Postoperative Management Of Patients Research Articles

Effects of Patient Assessment and Education by an Integrated Care Team on Postoperative Adherence and Failure Rates After Osteochondral Allograft and Meniscal Allograft Transplantation in the Knee

Patient nonadherence with prescribed rehabilitation protocols is associated with up to 16 times higher likelihood of treatment failure after osteochondral allograft transplantation (OCA) and meniscal allograft transplantation. Patients who completed counseling with an orthopaedic health behavior psychologist as part of an evidence-based shift in practice at our institution would have significantly lower rates of nonadherence and surgical treatment failure versus patients who did not participate in counseling. Cohort study; Level of evidence, 2. Patients in a prospective registry who underwent OCA and/or meniscal allograft transplantation between January 2016 and April 2021 were included for analysis when 1-year follow-up data were available. Of 292 potential patients, 213 were eligible for inclusion. Patients were categorized based on whether they participated in the preoperative counseling and postoperative patient management program: no health psych group (n = 172) versus health psych group (n = 41). Nonadherence was defined as documented evidence of a deviation from the prescribed postoperative rehabilitation protocol. In this cohort of patients, 50 (23.5%) were documented to be nonadherent. Patients in the no health psych cohort were significantly more likely to be nonadherent (P = .023; odds ratio [OR], 3.4). Tobacco use (OR, 7.9), higher preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference score, lower preoperative PROMIS Mental Health score, older age, and higher body mass index were also significantly associated with nonadherence (P < .001 for all). Patients who were nonadherent with the prescribed postoperative rehabilitation protocol during the first year after transplantation were 3 times more likely (P = .004) to experience surgical treatment failure than those who were adherent. Overall, 26.2% of patients in the no health psych group experienced surgical treatment failure versus 12.2% in the health psych cohort. Data from the present study suggest that preoperative counseling with a health behavior psychologist is associated with an improved rate of patient adherence and a lower proportion of surgical treatment failure after OCA and meniscal allograft transplantation. Patients who remained adherent to the postoperative protocol were 3 times more likely to have a successful short-term (≥1 year) outcome.

The Impact of Perioperative Morbidities, Lack of Discharge Aspirin, and Lack of Discharge Statin on Long Term Survival Following EVAR.

Adverse perioperative events and discharge medications both have the potential to impact survival following endovascular abdominal aortic aneurysm repair (EVAR). We hypothesize that variables such as blood loss, reoperation in the same hospital admission, and lack of discharge statin/aspirin have significant effect on long term survival following EVAR. Similarly, other perioperative morbidities, are hypothesized to affect long term mortality. Quantifying the mortality effect of perioperative events and treatment emphasizes to physicians the critical nature of preoperative optimization, case planning, operative execution and postoperative patient management. All EVAR in the Vascular Quality Initiative between 2003 and 2021 were queried. Exclusions were: ruptured/symptomatic aneurysm; concomitant renal artery or supra-renal intervention at the time of EVAR; conversion to open aneurysm repair at the time of initial operation; and undocumented mortality status at the 5 year mark postoperatively. 18,710 patients met inclusion criteria. Multivariable Cox regression time dependent analysis was performed to investigate the strength of mortality association of the exposure variables. Standard demographic variables and pre-existing major co-morbidities were included in the regression analysis to account for disproportionate, deleterious co-variables amongst those experiencing the various morbidities. Kaplan-Meier survival analysis was performed to provide survival curves for the key variables. Mean follow up was 5.99years and 5-year survival for included patients was 69.2%. Cox regression revealed increased long term mortality to be associated with the following perioperative events: reoperation during the index hospital admission (HR 1.21, P = .034), perioperative leg ischemia (HR 1.34, P = .014), perioperative acute renal insufficiency (HR 1.24, P = .013), perioperative myocardial infarction (HR 1.87, P < .001), perioperative intestinal ischemia (HR 2.13, P < .001), perioperative respiratory failure (HR 2.15, P < .001), lack of discharge aspirin (HR 1.26, P < .001), and lack of discharge statin (HR 1.26, P < .001). The following pre-existing co-morbidities correlated with increased long term mortality (P < .001 for all) : body mass index under 20kg/m2, hypertension, diabetes, coronary artery disease, reported history congestive heart failure, chronic obstructive pulmonary disease, peripheral artery disease, advancing age, baseline renal insufficiency and left ventricular ejection fraction less than 50%. Females were more likely to have EBL >300mL, reoperation, perioperative MI, limb ischemia and acute renal insufficiency than males (P < .01 for all). Female sex trended but was not associated with increased long term mortality risk (HR 1.06, 95% CI .995-1.14, P = .072). Survival after EVAR is improved with optimal operative planning to facilitate evading the need for reoperation and ensuring patients without contra-indication are discharged with aspirin and statin medications. Females and patients with pre-existing co-morbidity are at particularly higher risk for perioperative limb ischemia, renal insufficiency, intestinal ischemia and myocardial ischemia necessitating appropriate preparation and preventative measures.

