Perioperative Education Research Articles

“…I Wish Someone Told Me About That…”: A Qualitative Assessment of the Educational Needs of Patients Undergoing Cystectomy

OBJECTIVESTo utilize patient feedback to identify areas of need for information and ways to improve delivery of education, due to recognition that cystectomy and urinary diversion is a complex operation often overwhelming patients and caregivers. METHODSWe conducted 5 focus groups of bladder cancer patients (separated by gender and diversion type) treated with cystectomy and urinary diversion (n=17). Questions focused on areas of improvement for patient education. Transcripts were analyzed using the Sort and Sift, Think and Shift© method, with insights directing the creation of a flexible codebook. A team of researchers created thematic summaries from individual codes and performed higher level analyses to characterize salient findings. RESULTSPatients described ways to improve the content, timing, and format of education. Most patients expressed a desire to receive a list of common patient experiences pre-operatively. Information they wish they had known beforehand included nuances of new urinary routines, sexual dysfunction, complications such as abdominal adhesions or hernias, and details regarding discharge criteria. Patients had differing opinions on what amount of information should be offered before surgery, but most agreed that options for more details available later were ideal. Preferences on formatting of information varied. Overall, an assortment of formats could allow patients to tailor their process to different learning preferences and individual situations. CONCLUSIONSPatients highlighted key areas for improvement in the breadth, timing, and format of perioperative education. Continued involvement of patients while developing these educational interventions will be pivotal for meeting patient needs and improving outcomes.

SP2.3 - Environmental and non-technical factors influence surgical trainees involvement in laparoscopic appendectomy in Northern Italy: a propensity score matching and survey based multicenter analysis

Abstract Aims Laparoscopic appendectomy (LA) is an index procedure for surgical residents (R). The trends of R involvement in LA can be a quality benchmark for residency programs. The impact of clinical and non-clinical factors on such trends is still undisclosed. We aimed to investigate the prevalence of LA performed by R in the largest Italian educational network and explore the decision-making behind R involvement in LA. Methods We extracted data from the RESIDENT-1 (R1) multicenter trial registry and performed a propensity score matching (PSM) analysis to identify clinical and environmental differences according to the operator, surgeons(S) vs R. Additionally, to explore environmental and non-technical factors influencing the choice of the primary operator, we administered a survey to S and R in the R1 network. Results We enrolled 653 LA from October 2019 to October 2022, 234 (35.89%) were performed by R. We compared 231 per group after PSM. In academic hospitals and dedicated emergency surgery units LA were more frequently approached by R (57.14%vs26.84%, 51.08%vs19.05% p<0.001, respectively). The survey showed discrepant perspectives, R prioritize clinical factors, as the presence of complicated disease (25.53%vs.8.33%, p<0.015), whilst non-technical and environmental factors such as year of residency (63.1%vs.44.7%,p=0.05) and punctuality (47.2%vs.23.4%,p=0.041) were more important for S. Both groups agreed that a perioperative feedback system would improve the process of R involvement in LA. Conclusion Our study report a low rate of LA performed by R in northern Italy, primarily influenced by non-clinical factors. Furthermore, dedicated pathways and a well-structured perioperative teaching method could optimize the teaching process.

Are we informing our patients correctly? Evaluation of perioperative counselling for paediatric intestinal stoma formation: a national study.

Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation. UK paediatric surgery centres were invited to recruit patients aged 6-16years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants. Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5years (range 4.1-17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03). Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma.

