Postoperative Care Of Patients Research Articles

Does the patient's physical activity affect the course of cardiac surgery - a comprehensive approach to cardiac surgery patients

Cardiovascular diseases represent a leading cause of morbidity worldwide. Over the past years, the field of cardiac surgery has significantly evolved. Globally, more than 2 million cardiac surgeries are performed annually. Among the main procedures are coronary artery bypass grafting (CABG), valve replacements, and heart transplants. The increasing number of patients requiring such treatment and, consequently, the rising number of procedures performed imply an improvement in their quality. With advancements in surgical techniques, the scope of patients eligible for procedures has also expanded. Patients undergoing cardiac surgeries are increasingly older and often suffer from significant comorbidities, such as hypertension and diabetes. Effective cardiac surgery significantly enhances the quality of life. When caring for a patient undergoing cardiac surgery, many aspects of the patient need to be considered to approach them holistically, while simultaneously creating an individualized treatment pathway. Not only the cardiac aspect but also various other factors need to be taken into account, including the patient's diet, medications, comorbidities, mental state, and physical activity. In this work, we emphasize the role of both postoperative and preoperative care for cardiac surgery patients, which, when properly executed, can be the key to the patient's recovery.

Postoperative Care and Outcomes in Solid-Organ Transplant Patients Undergoing Lower Extremity Fracture Treatment.

To determine the postoperative outcomes in solid-organ transplant (SOT) patients undergoing operative treatment of lower extremity fractures. Retrospective comparative study. Academic Level 1 trauma center. Patients who underwent SOT and operative treatment of lower extremity fracture from 2013 to 2021 were identified, excluding pathologic fractures. Postoperative complications, length of stay, time to death, 90-day and 1-year readmission rates, readmission causes, discharge location, and immunosuppressive regiments. Sixty-one patients with an average age of 67 years (range 29-88) were included. The mortality rate was 37.7%. The average follow-up was 15.2 months (range of 2 weeks-10 years). The majority of patients (32.8%) had received a liver transplant, and femoral neck fractures constituted the largest fracture group. The average length of stay was 10 days, with the shortest being 1 day and the longest being 126 days (SD 18). The majority of patients (57.3%) were not discharged home. Only 2 suffered from a postoperative complication requiring another procedure: hardware removal and liner exchange for periprosthetic joint infection, respectively. There was a 27.9% 90-day readmission rate with 2 deaths within that period with the most common being altered mental status (29.4%), genitourinary infections (17.6%), repeat falls (11.8%), and low hemoglobin requiring transfusion (11.8%). The longest average time to death analyzed by transplant type was found among lung transplant patients (1076 days, 62.5% mortality), followed by liver transplant patients (949 days, 35.0% mortality), and then kidney transplant patients (834 days, 38.9% mortality). The shortest time to death was 71 days from index procedure. Family members of SOT patients undergoing operative treatment of lower extremity fractures should be made aware of the high risk for 90-day readmission postoperatively (27.9%) and overall mortality (12.5%). Providers should be aware of the need for multidisciplinary involvement for inpatient care, monitoring postoperative complications, and facilitating discharge planning. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Operation room nursing based on humanized nursing mode combined with nitric oxide on rehabilitation effect after lung surgery.

With advancements in the diagnosis and treatment of lung diseases, lung segment surgery has become increasingly common. Postoperative rehabilitation is critical for patient recovery, yet challenges such as complications and adverse outcomes persist. Incorporating humanized nursing modes and novel treatments like nitric oxide inhalation may enhance recovery and reduce postoperative complications. To evaluate the effects of a humanized nursing mode combined with nitric oxide inhalation on the rehabilitation outcomes of patients undergoing lung surgery, focusing on pulmonary function, recovery speed, and overall treatment costs. A total of 79 patients who underwent lung surgery at a tertiary hospital from March 2021 to December 2021 were divided into a control group (n = 39) receiving a routine nursing program and an experimental group (n = 40) receiving additional humanized nursing interventions and atomized inhalation of nitric oxide. Key indicators were compared between the two groups alongside an analysis of treatment costs. The experimental group demonstrated significant improvements in pulmonary function, reduced average recovery time, and lower total treatment costs compared to the control group. Moreover, the quality of life in the experimental group was significantly better in the 3 months post-surgery, indicating a more effective rehabilitation process. The combination of humanized nursing mode and nitric oxide inhalation in postoperative care for lung surgery patients significantly enhances pulmonary rehabilitation outcomes, accelerates recovery, and reduces economic burden. This approach offers a promising reference for improving patient care and rehabilitation efficiency following lung surgery.

