Postoperative Recovery Period Research Articles

Myringoplasty Using Human Birth Tissue Allografts to Repair Large Tympanic Membrane Perforations.

Examine outcomes among a series of pediatric patients who underwent myringoplasty using human birth tissue (BT) for repair of large tympanic membrane (TM) perforations. Case series. Single-institution pediatric hospital. Retrospective chart review of patients treated with BT during a 4-year study period. Subjects who underwent myringoplasty for large (size 40% or greater) TM perforations were included for this study. Patients with a stable perforation of at least 1 month's duration preoperatively who then followed up for at least 3 months postoperatively met inclusion criteria. Six subjects were included in this study. One subject underwent bilateral repair; thus, this series includes a total of 7 perforations. TM perforations ranged from 40% to 70% of the TM. At initial follow-up (median of 2 months), 5 of the 7 perforations had healed. One of these 5 had evidence of a 10% recurrent perforation at 5 months, which subsequently healed. Of the 2 patients not healed at initial follow-up, 1 had only a residual pinpoint perforation that subsequently healed; the other had a persistent 30% perforation that was possibly related to their postoperative recovery period, which was complicated by a respiratory viral illness. For large TM perforations, myringoplasty with BT grafts may be a viable alternative to longer, more invasive procedures like tympanoplasty. Larger, randomized, prospective studies are needed.

A Busoga Hernia: A Rare Case Report in India

Inguinal hernia stands as a prevalent surgical concern, often addressed either through elective procedures or as emergencies by surgeons. The indirect hernia has high propensity to bowel obstruction due to narrow constrictive ring. Direct hernia is comparatively safe from complications owing to the larger defect. Busoga hernia (BH), alternatively referred to as Gill-Ogilvie hernia, represents a seldom-seen variation of direct inguinal hernia affecting the conjoint tendon. This hernia type arises due to a weakness in the conjoint tendon and tends to manifest more frequently among young athletes. Some authors described herniation in the weakened conjoint tendon secondary to rigorous training, kicking, running and sharp turn. Busoga hernia (BH) represents an uncommon subtype of direct inguinal hernia, characterized by a heightened risk of strangulation of its contents. This risk is attributed to an exceptionally narrow neck under constant tension within a resilient fascial sling. BH may migrate into labia majora in female and rarely migrate to the scrotum in male. We encountered a case involving a male patient aged 64 years who arrived with a small painful inflammation in his right groin. Surgical exploration under general anesthesia, revealed a 1cm defect in the medial aspect of the conjoint tendon. Subsequent procedures included herniotomy and herniorrhaphy, wherein the hernial contents consisted of pre-vesical fats and a portion of the urinary bladder. Surgeons must possess a thorough understanding of the anatomy of the inguinal region to effectively manage situations with confidence. The postoperative recovery period progressed satisfactorily with good outcomes. Patient is under regular follow up.

Эффективность антисептической композиции при использовании спице-стержневых аппаратов наружной фиксации

The purpose of the study is to create and test a device that increases the effectiveness of treatment of open and sutured musculocutaneous wounds during open fractures and immersion osteosynthesis. To improve the healing process of open wounds and reduce possible complications, a group of inventions was developed, united by a common concept. One of the key elements of this group is the new composition. It helps create an aseptic environment for effective wound healing, reliably protects them from possible infections and contamination, and is also successfully used to prevent the development of purulent complications and postoperative osteomyelitis. To prepare it, you need to mix 150 mg of rifampicin, 4 mg of dexamethasone, 2.5 ml of 1 % dioxidine, 15 ml of 95 % ethyl alcohol, bringing the total volume to 100 ml using saline. This composition, used in combination with various external fixation devices, has outstanding antimicrobial, anti-inflammatory and wound healing properties. Another invention is an innovative device with a built-in dosing element, applicators and capillary tubes connected to a manifold, it provides precise and controlled delivery of the composition we have developed to the wound. This eliminates the need for frequent dressings and manual treatment of places where pins and rods penetrate or exit the body, which not only alleviates the patient’s discomfort, but also reduces the risk of developing secondary infections during the postoperative recovery period. In the period from 07/14/2021 to 05/31/2023, 15 mongrel dogs with open comminuted fractures of the right (8 heads) and left tibia (7 heads) were delivered to the veterinary clinic BION (Sevastopol), during the postoperative treatment of which they were tested antiseptic composition and modernized device. The results indicate the reliability and high efficiency of the resulting composition in the treatment and prevention of purulent-inflammatory processes in bones and soft tissues using pin-rod devices for fixation.

