Postoperative Instructions Research Articles

Impact of Illustrated Postoperative Instructions on Knowledge and Retention During a Cleft Lip and Palate Surgical Mission.

To determine the impact of illustrated postoperative instructions on patient-caregiver knowledge and retention. Prospective study with all participants receiving an educational intervention. Pediatric plastic surgical missions in Guatemala City, Guatemala, between 2019 and 2020. A total of 63 majority-indigenous Guatemalan caregivers of patients receiving cleft lip and/or palate surgery. Illustrated culturally appropriate postoperative care instructions were iteratively developed and given to caregivers who were surveyed on illustration-based and text-based information at preoperative, postoperative, and four-week follow-up time points. Postoperative care knowledge of illustration-based versus text-based information as determined by the ability to answer 11 illustration- and 8 text-based all-or-nothing questions, as well as retention of knowledge as determined by the same survey given at four weeks follow-up. Scores for illustration-based and text-based information both significantly increased after caregivers received the postoperative instructions (+13.30 ± 3.78 % SE, + 11.26 ± 4.81 % SE; P < .05). At follow-up, scores were unchanged for illustration-based (-3.42 ± 4.49 % SE, P > .05), but significantly lower for text-based information (-28.46 ± 6.09 % SE, P < .01). Retention of text-based information at follow-up correlated positively with education level and Spanish literacy, but not for illustration-based. In the setting of language and cultural barriers on a surgical mission, understanding of illustration-based and text-based information both increased after verbal explanation of illustrated postoperative instructions. Illustration-based information was more likely to be retained by patient caregivers after four weeks than text-based information, the latter of which correlated with increased education and literacy.

Patient-Specific E-mailed Discharge Instructions Improve Patient Satisfaction and Patient Understanding After Surgical Arthroscopy

PurposeThe purpose of this study is to determine whether patient-specific e-mails after surgical arthroscopy improve patient satisfaction and patient understanding of their procedure compared to traditional, preprinted discharge instructions.MethodsSixty patients who underwent surgical arthroscopy were prospectively, randomized into two separate groups. One cohort received a detailed e-mail of their procedure, discharge instructions, and labeled intraoperative arthroscopic images, while the second cohort received the standard preprinted instructions, while their arthroscopic images were discussed at the time of follow-up. The procedures were performed by a single surgeon. All patients were seen at 1-week follow-up and given a 14-question survey specific to their postoperative course, discharge instructions, and overall satisfaction using a 5-point Likert Scale. Demographic information was collected and data points comparing overall patient satisfaction, ease of understanding instructions, quality of information, and the number of times referenced were analyzed using nonparametric tests between the two cohorts.ResultsPatients in the e-mail cohort were significantly more satisfied with their surgery than patients in the printed cohort (medians: 5 versus 4, Wilcoxon chi-square = 9.98; P =.002). Patients in the e-mail cohort indicated that their instructions more greatly enhanced their overall understanding of their surgery (medians: 5 vs 3, Wilcoxon chi-square = 10.84; P = .001) and were more helpful to their recovery (medians: 5 vs 3, Wilcoxon chi-square = 7.37; P = .007). E-mail patients were significantly more likely to recommend similar instructions be sent to a friend undergoing surgery (medians: 5 versus 3, Wilcoxon chi-square = 11.10; P < .001) and share their instructions with others 72% (18/25) versus 34.5% (10/29). There was no significant difference between the e-mail cohort and the print cohort for the number of times patients referred to their instructions (medians: 3 versus 3, Wilcoxon chi-square = 2.41; P =.121).ConclusionsPatient-specific e-mailed discharge instructions improve patient satisfaction and overall understanding of the procedure compared with traditional printed discharge instructions after surgical arthroscopy.Level of EvidenceLevel II, prospective randomized trial.

