Postoperative Patient Satisfaction Research Articles

Feasibility study of a novel digital template-guided flapless extraction for maxillary palatal impacted teeth.

With the increasing maturity of 3D printing technology, the application of digital guide template in the extraction of impacted teeth has become more sophisticated. However, for maxillary palatal deeply impacted teeth, there still exist significant clinical challenges. This experiment introduces a novel digital guide template and innovatively employs a flapless technique to explore a minimally invasive approach for the extraction of palatal deeply impacted teeth. This experiment included 40 patients diagnosed with palatal completely impacted teeth, randomly divided into an experimental group and a control group. The experimental group used the new digital guide template for flapless extraction, while the control group employed the traditional freehand flap technique. The experimental group can significantly reduce the localization time of palatally impacted teeth (P < 0.001), with total surgery times of 18.15 ± 4.88min and 22.00 ± 7.71min for the experimental and control groups, respectively (P = 0.067). Although there were no significant statistical differences between the two groups in terms of intraoperative bleeding, adjacent tooth damage, infection, or damage to nearby important anatomical structures, the experimental group showed significant improvements in postoperative pain (P < 0.05), swelling (P < 0.001), and patient satisfaction (P < 0.001) compared to the control group. Compared to traditional freehand flap surgery, flapless extraction of palatally impacted teeth guided by digital templates significantly reduces the localization time of impacted teeth and demonstrates notable advantages in some postoperative complications. Future studies with larger sample sizes are needed to substantiate the feasibility of this technique.

Medial-pivot total knee arthroplasty enhances tibiofemoral axial rotation stability in weight-bearing mid-range flexion compared to posterior-stabilised system.

Total knee arthroplasty (TKA) stands as a primary intervention for severe knee ailments, yet concerns remain regarding postoperative patient satisfaction and flexion instability. This study aims to evaluate the in-vivo kinematics of medial-pivot (MP) and posterior-stabilised (PS) designs during step-up activity, in comparison to the kinematics of the nonoperated contralateral knee. Sixteen patients with PS-TKA and 14 with MP-TKA were retrospectively examined. Clinical outcomes were assessed using patient-completed questionnaires. Motion during step-up was captured using a dual fluoroscopic system. Statistical analysis was applied to evaluate the in-vivo tibiofemoral six-degree-of-freedom kinematics and articular contact positions between the two groups. Despite being older, patients in the MP group reported higher postoperative subjective scores for weight-bearing functional activities. The axial rotation centres of MP-TKA located on the medial tibial plateau exhibited less variance compared to PS-TKA and contralateral knees. Compared to the contralateral knee (contralateral to medial-pivot [C-MP] or contralateral to posterior-stabilised [C-PS]), the MP group exhibited limited range of motion in terms of anteroposterior translation (MP: 3.6 ± 1.3 mm vs. C-MP: 7.4 ± 2.5 mm, p < 0.01) and axial rotation (MP: 6.6 ± 1.9° vs. C-MP: 10.3 ± 4.9°, p = 0.02), as well as in the PS group for anteroposterior translation (PS: 3.9 ± 1.7 mm vs. C-PS: 7.2 ± 3.7 mm, p < 0.01). The MP group with better postoperative ratings demonstrated a more stable MP axial rotation pattern during step-up activity compared to the PS group, underscoring the pivotal role of prosthetic design in optimising postoperative rehabilitation and functional recovery. Level III.

THE EFFECT OF OSTEOARTHRITIS GRADE ON PATIENT-REPORTED OUTCOME MEASURES AFTER TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Although total hip arthroplasty (THA) is beneficial for many patients with hip osteoarthritis (OA), a subset of patients experience minimal benefit. It is therefore pertinent to understand the predictors of poor functional outcome to facilitate shared decision making. One such predictor is preoperative radiographic OA severity. The aim of this systematic review was to determine whether preoperative radiographic OA severity could predict postoperative patient-reported outcome measures (PROMs) and satisfaction rates after THA.This systematic review was conducted according to PRISMA guidelines, and the protocol published in PROSPERO (ID:Â CRD42023445918). A literature search was performed using Embase, MEDLINE and Cochrane Library databases. Demographics, radiographic OA severity, PROMs, satisfaction, and complications after THA were collected. A meta-analysis was performed, where appropriate, using a random-effects model.Of 631 identified articles, 12 were included in the final analysis (8,034 participants; mean age 65.2, 38.1% male, mean BMI 29.1 kg/m2). There were three key findings. Firstly, those with mild OA are less likely to achieve a meaningful clinical improvement in PROMs (odds ratio (OR) 0.50, 95% confidence interval (CI) 0.38, 0.65; p &lt; 0.00001). Secondly, two studies indicates that postoperative patient satisfaction was lower in participants with mild OA. Thirdly, participants with mild arthritis experience less improvement in SF-36 physical functioning (mean difference (MD) -8.31, 95% CI -10.97, -5.64; p &lt; 0.00001) and role physical (MD -5.59, 95% CI -8.40, -2.77; p &lt; 0.0001), but showed higher improvement in general health (MD 1.68, 95% CI 0.31, 3.06; p = 0.02).Patients with mild OA, as determined radiographically, are less likely to achieve meaningful clinical improvements in PROMs and have lower postoperative satisfaction after THA. This information will improve collaborative decision-making in the preoperative period.

