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Boitano TK, Virk A, Michael Straughn Jr J, Dowdy SC. Quality corner: Safely using cephalosporins in almost all patients with penicillin allergies: Mini-review and suggested protocol to improve efficacy and surgical outcomes. Gynecol Oncol Rep 2024; 53:101389. [PMID: 38623269 PMCID: PMC11016857 DOI: 10.1016/j.gore.2024.101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
Surgical site infections (SSI) are one of the most common gynecologic oncology postoperative complications and they have a significant deleterious impact on the healthcare system and in patients' outcomes. Cefazolin is the recommended antibiotic in women undergoing gynecologic surgical procedures that require that require prophylaxis. However, 10-20% of patients may report a penicillin allergy which can result in administration of a less effective antibiotic. This quality review evaluated the literature around this common perioperative issue and demonstrated that healthcare teams should consider the implementation of a protocol to safely use cefazolin in most patients with a penicillin allergy. Overall, literature shows this is a safe adjustment and would improve antimicrobial stewardship, decrease SSI rates, avoid acute kidney injury, and increase cost savings.
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Affiliation(s)
- Teresa K.L. Boitano
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abinash Virk
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - J. Michael Straughn Jr
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sean C. Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA
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Nakayama T, Shoda K, Shiraishi K, Furuya S, Hosomura N, Akaike H, Kawaguchi Y, Amemiya H, Kawaida H, Ichikawa D. Dynamics of perioperative pancreatic exocrine function in patients undergoing reconstruction after gastrectomy for gastric cancer. Surg Today 2024; 54:436-441. [PMID: 37768396 DOI: 10.1007/s00595-023-02746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Each method of reconstruction after gastrectomy results in a change in the digestive and absorptive status. However, there are few reports on the changes in pancreatic exocrine function after gastrectomy. We conducted this study to investigate the dynamics of pancreatic exocrine function after gastrectomy according to the method of reconstruction performed. METHODS The subjects of this study were 45 patients who underwent pancreatic exocrine function tests preoperatively and postoperatively, from among all patients who underwent gastrectomy for gastric cancer at our hospital between September, 2020 and March, 2022. We assessed pancreatic exocrine function using the Pancreatic Function Diagnostant (PFD) test. RESULT The mean preoperative PFD test result values for the distal gastrectomy (DG) Billroth I reconstruction (B-I) group and the DG Roux-en-Y reconstruction (R-Y) group were 62.6 and 67.3 (p = 0.36), respectively, and the mean postoperative PFD test result values for each group were 65.8 and 46.9 (p = 0.0094), respectively. A significant decrease in postoperative pancreatic function was observed in the DG R-Y group but not in the DG B-I group. The logistic regression analysis identified that age and the R-Y group were significantly correlated with a 10% decrease in the PFD value after gastrectomy. CONCLUSIONS Our study suggests that R-Y reconstruction may result in more impaired pancreatic exocrine function than B-I reconstruction.
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Affiliation(s)
- Takashi Nakayama
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Katsutoshi Shoda
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
| | - Kensuke Shiraishi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Naohiro Hosomura
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hidenori Akaike
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hidetake Amemiya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
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Musavi L, Bingham EG, Anderson L, Alnaseri T, Demirjian M, Kwan L, Crisera C, Festekjian J, DeLong MR. Impact of mastectomy flap necrosis on prepectoral reconstructive outcomes. J Plast Reconstr Aesthet Surg 2024; 91:128-134. [PMID: 38417391 DOI: 10.1016/j.bjps.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION As reconstructive surgeons have increasingly transitioned to the prepectoral plane for prosthetic breast reconstruction, the implications of mastectomy skin flap necrosis have become more concerning. Our goal was to evaluate the effect of skin flap necrosis on reconstructive outcomes in patients undergoing immediate prepectoral breast reconstruction. METHODS A retrospective review was conducted of patients undergoing immediate two-stage prepectoral reconstruction at a single center with at least 3 months follow-up. Postoperative complications, reconstructive outcome, and time to final implant were compared between patients with and without mastectomy skin necrosis. RESULTS A total of 301 patients underwent 509 prepectoral breast reconstructions. Forty-four patients (14.6%) experienced postoperative mastectomy skin flap necrosis. Demographic and reconstructive characteristics were similar between the necrosis and no necrosis cohorts. Patients with skin necrosis were more likely to undergo reoperation after tissue expander (64% vs 19%, p < 0.01) and undergo expander replacement (13.6% vs 3.5%, p = 0.02). However, rates of reconstructive failure (6.8% vs 6.2%), major infection (9.1% vs 9.0%), and minor infection (13.6% vs 17.5%) after expander placement were statistically similar. Patients with skin necrosis trended toward longer time before final implant placement, although the difference was not statistically significant (6.5 vs 5.0 months, p = 0.08). There was no difference in complication rates between the necrosis and no necrosis cohort after final implant placement. There was a higher rate of revision surgery after implant placement in the necrosis cohort (12.5% vs 4.1%, p = 0.047). CONCLUSIONS Mastectomy skin flap necrosis is a concerning postoperative event, particularly in patients with prepectoral prostheses. We observed that patients with skin necrosis experience higher reoperation rates in the expander period, yet have similar infection rates and achieve similar final reconstructive outcomes compared to patients without necrosis.
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Affiliation(s)
- Leila Musavi
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA, USA
| | - Elijah G Bingham
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA, USA
| | - Lexy Anderson
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA, USA
| | - Tahera Alnaseri
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA, USA
| | - Maral Demirjian
- Department of Urology, University of California, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, CA, USA
| | - Christopher Crisera
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA, USA
| | - Jaco Festekjian
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA, USA
| | - Michael R DeLong
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA, USA.
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Strother M, Barlotta R, Uzzo R, Bloom E, Jazayeri SB, Bigalli AC, Schober J, Lee J, Bernstein A, Ginsburg K, Handorf E, Chen DY, Correa A, Greenberg R, Smaldone M, Viterbo R, Kutikov A. Symptomatic and functional recovery after transurethral resection of bladder tumor: Data from ecological momentary symptom assessment. Urol Oncol 2024; 42:117.e1-117.e10. [PMID: 38369443 DOI: 10.1016/j.urolonc.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To quantitatively describe the nature, severity, and duration of symptoms and functional impairment during recovery from transurethral resection of bladder tumors. MATERIALS AND METHODS All patients scheduled for transurethral resection were approached for enrollment in a text-message based ecological momentary symptom assessment platform. Nine patients reported outcomes were measured 7 days before surgery and on postoperative days 1, 2, 3, 5, 7, 10, and 14 using a 5-point Likert scale. Self-reported degree of hematuria was collected using a visual scale. Clinical data was collected via retrospective chart review. RESULTS A total of 159 patients were analyzed. Postoperative symptoms were overall mild, with the largest differences from baseline to postoperative day 1 seen in dysuria (median 0/5 vs. 3/5) and ability to work (median 5/5 vs. 4/5). Recovery was generally rapid, with 76% of patients reporting ≥4/5 agreement with the statement "I feel recovered from surgery" by postoperative day 2, although 15% of patients reported persistently lower levels of agreement on postoperative day 10 or 14. Patients undergoing larger resections (≥2cm) did take longer to return to baseline in multiple symptom domains, but the difference of medians vs. those undergoing smaller resections was less than 1 day across all domains. Multivariable analysis suggested that receiving perioperative intravesical chemotherapy was associated with longer time to recovery. 84% of patients reported clear yellow urine by postoperative day 3. CONCLUSION In this population, hematuria and negative effects on quality of life resulting from transurethral resection of bladder tumors were generally mild and short-lived, although a small number of patients experienced longer recoveries.
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Affiliation(s)
| | - Ryan Barlotta
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert Uzzo
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Evan Bloom
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Seyed B Jazayeri
- Department of Urology, University of Florida Jacksonville, Jacksonville, FL
| | | | - Jared Schober
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jennifer Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Adrien Bernstein
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Kevin Ginsburg
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA
| | - David Yt Chen
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Andres Correa
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Marc Smaldone
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Rosalia Viterbo
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
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Kincaid K, Boitano TK, Scalise M, Patton S, Leath CA, Straughn JM, Smith HJ. Impact of steroid use and glycemic control on postoperative complications in diabetic gynecologic oncology patients undergoing laparotomy. Gynecol Oncol Rep 2024; 52:101344. [PMID: 38404909 PMCID: PMC10885540 DOI: 10.1016/j.gore.2024.101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024] Open
Abstract
Objective We aimed to assess the impact of preoperative steroid administration and perioperative glycemic control on postoperative complications in diabetic gynecologic oncology patients undergoing laparotomy. Methods This retrospective cohort study included gynecologic oncology patients with Type I and Type II diabetes (DM) undergoing laparotomy for any gynecologic indication at a single academic center from 10/2017 to 09/2020. The primary outcome was the rate of postoperative complications. Preoperative steroid administration and 24-hour postoperative average serum blood glucose (BG) ≥ 180 mg/dL were the studied exposures. Data was analyzed with SPSS Statistics v.28. Results 225 patients met inclusion criteria; 47.6 % had postoperative complications. Patient demographics were similar between patients with and without postoperative complications. Patients with complications had higher BMIs (36.8 vs. 34.0; p = 0.03), bowel surgery (33.0 % vs. 17.1 %; p = 0.008), operative time ≥ 240 min (14.2 % vs. 5.1 %; p = 0.02) and average BG ≥ 180 (63.6 % vs. 40.2 %; p < 0.01). On multivariate analysis, bowel surgery (OR 2.4 (1.2-4.8); p = 0.01) and average BG ≥ 180 (OR 2.8 (1.6-4.9); p < 0.01) remained significant predictors of postoperative complications. There were no differences in complication rates (42.3 % vs. 42.6 %; p = 1.0) between patients who received preoperative steroids and those who did not. When stratified by average postoperative BG < 180 mg/dL vs. BG ≥ 180 mg/dL, there was no difference in Clavien-Dindo classification, 30-day readmission rate (28.2 % vs. 22.1 %; p = 0.49) or 30-day mortality rate (2.9 % vs. 0.0 %; p = 0.53). Conclusion The administration of preoperative steroids did not increase complication rates. Perioperative hyperglycemia was associated with an increased risk of postoperative complications. Optimizing perioperative glycemic control is imperative to decrease postoperative complications.
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Affiliation(s)
- Kaitlyn Kincaid
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Teresa K.L. Boitano
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew Scalise
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Samantha Patton
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Charles A. Leath
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John M. Straughn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Haller J. Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
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Cheng JW, Christakis DA, Kieran K, Niessen BA, Fernandez N, Merguerian PA, Chang EK, Shnorhavorian M. Association between YouTube® videos and health literacy with postoperative healthcare utilization following pediatric urologic surgery: A randomized trial. J Pediatr Urol 2024; 20:226.e1-226.e9. [PMID: 38071113 DOI: 10.1016/j.jpurol.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Limited caregiver health literacy has been associated with poorer health outcomes in pediatric patients and may limit caregiver understanding of printed education resources. Postoperative healthcare utilization may be related to confusion about instructions or complications. OBJECTIVE To correlate caregiver health literacy and educational video intervention with postoperative healthcare utilization following ambulatory pediatric urologic surgery. STUDY DESIGN From July through December 2021, a randomized double-blinded trial assessed postoperative healthcare utilization following pediatric urologic surgery. Caregivers were randomized to receive standardized postoperative counseling and printed instructions (control) or access to English-language educational YouTube® videos with standardized postoperative counseling and printed instructions (intervention). Medical record abstraction was completed 30 days following surgery to identify postoperative healthcare utilization with calls, messages, add-on clinic visits, or presentation for urgent or emergent care, and postoperative complications. RESULTS Target enrollment was achieved with 400 caregivers with 204 in the intervention and 196 in the control groups. There was a 32.5 % overall rate of postoperative healthcare utilization. Health literacy was inversely associated with total postoperative healthcare utilization (p < 0.001). There was no difference in the incidence of postoperative healthcare utilization between the control and intervention groups (p = 0.623). However, on sub-analysis of caregivers with postoperative healthcare utilization (Summary Figure), there were fewer total occurrences in the intervention group (intervention median 1, IQR 1,2.3; control median 2, IQR 1,3; p < 0.001). For caregivers with limited health literacy, there was a greater associated reduction in median calls from 2 (IQR 0,2) to 0 (IQR 0,0.5) with video intervention (p = 0.016). On multivariate analysis, total postoperative healthcare utilization was significantly associated with limited caregiver health literacy (OR 1.08; p = 0.004), English as preferred language (OR 0.68; p = 0.018), and older patient age (OR 0.95; p = 0.001). DISCUSSION Current resources for postoperative education are limited as resources can be written above recommended reading levels and families can have difficulty recalling information discussed during postoperative counseling. Video intervention is an underutilized resource that can provide an additional resource to families with visual and auditory aids and be accessed as needed. CONCLUSION Caregiver health literacy was inversely associated with postoperative healthcare utilization. There was no difference in the incidence of postoperative healthcare utilization with video intervention. However, on subgroup analysis, supplemental videos were associated with fewer occurrences of postoperative healthcare utilization, especially in caregivers with limited health literacy. On multivariate regression, health literacy, preferred language, and patient age were significantly associated with total postoperative healthcare utilization.