Post-Hospitalization Problems and Nursing Care Needs of Patients who Underwent Thoracolumbar Spine Surgery

Introduction Thoracolumbar spine surgery is performed to relieve symptoms like radicular pain and numbness caused by conditions such as disc herniation, lumbar canal stenosis, and spondylolisthesis. Objective: To explore the problems experienced and nursing care needs of patients during home care after thoracolumbar spine surgery. Methods An exploratory study was conducted among 50 patients who underwent thoracolumbar spine surgery in Neurosurgery units, PGIMER, Chandigarh, from July 2018 to September 2020. The problems and nursing care needs were assessed by interviewing the participants telephonically, using an interview schedule comprising of (a) patient profile, (b) clinical variables, and (c) questionnaires to assess physical, psychological, functional, and other problems after discharge. Descriptive statistics (mean, frequency, and percentage) were applied to analyze the data. Results The patients experienced physical problems such as pain, numbness in lower limbs, weakness in limbs, and loss of bladder after discharge. The psychological problems that patients faced were early awakening, sleeplessness, worry about physical dependence on others, stress regarding the family’s role responsibility, and anxiety to return to the job. The common functional issues were difficulty in bathing, difficulty in ambulation, dependence in toileting, and the need for assistance in grooming. Furthermore, other problems perceived by patients were difficulty regarding follow-up in OPD, difficulty in understanding postoperative exercises, lack of understanding of postoperative instructions, and difficulty in carrying out wound dressing. Conclusion The findings of the study provide preliminary evidence that patients experience physical, psychological, and functional problems during their home care after thoracolumbar spine surgery. Hence, it is vital to develop strategies to address the issues by developing need-based nursing care guidelines.

Patient's performance program about self-care after craniotomy surgery

Background: craniotomy surgery is a terrible experience for patients and their families. Patients' worries regarding daily living activities prior surgery and after discharge are the most prevalent. Nurses assess and educate patients on their abilities to undertake self-care after release from the hospital, but they frequently express worry about what they may face at home. Patients got instructions from surgeons and nurses in our setting, but there was no one discharge document that served as a rapid and thorough reference. Precision postoperative instructions for patients to employ at home are crucial to their health. Aims: To evaluate the impact of an instructional program on patient's performance about self-care after craniotomy surgery. To find out the association between impact of an instructional program on patient's performance about self-care after craniotomy surgery and demographic data of patients. Subjects and methods: A pre-experimental design (one group pre-test/ post-test design) is applied has been done to obtain the study goals. Forty-four patients had craniotomy surgery selecting by non-probability sample (convenience) sampling. Their age ranged from (20-60 or more) years old, fully conscious after operation. One group that gives instructional program. Using a valid and reliable questionnaire, data was collected.

EDITORIAL COMMENT

Health literacy has been increasingly identified as a significant contributor to health-related outcomes. Increasing attention has been drawn to its impact on healthcare utilization, complication rates, all-cause mortality, and patient satisfaction. 1 Roy M Corkum JP Urbach DR et al. Health literacy among surgical patients: a systematic review and meta-analysis. World J Surg. 2019; 43 (PMID: 30105637): 96-106https://doi.org/10.1007/s00268-018-4754-z Crossref PubMed Scopus (12) Google Scholar Despite the profound impact on health outcomes, the effects of health literacy on the surgical population remains an understudied topic, with only a few urologic studies published to date. 2 Chang ME Baker SJ Dos Santos Marques IC et al. Health literacy in surgery. Health Lit Res Pract. 2020; 4 (PMID: 32053207; PMCID: PMC7015264): e46-e65https://doi.org/10.3928/24748307-20191121-01 Crossref PubMed Scopus (21) Google Scholar ,3 Jamieson SC Mallory CW Jivanji DR et al. The role of health literacy in prostate cancer screening. Urology. 2021; (S0090-4295(21)00735-4Epub ahead of print. PMID: 34375651)https://doi.org/10.1016/j.urology.2021.05.100 Abstract Full Text Full Text PDF Scopus (1) Google Scholar Elucidating the impact of health literacy among surgical patients is paramount as patients navigate complex decision-making, including understanding the risks and benefits of surgical interventions, and adherence to perioperative and post-operative instructions.

