Postoperative Day Research Articles

Cryotherapy for Rehabilitation After Total Knee Arthroplasty: A Comprehensive Systematic Review and Meta-Analysis.

Despite being well-studied and widely utilized, the efficacy of cryotherapy after total knee arthroplasty (TKA) in enhancing early rehabilitation lacks consensus. The aim of this systematic review and meta-analysis was to investigate (1) whether cryotherapy is able to promote the rehabilitation of patients undergoing TKA and (2) whether continuous cold flow device has superior results than cold pack in cryotherapy. A comprehensive trial searching was performed in the PubMed, Embase, Cochrane Library, and Google Scholar electronic databases in May, 2024. Randomized controlled trials (RCTs) comparing cryotherapy with no cryotherapy or comparing continuous cold flow device with cold pack after TKA were included. The primary outcome was visual analogue scale (VAS) of pain, and secondary outcomes included opioid consumption, blood loss (hemoglobin decrease and drainage), range of motion (ROM), swelling, length of stay (LOS), and adverse event. A total of 31 RCTs were included in this meta-analysis with 18 trials comparing cryotherapy with no cryotherapy and 13 trials comparing continuous cold flow device with cold pack. Pooled results showed cryotherapy group had significantly lower VAS scores than no cryotherapy group on postoperative day (POD) 1 (MD, -0.59 [95% CI, -1.14 to -0.04]; p = 0.04), POD 2 (MD, -0.84 [95% CI, -1.65 to -0.03]; p = 0.04), and POD 3 (MD, -0.86 [95% CI, -1.65 to -0.07]; p = 0.03). Cryotherapy group also showed reduced opioid consumption, reduced hemoglobin loss, decreased drainage, and improved ROM after TKA. Continuous cold flow device group had comparable VAS, opioid consumption, blood loss, ROM, knee swelling, and LOS with cold pack group. Cryotherapy can effectively alleviate postoperative pain, reduce blood loss, improve ROM, and thus promote the postoperative rehabilitation for TKA patients, but the continuous cold flow device did not show better efficacy than cold packs. These findings support the routine use of cryotherapy for the rapid rehabilitation of TKA patients, and the traditional cold pack is still recommended.

Aesthetic Surgical Treatment of Large Xanthelasma palpebrarum.

Xanthelasma palpebrarum (XP) is a common eyelid condition. Various treatment modalities exist, each with its own merits and drawbacks. Managing larger lesions poses increased challenges. This study aims to explore the aesthetic surgical management of large xanthelasma palpebrarum. Patients with xanthelasma palpebrarum presenting to our department underwent partial excision of the lesion and debridement of the medullary nucleus under local anesthesia for lesions with a diameter of 6mm or more. Microsurgical scissors were utilized to remove residual subcutaneous lesions. Postoperatively, tie-over bolster dressings were applied. Patients with lipid and glucose abnormalities received corresponding therapy. Bolster dressings were removed on the third postoperative day, with suture removal seven days later. All flaps subjected to subcutaneous medullary debridement exhibited complete viability, with minimal localized eyelid depression early postoperatively and inconspicuous scarring three months post-surgery. No instances of lid ectropion were observed. The eyelid maintained a natural appearance, with a low recurrence rate of xanthelasma palpebrarum. Surgical intervention involving partial excision of the lesion and medullary nucleus debridement offers a satisfactory approach for managing large xanthelasma palpebrarum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Outcomes of HeartMate 3 in pediatric patients with end-stage heart failure: a single-center preliminary experience from Turkey.

We aim to evaluate our initial experience with the HeartMate 3 (HM3) device (Abbott, USA) for palliating pediatric patients with end-stage heart failure (ESHF). We conducted a retrospective review of clinical data from pediatric patients (aged 7-18 years) who underwent HM3 implantation for ESHF at our institution between 2022 and 2024. Patient demographics and follow-up data were comprehensively analyzed. We identified 11 patients (45% males) with a median age of 14 years (IQR 11-17), a median weight of 47 kg (IQR 28-50), a median height of 159 cm (IQR 135-165), and a median body surface area of 1.36 m2 (IQR 1.07-1.53) at the time of the intervention. All patients were diagnosed with dilated cardiomyopathy and categorized with PEDIMACS profiles ranging from one to three. The median ICU stay was 14 days (IQR 6-32), with 11 patients receiving inotropic support for a median of four postoperative days (IQR 3-8). The median follow-up period was 150 days (IQR 90-210). Early complications included two cases of pleural effusion, 1 case of cardiac tamponade, 3 cases of polyuria, and one instance of positive blood cultures. One patient, who was non-compliant with warfarin therapy, developed a thrombus in the right atrium that was resolved with a revision of anticoagulant therapy, and did not experience pump thrombosis. During follow-up, one patient died after 28 days from sepsis, one underwent heart transplantation after 10 days, and nine patients remained alive on the device. Notably, there were no reported cases of pump thrombosis, ischemia, or stroke post- implantation. The HM3 device appears to be a safe and effective palliative option for pediatric patients with ESHF.

