Postoperative Care Of Patients Research Articles

AO FRACTURE MONITOR: CONTINUOUS SENSOR MONITORING FOR PERSONALIZED FRACTURE CARE

In absence of available quantitative measures, the assessment of fracture healing based on clinical examination and X-rays remains a subjective matter. Lacking reliable information on the state of healing, rehabilitation is hardly individualized and mostly follows non evidence-based protocols building on common guidelines and personal experience. Measurement of fracture stiffness has been demonstrated as a valid outcome measure for the maturity of the repair tissue but so far has not found its way to clinical application outside the research space. However, with the recent technological advancements and trends towards digital health care, this seems about to change with new generations of instrumented implants – often unfortunately termed “smart implants” – being developed as medical devices.The AO Fracture Monitor is a novel, active, implantable sensor system designed to provide an objective measure for the assessment of fracture healing progression (1). It consists of an implantable sensor that is attached to conventional locking plates and continuously measures implant load during physiological weight bearing. Data is recorded and processed in real-time on the implant, from where it is wirelessly transmitted to a cloud application via the patient's smartphone. Thus, the system allows for timely, remote and X-ray free provision of feedback upon the mechanical competence of the repair tissue to support therapeutic decision making and individualized aftercare.The device has been developed according to medical device standards and underwent extensive verification and validation, including an in-vivo study in an ovine tibial osteotomy model, that confirmed the device's capability to depict the course of fracture healing as well as its long-term technical performance. Currently a multi-center clinical investigation is underway to demonstrate clinical safety of the novel implant system. Rendering the progression of bone fracture healing assessable, the AO Fracture Monitor carries potential to enhance today's postoperative care of fracture patients.

Adhesion Reduction Agent Guardix-SG® Versus MegaShield® for Postoperative Swallowing Function Analysis in Thyroidectomy Patients.

Antiadhesion products are essential for postoperative care in patients after thyroidectomy by providing a physical barrier to cover the exposed tissue and thus preventing abnormal adhesion of adjacent tissues. Since thyroidectomy may result in swallowing difficulties arising from damage or inflammation of the surrounding tissues, the use of antiadhesion agents such as MegaShield® or Guardix-SG® will help reduce scar formation. This may thus improve postoperative swallowing function in patients. Patients were enrolled and followed up between October 4, 2018, and March 26, 2020. Patients during the postoperative follow-up sessions were randomly allocated to the standard care with Guardix-SG® and clinical trial medical device application group with MegaShield® (test group) in a 1:1 ratio by the permuted block randomization method. Patient performance on penetration aspiration scale (PAS), National Institutes of Health-Swallow Safety Scale (NIH-SSS), videofluoroscopic dysphagia scale (VDS), Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) based on Videofluoroscopic swallowing study (VFSS) were collected. Nonadhesion-reducing agent patient data were used as a control group. No statistical significance was shown (P > .05) between the 2 groups of MegaShield® and Guardix-SG® in various phases from thick semisolid, thin semisolid to liquid for both PAS and NIH-SSS. Several statistical significances were reported in the results comparing various criteria of PAS, NIH-SSS, VDS at different oral and pharyngeal phases, and DIGEST in all 3 stages among MegaShield®, Guardix-SG®, and nonadhesion-reducing agent group. These results prove the noninferiority of MegaShield® compared with Guardix-SG® as an antiadhesion agent in postthyroidectomy care.

Constructing an Osseointegrated Prosthetic Leg.

