Elective Patients Research Articles

Large-scale dynamic surgical scheduling under uncertainty by hierarchical reinforcement learning

Dynamic surgical scheduling within a workday is a complicated decision-making process. The critical challenge is that the actual duration of surgery and the arrival process of emergency patients are uncertain and unknown in advance. In this work, we propose a two-level dynamic scheduling framework based on hierarchical reinforcement learning to solve dynamic surgical scheduling problems considering both elective and emergency patients. Specifically, with the realisation of uncertainty, the upper-level agent (UA) dynamically decides whether to trigger rescheduling to optimise the workday total cost. The lower-level agent (LA) aims at obtaining subscheduling solutions when rescheduling is triggered. The subproblem at the LA can be formulated as a mixed integer programming model, which can be generalised to unrelated parallel machine scheduling with machine eligibility restrictions and sequence- and machine-dependent setup times. Such problems can be solved in small-scale cases and suffers the combinatorial explosion in large scale cases. To address this issue, we propose a heuristic method that is built upon deep reinforcement learning to obtain high-quality solutions. We conduct extensive simulation experiments with real data to test the effective of our framework. The results for different scenarios show that our proposed framework outperforms existing methods in terms of overall performance and has strong generalisation ability.

Postoperative bioactive adrenomedullin is associated with the onset of ARDS and adverse outcomes in patients undergoing open thoracoabdominal aortic surgery

Cytokine-mediated systemic inflammation after open thoracoabdominal aortic aneurysm (TAAA) repairs plays a pivotal role in disrupting circulatory homeostasis, potentially leading to organ dysfunction. The bioactive form of adrenomedullin (bio-ADM) is a peptide hormone with immunomodulatory and vasomotor effects, making it a potential diagnostic agent in these cases. This retrospective, bicentric study, conducted between January 2019 and December 2022, recruited 36 elective open TAAA repair patients in two German centres. Serum and plasma samples were collected at multiple time points to measure bio-ADM levels. The primary objective was to evaluate the association of bio-ADM levels with the onset of acute respiratory distress syndrome (ARDS), with secondary endpoints focusing on mortality and SIRS-related morbidity. Results showed a significant association between postoperative bio-ADM levels (12–48 h after surgery) and the onset of ARDS (p < .001), prolonged ventilation (p = .015 at 12h after surgery), atrial fibrillation (p < .001), and mortality (p = .05 at 24h). The biomarker was also strongly associated with sepsis (p = .01 at 12 h) and multi-organ dysfunction syndrome (MODS) (p = .02 at 24 h after surgery). The study underscores the potential utility of bio-ADM as a diagnostic tool for identifying patients at risk of postoperative complications following open TAAA repairs.

Prevalence of pre-operative anemia in elective surgical patients: A retrospective, observational study at a university hospital

BackgroundAnemia is the most hematological condition found in surgical patients. Pieces of empirical evidence shows that pre-operative anemia accounts for one- third of surgical patients. Yet, pre-operative anemia & blood transfusion for surgical patients has been associated with many complications such as lengthy hospital stay, post operation surgical wound infections, mortality and morbidity. PurposeThis Pilot preliminary study sought to determine the prevalence of pre-operative anemia in elective surgical patients and to assess health workers’ awareness and knowledge regarding patient blood management in Saudi Arabia. Material and methodsA questionnaire was used to collect data from the 129 healthcare workers in a selected hospital in Saudi Arabia. Additional data was obtained from the hospital electronic data records regarding the incidences of pre-operative anemia. Therefore, the study applied both retrospective and cross-sectional designs. The collected data was then analyzed using the Statistical Package for Social Services [SPSS]. ResultsThis study established the prevalence of pre-operative anemia in elective surgical patients to be 30 % (291 out of 970). In addition, 129 participants completed the questionnaires, from different hospital departments. From the questionnaire, it was noted that 74.2 % of the of physicians had the knowledge about patient blood management while 65 % (n = 50) were aware of the written protocol for the management of pre-operative anemia. This study also found out that 48.1 % of physicians rarely get to meet their patients assessed for possible anemia 4–8 weeks prior surgical operation. In addition, a relatively high number of physicians (42.6, n = 55 rarely investigate the cause of anemia after it has been established while 45.7 % confirm to rarely transfer their patient to pre-operative clinic for anemia management. Low intervention in correction of anemia of low iron origin by the physicians was established to be 44.2 %, and the most preferred hematology analyzer for point of care management was CBC Analyzer Sysmex (79.8 %). ConclusionThis study finds a significant lack of knowledge about pre-operative anemia management in line with the patient blood management protocol. Also, majority of physicians fail to follow the guidelines for anemia management despite the high incidence.