Impact of enhanced recovery after surgery (ERAS) on surgical site infection and postoperative recovery outcomes: a retrospective study of 1276 cases

This retrospective observational study aimed to evaluate the incidence of surgical site infection (SSI) in the era of enhanced recovery after surgery (ERAS) and the effect of ERAS on postoperative outcomes. Totally 1,276 patients (565 in ERAS group and 711 in non-ERAS group) who underwent operations at the department of general surgery during 2017–2021 were included. Risk factors were identified via logistic regression analysis and meta-analysis of all relevant published studies was performed. Subsequently, propensity score matching was used to match different risk factors. Overall, 40 patients were diagnosed with SSI, and the pooled incidence of SSI was 3.13%. In total, 14 (2.48%) and 26 (3.66%) patients in the ERAS and non-ERAS groups, respectively, were diagnosed with SSI (P = 0.230). Among patients for whom the ERAS protocol was adopted, 7 independent risk factors of SSI were identified. After propensity score matching, in patients without SSI, the number of hospital days was significantly lower in the ERAS group than in the non-ERAS group (2 [2, 5] vs. 3 [2, 7], P = 0.005), whereas in patients with SSI, the number of hospital days was similar between the ERAS and non-ERAS groups. ERAS had no effect on the incidence of SSI but could significantly accelerate the discharge of uninfected patients. In the era of ERAS, SSI incidence was affected by the type of surgery; number of postoperative hospital days; type of incision; serum hemoglobin, total protein, and albumin levels; and antibiotic prophylaxis. Furthermore, these results will significantly affect the implementation of the ERAS protocol and optimal preoperative management.

Italian survey about intraperitoneal drain use in distal pancreatectomy.

Intraperitoneal prophylactic drain (IPD) use in distal pancreatectomy (DP) is still controversial. A survey was carried out through the Italian community of pancreatic surgeons using institutional emails, Twitter, and Facebook accounts of the Italian Association for the Study of the Pancreas (AISP) and the Italian Association of Hepato-biliary-pancreatic Surgery (AICEP). The survey was structured to learn surgeons' practice in using IPD through questions and one clinical vignette. Respondents were asked to report their regrets for omission and commission regarding the IPD use for the clinical scenario, eliciting a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were built to identify respondents' attitudes. One hundred six surgeons completed the survey. Sixty-three (59.4%) respondents confirmed using at least 1 drain, while 43 (40.6%) placed 2 IPDs. Only 13 respondents (12.3%) declared a change in IPD strategy in patients at high risk of clinically relevant postoperative pancreatic fistula (CR-POPF), while 9 (9.4%) respondents changed their strategy in low-risk POPF situations. Thirty-five (35.5%) respondents declared they would remove the IPD within the third postoperative day (POD) in the absence of CR-POPF suspicion. The median omission regret, which proved to be the wrong decision, was 80 (50-100, IQR). The median regret due to the commission of IPD, which turned out to be useless, was 2.5 (1-20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 7% (1-35, IQR). The threshold to perceive drain omission as the least regrettable choice was higher in female surgeons (P < 0.001), in surgeons who modulated the strategies based on the risk of CR-POPF, and in high volume centers (p = 0.039). The threshold was lower in surgeons who performed minimally invasive distal pancreatectomy (P < 0.001), adopted a closed system (P < 0.001), placed two IPDs (P < 0.001), or perceived the IPD as important to prevent reintervention (p = 0.047). Drain management after DP remains very heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients (7% of CR-POPF), leading to low regret in the case of the wrong decision, making it an acceptable clinical decision.

