Elective General Surgery Research Articles

Development and Validation of a Preoperative Nursing Consultation Model: A Delphi Study

PurposeThis study aimed to validate the structure and content of a preoperative nursing consultation model for elective general surgery patients. DesignA Delphi study was conducted with experts to validate a five-dimension preoperative nursing consultation model. MethodsA 2-round Delphi study was conducted in 2022 involved 20 experts. The experts were asked to complete an online 48-item questionnaire rated on a 5-point Likert scale, ranging from totally disagree to totally agree. Participants were ensured anonymity and confidentiality. Consensus was identified as 80% agreement. The experts also made suggestions or comments, based on which the questionnaire was reformulated for round 2. Data were analyzed using SPSS software, version 25.0 (IBM SPSS Statistics). FindingsThe response rate was 100% in round 1 and 95% in round 2. After round 1, a consensus was reached on 35 items. The experts submitted the following dimensions for analysis: Requirements for the consultation, Patient welcoming and assessment, Information for the patient (and family member or significant person, if applicable), Summary of the consultation, and Documentation of the consultation. ConclusionsThe consensus among the experts allowed for the development of a specific intervention in the form of a preoperative nursing consultation. The validated intervention should be implemented and its impact on the quality of care assessed, particularly in elective general surgery.

How Much is Too Much? Evaluation of the Clinical Relevance of Routine Preoperative Investigations in American Society of Anaesthesiologist (ASA) Grades I and II Patients Undergoing Minor to Intermediate Elective Surgeries at Tertiary Care Teaching Hospital - Influence on Change in the Surgical Plan and Outcome

Abstract Background: In recent decades, experts have questioned the necessity of routine preoperative investigations due to their limited influence on perioperative management, higher expenses, postponed surgical procedures, patient anxiety resulting from false-positive results for minor operations and increased workload for laboratories. Objective: Our objective was to systematically evaluate the impact of pre-operative investigations on the treatment of patients opting for elective procedures. The study aimed to evaluate the impact of pre-operative investigations and peri-operative management on elective surgeries of the American Society of Anesthesiologists (ASA) physical status classification grades I and II, identifying common inappropriate investigations and assessing the impact of abnormal results on patient management. Materials and Methods: We conducted a prospective, cross-sectional, clinical, observational, single-centre study from February 2020 to March 2021 on 500 cases in the General Surgery Department of Tertiary Care Teaching Hospital. This study assessed the importance of pre-operative investigations in low-risk patients undergoing low-grade elective general surgical procedures. We recruited consecutive patients from the surgery wards of the institute, who fulfilled the inclusion criteria and obtained informed written consent for anaesthesia, surgery and participation in the study. Demographic data, the type of investigation conducted and test results were noted. We followed up with patients who had abnormal test results to record the consequences of the abnormality, such as the postponement of surgery and the requirement for additional investigations. Pre-operative transfusion, change in the management plan and change in the anaesthesia plan were recorded. Results: In the current study, the age of the patients ranged from 20 years to 45 years, and the mean age of the patients was 32.208 ± 9.16. The age group of 20–30 years was the commonest, being 158 (31.6%) patients. Out of 500 patients, 296 (59.2%) patients were males and the remaining 204 (40.8%) were female patients. Out of 500 tests, 44 (8.8%) had abnormal results. Most of the changes in our study were based on abnormal ECG findings. Out of a total of 500 surgical procedures performed, 497 (99.4%) were carried out without any difficulty, with two (0.4%) postponed due to abnormality in the pre-operative investigations and one (0.2%) cancelled. A total of 490 (98%) patients did not have any post-operative complications. Only ten (2%) patients developed post-operative complications, and out of those, only one (0.1%) had some abnormality in the pre-operative investigations. Conclusion: Preoperative laboratory investigations do not significantly influence the surgical outcome of the patients belonging to ASA grades I and II.

Perioperative Hypothermia in Surgical Patients: A Retrospective Cohort Analysis at a Busy District General Hospital.

