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Aslanlar E, Aslanlar DA, Doğanay C, Önal Ö, Sargin M, Çiçekci F, Kara F, Kara İ. The validity and reliability of the Turkish version of the quality of recovery-15 (QoR-15) questionnaire. Medicine (Baltimore) 2024; 103:e37867. [PMID: 38640327 PMCID: PMC11029978 DOI: 10.1097/md.0000000000037867] [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: 11/21/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
Quality of recovery (QoR) is a significant component of peri-operative health status and is influenced by patients' characteristics and surgical and anesthetic methods. The QoR-15 scale is a patient-reported outcome questionnaire that measures postoperative QoR. The validity of the QoR-15 scale has been proven in many languages. In this study, we aimed to translate the QoR-15 questionnaire into Turkish and evaluate its validity in the Turkish population. After being translated into Turkish, the questionnaire was administered to 190 patients who underwent obstetric, gynecological, orthopedic, or thoracic surgery under general or regional anesthesia. The Turkish version of QoR-15 (QoR-15T) was administered 2 times: before surgery and 24 hour after surgery. The feasibility, reliability, validity and responsiveness of the QoR-15T were evaluated. Because 13 patients were discharged within 24 hour postoperatively, the study was completed with 177 patients. The recruitment and completion rates of questionnaire were 95% and 93.1% respectively. The completing time of the questionnaire was 2.5 minutes preoperatively and 3.5 minutes postoperatively. The scale yielded a Cronbach α value of 0.75, a Cohen effect size of 1.42, and a standardized response mean of 1.39. There was a significant positive correlation (95% confidence interval; R = 0.68, P < .001) between QoR-15T and visual analog scale postoperatively. The correlation of the items with the total QoR-15T score ranged from 0.19 to 0.60. The total scores of preoperative and postoperative QoR-15T were mean: 130.67, standard deviation: 15.78 and mean: 108.23, standard deviation: 13.06, respectively, with a significant difference between them (P < .01). The QoR-15T is feasible, reliable, valid, and responsive among patients undergoing surgery under general and regional anesthesia.
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Affiliation(s)
- Emine Aslanlar
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey
| | - Durmuş Ali Aslanlar
- Necmettin Erbakan University Faculty of Medicine, Department of Medical Pharmacology, Konya, Turkey
| | - Cennet Doğanay
- Antalya City Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Özkan Önal
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey
| | - Mehmet Sargin
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey
| | - Faruk Çiçekci
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey
| | - Fatih Kara
- Selcuk University Faculty of Medicine, Department of Public Health, Konya, Turkey
| | - İnci Kara
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey
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Dahlberg K, Jaensson M, Nilsson U, Hugelius K. The Transition Between Surgery and Ward: Patients' Experiences of Care in a Postoperative Care Unit. J Perianesth Nurs 2024; 39:288-293. [PMID: 37877910 DOI: 10.1016/j.jopan.2023.08.022] [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: 05/04/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The aim of this study was to describe adult patients' experiences of postoperative care in the postanesthesia care unit (PACU) after undergoing surgery in Sweden. DESIGN Qualitative inductive study. METHODS Individual interviews with 14 adults who had experience of being cared for in the PACU were conducted on day 14 to day 26 after surgery. The interviews were analyzed using thematic analysis. FINDINGS Early recovery in the PACU was described as a small step in the recovery process and as a time of transition from surgery to the ward. When patients perceived the PACU staff as competent, and as having a positive attitude, providing individualized care, and addressing symptoms or discomfort without being specifically alerted, patients felt safe and cared for. When they were not personally acknowledged, the patients felt abandoned in the highly technological environment. CONCLUSIONS To enhance the transition from surgery to the ward, patients need to be personally acknowledged. Their symptoms need to be properly treated by competent staff with a positive and proactive attitude. This creates safe care that supports the transition from the PACU to the ward, as well as the overall recovery process.
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Affiliation(s)
- Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Maria Jaensson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Hugelius
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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He J, Zhang Y, Jia L, Cheng X, Tian Y, Hao P, Li T, Xiao Y, Peng L, Feng Y, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Association of persistent postoperative hyperglycemia with mortality after elective craniotomy. J Neurosurg 2024; 140:1080-1090. [PMID: 38564805 DOI: 10.3171/2023.7.jns23777] [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: 04/09/2023] [Accepted: 07/24/2023] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The influence of persistent postoperative hyperglycemia after craniotomy has not yet been explored. This study aimed to investigate the hypothesis that persistent postoperative hyperglycemia is associated with mortality in patients undergoing an elective craniotomy. METHODS This study included adult patients (age ≥ 18 years) undergoing an elective craniotomy between January 2011 and March 2021 at the West China Hospital, Sichuan University. Peak daily blood glucose values measured within the first 7 days after craniotomy were collected. Persistent hyperglycemia was defined by two or more consecutive serum glucose levels of mild, moderate, or severe hyperglycemia. Normoglycemia, mild hyperglycemia, moderate hyperglycemia, and severe hyperglycemia were defined as glucose values of ≤ 6.1 mmol/L, > 6.1 and ≤ 7.8 mmol/L, > 7.8 and ≤ 10.0 mmol/L, and > 10.0 mmol/L, respectively. RESULTS This study included 14,907 patients undergoing an elective craniotomy. In the multivariable analysis, both moderate (adjusted OR 3.76, 95% CI 2.68-5.27) and severe (adjusted OR 3.82, 95% CI 2.54-5.76) persistent hyperglycemia in patients were associated with higher 30-day mortality compared with normoglycemia. However, this association was not observed in patients with mild hyperglycemia (adjusted OR 1.32, 95% CI 0.93-1.88). Interestingly, this association was observed regardless of whether patients had preoperative hyperglycemia. There was no interaction between moderate or severe hyperglycemia and preexisting diabetes (p for interaction = 0.65). When postoperative peak blood glucose values within the first 7 days after craniotomy were evaluated as a continuous variable, for each 1-mmol/L increase in blood glucose, the adjusted OR of 30-day mortality was 1.17 (95% CI 1.14-1.21). Postoperative blood glucose (area under the curve [AUC] = 0.78) was superior to preoperative blood glucose (AUC = 0.65; p < 0.001) for predicting mortality. Moderate and severe persistent hyperglycemia in patients were associated with an increased risk of deep venous thrombosis (adjusted OR 3.20, 95% CI 2.31-4.42), pneumonia (adjusted OR 2.77, 95% CI 2.40-3.21), myocardial infarction (adjusted OR 4.38, 95% CI 3.41-5.61), and prolonged hospital stays (adjusted OR 1.43, 95% CI 1.29-1.59). CONCLUSIONS In patients undergoing an elective craniotomy, moderate and severe persistent postoperative hyperglycemia were associated with an increased risk of mortality compared with normoglycemia, regardless of preoperative hyperglycemia.
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Affiliation(s)
- Jialing He
- 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yu Zhang
- 2Evidence-Based Medicine Center, Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Lu Jia
- 3Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi
| | - Xin Cheng
- 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yixin Tian
- 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Pengfei Hao
- 2Evidence-Based Medicine Center, Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Tiangui Li
- 5Department of Neurosurgery, Longquan Hospital, Chengdu, Sichuan, China
| | - Yangchun Xiao
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Liyuan Peng
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Yuning Feng
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Haidong Deng
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Peng Wang
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Weelic Chong
- 6Department of Medical Oncology, Thomas Jefferson University, Philadelphia; and
| | - Yang Hai
- 7Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lvlin Chen
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Chao You
- 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Fang Fang
- 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan
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Tang YH, Bergmann J, Vaidya D, Faraday N. Association of Preoperative Immune Checkpoint Inhibitor Therapy With Cardiopulmonary Instability and Organ Injury After High-Risk Surgery. Crit Care Explor 2024; 6:e1068. [PMID: 38562380 PMCID: PMC10984666 DOI: 10.1097/cce.0000000000001068] [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] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES To assess the relationship between prior exposure to immune checkpoint inhibitors (ICIs) and the risk of postoperative complications in cancer patients. DESIGN Single-center retrospective cohort study. INTERVENTIONS The main exposure was treatment with an FDA-approved ICI within 6 months before surgery. MEASUREMENTS AND MAIN RESULTS Exposure to ICIs and covariates was determined from the electronic health record. The primary outcome was a composite of postoperative complications, including prolonged pressor or oxygen dependence, kidney injury, or myocardial injury. Secondary outcomes included each subcomponent of the primary outcome. Of 7674 subjects with cancer admitted to the ICU after surgery, 247 were exposed to one or more ICIs in the 6 months before surgery. After propensity score matching, 197 ICI-exposed subjects were matched to 777 nonexposed. The composite outcome occurred in 70 of 197 (35.5%) ICI-exposed subjects and 251 of 777 (32.3%) nonexposed. There was no difference between exposed and nonexposed groups in the primary composite outcome (odds ratio [OR], 1.12; 95% CI, 0.80-1.58) by conditional logistic regression. Risk of the secondary outcome of prolonged pressor dependence was significantly higher in ICI-exposed subjects (OR, 1.64; 95% CI, 1.01-2.67). Risks of oxygen dependence (OR, 1.13; 95% CI, 0.75-1.73), kidney injury (OR, 1.15; 95% CI, 0.77-1.71), and myocardial injury (OR, 1.76; 95% CI, 1.00-3.10) were not significantly different. There was no difference between groups in the time to hospital discharge alive (p = 0.62). CONCLUSIONS Exposure to ICIs within 6 months before high-risk surgery was not associated with the composite outcome of cardiopulmonary instability or organ injury in patients with cancer. The potential for an association with the secondary outcomes of cardiac instability and injury is worthy of future study.
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Affiliation(s)
- Ying-Hung Tang
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jules Bergmann
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nauder Faraday
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Li MM, Miles S, Callum J, Lin Y, Karkouti K, Bartoszko J. Postoperative anemia in cardiac surgery patients: a narrative review. Can J Anaesth 2024; 71:408-421. [PMID: 38017198 DOI: 10.1007/s12630-023-02650-9] [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: 04/19/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Anemia reduces the blood's ability to carry and deliver oxygen. Following cardiac surgery, anemia is very common and affects up to 90% of patients. Nevertheless, there is a paucity of data examining the prognostic value of postoperative anemia. In this narrative review, we present findings from the relevant literature on postoperative anemia in cardiac surgery patients, focusing on the incidence, risk factors, and prognostic value of postoperative anemia. We also explore the potential utility of postoperative anemia as a therapeutic target to improve clinical outcomes. SOURCE We conducted a targeted search of MEDLINE, Embase, and the Cochrane Database of Systematic Reviews up to September 2022, using a combination of search terms including postoperative (post-operative), perioperative (peri-operative), anemia (anaemia), and cardiac surgery. PRINCIPAL FINDINGS The reported incidence of postoperative anemia varied from 29% to 94% across the studies, likely because of variations in patient inclusion criteria and classification of postoperative anemia. Nonetheless, the weight of the evidence suggests that postoperative anemia is common and is an independent risk factor for adverse postoperative outcomes such as acute kidney injury, stroke, mortality, and functional outcomes. CONCLUSIONS In cardiac surgery patients, postoperative anemia is a common and prognostically important risk factor for postoperative morbidity and mortality. Nevertheless, there is a lack of data on whether active management of postoperative anemia is feasible or effective in improving patient outcomes.
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Affiliation(s)
- Michelle M Li
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Jeannie Callum
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - Yulia Lin
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Justyna Bartoszko
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, ON, Canada.
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada.
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Erdoğrul G. Postoperative results of modified Karydakis flap method for primary sacrococcygeal pilonidal sinus disease: short and long-term analysis. ANZ J Surg 2024; 94:199-203. [PMID: 37837259 DOI: 10.1111/ans.18738] [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: 03/06/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long-term outcomes of the modified Karydakis flap method in patients with sacrococcygeal pilonidal sinus. METHODS A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon between September 2015 and February 2021. The patients' demographics, operative time, hospitalization time and complications were recorded. RESULTS Of the 175 patients, 125 (71.43%) were male and 50 (28.57%) were female, with a mean age of 24.93 ± 10.27 years. The mean operative time was 55.05 ± 12.33 min, the follow-up time was 39.21 ± 17.58 months, and the mean hospitalization time was 3.4 ± 1.65 days. Complications were observed in 12 (6.85%) patients, including seroma (5.14%) and wound infection (1.71%), with no observed cases of flap necrosis or recurrence. CONCLUSION The modified Karydakis flap method appears to be a safe and effective treatment option for sacrococcygeal pilonidal sinus, with an acceptable complication rate and no observed cases of recurrence.