Effect of transcutaneous electrical acupoint stimulation on postoperative recovery quality in patients undergoing endoscopic sinus surgery: a randomized controlled trial

To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) on postoperative recovery and pain in patients undergoing elective endoscopic sinus surgery. One hundred and six patients scheduled for elective endoscopic sinus surgery were randomly divided into an observation group and a control group, with 53 patients in each group. Patients in both groups received TEAS or sham TEAS, respectively, from 30 min before intravenous anesthesia induction until the end of surgery. Acupoints selected were bilateral Neiguan (PC 6) and Zusanli (ST 36). The quality of requirements-15 (QoR-15) scores were assessed on the day before surgery (T0) and on postoperative days 1 (T1), 2 (T2) and 3 (T3). Pain visual analogue scale (VAS) scores were recorded at T1, T2 and T3. Athens insomnia scale (AIS) scores were measured at T0, T1, T2 and T3 in the two groups. The incidence of postoperative nausea-vomiting and dizziness-headache, usage of analgesics, number of patient-controlled analgesia (PCA) pump presses, and extubating time were also recorded in the two groups. At T1, T2 and T3, the observation group had higher QoR-15 scores (P<0.01, P<0.001) and lower AIS scores (P<0.001) than the control group. At T1 and T2, the observation group had lower pain VAS scores than the control group (P<0.001). The incidence of postoperative nausea-vomiting and dizziness-headache was 24.5% (13/53) and 37.7% (20/53) in the observation group, which were lower than 56.6% (30/53) and 66.0% (35/53) in the control group (P<0.01). There were no statistically significant differences in the use of rescue analgesics or the number of PCA pump presses between the two groups (P>0.05). The extubating time was shorter in the observation group compared with that in the control group (P<0.001). TEAS could improve postoperative recovery quality, alleviate postoperative pain, improve sleep quality, and reduce the incidence of postoperative nausea and vomiting in patients undergoing elective endoscopic sinus surgery.

Changes in Cx43 and AQP4 Proteins, and the Capture of 3 kDa Dextran in Subpial Astrocytes of the Rat Medial Prefrontal Cortex after Both Sham Surgery and Sciatic Nerve Injury.

A subpopulation of astrocytes on the brain's surface, known as subpial astrocytes, constitutes the "glia limitans superficialis" (GLS), which is an interface between the brain parenchyma and the cerebrospinal fluid (CSF) in the subpial space. Changes in connexin-43 (Cx43) and aquaporin-4 (AQP4) proteins in subpial astrocytes were examined in the medial prefrontal cortex at postoperative day 1, 3, 7, 14, and 21 after sham operation and sciatic nerve compression (SNC). In addition, we tested the altered uptake of TRITC-conjugated 3 kDa dextran by reactive subpial astrocytes. Cellular immunofluorescence (IF) detection and image analysis were used to examine changes in Cx43 and AQP4 protein levels, as well as TRITC-conjugated 3 kDa dextran, in subpial astrocytes. The intensity of Cx43-IF was significantly increased, but AQP4-IF decreased in subpial astrocytes of sham- and SNC-operated rats during all survival periods compared to naïve controls. Similarly, the uptake of 3 kDa dextran in the GLS was reduced following both sham and SNC operations. The results suggest that both sciatic nerve injury and peripheral tissue injury alone can induce changes in subpial astrocytes related to the spread of their reactivity across the cortical surface mediated by increased amounts of gap junctions. At the same time, water transport and solute uptake were impaired in subpial astrocytes.

Higher erythrocytes in cerebrospinal fluid on the first and seventh postoperative day: Associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

Aneurysmal subarachnoid hemorrhage is an acute cerebrovascular disease with high disability and mortality. We intended to explore the association between levels of erythrocytes in cerebrospinal fluid at different times of hemorrhage and the outcome of patients. One retrospective study including 216 patients with aneurysmal subarachnoid hemorrhage undergoing surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to July 2023 was carried. The univariable analysis and multivariable logistic regression analysis were used for factors associated with poor outcome. The level of erythrocytes in cerebrospinal fluid on the 1st postoperative day in patients with poor outcome was 311 × 103/µL, significantly higher than patients with good outcome (108 × 103/µL), P < .001. The level of erythrocytes in cerebrospinal fluid on 7th postoperative day was 86.5 × 103/µL, also significantly higher than patients with good outcome (26.0 × 103/µL). The multivariable logistic regression analysis results showed that erythrocytes in cerebrospinal fluid on the 1st postoperative day (≥177 × 103/µL) and on the 7th postoperative day (≥53.5 × 103/µL) were possibly associated with poor outcome in aneurysmal subarachnoid hemorrhage patients. Treatment with tranexamic acid and continuous lumbar drainage did not result in a decrease of erythrocytes in cerebrospinal fluid. Higher erythrocytes in cerebrospinal fluid on the 1st and 7th postoperative days were associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