Frequency of dry socket among patients undergoing dental extraction presenting to Ayub Teaching Hospital

BACKGROUND &amp; OBJECTIVE: Tooth extraction is the most common procedure performed at the dental office. A very well recognized and recurrent post tooth extraction complication that dental surgeons face is Dry Socket (DO) also introduced as alveolar osteitis, localized osteitis, or simply alveolitis. The objective of this study is to ascertain the frequency of dry socket among patients undergoing dental extraction at Ayub Teaching Hospital.&#x0D; METHODOLOGY: This descriptive cross-sectional study was performed in the department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad for six months. A sample size of 203 patients was predetermined using WHO a calculator. Patients of either gender from 18 to 65 years were selected. Following the standard extraction technique, detailed postoperative instructions were given. The patients were educated about the symptoms of dry socket and were requested to report immediately if he/she felt any of the said symptoms. Those patients that reported dry socket, were identified, and their data was noted on structured proforma. Statistical Package for Social sciences (SPSS) version 21 was used to analyze the data obtained.&#x0D; RESULTS: The Mean age recorded in present study was 35±12.00. Gender distribution showed that 155 (76.35%) patients were male and 48 (23.64%) patients were female. Mean number of days elapsed for dry socket was 5+0.57 Frequency of dry socket recorded was 12 (05.91%) patients.&#x0D; CONLCUSION: In this study, the results collected were found to be statistically insignificant on the accounts of trends such as female preponderance and dry socket distribution posteriorly in the mandible. Our study was in accordance with the studies in literature.

Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients—study protocol for a randomized controlled trial

BackgroundSuccessful pain management after outpatient surgery requires proper education leading to correct decisions on the analgesics use at home. Despite different strategies adopted, up to ½ of patients receive little or no information about the treatment of postoperative pain, 1/3 of them are not able to follow postoperative analgesia instructions. This leads to higher rates of unmet needs in pain treatment, post-discharge emergency calls, and readmissions. Structured educational interventions using psychological empowering techniques may improve postoperative pain management. We hypothesize that preoperative education on use of an improved pain scale to make correct pain management decisions will improve the quality of post-operative pain management at home and reduce analgesics-related side effects.MethodsA total of 414 patients scheduled for an outpatient orthopedic surgery (knee/shoulder arthroscopic interventions) are included in this randomized (1:1) controlled trial. Patients in the control arm receive standard information on post-discharge pain management. Patients in the experimental arm receive structured educational intervention based on the rational perception of postoperative pain and discomfort (anchoring and improved pain scale), and the proper use of analgesics. There is no difference in post-discharge analgesics regimen in both arms. Patients are followed for 30 days post-discharge, with the primary outcome expressed as total pain relief score at 5 days. Secondary outcomes include the incidence of severe pain during 30 days, changes in sleep quality (Pittsburg Sleep Quality Assessment), and patients’ perception of postoperative pain management assessed with the International Pain Outcomes questionnaire at day 30 post-discharge.DiscussionThe developed intervention, based on an improved pain scale, offers the advantages of being non-surgery-specific, is easily administered in a short amount of time, and can be delivered individually or in-group, by physicians or nurses.Trial registrationClinicalTrials.govNCT03754699. Registered on November 27, 2018.