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Affiliation(s)
- Güven Erdoğrul
- Department of General Surgery, Mersin City Hospital, Mersin, Turkey
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Lin H, Hajarizadeh B, Wood AJ, Selvarajah K, Ahmadi O. Postoperative Outcomes of Intracapsular Tonsillectomy With Coblation: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024; 170:347-358. [PMID: 37937711 DOI: 10.1002/ohn.573] [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: 06/05/2023] [Revised: 09/10/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE Following tonsillectomy, postoperative pain and hemorrhage from the tonsillar bed are causes of significant morbidity. Intracapsular tonsillectomy with Coblation is suggested to minimize such morbidity while remaining efficacious in long-term outcomes. This systematic review and meta-analysis assessed short-term morbidity and long-term outcomes from intracapsular tonsillectomy with Coblation, focusing primarily on posttonsillectomy hemorrhage. DATA SOURCES Medline, Embase, and the Cochrane Library. REVIEW METHODS Guided by PRISMA guidelines, studies on intracapsular tonsillectomy with Coblation published between December 2002 and July 2022 evaluating frequency of posttonsillectomy hemorrhage were screened. Studies without primary data were excluded. Meta-analysis was conducted using the random-effect model. The primary outcome was the proportion of patients who experienced posttonsillectomy hemorrhage. The secondary outcomes were posttonsillectomy pain, the proportion requiring revision tonsillectomy, and severity of sleep-disordered breathing measured by polysomnography outcomes. RESULTS From 14 studies there were 9821 patients. The proportion of total posttonsillectomy hemorrhage was 1.0% (95% confidence interval [CI] 0.5%-1.6%, n = 9821). The proportion experiencing primary hemorrhage, secondary hemorrhage, and those requiring further tonsil surgery were 0.1% (95% CI 0.0%-0.1%; study n = 7), 0.8% (95% CI 0.2%-1.4%; study n = 7), and 1.4% (95% CI 0.6%-2.2%; study n = 6), respectively. Mean reduction in apnea-hypopnea index was -16.0 events per hour (95% CI -8.8 to -23.3, study n = 3) and mean increase in oxygen nadir was 5.9% (95% CI 2.6%-9.1%, study n = 3). CONCLUSION Intracapsular tonsillectomy with Coblation has been demonstrated to have a low rate of posttonsillectomy hemorrhage. Data regarding long-term tonsil regrowth and need for reoperation were encouraging of the efficacy of this technique.
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Affiliation(s)
- Huiying Lin
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia
| | - Andrew James Wood
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Kumanan Selvarajah
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Omid Ahmadi
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand
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Suzuka T, Tanaka N, Kadoya Y, Ida M, Iwata M, Ozu N, Kawaguchi M. Comparison of Quality of Recovery between Modified Thoracoabdominal Nerves Block through Perichondrial Approach versus Oblique Subcostal Transversus Abdominis Plane Block in Patients Undergoing Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial. J Clin Med 2024; 13:712. [PMID: 38337406 PMCID: PMC10856699 DOI: 10.3390/jcm13030712] [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: 12/18/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) provides a wide analgesic range. Herein, we examined the quality of recovery (QoR) of M-TAPA for total laparoscopic hysterectomy (TLH) compared with oblique subcostal transversus abdominis plane block (OSTAPB) and measured plasma levobupivacaine concentrations (PClevo). Forty female patients undergoing TLH were randomized to each group. Nerve blocks were performed bilaterally with 25 mL of 0.25% levobupivacaine administered per side. The primary outcome was changes in QoR-15 scores on postoperative days (POD) 1 and 2 from the preoperative baseline. The main secondary outcomes were PClevo at 15, 30, 45, 60, and 120 min after performing nerve block. Group differences (M-TAPA-OSTAPB) in mean changes from baseline in QoR-15 scores on POD 1 and 2 were -11.3 (95% confidence interval (CI), -24.9 to 2.4, p = 0.104; standard deviation (SD), 22.8) and -7.0 (95% CI, -20.5 to 6.6, p = 0.307; SD, 18.7), respectively. Changes in PClevo were similar in both groups. The post hoc analysis using Bayesian statistics revealed that posterior probabilities of M-TAPA being clinically more effective than OSTAPB were up to 22.4 and 24.4% for POD 1 and 2, respectively. In conclusion, M-TAPA may not be superior to OSTAPB for TLH.
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Affiliation(s)
- Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Yuma Kadoya
- Department of Anesthesiology, Ikeda City Hospital, 3-1-18 Jonan, Ikeda 635-8501, Osaka, Japan;
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
| | - Masato Iwata
- Department of Anesthesiology, Yamatotakada Municipal Hospital, 1-1, Isonokita-cho, Yamatotakada 635-8501, Nara, Japan;
| | - Naoki Ozu
- Institute for Clinical and Translational Science, Nara Medical University Hospital, 840 Shijocho, Kashihara 634-8522, Nara, Japan;
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (T.S.); (M.I.); (M.K.)
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Melnikova EA, Starkova EY, Semenkov AV, Litau VY, Tulskih DA. [Pre-rehabilitation of oncological patients before extensive abdominal and thoracic surgery: a literature review]. Vopr Kurortol Fizioter Lech Fiz Kult 2024; 101:46-56. [PMID: 38639151 DOI: 10.17116/kurort202410102146] [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] [Indexed: 04/20/2024]
Abstract
Surgery is one of the leading treatment methods of patients with primary or recurrent malignant neoplasms in the thoracic or abdominal cavity. Extensive abdominal interventions are accompanied by such adverse outcomes as blood loss, hypoxia, inflammation, blood clotting abnormality, emotional and cognitive disorders, that increases the incidence of serious complications and worsens the treatment outcome and life quality in weakened oncological patients. Multimodal pre-rehabilitation before surgery can significantly decrease the incidence and severity of postoperative complications. The rehabilitation complex includes exercise therapy, nutritional and psychological support, smoking cessation and pharmacotherapy. Currently, there are a number of questions facing rehabilitation specialists and oncologists, that are related to the determination of pre-rehabilitation optimal timing and process duration, the choice of specific physical exercises, determining the load intensity. This review presents a current view on understanding of surgical stress in extensive abdominal interventions, its effect on the oncological process course, summarizes the experience of last years in choosing pre-rehabilitation program taking into account pathogenetic mechanisms of surgical stress and individual patient's characteristics. Special attention is paid to the comparison of physical exercises' various types, their action mechanisms at different stages of pathological process, the issues of load dosing during pre-rehabilitation activities.
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Affiliation(s)
- E A Melnikova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - E Yu Starkova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A V Semenkov
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V Yu Litau
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - D A Tulskih
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
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Sobodu O, Nash CM, Stairs J. Subcuticular Suture Type at Cesarean Delivery and Infection Risk: A Systematic Review and Meta-Analysis. Journal of Obstetrics and Gynaecology Canada 2024; 46:102191. [PMID: 37595945 DOI: 10.1016/j.jogc.2023.07.010] [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: 02/25/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Surgical site infections (SSI) are common causes of postoperative morbidity at cesarean delivery (CD). The objective of this study was to compare the risk of SSI and other wound complications associated with different suture materials for subcuticular skin closure at CD. DATA SOURCES We searched Cochrane Library, MEDLINE, Embase, and Clinicaltrials.gov from inception to June 3, 2021, and limited our search to English, peer-reviewed, randomized controlled trials and cohort studies. STUDY SELECTION Of 1541 titles identified, 4 studies met the selection criteria and were included. Studies were included if the population was pregnant individuals undergoing transverse incision primary or repeat, elective or emergent CD with subcuticular skin closure, and if outcomes related to SSI, wound seroma, hematoma, or dehiscence were reported. We completed the assessment using Covidence review management software. DATA EXTRACTION AND SYNTHESIS Two authors independently reviewed studies and assessed the risk of bias using the Cochrane 'Risk of bias' tool for randomized trials (RoB 2.0) and the Cochrane Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tools for cohort studies. We compared SSI risk and secondary outcomes of hematoma, seroma, and dehiscence between skin closure with monofilament (poliglecaprone 25 or polypropylene) versus multifilament (polyglactin 910) sutures using a fixed-effects meta-analysis. Statistical heterogeneity was estimated using the I2 statistic. Monofilament sutures were associated with a reduced risk of SSI (RR = 0.71, 95% CI 0.52-0.98, I2 = 0%) compared to multifilament sutures. There was no difference in the risk of secondary outcomes. CONCLUSION Monofilament suture for subcuticular skin closure at CD was associated with decreased risk of SSI compared to multifilament suture.
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Affiliation(s)
| | - Christopher M Nash
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS
| | - Jocelyn Stairs
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS.
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Li J, Liu J, Zhang M, Wang J, Liu M, Yu D, Rong J. Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case-control study. Brain Behav 2024; 14:e3379. [PMID: 38376027 PMCID: PMC10772846 DOI: 10.1002/brb3.3379] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is an acute neurological complication in the elderly undergoing thoracic surgery and can result in serious adverse consequences. AIMS This study aimed to identify the related risk factors for POD following thoracic surgery, primarily focusing on preoperative serum biomarkers, and further to establish a novel delirium index to better predict POD. METHODS A total of 279 patients aged ≥60 years who underwent elective thoracic surgery from August 2021 to August 2022 were enrolled in this observational study. The platelet-to-white blood cell ratio (PWR) was calculated as number the of platelets divided by the number of white blood cells. POD was defined by the confusion assessment method twice daily during the postoperative first 3 days. Multivariate regression analysis was performed to identify all potential variables for POD. Moreover, a novel thoracic delirium index (TDI) was developed based on the related risk factors. The accuracy of TDI and its component factors in predicting POD was determined by the curve of receiver operating characteristic (ROC). RESULTS In total, 25 of 279 patients developed POD (8.96%). Age, PWR, and average pain scores within the first 3 days after surgery were regarded as the independent risk factors for POD. Moreover, the ROC analysis showed the TDI, including age, PWR, and average pain scores within the first 3 days after surgery, can more accurately predict POD with the largest area under the curve of 0.790 and the optimal cutoff value of 9.072, respectively. CONCLUSION The TDI can scientifically and effectively predict POD to provide optimal clinical guidance for older patients after thoracic surgery.
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Affiliation(s)
- Jianli Li
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Jing Liu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
- Graduate FacultyHebei North UniversityZhangjiakou CityChina
| | - Mingming Zhang
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Jing Wang
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Meinv Liu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Dongdong Yu
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
| | - Junfang Rong
- Department of AnesthesiologyHebei General HospitalShijiazhuang CityChina
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Shockey W, Wiegel JJ, Parajuli S, Garg N, Swanson KJ, Mandelbrot DA. Potassium-lowering effects of sodium zirconium cyclosilicate in the early post-transplant period. Clin Transplant 2024; 38:e15156. [PMID: 37812572 DOI: 10.1111/ctr.15156] [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: 07/20/2023] [Revised: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
PROBLEM Hyperkalemia is a serious condition among intra-abdominal transplant recipients, and the safety and efficacy of sodium zirconium cyclosilicate (SZC) for its management during the early post-transplant period are not well-established. METHODS Adults who received at least one 10-g dose of SZC within 14 days after an intra-abdominal transplant between January 2020 and July 2022 were included in our study. The primary outcome was the change in potassium (K+) levels following the first SZC dose. Other analyses explored adjunctive potassium-lowering therapies, potential gastrointestinal complications, and patient subgroups based on therapy and transplant type. RESULTS Among the recipients (n = 46), 11 were kidney recipients, 26 were liver recipients, seven were simultaneous liver/kidney recipients, and two were simultaneous pancreas/kidney recipients. The mean time to first dose post-transplant was 7.6 (±4) days, and the mean change in serum K+ after the initial SZC dose was -.27 mEq (p = .001). No gastrointestinal complications were observed following the SZC dose. The mean increase in serum bicarbonate was .58 mEq (p = .41) following the first dose of SZC. Four kidney recipients required dialysis following the SZC dose. CONCLUSION This study represents the largest investigation on the use of SZC in transplant recipients. A single 10-g dose of SZC reduced serum K+ levels in all subgroups, while the use of adjunctive K+-lowering therapies did not provide additional reduction beyond the effects of SZC. Importantly, no gastrointestinal complications were observed. These findings suggest that SZC may be a safe and promising therapeutic option for hyperkalemia management following solid organ transplantation.
