Early Postoperative Phase Research Articles

Onset of Adverse Abdominal Events Due to Intestinal Ischemia-Reperfusion Injury after Aortic Cross-Clamping Is Associated with Elevated HSP70 Serum Levels in the Early Postoperative Phase

Tissue injury of the viscera during open thoracoabdominal aortic (TAA) reconstructions has been reported as the aftermath of the ischemia-reperfusion mechanism following supracoeliac aortic cross-clamping. Abdominal complications after open aortic reconstructions, although rare through the intraoperative implementation of selective visceral artery blood perfusion, are associated with high rates of reinterventions and a poor prognosis. Recent animal experiments demonstrated that provoking mesenteric ischemia in rats induces the leukocyte-mediated transcription of heat-shock protein 70 (HSP70), a chaperone belonging to the danger-associated molecular pattern proteins (DAMPs). Translating these findings clinically, we investigated the serum levels of HSP70 in patients undergoing open aortic reconstructions with supracoeliac clamping. We postoperatively observed a relevant induction of HSP70, which remained significantly elevated in cases of postoperative abdominal complications (paralytic ileus, abdominal compartment syndrome, and visceral malperfusion). The receiver-operator curve analysis revealed the reliable prognostic accuracy of HSP70 as a biomarker for these complications as soon as 12 h post-operation (AUC 0.908, sensitivity 88.9%, specificity 83.3%). In conclusion, measuring HSP70 serum levels in the early postoperative phase may serve as a further adjutant in the diagnostic decision making for both the vascular surgeon and intensivist for the timely detection and management of abdominal complications following open TAA surgery.

CAUSES OF EXCESSIVE BLEEDING IN PATIENTS UNDERGONE OPEN HEART SURGERY DURING EARLY POSTOPERATIVE PERIOD; OUR EXPERİENCES FOR TWO YEARS

<h3>Objective</h3> The rate of excessive bleeding during open-heart surgery is 10 %. The rate of re-exploration is about 4-6 %. Therefore, it makes the mortality and morbidity increase after surgery The aim of our study is to identify the incidence of excessive bleeding and its causes during the early postoperative phases in patients undergone open-heart surgery in our institution for two years respectively. <h3>Design and Method</h3> It reviewed the hospital database to identify patients who underwent elective open-heart surgery between Jan.2019 and Jan.2021. It was defined as excessive bleeding involved measuring the amount of hemorrhage during the 1st, 2nd, 3rd, and 24th hours. We divided the cases into two groups, Group Bleeding; Group B; if excessive bleeding was present, and Group Control; Group C; if it was not. Data on demographics, clamping and pumping times in the operating room, intraoperative interventions, and clinical data such as the need for blood and blood products replacement in the ICU were recorded in the case files. Data were analyzed Student's t, Mann Witney U, Pearson Chi-Square Tests and Correlations tests. p<0.05 is statically significant. <h3>Results</h3> The incidence of bleeding was 9.7%. The rate of re-exploration was 33%. The presence of chronic lung disease was significantly higher in the bleeding group (Group B) (p=0.006). Preoperative use of anti-aggregates and diuretics was significantly higher in Group B than in Group C (p=0.00 and p=0.02, respectively). There was no significant difference between the groups in terms of bleeding and coagulation laboratory values and the use of intraoperative blood and blood products (Table 1). Postoperative use of blood and blood products was significantly higher in Group B (p<0.001, Table 2). Negative correlation between the female gender and higher EF and bleeding (p=0.032, p=0.047, respectively). A positive correlation was found between chronic lung disease, presence of CRF, diuretic, anticoagulant, EuroScore level, duration of ECD, and duration of CC and bleeding. The incidence of anemia among all patients was found at 41 % <h3>Conclusion</h3> Patients undergoing open-heart surgery under elective conditions had a 9.7% occurrence of excess bleeding and the rate of re-exploration was 33% in the early postoperative period. The presence of chronic lung disease, use of anti-aggregates and diuretics prior to surgery, a low EF score and high EuroScore, and the duration of the patient's CC and ECD were all highly predictive of excessive bleeding. In a conclusion, we thought that to improve the anemia, stopping the anti-aggregates drugs convenient time and having optimum control of the chronic diseases during preoperative evaluation might be effective for preventing excessive bleeding during the perioperative period.

