Initial Postoperative Visit Research Articles

Factors influencing residual plus moist HS-W calcium alginate packing material after endoscopic sinus surgery

ObjectiveThis study aims to evaluate the presence of residual Plus Moist HS-W (PM), a novel calcium alginate packing material, during the initial postoperative visit following endoscopic sinus surgery. The research aims to identify factors that influence the quantity of remaining PM. MethodsA retrospective review of medical records was conducted for patients who underwent middle meatus packing with PM. ResultsA total of fifty-two patients (representing 92 sides of paranasal sinuses) were included in the analysis. The remaining PM was classified as follows: absent (0) in 41 out of 92 cases, minimal (1) in 22 out of 92 cases, moderate (2) in 15 out of 92 cases, and substantial (3) in 14 out of 92 cases. Notably, all three patients who underwent Draf III surgery exhibited a significant amount of PM during their initial visit, with two patients classified as grade 2 and one patient as grade 3. Other factors investigated were found to be unrelated to the persistence of PM. Removal of all PM was achieved effortlessly using suction under flexible endoscopy. ConclusionThis study highlights the efficacy of PM in post-endoscopic sinus surgery care. It is important to limit an amount of PM, particularly in Draf III procedures.

Factors influencing early recurrence of atrial fibrillation among elderly patients following radiofrequency catheter ablation and the impact of different antiarrhythmic regimens.

Patients with atrial fibrillation (AF) who undergo radiofrequency catheter ablation (RFCA) necessitate the administration of antiarrhythmic drugs to prevent early recurrence. The clinical outcomes among these patients may be influenced by varying antiarrhythmic regimens. To identify the risk factors associated with early recurrence and compare the clinical outcomes among different antiarrhythmic regimens in elderly patients with AF following radiofrequency catheter ablation (RFCA) during a 3-month period. A retrospective observational study encompassed 420 elderly patients with AF following RFCA. Baseline data were collected during the initial postoperative visit and clinical outcomes were carefully monitored over a 3-month follow-up period. Logistic regression and Cox-proportional hazard regression analyses were performed to investigate the relationship between various antiarrhythmic regimens and the clinical outcomes. Multivariate logistic regression analysis revealed that age (p = 0.001), left atrial diameter (p < 0.001), left ventricular diameter (p = 0.015), reactive hyperemia index (RHI) (p < 0.001), antiarrhythmic drug (p < 0.001) and hs-cTnI (p = 0.017) were independent risk factors of early recurrence. Furthermore, in cox survival regression analysis model, survival rate of early recurrence in the amiodarone group was higher than in the propafenone group (HR 2.30, 95%CI 1.17-4.53, p = 0.016) and in the sotalol group (HR 3.60, 95%CI 2.17-5.95, p < 0.001). Compared to the amiodarone group, the incidence of liver dysfunction was lower in the dronedarone group (p = 0.046) and the propafenone group (p = 0.021). The incidence of bradyarrhythmia (p = 0.003), QT interval prolongation (p = 0.035) and atrioventricular transmission block (p = 0.021) were higher in the sotalol group than in the amiodarone group. RHI was identified as an independent risk factor for early recurrence among elderly AF patients after RFCA. Compared to amiodarone, propafenone and sotalol exhibited an elevated risk of early recurrence. Although there was no significant difference in early recurrence between amiodarone and dronedarone, dronedarone emerged as the preferred option due to its lower frequency of adverse drug reactions than amiodarone.

Sex differences in patients with primary hyperparathyroidism

BackgroundDifferences in presenting symptoms of primary hyperparathyroidism and outcomes of parathyroidectomy between sexes have been described, but whether these can be assessed by perioperative use of a validated tool, such as the Pasieka Parathyroidectomy Assessment Score, is unknown. MethodAll patients with primary hyperparathyroidism were asked to complete symptom assessment at the preoperative and postoperative visits. The assessment included a query for 13 Pasieka Parathyroidectomy Assessment Score parameters evaluated using a visual analog scale as described by Pasieka (summative score 0–1,300), and general quality of life and wellness. A review of a prospectively maintained database of primary hyperparathyroidism patients (January 2016–December 2019) was performed, and those who had a 6-month cure after initial parathyroidectomy were included. ResultsThe study cohort was mostly women (77%, 541/701). The median preoperative Pasieka Parathyroidectomy Assessment Score was higher in women (155, 0–1,190) than in men (80.5, 0–855, P < .001), although there were similar rates of asymptomatic primary hyperparathyroidism (Pasieka Parathyroidectomy Assessment Score = 0, 12.5% vs 7%, P = .042). After curative parathyroidectomy, women reported a substantial reduction in symptomatology, with Pasieka Parathyroidectomy Assessment Score declining by 35% at initial postoperative visit (median, 155 vs 100, P < .001), further decreasing to 48% by 6 months (155 vs 80, P < .001). The Pasieka Parathyroidectomy Assessment Score in men did change but to a much smaller degree at both the initial postoperative visit (80.5 vs 70; P = .036) and at 6 months (80.5 vs 57.5; P = .048). ConclusionWhen assessed with the Pasieka Parathyroidectomy Assessment Score, improvement in symptoms was clearly demonstrated for women after curative parathyroidectomy. Whether symptom improvement also occurs in men is less apparent but may be due to disparities in the development and validation of outcomes tools in general.