Role of Vestibular Rehabilitation in Patients with Superior Semicircular Canal Dehiscence Syndrome

Superior canal dehiscence syndrome (SCDS) described in 1998 is a disorder characterized by vertigo in response to loud sounds, pulsatile tinnitus, conductive hyperacusis, autophony and chronic disequilibrium. While resurfacing and/or plugging of the superior canal may improve autophony and reduce dizziness handicap, it can result in immediate and long-term deficits in VOR function, necessitating vestibular rehabilitation (VR) during the early post-operative recovery period. Case description: a 34- year-old man with a history of autophony, pulsatile tinnitus and audible eye movements in his right ear. He denied any vertigo or disequilibrium. Immediately after surgical plugging he presented severe vertigo and disequilibrium as well as deterioration of right hearing loss. Due to persistent instability, VR was performed for five months after surgery with improved outcomes. Our purpose is to emphasize and increase awareness in surgeons, especially in Latin America, the importance of VR immediately after surgery. Additionally, we make some comments about the surgical decisions in two patients with otosclerosis and SCDS and the importance of VR.

Triplane technique for breast reconstruction after breast cancer surgery: A case series report.

Implant-based breast reconstruction is an important method for post-mastectomy breast reconstruction. Currently, the most commonly used technique is the biplane technique. However, the high rate of postoperative complications, the inability of pockets to accommodate larger implants, and the expensive costs of biological mesh make the development of new surgical methods urgent. The triplane technique for breast reconstruction is an ideal candidate method. The main local symptoms were breast lump, abnormal breast skin, nipple discharge, and abnormal nipple or areola in 24 patients. The study included 24 female patients who underwent breast reconstruction using the triplane technique after radical breast cancer surgery. The surgical procedure involved measuring the dimensions of the breast, designing the incision, and creating a pocket for the implant using the triplane technique, which includes the pectoralis major muscle, the pectoralis major fascia continuing to the rectus abdominis fascia, and the latissimus dorsa muscle fascia continuing to the rectus abdominis fascia. Postoperative follow-up included regular assessments of pain and evaluation of breast appearance. No cases of postoperative infection were observed in all patients. During the 1-year follow-up period after surgery, 5 patients (20.8%) who needed radiotherapy after mastectomy for cancer showed slight darkening of skin flap pigment after using the triplane technique implant. No cases of exposure or infection of the expanders were reported, and 1 patient underwent expander replacement with a permanent prosthesis. All patients expressed satisfaction with the reconstructed breast shape. The 10 patients (41.7%) experiencing postoperative swelling and pain. However, the pain gradually subsided during the postoperative recovery period. No cases of local recurrence or distant metastasis of breast cancer were observed during the 1-year-follow-up period. The triplane technique for breast reconstruction after breast cancer surgery provides good implant coverage, reduces the risk of complications, and is cost-effective.

Acute and Persistent Postoperative Functional Decline in Children with Severe Neurological Impairment: A Qualitative, Exploratory Study.

Children with severe neurologic impairment (SNI) regularly require major surgery to manage their underlying conditions. Anecdotal evidence suggests that children with SNI experience unexpected and persistent postoperative functional changes long after the postoperative recovery period; however, evidence from the perspective of caregivers is limited. The purpose of the study was to explore the functional postoperative recovery process for children with SNI. Eligible participants were English-speaking caregivers of children with SNI between 6 months and 17 years who were nonverbal, Gross Motor Function Classification Scale level IV/V, and who had surgery/procedure requiring general anesthetic at a tertiary children's hospital between 2012 and 2022. Demographic and basic health information were collected via surveys and corroborated by a review of the child's electronic health record. Semi-structured interviews were conducted and a thematic content analysis was used to formulate results. Data from 12 primary caregiver interviews revealed four main themes: (1) functional changes and complications in the child; (2) feeling unprepared; (3) perioperative support; and (4) changes to caregiver roles. Postoperative functional decline in children with SNI was prevalent in our sample. Providing pre-operative information to families to describe this phenomenon should be a regular part of family-informed care.

