Average Postoperative Day Research Articles

Analgesic Consumption Following Outpatient Carpal Tunnel Release

INTRODUCTION: After elective outpatient carpal tunnel surgery, patients’ need for opioid analgesic medication may be considerably less than typically dispensed. Few reports have examined actual consumption after elective surgery. A better understanding of actual opioid consumption after elective upper extremity surgery may lead to improve prescribing practices and less leftover medication available for diversion. Our goal for this study was to evaluate pain control and quantify the amount of leftover pain medication. MATERIALS AND METHODS: A prospective review for elective outpatient carpal tunnel surgery was performed independently by two main authors (B.P, AI). All patients failed conservative treatments. All carpal tunnels were released using short scar techniques and patients were encouraged to remove their dressing on the first post-operative day. Patients were also encouraged to shower on the first post-operative day. Information collected included age, gender, procedure performed, side, analgesic medication and regimen prescribed, satisfaction with pain control, number of tablets remaining, immediate post-operative pain, pain on post operative day one and two, satisfaction, post operative splinting, complications reasons for not taking medication, and other analgesic medications used. Exclusion criteria included patients with pervious upper extremities surgery or acute/chronic pain. RESULTS: A total of 56 were initially enrolled in this study. Of these, 7 patients did not meet the inclusion criteria, which left 49 patients who completed the study. The average age was 57.04 (18-88 years-old). Sixty-six percent of patients were female. Tylenol # 3 and Tramacet accounted for all post-operative analgesic prescription. Patients most frequently received 40 pills. The satisfaction rate was 98%. The average number of Tylenol # 3 consumed was 10.46 (0-40 tablets). More than half of patients consumed less than 2 tablets. The average post-operative days for consumption of analgesic were 2.33 (0-7 days). Only one patient continued to complain of continued post-operative pain and numbness. Only 5 patients continued to wear their pre-operative splint for average of 2 weeks. Overall there was a total 1,531 leftover tablets for the entire cohort. CONCLUSION: Our data shows that excess prescribed analgesics are made available after elective carpal tunnel surgery and could potentially become a source for diversion. A prescription of 40-50 opioid pills for outpatient surgery appears excessive and unnecessary.

53 SURGICAL SITE INFECTIONS IN UROLOGIC SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 201253 SURGICAL SITE INFECTIONS IN UROLOGIC SURGERY Lee C. Zhao, James M. Dupree, Brian V. Le, Marc Bjurlin, and Shilajit Kundu Lee C. ZhaoLee C. Zhao Chicago, IL More articles by this author , James M. DupreeJames M. Dupree Chicago, IL More articles by this author , Brian V. LeBrian V. Le Chicago, IL More articles by this author , Marc BjurlinMarc Bjurlin Chicago, IL More articles by this author , and Shilajit KunduShilajit Kundu Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.098AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Entering the urinary tract during urologic surgery may increase risk for surgical site infections (SSI). We evaluated the rate and risk factors for SSIs in common major urologic procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is a risk-adjusted data collection mechanism for analyzing clinical outcomes data including 30-day peri-operative complications. Using NSQIP data from 2005 to 2009, we identified patients who underwent cystectomy, laparoscopic (LPx) and open prostatectomy (OPx), laparoscopic (LPNx) and open radical partial nephrectomy (OPNx), and laparoscopic (LNx) and open (ONx) radical nephrectomy. Rates of superficial, deep, and organ space SSI were investigated. RESULTS From 2005-2009, 5,378 cases were identified. Superficial SSI was found in 1.6% of urologic cases. Deep incisional infections and organ space SSI were rare (0.3% and 0.7%, respectively). Cystectomy had the highest rate of SSI at 13.4%. Patients with SSI were older (age 63.7 vs 61.5), more likely to be smokers (3.6% vs 2.3%), had higher BMI (30.8 vs 28.9), and longer operative time (261 vs 202 minutes). Length of stay was increased for patients with infectious complications (see Table 1). The average post-operative day of occurrence for superficial, deep, and organ space SSI was day 13, 11, and 15, respectively. The rate of SSI was lower for laparoscopic prostatectomy compared to open (0.9% vs 2.0%, p = 0.007), and for laparoscopic partial nephrectomy compared to open (0.8% vs 4.0%, p = 0.01). There was a trend towards lower SSI for laparoscopic nephrectomy, but this did not reach statistical significance (2.0% vs 3.7%, p = 0.08). Table 1. Procedure N Superficial SSI Deep SSI Organ Space SSI Any SSI LOS without SSI LOS with SSI Cystectomy 343 31(9.0%) 2(0.5%) 15(4.4%) 46(13.4%) 11.1 days 16.6 days LPx 2205 13(0.6%) 1(0.0%) 5(0.2%) 19(0.9%) 1.8 days 3.9 days OPx 888 12(1.4%) 4(0.4%) 3(0.3%) 18(2.0%) 3.0 days 5.1 days LPN 261 0(0.0%) 1(0.4%) 1(0.4%) 2(0.8%) 3.2 days 6.5 days OPN 405 7(1.7%) 4(1.0%) 7(1.7%) 16(4.0%) 5.3 days 20.9 days LNx 824 13(1.6%) 3(0.4%) 1(0.1%) 17(2.0%) 4.5 days 7.6 days ONx 460 11(2.4%) 2(0.4%) 5(1.1%) 17(3.7%) 6.9 days 13.2 days CONCLUSIONS Surgical site infections were rare overall at 1.6% of all major urologic cases, but most common for cystectomy. The frequency of SSI was low for nephrectomy and prostatectomy, and laparoscopic procedures appear to have lower rates of SSIs compared open procedures. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e22-e23 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lee C. Zhao Chicago, IL More articles by this author James M. Dupree Chicago, IL More articles by this author Brian V. Le Chicago, IL More articles by this author Marc Bjurlin Chicago, IL More articles by this author Shilajit Kundu Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Comparison between transumbilical and transabdominal ports for the laparoscopic retrieval of benign adnexal masses: a randomized trial