Management of Oral Surgery in Patients by Anticoagulant Therapy

Background: Oral surgery is a common procedure performed on patients for various reasons such as implant placement, tooth extraction, and other surgical interventions. Anticoagulant therapy is prescribed to patients to prevent blood clot formation, which can lead to serious conditions. Post-operative management of patients on anticoagulant therapy is also critical to minimize bleeding complications. Study design: It is a systematic and controlled based study conducted at Azra Naheed Dental College/ Superior University, Lahore and DOW International Dental College, Karachi for the duration of six months from July 2022 to December 2022. Material and Methods: The participants were divided into two groups. Group A (n=35) included patients treated with direct oral anticoagulants (DOACs) after oral surgery and group B (n=20) had patients treated with vitamin K antagonists. The average age of patients in DOACs and VKA group was 71.3±2.33 and 72.1±1.6 years respectively. Results: Stroke, atrial fibrillation venous thromboembolism and acute coronary syndrome was found in 4,5,24 and 2 patients respectively. In case of VKA group there were 2,3,14 and 1 patient hat suffered from stroke, atrial fibrillation venous thromboembolism, and acute coronary syndrome in the VKA group. The duration of surgery in DOACs and VKA group was 34.5±2.33 and 31.8±3.2 respectively. Conclusion: This study concludes that bleeding risk in patients having some dental surgeries can effectively be controlled by interrupting the DOACs therapy and then restarting it after surgery along with some local hemostatic agents. However, the efficiency of VKAs and DOACs will be the same when DOAC therapy will not be interrupted right before an invasive surgical procedure in case of patients having higher bleeding risk treatment. Keywords: Oral surgery, anticoagulant therapy and thromboembolic events.

Sedation Weaning Initiative Targeting Methadone Exposure: Single Center Improvements in Withdrawal Symptoms and Hospital Length of Stay for Pediatric Cardiac Critical Care.

Sedation and pain medications are necessary in the management of postoperative pediatric cardiac patients. Prolonged exposure to these medications can lead to negative side effects including withdrawal. We hypothesized that standardized weaning guidelines would decrease exposure to sedation medications and decrease withdrawal symptoms. The primary aim was to decrease average days of methadone exposure to within goal for moderate- and high-risk patients within 6 months. Quality improvement methods were used to standardize sedation medication weaning in a pediatric cardiac ICU. This study took place at Duke Children's Hospital Pediatric Cardiac ICU in Durham, North Carolina from January 1, 2020, to December 31, 2021. Children less than 12 months old admitted to the pediatric cardiac ICU who underwent cardiac surgery. Sedation weaning guidelines were implemented over the course of 12 months. Data were tracked every 6 months and compared with the 12 months pre-intervention. Patients were stratified into low, moderate, and high risk withdrawal categories based on duration of opioid infusion exposure. Total sample size was 94 patients in the moderate and high risk categories. Process measures included documentation of Withdrawal Assessment Tool scores and appropriate methadone prescription in patients which increased to 100% post-intervention. For outcome measures, we observed decreased dexmedetomidine infusion duration, decreased methadone wean duration, decreased frequency of elevated Withdrawal Assessment Tool scores, and decreased hospital length of stay post-intervention. For the primary aim, methadone wean duration consistently decreased after each study period. Our intervention did not adversely impact balancing measures. A quality improvement initiative to standardize sedation weaning in a Pediatric Cardiac ICU was successfully implemented and was correlated with decreased duration of sedation medications, decreased withdrawal scores, and decreased length of stay.

Comparative Analysis of Isolated Abdominoplasty and Concomitant Hernio-Abdominoplasty