Constructing an osseointegrated prosthetic leg is the necessary subsequent phase of care for patients following the surgical implantation of an osseointegrated prosthetic limb anchor. The surgeon implants the bone-anchored transcutaneous implant1,2 and the prosthetist constructs the prosthetic leg, which then attaches to the surgically implanted anchor. An osseointegration surgical procedure is usually considered in patients who are unable to use or are dissatisfied with the use of a socket prosthesis. This present video article describes the techniques and principles involved in constructing a prosthetic leg for transfemoral and transtibial amputees, as well as postoperative patient care. Preoperatively, as part of a multidisciplinary team approach, the prosthetist should assist in patient evaluation to determine suitability for osseointegration surgery. Postoperatively, when approved by the surgeon, the first step is to perform an implant inspection and to take patient measurements. A temporary loading implant is provided to allow the patient to start loading the limb. When the patient is approved for full-length leg to begin full weight-bearing, the implant and prosthetic quality are evaluated, including torque, implant position, bench alignment, static alignment in the standing position, and initial dynamic alignment. This surgical procedure also requires long-term, continued patient care and prosthetic maintenance. For patients who are dissatisfied with the use of a socket prosthesis, adjustments can often be made to improve the comfort, fit, and performance of the prosthesis. Non-osseointegration surgical options include bone lengthening and/or soft-tissue contouring. Osseointegration can be provided for amputees who are expressing dissatisfaction with their socket prosthesis, and typically provides superior mobility and quality of life compared with nonoperative and other operative options3,4. Specific differences between the appropriate design and construction of osseointegrated prostheses versus socket prostheses include component selection, component fit, patient-prosthesis static and dynamic alignment, tolerances and accommodations, and also the expected long-term changes in patient joint mobility and behavior. Providing an osseointegrated prosthesis according to the principles appropriate for socket prostheses may often leave an osseointegrated patient improperly aligned and provoke maladaptive accommodations, hindering performance and potentially putting patients at unnecessary risk for injury. Review articles describing the clinical outcomes of osseointegration consistently suggest that patients with osseointegrated prostheses have improved prosthesis wear time, mobility, and quality of life compared with patients with socket prostheses. Importantly, studies have shown that osseointegrated prostheses can be utilized in patients with short residual limbs that preclude the use of a socket prosthesis, allowing them to regain or retain function of the joint proximal to the short residuum5,6. Osseoperception improves patient confidence during mobility7. Because there is an open skin portal, low-grade soft-tissue infection can occur, which is usually treated with a short course of oral antibiotics. Much less often, soft-tissue debridement or implant removal may be needed to treat infection8. Periprosthetic fractures can nearly always be treated with familiar fracture fixation techniques and implant retention9,10. Falls can lead to periprosthetic fractures.Malalignment can lead to unnecessary pathologic joint forces, soft-tissue contractures, and an accommodative gait.Inadequately sophisticated components can leave patients at a performance deficit.Wearing the prosthetic leg while sleeping may lead to rotational forces exerted on the limb, which may cause prolonged tension on the soft tissue. QTFA = Questionnaire for Persons with a Transfemoral AmputationLD-SRS = Limb Deformity Modified Scoliosis Research SocietyPROMIS = Patient-Reported Outcomes Measurement Information SystemEQ-5D = EuroQol 5 Dimensions.

Gender differences in robotic surgery for rectal cancer: A retrospective study

ObjectiveTo investigate gender-based differences in outcomes following robotic surgery for rectal cancer. MethodsA retrospective study was conducted on 155 patients (82 males, 73 females) who underwent robotic surgery for rectal cancer. Demographic, pre-operative, operative, and post-operative data were collected and analyzed. ResultsThere were no significant differences in demographic and pre-operative characteristics between genders. While males had longer operative times (177 ​min vs. 160 ​min for females), this was not statistically significant. However, males had significantly shorter hospital stays (P ​< ​0.05), while females had a higher incidence of Clavien-Dindo grade III-IV complications (48% vs. 37.8% in males). Complication rates were comparable, but specific complications varied between genders. ConclusionDemographic and pre-operative features were similar, notable differences between genders emerged in operative time, length of hospital stay and complication severity. These findings underscore the importance of gender-specific considerations in both surgical approaches and post-operative care for rectal cancer patients undergoing robotic surgery.

Assessment of manual operation note documentation practice: a cross-sectional study.

