Need For Postoperative Care Research Articles

Same-Day Discharge Does Not Increase Resource Utilization Within One Year of Total Joint Arthroplasty

BackgroundWhile the safety of rapid recovery total joint arthroplasty is well established, less is known about its impact on postoperative care utilization patterns. We wished to examine whether same-day discharge—and its associated presumed reduction in hospital-based postoperative care and education—translates to the need for more postoperative support during the 1-year recovery period. MethodsA retrospective review of 1,237 total hip arthroplasty (THA) and 1,710 total knee arthroplasty (TKA) patients who had 0- or 1-day length of stay (LOS) from January 2020 to October 2023 was conducted. The primary outcome was the number of follow-up visits with total joint arthroplasty providers at our institution during the 1-year postoperative period. Secondary outcomes included 30-day emergency department returns, readmissions, 1-year physical therapy utilization, and improvement in Patient-Reported Outcomes Measurement Information System Physical Function scores at 6 to 12 months postoperatively. Bivariate and multivariable analyses were performed to compare outcomes between 0-day and 1-day LOS THA and TKA patients. ResultsIn both the THA and TKA populations, 0-day LOS patients were younger, had a lower average body mass index, were more likely to be White, men, and had an American Society of Anesthesiologists score < 3 than 1-day LOS patients. After controlling for differences between groups, no significant differences in the number of one-year follow-up visits, physical therapy visits, emergency department returns, or readmissions were seen between 0 and 1-day THA or TKA patients. In TKA patients, 1-day LOS was associated with lower improvements in Patient-Reported Outcomes Measurement Information System Physical Function scores. ConclusionsAfter risk adjustment, same-day discharge of THA and TKA patients did not result in increased resource utilization during the one-year postoperative period. In the setting of a coordinated joint arthroplasty program with nurse navigator support, same-day discharge can be safely performed without increasing the need for postoperative care in appropriately selected patients undergoing both THA and TKA.

Compilation of a self-management assessment scale for postoperative patients with aortic dissection.

The aim of this research was to compile a self-management assessment scale for patients with aortic dissection (AD). The questionnaire is useful in making the patient aware of the need for post-operative care in order to contribute to improving the outcome and quality of life. The initial version of the "postoperative self-management assessment scale for patients with aortic dissection" was developed using the Delphi expert consultation method based on qualitative research results, consultation of self-management-related literature, reference to the existing self-management scale, and self-efficacy theory, combined with the disease characteristics of AD. By using the convenience sampling method, a total of 201 patients with AD who had undergone surgery were selected as the research participants. The initial version of the scale was used for follow-up investigation, and the scale entries were evaluated and exploratory factor analysis carried out to form the formal version of the "postoperative self-management assessment scale for patients with aortic dissection." A total of 214 patients with AD after surgery were selected as the research participants. The formal version of the scale was used for follow-up investigation, and its reliability and validity were evaluated. The formal version of the scale had 6 dimensions and 35 entries. The Cronbach's α coefficient for the total scale was 0.908, the split-half reliability was 0.790, and the test-retest reliability after 2 weeks was 0.471. The content validity index of the total scale was 0.963. Exploratory factor analysis yielded six common factors, and the cumulative contribution rate of variance was 66.303%. Confirmatory factor analysis showed that except for the incremental fit index, Tucker-Lewis index, and comparative fit index >0.85, slightly lower than 0.90, χ 2/df <3, root mean square of approximation <0.08, parsimonious goodness-of-fit index, and parsimonious normed fit index >0.50; all other model fitting requirements were satisfied, indicating that the model fitting was acceptable. We compiled the postoperative self-management assessment scale for patients with AD, which has demonstrated excellent reliability and validity and can be used as a tool to evaluate the postoperative self-management level in patients with aortic dissection.