Introduction . According to the statistics of Plastic Surgery Unit, Mother and Child Clinical Hospital, Ufa (Russia), for 2019–2022, surgical interventions on the anterior abdominal wall rank third in popularity. The complexity of the approach to the treatment of patients with concomitant pathology of the anterior abdominal wall implies the need to replace isolated techniques with simultaneous surgical intervention in this area. Aim . To analyze the experience of surgical treatment and postoperative management of patients with aesthetic and physiological pathology of the anterior abdominal wall, based on the clinical data of Plastic Surgery Unit, Mother and Child Clinical Hospital. Materials and methods . The study enrolled 54 women who were undergoing inpatient and outpatient treatment in Plastic Surgery Unit, Mother and Child Clinical Hospital from 2019 to 2022. 31 of them made up group 1 (persons with aesthetic and functional deformity of the anterior abdominal wall but without a hernial defect), and 23 made up group 2 (persons with aesthetic and functional deformity of the anterior abdominal wall and with a midline ventral hernia). Abdominoplasty was performed in group 1, and hernio-abdominoplasty was performed in group 2. Results and discussion . Both abdominoplasty and simultaneous hernio-abdominoplasty enable the lost shape and contours of the anterior abdominal wall to be restored. Simultaneous hernio-abdominoplasty increases the time of surgical intervention, but reduces the multiplicity of necessary operations and anaesthetic support, the duration of the rehabilitation period, and financial costs. Abdominoplasty provides convenient access to perform tension-free hernioplasty. The simultaneous approach to the treatment of the anterior abdominal wall did not cause an increase in the incidence of complications. Conclusion . Simultaneous hernio-abdominoplasty is a justified surgical intervention with a concomitant pathology of the anterior abdominal wall. An integrated approach improves immediate and long-term surgical out-comes.

Abstract 1036: Detection of circulating tumor DNA by whole genome sequencing enables prediction of recurrence in stage III colorectal cancer patients with great inter-lab reproducibility

Abstract Background: Detection of circulating tumor DNA (ctDNA) in plasma indicates the presence of cancer. In patients with very few copies of tumor DNA circulating in the blood, the blood sampling process becomes a potentially limiting factor. For ctDNA methods based on a single or a few genomic targets, it becomes stochastic whether the collected sample contains any tumor DNA fragments from targeted regions. To overcome this sampling limitation, we developed C2inform; a whole genome sequencing (WGS) approach, which detects ctDNA using a cumulative patient-specific signal from thousands of mutations throughout the entire genome. Aim: Here, we aim to I) evaluate the performance of C2inform in patients with UICC stage III colorectal cancer (CRC) using samples collected after the end of curatively intended treatment and serially during surveillance, II) assess the inter-lab reproducibility of C2inform and, III) investigate the potential for using the serial WGS data to track tumor genomic evolution in recurrence patients. Methods: From a cohort of 146 stage III CRC patients, including 37 patients with recurrence, 2 mL plasma samples were collected serially for up to three years (n = 1309, median 10 samples per patient). By WGS of tumor and blood-derived normal DNA, a mutational signature was established for each patient. Enhanced by an AI-based error suppression model, this signature was used to screen 20x WGS plasma cfDNA profiles for the presence of ctDNA. To evaluate the reproducibility, paired samples (n = 2 x 187 samples) were processed and sequenced at two independent laboratories while the bioinformatics processing of samples was identical. Using coverage, split-read, and discordant read-pair information, genomic structural alterations were identified in serial plasma samples from 19 recurrence patients and compared to tissue WGS from subsequent recurrence metastasis. Results: Preliminary results showed that detection of ctDNA after the end of treatment was associated with poor prognosis (HR = 7.1, 95% CI: 3.2-15.9). The presence of ctDNA during surveillance was a predictor of recurrence (HR = 9.5, 95% CI: 3.6-25.5) and enabled the detection of recurrence up to 21 months (median: 9.5 months) before detection by radiological imaging. We found indication of tumor evolution by searching serially collected plasma samples for novel genomic changes, which were confirmed by WGS of the metastatic tissue. Analysis of paired samples showed great reproducibility of C2inform with a high agreement between both ctDNA detection (Cohens Kappa = 0.9) and the estimated ctDNA level (r² = 0.99). Conclusion: C2inform showed great inter-lab reproducibility and enabled prediction of recurrence after treatment and during surveillance. Thus, C2inform has the potential to guide clinical decision-making during the postoperative management of CRC patients. Citation Format: Amanda Frydendahl, Jesper Nors, Mads Heilskov, Ester Ellegaard Sørensen, Thomas Reinert, Jesper Bramsen, Danielle Afterman, Tomer Lauterman, Maja Kuzman, Santiago Gonzalez, Dunja Glavas, James Samdbeck, Dillon Maloney, Jurica Levatic, Sunil Deochand, Michael Yahalom, Ryan Ptashkin, Iman Tavassoly, Zohar Donenhirsh, Eric White, Ravi Kandasamy, Ury Alon, Paz Polak, Anders Husted Madsen, Uffe Schou Løve, Per Vadgaard Andersen, Ole Thorlacius-Ussing, Lene Hjerrild Iversen, Kåre Andersson Gotschalck, Boris Oklander, Asaf Zviran, Claus Lindbjerg Andersen. Detection of circulating tumor DNA by whole genome sequencing enables prediction of recurrence in stage III colorectal cancer patients with great inter-lab reproducibility [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1036.