ACL Reconstruction: Which Additional Physiotherapy Interventions Improve Early-Stage Rehabilitation? A Systematic Review

Despite the restoration of the mechanical stability of the knee joint after ACL reconstruction (ACLR), patients often experience postoperative limitations. To our knowledge, there are no systematic reviews analyzing additional physiotherapy interventions implementing standard rehabilitation programs in the early postoperative phase after ACLR. The objective of this study was to analyze the additional physiotherapy interventions implemented in standard rehabilitation programs that improve early-stage ACLR rehabilitation. For this systematic review, we followed the PRISMA guidelines. In March 2022 we conducted a literature review using electronic databases. Primary outcomes were pain, edema, muscle strength, ROM, and knee function. The risk of bias and scientific quality of included studies were assessed with the RoB 2, ROBINS-I and PEDro scale. For the review, we included 10 studies that met the inclusion criteria (total n = 3271). The included studies evaluated the effectiveness of Kinesio Taping, Whole-body vibration, Local Vibration Training, Trigger Point Dry Needling, High Tone Power Therapy, alternating magnetic field, and App-Based Active Muscle Training Program. Most of the additional physiotherapy interventions improved pain, edema, ROM, knee muscle strength, or knee function in early-stage postoperative ACL rehabilitation. Except for one study, no adverse events occurred in the included studies, which demonstrates the safety of the discussed physiotherapy interventions. Further in-depth research is needed in this area.

Short-term results of the uncemented triathlon total knee arthroplasty: a large cohort single-centre comparative study.

The purpose of this study is to assess the short-term survivorship of a new uncemented TKA design in a high-volume centre to evaluate the safety of this design prior to widespread adoption. We performed a retrospective cohort study of all primary TKAs (cemented and uncemented) between May 2018 and May 2019. Primary outcome variables included aseptic revision, all-cause revision, time to revision, operative time and radiological outcomes. Predictor variables considered included age, gender, BMI, ASA, implant type (cruciate-retaining, posterior-stabilised or totally-stabilised) and the use of cemented or uncemented implants. There were 300 cemented TKAs and 249 uncemented TKAs (Triathlon, Stryker Inc., Mahwah, NJ) implanted. The mean follow-up for all cases was 31.6months (minimum follow-up 2years). Of the entire 549 implants only 4 were revised. Two of these were for infection, 1 was for patellar maltracking and 1 was for knee stiffness. All 4 revisions occurred in the cemented cohort. The aseptic revision rate in the cemented cohort was 0.7% compared to 0.0% in the uncemented cohort (p = 0.298). Operative times were significantly reduced in the uncemented cohort from 57.9 to 51.7min (p < 0.001). There were 8/300 (2.6%) patients with RLLs in the cemented cohort and 4/249 (1.6%) patients with RLLs in the uncemented cohort (p = 0.56). The uncemented Triathlon TKA demonstrates excellent survivorship at short-term follow-up when compared to the cemented Triathlon TKA, thus eliminating any potential clinical concerns with this novel implant in the early post-operative phase.

Dynamics in cognition and health-related quality of life in grade 2 and 3 gliomas after surgery

BackgroundThe focus of clinical management and research in gliomas has been on survival, but the interest in the treatment effects on cognition and health-related quality of life (HRQoL) is emerging. The primary aim of this study was to investigate the dynamics in cognition after brain tumor surgery for astrocytomas and oligodendrogliomas grade 2 and 3. The secondary aim was to investigate the association of postoperative changes in cognition with changes HRQoL.MethodsIn this observational study, 48 patients operated for an astrocytoma or oligodendrogliomas, grade 2 or 3, at the Department of Neurosurgery, Uppsala, Sweden, 2016–2021, were included. Cognitive and language skills were assessed with a selected test battery and HRQoL was patient-reported as assessed with RAND-36 pre- and approximately 3 months postoperatively.ResultsThere was a significant postoperative decrease in attention span and verbal learning, but the patients improved in the test for visual memory. There was no change in visual attention, executive function, verbal memory, visual organization and construction, verbal fluency, and confrontation naming. The RAND-36 variables physical function, role physical, general health, vitality, and social functioning decreased significantly after surgery. Patients operated for tumor recurrence exhibited greater deterioration in attention and a greater extent of resection correlated with a less pronounced decrease in verbal memory, but there were otherwise weak associations between the dynamics in cognition and patient-, tumor-, and treatment-variables. A decline in cognitive variables was not associated with worse HRQoL.ConclusionsAlthough both several cognitive and HRQoL domains deteriorated postoperatively, these changes did not correlate with each other. This highlights the complexity of cognitive and HRQoL dynamics in the early postoperative phase.