Operation note documentation captures the key findings and subtle elements of a surgical strategy and is crucial for patient safety. Poor operation note documentation can negatively influence postoperative patient care. This study aimed to assess manual operation note documentation practice. An institutional-based, cross-sectional study was conducted from 30 March to 30 April 2022, on 240 operation notes of patient data. Data were entered and analyzed by SPSS version 20. According to the RCSE, the Royal College of Surgeons of England, the practice of operation note documentation was rated excellent for each variable when it met 100%, good if it met more than 50%, and poor if it met less than 50% of the operation notes of patient data. All operation notes (n=240) were handwritten. The practice of manual operation note documentation was deemed excellent in two (7.69%), good in 18 (69.2%), and poor in six (23.1%). Residents wrote 84.2% of the operation notes and surgeons and assistants were identified in greater than 94% of the notes, while anesthesia team members were identified in 90.8%. Estimated blood loss was documented in 4.2% of the notes, and the closure technique was described in 64.2%. The operation note templates did not include antibiotic prophylaxis, runner nurse name, or gauze and instrument counts. The urgency of the surgery and time of documentation had a negative relationship, and the seniority of the operation note writer had a positive relationship with manual operative note documentation practice. Compared to the standard, all operation note documentation was incomplete and below the standard. We recommend that this comprehensive and specialized hospital administrator implement a new format for operation notes that incorporates RCSE requirements.

Monitoring Food Images After Rectal Surgery To Accelerate Recovery Of Postoperative Bowel Motility: A Quasi-Experimental Study

Objective: Considering the role of nurses in the postoperative care of patients, simple nursing interventions can prevent gastrointestinal motility problems. This study aimed to assess the impact of viewing food images on the recovery of intestinal motility after surgery in patients who were operated for rectal cancer. Methods: This quasi-experimental study was carried out with 48 patients who underwent rectal surgery in the general surgery clinic of a university hospital in Türkiye from May 2016 to December 2018. The control group had 25 participants and the experimental group had 23. From the first morning after surgery until defecation, patients in the experimental group were asked to monitor food pictures thrice a day, parallel to their meals. Results: In the experimental group, patients’ first flatus (3.30 ± 1.52, day) and defecation time (4.91 ± 1.27, day) were significantly shorter compared with the first flatus (4.28 ± 1.64, day) and defecation time (5.84 ± 1.40, day) of the control group (respectively; p = 0.037, p = 0.027). Conclusion: Monitoring food images supports the cephalic phase and could be a nursing intervention to speed up intestinal functions by increasing the release of gastrointestinal hormones and activating the parasympathetic nervous system. To accelerate bowel motility after rectal surgery, displaying the food images to the patients is a very simple intervention with low risk and cost and nurses should use it in the care of the patients who underwent surgery because of rectal cancer. It is recommended that further studies examining the effectiveness of monitoring food images on gastrointestinal surgeries should be performed.

Running Alterations Pre- and Postarthroscopy for Femoroacetabular Impingement Syndrome and Labral Tears.

Freemyer, B, Beeler, D, Crawford, S, Durkin, R, and Stickley, C. Running alterations pre- and postarthroscopy for femoroacetabular impingement syndrome and labral tears. J Strength Cond Res 38(3): 501-509, 2024-Running is essential to sports participation and activity over the lifespan; however, running biomechanics are not fully described in patients with femoroacetabular impingement (FAIS). The purpose was to compare FAIS patient report outcome surveys (PRO) and running biomechanics preoperatively and 6 months postoperatively with controls. Nineteen subjects (FAIS, n = 10 and age-matched controls, n = 9) were included. The UCLA, Hip Outcome Score activity of daily living (HOS ADL ) and sports subscale (HOS SS ), and 3-D running biomechanics were evaluated. Statistical parametric mapping was conducted on biomechanics data. Statistical significance was set at p ≤ 0.05. Femoroacetabular impingement had similar UCLA activity scores compared with controls by 6 months (FAIS: 8.4 ± 1.7, CON: 8.6 ± 2.0, p = 0.80), despite lower HOS ADL (FAIS-Six: 89.3 ± 6.3, CON: 100 ± 0, p = 0.04) and HOS SS (FAIS-Six: 82.6 ± 18.5, CON: 100 ± 0, p = 0.05). The FAIS group had lower knee adduction moments (KAM) around 22-27% of stance ( p = 0.05) and lower sagittal plane ankle power generation during the final 5% of stance compared with the controls ( p = 0.04) preoperatively. The FAIS also had lower vertical ground reaction forces the first 2% of stance ( p = 0.05) and lower KAM from 20 to 30% stance ( p = 0.03) at the postoperative time vs. controls. Femoroacetabular impingement had higher hip external rotation angles the first 5% stance ( p = 0.05) and the last 20% of stance ( p = 0.01) vs. controls. This is the first study to describe FAIS running pre- and postoperatively. Despite higher activity and health 6 months postarthroscopy, the patients with FAIS had altered running biomechanics. Clinicians should consider these findings when creating rehabilitation protocols and during running progressions across the postoperative care of patients with FAIS.