Using impedance planimetry to define the end of a peroral endoscopic myotomy.

Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic option for management of achalasia. Adequate distal myotomy is necessary for relief of symptoms, but when too long may also increase risk of reflux. The objective of this study is to evaluate clinical outcomes after POEM and final length of gastric myotomy using impedance planimetry (EndoFLIP). A retrospective review of 34 consecutive patients undergoing POEM with EndoFLIP were included. EndoFLIP measurements, including esophagogastric junction distensibility index (DI), minimum diameter (Dmin), and cross-sectional area (CSA) were recorded at 30- and 40-mL balloon-fill pre- and post- myotomy. The myotomy was considered complete when DI ≥ 3.4 mm2/mmHg. Postoperative Eckardt score (ES) was determined at initial postoperative visit and most recent follow-up. Linear and logistic regression were used to evaluate the association between gastric myotomy length and post-myotomy EndoFLIP measurements on postoperative ES and GERD. Wilcoxon rank-sum test was used to compare gastric myotomy lengths and EndoFLIP parameters in relation to clinical success and development of GERD, and paired t-test to compare EndoFLIP measurements and ES pre- and post-myotomy. Final length of gastric myotomy measured 1cm in 1 (2.9%), 1.5cm in 11 (32.4%), 2.0cm in 19 (55.9%), and 2.5cm in 3 (8.8%) patients. Mean preoperative ES was 6.6 ± 2.2. All patients achieved ES < 3 postoperatively, which was maintained in 88.5% of patients at a median of 7.5months of follow-up. Gastric myotomy length and post-myotomy EndoFLIP values were not associated with postoperative Eckardt scores or GERD. Early and late symptom relief was achieved in 100 and 88.5% of patients, respectively, at a gastric myotomy length of 1-2.5cm. Using EndoFLIP to define a completed myotomy at DI of 3.4 mm2/mmHg yielded variable lengths of gastric myotomy.

Immediate Intraoperative Microsurgical Repair of the Recurrent Laryngeal Nerve: A Fifteen-Year Institutional Experience

Abstract Background Recurrent laryngeal nerve (RLN) injury carries significant morbidity. Microsurgical repair of the RLN has proven promising for enhancing patient recovery of vocal function; however, data remains limited. Methods This retrospective cohort study included patients who underwent RLN repair from 2007 to 2022. Demographics and medical history were collected. The location and etiology of RLN injury, as well as the repair technique, were collected. Follow-up data were collected at the initial postoperative visit, at 6 months and at 1 year. Hoarseness was classified as mild, moderate, or severe. Of patients who underwent nasopharyngolaryngoscopy (NPL) following repair, the glottic gap was measured. Vocal interventions performed were also recorded. This study utilized descriptive statistical methods. Results Eleven patients underwent RLN repair. All patients underwent immediate repair. Fifty-four percent (n = 6) of RLN injuries resulted from tumor inflammation or nerve encasement. Eighty-two percent (n = 9) underwent direct RLN coaptation, 9% (n = 1) underwent vagus-RLN anastomosis, and 9% (n = 1) underwent an interposition nerve graft. Technical success was 100%. Seventy-three percent (n = 8) required otolaryngology referral, and of those, 50% (n = 4) required intervention. At initial evaluation, 91% (n = 10) suffered from mild to severe hoarseness, and of patients who underwent NPL, all had a glottic gap. At 1 year, 82% of patients (n = 9) improved to having mild to no appreciable hoarseness. Of the patients who underwent NPL, 62% (n = 5) had closure of the glottic gap. Conclusion Patients undergoing repair of the RLN following injury showed excellent recovery of vocal function and resolution of glottic gap at 1 year.

Reliability, validity, and responsiveness of a novel subscapularis outcome score: the Baltimore Orthopedic Subscapularis Score.

