Duration Of Postoperative Recovery Research Articles

A Modified Approach for Minimally Invasive Tubular Microdiscectomy for Far Lateral Disc Herniations: Docking at the Caudal Level Transverse Process.

Background and Objectives: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery after far-lateral disc herniations (FLDH). In this technical note, the technique of docking the tubular retractor on the caudal transverse process is described for an efficient approach with a decreased need for manipulation of the exiting nerve root. Materials and Methods: The case reported is that of a woman affected by a right-sided FLDH at the L4–5 level causing an L4 radiculopathy with weakness and numbness. A review of the literature for FLDH regarding the key anatomy used during a far lateral approach was also performed. Results: The patient showed a significant improvement of her dorsiflexion weakness and radiating leg pain at her 2-week and 5-week post-operative visits, and at a 6-month follow-up she had near-complete relief of her symptoms, including resolution of foot numbness. Prior techniques for tubular microdiscectomy for FLDH report docking on the facet joint, pars interarticularis, and the cranial transverse process. Conclusions: This technical note details that the utility of docking a tubular retractor at the caudal transverse process improves upon already established techniques for minimally invasive tubular discectomy for FLDH.

Trans-radial versus trans-femoral approach for cerebral angiography: a meta-analysis of randomized controlled trials.

Both the trans-radial approach (TRA) and the trans-femoral approach (TFA) have been employed for cerebral angiography, but the relative advantages of these two techniques remain uncertain. To compare the relative safety and efficacy of the TRA and TFA when conducting cerebral angiography. Relevant studies published up to August 2022 were identified in the PubMed, Embase, and Wanfang databases. The rate of successful cerebral angiography was the primary study endpoint, while secondary endpoints included successful puncture rates, operative duration, puncture time, fluoroscopic duration, complication rates, and duration of postoperative recovery. This meta-analysis incorporated 6 randomized controlled trials (RCTs) enrolling 542 and 539 patients who underwent TRA and TFA cerebral angiography, respectively. Comparable pooled successful puncture rates (p = 0.05), successful cerebral angiography rates (p = 1.00), and operative duration (p = 0.10) were observed when comparing these two groups of patients. Relative to the TFA, the TRA was associated with a significantly reduced puncture time (p < 0.00001), a decreased fluoroscopic duration (p < 0.00001), lower rates of complications (p < 0.00001), and more rapid postoperative recovery (p < 0.00001). Significant heterogeneity was found when analyzing the puncture duration (I2 = 98%), operative duration (I2 = 97%), and fluoroscopic duration (I2 = 82%). These results suggest that TRA and TFA cerebral angiography strategies can yield similar rates of successful cerebral angiography outcomes. However, complication rates are lower and postoperative recovery is more rapid for patients who undergo TRA cerebral angiography as compared to TFA cerebral angiography.

Surgical Improvement of Breast Abscess in Lactating Mothers

Objective: To examine the overall diagnostic and the surgical outcomes among lactating females of breast abscesses who were treated using minimally invasive procedures. Methods: This descriptive case series study was conducted during the seven months from May 2019 to November 2019. At the general surgery department of Liaquat University of Medical &amp; Health Sciences, Jamshoro, treated 60 lactating female patients with probable breast abscesses, with an age of more than 18 years. Percutaneous drainage insertion and ultrasound guided fine needle aspiration (FNA) were used in the treatment of breast abscesses in a minimally invasive manner. Ultrasound-guided fine needle aspiration was performed during drainage installation, followed by the insertion percutaneously of the ordinary drainage catheter through a prick incision. Data was collected by study proforma and SPSS version 20 was used for the analysis of data. Results: Average age of the females was 40 years. Clinical inflammation like puerperal mastitis was in 24(40%) patients, non-puerperal mastitis was in 27(45%) of the cases and other inflammation like as folliculinids and infected seroma were in 9(15%) patients. Fibrocystic variation was seen in 58 percent of the participants. 67 percent of non-puerperal mastitis patients had fibrocystic variations, 17 percent of puerperal mastitis patients had fibrocystic variations, and 56 percent of the other patients with other inflammatory forms had fibrocystic variations. Early problems occurred in 12 of every 60 patients (20%) whose are treated using minimally invasive procedures. Conclusion: As per study conclusion, fine needle aspiration (FNA) as per ultrasound guidance minimally invasive therapy combined with antibiotic treatment was observed to be the effective treatment approach for breast abscesses, and it is also a feasible and safe in terms of less post-operative recovery duration, complications, and hospital stay. Keywords: lactating mothers, Abscess, breast, surgery

Safety and Cost-Effectiveness of Interscalene Brachial Plexus Block With Sedation in Reverse Total Shoulder Replacement.

