Minor Surgery Research Articles

Comparison of the effect of ketamine and propofol on surgical operation patients

Background and objective: A prospective randomized controlled study was conducted to compare and evaluate the quality of anesthesia with ketamine or propofol.
 Materials and methods: 80 patients, aged 18-50 years, who were scheduled to undergo minor surgeries of short duration (less than 1 hour of expected duration) were selected and divided in two groups. The patients were randomly assigned to the first group and the second group of 40 patients in each. Group I patients were given ketamine injection 0.5 mg/kg and group II received propofol injection (1.5 μg/kg) as a co-induction agent. After 2 minutes, induction of anesthesia was given with propofol (2.5 mg/kg) and an appropriately sized laryngeal mask was inserted. Anesthesia was maintained with 60% NO in O2 and an intermittent bolus of propofol injection (0.5 mg/kg) given after significant changes in heart rate, blood pressure, lacrimation, sweating, and abnormal movements were noted.
 Results: There was a significant decrease (P < 0.05) in pulse rate, systolic and diastolic blood pressure at 1, 3 and 5 minutes in the group receiving propofol, while the change was insignificant (P > 0.05) at 10 minutes.
 Conclusion: It was noted that ketamine as a starting material was better than propofol with regard to hemodynamic stability and caused fewer adverse effects during surgery and after surgery.

#3122 30-DAY COMPLICATIONS IN PERITONEAL DIALYSIS CATHETERS INSERTED PERCUTANEOUSLY VERSUS SURGICALLY IN A SECOND LEVEL HOSPITAL IN MERIDA, YUCATAN, MEXICO

Abstract Background and Aims Peritoneal dialysis (PD) catheter insertion technique has an impact on the health outcomes and technical success in PD. The percutaneous technique allows for a bedside, minimally invasive and faster insertion without the need of using an operating room and general anesthesia. In 2021, Agarwal et. al reported that percutaneous insertion was associated with a 64% relative risk reduction (RRR) of early exit site infection and a 48% RRR of early peritonitis with no difference in terms of mechanical complications compared to the surgical technique [1]. The aim of our study was to describe the frequency of mechanical and infectious complications within the first 30 days of PD catheter insertion between the percutaneous and surgical technique. Method We conducted a descriptive and prospective study in our Hospital from January 1st to December 31st, 2022. Patients who were candidates for renal replacement therapy with PD and who had no previous history of abdominal surgery or only minor abdominal surgery, underwent percutaneous insertion of PD catheter by a nephrologist with a bedside blind technique, whereas patients with previous abdominal surgery underwent surgical insertion with a mini laparotomy. Informed consent and preoperative blood tests were obtained before the procedure in both techniques. Patient preparation for the percutaneous insertion included fasting the night before, colonic enema and the placement of a urinary catheter, patients received antimicrobial prophylaxis as well as analgesia and light sedation. Mechanical and infectious complications within the first 30 days after insertion of double cuff Tenckhoff catheters were registered. Results During the study period, 155 PD catheter insertions took place in our hospital, the majority of insertions were surgical (53.5% versus 46.4%) and happened in women (60.6%). The mean age of the population was 51.5 years and 70.3% of the participants were diabetic. Exit-site infection was significantly more frequent in the surgically placed PD catheters (10% versus 1%, p = 0.02), there was a tendency for more mechanical dysfunction in the surgical technique versus the percutaneous technique (14.4% versus 5.5%, p = 0.07) and transfer to hemodialysis was more frequent in the surgical insertion group (10.8% versus 1.3%, p = 0.01). There was no difference between peritonitis in both groups and the frequency of uncomplicated PD catheters (catheter survival without any complication) was similar in both techniques. Conclusion Bedside PD catheter insertion by the nephrologist using a percutaneous technique can be an easy, timely, safe and adequate procedure with comparable success to the surgical insertion. It may have the advantage of more efficient control of infectious and mechanical complications and what is more, this approach could reduce the cost of kidney failure treatment as it allows for the use of minimal material and human resources.