Implementing a Frailty-Specific Postoperative Order Set to Improve Postoperative Outcomes in Frail Adults After Elective Thoracic Surgery.

Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status. There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center. A quasi-experimental pre-/postimplementation study design, using the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework, was utilized. A frailty-specific postoperative order set (FPOS) was developed, including tailored nursing care, activity levels, and nutritional goals. There were significant improvements in nurse's self-reported familiarity with frailty (P =.003) and FPOS awareness (P <.001). The number of orders for delirium prevention, elimination, nutrition, sleep promotion, and sensory support increased (P <.001). Implementing an FPOS showed improvements in nurse frailty knowledge, awareness, and order set utilization.

Hyperbaric Oxygen Therapy for Complications in Nipple-Sparing Mastectomy with Breast Reconstruction: A Systematic Review.

Background: Research advancing effective treatments for breast cancer is crucial for eradicating the disease, reducing recurrence, and improving survival rates. Nipple-sparing mastectomy (NSM), a common method for treating breast cancer, often leads to complications requiring re-operation. Despite advancements, the use of hyperbaric oxygen therapy (HBOT) for treating these complications remains underexplored. Therefore, we analyze the efficacy of HBOT in the post-operative care of patients undergoing NSM. Methods: A systematic search was conducted using PubMed, Scopus, and the Cochrane Library. Studies were assessed for eligibility using the PICO (Population, Intervention, Comparison, Outcome) framework and classified based on American Society of Plastic Surgeons (ASPS) levels of evidence. Seven studies, totaling a pool of 63 female patients, met the inclusion criteria. Among these studies, four were categorized as Level III (57.1%), one as Level IV (14.3%), and two as Level V (28.6%). These studies focused on HBOT's role in wound healing, the successful salvage of breast reconstruction, and the optimal timing for HBOT. Results: This review revealed that HBOT indeed has potential for improving tissue oxygenation, vascularization, and, consequently, wound healing. It is noted that HBOT is efficacious for mitigating post-NMS complications, including infections, re-operation, flap loss, seroma, and hematoma. Conclusions: Overall, HBOT could be beneficial in standard post-surgical care protocols for patients undergoing NSM due to its role in mitigating common adverse effects that occur after mastectomy. Despite promising outcomes, the recent literature lacks rigorous clinical trials and well-defined control groups, underscoring the need for further research to establish standardized HBOT protocols.

Evaluation of the practice of reprocessing ORs in German hospitals from an infection prevention and control perspective.

The aim of this study was to analyze the cleaning and disinfection of operating rooms (ORs) status quo focusing on hygiene plans in German hospitals. In 2016, a structured online survey was sent to infection prevention and control (IPC) specialists at the cost calculation hospitals of the Institute for the Hospital Remuneration System (InEK) and all university hospitals in Germany (n = 365). With a response rate of 27.4%, 78% stated that written hygiene plans were available. After cleaning and disinfecting an OR with a "septic" patient, 55% waited until surfaces were dry before reusing in accordance with national recommendations, 27% waited > 30min. Additionally, 28% of hospitals had ORs only for "septic" patients. In 56% "septic" patients were only operated on at the end of the program. Postoperative monitoring of patients with bacteria with special IPC requirements took place in the post anesthesia care unit (PACU) (29%), operating room (OR) (52%), intensive care unit (ICU) (53%), and in the intermediate care unit (IMC) (19%). Despite written hygiene plans in place the partly long duration of OR nonuse time following IPC measures, the consistent continued use of stratification for "septic" patients and the postoperative follow-up care of patients with colonizing/infecting bacteria with special IPC requirements in the OR and high care areas represent relevant potential for improvement.

