Postoperative Care Plan Research Articles

Volume changes in the contralateral submandibular gland following unilateral gland excision in oral cancer patients

BackgroundThe effects of unilateral submandibular gland excision on the size of the contralateral gland are not well understood, with no human studies reported to date. This study aims to investigate the impact of unilateral submandibular gland excision on the contralateral gland’s size, providing insights into compensatory mechanisms and their clinical implications.MethodThis retrospective study involved patients with oral cancer who underwent unilateral submandibular gland excision and ipsilateral neck dissection at Gangneung-Wonju National University Dental Hospital between 2008 and 2023. Patients were included if they had preoperative and follow-up 3D radiological images. The contralateral submandibular gland volume was measured using 3D Slicer software on preoperative, post-operative, and follow-up radiographic data.ResultsThe mean volume change of the contralateral submandibular gland was 1.35 ± 2.06 cm3, with a mean change ratio of 1.18 ± 0.24. These changes were statistically significant (p = 0.006). Other factors such as age, gender, and radiotherapy did not significantly affect the volume change ratio (p > 0.05).ConclusionThe contralateral submandibular gland exhibits a statistically significant increase in volume following unilateral gland excision, indicating compensatory hypertrophy. This morphological adaptation should be considered in post-operative care and surgical planning for oral cancer patients to optimize outcomes.

Postoperative challenges addressed through nursing care of patients receiving lower extremity tumor prosthesis

BackgroundPatients with primary Bone Sarcoma and Giant Cell Tumors in the lower extremities often require major surgery involving tumor prostheses. The postoperative course for this patient group can be complex and influenced by various factors and challenges that demand careful nursing care. This study aims to identify challenges related to the nursing care of individuals with primary bone tumors following surgery for tumor prostheses in the lower extremities.MethodsA retrospective cohort study of 15 patients treated at Rigshospitalet, Copenhagen, Denmark, between November 5. 2016, and April 1. 2020 was conducted by medical record review, focusing on challenges related to postoperative nursing care. All patients with the surgery code “Bone Excision” were identified within the surgery booking system and screened for eligibility.ResultsPatients experienced postoperative challenges such as severe pain, prolonged time to mobilization (mean: 4 days), and defecation (mean: 5 days). The mean length of stay at the Rigshospitalet was 13 days. Furthermore, eleven patients (73%) reported disrupted sleep and nausea.ConclusionPatients undergoing tumor prosthesis surgery in the lower extremities face considerable postoperative challenges that contribute to a prolonged hospital stay. These challenges, including severe pain, delayed mobilization, and gastrointestinal issues, significantly impact recovery. The findings highlight the urgent need for targeted nursing interventions to address these issues effectively. Enhanced pain management protocols, early mobilization strategies, and comprehensive postoperative care plans are essential to improve patient outcomes and reduce the length of hospital stays. Addressing these challenges through dedicated nursing care is crucial for optimizing the recovery process for patients receiving lower extremity tumor prostheses.

Assessing Barriers and Facilitators to Return to Work for Kidney Cancer Survivors: A 6-Month Longitudinal Study

ObjectivesThis study aimed to investigate the factors that impact the readiness and success of kidney cancer survivors returning to work, providing insights for healthcare professionals, employers, and policymakers. MethodsA prospective longitudinal study was conducted at Sun Yat-sen University Cancer Center from April 2022 to June 2023. The study enrolled 282 kidney cancer survivors aged 18 to 60 who completed three surveys at 1, 3, and 6 months postsurgery. Data collection involved telephone interviews and self-administered questionnaires, capturing sociodemographic information, medical history, and employment status, while follow-up assessments tracked return-to-work readiness. The scales used for analysis included the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire, the Return-to-Work Self-Efficacy Questionnaire, the Perceived Social Support Scale, and the Brief Fatigue Inventory. Generalized Estimation Equations were applied to identify significant factors, with both single-factor and multivariate analyses performed to pinpoint the most critical variables. ResultsReturn-to-work rates at 1, 3, and 6 months postsurgery were 26.9%, 59.9%, and 76.2%, respectively. Higher levels of anxiety, lower self-efficacy, older age, and greater fatigue were associated with reduced return-to-work rates. Physically demanding jobs posed more barriers compared to nonmanual roles. Significant factors identified in multivariate analysis included anxiety, self-efficacy, fatigue, and the nature of the patient's work. ConclusionPsychological, physical, and job-related factors play a crucial role in determining whether kidney cancer survivors can successfully return to work. Tailored support and flexible work arrangements could help kidney cancer survivors reintegrate into the workforce, leading to better long-term outcomes. Implication for Nursing PracticeNursing professionals can play a vital role in assessing and supporting kidney cancer survivors during their recovery process by addressing both psychological and physical factors. Incorporating return-to-work readiness into postoperative care plans, offering mental health support, and liaising with employers to create flexible working conditions could enhance the reintegration of survivors into the workforce.

