Abdominal Surgery Patients Research Articles

Time to detection of serious adverse events by continuous vital sign monitoring versus clinical practice.

Continuous vital sign monitoring detects far more severe vital sign deviations (SVDs) than intermittent clinical rounds, and deviations are to some extent related to subsequent serious adverse events (SAEs). Early detection of SAEs is pivotal to allow for effective interventions but the time relationship between detection of SAEs by continuous vital sign monitoring versus clinical practice is not well-described at the general ward. To quantify the time difference between detection of SAEs by continuous vital sign monitoring and clinical suspicion of deterioration (CSD) in major abdominal surgery patients. Five hundred and five patients had their vital signs continuously monitored in combination with usual clinical practice consisting of National Early Warning Score assessments at least every 8'th hour, assessments during rounds, and other kinds of staff-patient interactions. The primary outcome was the time difference between the first chart note of CSD versus the first SVD, detected by continuous vital sign monitoring, in patients with a subsequent confirmed SAE during or up to 48 h after end of continuous vital sign monitoring. Out of the 505 continuously monitored patients, 142 patients had a combination of both postoperative SAE, CSD and SVD, and thus were included in the primary analysis. The median time from the first SVD to SAE was 42.8 h (interquartile range 19.8-72.1 h) compared to 13 minutes (interquartile range - 4.8 to 3.5 h) for CSD with a median difference of 48.1 h (95% confidence interval 43.0-54.8 h), p-value < .001. Continuous vital sign monitoring detects signs of oncoming SAEs in the form of SVD hours before CSD, potentially allowing for earlier and more effective treatments to reduce the extent of SAEs.

Spontaneous breathing trials should be adapted for each patient according to the critical illness. A new individualised approach: the GLOBAL WEAN study.

Spontaneous breathing trials (SBT) evaluate the patient's capacity to maintain inspiratory effort after extubation. SBT practices are heterogeneous and not individualised. The objective of this study was to assess which SBT best reproduces inspiratory effort after extubation in five critical illnesses. In this multicentre randomized cross-over study, adult intensive care unit patients under invasive mechanical ventilation for at least 24-h and ready for extubation, underwent three 15-min SBTs in random order: pressure support ventilation level of 7-cmH2O with positive end-expiratory pressure (PEEP) level of 0-cmH2O (PSV7PEEP0), PSV 0-cmH2O with PEEP 0-cmH2O (PSV0PEEP0) and T-piece trial. Primary outcome was the variation of pressure-time-product per minute (PTPmin) between each SBT and 20-min after extubation. Five categories of critical illnesses were selected: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease (COPD) and miscellaneous. Five hundred measures of effort from 100 patients were analysed. PTPmin (cmH2O s/min, median and interquartile range, IQR) was 256 (208-321) after extubation, 192 (127-281) at the end of PSV7PEEP0 (p < 0.001 in comparison to after extubation), 291 (235-347) at the end of PSV0PEEP0 and 262 (198-338) at the end of T-piece (both no different from after extubation). One method of SBT in patients with brain injury (PSV0PEEP0), two in abdominal surgery (PSV0PEEP0 and T-piece) and miscellaneous patients (PSV7PEEP0 and T-piece) and all three methods in chest trauma and COPD exacerbation patients replicated reasonably accurately the postextubation effort to breathe. Unassisted SBTs, namely PSV0PEEP0 and T-piece trial, are the most appropriate to replicate the postextubation effort to breathe.