Efficacy of bilateral erector spinae block for intraoperative and post-operative analgesia in lumbar decompression surgeries: A prospective randomized controlled trial

Background: Lumbar surgery is known to cause severe pain in the post-operative period. Modalities to reduce pain in the perioperative period include opioids, non-steroidal anti-inflammatory drugs, neuraxial blocks, and erector spinae block (ESB). Aims and Objectives: In this study, we aimed to evaluate whether ESB could reduce perioperative pain, opioid consumption, and muscle relaxant consumption. Materials and Methods: Fifty patients scheduled for lumbar decompression spine surgery were randomly allocated to two groups, the erector spinae plane (ESP) group (n=25) and the control group multimodal analgesia group (n=25). Intraoperative hemodynamics, muscle relaxant requirement, opioid consumption post-operative visual analog score, and rescue analgesia were evaluated. Results: Compared with the control group, heart rate (91.24±14.86 and 90.20±14.26) (77.12±11.96 and 77.44±11.96) arterial blood pressures (87.12±8.45 mmHg) (85.25±7.25) (78.73±5.56 and 79.64±5.95) were higher during surgical incision and 1st-time interval than in ESP group, respectively. The visual analog scale scores were higher in the control group than in the ESP group during all measurements of time. The requirement for rescue analgesia was more in the control group compared to the ESP group. Post-operative analgesia lasted for 15–18 h. Conclusion: Ultrasound-guided ESP block is a simple and safe technique which provides effective intraoperative, and post-operative analgesia and patient satisfaction with reduced opioid and muscle relaxant consumption.

Is Upper Extremity or Lower Extremity Function More Important for Patient Satisfaction? An Analysis of 24-Month Outcomes from the QOD Cervical Spondylotic Myelopathy Cohort.

Retrospective analysis of a prospective, multicenter registry. To assess whether upper or lower limb mJOA improvement more strongly associates with patient satisfaction after surgery for cervical spondylotic myelopathy (CSM). The modified Japanese Orthopaedic Association (mJOA) is commonly used to assess functional status in patients with CSM. Patients present with upper and/or lower extremity dysfunction, and it is unclear whether improvement in one and/or both symptoms drives postoperative patient satisfaction. This study utilizes the prospective Quality Outcomes Database (QOD) CSM data set. Clinical outcomes included mJOA and North American Spine Society (NASS) satisfaction. The upper limb mJOA score was defined as upper motor plus sensory mJOA, and the lower limb mJOA as lower motor plus sensory mJOA. Ordered logistic regression was used to determine whether upper or lower limb mJOA was more closely associated with NASS satisfaction, adjusting for other covariates. Overall, 1141 patients were enrolled in the QOD CSM cohort. In all, 780 had both preoperative and 24-month mJOA scores, met inclusion criteria, and were included for analysis. The baseline mJOA was 12.1±2.7, and postoperatively, 85.6% would undergo surgery again (NASS 1 or 2, satisfied). Patients exhibited mean improvement in both upper (baseline:3.9±1.4 vs. 24 mo:5.0±1.1, P<0.001) and lower limb mJOA (baseline:3.9±1.4 vs. 24 mon:4.5±1.5, P<0.001); however, the 24-month change in the upper limb mJOA was greater (upper:1.1±1.6 vs. lower:0.6±1.6, P<0.001). Across 24-month NASS satisfaction, the baseline upper and lower limb mJOA scores were similar (pupper=0.28, plower=0.092). However, as satisfaction decreased, the 24-month change in upper and lower limb mJOA decreased as well (pupper<0.001, plower<0.001). Patients with NASS scores of 4 (lowest satisfaction) did not demonstrate significant differences from baseline in upper or lower limb mJOA (P>0.05). In ordered logistic regression, NASS satisfaction was independently associated with upper limb mJOA improvement (OR=0.81; 95% CI: 0.68-0.97; P=0.019) but not lower limb mJOA improvement (OR=0.84; 95% CI: 0.70-1.0; P=0.054). As the magnitude of upper and lower mJOA improvement decreased postoperatively, so too did patient satisfaction with surgical intervention. Upper limb mJOA improvement was a significant independent predictor of patient satisfaction, whereas lower limb mJOA improvement was not. These findings may aid preoperative counseling, stratified by patients' upper and lower extremity treatment expectations. Level-III.

