Postsurgical Care Research Articles

Return to Vocal Performance Following Microlaryngoscopy in Singers.

Although microlaryngoscopy has been recognized to be effective in addressing lesions in vocal performers, no detailed information regarding return to performance (RTP) following surgery exists. We describe our experience and offer proposals to establish standardized criteria for RTP among vocal performers. Records for adult vocalists who underwent microlaryngoscopy for benign vocal fold (VF) lesions and had a clearly documented RTP date between 2006 and 2022 were reviewed. Patient demographics, diagnoses, interventions, and postsurgical care before and after RTP were described. The need for medical and procedural interventions and rate of reinjury were used to determine the success of RTP. Sixty-nine vocal performers (average age: 32.8 years, 41 [59.4%] female, 61 [88.4%] musical theater) underwent surgery for 37 (53.6%) pseudocysts, 25 (36.2%) polyps, 5 (7.2%) cysts, 1 (1.4%) varix, and 1 (1.4%) mucosal bridge. Fifty-seven (82.6%) underwent voice therapy. The average time to RTP was 65.0 ± 29.8 days. Prior to RTP, six (8.7%) experienced VF edema requiring oral steroids and one (1.4%) underwent a VF steroid injection. Within 6 months following RTP, eight (11.6%) received oral steroids for edema and three underwent procedural interventions (two steroid injections for edema/stiffness, one injection augmentation for paresis). One patient experienced pseudocyst recurrence. Return to vocal performance at an average of 2 months following microlaryngoscopy for benign lesions appears overwhelmingly successful, with low rates of need for additional intervention. There is a need for validated instruments to better measure performance fitness to refine and possibly accelerate RTP. 4 Laryngoscope, 134:329-334, 2024.

An Updated Review on Psoriasis and Surgery

Psoriasis is a chronic inflammatory skin disease with a complex pathogenesis involving the interaction between the innate and adaptive immune systems. The release of antimicrobial peptides (AMPs) by keratinocytes, particularly LL-37 peptides, plays a crucial role in the initiation of psoriatic inflammation. The activation of dendritic cells and distinct T-cell subsets, particularly Th1 and Th17, leads to the formation of scaly plaques in psoriasis. Although most cases are treated with topical or systemic medications, severe forms such as pustular psoriasis and psoriatic arthritis may require surgical management. Surgical procedures aim to relieve symptoms, improve function, and minimize scarring and cosmetic deformities. However, psoriatic patients are at higher risk of post-surgical infections and surgical stress may trigger psoriatic flare-ups. Thus, meticulous post-surgical wound care and psychological support are essential for optimal outcomes.

0788 Sleep Profile of Adolescents Following Posterior Spinal Fusion

Abstract Introduction Major musculoskeletal operations can have a prolonged impact on patients’ quality of life during the postoperative period. Sleep patterns can be affected by general anesthesia, complex and prolonged operations, and post-surgical care. Sleep disturbance can be considered a determinant of poor postsurgical outcomes. In this study, we examined the sleep profile of adolescents who underwent Posterior Spine Fusion (PSF) utilizing the FitBit Charge 4TM wearable device. Methods Patients were approached at the time of their evaluation in the orthopedic office once they had been scheduled for PSF. Patients received a Fitbit Charge 4TM at the time of enrollment. Total sleep time (TST), the duration of REM and Deep Sleep phases, and sleep efficiency were obtained from patients’ FitBit4 data and were calculated by averaging data recorded over a 2-4-day period during the week prior to surgery, during the hospital stay, one-two-three weeks, and 3 months after patients were discharged home. Patients were given a PROMIS sleep questionnaire delivered to their cellular phone using Qualtrics the week before the hospitalization, during hospitalization, and 3 months after surgery. Pain scores were obtained every 4-6 hours during the patient’s hospital stay using the self-reporting numeric scale. Results 16 patients (10 female (62%)) completed the 3 months study period. Mean age was 16±1.9 years. The average length of hospitalization was 3 days. The average TST, REM, and DEEP sleep at baseline was 387±111, 74±28, 75±25 minutes respectively. TST, REM, and DEEP sleep decreased during the acute post-operative period and gradually increased during the follow-up period going to baseline values by the 3rd post-surgery week in 72% of the cases. Perception of sleep showed mild disturbance at baseline and worsened during the hospital stay based on PROMIS scores with improvement or return to baseline by the 3rd month post-operatively in 86% of patients. Conclusion Sleep phases of adolescents are affected after a major surgery. Similar to patients of other major surgeries, these changes are short-lived and returned to baseline by the 3rd post-operative week. There was a broad range of changes among subjects during the study period. Support (if any)

Surgical service and distance traveled drive patient preference for Care Hotel: a retrospective cohort study.