Impact of preoperative frailty on outcomes of hepatic resection among elderly patients with hepatocellular carcinoma: A comprehensive multicenter cohort study.

e16254 Background: With the increasing prevalence of hepatic resection for hepatocellular carcinoma (HCC) in the elderly, understanding the impact of preoperative frailty on surgical outcomes is crucial. This multicenter cohort study investigates the association between frailty and both short- and long-term outcomes post-hepatic resection in elderly HCC patients. Methods: This multicenter study involved elderly HCC patients (≥ 70 years) undergoing curative-intent resection at 10 hospitals in China from 2012 to 2021. Frailty was assessed using the Clinical Frailty Scale (CFS), with a score of ≥5 indicating frailty. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS), while secondary outcomes included postoperative 30-day morbidity and mortality, and 90-day mortality. Comparisons were made between patients with and without preoperative frailty. Results: Out of 488 elderly patients, 148 (30.3%) were classified as frail. Frail patients had significantly higher rates of 30-day morbidity (68.9% vs. 43.2%), 30-day mortality (4.1% vs. 0.6%), and 90-day mortality (6.1% vs. 0.9%) compared to non-frail patients (all P &lt; 0.05). Over a median follow-up of 37.7 months, frail patients showed markedly lower median OS (41.6 months [95% CI, 32.0-51.2] vs. 69.7 months [55.6-83.8]) and RFS (27.6 months [23.1-32.1] vs. 42.7 months [34.6-50.8]) than non-frail patients (both P &lt; 0.01). Multivariable Cox regression analysis identified frailty as an independent risk factor for decreased OS (HR 1.61, P = 0.001) and RFS (HR 1.32, P = 0.028). Conclusions: Preoperative frailty is significantly associated with worse short-term and long-term outcomes following hepatic resection in elderly HCC patients. These findings underscore the importance of incorporating frailty assessment into the perioperative and postoperative care of elderly patients undergoing HCC resection.

Impact of preoperative frailty on outcomes of hepatic resection among elderly patients with hepatocellular carcinoma: A comprehensive multicenter cohort study.

e16254 Background: With the increasing prevalence of hepatic resection for hepatocellular carcinoma (HCC) in the elderly, understanding the impact of preoperative frailty on surgical outcomes is crucial. This multicenter cohort study investigates the association between frailty and both short- and long-term outcomes post-hepatic resection in elderly HCC patients. Methods: This multicenter study involved elderly HCC patients (≥ 70 years) undergoing curative-intent resection at 10 hospitals in China from 2012 to 2021. Frailty was assessed using the Clinical Frailty Scale (CFS), with a score of ≥5 indicating frailty. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS), while secondary outcomes included postoperative 30-day morbidity and mortality, and 90-day mortality. Comparisons were made between patients with and without preoperative frailty. Results: Out of 488 elderly patients, 148 (30.3%) were classified as frail. Frail patients had significantly higher rates of 30-day morbidity (68.9% vs. 43.2%), 30-day mortality (4.1% vs. 0.6%), and 90-day mortality (6.1% vs. 0.9%) compared to non-frail patients (all P &lt; 0.05). Over a median follow-up of 37.7 months, frail patients showed markedly lower median OS (41.6 months [95% CI, 32.0-51.2] vs. 69.7 months [55.6-83.8]) and RFS (27.6 months [23.1-32.1] vs. 42.7 months [34.6-50.8]) than non-frail patients (both P &lt; 0.01). Multivariable Cox regression analysis identified frailty as an independent risk factor for decreased OS (HR 1.61, P = 0.001) and RFS (HR 1.32, P = 0.028). Conclusions: Preoperative frailty is significantly associated with worse short-term and long-term outcomes following hepatic resection in elderly HCC patients. These findings underscore the importance of incorporating frailty assessment into the perioperative and postoperative care of elderly patients undergoing HCC resection.