Sünnet cerrahisi için en uygun anestezi yöntemi nedir? Lokal ve genel anestezinin karşılaştırılması: Prospektif klinik çalışma

Objective: It was aimed to compare the methods of local anesthesia and general anesthesia with circumcision study questionnaire applied before and after circumcision. Material and Methods: Parents of children aged 0-12 years who applied for circumcision between June and December 2021 who agreed to participate in the study were asked to fill out the circumcision study questionnaire. All patients were operated with same surgeon and surgical method. Patients were divided into local and general anesthesia groups, and data were compared. Results: Our study included 282 patients; general anesthesia was applied to 132 patients (48.9%), and local anesthesia was applied to 144 patients (51.1%). Age and weight averages of patients who were administered local anesthesia and age preferences suitable for circumcision were significantly lower than those in general anesthesia group (p:0.001). There was no significant difference between socioeconomic levels, educational status and reasons for circumcision in both groups (p≥0.05). Patients’ need for postoperative care and recovery time was significantly lower in the local anesthesia group (p:0.001). Conclusion: Circumcision is a surgical operation that can be performed safely with local or general anesthesia. Parents who want circumcision in the early months of life mostly prefer local anesthesia. Postoperative recovery time is shorter in this group. Preference for anesthesia has changed in favor of general anesthesia in advanced ages, including the sexual development period. The knowledge and awareness level of our society about circumcision has increased compared to previous years. Keywords: circumcision, local anesthesia, general anesthesia, urinary tract infection

Posterior lamellar keratoplasty: techniques, outcomes, and recent advances.

Over the past 2 decades, posterior lamellar keratoplasty (PLK) has emerged as an alternative to penetrating keratoplasty in the treatment of corneal endothelial disorders. The reasons for this trend include the search for a safer procedure to replace diseased endothelium that provides faster and better visual rehabilitation and reduces the need for postoperative care. Different surgical techniques, surgical instruments, devices, and lasers have been introduced to overcome technical difficulties, thus improving clinical outcomes. Yet, surgeons and eye banks must address the complications and limitations that arise during the transition to these new techniques. This review discusses the most significant aspects of the evolution of PLK, including a detailed description of current techniques and the direction of future treatment for corneal endothelial disease with the use of laser-assisted surgery, bioengineered corneas, cell therapy, and new pharmacologic therapy.

Radiographic results of percutaneous procedures for severe hallux valgus deformities

Most studies of hallux valgus surgery focus on the radiological findings or on medium-term clinical follow-up. The results obtained using various osteotomy techniques do not differ greatly. However, patient comfort and the need for postoperative care do appear to present differences.In the Kramer technique, the osteotomy is secured with a wire extruding from the skin of the foot. In this situation, patients may well experience problems (or at least discomfort) in the immediate postoperative period. Previous studies of the Kramer technique (also known as SERI, or percutaneous distal metatarsal osteotomy) do not report an increased number of complications. Early complications may not influence the outcome in the medium to long term, and patient discomfort during the postoperative period is rarely reflected in the analysis of one-year results obtained with standard scales such as AOFAS; in our experience, however, patient discomfort, the care burden (i.e., the number of visits and emergency service consultations) and the economic cost of immediate postoperative care are all aspects that should be borne in mind when assessing the merits of different surgical techniques.In this study we compare the care burden and economic cost of two surgical approaches to hallux valgus correction – the Kramer and the scarf techniques – during the first postoperative year.Retrospective review of two independent patient cohorts. Sixty-nine feet underwent Kramer osteotomy and 133 the scarf technique. Care burden was assessed by the number of visits each patient required and the complications. The follow-up and costs of each were assessed and compared independently.Both techniques obtain satisfactory clinical results at one year. However, comparison of clinical progression showed AOFAS score increases of 34.7 points for Kramer and 41.1 points for the scarf technique (p-value < 0.05). Patients in the Kramer group required a higher number of visits, especially postoperative emergency department visits (p < 0.05), and had a significantly higher number of complications (27.5% vs. 6.7%, p < 0.05). The mean cost of follow-up was significantly higher in the Kramer group (€ 218.97 vs. € 171.41, p < 0.05).Kramer osteotomy presented significantly higher care burdens, complication rates and associated costs during the first year of follow-up. It is therefore a less cost-effective technique. Thus, even though according to the results of AOFAS we would not have changed our clinical practice, the analysis of these data has made us change our treatment strategy for hallux valgus and practically abandoned the use of the Kramer osteotomies.