Evaluation of a Patient-Centered Perioperative Curriculum: A Pilot Study

Objectives: To evaluate a standardized patient perioperative education curriculum for women undergoing pelvic reconstructive surgery. Materials and Methods: We performed a feasibility study to examine the practicality of a group-based, perioperative patient-centered educational curriculum (PPEC). Adult (≥ 18 years) English-speaking women undergoing surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) at a single center from February 2020 to March 2020 were approached to complete a PPEC session instead of receiving usual perioperative counseling. In-person PPEC sessions were facilitated by one Registered Nurse and attended by 2-4 patients and their support people 2 weeks before surgery. Patients undergoing SUI and POP surgeries were combined in each session. Recruitment was halted prematurely due to the COVID-19 pandemic. The content of the PPEC incorporated information about health optimization, details regarding the day of surgery, and instructions for postoperative care including pain, urinary and bowel management. A questionnaire assessing six aspects of patient preparedness was completed prior to (pre) and immediately following (post) course completion. Each question was self-rated on a scale of preparedness from 0 (not at all) to 10 (proficient). The primary outcome was change in self-assessed patient preparedness for pelvic reconstructive surgery. Median and interquartile range of pre- and post-course scores for each question are reported and the Wilcoxon matched pairs signed rank test was used to test significance of differences. Results: A total of 16 patients were included in this pilot study. Patient preparedness was significantly improved among all domains for patients who completed the PPEC session. Prior to PPEC, patients self-reported they were most prepared in how to be healthy for surgery. The greatest difference in pre- to post-PPEC preparedness self-reported scores was in what to expect during hospital admission. Conclusion: Our novel approach to perioperative counseling through a standardized educational curriculum offered to mixed groups of patients undergoing SUI and/or POP surgery was associated with significant improvements in patient preparedness for surgery.

Real-time procedure information sharing as a means to reduce perioperative anxiety in families of children undergoing elective surgery - a randomized controlled study

ObjectiveTo investigate whether the surgical process information sharing system could alleviate the parental anxiety during a pediatric selective operation.DesignRandomized controlled trial.MethodsA questionnaire survey was conducted one day before surgery for the enrolled participants. Family members assigned to the intervention group received real-time process information sharing through service reminders during the surgical period, while the control group received standard perioperative education. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality during the perioperative period, and the State of Cohesion-13 Scale (SOC-13) and Self-rating Anxiety Scale (SAS) were used to assess anxiety levels. Satisfaction levels during the perioperative period were assessed through a follow-up survey conducted one day after surgery.ResultsThe intervention group showed better scores in terms of PSQI, SOC-13, SAS, and postoperative satisfaction levels at various time points compared to the control group, with statistically significant differences observed (P < 0.05).ConclusionReal-time process information sharing is effective in reducing perioperative sleep disorders and anxiety among family members of pediatric patients, as well as improving satisfaction levels. This approach not only establishes a process and mechanism for effective doctor-patient communication but also helps implement continuous perioperative care, thereby optimizing internet healthcare services.

Roadmap for integrating the AACN essentials with perioperative nursing

Faculty members teaching in pre-licensure nursing programs are entrusted with revising nursing education to meet the American Association of Colleges of Nursing's The Essentials: Core Competencies for Professional Nursing Education. Colleges of nursing faculty experience difficulty establishing enough clinical sites as healthcare facilities continue to overcome staffing challenges since the start of the COVID-19 pandemic. Perioperative nursing is an underutilized area despite the potential for students to attain valuable nursing competencies and experiences in perioperative areas. An opportunity exists for faculty, regardless of having perioperative nursing experience or not, to use perioperative environments for clinical experiences in didactic and simulation courses. Our aim is to provide a roadmap for nursing faculty to include perioperative nursing in the pre-licensure nursing curriculum. Perioperative education exemplars aligned with the American Association of Colleges of Nursing's The Essentials: Core Competencies for Professional Nursing Education domains are included for adoption in any college of nursing.

Implementation of a Blended-Learning Perioperative Nursing Education Program in Canada.

Governmental COVID-19 mandates in Ontario, Canada, resulted in a backlog of perioperative procedures. Organization leaders were required to expand services after the pandemic; however, the ongoing nursing shortage and college-based structure of perioperative education programs complicated their response. In 2021, we developed an in-house perioperative education program using a blended-learning theory comprising online modules and videos, skills laboratory sessions, and clinical placement experiences. Nurses were required to apply for the program and remain employed at the facility for two years. Program evaluations showed that the novice nurses felt confident when beginning clinical experiences and preceptors believed the nurses were prepared for practice. Sixteen of 19 participants successfully completed the program, which helped resolve the staffing shortage. Novice nurses may benefit from a shadowing experience before applying for this type of program. Leaders in nonperioperative specialties should consider an in-house education program to help meet staffing needs in their areas.