The Flexible Care Pathway: An Alternative Paradigm for Post-Operative Care

IntroductionTelehealth has demonstrated reduced cost and increased satisfaction post-operatively compared to Conventional Follow-up (CFU). However, a Flexible Care Pathway (FCP), which involves only “as-needed” follow-up, has never been formally evaluated. We hypothesize that the FCP is a safe and satisfactory for patients who undergo carpal (CTR)/ cubital tunnel release (CuTR).Materials and MethodsPreoperatively, veterans were given the option to enroll in the FCP, in which post-operative follow-up visits were “as-needed” only. Patients who chose CFU were evaluated within 2 weeks post-operatively. Preoperatively, detailed post-operative instructions were given to both groups. Both groups were contacted by phone 30 days post-operatively with a questionnaire. The main outcomes were the number of FCP to CFU conversions, complications, time and distance of patient travel, and patient satisfaction.Results105 patients were enrolled in the study, 60.2% chose FCP. One quarter (23.7%) of patients in the FCP group returned for in-person clinic evaluation. On average, the CFU group travelled a roundtrip distance of 102.9 miles and expended 3.51 h for their follow-up visits. CFU patients ranked their satisfaction at an average of 8.6/10, FCP patients ranked an average of 9.5/10 (p < 0.05).ConclusionsThe FCP can be used in ambulatory hand surgeries with a high degree of safety and satisfaction, studied up to 30 days post-operatively. The FCP demonstrated higher patient satisfaction and a decrease in patient travel than CFU. This is particularly relevant in geographically broad areas, in populations with less access to specialty care, and in a pandemic where contact is limited.Supplementary informationThe online version contains supplementary material available at 10.1007/s10916-022-01824-0.

How Much Opioid Medication Do Patients Need After Orthognathic Surgery?

Opioid misuse is a public health crisis. It is incumbent upon surgeons to understand analgesic requirements for operations they perform to inform responsible prescribing practices. The purpose of this study was to quantify opioid use following orthognathic surgery. This is a prospective cohort study including consecutive patients that had orthognathic surgery at the Boston Children's Hospital from May 2020 to September 2021. To be included, subjects had to have had a Le Fort I osteotomy, bilateral sagittal split osteotomies, or both. Subjects were excluded if they had a craniofacial syndrome (not including cleft lip and palate) or did not complete the study. Postoperative prescriptions and instructions were standardized. The primary outcome variable was total postoperative opioid use (inpatient+outpatient). Inpatient opioid delivery was recorded from the electronic medical record. Outpatient opioid use was ascertained via electronic questionnaire each day for 7 postoperative days. Descriptive and analytic statistics were calculated. Thirty-five subjects (54% male, age 18.7±2.7years) were included. Thirty-two subjects (91%) used postoperative opioid analgesia as inpatients, outpatient, or both, with mean total use of 18.2±20.9 morphine milligram equivalents/subject (equivalent to 7.3±8.4 oral oxycodone 5-mg doses). Nine (26%) subjects received inpatient opioid but did not use any oral opioid after discharge. As outpatients, a mean of 3.9±5.5 oral oxycodone 5-mg dose was used per patient over 2.1±2.1 postoperative days. Le Fort I osteotomy-only procedures had significantly lower (P=.032) and combined Le Fort I osteotomy and bilateral sagittal split osteotomy operations had significantly higher (P=.003) opioid requirements than the mean. Length of procedure and hospital length of stay were significant predictors of analgesic need, with an increase of 0.34 oxycodone doses/subject for each 10-minute increase in procedure time and 0.20 oxycodone doses/subject for each 1-hour increase in length of stay. Pain level on the first postoperative day was also a predictor of total opioid use (P<.050). Opioid use after orthognathic surgery is less than expected. Caution is necessary to avoid overprescribing.

Children’s general anaesthesia – parental preferences and information needs

Introduction The aim of this mixed methods study was to provide insight into the information needs of parents whose child received dental treatment under general anaesthesia. Methods The parents of 102 out of 113 children attending their dental general anaesthesia (DGA) appointment completed an interviewer-led questionnaire. Forty of these parents were followed up by telephone at least one week after their child’s DGA. Results The research revealed new insights into unmet information needs from the parents’ perspective (eg needing more information relating to food, ward waiting times, clothing, parking and regular medications) as well as identifying a need for more child centred resources. Parental preferences on the format of information delivery (eg via a mobile phone app, website or email) and timing of information delivery (eg giving pre and postoperative instructions at the assessment appointment) were also identified. Conclusions Seeking the views of parents highlighted the gap between clinicians’ perceptions of families’ DGA information needs and their actual need. The findings from this study will have implications for improving DGA information resources for both parents and children.