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Affiliation(s)
- William Shockey
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Joshua J Wiegel
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Neetika Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kurtis J Swanson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier A Mandelbrot
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Jeleff A, Suh N, Schranc Á, Diaper J, Bendjelid K, Schiffer E. New Noninvasive Method for the Assessment of Central Venous Oxygen Saturations in Critically Ill Patients. J Cardiothorac Vasc Anesth 2024; 38:170-174. [PMID: 37827917 DOI: 10.1053/j.jvca.2023.09.020] [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: 06/27/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To compare noninvasive external jugular vein oxygen saturations (SjvO2) and central venous oxygen saturation (ScvO2) from a blood sample in patients admitted to the intensive care unit. DESIGN A prospective, comparative, monocentric clinical trial design was used. SETTING The study was performed in the Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva (Switzerland). PARTICIPANTS A total of 79 patients were enrolled; patients with confirmed COVID-19 infection requiring invasive mechanical ventilation (patients with COVID-19, n = 36) and patients after liver transplantation (posttransplant patients, n = 43). INTERVENTIONS Simultaneous measurement of SjvO2 by near-infrared spectroscopy and ScvO2 from central venous blood samples using a blood gas analyzer in stable hemodynamic conditions. MEASUREMENTS AND MAIN RESULTS A strong linear correlation was evidenced in both the COVID-19 and posttransplant patient groups between the 2 modalities. The Bland-Altman analysis showed low bias in accordance with low percentage error in both groups (0.57% and 8.09% for patients with COVID-19; 0.00% and 13.72% for posttransplant patients). CONCLUSIONS Central venous oxygen saturation can be estimated reasonably by the continuous noninvasive measurement of SjvO2 using near-infrared spectroscopy.
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Affiliation(s)
- Alexandre Jeleff
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Noémie Suh
- Division of Intensive Care, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Álmos Schranc
- Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland.
| | - John Diaper
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland; Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University of Geneva, Geneva, Switzerland
| | - Karim Bendjelid
- Division of Intensive Care, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Eduardo Schiffer
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Cappuccio S, Marchetti C, Altıntaş DA, Oliva R, Russo SA, Costantini B, Giannarelli D, Quagliozzi L, Scambia G, Fagotti A. Low-grade versus high-grade serous ovarian cancer: comparison of surgical outcomes after secondary cytoreductive surgery. Int J Gynecol Cancer 2023:ijgc-2023-004854. [PMID: 38135438 DOI: 10.1136/ijgc-2023-004854] [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: 12/24/2023] Open
Abstract
OBJECTIVE Retrospective series have shown secondary cytoreductive surgery improves oncological outcomes in recurrent low-grade serous ovarian cancer. We aim to compare surgical procedures and complications between patients with low-grade and high-grade recurrent serous ovarian cancer. METHODS This retrospective single-institution study includes patients with recurrent low-grade and high-grade serous ovarian cancer undergoing surgery between January 2012 to December 2021. Patients were propensity matched 1:3 for residual tumor at first surgery, presence of ascites and performance status. Complexity of surgery and postoperative complications were analyzed. RESULTS A total of 116 patients undergoing secondary cytoreductive surgery were included with 29 patients (25%) having low-grade ovarian cancer. The median age of the patients was 54 years (range: 19-85) and 57 years (range: 29-78) in low-grade and high-grade ovarian cancer, respectively (p=0.13). Stages III/IV at diagnosis were more frequent in patients with high-grade ovarian cancers (p<0.001). Peritoneal involvement was higher in low-grade compared with high-grade ovarian cancer as shown by the higher rate of diaphragmatic (41.4% vs 21.8%, p=0.05), abdominal wall (41.4% vs 18.4%, p=0.02) and pelvic (51.7% vs 21.8%, p=0.01) peritonectomy. Multiple bowel resections were higher in low-grade ovarian cancer (24.1% vs 8.0%, p=0.04), while high-grade ovarian cancer had a higher rate of nodal recurrences (73.2%% vs 37.9%, p=0.03). Overall, surgical complexity was higher in low-grade ovarian cancer (58.6% vs 36.8%; p=0.05), with higher median estimated blood loss (400 vs 200 mL; p=0.01) compared with high-grade. Complete cytoreduction was achieved in 26 patients (89.7%) with low-grade and 84 (96.6%) with high-grade (p=0.16) ovarian cancer, with no significant differences in postoperative complications. CONCLUSIONS Secondary cytoreductive surgery in low-grade serous ovarian cancer patients was associated with higher complexity, multiple bowel resections, and higher median estimated blood loss than in high-grade serous ovarian cancer. The comparable rate of postoperative complications suggests that secondary cytoreductive surgery in this group of patients is feasible in expert centers.
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Affiliation(s)
- Serena Cappuccio
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Claudia Marchetti
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Barbara Costantini
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- UniCamillus, Rome, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics Facility, G-STeP Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorena Quagliozzi
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Department of Women, Child and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Blagova B, Krastev D, Malinova L. Conventional drilling versus ultrasound and laser osteotomy in mandibular third molar surgery: A comparative study. Lasers Surg Med 2023; 55:862-870. [PMID: 37811576 DOI: 10.1002/lsm.23730] [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: 05/30/2023] [Revised: 08/13/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND There are few research works with in-depth studies and direct simultaneous comparisons of the effects on tissue reactions and patients' recovery following in vivo conventional drilling, ultrasound- and laser-assisted osteotomy in humans. OBJECTIVE The current study aims to compare bone cutting duration, pain, swelling, and trismus in patients following surgical mandible third molar extraction by bone removal using three different osteotomes-a conventional rotary device, an ultrasonic unit, and an Er:YAG laser. METHODS A prospective, randomized three-group comparative clinical trial was performed. As an experimental setting for the study, аn open mandible third molar surgery was chosen because osteotomy is included in its protocol. Patients were divided into three groups according to the used device for bone removal. Bone cutting time intraoperatively, facial swelling, trismus, and pain on the first, second, and third postoperative days were assessed. The statistical analyses were performed using the SPSS v. 17.0-Kolmogorov-Smirnov test, one-way ANOVA, Student's t-test, Mann-Whitney test, and χ2 test. Statistical results were considered significant at p < 0.05 (confidence interval of difference, 95% CI). RESULTS Eighty patients (34 males and 46 females with an average age of 25.18 years) were included in the study. The average time for bone removal by the conventional low-speed device (4.95 min), by the ultrasonic unit (5.13 min), and by the Er:YAG laser (9.00 min) differed significantly (p = 0.001). The mean postoperative facial swelling showed a marked difference between the groups (p < 0.05), in favor of the laser and piezo groups. The osteotome proved to influence pain intensity not only immediately after surgery (p = 0.002), but also during the followed-up period (p = 0.001), again in favor of the two above-mentioned groups. No association was found between trismus and the osteotome used by the followed-up patients (p > 0.05). CONCLUSION Bone-cutting mechanism and the biological influence of the laser beam and ultrasound on living tissues proved to be favorable factors for patients' pain levels and tissue swelling postoperatively independent of the longer osteotomy duration compared to conventional drilling.
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Affiliation(s)
- Bistra Blagova
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, Bulgaria
| | - Dimo Krastev
- Medical College "Jordanka Filaretova", Medical University of Sofia, Sofia, Bulgaria
- Faculty of Public Health, Health Care and Sport, South-West University "Neofit Rilski", Blagoevgrad, Bulgaria
| | - Lina Malinova
- Department of Anatomy, Histology, and Embryology, Medical University of Sofia, Sofia, Bulgaria
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Echeverri-Mallarino V, Rodríguez Romero VA. Validation and cross-cultural adaptation of the quality of Recovery-15 questionnaire in a Spanish-speaking population in Colombia. BJA Open 2023; 8:100231. [PMID: 37869056 PMCID: PMC10589383 DOI: 10.1016/j.bjao.2023.100231] [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: 07/12/2023] [Revised: 09/05/2023] [Accepted: 09/16/2023] [Indexed: 10/24/2023]
Abstract
Background The quality of recovery is an important component in the evaluation of perioperative care. To measure this, the Quality of Recovery-15 (QoR-15) scale has been validated previously. The aim of this study was to culturally, linguistically, and psychometrically adapt this scale to the Colombian Spanish language. Methods After linguistic adaptation, a validation study of the psychometric properties was carried out. These included validity, reliability, and responsiveness. The scale was administered after the administration of general anaesthesia. Validity was determined by correlating with the general recovery VAS, surgical risk, surgical duration, and length of hospital stay. Structural validity was assessed using factor analysis. Test-retest and internal consistency were used to measure reliability. Results Interviews were conducted with 161 adults. A positive correlation was found between the Spanish version of the QoR-15 scale (QoR-15C) and VAS scores (r=0.51), and a negative correlation between the QoR-15C score and the duration of surgery (r=-0.47) and hospital stay (r=-0.62). The reliability of the scale was adequate. Cronbach's alpha was 0.74, and Lin's correlation concordance coefficient was 0.99. Confirmatory factor analysis indicated that the scale in the Colombian Spanish version does not have a single domain, whilst exploratory factor analysis indicated that the scale may measure an additional factor. Conclusions The QoR-15C scale for assessing the quality of recovery after general anaesthesia showed psychometric properties comparable with those of the English scale. This allows the scale to be considered for use in research and clinical practice.
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Wei C, Zhang X, Dong M, Lei B, Zhao J, Xi X, Zhao S, Zhou B. Risk Factors for Postoperative Knee Stiffness in Patients with Anteromedial Knee Osteoarthritis Undergoing Unicompartmental Knee Arthroplasty with Cemented Prostheses: A Short-Term, Retrospective, Case-Control Study. Med Sci Monit 2023; 29:e942440. [PMID: 38006202 PMCID: PMC10685645 DOI: 10.12659/msm.942440] [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: 09/05/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The present study was performed to determine the potential risk factors for postoperative knee stiffness in patients with anteromedial knee osteoarthritis undergoing unicompartmental knee arthroplasty with cemented prostheses. MATERIAL AND METHODS This retrospective cohort study evaluated patients with anteromedial knee osteoarthritis who underwent medial unicompartmental knee arthroplasty at our hospital between May 2017 and May 2020. The patients were divided into 2 groups according to their prognosis: those who experienced knee stiffness after undergoing unicompartmental knee arthroplasty and those who did not. The factors associated with stiffness after UKA were identified using univariate analysis. Frequencies are used to express categorical variables, while mean±SD is used to express continuous variables. The t test and chi-square test were used. A multivariate logistic regression model was built to identify the risk factors for postoperative stiffness. RESULTS We included 590 knees in the study after unicompartmental knee arthroplasty. The overall incidence of postoperative stiffness in unicompartmental knee arthroplasty surgery was 10.17%. In terms of the radiological measurements, varus deformity (70.34% vs 29.66%) and tibial component posterior slope angle (4.8±2.0 vs 4.6±2.0, P<0.001) were significantly differences between the 2 groups. Four independent risk factors for stiffness after unicompartmental knee arthroplasty were identified: age (95% CI, 1.022-1.048), varus deformity (95% CI, 1.186-1.192), tibial component posterior slope angle (95% CI, 0.550-0.870), and preoperative maximum flexion (95% CI, 0.896-0.923). CONCLUSIONS The overall incidence of postoperative knee stiffness in patients with anteromedial knee osteoarthritis undergoing unicompartmental knee arthroplasty with cemented prostheses was 10.17%, which was at a moderate level compared to patients with other diseases undergoing unicompartmental knee arthroplasty. Four independent risk factors were identified: age, varus deformity, preoperative maximum flexion, and tibial component posterior slope angle. Awareness these risk factors might help surgeons prevent the occurrence of postoperative knee stiffness in patients with UKA.
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Affiliation(s)
- Congcong Wei
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Xihan Zhang
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Mingming Dong
- Department of Geriatrics, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Boyi Lei
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Jiangbo Zhao
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Xiangdong Xi
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Shuai Zhao
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Baigang Zhou
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
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Bromfalk Å, Hultin M, Myrberg T, Engström Å, Walldén J. Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine. Paediatr Anaesth 2023; 33:962-972. [PMID: 37528645 DOI: 10.1111/pan.14740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/15/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2-6 years. METHODS In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured. RESULTS After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups. CONCLUSIONS No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2 -agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.