SP5.9 - A cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients

Abstract Aims To study the cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients. Methods 1. Preliminary data from patient survey - we designed a questionnaire to assess patients’ views of the Post Op app. 2. Estimates for NHS services cost - derived from the King’s Fund latest report (2023) and the NHS Digital National schedule of reference costs (2017, 2021-22). 3.Estimates for travel-associated costs - We assumed a total cost per mile of 16p, and also assumed the patients would need to pay an average cost of £1.6/h for hospital parking for an average of 3h per visit. We assumed a carbon emission of 221.4 grams per mile (Department for Transport data). 4.Modelling approach - We used a conservative modelling approach simulating different patient groups with varying levels of postoperative anxiety/complications. Results Taking into account avoidable presentations to ED, costs borne by the patients, lost productivity, environmental costs, avoidable re-operations and the costs related to antibiotic tolerance/resistance, the lower boundary of total savings from a digital post-operative follow-up tool equates to £58,739 per 100 patients and the upper boundary is £79,949 per 100 patients. Conclusion Post Op application provides excellent support for most patients in the immediate postoperative period and is likely to result in a significant reduction in the number of contacts patients make with the GP or hospital, and with the Emergency Department resulting in significant cost saving for both the service and the patients. Furthermore, earlier recognition, monitoring and appropriate treatment of SSIs provides further savings whose magnitude is likely underestimated.

Ureteroscopy for stone disease in pediatric patients with neurogenic bladder: A single institution case-control study

Ureteroscopy (URS) for urolithiasis in pediatric patients may be particularly challenging for patients with co-morbidities that increase the risk for stone formation and recurrence. Patients with neurogenic bladders (NGB) and/or patients that are non-ambulatory are reported to have higher rates of additional comorbidities and a particularly increased risk of developing urolithiasis, and higher rates of infections and post-operative complications. To report outcomes of URS for stone disease in pediatric patients with NGB and/or non-ambulatory status and compare these outcomes to patients without these co-morbidities. An IRB-approved prospective single institutional registry was used to retrospectively identify all patients under 18 years of age who underwent URS for stone disease between July 2012 and July 2021, excluding bladder stones. Patients were categorized in two groups: patient with NGB with or without non-ambulatory status versus all other patients (control). Baseline demographics, pre-operative radiologic imaging, intra-operative details, and post-operative outcomes including 30-day complications were aggregated and compared between the two groups. 275 URS in 198 patients were performed during the study period, and 49 (18%) of these were performed on patients with NGB. Pre-operative imaging showed significantly higher number of stones (3 vs 2, p=0.003) and larger total stone burden in patients with NGB than those without NGB (15mm vs 9mm, p=0.009). Patients with NGB had a significantly longer length of procedure (86 vs 60min, p=0.002), increased need for staged procedures, increased length of stay (1 vs 0 days, p<0.001), and increased use of an extended duration of antibiotics prior to the procedure (<0.001). There was no difference in need for passive dilation, stent placement, or other intra-operative parameters. There was no statistical difference in the incidence of 30-day complications between the two groups post-operatively. However, there was a higher incidence of febrile UTIs (8.2% vs 1.3%, p=0.021) in patients with NGB and a lower incidence of pain related complications (0 % vs 9.3%, p=0.032). Patients with NGB had a higher incidence of requiring ipsilateral URS for recurrent stone disease within a year of surgery (34.6% vs 18.9%, p=0.01). The results show that URS for urolithiasis can be done safely and effectively in pediatric patients with neurogenic bladders. The increased risk of infectious complications within 30 days of surgery warrants careful pre- and post-operative antibiotic care plan for this patient population.

A 3‐month mark to urinary continence, after robotic radical prostatectomy—Is it possible?

