[Evaluation of the quality of anesthetic recovery in postoperative patients]

Background

Comprehensive health care includes the evaluation of satisfaction in patient care and the quality of medical services. High-precision instruments have been used to assess the quality of recovery after anesthesia (QoR), such as the QoR-15 questionnaire, a validated and accurate assessment tool that considers aspects of emotionality, physical and psychological well-being, pain, and autonomy.

Objective

To assess QoR in postoperative patients who underwent anesthesia.

Material and methods

Observational, descriptive, cross-sectional study, carried out from March to August 2022. 80 patients from 18 to 70 years who underwent an anesthetic procedure and to which the anesthetic quality QoR-15 questionnaire was administered 24 hours after surgery were included. Descriptive statistics were performed according to the Shapiro-Wilk test. For quantitative variables it was used Mann-Whitney U, and for qualitative variables chi-squared; it was considered significant a value of p < 0.05.

Results

The 80 patients obtained a QoR-15 score of 122.06 (52-147), and their QoR was considered good. Anesthetic recovery quality in patients undergoing regional anesthetic techniques was excellent in 42.5% and 10% had balanced general anesthesia, p = 0.011.

Conclusions

QoR was higher with regional anesthetic techniques. Quality assessment through validated tools allows objective evaluation and monitoring of the care process in medical services.

Recovery of parathyroid function in patients with thyroid cancer treated by total thyroidectomy: An analysis of 685 patients with hypoparathyroidism at discharge of surgery

OBJECTIVE

We aimed to study the predictive factors for recovery of parathyroid function in hypoparathyroid patients after total thyroidectomy for thyroid cancer.

METHODS

We designed a retrospective, multicentre and nation-wide analysis of patients with total thyroidectomy who were seen in twenty endocrinology departments from January to March 2018. We selected patients with histologically proven thyroid cancer and retrieved information related to surgical procedure and thyroid cancer features. Survival analysis and Cox regression analysis were used to study the relationship between these variables and the recovery of parathyroid function.

RESULTS

From 685 patients with hypoparathyroidism at discharge of surgery, 495 (72.3%) recovered parathyroid function over time. Kaplan-Meier analysis showed that this recovery was significantly related to the presence of specialized surgical team (P<0.001), identification of parathyroid glands at surgery (P<0.001), papillary histopathology (P=0.040), and higher levels of postoperative calcium (Ca) (P<0.001) and parathyroid hormone (PTH) (P<0.001). Subjects with gross extrathyroidal extension (P=0.040), lymph node metastases (P=0.004), and surgical re-intervention after initial surgery (P=0.024) exhibited a significant risk of persistence of hypoparathyroidism. Multivariate Cox regression analysis showed that the significant and independent factors for recovery of parathyroid function were postoperative concentrations of Ca (P=0.038) and PTH (P=0.049). The presence of lymph node metastases was a negative predictor of recuperation of parathyroid function (P=0.042) in this analysis.

CONCLUSION

In patients with thyroid cancer, recovery of parathyroid function after total thyroidectomy was directly related to postoperative Ca and PTH concentrations, and inversely related to lymph node metastases.

Implementation of ERAS (Enhanced Recovery After Surgery) protocols for radical cystectomy patients: The pathway to standardization. A systematic review

CONTEXT

The development of ERAS (Enhanced Recovery After Surgery) protocols in patients undergoing major surgery has brought perioperative benefits in several disciplines. Its main application in urology is focused on patients undergoing radical cystectomy.

OBJECTIVE

Systematic review of the available literature on ERAS protocols applied to patients undergoing radical cystectomy in terms of perioperative outcomes as well in the analysis of their implementation.

EVIDENCE ACQUISITION

A bibliographic search was conducted in the electronic databases PubMed, Embase, Cochrane and Scopus, using the terms «Cystectomy», «Enhanced Recovery After Surgery» and «Fast-Track». Randomized and non-randomized studies that compared the implementation of an ERAS protocol versus a traditional protocol in patients undergoing radical cystectomy were selected.

EVIDENCE SYNTHESIS

869 articles were identified; 25 were selected for final analysis: 22 non-randomized and 3 randomized studies. No differences were observed in terms of demographic characteristics between studies. Statistically significant differences were identified in favor of the ERAS protocol: length of hospital stay, major complication rate, time to first ambulation and return of bowel function. In the analysis of protocols, a high variability was detected in the number of items and in the implementation method.

CONCLUSIONS

The multidisciplinary nature and the number of items of the ERAS protocols imply a high heterogeneity in their implementation. Further randomized studies, standardized reporting and analyzing results, as well as a systematic analysis of subsequent adherence are required to increase comparability between groups.

Functional Recovery in Schizophrenia

Recovery in schizophrenia is a topic that generates not only major clinical attention but also a significant economic and social impact. Until seventy years ago, these patients remained held in psychiatric institutions or asylums, usually with no hope of reintegrating into the community. A narrative review of relevant literature was conducted in order to answer key questions regarding recovery in schizophrenia. Treatment objectives in schizophrenia have changed substantially: from expecting a modest control of psychotic symptoms to considering functional recovery as a possibility. Available evidence indicates that one in seven patients with schizophrenia will achieve functional recovery, which implies that remission of positive symptoms is not the ultimate goal of treatment but only a basis for better social and cognitive functioning that translates into better quality of life. This view until recently was not believed to be possible for this major mental disorder.