Retrospective audit of pre-operative malnutrition risk screening in elective colorectal cancer surgical patients

Retrospective audit of pre-operative malnutrition risk screening in elective colorectal cancer surgical patients

Evaluation of the Effectiveness of Canadian Cardiovascular Society Guidelines in Minimizing Cardiac Events After Total Hip Arthroplasty

BackgroundThe aim of the study was to analyze the Canadian Cardiovascular Society (CCS) guidelines for routine postoperative troponin testing after elective total hip arthroplasty (THA) to reduce the mortality rate resulting from myocardial injury. The purpose of this study was to assess the prognostic relevance of implementing these guidelines to minimize cardiac events in patients undergoing elective THA. MethodsPatients who underwent THA surgery in 2020 were included in the study. The inclusion criteria were elective THA patients aged ≥45 years, while emergency, revision, and simultaneous bilateral THA surgeries were excluded. The patients were categorized into 4 groups based on the CCS guidelines. ResultsThe study included 669 patients who had an average age of 67 years. There were 43 patients (6.4%), who experienced a rise in troponin levels ≥30 ng/L and developed myocardial injury after noncardiac surgery. Among these patients, 8 developed cardiac complications, and one experienced a serious cardiac event that resulted in death. Notably, there was a significant increase in the length of hospital stay for patients who received the postoperative screening protocol. ConclusionsThe implementation of the CCS guidelines for routine postoperative troponin testing in elective THA surgery did not significantly decrease the rate of cardiac events or mortality.

Surgical Patient Preoperative Readiness: Translation into French, Cultural Adaptation for Switzerland and Cross-Sectional Exploratory Study in a Tertiary Hospital

PurposePreoperative evaluation of elective surgery patients traditionally focuses on somatic and organizational aspects of the situation. Patient feelings of readiness, called preoperative readiness (PR), impacts postoperative outcomes, and yet is rarely evaluated. The Preoperative Assessment Tool (PART) is a validated and reliable 15-item questionnaire available in Filipino and English. A reliable tool is essential for evaluating PR within the Swiss health context to offer optimized and comprehensive perioperative care. The aim of this study was to both translate into French and adapt culturally the Preoperative Assessment Tool for Switzerland’s francophone population, and to explore patient PR in the preoperative consultation within a Swiss tertiary hospital. DesignA mixed design with methodologic phases and descriptive study. MethodsA mixed design in two phases with a methodologic phase with (1) translation and (2) cultural adaptation for Romandie of the PART, following Wild’s 10 steps methodology (n = 11) and (3) a cross-sectional exploratory descriptive study with pilot testing of the translated version in a general elective preoperative consultation in a tertiary hospital in Romandie (N = 88). FindingsTranslation and cultural adaptations are well accepted and understood by the participants (n = 9/11), modifications are accepted by the authors and deemed adequate by the participants (n = 11/11). Time of completion is short (m = 69.06 seconds) and adapted to clinical context. The translated version has a Cronbach (α = 0.85) comparable to the original validated scale (α = 0.86). ConclusionsThe translation and cultural adaptation for Switzerland of the PART was achieved, and PR was explored. Further psychometric testing of the PART-FrenCH must be conducted to assess fully the tool before its use in a clinical setting. Including PR in preoperative evaluations could enhance patient-centered approaches and lead to improvement in the quality of care.