Introduction Perioperative hypothermia is a common yet underreported complication of surgery. It results from various factors, including cold operating theaters, anesthetic effects, environmental exposure, exposed tissues, and the administration of cold intravenous or irrigation fluids. This study aims to determine the incidence of perioperative hypothermia in a district National Health Service hospital to assess the feasibility of a randomized controlled trial (RCT) for interventions to prevent hypothermia. Methods This retrospective study included the data of 200 elective surgical patients at North Manchester General Hospital from June 1, 2022, to August 1, 2022. Inclusion criteria were elective general surgery, urology, breast, and gynecology patients aged 18 to 60 years. Exclusion criteria included emergency cases and patients younger than 18 or older than 60. Temperature measurement data were collected from the anesthesia records of the patients at six phases: preoperative, pre-induction, intraoperative, post-procedure, recovery room, and post-recovery. Data collection included specialty, surgery duration, and the use of intraoperative fluid warmers. Statistical analysis was performed using StatsDirect software (StatsDirect Ltd, Wirral, UK). Results Among the 200 patients, the overall incidence of hypothermia was 4% preoperatively, 5% pre-induction, 12% intraoperatively, 11% postoperatively, 8% in recovery, and 6% post-recovery. Intraoperative hypothermia incidence was significant, given that active warming was applied to patients with preoperative hypothermia. Regression analysis showed no correlation between intraoperative temperature and the use of intraoperative fluid warmers. Pre-induction temperature was the most statistically significant predictor of intraoperative hypothermia. Conclusions This study highlights the need for active interventions to recognize and prevent perioperative hypothermia in elective surgical patients. Active pre-warming of patients, regardless of surgery type and duration, is feasible and potentially beneficial. Future research should include an RCT comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

WP5.8 - Robotic versus laparoscopic general surgery in the emergency setting: a systematic review

Abstract Introduction Robot-assisted general surgery, a cutting-edge technology in minimally-invasive procedures, is increasingly utilised in elective general surgery, demonstrating advantages over laparoscopy in select cases. While laparoscopy remains a standard approach for common acute abdominal conditions, the role of robotic surgery in emergency general surgery is unclear. This systematic review aims to compare outcomes in acute general surgery settings for robotic versus laparoscopic surgeries. Method A PRISMA compliant systematic search across MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane library was performed. The literature review focused on articles comparing perioperative outcomes of emergency general surgery managed laparoscopically versus robot-assisted. A descriptive analysis was performed and outcome measures recorded. Results Six articles, reporting on 1063 patients, compared outcomes of robotic and laparoscopic procedures. Two covered cholecystectomies, while the others addressed ileocaecal resection, subtotal colectomy, hiatal hernia and perforated gastrojejunal ulcer repair. The level of evidence was low. Laparoscopic bowel resection in inflammatory bowel disease (IBD) patients had higher complications; no significant differences were found in complications for other operations. Operative time showed no differences for cholecystectomies, but robotic approaches were longer for other procedures. Robotic cases had shorter hospital length of stay, though the associated costs were significantly higher. Conclusion Perioperative outcomes for emergency robotic surgery in selected general surgery conditions are comparable to laparoscopic surgery. However, recommending robotic surgery in the acute setting requires a well-powered large population study for stronger evidence.

FP8.9 - Surgical Synergy: Rethinking waste for a greener tomorrow in General Surgery

Abstract Aims Every year in the UK, the NHS sends approximately 156,000 tonnes of clinical waste for processing via high temperature incineration or other treatments, and then to landfill sites. Majority of the waste produced by hospitals comes from the operating theatres (OTs). In this study, we aim to assess the current implementation of waste management strategies at an NHS district general hospital (DGH) in general surgery. We have investigated a variety of cases and have surveyed the volume of waste produced. Methods We observed elective and emergency general surgery cases across 2 weeks. For each case, we weighed the waste produced- both recyclable and non-recyclable (clinical). Results This study included four umbilical hernia repairs, two right hemicolectomies, one examination of rectum under anaesthesia with seton insertion and three laparoscopic cholecystectomies. Across the operations, the average total waste produced was 5.9kg. The average clinical waste and recyclable waste was 4.7kg and 1.2kg, respectively. Additionally, a significant proportion of non-infectious recyclable waste was incorrectly placed into the clinical waste bin. Conclusion On average 5.9kg of waste is produced after a general surgery operation. Most of this waste is clinical and not recycled. However, the clinical waste can be cut down by appropriate waste segregation, thus reducing the impact on the environment as well as reducing the cost of incineration.

Implementation of a perioperative registry in Ethiopia to enhance surgical quality improvement.