Comparative Evaluation of Intranasal Dexmedetomidine Spray Versus Intranasal Normal Saline Spray in Patients Undergoing Transalveolar Extractions for Anxiety Reduction: A Randomized Control Study.

Dexmedetomidine has dose-dependent selectivity for alpha 2 adrenoceptors. It is a good sedative with analgesic characteristics and good haemodynamic stability. Intranasal sedation is a non-invasive medication delivery method that is both safe and well accepted by both children and adults. One of the most common procedures in maxillofacial surgery is transalveolar extraction. In minor oral surgery, a painless transalveolar extraction with little post-operative pain would be ideal. To examine the effectiveness of intranasal dexmedetomidine spray against intranasal normal saline spray in patients undergoing transalveolar extractions for anxiety relief. We compared sedation effect by Ramsay sedation scale, analgesia by visual analogue scale, monitored BP and pulse rate for anxiety, and spo2 levels for any complication in this prospective double-blinded randomized control study for two groups, A group with intranasal dexmedetomidine spray and the B group of intranasal NS spray for placebo effect at 0min, 15min, 30min, and 45min until transalveolar extraction. As a result of the intranasal spray of dexmedetomidine, there were no related problems such as respiratory depression. There was a substantial difference in sedation and analgesia between group A and the placebo group, as well as a significant decrease in pulse rate and hypotension in the dexmedetomidine group to reduce anxiety. Intranasal injection of atomized dexmedetomidine (1.5mcg/kg) for patient sedation having transalveolar extractions or other minor surgical operations in oral and maxillofacial surgery is clinically effective, convenient, lowers anxiety, and safe.Clinical Trial Registration: No. CTRI/2021/07/035181.

Ventral hernia repair with concurrent intra-abdominal surgery: Results from an eleven-year population-based cohort in Sweden

BackgroundOne remaining question in ventral hernia repair is whether to perform concurrent abdominal surgery or plan two-stage procedures. The aim was to explore the risk for reoperation and mortality due to surgical complication during index admission. MethodEleven-year data were retrieved from the National Patient Register and 68,058 primary surgical admissions were included, divided into minor and major hernia surgery and concurrent abdominal surgery. Results were evaluated by logistic regression analysis. ResultsThe risk for reoperation during index admission was higher for patients with concurrent surgery. Major hernia surgery and major concurrent surgery had an OR 37.9 compared to major hernia surgery only. Mortality rate within 30 days increased, OR 9.32. The combined risk for serious adverse event was accumulative. ConclusionThese results stress the importance of critically evaluating needs for and planning of concurrent abdominal surgery during ventral hernia repair. Reoperation rate was a valid and useful outcome variable.

Indian Society of Anaesthesiologists' preoperative testing guideline: An insight.

Dear Editor, We appreciate the much-needed practice guideline on preoperative testing by the Indian Society of Anaesthesiologists (ISA).[1] The incorporation of the validity time of preoperative testing is praiseworthy. The current guideline considers extensive literature; still, it is felt that the expert’s opinion and prevailing practice have received equal importance, if not the upper hand, while formulating recommendations for minor surgeries, especially for complete blood counts (CBC). The guideline has emphasised the prevalence of anaemia to be 14% in American Society of Anesthesiologists (ASA) physical status I–II patients and that the preoperative CBC would have high utility and impacts the outcome even in minor surgeries. However, while preoperative anaemia prevalence is variable, not all anaemias are moderate to severe to significantly impact the haemodynamics and outcome[2] or require transfusion. Further, blood loss, tissue handling and fluid shift in minor surgeries are nominal and can be easily tolerated by often asymptomatic patients of ASA I–II. Interestingly, the guideline descriptions agree with the insufficient evidence for CBC in minor and intermediate surgeries.[1] Despite the negative recommendations for decades, routine testing has remained prevalent. Therefore, formulating a recommendation based on the prevailing practices will unlikely benefit the patient. Further, such interventions defy the global motto of cost-effective, quality and evidence-based medicine. Nevertheless, it will leave us at the prevailing crossroads of preoperative testing and fail to take a firm stance on medico-legal issues.[3] The current guidelines will encourage randomised trials, plan a national-level study using information technology for preoperative testing[4] and formulate a robust future update on this aspect and a few other prevalent routine tests. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