Importance of Intraoperative Factors in Postoperative Arginine Vasopressin Deficiency After Pituitary Adenoma Surgery

ObjectivePituitary adenoma (PA) is the most frequent tumor in the sellar region. Arginine vasopressin deficiency (AVP-D), formerly known as central diabetes insipidus, is a common complication after pituitary surgeries. In this study, we reviewed patients with PAs after endoscopic transsphenoidal surgery, evaluated the incidence of postoperative AVP-D, and determined associated risk factors. MethodsWe retrospectively studied 520 patients who underwent endoscopic transsphenoidal surgery for PAs and evaluated perioperative risk factors and their associations with postoperative AVP-D. Patients who developed AVP-D were categorized in 3 groups: (1) early AVP-D, (2) transient AVP-D, and (3) permanent AVP-D. ResultsOf the 520 patients, 24.8% experienced early AVP-D, and 1.9% (n = 10) had transient AVP-D. Permanent AVP-D was observed in only 6 patients (1.1%). Gross total resection, hormonal remission, pituitary stalk manipulation, and intraoperative cerebrospinal fluid leak were significantly associated with a higher incidence of AVP-D (P = .027, P = .002, P < .001 and P < .001, respectively). All patients who developed permanent AVP-D had somatotroph adenomas. AVP-D was not found to be related with tumor size. The length of hospital stay was prolonged by AVP-D on average by 1.5 days (P = .018). ConclusionThe reported incidence of AVP-D has a considerably wide range. A consistent definition and grading for AVP-D will increase consistency and comparability among studies. Nonetheless, most patients experience AVP-D on a temporary basis, and only a few require long-term treatment. Cerebrospinal fluid leak, gross total resection, and hormonal remission were identified as risk factors for postoperative AVP-D. We believe that the intraoperative risk factors play the main role in postoperative AVP-D. The course of surgery and operative findings help us plan selective postoperative patient monitoring and care.

Oral nanoliposome in postoperative home care of patients with myelitis.

Acute myelitis (AM) mainly presents with paralysis, and sensory and autonomic dysfunction, which affects the daily life and quality of life (QoL) of patients. Reasonable selection of treatment and nursing can promote the recovery of patients. It was to explore the effect of oral nanoliposomes combined with home care on the rehabilitation of patients. A total of 100 AM patients who received surgical treatment were enrolled. According to the treatment and nursing methods, they were grouped into a control (oral administration of nanoliposomes plus routine nursing, n=50) and an observation group (oral administration of nanoliposomes plus home care, n=50). Differences between patients' neurological recovery, lower limb muscle strength, activities of daily living, QoL, and satisfaction with quality of care were assessed. As against control, the time of muscle strength to level 2, urination recovery time, walking time, and sensory recovery time was shorter, and the degree of lower limb muscle strength recovery was higher, the Barthel and Newcastle Satisfaction with Nursing Scale (NSNS) scores of daily living ability increased, and the QoL EuroQol-5 dimensions (EQ-5D) score decreased in the observation group (P<0.05). Oral administration of nanoliposome plus home care can promote the recovery of lower limb muscle strength, improve daily living ability and QoL, and improve nursing satisfaction in patients with AM surgery.

