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Kwan YH, Tan KG. Patient-Controlled Analgesia and Peripheral Nerve Block Increase the Risk of Post-operative Urinary Retention after Total Knee Arthroplasty in Asian Patients. Malays Orthop J 2024; 18:42-48. [PMID: 39130499 PMCID: PMC11315951 DOI: 10.5704/moj.2407.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/23/2023] [Indexed: 08/13/2024] Open
Abstract
Introduction Post-operative urinary retention (POUR) is a common complication after total knee arthroplasty (TKA) and may result in severe complications such as urinary tract infection and deep joint sepsis, leading to prolonged hospital stay and increased medical costs. Hence a retrospective study was performed to identify the incidence and modifiable factors associated with POUR after elective TKA in Asian patients with the aim to prevent POUR and its undesirable consequences. Materials and Methods The medical records of 496 consecutive patients who underwent elective TKA between 1 August 2017 and 30 July 2018 were reviewed. There were 154 male (31.0%) and 342 female (69.0%) patients with an average age of 68 years old. The incidence of POUR was analysed with respect to various modifiable and non-modifiable risk factors, including patient demographics, medical comorbidities, duration of surgery, type of intra-operative anaesthesia and post-operative analgesia and early initiation of physiotherapy using univariate and multivariate analyses. Results A total of 120 (24.2%) of the 496 patients who underwent elective TKA developed POUR. The odds of a patient with patient-controlled analgesia (PCA) and peripheral nerve block (PNB) developing POUR were 4.2 times and 4.7 times that of a patient without PCA and PNB, respectively. Age, male gender and type of anaesthesia were not found to be significant. Conclusion In our study population, the incidence of POUR after elective TKA was 24% with major modifiable risk factors being associated with the use of PCA and PNB as post-operative anaesthesia. POUR can have deleterious effects thus alternative post-operative analgesia should be considered.
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Affiliation(s)
- Y H Kwan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - K G Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Yeo PY, Joseph T, Kunnasegaran R. Short-term outcomes of articular cement spacer in the treatment of prosthetic knee joint infections: a retrospective case series. Singapore Med J 2023:386982. [PMID: 37929559 DOI: 10.4103/singaporemedj.smj-2021-389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Ping Yen Yeo
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital; Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Titus Joseph
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tan BY, Goh ZZS, Lim CJ, Pereira MJ, Yang SY, Tan KG, Tan ACK, Liang P, Abbott JH, Briggs AM, Hunter DJ, Skou ST, Thumboo J, Car J. Singapore KneE osTeoarthritis CoHort (SKETCH): protocol for a multi-centre prospective cohort study. BMC Musculoskelet Disord 2023; 24:104. [PMID: 36750930 PMCID: PMC9903549 DOI: 10.1186/s12891-023-06207-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading cause of global disability. The understanding of the role of psychosocial factors in knee OA outcomes is still evolving particularly in an Asian context. The primary aim of this study is to explore psychosocial factors that prognosticate short and long-term clinical outcomes, productivity, and healthcare utilization in patients with knee OA. Secondary aims are to explore the mediation and directional relationships and the role it plays in predicting the discordance between self-reported measures (SRM), physical-performance measures (PPMs) and objective clinical parameters. METHODS A multi-centre prospective cohort study of community ambulant knee OA patients seeking treatment in the tertiary healthcare institutions in Singapore will be conducted. Patients with secondary arthritis, significant cognitive impairment, severe medical comorbidities or previous knee arthroplasty will be excluded. Primary clinical outcome measure is the Knee injury and OA Outcome Score-12 (KOOS-12). Baseline characteristics include sociodemographic status, arthritis status including symptom duration and radiographic severity, comorbidities and functional status through Charlson Comorbidities Index (CCI), Barthel Index (BI) and Parker Mobility Score (PMS). Psychosocial variables include social support, kinesiophobia, negative affect, self-efficacy, injustice, chronic illness shame and the built environment. Clinical outcomes include quality of life, physical performance, global assessment, satisfaction and physical activity levels. Productivity and healthcare utilization will be assessed by a modified OA Cost and Consequences Questionnaire (OCC-Q) and the Work Productivity and Activity Impairment Questionnaire (WPAI). Variables will be collected at baseline, 4, 12 months and yearly thereafter. Regression, mediation and structural equation modelling will be used for analysis. DISCUSSION Results will allow contextualization, identification, and phenotyping of the critical (and potentially modifiable) psychosocial parameters that predict positive clinical outcomes in the OA population to guide optimization and refinement of healthcare and community. This will facilitate: 1. identification of high-risk knee OA subpopulations that will likely experience poor outcomes and 2. formulation of targeted multidisciplinary comprehensive approaches to address these psychosocial factors to optimize non-surgical treatment care, maximize functional outcomes and create more value-based care model for knee OA. ETHICS AND DISSEMINATION The study has been registered under clinicaltrials.gov registry (Identifier: NCT04942236).