Artificial Intelligence in Postoperative Care: Assessing Large Language Models for Patient Recommendations in Plastic Surgery.

Since their release, the medical community has been actively exploring large language models' (LLMs) capabilities, which show promise in providing accurate medical knowledge. One potential application is as a patient resource. This study analyzes and compares the ability of the currently available LLMs, ChatGPT-3.5, GPT-4, and Gemini, to provide postoperative care recommendations to plastic surgery patients. We presented each model with 32 questions addressing common patient concerns after surgical cosmetic procedures and evaluated the medical accuracy, readability, understandability, and actionability of the models' responses. The three LLMs provided equally accurate information, with GPT-3.5 averaging the highest on the Likert scale (LS) (4.18 ± 0.93) (p = 0.849), while Gemini provided significantly more readable (p = 0.001) and understandable responses (p = 0.014; p = 0.001). There was no difference in the actionability of the models' responses (p = 0.830). Although LLMs have shown their potential as adjunctive tools in postoperative patient care, further refinement and research are imperative to enable their evolution into comprehensive standalone resources.

Prescription Data Mining and Network Pharmacology Study of 1152 Patients with Rectal Prolapse Using Traditional Chinese Medicine.

In recent years, the incidence of rectal prolapse has increased significantly due to the sedentary lifestyle and irregular eating habits of modern life. However, there is a lack of clinical studies on the treatment of rectal prolapse with traditional Chinese medicine (TCM) with a large sample size. Therefore, this study investigated the characteristics of rectal prolapse treatment formulas and then studied the network pharmacology of their core therapeutic drugs, which can help to provide a reference for the treatment and postoperative care of rectal prolapse patients. This study aimed to explore the prescription characteristics and the mechanism of action of core drugs in the treatment of rectal prolapse in Chinese medicine through data mining and bioinformatics techniques. We collected the diagnosis and treatment information of patients with rectal prolapse from January 2014 to September 2021 in the electronic case database of Nanjing Hospital of TCM, mined the patient information and prescription features using R, screened the active ingredients of the core pairs of drugs and disease drug intersection targets using TCMSP and GnenCard databases, and constructed a Protein-protein interaction (PPI) network using STRING and Cytoscape, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of the intersecting targets were performed using Metascape and R. We found that prolapse is easy to occur in people over 50 years old, preferably in autumn and winter. Commonly used therapeutic Chinese medicines include Glycyrrhiza glabra, Radix angelicae sinensis, Radix astragali, Atractylodes macrocephala, and Pericarpium citri reticulatae, which are mostly deficiency tonic medicines, warm in nature, and belong to spleen meridian. The core therapeutic medicinal pair was "Bupleuri radix-Cimicifugae rhizoma". There were 190 common targets of Bupleuri radix and Cimicifugae rhizoma, and 71 intersection targets of the drug pair and prolapse. The main components of the core drugs for the treatment of prolapse may be quercetin, kaempferol, Stigmasterol, etc, and the core targets may be CASP3, AKT1, HIF1A, etc. The total number of GO entries for the intersection targets of "Bupleuri radix-Cimicifugae rhizoma" and diseases was 3495, among which the molecular functions accounted for the largest proportion, mainly Pathways in cancer, IL-18 signaling pathway, etc. KEGG enriched pathway analysis yielded 168 results, and the major pathways were pathways in cancer, lipid and atherosclerosis, IL-17 signaling pathway, etc. Conclusion: This study adopted real-world research methodology and used data mining and bioinformatics technology to mine the medication law of rectal prolapse and its core drug action mechanism from the clinical information of Chinese medicine.