Modified Minimally Invasive Bunnell Suture Surgery with Channel-assisted Minimally Invasive Reconstruction Device for Treating Achilles Tendon Rupture.

The aim of this study was to improve the process of microincision and endoscopic surgery for the treatment of Achilles tendon (AT) rupture using the modified minimally invasive Bunnell suture (MIBS) technique.From December 2019 to December 2021, 20 patients with AT rupture who visited the First Affiliated Hospital of Harbin Medical University (Harbin, China) underwent MIBS surgery.A total of 20 patients were included, of whom 18 (90.0%) were male and 2 (10.0%) were female. The mean age of the patients was 37.75±9.94 years. In terms of the site of the AT, two (10.0%) had surgery on their left AT. The mean duration of surgery was 23.00±2.47 minutes, and the mean bleeding volume was 5.00±1.12mL. All 20 patients (100%) showed complete incisional healing (stage I healing) and normal functional recovery (3-6 months postoperatively). There were no cases of abnormal functional recovery or postoperative recurrence within the 3-6 month follow-up period. The Achilles tendon Total Rupture Score (ATRS) significantly improved post-surgery (83.6±5.59) compared to pretreatment (0.3±0.92, p<0.0001), indicating successful patient recovery.After the modified MIBS surgical process, the operation steps were simplified, the surgical difficulty was reduced, and the surgical trauma was alleviated, resulting in good postoperative recovery and patient satisfaction with the outcome. Therefore, the MIBS surgery has high promotability.

Patient Satisfaction After Cosmetic Breast Surgery Utilizing the Free Nipple Graft Technique

Introduction: Breast surgery using the free nipple areolar graft (FNG) technique is a less frequently utilized technique; however, a very safe alternative to other available dermoglandular pedicles when nipple areola vascularity is of concern. One of the drawbacks with FNG technique is the loss of tactile sensation and the overall postoperative esthetic appearance of the nipple areola complex (NAC). Objective: Our aim was to study patient satisfaction, specifically in regard to NAC sensation and esthetic appearance of the NAC in patients who underwent breast surgery utilizing the FNG technique. Study Design: This study is a case series of patients undergoing cosmetic breast procedures utilizing the FNG technique. Postoperative outcomes were evaluated both by the clinician and the patient by completing a survey questionnaire. Methods: We conducted a 3 month postoperative patient satisfaction survey utilizing a questionnaire in 74 patients who underwent various cosmetic surgical procedures on the breast using the FNG technique. Patients were also objectively evaluated by a physician during the same visit. Patients rated their NAC sensation and esthetic appearance on a scale of 1 to 5 and 1 to 10, respectively, and the physician rated the NAC loss on a scale of 1 to 5. Results were reported as percentages of total patients in each group. Results: Our results indicated that over 85% of patients in our study had more than 50% tactile sensation to the NAC at 3 months. We also found that over 75% of patients were very satisfied with the esthetics of the NAC after these procedures. Conclusions: We conclude that the risk of sensation loss to the NAC and patient satisfaction in regard to esthetic appearance of the NAC is better than what is believed to be and that the FNG technique may possibly be an underutilized tool in the surgeon’s toolbox.

Outcomes of Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy with Two-Year Minimum Follow-Up: A Retrospective Study

Introduction/Purpose: Insertional Achilles tendinopathy (IAT) is a common source of posterior heel pain treated by orthopaedic foot and ankle surgeons. Traditional surgical treatment consists of an open Achilles tendon debridement with re-attachment as well as excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. However, frequent complications include wound healing issue, scar pain, weakness and sural nerve injury. Accordingly, the percutaneous ZO is gaining popularity in the field as an alternative to an open midline splitting approach. Limited literature exists describing outcomes of the percutaneous ZO using a larger sample size. The purpose of this study was to analyze patient reported outcomes and complications after percutaneous ZO with a minimum two-year follow-up period. Methods: One hundred and eight cases treated with percutaneous ZO were retrospectively reviewed across October 2017-July 2021 and outcomes data was available for 104 cases with a minimum two-year follow-up. Patient sex, age, and pertinent comorbidities were recorded. Postoperative complications and patient satisfaction following intervention were evaluated. Foot Function Index score (FFI) was utilized to measure patients’ pain and functional outcomes. Visual Analyzing Scale score (VAS) was also utilized to evaluate pain. These measurements were taken at preoperative and final follow-up. Statistical comparisons were performed using two-tailed, paired t-test with p&lt; 0.05. Results: Mean follow-up time was 41.2±13.1 months (range 24-65 months). The mean FFI score improved from 56.1±5.9 (range 47-88) preoperatively to 11.0±5.1 (range 7-59) postoperatively (p &lt; 0.001). Average VAS score improved in patients receiving percutaneous ZO from 7.6±1.3 (range 5-10) to 0.4±0.9 (range 0-7) postoperatively (p &lt; 0.001). The overall complication rate was 3.8% (N =4). Of 104 cases, 98.1% of patients were satisfied with their procedure (102/104). Conclusion: The percutaneous ZO is a safe and highly effective intervention for treatment of IAT. At a minimum of two-years follow-up, this intervention is associated with minimal complications, improved functional outcomes, reduced pain, and high patient satisfaction. Table 1 Functional and subjective pain preoperative and postoperative scores as evaluated by functional foot index (FFI) and visual analogue scale (VAS), respectively

Outcome Study of Mandibular Fractures Treated by Surgical Stabilization With Plates and Screws.