This retrospective chart review of 1065 patients was conducted between 23 July 2020, and 31 December 2021. Variables examined included patient age, sex, race, ethnicity, Charlson comorbidity index, distance patient travelled to hospital, length of surgery, day of the week of surgery, and surgical service. Associations of patient and surgery characteristics with the primary outcome of staying at the Care Hotel were assessed using unadjusted and multivariable logistic regression models. Of the 1065 patients who met criteria for admission to the Care Hotel during the study period, 717 (67.3%) chose to stay at the Care Hotel while 328 (32.7%) choose to be admitted to the hospital. In multivariable analysis, there was a significant association between surgical service and staying at the Care Hotel (P<0.001). Specifically, there was a higher likelihood of staying at the Care Hotel for patients from Neurosurgery [odds rato (OR)=1.86, P=0.004], Otorhinolaryngology (OR=2.70, P<0.001), and General Surgery (OR=2.75, P=0.002). Additionally, there was a higher likelihood of staying at the Care Hotel with distance travelled over 110 miles [OR (per each doubling)=1.10, P=0.007]. When developing a post-surgical care model for patients following outpatient procedures, the referring surgical service is a primary factor to consider in order to ensure patient acceptance, along with patient distance. This study can assist other healthcare organizations considering this model, as it provides guidance on which factors are most indicative of acceptance.

Women's experiences of breastfeeding after a cesarean section: A meta-synthesis.

The World Health Organization and United Nations Children's Fund recommend the early initiation of breastfeeding within the first hour postpartum for successful exclusive breastfeeding. However, cesarean section is a risk factor for unsuccessful early initiation of breastfeeding. Herein, we aim to explore women's experiences of breastfeeding after a cesarean section. We used the Joanna Briggs Institute framework in this meta-synthesis. We searched articles published from 1990 to 2022 on PubMed, CINAHL, Cochrane library, PsycInfo, and EMBASE to identify qualitative studies on women's experiences of breastfeeding after a cesarean section. We used the Critical Appraisal Skills Programme checklist for qualitative studies to assess the quality of the included studies. Seven qualitative studies from five countries met the inclusion criteria, representing the views of 194 women who underwent cesarean sections. Six new categories were integrated into the women's experiences of breastfeeding after a cesarean section as follows: (i) Perceived values of breastfeeding, (ii) Emotional vulnerability in breastfeeding, (iii) Physical difficulties in breastfeeding, (iv) Inconvenient conditions in breastfeeding, (v) Inadequate resources for breastfeeding, and (vi) Support systems to enable breastfeeding. We provide evidence showing that knowledge of the specific breastfeeding mechanism and provision of the most appropriate postsurgical care by healthcare providers just after a cesarean section can reduce the barriers to post-cesarean breastfeeding. Moreover, effective hospital policies and family support can result in the initiation of positive breastfeeding outcomes. Future studies that consider the cultural aspects of breastfeeding practice may generate additional insights into providing optimal postpartum care.