The Effect of Dexamethasone on Postoperative Pain Management in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.

Objective The objective of this study was to evaluate the effectiveness ofdexamethasonein treating postoperative pain in patients undergoing total knee arthroplasty (TKA). Methodology This randomized controlled trial (RCT) was completed over the course of two years (September 7, 2015, to September 6, 2017). In the course of their treatment for osteoarthritis of the knee, all of the patients who had primary unilateral total knee replacement (TKR) participated in the research. Under spinal anesthesia, each patient had medial para-patellar approach medial orthopedic surgery. Patients were assigned to group A or group B based on a random selection. Each of the groups consisted of 79 individuals. Group A was given dexamethasone through intravenous administration at a dose of 0.1 mg/kg before the operation. During the subsequent period of 24 hours, no more treatment was administered (control group). On a predesigned questionnaire, postoperative pain was measured using the visual analog scale (VAS) for pain. Functional results, duration of hospital stay, and complications were all recorded on the questionnaire (VAS). Analysis of data was carried out using the Statistical Package for the Social Sciences (SPSS) version 23 (IBM SPSS Statistics, Armonk, NY, USA). Results There were 158 patients in total in the study, out of which 98 were females and 60 were males in the group. The patients' average body mass index (BMI) was 26.94 ± 3.14 kg/m2. Patients in group A had lower postoperative analgesic and antiemetic needs and higher VAS scores and spent less time in the hospital than patients in group B. There were no postoperative problems in either group. Conclusion In patients undergoing TKA, the use of dexamethasone during and after surgery decreases pain, the need for analgesics, and the duration of hospital stay.

413 Addressing Healthcare Disparities in Patients Undergoing Cervical Spine Surgery

INTRODUCTION: Health disparities may be observed across pre and post-operative hospital courses amongst patients undergoing cervical spine surgery across racial minorities and their white counterparts. METHODS: Retrospective data analysis of the Thomas Jefferson University Center City Department of Neurosurgery undergoing cervical spine surgeries (based on select CPT codes) between January 1, 2018, and January 6, 2021, was conducted to evaluate healthcare disparities across the post-operative management of cervical myelopathy cases as part of a quality improvement initiative. Outcomes evaluated included: hospital length of stay, the 30-day hospital readmission rate, and discharge disposition (home vs non-home). Normality was assessed using Kolmogorov-Smirnov test. Readmission rates, length of stay (LOS) in days, and discharge disposition (DD) (home vs. non-home) were analyzed using the Student's T-test, ANOVA, and Mann-Whitney test. RESULTS: Two thousand twenty-five patients were identified that met inclusion criteria, of which 298 (15%) were readmitted within 30 days to the Emergency Department at Thomas Jefferson University Hospital. Of the 15% readmitted, 74% (223/298) were white, while 25% (75/298) were non-white. Non-white LOS was higher compared to the white population (5.7 days vs 4.3 days, p &lt; 0.0001. Non-white readmission rate was higher compared to the white population (22.3% vs 16%) p &lt; 0.001. Non-white DD was higher compared to the white population (61.9% vs 50%) p &lt; 0.001. CONCLUSIONS: Significant disparities exist in the post-operative management of patients with cervical myelopathy, particularly affecting the non-white population. Health disparities exist across multiple aspects of the discharge process for post-cervical spine surgery cases. Future investigations and interventions are required to address this quality gap.

19 Development of the Puerto Rico Neoplasm and CNS Tumor Registry (PUNCTURE)

OBJECTIVES/GOALS: To describe and compare clinical data and outcomes for patients with CNS tumors and tumor mimics in Puerto Rico who are undergoing surgical and nonsurgical management. Thus, increasing data from an underrepresented group which can serve as a foundation for investigating determinants of outcomes. METHODS/STUDY POPULATION: This proposal will examine patient charts, radiology and pathology reports, financial data, and treatment details from the electronic medical record of patients receiving surgical and nonsurgical treatment for CNS tumors and mimics in the University of Puerto Rico Medical Sciences Campus and all associated institutions. Data will be analyzed retrospectively between January 1, 2014 and June 30, 2022, and prospectively for ten years until December 31, 2032. Patients with primary and metastatic CNS tumors and tumor mimics in the brain, meninges, ventricles, spinal cord, cranial nerves, orbit, facial sinuses, bony skull, vasculature will be included. The registry will include patients from birth onward. RESULTS/ANTICIPATED RESULTS: We plan to compare different surgical and non-surgical techniques and devices in terms of technical and clinical outcomes after surgical interventions for CNS tumors. We are collaborating with the CNS Tumor Outcome Registry at Emory (CTORE) and plan to continue collaboration with other institutions. Combining our data, we aim to develop predictive models of patient outcomes after surgical and nonsurgical intervention for CNS pathologies using supervised and unsupervised machine learning strategies. DISCUSSION/SIGNIFICANCE: There is a significant lack of literature on CNS intervention outcomes in Puerto Rico. This registry will provide the platform for cost-analysis studies for techniques and clinical protocols applicable to pre-operative, intra-operative, post-operative, and conservative management of patients, in Puerto Rico and beyond.