PROGNOSTIC VALUE OF LV GLOBAL STRAIN FOR PREDICTING POSTOPERATIVE MYOCARDIAL INJURY AND MORTALITY IN PATIENTS WITH MAJOR NONCARDIAC SURGERY: MULTICENTER, PROSPECTIVE, OBSERVATIONAL

Objective: The role of preoperative echocardiography at rest is less well studied. We analyzed the prognostic value of left ventricular global longitudinal strain (LVGLS) for predicting postoperative 30-day cardiovascular events and myocardial injury after noncardiac surgery (MINS). Design and method: We performed a prospective cohort study in two referral hospitals enrolling participants over 45-year-old with more than one cardiovascular risk factor or 65-year-old aged who planned elective noncardiac major surgery and underwent resting echocardiography before surgery. Preoperative demographic, clinical, and echocardiographic data, including LVGLS, were collected. Subjects with minor surgery, reduced ejection fraction below 40%, more than moderate valvular heart disease, and presence of regional wall motion abnormality were excluded. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) needing urgent revascularization at early postoperative period. MINS was defined as absolute increase troponin of at least 14 pg/mL between two measurements. Results: From 2020 June to 2022 March, 871 participants were enrolled; the mean age was 72.9 (SD 9.3) and 60.8% were female. There were 12 cases of the primary endpoint (1.4%): 10 cases of death, and 3 cases of revascularization due to ACS. Participants with impaired LVGLS <16.6% had a higher incidence of the primary endpoint (log-rank P = 0.015) than those without. This result was concordant after adjustment with clinical variable and preoperative troponin-T level (hazard ratio 1.30, 95% confidence interval [CI] 1.03–1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had incremental value for predicting the primary endpoint after noncardiac surgery. Among 538 (61.8%) participants available pre and post-troponin assay, LVGLS can predict MINS independently (odds ratio 3.54, 95% CI 1.70–7.36; P = 0.001). Conclusions: Preoperative LVGLS has independent and incremental value to predict early postoperative cardiovascular events and MINS.

Utilization of a Clinic-Based Hand Surgery Procedure Room in the US Military Health System: A Performance Improvement Analysis of Resource Savings and Patient Satisfaction

Recent studies examining the implementation of clinic-based procedure rooms (PRs) for wide-awake hand surgery have reported cost reduction, decreased burden on hospital systems, and improved patient satisfaction. This study evaluates other resource savings, primarily time spent by patients in the hospital. Thirty-two patients were enrolled in a PR or the operating room group for prospective evaluation. Time spent in the hospital on the day of surgery, several preprocedure appointments, complications, and cost comparisons were evaluated between the two groups. Patient-reported outcomes were also evaluated with postoperative surveys assessing anxiety, pain, and satisfaction. Significant time savings were noted between the groups. The median time spent in the hospital on the day of surgery for the patients in the operating room group was 256 minutes versus 90 minutes for the PR group, a time savings of approximately 3 hours. Eight additional preoperative clinic visits for operating room patients were generated compared with no additional preoperative visits for PR patients. Cost savings for surgeries performed in the clinic-based procedure amounted to $232,411. No postoperative complications were observed in the clinic setting. Continued utilization of the clinical PR for select hand surgery procedures will reduce the cost and time burdens for procedures while maintaining satisfaction and safety. A clinic-based PR for performing minor hand surgeries saves the patient time and ostensibly allows the operating room to be used for more complex surgeries that are not easily amenable to a wide-awake in-clinic procedure.

Direct oral anticoagulant drugs for the management of venous thromboembolism.