The impact of nursing interventions on the rehabilitation outcome of patients after lumbar spine surgery

BackgroundThis study aimed to investigate the impact of nursing interventions on the rehabilitation outcomes of patients after lumbar spine surgery and to provide effective references for future postoperative care for patients undergoing lumbar spine surgery.MethodsThe study included two groups: a control group receiving routine care and an observation group receiving additional comprehensive nursing care. The comprehensive care encompassed postoperative rehabilitation, pain, psychological, dietary management, and discharge planning. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Short-Form 36 (SF-36) Health Survey, self-rating depression scale (SDS) and self-rating anxiety scale(SAS) were used to assess physiological and psychological recovery. Blood albumin, haemoglobin, neutrophil counts, white blood cell counts, red blood cell counts, inflammatory markers (IL-6, IL-10, and IFN-γ) were measured, and the incidence of postoperative adverse reactions was also recorded.ResultsPatients in the observation group exhibited significantly improved VAS, ODI, SF-36, SDS and SAS scores assessments post-intervention compared to the control group (P < 0.05). Moreover, levels of IL-6, IL-10, and IFN-γ were more favorable in the observation group post-intervention (P < 0.05), indicating a reduction in inflammatory response. There was no significant difference in the incidence of postoperative adverse reactions between the groups (P > 0.05), suggesting that the comprehensive nursing interventions did not increase the risk of adverse effects.ConclusionComprehensive nursing interventions have a significant impact on the postoperative recovery outcomes of patients with LSS, alleviating pain, reducing inflammation levels, and improving the overall quality of patient recovery without increasing the patient burden. Therefore, in clinical practice, it is important to focus on comprehensive nursing interventions for patients with LSS to improve their recovery outcomes and quality of life.

Lipase-to-Amylase Ratio for the Prediction of Clinically Relevant Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy.

Postoperative pancreatic fistula (POPF) represents a leading cause of morbidity and mortality following major pancreatic resections. This study aimed to evaluate the use of postoperative drain fluid lipase-to-amylase ratio (LAR) for the prediction of clinically relevant fistulae (CR-POPF). Consecutive patients undergoing pancreaticoduodenectomy between 2017 and 2021 at a tertiary centre were retrospectively reviewed. Univariable and multivariable analyses were performed to identify predictors for CR-POPF (ISGPS grade B/C). Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the performance of LAR and determine optimum prediction thresholds. Among 130 patients, 28 (21.5%) developed CR-POPF. Variables positively associated with CR-POPF included soft gland texture, acinar cell density, diagnosis other than PDAC or chronic pancreatitis, resection without neoadjuvant therapy, and postoperative drain fluid lipase, amylase, and LAR (all P <0.05). Multivariable regression analysis identified LAR as an independent predictor of CR-POPF ( P <0.05). ROC curve analysis showed that LAR had moderate ability to predict CR-POPF on POD1 (AUC,0.64; 95%CI,0.54-0.74) and excellent ability on POD3 (AUC,0.85; 95%CI,0.78-0.92) and POD 5 (AUC,0.86; 95%CI,0.79-0.92). Optimum thresholds were consistent over PODs 1 to 5 (ratio>2.6) and associated with 92% sensitivity and 46% to 71% specificity. Postoperative drain fluid LAR represents a reliable predictor for the development of CR-POPF. With early prognostication, the postoperative care of patients at risk of developing high-grade fistulas may be optimized.

Polydopamine-Coated Kaempferol-Loaded MOF Nanoparticles: A Novel Therapeutic Strategy for Postoperative Neurocognitive Disorder.

