Early Ambulation Research Articles

Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions.

Radial access (RA) may offer advantages in peripheral interventions, but previous studies on this approach have been limited to retrospective or single-center studies. Our aim was to prospectively evaluate the safety and feasibility of RA for complex endovascular lower extremity interventions. In this prospective, multicenter, and observational study, eligible patients with peripheral artery disease scheduled for intervention through RA were enrolled. Primary efficacy end point was procedural success, defined as successful completion of the intended procedure without conversion to femoral access and without RA complications periprocedure. Primary safety end point included evaluation of RA-related complications at 30 days. From June 2020 to June 2021, 120 patients at 8 US centers were enrolled. Mean age was 68.7 years, and 31.7% were women. The 224 lesions treated were in iliac (12.9%), femoropopliteal (55.3%), isolated popliteal (11.9%), and tibial (19.5%) vessels. The primary efficacy end point was achieved in 112 (93.3%) patients. One patient (<1%) required femoral access conversion to complete the procedure. Thirty (25.0%) patients required 1 or more additional access to facilitate crossing and/or to complete the planned treatment (5 femoral, 10 tibial, and 17 pedal accesses). No serious adverse events were adjudicated to the procedure. Mean procedure time and time to ambulation was 74 minutes and 3 hours 30 minutes; respectively, with 93.3% same-day discharge. At 30 days, 97.2% of patients recorded ultrasound-confirmed RA patency. This is the first prospective and multicenter registry to show the safety and efficacy of RA approach for complex endovascular lesions and multilevel disease. RA allowed early ambulation and same-day discharge with no serious adverse events. Future randomized trials should examine the clinical and cost effectiveness of this approach compared with those of femoral access for patients with peripheral artery disease.

Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices

Background Bed rest duration following deployment of a vascular closure device after transfemoral left-sided cardiac catheterization is not standardized. Despite research supporting reduced bed rest, many hospitals require prolonged bed rest. Delayed ambulation is associated with back pain, urine retention, difficulty eating, and longer stay. Objective To study length of stay, safety, and opportunity cost savings of reduced bed rest at a large urban hospital. Methods A single-site 12-week study of 1-hour bed rest after transfemoral cardiac catheterizations using vascular closure devices. Results were compared with historical controls treated similarly. Results The standard bed rest group included 295 patients (207 male, 88 female; mean [SD] age, 64.4 [8.6] years). The early ambulation group included 260 patients (188 male, 72 female; mean [SD] age, 64 [9.3] years). The groups had no significant difference in age (t634 = 1.18, P = .21) or sex (χ12=0.2, P = .64). Three patients in the standard bed rest group and 1 in the early ambulation group had hematomas (P = .36). The stay for diagnostic cardiac catheterizations was longer in the standard bed rest group (mean [SD], 220.7 [55.2] minutes) than in the early ambulation group (mean [SD], 182.1 [78.5] minutes; t196 = 4.06; P &amp;lt; .001). Stay for percutaneous coronary interventions was longer in the standard bed rest group (mean [SD], 400.2 [50.8] minutes) than in the early ambulation group (mean [SD], 381.6 [54.7] minutes; t262 = 2.86; P = .005). Conclusion Reduced bed rest was safe, shortened stays, and improved efficiency by creating opportunity cost savings.

A Network Meta-Analysis of Randomized Controlled Trials Assessing Intraoperative Anesthetic Therapies for Analgesic Efficacy and Morphine Consumption Following Total Knee Arthroplasty