AimsTo investigate the safety and cost-effectiveness of interscalene brachial plexus block/regional anaesthesia (ISB-RA) in patients undergoing reverse total shoulder replacement.Patients and methodsThis retrospective study included 15 patients with symptomatic rotator cuff arthropathy who underwent reverse total shoulder arthroplasty (rTSA) under ISB-RA without general anaesthesia in the beach chair position from 2010 to 2018. The mean patient age was 77 years (range 59-82 years). Patients had associated medical comorbidities: American Society of Anesthesiologists (ASA) grade 2-4. Assessed parameters were: duration of anaesthesia, intra-operative systolic blood pressure variation, sedation and vasopressor use, duration of post-operative recovery, recovery scores, length of stay, and complications. A robust cost analysis was also performed.ResultsThe mean (range) duration of anaesthesia was 38.66 (20-60) min. Maximum and minimum intra-operative systolic blood pressure ranges were 130-210 and 75-145 mmHg, respectively (mean [range] drop, 74.13 [33-125] mmHg). Mean (range) propofol dose was 1.74 (1-3.0) mg/kg/h. The Median (interquartile range) post-operative recovery time was 30 (20-50) min. The mean (range) postoperative recovery score (local scale, range 5-28 where lower values are superior) was 5.2 (5-8). The mean (range) length of stay was 8 (1-20 days); the two included patients with ASA grade 2 were both discharged within 24 hours. One patient with predisposing history developed pneumonia; however, there were no complications related to ISB-RA. The mean (range) cost per patient was £101.36 (£59.80-£132.20).ConclusionsOur data demonstrate that rTSA under ISB-RA is safe, comfortable, and cost-effective. Notably, patients with ASA grade 2 who underwent rTSA under ISB-RA had a reduced length of stay and were discharged within 24 hours.Clinical relevance rTSA under ISB-RA is potentially a safe, cost-effective, and viable alternative for patients with multiple comorbidities.

Effect of General Anesthesia with Thiopental Sodium and Propofol on the 1- and 5 minute Apgar newborns by Cesarean

Background: The Apgar score of newborn babies is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol and thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ Apgar score. Methods: In this double-blind clinical trial, a total of 100 healthy women who volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical. Babies’ Apgar score 1 and 5 minutes after birth and recovery period and some of the critical maternal parameters after operation were recorded. The obtained data were analyzed by SPSS 19 software. Results: Apgar score I minute 1 (p=0.317) and Apgar score in minute 5 (p=1.00) for propofol group were not different meaningfully. The groups had significant differences in the indices such as first systolic (P=0.00) and diastolic (P=0.00) pressure in recovery, last diastolic pressure in recovery (P=0.001) and duration of postoperative recovery (P=0.001). Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather than the thiopental group (p=0.000). Conclusion: Propofol and thiopental did not differ significantly in Apgar score, but it seems that propofol can be a better option to induce anesthesia for an elective cesarean operation.

Patient Expectations of Adult Spinal Deformity Correction Surgery

There is a growing interest in examining preoperative expectations as a potential predictor of postoperative outcome. However, it has never been studied in the setting of adult spinal deformity (ASD). This study aims to characterize patient expectations before ASD surgery and examine the relationship between preoperative expectation and postoperative patient-reported outcomes (PROs). Analysis of prospectively collected clinical and PRO data was performed on patients who underwent ASD surgery. Inclusion criteria were age >18 years, a diagnosis of ASD, >3 vertebral level instrumentation, and completed pre- and postoperative surveys. The preoperative expectation survey included expectations of surgical outcome, pain reduction, complications, and the duration of postoperative recovery. Relationships between patient expectations and PROs were assessed. Twenty-seven patients who underwent operative management of ASD met the inclusion criteria. In their preoperative survey, 66% of patients expected highly successful surgery, whereas 22% had a moderate expectation of complications. Patients anticipated an average 71% reduction in back pain (range 42%-100%) and 68% reduction in leg pain (range 0%-100%). Patients who met their expectations of leg pain reduction had significantly greater satisfaction scores than those who did not. There were moderate-to-strong positive correlations between preoperative expectation and observed improvement in back pain, leg pain, and mental health. While substantial variability in patient expectation exists for the surgical management of ASD, patients anticipated a positive outcome with a significant reduction in pain. Greater postoperative satisfaction was associated with patients who met the expected improvement in leg pain. Preoperative expectation was positively correlated with change in pain and mental health scores.