This study aims to assess the outcomes of mandibular fractures treated through surgical stabilization using plates and screws, focusing on factors such as postoperative complications, patient satisfaction, and functional recovery. A total of 42 patients were included in the study. Surgical interventions involved the application of plates and screws at the fracture sites. Postoperative complications, including infection, hardware failure, and malocclusion, were recorded. Surgical stabilization of mandibular fractures using plates and screws demonstrates favorable outcomes in terms of stability, occlusal alignment, and patient satisfaction. The findings of this study contribute valuable insights into the efficacy of this surgical approach, highlighting its role in achieving successful outcomes for mandibular fracture management. Further prospective studies and randomized controlled trials are recommended to strengthen the evidence base and refine treatment protocols.

The Impact of Regular Diet Recovery on Postoperative Rehabilitation After Elective Cesarean Section

Abstract Objective To determine the role of regular diet recovery after restoration of normal muscle strength of both lower extremities in promoting postoperative recovery in women undergoing elective cesarean section. Methods This was a prospective observational cohort study. Patients who underwent elective cesarean section at Xiangya Hospital, Central South University, from October 2022 to December 2022, were categorized into two groups based on the duration of postoperative fasting: the observation group resumed eating after regaining lower extremity muscle strength, while the control group adhered to traditional postoperative fasting guidelines, waiting 6 hours before eating. Primary outcomes included postoperative pain levels assessed by visual analog scale (VAS) pain scores and time to first flatus. Demographic characteristics, time to first lactation, hospital stay length, and patient satisfaction were also assessed. Statistical analysis was conducted using Student’s t test and Chi-squared test, with significance set at P &lt; 0.05. Results Out of a total of 300 patients, 240 were included in the analysis, comprising 112 in the control group and 128 in the observation group. There were no significant differences in baseline demographic characteristics. The median values of the first flatus time and the first lactation time were 33.37 ± 1.22 vs. 18.06 ± 6.34 hours (P = 0.003) and 26.34 ± 8.21 vs. 7.05 ± 1.26 hours (P = 0.001) in the control and observation groups, respectively. The median hospital stay duration in the control and observation groups was 6.54 ± 0.53 vs. 4.84 ± 0.18 days (P = 0.000), respectively. Median postoperative VAS pain scores and patient satisfaction values were 8.57 ± 0.11 vs. 4.91 ± 0.27 (P = 0.000) and 9.36 ± 0.16 vs. 9.72 ± 0.08 (P = 0.005) in the control and observation groups, respectively. There were no statistically significant differences in other postoperative outcomes, such as intestinal obstruction, infection, and readmission within 42 days (P &gt; 0.05). Conclusion Food intake after restoration of lower extremity muscle strength improves first flatus, relieves postoperative pain, shortens hospital stay, and enhances satisfaction after elective cesarean section, without adverse effects. It is crucial for postoperative rehabilitation and should be encouraged.

The Results of Lomber Disc Hernia Patients Treated with Disc Restoration Hydrogel Implant (Gelstixtm): A Retrospective Cohort Study