Despite a glaring need and proven efficacy, prospective surgical registries are lacking in low- and middle-income countries. The objective of this study was to design and implement a comprehensive prospective perioperative registry in a low-income country. This study was conducted at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Design of the registry occurred from June 2021 to May 2022 and pilot implementation from May 2022 to May 2023. All patients undergoing elective or emergent general surgery were included. Following one year, operability and fidelity of the registry were analyzed by assessing capture rate, incidence of missing data, and accuracy. A total of 67 variables were included in the registry including demographics, preoperative, operative, post-operative, and 30-day data. Of 440 eligible patients, 226 (51.4%) were successfully captured. Overall incidence of missing data and accuracy was 5.4% and 90.2% respectively. Post pilot modifications enhanced capture rate to 70.5% and further optimized data collection processes. The establishment of a low-cost electronic prospective perioperative registry in a low-income country represents a significant step forward in enhancing surgical care in under-resourced settings. The initial success of this registry highlights the feasibility of such endeavors when strong partnerships and local context are at the center of implementation. Continuous efforts to refine this registry are ongoing, which will ultimately lead to enhanced surgical quality, research output, and expansion to other sites.

Impact on quality of life following inguinal hernia repair under local anaesthetic in a primary care setting.

Inguinal hernia repair remains one of the most common elective general surgical procedures. Previous studies have suggested high rates of chronic pain afterwards. The aim of this study was to evaluate changes in quality of life after local anaesthetic (LA) inguinal hernia surgery performed in a primary care setting. Quality of life (QoL) was measured in all patients both pre-operatively and at 6-months post-operatively using the European Hernia Society Scoring tool. Data was analysed by tertile grouping according to initial symptom score. 497 patients filled out pre-operative QoL forms between June 2020 and May 2022. Post-operative QoL scores were received from 179 patients (164 male (91.6%)). Median pre-operative score was 33 (IQR 20-48). Median post-operative score was 4 (IQR 1-11). Mean improvement in QoL score was 27.8. Nine patients had a worse score at 6-months compared to pre-op (5%). When the data was analysed by pre-op QoL group as expected the low symptom group (score 0-10) had minimal improvement in QoL (0.23) and 5 out of 13 patients (38%) had a worse score. The medium group (score 11-40) had a mean improvement in QoL of 17.25 with 3 out of 92 (3.2%) experiencing a worse score. The high symptom group (score 41-90) had a mean improvement in QoL of 45.4 with only 1 of 76 (1.3%) experiencing a worse score. LA Inguinal hernia repair improves QoL substantially 6-months after surgery. However, in those patients with low pre-operative scores (< 11) the gain is minimal and rates of chronic symptoms following surgery are very high. We recommend avoiding surgery in this group and instead adopting a surveillance approach.

Incidence of postoperative complications is underestimated if outcome data are recorded by interns and first year residents in a low volume hospital setting

The aim of this study is to evaluate the accuracy of outcome reporting after elective visceral surgery in a low volume district hospital. Outcome measurement as well as transparent reporting of surgical complications becomes more and more important. In the future, financial and personal resources may be distributed due to reported quality and thus, it is in the main interest of healthcare providers that outcome data are accurately collected. Between 10/2020 and 09/2021 postoperative complications during the hospitalisation were recorded using the Clavien–Dindo classification (CDC) and comprehensive complication index by residents of a surgical department in a district hospital. After one year of prospective data collection, data were retrospectively analyzed and re-evaluated for accuracy by senior consultant surgeons. In 575 patients undergoing elective general or visceral surgery interns and residents reported an overall rate of patients with complications of 7.3% (n = 42) during the hospitalization phase, whereas a rate of 18.3% (n = 105) was revealed after retrospective analysis by senior consultant surgeons. Thus, residents failed to report patients with postoperative complications in 60% of cases (63/105). In the 42 cases, in which complications were initially reported, the grading of complications was correct only in 33.3% of cases (n = 14). Complication grades that were most missed were CDC grade I and II. Quality of outcome measurement in a district hospital is poor if done by unexperienced residents and significantly underestimates the true complication rate. Outcome measurement must be done or supervised by experienced surgeons to ensure correct and reliable outcome data.