Comparing postoperative pain relief: ketorolac and nasocalcin spray versus lidocaine and nasocalcin spray in abdominal surgery patients

Objectives: Postoperative pain management is critical for patient recovery after abdominal surgery. This study compared intravenous lidocaine and ketorolac for reducing postoperative pain and opioid use, along with Nasocalcin nasal spray. Methods: In this randomized controlled trial, 58 abdominal surgery patients were allocated to receive either intravenous lidocaine plus Nasocalcin spray (n=29) or intravenous ketorolac plus Nasocalcin spray (n=29) before surgery. Pain intensity (visual analog scale) and postoperative opioid consumption were assessed at 1, 6, 12, and 24 hours after surgery. Results: Patients receiving ketorolac plus Nasocalcin spray reported significantly lower pain scores at all time points compared to lidocaine plus Nasocalcin (P&lt;0.001). Average 24-hour pain scores were 4.5 with ketorolac versus 5.1 with lidocaine. Mean opioid consumption was also lower in the ketorolac group (31.9 mg) versus the lidocaine group (43.9 mg, P&lt;0.001). Conclusion: Preoperative ketorolac plus Nasocalcin nasal spray resulted in superior pain relief and less opioid use compared to lidocaine plus Nasocalcin after abdominal surgery. Ketorolac may be a more effective analgesic option, while Nasocalcin spray is a safe adjunct. These findings can inform clinical practice for optimizing postoperative analgesia.

Comparative Rates of Stroke and Rehospitalization of Atrial Fibrillation in Patients with Perioperative Atrial Fibrillation Following Major Emergency Abdominal Surgery and Patients with Non-perioperative Atrial Fibrillation.

Major emergency abdominal surgery is associated with postoperative complications and high mortality. Long-term outcomes in patients with perioperative atrial fibrillation (POAF) have recently received increased attention, especially POAF in non-thoracic surgery. This study aimed to compare long-term AF related hospitalization and stroke in patients with POAF in relation to major emergency abdominal surgery and in patients with non-perioperative AF. We crosslinked data from Danish nationwide registries and identified all patients who underwent major emergency abdominal surgery (2000-2018) and were diagnosed with POAF, and patients who developed AF in a non-perioperative setting. Patients with POAF were matched in a 1:5 ratio on age, sex, year of AF diagnosis and oral anticoagulation (OAC) status at the beginning of follow-up with patients with non-perioperative AF. From discharge, we examined adjusted hazard ratios (HR) of stroke using multivariable Cox regression analysis. The study population comprised 1,041 (out of 42,021 who underwent major emergency abdominal surgery) patients with POAF and 5,205 patients with non-perioperative AF. The median age was 78 years [interquartile range: 71-84] for those initiated on OAC therapy and 78 years [interquartile range: 71-85] for those not initiated on OAC therapy. During the first year of follow up, POAF was associated with similar rates of stroke as non-perioperative AF (patients initiated on OAC: HR 0.96 (95% confidence interval (CI) 0.52-1.77) and patients not initiated on OAC: HR 0.69 (95% CI 0.41-1.15). POAF in relation to major emergency abdominal surgery was associated with similar rates of stroke as non-perioperative AF. These results suggest that POAF not only carry an acute burden but also a long-term burden in patients undergoing major emergency abdominal surgery.

Efficacy of a pre-operative anaemia clinic in patients undergoing elective abdominal cancer surgery.

Pre-operative iron deficiency anaemia (IDA) is common in patients undergoing elective major abdominal surgery and is associated with increased risk of perioperative complications. However, widespread implementation of pre-operative anaemia management is lacking. Guidelines recommend investigation of anaemia preferably 4-6 weeks before surgery to allow time for correction. However, this is not always feasible in abdominal cancer surgery with short time to surgery and may be influenced by concomitant chemotherapy. The objective of this study was to assess the efficacy of implementing a pre-operative screening and treatment programme for IDA in elective abdominal cancer surgery patients, with short duration to surgery and concomitant use of chemotherapy. All patients scheduled for elective abdominal cancer surgery with IDA were included. Anaemia was defined according to the World Health Organization-criteria and iron deficiency as a transferrin saturation <0.20. The primary outcome was change in haemoglobin (Hb) between iron infusion and surgery in patients receiving pre-operative intravenous iron infusion. Of 178 diagnosed IDA patients 134 (75%) received intravenous iron, 103 pre-operatively (58%) at median day 17 (interquartile range: 9-27) before surgery while 31 (17%) received post-operative intravenous iron treatment. The pre-operative Hb increased 0.89 g/dL (95% CI: 0.64-1.13, p < .001) compared to a decrease of 0.4 g/dL (95% CI: 0.19-0.58, p < .001) in 75 patients not treated pre-operatively. Patients diagnosed with severe anaemia had the largest pre-operative Hb increase. Iron infusion >2 weeks pre-operatively resulted in a greater Hb increment of 1.13 g/dL (95% CI: 0.81-1.45) compared to iron infusion ≤2 weeks before surgery 0.48 g/dL (95% CI: 0.16-0.81). Hb increased by 0.64 g/dL (95% CI 0.19-1.21) in patients receiving chemotherapy ≤31 days prior to surgery. In patients scheduled for abdominal cancer surgery, including in patients with concomitant chemotherapy, pre-operative IDA management is feasible and results in a significant pre-operative Hb increase compared to patients not treated. On the day of surgery 25% patients treated pre-operatively were no longer anaemic.