Objective: This study aims to evaluate the results of disc restoration hydrogel implanted (GelstixTM) lumber disc hernia patients. Materials and Method: Patients suffering from chronic back pain diagnosed with lumber disc hernia who were admitted to Firat University Algology Clinic and treated with disc restoration hydrogel between January 2013 and January 2014 were evaluated. Cases were evaluated for demographic characteristics, magnetic resistance imaging findings, preoperative and postoperative visual analog scale (VAS) scores, complications, side effects, and patient satisfaction after the procedure. Results: Of the operated 62 patients were 25 male (40.3%) and 37 female (59.7%). The mean age of all patients was 49.18±14.18 years, the mean age of female patients was 50.81±13.37 years and the mean age of male patients was 46.76±15.27 years. The mean duration of pain in female and male patients was 37.81±37.92 months and 25.36±33.58 months, respectively. Preoperative and postoperative VAS scores of female patients were 8.24±1.09 and 3.56±2.11; male patients were 7.88±1.01 and 3.76±2.17, respectively. Of the 62 patients suffered from 16 right leg pain (25.8%), 20 left leg pain (32. 3%), and 26 bilateral lower limb pain (41.9%). Of 62 patients 31 had no additional disorders (50%), 12 had cardiac disorders (19.4%), 3 had (4.8%) respiratory disorders, 7 had endocrine disorders (11.3%), 4 had both endocrine and cardiac disorders (6.5%), 2 had both cardiac and respiratory disorders (3.2%), 1 had both endocrine and respiratory disorders (1.6%), and 2 had both endocrine, cardiac and respiratory disorders (3.2%). Of the 62 patients 25 had bulging (40.3%), 5 had protrusion (8.1%), 4 had narrowed neural foramen (6.5%), 18 had bulging+narrowed neural foramen (29%), 3 had narrowed neural foramen + protrusion (4.8%) and 7 had bulging + protrusion (11.3%). Thirteen patients hadn’t had previous therapy (20.97%), transforaminal steroid injection was applied to 29 patients (46.77%), and medical therapy (such as NSAID, miyorelactants) was applied to 20 (32.26%). Levels of complaints were 2 at L2-L3 (3. 2%), 17 at L3-L4 (27.4%), 28 at L4-L5 (45.2%), and 15 at L5-S1 (24.2%). Without L2-L3 level other operated levels had significant differences between preoperative VAS scores and postoperative VAS scores. The number of unsatisfied patients was 9 (14.5%), moderated satisfied patients number 16(25.8%), good satisfied patients number was 16 (25. 8%), and perfectly satisfied patients number was 21 (33.9%). Conclusion: Disc restoration hydrogel is a safe minimal invasive technique with satisfactory results, low complication rates, and low side effect risk especially in young and middle-aged patients.

The feasibility and clinical significance of lateral approach thyroidectomy.

By comparing the three lateral approaches to thyroidectomy, the feasibility and clinical effects were analyzed, and the advantages of the lateral approach were summarized. From January 2022 to January 2023, 52 patients with thyroid cancer admitted to our department were selected and subjected to Lateral approach for thyroidectomy. Among them, 31 patients underwent thyroidectomy via the supraclavicular approach, 13 patients underwent endoscopic thyroidectomy via the subclavicular approach, and 8 patients underwent endoscopic thyroidectomy via the axillary approach. The basic conditions, surgical conditions, complications, postoperative pain scores and postoperative satisfaction of patients in the three approach surgery groups were recorded and analyzed. There were no significant differences among the three approach groups in terms of patient characteristics, number of central lymph node dissections, intraoperative blood loss, postoperative drainage volume, duration of drainage tube placement, length of hospital stay, postoperative pain, satisfaction, and complications. However, the operation time was longest in the subclavicular approach group, followed by the axillary approach group, and shortest in the supraclavicular approach group. The total hospitalization cost was highest in the axillary approach group, followed by the subclavicular approach group, and lowest in the supraclavicular approach group. The lateral approach for thyroidectomy is deemed a safe and effective method. The three different approach paths gradually increase in length, allowing for the accumulation of anatomical experience. This approach has a shorter learning curve for clinical doctors and is a favorable choice for patients seeking aesthetic benefits.

Comparison of Transpedicular Fixation with Fusion with Transpedicular Fixation Alone in Spondylolisthesis

Objective: This research evaluated the clinical outcomes of two surgical methods used to treat degenerative lumbar spondylolisthesis in the short term. Fixation through the pedicles with or without inter-body fusion. Utilizing a spinal cage for first- and second-degree condition patients is one of the two methods being compared. Materials &amp; Methods: A total of 28 individual lumbosacral spondylolisthesis were incorporated in the research. Based on the surgical method and fixation technique employed for their care, they were split into two groups at random. Posterolateral intertransverse bone fusion, transpedicular screw fixation, and posterior lumbar decompression operations were performed on Group A. Conversely, Group B underwent posterolateral interbody fusion via the implantation of interbody cages, transpedicular screws, and posterior decompression. Results: There existed no statistically significant association in terms of the two groups that is intraoperative and postoperative complications, clinical outcomes, and patient satisfaction, while noteworthy significance was observed about blood loss and rates of post-operative fusion. Conclusion: Incorporating a spinal implant in conjunction with transverse body fusion results in superior fusion rates and post-operative clinical improvements, while intertransverse bony fusion alone yields comparable patient satisfaction with reduced surgical times.