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Affiliation(s)
- Julie W Cheng
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States; Oregon Health and Science University, Department of Urology, United States.
| | | | - Kathleen Kieran
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
| | - Brett A Niessen
- Seattle Children's Hospital, Patient and Family Education and Communication, United States.
| | - Nicolas Fernandez
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
| | - Paul A Merguerian
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
| | - Edward K Chang
- University of Washington, Department of Urology, United States.
| | - Margarett Shnorhavorian
- Seattle Children's Hospital, Division of Urology, United States; University of Washington, Department of Urology, United States.
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Vianna FSL, Neves LL, Testa R, Nassar AP, Peres JHF, da Silva RÁJ, de Paula Sales F, Raglione D, Del Bianco Madureira B, Dalfior L, Malbouisson LMS, Ribeiro U, da Silva JM. Impact of the COVID-19 Pandemic on the Outcomes of Patients Undergoing Oncological Surgeries: CORONAL Study. Ann Surg Oncol 2024:10.1245/s10434-024-15152-9. [PMID: 38530529 DOI: 10.1245/s10434-024-15152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) on postoperative recovery from oncology surgeries should be understood for the clinical decision-making. Therefore, this study was designed to evaluate the postoperative cumulative 28-day mortality and the morbidity of surgical oncology patients during the COVID-19 pandemic. METHODS This retrospective cohort study included patients consecutively admitted to intensive care units (ICU) of three centres for postoperative care of oncologic surgeries between March to June 2019 (first phase) and March to June 2020 (second phase). The primary outcome was cumulative 28-day postoperative mortality. Secondary outcomes were postoperative organic dysfunction and the incidence of clinical complications. Because of the possibility of imbalance between groups, adjusted analyses were performed: Cox proportional hazards model (primary outcome) and multiple logistic regression model (secondary outcomes). RESULTS After screening 328 patients, 291 were included. The proportional hazard of cumulative 28-day mortality was higher in the second phase than that in the first phase in the Cox model, with the adjusted hazard ratio of 4.35 (95% confidence interval [CI] 2.15-8.82). The adjusted incidences of respiratory complications (odds ratio [OR] 5.35; 95% CI 1.42-20.11) and pulmonary infections (OR 1.53; 95% CI 1.08-2.17) were higher in the second phase. However, the adjusted incidence of other infections was lower in the second phase (OR 0.78; 95% CI 0.67-0.91). CONCLUSIONS Surgical oncology patients who underwent postoperative care in the intensive care unit during the COVID-19 pandemic had higher hazard of 28-day mortality. Furthermore, these patients had higher odds of respiratory complications and pulmonary infections. Trials registration The study is registered in the Brazilian Registry of Clinical Trials under the code RBR-8ygjpqm, UTN code U1111-1293-5414.
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Affiliation(s)
- Felipe Souza Lima Vianna
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Renato Testa
- Fundação Antonio Prudente- A C Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | - Dante Raglione
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | - Luiz Dalfior
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Ulysses Ribeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - João Manoel da Silva
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital do Câncer de Barretos- Fundação Pio XII, Barretos, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Torre T, Schlotterbeck H, Ferraro F, Klersy C, Surace G, Toto F, Pozzoli A, Ferrari E, Demertzis S. Continuous Glucose Monitoring System After Coronary Artery Bypass Graft Surgery: A Feasibility Study. Asian Cardiovasc Thorac Ann 2024:2184923241240035. [PMID: 38504616 DOI: 10.1177/02184923241240035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Blood glucose level variability has been associated with increased risk of complication in the postoperative setting of cardiovascular surgery. Although interesting for optimization of blood glucose management in this context, continuous blood glucose (CBG) devices can have a limited reliability in this context, in particular because of the use of paracetamol. The aim of this study was to evaluate the reliability of Dexcom G6®, a recently developed continuous glucose monitoring device. METHODS We performed a prospective, observational, non-randomized, single-centre study comparing Dexcom G6® CBG level monitoring with the standard methods routinely used in this context. The standard blood glucose values were paired to the time corresponding values measured with Dexcom G6®. Agreement between the two methods and potential correlation in case of paracetamol use were calculated. RESULTS From May 2020 to August 2021, 36 out of 206 patients operated for isolated coronary artery bypass grafting were enrolled; 673 paired blood glucose level were analyzed. Global agreement (ρc) was 0.85 (95% C.I.: 0.84-0.86), intensive care unit agreement was 0.78 (95%C.I.: 0.74-0.82) and ward agreement was 0.91 (95%C.I.: 0.89-0.93). In the diabetic population, it was 0.87 (95%C.I.: 0.85-0.90). When paracetamol was used, the difference was 0.02 mmol/l (95%C.I.: 0.29-0.33). CONCLUSIONS Dexcom G6® provides good blood glucose level accuracy in the postoperative context of cardiac surgery compared to the standard methods of measurements. The results are particularly reliable in the ward where the need for repeated capillary glucose measurements implies patient discomfort and time-consuming manipulations for the nursing staff.
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Affiliation(s)
- Tiziano Torre
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Hervé Schlotterbeck
- Anestesiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Francesco Ferraro
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giuseppina Surace
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Francesca Toto
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Enrico Ferrari
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Stefanos Demertzis
- Cardiac Surgery Department, Cardiocentro Ticino Institute, Lugano, Switzerland
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Zhou Z, Li X, Wu X, Wang X. Impact of early rehabilitation therapy on functional outcomes in patients post distal radius fracture surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:198. [PMID: 38443916 PMCID: PMC10913665 DOI: 10.1186/s12891-024-07317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND This meta-analysis aims to investigate the efficacy of early rehabilitation on patients who have undergone surgery for distal radius fractures (DRFs) with palmar plating, focusing on multiple outcome measures including upper limb function, wrist function, back extension mobility, pain levels, and complications. METHODS A rigorous search strategy adhering to the PRISMA guidelines was employed across four major databases, including PubMed, Embase, Web of Science, and the Cochrane Library. Studies were included based on stringent criteria, and data extraction was performed independently by two reviewers. Meta-analysis was conducted employing both fixed-effect and random-effects models as dictated by heterogeneity, assessed by the I2 statistic and chi-square tests. A total of 7 studies, encompassing diverse demographic groups and timelines, were included for the final analysis. RESULTS The meta-analysis disclosed that early rehabilitation yielded a statistically significant improvement in upper limb function (SMD -0.27; 95% CI -0.48 to -0.07; P < 0.0001) and back extension mobility (SMD 0.26; 95% CI 0.04 to 0.48; P = 0.021). A notable reduction in pain levels was observed in the early rehabilitation group (SMD -0.28; 95% CI -0.53 to -0.02; P = 0.03). However, there were no significant differences in wrist function (SMD -0.13; 95% CI -0.38 to 0.12; P = 0.36) and complications (OR 0.99; 95% CI 0.61 to 1.61; P = 0.96). CONCLUSIONS Early rehabilitation post-DRF surgery with palmar plating has been found to be beneficial in enhancing upper limb functionality and back extension mobility, and in reducing pain levels. Nevertheless, no significant impact was observed regarding wrist function and complications.
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Affiliation(s)
- Zhihui Zhou
- Department of Emergency, Dongguan Hospital of Traditional Chinese Medicine, No. 3 Dongcheng Section, Songshan Lake Avenue, Dongcheng Street, Dongguan, Guangdong, 523000, China
| | - Xiuying Li
- Traditional Chinese Medicine Department, Dongguan Songshan Lake Community Health Service Center, Lanxin Garden, Science and Technology, 9Th Road, Dongguan, Guangdong, 523000, China
| | - Xiaoyan Wu
- Traditional Chinese Medicine Department, Dongguan Songshan Lake Community Health Service Center, Lanxin Garden, Science and Technology, 9Th Road, Dongguan, Guangdong, 523000, China
| | - Xiaotian Wang
- Department of Hand Surgery, Dongguan Hospital of Traditional Chinese Medicine, No. 3 Dongcheng Section, Songshan Lake Avenue, Dongcheng Street, Dongguan, Guangdong, 523000, China.
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10
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Peter-Okaka UI, Shiri S, Owodunni O, Bagheri SR, Jalilian A, Uzoukwu C, Eden S, Alimohammadi E. Are there any benefits for post-operative splinting after carpal tunnel release? A systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:163. [PMID: 38383364 PMCID: PMC10880356 DOI: 10.1186/s12891-024-07230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND There is a controversy on the effectiveness of post-operating splinting in patients with carpal tunnel release (CTR) surgery. This study aimed to systematically evaluate various outcomes regarding the effectiveness of post-operating splinting in CTR surgery. METHODS Multiple databases, including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, were searched for terms related to carpal tunnel syndrome. A total of eight studies involving 596 patients were included in this meta-analysis. The quality of studies was evaluated, and their risk of bias was calculated using the methodological index for non-randomized studies (MINORS) and Cochrane's collaboration tool for assessing the risk of bias in randomized controlled trials. Data including the visual analogue scale (VAS), pinch strength, grip strength, two-point discrimination, symptom severity score (SSS), and functional status scale (FSS) were extracted. RESULTS Our analysis showed no significant differences between the splinted and non-splinted groups based on the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. The calculated values of the standardized mean difference (SMD) or the weighted mean difference (WMD) and a 95% confidence interval (CI) for different variables were as follows: VAS [SMD = 0.004, 95% CI (-0.214, 0.222)], pinch strength [WMD = 1.061, 95% CI (-0.559, 2.681)], grip strength [SMD = 0.178, 95% CI (-0.014, 0.369)], SSS [WMD = 0.026, 95% CI (- 0.191, 0.242)], FSS [SMD = 0.089, 95% CI (-0.092, 0.269)], and the two-point discrimination [SMD = 0.557, 95% CI (-0.140, 1.253)]. CONCLUSIONS Our findings revealed no statistically significant differences between the splinted and non-splinted groups in terms of the VAS, SSS, FSS, grip strength, pinch strength, and two-point discrimination. These results indicate that there is no substantial evidence supporting a significant advantage of post-operative splinting after CTR.