Rare huge bilateral adrenal myelolipoma confused with retroperitoneal liposarcoma

IntroductionAdrenal myelolipomas are uncommon benign adrenal tumors, which mostly occur unilaterally. We describe a rare case of giant bilateral adrenal myelolipoma mistaken for retroperitoneal liposarcoma.Case presentationA 49‐year‐old man developed fever, left flank pain, and a large mass in his left abdomen. Plain computed tomography showed a 23‐cm mass with fat‐containing components in the retroperitoneal cavity, suggestive of retroperitoneal liposarcoma. A similar 9‐cm mass was observed in the right adrenal gland, suggesting adrenal metastasis. With a clinical diagnosis of retroperitoneal liposarcoma, we administered preoperative radiation therapy and performed a bilateral tumor resection. On postoperative day 9, a surgical site infection occurred, necessitating incisional drainage and the administration of intravenous antibiotics. The histopathological diagnosis was bilateral myelolipoma of the adrenal glands.ConclusionIn cases of bilateral retroperitoneal tumors with a large fat component, adrenal myelolipoma should be considered in the differential diagnosis to avoid overtreatment.

The association between early postoperative food intake and postoperative hospital length of stay in patients undergoing cardiac surgery: A retrospective observational single-center study

Background & AimsPerioperative nutritional status is critical during the postoperative recovery process in patients undergoing cardiac surgery. Several studies on patients undergoing cardiac surgery have reported low energy intake in early postoperative food intake via oral nutrition; however, no study has shown an association of low energy intake with postoperative hospital length of stay (LOS). This study aimed to determine whether early postoperative low food intake was associated with prolonged postoperative hospital LOS in patients undergoing cardiac surgery. MethodsThis was a retrospective, observational, single-center study conducted in patients aged ≥18 years undergoing elective cardiac surgery from January 1, 2020, to May 31, 2023. Patients were categorized by food intake as food intake < 50% (low food intake group) and ≥ 50% (adequate food intake group) at lunch on postoperative day (POD) 3. The primary outcome of this study was the postoperative hospital LOS. A generalized linear model was used to examine the association between food intake and postoperative hospital LOS using the following explanatory variables: age, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, preoperative risk of malnutrition, activities of daily living status, Sequential Organ Failure Assessment score, and C-reactive protein level. ResultsOf the 315 patients, 104 (33.0%) had a food intake of <50% on POD3. There were no significant differences in age, sex, EuroSCORE II value, and comorbidities between the two groups. Patients in the low-food intake group had a significantly lower Barthel Index (6.7% vs. 1.4%, p = 0.017) and a higher malnutrition risk according to the Mini Nutritional Assessment Short Form score (40.4% vs. 28.2%, p = 0.043). Food intake of <50% on POD3 was associated with prolonged postoperative hospital LOS (β = 1.135 [95% confidence interval: 1.004–1.262], p = 0.018). ConclusionsLow food intake on POD3 is associated with prolonged postoperative hospital LOS in patients undergoing elective cardiac surgery. Early postoperative food intake should be closely monitored in patients after elective cardiac surgery.

Late-onset chylothorax after lung cancer surgery: clinical characteristics, management, and prevention.

The clinical characteristics and management of late-onset chylothorax after lung cancer surgery remained unknown. Here we aimed to provide evidence on the management of late-onset chylothorax by analysis of several cases with the largest sample size. We retrospectively collected clinical data of patients who developed late-onset chylothorax after lung cancer surgery and were re-admitted by a single surgeon in our center from 2016 to 2022. The clinical characteristics and management for these patients were analysed. The role of Hem-o-lok clipping after lymphadenectomy in preventing late-onset chylothorax was further explored by comparing the surgical outcomes between treated group and control group. A total of six patients who were re-admitted for late-onset chylothorax after lung cancer surgery were included for analysis. The mean age of them was 60.7 years old. The symptom of late-onset chylothorax was mainly dyspnea and cough and the diagnosis was all made by Sudan III staining between postoperative day 17 to 42. All patients were firstly treated with thoracocentesis and low-fat diet with intravenous nutrition. Four patients were successfully managed with low-fat diet and thoracocentesis, while the other two patients were further managed with pleurodesis with 50% glucose fluid solution. We found a significantly decreased risk of late-onset chylothorax in the treated group with improved procedure of applying Hem-o-lok clipping after lymphadenectomy than in the control group (0% versus 2.6%, P < 0.01). Late-onset chylothorax after lung cancer surgery was a rare and negligible complication, which may usually be managed by non-surgical methods. Hem-o-lok clipping during lymphadenectomy seemed to be an effective method to prevent late-onset chylothorax after lung cancer surgery.