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review.

Left ventricular assist devices (LVADs) are increasingly common across the heart failure population. Right ventricular failure (RVF) is a feared complication that can occur in the early post-operative phase or during the outpatient follow-up. Multiple tools are available to the clinician to carefully estimate the individual risk of developing RVF after LVAD implantation. This review will provide a comprehensive overview of available tools for RVF prognostication, including patient-specific and right ventricle (RV)-specific echocardiographic and hemodynamic parameters, to provide guidance in patient selection during LVAD candidacy. We also offer a multidisciplinary approach to the management of early RVF, including indications and management of right ventricular assist devices in this setting to provide tools that help managing the failing RV.

Thigh muscle strength is not related to self-reported function in the medium to long term after anterior cruciate ligament reconstruction

Introduction: Regaining muscle strength is a key goal of anterior cruciate ligament (ACL) rehabilitation and is linked to self-reported function and quality of life in the early post-operative phase after ACL reconstruction (ACLR). Less is known about how muscle strength relates to knee health and function in the longer term (e.g. after two years). We aimed to investigate the relationship between thigh muscle strength and self-reported function >2 years after ACLR, and explore if relationships differ between a cohort who run regularly and a cohort with ongoing symptoms.

Clinical usefulness and safety in the early phase after a newly designed rotating-platform total knee arthroplasty: A prospective multicentre cohort study with a 2-year follow up

BackgroundThis study aimed to assess the clinical results and safety of a newly designed rotating-platform posterior-stabilised total knee arthroplasty (TKA) in the early postoperative phase, within 2 years of follow up. MethodsThis prospective, multicentre cohort study included 100 consecutive patients who underwent rotating-platform posterior-stabilised (PS) TKA (Vanguard PSRP). After excluding dropouts, 93 patients were analysed. The objective Knee Society Score (KSS)-2011, subjective KSS-2011, knee range of motion, EuroQol 5 Dimension index, complications, and survival rates were assessed before TKA and at 6 months, 1 year, and 2 years postoperatively. The scores at each time-point were compared, and the survival rate was assessed with revision as the endpoint. To demonstrate non-inferiority, the clinical outcomes of patients who underwent rotating-platform PS TKA were compared with those collected retrospectively from 50 patients who underwent fixed-PS TKA (Vanguard PS), defined as the control group. ResultsAll clinical outcomes at the final follow up significantly improved compared with their preoperative values (P < 0.001). The objective KSS-2011 was 90.0 ± 8.2 points, subjective KSS-2011 satisfaction was 30.7 ± 8.6 points, expectation was 10.4 ± 2.1 points, and functional activity was 74.0 ± 18.5 points at 2 years postoperatively. Complications included knee dislocation in one patient and surgical site infection in one patient. The survival rate was 99% at 2 years postoperatively. Clinical outcomes, complications, and survival rates of newly designed TKA were not statistically different compared with the control group. ConclusionThe newly designed rotating-platform PS TKA showed good clinical results and suitable safety during the early postoperative phase in this prospective multicentre cohort study.

Concurrent Chemoradiotherapy Followed by Surgery for Borderline Resectable Esophageal Squamous Cell Carcinoma