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Affiliation(s)
- Åsa Bromfalk
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden
| | - Åsa Engström
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Lulea University of Technology, Luleå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Umeå, Sweden
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Leal NTB, de Araújo NM, Silva SDO, Cabral MAL, da Silva BVS, Pinheiro TBM, Dantas RAN, Dantas DV. Pain management in the postoperative period of amputation surgeries: A scoping review. J Clin Nurs 2023; 32:7718-7729. [PMID: 37605033 DOI: 10.1111/jocn.16846] [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: 09/22/2022] [Revised: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Pain in the postoperative period of amputation surgeries, when not managed correctly, can have consequences for the patient. PURPOSES AND OBJECTIVES The aim of this study was to map the scientific evidence on pain management in patients in the postoperative period of amputation surgeries. DESIGN Scoping review with elaboration based on the recommendations of the Joanna Briggs Institute, supported by The PAGER framework and guided by the PRISMA-ScR Checklist. METHODS The survey was conducted in August 2022 in 10 data sources. The 3300 publications found were analysed by two independent reviewers, after applying inclusion and exclusion criteria, 16 studies were selected. RESULTS Publications occurred between the years 1997 and 2022 and mainly dealt with the management of residual pain and phantom limb through pharmacological measures with pain assessment made by numerical scales. CONCLUSIONS The literature pointed out strategic uses of analgesics and highlighted technologies for neurostimulation through catheters. The need for new studies with non-pharmacological measures and with designs that can prove their effectiveness is reinforced. RELEVANCE TO CLINICAL PRACTICE The knowledge of these strategies by health professionals allows adequate pain management and patient follow-up for a less traumatic recovery. PATIENT OR PUBLIC CONTRIBUTION To patient or public involvement in this scoping review.
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Zhang L, Tang X, You G, Chen X, Yang S, Shi H, Wang G. Comparative Evaluation of Metallic and Biodegradable Suture Anchors in Arthroscopic Repair of Anterior Talofibular Ligament Injury: A Short-term Study on Clinical and Functional Outcomes. Med Sci Monit 2023; 29:e939830. [PMID: 37867316 PMCID: PMC10605517 DOI: 10.12659/msm.939830] [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: 02/13/2023] [Accepted: 04/04/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND With the development of arthroscopy and suture anchor, the modified Brostrӧm technique has made remarkable progress. However, it is unclear which material is most suitable for treating anterior talofibular ligament injury (ATFL). This study evaluated the short-term efficacy of 2 suture anchors (metal vs biodegradable materials) in arthroscopic ATFL repair. MATERIAL AND METHODS From January 2018 to December 2019, 82 patients with ankle disorders (51 men and 31 women) with ATFL injury received arthroscopic repair with suture anchor through the Brostrӧm-Gould procedure. The mean age was 38.70±9.35 years (range, 18-54 years). Each patient was followed up. American Orthopedic Foot and Ankle Society score (AOFAS), Karlsson Ankle Functional Score (KAFS), and the Visual Analogue Scale (VAS) were used to evaluate functional status and pain. RESULTS All patients were followed up for 21.21±2.19 months (range, 18-25 months). No complications were found either group. Preoperative clinical and functional scores in both groups had no significant difference (P>0.05). The functional score increased significantly in both groups (P<0.001). At the last follow-up, the mean AOFAS score was 93.00 (90.00, 96.00) in the Biodegradable group and 93.50 (91.00, 96.00) in the Metallic group (P=0.31). The mean KAFS score was 91.50 (85.00, 95.00) in the Biodegradable group and 93.00 (90.00, 95.50) in the Metallic group (P=0.10); the mean VAS score was 1.50 (1.00, 1.80) in the Biodegradable group and 1.30 (0.98, 1.70) in the Metallic group (P=0.22). CONCLUSIONS Arthroscopic repair of ATFL injury with suture anchors can improve the prognosis of CAI. There were no statistically significant differences in clinical and functional outcomes with metal or biodegradable suture anchors at short-term follow-up.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, PR
China
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, PR
China
| | - Xiaogao Tang
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, Sichuan, PR
China
| | - Guixuan You
- School of Physical Education, Southwest Medical University, Luzhou, Sichuan, PR
China
| | - Xueyi Chen
- School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, PR
China
| | - Siyi Yang
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, Sichuan, PR
China
| | - Houyin Shi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, PR
China
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, PR
China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, PR
China
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Kumar R, Mohammed S, Paliwal B, Kamal M, Chhabra S, Bhatia P, Syal R. The midpoint transverse process to pleura (MTP) block for postoperative analgesia in patients undergoing modified radical mastectomy: A case series. J Anaesthesiol Clin Pharmacol 2023; 39:648-650. [PMID: 38269175 PMCID: PMC10805222 DOI: 10.4103/joacp.joacp_147_22] [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: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/26/2024] Open
Abstract
Among the various regional anesthesia techniques used for postoperative analgesia in the modified radical mastectomy (MRM), thoracic paravertebral block (TPVB) is presently considered the technique of choice. Nevertheless, TPVB may lead to complications like inadvertent vascular puncture, hypotension, epidural or intrathecal spread, pleural puncture, or pneumothorax. Recently, a newer technique "midpoint transverse process to pleura" (MTP) block has been described in which the tip of the needle is placed at the midpoint between the transverse process and pleura. In this case series, we included ten patients of American Society of Anesthesiologist status I/II scheduled for MRM. Ultrasound-guided MTP block was performed and the catheter was inserted on the side of the surgery at the level of T4 level. The block was successful in the all patients as their median visual analogue score at rest and movement was 2 and 3, respectively, in first 24 h postoperatively. Only three patients required rescue analgesia in the first 24 h. No procedural-related complications were noticed in any patient. We concluded that MTP block provided effective perioperative analgesia with minimal rescue analgesia requirement and satisfactory safety profile.
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Affiliation(s)
- Rakesh Kumar
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sadik Mohammed
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharat Paliwal
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Swati Chhabra
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rashmi Syal
- Department of Anesthesiology and Critical Care, Dr S.N. Medical College, Jodhpur, Rajasthan, India
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22
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Wasniewski ABR, Ricachinevsky CP, Rezende RQ, Lorentz BT, Silveira EDS, Angeli VHR, de Oliveira MG, da Silveira TR. Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1. Crit Care Sci 2023; 35:377-385. [PMID: 38265319 PMCID: PMC10802767 DOI: 10.5935/2965-2774.20230215-en] [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: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events. METHODS This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical. RESULTS A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79). CONCLUSION Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.
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Affiliation(s)
- Ana Beatriz Ramos Wasniewski
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
| | - Claudia Pires Ricachinevsky
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
| | - Raíssa Queiroz Rezende
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
| | - Bruna Tomasi Lorentz
- Instituto do Coração, Hospital de Clínicas,
Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP),
Brazil
| | | | - Viviane Helena Rampon Angeli
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
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23
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Govorov AV, Sarukhanian AL. [Use of tamsulosin for a prevention of acute urinary retention in the perioperative period in patients undergoing to surgical procedures]. Urologiia 2023:129-135. [PMID: 37850293] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The perioperative management of patients involves multiple aspects. Acute urinary retention (AUR) is one of the possible postoperative complications. Alpha-adrenoblockers are commonly used for treatment and prevention of AUR. Tamsulosin is the most often prescribed drug; there are a lot of studies devoted to its use in different patient subgroups. The aim of our study was to evaluate the efficiency of perioperative use of tamsulosin for the prevention of postoperative AUR. A literature review from January 2013 to June 2023 in Scopus and PubMed databases was carried out. According to the results, tamsulosin results in a significant reduction in the risk of postoperative AUR. A personalized approach allows to overcome difficulties in the perioperative management of patients and significantly improve their quality of life/satisfaction from treatment.
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Affiliation(s)
- A V Govorov
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- Municipal clinical hospital named after S.I. Spasokukotskiy of the Moscow Healthcare Department, Moscow, Russia
| | - A L Sarukhanian
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia
- Municipal clinical hospital named after S.I. Spasokukotskiy of the Moscow Healthcare Department, Moscow, Russia
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24
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Alfattani N, Alqurashi AS, Kabli AF, Haji A, Alharthi BT, Mandili AK. The Rate and Predictors of Allergic Fungal Rhinosinusitis Recurrence Post-sinus Surgery: A Retrospective Cohort Study. Cureus 2023; 15:e43398. [PMID: 37706147 PMCID: PMC10495771 DOI: 10.7759/cureus.43398] [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] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
Objectives Chronic rhinosinusitis (CRS) is the persistent inflammation of the mucosal lining of the paranasal sinuses (PNS). By definition, the inflammatory process persists beyond 12 weeks. One of its subtypes is allergic fungal rhinosinusitis (AFRS), which has a high risk of recurrence, leading to revision surgery. This study aimed to establish the predictive factors for the recurrence of AFRS in post-sinus surgery patients. Methods This single-center retrospective study was conducted in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The charts of patients with AFRS who underwent surgery in our rhinology clinic between 2000 and 2020 were reviewed. Results Among the 116 patients included in this study, approximately half (53%) were female, with a median age of 24.5 years. Thirty-nine (33.6%) patients had recurrence post-sinus surgery, with 33.3% occurring within six months of follow-up. The results showed that patients with coexisting bronchial asthma were three times more likely to experience recurrence (adjusted odds ratio {AOR}, 3.43; confidence interval {CI}, 1.35-8.71), patients with uncorrected deviated nasal septum (DNS) were three times more likely to experience symptoms again following surgery (AOR, 3.70; CI, 1.14-12.02), and patients who presented with concomitant sinus headaches are 66% less likely to experience recurrence (AOR, 0.34; CI, 0.13-0.86). Conclusion The results showed that 33.62% of patients experienced recurrence following surgery. Bronchial asthma and DNS were strongly associated with recurrence; however, their presence does not always imply the need for additional surgery.
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Affiliation(s)
- Naif Alfattani
- Otolaryngology-Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah, SAU
| | | | | | - Aseel Haji
- Medicine, Umm Al-Qura University, Makkah, SAU
| | - Bassam T Alharthi
- Otolaryngology-Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
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25
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Heard JC, D’Antonio ND, Lambrechts MJ, Boere P, Issa TZ, Lee YA, Canseco JA, Kaye ID, Woods BR, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Does physical therapy impact clinical outcomes after lumbar decompression surgery? J Craniovertebr Junction Spine 2023; 14:230-235. [PMID: 37860023 PMCID: PMC10583794 DOI: 10.4103/jcvjs.jcvjs_61_23] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 10/21/2023] Open
Abstract
Objectives The objectives of our study were to (1) determine if physical therapy (PT) impacts patient-reported outcomes (PROMs) after lumbar decompression surgery and (2) determine if PT impacts postsurgical readmissions or reoperations after lumbar decompression surgery. Methods Patients >18 years of age who underwent primary one- or two-level lumbar decompression at our institution were identified. Patient demographics, surgical characteristics, surgical outcomes (all-cause 90 days readmissions and 90 days surgical readmissions), and patient-reported outcomes (PROMs) were compared between the groups. Multivariate linear regression was utilized to determine the individual predictors of 90 days readmissions and PROMs at the 1-year postoperative point. Alpha was set at P < 0.05. Results Of the 1003 patients included, 421 attended PT postoperatively. On univariate analysis, PT attendance did not significantly impact 90-day surgical reoperations (P = 0.225). Although bivariate analysis suggests that attendance of PT is associated with worse improvement in physical function (P = 0.041), increased preoperative Visual Analogue Scale leg pain (0 = 0.004), and disability (P = 0.006), as measured by the Oswestry Disability Index, our multivariate analysis, which accounts for confounding variables found there was no difference in PROM improvement and PT was not an independent predictor of 90-day all-cause readmissions (P = 0.06). Instead, Charlson Comorbidity Index (P = 0.025) and discharge to a skilled nursing facility (P = 0.013) independently predicted greater 90-day all-cause readmissions. Conclusions Postoperative lumbar decompression PT attendance does not significantly affect clinical improvement, as measured by PROMs or surgical outcomes including all-cause 90 days readmissions and 90-day surgical readmissions.
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Affiliation(s)
- Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicholas D. D’Antonio
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA
| | - Payton Boere
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tariq Z. Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yunsoo A. Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barrett R. Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
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26
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Massoudi N, Mohit B, Fathi M, Nooraei N, Hannani KK, ArianNik M. The impact of rivastigmine on post-surgical delirium and cognitive impairment; a randomized clinical trial. Int J Geriatr Psychiatry 2023; 38:e5970. [PMID: 37485727 DOI: 10.1002/gps.5970] [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: 09/12/2022] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Delirium is an acute and transient disorder of brain function that often occurs in post-surgical patients. Rivastigmine is a cholinesterase inhibitor drug that has been proposed as an adjuvant drug in recent years, still, despite significant theoretical evidence, few clinical studies have been performed on its impact on delirium. AIM Due to the widespread use of cholinesterase inhibitors in pediatric and adult surgery, the present study aims to investigate the impact of Rivastigmine as a cholinesterase inhibitor on delirium after radical surgery. METHODS In this randomized double-blind clinical trial, a hundred recruited patients were randomly assigned to either Rivastigmine (n = 50) or placebo (n = 50) groups, and we measured post-operative impact on delirium, by Confusion Assessment Method (CAM) score, and cognitive impairment, by the Mini-Mental State Examination (MMSE). Our univariate and multivariate logistical regression models assessed this hypothesized impact. RESULTS Treatment with Rivastigmine was significantly associated with reduced day one post-op delirium, as measured by CAM score (Odds Ratio (OR) = 0.35, 95% Confidence Interval (CI) 0.11 to 0.97, p = 0.05), and cognitive impairment, as measured by MMSE (OR = 0.25, 95% CI 0.1 to 0.59, p = 0.0022). These associations became stronger after controlling for age, blood loss, and post-op blood sodium levels: Delirium (OR = 0.23, 95% CI 0.05 to 0.92, p = 0.05), cognitive impairment (OR = 0.12, 95% CI 0.03 to 0.42, p = 0.000178). CONCLUSION The significant result of our randomized clinical trial is that pre-op Rivastigmine treatment may be associated with a substantial drop in patients experiencing post-op delirium and post-op cognitive impairment.