Implementation and Impact of an Adapted Digital Perioperative Competency-Building Tool to Enhance Teaching, Learning And Feedback in Postgraduate Competency-Based Medical Education

The purpose of this educational intervention was to introduce, iteratively adapt, and implement a digital formative assessment tool in a surgical speciality. The study also evaluated the intervention's impact on perioperative teaching, learning, feedback, and surgical competency. A participatory action research model with a mixed methods approach. This study was performed over 10 months in an institutional hospital in South Africa with a general surgery department. Twelve supervising surgical trainers/faculty and 12 surgical trainees/residents consented to participate in the intervention. The first 4 months of the intervention focused on relationship building, a multi-stakeholder contextual needs assessment and training sessions to support a shared mindset and shift in the teaching and learning culture. The final adapted perioperative competency-building tool comprised a 23-item assessment with four open-text answers (Table 1). Over the following 6-month period, 48 workplace-based competency-building perioperative evaluations were completed. Most trainees took less than 5 minutes to self-assess (67%) before most trainers (67%) took less than 5 minutes to give oral feedback to the trainee after the perioperative supervised learning encounter. On average, the digital tool took 6 minutes to complete during the bidirectional perioperative teaching and learning encounter with no negative impact on the operational flow. All trainers and trainees reported the training and implementation of the digital tool to be beneficial to teaching, learning, feedback, and the development of surgical competency. Analysis of the completed tools revealed several trainees showing evidence of progression in surgical competency for index procedures within the speciality. The focus groups and interviews also showed a change in the teaching and learning culture: more positively framed, frequent, structured, and specific feedback, improved accountability, and trainee-trainer perioperative readiness for teaching. Highlighted changes included the usefulness of trainee self-assessment before perioperative trainer feedback and the tool's value in improving competency to Kirkpatrick Level 4. Implementing an adapted digital Workplace-Based Assessment (WBA) tool using a participatory action research model has proven successful in enhancing the effectiveness of supervised perioperative teaching and learning encounters. This approach has improved teaching and feedback practices, facilitated the development of surgical competency, and ultimately impacted the overall culture to Kirkpatrick level 4. Importantly, it has positively influenced the trainee-trainer relationship dynamic. Based on these positive outcomes, we recommend using this effective method and our relationship-centred framework for implementing formative competency-building tools in future studies. By doing so, larger-scale and successful implementation of Competency-Based Medical Education (CBME) could be achieved in various contexts. This approach can potentially enhance teaching and learning encounters, promote competency development, and improve the overall educational experience for surgical trainees and trainers.

Effect of a Perioperative Educational Video in Patients Undergoing Mohs Reconstruction

Background Skin cancer is the most common type of cancer in the United States, and most are treated with Mohs micrographic surgery (MMS) by fellowship-trained dermatologic surgeons. Complex reconstruction in cosmetically and functionally sensitive areas often requires a plastic surgery consult. The uncertainty regarding reconstructive options and cosmetic appearance is difficult emotionally and cognitively for patients. Objectives To improve patient understanding about MMS reconstruction with plastic surgeons, we investigated the utility of a multimedia presentation during perioperative education. Methods A randomized clinical trial was conducted at a hospital-affiliated outpatient MMS clinic and surgery center in the United States. Patients in the intervention arm were given a tablet or Web site link to watch a multimedia presentation about reconstruction after MMS. All patients were given a questionnaire about their understanding of MMS reconstruction and satisfaction with the reconstructive care they received. Results A total of 46 patients were recruited for the study and completed the questionnaire. Of these patients, 22 were randomized to the test intervention arm, and the remaining 24 were in the control group. Among participants in the test intervention arm, feedback regarding the platform was positive with more than 90% of patients reporting that the video was engaging, useful, and easy to understand. Patient understanding and satisfaction scores in the test intervention arm ranked higher across all domains than those of the control group. Conclusions This randomized clinical trial showed increases in patient understanding and satisfaction among patients undergoing MMS reconstruction with the implementation of a perioperative educational video.

Periop 101: Improving Perioperative Nursing Knowledge andCompetence inLabor andDelivery Nurses Through an Evidence-Based Education andTraining Program.

To reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. In military treatment facilities, either perioperative registered nurses or labor and delivery (L&D) nurses provide skilled intraoperative nursing care for cesarean deliveries. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience. The purpose of this project was to improve surgical care quality by standardizing and strengthening L&D nurse perioperative training, knowledge, and competence. Our population, intervention, comparative, and outcome question was, "For labor and delivery nurses of a regional military medical center (P), does implementing an evidence-based training program (I), as compared to current institutional nursing practices (C), increase nursing knowledge and perioperative nursing competence (O)?" We implemented Periop 101: A Core Curriculum-Cesarean Section training for 17 L&D nurses, measured knowledge using product-provided testing, and assessed competence using the Perceived Perioperative Competence Scale-Revised. We found that perioperative nursing knowledge and competence significantly improved and were less varied among the nurses after completing the training program. Nurses demonstrated the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. Nurses reported significantly greater perceived competence across all six domains of the Perioperative Competence Scale-Revised, with the largest improvements realized in foundational skills and knowledge, leadership, and proficiency. We recommend that health care leaders develop policies to standardize perioperative education, training, and utilization for nurses providing intraoperative care to reduce clinician role ambiguity, decrease inefficiencies, and enhance care.

Surgical sensation during caesarean section: a qualitative analysis

BackgroundCaesarean section (CS) is a major abdominal surgery performed usually on a young and healthy population under neuraxial anesthesia with little to no sedation. This creates a distinct surgical experience whereby patients are aware of the surgical process, physical sensations, and their environment. This study aimed to provide an in-depth descriptive assessment of subjective surgical experience during CS under regional anaesthesia. We expected the information gained would enhance our current understanding and better alleviate patient anxiety through informed counselling. MethodsThis qualitative descriptive study was conducted at a Canadian academic centre. Twenty patients participated in semi-structured interviews within a week of CS, using an interview guide developed for this study. Patient medical records were reviewed to collect demographic and surgical information. Thematic analysis was conducted using an inductive approach to determine common themes. ResultsNine themes were identified. Five themes were identified in the category of surgical sensation and four themes were identified in the category of peri-operative education. ConclusionsPatients commonly experienced pressure and movement sensations at varying intensity, and most did not experience pain. Environmental factors, including sounds and distraction by the newborn, affected perception of surgical sensation. Patients wish to receive pre-operative counselling regarding potential surgical sensations, as well as ongoing communication from their anaesthesiologist. These results can be used to guide informed discussions with patients and direct further investigation in this area.

The pathophysiology and management of depression in cardiac surgery patients

BackgroundDepression is common in the cardiac surgery population. This contemporary narrative review aims to explore the main pathophysiological disturbances underpinning depression specifically within the cardiac surgery population. The common non-pharmacological and pharmacological management strategies used to manage depression within the cardiac surgery patient population are also explored.MethodsA total of 1291 articles were identified through Ovid Medline and Embase. The findings from 39 studies were included for qualitative analysis in this narrative review.ResultsDepression is associated with several pathophysiological and behavioral factors which increase the likelihood of developing coronary heart disease which may ultimately require surgical intervention. The main pathophysiological factors contributing to depression are well characterized and include autonomic nervous system dysregulation, excessive inflammation and disruption of the hypothalamic–pituitary–adrenal axis. There are also several behavioral factors in depressed patients associated with the development of coronary heart disease including poor diet, insufficient exercise, poor compliance with medications and reduced adherence to cardiac rehabilitation. The common preventative and management modalities used for depression following cardiac surgery include preoperative and peri-operative education, cardiac rehabilitation, cognitive behavioral therapy, religion/prayer/spirituality, biobehavioral feedback, anti-depressant medications, and statins.ConclusionThis contemporary review explores the pathophysiological mechanisms leading to depression following cardiac surgery and the current management modalities. Further studies on the preventative and management strategies for postoperative depression in the cardiac surgery patient population are warranted.

Exploring elderly patients’ experiences and concerns about early mobilization implemented in postoperative care following lumbar spinal surgery: a qualitative study

BackgroundGiven its apparent benefits, early mobilization is becoming increasingly important in spinal surgery. However, the time point at which patients first get out of bed for mobilization after spinal surgery varies widely. Beginning in January 2022, we conducted a study of early mobilization (mobilization within 4 h postoperatively) following multi-segment lumbar decompression and fusion surgery in elderly patients. The study goal was to better understand elderly patients’ perceptions of early mobilization and ultimately contribute to the improvement of elderly patients’ perioperative experiences and quality of life.MethodsWe employed a qualitative descriptive study design involving face-to-face semi-structured interviews. Forty-five consecutive patients were invited, among whom 24 were enrolled and completed the qualitative investigation from February to June 2022. Of these 24 patients, 10 underwent early mobilization (mobilization within 4 h postoperatively) and 14 underwent mobilization at ≥ 24 h postoperatively. Three researchers conducted a 15-question interview the day before each patient’s discharge. The interviews were audio-recorded, and content analysis was used to assess the data.ResultsSix themes regarding the patients’ experiences and concerns about early mobilization were identified: worries, benefits, daily routines, pain, education, and support. The study results revealed the obstacles in early mobilization practice and highlighted the importance of perioperative education on early mobilization.ConclusionsClear and explicit guidance on early mobilization and a multidisciplinary mobilization protocol that incorporates a comprehensive pain management plan are essential for effective patient education. These measures may have positive effects on reducing patients’ stress and anxiety regarding postoperative early mobilization.