(195) Penile Implants: Restoring Erectile Function Regardless of Age. A Mini–Case Series

Abstract Introduction Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction. Objective The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group. Methods The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia perioperative assessment and recommendations, details of the surgical procedure, intraoperative and postoperative recovery period, as well as clinic follow-up. Results Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intraoperative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects. Conclusions Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical comorbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant. Disclosure No.

First experience in laparoscopic surgery in low and middle income countries: A systematic review.

Laparoscopic surgery has reduced morbidity and mortality rates, shorter postoperative recovery periods and lower complication rates than open surgery. It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources. However, introducing laparoscopic surgery in low-and-middle-income countries (LMIC) can be expensive and requires resources, equipment, and trainers. To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources. MEDLINE, EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published between 1996 and 2022 with full text available in English. Exclusion criteria were studies considering only open surgery, ear, nose, and throat, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery. Ten studies out of 3409 screened papers, from eight LMIC were eligible for inclusion in the final analysis, totaling 2497 patients. Most reported challenges were related to costs of equipment and training programmes, equipment problems such as faulty equipment, and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including a reduction in hospital stay, complications, and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors. Despite financial and technical challenges, many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients. While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported, more support is critically required, in particular regarding training.

(316) Age Is Not a Number When It Comes to Penile Prosthesis Implantation. A Mini–Case Series

Abstract Introduction Given the overall aging of the population, erectile dysfunction has become an increasingly relevant issue among the elderly. When elective surgery is offered, the patient's age is often taken into consideration as a potential limiting factor. Moreover, the importance of addressing the quality of life and sexual satisfaction of older men tends to be overlooked in the management of erectile dysfunction. Objective The aim of this study is to investigate the safety of implanting penile prostheses (PP) in patients aged 90 years and older, as well as the potential complications associated with this age group. Methods The database of patients was screened between the years 2003 and 2023, to identify patients at least 90 years and older who underwent the implantation of penile prosthesis by a single surgeon at two large volume centers. We collected demographic information for the patients, including their past medical and surgical history, medication list, anesthesia peri-operative assessment and recommendations, details of the surgical procedure, intra-operative and postoperative recovery period, as well as clinic follow-up. Results Between 2003 and 2023, a total of 2000 men underwent PP surgery at the two centers. Out of the total number of patients, only two were 90 years or older at the time of implantation. One patient was a first timer, while the other had two previous PP surgeries over the span of 15 years for mechanical failure reasons. Both surgeries were performed using different device types, without any intra-operative or postoperative complications. At their three and six months follow up visits, both patients demonstrated the ability to cycle the implant smoothly, reported satisfactory penetrative intercourse with their partners, and improved sexual intimacy through Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. They were followed for a total of 1 year with no long-term negative effects. Conclusions Despite reporting only two cases in this specific cohort, it demonstrates that implantation of PP is a safe and effective treatment for elderly men with ED. Maintaining satisfactory sexual activity in this age group is vital and achievable through inflatable penile prosthesis (IPP) insertion. There are several complex factors that must be considered prior to operating on an older patient due to medical co-morbidities and age. However, with proper patient selection, pre-operative counseling and optimization, this operation can be effectively performed in patients who are at least 90 years old. Simply, age is not a limitation to undergo penile implant. Disclosure No.

Low opioid and opioid-free anesthesia - a review of current data

Introduction: Opioids are one of the most frequently used drugs during anesthesia. Due to the side effects anesthesiologists try to limit their number during anesthesia. They use low-opioid and opioid-free anesthesia. 
 Purpose: The purpose of this work is to present the current state of knowledge and recent reports on low-opioid and non-opioid anesthesia and their use. 
 Materials and Methods: The search was conducted using PubMed and GoogleScholar databases. Articles were searched in English using the following keywords: "low-opioid anesthesia," "non-opioid anesthesia," "OFA," "LOA" 
 Key words: "low-opioid anesthesia", "non-opioid anesthesia", "OFA", "LOA", "opioids". 
 Conclusion: low-opioid anesthesia techniques are being used more and more frequently and reduce the incidence of opioid side effects: respiratory depression, postoperative nausea and vomiting. This helps ensure greater patient safety and shortens the postoperative recovery period.

The Effects of Implantable Collamer Lens ICL Implantation in High Myopia Patients' Mental Health.