Effect of dexamethasone on postoperative swelling in patients undergoing impacted molar surgery

Background: The present study was undertaken for comparing the therapeutic effects of Dexamethasone administered intramuscularly pre-operatively vs. post operatively after the surgical extraction of impacted mandibular third molars. Materials and methods: A total of 40 participants were enrolled. Complete demographic and clinical details of all the patients were obtained. Clinical examination was carried out of all the subjects. Only those patients were enrolled which were scheduled to undergo impacted third molar extraction. All the subjects were randomly divided into two study groups with 20 participants in each group as follows: Group A: Administration of intramuscular Dexamethasone pre-operatively. Group B: Administration of intramuscular Dexamethasone post-operatively. All the surgical procedures were carried under the hands of skilled and experienced oral surgeons. Routine post-operative home care instruction was given to all the patients along with antibiotic coverage. Patients were recalled on the 7th day and sutures were removed. Clinical examination was done. Data was analyzed by using SPSS software. Results: Mean swelling among patients of group A at immediate postoperative period, postoperative 1st day, postoperative 3rd day and postoperative 7th day was 13.1 cm, 12.5 cm, 12.9 cm and 11.5 cm respectively. Mean swelling among patients of group B at immediate postoperative period, postoperative 1st day, postoperative 3rd day and postoperative 7th day was 13.5 cm, 14.8 cm, 15.1 cm and 11.3 cm respectively. Statistically significant difference was obtained while comparing the mean postoperative swelling among patients of group A and group B. Conclusion: Better post-operative therapeutic effects are achieved by pre-operative administration of intramuscular injection of dexamethasone as compared to post-surgical administration in impacted third molar surgeries.

Effect of honey dressing material on palatal wound healing after harvesting a free gingival graft: a prospective randomized case control study.

The aim of this prospective randomized case-control study was to understand the clinical benefits and effect of honey as a dressing material on palatal wound healing after harvesting free gingival graft (FGG). This prospective randomized case-control study was conducted on a sample of 20 patients with 10 patients in each group. Medihoney dressing material was applied to the donor site in the test group, whereas no dressing material was applied to the control group. All the patients received the same medication (Ibuprofen 600 mg) and post-operative instructions straight away after the surgical procedure. Patients were given the follow-up appointment at first, second and fourth week after the surgery during which the length and the width of the donor site was measured and recorded. At first week, a significant difference in the proportion of patients showing the healing of donor site percentage was found to be 56% (both in width and length) for test group vs. 44% (both in width and length) for the control group (p=0.001). At 4-week, the healing of donor site percentage was found to be 86% (in width) and 91% (in length) for test group vs. 14% (in width) and 9% (in length) for the control group, the difference being statistically significant (p=0.001). The result of this current study suggests that the honey dressing material accelerated the wound healing process of the palatal wound after harvesting FGG. It also showed a shorter recovery period along with less post-operative morbidity.

Tulane STAR (Sending Texts, Advancing Results): impact of text messaging on bariatric post-operative protocol compliance.