<h3>Purpose/Objective(s)</h3> This study aimed to clarify the efficacy and safety of induction CRT followed by esophagectomy for borderline resectable esophageal squamous cell carcinoma (BR-ESCC) in which tumors grow very close to the adjacent vital organs. <h3>Materials/Methods</h3> The cohort of this retrospective single-center study included 31 patients who received CRT (41.4 Gy/23 fractions) and radical minimally invasive esophagectomy for T4 BR-ESCC between June 2017 and November 2020. The overall survival (OS), disease-free survival (DFS) and the patterns of recurrence were analyzed. <h3>Results</h3> A total of 14 (45.16%) patients had T4a and 17 (54.84%) had T4b. The median age was 58 (53-65). The clinically involved site were as follows: pleura invasion (15/31), thoracic aorta (14/31), pericardium (13/31), tracheobronchial tree (4/31). The median number of dissected lymph nodes was 28 (16-35). Eight Patients (25.81%) were identified as having a pathologic complete response(pCR). The most surgical complication was anastomotic leakage (16.13%, 5/31) classified as Clavien-Dindo grade II. Respiratory failure was observed in one patient during the early postoperative phase. At a median follow-up interval of 38 months, neither median OS nor DFS was reached. The 3-OS and 3-DFS rates were 62.75% and 61.53%, respectively. Specifically, Patients with pCR showed significantly longer DFS than those who did not (stratified log-rank test: p=0.0301). The OS tended to be better in patients with pCR than in those without pCR (stratified log-rank test: p=0.5635), but not statistically significant. Ten patients (32.3%%) experienced progression during the follow-up period. The recurrence rate of lymph node and distant metastasis were 16.13% (5/31) and 25.81% (8/31). The most frequent metastatic organ was the lung (16.13%) . <h3>Conclusion</h3> The tolerability and efficacy for patients who obtained R0 resection after induction CRT for borderline resectable ESCC was encouraging. The long-term results are worthy of further exploration.

Heart transplantation after total artificial heart bridging-Outcomes over 15 years.

Data are limited on outcomes after heart transplantation in patients bridged-to-transplantation (BTT) with a total artificial heart (TAH-t). The UNOS database was used to identify 392 adult patients undergoing heart transplantation after TAH-t BTT between 2005 and 2020. They were compared with 11014 durable left ventricular assist device (LVAD) BTT patients and 22348 de novo heart transplants (without any durable VAD or TAH-t BTT) during the same period. TAH-t BTT patients had increased dialysis dependence compared to LVAD BTT and de novo transplants (24.7%vs. 2.7%vs. 3.8%) and higher levels of baseline creatinine and total bilirubin (all p<.001). After transplantation, TAH-t BTT patients were more likely to die from multiorgan failure in the first year (25.0%vs. 16.1%vs. 16.1%, p=.04). Ten-year survival was inferior in TAH-t BTT patients (TAH-t BTT 53.1%, LVAD BTT 61.8%, De Novo 62.6%, p<.001), while 10-year survival conditional on 1-year survival was similar (TAH-t BTT 66.8%, LVAD BTT 68.7%, De Novo 69.0%, all p>.20). Among TAH-t BTT patients, predictors of 1-year mortality included higher baseline creatinine and total bilirubin, mechanical ventilation, and cumulative center volume <20 cases of heart transplantation involving TAH-t BTT (all p<.05). Survival after TAH-t BTT is acceptable, and patients who survive the early postoperative phase experience similar hazards of mortality over time compared to de novo transplant patients and durable LVAD BTT patients.

Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures

IntroductionFemoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases.Material and methodsIn the present retrospective study geriatric patients with FNF (n = 100) treated either by anterior minimal-invasive surgery (AMIS; n = 50) or lateral conventional surgery (LCS; n = 50) were characterized (age at the time of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and 12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed.ResultsPatients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and complication rates did not differ between the two groups. Further, more patients in the AMIS group achieved full weight-bearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often than patients of the LCS group. No significant differences in functional and surgery-related performance could be observed between AMIS and LCS group at 12 months postoperatively.ConclusionsIn conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in these vulnerable patients.

Evaluation of patient STress level caused by radiological Investigations in early Postoperative phase After CRANIOtomy (IPAST-CRANIO): protocol of a Swiss prospective cohort study

IntroductionPostoperative imaging after neurosurgical interventions is usually performed in the first 72 hours after surgery to provide an accurate assessment of postoperative resection status. Patient frequently report that early postoperative...

Prevalence and Characteristics of Frailty at 6 months FollOwing Total Hip and Knee Arthroplasty in Patients With End-Stage OA.