To investigate the psychological changes in patients pre and post implantable collamer lens (ICL, EVO) implantation surgery in the posterior chamber. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the mental states of 43 patients who underwent ICL implantation surgery performed by the same surgeon between January 2021 and December 2022. Comparing the results before and one week after the operation, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). Similarly, when comparing the pre-operation and one-month post-operation results, there is also a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). However, when comparing the one-week post-operation and one-month post-operation results, there is no significant difference in either the SAS scale (P>0.05) or the SDS scale (P>0.05). Moving on to the comparison between the pre-operation results and the national norm level, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). When comparing the one-week post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05). Similarly, when comparing the one-month post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05). After undergoing ICL implantation surgery, patients typically experience a notable decrease in anxiety (SAS) and depression (SDS) scales. These improvements gradually stabilize and enhance during the postoperative recovery period. However, it may require a significant amount of time for patients to fully restore their psychological well-being to levels comparable to the national norm, particularly in terms of anxiety levels.

A Randomized Trial Investigating the Laparoscopic Transabdominal Preperitoneal Approach for Recurrent Inguinal Hernia Repair

Background: Repairing a recurrent hernia is a challenging endeavor due to the pre-existing weakened tissues and altered anatomy. Among the available approaches, the open posterior preperitoneal approach has demonstrated significantly better outcomes compared to the anterior approach. Additionally, the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair represents an evolving technique with the advantages of minimally invasive surgery. The objective of our study is to perform a comparative analysis of these three approaches for the repair of recurrent inguinal hernias, focusing on complications and the occurrence of early recurrences. This research aims to provide valuable insights into the most effective and safe approach for managing this challenging surgical condition. Methods: In our study, we conducted a randomized allocation of 200 patients into three equal groups: Group A, Group B, and Group C. Patients in Group A underwent the open posterior preperitoneal approach, while those in Group B received transinguinal anterior tension-free repair. Group C patients underwent the laparoscopic transabdominal preperitoneal (TAPP) procedure. The primary endpoint of our study was to assess the recurrence of inguinal hernias following the respective surgical approaches. Results: Our study yielded several noteworthy findings. The mean hospital stay, time to return to work, and time off from work were all shorter in Group C when compared to Groups A and B. Chronic postoperative pain was observed in 13.33% of patients in Group A, 30% of patients in Group B, and 10% of patients in Group C. Notably, the overall complication rate was lower in both Groups A and C at 19.7%, while Group B had a higher complication rate of 34.36%. Conclusion: In the context of recurrent inguinal hernia repair, our study findings suggest that the laparoscopic and open posterior approaches are equally effective in terms of operative outcomes. The open preperitoneal hernia repair stands out as a cost-effective option with a low recurrence rate. Patients undergoing this procedure experience a relatively short postoperative recovery period and report minimal postoperative pain. This approach has demonstrated significantly better outcomes compared to the commonly used anterior approach.

Laparoscopic repair of a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury: a case report

BackgroundA diaphragmatic hernia is a prolapse of the abdominal organs into the thoracic cavity through a hole in the diaphragm. Traumatic diaphragmatic injuries are rare and usually occur after blunt or penetrating thoracic or abdominal traumas. Blunt diaphragmatic rupture rarely accounts for immediate mortality and may go clinically silent until complications occur which can be life threatening. It usually present late with intrathoracic herniation of abdominal viscera and carry a high mortality rate. We experienced a very rare case who showed repeated colon incarcerations 7 years after injury. And, we operated laparoscopically.Case presentationA 64-year-old man presented with multiple left rib fractures that occurred during an accident. After 7 years, he visited the emergency department with the chief complaint of left shoulder pain and epicardial pain after eating. He was diagnosed with transverse colon incarceration due to a left diaphragmatic hernia by computed tomography (CT) and X-ray imaging. Surgical repair was recommended, but he refused as the symptoms improved. Fourteen months later, the patient revisited the hospital in similar symptoms and improved spontaneously. He consulted our hospital for the surgical indication. We recommended that he undergo surgery, showing images of the X-ray and CT when his transverse colon was obstructed and he felt pain and when symptoms improved. Finally, he decided to undergo surgery. We performed diaphragmatic hernia repair with laparoscopic direct suturing in good view. The patient experienced an uneventful postoperative recovery period. The absence of diaphragmatic herniation recurrence was confirmed seven months after surgery.ConclusionsWe experienced a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury and performed surgical repair laparoscopically.

Research Electronic Data Capture (REDCap) in an outpatient oncology surgery setting to securely email, collect, and manage survey data.