Del Nido versus conventional blood cardioplegia in patients with combined aortic root surgery: A retrospective study.

This study aimed to compare the safety and efficacy of Del Nido cardioplegia (DNC) and conventional blood cardioplegia (CBC) in combined aortic surgery. This retrospective study involved elective patients who underwent combined aortic root surgery between September 2017 and July 2023. Patients were divided into two groups: the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I and creatine kinase-MB levels at the 0, 1, 2, and three postoperative days. The secondary outcomes contained postoperative left ventricular ejection fraction, return to spontaneous rhythm after aortic de-clamping, postoperative myocardial infarction, new-onset atrial fibrillation, postoperative mechanical circulatory support, mechanical ventilation duration, intensive care unit stay, postoperative hospital stay, and the reduction of left ventricle end-diastolic diameter at 3months after surgery. 223 patients were included and divided into the CBC (n = 111) and the DNC group (n = 112). There was no statistical difference in patients' demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [35.25 (30.30,43.65) ml/kg versus 21.43 (18.42,25.62) ml/kg, p < 0.001] and infusion times [2 (2,3) times versus 1 (1,2) times, p < 0.001] were less and the incidence of return to spontaneous rhythm after de-clamping was higher in the DNC group [59.5% versus 83%, p < 0.001]. Postoperative high-sensitivity cardiac troponin I and creatine kinase-MB levels were comparable between the two groups. DNC is related to a shorter duration of mechanical ventilation, intensive care unit stay, and hospital stay than CBC. The rate of return to spontaneous rhythm after aortic de-clamping seemed to decrease with the prolongation of aortic cross-clamping (ACC) duration, and there was no difference between the two groups when the time exceeded 120min. The safety and efficacy of using DNC were comparable to CBC in combined aortic surgery. The rate of return to spontaneous rhythm after aortic de-clamping seemed to decrease with the prolongation of ACC time. Further studies may be needed to fully elucidate the advantages of DNC in postoperative recovery and its long-term effects on patient outcomes.

Effect of dexmedetomidine on postoperative high-sensitivity cardiac troponin T in patients undergoing video-assisted thoracoscopic surgery: a prospective, randomised controlled trial

BackgroundOne-lung ventilation and intrathoracic operations during thoracoscopic surgery often result in intraoperative hypoxaemia and haemodynamic fluctuations, resulting in perioperative myocardial injury. Dexmedetomidine, an alpha-2 (α-2) agonist, has demonstrated myocardial protection. We hypothesize that the routine intravenous administration of dexmedetomidine could reduce the extent of myocardial injury during video-assisted thoracoscopic surgery (VATS).MethodsThe study included patients aged ≥ 45 years, classified as American Society of Anesthesiologists physical status I-III, who underwent general anesthesia for video-assisted thoracoscopic surgery. The patients were randomly assigned to either the intervention group, receiving general anesthesia with dexmedetomidine, or the control group, receiving general anesthesia without dexmedetomidine. Patients in the intervention group received a loading dose of dexmedetomidine (0.5 µg·kg−1) before anesthesia induction, followed by a continuous infusion (0.5 µg·kg−1·h−1) until the completion of the surgery. Placebos (saline) were administered for the control group to match the treatment. The primary outcome assessed was the high-sensitivity cardiac troponin T on postoperative day 1. Additionally, the incidence of myocardial injury after noncardiac surgery (MINS) was noted.ResultsA total of 110 participants completed this study. The median [interquartile range (IQR)] concentration of hs-cTnT on postoperative day 1 was lower in the intervention group compared with the control group (7 [6-9] vs. 8 [7-11] pg·ml−1; difference in medians,1 pg·ml−1; 95% confidence interval [CI], 0 to 2; P = 0.005). Similarly, on postoperative day 3, the median [IQR] concentration of hs-cTnT in the intervention group was also lower than that in the control group (6 [5-7] vs. 7 [6-9]; difference in medians,1 pg·ml−1; 95%CI, 0 to 2; P = 0.011). Although the incidence of MINS was not statistically significant (the intervention group vs. the control group, 3.8% vs. 9.1%, P = 0.465), there was a decreasing trend in the incidence of MINS in the intervention group.ConclusionThe administration of perioperative dexmedetomidine in patients ≥ 45 years undergoing video-assisted thoracoscopic surgery could lower the release of postoperative hs-cTnT without reducing incidence of myocardial injury.Trial registrationchictr.org.cn (ChiCTR2200063193); prospectively registered 1 September 2022.