BackgroundThe purpose of this study was to compare intraoperative anesthetic therapies for total knee arthroplasty (TKA) regarding postoperative analgesic efficacy and morphine consumption by conducting a systematic literature search. MethodsRandomized controlled trials of TKA using various anesthetic therapies were identified from various databases from conception through December 31, 2021. A network meta-analysis of relevant literature was performed to investigate which treatment showed better outcomes. In total, 40 trials were included in this study. ResultsSurface under the cumulative ranking curve showed local infiltration anesthesia (LIA) with saphenous nerve block (SNB) to produce the best pain relief on postoperative days (PODs) 1 and 2 and the best reduction of morphine consumption on PODs 1 and 3. However, femoral nerve block showed the largest effect on pain relief on POD 3, and liposomal bupivacaine showed the largest effect on reduction of morphine consumption on POD 2. ConclusionsAccording to this network meta-analysis, surface under the cumulative ranking curve percentage showed that LIA with SNB provided the best analgesic effect after TKA. Furthermore, patients receiving LIA with SNB had the lowest consumption of morphine. Although femoral nerve block resulted in better pain relief on POD 3, LIA with SNB could be selected first when trying to reduce morphine consumption or increase early ambulation.

Conventional and digital pleural drainage systems - advantages and disadvantages.

Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers.

Ultrasound-Guided Transversus Abdominis Plane Block Versus Intraperitoneal Instillation of Bupivacaine after Laparoscopic Cholecystectomy – A Randomized Control Trial

Background: Postoperative pain prolongs hospital stay after laparoscopic cholecystectomy and remains a major challenge during the postoperative period. Effective pain control encourages early ambulation, which significantly reduces postoperative complications. In recent years, multimodal analgesia has been recommended with fewer adverse effects and more effective analgesia. The primary objective of this study was to compare the efficacy of analgesia between Transversus Abdominis Plane Block (TAP) Block and intraperitoneal instillation of bupivacaine by comparing the meantime of the first dose of rescue analgesia in either group and the total supplementary analgesia required. Methods: This retrospective observational study was conducted on 150 patients who underwent laparoscopic cholecystectomy Group 1 comprised of patients who had received Intraperitoneal Bupivacaine for analgesia and Group 2 received TAP Block for pain relief. Results: Time of the first dose of analgesia after surgery was observed earlier in Group 1 as compared to Group 2 (Time – hours: 9.2 ± 2 vs. 12.3 ± 1.6; p = 0.0001. The Total dose of analgesic was higher in the Intra Peritoneal Bupivacaine Group as compared to the TAP group. Conclusion: AP block provided for a better quality of analgesia as assessed by the reduced requirement of intravenous supplementary analgesia which was less in patients who were given TAP Block as compared to local instillation of Bupivacaine. Keywords: Cholecystectomy, Bupivacaine, Transversus abdominis plane block

The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis

Background: Lower back pain is a common cause of disability that affects mobility and quality of life (QOL) in both adult and elderly patients. Initial management of lower back pain includes anti-inflammatory drugs, analgesics, physiotherapy, and epidural steroid infiltration. Despite multiple attempts of conservative management, if a patient develops refractory radicular pain with or without neurologic deficit and claudication, surgery is indicated. The two main approaches to surgical intervention include decompression (laminectomy only) and decompression with fusion [transforaminal lumbar interbody fusion (TLIF)].&#x0D; Methods: The study was done between May 2019 and November 2022. In this randomized study, we compared the clinical outcome of TLIF and laminectomy for single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis. Forty patients with single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis were randomly divided into two equal groups. Patients in both groups were followed up for 2 years.&#x0D; Results: In this study, we also noted estimated amount of blood loss, procedure time, time taken for ambulation, length of hospitalization, and demography. The Oswestry Disability Index (ODI) scores improved significantly postoperatively. The modified MacNab criteria suggest the outcomes rated as excellent/good rate of 90% in TLIF and 85% in laminectomy.&#x0D; Conclusion: We evaluated that TLIF procedures were associated with slightly more significant improvement in clinical outcomes in all of the scoring systems that were applied; TLIF provides early ambulation but a higher cost of treatment and longer hospital stay compared to laminectomy. Laminectomy procedures are associated with lesser economic burden, hospital stay, and blood loss, as well as shorter surgical duration compared to TLIF.