Application of checklist-based nursing care process in patients undergoing intervention for coronary chronic total occlusions: a quasi-randomized study

BackgroundCoronary chronic total occlusion (CTO) interventions are more complex than general percutaneous coronary intervention (PCI) procedures. However, only a few nursing methods are specifically applied to patients undergoing CTO interventions. And the conventional nursing effect is not ideal, urgent need to explore more effective nursing methods. The checklist is a simple and effective tool for error management and performance improvement that has been widely used in many fields. But there have been no reports of the checklist being used to improve care for CTO patients.ObjectiveThis study aimed to investigate the effectiveness of a checklist-based nursing care process in patients undergoing Coronary chronic total occlusion (CTO) interventions, including duration of care, patient anxiety, improved patient satisfaction, and occurrence of adverse events.MethodsA total of 120 CTO patients undergoing percutaneous coronary intervention (PCI) were selected at our hospital and divided into an intervention group (n = 60, adopted the checklist-based nursing care process for patient care) and a control group (n = 60, adopted nursing care according to the existing workflow) according to different nursing interventions. After surgery, the nurse in charge of the patient completed the nursing according to the “List of postoperative care for CTO patients” filled in by the patient within 24 h after surgery, conducted a doctor satisfaction survey, recorded adverse events, and completed the postoperative Self-Rating Anxiety Scale (SAS) score and patient satisfaction survey before the patient was discharged. Subsequently, the Qc team checks the completion of the patient’s checklist for safety and the completion of the questionnaire. Finally, the differences between the two groups in preoperative nursing time, incidence of adverse events caused by nurses’ omission or inadequate guidance, patient anxiety, and doctor and patient satisfaction were compared.ResultsThe intervention grouphad significantly shorter preoperative nursing care time and significantly lower the total number of adverse events than the control group (P < 0.05).The postoperative Self-Rating Anxiety Scale (SAS) score of the intervention group was significantly lower than that of the control group (P < 0.05).The satisfaction of doctors and patients in the intervention groupwas significantly higher than that in the control group (P < 0.05).ConclusionThe application of the checklist-based nursing care process in patients with CTO intervention can significantly reduce the preoperative nursing care time, reduce patient anxiety, improve patients’ and doctors’ satisfaction with nursing care, and effectively reduce the occurrence of adverse events caused by nurses’ omissions or inadequate instructions.Trial registrationThe protocol of the trial was registered retrospectively of Chinese Clinical Trial Registry (registration number ChiCTR2200056804, reg date17/02/2022).

The Cost-Effectiveness of Early High-Acuity Postoperative Care for Medium-Risk Surgical Patients.

Initiatives in perioperative care warrant robust cost-effectiveness analysis in a cost-constrained era when high-value care is a priority. A model of anesthesia-led early high-acuity postoperative care, advanced recovery room care (ARRC), has shown benefit in terms of hospital and patient outcomes, but its cost-effectiveness has not yet been formally determined. Data from a previously published single-center prospective cohort study of ARRC in medium-risk patients were used to generate a Markov model, which described patient transition between care locations, each with different characteristics and costs. The incremental cost-effectiveness ratio (ICER), using days at home (DAH) and hospital costs, was calculated for ARRC compared to usual ward care using deterministic and probabilistic sensitivity analysis. The Markov model accurately described patient disposition after surgery. For each patient, ARRC provided 4.3 more DAH within the first 90 days after surgery and decreased overall hospital costs by $1081 per patient. Probabilistic sensitivity analysis revealed that ARRC had a 99.3% probability of increased DAH and a 77.4% probability that ARRC was dominant from the perspective of the hospital, with improved outcomes and decreased costs. Early high-acuity care for approximately 24 hours after surgery in medium-risk patients provides highly cost-effective improvements in outcomes when compared to usual ward care.

Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study.

The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education. This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis. In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants' proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out. A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%). Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care.