Наблюдательное несравнительное одноцентровое исследование эффективности и безопасности фиксированной комбинации Тобрамицин 0,3% + Фторметолон 0,1% (глазные капли) в качестве предоперационной подготовки и послеоперационного ведения пациентов с ВМД влажной формы после интравитреального введения ранибизумаба

Purpose. To evaluate safety and efficacy of Floas-T ® (Tobramycin 0.3% + Fluormetholone 0.1%) as a preoperative preparation and postoperative management of patients with wet form of age-related macular degeneration (AMD) before and after intravitreal injection (IVI) of anti-VEGF drugs. Material and methods. 50 patients (50 eyes) with the wet form of AMD were examined and divided into two groups. The first group included 32 patients (32 eyes) with wet form of AMD. The second group consisted of 18 patients (18 eyes) with primary (11 eyes) and advanced (7 eyes) stages of primary open angle glaucoma with normalized IOP and wet form of AMD. Results. There were no significant changes in ВСVA and tonometric IOP values in the two groups before and within 7 days after IVI of ranibizumab and Floas-T ® instillations. Average value of individually tolerable true IOP in patients of the second group was 16,3±1,1 mm Hg, while average value of initial true IOP (14,7±2,56 mm Hg) pre-op was lower than tolerable pressure, indicating that individual norm of ophthalmotonus in glaucoma patients was reached. The difference between the mean values of ocular hydrodynamics in both groups before and 1 week after surgery was also statistically unsignificant (p&gt;0.05). The difference between the mean values of the Schirmer I test was statistically unsignificant in patients in the two groups (p&gt;0.05) before and after surgery, indicating the absence of Floas-T ® effect on tear production. There were no local and systemic side effects of Floas-T ® in 50 patients (50 eyes) during the observation period. Conclusion. Floas-T ® had an antiinflammatory effect without a decrease in the aqueous humor outflow, did not cause a significant increase in IOP in the early postoperative period, did not decrease tear production, and did not cause adverse local and systemic side effects. Floas-T ® can be used as a preoperative preparation and postoperative management drug in patients with wet type of AMD as well as in combination with primary open angle glaucoma when achieving an individual level of intraocular pressure. Key words: wet AMD, preoperative preparation, postoperative management, Floas-T® drug

Postoperative complications and disposition for vascular surgery.

Among all surgical specialties, vascular surgery has the greatest proportion of patients with unplanned admissions to the intensive care unit postoperatively. Therefore, current clinical pathways for the postoperative management of vascular surgery patients may need to be revised. We aimed to compare the prevalence of postoperative deterioration in the high and standard risk cohorts of patients through several markers: medical emergency team activations and unplanned intensive care unit admissions. This was a single-centre, retrospective cohort study of all vascular surgical patients, emergency and elective, between 1 January and 31 December 2020 at Fiona Stanley Hospital, a tertiary hospital located in Perth, Western Australia. Patients (n = 680) were risk stratified using the surgical outcome risk tool into standard-risk (30-day mortality risk <5%; n = 475, 69.9%) and high-risk (30-day mortality risk ≥5%; n = 205, 30.1%). There were 43 unplanned intensive care unit admissions (6.3%) in total. Furthermore, surgical outcome risk tool 5% or greater risk patients were approximately eight times more likely to experience an unplanned intensive care unit admission compared with their surgical outcome risk tool less than 5% risk counterparts (relative risk 7.65, 95% confidence interval 3.84-15.21). There were 87 medical emergency team calls (12.8%) in total. In addition, surgical outcome risk tool 5% or greater risk patients were approximately five times more likely to experience a medical emergency team activation than their surgical outcome risk tool less than 5% risk counterparts (relative risk 5.15, 95% confidence interval 3.37-7.86). Our findings highlight the need for a revision of the inpatient journey for surgical outcome risk tool 5% or greater risk vascular patients, given their increased rates of unfavourable postoperative outcomes such as unplanned intensive care unit admission and medical emergency team activation. Ideally this can be addressed through appropriate postoperative triage, thus allowing this vulnerable population group early access to higher acuity care.