Augmented Reality for Perioperative Anxiety in Patients Undergoing Surgery

Both augmented reality (AR) and virtual reality (VR) have had increasing applications in medicine, including medical training, psychology, physical medicine, rehabilitation, and surgical specialties, such as neurosurgery and orthopedic surgery. There are little data on AR's effect on patients' anxiety and experiences. To determine whether the use of an AR walkthrough effects patient perioperative anxiety. This randomized clinical trial was conducted at an outpatient surgery center in 2021 to 2022. All patients undergoing elective orthopedic surgery with the senior author were randomized to the treatment or control group. Analyses were conducted per protocol. Data analysis was performed in November 2022. AR experience explaining to patients what to expect on their day of surgery and walking them through the surgery space. The control group received the standard educational packet. The main outcome was change in State-Trait Anxiety Inventory (STAI) from the screening survey to the preoperative survey. A total of 140 patients were eligible, and 45 patients either declined or were excluded. Therefore, 95 patients (63 [66.3%] male; mean [SD] age, 38 [16] years) were recruited for the study and included in the final analysis; 46 patients received the AR intervention, and 49 patients received standard instructions. The AR group experienced a decrease in anxiety from the screening to preoperative survey (mean score change, -2.4 [95% CI, -4.6 to -0.3]), while the standard care group experienced an increase (mean score change, 2.6 [95% CI, 0.2 to 4.9]; P = .01). All patients postoperatively experienced a mean decrease in anxiety score compared with both the screening survey (mean change: AR, -5.4 [95% CI, -7.9 to -2.9]; standard care, -6.9 [95% CI, -11.5 to -2.2]; P = .32) and preoperative survey (mean change: AR, -8.0 [95% CI, -10.3 to -5.7]; standard care, -4.2 [95% CI, -8.6 to 0.2]; P = .19). Of 42 patients in the AR group who completed the postoperative follow-up survey, 30 (71.4%) agreed or strongly agreed that they enjoyed the experience, 29 (69.0%) agreed or strongly agreed that they would recommend the experience, and 28 (66.7%) agreed or strongly agreed that they would use the experience again. No differences were observed in postoperative pain levels or narcotic use. In this randomized clinical trial, the use of AR decreased preoperative anxiety compared with traditional perioperative education and handouts, but there was no significant effect on postoperative anxiety, pain levels, or narcotic use. These findings suggest that AR may serve as an effective means of decreasing preoperative patient anxiety. ClinicalTrials.gov Identifier: NCT04727697.

The Use, Effectiveness, and Impact of Workplace-Based Assessments on Teaching, Supervision and Feedback Across Surgical Specialties

To investigate the use and effectiveness of Workplace-based assessments (WBAs) and their impact on training, feedback, and perioperative teaching in surgical training programs. A mixed methods cross-sectional, national electronic survey was conducted with surgical trainees and consultant trainers. The trainees and supervising faculty were from all 8 major surgical training universities across 11 surgical disciplines in South Africa. A total of 108 surgical trainees and 41 supervising consultant trainers from 11 surgical disciplines across 8 surgical training universities responded to the survey. The most significant educational gap identified by both the surgical trainees and trainers across all surgical disciplines was inadequate perioperative feedback. A third of the respondents were currently using workplace-based assessments. The WBA users (both trainees and trainers) had a higher rating for the general quality of surgical feedback than WBA nonusers (p = 0.02). WBA users also had a higher rating for the general quality of feedback given to trainees on their skills and competence (p = 0.04) and a higher rating for trainee supervision (p = 0.01) and the specialist training program overall (p = 0.01). The WBA users also had a higher rating for the assessment of competencies such as the trainee as an effective communicator (p < 0.01) and collaborator (p = 0.04). This study found that the use of WBAs enhances the quality and effectiveness of feedback in surgical training programs. We also found that the use of WBAs enhance perioperative teaching and learning and improves the assessment of relational competencies. This was also associated with high ratings for the quality of trainee supervision. Faculty and trainee development, strengthening the trainee-trainer relationship, and integrating iterative stakeholder feedback could help realize the full potential of WBAs to augment surgical training across disciplines.