Revised cardiac risk index in predicting cardiovascular complications in patients receiving chronic kidney replacement therapy undergoing elective general surgery

IntroductionThe Revised Cardiac Risk Index (RCRI) is a six-parameter model that is commonly used in assessing individual 30-day perioperative cardiovascular risk before general surgery, but its use in patients on chronic kidney replacement therapy (KRT) is unvalidated. This study aimed to externally validate RCRI in this patient group over a 15-year period.MethodsData linkage was used between the the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admisisons data across Australia and New Zealand to identify all incident and prevalent patients on chronic KRT between 2000 and 2015 who underwent elective abdominal surgery. Chronic KRT was categorised as haemodialysis (HD), peritoneal dialysis (PD), home haemodialysis (HHD) and kidney transplant. The outcome of interest was major adverse cardiovascular event (MACE) which was defined as nonfatal myocardial infarction, nonfatal stroke, non-fatal cardiac arrest and cardiovascular mortality at 30 days. Logistic regression was used with the RCRI score included as a continuous variable to estimate discrimination by area under the receiver operating curve (AUROC). Calibration was evaluated using a calibration plot. Clinical utility was assessed using a decision curve analysis to determine the net benefit.ResultsA total of 5094 elective surgeries were undertaken, and MACE occurred in 153 individuals (3.0%). Overall, RCRI had poor discrimination in patients on chronic KRT undergoing elective surgery (AUROC 0.67), particularly in patients aged greater than 65 years (AUROC 0.591). A calibration plot showed that RCRI overestimated risk of MACE. The expected-to-observed outcome ratio was 6.0, 5.1 and 2.5 for those with RCRI scores of 1, 2 and ≥ 3, respectively. Discrimination was moderate in patients under 65 years and in kidney transplant recipients, with AUROC values of 0.740 and 0.718, respectively. Overestimation was common but less so for kidney transplant recipients. Decision curve analysis showed that there was no net benefit of using the tool in neither the overall cohort nor patients under 65 years, but a slight benefit associated with threshold probability > 5.5% in kidney transplant recipients.ConclusionsThe RCRI tool performed poorly and overestimated risk in patients on chronic dialysis, potentially misinforming patients and clinicians about the risk of elective surgery. Further research is needed to define a more comprehensive means of estimating risk in this unique population.

Impact of non-emergency surgical timing on postoperative recovery quality in mild or asymptomatic SARS-CoV-2 infected patients: a grouped cohort study

ObjectiveTo explore the relationship between the timing of non-emergency surgery in mild or asymptomatic SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infected individuals and the quality of postoperative recovery from the time of confirmed infection to the day of surgery.MethodsWe retrospectively reviewed the medical records of 300 cases of mild or asymptomatic SARS-CoV-2 infected patients undergoing elective general anaesthesia surgery at Yijishan Hospital between January 9, 2023, and February 17, 2023. Based on the time from confirmed SARS-CoV-2 infection to the day of surgery, patients were divided into four groups: ≤2 weeks (Group A), 2–4 weeks (Group B), 4–6 weeks (Group C), and 6–8 weeks (Group D). The primary outcome measures included the Quality of Recovery-15 (QoR-15) scale scores at 3 days, 3 months, and 6 months postoperatively. Secondary outcome measures included postoperative mortality, ICU admission, pulmonary complications, postoperative length of hospital stay, extubation time, and time to leave the PACU.ResultsConcerning the primary outcome measures, the QoR-15 scores at 3 days postoperatively in Group A were significantly lower compared to the other three groups (P < 0.05), while there were no statistically significant differences among the other three groups (P > 0.05). The QoR-15 scores at 3 and 6 months postoperatively showed no statistically significant differences among the four groups (P > 0.05). In terms of secondary outcome measures, Group A had a significantly prolonged hospital stay compared to the other three groups (P < 0.05), while other outcome measures showed no statistically significant differences (P > 0.05).ConclusionThe timing of surgery in mild or asymptomatic SARS-CoV-2 infected patients does not affect long-term recovery quality but does impact short-term recovery quality, especially for elective general anaesthesia surgeries within 2 weeks of confirmed infection. Therefore, it is recommended to wait for a surgical timing of at least greater than 2 weeks to improve short-term recovery quality and enhance patient prognosis.

A prospective study on risk assessment and prophylaxis of venous thromboembolism in general surgery patients.