Prograde transposition for anteriorly low-set earlobe in lobule-type microtia reconstruction

BackgroundLobule transposition, a common procedure in auricle reconstruction, has been successfully performed over the past few decades. However, the transposition methods for unilateral microtia with evident asymmetry of bilateral earlobe positions still remain a challenge. The objective of this study was to investigate the application of prograde transposition for anteriorly low-set earlobes. MethodA total of 25 patients with lobule-type microtia with anteriorly low-set residual earlobe underwent prograde transposition during auricle reconstruction between 2020 and 2022. The post-operative earlobe aesthetic assessment and patient satisfaction were evaluated, and the data on any complications that occurred when followed-up were collected. This study provides a comprehensive analysis and summary of the techniques used in earlobe transposition for auricular reconstruction. ResultsThe patients with evident asymmetry between the residual and healthy earlobes were usually concomitant with hemifacial microsomia and the residual ear was located in the anterior and lower region. No instances of flap necrosis, hematoma, or wound dehiscence were observed following auricular reconstruction. The mean aesthetic score of the auricle was 3.52, with 23 patients attaining good or excellent aesthetic outcomes. The mean Visual Analog Scale satisfaction score was 3.68, with 24 patients reporting relative satisfaction or satisfaction. ConclusionThe prograde transposition of anteriorly low-set earlobe in lobule-type microtia reconstruction can effectively ensure adequate blood supply, enhance aesthetic appearance, and significantly improve patient satisfaction.

(043) Gender-Affirming Bilateral Orchiectomy Prior to Vaginoplasty versus with Vaginoplasty: A Comparison of Preoperative Goals and Postoperative Satisfaction

Abstract Introduction Gender-affirming bilateral orchiectomy (GA-BO), defined here as either a standalone procedure and/or precursor to vaginoplasty, is associated with a decrease in gender-affirming hormone therapy (GAHT) dosages. In comparison to bilateral orchiectomy at time of gender-affirming vaginoplasty (GA-V), GA-BO is associated with shorter waitlist times, procedure duration, and outpatient recovery. While objective benefits of GA-BO have been described, there is limited qualitative data that assesses the preoperative goals and postoperative satisfaction of patients who elect GA-BO. We aim to assess the decision-guiding factors that led patients to select GA-BO, and to compare measures of patient satisfaction between GA-BO and GA-V patients. Objective To assess the decision-guiding factors that led patients to select gender-affirming bilateral orchiectomy before vaginoplasty versus with vaginoplasty, and to compare measures of patient satisfaction between groups. Methods A retrospective chart review identified 170 patients who underwent GA-BO (n=106; 64%) or GA-V (n=64; 36%) between 4/2017 and 12/2020 at our institution. Patients were emailed a link to an anonymous, online questionnaire (QualtricsTM). Results 136/170 (80%) patients completed the questionnaire: 86/136 (63%) respondents were GA-BO patients and 50/136 GA-V (37%). 78/86 (91%) of GA-BO respondents had either subsequently undergone vaginoplasty, or, planned to do so in the future. For patients who later underwent vaginoplasty, the mean reported time interval between GA-BO and vaginoplasty was 15 months [Range: 1–34 months]. Respondents prioritized the following expectations in their decision to undergo GA-BO: potential to decrease GAHT medications and dosages (reported as important by 67%), low rates of complications (56.5%), short recovery time (51.6%), and low postoperative pain (46.2%). GA-BO and GA-V patients reported high postoperative improvement in various indices of gender dysphoria and body image, with only 1/4 indices of gender dysphoria differing significantly between the two groups (Figure 1). Unsurprisingly, GA-V patients reported a significantly greater improvement in 3/3 body image indices. Conclusions GA-BO is a low-risk procedure that provides a more immediate option to decrease gender dysphoria and improve QOL. All patients who were assigned male at birth and are interested in genital gender-affirming surgery should be made aware of the advantages of GA-BO and offered GA-BO alongside GA-V. Disclosure No.

Effect of Enhanced Recovery after Surgery (ERAS) protocol on maternal outcomes following emergency caesarean delivery: A randomized controlled trial

BackgroundWith ever increasing rates of emergency caesarean deliveries (CD),incorporating the ERAS protocol might provide a perfect window of opportunity to increase maternal comfort during the postsurgical period, but also improve outcomes and facilitate optimal return of physiological function. ObjectiveTo determine whether an ERAS pathway at emergency caesarean birth would permit a reduction in postoperative length of stay and improve postoperative patient satisfaction. Material & methodsPatients undergoing emergent caesarean delivery at ≥ 34 weeks of gestation were randomized to ERAS or conventional care. The primary outcome was to compare postoperative length of hospital stay. Secondary outcome variables included first oral intake, passage of flatus/defecation, first ambulation, first urination after catheter removal and postoperative pain scores in both groups. ResultsWe randomized 142 women (71 each in ERAS versus Conventional arm) undergoing emergency cesarean delivery. Incorporation of ERAS protocol resulted in shorter length of hospital stay (73.92 ± 8.96 in conventional arm vs 53.87 ± 15.02 in ERAS arm; p value <.0001). Significant difference was seen in visual analogue scoring during initial ambulation and rest on day 0 and day 1 between ERAS and conventional arms with mean scores being lower in ERAS arm compared to Conventional arm (p value <.05). In terms of quality of life, ERAS arm had better quality of life compared to conventional arm ConclusionIncorporation of ERAS protocol in emergency caesarean definitely improves patient outcome in terms of early resumption of activities with better quality of life.