AbstractIntroduction and ObjectivesUrinary incontinence (UI) remains a significant concern after radical prostatectomy. As a part of a nursing follow‐up, we evaluate quality‐of‐life (QoL) which includes UI recovery. Patients proposed to Retzius‐sparing robot assisted radical prostatectomy (RS‐RARP) have a bundle of appointments starting pre‐operatively and continuing after surgery 1 week, 1, 3, 6, 9 and 12 months. In these, we started a urinary rehabilitation programme (URP) performing Kegel Exercises, adaptative and behavioural strategies. The objective is to evaluate timeline until urinary continence recovery after RS‐RARP, since this is one of the most asked question by our patients.Materials and MethodsBetween July 2017 and April 2020 we conducted a prospective observational single‐centre study with a total of 208 patients submitted to RS‐RARP. We applied the Expanded Prostate Cancer Index Composite‐26 (EPIC‐26) questionnaire pre and postoperatively at 3, 6, 9 and 12 months, and studied UI by evaluating pad count measured in the 3rd question. The inclusion criteria are: patients that did not have adjuvant or salvage treatments during the follow up; have all pre‐ and post‐operative evaluations; who were continent pre‐operatively; and started the URP. A total of 72 patients were included. We have considered the criteria of no pad use for continence recovery. Every patient provided written informed consent for study inclusion, approved by the Institutional Ethics Committee (Approval 07.07.2017).ResultsPreliminary analysis of enrolled patients reveals that 57 (79,16%) recovered continence during the 12 months period. By 3‐month mark, we observed that 42 (73,68%) patients were continent; 7 (12,28%) recovered continence at 6‐month mark; 4 (7,02%) recovered continence at 9‐month mark and 4 (7,02%) recovered continence 1 year after surgery. We further analysed the total number of pads used daily by the 15 patients (20,83%) that had UI at 12‐month mark: 13 patients (86,67%) reported using 1 pad a day and 2 patients (13,33% or 2,77% of all studied population) reported using 3 or more pads a day.ConclusionThe preliminary results demonstrate a gradual improvement in UI over the first year, with a significant number of patients recovering at 3‐month mark. These positive results are most probably consequences of both the surgical approach and the URP. Is required a sub‐group analysis to further delineate factors impacting continence recovery, aiding in postoperative rehabilitation care plans that will impact positive outcome on QoL associated with a fast UI recovery. For the latter, digital tools to conduct patient reported outcomes are necessary to ascertain the extent of impact in QoL. Furthermore, we need to rethink remote strategies to improve patient compliance as a significant number of them were excluded for not attending on‐site nursing appointments.

Predicting delayed extubation and transfer to the intensive care unit in children undergoing posterior fusion surgery for scoliosis : Aretrospective observational study.

Delayed extubation and transfer to the intensive care unit (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay, and increase medical expenses; however, whether achild will require delayed extubation or transfer to the ICU after scoliosis orthopedic surgery is not fully understood. In this study, we reviewed the risk factors for delayed extubation and transfer to the ICU after scoliosis orthopedic surgery in children. The electronic medical records of pediatric patients (≤ 18years) who underwent posterior spinal fusion surgery between January 2018 and November 2021 were reviewed and analyzed. Patient characteristics (age, sex, body mass index, American Society of Anesthesiologists, ASA, grade, preoperative lung function, and congenital heart disease), preoperative Cobb angle, scoliosis type, correction rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allogeneic transfusion, intraoperative hemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg predicted body weight), surgical time, postoperative extubation, and transfer to the ICU were collected. The primary outcomes were delayed extubation and transfer to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and ICU transfer. Atotal of 246 children who satisfied the inclusion criteria were enrolled in this study, of whom 23(9.3%) had delayed extubation and 81(32.9%) were transferred to the ICU after surgery. High ASA grade (odds ratio [OR] 5.42; 95% confidence interval [CI] 1.49-19.78; p = 0.010), high Cobb angle (OR 1.04; 95% CI 1.02-1.07; p < 0.001), moderate to severe pulmonary dysfunction (OR 10.9; 95% CI 2.00-59.08; p = 0.006) and prolonged surgical time (OR 1.01; 95% CI 1.00-1.03; p = 0.040) were risk factors for delayed extubation. A high Cobb angle (OR 1.02; 95% CI 1.01-1.04; p = 0.004), high intraoperative bleeding volume (OR 1.06; 95% CI 1.03-1.10; p = 0.001), allogeneic transfusion (OR 3.30; 95% CI 1.24-8.83; p = 0.017) and neuromuscular scoliosis (OR 5.38; 95% CI 1.59-18.25; p = 0.007) were risk factors for transfer to the ICU. A high Cobb angle was arisk factor for both delayed extubation and ICU transfer. Age, sex, body mass index, number of vertebral fusion segments, correction rate, and intraoperative tidal volume were not associated with delayed postoperative extubation and ICU transfer. The most common risk factor for delayed extubation and ICU transfer in pediatric patients who underwent posterior spinal fusion was ahigh Cobb angle. Determining risk factors for apoor prognosis may help optimize perioperative respiratory management strategies and planning of postoperative care for children undergoing complicated spinal surgery.

