Management Of Postoperative Symptoms Research Articles

Investigation of Effects of Preoperative Readiness on Symptom Management in Patients with Intestinal Stoma: A Systematic Review and Meta-Analysis Study.

This study aims to examine the effect of preoperative readiness on postoperative symptom management in patients with intestinal stoma through systematic review and meta-analysis. "Intestinal stoma", "complications" and other related terms were searched regardless of the language of publication in the publications published in the databases until December 29, 2021. As a result, 30 studies were found. Two independent reviewers reviewed the studies, and the methodological quality of the included studies was assessed using the Health Evidence™ Quality Assessment Tool. The Comprehensive Meta-Analysis 3 was used to analyze the data. Publication bias, funnel plot, and the effect size were calculated using Cohen's kappa. Preparation for intestinal stoma surgery consisted of two main themes, and postoperative complications/problems consisted of nine sub-themes. The meta-analysis results showed that preoperative readiness had a moderate effect size on postoperative complications (d=0.498, d=0.457). It was thus concluded that preoperative practices were significant and effective in postoperative symptom management.

Review of patient experience with bilateral sagittal split osteotomies as a day case procedure

Historically, patients who received bilateral sagittal split osteotomies (BSSO) required an inpatient admission for at least one night. Since March 2015, the Oral and Maxillofacial Department at the Royal Gwent Hospital has performed bilateral sagittal split osteotomies (BSSO) as a day case procedure for their medically and socially fit patients. Our team’s service evaluation by Davies et al (2018) for this procedure, demonstrated that this could be done both routinely and successfully, whilst conforming to national day case procedural standards. The aim of this satisfaction survey was to evaluate this procedure from a patient’s perspective, to further consolidate our results from 2018. The forty-five patients who underwent day case BSSO (DCBSSO) between February 2015 and February 2020 were retrospectively identified and deemed eligible for inclusion. Participation involved completion of a 10-part questionnaire via telephone consultation. Patients were asked questions focussing on their experience of discharge timing, management of postoperative symptoms, and overall recovery at home. Twenty-four patients consented to partake in the survey (response rate of 73%). Twenty-three (96%) were extremely happy to be discharged the day of their surgery and felt that the timing of discharge was appropriate. Only 17% of patients experienced discomfort overnight and 96% of these stated they could manage their symptoms at home. From this survey, we can confirm that the majority of patients receiving DCBSSO at the Royal Gwent Hospital were happy to be discharged the day of their surgery and recover at home.

Preliminary Normative Standards of the Mayo Clinic Esophagectomy CONDUIT Tool.

ObjectiveTo collect patient-reported outcomes after esophagectomy to establish a set of preliminary normative standards to aid in symptom-score interpretation.Patients and MethodsPatients undergoing esophagectomy often have little understanding about postoperative symptom management. The Mayo Clinic esophageal CONDUIT tool is a validated questionnaire comprising 5 multi-item symptom-assessment domains and 2 health-assessment domains. A prospective nonrandomized cohort study was conducted on adult patients who have had esophagectomies using the CONDUIT tool from August 17, 2015, to July 30, 2018 (NCT02530983). The Statistical Analysis System v9.4 (SAS Institute Inc., Cary, NC) was used to calculate and analyze the scores.ResultsOver the study period, 569 patients were assessed for eligibility, and 241 patients consented and were offered the tool. Of these, 188 patients (median age: 65 years; range: 24 to 87 years; 80% male patients) had calculable scores. Of the 188 patients, 50 (26.6%) patients were identified as potential beneficiaries for educational intervention to improve symptoms (received moderate scores for a domain), and 131 (69.7%) patients were identified as needing further testing or provider intervention (received poor scores for a domain) based on the tool.ConclusionThe CONDUIT tool scores, when compared with standardized scales with established preliminary normative scores, could be used to identify and triage patients who need targeted education, further testing, or provider interventions. These score ranges will serve as the first set of normative standards to aid in the interpretation of conduit performance among providers and patients.

Patient information needs in upper gastrointestinal cancer: what patients and their families want to know.