The primary objective of this study was to develop an innovative nanomedicine-based therapeutic strategy to alleviate Postoperative Neurocognitive Disorder (PND) in patients undergoing surgery. To achieve this goal, polydopamine-coated Kaempferol-loaded Metal-Organic Framework nanoparticles (pDA/KAE@ZIF-8) were synthesized and evaluated. The study involved encapsulating Kaempferol (KAE) within ZIF-8 nanoparticles, followed by coating with polydopamine (PDA) to enhance biocompatibility and targeted delivery. The characterization of these nanoparticles (NPs) was conducted using various techniques including Scanning Electron Microscopy, Fourier-Transform Infrared Spectroscopy, X-ray Diffraction, and Ultraviolet-Visible spectroscopy. The efficacy of pDA/KAE@ZIF-8 NPs was tested in both in vitro and in vivo models, specifically focusing on their ability to penetrate the blood-brain barrier and protect neuronal cells against oxidative stress. The study found that pDA/KAE@ZIF-8 NPs efficiently penetrated the blood-brain barrier and were significantly taken up by neuronal cells. These nanoparticles demonstrated remarkable Reactive Oxygen Species (ROS) scavenging capabilities and stability under physiological conditions. In vitro studies showed that pDA/KAE@ZIF-8 NPs provided protection to HT-22 neuronal cells against H2O2-induced oxidative stress, reduced the levels of pro-inflammatory cytokines, and decreased apoptosis rates. In a PND mouse model, the treatment with pDA/KAE@ZIF-8 NPs significantly improved cognitive functions, surpassing the effects of KAE alone. This improvement was substantiated through behavioral tests and a noted reduction in hippocampal inflammation. The findings from this study underscore the potential of pDA/KAE@ZIF-8 NPs as an effective nanotherapeutic agent for PND. This approach offers a novel direction in the postoperative care of elderly patients, with the potential to transform the therapeutic landscape for neurocognitive disorders following surgery. The application of nanotechnology in this context opens new avenues for more effective and targeted treatments, thereby improving the quality of life for patients suffering from PND.

Obstructive Sleep Apnea and Risk of Postoperative Complications after Non-Cardiac Surgery.

Obstructive sleep apnea (OSA), a common sleep disorder, poses significant challenges in perioperative management due to its complexity and multifactorial nature. With a global prevalence of approximately 22.6%, OSA often remains undiagnosed, and increases the risk of cardiac and respiratory postoperative complications. Preoperative screening has become essential in many institutions to identify patients at increased risk, and experts recommend proceeding with surgery in the absence of severe symptoms, albeit with heightened postoperative monitoring. Anesthetic and sedative agents exacerbate upper airway collapsibility and depress central respiratory activity, complicating intraoperative management, especially with neuromuscular blockade use. Additionally, OSA patients are particularly prone to opioid-induced respiratory depression, given their increased sensitivity to opioids and heightened pain perception. Thus, regional anesthesia and multimodal analgesia are strongly advocated to reduce perioperative complication risks. Postoperative care for OSA patients necessitates vigilant monitoring and tailored management strategies, such as supplemental oxygen and Positive Airway Pressure therapy, to minimize cardiorespiratory complications. Health care institutions are increasingly focusing on enhanced monitoring and resource allocation for patient safety. However, the rising prevalence of OSA, heterogeneity in disease severity, and lack of evidence for the efficacy of costly perioperative measures pose challenges. The development of effective screening and monitoring algorithms, alongside reliable risk predictors, is crucial for identifying OSA patients needing extended postoperative care. This review emphasizes a multidimensional approach in managing OSA patients throughout the perioperative period, aiming to optimize patient outcomes and minimize adverse outcomes.

A Comparative Study between Intermittent Smead Jones Rectus Closure and Continuous Rectus Closure in Midline Laparotomy Wound

This comparative study delves into the efficacy and impact of two primary closure techniques, intermittent Smead Jones rectus closure, and continuous rectus closure, on midline laparotomy wound management. Aimed at offering evidence-based guidance to surgeons, this investigation encompasses a prospective observational study involving 98 patients aged ≥18 undergoing midline exploratory laparotomy at Acharya Vinoba Bhave Rural Hospital Sawangi. Divided into two groups—intermittent S-J closure and continuous closure—the study will meticulously assess wound parameters and complications, notably focusing on wound dehiscence, burst abdomen, and incisional hernia repair rates. Spanning from February 2023 to May 2025, the research aims to scrutinize statistical outcomes using SPSS and MS Excel, seeking to provide critical insights into these closure techniques’ comparative effectiveness. Despite its limitations, including a relatively small sample size and an observational nature without interventions, this study aspires to contribute valuable data that can aid surgeons in optimizing closure methods for midline laparotomy wounds, thereby enhancing postoperative outcomes and patient care.

