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Bridges T, Meade M, Brush P, Lee Y, Narayanan R, McCurdy MA, Lambrechts M, Charlton A, Jenkins E, Juniewicz R, Destine H, Kaye ID, Kurd M, Canseco J, Hilibrand A, Vaccaro AR, Schroeder G, Kepler C. Early Diet Liberalization After Anterior Lumbar Interbody Fusion Improves Postoperative Recovery. Global Spine J 2023:21925682231223461. [PMID: 38149647 DOI: 10.1177/21925682231223461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES The objective of this study was to assess the impact of diet liberalization on short-term outcomes in patients undergoing anterior interbody lumbar fusion (ALIF). METHODS A retrospective review was performed for patients undergoing ALIF at our tertiary care center institution from 2010 to 2022. Electronic medical records were reviewed for demographics, surgical characteristics, and 90-day postoperative outcomes. RESULTS We included 515 patients in this study with 102 patients receiving a full diet on the same day as their operation. All other patients had a delay of at least 1 day (average 1.6 days) until a full diet was provided. This group was found to have a higher rate of postoperative ileus (10.2% vs 2.9%) and urinary retention (16.0% vs 3.9%). The readmission rate and percent of patients presenting to the emergency department within 90 days postoperatively were similar. On multivariate regression analysis, same-day, full-diet patients had decreased odds of developing urinary retention (OR = .17) and a shorter length of hospital stay (Estimate: -.99). Immediate full diet had no impact on the development of ileus (OR: .33). CONCLUSIONS An immediate postoperative full diet following an anterior approach to the lumbar spine was not found to be associated with an increased risk of postoperative ileus in patients deemed appropriate for early diet liberalization. Moreover, an early full diet was found to reduce length of hospitalization and risk of postoperative urinary retention. Reconsideration of postoperative diet protocols may help optimize patient outcomes and recovery.
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Affiliation(s)
- Tiffany Bridges
- Department of Orthopaedic Surgery, Jefferson Health in New Jersey, Stratford, NJ, USA
| | - Matthew Meade
- Department of Orthopaedic Surgery, Jefferson Health in New Jersey, Stratford, NJ, USA
| | - Parker Brush
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael A McCurdy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
- Department of Orthopaedic Surgery, Washington University Hospital, St. Louis, MO, USA
| | - Alex Charlton
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Eleanor Jenkins
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert Juniewicz
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Henson Destine
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Maxwell CM, Weksler B, Houda J, Fernando HC. Intercostal Cryoablation During Video-Assisted Lung Resection Can Decrease Postoperative Opioid Use. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:352-356. [PMID: 37461202 DOI: 10.1177/15569845231185583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Pain requiring opioid use remains an issue even with minimally invasive thoracic surgery. The objective of this study was to investigate the effectiveness of intercostal nerve cryoablation (CRYO) for pain control in adult patients undergoing pulmonary resection. METHODS A retrospective analysis of patients undergoing pulmonary resection by uniportal video-assisted thoracic (uVATS) approach was undertaken. Patients treated with our usual pain regimen (STANDARD) were compared with those who additionally received CRYO. STANDARD includes intercostal bupivacaine, patient-controlled analgesia (24 h), ketorolac (48 to 72 h), and tramadol. Intraoperative CRYO was performed on 5 intercostal levels. The primary aim was to compare pain scores (range, 0 to 10) and morphine equivalent dosages (MED). Secondary outcomes included length of stay, chest tube duration, presence of an air leak, and adverse events. A p value <0.05 was considered significant. RESULTS There were 49 patients (34 female, 15 male). The median age was 74 (37 to 90) years. Procedures included lobectomy (n = 32), segmentectomy (n = 7), and wedge resections (n = 10). There were 23 (46.9%) CRYO and 26 (53.1%) STANDARD patients. Baseline characteristics were similar. Mean length of stay (2.9 vs 3.5 days), chest tube duration (2.2 vs 1.8 days), and adverse events (9 of 23 vs 7 of 26) were similar. There were no complications attributable to CRYO. Pain scores were not significantly different on postoperative days (POD) 1 to 4. MED was significantly reduced after CRYO on POD 1 (5 vs 47.24), POD 2 (10.93 vs 25.04), POD 3 (8.13 vs 21.7), and POD 4 (7.08 vs 19.17). CONCLUSIONS CRYO can be performed safely during pulmonary resection and can decrease in-hospital opioid use. The results from this retrospective study will need to be validated in future prospective studies.
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Affiliation(s)
- Conor M Maxwell
- Department of General Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Benny Weksler
- Division of Thoracic and Esophageal Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Joseph Houda
- Division of Thoracic and Esophageal Surgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Hiran C Fernando
- Division of Thoracic and Esophageal Surgery, Allegheny Health Network, Pittsburgh, PA, USA
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Zheng W, Zhang X, Zheng X, Liang Y, Liu Y, Gao Y. Construction and Validation of a Risk Prediction Model for Postoperative Urinary Retention in Lung Cancer Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2227629. [PMID: 35310184 PMCID: PMC8933071 DOI: 10.1155/2022/2227629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
Indwelling catheter is a routine procedure in surgical patients. Studies have shown that prolonged indwelling urinary catheterization increases the risk of postoperative urinary tract infection. Although early removal of the urinary catheter after operation can reduce the risk of postoperative urinary symptoms and tract infections, it may lead to postoperative anesthetic dysuria. Therefore, this study investigates the urinary retention and related risk factors in patients after thoracoscopic lobectomy under general anesthesia. The clinical data of 214 patients who underwent thoracoscopic lobectomy in the Department of Thoracic Surgery of a tertiary class A cancer hospital in Beijing from July 2020 to April 2021 were collected. A risk prediction model was established by logistic regression analysis, and the prediction effect was determined using the area under the receiver operating characteristic (ROC) curve. The incidence of indwelling catheter after thoracoscopic lobectomy was 44.8% (96/214). Sex (OR = 21.102, 95% CI: 2.906-153.239, P=0.003), perception of shame (OR = 74.256, 95% CI: 6.171-893.475, P=0.001), age (OR = 1.095, 95% CI: 1.014-1.182, P=0.021), and bed rest time (OR = 1.598, 95% CI: 1.263-2.023, P < 0.021) were the factors influencing urinary retention after thoracoscopic lobectomy. This model can effectively predict the occurrence of postoperative urinary retention in patients with lung cancer and help medical staff to intervene effectively before the onset of urinary retention, which provides reference for preventive treatment and nursing intervention.
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Affiliation(s)
- Wei Zheng
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xu Zhang
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xu Zheng
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yicheng Liang
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan Liu
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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