MIS hallux valgus correction with proximal osteotomy and internal bracing

Most studies of hallux valgus surgery focus on the radiological findings or on medium-term clinical follow-up. The results obtained using various osteotomy techniques do not differ greatly. However, patient comfort and the need for postoperative care do appear to present differences.In the Kramer technique, the osteotomy is secured with a wire extruding from the skin of the foot. In this situation, patients may well experience problems (or at least discomfort) in the immediate postoperative period. Previous studies of the Kramer technique (also known as SERI, or percutaneous distal metatarsal osteotomy) do not report an increased number of complications. Early complications may not influence the outcome in the medium to long term, and patient discomfort during the postoperative period is rarely reflected in the analysis of one-year results obtained with standard scales such as AOFAS; in our experience, however, patient discomfort, the care burden (i.e., the number of visits and emergency service consultations) and the economic cost of immediate postoperative care are all aspects that should be borne in mind when assessing the merits of different surgical techniques.In this study we compare the care burden and economic cost of two surgical approaches to hallux valgus correction – the Kramer and the scarf techniques – during the first postoperative year.Retrospective review of two independent patient cohorts. Sixty-nine feet underwent Kramer osteotomy and 133 the scarf technique. Care burden was assessed by the number of visits each patient required and the complications. The follow-up and costs of each were assessed and compared independently.Both techniques obtain satisfactory clinical results at one year. However, comparison of clinical progression showed AOFAS score increases of 34.7 points for Kramer and 41.1 points for the scarf technique (p-value < 0.05). Patients in the Kramer group required a higher number of visits, especially postoperative emergency department visits (p < 0.05), and had a significantly higher number of complications (27.5% vs. 6.7%, p < 0.05). The mean cost of follow-up was significantly higher in the Kramer group (€ 218.97 vs. € 171.41, p < 0.05).Kramer osteotomy presented significantly higher care burdens, complication rates and associated costs during the first year of follow-up. It is therefore a less cost-effective technique. Thus, even though according to the results of AOFAS we would not have changed our clinical practice, the analysis of these data has made us change our treatment strategy for hallux valgus and practically abandoned the use of the Kramer osteotomies.

Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team.

Proper planning of intervention and care of ovarian cancer surgery is of outmost importance and involves a wide range of personnel at the departments involved. The aim of this study is to evaluate the introduction of an ovarian surgery classification (COVA) system for facilitating multidisciplinary team (MDT) decisions. Four hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named "pre-COVA" 1 to 3 classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA performed. The MDT meeting allocated 213 women (51%) to pre-COVA 1, 136 (33%) to pre-COVA 2, and 52 (12%) to pre-COVA 3. At the end of surgery, 168 (40%) were classified as COVA 1, 158 (38%) were classified as COVA 2, and 28 (7%) were classified as COVA 3. Traced individually, 212 (51%) patients were correctly preclassified at the MDT meeting and distributed into 110 (52%) COVA 1, 71 (52%) COVA 2, and 17 (32%) COVA 3. Analyzing the subgroup of patients with cancer, 164 (47%) were correctly preclassified. Regarding the International Federation of Gynecology and Obstetrics (FIGO) stages, the pre-COVA classification predicted the actual COVA group in 79 (49%) FIGO stages I to IIIB and in 85 (45%) FIGO stages IIIC to IV. The COVA classification system is a simple and useful tool in the MDT setting where specialists make treatment decisions based on advanced technology. The use of pre-COVA classification facilitates well-organized patient care-relevant procedures to be undertaken. Pre-COVA accurately predicts the final COVA in 51% classified women.