Direct oral anticoagulants (DOACs) are effective for both prevention and treatment of venous thromboembolism (VTE) and have favorable safety in comparison with warfarin. Although drug-drug interactions with DOACs are not as frequent as with warfarin, certain drugs can interfere with DOAC metabolism, affect DOAC efficacy, and potentially cause adverse reactions when used in combination with DOACs. The NP must determine which agent is most beneficial for the individual patient with VTE based on a number of factors. A knowledge of periprocedural management of DOACs will assist the NP in providing a smooth transition for patients undergoing minor and major procedures and surgeries.

Critical shortage of capacity to deliver safe paediatric surgery in sub-Saharan Africa: evidence from 67 hospitals in Malawi, Zambia, and Tanzania.

Paediatric surgical care is a significant challenge in Sub-Saharan Africa (SSA), where 42% of the population are children. Building paediatric surgical capacity to meet SSA country needs is a priority. This study aimed to assess district hospital paediatric surgical capacity in three countries: Malawi, Tanzania and Zambia (MTZ). Data from 67 district-level hospitals in MTZ were collected using a PediPIPES survey tool. Its five components are procedures, personnel, infrastructure, equipment, and supplies. A PediPIPES Index was calculated for each country, and a two-tailed analysis of variance test was used to explore cross-country comparisons. Similar paediatric surgical capacity index scores and shortages were observed across countries, greater in Malawi and less in Tanzania. Almost all hospitals reported the capacity to perform common minor surgical procedures and less complex resuscitation interventions. Capacity to undertake common abdominal, orthopaedic and urogenital procedures varied-more often reported in Malawi and less often in Tanzania. There were no paediatric or general surgeons or anaesthesiologists at district hospitals. General medical officers with some training to do surgery on children were present (more often in Zambia). Paediatric surgical equipment and supplies were poor in all three countries. Malawi district hospitals had the poorest supply of electricity and water. With no specialists in district hospitals in MTZ, access to safe paediatric surgery is compromised, aggravated by shortages of infrastructure, equipment and supplies. Significant investments are required to address these shortfalls. SSA countries need to define what procedures are appropriate to national, referral and district hospital levels and ensure that an appropriate paediatric surgical workforce is in place at district hospitals, trained and supervised to undertake these essential surgical procedures so as to meet population needs.

Point-of-Care Testing for SARS-CoV-2: A Prospective Study in a Primary Health Centre.

In 2020, health systems across the world responded to the COVID-19 pandemic by making rapid changes to reduce the risk of exposure in patients and healthcare professionals. The use of point-of-care tests (POCT) has been a central strategy in dealing with the COVID-19 pandemic. The aims of this study were to evaluate the impact of POCT strategy (1) on maintaining elective surgeries by removing the risk of delayed pre-appointment testing and turn-around times and (2) on time dedicated for end-to-end appointment and management, and (3) to assess the feasibility of using the ID NOW® among healthcare professionals and patients in a primary care setting, requiring pre-surgical appointment and minor ENT surgery in the Townsend House Medical Centre (THMC), Devon, United Kingdom. A logistic regression was performed to identify factors associated with the risk of canceled or delayed surgeries and medical appointments. Second, a multivariate linear regression analysis was conducted to calculate changes in the time dedicated to administrative tasks. A questionnaire was developed to assess the acceptance of POCT in patients and staff. 274 patients were included in this study; 174 (63.5%) in Group 1 (Usual Care) and 100 (36.5%) in Group 2 (Point of Care). Multivariate logistic regression showed that the percentage of postponed or canceled appointments was similar between the two groups (adjusted OR = 0.65, [95%CI: 0.22-1.88]; p = 0.42). Similar results were observed for the percentage of postponed or canceled scheduled surgeries (adjusted OR = 0.47, [95%CI: 0.15-1.47]; p = 0.19). The time dedicated to administrative tasks was significantly lowered by 24.7 min in G2 compared to G1 (p < 0.001). 79 patients in G2 (79.0%) completed the survey, and the majority agreed or strongly agreed that it improved care management (79.7%), decreased administrative time (65.8%), reduced the risk of canceled appointments (74.7%) and the traveling time to do COVID-19 test (91.1%). Having point-of-care testing in the clinic in the future seemed more than welcome by 96.6% of patients; 93.6% declared to be less stressed by having the test at the clinic than waiting for the results of the test realized elsewhere. The five healthcare professionals of the primary care center completed the survey, and all agreed that the POCT positively influences the workflow and can be successfully implemented into routine primary care. Our study shows that NAAT-based point-of-care SARS-CoV-2 testing significantly improved flow management in a primary care setting. POC testing was a feasible and well-accepted strategy by patients and providers.