Macintosh-style videolaryngoscope use for tracheal intubation in elective surgical patients revisited: a sub-analysis of the 2022 Cochrane review data

The Cochrane systematic review and meta-analysis published in 2022 that compared videolaryngoscopy (VL) with direct laryngoscopy (DL) for facilitating tracheal intubation in adults found that all three types of VL device (Macintosh-style, hyper-angulated and channeled) reduced the risk of failed intubation and increased the likelihood of first-pass success. We report the findings of a subgroup re-analysis of the 2022 Cochrane meta-analysis data focusing on the Macintosh-style VL group. This was undertaken to establish whether sufficient evidence exists to guide airway managers in making purchasing decisions for their local institutions based upon individual device-specific performance. This re-analysis confirmed the superiority of Macintosh-style VL over Macintosh DL in elective surgical patients, with similar efficacy demonstrated between the Macintosh-style VL devices examined. Thus, when selecting which VL device(s) to purchase for their hospital, airway managers decisions are likely to remain focused upon issues such as financial costs, portability, cleaning schedules and previous device experience.

The development of day surgery in China and the effectiveness and reflection of day surgery in ophthalmology-specialized hospitals.

This survey investigates the development of day surgery in China, and analyzes the national policy support, medical service management model, disease types of day surgery, medical insurance payment methods, and the medical service capacity, efficiency, quality and safety, health economics indicators, and patient satisfaction after the implementation of day surgery in a tertiary eye hospital. After more than 20 years of development, China's day surgery has shown a good development trend. The implementation of day surgery in eye hospitals accounts for more than 70% of elective surgery, and patients, medical institutions, and medical insurance institutions have all achieved good social benefits.

Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe.

Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery. This was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery. Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more long-term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher in patients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16-3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35-3.64)). Frailty and ASA physical status 3-5 mediated an estimated 31.7% of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12-1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36-1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who received pre-operative medical assessment. Multimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity.

Preoperative investigation practices for elective surgical patients: clinical audit

BackgroundThe findings of pre-operative investigations help to identify risk factors that may affect the course of surgery or post-operative recovery by contributing to informed consent conversations between the surgical team and the patient, as well as guiding surgical and anesthetic planning. Certainly, preoperative tests are valuable when they offer additional information beyond what can be gathered from a patient’s history and physical examination alone. Preoperative testing practices differ significantly among hospitals, and even within the same hospital, clinicians may have varying approaches to requesting tests. This study aimed to investigate preoperative testing practices and compare them with the latest guidelines from the National Institute for Health and Care Excellence (NICE).MethodsThis three-month institutionally based study was carried out at the Debre Tabor Comprehensive Specialized Hospital from May 1 to July 30, 2023, including individuals aged 16 years and older who were not pregnant and had undergone elective surgery in the gynecological, orthopedic, and general units. Data on the sociodemographic characteristics, the existence of comorbidities, the invasiveness of surgery, and the tests taken into consideration by the guideline were gathered using a self-administered questionnaire. After rigorously analyzing and revising the results of preoperative investigation approaches, we compared them to the standard of recommendations. Moreover, the data was analyzed and graphically presented using Microsoft Excel 2013.ResultsDuring the data collection period, 247 elective patients underwent general, orthopedic, and gynecological operations. The majority of patients, 107 (43.32%), were between the ages of 16 and 40 and had an American Society of Anesthesiologists (ASA) class one (92.71%). 350 investigations were requested in total. Of these, 71 (20.28%) tests were ordered without a justified reason or in contravention of NICE recommendations.ConclusionsIn our hospital’s surgical clinical practice, unnecessary preoperative testing is still common, especially when it comes to organ function tests, electrocardiograms (ECGs), and complete blood counts (FBCs). When deciding whether preoperative studies are required, it is critical to consider aspects including a complete patient history, a physical examination, and the invasiveness of the surgery.

Off-Pump Reduces Risk of Coronary Bypass Grafting in Patients with High MELD-XI Score.