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Affiliation(s)
- Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore.
| | | | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore
| | - Michelle Jessica Pereira
- grid.466910.c0000 0004 0451 6215Health Services Outcome Research, National Healthcare Group, Singapore, Singapore
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, Singapore, Singapore
| | - Kelvin Guoping Tan
- grid.240988.f0000 0001 0298 8161Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Alvin Chin Kwong Tan
- grid.415203.10000 0004 0451 6370Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Phyllis Liang
- grid.59025.3b0000 0001 2224 0361Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - J. Haxby Abbott
- grid.29980.3a0000 0004 1936 7830Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew M. Briggs
- grid.1032.00000 0004 0375 4078Faculty of Health Sciences, Curtin School of Allied Health and Curtin enAble Institute, Curtin University, Perth, WA Australia
| | - David J. Hunter
- grid.412703.30000 0004 0587 9093Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Soren T. Skou
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Julian Thumboo
- grid.163555.10000 0000 9486 5048Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Josip Car
- grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Mohd Yusuf SY, Md-Yasin M, Mohd Miswan MF. Does Less Pain Predict Better Quality of Life among Malaysian Patients with Mild–Moderate Knee Osteoarthritis? Clin Pract 2022; 12:219-230. [PMID: 35447854 PMCID: PMC9031927 DOI: 10.3390/clinpract12020026] [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: 02/17/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Abstract
This study aims to identify the relationship between knee functional status and Health-Related QoL (HRQoL) in mild to moderate knee osteoarthritis (OA) patients and to ascertain which subdomain of knee functional status best predicts good HRQoL. A cross-sectional study was conducted in an orthopaedic clinic of a tertiary hospital in Malaysia. Patients aged 40–75 years old with mild–moderate primary knee OA were recruited. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and SF-36 questionnaires were used to measure knee functional status and HRQoL, respectively. Subdomains of KOOS include “function in daily living”, “function in recreational activities”, “pain”, “symptom”, and “knee-specific quality of life”. Subdomains for SF-36 are Physical Component Summary (PCS) and Mental Component Summary (MCS). Overall, 290 patients fulfilled the inclusion criteria of the study, with a mean age of 66.8 years old (±7.06). Majority were female (57.6%) and Malay (79.7%). The relationships between all KOOS and HRQoL subdomains were significant. “Pain” contributed most towards better physical HRQoL ((PCS) Adj. B (95% CI); 0.063 (0.044, 0.169)), while “function in daily living” contributed most towards better mental HRQoL ((MCS) Adj. B (95% CI); 0.624 (0.478, 0.769)). Thus, better HRQoL was related to better pain control and improved “function in daily living” in these patients.
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Affiliation(s)
- Salma Yasmin Mohd Yusuf
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
| | - Mazapuspavina Md-Yasin
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
- Correspondence: ; Tel.: +60-19-356-4020
| | - Mohd Fairudz Mohd Miswan
- Department of Orthopaedic, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
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Lim RBT, Wee WK, For WC, Ananthanarayanan JA, Soh YH, Goh LML, Tham DKT, Wong ML. Correlates, facilitators and barriers of physical activity among primary care patients with prediabetes in Singapore - a mixed methods approach. BMC Public Health 2020; 20:1. [PMID: 31898494 PMCID: PMC6941241 DOI: 10.1186/s12889-019-7969-5] [Citation(s) in RCA: 477] [Impact Index Per Article: 119.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Primary care patients with prediabetes is a priority group in the clinical, organisational and policy contexts. Engaging in regular physical activity is crucial to prevent diabetes for this group. The objectives of the study were to assess factors associated with meeting the recommendation of at least 150 min of moderate/vigorous physical activity weekly, and to explore facilitators and barriers related to the behaviour among primary care patients with prediabetes in Singapore. METHODS This was a mixed methods study, consisting of a cross-sectional survey involving 433 participants from 8 polyclinics, and in-depth interviews with 48 of them. Adjusted prevalence ratios (aPR) were obtained by mixed effects Poisson regression model. The socio-ecological model (SEM) was applied, and thematic analysis performed. RESULTS The prevalence of meeting the recommendation was 65.8%. This was positively associated with being male (aPR 1.21, 95%CI 1.09-1.34), living in 4-5 room public housing (aPR 1.19, 95%CI 1.07-1.31), living in executive flat/private housing (aPR 1.26, 95%CI 1.06-1.50), having family members/friends to exercise with (aPR 1.57, 95%CI 1.38-1.78); and negatively associated with a personal history of osteoarthritis (aPR 0.75, 95%CI 0.59-0.96), as well as time spent sitting or reclining daily (aPR 0.96, 95%CI 0.94-0.98). The recurrent themes for not meeting the recommendation included lacking companionship from family members/friends, medical conditions hindering physical activity (particularly osteoarthritis), lacking knowledge/skills to exercise properly, "no time" to exercise and barriers pertaining to exercise facilities in the neighbourhood. The recurrent themes for meeting the recommendation included family/peer influence, health/well-being concerns and education by healthcare professionals. CONCLUSIONS Much more remains to be done to promote physical activity among primary care patients with prediabetes in Singapore. Participants reported facilitators and barriers to physical activity at different levels of the SEM. Apart from the individual and interpersonal levels, practitioners and policy makers need to work together to address the organisational, community and policy barriers to physical activity.
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Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore.
| | - Wei Keong Wee
- Health Promotion & Preventive Care, National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, #05-10, Singapore, Singapore city, 138543, Singapore
| | - Wei Chek For
- Health Promotion & Preventive Care, National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, #05-10, Singapore, Singapore city, 138543, Singapore
| | - Jayalakshmy Aarthi Ananthanarayanan
- Health Promotion & Preventive Care, National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, #05-10, Singapore, Singapore city, 138543, Singapore
| | - Ying Hua Soh
- Health Promotion & Preventive Care, National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, #05-10, Singapore, Singapore city, 138543, Singapore
| | - Lynette Mei Lim Goh
- Clinical Services, National University Polyclinics and National University Health System, 1 Jurong East Street 21, Singapore, Singapore city, 609606, Singapore
| | - Dede Kam Tyng Tham
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549, Singapore
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Thumboo J, Yong FK. Rheumatology in the Singapore General Hospital — Looking Back, Looking Forward. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Julian Thumboo
- Head (2007 to present) & Senior Consultant, Department of Rheumatology & Immunology
| | - Fong Kok Yong
- Chairman Medical Board, SGH, Immediate Past Head (2003 to 2006) & Senior Consultant, Department of Rheumatology & Immunology
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