Methylprednisolone for acute type A aortic dissection patients undergoing total arch replacement: Design and rationale of the Medal trial: Short title Study protocol of the Medal trial

BackgroundThe mortality and morbidity of emergency total aortic arch replacement (TAAR) for acute type A aortic dissection (ATAAD) is high, which is partly due to the excessively activated systemic inflammatory response. Methylprednisolone, an anti-inflammatory agent, might suppress the systemic inflammatory response and lead to improved outcomes. However, the protective effects of methylprednisolone on TAAR for ATAAD were not clarified. The usage and dosage varied in different centers across the world. Methods and resultsThe Medal trial is a prospective, multicenter, randomized, double-blind, placebo-controlled, parallel-group trial to evaluate whether 500 mg methylprednisolone IV before cardiopulmonary bypass could reduce the incidence of postoperative major organ injury, compared to placebo. Adult patients with the diagnosis with ATAAD, awaiting emergency total aortic arch replacement with hypothermic circulatory arrest and selective cerebral perfusion will be included in the trial. A total of 340 eligible subjects from nine large cardiovascular centers will be randomized in a 1:1 ratio to recieve 500mg methylprednislone or placebo before cardiopulmonary bypass. The primary outcome is postoperative major adverse outcome [defined as all-cause death or postoperative neurological deficit or KDIGO II -III acute kidney injury or respiratory syndrome (tracheal intubation> 72 hours, tracheostomy or re-intubation) until postoperative day 30 or patient discharge]. The study has received approval from the local Ethics Committees of the nine participating centers, and enrolled its first subject in June 24, 2022. As of September 5,2024, 323 subjects have been enrolled. Results of the Medal trial will be published once data collection and analysis have been completed. ConclusionsThe Medal trial will determine the effectiveness of 500 mg methylprednisolone on the outcomes of patients with ATAAD undergoing TAAR. RegistrationURL https://www.chictr.org.cn/searchprojEN.html (Chinese Clinical Trial Registry). Unique identifier: ChiCTR2200059286

DIFFUSE PUNCTATE DEPOSITS ON THE SURFACE OF HYDROPHILIC ACRYLIC INTRAOCULAR LENSES EARLY POSTOPERATIVELY: CASE SERIES AND LABORATORIAL ANALYSES

Purpose: To describe cases of hydrophilic acrylic intraocular lenses (IOLs) (Eyecryl, Biotech) exhibiting surface punctate deposits early postoperatively, and provide laboratorial analyses of unused lenses of the same model. Setting: Altino Ventura Foundation (FAV), Recife, Brazil, and John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Design: Observational, descriptive, clinical study with laboratorial analysis. Methods: A thorough review of records of patients undergoing phacoemulsification with Eyecryl implantation in December 2022 at FAV was performed, with data collection. Five Eyecryl IOLs (never implanted/unused) were removed from the original package and underwent gross examination, light microscopy, and ultrastructural analyses using scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS). Results: Details on 5 clinical cases exhibiting surface IOL deposits on the first postoperative day after uneventful surgery, and followed for at least 6 months were included. The deposits disappeared by the 60th postoperative day. No inflammatory or toxic reactions were noted, visual outcomes were favorable, and IOL explantation was not necessary. Three of the 5 unused lenses undergoing laboratorial analyses revealed diffuse, star-like shaped deposits that could not be removed by thorough irrigation with distilled water. SEM/EDS revealed a composition of the deposits that primarily consisted of carbon and oxygen. Conclusion: Laboratorial findings suggest the etiology of the deposits might be related to the manufacturing/packaging process of lenses from specific lots. While the deposits did not appear to be associated with inflammatory or toxic reactions in the clinical cases, further investigations are necessary to elucidate their precise origin.

Implementation of music in the perioperative standard care of colorectal surgery (IMPROVE study).