Contornando as dificuldades para alcançar o lúmen coronário a partir do acesso radial

Through the efforts of dedicated interventionists, catheterization of the cardiovascular system by transradial method has been recognized as the gold standard due to the several advantages associated with it, such as early ambulation, decline in bleeding and in various other vascular complications. It has successfully turned as an alternative to femoral access. The huge experience of interventionists has helped in understanding the anatomical impediments that can result in many technical issues and complications associated with the transradial approach. A trial-and-error method adopted by the interventionists on their learning curve at the cost of increased procedural failure, complications and patient inconvenience may not be justifiable. The objective of the present manuscript was to review all these difficulties, and understand the treatment method and various preventative strategies that can be used to overcome the complications.

Restoring vertebral height in the treatment of multilevel vertebral compression fractures with vertebroplasty

BackgroundOsteoporosis (OP) is the fourth leading cause of disability in the elderly. The challenges presented by OP fractures are complex. Vertebral body fractures (VCF) are frequently encountered in osteoporotic patients. Due to the predominant age group of osteoporotic VCF along with co-morbidities, restoring the vertebral body height and the correction of kyphosis via minimally invasive methods are preferred. Vertebroplasty continues to be the most commonly employed method in this selection. The purpose of this study is to provide evidence for the combined employment of vertebroplasty with other minimally invasive techniques in the treatment of osteoporotic VCF. A retrospective analysis of patients treated for multilevel thoracolumbar osteoporotic VCF was performed. The patients were treated with percutaneous vertebroplasty (PVP), transforaminal lumbar interbody fusion supplemented by vertebroplasty (TLIF-VP) and minimally invasive transpedicular screw fixation supplemented by vertebroplasty (TP-VP). They were followed up for at least a year and VAS and ODI scores along with the degree of kyphotic correction and restoration of vertebral body height have been evaluated.ResultsSixty patients with 132 levels of VCF treated were evaluated. PVP was superior in terms of shortened operative period, decreased blood loss, earlier ambulation and not requiring general anesthesia. Both TLIF-VP and TP-VP required general anesthesia, with longer operative period and increased blood loss, however it provided greater kyphotic correction. Restoration of vertebral body height was the highest in the PVP and TP-VP group. All patients benefited clinically from the interventions in regard to VAS pain and ODI scores.ConclusionsVP continues to be the choice for minimally invasive correction of osteoporotic VCF. VP can be employed with other techniques as seen in this study in selected patients with sufficient symptomology. TLIF implantation allowed for discectomy and sufficient root decompression while transpedicular screw fixation allowed for greater correction especially in the chronic fractures.

Enhanced Recovery After Surgery: Exploring the Advances and Strategies.

Enhanced recovery after surgery (ERAS) has emerged as a paradigm-shifting approach in perioperative care, aimed at optimizing patient outcomes, accelerating recovery, and minimizing hospital stays. This review delves into the latest advances and strategies within the field of ERAS, encompassing a comprehensive examination of preoperative, intraoperative, and postoperative interventions. By analyzing an array of clinical studies, meta-analyses, and implementation experiences, this review highlights the multifaceted elements contributing to the success of ERAS programs. Key components such as preoperative patient education, minimally invasive surgical techniques, tailored anesthesia protocols, judicious fluid management, optimized pain control, early ambulation, and structured nutritional support are thoroughly explored. Furthermore, the review delves into the intricacies of ERAS implementation across diverse surgical specialties, emphasizing the significance of multidisciplinary collaboration, protocol customization, and sustained quality improvement initiatives. The analysis not only showcases the tangible benefits of ERAS, including reduced complication rates, shortened hospital stays, and enhanced patient satisfaction, but also underscores the challenges and barriers that medical professionals encounter during program adoption. By synthesizing the current state of ERAS research and practice, this review provides clinicians, administrators, and researchers with valuable insights into the evolving landscape of perioperative care, fostering a deeper understanding of ERAS as a holistic approach that transcends traditional surgical pathways.

The effect of bed exercises following major abdominal surgery on early ambulation, mobilization, pain and anxiety: A randomized-controlled trial.