Available surveys that evaluate shoulder strength and pain often combine rotator cuff muscles making the test unable to differentiate subscapularis tears from other pathology including concomitant supraspinatus, infraspinatus tears. The purpose of this study was to validate a subscapularis-specific shoulder survey (Baltimore Orthopedic Subscapularis Score) as a viable clinical outcome assessment through analysis of psychometric properties. A 5-question survey was given to a study population of 390 patients, 136 of whom had full thickness rotator cuff tears with a minimum score of 5 (better) and a maximum score of 25 (worse). Surveys were given during the initial consultation, preoperative visit, and postoperative visit. Content validity, construct validity, test-retest reliability, responsiveness to change, internal consistency, and minimal clinically important difference using distribution and anchor-based methods were determined for our subscapularis function survey. A high correlation was reported on test-retest reliability (intraclass correlation coefficient=0.89). An acceptable internal consistency was reported for all patients surveyed (Cronbach alpha=0.91). Floor and ceiling effects for patients with rotator cuff pathology were minimized (1% for both). Patients with an isolated subscapularis tear scored worse than supraspinatus/infraspinatus tears and exhibited similar dysfunction as patients with a supraspinatus/infraspinatus/subscapularis tear. An acceptable construct validity was reported with subscapularis-involved tears demonstrating higher scores with significance (P<.05). There was excellent responsiveness to change with a standardized response mean of 1.51 and effect size of 1.27 (large > 0.8). The minimal clinically important difference using a distribution and anchor-based method was 4.1 and 4.6, respectively. Among patients with rotator cuff tears in this population, a score of 22 or higher predicts a subscapularis tear 75% of the time, in spite of its low overall prevalence. The subscapularis shoulder score demonstrated acceptable psychometric performance for outcomes assessment in patients with rotator cuff disease. This survey can be used as an effective clinical tool to assess subscapularis function.

Takedown of Ankle Fusions and Conversion to Total Ankle Replacements.

With ankle replacements gaining credibility, there is a small subset of patients who might benefit from a conversion of an ankle fusion to a replacement. The objective of this study is to present clinical and radiographic results of patients who had their ankle fusion converted to total ankle arthroplasty (TAA). Patients presented to the senior author with ongoing ankle pain following fusion or increasing pain after a period of relative comfort after an ankle fusion. Outcomes were evaluated preoperatively and postoperatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), and visual analog scale (VAS) pain scale. A patient satisfaction survey was also distributed. All ankle fusion conversions between April 2010 and December 2019 were included. Fifty-one patients (30 females) with the mean age of 62.6 (range, 37-83) years were followed. Mean follow-up was 4.2±2.3 (range, 2-11.5) years. Two patients were lost to follow-up (1 is deceased). Pre- and postoperative mean patient-reported outcome scores were all significantly different between groups except VR-12 mental subscale scores. VR-12 physical scores improved from 28.7±8.9 preoperatively to 38.9±9.9 (P < .001) postoperatively; VR-12 mental score was stable. AOS pain and disability subscales similarly improved: 55.9±24.4 to 27.9±25.4 (P < .001) and 61.7±21.1 to 31.1±25.7 (P < .001), respectively. VAS pain improved from a mean of 64.5±27.3 to 29.4±27.7 (P < .001). There was no tibiotalar dorsiflexion or plantarflexion with the ankle fusion. Initial postoperative visit revealed that average dorsiflexion was 10.9±5.93 degrees and average plantarflexion was 14.1±5.22 degrees. At the latest follow-up, dorsiflexion improved significantly to 15.5±6.33 degrees (P < .001), with no significant improvement in plantarflexion (P = .980). In this single-surgeon longitudinal study of 51 patients with a painful, malaligned, or nonhealed ankle fusion treated with an ankle replacement, we found highly satisfactory functional outcomes at an average of 4.2 years. Continued long-term follow-up will reveal whether the longevity of these replacements is comparable to primary replacements.

A Short-Term Multicenter Analysis of Radiolucent Lines in a Single Uncemented Rotating Platform Implant for Total Knee Arthroplasty.

BackgroundUncemented total knee arthroplasty is increasing as a potential solution for aseptic loosening via biologic fixation and to increase operative efficiency. However, postoperative radiolucent lines (RLLs) remain a concern for some clinicians. We report on a multicenter analysis of these RLLs over a 2-year period to identify their incidence, progression, and clinical significance.Material and methodsInstitutional review board approval was obtained for this retrospective, multicenter case series. A total of 312 patients treated with a single cruciate-retaining, fully porous coated femoral and tibial component design were included in the study. All patients were evaluated clinically and radiographically in the early postoperative period and at final follow-up (average 2.0 years). Average age of the study group was 58.2 years, and average body mass index was 30.7. Of the total, 66% were male, and 34% were female. Two independent surgeons evaluated the radiographs at the initial postoperative visit and at the most recent follow-up for RLLs. Knee Society Scores and range of motion (ROM) were collected at each visit.ResultsWe identified RLLs in 25% of patients. All RLLs were less than 1 mm in size and located at the periphery of the tibial implant. None of the RLLs were progressive. At the final follow-up, compared with early postoperative imaging, no new RLLs were identified. Average ROM in flexion was 124 degrees, and the average Knee Society Scores at the most recent clinical follow-up was 96.ConclusionRLLs are commonly seen following cementless TKA, most commonly underneath the tibial tray. Based on this data set, there does not appear to be progression of these RLLs with time, and they do not appear to have an effect on ROM or clinical outcome at 2 years.