309 Antibiotic Usage in Abdominal Surgery Patients in Colorectal, Hepatobiliary and Upper Gastrointestinal Surgery

309 Antibiotic Usage in Abdominal Surgery Patients in Colorectal, Hepatobiliary and Upper Gastrointestinal Surgery

Risk factors for PPCs in laparoscopic non–robotic vs. laparoscopic robotic abdominal surgery (LapRas): rationale and protocol for a patient–level analysis of LAS VEGAS and AVATaR

IntroductionPostoperative pulmonary complications (PPCs) vary amongst different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non–robotic versus laparoscopic robotic abdominal surgery. Methods and analysisLapRas (Risk Factors for PPCs in Laparoscopic Non–robotic vs Laparoscopic robotic abdominal surgery) incorporates harmonized data from 2 observational studies on abdominal surgery patients and PPCs: ‘Local ASsessment of VEntilatory management during General Anaesthesia for Surgery’ (LAS VEGAS), and ‘Assessment of Ventilation during general AnesThesia for Robotic surgery' (AVATaR). The primary endpoint is the occurrence of one or more PPCs in the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay and in–hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non–robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the two groups are driven by differences in duration of anesthesia and/or the intensity of mechanical ventilation. Ethics and disseminationThis analysis will address a clinically relevant research question comparing laparoscopic and robotic assisted surgery. No additional ethical committee approval is required for this metanalysis. Data will be shared with the scientific community by abstracts and original articles submitted to peer-reviewed journals. RegistrationThe registration of this post-hoc analysis is pending; individual studies that were merged into the used database were registered at clinicaltrials.gov: LAS VEGAS with identifier NCT01601223, AVATaR with identifier NCT02989415.

Relationship Between Length of Surgery and Shivering in Postoperative Abdominal Surgery Patients

Relationship Between Length of Surgery and Shivering in Postoperative Abdominal Surgery Patients

Study of senile astheny markers against the background of acute inflammatory process in elderly and senile patients in emergency abdominal surgery