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Affiliation(s)
- Nilofar Massoudi
- Department of Anesthesiology, Clinical Research Development Center, Imam Hossein Educational Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Mohit
- Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Mohammad Fathi
- Department of Anesthesiology, Critical Care Quality Improvement Research Center at Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Nooraei
- Department of Anesthesiology, Critical Care Quality Improvement Research Center at Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kia Kazemzadeh Hannani
- Department of Anesthesiology, Anesthesiology Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen ArianNik
- Department of Anesthesiology, Anesthesiology Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kim TW, Kim SH. Effectiveness of patient education on total knee arthroplasty: A systematic review and meta-analysis. J Clin Nurs 2023; 32:2383-2398. [PMID: 35429079 DOI: 10.1111/jocn.16324] [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: 11/26/2021] [Revised: 02/06/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study was designed to examine the contents and methods of patient educational interventions about total knee arthroplasty (TKA) and their effectiveness in reducing postoperative pain and enhancing range of motion (ROM) in the literature. BACKGROUND Patient education has been provided to facilitate recovery after TKA; however, little is known about the contents and methods of the interventions and their effectiveness in reducing postoperative pain and enhancing ROM. DESIGN This is a systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS Published studies from June 1998-June 2021 were identified from electronic databases. Two independent investigators assessed the quality of the studies by using the revised Cochrane risk-of-bias tool. Meta-analyses with random-effects models were conducted to assess the effectiveness of the interventions using the Comprehensive Meta-Analysis Software. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. RESULTS Among 12 articles that met the inclusion criteria, three interventions provided education on pain management and mobility/exercises. The most common educational methods were the combinations of oral explanation, written materials, and audiovisual materials, group discussion, while four studies used information technology (IT) devices. The meta-analysis demonstrated that the educational interventions using IT devices were effective in improving pain and ROM, but not the interventions that did not use IT devices. CONCLUSION Structured education for pain management, communication and/or exercise support programs utilising diverse methods have been provided to patients undergoing TKA. Using IT devices could successfully enhance the effectiveness of educational interventions for patients undergoing TKA. RELEVANCE TO CLINICAL PRACTICE Integration of postoperative pain management and mobility/exercises with the use of IT devices should be actively considered in providing patient education in clinical nursing practice.
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Affiliation(s)
- Tae Woo Kim
- Kyungpook National University Hospital, Daegu, South Korea
| | - Su Hyun Kim
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea
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28
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Nair A, Arfan S, Holder SS, Bacchus KI, Stear TJ. Persistent Postoperative Delirium Following Laparoscopic Cholecystectomy. Cureus 2023; 15:e40523. [PMID: 37461784 PMCID: PMC10350320 DOI: 10.7759/cureus.40523] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Gallstones are the primary cause of symptomatic gallbladder disease and lead to a significant portion of hospitalizations related to gastrointestinal diseases. The gold standard treatment for gallbladder disease continues to be cholecystectomy, which is commonly done laparoscopically, and improves patients' quality of life. With any surgical intervention there are inherent risks, and in the setting of severe illness, the risk of potential complications increases immensely. Postoperative altered mental status, namely, delirium, may occur in the elderly and a high index of suspicion is required to recognize the clinical signs for swift diagnosis and management. This case involves a 61-year-old male who underwent laparoscopic cholecystectomy and developed persistent delirium during the hospital course. This report aims to explore the multiple risk factors that lead to postoperative delirium and review the diagnostic and therapeutic strategies utilized in managing this patient.
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Affiliation(s)
- Ameya Nair
- Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | - Sara Arfan
- General Surgery, Windsor University School of Medicine, Chicago, USA
| | - Shaniah S Holder
- Medicine, American University of Barbados School of Medicine, Bridgetown, BRB
| | | | - Timothy J Stear
- General Surgery, Community First Medical Center, Chicago, USA
- General Surgery, Resurrection Medical Center, Chicago, USA
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29
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Kim Y, Kim SH. The Relationship of Nurse and Physician Staffing in Intensive Care Units with Patient Outcomes in Postoperative Patients on Ventilators: An Analysis Using Korean National Health Insurance Data. Healthcare (Basel) 2023; 11:healthcare11081124. [PMID: 37107958 PMCID: PMC10138417 DOI: 10.3390/healthcare11081124] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
This study examined the associations of nurse and physician staffing in intensive care units (ICUs) with hospital-acquired pneumonia (HAP) incidence and in-hospital mortality in postoperative patients on ventilators. National Health Insurance claims data and death statistics were used to investigate the nurse staffing level and the presence or absence of a dedicated resident and specialist in each ICU. The participants were patients aged 20-85 who underwent any of 13 surgical procedures and were placed on a ventilator in the ICU after the procedure. Of 11,693 patients, 307 (2.6%) experienced HAP and 1280 (10.9%) died during hospitalization. Compared to hospitals with lower nurse-to-patient ratios, patients in hospitals with higher ratios had statistically significantly higher risks of HAP and in-hospital mortality. The presence of a dedicated resident in the ICU did not statistically significantly affect HAP incidence or in-hospital mortality. The presence of an ICU specialist was statistically significantly associated with in-hospital mortality but not HAP incidence. Our findings suggest that a higher level of nursing staff in the ICU is inversely associated with HAP incidence. The legal standards for nurse staffing in the ICU should be strengthened in order to improve the quality of care and patient safety.
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Affiliation(s)
- Yunmi Kim
- Department of Nursing, Eulji University, Seongnam 13135, Republic of Korea
| | - Seon-Ha Kim
- Department of Nursing, Dankook University, Cheonan 31116, Republic of Korea
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30
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Chyou JY, Barkoudah E, Dukes JW, Goldstein LB, Joglar JA, Lee AM, Lubitz SA, Marill KA, Sneed KB, Streur MM, Wong GC, Gopinathannair R. Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e676-e698. [PMID: 36912134 DOI: 10.1161/cir.0000000000001133] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient's underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient's ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.
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Santos A, Silva MF, Dos Santos EH, Tassiana Silva C, Obara K, Bonilha Oda S, Carrasco AC, Cardoso JR. Gait analysis of individuals with specific low back pain undergoing surgery: case series report with one and six-month follow-up. Physiother Theory Pract 2023:1-11. [PMID: 36892481 DOI: 10.1080/09593985.2023.2187267] [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: 07/18/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION In addition to pain, specific low back pain is frequently accompanied by restricted range of motion (ROM) during gait. PURPOSE To compare the behavior of kinematic and spatiotemporal gait parameters, pain, functional status, and self-efficacy, in patients with a diagnosis of herniated disk or lumbar stenosis undergoing surgery, in the pre- and postoperative periods of 1 and 6 months (PO6). METHODS Seven participants and 11 control subjects were assessed. A kinematics system comprising 10 optoelectronic cameras was used to assess gait. The Roland-Morris questionnaire, pain intensity, and self-efficacy, over three periods, were used. RESULTS The ROM of the pelvis, hip, and knee of the hernia group presented an increase after surgery and the stenosis group presented a reduction of values in the hip. During the stance phase, the pelvis and hip ROM of both groups remained smaller than the control group. There was improvement in pain in individuals with hernia and stenosis (effect size = 0.6 and 0.8, respectively) in the three analyzed moments; for functional status there was improvement in the first postoperative period (ES = 0.4) compared to the preoperative in those individuals with hernia; and those with stenosis had improvement at PO6 when compared to the time before the surgery (ES = 0.2). CONCLUSION Surgical intervention modifies the spatiotemporal parameters, the ROM of the pelvis, hip, and knee in the total gait cycle, primarily in the sagittal plane, and causes alterations, particularly in the hip joint, in these individuals during the support phase.
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Affiliation(s)
- Amanda Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Mariana Felipe Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Eduarda Hirle Dos Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Carla Tassiana Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Karen Obara
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Shigueo Bonilha Oda
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Aline Cristina Carrasco
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
- PT Department, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Jefferson Rosa Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
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Baysden M, Hein D, Castillo S. Tamsulosin for prevention of postoperative urinary retention: A systematic review and meta-analysis. Am J Health Syst Pharm 2023; 80:373-383. [PMID: 36445826 DOI: 10.1093/ajhp/zxac349] [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: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine if administration of tamsulosin before and/or after surgery is safe and effective in preventing postoperative urinary retention (POUR). METHODS A systematic review and meta-analysis comparing tamsulosin to control in patients undergoing surgery was conducted. The primary outcome was the incidence of POUR. Secondary outcomes included maximum urinary flow rate, surgery duration, International Prostate Symptom Score (IPSS), quality of life (QOL) score, and incidence of urinary tract infection (UTI). RESULTS Twenty-three randomized controlled trials (N = 3,555) met inclusion criteria. All were qualitatively analyzed, but one was excluded from quantitative analysis due to lack of statistical data. The risk of POUR was significantly lower with tamsulosin compared with control (relative risk, 0.50; 95% CI, 0.38-0.67; P < 0.001). A significant increase in maximum urinary flow rate with use of tamsulosin versus control was also observed across 4 studies (difference in means, 2.76 mL/sec; 95% CI, 1.21-4.30; P < 0.001). No significant differences between tamsulosin and control were observed amongst the studies that reported mean duration of surgery (P = 0.932), IPSS (P = 0.133), QOL score (P = 0.166), and UTI incidence (P = 0.624). CONCLUSION Administration of tamsulosin before and/or after surgery significantly reduced the risk of POUR and improved maximum urinary flow rate compared to control; however, it had no significant impact on mean duration of surgery, IPSS, QOL score, or UTI incidence. Nonetheless, it may be reasonable for providers to consider administering tamsulosin before and/or after surgery to prevent POUR.
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Affiliation(s)
- Maddy Baysden
- Creighton University Center for Drug Information & Evidence-Based Practice, Omaha, NE, USA
| | - Darren Hein
- Creighton University Center for Drug Information & Evidence-Based Practice, Omaha, NE, USA
| | - Shana Castillo
- Creighton University Center for Drug Information & Evidence-Based Practice, Omaha, NE, USA
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Stefanini R, Campanholo MDAT, Prescinotto R, Caparroz FDA, Bittencourt LRA, Tufik S, Haddad FLM. Immediate and Medium-Term Follow-Up of Patients with Obstructive Sleep Apnea Undergoing Pharyngeal and Nasal Surgery: A Pilot Study. Sleep Sci 2023; 16:7-13. [PMID: 37151764 PMCID: PMC10157821 DOI: 10.1055/s-0043-1767747] [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: 11/04/2021] [Accepted: 05/25/2022] [Indexed: 05/09/2023] Open
Abstract
Objectives To evaluate the evolution of obstructive sleep apnea (OSA), comparing data from preoperative, immediate postoperative and late postoperative, in patients undergoing pharyngeal surgery associated with nasal surgery, and to compare the findings of arterial tonometry and type 1 polysomnography in the late postoperative period. Methods Seventeen adults with moderate or severe OSA were included in the study. They underwent clinical evaluation, surgical intervention, and sleep study preoperatively, on the 1 st night after surgery, and after a minimum period of 3 months. The data for the three moments were compared. Results The mean age was 38.1 ± 12.5 years old (22 to 59 years old), and 82.3% were male. Body mass index (BMI) ranged from 25.6 to 45.1 kg/m2 (mean = 33.1 ± 5.8 kg/m 2 ). Fifteen patients (88.2%) were diagnosed with severe OSA. There was a progressive improvement, with a decrease in the indexes (AHI and RDI) and in the percentage of time with peripheral oxyhemoglobin saturation below 90% (tSpO < 90%), and an increase in nadir of SpO2. In the comparison between the 2 methods used in the late postoperative period - arterial tonometry and polysomnography - there was no difference in the indexes and in the tSpO < 90%. Discussion There was a progressive and favorable impact of pharyngeal surgery on the improvement of polysomnographic and clinical respiratory parameters; however, many patients maintained residual OSA, suggesting the need for a new sleep study in the postoperative period. The arterial tonometry showed similar findings to polysomnography, which can be considered as an option in postoperative follow-up of patients.