Can COVID-19 pandemic surveillance reduce nosocomial urinary infections in urologic surgery?

Since COVID-19 pandemic spread, strict preventive measures were adopted to reduce the risk of transmission. Antiseptic dispensers for hand hygiene were diffusely available for patients and hospital staff. To investigate the prophylactic role played by the strict antiseptic rules adopted during pandemic, the rates of nosocomial urinary infections in 2019 and 2020 were compared. Patients' clinical pre-operative characteristics, symptoms, fever, and laboratory data were recorded pre- and post-operatively. Urological surgery was classified in five categories: 1. major surgery 2. upper urinary tract endoscopy, 3. lower urinary tract endoscopy, 4. minor surgery, and 5. Nephrostomy and ureteral stenting. Clavien-Dindo complication score was used. Statistical analysis was performed with R 3.4.2 software. Out of 495 patients, 383 (57.1%) underwent surgical intervention in pre-pandemic March-May 2019 period and 212 (42.9%) in the same pandemic 2020 interval. Preoperatively, 40 (14.1%) and 11 (5.2%) and 77 (27.3%) and 37 (17.5%) patients had fever (p < 0.003) and leukocytosis (p < 0.02), in 2019 and 2020 respectively. Urine culture was positive in 29 (10.2%) and 13 (6.2%) patients respectively (p = 0.22). Post-operatively, 54 (19.1%) and 22 (10.4%) patients and 17 (6.1%) and 2 (0.6%) patients showed fever (p < 0.003) and positive urineculture (p < 0.03), in 2019 and 2020 respectively. Preoperative and post-operative clinical and laboratory signs of nosocomial urinary infection showed a statistically significant lower incidence during the pandemic period in 2020. This observation could be ascribed to the strong preventive measures, to the medical staff high adherence to hygiene and the diffuse availability of hand sanitizers.

Reconstruction challenges for complicated preauricular sinuses: case reports

Preauricular sinuses and pits are congenital anomalies located in or just in front of the ascending limb of the helix. Even though excising a sinus is a relatively minor surgical procedure, recurrence is not uncommon if an adequate resection is not done. Surgery is only indicated when it is complicated by recurrent infection or abscesses. Simple closure may not be possible when there is large tissue defect. In those circumstances local flaps will be required to cover the defect. In this article we report 2 cases which had large tissue defect after excision and closed with local rotational flaps. This provided good cosmetic outlook and no recurrences so far. There are not enough articles published so far with such kind of reconstruction techniques for preauricular sinus excision tissue defects.

Prevalence and risk factors of missed appointment among paediatric patients after minor oral surgical procedures in a tertiary hospital in Southern Nigeria