The aim of our work was to determine the influence of the acute inflammatory process on the diagnostic value of markers of senile asthenia in emergency abdominal surgery. Material and methods. The basis of the work included 92 (100.0 %) patients, the average age in the entire group was 72.0 ± 2.3 years. All patients were divided into three groups: group A – 32 (34.8 %) patients with acute surgical pathology and confirmed senile asthenia syndrome. The group included 15 (16.3 %) patients with acute cholecystitis and 17 (18.5 %) with perforation of a gastric or duodenal ulcer. Group B included 30 (32.6 %) people with acute surgical pathology, which was statistically comparable in terms of the number of surgical diagnoses to group A, but without asthenia. To determine the reliability of the inflammatory process influence on markers of senile asthenia, we formed group C – 30 (32.6 %) patients without acute surgical pathology, but with the syndrome of senile asthenia. Based on the literature analysis, we selected markers of malnutrition syndrome: total protein, albumin and cholesterol levels, and the marker of sarcopenia – somatotropic hormone. Results. Based on the comparison of the obtained results, we found a decrease in the level of total protein in groups A and C, which was not significantly different, p = 0.2519, U = 372.0. Whereas when comparing groups, A and B, a significant decrease was found in the group of patients with asthenia (A) – p = 0.0009, U = 224.0. The same data were obtained when comparing the level of albumin; in groups A and C the level of albumin was reduced but did not differ significantly between groups – p = 0.1932, U = 361.5, whereas comparing groups with senile asthenia syndrome (group A) and without it (group B), a significant difference was found – p = 0.0072, U = 268.0. When determining the cholesterol level, we did not find a significant difference between the groups with asthenia (A and C) – p = 0.0614, U = 323.0, as well as between the groups with asthenia and without asthenia with acute inflammation (A and B) – p = 0.01646. It was determined that the level of somatotropic hormone in the groups with asthenia (A and C) was equally low – p = 0.9646, U = 466.5, while when comparing the group with and without asthenia (A and B), a significant decrease in this hormone was found in group A – p = 0.0030, U = 248.5. Conclusions. The absence of acute inflammatory process influence on the diagnostic value of the studied markers of senile asthenia in the groups was determined. When comparing the results between group A (acute surgical pathology + senile asthenia syndrome) and group B (acute surgical pathology without senile asthenia syndrome), a significant decrease in the level of total protein, albumin, and somatotropic hormone was revealed, p = 0.0009, p = 0.0072 and p = 0.0030, respectively, while when comparing groups with asthenia (A and C) no significant difference was found, p = 0.2519, p = 0.1932 and p = 0.9646. The level of total cholesterol cannot be used as a marker for the diagnosis of senile asthenia in emergency abdominal surgery, as there are a significant number of factors that directly affect the results of the diagnosis. Comparison of the results of the groups with asthenia and without asthenia on the background of acute inflammatory process (A and B) showed no significant difference, p = 0.1646. The same negative results were obtained when evaluating groups with asthenia (A and C) – p = 0.0614.

Assessment of sleep quality in patients after abdominal surgery

ABSTRACT Objectives: Evaluating the sleep quality of patients after abdominal surgery at the General Surgery Department, Hue Central Hospital Base 2. Investigating some factors related to the sleep quality of the study subjects. Methods: Description of a cross-sectional study on 92 post-abdominal surgery patients at the Hospital from February 1, 2023, to August 31, 2023, using a single random sampling method. Results: The average sleep quality score of post - abdominal surgery patients on the second day was moderate (84.31 ± 30.16). Factors influencing patients’ sleep quality such as postoperative pain, level of anxiety, and the impact of the care environment were statistically significant (p &lt; 0.05) and had a 64.1% influence (correlation coefficient R = 0.641; p &lt; 0.001) on the sleep quality on the second night after surgery (F = 55.25; p &lt; 0.001). Among these factors, the highest influencing factor on sleep quality in post-abdominal surgery patients was the level of anxiety (β = -0.42; p &lt; 0.001). Conclusion: Developing patient - centered care programs focusing on improving sleep hygiene, enhancing access to sleep treatment methods, and educating patients about the benefits of good sleep

Changes Anxiety in Patients Preoperative Abdominal Surgery After Giving a Combination of Benson Relaxation and Dhikr

Background: Surgery is a medical procedure that aims to save lives and prevent disability by making an incision in the part of the body to be repaired. One type of major surgery is abdominal surgery. Surgery can cause a psychological response in patients. Anxiety is a psychological response that usually occurs in preoperative abdominal surgery patients. One of the ways to handle anxiety is with non-pharmacological techniques in the form of the Benson and Dhikr methods. Objective: To determine the effect of the combination of the Benson and Dhikr methods on anxiety levels in preoperative abdominal surgery patients at RSUD Dr. Moewardi Surakarta. Methods: This study used a pre-experimental research type with a one-group pretest-posttest design. The sample of this study consisted of 32 preoperative abdominal surgery patients with anxiety at RSUD Dr. Moewardi Surakarta. Sampling technique with purposive sampling. Results: After carrying out the Wilcoxon Signed Rank Test, the results obtained a significance of 0,000 (p-value&lt;0,05). Conclusions: There is a combined effect of the Benson and Dhikr methods on the level of anxiety in preoperative abdominal surgery patients at RSUD Dr. Moewardi Surakarta.