To evaluate the patients at risk of venous thromboembolism (VTE) based on Caprini VTE risk assessment scale and the effect of implementation of this scale on the use of thromboprophylaxis. A prospective study was conducted, including patients who underwent major elective surgical procedures. Demographic details were noted, and VTE prophylaxis offered if needed. According to the VTE risk assessment scale, patients were categorised into very low-, low-, moderate-, and high-risk categories. The data were analysed statistically. A total of 500 patients (women = 259; men = 241) were enrolled in this study. Of them, eight women and nine men developed VTE (P = 0.691). The maximum number of patients who developed VTE belonged to 61-70 years group (n = 7). According to VTE risk assessment, 61 patients were categorised as low-risk, 217 patients as moderate-risk, and 222 patients were categorised as high-risk. A significant (P < 0.0005) correlation was found between body mass index (BMI) and VTE development. In obese patients with BMI >25, 14 patients developed VTE. Out of total, 329 patients received prophylaxis for deep vein thrombosis. Of 284 patients who received pharmacologic prophylaxis, only three developed VTE (P = 0.002). Of 145 patients who received mechanical prophylaxis, 75 had high risk and none of them developed VTE. Four patients had mortality, and a significant (P = 0.022) correlation was found between mortality and VTE development. According to Caprini risk assessment scale, the prophylaxis for VTE was effective in patients undergoing major elective general surgery, resulting in significant lowering of morbidity and mortality.

Overuse of Hematocrit Testing After Elective General Surgery at a Veterans Affairs Medical Center.

To evaluate the clinical usefulness and costs of routine postoperative hematocrit testing after elective general surgery. We reviewed charts of all patients who had elective general surgery at New Mexico Veterans Affairs Health Care System, Albuquerque hospital from 2011 through 2014. Demographic data and patient characteristics (eg, comorbidities, smoking/drinking history), estimated blood loss (EBL), pre- and postoperative hematocrit levels, and signs and symptoms of anemia were compared in patients who did or did not receive a blood transfusion within 72 hours of the operation. Of 1531 patients who had an elective general surgery between 2011 and 2014, ≥ 1 postoperative hematocrit levels were measured in 288 individual patients. There were 1312 postoperative hematocrit measurements before discharge (mean, 8.7; range, 1-44). There were 12 transfusions (0.8%) for patients without moderate to severe pre-existing anemia (hematocrit < 30%). Five of 12 transfused patients received intraoperative transfusions and 7 patients were transfused within 72 hours postoperation. No patients were transfused preoperatively. Of 12 patients receiving transfusion, 11 had EBL > 199 mL and/or signs of anemia. Risk factors for postoperative transfusion included lower preoperative hematocrit, increased EBL, and having either abdominoperineal resection or a total proctocolectomy. Routine postoperative hematocrit measurements after elective general surgery at US Department of Veterans Affairs medical centers are of negligible clinical value and should be reconsidered. Clinical judgment, laboratory-documented pre-existing anemia, a high-risk operation, or symptoms of anemia should prompt monitoring of patient postoperative hematocrit testing. This strategy could have eliminated 206 initial hematocrit checks over the 4 years of the study.

Surgical site infections in elective and emergency general surgery cases in a tertiary public hospital of South India: a retrospective study

Surgical site infections in elective and emergency general surgery cases in a tertiary public hospital of South India: a retrospective study

Comparison of Hemodynamic Effect of Propofol and Ketofol during Induction of Anaesthesia in General Surgery Patients

Objective: To determine the comparison of homodynamic effect of propofol and ketofol duringinduction in general surgery patients.Study design: Randomized control trialSetting: Department of Anesthesia, Surgical ICU and Pain management, Civil Hospital Karachi.Duration: Seven months from June 2019 to January 2020.Methods: Patients scheduled for elective general surgery procedures, aged 20 to 60 years, bothmale and female patients were included. Patients were randomly allocated into two groups.Group A received a combination of ketofol while Group B received propofol as the inductionagent. After recording of the base line values of mean arterial pressure patient was induced usingpropofol or ketofol. Mean arterial pressure readings were noted at 30 seconds after druginjection, as well as at 1 minute, 5 minutes, and 10 minutes after intubation, to capture theimmediate hemodynamic effects of the drugs and to observe any potential changes over timefollowing intubation.Results: The average age of the patients was 37.38±13.78 years. Out of 64 patients, 30(46.9%)were male and 34(53.1%) were female. Homodynamic effect was significantly high in thosepatients who received ketofol than those who received propofol (100% vs. 59.4% p=0.0005).The findings observed also with significant differences in hemodynamic effects between the twogroups, even after controlling for age, gender, and ASA classification (p-&amp;lt;0.05).Conclusion: Combination of Ketofol with ketofol was observed to be the betterhemodynamically as compared to Propofol. Additionally, the use of ketofol reduces the cost ofinduction and decreasing the economic burden on the patient.