Performance status at the time of lung retransplant predicts long-term function.

Lung retransplantation is offered to select patients with chronic allograft dysfunction. Given the increased risk of morbidity and mortality conferred by retransplantation, post-transplant function should be considered in the decision of who and when to list. The aim of this study is to identify predictors of post-operative disability in patients undergoing lung retransplantation. Data were collected from the UNOS national dataset and included all patients who underwent lung retransplant from May 2005-March 2023. Pre- and post-operative function was reported by the Karnofsky Performance Status (KPS) and patients were stratified based on their needs. Cumulative link mixed effects models identified associations between pre-transplant variables and post-transplant function. A total of 1275 lung retransplant patients were included. After adjusting for between-group differences, pre-operative functional status was predictive of post-transplant function; patients requiring Total Assistance ( n=740) were 74% more likely than No/Some Assistance patients (n=535) to require more assistance in follow-up (OR 1.74, 95% CI 1.13-2.68, p=.012). Estimated one year survival of Total Assistance patients is lower than No/Some Assistance Recipients (72%vs. 82%, CI 69%-75%; 79%-86%) but similar to overall re-transplant survival (76%, CI 74%-79%). Both survival and regain of function in patients requiring Total Assistance prior to retransplant may be higher than previously reported. Pre-operative functional status is predictive of post-operative function and should weigh in the selection, timing and post-operative care of patients considered for lung retransplantation.

Effects of breastfeeding in postoperative complication in pediatric population: a systematic review.

Surgical complications in younger patients can lead to infections, delayed healing, prolonged hospital stays, and other negative outcomes, significantly affecting their recovery. This study explores the potential impact of breastfeeding on mitigating these complications, aiming to enhance our understanding of postoperative care for paediatric and adolescent patients. The authors conducted a systematic search on databases such as PubMed, Scopus, Web of Science, and EMBASE, using relevant MESH keywords, adhering to the "Preferred Reporting Items for Systematic Reviews and Meta-analysis" methodology. Quality assessments were performed, and studies scoring above 70% were included for standardized data incorporation. Data extraction followed Cochrane Consumers and Communication Review group's guidelines. Bias and ethical criteria were considered and provided valuable evidence to answer the research question. Among 402 initially reviewed articles, six met inclusion criteria: 3 observational cohort studies, 2 systematic reviews, and 1 randomized controlled trial. The selected literature consistently demonstrates a significant reduction in postoperative infection rates and improved outcomes. Breastfeeding shortened postoperative hospital stays, accelerated recovery, and enhanced nutritional status, potentially reducing healthcare resource utilization and patient financial burden. Lower mortality and morbidity rates were also observed. This systematic review provides compelling evidence of breastfeeding's positive impact on surgical outcomes in the paediatric population. While the authors' findings support the benefits of breastfeeding in this age group, further large-scale, multicenter research is needed to provide stronger evidence for guiding clinical practices.

1227 Superior Hypophyseal Artery Intraoperative Indocyanine Green Angiogram as a Predictor of Postoperative Visual Function After Endoscopic Endonasal Surgery

INTRODUCTION: To date, there are no tools to intraoperatively predict postoperative visual function following endoscopic endonasal surgery (EES) for suprasellar lesions. The development of such a tool would impact postoperative care for patients at risk of new visual deficits. METHODS: Patients undergoing EES for resection of suprasellar lesions were administered 5 mg of ICG diluted in 10 mL of saline after tumor removal. Time between luminescence of the anterior cerebral artery and the superior hypophyseal artery branches enveloping the optic chiasm was noted, and the percentage of optic chiasm vessels that luminesced was recorded. Postoperative exams and imaging studies were then used to assess visual function. Patients with and without new deficits were compared to examine trends in ICG findings. RESULTS: A total of seven trials were performed on six patients. Mean time to chiasm peak luminescence was 3.8 seconds, and 81.8% of chiasm vessels luminesced. Patients with stable or improved vision after resection demonstrated over 90% chiasm luminescence in every case, and mean time to chiasm luminescence in these post-resection ICG administrations was 4.0 seconds. One patient experienced new postoperative visual deficits; on review of their ICG administration, 11.5% of chiasm vessels luminesced, and the chiasm itself failed to display robust luminescence after 30 seconds of direct observation. CONCLUSIONS: This pilot study showed the capability of intraoperative indocyanine green angiography to demonstrate perfusion of the optic chiasm during endoscopic endonasal surgery for resection of suprasellar lesions. Chiasm times under 5 seconds and over 90% chiasm vessel illumination may reflect adequate chiasm perfusion, while those with delayed or absent chiasm luminescence may have compromised chiasm perfusion.