Effectiveness of Accupressure on Post Operative Nausea and Vomiting in Post Abdominal Surgery Patients A Systematic Review

Surgery is a form of medical therapy that can cause stress because it poses a threat to a person's body, integrity and soul (Mazzotta et al., 2020). The surgical process is also often associated with high treatment costs, infectious complications, perioperative nausea and vomiting (PONV), and readmissions (Carmichael et al., 2017). An integrated and continuous nursing care process can make a difference between a negative or positive surgical experience and can influence the client's recovery process (Abeles et al., 2017). Complementary therapy is known as traditional therapy combined in modern medicine. Complementary is the use of traditional therapy into modern medicine (Tóth et al., 2018). Some have been scientifically proven, for example, touch therapy to increase relaxation, reduce pain, reduce anxiety, speed up wound healing, and make a positive contribution to psychoimmunological changes (Niu et al., 2021). So it is necessary to carry out a systematic review of complementary therapies, especially acupressure, which is used to treat complaints of nausea and vomiting in post-abdominal surgery patients to identify the effectiveness of acupressure therapy for post-operative nausea and vomiting in post-abdominal surgery patients. The research design that will be carried out is a systematic review using the PRISMA flow diagram. Researchers used PIO and searched for articles that were in English and published from 2013 to November 2023. The databases used were Proquest, Pubmed, Sage, Clinical Key Nursing, Science Direct and Google Scholar. Researchers use the Covidence tool to carry out the data selection process through to extraction and use the CASP instrument to evaluate research articles. Eight articles were identified and analyzed. Five articles used an RCT design, one article used a Prospective Cohort design, and one article used a semi-experimental design. The sample size of the reported studies ranged from 60 to 227 people conducted in various geographic regions such as Turkey, Iran and China. Acupressure therapy used at several points has been proven to help reduce PONV in post-abdominal surgery patients. Acupressure therapy can reduce PONV complaints in post-abdominal surgery patients.

Benefits of dexmedetomidine during noninvasive mechanical ventilation in major abdominal surgery patients with postoperative respiratory failure.

The efficacy of non-invasive mechanical ventilation (NIMV) on the postoperative ARF is conflicting and the failure rate of NIMV in this patient population is high. In our study, we hypothesized that the use of dexmedetomidine during NIMV in major abdominal surgical patients can reduce NIMV failure without significant side affect. Medical records of patients who underwent major abdominal surgery, admitted to our general surgery intensive care unit (ICU), developed postoperative ARF, received NIMV (with oro-nasal mask) and dexmedetomidine infusion were enrolled in this study. The infusion rate was adjusted to maintain a target sedation level of a Richmond Agitation-Sedation Scale (RASS) (-2)-(-3). The sedation was stopped when NIMV was discontinued. A total of 60 patients, 42 (70.0%) male, and 18 (30.0%) female, with a mean age of 68 ± 11 years were included in the study. The mean APACHE II score was 20 ± 6. Dexmedetomidine was infused for a median of 25 h (loading dose of 0.2 mcg/kg for 10 min, maintained at 0.2-0.7 mcg/kg/h, titrated every 30 min). RASS score of all study group significantly improved at the 2 h of dexmedetomidine initiation (+3 vs. -2, p = 0.01). A targeted sedation level was achieved in 92.5% of patients. Six (10.0%) patients developed bradycardia and 5 (8.3%) patients had hypotension. The mean NIMV application time was 23.4 ± 6.1 h. Seven (11.6%) patients experienced NIMV failure, all due to worsening pulmonary conditions, and required intubation and invasive ventilation. Fifty-three (88.3%) patients were successfully weaned from NIMV with dexmedetomidine sedation and discharged from ICU. The duration of NIMV application and ICU stay was shorter in NIMV succeded group (21.4 ± 3.2 vs. 29.9 ± 6.4; p = 0.012). Our study suggests that dexmedetomidine demonstrates effective sedation in patients with postoperative ARF during NIMV application after abdominal surgery. Dexmedetomidine can be considered safe and capable of improving NIMV success.