IntroductionLower-limb osteoarthritis (OA) in the elderly can be a risk factor for frailty, which is the preliminary of disability, but it may be reversible with appropriate interventions. We aimed to use the Kihon Check List (KCL) to assess multiple domains of frailty and to identify the characteristics of frailty in patients with hip or knee OA following total joint arthroplasty.Materials and MethodsThis study included 136 ≥ 65-year-old patients (mean age: 73.0 years) who underwent total arthroplasty with end-stage hip and knee OA. We assessed frailty status, instrumental activities of daily living (IADL), and health-related quality of life (HRQoL) according to the KCL, functional ambulatory index (FAI) and EuroQol-5 Dimension (EQ5D), respectively, as well as the extent of pain preoperatively and at postoperative 6 months.ResultsUsing KCL, seventy-eight (57.4%) patients were frail preoperatively, but the prevalence significantly decreased to 52 patients (38.2%) at postoperative 6 months. Total arthroplasty intervention provided significant improvements in the total KCL scores, including the physical domain (P < .01), pain (P < .01), FAI scores (P < .01), and EQ5D (P < .01), but not the social domain. Multivariate logistic regression analysis identified age at surgery (OR: .93, 95% CI: .86-.99) and preoperative FAI score (OR: 1.10, 95% CI: 1.03-1.19) as independent predictors of postoperative frailty.ConclusionsTotal arthroplasty procedures on patients with hip and knee OA reduced their KCL score, but social aspects were less improved than physical aspects in the shortterm. Older age and preoperative lower IADL score can be useful for accurately estimating less improvement of frailty in the early postoperative phase. Our results suggest that long term follow-up of OA is needed to provide comprehensive interventions, including in social aspects, especially for patients with lower activity.

Procalcitonin in early allograft dysfunction after orthotopic liver transplantation: a retrospective single centre study

BackgroundIschemia–reperfusion injury (IRI) is the pathophysiological hallmark of hepatic dysfunction after orthotopic liver transplantation (OLT). Related to IRI, early allograft dysfunction (EAD) after OLT affects short- and long-term outcome. During inflammatory states, the liver seems to be the main source of procalcitonin (PCT), which has been shown to increase independently of bacterial infection. This study investigates the association of PCT, IRI and EAD as well as the predictive value of PCT during the first postoperative week in terms of short- and long-term outcome after OLT.MethodsPatients ≥ 18 years undergoing OLT between January 2016 and April 2020 at the University Hospital of Zurich were eligible for this retrospective study. Patients with incomplete PCT data on postoperative days (POD) 1 + 2 or combined liver-kidney transplantation were excluded. The PCT course during the first postoperative week, its association with EAD, defined by the criteria of Olthoff, and IRI, defined as aminotransferase level > 2000 IU/L within 2 PODs, were analysed. Finally, 90-day as well as 12-month graft and patient survival were assessed.ResultsOf 234 patients undergoing OLT, 110 patients were included. Overall, EAD and IRI patients had significantly higher median PCT values on POD 2 [31.3 (9.7–53.8) mcg/l vs. 11.1 (5.3–25.0) mcg/l; p < 0.001 and 27.7 (9.7–51.9) mcg/l vs. 11.5 (5.5–25.2) mcg/l; p < 0.001] and impaired 90-day graft survival (79.2% vs. 95.2%; p = 0.01 and 80.4% vs. 93.8%; p = 0.033). IRI patients with PCT < 15 mcg/l on POD 2 had reduced 90-day graft and patient survival (57.9% vs. 93.8%; p = 0.001 and 68.4% vs. 93.8%; p = 0.008) as well as impaired 12-month graft and patient survival (57.9% vs. 96.3%; p = 0.001 and 68.4% vs. 96.3%; p = 0.008), while the outcome of IRI patients with PCT > 15 mcg/l on POD 2 was comparable to that of patients without IRI/EAD.ConclusionGenerally, PCT is increased in the early postoperative phase after OLT. Patients with EAD and IRI have a significantly increased PCT maximum on POD 2, and impaired 90-day graft survival. PCT measurement may have potential as an additional outcome predictor in the early phase after OLT, as in our subanalysis of IRI patients, PCT values < 15 mcg/l were associated with impaired outcome.

Impacts of Surgeons' Experience on Patients with Epiretinal Membrane: A Retrospective Study from 2015 to 2020 in Wenzhou Eye Hospital.