Initial Post-Operative Visit Absenteeism is Associated With Worse Amputation-Free Survival after Tibial Angioplasty

ObjectivesTibial revascularization is often performed in the setting of critical limb ischemia and tissue loss requiring close patient monitoring in the early post-operative period for worsening gangrene and/or ischemia. Multiple studies have shown loss to follow-up is an independent risk factor for poor outcomes in several vascular procedures. Therefore, we evaluated the risk factors relating to loss to follow up against outcomes in patients undergoing tibial endovascular procedures with the hypothesis that poor post-operative visit compliance is associated with decreased amputation-free survival rates. MethodsWe performed a single-institution retrospective chart review of patients who underwent therapeutic endovascular tibial revascularization between 2014–2018. Patient follow-up and outcomes of death or major amputation (trans-tibial/trans-femoral) were followed up to 36-months post-operatively. Patients who had undergone previous infra-geniculate interventions or reached mortality/major amputation within 30-days post-operatively were excluded from analysis. ResultsWe identified 89 patients who met inclusion criteria. The overall rate of attendance at less than <1 month, 1–6 months, 6–15 months and 15–36 months post-operatively were 60%, 64%, 60 and 40% respectively. 16% of patients had complete loss to follow-up. Patients without tissue loss (≤ Rutherford 4) were less likely to attend early <1 month and 1–6 month follow-up intervals. Notably, absenteeism from the first immediate post-operative visit was a significant risk factor for further absenteeism at 1–6 months (51% vs. 26%; P = 0.01) and at greater than 6-month follow-up (48% vs. 31%; P = 0.05). Compared to the cohort of all patients, failure to follow-up within 1 month was associated with a decrease in attendance from 64% to 26% at 1–6 months and 63–31% at more than 6 months. Missing the first post-operative visit was also associated with decreased amputation-free survival (P = 0.04). ConclusionsAbsenteeism from the first post-operative visit is associated with worse amputation-free survival and a significant risk factor for further absenteeism from post-operative care. Given these results, ensuring close immediate post-operative follow up is essential to improving outcomes in patients undergoing tibial revascularization.

MP03-16 LONG-TERM FOLLOW-UP SUGGESTS HIGH SATISFACTION RATES FOR BULBOMEMBRANOUS RADIATION INDUCED URETHRAL STRICTURES TREATED WITH ANASTOMOTIC URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-16 LONG-TERM FOLLOW-UP SUGGESTS HIGH SATISFACTION RATES FOR BULBOMEMBRANOUS RADIATION INDUCED URETHRAL STRICTURES TREATED WITH ANASTOMOTIC URETHROPLASTY John Barnard, Aron Liaw, and Joel Gelman John BarnardJohn Barnard More articles by this author , Aron LiawAron Liaw More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation-induced bulbomembranous urethral stricture/stenosis (RIS) is definitively treated by anastomotic urethroplasty in select patients. Prior studies have characterized short and intermediate term success rates and rates of ED and UI. Long-term follow-up (>4-5 years) with the inclusion of urethroplasty specific patient reported outcome (PROM) assessment is lacking in the available research. We hypothesized that with longer follow-up more late recurrences, reflected by declining PROMs, may be captured given the time-dependent nature of radiation damage. The objective was to analyze patients who underwent anastomotic urethroplasty for RIS due to prostate cancer treatment with up to 19 years of follow-up. METHODS: Patients who underwent anastomotic urethroplasty for RIS were identified from 2002 to 2020. Inclusion criteria included completion of 4-month post-operative cystoscopy and a survey including IPSS, SHIM, MSHQ-EF, 6Q-LUTS, and global satisfaction queries at 4 months. PROMs were assessed annually, and cystoscopy was performed for adverse change PROMs or worsening uroflow/PVR. Patients were excluded if they had prostatectomy or radiation for non-prostatic malignancy. PROMs were compared at both the initial post-operative visit and at long-term follow up. RESULTS: 23 patients met inclusion criteria. Mean time from RT to obstructive symptoms was 75.9 months. Short-term anatomic success was 95.7%. At a mean follow-up of 73.1 months (9.1-228.9), one late recurrence occurred for an overall success of 91.3%. Significant and sustained objective improvement was identified in voiding scores, quality of life, and urethroplasty specific PROMs (Table 1). Satisfaction was 91.3% despite sexual side effects, and 95.7% of patients stated they would have surgery again knowing their outcome at a mean of over 6 years' follow up. CONCLUSIONS: RIS are challenging problems, but durable symptomatic relief is achievable in well-selected patients. Patients with bulbomembranous RIS should be appropriately counseled regarding the risk of urinary incontinence and sexual side effects after anastomotic urethroplasty. They should be reassured that long-term success is high, and overall QoL will have sustained subjective improvement in most cases. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e27-e27 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Barnard More articles by this author Aron Liaw More articles by this author Joel Gelman More articles by this author Expand All Advertisement Loading ...