The Efficacy and Safety Profile of Ocriplasmin in Vitreomacular Interface Disorders

ABSTRACTVitreomacular adhesion (VMA) describes the adhesion of the posterior hyaloid face to the inner retina in any part of the macula. This can arise after incomplete separation of the posterior vitreous cortex from the macula during vitreous liquefaction. While the VMA may resolve spontaneously, a strong and persistent adhesion can lead to a variety of anatomical changes, including vitreomacular traction (VMT) and macular hole (MH). Both conditions can present with metamorphopsia and decreased vision. In cases of symptomatic VMT and full-thickness macular hole, pars plana vitrectomy has long been the standard of care. However, due to the possible surgical complications and need for postoperative care, many have searched for non-surgical options via pharmacologic vitreolysis. Ocriplasmin (Jetrea, Thrombogenics USA, Alcon/Novartis EU) is a recombinant protease approved in October 2012 for the treatment of symptomatic vitreomacular adhesion (VMA). There have been conflicting views on the safety of Ocriplasmin with changes in the ellipsoid zone seen on OCT and changes seen on ERG indicating photoreceptor damage. This publication reviews the efficacy and safety of ocriplasmin injection for VMA based on previously published data.

Functional and Practical Outcomes of Inlay Butterfly Cartilage Tympanoplasty

For tympanoplasty, the most common grafting materials are the temporalis fascia or perichondrium; however, both require incision of the canal skin, which carries a risk of morbidity and the need for postoperative care. Inlay butterfly cartilage tympanoplasty, by which the perforation edges are refreshed and a cartilage is inserted through the perforation without canal incision, makes the graft easy, and reduces operating and recovery time. We analyze the outcome of inlay butterfly cartilage tympanoplasty. This study included 112 patients who underwent tympanoplasty from January 2011 to August 2012. Patients were divided into 2 groups: patients who underwent inlay butterfly cartilage tympanoplasty (Group I, n = 56) and patients who underwent conventional underlay tympanoplasty using the temporalis fascia (Group II, n = 56). Anatomic success was defined as an intact, repaired tympanic membrane, and functional success was defined as a significant decrease in the air-bone gap at the end of follow-up. Perioperative pain was analyzed using a visual analogue scale (VAS). Surgical success, functional success, perioperative pain, and operating time were evaluated and compared. The surgical success rate was 96.4% in Group I and 91.1% in Group II (p = 0.435). The mean air-bone gap decrease was 7.9 ± 2.2 dB in Group I and 8.9 ± 3.2 dB in Group II (p = 0.426). Group I showed a lower VAS score for pain (1.5 ± 1.2) and a shorter operation time (25.6 ± 8.5 min) compared with those of Group II (4.9 ± 1.7, 48.6 ± 19.5 min, respectively) (p < 0.01). Inlay butterfly cartilage tympanoplasty is compatible with the conventional underlay technique in both anatomic and functional success rates. Its simplicity, shorter operation time, and rapid recovery time could make it an attractive surgical option.

Use of gynaecological laparoscopy in a hospital ward in the West Bank, occupied Palestinian territory: a retrospective audit

Background Gynaecological laparoscopy is an important diagnostic and interventional method. It is widely applied, and increasingly accepted by the community because it is minimally invasive and is cheaper than the other methods. The introduction of gynaecological laparoscopy at Hebron Governmental Hospital, West Bank, occupied Palestinian territory (oPt), was an important step forward in service delivery. Despite several logistical barriers to adequate service provision in the biggest city in the oPt, the hospital serves more than 600 000 citizens with a small gynaecological ward (22 beds at the time of the study) and few funding sources compared with other hospitals in the oPt. Additionally our ward is the busiest compared with the gynaecological wards in other hospitals in the oPt. Our aim was to show that use of minimally invasive surgery such as laparoscopy can reduce hospital admission time and costs with a complication rate in the oPt that does not differ much from the international rate. Methods All gynaecological laparoscopic procedures (diagnostic and interventional) that were done between Jan 1, 2011, and Jan 1, 2013, in Hebron Hospital were included in this retrospective study. After obtaining written or verbal informed consent from all patients included in the study, data were gathered for inpatient stay and rates of complications. Our data were compared with those reported internationally in PubMed in recent years. We used SPSS (version 17.0) for the statistical analysis. The hospital's medical counsel provided ethics approval to undertake the study. Findings 200 women (mean age 28 years [range 25–35]) were admitted for gynaecological laparoscopic intervention: 65 for diagnostic laparoscopy and 135 for interventional laparoscopy. The inpatient stay in our ward was 1 day, similar to that reported internationally. The overall complication rate in the ward was 6% (six intraoperative and six postoperative complications). The complication rate reported in the Department of Obstetrics and Gynecology, St John Hospital and Medical Center, Detroit, MI, USA, was 9·8% between January, 1996, and June, 1996, and the overall complication rate in the Centre Hospitalier Universitaire Cochin Saint-Vincent-de-Paul, Paris, France, was 4·64 per 1000 gynaecological laparoscopies. Interpretation The use of laparoscopic gynaecology for diagnosis and treatment of emerging indications is an important advantage, especially for patients who have several logistical barriers to accessing health care in the oPt—eg, long distance from the hospital—because it can reduce the inpatient stay and the need for postoperative care. However, care must be taken with interventional laparoscopy to reduce the risk of complications. Funding Italian Association for Solidarity Among People.