This randomized-controlled trial aimed to investigate the effect of bed exercises on postoperative anxiety, pain, early ambulation and mobilization. This study was conducted with a randomized-controlled trial design and in the general surgical clinic of a research and training hospital. A total of 120 patients (60 in the experimental group and 60 in the control group) scheduled for major abdominal surgery took part in the study. The data were collected using a patient information form, the Anxiety Specific to Surgery Questionnaire and the Visual Analog Scale through face-to-face interviews. The patients in the experimental group performed 15-min bed exercises on the day of their operation, as well as on the postoperative first and second days, and the control group underwent only the routinely performed procedures in the clinic. The data were analysed using descriptive statistics, analysis of variance and t-tests. The sample of our study included major abdominal surgery patients. Ambulation was achieved at a mean time of 4 h earlier in the experimental group. On the postoperative first and second days, the patients in the experimental group had mean mobilization durations that were approximately 2 h longer compared with the patients in the control group. Moreover, the postoperative pain and anxiety levels of the patients in the experimental group were significantly lower than those of the patients in the control group (p < 0.05). We recommend that bed exercises be performed to lower anxiety and pain severity, achieve early ambulation and increase the duration of mobilization among patients following major abdominal surgery.

Ropivacaine with Fentanyl versus Bupivacaine with Fentanyl for Caudal Epidural in Pediatric Infraumbilical Surgeries – A Prospective Randomized Double-blinded Trial

Abstract Background: Caudal epidural block is widely used in the pediatric age group. This study aims to determine that ropivacaine with fentanyl provides a shorter duration of motor blockade than the comparable sensory blockade, which can be used as an effective alternative to bupivacaine in caudal epidural anesthesia. Objective: The objective of this study was to assess the efficacy of ropivacaine versus bupivacaine when combined with fentanyl in single-shot caudal epidural anesthesia in pediatric infraumbilical surgeries in terms of time taken for motor regression. Subjects and Methods: This was a prospective randomized double blinded study done among the pediatric population of 1-12years, undergoing infraumbilical surgeries under general anaesthesia. Efficacy of caudal epidural anaesthesia assessed with fentanyl+bupivacaine 30 patients (50%) and fentanyl+ ropivocaine 30 patients (50%). Group 1 received 0.25% of 0.7 mL/kg bupivacaine + 1 mg/kg of fentanyl with normal saline in a caudal epidural. Group 2 received 0.25% of 0.7 mL/kg ropivacaine + 1 mg/kg of fentanyl with normal saline in a caudal epidural. The demographic details and anthropometry were compared. The hemodynamic parameters were compared both intraoperatively and postoperatively. Bromage scale and Face, Legs, Activity, Cry, and Consolability pain score were compared postoperatively between both the groups. Results: The hemodynamic parameters, sedation, and pain were not statistically different between the groups. Among the bupivacaine group, there was a statistically significant, higher Bromage scale (P = 0.001), decreased time to rescue analgesia (P = 0.001), and higher duration of motor blockade (P = 0.001). Conclusion: We conclude that ropivacaine (0.25%) with fentanyl provides less intense motor nerve blockade with a shorter duration of analgesia, hence facilitating early ambulation.

High tibial osteotomy as a treatment protocol for osteoarthritis of a knee- time for a change?

Osteoarthritis is a common degenerative condition of the joints, consisting of retrogressive sequence of cell and matrix changes that result in loss of articular cartilage structure and function. It affects all ethnic groups in all geographic locations. There are several treatment options available for early OA knee including non pharmacological, pharmacological treatment and various surgical treatment. An arthroplasty is a good option for low demand and older patients there remains a significant concern regarding the longevity of implant, particularly in younger patients whereas high tibial osteotomy is joint preserving surgery . The normal anatomical tibial bone shape is maintained after the HTO, which allows for conversion to knee replacement if required in future . Early ambulation and weight bearing on operated limb is possible with use of orthofix .Orthofix does not require additional surgery for implant removal and bone graft is also not needed.

Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non-ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial.