MP55-05 NOVEL HYBRID PEDIATRIC VARICOCELE TECHNIQUE COMBINING SURGICAL VENOUS ACCESS WITH VENOGRAPHIC ROAD MAP DIRECTED ANTEGRADE COILING AND ADJUNCT SCLEROTHERAPY

You have accessJournal of UrologyPediatric Urology V (MP55)1 Sep 2021MP55-05 NOVEL HYBRID PEDIATRIC VARICOCELE TECHNIQUE COMBINING SURGICAL VENOUS ACCESS WITH VENOGRAPHIC ROAD MAP DIRECTED ANTEGRADE COILING AND ADJUNCT SCLEROTHERAPY David Strauss, Laura Kidd, Raphael Yoo, David Goldstein, and Gregory Dean David StraussDavid Strauss More articles by this author , Laura KiddLaura Kidd More articles by this author , Raphael YooRaphael Yoo More articles by this author , David GoldsteinDavid Goldstein More articles by this author , and Gregory DeanGregory Dean More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002085.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal surgical management of varicoceles remains controversial and debated. Various approaches to varicocelectomy, including open, laparoscopic, and minimally invasive techniques, have been described. We combine open surgical scrotal venous access with venography directed antegrade coiling with adjunct sclerotherapy. We believe that this offers multiple advantages including avoiding IR access through the jugular or femoral vein with targeted access only into the affected gonadal vessels. This approach also enables treatment of vascular variants which might be inadequately treated through alternative approaches. METHODS: All patients were aged 13-16. All patients had a grade 3 varicocele on exam. Our technique employs open scrotal access completed by the urological surgery team through a horizontal sub-inguinal incision followed by transection of a dilated vein. The distal end is ligated for vascular control, and the proximal end is cannulated in conjunction with the interventional radiologist. A road map venogram is performed to confirm standard vascular anatomy of the left gonadal vessels. The entire gonadal vein is coiled, and adjunct sclerotherapy performed. Accessory drainage routes are identified and additionally coiled. (Figure 1) The patients were followed postoperatively. RESULTS: Six patients were treated in this manner. There were no intraoperative complications or 30-day complications. All patients had initial postoperative visit within 3 months of the procedure, and none had detectible varicoceles. All patients remain without varicocele recurrence with short and median term follow up (median 13.5 months). Of note, aberrant drainage to the ipsilateral and contralateral internal iliac / hemiazygos systems were identified and treated in two patients. CONCLUSIONS: A combined approach comprised of scrotal access with venous cannulation followed by venographic roadmap directed antegrade coiling and adjunct sclerotherapy is an effective option for treatment of pediatric varicoceles. By performing concurrent venography, vascular variants can be addressed with the potential to decrease recurrence. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e959-e960 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Strauss More articles by this author Laura Kidd More articles by this author Raphael Yoo More articles by this author David Goldstein More articles by this author Gregory Dean More articles by this author Expand All Advertisement Loading ...

Use of a Personalized Multimedia Education Platform Improves Preoperative Teaching for Lung Cancer Patients

We sought to develop and evaluate a personalized multimedia education (ME) tool for preoperative patient education to improve patient health knowledge, quality of life and satisfaction with care in thoracic surgery. The ME tool was developed and deployed in outpatient clinic during preoperative teaching for patients undergoing surgical resection for lung cancer for quality improvement. Patients were given an electronic survey prior to preoperative teaching and at initial postoperative visit to assess teaching effectiveness and care satisfaction. Sequential patients received either standard preoperative teaching or teaching using the ME tool. Pre- and postoperative survey responses were compared using independent sample paired t test and multivariable linear regression modeling for adjustment. The final ME tool was an iPad application that incorporated real-time annotations of 3-dimensional, interactive anatomic diagrams. The tool featured video tours of operations, and radiology image import for annotation by the surgeon. Forty-eight patients were included in this pilot study (standard education n = 26; ME, n = 22). ME patients had significantly higher satisfaction scores compared to SE patients with respect to length of education materials, clarity of content, supportiveness of content and willingness to recommend materials to others. There was no difference in length of clinic visit between groups. Both patient and provider input can be used to create an innovative electronic preoperative educational tool that prepares and empowers patients in shared decision-making before surgery. Improvements in health literacy and self-efficacy may be more difficult to achieve but remain important as multimedia teaching tools are further developed.