Effect of Smartphone App Postoperative Home Monitoring After Oncologic Surgery on Quality of Recovery

There has been an increase in health care-focused smartphone apps, including those for encouraging healthy behaviors and managing chronic conditions, but app-assisted postsurgical care has yet to be fully explored. To compare quality of recovery and patient satisfaction between conventional in-person follow-up and smartphone app-assisted follow-up for patients following Enhanced Recovery After Surgery Society (ERAS) protocols. This randomized clinical trial, conducted from June 2019 to April 2021, included women older than 18 years undergoing oncologic breast reconstruction or major gynecologic oncology surgery following ERAS protocols with the care of 2 surgeons at an academic tertiary care center. Patients were randomized 1:1 to receive smartphone app-assisted follow-up or conventional in-person follow-up. The smartphone group used a surgeon-monitored app to record Quality of Recovery 15 (QoR15) scores, European Organisation for Research and Treatment of Cancer-selected adverse events, drain outputs, and surgical site photographs over 6 weeks. Patient satisfaction scores were assessed using validated Patient Satisfaction Questionnaire III (PSQ-III) subscales at 2 and 6 weeks postoperatively. The conventional follow-up group also completed the QoR15 and PSQ-III questionnaires at these intervals. The primary outcomes were quality of recovery and patient satisfaction, as measured by the QoR15 and PSQ-III, respectively. Secondary outcomes were costs of follow-up; the number of contacts with the medical system, complications, and surgeons' contacts with patients; and surgeons' perceptions of app-assisted care. Of 72 patients included in the trial, 36 underwent breast reconstruction (mean [SD] age, 45.30 [9.13] years) and 36 underwent gynecologic oncology surgery (mean [SD] age, 54.90 [11.18] years). Three patients dropped out (2 who underwent breast reconstruction [1 in the app group, 1 in the control group], 1 who underwent gynecologic oncology surgery [control group]). The app group had significantly higher mean (SD) QoR15 scores than the control group (2 weeks: 127.58 [22.03] vs 117.68 [17.52], P = .02; 6 weeks: 136.64 [17.53] vs 129.76 [16.42], P = .03). Patients were equally satisfied between groups in all subsets of the PSQ-III at these intervals. The mean (SD) number of complications was similar in both groups, and a similar number of surgeon contacts per patient occurred (1.6 [1.2] vs 2.1 [2.0], P = .16). Surgeons appreciated early identification of complications with the app. In this randomized clinical trial, postoperative follow-up for patients undergoing breast reconstruction and gynecologic oncology surgery using smartphone app-assisted monitoring led to improved quality of recovery and equal satisfaction with care compared with conventional in-person follow-up. ClinicalTrials.gov Identifier: NCT03456167.

Use of Complementary Pain Management Strategies in Postoperative Cardiac Surgical Patients.

Complementary pain management strategies are effective at reducing pain in postsurgical patients. Cardiac nurses at a large academic hospital reported inconsistent awareness of patient opioid utilization and poor implementation of complementary pain management strategies. A pre/post-quality improvement project was conducted on 2 inpatient cardiac units. Outcomes included nursing staff's perceived knowledge, confidence, and use of complementary pain management strategies and knowledge of patient postsurgical opioid utilization through calculation of morphine milligram equivalence (MME). A comprehensive education program was implemented that included increased patient access to pain management resources, nurse education about complementary pain management strategies, and nurse education and access to MME calculations using a custom electronic health record application. Nursing staff's perceived knowledge, confidence, and use of complementary pain techniques increased. Patient opioid utilization findings were inconclusive. Educational programs about complementary pain management offer promise to improve cardiac postsurgical patient care.