This study aimed to assess the influence of the model of end-stage liver disease without International Normalized Ratio (INR) (MELD-XI) score on outcomes after elective coronary artery bypass surgery (CABG) without (Off-Pump) or with (On-Pump) cardiopulmonary bypass. We calculated MELD-XI (5.11 × ln serum bilirubin + 11.76 × ln serum creatinine in + 9.44) for 3,535 consecutive patients having undergone elective CABG between 2009 and 2020. A MELD-XI threshold was determined using the Youden Index based on receiver operating characteristics. Propensity score matching and logistic regression was performed to identify risk factors for inhospital mortality and Major Adverse Cardiac and Cerebrovascular Event (MACCE). Patients were 68 ± 10 years old (76% male). Average MELD-XI was 10.9 ± 3.25. The MELD-XI threshold was 11. Patients below this threshold had somewhat lower EuroSCORE II than those above (3.5 ± 4 vs. 4.1 ± 4.7, p < 0.01), but mortality was almost four times higher above the threshold (below 1.5% vs. above 6.2%, p < 0.001). Two-thirds of patients received Off-Pump CABG. There was a trend towards higher risk in Off-Pump patients. Mortality was numerically but not statistically different to On-Pump below the MELD XI threshold (1.3 vs. 2.2%, p = 0.34) and was significantly lower above the threshold (4.9 vs. 8.9%, p < 0.02). Off-Pump above the threshold was also associated with less low-output syndrome and fewer strokes. Equalizing baseline differences by propensity matching verified the significant mortality difference above the threshold. Multivariable regression analysis revealed MELD-XI, On-Pump, atrial fibrillation, and the De Ritis quotient (Aspartate aminotransferase (ASAT)/Alanine Aminotransferase (ALAT)) as independent predictors of mortality. Elective CABG patients with elevated MELD-XI scores are at increased risk for perioperative mortality and morbidity. This risk can be significantly mitigated by performing CABG Off-Pump.

Return to athletics after total knee arthroplasty: a survey study of 784 recreational athletes across 12 sports.

Postoperative return to recreational activity is a common concern among the increasingly active total knee arthroplasty (TKA) patient population, though there is a paucity of research characterizing sport-specific return and function. This study aimed to assess participation level, postoperative return to activity, sport function, and limitations for recreational athletes undergoing TKA. A survey of recreational sports participation among primary, elective TKA patients from a single academic center between June 2011 and January 2022 was conducted. Of the 10,777 surveys administered, responses were received from 1,063 (9.9%) patients, among whom 784 indicated being active in cycling (273 [34.8%]), running (33 [4.2%]), jogging (68 [8.7%]), swimming (228 [29.1%]), tennis (63 [8.0%]), skiing (55 [7.0%]), or high-impact team sports (64 [8.2%]) between two years preoperatively and time of survey administration, and were included for analyses. Cycling (62.3% at two years preoperatively vs. 59.0% at latest follow-up) and swimming (62.7% at two years preoperatively vs. 63.6% at latest follow-up) demonstrated the most favorable participation rate changes, while running (84.0% at two years preoperatively vs. 48.5% at latest follow-up) and skiing (72.7% at two years preoperatively vs. 45.5% at latest follow-up) demonstrated the least favorable participation rate changes. The majority of respondents were "satisfied" or "very satisfied" with their return across all sports, though dissatisfaction was highest among runners and joggers. For cycling, running, jogging, and swimming, respondents most commonly reported no change in speed or distance capacity, though among these cyclists reported the highest rates of improved speed and distance. The majority of returning skiers reported improved balance, form, and ability to put on skis. Return to sport is feasible following TKA with high satisfaction. Swimming and cycling represent manageable postoperative activities with high return-rates, while runners and joggers face increased difficulty returning to equal or better activity levels. Patients should receive individualized, sports-specific counseling regarding their expected postoperative course based on their goals of treatment.