NURSING CARE FOR CLIENTS WHO EXPERIENCE POST OPERATING FEMUR FRACTURES WITH ACUTE PAIN NURSING PROBLEMS IN THE BIMA ROOM, JOMBANG HOSPITAL

Background:Fracture is a break or damage to the continuity of bone tissue caused by an external pressure that is greater than can be absorbed by the bone. Method:The research design was a case study using 2 postoperative femur fracture clients as subjects with acute pain nursing problems, nursing care was carried out for 3 consecutive days using cold compress therapy. Result:The results of the study showed acute pain by administering cold compress therapy, the problem was resolved by reducing pain scale to mild pain scale. Analysis:The results of the evaluation carried out by the researchers during the three days of treatment on both clients with postoperative femoral fracture problems found the diagnosis of acute pain was resolved. Conclusion:Non-pharmacological management of postoperative fracture patients with pain is to use cold compress therapy. Giving cold compresses can reduce pain, increase the release of endorphins which block the transmission of painful stimuli.

Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial

Background: Many techniques, including multimodal analgesia, have been used to manage postoperative pain after laparoscopic cholecystectomy (LC). Although the number of studies using intravenous ibuprofen (IV) is still limited, ibuprofen has been shown to have a potential role in managing postoperative pain. The primary outcome of this study is to evaluate and compare the impact of IV forms of ibuprofen and acetaminophen on 24-hour postoperative opioid consumption and pain management in patients undergoing LC. The second outcome of the study is to evaluate the impact of ibuprofen and acetaminophen on opioid-related adverse events (ORAE).&#x0D; Materials and Methods: This study was a prospective, randomized, double-blind clinical trial. Following ethical committee approval, 70 patients aged 18 to 65, American Society of Anesthesiology (ASA) score I- II, and those scheduled for LC were enrolled in the study. Patients were randomly divided into two groups. The control group (n=35) received 800 mg IV ibuprofen (group I) in 100 mL saline during surgery, while the acetaminophen group (n=35) received 1000 mg (group A). In the postoperative period, all patients received a patient-controlled analgesia (PCA) device with tramadol. The PCA device was set to a bolus dose of 10 mg and had a lockout time of 15 minutes. A blinded pain nurse assessed postoperative analgesia at 1, 2, 4, 6, 12, and 24 hours using a numerical rating scale (NRS). The incidence of postoperative nausea and vomiting (PONV), total tramadol consumption, and the need for additional analgesics during the 24-hour postoperative period were recorded.&#x0D; Results: Seventy patients who underwent LC participated in this study. The use of analgesic medications was statistically lower in group I than in the other group A. NRS scores between the IV ibuprofen and acetaminophen groups were statistically similar at 1, 2, 4, 6, 12, and 24 hours postoperatively (P&gt;0.05). 24-hour opioid consumption was statistically significantly higher in group A than in group I (P0.05). PONV rates were similar in the ibuprofen and acetaminophen groups (P&gt;0.05). ORAEs were similar between groups.&#x0D; Conclusion: Ibuprofen as part of tramadol-based multimodal analgesia reduced tramadol consumption compared to acetaminophen during the first 24 hours postoperatively following elective LC surgery. The IV ibuprofen-tramadol combination appeared superior to an acetaminophen-tramadol combination. ORAEs were similar in both groups.

Early Postoperative Volume Overload is a Predictor of 1-Year Post-Transplant Mortality in Pediatric Heart Transplant Recipients

Fluid restriction and diuretic management are mainstays in the postoperative management of cardiac patients, at risk of volume overload and its deleterious effects on primary cardiac function and multi-organ systems. The importance of fluid homeostasis is further emphasized among orthotopic heart transplant recipients (OHT). We sought to investigate the relationship between postoperative volume overload, mortality, and allograft dysfunction among pediatric OHT recipients within 1-year of transplantation. This is a retrospective cohort study from a single pediatric OHT center. Children under 21 years undergoing cardiac transplantation between 2010 and 2018 were included. Cumulative fluid overload (cFO) was assessed as percent fluid accumulation adjusted for preoperative body weight. Greater than 10% cFO defined those with postoperative cFO and a comparison of postoperative cFO vs. no postoperative cFO (< 5%) is reported. 102 pediatric OHT recipients were included. Early cFO at 72 h post-OHT occurred in 14% and overall cFO at 1-week post-OHT occurred in 23% of patients. Risk factors for cFO included younger age, lower weight, and postoperative ECMO. Early cFO was associated with postoperative mortality at 1-year, OR 8.6 (95% CI 1.4, 51.6), p = 0.04, independent of age and weight. There was no significant relationship between cFO and allograft dysfunction, measured by rates of clinical rejection and cardiopulmonary filling pressures within 1-year of transplant. Early postoperative volume overload is prevalent and associated with increased risk of death at 1-year among pediatric OHT recipients. It may be an important postoperative marker of transplant survival, and this relationship warrants further clinical investigation.

TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF INJURIES AND DISEASES OF PELVIC BONES

Summary. Purulent-inflammatory complications of fractures of pelvic bones represent up to currently one of the most difficult and little-studied sections of traumatology. Complexity anatomical structure and topographic relations of the pelvic region, deep location a significant part of the bones under the muscle mass create objective difficulties for surgical treatment of bone damage and later in the diagnosis of purulent processes. Osteomyelitis of the pelvis is accompanied by high mortality and is from 2.5 to 52% as in acute and in the chronic stage of the disease.&#x0D; Purpose: by analyzing clinical mistakes and the possibility of purulent-inflammatory complications during operative treatment and postoperative management of patients with fractures bones of the pelvis, as well as to determine methods of diagnosis, treatment and ways of prevention traumatic sacroiliitis.&#x0D; Materials and methods. In the period from 2017 to 2022 in the bone-purulent surgery department of Zaporizhzhia city clinical hospital №9 treated 9 patients with purulent processes in of the pelvic region, 6 (66.3%) of them were men, and 3 (33.4%) were women. With postoperative osteomyelitis, which occurred after osteosynthesis with plates of multiple pelvic bone fractures, 4 (44.5%) patients were treated. Conservative therapy with sacroiliitis, the cause of which was abortion, received by 2 (22.2%) women, 1 (11.1%) patient suffered from right-sided sacroiliitis since childhood and repeatedly operated, and 2 (22.2%) men were treated with cause of sacroiliitis, which occurred after slaughter of the sacroiliac joint area.&#x0D; Results. All patients who were treated in the bone-purulent surgery department for purulent-inflammatory processes of pelvic bones, recovered and were discharged for outpatient treatment. While treatment in the ward, patients received complex treatment, which included conservative therapy and surgical intervention. Despite the introduction of modern methods of treatment of osteomyelitis of the pelvis, a trend of steady growth in the number is noted exits of patients with disabilities, which is confirmed by world statistics.&#x0D; Conclusions. Lack of hard fixation of bone fragments by implants increases the risk of purulent complications in the postoperative period. Use of additional diagnostic methods and complex treatment, which includes radical purulent sanitation foci, creation of favorable conditions for tissue regeneration, prevention of relapses suppuration, targeted antibacterial therapy, correction of homeostasis indicators and increases the protective forces of the body during purulent processes of the bones and joints of the pelvis achieving positive results in 80.2% of patients.

Postoperative stroke assessment inconsistencies in cardiac surgery: Contributors to higher stroke-related mortality?

ObjectivesIn-hospital stroke mortality is surprisingly much worse than for strokes occurring outside of the hospital. Cardiac surgery patients are amongst the highest risk groups for in-hospital stroke and experience high stroke-related mortality. Variability in institutional practices appears to play an important role in the diagnosis, management, and outcome of postoperative stroke. We therefore tested the hypothesis that variability in postoperative stroke management of cardiac surgical patients exists across institutions. Materials and methodsA 13 item survey was employed to determine postoperative stroke practice patterns for cardiac surgical patients across 45 academic institutions. ResultsLess than half (44%) reported any formal clinical effort to preoperatively identify patients at high risk for postoperative stroke. Epiaortic ultrasonography for the detection of aortic atheroma, a proven preventative measure, was routinely practiced in only 16% of institutions. Forty-four percent (44%) reported not knowing whether a validated stroke assessment tool was utilized for the detection of postoperative stroke, and 20% reported that validated tools were not routinely used. All responders, however, confirmed the availability of stroke intervention teams. ConclusionsAdoption of a best practices approach to the management of postoperative stroke is highly variable and may improve outcomes in postoperative stroke after cardiac surgery.

The Impact of the Need for Language Assistance Services on the Use of Regional Anesthesia, Postoperative Pain Scores and Opioid Administration in Surgical Oncology Patients