MP39-19 VISUALIZING EPISODE-SPECIFIC COSTS FOR RENAL COLIC: A MODEL FOR BUNDLE PAYMENT REFORM

You have accessJournal of UrologyCME1 Apr 2023MP39-19 VISUALIZING EPISODE-SPECIFIC COSTS FOR RENAL COLIC: A MODEL FOR BUNDLE PAYMENT REFORM Loren Oh, Charles Scales, Marisa Domino, and David Friedlander Loren OhLoren Oh More articles by this author , Charles ScalesCharles Scales More articles by this author , Marisa DominoMarisa Domino More articles by this author , and David FriedlanderDavid Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bundled payments are value-based reimbursement models that link payments to providers for episodes of care related to inpatient admissions for certain conditions. What remains a limitation of episode-based payments, however, is their inability to account for health care expenditures that may accrue prior to the inciting inpatient admission. Renal colic is uniquely suited to evaluate the association between pre- and post-operative events. Renal colic episodes often begin in the emergency department and may require both inpatient and ambulatory care prior to definitive surgery. Therefore, limiting bundles to inpatient admissions associated with surgery may miss important upstream events that influence post-operative outcomes. The objective of this study is to better understand how pre-operative costs may relate to operative and post-operative costs for a renal colic episode. METHODS: Using 2018 data from the Healthcare Cost and Utilization Project, we identified individuals in Maryland and Florida who had a renal colic diagnosis, a subsequent definitive surgical episode after diagnosis, and a post-surgical health care encounter within 90 days of surgery. We then limited our sample to individuals who had information about pre-operative, operative, and post-operative costs. We categorized individuals into quartiles based on incurred costs during the pre-operative, operative, and post-operative periods. We then plotted the number of individuals in each quartile across the care time horizon using a Sankey diagram to visualize costs throughout a renal colic episode. RESULTS: A total of 1,525 individuals in Florida and Maryland underwent definitive surgery for renal colic during the study period. When looking at the movement of individuals between pre-operative and operative quartiles, 207 of 381 individuals (54.3%) with the lowest pre-operative costs remained in either the 1st or 2nd quartile of operative costs. Meanwhile, 219 out of 381 individuals (57.3%) in the highest quartile had operative costs in the upper half. Similar results are seen when looking at movement of individuals between operative and post-operative quartiles. Most of the individuals in the lowest quartile of operative costs remained in the lowest quartile of post-operative costs while individuals in the highest quartile of operative costs remained in the top two quartiles of post-operative costs. CONCLUSIONS: Our findings suggest that pre-operative spending influences post-operative expenditures for an episode of renal colic, and accounting for this relationship may help inform future iterations of surgical payment bundles. Source of Funding: American Urological Association Research Scholars Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e543 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Loren Oh More articles by this author Charles Scales More articles by this author Marisa Domino More articles by this author David Friedlander More articles by this author Expand All Advertisement PDF downloadLoading ...

A double-blinded, placebo-controlled, randomized study to evaluate the efficacy of perioperative dextromethorphan compared to placebo for the treatment of postoperative pain: a study protocol

BackgroundPain management is a critical component of comprehensive postsurgical care, as it influences patient safety and outcomes, and inadequate control has been associated with the development of chronic pain syndromes. Despite recent improvements, the management of postoperative pain following total knee arthroplasty (TKA) remains a challenge. The use of opioid-sparing, multimodal analgesic regimens has broad support, but there is a paucity of high-quality evidence regarding optimal postoperative protocols and novel approaches are needed. Dextromethorphan stands out among both well-studied and emerging pharmacological adjuncts for postoperative pain due its robust safety profile and unique pharmacology. The purpose of this study is to evaluate the efficacy of multi-dose dextromethorphan for postoperative pain control following TKA.MethodsThis is a single-center, multi-dose, randomized, double-blinded, placebo-controlled trial. A total of 160 participants will be randomized 1:1 to receive either 60 mg oral dextromethorphan hydrobromide preoperatively, as well as 30 mg 8 h and 16 h postoperatively, or matching placebo. Outcome data will be obtained at baseline, during the first 48 h, and the first two follow-up visits. The primary outcome measure will be total opioid consumption at 24 h postoperatively. Secondary outcomes related to pain, function, and quality of life will be evaluated using standard pain scales, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) questionnaire, the Patient-Reported Outcomes Measurement Information System (PROMIS-29) questionnaire, and clinical anchors.DiscussionThis study has a number of strengths including adequate power, a randomized controlled design, and an evidence-based dosing schedule. As such, it will provide the most robust evidence to date on dextromethorphan utilization for postoperative pain control following TKA. Limitations include not obtaining serum samples for pharmacokinetic analysis and the single-center study design.Trial registrationThis trial has been registered on the National Institute of Health’s ClinicalTrials.gov (NCT number: NCT05278494). Registered on March 14, 2022.