Patients undergoing surgery experience perioperative anxiety and pain. Music has been shown to reduce perioperative anxiety, pain and medication requirement. This study assessed the feasibility and effectiveness of implementing a perioperative music intervention. A prospective pre- and post-implementation pilot study was conducted to assess adherence to the intervention and the initial effect of music on postoperative pain scores (Numerical Rating Scale, 0-10) compared to a control group. Secondary outcomes encompassed pain scores throughout hospital admission, anxiety levels, medication usage, complications and hospital stay length. Adherence to the music intervention was preoperative 95.2%, intraoperative 95.7%, postoperative 31.9% and overall 29.7%. The intervention did influence postoperative pain. Patient's willingness to receive music was high (73%), they appreciated the intervention (median 8.0, interquartile range 7.0-9.0) and healthcare professionals were willing to apply the intervention. Music significantly reduced postoperative anxiety (2.0 vs. 3.0, p = 0.02) and the consumption of benzodiazepines on the first postoperative day (number of patients: zero [0%] vs. five [10%], p = 0.04). Implementation of music resulted in reduced postoperative anxiety and decreased consumption of benzodiazepines, and the strategy was feasible, but adjustments are needed to improve postoperative adherence. Both patients and healthcare professionals had a positive attitude towards the intervention.

Postoperative recovery in peroral versus intravenous antibiotic treatment following laparoscopic appendectomy for complicated appendicitis: a substudy of a cluster randomized cluster crossover non-inferiority study.

Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis. This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire. The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications. Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles. ClinicalTrials.gov NCT04803422.

Three-dimensional Morphometric Analysis of the Effectiveness of Kinesio Taping on Postoperative Discomfort Following Mandibular Third Molar Surgery: A Prospective Randomized Split-mouth Study

This study investigates the efficacy of Kinesio taping (KT) in reducing postoperative discomfort, including edema, trismus, and pain, following mandibular third molar extraction. A prospective randomized split-mouth design was employed, involving 7 patients with impacted mandibular third molars. KT was applied immediately postsurgery, and outcomes were assessed on the third and seventh postoperative days using a Visual Analog Scale (VAS) for pain, 3D morphometric analysis for swelling, and caliper measurements for trismus. Results showed significant reductions in pain, swelling, and trismus on the KT-treated side compared with the control side. The most notable differences were observed on day 7, where KT demonstrated superior effectiveness in alleviating symptoms. The control group showed improvement over time, but the KT-treated group experienced faster and more pronounced recovery. In conclusion, KT proved to be a safe and effective method for improving postoperative recovery following mandibular third molar surgery, offering a low-cost, accessible option to enhance patient comfort and quality of life.

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study.

We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level. The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL. From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%). We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

Clinical Significance of Grade A Small-for-size Syndrome After Living Donor Liver Transplantation Utilizing the New Definition of Diagnostic Criteria: An International Multicenter Study.

New diagnostic criteria have recently been established to classify small-for-size syndrome (SFSS) after living donor liver transplantation into 3 groups based on severity. This study aimed to evaluate the clinical impact of grade A SFSS and identify the mortality risk. We collected data from 406 patients diagnosed with grade A SFSS after living donor liver transplantation. Grade A SFSS is characterized by total bilirubin >5 mg/dL on postoperative day (POD) 7 or total bilirubin >5 mg/dL or ascites >1 L/d on POD 14. After propensity score matching, 193 patients were categorized into the up-trend group, down-trend group, and ascites group, with 43 patients (22.3%) in the up-trend group (total bilirubin on POD 7 < POD 14), 107 patients (55.4%) in the down-trend group (total bilirubin on POD 7 > POD 14), and 43 patients (22.3%) in the ascites group (only satisfying ascites criteria). There was no significant difference in survival between patients with grade A SFSS and those without SFSS (P = 0.152). The up-trend group showed a higher 90-d mortality rate than the down-trend and ascites groups (P = 0.025). The 1-y survival rate differed significantly between the groups (87.6%, 91.9%, and 97.7%, respectively; P = 0.044). The independent risk factors for survival were up-trend of total bilirubin, recipient age (65 y and older), model for end-stage liver disease score (≥30), and ABO incompatibility. Patients with ≥2 risk factors had worse survival rates than those with none and only 1 risk factor (P < 0.001). Although the survival rate was comparable between the grade A SFSS and non-SFSS cohorts, the up-trend group showed worse survival. Aggressive interventions should be considered for up-trend patients with risk factors.