BackgroundTo explore the impacts of surgeons’ experience in patients with epiretinal membrane (ERM).MethodsPatients with idiopathic ERM (334 eyes) who underwent PPV and membrane peeling were included in this study. The surgeries were performed by 9 surgeons. Patients were categorized into the experienced group (surgeons who had performed more than 5000 cases of PPV) and the regular group (surgeons who had performed less than 1000 cases of PPV). The patients were also categorized into five groups according to different preoperative best corrected visual acuity (BCVA): 20/100 or worse, 20/70-20/50, 20/40-20/30, 20/25 and 20/20. Impacts of preoperative BCVA, surgeons’ experience, lens status, and internal limiting membrane (ILM) peeling on postoperative BCVA were analyzed.ResultsThe postoperative BCVA was significantly better at 1 week and 1 month in the experienced group compared to the regular group (p = 0.022 and 0.045, respectively). There were no significant differences in postoperative BCVA at 3 months and 6 months between the two groups (p = 0.268 and 0.233, respectively). Postoperative BCVA at 6 months was similar in the 20/25 group and 20/20 group (p = 0.063); both groups had better BCVA compared to the other three groups. The 20/100 or worse group had the greatest visual improvement among the 5 groups at 6 months.ConclusionThis study suggested that although the experience of surgeons had no significant impact on the final BCVA following PPV and ERM removal, the BCVA during the early postoperative phase appeared to be better in the experienced group.

3D-printed lightweight dorsal skin fold chambers from PEEK reduce chamber-related animal distress

The dorsal skinfold chamber is one of the most important in vivo models for repetitive longitudinal assessment of microcirculation and inflammation. This study aimed to refine this model by introducing a new lightweight chamber made from polyetheretherketone (PEEK). Body weight, burrowing activity, distress, faecal corticosterone metabolites and the tilting angle of the chambers were analysed in mice carrying either a standard titanium chamber or a PEEK chamber. Data was obtained before chamber preparation and over a postoperative period of three weeks. In the early postoperative phase, reduced body weight and increased faecal corticosterone metabolites were found in mice with titanium chambers. Chamber tilting and tilting-related complications were reduced in mice with PEEK chambers. The distress score was significantly increased in both groups after chamber preparation, but only returned to preoperative values in mice with PEEK chambers. In summary, we have shown that light chambers reduce animal distress and may extend the maximum dorsal skinfold chamber observation time. Chambers made of PEEK are particularly suitable for this purpose: They are autoclavable, sufficiently stable to withstand rodent bites, inexpensive, and widely available through 3D printing.

Use of Opioids in the Early Postoperative Period After Arthroscopic Rotator Cuff Repair: A Systematic Review

Background:Postoperative treatment plans after orthopaedic procedures frequently include opioids for pain relief.Purpose:To evaluate opioid use in the early postoperative phase after arthroscopic rotator cuff repair (ARCR) to develop a procedure-specific understanding of the current role of opioids in pain management for this procedure.Study Design:Systematic review; Level of evidence, 4.Methods:A PubMed search was used to identify eligible studies. Data on patient demographics, visual analog scale pain scores, and opioid use patterns (in morphine milligram equivalents [MMEs]) were collected and assessed. Cumulative MMEs were reported on postoperative day (POD) zero, and mean MMEs were reported on subsequent PODs (days 1, 2, 3, 5, 7, and 14). Metaregression, I 2 indices, and Cochran Q tests were used to evaluate study variation, heterogeneity, and variance.Results:A total of 1487 patients in 22 studies were included in the analysis. An estimated 51% (95% CI, 31%-70%) of patients with nerve blocks (NBs) were opioid-free through POD-0 versus 40% (95% CI, 1.2%-97%) of patients without NBs, which increased to 65% (95% CI, 55%-74%) versus 25% (95% CI, 1.7%-86%) by POD-1. Opioid requirements were highest in the first 72 hours after ARCR. NB use reduced opioid requirement on POD-0 compared with no NB use (15.8 vs 45.0 MMEs, respectively; P < .001) but did not reduce requirements after that. In addition, NB use led to a statistically significant increase in opioid requirements on POD-7 (28.6 vs 9.5 MMEs, respectively; P < .001). Using a model that assumes stable opioid requirements between our time points, weighted mean cumulative opioid consumption was 163 MMEs in the first week and 273 MMEs in the first 2 weeks (150 and 287 MMEs in patients with NB; 180 and 261 MMEs in patients without NB, respectively).Conclusion:Opioid use is relatively common in the early postoperative period after ARCR. Pain scores and opioid requirements may spike on POD-1; however, patients should be educated and reassured that they will gradually decrease usage over the initial 2-week postoperative period.

Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction.