The incidence and factors associated with anemia in elective surgical patients admitted to a surgical intensive care unit: a retrospective cohort study

BackgroundAnemia is a frequently reported and commonly documented issue in intensive care units. In surgical intensive care units, more than 90% of patients are found to be anemic. It is a hematologic factor that contributes to extended mechanical ventilation, sepsis, organ failure, longer hospitalizations in critical care units, and higher mortality. Thus, this study aimed to determine the incidence and identify factors associated with anemia in elective surgical patients admitted to the surgical intensive care unit.MethodsA retrospective follow-up study involving 422 hospitalized patients was carried out between December 2019 and December 2022 in the surgical intensive care unit after elective surgery at Tikur-Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Data were gathered from the patients’ charts, and study participants were chosen using methods of systematic random sampling. SPSS 26 (the statistical software for social science, version 26) was used to analyze the data. Bivariable and multivariable binary logistic regression were used to examine associations between variables.ResultsThe incidence of anemia in elective surgical patients admitted to the intensive care unit was 69.9% (95% CI 65.4–74.5%). American Society of Anesthesiologists’ class III (ASA III) [AOR: 8.53, 95% CI 1.92–13.8], renal failure [AOR:2.53, 95% CI (1.91–5.81)], malignancy [AOR: 2.59, 95% CI (1.31–5.09)], thoracic surgery [AOR: 4.07, 95% CI (2.11–7.87)], urologic surgery [AOR: 6.22, 95% CI (2.80–13.80)], and neurosurgery [AOR: 4.51, 95% CI (2.53–8.03)] were significantly associated with anemia in surgical patients admitted to the intensive care unit.ConclusionMore than two-thirds of the intensive care unit-admitted surgical patients experienced anemia. An American Society of Anesthesiologists’ (ASA III score), renal failure, malignancy, thoracic surgery, urologic surgery, and neurosurgery were significantly associated with this condition. Early identification helps to institute preventive and therapeutic measures.

Relationship between cortical brain atrophy, delirium, and long-term cognitive decline in older surgical patients

In older patients, delirium after surgery is associated with long-term cognitive decline (LTCD). The neural substrates of this association are unclear. Neurodegenerative changes associated with dementia are possible contributors. We investigated the relationship between brain atrophy rates in Alzheimer’s disease (AD) and cognitive aging signature regions from magnetic resonance imaging before and one year after surgery, LTCD assessed by the general cognitive performance (GCP) score over 6 years post-operatively, and delirium in 117 elective surgery patients without dementia (mean age = 76). The annual change in cortical thickness was 0.2(1.7) % (AD-signature p = 0.09) and 0.4(1.7) % (aging-signature p = 0.01). Greater atrophy was associated with LTCD (AD-signature: beta(CI) = 0.24(0.06–0.42) points of GCP/mm of cortical thickness; p < 0.01, aging-signature: beta(CI) = 0.55(0.07–1.03); p = 0.03). Atrophy rates were not significantly different between participants with and without delirium. We found an interaction with delirium severity in the association between atrophy and LTCD (AD-signature: beta(CI) = 0.04(0.00–0.08), p = 0.04; aging-signature: beta(CI) = 0.08(0.03–0.12), p < 0.01). The rate of cortical atrophy and severity of delirium are independent, synergistic factors determining postoperative cognitive decline in the elderly.

Endovascular Arch Repair of Anastomotic Aneurysm and Pseudoaneurysm in Patients after Open Repair of the Ascending Aorta and Aortic Arch: A Case Series

Abstract Background Endovascular techniques have provided new options in the treatment of arch pathologies. Multiple studies have reported good results after endovascular treatment of aortic arch aneurysms and it has developed to be a considerable approach, especially in patients who are unfit for open surgery. In treatment of progressing distal pathologies after open ascending aorta and/or aortic arch replacement, the endovascular arch repair has shown promising results. Aims Aim of study was to investigate the outcomes of endovascular arch repair (b-TEVAR) with a custom-made double or triple branched arch endograft in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement. Methods Retrospective analysis was conducted of all consecutive patients with anastomotic aneurysms after open surgical repair involving the ascending aorta and/or aortic arch treated with b-TEVAR. All patients were treated with a custom-made double or triple inner-branched arch endograft. Study endpoints were technical success, 30-day and follow up mortality/ morbidity and re-interventions. Results Between 2018 and 2022, ten patients were treated with custom-made double or triple branched TEVAR due to anastomotic aneurysms after open ascending aorta and/or proximal aortic arch replacement. Eight patients received a triple and two a double arch branched endograft. Eight cases were performed electively and two urgently for contained rupture. Technical success was achieved in nine cases (90%). All elective patients survived. Two patients treated due to contained ruptures expired. Within 30 postoperative days, one transient ischemic attack occurred. No early endograft-related re-interventions were necessary. Median follow-up was 20 months. One patient died two months after discharge due to sepsis caused by pneumonia. No further deaths or endograft-related re-interventions were observed. Conclusion Endovascular aortic arch repair with double or triple inner-branched arch endograft for anastomotic aneurysms after open ascending and/or proximal arch replacement is technically feasible and a promising alternative in a patient cohort unfit for surgery.