Staff perspectives of a nurse practitioner-led orthogeriatric model of care in a large academic hospital: A mixed methods study

BackgroundResearch has shown that models of care involving geriatric care in orthopedics decrease hospitalizations, mortality, length of stay and post-operative complications. This article presents an example of a nurse practitioner-led orthogeriatric model of care in a large academic hospital in Ontario. The overall goal was to explore staff perspectives regarding the nurse practitioner-led orthogeriatric model of care. MethodsWe conducted a mixed methods approach consisting of an online questionnaire, semi-structured interviews, and a focus group with staff. ResultsQuestionnaire of staff showed overall support for functions of the NP within the model. Interviews with healthcare providers, and leadership as well as one focus group with orthopedic surgeons showed that despite the lack of formal awareness of the NP-led orthogeriatric model of care, staff felt that the model provided better care for the geriatric hip fracture population. ConclusionIn the current context of geriatricians’ shortages to provide post-surgical care to geriatric patients, the staff described that geriatric care of hip fracture patients can be well accomplished by a NP. Further improvement efforts to create better awareness of the NP-led orthogeriatric model among the care team is needed.

Live and Recorded Music Interventions to Reduce Postoperative Pain: Protocol for a Nonrandomized Controlled Trial.

Postoperative patients who were previously engaged in the live musical intervention Meaningful Music in Healthcare reported significantly reduced perception of pain than patients without the intervention. This encouraging finding indicates a potential for postsurgical musical interventions to have a place in standard care as therapeutic pain relief. However, live music is logistically complex in hospital settings, and previous studies have reported the more cost-effective recorded music to serve as a similar pain-reducing function in postsurgical patients. Moreover, little is known about the potential underlying physiological mechanisms that may be responsible for the reduced pain perceived by patients after the live music intervention. The primary objective is to see whether a live music intervention can significantly lower perceived postoperative pain compared to a recorded music intervention and do-nothing control. The secondary objective is to explore the neuroinflammatory underpinnings of postoperative pain and the potential role of a music intervention in mitigating neuroinflammation. This intervention study will compare subjective postsurgical pain ratings among 3 groups: live music intervention, recorded music intervention, and standard care control. The design will take the form of an on-off nonrandomized controlled trial. Adult patients undergoing elective surgery will be invited to participate. The intervention is a daily music session of up to 30 minutes for a maximum of 5 days. The live music intervention group is visited by professional musicians once a day for 15 minutes and will be asked to interact. The recorded music active control intervention group receives 15 minutes of preselected music over headphones. The do-nothing group receives typical postsurgical care that does not include music. At study completion, we will have an empirical indication of whether live music or recorded music has a significant impact on postoperative perceived pain. We hypothesize that the live music intervention will have more impact than recorded music but that both will reduce the perceived pain more than care-as-usual. We will moreover have the preliminary evidence of the physiological underpinnings responsible for reducing the perceived pain during a music intervention, from which hypotheses for future research may be derived. Live music can provide relief from pain experienced by patients recovering from surgery; however, it is not known to what degree live music improves the patients' pain experience than the logistically simpler alternative of recorded music. Upon completion, this study will be able to statistically compare live versus recorded music. This study will moreover be able to provide insight into the neurophysiological mechanisms involved in reduced pain perception as a result of postoperative music listening. The Netherlands Central Commission on Human Research NL76900.042.21; https://www.toetsingonline.nl/to/ccmo_search.nsf/fABRpop?readform&unids=F2CA4A88E6040A45C1258791001AEA44. PRR1-10.2196/40034.

Dentists’ perception of third molar surgery in the Kingdom of Saudi Arabia: A cross sectional pilot study

Concerns about the indications for the surgical removal of third molars have not yet reached a decisive agreement. The aim of the study was to evaluate the perception and practice of Saudi' dentists when encountering third molars clinical situations including diagnosis, treatment, and postsurgical care. A cross-sectional survey was conducted and approved by the ethics research committee at Prince Sattam Bin Abdulaziz (PSAU). The survey comprised of four sets of questions with multiple-choice answers including the participants' details and type of practice (private or government), clinical awareness and attitude regarding lower third molars surgery, and the confidence level of dentists when performing third molars extraction. The survey was published online with a timeframe of three months to respond. 196 participants responded to the designated survey (55 dental interns and 141 general dental practitioners (GPs)). Most responses (80.1%) were from Riyadh province (central region). There was a significant difference between GPs and interns in terms of impacted third molars with associated cystic lesions, bony impactions, and diffuse pain (P<0.05). Male dentists tend to prescribe antibiotics more than female dentists (P=0.001) and GPs more than interns (P=0.027). The results also indicated that male dentists were more confident than females when performing third molar extraction. Generally, female dentists preferred to have further training on such surgery (P<0.05). Continuing professional development programs both during dental internship and general practice are recommended to improve the required skills of third molar extraction.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