The treatment of upper gastrointestinal cancer (UGIC) patients is complex. Patients are often elderly, comorbid as well as nutritionally depleted and treatment involves multimodality therapy incorporating chemotherapy, radiation therapy and surgery. The pre-treatment information requirements of UGIC patients are not clear but crucially important in ensuring they complete treatment successfully. A systematic review of the English language literature was performed to determine the specific information needs of patients with UGIC. Following abstract review and comprehensive analysis six articles were included. UGIC patients nominated information regarding post-operative recovery, quality of life, expected survival, management of post-operative symptoms and coping strategies for insurance and financial issues, relationships and family as being most important to them. Patients' families nominated information on the effects of diagnosis on patient well-being over the ensuing months and detailed information on available support services as being most important. One-on-one consultations with senior medical staff were the preferred method of information transfer followed by web-based information services. For effective treatment of UGIC patients, physicians and surgeons must address issues pertaining to quality of life, finance and relationships and may require specific training, or administrative support, in these areas.

One-day surgery in breast cancer: Monoinstitutional results (experience during 2. 5 years)

e11596 Background: We want determine the effect of early discharge from hospital after surgery for breast cancer on physical and psychological illness. Moreover the study aimed to evaluate the management of post operative symptoms and post operative care. Methods: From January 2006 to July 2008, all breast cancer patients undergoing conservative breast cancer surgery or total mastectomy were offered surgery as an outpatient at One- Day Surgery Unit. Results: Three hundred seventy five patients underwent outpatient surgery for a total of four hundred four surgical procedures. The age of 375 patients varied from 14 years old to 94 years old, mean age was 55; in 79 of 404 (19.5%) surgical procedures patient remained in the hospital, for one night, after a surgical procedure regarding total axillary resection. Patients characteristics and post-operative complications were recorded for all 375 patients and 404 surgical procedures. All complications were treated by medical or nursing care. Complications included axillary seroma in nine patients (2.2 %), abscess in three patients (0.9%), pain in two patient (0.5%), hematoma formation in five patients (1.2%) for a total of 17 complications (4.2%). In our series, no hospital readmission was recorded during the first night and the first week and no death occurred. Conclusions: One day surgery for breast cancer patients is a totally safe and feasible procedure. We haven’t an increased rates of physical or psychological illness from early discharge after surgery for breast cancer. This policy can be recommended for patients with support at home. No significant financial relationships to disclose.

One day surgery in breast cancer patients: Safe and feasible procedure

11589 Background: To determine the effect of early discharge from hospital after surgery for breast cancer on physical and psychological illness. Moreover the study aimed to evaluate the management of post operative symptoms and postoperative care. Methods: From January 2006 to October 2007, all breast cancer patients undergoing conservative breast cancer surgery or total mastectomy were offered surgery as an outpatient at One Day Surgery Unit. Results: Two hundred sixty-three patients underwent outpatient surgery for a total of two hundred eighty-three surgical procedures. The age of 263 patients varied from 14 years old to 94 years old, 54 of 263 (20,5%) patients remained in the hospital for one night after surgical procedure regarding total axillary resection. In our series, no hospital readmission was recorded during the first night and the first week and no death occurred. Conclusions: Ambulatory surgery for breast cancer patients is safe and feasible. We haven’t an increased rates of physical or psychological illness from early discharge after surgery for breast cancer. This policy can be recommended for patients with support at home. No significant financial relationships to disclose.

Post-operative care and patient satisfaction after ambulatory surgery for breast cancer patients

Aim This study aimed to evaluate patient information provided, the management of post-operative symptoms and post-operative care, and patient satisfaction with ambulatory breast surgery over a 1-year period. Methods From January to December 2000, all breast cancer patients undergoing conservative breast surgery were offered surgery as an outpatient procedure at the Ambulatory Surgery Unit. Results Two hundred and thirty six patients underwent outpatient surgery. None were readmitted during the first night or the first week. Two hundred and nineteen patients completed a questionnaire. One hundred and sixty nine patients (group 1) underwent wide local excision (WLE) and 50 (group 2), WLE and axillary lymphadenectomy. Patients in group 2 experienced more pain at discharge from the hospital ( p≤0.01) and during the first week after discharge ( p≤0.00001) than patients in group 1. The mean overall satisfaction score was 8.97 on a scale of 1–10. Post-operative information provided by the surgeon before discharge from the hospital was rated 8.90 on a scale of 1–10 while information provided by the nurse was rated 9.33 ( p<0.0001). Conclusion Ambulatory surgery for breast cancer patients is safe and popular with patients, however, post-operative pain presents problem.