Interventional Intensive Care in Postoperative Period of Gastric Surgical Repair Due to Perforated Peptic Ulcer Disease : A Case Report

Introduction: Perforated peptic ulcer is the most common indication for emergency gastric surgery. good management of postoperative peptic ulcer perforation patients in the ICU will reduce patient mortality rates. Case presentation A 76-year-old male patient presented with a major complaint of pain throughout the abdomen that had worsened since 1 day, the abdominal pain had been felt for 4 days before admission. The patient had a history of painkiller drug consumption routinely for 3 years. The patient’s vital signs were normal, with a qSOFA score 1 and a VAS score 5. Abdominal physical examination showed the abdominal distended, no visible contour and no visible peristaltic, decreased bowel sound, and there is tenderness and rebound tenderness at the whole abdomen Patient was taken up for emergency laparostomy, then the patient underwent diagnostic laparoscopic in an elective setting with intraoperative findings of gastric perforation, then patient continued with the gastric repair. In the postoperative period, the patient was treated in the ICU of Dr. M. Djamil General Hospital. Conclusion: Intensive care management for post-gastric repair surgery patients is generally the same as for other abdominal surgery patients. The intensive care management needs comprehensive treatment, starting from oxygen therapy, monitoring, analgesia, fluid therapy, antibiotic therapy, glycemic control, and nasogastric tube nutrition.

Role of Prophylactic Negative Pressure Dressings in Determining the Surgical Site Infection (SSI) on Closed Laparotomy Wounds in Abdominal Surgery: Randomized Controlled Open Label Trial: Vacuum Assisted Closure (VAC) Trial in a Tertiary Care Setup

Background: Surgical site infections (SSIs) continue to pose a significant challenge in postoperative care, particularly in abdominal surgeries, due to their prevalence and the associated increase in morbidity, mortality, and healthcare costs. Despite advancements in surgical techniques and aseptic measures, the incidence of SSIs remains high, underscoring the need for innovative preventive strategies. Objective: This study aims to evaluate the efficacy of vacuum-assisted closure (VAC) dressings compared to standard dressing methods in reducing the incidence of surgical site infections in patients undergoing closed laparotomy wounds in abdominal surgeries. Methods: A randomized controlled trial was conducted over six months at Civil Hospital Karachi, involving 116 patients undergoing abdominal surgeries. Participants were randomly assigned to receive either the VAC dressing or standard dressing postoperatively. The primary outcome measured was the incidence of SSIs within 30 days post-surgery, evaluated using the CDC classification and Southampton wound grading system. Data were analyzed using SPSS version 25.0, employing descriptive statistics, independent t-tests, and Chi-square tests for continuous and categorical variables, respectively. Results: The VAC group demonstrated a significantly lower incidence of SSIs (13.8%) compared to the non-VAC group (96.6%), with statistical significance (p &lt; 0.001). Age and BMI showed significant differences between the groups; patients in the VAC group were younger (mean age 30.84 ± 10.71 years) and had a lower BMI (mean 19.69 ± 4.16 kg/m²) compared to the non-VAC group (mean age 37.31 ± 12.83 years, mean BMI 22.07 ± 4.41 kg/m²). The duration of surgery and length of incision did not significantly differ between the groups. Conclusion: The use of vacuum-assisted closure dressings significantly reduces the incidence of surgical site infections in abdominal surgery patients, offering a superior alternative to standard dressings. This method not only enhances patient outcomes but could also lead to a reduction in healthcare costs by minimizing complications associated with SSIs.

Efficacy of intratracheal dexmedetomidine on recovery from general anaesthesia in paediatric patients undergoing lower abdominal surgeries: A randomised controlled trial.