High triglyceride-glucose index is associated with low postoperative satisfaction in patients with posterior instrumented lumbar fusion.

This study aimed to determine the effect of the preoperative triglyceride-glucose (TyG) index on the postoperative quality of life, patient satisfaction, and surgical outcomes in patients who underwent posterior lumbar instrumentation and fusion surgery. This was a retrospective single-center cohort study (n = 136). Patients were divided into three groups according to the TyG index: < 25th percentile (L), 25-75 percentile (N), and > 75th percentile (H). Pearson correlation analysis was used to evaluate the relationship between the TyG index and the quantitative variables. Scatterplot and receiver operating characteristic (ROC) curve analysis were used to assess the relationship of the preoperative TyG index with postoperative Oswestry disability index (ODI) and physical function (PF) scores. The TyG index showed a significant correlation with postoperative ODI score. TyG index showed a significant negative correlation with postoperative PF score. On ROC curve analysis, postoperative ODI score ≥ 38 (optimal cut-off) had 79% sensitivity and 92% specificity for predicting high TyG index (group H) (p = 0.016). Postoperative PF score ≤ 80 predicted group H patients with 97% sensitivity and 75% specificity (p = 0.001). The area under the ROC curve was 0.74 (p = 0.016) for the postoperative ODI and 0.79 (p = 0.001) for the postoperative PF. In patients who underwent posterior lumbar instrumentation and fusion surgery, a high preoperative TyG index may predict poor postoperative ODI and PF scores, indicating lower patient satisfaction.

Arthroscopic rotator cuff repair in active patients younger than 45 Years: a prospective analysis with a mean 5-year follow-up

PurposeTo report clinical and activity specific outcomes after arthroscopic RCR(ARCR) for full-thickness supraspinatus tears in active individuals younger than or equal to 45 years of age. The pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along with a significant improvement of athletic abilities. MethodsPatients were included in this study if they were (1)active individuals between 18 and 45 years of age at the time of surgery, (2)had a full-thickness rotator cuff tear(RCT) of the supraspinatus tendon with or without anterior or posterior extension and (3)underwent ARCR. Pre- and postoperative patient-reported outcomes scores including the American Shoulder and Elbow Surgeons(ASES) score, Disabilities of Arm, Shoulder and Hand(Quick-DASH), Single Assessment Numeric Evaluation(SANE), Short Form-12 Physical Component Summary(SF-12PCS) were prospectively collected and postoperative patient satisfaction(scale of 1-10) was recorded at a minimum of 2 years postoperatively. Attainment of the minimal clinically important difference(MCID) and patient acceptable symptom state(PASS) for the ASES was calculated. Athletic activity specific outcomes and return to activity(RTA) were investigated prospectively via a custom-made comprehensive questionnaire. ResultsBetween 11/2005 and 6/2020, of 1149 RCRs performed by the senior author, 54 patients (mean age 40.9 years,13 female; follow-up 69.7 ± 35.2 months in a range of 24.6 – 179.6 months) were included into the outcomes analysis. Of those, 4 patients(7.4%) had progressed to revision rotator cuff repair. At a follow-up of 5.8 years, outcome scores had significantly improved compared to preoperative baselines (ASES55.6±13.8to90.1+15.8;p<.001;QuickDASH38.9±18.4to 11.9±17.1;p<.001, SANE60.7±22.7to79.3±27.6;p=.001, SF-12PCS41.6±8.3to51.9±9.0;p<=.001). 93.6% of the patients reached the MCID and 72.6% reached the PASS. Median satisfaction was 9.5/10. 86% of the patients returned to sports, while 67% of the patients returned to a similar level compared to preoperatively. All sport specific metrics such as shoulder strength and endurance(p<.001), intensity(p<.001), and impairments from pain affecting speed(p=0.002), endurance(p=.002) and competition(p<.001) significantly improved postoperatively. ConclusionARCR of full-thickness RCT in active individuals aged 45 or younger results in a clinically relevant improvement of outcomes, function and quality of life at a minimum of 2 years and mean 5.8-year follow-up with a low rate of revision. While 86% of patients were able to RTA and sport specific outcome metrics significantly and substantially improved compared to preoperatively, a return to preinjury levels was not reliably achieved in all patients, with particular limitations observed in overhead active individuals. The data support the hypothesis that patients in this age group demonstrate significant improvements in clinical outcomes following ARCR along with significant improvements in athletic abilities.

High Expectations Among Patients Who Have Undergone TKA Do Not Correlate With Satisfaction.