Initial Post-Operative Visit Absenteeism Is Associated With Worse Amputation-Free Survival After Tibial Angioplasty

Several studies have identified loss to follow-up (LTF) as a risk factor for worse outcomes in several vascular procedures. Specifically, tibial revascularization is often performed in the setting of critical limb ischemia and tissue loss thus requiring close patient monitoring in the early post-operative period for worsening gangrene and/or ischemia. Therefore, we evaluated the role of LTF and its risk factors against outcomes in patients undergoing tibial endovascular procedures.

Day-of-Surgery Video Calls and Phone Calls Increase Patient Satisfaction with Outpatient Surgery Experience: A Randomized Controlled Trial of Postoperative Communication Modalities.

With the increasing utilization of patient satisfaction as a metric for clinical care, there is growing interest in techniques that can be used to improve satisfaction in patients undergoing surgery. The purpose of this trial was to assess the impact of day-of-surgery video and phone calls on patient satisfaction. We enrolled 251 patients undergoing outpatient orthopaedic surgery with 3 participating surgeons. Surgeons were randomized to 1 of 3 patient communication modalities: no contact (standard of care), phone call, or video call. Several hours following discharge on the day of surgery, the surgeons contacted patients according to their assigned treatment group. At the initial postoperative office visit, satisfaction outcomes were assessed using the Consumer Assessment of Healthcare Providers and Systems Surgical Care (S-CAHPS) survey and an additional satisfaction questionnaire. Fifty-nine (97%) of 61 patients in the no-contact group, 118 (99%) of 119 patients in the phone group, and 71 (100%) of 71 patients in the video group completed follow-up assessment. The S-CAHPS top-box response rate in both the video group (0.86 ± 0.14, p < 0.001) and the phone group (0.84 ± 0.17, p < 0.001) was greater than in the no-contact group (0.68 ± 0.26). When asked to rate satisfaction with overall care, a greater proportion of patients in the video group (85.9%) gave the top-box response compared with both the phone group (71.8%, p = 0.040) and the no-contact group (60.7%, p = 0.002). Among the patients in the video group, 62.0% indicated that they would prefer a video call in future encounters with their surgeon compared with 1.8% of patients in the no-contact group (p < 0.001) and 1.7% of patients in the phone group (p < 0.001). Phone and video calls following discharge are an effective way of enhancing patient satisfaction with the clinical care experience as measured by the S-CAHPS survey. In terms of satisfaction with overall care, video calls may be superior to phone calls. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Telemedicine After Upper Extremity Surgery: A Prospective Study of Program Implementation

PurposeOur purpose was to evaluate the implementation of a postoperative hand and upper extremity telemedicine program. We aimed to compare travel burden, visit time, and patient satisfaction between an initial postoperative telemedicine visit and a second conventional in-clinic visit.MethodsTelemedicine guidelines established by our hospital system were used as inclusion criteria for this prospective study, which included patients indicated for surgery in the outpatient clinic during a 3-month period. Patients were excluded if they had wounds closed with nonabsorbable suture, remained admitted to the hospital, or required a custom orthosis at their first postoperative visit. Baseline demographics and patient-reported outcome measures were collected prior to surgery. Information pertaining to technology usage was collected for the telemedicine visit and travel information was obtained for the in-clinic visit. Patient satisfaction was recorded for both visits.ResultsFifty-seven of 87 patients (66%) who met the inclusion criteria elected to participate in the study. A cell phone was utilized by 89% of patients and 88% of visits were performed from the patient’s home. There were 4 technological complications during the study period (7%). Mean round-trip travel distance for the in-clinic visit was 60 miles with an average drive time of 85 minutes. Visit times were significantly shorter with telemedicine (7 minutes vs 38 minutes). Telemedicine was preferred by 90% of patients for subsequent encounters. All 4 clinical complications were recognized during the telemedicine visit.ConclusionsA telemedicine program for postoperative care after hand and upper extremity surgery decreases travel burdens associated with conventional in-clinic appointments. Telemedicine significantly decreases visit times without decreasing patient satisfaction for patients who elect to participate in remote video visits. The ability to recognize early postsurgical complications was not compromised by utilizing this technology, even during our early experience.Clinical relevanceTelemedicine after hand and upper extremity surgery results in high levels of patient satisfaction and decreases visit times and the travel burdens associated with conventional in-clinic appointments.