Abstract OT3-20-01: Ketamine Analgesia for Long Lasting Pain Relief after Surgery (KALPAS) Study

Abstract Background: Post-mastectomy pain syndrome (PMPS) affects up to 60% of women undergoing mastectomy. Standard perioperative multimodal analgesia remains only moderately effective in preventing PMPS, and many patients continue to rely on opioids for their chronic pain. In the context of the opioid overdose crisis, alternative interventions are urgently needed. Ketamine targets risks factors for PMPS including acute pain and negative mood, making it an ideal candidate for the prevention of PMPS. Trial Design: This is a multisite, three-arm, double-blind, RCT to test the effectiveness of ketamine in reducing PMPS in women undergoing mastectomy for oncologic indication. Arm 1 consists of continuous perioperative ketamine infusion that begins during surgery and continues for 2 hours in the post-anesthesia care unit (PACU). Arm 2 consists of a single-dose of ketamine in the PACU given over 50-60 minutes. Arm 3 consists of placebo. Standard surgical and postsurgical care remain unchanged across all arms. Eligibility Criteria: Inclusion criteria are: women ≥18 years of age undergoing total mastectomy for oncologic indication +/- lymph node dissection and +/- immediate or delayed reconstruction with no distant metastases. Exclusion criteria include: (1) history of cognitive impairment (2) past ketamine or phencyclidine misuse or abuse, (3) schizophrenia or history of psychosis, (4) history of post-traumatic stress disorder, (5) known sensitivity or allergy to ketamine, (6) liver or renal sufficiency, (7) uncontrolled hypertension, chest pain, cardiac arrhythmia, stroke, head trauma, intracranial mass or hemorrhage, glaucoma, porphyria, uncontrolled thyroid disease, or other contraindication to ketamine, (8) lamotrigine alfentanil, physostigmine, or 4-aminopyridine use, (9) currently pregnant, (10) body mass index greater than 35, (11) non-English or non-Spanish speaker, (12) currently participating in another pain interventional trial, (13) patient has started or undergone hormone therapy for gender transition into male, or (14) patient is scheduled for bilateral (or greater) flap reconstruction. Specific Aims: The primary outcome is pain intensity on the Brief Pain Inventory short form scale at the surgical site three months after mastectomy. Secondary outcomes include pain severity and interference at the surgical site, incidence of PMPS, anxiety, and depression over 12 months after surgery. Tertiary outcomes include neuropathic symptoms, fatigue, sleep, physical function, and opioid use. Statistical Methods: We will test the differences in the primary outcome between 1) the continuous ketamine infusion and the control; and 2) the single-dose ketamine and the control, each at 0.025 significance level (adjusted for multiple comparisons using the Bonferroni correction), based on the two-sample t-tests (allowing unequal variances) if outcome variables are approximately normal, or Wilcoxon’s rank-sum tests otherwise. Accrual: The target accrual for this study is ~750. Recruitment began January 2022. Recruitment is expected to be complete by October 2025. As of July 14, 2022, 43 participants have been enrolled across all sites. If interested in the KALPAS Study, please contact kalpas@nyulangone.org, jing.wang@nyulangone.org, or lisa.doan@nyulangone.org This research is supported by the National Institutes of Health through the NIH HEAL Initiative under UH3CA261067. It is also supported by the NCATS Trial Innovation Network under award numbers U24TR001608 (CCC), U24TR001597 (DCC), U24TR001609 (SSC), U24TR001579 (RIC) Citation Format: Lisa Doan, Raven Perez, Jeana Chun, Randy Cuevas, Pabel Miah, Amber Guth, Karen Hiotis, Freya Schnabel, Michele Curatolo, Robert Edwards, Hyung Park, John Rotrosen, Deborah Axelrod, Jing Wang. Ketamine Analgesia for Long Lasting Pain Relief after Surgery (KALPAS) Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-20-01.