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Affiliation(s)
| | - Samira Shiri
- Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Oluwafemi Owodunni
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalilian
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Sonia Eden
- Semmes Murphey Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ehsan Alimohammadi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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11
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Yang X, Yin D, Chen SQ. Effect of nursing on postoperative respiratory function and mental health of lung cancer patients. World J Clin Cases 2024; 12:922-930. [PMID: 38414608 PMCID: PMC10895621 DOI: 10.12998/wjcc.v12.i5.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer. However, few studies have combined the two to explore their combined effect. Therefore, this study aimed to investigate the effects of pulmonary rehabilitation training combined with psychological care on postoperative respiratory function and mental health in lung cancer patients. AIM To investigate effect of nursing on postoperative respiratory function and mental health of lung cancer patients. METHODS 122 cases of lung cancer patients who underwent surgical treatment in our hospital and were treated in our department from January 2022 to April 2023 were selected and randomly divided into the control group and observation group. The control group performed the routine care intervention. The observation group was given pulmonary rehabilitation training and psychological care based on conventional nursing interventions. Forced expiratory volume, forced vital capacity. Maximum ventilatory volume (MVV) in one second was measured, and the patient's 6-min walking distance and dyspnoea index scale were used to assess the patient's respiratory condition. The Connor-Davidson resilience scale (CD-RISC), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were used to evaluate the mental health of the patients. RESULTS There was no difference between the two groups regarding age, gender, education level, surgical procedure, type of pathology, and treatment (P > 0.05). After treatment, MVV, 6-min walking distance, toughness, strength, optimism, and total CD-RISC scores were significantly higher in the observation group (P < 0.05), dyspnoea scores, SAS, and SDS scores were substantially lower in the control group compared to the observation group (P < 0.05). CONCLUSION Pulmonary rehabilitation training combined with psychological care for patients after lung cancer resection could improve lung function, enhance daily activities, effectively relieve negative emotions such as anxiety and depression, and reduce complications.
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Affiliation(s)
- Xiang Yang
- Department of Rehabilitation, The First People's Hospital of Jiangxia District, Wuhan (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan 430200, Hubei Province, China
| | - Dan Yin
- Department of Intensive Care, The First People's Hospital of Jiangxia District, Wuhan (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan 430200, Hubei Province, China
| | - Shi-Qing Chen
- Department of Neurology, The First People's Hospital of Jiangxia District, Wuhan (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan 430200, Hubei Province, China
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12
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Souza AV, da Cunha Carvalho R, da Cruz Dias D, Santana DGT, de Cássia Mascarenhas H, Cordeiro ALL, Guimarães ARF. Clinical and functional outcomes associated with pulmonary complications after coronary artery bypass grafting. J Cardiothorac Surg 2024; 19:92. [PMID: 38355549 PMCID: PMC10865619 DOI: 10.1186/s13019-024-02538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Coronary artery bypass grafting(CABG) is a surgical treatment for coronary artery disease aiming at improving symptoms and life expectancy. Despite this, there are pulmonary and functional complications that may arise during the postoperative period due to invasive mechanical ventilation(IMV), cardiopulmonary bypass and immobility, leading to longer hospital stays. OBJECTIVE To evaluate the clinical and functional outcomes related to pulmonary complications in the postoperative period of CABG. METHODS Prospective cohort. During the ICU stay the patients were divided into: Non Complicated Group(NCG) who did not present complications and Complicated Group(CG) who presented complication. Functional variables were applied as the six-minute walk test(6MWT), gait speed, sit up and stand up test, Timed Up and Go, peripheral muscle strength, ventilatory, pulmonary function and Functional Independence Measure. These tests were applied preoperatively, at ICU discharge, hospital discharge and six months after surgery. RESULTS The study evaluated 90 patients, 59 in the NCG and 31 CG. In the 6MWT there was a 2%(p = 0.43) decrease in the NCG, while the decrease was 13%(p < 0.01) in the CG. In the MRC the drop was 2%(p = < 0.01) in the CNG, while in the CG the drop was 14%(p = < 0.01). In MIP the NCG had a 6%(p = 0.67) decrease, while the CG had a 16%(p = < 0.01) decrease. CONCLUSION Patients with postoperative complications of CABG may have reduced functional performance, muscle strength, and pulmonary function at hospital discharge and after six months.
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Affiliation(s)
- Altina Vitória Souza
- Centro Universitário Nobre, Red Bird Street, without number, Condominio Salvador Dali, house 47, Feira de Santana, BA, Brazil
| | - Raquel da Cunha Carvalho
- Centro Universitário Nobre, Red Bird Street, without number, Condominio Salvador Dali, house 47, Feira de Santana, BA, Brazil
| | - Daniela da Cruz Dias
- Centro Universitário Nobre, Red Bird Street, without number, Condominio Salvador Dali, house 47, Feira de Santana, BA, Brazil
| | - Darley Gabrielle Teles Santana
- Centro Universitário Nobre, Red Bird Street, without number, Condominio Salvador Dali, house 47, Feira de Santana, BA, Brazil
| | - Hayssa de Cássia Mascarenhas
- Centro Universitário Nobre, Red Bird Street, without number, Condominio Salvador Dali, house 47, Feira de Santana, BA, Brazil
| | - André Luiz Lisboa Cordeiro
- Centro Universitário Nobre, Red Bird Street, without number, Condominio Salvador Dali, house 47, Feira de Santana, BA, Brazil.
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
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13
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Abdullah HR, Lim DYZ, Ke Y, Salim NNM, Lan X, Dong Y, Feng M. The SingHealth Perioperative and Anesthesia Subject Area Registry (PASAR), a large-scale perioperative data mart and registry. Korean J Anesthesiol 2024; 77:58-65. [PMID: 37935575 PMCID: PMC10834714 DOI: 10.4097/kja.23580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/28/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area Registry (PASAR) to unify data from the preoperative, intraoperative, and postoperative stages. This study presents the methodology employed to create this database. METHODS Since 2016, data from surgical patients have been collected from the hospital electronic medical record systems, de-identified, and stored securely in compliance with privacy and data protection laws. As a representative sample, data from initiation in 2016 to December 2022 were collected. RESULTS As of December 2022, PASAR data comprise 26 tables, encompassing 153,312 patient admissions and 168,977 operation sessions. For this period, the median age of the patients was 60.0 years, sex distribution was balanced, and the majority were Chinese. Hypertension and cardiovascular comorbidities were also prevalent. Information including operation type and time, intensive care unit (ICU) length of stay, and 30-day and 1-year mortality rates were collected. Emergency surgeries resulted in longer ICU stays, but shorter operation times than elective surgeries. CONCLUSIONS The PASAR provides a comprehensive and automated approach to gathering high-quality perioperative patient data.
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Affiliation(s)
- Hairil Rizal Abdullah
- Department of Anesthesiology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Daniel Yan Zheng Lim
- Duke-NUS Medical School, Singapore
- Department of Gastroenterology, Singapore General Hospital, Singapore
| | - Yuhe Ke
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | | | - Xiang Lan
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| | - Yizhi Dong
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
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14
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Skraastad EJ, Borchgrevink PC, Opøyen LA, Ræder J. Wireless patient monitoring and Efficacy Safety Score in postoperative treatment at the ward: evaluation of time consumption and usability. J Clin Monit Comput 2024; 38:157-164. [PMID: 37460868 PMCID: PMC10879331 DOI: 10.1007/s10877-023-01053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/22/2023] [Indexed: 02/21/2024]
Abstract
To evaluate objective time consumption and how nurses perceived introducing wireless patient monitoring (WPM) and a validated score on patient quality and safety, the Efficacy Safety Score (ESS), at a mixed surgery ward. After fulfilling a randomised controlled trial combining the ESS and WPM, we addressed time consumption and conducted a questionnaire survey among nurses who participated in the study. The questionnaire appraised the nurses' evaluation of introducing these tools for postoperative management. Of 28 invited nurses, 24 responded to the questionnaire, and 92% reported the ESS and WPM-systems to increase patient safety and quality of care. 67% felt the intervention took extra time, but objective workload measurements revealed reduced time to 1/3 using ESS and WPM compared to standard manual assessment. Improved confidence when using the systems was reported by 83% and improved working situation by 75%. In a test situation to measure time consumption, the ESS and pre-attached WPM-systems require less time than the conventional standard of care, and may allow for more frequent clinical monitoring at the post-surgical ward. The combination of the ESS and the WPM systems was perceived as positive by participating nurses and further clinical development and research is warranted.
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Affiliation(s)
- Erlend Johan Skraastad
- Clinic of Anaesthesia and Intensive Care, St. Olavs hospital, Trondheim University Hospital, 3250 Torgarden, 7006, Trondheim, Norway.
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Petter Christian Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lillian Asbøll Opøyen
- Department of Thoracic and Occupational Medicine and Orkdal Dept. of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Johan Ræder
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
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15
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Sim AXJ, Tsen PY, Ngali NM, Lim SY, Gee T, Hanipah ZN. Enhancing Clinical Success Through Intensive Dietary Support in Bariatric Patients: a Retrospective Study in Asian Population. Obes Surg 2024; 34:509-514. [PMID: 38150118 DOI: 10.1007/s11695-023-07001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Weight loss surgery is an established intervention for obesity and related conditions, ensuring sustained weight reduction and improved comorbidities. Post-bariatric surgery, maintaining nutritional adequacy and weight loss necessitates ongoing, intensive dietary support. This research aims to discern the impact of standard care vs. intensive dietary support on outcomes following bariatric surgery within an Asian demographic. This study aims to research the part that intensive dietary support plays in contrast to standard care in altering weight loss and BMI change following bariatric surgery. METHODS A retrospective analysis of medical records from a Malaysian tertiary care hospital documented bariatric surgeries conducted from January 2020 to January 2022. Rigorous criteria selected 200 patients from 327, evenly split between standard care and intensive dietary support groups. The latter underwent six mandatory visits with a surgeon and a dietitian in the initial 3 months post-surgery. A dual-review mechanism was implemented for data interpretation, increasing robustness, and reducing biases in our findings. RESULTS At 6 and 12 months, the intensive dietary support group exhibited significantly greater weight loss and BMI reduction (p < 0.01). Postoperative complications did not significantly differ between groups. CONCLUSION In an Asian population, intensive dietary support enhances weight loss and BMI reduction compared to standard care after bariatric surgery.
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Affiliation(s)
- Alvina Xin Jie Sim
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia.
| | - Poh Yue Tsen
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Nurhanis Mohd Ngali
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Shu Yu Lim
- Department of General Surgery, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Tikfu Gee
- Department of General Surgery, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Kuala Lumpur, Malaysia
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16
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Tabone L, El-Tannoury J, Levy M, Sauthier M, Joram N, Du Pont-Thibodeau G, Bourgoin P, Al-Omar S, Poirier N, Emeriaud G, Thibault C. Determining Optimal Mean Arterial Blood Pressure Based on Cerebral Autoregulation in Children after Cardiac Surgery. Pediatr Cardiol 2024; 45:81-91. [PMID: 37945783 DOI: 10.1007/s00246-023-03326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
To evaluate the feasibility of continuous determination of the optimal mean arterial blood pressure (opt-MAP) according to cerebral autoregulation and to describe the opt-MAP, the autoregulation limits, and the time spent outside these limits in children within 48 h of cardiac surgery. Cerebral autoregulation was assessed using the correlation coefficient (COx) between cerebral oxygenation and MAP in children following cardiac surgery. Plots depicting the COx according to the MAP were used to determine the opt-MAP using weighted multiple time windows. For each patient, we estimated (1) the time spent with MAP outside the autoregulation limits and (2) the burden of deviation, defined as the area between the MAP curve and the autoregulation limits when the MAP was outside these limits. Fifty-one patients with a median age of 7.1 (IQR 0.7-52.0) months old were included. The opt-MAP was calculated for 94% (IQR 90-96) of the monitored time. The opt-MAP was significantly lower in neonates < 1 month old. The patients spent 24% (18-31) of the time outside of the autoregulation limits, with no significant differences between age groups. Continuous determination of the opt-MAP is feasible in children within the first 48 h following cardiac surgery.