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Affiliation(s)
- Renato Stefanini
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
- Address for correspondence Renato Stefanini
| | | | - Renato Prescinotto
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fábio de Azevedo Caparroz
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Lia Rita Azeredo Bittencourt
- Universidade Federal de São Paulo, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Fernanda Louise Martinho Haddad
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Obigbesan O, Hayden KA, Benzies KM. Scoping Review of Education for Women About Return to Driving After Abdominal Surgery. J Obstet Gynecol Neonatal Nurs 2023; 52:106-116. [PMID: 36463949 DOI: 10.1016/j.jogn.2022.11.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To conduct a scoping review to examine the evidence on education provided to women about when to return to driving after abdominal surgery and to assess variation in this education by type of abdominal surgery and source of education. DATA SOURCES We searched MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Scopus, and CINAHL for peer-reviewed articles. We searched the publications of professional associations, clinical guidelines, driver's licensing agencies, and clinical trial registries for gray literature. Searches generated 2,908 peer-reviewed titles and abstracts and 20 documents in the gray literature. STUDY SELECTION We included articles and documents published in English in which authors reported education, advice, counseling, or recommendations about return to driving after abdominal surgery for women ages 16 to 50 years. DATA EXTRACTION We identified 16 peer-reviewed articles and eight documents in the gray literature. We extracted data including the title, authors, country of origin, study design, study purpose, sample size, type of abdominal surgery, education about return to driving, source of evidence to support the education, source of education, outcomes, and relevance to the review question. DATA SYNTHESIS We found that recommendations about when to return to driving after abdominal surgery ranged from 1 to 10 weeks after surgery, and 6 weeks after surgery was the most common. Recommended times were shorter for laparoscopic surgeries and longer for nonlaparoscopic surgeries, including cesarean. Most recommendations were provided by health care providers, and some recommendations were provided in leaflets. Evidence to support these recommendations was limited, and they were based on common sense, traditional practice, perceptions of insurance policies, a women's comfort level, or her ability to deploy the emergency brake. CONCLUSION Education provided to women about return to driving after abdominal surgery varies substantially and has a weak evidence base.
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Jokinen K, Häkkinen A, Luokkala T, Karjalainen T. Clinical Outcomes After Aggressive Active Early Motion and Modified Kleinert Regimens: Comparison of 2 Consecutive Cohorts. Hand (N Y) 2023; 18:335-339. [PMID: 34088233 PMCID: PMC10035109 DOI: 10.1177/15589447211017222] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Modern multistrand repairs can withstand forces present in active flexion exercises, and this may improve the outcomes of flexor tendon repairs. We developed a simple home-based exercise regimen with free wrist and intrinsic minus splint aimed at facilitating the gliding of the flexor tendons and compared the outcomes with the modified Kleinert regimen used previously in the same institution. METHODS We searched the hospital database to identify flexor tendon repair performed before and after the new regimen was implemented and invited all patients to participate. The primary outcome was total active range of motion, and secondary outcomes were Disabilities of Arm, Shoulder, and Hand; grip strength; globally perceived function; and the quality of life. RESULTS The active range of motion was comparable between the groups (mean difference = 14; 95% confidence interval [CI], -8 to 36; P = .22). Disabilities of Arm, Shoulder, and Hand; grip strength; global perceived function; and health-related quality of life were also comparable between the groups. There was 1 (5.3%) rupture in the modified Kleinert group and 4 (15.4%) in the early active motion group (relative risk = 0.3; 95% CI, 0.04-2.5; P = .3). CONCLUSIONS Increasing active gliding with a free wrist and intrinsic minus splint did not improve the clinical outcomes after flexor tendon injury at a mean of 38-month follow-up.
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Affiliation(s)
- Kaisa Jokinen
- Central Finland Central Hospital, Jyväskylä, Finland
| | | | - Toni Luokkala
- Central Finland Central Hospital, Jyväskylä, Finland
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Rykkje AM, Larsen VA, Skjøth-Rasmussen J, Nielsen MB, Carlsen JF, Hansen AE. Timing of Early Postoperative MRI following Primary Glioblastoma Surgery-A Retrospective Study of Contrast Enhancements in 311 Patients. Diagnostics (Basel) 2023; 13. [PMID: 36832282 DOI: 10.3390/diagnostics13040795] [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: 01/08/2023] [Revised: 02/03/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
An early postoperative MRI is recommended following Glioblastoma surgery. This retrospective, observational study aimed to investigate the timing of an early postoperative MRI among 311 patients. The patterns of the contrast enhancement (thin linear, thick linear, nodular, and diffuse) and time from surgery to the early postoperative MRI were recorded. The primary endpoint was the frequencies of the different contrast enhancements within and beyond the 48-h from surgery. The time dependence of the resection status and the clinical parameters were analysed as well. The frequency of the thin linear contrast enhancements significantly increased from 99/183 (50.8%) within 48-h post-surgery to 56/81 (69.1%) beyond 48-h post-surgery. Similarly, MRI scans with no contrast enhancements significantly declined from 41/183 (22.4%) within 48-h post-surgery to 7/81 (8.6%) beyond 48-h post-surgery. No significant differences were found for the other types of contrast enhancements and the results were robust in relation to the choice of categorisation of the postoperative periods. Both the resection status and the clinical parameters were not statistically different in patients with an MRI performed before and after 48 h. The findings suggest that surgically induced contrast enhancements are less frequent when an early postoperative MRI is performed earlier than 48-h, supporting the recommendation of a 48-h window for an early postoperative MRI.
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Huang D, Harrison R, Curtis E, Mirabadi N, Chen GY, Alexandridis R, Barroilhet L, Rose S, Hartenbach E, Al-Niami A. Beyond post-operative readmissions: analysis of the impact of unplanned readmissions during primary treatment of advanced-stage epithelial ovarian cancer on long-term oncology outcome. Int J Gynecol Cancer 2023; 33:741-748. [PMID: 36808044 DOI: 10.1136/ijgc-2022-003765] [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: 02/19/2023] Open
Abstract
BACKGROUND Multiple studies have assessed post-operative readmissions in advanced ovarian cancer. OBJECTIVE To evaluate all unplanned readmissions during the primary treatment period of advanced epithelial ovarian cancer, and the impact of readmission on progression-free survival. METHODS This was a single institution retrospective study from January 2008 to October 2018. Χ2/Fisher's exact and t-test, or Kruskal-Wallis test were used. Multivariable Cox proportional hazard models were used to assess the effect of covariates in progression-free survival analysis. RESULTS A total of 484 patients (279 primary cytoreductive surgery, 205 neoadjuvant chemotherapy) were analyzed. In total, 272 of 484 (56%; 37% primary cytoreductive surgery, 32% neoadjuvant chemotherapy, p=0.29) patients were readmitted during the primary treatment period. Overall, 42.3% of the readmissions were surgery related, 47.8% were chemotherapy related, and 59.6% were cancer related but not related to surgery or chemotherapy, and each readmission could qualify for more than one reason. Readmitted patients had a higher rate of chronic kidney disease (4.1% vs 1.0%, p=0.038). Post-operative, chemotherapy, and cancer-related readmissions were similar between the two groups. However, the percentage of inpatient treatment days due to unplanned readmission was twice as high for primary cytoreductive surgery at 2.2% vs 1.3% for neoadjuvant chemotherapy (p<0.001). Despite longer readmissions in the primary cytoreductive surgery group, Cox regression analysis demonstrated that readmissions did not affect progression-free survival (HR=1.22, 95% CI 0.98 to 1.51; p=0.08). Primary cytoreductive surgery, higher modified Frailty Index, grade 3 disease, and optimal cytoreduction were associated with longer progression-free survival. CONCLUSIONS In this study, 35% of the women with advanced ovarian cancer had at least one unplanned readmission during the entire treatment time. Patients treated by primary cytoreductive surgery spent more days during readmission than those with neoadjuvant chemotherapy. Readmissions did not affect progression-free survival and may not be valuable as a quality metric.
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Affiliation(s)
- Dandi Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA .,Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ross Harrison
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin Curtis
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nina Mirabadi
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of General Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Grace Yi Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roxana Alexandridis
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lisa Barroilhet
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stephen Rose
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ellen Hartenbach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ahmed Al-Niami
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Wei W, Huang X, Zhu J. Effect of Acupoint Therapies on Postoperative Sleep Quality: A Narrative Review. Med Sci Monit 2023; 29:e938920. [PMID: 36760099 PMCID: PMC9926797 DOI: 10.12659/msm.938920] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Several studies have reported that sleep quality often decreases in patients after surgery, especially in elderly patients, which seriously affects postoperative prognosis and outcomes, inducing diseases such as postoperative delirium, long-term chronic pain, and potentially fatal cardiovascular events. With the popularization of comfortable medicine, medical workers pay more attention to the postoperative sleep quality of patients. The causes underlying the decrease in postoperative sleep quality may include postoperative pain, the severity of surgical trauma and stress, perioperative anxiety and depression, and postoperative complications. Patients with insomnia often use acupoint therapies as a safe and effective alternative to drugs. Acupoint therapies are among the oldest medical therapies of Traditional Chinese Medicine and are gradually gaining recognition among medical workers worldwide. Various types of acupoint stimulation methods such as transcutaneous electrical acupoint simulation (TEAS), acupressure, acupuncture, and electroacupuncture can change the brain's local electrical activity, inhibit the central nervous system, and achieve deep sedation through stimulating the related acupoints, which provides a novel idea and basis for improvement in factors affecting postoperative sleep quality. This review explores the mechanism of acupoint therapies from several aspects of affecting the sleep quality of patients after surgery and its clinical results. We found that acupoint therapies effectively improve sleep quality and alleviate the postoperative complications of patients, and we emphasize the importance of acupoint therapies to guide future research and clinical practice. Large-scale, multicenter studies are needed to determine the optimal duration, frequency, and timing of acupoint stimulation for improving postoperative sleep quality.
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Affiliation(s)
- Wenxin Wei
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Xin Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
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Kengsakul M, Nieuwenhuyzen-de Boer GM, Udomkarnjananun S, Kerr SJ, van Doorn HC, van Beekhuizen HJ. Clinical validation and comparison of the Comprehensive Complication Index and Clavien-Dindo classification in predicting post-operative outcomes after cytoreductive surgery in advanced ovarian cancer. Int J Gynecol Cancer 2023; 33:263-270. [PMID: 36600504 DOI: 10.1136/ijgc-2022-003998] [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: 12/13/2022] Open
Abstract
OBJECTIVE The Comprehensive Complication Index (CCI) is an instrument used to measure cumulative post-operative complications. Our study aimed to validate the CCI after cytoreductive surgery for primary advanced-stage epithelial ovarian cancer, and to compare its diagnostic performance with the Clavien-Dindo classification. METHODS This prospective cohort study classified post-operative complications according to the Clavien-Dindo classification and the CCI. Logistic regression was used to determine the association between both classifications with intensive care unit admission, prolonged length of hospital stay (defined as stays longer than the 75th percentile of all stays in this study), 30-day readmission, and time to initiating chemotherapy after surgery >42 days. Area under the receiver operating characteristic curves (AUC) were used to assess the discriminative performance of each classification. RESULTS A total of 300 patients were included in the analysis. Most patients (n=255, 85%) underwent interval cytoreductive surgery. Complete cytoreduction was achieved in 235 (78%) patients. Overall, 30-day post-operative complications classified by the Clavien-Dindo classification occurred in 147 (49%) patients. Severe complications (grade ≥3a) occurred in 51 (17%) patients. Approximately 30% (n=82) had multiple complications. The CCI showed an excellent correlation with the Clavien-Dindo classification (r=0.906, p<0.001). In comparison with the Clavien-Dindo classification, the proportion of patients classified with severe complications increased from 17% to 30% when stratified with the CCI, and 20% of patients were diagnosed with a CCI score that correlated with a higher Clavien-Dindo classification grade. On regression analysis, both Clavien-Dindo classification and CCI had associations with intensive care unit admission, prolonged length of hospital stay, 30-day readmission, and time to chemotherapy >42 days (all p<0.05). AUC demonstrated that CCI (0.842, 95% CI 0.792 to 0.893) and Clavien-Dindo classification (0.813, 95% CI 0.762 to 0.864, p<0.001) had a good diagnostic performance for prolonged length of hospital stay. CONCLUSIONS Both the Clavien-Dindo classification and CCI showed significant associations with all surgical outcomes. However, the cumulative complications score of the CCI demonstrated a more superior discriminative performance than the Clavien-Dindo classification for prolonged length of hospital stay in advanced-stage epithelial ovarian cancer.