Postoperative Care for Patients with Hypertensive Intracerebral Hemorrhage

This article summarizes the postoperative care plan for patients with hypertensive intracerebral hemorrhage (HICH). Nursing strategies are analyzed in terms of the level of consciousness, pupil care, vital sign care, temperature care, complication care, and early rehabilitation care, with the goal of providing reference for follow-up care of HICH patients.

Improvement in Pre-Operative Abnormal Posture After Total Knee Arthroplasty for Knee-Hip-Spine Syndrome

A retrospective cohort study aims at assessing the effectiveness of total knee arthroplasty (TKA) in treating pre-operative aberrant posture in a patient with Knee-hip-spine syndrome. Preoperative and post-operative at (6 and 12 months) assessments, were done by combining clinical evaluations, radiographic analyses, and posture assessments, KSS, HOOS and ODI were used to conduct a thorough analysis of a cohort of 62 patients receiving TKA for KHSS. The main goal was to assess how TKA affected individuals who already had aberrant posture in terms of knee, hip, and spine alignment. Our findings showed that after TKA, pre-operative aberrant posture significantly improved in a way that was clinically meaningful. Significant realignment of the knee, hip, and spine was shown by radiographic data, demonstrating the TKA's all-encompassing remedial effect on the musculoskeletal system. Clinical evaluations correlated to the radiological results, with patients expressing better functional results and more effective postoperative pain alleviation which were demonstrated by the HOOS, KSS and ODI scores. The research highlights the advantages of TKA that extend beyond the knee joint by indicating a favourable link between patient-reported improvements and the treatment of aberrant posture. Our study concluded that, in the treatment of knee osteoarthritis, hip dysfunction, and spinal problems, TKA significantly improves preoperative aberrant posture in patients with KHSS. Following total knee arthroplasty (TKA), the realignment of the lower limbs has a role in improving the balance of the spine, which in turn reduces disability and improves the quality of life for patients. The best surgical methods and post-operative care plans must be determined via more study in order to optimize the advantages of TKA for patients with KHSS.

Reducing surgical site infections after spine surgery: the optimal amount of normal saline for intra-wound irrigation

BACKGROUND CONTEXTSurgical site infection (SSI) following lumbar surgery can increase healthcare costs and lead to poor clinical outcome. Irrigation of wounds with saline solution is widely accepted globally and safe for nearly all kinds of surgery. However, the efficacy of different volumes of wound irrigation has not been addressed in elective spine surgery. The role and the optimal amount of intraoperative wound saline irrigation in preventing SSI in clean spinal surgery remain unclear. PURPOSEWe aimed to investigate if insufficient intraoperative irrigation may be a risk factor for postoperative SSI. Additionally, we investigated the optimal amount of normal saline (NS) for irrigation to prevent postoperative SSI. STUDY DESIGNThis is a retrospective study of patients with degenerative spinal stenosis who were treated surgically. Patients were grouped according to the amount of intra-wound irrigation during surgery. PATIENT SAMPLEWe included 444 patients with degenerative lumbar spinal conditions who had undergone one to five level open spinal fusion surgeries from January 2015 through April 2020. OUTCOME MEASURESThe definition of superficial or deep SSI in this study was based on the Centers for Disease Control and Prevention criteria for SSI. The fusion status accessed was based on the Bridwell grading system at the final follow-up. Self-reported and clinical outcome measures include visual analog scale and Oswestry Disability Index. METHODSA total of 193 patients underwent irrigation with a bulb syringe with manual method (B group) with 2,000 mL NS; 251 patients underwent interpulse battery-powered device irrigation (P group) with >6,000 mL NS. Based on our protocolized departmental guidelines, all patients received the same preoperative preparation and standard surgical steps and postoperative care plan. Patients’ demographic and surgical parameters were recorded. The main outcome measures included superficial wound infection, deep infection and overall infection. RESULTSThe incidence of overall SSI was 4.66% in the B group and 1.59% in the P group. The univariate analysis revealed a significant correlation with DM and irrigation amount per hour during surgery but not age, BMI, smoking, operative duration, fusion level, or blood loss. We determined the optimal irrigation amount during surgery as 1,400 mL per hour based on the receiver operating characteristic (ROC) curve (sensitivity, 92.3%; specificity, 44.1%). This was statistically significant (p=.033) with an odds ratio of 9.284 (95% confidence interval 1.2–72.0). In the analysis of surgical factors, the infection group had a significantly lower irrigation amount during surgery. To summarize, patients with diabetes and those receiving less than 1,400 mL of NS/hour had a higher likelihood of developing SSI. CONCLUSIONSWe observed that diabetes and lower volume of intraoperative irrigation were both risk factors for postoperative SSI following degenerative lumbar spine surgery. To reduce SSI in lumbar spine surgery, intra-wound irrigation with more than 1,400 mL/h of NS was recommended.