Severe cholecystitis during the COVID-19 pandemic : Influence of the COVID-19 pandemic on the frequency of surgery and outcome for elective and emergency cholecystectomy: a monocentric retrospective cohort analysis

With the outbreak of the COVID-19 pandemic medical care focused on management of the infectious event. Elective interventions were cancelled and the general advice was to stay at home. How this impacted urgent and elective cholecystectomies is the subject of this work. Urgent and elective cholecystectomy patients during the first year of the pandemic were compared with those of the previous year. The primary endpoint was the frequency of surgery. Furthermore, the American Society of Anesthesiologists (ASA) score, symptom duration until presentation as well as until surgery, preoperative inflammatory parameters, imaging, positive Murphy's sign, type and duration of surgery, intraoperative drain placement, intraoperative and histological severity, need for and duration of postoperative antibiotic therapy, intensive care stay, length of stay and occurrence of postoperative complications were recorded. During the pandemic patients were sicker (ASA2.13 vs. 2.31; p = 0.039), the operating time was prolonged (64.4 min vs. 74.9 min; p = 0.001) and patients were more likely to have concomitant peritonitis (15.4% vs. 29.1%: p = 0.007). Furthermore, there was atrend in the presence of leukocytosis, apositive Murphy's sign, intraoperative drain placement, intraoperative severity of inflammation, duration of postoperative antibiotic therapy and complication rate. During the COVID-19 pandemic cholecystitis presented with more pronounced inflammation, the surgical conditions were more difficult and postoperative recovery was prolonged.

COMPARISON BETWEEN NEBULISATION OF MGSO4 20 MG/KGBW WITH KETAMINE 0.5 MG/KGBW ON THE INCIDENT OF POST-OPERATIVE SORE THROAT DUE TO ENDOTRACHEAL INTUBATION IN PATIENTS UNDERGOING GENERAL ANESTHESIA IN DR. HASAN SADIKIN HOSPITALS BANDUNG

Post Operative Sore Throat (POST) is a Symptoms often experienced by patients after surgery under general anesthesia and endotracheal intubation. The incidence of POST is between 21-71.8. POST causes discomfort to patients which can prolong hospital stay. In this study, a comparison was made between MgSO4 nebulization 20 mg/ KgBW and ketamine nebulization 0.5 mg/ KgBW on the incidence of POST after general anesthesia at RSUP Dr. Hasan Sadikin Bandung . This study used a double blind randomized controlled trial design. 72 elective surgery patients were randomly divided into 2 groups. Group M was given MgSO4 nebulization while group K was given ketamine nebulization. Nebulization was performed 15 minutes before induction of general anesthesia. POST monitoring was performed at 1, 4 and 24 hours after extubation using POST scoring. In this study, it was found that the incidence of POST in group M, namely the 1st hour of 13.5, the 4th hour of 10.8 and the 24th hour of 0 was lower than that in group K, namely the 1st hour of 28.5, the 4th hour of 32.5 and the 24th hour of 0. Statistical test results p0.033 showed a significant difference in group M better than group K at the 4th hour in reducing the incidence of POST. MgSO4 and ketamine have antinociceptive and anti-inflammatory effects with the mechanism of action of blocking NMDA receptors that inhibit calcium influx that avoids central sensitization. MgSO4 also has a muscle relaxing effect and reduces airway mucus secretion, thus reducing the risk of trauma during endotracheal intubation. The conclusion of this study is that MgSO4 nebulization shows a lower incidence of POST than ketamine nebulization.