Missed appointments are common in paediatric dentistry, yet not many studies have explored its prevalence and associated factors. To determine the prevalence of missed appointments and the associated factors. This prospective study design recruited all consecutive paediatric patients that presented for minor oral surgical procedures from 1st July 2020 to 30th June 2021. Data collected was the age of patients, gender, parents’ educational level, distance from the clinic, type of minor oral surgical procedures and missed appointments. Descriptive and inferential statistics were performed. Chi-square test of association was used to determine the association between study participants’ age, sex, parents’ educational level, the distance from the clinic, and the prevalence of missed dental appointments. Binary logistic regression was used to determine the predictors. Data was analysed using the Statistical Package of Social Science (SPSS) version 26 (IBM, Chicago, IL, USA). A p-value of less than 0.05 was considered significant. A total of 182 paediatric dental patients, age ranged from 0.5 to 16 years and with a mean age of 8.55+3.88 participated. Most (60.4%) of the patients were females and 46.2% of them were of school age. Most of the parents had a tertiary level of education and lived within 7 to 12 kilometers from the clinic. The prevalence of missed appointments was 54.9% and the most performed minor oral surgical procedure was primary tooth extraction. The relationship between age group, minor surgical procedures with missed appointments was statistically significant (P&lt;0.05). Binary logistic regression analysis revealed that the type of surgical procedure was the only independent predictor of missed appointments (p&lt;0.05) The prevalence of missed appointments in this study is remarkably high. Although the age of the patients and the type of procedure was associated with the prevalence of missed appointment, it was only the type of surgical procedure that was a significant risk factor for missed appointment.

Safety and Efficacy of In-Office Hand Procedures

BackgroundThe primary concerns with operating on patients in the office setting are insufficient sterility and lack of appropriate resources in case of excessive bleeding or other surgical complications. This study serves to investigate these concerns and determine whether in-office hand surgeries are safe and clinically effective. MethodsA retrospective review of patients who underwent minor hand operations in the office setting between December 2020 and December 2021 was performed. The surgical procedures included in this analysis are needle aponeurotomy, trigger finger release, foreign body removal, mass removal, and reduction in a finger fracture with or without percutaneous pinning. All fractures, which primarily included metacarpal and phalangeal fractures, were subsequently splinted. Sterility and hemostatic support were achieved via the Wide-Awake Local Anesthesia No Tourniquet (WALANT) method. Major complications were defined as infection, major bleeding, and neurological deficits. Minor complications were defined as prolonged pain, prolonged inflammation, residual symptoms, and recurrence of symptoms within 1 month. ResultsFive patients (3.8%) returned to the office for pain, inflammation, or stiffness of the affected finger, with two of the five returning with symptoms associated with osteoarthritis or pseudogout flare-ups. Five additional patients returned due to residual symptoms or recurrence of the primary complaint within 1 month of surgery. No patients experienced exogenous infection. ConclusionThe absence of major complications and high success rate for minor hand procedures shows the high degree of safety and efficacy that can be achieved via the in-office setting for select procedures. While proper patient selection is key, our result shows the in-office procedure room setting can offer the necessary elements of sterility and hemostatic support for several common hand surgeries.

Frequency and Difficulty in the Usage of Face Shields Among Oral and Maxillofacial Surgeons During the COVID-19 Era: An Online Survey

During the COVID-19 era, personal protective equipment (PPE) has become a necessary part of surgeons' routines, and face shields are considered an additional barrier to prevent disease transmission via aerosols. This study aimed to evaluate how often oral and maxillofacial surgeons (OMFS) use face shields and the challenges they face while using them. An online survey consisting of fourteen questions was distributed to OMFS, and the responses were collected and analyzed using the chi-square test to determine any associations between categorical variables. A P-value of ≤ 0.05 was considered statistically significant. Out of the 310 OMFS who responded to the survey (181 males, 129 females, 235 residents, 10 fellows, and 65 practitioners), 42.9% (133/310) and 39.4% (122/310) reported using face shields for minor and major surgical procedures, respectively. The majority of the respondents (74.1%, 230/310) reported decreased efficiency while using a face shield. Reasons for non-compliance included vision-related issues, headache, difficulties with disinfection, and ergonomic factors. Based on the survey results, the regular use of face shields by OMFS was less frequent, and almost three-fourths of the surgeons found it challenging to use due to various reasons. The reduced compliance with face shield usage highlights the need for more ergonomic face shields to improve compliance.