This study investigated the effectiveness of intratracheal dexmedetomidine in reducing untoward laryngeal responses in paediatrics undergoing lower abdominal surgeries. This trial included 60 patients divided into two groups scheduled for lower abdominal surgeries. Group D were given intratracheal dexmedetomidine at a dosage of 0.5mg/kg, while Group C received intratracheal saline (0.9%). The cough severity score, the Paediatric Objective Pain Scale for pain assessment, awareness, extubation, emergence agitation score, Ramsay sedation score and adverse effects were recorded. There was a significant difference in the incidence of coughing severity between Groups D and C both at extubation and after five minutes of extubation (p < 0.001). The median scores of the Paediatric Objective Pain Scales and the median agitation scales of Group D were significantly lower over the first four hours (p < 0.050). The mean time to first request rescue analgesia was significantly longer in the D group than in the control group (p < 0.001). The mean total consumption of rescue analgesia in the first 24 hours postoperatively was significantly lower in the dexmedetomidine group (p < 0.050). Awareness and extubation times were comparable in both groups, and none of the subjects reported any adverse effects. In the current study, lower abdominal surgery patients who received intratracheal dexmedetomidine at a dose of 0.5mg/kg 30 minutes before the completion of the procedure experienced smooth extubation and balanced anaesthetic recovery.

Exploring the Severity of Kinesiophobia at Hospital Discharge in Patients Undergone Abdominal Surgery

Abstract Objective: The objective of the study was to explore the severity of kinesiophobia at hospital discharge in individuals undergone abdominal surgery by using the Tampa Scale of Kinesiophobia-11 (TSK-11). Materials and Methods: A cross-sectional observational study was carried out in a tertiary care hospital. Purposive sampling was used to select the individuals. A total of 80 participants (n = 80) were included in the study. The subjects were given the Marathi version of TSK-11. All responses were collected and statistically analyzed. Results: There were 80 participants in this study, from which 70% displayed combined “Low” and “Moderate” kinesiophobia levels. This data were collected on the day of discharge, which varied because each of the patients had different lengths of stay. The severity of kinesiophobia in these individuals displayed low-to-moderate levels of kinesiophobia due to the tolerance of pain as it differs from individual to individual. Conclusions: The study reveals that low-to-moderate kinesiophobia is common after abdominal surgery. Treatment of kinesiophobia can increase patient well-being and recovery through individualized therapy, early intervention, and psychological support. This study adds insight into postabdominal surgery kinesiophobia, highlighting varying severity levels within this population. Detecting and treating kinesiophobia in abdominal surgery patients can result in customized rehab, fewer complications, and improved health outcomes, promoting overall recovery.

Pulse pressure variation guided goal-direct fluid therapy decreases postoperative complications in elderly patients undergoing laparoscopic radical resection of colorectal cancer: a randomized controlled trial

ObjectiveThe use of goal-directed fluid therapy (GDFT) has been shown to reduce complications and improve prognosis in high-risk abdominal surgery patients. However, the utilization of pulse pressure variation (PPV) guided GDFT in laparoscopic surgery remains a subject of debate. We hypothesized that utilizing PPV guidance for GDFT would optimize short-term prognosis in elderly patients undergoing laparoscopic radical resection for colorectal cancer compared to conventional fluid therapy.MethodsElderly patients undergoing laparoscopic radical resection of colorectal cancer were randomized to receive either PPV guided GDFT or conventional fluid therapy and explore whether PPV guided GDFT can optimize the short-term prognosis of elderly patients undergoing laparoscopic radical resection of colorectal cancer compared with conventional fluid therapy.ResultsThe incidence of complications was significantly lower in the PPV group compared to the control group (32.8% vs. 57.1%, P = .009). Additionally, the PPV group had a lower occurrence of gastrointestinal dysfunction (19.0% vs. 39.3%, P = .017) and postoperative pneumonia (8.6% vs. 23.2%, P = .033) than the control group.ConclusionUtilizing PPV as a monitoring index for GDFT can improve short-term prognosis in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Registration numberChiCTR2300067361; date of registration: January 5, 2023.