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Affiliation(s)
- Laurence Tabone
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Pediatric Intensive Care Unit and Pediatric Emergency Department, CHU Clocheville, Tours, France
| | - Jihad El-Tannoury
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Michael Levy
- Pediatric Intensive Care Unit, CHU Robert Debré, Paris, France
| | - Michael Sauthier
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Nicolas Joram
- Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
| | - Geneviève Du Pont-Thibodeau
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Pierre Bourgoin
- Pediatric Intensive Care Unit, CHU de Nantes, Nantes, France
| | - Sally Al-Omar
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Nancy Poirier
- Department of Cardiac Surgery, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Emeriaud
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Céline Thibault
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
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Venugopal NK, O'Leary S, Robledo A, Husain A, Tom RB, Nuti SA, Jupiter DC, Panchbhavi VK. Safe driving recommendations following lower extremity orthopedic surgery: a systematic review. Eur J Orthop Surg Traumatol 2024; 34:59-66. [PMID: 37639004 DOI: 10.1007/s00590-023-03705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE We analyzed the published literature on return-to-driving (RTD) recommendations following lower extremity orthopedic surgery, including knee and hip arthroplasty and ankle and foot surgery. METHODS We conducted a PubMed MEDLINE database search for the relevant literature spanning from 1988 to 2022. Data were extracted from the selected articles independently by six investigators, and the mean, standard deviation, and range of RTD recommendations for each surgical region and procedure were calculated. RESULTS The 34 studies included in our review evaluated brake response time, reaction time, movement time, braking force, and other parameters. Average RTD recommendations in weeks were: hip surgeries, 4.1 (± 2.7); foot surgeries, 6.67 (± 0.94); Achilles surgeries, 6.67 (± 0.25); ankle surgeries, 4 (± 2); knee surgeries, 5.42 (± 0.77); and multiple lower extremity surgeries, 3.85 (± 0.15). CONCLUSION Our findings can assist physicians in providing informed recommendations to patients, promoting safe driving practices, and optimizing postoperative recovery. LEVEL OF EVIDENCE Therapeutic, Level III: Retrospective comparative study.
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Affiliation(s)
- Navneet K Venugopal
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Sean O'Leary
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Ariadna Robledo
- Department of Neurosurgery, The University of Texas Medical Branch, 1005 Harborside Dr, Fifth Floor, Galveston, TX, 77555, USA
| | - Adam Husain
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Roshan B Tom
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Shiva A Nuti
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, 700 Harborside Drive, Ewing Hall 1.134, Galveston, TX, 77555-1148, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
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18
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Ma F, Guo S, Wu XE, Song Y. Postoperative nursing care of a child with dilated cardiomyopathy of mismatched donor-recipient weight undergoing heart transplantation. Asian J Surg 2023; 46:6041-6042. [PMID: 37718210 DOI: 10.1016/j.asjsur.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Fuzhen Ma
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Shuping Guo
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Xi E Wu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China.
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19
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Gibson AC, Merrill TB, Boyette JR. Complications of Mandibular Fracture Repair. Otolaryngol Clin North Am 2023; 56:1137-1150. [PMID: 37353369 DOI: 10.1016/j.otc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have continued to change as well. This article aims to assess the most common and most concerning complications that can occur secondary to management of mandibular fractures by examining categories of complication types. This article also explores factors and techniques associated with reduced rates of complications as well as the management of complications.
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Affiliation(s)
- Anna Celeste Gibson
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA.
| | - Tyler Branch Merrill
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
| | - Jennings Russell Boyette
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
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20
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Gutiérrez-Soriano L, Becerra Zapata E, Maya Trujillo N, Franco Gruntorad GA, Hurtado Peña P. ECPR for prolonged Pediatric Cardiac Arrest, an outcome without major neurological compromise. J Extra Corpor Technol 2023; 55:197-200. [PMID: 38099635 PMCID: PMC10723570 DOI: 10.1051/ject/2023019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/24/2023] [Indexed: 12/17/2023]
Abstract
Pediatric in-hospital cardiac arrest (IHCA) has been reported in 1-3% of pediatric intensive care unit (ICU) admissions and up to 6% of children admissions to the cardiac ICU. In the last 25 years, the survival to hospital discharge after pediatric IHCA has improved from 9% to 13.7% up to 35%. The improvement in outcomes was attributed in part to the application of ECMO as a rescue strategy when prolonged conventional CPR cannot restore spontaneous circulation. We report a case of a 4-month-old patient with a history of ventricular and septal defects, with left to right shunt and enlargement of left heart chambers that underwent surgery for the closure of the atrial and septal defects, and experienced complications that led to the use of ECMO in response to a prolonged cardiac arrest.
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Affiliation(s)
- Laura Gutiérrez-Soriano
- Cardiovascular Anesthesiologist Anesthesiology Department, Fundación Cardioinfantil 1113111 Bogota Colombia
| | | | | | | | - Pedro Hurtado Peña
- Anesthesiology Department, Hospital Universitario San Ignacio 1113111 Bogota Colombia
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Goodner C, Moran G, Williams K, Mounir D. The clinical utility of routine postoperative hemoglobin and creatinine after reconstructive surgery for apical pelvic organ prolapse. Int Urogynecol J 2023; 34:2759-2766. [PMID: 37466693 DOI: 10.1007/s00192-023-05601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Postoperative laboratory tests are routinely ordered after apical prolapse repair on asymptomatic patients. We hypothesize that routine serum hemoglobin (Hb) and creatinine (Cr) have limited clinical utility in the postoperative period in asymptomatic patients. METHODS This is a retrospective cohort study of patients who underwent surgical repair of apical prolapse between 2017 and 2019 at our institution. Subjects were divided into two groups postoperatively: symptomatic and asymptomatic anemia. Symptomatic patients were defined as having one or more of the following: blood pressure (BP) <90/60, heart rate (HR) >100, urine output <30 cc/h, subjective dizziness, flank pain, or abdominal pain. The primary aim was to evaluate the utility of postoperative serum Hb and Cr in symptomatic and asymptomatic patients. Fisher's exact and Mann-Whitney tests analyzed categorical and continuous data respectively. A total of 325 patients were included. RESULTS Patients with symptomatic anemia had a larger decrease in Hb on postoperative day 1 (POD1) with a mean decrease of -18.11% (± 6.64) compared with asymptomatic patients, who had a mean difference of -15.49% (± 5.63; p < 0.001). The total cost of tests evaluating Hb was US$61,745. Patients with symptomatic acute kidney injury had an increase in Cr on POD1 compared with asymptomatic patients, with a mean increase of 0.23% (± 16.06) and -3.07% (± 13.10) respectively (p < 0.05). The total cost of tests including Cr was US$131,812. CONCLUSIONS Our results indicate that routine postoperative Hb and Cr testing for apical prolapse should be reserved for symptomatic patients as it has minimal clinical value in asymptomatic patients and contributes to increased overall health care cost.
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AlSabah S, Al Haddad E. Bariatric Surgery and Malpractice: an Extensive Review of Demographics, Complications, Litigation, and Proactive Mitigation Strategies. Obes Surg 2023; 33:3611-3620. [PMID: 37770777 DOI: 10.1007/s11695-023-06837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
The rising prevalence of severe obesity has led to a parallel increase in bariatric surgeries, raising a complex array of medicolegal issues. This review aims to analyze and synthesize literature on bariatric surgery malpractice, focusing on patient demographics, surgical complications, litigation costs, and the nature of malpractice cases. A systematic search was conducted across multiple databases for relevant studies published up to May 2023. Our review endeavors to provide insights into these medicolegal challenges and their implications and foster an informed dialogue on strategies for their effective management. By doing so, we hope to enhance ethical and legally sound bariatric practices, safeguarding both patient welfare and surgical practitioners from legal repercussions.
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Sirilaksanamanon P, Thawitsri T, Charuluxananan S, Chirakalwasan N. Diagnostic Value of the Bispectral Index to Assess Sleep Quality after Elective Surgery in Intensive Care Unit. Indian J Crit Care Med 2023; 27:795-800. [PMID: 37936795 PMCID: PMC10626235 DOI: 10.5005/jp-journals-10071-24555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/15/2023] [Indexed: 11/09/2023] Open
Abstract
Purpose Monitoring and improving sleep quality may help recovery from major illness. Polysomnography is a gold standard for measuring sleep quality, but routine use is not practical. The goal of this study is to investigate the diagnostic accuracy of an alternative monitor, the Bispectral Index (BIS), for evaluating the quality of sleep-in postoperative patients in the intensive care unit (ICU). Study design An observational study. Materials and methods Patients admitted to postoperative ICU after elective major noncardiac surgery were monitored with both BIS and PSG during the first night. The temporally synchronized data from both monitors were obtained for measurement of the association. Clinical outcomes were compared between patients with different postoperative sleep quality. Results Thirty-three patients were enrolled in this study. For determining the average BIS index associated with good postoperative sleep quality, receiver operating characteristics (ROC) curve was generated. Area under the ROC curve (AUC) was 0.65. The cutoff with best discriminability was 75 with a sensitivity of 68% and a specificity of 56%. Compared with those with good and poor postoperative sleep quality, there were no differences in main postoperative outcomes including duration of mechanical ventilation and ICU stay. Although the quality of sleep after surgery of all subjects with postoperative delirium was poor, the incidence of delirium between the groups did not significantly differ (0% vs 10.3%; p = 0.184). Conclusion The monitoring of BIS is a viable tool for evaluating sleep quality in mechanically ventilated patients in the postoperative ICU with acceptable precision. Trial registration www.clinicaltrials.in.th, TCTR20200310005. How to cite this article Sirilaksanamanon P, Thawitsri T, Charuluxananan S, Chirakalwasan N. Diagnostic Value of the Bispectral Index to Assess Sleep Quality after Elective Surgery in Intensive Care Unit. Indian J Crit Care Med 2023;27(11):795-800.
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Affiliation(s)
- Pongpol Sirilaksanamanon
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thammasak Thawitsri
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Somrat Charuluxananan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Chandrababu R, Ramesh J, Jagadeesh NS, Guo P, Reddy GG, Hayter M. Effects of yoga on anxiety, pain, inflammatory and stress biomarkers in patients undergoing cardiac surgery: A systematic review and meta-analysis. Complement Ther Clin Pract 2023; 53:101798. [PMID: 37708834 DOI: 10.1016/j.ctcp.2023.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The most common surgical method of managing coronary artery disease is coronary artery bypass grafting (CABG). Stress, anxiety, and pain are commonly identified postoperative symptoms and are closely correlated to patient recovery. OBJECTIVE The purpose of this review was to investigate the effects of yoga interventions on anxiety, pain, inflammatory and stress biomarkers in CABG surgery patients. METHODS and analysis: The databases PUBMED, The Cochrane CENTRAL, EMBASE, CINAHL, Scopus, and Web of Science were comprehensively searched from the inception to December 2022. The quantitative research studies that evaluated the effects of yoga on anxiety, pain, inflammatory and stress biomarkers in CABG patients were included. This systematic review and meta-analysis followed the Cochrane guidelines and is reported using the PRISMA checklist. The RevMan 5.4 software was used for the meta-analysis. RESULTS Seventeen studies met the inclusion criteria, representing 1227 patients with a mean age of 58 years. All studies have reported that yoga interventions significantly reduced anxiety, pain, inflammatory and stress biomarkers in the experimental group compared to the control group. According to the GRADE criteria, moderate quality of evidence was found on effects of yoga intervention in CABG surgery patients. CONCLUSION Yoga has been shown to benefit patients undergoing CABG surgery. It can be used as an adjunctive intervention. However, more rigorous randomized controlled trials are required to generate high-quality evidence for yoga interventions. REGISTRATION PROSPERO CRD42020175833.
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Affiliation(s)
- Ramesh Chandrababu
- Department of Medical Surgical Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.
| | - Jyothi Ramesh
- Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.
| | - Nalini Sirala Jagadeesh
- Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.
| | - Ping Guo
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Gajjela Govardhan Reddy
- Division of Yoga, Centre for Integrative Medicine and Research, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Mark Hayter
- Department of Nursing, Manchester Metropolitan University, All Saints Building, Manchester, M15 6BH, United Kingdom.