Perspectives of Patients and Professionals on Patient Education in Complex Endovascular Aortic Repair

Misinterpretation of patient preferences in perioperative education can lead to an undesired treatment decision. This explorative interview study presents differences in perspectives of patients and professionals on patient education in complex endovascular aortic aneurysm management. Using convenience sampling, a cross-sectional interview study was performed among patients who were in various stages of the decision-making process for complex endovascular aortic repair. Five physicians were interviewed, representing the main providers of clinical information. Interviews were transcribed verbatim and analyzed inductively. Twelve patients (mean age 76.6 [standard deviation: 6.4], 83% male) were interviewed. Ten (83%) felt like they had no other realistic option besides undergoing surgery, whereas all professionals (5/5) stressed the importance of delicate patient selection. Five patients out of 10 (50%) who commented on their preferred decisional role considered the professional's advice as decisive. All but 1 patient (11/12) reported that the information was easy to understand, whereas 4 out of 5 professionals (80%) doubted whether patients could fully comprehend everything. Patients experienced a lack of information on the recovery process, although professionals stated that this was addressed during consultation. Several differences were found in the perspectives of patients and professionals on education in complex aortic aneurysm management. In order to optimize patient involvement in decision-making, professionals should be aware of these possible discrepancies and address them during consultation. Future research could focus on these differences in more detail by including more patients depending on their treatment and decision stages.

Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention

BackgroundMultimodal perioperative patient education and expectation-setting can reduce post-operative opioid use while maintaining pain control and satisfaction. As part of a quality-improvement project, we developed a standardized model for perioperative education built upon the American College of Surgeons (ACS) Safe and Effective Pain Control After Surgery (SEPCAS) brochure to improve perioperative education regarding opioid use and pain control. Material and methodsOur study was designed within the Define, Measure, Analyze, Improve, Control (DMAIC) quality-improvement framework. Patients were surveyed about the adequacy of their perioperative education regarding pain control and use of prescription opioid medication. After gathering baseline data, a multimodal educational intervention based on the SEPCAS brochure was implemented. Survey responses were then compared between groups. ResultsTwenty-seven subjects were included from the pre-intervention period, and thirty-nine were included from the post-intervention period (n = 66). Those in the post-intervention period were more likely to report receiving the appropriate amount of education regarding recognizing the signs of opioid overdose and how to safely store and dispose of opioid medications. The majority of patients who received the SEPCAS brochure reported that it was useful in their post-operative recovery and that it should be given to every patient undergoing surgery. ConclusionsThe ACS SEPCAS brochure is an effective tool for improving patient preparation to safely store and dispose of their opioid medication and recognize the signs of opioid overdose. The brochure was also well received by patients and perceived as an effective educational material.

Peroral Endoscopic Myotomy: What Nurses Need to Know to Provide Preeminent Perioperative Care.

This article aims to explore details of research, evidence, and key concepts intended for nurses and other healthcare clinicians surrounding the paradigm shift in therapeutic endoscopy relating to the third-space endoscopic procedure, peroral endoscopic myotomy. Although many medical publications detail the procedure, there are no specific guidelines for nurses to reference when caring for the patient undergoing peroral endoscopic myotomy. With scant published resources available to direct nurses distinctly in the delivery of exceptional care to patients undergoing peroral endoscopic myotomy, there is an identified need for collated information to be accessible to all nurses providing perioperative teaching and care. As peroral endoscopic myotomy continues to transpire as a mainstream or preferred standard treatment for patients who suffer from achalasia, relevant education remains to be fully understood and assessed in the nursing arena. By examining nursing considerations for patient care, indications, techniques, and advancements regarding this ever-emergent breakthrough, readers will discover guidance in comprehensive care encompassing patients undergoing the peroral endoscopic myotomy procedure.