Enhanced recovery after surgery (ERAS) protocol improves patient outcomes in free flap surgery for head and neck cancer

BackgroundIn recent years, enhanced recovery after surgery (ERAS) guidelines have been developed to optimize pre-, intra-, and postoperative care of surgical oncology patients. The aim of this study was to compare management outcome of patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction at our institution before and after the implementation of the ERAS guidelines.MethodsThis retrospective study comprised 283 patients undergoing HNC surgery with free flap reconstruction between 2013 and 2020. Patients operated before and after the implementation of the ERAS protocol in October 2017 formed the pre-ERAS group (n = 169), and ERAS group (n = 114), respectively.ResultsIn the pre-ERAS group the mean length of stay (LOS) and intensive care unit length of the stay (ICU–LOS) were 20 days (range 7–79) and 6 days (range 1–32), and in the ERAS group 13 days (range 3–70) and 5 days (range 1–24), respectively. Both LOS (p < 0.001) and ICU–LOS (p = 0.042) were significantly reduced in the ERAS group compared to the pre-ERAS group. There were significantly fewer medical complications in the ERAS group (p < 0.003). No difference was found between the study groups in the surgical complication rate or in the 30-day or 6-month mortality rate after surgery.ConclusionsWe found reduced LOS, ICU–LOS, and medical complication rate, but no effect on the surgical complication rate after implementation of the ERAS guidelines, which supports their use in major HNC surgery.

Decision-making for Postoperative Care in Geriatric Patients Undergoing Minor Surgeries using Mini Mental State Examination, Barthel Index of Activities of Daily Living and CSHA-Clinical Frailty Scale

Purpose: The prediction of postoperative outcome following major surgeries in elderly patients requires a decision-making process, which was suggested to be constructed on data pertaining to the cognitive function, functional status and frailty. We aimed to evaluate their predictive value for minor surgeries.&#x0D; Material and Methods: Patients, ≥65 years of age with ASA 1-3, scheduled for elective minor surgeries between January-June 2019 were enrolled. MMSE, Barthel Index (BI) of ADL and CSHA-CFS were used to evaluate the cognitive function, functional status and frailty on admission, respectively. The MMSE cut-off point was 24 and the frailty cut-off point was 4. The relationships of these parameters with postoperative status either as outpatient or inpatient, PACU stay, LOS in hospital and readmission within 30 days were evaluated. &#x0D; Results: Ninety-nine patients were included. The MMSE scores, BIs and CSHA-CFS scores were similar in all groups. The number of inpatients were higher among patients either with MMSE 2 (n=20 (83.3%)) (p=0.023). The patients with ASA&gt;2 had higher probability of length of stay &gt;1 day (p=0.036) and for PACU stay (p=0.042) irrespective of frailty score. There was no correlation with readmission within 30 days.&#x0D; Conclusion: ASA&gt;2 was correlated with inpatient status when associated with MMSE1 day in the elderly after minor surgeries. CSHA-CFS ≥4 was also correlated with inpatient status independently.

Anesthetic consideration on myeloradiculopathy patient undergoing anterior cervicosternotomy

Myeloradiculopathy, a condition that involves the spinal cord and spinal nerve roots, is the major cause of disability patients. Most patients with myeloradiculopathy receive surgical intervention with the aim of removing the underlying compression injury from the nerve, decompressing the cord, and moving it without friction or further damage. Surgery on the spine and spinal cord has broadened its scope in recent years. The anterior approach is a challenging procedure given the various vascular, osseous, nervous, and articular structures that prevent adequate exposure and the potential damage to anesthetists. Our objective was to evaluate the pre-operative analysis, maintenance during intra-operative care, and post-operative care in patients with myeloradiculopathy undergoing posterior stabilization surgery with an anterior approach (cervicosternotomy). A 23-year-old woman was diagnosed with Myeloradiculopathy at Th2 Vertebrae Level due to space-occupying extradural lesion at Th2-Th4 vertebral level with pathological fracture at Thoracal Th2 et Th7 et Th10 due to suspected spondylitis tuberculosis with paravertebral abscess, with ASA I (Physical Status Classification System). The patient was then treated with laminectomy debridement, abscess drainage, and posterior stabilization through a cervicothoracic spine surgery with an anterior approach. The patient received the preoperative assessment, intraoperative maintenance, and postoperative evaluations, which are very important to ensure a good outcome of the cervicosternotomy with an anterior approach.