Language barriers can negatively impact the quality of healthcare. In surgical patients, limited English proficiency (LEP) can lead to disparities in acute postoperative pain management. Interpreters are often used for communication with LEP patients to help alleviate these disparities. We aimed to investigate the impact of the need for language assistance services (LAS) in acute postoperative pain management in patients undergoing oncologic surgery. We retrospectively collected data on adult patients undergoing open abdominal oncologic surgery between March 2016 and August 2021. The need for LAS, patient demographics, treatment and clinical outcomes were obtained from the patient's electronic medical record. The primary endpoint was pain intensity, while secondary endpoints included opioid use in PACU and regional anesthesia. Post-matching analysis (n = 590) demonstrated no significant difference in preoperative variables between patients needing LAS and those not needing LAS. The rate of regional use was slightly lower but not statistically significant in patients needing LAS. Patients needing LAS had significantly lower opioid consumption and reported lower pain intensity in PACU than subjects not requiring translation. In this study, LAS may have aided in the patient decision process regarding the acceptance of regional anesthesia. Although the need for LAS was associated with statistically significant lower pain intensity scores and a corresponding lesser opioid use than no LAS, the margin of differences, especially in pain intensity scores, may not be clinically significant. This may suggest that LAS allowed for better patient-provider communication and appropriate pain management.

Perioperative Management of Elective Surgery in Patients with COVID-19 Infection

SARS-CoV2 is a deadly virus belonging to the family Corona-viridae, with the primary target pulmonary system, known as the coronavirus pandemic disease (COVID-19). This virus has caused a high death rate of approximately 9,500 deaths as of December 2020. Along this pandemic, the hospital will treat non-emergent conditions in COVID-19 patients require nonemergent surgery. Anesthesiologists have an important role in the anesthesia management in patients with COVID-19 utilization and require airway management. This article explains optimal preoperative evaluation, intraoperative management, and postoperative management of COVID-19 patients. Optimal treatment is expected to minimize complications and the spread of COVID-19 disease. The optimal time for elective surgery should be decided by a multidisciplinary committee that considers the risk of complications either the patient, the disease itself, the surgical procedure, or other alternatives with lower risk. Perioperative management is carried out preoperatively, intraoperatively, and postoperatively. The safety of anesthesiologists using personal protective equipment (PPE) to carry out preoperative evaluations is important. The number of disease severity can use a scoring system, the results of which can be used as a reference for multidisciplinary discussions related to perioperative management plans. General anesthesia can contribute to the spread of disease resulting from the risk of droplets resulting from airway action, so regional anesthesia can be considered to reduce the risk of spread. For this reason, optimal management is needed to reduce risks to patients as well as medical personnel.

Can a community hospital successfully transition to outpatient total knee arthroplasty in unselected patients?

BackgroundThe removal of total knee arthroplasty (TKA) from the Inpatient-Only list in 2018 created pressure on community hospitals to develop rapid discharge protocols (RAP) to increase outpatient discharge. The purpose of this study, therefore, was to compare the efficacy, safety and barriers in achieving outpatient discharge between the standard discharge protocol and newly developed RAP in unselected, unilateral TKA patients. MethodsThis retrospective chart review included 288 standard protocol patients and the first 289 RAP patients following unilateral TKA in a community hospital. The RAP focused on patient discharge expectations and post-operative patient management, with no change in post-operative nausea or pain management. Non-parametric tests were performed to compare demographics, perioperative variables and 90-readmission/complication rates between standard and RAP groups, as well as between inpatient and outpatient discharged RAP patients. Multivariate, stepwise logistic regression was performed to evaluate patient demographics and discharge status, presented as odds ratios (OR) and 95% confidence intervals (CI). ResultsDemographics were similar between groups, however, outpatient discharge significantly increased from 22.2% to 85.8% for standard discharge and RAP, respectively (p < 0.001), with no significant difference in post-operative complications. For RAP patients, age (OR:1.062, CI:1.014–1.111; p = 0.011) and female gender (OR:2.224, CI:1.042–4.832; p = 0.039) increased the risk of inpatient and 85.1% of RAP outpatients were discharged home. ConclusionsWhile RAP was successful, 15% of patients required inpatient care and 15% of patients achieving outpatient discharged were not discharged to their home environment, emphasizing the difficulties of achieving true outpatient status in 100% of patients from a community hospital.

Consensus of Chinese Experts on Surgical Treatment of Lung Cancer in the Elderly (2022 Edition)

Lung cancer ranked the highest incidence rate and mortality among people over 60 years old in China. With the increasing social population and incidence of lung cancer, the treatment of elderly lung cancer patients has become a major concern. Due to the improvement of surgical techniques and the application of enhanced recovery after surgery in thoracic surgery, more elderly patients could tolerate surgical treatment. At the same time, with the improvement of health awareness and the popularization of early diagnosis and screening, more lung cancer can be detected at the early stage. However, considering the organ dysfunction, various complications, physical weakness and other factors of elderly patients, it is important to provide individualized surgical treatment for the elderly. Therefore, based on the latest research progress worldwide, the experts in relevant fields have developed this consensus which contributes to guide the preoperative evaluation, surgical strategy, intraoperative anesthesia management, and postoperative management for elderly patients of lung cancer. .