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Affiliation(s)
- Malika Kengsakul
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands .,Department of Obstetrics and Gynecology, Srinakharinwirot University Panyananthaphikkhu Chonprathan Medical Center, Nonthaburi, Thailand
| | - Gatske M Nieuwenhuyzen-de Boer
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Helena C van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Heleen J van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Wang XS, Ramirez PT, Shi Q, Kamal M, Garcia-Gonzalez A, Iniesta MD, Cleeland CS, Meyer LA. Patient-reported symptoms at discharge and risk of complications after gynecologic surgery. Int J Gynecol Cancer 2023; 33:271-277. [PMID: 36600503 PMCID: PMC10009896 DOI: 10.1136/ijgc-2022-004016] [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: 12/13/2022] Open
Abstract
OBJECTIVE Current gaps in knowledge limit clinicians from fully implementing patient-reported outcomes in routine post-operative care. METHODS This prospective study assessed symptoms via the gynecologic module of the MD Anderson Symptom Inventory (MDASI-PeriOp-GYN) in patients who underwent open laparotomy. RESULTS At discharge, patient-reported moderate to severe (≥4 on a 0-10 scale) abdominal bloating or abdominal cramping, combined with length of stay of ≥4 days, were found to be associated with a higher risk of 30-day post-operative grade II-IV complications by the Clavien-Dindo system (all p values <0.01). Also, length of stay of ≥4 days and moderate to severe urinary urgency at discharge were found to be associated with the need for re-admission (all p values <0.01). CONCLUSION This study defined the clinically meaningful symptoms that related to the risk of developing important complications after discharge from major open gynecological surgery.These findings support the integration of assessment of patient-reported outcomes into patient-centered post-operative care.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Chongqing Medical University, Chongqing, China
| | - Mona Kamal
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Araceli Garcia-Gonzalez
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria D Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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Hussein K, Black C. Incidence of radiographic pulmonary abnormalities after posterior spinal fusion surgery for pediatric scoliosis. J Anaesthesiol Clin Pharmacol 2023; 39:56-60. [PMID: 37250263 PMCID: PMC10220193 DOI: 10.4103/joacp.joacp_147_21] [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: 03/25/2021] [Revised: 07/05/2021] [Accepted: 07/18/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Pulmonary complications are the most common non-neurologic complications following surgical correction of scoliosis. These can affect postoperative recovery by increasing the length of stay and/or the need for ventilatory support. The aim of this retrospective study is to determine the incidence of radiographic abnormalities reported in chest radiography after posterior spinal fusion surgery for the treatment of scoliosis in children. Material and Methods A retrospective chart review of all patients who underwent posterior spinal fusion surgery in our center between January 2016 and December 2019 was attempted. Radiographic data including chest and spine radiographs were reviewed on the national integrated medical imaging system using medical record numbers for all patients in the 7 postoperative days. Results Seventy-six (45.5%) of the 167 patients developed radiographic abnormalities in the postoperative period. There was evidence of atelectasis in 50 (29.9%) patients, pleural effusion in 50 (29.9%) patients, pulmonary consolidation in 8 (4.8%) patients, pneumothorax in 6 (3.6%) patients, subcutaneous emphysema in 5 (3%) patients, and rib fracture in 1 (0.6%) patient. Four (2.4%) patients were noted to have an intercostal tube inserted postoperatively, three for treating pneumothorax, and one for pleural effusion. Conclusion A large number of radiographic pulmonary abnormalities were encountered in children following surgical treatment of pediatric scoliosis. Although not all radiographic findings may be clinically significant, early recognition may guide clinical management. The incidence of air leak (pneumothorax, subcutaneous emphysema) was significant and could influence local protocol formulation with regards to obtaining immediate postoperative chest radiograph and intervention if clinically necessary.
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Affiliation(s)
- Kareem Hussein
- Department of Anaesthesia, Children Health Ireland at Crumlin Hospital, Dublin, Ireland
| | - Colin Black
- Department of Anaesthesia, Children Health Ireland at Crumlin Hospital, Dublin, Ireland
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Brailovskaya TV, Kibitov AO, Gadzhikulieva AK, Chuprova NA, Nikolishin AE, Sherstobitov VA. [Comparative analysis of the effectiveness of SF-MPQ-2 and VAS for assessing the severity of pain syndrome in dental patients in the postoperative period]. Stomatologiia (Mosk) 2023; 102:11-17. [PMID: 37622294 DOI: 10.17116/stomat202310204111] [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] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Conducting a comparative analysis of the effectiveness of the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2) and the Visual Analogue Scale (VAS) for assessing the severity of pain syndrome in dental patients in the postoperative period in dynamics. MATERIAL AND METHODS The study included 51 patients who received dental surgical treatment. Two groups of patients were formed, depending on the type of surgery and the degree of trauma of the operation. Group 1 - low degree of injury - 28 patients; group 2 - high degree of injury - 23 patients. Patients independently filled out questionnaires at four stages of the study: before surgery, on the 1st, 3rd, and 5th days after surgery as part of scheduled visits. RESULTS AND DISCUSSION In patients of group 2, the severity of pain symptoms was higher than in patients of group 1 in terms of pain symptoms on SF-MPQ-2 at all stages of the study, except the day before surgery. At the same time, there were no differences with the indicators of the VAS scale at any of the stages of the study. The most informative indicators of SF-MPQ-2 are the total indicator MPQ-Sum and the constant pain indicator MPQ-Const, which were significantly higher in group 2 on the 1st day after surgery, taking into account the correction for gender and age. The highest level of coincidence of indicators on VAS and the total score on MPQ-Sum was revealed on the 5th day of the operation, regardless of the degree of trauma of the operation. CONCLUSION The use of SF-MPQ-2 with a detailed description of pain sensations is the most acceptable way to assess the degree of pain syndrome in operative surgery, especially during the period when the severity of pain symptoms is maximum (in the first days of the postoperative period).
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Affiliation(s)
- T V Brailovskaya
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A O Kibitov
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - A K Gadzhikulieva
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - N A Chuprova
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - A E Nikolishin
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - V A Sherstobitov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Kırca AŞ, Gül DK. Effect of Acupressure Applied After Cesarean Section Under Spinal Anesthesia Postpone the Duration of Taking Analgesics and on The Gastrointestinal System: A Randomized Controlled Trial. Explore (NY) 2023; 19:58-64. [PMID: 35074319 DOI: 10.1016/j.explore.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 11/06/2021] [Accepted: 12/31/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Cesarean deliveries are one of the primary conditions associated with postoperative decreased motility of the gastrointestinal system and are characterized by acute pain and distention. The aim of the present study was to investigate the application of acupressure and the administration of analgesics for women who underwent cesarean section under spinal anesthesia could be delayed and how spontaneous gastrointestinal system motility could be achieved in the postoperative period. DESIGN Randomized controlled trial SETTING: Private Medipol Nisa Hospital, Istanbul, Turkey INTERVENTION: This trial was conducted with 112 primipara pregnant women who delivered via cesarean section under spinal anesthesia and were randomly assigned into the acupressure (n=52) and control (n=60) groups. The participants in the acupressure group (n=52) were treated for 20 minutes. The participants in the control group (n=60) were treated per the hospital protocol (analgesics for pain, flatulation and defecation, no pharmacological or non-pharmacological application was performed). RESULTS The time that elapsed for the administration of analgesics was significantly later in the acupressure group than in the control group (p <.001). The first occurrence of flatulation and defecation were significantly earlier in the acupressure group (19 and 23 hours, respectively) than in the control group (34 and 27 hours, respectively) (p <.001). CONCLUSION Acupressure is an easy, non-invasive method that postpones the administration of analgesics in the postoperative period and prevents flatulence and constipation caused by the decreased motility of GIS.
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Peter V, Shenoy U, Rukkiyabeevi B. Effect of a single intraoperative dose of dexamethasone on glycaemic profile in postoperative patients - A double-blind randomised controlled study. Indian J Anaesth 2022; 66:789-795. [PMID: 36590189 PMCID: PMC9795505 DOI: 10.4103/ija.ija_332_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/11/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Aims The effect of a single intraoperative dose of steroids on perioperative blood sugar levels is uncertain. We hypothesised that a single dose of dexamethasone would not unfavourably alter the glucose levels of non-diabetic patients. This study aimed to evaluate the post-operative glycaemic profile after a single dose of intraoperative dexamethasone in non-diabetic patients. The presence of post-operative nausea and vomiting (PONV), pain, surgical site infection (SSI) and length of hospital stay were also evaluated. Methods This randomised, double-blind, controlled study was done by recruiting 150 non-diabetic adult patients of the American Society of Anesthesiologists physical status I/II undergoing elective surgery. Patients in the study group were administered a single dose of dexamethasone (0.15 mg/kg). Blood glucose levels were assessed at various time points for up to 72 hours post-operatively using point-of-care testing. Secondary outcomes such as PONV, pain, fever and SSI were also documented. Data were compared and analysed using Student's t-test, Chi-square test, Mann-Whitney test and analysis of variance test. Results There was an earlier, higher and prolonged elevation in blood glucose levels in patients receiving dexamethasone. The mean (standard deviation) of fasting/postprandial blood sugars on the first, second and third postoperative days respectively was significantly higher in the study group 98.04 (21.89)/139.16 (20.59), 96.64 (19.20)/138.17 (18.05), 96.60 (17.40)/138.32 (15.10) mg/dl as compared to control group 86.9 6 (10.28)/128.95 (10.53), 88.81 (8.87)/131.97 (9.68), 88.16 (8.50)/130.88 (9.48) mg/dl. About 10.7% of the patients who received dexamethasone had blood glucose levels greater than 180 mg/dl. There were no significant differences in the secondary outcomes. Conclusion Even a single dose of dexamethasone in non-diabetic adults causes significant and prolonged postoperative hyperglycaemia.
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Affiliation(s)
- Vigil Peter
- Department of Anaesthesia, Jubilee Mission Medical College and Regional Institute, Thrissur, Kerala, India,Address for correspondence: Dr. Vigil Peter, Alapatt House, Parappukkara P.O, Thrissur, Kerala - 680 310, India. E-mail:
| | - Usha Shenoy
- Department of Anaesthesia, Jubilee Mission Medical College and Regional Institute, Thrissur, Kerala, India
| | - Buena Rukkiyabeevi
- Department of Anaesthesia, Jubilee Mission Medical College and Regional Institute, Thrissur, Kerala, India
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Kozanhan B, Semerkant T, Esme H, Canitez A, Iyisoy MS. Evaluation of Rhomboid Intercostal and Subserratus Plane Block Under Direct Vision For Postoperative Analgesia in Thoracic Surgeries: A Prospective, Randomized Controlled Trial. Eur J Cardiothorac Surg 2022; 62:6758247. [PMID: 36218395 DOI: 10.1093/ejcts/ezac498] [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: 04/04/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study is designed to evaluate the efficacy of rhomboid intercostal and subserratus plane (RISS) block under the surgeon's direct vision for providing postoperative pain relief after thoracic surgeries. METHODS Forty patients who underwent thoracotomy were prospectively recruited and randomly assigned to group R (intravenous patient-controlled analgesia (IVPCA)+continued RISS block; n = 20) and group C (IVPCA; n = 20). Numeric rating scale (NRS) at rest and cough, at post-anesthetic care unit, 1, 2, 6, 9, 12, 24, and 48 hours was used as the primary outcome measure. Secondary outcome measures were the amount of tramadol consumption, the number of patients required rescue analgesia, the occurrence of postoperative adverse effects, pulmonary functions, and the overall satisfaction with pain management. RESULTS NRS scores both at rest and during coughing were significantly lower in group R than the group C group at all time intervals (p < 0.001 in each). Tramadol consumption at 24 h and 48 h was significantly lower in the group R block than group C (p < 0.001 for each). None of the patients in group R require rescue analgesia. The incidence of nausea and vomiting was similar among the groups. Compared with group C, change in lung function from baseline levels was significantly less in group R (p = 0.047 and p = 0.04 for FEV1 and FVC, respectively). The satisfaction scores in group R were significantly higher than group C (p < 0.001). CONCLUSION Continuous RISS block improved postoperative outcomes of thoracic surgery in terms of reduced postoperative pain scores, sparing opioid consumption, pulmonary function, and patient satisfaction. CLINICAL TRIAL REGISTRATION NCT04443556 (https://clinicaltrials.gov/ct2/show/NCT04443556).