BackgroundText messaging is frequently employed in the outpatient setting to communicate with or send reminders to patients. However, there is a paucity of literature on the impact of text messaging on inpatient care. In this study, the use of text messaging in hospitalized patients is evaluated by assessing patient compliance to a post-operative bariatric protocol.MethodsThis was a randomized controlled trial that studied compliance to a post-operative bariatric protocol in patients who underwent bariatric surgery at a tertiary, academic medical center between February and May 2021. Patients were randomized to either the control group, in which they received standard post-operative education alone or the Tulane Sending Texts, Advancing Results (STAR) intervention arm, in which participants received the same post-operative education along with two text message reminders to drink water, use their incentive spirometers, and ambulate (per post-operative instructions) on post-operative day (POD) # 0 and POD # 1. The primary outcome was compliance with the protocol, defined as the number of 1-oz cups of water consumed, incentive spirometry usage, and ambulation frequency and distance. Secondary outcomes include length of stay and complications.ResultsA total of 35 patients were enrolled in the study (17 control, 18 STAR intervention). There was no significant difference in age, BMI, or type of surgery performed between the two groups. Clear liquid consumption was significantly higher in the STAR intervention group with an average of 27.7 ± 3.5 cups as compared to 18.2 ± 8.9 in the control group (p < 0.001). Similarly, statistically significant increases in incentive spirometry usage (p < 0.01) and ambulation distance and frequency (p < 0.02) were observed in the STAR intervention group.ConclusionsWhile patients are in the hospital, text messaging can improve compliance to post-operative protocols. Peri-operative text messaging can enhance patient education and communication.

Gabapentin Premedication to Reduce Postoperative Pain for Pediatric Tonsillectomy/Adenoidectomy: A Pilot Study

PurposeTo examine the effects of preoperative gabapentin administration on postoperative pain in pediatric patients undergoing tonsillectomy/adenoidectomy (T/A) in a single ambulatory surgery location within a pediatric healthcare organization. DesignThis randomized, controlled pilot study enrolled patients age 3–18 years with American Society of Anesthesiologists (ASA) scores of I-II undergoing T/A. MethodsBoth gabapentin and placebo groups were given study medication preoperatively and received standard opiate regimens intraoperatively and postoperative pain instructions. Outcome measurements included: time to first analgesic medication in the postanesthesia care unit (PACU), mean acetaminophen, ibuprofen, and opiate doses in mg/kg. Additionally, we examined pain scores, medication use, and side effects reported by daily pain diaries completed by patients/families for 3 days postoperatively. FindingsForty-nine patients were included in final analysis (gabapentin n = 26, placebo n = 23). Demographic and clinical characteristics of both groups were similar; the majority (46 of 49) were under the age of 13.Both groups received opiates in PACU. Some patients in both groups received hydrocodone/acetaminophen postoperatively. There were no reported differences in side effects between groups. Gabapentin group reported less use of opiates, acetaminophen, and ibuprofen post-discharge. We identified small effect sizes for opiates and acetaminophen, and medium effect size for ibuprofen (80.1% gabapentin versus 100% placebo, RR 0.81 [95% CI 0.67–0.97]).Median pain scores were 4 on a scale of 10 for both groups for all 3 days of follow-up. Overall median satisfaction score was 9, with a mean difference of 0.35 (95% CI -0.78 – 1.37). Analysis of variance revealed no difference in pain scores or satisfaction per pain diaries between the groups in general and no difference in score trajectory. ConclusionsWe were able to establish a rigorous process and feasibility to launch a larger, multi-center trial to examine this important issue. There remain few evidence-based options for acute pain relief in pediatric surgical populations besides opiates. Identifying opiate alternatives that are effective, cost efficient and safe are needed for pediatric tonsillectomy patients.

Influence of Weight Bearing on Postoperative Complications after Surgical Treatment of the Lower Extremity.

In order to prevent implant failure and secondary fracture dislocation, it is often recommended that patients perform partial weight-bearing after surgery of the lower extremity. Previous examinations showed that patients are often not able to follow these instructions. In this study, patients who had undergone surgery of the lower extremity were studied in order to analyze whether incorrect loading influenced the number and severity of complications. Fifty-one patients were equipped with electronic shoe insoles, which measure loading and other parameters. The measurement period was 24 to 102 hours. Median duration of follow-up was 490 days. The primary outcome parameter was postoperative complications leading to revision surgery. Statistical analysis was performed using the chi-square and Fisher exact tests with significance set at a p<0.05. Seven out of fifty-one patients had postoperative complications. Four wound complications, one implant failure, chronic instability after fracture of the tibia, and one implant loosening of a hip prosthesis were recorded. In total, 26 of 39 patients were not able to follow the postoperative instructions. Five of the twenty-six patients with difficulties in partial weight-bearing suffered a postoperative complication. In comparison, only 2 of the other 25 patients were affected. There was no statistically significant correlation between high weight-bearing and occurrence of complications (p=0.29). Most of the patients were unable to follow the surgeon's instructions for partial weight-bearing. Excessive loading did not seem to influence the number and severity of postoperative complications, especially regarding implant failure. Therefore, we should continue with measurements and reevaluate the "partial weight-bearing doctrine".