Creation and Expansion of a Mixed Patient Intermediate Care Unit to Improve ICU Capacity.

ICU capacity strain is associated with worsened outcomes. Intermediate care units (IMCs) comprise one potential option to offload ICUs while providing appropriate care for intermediate acuity patients, but their impact on ICU capacity has not been thoroughly characterized. The aims of this study are to describe the creation of a medical-surgical IMC and assess how the IMC affected ICU capacity. Descriptive report with retrospective cohort review. Six hundred seventy-three-bed tertiary care academic medical center with 77 ICU beds. Adult inpatients who were admitted to the IMC. An interdisciplinary working group created an IMC which was located on a general ward. The IMC was staffed by hospitalists and surgeons and supported by critical care consultants. The initial maximum census was three, but this number increased to six in response to heightened critical care demand. IMC admission criteria also expanded to include advanced noninvasive respiratory support defined as patients requiring high-flow nasal cannula, noninvasive positive pressure ventilation, or mechanical ventilation in patients with tracheostomies. The primary outcome entailed the number of ICU bed-days saved. Adverse outcomes, including ICU transfer, intubation, and death, were also recorded. From August 2021 to July 2022, 230 patients were admitted to the IMC. The most frequent IMC indications were respiratory support for medical patients and post-operative care for surgical patients. A total of 1023 ICU bed-days were made available. Most patients were discharged from the IMC to a general ward, while 8% of all patients required transfer to an ICU within 48 hours of admission. Intubation (2%) and death (1%) occurred infrequently within 48 hours of admission. Respiratory support was the indication associated with the most ICU transfers. Despite a modest daily census, an IMC generated substantial ICU bed capacity during a time of peak critical care demand.

Predictive value of hematological parameters in cirrhotic patients with open umbilical hernia repair.

Patients with liver cirrhosis sometimes suffer from high recurrence rates and postoperative complications. We previously reported that platelet-related hematological parameters are associated with the outcomes after incisional herniorrhaphy, and aim to evaluate the predictive value of these criteria in cirrhotic patients undergoing open umbilical herniorrhaphy. This is a retrospective study. The data of 95 cirrhotic patients undergoing open umbilical herniorrhaphy were analyzed. Patients were grouped based on the recurrence and defined hematological values. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio, lymphocyte-monocyte ratio, platelet-neutrophil ratio, systemic immune-inflammation index, and aspartate aminotransferase-leukocyte ratio values were calculated based on preoperative blood analyses. The outcomes were obtained from hospital records and follow-up calls to patients. Using cutoff values acquired by the Youden Index, we found a PLM value < 27.9, and the history of inguinal herniorrhaphy were revealed to be statistically significant in the recurrence based on univariant and multivariant analyses (p < 0.05). We further divided patients into two groups based on the cutoff value of PLM and found that a PLM value < 27.9 was significantly associated with the recurrence of incisional hernias (p = 0.018) and the occurrence of postoperative foreign sensation (p = 0.044), and tended to result in other postoperative complications such as cardiopathy, respiratory infection, hypoproteinemia, and hepatic diseases (p = 0.089). The preoperative hematological values, especially PLM, may indicate the outcomes in cirrhotic patients after open umbilical herniorrhaphy. Accurate identification of risks may alert the intraoperative and postoperative care for patients.

A Comparative Analysis of Safety and Efficacy of Bariatric Surgery During the COVID-19 Pandemic and Pre-Pandemic Period: Insights from the Tehran Obesity Treatment Study.