Hysteroscopy in 2001: a comprehensive review.

Keywords: diagnostic hysteroscopy; endometrial ablation; hysteroscopic metroplasty; hysteroscopic myomectomy; outpatient hysteroscopy

The intensive care unit in paediatric oncology: 10 years experience

We report the results of a retrospective study of the intensive care outcome of 196 children admitted with malignancy at a tertiary referral institution over a period of 10 years from 1988 to 1997. A total of 165 children required 196 admissions for a median of 3 days. Their mean age was 5.82 years and there were 100 boys (51%) and 96 girls (49%). Their admission median Apache II score was 18. A total of 150 children (76.5%) survived intensive care. Nonsurvivors had a higher Apache II score than survivors (23 vs 15 respectively, P < 0.001). Patients were divided into those needing postoperative care (n = 55), patients with respiratory infection (n = 39), systemic infection (n = 30), neurological complications (n = 20), respiratory failure with no evidence of infection (n = 17), metabolic effect (n = 13), tumour mass effect (n = 9), GI bleed (n = 5), cardiac failure (n = 4), post cardiac arrest (n = 3). The overall survival, defined as those who survived 1 week after discharge from PICU, was 73.4%. Invasive monitoring including arterial and central venous pressure line were inserted in 143 (72.9%), mechanical ventilation was required for 133 (67.8%), ionotropic support for 66 (33%), pulmonary artery floatation catheter insertion and monitoring in 23 (11.7%) and renal replacement therapy for 13 (6.6%) children. The profile of diseases in children admitted in PICU appears to be changing since last report from this unit in 1992 [1]. The most common reason for admission was need for postoperative care (28%) and survival in this group was 100%. There also is a significant improvement in survival rate of patients with systemic infections (63%) needing ventilatory support and children with respiratory (with or without infection) failure (67%) [2].

The changing role of monitored anesthesia care in the ambulatory setting.

The changing role of monitored anesthesia care in the ambulatory setting.

Cataract operation with anterior chamber lens implant

The results of 106 intracapsular cataract extractions with implantation of an anterior chamber lens are reported. The indications were monocular cataract in 63%, bilateral cataract in 15%, cataract with maculopathy in 10%, practical monocularity, parkinsonism etc. in 12%. Postoperative visual acuity was 0.4 to 1.0 in 88%; diminished vision was caused by maculopathy, central venous thrombosis, or glaucoma in 12%. Postoperative complications: pupillary block in 8.5%, glaucoma in 10.5%, cystoid macular edema in 3.6%, and decentration of implant in 1%. The need for postoperative care of patients with intraocular implants after cataract surgery is pointed out.

Failure of intramuscularly administered lorazepam and scopolamine-morphine premedication to produce amnesic effects to supplement conduction anaesthesia.