Objective To compare the feasibility, operative time, specimen retrieval time, and effect on postoperative pain of laparoscopic retrieval of benign adnexal masses between a 10-mm transumbilical and a 10-mm transabdominal port. Study design Fifty women with adnexal masses who were scheduled for a laparoscopic procedure between July 2008 and April 2009 were enrolled. The patients were randomized into two groups; these were patients where a transumbilical port was used for specimen retrieval (transumbilical group, n = 25) and patients where a transabdominal port was used for specimen retrieval (transabdominal group, n = 25). Preoperative suspicion of malignancy and indications suggesting a need for hysterectomy or myomectomy were considered to be exclusion criteria. Randomization was centralized and computer-based. Patients recorded the severity of incisional pain on a visual analog scale (VAS) with 0 meaning no pain and 10 meaning unbearable pain. Results There were no significant differences in age, body mass index, umbilical thickness, abdominal thickness, cyst size, cyst amount, cyst weight, histology, complications and duration of hospital stay when the two groups were compared. Patients in the transumbilical group had a significantly shorter specimen retrieval time (0.7 ± 1.8 min vs. 4.9 ± 12.6 min, p = 0.006) and a significantly lower postoperative day (POD) 0 VAS pain score (5.2 ± 2.1 vs. 6.6 ± 2.2, p = 0.015). Significantly fewer patients in the transumbilical group had a specimen retrieval time of ≥10 min (0% vs. 20%, p = 0.025) and a POD 0 VAS pain score of >5 (36% vs. 84%, p < 0.001). However, the average POD 1 VAS pain score (3.2 ± 1.8, vs. 3.6 ± 1.6) and the proportion with a POD 1 VAS pain score >5 (12% vs. 12%) were similar for the two groups. Conclusion When laparoscopic surgery on benign adnexal masses is carried out using a 10-mm incision wound, removal of the specimen via the umbilical port has a shorter retrieval time and produces less postoperative pain than retrieval via a lateral abdominal port.

3D Analysis of Breast Augmentation Defines Operative Changes and Their Relationship to Implant Dimensions

Breast augmentation is one of the most common plastic surgery procedures performed in the United States today. Evaluation of postoperative results lacks true objective measurements. The following study reports the application of 3-dimensional (3D) photography to document changes that occur in breast morphology after breast augmentation. Patients undergoing augmentation mammaplasty with a periareolar incision were offered pre- and postoperative 3D photographs. 3D models were constructed and the following parameters were assessed: maximum anterior-posterior projection from the chest wall, angle of breast projection, total breast volume, volumetric tissue distribution in the superior and inferior poles, and surface and vector distance measurements to key landmarks. A completed series of 3D images were obtained from 14 augmentation patients (28 breasts) at an average postoperative day of 143. Saline and silicone implants were used equally (n = 14 for each). Total volume of the breast changed in correlation with the implant size (1.9% difference, P = 0.83). There were no significant changes in the volumetric distribution within the upper and lower poles of the breasts noted between pre- and postoperative scans (P = 0.81). The internal angle of breast projection was found to increase (13.6 degrees, P < 0.01), as did the sternal notch to nipple distance (11 mm, P = 0.018). Anterior-posterior projection significantly increased by 23.3 mm. However, this increase in projection was 20.9% less than expected based on implant dimensions (72.7-58.7 mm, respectively, P < 0.01). This study documents objective changes in breast morphology after augmentation mammaplasty. 3D imaging scans were able to document true changes that occur with breast augmentation including breast volume, the increase in the internal angle of the breast projection, and the sternal notch to nipple distance. 3D photography further highlighted that breast augmentation results in less than expected anterior-posterior projection, possibly due to tissue attenuation occurring anterior to the implant.