An audit, literature review and quality improvement project regarding post-operative aftercare of facial lacerations in children

Aims & objectivesTo evaluate the communication of post-procedural instructions following repair of paediatric facial lacerations and design a post-procedural informative package to streamline and improve patients’ post-operative care. Methods1. Quantitative analysis of clinical records of 50 patients who underwent facial laceration repair, to evaluate clinical documentation 2. Informal survey of OMFS staff regarding perceived shortcomings of communicating post-procedural instructions to these patients’ parents 3. Literature review on post-procedure instructions after facial laceration repair. Results34% of clinical records had no mention of post-operative instructions given to patient’s parents. 38% had a non-specific mention: “post-operative instructions given”. Specific instructions were recorded as given in between 16-43% of clinical notes. DiscussionThese shortcomings were exacerbated by an increase in cases during lockdown and the timing of presentation- majority ‘out of hours’. We designed and implemented a pack to address this - an evidence-based patient information leaflet with an analgesic (Calpol), in collaboration with the hospital pharmacy and Patient Experience team. We noted, importantly, that routine use of Chloramphenicol is not endorsed by NICE. ConclusionThis audit highlighted the importance of heterogeneity of post-procedural instructions and documentation. Our simple intervention eases DCT burden, streamlines care and improves patient outcomes.

Post-surgical emergency after-hours calls: Prevalence, concerns, and management.

The purpose of this study was to investigate the prevalence, nature, and management of post-surgical emergency after-hours calls in a dental school setting with predoctoral students, graduate students/residents, and faculty providers. A patient chart review (March 2018-February 2020) for post-surgical calls through the emergency after-hours pager system was conducted at the Marquette University School of Dentistry. The total number of surgical procedures, procedure type, the timing of call, operator experience, concern, and recommendation given during the call were documented. During the review period, 83 calls (from 75 patients) were recorded after 8,487 surgical procedures (1% of procedures). Patients called 5.4 ± 0.8 days postoperatively. Procedure type affected call prevalence (p=0.04), with most calls made after extractions (69.9% of all calls; 1% of extractions; 58/5,725), implant placement (6%; 0.9% of implant placements; 5/530) and periodontal plastic surgery (6%; 3.1% of all plastic surgeries; 5/161). The most common concern was pain (72.3%), then swelling (36.1%), bleeding (12%), and infection (9.6%). Operator experience did not affect call prevalence. Recommendations given were next business day follow-up (79.5%), reinforcement of already given postoperative instructions (51.8%), prescription (15.7%), and hospital emergency department (ED) visit (7.2%). Post-surgical emergency after-hours calls in a dental school setting occur within the first postoperative week and are rare, unrelated to operator experience, typically prompted by pain, and rarely resulting in referral to hospital ED. The use of a pager system is adequate for the management of after-hours emergencies and may reduce self-referrals to the hospital ED.

Mid-term results of the Latitude primary total elbow arthroplasty.