(052) Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery

Abstract Introduction Sexuality and sexual function are understood as fundamental facets of the human experience. The disruption of sexual function is socially disruptive and emotionally distressing. Studies demonstrate the connection between adverse sexual function and medical conditions such as diabetes and heart disease, however in the areas of spinal pathologies, sexual function remains mostly studied in males or as a collective of male and female patients. The male and female sexual experience may be quite different, and a combined cohort may not appropriately characterize female-specific dysfunction. Objectives Sexual dysfunction associated with spinal pathologies in males is well studied. However, little research exists addressing this issue in females. This review presents data on female sexual dysfunctions associated with spinal pathologies. Methods PubMed and Google Scholar identified case reports and primary studies evaluating female sexual dysfunction associated with spinal pathology as well as surgical intervention success were reviewed to contextualize and characterize female sexual dysfunction in this population. Results Female sexual dysfunction has been cited to arise from the spine due to traumatic etiologies, malignant tumors, and benign tumors with and without bony involvement. Surgeons identify the absence of bowel, bladder, and/or sexual dysfunction as one of the key preoperative predictors in maintenance or improvement of neurologic status, however sexuality is rarely addressed in the pre-operative or post-operative neurosurgical care plan. In data generated from males and females with spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Post-operatively, there appears to be a significant decrease in sexual pain. However, the data do not separately report results for females versus males. Importantly, while pain can hinder sexual activity in females, there also are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that should be explored. By the use of the Female Sexual Function Index (FSFI), one study compared sexually active females with protruding disc herniation with healthy females. These data showed a lower FSFI, a lower number of weekly sexual intercourse and a higher score for depression in women with this condition. Further detangling painful intercourse from other types of sexual dysfunction, case studies have shown pre and post op sexual dysfunction from perianal hypoesthesia, and reduced sensation in the sacral area associated with an L5-S1 disc pathology. It is suggested that these other types of sexual dysfunction with lack of coital pain fail to improve after surgical intervention. Conclusions There is a gender disparity when addressing sexual dysfunction and the implications of spinal surgery. The lack of high-quality research with adequate numbers of female participants that appropriately characterizes the nuances of female sexual dysfunction across various spinal pathologies, with post- surgical intervention analysis and consideration of surgical approach, necessitates consideration for study. Pre-op and post-op sexual history should be included for all women with spinal health issues. Disclosure No.

Risk Factors and Complications in Reduction Mammaplasty: A Systematic Review and Meta-analysis.