Background:Magnetic resonance imaging (MRI) graft signal intensity is associated with graft damage after anterior cruciate ligament reconstruction (ACLR). However, little is known about the relationship between graft signal intensity and residual laxity of the reconstructed knee based on patient age.Purpose/Hypothesis:To evaluate the relationship between graft signal intensity and residual laxity in younger and older patients who underwent ACLR. We hypothesized that higher graft signal intensity would be associated with reduced postoperative knee stability.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 192 patients who underwent double-bundle ACLR were recruited. Proton density–weighted and T2-weighted MRI was performed at 3, 6, and 12 months after surgery, and the signal intensity ratio (SIR) of the anteromedial and posterolateral bundles was measured as the graft signal intensity reference values. At 12 months after surgery, if the KT-1000 arthrometer measurement exhibited a side-to-side difference of ≥2 mm, the patient was determined as having anterior knee laxity. Rotatory knee laxity was defined as a positive pivot shift with International Knee Documentation Committee grade ≥1. The Mann-Whitney U test was used to compare the SIR in patients with and without residual laxity. The Spearman correlation coefficient was used to evaluate the relationship between demographic parameters and the SIR. Based on receiver operating characteristic curves, the optimal SIR cutoff values to predict residual laxity were calculated, and logistic regression analysis was conducted.Results:Of 192 patients, 26 (13.5%) had anterior knee laxity, and 20 (10.4%) had rotatory knee laxity. The SIR was negatively correlated with age. In younger patients (<30 years; n = 135), those with residual laxity had a significantly higher SIR than those without laxity; this relationship was not significant in older patients (≥30 years; n = 57). Based on receiver operating characteristic curves and logistic regression analysis, the cutoff values that were determined for the SIR were significantly associated with a higher odds ratio of residual laxity.Conclusion:Graft signal intensity decreased with patient age. Patients with higher graft signal intensity in the early postoperative phase after ACLR exhibited a higher prevalence of residual laxity, particularly in younger patients.

The current and future role of nurses within enhanced recovery after surgery pathways.

Enhanced recovery after surgery (ERAS) pathways have been proven to expedite recovery after many procedures and reduce lengths of stay in hospital and surgical complications. However, improvements are still needed, especially in postoperative ERAS components delivered by nurses such as early mobilisation and oral feeding. This article summarises the current and possible future role of nurses within ERAS, and recommends areas for future research. Nurses are the professionals who spend the most time with patients throughout the perioperative pathway and are known to play a vital role in delivering many components of an ERAS pathway. They frequently co-ordinate care across disciplines and ensure continuity of care. However, there is a paucity of ERAS research specific to nurses compared to other professional groups. Continual training on ERAS will be required to ensure nurses are highly educated and for the best possible ERAS implementation. In certain types of surgery, nurses may fulfil extended roles in the postoperative period, such as taking over responsibility and leadership for co-ordinating pain management, mobilisation and discharge. However, this requires a well-defined care programme, a clear definition of nursing responsibilities from surgeons, agreed discharge criteria and highly qualified nurses, along with the collection and analysis of data to test safety and efficacy. Increasing nurse involvement in ERAS research is vital to drive improvements in care and to develop nursing roles. Nurses should have a major role in the preoperative clinic, the early postoperative phase and the follow-up post-discharge period, where the benefits of ERAS need to be further documented.

The modifying factors that help improve anterior cruciate ligament reconstruction rehabilitation: A narrative review.

The goal of a rehabilitation programme after anterior cruciate ligament (ACL) reconstruction is to manage a patient's goals and expectations (i.e., returning to physical activities and sports) while minimizing the risk of new injury, particularly a new ACL injury. Although general rehabilitation programmes have been proposed, some factors can lead to adapting each programme to each patient. To describe how different variables, including surgical techniques, sports participation, psycho-social and contextual factors can modify the rehabilitation programme. We performed a narrative review with input from experts in the field (level of evidence 5). Modifying factors of the ACL rehabilitation programme are related to the initial lesion or surgery, to sports, or to psychological or social aspects. Regarding the type of graft, the rehabilitation is mainly different in the early postoperative phase; the other phases are not graft-based but rather goal-based rehabilitation. Depending on the meniscal or cartilage repair, the rehabilitation protocol will initially take priority over the anterior cruciate ligament reconstruction protocol. The ACL reconstruction rehabilitation programme should meet the requirements of the anticipated sports, to optimize the athlete's ability to return to the expected level and minimize the risk of reinjury. Psycho-social and contextual factors must also be considered in rehabilitation care to individualize and optimize each patient's programme.