Factors Contributing to a Prolonged Stay After Ambulatory Surgery

We identified predictors for prolonged postoperative stay after ambulatory surgery using multiple logistic regression models. We collected perioperative data for 16,411 ambulatory surgical patients. A log-transformed time to discharge variable was modeled by multiple linear regression, including patient-, anesthesia-, and surgery-specific variables. The impact of hypothetical elimination of perioperative adverse events on mean length of stay was also estimated. Separate analyses were performed among patients who received general anesthesia (GA) and monitored anesthesia care (MAC). Patients receiving GA stayed 50 min longer than patients receiving MAC. Patients receiving GA and undergoing strabismus, transurethral, or otorhinolaryngological/dental procedures had the longest postoperative stay. Among patients receiving GA, smokers had a 4% shorter stay compared with nonsmokers; among patients receiving MAC, those with congestive heart failure (CHF) had a 11% longer stay compared with patients without CHF. Postoperative nausea and vomiting, dizziness, excessive pain, and cardiovascular events predicted 22%–79% increases in postoperative stay. The hypothetical elimination of all adverse events resulted in a 9.6% decrease in mean length of stay among patients receiving GA, but in only a 3.8% decrease among patients receiving MAC. The length of postoperative stay among ambulatory surgical patients is mainly determined by the type of surgery and by adverse events, such as excessive pain, postoperative nausea and vomiting, dizziness, drowsiness, and cardiovascular events. Patients with CHF and those who underwent long procedures had a higher risk of a prolonged stay. Appropriate prevention and management of postoperative symptoms could significantly decrease the length of stay among patients receiving GA. Implications The length of postoperative stay among ambulatory surgical patients is mainly determined by the type of surgery and by adverse events, such as excessive pain, postoperative nausea and vomiting, dizziness, drowsiness, and untoward cardiovascular events. Patients with congestive heart failure and those who underwent long procedures had a higher risk of a prolonged stay. Appropriate prevention and management of postoperative symptoms could significantly decrease the length of stay among patients receiving general anesthesia.

Integrating in- and out-patient nursing services for breast cancer patients undergoing mastectomy and breast conserving surgery

Research has demonstrated the feasibility of discharging patients between the 6th and 7th day following mastectomy or breast conserving surgery. Although this possibility can be advantageous to patients it comprimises the time needed to achieve all the goals of nursing care. In order to provide comprehensive nursing care and continuity in the care process, our nursing department developed an integrated in-patient and out-patient nursing care service for breast cancer patients in this phase of their disease. This novel approach is coordinated by the nurse manager from the in-patient nursing department. Nurses from the ward rotate through the new ambulatory breast clinic giving them the opportunity to broaden the scope of their practice. This expanded role includes patient support at initial diagnoses, more extensive pre-operative patient information and post-operative symptom management and wound care. Continuity of care and documentation of the care delivered is the major goal of this approach. Nursing care goals are now set in the out-patient department following the initial nursing assessment. The nursing interventions can be carried out either during clinic visits prior to hospital admission or during the admission period. Documentation plays a vital role and a special patient file has been developed to reflect the steps of the care process. The patient is responsible for the file and presents it to the nurse during each visit. Nurses who assess the patient in the clinic are often those who care for the patient on the nursing ward. This provides the opportunity to build solid relationships with patients giving nurses an integral role in the patient's treatment trajectory. This role promotes a greater sense of proffesionalism and job satisfaction. The clinic is in its grassroots phase, but as our experience increases so will the possibilities for expansion to eventually provide the breast cancer patient with continuity of care beyond the borders of surgical treatment to include rehabilitation.