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Ohtera S, Kato G, Ueshima H, Mori Y, Nakatani Y, Nakayama T, Kuroda T. Variation in Utilization of Postoperative Rehabilitation After Total Hip Arthroplasty in Japan. Arch Phys Med Rehabil 2023:S0003-9993(23)00600-7. [PMID: 37890550 DOI: 10.1016/j.apmr.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/23/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE The use of rehabilitation after arthroplasty in Japan is unknown. We aimed to identify utilization of postoperative rehabilitation after total hip arthroplasty (THA) and to explore the factors associated with rehabilitation usage. DESIGN A retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). SETTING Hospitals nationwide. PARTICIPANTS Patients aged >40 years who underwent primary THA between 2017 and 2018 (N=51,332). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The proportion of patients who underwent postoperative rehabilitation and the number of rehabilitation days were also calculated. Patient demographic characteristics, hospital case volumes, and regions associated with continuing postoperative rehabilitation were analyzed using a Cox proportional hazards model. RESULTS Eligible patients were selected from 3033 hospitals, of whom 41,192 (80%) were women. Of these, 94% used inpatient rehabilitation, and 20% received outpatient rehabilitation. The mean durations of rehabilitation were 47±72 days for inpatient and 195±109 days for outpatient, respectively. Large-scale hospitals performing more than 200 procedures annually had the shortest duration of inpatient rehabilitation (36-65 days) and the longest duration of outpatient rehabilitation (220-109 days) compared with smaller hospitals. The regression model consistently showed that rehabilitation continued longer at hospitals with over 200 patients per year (HR 0.96, 95% CI 0.93-0.99, P<.007). CONCLUSION The Japanese health care system provided higher access to inpatient rehabilitation after THA than other countries. One limitation of this study is that long-term care insurance data were not analyzed. However, outpatient rehabilitation vary according to hospital case volume. Further research is needed to determine the causes of variation in rehabilitation use and the effect of variation on patient outcomes.
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Affiliation(s)
- Shosuke Ohtera
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan; Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan; Department of Health Economics, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Genta Kato
- Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan.
| | - Hiroaki Ueshima
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan; Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Science, Kyoto University, Kyoto, Japan
| | - Yukiko Mori
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Yuka Nakatani
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Tomohiro Kuroda
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
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Aldabek K, Luketich S, Abdelhalim A, Elbakry A, Al-Omar O. Double versus single diaper technique after hypospadias repair, does it really matter? J Pediatr Urol 2023; 19:582.e1-582.e5. [PMID: 37353360 DOI: 10.1016/j.jpurol.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Double-diaper technique with an open-drainage catheter is a common practice after hypospadias repair. However, double-diapering may increase the burden of postoperative care and has not been compared to single-diapering with an open-drainage catheter. OBJECTIVES This study investigates whether the single-diaper technique is associated with inferior surgical outcomes compared to the double-diaper technique. MATERIALS AND METHODS A single surgeon database was retrospectively reviewed for patients who underwent hypospadias repair between 2013 and 2021. Patients who were lost to follow-up and those in whom the type of diaper care (single- or double-diaper) was not documented were excluded. Patients in the single-diaper technique received the same type of dressing and discharge instructions, as those in the double-diaper group, except for leaving the catheter freely draining into a single-diaper. Short-term complications including surgical site infection (SSI), urinary tract infection (UTI) and wound dehiscence, were the primary outcome; whereas the long-term urethroplasty complications (urethrocutaneous fistula and meatal stenosis) were secondary outcomes. Outcomes were analyzed according to the type of diaper care. RESULTS Among 323 patients reviewed, 219 patients met the inclusion criteria (72 patients in the double-diaper and 147 in the single-diaper group). Both study groups were similar regarding patient demographics, hypospadias characteristics and surgical technique. Looking at the primary outcomes, there was no statistically significant difference in SSI, UTI or wound dehiscence. For the secondary outcomes, the incidence of meatal stenosis (8.3 vs. 1.4%, p = 0.044), and fistula formation (15.3% vs 5.4%, p = 0.037) was significantly higher in the double-diaper than the single-diaper group, respectively (Table 2). CONCLUSION Single-diaper technique following hypospadias repair is not associated with increased risk of complications compared to double-diaper technique.
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Affiliation(s)
- Khaled Aldabek
- University of Tennessee Health Science Center, University of Tennessee, Memphis, TN, USA.
| | - Samuel Luketich
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Ahmed Abdelhalim
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr Elbakry
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Osama Al-Omar
- Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
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Unaldi HE. Effects of mobilization within the first 4 h following anatomical lung resection with thoracotomy. Updates Surg 2023; 75:2027-2031. [PMID: 37524991 DOI: 10.1007/s13304-023-01617-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
Thoracic incisions are very painful and complicated incisions. Many analgesic drugs including opioids are used to relieve pain in patients. We hypothesized that early mobilization and patient-centered strategy after lung resection reduce the incidence of perioperative complications and postoperative pain. We conducted a retrospective study on patients who underwent lung resection via thoracotomy and were mobilized in the first 4 h postoperatively. Mobilization was defined as standing and walking at least 100 m from the bed. If orthostatic hypotension occurred, mobilization was postponed for 30 min. Analgesic treatment needs, walking distance, co-morbidity, hospitalization, postoperative complications within 30 days, and drainage and discharge times of patients were analyzed. The lobectomy with thoracotomy was performed in 48 patients. Thirty-six patients were male. The rate of additional systemic diseases was 58.3%. Forty patients walked in the first 3 h postoperatively. The mean walking distance was 140 ± 38.5 m. The rate of orthostatic hypotension was 8.3%. The routine analgesic treatment included intravenous paracetamol 3 g and dexketoprofen 100 mg daily. In this study, 18% of patients received narcotic analgesics. Thromboembolic event and arrhythmia did not develop in any patient. The most common complication was prolonged air leaks (18.8%). Mobilization within the first 4 h following anatomical lung resection is feasible and safe. Early mobilization provided pain relief after lung surgery and reduced the use of narcotic analgesics and cardiovascular complications. The article is the first study about walking in first hours after pulmonary lobectomy with thoracotomy in the thoracic surgery literature.
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Affiliation(s)
- Hatice Eryigit Unaldi
- Department of Thoracic Surgery, Istinye University, Maltepe Mah., Edirne Cırpıcı Yolu, No.9 Zeytinburnu, 34010, Istanbul, Turkey.
- Department of Thoracic Surgery, Medical Park Gebze Hospital, Gebze, Kocaeli, Turkey.
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Anilakumari D, Singla D, Agarwal A, Kumari R. Comparative efficacy of Micropore™ surgical dressing, Tegaderm™ and Lockit plus® for lumbar epidural catheter fixation in children: a prospective parallel group randomized controlled trial. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:429-437. [PMID: 37683972 DOI: 10.1016/j.redare.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/29/2022] [Indexed: 09/10/2023]
Abstract
BACKGROUND Proper fixation of an epidural catheter is necessary for desired drug effect and to prevent catheter displacement. Different techniques have been used for epidural catheter fixation. The aim of the study was to compare the relative efficacy of Micropore™ surgical dressing, Tegaderm™, and Lockit plus® in preventing lumbar epidural catheter migration in children. METHODS We studied 167 patients aged 5-16 years, for up to 48 h. After the elective abdominal or lower limb surgery. Patients were randomly assigned to one of three groups: (1) Micropore™ surgical dressing (group M), (2) Tegaderm™ (group T), or (3) Lockit plus® (group L). Incidence and extent of epidural catheter migration in centimetres (cm); was compared at 24 and 48 h post epidural fixation. Correlation between epidural catheter migration and patient characteristics, and relative incidence of complications in three groups was also analysed. RESULTS Incidence of catheter migration was 9.6% at 24 h (group M: 7.1%, group T: 21.1% and group L: 0%) and 45.5% at 48 h (group M: 66.1%, group T: 45.6% and group L: 24.1%). After 48 h, absolute migration (mean migration rounded off to the nearest 0.5 cm) was least in patients in group L: 0.34 cm (1.39) compared to group M 1.22 cm (SD: 1.85) group T: 0.94 cm (1.94) (p = <0.001). CONCLUSION Up to 48 h after surgery, the Lockit plus® device demonstrated the less epidural catheter migration when compared to micropore surgical dressing or tegaderm in children undergoing elective abdominal or lower limb surgery.
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Affiliation(s)
- D Anilakumari
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - D Singla
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India.
| | - A Agarwal
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - R Kumari
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India
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Retrouvey H, Ipaktchi K, Lauder A. Evidence-based postoperative replantation protocols. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03706-8. [PMID: 37639003 DOI: 10.1007/s00590-023-03706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
Postoperative care is essential to upper extremity replantation success and includes careful and frequent monitoring of the replanted part. During this period, pharmacologic agents such as antithrombotic and anticoagulants may prevent complications such as arterial thrombosis and venous congestion. Dressings and therapy can also impact short- and long-term outcomes following replantation. This article reviews the literature to provide guidance for postoperative protocols following upper extremity replantation.
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Affiliation(s)
- Helene Retrouvey
- Division of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, Academic Office 1, Mail Stop B202, Aurora, CO, 80045, USA.
| | - Kyros Ipaktchi
- Division of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, Academic Office 1, Mail Stop B202, Aurora, CO, 80045, USA
| | - Alexander Lauder
- Division of Orthopedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, Academic Office 1, Mail Stop B202, Aurora, CO, 80045, USA
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Huh JW, Kim MW, Noh YM, Seo HE, Lee DH. Effectiveness of ultrasound-guided dual nerve block in the below-knee amputation. BMC Surg 2023; 23:227. [PMID: 37563582 PMCID: PMC10413713 DOI: 10.1186/s12893-023-02138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Below knee amputation (BKA) is a common surgical procedure for diabetic foot ulcers and necrotizing lower limb fasciitis patients. However, it is a painful procedure and inadequate postoperative analgesia impedes rehabilitation and prolongs hospitalization. An ideal pain management regimen should provide superior analgesia while minimizing opioid consumption and improving rehabilitation. METHODS We retrospectively reviewed medical charts of 218 patients who underwent BKA for diabetic foot ulcer or necrotizing lower limb fasciitis at a single center between January 2017 and September 2020. Two groups were analyzed: patients who received dual nerve block (DNB) before surgery (Group I; n = 104), and patients who did not (Group II; n = 93). By the exclusion criteria, 21 patients were excluded. The femoral and sciatic nerves were each blocked separately under ultrasound guidance. This procedure was performed immediately before the operation. RESULTS Group I patients' subjective pain scores were significantly lower than that of Group II at 6, 12, and 24 h after BKA (P < 0.05). Group I's morphine milligram equivalent (MME) was significantly lower than those of Group II at 72 h after BKA (P < 0.05). Moreover, the rate of postoperative nausea and vomiting (PONV) and delirium was significantly lower in Group I patients than that in Group II patients. CONCLUSION Ultrasound-guided lower extremity nerve block surgery is excellent for early postoperative pain control, could be used as an accurate and effective pain control method, and can reduce the side effects of opioid consumption after BKA.
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Affiliation(s)
- Jung Wook Huh
- Department of Orthopedic Surgery, Busan Medical Center, 62, Yangjeong-ro, Busan, Republic of Korea
| | - Min Woo Kim
- Department of Orthopedic Surgery, Busan Medical Center, 62, Yangjeong-ro, Busan, Republic of Korea
| | - Young Min Noh
- Department of Orthopedic Surgery, Busan Medical Center, 62, Yangjeong-ro, Busan, Republic of Korea
| | - Han Eol Seo
- Department of Orthopedic Surgery, Busan Medical Center, 62, Yangjeong-ro, Busan, Republic of Korea
| | - Dong Ha Lee
- Department of Orthopedic Surgery, Busan Medical Center, 62, Yangjeong-ro, Busan, Republic of Korea.