MP69-18 IMPACT OF HEALTH LITERACY ON URETEROSCOPY OUTCOMES AMONG KIDNEY STONE PATIENTS

You have accessJournal of UrologyStone Disease: Surgical Therapy VII (MP69)1 Apr 2020MP69-18 IMPACT OF HEALTH LITERACY ON URETEROSCOPY OUTCOMES AMONG KIDNEY STONE PATIENTS Naren Nimmagadda*, Caroline Kang, Nicole Miller, S Duke Herrell, and Ryan Hsi Naren Nimmagadda*Naren Nimmagadda* More articles by this author , Caroline KangCaroline Kang More articles by this author , Nicole MillerNicole Miller More articles by this author , S Duke HerrellS Duke Herrell More articles by this author , and Ryan HsiRyan Hsi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000949.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephrolithiasis is a disease dependent on patients’ self-management; however, little is known on the effect of health literacy on treatment outcomes. We sought to understand the impact of health literacy in this population using the validated Brief Health Literacy Screen (BHLS). METHODS: A retrospective review was conducted of all patients who underwent ureteroscopy for upper tract stones between January and June 2017. Of the 244 patients, BHLS data was available for 105 patients. Demographic, surgical, and postoperative data were collected using the electronic medical record. Opiate usage was obtained from the local controlled substance monitoring database. Univariate and multivariable logistic regression analysis were performed to assess the association of BHLS scores with postoperative complications, stone outcomes, adherence to follow-up and treatment, and opiate use. RESULTS: Mean BHLS score was 13.37 (range 4.09-15.0). 81% of patients attended their initial postoperative visit of which 87.6% maintained subsequent follow-up. On univariate analysis, health literacy did not associate with 30-day complications, ipsilateral stone recurrence or progression, ipsilateral stone events, rates of postoperative follow-up, 24-hour urine collection prescription at initial follow-up, 24-hour urine collection completion by subsequent follow-up, or additional requests for opiates within 30 days. Lower BHLS scores were significantly associated with new chronic opiate usage, defined as obtaining an opiate prescription > 60 days postoperatively without a prior history of chronic usage (OR 0.75, 95% CI 0.59-0.96, p = 0.02). Preoperative opiate prescription patterns were also associated with new chronic opiate usage including increased number of preoperative prescriptions, days supplied, and number of prescribing providers. On multivariable logistic regression, lower health literacy remained a significant predictor of postoperative opiate usage > 60 days (Table 1). CONCLUSIONS: An assessment of health literacy can further screen individuals at risk of postoperative opiate dependence after ureteroscopy. These data identify a need to develop decision-making and counseling tools that account for varying levels of health literacy among kidney stone patients. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1052-e1053 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naren Nimmagadda* More articles by this author Caroline Kang More articles by this author Nicole Miller More articles by this author S Duke Herrell More articles by this author Ryan Hsi More articles by this author Expand All Advertisement PDF downloadLoading ...

A Comparison of Two Methods of Catheter Management After Pelvic Reconstructive Surgery

To compare effects on activity between two catheter management systems after failed voiding trial after pelvic reconstructive surgery. Women with a failed postoperative voiding trial after reconstructive pelvic surgeries were randomized to plug-unplug or continuous drainage catheters. The primary outcome was a mean activity assessment scale score. Secondary outcomes included urinary tract infection (UTI), time to passing outpatient voiding trial, and patient satisfaction. Enrollees who passed the voiding trial were assigned to a "Reference" arm. Ninety participants (30 per arm) provided more than 80% power to detect an effect size of 0.33 in the primary outcome, using a two-sided alpha of 0.05. Sixty-three patients were randomized (32 plug-unplug, 31 continuous drainage). The first 30 participants discharged without a catheter comprised the reference arm. There was no difference in postoperative activity assessment scale scores (total: plug-unplug 70.3, continuous drainage 67.7, reference arm 79.4; P=.090) between arms. Women in the continuous drainage arm noted more difficulty compared with the plug-unplug arm when managing the catheter "during the day" (P=.043) and "all the time" (P=.049) and felt the catheter impeded activities (P=.012) and wearing clothes (P=.005). The catheter arms had significantly higher rates of culture-positive UTI compared with the reference arm (58.7% vs 6.7%, P<.001). However, rate of UTI did not differ between catheter arms (plug-unplug, 68.8% vs continuous drainage, 48.4%, P=.625). The majority of patients passed their outpatient voiding trials at the initial postoperative visit (plug-unplug 71.9%, continuous drainage 58.1%, P=.250). There was no difference in patient satisfaction, with the majority reporting they were "very satisfied" (plug-unplug 78.1%, continuous drainage 80.0%, reference 66.7%, P=.202). Postoperative activity does not differ in patients discharged with plug-unplug or continuous drainage catheters, but those with plug-unplug perceive easier management and ability to complete activities of daily living. The plug-unplug method is an acceptable alternative to traditional catheterization after pelvic reconstructive surgery. ClinicalTrials.gov, NCT03071211.