Acceptability of a virtual prostate cancer survivorship care model in regional Australia: A qualitative exploratory study.

To assess the acceptability of a nurse-led prostate cancer survivorship intervention adapted for virtual delivery and tailored to post-surgical care, in a regional Australian hospital and health service. A qualitative exploratory study using the Theoretical Framework of Acceptability (TFA). Twenty-two participants took part in a semistructured interview comprising men who had completed the program (n=16) and health professionals/service stakeholders involved in program delivery (n=6). Acceptability of this virtual prostate cancer survivorship care program was very high across all constructs of the TFA, from the perspectives of both program recipients and those delivering the program. The quality of care received was seen as superior to what men had experienced previously (burden, opportunity costs). The time afforded by the regularly scheduled video-consultations allowed men to come to terms with the recovery process in theirown time (self-efficacy), and provided an ongoing sense of support and access tocareoutside the consultation (ethicality). Clinically, the program improved careco-ordination, expedited identification of survivorship care needs, and met servicepriorities of providing quality care close to home (burden, perceived effectiveness). Findings from this study suggest virtual post-surgical care delivered via videoconferencing is highly acceptable to prostate cancer survivors in a regional setting. Future research exploring virtual program implementation at scale and long-term patient and service outcomes is warranted.

A successful separation of omphalopagus twins during COVID-19 pandemic: A case report

Background: Omphalopagus is a rare condition involving digestive system and abdominal wall fusion. This study reports an omphalopagus case during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Indonesia.Case: Male conjoined twins, aged 14 months, were diagnosed with omphalopagus and several organ failures. We performed separation surgery of the omphalopagus with primary closure and post-surgical care for fifteen days. The early surgery was preferable in this case due to life-threatening issues of COVID-19, despite omphalopagus separation may cause post-surgical complications. Furthermore, the emerging pandemic conditions also required a more stringent procedure to avoid the risk of viral spread.Conclusion: We conclude that, in the lack of evidence-based instruction for hospital care during the early phase of COVID-19 in Indonesia, life-saving surgical considerations from death due to complications of COVID-19 infection and acute respiratory distress syndrome must be performed and prioritized. However, potential omphalopagus complications must be evaluated.

Patient reported symptoms and adverse outcomes seen in Canada's first vaginoplasty postoperative care clinic.

Vaginoplasty is a relatively common gender-affirmingsurgery with approximately 200 Ontarians seeking this surgery annually. Although Ontario now offers vaginoplasty in province, the capacity is not meeting demand; the majority of trans and gender-diverse patients continue to seek vaginoplasty out of province. Out-of-province surgery presents a barrier to accessing postsurgical follow-up care leaving most patients to seek support from their primary care providers or providers with little experience in gender-affirming surgery. To provide an account of the common postoperative care needs and neovaginal concerns of Ontarians who underwent penile inversion vaginoplasty out of province and presented for care at a gender-affirming surgery postoperative care clinic. A retrospective chart review of the first 80 patients presenting to a gender-affirmingsurgery postoperative care clinic who had undergone vaginoplasty at an outside surgical center was performed. Descriptive analyses were performed for all variables. The sample consisted of 80 individuals with the mean age of 39 years (19-73). Most patients had surgery at another surgical center in Canada (76.3%). Many patients (22.5%) accessed care in the first 3 months after surgery, with the majority (55%) seeking care within the first perioperative year. Most patients (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns. Common patient-reported symptoms during clinical visit included pain (53.8%), dilation concerns (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%) with anorgasmia (11.3%) and dyspareunia (11.3%) being the most frequent complications. The most common adverse outcomes identified by health care providers included hypergranulation (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). Findings from chart review offer valuable insights into the postoperative needs and neovaginal concerns of Ontarians who have had vaginoplasty out of province. This study demonstrates the need for routine postoperative care in patients undergoing vaginoplasty. Patients experience numerous symptoms and concerns that often correlate with clinical findings and require multiple follow-up appointments. Health care providers may benefit from further education on the more common nonsurgical issues identified in this study.