Prevalence of Delirium After Abdominal Surgery and Association With Ketamine: A Retrospective, Propensity-Matched Cohort Study.

Delirium is a common postoperative complication for older patients in the ICU. Ketamine, used primarily as an analgesic, has been thought to prevent delirium. Determine the prevalence and association of delirium with low-dose ketamine use in ICU patients after abdominal surgery. Single-center, retrospective, propensity-matched cohort study. Eight hospital academic medical center. Cohort comprising 1836 patients admitted to the ICU after abdominal surgery between June 23, 2018 and September 1, 2022. Propensity score matching (PSM) with a 3:1 ratio between no-ketamine use and ketamine use was performed through a greedy algorithm (caliper of 0.005). Outcomes of interest included: delirium (assessed by Confusion Assessment Method-ICU), mean pain score (Numeric Pain Scale or Critical Care Pain Observation Tool score as available), mean opioid consumption (morphine milligram equivalents), length of stay (d), and mortality. Prevalence of delirium was 47.71% (95% CI, 45.41-50.03%) in the cohort. Of 1836 patients, 120 (6.54%) used low-dose ketamine infusion. After PSM, the prevalence of delirium was 56.02% (95% CI, 51.05-60.91%) in all abdominal surgery patients. The ketamine group had 41% less odds of delirium (odds ratio [OR] = 0.59; 95% CI, 0.37-0.94; p = 0.026) than patients with no-ketamine use. Patients with ketamine use had higher mean pain scores (3.57 ± 2.86 vs. 2.21 ± 2.09, p < 0.001). In the subgroup analysis, patients in the ketamine-use group 60 years old or younger had 64% less odds of delirium (OR = 0.36; 95% CI, 0.13-0.95; p = 0.039). The mean pain scores were higher in the ketamine group for patients 60 years old or older. There was no significant difference in mortality and opioid consumption. Low-dose ketamine infusion was associated with lower prevalence of delirium in ICU patients following abdominal surgery. Prospective studies should further evaluate ketamine use and delirium.

Impact of wearable wireless continuous vital sign monitoring in abdominal surgical patients: before-after study.

Technological advances have enabled continuous monitoring of vital signs (CMVS) by wearable, wireless devices on general hospital wards to facilitate early detection of clinical deterioration, which could potentially improve clinical outcomes. However, evidence on the impact of these CMVS systems on patient outcomes is limited. This research aimed to explore the effect of CMVS on the clinical outcomes in major abdominal surgery patients in a general surgery ward. A single-centre before-after study was conducted from October 2019 to June 2022. Patients in the intervention group received CMVS in addition to conventional intermittent vital sign monitoring (standard care for control group). With CMVS, heart rate and respiratory rate were measured every 5 min by a patch sensor. Proactive vital signs trends assessments and, when necessary, subsequent nursing activities were performed every nursing shift. The primary outcome of interest was the length of hospital stay (LOS); also, 12 patient-related outcomes were analysed. In the CMVS group, follow-up nursing activities of deviating vital signs trends were described and patient acceptability was measured. Post-hoc subgroup analysis was performed for colorectal and hepatopancreatobiliary surgery. A total of 908 patients were included (colorectal: n = 650; hepatopancreatobiliary: n = 257). Overall, median LOS was lower in the CMVS group (5.0 versus 5.5 days; P = 0.012), respectively. Post-hoc subgroup analysis showed this reduction in LOS was mostly observed in the colorectal group and not in the hepatopancreatobiliary group. Apart from a decrease in nurse-to-house-officer calls (from 15.3% to 7.7%; P = 0.007), all secondary clinical outcomes were similar in CMVS and control groups. However, a non-significant trend towards less-severe complications and reduced ICU LOS was observed in the CMVS group. In CMVS patients, 109 additional nursing activities were performed and 83% of patients indicated CMVS was acceptable. CMVS was associated with a significant reduction in LOS, while other clinical outcomes were unchanged. CMVS triggered additional nursing activities such as extra patient assessments and therapeutic interventions.