OC-057 VENTRAL HERNIA REPAIR WITH CONCURRENT INTRA-ABDOMINAL SURGERY: RESULTS FROM AN ELEVEN-YEAR POPULATION-BASED COHORT IN SWEDEN

Abstract Aim One remaining question in ventral hernia repair is whether to perform concurrent abdominal surgery or plan two-stage procedures. The aim was to explore the risk for reoperation and mortality due to surgical complication during index admission. Method Eleven-year data were retrieved from the National Patient Register and 68,058 primary surgical admissions were included, divided into minor and major hernia surgery and concurrent abdominal surgery. Results were evaluated by logistic regression analysis. Results The risk for reoperation during index admission was higher for patients with concurrent surgery. Major hernia surgery and major concurrent surgery had an OR 37.9 compared to major hernia surgery only. Mortality rate within 30 days increased, OR 9.32. The combined risk for serious adverse event was accumulative. Conclusion These results stress the importance of critically evaluating needs for and planning of concurrent abdominal surgery during ventral hernia repair. Reoperation rate was a valid and useful outcome variable

Comprehensive review of a large cohort of outpatient versus inpatient open renal and bladder surgery in children

Outpatient surgery and pediatric ambulatory surgery centers continue to have increasing popularity among pediatric urologist for minor surgeries. Past studies have shown that open renal and bladder surgeries (i.e. nephrectomy, pyeloplasty and ureteral reimplantation) can also be done in an outpatient setting. With health care costs continuing to rise, it may be reasonable to explore performing these surgeries as an outpatient and consider performing them in a pediatric ambulatory surgery center. Our study assesses the safety and utility of outpatient open renal and bladder surgeries in children compared to those done as inpatients. IRB-approved chart review was performed on patients undergoing nephrectomy, ureteral reimplantation, complex ureteral reimplantation, and pyeloplasty by a single pediatric urologist between January 2003-March 2020. Procedures were performed at a freestanding pediatric surgery center (PSC) and a children's hospital (CH). Demographics, type of procedures, American Society of Anesthesiologists score, operative times, time to discharge, ancillary procedures, readmission or ER visits within 72h were reviewed. Home zip codes were used to determine the distance from pediatric surgery center and children's hospital. 980 procedures were evaluated. Of these, 94% procedures were performed as an outpatient and 6% procedures were performed as inpatients. 40% of patients underwent ancillary procedures. Outpatients had a significantly lower age, ASA score, operative time, and readmission or return to ER within 72h (1.5% vs. 6.2%). Twelve patients were readmitted (9 outpatient, 3 inpatient) and six returned to the ER (5 outpatient, 1 inpatient). 15/18 of these patients underwent reimplantations. Four required early reoperation on postoperative day (POD)2-3. Only one outpatient reimplant was admitted one day later. PSC patients lived farther away. Outpatient open renal and bladder surgery was found to be safely performed in our patients. In addition, it did not matter whether the operation was done in the children's hospital or pediatric ambulatory surgery center. Since outpatient surgery has been shown to be significantly less expensive than inpatient surgery, it is reasonable for pediatric urologist to consider performing these operations in the outpatient setting. Our experience shows that an outpatient approach to open renal and bladder procedures is safe and should be considered when counseling families about treatment options.

COMPARISON OF THE EFFECT OF CONSCIOUS SEDATION VS LOCAL ANAESTHESIA ON MANAGEMENT OF MAXILLOFACIAL TRAUMA WITH CLOSED REDUCTION