Incidence, predictors, and 30-day outcomes of Clostridioides difficile infection in patients undergoing cystectomy: A national database analysis

Clostridioides difficile infection (CDI) is the second most common health care acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the center for disease control in 2017. CDI continues to remain a major cause of inpatient admission and utilization of health care resources. This study aimed to determine the true incidence, risk factors, and outcomes of CDI in patients undergoing cystectomy. We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the American college of surgeon National Surgical Quality Improvement Program to study the incidence, risk factors, and 30 day postsurgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk adjusted, and outcomes based program designed to determine and improve the quality of surgical and postsurgical care. The incidence of CDI following cystectomy was 3.6% in our patient cohort. About 18.8% of patients developed CDI following hospital discharge. None elective surgeries and complete cystectomy procedures had a higher rate of CDI. About 48.4% of patients with CDI had a preceding postoperative infection. Postoperative organ space infections, postoperative renal failure, postoperative sepsis, and septic shock were independently associated with the development of CDI, (all P < 0.05). Patients who developed postoperative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI and had a higher risk of deep venous thrombosis formation. A sizable number of patients experience CDIs after cystectomy procedures in the USA, and CDI development is associated with an increase in length of stay and unplanned readmissions. Interventions and initiatives are needed to reduce this burden of disease.

Management of incidental durotomies in an integrated Orthopaedic and Neurosurgical Spinal Unit

IntroductionIncidental durotomy (ID) is an intraoperative event associated to prolonged bed rest and hospital stay, antibiotic use, higher patient dissatisfaction, and leg pain among other complications of its postoperative course. Several repair techniques and postsurgical care have been proposed for its management. This study was designed to develop an agreed protocol in cases of ID among Orthopaedic Surgeons (OS) and Neurosurgeons (NS) integrated into a Spinal Surgery Unit. Research questionIncidental durotomies management protocol. Materials and methodsFrom 997 eligible cases operated in Hospital del Mar (Barcelona, Spain) from April 2018 to March 2022, demographic, clinical, surgical and postoperative data was collected for statistical analysis from the morbidity and mortality database, with 79 identified IDs. Redo procedures were significantly associated to OS, and cervical and anterior/lateral approaches to NS, both groups were not comparable. ResultsID occurred in 7.9% of cases, more frequently after the lockdown (p=0.03), in females (p=0.04), during posterior approaches (p=0.003), and less frequently in the cervical spine (p=0.009). IDs were linked to postoperative infections (p< 0.001) and nerve root damage (p< 0.001). Patients without ID evolved more satisfactorily during the postoperative period (p=0.002), and those with CSF leak (20/79) spent on bed rest more than twice the time as those without (p<0.001). Multivariable logistic regression showed strong association between posterior approaches and ID, between complicated postoperative courses and ID. Discussion and conclusionsID is linked to an adverse postoperative recovery, and it should be primarily repaired under microscope, with early mobilization of patients after surgery.

Neutrosophic Fuzzy Neural Network Modelling and Current-Voltage Analysis for Forecasting Post-Surgery Risks

The electrical reaction of bioactive sites in the individual’s body can be used to diagnose various disorders. Forecasts are made by examining the electric signal of the biologically active points onto patients. Measurements of the organ’s present level and variations in the passive electrical characteristics at specific bioactive sites on the body were made to evaluate the influence on the organ. The study aims to create a Neutrosophic fuzzy neural network (NFNN) approach to forecast the probability of complications following surgery. The research investigates a neural network method for predicting hazards associated with post-surgical care. Examining the current-voltage features of the biologically active spots forms the basis for the characteristics of the risk classifiers. By looking at patients who had been given a diagnosis of a disease, the training, as well as verification samples, as well as verification samples were created. Patients with type 1 had successful operations, but type 2 patients experienced a variety of post-operative problems, and type 3 patients needed extra treatment. The created classifiers show an excellent ability to foresee severe circumstances during surgical therapy. The neutrosophic fuzzy neural network model may be more sophisticated and advanced compared to conventional fuzzy neural network models. It can help differentiate the proposed model from existing models and highlight its unique features and advantages. The results show that the proposed