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Kleipool SC, van Rutte PWJ, Eeftinck Schattenkerk LD, Bonjer HJ, Marsman HA, de Castro SMM, van Veen RN. Evaluation of Postoperative Care Protocol for Roux-en-Y Gastric Bypass Patients with Same-Day Discharge. Obes Surg 2023; 33:2317-2323. [PMID: 37347399 DOI: 10.1007/s11695-023-06697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Same-day discharge (SDD) after bariatric surgery is increasingly being performed and is safe with careful patient selection. However, detecting early complications during the first postoperative days can be challenging. We developed a postoperative care protocol for these patients and aimed to evaluate its effectiveness in detecting complications and monitoring patient recovery. METHODS A single-center retrospective observational study was conducted with patients with who underwent Roux-en-Y Gastric Bypass (RYGB) with successful SDD. The study evaluated the effectiveness of the safety net that included simple remote monitoring with a pulsoximeter and thermometer, a phone consultation on postoperative day (POD) 1, and a physical consultation on POD 2-4. Furthermore, an analysis was performed on various factors including pain scores, painkiller usage, and incidences of nausea and vomiting on POD 1. RESULTS In this study, 373 consecutive patients were included, of whom 19 (5.1%) were readmitted until POD 4. Among these, 12 patients (3.2%) reached out to the hospital themselves, while 7 (1.9%) were readmitted after phone or physical consultations. Ten of the readmitted patients had tachycardia. On POD 1, the mean numeric rating scale was 4 ± 2, and 96.6% of the patients used acetaminophen, 35.5% used naproxen, and 9.7% used oxynorm. Of the patients, 13.9% experienced nausea and 6.7% reported vomiting. CONCLUSION A postoperative care protocol for SDD after RYGB, comprising simple remote monitoring along with a phone consultation on POD 1 and a physical checkup on POD 2-4, was effective in monitoring patient recovery and detecting all early complications.
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Affiliation(s)
| | | | | | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Bizzoca D, Piazzolla A, Moretti L, Vicenti G, Moretti B, Solarino G. Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty: A prospective observational study. World J Orthop 2023; 14:547-553. [PMID: 37485426 PMCID: PMC10359746 DOI: 10.5312/wjo.v14.i7.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in diagnosing and managing periprosthetic joint infections.
AIM To define the normal postoperative presepsin plasmatic curve, in patients undergoing primary cementless total hip arthroplasty (THA).
METHODS Patients undergoing primary cementless THA at our Institute were recruited. Inclusion criteria were: Primary osteoarthritis of the hip; urinary catheter time of permanence < 24 h; peripheral venous cannulation time of permanence < 24 h; no postoperative homologous blood transfusion administration and hospital stay ≤ 8 d. Exclusion criteria were: The presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 mo; diabetes mellitus; immunosuppressive drug or corticosteroid assumption. All the patients received the same antibiotic prophylaxis. All the THA were performed by the same surgical and anaesthesia team; total operative time was defined as the time taken from skin incision to completion of skin closure. At enrollment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-reactive protein 24 h before arthroplasty and at 24, 48, 72 and 96 h postoperatively and at 3, 6 and 12-mo follow-up.
RESULTS A total of 96 patients (51 female; 45 male; mean age = 65.74 ± 5.58) were recruited. The mean PS values were: 137.54 pg/mL at baseline, 192.08 pg/mL at 24 h post-op; 254.85 pg/mL at 48 h post-op; 259 pg/mL at 72 h post-op; 248.6 pg/mL at 96-h post-op; 140.52 pg/mL at 3-mo follow-up; 135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up. In two patients (2.08%) a soft-tissue infection was observed; in these patients, higher levels (> 350 pg/mL) were recorded at 3-mo follow-up.
CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection. The PS plasmatic concentration should be also assessed at 72 h post-operatively, evaluate the maximum postoperative PS value, and at 96 h post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.
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Affiliation(s)
- Davide Bizzoca
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Andrea Piazzolla
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Lorenzo Moretti
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | | | - Biagio Moretti
- Di BraiN, University of Bari "Aldo Moro", Bari 70124, Italy
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Williams CT, Whyman J, Loewenthal J, Chahal K. Managing Geriatric Patients with Falls and Fractures. Orthop Clin North Am 2023; 54:e1-e12. [PMID: 37349065 DOI: 10.1016/j.ocl.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Orthopedic fractures in adults 65 and older are common and can lead to functional decline and increased morbidity and mortality. Falls are often the precipitating event for fractures in this population, linked to common aging physiology with increasing comorbid conditions and advancing frailty. Managing falls and orthopedic fractures in the geriatric population is complex, requiring a systematic and collaborative approach spearheaded by a multidisciplinary team focused on improving patient outcomes.
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Affiliation(s)
- Carla T Williams
- Division of Gerontology, Harvard Medical School, Beth Israel Deaconess Medical Center, 1 Brookline Place, Suite 230, Boston, MA 02445, USA.
| | - Jeremy Whyman
- Harvard Medical School Multicampus Geriatric Fellowship Program, Division of Gerontology, Section of Palliative Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julia Loewenthal
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen Chahal
- Geriatric Inpatient Fracture Trauma Service (GIFTS), Department of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Jeong SA, Ko CS, Kim NY, Gong CS, Lee IS, Kim BS, Yoo MW. Factors Associated With Loss to Follow-up After Laparoscopic Sleeve Gastrectomy: A Single-Center Retrospective Study. J Metab Bariatr Surg 2023; 12:1-10. [PMID: 37416853 PMCID: PMC10320437 DOI: 10.17476/jmbs.2023.12.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 07/08/2023]
Abstract
Purpose After bariatric surgery, postoperative follow-up is important for evaluating long-term outcomes, such as successful weight loss and improvement of metabolic parameters. However, many patients are lost to follow-up within 1 year. This study aimed to identify the follow-up rate of bariatric surgery and predictive factors of loss to follow-up (LTF). Materials and Methods We retrospectively reviewed the data of 61 patients receiving bariatric surgery for obesity (laparoscopic sleeve gastrectomy; LSG group) and 872 for early gastric cancer (EGC group) from November 2018 to July 2020 in a single center. After 1:1 matching, we compared the LTF rate. In the LSG group, we analyzed the factors associated with LTF. Additionally, we collected weight data in the LTF group by a telephone survey. Results By 1:1 matching, 47 patients for each group were identified. The LTF rates of the LSG and EGC groups were 34.0% (16 patients) and 2.1% (one patient), respectively (P=0.0003). In the LSG group, the LTF rate increased over the postoperative month. Of the patients, 29.5% who missed a scheduled appointment within one year comprised the LTF group. In the analysis, no significant factors associated with LTF were identified. The only factor with borderline significance was dyslipidemia with medication (P=0.094). Conclusion The LSG group demonstrated a high LTF rate, although adherence to follow-up was closely related to postoperative outcomes. Therefore, educating patients on the significance of follow-up is important. Particularly, continuous efforts to identify the associated factors and develop a multidisciplinary management protocol after bariatric surgery are necessary.
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Affiliation(s)
- Seong-A Jeong
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Chang Seok Ko
- Department of Gastrointestinal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Na Young Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chung Sik Gong
- Department of Gastrointestinal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Seob Lee
- Department of Gastrointestinal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Su Kim
- Department of Gastrointestinal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon-Won Yoo
- Department of Gastrointestinal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shields JK, Kenyon L, Porter A, Chen J, Chao L, Chang S, Kho KA. Ice-POP: Ice Packs for Postoperative Pain: A Randomized Controlled Trial. J Minim Invasive Gynecol 2023; 30:455-461. [PMID: 36740018 DOI: 10.1016/j.jmig.2023.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/12/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE To evaluate the benefit of ice packs as a supplement to standard pain management following laparoscopic hysterectomy (LH). DESIGN This Institutional Review Board-approved randomized controlled trial involved patients undergoing LH for benign conditions. Subjects were randomized to receive standard enhanced recovery after surgery pain management or standard enhanced recovery after surgery plus ice packs. SETTING Two academic tertiary care centers PATIENTS: Patients undergoing planned outpatient LH with the minimally invasive gynecologic surgery team between February 2019 and November 2020 were considered. Patients with chronic pain, current opioid use ≥1 week, or planned overnight hospitalizations were excluded. Primary outcome data were available for 51 subjects (24 control, 27 intervention). INTERVENTIONS Ice packs were placed on the abdomen in the operating room. MEASUREMENTS AND MAIN RESULTS Pain was assessed at multiple time points throughout the study using a visual analogue scale (VAS). Opioid requirement was assessed using morphine milligram equivalent. There was no difference between the groups on any demographic variables. Morphine milligram equivalent requirements were also not different between the groups (p = .63). Postoperative day 1 (POD#1) VAS scores were not different (p = .89). Eighty-five percent of subjects reported feeling that their pain was controlled. Subjects who reported that they did not feel their pain was controlled did not use more opioids on POD#1 (p = .37), nor did they have higher POD#1 VAS scores (p = .55). Eighty-seven percent of the intervention subjects said they would use ice again, and 82.6% of them said they would recommend ice to others. There were no adverse events related to ice. All subjects were prescribed 20 tablets oxycodone and averaged 2.9 (SD 3.4) tablets used after discharge. CONCLUSION Ice packs are an acceptable supplement for postoperative pain control, but they do not reduce postoperative pain or opioid usage compared to standard pain management without ice packs.
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Affiliation(s)
- Jessica K Shields
- University of Texas Southwestern Medical Center (Dr. Shields, Kenyon, Chao, Chang and A. Kho), Dallas, TX.
| | - Laura Kenyon
- University of Texas Southwestern Medical Center (Dr. Shields, Kenyon, Chao, Chang and A. Kho), Dallas, TX
| | - Anne Porter
- University of Texas Health Science Center at San Antonio (Dr. Porter), San Antonio, TX
| | | | - Lisa Chao
- University of Texas Southwestern Medical Center (Dr. Shields, Kenyon, Chao, Chang and A. Kho), Dallas, TX
| | - Stephanie Chang
- University of Texas Southwestern Medical Center (Dr. Shields, Kenyon, Chao, Chang and A. Kho), Dallas, TX
| | - Kimberly A Kho
- University of Texas Southwestern Medical Center (Dr. Shields, Kenyon, Chao, Chang and A. Kho), Dallas, TX
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de Bock E, Filipe MD, Herman ES, Pronk A, Boerma D, Heikens JT, Verheijen PM, Vriens MR, Richir MC. Risk factors of postoperative intensive care unit admission during the COVID-19 pandemic: A multicentre retrospective cohort study. Int J Surg Open 2023; 55:100620. [PMID: 37163195 PMCID: PMC10159662 DOI: 10.1016/j.ijso.2023.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023]
Abstract
Background During the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is essential. This study aims to determine which factors led to an increased risk of unplanned postoperative ICU admission during the COVID-19 pandemic. Methods This multicentre retrospective cohort study investigated all patients who underwent surgery between 9 March 2020 and 30 June 2020. The primary endpoint was the number of surgical patients requiring postoperative ICU admission. The secondary endpoint was to determine factors leading to an increased risk of unplanned postoperative ICU admission, calculated by multivariate analysis with odds ratios (OR's) and 95% confidence (CI) intervals. Results One hundred eighty-five (4.6%) of the 4051 included patients required unplanned postoperative ICU admission. COVID-19 positive patients were at an increased risk of being admitted to the ICU compared to COVID-19 negative (OR 3.14; 95% CI 1.06-9.33; p = 0.040) and untested patients (OR 0.48; 95% CI 0.32-0.70; p = 0.001). Other predictors were male gender (OR 1.36; 95% CI 1.02-1.82; p = 0.046), body mass index (BMI) (OR 1.05; 95% CI 1.02-1.08; p = 0.001), surgical urgency and surgical discipline. Conclusion A confirmed COVID-19 infection, male gender, elevated BMI, surgical urgency, and surgical discipline were independent factors for an increased risk of unplanned postoperative ICU admission. In the event of similar pandemics, postponing surgery in patients with an increased risk of postoperative ICU admission may be considered.