Nursing interventions in the post-operative time period including psychological and emotional support, adverse event education, and instructions for follow-up care contribute patient satisfaction, safety, and quality of life. However, the time spent in the post-anesthesia care unit (PACU) and hospital continues to shorten around the world to reduce health care spending and improve patient outcomes. Nurses conducting research during the important post-operative recovery period need to utilize unique techniques and emerging technologies to contact, recruit and collect data outside of the hospital setting including the Research Electronic Data Capture (REDCap) platform. This paper describes the feasibility and acceptability, facilitators and barriers of the software application, REDCap, to complete a repeated-measures, descriptive correlational study in patients undergoing outpatient breast cancer surgeries. The recruitment, data collection and storage were completed utilizing the secure REDCap Platform. The Institutional Research Board (IRB)-approved study was a repeated-measures, descriptive, correlational study with data collection at three time points. The data points aligned with important transitions and routine visits to improve data collection feasibility and increase relevance to clinical practice. The sample consisted of women diagnosed with breast cancer undergoing breast conserving surgery between August 15 and October 15, 2020. There were 123 potential participants, of which 76 started the surveys and 75 participated (61%) responded and participated in the study on Post-operative Day 1. Fifty-nine participants (78%) completed the surveys on post-operative Day 14. As the frequency of outpatient treatment increases, nurses conducting post-operative research will need to collect the data outside of the hospital setting. Email provides a method of studying new phenomena by recruiting participants, providing information about the study, and collecting results in a non-traditional setting. REDCap provides a method to facilitate nursing research through a securely encrypted integrated process.

Preliminary Survey in preparation for the implementation of ERAS at Dr Soetomo Hospital

Background&#x0D; Medical science has developed rapidly. One of them is ERAS (Enhanced Recovery After Surgery) which is a multidisciplinary team development pathway for perioperative methods that offer a variety of benefits. Some of the advantages of the ERAS method are speeding up the post-operative recovery period, economic benefits, and shortening the Length of Stay (LOS) by minimizing surgical stress so that the patient quickly returns to a normal physiological state.&#x0D; Objective&#x0D; This study aims to analyze the readiness of the team that will support the ERAS application at General Academic Hospital (RSUD) Dr Soetomo.&#x0D; Methods&#x0D; This is an observational analytic study with a cross-sectional design using a questionnaire. Patient baseline data were taken from the examination at the anesthesiology outpatient clinic. Assessment for patient understanding was carried out directly after a brief explanation of ERAS method by the researcher. The patient's level of understanding was assessed by two investigators and rated on a scale of 1 to 5. Primary data and assessment of understanding of doctors and medical personnel were filled in independently by research subjects on online forms and rated on a scale of 1 to 5. Data was collected from March 23 to April 14 2022, at RSUD Dr. Soetomo Surabaya. The analysis results are considered significant if the p-value is less than 0.05. The analysis was carried out using SPSS 19 software.&#x0D; Results &#x0D; Most patients planned to undergo surgery in the field of urology (82.9%), followed by caesarean section (14.6), and almost all patients or their families agreed to surgery using the ERAS method (95.1%). The medical team consists of 110 doctors from 4 areas of expertise, namely specialist doctors and residents in anesthesiology, urology surgery, obstetrics and gynecology, as well as orthopedics and traumatology. The health team consists of 56 personnel, namely anesthesiologists, surgeons, recovery room nurses, nutritionists and pharmacists. The majority (61%) of health workers had heard about ERAS and stated that ERAS was ready to be implemented at RSUD Dr. Soetomo (89%). Most doctors stated that ERAS was ready to be implemented at Dr. Soetomo and its human resources and facilities are considered qualified.&#x0D; Conclusion&#x0D; The ERAS method at RSUD Dr. Soetomo is considered quite ready to start, especially the Obsgyn study program, which is supposed to have an excellent level of understanding of ERAS and is enthusiastic to begin immediately. The patient group can be said to understand and accept the ERAS method well as a perioperative method for handling their cases.