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Affiliation(s)
- Betul Kozanhan
- University of Health Sciences, Konya City Hospital, Department of Anesthesiology and Reanimation, Konya, Turkey
| | - Tolga Semerkant
- University of Health Sciences, Konya City Hospital, Department of Thorax Surgery, Konya, Turkey
| | - Hıdır Esme
- University of Health Sciences, Konya City Hospital, Department of Thorax Surgery, Konya, Turkey
| | - Ahmet Canitez
- Abdulkadir Yuksel City Hospital, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Mehmet Sinan Iyisoy
- Necmettin Erbakan University, Department of Medical Education and Informatics, Konya, Turkey
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Tapar H, Demir Ö, Genç A, Balta MG, Kölükçü V, Karaman T, Dogru S, Karaman S, Suren M. Investigation of the analgesic efficacy of ultrasound-guided thoracolumbar interfacial plane block in vertebral surgery: A prospective randomized clinical study. Saudi Med J 2022; 43:1136-1141. [PMID: 36261200 PMCID: PMC9994504 DOI: 10.15537/smj.2022.43.10.20220467] [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: 06/13/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To investigate the effect of thoracolumbar interfacial plane block (TLIP) on analgesic consumption and pain score in vertebral surgery. METHODS All patients (64 patients undergoing vertebral surgery) were randomly allocated as Group T (patients with block, n=32) and Group C (patients without block, n=32). After surgery, patient-controlled analgesia using tramadol was administered to all patients. Pain intensity was evaluated with visual analogue scale (VAS; recovery room at 1, 2, 6, 12, and 24 hours postoperative), and as rescue analgesia, morphine was administered to patients with VAS scores of >4. In this study, total tramadol consumption, the number of patients requiring morphine, VAS score, and Quality of Recovery-40 of all patients questionnaire was evaluated. RESULTS There were important differences between the 2 groups according to mean postoperative tramadol consumption (Group T and Group C; 180 mg [100-260] vs. 210 mg [100-300]; p=0.001) and the number of patients requiring additional analgesia (n=4; 12.5% vs. n=24; 75%, p=0.000). There were important differences between the 2 groups according to the postoperative VAS pain score (p=0.000). CONCLUSION Ultrasound-TLIP reduces analgesic consumption and pain severity after vertebral surgery. Therefore, it is an important regional analgesia technique. CLINICALTRIALSGOV GRANT NO: NCT04548076.
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Affiliation(s)
- Hakan Tapar
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Özgür Demir
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Ali Genç
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Mehtap G. Balta
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Vildan Kölükçü
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Tugba Karaman
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Serkan Dogru
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Serkan Karaman
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
| | - Mustafa Suren
- From the Department of Anesthesiology and Reanimation (Tapar, Balta, Kölükçü, T. Karaman, S. Karaman,); from the Department of Neurosurgery (Demir), Medical Faculty, Tokat Gaziosmanpasa University, from the Department of Anesthesiology and Reanimation (Genç), Turhal State Hospital, from the Department of Anesthesiology and Reanimation (Suren), Medical Faculty, Samsun University, Tokat, and from the Department of Anesthesiology and Reanimation (Dogru), Mersin City Hospital, Mersin, Turkey.
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Heredia-Rodríguez M, Balbás-Álvarez S, Lorenzo-López M, Gómez-Pequera E, Jorge-Monjas P, Rojo-Rello S, Sánchez-De Prada L, Sanz-Muñoz I, Eiros JM, Martínez-Paz P, Gonzalo-Benito H, Tamayo-Velasco Á, Martín-Fernández M, Sánchez-Conde P, Tamayo E, Gómez-Sánchez E. PCR-based diagnosis of respiratory virus in postsurgical septic patients: A preliminary study before SARS-CoV-2 pandemic. Medicine (Baltimore) 2022; 101:e29902. [PMID: 35960076 PMCID: PMC9370242 DOI: 10.1097/md.0000000000029902] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Respiratory viruses are part of the normal microbiota of the respiratory tract, which sometimes cause infection with/without respiratory insufficiency and the need for hospital or ICU admission. The aim of this study is to determine the prevalence of respiratory viruses in nontransplanted postoperative septic patients as well as lymphocyte count influence in their presence and its relationship to mortality. 223 nontransplanted postsurgical septic patients were recruited on the Intensive Care Unit (ICU) at Hospital Clínico Universitario de Valladolid prior to the SARS-COV-2 pandemic. Patients were split into 2 groups according to the presence/absence of respiratory viruses. Multivariate logistic regression analysis was used to identify independent factors related to positive respiratory virus PCR test. Respiratory viruses were isolated in 28.7% of patients. 28-day mortality was not significantly different between virus-positive and virus-negative groups. Logistic regression analysis revealed that lymphocyte count ≤ 928/µl is independently associated with a positive PCR result [OR 3.76, 95% CI (1.71-8.26), P = .001] adjusted by platelet count over 128,500/µL [OR 4.27, 95% CI (1.92-9.50) P < .001] and the presence of hypertension [OR 2.69, 95% CI (1.13-6.36) P = .025] as confounding variables. Respiratory viruses' detection by using PCR in respiratory samples of nontransplanted postoperative septic patients is frequent. These preliminary results revealed that the presence of lymphopenia on sepsis diagnosis is independently associated to a positive virus result, which is not related to a higher 28-day mortality.
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Affiliation(s)
- María Heredia-Rodríguez
- Department of Anaesthesiology and Critical Care, Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Sara Balbás-Álvarez
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Mario Lorenzo-López
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Estefanía Gómez-Pequera
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Pablo Jorge-Monjas
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Silvia Rojo-Rello
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Laura Sánchez-De Prada
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Ivan Sanz-Muñoz
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - José María Eiros
- Department of Microbiology, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Pedro Martínez-Paz
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Hugo Gonzalo-Benito
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Research Unit, Hospital Clínico Universitario de Valladolid, Instituto de Estudios en Ciencias de la Salud de Castilla y León (ICSCyL), Valladolid, Spain
| | - Álvaro Tamayo-Velasco
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Marta Martín-Fernández
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- *Correspondence: Marta Martín-Fernández, Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain (e-mail: )
| | - Pilar Sánchez-Conde
- Department of Anaesthesiology and Critical Care, Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Eduardo Tamayo
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Esther Gómez-Sánchez
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
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Aydın Sayılan A, Yıldızeli Topçu S. Do the Fluids Consumed by Surgical Patients in the Postoperative Period Affect Their Gastrointestinal Motility?: A Correlational Study. J Perianesth Nurs 2022; 37:907-912. [PMID: 35835635 DOI: 10.1016/j.jopan.2022.02.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to determine the relationship between gastrointestinal (GI) motility and oral fluid intake levels in the postoperative period. DESIGN This descriptive and correlational study was performed in an education and research hospital between June and September 2019. METHODS The sample in this study consisted of individuals aged 18 to 80 years who had undergone laparoscopic abdominal surgery. No sampling was performed, and all patients volunteering to take part were included. FINDINGS Patients were started on oral nutrition in a median of 6 hours (min: 6 max: 8) after surgery and received 500.00 mL (min: 100 max: 500) oral fluid on the first day after surgery, 600.00 mL (min: 200 max: 1200) on the second, and 725.00 mL (min: 652.47 max: 759.52) on the third. Median time to passage of flatus was 22.50 hours (min: 6 max: 36), and median time to stool production was 39.00 hours (min: 16 max: 70). A positive correlation was found between the amount of oral fluid consumption on the first day and time to passage of flatus, while a negative correlation was observed between the amount of fluid consumption on the second day and time to both flatus and stool production. CONCLUSIONS Time to flatus production increased in line with the amount of fluid consumed via the oral route on the first day postoperatively, while times to production of flatus and stool decreased as the amount of fluid consumed orally on the second day increased.
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Affiliation(s)
- Aylin Aydın Sayılan
- Kirklareli University, Faculty of Health Science, Nursing Department, Kirklareli, Turkey.
| | - Scide Yıldızeli Topçu
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey
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Auzhanov D, Aimagambetov M, Omarov N. Complex assessment of immunosuppression effects in prevention and treatment of adhesive disease, an experiment. J Med Life 2022; 15:762-767. [PMID: 35928349 PMCID: PMC9321496 DOI: 10.25122/jml-2021-0371] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022] Open
Abstract
The cause of all small bowel obstruction in 60-75% of cases is adhesive development. The first and main method for adhesion prevention is undoubtedly the surgical technique, but the prevention of adhesive development is still actual. We aimed to study macroscopic and microscopic peculiarities of the intestine, peritoneum, and scars of the anterolateral abdominal wall. Also, immunological blood changes were observed in rats with the experimental created adhesive disease on the background of azathioprine introduction. The experiment was conducted on 40 rats divided into 2 subgroups: 20 animals as an experimental group (EG1) and 20 as a control group (CG1). Animals from EG received azathioprine (Moshimerampreparaty named by N.A. Semashko, Russia) in a dosage of 1 mg/100g of weight once a day for the first 3 days (starting from the day of surgery). The control group did not receive any drugs. All 40 rats survived the postoperative period. Rats were removed from the experiment on the 7th day after the operation. There were significant statistical differences in most indicators between the experimental and control groups. Phagocytic index (PI) was reduced by 4.55 due to the natural reaction of the rat organism to the surgery. Indicators of EG were a slight decrease in leukocytes and lymphocytes by 0.3 and 0.9, respectively, a moderate decrease in T-lymphocytes by no more than 2.0, and a decrease in phagocytic activity by 5.8. Immunosuppression with azathioprine significantly reduced the frequency and severity of the adhesive process of the abdominal cavity. Used in the recommended dose does not significantly inhibit important indicators of immunity and does not affect wound healing processes.
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Affiliation(s)
- Dauren Auzhanov
- Department of Hospital Surgery, Non-Commercial Joint-Stock Company Semey Medical University, Semey, Kazakhstan,Corresponding Author: Dauren Auzhanov, Department of Hospital Surgery, Non-Commercial Joint-Stock Company Semey Medical University, Semey, Kazakhstan. E-mail:
| | - Meirbek Aimagambetov
- Department of Hospital Surgery, Non-Commercial Joint-Stock Company Semey Medical University, Semey, Kazakhstan
| | - Nazarbek Omarov
- Department of Hospital Surgery, Non-Commercial Joint-Stock Company Semey Medical University, Semey, Kazakhstan
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Benedict PA, Connors JR, Timen MR, Bhatt N, Lebowitz RA, Pacione DR, Lieberman SM. Detection of Cerebrospinal Fluid Leaks Using the Endoscopic Fluorescein Test in the Postoperative Period following Pituitary and Ventral Skull Base Surgery. J Neurol Surg B Skull Base 2022; 84:17-23. [PMID: 36743707 PMCID: PMC9897891 DOI: 10.1055/a-1722-4433] [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: 06/09/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
Objective Diagnosis of cerebrospinal fluid (CSF) leaks is sometimes challenging in the postoperative period following pituitary and ventral skull base surgery. Intrathecal fluorescein (ITF) may be useful in this setting. Design Retrospective chart review. Setting Tertiary care center. Methods and Participants All patients who underwent pituitary and ventral skull base surgery performed by a single rhinologist between January 2017 and March 2020 were included. There were 103 patients identified. Eighteen patients received 20 ITF injections due to clinical suspicion for CSF leak during the postoperative period without florid CSF rhinorrhea on clinical exam. Computed tomography scans with new or increasing intracranial air and intraoperative findings were used to confirm CSF leaks. Clinical courses were reviewed for at least 6 months after initial concern for leak as the final determinate of CSF leak. Main Outcome Measures Specificity and safety of ITF. Results Eleven (61%) ITF patients were female and 7 (39%) were male. Average patient age was 52.50 ± 11.89. There were six patients with confirmed postoperative CSF leaks, 3 of whom had evaluations with ITF. ITF use resulted in 2 true positives, 1 false negative, 17 true negatives, and 0 false positives. ITF sensitivity was 67%, specificity was 100%, and positive and negative predictive values were 100 and 94.4%, respectively. There were no adverse effects from ITF use. Conclusions Existing modalities for detecting postoperative CSF leaks suffer from suboptimal sensitivity and specificity, delayed result reporting, or limited availability. ITF represents a specific and safe test with potential utility in the postoperative setting.
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Affiliation(s)
- Peter A. Benedict
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
| | - Joseph R. Connors
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
| | - Micah R. Timen
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
| | - Nupur Bhatt
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
| | - Richard A. Lebowitz
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States
| | - Donato R. Pacione
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Seth M. Lieberman
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York, United States,Address for correspondence Seth Lieberman, MD Department of Otolaryngology – Head and Neck Surgery, NYU Langone Health222 East 41st Street, 8th Floor, New York, NY 10017United States
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