Evaluating the safety and efficacy of a novel polysaccharide hemostatic system during surgery: A multicenter multispecialty prospective randomized controlled trial

BackgroundOperative blood loss is associated with postoperative morbidity and mortality in surgery. Hemostatic agents are used as adjuncts for hemostasis during surgery and help to prevent postoperative bleeding. We evaluated the safety and efficacy of an investigational polysaccharide hemostatic (PH) topical product compared to a U.S. Food and Drug Administration (FDA)-approved control in clinical use comprising microporous polysaccharide hemospheres (MPH) to achieve hemostasis of bleeding surfaces during surgery. Study designThis prospective multicenter trial enrolled patients undergoing open elective cardiac, general, or urologic surgery. Patients were stratified by bleeding severity and therapeutic area, then randomized 1:1 to receive PH or MPH. Bleeding assessments occurred intraoperatively using a novel bleeding assessment methodology. Primary endpoint was noninferiority as compared with control via effective hemostasis at 7 min. Patients were monitored and followed daily in the postoperative period until time of discharge and again at 6 weeks. Overall survival was assessed in oncology patients at 24 months. Safety of PH vs. MPH was determined by comparing relative incidence of adverse events. ResultsAcross 19 centers, 324 (161 PH, 163 MPH) patients were randomized (48 % general surgery, 27 % cardiac surgery, and 25 % urologic surgery). PH was noninferior to MPH and met the primary endpoint of hemostatic success at 7 min at a non-inferiority margin of 10 %. No significant differences were found in adverse event rates. Six deaths were reported within the 6-week follow-up period. No difference in overall survival was observed at 2 years (76 % PH vs. 74 % MPH, P = .66) for patients undergoing cancer operations. ConclusionAcross three therapeutic areas, PH was noninferior to MPH at all hemostasis assessment time points with no safety concerns. PH is an effective alternative to MPH for hemostasis during surgery.ClinicalTrials.gov Identifier: NCT02359994

Early Complications of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Obstructive hydrocephalus (HCP) occurs when cerebrospinal fluid is blocked leading to the enlargement of ventricular pathways stream resulting into increase pressure within skull. Endoscopic third ventriculostomy (ETV) is considered an effective management strategy for hydrocephalus especially for third/fourth ventricle level. Objective: To study the per-operative and post-operative early complications of endoscopic third ventriculostomy in obstructive hydrocephalus patients. Methods: This prospective study was conducted at Department of Neurosurgery, Liaquat University Hospital, Hyderabad, from 1st January 2020 to 31st December 2022. One hundred and fifty patients were included. All the cases, were underwent general anesthesia and elective surgery was performed in them. The patients were followed post operatively for 7 days in context to cerebrospinal fluid (CSF) leakage, wound infection, bleeding, seizures as well as meningitis. Results: Seventy six (50.7%) were males and 74 (49.3%) were female. Mean age was 5.5 ± 2.3 years with maximum number of patients (70.7%) were under or equal the age of 5 years. Complications occurred in 18 patients (12%) out of 150 patients. Cerebrospinal fluid leakage was the most common complication occurred in 5 (3.33%) patients, wound infection was seen in 2 (1.3%) patients, meningitis developed in 3 (2%) patients, minor bleeding was seen in 3 (2%) patients, seizures developed in 4 (2.6%) patients, in hospital mortality occurred in 1 (0.66%) patient on 3rd post-operative day. Conclusions: Ventriculostomy appeared to be the better surgical approach for obstructive hydrocephaly management. Minimum numbers of associated complications were observed in present study group.

A longitudinal study examining the relationship between prioritization scores and changes in impact on life scores in elective surgery patients.

Healthcare systems globally face the issue of resource constraints and need for prioritization of elective surgery. Inclusive, explicit prioritization tools are important in improving consistency and equity of access to surgery across health systems. The General Surgical Prioritization Tool developed by New Zealand's Ministry of Health scores patients for elective non-cancer surgery based on surgeon's clinical judgement and patient derived Impact on Life (IoL) scores. This study aims to measure the changes in patient derived IoL scores after common general surgical procedures to enable direct comparison and inform future prioritization. This longitudinal observational study enrolled 322 participants who had undergone elective general surgical procedures. Participants were contacted 3 to 9 months after their procedures and requested to complete the IoL questionnaire. The primary endpoint was the change in IoL scores after surgery among the different procedures. Overall, 229/304 (75%) participants responded to the questionnaire and there were no significant baseline differences between responders and non-responders. Patients in the gallbladder treatment group had the greatest improvement in IoL scores. Patients across all ethnic groups had similar changes in IoL scores. Multivariate analysis showed that gallbladder surgery (relative to hernia surgery) and pre-surgery IoL scores significantly predicted improvement. The patient reported IoL score recorded at prioritization for surgery all reduced, albeit to varying amounts, after common general surgical procedures. This, combined with the fact that IoL scores predicted post-operative improvement support their inclusion in prioritization tools in addition to surgeon derived components.