Treatment of Insertional Achilles Tendinopathy with MRI Confirmed Small or No Tear Using a Gastrocnemius Recession

Category:AnkleIntroduction/Purpose:Insertional Achilles tendinopathy can be a distressing problem for an active patient. Treatment begins conservatively, and when this fails a patient’s next best option may involve operating on the affected tendon. Depending on the disease state of the tendon, the surgeon may decide to repair or augment the Achilles with a flexor hallucis longus (FHL) transfer. The current literature supports the gastrocnemius recession for non-insertional cases, but is inconsistent in its efficacy for insertional cases. Our study looks at how patients with insertional Achilles tendinopathy with a small tear involving 20% of the tendon or less responded to an isolated gastrocnemius recession. Our hypothesis was that patients could do well without the need for a large repair or FHL transfer procedure.Methods:We retrospectively reviewed patients who underwent an isolated gastrocnemius recession for recalcitrant insertional Achilles tendinopathy between January 2015 and July 2018. Patients were included based on the diagnosis of insertional Achilles tendinopathy, having an MRI confirming tendinopathy, a tear involving less than 20% of the tendon or no tear, and no other concurrent pathologies. These criteria yielded 14 patients. One of these 14 patients was removed from the data analysis due to non-surgical complaints after surgery stemming from new onset posterior ankle pain. The patient charts were reviewed for their subjective VAS pain scores during office visits pre and postoperatively. Immediate preoperative visit, initial postoperative visit and final visit VAS scores were recorded.Results:The average time of chart follow up for the 13 patients included in the study was 15.5±10.5 weeks postoperatively (range 4-38). 2 patients were found to have a tear <20% (15%), and the remaining 11 patients were found to have no tear on their MRI (85%). The average final preoperative VAS pain score for the patients was 5.4±1.8 (range 3-9). The average final postoperative VAS pain score for the patients was 0.9±1.3 (range 0-5). These values were found to be statistically different (p<0.001). Of note all patients saw a reduction in their pain score of at least 2 points.Conclusion:Previous literature is inconclusive on the efficacy of the gastrocnemius recession for insertional Achilles tendinopathy. No other study has identified the amount or type of tendon involvement by advanced imaging. Our study supports the notion that patients with MRI confirmed tendinopathy and a tear involving less than 20% of the tendon or no tear, often do quite well in reaching a reduction in their pain. Our study is limited in power due to our small sample size, but the results suggest that this procedure deserves more attention for the treatment of insertional Achilles tendinopathy when appropriate.

The Association Between Mindfulness and Postoperative Pain: A Prospective Cohort Study of Gynecologic Oncology Patients Undergoing Minimally Invasive Hysterectomy

To describe the association between preoperative dispositional mindfulness (the personality trait of being mindful) and postoperative pain in gynecologic oncology patients undergoing minimally invasive hysterectomy. Prospective cohort study. University-affiliated teaching hospital. Gynecologic oncology patients (n = 126) planning minimally invasive hysterectomy. Minimally invasive hysterectomy. Baseline mindfulness was assessed at the preoperative visit using the Five Facet Mindfulness Questionnaire (FFMQ). Postoperative pain and opioid usage were evaluated via chart review and surveys at postoperative visits at 1 to 2 weeks and 4 to 6 weeks. Higher baseline mindfulness was correlated with lower postoperative pain as measured by both the average and highest numeric pain scores during the inpatient stay (r = -.23, p = .020; r = -.21, p = .034). At the initial postoperative visit, pain score was also inversely correlated with preoperative mindfulness score (r = -.26, p = .008). This relationship was not observed at the final postoperative visit (r = -.08, p = .406). Pre-operative mindfulness and opioid usage were also inversely associated, though this relationship did not reach statistical significance (r = -.18, p = .066). Mindfulness was previously shown to be a promising intervention for chronic pain treatment. Our study demonstrates that higher preoperative dispositional mindfulness is associated with more favorable postoperative pain outcomes, including lower pain scores but not lower opioid consumption. This relationship provides an opportunity to target the modifiable personality characteristic of mindfulness, to reduce postoperative pain in patients following gynecologic surgery.

Does long-term success from endoscopic DCR correlate with early post-operative reduction in tearing?

PurposeThe purpose of the study was to determine the association between early post-operative improvement in tearing and the long-term success rate of endoscopic dacryocystorhinostomy (eDCR). MethodsA retrospective review of consecutive patients who underwent eDCR and were followed up for at least 6 months at our institution from January 2010 to December 2017 was performed. Results47 cases(39 patients) of eDCR met the inclusion and exclusion criteria during this time period.Mean follow up after the surgery was 12.5 ± 8 months. In 45 out of 47 (96%) cases post-operative improvement in epiphora within 2 weeks of surgery, or lack thereof, correlated with long-term success or failure of the procedure.There were only 2 cases in which the patients felt improvement in tearing at the initial post-operative visit and the tearing recurred in the late post-operative period (>6 months). ConclusionsThere is a strong association between the early initial post-operative assessment of tearing resolution and the long-term result of eDCR.