Patients undergoing surgery under regional anaesthesia often prefer to be sedated and do not later want to recall the procedure. One hundred and twenty-one patients scheduled for various surgical procedures under epidural, spinal, sacral, or brachial plexus blockades received 1 mg/kg of pethidine, 0.007 mg/kg of scopolamine, plus 0.14 mg/kg of morphine, or 0.03 mg/kg or 0.06 mg/kg or lorazepam intramuscularly as preanaesthetic medication before the operation. The patients's self-assessments of degree of fatigue and apprehension were similar after each premedication when assessed before operation. Postoperative anxiety and confusion as well as need for postoperative care and supervision were greatest after 0.06mg/kg of lorazepam. Significantly (P smaller than 0.05 to P smaller than 0.01) fewer patients given 0.06 mg/kg or lorazepam remembered different events and procedures carried out on them before and after operation than those given other premedications, but no significant differences were noted in patients' ability to recall the performance of operation when asked on the following day. Seventy-seven, 63, and 57% of patients receiving 0.06 mg/kg of lorazepam remembered the start of blockade, performance of operation, and stay in recovery room, respectively. Intravenous sedation should be preferred to these intramuscularly administered premedications if drug-induced amnesia is sought to supplement local anaesthetic techniques.

Untoward Effects of Ketamine Combined with Diazepam for Supplementing Conduction Anaesthesia in Young and Middle-Aged Adults

Fifty-six young and 29 middle-aged adults who were scheduled for lower abdominal, anorectal or extremity surgery under epidural, sacral or brachial plexus blockades received intravenous analgesic or anaesthetic doses of ketamine, combined with diazepam, immediately before the start of the operation. Forty-one patients received no supplementary drugs for the conduction anaesthesia and were divided into two groups of controls. On the day following the operation, all the patients were asked about their postanaesthetic reactions and their acceptance of the anaesthetic technique, and the nursing staff expressed their opinion on the amount of work and supervision needed during the post-operative care of the patients. Administration of ketamine 0.5 mg/kg with diazepam 0.15 mg/kg to young or middle-aged patients was not associated with more side-effects or a greater need for post-operative care and supervision than in the control groups. Administration of anaesthetic doses of ketamine 1.5 mg/kg and 3.0 mg/kg with 0.15 mg/kg and 0.3 mg/kg of diazepam, respectively, caused significantly (P less than 0.05) more post-operative anxiety and confusion, as well as a significantly greater need for post-operative care and supervision than in the control patients. It is concluded that, in young or middle-aged patients, supplementing conduction anaesthesia with ketamine 0.5 mg/kg plus diazepam 0.15 mg/kg is not associated with the untoward effects which can be expected after anaesthetic doses of 1.5 mg/kg (or more) of ketamine.

Untoward effects of ketamine combined with diazepam for supplementing conduction anaesthesia in young and middle-aged adults.

Fifty-six young and 29 middle-aged adults who were scheduled for lower abdominal, anorectal or extremity surgery under epidural, sacral or brachial plexus blockades received intravenous analgesic or anaesthetic doses of ketamine, combined with diazepam, immediately before the start of the operation. Forty-one patients received no supplementary drugs for the conduction anaesthesia and were divided into two groups of controls. On the day following the operation, all the patients were asked about their postanaesthetic reactions and their acceptance of the anaesthetic technique, and the nursing staff expressed their opinion on the amount of work and supervision needed during the post-operative care of the patients. Administration of ketamine 0.5 mg/kg with diazepam 0.15 mg/kg to young or middle-aged patients was not associated with more side-effects or a greater need for post-operative care and supervision than in the control groups. Administration of anaesthetic doses of ketamine 1.5 mg/kg and 3.0 mg/kg with 0.15 mg/kg and 0.3 mg/kg of diazepam, respectively, caused significantly (P less than 0.05) more post-operative anxiety and confusion, as well as a significantly greater need for post-operative care and supervision than in the control patients. It is concluded that, in young or middle-aged patients, supplementing conduction anaesthesia with ketamine 0.5 mg/kg plus diazepam 0.15 mg/kg is not associated with the untoward effects which can be expected after anaesthetic doses of 1.5 mg/kg (or more) of ketamine.