Effect of postoperative oxygen therapy regimen modification on oxygenation in patients with acute type A aortic dissection

ObjectiveIn this study, we investigated the effect of various oxygen therapy regimens on oxygenation in patients with acute type A aortic dissection (AAD). MethodsA quasi-randomized controlled trial was conducted, in which patients with AAD hospitalized for surgery from June to September 2021 were assigned to the control group (patients received conventional oxygen therapy after postoperative mechanical ventilation, weaning, and extubation) and those who were admitted from October to December 2021 were assigned to the observation group [patients underwent optimally adjusted therapy based on the treatment of the control group, which mainly included prioritized elevation of positive end-expiratory pressure (PEEP) and restricted use of the fraction of inspired oxygen (FiO2)].The postoperative oxygenation index, blood gas analysis, and duration of mechanical ventilation were compared between the two groups. ResultsThere were significant differences in oxygenation observed at 2 h postoperatively between the groups. 12, 24, and 72 h postoperatively, the oxygenation index varied significantly between the two groups. There were statistically significant differences in the time effects of the oxygenation index and PaO2 between the two groups, as well as significant differences in the length of stay in the intensive care unit. ConclusionFor the postoperative care of patients with AAD, it is suggested that the minimum FiO2 required for oxygenation of patients be maintained. In addition, it is possible to enhance PEEP as a priority when PaO2 is low.

Interventions of warm blanket compresses and aromatherapy on blood pressure of post-surgery patients

Background: Post-surgery is a condition that is prone to post-surgery complications. During this condition the patient is in the recovery room and observations are made on the function of circulation, respiration and consciousness. Surgical procedures carry the risk of disrupting body integrity and can even become a threat to the patient's life. Effective therapy is used to overcome problems experienced by patients in post-operative care. One of the therapies carried out is by combining warm compresses using blankets and aromatherapy which is expected to have a stronger effect in increasing tolerance of the body's regulatory system to changes in blood pressure. Purpose: This research proves the effectiveness of the combined intervention of providing warm blanket compresses and essential aroma therapy to determine changes in blood pressure in patients after surgery. Method: The research is true experimental research with a pretest-posttest design. This study had 60 respondents who were divided into 2 groups and were taken using random sampling method techniques. The research was conducted on 26 December 2022 – 28 January 2023. In this research statistical analysis was carried out computerized. The pre-test post-test difference test uses the Wilcoxon test. The difference test between groups uses Mann – Whitney. Results: Receiving a combination of warm compresses, blankets heated to a temperature of 44 Celsius for 30 minutes and giving 4 drops of essential aromatherapy in 100 cc of water with diffusion for 15 minutes. This research shows that there is a significant difference in the average value of blood pressure reduction. Conclusion: The combination of giving warm blanket compresses and essential aromatherapy was effective in reducing blood pressure in patients after spinal anesthesia surgery in the recovery room with significant results obtained, namely with a pre value of 134.30 mmHg and a post value of 120.80. Diastolic values ​​were significant, namely with a pre-value of 88.10 mmHg and a post value of 79.67. The mean delta value for systolic blood pressure in the intervention group was -14.50 mmHg in the control group and -6.70 mmHg. The mean delta value for diastolic blood pressure in the intervention group was -8.43 mmHg in the control group and -4.83 mmHg.