Enhanced recovery after laparoscopic cholecystectomy: A single-center experience

Objective:The role of Eintraoperative joint organ removal or transit abdominal surgery recovery after surgery (ERAS) in reducing hospital stay time and perioperative hospitalization costs have been proven. However, most studies have been carried out in areas rich in medical resources. In this study, we evaluated the safety and efficacy of ERAS compared with traditional perioperative period care for laparoscopic cholecystectomy(LC) in areas poor in medical resources in China. Methods:A randomized controlled trial on laparoscopic cholecystectomy was conducted at The People's Hospital ofFengqing from July 2020 to March 2021. Patients were randomly divided into an ERAS group and a traditional care group. The main outcome was the length of hospital stay after surgery. The secondary outcomes included hospitalization costs and visual analogue scale (VAS) scores for postoperative pain, first exhaust time, and first semi-liquid diet time after surgery. The ERAS group was provided with perioperative education, nutritional support, preoperative 2 h oral carbohydrates, restricted rehydration, intraoperative insulation, no drainage tubes, wound hemp, early mobilization postoperative nausea and vomiting (PONV) prevention and multi-modal analgesia, early activity. Results: The study was conducted on a total of 140 patients with 70 patients each in the ERAS group and traditional care groups. In the ERAS group, Thelength of hospital stay after surgery was shorter (4.06 vs.4.61 days, P&lt;0.05), the average hospitalization cost (CNY 7900 vs. 8470, P&lt;0.05),and VAS score (3.10 vs. 3.57 points, compared to the eraser group P&lt;0.001) was lower, the first exhaust time was shorter (12.2 vs. 14.2 hours, P&lt;0.001),thefirst semi-liquid diet time after surgery was shorter(14.5 vs. 16.8 hours, P&lt;0.001), and the incidence of major postoperative complications was lower (bile leakage, postoperative bleeding, bile duct damage) (0% vs. 12.9%, P&lt;0.05). No significant difference in surgery time (57.8 vs. 54.6 min, P&gt;0.05) was observed between the two groups. Conclusion: Even in areas poor in medical resources in China, the use of the ERAS concept for LC surgery can reduce the length of hospital stay, cut down the cost of hospitalization, and lessen the pain of patients after surgery and accelerate postoperative recovery.

A multi-disciplinary program for opioid sparse arthroplasty results in reduced long-term opioid consumption: a four year prospective study

IntroductionThe current opioid epidemic poses patient safety and economic burdens to healthcare systems worldwide. Postoperative prescriptions of opioids contribute, with reported opioid prescription rates following arthroplasty as high as 89%. In this multi-centre prospective study, an opioid sparing protocol was implemented for patients undergoing knee or hip arthroplasty. The primary outcome is to report our patient outcomes in the context of this protocol, and to examine the rate of opioid prescription on discharge from our hospitals following joint arthroplasty surgery. This is possibly associated with the efficacy of the newly implemented Arthroplasty Patient Care Protocol.MethodsOver three years, patients underwent perioperative education with the expectation to be opioid-free after surgery. Intraoperative regional analgesia, early postoperative mobilisation and multimodal analgesia were mandatory. Long-term opioid medication use was monitored and PROMs (Oxford Knee/Hip Score (OKS/OHS), EQ-5D-5 L) were evaluated pre-operatively, and at 6 weeks, 6 months and 1 year postoperatively. Primary and secondary outcomes were opiate use and PROMs at different time points.ResultsA total of 1,444 patients participated. Two (0.2%) knee patients used opioids to one year. Zero hip patients used opioids postoperatively at any time point after six weeks (p < 0.0001). The OKS and EQ-5D-5 L both improved for knee patients from 16 (12–22) pre-operatively to 35 (27–43) at 1 year postoperatively, and 70 (60–80) preoperatively to 80 (70–90) at 1 year postoperatively (p < 0.0001). The OHS and EQ-5D-5 L both improved for hip patients from 12 (8–19) preoperatively to 44 (36–47) at 1 year postoperatively, and 65 (50–75) preoperatively to 85 (75–90) at 1 year postoperatively (p < 0.0001). Satisfaction improved between all pre- and postoperative time points for both knee and hip patients (p < 0.0001).ConclusionsKnee and hip arthroplasty patients receiving a peri-operative education program can effectively and satisfactorily be managed without long-term opioids when coupled with multimodal perioperative management, making this a valuable approach to reduce chronic opioid use.