Introduction: Minor oral surgical procedures are routinely carried out under local anaesthesia. However, favourable conditions for the operator and patient are seldom achieved. The technique of anaesthesia in the form of “conscious sedation” has been developed to overcome the drawbacks of operating under local anaesthesia alone and to avoid the risks associated with general anaesthesia. The purpose of this study is to investigate the effect Objective: s of sedation on postoperative pain and patient satisfaction in patients undergoing closed reduction of maxillofacial trauma under conscious sedation with local anaesthesia versus local anaesthesia alone. Methods: The study included patients aged 18-78 years who presented to the Oral and Maxillofacial Surgery Department for closed reduction of maxillofacial trauma. Patients were divided into two groups based on the anesthetic technique used for the procedure: (i) local anaesthesia (Control group, n=5) and (ii) Conscious sedation + local anaesthesia (Experimental group, n=5). Postoperative pain was assessed using Visual Analogue Scale (VAS). Relationship between VAS scores and age groups was analyzed in both experimental and control groups. Patient satisfaction was assessed via face-to-face or telephone interviews 7 days after the procedure in both groups. The VAS scores were Results: signicantly lower in the experimental group compared to the control group in all three measurements (p&lt;0.05). A signicant difference was found between the two groups with regard to their responses in the satisfaction questionnaire (p&lt;0.0001), whereby 80% of the patients in the experimental group replied as “Absolutely yes”. The results indicated that Conclusion: the pain levels were lower in patients that underwent closed reduction of maxillofacial trauma under conscious sedation with local anaesthesia compared to patients that underwent local anaesthesia alone

RSTN COVID Hand: Hand trauma in the United Kingdom and Europe during the COVID-19 pandemic

The COVID-19 pandemic rapidly impacted the delivery of hand surgery services throughout the UK and Europe; from triage to treatment. Our aim was to assess the impact on management of common hand trauma injuries to inform future service delivery and research. The Reconstructive Surgery Trials Network led a service evaluation during the first wave of COVID-19 in 2020. Data was collected on hand injury management during the COVID-19 pandemic and was compared to the management clinicians would have delivered prior. Across 35 hand surgery units, 2540 patients with hand trauma were included. There was an increase of between 3% and 7% in non-operative management of injuries, apart from flexor tendon injuries where management remained unchanged. Cases triaged by a consultant doubled, with a 22% increase in the see-and-treat model. There was a move to operating in low-resource settings; a 13% increase in the use of minor operating theatres and 10% in clinic rooms. Use of WALANT, absorbable sutures, and remote follow-up also increased by 16%, 24%, and between 11% and 25%, respectively. The reported 30-day complication rate was 3.2%, with a surgical site infection rate of 1.8%. The pandemic led to rapid change in many aspects of hand trauma care. It was the impetus for increased out-of-theatre operating, use of local anaesthetic, and more non-operative management of injuries, without an increase in complication rate. Further research needs to assess the clinical and cost-effectiveness of these changes to ensure that COVID-19 is a catalyst for a modern, evidence-based, and environmentally sustainable delivery of hand trauma services.

Factors affecting the postoperative quality of life and psychological well-being in pediatric urology patients

While most studies in pediatric urology investigate the clinical results, very few explore the relationship between surgery and quality of life and psychosocial well-being in pediatric urology practice. The determination of the effects of the surgical method on the quality of life (QoL) is of increasing importance. This study investigated the effect of surgery type on the postoperative QoL and psychological well-being of pediatric urological surgery patients. A total of 151 children and adolescents (4-18 years old) undergoing elective urological surgery between September 2020 and July 2021 were evaluated preoperatively; those who currently had psychiatric disorders were excluded. Of the 98 patients undergoing subsequent detailed preoperative assessment using standardized instruments to evaluate QoL and depression and anxiety symptom levels, only 63 could be re-evaluated postoperatively at a 6-month follow-up. Additionally, preoperative parental psychiatric symptom load was assessed using standardized self-report forms. The patients were classified into two categories for analysis-open versus endourological surgery and major versus minor surgery. In the latter category, there was a significant increase in the postoperative QoL in children undergoing minor urological surgery (p=0.037). Furthermore, the table depicted the regression analysis indicating the predictors for lower postoperative QoL. Those predictors were higher parental preoperative psychiatric symptom load, a greater number of previous surgeries, and female gender (p<0.001, adjusted R2=0.304). Postoperative QoL of children/adolescents undergoing pediatric urology surgery is affected more by the patient's preoperative medical condition and the psychological status of the patient's parents, rather than the surgical method opted for.