Associated factors of mortality and morbidity in emergency and elective abdominal surgery: a two-year prospective cohort study at lacor hospital, Uganda

BackgroundThe mortality rate associated with open abdominal surgery is a significant concern for patients and healthcare providers. This is particularly worrisome in Africa due to scarce workforce resources and poor early warning systems for detecting physiological deterioration in patients who develop complications.MethodsThis prospective cohort study aimed to follow patients who underwent emergency or elective abdominal surgery at Lacor Hospital in Uganda. The participants were patients who underwent abdominal surgery at the hospital between April 27th, 2019 and July 07th, 2021. Trained research staff collected data using standardized forms, which included demographic information (age, gender, telephone contact, and location), surgical indications, surgical procedures, preoperative health status, postoperative morbidity and mortality, and length of hospital stay.ResultsThe present study involved 124 patients, mostly male, with an average age of 35 years, who presented with abdominal pain and varying underlying comorbidities. Elective cases constituted 60.2% of the total. The common reasons for emergency and elective surgery were gastroduodenal perforation and cholelithiasis respectively. The complication rate was 17.7%, with surgical site infections being the most frequent. The mortality rate was 7.3%, and several factors such as preoperative hypotension, deranged renal function, postoperative use of vasopressors, and postoperative assisted ventilation were associated with it. Elective and emergency-operated patients showed no significant difference in survival (P-value = 0.41) or length of hospital stay (P-value = 0.17). However, there was a significant difference in morbidity (p < 0.001).ConclusionCholelithiasis and gastroduodenal perforation were key surgical indications, with factors like postoperative ventilation and adrenaline infusion linked to mortality. Emergency surgeries had higher complication rates, particularly surgical site infections, despite similar hospital stay and mortality rates compared to elective surgeries.

Analysis of the Knowledge Level of Surgical Residents Regarding the Preoperative Assessment of Adult Elective Non-cardiac Surgery Patients with Specific Clinical Conditions

Analysis of the Knowledge Level of Surgical Residents Regarding the Preoperative Assessment of Adult Elective Non-cardiac Surgery Patients with Specific Clinical Conditions

A retrospective study of the prevalence of isolated prolongation of activated partial thromboplastin time in the preoperative setting

BackgroundIsolated prolongation of activated partial thromboplastin time (APTT) has various causes including inheritable bleeding disorders, and has medical significance as it can lead to the cancelation of surgery. However, even an emergency surgery can be conducted in a patient presenting with severe APTT prolongation, provided careful evaluation and appropriate measures are taken. Hence, the identification of the underlying etiology of the prolonged APTT is crucial. To date, little evidence exists regarding the prevalence of isolated APTT prolongation in Japanese patients undergoing surgery. Herein, we aimed to clarify the prevalence of isolated prolongation of APTT in the preoperative setting and to identify the reasons underlying isolated, severely prolonged APTT.MethodsPreoperative coagulation data of all elective and emergent patients who presented to the anesthetic department between January 1, 2020, and June 30, 2023, were retrospectively collected. Isolated prolongation of APTT was defined as an APTT ≥ 37 s with an international normalized ratio of prothrombin time < 1.2. The underlying etiology of the patient with isolated, severely prolonged APTT (≥ 46 s) was investigated, and canceled surgical procedures in relation to the isolated APTT prolongation were searched.ResultsOverall, 10,684 measurements from 9413 patients were included, of which 725 (6.8%) were identified as having isolated APTT prolongation. The reasons for the severely prolonged APTT (n = 60) were miscellaneous, with the most frequently detected etiology being antiphospholipid antibody positivity. Preoperative isolated APTT prolongation contributed to the cancellation of surgery in elective five cases.ConclusionsWe clarified the prevalence of preoperative isolated prolongation of APTT. The presence of antiphospholipid antibody was the most frequently detected etiology of the patient with isolated, severely prolonged APTT. The present study provides an important dataset regarding the isolated prolongation of APTT in East Asian patients undergoing surgery.