Enhanced Recovery After Surgery (ERAS) is a multimodal approach with promising results in improving patient outcome. Only recently, is evidence emerging highlighting how similar principles of care can be applied to patients undergoing emergency abdominal surgery. A randomized controlled trial was conducted from November 2021 to April 2022 at PGIMER Chandigarh, which is a leading tertiary care hospital in northern India. 60 patients with acute intestinal obstruction requiring emergency laparotomy were randomized and assigned to ERAS or Non-ERAS group. ERAS protocol with some modifications was applied. Primary endpoints were post-operative hospital stay. Secondary end points were morbidity, 30-day readmission and mortality rate. Data analysis was done using SPSS 22.0. Independent t test or Mann-Whitney test and Chi-square or Fisher-exact test were used for analysis. A significant 3-day reduction in hospital stay was observed in ERAS compared to non-ERAS group (median (interquartile range) 5.50 (4.75-8.25) vs 8.0 (6.0-11.0) p = 0.003) with no difference in 30-day readmission rate, mortality rate and complication rate (according to Clavien-Dindo classification). ERAS group was associated with early recovery of gastrointestinal functions including time to first passage of flatus (p < 0.001), stools (p = 0.014), early ambulation (p < 0.001), time to first fluid diet (p < 0.001), solid diet (p = 0.001) and reduced nasogastric tube reinsertion rates (p = 0.01) despite its early removal. ERAS with some modifications can be applied in patients with intestinal obstruction. Thus, we can expedite post-operative recovery and early regain of gastrointestinal function with decreased hospital stay, comparable morbidity and mortality. Further studies are needed to assess ERAS role in emergency gastrointestinal surgeries. Trial registration Ctri.gov Identifier: CTRI/2022/04/042156.

A Literature Review on Effects of Positioning and Early Ambulation on Coronary Angiography Complication

Introduction: The study was carried out to get a greater awareness of the impact of early ambulation and positioning on coronary angiography complications. And to build an evidence study on what other research said. Objectives: The objective of this study is to review the effect of changing position and early ambulation on coronary angiography complications. Methods: I used search engines were Identified 700 articles, I excluded 500, then screened total of 200 articles, 150 articles are not my concern, I included 36 articles in this research Result: According to the various research early ambulation and early position is safe after coronary angiography because it is effective way to minimize the risk of back pain and has no linkage in increasing risk of vascular complications like bleeding or hematoma.

Surgical Management of Unstable Trochanteric Fractures of the Femur Using Cemented Hemi-Prosthesis in Elderly Patients: A Prospective Study.

Background In the case of elderly patients suffering from osteoporosis, the primary objectives of addressing comminuted intertrochanteric fractures are centered upon the recuperation of the patients' pre-fracture levels of activity, the expeditious promotion of full weight-bearing capacity, and the minimization of the likelihood of further surgical interventions. The adoption of hemiarthroplasty as a method for comminuted intertrochanteric fractures is proven as a means of hastening the recovery process, enabling early weight-bearing and mitigating the problems associated with extended bed rest. The outcomes that resulted from the application of this technique will be evaluated and analyzed as part of this study's objectives. Methodology A prospective study was conducted over the course of one year at a tertiary care hospital in the northern part of India. The study comprised a total of 30 individuals; however, unfortunately, one of the patients could not be located for further analysis. Patients of either gender in the age group of over 60 years old and with unstable osteoporotic intertrochanteric fractures were included (AO Foundation/Orthopaedic Trauma Association type 31-A2.2, A2.3, or 31-A3 group). Patients were observed at one, three, and six months after the surgical operation. The Harris Hip Score (HHS) was used for the functional outcome evaluation. Results Throughout the course of our analysis, we saw an increase in the overall HHS that was statistically significant. The HHS exhibited a mean value of 34.33 during the period of discharge, with a range of 32 to 39. It increased to 55.34 (range = 52-59) after one month of follow-up, and it continued to rise to 85.03 (range = 63-89) after three months of follow-up. It is important to note that the mean HHS reached 95.24 (range = 63-98) by the sixth month of follow-up. The study showed a statistically significant upward trend in HHS scores across all time periods (p < 0.001). Conclusions Early postoperative ambulation was made possible with the use of cemented prostheses, which contributed to patients' overall improvements in their functional results. Cemented primary bipolar hemiarthroplasty has emerged as a promising alternative for the treatment of unstable intertrochanteric fractures. The enhanced functional outcomes measured by the HHS provide evidence of this. The transtrochanteric technique has shown advantages in retaining the anatomical integrity of external rotators, minimizing the necessity for their resection, and reducing the danger of sciatic nerve injury. These advantages were displayed by the transtrochanteric approach. Moreover, owing to the implementation of wiring techniques, the larger trochanter could be conserved, resulting in enhanced postoperative recovery and expediting the return to the preoperative condition. When compared with other techniques of internal fixation, the utilization of cemented bipolar hemiarthroplasty demonstrated much-reduced rates of complications, such as the need for further surgery and implant failure.

Attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana.

Pressure ulcers (PUs), which affect millions of people worldwide, are among the five most prevalent hospitalized cases causing adverse impairment. Nevertheless, pressure ulcers are largely preventable, and their management depends on their severity. The authors, therefore, explored the attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. An exploratory descriptive qualitative approach was employed for this study to help researchers explore the attitude and practices toward PU (Pressure Ulcer). Purposive sampling approach was employed, and data was analyzed using thematic content analysis. The sample size for this study was 30 which was obtained based on saturation. Participants were engaged in face-to-face interviews which were transcribed verbatim. Two themes and eight subthemes were generated from the analysis of this study. The two themes were preventive practices and attitude towards PU. The study identified that there were no specific protocols illustrated on the wards for managing pressure ulcers. Nevertheless, the study participants were keen on preventing pressure ulcers and hence engaged in practices such as early patients' ambulation, early identification of PU signs, removing creases and crumps from patient beds, nutritional management for PU prevention, and dressing of PU wounds. Practices of pressure ulcer management were highly valued by the orthopedics nurses. Hence, the nurses recommended the need for accepted guidelines on pressure ulcer management to be illustrated in the various orthopedic wards in the country.

Current Status of and Barriers to the Implementation of Enhanced Recovery After Surgery in 77 Tertiary Hospitals

To investigate the status of and obstacles to the implementation of enhanced recovery after surgery (ERAS) in tertiary-care general hospitals in China. Questionnaire on the Current Status of and Barriers to the Implementation of ERAS in Tertiary-Care Hospitals, a self-developed questionnaire, was used to conduct a survey of 77 tertiary hospitals from 21 provinces across China between May 2022 and June 2022. The participating hospitals were selected by convenience sampling. The questionnaire on the current implementation status of ERAS was mainly focused on the departments involved and the ERAS programs implemented, incorporating a total of 25 items of three dimensions, preoperative, intraoperative, and postoperative. The answer to each question consisted of 5 options from "never" to "always", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating better implementation of the program concerned. In the questionnaire on barriers to ERAS implementation and recommendations, 10 items of two dimensions, including hospital management, and patient and caregiver, were concerned with the barriers to implementation. The answer to each question consisted of 5 options from "disagree" to "strongly agree", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating the greater importance of the barriers. ERAS programs were implemented in 73 (94.8%) hospitals. The best-implemented items were preoperative education (4.73±0.51), prevention and treatment of deep vein thrombosis (4.55±0.71), and postoperative follow-up (4.40±0.81). The items of poor implementation status were preoperative prehabilitation (2.71±1.40), preoperative oral carbohydrate drinks (3.03±1.49), and early ambulation after surgeries (3.04±1.22). The main obstacles to ERAS implementation included a lack of effective incentive systems, poor motivation among the medical and nursing staffs (3.21±0.93), a lack of disease-specific clinical implementation pathways (3.16±1.06), and a lack of experience in multidisciplinary teamwork (2.98±1.17). There is a high rate of ERAS implementation in tertiary general hospitals in China, but clinical implementation and dissemination are still confronted with many obstacles.