Reduction mammaplasty (RM) has become established as the standard effective method for treating macromastia, but reports on the risk factors that predispose to postoperative complications have been conflicting. This meta-analysis aimed to pool the available data to identify predictors of complications following RM. The PubMed, Web of Science, Embase, and Cochrane databases were screened from inception to 1 Jan 2022, and studies were included based on predefined criteria. The perioperative risk factors BMI, smoking, age, diabetes, radiation therapy, and tissue resection weight were extracted and their correlation with complications assessed. A total of 40 studies comprising of 5908 patients were included. BMI ≥ 30kg/m2 (OR = 1.65, 95% CI 1.35-2.02; p < 0.01) and ≥ 40kg/m2 (OR = 1.97, 95% CI 1.26-3.08; p < 0.01), smoking (OR = 2.57, 95% CI 2.01-3.28; p < 0.01), diabetes (OR = 2.21, 95% CI 1.19-4.07; p < 0.05), a unilateral resection weight ≥ 1000g (OR = 1.76, 95% CI 1.02-3.05; p < 0.05), and radiation therapy (OR = 11.11, 95% CI 2.01-3.28; p < 0.01) were associated with higher rates of postoperative complications. Obese patients (BMI ≥ 30kg/m2) were more likely to experience fat necrosis (OR = 3.00, 95% CI 1.37-6.57; p < 0.01) and infection (OR = 1.66, 95% CI 1.15-2.40; p < 0.05). Smokers had a 2.03 times higher risk of infection (95% CI 1.24-3.31; p < 0.01) and 2.34 times higher risk of dehiscence (95% CI 1.38-3.98; p < 0.01). No association between complication occurrence and age 40 or 50 years or total tissue resection weight ≥ 1000g was identified. This meta-analysis provides evidence that obesity, smoking, diabetes, unilateral resection weight ≥ 1000g, and preoperative radiation therapy predispose to complication occurrence in RM. This information can optimize the ability of surgeons to provide preoperative patient education, perioperative assessment, and postoperative care planning. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medical Tourism and Budget Brazilian Butt Lifts: A High Cost to US Healthcare Systems and a Danger to Patients.

In 2017, Adabi et al1 published one of the first studies to examine the complications, management, and medical system cost of medical tourism with a relatively large patient cohort (n = 42). The most common complication was infection, followed by abscess and wound dehiscence. Of the 20 patients requiring hospitalization, over half underwent a surgical procedure for treatment. Cost is the most frequently reported consideration for medical tourism, but the cost of associated complications often far surpasses that of the primary procedure. Average reported cost for treatment of cosmetic surgery complications in the United States ranges from $15,000 to $40,000.1,2 This burden often does not fall on the patient, but on insurance companies, hospitals, and public health programs. To avoid the dangers associated with obtaining cosmetic surgery abroad, patients may elect to have their procedures done at budget clinics in the United States, where low costs are balanced by the high volume of procedures performed by personnel who are, at times, not adequately trained to perform the procedure safely. Unfortunately, the risks of low-cost procedures are not limited to medical tourism alone; the incredibly high mortality rate of up to 1:3000 due to pulmonary fat emboli (PFE) after gluteal fat grafting, or Brazilian butt lift (BBL), performed in an unsafe manner (resulting in fat deposition deep to the muscle fascia) has become a widely acknowledged concern.3 A review of fatal BBL PFE in South Florida from 2010 to 2022 demonstrated that 92% of deaths occurred at high-volume, budget clinics; two-thirds of these cases were performed by American Board of Plastic Surgery certified surgeons.4 There have been 14 deaths since 2018, with six fatal PFE cases and two nonfatal PFE cases in 2021 alone. Despite recent recommendations, enacted legislation, and patient education, patients continue to be harmed from cosmetic procedures performed both abroad and domestically. In May of 2022, six patients presented to our institution for treatment of complications from BBLs that were performed abroad (Dominican Republic and Mexico) and in the United States (Florida). All patients were women, age range 20–49 years, and none had health insurance at the time of presentation to the emergency department. Four patients experienced postoperative infections, one leading to severe sepsis requiring surgical intervention. Imaging confirmed intramuscular injection of fat in two patients, one with PFE causing severe pneumonitis. There were no mortalities. All patients reported finances as the motivating factor for medical tourism. Our institution contributed to the formation of The Multi-Society Task Force for Safety in Gluteal Fat Grafting to help address BBL-related complications. Guidelines were recently published in our joint safety statement to maximize patient safety, and we encourage their review.5 The guidelines include procedures only being performed by surgeons with privileges in state-approved or licensed ambulatory surgical centers or hospitals; the use of real-time ultrasound during fat injection; establishing appropriate doctor–patient relationships; comprehensive pre- and postoperative care plans, including availability and direct care for complication management; and prioritizing patient safety and ethical business models over profits. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Application and evaluation of transitory protective stoma in ovarian cancer surgery.

Ovarian cancer is the most fatal of all female reproductive cancers. The fatality rate of OC is the highest among gynecological malignant tumors, and cytoreductive surgery is a common surgical procedure for patients with advanced ovarian cancer. To achieve satisfactory tumor reduction, intraoperative bowel surgery is often involved. Intestinal anastomosis is the traditional way to restore intestinal continuity, but the higher rate of postoperative complications still cannot be ignored. Transitory protective stoma can reduce the severity of postoperative complications and traumatic stress reaction and provide the opportunity for conservative treatment. But there are also many problems, such as stoma-related complications and the impact on social psychology. Therefore, it is essential to select appropriate patients according to the indications for the transitory protective stoma, and a customized postoperative care plan is needed specifically for the stoma population.