Ministernotomy versus conventional sternotomy for aortic valve replacement: matched propensity score analysis of 808 patients

The proportion of minimally invasive approaches is rising in cardiac surgery, in part driven by increasing patient demand. This study aimed to perform a risk-adjusted comparison of mortality, rate of stroke and perioperative morbidity of aortic valve replacement (AVR) conducted through either partial mini-sternotomy or conventional sternotomy. Between July 2009 and July 2012, data from 984 consecutive patients undergoing isolated AVR were prospectively recorded. In 44.3% (n = 436), the less invasive partial mini-sternotomy was used. Propensity score matching was performed based on 15 preoperative risk factors to correct for selection bias. In-hospital mortality, stroke rate as well as other major complications in the minimally invasive group and conventional sternotomy group were compared in 404 matched patient pairs (total 808). In-hospital mortality and rate of postoperative intra-aortic balloon pump use were identical for propensity-matched patients, 1.0% (4 in each group). The rate of stroke [OR (95% confidence interval (CI)): 0.80 (0.22-2.98)], perioperative myocardial infarction [OR (95% CI): 2.00 (0.18-22.06)], low-output syndrome [OR (95% CI): 0.90 (0.37-2.22)], new onset of dialysis [OR (95% CI): 1.25 (0.49-3.17)] and re-exploration for bleeding [OR (95% CI): 0.88 (0.50-1.56)] were similar. Likewise, resource utilization (operation time, duration of stay in the intensive care unit and in-hospital stay) and valve selection (type and size) was not affected by the surgical approach either. AVR can be safely conducted through a partial mini-sternotomy. This approach is not associated with an increased rate of complications. However, wide CIs reflect the still prevailing statistical uncertainty in estimates, not excluding patient-relevant differences between approaches. Large trials, which also address end points, such as postoperative pain, duration of postoperative recovery and quality of life, are needed to clarify the role of minimally invasive AVR.

Coagulopathy in a subtype of choledochal cyst and management strategy.

To evaluated our management algorithm of the coagulopathy. We evaluated our management algorithm of the coagulopathy. Between October 2001 and January 2013, 160 CDC children with coagulopathy (fibrinogen, FIB < 2 g/L) were recruited. FIB ≥ 1 g/L is generally required for safe elective surgery. We used FIB level as an indicator when: (1) patients with FIB levels between 1-2 g/L underwent one-stage definitive operation; and (2) patients with FIB < 1 g/L underwent 3 d of medical treatment. Thereafter, those with FIB ≥ 1 g/L underwent one-stage definitive operation whereas those with FIB < 1 g/L underwent external biliary drainage to allow liver function improvement. Those patients with liver function improvements underwent definitive operation after 7 d of drainage. After preoperative optimization, 92.5% of CDC children with coagulopathy underwent successful one-stage definitive operation. The remaining 7.5% of CDC children required initial external bile drainage, and underwent definitive operation 11 d after the admission. The mean operative time and postoperative recovery duration were comparable to those with normal coagulations. The median follow-up period was 57 mo. No blood transfusion or other postoperative complications were encountered. Following our management protocol, the majority of CDC children with coagulopathy can be managed with one-stage definitive operation.

Caesarean deliveries by Pfannenstiel versus Joel-Cohen incision: A randomised controlled trial

This study was designed to compare the Pfannenstiel versus Joel-Cohen incisions during caesarean deliveries. Women undergoing caesarean deliveries (n=153) were randomly assigned to the conventional Pfannenstiel or the Joel-Cohen incision. The outcome measures included postoperative pain, requirement for analgesics, operative time and other postoperative data. Maternal age, parity, gestational age and indications for caesarean delivery were similar across groups. Total operative time, postoperative recovery duration, time to get out of bed, to walk straight without support, to detect audible intestinal sounds and to pass gases or stools were shorter in the Joel-Cohen group. Postoperative haematocrit decreases and estimated intraoperative blood loss were similar between the two techniques. Moderate and severe pain at 6, 12 and 18 hours postoperatively was less frequent after the Joel-Cohen technique. Joel-Cohen incision in the non-scarred abdomen may provide a faster technique for caesarean section with less postoperative pain and probably early postoperative recovery in our circumstances.

Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial

A laparoscopic approach to pyloromyotomy for infantile pyloric stenosis has gained popularity but its effectiveness remains unproven. We aimed to compare outcomes after open or laparoscopic pyloromyotomy for the treatment of pyloric stenosis. We did a multicentre international, double-blind, randomised, controlled trial between June, 2004, and May, 2007, across six tertiary paediatric surgical centres. 180 infants were randomly assigned to open (n=93) or laparoscopic pyloromyotomy (n=87) with minimisation for age, weight, gestational age at birth, bicarbonate at initial presentation, feeding type, preoperative duration of symptoms, and trial centre. Infants with a diagnosis of pyloric stenosis were eligible. Primary outcomes were time to achieve full enteral feed and duration of postoperative recovery. We aimed to recruit 200 infants (100 per group); however, the data monitoring and ethics committee recommended halting the trial before full recruitment because of significant treatment benefit in one group at interim analysis. Participants, parents, and nursing staff were unaware of treatment. Data were analysed on an intention-to-treat basis with regression analysis. The trial is registered with ClinicalTrials.gov, number NCT00144924. Time to achieve full enteral feeding in the open pyloromyotomy group was (median [IQR]) 23.9 h (16.0-41.0) versus 18.5 h (12.3-24.0; p=0.002) in the laparoscopic group; postoperative length of stay was 43.8 h (25.3-55.6) versus 33.6 h (22.9-48.1; p=0.027). Postoperative vomiting, and intra-operative and postoperative complications were similar between the two groups. Both open and laparoscopic pyloromyotomy are safe procedures for the management of pyloric stenosis. However, laparoscopy has advantages over open pyloromyotomy, and we recommend its use in centres with suitable laparoscopic experience.

Laparoscopic Removal of an Intravesical Foreign Body After Laparoscopically Assisted Vaginal Hysterectomy

A foreign body in the bladder is a rare occurrence. Although most intravesical foreign bodies can be removed successfully using endoscopic transurethral extraction, suprapubic cystotomy may be required for the removal of large bodies. We report a case of an intravesical mass 8 cm in diameter that was successfully removed using laparoscopic cystotomy without further complications. The foreign body was a leiomyoma of the uterus that had not been removed during laparoscopically assisted vaginal hysterectomy. The myoma entered into the bladder through a defect that was not diagnosed nor repaired until after the vaginal extraction portion of the laparoscopically assisted vaginal hysterectomy. Laparoscopic removal of intravesical foreign bodies is desirable because it can shorten the duration of postoperative recovery, decrease morbidity, and reduce the incidence of postoperative complications. Laparoscopy is a useful modality for resolving complications within the urinary bladder.

Evaluation of early period physical performance, physical activity, pain and disability levels of patients operated for cervical disc hernia

Abstract. Study design: A prospective study made into cervical disc hernias.Objectives: To assess the changes in the early postoperative period of the patients with cervical disc hernia in terms of the painand disability we measured according to ‘The Neck Pain and Disability Scale’, physical performance, fatigue, fear of activity(kinesiophobia), physical activity levels.Setting: Neurosurgical department.Summaryofbackgrounddata: Kinesiophobiaanditsassociatedavoidancebehaviorinthedevelopmentofchronicmusculoskeletalpain has been of great concern over the past decade, thus rendering appropriate and detailed assessments in the postoperativeperiod very important.Methods: Sixteenpatients operated onbecause ofcervical discherniawereincluded inourstudy. Thepain anddisability, physicalperformance, fatigue, kinesiophobia, and physical levels of the patients were evaluated pre-postoperatively, during discharge andat the end of the second month.Results: While pain, disability measured according to ‘The Neck Pain and Disability Scale’ fatigue were decreasing, allperformance measurements except the sit/stand, lying/sit and loaded reach were getting highest scores on the 2nd postoperativemonth. Although kinesiophobia, peaked at the 2nd postoperative month, physical activity level had also arrived the preoperativelevel at this time.Conclusion: Increased kinesiophobia, affected the physical performances and physical activity levels of the patients in daily livesin spite of decreased pain, disability and fatigue. Kinesiophobia had effects on postoperative recovery duration, daily life, andreturn to work. A detailed evaluation should be performed particularly for kinesiophobia in early postoperative period.Keywords: Cervical fusion, neck pain, performance, physical activity, performance early period