Hubungan Dukungan Keluarga dan Pengetahuan dengan Ambulasi Dini pada Pasien Post Operasi Abdomen

The study's objective was to know the determinant of the early ambulation of post-abdominal surgery patients. The type of study was quantitative. It found that 171 treated post-abdominal surgery patients as samples of the Government Hospital in Pidie. To collect the data, the researcher used a questionnaire sheet to know the characteristics of patients, family support, and knowledge of the early ambulation of post-abdominal surgery patients. The analysis data were descriptive and inferential through Chi-square and binary regression logistics. It showed that family support of (p=0,000) and Knowledge of (p=0,001) related to the early ambulation of post-abdominal surgery patients. It found that regression logistics analysis showed knowledge of (p =0,009; OR: 3,694) the most dominant determinant associated with the early ambulation of post-abdominal surgery patients. The knowledge obtained by patients from nurses is closely related to the implementation of early ambulation in posr-abdominal surgery patients. Therefore, it should increase the patient’s knowledge, and family, especially about the early ambulation of post-abdominal surgery.&#x0D; &#x0D; Keywords : Determinants, the early ambulation, post-surgery, abdomen

Surgical Outcomes in Primary Benign Extradural Tumors of The Cervical Spine

Introduction: The prevalence of spinal tumors is rare, only about 15% of all cases of central nervous system tumors and 90% of cases occur at the age of &gt;20 years, which is a productive age for a person. Case Report: A young 25-year-old woman came to the polyclinic complaining of weakness of both hands and feet (all limbs). The MRI results show a suspected of a space occupying lesion of the extradural spinal cord. The patient then underwent tumor removal laminectomy surgery with a posterior approach. After the operation, his motoric was improving and increased to 4/4. After three months she was able to walk and perform daily activities. Discussion: In younger patients, the tumor diagnosis may be more catastrophic, and the required treatment can have a severe impact on the patient's health-related quality of life. The patient was also very fast and assisted with early ambulation. This can be related to the progressivity of tumor cells, in this case a benign tumor with a border that is not aggressive in invading the surrounding tissue. Conclussion: Early diagnostic and complete surgical resection before the occurrence of severe symptoms will show an excellent prognosis in benign primary extradural tumor. Multidisciplinary surgical planning should therefore also include the histological grade, stage, and extent of the tumor to establish the objective biological aggressiveness of the overlying tumor and in turn estimate the feasibility of resection Keywords: Benign; Primary extradural tumor; Surgical outcome

Grip strength is an important predictor for nutritional risk and early postoperative ambulation in gastrointestinal tumors undergoing laparoscopic surgery: a prospective multicenter clinical study

BackgroundUsing grip strength as a predictor of nutritional risk and early ambulation for gastrointestinal tumor surgery and determining its critical value have not been reported. This study was designed to explore the influencing factors of early postoperative ambulation ability for patients with gastrointestinal tumors who underwent laparoscopic surgery.MethodsFour-hundred twenty-seven patients with gastrointestinal tumors who underwent laparoscopic surgery at three tertiary A hospitals in Beijing were prospectively enrolled. Subsequently, logistic regression analysis was conducted to determine the independent predictors of early postoperative ambulation. Logistic regression analyses for the different gender were also performed. In addition, the effectiveness of preoperative grip strength measurement in nutritional risk assessment was analyzed by using nutritional risk score 2002 (NRS 2002) as a control.ResultsThe included cases were comprised of 283 male and 144 female patients, with an age of 59.35 ± 11.70 years. Gender, preoperative grip strength, operative time, and number of indwelling tubes were independent predictors of early postoperative ambulation. In the male group, lower preoperative grip strength and more indwelling tubes were independent risk factors for early postoperative ambulation. In the female group, lower preoperative grip strength and extended operating time were independent risk factors. Moreover, preoperative grip strength (male < 32 kg, female < 21 kg) can be used as a risk predictor for both preoperative nutritional risk and early postoperative ambulation.ConclusionsAs a simple and objective measure of muscle strength, grip strength measurement is expected to be an effective predictor for both early postoperative ambulation ability and nutritional status of patients.