraperitoneal meshes and the effect of a natural anti-inflammatory product on their formation. Acta Cir Bras 2021; 35:e351205. [PMID: 33503218 PMCID: PMC7819683 DOI: 10.1590/acb351205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/13/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: In laparoscopic incisional hernia repair, meshes with a tissue-separating
barrier are positioned intraperitoneally. Despite this property, the close
contact between mesh and viscera involves a risk of adhesion formation. Some
natural products, such as red propolis (RP), could reduce these adhesions
owing to their anti-inflammatory properties. This study aimed to compare two
different intraperitoneal meshes with respect to their characteristics of
adhesion formation, histological findings and evaluate the role of RP in the
development of these adhesions. Methods: 40 Wistar rats received placement of two different meshes (Symbotex and
Dynamesh IPOM) on peritoneum. The animals were divided into two groups:
control group (mesh) and treatment group (mesh and RP). After 7 and 14 days,
20 animals of each group underwent midline laparotomy to determine the
adhesions and histological characteristics. Results: Out of the 40 animals, there were two deaths in the test group and two in the
control group. All animals in both groups developed adherence to the mesh.
At postoperative day (POD) 7, two Symbotex meshes presented firm adhesions
and at POD 14, two Dynamesh meshes had firm adhesions as well. The
comparison between the meshes under the effect of RP in relation to the
control group showed no statistical difference. Conclusions: Both meshes showed intraperitoneal adhesions in all evaluated samples with
similar results on the characteristics of adhesions. RP showed no effect on
the incidence or gradation of intraperitoneal adhesions with the mesh.
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Samartcev VA, Gavrilov VA, Parshakov AA, Kanaeva MA. METHODS FOR ASSESSING THE RISKS OF COMPLICATIONS IN PATIENTS WITH HERNIAS OF THE ANTERIOR ABDOMINAL WALL. REVIEW. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-3-5-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The work is based on the analysis of literature data devoted to the problem of assessing postoperative complications in patients with primary and incisional hernias of the anterior abdominal wall. The main purpose of this review is identifying existing methods for assessing local, general perioperative complications and determining of the most reliable prognostic scales and methods for assessing risk factors among the existing ones.The first part of the article is devoted to the assessment of the general condition of patients with hernias of the anterior abdominal wall. The existing scales for assessing modifiable risk factors (MFR), methods of preventing complications, including abdominal bandage, are considered. The main risk factors were determined: CDC wound class, patient age, hernia size, smoking, diabetes, risk 3 and higher according to ASA.In the second part, the assessment of risk factors for complications from the surgical site is considered. The problem of terminology standardization, the difference between surgical site infection (SSI), adverse surgical events (SSO) and surgical site occurrences requiring procedural interventions (SSOPI) is described. Scales for assessing the risks of perioperative complications are presented. The evolution of SSO assessment methods from a four level to a three level scale is described. The Russian experience in assessing the combination of MFR is presented.The third part describes the importance of evaluating post traumatic stress disorder in patients as a risk factor for an unfavorable course of the postoperative period. The European EuraHS QoL Questionnaire, recommended for use in the European Hernia Registry, is presented. The section also highlights the relevance of the selection of patients with hernias in outpatient surgery and one day hospitals.The main idea of developing modern methods for assessing complications after hernioplasty is a comprehensive assessment of the patient's individual profile before operations for primary and incisional hernias in different risk groups. Priority should be given to tailored specific electronic questionnaires.
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Affiliation(s)
- V. A. Samartcev
- Federal State Educational Institution of Higher Education E. A. Vagner Perm State Medical University
| | - V. A. Gavrilov
- Federal State Educational Institution of Higher Education E. A. Vagner Perm State Medical University
| | - A. A. Parshakov
- Federal State Educational Institution of Higher Education E. A. Vagner Perm State Medical University
| | - M. A. Kanaeva
- Federal State Educational Institution of Higher Education E. A. Vagner Perm State Medical University
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Vogel M, Meyer F, Frommer J, Walter M, Lohmann CH, Croner R. Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation? Scand J Pain 2020; 21:238-246. [PMID: 34387954 DOI: 10.1515/sjpain-2020-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient's capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized. METHOD The present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery. CONCLUSION Aspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core. IMPLICATIONS Not least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.
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Affiliation(s)
- Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Meyer
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jörg Frommer
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena Friedrich Schiller University, Jena, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Roland Croner
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
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Chen N, McLaren M, Slater K. The Abdominal Re-Approximation Anchor device (ABRA®) has the potential to be useful in both emergency and elective dynamic temporary fascial closure. ANZ J Surg 2020; 90:2456-2462. [PMID: 33021018 DOI: 10.1111/ans.16322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The management of an open abdomen (OA) remains an evolving field because of its relative rarity. Many techniques to achieve temporary abdominal closure exist, but often require multiple returns to the operating theatre and usually do not address the issue of lateral fascial retraction and do not achieve primary fascial closure (PFC). The ensuing incisional hernias result in a significant surgical challenge affecting both the physical and mental health of the patient. We describe our experience with the Abdominal Re-approximation Anchor (ABRA) device, which addresses some of these issues. METHODS The records of patients with an OA managed by a single surgeon using the ABRA device at Princess Alexandra Hospital, Queensland, Australia, between December 2014 and April 2020 were analysed retrospectively. RESULTS Six patients with OA were managed with the ABRA. All patients required an OA for the ramification of intraabdominal sepsis. Three patients were managed with the ABRA device electively and three in the acute setting. 100% of patients achieved PFC. Average follow-up was 40 months with three developing incisional hernias that were subsequently repaired. CONCLUSION The OA in critically ill surgical patients remains one of the most challenging problems in general surgery. The ABRA device is simple to use and has shown positive outcomes in both the acute and elective setting. Our use has resulted in 100% PFC, which demonstrates that the ABRA device is an important tool for the general surgeon in managing these complex cases.
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Affiliation(s)
- Nelson Chen
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of General Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mairi McLaren
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of General Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kellee Slater
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of General Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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