Anesthetic management of laparoscopic adrenalectomy for pheochromocytoma

To investigate the anesthetic management features of laparoscopic adrenalectomy for pheochromocytoma. Twelve patients scheduled for laparoscopic adrenalectomy for pheochromocytoma under general anesthesia were allocated into group 1, while another 12 patients who received transabdominal adrenalectomy for pheochromocytoma under general anesthesia were selected as group 2. The hemodynamic changes and the postoperative recovery profiles between the two groups were compared. Hemodynamic fluctuation occurred during carbon dioxide insufflation and tumor manipulation in group 1. However, there were no differences between the two groups. Duration of post operative recovery and hospital stay as well as requirement of analgesics in group 1 were significantly lower than those in group 2 (P < 0.05). Hemodynamic fluctuation still exists during laparoscopic adrenalectomy for pheochromacytoma. However, patients undergoing such surgical procedure recover faster as compared with open surgery.

Laparoscopic versus open vertical banded gastroplasty for the treatment of morbid obesity.

Vertical banded gastroplasty (VBG) is an effective treatment for morbid obesity. Recent advancement in laparoscopic surgery has made laparoscopic VBG possible. The authors compared retrospectively the outcomes of laparoscopic VBG versus open VBG in patients with morbid obesity. From June 1998 to April 1999, 100 patients (18 men, 82 women; average age, 32.6 years) underwent laparoscopic VBG, and 40 patients (7 men, 33 women; average age, 28.8 years) underwent conventional open VBG. The two groups were similar regarding sex, age, and body mass index distribution. Mean surgical time, blood loss estimate, duration of postoperative recovery, analgesic usage, complications, and weight reduction were compared among the two groups. Laparoscopic VBG was successful in 99 (99%) of the 100 patients. Mean surgical time was longer in duration for the laparoscopic VBG group than it was for the open VBG group (173 vs. 101 minutes, P < 0.01). The laparoscopic VBG group had earlier flatus passage (1.9 vs. 2.6 days; P < 0.01), less usage of analgesics (meperidine 50 mg/unit; 0.9 vs. 2.3 units; P < 0.01), and a shorter postoperative hospital stay (3.7 vs. 6.0 days; P < 0.01). Estimated blood loss, surgical complication rate, and weight reduction were similar among the two groups. Although laparoscopic VBG required a longer surgical time and was technically more demanding, it resulted in shorter recovery time, less analgesic use, and less severe physical discomfort. The authors' findings show that the two methods were approached safely equally.

Laparoscopic Versus Open Vertical Banded Gastroplasty for the Treatment of Morbid Obesity

Vertical banded gastroplasty (VBG) is an effective treatment for morbid obesity. Recent advancement in laparoscopic surgery has made laparoscopic VBG possible. The authors compared retrospectively the outcomes of laparoscopic VBG versus open VBG in patients with morbid obesity. From June 1998 to April 1999, 100 patients (18 men, 82 women; average age, 32.6 years) underwent laparoscopic VBG, and 40 patients (7 men, 33 women; average age, 28.8 years) underwent conventional open VBG. The two groups were similar regarding sex, age, and body mass index distribution. Mean surgical time, blood loss estimate, duration of postoperative recovery, analgesic usage, complications, and weight reduction were compared among the two groups. Laparoscopic VBG was successful in 99 (99%) of the 100 patients. Mean surgical time was longer in duration for the laparoscopic VBG group than it was for the open VBG group (173 vs. 101 minutes, P < 0.01). The laparoscopic VBG group had earlier flatus passage (1.9 vs. 2.6 days;P < 0.01), less usage of analgesics (meperidine 50 mg/unit; 0.9 vs. 2.3 units;P < 0.01), and a shorter postoperative hospital stay (3.7 vs. 6.0 days;P < 0.01). Estimated blood loss, surgical complication rate, and weight reduction were similar among the two groups. Although laparoscopic VBG required a longer surgical time and was technically more demanding, it resulted in shorter recovery time, less analgesic use, and less severe physical discomfort. The authors' findings show that the two methods were approached safely equally.