Integrating machine learning predictions for perioperative risk management: Towards an empirical design of a flexible-standardized risk assessment tool

BackgroundSurgical patients are complex, vulnerable, and prone to postoperative complications that can potentially be mitigated with quality perioperative risk assessment and management. Several institutions have incorporated machine learning (ML) into their patient care to improve awareness and support clinician decision-making along the perioperative spectrum. Recent research suggests that ML risk prediction can support perioperative patient risk monitoring and management across several situations, including the operating room (OR) to intensive care unit (ICU) handoffs. ObjectivesOur study objectives were threefold: (1) evaluate whether ML-generated postoperative predictions are concordant with clinician-generated risk rankings for acute kidney injury, delirium, pneumonia, deep vein thrombosis, and pulmonary embolism, and establish their associated risk factors; (2) ascertain clinician end-user suggestions to improve adoption of ML-generated risks and their integration into the perioperative workflow; and (3) develop a user-friendly visualization format for a tool to display ML-generated risks and risk factors to support postoperative care planning, for example, within the context of OR-ICU handoffs. MethodsGraphical user interfaces for postoperative risk prediction models were assessed for end-user usability through cognitive walkthroughs and interviews with anesthesiologists, surgeons, certified registered nurse anesthetists, registered nurses, and critical care physicians. Thematic analysis relying on an explanation design framework was used to identify feedback and suggestions for improvement. Results17 clinicians participated in the evaluation. ML estimates of complication risks aligned with clinicians' independent rankings, and related displays were perceived as valuable for decision-making and care planning for postoperative care. During OR-ICU handoffs, the tool could speed up report preparation and remind clinicians to address patient-specific complications, thus providing more tailored care information. Suggestions for improvement centered on electronic tool delivery; methods to build trust in ML models; modifiable risks and risk mitigation strategies; and additional patient information based on individual preferences (e.g., surgical procedure). ConclusionsML estimates of postoperative complication risks can provide anticipatory guidance, potentially increasing the efficiency of care planning. We have offered an ML visualization framework for designing future ML-augmented tools and anticipate the development of tools that recommend specific actions to the user based on ML model output.Statement of Significance.•Problem: Implementation of machine-learning (ML) output within clinical workflows is not trivial.•What is already known: Barriers to ML implementation and appropriate use within clinical workflows include clinicians’ limited understanding of ML, wariness of ML output, and lack of ML output actionability.•What this paper adds: Qualitative end-user evaluation of postoperative risk predictions found high-levels of agreement between rankings of clinicians' manual risk rankings and ML-augmented risk estimates. The evaluation also highlighted design (functional and visual) enhancements for translational implementation of ML models within clinical workflows.

A time-aware attention model for prediction of acute kidney injury after pediatric cardiac surgery.

Acute kidney injury (AKI) is a common complication after pediatric cardiac surgery, and the early detection of AKI may allow for timely preventive or therapeutic measures. However, current AKI prediction researches pay less attention to time information among time-series clinical data and model building strategies that meet complex clinical application scenario. This study aims to develop and validate a model for predicting postoperative AKI that operates sequentially over individual time-series clinical data. A retrospective cohort of 3386 pediatric patients extracted from PIC database was used for training, calibrating, and testing purposes. A time-aware deep learning model was developed and evaluated from 3 clinical perspectives that use different data collection windows and prediction windows to answer different AKI prediction questions encountered in clinical practice. We compared our model with existing state-of-the-art models from 3 clinical perspectives using the area under the receiver operating characteristic curve (ROC AUC) and the area under the precision-recall curve (PR AUC). Our proposed model significantly outperformed the existing state-of-the-art models with an improved average performance for any AKI prediction from the 3 evaluation perspectives. This model predicted 91% of all AKI episodes using data collected at 24h after surgery, resulting in a ROC AUC of 0.908 and a PR AUC of 0.898. On average, our model predicted 83% of all AKI episodes that occurred within the different time windows in the 3 evaluation perspectives. The calibration performance of the proposed model was substantially higher than the existing state-of-the-art models. This study showed that a deep learning model can accurately predict postoperative AKI using perioperative time-series data. It has the potential to be integrated into real-time clinical decision support systems to support postoperative care planning.