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Affiliation(s)
- Ellen de Bock
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Eline S Herman
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joost T Heikens
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, Rivierenland Hospital, Tiel, the Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - Menno R Vriens
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
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Chappidi MR, Escobar D, Meng MV, Washington SL, Porten SP. Readmissions trends following radical cystectomy for bladder cancer unchanged in the era of enhanced recovery after surgery (ERAS) protocols. Urol Oncol 2023:S1078-1439(23)00172-2. [PMID: 37258373 DOI: 10.1016/j.urolonc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/08/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE To provide nationally representative estimates of contemporary trends in readmission rates, readmission location (index vs. nonindex hospital), and causes of readmission following radical cystectomy (RC) in the era of enhanced recovery after surgery (ERAS) protocol implementation. MATERIALS AND METHODS Patients with bladder cancer who underwent RC were identified in the Nationwide Readmissions Database (2016-2019). Yearly trends in 30-day and 90-day readmission rates and readmission causes were assessed in the whole cohort and subset of patients who underwent RC at high volume centers (>22 RCs/year). Multivariable logistic regression was used to determine predictors of index readmission, nonindex readmission, death during readmission, and experiencing a second readmission. RESULTS Among the 20,957 RC patients, the 30-day and 90-day readmission rates were 23.5% (n = 4,931) and 39.1% (n = 7,987), respectively. For 90-day readmissions, 27.6% (n = 2,206) were to nonindex hospitals. During the study period, there was no significant change in the yearly 30-day or 90-day readmission rates and percentage of readmissions to nonindex hospitals (all p > 0.05). This was also true in the subset of patients who underwent RC at high volume centers. The only significant change in causes of readmission during the study period was wound readmissions (2.7% in 2016 vs. 5.1% of readmissions in 2019, p = 0.02). CONCLUSIONS During the era of ERAS protocol implementation, in this nationally representative study, most causes of readmission and both 30 and 90-day readmission rates were unchanged, even at high volume RC centers. Moving forward, novel interventions are needed which focus on the postdischarge recovery period to help decrease readmission rates following RC.
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Affiliation(s)
- Meera R Chappidi
- Department of Urology, University of California, San Francisco, CA.
| | | | - Maxwell V Meng
- Department of Urology, University of California, San Francisco, CA
| | - Samuel L Washington
- Department of Urology, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Sima P Porten
- Department of Urology, University of California, San Francisco, CA
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Pereira MG, Silva AMO, Galhardo FDM, Almeida BDM, Lopes RL, Boin IDFSF. Respiratory muscle training with electronic devices in the postoperative period of hepatectomy: A randomized study. World J Hepatol 2023; 15:688-698. [PMID: 37305375 PMCID: PMC10251281 DOI: 10.4254/wjh.v15.i5.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/21/2023] [Accepted: 03/06/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Many studies have been developed with a focus on surgical techniques and drugs, but few that address the importance of rehabilitation in the pre and postoperative period, and the specific benefits for each surgical procedure or type of neoplasm, aiming to minimize respiratory complications in the postoperative period.
AIM To compare the strength of the respiratory muscles in the pre and postoperative periods of hepatectomy by laparotomy and to verify the incidence of postoperative pulmonary complications among the groups studied.
METHODS Prospective, randomized, clinical trial study that compared the inspiratory muscle training group (GTMI) with the control group (CG). After the collection of sociodemographic and clinical data, in both groups, preoperatively, on the first and fifth postoperative days, vital signs and pulmonary mechanics were evaluated and recorded. Albumin and bilirubin values were recorded for the albumin-bilirubin (ALBI) score. After randomization and allocation of participants, those in the CG underwent conventional physical therapy and those in the GTMI underwent conventional physical therapy plus inspiratory muscle, in both groups for five postoperative days.
RESULTS Of 76 subjects met eligibility criteria. The collection of 41 participants was completed: 20 in the CG and 21 in the GTMI. The most frequent diagnosis was 41.5% with liver metastasis, followed by 26.8% with hepatocellular carcinoma. As for respiratory complications in the GTMI, there was no incidence. In the CG, there were three respiratory complications. Patients in the CG classified as ALBI score 3 presented, statistically, a higher energy value compared to patients classified as ALBI score 1 and 2 (P = 0.0187). Respiratory variables, measured preoperatively and on the first postoperative day, had a significant drop in both groups from the preoperative to the first postoperative day (P ≤ 0.0001). When comparing the preoperative period and the fifth postoperative day between the GTMI and the CG, the maximal inspiratory pressure variable in the GTMI was statistically significant (P = 0.0131).
CONCLUSION All respiratory measures showed a reduction in the postoperative period. Respiratory muscle training using the Powerbreathe® device increased maximal inspiratory pressure and this may have contributed to a shorter hospital stay and better clinical outcome.
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Affiliation(s)
- Marcelo Gustavo Pereira
- Hospital de Clínicas, Universidade Estadual de Campinas, Campinas 13076-4151, São Paulo, Brazil
| | | | | | | | - Railaine Lais Lopes
- Hospital de Clínicas da Unicamp, Universidade Estadual de Campinas, Campinas 13083-888, São Paulo, Brazil
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Engskov AS, Ydrefors A, El-Jaleb K, Åkeson J. Prospective paired crossover evaluation of potential impact of investigator gender on perceived pain intensity early after acute or scheduled surgery. Biol Sex Differ 2023; 14:23. [PMID: 37095547 PMCID: PMC10127324 DOI: 10.1186/s13293-023-00508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Postoperative pain is common but often difficult to assess, and there are many potential confounders. Over the last decades, the gender of investigator as well as participant has been found to influence pain perception in both preclinical and clinical studies. However, to our knowledge this has not been studied in various postoperative patients. Objectives of this study were to test the hypotheses that pain intensity levels early after acute or scheduled in- or out-hospital surgery are lower when evaluated by a female investigator, and higher when reported by a female patient. METHODS In this prospective observational paired crossover study, two investigators of opposite genders independently obtained individually reported pain intensity levels with a visual analogue scale in a mixed cohort of adult postoperative study patients at Skåne University Hospital in Malmö, Sweden. RESULTS In total, 245 (129 female) study patients were included and then one female excluded. The study patients rated their intensity of postoperative pain lower when evaluated by a female than by a male investigator (P = 0.006), where the male patients constituted the significant difference (P < 0.001). Pain intensity levels did not differ between female and male study patients (P = 0.210). CONCLUSIONS Main findings of lower pain intensity reported by males to a female than to a male investigator early after surgery in this paired crossover study in mixed postoperative patients, indicate that potential impact of investigator gender on pain perception should be considered and further evaluated in clinical bedside practice. Trial registration Retrospectively registered in the ClinicalTrials.gov research database on 24th June 2019 with TRN number NCT03968497.
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Affiliation(s)
- Anna Sellgren Engskov
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden.
- Skåne University Hospital, Carl Bertil Laurells Gata 9, 3rd floor, SE-20502, Malmö, Sweden.
| | - Andreas Ydrefors
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
| | - Karolin El-Jaleb
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden
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Morell A, Samborski A, Williams D, Anderson E, Kittel J, Thevenet-Morrison K, Wilbur M. Calculating surgical readmission rates in gynecologic oncology: The impact of patient factors. Gynecol Oncol 2023; 172:115-120. [PMID: 37027939 DOI: 10.1016/j.ygyno.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To determine the 30-day surgical readmission rate after major gynecologic oncology surgeries at a high-volume academic institution and correlated risk factors. METHODS Retrospective cohort study was conducted of surgical admissions from January 2016 - December 2019 at a single institution. Data were extracted from patient charts, including reason for readmission and length of stay. A readmission rate was calculated. Nested case control design was used to identify correlations between readmission and patient specific risk-factors. Multivariable logistic regression models were used to determine risk factors with readmission. RESULTS A total of 2152 patients were included. The readmission rate was 3.5%, most commonly due to GI disturbance and surgical site infection. Average readmission length was 5 days. Prior to adjusting for covariates, insurance status, primary diagnosis, index admission length, and disposition at discharge differed between patients who were and were not readmitted. After adjusting for co-variates, younger patients, index admission >2 days, and higher Charlson co-morbidity index were associated with readmission. CONCLUSIONS Our surgical readmission rate was lower than previously reported rates in gynecologic oncology patients. Patient factors associated with readmission included younger age, longer index hospital admission, and higher medical co-morbidity index scores. Provider factors and institutional practice patterns could contribute to the decreased readmission rate. These findings underscore the importance of standardizing how we calculate readmission rate and interpret these data. Varying readmission rates and institutional practice patterns deserve closer scrutiny to inform best practice and future policies.
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Affiliation(s)
- Alexandra Morell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States of America.
| | - Alexandra Samborski
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Devin Williams
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Elizabeth Anderson
- Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, NY, United States of America
| | - Julie Kittel
- Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, NY, United States of America
| | - Kelly Thevenet-Morrison
- Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, NY, United States of America
| | - MaryAnn Wilbur
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States of America
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Tsai HY, Chao A, Hsiao WL. The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis. Intensive Crit Care Nurs 2023; 75:103359. [PMID: 36535871 DOI: 10.1016/j.iccn.2022.103359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/21/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the effectiveness of cold oral stimuli in quenching postoperative thirst in patients undergoing surgery. DESIGN A systematic review and meta-analysis of interventional studies. SETTING Postoperative care units. METHODS Seven electronic databases (Medline, Scopus, Web of Science, PubMed, CINHAL, PsycInfo, and EMBASE) were systematically searched from their inception to January 12, 2022. The Cochrane Handbook for Systematic Reviews of Interventions was followed. Two researchers examined the study quality using the Cochrane risk of bias tools. A meta-analysis with a subgroup analysis was performed. Sensitivity analysis, funnel plots and Egger's test were used to examine publication bias. MAIN OUTCOME MEASURE A thirst intensity score was used to rate postoperative thirst. RESULTS Data were collected from 11 interventional studies for this systematic review. Eight studies underwent a meta-analysis with a total of 1504 patients. Our meta-analysis showed that the thirst intensity scores decreased in the experimental groups by 1.42 points (95% confidence interval: -2.162 to -0.684) more than those of the control groups. Subgroup analysis indicated that Asian patients and age were two factors that moderated the thirst intensity score after applying cold oral stimuli. CONCLUSION Cold oral stimuli were effective in mitigating postoperative thirst. Ice products such as ice cubes, or ice chips are easily available in postoperative units. When applying cold oral stimuli, health professionals should be aware of that in Asian and older patients. Cultural acceptance and physiological degeneration, respectively, may influence the thirst ratings. Future research should investigate various factors underlying the perioperative period. Network meta-analysis can be used to examine multiple strategies for thirst management.
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Affiliation(s)
- Han-Yi Tsai
- School of Nursing, College of Medicine, National Taiwan University, No 1, Sec 1, Jen-Ai Rd, Taipei 10051, Taiwan; Department of Nursing, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan.
| | - Anne Chao
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei 100225, Taiwan; School of Medicine, College of Medicine, National Taiwan University, No 1, Sec 1, Jen-Ai Rd, Taipei 10051, Taiwan
| | - Wei-Ling Hsiao
- School of Nursing, College of Medicine, National Taiwan University, No 1, Sec 1, Jen-Ai Rd, Taipei 10051, Taiwan; Department of Nursing, National Taiwan University Hospital, No. 7, Zhongshan S. Rd, Zhongzheng Dist., Taipei 100225, Taiwan.
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Kameda N. A qualitative study of nurse-perceived barriers to body temperature management in postoperative patients. J Perioper Pract 2023; 33:56-61. [PMID: 35787027 DOI: 10.1177/17504589221107235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although evidence-based practices exist for preventing hypothermia in patients during surgery, few studies have focused on this concern in postoperative patients. The aim of this qualitative study was to explore the most challenging issues experienced by surgical ward nurses while managing the body temperature of adult surgical patients. To address this research gap, this study used a qualitative descriptive design to document barriers to body temperature management as reported by a sample of 16 perioperative nurses. The semi-structured, face-to-face interviews were digitally recorded, transcribed verbatim and analysed using inductive content analysis. The main barriers fell into three categories: professional nursing ability limitations, unfavourable working conditions and management of human resources. The eight subcategories were disadvantageous professional views, professional knowledge limitations, low motivation to provide nursing care, non-standard treatment environment, inadequate equipment and care protocols, heavy nursing care loads, inadequate staff training and ineffective staff supervision. These findings highlighted the importance of adequate resources, proper education and evidence-based care protocols in the effective delivery of body temperature management to postoperative patients.