One of five patients is dissatisfied with the outcome of TKA. With the increasing number of TKAs, this affects many patients. It has been suggested that high expectations may influence satisfaction, but the relationship between preoperative patient expectations and postoperative patient satisfaction remains poorly understood. (1) Are preoperative patient expectations correlated with postoperative satisfaction? (2) Are expectations correlated with patient characteristics or patient-reported outcome measures (PROMs)? (3) Is satisfaction correlated with patient characteristics or PROMs? (4) Do patients report specific items as more relevant to their expectations? This was a single-center, observational, retrospective, comparative study involving patients who underwent TKA. Between December 2020 and June 2022, three senior surgeons performed 306 TKAs. Of these, 76% (234) had the preoperative PROMs required for this study, and of these, 82% (193) had completed PROMs at the 12-month follow-up interval and were analyzed. Of the 193 included patients, 53% (102) were women; the mean age was 68 ± 9 years. Data were collected at baseline, 4 months, and 12 months. Twelve months of follow-up has been shown to be adequate in studies with PROMs. Patient expectations were measured using the validated Hospital for Special Surgery Knee Replacement Expectation Survey on a scale from 0 to 100, with higher scores indicating higher expectations. We also assessed patient satisfaction, the Knee injury and Osteoarthritis Outcome Score, Forgotten Joint Score, High-Activity Arthroplasty Score, EQ-5D-3L, and the objective Knee Society Score. Bivariate linear correlations were analyzed using the Pearson or Spearman test. Preoperative patient expectations did not correlate with postoperative satisfaction. The mean Hospital for Special Surgery Knee Replacement Expectation Survey score was 82 ±16 points and did not correlate with satisfaction at either 4 months (r = -0.061; p = 0.42) or 12 months (r = -0.126; p = 0.11). Expectations did not correlate with patient characteristics or any of the preoperative or postoperative PROMs or the Knee Society Score. Patient satisfaction was 88% (158 of 179) at 4 months and 83% (160 of 193) at 12 months and did not correlate with patient characteristics or any of the preoperative PROMs or Knee Society Score. Patient satisfaction was medium to strongly correlated with postoperative PROMs and Knee Society Score. The Hospital for Special Surgery Knee Replacement Expectation Survey items with the most frequent expected improvement were "ability to walk" (99% [192 of 193]), "go downstairs" (99% [191 of 192]), and "go upstairs" (99% [192 of 193]). Preoperative expectations were not correlated with postoperative satisfaction or PROMs. Surgeons should be aware that patients have high expectations. However, these expectations appear to be less relevant in determining postoperative satisfaction. Level III, therapeutic study.

Comparison of Radiofrequency Ablation and Cyanoacrylate Closure for Large-Diameter Great Saphenous Vein Insufficiency

ObjectiveTo compare radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for large-diameter great saphenous vein insufficiency (GSV) between diameters of 12 and 16 mm. Material-MethodsThis study is a single-centre retrospective study. Subjects who underwent endovenous treatment with RFA (Group A) or CAC (Group B) for GSV insufficiency between June 2015 and June 2021 who were followed up for at least 2 years were included in the study. Subjects who had a 12 to 16 mm target vessel diameter and subjects with grade 3 and grade 4 reflux were included. Subjects’ demographic data (age, sex), body mass indices (BMI), clinical, aetiological, anatomic, pathophysiologic (CEAP) classification, GSV diameter, reflux grade, target vessel length, preoperative venous clinical severity score (VCSS), procedural time, postoperative 1st-day pain scores, postoperative 14th-day patient satisfaction scale and postoperative complications were noted. In follow-up, subjects were evaluated with duplex ultrasonography and VCSS at 1, 6, 12 and 24 months. ResultsIn total, 142 subjects were included (n=71 for both groups). The mean GSV diameter was 13,21±1,00 for Group A and 13,51±0,97 for Group B. The groups did not differ in terms of age, sex, BMI, CEAP classification, GSV diameter, reflux grade, target GSV length, preoperative VCSS, complications, postoperative 24-hour pain status or postoperative 14-day patient satisfaction scale (p>0.05 for all comparisons). The procedure time was significantly shorter in Group B (34,68±4,22 min for Group A vs. 22,59±4,5 min for Group B, p=0,001). In the 1-month and 6-month Duplex ultrasonography of the subjects, partial closure and patency rates in Group B were significantly higher than those in Group A (p=0.003 and p=0.025, respectively). At the 12- and 24-month evaluation, closure rates did not show a statistically significant difference between the groups (p=0.056 and p=0.090, respectively). Preoperative and 1-month VCSS measurements did not show a statistically significant difference between groups (p>0.05 for all comparisons). The 6- and 12-month 24-month VCSS measurements of Group A were significantly higher than those in Group B. (p=0.043, p=0.009 and p=0.002, respectively). ConclusionBoth RFA and CAC were found to be effective in the treatment of large-diameter GSV incompetency. The complication rates were similar between the two techniques. CAC had a shorter procedure time. Although the closure rates in the early postoperative period were better in the RFA group, long-term follow-up demonstrated similar patency rates. The functional results in the long-term follow-up were better in the RFA group.