Predicting Elective Surgical Patient Outcome Destination Based on the Preoperative Modified Frailty Index and Laboratory Values.

To determine the accuracy of preoperative modified frailty index (mFI) with or without laboratory values (mFI-labs or labs-continuous) in predicting postoperative discharge destination. Discharge destination is important to providers and patients. The ability to accurately predict discharge destination preoperatively can improve hospital resource utilization and help set patient and family expectations. Cohort analysis of the 2018 American College of Surgeon National Surgical Quality Improvement Project (ACS-NSQIP) Participant Use File of patients undergoing operations with complete data point sets: age, sex, operation work relative-value units; mFI-clinical based on 12 clinical findings, mFI-labs based on seven laboratory values. The nine hierarchical destinations: home, home with assistance, multi-level community, unskilled-care facility, rehabilitation facility, skilled-nursing facility, acute care hospital, hospice, or death, from best to worst outcome. Data were analyzed using univariate analysis, multiple logistic regression and supervised learning artificial neural networks. Univariate and multivariate in general showed that patients with higher mFI-clinical and mFI-lab scores, as well as older age and more complex operations were more likely to be discharged to facilities other than home. However, these statistical techniques could not predict the exact destination. An artificial neural network analysis demonstrated perfect location prediction in 64.9% of cases and within one level of prefect prediction is 87.4%. Using a limited number of preoperative factors, combining the mFI-clinical with laboratory values significantly improves the destination prediction performance significantly better than using the values separately. Preoperative knowledge of the likely discharge destination can benefit postoperative care planning and delivery.

Prospective Comparison of Opioid vs Nonopioid Pain Regimen After Ureteroscopy.

Objective: We wanted to evaluate two new treatment phases within our practice, including a nonopioid pathway, to determine the effect on opioid usage, health care utilization, and pain following ureteroscopy. Methods: Patients undergoing ureteroscopic lithotripsy were enrolled in a study utilizing text messaging to evaluate postoperative pain and opioid usage. Our historical postoperative pain regimen included #30 oxycodone. Patients in the N15 cohort were given improved counseling, preanesthesia acetaminophen, and #15 oxycodone. With further experience, narcotics were removed entirely from our postoperative care plan (N0) and replaced with a nonopioid multimodal regimen. Results: There were 61 and 58 patients in cohorts N15 and N0, respectively, with no difference in demographics, stone, or procedure details between each cohort. No difference in pain scores was detected between the N15 and N0 cohorts (p = 0.14). The median time to pain resolution was postoperative day (POD) 4 for cohort N15 and POD 3 for cohort N0 (p = 0.06). In the N0 cohort, nine patients required postoperative narcotics (15.5%; average of 2.4 pills/patient). There was no significant difference in emergency department visits, phone calls, or clinic visits (p = 0.17) between each cohort. Conclusions: Patients undergoing ureteroscopy have adequate postoperative pain control with a nonopioid treatment regimen, although some patients will still ultimately require narcotics.

The Ideal Donor Site Dressing: A Comparison of a Chitosan-Based Gelling Dressing to Traditional Dressings.

Donor site wound management is critical in split-thickness skin graft surgeries. These sites typically recover in 7 to 14 days due to the dermal-imbedded keratinocytes that promote skin regeneration. An ideal donor site dressing can help to mitigate pain, reduce infection risk, promote hemostasis, and accelerate healing times. Additionally, this dressing would be easy to apply in the operating room, easily managed, and cost-effective. Chitosan-based gelling dressings (CBGD) possess many of these qualities that make an ideal donor site dressing. We conducted a retrospective chart review of patients who received CBGD as part of their postoperative wound care plan. We collected data on infections, hemostasis, dressing failure, and hospital course over a 14-month period where CBGD was used as the donor site dressing. One hundred and fourteen patients were evaluated. We found an infection rate of 7%, a bleed-through rate of 1.8%, and a re-application rate of 9.6%. The average CBGD cost per patient was $75.15. CBGD has acceptable infection rates, and pain scores as traditional donor site dressings. However, it possesses several qualities of a suitable donor site dressing notably swift healing rates, impressive hemostatic property, and low cost. Our study supports the idea that CBGD is a suitable donor site dressing for split-thickness skin graft surgeries.

What's Important: Postoperative Care Planning. Recognizing the Central Role of Pets in Many Patients' Lives.

What's Important: Postoperative Care Planning. Recognizing the Central Role of Pets in Many Patients' Lives.