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Affiliation(s)
- Norihiro Kameda
- Graduate School of Nursing Sciences, St. Luke's International University, Tokyo, Japan
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Straubhar AM, Stroup C, de Bear O, Dalton L, Rolston A, McCool K, Reynolds RK, McLean K, Siedel JH, Uppal S. Provider compliance with a tailored opioid prescribing calculator in gynecologic surgery. Gynecol Oncol 2023; 170:229-233. [PMID: 36716511 DOI: 10.1016/j.ygyno.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the impact a tailored opioid prescription calculator has on meeting individual patient opioid needs while avoiding opioid over prescriptions. METHODS Our group previously developed and published an opioid prescribing calculator incorporating patient risk factors (history of depression, anxiety, chronic opioid use, substance abuse disorder, and/or chronic pain) and type of surgery (laparotomy or laparoscopy). This calculator was implemented on 1/1/2021 and its impact on opioid prescriptions was evaluated until 12/31/21. The primary outcome of the present study is to determine prescriber compliance with the calculator (defined as not overprescribing from the number of pills indicated by the calculator). The secondary outcome is to determine the excess prescription rate (defined as proportion of patients reporting more than 3 pills remaining at 30 days post-surgery). Refill rates and pain related patient phone calls were collected. Descriptive statistics were used to summarize the cohort. RESULTS Of the 355 patients included, 54.7% (N = 194) underwent laparoscopy and 45.4% (N = 161) underwent laparotomy. One hundred and forty-two patients (40%) had at least one risk factor for opioid usage. The median number of opioid pills prescribed following laparoscopy was 3 (range 0-15) and 6 (0-20) after laparotomy. The prescriber compliance was 88.2% and the excess prescription rate was 25.1% (N = 89 patients). CONCLUSIONS Our tailored opioid calculator has a high prescriber compliance. Implementation of this calculator led to a standardization of tailored opioid prescribing, while limiting the number of over prescriptions. A free web version of the calculator can be easily accessed at www.opioidcalculator.org.
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Affiliation(s)
- Alli M Straubhar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Cynthia Stroup
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Olivia de Bear
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Liam Dalton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Aimee Rolston
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Kevin McCool
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - R Kevin Reynolds
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Karen McLean
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Jean H Siedel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Shitanshu Uppal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
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Evans J, Chan J, Saraqini DH, Mallick R. Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up? J Perioper Pract 2023; 33:76-81. [PMID: 34396824 DOI: 10.1177/17504589211031076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.
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Affiliation(s)
- Jessica Evans
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - James Chan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Ranjeeta Mallick
- The Ottawa Methods Center, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Tripyla N, Katsas K, Karagkouni K, Liosis I, Ntelis S, Linos D. Evaluation of the effect of Mozart music on pain and respiratory rate after thyroidectomy. Hormones (Athens) 2023; 22:113-119. [PMID: 36418659 DOI: 10.1007/s42000-022-00421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/08/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Pain has always been a major concern in postoperative care. The aim of this study was to assess the impact of Mozart music on postoperative pain and physiological parameters in patients who underwent total thyroidectomy. METHODS Patients scheduled for total thyroidectomy were randomly assigned to a music group or a control group. The music intervention was applied immediately after surgery, whereas the control group received only usual care. Measurements of pain perception and physiological parameters were performed before, during, and after the music intervention in the music group and at the same time points in the control group. Pain was evaluated with the visual analog scale. RESULTS In a study population of 50 patients, a higher rate of decrease in pain was observed in the music group after the first 10 min of the music intervention compared to the control group (estimate = - 1.329; 95% CI [- 2.490, - 0.169]). Music also reduced respiratory rate by 1.31 rates/min more in the music group than in the control group at every assessment point (95% CI [- 2.171, - 0.451]). Changes in the remaining physiological parameters were not statistically significant between the music and the control group and within each group. CONCLUSION This study suggests that the use of music during immediate postoperative care after thyroidectomy could accelerate pain relief and lead to a greater decline of respiratory rate compared to that achieved in usual care. TRIAL REGISTRATION NUMBER NCT04699084, 30/12/2020.
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Affiliation(s)
- Niki Tripyla
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantinos Katsas
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis Marousi, Greece
| | - Katerina Karagkouni
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Liosis
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Ntelis
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis Marousi, Greece
| | - Dimitrios Linos
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Surgical Department of Hygeia Hospital, Erithrou Stavrou 4, 15 123, Marousi, Greece
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Nag P, Chowdhury SR, Behera SK, Das M, Narayan P. Levosimendan or Milrinone for Ventricular Septal Defect Repair With Pulmonary Arterial Hypertension. J Cardiothorac Vasc Anesth 2023; 37:972-979. [PMID: 36906394 DOI: 10.1053/j.jvca.2023.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/10/2023] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Both milrinone and levosimendan have been used in patients undergoing surgical closure of ventricular septal defects (VSD) with pulmonary artery hypertension (PAH); however, the evidence base for their use is limited. In the present study, the authors sought to compare the role of levosimendan and milrinone in the prevention of low-cardiac-output syndrome in the early postoperative period. DESIGN A prospective, randomized, controlled trial. SETTING At a tertiary-care center. PARTICIPANTS Children between 1 month and 12 years presenting with VSD and PAH between 2018 and 2020. INTERVENTIONS A total of 132 patients were randomized into the following 2 groups: Group L (levosimendan group) and Group M (milrinone group). MEASUREMENTS AND MAIN RESULTS In addition to conventional hemodynamic parameters, the authors also included a myocardial performance index assessment to compare the groups. The levosimendan group had significantly lower mean arterial pressure while coming off cardiopulmonary bypass, after shifting to intensive therapy unit, as well as at 3 and 6 hours postoperatively. The duration of ventilation (29.6 ± 13.9 hours v 23.2 ± 13.3 hours; p = 0.012), as well as postoperative intensive care unit stay, were significantly prolonged in the levosimendan group (5.48 ± 1.2 v 4.7 ± 1.3 days, p = 0.003). There were 2 (1.6%) in-hospital deaths in the entire cohort, 1 in each arm. There was no difference in the myocardial performance index of the left or right ventricle. CONCLUSIONS In patients undergoing surgical repair for VSD with PAH, levosimendan does not confer any additional benefit compared to milrinone. Both milrinone and levosimendan appear to be safe in this cohort.
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Affiliation(s)
- Prachi Nag
- Department of Cardiac Anesthesia, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Saibal Roy Chowdhury
- Department of Cardiac Anesthesia, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Sukanta Kumar Behera
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Mrinalendu Das
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India.
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Murana G, Di Marco L, Pacini D. Fast-track protocols in proximal aortic repair: teamwork makes the dream work. Eur J Cardiothorac Surg 2023; 63:7031242. [PMID: 36752511 DOI: 10.1093/ejcts/ezad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Giacomo Murana
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Luca Di Marco
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
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Puccetti F, Elmore U, Rosati R. Application of ERAS protocols in esophagogastric emergency surgery: is it feasible and does it make sense? Updates Surg 2023; 75:383-387. [PMID: 36044180 DOI: 10.1007/s13304-022-01362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/13/2022] [Indexed: 01/24/2023]
Abstract
Management and treatment of esophagogastric diseases have been evolving in terms of multimodal approach and quality of care. The recent introduction of standardized perioperative protocols has represented the opportunity to homogenize the multiple factors enhancing patients' recovery after surgery worldwide. A further optimization would lead to the extension of the ERAS program to upper GI emergencies. This review provides a comprehensive collection of scientific basis, current supporting evidence, and potential applicative limitations.
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Affiliation(s)
- Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan (MI), Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan (MI), Italy.
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan (MI), Italy
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Havan M, Emekli B, Özcan S, Gün E, Botan E, Ramoğlu M, Karagözlü S, Dikmen N, Erdoğan BD, Uçar T, Eyileten Z, Tutar E, Uysalel A, Kendirli T. Evaluation of the Performance of Vasoactive Ventilation Renal Score in Predicting the Duration of Mechanical Ventilation and Intensive Care Hospitalization After Pediatric Cardiac Surgery. Pediatr Cardiol 2023; 44:161-7. [PMID: 36173454 DOI: 10.1007/s00246-022-03016-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/18/2022] [Indexed: 01/24/2023]
Abstract
Various methods have been used to evaluate the predictivity of some markers during the recovery process after cardiac surgery in children. The aim herein was to evaluate the vasoactive ventilation renal (VVR) score in predicting the clinical outcomes of children who underwent congenital cardiac surgery within the early period in the pediatric intensive care unit (PICU). Patients who underwent congenital heart surgery (CHS) between November 2016 and March 2020 were enrolled and evaluated prospectively. The VVR score was calculated as follows: vasoactive inotrope score (VIS) + ventilation index + (change in serum creatinine level based on the baseline value × 10). The relationship between the duration of mechanical ventilation and the length of stay (LOS) in the PICU was evaluated via receiver operating characteristic (ROC) curve analysis and the cut-off values were calculated. At all of the time points identified in the study, the VVR score had a higher area under the ROC curve (AUC) when compared to the VIS and serum lactate levels, and the 48-h VVR score had the highest AUC (AUC 0.851, 95% confidence interval (CI) 0.761-0.942/LOS in the PICU; AUC 0.946, 95% CI 0.885-1.000/duration of mechanical ventilation). The 48-h VVR score for the LOS in the PICU was 6.7 (sensitivity 70%, specificity 92%) and that for the duration of mechanical ventilation was 9.1 (sensitivity 87%, specificity 97%). As a result, in our study, it was found that the VVR score is a new and effective predictor of the duration of mechanical ventilation and LOS in the PICU in postoperative CHS patients.
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Zeiner S, Haider T, Zotti O, Thüringer K, Höbart P, Kimberger O, Knolle E. Intravenous diclofenac and orphenadrine for the treatment of postoperative pain after remifentanil-based anesthesia : A double-blinded, randomized, placebo-controlled study. Wien Klin Wochenschr 2023; 135:67-74. [PMID: 36576555 DOI: 10.1007/s00508-022-02131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative intravenous diclofenac reduces patient opioid demand and is commonly used in surgical units. Orphenadrine is mainly used in combination with diclofenac for musculoskeletal injuries and postoperative pain control. The objective of this study was to compare the analgesic efficacy of diclofenac-orphenadrine, diclofenac alone and saline. METHODS We performed a double-blind, randomized, placebo-controlled, parallel-group, single-center clinical study investigating the opioid-sparing effect of a combination of diclofenac and orphenadrine versus diclofenac alone versus isotonic saline solution. Initially 72 patients were included and received total intravenous anesthesia during cruciate ligament surgery. All patients were postoperatively treated with a patient-controlled analgesia (PCA) device containing hydromorphone. Pharmacological safety was assessed by laboratory parameters, vital signs, and delirium detection scores. RESULTS There was no significant difference between the groups in cumulative dose of PCA analgesics required after 24 h postsurgery, with 5.90 mg (SD ± 2.90 mg) in the placebo group, 5.73 mg (SD ± 4.75 mg) in the diclofenac group, and 4.13 mg (SD ± 2.57 mg) in the diclofenac-orphenadrine group. Furthermore, there was no significant difference between the groups in cumulative dose of PCA analgesics required 2 h postsurgery (n = 65). Mean dose of hydromorphone required after 2 h was 1.54 mg (SD ± 0.57 mg) in the placebo group, 1.56 mg (SD ± 1.19 mg) in the diclofenac-only group, and 1.37 mg (SD ± 0.78 mg) in the diclofenac-orphenadrine group. However, when comparing the diclofenac-orphenadrine group and the diclofenac group combined to placebo there was a significant reduction in PCA usage in the first 24 h postsurgery. In total, there were 25 adverse events reported, none of which were rated as severe. CONCLUSION Orphenadrine-diclofenac failed to significantly reduce postoperative opioid requirements. However, in an exploratory post hoc analysis the diclofenac-orphenadrine and the diclofenac group combined versus placebo showed a tendency to reduce opioid demand in postoperative pain control. Further research is required to determine the value of orphenadrine as an adjuvant in a multimodal approach for postoperative pain management.
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