The COVID-19 pandemic has raised global health concerns and posed challenges for postoperative follow-up care for patients undergoing bariatric surgery due to social distancing rules. This was a cohort study on patients with morbid obesity who underwent bariatric surgery and had been enrolled in Tehran Obesity Treatment Study. Patients who had surgery between March 2020 and March 2021 were classified as those undergoing the procedure amid the COVID-19 pandemic, while those who had surgery between March 2017 and March 2018 were categorized as the pre-pandemic group. The study included 982 patients in the pre-COVID-19 pandemic group and 602 patients in the COVID-19 pandemic group, with mean ages of 39.61 and 39.51 years, respectively. After adjusting for preoperative body mass index (BMI) and surgery type, the patients who underwent surgery during the COVID-19 pandemic demonstrated comparable results to the pre-COVID-19 group in terms of total weight loss %, excess weight loss %, BMI reduction, and fat mass reduction during the 12-month postoperative period. Additionally, the rate of complications with a grade≥III based on the Clavien-Dindo classification was significantly lower in patients who underwent surgery during the COVID-19 pandemic. Notably, there were no deaths reported in either group. Despite social isolation and unfavorable lifestyle modifications, bariatric surgery-induced weight loss after one year was the same in patients undergoing the procedure either before or after the implementation of social distancing measures. More research is needed to analyze the influence of the COVID-19 pandemic on the long-term outcomes of bariatric surgery.

Severe hypernatremia during postoperative care in patients with craniopharyngioma.

We aimed to describe and predict the risk of severe hypernatremia after surgical resection of craniopharyngioma and to identify the association of water intake, urine output, and sodium level change in the patients. The outcome was postoperative severe hypernatremia. We identified risk factors associated with hypernatremia using multivariable regression. We trained machine learning models to predict the outcome. We compared serum sodium change, intravenous input, oral input, total input, urine output, and net fluid balance according to different nurse shifts. Among 234 included patients, 125 developed severe hypernatremia after surgery. The peak incidence occurred during day 0 and day 6 after surgery. The risk was increased in patients with gross total resection (odds ratio (OR) 2.41, P < 0.001), high Puget classification (OR 4.44, P = 0.026), preoperative adrenal insufficiency (OR 2.01, P = 0.040), and preoperative hypernatremia (OR 5.55, P < 0.001). The random forest algorithm had the highest area under the receiver operating characteristic curve (0.770, 95% CI, 0.727-0.813) in predicting the outcome and was validated in the prospective validation cohort. Overnight shifts were associated with the highest serum sodium increase (P = 0.010), less intravenous input (P < 0.001), and less desmopressin use (P < 0.001). The overall incidence of severe hypernatremia after surgical resection of craniopharyngioma was significant, especially in patients with gross total resection, hypothalamus distortion, preoperative adrenal insufficiency, and preoperative severe hypernatremia. Less intravenous input and less desmopressin use were associated with serum sodium increases, especially during overnight shifts.

Comparison of Satisfaction Levels Between Post-Operative Sectio Caesaria Patients Followed by the Eracs Protocol TAP Block Analgesia Method and IV Patient Controlled Analgesia: A Literature Review

Purpose: This paper aims to examine the results of the past ten years of research related to the satisfaction levels of postoperative sectio cesarea patients followed by the ERACS protocol TAP block analgesia method and IV patient-controlled analgesia. Theoretical framework: Cesarean section is one of the most common methods of delivery in the world. The enhancement of public interest in the cesarean section has also increased perioperative services. In order to increase the clinical benefits of cesarean section, enhanced recovery care is an effective way to do it. ERACS (Enhanced Recovery After Caesarian Surgery) is a fast recovery program after a cesarean section in the form of a series of treatments to improve post-surgical recovery. These conditions make expectations related to patient comfort and satisfaction during treatment. Design/Methodology/Approach: The method used in the preparation of a literature review is to search for several articles by searching through science direct, google scholar, and Pubmed. Findings: The results of 20 previous research articles showed that Enhanced recovery after surgery (ERAS) in cesarean section showed the results that standardizing postoperative patient care, improving patient outcomes, reducing the postoperative length of stay, and optimizing patient satisfaction. Research, Practical &amp; Social implications: In postoperative management of the ERAS method, there are various methods, including regional block analgesia and patient-controlled analgesia. TAP block and PCA effectively relieve postoperative pain after cesarean section. Originality/Value: This paper shows a large number of alternatives and the choice of post-cesarean section analgesic methods and drugs with the ERACS protocol means that pharmacology and anesthesia must be accompanied by aspects of patient satisfaction surveys which play a role in selecting the most effective drug or analgesic method.