Abstract 005: Outcomes of Heparin Induced Thrombocytopenia Type II in Aneurysmal Subarachnoid Hemorrhage Patients

Introduction Heparin‐induced thrombocytopenia (HIT) is a rare complication characterized by a decreased platelet count and hypercoagulability following heparin and light‐molecular weight heparin administration. Both anticoagulants can be used intraoperatively and postoperatively for DVT prophylaxis in patients undergoing subarachnoid hemorrhage (SAH) treatment. Patients with SAH are an understudied population in terms of assessing incidence and impact of HIT. This study aims to investigate the incidence, complications, and outcomes of SAH patients who develop HIT. Methods ICD‐9‐CM and ICD‐10‐CM codes were used to query the National Inpatient Sample for patients with SAH between 2010 and 2019. Subgroup analysis was stratified by HIT development. SAH severity was determined using the National Institute of Health Stroke Scale as a template. Patients from both groups were assessed for baseline clinical characteristics, comorbidities, interventions, complications, and outcomes. Cohorts containing ten or fewer patients must only be described qualitatively. Descriptive statistics, multivariate regressions, and propensity score‐matching were all performed using IBM SPSS 28. Results 76,387 patients were diagnosed with SAH between 2010 and 2019. 166 (.22%) had developed HIT in response to anticoagulant administration. The incidence of HIT was higher in patients who were younger (58.04 vs 61.39, p = 0.01), obese (0.4% vs 0.2%, p &lt; 0.01), on long‐term anticoagulant use (10.84% vs 5.72%, p &lt; 0.01), and had an implanted cerebrospinal fluid drainage device (p &lt; 0.01). Patients with HIT were associated with higher SAH severity (1.42 vs 1.06, p &lt; 0.01). Through both the complete cohort and propensity score‐matched cohort, patients with HIT were associated with higher rates of endovascular coiling, external ventricular drain placement (p &lt; 0.01), and ventriculoperitoneal shunt placement (p &lt; 0.01). HIT patients had significantly higher rates of deep vein thrombosis (p &lt; 0.01), pulmonary embolism (p &lt; 0.01), central venous sinus thrombosis (p = 0.01), pneumonia (p &lt; 0.01), urinary tract infection (p &lt; 0.01), acute kidney injury (p &lt; 0.01), and cerebral vasospasm (p &lt; 0.01). Patients who develop HIT had a longer length of stay (LOS) (24.04 vs 10.48, p &lt; 0.01). HIT continued to be a significant predictor of having an above average LOS (OR: 6.799, CI: 3.985 ‐ 11.6, p &lt; 0.01) when controlling for age, SAH severity, and significant comorbidities. Conclusion Our study revealed that younger SAH patients with various comorbidities are more prone to developing HIT, leading to higher rates of thrombotic events, acute kidney injury, and nosocomial infections, which can significantly prolong their hospital stay. Considering the extended postoperative recovery period for SAH, investigating the causes of HIT can facilitate earlier detection and prevention of thrombotic complications. This nationwide, multicenter, retrospective study provides valuable insights for clinicians on how to prevent and manage HIT in patients with subarachnoid hemorrhage.

Intraobserver and Interobserver Reliability of the Snyder and Expanded SLAP Classification System: A Video Study

Background: Superior labral anterior and posterior (SLAP) tears are a common finding in overhead athletes. The original classification system produced by Snyder in 1990 contained 4 types of SLAP tears and was later expanded to 10 types. The classification has been challenging because of inconsistencies between surgeons making diagnoses and treatments based on the diagnosis. Furthermore, patient factors—such as age and sports played—affect the treatment algorithms, even across similarly classified SLAP tears. Purpose: To (1) assess the interobserver and intraobserver reliability of the Snyder and expanded SLAP (ESLAP) classification systems and (2) determine the consistency of treatment for a given SLAP tear depending on different clinical scenarios. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 20 arthroscopic surgical videos and magnetic resonance imaging scans of patients with SLAP tears were sent to 20 orthopaedic sports medicine surgeons at various stages of training. Surgeons were asked to identify the type of SLAP tear using the Snyder and ESLAP classifications. Surgeons were then asked to determine the treatment for a SLAP tear using 4 clinical scenarios: (1) in the throwing arm of an 18-year-old pitcher; (2) in the dominant arm of an 18-year-old overhead athlete; (3) a 35-year-old overhead athlete; (4) or a 50-year-old overhead athlete. Responses were recorded, and the cases were shuffled and sent back 6 weeks after the initial responses. Results were then analyzed using the Fleiss kappa coefficient (κ) to determine interobserver and intraobserver degrees of agreement. Results: There was moderate intraobserver reliability in both the Snyder and ESLAP classifications (κ = 0.52) and fair interobserver reliability for both classification systems (Snyder, κ = 0.31; ESLAP, κ = 0.30; P &lt; .0001) among all surgeons. Additionally, there was only fair agreement (κ = 0.30; P &lt; .0001) for the treatment modalities chosen by the reviewers for each case. Conclusion: This study demonstrated that SLAP tears remain a challenging problem for orthopaedic surgeons in diagnostics and treatment plans. Therefore, care should be taken in the preoperative discussion with the patient to consider all the possible treatment options because this may affect the postoperative recovery period and patient expectations.