The Latitude total elbow prosthesis is a third-generation implant, developed to restore the natural anatomy of the elbow. Literature on this prosthesis is scarce. The aim of this study was to analyze the mid-term results of the Latitude total elbow prosthesis. We retrospectively evaluated 62 patients (21 men and 41 women). The mean age at the time of surgery was 65 years (range, 28-87 years). The main indication for surgery was inflammatory arthritis. The outcome measures were complications, reoperations, self-reported physical functioning, pain, satisfaction, objectively measured physical functioning, and radiologic signs of loosening. Kaplan-Meier survival analysis was used to determine survival with revision as the endpoint. Sixty-nine primary Latitude prostheses were placed in 62 patients between 2008 and 2019. Six patients (7 prostheses) died, 3 elbows underwent revision, and 9 patients were lost to follow-up. A total of 44 patients (50 prostheses) were available for follow-up. The mean length of follow-up was 51 months (range, 10-144 months). Kaplan-Meier survival analysis showed a survival rate of 82% at 10 years after surgery. The main reason for revision was aseptic loosening. Radial head dissociation was seen in 8 patients (24%), but none had complaints. Self-reported and objectively measured physical functioning yielded good results, although 23 patients (46%) did show radiolucent lines on radiographs. Latitude total elbow arthroplasty is considered a successful procedure with low pain scores, high patient satisfaction, and good physical functioning. Survival rates nonetheless remain low and complication rates remain high yet are comparable to those of other elbow arthroplasties. We recommend biomechanical studies to concentrate on specific postoperative loading instructions to minimize wear and consequent loosening.

Semilunar Coronally Repositioned Flap- the Minimally Invasive Root Coverage Technique: A Report of 3 Cases

Introduction: Gingival recession (GR) is the location of marginal periodontal tissues apical to the cemento-enamel junction. Treatment of GR can be done by free gingival graft, laterally positioned pedicle flap, coronally displaced flap, and subepithelial connective tissue graft, semilunar coronally repositioned flap (SCRF). The purpose of this case report is to highlight the simplicity of carrying out SCRP procedure and its long-term benefits in case of maxillary gingival recession.&#x0D; Methods: Three systemically healthy patients aged 35-43 years reported with chief complaint of unesthetic appearance of teeth. Following full mouth scaling and root planning, patients were scheduled for root coverage procedure. SCRF was performed under local anaesthesia and postoperative instructions were given. Patients were asked to record VAS pain score and number of analgesics consumed for 3 days and recalled on 3rd, 10th day, 1, 3, 6 months and 1 year postoperatively.&#x0D; Results: All patients showed complete root coverage for 1 year postoperatively. VAS score showed mild pain for 3 days postoperatively.&#x0D; Conclusion: Semilunar coronally advanced flap is an effective, simple and highly acceptable periodontal plastic procedure.

Enhanced Recovery After Surgery: Standardized Postoperative Instructions in Hand Surgery.

Background: Enhanced Recovery After Surgery (ERAS) is a standardized approach to care of the surgical patient. Postoperative patient instructions, an aspect of ERAS protocols, are difficult to standardize in hand surgery because of the diversity of procedures. The aim of this study was to determine the effect of standardized hand surgery postoperative instructions on the number of unscheduled postoperative patient encounters. Methods: The study was an institutional review board-approved prospective cohort in which all hand surgery patients from 6 surgeons at a single, hospital-based academic institution were included. For a 6-month period, both before and after establishing a standardized postoperative instructional handout, data were collected on unscheduled postoperative encounters within 14 days of surgery. Results: There were 330 patients in the control group versus 282 who received standardized postoperative instructions. Trauma comprised 24.6% of cases in comparison to 75.4% elective. Individual surgeons did not significantly influence whether patients had an encounter. Overall, patients who received standardized instructions were just as likely as the control group to have unscheduled encounters (41.5% vs 43.9%, respectively). Notably, elective patients were significantly more likely to have encounters (46%) versus trauma patients (33.1%; P = .007); however, the standardized instructions did not influence the number of encounters for either group. Conclusions: This study did not demonstrate a difference in unscheduled postoperative encounters after initiation of standardized postoperative instructions for hand surgery patients. These findings may help providers save time and resources by tailoring the use of ERAS in this distinct patient population.