The Incidence of Abnormal Preoperative Testing Among Elective Surgery Patients in a Referral Hospital in Southern Saudi Arabia.

Background Preoperative investigations are important to assess the clinical condition of patients who undergo elective surgical procedures. However, there is still debate about the usefulness of performing preoperative investigations. We aimed to determine the prevalence of routine preoperative investigation abnormalities among elective general surgery patients. Methodology This retrospective hospital-record-based study was conducted at the King Abdullah Hospital in Bisha Province, southern Saudi Arabia. General and clinical data of 968 patients who underwent elective surgical interventions from February 2022 to January 2023 were retrieved and analyzed. Result A total of 968 patients (578 females and 390 males) aged between 14 and 80 years were included in the study. Four hundred and eleven (42.5%) patients were in the age groupof 40 years and above. The commonly detected comorbidities among the patients were diabetes (15%), hypertension (12%), respiratory diseases (7.5%), and cardiac diseases (2.5%). Abnormalities related to hemoglobin (31%), total leucocyte count (12.7%), and platelets (8.5%) were found in 968 patients. Around 15% of patients had increased creatinine levels. Hypokalemia was observed in 6.8% of patients. Increased liver enzymes were reported in limited proportions (10% to 14%) of patients. Slightly abnormal radiological findings were reported for chest X-ray (CXR) (2.8%), electrocardiogram (ECG) (2%), and Doppler echocardiography (Echo) (0.8%). A statistically significant association between the age of the patient and abnormal findings of ECG (p <.001), Echo (p = .001), and CXR (p <.001). Cardiac abnormalities were commonly associated with patients of ≥ 40 years. Abnormal cardiac findings (CXR, ECG, Echo) were significantly (p<.05) increased with the presence of diabetes, hypertension, and cardiovascular comorbidities. Conclusions Preoperative testing revealed limited proportions of abnormal findings among patients with elective surgical procedures. Routine ordering of many preoperative investigations without specifications may not predict postoperative complications of the patients. Therefore, undertaking preoperative testing should be guided by targeted history, physical examination, clinical risk factors, and type of surgical procedure intended to be performed.

Quality of life among older patients after elective ventral hernia repair: A retrospective review

BackgroundVentral hernia repair is a common elective general surgery procedure among older patients, a population at greater risk of complications. Prior research has demonstrated improved quality of life in this population despite increased risk of complications. This study sought to assess the relationship between post–ventral hernia repair quality of life and patient frailty. We hypothesized that frail patients would report smaller gains in quality of life compared to the non-frail group. MethodsThe Abdominal Core Health Quality Collaborative was used to identify a cohort of patients 65 years of age or older undergoing elective ventral hernia repair from 2018 to 2022. Patients were categorized based on their modified frailty index scores as not frail/prefrail, frail, and severely frail. Quality of life was assessed using a patient-reported 12-item scale preoperatively, 30 days, 6 months, and 1 year postoperatively. ResultsA total of 3,479 patients were included: 30.93% non-frail, 47.17% frail, and 21.90% severely frail. Severely frail patients had lower quality of life scores at baseline (P = .001) but reported higher quality of life at both 30 days (1.24 points higher, 95% confidence interval (–1.51, 2.52), P = .010) and 6 months (0.92 points higher, 95% confidence interval (–2.29, 4.13), P = .005). Severely frail patients had higher rates of surgical site complications (P < .001) but no difference in 30-day readmissions. ConclusionOur results found that frail patients reported the greatest increase in quality of life 1 year from baseline, showing that they, when selected appropriately, can gain equal benefits and have similar surgical outcomes as their non-frail counterparts.

Pain Neuroscience Education in elective surgery patients: study protocol for a randomised controlled trial

BackgroundPain Neuroscience Education (PNE) consists of an educational strategy that seeks to understand the biological processes of pain and how to control it. The main objective of this study will...