Preoperative care dependency and postoperative quality of recovery of the surgical patients

Objective The purpose of the study was to determine the relationship between preoperative care dependency and postoperative quality of recovery in patients undergoing surgery. Methods The sample of the descriptive, cross-sectional and correlational study consisted of 215 patients. A Patient Information Form, the Care Dependency Scale and the Recovery Quality-40 Scale were applied to the patients through face-to-face interview technique in order to collect the data between June and December 2018. This study adhered to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results There was a statistically significant difference between Care Dependency Scale and the Recovery Quality-40 Scale mean scores of the patients and their physical comfort, physical independence, and pain in terms of age groups and genders (p&lt;.05). A positive and moderate correlation was found between the patients’ care dependency and physical independence. Conclusion It was observed that when the care dependency level decreased, the patients needed less assistance throughout the postoperative recovery period, as they were able to carry out their daily activities independently.

The Effect of Warmed Serum on Shivering and Recovery Period of Patients Under General and Spinal Anesthesia: A Randomized Clinical Trial

PurposePostoperative hypothermia followed by shivering is a common phenomenon in patients undergoing surgery under anesthesia, and should be prevented and treated in postoperative patient care units. This study was conducted to investigate the effect of warmed serum injection on postoperative shivering and recovery period of patients operated under general and spinal anesthesia. DesignIn this clinical trial, patients to be operated on under general and spinal anesthesia were randomly assigned into two groups of test and control. In the test group, patients received warmed intravenous fluids and blood products. All patients were monitored to record vital signs, incidences of hypothermia and shivering, and recovery period. MethodsThe collected data were analyzed with repeated measures analysis of variance to detect significant differences between groups and significant changes within groups over time. FindingsThe incidence of nausea, vomiting, and shivering in the intervention and control groups was (4.7%, 42%), (2.8%, 16.8%), and (6.6%, 43%), respectively. Patients in the intervention group had higher body temperature than the control group (<0.001). Also, patients under spinal anesthesia had higher body temperature than patients under general anesthesia (<0.001). Blood pressure reduction was also significantly higher in the control group than in the intervention group. The patients who received warm intravenous serum, and especially those who had received spinal anesthesia spent less time in the recovery room (<0.001). ConclusionsThe use of warmed intravenous serum increased the patients’ core temperature, reduced their postoperative shivering, and shortened their recovery period. Considering the potential risks associated with hypothermia, using such methods for hypothermia prevention can be highly effective in preventing shivering and prolongation of the recovery period and other potential complications. Anesthesia specialists and technicians are therefore encouraged to use this method as a preventive measure.

Experience with ultrasound neurography for postoperative evaluation of targeted muscle reinnervation.

Targeted muscle reinnervation (TMR) was originally developed as a means for increasing intuitive prosthesis control, though later found to play a role in phantom limb pain and neuroma prevention. There is a paucity of literature describing the clinical course of patients with poor TMR surgical outcomes and the value of imaging in the postoperative recovery period. This report will illustrate the potential utility of ultrasound neurography to accurately differentiate TMR surgical outcomes in two patients that received upper extremity amputation and subsequent reconstruction with TMR. Ultrasound evaluation of TMR sites in patient 1 confirmed successful reinnervation, evident by nerve fascicle continuity and eventual integration of the transferred nerve into the target muscle. Conversely, the ultrasound of patient 2 showed discontinuity of the nerve fascicles, neuroma formation, and muscle atrophy in all three sites of nerve transfer, suggesting an unsuccessful procedure and poor functional recovery. Ultrasound neurography is uniquely able to capture the longitudinal trajectory of rerouted nerves to confirm continuity and eventual reinnervation into muscle. Therefore, the application of ultrasound in a postoperative setting can correctly identify instances of failed TMR before this information would become available through clinical evaluation. Early identification of poor TMR outcomes may benefit future patients by fostering the discovery of failure mechanisms and aiding in further surgical planning to improve functional outcomes.