Costal Cartilage Tracheoplasty for Congenital Long-Segment Tracheal Stenosis

To evaluate and report the outcome of costal cartilage tracheoplasty for the treatment of congenital long-segment tracheal stenosis. Retrospective chart review. Academic tertiary care children's hospital. Consecutive series of 10 patients who presented with congenital long-segment tracheal stenosis. All patients underwent costal cartilage tracheoplasty while receiving cardiopulmonary bypass. Age at repair, weight at repair, length of stenosis, minimal diameter of stenosis, postoperative days receiving ventilator support, postoperative days until discharge, postoperative bronchoscopies, postoperative complications, associated anomalies, survival rate, and current status. There were 8 males and 2 females with an average age at repair of 18 weeks. Average weight was 5.2 kg. Average length of stenosis was 3.2 cm, and average minimal diameter was 1.9 mm. Average postoperative days receiving ventilator support was 17 with a median of 9.5. Average postoperative days until discharge was 35.2 with a median of 17. Average postoperative bronchoscopies was 18 with a median of 4.5. There was a 40% major postoperative complication rate. Seven of the patients had associated anomalies. No patient died from an inadequate tracheal airway, though 2 patients ultimately died from other cardiopulmonary complications for a survival rate of 80%. Average time since surgery for survivors is 8.0 years. Two patients still require treatment. Seven of the original 10 patients are fully active without tracheostomy. We report one of the largest series of costal cartilage tracheoplasty for congenital long-segment tracheal stenosis and one that has met with a relatively high success rate.

Vaginal Hysterectomy for Elective Sterilization

The records of 595 patients undergoing elective sterilization by vaginal hysterectomy between 1971-1974 at any army medical center were reviewed for age gravidity parity pathologic diagnosis complications additional procedures performed and length of postoperative stay. Average age gravidity and parity were 31 3.7 and 3.0 respectively. 27% had a pathologic diagnosis (12% fibroids 4.8% adenomyosis 4.4% dysplasia or carcinoma in situ of the cervix). This was not unexpected as many women selected hysterectomy because of minor menstrual irregularity or pelvic discomfort. The incidence of such findings increased with age but was unrelated to gravidity or parity. The overall complication rate was 23% comparing favorably with most series reported in the literature. There was no morbidity and only 1 patient had a pulmonary embolus. The febrile morbidity rate was 12.4% 29.7% of which was caused by urinary tract infection 25.6% by hematoma 17.6% by pelvic cellulitis 2.7% by cuff abscess and 4% by other problems. Incidence of complications was not correlated with age gravidity or parity. Additional procedures including posterior and anterior repair and salpingo-oophorectomy were performed in 9.7% of patients. All women were placed on prophylactic antibiotics prior to surgery and it is considered important to continue to monitor infection rates in case an antibiotic-resistant bacteria emerges. 8.4% of patients had bleeding complications which were found to increase when adnexal pathology was present or additional procedures performed. The average postoperative day of discharge was 5.56 for the entire series 6.7 for those with infectious complications and 7.34 for patients with bleeding complications.

Disruption of abdominal wounds.

A survey of disruption of abdominal wounds was made at a veterans hospital during the period 1953-1958. Among 8,277 major operations there were 3,988 procedures which might lead to wound separation. Appendectomies performed through a right lower quadrant musclesplitting incision were not included, as disruption with this incision did not occur during this period. Abdominalwound separation occurred in 109 instances. Ninety-three patients were over 50 years of age. The average postoperative day on which disruption occurred was the ninth. Eighty-seven disruptions followed operation for benign disease. Fifty-eight followed upper gastrointestinal tract surgery. The type of closure or suture material appeared not to affect development of disruption. Abnormal distention and coughing were major contributing factors. Twenty-four of 84 known survivors subsequently developed a ventral hernia.